Wood Street Clinic Blog

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Gender transition drugs could be bad for the heart

New research now published in the journal Circulation finds that some people who are gender transitioning may be at a higher risk of experiencing cardiovascular conditions due to the hormone therapy they are receiving.
gender fluid person having coffee
Some drugs required for gender transition may increase cardiovascular risk.

Previous studies have revealed that hormone therapy raises cardiovascular risk.

For instance, according to estimates from the National Institutes of Health (NIH), therapy with estrogen and progestin puts menopausal women at:

a 41 percent higher risk of stroke a 29 percent higher risk of a heart attack a 100 percent higher risk of blood clots

Estrogen alone increases stroke risk by 39 percent and blood clot risk by 47 percent, according to the same NIH estimates.

However, how does hormone therapy affect people who are gender transitioning? So far, scientists have not addressed this question fully, so a new study aimed to fill this gap in research.

Dr. Nienke Nota — a researcher in the Department of Endocrinology at the Amsterdam University Medical Center in the Netherlands — and her team examined the medical records of 3,875 Dutch transgender people who had hormone therapy between 1972 and 2015.

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Their study examined 2,517 transgender women and 1,358 transgender men. The women were 30 years old, on average, and they had received estrogen either alone or in combination with androgen suppressors.

The men were 23 years old, on average, and they received testosterone therapy as a part of their gender transition.

Dr. Nota and her colleagues clinically followed the trans women for an average period of 9 years and the trans men for an average of 8 years after they started hormone therapy.

The researchers examined the incidence of cardiovascular problems such as heart attacks, strokes, and blood clots among transgender people and compared it with the incidence of such events in cis men and cis women.

Cis people are those whose gender identity matches the biological sex assigned to them at birth.

The study found that trans women were more than twice as likely to have a stroke as cis women and almost twice as likely to have a stroke as cis men.

Trans women were also five times and 4.5 times more likely to develop blood clots than cis women and cis men, respectively.

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Trans women also had heart attacks more than twice as often as cis women, and trans men were over three times more likely to have a heart attack than cis women.

Dr. Nota comments on the findings, saying, "In light of our results, we urge both physicians and transgender individuals to be aware of this increased cardiovascular risk."

"It may be helpful to reduce risk factors by stopping smoking, exercising, eating a health[ful] diet and losing weight, if needed before starting therapy, and clinicians should continue to evaluate patients on an ongoing basis thereafter."

Dr. Nienke Nota

The authors caution that their analysis did not account for modifiable risk factors such as smoking, stress, diet, and exercise.

However, they say that hormone therapy may be largely to blame for the increased cardiovascular risk.

Specifically, estrogen promotes blood clotting, and testosterone could do the same by raising the concentration of red blood cells and increasing the levels of bad cholesterol, they explain.

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Marijuana may be risky for those with heart disease

Although marijuana may have some benefits, its use could cause health issues for older people with cardiovascular disease. One case, in particular, is sparking some questions.
Marijuana in hand
Marijuana in edible form may have cardiovascular risks for people at risk.

In recent years, the legalization of marijuana has become more widespread.

Some people use the drug recreationally, while some use it to relieve chronic pain and the impact of some mental health issues.

However, experts state that there needs to be more research into the effects of marijuana in older people.

Specifically, the scientific community needs to focus on educating the public on aspects such as potential effects and recommended dosages.

A Canadian Journal of Cardiology case report goes some way toward that. It examined a 70-year-old man who had a heart attack after eating a lollipop that was infused with 90 milligrams (mg) of tetrahydrocannabinol (THC) — which is largely responsible for marijuana's psychological effects.

The man lived with stable coronary artery disease, and he was taking cardiac medication. He ate most of the lollipop and did so to help minimize pain and improve sleep.

Dr. Alexandra Saunders — who works in Horizon Health Network's Department of Cardiology in New Brunswick, Canada — described the man's 90-mg dose as "inappropriate."

Smoking a typical joint would expose a person to just 7 mg of THC, while a starting dose of a synthetic THC called dronabinol is only 2.5 mg. People with AIDS or cancer tend to use this version, and it can also combat nausea and encourage appetite.

"Marijuana can be a useful tool for many patients, especially for pain and nausea relief. At the same time, like all other medications, it does carry risk and side effects."

Dr. Alexandra Saunders

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A cardiovascular link

The large amount of THC the man consumed caused him to experience anxiety and hallucinations. The strain that these effects put on his body is what likely caused his heart attack, by triggering a response in the sympathetic nervous sytem.

His cardiac event was demonstrated by a rapid heart rate, an abnormally high blood pressure, and the release of the stress hormone catecholamine. The man's chest pain went away as soon as the effects of the marijuana had worn off.

Previously, there had been reports of similar incidences showing a relationship between cannabis consumption and acute cardiovascular adverse events. These have ranged from an irregular heartbeat to stroke, and even sudden death.

However, Dr. Robert S. Stevenson — who also works at Horizon Health Network's Department of Cardiology — says, "Most previous research on marijuana-induced myocardial ischemia focused mostly on younger patients and did not focus on its different formulations and potencies."

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A word of warning

The doctors examining the most recent case have issued advice, particularly for older people who use marijuana.

They advise people to use the smallest dose possible for their chosen benefit. Anyone who has a cardiovascular condition or is at high risk of developing one should steer clear of THC. Instead, they can try cannabidiol, which is a nonpsychoactive alternative.

They should also take factors such as tolerance and consumption method into consideration. For example, a person who has smoked marijuana over a long period of time is likely to experience fewer distressing side effects than someone who is not used to the drug.

Similarly, eating a THC-infused brownie or lollipop would expose a person to more THC than if they had used a vaporizer.

With further decriminalization, it is hoped that scientists will work on conducting more research into the potential side effects of marijuana. For now, educating the public — especially aging members — should be a priority.

"For better or worse," concludes Dr. Neal L. Benowitz, chief of the Division of Clinical Pharmacology and Experimental Therapeutics at the University of California, "providing advice and care to such patients who are using cannabis is now necessary for the provision of optimal medical care to these patients."

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Exercise boosts well-being by improving gut health

Both bacterial diversity in the gut and regular exercise are important when it comes to health. But how are the two related? A new study uncovers the effect that exercise has on our health by adjusting the balance of the gut microbiome.
women at the gym
New research finds out how exercise could support bacterial diversity in the gut.

Though this may seem strange, human bodies are actually made, according to recent estimates, of about as many bacteria and other microorganisms as regular human cells.

In the colon alone — the tract that contains the largest number of bacterial cells — there are approximately 38 trillion bacteria.

These bacteria have important effects on the state of our health, and loss of bacterial diversity in the gut is linked to a heightened risk of disease.

Now, a new study suggests that the level of a person's physical activity may affect the bacterial diversity in their gut, and thus influence their health.

In a paper that appears in the journal Experimental Physiology, the authors, from Indiana University Bloomington and the University of Alabama at Birmingham, also explain the biological mechanism that makes this possible.

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The link between exercise and the gut

The researchers knew that cardiorespiratory fitness — the efficiency with which the circulatory and respiratory systems deliver oxygen during exercise — was associated with greater bacterial diversity, but it was unclear whether this was due to physical activity or an individual's percentage of body fat.

In order to find out, the team worked with a cohort of 37 participants who had been successfully treated for nonmetastatic breast cancer.

The decision to work with this cohort resulted from the fact that cancer treatment typically has a negative impact on metabolic health, including cardiorespiratory fitness.

The participants agreed to perform graded exercises so that the researchers could assess their peak cardiorespiratory fitness, as well as total energy expenditure. The investigators also collected fecal samples from the volunteers and used them to analyze the participants' gut microbiota.

Following all the assessments and analyses, the researchers established that participants with higher cardiorespiratory fitness also had more diverse bacterial populations in the gut, compared with peers who had low cardiorespiratory fitness.

Moreover, the team confirmed that cardiorespiratory fitness was linked with about a quarter of the variance in bacterial species diversity and that this effect was independent of that produced by an individual's body fat percentage.

The data thus indicate that exercising with an intensity that is adequately high and can boost cardiorespiratory effectiveness will improve overall health by supporting a better-balanced gut.

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New line of research

Still, the researchers warn that their findings are only correlative, and further research should aim to test the potential causational relationships.

Furthermore, the cohort was very restricted — a small group of women treated for breast cancer — so the team advises caution in applying the findings to other populations.

However, going forward, the investigators aim to address these shortcomings and find out how best to apply their findings to improve the health of at-risk individuals.

"Our group is actively pursuing an interventional study to determine how variation in exercise intensity can influence gut microbiota diversity under controlled-feeding conditions," says the study's lead author, Stephen Carter, Ph.D.

"[The aim is] to uncover how exercise may affect functional outcomes of gut microbiota, as well as studying how exercise prescription may be optimized to enhance health outcomes among clinical populations."

Lead author Stephen Carter, Ph.D.

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Diet drinks linked to a higher risk of stroke after the menopause

Fresh research offers further information on the potential for diet drinks — that is, beverages sweetened with artificial sugar substitutes — to harm cardiovascular health.
senior woman drinking coke
Artificially sweetened soft drinks may raise the risk of heart disease and death in postmenopausal women.

A study that followed tens of thousands of postmenopausal women for more than 10 years has linked a higher consumption of diet drinks to an increased risk of stroke, heart disease, and death.

The link between diet drinks and stroke was strongest for strokes that arise from blocked arteries, and from smaller blood vessels in particular.

The journal Stroke has now published a paper about the analysis. The lead author is Dr. Yasmin Mossavar-Rahmani, an associate professor of clinical epidemiology and population health in the Albert Einstein College of Medicine in the Bronx, NY.

Dr. Mossavar-Rahmani and her team point out that the findings do not prove that diet drinks harm the heart and circulation system. That is because the study was an observational one, and the figures on diet drink consumption came from self-reports.

However, Rachel K. Johnson — who chaired the panel that wrote the science advisory from the American Heart Association (AHA) about diet drinks and heart health — comments, "This study adds to the evidence that limiting use of diet beverages is the most prudent thing to do for your health."

Experts commenting in an editorial that accompanies the new study paper also suggest that until there is sufficient evidence regarding who might benefit from consuming diet drinks, the emphasis should be on drinking water as the most healthful no-calorie drink.

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Diet drinks and cardiovascular risks

The data for this study came from a racially diverse group of 81,714 postmenopausal women in the Women's Health Initiative Observational Study.

The women were all aged 50–79 years when they enrolled during 1993–1998. The study then tracked their health with regular evaluations for an average of 11.9 years afterward.

At the 3-year evaluation point, the women answered some questions regarding how often they had consumed diet drinks in the previous 3 months.

The researchers defined diet drinks as any low-calorie colas, soda, and fruit drinks sweetened with artificial sugar substitutes.

They did not ask the women to specify the which artificial sweeteners the drinks contained.

When they analyzed the data, they adjusted the results to eliminate the effect of other factors that influence stroke risk, such as age, smoking, and high blood pressure.

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The researchers found that compared with consuming fewer than one diet drink per week or none at all, consuming two or more per day was associated with:

a 23 percent raised risk of stroke a 31 percent higher risk of a stroke that results from a clot a 29 percent higher risk of heart disease, as in a fatal or nonfatal heart attack a 16 percent raised risk of death from any cause

They also revealed that a high intake of diet drinks among postmenopausal women with no history of heart disease or diabetes was linked to a more than twofold raised risk of strokes arising from blockages in small arteries in the brain.

Postmenopausal women with obesity who drank two or more diet drinks each day also had twice the risk of stroke than those who drank fewer than one per week.

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'Limit prolonged use of diet drinks'

Because they confined the study to postmenopausal women, the researchers cannot say whether the same would be true for men, or for women before the menopause. It is now up to further studies to determine this.

Also, because the data did not specify which artificial sweeteners the women had consumed, Dr. Mossavar-Rahmani says that the scientists could not distinguish the potentially harmful from the potentially harmless.

"Our research and other observational studies have shown that artificially sweetened beverages may not be harmless and high consumption is associated with a higher risk of stroke and heart disease."

Dr. Yasmin Mossavar-Rahmani

While the AHA advise that people drink water as their preferred no-calorie drink, they acknowledge that diet drinks might help them move away from sugar-sweetened beverages.

However, Dr. Johnson cautions, "Since long-term clinical trial data are not available on the effects of low-calorie sweetened drinks and cardiovascular health, given their lack of nutritional value, it may be prudent to limit their prolonged use."

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Study finds new cognitive decline mechanism in Alzheimer's

People with Alzheimer's disease experience poor blood flow to the brain, which affects cognitive function. A new study conducted in a mouse model has finally uncovered the reason behind this reduced blood flow.
elderly woman
Reduced blood flow to the brain contributes to Alzheimer's, but what mechanism leads to this vascular problem in the first place?

For a while now, researchers have been aware that Alzheimer's disease goes hand in hand with vascular dysfunction, and reduced blood flow to the brain, in particular.

However, it is only recently that investigators have begun to focus their efforts on understanding just how and why poor vascular health can contribute to cognitive decline in this type of dementia.

A study published last month in Alzheimer's and Dementia, the journal of the Alzheimer's Association, calls vascular dysfunction "the disregarded partner of Alzheimer's disease." It argues that researchers must first fully understand all the factors involved in the pathology of this type of dementia before they can develop a pluripotent treatment for it.

"Individualized, targeted therapies for [Alzheimer's disease] patients will be successful when the complexity of [this condition's] pathophysiology is fully appreciated," the study authors write.

Now, in a study in mice, a team of investigators from Cornell University in Ithaca, NY has identified a mechanism — tied to poor blood flow to the brain — that directly contributes to cognitive decline.

The study paper detailing the researchers' findings appears in the journal Nature Neuroscience.

In its introduction, the authors explain that "[v]ascular dysfunction is implicated in the pathogenesis of Alzheimer's disease," and that "[b]rain blood flow is also severely compromised; cortical cerebral blood flow reductions of [approximately] 25 percent are evident early in disease development in both patients with Alzheimer's disease, and in mouse models."

"People probably adapt to the decreased blood flow, so that they don't feel dizzy all of the time, but there's clear evidence that it impacts cognitive function," notes study author Chris Schaffer.

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Researchers find cellular mechanism

According to the researchers, the reduction of blood flow to the brain immediately impairs cognitive function — including attention — when it happens in otherwise healthy humans. In their mouse study, the investigators wanted to find out why this poor blood flow occurs in the first place.

In a past study, co-author Nozomi Nishimura had tried to induce clotting in the brain blood vessels of mouse models to see how that would affect their cognitive abilities. However, Nishimura and team soon found that the vascular problems were already present in rodent models of Alzheimer's pathology.

"It turns out that [...] the blockages we were trying to induce were already in there," she said. "It sort of turned the research around — this is a phenomenon that was already happening," says Nishimura.

The new research revealed that white blood cells — called neutrophils — get stuck inside brain capillaries, which are minuscule blood vessels that usually carry oxygenated blood to this organ. Although few capillaries become clogged in this way, this means that blood flow to the brain decreases considerably.

"What we've done is identify the cellular mechanism that causes reduced brain blood flow in Alzheimer's disease models, which is neutrophils [white blood cells] sticking in capillaries," says Schaffer.

"We've shown that when we block the cellular mechanism [that causes the clogging], we get an improved blood flow, and associated with that improved blood flow is immediate restoration of cognitive performance of spatial- and working-memory tasks."

Chris Schaffer

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'A complete game-changer?'

The researchers add that these findings provide a new potential clinical target for Alzheimer's disease. As Schaffer also notes, "Now that we know the cellular mechanism, it's a much narrower path to identify the drug or the therapeutic approach to treat it."

In fact, the researchers have already identified about 20 different drugs — a good number of which the Food and Drug Administration (FDA) have already approved — that they believe could address this new target. Right now, the investigators are testing these drugs in mouse models.

Though the team acknowledges that further research is necessary in order to ascertain that the same cellular mechanism seen in mice is also present in people with Alzheimer's, its members are happy about their current findings.

Schaffer has even gone so far as to declare himself "super-optimistic" that, in the future, research stemming from these findings "could be a complete game-changer for people with Alzheimer's disease."

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Top 12 healthful fruits

Eating more fruit is an excellent way to improve overall health and reduce the risk of disease.

Fruits are an excellent source of essential vitamins and minerals, and they are high in fiber. Fruits also provide a wide range of health-boosting antioxidants, including flavonoids.

Eating a diet high in fruits and vegetables can reduce a person's risk of developing heart disease, cancer, inflammation, and diabetes. Citrus fruits and berries may be especially powerful for preventing disease.

A 2014 study ranked "powerhouse" fruit and vegetables by high nutrient density and low calories. Lemons came out top of the list, followed by strawberry, orange, lime, and pink and red grapefruit.

In this article, we look at the nutrition and the many and varied health benefits of these and other fruits you can find in the supermarket.

1. Lemons Healthiest fruits lemons
Lemons contain vitamin C and other antioxidants that benefit health.

Lemons are a citrus fruit that people often use in traditional remedies because of their health benefits. Like other citrus fruits, they contain vitamin C and other antioxidants.

Antioxidants are essential for human health. These compounds mop up free radicals in the body that can damage the body's cells and lead to diseases, such as cancers.

Researchers believe that the flavonoids in lemon and other citrus fruits have antibacterial, anticancer, and antidiabetic properties.

Citrus fruits, including lemons, contain active components called phytochemicals that benefit health. These include:

The juice from one 48 g lemon contains the following nutrients in grams (g) or milligrams (mg):

Lemons also contain thiamin, riboflavin, niacin, vitamin B-6, folate, and vitamin A.

Read more about the health benefits of lemons and lemon water here.

How to eat lemons

Use the juice of a lemon to flavor drinking water or squeeze over a salad or fish. Try adding lemon juice to boiling water with a teaspoon of honey to help soothe a sore throat. It is also possible to eat the rind of organic lemons. Some people use the rind in recipes.

2. Strawberries Strawberries are a juicy, red fruit with a high water content. The seeds provide plenty of dietary fiber per serving. Strawberries contain many healthful vitamins and minerals. Of particular note, they contain anthocyanins, which are flavonoids that can help boost heart health. The fiber and potassium in strawberries can also support a healthy heart. In one study, women who ate 3 or more servings per week of strawberries and blueberries — which are both known for their high anthocyanin content — had a lower risk of having a heart attack than those with lower intake. Strawberries and other colorful berries also contain a flavonoid called quercetin. This is a natural anti-inflammatory compound. A serving of 3 large strawberries provides the following nutrients: 17 calories 4.15 g carbohydrate 1.1 g of fiber 9 mg of calcium 7 mg of magnesium 83 mg of potassium 31.8 mg of vitamin C Strawberries also contain thiamin, riboflavin, niacin, folate, and vitamins B-6, A and K. Read more about strawberries. How to eat strawberries Strawberries are a versatile fruit. People can eat them raw or add them to breakfast cereals or yogurt, blend them into a smoothie, or make them into jam. 3. Oranges Oranges are a sweet, round citrus fruit packed with vitamins and minerals. Oranges are among the richest sources of vitamin C, with one medium fruit providing 117 percent of a person's daily value of vitamin C. A 141 g orange also contains the following nutrients: 65 calories 16.27 g carbohydrate 3.4 g of fiber 61 mg of calcium 14 mg of magnesium 238 mg of potassium 63.5 mg of vitamin C Vitamin C acts as a powerful antioxidant in the body. This vitamin is also essential for immune system function. It boosts immune function by helping the body to absorb iron from plant-based foods. The human body cannot make vitamin C itself, so people need to get this vitamin from their diet.Oranges also contain high levels of pectin, which is a fiber that can keep the colon healthy by binding to chemicals that can cause cancer and removing them from the colon. Oranges also provide the following healthful vitamins: vitamin A, a compound that is important for healthy skin and eyesight B-vitamins, including thiamin and folate, which help keep the nervous and reproductive systems healthy and help create red blood cells. Read more about the benefits of oranges. How to eat oranges People can eat oranges on their own as a refreshing snack or by drinking a glass of pure orange juice. Juice oranges at home or choose a brand of fresh juice whose label states it is not from concentrate. People can also grate orange peel into a salad, yogurt, or as a cereal topping to add extra flavor. 4. Limes Limes are a sour citrus fruit that provide a range of health benefits. Like other citrus fruits, limes provide a healthful dose of vitamin C. They also have similar health benefits, antibacterial, and antioxidant properties. The juice of one lime provides the following nutrients: 11 calories 3.7 g carbohydrate 6 g calcium 4 mg magnesium 51 mg potassium 13.2 mg vitamin C Read more about the benefits of limes and lime water here. How to eat limes Limes work well in savory foods. Try adding the juice or grated peel of a lime to flavor salad dressings or rice dishes. Otherwise, juice a lime and add to hot or cold water for a refreshing drink. Thank you for supporting Medical News Today 5. Grapefruit Healthiest fruits grapefruit
Grapefruits contain flavonoids, which can help protect against some cancers, inflammation, and obesity. Grapefruits are sour fruits full of health-inducing vitamins and minerals. Grapefruits can be pink, red, or white. Half a grapefruit contains the following nutrients: 52 calories 13.11 g carbohydrate 2.0 g fiber 27 g calcium 11 g magnesium 166 g potassium 38.4 g vitamin C The flavonoids in grapefruits can help protect against some cancers, inflammation, and obesity. A review study suggests the compounds called furanocoumarins found in grapefruits can help protect against oxidative stress and tumors and may support healthy bones. Some research from this review suggests that grapefruit furanocoumarins may have anticancer properties, which may be especially effective against breast cancer, skin cancer, and leukemia. Researchers still need to carry out more studies on animals and humans to confirm these properties. People may wish to see a doctor before adding grapefruit to their diet, as it can interact with certain medications. Read more about grapefruit benefits. How to eat grapefruit Try adding grapefruit slices to a fruit salad, or squeeze the juice into water to make a drink. Otherwise, people can buy pure grapefruit juice from the supermarket. 6. Blackberries Like other berries, blackberries contain health-boosting anthocyanins. Blackberries contain many seeds, so they have a high fiber content. This means they can help improve gut health and heart health. Half a cup of blackberries contains the following nutrients: 31 calories 6.92 g carbohydrate 3.8 g fiber 21 mg calcium 14 mg magnesium 117 mg potassium 15.1 mg vitamin C Read more about blackberries here. How to eat blackberries People can eat blackberries fresh, add them to yogurt for breakfast or dessert, or add frozen blackberries to smoothies. 7. Apples Apples make a quick and easy addition to the diet. Eat them with the skin on for the greatest health benefits. Apples are high-fiber fruits, meaning that eating them could boost heart health and promote weight loss. The pectin in apples helps to maintain good gut health. One medium apple contains the following nutrients: 95 calories 25.13 g of carbohydrate 4.4 g of fiber 195 mg of potassium 11 mg calcium 8.4 mg vitamin C Research has shown that there is a link between eating apples regularly and a lower risk of cardiovascular disease, certain cancers, and diabetes. Apples also have high levels of quercetin, a flavonoid which may have anti-cancer properties. One study found that people who ate whole apples were 30 percent less likely to be obese than those who did not. This can lower the risk for diabetes and heart disease. Read more about apples. How to eat apples Raw apples make a great snack and combining them with almond butter helps balance protein and fat intake. People can also add raw or stewed apples to yogurt, or use applesauce in cooking. 8. Pomegranate Many people consider pomegranates to be a 'superfood.' They are high in antioxidants and polyphenols, which help to combat the oxidative stress that can cause disease in the body. Eat pomegranates with the seeds to get the fiber benefits. One raw pomegranate contains: 234 calories 52.73 g of carbohydrate 11.3 g of fiber 666 mg of potassium 28 mg calcium 28.8 mg vitamin C One pomegranate also contains 46.2 micrograms (mcg) of the recommended 80 mcg daily allowance of vitamin K. This vitamin is essential for strong bones and healthy blood cells. A review study about the health benefits of pomegranates suggests that they have anti-inflammatory effects and may help protect against brain-related diseases, such as Alzheimer's disease and Parkinson's disease. This may be because pomegranates contain particularly high levels of polyphenols. Research discussed in this review also suggests that pomegranates may restrict the growth of human prostate cancer cells. Read more about the benefits of pomegranate juice. How to eat pomegranate Pomegranates can make a great addition to salads, or to couscous or rice dishes. Pomegranates are sweet, so people can also add them to yogurt and fruit salads. 9. Pineapple Pineapple is an exotic fruit that may help reduce inflammation and promote healthy tissue growth. Pineapple contains an active compound called bromelain, which many people take as a dietary supplement because of its potential health benefits. The National Center for Complementary and Integrative Health state that bromelain can help with reducing nasal inflammation or sinusitis. However, scientists need to carry out more research into its benefits for osteoarthritis and its anticancer potential. Pineapples contain manganese, which the body uses to build bone and tissue. A medium slice of pineapple also contains the following nutrients: 42 calories 11.02 g carbohydrate 1.2 g fiber 92 mg potassium 40.2 mg vitamin C 11 mg calcium Read more about the benefits of pineapple, the pineapple juice, and potential bromelain benefits. How to eat pineapple People can enjoy fresh pineapple by itself or in fruit salads. They can also use pineapple to make a tropical salsa or add it as a topping on fish tacos. Try adding frozen pineapple to smoothies. Thank you for supporting Medical News Today 10. Bananas Healthiest fruits banana
Bananas are rich in potassium, which helps the body control heart rate and blood pressure. Bananas are well known for their high potassium content. A medium banana contains 422 mg of the adequate adult intake of 4,500 mg of potassium. Potassium helps the body control heart rate and blood pressure. Bananas are also a good source of energy, with one banana containing 105 calories and 26.95 g of carbohydrate. The 3.1 g of fiber in a regular banana can also help with regular bowel movements and stomach issues, such as ulcers and colitis. A medium banana also contains the following nutrients: 1.29 g protein 6 mg calcium 32 mg magnesium 10.3 mg vitamin C Read more about bananas. How to eat bananas A banana is an excellent fruit to use to thicken a smoothie. People can also use them in baking as a natural sweetener or to make banana bread or pancakes. 11. Avocado Many people refer to avocados as a superfood because of their healthful qualities. Avocados are rich in oleic acid, a monounsaturated fat which helps lower cholesterol levels. The American Heart Association say that maintaining healthy cholesterol levels with healthful fats could reduce the risk of heart disease and stroke. Like bananas, avocados are rich in potassium. They also contain lutein, an antioxidant which is important for healthy eyes and skin. Half an avocado contains the following nutrients: 161 calories 2.01 g protein 8.57 g carbohydrate 6.7 g fiber 12 mg calcium 29 mg magnesium 487 mg potassium 10.1 mg vitamin C Avocados also contain folate, vitamin A, and beta-carotene. Read more about avocados. How to eat avocado People can add avocado to salads, or mix with lime, garlic, and tomatoes to make guacamole. Add avocado to smoothies or hummus, or use avocado instead of other fats in baking. 12. Blueberries Blueberries are another superfood that can provide many health benefits. Like strawberries, blueberries contain anthocyanin, which is a powerful antioxidant. Because of this, they might protect against heart disease, stroke, cancers, and other diseases. Blueberries also contain pterostilbene, a compound that may help prevent plaque from collecting in the arteries. Half a cup of blueberries provides the following nutrients: 42 calories 10.72 g carbohydrate 1.8 g fiber 4 mg calcium 57 mg potassium 7.2 mg vitamin C Read more about blueberries. How to eat blueberries Fresh or frozen blueberries are a great addition to breakfast cereals, desserts, yogurt, or smoothies. Summary Fruits come in all shapes and sizes, and different fruits have different health benefits. For the best results, add a variety of fruits to the diet. By eating fruit, a person is providing their body with key vitamins, antioxidants, and dietary fiber. This can have significant benefits for heart health, digestion, weight management, and skin health. People can enjoy a wide variety of fruits to improve their health and lower the risk of inflammation, heart disease, cancer, obesity, and diabetes.
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How to avoid getting sick

Most people experience colds or the flu from time to time. However, there are some proven ways to reduce the chances of becoming infected.

Although most cold and flu infections occur during the fall and winter seasons, the viruses responsible for these illnesses are present year-round.

Fighting off a viral infection takes its toll on most people, causing them to miss days at work and valuable time with their friends and families.

In this article, we describe eight evidence-based ways to avoid getting sick, so people can maintain their health and make the most of their time.

1. Getting vaccinated how to not get sick vaccination
Getting vaccinated offers the strongest protection against seasonal flu infections.

According to the Centers for Disease Control and Prevention (CDC), getting vaccinated is the best way to protect against seasonal flu infections.

The flu occurs when a person becomes infected with an influenza virus. Flu vaccines contain influenza antigens, which signal the immune system to produce antibodies. These antibodies can protect against invading flu viruses and keep people from getting sick.

There are four types of influenza virus, all of which can mutate throughout the year. These mutations can reduce the effectiveness of seasonal flu vaccines. If the vaccine is well-matched to the circulating influenza virus, it can prevent 40–60 percent of flu infections.

While flu vaccines do not guarantee total immunity, they can reduce the severity of symptoms and lower the risk of flu-related hospitalizations and deaths.

Below are some other reasons to get a flu shot:

The CDC estimate that flu vaccination prevented 5.3 million influenza illnesses between 2016 and 2017. According to a 2018 study, during 2012–2015, adults in New Zealand who had received a flu vaccination were 59 percent less likely to be admitted to an intensive care unit due to the flu, compared with individuals who were not vaccinated. A 2017 study found that flu vaccinations reduced the number of flu-related deaths in children aged 6 months to 17 years by 65 percent. 2. Disinfecting surfaces Viruses can survive on many different types of surface, including: metal plastic fabrics paper glass How long a virus can remain infectious on these surfaces depends on a variety of factors, such as the temperature and humidity. However, a 2016 study suggests that influenza viruses can survive outside the body for extended periods, possibly even months. People can lower their risk of infection by using products that contain alcohol or bleach to disinfect frequently used objects, such as countertops, desks, and keyboards. When using disinfectants and cleaning products, it is essential to read the labels and follow the instructions carefully to ensure that surfaces are properly disinfected. Thank you for supporting Medical News Today 3. Keeping the air clean Common colds and the flu are types of respiratory infection. The viruses that cause these illnesses replicate in the mucus membranes that line the respiratory tract, and they can travel through the air in tiny droplets of mucus. This means that people with a cold or the flu can spread the virus whenever they cough or sneeze. For example, influenza viruses can travel up to 3.7 meters, around 12.2 feet, through the air after a person coughs or sneezes. People can reduce the risk of infecting others by staying home when they are ill and covering their faces when they sneeze or cough. 4. Practicing good hygiene how to not get sick wash hands
Washing the hands regularly is an effective way to protect against viral infections. Viruses can enter the respiratory tract through a person's eyes, nose, or mouth. A person can infect themselves by touching a contaminated surface and then touching their face. Washing the hands regularly and thoroughly with clean water and soap is an effective way to protect against viral infections. According to the CDC, proper hand washing can result in a 16–21 percent decrease in respiratory illnesses, such as colds and the flu. If soap is not available, a person can use an alcohol-based hand sanitizer. A range of hand sanitizers are available to purchase online. 5. Taking zinc supplements Zinc is an important micronutrient that occurs naturally in meat, fish, nuts, and other foods. According to a 2016 review, zinc deficiency can lead to a weakened immune response and inflammatory skin conditions. People with a weakened immune response are less able to fight off infections. A 2017 meta-analysis suggests that zinc lozenges can reduce the duration of common colds by about 33 percent. Participants in the study were consuming between 80 and 207 milligrams of zinc per day. Thank you for supporting Medical News Today 6. Eating more fiber Dietary fiber has many health benefits, including regulating digestion, preventing constipation, and lowering the risk of a number of health conditions. A 2018 study in mice suggests that dietary fiber may also boost the immune system. The researchers compared the immune responses in mice that ate a low-fiber diet with those that ate a high-fiber diet. The results of the study suggest that the short-chain fatty acids present in dietary fiber enhanced the mice's immunity to influenza infections. 7. Avoiding cigarette smoke Smoking is a known risk factor for several diseases, such as cancer, asthma, and respiratory infections. Breathing in secondhand smoke can also increase a person's risk of developing these conditions. People who smoke or regularly inhale cigarette smoke are also more likely to experience severe symptoms when they get colds or the flu. According to a 2018 review, cigarette smoke can affect the immune system and reduce a person's ability to fight off infections. Quitting smoking and avoiding secondhand smoke are great ways to improve overall health and reduce the chances of getting sick. 8. Exercising how to not get sick exercise
Participating in regular physical activity reduces the risk of a number of illnesses. Regular physical activity can improve a person's general health and wellbeing and reduce the risk of a number of illnesses, including: In addition to these benefits, research from 2016 indicates that physical activity can also improve a person's immune function and decrease their risk of respiratory infections. A 2018 study also examined the benefits of meditation and exercise for preventing acute respiratory infections. The 8-week study followed 390 participants, who the researchers had randomly assigned to one of three groups: no training (control group) mindfulness-based stress reduction (MBSR) training moderate-intensity exercise (EX) training The researchers reported a 14–33 percent reduction in the number of acute respiratory infections among participants in the MBSR and EX groups, compared with the control group. People in the MBSR and EX groups who developed acute respiratory infections also experienced less severe symptoms. The United States Department of Health and Human Services state that any physical activity is better than none. However, to experience substantial health benefits, they recommend that adults do at least 150 minutes of moderate-intensity exercise per week or 75 minutes of vigorous-intensity aerobic exercise per week. A person can spread this activity throughout the week. Thank you for supporting Medical News Today Summary Viruses are present all year, but there are ways to prepare for cold and flu season and to reduce the chances of becoming sick. Getting an annual flu vaccine and practicing good hygiene are great ways for a person to protect themselves and others. Some lifestyle and dietary changes that can reduce the likelihood of getting sick include regular exercise, increasing zinc and fiber intake, and quitting smoking.
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What to know about the warfarin diet

People taking the blood thinning medication warfarin may need to moderate vitamin K levels in their diets. Vitamin K may interfere with the effectiveness of warfarin.

A doctor may prescribe warfarin to someone who has had a blood clot in the past, as they are at a higher risk of blood clots in the future. Other factors that increase the chances of a blood clot include:

Warfarin works by slowing the production of clotting factors, which the body makes by using vitamin K from food. Levels of vitamin K in a person's diet could influence the effects of warfarin.

It is possible that vitamin-K rich diets can reduce the effectiveness of warfarin.

The warfarin diet Asparagus being washed under a tap
Asparagus is high in vitamin K.

Vitamin K, which is in some foods, has an important role in blood clotting, and how warfarin works.

The liver uses vitamin K to produce clotting factors, which are cells that help to control bleeding and enable blood clots to form.

Warfarin disrupts this clotting process by inhibiting an enzyme in the liver that uses vitamin K to form clotting factors.

Warfarin can reduce the chances of a dangerous blood clot forming by increasing the time it takes for the liver to produce clotting factors.

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It is possible that eating a diet rich in vitamin K could reduce the effect of warfarin on clotting factors.

The American Heart Association (AHA) suggest that eating vitamin K-rich foods may counteract the effects of warfarin, and lower the prothrombin time. This is the time it takes for a blood clot to form.

The AHA'a list of 19 foods high in vitamin K includes:

It is not necessary to cut out foods that contain vitamin K entirely. The foods that contain vitamin K also have other nutritional properties that contribute to a healthful diet.

It is important to note that the guidance varies on how much vitamin K people on warfarin can consume.

For example, a recent systematic review suggests a diet that restricts vitamin K intake is unlikely to improve the efficacy of warfarin. The authors suggest that keeping vitamin K levels consistent may be more beneficial.

The average person only needs a small amount of vitamin K, around 60 to 80 micrograms (mcg) per day. As this amount is so small, it can be easy for vitamin K levels to fluctuate across different days, creating a problem for people on warfarin.

Keeping vitamin K levels stable, and within a normal range, may reduce its effect on the actions of warfarin. Keeping a food diary and being aware of foods that are high in vitamin K can help a person keep track.

Thank you for supporting Medical News Today Alcohol and warfarin alcohol increases risk of cluster headaches
Drinking alcohol can be harmful for people taking warfarin. Alcohol can also affect the action of warfarin and, therefore, the risk of developing blood clots. High levels of alcohol consumption can alter the way the body metabolizes warfarin. The AHA suggest that, on average, men should drink no more than one or two drinks per day, and women should drink no more than one drink per day. Examples of one drink are a 12-oz beer, a 4-oz glass of wine, 1/5 oz of 80-proof spirits, or 1 oz of 100-proof spirits. Drinking too much alcohol can be particularly harmful for people taking warfarin. A study of 570 people in 2015 found that alcohol misuse has links to a higher risk of major bleeding in people taking warfarin. Thank you for supporting Medical News Today Summary Warfarin can help to prevent dangerous blood clots. It works by slowing the production of clotting factors, which the body makes by using vitamin K from food. Levels of vitamin K in a person's diet could influence the effects of warfarin. People taking warfarin must avoid eating too many foods that are high in vitamin K, but it is not necessary to avoid these foods entirely. A stable diet, containing around 60 to 80 mcg of vitamin K is desirable. People on warfarin must also ensure that they only consume alcohol in moderation. High levels of alcohol may affect the metabolism of warfarin and increase the risk of major bleeding.
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Blood-clotting protein contributes to Alzheimer's

It is still unclear exactly what causes Alzheimer's disease, which is a neurodegenerative condition chiefly characterized by memory loss and other forms of cognitive impairment. However, new research is uncovering more of the factors that contribute to its pathology.
portrait of older woman
According to a new study, a blood protein leaked into the brain contributes to cognitive decline.

According to existing guidelines, the main mechanism associated with cognitive problems in the brains of people with Alzheimer's disease is the formation of beta-amyloid plaques.

These are buildups of toxic proteins that disrupt the normal functioning of synapses. Synapses are the connections formed between brain cells that allow information to circulate within and to and from the brain.

However, in a new study from the Gladstone Institutes in San Francisco, CA, a team of researchers has identified another mechanism that affects how synapses work, contributing to Alzheimer's pathology.

The researchers began by investigating problems that appear in the blood vessel network in the brain, which is another biological characteristic of this form of dementia.

Senior investigator Prof. Katerina Akassoglou and her team have for the first time identified a blood-derived protein that leaks into the brain disrupting cell-to-cell communication.

The findings, which appear in the journal Neuron, indicate that in Alzheimer's, fibrinogen, a protein that usually contributes to blood clotting, plays a vital role in cognitive dysfunction.

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New factor: 'Blood leaks in the brain'

In this study, the investigators used sophisticated imaging technology to scan both the brains of mice simulating a form of dementia and those of people with an Alzheimer's diagnosis.

Through their analyses, the researchers found that fibrinogen passes from blood vessels into the brain, triggering immune cell activity, which in turn leads to the breakdown of synapses.

To confirm the protein's role in synaptic breakdown, the team tried blocking fibrinogen's action on the brain's immune cells in a mouse model of Alzheimer's. This strategy protected the rodents from experiencing the type of memory loss typically associated with this condition.

"We found that blood leaks in the brain can cause elimination of neuronal connections that are important for memory functions. This could change the way we think about the cause and possible cure of cognitive decline in Alzheimer's disease and other neurological diseases."

Prof. Katerina Akassoglou

Moreover, Prof. Akassoglou and her team found that leaked fibrinogen can lead to synaptic breakdown even in the absence of beta-amyloid plaques.

When the researchers injected even the smallest of quantities of fibrinogen into healthy brains, they saw that the protein triggered the same mechanism that caused the loss of synapses as it did in brains affected by Alzheimer's disease.

"Traditionally, the buildup of amyloid plaques in the brain has been seen as the root of memory loss and cognitive decline in Alzheimer's disease," explains the study's first author, Mario Merlini.

"Our work identifies an alternative culprit that could be responsible for the destruction of synapses," he notes.

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'Far-reaching therapeutic implications'

The team that conducted the current study explains that existing research has shown that cerebrovascular problems, as well as the formation of beta-amyloid plaques, each contribute to cognitive decline.

Moreover, both of these pathologies contribute to the cognitive decline at similar rates. However, the researchers add that people who present both pathologies at the same time experience much quicker neurodegeneration.

Prof. Akassoglou and colleagues believe that their current findings finally offer an explanation for these phenomena.

"Given the human data showing that vascular changes are early and additive to amyloid, a conclusion from those studies is that vascular changes may have to be targeted with separate therapies if we want to ensure maximum protection against the destruction of neuronal connections that leads to cognitive decline," notes the senior researcher.

So far, researchers have been developing therapies targeting beta-amyloid, but these new findings suggest that other therapeutic targets may also be valuable.

"These exciting findings greatly advance our understanding of the contributions that vascular pathology and brain inflammation make to the progression of Alzheimer's disease," says study co-author Dr. Lennart Mucke.

"The mechanisms our study identified may also be at work in a range of other diseases that combine leaks in the blood-brain barrier with neurological decline, including multiple sclerosis, traumatic brain injury, and chronic traumatic encephalopathy. It has far-reaching therapeutic implications," he adds.

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Immunosuppressants reduce artery plaque in people with psoriasis

New research finds that treatment with biologic drugs reduces coronary plaque buildup among people with severe psoriasis.
nurse giving senior drugs
An immunosuppressant drug for psoriasis can also improve heart artery health for those with the skin condition.

Psoriasis is a chronic, inflammatory skin condition that affects 7.5 million people in the United States and approximately 125 million worldwide. Psoriasis is also the most widely spread autoimmune disorder in the U.S.

Scientists have previously linked the condition with a higher risk of heart disease, but the connection is still unclear.

People with psoriasis have a higher incidence of cardiovascular disease than others, partly because the inflammation present in psoriasis raises the risk of blood vessel damage.

New research delves deeper into the link between inflammation, immunity, and heart disease in people with psoriasis.

Dr. Nehal N. Mehta, head of the Lab of Inflammation and Cardiometabolic Diseases at the National Heart, Lung, and Blood Institute, and colleagues have investigated the effect of immunotherapy on heart artery disease in those who live with psoriasis.

Dr. Mehta and team examined the effect of so-called biologic drugs — that is, a medication that suppresses the immune system — in people who have psoriasis.

The researchers published their results in the journal Cardiovascular Research.

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Dr. Mehta and team analyzed the data available from the National Institutes of Health Psoriasis Atherosclerosis Cardiometabolic Initiative cohort — a prospective, observational study of 290 participants who the project clinically followed between January 1, 2013, and October 31, 2018.

Of the total number of participants, 121 qualified for biologic treatment, as they had a moderate-to-severe skin condition.

Dr. Mehta and colleagues also clinically followed these participants for a year and compared them with those who chose not to take biologic drugs.

The researchers assessed the health of the participants' arteries by using coronary computed tomography angiography.

Overall, the study revealed that a reduction of coronary artery plaque of 8 percent correlated with taking biologic drugs.

Coronary plaque builds up inside a person's arteries, narrowing them and reducing their elasticity. A buildup of plaque in these blood vessels can lead to heart attacks and stroke over time.

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"The findings that intrigued us most were that coronary plaque sub-components changed over one year," explains Dr. Mehta, "including the necrotic core and non-calcified components, which are the culprits for most heart attacks."

The researcher also speculates on the potential mechanisms that may explain the findings. "This appears to be an anti-inflammatory effect," he says.

"In the absence of improvement in other cardiovascular risk factors, and without adding new cholesterol medications, patients' soft-plaque still improved. The only change was the severity of their skin disease," says Dr. Mehta.

The researcher also highlights the importance of inflammation in the development of cardiovascular disease. "Classically, a heart attack is caused by one of five risk factors: Diabetes, hypertension, high cholesterol, family history, or smoking," he states.

"Our study presents evidence that there is a sixth factor, inflammation, and that it is critical to both the development and the progression of atherosclerosis to heart attack."

The authors concede, however, that they need to do more research. Their study is an observational one, and so the cause and effect cannot be established. For future study, says Dr. Mehta, "the next steps should be randomized, controlled trials."

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Cardiovascular deaths on the rise in the US

According to the American Heart Association (AHA), nearly half of all adults in the United States have cardiovascular disease. It caused more deaths in 2016 than previous years, despite rates of cardiovascular deaths having declined worldwide.
man having his blood pressure taken
The amended hypertension guidelines explain the high prevalence of cardiovascular disease in the U.S., say the AHA.

Heart disease is the leading cause of mortality in the United States, followed closely by cancer and chronic respiratory diseases.

In fact, heart disease causes almost 1 in 4 deaths in the U.S.

Staying abreast of the latest statistics on the prevalence of this condition is key for prevention.

Physicians, governmental organizations, and patients alike can benefit from information on heart disease death rates and risk factors that stave off cardiovascular conditions.

In this context, the American Heart Association (AHA) have just published their 2019 updated Heart and Stroke statistics in the journal Circulation.

The report is a compilation of the latest statistics on the prevalence of cardiovascular disease both in the U.S. and across the globe. The AHA worked in collaboration with the National Institutes of Health (NIH) and other governmental organizations to put the report together.

According to the report, about 48 percent of all U.S. adults — or almost half of the adult population — are living with a form of cardiovascular disease.

Cardiovascular disease is an umbrella term for several conditions, including atherosclerosis, heart disease, heart failure, stroke, heart attack, arrhythmia, and heart valve problems.

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Hypertension and cardiovascular risk

The updated AHA report found that in the U.S., cardiovascular deaths have increased significantly in recent years, despite the fact that across the globe, the number of cardiovascular deaths has declined.

Specifically, in the U.S., 840,678 cardiovascular deaths were registered in 2016, a number that has gone up from 836,546 deaths in 2015.

However, worldwide, 17.6 million people died from a cardiovascular condition in 2016, compared with 17.9 million in 2015.

Importantly, the recently reported high prevalence of cardiovascular disease is mainly due to the fact that the definition of what constitutes high blood pressure has changed.

According to the AHA's updated 2017 hypertension guidelines, a reading of 130/80 millimeters of mercury (mm Hg) or above counts as high blood pressure, whereas previously this reading was 140/90 mm Hg.

Dr. Ivor J. Benjamin, the president of the AHA and the director of the Cardiovascular Center at the Medical College of Wisconsin in Milwaukee, comments on the importance of high blood pressure for cardiovascular risk.

"As one of the most common and dangerous risk factors for heart disease and stroke," he states, "this overwhelming presence of high blood pressure can't be dismissed from the equation in our fight against cardiovascular disease."

"Research has shown that eliminating high blood pressure could have a larger impact on [cardiovascular] deaths than the elimination of all other risk factors among women and all except smoking among men."

Dr. Ivor J. Benjamin

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Fewer people smoke and more are exercising

The recent report also notes some encouraging improvements in risk reduction. The proportion of teenagers who do not smoke, for example, has increased by almost 20 percent in 1999–2016.

Meanwhile, 94 percent of adolescents aged 12–19 did not smoke in 2015–2016, whereas only 76 percent did not smoke in 1999–2000.

Additionally, the number of teenagers aged 12–17 who smoked in the past month decreased by two-thirds between 2002 and 2016.

Approximately 80 percent of adults did not smoke in 2015–2016, and the number of male adults who smoke has dropped from 51 percent in 1965 to 16.7 percent in 2015. Also, 34 percent of females smoked in 1965, while only 13.6 percent smoked in 2015.

Finally, the report also mentions that the rate of physical inactivity has declined, as more and more U.S. individuals are engaging in various types of exercise.

Namely, over half of U.S. students engage in muscle-strengthening exercise on 3 days per week or more, and the number of physically inactive adults has dropped by over a third between 2005 and 2016.

However, the report authors warn that obesity and sleep deprivation remain significant risk factors for cardiovascular disease and other chronic conditions. The rates of obesity in the U.S. are still high, as are the number of adults who do not get enough sleep.

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High blood pressure linked to zinc deficiency

A new study demonstrates a link between zinc deficiency and high blood pressure. The findings could help scientists design new ways of intervening in at-risk patient populations.
Woman checking blood pressure
Hypertension is incredibly common; understanding how it works is vital.

High blood pressure, or hypertension, is a huge and growing health concern in the United States.

According to the American Heart Association, hypertension affects more than 100 million people in the U.S.

Over recent years, researchers have noted a relationship between lower zinc levels and hypertension.

However, to date, scientists have been unable to pinpoint zinc's exact role in the development of hypertension.

For instance, individuals with certain conditions, such as type 2 diabetes and chronic kidney disease, commonly have a zinc deficiency and high blood pressure. Scientists are still unclear whether zinc levels are a cause or an effect of elevated blood pressure.

Similarly, other studies have shown that individuals with lower zinc levels are more likely to be hypertensive.

As further evidence of zinc's involvement in hypertension, rats that are particularly sensitive to salt and readily develop high blood pressure have lower levels of zinc in their blood.

Recently, a group of researchers set out to investigate the links between zinc and blood pressure. They wanted to dig a little deeper into the mechanisms of action. The team published their findings in the American Journal of Physiology–Renal Physiology.

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Kidneys and blood pressure

Sodium absorption plays a vital role in moderating blood pressure. The sodium chloride cotransporter (NCC) in the kidney is particularly important. It reabsorbs sodium from the fluid that is destined to become urine and feeds it back into the body.

Generally, lower levels of sodium in the urine correspond with increased blood pressure. In other words, when the NCC is too active, it pumps more sodium back into the body, the urine removes less, and blood pressure rises.

As the authors write, "Renal modulation of urinary sodium excretion is the cornerstone of [blood pressure] control."

A number of proteins can interact with the NCC to alter the amount of sodium that the body reabsorbs and excretes.

Zinc acts as a cofactor, which means that it influences the activity of a wide range of proteins, including enzymes, transcription factors, and regulatory proteins.

Researchers think that zinc impacts one of the proteins that moderates the NCC, although they have struggled to find evidence for this.

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Zinc and hypertension

In this latest study, the scientists ran a series of experiments to investigate the relationship between zinc and hypertension, and observe the role of the NCC.

Firstly, they demonstrated that mice that ate a diet with lower levels of zinc developed hypertension. Then, they split these animals into two groups. They fed half of the animals on a diet that contained adequate levels of zinc. As expected, their blood pressure soon returned to normal.

The researchers gave the remaining mice hydrochlorothiazide, a drug that inhibits the NCC. The blood pressure of these animals also returned to normal. This is because the NCC stopped pumping sodium back into the body, which allowed the urine to flush it away.

In other experiments, the researchers worked on animal tissue in the laboratory. They demonstrated that the NCC is responsible for hypertension that is mediated by zinc deficiency.

They also showed that NCC activity is altered by the presence of zinc — specifically, NCC activity increases when zinc is at a lower level. The scientists believe that when zinc is in short supply, the NCC is more stable and therefore able to function for longer.

These results tie together findings from earlier work and confirm the role of zinc in hypertension. The authors write:

"Understanding the specific mechanisms by which [zinc deficiency] contributes to [blood pressure] dysregulation may have an important effect on the treatment of hypertension in chronic disease settings."

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What to know about amlodipine

Amlodipine is an oral medication that doctors prescribe to treat some cardiovascular conditions. In the United States, it commonly goes under the brand name Norvasc.

Amlodipine is a type of calcium channel blocker. Doctors commonly prescribe these drugs to treat people with high blood pressure. A doctor may also prescribe amlodipine for coronary artery disease and angina.

In this article, we look at what doctors prescribe amlodipine for and its recommended dosage. We also cover the side effects, interactions, warnings, and considerations for amlodipine as well as some alternative drugs.

What is it used to treat? packages of Norvasc, brand name of amlodipine. image credit: Kimivanil, 2015.
Amlodipine is usually known as Norvasc in the U.S.
Image credit: Kimivanil, 2015.

The U.S. Food and Drug Administration (FDA) first approved amlodipine in 1987. The FDA consider amlodipine safe and effective for treatment of:

high blood pressure, which doctors refer to as hypertension coronary artery disease angina, which is chest pain resulting from reduced blood flow to the heart

Doctors sometimes also prescribe amlodipine to treat people with other conditions. This is known as "off-label" treatment because the FDA has not yet approved the drug for these uses.

According to one source, off-label uses of amlodipine include:

Dosage guide The dosage for amlodipine depends on the person's condition and how well their symptoms respond to treatment. The doctor will also take into account an individual's age and medical history when recommending a dosage. According to the FDA's prescribing information leaflet, amlodipine is available in tablets and capsule form and in a range of strengths, including 2.5 milligrams (mg), 5mg, and 10mg quantities. Doctors prescribe amlodipine for a variety of conditions, and the FDA recommend the following dosages: For treating high blood pressure: For adults: starting with 5 mg once daily with a maximum dose of 10 mg daily. For older people or those with liver problems: 2.5mg once daily. For children aged 6–17 years old: 2.5mg or 5 mg once daily. The FDA also recommend that doctors adjust a person's dosage according to blood pressure goals, but wait between 7 and 14 days between changes. For treating chronic stable or vasospastic angina: For adults: 5 mg to 10 mg once daily. Most people will need to take 10 mg for the drug to treat their angina effectively. For older people or those with liver problems: 5 mg once daily. For treating chronic artery disease: For adults: 5 to 10mg once daily. For older people or those with liver problems: 5 mg once daily. For some people who have difficulty swallowing, such as children and older people, a doctor may administer amlodipine as an intravenous injection or drip. Thank you for supporting Medical News Today Side effects Side effects of amlodipine can include drowsiness.
Side effects of amlodipine can include drowsiness. According to the FDA, researchers have used clinical trials to evaluate the safety of amlodipine in over 11,000 people. These studies found that the drug rarely caused problems in dosages up 10 mg daily. However, common side effects include: edema, which is a swelling that occurs in different parts of the body, particularly the feet or ankles dizziness flushing palpitations, which are feelings of a fast or irregular heartbeat Less common side effects include: Interactions Amlodipine can potentially interact with some other medications, including: Simvastatin. The FDA recommends limiting the dosage of simvastatin to 20mg daily while also taking amlodipine. CYP3A4 inhibitors. Medications that inhibit an enzyme called CYP3A4 can increase the concentration of amlodipine in the blood. These drugs include diltiazem, ketoconazole, itraconazole, and ritonavir. The FDA recommend that doctors monitor people who are taking both CYP3A4 inhibitors and amlodipine for symptoms of edema and low blood pressure. Cyclosporine. In people who have had a kidney transplant, taking amlodipine and cyclosporine together may increase the levels of cyclosporine in the body. It is essential that people inform their doctors about all the medications, herbs, and supplements they are currently taking before starting amlodipine or any other new medicines. Warnings The FDA have issued several warnings for doctors to take note of when prescribing amlodipine. These include: Hypotension Amlodipine can cause hypotension, or low blood pressure, in some people, particularly those with severe aortic stenosis. Symptoms of hypotension include feeling faint, tired, and nauseous. Increased angina or myocardial infarction When starting or increasing the dosage of amlodipine, it can worsen symptoms of angina and increase the risk of heart attack in some people, particularly those with severe obstructive coronary disease. However, this is rare. Liver problems The liver extensively metabolizes amlodipine, so doctors need to be cautious when prescribing this drug to people with liver conditions. The FDA recommend that doctors closely monitor these individuals and increase the dosages of amlodipine slowly. Thank you for supporting Medical News Today Considerations The FDA have also highlighted some considerations that both the prescribing doctor and the person taking amlodipine need to be aware of. These include: Pregnancy There is a lack of research into the safety of taking amlodipine during pregnancy. The FDA recommend that doctors should only prescribe amlodipine to pregnant women if the potential benefits outweigh the risks to the fetus. Breastfeeding Scientists have not yet determined whether amlodipine can enter a woman's breast milk. Because of this, the FDA recommend that women do not take amlodipine while breastfeeding. Children under 6 years Due to a lack of studies, doctors do not know how safe or effective amlodipine is in children under the age of 6 years. Alternative drugs Alternative medications are available.
Alternative medications are available. Possible alternative medications to amlodipine include other calcium channel blockers, such as nicardipine, clevidipine, and nifedipine However, doctors often prescribe amlodipine over some other medications because a person usually only needs to take one dose per day. If a person experiences side effects on amlodipine, they should speak to a doctor about changing medication. Summary Amlodipine is an oral medication that doctors prescribe to treat high blood pressure, coronary artery disease, and angina. It is generally a safe and effective drug, but it may cause side effects in some people. However, a doctor may recommend a lower dosage and close monitoring for some individuals taking amlodipine, such as older people, pregnant women, and people with liver conditions. Amlodipine can also interact with some other medications. A person should speak to their doctor if they have any concerns about taking amlodipine or are experiencing any troubling side effects.
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What to know about a slow heart rate

A person's heart rate generally slows with age and while resting. However, athletes may also have slow heart rates. Anyone with concerns about their heart rate should talk to a doctor for help in determining whether bradycardia suggests a problem.

Heart rate changes with a person's activity level. During intense physical exertion, the heart has to pump faster and harder, so the rate goes up.

In most adults, a slow heart rate is below 60 beats per minute (bpm). However, athletes and people who are asleep may have a heart rate of below 60 bpm.

Symptoms Person having their pulse measured by nurse for bradycardia
Bradycardia can cause a heart rate of less than 60 bpm.

The primary symptom of bradycardia is a slow heart rate. Some people have no other symptoms.

Other people do experience symptoms. In these cases, a slow heart rate is more likely to be due to a serious issue.

Some common bradycardia symptoms include:

feelings of exhaustion and weakness fainting or dizziness confusion shortness of breath trouble breathing when working out

When a serious medical condition causes bradycardia, and a person does not seek treatment, more severe symptoms may appear.

Those include:

Thank you for supporting Medical News Today Measuring heart rate A person can find out their heart rate by taking their pulse. To accurately test for a slow heart rate, a person must measure their resting heart rate. To achieve this, they must avoid checking the pulse shortly after exercising or waking up. To check the pulse, a person should sit in a comfortable and relaxed position and feel for the pulse at the wrist. If unable to locate the pulse at the wrist, they should try feeling for the pulse on the side of their neck. To work out their heart rate, the person counts heartbeats for 10 seconds, then multiplies the number by six. For a more accurate pulse, the person can count the number of beats for a full minute. This figure is the resting pulse. If the number is lower than 60, a person has bradycardia. Children and young people have more rapid heart rates than adults. In young people, normal heart rates are as follows: Newborns: 100 to 180 bpm Infants: 80 to 150 bpm Children ages 2 – 6: 75 to 120 bpm Children ages 6 – 12: 70 to 110 bpm A slow heart rate in a child, especially a newborn, is a medical emergency. What are the causes? Woman athlete by the sea in outdoor swimmer wetsuit, going swimming.
People who engage in intense cardiovascular activity may have a slow heart rate, as their hearts are efficient. Some people have only moderate bradycardia. Others only experience occasional bradycardia. Although it is vital that anyone with a slow heart rate seeks medical guidance, not everyone will require treatment. When bradycardia causes no other symptoms, and when a person does not have an underlying condition, a slow heart rate may be a harmless or minor issue. The heart rate tends to decline with age, which means older people may experience episodes of bradycardia. While this is typical, it still warrants investigation by a doctor. Exercise strengthens the heart. Athletes, especially those who engage in intense cardiovascular activity, tend to have more efficient hearts. This may slow their pulse because their heart does not have to pump as hard or as fast to supply blood to the rest of their body. Some medical conditions may also cause a slow heart rate. These include the following: Problems with the heart's natural pacemaker The heart's natural pacemaker, or sinoatrial node, helps regulate heartbeat. Problems affecting this can cause a person's heart to beat unusually slow or fast, which doctors call tachycardia. A condition that doctors call sick sinus syndrome refers to problems with the natural pacemaker. Typically, another heart health problem, such as scar tissue in the heart, complications of diabetes, or coronary artery disease, causes these problems. Other heart electrical issues The heart communicates by sending electrical signals. For example, one chamber of the heart sends electrical signals to another, telling it how and when to squeeze blood into the next chamber. The pacemaker helps regulate this electrical system. If the heart is not able to send the correct electrical signals, due to a blockage or heart disease, it can cause bradycardia. Complete heart block is a type of electrical issue that makes it impossible for electrical signals to travel from the atria — the top two chambers of the heart — to the ventricles, which are the bottom two chambers. In complete heart block, the top two chambers may have totally different rhythms to the bottom two. Metabolic problems Some metabolic disorders can slow the heart rate. One of the most common is hypothyroidism, in which the thyroid does not produce enough thyroid hormones. Hypothyroidism can affect the health of the blood vessels, which may slow the heart rate. People with hypothyroidism may also have a high diastolic blood pressure — a diastolic measurement identifies the pressure in the arteries between heartbeats, and is the bottom number on a blood test reading. A person has a high diastolic blood pressure if the test shows a reading above 80. Thyroid disorders are common and may affect young and otherwise healthy people. Between 4 and 10 percent of people in the United States have hypothyroidism. Heart disease Damage to the heart from congestive heart failure, coronary artery disease, previous heart attacks, and other heart problems may affect the heart's electrical system, making the heart pump more slowly and less effectively. Heart medication Some medications, including medications for heart disease and high blood pressure, may lower heart rate. Beta-blockers, which doctors prescribe for a rapid heart rate and some other heart conditions, may also slow heart rate. People taking a new medication who experience symptoms of bradycardia should contact a doctor. Oxygen deprivation Doctors use the term hypoxia when the body cannot get enough oxygen, which may slow down the heart rate. Hypoxia is a medical emergency, and it can occur when a person is choking or having a severe asthma attack. Chronic medical conditions, such as chronic obstructive pulmonary disease, may also cause hypoxia. When hypoxia lowers the heart rate, it is essential to treat the underlying cause. Thank you for supporting Medical News Today When to see a doctor A person should speak to a doctor if they notice their heart rate is slow.
A person should speak to a doctor if they notice their heart rate is slow. When a baby has a low pulse, a parent or carer should take them to the emergency room. Adults and children who have a low pulse and experience severe symptoms, such as chest pain or fainting, should also go to the hospital. A person should see a doctor for bradycardia when: they experience an unexplained change in heart rate that lasts for several days they have bradycardia and other heart health risk factors, such as diabetes or smoking they have heart disease and bradycardia they experience bradycardia and other symptoms, such as fainting spells they experience episodes of bradycardia and tachycardia Treatment options A doctor may not always need to treat a slow heart rate. However, when a slow heart rate causes serious health problems or when heart disease slows the heart, it is essential that people receive treatment. An artificial pacemaker, which is an electrical device that a doctor inserts into the heart to promote regular rhythms, can help. Depending upon the cause, a doctor might also recommend: changing heart medications taking medication to treat thyroid or other metabolic disorders making lifestyle changes, such as eating a low-fat diet, doing more exercise, or quitting smoking monitoring heart rate or blood pressure frequently Thank you for supporting Medical News Today Takeaway Heart disease is the leading cause of death in the U.S., accounting for 1 out of every 4 deaths. It is crucial that a person takes any changes in heart health, blood pressure, or pulse seriously. However, a slow heart rate is not always a reason for concern. In many cases, a slow heart rate is merely a variation of normal. It may even be a sign of heart health and indicate good levels of fitness. Only a doctor can evaluate an individual's cardiovascular risk factors. People should see a doctor for guidance and reassurance.
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How your flu medicine can affect your heart

January is at the heart of the cold and flu season, and whenever the sneezing and coughing hits, we tend to stock up on anti-inflammatories and decongestants to help us fight these symptoms. However, the American Heart Association warn that these drugs can have unwanted effects on the heart.
person with the flu
Some of the most common drugs used to treat colds and flu could influence our cardiovascular risk, experts warn.

Over-the-counter drugs are most people's go-to solution for the relief of aches, mild fever, a blocked nose, and other symptoms of the flu or a seasonal cold.

Such medicines include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, and decongestants that include pseudoephedrine and phenylephrine.

While these drugs are typically safe to take as long as you follow the recommended dosages, specialists from the American Heart Association (AHA) and other institutions warn that they could worsen the cardiovascular health of certain at-risk individuals.

"People with uncontrolled high blood pressure or heart disease should avoid taking oral decongestants," cautions Sondra DePalma, who is a physician assistant at the PinnacleHealth CardioVascular Institute at UPMC Pinnacle in Harrisburg, PA, and one of the specialists behind the AHA's and American College of Cardiology's (ACC) guidelines for the management of high blood pressure.

"And for the general population or someone with low cardiovascular risk, they should use them with the guidance of a healthcare provider," DePalma also advises.

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Increased cardiovascular risk

According to the AHA and ACC guidelines, both NSAIDs and decongestants can increase blood pressure due to the way in which they act on the body. Decongestants, particularly, tighten the blood vessels in the nose, which helps reduce inflammation in that area.

"But if you have high blood pressure or heart disease, the last thing you need is constricting blood vessels. It can exacerbate or worsen the condition," notes Dr. Erin Michos, the associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, MD.

Dr. Michos explains that the people most at risk if they were to use decongestants are those with unmanaged high blood pressure, those with heart failure, as well as individuals who have had a heart attack or stroke.

As for NSAIDs, existing studies show that they can also place people at higher cardiovascular risk.

One study paper that the AHA cite — and which the Journal of Infectious Diseases published in 2017 — focused on a cohort of 9,793 individuals who had taken treatments for respiratory infections and ended up in hospital following a heart attack.

The participants averaged 72 years of age when they experienced their heart attacks, and many of them had preexisting cardiovascular risk factors, such as high blood pressure or diabetes.

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Prevention is the best approach

According to the study, those who took NSAIDs to treat their respiratory infections were in excess of three times more at risk of a heart attack within 1 week than they had been during the same period the year before when they did not use NSAIDs.

To avoid exposure to such risks, Dr. Michos advises using NSAIDs and decongestants sparingly or opting for an alternative solution where possible, such as antihistamines.

"There are effective therapies that are less risky and definitely should be tried first," notes DePalma.

"If other over-the-counter medications are needed, use them cautiously. And if someone finds they are having problems like high blood pressure or other things like heart palpitations, they should talk with their healthcare provider," she urges.

Finally, the best approach when it comes to colds and flu is prevention, and the AHA point to the Centers for Disease Control and Prevention (CDC) recommendations, which suggest getting a flu shot each year.

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What to know about hypokalemia

Hypokalemia describes a person having too little potassium in their blood. If it is severe, it can lead to muscle weakness, which can have many health consequences. The cause is usually a person's body excreting too much potassium.

Hypokalemia is always a symptom of another illness or a side effect of a medication. It is not an illness in itself. Therefore, the underlying condition requires treatment to resolve the hypokalemia. A medical professional can diagnose hypokalemia by taking a person's medical history and carrying out tests.

A person may not be aware of mild hypokalemia. However, if hypokalemia is moderate or severe, the individual is likely to have other signs of being unwell, for example, vomiting or diarrhea. If a person feels ill for an extended period, they should see a doctor.

In this article, we look at the symptoms, causes, diagnosis, and treatment of hypokalemia, as well as the outlook for people with low potassium levels.

Symptoms Person having their blood pressure measured
Hypokalemia can cause symptoms such as low blood pressure and muscle weakness.

When a person's hypokalemia is mild, they will often not experience any symptoms.

However, people who have moderate or severe hypokalemia, are older, or have heart or kidney issues can experience symptoms that relate to severe muscle weakness.

According to the National Organization for Rare Disorders, these symptoms can include:

muscle weakness that can result in paralysis respiratory failure low blood pressure muscle twitching cramping during exercise feeling very thirsty excessive urination loss of appetite nausea heart irregularities

However, people should note that experiencing any symptoms with hypokalemia is rare.

A study in the European Journal of Emergency Medicine looked at the data of 4,826 people who presented to the emergency department of a hospital with hypokalemia.

The researchers found that just 1 percent of these individuals had severe hypokalemia, and only half of the people in this subgroup had any symptoms.

Thank you for supporting Medical News Today What are the causes? Prolonged diarrhea or vomiting can cause loss of potassium.
Prolonged diarrhea or vomiting can cause a loss of potassium. The usual cause of hypokalemia is a person losing potassium too quickly. In rare cases, it can occur because someone is not getting enough potassium. A person may also not get sufficient potassium if they have a diet that contains very small amounts of it. However, it is unusual for this to be the cause of hypokalemia. Many foods contain potassium, and the kidneys are usually capable of reducing the excretion of potassium if the body is not getting enough. A person might lose potassium too quickly for several different reasons. According to a 2018 clinical update, these can include: persistent diarrhea prolonged vomiting kidney issues side effects of diuretic drugs Hypokalemia can also occur when there is an "intracellular shift" of the potassium in the body, which stops the correct transmission of potassium between cells. It can occur as a side effect of various medications. Diagnosis Hypokalemia is not an illness in itself, so when a person receives a diagnosis, the doctor will need to identify what is causing the loss of potassium. In most cases, this is relatively straightforward. A doctor will check for: recent vomiting recent diarrhea associated heart problems particular medications, such as insulin, beta agonists, or diuretics If a doctor suspects that a person is hypokalemic, they may run tests to measure the amount of potassium in their body. They will usually do this by checking the potassium level in a person's urine. Thank you for supporting Medical News Today Treatment Banana slices and honey drizzled in a bowl of porridge
Bananas are a natural source of potassium. Once a doctor has determined the underlying issue that is causing hypokalemia, they can recommend a suitable treatment. For example, if a person has hypokalemia as a result of prolonged vomiting, treating the cause of the vomiting will also address the hypokalemia. Alternatively, if a particular medication is making a person hypokalemic, then reducing or replacing that medication may resolve the problem. If a person's hypokalemia is severe or causing muscular issues, they may receive a prescription for additional potassium supplements to respond to these symptoms immediately. The supplement will often be in the form of tablets, but intravenous delivery might be necessary if the hypokalemia is severe. Doctors may also instruct people to eat foods that are rich in potassium, such as bananas, avocados, chard, and other plant-based foods. However, the authors of an article in the journal American Family Physician note that, although changing the diet can be beneficial, it is usually far less effective than taking potassium supplements. Outlook The outlook for a person with hypokalemia will depend on the underlying illness or side effect that is causing them to have low potassium. In some cases, this may be simple to resolve by changing medication or dealing with an illness that responds quickly to treatment. However, the cause may also be more complex. In the rare instances when severe hypokalemia is symptomatic, potassium supplements will usually resolve it.
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Stair-climbing exercise 'snacks' boost health

Time is no longer an excuse for not exercising, as new research finds that even a few minutes of stair climbing at intervals every day is enough to improve cardiovascular and overall health.
woman exercising on stairs
New research finds that even brief bouts of stair climbing can bring unexpected health benefits.

Several recent studies have pointed out the many health benefits of short bursts of exercise.

For instance, a review of existing studies, which Medical News Today reported on, shows that an acute period of exercise can immediately protect the heart against future ischemic episodes.

Results of another recent study indicate that 10 minutes of physical activity is enough to give the brain a boost, improving attention, working memory, and cognitive flexibility, among other mental skills.

Now, research suggests that even intervals of stair climbing that last a few minutes, with recovery periods between, can improve cardiorespiratory health.

Martin Gibala, Ph.D., a professor of kinesiology at McMaster University in Hamilton, Canada, is the senior author of the new study, which appears in the journal Applied Physiology, Nutrition, and Metabolism.

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Prof. Gibala and the team set out to investigate whether sprint interval training — that is, short bouts of intense exercise separated by a few minutes of recovery, amounting to about 10 minutes in total — can improve cardiorespiratory fitness.

Cardiorespiratory fitness refers to "the ability of the heart, lungs, and vascular system to deliver oxygen-rich blood to working muscles" during intense physical exercise.

Research has suggested that greater respiratory fitness brings several health benefits, including better cardiovascular health, improved insulin resistance, and a lower risk of premature death.

For the current study, a group of 12 sedentary young participants climbed three flights of stairs three times a day, with 1–4 hours of recovery between sessions.

The participants engaged in this regimen three times a week for 6 weeks, while a control group of 12 age-matched, sedentary individuals did not exercise.

At the end of the intervention period, cardiorespiratory fitness "was higher in the climbers [...] suggesting that stair-climbing 'snacks' are effective in improving cardiorespiratory fitness," report the authors.

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The climbers were also stronger at the end of the intervention, and they performed better in a maximal cycling test, compared to the controls.

"We know that sprint interval training works, but we were a bit surprised to see that the stair snacking approach was also effective," says study co-author Jonathan Little, Ph.D., an assistant professor of kinesiology at the University of British Columbia in Okanagan, Canada.

"Vigorously climbing a few flights of stairs on your coffee or bathroom break during the day seems to be enough to boost fitness in people who are otherwise sedentary," Little explains.

"The findings make it even easier for people to incorporate 'exercise snacks' into their day," Prof. Gibala adds.

"Those who work in office towers or live in apartment buildings can vigorously climb a few flights of stairs in the morning, at lunch, and in the evening and know they are getting an effective workout."

Prof. Martin Gibala, Ph.D.

In the future, the team plans to test the effects of various exercise "snacking" regimens, varying the duration of the recovery intervals. They also wish to study the effects of these bouts of exercise on blood pressure and blood sugar.

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What role does the immune system play in hypertension?

Millions of people in the United States and across the world have hypertension, a condition that, without proper management, can contribute to the risk of heart disease and stroke.
woman getting her blood pressure checked
Specialist white blood cells play an important role in the regulation of blood pressure, a new study finds.

Data from the Centers for Disease Control and Prevention (CDC) indicate that approximately 75 million adults in the U.S. live with hypertension.

American Heart Association (AHA) guidelines from 2017 define "hypertension" as systolic blood pressure (during a heartbeat) of 130 millimeters of mercury (mm Hg) or higher and diastolic blood pressure (when the heart is resting) of 80 mm Hg or higher.

The AHA also name lack of physical activity, an unhealthful diet, high cholesterol, and stress as some of the primary modifiable factors that increase the risk of hypertension.

New research by scientists at the University of Edinburgh in the United Kingdom has now uncovered another factor that seems to play a role in the development of this condition.

The study, which the British Heart Foundation funded, found that a type of specialized immune cell could make a real difference to the risk of hypertension.

"Hypertension affects millions of people across the globe, including 70 percent of people over 70," says lead researcher Prof. Matthew Bailey.

"Our discovery sheds light on risk factors and, crucially, opens routes to investigate new drugs that could help patients," he adds.

Prof. Bailey and team's findings appear in the European Heart Journal, and they are available online.

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Cellular debris-eaters and blood pressure

In the new study, the researchers worked with mouse models and zeroed in on macrophages, a type of white blood cell that forms part of the immune system.

The role of macrophages is to identify and "eat up" foreign bodies that are present due to injury and infection. The immune cells also "eat" cellular debris, which consists of the remains of cells that are no longer functional.

The current research has now uncovered a new role that macrophages play. It seems that they also consume molecules of endothelin, which is a hormone that acts as a vasoconstrictor, meaning that it can stimulate blood vessels to narrow.

Prof. Bailey and colleagues explain that, by controlling blood levels of endothelin, macrophages can ensure that blood vessels properly relax, which helps lower blood pressure.

The researchers verified this mechanism by feeding mice with lowered blood macrophage levels a high-salt diet (which increases the risk of high blood pressure) and monitoring their physiological reactions.

These rodents, the researchers soon found, experienced high blood pressure. However, when the team allowed macrophage levels to return to normal, the mice's blood pressure became healthy again, which suggests that the specialist white blood cells had an important role to play.

When they repeated the experiment in mice that they had genetically modified to have poor endothelin system functioning, the findings remained consistent.

The researchers further verified the link between macrophages and blood pressure in rodents with drug-induced hypertension.

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A potential therapeutical target

To see whether these findings were also valid in humans, the research team analyzed macrophage activity in individuals who took drugs for the management of antineutrophil cytoplasmic antibody vasculitis, a condition that affects the immune system and damages blood vessels.

The scientists found that the drugs that lowered macrophage levels, such as cyclophosphamide, led to higher blood pressure readings in the people who took them.

These findings, note Prof. Bailey and team, could help doctors better identify people who are most at risk of hypertension, and they could also lead to new and improved therapies for high blood pressure.

Still, the researchers caution that further studies are necessary before the interaction between macrophages and endothelin can get the go-ahead as a therapeutic target.

"Our next steps will be to investigate the role of macrophages in people living with hypertension," says Prof. Bailey.

"[Undiagnosed high blood pressure] causes damage to the heart and blood vessels, putting you at risk of a potentially fatal heart attack or stroke. But, we still don't fully understand all the mechanisms that lead to high blood pressure," adds Jeremy Pearson, the associate medical director of the British Heart Foundation, who was not involved in the study.

"This study shows for the first time that macrophages — a type of cell that helps regulate our immune responses — can be involved in the control of blood pressure. More research is needed but these cells could be a new target for drugs to treat the condition."

Jeremy Pearson

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What is a stent? Everything you need to know

A stent is a tiny tube that a doctor places in an artery or duct to help keep it open and restore the flow of bodily fluids in the area.

Stents help relieve blockages and treat narrow or weakened arteries. Doctors may also insert stents in other areas of the body to support blood vessels in the brain or ducts that carry urine and bile.

A stent is usually a mesh-like metal tube, although fabric stents are also available. Sometimes, doctors will use dissolvable stents coated in medication as a temporary solution.

In this article, learn about why doctors use stents, as well as the benefits and possible risks.

Uses Doctor holding up heart stent
A stent can open up blood vessels with plaque blockages.

One of the most common uses for a stent is to open up a blood vessel that has a plaque blockage.

Plaque is a buildup of cholesterol, fat, and other substances found in the blood. When this plaque collects in the bloodstream, it sticks to the walls of the arteries.

Over time, this buildup narrows the arteries, limiting the amount of fresh blood that can reach the body.

A buildup of plaque in the arteries is a cause of coronary heart disease. Over time, people with narrowed arteries may begin to notice warning symptoms, such as chest pain. If people with the condition do not receive treatment, they may be at a higher risk of complications, such as a heart attack or stroke.

If the artery is at risk of collapsing or becoming blocked again, doctors may recommend inserting a stent to keep it open.

Doctors put a stent into an artery in a procedure known as a percutaneous coronary intervention (PCI), or angioplasty with stent.

During PCI, doctors will insert a catheter into the artery. The catheter has a small balloon with a stent around it on one end.

When the catheter reaches the point of the blockage, the doctor will inflate the balloon. When the balloon inflates, the stent expands and locks into place. The doctor will then remove the catheter, leaving the stent in place to hold the artery open.

A doctor will decide whether or not to insert a stent based on a few factors, such as the size of the artery and where the blockage occurs.

Doctors may also use stents for:

blood vessels in the brain or aorta that are at risk of an aneurysm bronchi in the lungs that are at risk of collapse ureters, which carry urine from the kidneys into the bladder bile ducts, which carry bile between the organs and small intestine Thank you for supporting Medical News Today Risks Surgeon looking at screen in operating theatre
A surgeon can explain the risks and benefits of PCI. PCI carries a small risk of complications, which include: bleeding from the catheter insertion site an infection an allergic reaction damage to the artery from inserting the catheter damage to the kidneys irregular heartbeat In some cases, restenosis may occur. Restenosis is when too much tissue grows around the stent. This could narrow or block the artery again. Doctors may recommend forms of radiation therapy or opt to insert a medication-coated stent to slow the growth of the tissue. People at risk of complications include: A stent can cause blood clotting, which may increase the risk of heart attack or stroke. The National Heart, Lung, and Blood Institute state that about 1 to 2 percent of people who have stented arteries develop a blood clot at the site of the stent. Doctors will usually prescribe one or more drugs to prevent clotting. Anti-clotting medications may carry their own risks and can cause irritating side effects, such as rashes. In rare cases, a person's body may reject the stent, or they may have an allergic reaction to the material in the stent. Anyone who has a known reaction to metals should talk to their doctor about alternatives. What to expect The surgeon will discuss the procedure with a person in advance, but it can help to know what to expect. Before the surgery A doctor will advise individuals on how they should prepare for a stent procedure. They will give them information on when to stop eating and drinking, as well as when to start or stop taking medications before the procedure. Anyone who has any other health conditions, such as diabetes or kidney disease, must tell their doctor. The doctor may then have to consider some additional steps. Doctors may also give the person prescriptions to fill before having the stent inserted, as they will need to start taking the medications as soon as the procedure is complete. During the surgery According to the National Heart, Lung, and Blood Institute, a stent procedure only takes about an hour and does not require general anesthesia. The person remains awake during the entire process so can hear any instructions the doctors may have. Doctors will administer medication to help the person relax. They will also numb the area where they insert the catheter. Most people do not feel the catheter threading through the artery. They may, however, feel a bit of pain as the balloon expands and pushes the stent into place. After placing the stent, doctors deflate the balloon and remove the catheter. They bandage the area where the catheter entered the skin and put pressure on the bandage to help prevent bleeding. After the surgery Most people will need to stay in the hospital for at least one night after having the procedure. This allows hospital staff to monitor the person. During the hospital stay, a nurse will regularly check the person's heart rate and blood pressure. They may also change the dressings or clean the wound. The person may leave the hospital the following day if there are no complications. As the insertion site heals, it will bruise and may develop into a small knot of tissue, which is normal. The area may remain tender for at least a week. Thank you for supporting Medical News Today Recovery Patient in hospital bed.
A person may have to rest for about a week after surgery. A successful stent surgery should reduce symptoms, such as chest pain and shortness of breath. Many people may be able to return to work and most normal activities within a week of a successful stent surgery. During recovery, doctors will prescribe antiplatelet drugs to help prevent blood clots from forming near the stent. Aspirin is an antiplatelet drug that a person will need to take daily for an indefinite period after having a stent inserted. Doctors may also recommend a drug called a P2Y inhibitor. P2Y inhibitors include clopidogrel, ticagrelor, and prasugrel. They will also provide the person with special recovery instructions, such as avoiding strenuous work or exercise while the body heals. Long-term use Most stents remain in the artery permanently to keep it open and prevent collapse and potentially life-threatening complications. Some stents are temporary. Doctors may use stents coated in particular medications that help break down plaque or prevent it from building up in the area. These stents will dissolve over time. While a stent may relieve symptoms, such as chest pain, it is not a cure for other underlying issues, such as atherosclerosis and coronary heart disease. Even with a stent, a person with these conditions may need to take steps to prevent further complications. Doctors will recommend healthy lifestyle changes after inserting a stent to help prevent plaque building up in the body. These recommendations often include: eating a healthful diet exercising regularly maintaining a healthy weight quitting smoking and tobacco use reducing stress Stents are often just one part of treatment. Doctors may also prescribe medications for any underlying conditions. If anyone experiences any bothersome side effects, it is best to talk to a doctor. They may recommend alternative medications or change the dose to help relieve side effects. Do not stop taking any medications without consulting a doctor first, however. Thank you for supporting Medical News Today Outlook Doctors commonly insert stents to widen arteries and prevent complications from coronary heart disease and other conditions. While a stent may provide relief, it is only one part of a treatment program. Even with a stent, it is possible for severe complications to occur. Always follow a doctor's advice about medications and recovery.
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Our guide to the Mediterranean diet

Many doctors and dietitians recommend a Mediterranean diet to prevent disease and keep people healthy for longer.

The Mediterranean diet emphasizes fruits, vegetables, and whole grains, and it includes less dairy and meat than a typical Western diet.

In this article, we explain what the Mediterranean diet is and provide a 7-day meal plan for people to follow.

What is a Mediterranean diet? Foods from a Mediterranean diet
A Mediterranean diet includes fresh produce and some healthful fats and oils.

Essentially, following a Mediterranean diet means eating in the way that the people in the Mediterranean region traditionally ate.

A traditional diet from the Mediterranean region includes a generous portion of fresh produce, whole grains, and legumes, as well as some healthful fats and fish.

The general guidelines of the diet recommend that people eat:

a wide variety of vegetables, fruits, and whole grains healthful fats, such as nuts, seeds, and olive oil moderate amounts of dairy and fish very little white meat and red meat few eggs red wine in moderation

The American Heart Association note that the average Mediterranean diet contains a high percentage of calories from fat.

Although more than half of the calories from fat come from monounsaturated fats, such as olive oil, the diet may not be right for people who need to limit their fat intake.

Thank you for supporting Medical News Today Building a meal plan The Mediterranean diet puts a higher focus on plant foods than many other diets. It is not uncommon for vegetables, whole grains, and legumes to make up all or most of a meal. People following the diet typically cook these foods using healthful fats, such as olive oil, and add plenty of flavorful spices. Meals may include small portions of fish, meat, or eggs. Water and sparkling water are common drink choices, as well as moderate amounts of red wine. People on a Mediterranean diet avoid the following foods: refined grains, such as white bread, white pasta, and pizza dough containing white flour refined oils, which include canola oil and soybean oil foods with added sugars, such as pastries, sodas, and candies deli meats, hot dogs, and other processed meats processed or packaged foods 7-day meal plan Here is an example of a 7-day Mediterranean diet meal plan: Day 1 Greek yoghurt with blueberries and walnuts
One breakfast option is greek yogurt with blueberries and walnuts. Breakfast one pan-fried egg whole-wheat toast grilled tomatoes For additional calories, add another egg or some sliced avocado to the toast. Lunch 2 cups of mixed salad greens with cherry tomatoes and olives on top and a dressing of olive oil and vinegar whole-grain pita bread 2 ounces (oz) of hummus Dinner whole-grain pizza with tomato sauce, grilled vegetables, and low-fat cheese as toppings For added calories, add some shredded chicken, ham, tuna, or pine nuts to the pizza. Day 2 Breakfast 1 cup of Greek yogurt One-half of a cup of fruits, such as blueberries, raspberries, or chopped nectarines For additional calories, add 1–2 oz of almonds or walnuts. Lunch Whole-grain sandwich with grilled vegetables, such as eggplant, zucchini, bell pepper, and onion To increase the calorie content, spread hummus or avocado on the bread before adding the fillings. Dinner one portion of baked cod or salmon with garlic and black pepper to add flavor one roasted potato with olive oil and chives Day 3 Breakfast 1 cup of whole-grain oats with cinnamon, dates, and honey top with low-sugar fruits, such as raspberries 1 oz of shredded almonds (optional) Lunch boiled white beans with spices, such as laurel, garlic, and cumin 1 cup of arugula with an olive oil dressing and toppings of tomato, cucumber, and feta cheese Dinner one-half of a cup of whole-grain pasta with tomato sauce, olive oil, and grilled vegetables 1 tablespoon of Parmesan cheese Day 4 Breakfast two-egg scramble with bell peppers, onions, and tomatoes top with 1 oz of queso fresco or one-quarter of an avocado Lunch roasted anchovies in olive oil on whole-grain toast with a sprinkling of lemon juice a warm salad comprising 2 cups of steamed kale and tomatoes Dinner 2 cups of steamed spinach with a sprinkling of lemon juice and herbs one boiled artichoke with olive oil, garlic powder, and salt Add another artichoke for a hearty, filling meal. Day 5 Breakfast 1 cup of Greek yogurt with cinnamon and honey on top mix in a chopped apple and shredded almonds Lunch 1 cup of quinoa with bell peppers, sun-dried tomatoes, and olives roasted garbanzo beans with oregano and thyme top with feta cheese crumbles or avocado (optional) Dinner 2 cups of steamed kale with tomato, cucumber, olives, lemon juice, and Parmesan cheese a portion of grilled sardines with a slice of lemon Day 6 Breakfast two slices of whole-grain toast with soft cheese, such as ricotta, queso fresco, or goat cheese add chopped blueberries or figs for sweetness Lunch 2 cups of mixed greens with tomato and cucumber a small portion of roasted chicken with a sprinkling of olive oil and lemon juice Dinner oven-roasted vegetables, such as: artichoke carrot zucchini eggplant sweet potato tomato toss in olive oil and heavy herbs before roasting 1 cup of whole-grain couscous Day 7 Breakfast whole-grain oats with cinnamon, dates, and maple syrup top with low-sugar fruits, such as raspberries or blackberries Lunch stewed zucchini, yellow squash, onion, and potato in a tomato and herb sauce Dinner 2 cups of greens, such as arugula or spinach, with tomato, olives, and olive oil a small portion of white fish leftover vegetable stew from lunch Thank you for supporting Medical News Today Snacks Avocado on toast
Avocado on toast is a healthful snack for people on a Mediterranean diet. There are many snack options available as part of the Mediterranean diet. Suitable snacks include: a small serving of nuts whole fruits, such as oranges, plums, and grapes dried fruits, including apricots and figs a small serving of yogurt hummus with celery, carrots, or other vegetables avocado on whole-grain toast Health benefits The Mediterranean diet receives a lot of attention from the medical community because many studies verify its benefits. The benefits of a Mediterranean diet include: Lowering the risk of cardiovascular disease Evidence suggests that a Mediterranean diet may reduce the risk of cardiovascular disease. A study that featured in The New England Journal of Medicine compared two Mediterranean diets with a control diet for almost 5 years. The research suggested that the diet reduced the risk of cardiovascular issues, including stroke, heart attack, and death, by about 30 percent compared with the control group. More studies are necessary to determine whether lifestyle factors, such as more physical activity and extended social support systems, are partly responsible for the lower incidence of heart disease in Mediterranean countries than in the United States. Improving sleep quality In a 2018 study, researchers explored how the Mediterranean diet affects sleep. Their research suggested that adhering to a Mediterranean diet may improve sleep quality in older adults. The diet did not seem to affect sleep quality in younger people. Weight loss The Mediterranean diet may also be helpful for people who are trying to lose weight. The authors of a 2016 review noted that people who were overweight or had obesity lost more weight on the Mediterranean diet than on a low-fat diet. The Mediterranean diet group achieved results that were similar to those of the participants on other standard weight loss diets. Thank you for supporting Medical News Today Summary Following a Mediterranean diet involves making long-term, sustainable dietary changes. Generally speaking, a person should aim for a diet that is rich in natural foods, including plenty of vegetables, whole grains, and healthful fats. Anyone who finds that the diet does not feel satisfying should talk to a dietitian. They can recommend additional or alternative foods to help increase satiety.
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