FitSugar

MoonWalk - Uniting Against Breast Cancer

FitSugar — Thu, 15 Feb 2007 14:00:00 -0800

Walk the Walk is a charity committed to raising money and awareness for breast cancer research and cancer care. They are also passionate about encouraging women and men to become healthier, fitter, and to take charge of their own well being.

One of their fundraisers is called the MoonWalk. It's taking place on June 16, 2007, in Edinburgh, Scotland. Not only are the men and women power walking throughout the entire night, they are doing it wearing decorated bras to raise awareness for breast cancer.

You can go to their website to register.

Fit's Tips: If you won't be in Scotland for the MoonWalk, you can still help raise money for breast cancer. Host your own fundraiser event and donate all the proceeds to the Breast Cancer Fund.

Want to see a video about "The Moonlight Walk to Kingsley Vale." Then read more

They're not in their bras, but they are walking through the night to raise money for diagnostic equipment for breast cancer.

Fiber

FitSugar — Wed, 08 Oct 2008 17:35:33 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Overview

Dietary fiber, found in the walls of plant cells, cannot be digested by enzymes in the human digestive tract but plays an essential role in human health. It is found in all plant-based foods, with most whole foods containing a combination of the two types of fiber, including soluble and insoluble fiber. Both types of fiber help maintain the health of the intestinal tract and promote regular elimination of stool.

Soluble fiber attracts water and forms a gel in the digestive tract. This slows digestion and lowers the rate of nutrient absorption (such as starch and sugars) from the stomach and intestine. The result is a significant reduction in cholesterol levels over time, which may help prevent heart disease and stroke. Intake of soluble fiber may also improve glucose tolerance in people with diabetes. Psyllium husk, pectin, and the soft parts of fruits, dried beans, and peas are examples of soluble fiber.

Insoluble fiber, on the other hand, is the portion of plant cells that gives the wall its structural integrity. Insoluble fiber can be found in the peels of fruit, such as apples, blueberries, and grapes. It acts as a natural laxative that speeds the passage of foods through the stomach. It also gives stool its bulk and helps it move quickly through the gastrointestinal tract.

Dietary fiber has been shown to play a role in the treatment of conditions such as gastrointestinal disease, constipation, hemorrhoids, high cholesterol, heart disease, and diabetes. However, most Americans consume only 11 - 13 grams of dietary fiber per day -- less than half the amount recommended by health care professionals. It has been recommended that Americans should strive to achieve a total dietary fiber intake of 25 - 30 grams daily, preferably from foods and not supplements.

Uses

Constipation

Many well-designed clinical studies have concluded that fiber relieves constipation. Clinical studies have used wheat bran and psyllium primarily. Fiber is believed to relieve constipation by adding bulk to stool and speeding its transit through the gastrointestinal tract.

Diarrhea

When recommended by a health care provider, fiber can be used to relieve mild-to-moderate diarrhea. Soluble fiber soaks up a significant amount of water in the digestive tract, thereby making stool firmer and slower to pass.

Irritable bowel syndrome (IBS)

Several well-designed clinical studies have found that soluble fiber helps regulate stool frequency and consistency in people with IBS.

Hemorrhoids

Soluble fiber may be recommended by a doctor to help soften stool and reduce the pain associated with hemorrhoids.

Inflammatory bowel disease (IBD)

In a clinical study of people with ulcerative colitis (a type of IBD), psyllium seeds were as effective as the prescription drug mesalamine in reducing recurrences of the disease. In addition, a doctor may recommend the use of fiber as a bulking agent for mild-to-moderate cases of diarrhea from either ulcerative colitis or Crohn's disease (another important type of IBD).

Diverticulosis

Patients with diverticulosis are often given fiber supplements to increase the tone of their digestive tract. The American Dietetic Association (ADA) recommends 25 - 30 grams per day. Some nutritionally-oriented doctors may recommend even more. Care should be taken to discuss the appropriate type of fiber for each individual patient as certain types of fiber may actually aggravate diverticulosis. In particular, avoidance of nuts, pumpkin, caraway, and sesame seeds is recommend out of concern that the small particles may get lodged in the diverticula and cause infection and irritation.

High cholesterol

Soluble fibers, such as those in psyllium husk, guar gum, and oat bran, have a cholesterol-lowering effect when added to a low-fat, low-cholesterol diet. Clinical studies have shown psyllium, in particular, to be quite effective in lowering total as well as low density lipoprotein (LDL or "bad") cholesterol levels.

Diabetes

Clinical studies suggest that a high-fiber diet may help prevent type 2 diabetes, lower insulin and blood sugar levels, and improve cholesterol and triglyceride levels in people with diabetes. In addition, one well-designed clinical study suggests that pregnant women with type 1 diabetes are able to lower the amount of insulin they use if they eat a high fiber diet.

A clinical study compared patients with type 2 diabetes who were consuming 50 grams of fiber daily with patients following the American Diabetes Association’s recommendation of 24 grams of fiber daily. After 6 weeks, patients on the higher fiber diet had substantially better control of blood glucose, insulin, and blood lipids. In another clinical study, a group of men with type 2 diabetes who took psyllium twice daily experienced significant improvements in blood glucose and lipid values compared to a control group taking a placebo.

Obesity

Clinical studies and human case reports suggest that soluble fiber (such as psyllium, pectin, and guar gum) may enhance the sensation of fullness and reduce hunger cravings. For these reasons, incorporating soluble fiber into the diet may aid weight loss.

High blood pressure

Although not entirely conclusive, the addition of fiber (namely, 12 grams of soluble fiber per day) may help lower blood pressure (also called hypertension).

Heart disease

Incorporating high-fiber foods (such as oatmeal, oat bran, psyllium, and legumes) into the diet may help lower heart disease risk.

Colon cancer

Although initial clinical reports were promising, studies investigating the value of a high-fiber diet for colorectal cancer have been conflicting. While some clinical studies evaluating groups of people have suggested that fiber protects against the development of colorectal cancer, most large, better-designed clinical studies have found only a minimal association between fiber intake and colorectal cancer risk. In addition, fiber does not appear to protect against the recurrence of colorectal cancer in people who have already been treated for the condition.

Other types of cancer

Preliminary clinical evidence suggests that a diet high in fiber (in conjunction with lifestyle changes and conventional medication) may help protect against the development of certain types of cancer such as prostate, breast, and lining of the uterus. Further studies are needed to confirm these findings, however.

Dietary Sources

Soluble fiber is found in dried beans and peas, oats, barley, fruits, and psyllium seed husks.

Insoluble fiber is found primarily in fruits and vegetables, whole-grain products, whole grain cereals, and wheat and corn bran.

Available Forms

Dietary fiber is available as a supplement in several forms, including fiber tablets, capsules, and powders. Fiber is also available as bulk fiber laxatives, including psyllium.

How to Take It

The National Academy of Sciences' Institute of Medicine, which provides science-based advice on matters of medicine and health, gives the following daily fiber recommendations for adults:

Pediatric

Infants and children under 18 years of age: There is no specific dietary amount established for pediatric fiber intake. Children with specific fiber needs should increase the daily intake of fibrous foods slowly over a period of days. Fiber supplements should only be taken under the guidance of a qualified health care practitioner.

Adults

For adult males ages 19 - 50: The recommended daily fiber intake amount is 38 grams.

For adult females ages 19 – 50: The recommended daily fiber intake amount is 25 grams.

For adult males ages 51 and older: The recommended daily fiber intake amount is 30 grams.

For adult females ages 51 and older: The recommended daily fiber intake amount is 21 grams.

If you are not getting enough fiber each day, you may need to boost your fiber intake in the diet. Choose whole-grain products, raw or cooked fruits and vegetables, dried beans, and dried peas. Refined or processed foods, including fruit juices, white breads, pastas, and rice, and non-whole-grain cereals, are lower in fiber content. The grain-refining process removes the outer coat (bran) from the grain, which lowers its fiber content. Similarly, removing the skin from fruits and vegetables decreases their fiber content.

Precautions

Because supplements may have side effects or interact with medications, they should be taken only under the supervision of a knowledgeable health care provider.

In general, fiber supplements may reduce or delay the absorption of certain medications. For this reason, it is best to refrain from taking fiber supplements at the same time as other medications. Instead, medications should be taken at least 1 hour before or between 2 - 4 hours after taking fiber.

Fiber should always be taken with a full 8 oz glass of water. It is also important to drink at least 6 - 8 full glasses of water throughout the day or constipation may develop. Taking fiber supplements without adequate liquids may cause it to swell and, in extreme cases, cause choking. Do not take this product if you have difficulty swallowing. People with esophageal stricture (narrowing of the esophagus) or any other narrowing or obstruction of the gastrointestinal tract should not take fiber supplements.

If you experience chest pain, vomiting, or difficulty swallowing or breathing after taking fiber supplements, seek immediate medical attention.

A potential side effect from any fiber product is gas and bloating.

Although very uncommon, allergic reactions (even anaphylaxis) to soluble fiber may develop in people who consume these types of supplements over a long period of time.

Possible Interactions

If you are currently being treated with any of the following medications, you should not use fiber supplements without first talking to your health care provider.

Antidepressant medications (Tricyclic antidepressants) -- Dietary fiber has been reported to lower the blood levels and effectiveness of tricyclic antidepressant medications, such as amitriptyline (Elavil), doxepin (Sinequan), and imipramine (Tofranil), in several patients. Reduced dietary fiber intake increased the blood levels and improved symptoms in these patients. Individuals currently taking tricyclic medications should consult a health care provider before increasing fiber intake.

Diabetes medications -- While fiber supplements may help to regulate blood sugar levels, they may also interfere with the absorption of anti-diabetic medications, specifically glyburide (Diabeta) and metformin (Glucophage). Therefore, fiber supplements should not be taken at the same time as these medications.

Carbamazepine -- Taking soluble fiber such as psyllium with carbamazepine (Tegretol), a medication used to treat seizure disorders, may decrease the absorption and effectiveness of carbamazepine. A health care provider should close monitor blood levels of anyone taking both soluble fiber and carbamazepine.

Cholesterol-lowering medications -- Combining psyllium or other soluble fibers with cholestyramine (Questran) or colestipol (Colestid), two types of cholesterol-lowering medications known as bile acid sequestrants, may be beneficial in lowering cholesterol levels. Individuals taking these medications should consult a health care provider to determine whether psyllium is safe and appropriate.

Fiber in the form of pectin (from fruit) and oat bran reportedly reduces the body's ability to absorb cholesterol-lowering medications known as "statins," including lovastatin (Mevacor) and atorvastatin (Lipitor), and could lead to decreased effectiveness of these medications.

Digoxin -- Fiber supplements may reduce the body's ability to absorb digoxin (Lanoxin), a medication used to regulate heart function. Therefore, fiber supplements should not be taken at the same time as this medication.

Lithium -- Clinical reports suggest that psyllium or other soluble fibers may lower lithium levels in the blood, reducing the effectiveness of this medication. Lithium levels should be monitored very closely by a health care provider, particularly if there is any significant change in fiber intake.

Penicillin -- In one clinical study, the fiber supplement guar gum reduced blood levels of penicillin. Therefore, it would be best not to take penicillin at the same time as fiber supplements.

Supporting Research

Alabaster O, Tang ZC, Frost A, Sivapurkar N. Potential synergism between wheat brain and psyllium: enhanced inhibition of colon cancer. Cancer Lett. 1993;75:53–58.

Alberts DS, Martínez ME, Roe DJ, et al. Lack of effect of a high-fiber cereal supplement on the recurrence of colorectal adenomas. N Eng J Med. 2000;342(16):1156-1162.

American Diabetes Association. Nutrition recommendations and principles for people with diabetes mellitus. Diabetes Care. 1999;22(1):S42-S45.

Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr. 2000;71:472-479.

Anderson JW, Allgood LD, Turner J, Oeltgen PR, Daggy BP. Effects of psyllium on glucose and serum lipid responses in men with type 2 diabetes and hypercholesterolemia. Am J Clin Nutr. 1999;70:466-473.

Appel LJ. Nonpharmacologic therapies that reduce blood pressure: a fresh perspective. Clin Cardiol. 1999;22(Suppl. III):III1-III5.

Ashraf W, Park F, Lof J, Quigley EM. Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation. Aliment Pharmacol Ther. 1995;9:639–647.

Bazzano LA, He J, Ogden LG, Loria C, Vupputuri S, Myers L, Whelton PK. Legume consumption and risk of coronary heart disease in US men and women: NHANES epidemiologic follow-up study. Arch Intern Med. 2001;161(21):2573-2578.

Bonithon-Kopp C, Kronborg O, Giacosa A, Rath U, Faivre J. Calcium and fibre supplementation in prevention of colorectal adenoma recurrence: a randomised intervention trial. European Cancer Prevention Organisation Study Group. Lancet. 2000;356(9238):1286-1287.

Botterweck AA, van den Brandt PA, Goldbohm RA. Vitamins, carotenoids, dietary fiber, and the risk of gastric carcinoma: results from a prospective study after 6.3 years of follow up. Cancer. 2000;88(4):737-748.

Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nut. 1999;69(1):30-42.

Burke V, Hodgson JM, Beilin LJ, Giangiulioi N, Rogers P, Puddey IB. Dietary protein and soluble fiber reduce ambulatory blood pressure in treated hypertensives. Hypertension. 2001;38(4):821-826.

Chandalia M, Garg A, Lutjohann D, von Bergmann K, Grundy SM, Brinkley LJ. Beneficial effect of high dietary fiber intake in patients with type 2 diabetes mellitus. N Eng J Med. 2000; 342:1392-1398.

Cohen LA. Dietary fiber and breast cancer. Anticancer Res. 1999;19(5A):3685-3688.

Compher CW, Frankel WL, Tazelaar J, Lawson JA, McKinney S, Segall S, et al. Wheat bran decreases aberrant crypt foci, preserves normal proliferation, and increases intraluminal butyrate levels in experimental colon cancer. JPEN: J Paren Enteral Nutr. Sep-Oct 1999;23(5):269-277.

Etman MA. Effect of a bulk forming laxative on the bioavailability of carbamazepine in man. Drug Dev Ind Pharm. 1995;21(16):1901-1906.

Ettinger AB, Shinnar S, Sinnett MJ, Moshe SL. Carbamazepine-induced constipation. J Epilepsy. 1992;5(3):191-193.

Fernandez-Banares F, Hinojosa J, Sanchez-Lombrana JL, et al. Randomized clinical trials of Platago ovata seeds (dietary fiber) as compared with mesalamine in maintaining remission in ulcerative colitis. Am J Gastroenterol. 1999;94:427–433.

Gallaher DD, Schneeman BO. Dietary fiber. In: Ziegler EE, Filer LJ, eds. Present Knowledge in Nutrition. 7th ed. Washington, DC: International Life Sciences Institute; 1996:87-94.

Gin H, Orgerie MB, Aubertin J. The influence of guar gum on absorption of metformin from the gut in healthy volunteers. Horm Metab Res. 1989;21(2):81-83.

Goodman MT, Wilkens LR, Hankin JH, Lyu LC, Wu AH, Kolonel LN. Association of soy and fiber consumption with the risk of endometrial cancer. Am J Epidemiol. 1997;146(4):294-306.

Gray DS. The clinical uses of dietary fiber. Am Fam Physician. 1995;51(2):419-426.

Hayes RB, Ziegler RG, Gridley G, et al. Dietary factors and risks for prostate cancer among blacks and whites in the United States. Cancer Epidemiol Biomarkers Prev. 1999;8(1):25-34.

Hermansen K, Sondergaard M, Hoie L, Carstensen M, Brock B. Beneficial effects of a soy-based dietary supplement on lipid levels and cardiovascular risk markers in type 2 diabetic subjects. Diabetes Care. 2001;24(2):228-233.

Hillemeier C. An overview of the effects of dietary fiber on gastrointestinal transit. Pediatr. 1995:997-999.

Howard BV, Manson JE, Stefanick ML, et al., Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial. JAMA. 2006;295(1):39-49.

Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790-797.

Huupponen R, Seppala P, Iisalo E. Effect of guar gum, a fibre preparation, on digoxin and penicillin absorption in man. Eur J Clin Pharmacol. 1984;26(2):279-281.

Jänne PA, Mayer RJ. Chemoprevention of colorectal cancer. N Engl J Med. 2000;342(26):1960-1968.

Jenkins DJ, Kendall CW, Vuksan V. Viscous fibers, health claims, and strategies to reduce cardiovascular disease risk. Am J Clin Nut. 2001;73(3):653-654.

Jenkins DJ, Popovich DG, Kendall CW, Vidgen E, Tariq N, Ransom TP, et al. Effect of a diet high in vegetables, fruit, and nuts on serum lipids. Metabol. 1997;46(5):530-537.

Johnson BF, Rodin SM, Hoch K, Shakar V. The effect of dietary fiber on the bioavailability of digoxin in capsules. J Clin Pharmacol. 1987;27(7):487-490.

Kalkwarf HJ, Bell RC, Khoury JC, Gouge AL, Miodovnik M. Dietary fiber intakes and insulin requirements in pregnant women with type 1 diabetes. J Am Diet Assoc. 2001;101(3):305-310.

Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, et al. AHA Scientific Statement: AHA Dietary guidelines Revision 2000: A statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation. 2000;102(18):2284-2299.

Kritchevsky D. Dietary fibre and cancer. Eur J Cancer Prev. 1997;6:435-441.

Kurtz RC, Zhang ZF. Gastric cardia cancer and dietary fiber. Gastroenterology. 2001;120(2):568-70

Lantner RR, Espiritu BR, Zumerchik P, Tobin MC. Anaphylaxis following ingestion of a psyllium-containing cereal. JAMA. 1990;264(19):2534-2536.

Le Marchand L, Wilkens LR, Hankin JH, Kolonel LN, Lyu LC. Independent and joint effects of family history and lifestyle on colorectal cancer risk: Implications for prevention. Cancer Epidemiol Biomarkers Prevent. 1999;8:45-51.

Liu S, Manson JE, Stampfer MJ, Hu FB, Giovannucci E, Colditz GA, et al. A prospective study of whole-grain intake and risk of type-2 diabetes mellitus in women. Am J Pub Health. 2000;90:1409-1415.

Lu LJ, Anderson KE, Grady JJ, Kohen F, Nagamani M. Decreased ovarian hormones during a soya diet: implications for breast cancer prevention. Can Res. 2000;60(15):4112-4121.

Ludwig DS, Pereira MA, Kroenke CH, Hilner JE, Van Horn L, Slattery ML, Jacobs DR Jr. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. JAMA.1999:282(16):1529-1546.

Marlett JA, et al. Mechanism of serum cholesterol reduction by oat bran. Hepatology. 1994;20:1450-1457.

Mayne ST, Risch HA, Dubrow R, Chow WH, Gammon MD, Vaughan TL, et al. Nutrient intake and risk of subtypes of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev. 2001;10(10):1055-1062.

McGuffin M, ed. American Herbal Products Association's Botanical Safety Handbook. Boca Raton, FL: CRC Press, 1997.

McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther. 1998;12:491–497.

Michels KB, Giovannucci E, Joshipura KJ, Rosner BA, Stampfer MJ, Fuchs CS, et al. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. J Natl Cancer Inst. 2000;92(21):1740-1752.

Murray MT, Pizzorno JE. Role of dietary fiber in health and disease. In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. Vol 1. 2nd ed. Edinburgh: Churchill Livingstone; 1999:507-516.

National Cholesterol Education Program. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-2497.

Perlman BB. Interaction between lithium salts and ispaghula husk [letter]. Lancet. 1990;355:416.

Persson PG, Ahlbom A, Hellers G. Diet and inflammatory bowel disease: a case-control study. Epidemiol. 1992;3(1):47-52.

Potischman N, Swanson CA, Coates RJ, Gammon MD, Brogan DR, Curtin J, et al. Intake of food groups and associated micronutrients in relation to risk of early-stage breast cancer. Int J Cancer. 1999;82(3):315-321.

Richter WO, Jacob BG, Schwandt P. Interaction between fibre and lovastatin. Lancet. 1991;338;706.

Rodrigues-Moran M, Guerrero-Romero F, Lazcano-Burciaga G. Lipid- and glucose-lowering efficacy of Plantago Psyllium in type II diabetes. J Diabetes Complications. 1998;12:273–278.

Schatzkin A, Lanza E, Corle D, Lance P, Iber F, Caan B, et al. Lack of effect of a low-fat, high-fiber diet on the recurrence of colorectal adenomas. N Engl J Med. 2000;342(16):1149-1155.

Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease. 9th ed. Media, Pa: Williams & Wilkins; 1999.

Soffer EE. Constipation: an approach to diagnosis, treatment, referral. Cleve Clin J Med. 1999;66(1):41-46.

Sola R, Godas G, Ribalta J, et al., Effects of soluble fiber (Plantago ovata husk) on plasma lipids, lipoproteins, and apolipoproteins in men with ischemic heart disease. Am J Clin Nutr. 2007;85(4):1157-63.

Soler M, Bosetti C, Franceschi S, Negri E, Zambon P, Talamini R, et al. Fiber intake and the risk of oral, pharyngeal, and esophageal cancer. Int J Cancer. 2001;91(3):283-287.

Spence JD, Huff MW, Heidenheim P et al. Combination therapy with colestipol and psyllium mucilloid in patients with hyperlipidemia. Ann Intern Med. 1995;123:493-499.

Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343(1):16-22.

Stewart DE. High-fiber diet and serum tricyclic antidepressant levels. J Clin Psychopharmacol. 1992;12:438-440.

Tariq N, Jenkins D, Vidgen E, Fleshner N, Kendall CW, Story JA, et al. Effect of soluble and insoluble fiber diets on serum prostate specific antigen in men. J Urol. 2000;163:114-118.

Terry P, Lagergren J, Ye W, Wolk A, Nyren O. Inverse association between intake of cereal fiber and risk of gastric cardia cancer. Gastroenterology. 2001;120(2):387-391.

Toutoungi M, Schulz P, Widmer J, et al. Probable interaction of psyllium and lithium. Therapie. 1990;45(4):358-360.

Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-1350.

Turley SD, Daggy BP, Dietschy JM. Effect of feeding psyllium and cholestyramine in combination on low density lipoprotein metabolism and fecal bile acid excretion in hamsters with dietary-induced hypercholesterolemia. J Cardiovasc Pharmacol. 1996;27:71-79.

Turnbull WH, Thomas HG. The effect of a Plantago ovata seed containing preparation on appetite variables, nutrient and energy intake. Int J Obes Relat Metab Disord. 1995;19:338-342.

Vaswani SK, Hamilton RG, Valentine MD, Adkinson NF Jr. Psyllium laxative-induced anaphylaxis, asthma, and rhinitis. Allergy. 1996;51(4):266-268.

Wald A. Constipation. Med Clin North America. 2000;84(5):1231-1246.

Wursch P, Pi-Sunyer FX. The role of viscous soluble fiber in the metabolic control of diabetes. A review with special emphasis on cereals rich in beta-glucan. Diabetes Care. 1997; 20:1774-1780.

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Review Date:
5/25/2007
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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Myocardial infarction

FitSugar — Wed, 08 Oct 2008 17:34:55 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment Approach
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Myocardial infarction is the technical name for a heart attack. The heart is responsible for pumping blood, which carries oxygen, to every organ in the body – including the heart itself. A heart attack occurs when an artery leading to the heart becomes completely blocked and the heart doesn’t get enough blood or oxygen. Cells in that area of the heart start to die (called an infarct).

A heart attack is a medical emergency. If you or someone you know has any of the symptoms below, call 911 immediately. Waiting even 15 minutes can be fatal. But if you get prompt medical treatment, you can limit damage to your heart. Although heart attack is the leading cause of death in the United States, up to 95% of people who are hospitalized with a heart attack survive.

Most heart attacks are caused by blood clots, which are in turn caused by atherosclerosis (stiffening and narrowing of the arteries). High blood fats (triglycerides) and LDL or “bad” cholesterol form plaque inside arteries, narrowing the passageway and reducing the amount of blood that can flow through. Your lifestyle plays a crucial role in preventing a heart attack or recovering from one. Eating a heart-healthy diet and getting at least 30 minutes of exercise five days a week (or more) can reduce your risk of heart attack.

Signs and Symptoms

Squeezing pain, heaviness, tightness, pressure in center of chest
Pain that spreads to your back, left arm, jaw, neck
Shortness of breath
Dizziness, weakness
Nausea, vomiting
Irregular heartbeat
Sweating
Feeling of doom

Women may experience different symptoms than men. In women, along with chest pain, symptoms can include:

Heartburn or pain in the abdomen
Unusual fatigue
Clammy skin

Causes

Heart attacks happen when an artery supplying your heart with blood becomes blocked. Without blood, the heart doesn’t get enough oxygen and cells in the heart start to die.

The most common cause of blocked arteries is atherosclerosis. No one knows the exact cause of atherosclerosis, but most researchers believe it begins with an injury to the innermost layer of the artery, known as the endothelium. The following factors are thought to contribute to the damage:

High blood pressure
Elevated LDL ("bad") cholesterol
An accumulation of homocysteine (an amino acid produced by the human body, thought to be a risk factor for heart disease, stroke, osteoporosis, diabetes, and dementia)
Smoking
Diabetes
Inflammation

Once the artery is damaged, blood cells called platelets build up there to try and repair the injury. Over time, fats, cholesterol, and other substances also build up at the site, which thickens and hardens the artery wall. The amount of blood that flows through the artery is decreased, and oxygen supply to organs also decreases. Blood clots may also form, blocking the artery.

Rarely, a spasm in a coronary artery (one that supplies blood to the heart) stop blood flow and can cause a heart attack.

Risk Factors

These risk factors increase your chances of developing atherosclerosis:

Smoking
High-fat diet
High LDL “bad” cholesterol and triglycerides (fats in the blood)
Lack of exercise
Being overweight or obese
Family history of heart attack
Diabetes
High blood pressure
Being male, or a female who has gone through menopause
Stress

Also, people who have elevated homocysteine, C-reactive protein (CRP), and fibrinogen levels seem to have an increased risk of heart attack. These are markers of inflammation, but researchers aren’t sure whether they contribute to heart disease or occur when you have heart disease. High homocysteine can be treated with folic acid (see Nutrition and Supplements). More research in these areas is currently underway.

Diagnosis

If you think that you are having a heart attack, don’t wait to be sure – call 911 immediately. Treating a heart attack quickly can save your life, while delay can be fatal. In the emergency room, a doctor will ask you about your symptoms and perform a physical examination. He or she will immediately run tests to determine your heart function. They may include:

Electrocardiogram (ECG) - the first test done to check for a heart attack; you may be hooked up to a monitor even as the doctor is asking you questions. An ECG measures electrical activity of your heart.

Blood tests - Your doctor may look for certain enzymes that are released into your blood when you have a heart attack.

Other tests include:

Chest x-ray
Echocardiogram (uses sound waves to take a picture of your heart)
Coronary catheterization or angiogram (uses a liquid dye inserted through a catheter to see whether your arteries are blocked)
Stress test (involves walking on a treadmill while hooked up to a ECG machine to see how your heart responds to exercise)

Preventive Care

You can reduce your risk of heart attack by:

Stopping smoking.
Getting aerobic exercise (such as walking, biking, or swimming) for at least 30 minutes 5 days per week. If you haven't exercised much in the past, walking is a great way to start.
Reducing stress and learning stress-reduction techniques such as deep breathing and meditation. Yoga and tai chi, two forms of exercise that emphasize stretching, breathing, and meditating, can also help you reduce your stress level.
Eating a diet low in saturated fat and rich in fruits, vegetables, and whole grains.
Losing weight or maintaining a proper weight.

If you have high cholesterol, diabetes, or high blood pressure, follow your doctor’s instructions to keep these risk factors under control. You may need medications in addition to lifestyle changes. If you don't have heart disease yet or have not had a heart attack despite these risk factors, aggressive control can help prevent a heart attack. And, if you already have heart disease, aggressive control of these risk factors can prevent further heart attacks or other problems related to heart disease.

Treatment Approach

The goal when treating a heart attack is to restore blood flow to the affected area of the heart immediately, to preserve as much heart muscle and heart function as possible. If your doctor has prescribed nitroglycerin, take it while you are waiting for emergency medical personnel to arrive. Once at the hospital, your doctor may use drug therapy, angioplasty (using one of several methods to clear the blocked blood vessel, such as inflating a balloon inside it or holding it open with a device called a stent), and surgery.

Once you have been treated for a heart attack, making changes in your lifestyle (especially in your diet and exercise habits) and taking medications as prescribed is very important for avoiding recurrent heart attacks and even death. Although certain herbal remedies as well as relaxation techniques may also be used, they should never be used alone to treat a heart attack. A heart attack always requires emergency medical attention.

Lifestyle

Making lifestyle changes can improve many of your risk factors for heart disease, including high cholesterol, high blood pressure, extra weight, high homocysteine, and elevated C-reactive protein. Cardiac rehabilitation programs generally involve teaching you about diet, physical activity, and relaxation techniques. To keep your risk factors low, you will need to follow the healthy habits taught in cardiac rehab, like exercise and eating properly, for the rest of your life.

Medications

Aspirin - helps stop blood from clotting. You may be given aspirin in the ambulance or as soon as you get to the hospital.

Nitroglycerin - helps dilate (widen) blood vessels. You may be given nitroglycerin in the ambulance or as soon as you get to the hospital.

Pain reliever - Morphine is often given intravenously (IV) to relieve pain.

Thrombolytics - “Clot-busting” drugs may be used, depending on the type of heart attack. They are most effective when taken within 2 hours of the heart attack, and are not given after 12 hours have elapsed. These drugs may be given with other anticoagulants (blood-thinners).

Anticoagulants (blood-thinners) - Make your blood less likely to form clots. Heparin is often given by injection while you are in the hospital.

After you recover, other drugs are used to lower your risk of having another heart attack. They include:

ACE inhibitors - widen blood vessels and make it easier on your heart to pump blood. Side effects can include chronic cough. ACE inhibitors include

Benazepril (Lotensin)
Captopril (Capoten)
Fosinopril (Monopril)
Lisinopril (Zestril)
Enlapril (Vasotec)

Beta-blockers - slows heart rate, thus lowering blood pressure. These drugs include

Acebutolol (Sectral)
Atenolol (Tenormin)
Bisoprolol (Zebeta)
Carteolol (Cartrol)
Metoprolol (Toprol XL)
Nadolol (Corgard)
Propranolol (Inderal)

Statins - help lower cholesterol. People who are pregnant or have liver disease should not take statins. They include

Lovastatin (Mevacor)
Simvastatin (Zocor)
Pravastatin (Pravachol)
Atorvastatin (Lipitor)
Fluvastatin (Lescol)
Rosuvastatin (Crestor)

Niacin (nicotinic acid) - In prescription form, is sometimes used to lower cholesterol. Dietary supplements of niacin should not be used instead of prescription niacin, as it can cause side effects. Only take niacin for high cholesterol with your doctor's supervision.

Bile acid sequestrants - lowers cholesterol; people who have high levels of triglycerides (fats in the blood) should not take bile acid sequestrants. These drugs include

Cholestyramine (Questran)
Colestipol (Colestid)
Colesevelam (Welchol)

Fibric acid derivatives - lower triglycerides and moderately lower LDL cholesterol. They include Gemfibrozil (Lopid).

Anticoagulants (blood thinners) - help keep clots from forming. Your doctor may prescribe aspirin, warfarin (Coumadin), or Clopidogrel (Plavix)

Surgical Treatments

Percutaneous coronary intervention (PCI) – In primary PCI, the doctor performs a coronary angiogram (injecting dye into the arteries) to see where the artery is blocked. The doctor then performs balloon angioplasty (widening an artery with a balloon), often with stent placement, to keep the artery open.

Coronary artery bypass graft (CABG) – This surgery bypasses the blocked arteries by using a graft of another blood vessel (usually from your arm or leg) to restore blood flow to the heart.

Nutrition and Dietary Supplements

Healthy eating habits can help reduce high cholesterol, high blood pressure, and overweight –three of the major risk factors for heart disease. The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease and heart attack. The AHA does not recommend very low-fat diets, because new research shows that unsaturated ("good") fats, such as those found in olive oil, are good for your heart.

Many fad diets are popular, but they may not help you lose weight and keep it off – and in some cases, they may not even be healthy. Any healthy diet will include a variety of foods. If a diet bans an entire food group (such as carbohydrates), it's probably not healthy.

The AHA recommends the following for healthy eating:

Grains: 6 to 8 servings per day (half should be whole grains)
Vegetables: 3 to 5 servings per day
Fruits: 4 to 5 servings per day
Fat-free or low-fat dairy: 2 to 3 servings per day
Lean meat, poultry, seafood: 3 to 6 oz. per day (about the size of a deck of cards)
Fats and oils: 2 to 3 tbsp. per day (use unsaturated fats such as olive oil or canola oil)
Nuts, seeds, legumes: 3 to 5 servings per week
Sweets, sugars: 5 or fewer servings per week (the fewer, the better)

In addition, the AHA also recommends eating 2 servings of fatty fish (such as salmon or lake trout) per week; holding sodium (salt, including salt already added to food) to 2,400 mg per day or less; and limiting alcohol intake to one drink a day for women and two for men.

Diets for People with High Blood Pressure

People with high blood pressure especially need to lower the amount of sodium in their diet. The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes a diet rich in fruits, vegetables, and low-fat or non-fat dairy products that provide high intake of potassium, magnesium, and calcium sources. Sodium intake should be between 1,500 mg to 2,400 mg per day (the lower, the better) . Weight loss, regular exercise, and limiting alcohol are also very important factors for lowering blood pressure.

Mediterranean Diet

The Mediterranean Style Diet concentrates on whole grains, fresh fruits and vegetables, fish, olive oil, and moderate, daily wine consumption. The Mediterranean Style Diet is not low-fat; it is low in saturated fat but high in monounsaturated fat. It appears to be heart-healthy: In a long-term study of 423 patients who had a heart attack, those who followed a Mediterranean Style Diet had a 50% to 70% lower risk of recurrent heart disease compared with people who received no special dietary counseling.

Vitamins and Supplements

Some supplements may help lower your risk factors for heart attacks, such as high blood pressure or high cholesterol. Most do not work as well as prescription medications, but some can be used along with prescription medications in your treatment. If you have had a heart attack or are at high risk of having on, be sure to ask your doctor before taking any supplements.

Folic acid (400 mcg per day), vitamin B6 (25 to 100 mg per day), vitamin B12 (2 to 100 mcg per day) - The B vitamins help the body break down homocysteine, an amino acid that's been linked to increased risk of heart disease and stroke. Researchers believe that homocysteine may also contribute to atherosclerosis by damaging artery walls, making it easier for blood clots to form – but so far they haven't found a definite link. Researchers also don't yet know whether taking B vitamins reduces the risk of atherosclerosis or heart attack, nor do they know how much might have an effect. Talk to your doctor about checking your homocysteine levels and whether your doctor would recommend a B complex vitamin supplement. In the meantime, be sure to get enough B vitamins through your diet by eating fruits and leafy green vegetables every day.
Omega-3 fatty acids (fish oil, 1 to 4 g per day) - There is good evidence that omega-3 fatty acids (known as EPA and DHA) found in fish oil can help treat atherosclerosis by preventing the development of plaque and blood clots. Omega-3s can also help prevent heart disease, lower blood pressure, and reduce the level of triglycerides (fats) in the blood. The AHA recommends that people eat at least two servings of fatty fish (such as salmon) per week. For people who have had a heart attack, several studies show that eating fish or taking fish oil reduces the risk of both fatal and nonfatal heart attacks, as well as lowers your risk of death from any cause. Because fish oil at high doses can increase the risk of bleeding, talk to your doctor before taking a high dose (more than 1 g per day), especially if you already take blood-thinning medication.
Beta-sitosterol (800 mg to 6g per day in divided doses about 30 minutes before meals) - Beta-sitosterol is a plant sterol, a chemical found in plants that can stop cholesterol from being absorbed by the intestines. A number of well-designed scientific studies have shown that beta-sitosterol does lower LDL ("bad") cholesterol levels in the body. Beta-sitosterol may lower the amount of vitamin E and beta-carotene absorbed by the body, so you may want to ask your doctor if you need to take extra E or carotene.
Policosanol (5 to 10 mg two times per day) - Policosanol is a mix of waxy alcohols usually derived from sugar cane and yams. Several studies have indicated it may lower LDL ('bad") cholesterol and possibly even raise HDL ("good") cholesterol. One study found that policosanol was equivalent to fluvastatin (Lescol) and simvastatin (Zocor) in lowering cholesterol levels. It may also help stop blood clots from forming. However, almost all the studies have been conducted in Cuba by a research group that uses a proprietary form of policosanol and is funded by the manufacturer, so it is hard to evaluate the evidence. Policosanol may increase the risk of bleeding, and should not be taken by people who also take blood-thinning medications.
Coenzyme Q10 (CoQ10) - Researchers believe that CoQ10 may help stop blood clots from forming and boost levels of antioxidants. One study found that people who received daily CoQ10 supplements within three days of a heart attack were much less likely to experience another heart attack and chest pain. They were also less likely to die from heart disease than those who did not receive the supplements. Statins, drugs that lower cholesterol, can actually interfere with the body’s natural ability to make CoQ10, so your doctor may recommend taking a CoQ10 supplement. Still, more research is needed to say whether CoQ10 has any role in preventing or treating atherosclerosis.
Psyllium (Plantago psyllium, 10 to 30 g per day in divided doses taken 30 to 60 minutes after meals) - Taking psyllium, a type of fiber, helps lower cholesterol levels as well as blood sugar levels. If you take medicine for diabetes, talk to your doctor before taking psyllium.
L-carnitine (4 to 6 g per day) - Studies suggest that people who take L-carnitine (an amino acid) soon after a heart attack may be less likely to have a subsequent heart attack, die of heart disease, experience chest pain and abnormal heart rhythms, or develop congestive heart failure. (Congestive heart failure occurs when the heart can’t pump blood properly and blood backs up into the lungs and legs.) Studies also suggest that people with heart disease who take carnitine may be better able to exercise. Most studies used a special form of carnitine called propionyl-L-carnitine.

Herbs

Herbs should not be used in place of emergency medical attention for a heart attack, nor should they be used by themselves to lower your risk of heart attack after you’ve had one. However, some can be used along with prescription medications in your treatment. If you have had a heart attack or are at high risk of having on, be sure to ask your doctor before taking any herbs.

Hawthorn (Crataegus monogyna, 160 to 1,800 mg per day in two or three divided doses) - Hawthorn contains the polyphenols rutin and quercetin, and was used traditionally to treat cardiovascular diseases. Animal and laboratory studies show that hawthorn has antioxidant properties that help protect against the formation of plaques and may help lower high cholesterol and high blood pressure. Talk to your doctor before taking hawthorn, as it can interact with other drugs taken for heart disease and high blood pressure.
Garlic (Allium sativum, 900 mg per day of garlic powder, standardized to 0.6% allicin) - Clinical trials have shown that fresh garlic and garlic supplements may lower cholesterol levels, prevent blood clots, and destroy plaque. However, other studies show mixed evidence. In one study, people who had a previous heart attack and then took a garlic oil extract for 3 years had fewer second heart attacks and a 50% reduction in death rate than those who did not take garlic. Garlic can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication.
Bilberry (Vaccinium myrtillus) and other flavonoids - A close relative of the cranberry, bilberry fruits contain flavonoid compounds called anthocyanidins. Flavonoids are plant pigments that have antioxidant properties, and researchers think they may help prevent a number of illnesses including heart disease and diabetes. Bilberry has been used traditionally to treat heart disease, but only animal and test-tubes studies have been done. Animal studies have found that anthocyanidins and other flavonoids may strengthen blood vessels, improve circulation, and prevent LDL ("bad") cholesterol from being damaged (which may cause blood clots to form in arteries).
Asian ginseng (Panax ginseng) – Ginseng may help reduce risk factors for heart disease, including lowering blood pressure and cholesterol, but more studies are needed to be sure. Ginseng can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication. Ginseng should not be used if you have high blood pressure unless your doctor recommends it.
Green tea (Camellia sinensis) - Population studies suggest that regularly drinking green tea may reduce the risk of heart attack from atherosclerosis. It also may help you lower your cholesterol and your weight, although more research is needed to know for sure.
Kudzu (Pueraria lobata) - Kudzu has been used traditionally to treat heart disease, including heart attack and congestive heart failure. A few studies suggest it may help relieve angina, but the studies were of poor quality. More research is needed to know whether kudzu has any benefit for heart disease.

Homeopathy

Homeopathy should not be used instead of immediate medical attention for a heart attack. Homeopathy may, however, be used to help reduce your risk of heart disease. Although few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths would recommend appropriate therapy to lower high blood pressure and cholesterol. Before prescribing a remedy, homeopaths take into account your constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath would assess all of these factors when determining the most appropriate remedy for you as an individual.

Acupuncture

Acupuncture may be helpful in reducing some risk factors for heart disease. Some studies show that it can help people who want to stop smoking, and it may help some people lose weight and lower their blood pressure.

Massage and Physical Therapy

Although few studies have examined the effectiveness of massage therapy for heart disease, massage has a relaxing effect and can reduce stress-related hormone levels. Lowering stress hormone levels can lower cholesterol and blood pressure, reducing your risk of heart disease. In addition, relaxation techniques may help you make lifestyle changes such as eating healthy, quitting smoking, and exercising. At least one study found that massage can lower blood pressure.

Other Considerations

Prognosis and Complications

After a heart attack, a person’s prognosis depends on how damaged the heart is. If the person is alive 2 hours after an attack, he or she has a good chance for survival, but may experience complications such as:

Irregular heart rhythm, called an arrhythmia
Congestive heart failure
Shock
Infarct extension (extension of the amount of affected heart tissue) or recurrent heart attack(s)
Pericarditis (infection around the lining of the heart)
Pulmonary embolism (blood clot in the lungs)
Complications from treatment (for example, thrombolytic agents increases the risk of bleeding)

The good news, however, is that heart attacks are not always disabling, especially when there are no complications. In fact, a full recovery is possible that allows you to do all the tings you used to do, including sexual activity. Going through cardiac rehabilitation and sticking with lifestyle changes can help lead to a positive recovery.

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Review Date:
12/26/2007
Reviewed By:
Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Hypertension

FitSugar — Wed, 08 Oct 2008 17:34:55 -0700

Overview

Signs and Symptoms
Causes
Risk Factors
Diagnosis
Preventive Care
Treatment
Other Considerations
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Hypertension, or high blood pressure, is a serious condition that affects 50 million Americans -- one in four adults. It is defined as an average systolic blood pressure above 140 mm Hg, a diastolic blood pressure above 90 mm Hg, or both. High blood pressure increases the risk of heart disease and stroke, the first and third most common causes of death among Americans. In the early and middle adult years, men are more likely than women to develop the condition, but as men and women age, the reverse is true -- more women older than the age of 55 have high blood pressure than men of the same age. While hypertension generally develops in people older than 20 years of age, more than half of all Americans over the age of 65 have the condition.

Signs and Symptoms

Most people who have high blood pressure do not know they have it because they generally experience no symptoms at all. Occasionally, some individuals may experience a mild headache when their blood pressure is high. Serious cases of hypertension, which happen infrequently, may produce the following symptoms:

Severe headache
Confusion
Nausea
Visual disturbances
Seizure

Causes

There are two major types of hypertension: essential (primary) and secondary. Essential hypertension is by far the most common, accounting for more than 95% of all cases. The cause of this form of hypertension is not known for certain, but is likely a combination of factors, including:

Genes for high blood pressure
Low levels of nitric oxide, a naturally occurring agent responsible for the dilation of blood vessels (African Americans are believed to have low levels of this substance)
Insulin resistance
Obesity

The causes of secondary hypertension include:

Kidney disorders
Endocrine disorders, such as Cushing's syndrome
Obstructive sleep apnea (episodes during sleep when breathing stops due to obstruction of the air passages)
Stress
Chronic heavy alcohol consumption (accounts for 10% of cases of secondary high blood pressure)
Long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly in the elderly
Use of certain medications, including oral contraceptives, pseudoephedrine, hormone replacement therapy, and steroids
Heavy coffee drinking (5 or more cups per day), particularly in those who have previously had high blood pressure
Use of cocaine, nicotine, or other stimulants or the herb licorice (Glycyrrhiza glabra) can cause or worsen existing hypertension.

Risk Factors

The following factors increase an individual's risk for high blood pressure:

Family history of hypertension
Alcohol abuse
High sodium intake
Inactive lifestyle
Being overweight
Mood disorders, particularly depression and anxiety. They may have a direct impact on blood vessels or they may lead to unhealthy behaviors such as alcohol and substance abuse or poor weight management.
Hypertension is more common among African Americans than Whites. This may be due to nitric oxide levels or to social factors such as chronic life stressors.

Diagnosis

Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats, or contracts, it pumps blood into the arteries. This is called systolic blood pressure, when blood pressure is at its maximum at this time. When the heart is at rest, between beats, the blood pressure falls, which is known as the diastolic pressure. A person with hypertension has an average systolic blood pressure above 140 mm Hg and/or a diastolic blood pressure above 90 mm Hg (usually written as 140/90).

To diagnose hypertension, a physician will obtain a blood pressure measurement during a routine physical examination. An inflatable cuff is wrapped around the arm, and the person taking the blood pressure listens with a stethoscope over the artery. If blood pressure is elevated, the doctor will check the pulse rate, examine the neck for swollen veins or an enlarged thyroid gland, listen to the heart for murmurs, feel the abdomen, and examine the eyes for damaged blood vessels in the retina. If the doctor suspects hypertension, additional laboratory and blood tests will help determine if it is secondary hypertension or essential hypertension.

Preventive Care

Studies suggest that the following lifestyle factors can help prevent hypertension:

Maintaining a desirable weight

According to several large-scale, population-based studies, being overweight is one of the strongest predictors of development of high blood pressure, including in adolescents and young adults. Similarly, maintaining a normal body weight is one of the most effective ways to prevent high blood pressure. Therefore, weight reduction, in overweight individuals of any age, should be a priority goal in the prevention of hypertension.

Reducing salt intake

Although population-based studies suggest a link between salt intake and prevalence of high blood pressure in particular groups of people (African Americans, for example), how each individual responds to sodium in his or her diet is quite variable. Since reducing dietary salt is generally considered safe, however, low-salt diets are recommended, particularly for those at risk for developing hypertension or heart disease.

Increasing physical activity

Several studies suggest that physically inactive people may be at an increased risk for developing hypertension. According to some population-based studies, men who lead physically active lives can reduce their risk of developing hypertension by 35 - 70 %. Although the duration and frequency of exercise necessary to prevent or treat hypertension is not well established, some evidence suggests that low to moderate intensity exercise may be more effective than higher intensity exercise training.

Limiting alcohol consumption

Studies suggest that people who consume three or more alcoholic beverages per day increase their risk for developing hypertension. If an individual is going to drink alcohol, therefore, intake should be limited to no more than two drinks per day. Also, drinking red wine may have more health benefits than other forms of alcoholic beverages.

Eating a diet rich in fruits and vegetables

People who consume vegetarian diets have significantly lower blood pressure than those who do not. The specific nutrients responsible for lowered blood pressure remain largely unknown, however.

Treatment

The goal in treating hypertension is to reduce the risk of serious complications, including heart disease and stroke. While the optimum blood pressure is 120/80 mm Hg, even partial reduction in blood pressure is beneficial. Prescription medications are often needed to treat hypertension, but lifestyle modifications -- including diet, exercise, and relaxation -- are necessary with or without medications.

A National Institute of Health (NIH) statement issued in 1996 asserts that behavioral and relaxation therapies must be integrated into conventional medical treatment of high blood pressure. Examples of relaxation techniques include biofeedback, massage, meditation, and qi gong. Often, in the early stages of hypertension when blood pressure elevation is mild, the doctor will recommend lifestyle modifications alone for a period of 6 - 12 months. After this time, if blood pressure is still high, medication will likely be prescribed.

Medications

Medication is recommended for people with sustained systolic pressure above 160 mm Hg or diastolic pressure above 100 mm Hg. There are several medications available to treat hypertension, and the medications prescribed depend on each individual case. Ten percent of hypertension patients may require as many as three drugs to control their condition.

Some of the most commonly prescribed medications include:

Diuretics

Diuretics help the kidneys eliminate sodium and water from the body. This decreases the volume of blood in the body and lowers blood pressure.

There are three types of diuretics: thiazide, loop, and potassium-sparing. The effects of these and other types of medications used to treat hypertension follow.

Thiazide diuretics (such as hydrochlorothiazide) -- tend to deplete potassium and may increase cholesterol and blood sugar.
Loop diuretics (such as furosemide and bumetanide) -- also tend to lower potassium levels
Potassium-sparing diuretics (such as spironolactone) -- this class does not lower potassium

Other medications used to treat hypertension include:

Beta-blockers (such as acebutolol, atenolol, metoprolol, nadolol, and propranolol) -- slow the heart rate down (thereby reducing the workload on the heart) and diminish stress hormones in the body (which allows blood vessels to relax).
Angiotensin-converting enzyme (ACE) inhibitors (such as benazepril, captopril, enalapril, lisinopril, and ramipril) -- by inhibiting a chemical reaction in the body, these drugs decrease production of a substance in the body that, in susceptible individuals, increases blood pressure.
Calcium-channel blockers (such as amlodipine, felodipine, nifedipine, nicardipine, and verapamil) -- relax blood vessels, thereby lowering blood pressure. Side effects may include constipation, nausea, and headache.
Angiotensin II receptor blockers (such as losartan, valsartan, candesartan, irbesartan, and telmisartan) -- block the effects of a particular chemical in the body, thereby preventing it from increasing blood pressure.

Nutrition and Dietary Supplements

Generally, small frequent meals are recommended for individuals prone to motion sickness. A comprehensive treatment plan for recovering from motion sickness may include a range of complementary and alternative therapies. Ask your team of health care providers about the best ways to incorporate these therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

Following these nutritional tips may help reduce symptoms and improve overall health:

Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
Avoid refined foods, such as white breads, pastas, and especially sugar.
Limit your salt intake.
Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
Use healthy oils in foods, such as olive oil or vegetable oil.
Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
Avoid coffee and other stimulants, alcohol, and tobacco.
Drink 6 - 8 glasses of filtered water daily.
Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
Magnesium citrate, 200 - 400 mg daily, for blood pressure regulation.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil one to three times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources.
Resveratrol (from red wine), 50 - 200 mg daily, to help decrease inflammation and for antioxidant effects.
SAMe (s-adenosyl-L-methionine), 100 - 200 mg before breakfast daily, for stress and mood improvement.
Lycopene, 5 mg one to three times daily, for antioxidant and blood pressure lowering activity.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, blood pressure lowering, and muscular support.
L-theanine, 200 mg one to three times daily, for stress and nervous system support.
L-arginine, 1 -2 gm three times daily, for blood vessel and immune support.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and heart health effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg three times daily, for antioxidant and heart health support.
Reishi mushroom (Ganoderma lucidum), 150 - 300 mg two to three times daily, for blood pressure support. You may also take a tincture of this mushroom extract, 30 - 60 drops two to three times a day.
Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for heart health.
Rhodiola (Rhodiola rosea ) standardized extract, 100 - 600 mg daily, for stress reducing activity.

Acupuncture

Several studies involving small numbers of people with hypertension showed a reduction in blood pressure with the use of acupuncture. While these clinical trials were conducted over a short period of time, the encouraging results suggest that it would be worthwhile for scientists to conduct long-term research of acupuncture for treating high blood pressure.

Chiropractic

Preliminary evidence suggests that people with high blood pressure who receive spinal manipulation receive a significant reduction in their blood pressure, but more research is needed to confirm its use for hypertension. In fact, on rare occasions, a spinal manipulation session may actually cause extremely low blood pressure leading to dizziness or lightheadedness.

Massage and Physical Therapy

Massage may be particularly helpful for people with hypertension brought on by stress. This is because the beneficial effects of massage are due at least in part to a reduction in stress. One recent study revealed that people with hypertension who receive massage showed significant reductions in blood pressure and steroid hormones, an indicator of stress. Although more studies are needed to evaluate the long-term safety and effectiveness of massage, people with hypertension who tend to have high levels of stress in their lives may benefit from massage therapy. In addition, massage tends to help people stick with healthy behaviors such as eating healthfully and not smoking.

Mind-Body Medicine

Although the association between ongoing life stress and hypertension is complex and somewhat controversial, many believe that relaxation techniques may be helpful in alleviating feelings of stress, which is often a contributing factor to hypertension. While the results of studies investigating this relationship have been mixed, one study of older African Americans living in an urban setting found that those who participated in a transcendental meditation (TM) or progressive muscle relaxation (PMR) program had a significant reduction in blood pressure compared to those who participated in a lifestyle education program. While both techniques were beneficial, TM was twice as effective as PMR.

In addition to TM and PMR, other mind-body techniques such as self-hypnosis and biofeedback have shown promising results in recent studies. Biofeedback in particular may reduce elevated blood pressure from stress and help individuals achieve healthful lifestyle modifications, such as stopping smoking and losing weight.

Other Considerations

Pregnancy

Blood pressure is monitored frequently during pregnancy because some women may develop high blood pressure for the first time while pregnant. If this occurs, medication may be needed. In addition, a condition known as preeclampsia is very serious and even life-threatening. Preeclampsia is high blood pressure during pregnancy that occurs along with other symptoms and signs, such as swelling of the ankles and legs, blurred vision, liver test abnormalities, and protein in the urine.

Warnings and Precautions

Avoid fish high in mercury, which may increase blood pressure.
The use of cocaine, nicotine, or licorice (Glycyrrhiza glabra) can cause or worsen existing hypertension.
Caffeine can exacerbate high blood pressure.

Prognosis and Complications

If left untreated, hypertension can cause several serious complications, including:

Stroke
Coronary artery disease and heart attack
Congestive heart failure
Kidney disorder
Disorders of the retina, which can ultimately lead to blindness
Impotence in men and decreased orgasm in women
Memory impairment and dementia

Fortunately, there are several treatment options for hypertension. Comprehensive treatment, including lifestyle modifications and blood pressure medications, usually results in much lower risk for complications and a generally good prognosis.

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Review Date:
10/20/2006
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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