Hypertension Institute Health Topics

Commonly discussed health topics at Hypertension Institute include: Breast Cancer Prevention, Cardiovascular Disease, Cholesterol (Hyperlipidemia), Exercise, Hypertension, Metabolic Syndrome, Obesity, and Supplements.

Breast Cancer Prevention: How to Reduce Your Risk

Breast Cancer Prevention

How to Reduce Your Risk

Breast cancer prevention starts with healthy habits – such as limiting the amount of alcohol you drink and staying physically active. Understand what you can do to prevent breast cancer.

If you’re concerned about breast cancer, you may be wondering if there are steps you can take toward breast cancer prevention. Understand the lifestyle factors that may affect your risk of breast cancer and what you can do to stay healthy.

What can I do to reduce my risk of breast cancer?

Breast cancer prevention begins with various factors you can control. For example:

  • Limit alcohol. The more alcohol you drink, the greater your risk of developing breast cancer. If you choose to drink alcohol – including beer, wine or liquor – limit yourself to no more than one drink a day.
  • Control your weight. Being overweight or obese increases the risk of breast cancer. This is especially true if obesity occurs later in life, particularly after menopause.
  • Get plenty of physical activity. Being physically active can help you maintain a healthy weight, which, in turn, helps prevent breast cancer. For most healthy adults, the Department of Health and Human Services recommends at least 150 minutes a week of moderate aerobic activity (think brisk walking or swimming) or 75 minutes of vigorous aerobic activity (such as running), in addition to strength training exercises at least twice a week. If you’re just starting a physical activity program, start slowly and build intensity gradually.
  • Breast-feed. Breast-feeding may also play a role in breast cancer prevention. The longer you breast-feed, the greater the protective effect.
  • Discontinue hormone therapy. Long-term combination hormone therapy increases the risk of breast cancer. If you’re taking hormone therapy for menopausal symptoms, ask Dr. Houston about other options. You may be able to manage your symptoms with non-hormonal therapies, such as physical activity. If you decide that the benefits of short-term hormone therapy outweigh the risks, consider using the lowest dose that’s effective for your symptoms, and plan to use it only temporarily.
  • Avoid exposure to environmental pollution. While further studies are needed, some research suggests a link between breast cancer and exposure to the polycyclic aromatic hydrocarbons found in vehicle exhaust and air pollution.

Can a healthy diet prevent breast cancer?

Research shows that eating a diet rich in fruits and vegetables doesn’t offer direct protection from breast cancer. In addition, a recent study of dietary fat and breast cancer showed only a slight decrease in the risk of invasive breast cancer for women who ate a low-fat diet. However, eating a healthy diet may decrease your risk of other diseases, such as diabetes, cardiovascular disease and stroke. A healthy diet can also help you maintain a healthy weight – a key factor in breast cancer prevention.

Breast Cancer Prevention: Breast Thermography

Breast Cancer Prevention

Breast Thermography

To detect early stages of breast cancer-non invasive, safe procedure. Breast Thermography is a breakthrough imaging procedure where infrared images of the breast are analyzed and rated to determine the risk of developing breast cancer.

“Breast cancer is the most common cancer in women and the risk increases with age. Current research indicates that one in 8 women will develop breast cancer in her lifetime”

Breast Thermography is a breakthrough imaging procedure where infrared images of the breast are analyzed and rated to determine the risk of developing breast cancer.

Thermography is: 

  • Non-invasive
  • No Radiation
  • No Compression
  • Safe and Pain Free

The infrared imaging process allows you to see the range and amount of heat or thermal energy emitted from the body.

Structural tests, such as mammograms and ultrasound rely on finding physical lesions (anatomy), while breast thermography detects asymmetrical blood vessel circulation (physiology) within the breast. Thermography is based on the scientific premise that before the growth of abnormal cells can occur, an increased blood supply must be circulated to the growth area. Thermography measures the heat generated by the microcirculation of blood in the breast during this process. Early detection is important, but prevention is the key!  The advantage of an early assessment of risk factors could be life-saving. Breast Thermography is one of the best early-detection systems available today.

Studies have shown that:

  • An abnormal infrared image is the single-most important marker of high risk for developing breast cancer.
  • persistent abnormal image carries with it a 22 times higher risk of developing future breast cancer.
  • When thermography is added to a woman’s regular breast health check up, a 61% increase in survival rates has been shown.
  • When thermography is used as part of a multimodal approach (Clinical examination, mammography and thermography) 95% of early-stage breast cancers can be detected.

Who should have breast Thermography testing?

  • Woman who want to take a pro-active approach to their health find great value in the additional information provided by Breast Thermography.
  • Woman who have had inconclusive mammograms or physical breast examinations find that Breast Thermography can help to clarify these tests, thus enabling woman to better manage their breast health.
  • Woman with dense fibrocystic breasts, where mammography is of little value, will benefit from thermographic monitoring.
  • Young woman – Breast Thermography can be safely performed on young or pregnant woman.
  • In addition, early breast exams can provide a valuable baseline form which to measure future breast health and potential risk factors.

Cardiovascular Disease: Atherosclerosis Prevention

Cardiovascular Disease

Atherosclerosis Prevention

Atherosclerosis is progressive, but it’s also preventable. For example, nine risk factors are to blame for up to 90% of all heart attacks:

  • Smoking
  • High cholesterol
  • High blood pressure
  • Diabetes
  • Abdominal obesity (“spare tire”)
  • Stress
  • Not eating fruits and vegetables
  • Excess alcohol intake (more than one drink for women, one or two drinks for men, per day)
  • Not exercising regularly

You may notice all of these have something in common: You can do something about them! Experts agree that reducing your risk factors leads to a lower risk of cardiovascular disease.

For people at moderate or higher risk — those who’ve had a heart attack or stroke, or who suffer angina – taking a baby aspirin a day can be important. Aspirin helps prevent clots from forming. Ask Dr. Houston before starting daily aspirin, as it can have side effects.

Cardiovascular Disease: Atherosclerosis Treatment

Cardiovascular Disease

Atherosclerosis Treatment

Once a blockage is there, it’s generally there to stay. With medication and lifestyle changes, though, plaques may slow or stop growing. They may even shrink slightly with aggressive treatment.

  • Lifestyle changes: Reducing the lifestyle risk factors that lead to atherosclerosis will slow or stop the process. That means a healthy diet, exercise, and no smoking. These lifestyle changes won’t remove blockages, but they’re proven to lower the risk of heart attacks and strokes.
  • Medication:Taking drugs for high cholesterol and high blood pressure will slow and perhaps even halt the progression of atherosclerosis, as well as lower your risk of heart attacks and stroke.

Using invasive techniques, doctors can also open up blockages from atherosclerosis, or go around them:

  • Angiography and stenting: Cardiac catheterization with angiography of the coronary arteries is the most common angiography procedure performed. Using a thin tube inserted into an artery in the leg or arm, doctors can access diseased arteries. Blockages are visible on a live X-ray screen. Angioplasty (catheters with balloon tips) and stenting can often open up a blocked artery.
  • Bypass surgery: Surgeons “harvest” a healthy blood vessel (often from the leg or chest). They use the healthy vessel to bypass a segment blocked by atherosclerosis.

These procedures involve a risk of complications. They are usually saved for people with significant symptoms or limitations caused by atherosclerosis.

Cardiovascular Disease: What is Atherosclerosis?

Atherosclerosis

What is atherosclerosis?

Atherosclerosis is a type of arteriosclerosis caused by a build-up of plaque in the inner lining of an artery. (Arteriosclerosis is a general term for thickening or hardening of the arteries.) Plaque is made up of deposits of fatty substances, cholesterol, cellular waste products, calcium, and fibrin, and can develop in medium or large arteries. The artery wall becomes thickened and loses its elasticity.

Atherosclerosis is a slow, progressive disease that may start as early as childhood. However, the disease has the potential to progress rapidly.

What causes atherosclerosis?

It is unknown exactly how atherosclerosis begins or what causes it. Some scientists think that certain risk factors may be associated with atherosclerosis, including:

  • elevated cholesterol and triglyceride levels
  • high blood pressure
  • smoking
  • diabetes mellitus (type 1 diabetes)
  • obesity
  • physical inactivity
  • high saturated fat diet

How does the disease progress?

There is a gradual build-up of plaque or thickening of the inside of the walls of the artery, causing a decrease in the amount of blood flow, and a decrease in the oxygen supply to the vital body organs and extremities.

A heart attack may occur if the oxygenated blood supply is reduced to the heart. A stroke may occur if the oxygenated blood supply is cut off to the brain. Gangrene may occur if the oxygenated blood supply is reduced to the arms and legs.

What are the symptoms of atherosclerosis?

Signs and symptoms of atherosclerosis may develop gradually, and may be few, as the plaque builds up in the artery. Symptoms may also vary depending on the affected artery. However, when a major artery is blocked, signs and symptoms may be severe, such as those occurring with heart attack, stroke, aneurysm, or blood clot.

The symptoms of atherosclerosis may resemble other cardiac conditions. Consult your physician for a diagnosis.

How is atherosclerosis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for atherosclerosis may include any, or a combination of, the following:

  • cardiac catheterization – with this procedure, x-rays are taken after a contrast agent is injected into an artery to locate the narrowing, occlusions, and other abnormalities of specific arteries.
  • Doppler sonography – a special transducer is used to direct sound waves into a blood vessel to evaluate blood flow. An audio receiver amplifies the sound of the blood moving though the vessel. Faintness or absence of sound may indicate an obstruction in the blood flow.
  • blood pressure comparison – comparing blood pressure measurements in the ankles and in the arms to determine any constriction in blood flow. Significant differences may indicate a narrowing of vessels which could be caused by atherosclerosis.
  • MUGA/radionuclide angiography – a nuclear scan to see how the heart wall moves and how much blood is expelled with each heartbeat, while the patient is at rest.
  • thallium/myocardial perfusion scan – a nuclear scan given while the patient is at rest or after exercise that may reveal areas of the heart muscle that are not getting enough blood.

Treatment for Atherosclerosis

Specific treatment will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • the location of the blockage
  • your signs and symptoms
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include:

  • modification of risk factors – Risk factors that may be modified include smoking, elevated cholesterol levels, elevated blood glucose levels, lack of exercise, poor dietary habits, and elevated blood pressure.
  • medications – Medications that may be used to treat carotid artery disease include:
    • antiplatelet medications – medications used to decrease the ability of platelets in the blood to stick together and cause clots. Aspirin, clopidogrel (Plavix®), ticlopidine (Ticlid®), and dipyridamole (Persantine®) are examples of antiplatelet medications.
    • anticoagulants – also described as “blood thinners,” these medications work differently than antiplatelet medications to decrease the ability of the blood to clot. An example of an anticoagulant is warfarin (Coumadin®).
    • antihyperlipidemics – medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor®), atorvastatin (Lipitor®), and pravastatin (Pravachol®), among others. Bile acid sequestrants — colesevelam, cholestyramine and colestipol — and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels.
    • antihypertensives – medications used to lower blood pressure. There are several different groups of medications which act in different ways to lower blood pressure
  • coronary angioplasty – With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous coronary intervention (PTCA). There are several types of PCI procedures, including:
    • balloon angioplasty – a small balloon is inflated inside the blocked artery to open the blocked area.
    • atherectomy – the blocked area inside the artery is “shaved” away by a tiny device on the end of a catheter.
    • laser angioplasty – a laser used to “vaporize” the blockage in the artery.
    • coronary artery stent – a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
  • coronary artery bypass – Most commonly referred to as simply “bypass surgery,” this surgery is often performed in people who have angina (chest pain) due to coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.

Cardiovascular Disease: Atrial Fibrillation

Cardiovascular Disease

Atrial Fibrillation

How Your Heart Beats

The electrical heart conduction pathway must be followed to ensure the heart pumps properly.

The heartbeat starts in the right atrium when a special group of cells (the sinus node or “pacemaker” of the heart) sends an electrical signal.

The signal spreads throughout the atria and to the atrioventricular (A-V) node.

The A-V node connects to a group of fibers in the ventricles that conduct the electric signal.

The impulse travels down these specialized fibers to all parts of the ventricles.

What is an arrhythmia?

Arrhythmias (or dysrhythmias) are abnormal rhythms of the heart which cause the heart to pump less effectively.

Normally, as the electrical impulse moves through the heart, the heart contracts – about 60 to 100 times a minute. Each contraction represents one heartbeat. The atria contract a fraction of a second before the ventricles so their blood empties into the ventricles before the ventricles contract.

Under some conditions almost all heart tissue is capable of starting a heartbeat, or becoming the pacemaker. An arrhythmia occurs when:

  • the heart’s natural pacemaker develops an abnormal rate or rhythm.
  • the normal conduction pathway is interrupted.
  • another part of the heart takes over as pacemaker.

What is an electrocardiogram (ECG)?

The electrical activity of the heart is measured by an electrocardiogram (ECG or EKG). By placing electrodes at specific locations on the body (chest, arms, and legs), a graphic representation, or tracing, of the electrical activity can be obtained. Changes in an ECG from the normal tracing can indicate arrhythmias, as well as other heart-related conditions.

How does the physician know what an ECG means?

Almost everyone knows what a basic ECG tracing looks like. But what does it mean?

  • The first little upward notch of the ECG tracing is called the “P wave.” The P wave indicates that the atria (the two upper chambers of the heart) are electrically stimulated to pump blood to the ventricles.
  • The next part of the tracing is a short downward section connected to a tall upward section. This spike-like section is called the “QRS complex.” This part indicates that the ventricles (the two lower chambers of the heart) are electrically stimulated (“depolarization”) to pump out blood.
  • The next short flat segment is called the “ST segment.” The ST segment indicates the amount of time from the end of the electrical signal for the contraction of the ventricles to the beginning of the “T wave”.
  • The next upward curve is the T wave. The T wave indicates the electrical recovery period (“repolarization”) of the ventricles.

When your physician studies your ECG, he/she looks at the size and length of each part of the ECG. Variations in size and length of the different parts of the tracing may be significant. The tracing for each lead of a 12-lead ECG will look different, but will have the same basic components as described above. Each lead of the 12-lead is “looking” at a specific part of the heart, so variations in a lead may indicate a problem with the part of the heart associated with the lead.

What is atrial fibrillation?

Atrial fibrillation is a type of arrhythmia. With atrial fibrillation, the electrical signals in the atria (the two small chambers of the heart) are fired in a very fast and uncontrolled manner. The atria quiver instead of contract. The electrical signals then arrive in the ventricles in an irregular fashion. When atria do not contract effectively, the blood may pool and/or clot. If a blood clot becomes lodged in an artery in the brain, a stroke (brain attack) may occur. About 15 percent of strokes occur in persons with atrial fibrillation. Aspirin, warfarin, and other cardiac medications may be used to treat atrial fibrillation.

How is atrial fibrillation treated?

According to the latest recommendations from the American College of Physicians and the American Academy of Family Physicians, for most patients with atrial fibrillation, slowing heart rate with beta-blocker medication such as atenolol or metoprolol, or calcium-channel blockers such as diltiazem or verapamil, is the most appropriate treatment. Patients with atrial fibrillation should receive blood thinners (warfarin) to prevent stroke unless they have a condition that would make anticoagulation dangerous (such as alcoholism with frequent falls).

Patients who choose conversion to normal heart rhythm instead of rate control because of symptoms can select electrical or medical cardioversion. For patients who choose cardioversion, outcomes are similar whether patients have immediate cardioversion following a special test (transesophageal echocardiogram) to make sure no blood clots exist in the atria or if they delay cardioversion until blood thinners take effect. Most patients take medications to maintain normal rhythm after cardioversion .

Cardiovascular Disease: Risk Factors

Cardiovascular Disease

Risk Factors

There are many cardiovascular disease risk factors of which to be aware. While all of these factors are serious, it is important to remember that with a diet based on heart healthy foods, nutritional supplements, and exercise, you can prevent and even reverse these cardiovascular disease risk factors. Below are some of the most common risk factors.

Asymmetric Dimethylarginine (ADMA) – This modified amino acid is a better indicator of endothelial dysfunction than the blood level of cholesterol.

Smoking – Tobacco smoke has about 4,000 different substances in it, and any of them can cause problems with your blood vessels. Even second-hand smoke damages blood vessels and speeds up plaque formation. There are several poisons, one being nicotine, that damage blood vessels. John P. Cooke, M.D., Ph.D. and head of vascular research at Stanford University School of Medicine has shown in his research that nicotine can cause plaques and tumors to grow much more quickly. (Short-term use of nicotine patches or gums to stop smoking is safe).

Obesity – Excess body fat is a cardiovascular disease risk factor that puts strain on the heart, elevates blood pressure, and raises cholesterol levels. It also increases the chance of developing diabetes. Overweight individuals tend to lead more sedentary lifestyles, have high blood pressure, and higher blood sugar levels, which all can damage to the endothelium.

High Blood Pressure or Hypertension – This disorder is caused by too much pressure of the blood against the blood vessel walls and heart. This damages both the blood vessels and heart over time. High blood pressure may be caused by high levels of circulating hormones such as angiotensin and adrenaline. These “stress” hormones are useful if you are in a flight-or-fight situation, but if they are constantly increased, then blood vessels will form free radicals that can damage the endothelium and reduce production of nitric oxide.

Diabetes – Often termed the silent epidemic, diabetes involves high blood sugar levels, which seriously increase your risk of developing cardiovascular disease. If you have excessive amounts of sugar in the blood, the sugar sticks to the proteins in the blood vessels. These “glycosylated” proteins function abnormally, and the body does not recognize them. The body’s immune system thinks they are a foreign substance and may attack them. This results in inflammation in the blood vessel wall that can damage the vessel and speed up hardening of the arteries or arteriosclerosis (the general term for any hardening of the arteries; atherosclerosis is hardening of the arteries caused by fatty deposits of plaque in the arterial wall).

High Cholesterol – While high cholesterol is a heart disease risk factor, to what extent depends on several variables. If you have a healthy endothelium that produces adequate nitric oxide, then cholesterol is not much of a risk factor. Knowing your HDL to LDL cholesterol ratio is also an important factor, as your body needs plenty of HDL cholesterol for the structure of our cell membranes.

Homocysteine – This cardiovascular disease risk factor is a modified amino acid that comes from another amino acid, methionine. Our bodies can produce methionine, and we also ingest it from protein we eat. Methionine is converted to homocysteine in a chemical reaction that is important for cell function. However, homocysteine in high levels can damage endothelial cells. The most common reason for high homocysteine levels is vitamin B deficiency. Supplementing with B vitamins can lower homocysteine, and l-arginine or antioxidants like vitamin C may reverse the effects of homocysteine.

C-reactive protein (CRP) – CRP is a protein found in the blood, the levels of which rise as a response to inflammation. Recent research indicates that patients with elevated basal levels of CRP are at an increased risk of diabetes, hypertension and cardiovascular disease.

Stress – Stress is another cardiovascular disease risk factor that can cause damage to the blood vessels. Like other muscles in your body, blood vessels contract and expand according to signals from the nervous system. Fear, anxiety, and stress can activate nerve fibers in the blood vessels, which release adrenaline-like substances into the vessel wall, causing it to either relax or constrict. This helps explains why angina (chest pain) can occur when you have blood vessels that are narrowed by plaque, by activating the nerves in the blood vessels, causing them to constrict.

Vasoconstrictor nerves activated by anger or other stron emotions also stimulate the adrenal gland to release adrenaline into the blood stream. Adrenaline causes the heart to race, along with constricting vessels in the skin and gut, and relaxes vessels to the heart and brain. This is in order to redirect blood to where it is needed in a fight-or-flight situation. Adrenaline also improves the ability of blood to clot. This reaction is beneficial in certain situations, but not if you feel stress from work, traffic for example.

Parasympathetic nerves are ones that slow the heartbeat and cause blood vessels to relax and open. Obviously it is better for these nerves to have more influence over your coronary arteries and heart. This should be the goal with any stress reduction plan.

Sedentary Lifestyle – Is a cardiovascular disease risk factor that makes you twice as likely to have a heart attack or stroke than an active person. Exercising daily benefits cardiovascular health in many ways. Exercise increases your production of good cholesterol (HDL) and decreases your production of bad cholesterol (LDL). It also reduces your blood sugar levels, stress hormones (adrenaline), lowers your resting heart rate and blood pressure, helps with weight loss, and directly benefits the health of your endothelium and blood vessels. Even moderate daily exercise, such as vigorous walking for 30 minutes, can help add years to your life.

One quarter of the Unites States population suffers from at least one cardiovascular disease risk factor, but by taking proper steps through a heart healthy diet, nutritional supplements, and exercise you can take steps toward preventing and even reversing heart disease.

Cardiovascular Disease: Coronary Heart Disease

Cardiovascular Disease

Coronary Heart Disease

What are the coronary arteries?

Coronary arteries supply blood to the heart muscle. Like all other tissues in the body, the heart muscle needs oxygen-rich blood to function, and oxygen-depleted blood must be carried away. The coronary arteries consist of two main arteries: the right and left coronary arteries. The left coronary artery system branches into the circumflex artery and the left anterior descending artery.

What are the different coronary arteries?

The two main coronary arteries are the left main and right coronary arteries. The left main coronary artery (LMCA) which divides into the left anterior descending artery and the circumflex branch, supplies blood to the left ventricle and left atrium. The right coronary artery (RCA), which divides into the right posterior descending and acute marginal arteries, supplies blood to the right ventricle, right atrium sinoatrial node (cluster of cells in the right atrial wall that regulates the heart’s rhythmic rate), and atrioventricular node (AV node, a cluster of cells between the atria and ventricles that regulate the electrical current).

Additional arteries branch off the left main coronary artery to supply the left side of the heart muscle with blood. These include the following:

  • circumflex artery (Cx)The circumflex artery branches off the left coronary artery and encircles the heart muscle. This artery supplies blood to the lateral side and back of the heart.
  • left anterior descending artery (LAD)The left anterior descending artery branches off the left coronary artery and supplies blood to the front of the left side of the heart.

Smaller branches of the coronary arteries include: acute marginal (AM), posterior descending (PDA), obtuse marginal (OM), septal perforator (SP), and diagonals.

Why are the coronary arteries important?

Since coronary arteries deliver blood to the heart muscle, any coronary artery disorder or disease can have serious implications by reducing the flow of oxygen and nutrients to the heart, which may lead to a heart attack and possibly death. Atherosclerosis (a build-up of plaque in the inner lining of an artery causing it to narrow or become blocked) is the most common cause of heart disease.

What is coronary artery disease?

Coronary heart disease, or coronary artery disease (CAD), is characterized by the accumulation of fatty deposits along the innermost layer of the coronary arteries. The fatty deposits may develop in childhood and continue to thicken and enlarge throughout the life span. This thickening, called atherosclerosis, narrows the arteries and can decrease or block the flow of blood to the heart.

Nearly 16 million Americans suffer from coronary artery disease – the number one killer of both men and women in the US.

What are the risk factors for coronary artery disease?

Risk factors for CAD often include:

  • high LDL cholesterol, high triglycerides levels and reduced HDL cholesterol
  • high blood pressure (hypertension)
  • physical inactivity
  • smoking
  • obesity
  • high saturated fat diet
  • diabetes

Controlling risk factors is the key to preventing illness and death from CAD.

What are the symptoms of coronary artery disease?

The symptoms of coronary heart disease will depend on the severity of the disease. Some persons with CAD have no symptoms, some have episodes of mild chest pain or angina, and some have more severe chest pain.

If too little oxygenated blood reaches the heart, a person will experience chest pain called angina. When the blood supply is completely cut off, the result is a heart attack, and the heart muscle begins to die. Some persons may have a heart attack and never recognize the symptoms. This is called a “silent” heart attack.

When symptoms are present, each person may experience them differently. Symptoms of coronary artery disease may include:

  • heaviness, tightness, pressure, and/or pain in the chest – behind the breastbone
  • pain radiating in the arms, shoulders, jaw, neck, and/or back
  • shortness of breath
  • weakness and fatigue

How is coronary artery disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for coronary artery disease may include any, or a combination of, the following:

  • electrocardiogram (ECG or EKG) – a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
  • stress test (usually with ECG; also called treadmill or exercise ECG) – a test that is given while a patient walks on a treadmill to monitor the heart during exercise. Breathing and blood pressure rates are also monitored. A stress test may be used to detect coronary artery disease, and/or to determine safe levels of exercise following a heart attack or heart surgery.
  • cardiac catheterization – with this procedure, x-rays are taken after a contrast agent is injected into an artery – to locate the narrowing, occlusions, and other abnormalities of specific arteries.
  • nuclear scanning – radioactive material is injected into a vein and then is observed using a camera as it is taken up by the heart muscle. This indicates the healthy and damaged areas of the heart.

Treatment for coronary heart disease:

Specific treatment will be determined by your physician based on:

  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

Treatment may include:

  • modification of risk factors – Risk factors that may be modified include smoking, elevated cholesterol levels, elevated blood glucose levels, lack of exercise, poor dietary habits, being overweight/obese, and elevated blood pressure.
  • medications – Medications that may be used to treat coronary artery disease include:
    • antiplatelet medications – medications used to decrease the ability of platelets in the blood to stick together and cause clots. Aspirin, clopidogrel (Plavix®), ticlopidine (Ticlid®), and prasugrel are examples of antiplatelet medications.
    • anticoagulants – also described as “blood thinners,” these medications work differently than antiplatelet medications to decrease the ability of the blood to clot. An example of an anticoagulant is warfarin (Coumadin®).
    • antihyperlipidemics – medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor®), atorvastatin (Lipitor®), and pravastatin (Pravachol®), among others. Bile acid sequestrants – colesevelam, cholestyramine and colestipol – and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels.
    • antihypertensives – medications used to lower blood pressure. There are several different groups of medications which act in different ways to lower blood pressure
  • coronary angioplasty – with this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PCI procedures, including:
    • balloon angioplasty – a small balloon is inflated inside the blocked artery to open the blocked area.
    • coronary artery stent – a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
    • atherectomy – the blocked area inside the artery is cut away by a tiny device on the end of a catheter.
    • laser angioplasty – a laser used to “vaporize” the blockage in the artery.
  • coronary artery bypass – Most commonly referred to as simply “bypass surgery,” this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.

Cardiovascular Disease: Diet and Cardiovascular Disease

Cardiovascular Disease

Diet and Cardiovascular Disease

Following a healthy diet plan:

The food guide pyramid is a guideline to help you eat a healthy diet. The food guide pyramid can help you eat a variety of foods while encouraging the right amount of calories and fat. The United States Department of Agriculture (USDA) and the US Department of Health and Human Services have prepared the following food pyramid to guide you in selecting foods.

The Food Pyramid is divided into 6 colored bands representing the 5 food groups plus oils:

  • Orange represents grains: Make half the grains consumed each day whole grains. Whole-grain foods include oatmeal, whole-wheat flour, whole cornmeal, brown rice, and whole-wheat bread. Check the food label on processed foods – the words “whole” or “whole grain” should be listed before the specific grain in the product.
  • Green represents vegetables: Vary your vegetables. Choose a variety of vegetables, including dark green- and orange-colored kinds, legumes (peas and beans), starchy vegetables, and other vegetables.
  • Red represents fruits: Focus on fruits. Any fruit or 100 percent fruit juice counts as part of the fruit group. Fruits may be fresh, canned, frozen, or dried, and may be whole, cut-up, or pureed.
  • Yellow represents oils: Know the limits on fats, sugars, and salt (sodium). Make most of your fat sources from fish, nuts, and vegetable oils. Limit solid fats like butter, stick margarine, shortening, and lard, as well as foods that contain these.
  • Blue represents milk: Get your calcium-rich foods. Milk and milk products contain calcium and vitamin D, both important ingredients in building and maintaining bone tissue. Use low-fat or fat-free milk after the age of two years. However, during the first year of life, infants should be fed breast milk or iron-fortified formula. Whole cow’s milk may be introduced after an infant’s first birthday, but lower-fat or skim milk should not be used until the child is at least two years old.
  • Purple represents meat and beans: Go lean on protein. Choose low fat or lean meats and poultry. Vary your protein routine – choose more fish, nuts, seeds, peas, and beans.

Activity is also represented on the pyramid by the steps and the person climbing them, as a reminder of the importance of daily physical activity.

To find more information about the Dietary Guidelines for Americans 2005 and to determine the appropriate dietary recommendations for your age, sex, and physical activity level, visit the Online Resources page for the links to the Food Pyramid and 2005 Dietary Guidelines sites. Please note that the Food Pyramid is designed for persons over the age of two who do not have chronic health conditions.

Cardiovascular Disease: Heart Attack (Myocardial Infarction)

Cardiovascular Disease

Heart Attack (Myocardial Infarction)

What is a heart attack (myocardial infarction or MI)?

A heart attack, or myocardial infarction, occurs when one or more regions of the heart muscle experience a severe or prolonged lack of oxygen caused by blocked blood flow to the heart muscle.

The blockage is often a result of atherosclerosis – a buildup of plaque composed of fat deposits, cholesterol, and other substances. Plaque ruptures and eventually a blood clot forms. The actual cause of a heart attack is a blood clot that forms within the plaque-obstructed area.

If the blood and oxygen supply is cut off severely or for a long period of time, muscle cells of the heart suffer damage and die. The result is dysfunction of the muscle of the heart in the area affected by the lack of oxygen.

What are the risk factors for heart attack?

There are two types of risk factors for heart attack, including:

Inherited (or genetic): Acquired:
Inherited or genetic risk factors are risk factors you are born with that cannot be changed, but can be improved with medical management and lifestyle changes. Acquired risk factors are caused by activities that we choose to include in our lives that can be managed through lifestyle changes and clinical care.

Who is most at risk-inherited (genetic) factors?

  • persons with inherited hypertension (high blood pressure)
  • persons with inherited low levels of HDL (high-density lipoproteins), or high levels of LDL (low-density lipoprotein) blood cholesterol or high levels of triglycerides
  • persons with a family history of heart disease (especially with onset before age 55)
  • aging men and women
  • persons with type 1 diabetes
  • women, after the onset of menopause (generally, men are at risk at an earlier age than women, but after the onset of menopause, women are equally at risk)

Who is most at risk – acquired risk factors?

  • persons with acquired hypertension (high blood pressure)
  • persons with acquired low levels of HDL (high-density lipoproteins), high levels of LDL (low-density lipoprotein) blood cholesterol or high levels of triglycerides
  • cigarette smokers
  • people who are under a lot of stress
  • people who drink too much alcohol
  • individuals who lead a sedentary lifestyle
  • persons overweight by 30 percent or more
  • persons who eat a diet high in saturated fat
  • persons with Type II diabetes

A heart attack can happen to anyone – it is only when we take the time to learn which of the risk factors apply to us, specifically, can we then take steps to eliminate or reduce them.

Managing heart attack risk factors:

Managing your risks for a heart attack begins with:

  • examining which of the risk factors apply to you, and then taking steps to eliminate or reduce them.
  • becoming aware of conditions like hypertension or abnormal cholesterol levels, which may be “silent killers.”
  • modifying risk factors that are acquired, not inherited, through lifestyle changes. See your physician as the first step in starting right away to make these changes.
  • consulting your physician soon to determine if you have risk factors that are genetic or inherited and cannot be changed, but can be managed medically and through lifestyle changes.

What are the warning signs of a heart attack?

The following are the most common symptoms of a heart attack. However, each individual may experience symptoms differently. Symptoms may include:

Indigestion

Indigestion, also known as upset stomach or dyspepsia, is a painful or burning feeling in the upper abdomen that may include nausea; abdominal bloating; belching; vomiting; severe pain in the upper right abdomen; discomfort unrelated to eating; and indigestion accompanied by shortness of breath, sweating, or pain radiating to the jaw, neck, or arm

The symptoms of indigestion may resemble other medical conditions, such as chest pain. Always consult your physician for diagnosis.

  • severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes
  • pain or discomfort that spreads to the shoulders, neck, arms, or jaw
  • chest pain that increases in intensity
  • chest pain that is not relieved by rest or by taking nitroglycerin
  • chest pain that occurs with any/all of the following (additional) symptoms:
    • sweating, cool, clammy skin, and/or paleness
    • shortness of breath
    • nausea or vomiting
    • dizziness or fainting
    • unexplained weakness or fatigue
    • rapid or irregular pulse

Although chest pain is the key warning sign of a heart attack, it may be confused with indigestion, pleurisy, pneumonia, or other disorders.

Responding to heart attack warning signs:

If you, or someone you know exhibits any of the above warning signs, act immediately. Call 911.

Treatment for a heart attack:

The goal of treatment for a heart attack is to relieve pain, provide reperfusion (immediate blood flow) to preserve the heart muscle function, and prevent death.

A 12-lead electrocardiogram (ECG) will be done immediately in the Emergency Department (ED) or in the ambulance if 911 was called. If signs of acute MI are noted on the ECG, such as elevation of the ST segment, immediate intervention is necessary.

Emergent treatment options include:

fibrinolytic therapy – an IV medication is given to break up the clot which is occluding the coronary artery. The goal is to give this within 30 minutes of presentation to an emergency room without access to a cath lab with angioplasty/stent capabilities. Contraindications to fibrinolytic therapy include low platelet count, recent stomach or cerebral (brain) bleeding, high blood pressure, or receiving blood-thinners such as warfarin.

coronary angioplasty – with this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow. Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart. This should be done within 90 minutes of presentation to an Emergency Department (ED). PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PCI procedures, including:

  • balloon angioplasty – a small balloon is inflated inside the blocked artery to open the blocked area.
  • atherectomy – the blocked area inside the artery is cut away by a tiny device on the end of a catheter.
  • laser angioplasty – a laser used to “vaporize” the blockage in the artery.
  • coronary artery stent – a tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
  • coronary artery bypass – most commonly referred to as simply “bypass surgery,” this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries). During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction. Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.

Other interventions/medications that will be administered include:

  • continuous monitoring of the heart rhythm and vital signs
  • oxygen therapy – to improve oxygenation to the damaged heart muscle
  • pain medication, such as morphine – by decreasing pain, the workload of the heart decreases, thus, the oxygen demand of the heart decreases
  • cardiac medication – such as beta-blockers or calcium channel blockers to promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure
  • antiplatelet (aspirin on arrival)/antithrombin therapy (heparin) – used to prevent further blood clotting
  • intravenous therapy – nitroglycerin
  • antihyperlipidemics – medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol. Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor), atorvastatin (Lipitor), and pravastatin (Pravachol), among others. Bile acid sequestrants – colesevelam, cholestyramine and colestipol – and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels. These will be given after the patient is stabilized and will be prescribed at discharge.

Once the patient stabilized, procedures such as PCI to restore coronary blood flow may be utilized.

Cardiovascular Disease: How Inflammation Contributes to Coronary Heart Disease

Cardiovascular Disease

How Inflammation Contributes to Coronary Heart Disease

Heart disease begins with a little “scratch” to the endothelium. The body repairs the injury, but during the repair process, immune system cells, oxidized LDL cholesterol, and other cells and particles can slip through the endothelium and into the artery wall, setting the stage for endothelial dysfunction and coronary heart disease.

Inflammation can start this terrible progression by causing or contributing to the initial scratch. And once the toxic brew has begun to bubble within the arterial wall, inflammation can stir the pot by serving as a beacon, drawing additional immune system cells, oxidized LDL cells, and more to the site. From start to finish, the creation and rupture of the toxic brew plaque is driven by inflammation. Among other things, inflammation

  • draws immune system cells to the injured site, where they can slip through the endothelium and into the artery wall
  • alters the activity of the endothelium so that it attracts substances that contribute to the build-up of plaque
  • loosens the junctions between endothelial cells, making the migration of foreign substances into the artery wall easier
  • transforms helpful immune system cells called macrophages into harmful foam cells
  • attracts immune system cells called T cells that, upon arrival, release substances that keep the inflammatory process going

Through these actions, the toxic brew itself becomes a source of chronic inflammation, fueling its own growth.  Inflammation is present at the beginning, middle, and end of the coronary heart disease process. It is so potentially harmful that  inappropriate inflammation is much more dangerous to the artery linings than is an extra 10, 20, or even 50 cholesterol points over the ideal.

Cardiovascular Disease: Inflammation - A Fast Track to Heart Disease

Cardiovascular Disease

Inflammation – A Fast Track to Heart Disease

We used to believe that “hardening of the arteries” (atherosclerosis) was triggered by excess cholesterol and fat in the bloodstream that somehow attached itself to the inner lining of an artery, like a barnacle sticks to the hull of a ship. More and more would attach, glomming on to what was already there, until sooner or later, one of these little “barnacle groups” would grow large enough to block the flow of blood. If the blockage happened to occur in an artery that fed the heart, the part of the heart that was no longer receiving fresh blood would die—in other words, a heart attack would strike. But that idea was rendered obsolete when numerous studies conducted during the past decade showed that the genesis of a heart attack involves a lot more than a clump of fat damming blood flow. We now know that one of the primary coronary heart disease risk factors is inflammation, and it plays an important role in promoting heart disease from the very beginning.

What Is Inflammation?

Inflammation of the body is a natural response designed to prevent infection and repair damage. You’re undoubtedly familiar with the outward signs of inflammation: swelling, redness, warmth, and pain. In simple terms, here’s how it works: You cut your finger, and bacteria race in through this break in the skin. Your body recognizes the bacteria as foreign invaders and begins to defend itself. The defense begins as the walls of nearby blood vessels “loosen up” so that plasma (the liquid part of the blood) can leak into the surrounding tissue. As the infected area floods, immune system cells in the plasma come into contact with the invading bacteria and begin to do battle. The flooding also causes swelling and creates tension in the area, causing pain. Some red blood cells also escape from the blood vessels into the surrounding tissue, causing redness. The increased circulation of fluids promotes warmth.

All the while, the immune system cells fight with and destroy the bacteria, engaging the invaders in hand-to-hand combat, shooting out chemicals designed to destroy the enemy, literally engulfing and devouring them, and otherwise doing what it takes to protect the body. Sooner or later the battle is won, the excess fluid is reabsorbed, the immune system cells are recalled, the battlefield debris is cleared away, the pain recedes, and the body returns to normal. Mission accomplished!

This kind of inflammation is short term, beneficial, and absolutely necessary. Without it, we could not survive. But inflammation becomes a problem if it is chronic, lasting long after the initial danger has been dealt with—or perhaps arising for no reason at all. Then it serves no useful function and is very destructive to the body. With chronic inflammation, the body keeps sending out immune system soldiers after the battle has been won—or even when there has been no invasion or obvious damage. The system gets stuck in “fight mode,” and the chemicals continually released by immune system cells to defend the body wind up damaging or killing the body’s own cells. Thus, instead of protecting the body, the inflammatory process starts to destroy it. Chronic inflammation is believed to be the root of most degenerative diseases, including arthritis, diabetes, cancer, and heart disease.

Cardiovascular Disease: Trans Fats

Cardiovascular Disease

Trans Fats

Trans fat raises your “bad” (LDL) cholesterol and lowers your “good” (HDL) cholesterol. Find out more about trans fat and how to avoid

When it comes to fat, trans fat is considered by some doctors to be the worst type of fat. Unlike other fats, trans fat — also called trans-fatty acids — both raises your “bad” (LDL) cholesterol and lowers your “good” (HDL) cholesterol.

A high LDL cholesterol level in combination with a low HDL cholesterol level increases your risk of heart disease, the leading killer of men and women. Here’s some information about trans fat and how to avoid it.

What is trans fat?

Trans fat is made by adding hydrogen to vegetable oil through a process called hydrogenation, which makes the oil less likely to spoil. Using trans fats in the manufacturing of foods helps foods stay fresh longer, have a longer shelf life and have a less greasy feel.

Scientists aren’t sure exactly why, but the addition of hydrogen to oil increases your cholesterol more than do other types of fats. It’s thought that adding hydrogen to oil makes the oil more difficult to digest, and your body recognizes trans fats as saturated fats.

Trans fat in your food

Commercial baked goods — such as crackers, cookies and cakes — and many fried foods, such as doughnuts and french fries — may contain trans fats. Shortenings and some margarines can be high in trans fat.

Trans fat used to be more common, but in recent years food manufacturers have used it less because of concerns over the health effects of trans fat. Food manufacturers in the United States and many other countries list the trans fat content on nutrition labels.

However, you should be aware of what nutritional labels really mean when it comes to trans fat. For example, in the United States if a food has less than 0.5 grams of trans fat per serving, the food label can read 0 grams trans fat. Though that’s a small amount of trans fat, if you eat multiple servings of foods with less than 0.5 grams of trans fat, you could exceed recommended limits.

Reading food labels

How do you know whether food contains trans fat? Look for the words “partially hydrogenated” vegetable oil. That’s another term for trans fat.

It sounds counterintuitive, but “fully” or “completely” hydrogenated oil doesn’t contain trans fat. Unlike partially hydrogenated oil, the process used to make fully or completely hydrogenated oil doesn’t result in trans-fatty acids. However, if the label says just “hydrogenated” vegetable oil, it could mean the oil contains some trans fat.

Although small amounts of trans fat occur naturally in some meat and dairy products, it’s the trans fats in processed foods that seem to be more harmful.

Cardiovascular Disease: What is VLDL?

Cardiovascular Disease

What is VLDL?

Can it be harmful?

Very-low-density lipoprotein (VLDL) cholesterol is a type of lipoprotein. Although you may hear about VLDL, your VLDL level usually isn’t reported to you as a part of a routine cholesterol test.

There are several types of cholesterol, each made up of lipoproteins and fats. Each type of lipoprotein contains a mixture of cholesterol, protein and a type of fat (triglyceride), but in varying amounts.

Of the lipoprotein types, VLDL contains the highest amount of triglyceride. Because it contains a high level of triglyceride, having a high VLDL level means you may have an increased risk of coronary artery disease, which can lead to a heart attack or stroke.

There’s no simple, direct way to measure VLDL cholesterol, which is why it’s normally not mentioned during a routine cholesterol screening. VLDL cholesterol is usually estimated as a percentage of your triglyceride value. A normal VLDL cholesterol level is between 5 and 40 milligrams per deciliter.

Cholesterol (Hyperlipidemia): Fact vs. Fiction

Cholesterol (Hyperlipidemia)

Fact vs. Fiction

High cholesterol level in the blood (hypercholesterolemia) is a supposedly well-known risk factor for impairment of your endothelium and atherosclerosis. Approximately 100 million Americans have hypercholesterolemia, which is not surprising, with diets high in saturated fat and cholesterol. Foods high in animal fat, like fatty meats, whole-fat dairy products, and fried foods are the biggest reasons for high blood cholesterol. However, cholesterol itself may not be as big of a risk factor for heart disease as many scientists and doctors have thought for years.

Cholesterol is our most important molecule because it provides structure to every cell in our body. Without it we cannot produce sex hormones or bile synthesis. Cholesterol will not stick to your arterial walls if your endothelium is healthy. When it can be a problem is when your blood vessels start becoming damaged, which makes the surface rough, and this gives it something to attach to.

Cholesterol (Hyperlipidemia): How Important Is Cholesterol Ratio?

Cholesterol (Hyperlipidemia)

How Important Is Cholesterol Ratio?

Calculating your cholesterol ratio can provide useful information about your heart disease risk, but it isn’t useful for deciding what treatment you should have to reduce your heart disease risk. Your total cholesterol and low-density lipoprotein (LDL, or “bad”) cholesterol levels are more useful in guiding treatment decisions than is your cholesterol ratio.

You can calculate your cholesterol ratio by dividing your high-density lipoprotein (HDL, or “good”) cholesterol into your total cholesterol. For example, if your total cholesterol is 200 milligrams per deciliter (mg/dL) (5.2 millimoles per liter, or mmol/L) and your HDL cholesterol is 50 mg/dL (1.3 mmol/L), your cholesterol ratio is 4-to-1. The goal is to keep your cholesterol ratio 4-to-1 or lower. A higher ratio indicates a higher risk of heart disease; a lower ratio indicates a lower risk.

For treatment purposes, it’s more important to know absolute numbers for all your cholesterol levels – including HDL, LDL and total cholesterol – than to know ratios. This is because HDL cholesterol and LDL cholesterol both affect your heart disease risk, and treatment may be directed at improving both. For example, if you have LDL cholesterol of 100 mg/dL (2.6 mmol/L) or above, the main goal of treatment is to lower your LDL cholesterol.

Cholesterol (Hyperlipidemia): Do Cholesterol Numbers Really Assess Cardiovascular Risk?

Cholesterol (Hyperlipidemia)

Do Cholesterol Numbers Really Assess Cardiovascular Risk?

LPP™ Testing is essential to identifying at-risk patients. Up to 50 percent of those who have suffered heart attacks had “normal” cholesterol numbers. How can the large discrepancy between accurate diagnosis and standard cholesterol testing be prevented? Simply by testing the LDL (low density lipoprotein) particle numbers using the Lipoprotein Particle Profile™ (LPP™) from SpectraCell Laboratories.

Overview of lipoprotein particles and cholesterol

Cholesterol testing has historically been used as the standard indicator for cardiovascular disease classified as HDL (good) or LDL (bad). However, it is actually the lipoprotein particles that carry the cholesterol throughout the body, not necessarily the cholesterol within them, that are responsible for key steps in plaque production and the resulting development of cardiovascular disease.

Approximately 50 percent of people suffering from heart attacks have shown “normal” cholesterol numbers (NHLBI – The National Heart, Lung, and Blood Institute).

Now there is an advanced cholesterol testing technology which accurately measures both the density and number of lipoprotein particles. This test is the Lipoprotein Particle Profile™, or LPP™, from SpectraCell Laboratories.

Measuring the lipoprotein subgroups is the only way to evaluate new risk factors, which is crucial for an accurate assessment of cardiovascular risk – according to the National Cholesterol Education Program (NCEP).

NCEP new Risk Factors:

  • Small, dense LDL: these atherogenic particles are easily oxidized and penetrate the arterial endothelium to form plaque
  • Lp(a): this small, dense LDL is involved in thrombosis
  • RLP (Remnant Lipoprotein): is very atherogenic, has a similar composition and density of plaque, is believed to be a building block of plaque and does not need to be oxidized like other LDL particle
  • HDL2b: positively correlates with heart health because it is an indicator of how well excess lipids are removed
  • Why is it important to know lipoprotein numbers?

Cardiovascular risk increases with a higher LDL particle count. With a higher non-HDL lipoprotein count the probability of particle penetration of the arterial wall rises, regardless of the total amount of cholesterol contained in each particle. On average, the typical particle contains 50 percent cholesterol.

More than 30 percent of the population has cholesterol-depleted LDL, a condition in which a patient’s cholesterol may be “normal” but their lipoprotein particle number, and hence their actual risk, could be much higher than expected. This is especially common in persons whose triglycerides are high or HDL is low. In the population with a cholesterol-depleted LDL, there can be up to a 40 percent error in risk assessment.

Cholesterol (Hyperlipidemia): Cholesterol

Cholesterol (Hyperlipidemia)

Cholesterol

Cholesterol is a waxy substance that’s found in the fats (lipids) in your blood. While your body needs cholesterol to continue building healthy cells, having high cholesterol can increase your risk of heart disease.

When you have high cholesterol, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen-rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke.

High cholesterol (hypercholesterolemia) can be inherited, but is often preventable and treatable. A healthy diet, regular exercise and sometimes medication can go a long way toward reducing high cholesterol.

High cholesterol has no symptoms. A blood test is the only way to detect high cholesterol.

When to see a doctor?

Ask your doctor for a baseline cholesterol test at age 20 and then have your cholesterol retested at least every five years. If your test results aren’t within desirable ranges, your doctor may recommend more frequent measurements. Your doctor may also suggest you have more frequent tests if you have a family history of high cholesterol, heart disease or other risk factors, like smoking, diabetes or high blood pressure.

Cholesterol is carried through your blood, attached to proteins. This combination of proteins and cholesterol is called a lipoprotein. You may have heard of different types of cholesterol, based on what type of cholesterol the lipoprotein carries. They are:

  • Low-density lipoprotein (LDL). LDL, or “bad,” cholesterol transports cholesterol particles throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow.
  • Very-low-density lipoprotein (VLDL). This type of lipoprotein contains the most triglycerides, a type of fat, attached to the proteins in your blood. VLDL cholesterol makes LDL cholesterol larger in size, causing your blood vessels to narrow. If you’re taking cholesterol-lowering medication but have a high VLDL level, you may need additional medication to lower your triglycerides.
  • High-density lipoprotein (HDL). HDL, or “good,” cholesterol picks up excess cholesterol and takes it back to your liver.

Factors within your control – such as inactivity, obesity and an unhealthy diet – contribute to high LDL cholesterol and low HDL cholesterol. Factors beyond your control may play a role, too. For example, your genetic makeup may keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce too much cholesterol.

You’re more likely to have high cholesterol that can lead to heart disease if you have any of these risk factors:

  • Smoking. Cigarette smoking damages the walls of your blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower your level of HDL, or “good,” cholesterol.
  • Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.
  • Poor diet. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will increase your total cholesterol. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, also can raise your cholesterol level.
  • Lack of exercise. Exercise helps boost your body’s HDL “good” cholesterol while lowering your LDL “bad” cholesterol. Not getting enough exercise puts you at risk of high cholesterol.
  • High blood pressure. Increased pressure on your artery walls damages your arteries, which can speed the accumulation of fatty deposits.
  • Diabetes. High blood sugar contributes to higher LDL cholesterol and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.
  • Family history of heart disease. If a parent or sibling developed heart disease before age 55, high cholesterol levels place you at a greater than average risk of developing heart disease.

High cholesterol can cause atherosclerosis, a dangerous accumulation of cholesterol and other deposits on the walls of your arteries. These deposits – called plaques – can reduce blood flow through your arteries, which can cause complications, such as:

  • Chest pain. If the arteries that supply your heart with blood (coronary arteries) are affected, you may have chest pain (angina) and other symptoms of coronary artery disease.
  • Heart attack. If plaques tear or rupture, a blood clot may form at the plaque-rupture site – blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of your heart stops, you’ll have a heart attack.
  • Stroke. Similar to a heart attack, if blood flow to part of your brain is blocked by a blood clot, a stroke occurs.

A blood test to check cholesterol levels – called a lipid panel or lipid profile – typically reports:

  • Total cholesterol
  • LDL cholesterol
  • HDL cholesterol
  • Triglycerides – a type of fat in the blood

For the most accurate measurements, don’t eat or drink anything (other than water) for nine to 12 hours before the blood sample is taken.

Interpreting the numbers

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood in the United States and some other countries. Canada and most European countries measure cholesterol in millimoles (mmol) per liter (L) of blood. Consider these general guidelines when you get your lipid panel (cholesterol test) results back to see if your cholesterol falls in ideal levels.

Total cholesterol
(U.S. and some other countries)
Total cholesterol*
(Canada and most of Europe)
 
Below 200 mg/dL Below 5.2 mmol/L Best
200-239 mg/dL 5.2-6.2 mmol/L Borderline high
240 mg/dL and above Above 6.2 mmol/L High
LDL cholesterol
(U.S. and some other countries)
LDL cholesterol*
(Canada and most of Europe)
 
Below 70 mg/dL Below 1.8 mmol/L Best for people at high risk of heart disease
Below 100 mg/dL Below 2.6 mmol/L Best for people at risk for heart disease
100-129 mg/dL 2.6-3.3 mmol/L Near ideal
130-159 mg/dL 3.4-4.1 mmol/L Borderline high
160-189 mg/dL 4.1-4.9 mmol/L High
190 mg/dL and above Above 4.9 mmol/L Very high
HDL cholesterol
(U.S. and some other countries)
HDL cholesterol*
(Canada and most of Europe)
 
Below 40 mg/dL (men)Below 50 mg/dL (women) Below 1 mmol/L (men)Below 1.3 mmol/L (women) Poor
50-59 mg/dL 1.3-1.5 mmol/L Better
60 mg/dL and above Above 1.5 mmol/L Best
Triglycerides
(U.S. and some other countries)
Triglycerides*
(Canada and most of Europe)
 
Below 150 mg/dL Below 1.7 mmol/L Best
150-199 mg/dL 1.7-2.2 mmol/L Borderline high
200-499 mg/dL 2.3-5.6 mmol/L High
500 mg/dL and above Above 5.6 mmol/L Very high

The American Heart Association (AHA) recommends that a triglyceride level of 100 mg/dL (1.3 mmol/L) or lower is considered “optimal.” The AHA says this optimal level would improve your heart health. However, the AHA doesn’t recommend drug treatment to reach this level. Instead, for those trying to lower their triglycerides to this level, lifestyle changes such as diet, weight loss and physical activity are encouraged. That’s because triglycerides usually respond well to dietary and lifestyle changes.

*Canadian and European guidelines differ slightly from U.S. guidelines. These conversions are based on U.S. guidelines.

LDL targets differ

Because LDL cholesterol is a major risk factor for heart disease, it’s the main focus of cholesterol-lowering treatment. Your target LDL number can vary, depending on your underlying risk of heart disease.

Most people should aim for an LDL level below 130 mg/dL (3.4 mmol/L). If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL (2.6 mmol/L). If you’re at very high risk of heart disease, you may need to aim for an LDL level below 70 mg/dL (1.8 mmol/L). In general, the lower your LDL cholesterol level is, the better.

You’re considered to be at a high risk of heart disease if you:

  • Have had a previous heart attack or stroke
  • Have artery blockages in your neck (carotid artery disease)
  • Have artery blockages in your arms or legs (peripheral artery disease)

In addition, two or more of the following risk factors might also place you in the high-risk group:

  • Smoking
  • High blood pressure
  • Low HDL cholesterol
  • Diabetes
  • Family history of early heart disease
  • Age older than 45 if you’re a man, or older than 55 if you’re a woman
  • Elevated lipoprotein (a), another type of fat (lipid) in your blood

Lifestyle changes such as exercising and eating a healthy diet are the first line of defense against high cholesterol. But, if you’ve made these important lifestyle changes and your total cholesterol – and particularly your LDL cholesterol – remains high, your doctor may recommend medication.

The specific choice of medication or combination of medications depends on various factors, including your individual risk factors, your age, your current health and possible side effects. Common choices include:

  • Statins. Statins – among the most commonly prescribed medications for lowering cholesterol – block a substance your liver needs to make cholesterol. This causes your liver to remove cholesterol from your blood. Statins may also help your body reabsorb cholesterol from built up deposits on your artery walls, potentially reversing coronary artery disease. Choices include atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
  • Bile-acid-binding resins. Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite, Questran), colesevelam (Welchol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.
  • Cholesterol absorption inhibitors. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia can be used in combination with any of the statin drugs.
  • Combination cholesterol absorption inhibitor and statin. The combination drug ezetimibe-simvastatin (Vytorin) decreases both absorption of dietary cholesterol in your small intestine and production of cholesterol in your liver. It’s unknown whether Vytorin is more effective in reducing heart disease risk than taking simvastatin by itself.

Medications for high triglycerides

If you also have high triglycerides, your doctor may prescribe:

  • Fibrates. The medications fenofibrate (Lofibra, TriCor) and gemfibrozil (Lopid) decrease triglycerides by reducing your liver’s production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides.
  • Niacin. Niacin (Niaspan) decreases triglycerides by limiting your liver’s ability to produce LDL and VLDL cholesterol. Prescription and over-the-counter niacin is available, but prescription niacin is preferred as it has the least side effects. Dietary supplements containing niacin that are available over-the-counter are not effective for lowering triglycerides, and may damage your liver.
  • Omega-3 fatty acid supplements. Omega-3 fatty acid supplements can help lower your cholesterol. You can take over-the-counter supplements, or your doctor may prescribe Lovaza, a prescription omega-3 fatty acid supplement, as a way to lower your triglycerides. Lovaza may be taken with another cholesterol-lowering medication, such as a statin. If you choose to take over-the-counter supplements, get your doctor’s OK first. Omega-3 fatty acid supplements could affect other medications you’re taking.

Effectiveness varies

Most cholesterol medications are well tolerated, but effectiveness varies from person to person. The common side effects are muscle pains, stomach pain, constipation, nausea and diarrhea. If you decide to take cholesterol medication, your doctor may recommend liver function tests every few months to monitor the medication’s effect on your liver.

Lifestyle changes are essential to improve your cholesterol level. To bring your numbers down, lose excess weight, eat healthy foods and increase your physical activity. If you smoke, quit.

Lose extra pounds

Excess weight contributes to high cholesterol. Losing even 5 to 10 pounds can help lower total cholesterol levels. Start by taking an honest look at your eating habits and daily routine. Consider your challenges to weight loss – and ways to overcome them. Set long-term, sustainable goals.

Eat heart-healthy foods

What you eat has a direct impact on your cholesterol level. In fact, a diet rich in fiber and other cholesterol-lowering foods may help lower cholesterol as much as statin medication for some people.

  • Choose healthier fats. Saturated fat and trans fat raise your total cholesterol and LDL cholesterol. Get no more than 10 percent of your daily calories from saturated fat. Monounsaturated fat – found in olive, peanut and canola oils – is a healthier option. Almonds and walnuts are other sources of healthy fat.
  • Eliminate trans fats. Trans fats, which are often found in margarines and commercially baked cookies, crackers and snack cakes, are particularly bad for your cholesterol levels. Not only do trans fats increase your total LDL (“bad”) cholesterol, but they also lower your HDL (“good”) cholesterol.

You may have noticed more food labels now market their products as “trans fat-free.” But don’t rely only on this label. In the United States, if a food contains less than 0.5 grams of trans fat a serving, it can be marked trans fat-free. It may not seem like much, but if you eat a lot of foods with a small amount of trans fat, it can add up quickly. Instead, read the ingredients list. If a food contains a partially hydrogenated oil, that’s a trans fat, and you should look for an alternative.

  • Limit your dietary cholesterol. Aim for no more than 300 milligrams (mg) of cholesterol a day – or less than 200 mg if you have heart disease. The most concentrated sources of cholesterol include organ meats, egg yolks and whole milk products. Use lean cuts of meat, egg substitutes and skim milk instead.
  • Select whole grains. Various nutrients found in whole grains promote heart health. Choose whole-grain breads, whole-wheat pasta, whole-wheat flour and brown rice. Oatmeal and oat bran are other good choices.
  • Stock up on fruits and vegetables. Fruits and vegetables are rich in dietary fiber, which can help lower cholesterol. Snack on seasonal fruits. Experiment with vegetable-based casseroles, soups and stir-fries.
  • Eat heart-healthy fish. Some types of fish – such as cod, tuna and halibut – have less total fat, saturated fat and cholesterol than do meat and poultry. Salmon, mackerel and herring are rich in omega-3 fatty acids, which help promote heart health.
  • Drink alcohol only in moderation. Moderate use of alcohol may increase your levels of HDL cholesterol – but the benefits aren’t strong enough to recommend alcohol for anyone who doesn’t drink already. If you choose to drink, do so in moderation. This means no more than one drink a day for women and one to two drinks a day for men.

Exercise regularly

Regular exercise can help improve your cholesterol levels. With your doctor’s OK, work up to 30 to 60 minutes of exercise a day. Take a brisk daily walk. Ride your bike. Swim laps. To maintain your motivation, keep it fun. Find an exercise buddy or join an exercise group. And, you don’t need to get all 30 to 60 minutes in one exercise session. If you can squeeze in three to six 10-minute intervals of exercise, you’ll still get some cholesterol-lowering benefits.

Don’t smoke

If you smoke, stop. Quitting can improve your HDL cholesterol level. And the benefits don’t end there. Just 20 minutes after quitting, your blood pressure decreases. Within 24 hours, your risk of a heart attack decreases. Within one year, your risk of heart disease is half that of a smoker’s. Within 15 years, your risk of heart disease is similar to that of someone who’s never smoked.

Cholesterol (Hyperlipidemia): Cholesterol-lowering supplements

Cholesterol (Hyperlipidemia)

Cholesterol-lowering supplements

Cholesterol-lowering supplements: Lower your numbers without prescription medication

If you’re worried about your cholesterol and have already started exercising and eating healthier foods, you might wonder if adding a cholesterol-lowering supplement to your diet can help reduce your numbers. Although few natural products have been proven to reduce cholesterol, some might be helpful. With Dr. Houston’s approval, consider these cholesterol-lowering supplements and products.

Cholesterol-lowering supplement What it does Side effects and drug interactions
Artichoke extract May reduce total cholesterol and LDL, or “bad,” cholesterol May cause gas or an allergic reaction
Barley May reduce total cholesterol and LDL cholesterol None
Beta-sitosterol (found in oral supplements and some margarines, such as Promise Activ) May reduce total cholesterol and LDL cholesterol May cause nausea, indigestion, gas, diarrhea or constipation
May be ineffective if you take ezetimibe (Zetia), a prescription cholesterol medication
Blond psyllium (found in seed husk and products such as Metamucil) May reduce total cholesterol and LDL cholesterol May cause gas, stomach pain, diarrhea, constipation or nausea
Fish oil (found as a liquid oil and in oil-filled capsules) May reduce triglycerides May cause a fishy aftertaste, bad breath, gas, nausea, vomiting or diarrhea
May interact with some blood-thinning medications, such as warfarin (Coumadin)
Flaxseed, ground May reduce triglycerides May cause, gas, bloating or diarrhea
May interact with some blood-thinning medications, such as aspirin, clopidogrel (Plavix) and warfarin (Coumadin)
Garlic extract May reduce total cholesterol, LDL cholesterol and triglycerides May cause bad breath, body odor, heartburn, gas, nausea, vomiting or diarrhea
May interact with blood-thinning medications, such as warfarin (Coumadin)
Green tea extract May lower LDL cholesterol May cause nausea, vomiting, gas or diarrhea
May interact with blood-thinning medications, such as warfarin (Coumadin)
Oat bran (found in oatmeal and whole oats) May reduce total cholesterol and LDL cholesterol May cause gas or bloating
Sitostanol (found in oral supplements and some margarines, such as Benecol) May reduce total cholesterol and LDL cholesterol May cause diarrhea

Another popular cholesterol-lowering supplement is red yeast rice. There is some evidence that red yeast rice can help lower your LDL cholesterol. However, the Food and Drug Administration has warned that red yeast rice products could contain a naturally occurring form of the prescription medication known as lovastatin. Lovastatin in the red yeast rice products in question is potentially dangerous because there’s no way for you to know what level or quality of lovastatin might be in red yeast rice.

Sometimes healthy lifestyle choices, including supplements and other cholesterol-lowering products, aren’t enough. If Dr. Houston prescribes medication to reduce your cholesterol, take it as directed while you continue to focus on a healthy lifestyle. As always, if you decide to take an herbal supplement, be sure to tell Dr. Houston or his nurses. The herbal supplement you take may interact with other medications you take.

Cholesterol (Hyperlipidemia): Top 5 foods to lower your numbers

Cholesterol (Hyperlipidemia)

Top 5 foods to lower your numbers

Diet can play an important role in lowering your cholesterol. Here are five foods that can lower your cholesterol and protect your heart.

Can a bowl of oatmeal help lower your cholesterol? How about a handful of walnuts or even a baked potato topped with some heart-healthy margarine? A few simple tweaks to your diet – like these – may be enough to lower your cholesterol to a healthy level and help you stay off medications.

1. Oatmeal, oat bran and high-fiber foods

Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the “bad” cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, barley and prunes.

Soluble fiber can reduce the absorption of cholesterol into your bloodstream. Five to 10 grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you’ll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran.

2. Fish and omega-3 fatty acids

Eating fatty fish can be heart-healthy because of its high levels of omega-3 fatty acids, which can reduce your blood pressure and risk of developing blood clots. In people who have already had heart attacks, fish oil – or omega-3 fatty acids – reduces the risk of sudden death.

Doctors recommend eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in:

  • Mackerel
  • Lake trout
  • Herring
  • Sardines
  • Albacore tuna
  • Salmon
  • Halibut

You should bake or grill the fish to avoid adding unhealthy fats. If you don’t like fish, you can also get small amounts of omega-3 fatty acids from foods like ground flaxseed or canola oil.

You can take an omega-3 or fish oil supplement to get some of the benefits, but you won’t get other nutrients in fish, like selenium. If you decide to take a supplement, just remember to watch your diet and eat lean meat or vegetables in place of fish.

3. Walnuts, almonds and other nuts

Walnuts, almonds and other nuts can reduce blood cholesterol. Rich in polyunsaturated fatty acids, walnuts also help keep blood vessels healthy.

According to the Food and Drug Administration, eating about a handful (1.5 ounces, or 42.5 grams) a day of most nuts, such as almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts and walnuts, may reduce your risk of heart disease. Just make sure the nuts you eat aren’t salted or coated with sugar.

All nuts are high in calories, so a handful will do. To avoid eating too many nuts and gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.

4. Olive oil

Olive oil contains a potent mix of antioxidants that can lower your “bad” (LDL) cholesterol but leave your “good” (HDL) cholesterol untouched.

The Food and Drug Administration recommends using about 2 tablespoons (23 grams) of olive oil a day in place of other fats in your diet to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade, or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat or as a dip for bread. Olive oil is high in calories, so don’t eat more than the recommended amount.

The cholesterol-lowering effects of olive oil are even greater if you choose extra-virgin olive oil, meaning the oil is less processed and contains more heart-healthy antioxidants. But keep in mind that “light” olive oils are usually more processed than extra-virgin or virgin olive oils and are lighter in color, not fat or calories.

5. Foods with added plant sterols or stanols

Foods are now available that have been fortified with sterols or stanols – substances found in plants that help block the absorption of cholesterol.

Margarines, orange juice and yogurt drinks with added plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams – which equals about two 8-ounce (237-milliliter) servings of plant sterol-fortified orange juice a day.

Plant sterols or stanols in fortified foods don’t appear to affect levels of triglycerides or of high-density lipoprotein (HDL), the “good” cholesterol.

Other changes to your diet

For any of these foods to provide their benefit, you need to make other changes to your diet and lifestyle. Cut back on the cholesterol and total fat – especially saturated and trans fats – that you eat. Saturated fats, like those in meat, full-fat dairy products and some oils, raise your total cholesterol. Trans fats, which are sometimes found in margarines and store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels. Trans fats raise low-density lipoprotein (LDL), the “bad” cholesterol, and lower high-density lipoprotein (HDL), the “good” cholesterol.

Cholesterol (Hyperlipidemia): Omega-3 in fish: How eating fish helps your heart

Cholesterol (Hyperlipidemia)

Omega-3 in fish: How eating fish helps your heart

The omega-3 fatty acids in fish are good for your heart. Find out why the heart-healthy benefits of eating fish usually outweigh any risks.

If you’re worried about heart disease, eating one to two servings of fish a week could reduce your risk of dying of a heart attack by a third or more.

Doctors have long recognized that the unsaturated fats in fish, called omega-3 fatty acids, appear to reduce the risk of dying of heart disease. For many years, the American Heart Association has recommended that people eat fish rich in omega-3 fatty acids at least twice a week.

But some people are still concerned about mercury or other contaminants in fish outweighing its heart-health benefits. However, when it comes to a healthier heart, the benefits of eating fish usually outweigh the possible risks of exposure to contaminants. Find out how to balance these concerns with adding a healthy amount of fish to your diet.

What are omega-3 fatty acids, and why are they good for your heart?

Fish contain unsaturated fatty acids, which, when substituted for saturated fatty acids such as those in meat, may lower your cholesterol. But the main beneficial nutrient appears to be omega-3 fatty acids in fatty fish. Omega-3 fatty acids are a type of unsaturated fatty acid that’s thought to reduce inflammation throughout the body. Inflammation in the body can damage your blood vessels and lead to heart disease.

Omega-3 fatty acids may decrease triglycerides, lower blood pressure, reduce blood clotting, boost immunity and improve arthritis symptoms, and in children may improve learning ability. Eating one to two servings a week of fish, particularly fish that’s rich in omega-3 fatty acids, appears to reduce the risk of heart disease, particularly sudden cardiac death.

Does it matter what kind of fish you eat?

Fatty fish, such as salmon, herring and to a lesser extent tuna, contain the most omega-3 fatty acids and therefore the most benefit, but many types of seafood contain small amounts of omega-3 fatty acids.

Most freshwater fish have less omega-3 fatty acids than do fatty saltwater fish. Some varieties of freshwater trout have relatively high levels of omega-3 fatty acids.

Are there any kinds of fish you should avoid?

Some fish, such as tilapia and catfish, don’t appear to be as heart healthy because they contain higher levels of unhealthy fatty acids. Keep in mind that any fish can be unhealthy depending on how it’s prepared. For example, broiling or baking fish is a healthier option than is deep-frying.

Some researchers are concerned about eating fish produced on farms as opposed to wild-caught fish. Researchers think antibiotics, pesticides and other chemicals used in raising farmed fish may have harmful effects to people who eat the fish.

How much fish should you eat?

For adults, at least two servings of omega-3-rich fish a week are recommended. A serving size is 3 ounces (85 grams), or about the size of a deck of cards. Women who are pregnant or plan to become pregnant and children under age 12 should limit the amount of fish they eat because they’re most susceptible to the potential effects of toxins in fish.

Does mercury contamination outweigh the health benefits of eating fish?

The risk of getting too much mercury or other contaminants from fish is generally outweighed by the health benefits that omega-3 fatty acids have. The main types of toxins in fish are mercury, dioxins and polychlorinated biphenyls (PCBs). The amount of toxins depends on the type of fish and where it’s caught.

Mercury occurs naturally in small amounts in the environment. But industrial pollution can produce mercury that accumulates in lakes, rivers and oceans, which turns up in the food fish eat. When fish eat this food, mercury builds up in the bodies of the fish.

Large fish that are higher in the food chain — such as shark, tilefish, swordfish and king mackerel — tend to have higher levels of mercury than do smaller fish. Larger fish eat the smaller fish, gaining higher concentrations of the toxin. The longer a fish lives, the larger it grows and the more mercury it can collect.

Pay attention to the type of fish you eat, how much you eat, and other information such as state advisories. Each state issues advisories regarding the safe amount of locally caught fish that can be consumed.

Should anyone avoid eating fish because of the concerns over mercury or other contaminants?

If you eat enough fish containing mercury, the toxin can accumulate in your body. It can take weeks, months or even a year for your body to remove these toxins. Mercury is particularly harmful to the development of the brain and nervous system of unborn children and young children. For most adults, however, it’s unlikely that mercury would cause any health concerns.

Still, the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) recommend that these groups limit the amount of fish they eat:

  • Women who are pregnant or trying to become pregnant
  • Breast-feeding mothers
  • Children under age 12

Pregnant women, breast-feeding mothers and children can still get the heart-health benefits of fish by eating fish that’s typically low in mercury, such as salmon, and limiting the amount they eat to:

  • No more than 12 ounces (340 grams) of fish in total a week
  • No more than 6 ounces (170 grams) of canned tuna a week
  • No amount of any fish that’s typically high in mercury (shark, swordfish, king mackerel and tilefish)

Can you get the same heart-health benefits by eating other foods that contain omega-3 fatty acids, or by taking omega-3 fatty acid supplements?

The evidence is stronger for the benefits of eating fish rich in omega-3 fatty acids than for using supplements. However, people who have heart disease may benefit from supplements of omega-3 fatty acids and should discuss this with their doctors.

Other nonfish food options that do contain some omega-3 fatty acids include flaxseed, flaxseed oil, walnuts, canola oil, soybeans and soybean oil. However, similar to supplements, the evidence of heart-healthy benefits from eating these foods isn’t as strong as it is from eating fish.

Cholesterol (Hyperlipidemia): Statins: Are these cholesterol-lowering drugs right for you?

Cholesterol (Hyperlipidemia)

Statins: Are these cholesterol-lowering drugs right for you?

Should you be on a statin? These cholesterol-lowering drugs have benefits and risks. Find out whether your risk factors for heart disease make you a good candidate for statin therapy.

Statins are drugs that can lower your cholesterol. They work by blocking a substance your body needs to make cholesterol. Statins may also help your body reabsorb cholesterol that has built up in plaques on your artery walls, preventing further blockage in your blood vessels and heart attacks.

Statins include well-known medications such as atorvastatin (Lipitor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and others. Lower cost generic versions of many statin medications are available.

Already shown to be effective in lowering cholesterol, statins may have other potential benefits. But doctors are far from knowing everything about statins. Are they right for everybody with high cholesterol? What happens when you take a statin for decades? Can statins help prevent other diseases?

Should you be on a statin?

Whether you need to be on a statin depends on your cholesterol level along with your other risk factors for cardiovascular disease.

High cholesterol

If you have high cholesterol, meaning your total cholesterol level is 240 milligrams per deciliter, or mg/dL, (6.22 millimoles per liter, or mmol/L) or higher, or your “bad” cholesterol (LDL) level is 130 mg/dL (3.68 mmol/L) or higher, your doctor may recommend you begin to take a statin. But the numbers alone won’t tell you or Dr. Houston the whole story.

If the only risk factor you have is high cholesterol, you may not need medication because your risk of heart attack and stroke could otherwise be low. High cholesterol is only one of a number of risk factors for heart attack and stroke.

Other risk factors

Before you’re prescribed a statin, your cholesterol level is considered along with other risk factors for cardiovascular disease, including:

  • Family history of high cholesterol or cardiovascular disease
  • Inactive (sedentary) lifestyle
  • High blood pressure
  • Age older than 55 if you’re a man, or older than 65 if you’re a woman
  • Poor general health
  • Having diabetes
  • Overweight or obesity
  • Smoking
  • Narrowing of the arteries in your neck, arms or legs (peripheral artery disease)

If Dr. Houston decides you should take a statin, you and Dr. Houston will have to decide what dose to take. Statins come in varied doses — from as low as 5 milligrams to as much as 80 milligrams, depending on the medication. If you need to decrease your LDL cholesterol significantly — by 50 percent or more — it’s likely you’ll be prescribed a higher dose of statins. If your LDL cholesterol isn’t as high, you’ll likely need a lower dose. Talk to Dr. Houston if you have concerns about the amount of statins you’re taking.

Lifestyle is still key for lowering cholesterol

Lifestyle changes are essential for reducing your risk of heart disease, whether you take a statin or not. Lifestyle changes you should consider making include:

  • Quitting smoking
  • Eating a healthy diet that’s low in fat, cholesterol and salt
  • Exercising 30 minutes a day on most days of the week
  • Managing stress

If you’re following the recommended lifestyle behaviors but your cholesterol — particularly your low-density lipoprotein (LDL, or “bad”) cholesterol — remains high, statins might be an option for you. Risk factors for heart disease and stroke are:

  • High cholesterol
  • High blood pressure
  • Diabetes
  • Being overweight or obese
  • Family history of heart disease
  • Not exercising
  • Heavy alcohol use
  • Poor stress and anger management
  • Older age
  • Smoking
  • Narrowing of the arteries in your neck, arms or legs (peripheral artery disease)

Consider statins a lifelong commitment

You may think that once your cholesterol goes down, you can stop taking medication. But, if your cholesterol levels have decreased after you take a statin, you’ll likely need to stay on it indefinitely. If you stop taking it, your cholesterol levels will probably go back up.

The exception may be if you make significant changes to your diet or lose a lot of weight. Substantial lifestyle changes may help you lower your cholesterol without continuing to take the medication, but don’t make any changes to your lifestyle or medications without talking to your doctor first.

The side effects of statins

Although statins are well tolerated by most people, they do have side effects, some of which may go away as your body adjusts to the medication.

Common, less serious side effects

  • Muscle and joint aches (most common)
  • Nausea
  • Diarrhea
  • Constipation

Potentially serious side effects

  • Liver damage. Occasionally, statin use causes an increase in liver enzymes. If the increase is only mild, you can continue to take the drug. If the increase is severe, you may need to stop taking it, which usually reverses the problem. If left unchecked, increased liver enzymes can lead to permanent liver damage. Certain other cholesterol-lowering drugs, such as gemfibrozil (Lopid) and niacin, increase the risk of liver problems even more in people who take statins. Because liver problems may develop without symptoms, people who take statins have a blood test six weeks after starting a statin medication to check their liver function. After that, your doctor may recommend yearly blood tests.
  • Muscle problems. Statins may cause muscle pain and tenderness (statin myopathy). The higher the dose of statin you take, the more likely you are to have muscle pains. In severe cases, muscle cells can break down (rhabdomyolysis) and release a protein called myoglobin into the bloodstream. Myoglobin can damage your kidneys. Certain drugs when taken with statins can increase the risk of rhabdomyolysis. These include gemfibrozil, erythromycin (Erythrocin), antifungal medications, nefazodone, cyclosporine and niacin. If you take statins and have new muscle aching or tenderness, check with your doctor.

It’s important to consider the effects of statins on other organs in your body, especially if you have health problems such as liver or kidney disease. Also, check whether statins interact with any other prescription or over-the-counter drugs or supplements you take.

Keep in mind that when you begin to take a statin, you’ll most likely be on it for the rest of your life. Side effects are often minor, but if you experience them, you may want to talk to your doctor about decreasing your dose or trying a different statin. Don’t stop taking a statin without talking to Dr. Houston first.

Are there other options?

Statins effectively reduce “bad” cholesterol (LDL). But, because of genetic differences, the type or dose of statin or combination of statins with other cholesterol-lowering drugs each person takes can vary. For example:

  • If you are not able to lower your LDL to the desired goal using statin medication, your doctor may add ezetimibe (Zetia) to your treatment plan or switch to a combination ezetimibe and simvastatin medication (Vytorin). This combination will help drop your LDL level further, perhaps even another 15 to 20 percent.
  • If you have both high LDL and high triglycerides, you may benefit from combining the statin with prescription niacin (Niaspan, Niacor) or combining the statin with a fibric acid drug such as fenofibrate (TriCor) or gemfibrozil (Lopid). The risk of muscle problems is higher when these medications are paired, so your dose of statins may be lowered to less than 20 milligrams (mg).
  • If you have just high triglycerides, use of niacin (Niaspan, Niacor) is very effective. Fibric acid agents (TriCor and Lopid) are another option. Fish oil (omega-3 fatty acid) supplements (Lovaza) in 2- to 4-gram doses also can help.
  • If your high-density lipoprotein (HDL) cholesterol is low, niacin might be the best choice to raise it. Fibric acids also are useful but less effective than niacin. Exercise and weight loss may help, as well.
  • If your doctor recommends niacin in addition to a statin, you might want to discuss taking a medication that combines both niacin and a statin, such as Simcor or Advicor. These medications can reduce the number of pills you have to take. However, that may be the only benefit. Research hasn’t shown that the combination drugs lower cholesterol more than does taking niacin and a statin separately.

What if taking a statin doesn’t lower your cholesterol?

If a statin doesn’t help lower your cholesterol, Dr. Houston may first suggest trying a different statin or increasing the dose of the statin you currently take. In some cases, one medication may simply not be effective and a different drug must be substituted.

Your doctor may also add other medications, or may suggest that you make more lifestyle changes to help lower your cholesterol.

What other benefits do statins have?

Researchers think statins may have benefits other than just lowering your cholesterol. One promising benefit of statins appears to be their anti-inflammatory properties, which help stabilize the lining of blood vessels. This has potentially far-reaching effects, from the brain and heart, to blood vessels and organs throughout the body.

In the heart, stabilizing the blood vessel linings would make plaques less likely to rupture, thereby reducing the chance of a heart attack. Statins also help relax blood vessels, lowering blood pressure. In addition, statins could reduce your risk of blood clots. For these reasons, doctors are now beginning to prescribe statins before and after coronary artery bypass surgery or angioplasty, and following certain types of strokes.

Statins could also have benefits that help prevent diseases that aren’t related to your heart health, although more research is necessary. Other benefits of statins could include a reduced risk of:

  • Arthritis and bone fractures
  • Some forms of cancer
  • Dementia and Alzheimer’s disease
  • Kidney disease

Statins may also be helpful in controlling the body’s immune system response after an organ transplant.

Weighing the risks and benefits of statins

When thinking about whether you should take statins for high cholesterol, ask yourself these questions:

  • Do I have other risk factors for cardiovascular disease?
  • Am I willing and able to make lifestyle changes to improve my health?
  • Am I concerned about taking a pill every day, perhaps for the rest of my life?
  • Am I concerned about statins’ side effects or interactions with other drugs?

It’s important to take into account not only your medical reasons for a decision, but also your personal values and concerns. Talk to Dr. Houston about your total risk of cardiovascular disease and discuss how your lifestyle and preferences play a role in your decision about taking medication for high cholesterol.

Exercise: ABCT Exercise Program

Exercise

ABCT Exercise Program

Aerobics, Build, Contour and Tone Exercise Program

The ABCT Exercise Program has numerous positive effects on body and mind, much more than the typical aerobic-based programs.  Among other things, it:

  • Reduces risk of heart disease and heart attack, and lowers risk of recurrent heart attack
  • Improves heart function
  • Lowers blood pressure and reduces risk of developing hypertension
  • Reduces total cholesterol, triglycerides, and LDL
  • Increases HDL
  • Reduces body weight and body fat
  • Reduces clotting tendencies
  • Lowers blood sugar and decreases risk of diabetes
  • Improves insulin sensitivity
  • Improves all abnormalities of metabolic syndrome
  • Improves immune function
  • Reduces risk of stroke Reduces risk of certain cancers, such as colon, breast, and prostate
  • Improves memory and focus and reduces risk of Alzheimer’s Disease, disease and dementia
  • Improves skin tone and, elasticity and decreases wrinkles
  • Improves depression, stress, and anxiety, and overall psychological well-being
  • Improves sleep

ABCT stands for Aerobics, Build, Contour, and Tone. It has additional meanings that help define its goals:
A = Aerobics, plus action and adaptation. The program focuses on the types of action best suited for muscle and cardiovascular conditioning. You will adapt to new exercises so your muscles do not accommodate or become “used to” to the same daily training.

B = Build, plus bulk, burn, and breathe. The program builds and increases muscle strength more than any other exercise regimen you have tried before. (Males will build bulk, while women generally do not increase bulk but will instead tone, firm, and sculpture, due to hormonal differences.) You’ll use the muscle burn to best advantage. And with proper breathing, you’ll increase oxygen consumption while removing carbon dioxide to improve cardiovascular and muscle conditioning and function, while reducing fatigue.

C = Contour, plus core and controlling your genes, and core. Muscular exercise regulates the expression of over more than four hundred 400 genes that mediate the beneficial effects of physical activity. In addition to aerobics and resistance exercise, you will practice core exercises that improve abdominal and back muscular strength while increasing flexibility and balance.

T = Tone, plus trim and tight. You will trim away total fat, as well as central or visceral body fat, lose weight, and increase your lean muscle mass. Your muscles, subcutaneous tissue, and skin will become tight and look more youthful.

Here are the main elements of ABCT:

  • Resistance Training – Weight lifting modified to encourage the muscles to “talk” to the body in such a way as to encourage better heart and full-body health. ABCT uses graduated weights and variable repetitions. In brief, lift the heaviest weight you can twelve times to get the burn, then decrease the weight with each subsequent set—but keep increasing the number of times you lift that weight. This is done using FIVE variable weights and repetitions as follows:
  • For example if you do a bench press at 100 pounds for 12 repetitions then do the following sequence with a 60 second rest between each set
  • 75% of first weight or 75 lbs for 18 reps
  • 50% of first weight or 50 lbs for 24 reps
  • 25% of first weight or 25 lbs for 50 reps
  • 100 % of first weight or 25 lbs for 50 reps

This maximizes post exercise oxygen consumption, depletes glycogen, and increases the production of lactic acid to achieve all the muscle-, hormone-, cytokine-, and interleukin-stimulating effects that lead to the health benefits of exercise.

Aerobic Training in Intervals – Jogging, swimming, biking and other forms of continual movement that set the heart beating at an elevated rate and keep it there for a predetermined amount of time. However, the standard approach—keeping the heart beating at a certain elevated rate for twenty, thirty, or even sixty minutes—is faulty. The best technique is aerobic interval training, which consists of short periods ranging from twenty to sixty seconds of “burst” aerobic training at 80 to 90 percent of your maximal aerobic capacity (MAC) or heart rate for your age then dropping to 50% of the maximal aerobic capacity (MAC) or heart rate for three times the length of the initial burst of activity. You then repeat this six times., The length of your burst of activity and resting period will depend on your present level of exercise conditioning.  For example if you run for 20 seconds at 80 % MAC then you would do 60 seconds at 50% MAC.This more closely mimics the natural activities we evolved to perform and benefit from and strings together several periods of intense and semi-intense activity into a single, longer exercise period that still burns calories and builds endurance.

Proper Ratio of Aerobic Training to Resistance Training – The optimal ratio of resistance to interval aerobic training should be 2:1. For example, during a sixty-minute workout, you would perform forty minutes of resistance training and twenty minutes of interval aerobics, with the aerobics coming after the resistance training.  This should be done at least 4 days per week but daily is the best to achieve cardiovascular conditioning and optimal body composition with  increases in lean muscle mass and reduction in body fat.

Exercise: Belly Fat in Women: Keeping It Off

Exercise

Belly Fat in Women: Keeping It Off

What does your waistline say about your health? Find out why belly fat is more common after menopause, what dangers it poses – and what to do about it.

An expanding waistline is sometimes considered the price of getting older. For women, this might be especially true after menopause, when body fat tends to shift from the arms, legs and hips to the abdomen. Yet an increase in belly fat can do more than make it hard to zip up your jeans. Research indicates that belly fat also increases the risk of cardiovascular disease, diabetes, certain cancers – even premature death. The good news? The threats posed by belly fat can be cut down to size.

What’s behind belly fat?

Your weight is largely determined by how you balance the calories you eat with the energy you burn. If you eat too much and exercise too little, you’re likely to pack on excess pounds – including belly fat. However, aging also plays a role. Muscle mass gradually diminishes with age, and fat accounts for a greater percentage of your weight. Less muscle mass also decreases the rate at which your body uses calories, which can make it more challenging to maintain a healthy weight or lose excess pounds.

In addition, many women notice an increase in belly fat as they get older – even if they aren’t gaining weight. This is likely due to a decreasing level of estrogen, which appears to influence where fat is distributed in the body. The tendency to gain or carry weight around the waist – have an “apple” rather than a “pear” shape – can have a genetic component as well.

Why belly fat is more than skin deep

The trouble with belly fat is that it’s not limited to the extra layer of padding located just below the skin (subcutaneous fat). It also includes visceral fat – which lies deep inside your abdomen, surrounding your internal organs.

Although subcutaneous fat poses cosmetic concerns, visceral fat is associated with far more dangerous health consequences. That’s because an excessive amount of visceral fat produces hormones and other substances that can raise blood pressure, negatively alter good and bad cholesterol levels and impair the body’s ability to use insulin (insulin resistance). An excessive amount of any fat, including visceral fat, also boosts estrogen levels. All of this can increase the risk of serious health problems, including:

  • Cardiovascular disease
  • Stroke
  • Type 2 diabetes
  • Breast cancer
  • Colorectal cancer

Recent research also has associated belly fat with an increased risk of premature death – regardless of overall weight. In fact, some studies have found that even when women were considered a normal weight based on standard body mass index (BMI) measurements, a large waistline increased the risk of dying of cardiovascular disease, cancer and other causes.

Measuring your middle

So how do you know if you have too much belly fat? Simply measure your waist:

  • Place a tape measure around your bare stomach, just above your hipbone.
  • Pull the tape measure until it fits snugly around you, but doesn’t push into your skin.
  • Make sure the tape measure is level all the way around.
  • Relax, exhale and measure your waist, resisting the urge to suck in your stomach.

For women, a waist measurement of 35 inches (89 centimeters) or more indicates an unhealthy concentration of belly fat and a greater risk of problems such as heart disease, high blood pressure and type 2 diabetes. For men, a waist measurement of 40 inches (102 centimeters) or more is considered cause for concern.

Trimming the fat

You can tone abdominal muscles with crunches or other targeted abdominal exercises, but these exercises won’t get rid of belly fat. Fortunately, however, visceral fat responds to the same diet and exercise strategies that can help you shed excess pounds and lower your total body fat. To fight back the bulge, stick to the basics:

  • Eat a healthy diet. Emphasize plant-based foods, such as fruits, vegetables and whole grains, and choose lean sources of protein and low-fat dairy products. Limit saturated fat, found in meat and high-fat dairy products, such as cheese and butter. Choose moderate amounts of monounsaturated and polyunsaturated fats – found in fish, nuts and certain vegetable oils – instead.
  • Keep portion sizes in check. Even when you’re making healthy choices, calories add up. At home, slim down your portion sizes. In restaurants, share meals – or eat half your meal and take the rest home for another day.
  • Include physical activity in your daily routine. For most healthy adults, the Department of Health and Human Services recommends moderate aerobic activity, such as brisk walking, for at least 150 minutes a week or vigorous aerobic activity, such as jogging, for at least 75 minutes a week. In addition, strength training exercises are recommended at least twice a week. If you want to lose weight or meet specific fitness goals, you may need to exercise more.

To lose excess fat and keep it from coming back, aim for slow and steady weight loss – up to 2 pounds (1 kilogram) a week. Consult Dr. Houston for help getting started and staying on track. Your patience and effort will pay off in a lifetime of better health.

Exercise: Benefits of Regular Exercise on the Endothelium

Exercise

Benefits of Regular Exercise on the Endothelium

Engaging in regular exercise is absolutely one of the best things you can do for your cardiovascular health, and the function of your endothelium. Even though most people know about the benefits of exercise on their overall health, the majority still do not incorporate physical activity into their lives. It is true that there are fewer opportunities to be active with regards to occupational choices, and the many advancements in technology allow us to perform tasks that used to require more physical exertion in much easier ways. However, there are also many more ways to get the necessary levels of exercise we need through our leisure and recreational activities. Also, there is more accessibility to health clubs and fitness centers than ever before. If joining a workout facility does not suit you or your finances, there are more types of home workout equipment than ever before.

According to the American Council on Exercise (ACE), approximately 88 million Americans are inactive. In 1997, only 22 percent of americans engaged in enough physical activity to see some benefit. The Centers for Disease Control (CDC) was so concerned about the 34 percent of population over 50 that was sedentary, that in 2001 they published theNational Blueprint: Increasing Physical Activity Among Adults Aged 50 and older, a report that strongly recommends that this group of people boost its amount of exercise. People who are physically active have less risk for breast, prostate, and colon cancer. They also experience an increase in insulin sensitivity and improved carbohydrate metabolism.

The problem of inactivity is extending to our children, who are more overweight than any generation. In 1999, researchers found that 60 percent of children between the age of 5 and 10 had at least one risk for heart disease. This rise in children at risk is largely due to less physical activity and increased body weight.

Regular exercise improves overall health, and aerobic exercise in particular, is the best way to improve your cardiovascular health. Brisk walking, jogging, jumping rope, cross-country skiing, swimming, biking are all examples of aerobic exercise. All these activities require vigorous and sustained use of your large muscle groups.

The following guidelines are helpful in determining the intensity and length of your aerobic sessions.

Your maximum heart rate is determined as follows:

220 – your age = maxium heart rate

This number represents your approximate heart rate if you were exercising at your highest level. This is an important number for determining a safe, yet challenging, Target Heart Rate for your particular fitness level. Your Target Heart Rate is the heart rate you should try to reach during aerobic exercise for at least 20 minutes.

For individuals who are already active, determine your maximum heart rate and then multiply that number by 75 percent. This is your Target Heart Rate. This range will provide the most benefit for your heart, lungs, and circulatory system.

If you have been sedentary, but feel good otherwise, multiply your maximum heart rate by 60 percent for your Target Heart Rate. Once you have been exercising at this level for a few weeks, gradually increase your heart rate until you are up to 75 percent of your maximum heart rate.

If you are over 65, there are a few other considerations to follow. If you have been sedentary, a heart rate of 100 would be a good target to aim for. As you become more fit, increase your heart rate to around 115. If you are fit and over 65, you may be able to exercise at a higher heart rate than this level.

If you are at risk for cardiovascular disease, or already have symtpoms, you should consult with a physician before starting an exercise program. An EKG-monitored treadmill test may be necessary to determine a safe level of exercise.

If you are already physically fit, performing vigorous aerobic exercise for at least 30 minutes three to four times per week is advised, with a Target Heart Rate of 75 percent of your maximum. You can also receive some benefit from more moderate activity for 30 minutes, but not to as great an extent. If you have been sedentary or are unable to perform vigorous exercise, you should just try to do as much moderate level exercise as possible. Even small amounts can help lower the risk of cardiovascular disease. If possible, try to walk at least 30 minutes per day.

Aerobic exercise has metabolic benefits that help prevent heart disease. It reduces LDL (bad) cholesterol and increases HDL (bad) cholesterol. It also lowers your blood sugar to healthy levels, and lowers blood pressure and heart rate. Aerobic exercise is one of the best methods for burning calories, and in so doing, lowering your body fat percentage. This is especially important because being overweight is a risk factor for several types of disease, including heart disease, high blood pressure, stroke, and diabetes.

The two other types of exercise are strength training and stretching to improve flexibility. While the best type of exercise to improve your cardiovascular health is aerobic exercise, both strength training and stretching for flexibility are very important for your overall health and well-being. Strength training is important for maintaining and building muscle mass and muscle tone. Weight training also strengthens your bones and decreases the chances of osteoporosis. It also decreases your chances of developing adult-onset diabetes (type II diabetes), and like aerobic exercise, increases your HDL cholesterol level. Stretching to improve flexibility is also very important for your overall health and fitness. As you get older, muscles begin to tighten and range of motion is decreased. Stretching will help lengthen your muscles, helping make day-to-day activities much easier. Increased flexibility also improves circulation, which can provide many benefits for all body systems. Increased range of motion also decreases injuries by allowing your joints to move further before an injury occurs.

Like all other muscles, the heart needs to be exercised for maximum performance. If your heart is stronger, it does not have to work as hard to pump blood and oxygen throughout your body. The reduced chance of heart attack by people who exercise regularly has been well documented in a number of studies. The Honolulu Heart Program, begun in 1965 by the National Heart, Lung, and Blood Institute, carefully monitored 8,000 Hawaiian men of Japanese ancestry for 30 years. The researchers found that retired men who walked two miles per day had half the risk for serious heart disease than those who were sedentary.

Aerobic exercise improves your heart and blood vessel health by directly benefitting the endothelium. Being active is one of the best ways to restore the health of the endothelium. Exercise improves blood flow through your vessels. The endothelium senses the increased flow and responds by producing more of the enzyme NO synthase, which in turn produces more nitric oxide. When your endothelial cells are exposed to long-term increases in blood flow, they become more like Teflon and less like Velcro. This makes white blood cells and platelets less likely to stick to blood vessel walls, and reduces the chance of plaque build-up.

Exercise also increases the diameter of your blood vessels. The first to notice this benefit was the great cardiac pathologist Paul Wood about 60 years ago when he performed an autopsy on an old marathon runner who had died of cancer. Dr. Wood noticed that the marathon runner’s coronary arteries were two to three times the size of a normal man.

A paper published in the journal Circulation in 2000, Italian researchers examined whether the impairment of the endothelium – which had been described as part of the aging process – can be minimized by regular physical activity. The health of the endothelial cells was evaluated in older people (average age 64) who exercised, compared to much younger individuals (average age 28). The older people had blood vessels that were as healthy as those of the younger group. Researchers concluded that “regular physical training protects the vascular endothelium from aging-related alterations.” They added that this positive effect of exercise is “related to preservation of NO availability.”

Exercise: Menopause Weight Gain - Stop the Middle Age Spread

Exercise

Menopause weight gain: Stop the middle age spread

Most women gain weight as they age, but excess pounds aren’t inevitable. To minimize menopause weight gain, step up your activity level and enjoy a healthy diet.

As you get older, you may notice that maintaining your usual weight becomes more difficult. In fact, the most profound weight gain in a woman’s life tends to happen during the years leading up to menopause (perimenopause). Weight gain after menopause isn’t inevitable, however. You can reverse course by paying attention to healthy-eating habits and leading an active lifestyle.

What causes menopause weight gain?

The hormonal changes of menopause may make you more likely to gain weight around your abdomen, rather than your hips and thighs. Hormonal changes alone don’t necessarily trigger weight gain after menopause, however. Instead, the weight gain is usually related to a variety of lifestyle and genetic factors.

For example, menopausal women tend to exercise less than other women, which can lead to weight gain. In addition, muscle mass naturally diminishes with age. If you don’t do anything to replace the lean muscle you lose, your body composition will shift to more fat and less muscle – which slows down the rate at which you burn calories. If you continue to eat as you always have, you’re likely to gain weight.

For many women, genetic factors play a role in weight gain after menopause. If your parents or other close relatives carry extra weight around the abdomen, you’re likely to do the same. Sometimes, factors such as children leaving – or returning – home, divorce, the death of a spouse or other life changes may contribute to weight gain after menopause. For others, a sense of contentment or simply letting go leads to weight gain.

How risky is weight gain after menopause?

Weight gain after menopause can have serious implications for your health. Excess weight increases the risk of high cholesterol, high blood pressure and type 2 diabetes. In turn, these conditions increase the risk of heart disease and stroke. Excess weight also increases the risk of various types of cancer, including colorectal cancer and breast cancer. In fact, some research suggests that gaining as little as 4.4 pounds (2 kilograms) at age 50 or later could increase the risk of breast cancer by 30 percent.

What’s the best way to prevent weight gain after menopause?

There’s no magic formula for preventing – or reversing – weight gain after menopause. Simply stick to weight-control basics:

  • Move more. Aerobic activity can help you shed excess pounds or simply maintain a healthy weight. Strength training counts, too. As you gain muscle, your body burns calories more efficiently – which makes it easier to control your weight. As a general goal, include at least 30 minutes of physical activity in your daily routine and do strength training exercises at least twice a week. If you want to lose weight or meet specific fitness goals, you may need to increase your activity even more.
  • Eat less. To maintain your current weight – let alone lose excess pounds – you may need about 200 fewer calories a day during your 50s than you did during your 30s and 40s. To reduce calories without skimping on nutrition, pay attention to what you’re eating and drinking. Choose more fruits, vegetables and whole grains. Opt for lean sources of protein. Don’t skip meals, which may lead you to overeat later.
  • Seek support. Surround yourself with friends and loved ones who’ll support your efforts to eat a healthy diet and increase your physical activity. Better yet, team up and make the lifestyle changes together.

The bottom line? Successful weight loss at any stage of life requires permanent changes in diet and exercise habits. Take a brisk walk every day. Try a yoga class. Trade cookies for fresh fruit. Share restaurant meals with a friend. Commit to the changes and enjoy a healthier you!

Exercise: Strength Training: Get Stronger, Leaner, Healthier

Exercise

Strength Training: Get Stronger, Leaner, Healthier

Strength training is an important part of an overall fitness program. Here’s what strength training can do for you – and how to get started.

You know exercise is good for you. Ideally, you’re looking for ways to incorporate physical activity into your daily routine. If your aerobic workouts aren’t balanced by a proper dose of strength training, though, you’re missing out on a key component of overall health and fitness. Despite its reputation as a “guy” or “jock” thing, strength training is important for everyone. With a regular strength training program, you can reduce your body fat, increase your lean muscle mass and burn calories more efficiently.

Use It or Lose It

Muscle mass naturally diminishes with age.   According to Dr. Houston, “If you don’t do anything to replace the lean muscle you lose, you’ll increase the percentage of fat in your body,” but strength training can help you preserve and enhance your muscle mass – at any age.”

Strength training also helps you:

  • Develop strong bones. By stressing your bones, strength training increases bone density and reduces the risk of osteoporosis.
  • Control your weight. As you gain muscle, your body gains a bigger “engine” to burn calories more efficiently – which can result in weight loss. The more toned your muscles, the easier it is to control your weight.
  • Reduce your risk of injury. Building muscle helps protect your joints from injury. It also contributes to better balance, which can help you maintain independence as you age.
  • Boost your stamina. As you get stronger, you won’t fatigue as easily.
  • Manage chronic conditions. Strength training can reduce the signs and symptoms of many chronic conditions, including arthritis, back pain, depression, diabetes, obesity and osteoporosis.
  • Sharpen your focus. Some research suggests that regular strength training helps improve attention for older adults.

Consider the Options

Strength training can be done at home or in the gym. Consider the options:

  • Body weight. You can do many exercises with little or no equipment. Try push-ups, pull-ups, abdominal crunches and leg squats.
  • Resistance tubing. Resistance tubing is inexpensive, lightweight tubing that provides resistance when stretched. You can choose from many types of resistance tubes in nearly any sporting goods store.
  • Free weights. Barbells and dumbbells are classic strength training tools.
  • Weight machines. Most fitness centers offer various resistance machines. You can also invest in weight machines for use at home.

Getting Started

When you have your doctor’s OK to begin a strength training program, start slowly. Warm up with five to 10 minutes of stretching or gentle aerobic activity, such as brisk walking. Then choose a weight or resistance level heavy enough to tire your muscles after about 12 repetitions.

“On the 12th repetition, you should be just barely able to finish the motion,” Dr. Houston says. “When you’re using the proper weight or amount of resistance, you can build and tone muscle just as efficiently with a single set of 12 repetitions as you can with more sets of the same exercise.”

To give your muscles time to recover, rest one full day between exercising each specific muscle group. When you can easily do more than 15 repetitions of a certain exercise, gradually increase the weight or resistance. Remember to stop if you feel pain. Although mild muscle soreness is normal, sharp pain and sore or swollen joints are signs that you’ve overdone it.

When to Expect Results

You don’t need to spend hours a day lifting weights to benefit from strength training. Two to three strength training sessions a week lasting just 20 to 30 minutes are sufficient for most people. You may enjoy noticeable improvements in your strength and stamina in just a few weeks. With regular strength training, you’ll continue to increase your strength – even if you’re not in shape when you begin.

Strength training can do wonders for your physical and emotional well-being. Make it part of your quest for better health.

Hypertension: Definition of Hypertension

Hypertension

Definition of Hypertension

High blood pressure is a common condition in which the force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease.

Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

You can have high blood pressure (hypertension) for years without any symptoms. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

High blood pressure typically develops over many years, and it affects nearly everyone eventually. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms typically don’t occur until high blood pressure has reached a severe – even life-threatening – stage.

When to see a doctor

You’ll likely have your blood pressure taken as part of a routine doctor’s appointment.

Ask your doctor for a blood pressure reading at least every two years starting at age 20. He or she will likely recommend more frequent readings if you’ve already been diagnosed with high blood pressure or other risk factors for cardiovascular disease. Children age 3 and older will usually have their blood pressure measured as a part of their yearly checkups.

If you don’t regularly see your doctor, you may be able to get a free blood pressure screening at a health resource fair or other locations in your community. You can also find machines in some stores that will measure your blood pressure for free, but these machines can give you inaccurate results.

There are two types of high blood pressure.

Primary (essential) hypertension

For most adults, there’s no identifiable cause of high blood pressure. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.

Secondary hypertension

Some people have high blood pressure caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions and medications can lead to secondary hypertension, including:

  • Kidney problems
  • Adrenal gland tumors
  • Certain defects in blood vessels you’re born with (congenital)
  • Certain medications, such as birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs
  • Illegal drugs, such as cocaine and amphetamines

High blood pressure has many risk factors, including:

  • Age. The risk of high blood pressure increases as you age. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.
  • Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks.
  • Family history. High blood pressure tends to run in families.
  • Being overweight or obese. The more you weigh, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
  • Not being physically active. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction – and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
  • Using tobacco. Not only does smoking or chewing tobacco immediately raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls. This can cause your arteries to narrow, increasing your blood pressure. Secondhand smoke can also increase your blood pressure.
  • Too much salt (sodium) in your diet. Too much sodium in your diet can cause your body to retain fluid, which increases blood pressure.
  • Too little potassium in your diet. Potassium helps balance the amount of sodium in your cells. If you don’t get enough potassium in your diet or retain enough potassium, you may accumulate too much sodium in your blood.
  • Too little vitamin D in your diet. It’s uncertain if having too little vitamin D in your diet can lead to high blood pressure. Vitamin D may affect an enzyme produced by your kidneys that affects your blood pressure.
  • Drinking too much alcohol. Over time, heavy drinking can damage your heart. Having more than two or three drinks in a sitting can also temporarily raise your blood pressure, as it may cause your body to release hormones that increase your blood flow and heart rate.
  • Stress. High levels of stress can lead to a temporary, but dramatic, increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only increase problems with high blood pressure.
  • Certain chronic conditions. Certain chronic conditions also may increase your risk of high blood pressure, including high cholesterol, diabetes, kidney disease and sleep apnea.

Sometimes pregnancy contributes to high blood pressure, as well.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits – such as an unhealthy diet and lack of exercise – contribute to high blood pressure.

The excessive pressure on your artery walls caused by high blood pressure can damage your blood vessels, as well as organs in your body. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to:

  • Heart attack or stroke. High blood pressure can cause hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack, stroke or other complications.
  • Aneurysm. Increased blood pressure can cause your blood vessels to weaken and bulge, forming an aneurysm. If an aneurysm ruptures, it can be life-threatening.
  • Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body’s needs, which can lead to heart failure.
  • Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
  • Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
  • Metabolic syndrome. This syndrome is a cluster of disorders of your body’s metabolism – including increased waist circumference, high triglycerides, low high-density lipoprotein (HDL), or “good,” cholesterol, high blood pressure, and high insulin levels. If you have high blood pressure, you’re more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.
  • Trouble with memory or understanding. Uncontrolled high blood pressure also may affect your ability to think, remember and learn. Trouble with memory or understanding concepts is more common in people who have high blood pressure.

Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

Blood pressure measurements fall into four general categories:

  • Normal blood pressure. Your blood pressure is normal if it’s below 120/80 mm Hg. However, some doctors recommend 115/75 mm Hg as a better goal. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
  • Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg. Prehypertension tends to get worse over time.
  • Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 mm Hg or a diastolic pressure ranging from 90 to 99 mm Hg.
  • Stage 2 hypertension. More severe hypertension, stage 2 hypertension is a systolic pressure of 160 mm Hg or higher or a diastolic pressure of 100 mm Hg or higher.

Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more significant. Isolated systolic hypertension (ISH) – when diastolic pressure is normal but systolic pressure is high – is the most common type of high blood pressure among people older than 50.

Your doctor will likely take two to three blood pressure readings each at two or more separate appointments before diagnosing you with high blood pressure. This is because blood pressure normally varies throughout the day – and sometimes specifically during visits to the doctor, a condition called white-coat hypertension. Your doctor may ask you to record your blood pressure at home and at work to provide additional information.

If you have any type of high blood pressure, your doctor may recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram (ECG) – a test that measures your heart’s electrical activity. Your doctor may also recommend additional tests, such as a cholesterol test, to check for more signs of heart disease.

Taking your blood pressure at home

An important way to check if your blood pressure treatment is working, or to diagnose worsening high blood pressure, is to monitor your blood pressure at home. Home blood pressure monitors are widely available, and you don’t need a prescription to buy one. Talk to your doctor about how to get started.

Your blood pressure treatment goal depends on how healthy you are.

Blood pressure treatment goals*
140/90 mm Hg or lower If you are a healthy adult
130/80 mm Hg or lower If you have chronic kidney disease, diabetes or coronary artery disease or are at high risk of coronary artery disease
120/80 mm Hg or lower If your heart isn’t pumping as well as it should (left ventricular dysfunction or heart failure) or you have severe chronic kidney disease

*Although 120/80 mm Hg or lower is the ideal blood pressure goal, doctors are unsure if you need treatment (medications) to reach that level.

If you’re an adult age 80 or older and your blood pressure is very high, your doctor may set a target blood pressure goal for you that’s slightly higher than 140/90 mm Hg.

Changing your lifestyle can go a long way toward controlling high blood pressure. But sometimes lifestyle changes aren’t enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure. Which category of medication your doctor prescribes depends on your stage of high blood pressure and whether you also have other medical problems.

Medications to treat high blood pressure

  • Thiazide diuretics. Diuretics, sometimes called “water pills,” are medications that act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first – but not the only – choice in high blood pressure medications. If you’re not taking a diuretic and your blood pressure remains high, talk to your doctor about adding one or replacing a drug you currently take with a diuretic.
  • Beta blockers. These medications reduce the workload on your heart and open your blood vessels, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don’t work as well in blacks or in the elderly – but they’re effective when combined with a thiazide diuretic.
  • Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels.
  • Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action – not the formation – of a natural chemical that narrows blood vessels.
  • Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks and older adults than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Talk to your doctor or pharmacist if you’re concerned about interactions.
  • Renin inhibitors. Aliskiren (Tekturna) slows down the production of renin, an enzyme produced by your kidneys that starts a chain of chemical steps that increases blood pressure. Tekturna works by reducing the ability of renin to begin this process.

If you’re having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

  • Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
  • Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
  • Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
  • Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.

Once your blood pressure is under control, your doctor may have you take a daily aspirin to reduce your risk of cardiovascular disorders.

To reduce the number of daily medication doses you need, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication – or combination of drugs – is a matter of trial and error.

Lifestyle changes to treat high blood pressure

No matter what medications your doctor prescribes to treat your high blood pressure, you’ll need to make lifestyle changes to lower your blood pressure. These changes usually include eating a healthier diet with less salt (the Dietary Approaches to Stop Hypertension, or DASH, diet), exercising more, quitting smoking and losing weight.

Resistant hypertension: When your blood pressure is difficult to control

If your blood pressure remains stubbornly high despite taking at least three different types of high blood pressure drugs, one of which should be a diuretic, you may have resistant hypertension. Resistant hypertension is blood pressure that’s resistant to treatment. People who have controlled high blood pressure but are taking four different types of medications at the same time to achieve that control also are considered to have resistant hypertension.

Having resistant hypertension doesn’t mean your blood pressure will never get lower. In fact, if you and your doctor can identify what’s behind your persistently high blood pressure, there’s a good chance you can meet your goal with the help of treatment that’s more effective.

Your doctor or hypertension specialist can evaluate whether the medications and doses you’re taking for your high blood pressure are appropriate. You may have to fine-tune your medications to come up with the most effective combination and doses.

In addition, you and your doctor can review medications you’re taking for other conditions. Some medications, foods or supplements can worsen high blood pressure or prevent your high blood pressure medications from working effectively. Be open and honest with your doctor about all the medications or supplements you take.

If you don’t take your high blood pressure medications exactly as directed, your blood pressure can pay the price. If you skip doses because you can’t afford the medication, because you have side effects or because you simply forget to take your medications, talk to your doctor about solutions. Don’t change your treatment without your doctor’s guidance.

Hypertension: Oxygen Radicals and Their Destructive Forces

Hypertension

Oxygen Radicals and Their Destructive Forces

Oxygen radicals are the most common type of free radicals in the body. There are several types of these oxygen-derived free radicals, including superoxide radicals, hydroxyl radicals, hypochlorite radicals, hydrogen peroxide, and various lipid peroxides. These compounds cause substantial cellular damage within the body. It took scientists many years to identify all the mechanisms involved with free radical damage.

For many years, scientists who studied free radicals thought that derivatives of oxygen could be a factor in many diseases, but there was not much evidence to support this theory. Now, however, there is proof. An atom has particles, called electrons, that rotate around the nucleus of the atom in pairs. As long as these electrons remain paired together, the oxygen atom stays stable. However, when an atom loses one of its electrons, the molecule becomes unstable. When this happens, oxygen or free radicals are formed.

Free radicals desperately want to become stable again, and so they will try to capture electrons from any other compound they can within nearby cells. This causes damage to those cells, and triggers a chain reaction of cellular damage, which further creates more free radicals. This damaging cycle causes more and more cells to be injured and killed, which can cause tissues and whole physiological systems to break down.

Many factors can cause the formation of free radicals. Normal biochemical processes are one factor, but they can also form because of your exposure to many different environmental chemicals. Cigarette smoke is one pollutant that causes the formation of free radicals that damage the lining of the lungs. Other damaging factors are chemicals in the air and water, pesticides found in food, radiation from X-rays, and too much ultraviolet light from the sun or a sun lamp. A sometimes forgotten factor in free radical formation is stress, over an extended period of time. All of these factors can cause damage to cells and levels of nitric oxide in the body.

Fortunately, our bodies produce many antioxidants, a group of vitamins and natural substances, that destroy many free radicals before they are able to inflict their damage. Antioxidants neutralize free radicals, and act as a protector of nitric oxide, thereby extending its brief lifespan. Nitic oxide itself is a powerful antioxidant, with the ability to ward off damaging free radicals. In fact, among the antioxidants produced within our bodies, nitric oxide is the most important due to its seeking out, reacting with, and neutralizing of free radicals wherever it comes in contact with them.

When nitric oxide acts as an antioxidant, it also becomes a potent anti-inflammatory agent. It works in conjunction with enzymes and genes to minimize the effects of inflammation. It is in a continual internal battle with chemicals that promote disease within the body.

There are four important enzymes that neutralize oxygen radical activity, superoxide dismutase (SOD), methionine reductase, catalase, and glutathione peroxidase that are naturally produced within the body. These enzymes, along with a number of phytochemicals and other nutrients, such as various vitamins, normally keep the activity of free radicals in check. However, when we are exposed to excessive amounts of toxic pollutants and environmental hazards, the need for additional nutritional supplements may be necessary to fend off the increased levels of oxygen radicals.

Hypertension: Prehypertension

Hypertension

Prehypertension

Slightly elevated blood pressure is known as prehypertension. Prehypertension will likely turn into high blood pressure (hypertension) if you don’t make lifestyle changes, such as start exercising and eating healthier. Both prehypertension and high blood pressure increase your risk of heart attack, stroke and heart failure.

A blood pressure reading has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure). Prehypertension is a systolic pressure from 120 to 139 millimeters of mercury (mm Hg) or a diastolic pressure from 80 to 89 mm Hg.

Weight loss, exercise and other healthy lifestyle changes can often control prehypertension – and set the stage for a lifetime of better health.

Prehypertension doesn’t cause symptoms. In fact, severe high blood pressure may not cause symptoms.

The only way to detect prehypertension is to keep track of your blood pressure readings. Have your blood pressure checked at each doctor’s visit – or check it yourself at home with a home blood pressure monitoring device.

When to see a doctor

Ask your doctor for a blood pressure reading at least once every two years. You may need more frequent readings if you have prehypertension or other risk factors for cardiovascular disease.

Causes

Any factor that increases pressure against the artery walls can lead to prehypertension. Atherosclerosis, which is the buildup of fatty deposits in your arteries, can lead to high blood pressure. Sometimes an underlying condition causes blood pressure to rise. Possible conditions that can lead to prehypertension or high blood pressure include:

  • Atherosclerosis
  • Sleep apnea
  • Kidney disease
  • Adrenal disease
  • Thyroid disease

Certain medications – including birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs – also may cause blood pressure to temporarily rise. Illegal drugs, such as cocaine and amphetamines, can have the same effect.

Often, however, high blood pressure develops gradually over many years without a specific identifiable cause.

Risk factors for prehypertension include:

  • Being overweight or obese. A primary risk factor is being overweight. The greater your body mass, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the force on your artery walls.
  • Age. Younger adults are more likely to have prehypertension than are older adults – probably because most older adults have progressed to high blood pressure. In fact, adults who are healthy at age 55 have a 90 percent chance of developing high blood pressure at some point in their lives, according to the American Heart Association.
  • Sex. Prehypertension is more common in men than in women.
  • Family history of high blood pressure.
  • Sedentary lifestyle.
  • Diet high in sodium or low in potassium.
  • Tobacco use.
  • Excessive alcohol use.

Certain chronic conditions – including high cholesterol, diabetes and sleep apnea – may increase the risk of prehypertension as well.

Prehypertension itself doesn’t often have complications. If you have prehypertension, it’s likely to worsen and develop into high blood pressure (hypertension). The term “prehypertension” is often used by doctors to signal that it’s time to begin making lifestyle changes or, if you have certain conditions such as diabetes, taking medications to stop your blood pressure from rising.

High blood pressure can damage your organs and increase the risk of heart attack, stroke and heart failure.

Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

The National Heart, Lung, and Blood Institute, says normal blood pressure is below 120/80. Higher readings are classified as:

  • Prehypertension – 120/80 to 139/89
  • Stage 1 hypertension – 140/90 to 159/99
  • Stage 2 hypertension – 160/100 or higher

Because blood pressure tends to fluctuate, a diagnosis of prehypertension is based on the average of two or more blood pressure readings taken on separate occasions in a consistent manner.

Hypertension Drugs: Angiotensin-converting enzyme (ACE) inhibitors

Hypertension Drugs

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors treat a variety of conditions, such as high blood pressure, scleroderma and migraines. Find out more about this class of medication.

Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance in your body that affects your cardiovascular system by narrowing your blood vessels and releasing hormones that can raise your blood pressure. This narrowing can cause high blood pressure and force your heart to work harder.

Examples of ACE Inhibitors

Many ACE inhibitors are available. Which one is best for you depends on your health and the condition being treated.

Examples of ACE inhibitors include:

  • Benazepril (Lotensin)
  • Captopril
  • Enalapril (Vasotec)
  • Fosinopril
  • Lisinopril (Prinivil, Zestril)
  • Moexipril (Univasc)
  • Perindopril (Aceon)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)

Uses for ACE Inhibitors

Doctors prescribe ACE inhibitors to prevent, treat or improve symptoms in conditions such as:

  • High blood pressure
  • Coronary artery disease
  • Heart failure
  • Diabetes
  • Certain chronic kidney diseases
  • Heart attacks
  • Scleroderma
  • Migraines

Your doctor may prescribe other medications in addition to an ACE inhibitor, such as a diuretic or calcium channel blocker, as part of your high blood pressure treatment. ACE inhibitors are usually taken once daily, and many people take them in the morning.

Side Effects and Cautions

Doctors commonly prescribe ACE inhibitors because they don’t often cause side effects.

Possible ACE inhibitor side effects include:

  • Dry cough
  • Increased blood-potassium level (hyperkalemia)
  • Fatigue
  • Rash
  • Dizziness
  • Headaches
  • Sleep problems
  • Rapid heartbeat

In rare cases – but more commonly in blacks and in smokers – ACE inhibitors can cause some areas of your tissues to swell (angioedema). If it occurs in the throat, that swelling can be life-threatening.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) decrease the effectiveness of ACE inhibitors. While taking an occasional dose of these medications shouldn’t change the effectiveness of your ACE inhibitor, talk to your doctor if you regularly take NSAIDs.

Because ACE inhibitors can cause birth defects, don’t take them if you are pregnant or plan to become pregnant.

Hypertension Drugs: Alpha Blockers

Hypertension Drugs

Alpha Blockers

Alpha blockers, also called alpha-adrenergic antagonists, treat a variety of conditions, such as high blood pressure, benign prostatic hyperplasia and Raynaud’s disease. Find out more about this class of medication.

Alpha blockers relax certain muscles and help small blood vessels remain open. They work by keeping the hormone norepinephrine (noradrenaline) from tightening the muscles in the walls of smaller arteries and veins. Blocking that effect causes the vessels to remain open and relaxed. This improves blood flow and lowers blood pressure.

Because alpha blockers also relax other muscles throughout the body, these medications can help improve urine flow in older men with prostate problems.

Examples of Alpha Blockers

Many alpha blockers are available, in either short-acting or long-acting forms. Short-acting medications work quickly, but their effects last only a few hours. Long-acting medications take longer to start working, but their effects last longer. Which one is best for you depends on your health and the condition being treated.

Alpha blockers are also called alpha-adrenergic blocking agents, alpha-adrenergic antagonists, adrenergic blocking agents and alpha-blocking agents.

Examples of alpha blockers include:

  • Alfuzosin (Uroxatral)
  • Doxazosin (Cardura)
  • Prazosin (Minipress)
  • Terazosin
  • Tamsulosin (Flomax)

Doctors prescribe alpha blockers to prevent, treat or improve symptoms in conditions such as:

  • High blood pressure
  • Enlarged prostate (benign prostatic hyperplasia)
  • Some circulatory conditions, such as Raynaud’s disease
  • Hardening and thickening of the skin (scleroderma)
  • Adrenal gland tumors (pheochromocytoma)

Though alpha blockers are commonly used to treat high blood pressure, they’re typically not preferred as the first treatment option. Instead, they’re used in combination with other drugs, such as diuretics, when your high blood pressure is difficult to control.

Side Effects and Cautions

Alpha blockers may have what’s called a “first-dose effect.” When you start taking an alpha blocker, you may develop pronounced low blood pressure and dizziness, which can make you suddenly faint when you rise from a sitting or lying position.

Other side effects include headache, pounding heartbeat, nausea, weakness, weight gain and small decreases in low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol).

Alpha blockers can increase or decrease the effects of other medications you take. Tell your doctor if you take any other medications, such as beta blockers, calcium channel blockers or medications used for erectile dysfunction, if you’re prescribed an alpha blocker.

Some research has found that some alpha blockers can increase the risk of heart failure with long-term use. While more research is needed to confirm this finding, talk to your doctor if you’re concerned.

Hypertension Drugs: Angiotensin II Receptor Blockers

Hypertension Drugs

Angiotensin II Receptor Blockers

Angiotensin II receptor blockers (ARBs) are used to treat conditions such as high blood pressure and heart failure. Find out more about this class of medication.

Angiotensin II receptor blockers help relax your blood vessels, which lowers your blood pressure and makes it easier for your heart to pump blood.

Angiotensin II is a natural substance in your body that affects your cardiovascular system in many ways, such as by narrowing your blood vessels. This narrowing can increase your blood pressure and force your heart to work harder. Angiotensin II also starts the release of a hormone that increases the amount of sodium and water in your body, which can lead to increased blood pressure. Angiotensin II can also thicken and stiffen the walls of your blood vessels and heart.

Angiotensin II receptor blockers block the action of angiotensin II. That allows blood vessels to widen (dilate).

Examples of angiotensin II receptor blockers

Several angiotensin II receptor blockers are available. Which one is best for you depends on your health and the condition being treated.

Examples of angiotensin II receptor blockers include:

  • Candesartan (Atacand)
  • Eprosartan (Teveten)
  • Irbesartan (Avapro)
  • Losartan (Cozaar)
  • Olmesartan (Benicar)
  • Telmisartan (Micardis)
  • Valsartan (Diovan)

Uses for angiotensin II receptor blockers

Doctors prescribe these drugs to prevent, treat or improve symptoms in a variety of conditions, such as:

  • High blood pressure
  • Heart failure
  • Kidney failure in diabetes
  • Chronic kidney diseases
  • Hardening and thickening of the skin (scleroderma)

Side effects and cautions

Few people have side effects when taking angiotensin II receptor blockers, but possible side effects may include:

  • Headache
  • Dizziness
  • Lightheadedness
  • Nasal congestion
  • Back and leg pain
  • Diarrhea

Rare but more-serious side effects include:

  • Kidney failure
  • Liver failure
  • Allergic reaction
  • A drop in white blood cells
  • Localized swelling of tissues (angioedema)

Because angiotensin II receptor blockers can cause birth defects, don’t take them if you are pregnant or plan to become pregnant.

Hypertension Drugs: Beta Blockers

Hypertension Drugs

Beta Blockers

Beta blockers, also called beta-adrenergic blocking agents, treat a variety of conditions, such as high blood pressure, glaucoma and migraines. Find out more about this class of medication.

Beta blockers, also known as beta-adrenergic blocking agents, are medications that reduce your blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. When you take beta blockers, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels open up to improve blood flow.

Examples of Beta Blockers

Some beta blockers mainly affect your heart, while others affect both your heart and your blood vessels. Which one is best for you depends on your health and the condition being treated.

Examples of beta blockers include:

  • Acebutolol (Sectral)
  • Atenolol (Tenormin)
  • Bisoprolol (Zebeta)
  • Metoprolol
  • Nadolol (Corgard)
  • Nebivolol (Bystolic)
  • Propranolol (Inderal LA)

Uses for Beta Blockers

Doctors prescribe beta blockers to prevent, treat or improve symptoms in a variety of conditions, such as:

  • High blood pressure
  • Irregular heart rhythm (arrhythmia)
  • Heart failure
  • Chest pain (angina)
  • Heart attacks
  • Glaucoma
  • Migraines
  • Generalized anxiety disorder
  • Hyperthyroidism
  • Certain types of tremors

Beta blockers aren’t usually prescribed until other blood pressure medications, such as diuretics, haven’t worked effectively. Your doctor may prescribe beta blockers as one of several medications to lower your blood pressure, including angiotensin-converting enzyme (ACE) inhibitors, diuretics or calcium channel blockers.

Beta blockers may not work as effectively for blacks as for people of other races, especially when taken without other blood pressure medications.

Side Effects and Cautions

Side effects may occur in people taking beta blockers. However, many people who take beta blockers won’t have any side effects.

Common side effects of beta blockers include:

  • Fatigue
  • Cold hands
  • Headache
  • Upset stomach
  • Constipation
  • Diarrhea
  • Dizziness

Less common side effects include:

  • Shortness of breath
  • Trouble sleeping
  • Loss of sex drive
  • Depression

Beta blockers generally aren’t used in people with asthma because of concerns that the medication may trigger severe asthma attacks. In people who have diabetes, beta blockers may block signs of low blood sugar, such as rapid heartbeat. It’s important to monitor your blood sugar on a regular basis.

Beta blockers can also affect your cholesterol and triglyceride levels, causing a slight increase in triglycerides and a modest decrease in high-density lipoprotein, the “good” cholesterol. These changes often are temporary. You shouldn’t abruptly stop taking a beta blocker because doing so could increase your risk of a heart attack or other heart problems.

Hypertension Drugs: Calcium Channel Blockers

Hypertension Drugs

Calcium Channel Blockers

Calcium channel blockers, or calcium antagonists, treat a variety of conditions, such as high blood pressure, migraines and Raynaud’s disease. Find out more about this class of medication.

Calcium channel blockers prevent calcium from entering cells of the heart and blood vessel walls, resulting in lower blood pressure. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls.

Some calcium channel blockers have the added benefit of slowing your heart rate, which can further reduce blood pressure, relieve chest pain (angina) and control an irregular heartbeat.

Examples of Calcium Channel Blockers

Some calcium channel blockers are available in short-acting and long-acting forms. Short-acting medications work quickly, but their effects last only a few hours. Long-acting medications are slowly released to provide a longer lasting effect.

Several calcium channel blockers are available. Which one is best for you depends on your health and the condition being treated.

Examples of calcium channel blockers include:

  • Amlodipine (Norvasc)
  • Diltiazem (Cardizem LA, Tiazac)
  • Felodipine
  • Isradipine (DynaCirc CR)
  • Nicardipine (Cardene SR)
  • Nifedipine (Procardia, Procardia XL, Adalat CC)
  • Nisoldipine (Sular)
  • Verapamil (Calan, Verelan, Covera-HS)

In some cases, your doctor might prescribe a calcium channel blocker along with other high blood pressure medications or with cholesterol-lowering drugs such as statins.

Uses for Calcium Channel Blockers

Doctors prescribe calcium channel blockers to prevent, treat or improve symptoms in a variety of conditions, such as:

  • High blood pressure
  • Chest pain (angina)
  • Brain aneurysm complications
  • Irregular heartbeats (arrhythmia)
  • Migraines
  • Some circulatory conditions, such as Raynaud’s disease
  • High blood pressure that affects the arteries in your lungs (pulmonary hypertension)

Calcium channel blockers may not be as effective as diuretics, beta blockers or angiotensin-converting enzyme (ACE) inhibitors at lowering blood pressure. Because of this, calcium channel blockers aren’t usually the first medication you’d be prescribed to lower your blood pressure.

However, for blacks, calcium channel blockers may be more effective than other blood pressure medications, such as beta blockers, ACE inhibitors or angiotensin II receptor blockers.

Side Effects and Cautions

Side effects of calcium channel blockers may include:

  • Constipation
  • Headache
  • Rapid heartbeat (tachycardia)
  • Dizziness
  • Rash
  • Drowsiness
  • Flushing
  • Nausea
  • Swelling in the feet and lower legs

Certain calcium channel blockers interact with grapefruit products. Don’t take these medications with grapefruit or grapefruit juice because they can reduce your ability to eliminate calcium channel blockers from your body, allowing the medications to build up in your body. This buildup could cause serious side effects.

Hypertension Drugs: Central-acting Agents

Hypertension Drugs

Central-acting Agents

Central-acting agents, also called central adrenergic inhibitors, treat several conditions, including high blood pressure, drug and alcohol withdrawal, and hot flashes. Find out more about these medications.

Central-acting agents lower your heart rate and reduce your blood pressure. They work by preventing your brain from sending signals to your nervous system to speed up your heart rate and narrow your blood vessels. As a result, your heart doesn’t pump as hard and your blood flows more easily through your blood vessels.

Examples of Central-acting Agents

Central-acting agents are also called central adrenergic inhibitors, centralalpha agonists and central agonists. Several central-acting agents are available. Which one is best for you depends on your health and the condition being treated.

Examples of central-acting agents include:

  • Clonidine (Catapres)
  • Guanfacine (Tenex)
  • Methyldopa

Uses for Aentral-acting Agents

Doctors prescribe central-acting agents to prevent, treat or improve symptoms in conditions, such as:

  • High blood pressure
  • Hot flashes
  • Alcohol or drug withdrawal
  • Attention-deficit/hyperactivity disorder (ADHD)
  • Tourette syndrome

Side Effects and Cautions

These medications can have strong side effects, so they aren’t commonly used. Side effects include:

  • Extreme fatigue
  • Drowsiness or sedation
  • Dizziness
  • Impotence
  • Constipation
  • Dry mouth
  • Headache
  • Weight gain
  • Psychological problems, such as depression

Abruptly stopping use of some central-acting agents can cause a sudden, dangerous increase in blood pressure. Don’t stop taking these medications, especially if you are taking a beta blocker, without talking to your doctor.

Hypertension Drugs: Direct Renin Inhibitors

Hypertension Drugs

Direct Renin Inhibitors

How It Works

Direct renin inhibitors block the enzyme renin from triggering a process that helps regulate blood pressure. As a result, blood vessels relax and widen, making it easier for blood to flow through the vessels, which lowers blood pressure.

Direct renin inhibitors, angiotensin-converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) all target the same process that narrows blood vessels. But each type of medicine blocks a different part of the process.

Aliskiren can be used alone or in combination with a diuretic or other medicines for high blood pressure.

Why It Is Used

Direct renin inhibitors are used to lower high blood pressure.

How Well It Works

Direct renin inhibitors can lower blood pressure in people with mild to moderate high blood pressure. This medicine is effective when used alone or in combination with other medicines for high blood pressure.1

Side Effects

The most common side effect of direct renin inhibitors is diarrhea.

Other, more rare, side effects may include:

  • Allergic reaction with swelling in the face, lips, tongue, or throat which may cause difficulty breathing or swallowing.
  • Rash.

What To Think About

Direct renin inhibitors are the newest type of medicine for high blood pressure. This medicine was approved by the U.S. Food and Drug Administration (FDA) in 2007. So long-term safety and effectiveness are not yet known.

Direct renin inhibitors should not be used by pregnant women. If you become pregnant, stop taking this medicine and call your doctor.

Before taking a direct renin inhibitor, tell your doctor if you have kidney problems. People with kidney problems may need to have regular blood tests to make sure this medicine does not reduce kidney function.

Talk to your doctor or pharmacist about possible interactions that aliskiren may have with your current medicines. The amount of aliskiren in your body may change when you also take furosemide (such as Lasix) or ketoconazole (such as Nizoral).

Hypertension Drugs: Diuretics

Hypertension Drugs

Diuretics

Diuretics, sometimes called water pills, treat a variety of conditions, such as high blood pressure, glaucoma and edema. Find out more about this class of medication.

Diuretics, sometimes called water pills, help rid your body of salt (sodium) and water. They work by making your kidneys put more sodium into your urine. The sodium, in turn, takes water with it from your blood. That decreases the amount of fluid flowing through your blood vessels, which reduces pressure on the walls of your arteries.

Examples of Diuretics

There are three types of diuretics: thiazide, loop and potassium-sparing. Each works by affecting a different part of your kidneys, and each may have different uses, side effects and precautions. Which diuretic is best for you depends on your health and the condition being treated.

Examples of thiazide diuretics include:

  • Chlorothiazide
  • Hydrochlorothiazide (Microzide)
  • Indapamide
  • Metolazone (Zaroxolyn)

Examples of loop diuretics include:

  • Bumetanide
  • Ethacrynic acid (Edecrin)
  • Furosemide (Lasix)
  • Torsemide (Demadex)

Examples of potassium-sparing diuretics include:

  • Amiloride
  • Eplerenone (Inspra)
  • Spironolactone (Aldactone)
  • Triamterene (Dyrenium)

Different types of diuretics may also be combined into one pill.

Uses for Diuretics

A large group of medical experts known as the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends that most people should try thiazide diuretics as the first choice to treat high blood pressure and heart problems related to high blood pressure. If diuretics alone aren’t enough to lower your blood pressure, your doctor may also recommend adding medications such as beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers to your blood pressure treatment.

In addition, doctors prescribe certain diuretics to prevent, treat or improve symptoms in a variety of conditions, such as:

  • Heart failure
  • Tissue swelling (edema)
  • Polycystic ovary syndrome
  • Certain kidney disorders, such as kidney stones
  • Diabetes characterized by frequent urination (diabetes insipidus)
  • Male-pattern hair growth in women (female hirsutism)
  • Osteoporosis

Side Effects and Cautions

Diuretics are generally safe, but do have some side effects. The most common side effect of diuretics is increased urination. This occurs most frequently in people taking loop diuretics. For most people, this side effect improves within a few weeks of taking a diuretic. People who take diuretics may also have too much potassium in their blood (hyperkalemia) if they take a potassium-sparing diuretic, or too little potassium in their blood (hypokalemia) if they take a thiazide diuretic.

Other side effects of diuretics may include:

  • Low sodium in your blood (hyponatremia)
  • Dizziness
  • Headaches
  • Increased thirst
  • Muscle cramps
  • Increased blood sugar
  • Increased cholesterol
  • Rash
  • Joint disorders (gout)
  • Impotence
  • Menstrual irregularities
  • Breast enlargement in men (gynecomastia)

Hypertension Drugs: Vasodilators

Hypertension Drugs

Vasodilators

Vasodilators treat a variety of conditions, including high blood pressure. Find out more about this class of medication.

Vasodilators are medications that open (dilate) blood vessels. They work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and the walls from narrowing. As a result, blood flows more easily through your arteries, your heart doesn’t have to pump as hard and your blood pressure is reduced.

Examples of Vasodilators

Several vasodilators are available. Which one is best for you depends on your health and the condition being treated.

Examples of vasodilators include:

  • Hydralazine
  • Minoxidil (in pill form)

Uses for Vasodilators

Doctors prescribe vasodilators to prevent, treat or improve symptoms in a variety of conditions, such as:

  • High blood pressure
  • High blood pressure during pregnancy or childbirth (preeclampsia or eclampsia)
  • Heart failure
  • High blood pressure that affects the arteries in your lungs (pulmonary hypertension)

Side Effects and Cautions

Vasodilators are strong medications and are generally used only as a last resort, when other medications haven’t adequately controlled your blood pressure.

These medications have a number of side effects, some of which require taking other medications to counter those effects.

Side effects include:

  • Chest pain
  • Rapid heartbeat (tachycardia)
  • Heart palpitations
  • Fluid retention (edema)
  • Nausea
  • Vomiting
  • Dizziness
  • Flushing
  • Headache
  • Nasal congestion
  • Excessive hair growth

In addition, some vasodilators can increase your risk of developing lupus, a connective tissue disease.

Metabolic Syndrome: Are You at Risk for Metabolic Syndrome

Metabolic Syndrome

Are You at Risk for Metabolic Syndrome

Given how common metabolic syndrome is — it’s estimated that one out of six people have it — everyone should be worried about their risk factors. After all, metabolic syndrome can dramatically increase your risk of serious health problems, such as diabetes, heart attacks, and strokes — yet often people don’t even know what it is.

Metabolic syndrome is generally defined as a cluster of risk factors, including high blood sugar, extra abdominal fat, high blood pressure, and unhealthy cholesterol levels.

Some of these risk factors you can control. Others are outside your control. But if you understand the entire range of risk factors, you can better protect your health. You may have a higher risk of metabolic syndrome if:

  • You are older. It’s more common as people age. The risk of getting metabolic syndrome rises from 20% in your 40s, to 35% in your 50s, to 45% in your 60s and beyond.
  • You are prone to blood clots and inflammation. Both are common in people with metabolic syndrome. Your doctor can do blood tests to find out if you have a high risk of clots and inflammation.
  • You have other medical conditions. Metabolic syndrome is associated with a number of medical conditions. These include polycystic ovary syndrome (PCOS), fatty liver, cholesterol gallstones, and lipodystrophy (which affects fat distribution).
  • It runs in the family. Even if you are not obese you may have inherited a higher risk. This includes people who have parents or other first-degree relatives with diabetes.
  • You are South Asian. South Asians seem to have a higher risk of insulin resistance and thus metabolic syndrome. Because of this, the American Heart Association and the National Heart, Lung, and Blood Institute have different recommendations for this group. A waist size above 35″ (for men) and 31″ (for women) is considered a metabolic syndrome risk factor.

Symptoms of Metabolic Syndrome

Most of the metabolic syndrome risk factors don’t have any symptoms. You usually can’t feel high blood pressure or high cholesterol. Often, the only outward sign is packing some extra weight in the belly.

So the only way to find out if you have metabolic syndrome is to meet with your doctor. He or she will check your blood pressure, blood sugar, and cholesterol. It’s another reason that regular check-ups are the key to staying healthy.

Metabolic Syndrome: How Do You Treat Metabolic Syndrome?

Metabolic Syndrome

How Do You Treat Metabolic Syndrome?

Metabolic syndrome — a group of risk factors that include abdominal fat, high blood pressure, high blood sugar, and unhealthy cholesterol levels — has, perhaps surprisingly, no special treatment regime.

Instead, treatment is focused on simply tackling each risk factor. The goal is to cut your odds of blood vessel and heart disease, as well as diabetes.

In most cases, the best treatment for metabolic syndrome rests with you. Changes to your behavior — such as eating healthier and getting more exercise — are the first things your doctor will suggest.

Unhealthy habits may have led you into this trouble. But by changing your ways, you may be able to completely negate your risk factors.

Experts say that changing your lifestyle is the main treatment for metabolic syndrome.

Get some exercise. Exercise is a great way to lose weight. That’s key if you’re heavy. But don’t get down if the scale isn’t showing progress. Even if you don’t lose a single pound, exercise can lower blood pressure, improve cholesterol levels, and improve insulin resistance.

If you’re out of shape, start slowly. Try walking more. Work more physical activity into your day. When you’re on foot, allow a little extra time to take the scenic route to get some extra steps. To keep track, buy a pedometer or “step counter.”

Ideally, you should increase your physical activity until you’re doing it on most days of the week. But don’t get too ambitious. If you try a workout regime that’s too tough, you may just give up. You need to find a level of exercise that fits with your personality.

Eat a healthy diet. Eating a healthy diet can improve your cholesterol, insulin resistance, and blood pressure — even if your weight stays the same.

Ask your doctor about what sort of diet you should eat. People who have heart disease or diabetes may need to have special meal plans. In general, a diet that’s low in saturated fats, trans fat, cholesterol, and salt and high in fruits and vegetables has been shown to help people with high blood pressure and a higher risk of cardiovascular disease. Many doctors suggest a “Mediterranean diet.” This meal plan emphasizes “good” fats (like the monounsaturated fat in olive oil) and a balance of carbohydrates and proteins.

Lose some weight. Obviously, this is often a byproduct of exercising and eating well. But it’s a key goal in itself if you’re overweight or obese. Weight loss can improve every aspect of metabolic syndrome.

If you smoke, quit. It’s not a risk factor for metabolic syndrome itself. But smoking greatly increases your risk of blood vessel and heart disease.

Medicine for Metabolic Syndrome

Some people with metabolic syndrome will also need medicine. Drugs might be needed if lifestyle changes aren’t enough to reduce your risk factors. Some drugs you might use are:

  • High blood pressure medicines, which include medicines such as ACE inhibitors (like Capoten and Vasotec), angiotensin II receptor blockers (like Cozaar and Diovan), diuretics, beta-blockers, and other drugs.
  • Cholesterol medicines, which include statins (like Crestor, Lescol, Lipitor, Mevacor, Pravachol, and Zocor), niacin (like Niacor, Niaspan, and Nicolar), bile acid resins (like Colestid and Questran), Zetia, and other drugs.
  • Diabetes medicines, which may be necessary if you have glucose intolerance. Drugs include Glucophage, Actos, and Avandia.
  • Low-dose aspirin, which can reduce the risks of heart attacks and strokes. It may be especially important for people who are “prothrombotic,” or prone to blood clots.

Keep in mind that all medicines can have side effects and risks. Talk with Dr. Houston about the pros and cons of using any of these medicines.

Metabolic Syndrome: How Can You Prevent Metabolic Syndrome?

Metabolic Syndrome

How Can You Prevent Metabolic Syndrome?

Metabolic syndrome is a group of risk factors: high blood pressure, high blood sugar, unhealthy cholesterol levels, and excess fat in the abdomen. Having these risk factors drastically raises your risk of diabetes, and blood vessel and heart disease.

Experts say you can prevent metabolic syndrome in the same way you would treat it. You need to make sensible changes to your lifestyle. You should:

  • Exercise. Start slowly. The American Heart Association recommends, if possible, that you gradually step up to exercising on most days of the week for 30-60 minutes.
  • Eat a healthy diet with lots of fruits and vegetables and go easy on the saturated fats, trans fat, cholesterol, and salt.
  • Lose weight if you’re overweight.
  • Quit smoking if you smoke — now.
  • Schedule regular checkups with your doctor. Since metabolic syndrome doesn’t have symptoms, you need regular doctor visits to check your blood pressure, cholesterol, and blood sugar.

One 2005 study published in the Annals of Internal Medicine showed how well lifestyle changes could prevent metabolic syndrome. Researchers looked at more than 3,200 people who already had impaired glucose tolerance, a pre-diabetic state. One group was instructed to make lifestyle changes. They exercised 2.5 hours a week and ate a low- calorie, low-fat diet. After three years, people in the lifestyle group were 41% less likely to have metabolic syndrome than those who got no treatment. The lifestyle changes were also about twice as effective as using a diabetes medicine, Glucophage.
Of course, if you already have some of the risk factors, your odds of getting metabolic syndrome are higher. You need to work hard to prevent it. You must not wait if you have:

  • Unhealthy cholesterol levels
  • High blood pressure
  • High blood sugar
  • Excess weight, particularly around the belly

If these conditions apply to you, take action now, before you actually develop metabolic syndrome.
In addition to making lifestyle changes, you might also need medicine. Drugs can get your blood pressure, blood sugar, and cholesterol under control.

Metabolic Syndrome: What Is Metabolic Syndrome?

Metabolic Syndrome

What Is Metabolic Syndrome?

Metabolic syndrome: Suddenly, it’s a health condition that everyone’s talking about. While it was only identified less than 20 years ago, metabolic syndrome is as widespread as the common cold. According to the American Heart Association, 47 million Americans have it. That’s almost a staggering one out of every six people.

Indeed, metabolic syndrome seems to be a condition that many people have, but no one knows very much about. It’s also debated by the experts – not all doctors agree that metabolic syndrome should be viewed as a distinct condition.

So what is this mysterious syndrome – which also goes by the scary-sounding name Syndrome X – and should you be worried about it?

Understanding Metabolic Syndrome
Metabolic syndrome is not a disease in itself. Instead, it’s a group of risk factors – high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat.

Obviously, having any one of these risk factors isn’t good. But when they’re combined, they set the stage for grave problems. These risk factors double your risk of blood vessel and heart disease, which can lead to heart attacks and strokes. They increase your risk of diabetes by five times.
Metabolic syndrome is also becoming more common. But the good news is that it can be controlled, largely with changes to your lifestyle.

Risk Factors for Metabolic Syndrome
According to the American Heart Association and the National Heart, Lung, and Blood Institute, there are five risk factors that make up metabolic syndrome.

Large Waist Size For men: 40 inches or larger
For women: 35 inches or larger
Cholesterol: High Triglycerides Either
150 mg/dL or higher
or
Using a cholesterol medicine

Cholesterol: Low Good Cholesterol (HDL)
Either
For men: Less than 40 mg/dL
For women: Less than 50 mg/dL
or
Using a cholesterol medicine
High Blood Pressure Either
Having blood pressure of 130/85 mm Hg or greater
or
Using a high blood pressure medicine
Blood Sugar: High Fasting Glucose Level 100 mg/dL or higher

To be diagnosed with metabolic syndrome, you would have at least threeof these risk factors.
What Causes Metabolic Syndrome?
Experts aren’t sure why metabolic syndrome develops. It’s a collection of risk factors, not a single disease. So it probably has many different causes. Some risk factors are:

  • Insulin resistance. Insulin is a hormone that helps your body use glucose – a simple sugar made from the food you eat – as energy. In people with insulin resistance, the insulin doesn’t work as well so your body keeps making more and more of it to cope with the rising level of glucose. Eventually, this can lead to diabetes. Insulin resistance is closely connected to having excess weight in the belly.
  • Obesity – especially abdominal obesity. Experts say that metabolic syndrome is becoming more common because of rising obesity rates. In addition, having extra fat in the belly – as opposed to elsewhere in the body – seems to increase your risk.
  • Unhealthy lifestyle. Eating a diet high in fats and not getting enough physical activity can play a role.
  • Hormonal imbalance. Hormones may play a role. For instance, polycystic ovary syndrome (PCOS) – a condition that affects fertility – is related to hormonal imbalance and metabolic syndrome.

If you’ve just been diagnosed with metabolic syndrome, you might be anxious. But think of it as a wake-up call. It’s time to get serious about improving your health. Making simple changes to your habits now can prevent serious illness in the future.

Obesity: Overview of Obesity

Obesity

Overview of Obesity

Facts about obesity:

Overweight and obesity together represent the second leading preventable cause of death in the United States. Obesity is a serious, chronic disease that can inflict substantial harm to a person’s health. Overweight and obesity are not the same; rather, they are different points on a continuum of weight ranging from being underweight to being morbidly obese. The percentage of people who fit into these two categories, overweight and obese, is determined by Body Mass Index (BMI).

Public health professionals agree that overweight and obesity have reached epidemic proportions in this country. Public health officials say physical inactivity and poor diet are catching up to tobacco as a significant threat to health. According to the most recent data from the 2003-2006 National Health and Nutrition Examination Survey (NHANES), one out of five or 17 percent of US children, ages 6 to 19, are overweight or obese. In addition, more than one third of the US population is overweight or obese – 35 percent of women and 33 percent of men. However, for the first time in decades, the prevalence of US adult obesity is not rising.

BMI is a measure of weight proportionate to height. BMI is considered a useful measurement of the amount of body fat. Occasionally, some very muscular people may have a BMI in the overweight range. However, these people are not considered overweight because muscle tissue weighs more than fat tissue. Generally, BMI can be considered an effective way to evaluate whether a person is overweight or obese.

In adults, a BMI from 18.5 to 24.9 is considered normal while a BMI of more than 25 is considered overweight. A person is considered obese if the BMI is greater than 30 and morbidly obese if the BMI is 40 or greater. In general, after the age of 50, a man’s weight stabilizes and even drops slightly between the ages of 60 and 74. However, a woman’s weight continues to increase until age 60 and then begins to drop. When assessing a child’s weight, the BMI is calculated and then plotted on a BMI for age percentile curve. The Centers for Disease Control and Prevention (CDC) developed sex-specific BMI for age growth curves to account for a child’s for body fat variances across ages and genders. Public health professionals classify a child overweight if his BMI for age percentile ranking is 85th to less than 95th percentile or obese if his BMI for age percentile ranking is greater than the 95th percentile.

Another measure of obesity is the waist-to-hip ratio (WHR). The WHR is a measurement tool that looks at the proportion of fat stored on the waist, and hips and buttocks. The waist circumference indicates abdominal fat. A waist circumference over 40 inches in men and over 35 inches in women may increase the risk for heart disease and other diseases associated with being overweight.

Consult your physician with questions regarding healthy body weight.

What causes obesity?

In many ways, obesity is a puzzling disease. How the body regulates weight and body fat is not well understood. On one hand, the cause appears to be simple in that if a person consumes more calories than he or she expends as energy, then he or she will gain weight.

However, the risk factors that determine obesity can be a complex combination of genetics, socioeconomic factors, metabolic factors, and lifestyle choices, as well as other factors. Some endocrine disorders, diseases, and medications may also exert a powerful influence on an individual’s weight.

Factors which may influence the occurrence of obesity include, but are not limited to, the following:

  • genetics – Studies have shown that a predisposition toward obesity can be inherited. Although researchers have identified several genes that appear to be associated with obesity, most believe that one gene is not responsible for the entire obesity epidemic. The majority of current and future research aims to better understand the interaction between these gene variations and our ever-changing environment in the development of obesity.
  • metabolic factors – How a particular person expends energy is different from how someone else’s body uses energy. Both metabolic and hormonal factors are not the same for everyone, but these factors play a role in determining weight gain. Recent studies show that levels of ghrelin, a peptide hormone known to regulate appetite, and other peptides in the stomach, play a role in triggering hunger and producing a feeling of fullness (satiety).
  • socioeconomic factors – There is a strong relationship between economic status and obesity, especially among women. Women who are poor and of lower social status are more likely to be obese than women of higher socioeconomic status. The occurrence of obesity is also highest among minority groups, especially among women.
  • lifestyle choices – Overeating, along with a sedentary lifestyle, contributes to obesity. These are lifestyle choices that can be affected by behavior change.Eating a diet in which a high percentage of calories come from sugary, high-fat, refined foods promotes weight gain. And, as more US families eat on the go, high-calorie foods and beverages are often selected.Lack of regular exercise contributes to obesity in adults and makes it difficult to maintain weight loss. In children, inactivity, such as watching television or sitting at a computer, contributes to obesity.

Health Effects of Obesity

Obesity has a far-ranging negative effect on health. Each year obesity-related conditions cost over 100 billion dollars and cause premature deaths in the US. The health effects associated with obesity include, but are not limited to, the following:

  • high blood pressure – Additional fat tissue in the body needs oxygen and nutrients in order to live, which requires the blood vessels to circulate more blood to the fat tissue. This increases the workload of the heart because it must pump more blood through additional blood vessels. More circulating blood also means more pressure on the artery walls. Higher pressure on the artery walls increases the blood pressure. In addition, extra weight can raise the heart rate and reduce the body’s ability to transport blood through the vessels.
  • diabetes – Obesity is the major cause of type 2 diabetes. Obesity can cause resistance to insulin, the hormone that regulates blood sugar. When obesity causes insulin resistance, the blood sugar becomes elevated. Even moderate obesity dramatically increases the risk of diabetes.
  • heart disease – Atherosclerosis (hardening of the arteries) occurs more often in obese people compared to those who are not obese. Coronary artery disease is also more prevalent because fatty deposits build up in arteries that supply the heart. Narrowed arteries and reduced blood flow to the heart can cause chest pain (angina) or a heart attack. Blood clots can also form in narrowed arteries and cause a stroke.
  • joint problems, including osteoarthritis – Obesity can affect the knees and hips because of the stress placed on the joints by extra weight. Joint replacement surgery, while commonly performed on damaged joints, may not be an advisable option for an obese person because the artificial joint has a higher risk of loosening and causing further damage.
  • sleep apnea and respiratory problems – Sleep apnea, which causes people to stop breathing for brief periods, interrupts sleep throughout the night and causes sleepiness during the day. It also causes heavy snoring. Respiratory problems associated with obesity occur when added weight of the chest wall squeezes the lungs and causes restricted breathing. Sleep apnea is also associated with high blood pressure.
  • cancer – In women, being overweight contributes to an increased risk for a variety of cancers including breast, colon, gallbladder, and uterus. Men who are overweight have a higher risk of colon and prostate cancers.
  • metabolic syndrome – The National Cholesterol Education Program has identified metabolic syndrome as a complex risk factor for cardiovascular disease. Metabolic syndrome consists of six major components: abdominal obesity, elevated blood cholesterol, elevated blood pressure, insulin resistance with or without glucose intolerance, elevation of certain blood components that indicate inflammation, and elevation of certain clotting factors in the blood.
  • psychosocial effects – In a culture where often the ideal of physical attractiveness is to be overly thin, people who are overweight or obese frequently suffer disadvantages. Overweight and obese persons are often blamed for their condition and may be considered to be lazy or weak-willed. It is not uncommon for overweight or obese conditions to result in persons having lower incomes or having fewer or no romantic relationships. Disapproval of overweight persons expressed by some individuals may progress to bias, discrimination, and even torment.

Obesity: Preventing Obesity

Obesity

Preventing Obesity

Facts About Prevention

Obesity is a chronic disease affecting increasing numbers of children and adolescents as well as adults. Obesity rates among children in the US have doubled since 1980 and have tripled for adolescents. About 17 percent of children aged two to 19 are considered overweight compared to over 66 percent of adults who are considered overweight or obese.

Earlier onset of type 2 diabetes, cardiovascular disease, and obesity-related depression in children and adolescents is being seen by healthcare professionals. The longer a person is obese, the more significant obesity-related risk factors become. Given the chronic diseases and conditions associated with obesity and the fact that obesity is difficult to treat, prevention is extremely important.

A primary reason that prevention of obesity is so vital in children is because the likelihood of childhood obesity persisting into adulthood is thought to increase as the child ages.

Infants

Breastfed babies are 20 percent less likely to develop diabetes and are less likely to become overweight. Therefore, the longer babies are breastfed, the less likely they are to become overweight as they grow older.

Children and adolescents:

Young people generally become overweight or obese because they do not get enough physical activity in combination with poor eating habits. Genetics and lifestyle also contribute to a child’s weight status.

Recommendations for prevention of overweight and obesity during childhood and adolescence include:

  • Gradually work to change family eating habits and activity levels rather than focusing on a child’s weight.
  • Be a role model. Parents who eat healthy foods and participate in physical activity set an example so that a child is more likely to do the same.
  • Encourage physical activity. Children should have 60 minutes of moderate physical activity most days of the week. More than 60 minutes of activity may promote weight loss and provide weight maintenance.
  • Reduce “screen” time in front of the television and computer to less than two hours daily.
  • Encourage children to eat when hungry and to eat slowly.
  • Avoid using food as a reward or withholding food as a punishment.
  • Keep the refrigerator stocked with fat-free or low-fat milk, fresh fruit, and vegetables instead of soft drinks and snacks high in sugar and fat.
  • Serve at least five servings of fruits and vegetables daily.
  • Encourage children to drink water rather than beverages with added sugar, such as soft drinks, sports drinks, and fruit juice drinks.

Adults

Many of the strategies that produce successful weight loss and maintenance help prevent obesity. Improving eating habits and increasing physical activity play a vital role in preventing obesity. Recommendations for adults include:

  • Eat five to nine servings of fruits and vegetables daily. A vegetable serving is one cup of raw vegetables or one-half cup of cooked vegetables or vegetable juice. A fruit serving is one piece of small to medium fresh fruit, one-half cup of canned or fresh fruit or fruit juice, or one-fourth cup of dried fruit.
  • Choose whole grain foods such as brown rice and whole wheat bread. Avoid highly processed foods made with refined white sugar, flour, and saturated fat.
  • Weigh and measure food in order to be able to gain an understanding of portion sizes. For example, a 3-ounce serving of meat is the size of a deck of cards. Avoid supersized menu items.
  • Balance the food “checkbook.” Taking in more calories than are expended for energy will result in weight gain. Regularly monitor weight.
  • Avoid foods that are high in “energy density,” or that have a lot of calories in a small amount of food. For example, a large cheeseburger with a large order of fries may have almost 1,000 calories and 30 or more grams of fat. By ordering a grilled chicken sandwich or a plain hamburger and a small salad with low-fat dressing, you can avoid hundreds of calories and eliminate much of the fat intake. For dessert, have fruit or a piece of angel food cake rather than the “death by chocolate” special or three pieces of home-made pie.
  • Remember that much may be achieved with proper choices in serving sizes.
  • Accumulate at least 30 minutes or more of moderate-intensity activity on most, or preferably all, days of the week. Examples of moderate intensity exercise are walking a 15-minute mile, or weeding and hoeing a garden.
  • Look for opportunities during the day to perform even ten or 15 minutes of some type of activity, such as walking around the block or up and down a few flights of stairs.

Obesity: Maintaining Weight Loss

Obesity

Maintaining Weight Loss

Benefits of Maintaining Weight Loss

While losing weight is difficult for many people, it is even more challenging to keep weight off. Most individuals who lose a large amount of weight regain it two to three years later. One theory about regaining lost weight is that people who decrease their caloric intake to lose weight experience a drop in their metabolic rate, making it increasingly difficult to lose weight over a period of months. A lower metabolic rate may also make it easier to regain weight after a more normal diet is resumed. For these reasons, extremely low calorie diets and rapid weight loss are discouraged.

Losing no more than one to two pounds per week is recommended. Incorporating long-term lifestyle changes will increase the chance of successful long-term weight loss.

Weight loss to a healthy weight for a person’s height can promote health benefits such as lower cholesterol and blood sugar levels, lower blood pressure, less stress on bones and joints, and less work for the heart. Thus, it is vital to maintain weight loss to obtain health benefits over a lifetime.

Keeping extra weight off requires effort and commitment, just as losing weight does. Weight loss goals are reached by changes in diet, eating habits, exercise, and, in extreme circumstances, surgery.

Weight Loss Maintenance Strategies

The strategies that encourage weight loss also play an important role in maintenance:

  • Support systems used effectively during weight loss can contribute to weight maintenance. A study conducted by the National Weight Control Registry found people who lost weight and continued bi-monthly support group meetings for one year maintained their full weight loss. Study participants who did not attend support group meetings regained almost half of the weight.
  • Physical activity plays a vital role in maintaining weight loss. Studies show that even exercise that is not rigorous, such as walking and using stairs, has a positive effect. Activity that uses 1,500 to 2,000 calories per week is recommended for maintaining weight loss.
  • Diet and exercise are vital strategies for losing and maintaining weight. A study by the National Weight Control Registry found that nearly all of 784 study participants who had lost at least 30 pounds, and had maintained that loss for one year or longer, used diet and exercise to not only lose the weight, but also to maintain the weight loss.
  • Once the desired weight has been reached, the gradual addition of about 200 calories of healthy, low-fat food to daily intake may be attempted for one week to see if weight loss continues. If weight loss does continue, additional calories of healthy foods may be added to the daily diet until the right balance of calories to maintain the desired weight has been determined. It may take some time and record keeping to determine how adjusting food intake and exercise levels affect weight.

Continuing to use behavioral strategies can help maintain weight. Be aware of eating as a response to stress and use exercise, activity, or meditation to cope instead of eating.

A return to old habits does not mean failure. Paying renewed attention to dietary choices and exercise can help sustain behaviors that maintain weight loss. Identifying situations such as negative moods and interpersonal difficulties and incorporating alternative methods of coping with such situations rather than eating can prevent relapses to old habits.

Weight Cycling

Weight cycling is losing and regaining weight multiple times. Some studies suggest that weight cycling, also called “yo-yo dieting,” may result in some health risks such as high blood pressure, gallbladder disease, and high cholesterol. However, these studies are not conclusive. The best strategy is to avoid weight cycling and to maintain healthy weight through activity and healthy eating.

One myth about weight cycling is that a person who loses and regains weight will have more difficulty losing weight again and maintaining it compared to a person who has not gone through a weight-loss cycle. Most studies show that weight cycling does not affect the rate at which the body burns fuel and a previous weight cycle does not influence the ability to lose weight again. In addition, weight cycling does not increase the amount of fat tissue or increase fat distribution around the stomach.

Obesity: Medical Treatment for Obesity

Obesity

Medical Treatment for Obesity

Medical Treatment Overview

Treatment by a physician may be necessary when an individual’s own efforts to lose weight have failed and/or when co-existing medical conditions make it crucial for a person to lose weight.  To ensure long-term success, behavioral weight loss measures are an important part of any weight loss program. Behavioral strategies target unhealthy dietary habits and the incorporation of physical activity into daily life. Obesity-associated eating disorders require treatment by a therapist.  Specific treatment for obesity will be determined by your physician based on:

  • Your age, overall health, and medical history
  • Extent of the condition
  • Your tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Types of medical treatment for obesity:

Medical treatment for obesity includes, but is not limited to, the following:

Prescription Medications

Weight loss prescription medications are never prescribed at the Hypertension Institute, under any circumstance.

The most commonly prescribed medication is called orlistat, or Xenical. Orlistat reduces the absorption of about 30 percent of fat as food travels through the digestive system. It may cause frequent, oily bowel movements, but if fat in the diet is reduced, symptoms often improve. Once the medication is stopped, some or most of the weight may be regained.

Another medication, sibutramine (sold as Meridia), was voluntarily removed from the market by its makers in October, 2010 after the FDA found that the drug was associated with an increased risk for heart attack.

Supplements

Weight loss supplements are never prescribed at the Hypertension Institute, under any circumstance.

Many over-the-counter supplements promise to help burn fat faster or reduce hunger. These supplements are dangerous. Dietary supplements containing ephedra (ma-huang) have been banned by the US Food and Drug Administration (FDA) because of potentially dangerous side effects.  Additionally, products that work as a laxative can cause the blood’s potassium level to drop, which may cause heart and/or muscle problems.

While there is no supplement that can take the place of eating a healthy diet, a multivitamin taken daily can help close the nutritional gap even for those people who eat a balanced diet. However, vitamin supplements do not produce weight loss.

Behavioral Strategies

Over the long term, most obese adults who lose weight will return to their baseline weight if ongoing behavioral strategies are not used. There are techniques for initiating and maintaining changes in lifestyle that may result in sustained weight loss.

Some behavioral strategies include keeping a food journal of what was eaten, where food was eaten, when food was eaten, when hunger occurred, and the feelings that were present when eating. A similar activity journal may also be kept. These techniques are useful to analyze eating and activity behaviors, so that behaviors that need to be modified can be identified and strategies for changing those behaviors can be developed.

A counselor may be helpful with cognitive techniques that may be used to help change a person’s thinking about body image. A non-food-related reward system may be developed to help keep a person on track toward weight loss goals. Additional behavioral techniques may include serving food from the stove rather than family style and never watching television, reading, or doing another activity while eating.

Psychotherapy for Eating Disorders

Eating a large amount of food at one time does not necessarily make a person a binge eater. Everyone overindulges from time to time. However, there are some obese people who binge and purge (self-induced vomiting or laxative abuse to get rid of unwanted calories from binge eating) or eat large amounts of food compulsively without the purging component. These behaviors are eating disorders that require treatment by a physician or other healthcare provider. Most people who have these disorders are usually either overweight or obese. It is important that the eating disorder be treated before an obese person attempts to lose weight.

Some eating disorders for which psychotherapy may be prescribed include:

Bulimia – a disorder in which a person eats compulsively and then vomits or uses water pills (diuretics), laxatives, or strenuous exercise to prevent weight gain. As many as 11 million adults and adolescents in the US have anorexia or bulimia, considered the most common eating disorder. Feelings of guilt, shame, and depression often follow the binge.

Binge eating disorder – a disorder that resembles bulimia and is characterized by episodes of uncontrolled eating or bingeing. It differs from bulimia in that its sufferers do not purge their bodies of the excess food by vomiting, laxative abuse, or diuretic abuse.

Physicians, psychotherapists, and dietitians can help a person with an eating disorder. Therapy can also help modify behavior and attitudes.

Obesity: Surgical Treatment for Obesity

Obesity

Surgical Treatment for Obesity

Weight-loss surgery (bariatric surgery) is the only option today that effectively treats morbid obesity in people for whom more conservative measures such as diet, exercise, and medication have failed.

There are a variety of approaches to bariatric surgery, but all procedures are either malabsorptive, restrictive, or a combination of the two. Malabsorptive procedures change the way the digestive system works. Restrictive procedures are those that severely reduce the size of the stomach to hold less food, but the digestive functions remain intact.

Gastric Bypass (Malabsorptive) Surgery

(Malabsorptive Procedure, Roux-en-Y Gastric Bypass, Biliopancreatic Diversion)

What is Gastric Bypass Surgery?

Gastric bypass surgery, a type of bariatric surgery (weight loss surgery), is a surgical procedure that alters the process of digestion. Bariatric surgery is the only option today that effectively treats morbid obesity in people for whom more conservative measures such as diet, exercise, and medication have failed.

There are several types of gastric bypass procedures, but all of them involve bypassing part of the small bowel by greater or lesser degrees. For this reason, procedures of this type are referred to as malabsorptive procedures, because they involve bypassing a portion of the small intestine that absorbs nutrients.

Some of these procedures also involve stapling the stomach to create a small pouch that serves as the “new” stomach or surgically removing part of the stomach.

Although a gastric bypass procedure is malabsorptive, it may also be restrictive because the size of the stomach is reduced so that the amount of food that can be eaten is “restricted” due to the smaller stomach. While malabsorptive procedures are more effective in causing excess weight to be lost than procedures that are solely restrictive, they also carry more risk for nutritional deficiencies.

Types of gastric bypass, or malabsorptive, surgical procedures include:

  • roux-en-Y gastric bypass (RGB)Roux-en-Y gastric bypass, the most commonly performed bariatric procedure, is both malabsorptive and restrictive. This surgery can result in two-thirds of extra weight loss within two years. The procedure involves stapling the stomach to create a small pouch that holds less food and then shaping a portion of the small intestine into a “Y.” The “Y” portion of intestine is then connected to the stomach pouch so that when food is being digested it travels directly into the lower part of the small intestine, bypassing the first part of the small intestine (called the duodenum) and the first part of the second section of the small intestine (called the jejunum). The effect of bypassing these sections of the intestine is to restrict the amount of calories and nutrients that are absorbed into the body.The Roux-en-Y gastric bypass may be performed with a laparoscope rather than through an open incision in some patients. This procedure uses several small incisions and three or more laparoscopes – small thin tubes with video cameras attached – to visualize the inside of the abdomen during the operation. The surgeon performs the surgery while looking at a TV monitor. Persons with a Body Mass Index (BMI) of 60 or more or those who have already had some type of abdominal surgery are usually not considered for this technique. A laparoscopic method allows the physician to make a series of much smaller incisions. Laparoscopic gastric bypass usually reduces the length of hospital stay, the amount of scarring, and results in quicker recovery than an open procedure.
  • biliopancreatic diversion (BPD)A biliopancreatic diversion is both restrictive and malabsorptive, and is a more complicated procedure than the Roux-en-Y procedure. In this procedure a large part of the lower stomach is removed. The small part of stomach that is left is connected directly to the last part of the small intestine (jejunum). As food is digested, it completely bypasses the duodenum and the jejunum. Because this procedure may result in nutritional deficiencies, it is not as commonly performed.A variation of the biliopancreatic diversion is a procedure called the duodenal switch. More of the stomach is retained, including the valve that controls the release of food into the small intestine. This helps to prevent the “dumping syndrome” which can result in vomiting or diarrhea. A small part of the duodenum is also retained.

Digestion is the process by which food and liquid are broken down into smaller parts so that the body can use them to build and nourish cells. Digestion begins in the mouth, where food and liquids are taken in, and is completed in the small intestine. The digestive tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.

The stomach is where the three mechanical tasks of storing, mixing, and emptying occur.

Normally, this is what happens:

  • First, the stomach stores the swallowed food and liquid, which requires the muscle of the upper part of the stomach to relax and accept large volumes of swallowed material.
  • Second, the lower part of the stomach mixes up the food, liquid, and digestive juices produced by the stomach by muscle action.
  • Third, the stomach empties the contents into the small intestine.

The food is then digested in the small intestine and dissolved by the juices from the pancreas, liver, and intestine, and the contents of the intestine are mixed and pushed forward to allow further digestion.

Malabsorptive procedures alter this process in different ways depending on the type of procedure.

Reasons for the Procedure

Bariatric surgery is performed because it is currently the best treatment option for producing lasting weight loss in obese patients for whom nonsurgical methods of weight loss have failed.

Potential candidates for bariatric surgery include:

  • persons with a Body Mass Index (BMI) greater than 40
  • men who are 100 pounds over their ideal body weight or women who are 80 pounds over their ideal body weight
  • persons with a BMI between 35 and 40 who have another condition such as obesity-related type 2 diabetes, sleep apnea, or heart disease

Because the surgery can have serious side effects, the long-term health benefits must be considered and found greater than the risk. Despite the fact that some surgical techniques can be done laparoscopically with reduced risk, all bariatric surgery is considered to be major surgery.

Although not all risks with each procedure are fully known, bariatric surgery does help many people to reduce or eliminate some health-related obesity problems. It may help to:

  • lower blood sugar
  • lower blood pressure
  • reduce or eliminate sleep apnea
  • decrease the workload of the heart
  • lower cholesterol levels

Surgery for weight loss is not a universal remedy, but these procedures can be highly effective in people who are motivated after surgery to follow their physician’s guidelines for nutrition and exercise and to take nutritional supplements.

There may be other reasons for your physician to recommend a gastric bypass procedure.

Risks of the Procedure

As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to, the following:

  • infection
  • blood clots
  • pneumonia
  • bleeding ulcer
  • development of gallstones

With Roux-en-Y gastric bypass procedures, malabsorptive symptoms may be more serious with an increased risk of anemia and loss of fat-soluble vitamins (vitamins A, D, E, and K). Adequate amounts of iron, calcium, and vitamin B12 may not be absorbed. This can cause metabolic bone disease and osteoporosis.

Stomal stenosis occurs when there is a stricture (tightening) of the opening between the stomach and intestine after a Roux-en-Y procedure. When this occurs, vomiting after eating and sometimes after drinking may occur. Stomal stenosis can be treated easily but should be treated immediately.

“Dumping syndrome” is also more likely to occur with these procedures because the food in the stomach moves to the intestines quickly. Symptoms include nausea, sweating, fainting, weakness, and diarrhea.

There is a risk that additional surgery may be necessary because of complications, including gallstones.

One of the most serious complications of gastric bypass is a stomach leak that can cause peritonitis to develop. Peritonitis is an inflammation of the peritoneum, the smooth membrane that lines the cavity of the abdomen.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Gastric Stapling (Restrictive) Surgery

(Gastric Banding Surgery, Adjustable Gastric Banding, Vertical Banded Gastroplasty)

What is gastric stapling (restrictive) surgery?

Gastric stapling (restrictive) surgery is a type of bariatric surgery (weight loss surgery) procedure performed to limit the amount of food a person can eat. Bariatric surgery is the only option today that effectively treats morbid obesity in people for whom more conservative measures such as diet, exercise, and medication have failed.

In gastric banding surgery, no part of the stomach is removed and the digestive process remains intact. Either staples or a band are used to separate the stomach into two parts, one of which is a very small pouch that can hold about one ounce of food. The food from this “new” stomach empties into the closed-off portion of the stomach and then resumes the normal digestive process. Over time, the pouch can expand to hold two to three ounces of food. Because the size of the stomach is reduced so dramatically, this type of procedure is referred to as a restrictive procedure.

After gastric stapling or banding, a person can eat only about three-quarters to one cup of food. The food must be well-chewed. Eating more than the stomach pouch can hold may result in nausea and vomiting. Restrictive procedures pose fewer risks than gastric bypass procedures, but they are also less successful because continuous overeating can stretch the pouch so that it accommodates more food.

The types of gastric banding procedures include:

  • adjustable gastric banding (AGB)This procedure involves attaching an inflatable band around the top portion of the stomach and tightening it like a belt to form a small pouch that serves as a new, much smaller stomach. After the procedure, the diameter of the band around the stomach can be adjusted by a physician by adding or removing saline (salt water). No staples are used in this procedure, which is relatively new in the US.Like other restrictive procedures, AGB may not achieve significant weight loss. The US Food and Drug Administration (FDA) approved an AGB system in 2001 that can be put in place with a laparoscope (a small thin tube with a video camera attached) rather than with an open incision for patients who are morbidly obese, as indicated by a Body Mass Index (BMI) of 40 or more.
  • vertical banded gastroplasty (VBG)This procedure uses a combination of staples and a band to create the pouch. There is a dime-sized opening at the bottom of the “new” stomach that opens into the rest of the larger stomach. Plastic tissue or mesh is wrapped around the opening to help prevent the opening from stretching. Weight loss is about 45 percent of extra body weight at one year after the surgery.
  • vertical sleeve gastrectomy (VSG)This procedure uses staples to remove a large portion of the stomach; the remaining stomach “sleeve” will hold approximately one-quarter cup of liquid. Over time, the stomach can expand to hold one cup of food.This procedure was created as a first step of a two-step surgery (second step surgery involves changing direction of food in the small intestine for a malabsorption). Many patients lose the desired amount of weight and do not have the second surgery. Weight loss can be 33 percent to 80 percent of excess body weight at one year after surgery. Since the rest of the stomach has been removed, this procedure is not reversible.

VBG and AGB may be performed with a laparoscope rather than through an open incision in some patients. This procedure uses several small incisions and three or more laparoscopes – small thin tubes with video cameras attached – to visualize the inside of the abdomen during the operation. The physician performs the surgery while looking at a TV monitor. Laparoscopic gastric surgery usually reduces the length of hospital stay and the amount of scarring, and often results in quicker recovery than an “open” or standard procedure.

Persons with a BMI of 60 or more or persons who have already had some type of abdominal surgery are usually not considered as a candidate for the laparoscopic technique.

Digestion is the process by which food and liquid are broken down into smaller parts so that the body can use them to build and nourish cells. Digestion begins in the mouth, where food and liquids are taken in, and is completed in the small intestine. The digestive tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus.

The stomach is where the three mechanical tasks of storing, mixing, and emptying occur. Normally, this is what happens:

  • First, the stomach stores the swallowed food and liquid, which requires the muscle of the upper part of the stomach to relax and accept large volumes of swallowed material.
  • Second, the lower part of the stomach mixes up the food, liquid, and digestive juices produced by the stomach by muscle action.
  • Third, the stomach empties the contents into the small intestine.

The food is then digested in the small intestine and dissolved by the juices from the pancreas, liver, and intestine, and the contents of the intestine are mixed and pushed forward to allow further digestion.

Reasons for the Procedure

Bariatric surgery is performed because it is currently the best treatment option for producing lasting weight loss in obese patients for whom nonsurgical methods of weight loss have failed.

Potential candidates for bariatric surgery include:

  • persons with a Body Mass Index (BMI) greater than 40
  • men who are 100 pounds over their ideal body weight or women who are 80 pounds over their ideal body weight
  • persons with a BMI of 35 or more who have another condition such as obesity-related type 2 diabetes, sleep apnea, or heart disease

Because the surgery can have serious side effects, the long-term health benefits must be considered and found greater than the risk. Despite the fact that some surgical techniques can be done laparoscopically with reduced risk, all bariatric surgery is considered to be major surgery.

Although not all risks with each procedure are fully known, bariatric surgery does help many people to reduce or eliminate some health-related obesity problems. It may help to:

  • lower blood sugar
  • lower blood pressure
  • reduce or eliminate sleep apnea
  • decrease the workload of the heart
  • lower cholesterol levels

Surgery for weight loss is not a universal remedy, but these procedures can be highly effective in people who are motivated after surgery to follow their physician’s guidelines for nutrition and exercise and to take nutritional supplements.

There may be other reasons for your physician to recommend a gastric banding procedure.

Risks of the procedure:

As with any surgical procedure, complications may occur. Some possible complications include, but are not limited to, the following:

  • infection
  • blood clots
  • pneumonia
  • bleeding ulcer
  • development of gallstones
  • obstruction or nausea can occur when food is not well-chewed
  • poor nutrition
  • scarring inside the abdomen
  • vomiting due to eating more than the stomach pouch can hold

Risks specific to vertical gastric banding include breakdown of the line of staples and erosion of the band. Rarely, stomach juices may leak into the abdomen and emergency surgery may be needed. The most common complication that may develop with adjustable gastric band surgery is that the stomach pouch enlarges. Band slippage and saline leaks are also risks specific to adjustable gastric band surgery.

Risk is reduced with a laparoscopic banding procedure because there is no incision in the stomach wall.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Supplements: Alpha Lipoic Acid

Supplements

Alpha Lipoic Acid

Alpha lipoic acid (ALA) is familiar to many people as an ingredient in skin care products. However, researchers are now learning that it is a valuable antioxidant in the battle against many types of free radicals. ALA is both a water- and fat-soluble substance. Its fat-soluble properties make it able to reside in cell membranes, and it keeps those membranes from being destroyed by free radicals. ALA also enters water-based parts of cells, providing further protection.

The antioxidant capabilities of ALA were first investigated in the late 1930s. Early in the 1940s, research studies proved that antioxidant ALA fought free radicals. By 1951, scientists had learned that ALA is naturally present in our energy-generating cells of the body. When ALA production is increased, it enters those cells and protects their molecules from being damaged by unstable free radicals that are trying to become stable by replacing their missing molecules.

Benefits of ALA:

  1. ALA can cause chemical reactions in the body that boost or recycle other key antioxidant levels, including vitamins C and E.
  2. It can increase nitric oxide production, as well as making it more stable and increasing its duration.
  3. ALA can help with glucose metabolism, making it often recommended for people with diabetes.
  4. Animal studies have shown that ALA has lowered blood pressure, provided protection in the brain from stroke-related injuries, and improved vascular system functioning.

In an animal study reported in Brain Research in 1996, scientists in India and the U.S. induced a stroke in laboratory rats by manipulating the carotid artery leading to the brain. When they restored bloow flow, there was a surge in oxygen radicals, causing 78 percent of the animals to die within 24 hours. They repeated the experiment, but gave the rats alpha lipoic acid this time just before the blood flow was reestablished. After 24 hours, the death rate had fallen to 26 percent, which indicates that the antioxidant properties of ALA may have provided protection for the animal brains against injury when the blood flow resumed.

In another study, Canadian researchers divided hypertensive rats into groups, supplementing the diet of one group with alpha lipoic acid, while the other group had a normal diet without ALA. After nine weeks, systolic blood pressure readings were significantly lower in the group supplemented with ALA. The systolic measurements decreased from a mean of 180 mm Hg to 140 mm Hg, while the systolic rate in the group treated without ALA increased from 180 to 195 mm Hg. There were also signs of structural improvement within the vascular system, including reduced vascular damage and decreased signs of atherosclerosis.

Supplements: Arginine

Supplements

Arginine

Arginine improves memory, especially long-term memory, and may help to diminish or reverse the effects of dementia and Alzheimer’s disease. It boosts human growth hormone (HGH) production, which has anti-aging benefits, including preservation of lean muscle mass and bone density. It also improves communication between nerve cells and the brain cells, and enhances immune function and protection against bacterial infections.

It benefits people with diabetes due to the many complications associated with this disease, such as poor circulation and blindness, which are due to vascular problems. It also helps regulate insulin secretion in the pancreas. This is especially important news due to the near epedemic of type 2 diabetes in the U.S.

Arginine is helpful in treating asthma by opening pulmonary pathways for easier breathing, and the treatment of lung disorders. Another benefit is helping to heal hemorrhoids by relaxing the hypertonic sphincter muscles. It can be beneficial in cardiovascular and lung damage caused by tobacco use, due to increased nitric oxide production, which is approximately half the level in smokers as non-smokers.

Research shows that arginine helps to accelerate wound healing and post-surgery recovery in the elderly. It may improve athletic performance, as well, due to its ability to boost exercise tolerance resulting from the vasodilation effect of increased nitric oxide production.

Arginine may also improve the function of the prostate, and has been used as a treatment for irritable bowel syndrom (IBS). It has been used to reduce the occurrence of ulcers, however, it does not affect gastric acid production. L-arginine’s protective effect on kidneys may be beneficial for people with diabetes.

Supplements: Coenzyme Q10

Supplements

Coenzyme Q10

A Powerful Antioxidant In the Treatment of Cardiovascular Disease

Coenzyme Q10, also known as CoQ10 is a powerful and especially effective natural antioxidant that has been available for years in Europe and Japan. There are 10 common substances designated coenzyme Qs, but CoQ10 is the only one found in human tissue. CoQ10 is a fat-soluble molecule that does several important functions, such as neutralizing free radicals. For example, it helps vitamins C and E to detoxify superoxide anion, and reduces the oxidation of cholesterol in the vascular wall. The “Q” in coenzyme Q10 stands for quinone, a molecule that is similar to Vitamin E. The “10” stands for the molecule’s 10 units of carbon atoms.

All of us produce CoQ10 internally, and it is present in every cell in the body. In order for our cells to produce ATP, the energy that is used to keep us going, there must be CoQ10. Unfortunately, as we get older, our natural production of CoQ10 diminishes, leading researchers to believe that low levels of this antioxidant contribute to age-related diseases, such as cardiovascular problems and cancer. Some of the best food sources of CoQ10 are mackarel, salmon, sardines, nuts, and such organ meats as liver. Additional supplementation of CoQ10 can provide many health benefits, especially if you are over the age of 50.

Because CoQ10 is fat-soluble, it is best absorbed when taken with oily or fatty food, such as fish. You should be cautious when buying CoQ10, as not all supplement companies provide it in its purest form. Its natural color is dark bright yellow to orange, and is almost tasteless in the powdered form. Store it away from heat and light. Pure coenzyme Q10 is perishable and will deteriorate in temperatures above 115 degrees F. A supplement that is oil-based is preferable, and if it includes a small amount of vitamin E it will help preserve it.

CoQ10 interacts with enzymes present in the body to cause chemical reactions that neutralize free radicals, converting them into something safe before they can oxidize LDL cholesterol. In addition, it stimulates the activity of other natural antioxidants in the body, working synergistically with them to keep them regenerating, which helps protect the endothelium and its ability to produce nitric oxide.

Research has shown that supplemental CoQ10 has the ability to counter histamine, which is beneficial for people with allergies, asthma, and respiratory disease. It is also used by many healthcare professionals to treat mental function abnormalities, such as those found with schizophrenia and Alzheimer’s disease. It also provides benefits in fighting obesity, candidiasis, multiple sclerosis, and diabetes.

American scientists are now considering it as a breakthrough in the treatment of cardiovascular disease. A six-year study by scientists at the University of Texas showed that patients being treated for congestive heart failure who took coenzyme Q10 in addition to conventional therapy had a 75 percent chance of survival after three years, compared to a 25 percent survival rate for those using conventional therapy alone. In a similar study by the University of Texas and the Center for Adult Diseases in Japan, CoQ10 was shown to be able to lower blood pressure without medication or dietary changes.

Other research has shown CoQ10 to be effective in reducing mortality rates in experimental animals who have tumors and leukemia. Some doctors give CoQ10 to their patients who have had chemotherapy to reduce the side effects.

CoQ10 is very popular in Japan where more than 12 million people are taking it for the treatment of heart disease, under their physician’s direction, due to its ability to strengthen the heart muscle, lower blood pressure, and enhance the immune system. Studies in Japan have also shown that it protects the stomach lining and duodenum, and may heal duodenal ulcers.

There is a tremendous amount of research which shows that statin drugs, used to decrease blood cholesterol levels, lower levels of coenzyme Q10.

Supplements: The Benefits of Fish Oil and Omega-3 Fatty Acids

Supplements

The Benefits of Fish Oil and Omega-3 Fatty Acids

Fish oil is especially important for cardiovascular health. Fish is generally low in saturated fat, and often times is high in omega-3 fatty acids. Fatty acids from fish are the primary source of omega-3 fatty acids. Omega-3s have an anti-inflammatory effect, which is beneficial for preventing and treating heart disease, since atherosclerosis causes inflammation of the blood vessel wall. In 1980, two Danish physicians, Drs. Bang and Dyerberg made a remarkable observation in their research. They noted that Greenland Eskimos have a very low chance of having a heart attack (one-tenth that of the average American), even though they eat a very high-fat diet consisting of whale blubber.

The answer to this puzzle is the fat itself. About 40 percent of the fatty acids in fish are omega-3 polyunsaturated fatty acids that have several heart-healthy benefits. They help keep cells more flexible, and the blood vessels more elastic, which reduces the work of the heart. Additionally, the improve the health of the endothelium, enabling increased production of nitric oxide.

In another study researchers followed more than 20,000 male physicians between 40-80 years of age for 11 years and observed the amount of fish they consumed. The results showed that the physicians who ate fish once a week were 52 percent less likely to die of an irregular heartbeat (cardiac arrhythmia) than those who only ate fish once per month. In addition, a published study reported that eating one serving of salmon per week reduces the chance of a heart attack in half.

It is sometimes reported that shellfish is dangerously high in cholesterol, and should be avoided by people with high cholesterol levels. However, the LDL content of certain shellfish, like lobster and crab meat, is as low or lower than skinless white meat of chicken or lean beef. If you have preexisting cariovascular problems, it is probably wise to limit your consumption to shrimp and squid, with only 160 mg and 233 mg of LDL cholesterol per serving respectively.

If you are allergic to seafood, or just don’t like it’s flavor, you may want to consider taking a fish oil supplement. These supplements are available in most health food stores and can help maintain the health of your endothelium. However, it is very important that you purchase a high-quality supplement. Because the oil from fish is very unsaturated, it can become oxidized or rancid quite easily, and if oxidized it is not good for you. Oxidized fish oil can generate free radicals and exhaust your body’s stores of vitamin E. It can also increase the blood sugar level in diabetics. You can determine if your fish oil capsule is oxidized by biting through it and tasting it. If it is oxidized, it has an unpleasant or fishy odor and taste. If it is high quality, it will have no odor or taste.

Supplements: Folic Acid, and the B Complex Vitamins

Supplements

Folic Acid, and the B Complex Vitamins

Folic acid (folate), along with vitamin B6 and vitamin B12, act as co-factors in our body to help the function of certain enzymes. Folate must be present for certain enzymes to perform their vital functions in the body, some of which include the reduction of free radicals. By interfering with oxidative stress, you can stabilize the nitric oxide in your body.

These vitamins also play an important role in cardiovascular health. The Nurses’ Health Study showed that women who consume more B vitamins (either from food or vitamin supplements) had half the risk of heart disease as those who consumed less B vitamins. Folate plays a vital role in reducing homocysteine levels in the body. Homocysteine increases ADMA (asymmetric dimethylarginine) which damages the endothelium, thus reducing the production of nitric oxide. High levels of homocysteine are toxic to the body and a risk factor for cardiovascular disease. Kilmer McCully, a Harvard pathologist, proposed an association between severe atherosclerosis and high homocysteine levels as far back as 1969, however, his hypothesis gained little support until the 1990s, when additional research began confirming his findings.

A brief history of folate – In the 1920s, there were a substantial number of deaths among pregnant women in Bombay, India. It was discovered that these young women had a form of anemia, which was labeled “pregnancy anemia.” These victims tended to be poorly nourished from living mostly on bread and polished rice. However, they did not appear to be deficient in iron or other nutrients typically associated with anemia.

Desperate for some form of treatment, doctors began giving these women extracts of yeast and liver. Amazingly, the health of these women returned. It took more than a decade to better understand the reason for their improvement. Scientists identified a vitamin, present in these foods, as the key factor for the recovery of these pregnant women. In the 1940s, scientists were able to manufacture an extract of this vitamin from spinach leaves, and called it “folic acid” from the Latin folium, meaning leaf.

Researchers at the Harvard School of Public Health wrote a review article regarding a series of studies that looked at a person’s diet to modify the functioning of the endothelium. Their article, which was published in theAmerican Journal of Clinical Nutrition in 2001, concluded that the “overall results of these studies suggest that folic acid supplementation has a beneficial effect on endothelial function…in healthy subjects or patients with elevated homocysteine.” The scientists stated that this benefit “is probably explained largely by the homocysteine-lowering effect of folic acid,” although they also said that folate is found to have some antioxidant properties in laboratory research and “may directly improve nitric-oxide production by enhancing enzymatic activity of nitric-oxide synthase.”

Supplements: Nitric Oxide

Supplements

Nitric Oxide

A Major Advancement in Cardiovascular Medicine

Nitric oxide (NO) is one of the most important discoveries ever regarding the advancement of cardiovascular health. This includes our heart, but also our blood vessels and endothelium, which is a one cell thick lining covering the inside of our blood vessels and organs. However, NO suffers from an identity crisis. If you asked a roomful of people what NO is, most would probably either have no idea, or think it is laughing gas you get at a dentist’s office. Even many doctor’s are not aware of the recent research regarding nitric oxide and how it can benefit your cardiovascular health.

R It is now known that eating the right foods, along with heart healthy supplements, and daily moderate exercise can have a dramatic effect on keeping your endothelium and blood vessels healthy. A healthy endothelium will produce the amount of nitric oxide that is necessary to keep your blood vessels smooth, like Teflon, as opposed to sticky, like Velcro.

If your endothelium produces the proper amount of NO, then you can eliminate cardiovascular disease risk factors, such as high blood pressure, high cholesterol, and high homocysteine levels. By having relaxed, dilated blood vessels, the rest of your body and organs will receive proper blood flow and the nutrients needed for optimal cardiovascular health.

esearch showed that a healthy endothelium releases its own form of nitroglycerin, a powerful vasodilator and muscle relaxant that is essential for cardiovascular health. A healthy endothelium is like having a life-long supply of nitroglycerin, only much better. Nitroglycerin exposes your blood vessels to a blast of NO all at once, where endothelium produced NO is released specifically where it is needed. This NO production is controlled by nerve stimulation, circulating hormones, and the tissue served by the vessels. This research regarding cardiovascular health is shedding some much needed light on the importance of nitric oxide.

It is now known that eating the right foods, along with heart healthy supplements, and daily moderate exercise can have a dramatic effect on keeping your endothelium and blood vessels healthy. A healthy endothelium will produce the amount of nitric oxide that is necessary to keep your blood vessels smooth, like Teflon, as opposed to sticky, like Velcro.

If your endothelium produces the proper amount of NO, then you can eliminate cardiovascular disease risk factors, such as high blood pressure, high cholesterol, and high homocysteine levels. By having relaxed, dilated blood vessels, the rest of your body and organs will receive proper blood flow and the nutrients needed for optimal cardiovascular health.

Supplements: Vitamin C

Supplements

Vitamin C

An Essential Part of Cardiovascular Health

Vitamin C has been used to help treat many ailments, from the common cold to cancer. It actually came to the forefront of research back in the 1930’s when a Hungarian researcher, Albert Szent-Gyorgyi, first isolated this vitamin. He was awarded the Nobel Prize in 1937 for this discovery. This vitamin was identified as the substance found in fruits and vegetables that was capable of preventing and curing scurvy, a disease that had killed thousands of sailors who had to survive for months at a time on diets low on vitamin C. Szent-Gyorgyi gave the substance the name of ascorbic acid. This vitamin is known today as a water-soluble vitamin, meaning it dissolves in water.

The following are some of the benefits ascorbic acid can provide:

  1. Helps with the formation of collagen, an important protein in the body’s connective tissue.
  2. Stimulates wound healing.
  3. Aids with the absorption of iron from the intestinal tract, which reduces the risk of iron-deficiency anemia.
  4. Maintains the health of your immune system by stimulating the production of a number of antibodies that can resist bacteria and viruses.
  5. Protects the body against free radicals and the potential injuries they cause, which includes damage to the cardiovascular system.

At the UCLA School of Public Health, researchers looked at the relationship between ascorbic acid and death rates in more than 11,300 adults over a period of 10 years. In their study published in Epidemiology in 1992, the individuals who had the highest intake (more than 50 mg per day), were more likely to remain disease-free than those with a lower intake. The higher-intake group not only had a lower overall death rate, but also a lower risk of death from both heart disease and cancer.

Our bodies do not produce ascorbic acid. This makes it especially important that you consume adequate amounts of this vitamin through your diet and supplementation.

Supplements: Vitamin D

Supplements

Vitamin D

The Prohormone Vitamin D

The prohormone vitamin D is comprised of a group of of fat-soluble vitamins. There are two major forms, vitamin D2 (ergocalciferol) and vitamin D3 cholecalciferol). A third synthetic form is known as vitamin D5. Of these three types, vitamin D3 is considered the natural form and is the most active.

Vitamin D is important for its maintenance role of our various organ systems. The type of vitamin D we get from food or supplements is not fully active, and requires conversion by the liver and then kidneys for it to become fully active. For this reason, people with liver or kidney disorders are at a greater risk for osteoporosis. A deficiency of vitamin D may also be caused by insufficient intake along with a lack of sunlight exposure, which limits its absorption. It has a positive effect on the immune system by promoting phagocytosis, anti-tumor activity, and immunomodulatory function.

Vitamin D2 is not produced by the human body, but comes from plant and fungal sources. Vitamin D3 is derived from animal sources, and when your skin is exposed to ultraviolet rays from the sun. When this happens a cholesterol compound in the skin is transformed into a precursor of vitamin D. Researchers have learned that people with dark skin (because skin pigment blocks the sunlight) and people who live in the northern and southern regions of the hemispheres cannot produce enough vitamin D during the winter months from sunlight exposure and additional supplementation is necessary.

As a prohormone, Vitamin D has no hormone activity by itself, but is converted to the active hormone 1,25-D, through a synthesis mechanism that is tightly regulated. Even when vitamin D derived from food or animal sources, ultraviolet sun rays play some part in the process. These organisms or animals are not able to synthesize the vitamin D except by the presence of ultraviolet light at some point in the synthetic chain.

Most doctors who specialize in vitamin D are now recommending at least 2,000 IU per day. However, there are a number of doctors, such as Dr. J. Joseph Prendergast, an endocrinologist in Palo Alto, CA, that recommend 5,000 to 10,000. Dr. Cedric Garland of the University of California at San Diego Medical School, Moores Cancer Center, believes that 75% of breast cancer and colon cancer deaths could be prevented with adequate blood levels of vitamin D.

Supplements: Vitamin E

Supplements

Vitamin E

Vitamin E Boosts Your Heart Health

Vitamin E is actually a group of compounds, the tocopherols and tocotrienols. The most biologically active form of this vitamin is Alpha-tocopherol, and is found in small amounts in foods, especially vegetable oils – including corn, soybean, and safflower – wheat germ, and nuts. Alpha-tocopherol should be a part of everyone’s antioxidant regimen. It may also interfere with inflammatory processes within the body that could further jeopardize your cardiovascular health, without this intervention. There is also evidence that it slows the formation of LDL (bad) cholesterol.

At Cambridge University in the United Kingdom, researchers in the Cambridge Heart Antioxidant Study (CHAOS) looked at the effects of tocopherol on 2,002 people with confirmed heart disease. A little more than half the individuals were given alpha-tocopherol capsules (some at a dose of 800 IU/day, others at 400 IU/day for a median of 510 days, and the remaining participants were given placebo capsules. The journal Lancet reported that the group taking the active vitamin had a 77% reduced risk of a non-fatal heart attack when compared to the placebo group. These results came within six and a half months of taking the supplements.

There is a caution to be aware of with this vitamin. Because it has mild blood-thinning properties, you should talk to your doctor if you are already taking an anticoagulant or blood thinner such as Coumadin or aspirin. Your doctor might suggest that you not take a tocopherol supplement to avoid increasing the blood-thinning properties of the drugs you are taking.

There are many studies that confirm the positive effects of tocopherols on oxidizing free radicals before they can cause cardiovascular or other serious diseases.