PopSugar

Introducing Henry Daniel Moder!

LilSugar — Mon, 19 Nov 2007 18:09:02 -0800

Pretty mama Julia Roberts and Tom Hanks were on Oprah today promoting their movie, Charlie Wilson's War, which opens in theaters on Christmas day. But the audience members weren't cooing over the Oscar winners on stage; they were admiring the picture of 5-month-old Henry Daniel Moder that proud mom Julia brought to share.

Heart-healthy diet

FitSugar — Wed, 08 Oct 2008 17:35:07 -0700

HEALTH GUIDE REFERENCE FROM A.D.A.M

Highlights

General Dietary Guidelines

In 2006, the American Heart Association (AHA) revised its dietary and lifestyle recommendations. The new guidelines specifically recommend limiting daily saturated fat intake to less than 7% and trans fats to less than 1% of total daily calories.
The AHA recommends consuming plenty of deep-colored vegetables and fruits, eating oily fish at least twice a week, and including whole grains in your daily diet.

Fish

Women with existing heart disease may consider taking fish oil supplements, suggests 2007 AHA guidelines. Women should include a variety of low-mercury fish in their diet. Women who are of childbearing age or nursing should avoid high-mercury fish (such as swordfish) and limit tuna consumption to no more than 6 ounces a week.
The benefits of fish outweigh its risks, according to a 2006 Journal of the American Medical Association (JAMA) study. The researchers found that eating fish 1 – 2 times a week may help reduce the risk of heart-related death by 36%.

Diet Plans

Low-carbohydrate diets do not increase heart disease risks for women, indicates a 2006 New England Journal of Medicine study. A 2007 JAMA study found that people lost somewhat more weight on the Atkins diet compared with three other popular diet plans. The Atkins diet also helped raise HDL (“good”) cholesterol levels, reduce triglycerides, and improve blood pressure. Some experts think that the weight loss may have been the main factor for the heart benefits.
However, according to a 2006 study in the Archives of Internal Medicine, diets that are high in carbohydrates but low on the glycemic index may also help promote weight loss, reduce body fat, and improve heart disease risk factors.
The Mediterranean diet is better than a low-fat diet in quickly lowering blood pressure, cholesterol levels, and blood sugar levels, according to a 2006 Annals of Internal Medicine study.

Introduction

Heart-Healthy Goals. The goals of a heart-healthy diet are to eat foods that help obtain or maintain healthy levels of cholesterol and fatty molecules called lipids. You can achieve this by:

Reducing overall cholesterol levels and low-density lipoproteins (LDL), which are harmful to the heart
Increasing high-density lipoproteins (HDL), which are beneficial for the heart
Reducing other harmful lipids (fatty molecules), such as triglycerides and lipoprotein(a)

Any diet should also help keep blood pressure and weight under control.

General Recommendations

In 2006, the American Heart Association (AHA) issued revised diet and lifestyle recommendations. The current guidelines recommend:

Balance calorie intake and physical activity to achieve or maintain a healthy body weight. (Controlling weight, quitting smoking, and exercising regularly are essential companions of any diet program. Try to get at least 30 minutes, and preferably 60 – 90 minutes, of daily exercise.)
Consume a diet rich in a variety of vegetables and fruits. Vegetables and fruits that are deeply colored (spinach, carrots, peaches, berries) are especially recommended as they have the highest micronutrient content.
Choose whole-grain, high-fiber foods. These include fruits, vegetables, and legumes (beans). Good whole grain choices include whole wheat, oats/oatmeal, rye, barley, brown rice, buckwheat, bulgur, millet, and quinoa.
Consume fish, especially oily fish, at least twice a week (about 8 ounces/week). Oily fish such as salmon, mackerel, and sardines are rich in the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Consumption of these fatty acids is linked to reduced risk of sudden death and death from coronary artery disease.
Limit daily intake of saturated fat (found mostly in animal products) to less than 7% of total calories, trans fat (found in hydrogenated fats, commercially baked products, and many fast foods) to less than 1% of total calories, and cholesterol (found in eggs, dairy products, meat, poultry, fish, shellfish) to less than 300 mg per day. Choose lean meats and vegetable alternatives (such as soy). Select fat-free and low-fat dairy products. Grill, bake, or broil fish, meat, and skinless poultry.
Use little or no salt in your foods. Reducing salt can lower blood pressure and decrease the risk of heart disease and heart failure.
Cut down on beverages and foods that contain added sugars (corn syrups, sucrose, glucose, fructose, maltrose, dextrose, concentrated fruit juice, honey).
If you consume alcohol, do so in moderation. The AHA recommends limiting alcohol to no more than 2 drinks per day for men and 1 drink per day for women.

Women

The AHA guidelines for women are similar to the general dietary recommendations. However, the AHA suggests that women with existing heart disease consider taking omega-3 fatty acid supplements (850 - 1,000 mg/day of EPA and DHA). For women with high triglyceride levels, higher doses (2 - 4 g/day) may be appropriate. The AHA recommends against women taking antioxidant vitamin supplements (C, E, beta-carotene) or folic acid supplements for prevention of heart disease.

In addition, women who are pregnant or breast-feeding should avoid eating fish that is high in mercury content (shark, swordfish, mackerel, and tile fish). Choose fish and shellfish that are lower in mercury content and eat about 12 ounces/week. (The AHA recommends a higher weekly fish amount for women than for men. However, women of childbearing age should limit tuna to 6 ounces a week to reduce the risks for mercury contamination.)

Children

Atherosclerosis, the build-up of plaque in the arteries, begins in childhood. Experts stress the importance of heart-healthy dietary guidelines for children and adolescents to help prevent the development of heart disease later in life. Children should eat foods that are low in saturated fat, trans fat, and cholesterol. These foods include:

Fruits and vegetables
Whole grains
Low-fat and nonfat dairy products
Beans, fish, and lean meats

Cholesterol is a soft, waxy substance that is present in parts of the body including the nervous system, skin, muscle, liver, intestines, and heart. It is made by the body and obtained from animal products in the diet. Cholesterol is manufactured in the liver and is needed for normal body functions, including the production of hormones, bile acid, and vitamin D. Excessive cholesterol in the blood contributes to atherosclerosis and subsequent heart disease. The risk of developing heart disease or atherosclerosis increases as the level of blood cholesterol increases.

[See In-Depth Report #23: Cholesterol; Report #3: Coronary artery disease and angina; Report #14: High blood pressure; Report #53: Weight control and diet.]

Some fat is essential for normal body function. Fats can have good or bad effects on health, depending on their chemistry. New research suggests that the type of fat is more important than the total amount of fat when it comes to reducing heart disease.

All fats, good or bad, are high in calories compared to proteins and carbohydrates. In order to calculate daily fat intake, multiply the number of fat grams eaten by nine (one fat gram is equal to 9 calories, whether it's oil or fat) and divide by the number of total daily calories desired. One teaspoon of oil, butter, or other fats equals about 5 grams of fat. All fats, no matter what source they are from, add the same calories. The American Heart Association recommends that fats and oils have less than 2 grams of saturated fat per tablespoon.

Try to replace saturated fats and trans fatty acids with unsaturated fats from plant and fish oils. Omega-3 fatty acids, which are found in fish and plant sources, are a good source of unsaturated fats. Generally, two servings of fish per week provide a healthful amount of omega-3 fatty acids.

The Chemistry of Fats and Cholesterol.

Fatty Acids. All fats and oils found in foods are made up of chains of molecules called fatty acids. There are three major chains: saturated fatty acid (found mostly in animal products) and two unsaturated fatty acids -- monounsaturated and polyunsaturated fatty acids (found in plant products). The oils and fats that people and animals eat are nearly always mixtures of these three chains, but one type of fatty acid usually predominates in specific oils or fats.
Essential Fatty Acids. In addition, there are three chemical subgroups of polyunsaturated fatty acids called essential fatty acids: omega-3 and omega-6 polyunsaturated fatty acids, and omega-9 monounsaturated fatty acids.
Trans Fatty Acids. Trans fatty acids are manufactured by adding hydrogen atoms to polyunsaturated fatty acids (a process called hydrogenation). This process helps keep foods fresh, or may be performed to produce a solid fat product, such as margarine.

Harmful Fats. Reducing consumption of saturated fats and trans fatty acids is the first essential step in managing cholesterol levels through diet.

Saturated Fats. Saturated fats are found predominantly in animal products, including meat and dairy products. They are strongly associated with higher cholesterol levels, and they may be even more dangerous in women than in men. High-fat meals are associated with sudden surges in triglyceride levels and other lipids along with impaired blood flow in the arteries to the heart. (Tropical oils such as palm, coconut, and cocoa butter are also high in saturated fats.) The American Heart Association recommends limiting saturated fat consumption to less than 7% of total calories per day.

Click the icon to see an image of saturated fats.

Trans Fatty Acids. Trans fatty acids are manufactured fats created during a process called hydrogenation, which is aimed at stabilizing polyunsaturated oils to prevent them from becoming rancid and to keep them solid at room temperature. They are particularly dangerous for the heart and may pose a risk for certain cancers. These partially hydrogenated fats are even worse than saturated fats. Studies report that high consumption of these fats reduces HDL cholesterol levels, has harmful effects on the linings of the arteries, and may increase the risk for type 2 diabetes. Hydrogenated fats are used in stick margarine and in many fast foods and baked goods, including most commercially produced white breads. (Liquid margarine is not hydrogenated and is recommended.) The FDA ordered that food labels list the amount of trans fatty acids in food products beginning in January 2006. The American Heart Association recommends limiting daily consumption of trans fats to less than 1% of total daily calories.

Click the icon to see an image of trans fatty acids.

Beneficial Fats and Oils. Some fat is essential for health, and fat is essential for healthy development in children. Public attention has mainly focused on the possible benefits or hazards of monounsaturated (MUFA) and polyunsaturated (PUFA) fats.

Polyunsaturated fats are found in safflower, sunflower, corn, and cottonseed oils and fish.
Monounsaturated fats are mostly present in olive, canola, and peanut oils and in most nuts. (Canola is the least saturated of all the fats.) Studies report that replacing carbohydrates with monounsaturated fats improves glucose control after meals and reduces triglycerides in people with type 2 diabetes. Oils are more calorie-dense, however, and such patients should be wary of weight gain.

Researchers are most interested in the smaller fatty-acid building blocks contained in both oils, which may have more specific effects on lipids. Three important fatty acids are the essential fatty acids omega-3, omega-6, and omega-9.

Omega-3 fatty acids are found in fish oil (docosahexaenoic and eicosapentaneoic acids) and plants (alpha-linolenic acid).

Click the icon to see an image of omega-3 fatty acids.

Docosahexaenoic (DHA) and Eicosapentaneoic (EPA) Acids. DHA and EPA are found in fish oils, and evidence suggests that they have significant benefits for the heart, including reducing sudden death from heart disease, inflammation, blood clotting factors, blood pressure, and improving triglyceride and HDL levels. Results from a study presented at the 2005 meeting of the American Heart Association suggested that daily EPA supplements plus statin therapy can protect against heart attack, angina, and coronary artery disease. However, although fish and fish oil are good for the heart, patients who have an implantable defibrillator should not take fish oil supplements. A 2005 study suggested that these supplements may make heart rhythm problems worse in some patients.
Alpha-linolenic Acid. Alpha-linolenic acid is a plant precursor of DHA, which means the body can convert it to DHA. Sources include canola oil, soybeans, flaxseed, and certain nuts and seeds (walnut, flax, chia, and sometimes pumpkin seed). Some, but not all, studies suggest that oils or foods containing alpha-linolenic acid may also be heart-protective. Supplements or foods containing alpha-linolenic acid may also protest the heart. For example studies have reported heart protection from flaxseed supplements and also from nuts, such as almonds, macadamia, and walnuts. Nuts are high in calories, however.

Omega-6 polyunsaturated fatty acids are found in corn, safflower, soybean, and sunflower oil. PUFA oils containing omega-6 fatty acids constitute most of the oils consumed in the US. Some omega-6 fatty acids are important for health. However, high intake of these fats may be associated with weight gain in the abdomen (the so-called apple shape), a risk factor for heart disease. High consumption is also associated with a higher risk for certain cancer and some chronic diseases.

Click the icon to see an image of different types of weight gain.

Omega-9 monounsaturated fatty acids are contained in canola and olive oil, which help protect the heart.

Research suggests that a healthy balance of all these fats may be important and that our current Western diet contains an unhealthy ratio of omega-6 to omega-3 fatty acids (10 to 1). Omega-9 fatty acids may also contain chemicals that block harmful factors found in omega-6 fatty acids. Researchers suggest that the most benefits may be found in mixture of all three fatty acids found in both poly- and monounsaturated oils, but in modest amounts that do not add too many calories.

Fat Substitutes. Fat substitutes added to commercial foods or used in baking, deliver some of the desirable qualities of fat, but do not add as many calories.

Plants substances known as sterols, and their derivatives called stanols, reduce cholesterol by blocking its absorption in the intestinal tract. Margarines containing sterols (Benecol, Take Control) are available. Benecol is derived from pine bark and Take Control from soybeans. Two servings a day of either brand as part of a low-fat diet can lower LDL and total cholesterol. In one study, consuming a sterol-based margarine doubled the LDL-lowering effects of a statin (a common cholesterol-lowering drug) compared to a standard margarine. These products do not appear to block absorption of fat-soluble nutrients or vitamins, as olestra does. They may be hydrogenated and include some trans fatty acids, however.
Olestra (Olean) passes through the body without leaving behind any calories from fat. Studies suggest that it helps improve cholesterol levels and may help overweight people lose weight. Early reports of cramps and diarrhea after eating food containing olestra have not proven to be significant. Of greater concern is the fact that even small amounts of olestra deplete the body of certain vitamins and nutrients that may help protect against serious diseases, including cancer. The FDA requires that the missing vitamins be added back to olestra products, but not other nutrients.
Beta-glucan is a soluble fiber found in oats and barley. Products using this substance (Nu-Trim) may reduce cholesterol and have additional health benefits.

A number of other fat-replacers are also available. Although studies to date have not shown any significant adverse health effects, their effect on weight control is uncertain, since many of the products containing them may be high in sugar. One study suggested that people who consume foods that contain fat substitutes do not learn to dislike fatty foods, while people who learn to cook using foods naturally lacking or low in fat eventually lose their taste for high-fat diets.

The story on cholesterol found in the diet is not entirely straightforward. The body produces cholesterol naturally or obtains it through meals. Animal-based food products contain cholesterol. High amounts occur in meat, dairy products, egg yolks, and shellfish. (Plant foods, such as fruits, nuts, grains, do not contain cholesterol.) The American Heart Association recommends no more than 300 mg of dietary cholesterol per day for the general population and no more than 200 mg daily for those with high cholesterol.

Click the icon to see an image of foods that contain cholesterol.

Carbohydrates are either complex (as in starches) or simple (as in fruits and sugars). One gram of carbohydrates equals four calories. The current general recommendation is that carbohydrates should provide between 50 - 60% of the daily caloric intake. Many studies report that people can protect their heart and circulation by eating plenty of fruits and vegetables.

Complex Carbohydrates. Complex carbohydrates found in whole grains and vegetables are preferred over those found in starch-heavy foods, such as pastas, white-flour products, and potatoes. Most complex carbohydrates are high in fiber, which is important for health. Whole grains specifically are extremely important for people with diabetes or at risk for it.

Click the icon to see an image of complex carbohydrates.

Simple Carbohydrates (Sugar). Experts recommend that no more than 10% of daily calories should come from sugar. (Currently, Americans eat nearly half a pound of sugar a day on average, and sugar intake constitutes 25% of a day's calories.) Sugars are usually one of two types:

Click the icon to see an image of simple carbohydrates.

Sucrose. Source of most dietary sugar, found in sugar cane, honey, and corn syrup.
Fructose. Found in fruits and vegetables. Although fructose does not appear to be have any different effects in the body than sucrose, most of the fruits and vegetables that contain it are vital for good health.

High levels of sugar consumption -- whether fructose or sucrose -- have been associated with higher triglycerides and lower levels of HDL cholesterol, the so-called good cholesterol. The high consumption of sugar is most likely one of the factors in the current obesity epidemic. Soda, other sweetened beverages, and fruit juice are major contributors to childhood obesity.

Fiber is an important component of many complex carbohydrates. It is almost always found only in plants. (One exception is chitosan, a dietary fiber made from shellfish skeletons.) Fiber cannot be digested but passes through the intestines, drawing water with it, and is eliminated as part of feces content. High-fiber diets (up to 55 grams a day) can be very helpful. Different fiber types may have specific benefits:

Insoluble fiber (found in wheat bran, whole grains, seeds, nuts, legumes, and fruit and vegetable peels) may help achieve weight loss. Consuming whole grains on a regular basis may lower the risk for heart disease and heart failure, improve factors involved with diabetes, and lower the risk for type 2 diabetes. (Wheat bran taken as a supplement has not been associated with any benefits. The whole grain may be needed for good health.) High consumption of nuts (such as almonds, macadamia, and walnuts) may be highly heart protective, independent of their fiber content.
Soluble fiber (found in dried beans, oat bran, barley, apples, citrus fruits, and potatoes) may help achieve healthy cholesterol levels and possibly reduce blood pressure as well. For example, one study indicated that eating beans four or more times a week reduced the risk for heart disease by 22%. Oat bran has also been highly studied for its benefits on the heart.
Soluble fiber supplements, such as those that contain psyllium or glucomannan, may also be beneficial. Psyllium is taken from the husk of a seed grown in India and is very effective for lowering total and LDL cholesterol. It is found in laxatives (Metamucil), breakfast cereals (Bran Buds, Plantaben), and other products. However, some studies suggest that psyllium increases triglyceride levels in postmenopausal women. Sodium levels may also rise. People who increase intake of soluble fiber should also drink more water.

Click the icon to see an image of soluble and insoluble fiber.

In general, experts recommend that proteins should provide 12 - 20% of daily calories. One gram of protein contains four calories. Protein is important for strong muscles and bones and may have specific benefits on blood pressure. The best sources of protein are fish, poultry, and soy. Restrict intake of red meat or any meat that is not lean.

Fish. Fish is probably the best source of protein. Evidence suggests that eating moderate amounts of fish (twice a week) may improve triglyceride and HDL levels and help lower the risks for death from heart disease, dangerous heart rhythms, blood pressure, a tendency for blood clots, and the risk for stroke.

Click the icon to see an image of stroke.

The most healthy fish are oily fish, such as salmon, mackerel, or sardines, which are high in omega-3 fatty acids. A 2006 Journal of the American Medical Association (JAMA) study suggested that modest consumption of oily fish can reduce the risk of heart-related death by 36% and death from all causes by 17%. On average, three capsules of fish oil (preferably as supplements of DHA-EPA) is about equivalent to eating one serving of fish.

Most guidelines recommend eating fish at least twice a week. Doctors may recommend that people with existing heart disease or high triglyceride levels consume extra quantities or take DHA-EPA supplements.

Women of childbearing age or nursing mothers should avoid fish that contains high amounts of mercury (shark, swordfish, golden bass, king mackerel) and limit intake of tuna to 6 ounces/week. They should, however, try to eat at least 12 ounces/week of a variety of lower mercury-containing fish and shellfish (catfish, salmon, haddock, perch, tilapia, trout, crab, shrimp, scallops). According to the JAMA study, the benefits of fish intake (especially from low-mercury fish) outweigh the potential risks.

Soy. Soy is an excellent food. It is rich in both soluble and insoluble fiber, omega-3 fatty acids, and provides all essential proteins. Soy proteins have more vitamins and minerals than meat or dairy proteins. They also contain polyunsaturated fats, which are better than the saturated fat found in meat. The best sources of soy protein are soy products (tofu, soy milk, soybeans). Soy sauce is not a good source. It contains only a trace amount of soy and is very high in sodium.

For many years, soy was promoted as a food that could help lower cholesterol and improve heart disease risk factors. But an important 2006 American Heart Association (AHA) review of studies found that soy protein and isoflavone supplement pills do not really have any effects on cholesterol or heart disease prevention. The AHA still encourages patients to include soy foods as part of an overall heart healthy diet but does not recommend using isoflavone supplements.

Meat and Poultry. For heart protection, choose lean meat. Saturated fat in meat is the primary danger to the heart. The fat content of meat varies depending on the type and cut. It is best to eat skinless chicken or turkey. However, the leanest cuts of pork (loin and tenderloin), veal, and beef are nearly comparable to chicken in calories and fat as well as their effect on LDL and HDL levels. However, even chicken and lean meat do not improve cholesterol levels and, in terms of heart health, fish is a more desirable choice.

Dairy Products. The best dairy choices are low-fat or fat-free products. A 2006 study indicated that consuming low-fat dairy products can help lower blood pressure. In the study, patients who ate the most low-fat dairy products had lower systolic blood pressure. A 2002 study also reported a lower incidence of factors related to type 2 diabetes and heart disease (insulin resistance, high blood pressure, obesity, and unhealthy cholesterol) with a high intake of dairy products. Some researchers suggest the calcium in dairy products may be partially responsible for these benefits. However, at least with high blood pressure, many studies indicate that the helpful effects of dairy products are not directly related to calcium.


Foods	Important Phytochemicals (Plant chemicals) Contained in the Foods	Vitamins and other valuable food components	Possible Benefits
Apples	Flavonoids	Fiber	May protect against certain cancers (lung), heart disease, asthma, and type 2 diabetes.
Avocados		Vitamin E, vitamin B6, folate	May be heart protective.
Beans	Flavonoids	Folate, iron, potassium and zinc, fiber	Some experts believe beans are the perfect food.
Berries, all kinds of dark colored (especially blueberries)	Ellagic Acid	Vitamin C, minerals	May protect the aging brain. (Many studies recommend blueberries.)
Broccoli (also kale, Brussels sprouts, cauliflower)	Flavonoids, Isothiocyanates	Vitamin C, folate, fiber, and selenium	Anticancer properties. Protects against heart disease and stroke.
Carrots and other bright yellow vegetables	Lutein, Beta carotene	Vitamin A (converted from carotenoids), vitamin C, fiber	Protect heart, eyes, lungs. (Cooking carrots may increase their benefits.)
Fish (particularly oily fish, such as mackerel, salmon, sardines)		Vitamins B3 and B12, essential fatty acids, selenium	Heart and brain protective.
Garlic	Allium (organosulfurs)		Although garlic does not appear to help lower cholesterol levels, it still may protect against heart disease. Possible infection fighter.
Ginger	Zingiberaceae		Cancer fighting properties.
Grains (whole)	Lignans (phytoestrogens)	Vitamin B, selenium (important antioxidant mineral), fiber, folate	May help reduce the ability of cancer cells to invade health tissue.
Grapes and red wine	Flavonoids, resveratrol		Fight heart disease and cancer. May have activity against asthma, and type 2 diabetes.
Nuts (such as almonds, macadamia, and walnuts)		Vitamin E, Vitamin B1, Essential fatty acids, folate, fiber	May lower cholesterol levels, reduce sudden death rates from heart disease, and help prevent stroke and type 2 diabetes.
Onions	Flavonoids, allium (organosulfurs)		May have activity against certain cancers (lung), heart disease, asthma, and type 2 diabetes.
Oranges and orange juice	Monoterpenes	Vitamin C, folate, potassium, fiber	Many health benefits. Increase HDL levels and helps maintain normal blood pressure.
Potatoes (Sweet)		Vitamins A, C, and E	Many health benefits.
Soy: Four ounces of tofu equals about 8 - 13 grams of soy. A soy burger contains about 18 grams of soy.	Isoflavones (phytoestrogens), flavonoids, phytosterol, phytate, saponins		May have effects similar to estrogen, including maintaining bone and benefiting the heart. May protect against prostate cancer and possibly other cancers. Possible protection against mental decline.
Spinach and other dark green leafy vegetables	Zeaxanthin, Beta carotene	Vitamin C, folate, vitamin A (converted from carotenoids)	Protects heart, lungs and brain.
Tomatoes	Lycopene, flavonoids	Vitamin C, biotin, minerals	Protects heart. Studies suggest reductions in prostate and other cancers. Infection fighters.

Antioxidant Vitamins E, C, and A. Vitamins E, C, and A are most studied for their health effects because they serve as antioxidants. Antioxidants are chemicals that act as scavengers of particles known as oxygen-free radicals (also sometimes called oxidants ). High intake of foods rich in these vitamins (as well as other food chemicals) have been associated with many health benefits, including prevention of heart problems.

Research on the effects of vitamin supplements on heart disease and diabetes, however, has been mixed. Although some research initially observed favorable effects from vitamin E in preventing blood clots and preventing build-up of plaque on blood vessel walls, most studies found no heart protection from either vitamin E or C supplements. A 2005 Journal of the American Medical Association study found that vitamin E supplements can actually increase the risk of heart failure, especially for patients with diabetes or vascular diseases. Results from the long-term Women’s Health Study, also released in 2005, showed that vitamin E supplements do not protect women from attacks or stroke.

Click the icon to see an image of the benefits of vitamin C.

Antioxidants are chemicals that act as scavengers of particles known as oxygen-free radicals (also sometimes called oxidants). These chemically active particles are by-products of many of the body's normal chemical processes. Their numbers are increased by environmental assaults, such as smoking, chemicals, toxins, and stress. In higher levels, oxidants can be very harmful:

Oxygen-free radicals can damage cell membranes and interact with genetic material, possibly contributing to the development of a number of disorders including diabetes, cancer, heart disease, cataracts, and even the aging process itself.

They can also enhance the dangerous properties of low-density lipoprotein (LDL) cholesterol, a major player in the development of coronary artery disease.

Antioxidant vitamins (A, C, and E), beta carotene, and many phytochemicals can neutralize free radicals and have been studies for possible benefits. It is clear that such vitamins are required to prevent deficiency diseases. In addition, foods rich in antioxidants are important disease fighters. To date, however, there is no strong evidence that antioxidant supplements offer any real protection.

Special Warning on High-Dose Antioxidant Supplements. Some studies suggest that excessive use of antioxidant supplements may interfere with other nutrients or convert into pro-oxidants and become harmful. Some of the findings are as follows:

A 2002 randomized study of postmenopausal women found a higher risk for heart disease in people who took vitamin E and C supplements. A 2005 study found that vitamin E supplements can increase the risk of heart failure, especially for patients with diabetes or vascular diseases.
Of particular concern are studies that have found an increase in lung cancer and overall mortality rate among smokers who took beta carotene supplements. A 2000 study further reported a higher risk for cancer in male smokers who took multivitamins plus A, C, or E. Even more worrisome, in people with existing cancer, high doses of antioxidant vitamins, such as vitamin C or beta carotene, may actually protect cancer cells (just as they do healthy cells).

Click the icon to see an image of a cataract.

Click the icon to see an image of coronary artery disease.

Click the icon to see an image of phytochemicals.

B Vitamins (Folic Acid). Deficiencies in the B vitamins folate (known also as folic acid), B6, and B12 have been associated with a higher risk for heart disease in some studies. Such deficiencies produce higher blood levels of homocysteine, an amino acid that has been associated with a higher risk for heart disease, stroke, and heart failure. Researchers have been studying whether vitamin B supplements can reduce homocysteine levels and, consequently, heart disease risks.

Several major 2006 studies indicated that while B vitamin supplements help lower homocysteine levels, they have no effect on heart disease outcomes. The studies, published in the New England Journal of Medicine, examined patients who had either recently had a heart attack or who suffered from diabetes or heart disease. Results showed a similar number of heart attacks and strokes among patients who took folic acid and B6 and B12 vitamins and those who received placebo. And, the vitamins seemed to increase risks for patients who had undergone stenting. A 2006 Journal of the American Medical Association study also found that folic acid supplements did not help reduce the risk of heart disease or stroke in patients with a history of vascular disease. Some experts think that homocysteine may be a marker for heart disease rather than a cause of it.

Click the icon to see an image of sources of folate.

Click the icon to see an image of sources of B12.

Potassium, Magnesium, and Calcium. Some experts believe that sufficient intake of minerals, particularly potassium, magnesium, and calcium, may be even more beneficial than salt restriction for reducing blood pressure.

Potassium. Evidence strongly indicates that a potassium-rich diet can help achieve healthy blood pressure levels, and that potassium supplements can lower systolic blood pressure by 1.8 m Hg and diastolic blood pressure by 1 mm Hg. Some evidence suggests that a potassium-rich diet can reduce the risk of stroke by 22 - 40%. Expert guidelines now support the use of potassium supplements or enough dietary potassium to achieve 3,500 mg per day for people who have no risk factors for excess potassium levels. (People who take potassium-sparing diuretics should not take potassium supplements.) This goal is particularly important for people who have a high sodium intake. The best source of potassium is from the fruits and vegetables that contain them. Potassium-rich foods include bananas, oranges, pears, prunes, cantaloupes, tomatoes, dried peas and beans, nuts, potatoes, and avocados.
Magnesium. Some studies report that magnesium supplements may cause small but significant reductions in blood pressure. The recommended daily allowance is 320 mg. People who live in soft water areas, who use diuretics, or who have other risk factors for magnesium loss may require more dietary magnesium than others. No major studies have been done on long-term benefits or risks of magnesium supplements.
Calcium. Calcium regulates the tone of the smooth muscles lining blood vessels. Studies have found that people who consume enough dietary calcium on a daily basis have lower blood pressure than those who do not. Hypertension increases calcium loss from the body. The effects of extra calcium on blood pressure, however, are mixed, with some showing higher pressure.

Click the icon to see an image of sources of calcium.

In the past, everyone was advised to consume less than 2,400 mg (about one teaspoon) of sodium (salt) each day. However, in February 2004, a long-awaited report by the Institute of Medicine (IOM) recommended that individuals slash their salt intake in half. The IOM report stressed that no one should consume more than 1,500 mg/day. Because blood pressure tends to rise with age, the Institute also suggested that people over 50 reduce their sodium intake to less than 1,300 mg daily; those over 70 should not eat more than 1,200 mg a day. Reducing sodium may also help protect against heart failure. Unfortunately many people find it very difficult to achieve these goals. Experts disagree on the overall benefits of salt restriction for everyone. Still, the following people should take particular measures to restrict salt:

People at Risk for Salt-Sensitivity. About half of people with hypertension have blood pressure that reacts significantly to salt. Such people are known as salt-sensitive. Among those at highest risk for salt sensitivity are African-Americans, people with diabetes, and elderly people.
Overweight People. Overweight individuals may absorb and retain sodium differently from people with normal weights. One study reported that high sodium intake was associated with an increased risk of heart disease and all-cause mortality in overweight, but not in normal weight, people. Reducing sodium can also help reduce the risk of stroke in people who are overweight.

Simply eliminating table and cooking salt can be beneficial. Salt substitutes, such as Cardia, (containing mixtures of potassium, sodium, and magnesium) are available, but they are expensive. About 75% of the salt in the typical American diet comes from processed or commercial foods, not from food cooked at home, so the benefits of table-salt substitutes are likely to be very modest. Some sodium is essential to protect the heart, but most experts agree that the amount is significantly less than that found in the average American diet. If people cannot significantly reduce the amount of salt in their diets, adding potassium-rich foods might help to restore a healthy balance.

Water. Many heart risk factors, especially those associated with blood clotting, are increased with dehydration. In one study, drinking five or more glasses of water a day was significantly associated with a lower risk for fatal heart events than drinking two or fewer glasses a day.

Alcohol. A number of studies have found heart protection from moderate alcohol intake (one or two glasses a day). The benefits reported include higher HDL levels, blood clot prevention, and anti-inflammatory properties plus lower rates of heart failure and heart attack. Although red wine is most often cited for healthful properties, any type of alcoholic beverage appears to have similar benefit.

On the negative side, an estimated 10% of hypertension cases are caused by alcohol abuse. Men with high blood pressure should limit their intake to an average of no more than one or two drinks a day, and women (especially those at risk for breast cancer) and lighter people should only have one drink a day. (A “drink” is equivalent to a 12-ounce bottle of beer, a 4-ounce glass of wine, or a 1.5-ounce shot of hard liquor.) Alcohol may raise a man’s risk for atrial fibrillation according to a study in the Archives of Internal Medicine. Pregnant women, people who can't drink moderately, and people with liver disease should not drink at all. People who are watching their weight should be aware that alcoholic beverages are very high in calories.

Caffeinated Beverages.

Tea. Although it contains caffeine, tea, both black and green, is often cited for its health benefits. Green tea especially is rich in chemicals that may offer protection against damaging forms of LDL. A 2006 study of Japanese adults who drank high amounts of green tea (3 or more cups a day) found that green tea consumption was associated with reduced risk of death from heart disease. Green tea did not, however, appear to offer any protection against cancer.
Coffee. Coffee, like red wine, contains phenol, which helps prevent oxidation of LDL cholesterol. However, unfiltered coffee (Turkish coffee, Scandinavian boiled or French pressed coffee, and espresso) contains an alcohol called cafestol, which may raise cholesterol and triglyceride levels. Filtered coffee does not contain this residue. Coffee drinking is associated with small increases in blood pressure, but the risk it poses is very small in people with normal blood pressure. Moderate coffee consumption (1 - 2 cups a day) poses no heart risks and a 2006 Circulation study found that long-term coffee consumption did not increase the risk for heart disease in most people, even if they consumed large daily amounts.

Dietary Changes

The Atkins diet restricts healthful complex carbohydrates in vegetables and particularly in fruits that are known to protect against heart disease. The Atkins diet also causes excessive calcium excretion in urine, which increases the risk for kidney stones and osteoporosis, and the release of ketones. An overload of ketones leads to ketosis, which can cause nausea, lightheadedness, and bad breath.

Low-carb diets such as South Beach, The Zone, and Sugar Busters rely on a concept called the "glycemic index," or GI, which ranks foods by how fast and how high they cause blood sugar levels to rise. Foods on the lowest end of the index take longer to digest. Slow digestion wards off hunger pains. It also helps stabilize insulin levels. Foods high on the glycemic index include bread, white potatoes, and pasta while low-glycemic foods include whole grains, fruit, lentils, and soybeans. A 2006 study indicated that a high-protein, low-glycemic index diet can help produce better reductions in total and LDL cholesterol than a high-protein, high-glycemic index diet. Reducing glycemic load may also help to promote weight loss, especially for women.

There has been debate about whether Atkins and other low-carbohydrate diets can increase the risk for heart disease, especially as people who follow these diets tend to eat more animal-saturated fat and protein and less fruits and vegetables. A 2006 New England Journal of Medicine study of over 80,000 women found that diets lower in carbohydrates and higher in protein do not increase heart disease risk. In fact, if people select vegetable sources of fat and protein (such as soy and nuts), these diets may even moderately reduce the risk of heart disease.

A 2006 review of low-carbohydrate diets found that they did help weight loss in the short term. However, while these diets appeared to lower triglyceride levels and raise HDL (“good”) cholesterol levels, they also raised overall cholesterol and LDL (“bad”) cholesterol levels. In contrast, a 2007 Journal of the American Medical Association study that compared four different diet plans (Atkins, Zone, Ornish, and LEARN) found that the Atkins diet helped raise HDL levels, and reduce triglyciderides (although it had no effect on LDL levels). Women who followed the Atkins diet also had improved blood pressure compared to patients on the other diets. The Atkins diet resulted in better weight loss (an average of 10 pounds over the course of a year versus 4 - 6 pounds for the other diet plans), which in itself may have accounted for the improved heart risk factors. Some experts think that the main finding from this study is that even moderate weight loss can help improve heart health.

The Mediterranean diet is rich in heart-healthy fiber and nutrients, including omega-3 fatty acids and antioxidants. The diet consists of fruits, vegetables, and unsaturated “good” fats, particularly olive oil. Olive oil has been associated with lower blood pressure, a lower risk for heart disease, and possible benefits for people with type 2 diabetes. Experts think that the main health benefit of olive oil is oleic acid, which is a type of monounsaturated fatty acid. Olive oil also contains polyphenol, which are phytochemicals that contain antioxidant properties. A 2006 study found that virgin olive oil, which comes from the first pressing of olives, contains a higher polyphenol content than refined olive oil, which comes from later pressings.

There are several variations to the Mediterranean diet, but general recommendations include:

Limit red meats.
Drink one or two glasses of wine each day if alcohol is enjoyable and there are no reasons to restrict its use.
Limit dairy products.
Eat moderate amounts of fish and poultry. Fish is the diet’s main protein source. Some studies suggest that fish is the primary heart-protective ingredient in this diet.
Eat plenty of fresh fruits and vegetables, nuts, legumes, beans, and whole grains.
Season foods with garlic, onions, and herbs.
Use virgin olive oil.

Positive Arguments. Even though fats make up about 40% of the calories found in the traditional Mediterranean diet, they are largely unsaturated. Growing evidence continues to support the heart-protective properties of the Mediterranean diet. Research has shown that such a diet reduces the risk for a second heart attack and helps cholesterol-lowering statin drugs work better.

Seniors who combine a Mediterranean diet with healthy lifestyle habits live longer lives, according to a 2004 study in The Journal of the American Medical Associationstudy. Researchers observed the effect of a Mediterranean diet on more than 2,000 elderly people for a period of 10 years, and measured the diet's effects on death rates alone and in combination with three risk factors: smoking, physical activity, and alcohol use. Overall, seniors who followed the Mediterranean diet decreased their risk of death from all causes by 23%. The elimination of each additional risk factor boosted their life expectancy rate even more. For example, non-smoking seniors on the diet who exercised regularly and drank only a moderate amount of alcohol reduced their death rates by 65%.

Negative Arguments. Weight gain due to a high intake of fats and risk for alcohol abuse can be problems with the Mediterranean diet. However, a 2006 study that compared several types of Mediterranean diets to a low-fat diet found that the Mediterranean diets were better at lowering blood pressure, cholesterol levels, and blood sugar levels after only 3 months. And, in research presented at the 2007 American College of Cardiology annual conference, the Mediterranean diet proved just as good as the American Heart Association low-fat diet for preventing recurrence of heart attack, stroke, or other heart events.

Other concerns include reduced iron levels and possible calcium loss resulting from a reduced consumption of dairy products. People on the diet should eat foods rich in iron or vitamin C, which aids in iron absorption. They should also ask their doctor if a calcium supplement may be needed because of a lack of dairy products. People should avoid wine if they have risk factors for complications from alcohol. Such people include women who are pregnant or at risk for breast cancer and anyone prone to alcohol abuse.

The DASH diet (Dietary Approaches to Stop Hypertension) is proven to help lower blood pressure. Results are sometimes seen within a few weeks. Restricting sodium improves results. The diet appears to have antioxidant effects and may help lower LDL cholesterol levels, although beneficial HDL levels also decline. This diet is not only rich in important nutrients and fiber but also includes foods that contain far more electrolytes, potassium (4,700 mg/day), calcium (1,250 mg/day), and magnesium (500 mg/day) than are found in the average American diet.

A diet that is effective in lowering blood pressure is called Dietary Approaches to Stop Hypertension (DASH).

DASH diet recommendations:

Limit salt intake to no more than 2,300 mg a day (a maximum intake of 1,500 mg a day is an even better goal.)
Reduce saturated fat to no more than 6% of daily calories and total fat to 27% of daily calories. (But, include calcium-rich dairy products that are non- or low-fat.)
When choosing fats, select monounsaturated oils, such as olive or canola oils.
Choose whole grains over white flour or pasta products.
Choose fresh fruits and vegetables every day. In one study people who increased their intake of fruits and vegetables experienced a drop in blood pressure after 6 months. Many of these foods are rich in potassium, fiber, or both which may help lower blood pressure.
Include nuts, seeds, or legumes (dried beans or peas) daily.
Choose modest amounts of protein (no more than 18% of total daily calories). Fish, skinless poultry, and soy products are the best protein sources.)
Other daily nutrient goals in the DASH diet include limiting carbohydrates to 55% of daily calories and dietary cholesterol to 150 mg. Patients should try to get at least 30 g of daily fiber.

Slight changes to the DASH diet might help lower blood pressure even more, as well as improve cholesterol and lipid levels. Researchers reporting in the Journal of the American Medical Association and at the 2005 American Heart Association meeting said that replacing some carbohydrates in the DASH diet with protein-rich foods from plant sources (nuts, seeds, soy) or monounsaturated fats (canola or olive oil) may help reduce heart disease risk factors.

Dietary guidelines recommend keeping total fat intake to 20 - 30% of total daily calories, with saturated fat less than 10% of calories. Low-fat diets generally restrict fat intake to 20% or less of total daily calories. The Ornish program, which is recommended for some heart disease patients, limits fats even more drastically. It aims at reducing saturated fats as much as possible, restricting total fat to 10%, and increasing carbohydrates to 75% of calories.

The Ornish program is a very demanding regimen:

It excludes all oils and animal products except nonfat yogurt, nonfat milk, and egg whites.
Foods stressed are whole grains, legumes, and fresh fruits and vegetables.
People in the program exercise for 90 minutes at least three times a week.
Stress reduction techniques are used.
People do not smoke or drink more than two ounces of alcohol per day.

Positive Arguments.

Low-fat programs may help keep weight off.
Low-fat diets that are high in fiber, whole grains, legumes, and fresh produce offer health advantages in addition to their effects on cholesterol. These foods are also lower on the glycemic index than high-glycemic foods such as bread, potatoes, and pasta. Lowering the glycemic index (by, for example, cutting down on starchy vegetables and replacing pasta with whole grains) may help increase weight loss and heart benefits for high-carbohydrate diets.
The Ornish program directors have reported a 91% reduction in angina after 1 year and a 72% reduction after 4 years in spite of significant HDL cholesterol reduction. One study reported that the diet reduced LDL levels to recommended levels without the addition of a cholesterol-lowering drug.

Negative Arguments.

In 2006, the largest study-to-date on low-fat diets found that they did not help prevent heart disease or cancer. Women in the study reduced their fat consumption to 24 – 29% of total daily calories. Some critics say that the study did not do enough to distinguish between good types of fats (monounsaturated omega-3 polyunsaturated) and bad fats (saturated and trans fats).
The American Heart Association notes that the Ornish program is so difficult to maintain that it will not benefit many people. In a 2007 study comparing various weight loss plans, patients on the Ornish diet lost slightly less weight than those on Atkins. The difficulty of the Ornish diet may have been one factor.
Very low-fat diets may reduce calcium absorption, which may be particularly harmful for women at risk for osteoporosis.
Many people who reduce their fat intake do not consume enough of the basic nutrients, including vitamins A and E, folic acid, calcium, iron, and zinc. People on low fat diets should consume a wide variety of foods and take a multivitamin if appropriate.

Calorie restriction has been the cornerstone of weight-loss programs. Restricting calories in such cases also appears to have beneficial effects on cholesterol levels, including reducing LDL and triglycerides and increasing HDL levels. At this point, reducing calories and increasing exercise is still the best method for maintaining weight loss and preventing serious conditions, notably diabetes. A 2006 study reported that a low-calorie, but nutritionally balanced, diet can help prevent an aging-associated change in heart function. Patients in the small study took in 1,400 - 2,000 calories a day for an average of 6 years.

The standard dietary recommendations for losing weight are:

As a rough rule of thumb, one pound of fat equals about 3,500 calories, so one could lose a pound a week by reducing daily caloric intake by about 500 calories a day. Naturally, the more severe the daily calorie restriction, the faster the weight loss.
To determine the daily calories requirements for specific individuals, multiply the number of pounds of ideal weight by 12 - 15 calories. The number of calories per pound depends on gender, age, and activity levels. For instance a 50-year old woman who wants to maintain a weight of 135 pounds and is mildly active might require only 12 calories per pound (1,620 calories a day). A 25-year-old female athlete who wants to maintain the same weight might require 25 calories per pound 2,025 (calories a day).
Fat intake should be no more than 30% of total calories. Most fats should be in the form of monounsaturated fats (such as olive oil). Saturated fats (found in animal products) should be avoided.

Lifelong changes in eating habits, physical activity, and attitudes about food and weight are essential to weight management. Unfortunately, although many people can lose weight initially, it is very difficult to maintain weight loss. People with type 2 diabetes may have a particularly difficult time. Here are some general suggestions that may be helpful:

Start with realistic goals. When overweight people achieve even modest weight loss they reduce risk factors in the heart. Ideally, overweight patients should strive for 15% weight loss or better, particularly people with type 2 diabetes.
A regular exercise program is essential for maintaining weight loss. If there are no health prohibitions, choose one that is enjoyable. Check with a doctor about any health consideration. [See In-Depth Report #29:Exercise.]
Hunger pangs should not be taken as cues to eat. A stomach that has been stretched by large meals will continue to signal hunger for large amounts of food until its size reduces over time with smaller meals.
Be honest about how much you eat, and track calories carefully. Studies on weight control that depend on self-reporting of food intake frequently reveal that subjects badly misjudge how much they eat (typically underestimating high-calorie foods and overestimating low-calorie foods). In one study, even dietitians underreported their calorie intake by 10%. People who do not carefully note everything they eat tend to take in excessive calories when they believe they are dieting.
For patients who cannot lose weight with diet alone, effective weight-loss medications are now available, including sibutramine (Meridia) and orlistat (Xenical). Orlistat may have particular benefits for patients with type 2 diabetes. This drug may delay or even prevent the onset or progression of diabetes. It may also improve cholesterol levels, regardless of weight loss. Sibutramine is also helpful in weight loss but should not be used by patients with high blood pressure or kidney or liver problems.
Once a person has lost weight, maintenance is required. To maintain a healthy weight, make careful decisions about how many calories you consume in food and how many calories you expend through physical activity. Such thinking will eventually become automatic.
A procedure known as bariatric surgery has been very helpful in producing rapid weight loss and improving insulin and glucose levels in people with diabetes.

Even repeated weight loss failure is no reason to give up. [See In-Depth Report #53: Weight control and diet.]

Lifestyle Changes

Inactivity is a major risk factor for coronary artery disease, on par with smoking, unhealthy cholesterol, and high blood pressure. In fact, studies suggest that people who change their diet in order to control cholesterol lower their risk for heart disease only when they also follow a regular aerobic exercise program.

Research strongly supports the benefits of exercise on coronary artery disease:

People who maintain an active lifestyle have a 45% lower risk of developing heart disease than do sedentary people. Even moderate exercise reduces the risk of heart attack.
People who lose weight and exercise regularly have a significantly better chance of maintaining weight loss compared to those who do not exercise.
Some studies suggest that for the greatest heart protection, it is not the duration of the exercise that counts but the total daily amount of energy expended. Therefore, the best way to exercise may be in multiple short bouts of intense exercise.
Burning at least 250 calories a day (the equivalent of about 45 minutes of brisk walking or 25 minutes of jogging) seems to confer the greatest protection against coronary artery disease, particularly by raising HDL (the so-called good cholesterol) levels. (It may take up to a year of sustained exercise for HDL levels to show significant improvement, but in terms of raising HDL levels, more is better.)
Aerobic exercise also appears to open up the blood vessels and, in combination with a healthy diet, may improve blood-clotting factors.
Resistance (weight) training offers a complementary benefit by reducing LDL (the so-called bad cholesterol) levels.
Exercises that train and strengthen the chest muscles may be very important for patients with angina.

[See In-Depth Report #29: Exercise.]

Stress is always highly associated with negative effects on the heart and other parts of the body. A number of techniques are available to help people relax and reduce tension. [See In-Depth Report #31: Stress.]

Resources

www.nhlbi.nih.gov -- National Heart, Lung, and Blood Institute
www.eatright.org -- American Dietetic Association
www.americanheart.org -- American Heart Association
www.acc.org -- American College of Cardiology
http://fnic.nal.usda.gov -- Food and Nutrition Information Center

References

American Heart Association Nutrition Committee; Lichtenstein AH, Appel LJ, Brands M, Carnethon M, Daniels S, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006 Jul 4;114(1):82-96.

Bazzano LA, Reynolds K, Holder KN, He J. Effect of folic acid supplementation on risk of cardiovascular diseases: a meta-analysis of randomized controlled trials. JAMA. 2006 Dec 13;296(22):2720-6.

Bryson CL, Mukamal KJ, Mittleman MA, Fried LP, Hirsch CH, Kitzman DW, et al. The association of alcohol consumption and incident heart failure: the Cardiovascular Health Study. J Am Coll Cardiol. 2006 Jul 18;48(2):305-11.

Covas MI, Nyyssonen K, Poulsen HE, Kaikkonen J, Zunft HJ, Kiesewetter H, et al. The effect of polyphenols in olive oil on heart disease risk factors: a randomized trial. Ann Intern Med. 2006 Sep 5;145(5):333-41.

Djousse L, Pankow JS, Hunt SC, Heiss G, Province MA, Kabagambe EK, et al. Influence of saturated fat and linolenic acid on the association between intake of dairy products and blood pressure. Hypertension. 2006 Aug;48(2):335-41.

Estruch R, Martinez-Gonzalez MA, Corella D, Salas-Salvado J, Ruiz-Gutierrez V, Covas MI, et al. Effects of a Mediterranean-style diet on cardiovascular risk factors: a randomized trial. Ann Intern Med. 2006 Jul 4;145(1):1-11.

Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA. 2007 Mar 7;297(9):969-77.

Gardner CD, Lawson LD, Block E, Chatterjee LM, Kiazand A, Balise RR, et al. Effect of raw garlic vs commercial garlic supplements on plasma lipid concentrations in adults with moderate hypercholesterolemia: a randomized clinical trial. Arch Intern Med. 2007 Feb 26;167(4):346-53.

Halton TL, Willett WC, Liu S, Manson JE, Albert CM, Rexrode K, et al. Low-carbohydrate-diet score and the risk of coronary heart disease in women. N Engl J Med. 2006 Nov 9;355(19):1991-2002.

Kuriyama S, Shimazu T, Ohmori K, Kikuchi N, Nakaya N, Nishino Y, et al. Green tea consumption and mortality due to cardiovascular disease, cancer, and all causes in Japan: the Ohsaki study. JAMA. 2006 Sep 13;296(10):1255-65.

Lopez-Garcia E, van Dam RM, Willett WC, Rimm EB, Manson JE, Stampfer MJ, et al. Coffee consumption and coronary heart disease in men and women: a prospective cohort study. Circulation. 2006 May 2;113(17):2045-53.

McMillan-Price J, Petocz P, Atkinson F, O'Neill K, Samman S, Steinbeck K,et al. Comparison of 4 diets of varying glycemic load on weight loss and cardiovascular risk reduction in overweight and obese young adults: a randomized controlled trial. Arch Intern Med. 2006 Jul 24;166(14):1466-75.

Mosca L, Banka CL, Benjamin EJ, Berra K, Bushnell C, Dolor RJ, et al. Evidence-based guidelines for cardiovascular disease prevention in women: 2007 update. Circulation. 2007 Mar 20;115(11):1481-501.

Mozaffarian D, Prineas RJ, Stein PK, Siscovick DS. Dietary fish and n-3 fatty acid intake and cardiac electrocardiographic parameters in humans. J Am Coll Cardiol. 2006 Aug 1;48(3):478-84.

Mozaffarian D, Rimm EB. Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA. 2006 Oct 18;296(15):1885-99.

Mukamal KJ, Chiuve SE, Rimm EB. Alcohol consumption and risk for coronary heart disease in men with healthy lifestyles. Arch Intern Med. 2006 Oct 23;166(19):2145-50.

Review Date:
4/9/2007
Reviewed By:
Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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adam.com

Hypercholesterolemia

FitSugar — Wed, 08 Oct 2008 17:34:56 -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

Hypercholesterolemia, or high cholesterol, occurs when there is too much cholesterol in the body. Cholesterol is a soft, waxy, fat-like substance that is a natural component of all the cells of the body. Your body makes all the cholesterol it needs. Any added cholesterol, which comes through the foods you eat, can cause harm.

High cholesterol raises your risk for heart disease, heart attack, and stroke. When there is too much cholesterol circulating in the blood, it can create sticky deposits (called plaque) along the artery walls. Plaque can eventually narrow or block the flow of blood to the brain, heart, and other organs.

The normal range for total blood cholesterol is between 140 and 200 mg per decilitre (mg/dL) of blood (usually just expressed as a number). However, the total number doesn't tell the whole story: There are two types of cholesterol -- HDL (high-density lipoproteins, or "good" cholesterol) and LDL (low-density lipoproteins, or "bad" cholesterol). The amount of HDL relative to LDL is considered a more important indicator of your risk for heart disease. There is a third kind of fatty material, triglycerides, found in the blood, that also plays a role (generally as triglyceride levels rise, HDL or "good" cholesterol falls). High cholesterol is characterized by high levels of LDL cholesterol, normal or low levels of HDL cholesterol, and normal or high levels of triglycerides.

More and more Americans have high cholesterol. While heredity may be a factor for some people, lack of exercise plus diets high in saturated fats appear to be the main culprits. High cholesterol can be prevented, often with lifestyle changes (diet and exercise) alone. If these do not work, your doctor may recommend medications to bring down your cholesterol levels.

Signs and Symptoms

High cholesterol generally occurs without any symptoms, especially in early stages. The only way to tell if your cholesterol is high is through a blood test.

Causes

In some cases, high levels cholesterol may be inherited -- your liver may make too much cholesterol, or your body may not remove LDL from your blood as efficiently as normal. High cholesterol or triglycerides can also be associated with other diseases, such as diabetes. In most cases, however, high cholesterol is the result of a diet high in saturated fat and a lack of regular exercise. High cholesterol is more common in people who are overweight or obese, a condition that is true of as much as half of the adult U.S. population.

Risk Factors

There are certain factors that put a person at increased risk of having high cholesterol. While some factors cannot be altered by changes in lifestyle, many can be changed. The most important risk factors for high cholesterol are:

Obesity
Eating a diet high in saturated fat and trans fatty acids (found frequently in processed and fried foods)
Not getting enough exercise
Family history of heart disease
High blood pressure
Smoking cigarettes
Diabetes

Diagnosis

Since most people have few if any symptoms of high cholesterol, a blood test is the only way to check levels of cholesterol in your blood. If your levels are above 200 mg/dL or your HDL below 40, your doctor may do a fasting lipid profile (a test performed after you abstain from food for 12 hours).

Although cholesterol levels above 200 are generally considered high, the optimal level for LDL cholesterol depends on whether you are at risk for or have heart disease.

Total cholesterol levels:

Desirable: Below 200 mg/dL
Borderline high: 200 - 239
High: Above 240

LDL cholesterol levels:

Optimal for people with heart disease or at high risk: Below 70 mg/dL
Optimal for people at risk of heart disease: Below 100
Optimal: 100 - 129
Borderline high: 130 - 159
High: 160 - 189

HDL cholesterol levels:

Poor: Below 40 mg/dL
Acceptable: 40 - 59
Optimal: 60 or above

Triglyceride levels:

Optimal: Below 150 mg/dL
Borderline high: 150 - 199
High: Above 200

Adults with normal total and HDL cholesterol levels should have their cholesterol checked every 5 years. If you have high cholesterol, you should be checked every 2 - 6 months and have liver function tests as well if you are on cholesterol-lowering medication.

Preventive Care

Most people can lower cholesterol levels by eating a well-balanced diet, getting regular exercise, and losing any excess weight.

Diet

A healthy diet can help you lose any excess pounds. Even losing just 5 or 10 pounds may help you lower your cholesterol. To eat a healthy diet:

Cut down on saturated fats and trans fats. No more than 10 percent of your daily calories should come from saturated fat, and you should avoid trans fats completely. Choose unsaturated fats, such as olive oil and canola oil, instead.
Eat whole grains -- whole wheat bread and pasta, oatmeal, oat bran, and brown rice.
Eat more fruits and vegetables, which are high in fiber and can help lower cholesterol levels.
Limit cholesterol in your diet. The highest amounts are found in egg yolks, whole milk products, and organ meats.
Eat fatty fish. The American Heart Association recommends that people eat at least 2 servings of fatty fish (such as salmon or herring) each week.

The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease. The AHA does not recommend very low-fat diets, because new research shows that people benefit from unsaturated ("good") fats, such as those found in olive oil, in their diet.

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 - 8 servings per day (half should be whole grains)
Vegetables: 3 - 5 servings per day
Fruits: 4 - 5 servings per day
Fat-free or low-fat dairy: 2 - 3 servings per day
Lean meat, poultry, seafood: 3 - 6 oz. per day (about the size of a deck of cards)
Fats and oils: 2 - 3 tbsp. per day (use unsaturated fats such as olive oil or canola oil)
Nuts, seeds, legumes: 3 - 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, herring, or lake trout) per week; holding sodium (salt, including salt already added to food) to less than 2,400 mg per day; and limiting alcohol intake to one drink a day for women and two for men.

The Mediterranean style diet concentrates on whole grains, fresh fruits and vegetables, fish, olive oil, and moderate, daily wine consumption. This diet is not low-fat. Instead, it is low in saturated fat but high in monounsaturated fat. This diet is naturally rich in fiber, antioxidants, and omega-3 fatty acids. 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 - 70% lower risk of recurrent heart disease compared with people who received no special dietary counseling.

Losing Weight

Being overweight increases risk of high cholesterol and heart disease. Even a 5- to 10-pound weight loss can lower LDL twice as much as diet alone. Weight loss often results in lower triglyceride levels and increased HDL, too. To maintain a healthy diet, you should aim for a gradual, weekly weight loss of 1/2 to 1 pound.

Getting Exercise

Regular exercise both reduces the risk of death from heart disease and helps lower LDL cholesterol levels, especially when combined with a healthy diet. Thirty minutes of moderate exercise three to five times per week can help you lose weight or maintain a proper weight, reduce LDL and triglyceride levels, and increase levels of HDL. Exercise may also lower blood pressure. Talk with your doctor before starting a new exercise plan.

Treatment Approach

Lowering your cholesterol level reduces your risk of heart disease and stroke. Studies have shown that for every 1% reduction in cholesterol levels there is a 2% reduction in the rate of heart disease. People who already have heart disease or are at higher risk benefit most from lowering their cholesterol.

Changes in lifestyle -- better diet, more exercise -- are the most effective means of both preventing and, in less severe cases, treating high LDL cholesterol levels. In addition to lifestyle changes, specific cholesterol-lowering medications are often prescribed.

Medications

If, after making adjustments to your diet and exercise habits, your LDL cholesterol remains high, your doctor may prescribe medications to lower it. If your cholesterol is extremely elevated (more than 200 mg/dL), you may start drug therapy at the same time you make lifestyle changes. Drugs commonly used to treat high cholesterol include:

Statins (such as lovastatin, pravastatin, simvastatin, atorvastatin, and fluvastatin) -- These are usually the drugs of choice as they are easy to take and have few interactions with other drugs. Side effects can include myositis (inflammation of the muscles), joint pain, stomach upset, and liver damage. People who are pregnant or have liver disease should not take statins.

Niacin (nicotinic acid) -- In prescription form, niacin is sometimes used to lower LDL cholesterol and can be more effective in raising HDL cholesterol than other medications. Side effects may include redness or flushing of the skin (which can be reduced by taking aspirin 30 minutes before the niacin), stomach upset (which usually subsides in a few weeks), headache, dizziness, blurred vision, and liver damage. 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 (such as cholestyramine, colestipol, and colesevelam) -- These are used to treat high levels of LDL. Common side effects include bloating, constipation, heartburn, and elevated triglycerides. People who have high levels of triglycerides (fats in the blood) should not take bile acid sequestrants.

Fibric acid derivatives (such as gemfibrozil and clofibrate) -- These medicines are effective at lowering triglyceride levels, and moderately effective at lowering LDL. They are used to treat high triglycerides and low HDL in people who cannot tolerate niacin. Side effects include myositis, stomach upset, sun sensitivity, gallstones, irregular heartbeat, and liver damage.

Probuchol -- This medicine lowers both LDL and HDL. Its use is generally limited to certain types of hereditary high cholesterol or when other cholesterol-lowering medications have been ineffective. Side effects include diarrhea, bloating, nausea, and dizziness

If you do not respond to one class of drugs, you doctor may use a combination of drugs from two classes.

Nutrition and Dietary Supplements

In addition to eating a healthy diet -- low in saturated fat, with plenty of whole grains, fruits, and vegetables -- some specific foods and supplements may help lower cholesterol.

Fiber -- Several studies have shown that soluble fiber (found in beans, oat bran, barley, apples, psyllium, flaxseed, and glucomannan) lowers LDL cholesterol and triglycerides. Fiber can also help you lose weight because it makes you feel full faster. Your doctor will encourage you to get more fiber in your diet. You may also take a fiber supplement. Men should get 30 - 38 g of fiber per day. Women should get 21 - 25 g.

Soy -- Many studies have shown that eating soy protein (tofu, tempeh, miso) rather than animal meat helps lower blood cholesterol levels, especially when you eat a diet low in saturated fat. One study has shown that as little as 20 g of soy protein per day is effective in reducing total cholesterol, and that 40 - 50 g shows faster effects (in 3 weeks instead of 6). One study has shown that soy can help reduce triglyceride levels. The AHA recommends that people with elevated total and LDL cholesterol add soy to their daily diet, and that soy is safe when consumed as part of your regular diet. Before you take soy supplements, however, talk to your doctor. Soy isoflavones may have estrogen-like effects on the body, which might lead to an increased risk of breast and other cancers.

Omega-3 fatty acids, found in fish oil -- There is good evidence that omega-3 fatty acids (namely EPA and DHA) found in fish oil can help prevent heart disease, lower blood pressure, and reduce the level of triglycerides (fats) in the blood. However, fish oil can also raise levels of both HDL and LDL slightly. When taken as a supplement, it can also act as a blood-thinner, so people who already take blood-thinning medication should only take a fish oil supplement under their doctor's supervision. The AHA recommends that people eat at least two servings of fatty fish (such as salmon) per week, and that fish is safe when consumed as part of your regular diet. If you have high cholesterol, talk to your doctor before taking a fish oil supplement.

Alpha-linolenic acid (ALA) -- ALA is another omega-3 fatty acid that may protect the heart against heart disease. However, studies have shown conflicting results about its ability lower LDL, and it does not appear to lower triglyceride levels.

Vitamin C (100 - 200 mg per day) -- Several studies suggest that eating a diet high in vitamin C can help lower cholesterol levels, but there is no evidence that taking extra vitamin C through a supplement will help.

Beta-sitosterol (800 mg to 6 g per day in divided doses about 30 minutes before meals) -- Beta-sitosterol is a plant sterol, a compound that can stop cholesterol from being absorbed by the intestines. Several 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 vitamin E or carotene.

Policosanol (5 - 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 inhibit blood clots from forming. However, almost all the studies have been conducted in Cuba or Latin America using a proprietary form of policosanol, 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 medication.

Coenzyme Q10 (CoQ10) -- Researchers believe that CoQ10 may inhibit blood clot formation and boost levels of antioxidants. One study found that people who received daily CoQ10 supplements within 3 days of a heart attack were much less likely to experience subsequent heart attacks and chest pain and were also less likely to die of the condition than those who did not receive the supplements. Still, more research is needed to say whether CoQ10 has any role in preventing or treating atherosclerosis. People who take statins may have low levels of CoQ10. If you take statins you may want to ask your doctor about taking a CoQ10 supplement.

Polyphenols -- Polyphenols are chemical substances found in plants that have antioxidant properties. Test tube, animal, and some population-based studies suggest that the flavonoids quercetin, resveratrol, and catechins (all found in high concentration in red wine, and in grape juice) may help reduce the risk of atherosclerosis by protecting against the damage caused by LDL cholesterol. However, more studies in humans are needed to confirm these findings.

Resveratrol -- A recent study of resveratrol in mice found that it protected against age-related damage to vital organs, including the heart and liver, even when the mice ate a high-fat diet. Although this study is promising, researchers need to confirm its findings and to determine whether resveratrol would have the same effect in humans. To equal the rate at which the mice were given resveratrol, humans would have to consume enormous quantities. In addition, resveratrol may have estrogen-like effects, and researchers don't yet know whether it would pose the same risks as estrogen supplements.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a healthcare practitioner.

Hawthorn ( Crataegus monogyna, 900 - 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 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) -- Previous clinical trials have shown that fresh garlic and garlic supplements may lower cholesterol levels, prevent blood clots, and destroy plaque. However, more recent studies show no effect on cholesterol. Garlic can increase the risk of bleeding and should not be taken if you are also taking blood-thinning medication.

Red yeast ( Monascus purpureus , 1,200 mg two times per day with meals) -- Several studies indicate that a proprietary form of red yeast (Cholestin) can lower cholesterol levels, and that the herb acts like prescription statin drugs (See "Medications" section). For that reason, you should not take red yeast without a doctor's supervision, especially if you already take statins to lower cholesterol.

Psyllium ( Plantago psyllium, 10 - 30 g per day in divided doses taken 30 - 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.

Guggul (Commiphora mukul, 3 - 6 g per day) -- Guggul is used in Ayurvedic medicine to treat high cholesterol levels. Scientific studies have found mixed results -- guggul appears to work in Indian populations, but not in people who eat Western-style, high-fat diets.

Other Considerations

Pregnancy

Cholesterol-lowering medications should be avoided during pregnancy.

Prognosis and Complications

Several complications may occur if high cholesterol is left untreated. These include:

Heart disease -- elevated cholesterol levels more than double the risk of heart attack. Lowering cholesterol by 1% reduces the risk of coronary artery disease by 2%.
Stroke -- low levels of HDL cholesterol have been associated with an increased risk of stroke.
Insulin resistance -- 88% of people with low HDL and 84% with high triglycerides also have insulin resistance (which leads to high blood sugar levels). Many people with insulin resistance go on to develop diabetes.

Maintaining the proper weight, eating a diet low in saturated fat, and exercising can lower cholesterol levels and improve long-term prognosis.

Supporting Research

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Review Date:
3/23/2007
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

Diabetes

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

Diabetes is a chronic (long-term) condition marked by abnormally high levels of sugar (glucose) in the blood. People with diabetes either do not produce enough insulin -- a hormone that is needed to convert sugar, starches and other food into energy needed for daily life -- or cannot use the insulin that their bodies produce. As a result, glucose builds up in the bloodstream. If left untreated, diabetes can lead to blindness, kidney disease, nerve disease, heart disease, and stroke.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 20.8 million Americans have diabetes.

While an estimated 14.6 million have been diagnosed with diabetes (both type 1 and type 2), unfortunately, 6.2 million people (or nearly one-third) are unaware that they have type 2 diabetes.

Diabetes is widely recognized as one of the leading causes of death and disability in the United States. The Centers for Disease Control and Prevention (CDC) recognize diabetes as the 6th leading cause of death in the U.S.

There are two major types of diabetes:

Type 1 -- Also known as juvenile or insulin-dependent diabetes, type 1 diabetes occurs when the pancreas produces too little insulin to regulate blood sugar levels appropriately. It is usually diagnosed in childhood.
Type 2 -- This form of the disease is far more common than type 1 and makes up 90% or more of all cases of diabetes. It usually occurs in adulthood. It occurs when the pancreas does not make enough insulin to keep blood glucose levels normal. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity, and failure to exercise.

Pre-diabetes occurs in those individuals with blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes. This condition raises the risk of developing type 2 diabetes, heart disease, and stroke. Pre-diabetes is also called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. Some individuals have both IFG and IGT. In IFG, glucose levels are a little high when it has been several hours after eating. In IGT, glucose levels are a little higher than normal right after eating. Pre-diabetes is becoming more common in the U.S., according to estimates provided by the U.S. Department of Health and Human Services (DHHS). Many individuals with pre-diabetes go on to develop type 2 diabetes within 10 years.

Gestational diabetes is high blood glucose that develops at any time during pregnancy in a person who does not have diabetes. Four percent of all pregnant women develop gestational diabetes. Although it usually disappears after delivery, the mother is at increased risk of developing type 2 diabetes later in life.

Diabetes may also be associated with genetic syndromes, surgery, drugs, malnutrition, infections, and other illnesses.

Signs and Symptoms

Type 1: Type 1 diabetes can occur at any age, but it usually starts in people younger than 30. Symptoms are usually severe and occur rapidly. They include:

Increased thirst
Increased urination
Weight loss despite increased appetite
Nausea
Vomiting
Abdominal pain
Fatigue
Absence of menstruation

Type 2: People with type 2 diabetes often have no symptoms, and their condition is detected only when a routine exam reveals high levels of glucose in their blood. Occasionally, however, a person with type 2 diabetes may experience symptoms listed below, which tend to appear slowly over time:

Numbness or burning sensation of the feet, ankles, and legs
Blurred or poor vision
Impotence
Fatigue
Poor wound healing

In some cases, symptoms may mimic type 1 diabetes and appear more abruptly:

Excessive urination and thirst
Yeast infections
Whole body itching
Coma -- in severe cases, high blood glucose may affect water distribution in brain cells, causing a state of deep unconsciousness, or coma.

Causes

Both type 1 and type 2 diabetes are caused by the absence, insufficient production, or lack of response by cells in the body to the hormone insulin. Insulin is a key regulator of the body's metabolism. After meals, food is digested in the stomach and intestines. Sugar (glucose) molecules are absorbed directly into the bloodstream, and blood glucose levels rise. Under normal circumstances, the rise in blood glucose levels signals specific cells in the pancreas -- called beta cells -- to secrete insulin into the bloodstream. Insulin, in turn, enables glucose to enter cells in the body that may be burned for energy or stored for future use.

In type 1 diabetes, the beta cells of the pancreas produce little or no insulin, the hormone that allows glucose to enter body cells. Once glucose enters a cell, it is used as fuel. Without adequate insulin, glucose builds up in the bloodstream instead of going into the cells. The body is unable to use this glucose for energy despite high levels in the bloodstream, leading to increased hunger.

In addition, the high levels of glucose in the blood cause the patient to urinate more, which leads to excessive thirst. Within 5 - 10 years after diagnosis, the insulin-producing beta cells of the pancreas are completely destroyed, and no more insulin is produced.

The exact cause of type 1 diabetes is not known. Type 1 diabetes accounts for 3% of all new cases of diabetes each year. There is 1 new case per every 7,000 children per year. New cases are less common among adults older than 20.

Type 2 diabetes usually develops in older, overweight individuals who become resistant to the effects of insulin over time. When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin but, for unknown reasons, the body cannot use the insulin effectively. This is called insulin resistance. This means that the insulin produced by your pancreas cannot connect with fat and muscle cells to let glucose inside and produce energy. This causes hyperglycemia (high blood glucose). To compensate, the pancreas produces more insulin. The cells sense this flood of insulin and become even more resistant, resulting in a vicious cycle of high glucose levels and often high insulin levels.

Inflammation has also been found to be common among those with type 2 diabetes. Inflammatory markers (chemicals in the body that lead to inflammation), such as interleukin-6 (Il-6) and C-reactive protein, have been found to be increased in those with type 2 diabetes.

Type 2 diabetes usually occurs gradually. Most people with type 2 diabetes are overweight at the time of diagnosis. However, the disease can also develop in lean people, especially the elderly.

Risk Factors

Type 1 diabetes

Family history of type 1 diabetes
Mother who had pre-eclampsia (a condition characterized by a sharp increase in
Blood pressure during the third trimester of pregnancy)
Family history of autoimmune diseases, including Hashimoto's thyroiditis, Graves disease, myasthenia gravis, Addison's disease, or pernicious anemia
Viral infections during infancy, including mumps, rubella, and coxsackie
Child of an older mother
Northern European or Mediterranean descent
Lack of breast-feeding and consumption of cow's milk during infancy (still controversial)

Type 2 diabetes

Family history of type 2 diabetes (one-quarter to one-third of all individuals with type 2 diabetes have a family history of the condition)
Age older than 45 years
Excess body fat, particularly around the waist
Sedentary lifestyle and high-fat, high-calorie diet
Abnormal levels of cholesterol or triglycerides in the blood
High blood pressure
History of gestational diabetes or polycystic ovary syndrome (a hormonal disorder that causes women to have irregular or no menstruation)
African-American, Hispanic American or Native American (particularly Pima tribe in Arizona) descent
Low birth weight or a mother's malnutrition in pregnancy (this may cause metabolic disturbances in a fetus that lead to diabetes later in the child's life)

Diagnosis

According to the American Diabetes Association, all pregnant women should be screened for gestational diabetes during their third trimester, People who are 45 years or older should have their blood glucose levels checked every 3 years. Those who have a high risk of developing diabetes (such as people with a family history of the disease) should be tested more often.

Different types of tests are used to diagnose diabetes: Random plasma glucose level, fasting plasma glucose level, and oral glucose tolerance test.

If the fasting glucose level is 100 - 125 mg/dL, the individual has a form of pre-diabetes called impaired fasting glucose (IFG), meaning that the individual is more likely to develop type 2 diabetes but does not have the condition yet. A level of 126 mg/dL or above, confirmed by repeating the test on another day, means that the individual has diabetes.

Other diagnostic tests for diabetes includes fructosamine testing and hemoglobin A1c. The American Diabetes Association (ADA) recommends A1c as the best test to find out if an individual's blood sugar is under control over time. The test should be performed every 3 months for insulin-treated patients, during treatment changes, or when blood glucose is elevated. For stable patients on oral agents, health care professionals recommended testing A1c at least twice per year. The ADA currently recommends an A1c goal of less than 7.0%. Studies have reported that there is a 10% decrease in relative risk of microvascular complications, such as diabetic nephropathy or diabetic neuropathy, for every 1% reduction in hemoglobin A1c.

People with diabetes must closely monitor their blood sugar and see their doctor regularly. Self-monitoring of blood glucose is done by checking the glucose content of a drop of blood. Regular testing tells you how well diet, medication, and exercise are working together to control your diabetes. Dieticians can also be an integral part of care.

Preventive Care

Type 1 diabetes

There is currently no proven way to prevent type 1 diabetes. However, research conducted in Finland suggests that adequate amounts of vitamin D, particularly in the first year of life, may decrease one's chances of developing type 1 diabetes within the first 30 years of life. In northern Finland (where the annual exposure to sunlight is very limited) researchers followed 10,000 infants for up to 30 years. Those given at least 2,000 IU of vitamin D per day (generally from cod liver oil) for the first year of life were significantly less likely to develop type 1 diabetes over a 30 years than infants who were given less than that. Other studies have confirmed that doses of 2,000 IU or higher of vitamin D may have a strong protective effect against type 1 diabetes. For this reason, caretakers of infants and children at increased risk for type 1 diabetes might wish to consider supplementation. Experts suggest supplementing these individuals at the high end of current U.S. recommendations for vitamin D, which is 200 - 1,000 IU.

Type 2 diabetes

Considerable evidence from population-based studies suggests that type 2 diabetes is highly preventable -- particularly through exercise and weight management. Individuals who are physically inactive or overweight are much more likely to develop type 2 diabetes. Similarly, people who move from a non-Westernized country to a Westernized country (such as the United States where more people are overweight and live sedentary lives), increase their risk for type 2 diabetes. Studies suggest that you do not need vigorous physical activity to lower your risk of diabetes; moderate, regular exercise such as walking for 30 minutes most days of the week, is enough. In general, lifestyle changes recommended to treat diabetes may help prevent the condition as well.

Treatment Approach

The goal of diabetes treatment is to achieve and maintain a healthy blood glucose levels. A major study called the Diabetes Control and Complications Trial (DCCT) found that people with diabetes who kept their blood glucose levels close to normal reduced their risk of developing major complications from the condition.

People with diabetes can use the following therapies to help manage their blood glucose levels and to prevent complications:

Lifestyle changes, such as a well-balanced diet and regular exercise
Medications, particularly insulin for individuals with type 1 diabetes and some people with type 2 diabetes
Supplements, including fiber and chromium
Relaxation techniques
Acupuncture for pain from nerve damage

Lifestyle

People with diabetes can improve significantly from lifestyle changes -- particularly diet and exercise. People with type 2 diabetes may even eliminate the need for medications when they make appropriate lifestyle changes.

Diet

The American Diabetes Association (ADA) recommends that people with diabetes consume a healthy, low-fat diet, rich in grains, fruits, and vegetables. A healthy diet typically includes 10 - 20% of daily calories from protein such as poultry, fish, dairy, and vegetable sources. People with diabetes who also have kidney disease should work with their health care providers to limit protein intake to 10% of daily calories. A low-fat diet typically includes 30% or less of daily calories from fat -- less than 10% from saturated fats and up to 10% from polyunsaturated fats (such as fats from fish).

Carbohydrates tend to have the greatest effect on blood glucose. The balance between the amount of carbohydrate eaten and the available insulin determines how much the blood glucose level goes up after meals or snacks. To help control blood glucose, people should watch how many carbohydrate servings they eat each day. Foods that contain a high amount of carbohydrates include grains, pasta, and rice; breads, crackers, and cereals; starchy vegetables, including potatoes, corn, peas, and winter squash; legumes such as beans, peas, and lentils; fruits and fruit juices; milk and yogurt; and sweets and desserts. Non-starchy vegetables, such as spinach, kale, broccoli, salad greens, and green beans, are very low in carbohydrates. Carbohydrate counting can ensure that the right amount of carbohydrate is eaten at each meal and snack. A dietician can help each person work out a dietary plan that is right for them.

In addition, weight loss should be part of the plan for those with type 2 diabetes. Moderate weight loss (achieved by reducing calories by 250 - 500 per day and exercising regularly) not only controls blood sugars but blood pressure and cholesterol as well. People with diabetes who eat healthy, well-balanced diets will not need to take extra vitamins or minerals to treat their condition.

Exercise

Exercise plays an important role in controlling diabetes because it lowers blood sugar and helps insulin work more efficiently in the body. Exercise also enhances cardiovascular fitness by improving blood flow and increasing the heart's pumping power, promoting weight loss, and lowering blood pressure. However, exercise has the most value when it’s done regularly -- at least three to four sessions per week for 30 - 60 minutes per session. As little as 20 minutes of walking, three times a week, has a proven beneficial effect. People with type 2 diabetes who exercise regularly have been shown to lose weight and gain better control over their blood pressure, thereby reducing their risk for cardiovascular disease (a major complication of diabetes). Studies have also shown that people with type 1 diabetes who regularly exercise reduce their need for insulin injections.

Despite the benefits of exercise, many people have difficulty sticking with an exercise program for a long period of time. Health care providers can help develop suitable routines as well as strategies that may improve adherence to such routines. Anyone with long-standing diabetes should have a thorough screening before starting an exercise program and receive careful monitoring from a physician.

Medications

Medications for diabetes must always be used in combination with lifestyle changes, particularly diet and exercise, to improve the symptoms of diabetes. Medications include insulin, oral sulfonylureas (like glimepiride, glyburide, and tolazamide), biguanides (Metformin), alpha-glucosidase inhibitors (such as acarbose), thiazolidinediones (such as rosiglitazone) and meglitinides (including repaglinide and nateglinide). A new agent in the fight against diabetes, exenatide (Byetta), is an injectable drug that reduces the level of sugar (glucose) in the blood. In clinical studies, exenatide-treated patients achieved lower blood glucose levels and experienced weight loss. Exenatide was approved by the U.S. Food and Drug Administration in May 2005.

Nutrition and Dietary Supplements

Considerable research has been conducted on the relationship between diabetes and specific nutrients and dietary supplements. Dietary supplements may increase the effects of blood sugar lowering medications, including insulin. Whenever considering the use of supplements or making dietary changes, be sure to discuss these changes with your health care provider to ensure safety and appropriateness.

Supplements with Blood Sugar Lowering Effects

Chromium -- Found in a variety of foods and supplements, including liver, brewer's yeast, cheese, meats, fish, fruits, vegetables, and whole grains, chromium appears to enhance the body's sensitivity to insulin. Researchers believe that chromium helps insulin pull glucose from the bloodstream into the cells for energy. The benefit of chromium supplements for diabetes has been studied and debated for a number of years. While some studies show no beneficial effects of chromium use for people with diabetes, other studies have shown that chromium supplements may reduce blood glucose levels in individuals with type 2 diabetes and reduce the need for insulin in those with type 1 diabetes. Most Americans get at least 50 mcg of chromium in their diets each day. The National Research Council estimates that intakes of 50 - 200 mcg per day are safe and effective. Clinical studies showing improved blood sugar control for those with diabetes have used doses of chromium picolinate ranging from 200 - 1,000 mcg per day. However, until human studies of long-term safety are conducted with higher doses, it is best to use 200 mcg or less per day.

Magnesium -- Several clinical studies have demonstrated a strong association between low levels of magnesium in the blood and type 2 diabetes. However, researchers are still unclear about the cause and effect in that association. They are investigating whether low magnesium levels worsen blood sugar control in people with type 2 diabetes or whether diabetes causes magnesium deficiencies. Some experts believe that low magnesium levels worsen blood sugar control and that foods rich in magnesium (such as whole grains, green leafy vegetables, bananas, legumes, nuts, and seeds) or magnesium supplements may promote healthy blood glucose levels. At least one small study suggests that taking magnesium supplements may improve the action of insulin and decrease blood sugar levels, particularly in the elderly. People with severe heart disease or kidney disease should not take magnesium supplements. People with diabetes should discuss whether it’s safe and appropriate to take magnesium supplements with a health care provider.

Fiber -- Studies suggest that a high-fiber diet may help:

Prevent development of type 2 diabetes
Lower average glucose and insulin levels in people who already have type 2 diabetes
Improve cholesterol and triglyceride levels in those with diabetes

In a large-scale study of nurses in the United States, women who consumed the most whole grain foods in their diets were nearly 40% less likely to develop diabetes than women who consumed the least.

Studies have also shown that cholesterol levels improved in people with type 2 diabetes after they took supplements of a soluble fiber known as psyllium (Plantago psyllium).

Beta-glucan is a soluble fiber derived from the cell walls of algae, bacteria, fungi, yeast, and plants. It is commonly used for its cholesterol-lowering effects. There are several human trials supporting the use of beta-glucan for glycemic (blood sugar) control.

Vanadium -- Vanadium is an essential trace mineral present in the soil and in many foods. It appears to mimic the action of insulin and, in a number of human studies, vanadyl sulfate (a form of vanadium) has increased insulin sensitivity in those with type 2 diabetes. Animal studies and some small human studies also suggest that vanadium may lower blood glucose to normal levels (reducing the need for insulin) in people with diabetes. One preliminary clinical study found that people with diabetes using insulin who were given vanadium were able to lower their dose of insulin.

Antioxidants

Antioxidants such as beta-carotene and vitamin C are scavengers of free radicals -- unstable and potentially damaging molecules generated by normal chemical reactions in the body. Free radicals are unstable because they lack one electron. In an attempt to replace this missing electron, the free radical molecules react with neighboring molecules in a process called oxidation. Some clinical studies suggest that people with diabetes have elevated levels of free radicals and lower levels of antioxidants. Preliminary clinical studies show that the following antioxidants may improve symptoms of diabetes (by returning blood glucose levels to the normal range) and reduce the risk of associated complications:

Vitamin E
Selenium
Zinc

Two additional substances that show preliminary evidence to possibly help control blood sugar include:

Biotin (a B-complex vitamin) -- helpful for type 2 diabetes; brewer's yeast is a good source of biotin
Vitamin B6 -- helpful for both type 1 and type 2 diabetes

Supplements with Cardiovascular Effects

Because insulin resistance is often associated with cardiovascular disease, people with diabetes may benefit from nutrients that help manage elevated blood lipid levels, high blood pressure, or heart failure. Although the following supplements have been shown to improve cardiovascular health, there is some concern that they may raise blood glucose levels. People with diabetes interested in trying the following supplements should first consult with their health care providers:

Coenzyme Q10 (CoQ10)
Niacin
Omega-3 Fatty acids

Although clinical studies have not shown that either CoQ10 or omega-3 fatty acid supplements raise blood sugar levels, people with diabetes should discuss the safety and appropriateness of using these, or any supplements, with their doctor or pharmacist.

In addition, the following antioxidants have been shown to improve cholesterol levels in people with type 2 diabetes:

Beta-carotene
Vitamin C (1000 mg per day)
Vitamin E (800 IU per day)

Several clinical studies have also found that elevated manganese levels may help protect against LDL oxidation (a process that contributes to the development of plaque in the arteries).

Supplements that May Reduce Complications of Diabetes

More than one-third of all people with diabetes develop a painful condition known as diabetic neuropathy (nerve damage). Some researchers speculate that elevated levels of free radicals, which can cause damage to nerves and blood vessels, may cause this condition. Clinical studies suggest that the following antioxidant supplements may improve nerve communication in damaged areas and reduce the symptoms of diabetic neuropathy:

Alpha-lipoic acid
Gamma-linolenic acid [evening primrose oil (Oenothera biennis ) is a rich source]

Herbs

People have long used plant-based medicines in the treatment of diabetes. For instance, the plant extract guanidine, which lowers blood glucose, prompted the development and use of biguanides, a commonly used oral medication for diabetes. Other herbs may have a role in the management or prevention of diabetes. These include:

Bitter melon (Momordica charantia). Bitter melon has traditionally been used as a remedy for lowering blood glucose in patients with diabetes mellitus. Preliminary clinical studies have indicated that bitter melon may decrease serum glucose levels.
Fenugreek seeds (Trigonella foenum graecum). Fenugreek seeds, a spice found in many curry preparations, are high in fiber and have been shown to regulate glucose and improve lipid levels in both animals and humans. In two small studies of people with either type 1 or type 2 diabetes, fenugreek seed powder lowered blood glucose and improved levels of blood cholesterol and trigylcerides, among other beneficial effects.
Gymnema (Gymnema sylvestre). Preliminary human research reports that gymnema may be beneficial in patients with type 1 or type 2 diabetes when it is added to diabetes drugs being taken by mouth or to insulin. Gymnema may alter the ability to detect sweet tastes.
Cinnamon (Cinnamomum zeylanicum). In a clinical study of 60 people with type 2 diabetes, intake of 1, 3, or 6 grams of cinnamon per day reduced glucose, triglyceride, LDL cholesterol, and total cholesterol. Other clinical studies have found similar results. As a result, experts claim that cinnamon may play an important role in regulating blood sugar in people with diabetes.
American ginseng (Panax quinquefolium). Although both Asian (Panax ginseng) and American (Panax quinquefolium) appear to lower blood glucose levels, only American ginseng has been studied scientifically. Several clinical studies report a blood sugar lowering effect of American ginseng (Panax quinquefolium) in individuals with type 2 diabetes, both on fasting blood glucose and on postprandial glucose levels. One clinical study found that people with type 2 diabetes who take American ginseng before or together with a glucose meal experience a reduction in glucose levels after they consume the meal.

Acupuncture

Some researchers speculate that acupuncture may trigger the release of natural painkillers and reduce the debilitating symptoms of a complication of diabetes known as neuropathy (nerve damage). In one clinical study of people with diabetes suffering from chronic, painful neuropathy, acupuncture reduced pain and improved sleep in 77% of the participants and eliminated the need for pain medications in 32% of the participants. Given these findings, acupuncture may be a reasonable option for people with diabetes who have neuropathy and either find no symptom relief or develop side effects from conventional drug treatment.

Mind-Body Medicine

Stressful life events can worsen diabetes in several ways. For example, stress stimulates the nervous and endocrine systems in ways that increase blood glucose levels and disrupts healthful behaviors (increasing the chances that an individual may consume a high level of calories and limit his or her physical activity -- a pattern that leads to elevated blood glucose).

It makes sense, then, to consider stress management as part of the treatment and prevention of diabetes. Clinical studies have reported that people with diabetes who participate in biofeedback sessions (a technique that increases awareness and control of the body's response to stress) are more likely to reach target blood glucose levels than those who do not receive biofeedback. Although other studies have produced results that contradict this, researchers and clinicians agree that long-term stress is likely to worsen diabetes and that biofeedback, tai chi, yoga, and other forms of relaxation may help motivate people with diabetes to change their habits in order to manage their condition.

Other Considerations

Pregnancy

Women of child-bearing age who have diabetes should consult an endocrine specialist about the benefits of managing glucose levels before trying to conceive.

About 4% of all pregnant women in the United States are diagnosed with gestational diabetes. Risk factors for developing diabetes while pregnant include:

Modest weight gain prior to pregnancy (11 - 22 pounds or more)
Family history of diabetes
Tobacco use
African-American, Hispanic American, or Asian ancestry
Age older than 50 at conception

Normalizing glucose levels in women with gestational diabetes reduces their risk of complications, such as having an overweight baby, birth trauma, or the need for cesarean section. If the mother's glucose levels are uncontrolled, an infant can be stillborn or suffer from any number of complications, including defects of the brain or central nervous system, an abnormally large body or organs, heart or kidney abnormalities, asphyxia, respiratory distress, and congestive heart failure.

If dietary restrictions fail to improve glucose levels, a woman with gestational diabetes may need insulin. Women should not take oral diabetes medications during pregnancy. Women who develop gestational diabetes may experience the condition again in subsequent pregnancies. Gestational diabetes also increases the risk for developing type 2 diabetes.

Prognosis and Complications

People who maintain tight control over their blood glucose levels can prevent or delay the development of long-term complications from diabetes. Type 1 diabetes generally has more complications than type 2 diabetes.

Long-term complications of diabetes may include:

Heart disease and stroke
Vision loss and blindness
Kidney disease
Neuropathy (nerve damage)
Foot ulcers and infections
Skin problems, including bruising, dryness, itching, hair loss, warts, gangrene (tissue death), and skin ulcers

Supporting Research

Baker H. Nutrition in the elderly: nutritional aspects of chronic diseases. Geriatrics. 2007;62(9):21-5.

Batty GD, Kivimaki M, Smith GD, Marmot MG, Shipley MJ. Obesity and overweight in relation to mortality in men with and without type 2 diabetes/impaired glucose tolerance: the original Whitehall Study. Diabetes Care. 2007;30(9):2388-91.

Bo S, Ciccone G, Baldi C, et al., Effectiveness of a Lifestyle Intervention on Metabolic Syndrome. A Randomized Controlled Trial. J Gen Intern Med. 2007; [Epub ahead of print].

Bozkurt O, de Boer A, Grobbee DE, et al. Pharmacogenetics of glucose-lowering drug treatment: a systematic review. Mol Diagn Ther. 2007;11(5):291-302.

Casellini CM, Vinik AI. Clinical manifestations and current treatment options for diabetic neuropathies. Endocr Pract. 2007;13(5):550-66.

Diabetes Research in Children Network (DirecNet) Study Group, Buckingham B, Beck RW, Tamborlane WV, et al. Continuous glucose monitoring in children with type 1 diabetes. J Pediatr. 2007;151(4):388-93, 393.e1-2.

Herder C, Schneitler S, Rathmann W, et al. Low-Grade Inflammation, Obesity and Insulin Resistance in Adolescents. J Clin Endocrinol Metab. 2007; [Epub ahead of print].

Hypponen E, Laara E, Reunanen A, Jarvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500-1503.

Kapoor R, Huang YS. Gamma linolenic acid: an antiinflammatory omega-6 fatty acid. Curr Pharm Biotechnol. 2006;7(6):531-4.

Khan A, Khattak K, Sadfar M, Anderson R, Khan M. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003;26:3215-3218.

Malnick SD, Somin M. The VALIDD study. Lancet. 2007;370(9591):931; author reply 931-2.

Marz W, Wieland H. HMG-CoA reducatse inhibition: anti-inflammatory effects beyond lipid lowering. Herz. 2000;25(6):117-25.

Mosdol A, Witte DR, Frost G, Marmot MG, Brunner EJ. Dietary glycemic index and glycemic load are associated with high-density-lipoprotein cholesterol at baseline but not with increased risk of diabetes in the Whitehall II study. Am J Clin Nutr. 2007;86(4):988-94.

Nutrition Committee of the American Heart Association. AHA Dietary Guidelines. Revision 2000: A Statement for Healthcare Professionals. Circulation. 2000; 102:2284-2299.

Pedersen BK. IL-6 signalling in exercise and disease. Biochem Soc Trans. 2007;35(Pt 5):1295-7.

Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007;64(5 Suppl):101S-56S.

Ripsin CM, Keenan JM, Jacobs Jr. DR, et al. Oat products and lipid lowering: a meta-analysis. JAMA. 1992;267:24:3317-3325.

Srivastava AK. Anti-diabetic and toxic effects of vanadium compounds. Mol Cell Biochem. 2000;206(1-2):177-182.

Stevinson C, Pittler MH, Ernst E. Garlic for treating hypercholesterolemia. Ann Intern Med. 2000;133(6):420-429.

Tofler GH, Stec JJ, Stubbe I, Beadle J, Feng D, Lipinska I, Taylor A. The effect of vitamin C supplementation on coagulability and lipid levels in healthy male subjects. Thromb R es. 2000;100(1):35-41.

Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-Etherton PM.Effects of the National Cholesterol Education Program's Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Am J Clin Nutr. 1999;69:632-646.

Willett WC. The role of dietary n-6 fatty acids in the prevention of cardiovascular disease. J Cardiovasc Med (Hagerstown). 2007;8 Suppl 1:S42-5.

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Review Date:
12/7/2007
Reviewed By:
Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, NMD, private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Asthma

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

Overview

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

HEALTH GUIDE REFERENCE FROM A.D.A.M

Asthma is a chronic disease that involves inflammation of the lungs. Airways swell and restrict airflow in and out of the lungs, making it hard to breathe. The word asthma comes from the Greek word for "panting." People with asthma pant and wheeze because of the restricted flow of air.

Normally, when you breathe in an irritant or are subjected to stressful activity such as exercise, your airways relax and open, allowing the lungs to get rid of irritants or take in more air. With asthma, muscles in the airways tighten, and the lining of the air passages swells.

About 20 million Americans have asthma, including 9 million children. In fact, asthma is the most common chronic childhood illness. About half of all cases develop before the age of 10, and many children with asthma also have allergies.

Asthma can either be allergic or non-allergic. In allergic asthma, an allergic reaction to an inhaled irritant -- pet dander, pollen, dust mites -- triggers an attack. The immune system gets involved, but instead of helping, it causes inflammation. This is the most common form of asthma.

Non-allergic asthma does not involve the immune system. Attacks can be triggered by stress, anxiety, cold air, smoke, or a virus. Some people experience symptoms only when they exercise, a condition known as exercise-induced asthma.

While there is no cure for asthma, it can be controlled.

Signs and Symptoms

Most people with asthma may go for periods of time without any symptoms, then experience an asthma attack. Some people experience chronic shortness of breath that gets worse during an attack. Asthma attacks can last minutes to days, and can become dangerous if the airflow becomes severely restricted.

Primary symptoms include:

Shortness of breath
Wheezing -- usually begins suddenly; may be worse at night or early in the morning; can be made worse by exposure to cold air, exercise, and heartburn; is relieved by using bronchodilators (drugs that open the airways; see Medications)
Chest tightness
Cough (dry or with sputum) -- in cough-variant asthma, this may be the only symptom

If you experience any of these symptoms, seek emergency treatment:

Extreme difficulty breathing or cessation of breathing
Bluish color to the lips and face (called cyanosis)
Severe anxiety
Rapid pulse
Profuse sweating
Decreased level of consciousness (such as drowsiness or confusion)

Causes

Asthma is most likely caused by a combination of several factors. Genes play a part; you’re more likely to develop asthma if others in your family have it. Among those who are susceptible, exposure to environmental factors such as allergens (substances that cause an allergic reaction) or infections may increase the likelihood of developing asthma.

Risk Factors

The following factors may increase the risk of developing asthma:

Having allergies
Family history of asthma or allergies
Exposure to secondhand smoke
Having upper respiratory infections as an infant
Living in a large city
Gender -- among younger children, asthma develops twice as often in boys as in girls, but after puberty it may be more common in girls
Obesity
Gastroesophageal reflux (heartburn)

Triggers

Childhood asthma in particular can be triggered by almost all of the same things that trigger allergies, such as:

Sensitivity to allergens such as dust, cockroach waste, pet dander, indoor and outdoor mold, pollen
Air pollutants, such as smoke, aerosols, perfumes, diesel particles, sulfur dioxide, high ozone levels, and fumes from paint, cleaning products, and gas stoves
Changes in the weather, especially in temperature (particularly cold) and humidity

Other triggers include:

Activities that affect breathing (exercising, laughing, crying, yelling)
Stress and anxiety

Diagnosis

The symptoms of asthma can mimic several other conditions, and your doctor will take a thorough history to rule out other diseases. You may also have lung function tests to measure, among other things, how much air your lungs can hold and how much air you exhale. Your doctor may use a spirometer to measure how much air you exhale and how quickly you get air out of your lungs. Other tests may include chest and sinus x-rays, blood tests, or allergy tests.

Asthma is classified as

Mild intermittent: Having mild symptoms up to 2 days a week and 2 nights a month
Mild persistent: Having symptoms more than 2 a week but not more than one time in a single day
Moderate persistent: Having symptoms once a day and more than one night per week
Severe persistent: Having symptoms throughout the day on most days and often at night.

Prevention

Although there is no way you can prevent asthma, you can take several steps to reduce the number and frequency of attacks:

Avoid allergens and irritants as much as possible. For example, to reduce exposure to dust mites, use special mattress and pillow covers that keep allergens out and remove carpets from bedrooms. Clean your house frequently.
Exercise. Even people with exercise-induced asthma can stay active, and exercise will benefit you by strengthening your lungs and helping you maintain a proper weight. Taking precautions when it’s cold outside -- such as wearing a face mask to warm the air that you’re breathing -- can help you avoid asthma symptoms. Talk to your doctor before starting an exercise regimen.
Pay attention to your breathing. Watch for signs of an oncoming attack, such as wheezing. Your doctor may give you a machine called a peak flow meter that can detect slight differences in your breathing before you even notice them and allow you to take medication immediately to ward off an attack.
Treat attacks quickly. The sooner you treat an attack, the less severe it will be, and the less medication you’ll need.

If you have allergies, a process known as allergy desensitization may decrease the number of asthma attacks and their intensity, and lower the amount of medication you need. Desensitization includes regular injections of the allergen (substance causing the allergic reaction), with each shot containing a slightly higher amount. Gradually your immune system becomes used to the allergen and no longer attacks it. Talk to your doctor about whether desensitization is right for you.

Treatment

Avoiding asthma attacks, reducing inflammation, and preventing lung damage are the primary goals of treatment. The more you know about your condition, the more you can work closely with your doctor to develop a treatment plan. Preventing exposure to allergens or irritants and taking medication as prescribed are important for the successful control of asthma. You may need emergency medications during an asthma attack, but monitoring your breathing taking your medications every day will help you control asthma over the long term.

Severe attacks may require hospitalization for oxygen and medications that are given intravenously (IV).

Lifestyle

If you smoke, quit.
Lose weight if you are overweight; excess weight may put pressure on the lungs and trigger an inflammatory response.
Monitor your condition every day using a peak flow meter (a portable device that helps measure how your lungs are working). Keep a diary of readings to show your doctor; together, you will establish your "personal best" reading. You should call your doctor if your peak flow reading falls below 80% of your personal best and go to the hospital if it falls below 50%.
Keep a journal that logs changes or attacks -- it may help determine triggers

Medications

Medications for asthma are prescribed for two different purposes: to stop an immediate attack, and to control inflammation and reduce lung damage over the long term.

Quick relief medications -- These drugs are called bronchodilators and help open the airways when you have an attack.

Short-acting beta-adrenergic agonists start working immediately. These drugs include:

Albuterol (Proventil)
Isoproterenol (Isuprel)
Metaproterenol (Aluprent)
Pirbuterol (Maxair)
Terbutaline (Brethine)
Levalbuterol (Xopenex)

Another drug that might be prescribed to help open your airway is ipratropium (Atrovent).

Sometimes, steroids are needed for an acute asthma attack. They can take longer to work (from a couple of hours to a few days) and include:

Prednisone
Prednisolone
Methylprednisolone
Hydrocortisone

Long-term control -- These drugs are usually taken every day.

Inhaled corticosteroids reduce inflammation have fewer side effects than oral corticosteroids. They include

Beclamethasone (Qvar)
Budesonide (Pulmicort)
Flunisolide (Aerobid)
Fluticasone (Flovent)
Triamcinolone (Azmacort)

A class of drugs called leukotreine modifiers help reduce the production of inflammatory chemicals called leukotreines that cause your airways to swell. They include:

Montelukast (Singulair)
Zafirlukast (Accolate)

Cromolyn (Intal), Nedocromil (Tilade) -- These medications, which are inhaled, can help prevent mild to moderate attacks and are used to treat exercise-induced asthma.

Theophylline (TheoDur) -- This medication helps open airways and prevent asthma symptoms, especially at night. Too much can cause serious side effects, so your doctor will monitor levels in your blood.

Nutrition and Dietary Supplements

Although asthma cannot be cured by any nutritional supplement, people who have a chronic illness such as asthma should eat well-balanced meals that include plenty of fruits and vegetables. Some studies have shown that people with asthma tend to have low levels of certain nutrients, but there is no evidence that taking supplements has any benefit. Rather, an overall healthy diet will ensure you get the nutrients you need and help your body deal with a long-term condition such as asthma.

Choline (3 g per day) -- Choline, a B vitamin, may help reduce the severity and frequency of asthma attacks, and allow people with asthma to use bronchodilators less often. Some evidence indicates that higher doses (3 g per day) may be most effective. More research is needed to say for sure whether choline helps.
Magnesium -- The suggestion of taking magnesium to treat asthma comes from the fact that people who have asthma often have low levels of magnesium, and from some (but not all) studies showing that intravenous (IV) magnesium can be effective as an emergency treatment for an asthma attack. However, studies that have looked at whether taking magnesium orally was beneficial have shown mixed results. More research is needed.
Omega-3 fatty acids -- The evidence for using omega-3 fatty acids (fish oil) to treat asthma is mixed. At least a few studies have found that fish oil supplements may improve inflammation and symptoms in children and adults with asthma. But the studies have only included a small number of people, and one study found that fish oil might make aspirin-induced asthma worse. Talk to your doctor about whether a high quality fish oil supplement makes sense for you.
Quercetin -- Quercetin, a kind of antioxidant called a flavonoid, inhibits the production and release of histamine and other allergic/inflammatory chemicals in the body. Histamine contributes to allergy symptoms such as a runny nose, watery eyes, and hives. Because of that, quercetin has been proposed as a treatment for asthma, but no human studies have examined whether it works or not.
Selenium -- Studies suggest that people with asthma tend to have low levels of selenium. In addition, a population-based study suggested that eating selenium-rich foods may reduce the risk of asthma. And in one small study of 24 people with asthma, those who received selenium supplements for 14 weeks had fewer symptoms than those who received placebo. However, a recent study indicated that people who took 200 mcg of selenium per day for about eight years were more likely to develop type 2 diabetes. Talk to your doctor before taking selenium supplements.
Vitamin C (1 g per day) -- One preliminary study suggested that children with asthma experienced significantly less wheezing when the ate a diet that was rich in fruits with vitamin C. Vitamin C does have anti-inflammatory and antioxidant properties, which may help you maintain good health overall. Other studies have indicated that taking a vitamin C supplement (1 g per day) may help keep airways open, but other studies have found no benefit.
Other -- Other supplements that may have benefit for asthma include:
- Coenzyme Q 10 (CoQ10) -- if you have asthma, you may have low levels of this antioxidant in your blood. It is not known, however, whether taking CoQ10 supplements will make any difference in your symptoms.
- Lycopene and beta-carotene -- preliminary data suggests that these two antioxidants, found in many fruits and vegetables, may help prevent exercise-induced asthma.
- Vitamin B6 -- may be needed if you are taking theophylline because this medication can lower blood levels of this nutrient.
- Potassium -- levels in the body also may be lowered if you take theophylline.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care practitioner.

Boswellia (Boswellia serrata, 3 mg three times per day) -- Boswellia (also known as Salai guggal), an herb commonly used in Ayurvedic medicine (a traditional Indian system of health care), has shown promise in treating asthma. In one double-blind, placebo-controlled study, people who took boswellia had fewer attacks and improved lung function. Boswellia may help leukotreine modifiers work better. However, more research is needed. People who take medication to lower their cholesterol, or people who take nonsteroidal anti-inflammatory drugs (NSAIDs) should talk to their doctor before taking boswellia.
Coleus forskohlii -- Coleus forskohlii is another herb used in Ayurvedic medicine to treat asthma. A few preliminary studies that used inhaled coleus powder seemed to relieve symptoms, but more research is needed to know for sure. People who have diabetes or thyroid conditions should not take coleus. If you take an anticoagulant (blood thinner), taking coleus may increase your risk of bleeding. Pregnant women should not take coleus.
Tylophora (Tylophora indica, 250 mg one to three times per day) -- Tylophora has also been used historically to treat asthma. Some modern scientific studies show that it can help reduce symptoms, but the studies were not the best quality. More research is needed. Tylophora may cause serious side effects at high doses, so talk to your doctor before taking it. Do not take tylophora if you are pregnant, have diabetes, high blood pressure, or congestive heart failure.
Pycnogenol (Pinus pinaster, 1 mg per pound of body weight, up to 200 mg) -- A 2002 review of studies on a standardized extract from French maritime pine bark, called pycnogenol, suggests that it may reduce symptoms and improve lung function in people with asthma. Do not use pycnogenol if you have diabetes or take medication for high blood pressure. Taking pycnogenol with an anticoagulant (blood thinner) -- including aspirin -- can increase your risk of bleeding; talk to your doctor first.
Saiboku-to -- A traditional Japanese herbal mixture called Saiboku-to has helped reduce symptoms and allowed study participants to reduce doses of corticosteroids in three preliminary trials. In test tubes, Saiboku-to has shown anti-inflammatory effects. Saiboku-to contains several herbs, including Asian ginseng (Panax ginseng), Chinese skullcap (Baikal scutellaria), licorice (Glycyrrhiza glabra), and ginger (Zingiber officinale). Talk to your healthcare provider before taking Saiboku-to as the herbs it contains can interact with other herbs and medications.

Acupuncture

Some preliminary studies indicate that acupuncture may help reduce symptoms for some people with asthma, but not all studies agree. It is important to note that acupuncture should be used in addition to, not as a replacement for, conventional medicine when treating asthma.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of asthma based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type-- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Arsenicum album -- for asthma that generally worsens between midnight and 2 am and is accompanied by restlessness, anxiety, chills, and thirst.
Ipecacuanha -- for those with asthma, particularly children, who have significant tightness in the chest, a chronic cough with lots of phlegm that may lead to vomiting, and worsening of symptoms in hot, humid weather.
Pulsatilla -- for asthma with yellow or greenish phlegm that gets worse in the evening, in warm, stuffy rooms, or after consuming rich, fatty foods; this remedy is most appropriate for adults or children who are tearful and clingy or sweet and affectionate.
Sambucus -- for asthma that awakens a person at night with a sensation of suffocation; symptoms worsen when the person is lying down .

Mind-Body Medicine

Because stress and anxiety can make asthma worse, incorporating stress management techniques into daily life may help reduce symptoms. These techniques do not directly treat asthma, however.

Hypnosis -- may be especially useful for children, who can readily learn the technique.
Yoga -- in addition to general relaxation and reduction of stress, several studies of people with asthma have suggested that lung function improve with the regular practice. Any benefits in breathing appear to be slight, however.
Journaling -- A study published in the New England Journal of Medicine documented the positive effect of daily journaling on people with asthma. Some theorize that journaling allows for the release of pent-up emotions and leads to overall stress reduction.

Other Considerations

Warnings and Precautions

Long-term treatment with theophylline for asthma may reduce blood levels of vitamin B6.

Prognosis and Complications

People with asthma can live normal, active lives. Because asthma is a chronic illness, it requires self-care and monitoring over the long term, as well as close contact with your doctor. Most people with asthma have occasional attacks separated by symptom-free periods. Paying attention to your mood, lowering the stress in your life, and having a good emotional support system will help you take good care of yourself.

Supporting Research

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Review Date:
9/23/2007
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

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Fab Read: Fashion Inside Out, Daniel V's Guide to How Style Happens From Inspiration to Runway and Beyond

FabSugar — Fri, 03 Oct 2008 04:00:22 -0700

Project Runway alum Daniel Vosovic has taken fate into his own hands with his new book, Fashion Inside Out: Daniel V's Guide to How Style Happens From Inspiration to Runway and Beyond ($20).

In it, Daniel reveals his tips on how to become a successful fashion designer. From connecting with the right people to self promotion, this how-to is an informative easy read. Don't forget to read the touching foreword from Tim Gunn. This is a must-read for every aspiring fashion designer. If you don't believe me, ask him yourself at his upcoming blog interview with Craft. Just submit your questions in the comments section of the Craft post and the moderators will take it from there.

Fiber

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

Overview

Overview
Uses
Dietary Sources
Available Forms
How to Take It
Precautions
Possible Interactions
Supporting Research

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, 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.

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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.

A.D.A.M. Copyright

adam.com

Alzheimer's disease

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

Alzheimer's disease (AD) is a progressive, degenerative brain disease that results in impaired memory, thinking, and behavior. People with AD experience gradual memory loss as well as impaired judgement, difficulty concentrating, loss of language skills, personality changes, and a decline in the ability to learn new tasks.

The rate of progression is different for each person. If AD develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course.

There is no cure for AD, but studies suggest that medications, herbs and supplements, and lifestyle adjustments may help slow the progression and improve the symptoms of the disease.

Signs and Symptoms

The early symptoms of AD are occasionally overlooked because they resemble signs that many people attribute to "natural aging." The following are the most common signs and symptoms of AD:

Psychological Symptoms

Memory loss, including not recognizing friends and family members
Difficulty concentrating
Difficulty comprehending words, completing sentences, or finding the right words
Loss of familiarity with surroundings, wandering aimlessly
Depression
Hallucinations, delusions, and psychosis
Aggression, agitation, anxiety, restlessness
Accusatory behaviors (such as accusations of spousal infidelity)
Withdrawal, disinterest, hostility, loss of inhibitions

Physical Symptoms

Impaired movement or coordination
Muscle rigidity, shuffling or dragging feet while walking
Insomnia or disturbances in sleep patterns
Weight loss
Incontinence
Muscle twitching or seizures

Causes

The causes of AD are not entirely known but are thought to include genetics and environmental factors. New research indicates that free radicals (highly reactive molecules that can cause oxidation, or damage to cells) may play a role in the development of AD.

A gene for the protein epsilon apolipoprotein (Apo E) -- especially Apo E3 and Apo E4 varieties -- is thought to accelerate the formation of abnormal deposits (called plaques) in the brain and increase the risk for AD. Reports indicate that 50 - 90% of those with the Apo E4 gene develop AD. However, even people without inherited genes for the disease can get AD.

Scientists also believe the environment may play a part in AD because people in different regions of the world have widely varying risks of developing the disease. For example, people living in Japan and West Africa have much less risk for AD than Japanese Americans and African-Americans.

People with AD have abnormal deposits, or plaques, in their brain tissue. These plaques contain beta amyloid, a protein that releases free radicals, or highly reactive molecules, that can cause damage to cells through a process called oxidation. These free radicals are believed to lower levels of acetylcholine (a brain chemical that helps transmit impulses in the nervous system) and damage brain tissue, bringing on the symptoms of AD.

Although not confirmed by scientific studies, other factors that have been speculated to contribute to the development of AD include infections (such as herpesvirus type 1), exposure to metal ions (such as aluminum, mercury, zinc, copper, and iron), or prolonged exposure to electromagnetic fields.

Risk Factors

The causes and risk factors contributing to the development of AD are not entirely clear. The following all appear to have an association with AD to varying degrees.

Family history of AD
Older age -- 20 - 40% of people with AD are older than 85
Female gender -- while women tend to develop AD more than men, this may be related to the tendency for women to live longer.
Americans are more likely to get AD than Asians or Native Americans
Long-term high blood pressure
History of head trauma -- one or more serious blows to the head may put a person at an increased risk.
Down syndrome
Elevated levels of homocysteine (a body chemical that contributes to chronic illnesses such as heart disease, depression, and AD)
Aluminum or mercury poisoning
Prolonged exposure to electromagnetic fields

Diagnosis

There is no definitive test for AD. A true diagnosis can only be made after a person dies and an autopsy is performed on the brain.

However, AD usually has a characteristic pattern of symptoms. A health care provider will try to narrow down a diagnosis by ruling out other possible causes. The health care provider will ask questions about medical history and symptoms and do a physical exam (including a neurological exam).

The following tests may also be used to aid in the diagnosis:

Psychological tests assess the individual's memory and attention span. They may also reveal difficulties in problem-solving, social, and language skills.
Electroencephalograph (EEG) traces brain-wave activity. This test sometimes reveals "slow waves" in people with AD.
Blood test for the Apo E4 gene may indicate a genetic tendency for AD. The presence of the gene in the blood may suggest AD, but it does not always make an accurate diagnosis.
Imaging tests such as CT, MRI, or PET scans.

In the early stages of dementia, brain image scans may be normal. In later stages, an MRI may show a decrease in the size of certain brain areas. While the scans do not confirm the diagnosis of AD, they do exclude other causes of dementia such as stroke and tumor.

Preventive Care

Consuming a low-fat, low-calorie diet may reduce the risk for AD.
Higher intake of fatty, cold-water fish (such as tuna, salmon, and mackerel) may be associated with a lower risk of dementia. This may be due to the high level of omega-3 fatty acids found in such fish. Eating fish at least two to three times per week provides a healthy amount of omega-3 fatty acids, but dietary supplementation with capsules or liquid products is still recommended.
Reducing intake of linoleic acid (found in margarine, butter, and dairy products) may prevent cognitive decline.
Antioxidants, such as vitamins A, E, and C (found in darkly colored fruits and vegetables), may help prevent damage caused by free radicals.
Maintaining normal blood pressure levels may reduce the risk for AD.
Hormone-replacement therapy (HRT) in postmenopausal women may decrease production of chemicals that cause AD, stimulate growth of brain cells, and improve blood flow in the brain. However, the role of hormones in the prevention of AD is still controversial. HRT has also been shown to increase the risk for breast cancer, heart attacks, strokes, and blood clots.
Some studies suggest that certain medications may prevent AD, including statin drugs (such as pravastatin or lovastatin, used to lower cholesterol) and nonsteroidal anti-inflammatories (NSAIDs), with the exception of aspirin. More research is necessary, however, to determine how effective these medications are in reducing the risk of the disease.
Keeping mentally and socially active may help delay the onset or slow the progression of AD.

Treatment

The goals in managing AD are to:

Slow the progression of the disease.
Manage behavior problems, confusion, and agitation.
Modify the home environment.
Support family members and other caregivers.

There is no cure for AD. The most promising treatments include lifestyle changes, medications, and antioxidant supplements.

Lifestyle

Research indicates that the following lifestyle modifications may help improve behavior in people with AD:

Walking regularly with a caregiver or other reliable companion may improve communication skills and diminish the risk of wandering.
Bright light therapy may reduce insomnia and wandering.
Calming music may reduce wandering and restlessness, boost brain chemicals, and improve behavior.
Pet dogs can increase appropriate social behaviors.
Relaxation training and other exercises that require focused attention (often used with refreshments as rewards) can improve social interaction and the ability to perform tasks.

The Safe Return Program, implemented by the Alzheimer's Association, encourages identification bracelets, wallet cards, and clothing labels for patients with AD. Identifying information is stored in a national database and distributed to authorities when a patient is reported missing. If a registered person is found, the information is used to contact their caregiver.

Medications

Several drugs are available to try to slow the progression of AD and possibly improve the person's mental capabilities. These include:

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne, formerly called Reminyl)
Tacrine (Cognex)

Memantine (Namenda) is currently the only drug approved for treatment of moderate-to-severe Alzheimer’s disease.

The following medications may ease the symptoms related to AD:

Selective serotonin reuptake inhibitors (SSRIs) increase activity of a brain chemical called serotonin. They are used to treat depression.
Methylphenidate stimulates the brain to increase alertness. It is used to treat withdrawal and apathy.
Risperidone, olanzapine, and haloperidol are mood stabilizers. They help improve social interactions, and reduce delusions, paranoia, and aggression.
Carbamazepine is an anti-seizure drug that stabilizes sodium levels in the brain. It is used to treat agitation.

Nutrition and Dietary Supplements

Individuals with AD may have particular dietary concerns. People with AD often forget to eat and drink, and, as a result, often become dehydrated.

Following these nutritional tips may help improve general health and well-being:

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 such as kelp and dulce.
Eat more high-fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
Avoid refined foods such as white breads, pastas, and especially sugar.
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, five 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.
Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls 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 but not substitutes for supplementation.
Vitamin C, 500 - 1,000 mg one to three times daily, as an antioxidant and for immune support.
Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant, immune, and muscular support.
Acetyl-L-carnitine, 500 mg daily, for antioxidant and muscle protective activity.
Probiotic supplement (containing Lactobacillus acidophilus and other species), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
L-arginine, 1 -2 gm three times daily, for blood vessel support.
SAMe (s-adenosyl-L-methionine), 100 - 200 mg before breakfast daily, for mood improvement.
Resveratrol (from red wine), 50 - 200 mg daily, for antioxidant and immune system effects.
L-theanine, 200 mg one to three times daily, for nervous system and brain support.
Melatonin, 2 - 5 mg one hour before bedtime, for sleep and immune protection. Ask your health care provider about potential drug interactions with the use of melatonin.

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.

Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg three times daily, for blood flow and brain health. Ginkgo is the most widely studied herb, especially for symptoms related to dementia and Alzheimer's disease.
Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anti-inflammatory, and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support and antiviral effects.
Bacopa (Bacopa monnieri) standardized extract, 50 - 150 mg three times daily, traditionally used in India to improve mental performance.
Vinpocetine (isolated from Vina minor), 10 - 40 mg twice daily, for symptoms of Alzheimer's disease or dementia.

Acupuncture

Small studies have shown that transcutaneous electrical nerve stimulation (TENS), a technique used in physical therapy and certain types of acupuncture, may improve memory and daily living skills in people with AD. Further studies are needed to confirm whether acupuncture may be effective in the treatment of AD.

Massage and Physical Therapy

The inability to communicate normally with language increases anxiety and frustration in people with AD. Using touch, or massage, as a form of nonverbal communication has been shown to benefit those with AD. In one study, people with AD who received hand massages and were spoken to in a calming manner had a reduction in pulse rate and in inappropriate behavior. Health care professionals speculate that massage may be beneficial for people with AD not only because it is relaxing, but because it provides a form of social interaction and a moderate form of exercise.

Mind-Body Medicine

Music Therapy

Music therapy, the use of music to calm and heal an individual, cannot slow or reverse dementia, but it may improve quality of life for both a person with AD and their caregiver. Clinical reports suggest that music therapy may reduce wandering and restlessness and increase chemicals in the brain that enhance sleep and ease anxiety. For example, people with AD have been shown to experience significant increases in levels of brain chemicals such as melatonin, norepinephrine, and epinephrine after listening to live music regularly for a month. Mood also improved after listening to the music.

Support for the Caregiver

Studies suggest that caregivers who receive emotional support tend to experience an improvement in their quality of life, and those they are caring for benefit as well.

Other Considerations

A person with AD can experience the following complications:

Falls (from impaired coordination)
"Sundowning" (withdrawal or agitation in the evening)
Malnutrition and dehydration
Infection (from urinary tract infections or pneumonia)
Asphyxiation (stopped breathing)
Harmful or violent behavior toward self or others
Suicide
Poor health and support due to caregiver burnout
Physical and emotional abuse, including neglect
Heart disease

Alzheimer's disease gets worse over time. However, people with the disease can survive for many years. Those with a long-standing history of high blood pressure are more likely to get worse faster.

Supporting Research

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Review Date:
11/8/2006
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.

A.D.A.M. Copyright

adam.com

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

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Weight problems and children

admin — Thu, 04 Sep 2008 18:50:23 -0700

Overview

Alternative Names
Information

Illustrations

Childhood obesity

HEALTH GUIDE REFERENCE FROM A.D.A.M

Alternative Names

Children and weight problems

Information

In the U.S., at least one out of five kids is overweight. The number of overweight children continues to grow. Over the last two decades, this number has increased by more than 50% and the number of "extremely" overweight children has nearly doubled.

A doctor determines if children are overweight by measuring their height and weight. Although children have fewer weight-related health problems than adults, overweight children are at high risk of becoming overweight adolescents and adults. Overweight adults are at risk for a number of health problems including heart disease, diabetes, high blood pressure stroke, and some forms of cancer.

Did You Know That...

Obese children and adolescents have shown an alarming increase in the incidence of type 2 diabetes, also known as adult-onset diabetes.
Many obese children have high cholesterol and blood pressure levels, which are risk factors for heart disease.
One of the most severe problems for obese children is sleep apnea (interrupted breathing while sleeping). In some cases this can lead to problems with learning and memory.
Obese children have a high incidence of orthopedic problems, liver disease, and asthma.
Overweight adolescents have a 70 percent chance of becoming overweight or obese adults.

Children become overweight for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. In rare cases, a medical problem, such as an endocrine disorder, may cause a child to become overweight. Your doctor can perform a careful physical exam and some blood tests, if necessary, to rule out this type of problem.

Genetic Factors: Children whose parents or brothers or sisters are overweight may be at an increased risk of becoming overweight themselves. Although weight problems run in families, not all children with a family history of obesity will be overweight. Genetic factors play a role in increasing the likelihood that a child will be overweight, but shared family behaviors such as eating and activity habits also influence body weight.
Lifestyle: A child's total diet and his or her activity level both play an important role in determining a child's weight. The increasing popularity of television and computer and video games contributes to children's inactive lifestyles. The average American child spends approximately 24 hours each week watching television-time that could be spent in some sort of physical activity.

TALK TO YOUR DOCTOR

If you think that your child is overweight, it is important to talk with your child's doctor. A doctor is the best person to determine whether your child has a weight problem. doctors will measure your child's weight and height to determine if your child's weight is within a healthy range. A doctor will also consider your child's age and growth patterns to determine whether your child is overweight. Assessing overweight in children is difficult because children grow in unpredictable spurts. Based on your child's height and weight, they will calculate a body mass index (BMI). If your child's BMI is greater than 95% of children their age and gender, they are considered to be overweight

For example, it is normal for boys to have a growth spurt in weight and catch up in height later. It is best to let your child's doctor determine whether your child will "grow into" a normal weight. If your doctor finds that your child is overweight, he or she may ask you to make some changes in your family's eating and activity habits.

BE SUPPORTIVE

One of the most important things you can do to help overweight children is to let them know that they are okay whatever their weight. Children's feelings about themselves often are based on their parents' feelings about them. If you accept your children at any weight, they will be more likely to accept and feel good about themselves. It is also important to talk to your children about weight, allowing them to share their concerns with you. Your child probably knows better than anyone else that he or she has a weight problem. For this reason, overweight children need support, acceptance, and encouragement from their parents.

FOCUS ON THE FAMILY

Parents should try not to set children apart because of their weight, but focus on gradually changing their family's physical activity and eating habits. Family involvement helps to teach everyone healthful habits and does not single out the overweight child.

INCREASE YOUR FAMILY'S PHYSICAL ACTIVITY

Regular physical activity, combined with healthy eating habits, is the most efficient and healthful way to control your weight. It is also an important part of a healthy lifestyle. Some simple ways to increase your family's physical activity include the following:

Be a role model for your children. If your children see that you are physically active and have fun, they are more likely to be active and stay active for the rest of their lives.
Plan family activities that provide everyone with exercise and enjoyment, like walking, dancing, biking, or swimming. For example, schedule a walk with your family after dinner instead of watching TV. Make sure that you plan activities that can be done in a safe environment.
Be sensitive to your child's needs. Overweight children may feel uncomfortable about participating in certain activities. It is important to help your child find physical activities that they enjoy and that aren't embarrassing or too difficult.
Reduce the amount of time you and your family spend in sedentary activities, such as watching TV or playing video games.
Become more active throughout your day and encourage your family to do so as well. For example, walk up the stairs instead of taking the elevator, or do some activity during a work or school break-get up and stretch or walk around.

The point is not to make physical activity an unwelcome chore, but to make the most of the opportunities you and your family have to be active.

TEACH YOUR FAMILY HEALTHY EATING HABITS

Teaching healthy eating practices early will help children approach eating with the right attitude-that food should be enjoyed and is necessary for growth, development, and for energy to keep the body running. The best way to begin is to learn more about children's nutritional needs by reading or talking with a health professional and then to offer them some healthy options, allowing your children to choose what and how much they eat.

DON'T PLACE YOUR CHILD ON A RESTRICTIVE DIET

Children should never be placed on a restrictive diet to lose weight, unless a doctor supervises one for medical reasons. Limiting what children eat may be harmful to their health and interfere with their growth and development.

To promote proper growth and development and prevent overweight, parents should offer the whole family a wide variety of foods from each of the food groups.

Most of the foods in your diet should come from the grain products group (6-11 servings), the vegetable group (3-5 servings), and the fruit group (2-4 servings). (See chart for suggested serving sizes.)
Your diet should include moderate amounts of foods from the milk group (2-3 servings) and the meat and beans group (2-3 servings).
Foods that provide few nutrients and are high in fat and sugars should be used sparingly. Fat should not be restricted in the diets of children younger than 2 years of age.

EXAMPLES OF ONE SERVING

Bread, cereal, rice, pasta

1 slice of bread
1 ounce of ready to eat cereal
1/2 cup of cooked cereal, rice, or pasta

Milk, yogurt, cheese

1 cup of milk or yogurt
1 1/2 ounces of natural cheese
2 ounces of processed cheese

Vegetables

1 cup of raw vegetables or 1/2 cup of frozen leafy leafy vegetables (cooked)
1/2 cup of other vegetables - cooked or chopped raw
3/4 cup of vegetable juice

Meat, poulty, fish, beans, nuts

2-3 ounces of cooked lean meat, poultry, or fish
1/2 cup of cooked dry beans or 1 egg counts as 1 ounce of lean meat
2 tablespoons of peanut butter or 1/3 cup of nuts count as 1 ounce of meat

Fruits

1 medium apple, banana, or orange
1/2 cup of chopped, cooked, or canned fruit
3/4 cup of fruit juice

Serving sizes are for children and adults ages 2 years and older. A range of servings is given for each food group. The smaller number is for children who consume about 1,300 calories a day, such as 2-4 years of age. The larger number is for those who consume about 3,000 calories a day, such as boys 15-18 years of age.

CUT DOWN ON FAT

Reducing fat is a good way to cut calories without depriving your child of nutrients. Simple ways to cut the fat in your family's diet include eating lowfat or nonfat dairy products, poultry without skin and lean meats, and lowfat or fat-free breads and cereals.

Making small changes to the amount of fat in your family's diet is a good way to prevent excess weight gain in children: however, major efforts to change your child's diet should be supervised by a health professional.

In addition, fat should not be restricted in the diets of children younger than 2 years of age. After that age, children should gradually adopt a diet that contains no more than 30 percent of calories from fat by the time the child is about 5 years old.

DON'T OVERLY RESTRICT SWEETS OR TREATS

While it is important to be aware of the fat, salt, and sugar content of the foods you serve, all foods -- even those that are high in fat or sugar -- have a place in the diet (in moderation, of course). However, children should be taught to limit high-calorie soft drinks and foods such as candy and deserts, and salty snacks such as potato chips and french fries.

GUIDE CHOICES RATHER THAN DICTATE FOODS

Make a wide variety of healthful foods available in the house. This practice will help your children learn how to make healthy food choices.

ENCOURAGE YOUR CHILD TO EAT SLOWLY

A child can detect hunger and fullness better when eating slowly.

EAT MEALS TOGETHER AS A FAMILY

Try to make mealtimes pleasant with conversation and sharing, not a time for scolding or arguing. If mealtimes are unpleasant, children may try to eat faster to leave the table as soon as possible. They then may learn to associate eating with stress.

INVOLVE CHILDREN IN FOOD SHOPPING AND PREPARING

These activities offer parents hints about children's food preferences, teach children about nutrition, and provide children with a feeling of accomplishment. In addition, children may be more willing to eat or try foods that they help prepare.

PLAN FOR SNACKS

Continuous snacking may lead to overeating, but snacks that are planned at specific times during the day can be part of a nutritious diet, without spoiling a child's appetite at mealtimes. You should make snacks as nutritious as possible, without depriving your child of occasional chips or cookies, especially at parties or other social events. Below are some ideas for healthy snacks.

EXAMPLES OF HEALTHY SNACKS

Fresh, frozen, or canned vegetables and fruit served either plain or with lowfat or fat-free cheese or yogurt
Dried fruit, served with nuts or sunflower or pumpkin seeds
Breads and crackers made with enriched flour and whole grains, served with fruit spread or fat-free cheese
Frozen desserts, such as nonfat or lowfat ice cream, frozen yogurt, fruit sorbet, popsicles, water ice, and fruit juice bars

Warning: Children of preschool age can easily choke on foods that are hard to chew, small and round, or sticky, such as hard vegetables, whole grapes, hard chunks of cheese, rasins, nuts, and seeds, and popcorn. It's important to carefully select snacks for children in this age group.

DISCOURAGE EATING WHILE WATCHING TV

Try to eat only in designated areas of your home, such as the dining room or kitchen. Eating in front of the TV may make it difficult to pay attention to feelings of fullness, and may lead to overeating.

DON'T USE FOOD TO PUNISH OR REWARD

Withholding food as a punishment may lead children to worry that they will not get enough food. For example, sending children to bed without any dinner may cause them to worry that they will go hungry. As a result, children may try to eat whenever they get a chance. Similarly, when foods, such as sweets, are used as a reward, children may assume that these foods are better or more valuable than other foods. For example, telling children that they will get dessert if they eat all of their vegetables sends the wrong message about vegetables.

MONITOR MEALS OUTSIDE THE HOME

Find out more about your school lunch program, or pack your child's lunch to include a variety of foods. Also, select healthier items when dining at restaurants.

SET A GOOD EXAMPLE

Children are good learners, and they learn best by example. Setting a good example for your kids by eating a variety of foods and being physically active will teach your children healthy lifestyle habits that they can follow for the rest of their lives.

ADDITIONAL HELP

If you need to make changes to your family's eating and exercise habits, but are finding it difficult, a registered dietitian (RD) may be able to help. Your doctor may be able to refer you to an RD, or you can call the National Center for Nutrition and Dietetics of The American Dietetic Association at 800-366-1655 and ask for the name of an RD in your area.

If your efforts at home are unsuccessful in helping your child reach a healthy weight and your doctor determines that your child's health is at risk unless he or she loses weight steadily, you may want to consider a formal treatment program. To locate a weight-control program for your child, you may want to contact a local university-based medical center.

Look for the following characteristics when choosing a weight-control program for your child. The program should:

Be staffed with a variety of health professionals. The best programs may include RDs, exercise physiologists, pediatricians or family doctors, and psychiatrists or psychologists.
Perform a medical evaluation of the child. Before being enrolled in a program, your child's weight, growth, and health should be reviewed by a doctor. During enrollment, your child's weight, growth, and health should be monitored by a health professional at regular intervals.
Focus on the whole family, not just the overweight child.
Be adapted to the specific age and capabilities of the child. Programs for 4-year-olds are different from those developed for children 8 or 12 years of age in terms of degree of responsibility of the child and parents.
Focus on behavioral changes.
Teach the child how to select a variety of foods in appropriate portions.
Encourage daily activity and limit sedentary activity, such as watching TV.
Include a maintenance program and other support and referral resources to reinforce the new behaviors and to deal with underlying issues that contributed to overweight.

The overall goal of a successful treatment program should be to help the whole family focus on making healthy changes to their eating and activity habits that they will be able to maintain throughout life.

Created by the National Institute of Health. NIH Publication No. 97-4096 and NIH Word on Health, June 2002

Review Date: 10/23/2007

Reviewed By: Daniel Rauch, M.D., FAAP., Director, Pediatric Hospitalist Program, New York University School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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