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In Reply: I agree with Dr Beilin and colleagues that 2 of their studies did find an additive effect on BP: one by combining weight loss and increased fish intake,¹ and the other by combining weight loss with alcohol restriction.² However, whether these are really different lifestyles is questionable, because in both studies what was being changed was what participants ate and drank. Thus, in the first study participants were asked only to consume diets that varied in the amount of fish and calories. In the latter, alcohol restriction resulted in weight loss, presumably because this was another form of caloric restriction.

Exercise and dietary changes are genuinely different lifestyle changes. The results of combined interventions are more complex. In the study by Cox et al³ the effect was interactive rather than additive and could only be demonstrated by time series analysis of the ambulatory BP data rather than by . . . [Full Text of this Article]

Thomas G. Pickering, MD, DPhil
Integrative & Behavioral Cardiovascular Health Program
Mount Sinai Medical Center
New York, NY

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