coronary heart disease
The long-standing consensus surrounding moderate alcohol consumption has recently been disrupted by a landmark review. Initiated under a US congressional mandate to evaluate the evidence base for the US Dietary Guidelines for Americans, the study—convened by the National Academies of Sciences, Engineering, and Medicine (NASEM) alongside the Department of Health and Human Services (HHS)—concluded that even a single alcoholic beverage per day significantly elevates the risks of serious chronic illness and premature death. After unexplained bureaucratic delays, the release of this taxpayer-funded research delivers a sobering truth: there is no net health benefit derived from alcohol consumption at any level.
For decades, public perception was shaped by data suggesting that a daily glass of wine or beer could act as a cardiovascular shield. This new review systematically dismantles that notion by identifying significant methodological biases in the previous evidence. Chief among these is the “sick quitter” effect, wherein baseline categories of non-drinkers inadvertently included individuals who had abstained precisely because of pre-existing, severe health conditions. By correcting for these distortions, the review demonstrated that health risks accumulate linearly. Alcohol acts as a dose-dependent toxin with no safe lower threshold, and even minimal daily intake accelerates linear risk trajectories for:
- liver cirrhosis,
- severe hypertension,
- various malignancies, including esophageal, colorectal, and breast cancers.
Beyond chronic pathology, low-level consumption also:
- impairs cognitive architecture,
- accelerating brain aging,
- elevates the immediate probability of physical injury.
The friction surrounding the report’s delayed release has exposed systemic vulnerabilities at the intersection of federal policy and corporate lobbying. Historically, US dietary guidelines defined moderate drinking as up to two drinks per day for men and one for women. The new scientific consensus exposes these thresholds as dangerously obsolete, highlighting a stark disconnect between federal health advice and contemporary medical data.
This friction might underscore the impact of the commercial determinants of health, exposing how multi-billion-dollar alcohol conglomerates employ aggressive public relations campaigns and sophisticated scientific interference to preserve market shares. By aggressively marketing alcohol as a benign staple of a healthy lifestyle, the industry had successfully obscured its intrinsic risks. The new evidence shifts the conversation from personal indulgence to an important public health issue.
Update (July 2026): a US government–commissioned analysis of alcohol-related risk was published. Here is its abstract:
The purpose of this study was to estimate the lifetime risk of alcohol-attributable mortality and morbidity in the United States based on a person’s average lifetime weekly alcohol consumption to assess the impact of per-occasion alcohol consumption on health.
Lifetime risks were estimated using a cause-specific modeling approach that combined exposure data from national health surveys, relative risks, population data from the U.S. Census Bureau, mortality data from the Centers for Disease Control and Prevention, and morbidity data from the Institute for Health Metrics and Evaluation. A narrative review assessed the health impact of per-occasion alcohol consumption on health.
At low levels of consumption, no protective net effect of alcohol consumption on health was observed. Elevated mortality and morbidity risks were associated with alcohol consumption starting at relatively low levels. Males consuming >6.5 (95% CI [<1, 13.5]) and females consuming >7.0 (95% CI [<1, 11.5]) drinks per week had life-time alcohol-attributable mortality risks >1:1,000. At >8.5 (95% CI [2.5, 13]) drinks per week for both males and females, these risks increased to >1:100. At 14 drinks per week for males (the upper limit of the former Dietary Guidelines for males), the risk of an alcohol-caused death was 1:25 (4%). Drinking patterns also impacted risk. Above 1 drink per occasion, higher consumption was associated with progressively increased risks of breast cancer, cardiovascular disease, and injury.
Alcohol consumption, including at what may be perceived as “moderate” levels, is associated with increased mortality and morbidity risks. These results support tightening alcohol use guidance in the United States, for both males and females, to no more than 1 drink per day.
Public health significance statement: The Alcohol Intake and Health Study shows that for Americans, even what is socially considered “moderate drinking” increases the risk of dying or developing health problems, helping people better understand the net health impact of alcohol. Furthermore, by identifying the levels of alcohol use that raise the risk of cancer, cardiovascular disease, and injury, these findings can guide individuals, families, and communities in making safer choices about drinking patterns. The results also support changing the U.S. Dietary Guidelines on alcohol to recommend that current adult drinkers consume 1 drink or less in a day.
Authors and independent observers have described the report as having been sidelined during the Trump administration, citing conflicts with industry interests and existing “moderate drinking is safe” messaging.
For several decades, eggs were commonly portrayed as a major cause of raised cholesterol and cardiovascular disease. That position has been substantially revised: current evidence suggests that dietary cholesterol has a relatively modest effect on blood cholesterol in most people, whereas saturated and trans fats are more important determinants of LDL cholesterol and cardiovascular risk.
The physiology is more nuanced than the older “cholesterol-in, cholesterol-out” model implied. The liver does synthesise cholesterol endogenously, and many people compensate for increased dietary cholesterol by reducing hepatic production, but the degree of compensation varies considerably between individuals. For that reason, eggs are not best understood as “heart-healthy” in all circumstances, but rather as a food whose impact depends on the wider dietary pattern and the individual’s metabolic risk profile.
There is stronger support for improving lipid profiles by changing the quality of dietary fat and increasing fibre intake. Replacing saturated fats with unsaturated fats, particularly polyunsaturated fats, is associated with lower LDL cholesterol and a reduced risk of cardiovascular events, while soluble fibre helps lower LDL cholesterol by interrupting enterohepatic bile acid recycling. In practical terms, this means that foods such as olive oil, nuts, seeds, legumes, oats, vegetables, and oily fish are more consistently supported than a narrow focus on single items such as eggs.
Low-carbohydrate and ketogenic diets are more complex. Many people lose weight on them, which may improve some cardiometabolic markers, but a subset of lean individuals show pronounced rises in LDL cholesterol and related atherogenic markers during carbohydrate restriction. Emerging evidence also indicates that gut microbial changes may contribute to altered lipid metabolism, although this area is still developing and should not be overstated.
Highly restrictive “detox” or “alternative” dietary programs are unsupported by clinical evidence and may be nutritionally unbalanced and thus harmful. They might be claimed to “purify” the body or reset metabolism, but heart health is better served by sustainable patterns that improve LDL cholesterol, support fibre intake, and minimise excess saturated fat.
What does all that mean in practice? Here are a few simple rules that follow from the new insights:
- Do not over-emphasize dietary cholesterol (e.g., eggs) as a primary driver of cardiovascular risk.
- Focus instead on reducing saturated and trans fat intake.
- Replace saturated fats with unsaturated fats, especially polyunsaturated fats (e.g., use olive oil, eat nuts and seeds).
- Increase intake of soluble fibre (e.g., oats, legumes, vegetables) to help lower LDL cholesterol.
- Consider overall dietary patterns rather than judging single foods in isolation.
- Recognize that individual responses to dietary cholesterol vary; tailor intake accordingly if lipid levels are a concern.
- Include foods with consistent cardiovascular benefit, such as oily fish, plant-based foods, and whole grains.
- Be cautious with low-carbohydrate or ketogenic diets, particularly if lean, and monitor lipid profiles if following such diets.
- Prioritize sustainable, balanced eating patterns over restrictive or extreme diets.
- Avoid “detox” or alternative dietary regimens lacking clinical evidence, as they are ineffective or harmful.
Key references
- Carson JAS, Lichtenstein AH, Anderson CAM, et al. Dietary cholesterol and cardiovascular risk: a science advisory from the American Heart Association. Circulation. 2020;141:e39–e53.
- Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368:1279–1290.
- Hooper L, Martin N, Jimoh OF, et al. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020;(5):CD011730.
- British Heart Foundation. Healthy eating – reduce your risk of developing heart disease. 2023. – Search
- NHS. Facts about fat. 2022. – Search
- Ketogenic Diet reduces friendly gut bacteria and raises cholesterol levels
- Gut bacteria can break down cholesterol | Nature Reviews Cardiology
- Healthy eating: applying All Our Health – GOV.UK
Recently, he has been in the news mainly because of his statements on COVID-19 vaccines:
- Malhotra was a prominent speaker at the Reform UK party conference in September 2025. During his main-stage speech, he made headlines by claiming that the COVID-19 vaccine was a “significant factor” in the cancer of members of the royal family.
- Malhotra was appointed as Chief Medical Adviser to the “Make America Healthy Again” (MAHA) campaign group. This group was co-founded by Robert F. Kennedy Jr., who is the current US Health Secretary.
- Following his statements at the Reform UK conference, the General Medical Council (GMC) confirmed that it is examining his comments to determine if they warrant action.
- This is not the first time Malhotra has been reported to the GMC over his views on COVID-19 vaccines. A previous complaint was made in 2022 and 2023, and in 2024, the GMC acknowledged it had made an “error” in not investigating the matter sooner, stating it would reconsider its review.
- Malhotra is a regular guest on various media outlets and podcasts, often those with a right-leaning or anti-establishment audience, to promote his views on the COVID-19 vaccine. This includes interviews with UK newspapers like The Telegraph, where he claimed the vaccine had “done more harm than good.”
I am seriously puzzled by Malhotra: what turns an evidently decent cardiologist into a raving anti-vaxxer? When looking him up on ‘X’, I found his comment from October 2022:
It thus seems that, when Malhotra was mourning his father’s death, he made a vow. He believes that his father’s death was a result of the Pfizer-BioNTech mRNA COVID-19 vaccine and publicly stated that his father, who had a history of heart disease, suffered a sudden cardiac arrest 6 months after receiving his second dose of the vaccine.
Before that sad event, Malhotra had been an advocate of vaccinations. But now he argued that the mRNA vaccines carry a significant risk of cardiovascular harm and that the risks outweigh the benefits for many people, especially younger individuals. He thus has repeatedly called for a global pause on the use of mRNA vaccines.
Yet, the overwhelming evidence shows that COVID-19 vaccines are safe and effective, and that the benefits far outweigh the risks. True, a very small number of cases of myocarditis have been linked to the mRNA vaccines, but this condition is usually mild and much more common and severe with COVID-19 infections of unvaccinated people.
Consequently, Malhortra’s views have been described as dangerous misinformation by many experts. A junior doctor has even launched a legal challenge against the UK General Medical Council for its refusal to investigate Malhotra’s misinformation.
Altogether this is a sad story, I find. A young man you really should know better gets blinded by a very powerful and painful anecdote. This experience and his seemingly insatiable need to be in the limelight accelerate his descent into unreason and destroy his initially promising career. As a result, the health of millions is endangered. Tragic!
The aim of the present study entitled “Osteopathic manipulation as a complementary treatment for the prevention of cardiac complications: 12-Months follow-up of intima media and blood pressure on a cohort affected by hypertension” was to investigate the association between osteopathic treatment and hypertension. It was designed as a non-randomized trial including consecutive subjects affected by hypertension and vascular alterations, using pre-post differences in intima-media thickness, systolic and diastolic blood pressure as primary endpoints. A total of 31 out of 63 eligible subjects followed by a single cardiologist received osteopathic treatment in addition to routine care. Clinical measurements were recorded at baseline and after 12 months.
Univariate analysis found that osteopathic treatment was significantly associated to an improvement in all primary endpoints. Multivariate linear regression showed that, after adjusting for all potential confounders, osteopathic treatment was performing significantly better for intima-media thickness (delta between preepost differences in treated and control groups:
The author concluded that their study shows that, among patients affected by cardiovascular disorders, osteopathic treatment is significantly associated to an improvement in intima-media and systolic blood pressure after one year. Multicentric randomized trials of adequate sample size are needed to evaluate the efficacy of osteopathic manipulative treatments in the treatment of hypertension.
This conclusion is indeed wisely phrased, because:
ASSOCIATION IS NOT CAUSATION!
The data provided are far from supporting the hypothesis that osteopathic treatments caused the positive effects. In fact, the opposite might be the case: osteopathy my have slowed down the normalization of the outcome measures, and, without any intervention, they might have improved faster and more significantly.
So, are the authors correct with their 2nd conclusion that multicentric randomized trials of adequate sample size are needed to evaluate the efficacy of osteopathic manipulative treatments in the treatment of hypertension? Personally, I doubt it. Such a trial would have no plausible basis, and I fear it would be little more than a waste of resources.
My final point is about the title of the paper, “Osteopathic manipulation as a complementary treatment for the prevention of cardiac complications: 12-Months follow-up of intima media and blood pressure on a cohort affected by hypertension”. The study is NOT about the prevention of cardiac complications! It seems to be borne out by the wishful thinking of the author. As such, it tells us perhaps more about osteopathy than the rest of this article.
This systematic review/network meta-analysis assessed whether relaxation and stress management techniques are useful in reducing blood pressure in individuals with hypertension and prehypertension. The authors retrieved all studies published in English of adults with hypertension (blood pressure ≥140/90 mm Hg) or prehypertension (blood pressure ≥120/80 mm Hg but <140/90 mm Hg). Studies were considered that compared non- pharmacological interventions used to promote relaxation or reduce stress with each other, or with a control group (eg, no intervention, waiting list, or standard care). Studies were assessed with the risk of bias 2 tool (RoB2), and those at high risk of bias were excluded from the primary analysis. The certainty of the evidence was assessed with CINeMA (Confidence in Network Meta- Analysis).
A total of 182 studies were included (166 for hypertension and 16 for prehypertension). Results from a random effects network meta-analysis showed that, at short term follow- up (≤3 months), most relaxation interventions appeared to have a beneficial effect on systolic and diastolic blood pressure for individuals with hypertension. Between study heterogeneity was moderate (τ=2.62- 4.73). Compared with a passive comparator (ie, no intervention, waiting list, or usual care), moderate reductions in systolic blood pressure were found for breathing control (mean difference −6.65 mm Hg, 95% credible interval −10.39 to −2.93), meditation (mean difference −7.71 mm Hg, −14.07 to −1.29), meditative movement (including tai chi and yoga, mean difference −9.58 mm Hg, −12.95 to −6.17), mindfulness (mean difference −9.90 mm Hg, −16.44 to −3.53), music (mean difference −6.61 mm Hg, −11.62 to −1.56), progressive muscle relaxation (mean difference −7.46 mm Hg, −12.15 to −2.96), psychotherapy (mean difference −9.83 mm Hg, −16.24 to −3.43), and multicomponent interventions (mean difference −6.78 mm Hg, −11.59 to −1.99). Reductions were also seen in diastolic blood pressure. Few studies conducted follow-up for more than three months, but effects on blood pressure seemed to lessen over time. Limited data were available for prehypertension; only two studies compared short term follow- up of relaxation therapies with a passive comparator, and the effects on systolic blood pressure were small (mean difference −3.84 mm Hg, 95% credible interval −6.25 to −1.43 for meditative movement; mean difference −0.53 mm Hg, −2.03 to 0.97 for multicomponent intervention). The certainty of the evidence was considered to be very low based on the CINeMA framework, owing to the risk of bias in the primary studies, potential publication bias, and imprecision in the effect estimates.
The authors concluded that the results of our study indicated that many relaxation interventions show promise for reducing blood pressure in the short term but the longer term effects are unclear. Future studies in this area should include adequate follow-up to establish whether the effects on blood pressure persist over time, both while the relaxation interventions are ongoing and after they have been completed. Researchers should also use rigorous study methods and reporting to minimise the risk of bias in the results. Finally, we encourage researchers to assess all relevant outcomes, including cardiovascular events and adverse events, as well as blood pressure itself.
I was asked to provide a comment on this paper for a ‘Science Media Centre Roundup’ – here is what I wrote:
“This is a rigorous and important review. Its findings are eminently plausible: just like stress would increase blood pressure, so does relaxation decrease it. The problem, as I see it, might be compliance. Stressed people tend to be chronically pressed for time, and relaxation techniques take considerably more time than simply swallowing an antihypertensive pill.”
On this blog and elsewhere, we have many people doubting that COVID vaccinations were effective; some even claim that they were detrimental to our long-term health. In this context, cardiac conditions are often mentioned, as they constitute a significant category of potentially serious post-COVID conditions.
Perhaps these doubters will find this new analysis relevant. The objective of this systematic review was to synthesise the evidence on the factors associated with the development of post-COVID cardiac conditions, the frequency of clinical outcomes in affected patients, and the potential prognostic factors. A systematic review was conducted using the databases EBSCOhost, MEDLINE via PubMed, BVS, and Embase, covering studies from 2019 to December 2023. A total of 8343 articles were identified, and seven met the eligibility criteria for data extraction. The protective effect of vaccination stood out among the associated factors, showing a reduced risk of developing post-COVID cardiac conditions. Conversely, COVID-19 reinfections were associated with an increased risk of cardiovascular outcomes. Regarding the main outcomes in these patients, most recovered, although some cases persisted beyond 200 days of follow-up. The study included in the analysis of prognostic factors reported that the four children who did not recover by the end of the study were between two and five years old and had gastrointestinal symptoms during the illness.
The authors concluded that the present findings provide valuable contributions to a better understanding of the evolution of post-COVID cardiac conditions. Despite the limited number of eligible studies, this review offers insights that describe the progression of cardiac conditions, from their onset to medium-term follow-up of patients. The protection offered by the COVID-19 vaccination regimen was observed beyond the acute phase of the disease, reducing the risk of developing post-COVID cardiac conditions. Public policies encouraging vaccination should be promoted to prevent SARS-CoV-2 infections and reinfections. Given that both COVID-19 and heart diseases occupy a significant place on the global health agenda, post-COVID cardiac conditions deserve due attention. Although most patients recover in the short term, some require care for many months to prevent chronicity and complications, particularly in vulnerable groups such as children and older adults. COVID-19 emerged as a pandemic in 2020, and four years later, it continues to impact the entire planet. This study provides important evidence to guide government policies on post-COVID conditions surveillance, prevention, and targeted healthcare interventions. Although this review compiles the available evidence on the topic, it is clear that there is still much to learn about post-COVID cardiac conditions. Strengthening the research agenda by proposing and conducting primary studies on the subject is important. Additionally, this review should be regularly updated as new studies are published in the field.
I would be delighted to hear that this new analysis has persuaded some doubters that COVID vaccinations are, after all. helpful interventions – but (as always on such occasions) I will not hold my breath!
The year 2024 brought many disappointments. But let’s not dwell on those, lets get in the mood for tonights celebrations! And what could be more fitting for that than a review of the positive cardiovascular effects of wine drinking? After all wine involves both aromatherapy as well as antioxidants, botanical medicine and naturopathy! As luck would have it, we even have some recent evidence on this very subject.
The objectives of this systematic review and meta-analysis were:
- (i) to examine the association between wine consumption and cardiovascular mortality, cardiovascular disease (CVD), and coronary heart disease (CHD),
- (ii) to analyse whether this association could be influenced by personal and study factors, including the participants’ mean age, the percentage of female subjects, follow-up time and percentage of current smokers.
The searched several databases for longitudinal studies from their inception to March 2023.
A total of 25 studies were included in the systematic review, and 22 could be included the meta-analysis. The pooled risk ration (RR) for the association of wine consumption and the risk of CHD using the DerSimonian and Laird approach was 0.76 (95% CIs: 0.69, 0.84), for the risk of CVD was 0.83 (95% CIs: 0.70, 0.98), and for the risk of cardiovascular mortality was 0.73 (95% CIs: 0.59, 0.90).
The authors concluded that their research revealed that wine consumption has an inverse relationship to cardiovascular mortality, CVD, and CHD. Age, the proportion of women in the samples, and follow-up time did not influence this association. Interpreting these findings with prudence was necessary because increasing wine intake might be harmful to individuals who are vulnerable to alcohol because of age, medication, or their pathologies.
What, you suspect that this paper was sponsored by the wine industry?
No, you are mistaken! It was funded by FEDER funds, by a grant from the University of Castilla-La Mancha, and by a grant from the science, innovation and universities.
So, maybe just for tonight we put the worries about our livers aside and enjoy a (non-homeopathic) dose of wine.
Cheers!
An article entitled “The use of ayurvedic medicine in the management of hypertension” was recently published in the ‘Journal of Ayurveda and Naturopathy’ (no, I did not know either that this journal existed). Here I show you merely its conclusion, but encourage you to read the entire paper.
Hypertension, a significant risk factor for cardiovascular diseases, necessitates effective and sustainable management strategies. Ayurveda, with its holistic approach, offers a comprehensive framework for managing hypertension by addressing the underlying dosha imbalances through dietary and lifestyle modifications, herbal formulations, and therapeutic procedures. This review has highlighted the
efficacy of various Ayurvedic interventions, including the use of specific herbs like Ashwagandha, Arjuna, Brahmi, Gokshura, and Sarpagandha, which have demonstrated significant benefits in reducing blood pressure and improving overall health. Panchakarma therapies such as Virechana, Basti, Nasya, and Shirodhara have also been shown to detoxify the body, restore balance, and promote
long-term well-being.
Integrating Ayurvedic practices with modern medical approaches can enhance treatment outcomes, offering a more personalized and holistic approach to hypertension management. This synergy can potentially reduce the reliance on pharmaceuticals, minimize side effects, and improve patient compliance and quality of life. Future research should focus on rigorous clinical trials and the standardization of Ayurvedic formulations to further validate their efficacy and facilitate their integration into mainstream healthcare.
By embracing the principles of Ayurveda, individuals can achieve better control over hypertension, reduce the risk of associated complications, and enhance their overall health and well-being. This comprehensive approach not only addresses the symptoms but also tackles the root causes, promoting a sustainable and balanced lifestyle.
END OF QUOTE
Not only does the author, Dr. Zafar Siddiqa (from the Faculty of Natural Medicine and Holistic Sciences, Rajshahi Holistic Health College, Rajshahi, Bangladesh) re-write the current knowledge of hypertonology, he also provides no evidence for any of the far-reaching statements he makes in this paper. In particular, he cites no rigorous studies that “highlighted the efficacy of various Ayurvedic interventions” (most likely because such studies do not exist).
The autor is correct in the 1st sentence of his conclusion: “Hypertension, a significant risk factor for cardiovascular diseases, necessitates effective and sustainable management strategies”. But he is wrong in almost everything else! Because hypertension is such an important risk factor for stroke and ischaemic heart disease, we MUST treat it effectively.
Today, we fortunately have many conventional treatments that control hypertension well and with no or just minimal adverse effects. Advocating quackary or unproven therapies for managing hypertension is thus deeply unethical. It could contribute to the premature deaths of millions. I thus fear that the ‘Faculty of Natural Medicine and Holistic Sciences, Rajshahi Holistic Health College’ is in urgent need of taking a few courses in proper science and medical ethics.
Many patients seek Chinese herbal medicines (CHM) from traditional Chinese medicine (TCM) clinics. This study aimed to estimate the risk of major adverse cardiovascular events (MACEs) in adults diagnosed with obesity, with or without CHM.
Patients with obesity aged 18 to 50 years were identified using diagnostic codes from Taiwan’s National Health Insurance Research Database between 2008 and 2018. The researchers randomized 67,655 patients with or without CHM using propensity score matching. All patients were followed up from the start of the study until MACEs, death, or the end of 2018. A Cox proportional regression model was used to evaluate the hazard ratios of MACEs in the CHM and non-CHM cohorts.
During a median follow-up of 4.2 years, the CHM group had a higher incidence of MACEs than the non-CHM control cohort (9.35 versus 8.27 per 1,000 person-years). The CHM group had a 1.13-fold higher risk of MACEs compared with the non-CHM control (adjusted hazard ratio [aHR] = 1.13; 95% confidence interval [CI]: 1.07–1.19; p <0.001), especially in ischemic stroke (aHR = 1.18; 95% CI: 1.07–1.31; p <0.01), arrhythmia (aHR = 1.26; 95% CI: 1.14–1.38; p <0.001), and young adults aged 18 to 29 years (aHR = 1.22; 95%
CI: 1.05–1.43; p <0.001).
The authors concluded that, although certain CHMs offer cardiovascular benefits, young and middle-aged obese adults receiving CHM exhibit a higher risk of MACEs than those not receiving CHM. Therefore, TCM practitioners should be cautious when prescribing medications to young patients with obesity, considering their potential cardiovascular risks.
I am not sure why the authors concluded that “certain CHMs offer cardiovascular benefits”; their data do not support this statement and I am not aware of any such evidence either. The more valid result of this study is that the use of CHMs is a risk factor for cardiovascular health in obese people. I fear that this might also be true for non-obese individuals and could also apply to non-cardiovascular areas of health.
Just like any other form of herbal therapy, CHMs can contain toxic ingredients and might interact with prescribed medications. Unlike most other forms of herbal treatments CHMs are known to be often contaminated (e.g. with heaviy metals) and/or adulterated (e.g. with illegal amounts of synthetic drugs). as they typically contain a multitude of herbs, the risk of interactions is also increased. Our 2013 review shoed that “herbal medicinal products (HMPs) were adulterated or contaminated with dust, pollens, insects, rodents, parasites, microbes, fungi, mould, toxins, pesticides, toxic heavy metals and/or prescription drugs. The most severe adverse effects caused by these adulterations were agranulocytosis, meningitis, multi-organ failure, perinatal stroke, arsenic, lead or mercury poisoning, malignancies or carcinomas, hepatic encephalopathy, hepatorenal syndrome, nephrotoxicity, rhabdomyolysis, metabolic acidosis, renal or liver failure, cerebral edema, coma, intracerebral haemorrhage, and death. Adulteration and contamination of HMPs were most commonly noted for traditional Indian and Chinese remedies, respectively.”
My advice has therefore long been very clear and outspoken:
CHMs are best avoided!
This systematic review and meta-analysis aimed to evaluate the effectiveness of spiritually based interventions on blood pressure (BP) among adults. A systematic search was performed using the PubMed, Scopus, and Cochrane databases to identify studies evaluating spiritual interventions, including:
- meditation,
- transcendental meditation,
- mindfulness meditation,
- yoga,
for high BP among adults up to January 1, 2022.
The inclusion criteria were:
- (a) randomized controlled trials (RCTs),
- (b) studies in English or Persian,
- (c) studies conducted among adults (≥ 18 years),
- (d) studies reporting systolic or diastolic BP.
Given the high heterogeneity of these studies, a random effect model was used to calculate the effect sizes for the RCTs.
In total, the systematic review included 24 studies and the meta-analysis included 23 studies. As some of studies reported two or more outcome measurements, separate estimates of each outcome were extracted for that study (24 datasets). Fifteen trials reported the mean (SD) systolic blood pressure (SBP), and 13 trials reported the mean (SD) diastolic blood pressure (DBP). In addition, 13 studies reported means (SDs) and six trials reported mean changes in DBP. A significant decrease was found in systolic BP following intervention ((WMD (weighted mean difference) = − 7.63 [− 9.61 to − 5.65; P < 0.001]). We observed significant heterogeneity among the studies (I2 = 96.9; P < 0.001). A significant decrease was observed in DBP following the interventions (WMD = − 4.75 [− 6.45 to − 3.05; P < 0.001]).
The authors concluded that spiritually based interventions including meditation and yoga had beneficial effects in reducing both SBP and DBP. Reducing BP can be expected to reduce the risk of cardiovascular diseases.
Q: What do the RCTs of these interventions have in common?
A: They cannot normally be placebo-controlled because no adequate placebos exist for these therapies.
Q: What does that mean?
A: It means that patients could not be blinded and that patient expectations influenced the outcome.
In view of the fact that blood pressure is an endpoint that is extremely sensitive to expectation, I think, the conclusions of this paper might need to be re-formulated:
This analysis confirms that expectation can have beneficial effects in reducing both SBP and DBP. Reducing BP can be expected to reduce the risk of cardiovascular diseases.
