Wood Street Clinic Blog

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New 'triple pill' could eliminate high blood pressure

A new combination drug may have the potential to revolutionize hypertension treatment worldwide, after a clinical trial has declared it safe to use and very effective.
concept photo of heart pills and pulse
A recent clinical trial has confirmed that a new pill can treat hypertension more effectively than traditional therapy.

In a recent clinical trial led by researchers from the George Institute for Global Health — with branches in the United Kingdom, Australia, and India — they tested the effectiveness and safety of using an innovative drug for the treatment of high blood pressure, or hypertension.

This drug, nicknamed the "triple pill" by the investigators, combines low doses of three existing drugs for blood pressure.

Namely, these are: telmisartan (20 milligrams), amlodipine (2.5 milligrams), and chlorthalidone (12.5 milligrams).

According to World Health Organization (WHO) data from 2008, about 40 perecent of adults aged over 25 had raised blood pressure worldwide. The WHO also estimate that hypertension is responsible for 7.5 million of all deaths across the globe.

That is because this condition is a major risk factor for both heart disease and stroke, making it a priority to have effective treatments in place for the regulation of blood pressure.

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Normally, people with hypertension start taking one blood pressure drug at low doses, only to have to return to their doctors time and again. They then get prescriptions for increasingly higher doses and more hypertension drugs.

According to study co-author Dr. Ruth Webster, "Patients are brought back [to the doctor's office] at frequent intervals to see if they are meeting their targets with multiple visits required to tailor their treatments and dosage."

"The problem with this approach," she adds, is that it "is not only time inefficient, it's costly. We also know that many doctors and patients find it too complicated and often don't stick to the process."

So, Dr. Webster and colleagues tested a method that, they hoped, would be more efficient, would not have additional side effects, and would remove some of the inconveniences related to a traditional treatment.

This is how they came up with the "triple pill," which combines fixed low doses of three already existent drugs commonly used to treat hypertension.

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'Triple pill' vs. traditional therapy

The clinical trial testing the efficacy and safety of the new combination pill took place in Sri Lanka. It involved 700 participants — aged 56, on average — whose average blood pressure amounted to 154/90 millimeters of mercury (mm Hg), which is a typical sign of hypertension.

Of all the participants, some took the combination pill, while others continued to follow their usual blood pressure-lowering therapy, as per their doctors' advice.

In contrast to those following traditional therapy for hypertension, a larger number of those taking the combination pill were able to lower their blood pressure effectively, reaching their target pressure of 140/90 mm Hg or under.

The target for individuals with diabetes or kidney disease was 130/80 mm Hg, which many people taking the "triple pill" were able to reach.

More specifically, 70 percent of the people taking the "triple pill" achieved their target blood pressure, compared with a little over 50 percent of the participants who continued on traditional hypertension therapy.

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In the study paper they published in JAMA, the authors explain that after 6 months from the start of the trial, 83 percent of the people who had started on the "triple pill" were still following this same treatment.

To the contrary, most of the participants following a traditional treatment had added medication or increased drug quantities by the 6-month mark.

"The World Heart Federation [have] set an ambitious goal that by 2025 there will be a 25 percent reduction in blood pressure levels globally," says study co-author Prof. Anushka Patel.

"The triple pill," she continues, "could be a low-cost way of helping countries around the world to meet this target."

'This study has global relevance'

Researchers at the George Institute believe that their "triple pill" could really make a difference to current therapy for hypertension.

Right now, the team is looking into the combination drug's cost effectiveness for various countries and putting into place strategies to make the drug accessible across the world. "This study has global relevance," says Prof. Patel.

"While the most pressing need, from the perspective of the global burden of disease, is low- and middle-income countries, it's equally relevant in a country like Australia where we're still achieving only [40–50 percent] control rates for high blood pressure."

Prof. Anushka Patel

In the video below, you can listen to Prof. Patel as she explains exactly how the "triple pill" works.

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Foods to eat for better sex

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Barassi, A., Corsi Romanelli, M. M., Pezzilli, R., Damele, C. A. L., Vaccalluzzo, L., Goi, G., . . . Melzi d'Eril, G. V. (2017, February 8). Levels of L-arginine and L-citrulline in patients with erectile dysfunction of different etiology. Andrology, 5(2), 256–261. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/andr.12293/full

Cassidy, A., Franz, M., & Rimm, E. B. (2016, February 1). Dietary flavonoid intake and incidence of erectile dysfunction. The American Journal of Clinical Nutrition, 103(2), 534–541. Retrieved from https://academic.oup.com/ajcn/article/103/2/534/4564750

Davis, S. R., Worsley, R., Miller, K. K., Parish, S. J., & Santoro, N. (2016, February). Androgens and female sexual function and dysfunction – Findings from the Fourth International Consultation of Sexual Medicine [Abstract]. Journal of Sexual Medicine, 13(2), 168–178. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26953831

English, J. (2013, April 19). A natural approach to enhancing sexual libido and performance. Retrieved from https://nutritionreview.org/2013/04/arginine-select-phytonutrients-enhance-libido/

Fallah, A., Mohammad-Hasani, A., & Colagar, A. H. (2018, April–June). Zinc is an essential element for male fertility: A review of Zn roles in men's health, germination, sperm quality, and fertilization. Journal of Reproduction & Infertility, 19(2), 69–81. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010824/

Fulgoni III, V. L., Dreher, M., & Davenport, A. J. (2013, January 2). Avocado consumption is associated with better diet quality and nutrient intake, and lower metabolic syndrome risk in US adults: Results from the National Health and Nutrition Examination Survey (NHANES) 2001–2008. Nutrition Journal, 12(1). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545982/

Higdon, J. (2016, February). Flavonoids. Retrieved from https://lpi.oregonstate.edu/mic/dietary-factors/phytochemicals/flavonoids

Kaya, E., Sikka, S. C., & Gur, S. (2015, April). A comprehensive review of metabolic syndrome affecting erectile dysfunction [Abstract]. Journal of Sexual Medicine, 12(4), 856–875. Retrieved from https://onlinelibrary.wiley.com/doi/pdf/10.1111/jsm.12828

Kotta, S., Ansari, S. H., & Ali, J. (2013, January–June). Exploring scientifically proven herbal aphrodisiacs. Pharmacognosy Review, 7(13), 1–10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3731873/

Leung, K. W., & Wong, A. S. T. (2013, September 13). Ginseng and male reproductive function. Spermatogenesis, 3(3). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861174/

Maca. (2016, March 14). Retrieved from https://medlineplus.gov/druginfo/natural/555.html

Munglue, P., Kupittayanant, S., & Kupittayanant, P. (2014, January). Effects of watermelon (Citrullus lanatus) flesh extract on sexual behavior in male rats. Chiang Mai University Journal of Natural Sciences, 13(1), 12982. Retrieved from https://www.researchgate.net/publication/271073831_Effect_of_Watermelon_Citrullus_lanatus_Flesh_Extract_on_Sexual_Behavior_of_Male_Rats?enrichId=rgreq-984b664ec0ffa10d07f2aae94217a475-XXX&enrichSource=Y292ZXJQYWdlOzI3MTA3MzgzMTtBUzoxODczMjA2NjU5MTEyOThAMTQyMTY3MjEzNTcxMA%3D%3D&el=1_x_2&_esc=publicationCoverPdf

Steels, E., Rao, A., & Vitetta, L. (2011, September). Physiological aspects of male libido enhanced by standardized Trigonella foenum-graecum extract and mineral formulation [Abstract]. Phytotherapy Research, 25(9), 1294–1300. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/21312304

The American Heart Association's diet and lifestyle recommendations. (2018, April 17). Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.W1Y5Aa3Mwkg

Vecchio, M., Navaneethan, S. D., Johnson, D. W., Lucisano, G., Graziano, G., Querques, M., Saglimbene, V., … Strippoli, G. F. M. (2010, June). Treatment options for sexual dysfunction in patients with chronic kidney disease: A systematic review of randomized controlled trials. Clinical Journal of the American Society of Nephrology, 5(6), 985–995. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879298/

What is erectile dysfunction? (2018, June). Retrieved from http://www.urologyhealth.org/urologic-conditions/erectile-dysfunction?article=60

Zinc [Fact sheet]. (2018, March 2). Retrieved from https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/

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How much salt does it really take to harm your heart?

Too much salt is bad for you, particulary because it is associated with an increased risk of heart problems — but how much is too much? A new study suggests that we may not have to worry so much about how salty we like our food to be.
salt shaker
A new international study suggests that we may want to rethink how much salt is actually harmful.

Table salt, which we commonly use to season our food, contains sodium.

Sodium, if often ingested in large quantities, can lead to a range of cardiovascular problems, including hypertension.

The World Health Organization (WHO) say that a person should not consume more than 2 grams of sodium per day, which is about 5 grams of salt per day.

The American Heart Association (AHA) recommend no more than 2.5 grams of sodium per day, though they state that the ideal intake is of no more than 1.5 grams per day for an adult.

However, researchers from a range of international institutions — including McMaster University and Hamilton Health Sciences, both in Hamilton, Canada, as well institutions from 21 other countries — suggest that these limits are unnecessarily low.

Researcher Andrew Mente and colleagues conducted a study of 94,000 people aged 35–70, aiming to establish how much sodium really is too much for heart health.

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Current guidelines, the team notes, push for standards that are unrealistic for many, seeing as salt is often an almost invisible ingredient contained by numerous packaged foods.

"The [WHO recommend] consumption of less than 2 grams of sodium — that's one teaspoon of salt — a day as a preventative measure against cardiovascular disease," says Mente.

He also adds, however, that "there is little evidence in terms of improved health outcomes that individuals ever achieve at such a low level."

The new study, whose results are now featured in The Lancet, now suggests that we can be more lenient about our salt consumption without fearing that it will harm our cardiovascular health.

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Slightly higher sodium intake is safe

The study followed the participants — who were based in communities across 18 different countries — for an average period of 8 years.

Mente and his colleagues revealed that a high intake of sodium did lead to an increased risk of cardiovascular disease and stroke — but only in communities where the average intake for an adult was greater than 5 grams per day.

This amounts to about 2.5 teaspoons of table salt, the researchers explain.

Encouragingly, the researchers also noticed that under 5 percent of the participants coming from developed countries exceeded the 5-gram cutoff point for sodium intake.

In most of the countries, the majority of the communities that the researchers observed had an average sodium intake of 3–5 grams of sodium — or 1.5 to 2.5 teaspoons of salt — per day.

In fact, of all the populations in the study, only those from China showed a consistently high intake of sodium. Specifically, 80 percent of the communities from China had a sodium intake that was higher than 5 grams per day.

"Only in the communities with the most sodium intake — those over 5 grams [per] day of sodium — which is mainly in China, did we find a direct link between sodium intake and major cardiovascular events like heart attack and stroke," Mente explains.

On the other hand, he adds, "In communities that consumed less than 5 grams of sodium a day, the opposite was the case. Sodium consumption was inversely associated with myocardial infarction or heart attacks and total mortality, and [there was] no increase in stroke."

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Community interventions can help

Even in the case of individuals who do consume too much table salt, however, the situation is not unsalvageable, the researchers say.

Mente notes that people can easily redress the balance and protect their heart health by making a few simple adjustments to their diets, such as adding more fruits, vegetables, and foods naturally rich in potassium.

"We found all major cardiovascular problems, including death, decreased in communities and countries where there is an increased consumption of potassium which is found in foods such as fruits, vegetables, dairy foods, potatoes, and nuts and beans," says the study author.

Another one of the researches involved with the current study, Martin O'Donnell, notes that most of the studies looking at the relationship between sodium intake and cardiovascular risk so far have focused on individual data, rather than information collected from larger cohorts.

This, he suggests, may have skewed the best practice guidelines into a direction that is both unrealistic and perhaps too cautious.

"Public health strategies should be based on best evidence. Our findings demonstrate that community-level interventions to reduce sodium intake should target communities with high sodium consumption, and should be embedded within approaches to improve overall dietary quality."

Martin O'Donnell

"There is no convincing evidence that people with moderate or average sodium intake need to reduce their sodium intake for prevention of heart disease and stroke," O'Donnell adds.

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'Monster' radish might help fight heart disease

Discovering ways of reducing cardiovascular risk is an ongoing challenge for medical science. A recent study asks whether "monster" radishes might provide some assistance.
Radish heart shape
The Sakurajima radish dwarfs the regular radishes pictured here.

The official name for the so-called monster radish is the Sakurajima daikon.

Originally cultivated on the island of Sakurajima, Japan, centuries ago, it is an impressive beast.

The largest Sakurajima on record weighed almost 69 pounds, measuring well over 1 meter in circumference.

Radishes in general are known to contain high levels of antioxidants. Also, according to earlier studies, they may influence factors associated with heart attack and stroke — namely, increased blood pressure and the risk of blood clots.

Roughly 1 in 4 deaths are due to cardiovascular diseases, such as heart attack and stroke, so discovering a natural chemical that can reduce the risks would be a big win.

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Dissecting the monster radish

To date, no studies have investigated the potential cardiovascular benefits of the monster radish. So, recently, researchers from Kagoshima University in Japan set up a trial to see whether the radishes' health benefits are as sizable as its girth. The results were published recently in the Journal of Agricultural and Food Chemistry.

The team of scientists, led by Katsuko Kajiya, was particularly interested in the Sakurajima's influence over nitric oxide production, an important regulator of blood vessel function.

The cells that line blood vessels — vascular endothelial cells — produce nitric oxide; when this gas is released into the bloodstream, it causes blood vessels to relax, which reduces blood pressure.

Nitric oxide helps reduce cardiovascular risk in more than one way: white and red blood cells sometimes attach to blood vessel walls, which increases the risk of clots forming. Nitric oxide release prevents this from happening so freely.

Antioxidants are thought to damage endothelial cells, which reduces their ability to produce nitric oxide and therefore increases the risk of cardiovascular disease.

Uncovering interventions that can induce nitric oxide release from these cells would, therefore, have a protective effect on vascular health.

The team used vascular endothelial cells from both humans and pigs to pit Sakurajima daikon against other, less impressive types of radish. Using a range of tests, including fluorescence microscopy, the scientists demonstrated that the monster radish "induced more nitric oxide production" than its diminutive cousins.

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Radish compound identified

Kajiya also wanted to understand exactly how the Sakurajima daikon influences nitric oxide. After ruling out other potential compounds, including the neurotransmitter GABA, the team concluded that a plant hormone called trigonelline could be the main player.

Trigonelline seems to trigger a molecular cascade that boosts nitric oxide production. Interestingly, trigonelline is not a stranger to medical research, as the authors explain:

"The compound is found in coffee and some agricultural and marine products. [...] Trigonelline has been reported to reduce brain aging and Alzheimer-type dementias, and it has inhibitory effects on the invasion of cancer cells."

The compound may also be useful in the prevention of diabetes. It is present in a number of plants, including garden peas, hemp seed, oats, and potatoes. It might be that, over the coming years, we hear more about the potential uses of this chemical.

The authors of the new study hope that their results will be useful to scientists looking for active components in other vegetables.

Once the mechanism is understood in more detail, it could lead to much improved pharmaceutical interventions that slow the progression of cardiovascular disease or prevent it from developing in the first place.

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Can you have hypoglycemia without diabetes?

Hypoglycemia occurs when blood sugar levels fall dangerously low. It is more common in people with diabetes, but it can affect others.

In this article, we explore the health conditions beyond diabetes that can cause hypoglycemia. We also look at treatment options and the dietary changes that can help prevent low blood sugar.

What is hypoglycemia? Blood sugar
Hypoglycemia is when blood sugar levels are very low.

Hypoglycemia occurs when blood sugar levels drop below 70 milligrams per deciliter (mg/dl). Severe hypoglycemia can be life-threatening if a person does not receive treatment. Treatments focus on returning blood sugar to safe levels.

Blood sugar, or glucose, is the body's primary source of energy. When levels fall too low, the body does not have enough energy to function fully. This is called hypoglycemia.

Insulin helps the body's cells to absorb sugar from the bloodstream. A person with diabetes may take insulin shots because their body is resistant to insulin or because it does not produce enough.

In people with diabetes, taking too much insulin can cause blood sugar levels to drop too low. Not eating enough or exercising too much after taking insulin can have the same effect.

However, people who do not have diabetes can also experience hypoglycemia.

Thank you for supporting Medical News Today Causes of hypoglycemia without diabetes In people without diabetes, hypoglycemia can result from the body producing too much insulin after a meal, causing blood sugar levels to drop. This is called reactive hypoglycemia. Reactive hypoglycemia can be an early sign of diabetes. Other health issues can also cause hypoglycemia, including: Drinking too much alcohol When a person's blood sugar levels are low, the pancreas releases a hormone called glucagon. Glucagon tells the liver to break down stored energy. The liver then releases glucose back into the bloodstream to normalize blood sugar levels. Drinking too much alcohol can make it difficult for the liver to function. It may no longer be able to release glucose back into the bloodstream, which can cause temporary hypoglycemia. Medication Taking another person's diabetes medication can cause hypoglycemia. Hypoglycemia can also be a side effect of: Some groups have an increased risk of medication-induced hypoglycemia, including children and people with kidney failure. Anorexia A person with the eating disorder anorexia may not be consuming enough food for their body to produce sufficient glucose. Hepatitis Hepatitis is an inflammatory condition that affects the liver. Having hepatitis can prevent the liver from working properly. If the liver cannot produce or release enough glucose, this can cause problems with blood sugar levels and lead to hypoglycemia. Adrenal or pituitary gland disorders Problems with the pituitary gland or adrenal glands can cause hypoglycemia because these parts of the body affect the hormones that control glucose production. Kidney problems The kidneys help the body process medication and excrete waste. If a person has a problem with their kidneys, medication can build up in their bloodstream. This type of buildup can change blood sugar levels and lead to hypoglycemia. Pancreatic tumor Pancreatic tumors are rare, but having one can lead to hypoglycemia. Tumors in the pancreas can cause the organ to produce too much insulin. If insulin levels are too high, blood sugar levels will drop. Symptoms Dizzy and confused senior woman outdoors.
Dizziness and confusion can be symptoms of hypoglycemia. When a person has hypoglycemia, they may feel: shaky dizzy unable to concentrate unable to focus their eyes confused moody hungry A person with hypoglycemia may develop a headache or pass out (lose consciousness). If a person has hypoglycemia often, they may stop experiencing symptoms. This is called hypoglycemia unawareness. Thank you for supporting Medical News Today Diagnosis To diagnose hypoglycemia, a doctor first asks a person about their symptoms. If the doctor suspects hypoglycemia, they may perform a blood test. Blood sugar levels below 70 mg/dl can indicate hypoglycemia. However, everyone has a different base blood sugar level, and the measurement that determines hypoglycemia can vary. The doctor may use other tests to determine the underlying cause of low blood sugar. Treatment Pink round tablet supplements
Glucose tablets can help to raise blood sugar levels. Treating the underlying cause is the best way to prevent hypoglycemia in the long term. In the short term, receiving glucose helps blood sugar levels return to normal. According to research from 2014, the best way to treat mild hypoglycemia is to: take 15 grams of glucose wait for 15 minutes measure blood glucose levels again repeat this treatment if hypoglycemia persists There are many ways to receive glucose, including: taking a glucose tablet injecting glucose drinking fruit juice eating carbohydrates Eating slow-release carbohydrates may help sustain blood sugar levels. Thank you for supporting Medical News Today Non-diabetic hypoglycemia diet A non-diabetic hypoglycemia diet can help keep blood sugar levels balanced. The following tips can help to prevent hypoglycemia: eating small meals regularly, rather than three large meals eating every 3 hours eating a variety of foods, including protein, healthful fats, and fiber avoiding sugary foods Carrying a snack to eat at the first sign of hypoglycemia can prevent blood sugar levels from dipping too low. Ultimately, the best way to prevent hypoglycemia is to identify and treat the underlying cause.
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What is the difference between heartburn and acid reflux?

Understanding the differences between heartburn, acid reflux, and gastroesophageal reflux disease involves understanding the links between them.

According to the American College of Gastroenterology, heartburn is a common digestive complaint in the United States, affecting more than 60 million Americans each month.

Heartburn is not a condition on its own, and it has nothing to do with the heart. Instead, it is a symptom of acid reflux.

If symptoms of acid reflux occur frequently, it can indicate that a person has gastroesophageal reflux disease (GERD).

Distinguishing between heartburn, acid reflux, and GERD may be hard, because they may all feel the same in the moment. However, understanding the differences can help a person find the right treatment.

Symptoms The following symptoms can help a person to tell the difference between acid reflux, heartburn, and GERD: Symptoms of acid reflux Heartburn vs. acid reflux
Acid reflux causes stomach acid to travel up the food pipe into the mouth.

Acid reflux is sometimes called gastroesophageal reflux or GER. It occurs when stomach acid travels up the food pipe to the mouth.

This can happen when the muscle at the bottom of the food pipe, which acts as a gateway to the stomach, becomes weak or loose.

Heartburn is a burning sensation in the chest or abdomen, and it has nothing to do with the heart. People often feel heartburn behind the breastbone and after eating. It can get worse when sitting or lying down.

Heartburn is the most common symptom of acid reflux, though it does not appear in every case.

Acid reflux also causes the following symptoms:

bad breath nausea or vomiting difficulty or pain when swallowing breathing problems

Symptoms of GERD

GERD is the term for chronic acid reflux. The symptoms are the same, but they happen more frequently with GERD.

If a person experiences symptoms of acid reflux more than twice a week for a few weeks, they may have GERD. The disease affects about 20 percent of the U.S. population.

Causes The stomach is built to withstand acid. The food pipe is not, and when acid rises into it, a person experiences burning pain. The muscle at the end of the food pipe is called the lower esophageal sphincter. It can weaken or relax, and potentially cause acid reflux, for several reasons. For example, high amounts of pressure on the abdomen can cause the sphincter to grow slack. For this reason, acid reflux is common in people who are overweight, obese, or pregnant. Other causes of acid reflux involve: smoking or regular exposure to secondhand smoke alcohol consumption a type of hernia called a hiatal hernia eating large meals eating late at night or just before bed consuming high-fat or fried foods acidic drinks, such as fruit juice Various medications can also trigger acid reflux, including: Thank you for supporting Medical News Today Heartburn vs. heart attack Heartburn vs. acid reflux chest pain
Seek medical care immediately if chest pain accompanies shortness of breath and a squeezing feeling. Chest pain and related symptoms are among the top reasons for visits to emergency departments in the U.S. Acid reflux is a common cause of chest pain, and it can be easy to confuse this pain with that of a heart attack. Because heartburn can spread to the neck, throat, and jaw, it may feel like the radiating chest pain of a heart attack. There are a few ways to tell the difference between heartburn and a heart attack. If the pain improves after a quick antacid or a belch, or if there is a sour taste in the mouth, a person most likely has heartburn. A person having a heart attack often experiences a feeling of squeezing or pressure and shortness of breath. Due to the seriousness of a heart attack, The American Heart Association recommend that anyone who believes they may be having a heart attack should seek medical care as soon as possible. This includes people who are unsure whether their chest pain results from a heart. Diagnosis A doctor is a good place to start for an acid reflux or GERD diagnosis. Assessments typically begin with a few questions and a review of the person's medical history. The doctor may suggest changes to the diet or medications because these can influence symptoms. If the symptoms persist, especially any related to swallowing, the doctor may work with a gastroenterologist, surgeon, or another healthcare professional to confirm a diagnosis. Tests that can help diagnose GERD include: Upper gastrointestinal (GI) endoscopy and biopsy. A doctor inserts a thin, tube-like camera down the food pipe to look inside the stomach and perhaps take a tissue sample. Upper GI series. A doctor checks X-rays to see whether something inside the body, such as a hernia, is causing the acid reflux. Esophageal pH and impedance monitoring. The doctor places a thin tube inside the food pipe for about 1 day to measure acid levels. Bravo wireless esophageal pH monitoring. The doctor monitors acid levels using a small capsule inside the food pipe and a receiver outside the body. Esophageal manometry. This allows the doctor to measure muscle contractions in the food pipe. Complications If a person does not receive treatment for GERD, it can lead to more severe complications, including: esophagitis, or inflammation of the food pipe narrowing of the food pipe that causes trouble swallowing respiratory problems, such as pneumonia or laryngitis Barrett's esophagus, a condition that causes cells in the food pipe to change. Without treatment, this can potentially lead to cancer. Thank you for supporting Medical News Today Treatment and prevention Heartburn vs. acid reflux antacids
Antacids neutralize stomach acid and may reduce the symptoms of acid reflux. Acid reflux and GERD are treatable with medications, lifestyle changes, or both. Some medications for acid reflux include: Antacids, which neutralize stomach acid. Options include Tums, Rolaids, Pepto-Bismol, and Mylanta. Many brands can be purchased online. H2 blockers, which reduce acid production. Options include Pepcid, Zantac, Axid, and Tagamet. Proton pump inhibitors, a group of longer-term prescription medications that can reduce stomach acid. Options include Nexium, Prevacid, and Prilosec. Prokinetics, a type of prescription drug that helps to empty the stomach more quickly. Options include Reglan and Urecholine. People with acid reflux or GERD can manage symptoms by taking steps to avoid triggers. Start by avoiding some or all of the following: fried and fatty foods large meals smoking alcohol coffee tomatoes and tomato products spicy food peppermint citrus fruits and juices Weight loss can also help to reduce symptoms, as it decreases pressure on the food pipe. People should also try not to eat late at night or lie down soon after eating. In serious cases of GERD, surgery may help to strengthen the muscles in the gut. Children and pregnancy Children, adolescents, and pregnant women often experience acid reflux. Heartburn may occur with 17 to 45 percent of pregnancies. Fortunately, over-the-counter heartburn and acid reflux treatments tend to be safe to use during pregnancy. About 10 percent of teenagers and pre-teens experience GERD, according to the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. The symptoms, diagnosis, and treatments for children with GERD are similar to those for adults. Check with a pediatrician to learn more. When to see a doctor If acid reflux occurs on a regular basis, use an antacid, and try different brands if the first is ineffective. Also, try making lifestyle changes, such as eliminating certain foods or drinks from the diet. If the acid reflux still recurs after making these changes, it may be time to call the doctor. Although chest pain is often a symptom of acid reflux or GERD, do not hesitate to visit the doctor or the emergency room if it seems more serious. Sometimes GERD symptoms warrant urgent attention. A person experiencing any of the following should seek immediate medical care: regular, forceful vomiting persistent upper body pain difficulty breathing difficulty swallowing Outlook The relationship between heartburn and acid reflux is that of a symptom and its cause. Heartburn is a painful, common problem that can affect a person's quality of life. To eliminate it, a person needs to treat the underlying cause, which is acid reflux. Manage symptoms of acid reflux by avoiding the many potential triggers. If acid reflux goes unchecked or untreated, it may develop into GERD.
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Experts advise 'healthful range' rather than 'variety of foods'

Advising people to have a varied diet could encourage them to eat foods that are not so good for their health in addition to those that are.
a selection of healthful foods
The term 'a range of healthful foods' could be less misleading than 'a varied diet,' a new statement suggests.

Instead, the emphasis should be on "health[ful] eating patterns" with sufficient amounts of vegetables, fruits, whole grains, pulses, nuts, seeds, low-fat dairy foods, and vegetable oils, while limiting consumption of red meats, sugar-sweetened drinks, and sweets.

This is the main message of a new scientific statement from the American Heart Association, which they have now published in the journal Circulation.

The statement includes a review of studies that have investigated links between consuming a "wide range of foods" and obesity, eating, and diet quality.

Public health bodies in the United States and elsewhere have long advocated "dietary diversity" — or "eating a variety of foods" — as a way to ensure adequate nutrition and keep down the risk of "major chronic diseases."

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'Little consensus on dietary diversity'

However, the authors note that there is "little consensus" on what is meant by dietary diversity, and also on whether it is a healthful goal and how it should be measured.

Also, studies that have followed people over time have recently published evidence to suggest that "greater dietary diversity" is tied to less-than-ideal patterns of eating that "may be associated with weight gain and obesity in adult populations."

Such patterns feature, for example, higher consumption of refined grains, processed foods, and sugary drinks, while fruit, vegetables, fish, and other "minimally processed foods" tend to be consumed less.

To investigate this further, the authors reviewed and analyzed scientific papers on the subject that were published in 2000–2017.

This work revealed that there was insufficient information on which aspects of dietary diversity can help and hinder healthy weight.

They also found evidence that meals that contain a "wider variety of food options" could be less satiating. This promotes over-eating because people then eat more than they need to feel full.

There is some, but not a lot, of evidence to suggest that "greater dietary diversity" could also be tied to adults consuming more calories, putting on weight, and adopting "poor eating patterns."

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'Choose range of healthful foods'

Therefore, the team concluded that instead of "eating a variety of foods," the emphasis should be on: "adequate intake of plant foods, protein sources, low-fat dairy products, vegetable oils, and nuts and limits consumption of sweets, sugar-sweetened beverages, and red meats," write the authors.

Choosing and sticking to "a range of health[ful] foods" that suits personal taste or budget may be a better way to keep to a healthy weight, says Dr. Marcia C. de Oliveira Otto, the lead author of the statement.

This would be more effective, she suggests, "than choosing a greater range of foods that may include less health[ful] items such as donuts, chips, fries, and cheeseburgers, even in moderation."

Dr. Otto is assistant professor of epidemiology, human genetics, and environmental science at the University of Texas Health Science Center in Houston.

She and her colleagues give the Dietary Approaches to Stop Hypertension (DASH) diet as a good example of a healthful eating pattern.

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The DASH diet

The DASH diet is described as a "flexible eating plan" that advises "daily and weekly nutritional goals," rather than eating special foods.

For example, for a 2,000-calorie per day eating plan, the DASH diet recommends:

six to eight daily servings of grains six or fewer servings of meat, fish, and poultry four to five servings of vegetables four to five servings of fruit two to three servings of fat-free or low-fat dairy foods two to three servings of fats and oils 2,300 milligrams of sodium — or even better, 1,500 milligrams four to five weekly servings of dried bean, peas, nuts, and seeds no more than five servings per week of sweets

"Eating a more diverse diet might be associated with eating a greater variety of both health[ful] and unhealth[ful] foods. Combined, such an eating pattern may lead to increased food consumption and obesity."

Dr. Marcia C. de Oliveira Otto

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How red blood cells harm cardiovascular health in diabetes

People with type 2 diabetes are more exposed to cardiovascular injury and recover with more difficulty from events such as heart attacks. Still, it has so far been unclear why that is, exactly. Two new studies now explain the causes.
red blood cells concept
Researchers investigate why people with type 2 diabetes are more exposed to cardiovascular injury.

According to the National Institute of Diabetes and Digestive Kidney Diseases, an estimated 23.1 million people in the United States have type 2 diabetes.

This is a metabolic disease in which the pancreas does not produce enough of the hormone tasked with keeping blood sugar levels in check.

The Centers for Disease Control and Prevention (CDC) note that people with type 2 diabetes face twice the risk of heart disease and stroke, compared with those who are free of diabetes. They are also exposed to cardiovascular risks at an earlier age, say the CDC.

However, the reasons why people with diabetes are more exposed to cardiovascular harm have remained largely unclear, which also means that there is currently no specific preventive treatment.

Now, scientists from the Karolinska Institutet in Stockholm, Sweden, have conducted a series of studies to further investigate the causes of cardiovascular risk in diabetes.

They have revealed that red blood cells undergo certain changes in the case of people with type 2 diabetes, which means that those individuals are more predisposed to heart problems and less well equipped to recover following a cardiovascular event.

These findings now appear in two related papers: the first one published in The Journal of the American College of Cardiology, and the second one in JACC: Basic to Translational Science.

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'Damage to the innermost cell layers'

In the first paper, the authors report that when otherwise healthy blood vessels come into contact with red blood cells taken from people with diabetes, the vessels' tissue became damaged.

"We found that healthy blood vessels exposed to red blood cells from patients with type 2 diabetes suffer damage to their innermost cell layers, the endothelial cells."

Study co-author Prof. John Pernow

"This phenomenon, which is called endothelial dysfunction, appears early on in the development of diabetes-related vessel injury and greatly reduces the ability of the vessels to dilate while aggravating the inflammation," Prof. Pernow explains.

In the second published paper, the research team explains how red blood cells affect heart health and predispose individuals to greater harm in the case of a heart attack.

Prof. Pernow and colleagues conducted experiments using red blood cells from mouse models of diabetes, as well as from human patients with this condition. They ascertained that the increased injury occurs due to the abnormal activity of the enzyme arginase.

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Findings may lead to preventive therapy

Overactive arginase can impair the production of the free radical nitric oxide, which would normally help blood vessels dilate. It also increased the production of other harmful free radicals within red blood cells.

These findings also allowed the researchers to come up with a solution to address the problem.

"We also found," says Prof. Pernow, "that treatment that targeted arginase or oxygen-derived free radicals normalised red blood cell function, which meant that their harmful effect on cardiovascular function could be prevented."

In the future, the team hopes that this will eventually lead to new preventive treatments, which would — as far as possible — eliminate the risk of cardiovascular harm in type 2 diabetes.

"Our hope," Prof. Pernow adds, "is that this knowledge will give rise to new treatments, specifically targeted at red blood cells, that prevent vascular injury and protect the heart in the event of heart attack in patients with type 2 diabetes."

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Too much sleep could be worse for health than too little

Sleeping more or less than 7–8 hours per night could be bad for your health, with too much sleep being worse than too little, say researchers.
young woman sleeping
Both too much and too little sleep can lead to poor health.

An analysis of pooled data from dozens of studies covering more than 3 million people finds that self-reported sleep duration outside of 7–8 hours each night is linked to a higher risk of death and cardiovascular diseases.

The study — which scientists at Keele University in the United Kingdom led and which is now published in the Journal of the American Heart Association — found a "J-shaped" relationship between duration of sleep and deaths. The same relationship was observed with incidents of cardiovascular illness.

The authors say that their findings suggest that sleeping for more than 7–8 hours "may be associated with a moderate degree of harm" compared with sleeping less.

The J-shaped relationship showed that the size of the risk rose in line with greater duration of sleep. Sleeping for 9 hours, for example, carried a 14 percent higher risk of death, while 10-hour sleeps carried a 30 percent higher risk.

The results also showed that poor-quality sleep was linked to a 44 percent higher risk of coronary heart disease.

"Our study," says lead study author Dr. Chun Shing Kwok, a clinical lecturer in cardiology at Keele University, "has an important public health impact in that it shows that excessive sleep is a marker of elevated cardiovascular risk."

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Cardiovascular diseases and events

Cardiovascular disease is an umbrella term for disorders of the heart and blood vessels. The heart provides the pressure for pumping the blood through the vessels that carry it to all parts of the body.

Some of the diseases overlap due to a common underlying condition. Atherosclerosis, for example, is an inflammatory condition in which plaque builds up in artery walls and restricts blood flow. This can lead to heart disease, heart attack, and stroke.

Heart failure, in which the heart does not pump enough blood to meet the body's needs, is another type of cardiovascular disease. Abnormal heartbeat, or arrhythmia, and defective heart valves are also classed as cardiovascular diseases.

In the United States, where 610,000 people die of it every year, heart disease is the primary cause of death in men and women.

Also, every year in the U.S., around 735,000 people experience a heart attack. This number includes 210,000 people for whom it is not their first.

In their analysis, the researchers focused on links between sleep, rates of death, and cardiovascular events such as heart attack, stroke, and coronary heart disease.

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Sleep duration and quality

In their study paper, the researchers explain that while there appears to be "growing evidence" to support the idea, current guidelines for reducing the risk of cardiovascular diseases "make limited recommendations" about duration and quality of sleep.

The National Sleep Foundation's latest guidelines recommend 7–9 hours of sleep every night for adults aged 26–64, and 7–8 hours for older people.

For their study, the researchers used 7–8 hours as the recommendation against which to compare the various results.

They note that while previous studies had examined the relationship between hours of sleep, deaths, and cardiovascular disease, they had not evaluated the effect of each hour of increase or decrease on the relationship. Also, none had evaluated the effect of sleep quality.

They suggest that their findings are significant because they highlight a problem with longer as opposed to shorter sleep, and that the greater the duration of sleep, the more severe the problem appears to be.

They also note that their study is the first to declare sleep quality as a risk factor for coronary heart disease and suggest that doctors should take into account "nonrestorative sleep (or 'waking up unrefreshed')" when they assess their patients.

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Mechanisms are poorly understood

The biology of the relationship between sleep duration, sleep quality, and cardiovascular diseases and mortality is unclear. Those who have studied it conclude that it is complex and involves many factors that interact with each other.

There is some evidence that insufficient sleep raises levels of the energy and appetite hormones leptin and ghrelin and that this can lead to obesity and impaired control of blood sugar. Reduced sleep can also promote inflammation, which some have linked to cardiovascular diseases and cancer.

Too much sleep may be linked to cardiovascular diseases because of existing conditions that increase fatigue. These include persistent inflammatory conditions and anemia.

Scientists also tie low physical activity, depression, unemployment, and low socioeconomic status to longer sleep. These may contribute to, but they could also mask, the link between longer sleep duration and cardiovascular disease and risk of death.

Dr. Kwok remarks that in modern society sleep is subject to many "cultural, social, psychological, behavioral, pathophysiological, and environmental influences."

These influences arise for many different reasons. He lists examples ranging from caring for children and other relatives, to shift-working, mental and physical illnesses, and the "24-hour availability of commodities."

"Our findings have important implications as clinicians should have greater consideration for exploring sleep duration and quality during consultations."

Dr. Chun Shing Kwok

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How 30 minutes of hookah smoking affects your heart

Smoking traditional cigarettes causes a range of serious health issues, but many people think alternatives such as electronic cigarettes or waterpipe smoking are less harmful. The conclusions of a new study dispel such beliefs.
hookah smoking
A new study shows that only 30 minutes of hookah smoking has serious cardiovascular consequences.

The practice of hookah smoking, or waterpipe smoking, has been around for centuries.

Originating in Africa and Asia, hookah smoking has become a worldwide phenomenon in the past few decades — particularly among teenagers.

The practice is widely perceived and marketed as a safer alternative to traditional cigarettes.

However, the World Health Organization (WHO) warn that "contrary to ancient lore and popular belief, the smoke that emerges from a waterpipe contains numerous toxicants known to cause lung cancer, heart disease, and other diseases."

A new study conducted by researchers at the University of California Los Angeles (UCLA) supports the WHO's conclusion. Specifically, the researchers show the effects of just one session of hookah smoking on heart rate, blood pressure, and arterial stiffness.

The researchers — led by Mary Rezk-Hanna, an assistant professor at UCLA — published their findings in the American Journal of Cardiology.

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Hookah smoking and cardiovascular health

Rezk-Hanna and her colleagues investigated the cardiovascular effects of hookah smoking in 48 healthy young adults who were not in the habit of smoking traditional cigarettes.

To examine these effects, the researchers took the following measurements: heart rate, peripheral and central blood pressure, a measure of arterial stiffness called "carotid-femoral pulse wave velocity," and an index of aortic enlargement.

Arterial stiffness, or the loss of arterial elasticity, is a reliable predictor of stroke. The enlargement of the aorta — which is the main artery that transports blood from the heart to the rest of the body — is a condition that can be fatal if left untreated.

Both aortic enlargement and artery stiffness can increase the risk of heart attack and other adverse cardiovascular events.

In the new study, the researchers also looked at blood levels of nicotine, as well as the levels of exhaled carbon monoxide.

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Not a more healthful alternative to cigarettes

After only 30 minutes of hookah smoking, the participants' heart rates increased by 16 beats per minute, and their blood pressure rose.

Additionally, the researchers found hookah smoking to heighten arterial stiffness to a degree comparable with the damage caused by smoking one traditional cigarette.

The results are concerning given that the study tested only the effects of half an hour of smoking, whereas most people smoke hookahs for several hours.

The authors report additional concerns. "We know that flavored tobacco products are frequently the first kind of tobacco product used by youth," says the study's lead author.

"One of the major issues with hookah is the fact that the tobacco is flavored with fruit, candy, and alcohol flavors, making hookah the most popular flavored tobacco product among this audience."

"Our findings challenge the concept that fruit-flavored hookah tobacco smoking is a healthier tobacco alternative. It is not."

Mary Rezk-Hanna

To the authors' knowledge, this is the first time that a study has examined the effects of hookah smoking on the elasticity of the arteries.

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Scientists link 151 genes to atrial fibrillation

Using genomic data from more than 1 million people, scientists have picked out 151 genes that are likely associated with atrial fibrillation, which is a condition that causes irregular heartbeat and raises the risk of stroke.
female genetic scientists in a lab
New research uncovers 151 genes linked to A-fib.

The findings of the "big data" international study — now published in the journal Nature Genetics — should improve our understanding of the biology of atrial fibrillation (A-fib) and lead to better treatments.

They could also "have important implications for precision health and prevention of cardiovascular disease," says co-senior study author Cristen J. Willer, an associate professor of computational medicine and bioinformatics at the University of Michigan in Ann Arbor.

From the genes that they identified, the researchers compiled a genetic "risk score" for helping to pick out individuals at higher risk for A-fib for closer monitoring.

Many of the genes influence heart development in the fetus. The team says that this implies that variants in these genes could instil susceptibility to A-fib before birth.

Another possibility is that they could cause genes that have been inactive since before birth to switch on again in adulthood.

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A-fib needs new treatments

Around 2.2 million people in the United States have A-fib, a condition in which the left side of the heart's upper chamber, or atrium, beats irregularly. This causes blood to pool and raises the likelihood of blood clots.

If a blood clot forms in the atrium, it can travel to the brain and block one of its arteries, giving rise to a stroke. This is why having A-fib raises a person's risk of stroke by an average of four to six times.

Some people with A-fib experience symptoms such as chest pain, fluttering in the chest, fatigue, fainting, and shortness of breath. Others have none.

The earlier A-fib is detected, the greater the chances of preventing stroke, heart failure, and other complications.

However, there are few current options for treating A-fib, and those that do exist rarely cure it and often result in grave side effects.

Willer and her colleagues claim that it is likely that 32 of the 151 genes that they identified interact with drugs already approved for treating other conditions.

They suggest that their findings provide a foundation for further research into whether or not such drugs can prevent or cure A-fib.

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Data from several biobanks

The researchers carried out a genome-wide association study on data pooled from six studies. The datasets came from a number of "biobanks" in different countries. These included datasets from: AFGen Consortium, DiscovEHR, Michigan Genomics Initiative, UK Biobank, deCODE Genetics in Iceland, and the HUNT study in Norway.

By using a collaborative big data approach, the researchers believe that they were able to identify genes that do not emerge from analyses of individual datasets.

They note that many of the risk variants they identified are located near genes where more harmful mutations "have been reported to cause serious heart defects in humans [...] or near genes important for striated muscle function and integrity."

They also discovered that people who develop A-fib early in life carry more of the risk genes than those who develop it later.

The team concludes that, while the findings are significant, further studies now need to confirm them.

"We are hopeful that additional molecular biology experiments will determine how to create sustained regular heart rhythms by studying the genes we and others have identified."

Cristen J. Willer

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Targeting gut bacteria to reduce heart disease

A new drug that blocks the production of one chemical by gut bacteria significantly reduces cardiovascular risk factors.
Gut bacteria among villi
Blocking a gut bacteria enzyme could improve heart health.

Gut bacteria are intrinsically linked with the health of our entire body. Be it the gut, the brain, or the heart, our microbiome is involved.

One important way in which they influence our health is through the chemicals that they produce and release.

Some of these can leach into our blood, and, once in the circulatory system, travel far and wide.

Although we are very far from understanding the full range of influences that our bacterial residents have on cardiovascular health, researchers from the Cleveland Clinic in Ohio are focusing on one in particular.

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Gut bacteria and the heart

Led by Dr. Stanley Hazen, Ph.D., the Cleveland researchers are interested in a particular chemical called atrimethylamine N-oxide (TMAO), which gut bacteria produce.

When gut bacteria break down choline, lechithin, and carnitine — compounds found in particularly high levels in high-fat dairy producs, egg yolk, liver, and red meat — the process produces TMAO.

Previous studies by Dr. Hazen and team demonstrated that TMAO levels are powerful predictors of future cardiovascular disease, including stroke and heart attack.

They showed that this increase in risk is due to TMAO's ability to increase platelet reactivity, or how "sticky" platelets are, and thrombosis, or clotting potential.

The researchers wanted to see whether they could interfere with the bacteria to prevent or reduce TMAO production in a mouse model. They published their findings in the journal Nature Medicine.

To influence TMAO levels, they used a choline analog — a compound structurally similar to choline, which is an essential chemical in the manufacture of TMAO. Because bacteria use choline as an energy source, they absorb the analog readily.

Once the analog enters the bacteria, it blocks the production of TMAO by inhibiting the enzyme choline utilization protein C. As expected, this reduced circulating TMAO levels significantly.

In fact, one oral dose of the inhibitor reduced TMAO levels for 3 days. It also lowered platelet responsiveness and excessive clot formation following arterial injury.

Commonly, drugs that reduce clot formation also increase the risk of excessive bleeding. With this inhibitor, that was not the case.

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A novel approach

Importantly, this experimental approach does not kill gut bacteria; it simply removes their ability to produce TMAO. Compared with antibiotics that indiscriminately destroy potentially useful gut bacteria, this novel technique could be a game-changer.

"To our knowledge, this is the most potent therapy to date for 'drugging' the microbiome to alter a disease process. In addition, gut bacteria are altered but not killed by this drug, and there were no observable toxic side effects."

Dr. Stanley Hazen, Ph.D.

This is an entirely new way of interacting with the microbiome and the team plans to continue traveling down this exploratory road; Dr. Hazen believes that eventually, with some tweaks, it "could potentially be used to target other gut microbial pathways."

The path will be a long one, but the team is looking forward "to advancing this novel therapeutic strategy into humans."

With so many boxes ticked — the drug is not toxic, has no side effects, and does not add to antibiotic resistance — this new methodology is likely to receive a great deal of interest. We eagerly await the results of clinical trials.

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Even low air pollution may cause you serious heart problems

A new study that appears in the journal Circulation looks at the effects of low levels of pollution on the anatomy of the heart.
cars in traffic
Living next to a busy road may cause you serious heart problems, a new study suggests.

The perils of air pollution are real and plentiful. Two years ago, a study published in The Lancet Neurology claimed that air pollution was one of the leading risk factors for stroke worldwide.

Also, even low levels of pollution seem to be very harmful. Medical News Today recently reported on a study that linked levels of air pollution deemed "safe" by the Environmental Protection Agency (EPA) with a high risk of diabetes.

Now, Steffen Petersen — a professor of cardiovascular medicine at Queen Mary University of London in the United Kingdom — has led a new study that suggests that low levels of air pollution may cause changes in the heart that are similar to those seen in heart failure.

Dr. Nay Aung, who is also affiliated with Queen Mary University, is the first and corresponding author of the paper.

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Air pollution may cause heart enlargement

Dr. Aung and colleagues examined data on over 3,900 healthy people enrolled in the UK Biobank study.

The participants volunteered information about their health, residential area, and lifestyle, and they allowed the researchers to take measurements of their hearts' size, weight, and function using MRI.

The study revealed a strong correlation between living next to a busy road and therefore being exposed to nitrogen dioxide (NO2) and developing enlarged right and left heart ventricles.

The researchers note that ventricle enlargement of this type is often seen in the early stages of heart failure.

Furthermore, Dr. Aung and team found a dose-response relationship between pollution exposure and changes in heart anatomy.

Using fine particulate matter (PM2.5) to measure air pollution particles, the scientists found that the heart ventricles enlarged by 1 percent for every microgram of PM2.5 per cubic meter and for every 10 micrograms per cubic meter of NO2.

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Air pollution just as important as cholesterol

Dr. Aung comments on the findings, saying, "Although our study was observational and hasn't yet shown a causal link, we saw significant changes in the heart, even at relatively low levels of air pollution exposure."

"Air pollution should be seen as a modifiable risk factor," the first author adds.

"Doctors and the general public all need to be aware of their exposure when they think about their heart health, just like they think about their blood pressure, their cholesterol, and their weight."

Dr. Nay Aung

"Our future studies," says Dr. Aung, "will include data from those living in inner cities like Central Manchester and London, using more in-depth measurements of heart function, and we would expect the findings to be even more pronounced and clinically important."

Prof. Jeremy Pearson, the associate medical director at the British Heart Foundation — a nonprofit organization that partially funded the study — also weighs in on the findings.

"We can't expect people to move home to avoid air pollution," he says. "Governments and public bodies must be acting right now to make all areas safe and protect the population from these harms."

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What is the Valsalva maneuver?

The Valsalva maneuver is a particular way of breathing that increases pressure in the chest. It causes various effects in the body, including changes in the heart rate and blood pressure.

People may perform the maneuver regularly without knowing it. For example, they may use it when they push to initiate a bowel movement.

However, this technique can also be beneficial when people use it intentionally as it can regulate heart rhythms and help the ears to pop.

The physician Antonio Maria Valsalva first described the technique in the 1700s as a way to clear pus out of the ears.

How to do the Valsalva maneuver Person holding their breath and their nose for valsalva maneuver
The Valsalva maneuver involves holding the breath.

To do the Valsalva maneuver, follow these steps:

Inhale deeply and then hold your breath. Imagine that the chest and stomach muscles are very tight and bear down as though straining to initiate a bowel movement. Hold this position for a short time, usually about 10 seconds. Breathe out forcibly to release the breath rapidly. Resume normal breathing.

An alternative method involves lying down and blowing into an empty syringe for 15 seconds.

The Valsalva maneuver creates numerous effects in the body because it builds up the pressure in the pleural cavity, known as the intrapleural pressure.

This increased pressure can lead to the compression of the chambers of the heart and key blood vessels in the body, including:

the aorta, which is the major artery that pumps oxygen-rich blood through the body the vena cava, which is the major vein that returns blood to the heart

The compression of the aorta initially causes the blood pressure to rise. A sensor in the carotid artery, called the baroreceptor, detects the increased blood pressure.

This activates parasympathetic fibers, which quickly reduce the heart rate and blood pressure. Doctors sometimes refer to this effect as vagaling.

The Valsalva maneuver reduces cardiac output, which is the amount of blood that the heart puts out with every beat. The individual may feel lightheaded or dizzy as a result.

Once the baroreceptor senses the decrease in heart rate and blood pressure, it will stimulate the sympathetic nervous system. This can cause a person's heart rate and blood pressure to increase, offsetting the parasympathetic effects.

However, when a person breathes out, this releases the compression on the heart, allowing it to fill back up with blood. Breathing out increases the pressure inside the aorta, stimulating the parasympathetic nervous system and decreasing the heart rate again.

Thank you for supporting Medical News Today Uses Person sweating after work out receiving breathing and recovery advice from doctor.
The Valsalva maneuver helps treat a rapid heart rate. Doctors can use the Valsalva maneuver to treat people with supraventricular tachycardia (SVT). SVT is a rapid heart rate that is typically over 100 beats per minute at rest. It can cause symptoms including heart palpitations, chest pain, and shortness of breath. A heart rate of this speed can be dangerous because the heart cannot pump enough blood when it beats so quickly. SVT often requires emergency treatment. Once emergency responders have identified a person's heart rhythm and determined that their blood pressure is stable, they may demonstrate how to perform the Valsalva maneuver. According to a report in the Journal of the American College of Cardiology, the Valsalva maneuver was more effective in slowing down the heart rate than other similar procedures, such as carotid sinus massage or applying an ice-cold towel to the face. A meta-analysis found that the Valsalva maneuver can restore regular heart rate between 19.4 and 54.3 percent of the time. If the Valsalva maneuver does not normalize the heart rhythm, a person will need to receive electric shocks, called cardioversion, or medications. These approaches can cause unpleasant side effects, such as chest pain, pressure, and flushing. The Valsalva maneuver has other uses too. These include: clearing the ears when scuba diving or a change in altitude increases pressure increasing colonic pressure to induce a bowel movement Weightlifters also tend to perform the Valsalva maneuver when they lift heavy weights. Some may try this technique deliberately while others will not realize that they are using it. It is a common belief that using the Valsalva maneuver when lifting heavy weights can provide momentum and trunk stabilization. Risks and considerations The primary side effect of the Valsalva maneuver is hypotension, which is a sudden, persistent decrease in blood pressure. People performing the maneuver may also feel lightheaded or experience syncope, which is a brief loss of consciousness. Thank you for supporting Medical News Today Takeaway The Valsalva maneuver can help reduce rapid heart rhythms for some people. It can also help people to pop their ears, lift weights, or have a bowel movement. While the Valsalva maneuver does have some potential side effects, it is a non-invasive alternative to other treatments, such as medication or electric shocks.
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How are thyroid and cholesterol related?

High cholesterol is a risk factor for heart disease and stroke. Diet and other lifestyle choices are often to blame for high cholesterol. But sometimes medical conditions, such as a thyroid disorder, are at fault.

Producing too many or too few thyroid hormones increases the risk of abnormal blood cholesterol.

We take a closer look at the link between thyroid and cholesterol in this article. We also discuss some of the ways to manage cholesterol and thyroid conditions.

The thyroid gland Diagram of the thyroid gland
The thyroid gland regulates body temperature, mood, and development.

The thyroid is a gland located in the neck. It produces two hormones, known as the thyroid hormones. The main ones are triiodothyronine (T3), which is the active form of thyroid hormone, and thyroxine (T4), which the body converts to T3.

Thyroid hormones play a role in regulating:

brain development in children body temperature metabolism mood normal growth and development the function of the heart, brain, muscle, and other organs

The pituitary gland secretes thyroid-stimulating hormone (TSH) to stimulate the thyroid to produce hormones.

The thyroid gland also produces a hormone called calcitonin, which helps maintain strong bones by keeping the amount of calcium in the blood low.

Thyroid problems

When the thyroid does not produce enough thyroid hormones, it is underactive, which is called hypothyroidism. Producing too many hormones leads to an overactive thyroid, which is called hyperthyroidism.

Approximately 4.6 percent of people aged 12 or older in the United States have an underactive thyroid.

An underactive thyroid causes the following symptoms:

An underactive thyroid often arises from an autoimmune disease, such as Hashimoto's thyroiditis, or surgical removal of the thyroid.

Less commonly, the thyroid gland goes into overdrive and produces too many thyroid hormones. Approximately 1.2 percent of people in the U.S. have an overactive thyroid.

Symptoms of an overactive thyroid include:

diarrhea or frequent bowel movements difficulty sleeping fatigue increased sensitivity to heat mood swings muscle weakness nervousness or irritability rapid heartbeat shaky hands weight loss

Several conditions and situations can cause an overactive thyroid, including an autoimmune condition called Graves' disease, inflammation of the thyroid (thyroiditis), and taking too much iodine or thyroid hormone pills.

Thank you for supporting Medical News Today Cholesterol cholesterol buildup in arteries
A cholesterol buildup in the arteries can cause heart disease. Cholesterol is a waxy substance that is present in every cell in the body. The body uses cholesterol to make hormones as well as bile acids to help digest fat. When too much cholesterol builds up in the arteries, it can cause problems, such as heart disease. Cholesterol travels through the blood by attaching itself to a protein. This bundle of cholesterol and protein is called a lipoprotein. The main lipoprotein bundles are: High-density lipoprotein (HDL): HDL is so-called because there is a high cholesterol to protein ratio. It is also known as "good" cholesterol because it helps the body get rid of cholesterol from the blood. Low-density lipoprotein (LDL): LDL features a low cholesterol to protein ratio. It is also known as "bad" cholesterol. Higher LDL rates indicate a higher risk of heart disease. Although dietary causes (in those predisposed to it) may cause a buildup of bad cholesterol in the blood, it may also arise from some medical conditions, including thyroid disorders. Understanding the link between the thyroid and cholesterol The link between the thyroid and cholesterol can result in conditions affecting each of them: Can an underactive thyroid cause high cholesterol? Thyroid hormones, especially T3, play an essential role in helping the liver process and remove any excess cholesterol from the body. When the body does not produce enough thyroid hormones, the liver cannot process as much cholesterol as it should. An underactive thyroid means that the body removes less "bad" cholesterol from the blood than it should, which often leads to high levels of "bad" and total cholesterol. According to research, up to 13 percent of people with high blood cholesterol also have an underactive thyroid. The same research notes that societies, such as the American Association of Clinical Endocrinologists and the American Thyroid Association, recommend that people newly-diagnosed with high cholesterol get tested for an underactive thyroid. The research also suggests that a person's cholesterol levels may improve once they have received treatment for an underactive thyroid, even if they do not require cholesterol-lowering medications. Even mildly low thyroid hormone levels (subclinical hypothyroidism) can lead to high cholesterol. According to 2012 research, elevated TSH levels can also cause high cholesterol, even if T3 and T4 are not elevated. Can an overactive thyroid cause low cholesterol? An overactive thyroid might have the opposite effect and cause low levels of cholesterol in the blood. However, there is no scientific proof that low cholesterol increases the risk for health problems. Thank you for supporting Medical News Today Testing thyroid and cholesterol levels Thyroid gland and cholesterol
A blood sample will check levels of TSH, thyroid hormones, and cholesterol. People with symptoms of an underactive or overactive thyroid should see a doctor for further testing, especially if their cholesterol levels are high or low. A doctor will take a sample of blood to check for levels of TSH and thyroid hormones. The results will show if the thyroid is overactive, underactive, or is functioning normally. The doctor or lab technician should be able to test blood cholesterol levels from the same blood sample, but for accurate results, people must fast for 8 to 12 hours beforehand. Treating thyroid problems and high cholesterol If the thyroid is underactive or overactive, a doctor can recommend a treatment plan to manage the thyroid condition and abnormal cholesterol levels. Underactive thyroid People with an underactive thyroid will often see improvements in cholesterol levels if they take a T4-replacement medication such as: Levothyroxine Levothyroxine sodium Levoxyl Novothyrox Synthroid Unithroid Where thyroid hormone levels are only slightly below normal, the doctor may recommend a statin or other treatment for cholesterol instead of a thyroid-replacement drug. Commonly prescribed statins include: Crestor (rosuvastatin calcium) Lescol (fluvastatin) Lipitor (atorvastatin) Mevacor, Altoprev (lovastatin) Pravachol (pravastatin) Zocor (simvastatin) Other treatments for high cholesterol include: weight loss for those who are overweight regular exercise dietary changes, including reducing saturated fat and increasing fiber intake Overactive thyroid People with an overactive thyroid can get relief from their symptoms by taking medications to reduce thyroid hormone production. Lower levels of the hormone may also increase their cholesterol levels if they are low. If medications do not work, the doctor may suggest radioactive iodine to shrink the thyroid gland or surgery to remove part of the gland, which will reduce hormone levels. People who have low cholesterol caused by high thyroid hormone levels may see their cholesterol levels increase as a result of the treatment. Thank you for supporting Medical News Today Takeaway There is a clear link between thyroid disorders and abnormal cholesterol levels. Those who are newly-diagnosed with high cholesterol should ask their doctor to check their thyroid hormone levels. Similarly, those who have an underactive thyroid should regularly monitor their blood cholesterol levels and take steps to reduce the risk of developing high cholesterol. Some people may see results once they treat their thyroid disorder. However, others with high cholesterol levels will need to take cholesterol-lowering medications and make lifestyle changes to bring cholesterol back into normal levels.
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Feeling dizzy after standing may predict dementia

According to a new study, middle-aged people who feel dizzy when they stand up may have a higher risk of developing dementia later in life.
Dizzy trees
Orthostatic hypotension may be a risk factor for dementia.

Some people feel a lightheaded sensation when standing up. This is referred to as orthostatic hypotension.

As we get to our feet, gravity causes blood to pool in the large vessels of the lower body, causing a sudden drop in blood pressure. Normally, the nervous system orchestrates a response to counteract this, increasing heart rate and constricting blood vessels.

However, in some people, this mechanism does not work properly, or it works too slowly, leading to a reduction of blood in the brain and therefore a sensation of dizziness.

Recently, researchers from Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, decided to look at orthostatic hypotension in more detail. They wanted to understand whether it might be a useful predictor of future health.

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Study author Andreea Rawlings, Ph.D., explains the reasons why they embarked on the study. "Orthostatic hypotension," she says, "has been linked to heart disease, fainting, and falls, so we wanted to conduct a large study to determine if this form of low blood pressure was also linked to problems in the brain, specifically dementia."

To open this question up, they had access to data from 11,709 people, aged 54, on average. None of the participants had a history of stroke or heart disease at the start of the study. They were followed for 25 years, and across that period they met up with the researchers around five times.

During their first visit, participants were tested for orthostatic hypotension. They lay down for 20 minutes before being asked to stand up quickly but smoothly. After standing, their blood pressure was taken five times. In total, 4.7 percent of the participants were defined as having orthostatic hypotension.

Over the following 25 years, 1,068 people developed dementia and 842 experienced an ischemic stroke, which occurs when blood flow is blocked to an area of the brain.

Of the 11,156 without orthostatic hypotension, 999 developed dementia (9 percent), and of the 552 people with orthostatic hypotension, 69 developed dementia (12.5 percent).

So, overall, individuals who had orthostatic hypotension at the beginning of the study had a 54 percent higher risk of developing dementia than those who did not.

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They also found that people with orthostatic hypotension had double the risk of ischemic stroke: 15.2 percent, compared with 6.8 percent of those without orthostatic hypotension.

"Measuring orthostatic hypotension in middle-age may be a new way to identify people who need to be carefully monitored for dementia or stroke. More studies are needed to clarify what may be causing these links as well as to investigate possible prevention strategies."

Andreea Rawlings, Ph.D.

The findings, published this week in the journal Neurology, are likely to spark further investigation.

However, the study does have some limitations. For instance, orthostatic hypotension was only tested at the start of the study, and an individual's blood pressure might change dramatically over the course of decades.

Although more research is needed, this symptom could eventually be used as an early warning system for those with an increased risk of dementia.

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Is my newborn sleeping too much?

Most newborns spend more time sleeping than they do awake, though the sleep may happen in small chunks or on an irregular schedule.

Managing a newborn's sleep is one of the most challenging tasks of looking after a newborn. Newly-born babies are not accustomed to schedules or the rhythms of a typical day. For this reason, they might not sleep at the appropriate times.

Some people may worry that the baby is sleeping too little or too much. Anyone concerned about a baby's sleep habits could try keeping a sleep log. They might find that the newborn is sleeping much less — or much more — than they thought.

How long do newborns typically sleep? Newborn sleeping too much
Experts recommended that newborns sleep for 14–17 hours per day.

The National Sleep Foundation recommend that newborns get 14-17 hours of sleep per day.

However, this timescale varies widely, and some newborns may only sleep for 11 hours while others will sleep for up to 19 hours per day. Newborns may sleep more or less than usual when they are sick or experience a disruption in their regular routines.

Most newborns sleep in bursts of 30–45 minutes to as long as 3–4 hours. In the first couple of weeks, it is standard for a newborn to wake up to feed and then go right back to sleep.

As a newborn grows into an infant, it begins to develop a schedule. They eventually start sleeping at night, though they may still wake several times to feed. Most babies do not have a regular sleep schedule until they are about 6 months old. Even then, there is a significant variation from baby-to-baby.

Newborns are not typically awake for longer than 3 hours at a time.

Thank you for supporting Medical News Today How can I tell if a newborn is sleeping too much? A baby who occasionally sleeps more than usual is not a cause for concern unless there are other symptoms. Some of the most common reasons why a healthy baby sleeps more than usual include: a growth spurt or developmental leap a minor illness, such as a cold receiving immunizations not getting enough quality sleep because of a respiratory infection that makes breathing difficult Some babies sleep too much because they have jaundice or are not getting enough food. A newborn who has jaundice will have a yellow color to their skin and a yellow cast to the whites of their eyes. Other signs of more severe jaundice include: being lethargic having trouble eating being fussy or irritable Babies who do not eat enough can become dehydrated, lose too much weight, and even suffer from a failure to thrive. Some people may struggle to work out whether the baby is getting enough to eat, especially if they are breast-feeding. The good news is that early intervention from a pediatrician and breast-feeding consultant can ensure babies get enough food and reassure people that breast-feeding is possible. A baby, whether breast-fed or formula-fed, may not be getting enough to eat if: they seem very lethargic and unresponsive they are older than 6 weeks old and are consistently gaining less than 6 ounces per week they are producing fewer than four very wet diapers per day they do not seem calmer after eating In very rare instances, a baby may have a medical condition that causes them to sleep too much. Breathing and heart disorders may affect sleep, and premature babies often have different sleep patterns from full-term infants. When to wake a baby for feeding Newborn sleeping too much feeding
Newborns typically require feeding every 2-3 hours. Newborns often cluster-feed, which means they may eat several times over the course of 1–2 hours or nurse for an extended period. Most newborns should eat every 2-3 hours (or 8-12 times every 24 hours), or more if a pediatrician recommends so or the baby is not gaining enough weight. Feeding a newborn whenever the baby shows hunger cues, such as rooting, sucking, or sticking out their tongue, is the best way to ensure the baby gets enough food. It is not necessary to wake up most older newborns to eat. But those younger than 1 month or so may not wake up when they feel hungry. Babies younger than 4 weeks should not go longer than 4 to 5 hours without food. To wake a baby to eat, try brushing the side of their cheek. This can trigger the rooting reflex. Most babies dislike having their feet stroked. So if stroking the cheek fails, try gently wiggling the baby's toes or gently stroking the bottom of their feet. Food needs vary from baby-to-baby. Parents should consult a pediatrician or breast-feeding expert, who can offer individual advice based on the needs and development of the baby. Thank you for supporting Medical News Today What to do if your newborn is sleeping too much Usually, a newborn who appears to be sleeping too much is just sleeping on an irregular schedule. Nevertheless, health issues, such as respiratory infections that are minor annoyances in older babies can be much more dangerous in newborns. So anyone who is concerned about a baby's sleeping schedule should consult a pediatrician. Some strategies to try before calling the doctor include: feeding the baby every time they show hunger cues offering the baby the breast every 1–2 hours to ensure adequate food intake making sure the baby is not too cold or too hot keeping a log of the baby's sleep schedule for 1–2 days When to see a doctor Newborn sleeping too much chest pain
If a baby is breathing loudly or gasping for air, they should see a doctor. When in doubt, see a doctor. Only a doctor can diagnose for sure the reason why a newborn is sleeping too much. In many cases, a pediatrician may be able to assess the problem over the phone. Excess sleep in a newborn is not typically an emergency unless the baby shows signs of respiratory problems. Call a doctor or go to the emergency room if: the baby is gasping for air or wheezing the baby is breathing is very loud the baby's nostrils flare when they breathe the skin around the baby's ribs sinks in when they breathe the baby has a fever you think the baby may have inhaled, touched, or eaten something toxic Takeaway Finding the rhythm of a newborn's sleep patterns is a constant challenge. Most babies settle into a comfortable routine sooner or later. Parents and carers eventually understand what is and is not normal for their babies. It is common to worry about a baby's sleep. This concern often helps people to detect problems early and encourages them to seek expert advice. Anyone who is worried that a baby may be sleeping too much should talk to a pediatrician.
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Peripheral cyanosis: Causes of blue hands and feet

Peripheral cyanosis is when the hands, fingertips, or feet turn blue because they are not getting enough oxygen-rich blood.

Cold temperatures, circulation problems, and tight jewelry are common causes of peripheral cyanosis.

In this article, we take a close look at peripheral cyanosis, including its causes, symptoms, and treatment. We also look at another type of cyanosis called central cyanosis that affects central parts of the body, the lips, or the tongue.

Cyanosis gets its name from the word cyan, which means a blue-green color.

Symptoms of peripheral cyanosis People with peripheral cyanosis may notice the following symptoms: the skin on the fingertips, toes, palms, or feet is bluey-green the affected body part feels cold to the touch the color returns to normal after warming up the body part Causes of peripheral cyanosis Peripheral cyanosis causing blue fingers as a symptom of Raynaud's syndrome. Image credit: WaltFletcher, (2013 June 3).
Peripheral cyanosis causes the extremities to turn blue.
Image credit: WaltFletcher, (2013 June 3).

All organs and tissues of the body need oxygen to carry out their functions. A person's body absorbs oxygen from the air that they breathe. The blood contains a protein called hemoglobin that carries oxygen to the body's cells. If the body cannot deliver enough oxygen to parts of the body, cyanosis may occur.

Certain medical conditions can prevent oxygen-rich blood from reaching parts of the body. Sometimes, people are born with abnormal hemoglobin, which affects the hemoglobin's ability to bind to oxygen and carry it to the cells.

People tend to experience cyanosis in the extremities of their body, such as their fingertips and feet. This is because these body parts are furthest away from the heart, so the blood has further to travel.

Common causes of peripheral cyanosis include:

Raynaud's syndrome. Raynaud's disease is a condition where the fingertips and toes become painful and become blue or white in cold temperatures. This happens when the blood vessels narrow, preventing blood from reaching the extremities. Low blood pressure. Low blood pressure is when there is not enough pressure to push blood and oxygen to the hands and feet. Low blood pressure is also called hypotension. Hypothermia. This is where the body temperature drops to dangerously low levels. Hypothermia is a medical emergency. Vein or artery problems. If a person has problems with their veins or arteries, their bodies may not send enough blood and oxygen to their hands and feet. Possible causes include venous insufficiency, peripheral vascular disease, or blockages in the veins or arteries. Heart failure. When a person has heart failure, their heart may not be able to pump blood around the body effectively. Problems with the lymph system. Lymphatic dysfunction is a condition where the lymph fluid does not flow and drain as it should. This often results in tissues that swell up with lymph fluid. Deep vein thrombosis. This is caused by clots that form in the veins in the leg or limb extremities. Hypovolemic shock. When a person experiences hypovolemic shock, their body diverts blood from the skin towards the internal organs.

Peripheral vs. central cyanosis

The key difference between peripheral and central cyanosis is how they affect the body.

Peripheral cyanosis affects a person's hands or legs, especially the extremities, such as fingertips, fingernails, and feet. It may affect just one side of the body or both sides equally.

Central cyanosis affects the core organs of the body, causing a blue-green tint across central areas of the body, the lips, or the tongue. The symptoms of central cyanosis do not get better when the body part is heated up.

Both central and peripheral cyanosis have similar causes, including problems with the heart, blood, lungs, or nervous system.

Thank you for supporting Medical News Today Diagnosis Doctor holding lung x-ray
A doctor may recommend an x-ray to diagnose the cause of peripheral cyanosis. Doctors diagnose peripheral cyanosis through a combination of physical tests, imaging scans, such as X-rays, and blood tests. These tests can identify the presence of other conditions that affect the heart or lungs or that alter the body's normal oxygen levels. It is vital to follow the doctor's advice about diagnosing the underlying cause of peripheral cyanosis. Treatment Treatment for peripheral cyanosis depends on the underlying cause of the problem. Doctors may prescribe specific medicines to treat heart and lung conditions. These medications help improve blood flow and oxygen supply to the organs and tissues. Some people may need oxygen therapy to restore normal levels of oxygen supply. Doctors may recommend that a person with peripheral cyanosis stops taking any medications that restrict blood flow. Medicines include beta blockers, birth control pills, and certain allergy medications. A doctor may also recommend that people make lifestyle changes, such as quitting smoking or drinking caffeine. When to see a doctor In most cases, peripheral cyanosis is a symptom of another condition rather than being a medical condition by itself. Some of the underlying conditions could be life-threatening, so anyone experiencing any of the following signs and symptom must seek medical treatment immediately: difficulty breathing or gasping for breath chest pain profuse sweating sudden pain or numbness in the limbs, hands, or feet inability to concentrate or disorientation fever- or flu-like symptoms Thank you for supporting Medical News Today Peripheral cyanosis in babies Mother holding baby to her chest.
Newborns and babies can experience peripheral cyanosis. Peripheral cyanosis can occur in people of all ages, including newborns. An estimated 4.3 percent of newborns have cyanosis that requires oxygen therapy. Cyanosis can develop in babies and newborns for many reasons. It may be related to the heart, nerves, or lungs, or the result of abnormal or dysfunctional cell functioning. It is sometimes difficult to detect peripheral cyanosis in babies, particularly newborns, because other factors, such as jaundice and skin color may mask the blue-green skin color. Peripheral cyanosis is usually not a medical emergency. However, central cyanosis is more likely to be a sign of something more serious that requires immediate medical attention. Outlook The outlook depends on the cause of peripheral cyanosis and the seriousness of the underlying cause People should consult their doctor if their symptoms do not go away after they have warmed up their hands or feet or massaged them to increase blood flow. Timely diagnosis of the problem can provide the right treatment at an early stage, which helps avoid further complications.
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Heart health: What to eat and what to avoid

Is dairy good or bad for your heart? And what about coffee? Are foods rich in omega-3 really as good as people say? These are legitimate questions that riddle the average consumer. A new review sifts through the nutritional studies available in order to give us the bottom line on which foods are best for heart health.
legumes in the shape of a heart
Legumes such as beans and peas are great for your heart, concludes the new review.

Here at Medical News Today, we're constantly keeping our readers informed on the latest trends in healthful nutrition, as well as the scientific evidence that backs them up.

For instance, we recently reported on a review that critically examines the hype around omega-3 supplements.

The scientific evidence doesn't support the claim that fish supplements protect against heart disease, the review concluded, even though millions of people in the United States take them.

Similarly, a new meta-analysis of existing studies — conducted by the American College of Cardiology Nutrition & Lifestyle Workgroup of the Prevention of Cardiovascular Disease Council — reviews the pros and cons of popular foods for heart health.

Dr. Andrew Freeman, a Fellow of the American College of Cardiologists and the director of cardiovascular prevention and wellness at National Jewish Health in Denver, CO, led the research.

The findings were published in the Journal of the American College of Cardiology.

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Controversy over heart-healthy foods

Dr. Freeman explains the rationale for the review, saying, "The current nutritional recommendations show a heart-healthy diet is high in fruits, vegetables, whole grains, and nuts in moderation."

"However," he adds, "there are many food groups which can result in confusion for patients, including dairy, added sugar, coffee, and alcohol."

Indeed, while the National Institutes of Health (NIH) recommend fat-free or low-fat dairy for optimal heart health, several recent studies have suggested that full-fat dairy is not harmful to the heart and may even have cardiovascular benefits.

Similarly, moderate alcohol consumption has been associated with heart health benefits in many studies, but other researchers point out the methodological flaws and biases that may be responsible for these results.

So, Dr. Freeman and his team reviewed several meta-analyses of only the highest-quality papers to elucidate the link between heart health and alcohol, dairy, and other controversial foods.

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Foods you should avoid

The researchers found studies suggesting that low-fat dairy can lower blood pressure. However, they also found that it may raise levels of "bad" cholesterol, fractures, and death risk from any cause.

So, in light of this controversial evidence — and given that dairy is rich in saturated fats and salt — the researchers concluded that ideally, dairy products should be avoided or at least consumed with caution.

Additionally, the team found a link between added sugars, such as table sugar or syrups, and a high risk of coronary heart disease, stroke, and death resulting from atherosclerosis.

As a result, they strongly advise that people avoid processed foods that have added sugar, as well as sweetened drinks such as soda, fruit drinks, sports drinks, and energy drinks.

Finally, although a low to moderate intake of alcohol reduces the risk of cardiovascular disease, the researchers warn that people should not drink alcohol for its alleged cardiovascular benefits. This is due to the high risks of liver disease and cancer, which outweigh its potential benefits.

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Foods you should add to your diet

Conversely, legumes such as beans, chickpeas, lentils, peas, soybeans, and peanuts lower the risk of coronary heart disease, cholesterol levels, and blood pressure. The consumption of legumes also helps reduce weight.

"Legumes are affordable and a rich source of protein," Dr. Freeman says. "We should be incorporating more beans and bean-dishes like hummus into our diets to promote heart health."

Coffee was associated with a reduced risk of death from any cause, as well as death from heart disease. No links were found between coffee consumption and the risk of high blood pressure.

Some studies suggested that black and green tea, when consumed without added dairy, sugar, or sweeteners, can contribute to a healthy heart and safe levels of blood lipids — which include cholesterol and triglycerides.

Overall, evidence supports the cardiovascular benefits of plant-based proteins such as the ones from legumes, foods rich in omega-3 fatty acids, mushrooms, coffee, and tea.

However, "There is no perfect, one-size-fits-all dietary pattern for preventing heart disease," Dr. Freeman says.

"But, most of the evidence continues to reinforce that a predominantly plant-based diet lower in fat, added sugars, added salt, processed foods, and with limited if any animal products [benefits heart health]."

Dr. Andrew Freeman

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What are the benefits of drinking lime water?

Flavoring water with citrus fruit, such as lime, can liven up a glass of water, encouraging reluctant water-drinkers to consume more.

The body needs water to survive and drinking enough is crucial for maintaining optimal health.

Water ensures the human body is adequately hydrated. People stay hydrated by drinking liquids and consuming foods with high water content.

The amount of water a person needs to drink varies according to:

their age their sex the amount of physical activity they do whether someone is pregnant or breast-feeding the temperature and other environmental factors whether or not a person has a fever or diarrhea or vomiting

Many people do not drink enough water. In fact, many people drink more sweetened beverages than plain water.

Some people might find that a squeeze of lime improves the taste of the water, encouraging them to drink more of it. By drinking lime water, people can also take advantage of the many health benefits it offers.

12 benefits of lime water Lime water
Lime water can aid digestion and may encourage people to drink more water.

This small citrus fruit with origins in Asia packs a large nutritional punch. According to the United States Department of Agriculture (USDA), one lime with a 2-inch diameter contains just 20 calories.

The same size lime also contains the following nutrients:

22 milligrams (mg) calcium 12 mg phosphorus 68 mg potassium 19.5 mg vitamin C, which is about 20–25 percent of the daily value recommended for adults

In addition to the nutritional value of limes, lime water has the following benefits:

1. Promotes consumption of water

The Centers for Disease Control and Prevention (CDC) suggest that people who do not drink enough water could add a squeeze of lime to enhance the flavor, which may encourage them to drink more water.

2. Helps improve diet

A recent study in Nutritional Epidemiology showed that people who drank more water instead of sugary drinks, such as soda or juice, improved their diet.

People who drank water instead of sweetened drinks reduced the amount of sugar and fat they consumed on a daily basis.

3. May aid digestion

Adding lime to water can help aid digestion. Limes contain compounds that help stimulate digestive secretions in the stomach. Also, the acid in the lime juice helps the saliva break down food.

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4. Reduces cancer chances

Several studies show a link between citrus fruit and a reduced risk of some types of cancer. A 2015 study in Medicine (Baltimore) showed a possible link between increased citrus fruit consumption and a diminished risk of esophageal cancer. However, more research is required.

5. Improves skin quality

Limes contain vitamin C and antioxidants, both of which are ingredients in many commercial skin products. When consumed with water, the natural ingredients in the lime juice can help improve the appearance of aging skin.

6. Promotes weight loss

Nutritionists often recommend drinking a glass of water with a meal to help prevent overeating.

Lime water has an additional benefit. The citric acid found in lime juice helps boost a person's metabolism, helping them burn more calories and store less fat.

7. Improves immune system

The vitamin C combined with the antioxidants contained in limes provide support to the body's immune system.

When drunk regularly, lime water might help prevent and shorten the lifespan of colds and cases of flu.

8. Reduces risk of heart disease

Limes contain high levels of magnesium and potassium.

Both of these elements help support the overall health of the heart. In particular, potassium can improve blood flow and reduce blood pressure.

There is also limited research indicating that limes may also help reduce cholesterol levels.

9. Lowers blood sugar

According to some research, vitamin C can help lower morning and post-meal blood sugar changes. Though the study focused on people taking supplements of vitamin C, the conclusion indicated that vitamin C offers excellent potential for improving a person's sugar levels.

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10. Prevents the growth of micro-organisms

According to some research, the limonins found in limes can help prevent the accumulation of Streptococcus bacteria.

Streptococcus is a type of bacteria responsible for a variety of infections and health conditions, including respiratory and mouth infections.

Drinking lime water may help stop these harmful organisms from developing and prevent bacterial illnesses.

11. Has anti-inflammatory properties

Limes provide a good source of vitamin C. Among many other potential benefits, vitamin C acts as an anti-inflammatory agent in the body.

Oregon State University conducted a review of research that focused on the positive effect vitamin C has on reducing inflammation.

They concluded that the majority of studies indicated that the use of vitamin C showed favorable results in reducing inflammation.

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12. Helps prevent kidney stones

Limes contain both citric acid and vitamin C. A 2014 study showed that both vitamin C and citric acid helped break up or prevent the formation of some types of kidney stones.

The researchers concluded that by including vitamin C and citric acid in their diet, a person could reduce their risk of developing specific stones again in the future.

How to make lime water Fresh lime being cut
It is best to drink lime water within 1 day of making it. Lime water is easy to make: Wash a fresh lime before cutting it. Fill a glass with water and squeeze the juice from a piece of the lime into the water. To make lime water ahead of time, fill a pitcher with water and squeeze in the juice of a whole lime. Add lime slices to the pitcher for added flavor. Drink the water within 1 day for best flavor. Takeaway For people who have trouble drinking the recommended amount of water each day, lime water may be a good alternative. In addition to extra flavor, lime water also offers additional nutrients that may have a variety of health benefits. Lime water is easy to prepare, and almost everyone can add it to their diet.
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