Wood Street Clinic Blog

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Experts advise 'healthful range' rather than 'variety of foods'

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

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

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

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

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

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'Little consensus on dietary diversity'

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

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

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

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

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

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

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

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'Choose range of healthful foods'

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

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

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

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

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

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The DASH diet

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

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

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

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

Dr. Marcia C. de Oliveira Otto

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How red blood cells harm cardiovascular health in diabetes

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

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

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

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

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

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

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

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

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'Damage to the innermost cell layers'

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

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

Study co-author Prof. John Pernow

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

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

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

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Findings may lead to preventive therapy

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

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

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

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

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

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Too much sleep could be worse for health than too little

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

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

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

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

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

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

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

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Cardiovascular diseases and events

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

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

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

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

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

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

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Sleep duration and quality

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

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

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

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

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

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

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Mechanisms are poorly understood

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

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

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

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

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

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

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

Dr. Chun Shing Kwok

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How 30 minutes of hookah smoking affects your heart

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

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

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

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

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

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

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

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Hookah smoking and cardiovascular health

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

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

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

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

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

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Not a more healthful alternative to cigarettes

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

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

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

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

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

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

Mary Rezk-Hanna

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

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Scientists link 151 genes to atrial fibrillation

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

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

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

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

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

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

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A-fib needs new treatments

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

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

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

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

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

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

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

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Data from several biobanks

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

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

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

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

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

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

Cristen J. Willer

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Targeting gut bacteria to reduce heart disease

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

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

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

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

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

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Gut bacteria and the heart

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

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

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

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

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

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

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

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

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

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A novel approach

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

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

Dr. Stanley Hazen, Ph.D.

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

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

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

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Even low air pollution may cause you serious heart problems

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

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

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

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

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

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Air pollution may cause heart enlargement

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

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

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

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

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

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

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Air pollution just as important as cholesterol

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

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

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

Dr. Nay Aung

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

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

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

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What is the Valsalva maneuver?

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

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

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

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

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

To do the Valsalva maneuver, follow these steps:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thyroid hormones play a role in regulating:

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

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

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

Thyroid problems

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

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

An underactive thyroid causes the following symptoms:

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

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

Symptoms of an overactive thyroid include:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Andreea Rawlings, Ph.D.

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

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

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

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Is my newborn sleeping too much?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Common causes of peripheral cyanosis include:

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

Peripheral vs. central cyanosis

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

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

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

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

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

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

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

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

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

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

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

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

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Controversy over heart-healthy foods

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

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

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

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

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

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Foods you should avoid

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

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

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

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

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

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Foods you should add to your diet

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

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

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

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

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

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

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

Dr. Andrew Freeman

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What are the benefits of drinking lime water?

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

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

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

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

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

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

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

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

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

The same size lime also contains the following nutrients:

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

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

1. Promotes consumption of water

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

2. Helps improve diet

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

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

3. May aid digestion

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

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4. Reduces cancer chances

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

5. Improves skin quality

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

6. Promotes weight loss

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

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

7. Improves immune system

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

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

8. Reduces risk of heart disease

Limes contain high levels of magnesium and potassium.

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

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

9. Lowers blood sugar

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

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10. Prevents the growth of micro-organisms

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

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

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

11. Has anti-inflammatory properties

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

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

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

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12. Helps prevent kidney stones

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

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

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

A 16-year study, which dove into the data of almost half a million men and women, concludes that a diet rich in fish predicts a longer life.
Fresh fish on ice
Could fish extend your life?

Consuming fish has long been recommended as part of a nutritious diet. Rich in high-quality proteins, vitamins, and healthful oils, fish is roundly considered a healthful choice.

Oily fish are rich in omega-3, and, over recent years, this oil has received a great deal of attention from medical researchers and supplement manufacturers alike.

Evidence is far from overwhelming, but scientists have already searched for any associations it might have with lower cancer risk, improved cardiovascular health, and reduced inflammation.

Other studies have tried to find links between omega-3 and mental health, aging, and vision. Work is ongoing, but because findings are often contradictory or weak, the relationship between a fish-heavy diet, omega-3 intake, and good health are still up for debate.

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Fishing for details

Recently, a team of researchers set out to gain more clarity on the important question, "Does eating fish impact mortality risk, and how does omega-3 fit in?"

The scientists delved into data from the NIH‐AARP Diet and Health Study, which is the largest study on health and diet ever carried out. In all, they followed 240,729 men and 180,580 women for 16 years.

Participants provided information about their dietary habits, and their health was monitored. Over the course of the study, 54,230 men and 30,882 women died. The results have been published recently in the Journal of Internal Medicine.

The main finding is that consuming more fish and long-chain omega-3s reduces total mortality.

And, looking further into these data, the researchers found that men who ate the most fish had a 9 percent lower mortality risk than those who ate the least.

When the researchers drilled down into specific causes of death, they found that males who ate the most fish, compared with those who ate the least fish, had a:

10 percent reduction in cardiovascular disease mortality 6 percent reduction in cancer mortality 20 percent reduction in respiratory disease mortality 37 percent reduction in chronic liver disease mortality

Comparing the highest and lowest fish consumers among female particiapants, they measured an 8 percent reduction in overall mortality and a:

10 percent reduction in cardiovascular disease mortality 38 percent reduction in Alzheimer's disease mortality

The scientists switched their analysis to look specifically at the level of omega-3 intake calculated from the participants' food intake surveys. They discovered that men and women who consumed the most omega-3 had 15 and 18 percent reductions in cardiovascular mortality, respectively.

The results are intriguing and add to the evidence for the health benefits of omega-3 and fish in general. However, not all fish was protective.

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Avoid the frier

Importantly, these results did not apply to fried fish. Among men, the consumption of fried fish had no impact on mortality risk. Among women, however, higher consumption of fried fish increased the risk of cardiovascular mortality, respiratory disease mortality, and overall mortality.

This is probably for a number of reasons. For instance, frying the fish creates trans-fatty acids and also increases the energy density of the end product, both of which could potentially undo any good work that omega-3s carry out.

Overall, the authors conclude:

"Consumption of fish and [omega-3s] was robustly associated with lower mortality from major causes. Our findings support current guidelines for fish consumption while advice on non-frying preparation methods is needed."

The study does have some shortfalls, though. For example, it was observational, so it is difficult to tease apart cause and effect. Also, the participants — on average — did not consume a great deal of fish when compared with those in other studies.

However, the project was large — it is the largest study to investigate dietary fish and mortality to date — and the long follow-up duration was key; similarly, there were a relatively high number of deaths, making the analysis more robust.

For these reasons, the results provide a welcome boost to the evidence in favor of the protective power of fish-based foods.

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Does 'good cholesterol' really protect heart health?

Traditionally, our high-density lipoprotein levels — also known as "good cholesterol" — have been considered a good indicator of heart health, particularly for women. Increasingly, however, research is casting doubts over this idea.
concept illustration for cholesterol effects
New research urges specialists to reassess existing notions about HDL cholesterol and cardiovascular health.

High-density lipoproteins (HDL) are molecules that transport fat through the body and to the liver so that it can be processed.

This helps to prevent excess accumulation, which is why it is also referred to as "good cholesterol."

High levels of HDL cholesterol have always been considered to be protective for heart health.

Women, in particular, tend to have higher levels of HDL cholesterol than men, but these do normally begin to decline when they reach menopause.

For this reason, specialists will often advise women on how to raise their "good cholesterol" levels at middle age. However, in recent years, some studies have suggested that HDL cholesterol may not, in fact, be as good for heart health as previous believed.

Now, researchers at the University of Pittsburgh Graduate School of Public Health in Pennsylvania — in collaboration with colleagues from other institutions — are questioning whether the ways in which we look at HDL cholesterol levels to predict cardiovascular risk may not be helpful for women.

"The results of our study," says lead author Samar El Khoudary, "are particularly interesting to both the public and clinicians because total HDL cholesterol is still used to predict cardiovascular disease risk."

Questioning the usefulness of looking at "good cholesterol" as protective for the heart, the team's findings are published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology of the American Heart Association.

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Current notions may be inaccurate

The scientists analyzed the medical data of 1,138 women, aged 45–84, recruited through the Multi-Ethnic Study of Atherosclerosis.

"We have been seeing an unexpected relationship between HDL cholesterol and postmenopausal women in previous studies, but have never deeply explored it," notes El Khoudary.

At menopause, women's bodies go through several changes, especially hormonal fluctuations that can influence various physiological processes and measurements. El Khoudary and team believe that changes in estrogen levels, as well as other metabolic alterations, might lead to chronic inflammation, which can affect the quality of HDL particles over time.

The research assessed the number and size of HDL particles, as well as the total cholesterol that these particles carried, to establish whether high HDL levels were, in fact, protective for cardiovascular health in postmenopausal women.

El Khoudary and team also considered the influence of women's age at menopause and the time it took for women to transition to the postmenopausal period on HDL's contribution to heart health.

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'Total HDL could mask significant risk'

Following their analysis, the researchers concluded that traditional methods of assesing HDL levels and their impact on cardiovascular health are not reliable enough in the case of postmenopausal women.

The scientists found a link between high HDL cholesterol and increased risk of atherosclerosis, particularly among women who had a greater age at the time of menopause and those at least 10 years into the postmenopausal period.

However, the researchers also found that a higher concentration of total HDL particles indicated a lower risk of developing atherosclerosis among the study participants.

But the results get even more complicated: having a high number of small-sized HDL particles, El Koudary and team observed, seemed to have cardioprotective effects for all postmenopausal women, regardless of their age at menopause or how far into postmenopause they were.

Conversely, large-sized HDL particles indicated an increased risk of cardiovascular disease in the case of women who were close to menopause. This, the researchers explain, is likely due to the fact that at this time, the quality of HDL is affected.

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But as women transition away from the menopause period, later in life, it may be that HDL quality increases once more, meaning that HDL cholesterol regains its protective effects.

"Identifying the proper method to measure active 'good' HDL is critical to understanding the true cardiovascular health of these women," notes senior study author Dr. Matthew Budoff.

El Khoudary explains, "This study confirms our previous work on a different group of women and suggests that clinicians need to take a closer look at the type of HDL in middle-aged and older women, because higher HDL cholesterol may not always be as protective in postmenopausal women as we once thought."

"High total HDL cholesterol in postmenopausal women could mask a significant heart disease risk that we still need to understand."

Samar El Khoudary

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Diabetes: Switching to common drugs raises risk of complications

A new study, published in the journal BMJ, finds that switching to a class of drugs called sulfonylureas could raise the risk of complications for people living with type 2 diabetes.
diabetes pills and syringe
New research shows that switching to sulfonylureas, a common class of antidiabetic drugs, may raise the risk of major complications.

Researchers set out to investigate how safe it is for patients with type 2 diabetes to switch from taking metformin, which is a standard "first-line" antidiabetic drug, to taking sulfonylureas, often prescribed to control blood sugar levels when metformin alone fails.

They were led by Prof. Samy Suissa, from McGill University in Quebec, Canada.

As Prof. Suissa and colleagues explain in their paper, numerous studies have confirmed the safety of sulfonylureas.

Fewer, however, have focused on their safety when patients have switched to the drugs or when they have added them to their previous treatment.

So, to fill this research gap, the scientists examined whether adding sulfonylureas or switching to them from metformin raises the risk of cardiovascular problems such as heart attack or stroke, or the risk of death from cardiovascular problems or from any other causes.

Also, the team examined whether or not switching to, or adding, sulfonylureas raised the risk of severe hypoglycemia, or low blood sugar. All these risks were compared with taking metformin alone.

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In order to study these links, the researchers examined over 77,138 people with type 2 diabetes who started taking metformin between 1998 and 2013.

Of these, 25,699 either added sulfonylureas to their treatment or switched to them altogether during the study period.

The team compared these people with age-matched controls who continued to take only metformin over a follow-up period of 1.1 years, on average.

Overall, when compared with staying on metformin, the study found that adding, or switching to, sulfonylureas was linked with a higher risk of a heart attack, death from any causes, and severe hypoglycemia.

More specifically, people adding, or switching to, the second-line treatment were 26 percent more likely to have a heart attack, 28 percent more likely to die from any causes, and over seven times more likely to have severe hypoglycemia, on average.

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The researchers also discovered a trend toward a higher likelihood of stroke and death from heart problems in those switching to, or adding, sulfonylureas.

Finally, when comparing just adding sulfonylureas to metformin with switching to sulfonylureas completely, the latter raised the risk of a heart attack by 51 percent and mortality from all causes by 23 percent.

However, no differences were found in the risk of stroke, cardiovascular death, or hypoglycemia between just adding the drugs and switching to them.

Prof. Suissa and colleagues conclude, "Sulfonylureas as second-line drugs are associated with an increased risk of myocardial infarction, all-cause mortality, and severe hypoglycemia, compared with remaining on metformin monotherapy."

"Thus, in line with current recommendations on the treatment of type 2 diabetes, continuing metformin when introducing sulfonylureas is safer than switching."

As with any observational study, causality cannot be inferred from the results. But researchers Lucy D'Agostino McGowan and Christianne Roumie deem the study "well designed and the relations [...] strong and consistent" in an accompanying editorial, which is also published in the BMJ.

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Do omega-3 supplements really benefit the heart?

Every day, millions of people from all over the world take fish oil supplements in the hope that they will protect them from heart disease. But do these golden capsules really work? A large systematic review investigates.
fish oil supplements on blue background
Should we believe the hype around these little golden capsules?

Omega-3 is a kind of fat found in fish, seafood, certain nuts, and plant oils.

More specifically, omega-3 fatty acids are of three main types: alpha­linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA).

ALA is an essential fatty acid, which means that the human body cannot produce it on its own and has to get it from food.

Flaxseed, soybean, and canola oils, as well as chia seeds and walnuts, all contain ALA.

DHA and EPA — also called long-chain omega-3s — can both be found in fatty fish such as salmon, mackerel, tuna, herring, and sardines, as well as in other kinds of seafood.

Studies have shown that those who consume fish regularly as part of a healthful, balanced diet are at a lower risk of heart problems. But the National Institutes of Health (NIH) explain that research is unclear as to whether these benefits come from fish or omega-3 in particular.

While the jury is still out on the matter, millions of people in the United States have turned to omega-3, or fish oil supplements, due to their alleged heart health benefits.

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In fact, as a survey carried out by the NIH reports, "Fish oil was the most popular natural product used by adults in the United States in 2012," with about 18.8 million U.S. individuals taking it.

But are the supplements actually worth the hype? A new review by researchers at Cochrane, an independent organization that evaluates existing medical research, assesses the benefits of the supplements by looking at the evidence available.

Lee Hooper, the lead author of the meta-analysis, is an expert systematic reviewer and reader in research synthesis, nutrition, and hydration from the Norwich Medical School at the University of East Anglia in the United Kingdom

The findings are now published in the Cochrane Library.

Reviewing almost 80 clinical trials

Hooper and colleagues reviewed 79 randomized trials, summing up 112,059 participants. The trials assessed the cardiovascular effects of taking omega-3 supplements and compared them with those of normal or lower intake of omega-3.

In most studies, some participants were given fish oil supplements, while others took placebos.

Other studies had prompted participants to increase their omega-3 intake over the course of 1 year, while other participants were asked to keep it the same.

The majority of the trials that assessed the effect of ALA intake gave participants in the intervention group omega-3-enriched foods such as margarine, or foods naturally rich in ALA, including walnuts. The control group had a normal, non-enriched diet.

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Supplements have 'little or no effect'

The review found that taking long-chain omega-3 supplements had "little or no effect" on death risk from any causes, death risk from cardiovascular problems, or death risk from coronary heart disease.

The supplements are also reported to have had "little or no effect" on the risk of cardiovascular events, stroke, or irregular heartbeat.

As for ALA, increasing intake from walnuts or fortified products such as margarine "probably makes little or no difference to all-cause or cardiovascular deaths or coronary events but probably slightly reduce[s] cardiovascular events, coronary mortality, and heart irregularities," the authors conclude.

However, this reduction is so slight that 1,000 people would have to increase their ALA intake in order for one of them to benefit, say the researchers.

This is based on "moderate- and high-quality evidence." Conversely, "Previous suggestions of benefits from EPA and DHA supplements appear to spring from trials with higher risk of bias," write the authors.

Finally, the effects of ALA on stroke risk remain unclear because the evidence was considered to be "of very low quality."

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Diet may help, but supplements do not

Hooper comments on the results, saying, "We can be confident in the findings of this review which go against the popular belief that long-chain omega-3 supplements protect the heart."

"The review provides good evidence," she adds, "that taking long-chain omega-3 (fish oil, EPA, or DHA) supplements does not benefit heart health or reduce our risk of stroke or death from any cause."

"The most trustworthy studies consistently showed little or no effect of long-chain omega-3 fats on cardiovascular health," Hooper emphasizes. "On the other hand, while oily fish is a healthy food, it is unclear from the small number of trials whether eating more oily fish is protective of our hearts."

In an expert reaction to the review, Tim Chico — who is a professor of cardiovascular medicine and an honorary consultant cardiologist at the University of Sheffield in the U.K. — says, "Although diet plays an important role in preventing heart disease, this is complex and unlikely to relate much to any single element of the diet."

"Previous experience has shown that although some types of diet are linked to lower risk of heart disease, when we try to identify the beneficial element of the diet and give it as a supplement it generally has little or no benefit."

Prof. Tim Chico

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What happens when you get an adrenaline rush?

An adrenaline rush is one of the body's vital defense mechanisms. A stressful situation will trigger the release of the hormone adrenaline, also known as epinephrine, into the bloodstream.

The production of adrenaline occurs in the adrenal glands, which sit above the kidneys. Adrenaline is responsible for the fight-or-flight reaction to a threat, and it triggers specific processes in the body. For example, it might make the body send extra oxygen to the lungs to aid a person to run away.

As well as allowing a quick escape from danger, adrenaline has other effects on the body. These include:

decreasing the body's ability to feel pain increasing strength temporarily sharpening mental focus, which will allow a person to think quickly and form a clear plan to escape a potential threat

However, the release of adrenaline into the body may sometimes occur when there is no real threat. The hormone has the same effect on the body whether or not the danger is present.

What happens during an adrenaline rush? adrenaline rush
A person's strength and pain threshold increase during an adrenaline rush.

The release of adrenaline into the body occurs very quickly, usually within a few seconds.

It goes away once the possible threat has disappeared. This speed is what gives an adrenaline rush its name.

Adrenaline triggers the following changes in the body:

increasing the heart rate, which may lead to a feeling of the heart racing redirecting blood toward the muscles, causing a surge in energy or shaking limbs relaxing the airways to give the muscles more oxygen, which may cause breathing to become shallow increasing the speed at which the brain works to plan an escape route widening the pupils to let more light enter the eyes

Side effects may include sweating as a reaction to stress, feeling lightheaded due to changes in blood and oxygen supply, and a change in temperature as a result of the blood redirection.

The effects of adrenaline on the body can last for up to 1 hour after an adrenaline rush.

Activities that trigger an adrenaline rush An adrenaline rush does not always happen when a person is facing a real threat. It may also occur during times of stress, such as an exam or job interview. Extreme activities, which include riding a rollercoaster or doing a bungee jump, can also trigger an adrenaline rush. Some people enjoy the feeling of an adrenaline rush. They may choose to do extreme sports or activities to trigger a deliberate release of adrenaline into the body. Thank you for supporting Medical News Today Adrenaline rush at night During the day, a person may be too busy or distracted to think about sources of stress or worry. Therefore, these thoughts often appear at night as a person is trying to sleep. If the stress is extreme, it may trigger an adrenaline rush. It is also possible for a dream to trigger a fight-or-flight response. What are the causes? Adrenaline rush caused by bungee jump
Participating in extreme sports, such as bungee jumping, can trigger an adrenaline rush. The primary causes of an adrenaline rush are: a threat stress excitement Anxiety and stress can cause a more frequent release of adrenaline into the body. Other causes include the following: Post-traumatic stress disorder (PTSD) PTSD can affect people who have had a traumatic experience, such as combat or sexual assault. People who have PTSD may experience an adrenaline rush when thinking about their stress or trauma from the past. This is sometimes known as hyperarousal. It can cause concentration problems, a jittery feeling, difficulty sleeping, constant alertness to possible danger, and feelings of irritability. Tumors Sometimes a tumor can cause the body to create too much adrenaline. This can occur when the tumor is on the adrenal glands, called a pheochromocytoma, or in part of the nervous system other than the brain, known as a paraganglioma. Both of these types of tumor are very rare, but they may cause a person to experience an adrenaline rush at random. This might feel similar to a panic attack. How can you control them? yoga can help reduce an adrenaline rush
Yoga exercises can help reduce anxiety and control the release of adrenaline. An adrenaline rush can be an uncomfortable experience. Sometimes it will happen at an inconvenient time. There are some steps that a person can take to control their body's reaction to a release of adrenaline. Slowing one's breathing or breathing into a paper bag can balance the oxygen supply to the body. This can help to reduce feelings of dizziness. It may also help a person to feel calmer and more in control. Doing some exercise can help to provide a distraction from the stimulus. Yoga or stretching exercises may also relieve stress and anxiety. Getting some fresh air and space can help a person to control an adrenaline rush. Taking a walk around the block or stepping outside may help. Choosing and repeating one specific word that is calming can distract from the body's reaction to adrenaline. Picturing a relaxing image is another method that may help to reduce stress. These techniques can help to calm the body and mind, and they may lessen the immediate effects of an adrenaline rush. Thank you for supporting Medical News Today What does it do to your system? Over time, high levels of adrenaline in the body can cause health problems. These include: In the short term, an adrenaline rush should have no impact on health. Takeaway and when to see a doctor An adrenaline rush will usually have an underlying cause, such as stress or a tumor on the adrenal glands. People should consider seeing a doctor if they are experiencing frequent adrenaline rushes, as these can have an impact on health in the long term. If an adrenaline rush occurs as a result of stress or anxiety, a doctor should be able to offer advice or treatment. They may recommend lifestyle changes, medication, or therapy. Seeking support from others, addressing the underlying cause of stress, sleeping well, and doing regular exercise may all help.
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E-counseling can lower blood pressure, heart disease risk

A new study, published in Circulation: Cardiovascular Quality and Outcomes, has found that virtual counseling can significantly improve the lives of people with high blood pressure.
woman looking at computer
Watching motivational videos on how to keep your blood pressure in check could considerably improve your cardiovascular health.

The American Heart Association (AHA) estimate that more than 100 million people in the United States live with hypertension, or high blood pressure.

Dubbed the silent killer due to its asymptomatic nature, high blood pressure damages blood vessels over time.

This may lead to a range of serious conditions, including kidney failure, heart failure, heart attack, or stroke.

Luckily, there are several things that a person can do to lower their blood pressure. Eating sensibly, drinking only in moderation, managing stress, and taking one's medication are only some of the changes that can reduce hypertension.

Now, researchers make a new addition to this list of positive changes: electronic counseling (e-counseling).

A new study — which was led by Robert Nolan, the director of cardiac e-health at the University Health Network's Peter Munk Cardiac Centre in Toronto, Canada — shows that adding virtual counseling to regular medical therapy lowers blood pressure and the risk of developing cardiovascular problems in the following 10 years.

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How does e-counseling affect hypertension?

Nolan and his team explain that using the Internet in search of health tips is "the third most popular online activity," with 72 percent of users engaging in it.

However, people need guidance to help them tell accurate from inaccurate medical information. In fact, one survey found that as many as 91 percent of online information seekers who live with a chronic health condition say that they need such guidance.

So, Nolan and team set out to investigate whether e-counseling would help with this need. In order to do so, they divided 264 men and women who had hypertension into two groups.

One group received regular emails with links to online tutorials and interactive online tools showing the participants how to improve their cardiovascular health and motivating them to do so.

The other group only received generic emails with information about blood pressure management.

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A 'meaningful reduction' in blood pressure

A year later, the researchers measured the participants' blood pressure and found that those in the intervention group had an average drop of 10 points in their systolic blood pressure — that is, from 141 to approximately 130.

Systolic blood pressure is the first number showing in a blood pressure reading, and hypertension occurs when this number is 130 or above. By comparison, the control group only saw a drop of 6 points.

The researchers deem this reduction "meaningful" and quote a previous study that found that a 10-point decrease in systolic blood pressure can reduce all-cause mortality risk by 13 percent.

Nolan comments on the study's findings, saying, "Internet-based supportive lifestyle counseling does indeed work effectively when it's clinically organized and when it complements medical therapy."

"We aimed for a program that's in the middle of the spectrum," he explains. "It's automated, but it's also interactive," he goes on, also stressing the importance of actively engaging the patients to improve their health.

"The interactive tools help people self-assess their changes in blood pressure or lifestyle behavior, which is very important. It gives them feedback, builds confidence, and helps them sustain their changes."

Robert Nolan

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