Wood Street Clinic Blog

Here you will find a selection of RSS feeds and blog entries

Type 2 diabetes: Intensive hypertension therapy may lower death risk

According to a new study, intensive treatment for high blood pressure may reduce the risk of death from any cause, including cardiovascular disease, in people with type 2 diabetes.
close up of a person taking their blood sugar test
New research suggests that intensive blood pressure treatment may help those with type 2 diabetes.

Diabetes is one of the most common and costly chronic conditions in the United States. Over 100 million people in the U.S. have diabetes or prediabetes, according to the 2017 report compiled by the Centers for Disease Control and Prevention (CDC).

Diabetes is a disease that affects how the body processes glucose. Type 2 diabetes, which is the most common form of the disease, reduces the production of insulin, a hormone that regulates blood sugar levels. When this occurs, blood sugar levels rise, increasing the risk of heart disease.

Hypertension, or high blood pressure, also increases the risk of cardiovascular disease. According to the National Institutes of Health (NIH), blood pressure is "the force of blood pushing against the walls of [the] arteries as the heart pumps blood." Hypertension happens when "this force against the artery walls is too high."

Doctors measure blood pressure in millimeters of mercury (mmHg). The first number, or the systolic pressure, refers to the pressure in the blood vessels when the heart beats. The second number measures the diastolic blood pressure, which is the pressure in the blood vessels when the heart rests between beats.

Doctors define "prehypertension" as 120–139 mm Hg for systolic pressure and between 80–89 mmHg for diastolic pressure. They consider a pressure of 140/90 mmHg as high.

According to the CDC, about 75 million people in the U.S. have high blood pressure, but only about half of them have the condition under control.

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Link between diabetes and hypertension

Many people with diabetes also have high blood pressure. Studies found that at least 1 in 3 people with diabetes also have hypertension.

Diabetes and high blood pressure make for a deadly combination because one condition makes the other worse. Diabetes may increase blood pressure by reducing the blood vessels' ability to stretch, increasing the fluid in the body, and affecting how the body manages insulin.

According to the American Heart Association (AHA), nearly 70% of people age 65 or older with diabetes die from cardiovascular disease, and 16% die of stroke. In addition, people with diabetes are up to four times more likely to die from heart disease than those without diabetes.

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Looking for the best blood-pressure targets

Now, a new study, which appears in the AHA's journal Hypertension, found that people with type 2 diabetes who received intensive treatment to keep blood pressure levels at or below 130/80 mmHg experienced fewer heart attacks, strokes, and had a lower risk of death from any cause.

"Our findings demonstrate a benefit of more intensive therapy aiming for blood pressure thresholds at 130/80 [mmHg] or below and should help resolve some ongoing confusion over the best blood pressure targets for people with diabetes," says the study's senior investigator J. Bill McEvoy, a professor of preventive cardiology at the National University of Ireland in Galway.

The 2017 AHA blood pressure guidelines recommended intensive treatment for people with diabetes and hypertension to help reduce their blood pressure. The new study revealed that blood pressure levels of 130/80 mm/Hg may benefit people regardless of cardiovascular risk.

"Patients, including those with diabetes, with blood pressure levels above 130/80 on two consecutive checks should discuss with their physicians whether they need [a] change in treatment to get to a lower number."

Prof. McEvoy

Benefits of intensive hypertension therapy

The researchers analyzed the outcomes of about 11,000 people with type 2 diabetes. The researchers clinically followed the study participants over 4 years across multiple clinical centers and locations.

The scientists examined people with type 2 diabetes and high blood pressure, who had different levels of cardiovascular risk, and who received intensive treatment. They then compared them with people with the same conditions who received a placebo.

Previous findings had suggested that hypertension treatment was effective, but researchers did not know whether this benefit also applied to people with diabetes and blood pressure below 140/90 mmHg.

The new study looked at rates of overall death from any cause and found that all people benefited from intensive treatment, regardless of cardiovascular risk.

More than 800 deaths and over 950 major vascular events — including heart attacks, strokes, diabetic kidney disease, and diabetic eye disease — occurred during the study period.

The people who received intensive blood pressure treatment experienced 9% fewer events and 14% fewer deaths than the people who took a placebo.

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Stress, insomnia may triple death risk for those with hypertension

A stressful work environment coupled with a lack of sleep can result in a threefold-higher risk of cardiovascular death in people with hypertension.
man looking tired in front of their computer
Having both a stressful job and difficulty sleeping may dramatically increase a person's risk of cardiovascular death.

Recent research looked at how stress and insomnia affected the health of employees who have hypertension, and the news was sobering.

The researchers found that in comparison with their peers who slept well and did not experience work-related stress, hypertensive employees with stress and insomnia were three times more likely to die from cardiovascular disease.

Researchers analyzed data from nearly 2,000 employees whose ages ranged from 25 to 65 years. These workers had high blood pressure, but, at the time of the study, they did not have cardiovascular disease or diabetes.

Although those with either job-related stress or insomnia did have an increased risk of cardiovascular death, the risk was higher when people had both of these factors present in their everyday lives.

The authors published their findings in the European Journal of Preventive Cardiology.

"These are insidious problems," notes Prof. Karl-Heinz Ladwig of the German Research Centre for Environmental Health and the Medical Faculty, Technical University of Munich.

"The risk is not having one tough day and no sleep. It is suffering from a stressful job and poor sleep over many years, which fade energy resources and may lead to an early grave."

Prof. Karl-Heinz Ladwig

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Hypertension is a major risk factor for many

Researchers define hypertension as high blood pressure in the arteries.

According to the American Heart Association (AHA), normal blood pressure readings for adults sit below 120/80 millimeters of mercury (mm Hg), while people with hypertension have either a systolic pressure (upper number) of 130 mm Hg or higher or a diastolic pressure (lower number) of 80 mm Hg or above.

High blood pressure is a widespread problem in the United States, with the AHA estimating that close to 103 million adults have hypertension.

This number equates to almost half of all adults in the U.S., and experts note that the death rate stemming from hypertension is increasing. In fact, it rose by nearly 11% from 2005 to 2015.

Many factors can increase a person's risk of heart disease, some of which are uncontrollable, such as increasing age, biological sex, and heredity.

However, other factors — such as smoking habits, high blood cholesterol, high blood pressure, physical inactivity, and being overweight — are modifiable.

High blood pressure is a significant risk factor for heart disease because when blood pressure becomes elevated, the heart has to work harder to pump blood around the body.

This extra work thickens the muscles of the heart, and it can also harden or damage artery walls. As a result, less oxygen makes its way to the body's organs, and the heart becomes damaged over time due to its increased workload.

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How stress relates to sleep, heart health

Stress is another factor that can contribute to heart disease.

In the current study, the researchers defined a stressful job as one that places high demands on the employee without giving them much control over what they have to do and achieve each day.

They also noted that most of the people with sleep issues had problems staying asleep, while others had trouble falling asleep.

"Maintaining sleep is the most common problem in people with stressful jobs," says Prof. Ladwig. "They wake up at 4 o'clock in the morning to go to the toilet and come back to bed ruminating about how to deal with work issues."

Hypertension on its own is a major risk factor for heart disease, but pairing it with both insomnia and work-related stress compounds the potential problems.

Prof. Ladwig says that it would be a good idea for employers to offer stress management and sleep treatment in the workplace, while doctors should discuss sleep and job stress with people who have hypertension and may have a higher risk of issues with their cardiovascular health.

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Obesity: Could fat cell differences predict diabetes risk?

Differences in the cells that store fat in the body could explain why some people are more prone to obesity-related conditions, such as type 2 diabetes.
Pink fat cells
This colored scanning electron micrograph shows fat cells in bone marrow tissue.

Scientists at the University of Melbourne, in Australia, led an investigation that examined human white fat cells from samples that volunteers had donated.

The samples came from white fat tissues in different parts of the body.

White fat cells are the cells that store energy in fat molecules called triglycerides.

The human body has reservoirs of regenerative cells, called adipose progenitor cells (APCs), which mature into white fat cells.

Using tools that assessed genes, proteins, and metabolism, the study is the first to identify three distinct subtypes of APCs.

In a recent Cell Reports paper, the authors explain how the APC subtypes differ in the ways that they deal with energy and hormones.

The findings suggest that the makeup and distribution of white fat in the body, in terms of the APC subtypes, could predict a person's risk of developing type 2 diabetes and other metabolic diseases.

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The first APC subtype matures into fat cells that discharge lots of fat molecules into the bloodstream, while the second type leads to cells that burn energy fast. The third subtype has a more "neutral" profile and behaves more like scientists might expect a fat cell to behave, if rather more slowly.

Senior study author Prof. Matthew J. Watt, who heads the physiology department in the School of Biomedical Sciences at the University of Melbourne, suggests that the first subtype could be one that promotes fat deposits on organs and in other parts of the body. This could happen in people of healthy weight as well as in those who are overweight.

He suggests that the second APC subtype could be one that stops people from gaining weight.

Need for better understanding of fat cells

The World Health Organization (WHO) declare that the worldwide prevalence of obesity "has nearly tripled since 1975."

In the United States, figures from the Centers for Disease Control and Prevention (CDC) reveal that 40% of adults, amounting to some 93.3 million people, had obesity in 2015–2016.

Obesity-related health conditions such as heart disease and type 2 diabetes account for a large number of preventable early deaths.

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In their study paper, Prof. Watt and his colleagues note that obesity and dysfunction of fat tissues are "inextricably linked to the development of metabolic diseases, such as dyslipidemia and type 2 diabetes."

Given the rising tide of worldwide obesity, "There remains intense interest," they write, in furthering knowledge of how fat cells develop and how their energy and hormone mechanisms work, especially in relation to overeating.

When they examined the fat tissue samples, the researchers found all three APC subtypes in all the samples. There was no part of the body in which white fat tissue did not have all three.

However, they did find that the distribution of the subtypes differed among individuals: Some subtypes were more abundant, while others were less so.

Prof. Watt remarks that this could mean that the makeup of people's APC subtypes in their white fat tissues could be a factor in their metabolic health.

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Switching on the fast-burners to lose weight?

He imagines, for example, that future weight loss treatments could involve switching off the fat-releasing APCs and switching on the fast-burners.

Drugs that do this could potentially help to prevent obesity-related conditions and offer less invasive alternatives to surgery.

However, Prof. Watt cautions that there is still a lot of work to do, and it could be 10 years or more before such treatments become available.

Further studies should, for example, confirm whether having more or less of certain APC subtypes actually raises or lowers risk of specific metabolic diseases.

They then need to find out whether increasing or decreasing certain cell types can affect disease outcomes.

Even if treatments that alter APCs become available, Prof. Watt predicts that people will likely still need to adopt healthful lifestyles, reduce food consumption, and increase physical activity.

"The discovery is important because it tells us that not all fat cells are the same and that by understanding the fat subtypes in a human, we might be able to predict their future metabolic health."

Prof. Matthew J. Watt

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Atherosclerosis: Research reveals new mechanism and therapeutic target

New research offers fresh insights into how a type of immune cell can destabilize the fatty deposits, or plaques, that form in arteries during atherosclerosis.
illustration of a heart on black background
Healthy arteries keep the heart healthy. A new study may help prevent atherosclerosis — a disease that affects our blood vessels.

Atherosclerosis is a persistent, inflammatory condition in which plaques build up inside arteries, causing them to narrow and restrict blood flow.

When an atherosclerotic plaque bursts or breaks, it can trigger a heart attack or stroke.

Neutrophils are an abundant type of leukocyte (white blood cell) that defend against infection by attacking microbes. They also serve "many roles in inflammation."

The new international study reveals that neutrophils can aggravate atherosclerosis by triggering a previously unknown type of cell death that destabilizes arterial plaques.

A recent Nature paper describes how neutrophils can induce a series of molecular events that also kills the smooth muscle cells that help to retain the plaques in the artery wall.

"Every inflammatory reaction," says co-corresponding study author Prof. Oliver Söhnlein, who is the director of the Institute for Cardiovascular Prevention at the Ludwig Maximilian University (LMU) of Munich in Germany, "results in some collateral damage, because neutrophils also attack healthy cells."

He and his colleagues have also designed and made a "tailored peptide" that could potentially target and block the cell-death process.

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Atherosclerosis and its consequences

Arteries are vessels that supply the heart and other parts of the body with oxygen- and nutrient-rich blood, which cells need to function and live.

Atherosclerosis develops when various materials, such as cholesterol, fat, and cellular waste, deposit in the tissue lining the arteries. The deposits, or plaques, build up slowly over time causing the arteries to narrow and harden.

When arteries narrow, they impede blood flow and restrict the supply of oxygen and nutrients to cells. Depending on where it occurs, the restricted blood flow can result in heart disease, angina, carotid artery disease, peripheral artery disease, and chronic kidney disease.

The plaques themselves are also a risk. They can rupture, or pieces can break off, causing blockages. In addition, blockages can arise from blood clots that stick to the inner walls of narrowed arteries.

If the blockage is in an artery that supplies blood to the brain or the heart, it can result in a stroke or heart attack. Blockages in arteries that supply the legs can lead to tissue death, or gangrene.

According to statistics that the American Heart Association publish online, cardiovascular conditions, such as heart attack and stroke, were the primary cause of 840,678 deaths in 2016 in the United States.

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Neutrophils help plaques become unstable

Another feature of atherosclerosis is that it triggers signals that prompt the immune system to send neutrophils and other immune cells through the bloodstream to the plaques.

When they reach a plaque site, the immune cells slip between the endothelial tissue cells of the artery lining. At the same time, they release chemicals that signal to the immune system to send even more immune cells.

This can set up a cycle that turns the initial inflammation response into persistent, or chronic, inflammation. Once the inflammation becomes chronic, it raises the risk that the plaque will grow, rupture, and cause a blockage.

Using mouse models of atherosclerosis to investigate what goes on at cell level, the researchers discovered that neutrophils can play a particularly destructive role in destabilizing plaques.

"They bind to the smooth muscle cells that underlie the vessel wall, and are activated," Prof. Söhnlein explains.

Once active, the neutrophils release "chromosomal DNA and its associated histones, which are highly charged and [toxic to cells]," he continues, adding: "Free histones kill nearby cells – in the case of atherosclerosis, smooth muscle cells."

Histones are proteins that help to package DNA tightly inside chromosomes.

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Peptide could block toxic histones

The histones kill the smooth muscle cells by causing pores to form in their walls. This allows extracellular fluids to seep through the pores into the cells, causing them to burst.

Because smooth muscle cells help to retain the plaques in the artery wall, their destruction causes the fatty deposits to become unstable and more likely to rupture and break.

In another part of the study, the team used molecular modeling to design a small protein molecule, or peptide, that could block the toxic effect of the free histones.

The authors suggest that the "histone-inhibitory peptide" could disrupt the histones by binding to them so that they cannot create pores in the cell membranes.

Prof. Söhnlein says that the synthetic peptide could have a similar effect on other conditions that involve chronic inflammation, such as chronic bowel inflammation and arthritis.

He and his co-authors conclude:

"Our data identify a form of cell death found at the core of chronic vascular disease that is instigated by leukocytes and can be targeted therapeutically."
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'A Viagra-like drug could reverse heart failure'

New research in sheep shows that a drug that doctors usually prescribe for the treatment of erectile dysfunction can also treat heart failure.
man taking pills
A drug that treats erectile dysfunction could also reverse heart failure, according to an animal study.

In people with heart failure, the heart muscle becomes unable to pump out blood efficiently, meaning that some organs may not receive the amount of oxygen that they need to function properly.

The Centers for Disease Control and Prevention (CDC) note that 5.7 million adults in the United States have heart failure and that approximately half of the people with this condition die within about 5 years of receiving their diagnosis.

Moreover, research that Cardiac Failure Review published in 2017 argued that there is a "global pandemic" of heart failure, with this condition affecting an estimated 26 million people worldwide.

Such numbers suggest that finding new ways to treat heart failure is a priority for specialists who study this condition.

Recently, Prof. Andrew Trafford led a team of researchers from the University of Manchester in the United Kingdom who found that a drug that doctors typically use to treat erectile dysfunction could also treat systolic heart failure, in which the heart's left ventricle loses the ability to contract as normal.

The findings of the new study, which the researchers conducted in sheep, appeared today in the journal Scientific Reports.

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Tadalafil brings significant improvements

Prof. Trafford and team decided to focus on tadalafil, which is available under the brand name Cialis among others. This drug falls under the same category as sildenafil, which people commonly refer to by the brand name Viagra.

"We do have limited evidence from human trials and epidemiological studies that show tadalafil can be effective in treating heart failure," Prof. Trafford says.

The researchers studied the effects of the drug in sheep, whose hearts are very similar to those of humans. The team treated the sheep with tadalafil once they had developed heart failure symptoms that were serious enough to require intervention.

Prof. Trafford and colleagues induced heart failure in the animals through the use of a pacemaker, and when they treated them with tadalafil, they gave them doses consistent with what a human patient would usually receive for erectile dysfunction.

After just 3 weeks of tadalafil treatment, the researchers began to notice improvements in the animals that received this drug.

The drug improved the heart's contraction and almost completely restored its ability to respond to epinephrine. It is a lack of response to this hormone that causes breathlessness in heart failure.

Although so far, the researchers have only tested the effects of this drug in sheep, Prof. Trafford maintains that humans are likely to experience the same benefits.

"This study provides further confirmation, adds mechanistic details, and demonstrates that tadalafil could now be a possible therapy for heart failure," the researcher notes, adding, "It's entirely possible that some patients taking it for erectile dysfunction have also unwittingly enjoyed a protective effect on their heart."

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'We need safe and effective new treatments'

So, why does this drug have a therapeutic effect on heart failure? The scientists explain that tadalafil helps treat erectile dysfunction by acting on a particular enzyme called phosphodiesterase 5. This enzyme plays a key role in determining how different types of tissue interact with hormones, including epinephrine.

In the case of heart failure, the research team notes, tadalafil allows the heart to start responding to epinephrine once more, which means that the heart muscle regains its ability to pump out blood effectively.

These findings are promising because, as Prof. Trafford says, tadalafil "is a widely used and very safe drug with minimal side effects," but the researcher nevertheless cautions against self-prescription.

"[W]e would not advise the public to treat themselves with the drug, and [they] should always [speak] to their doctor if they have any concerns or questions," Prof. Trafford emphasizes.

"Tadalafil is only suitable as a treatment for systolic heart failure — when the heart is not able to pump properly — and there may be interactions with other drugs patients are taking," he warns.

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Prof. Metin Avkiran, who is Associate Medical Director at the British Heart Foundation, which funded the current study, expresses hope that these findings might lead to a better treatment that could not only reduce the symptoms of heart failure but also potentially reverse the condition entirely.

"We need safe and effective new treatments for heart failure [...]. The evidence from this study — that a Viagra-like drug could reverse heart failure — should encourage further research in humans to determine if such drugs may help to save and improve lives."

Prof. Metin Avkiran

"Viagra-type drugs were initially developed as potential treatments for heart disease before they were found to have unexpected benefits in the treatment of erectile dysfunction," Prof. Avkiran notes.

"We seem to have gone full circle," he continues, "with findings from recent studies suggesting that they may be effective in the treatment of some forms of heart disease — in this case, heart failure."

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Blood test may predict cardiovascular disease

New research suggests that a simple blood test, which doctors currently use to diagnose heart attacks, may be useful in predicting the risk of cardiovascular disease.
scientist looking at blood sample
New research suggests a simple blood test could accurately predict who will go on to develop cardiovascular disease.

According to the latest statistics from the American Heart Association (AHA), almost half of the people living in the United States have some form of cardiovascular disease.

In fact, according to 2016 figures, 121.5 million U.S. adults, or 48 percent of the entire population, have cardiovascular disease (CVD), which is a cluster of conditions that includes hypertension. Doctors often call hypertension the "silent killer" because it does not show any visible symptoms until it is too late.

The same AHA report predicts that by 2035, over 130 million adults will have a form of CVD that could bring costs in the U.S. to 1.1 trillion dollars.

Currently, heart disease is the top leading cause of death in the U.S., while stroke is the fifth.

But what if there was a blood test that could accurately predict whether a person will have heart disease or a stroke?

New research suggests that such a test may already exist. By detecting the blood levels of specific proteins that heart muscles release when they are injured, scientists may be able to predict a person's risk of eventually developing CVD.

Dr. Christie Ballantyne, who is the cardiology chief at Baylor College of Medicine in Houston, TX, and his team, detail this idea in a new study that appears in the AHA journal Circulation.

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Troponins are proteins that signal heart muscle damage, and in the new research, Dr. Ballantyne and his colleagues wanted to see if detecting troponin in the blood of healthy middle-aged adults or seniors could predict CVD risk.

Dr. Ballantyne and colleagues analyzed a group of 8,121 people aged 54–74 who participated in the "Atherosclerosis Risk in Communities" study. None of the participants had a history of cardiovascular disease.

The scientists identified troponin levels in 85% of the participants and applied Cox proportional hazards models to examine the links between these levels and cardiovascular disease.

Namely, they studied correlations with coronary heart disease, myocardial infarction, ischemic stroke, atherosclerotic cardiovascular disease, heart failure hospitalization, global cardiovascular disease, and all-cause mortality.

The research found that high levels of troponin correlated strongly with "increased global CVD incidence in the general population independent of traditional risk factors."

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High-sensitivity troponin tests, therefore, proved to be an accurate way of predicting CVD risk, especially when combined with a standard method of calculating a person's 10-year cardiovascular risk.

"What we're finding out is that these tests can be used in the general population to give us information as to who is most likely to have a future problem, whether it be a heart attack, stroke, or heart failure," says Dr. Ballantyne.

"If you can treat someone much earlier, before {they] have symptoms, you will be far more effective in preventing events," continues the researcher, who adds, "Our major problem is that we do too little too late."

"If the first time you find out that you're at risk for heart failure is when you actually start getting short of breath and you end up in the hospital, you probably have advanced heart disease already, and it is going to be harder to treat than if that person took steps years earlier."

Dr. C. Ballantyne

Instead, knowing the risk in advance can prompt people to take preventive measures, such as exercising more and watching their blood pressure.

However, the scientists explain that although doctors currently use troponin tests to diagnose a heart attack, they do not yet accept them as a tool for predicting risk. Scientists need to do more research before using these tests to evaluate risk.

"Research in this area is leading us toward individualized care more and more, so we can better predict who's at risk for developing adverse cardiovascular outcomes," comments Dr. Rebecca Vigen, an assistant professor of internal medicine at the University of Texas Southwestern Medical Center in Dallas, who did not participate in the research.

"This study is a step in the direction of personalizing care," Dr. Vigen says.

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What to know about vitamin K-2

Vitamin K is an essential vitamin that supports blood clotting and healthy bones. It occurs in two forms, K-1 and K-2.

Vitamin K-1 is the primary form, and it mainly comes from leafy green vegetables. Vitamin K-2 occurs in animal proteins and fermented foods. The bacteria in the human gut also produce small quantities of K-2.

In this article, we discuss vitamin K-2, its functions, and how it differs from K-1. We also describe dietary sources, health benefits, the recommended daily intake, deficiency symptoms, and supplements.

What is it? Sauerkraut, which contains vitamin K-2
Sauerkraut is a good dietary source of vitamin K-2.

Vitamin K refers to a family of fat-soluble vitamins that the body needs to produce a protein called prothrombin, which promotes blood clotting and regulates bone metabolism.

The vitamin comes in two main forms:

Vitamin K-1, or phylloquinone, occurs naturally in dark leafy green vegetables and is the main dietary source of vitamin K. Vitamin K-2, or menaquinone, is present in small quantities in organ meats and fermented foods. Gut bacteria also produce vitamin K-2. Functions The body needs both types of vitamin K to produce prothrombin, a protein that plays crucial roles in blood clotting, bone metabolism, and heart health. Vitamin K also helps facilitate energy production in the mitochondria of cells. Vitamin K-1 is primarily involved in blood coagulation. K-2 may have a more diverse range of functions in the body. In a long-term study involving 36,629 participants, researchers observed an association between high intakes of vitamin K-2 and a reduced risk of developing peripheral arterial disease (PAD), particularly in people with high blood pressure. However, the authors concluded that K-1 had no effect on PAD risk. Vitamin K has antioxidant properties. It protects cellular membranes from damage due to excess free radicals, in a process known as peroxidation. Blood thinning medication, such as warfarin, can lower the antioxidative potential of vitamin K. Thank you for supporting Medical News Today K-1 vs. K-2 Vitamins K-1 and K-2 have different chemical structures. Both types have a phytyl side chain, but K-2 also has isoprenoid side chains. K-2 has several subtypes, called menaquinones (MKs), which scientists have numbered MK-4 through MK-13, based on the length of their side chains. K-1 is the primary form of the vitamin, and it is mainly present in leafy green vegetables. However, the body has difficulty absorbing vitamin K-1 from plants. According to a 2019 review, research suggests that the body absorbs 10 times more vitamin K-2, in the form of MK-7, than vitamin K-1. Vitamin K is fat-soluble, so eating dietary fats, such as butter or plant oils, may enhance the body's absorption of vitamin K-1 from plants. Bacteria in the gut can synthesize vitamin K-1 into vitamin K-2. Also, fermented foods, meat, and dairy products contain modest amounts of vitamin K-2. The body stores vitamins K-1 and K-2 differently. K-1 accumulates in the liver, heart, and pancreas. K-2 occurs in high concentrations in the brain and kidneys. Best dietary sources Leafy greens which contain vitamin K-2
Leafy green vegetables contain vitamin K-1. Several foods are rich in vitamin K-1, and vitamin K-2 is much less common. Bacteria in the gut can convert some K-1 into K-2. Fermented foods are a good source of vitamin K-2. Also, because it is fat-soluble, organ meats and high-fat dairy products contain fairly substantial quantities of vitamin K-2. Conversely, lean meats, such as poultry, are not good sources of K-2. Dietary sources of vitamin K-1 include: dark leafy green vegetables, such as spinach, kale, and collards lettuce turnips broccoli carrots vegetable oils blueberries grapes Dietary sources of vitamin K-2 include: natto, a traditional Japanese dish of fermented soybeans sauerkraut dairy products, especially hard cheeses liver and other organ meats beef pork egg yolks chicken fatty fish, such as salmon Health benefits of vitamin K-2 In addition to its crucial role in blood clotting and wound healing, vitamin K-2 has a number of other health benefits. We discuss some of these below. Heart health Vitamin K-2 may lower the risk of cardiovascular damage and improve overall heart health. According to a 2015 review article, K-2 activates a protein that prevents calcium deposits from forming in the walls of blood vessels. The author cited findings suggesting that a diet high in natural vitamin K2 may decrease the risk of coronary heart disease. Bone health Vitamin K-2 promotes healthy bone mineral density by carboxylating osteocalcin, a protein that binds calcium to bones. A 2019 study investigated the effects of taking MK-4 supplements in 29 postmenopausal females who had experienced hip or vertebral compression fractures. The researchers concluded that taking 5 milligrams of an MK-4 supplement daily reduced the levels of undercarboxylated osteocalcin to that "typical of healthy, premenopausal women." A 2017 study from Japan examined whether vitamin K-2 enhances the effects of standard medication for osteoporosis in adult females aged 65 or older. According to the results, vitamin K-2 did not appear to enhance the effects of the osteoporosis medication. Anxiety and depression High blood glucose levels may increase a person's risk of developing depression, anxiety, and cognitive impairment. A 2016 study investigated the effects of vitamin K-2 in rats with metabolic syndrome, high blood glucose levels and symptoms of anxiety, depression, and memory deficit. After 10 weeks, treatment with vitamin K had normalized blood glucose and reduced symptoms of anxiety and depression. However, it did not improve memory deficit in the rats. Cancer Vitamin K-2 has antioxidant properties that may help protect against cancer. In addition, findings suggest that K-2 may suppress genetic processes that lead to tumor growth. According to a 2018 study, vitamin K-2 that scientists had modified with a sialic acid-cholesterol conjugate significantly suppressed tumor growth in mouse cells. A 2019 study suggests that K-2 significantly reduces the activity of hypoxia-inducible factor 1-alpha (HIF-1A) in hepatocellular carcinoma cells. HIF-1A is an important target for cancer drug therapy. Thank you for supporting Medical News Today Recommend daily intake The Office of Dietary Supplements (ODS) recommend a daily intake of 120 micrograms (mcg) of vitamin K for adult males and 90 mcg for adult females. There is no specific recommendation for vitamin K-2. Deficiency symptoms According to the ODS, vitamin K deficiency affects very few adults in the United States. Newborns and people with certain gastrointestinal disorders, such as celiac disease and ulcerative colitis, have a higher risk of vitamin K deficiency. A severe deficiency increases the time it takes for the blood to clot, making a person more prone to bruising and bleeding and increasing the risk of hemorrhage. A deficiency of the vitamin can also reduce bone mineralization, which can lead to osteoporosis. Certain medications can affect vitamin K levels in the body. For example, long courses of antibiotics can kill the gut bacteria that produce vitamin K. Some cholesterol-lowering medications can also interfere with the body's ability to absorb vitamin K. Blood thinners, such as warfarin, can interact dangerously with the vitamin. It is important for people taking these medications to consume the same amount of dietary vitamin K each day and to speak to a doctor before taking supplements or making dietary changes. Supplements woman takes supplements
Many multivitamins contain vitamin K. While the ODS report that vitamin K deficiency is very rare and that most people are getting enough of the vitamin from their diet, anyone at risk of a deficiency may wish to consider dietary supplements. Many multivitamins contain both forms of vitamin K. A person can also purchase vitamin K as a standalone supplement or in combination with specific nutrients, such as vitamin D, calcium, or magnesium. The types of vitamin K commonly available in dietary supplements include: vitamin K-1, as either phylloquinone or a synthetic form called phytonadione vitamin K-2, as either MK-4 or MK-7 The concentrations of K-1 and K-2 vary, depending on the supplement. Always check the nutrition label before purchasing supplements. Vitamin K can interact with some drugs, especially blood thinners, so it is important for people taking prescription medications to speak to their doctor before using a dietary supplement. A variety of vitamin K supplements are available to purchase online. Thank you for supporting Medical News Today Summary There are two main forms of vitamin K: vitamin K-1 and vitamin K-2. K-1 primarily occurs in leafy green vegetables, and it is the main dietary source of vitamin K. However, the body absorbs K-2 more readily, particularly the K-2 subtype MK-7. Good sources of vitamin K-2 include fermented foods, organ meats, and dairy products. Fermented soybeans, such as natto, are an especially rich source of vitamin K-2. Bacteria that live in the human gut also produce small quantities of K-2. Both forms of vitamin K are essential for blood clotting and bone health. However, vitamin K-2 may also protect against certain forms of cancer and heart disease. Vitamin K deficiency is very rare and most people get enough of this vitamin from their diet. Some gastrointestinal conditions can increase the risk of a deficiency. However, people with these conditions should speak to their doctor before taking a dietary supplement. People currently taking blood thinners, such as warfarin, should not take vitamin K supplements without seeking medical advice first. Sudden changes in vitamin K levels can impact the anticoagulant effects of warfarin and lead to dangerous complications. We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link(s) above.
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What is the best time to take statins and why?

Statins are cholesterol-lowering drugs. Some statins work best in the evening while others work just as well in the morning. The best time to take statins depends on the specific drug.

Statins are a type of prescription medication that can lower a person's risk of heart disease. They do this primarily by reducing a person's low-density lipoprotein (LDL) cholesterol.

There are several different types of statin on the market, which the body may process differently. People may need to take some statins at specific times of the day to get the most benefit from them.

In this article, we look at the effects of statins at different times of the day and discuss the best times to take certain types. We also cover side effects and how a person can choose the right statin to suit their needs.

What do statins do? Senior man in bed taking prescription medication statin pills and drinking water
Statins can help manage cholesterol levels.

Statins are also called lipid-lowering medications or HMG-CoA reductase inhibitors. They reduce the levels of LDL cholesterol in the blood.

LDL cholesterol, which people sometimes refer to as bad cholesterol, can build up in the arteries and form plaque. This plaque can block blood flow in the arteries, leading to heart attack and stroke.

Statins block an enzyme in the liver that makes cholesterol, which reduces the risk of plaque buildup. Statins may also help the body remove cholesterol that has started to accumulate in the arteries.

Conversely, high-density lipoprotein (HDL), or good, cholesterol can reduce the risk of heart attack and stroke. Doctors consider HDL cholesterol to be beneficial because it can transport other forms of cholesterol from the blood to the liver, which helps the body get rid of bad cholesterol.

Studies have shown that statins are effective in improving a person's cholesterol levels:

A large-scale 2017 study found that statins can reduce the risk of heart disease by 27 percent by decreasing LDL levels. The authors of a 2010 meta-analysis concluded that statins might raise HDL levels, which can further protect a person from heart disease. In a 2015 study paper, researchers reported that the effects of statins vary depending on a person's genetic risk factor. These drugs reduced the risk of heart disease by 13 percent in people at low risk, 29 percent in those at medium risk, and 48 percent in the participants whose risk was high. Thank you for supporting Medical News Today Best time to take different statins It is important that a person taking statins follows the advice of their prescribing doctor regarding the time of day to take them. The recommended time, which is something that a person should discuss with their doctor, will vary depending on the type of statin. Short-acting statins A systematic review found that short-acting statins worked best when people took them in the evening. The people who took these statins toward the end of the day had lower total cholesterol and LDL cholesterol levels compared with the people who took them in the morning. Another review came to the same conclusion. Short-acting statins work better at night because the liver enzyme that produces cholesterol is more active at this time. Most short-acting statins have a half-life of 6 hours. A medication's half-life is the time that it takes for the body to process and remove half of the medication. Short-acting statins include: lovastatin (Mevacor) fluvastatin (the standard-release tablet) pravastatin (Pravachol) simvastatin (Zocor) Long-acting statins It takes longer for the body to process long-acting statins, which may have a half-life of up to 19 hours. The two reviews above noted that long-acting statins worked equally well whether a person took them in the morning or the evening. Therefore, people taking long-acting statins can choose which time of the day best suits them. The authors recommend that people using long-acting statins take them at a time of day that is easy for them to remember. It is important to be consistent with the timing of doses, so if a person prefers to take statins in the morning, they should take them in the morning every day. Long-acting statins include: People who are taking statins may need to take them indefinitely. In many cases, when a person stops taking statins, their cholesterol levels increase again. People should not stop taking statins without a doctor's approval. Some people might be able to stop taking statins or reduce their dosage if they significantly lower their risk of heart disease. A person may do this by losing a significant amount of weight, quitting smoking, or making other major lifestyle changes that improve their health. Even in these cases though, a person should talk to a doctor before they stop taking statins or any other medications. Which statin is right for me? A person can discuss the types of statins with a doctor to choose the best one.
A person can discuss the different types of statins with a doctor. Statins come in a range of types and dosages. A person can discuss with their doctor which type of statin may work best for them. The doctor's recommendation will depend on many factors, including the person's: current cholesterol levels other risk factors for heart disease other medical conditions, such as diabetes family history of heart disease other medications If a person has an increased risk of heart disease, their doctor may prescribe a higher dosage or a long-acting statin. Conversely, a person with less risk of heart disease may start on a lower dosage or a short-acting statin. Recent evidence suggests that many people can benefit from taking statins, even if they do not have high blood cholesterol levels. The American Heart Association say that statins can benefit people who have an average risk of heart disease, especially when they take them in combination with medications to lower blood pressure. Thank you for supporting Medical News Today Side effects of statins Statins do not cause serious side effects for most people. According to the American College of Cardiology, as many as 90 percent of people taking statins do not experience bothersome side effects. For those who do experience side effects, these may include: The Food and Drug Administration (FDA) state that the risk of these side effects is small and that the benefits of statins usually outweigh this risk. Some reports have warned that statins can cause severe memory loss, but an investigation found inconsistent evidence of this side effect. Another review states that there is evidence to suggest that statins do not affect memory. In rare cases, a person taking statins may have serious side effects, such as liver damage or an allergic reaction. The following side effects require immediate medical attention: fever upper abdominal pain yellow skin or eyes dark-colored urine unusual bleeding or bruising extreme fatigue rash, hives, or itching swelling of the face, lips, tongue, eyes, or throat difficulty speaking How to stay healthy when taking statins Regular exercise can help lower the risk of heart disease.
Regular exercise can help lower the risk of heart disease. Statins can interact with some medications. People who take statins will need to make their doctor aware of any medicines, vitamins, herbs, or other supplements that they take to help prevent dangerous interactions. Statins may also interact with grapefruit and grapefruit juice. Therefore, it is important to avoid eating grapefruit or drinking grapefruit juice while taking statins unless a doctor says it is safe. People who have a higher risk of heart disease can work with a doctor or nutritionist to modify their diet. In many cases, a medical professional is likely to advise the person to eat a diet that is low in cholesterol and saturated fat, free of trans fats, and rich in fruits and vegetables. In addition, a person may need to increase their weekly exercise and work toward a healthy weight. In this way, they can further lower their risk of heart disease. Smoking is a significant risk factor for heart disease. A doctor may advise a person to get help with quitting if they do smoke. Whether or not they are taking statins, people can help keep their cholesterol in check by maintaining a healthy weight, exercising regularly, and eating a healthful diet that contains plenty of fruits and vegetables. Thank you for supporting Medical News Today Summary Doctors have been prescribing statins for more than 30 years, and these medications are generally safe and effective with a low risk of serious side effects. Short-acting statins are most effective when a person takes them at night, but a person can take long-acting statins at any time of the day. The most important point to remember is to take them every day, ideally at the same time. As with any medication, a person should take it according to their prescription. They should also tell a doctor if they notice any side effects.
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Patterns of antibiotic use may predict cardiovascular risk

A new study that analyzed the health information of thousands of women found that prolonged antibiotic use is correlated with a higher risk of experiencing a cardiovascular event.
woman taking medicine
Women may wish to consider limiting their use of antibiotics to prevent cardiovascular issues.

Scientists at Tulane University in New Orleans, LA, Harvard Medical School and Harvard T. H. Chan School of Public Health in Boston, MA, and Fudan University in Shanghai, China investigated how antibiotic use is linked to women's risk of experiencing cardiovascular problems.

They were interested in the link between antibiotics and cardiovascular health because, they explain, antibiotics can have an important impact on gut microbiota, which, in turn, can affect various other aspects of health.

"Antibiotic use is the most critical factor in altering the balance of microorganisms in the gut," says study co-author Prof. Lu Qi.

"Previous studies have shown a link between alterations in the microbiotic environment of the gut and inflammation and narrowing of the blood vessels, stroke, and heart disease," he adds.

The study — the findings of which appear in the European Heart Journal — analyzes information the scientists collected from a cohort of 36,429 women enrolled in the Nurses' Health Study.

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Specifically, the researchers examined data from 2004–2012; at the beginning of this period, all the women in the cohort were 60 or older.

All the participants reported how often they used antibiotics and other relevant information during three periods of their lives: ages 20–39, ages 40–59, and ages 60 and over.

Based on the antibiotic use patterns that the women reported, the scientists split them into four groups:

those who had never used antibiotics those who took antibiotics for fewer than 15 consecutive days at a time those who used antibiotics for between 15 days and 2 months those who took antibiotics for over 2 months
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'A cumulative effect' of antibiotic use?

Over a follow-up period of almost 8 years, on average, 1,056 participants developed cardiovascular problems.

Throughout this period, the women continued to offer information about their antibiotic use every couple of years.

The scientists analyzed the data they took throughout this time, adjusting the results for potentially confounding factors. These included age, race, dietary choices, lifestyle habits, medical conditions, and overall drug use.

Women who took antibiotics for very long periods of time (for 2 months or longer) at age 60 or over had a 32% higher risk of experiencing cardiovascular disease compared with those who had never taken antibiotics.

Those who took antibiotics for 2 months or longer at ages 40–59 were 28% more likely to develop cardiovascular problems than women who did not take antibiotics at that age. However, the team found no correlation between prolonged antibiotic use at ages 20–39 and cardiovascular risk.

"By investigating the duration of antibiotic use in various stages of adulthood," points out first study author Yoriko Heianza, Ph.D., "we have found an association between long-term use in middle age and later life and an increased risk of stroke and heart disease during the following 8 years."

"As these women grew older they were more likely to need more antibiotics, and sometimes for longer periods of time, which suggests a cumulative effect may be the reason for the stronger link in older age between antibiotic use and cardiovascular disease."

Yoriko Heianza, Ph.D.

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'The shorter time of use, the better'

The researchers also note that some of the most common reasons women cited for their antibiotic use included infections — respiratory and pertaining to the urinary tract — and oral health conditions.

Though this is the largest prospective study to date that has looked at the correlation between the use of antibiotics for long periods of time and cardiovascular risk, the research was not without its limitations.

For example, the researchers admit that the main problem they faced in this study was the fact that the participants self-reported their use of antibiotics, which tends to leave room for inaccuracies.

However, they also argue that the participants were likely to report fairly precise information, being healthcare professionals themselves.

The scientists are quite confident in their findings, but they explain that the study was observational and cannot, as yet, speak to cause and effect.

"This is an observational study," notes Prof. Qi, "and so it cannot show that antibiotics cause heart disease and stroke, only that there is a link between them."

"It's possible that women who reported more antibiotic use might be sicker in other ways that we were unable to measure, or there may be other factors that could affect the results that we have not been able [to] take account of," he goes on.

Despite these points, Prof. Qi concludes: "Our study suggests that antibiotics should be used only when they are absolutely needed. Considering the potentially cumulative adverse effects, the shorter time of antibiotic use the better."

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Innovative patch may reduce muscle damage after a heart attack

A recent study in rats shows that an innovative patch prevented the stretching of the heart muscle common after a heart attack.
heart illustration with stethoscope
An innovative new patch limits heart muscle damage after a heart attack.

A heart attack occurs when the blood flow that provides the heart muscle with oxygen is significantly reduced or blocked.

The heart muscle is injured in the process, and the amount of damage usually depends on the size of the area supplied by the blocked artery.

It can take about 8 weeks for the heart muscle to heal. Despite the damage, the rest of the heart has to keep on pumping blood.

Scar tissue may form in the injured area and have an impact on the amount of blood that the heart is able to pump.

Most people who survive a heart attack have some degree of coronary artery disease. This occurs when arteries become hardened and narrowed. Usually, survivors have to make crucial lifestyle changes and may have to take medication to prevent a future heart attack.

According to the Centers for Disease Control and Prevention (CDC), more than 700,000 people in the United States have a heart attack every year. Of these, more than 500,000 experience their first heart attack and about 200,000 have already had one.

Signs of a heart attack include chest pain and shortness of breath. Half of U.S. individuals have at least one of the following risk factors: high blood pressure, high cholesterol, or smoking.

Diabetes, obesity, physical inactivity, and excessive alcohol use also increase the risk of a heart attack.

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Testing a new type of adhesive heart patch

Scientists at Brown University in Providence, RI, Fudan University in Shanghai, China, and Soochow University in Suzhou, China have collaborated to create and test a new type of adhesive heart patch on rats.

The study was an interdisciplinary effort among researchers in computer modeling and mechanics, material scientists, and cardiology. The scientists published their findings in the journal Nature Biomedical Engineering.

The scientists created this adhesive patch using a water-based hydrogel material and developed it using computer simulations. The patch can sit directly on the heart, and the results of the study show that it may help limit the muscle damage that often occurs after a heart attack.

"The idea here," explains study co-author Prof. Huajian Gao, from Brown University, "is to provide mechanical support for damaged tissue, which hopefully gives it a chance to heal."

Prof. Gao goes on to say that past studies had shown that mechanical patches could be effective, but no research had attempted to identify the "optimum mechanical properties." Getting those properties right is crucial to ensuring that the patch can work properly.

"If the material is too hard or stiff," he adds, "then you could confine the movement of the heart so that it can't expand to the volume it needs to. But, if the material is too soft, then it won't provide enough support. So, we needed some mechanical principles to guide us."

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Creating right mechanical properties is key

The researchers developed a computer model focused on two key components, one of which was the expanding and contracting of the heart and the impact the patch had on these functions.

The other was to model the injuries that occur after a heart attack. In this way, the team could look at how much mechanical support would be necessary to limit the damage.

Following the results of the computer model, the researchers — led by Prof. Lei Yang, of Soochow University — created a hydrogel material using food-sourced starch. This material is inexpensive, easy to make, and viscoelastic, which means that "it combines fluid and solid properties."

The study in rats showed that this new type of adhesive patch was effective in reducing muscle damage after a heart attack.

"[It] maintained a better cardiac output and thus greatly reduced the overload of those remaining cardiomyocytes and adverse cardiac remodeling," says study co-author Ning Sun, a cardiology researcher at Fudan University.

Their research found that the patch can reduce cell death, the accumulation of scar tissue, and oxidative stress. The researchers believe that more testing is required, but the results are promising.

"It remains to be seen if it will work in humans, but it's very promising."

Prof. Huajian Gao

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Is this chest pain from GERD or a heart attack?

Chest pain can be a sign that a person is having a heart attack. However, chest pain is also a common symptom of other, less serious conditions, such as gastroesophageal reflux disease.

Doctors refer to pain from heart attacks and other conditions that affect the cardiovascular system as cardiac chest pain. Pain that does not come from the cardiovascular system is called noncardiac chest pain.

Gastroesophageal reflux disease (GERD) can cause heartburn, which is a common type of noncardiac chest pain.

While heart attacks are a life-threatening medical emergency, heartburn is not. Therefore, being able to recognize the difference between cardiac and noncardiac chest pain is essential.

In this article, we discuss the symptoms of GERD and heart attacks along with the differences between cardiac and noncardiac chest pain. We also cover other causes of both types of chest pain.

Is it GERD? Person holding hands over chest in pain because of gerd or heart attack
Many conditions can cause chest pain, including acid reflux.

Acid reflux occurs when acid from the stomach leaks up into the food pipe, or esophagus. One of the most common symptoms of acid reflux is heartburn, which is a painful burning sensation in the center of the chest just behind the breastbone, or sternum.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, a person who experiences acid reflux more than twice a week for a few weeks may have GERD. Close to 20 percent of people in the United States have GERD.

Other symptoms of acid reflux and GERD can include:

People with persistent symptoms of acid reflux or GERD should see a doctor.

Thank you for supporting Medical News Today Is it a heart attack? Heart attacks occur when the blood supply to the heart muscles becomes completely blocked. If a person does not receive immediate treatment, part of the heart muscle can die. A common symptom of a heart attack is pain or discomfort that typically occurs in the center or left side of the chest. This pain may come and go, and its severity can range from mild to severe. It can also sometimes feel like heartburn or indigestion. However, not everyone who has a heart attack experiences chest pain. The symptoms of a heart attack can vary considerably from person to person, and they may come on slowly or very suddenly. Other symptoms of a heart attack might include: intense pressure or tightness in the center of the chest a feeling of heaviness or weakness in one or both arms pain, numbness, or a tingling sensation in the arms, neck, jaw, lips, or stomach difficulty breathing or shortness of breath nausea and vomiting dizziness or lightheadedness fatigue breaking out in a cold sweat Anyone who suspects that they or someone else is having a heart attack should immediately call 911 or go to the emergency room. Cardiac vs. noncardiac chest pain A person experiencing recurring or severe chest pain should speak to a doctor.
A person experiencing recurring or severe chest pain should speak to a doctor. When trying to distinguish between cardiac and noncardiac chest pain, a person needs to consider the following three factors: the location of the pain how the pain feels the accompanying symptoms We discuss each of these in more detail below: Location of chest pain Both cardiac and noncardiac chest pain can occur in the center of the chest behind the breastbone. However, cardiac chest pain can spread across the chest and even affect other parts of the body, such as the: arms back shoulders neck or throat jaw teeth Noncardiac chest pain, such as heartburn, tends to remain localized, meaning that it does not spread to other areas. Heartburn typically develops behind or underneath the breastbone. How the pain feels Some of the words that people use to describe cardiac chest pain are: pressure squeezing heaviness fullness tightening aching burning In contrast, noncardiac chest pain tends to feel like an intense stabbing or burning sensation just beneath the surface of the skin. Coughing, breathing, or moving can affect the intensity of noncardiac chest pain, while the severity of cardiac chest pain usually remains stable, even when resting. Accompanying symptoms The symptoms accompanying chest pain can be an important indication of whether it is cardiac or noncardiac. The symptoms that can occur along with cardiac chest pain may include: shortness of breath irregular heartbeat dizziness or lightheadedness numbness pain or discomfort in other parts of the body, such as the arms, neck, jaw, shoulders, and back Symptoms that indicate that the chest pain is from heartburn or GERD can include: Thank you for supporting Medical News Today Other causes of cardiac chest pain Causes of cardiac chest pain can include: Angina Coronary artery disease (CAD), also called ischemic heart disease or coronary heart disease, occurs when fatty deposits build up in the arteries that supply blood to the heart muscle. Over time, these deposits can restrict blood flow, which can cause a type of chest pain called angina. CAD can also lead to heart attacks and heart failure. People often describe angina as a feeling of pressure, squeezing, burning, or tightness behind the breastbone. This pain can spread to other parts of the body, including the arms, jaw, neck, and shoulders. Angina often occurs during physical activity, and stress can also bring it on. If the pain continues after rest, this can be a sign of a heart attack. People who are unsure whether they are experiencing angina or a heart attack should call 911 immediately or go to the emergency room. Myocarditis Myocarditis is a rare form of cardiovascular disease that causes inflammation of the heart muscle. This inflammation can lead to chest pain, heart failure, or sudden death. According to the National Organization for Rare Disorders, myocarditis commonly develops without an identifiable cause. However, doctors often diagnose people with myocarditis following a viral or bacterial infection. Myocarditis produces symptoms similar to those of other heart conditions, such as chest tightness and fatigue. Leaning forward can help relieve chest pain resulting from myocarditis. Other symptoms of myocarditis include: slow heart rate irregular heartbeat dizziness or lightheadedness loss of consciousness Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy (HCM) is a thickening of the muscle wall in the heart. People can inherit genes from their parents that increase their risk of developing HCM. However, HCM can also occur as a result of high blood pressure, diabetes, or thyroid disease. The symptoms of HCM include: chest pain that often results from exercise shortness of breath fainting fluttering heartbeat or heart palpitations Pulmonary hypertension Pulmonary hypertension refers to high blood pressure in the arteries that supply the lungs. Common symptoms include shortness of breath and chest pain, which may occur or worsen with physical activity. Over time, symptoms may become more frequent as the disease progresses. People with pulmonary hypertension may also experience: fatigue and weakness fainting, lightheadedness, or dizziness irregular heartbeat a dry cough that may bring up blood swelling of the legs or feet that results from fluid buildup Other causes of noncardiac chest pain Causes of noncardiac chest pain can include: Pneumonia Pneumonia can cause shortness of breath and chest pain.
Pneumonia can cause shortness of breath and chest pain. Pneumonia is a chest infection that causes the tiny air sacs inside the lungs to become inflamed and fill with fluid. A common symptom of pneumonia is chest pain that typically worsens when a person inhales deeply or coughs. The chest pain can range from mild to severe. Other symptoms of pneumonia can include: Peptic ulcer A peptic ulcer is an open sore in the lining of the stomach or small intestine. Bacterial infections and long-term use of nonsteroidal anti-inflammatory drugs can lead to peptic ulcers. Peptic ulcers can cause a painful burning sensation that starts in the abdomen and extends to the chest. This pain can come and go and may get better when a person eats or takes an antacid. Other symptoms of peptic ulcers can include: bloating belching nausea and vomiting dark stools unexplained weight loss loss of appetite lightheadedness However, not everyone with peptic ulcers experiences symptoms. Costochondritis Costochondritis is an inflammation of the cartilage around the breastbone. This inflammation can cause tenderness and sharp chest pain that may feel similar to the pain of a heart attack. The pain from costochondritis usually affects the left side of the chest, but it can sometimes affect both sides. Deep breathing, coughing, and physical activity may make the pain worse. Possible causes of costochondritis include severe coughing, chest injuries, infections, and overexertion. Esophageal spasms Involuntary spasms or contractions of the food pipe can cause intense chest pain. These spasms can come on suddenly and sometimes last for several hours. Other symptoms of esophageal spasms may include: intense pain or tightness in the chest feeling as though something has become stuck in the throat stomach contents coming up the food pipe difficulty swallowing It is not always clear why esophageal spasms occur, but risk factors include GERD, anxiety, and high blood pressure. Panic attack A panic attack refers to a sudden attack of intense anxiety and fear. These attacks can last for between a few minutes and several hours, and a person may feel as though they are having a heart attack. Symptoms of a panic attack can include: chest pain pounding, rapid, or irregular heartbeat trembling or shaking shortness of breath a sensation of choking or suffocating nausea dizziness or lightheadedness numbness sweating feelings of doom, loss of control, or unreality A person may have a panic attack in response to a stressful event, but an attack can also occur unexpectedly. Recurrent panic attacks are a symptom of panic disorder. Thank you for supporting Medical News Today Summary Heartburn is a symptom of acid reflux and GERD that causes a painful burning sensation in the center of the chest. This sensation can sometimes feel similar to the chest pain that people experience during a heart attack or attacks of angina. A heart attack is a medical emergency, so being able to tell the difference between heartburn and cardiac chest pain is crucial. If chest pain spreads to other areas of the body, such as the arms or jaw, or occurs alongside symptoms such as shortness of breath and a feeling of tightness in the chest, it might be a sign of a heart attack. If chest pain lasts for more than a few minutes, call 911 immediately. A person who suspects that they or someone else is having a heart attack should immediately call 911 or go straight to the emergency room. It is also advisable to see a doctor about any unexplained chest pain, even if it goes away on its own.
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Plant-based diet cuts heart failure risk by over 40 percent

New research finds that sticking to a diet rich in fruits, vegetables, and fish can slash heart failure risk by 41 percent. By contrast, a diet rich in fats, fried foods, processed meat, and sugary drinks can raise the risk of this condition.
male hands eating tomato salad
Adding more vegetables to our plate could keep heart failure at bay.

Heart failure occurs when the heart cannot supply enough blood and oxygen to the main organs in the body.

The condition affects about 5.7 million people in the United States and approximately 26 million people worldwide.

Some experts predict that heart failure will become more and more prevalent worldwide, which has led them to refer to it as a "global pandemic."

However, emerging evidence suggests that a diet consisting mainly of fruits and vegetables can prevent cardiovascular disease. Now, a new study strengthens this idea.

Dr. Kyla Lara, a cardiology fellow at the Mayo Clinic in Rochester, MN, and her colleagues, have examined the associations between five major dietary patterns and the risk of heart failure among people without any known history of heart disease.

Dr. Lara and her team published the results of their study in the Journal of the American College of Cardiology.

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The effect of diets on heart failure

The researchers examined data available from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Namely, they looked at the dietary patterns among 16,068 black and white people who were 45 years old, on average.

The participants answered a 150-item survey, which included 107 food items. The researchers grouped the foods into five dietary patterns:

"convenience" diets, which consisted of meat-heavy dishes, pasta, pizza, and fast food "plant-based" diets, consisting mainly of vegetables, fruit, beans, and fish "Southern" diets, which comprised a significant amount of fried foods, processed meat, eggs, added fats, and sugary drinks "alcohol/salads" diets, which included lots of wine, liquor, beer, leafy greens, and salad dressing.

Dr. Lara and team followed the participants for 8.7 years on average, during which time, 363 people spent time in the hospital for heart failure for the first time.

Of these, 133 people had heart failure with preserved ejection fraction, and 157 had heart failure with reduced ejection fraction. The former refers to a form of heart failure in which the ejection fraction — a measure of how well the heart is pumping blood — is "normal," or "preserved."

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Plant-based diets slash heart failure risk

Overall, the researchers found that adhering to the Southern diet increased the risk of hospitalization due to heart failure by 72 percent.

But when the researchers adjusted for body mass index (BMI), "waist circumference, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease," this association became no longer statistically significant.

This could mean that the Southern diet raises heart failure risk by increasing obesity and abdominal fat, explain the researchers.

Importantly, the researchers found that the risk of heart failure hospitalizations was 41 percent lower among people who adhered to the plant-based diet.

Finally, the researchers found no statistically significant associations among heart failure risk and the other three dietary patterns.

"Adherence to a plant-based dietary pattern was inversely associated with incident [heart failure] risk, whereas the Southern dietary pattern was positively associated with incident [heart failure] risk," conclude the researchers, who also outline some strengths and limitations to their study.

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The researchers say that the socio-economically and demographically diverse study sample made the associations stronger. However, the study participants may have wrongly estimated their dietary intakes, which may have biased the results.

Also, the researchers examined the participants' diets only at the beginning of the study, and these dietary habits may have changed throughout the study period.

In a linked editorial, Dr. Dong Wang, a research fellow at the Harvard T.H. Chan School of Public Health in Boston, MA, comments on the significance of the findings, "This study represents an important step forward in establishing a robust evidence base for the dietary prevention of heart failure."

"The need for population-based preventive strategies for heart failure is critical [...] These findings support a population-based dietary strategy for lowering the risk of incident heart failure."

Dr. Kyla Lara

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Replacing red meat with plant protein reduces heart disease risk

A meta-analysis of trials comparing the health effects of red meat consumption with those of other diets found that substituting healthful plant protein for red meat helps lower the risk of cardiovascular disease.
Spelt, broccoli, savoy cabbage with chargrilled tofu with sriracha as plant protein
Eating plant proteins, such as tofu, may benefit cardiovascular health.

Many studies throughout the years have linked the consumption of red meat to cardiovascular disease and cancer, but the results have been inconsistent.

A 2015 study comparing the effects of plant protein and animal protein on the risk of cardiovascular disease found that the evidence was inconclusive.

Recent studies further investigated the link between red meat consumption and heart disease and found that red meat does not significantly increase the risk of cardiovascular disease when a person sticks to the recommended intake. Most of these studies focused on the potential harms of red meat, but they did not include an analysis of other specific diets.

Researchers from Harvard T.H. Chan School of Public Health in Boston, MA, and Purdue University in West Lafayette, IN, conducted the first meta-analysis of randomized controlled trials analyzing the effects of red meat by replacing it with other types of food. The results feature in the journal Circulation.

Red meat consumption in the United States

This new approach allowed researchers to examine a different side of the issue. Red meat consumption remains a very controversial topic, especially in the U.S., where the consumption of red meat per capita was more than 200 pounds in 2018, according to the U.S. Department of Agriculture.

Although red meat consumption in the U.S. is still high, chicken production and consumption have been increasing. The U.S. per capita beef consumption is down from its peak, but it is still remarkable — it is four times as high as the global average, according to the Organisation for Economic Co-operation and Development.

A recent survey showed that many people in the U.S. might be open to reducing their meat consumption in the future because they are becoming more aware of the associations that red meat has with nutritional and environmental health harms. The researchers suggested that education campaigns are necessary to accelerate the shift to a more sustainable diet.

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Asking 'Is red meat good or bad?' is useless

In this latest study, the researchers analyzed data from 36 randomized controlled trials, which included a total of 1,803 participants. The team looked at blood pressure and blood concentrations of cholesterol, triglycerides, and lipoproteins in people who ate diets with red meat. They then compared these values with those of people who ate more of other foods, such as chicken, fish, carbohydrates, legumes, soy, or nuts.

"Previous findings from randomized controlled trials evaluating the effects of red meat on cardiovascular disease risk factors have been inconsistent," says Marta Guasch-Ferré, lead author of the study and research scientist in the Department of Nutrition at the Harvard T.H. Chan School of Public Health.

"But, our new study, which makes specific comparisons between diets high in red meat versus diets high in other types of foods, shows that substituting red meat with high-quality protein sources lead to more favorable changes in cardiovascular risk factors."

The findings showed that there were no significant differences in total cholesterol, lipoproteins, or blood pressure between those who ate red meat and those who ate more of other types of food. However, diets high in red meat did cause an increase in triglyceride concentrations. Conversely, diets rich in high-quality plant protein lowered the levels of bad cholesterol.

"Asking 'Is red meat good or bad?' is useless," says Meir Stampfer, senior author of the study and professor of epidemiology and nutrition at Harvard T.H. Chan. "It has to be 'Compared to what?'"

"If you replace burgers with cookies or fries, you don't get healthier. But, if you replace red meat with healthy plant protein sources, like nuts and beans, you get a health benefit."

Prof. Meir Stampfer

The authors recommend that people follow healthful vegetarian and Mediterranean-style diets that provide plenty of high-quality plant protein because they offer excellent health benefits and promote environmental sustainability.

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What are the nutritional benefits of peanuts?

Peanuts have a strong nutritional profile. They are an excellent source of plant-based protein, fiber, and many key vitamins and minerals.

Peanuts come in many forms, including roasted, salted, chocolate-coated, and as peanut butter. Different types have different nutritional profiles and various health benefits.

Along with their healthful nutritional profile, peanuts are a calorie-rich food, so they are most healthful when enjoyed in moderation.

In this article, we provide the nutritional profile of peanuts, their health benefits, and how different types compare.

Nutritional breakdown Peanuts in a bowl on wooden table top down view.
Peanuts are most healthful when they are in their raw form.

Peanuts are an especially good source of healthful fats, protein, and fiber. They also contain plenty of potassium, phosphorous, magnesium, and B vitamins. Despite being high in calories, peanuts are nutrient-rich and low in carbohydrates.

According to the United States Department of Agriculture (USDA), 100 grams of raw peanuts contain 567 calories and the following nutrients in grams (g), milligrams (mg), or micrograms (mcg):

macronutrients protein
25.8 g
16.13 g
8.5 g
4.72 g
fats monounsaturated fats
polyunsaturated fats
saturated fats
24.43 g
15.56 g
6.28 g
minerals potassium
705 mg
376 mg
168 mg
92 mg
18 mg
4.58 mg
3.27 mg
vitamins vitamin B-3 (niacin)
vitamin E (alpha-tocopherol)
vitamin B-1 (thiamine)
vitamin B-6 (pyridoxine)
riboflavin (vitamin B-2)
folate (vitamin B-9)
12.07 mg
8.33 mg
0.64 mg
0.35 mg
0.14 mg
240 mcg

The mixture of healthful fats, protein, and fiber in peanuts means they provide nutritional benefits and make a person feel fuller for longer. This makes peanuts a healthful, go-to snack when people compare them with chips, crackers, and other simple carbohydrate foods.

Below, we discuss the benefits of key nutrients in peanuts.

1. Protein Peanuts are an excellent source of plant-based protein, offering 25.8 g per 100 g of peanuts, or around half of a person's daily protein needs. The recommended daily allowance (RDA) for protein in adults is: 46 g for women 56 g for men Protein is essential for building and repairing body cells. The amount of protein a person needs varies, depending on their age and activity level. Thank you for supporting Medical News Today 2. Healthful fats Peanut butter on toast with fruit for breakfast
Peanuts contain healthful fats that are an essential part of a nutritious diet. Fatty acids are an essential part of every diet. Most of the fats in peanuts are monounsaturated and polyunsaturated fatty acids, which are a healthful type of fat. According to the American Heart Association (AHA), consuming monounsaturated fats and polyunsaturated fats instead of saturated and trans fats can improve a person's blood cholesterol levels. This, in turn, lowers the risk of heart disease and stroke. There is also a small amount of saturated fat in peanuts. Saturated fat is less healthful than unsaturated or polyunsaturated. Doctors link too much saturated fat with cardiovascular disease. As a consequence, it is best to eat peanuts in moderation to get their optimal health benefits. 3. Dietary fiber Peanuts are a good source of dietary fiber. They contain 8.5 g per 100 g, which around one-quarter of a male's recommended fiber intake or one-third for females. The current Dietary Guidelines for Americans recommend that adults get the following amounts of fiber per day: 34 g for men 28 g for women Fiber is a heart-healthful nutrient. The AHA report that eating fiber-rich foods improves blood cholesterol levels and lowers the risk of heart disease, stroke, obesity, and type 2 diabetes. Which types of peanuts are most healthful? Raw peanuts are the most healthful variety. Peanut butter is a great choice, offering a healthy nutritional profile and a range of health benefits. Learn about the health benefits of peanut butter. People can also buy roasted, salted peanuts. Eating these types is okay in moderation, though consuming too much sodium is linked with high blood pressure and heart disease. The AHA recommend an ideal limit of 1,500 mg of sodium per day, and no more than 2,300 mg of sodium — equivalent to 1 teaspoon of salt — especially for people with high blood pressure. Where possible, choose raw peanuts with the skin attached. Peanut skins contain antioxidants. Antioxidants help protect the body's cells from damage from free radicals. Producers usually remove the skins from most roasted or salted peanut. People can enjoy peanuts and peanut butter in moderation as a snack throughout the day. In main meals, peanuts make a great addition to salads or Thai dishes. Thank you for supporting Medical News Today Health benefits of peanuts Woman at desk at work snacking and eating on peanut
Eating peanuts may help with managing blood sugar levels. Eating peanuts has three main health benefits: supporting heart health maintaining a healthy weight managing blood sugar The following sections discuss these benefits and the science behind them. 1. Supporting heart health Peanuts contain more healthful monounsaturated and polyunsaturated fats than they do saturated fats. This fat ratio makes peanuts better for the heart than fat sources with a higher proportion of saturated fats. A 2014 study found that eating 46 g of peanuts or peanut butter each day may improve heart health for people with diabetes. 2. Maintaining a healthy weight Because peanuts are full of healthful fats, protein, and fiber, they make a satisfying snack. Eating them in moderation may help a person maintain a healthy weight. Research found that women who ate nuts, including peanuts, twice a week had a slightly lower risk of weight gain and obesity over 8 years than those who rarely ate nuts. A large-scale study found that eating peanuts and other nuts may reduce a person's risk of obesity over 5 years. 3. Managing blood sugar levels Peanuts are an excellent food for people with diabetes or a risk of diabetes. Peanuts have a low glycemic index (GI), meaning they do not cause big spikes in blood sugar levels. Nutritionists see foods with a GI of 55 or lower as low-GI foods, and those with a GI of more than 70 are high-GI foods. Peanuts have a GI score of 23, making them a low-GI food. Learn more about the GI scale here. Peanuts help control blood sugar levels because they are relatively low in carbohydrates but high in protein, fat, and fiber. Fiber slows down the digestive processes, allowing a steadier release of energy, and protein takes longer to break down than simple carbohydrates. Research suggests that eating peanut butter or peanuts may help women with obesity and a higher type 2 diabetes risk to manage their blood sugar levels. Risks and considerations Peanuts contain proteins called arachin and conarachin. Some people are severely allergic to these proteins. For these people, peanuts can cause a life-threatening allergic reaction. Because peanuts are high in calories, it is sensible to eat them in moderation as part of a balanced diet. Consuming too many calories may lead to weight gain. This is true regardless of whether the foods those calories come from are nutritious or not. Roasted, salted peanuts may be less healthful than raw peanuts due to their high sodium content. That said, if people consume them in moderation, they can enjoy them as a part of a healthful, balanced diet. Summary Peanuts are a nutrient-rich source of protein, dietary fiber, and healthful fats. Eating them in moderation, as part of a balanced diet, may: support heart health help a person maintain a healthy weight help a person manage their blood sugar levels Peanuts are a good option for people with diabetes for these reasons. They are also a good snack option for those looking to reduce carbohydrates and increase healthful fat intake. For their optimal health benefits, choose raw peanuts with the skin on. Raw peanuts with their skin on are high in cell-defending antioxidants. Roasted, salted peanuts are high in sodium, which health professionals link to heart disease. That said, eating roasted, salted peanuts as part of a balanced diet is okay. As with most foods, the key to enjoying peanuts is eating them in moderation as part of a healthful, calorie-controlled diet.
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What are the benefits of eating Brazil nuts?

Brazil nuts come from the South American Bertholletia excelsa, or Brazil nut, tree. They are a good source of healthful fats, protein, fiber, and selenium.

Despite its name, the Brazil nut is technically a seed rather than a nut. By definition, nuts are hard-shelled fruits that contain a single, large seed. Walnuts and pistachios are good examples.

Brazil nuts may offer surprising and powerful nutritional benefits, including boosting heart health, providing antioxidants, and improving brain function.

In this article, we discuss the health benefits of Brazil nuts, their risks, and how to add them to the diet.

1. Nutrition Brazil nuts in a bowl
Brazil nuts are a healthful source of essential nutrients.

Brazil nuts are among the richest dietary sources of selenium, an essential mineral with antioxidant properties. Selenium plays an important role in reproduction, metabolism, and immune health.

A single Brazil nut contains 68 to 91 micrograms (mcg) of selenium, meaning that just one nut per day can provide the daily recommended adult allowance of 55 mcg.

In addition to selenium, Brazil nuts contain plenty of protein, essential minerals, and healthful fats.

According to the United States Department of Agriculture (USDA), a serving of three Brazil nuts contains the following nutrients:

99 calories 2.15 grams (g) of protein 10.06 g of fat 1.76 g of carbohydrate 1.10 g of fiber 109 milligrams (mg) of phosphorus 99 mg of potassium 56 mg of magnesium 24 mg of calcium 0.61 mg of zinc 0.36 g of iron 0 mg of sodium

Given their impressive nutritional profile, it is no surprise that Brazil nuts have become so popular.

2. Heart health Brazil nuts contain healthful fats called polyunsaturated and monounsaturated fatty acids. According to the American Heart Association (AHA), consuming monounsaturated fats and polyunsaturated fats instead of saturated and trans fats helps improve cholesterol levels, which lowers the risk of heart disease and stroke. Brazil nuts also provide dietary fiber. The AHA report that eating fiber-rich foods improves blood cholesterol levels and lowers the risk of heart disease, stroke, obesity, and type 2 diabetes. The findings of a 2019 study showed that higher consumption of tree nuts decreased the risk of cardiovascular disease and heart attack among people living with diabetes. 3. Thyroid health Selenium deficiency can cause hormonal imbalances that can negatively affect sleep, mood, concentration, and metabolism. Selenium plays an essential role in hormone production. The thyroid gland uses selenium to convert thyroxine hormone (T4) into its active form, triiodothyronine hormone (T3). Obtaining enough selenium from dietary sources may prevent or help regulate thyroid problems, such as hypothyroidism. Thank you for supporting Medical News Today 4. Antioxidant effects Brazil nut pod containing shelled brazil nuts
Eating brazil nuts may help prevent oxidative stress. The selenium in Brazil nuts may boost the body's antioxidant system and prevent oxidative stress. The liver breaks selenium down into a type of protein called selenoprotein P, which effectively removes excess free radicals. Free radicals cause oxidative stress, and research has linked them to many chronic health conditions, including cancer. A double-blind, placebo-controlled study examined the antioxidant effects of Brazil nut consumption. During the study, 91 people with hypertension and high blood-lipid concentrations received either 13 g of granulated, partially defatted Brazil nuts or a placebo every day for 12 weeks. The participants in the Brazil nut group had higher selenium levels and increased activity of an antioxidant enzyme called GPx3. They also had lower levels of oxidized low-density lipoprotein (LDL), which people sometimes refer to as "bad cholesterol." 5. Anti-inflammatory effects The antioxidant properties of Brazil nuts may help reduce inflammation in the body. Inflammation has an association with many chronic health conditions. A small-scale 2014 study looked at the health effects of eating one Brazil nut per day in people with chronic kidney disease. After 3 months, the researchers noticed a reduction in inflammation and markers of oxidative stress. 6. Lowering blood sugar Foods rich in selenium may help improve people's blood sugar levels. A study in the European Journal of Nutrition reported that eating one Brazil nut per day for 8 weeks lowered total cholesterol and fasting glucose levels in healthy adults. The findings of another 8-week-long study showed that taking a 200-mcg selenium supplement reduced insulin levels and improved insulin sensitivity in people with type 2 diabetes and coronary heart disease. The researchers also reported increased antioxidant capacity in the body. 7. Improving brain functioning Antioxidants help keep the brain healthy. Brazil nuts have powerful antioxidant effects, which may boost brain functioning. Scientists have linked decreases in antioxidant function to cognitive impairment and neurodegenerative diseases, including Alzheimer's disease. The findings of a 2014 study suggested that people with Alzheimer's disease have lower selenium levels than those without the condition. A small-scale trial reported that eating one Brazil nut per day for 6 months had positive effects on some cognitive functions among older adults with minor cognitive impairment (MCI) compared with those in a control group. This result may be due to the nuts reversing selenium deficiency. However, a recent study found no association between selenium levels and cognitive ability. More research is necessary to uncover how selenium affects cognition and to determine whether or not it could prevent or treat neurogenerative diseases. Thank you for supporting Medical News Today How to eat Brazil nuts Brazil nut on wooden table in process of being unshelled
Brazil nuts are a convenient snack. People can eat whole Brazil nuts as a snack or add them to other foods. Brazil nuts are fine to eat raw or roasted. To cook Brazil nuts on the stovetop: Place a layer of Brazil nuts in a skillet over medium heat. Stir the nuts every minute or so to avoid burning them. Continue cooking for about 5 to 10 minutes until the nuts become aromatic. To roast Brazil nuts in the oven: Preheat the oven to 350°F. Place the nuts on a layer of parchment paper on a baking sheet. Place the baking sheet in the preheated oven and roast for 5 minutes. Remove the baking sheet and stir the nuts. Return the baking sheet to the oven for another 5 minutes. Remove the nuts from the oven and season them with salt, herbs, or spices. Allow the nuts to cool completely before eating them. People can try adding Brazil nuts to pad Thai dishes, trail mixes, or pesto. Alternatively, they can use chopped Brazil nuts as a nutritious topping for oatmeal, salads, or even brownies. Brazil nuts are available in most supermarkets, or people can choose between brands online. Can you eat too many Brazil nuts? When it comes to Brazil nuts, more is not necessarily better. People should limit their intake of Brazil nuts to a few per day to avoid negative side effects. Brazil nuts are high in calories, and eating too many can cause selenium toxicity. Like most nuts, Brazil nuts are very calorie-dense. People who eat too many Brazil nuts run the risk of exceeding their daily recommended calorie intake. Consuming too many calories can cause unwanted weight gain. As a member of the tree nut family, Brazil nuts may cause allergic reactions in some people. According to the American College of Allergy, Asthma & Immunology, an estimated 25 to 40 percent of people who have a peanut allergy react to at least one type of tree nut. Selenium toxicity Many of the health benefits of Brazil nuts come from their high selenium content. Although beneficial in small quantities, Brazil nuts could cause selenium toxicity if a person regularly eats them in large numbers. According to the National Institutes of Health (NIH), selenium toxicity can cause a variety of symptoms, such as: dizziness gastrointestinal problems hair loss brittle nails skin rashes or lesions nervous system problems fatigue irritability muscle tenderness or soreness joint pain It can sometimes also cause severe symptoms, which may include: acute respiratory distress syndrome heart attack kidney failure heart failure In rare cases, selenium toxicity can be fatal. The selenium concentration in Brazil nuts varies depending on the amount present in the soil so each nut may contain a different amount. Summary Brazil nuts may provide some impressive health benefits, but it is best to eat them in moderation. According to the findings of scientific studies, certain compounds in Brazil nuts may benefit health in a range of ways, such as lowering the risk of heart disease, regulating blood sugar levels, and boosting the body's antioxidant system. Brazil nuts are among the best sources of natural selenium, an essential mineral known for its antioxidant properties. Although selenium can promote health, too much can result in selenium toxicity. We picked linked items based on the quality of products, and list the pros and cons of each to help you determine which will work best for you. We partner with some of the companies that sell these products, which means Healthline UK and our partners may receive a portion of revenues if you make a purchase using a link(s) above.
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Scientists 'print' 3D heart using patient's tissue

Although 3D printing has advanced in leaps and bounds over the past few years, using it to print functioning human organs is still a far-flung dream. Recently, however, scientists have brought this dream one step closer.
3D printed heart
A 3D-printed heart engineered from the patient's own tissues and cells.
Image credit: Advanced Science 2019 The Authors

Cardiovascular disease is the leading cause of death in the United States.

According to the Centers for Disease Control and Prevention (CDC), 610,000 people in the U.S. die from heart disease each year.

Once it has progressed to its final stages, the only treatment option is a heart transplant.

Because there are too few heart donors, the wait for a life-saving transplant is long.

Scientists are keen to find ways of patching up existing heart tissue to remove or postpone the need for a transplant.

For instance, if surgeons could impant a material into the heart, it could form a temporary scaffold to support cells and boost cellular reorganization.

This so-called cardiac tissue engineering has a number of problems; primarily, scientists need to find a type of material that the body would not reject. Researchers have already tried a range of materials and methods, but the perfect candidates are cells from the body of the patient.

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Bioink and stem cells

During recent years, researchers have made some progress toward artificially replicating human tissue.

A group of scientists from Tel Aviv University in Israel has taken this work one step further and moved cardiac tissue engineering to the next stage.

"This is the first time anyone anywhere has successfully engineered and printed an entire heart replete with cells, blood vessels, ventricles, and chambers."

Lead researcher Prof. Tal Dvir

The scientists have designed a groundbreaking approach that allows them to create the closest thing to an artificial heart to date.

Their first step was to take a biopsy of fatty tissue from the patient; then, they separated cellular material from noncellular material.

The researchers reprogrammed the cells of the fatty tissue to become pluripotent stem cells, which can develop into the range of cell types necessary to grow a heart.

The noncellular material consists of structural components, such as glycoproteins and collagen; the scientists modified these to turn them into a "bioink."

Then, they mixed this bioink with the stem cells. The cells differentiated into cardiac or endothelial cells (which line blood vessels), which the scientists could use to create cardiac patches, including blood vessels.

They describe their methods in detail in a recent paper published in the journal Advanced Science.

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'The size of a rabbit's heart'

"This heart is made from human cells and patient-specific biological materials. In our process these materials serve as the bioinks, substances made of sugars and proteins that can be used for 3D printing of complex tissue models," says Prof. Dvir.

He goes on to say: "People have managed to 3D-print the structure of a heart in the past, but not with cells or with blood vessels. Our results demonstrate the potential of our approach for engineering personalized tissue and organ replacement in the future."

To demonstrate the potential of their technique, the scientists created a small but anatomically precise heart, complete with blood vessels and cells.

"At this stage, our 3D heart is small, the size of a rabbit's heart," says Prof. Dvir. "But larger human hearts require the same technology."

It is worth noting that this technology is still very far from being able to replace heart transplants. This is just another step along the path — albeit a rather large step.

The crucial next task, as Prof. Dvir says, is to teach them to behave like hearts; he explains that they "need to develop the printed heart further. The cells need to form a pumping ability; they can currently contract, but we need them to work together."

"Our hope," he goes on, "is that we will succeed and prove our method's efficacy and usefulness."

There is still a long road ahead, but the researchers are excited about how far they have come.

"Maybe, in 10 years, there will be organ printers in the finest hospitals around the world, and these procedures will be conducted routinely."

Prof. Tal Dvir

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Low levels of 'bad cholesterol' may actually increase stroke risk

A recent study warns that women with low levels of low-density lipoprotein cholesterol, sometimes called "bad cholesterol," may face an increased risk of bleeding stroke.
woman checking cholesterol measurements
Women with low LDL cholesterol levels may be more at risk of bleeding stroke, new research finds.

According to the latest guidelines from the American College of Cardiology and the American Heart Association, a person's levels of low-density lipoprotein (LDL) cholesterol should remain under 100 milligrams per deciliter (mg/dl) to maintain health.

That is because, generally, specialists have considered LDL to be "bad" cholesterol. LDL carries cholesterol to the cells that need to make use of it, but if its levels are too high, it can stick to the arteries, leading to all manner of cardiovascular problems.

However, new research from the Brigham and Women's Hospital and Harvard Medical School in Boston, MA, has found that women with LDL levels below 100 mg/dl may actually be more at risk of hemorrhagic (bleeding) stroke. This type of stroke, though less common than an ischemic stroke, is harder to treat and thus more dangerous to the person experiencing it.

"Strategies to lower cholesterol and triglyceride levels, like modifying diet or taking statins, are widely used to prevent cardiovascular disease," explains study author Pamela Rist, from Brigham and Women's Hospital.

"But, our large study shows that in women, very low levels may also carry some risks. Women already have a higher risk of stroke than men, in part because they live longer, so clearly defining ways to reduce their risk is important."

Pamela Rist

The new study's findings now appear online ahead of print in the journal Neurology.

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In this study, the researchers looked at the data of 27,937 women aged 45 years and over who took part in the Women's Health Study. The data included measurements of each participant's LDL cholesterol, high-density lipoprotein (HDL) cholesterol, and triglyceride levels at the beginning of the study.

Rist and team looked at both these data and the participants' medical records over an average 19-year follow-up period.

They found that during this time, 137 women had experienced a bleeding stroke. They noted that nine (or 0.8 percent) of the 1,069 women with LDL levels of 70 mg/dl or lower experienced this type of cardiovascular event, whereas it affected 40 (or 0.4 percent) of the 10,067 women with LDL cholesterol levels of 100–130 mg/dl.

After adjusting for possible confounding factors, the researchers concluded that women with the lowest levels of LDL cholesterol were more than twice (2.2 times) as likely to have a bleeding stroke as those with high LDL cholesterol levels.

They identified a similar association in relation to triglyceride levels: 34 (or 0.6 percent) of the 5,714 women with the lowest triglyceride levels had experienced a bleeding stroke, whereas this event had occurred in 29 (0.4 percent) of the 7,989 women with the highest triglyceride levels.

Once more, after adjusting for other potential risk factors, the team concluded that women with the lowest triglyceride levels had a risk of bleeding stroke that was twice as high as that of the women with the highest triglyceride levels.

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At the same time, the researchers found no such discrepancies regarding total cholesterol and HDL cholesterol levels.

"Women with very low LDL cholesterol or low triglycerides should be monitored by their doctors for other stroke risk factors that can be modified, like high blood pressure and smoking, in order to reduce their risk of hemorrhagic stroke," Rist advises.

"Also, additional research is needed to determine how to lower the risk of hemorrhagic stroke in women with very low LDL and low triglycerides," she adds.

The researchers also admit that their study has faced some limitations, including the fact that they only had access to cholesterol and triglyceride level measurements at baseline and that they did not have a chance to investigate whether menopause-related factors played a role in some of the women's increased stroke risk.

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What to know about low-carb, high-fat diets

A low-carb, high-fat diet involves a person reducing the number of carbohydrates they consume and replacing them with healthful fats. In recent years, this type of diet has become popular among people trying to lose weight.

A low-carb, high-fat diet (LCHF) involves using ketones from fat for energy instead of glucose, which comes directly from carbohydrates. When a person significantly reduces or limits the number of carbs they consume in a day, it forces the body to use fat stores as fuel, which may lead to weight loss.

However, science does not always agree on the safety of LCHF diets. Although some research supports its use to help a variety of health conditions, other studies report that LCHF diets can be dangerous.

Read on to learn more about LCHF diets, how to begin, and are they safe?

Is a low-carb, high-fat diet good for you? Omelette and avocado for a low-carb, high-fat diets
An LCHF diet may have a positive effect on type 2 diabetes and certain cancers.

Eating a diet that is high in protein and fat tends to make a person feel full faster than they would if they consumed only carbohydrates, particularly simple carbohydrates, such as sugar.

As well as weight loss, some evidence supports the use of LCHF diets to help certain medical conditions.

An LCHF diet may have a positive effect on the following conditions:

However, scientists need to carry out more research to understand the LCHF diet's long-term effect on overall health. There is conflicting evidence on the safety and effectiveness of the LCHF diet. One study suggests that diets low in carbohydrates may lead to premature death from heart disease, cancer, and stroke.

How to start For some people who want to lose weight, simple lifestyle changes, such as exercise and a balanced diet, might be all they need to improve their overall health and well-being. However, for those who want to follow an LCHF diet, it is essential that they implement it in a healthful, well-planned way. It is always a good idea to consult a healthcare professional before beginning an LCHF diet, particularly for those people with a medical diagnosis. It might be a good idea to ease into an LCHF diet by first cutting out refined and processed carbs, such as white bread and processed sugar and focusing on whole food based carbohydrates, such as fruits, beans, legumes, and whole grains. This may be a good start to reaching weight loss and health goals without having to drastically reduce the number of carbs eaten. Thank you for supporting Medical News Today Consider a formal dietary plan An LCHF diet can include anything from a casual reduction in carbohydrate intake to following a much more structured plan. However, any LCHF diet involves reducing carbohydrate consumption. Most LCHF diets recommend that a person eats 50 grams (g) or less of carbohydrates in a day. The Atkins diet The Atkins diet is a popular LCHF diet that promotes weight loss. The Atkins diet involves four phases: Phase 1: A person eats no more than 20 g of carbohydrates a day for 2 weeks. Phase 2: A person can start to add more foods, such as nuts, fruits, and low-carb vegetables, into the diet. Phase 3: As the person approaches their goal weight, they can consume more carbohydrates. Phase 4: A person can eat whole grain carbs and other healthful carbohydrates as long as they do not start gaining weight. Many of the pre-packaged products linked to the Atkins diet are processed and contain sugar alcohols and artificial sweeteners. Some research links these types of sweeteners to metabolic syndrome, type 2 diabetes, heart disease, and weight gain. If following an Atkins-type diet, it is a good idea to focus on whole food sources rather than processed foods and bars. The ketogenic diet The ketogenic, or keto, diet also encourages a low-carbohydrate and high-fat intake. Though there are a few variations, a ketogenic diet typically involves a person consuming no more than 5–10 percent of carbohydrates in their daily diet — this equates to about 20–50 g of carbs per day. The ketogenic diet aims to help the body achieve a state of ketosis. Ketosis occurs when there are not enough carbohydrates available for the body to use for energy, so it starts to break down fat stores to use instead. This effect typically induces weight loss and may have other health benefits for some people. However, the diet may also have side effects and scientists need to carry out further research to identify the long-term benefits and dangers of the ketogenic diet. Meal planning When a person starts an LCHF diet, it is essential that they plan their meals. Meal planning can help a person: buy only the food they need, which will save wastage and money avoid eating the same foods repetitively cut out meals heavy in carbohydrates For those following an LCHF dietary plan, such as the Atkins or ketogenic diet, there are many resources available to help a person plan their meals and create shopping lists. Foods to eat cashew nuts on wooden spoon
Cashew nuts are a good source of fat and protein for people on an LCHF diet. LCHF diets typically require a person to eat foods that are low in carbohydrates. In general, a person following an LCHF diet should include lean proteins and healthful fats in their daily diets. It is essential to be mindful of portion sizes to avoid overeating. Some sources of fat and protein for LCHF diets include: meat, including beef, pork, chicken, and turkey fish, such as salmon, tuna, herring, and cod cheese butter avocado oils, such as olive, coconut, flaxseed, and avocado oil nuts, such as peanuts, almonds, walnuts, and cashews seeds such as sunflower, chia, and flax eggs Some fruits and most non-starchy vegetables are low in carbohydrates. These include: spinach and other dark leafy greens berries, such as strawberries, blueberries, and blackberries broccoli cauliflower asparagus Brussels sprouts carrots small portions of melons, peaches, and apples In moderation, a person can also eat dark chocolate and drink dry wine and still stay low-carb. Depending on the exact dietary plan a person is following, they may choose to include small amounts of the following higher-carb food items: quinoa sweet potatoes potatoes beans and legumes brown rice oats other tuber vegetables other whole grains People following an LCHF diet should avoid drinks that contain large amounts of added sugar, such as sodas, sweetened teas, and juices. Unsweetened teas, coffee, and water are excellent choices. Thank you for supporting Medical News Today Foods to avoid The most obvious foods to avoid are those that contain high carbohydrates with little nutritional value or fiber, such as refined and overly processed foods. This includes sodas, cakes, and cookies. These often contain a lot of added sugar, including artificial sweeteners and sugar alcohols. Other foods that people can avoid or consume in smaller quantities include: white pasta white rice bread and rolls baked goods such as pastries, cakes, and muffins candy drinks with added sugar, such as energy drinks, soft drinks, and fruit juices beer sugar-heavy coffees diet drinks low-fat foods as they may contain extra sugar Some people may choose to avoid starchy vegetables, such as potatoes, beans, and whole grains. However, a person might not need to exclude all these foods to maintain an LCHF diet. Side effects woman with a headache and fatigue at her desk
A person may experience fatigue if they suddenly cut down on carbohydrates. When a person suddenly cuts down on the number of carbohydrates they eat, they may experience some temporary side effects, including: As the body adjusts to these dietary change, these effects should go away. There is currently not a lot of research into the long-term side effects of LCHF diets. However, some potential risks may include: a higher chance of developing heart disease from eating animal protein and fat increase in the risk of developing chronic diseases nutritional deficiencies Children and teenagers should not attempt a diet that reduces their carbohydrate intake. Nutritional deficiencies could lead to bone density loss or impaired growth. People with medical conditions or other concerns should speak to their healthcare provider before starting an LCHF diet. Takeaway In the short-term, an LCHF diet may help a person lose weight. However, there is little research on the long-term health effects of LCHF diets. Some studies indicate that the diet may help a person avoid heart disease and other medical conditions, while others suggest it may lead to more chronic conditions. Before starting an LCHF diet, a person should speak to their healthcare professional.
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Large study ties PTSD, acute stress to cardiovascular disease

A large Swedish population study has found strong links between psychiatric conditions that can follow extremely stressful experiences and the risk of several types of cardiovascular disease.
man holding his head in his hands, looking very stressed
The link between acute stress and cardiovascular symptoms may be bidirectional, suggests new research.

In addition, the researchers found that the risk of a heart attack and other sudden and severe cardiovascular events is especially high in the 6 months that follow the diagnosis of the stress-related condition.

For other types of cardiovascular disease — such as heart failure, a disease that develops slowly — the risk appears to be highest during the 12 months that follow the psychiatric diagnosis.

For embolism and thrombosis, which are major conditions that develop from blood clots, the risk is likely higher 1 year or more after a diagnosis of stress-induced illness.

In a paper in The BMJ about the study, the authors state that the findings apply "equally to men and women" and do not depend on medical history, family background, or having other psychiatric illnesses.

They also note that the results support those of previous studies on relations between stress-induced conditions and cardiovascular disease.

However, most previous findings have come from research that drew largely on male war veterans or men on active military service, and they also focused almost entirely on PTSD, with symptom data from self-reports.

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PTSD and similar stress-induced conditions

Anyone who has witnessed or experienced a traumatic event, such as combat, rape, violent assault, or natural disaster can develop PTSD, which affects around 3.5 percent of adults in the United States.

However, witnessing or experiencing a traumatic event does not necessarily lead to PTSD.

When diagnosing PTSD, doctors look for symptoms such as startled reaction to loud noise, flashbacks, and nightmares, together with feelings of detachment, more-than-usual anger, sadness, and irritability that remain intense and do not wane with time.

In some people, the symptoms of PTSD can last for years.

Acute stress disorder is a similar condition to PTSD; it can occur in response to traumatic events and has some of the same symptoms, but it tends to arise within 3–30 days after the traumatic event.

In the U.S., estimates suggest that 13–21 percent of car accident survivors and up to half of those who survive rape, assault, or mass shootings will develop acute stress disorder. Around half of the people with acute stress disorder go on to develop PTSD.

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The study and its key findings

The new investigation used 1987–2013 data from the Swedish National Patient Register on 136,637 patients "with stress-related disorders, including [PTSD], acute stress reaction, adjustment disorder, and other stress reactions."

The researchers ran comparisons between this "exposed" cohort and two other "unexposed" cohorts, one comprising 171,314 full siblings and the other comprising 1,366,370 matched individuals from the general population. By unexposed, the researchers mean free of stress-related conditions.

The team first calculated the average rate of cardiovascular disease among the three cohorts over the period of the study. This came to 10.5 per 1,000 person-years for the exposed group and 8.4 and 6.9 for the unexposed sibling and matched general population cohorts, respectively.

Further analysis revealed links between psychiatric conditions resulting from trauma or highly stressful life events and a raised risk of developing a number of cardiovascular diseases. These links were particularly marked during the 12 months following the psychiatric diagnosis.

Specifically, those with a stress-related illness were 64 percent more likely to develop a form of cardiovascular disease in the 12 months after a psychiatric diagnosis than their unexposed siblings. Comparisons with unexposed, matched members of the general population yielded a similar result.

The researchers also found a particularly strong link between stress-induced psychiatric conditions and cardiovascular diseases that tend to develop before the age of 50.

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Need to investigate 'bidirectional nature'

The authors point out that, due to the nature of their study design, they cannot conclude that stress-related disorders actually cause cardiovascular diseases.

Simon Bacon, a professor at Concordia University, in Montreal, Canada, takes up this point in a linked editorial.

He raises the possibility of cause being in the other direction. For example, could it be the case that people who already have some degree of cardiovascular disease are more susceptible to developing stress-induced psychiatric conditions?

To counter this, "as evidence" of cause running in the other direction, he points out that the researchers "quite rightly cite" the raised risk that they found of heart attack, stroke, and other acute cardiovascular events 1 year following the psychiatric diagnosis.

However, he also highlights the large effect that the researchers found in the link to a raised risk of heart failure and how this occurred "less than 1 year after diagnosis." Because heart failure is a disease that progresses slowly, "reverse causation cannot be ruled out entirely."

Prof. Bacon argues that these questions call for further investigation into the "potential bidirectional nature" of these links.

The researchers suggest that there is a need for doctors to know that cardiovascular disease could be more likely to develop following highly stressful events that lead to diagnoses of stress-related conditions, especially during the first year.

The authors conclude:

"These findings call for enhanced clinical awareness and, if verified, monitoring or early intervention among patients with recently diagnosed stress-related disorders."
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5-minute breathing 'workout' may benefit heart and brain health

Preliminary research reveals that a technique called Inspiratory Muscle Strength Training can boost cognitive and physical performance, as well as cardiovascular health.
nurse taking woman's blood pressure
New research adds another tool in the toolbox for preventing high blood pressure.

Most of us know that exercising and eating right are good for us.

However, putting in the effort to do so can often require more willpower than we have.

What if there was a way to reap all the benefits of a workout without having to lift a finger?

New research introduces a 5-minute technique that might improve blood pressure, lower heart attack risk, boost cognitive ability, and enhance sports performance — all while barely having to move.

The technique is called Inspiratory Muscle Strength Training (IMST), and researchers led by Daniel Craighead — a postdoctoral researcher in the University of Colorado Boulder's Department of Integrative Physiology — have tested the technique in a clinical trial.

"IMST is basically strength-training for the muscles you breathe in with," explains Craighead. The researcher and his colleagues presented the preliminary results of their research at the annual Experimental Biology conference, which this year takes place in Orlando, FL.

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Why study the benefits of IMST?

IMST involves inhaling through a resistive hand-held device called an inspiratory muscle trainer. Its creators initially developed it for people with respiratory problems such as chronic obstructive pulmonary disease, bronchitis, or cystic fibrosis, or to wean people off ventilators.

Craighead and team explain that in 2016, a 6-week trial on the effects of IMST on obstructive sleep apnea — during which participants performed 30 inhalations per day — revealed that using the device also lowered systolic blood pressure by 12 millimeters of mercury.

Exercising for the same amount of time usually only lowers blood pressure by half that amount, and the benefits seem to exceed those normally achieved with hypertension medication.

This trial piqued the researchers' interest, so they set out to study the possible benefits of IMST for the vascular, cognitive, and physical health of 50 middle-aged adults.

"Our goal is to develop time-efficient, evidence-based interventions that [...] busy midlife adults will actually perform," explains senior investigator Prof. Doug Seals, the director of the University of Colorado Boulder's Integrative Physiology of Aging Laboratory.

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Lowers blood pressure and boosts cognition

The researchers compared participants who tried IMST with people who used a sham device that provided no resistance on inhalation. They found that the blood pressure was significantly lower among IMST participants and that the function of their large arteries had improved considerably.

IMST participants also performed better on cognitive tests and treadmill tests. In the treadmill tests, they were able to run for longer and keep their heart rate and oxygen consumption low.

"[IMST is] something you can do quickly in your home or office, without having to change your clothes, and so far it looks like it is very beneficial to lower blood pressure and possibly boost cognitive and physical performance."

Daniel Craighead

"High blood pressure," claims Craighead, "is a major risk factor for cardiovascular disease, which is the number one cause of death in America. Having another option in the toolbox to help prevent it would be a real victory."

However, the study authors caution that their results are preliminary, and that people interested in the technique should consult their physician first.

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