Wood Street Clinic Blog

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Inhaled blood pressure drug could prevent panic attacks

Amiloride, a drug that's used to treat hypertension, successfully relieves signs of anxiety and panic in a preclinical study. The findings are underpinned and strengthened by epigenetic changes caused by anxiety and panic disorder.
woman breathing in paper bag
An inhaled version of amiloride may relieve hyperventilation, which often accompanies panic attacks.

As many as 40 million individuals in the United States live with anxiety disorders.

Around 6 million of them have panic disorder, which is a condition characterized by the sudden onset of panic attacks.

Treatment for anxiety disorders may include psychotherapy and medication such as antidepressants.

However, there are few safe, effective options that provide instant relief for panic attacks.

Panic disorders have a range of risk factors — ranging from hereditary ones to traumatic childhood experiences.

Adverse events in one's childhood, such as a death in the family or separation from one's parents, can have not only a profound psychological effect, but also molecular and genetic ones.

Using existing knowledge on the genetic impact of childhood adversity and the risk of developing anxiety disorders into adulthood, researchers from the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada, investigated whether an existing drug can instantly alleviate the symptoms of panic attacks by acting on the molecular changes that are brought about by childhood adversity.

Dr. Marco Battaglia, associate chief of child and youth psychiatry in the Campbell Family Mental Health Research Institute at CAMH, is the lead author of the new study, which has now been published in the Journal of Psychopharmacology.

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Childhood trauma, epigenetics, and anxiety

As Dr. Battaglia and his colleagues explain in their paper, experiments in mice have revealed that repeatedly separating pups from their mothers causes epigenetic modifications.

Epigenetics refers to modifications in the DNA that do not change the DNA's sequence but can affect whether some genes are switched on or off.

Specifically, in this new study, the scientists build on previous research in mice that has suggested that childhood trauma causes changes in the acid-sensing-ion-channel-1 gene, heightened pain sensitivity, and hypersensitivity to carbon dioxide in the air.

As the researchers explain, these physiological changes (such as carbon dioxide hypersensitivity) may lead to physical symptoms, such as difficulty breathing and hyperventilation, which are markers of panic attacks.

Based on this knowledge, the team hypothesized that a drug that can inhibit acid-sensing ion channels can also reduce pain sensitivity and hypersensitivity to carbon dioxide.

So, Dr. Battaglia and his team assessed the effects of the acid-sensing ion channel inhibitor "amiloride," a drug commonly used to treat hypertension.

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Inhaled amiloride may treat panic disorder

To circumvent the issue of the brain-blood barrier, the scientists administered the drug to mice via inhalation. This enabled the drug to reach the rodents' brains immediately.

In its inhaled form, one dose of amiloride improved the respiratory signs of anxiety and pain sensitivity in the rodents.

"Inhaled amiloride may prove to have benefits for panic disorder, which is typically characterized by spells of shortness of breath and fear, when people feel anxiety levels rising."

Dr. Marco Battaglia

"Inasmuch as these results pertain to human anxiety and/or pain hypersensitivity," conclude the researchers, "our findings provide a rationale for studying inhaled amiloride in some anxiety disorders and/or pain syndromes."

Such hopeful preclinical results have prompted them to replicate the findings in a clinical setting. Next, Dr. Battaglia and team are planning to see whether the drug relieves anxiety symptoms in humans.

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Using the body clock to make drugs more effective

Researchers created a database for the daily circadian rhythms of genetic activity. The findings may help physicians time the delivery of drugs in accordance with a person's body clock, boosting treatment for cardiovascular disease and other conditions.
clock with stethoscope
Our body clock can influence how effective drugs are — especially for treating cardiovascular problems.

Our circadian rhythm, or body clock, regulates key aspects of our health and daily lives.

Our body clock controls sleep-wake cycles, digestion, and body temperature, among several other functions.

Scientists have tied disruption to one's circadian rhythm to a range of physical disorders, such as diabetes and obesity, as well as some mental health conditions, such as depression and bipolar disorder.

More recently, scientists have found links between sleep-wake cycle disruptions and the onset of Alzheimer's disease.

Conversely, specialists use chronotherapy — or the process of progressively adjusting a person's bedtime and waking time — to time the delivery of drugs so that it falls in line with circadian changes.

In conditions such as cardiovascular disease or high blood pressure, for example, chronotherapy has proven useful because some cardiovascular diseases — such as heart attacks, angina, and stroke — have a higher incidence in the morning.

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More recent research also suggests that our body clock — or the collection of proteins that interact within cells, regulating cellular activity and their corresponding genetic expressions — plays a key role in cancer, and that chronotherapy could boost the effectiveness of cancer treatment.

In this context, researchers led by John Hogenesch, Ph.D. — a circadian biologist in the Divisions of Human Genetics and Immunobiology at the Cincinnati Children's Hospital Medical Center in Ohio — set out to create a database of daily genetic rhythms.

Some of these genes can control the activity of drugs, which makes for an important contribution to the growing field of circadian medicine.

The researchers detail their efforts in the journal Science Translational Medicine, and Marc Ruben, Ph.D., is the first author of the paper.

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Hogenesch and team created a computer algorithm called cycling ordering by periodic structure to study how circadian rhythms control the changes in gene activity that occur throughout the day.

Specifically, the researchers used the algorithm to study the gene-to-tissue interactions of thousands of genes in the tissues of over 630 human participants.

Of all the genes studied, 917 expressed proteins that help metabolize and absorb drugs, or that are drug targets themselves.

"Overall this connects thousands of different drugs, both approved and experimental, to nearly 1,000 cycling genes [...] We found that genes that cycle in the human cardiovascular system are targeted by many of these drugs."

Marc Ruben, Ph.D.

According to the study authors, the genes for 136 drug targets were found to cycle rhythmically in at least one of the following four heart tissues: the atrial chamber, aorta, coronary artery, and the tibial artery.

"We identified rhythms in gene expression across the body in a large and diverse group of people," explains Hogenesch. "It doesn't matter if you're male, female, young, or old, or what your ethnicity is, your body's internal clock regulates half your genome."

"This includes drug-metabolizing enzymes, transporters, and targets," he says. "Now we are learning which drugs hit clock-regulated products and may benefit from optimizing administration time in people."

Hogenesch cautions that more research is required before the findings can be applied to clinical practice.

However, "As most of these drugs are safe and approved, this process should go much faster than traditional drug discovery, which can take a decade or more," he concludes.

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Fasting-induced anti-aging molecule keeps blood vessels young

New research has found that fasting triggers a molecule that can delay the aging of our arteries. The findings could help prevent age-related chronic diseases such as cancer, cardiovascular disease, and Alzheimer's.
blood vessels
Scientists have discovered a new role for a molecule produced during fasting: it can keep our vascular system supple and young.

The search for eternal youth has preoccupied the human imagination since the times of Ancient Greece.

In fact, a quick look at Greek mythology shows that youth was more prized than immortality, as some myths tell the story of how futile the latter is if it's not accompanied by the former.

In this regard, modern medicine has recently been catching up with ancient mythology.

Emerging scientific breakthroughs encourage us to hope that the myth of eternal youth will soon become a reality.

In a recent study, researchers were able to reverse signs of aging such as hair loss and wrinkles in mice; and, perhaps more impressively, another team of researchers managed to rejuvenate aging human cells.

Now, a new study adds to the evidence that aging can indeed be reversed. Scientists led by Dr. Ming-Hui Zou — the director of the Center for Molecular and Translational Medicine at Georgia State University in Atlanta — showed that fasting, or restricting calorie intake, can produce a molecule that delays vascular aging.

The findings were published in the journal Molecular Cell.

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How a ketone molecule keeps cells young

Dr. Zou explains the motivation for this study, saying, "The most important part of aging is vascular aging. When people become older, the vessels that supply different organs are the most sensitive and more subject to aging damage, so studying vascular aging is very important."

So, the scientists set out to focus on vascular aging, on the changes that occur with senescence, and on ways to prevent them.

Specifically, the researchers looked at the link between calorie restriction and vascular aging. Dr. Zou used mouse models of atherosclerosis, studied their aortas post-mortem, and performed a series of cell culture experiments. They also induced starvation in the rodents and conducted similar tests.

They saw that, as expected, the starving mice produced the molecule beta-hydroxybutyrate. Surprisingly, however, this molecule also prevented vascular aging.

Beta-hydroxybutyrate is a ketone — that is, a molecule produced by the liver and used as an energy source when glucose is not available. The body produces ketones during fasting or starvation, on low-carb diets, and after prolonged exercise.

Interestingly, the research also revealed that beta-hydroxybutyrate promotes the division and multiplication of the cells that line the inside of blood vessels. Cellular division is a marker of cellular youth.

"We found [that beta-hydroxybutyrate] can delay vascular aging. That's actually providing a chemical link between calorie restriction and fasting and the anti-aging effect."

Dr. Ming-Hui Zou

"This compound can delay vascular aging through endothelial cells," Dr. Zou explains, "which line the interior surface of blood vessels and lymphatic vessels. It can prevent one type of cell aging called senescence, or cellular aging."

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A drug target to stop aging, chronic disease

The study also revealed that the compound triggers another chain reaction that keeps the DNA of these endothelial cells young and undamaged.

More specifically, when beta-hydroxybutyrate attaches to the RNA-binding protein heterogeneous nuclear ribonucleoprotein A1, it boosts the activity of a stem cell transcriptional factor called Octamer-binding transcriptional factor (Oct4).

In turn, Oct4 "increases Lamin B1, a key factor against DNA damage-induced senescence," which keeps the blood vessels young.

"This stem cell factor (Oct4)," says Dr. Zou, "could be a pharmaceutical or pharmacological target for slowing down or preventing aging."

"Then, if the vascular system becomes younger, it is less likely to have cardiovascular disease, Alzheimer's disease, and cancer because all of these diseases are age-related."

Dr. Ming-Hui Zou

"We think this is a very important discovery, and we are working on finding a new chemical that can mimic the effect of this ketone body's function," Dr. Zou adds.

"It's difficult to convince people not to eat for the next 24 hours to increase the concentration of this compound [...], and not everybody can do that, but if we can find something that can mimic this effect and people can still eat, it would make life more enjoyable and help fight disease."

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Can a 16-week lifestyle intervention impact blood pressure?

A study led by researchers in North Carolina reveals that over the course of a 16-week program, lifestyle changes had the biggest impact on high blood pressure.
Blood pressure check
A new study demonstrates that lifestyle changes can be as effective as medication.

Importantly, those in the study had a reduced need for hypertension medication after the 16 weeks.

The study was presented at the American Heart Association's Joint Hypertension 2018 Scientific Sessions, which outlines new hypertension research each year.

In all, the study involved 129 men and women who were either overweight or obese.

They were all aged 40–80, and all participants had elevated blood pressures.

None of the participants were taking blood pressure medication at the time of the study, but about half met the criteria for hypertension drugs.

Diet, exercise, and hypertension

Each participant was randomly assigned one type of intervention. One group changed its diet to the DASH diet, participated in counseling, and underwent supervised exercise three times per week. Another group only changed its diet (again, the DASH diet was used). Another group changed nothing.

The DASH diet is an eating plan specifically designed to improve heart health. It includes eating vegetables, fruits, whole grains, low-fat or fat-free dairy products, fish, poultry, beans, and nuts. Adherents limit foods high in saturated fats, such as fatty meats, full-fat dairy, and tropical oils (including coconut, palm kernel, and palm).

Those in the first group had the most success overall in lowering their blood pressure. They lost an average of 19 pounds over 16 weeks and reduced their blood pressure readings by an average of 16 millimeters of mercury (mm Hg) systolic and 10 mm Hg diastolic.

By contrast, those eating a DASH diet showed a blood pressure decrease of 11 mm Hg systolic and 8 mm Hg diastolic, while those who did not modify their behavior averaged a blood pressure reading decline of 3 mm Hg systolic and 4 mm Hg diastolic.

At baseline, 50 percent of the participants met the criteria to receive hypertensive medication. However, by the end of the study, only 23 percent of those who changed their diet still met criteria, as well as just 15 percent of those who changed both diet and exercise routine.

"Lifestyle modifications, including healthier eating and regular exercise, can greatly decrease the number of patients who need blood pressure-lowering medicine," states study author Dr. Alan Hinderliter, an associate professor of medicine at University of North Carolina in Chapel Hill.

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The health impact of hypertension

High blood pressure is common. The American Heart Association (AHA) estimate that hypertension affects almost half of adults living in the U.S., and that many of those affected don't know that they have a blood pressure problem.

This is why high blood pressure is known as a "silent killer" — there are very few, if any symptoms.

Hypertension, if left untreated and unchecked, can lead to serious health problems. Untreated high blood pressure can contribute to heart attacks, strokes, heart failure, kidney disease, vision loss, sexual dysfunction, angina, and peripheral artery disease.

It can also damage your blood vessels and prompt low-density lipoprotein (the "bad" cholesterol) to build up in fissures along artery walls, making the circulatory system work harder while being less efficient.

While this study showed that lifestyle modifications, including diet and exercise, might be able help decrease the need for blood pressure medications, Hinderliter notes that there should be further research before recommendations can be made.

Also, individuals with elevated blood pressure should always follow doctor's orders, and if already taking those medications, continue for as long as it's recommended.

Still, altering diet and adding exercise to a weekly routine is one measure the AHA recommend for those who experience hypertension; it can have a considerable impact on overall health.

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These supplements may actually harm your health

New research warns that a number of weight loss and workout supplements contain — without accurately listing — potentially harmful doses of a substance that has been ruled as unsafe.
various pills and supplements
A range of dietary supplements contain a substance that may harm you.

Recently, scientists looked into whether a range of supplements used as weight loss or workout aids may actually be harmful to those who take them.

The World Anti-Doping Agency (WADA) ban all athletes from taking any drugs or supplements that include higenamine, a beta-2 agonist that may have toxic effects on the heart.

Yet despite the fact that higenamine is banned by the WADA, and that it might be harmful to people's cardiovascular health, many dietary supplements still contain it as a substance that naturally occurs in certain plants, such as aconite.

The researchers — including John Travis, a senior research scientist at NSF International in Ann Arbor, MI — have revealed not only that higenamine is a widely used supplement ingredient, but also that companies that produce such supplements do not properly list the dosage at which this ingredient is used.

"We're urging competitive and amateur athletes, as well as general consumers, to think twice before consuming a product that contains higenamine," says Travis.

"Beyond the doping risk for athletes," he adds, "some of these products contain extremely high doses of a stimulant with unknown safety and potential cardiovascular risks when consumed."

"What we've learned from the study is that there is often no way for a consumer to know how much higenamine is actually in the product they are taking."

John Travis

These findings now appear in the journal Clinical Toxicology.

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The researchers analyzed 24 supplements for weight loss or preworkout that listed higenamine — also known as norcoclaurine and demethylcoclaurine — and noticed that they featured widely varying and unreliable amounts of this substance.

The 24 products tested in the study were: Adrenal Pump, Apidren, Beta-Stim, Burn-HC, Defcon1 Second Strike, Diablo, DyNO, Gnar Pump, Higenamine, High Definition, HyperMax, iBurn2, Liporidex Max, Liporidex PLUS, LipoRUSH DS2, N.O. Vate, OxyShred, Prostun-Advanced Thermogenic, Pyroxamine, Razor8, Ritual, Stim Shot, ThermoVate, and Uplift.

Worryingly, of all the supplements that the researchers looked at, only five products mentioned an exact quantity of higenamine. However, when the supplements were tested, Travis and his colleagues found that the listed quantities were incorrect.

Actual quantities of higenamine across the range of products included anything from trace amounts to 62 milligrams per serving. However, based on the label instructions, users may actually take up to 110 milligrams of the substance per day, which may harm their health in unpredictable ways.

"Some plants, such as ephedra, contain stimulants. If you take too much of the stimulants found in ephedra, it can have life-threatening consequences," explains study co-author Dr. Pieter Cohen.

"Similarly," he adds, "higenamine is a stimulant found in plants. When it comes to higenamine, we don't yet know for certain what effect high dosages will have in the human body, but a series of preliminary studies suggest that it might have profound effects on the heart and other organs."

According to a study published in The New England Journal of Medicine in 2015, about 23,005 emergency department visits in the United States are related to supplement intake.

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"While higenamine is considered a legal dietary ingredient when present as a constituent of botanicals, our research identified concerning levels of the stimulant and wildly inaccurate labeling and dosage information," Travis explains.

"And, as a WADA-prohibited substance," he continues, "any amount of higenamine in a dietary supplement should be of concern to the competitive athlete."

The study concludes that, to better protect consumers, the Food and Drug Administration (FDA) should now finalize their guidelines on supplement ingredients. It also warns doctors that the higenamine quantities in many dietary supplements may impact cardiovascular health.

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Why does olive oil keep heart attack and stroke at bay?

There is a protein in our blood that rises after we eat, especially when we eat foods such as olive oil that are high in unsaturated fats. Now, new research reveals that it plays an important role in preventing a major cause of heart attack and stroke.
simple image of olive oil
The unsaturated fats in olive oil could protect against heart attacks and stroke.

The protein is called apolipoprotein A-IV (ApoA-IV), and evidence already exists to suggest that higher blood levels of it are linked to lower risk of cardiovascular diseases.

Now, for the first time, scientists at St. Michael's Hospital in Toronto, Canada, have shown that ApoA-IV stops blood platelets forming into blood clots.

They also suggest that ApoA-IV could work to slow down inflammatory conditions — such as those that gradually clog arteries — without hampering the "platelet aggregation" that stops bleeding.

They report their findings in a study paper that now features in the journal Nature Communications.

"Platelet aggregation can save lives," says senior study author Heyu Ni, a platform director in the St. Michael's Hospital Keenan Research Centre for Biomedical Science, "because it can stop bleeding in damaged vessels."

"But," he adds, "we usually don't want platelets to block blood flow in the vessels." If the blocked blood vessel is in the heart or brain, for instance, "it can cause heart attack, stroke, or death."

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Atherosclerosis and thrombosis

As Ni and his colleagues note in their study paper, "Thrombotic disorders, such as heart attack and stroke, are the leading causes of mortality and morbidity worldwide."

In the United States, approximately 790,000 people have a heart attack and 795,000 people have a stroke every year.

Most heart attacks and strokes are due to atherosclerosis, a disease in which plaques build up in the lining of arteries that deliver oxygen- and nutrient-rich blood to the heart and the rest of the body.

These plaques consist of substances that are found in blood, such as calcium, fats, and cholesterol.

The exact causes of atherosclerosis are unclear, but there is evidence to suggest that it is complex, starts early in life, and speeds up with age.

It could be that plaques form at sites of damage in the artery, and — as they harden and thicken with time — they narrow the blood vessel.

Eventually, the plaque can burst, causing platelets to clump together into a blood clot (thrombosis) at the injury site. This makes the artery even narrower and further reduces blood flow.

Thrombosis can cause angina, which is felt as pain in the chest, or result in stroke or heart attack, depending on which artery is affected. Thrombosis can also arise in veins, such as deep vein thrombosis of the leg.

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ApoA-IV blocks platelets

In order to form a clot, platelets have to stick to each other. This happens through a bridge made from a protein called fibrinogen, which connects to the platelets by binding to integrin αIIβ3 receptors on their surfaces.

Using human blood samples and mice, Ni and his colleagues found that ApoA-IV can reduce platelet aggregation in blood vessels by blocking their integrin αIIβ3 receptors and thereby stopping them binding to fibrinogen.

They also found that ApoA-IV can help prevent blockage in blood vessels by changing shape, which eases blood flow.

The findings also explain why having more ApoA-IV in the blood can slow down atherosclerosis, says Ni, "because this process is also related to platelet function."

He and his team then went on to examine how ApoA-IV interacts with food. It is usual, after a meal, for platelet activity to increase. Also, when we eat foods rich in unsaturated fats, blood levels of ApoA-IV go up.

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Link to unsaturated fats and good sleep

The researchers suggest that the rise in ApoA-IV blood levels following meals containing olive oil and other unsaturated fats reduces "platelet hyperactivity and bonding," which, in turn, reduces inflammation and stroke and heart attack risk.

Further investigation found a link with sleep. It seems that ApoA-IV is busiest when we are asleep at night, and its lowest level of activity is in the morning.

"So, we are protected by this protein while we sleep," states Ni, "and most likely to experience a cardiovascular event after waking up in the morning."

The researchers say that their findings support the idea that eating foods high in unsaturated fats, together with "appropriate sleep patterns," are the ideal conditions for helping ApoA-IV lower the risk of atherosclerosis, stroke, and heart attack.

The scientists' next step will be to study ApoA-IV in more depth with a view to using it in therapies for cardiovascular disease and possibly other conditions caused by problems with blood platelets.

"This is the first study to link ApoA-IV with platelets and thrombosis."

Heyu Ni

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How many is too many eggs?

There is not a specific number of eggs a person can eat as part of a healthful diet. Eggs were once considered to be an unhealthy food source in terms of high cholesterol and heart problem concerns. The fact that the yolk of an egg contains a high level of cholesterol was the primary cause of this.

Consuming cholesterol was initially thought to significantly raise the levels of cholesterol in the body, which can increase the risk of heart disease.

Research has shown, however, that eggs do not increase the chances of heart disease.

Cholesterol in the body Bowl full of eggs
Cholesterol from food has a small impact on cholesterol in the body.

Cholesterol is a fatty substance that has a range of essential bodily functions.

Its role includes supporting the production of new cells and hormones to the formation of fat-dissolving bile acids and helping with the absorption of vitamins.

Scientists now understand that the cholesterol people consume in foods only has a small impact on cholesterol levels in the body.

The majority of cholesterol production takes place in the liver. The main influencing factor for this is not how much cholesterol someone consumes, but other factors, such as the amount of saturated fat in the diet.

In the past, there was also a misunderstanding about the role of cholesterol in the body, but more recent research has now challenged this too.

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Good and bad cholesterol levels

The way cholesterol moves through the bloodstream is relevant to the impact it can have.

Either low-density lipoproteins (LDL) or high-density lipoproteins (HDL) transport the cholesterol.

HDL is responsible for collecting cholesterol that is no longer needed, and LDL transports cholesterol to areas where it is needed.

Abnormally high levels of LDL cholesterol are typically unhealthy because they can build up and cause clogging in the arteries. This buildup of cholesterol can increase the risk of heart attacks.

HDL cholesterol is considered to be 'healthier' than LDL cholesterol, as it plays a role in removing the cholesterol from the body.

A greater understanding of how cholesterol works in the body means that it is now unclear whether high levels of cholesterol are always unhealthy.

For example, one recent review of existing studies found that there was no link between LDL cholesterol and heart disease.

While this study had several limitations, it demonstrates that the relationship between cholesterol and health is much less clear than previously thought.

Thank you for supporting Medical News Today Benefits of eggs Egg frying in a pan
Eggs are a nutritious source of protein. Eggs may contain a relatively high amount of cholesterol, but they do not have a major impact on cholesterol levels. They are a highly nutritious source of protein, containing a range of vitamins and minerals, including: Eggs are affordable and easily included in a balanced diet. The best way of consuming eggs is to boil or poach them without using salt. Eggs that have been enriched with omega-3 and sourced from free-range farms are the healthiest eggs. Eating between one and three eggs per day can have several health benefits, but this varies from person-to-person. At this level of consumption, people can expect minimal changes in their cholesterol levels. It is unclear whether there is an upper limit on how many eggs a person can eat per day. More research in this area is needed to provide clarity. But when people have no health issues causing concern, they can eat eggs in moderate quantities, and they are unlikely to have any effects on cholesterol levels. Takeaway Large-scale studies have consistently shown that consuming eggs does not increase the risk of heart disease. Unless under specific advice from a doctor, it is not necessary for people with high cholesterol or those at risk of heart disease to avoid eggs. It is possible to contact food poisoning from consuming raw eggs. Food poisoning is, however, becoming increasingly more unlikely with the rise in health and food safety standards in the United States.
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Walking may prevent heart failure in senior women

New research examines the effect of walking on two subtypes of heart failure in aging women. The findings were published in the Journal of the American College of Cardiology: Heart Failure.
senior woman walking
Senior women, walking could do wonders for your hearts.

According to recent estimates, almost 5 million people in the United States have congestive heart failure.

Over half a million cases are diagnosed each year.

Despite its name, "heart failure" does not mean that the heart has stopped working completely, explain the American Heart Association (AHA).

In congestive heart failure, the heart is not pumping blood as well as it should be.

Heart failure occurs in two main ways: either the muscles of the heart weaken, or they become stiff and lose their elasticity.

Although the condition affects people of all ages, it is more prevalent among seniors over the age of 60. The AHA recommend that people at risk avoid smoking, exercise more, and eat heart-healthy foods.

A new study delves deeper into one of these potential strategies for prevention. Researchers from the University of Buffalo in New York set out to investigate how walking affects two heart failure subtypes: reduced ejection fraction heart failure, and preserved ejection fraction heart failure.

Michael LaMonte, a research associate professor of epidemiology at the University of Buffalo School of Public Health and Health Professions, led the study.

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Studying walking and heart failure in women

Reduced ejection fraction heart failure occurs when the heart's left side pumps less blood into the body than normal.

Specifically, the normal ejection fraction — which measures how much blood is pumped out of the left ventricle into the body in one heartbeat — is over 55 percent. In reduced ejection heart failure, this rate drops to 40 percent or under.

In preserved ejection fraction heart failure, this rate may be over 50 percent and thus appear to be normal. However, if the heart muscles are too thick or stiff, the initial amount of blood that the ventricles can hold may already be too small for what the body needs.

As LaMonte and team explain, the first form of heart failure has a poorer outlook, whereas the second form is more common in seniors and tends to affect women and ethnic minorities in particular.

The researchers examined the link between physical activity levels as reported by 137,303 people who registered in the Women's Health Initiative, a long-term study of postmenopausal women.

Then, the scientists zoomed in on a subgroup of 35,272 women who lived with either one of the two subtypes of heart failure.

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Why walking is 'particularly important'

For each additional 30–45 minutes of daily physical activity, the risk of developing heart failure was reduced by 9 percent for heart failure in general, by 8 percent for preserved ejection fraction heart failure, and by 10 percent for reduced ejection fraction heart failure.

Crucially, while walking and physical activity correlated inversely with heart failure risk, the intensity of the physical activity did not have any effect; this suggests that the amount of activity is what matters.

"The finding that walking showed a protective association with heart failure and its subtypes is particularly important in a public health context. This is especially relevant given that walking is by far the most commonly reported physical activity in older adults."

Michael LaMonte

"This is the first study to report physical activity levels are related to a lower risk of developing heart failure with reduced ejection fraction in older adults, particularly in women," highlights LaMonte.

"This is pretty important from a public health standpoint, given the poor prognosis this type of heart failure has once it's present," he adds.

"Because heart failure is much more common after age 60," he says, "and because its treatment is very challenging and costly, the possibility of preventing its development by promoting increased physical activity levels, and specifically walking, in later life could have an important impact on the overall burden of this disease in an aging society."

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How to tell if stress is affecting your sleep

Stress often impacts on sleep quality and duration. Stress and a lack of sleep can both have a severe impact on physical and mental health. Experts recommend that people aim for 7–9 hours of sleep a night, depending on their age and other factors.

According to the Centers for Disease Control and Prevention (CDC), 35.2 percent of adults in the United States are getting less than 7 hours of sleep each night. This can lead to a sleep deficit that results in lasting physical and mental health problems.

The exact role of sleep is not clear, but research has shown that it facilitates a wide range of bodily processes. These include physical changes, such as muscle repair, and mental tasks, such as concentration.

Sleep deprivation effects Yawning woman in a car who may be stressed
Persistent sleep deprivation can increase the risk of heart disease, stroke, and depression.

Not getting enough sleep can cause a negative mood, low energy, difficulty concentrating, and a general inability to function as usual.

Lack of sleep may have severe consequences in some circumstances, such as if a person is driving or operating heavy machinery when tired.

The occasional night of poor sleep is unlikely to cause harm, but persistent sleep deprivation can increase the risk of several chronic health conditions.

According to a report by the CDC, people who get less than 7 hours of sleep per night have an increased risk of the following conditions:

Although a range of factors can cause these conditions, sleep deprivation may contribute to their development.

Thank you for supporting Medical News Today The link between stress and sleep Stress has many negative connotations, but it is a response that has evolved in humans and animals to allow them to deal with important or dangerous situations. In humans, stress can cause the central nervous system (CNS) to release hormones, such as adrenaline and cortisol. These hormones raise the heart rate to circulate blood to vital organs and muscles more efficiently, preparing the body to take immediate action if necessary. This CNS reaction is known as the fight-or-flight response, and it was vital for human survival during the earlier stages of evolution. Nowadays, issues that are not a threat to survival can trigger the fight-or-flight response. For example, problems at work or relationship difficulties. What stress does to the body in the long term It is normal to feel stressed occasionally, but chronic feelings of stress can cause the CNS to maintain a heightened state of arousal for extended periods. Being in this state can severely impact physical and mental health in the long term. One effect of stress is that it can cause sleep deprivation. Frequently being in a heightened state of alertness can delay the onset of sleep and cause rapid, anxious thoughts to occur at night. Insufficient sleep can then cause further stress. According to a National Sleep Foundation survey, 43 percent of people aged 13–64 have reported lying awake at night due to stress at least once in the past month. Reducing stress levels to improve sleep By lowering their stress levels in the evening before bed, many people could improve the duration and quality of their sleep. The lifestyle changes below may help reduce stress: Mindfulness meditation Mindfulness meditation is a relaxation technique that aims to make people more aware of the present moment. The aim is to acknowledge all the thoughts, feelings, and sensations happening within and outside the body without reacting to them. Research has shown that this technique offers several benefits for mental well-being. A review of 47 trials, which included a total of 3,515 participants, found that mindfulness meditation led to small-to-moderate improvements in anxiety, depression, and stress. More high-quality research is necessary to determine whether or not mindfulness works as a clinical treatment, but it may be a useful at-home method for people to use. Practicing mindfulness for 10–30 minutes before going to bed could be an effective method of reducing stress and improving sleep. Exercise man swimming in a pool
Exercise can reduce the symptoms of anxiety and stress. Physical exercise is a useful tool for improving mental health and well-being, as well as providing physical benefits. Research suggests that the effects of physical exercise on psychological well-being could make it a suitable treatment for anxiety and stress-related disorders, reducing the need to pursue other treatments. A review published in 2017 found that physical activity is effective at reducing the symptoms of anxiety and stress. Further evidence also suggests that exercise has a direct impact on improving the quality of sleep in people over the age of 40 with sleep difficulties. Engaging in moderate or high-intensity physical exercise, such as a 30-minute run, could help reduce stress levels and improve sleep quality. Other lifestyle changes The following lifestyle changes may also help some people reduce their stress levels: adapting to a more healthful diet lowering caffeine and alcohol intake avoiding taking work home or checking work emails in the evening seeking support from friends and family Reducing stress can be very challenging. It is essential to identify the source of the stress, which is often related to work or a relationship. Although these problems can be difficult and slow to resolve, removing the source of stress is vital to getting better. Thank you for supporting Medical News Today Takeaway Stress and sleep are closely linked. Stress can adversely affect sleep quality and duration, while insufficient sleep can increase stress levels. Both stress and a lack of sleep can lead to lasting physical and mental health problems. It is crucial that people who are having issues with stress or lack of sleep do not try to tackle these problems alone. Mental health professionals can provide care and guidance, and friends and family members can offer additional support.
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Common painkiller poses risk to heart health

One of the most widely used painkillers may pose a threat to cardiovascular health. This is the main takeaway of new research, recently published in The BMJ.
painkillers
Common painkillers may hide major risks, says a new study.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to alleviate pain.

In fact, according to the National Institutes of Health (NIH), about 30 million people in the United States take NSAIDs each year.

While NSAIDs are commonly recommended to treat inflammatory conditions, headaches, and fever, the drugs are thought to have some cardiovascular risks.

However, due to ethical concerns, these risks cannot be evaluated in clinical trials.

The European Society of Cardiology therefore carried out an extensive review of existing research that concluded that nonaspirin NSAIDs should not be prescribed to individuals at high risk of heart disease, nor should they be sold over the counter without issuing an "appropriate warning of their frequent cardiovascular complications."

Now, a new study focuses on one NSAID in particular: diclofenac. Scientists led by Morten Schmidt, at Aarhus University Hospital in Denmark, set out to investigate the cardiovascular risks of taking this common painkiller, which some rank as "the most widely used [...] NSAID in the world."

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Schmidt and team examined 252 national studies for information on over 6.3 million Danish people over a period of 20 years in 1996–2016. On average, the participants were aged 46–56.

During the study period, the researchers examined the cardiovascular risks of taking up diclofenac and compared them with the risks of starting paracetamol, ibuprofen, or naproxen.

After accounting for potentially confounding factors, the researchers found that within 30 days of taking up diclofenac, the rate of major cardiovascular problems — such as arrhythmia, ischemic stroke, heart failure, and heart attack — was much higher compared with other NSAIDs.

Specifically, the risk of such adverse cardiovascular events was 50 percent higher among those who started taking diclofenac, compared with those who did not take it. Compared with taking paracetamol or ibuprofen, taking diclofenac raised cardiovascular risk by 20 percent.

Additionally, write the authors, "Diclofenac initiation [...] increased the risk of upper gastrointestinal bleeding [...] by approximately 4.5-fold compared with no initiation [and] 2.5-fold compared with initiation of ibuprofen or paracetamol."

The cardiovascular threat also increased with the risk at baseline. In other words, the higher the risk of heart problems when the patients started taking the drug, the higher the risk of actually developing heart problems over the course of the treatment.

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"Diclofenac poses a cardiovascular health risk compared with non-use, paracetamol use, and use of other traditional nonsteroidal anti-inflammatory drugs," explain the authors.

Although the study is observational, they say — which means that no conclusions can be drawn about causality — the large sample size and the quality of the research is sufficiently "strong evidence to guide clinical decision-making."

"Treatment of pain and inflammation with NSAIDs," explain the authors, "may be worthwhile for some patients to improve quality of life despite potential side effects."

"Considering its cardiovascular and gastrointestinal risks, however, there is little justification to initiate diclofenac treatment before other traditional NSAIDs."

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What to eat before a workout to lose weight and build muscle

The best foods to eat before exercising depend on the type of workout and a person's goals. Foods rich in protein, for example, can help a person to build muscle with resistance training.

When choosing a pre-workout meal, it is important to aim for a balance of macronutrients. Macronutrients are dietary compounds that the body needs in large quantities to function correctly.

The three macronutrients are:

protein carbohydrates fat

Macronutrients are all key sources of energy, but each can contribute differently to a pre-workout meal.

Protein Protein supplies amino acids, and both are essential for a range of bodily functions, including the building, maintenance, and repair of muscle fibers. Eating a meal that contains a significant amount of lean protein before exercising can help to improve performance. Why is protein a good pre-workout food? What to eat before a workout salmon
Consuming high-protein foods such as salmon before a workout can increase gains in muscle mass.

Protein can increase the amount of muscle mass gained from a resistance workout.

Intense bouts of resistance exercise damage the muscles, but consuming protein increases the number of amino acids in the body. These work to reduce deterioration, synthesize muscle proteins, and stimulate growth.

Consuming 20–30 grams of protein before a workout can result in an increased rate of muscle protein synthesis that lasts for several hours.

High-protein foods

The following are some examples of healthful foods that are rich in protein:

fish, such as salmon and tuna poultry, such as chicken and turkey nuts beans lentils eggs soy

Anyone interested in gaining muscle should ensure that they receive an adequate overall daily protein intake.

Research has consistently shown that consuming between 1.6 and 1.8 grams of protein for every pound of bodyweight is sufficient for building muscle.

Many sources recommend consuming more, but any additional protein is unlikely to make a significant impact on muscle mass.

Thank you for supporting Medical News Today Carbohydrates What to eat before a workout beans
People should consume complex carbohydrates, such as beans, 2-3 hours before working out. Carbohydrates are an essential energy source. Consuming the right amount of carbohydrates before a workout will ensure that the body has enough energy to perform well. This is true for people engaging in cardiovascular and resistance exercises, among other kinds. However, different types of carbohydrates will have a different impact: Simple carbohydrates: These are sugars that provide a rapid rise in energy. A common source of these carbohydrates is white bread. Complex carbohydrates: These include fiber or starch. They provide a slower, more long-term source of energy. Whole-grain foods are a good source of complex carbohydrates. Which type of carbohydrate is better in a pre-workout meal? Complex carbohydrates have a number of advantages, for example: Simple carbohydrates are short-term sources of energy. If a pre-workout meal includes too many simple carbohydrates, a person may feel a drop in energy before they finish their workout. Complex carbohydrates provide energy more consistently over a more extended period. Complex carbohydrates are components of foods that tend to be rich in nutrients, such as beans. Simple carbohydrates are typically components of foods that have little or no nutritional value, such as chocolate bars and cakes. Foods that contain complex carbohydrates have lower glycemic index scores than those that contain simple carbohydrates. A type of food with a low glycemic index score is unlikely to cause blood glucose levels to spike and increase the risk of type 2 diabetes. The body digests complex carbohydrates more slowly than simple carbohydrates. To increase energy ahead of a workout, a person should consume complex carbohydrates 2–3 hours in advance, and any simple carbohydrates 30–60 minutes in advance. Complex carbohydrate foods Below are some examples of healthful foods that contain complex carbohydrates: broccoli, sweet potatoes, and other vegetables whole-grain pasta beans lentils brown rice oats whole-grain bread Fruits provide the best source of simple carbohydrates before a workout. Bananas are a popular choice, as they contain potassium as well as simple carbohydrates. Fats Fats are an essential energy source. Traditionally, medical professionals have advised against consuming high-fat meals before exercise because the body digests fats more slowly than carbohydrates. This means that the body may not be able to break down and absorb fats before a workout begins. Can fats help before a workout? What to eat before a workout avocado
Avocados are rich in unsaturated fats, which are necessary for a balanced diet. Before a workout, it may be better to eat a meal that focuses more on protein and carbohydrates than fats. However, it is important to incorporate healthful fats elsewhere in a balanced diet. It is also worth noting that not all fats are healthful. Certain types, most notably saturated and trans fats, can negatively impact overall health. Healthful-fat foods Other types of fats are, however, highly nutritious. Unsaturated fats, for example, provide a range of health benefits. Below are some foods rich in unsaturated fats: avocados nuts and seeds olive oil Thank you for supporting Medical News Today When to eat a pre-workout meal Ideally, a person should eat a meal rich in complex carbohydrates and protein around 2–3 hours before exercising. Waiting a few hours after eating allows the body enough time to digest the meal. Alternately, a person may prefer a smaller meal that is mostly made up of simple carbohydrates. In this case, they need only wait for 30–60 minutes before working out.
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Cardiovascular disease: Study finds best drugs for prevention

A large cohort study has identified which treatment combinations work best for people with high blood pressure who are at risk of heart disease. Taking both blood pressure drugs and statins might be the best choice, the researchers find.
organizer with different pills
Which treatments work best for preventing cardiovascular events?

Researchers from the William Harvey Research Institute at Queen Mary University London in the United Kingdom have recently made public the results of a large long-term study that looked at the efficiency of different treatments in keeping cardiovascular disease at bay.

A combination of blood pressure-lowering drugs and statins (which are drugs that help regulate cholesterol levels) show the best results, the experts explain.

They presented the study's results at the European Society of Cardiology annual congress, held in Munich, Germany, and they featured them in a dedicated paper now published in The Lancet.

"Patients in their mid-60s with high blood pressure were less likely to die from heart disease or stroke by age 75–80 if they had taken both calcium channel blocker-based blood pressure lowering treatment and a statin," explains Dr. Ajay Gupta.

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Best preventive approach against stroke?

The scientists derived their results from the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT) Legacy study, which continued the work started by the original ASCOT.

In the new study, the investigators followed 8,580 U.K. participants who were initially recruited in 1998–2000. All of the participants had high blood pressure at baseline, as well as several risk factors for developing cardiovascular disease.

The original ASCOT study had three main aims; first, to test which of two approaches to treatment — a traditional or an innovative one — would work best for preventing heart attacks.

To do so, the team gave some participants the innovative therapy, which consisted of amlodipine and, if necessary, perindopril. These are two specialized drugs that aim to lower blood pressure.

The other participants all took the traditional treatment of atenolol (another blood pressure drug), and bendroflumethiazide (which is a diuretic used to treat hypertension), to which potassium was added on a case-by-case basis.

Since the novel approach proved effective in preventing strokes and premature death after a median period of 5.5. years, the researchers stopped the trial at that point.

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The ASCOT study's second aim was to see whether people with high blood pressure who also took statins would be any more shielded against the development of coronary heart disease. The team gave this new treatment to those with hypertension and average cholesterol levels (under 6.5 millimoles per liter).

On the basis of a randomized allocation, these participants took either atorvastatin or a placebo for 3.3 years. Once more, the trial was so successful in preventing heart attacks and strokes that it ended early.

Finally, the ASCOT study also aimed to assess the overall effectiveness of the two therapies for blood pressure in individuals with hypertension and high blood pressure (reading over 6.5 millimoles per liter).

The researchers did not give statins to this group of participants over the 5.5 years during which they were involved in the study.

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'These results are remarkable'

Based on the ASCOT data, Dr. Gupta and team were able to assess the effectiveness of the various treatment combinations in the long-term.

They found that the study participants who had taken amlodipine and perindopril for 5.5 years had a 29 percent lower likelihood of having died due to a stroke 10 years later, compared with the participants who followed the traditional therapy for blood pressure.

Moreover, participants with average cholesterol levels at baseline who took a statin during the trial had a 15 percent lower risk of death due to heart disease and stroke after 16 years, compared with those who only took a placebo.

Also, the participants with high cholesterol at baseline who took their usual cholesterol-lowering treatment as well as the innovative blood pressure therapy saw 21 percent fewer deaths due to cardiovascular disease over 10 years.

"These results are remarkable. We have previously shown that statins confer long-term survival benefits after trials have stopped, but this is the first time it has been found with a blood pressure treatment."

Study co-author Prof. Peter Sever

Prof. Mark Caulfield, the director of the William Harvey Research Institute, also emphasizes the importance of the study's findings for preventive medicine.

"This study confirms the importance of lowering blood pressure and cholesterol to prevent disabling and life-shortening cardiovascular disease," he notes.

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Mediterranean diet shown to prolong seniors' lives

A study of older adults by researchers in Italy suggests that the recipe for a longer life is to follow a Mediterranean diet.
mediterranean diet foods
The Mediterranean diet is shown to lengthen life.

Many studies have already hailed the benefits to health and longevity of the Mediterranean diet, but few have focused on older people.

The new research has come from the I.R.C.C.S. Neuromed Mediterranean Neurological Institute in Italy and comprises two parts.

The first is a study that followed 5,200 people aged 65 and older for approximately 8 years.

The second is an analysis that added data from several other studies, bringing the total of older individuals evaluated to 12,000.

In a paper on the findings that now features in the British Journal of Nutrition, the researchers describe how they found that the seniors whose food intake most closely matched a Mediterranean diet lived the longest.

First study author Marialaura Bonaccio, an epidemiologist at I.R.C.C.S. Neuromed, explains that while they knew "that the Mediterranean diet is able to reduce the risk of mortality in the general population," they did not know whether this might also be the case for older people "specifically."

She and her colleagues also observed that there was a "dose-response" relationship between diet and survival in seniors: the closer the diet was to a Mediterranean one, the longer the survival.

The findings support the idea that adopting or continuing with a Mediterranean diet could help older people "maximize their prospects for survival," they conclude.

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Assessing the Mediterranean diet

Researchers started to define the Mediterranean diet in the 1960s as they compared eating habits and heart risks of people living in Greece and Southern Italy with those of individuals living in Northern Europe and the United States.

As more and more studies have been done, diverse definitions of what constitutes a Mediterranean diet have arisen. While there are some differences, they generally emphasize the following core components:

high intake of plant foods such as leafy and other vegetables, nuts, fruits, pulses, whole cereals, and olive oil moderate consumption of fish, dairy, meat, and red wine low intake of eggs and sweets

For their investigations, Bonaccio and colleagues used a 10-point Mediterranean diet score (MDS) based on one that has been used to study Greek populations.

The MDS assesses intake of different foods and also the ratio of unsaturated to saturated fats in the diet.

An MDS of 0 means minimal adherence to a traditional Mediterranean diet, while a score of 9 means maximum adherence.

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The study findings

For the first part of the study, the team analyzed the link between adherence to the Mediterranean diet and survival in 5,200 individuals aged 62 living in the Molise region in central Italy. The people had been recruited for the Moli-sani project during 2005–2010.

The purpose of the Moli-sani project was to set up a study population that was separate from those that typically feature in health studies, which tend to focus on Northern Europe and the U.S.

The scientists found that over an 8.1-year median follow-up period, for every one-point increase in MDS, there was an associated reduction in risk of death from: all causes, coronary artery disease, cerebrovascular diseases, and diseases not due to cancer or cardiovascular causes.

In the second part of the study, the scientists searched databases for other similar studies that had examined links between the Mediterranean diet and mortality in older people.

They found six studies that matched their criteria, and they added the data from those to the data they had from the Moli-sani cohort. This gave a large pool of data on 11,738 individuals.

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Analysis of the pooled data showed a similar pattern to the earlier results. A one-point rise in MDS was linked to around 5 percent reduction in risk of death from all causes.

Furthermore, an analysis of pooled data from three of the studies revealed an "inverse linear dose-response relationship."

Commenting on their findings, the researchers explain that the foods that appear to offer the most protection in the Mediterranean diet are higher intakes of monounsaturated fats, such as in virgin olive oil, and "moderate consumption of alcohol, preferably during meals."

Bonaccio remarks that while they considered "nutrition as a whole," it was interesting to see the foods that "contribute to the 'driving' effect of the Mediterranean diet."

"Our data confirm what has already been observed in numerous epidemiological and metabolic studies, namely that a moderate consumption of alcoholic beverages, if inserted in a Mediterranean food context, is a protective factor for our health."

Marialaura Bonaccio

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What to know about brain stem strokes

The brain stem controls essential bodily functions, such as breathing, swallowing, and balance. A blockage or a bleed in the brain stem can cause a brain stem stroke, which can affect these vital roles.

In this article, we take a close look at brain stem strokes, including the symptoms, diagnosis, recovery, and outlook.

What is brain stem stroke? Diagram of the brain stem
The brain stem controls breathing, eye movement, facial movement, heart rate, and blood pressure.

According to the World Health Organization (WHO), stroke is the "second leading cause of death and the third leading cause of disability" worldwide.

A stroke occurs when the blood supply to a part of the brain is interrupted, either due to a blocked artery or a leaking blood vessel.

The brain stem is located at the base of the brain and is responsible for receiving and relaying information throughout the body.

The brain stem controls essential body functions, such as:

breathing swallowing eye movement facial movement and sensation hearing heart rate blood pressure

Brain stem strokes can affect a person's fundamental bodily functions and may lead to long-term complications.

Types of strokes There are two main types of strokes, both of which can affect the brain stem: Ischemic stroke Ischemic strokes occur when blood clots form in the narrow arteries in the head or neck, cutting off the blood supply to an area of the brain. Ischemic strokes are the most common type, accounting for 87 percent of all strokes. Around 10 percent of all ischemic strokes affect the brain stem. A transient ischemic attack (TIA), also called a mini-stroke or a warning stroke occurs when the blood supply to the brain is interrupted briefly. TIAs cause milder symptoms than full ischemic strokes, and most symptoms go away within an hour. Hemorrhagic stroke Hemorrhagic strokes, or brain bleeds occur when a weak blood vessel leaks or breaks open, creating swelling and pressure. This pressure damages tissues and cells in the brain. Hemorrhagic strokes are less common than other types of stroke, but they account for 40 percent of all stroke deaths. Thank you for supporting Medical News Today Symptoms of a brain stem stroke Girl with dizziness on a train which may be a symptom of stroke
Dizziness and loss of balance are common symptoms of stroke. Because the brain stem controls a variety of motor functions, strokes in this area of the brain cause a diverse range of symptoms. Brain stem strokes can disrupt vital bodily functions, such as: breathing swallowing heart rate The brain stem receives various signals from the brain and sends them to different parts of the body. Brain stem strokes disrupt these signals, which is why people experience physical symptoms, including numbness or weakness in the face, arms, or legs. Other common stroke symptoms include: Diagnosing a brain stem stroke If a person experiences symptoms of a stroke, their doctor will use imaging tests, such as CT and MRI scans to determine whether the stroke is ischemic or hemorrhagic. Doctors may also order additional procedures, such as blood tests, echocardiograms, carotid ultrasounds, and cerebral angiography. Complications Because the brain stem is responsible for several vital bodily functions, a stroke in this area of the brain can have devastating effects on necessary motor-skills and processes, such as eye movement, speech, and spatial reasoning. A rare, but severe type of brain stem stroke can result in a person developing locked-in syndrome, which causes full-body paralysis—except for the muscles that control eye movement. Thank you for supporting Medical News Today Treatment A brain stem stroke is a medical emergency. It requires immediate treatment to save lives and reduce the risk of lasting complications. Treatment depends on the type, location, and severity of stroke: Ischemic stroke Treatment for an ischemic stroke involves restoring blood flow by eliminating the clot. Methods include the following: Clot-busting drugs, such as tissue plasminogen activator (t-PA), which will help dissolve the clot and restore blood flow to the affected area. Anti-platelet drugs, such as aspirin. Endovascular therapy, which is a surgical procedure that involves the use of mechanical retrievers to remove blood clots. Other devices, such as balloons or stents, which can be used to open up narrowed blood vessels and improve blood flow. Hemorrhagic stroke Treatment for hemorrhagic strokes focuses on controlling bleeding and reducing pressure in the brain. Treatment methods include: Administering drugs to control blood pressure and prevent seizures. Coil embolization, which is a surgical procedure that helps form a blood clot in the weakened vessel. The clot will reduce bleeding and stop the blood vessel from breaking open again. Once bleeding in the brain is under control, doctors may perform surgical procedures to repair the broken blood vessel to prevent it from hemorrhaging again. Risk factors for stroke doctor taking patients blood pressure
High blood pressure can increase the risk of stroke. Anyone can have a stroke, but specific genetic factors, such as family history, gender, race, and age put some people at higher risk for stroke than others. According to the American Stroke Association, women have more strokes than men and are more likely to die from a stroke than men. Some risk factors that are unique to women include: use of hormone replacement therapies long-term use of birth control pills in combination with other risk factors, such as smoking pregnancy People of African-American and Hispanic descent are also at higher risk of stroke. The majority of strokes occur in people over the age of 65. However, research suggests that the rate of stroke hospitalizations and the presence of stroke risk factors in younger adults has increased significantly. Medical conditions that increase the risk of stroke include: People cannot control genetic factors, but they can control lifestyle factors that increase the risk of stroke. Behaviors that increase high blood pressure or the risk of clot formation can lead to a higher risk of stroke. Behaviors that can increase the risk of stroke include: smoking tobacco excessive alcohol use illegal drug use a sedentary lifestyle poor diet Prevention An estimated 80 percent of strokes are preventable. People can reduce their risk of stroke by making the following lifestyle changes: monitoring lipid and cholesterol levels controlling blood pressure with medication and behavioral changes controlling medical conditions, such as diabetes quitting smoking eating low-fat, low-sodium diets eating 5 or more servings of fruits and vegetables taking part in regular exercise Thank you for supporting Medical News Today Recovery and outlook A brain stem stroke can result in severe long-term complications. Medication and behavioral changes can help reduce the risk of future strokes. Physical therapy can improve muscle strength, coordination, and ultimately help people regain lost motor skills. Occupational therapy can help people improve their cognitive abilities, such as memory, problem-solving, and judgment. Some people who have had a brain stem stroke and have severe disabilities may require psychological counseling to help them adjust.
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Is there a link between acid reflux and palpitations?

Palpitations are irregular heartbeats that can occur sporadically or frequently. Although palpitations have many direct causes, gastroesophageal reflux disease (GERD), the long-term and frequent occurrence of acid reflux, is unlikely to be one of them. However, acid reflux shares some of the same triggers as palpitations and may also lead to them indirectly.

The primary symptom that acid reflux does cause is a burning pain in the chest and upper abdomen, which occurs due to stomach acid leaking back into the food pipe.

In this article, we look at heart palpitations in more detail, including the common causes of palpitations and how they might relate to acid reflux.

What are palpitations? Heart palpitations represented by model fo a heart over a stethoscope.
A palpitation is an irregular heartbeat.

Palpitations are irregular heartbeats that can make a person feel as though their heart has skipped a beat. The heart may also feel like it is fluttering in the chest.

Other people with heart palpitations may feel that their heart is beating harder than usual or beating too fast in comparison to its regular rate.

Much of the time, heart palpitations are harmless, and people can think of them as a speed bump in the heart's natural rhythm.

Other times, heart palpitations may signal a problem with the heart or other organs.

Some people experience heart palpitations regularly while others may only have them on rare occasions.

Acid reflux and causes of heart palpitations While acid reflux will not usually be a direct cause of heart palpitations, it may lead to them indirectly. For instance, if a person with GERD feels stressed or anxious about their symptoms, this may lead to palpitations. Several factors may also trigger both acid reflux and heart palpitations. When this happens, it is easy to confuse the causes. For example, alcohol consumption may cause palpitations in some people, and it can also trigger GERD symptoms. Likewise, too much caffeine may sometimes trigger GERD symptoms, and the effects of caffeine can also cause skipped heartbeats or palpitations. Eating too much, or eating a particularly heavy meal, may also cause both heart palpitations and acid reflux in some people. Thank you for supporting Medical News Today Other causes of heart palpitations Other possible causes of palpitations can include: illegal drugs, such as cocaine or methamphetamine smoking tobacco smoking marijuana pregnancy some stimulating medications electrolyte imbalance, such as low potassium levels low blood sugar sickness Some medical conditions may cause palpitations, including: Symptoms of heart palpitations Man touching chest in doctors office explaining heart problem
A fast heartbeat is a potential symptom of heart palpitations. The symptoms of heart palpitations can vary from person-to-person, but may include: a fast or racing heartbeat the heart pounding in the chest or beating very hard a fluttering sensation in the chest a feeling of the heart skipping a beat a "flip-flopping" sensation in the chest, as though the heart has turned over These sensations are due to either premature atrial contractions (PACs) or premature ventricular contractions (PVCs). Both of these are extra beats in the heart that happen just before the regular heartbeat, causing the person to feel an odd sensation. Severe symptoms are also possible alongside heart palpitations. These may include: chest pain breathing difficulty cold sweats feeling dizzy or fainting tightness, pain, or pressure in the shoulder, neck, or jaw When they occur together with heart palpitations, these symptoms may signify a heart condition or medical emergency. Anyone experiencing these symptoms should seek emergency medical attention. Diagnosing heart palpitations To diagnose heart palpitations, doctors will first perform a physical exam and ask about any symptoms. It may be beneficial for people with heart palpitations to keep a daily journal of their symptoms to discuss with the doctor at the appointment. The doctor may do some physical checks, such as listening to the heart with a stethoscope or checking the thyroid gland for swelling. Much of the time, they will also order one or more tests to examine the heart in more detail. Possible tests include: Electrocardiogram (ECG) An ECG records impulses in the heart. Doctors may order an ECG to track the rhythm and beats of the heart and check for irregularities. Holter monitor If a simple ECG does not capture any irregularities, doctors may have the person wear a Holter monitor. A Holter monitor is a portable ECG that records the heart for an extended continuous period, potentially 24 hours or more. This may be helpful for people who only have palpitations in specific situations, such as when lying down or after a meal. Event recorder If palpitations are less frequent, a doctor may ask the individual to wear an event recorder. An event recorder only records the heart when prompted. The user pushes a button when they feel the palpitation, and the recorder picks it up for the doctor to examine later. People may wear event recorders for much longer than Holter monitors, sometimes keeping them on for up to several weeks. Ultrasound Doctors will sometimes order an ultrasound of the chest, called an echocardiogram, to view the heart and see how it is looking and working. Blood tests Some blood tests may help diagnose underlying causes, such as anemia or thyroid problems. Thank you for supporting Medical News Today Treatment for heart palpitations Woman drinking from mug with headphones in relaxing to mindfulness or meditation app
Meditation and deep breathing exercises may help treat stress-related palpitations. Doctors usually only treat heart palpitations related to more severe heart conditions. The treatment can vary in each case, and doctors will thoroughly discuss all of the person's options with them. For common heart palpitations, a doctor may recommend lifestyle changes. If palpitations seem to occur around the same time as GERD symptoms, it is likely to be because of the meal the person just ate. They may be consuming meals that are too large, or their body may be sensitive to a specific food that they are eating. People can often identify trigger foods by keeping a daily journal of what they eat and any symptoms that they experience. Treating palpitations can sometimes be as simple as removing these foods from the diet. Avoiding the excessive consumption of tobacco, alcohol, and marijuana is also likely to help some people. For stress-related palpitations, doctors may recommend that people relieve stress by incorporating some of the following activities into their weekly routines: meditation yoga tai chi deep breathing exercises mild-to-moderate exercise Doing at least one of these activities regularly may help reduce stress, which can cause palpitations in some people. What to do when you experience palpitations Palpitations may be a sign of an underlying condition, even in cases where stress triggers them. Anyone experiencing heart palpitations along with other serious symptoms should seek emergency medical care. These symptoms include: chest, back, or shoulder pain tightness in the jaw shortness of breath How to stop palpitations There are a couple of techniques that people can try to stop palpitations when they are occurring. These methods stimulate the vagus nerve, which may help control the heartbeat: Valsalva maneuver. Pinch the nose and close the mouth. Try to breathe out of the nose for a couple of seconds to create a feeling of pressure in the head. Cold water. Splash cold water on the face for 30 seconds or dunk the head in cold water. This may stimulate a response in the body, slowing down the heart rate. Bearing down. Bearing down is the act of clenching the muscles in the stomach and closing the anal sphincter while pushing down as if initiating a bowel movement. This action has the same result as the Valsalva maneuver. These techniques may work temporarily, but it is vital not to ignore the underlying cause of palpitations. Long-term treatment should be a top priority for people with this symptom. Takeaway While GERD or acid reflux is unlikely to cause heart palpitations directly, symptoms associated with GERD may trigger palpitations in some people. Anyone who is unsure about their symptoms should talk to a doctor, and any severe symptoms indicate that emergency medical care is necessary.
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What are the consequences of a sedentary lifestyle?

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2008 physical activity guidelines for Americans. (2008, October). Retrieved from https://health.gov/paguidelines/pdf/paguide.pdf

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How exercise affects metabolic hormones

Researchers from Denmark have found that cardio or endurance exercise impacts metabolic hormones differently to strength or resistance training with weights.
sweaty woman at the gym
Cardio exercise and strength training impact our metabolic hormones in different ways.

The research has deepened our understanding of how different forms of exercise affect the body.

A significant finding is that endurance exercise increases a metabolic hormone called fibroblast growth factor 21 (FGF21), whereas strength training decreases another called fibroblast growth factor 19 (FGF19).

The effects of various forms of exercise on better-known hormones such as insulin and adrenalin are already well-understood, says senior study author Christoffer Clemmensen, who is working as an associate professor in the Novo Nordisk Foundation Center for Basic Metabolic Research in Copenhagen.

The new insight from their findings, he explains, is "that strength training and cardio exercise affect FGF hormones differently."

The study — which features in the Journal of Clinical Investigation: Insight — also confirmed some known effects of other metabolic substances.

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Metabolism and exercise

The word metabolism comes from the Greek phrase for "to change," but we use it to refer to all the processes that extract and use energy to sustain life.

These range from breathing, digestion, and temperature regulation to muscle contraction, keeping the brain and nerves working, and getting rid of waste through feces and urine.

Metabolism changes over the lifespan. As we get older, we burn fewer calories and our digestion alters. We also lose lean muscle and — unless we take care of our diet and exercise regularly — gain weight.

Eating too much and having a lifestyle that is mostly sedentary can hasten these age-related changes.

To protect against this, experts advise us to follow guidelines on how to eat a healthful diet and remain physically active.

In the United States, the physical activity guidelines for adults advise a combination of muscle-strengthening and aerobic, or endurance, exercise.

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Exercise and metabolic hormones

However, while there is a lot of evidence outlining the various benefits of exercise on health, "the underlying mechanisms remain incompletely understood," Clemmensen and his colleagues note in their study paper.

So, they investigated this further by examining the impact of two forms of exercise on metabolic hormones, which are the chemical messengers that regulate the processes of metabolism.

They recruited 10 healthy young men and randomly split them into two groups. In one group, the men did cardio training first, and then strength training about a week later. In the other group, the men did the strength training first and then the cardio.

All the exercise sessions lasted for about an hour and were intensive. In the cardio session, the men cycled at 70 percent maximum intake of oxygen. In the strength training session, they put all major muscle groups through a regime comprising five different exercises repeated between five and 10 times.

During the 3-hour recovery period following each exercise session, the researchers took blood samples from each man immediately after exercise and then at intervals thereafter.

They used the blood samples to measure changes in levels of: blood sugar, lactic acid, several hormones, and bile acid.

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Different effects on metabolic hormones

The results showed that blood levels of FGF21 rose significantly during the cardio or endurance sessions, but not in the strength training sessions.

The effect of cardio on FGF21 was so marked that the researchers believe that it warrants further investigation. Of particular interest is whether the hormone is directly involved in the health-promoting effects of cardio exercise.

The results also showed that levels of FGF19 fell slightly after strength training. This was a surprise to the researchers who were expecting it to rise, since animal studies suggest that the metabolic hormone helps with muscle growth.

FGFs are active in many different biological processes, in addition to helping regulate metabolism. These include, for example, cell growth, embryonic development, tissue repair, and tumor formation.

FGF21 is produced in several organs and is active in weight loss, glucose control, and reducing inflammation.

In fact, researchers have proposed that FGF21 has potential as a drug for treating "metabolic complications such as diabetes and fatty liver disease."

FGF19, which is produced in the gut, is described as an "atypical" member of the FGF family. As a hormone, it helps regulate bile acid production and metabolism of glucose and lipids.

Animal studies have shown that, as well as helping with muscle growth, FGF19 can aid weight loss, reduce fats and glucose levels in the liver, and improve use of insulin.

The team now plans to further investigate the links between metabolic hormones and exercise. One limitation of the new study was that it only looked at changes in the 3 hours following the exercise session. It is still not clear what happens in the longer-term.

"FGF21's potential as a drug against diabetes, obesity, and similar metabolic disorders is currently being tested, so the fact that we are able to increase the production ourselves through training is interesting."

Christoffer Clemmensen

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Dairy and meat 'beneficial for heart health and longevity'

New research suggests that current dietary guidelines should be revised to account for the dietary habits of modern populations from across the globe. Unprocessed red meat and dairy, for instance, should be included as part of a heart-healthy diet.
dairy and meat
Dairy products, such as cheese and milk, and unprocessed meat may actually benefit heart health.

Many studies suggest that a diet that avoids red meat and dairy but is rich in fruit, vegetables, nuts, and whole grains is the best for heart health.

However, new research suggests that we should amend these guidelines.

The Prospective Urban Rural Epidemiological (PURE) study — which was led by Prof. Salim Yusuf, the director of the Population Health Research Institute (PHRI) at McMaster University in Hamilton, Canada — suggests that the results of these traditional studies may be biased and outdated.

Specifically, explain the researchers, such studies are based on the dietary habits of high-income countries and rely on data from decades ago. For these reasons, the new study aimed to make a more comprehensive analysis of people's dietary patterns across the world.

Its findings were presented at the 2018 annual conference of the European Society of Cardiology, held in Munich, Germany.

The researchers have also published their results in the journal The Lancet.

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Diet quality and cardiovascular health

For the PURE study, Prof. Yusuf and colleagues examined the link between diet and heart health in almost 140,000 healthy people, aged 35–70, who were clinically followed for over 9 years.

During this period, 6,821 people died of a cardiovascular disease and 5,466 experienced major cardiovascular events such as heart attack, stroke, and heart failure.

The quality of the participants' diets was assessed using a food score. To develop the score, the researchers included foods that previous studies suggested might lower the risk of premature death, such as: fruit, vegetables, nuts, legumes, fish, dairy products, and meat.

PHRI's Andrew Mente, the study's co-principal investigator, summarizes the findings. "People who consumed a diet emphasizing fruit, vegetables, nuts, legumes, fish, dairy products, and meat had the lowest risks of cardiovascular disease and early death," he says.

"Regarding meat, we found that unprocessed meat is associated with benefit."

Andrew Mente

Specifically, compared with people who scored the lowest on the quality of their diet, those with the highest quality score were 11 percent less likely to experience a major cardiovascular event, 17 percent less likely to have a stroke, and 25 percent less likely to die of any cause.

Additionally, the findings suggest that the intake of refined carbs should be limited, but that dairy and unprocessed red meat may be healthful.

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'Dairy products and meat are beneficial'

The researchers replicated their findings in four further studies. Overall, the results were confirmed in a total sample of more than 218,000 people from over 50 countries spread across the globe.

"Our results appeared to apply to people from different parts of the world and so the findings are globally applicable," explains Mahshid Dehghan, who is also a co-principal investigator affiliated with PHRI.

Prof. Yusuf explains that, while these findings may go against traditional beliefs, they are a better reflection of our modern, international dietary habits.

"Thinking on what constitutes a high-quality diet for a global population needs to be reconsidered. For example, our results show that dairy products and meat are beneficial for heart health and longevity. This differs from current dietary advice."

Prof. Salim Yusuf

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Newly discovered skull channels play role in immunity

Researchers have now discovered "tiny channels" that allow the injured brain to communicate with bone marrow in the process of inflammation. These "tunnels" are key to ensuring a quick immune response.
blue and fuchsia brain concept
'Tiny channels' in the skull allow injured brain tissue to recruit help fast.

Inflammation occurs as an immune response to instances of infection or injury within the body.

The immune response is subject to a complex process of coordination that involves a type of spongy tissue known as bone marrow.

Bone marrow can be found inside a number of bones, including the skull, the vertebrae of the vertebral column, and leg bones, such as the tibia.

This tissue produces both red blood cells and some types of immune cells, all of which are involved in inflammation, responding to injuries or infections.

Now, a study conducted by researchers from the Harvard Medical School in Boston, MA, and partly funded by the National Institutes of Health (NIH), has discovered how the brain and bone marrow coordinate to ensure a quick, targeted immune response.

The answer, the specialists explain in a paper featured in the journal Nature Neuroscience, lies in previously unknown channels that allow the two to communicate.

"We always thought that immune cells from our arms and legs traveled via blood to damaged brain tissue. These findings suggest that immune cells may instead be taking a shortcut to rapidly arrive at areas of inflammation," explains Francesca Bosetti, program director at the NIH's National Institute of Neurological Disorders and Stroke.

"Inflammation plays a critical role in many brain disorders and it is possible that the newly described channels may be important in a number of conditions. The discovery of these channels opens up many new avenues of research."

Francesca Bosetti

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The injured brain recruits help from the skull

The researchers first conducted their study in a mouse model, and once they knew what to search for, they were also able to replicate their findings in humans.

Using advanced optical imaging techniques, they tracked the movements of neutrophils, a type of immune cell typically first to migrate to places in the body that have sustained an injury.

Specifically, the researchers could find out whether neutrophils that reached brain tissue damaged as the result of a stroke or meningitis were released from bone marrow found in the skull or from marrow found in the tibia.

Looking at brains of mice, the scientists saw that during a stroke, injured brain tissue receives neutrophils from the skull, rather than the tibia, in most cases.

During a heart attack, however, the researchers revealed that the heart is likely to receive a similar number of neutrophils from both skull and tibia marrow, seeing as the heart is situated farther from both of those bone structures.

Also, they noted that 6 hours after a stroke occurs, there are fewer neutrophils in the marrow of the skull than in that of the tibia.

What this suggests is that the injured brain tissue and the marrow found in the skull have a direct means of "communication," which allows for a quick and targeted immune response from the closest "respondent."

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An 'unexpected' discovery

How does this all happen? The first clue about the mechanisms involved came from a bone marrow protein known as stromal cell-derived factor-1 (SDF-1), whose role is to regulate when immune cells are stored in the bone marrow and when they are released.

When SDF-1 levels drop, the bone marrow releases neutrophils, so they can attend to the injured tissue.

The team noted that SDF-1 levels decrease 6 hours after a stroke only in the marrow found in skull bones, which indicates that the bone marrow found in the skull is in direct communication with the brain, which "alerts" it of the damage, "recruiting" the closest source of help.

"We [then] started examining the skull very carefully, looking at it from all angles, trying to figure out how neutrophils are getting to the brain," explains study co-author Dr. Matthias Nahrendorf.

"Unexpectedly, we discovered tiny channels that connected the marrow directly with the outer lining of the brain," he adds.

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Dr. Nahrendorf and his team identified such "tiny channels" of communications not just all over the skull, but also in the tibia.

Following these findings in mice, the researchers then searched for the same structures in humans and found them; the channels they observed in human skulls were five times larger than the ones seen in mice, they report.

Moreover, in mice as well as in humans, the channels appear both in the inner and outer layers of the skull.

In the future, the scientists are eager to see what other types of cells may move through these newly discovered channels and to uncover more information about how these tiny passages mediate the immune response.

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Dairy consumption guidelines 'should be revised'

Guidelines that advise people to limit how much dairy food — particularly yogurt and cheese — they eat should be revised, according to new research.
milk, cheese and yogurt
Researchers believe that dairy consumption guidelines should now be revised.

It found that higher overall consumption of dairy products is linked to a lower risk of premature death from all causes and "cerebrovascular causes" such as stroke.

Drinking milk, on the other hand, was found to be associated with a higher risk of coronary heart disease.

However, the researchers also say that this needs further investigation.

Meanwhile, they recommend that the guideline for milk consumption should be to drink fat-free or low-fat milk, especially for those who drink a lot of milk.

Maciej Banach, who is a professor in the Department of Hypertension at Medical University of Lodz in Poland, and his colleagues analyzed national survey data from the United States and confirmed their results in a further analysis of pooled data from several other studies.

Their findings feature at the 2018 annual congress of the European Society of Cardiology, held in Munich, Germany.

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Conflicting evidence on dairy foods

Cerebrovascular diseases, such as stroke, affect the blood vessels in the brain. Stroke accounts for high rates of disability and death. In the U.S., it is the "fifth leading cause of death."

For a long time, it was thought that eating dairy foods — because they contain more saturated fat — raised people's risk of premature death, especially from cancer, cerebrovascular diseases, and coronary heart disease.

However, the researchers say that the evidence to support this idea, especially that which applies to U.S. adults, is conflicting.

Prof. Banach notes, for example, that an analysis of pooled data from 29 studies that was published in 2017 "found no association between the consumption of dairy products and either cardiovascular disease [...] or all-cause mortality."

That being said, another study of adults in Sweden that was published in the same year found that drinking more milk was linked to double the risk of premature death — including death from cardiovascular disease — in women.

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Lower risk of death

For the new analysis, the researchers used data from the 1999–2010 National Health and Nutrition Examination Surveys (NHANES) covering 24,474 adults — aged 47.6 years, on average — of whom 51.4 percent were female.

The Centers for Disease Control and Prevention (CDC) carry out a NHANES survey every year with a nationally representative sample of 5,000 U.S. residents. It includes physical examinations and interviews.

Over an average follow-up period of 76.4 months, there were 3,520 deaths. Of these, 827 were from cancer, 709 were due to heart-related causes, and 228 were due to cerebrovascular diseases.

The researchers found that overall consumption of dairy foods was linked to a 2 percent lower risk of death from all causes, while cheese consumption in particular was tied to an 8 percent lower risk.

Focusing on cerebrovascular disease deaths, the researchers found that overall dairy food intake was tied to a 4 percent lower risk, while milk consumption was linked to a 7 percent lower risk.

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Results confirmed — except for milk

The team then sought to confirm these findings by analyzing pooled data from 12 other studies that followed groups of people over time. Overall, the data covered a total of 636,726 individuals with a follow-up of around 15 years.

The analysis confirmed the earlier results, with the exception of milk consumption. Here, much like in the Swedish study that Prof. Banach mentioned, milk intake was linked to a 4 percent higher risk of death from coronary heart disease.

Consumption of yogurt and other fermented dairy foods, on the other hand, was tied to a 3 percent lower risk of death from all causes. Further adjustment, however, showed that the results on yogurt were not statistically significant and could just as likely have occurred by chance.

The researchers note that the links found between milk and coronary heart disease warrant further investigation. Because many people who drink milk also consume other dairy products, it is not easy to untangle the effect of milk from the rest.

In the meantime, they advise milk drinkers to confine their intake to the fat-free and low-fat varieties.

"In light of the protective effects of dairy products, public health officials should revise the guidelines on dairy consumption."

Prof. Maciej Banach

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