Wood Street Clinic Blog

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CPR steps: A visual guide

People without first aid training can still save a life by performing CPR.

Performing CPR on someone having a cardiac or breathing emergency can help keep them alive until the emergency services arrive.

If a person carries it out immediately after a person's heart stops beating, CPR can double or even triple the chances of them surviving. CPR works by keeping the blood flowing until healthcare professionals can help them.

Use CPR when an adult is not breathing or when they are only gasping occasionally, and when they are not responding to questions or taps on the shoulder.

In children and infants, use CPR when they are not breathing normally and not responding.

cpr step-by-step visual-guide illustration
CPR steps: Quick reference Check that the area is safe, then perform the following basic CPR steps: Call 911 or ask someone else to. Lay the person on their back and open their airways. Check for breathing. If they are not breathing, start CPR. Perform 30 chest compressions. Perform two rescue breaths. Repeat until an ambulance or automated external defibrillator (AED) arrives. Read on for more detailed descriptions of how to perform CPR in adults, children, and infants. Thank you for supporting Medical News Today
CPR step-by-step There are two main stages to CPR: the preparation stage and the CPR stage. Preparation steps Before performing CPR on an adult, use the following preparation steps: Step 1. Call 911 First, check the scene for factors that could put you in danger, such as traffic, fire, or falling masonry. Next, check the person. Do they need help? Tap their shoulder and shout, "Are you OK?" If they are not responding, call 911 or ask a bystander to call 911 before performing CPR. If possible, ask a bystander to go and search for an AED machine. People can find these in offices and many other public buildings. Step 2. Place the person on their back and open their airways Place the person carefully on their back and kneel beside their chest. Tilt their head back slightly by lifting their chin. Open their mouth and check for any obstruction, such as food or vomit. Remove any obstruction if it is loose. If it is not loose, trying to grasp it may push it farther into the airway. Step 3. Check for breathing Place your ear next the person's mouth and listen for no more than 10 seconds. If you do not hear breathing, or you only hear occasional gasps, begin CPR. If someone is unconscious but still breathing, do not perform CPR. Instead, if they do not seem to have a spinal injury, place them in the recovery position. Keep monitoring their breathing and perform CPR if they stop breathing. CPR steps Use the following steps to perform CPR: Step 4. Perform 30 chest compressions Place one of your hands on top of the other and clasp them together. With the heel of the hands and straight elbows, push hard and fast in the center of the chest, slightly below the nipples. Push at least 2 inches deep. Compress their chest at a rate of least 100 times per minute. Let the chest rise fully between compressions. Chest compressions in CPR visual guide infographic
Step 5. Perform two rescue breaths Making sure their mouth is clear, tilt their head back slightly and lift their chin. Pinch their nose shut, place your mouth fully over theirs, and blow to make their chest rise. If their chest does not rise with the first breath, retilt their head. If their chest still does not rise with a second breath, the person might be choking. CPR rescue breaths visual guide illustration
Step 6. Repeat Repeat the cycle of 30 chest compressions and two rescue breaths until the person starts breathing or help arrives. If an AED arrives, carry on performing CPR until the machine is set up and ready to use. CPR for children and infants The CPR steps for children and infants are slightly different to the steps for adults, as below. Preparation steps To perform CPR on an infant or child, use the following preparation steps: Step 1. Call 911 or give 2 minutes of care First, check the surrounding area for factors that could put you in danger. Next, check the child or infant to see whether they need help. For children, tap their shoulder and shout, "Are you OK?" For infants, flick the sole of their foot to see if they respond. If you are alone with the child and they are not responding, give them 2 minutes of care and then call 911. If there is a bystander, ask them to call 911 while you give 2 minutes of care. If possible, ask a bystander to go and search for an AED machine. Offices and other public buildings tend to house these. If the child does respond, call 911 to report any life-threatening conditions. Step 2. Place them on their back and open their airways Place the child or infant carefully on their back and kneel beside their chest. Tilt their head backward slightly by lifting their chin. Open their mouth. Check for any obstruction, such as food or vomit. If it is loose, remove it. If it is not loose, do not touch it, as this may push it farther into their airways. Step 3. Check for breathing Place your ear next to their mouth and listen for around 10 seconds. If you do not hear breathing, or you only hear occasional gasps, begin to administer CPR. Changes in an infant's breathing patterns are normal, as they usually have periodic breathing. Keep monitoring their breathing and perform CPR if they stop breathing. CPR steps Use the following steps to perform CPR on a child or infant: Step 4. Perform two rescue breaths If the child or infant is not breathing, perform two rescue breaths with their head tilted backward and their chin raised. For a child, pinch their nose shut and place your mouth over theirs. Breathe into their mouth twice. For an infant, place your mouth over their nose and mouth and blow for 1 second to make their chest rise. Then, deliver two rescue breaths. If they are still unresponsive, begin chest compressions. Step 5. Perform 30 chest compressions Kneel beside the child or infant. For a child, use one of your hands. Place the heel of the hand at their sternum, which is in the center of the chest, between and slightly below their nipples. Press down hard and fast around 2 inches deep, or one-third the depth of the chest, at least 100 times per minute. For an infant, use two fingers. Place your fingers in the center of their chest, between and slightly below the nipples. Perform 30 quick compressions around 1.5 inches deep. Step 6. Repeat Repeat the cycle of rescue breaths and chest compressions until the child starts breathing or help arrives. Thank you for supporting Medical News Today When to use CPR and when not to CPR chest compressions being performed on unconscious man
Performing CPR when a person is not breathing can help prevent brain damage. Use CPR when an adult is not breathing at all. For a child or infant, use CPR when they are not breathing normally. Always use CPR if the adult or child is not responding when you talk to them or tap them. If someone is not breathing, giving CPR can ensure that oxygen-rich blood reaches the brain. This is important, as without oxygen, someone can sustain permanent brain damage or die in under 8 minutes. A person might need CPR if they stop breathing in any of the following circumstances: a cardiac arrest or heart attack choking a road traffic accident near-drowning suffocation poisoning a drug or alcohol overdose smoke inhalation electrocution suspected sudden infant death syndrome Only perform CPR if the adult is not breathing, or in children and infants, when they are not breathing normally, and their blood is not circulating. This is why it is important to ensure that the person does not respond to verbal or physical calls to attention before starting the CPR process. Summary CPR is a life-saving first aid procedure. It can significantly improve someone's changes of surviving if they suffer a heart attack or stop breathing following an accident or trauma. The steps vary depending on whether the person is an infant, child, or adult. However, the basic cycle of chest compressions and rescue breaths will remain the same. Only use CPR when an adult has stopped breathing. Check the person to see whether they respond to verbal or physical stimuli before starting CPR.
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Heart failure: New drug could halt disease and improve heart function

Heart failure occurs when the heart loses its ability to pump blood effectively. Current treatments can slow or stop the disease getting worse, but they can't regress it. Now, scientists have designed a molecule that could not only curb heart failure but also improve the heart's blood pumping ability.
a scientist designs a new molecule to treat heart failure
A new molecule could help prevent heart failure.

The researchers in Brazil and the United States who developed and tested the experimental drug have named it "SAMβA," which is short for "selective antagonist of mitofusin 1-β2PKC association."

When the researchers gave it to rats with heart failure, the molecule not only stopped the disease from progressing but also reduced its severity by improving the ability of heart muscle to contract.

The journal Nature Communications has now published a paper on how the researchers developed SAMβA and tested it on heart cells and rodent models of heart failure.

"The drugs in current use," says first study author Julio C. B. Ferreira, who is a professor in the Biomedical Science Institute at the University of São Paulo in Brazil, "halt [the] progression of the disease but never make it regress."

SAMβA works by blocking a specific interaction between the proteins mitofusin 1 (Mfn1) and beta II protein kinase C (β2PKC) whose association impairs mitochondria in heart muscle cells, causing the cells to die. Mitochondria are tiny compartments inside cell bodies that make the chemical energy cells need to function and live.

"We showed that by regulating this specific interaction, we could both halt [the] progression and make the disease regress to a less severe stage," Prof. Ferreira explains.

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Heart failure and causes

According to the most recent figures from the Centers for Disease Control and Prevention (CDC), in 2016 there were around 5.7 million people in the United States living with heart failure.

The body's organs and tissues require a constant supply of oxygen- and nutrient-rich blood to function and stay in good health.

Heart failure arises when the heart's ability to pump blood does not match the body's needs.

In a healthy heart, the heart muscle contracts and pumps freshly oxygenated blood into the aorta from where it travels to the rest of the body.

In a person with heart failure, the heart muscle is weak or damaged and does not fully contract, leaving some blood left to pool inside the organ.

People with heart failure often feel tired and fatigued and may experience shortness of breath as they go about their everyday lives. They can also struggle to breathe when they lie down, and they can put on weight due to swelling in the stomach, ankles, feet, or legs.

The most common causes of heart failure are diseases and conditions that weaken or damage the heart. These include coronary artery disease, heart attacks, high blood pressure, and diabetes.

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SAMβA 'is selective'

Failing hearts overproduce the protein β2PKC. Previous work by some of the researchers in Brazil had shown that blocking the protein improved heart function in people with heart failure.

However, while the β2PKC inhibitor that they used improved heart function, it also stopped the protein from doing other things that help the heart.

What the new study shows is that SAMβA "is more selective." It only blocks one specific interaction, and that is the one that β2PKC has with Mfn1 — the one that affects the function of mitochondria. It does not affect β2PKC's other interactions.

To show this, the team carried out a series of tests in cells, rodents, and samples of heart tissue from people with heart failure.

It reveals that β2PKC builds up on the outer wall of mitochondria and chemically alters the function of Mfn1 by adding a phosphate group to it. This leads to "buildup of fragmented and dysfunctional mitochondria in heart failure," note the study authors.

Scientists call the process through which β2PKC alters Mfn1 phosphorylation, and it is one of the "most common" mechanisms in cells for altering the function of proteins.

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The team experimented with various compounds to find candidate molecules that could block this interaction between β2PKC and Mfn1 to prevent the ensuing damage to mitochondria.

They identified six molecules that could block the β2PKC-Mfn1 interaction, but of these, only SAMβA did it in a way that did not affect β2PKC's other interactions.

Tests using human heart cells showed that, like the drugs already in use for the treatment of heart failure, SAMβA could curb the progression of the disease.

However, unlike conventional treatments, many of which have been around since the 1980s, SAMβA went a step further: it enhanced the ability of heart cells to contract, which is essential for effective pumping of blood.

The researchers observed that SAMβA also reduced a marker of oxidative stress in the heart cells. Oxidative stress can trigger cell death if the cell cannot defend itself against it.

In a final set of tests, the team induced heart failure in rats by provoking a heart attack. Unlike the rats that received a placebo, those that received SAMβA stopped showing signs of heart failure and showed improvement in heart function.

To make progress toward a clinical treatment, other teams now need to test the molecule independently. There is also a need to check its compatibility with other heart failure drugs.

"Validation and reproduction of our findings by other groups are critical to the process of developing SAMβA for use in treating heart failure. We will be seeking partners in the private and public sectors for this purpose."

Prof. Julio C. B. Ferreira

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What to know about mustard oil

Mustard oil comes from the seeds of mustard plants. It is rich in monounsaturated fatty acids, which appear to reduce the likelihood of developing cardiovascular disease. However, cooking with the oil may pose a serious risk, especially for children.

People have long used mustard oil in cooking and alternative medicine. It is common in Asian, notably Indian, cuisines. The oil's strong taste comes from a compound that is also present in horseradish and wasabi.

Mustard oil is rich in monounsaturated fatty acids, which could mean that it benefits cardiovascular health. It also contains a compound that may have anti-inflammatory properties.

However, the use of mustard oil is controversial, and the potential risks are so great that the Food and Drug Administration (FDA) have prohibited its use in cooking.

This article will discuss the benefits and risks of using mustard seed oil.

Cardiovascular benefits Mustard seed oil in glass jar surrounded by mustard seeds on table
Mustard oil may help lower the risk of cardiovascular disease.

Mustard oil is rich in monounsaturated fatty acids. Researchers have consistently found that including monounsaturated fatty acids in the diet can reduce the risk of cardiovascular disease.

One systematic review found that people with diets rich in monounsaturated fatty acids had lower blood pressure and less body fat than others who consumed fewer of these acids. A high proportion of body fat and high blood pressure increase the risk of cardiovascular disease.

While mustard oil contains high levels of these fatty acids, avocados and olive oil contain more.

It is important to note that these potential benefits are likely to be very small, compared with other factors that influence cardiovascular risk. Consuming mustard oil will not compensate for a broadly unhealthful diet or a lack of physical activity.

Thank you for supporting Medical News Today Anti-inflammatory potential Mustard oil contains a compound that could be useful for reducing inflammation: allyl isothiocyanate. One study found that allyl isothiocyanate has anti-inflammatory potential. The study's authors noted this effect in cell cultures, which are cells that researchers grow in a controlled setting. However, they also found that the anti-inflammatory effect was much smaller in mice. Results of a more recent study indicate that allyl isothiocyanate reduced inflammation and had a range of other benefits in mice with colitis, a condition that causes inflammation in the colon. Inflammation is a characteristic of a wide range of health issues, and it can cause a host of symptoms. If allyl isothiocyanate can reduce inflammation, mustard oil could help treat these issues. However, there is currently very little evidence to support the idea. Nutritional content Mustard is a plant native to Europe. There are several varieties, and the seeds are ingredients in many foods and condiments. Producing mustard oil involves pressing or grinding these seeds. The oil is much more potent than the condiment called mustard. Mustard oil is predominantly made up of monounsaturated fatty acids. In 100 grams (g) of mustard oil, there are: 59 g of monosaturated fatty acids 21 g polyunsaturated fatty acids 11 g saturated fatty acids The allyl isothiocyanate in the oil gives mustard its strong taste and may contribute some health benefits. This compound is also present in foods such as horseradish and wasabi. Thank you for supporting Medical News Today Dangers and side effects Woman preparing food in kitchen for cooking recipe while child in foreground plays on tablet
Mustard oil is not safe for use as a cooking oil. Mustard oil may pose a serious risk because it contains high levels of erucic acid. This monounsaturated fatty acid is present in several oils. In small doses, erucic acid is safe, but higher levels may be dangerous. Research in animals indicates that, over long periods, erucic acid may cause a heart condition called myocardial lipidosis. It is unclear whether humans experience the same effect, but high levels of erucic acid could pose risks to certain groups, such as children. In 2016, the FDA issued a warning that mustard oil is not safe to use in cooking because of its high erucic acid content. This means that the FDA do not permit its use as a cooking oil in the United States. How to use It is never safe to use pure mustard oil in cooking or to take it as a dietary supplement. It is best to avoid eating or drinking it. Topical application of mustard oil Mustard oil is available as an essential oil. The safest method of using it is to dilute it in a carrier oil and apply it to the skin. People should not diffuse mustard essential oil close to anyone who may be allergic to it. Taken orally, mustard essential oil is toxic. Thank you for supporting Medical News Today Takeaway Mustard oil is rich in monounsaturated fatty acids and could have some health benefits. However, there is little direct scientific evidence to support the idea. Mustard oil may pose a serious health risk, and the FDA prohibit its use in cooking. In the future, more research may better determine the safety of using mustard oil. Until then, it is best to avoid the product.
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Is high blood pressure always bad?

Hypertension, or high blood pressure, is a risk factor for several health conditions, including cardiovascular problems, diabetes, and other metabolic issues. However, is high blood pressure always a cause for concern? New findings question that assumption.
senior woman checking blood pressure
Having high blood pressure may sometimes have a protective effect.

Up to 75 million adults in the United States have high blood pressure, according to the Centers for Disease Control and Prevention (CDC).

What is high blood pressure? Well, it is hard to accurately answer that question, as specialists are still debating what counts as normal blood pressure.

Different organizations currently offer different guidelines on high blood pressure.

For instance, the National Heart, Lung, and Blood Institute explain that, among adults, hypertension is a "consistent systolic reading of 140 mm Hg [millimiters of mercury] or higher."

However, the American Heart Association (AHA) suggest that hypertension occurs when a person has a systolic blood pressure of 130 mm Hg or above. Meanwhile, the CDC consider people with systolic blood pressure of 120–139 mm Hg as being only "at risk" of hypertension.

Generally speaking, doctors advise their patients — especially older adults — to keep monitoring their own blood pressure and keep it in check.

This is to make sure that it does not reach the threshold for hypertension, which many healthcare professionals consider to be a risk factor for heart disease and stroke, among other things.

Now, however, a study that researchers at Charité - Universitätsmedizin Berlin in Germany carried out suggests that some older people may not face other health problems if they have high blood pressure.

In fact, the researchers note, some people in their 80s may even see some benefits.

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The new study — the findings of which appear in the European Heart Journal — looked at a cohort of 1,628 women and men with a mean age of 81 years. All were 70 or older when they joined in 2009, and they were all following antihypertensive treatments.

Researchers collected data about the participants' health status through the Berlin Initiative Study, a Charité research project. They questioned participants every 2 years and assessed their blood pressure, among other health measurements.

At the 6-year mark, the investigators performed a statistical analysis to find out how blood pressure could affect a person's mortality risk. They also adjusted for potential confounding factors, such as sex, lifestyle choices, body mass index (BMI), and how many drugs for high blood pressure each person took.

They saw that people aged 80 and over who had a lower blood pressure — of 140/90 mm Hg or under — actually had a 40 percent higher mortality risk than peers with blood pressure exceeding those thresholds.

Even people who'd already had a stroke or a heart attack presented a similar link between blood pressure levels and mortality risk.

The team also emphasizes that people with blood pressure lower than 140/90 mm Hg had a 61 percent higher risk of death than those whose blood pressure remained high in spite of their antihypertensive drug regimen.

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"Our results show clearly that, within these groups of patients, antihypertensive treatment should be adjusted based on the needs of the individual," notes first study author Dr. Antonios Douros.

"We should move away from the blanket approach of applying the recommendations of professional associations to all groups of patients."

Dr. Antonios Douros

In the future, the scientists aim to have a more in-depth look at blood pressure-lowering medication to establish when it is actually most likely to help.

"As a next step, we want to study which groups of patients actually benefit from antihypertensive treatment," concludes study co-author Prof. Elke Schäffner.

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Napping may be as good as drugs for lowering blood pressure

A midday nap may be just what you need, not just to boost your energy levels but also to lower high blood pressure. This, at least, is what new research from Greece suggests.
older woman taking a nap on the sofa
Napping could effectively help lower your blood pressure, new findings reveal.

When the afternoon slump hits in the middle of a busy workday, many of us may feel tempted to catch some shut-eye in a quiet corner.

Daytime napping can definitely help boost our energy levels and productivity for the rest of the workday, but does it bring any other health benefits?

A new study that investigators from the Asklepieion General Hospital in Voula, Greece conducted now suggests that taking a nap at midday can effectively help people lower their blood pressure levels.

One of the study researchers, Dr. Manolis Kallistratos, is due to present the findings at the American College of Cardiology's 68th Annual Scientific Session in New Orleans, LA next Monday.

"Midday sleep appears to lower blood pressure levels at the same magnitude as other lifestyle changes. For example, salt and alcohol reduction can bring blood pressure levels down by 3 to 5 [millimeters of mercury (mmHg)]," reports Dr. Kallistratos.

In this study, the investigators worked with 212 participants who had a mean blood pressure of 129.9 mm Hg. According to guidelines from the National Heart, Lung, and Blood Institute, a person has high blood pressure if their readings of systolic blood pressure (pressure during a heartbeat) are 140 mm Hg or higher, and their readings of diastolic blood pressure (pressure between heartbeats) are 90 mm Hg or higher.

The participants were, on average, 62 years old, and close to one in four of them smoked, had a diagnosis of type 2 diabetes, or both.

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Significant drop in blood pressure

Dr. Kallistratos and team split the participants into two groups — one that practiced midday napping and one that did not take up this practice.

Over 24 consecutive hours, the researchers took note of the participants' blood pressure measurements, the duration of their midday naps, their general lifestyle choices (such as alcohol consumption and physical activity), and their pulse wave velocity, which measures artery stiffness.

To obtain accurate blood pressure measurements from the participants throughout the day, the investigators asked them to wear ambulatory blood pressure monitoring devices.

Dr. Kallistratos and colleagues also adjusted for potential confounding factors that could affect blood pressure, such as age, biological sex, prescription medication, and lifestyle choices. They noted that there were no significant differences between how many blood pressure drugs participants in the two groups took.

The researchers found that people who took a daytime nap saw a 5.3 mm Hg drop in systolic blood pressure, which, the researchers explain, is about as much as someone could expect when taking blood pressure medication or making certain lifestyle changes to lower blood pressure.

Moreover, the team adds that each additional 60 minutes of napping time reduced average 24-hour systolic blood pressure by 3 mm Hg. Dr. Kallistratos explains that taking low doses of specialized drugs can lower a person's blood pressure levels by about 5–7 mm Hg on average.

"These findings are important because a drop in blood pressure as small as 2 mm Hg can reduce the risk of cardiovascular events, such as heart attack, by up to 10 percent," says the researcher.

"Based on our findings, if someone has the luxury to take a nap during the day, it may also have benefits for high blood pressure," he adds, noting that "[n]apping can be easily adopted and typically doesn't cost anything."

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Researchers are confident in their findings

The researchers note that this is the first time that anyone has studied the effects of daytime naps on a person's blood pressure levels. Although the team encourages further research to replicate and validate the current results, its members are confident that their study offers important new information.

Dr. Kallistratos and colleagues explain that they made an effort to recruit study participants who reasonably controlled their blood pressure levels to ensure that their findings would be credible.

"The higher the blood pressure levels, the more pronounced any effort to lower it will appear," explains Kallistratos.

He continues, "By including people with relatively well-controlled blood pressure, we can feel more confident that any significant differences in blood pressure readings are likely due to napping."

The researchers observe that the results of their study should provide grounds for people to indulge in midday naps with less of a sense of guilt.

"We obviously don't want to encourage people to sleep for hours on end during the day," says Dr. Kallistratos, "but, on the other hand, they shouldn't feel guilty if they can take a short nap, given the potential health benefits."

"Even though both groups [of participants] were receiving the same number of medications and blood pressure was well controlled, there was still a significant decrease in blood pressure among those who slept during midday."

Dr. Manolis Kallistratos

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What to know about heart pacemakers

A pacemaker is a device that helps keep the heart beating regularly. It can represent a life-changing treatment for heart conditions such as arrhythmias, which involve the heart beating irregularly.

Inserting a pacemaker into the chest requires minor surgery. The procedure is generally safe, but there are some risks, such as injury around the site of insertion.

This article will discuss the purpose of a heart pacemaker, the insertion surgery, and the risks.

Purpose Close up image of a heart pacemaker
Doctors use pacemakers to treat heart conditions.

A pacemaker is a small electronic device for treating heart conditions, such as arrhythmias. This refers to a group of conditions that disrupt the rhythm of the heart.

The heart has two upper and two lower chambers. The upper chambers contract, pulling blood into the heart's lower chambers.

When the ventricles contract, they push this blood out of the heart so it can circulate throughout the body. This contraction is a heartbeat, and electrical signals are responsible for controlling the rhythm.

Cells in the upper chambers generate these electrical signals, which travel down the heart and coordinate its activity. An arrhythmia disrupts this electrical signaling, causing the heart to beat irregularly.

Tachycardia involves the heart beating too quickly, and bradycardia involves the heart beating too slowly. The heart can also beat irregularly in other ways.

Arrhythmias can prevent the heart from supplying blood properly. This can cause symptoms such as:

fatigue weakness fainting a rapid heartbeat shortness of breath chest pain

Severe cases can cause lasting damage to internal organs or cardiac arrest. A pacemaker can help reduce these symptoms by using electrical pulses to influence the rhythm of the heart. Depending on the problem, a pacemaker can speed up, slow down, or stabilize the heartbeat.

Pacemakers can address specific problems, such as atrial fibrillation. In this form of arrhythmia, the heart's upper chambers do not contract properly, and the ventricles are unable to pump enough blood out of the heart.

A pacemaker can ensure that the upper chambers contract properly. If a pacemaker is treating an arrhythmia, it is usually permanent.

Doctors can use pacemakers to monitor these types of conditions, and the devices can record a range of important health indicators, including heart activity. A pacemaker can automatically adjust the heart's electrical pulses, according to the information it records.

Otherwise, a person may need a temporary pacemaker, typically in response to acute heart trauma, such as a heart attack or drug overdose.

Thank you for supporting Medical News Today Procedure X-ray showing a heart pacemaker
The surgery to insert a heart pacemaker is a straightforward procedure. Surgery is necessary to insert a pacemaker into the chest. When preparing for the procedure, the doctor will assess the person's medical history and take blood tests. There will be forms to fill out, and the person will also need to fast. Before the surgery, a healthcare provider will insert an intravenous drip into a vein in the arm or hand. This will deliver a sedative and any other necessary medications. The doctor will then clean the injection site, which is near the shoulder. Next, they will insert a needle into a vein just below the collarbone. The doctor will use this needle to thread the wires that control the pacemaker through the veins, toward the heart. There are between one and three wires, depending on the type of pacemaker. The doctor will use fluoroscopy to guide the needles correctly. This involves continuous X-ray imaging that feeds live pictures to a monitor. They will test the wires to ensure that they are working properly before proceeding. The doctor then makes a small cut in the chest and inserts the pacemaker's generator and battery, which may resemble a small box. Finally, they will seal the incision and use an electrocardiogram to test the device. After surgery, it is often necessary to stay overnight in the hospital. This allows doctors and nurses to ensure that the device is working properly. Risks Inserting a pacemaker is a relatively safe procedure. A person is likely to feel some pain or tenderness around the area of insertion, but this should be temporary. Other risks involve: swelling or bleeding at the site of insertion infection blood vessel or nerve damage a collapsed lung a reaction to medications Thank you for supporting Medical News Today Outlook Inserting a heart pacemaker is a fairly straightforward and safe surgical procedure. A period of rest will be necessary, but a person can usually return to their regular routine within a few days. For the first 8 weeks, it is important to avoid sudden movements that involve moving the arms away from the body. Living with a pacemaker will require some adjustments. These include: avoiding putting pressure on the pacemaker knowing the pacemaker's upper and lower heart rate limits and ensuring that the heart rate stays within these limits remaining physically active, but stopping before getting too tired restricting contact with devices that can interfere with the pacemaker, such as mobile phones and microwave ovens visiting a doctor for checkups and if any problems occur An arrhythmia is a lifelong condition that can become severe. Pacemakers are a highly effective form of treatment, and they can help people with the condition lead relatively regular lives.
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New drug limits damage to heart muscle from heart attack

An experimental drug has shown great promise in limiting the damage that a heart attack can inflict on the heart. It targets a protein that plays a central role in the death of heart muscle cells.
medical illustration of a heart
New experiments in mice find that a small molecule can restrict the damage to heart muscle that a heart attack can cause.

Tests on mice have revealed that the drug could markedly reduce heart injury from a heart attack.

The small-molecule drug blocks the protein MAP4K4, which relays the oxidative stress signals that cause the death of heart muscle cells and damage to tissue.

"There are no existing therapies," says lead investigator Dr. Michael D. Schneider, from Imperial College London in the United Kingdom, "that directly address the problem of muscle cell death, and this would be a revolution in the treatment of heart attacks."

Schneider and the team report their findings in a paper that now appears in the journal Cell Stem Cell.

There, they also describe how they grew heart tissue from human stem cells and developed a way of modeling a "heart attack in a dish" for testing the drug.

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Heart attack and heart failure

Heart attack is the common name for myocardial infarction, which means the death of heart muscle tissue due to a lack of oxygen and nutrients. It occurs when a clot obstructs one of the arteries that bring nutrient- and oxygen-rich blood to the heart.

When they don't get enough oxygen and nutrients, the heart cells become stressed, generate stress signals, and eventually die.

Loss of cells damages the heart muscle, causing the heart to pump less efficiently. This leads to heart failure, which is a condition wherein the heart cannot pump enough blood to meet the body's needs.

According to the Centers for Disease Control and Prevention (CDC), around 5.7 million adults in the United States have heart failure.

People with heart failure struggle with everyday activities and get out of breath easily. They feel weak and tired nearly all the time and have trouble breathing when they lie down. Other symptoms include weight gain and swelling in the feet, ankles, legs, and stomach.

Thanks to treatments such as drugs that break up blood clots and stents that keep arteries open, an increasing number of people are surviving heart attacks. This means that the number living with heart failure is also increasing.

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Reducing cell death from oxidative stress

The stress signals that a heart attack induces in heart muscle also occur following blood flow restoration.

So, while it is crucial to restore blood flow following a heart attack, there is also a need to add treatments that limit this "reperfusion injury." Scientists have been searching for such treatments for some time.

Dr. Schneider and his team are the first to uncover the role of MAP4K4 in the process through which a heart attack, by inducing oxidative stress, kills heart muscle cells.

In their investigation, they revealed that MAP4K4 is active in heart tissue of people with heart failure, and also in mice, following a heart attack.

They then devised a number of "highly selective" small-molecule blockers of MAP4K4 and demonstrated that their use can effectively protect human heart muscle cells from "lethal experimental injury."

They used chemicals to induce oxidative stress in heart cells and human heart muscle tissue that they had grown from human induced pluripotent stem cells.

The team observed how oxidative stress activated MAP4K4 and how raising levels of the protein also made heart muscle cells more sensitive to it. Blocking the protein, on the other hand, protected the cells from stress-induced death.

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First to test drug on human cells

Following the cell experiments, the scientists selected one candidate small molecule and took it forward "into further proof-of-concept studies in mice."

The team found that giving mice the drug 1 hour after restoring blood flow to the heart reduced reperfusion injury "by more than 50 percent."

The researchers hope that their findings will lead to an injection that doctors can give to people about to undergo balloon angioplasty to open a blocked artery following a heart attack.

Another possibility is that such a drug could also help limit heart muscle damage from heart attacks in regions with no rapid access to treatments that restore blood flow.

The team believes that, because they tested the drug in a model that they had developed using human stem cells, it should stand a good chance of succeeding in human clinical trials.

"One reason why many heart drugs have failed in clinical trials may be that they have not been tested in human cells before the clinic. Using both human cells and animals allows us to be more confident about the molecules we take forward."

Dr. Michael D. Schneider

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Vascular risk factors tied to brain health

New research uncovers a host of vascular risk factors that may affect the health of our brains as we get older.
doctor explaining something to older lady
New research finds that some risk factors that affect the health of our blood vessels can also influence the health of our brains into old age.

It is no secret that the global population is aging at an increasingly fast pace. According to the World Health Organization (WHO), there were approximately 900 million people across the globe who were aged 60 and above in 2015. The WHO expect this number to jump to 2 billion by 2050.

According to the Population Reference Bureau, the number of seniors in the United States over the age of 65 may more than double from 46 million today to more than 98 million by 2060.

The burden of age-related chronic disease is also increasing. For instance, the Centers for Disease Control and Prevention (CDC) warn that the burden of Alzheimer's disease will double by 2060 when 13.9 million people in the U.S. will have the disease.

In this context, it is more important than ever to understand the mechanisms and risk factors behind age-related cognitive impairment.

New research, published in the European Heart Journal, examines the role that vascular risk factors, such as smoking, hypertension, or obesity, may play in brain health.

Dr. Simon Cox, a senior research associate at the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh in the United Kingdom, led the new research.

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Vascular risk tied with 'worse brain structure'

Cox and colleagues examined the brain scans of 9,772 people who were between 44 and 79 years old. They looked for any connections between the participants' brain structure and the following vascular risk factors: "smoking, hypertension, pulse pressure, diabetes, [high cholesterol], body mass index (BMI), and waist-hip ratio."

The study's senior author explains the methods used in the study, "We compared people with the most vascular risk factors with those who had none, matching them for head size, age, and sex."

The study found that all of these vascular risk factors — apart from high cholesterol — correlated with greater brain atrophy, less gray matter, and poor white matter health.

"We found that, on average, those with the highest vascular risk had around 18 [milliliters (ml)], or nearly 3 [percent], less volume of grey matter," reports the lead author, "and one-and-a-half times the damage to their white matter — the brain's connective tissue — compared to people who had the lowest risk; 18 ml is slightly more than a large tablespoon-full, or a bit less than a small, travel-sized toothpaste tube."

Gray matter is brain tissue located mostly on the surface of the brain that contains most of the neurons (nerve cells). White matter is tissue found deeper in the brain. White matter declines with age and previous studies have linked the loss of white matter integrity with "slower processing speed and poorer executive function."

The study's senior author further details the findings, saying, "We found that higher vascular risk is linked to worse brain structure, even in adults who were otherwise healthy."

"These links were just as strong for people in middle-age as they were for those in later life, and the addition of each risk factor increased the size of the association with worse brain health."

"Importantly," continues the researcher, "the associations between risk factors and brain health and structure were not evenly spread across the whole brain; rather, the areas affected were mainly those known to be linked to our more complex thinking skills and to those areas that show changes in dementia and 'typical' Alzheimer's disease."

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Lifestyle changes may improve brain aging

Of all the vascular risk factors the team investigated, smoking, hypertension, and diabetes had the most consistent associations with changes in brain structure.

Because it is possible to modify some of these vascular risks, the findings point to lifestyle changes that could improve brain health and ensure healthy cognitive aging.

"Lifestyle factors are much easier to change than things like your genetic code — both of which seem to affect susceptibility to worse brain and cognitive aging. Because we found the associations were just as strong in mid-life as they were in later life, it suggests that addressing these factors early might mitigate future negative effects."

Dr. Simon Cox

"These findings might provide an additional motivation to improve vascular health beyond respiratory and cardiovascular benefits," concludes the researcher.

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How yo-yo dieting impacts women's heart health

New research reveals worrying associations between yo-yo dieting and seven well-established markers of cardiovascular health.
woman eating breakfast
New research looks into how yo-yo dieting may affect a woman's cardiovascular health.

As if losing weight wasn't hard enough, up to 80 percent of people who manage to lose more than 10 percent of their body weight end up regaining the weight within a year.

Losing weight for a short period and then regaining it bears the name of yo-yo dieting, which some people refer to as "weight cycling."

Previous research has pointed out the potentially damaging effects of these repeated cycles of weight loss and weight gain.

Some studies have suggested that yo-yo dieting raises the risk of mortality from any cause, while others have pointed to an increased risk of death from heart disease in particular.

Another study suggested that yo-yo dieting can lead to a cardiometabolic "roller coaster" in which cardiovascular health remarkably improves with just a few weeks of healthful dieting, but the negative cardiovascular effects are immediate once the individual abandons the diet.

Now, scientists have turned their attention to the cardiovascular effects of yo-yo dieting in women.

Dr. Brooke Aggarwal, who is an assistant professor of medical sciences at Columbia University Vagelos College of Physicians and Surgeons in New York, led a team examining the effects of weight cycling on seven heart disease risk factors.

Dr. Aggarwal and her colleagues presented their findings at the American Heart Association's (AHA) Epidemiology and Prevention | Lifestyle and Cardiometabolic Health 2019 Scientific Sessions, which took place in Houston, TX.

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The researchers examined 485 women who had an average age of 37 years and a median body mass index (BMI) of 26.

The study participants reported how often in their lives they had lost at least 10 pounds and then regained the weight within a year.

The researchers assessed the women's health using "Life's Simple 7" — the risk factors that the AHA use to define ideal cardiovascular health.

"Life's Simple 7" uses seven modifiable risk factors to measure a person's heart health. These factors are: "smoking status, physical activity, weight, diet, blood glucose, cholesterol, and blood pressure."

Overall, 73 percent of the women in the study said that they had experienced at least one episode of weight cycling. These women were 82 percent less likely to have a healthy BMI, which the medical community defines as being between 18.5 and 25, than the women who had not had any episodes of yo-yo weight loss.

These women were also 65 percent less likely to fall within the "optimal" range of "Life's Simple 7." The AHA note that people in the optimal range have a much lower risk of heart disease and stroke than those who fall in the "poor" ranges.

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In the current study, the negative effects of yo-yo dieting were more noticeable in the women who had never been pregnant.

"The women without a pregnancy history were likely younger and might be those who started weight cycling at an earlier age," explains Dr. Aggarwal.

"We need to identify critical periods for the effect of weight fluctuation on heart disease risk over the life course to find out whether it is worse when women start on a dieting roller coaster at an early age," she continues.

However, the senior author emphasizes that the study cannot establish causality. The team was unable to determine whether yo-yo dieting negatively affects a person's ability to adhere to "Life's Simple 7" or whether the reverse is true.

"We hope to extend the study 5 to 10 years to confirm these results and look at long-term effects," Dr. Aggarwal says.

Although the current findings are not generalizable to men, "there has been prior research that showed similar results in men, with those who weight cycled having twice the risk of cardiovascular death in middle age," the author explains.

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Why do doctors underdiagnose these 3 conditions in women?

International Women's Day prompts us to celebrate women and womanhood. However, recent research suggests that women may face more than their fair share of challenges, including in receiving appropriate medical care. What are some of these challenges, and why do they occur?
blonde woman facing man
Why do women still have to fight to receive the correct diagnosis?

Women have played a vital role in the improvement of medical care across clinical fields.

Figures such as Dorothea Dix, who helped change the face of mental health care, Rosalind Franklin, who contributed to the discovery of human DNA structure, and Dr. Virginia Apgar, who put together the evaluation criteria assessing the health status of newborn infants, have revolutionized medicine.

Despite this, women and girls across the world still face challenges and discrimination in medical settings.

Only last year, for instance, senior staff from the Tokyo Medical School, as well as from Juntendo and Kitasato Universities in Japan, admitted to manipulating entrance exam scores so that fewer women candidates would qualify for their courses.

These admissions spurred endless debates about the degree to which women who choose medical care as a profession keep on facing waves of discrimination.

Such problems, however, do not stop at women trying to build a career in medical sciences. According to some reports, women also face discrimination as patients. Sometimes, their doctors fail to diagnose conditions they are struggling with, or offer them the wrong diagnosis and consequently, the wrong kind of therapy.

In this Spotlight feature, we will look at some of the conditions that doctors underdiagnosed in women and explore some of the possible reasons behind these lacks in medical care.

1. Endometriosis

One of the chronic conditions that many women struggle with for a long time before they manage to receive a correct diagnosis — if they ever do — is endometriosis.

woman in pain holding her abdomen
Women have to wait to get their endometriosis diagnosed for 'a disturbingly long time.'

Endometriosis is a progressive gynecological condition, which doctors currently consider incurable. Endometriosis occurs when the type of tissue that usually only lines the uterus grows in other parts of the body. This can include the ovaries, fallopian tubes, urethra, but also the bowel, kidneys, and other organs.

Symptoms of this condition include debilitating pain in the pelvic area, as well other parts of the body, heavy and persistent menstrual bleeding, spotting between periods, pain during sex with vaginal penetration, nausea and vomiting, severe headaches, and persistent fatigue.

These symptoms can often have a severe impact on an individual's quality of life, affecting their productivity, other aspects of their physical and mental health, and their relationships.

Estimates in the journal Fertility and Sterility indicate that 10–15 percent of women of reproductive age live with this condition, and 70 percent of women who experience chronic pelvic pain actually have endometriosis.

Researchers from the Endometriosis Association, which is an international research and advocacy organization, write, "The time from the onset of symptoms to diagnosis is disturbingly long." Two-thirds of the people they spoke to begin to experience symptoms of endometriosis during adolescence. However, most of these people do not seek medical attention immediately, and once they do, it can take doctors 10–12 years to make a correct diagnosis.

Typically, doctors can only diagnose endometriosis by conducting a laparoscopy. This is a minor surgical procedure in which a doctor inserts a tiny camera into the abdomen to look for lesions and abnormalities.

A doctor may prescribe pain relief medication or hormonal therapy for the management of endometriosis, but since this condition is progressive, many people require multiple and regular surgeries to remove the abnormal tissue growth.

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'So validating to know I wasn't weak or crazy'

One woman, aged 25, who spoke to Medical News Today, explained that she lived with severe endometriosis symptoms for years before she received a correct diagnosis.

Primarily, this was because both she, her family, and the doctors that she consulted, thought that her disabling symptoms were nothing more than "bad period pains," or else they mistook them for other health problems.

"I thought it was totally normal to have excruciating pain and 10-day-long heavy periods," she told us. "My mom, aunt, and grandmother all had the same experience, so I was always told 'that's just how it is for women in our family,'" she added.

"I thought maybe I was weak and not able to handle the pain as well as other girls. Last year I was diagnosed with deep infiltrating endometriosis and finally had an explanation and, most importantly, a treatment plan. It was so validating to know I wasn't weak or crazy, just dealing with a chronic condition."

She also told us that her journey towards a diagnosis was difficult and long-winded. "I've gone through three [general practitioners] and two gynecologists in 2 years," she explained. She added that because her condition affected several organs, she received many different — and incorrect — diagnoses before the doctors eventually identified the real issue.

"I have endometriosis on my bladder, urethra, kidneys, and bowel, so I wound up with many doctors saying 'you have [irritable bowel syndrome]' and 'you have [pelvic inflammatory disease],' when I knew this wasn't the case."

2. Coronary heart disease

Another health problem that doctors often fail to spot in women is coronary (or ischemic) heart disease (CHD). This disease occurs when the arteries that deliver oxygenated blood into the heart, so that the heart can pump it out to the other organs, become unable to "service" the heart effectively.

woman pressing her chest
Since researchers conduct most clinical trials in men, we still lack a clear idea of how heart disease manifests in women.

The symptoms of CHD vary from person to person, which can make the condition challenging for doctors to spot. However, more generally, symptoms also differ between men and women, and more women thus go undiagnosed until the condition becomes exacerbated.

The National Heart, Lung, and Blood Institute explain that symptoms can also vary between different types of CHD, and some people do not experience any symptoms at all. However, some common symptoms include angina (pressure in the chest area, especially during physical activity), neck pain, and fatigue.

They also state that "[h]eart disease is the leading cause of death for women," and that women are more at risk than men of developing non-obstructive CHD. This condition can occur when the arteries that go into the heart abnormally tighten or are "squeezed" by the surrounding tissue.

Unlike obstructive CHD, which is more likely to be characterized by tell-tale chest pain, non-obstructive CHD is often "silent" and may go unnoticed for a long time.

Past research published in the BMJ has argued that doctors often miss CHD in women because of the different set of symptoms and because women themselves do not seek medical attention early on.

"Women may have more atypical symptoms than men — such as back pain, burning in the chest, abdominal discomfort, nausea, or fatigue — which makes the diagnosis more difficult," the researchers write.

Moreover, they add that: "Women are less likely to seek medical help and tend to present late in the process of their disease. They are also less likely to have appropriate investigations, such as coronary angiography and, together with late presentation to hospital, this can delay the start of effective treatment."

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'Research has focused primarily on men'

Specialists have been trying to find better ways of assessing and diagnosing women with heart problems, but they acknowledge there is still a long way to go in this respect.

One review, which appears in the journal Circulation Research, notes, "For the past 3 decades, dramatic declines in heart disease mortality for both men and women have been observed, especially in the [over] 65 years age group."

"However," its authors add, "recent data suggest stagnation in the improvements in incidence and mortality of coronary heart disease, specifically among younger women."

But why is this the case? The study authors argue that it may all be down to the underrepresentation of female populations in clinical studies for heart and vascular problems. They write:

"For many decades, [cardiovascular disease] research has focused primarily on men, thus leading to an underappreciation of sex differences from an etiologic, diagnostic, and therapeutic perspective. As long as women are underrepresented in clinical trials, we will continue to lack data to make accurate clinical decisions on 51 [percent] of the world's population."

3. Attention deficit/hyperactivity disorder

Women do not just miss out on physical health diagnoses; this problem also extends to other conditions, such as behavioral conditions, and more specifically, attention deficit/hyperactivity disorder (ADHD).

two girls in tutus holding rag dolls
Girls and women with ADHD may never receive a diagnosis.

The National Institute of Mental Health define ADHD as "a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development."

Typically, doctors see ADHD as a problem specific to childhood, and the Centers for Disease Control and Prevention (CDC) note that in 2016 — the latest year for which data are available — around 6.1 million children in the United States had received an ADHD diagnosis.

Furthermore, according to the Anxiety and Depression Association of America, while approximately 60 percent of children with ADHD in the U.S. continue to experience the symptoms of this condition as adults, less than 20 percent of adults with ADHD receive the correct diagnosis.

If adults, in general, struggle to receive a diagnosis, the situation is even worse in the case of women. Research has shown that both families and healthcare professionals are biased towards believing that boys and men are more likely to have ADHD, and they are more likely to ignore similar symptoms in girls and women.

In fact, some sources indicate that up to three-quarters of all women with ADHD never receive a diagnosis, and in the case of children, doctors diagnose fewer girls than boys with ADHD.

Moreover, girls have to wait longer than boys to receive a diagnosis of ADHD. While boys, on average, receive a diagnosis at age 7, girls have to wait until they reach the age of 12 to get the same clinical attention.

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Some women think 'it is too late'

In a review published in The Primary Care Companion for Central Nervous System Disorders, researchers explain that in boys and men, ADHD manifests as hyperactivity and impulsiveness; in girls and women, this condition takes a different guise. In women and girls, the primary symptom of ADHD is inattentiveness, which doctors may struggle to spot. Often doctors take this less seriously.

The same source also suggests that girls and women with ADHD may develop ways of masking their symptoms. Some may appear to have better coping strategies than boys and men with the same condition.

Also, because people with ADHD sometimes have other mental health problems, such as anxiety, depression, and obsessive-compulsive disorder, the review authors point out that existing evidence indicates that doctors will much more eagerly diagnose women as living with a mental health condition, but deny them an ADHD diagnosis.

One woman — now in her 50s — who spoke to MNT told us that although she fits ADHD criteria and has lived with ADHD symptoms for a long time, she still has not received an official diagnosis.

"Therapists are pretty sure I have ADHD, the [national health services] still do not diagnose ADHD in adults and in particular women, and [only] direct you to do online tests," she explained, adding:

"[After] reading an article by a man in the United Kingdom that [said] it took years for him to get a diagnosis, I stopped worrying about it. It is too late to take medication for it at my age; as they say, [it would be like] shutting the stable door after the horse has bolted."

Although medical systems across the globe have come a long way in terms of providing better quality care at an appropriate time, such accounts make one issue very apparent, namely that discrimination is still present in clinical research and health care. To fight it, we must all learn how to listen — really listen.

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How TV and breakfast may impact heart health

Leading a sedentary lifestyle can be bad for our health. However, how much TV do we have to watch to negatively impact our cardiovascular health? Does eating a high-energy breakfast every morning affect our heart health? New research explores.
a tray with breakfast foods seen from above
Eating a breakfast rich in calories may keep heart disease at bay.

Previous studies have linked sedentarism with a range of adverse health effects.

These include obesity, type 2 diabetes, cancer, heart disease, and premature death.

Scientists suggest that sitting for long periods can impair the body's ability to regulate blood pressure and reduce blood flow.

They also argue that it can affect blood sugar metabolism and increase inflammation and oxidative stress, which scientists have linked to aging and disease. However, there are some ways to counter the negative effects of sedentarism.

New research has found that reducing the amount of time we spend watching TV and making sure we eat an energy-rich breakfast lowers the risk of heart disease and stroke. They can also reduce the amount of plaque that tends to build up in the arteries over time.

Dr. Sotirios Tsalamandris — who is a cardiologist at the First Cardiology Clinic at the National and Kapodistrian University in Athens, Greece — led the new study, which consisted of two parts.

The researchers presented their findings at the American College of Cardiology's 68th Annual Scientific Session, which this year takes place in New Orleans, LA.

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How watching TV affects heart health

In the first part of the study, Dr. Tsalamandris and his colleagues evaluated the various markers of cardiovascular health and lifestyle habits of 2,000 people, aged 40–99, from Greece.

The study participants included people who were at risk of developing heart disease or who had already developed the condition, as well as healthy individuals.

The cardiovascular markers that the researchers examined included carotid-femoral pulse wave velocity (which detects atherosclerosis) and the thickness of the arterial walls (which indicates plaque buildup and stroke risk).

Based on the participants' TV-watching habits, the researchers divided them into three groups:

the low group, wherein people watched TV for 7 hours or under per week the moderate group, wherein people watched TV for 7–21 hours per week the high group, wherein people watched TV for more than 21 hours per week

The research found that people in the high group had almost double the chances of plaque buildup in their arteries compared with those in the low group.

Also, watching more TV correlated with a higher risk of hypertension and diabetes. People in the high TV-watching group were 68 percent more likely to have hypertension and 50 percent more likely to have diabetes than those who watched TV for 7 hours or under per week.

Dr. Tsalamandris says, "Our results emphasize the importance of avoiding prolonged periods of sedentary behavior."

"These findings suggest a clear message to hit the 'off' button on your TV and abandon your sofa. Even activities of low energy expenditure, such as socializing with friends or housekeeping activities, may have a substantial benefit to your health compared [with] time spent sitting and watching TV."

Dr. Sotirios Tsalamandris

"[P]erforming recreational activities, weight lifting, stretching bands, or treadmill exercise while watching TV may be a health[ful] alternative," he adds.

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The importance of a high-energy breakfast

For the second part of the study, the researchers grouped the participants according to how many calories they took from their breakfast:

Individuals in the high-energy breakfast group took over 20 percent of their daily calories from their breakfast. Participants in this group tended to consume milk, cheese, cereals, bread, and honey for the first meal of the day. Those in the low-energy group derived 5–20 percent of their daily calorie intake from their breakfast, usually by consuming coffee or low-fat milk along with bread with butter, honey, olives, or fruit. One group consisted of people who did not have breakfast at all.

Overall, the participants who ate a high-energy breakfast on a regular basis were more likely to have more healthful arteries than people in the other two groups. "A high-energy breakfast should be part of a health[ful] lifestyle," says Dr. Tsalamandris.

"Eating a breakfast constituting more than 20 percent of the total daily caloric intake may be of equal or even greater importance than a person's specific dietary pattern, such as whether they follow the Mediterranean diet, a low-fat diet, or other dietary pattern[s]."

Dr. Sotirios Tsalamandris

However, the authors caution that because almost all of the participants followed a Mediterranean diet, the results may not be generalizable to a wider population.

They also speculate on the possible mechanisms behind their observational findings. One possible explanation, they say, could be that people who do not skip breakfast tend to have more healthful dietary habits overall, as well as more healthful lifestyles.

A second explanation could be that the foods eaten by those in the high-energy breakfast group, such as dairy, may in themselves have cardioprotective effects.

In the future, Dr. Tsalamandris and colleagues plan on following these participants for at least a decade to assess whether any environmental exposures also affect the results.

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How does smoking affect the body?

Smoking cigarettes can have many adverse effects on the body. Some of these can lead to life-threatening complications.

In fact, according to the Centers for Disease Control and Prevention (CDC), smoking cigarettes increases the risk of dying from all causes, not just those linked to tobacco use.

Smoking cigarettes affects the respiratory system, the circulatory system, the reproductive system, the skin, and the eyes, and it increases the risk of many different cancers.

In this article, we look at 10 possible effects of smoking cigarettes.

Effects on the body smoking <br>Image credit: Stephen kelly, 2019</br>
Image credit: Stephen Kelly, 2019
1. Lung damage Smoking cigarettes affects lung health because a person breathes in not only nicotine but also a variety of additional chemicals. Cigarettes are responsible for a substantial increase in the risk of developing lung cancer. This risk is 25 times greater for men and 25.7 times greater for women. The CDC report that roughly 9 out of 10 lung cancer deaths is linked to smoking. Smoking cigarettes also presents a greater risk of developing and dying from chronic obstructive pulmonary disorder (COPD). In fact, the American Lung Association report that smoking causes 80 percent of COPD deaths. Cigarettes are also linked to developing emphysema and chronic bronchitis. They can also trigger or exacerbate an asthma attack. 2. Heart disease Smoking cigarettes can damage the heart, blood vessels, and blood cells. The chemicals and tar in cigarettes can increase a person's risk of atherosclerosis, which is the buildup of plaque in the blood vessels. This buildup limits blood flow and can lead to dangerous blockages. Smoking also increases the risk of peripheral artery disease (PAD), which occurs when the arteries to the arms and legs start to narrow, restricting blood flow. Research shows a direct link between smoking and developing PAD. Even those who used to smoke face a higher risk than people who never smoked. Having PAD increases the risk of experiencing: 3. Fertility problems Smoking cigarettes can damage a female's reproductive system and make it more difficult to get pregnant. This may be because tobacco and the other chemicals in cigarettes affect hormone levels. In males, the more cigarettes a person smokes and the longer they smoke for, the higher the risk of erectile dysfunction. Smoking can also affect the quality of the sperm and therefore reduce fertility. Thank you for supporting Medical News Today
4. Risk of pregnancy complications Woman smoking a cigarette in her car
Smoking can increase the risk of ectopic pregancy and reduce the baby's birth weight. According to the CDC, smoking can affect pregnancy and the developing fetus in several ways, including: increasing the risk of ectopic pregnancy reducing the baby's birth weight increasing the risk of preterm delivery damaging the fetus's lungs, brain, and central nervous system increasing the risk of sudden infant death syndrome contributing to congenital abnormalities, such as cleft lip or cleft palate 5. Risk of type 2 diabetes The CDC report that people who smoke regularly have a 30–40 percent higher risk of developing type 2 diabetes than those who do not. Smoking can also make it more difficult for people with diabetes to manage their condition. 6. Weakened immune system Smoking cigarettes can weaken a person's immune system, making them more susceptible to illness. It can also cause additional inflammation in the body. 7. Vision problems Smoking cigarettes can cause eye problems, including a greater risk of cataracts and age-related macular degeneration. Other vision problems related to smoking include: Thank you for supporting Medical News Today 8. Poor oral hygiene People who smoke have double the risk of gum disease. This risk increases with the number of cigarettes a person smokes. Symptoms of gum disease include: swollen and tender gums bleeding when brushing loose teeth sensitive teeth Smoking tobacco can limit a person's ability to taste and smell things properly. It can also stain the teeth yellow or brown. 9. Unhealthy skin and hair Smoking tobacco can affect a person's skin and hair. A person who smokes may experience prematurely aged, wrinkled skin. They also have a higher risk of skin cancer, "especially on the lips." Smoking can cause the hair and skin to smell of tobacco. It can also contribute to hair loss and balding. 10. Risk of other cancers In addition to the well-documented link with lung cancer, smoking cigarettes can also contribute to other forms of cancer. The American Cancer Society report that cigarette smoking causes 20–30 percent of pancreatic cancers. People who smoke are also three times as likely to develop bladder cancer than people who do not. Smoking cigarettes can also double a person's risk of stomach cancer. Tobacco is especially linked to stomach cancers that occur near the esophagus. Cigarettes can also increase the risk of: Secondhand smoke man smoking at his computer
Secondhand smoke can increase the risk of colds, make asthma worse, and damage the heart. The ill effects of smoking cigarettes do not only affect people who smoke. Secondhand smoke can also have significant health effects on family members, friends, and coworkers. Effects of exposure to secondhand smoke include: increasing the risk of colds and ear infections making asthma worse raising blood pressure damaging the heart reducing levels of high-density lipoprotein, or "good," cholesterol Thank you for supporting Medical News Today Quitting While quitting smoking can be challenging, the CDC report that today, there are more people who used to smoke than people who currently smoke. Once a person stops smoking, the benefits start accumulating. These include clearer skin, improved oral health, more stable hormones, a stronger immune system, and a reduced risk of many types of cancers. Some other benefits of quitting smoking include: After 20 minutes–12 hours: Heart rate and carbon monoxide in the blood drop to normal levels. After 1 year: The risk of a heart attack is much lower, as is blood pressure. Coughing and upper respiratory problems begin to improve. After 2–5 years: The risk of stroke drops to that of someone who does not smoke, according to the CDC. After 5–15 years: The risk of mouth, throat, esophagus, and bladder cancer is reduced by half. After 10 years: The risk of lung cancer and bladder cancer is half that of someone who currently smokes. After 15 years: The risk of heart disease is similar to that of someone who never smoked. Nicotine is an addictive drug and can cause withdrawal symptoms when a person stops using it. These symptoms including cravings, increased appetite, and irritability. Cravings and other effects typically subside over time. A doctor or other healthcare professional can help a person take positive steps toward quitting smoking. Read about some simple steps to quit smoking here.
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Being overweight or obese may improve stroke survival

New research reveals that being overweight, obese, or severely obese may improve a person's chances of surviving after a stroke.
doctor explaining something to overweight woman
Being obese or overweight may have its advantages, suggests one new study.

Obesity is a "serious medical condition" that can lead to various complications.

These might include atherosclerosis and heart disease, diabetes, cancer, and even sleep disorders.

Being overweight may also raise the risk of all-cause mortality and mental health conditions such as depression and anxiety.

Despite this, some researchers maintain that excessive body fat can have a protective cardiovascular effect.

In fact, the authors of a 2002 reference paper coined the phrase "obesity paradox" to describe the observation that people with a higher body mass index (BMI) are less likely to die from cardiovascular conditions than people with a normal weight.

Since then, the theory has been the subject of much controversy. However, new evidence appears to support it.

Dr. Zuolu Liu — from the University of California, Los Angeles — and her colleagues wanted to see how the obesity paradox applies to stroke. Previous research into the same issue, explain the researchers, yielded mixed results.

They will present their new findings at the American Academy of Neurology's 71st Annual Meeting, which this year takes place in Philadelphia, PA.

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Dr. Liu explains the motivation for their study, saying, "It was first noticed that carrying extra weight may play a role in survival for people who had suffered from kidney and heart disease, so we felt the need to investigate whether it also was tied to improved stroke survival."

To do so, the researchers examined 1,033 people who had experienced an ischemic stroke — that is, a condition wherein the arteries that pump blood to the brain are blocked.

The participants were 71 years old, on average, and their average BMI was 27.5. People whose BMI is between 25 and 29.9 are considered overweight, while a BMI of over 29.9 indicates obesity.

Dr. Liu and team grouped the participants into five categories — "underweight, normal, overweight, obese, and severely obese" — according to their BMI. The researchers monitored the participants' survival and recovery for 3 months after their stroke.

Overall, people with severe obesity had a 62 percent lower chance of dying from a stroke than people with a normal BMI, people with obesity had a 46 percent lower chance of death, and those who were overweight had a 15 percent lower chance of dying.

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However, those who were underweight had a 67 percent higher chance of dying following a stroke than people with a normal BMI. Dr. Liu and colleagues conclude:

"Outcome from acute ischemic stroke is characterized by an obesity paradox: elevated BMI is associated with reduced 3-month mortality over all, and reduced disability over most weight ranges."

The study was observational, so it cannot account for causality. However, a "possible explanation is that people who are overweight or obese may have a nutritional reserve that may help them survive during prolonged illness," says Dr. Liu.

The researchers also caution that their results may not be applicable to the general population, as the study sample was limited to people from southern California.

"More research is needed to investigate the relationship between [BMI] and stroke," says Dr. Liu.

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Can mouthwash raise your blood pressure?

New research, published in the journal Frontiers in Cellular and Infection Microbiology, shows that an antiseptic compound found in mouthwash destroys "friendly" oral bacteria that help maintain normal blood pressure levels.
young man using mouthwash
New research finds that mouthwash could destroy 'friendly' oral bacteria, which may have important consequences for a person's cardiovascular health.

Scientists know that the bacteria in our guts influence overall health, but perhaps less obvious is the connection between oral bacteria and a variety of health conditions.

For instance, Medical News Today recently reported on a range of studies that linked gum disease and the buildup of certain bacteria in the mouth with Alzheimer's disease, cardiovascular disease, and respiratory conditions.

Another recent article showed how a specific oral bacterium could speed up the progression of colorectal cancer and make the disease more aggressive.

These studies focused on bacteria that cause disease, but, just like our guts, our mouths also contain "friendly" bacteria, which are necessary for maintaining good health.

An oral microbiome with a good balance between these different kinds of bacteria can keep disease at bay. Studies have found that when this balance is upset it "contributes to oral and whole-body systematic diseases" as diverse as inflammatory bowel disease, Alzheimer's, rheumatoid arthritis, obesity, atherosclerosis, and diabetes.

New research points out that a balanced oral microbiome helps maintain good cardiovascular health by helping the conversion of dietary nitrate into nitric oxide (NO) — a signaling molecule that helps maintain normal blood pressure.

Worryingly, however, the new study shows that chlorhexidine, an antiseptic substance in mouthwash, may kill NO-producing bacteria, which in turn, may raise systolic blood pressure.

Nathan Bryan, Ph.D., from the Department of Molecular and Human Genetics at Baylor College of Medicine in Houston, TX, led the new research.

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Bryan and colleagues used "16S rRNA gene sequencing and analysis" to examine whether using chlorhexidine antiseptic mouthwash twice a day for 1 week changed the oral bacterial communities and blood pressure levels in 26 healthy individuals.

After 1 week, the 26 study volunteers went back to their usual oral hygiene practices.

The researchers collected samples of the participants' saliva and tongue scrapings and measured their blood pressure at four different points throughout the study: at baseline, then 7, 10, and 14 days later.

Bryan and colleagues report that "twice-daily chlorhexidine usage was associated with a significant increase in systolic blood pressure after 1 week of use and recovery from use resulted in an enrichment in nitrate-reducing bacteria on the tongue."

"The demonstration that the presence of NO-producing bacteria in the oral cavity can help maintain normal blood pressure gives us another target to help the more than 100 million Americans living with high blood pressure," comments the study's senior author.

"Two out of three patients prescribed high blood pressure medication do not have their blood pressure adequately managed," he adds, and "this may provide an explanation as to why. None of the [current] drugs for management of hypertension are targeted towards these NO-producing bacteria."

The researcher continues to explain the mechanisms underlying the findings, saying that NO "is one of the most important signaling molecules produced in the human body."

Because of the "ubiquitous" nature of this molecule, "the systemic effects of orally produced bacteria may have other significant effects on human health beyond maintenance of blood pressure," Bryan says.

"We know one cannot be well without an adequate amount of NO circulating throughout the body. Yet, the very first thing over 200 million Americans do each day is use an antiseptic mouthwash, which destroys the 'good bacteria' that helps to create the NO. These once thought good habits may be doing more harm than good."

Nathan Bryan, Ph.D.

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February 2019: Nutrition research highlights

Our dietary habits play an important role in shaping our health and well-being, but there are still many unknowns about the diet's ultimate impact on minute biological mechanisms. In this Spotlight feature, we give an overview of some of the best nutrition research published in February 2019.
large plate of salad
What does the most recent nutrition research say about our dietary choices?

Last month on Medical News Today, we covered numerous peer-reviewed studies concerned with matters of nutrition.

Each asked and answered questions about how our dietary practices affect our well-being.

And you, our readers, have shown particular interest in which diets are best for health, as well as which foods may have unexpectedly negative effects.

There is no doubt about it and no use denying it: What we eat is at the heart of our daily existence. Food is a necessity for life, and eating well helps us feel well, have more energy, and become more productive.

In the essay "A Room of One's Own," writer Virginia Woolf even forcefully remarks that "One cannot think well, love well, sleep well, if one has not dined well."

But what does it mean to eat well? What should you eat, what should you avoid, and which dietary patterns should you choose?

Researchers are constantly hard at work to get a better understanding of these issues and offer suggestions for better dietary practices.

In this Spotlight feature, we look at some of the most important findings in nutrition research that were published last month.

Best dietary habits for health

Existing studies have suggested that intermittent fasting — in which a person fasts for a set number of hours each day but eats freely in the remaining hours — can help with losing weight and may provide other health benefits, including prolonging a person's lifespan and reducing harmful inflammation.

breakfast options
Having breakfast daily will probably not aid weight loss efforts.

Essentially, fasting triggers changes in the body — such as stimulating weight loss — by acting on metabolic processes.

Usually, our bodies rely on carbohydrates to produce energy, but when a person fasts and carbohydrates are no longer readily available, the body starts looking for and utilizing other resources.

A study published in the journal Scientific Reports early last month identified some metabolic changes triggered by fasting that researchers had not previously been aware of.

Specifically, the study's authors — who are based at the Okinawa Institute of Science and Technology Graduate University in Japan — found that fasting boosts levels of purine and pyrimidine, two organic compounds that act on gene expression and protein synthesis at a cellular level.

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"These [substances] are very important metabolites for maintenance of muscle and antioxidant activity," explains study author Dr. Takayuki Teruya. This means that by increasing levels of purine and pyrimidine, fasting can stimulate rejuvenating processes, potentially keeping the body younger for longer.

Other research published last month sought to debunk long-standing myths about dietary best practices. One such myth is that eating breakfast is important when it comes to achieving weight loss.

Some believe that eating a morning meal helps stimulate the metabolism so that more calories burn faster. Moreover, certain studies have found a correlation between obesity and a tendency to skip breakfast.

However, this not what a study published in the BMJ last month found. The researchers worked with some participants who reported usually having breakfast and others who, more often than not, preferred to skip it.

The team's findings contradict existing notions about breakfast and weight loss, as they indicate that the total daily energy (calorie) intake tends to be higher in people who regularly eat breakfast.

Moreover, the researchers found that individuals who tended to go without breakfast on a daily basis actually had less body weight than breakfast-eaters, on average.

In their study paper, the authors go so far as to warn that "Caution is needed when recommending breakfast for weight loss in adults, as it may have the opposite effect."

The protective effects of common foods

At the same time, researchers have been identifying additional benefits of common natural foods. One example is flaxseed, which many of us use to enrich our smoothies or add some extra crunch to crackers and granola bars.

bowl of blueberries
Blueberries may vie with specialized medication in lowering cardiovascular risk.

Flaxseed fiber reportedly helps balance cholesterol levels and lower blood pressure, among other benefits.

Now, a new study published in the American Journal of Physiology: Endocrinology and Metabolism suggests that flaxseed fiber can also lower obesity markers.

Flaxseed starts breaking down once it reaches the gut. The research, which the team conducted in a mouse model, showed that the fiber produces changes in the gut microbiota that lead to a more healthy bacterial population.

These changes affect metabolic processes, accelerating the consumption of energy, and thus lowering markers associated with obesity.

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In addition to this, they help boost glucose (sugar) tolerance, which may mean that they have a protective effect against features that define other metabolic conditions, such as diabetes, which is characterized by impaired glucose tolerance.

According to other research published last month, onions and garlic, two key ingredients in global cuisines, are also important allies when it comes to safeguarding our health.

Garlic already has a reputation as a natural antibiotic, as it has antibacterial properties, and many people traditionally use it to fight the flu or treat insect bites.

In a paper, published in the Asia-Pacific Journal of Clinical Oncology last month, researchers from the First Hospital of China Medical University report that these two vegetables have an anti-cancer effect.

Both garlic and onions belong to the family of allium vegetables, all of which have similarly pungent smells and flavors.

The present study looked at 833 individuals who had been diagnosed with colorectal cancer, assessing how many allium vegetables they tended to consume on a regular basis. The team then matched this group with that of an equal number of cancer-free individuals.

The researchers found that participants who ate the largest quantities of garlic and onions had a 79 percent lower risk of colorectal cancer, compared with people who consumed low quantities of allium vegetables.

Based on these results, the investigators concluded that "The greater the amount of allium vegetables, the better the protection," in the words of senior researcher Dr. Zhi Li.

Another well-loved food item that received positive attention in February is the blueberry. Blueberries are often hailed as a superfood because they are packed with antioxidants, substances that help protect cellular health and fend off disease.

Last month, researchers from King's College London in the United Kingdom found that the anthocyanins — pigments with antioxidant properties — in these berries could help lower a person's risk of cardiovascular problems.

Study participants who ate 200 grams of blueberries per day for a month saw a significant decrease in blood pressure, which, the investigators note, does not usually occur in the absence of specialized medication.

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Warnings about dietary choices

February also saw the publication of studies that warned that some dietary choices may be putting our health at risk.

selection of soft drinks
Low-calorie soft drinks with artificial sweeteners can contribute to the risk of stroke.

For example, research that appears in JAMA Internal Medicine cautions, once more, that eating ultra-processed foods could be extremely harmful.

This study was conducted by specialists from the Sorbonne University in Paris and the Avicenne Hospital, both in France.

The researchers explain that such foods — which include ready-made meals and processed meats — have high contents of fat, sugar, and sodium (salt) while being low in natural fiber.

This means that, while tasty, they are not nutritious and will cheat our stomachs into feeling satisfied, while failing to offer the real sustenance that we need.

At the same time, the investigators add, ultra-processed foods often contain artificial additives, which could increase our exposure to a range of diseases.

While specialists already understood that such foods exacerbate our vulnerability to disease, the effect on overall mortality risk remained unclear. In the present study, the authors have, for perhaps the first time, concluded that as little as a 10 percent increase in the amount of ultra-processed food that we eat leads to a 14 percent higher mortality risk.

Another study, featured in the journal Stroke, drew some bleak conclusions about the consumption of artificially sweetened diet drinks.

The team that conducted this research was specifically interested in seeing how diet drink consumption affected women over 50, so they analyzed data from 81,714 women in this age category.

The analysis revealed a worrying trend: Women who had two or more diet drinks per day had a 23 percent higher risk of stroke and a 29 percent higher risk of a heart attack or a similar event.

That being the case, the study authors urge us to reconsider whenever we feel tempted to reach out for a low-calorie soft drink and opt for an alternative.

Finally, a team of scientists from Flinders University in Adelaide, Australia, has turned its attention to the harms of alcohol, which, according to the team's new study — published in PLOS ONE — many people still ignore.

The Australian researchers chose to focus on alcohol's well-recognized status as a risk factor for breast cancer. They turned to women aged between 45 and 64, asking them how often and how much they drink and whether they are aware of the risks.

According to lead author Dr. Emma Miller, "There is a low level of awareness about the established link between alcohol and breast cancer," and women continue to actively put themselves at risk.

"[It's] really important to understand the patterns and drivers behind drinking behavior, in order to develop policies and interventions that might reduce the increasing burden on the women and our health system," Dr. Miller stresses.

One message emerges from the studies that top researchers have made available in February, namely: We all need to learn how to make our diets work for us, rather than against us, and make choices for which our bodies will be grateful.

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What are the best dietary sources of vitamin D?

Vitamin D is a type of nutrient that the body produces when a person's skin has exposure to direct sunlight. People can also consume vitamin D, but it is not naturally present in many foods. High quantities of vitamin D are present in oily fish and certain types of mushrooms.

According to the Office of Dietary Supplements (ODS), the key benefit of vitamin D is that it helps keep a person's bones, muscles, and nerves healthy. It also contributes to a healthy immune system.

It is present in egg yolks if the chickens laying them are free-range. Some mushrooms also contain vitamin D.

However, no other plant-based foods produce vitamin D. For people whose diets are mostly vegetarian or vegan, and for people who do not or cannot spend a lot of time outdoors, it can be difficult to get enough vitamin D.

If a person has concerns that they are not getting enough vitamin D from direct sunlight, consuming the following foods will help increase the overall amount they have in their bodies.

Oily fish Vitamin d foods swordfish
Swordfish is an excellent source of vitamin D.

Oily fish, as well as oils from fish, have some of the highest quantities of vitamin D in food sources.

These may include:

Thank you for supporting Medical News Today Mushrooms If a person does not like fish, or if they are vegetarian or vegan, specific mushrooms may be an option. Some types of mushroom contain high amounts of vitamin D. These include: Raw maitake mushrooms: These contain 562 IU per 50 grams (g), which is 94 percent of a person's RDA. Dried shiitake mushrooms: These contain 77 IU per 50 g, which is 12 percent of a person's RDA. Mushrooms with exposure to ultraviolet (UV) light can also contain large amounts of vitamin D. These may include: UV-exposed raw Portobello mushrooms: These contain 568 IU per 50 g, which is 95 percent of a person's RDA. UV-exposed raw white mushrooms: These contain 523 IU per 50 g, which is 87 percent of a person's RDA. Egg yolks Egg yolks can also be high in vitamin D, especially if the chickens are free-range. For example, a dish of scrambled eggs using two large hen eggs contains 88 IU, which is 15 percent of a person's RDA. Thank you for supporting Medical News Today Fortified foods Manufacturers add vitamin D to many commercially available foods. People describe these foods as being fortified with vitamin D, or other nutrients. Common foods with extra vitamin D and other nutrients include: cow's milk orange juice various breakfast cereals Getting enough vitamin D Vitamin d foods orange juice
Vitamin D may provide resistance to some cancers and cardiovascular diseases. According to the ODS, if a person does not have enough vitamin D in their diet, they are at risk of developing weak bones. Symptoms of this might include pain in a person's bones or weakness in their muscles. These symptoms can be subtle initially. There is some research to suggest that vitamin D may contribute to other health benefits, such as: However, according to the ODS, there is not yet enough evidence to know whether this is the case. Existing research has yielded mixed results. The RDA of vitamin D for all people aged 1–70 is 600 IU. For children below the age of 1, it is 400 IU, and for adults over 70, it is 800 IU. This assumes that a person has the minimum amount of direct sun exposure. The general assumption is that a person who spends some time outside a few times per week will produce sufficient vitamin D. However, according to the ODS, this can vary considerably depending on: season time of day the presence of cloud cover or smog the color of a person's skin whether a person is wearing sunscreen Being in direct sunlight behind a window will not aid vitamin D production because glass cuts out the radiation that produces vitamin D. Thank you for supporting Medical News Today Summary Getting enough vitamin D is crucial to maintaining healthy bones. The easiest way of getting enough vitamin D is to regularly spend time outside, making sure that the arms, face, and legs have exposure. Depending on a person's dietary preferences, consuming enough vitamin D may be difficult. In this case, vitamin D supplements, which are available to purchase online, may be a beneficial choice. However, if this is not possible, try to consume oily fish, some mushrooms, and free-range egg yolks. 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 are the health benefits of water chestnuts?

Water chestnuts are an aquatic tuber vegetable. They grow in parts of Southeast Asia, Africa, Australia, and many Pacific islands. A water chestnut resembles an actual chestnut in both color and shape, but it is not a nut.

Water chestnuts are popular in many cuisines and have a variety of potential health benefits.

These benefits may include:

Providing antioxidants Whole and peeled chestnuts
Eating water chestnuts could help reduce the risk of cancer.

Water chestnuts are an excellent source of antioxidants. Antioxidants help the body's immune system fight free radicals, which are potentially harmful molecules.

When free radicals accumulate to a certain extent, they can cause a state of oxidative stress, impacting the body's natural defenses and damaging cells.

Oxidative stress is linked to an increased risk of developing chronic illnesses, including cancer.

However, some research suggests that the antioxidants found in water chestnut peel can help neutralize the effects of free radicals on the body.

Thank you for supporting Medical News Today Slowing tumor growth Water chestnuts contain an antioxidant called ferulic acid. There is some evidence that ferulic acid can help reduce or slow the growth of cancer cells. For example, a test tube study of breast cancer found that ferulic acid both helped kill and reduce the growth rate of the cells. However, determining whether the compounds in water chestnuts can help fight cancer will require more research in humans. Lowering calorie consumption Water chestnuts are very low in calories. Half a cup of sliced water chestnuts contains just 60 calories. Despite having a low calorie count, water chestnuts contain many nutrients, including: Thank you for supporting Medical News Today Lowering high blood pressure and associated risks Person cooking water chestnuts in street
Water chestnuts are rich in nutrients. High blood pressure can contribute to several health issues, including stroke and heart disease. Potassium, a nutrient in water chestnuts, is linked to reducing blood pressure. A 2013 review found that increasing the intake of potassium could help reduce blood pressure in people with hypertension. The researchers also found moderate-quality evidence to suggest that a higher potassium intake could reduce the risk of stroke by 24 percent. This review considered a higher intake to consist of 3,500–4,700 milligrams (mg). Another, smaller review of 11 studies found that higher potassium intake reduced both the risks of stroke and heart disease. Half a cup of sliced water chestnuts contains 362 mg of potassium. Adding extra potassium to a healthful diet may help lower high blood pressure and its associated risks. How to use water chestnuts Water chestnuts are easy to prepare and eat. Grocery stores that stock international foods often offer them canned or whole. People can also purchase them online. To use a whole, fresh water chestnut, peel away the outer brown skin to reveal the white flesh beneath. A person can eat the flesh raw. They can also be fried, grilled, boiled, or sautéed to provide a sweet, crunchy addition to a meal. Depending on the dish, a person may serve them whole, sliced, diced, or ground up. They are popular in stir-fries, chop suey, and many curries. People also enjoy candied or pickled water chestnuts as a snack. Or, to them in a flour mixture or as a thickening agent, dry water chestnuts out and grind them up. Thank you for supporting Medical News Today Summary Water chestnuts are an excellent source of nutrients and antioxidants, making them a good addition to a healthful diet. Some evidence suggests that consuming water chestnuts could help reduce free radicals in the body and lower blood pressure, among other benefits. Water chestnuts are quite versatile — people can use them in many types of cooking or eat them raw. 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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Sleep apnea: Daytime sleepiness might help predict cardiovascular risk

A recent study categorizing people with obstructive sleep apnea based on their differing symptoms found a strong link between excessive daytime sleepiness and cardiovascular disease.
Older man asleep in pajamas
OSA increases hypertension risk.

Obstructive sleep apnea (OSA) causes sporadic airflow blockages during sleep.

All of the different types of sleep apnea, OSA is the most common.

Symptoms include snoring, daytime sleepiness, difficulty concentrating, and high blood pressure.

OSA occurs when the throat muscles relax too much to keep the airway open.

According to the National Sleep Foundation, more than 18 million adults in the United States have sleep apnea. If a person does not seek treatment, it can lead to several complications — one of which is cardiovascular disease.

Sleep apnea and cardiovascular problems

According to the American Thoracic Society, about 30 percent of people with high blood pressure, or hypertension, have OSA. Also, individuals with OSA have a 50 percent chance of developing hypertension.

However, researchers do not yet know why people with OSA are likelier to develop heart disease.

When these breathing pauses occur, the oxygen level in the blood gets low, and these frequent bouts of low oxygen levels during sleep may damage the blood vessels that supply the heart.

During these pauses, the heart beats faster and the blood pressure goes up. Severe OSA can also cause the heart to become enlarged. When this occurs, the heart receives less oxygen and works less efficiently.

Previous studies have identified a link between OSA and heart disease. However, to understand the association better, researchers categorized people with OSA based on their symptoms and conducted a new study.

Their results now appear in the American Journal of Respiratory and Critical Care Medicine.

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Excessive sleepiness: A marker of risk?

The researchers categorized the participants into four subtypes of OSA according to the symptoms they reported, which included: difficulty falling and staying asleep, snoring, fatigue, drowsy driving, disturbed sleep, moderate sleepiness, and excessive sleepiness. The four subtypes were:

those with disturbed sleep those with few symptoms those who felt moderately sleepy those who felt excessively sleepy

The study analyzed data from more than 1,000 adults who had moderate to severe OSA (which the scientists defined as having at least 15 breathing pauses while sleeping or reduced breathing).

All had participated in the Sleep Heart Health Study, which was available from the National Sleep Research Resource. The team followed the participants for about 12 years.

"Multiple studies from our group," explains study co-author Dr. Diego Mazzotti, at the University of Pennsylvania in Philadelphia, "have shown that patients with moderate to severe OSA throughout the world can be categorized into specific subtypes based on their reported symptoms."

"However," he notes, "until now, it was unclear whether these subtypes had different clinical consequences, especially in regard to future cardiovascular risk."

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A 'surrogate marker'

The analysis showed that participants with OSA who experienced excessive sleepiness had higher rates of cardiovascular disease at enrollment when compared with people without OSA.

Also, they were around twice as likely to experience cardiovascular issues during the follow-up period.

The researchers are aware that these results do not prove that excessive sleepiness is a causal factor for cardiovascular disease. That said, they do believe that this specific symptom of OSA could be a "surrogate marker of underlying cardiovascular risk pathways."

Despite the study's limitations, the team suggests that treatments for OSA, such as continuous positive airway pressure (CPAP), should focus on people who have the excessive sleepiness subtype, as they would benefit the most.

CPAP uses machines that keep airways open to allow people to breathe properly during sleep.

"Even without further research, clinicians should recognize that patients with OSA who complain of feeling tired when they wake up and sleepy during the day and have a high score on the Epworth Sleepiness Scale are at greater risk for cardiovascular disease."

Dr. Diego Mazzotti

He adds that his colleagues are developing a simple tool to categorize people into symptom subtypes, which should improve the clinical utility of their findings.

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Blueberries may lower cardiovascular risk by up to 20 percent

The phytochemicals that give blueberries their blue color can significantly improve cardiovascular health, finds a new two-part study.
person eating breakfast bowl with blueberries
The positive effect that blueberries can have on blood pressure is comparable to that of hypertension drugs.

Dubbed "the silent killer" because it has no visible symptoms in its early stages, hypertension affects approximately 1 in 3 adults in the United States.

The condition puts a strain on the cardiovascular system, which in the long run may contribute to heart failure, stroke, and kidney failure.

The National Institutes of Health (NIH) recommend that people with high blood pressure stay in control of the condition by eating healthfully, exercising, not smoking, and maintaining a healthy weight.

But should you eat anything in particular to keep your arteries healthy? In a previous Spotlight feature, we rounded up 16 foods that studies have suggested can improve cardiovascular health.

Along with broccoli, spinach, pulses, and fish, berries may also reduce heart disease, due to their antioxidant polyphenols.

New research zooms in on the cardiovascular effects of blueberries and finds that anthocyanins — the phytochemicals that give blueberries their color — mediate the beneficial effects that this fruit has on the cardiovascular system.

The lead author of the study is Ana Rodriguez-Mateos, Ph.D., from the Department of Nutritional Sciences at King's College London, in the United Kingdom. The researchers published their findings in The Journals of Gerontology: Series A.

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Anthocyanins and blood pressure

Rodriguez-Mateos and her colleagues recruited 40 study participants who were in perfect health and randomly divided them into two groups: One received a daily drink consisting of 200 grams (g) of blueberries, and another group received a control drink.

To examine the effects of the blueberries, the researchers took the participants' blood pressure and measured the flow-mediated dilation (FMD) of their brachial arteries.

FMD is a standard indicator of cardiovascular risk; it measures how much the brachial artery widens when blood flows at a higher rate.

In the second part of the study, the researchers compared drinking blueberries with drinking purified anthocyanins or control drinks that had concentrations of fiber, minerals, or vitamins equivalent to those in blueberries.

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Blood pressure decreases by 5 mm Hg

The scientists noticed the beneficial effects of the blueberry drinks only 2 hours after the participants had consumed them.

"Purified anthocyanins exerted a dose-dependent improvement of endothelial function in healthy humans, as measured by [FMD]," report the authors.

The endothelium is a type of membrane inside the heart and blood vessels. It contains endothelial cells that help control the dilation and contraction of the arteries.

Endothelial cells also help keep blood pressure in check and play a key role in blood clotting.

The authors continue, "[t]he effects were similar to those of blueberries containing similar amounts of anthocyanins, while control drinks containing fiber, minerals, or vitamins had no significant effect."

After a month of having 200 g of blueberries each day, the participants' blood pressure decreased by 5 millimeters of mercury (mm Hg), on average. The researchers note that such a decrease is usually obtained with medication.

"Our results identify anthocyanin metabolites as major mediators of vascular bioactivities of blueberries and changes of cellular gene programs," conclude the researchers.

Rodriguez-Mateos comments on the findings, saying, "although it is best to eat the whole blueberry to get the full benefit, our study finds that the majority of the effects can be explained by anthocyanins."

The scientists explain that anthocyanins "circulate in [the] blood as phenolic acid metabolites."

"If the changes we saw in blood vessel function after eating blueberries every day could be sustained for a person's whole life, it could reduce their risk of developing cardiovascular disease by up to 20 [percent]."

Ana Rodriguez-Mateos

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What to know about acute respiratory failure

When a person has acute respiratory failure, the usual exchange between oxygen and carbon dioxide in the lungs does not occur. As a result, enough oxygen cannot reach the heart, brain, or the rest of the body.

This can cause symptoms such as shortness of breath, a bluish tint in the face and lips, and confusion.

Acute respiratory failure has many possible causes. The cause may be acute, including pneumonia, or chronic, such as amyotrophic lateral sclerosis (ALS).

Acute respiratory failure is a serious illness. If a person thinks they or someone else has it, they should seek immediate medical attention.

A doctor can evaluate the person's breathing, the amount of oxygen and carbon dioxide in the blood, and the overall symptoms to determine appropriate treatments.

Causes Acute respiratory failure
The respiratory system cannot perform its usual functions when the lungs don't receive enough oxygen.

Acute respiratory failure usually stems from difficulty getting enough oxygen to the lungs, problems removing carbon dioxide from the lungs, or both.

As a result, the respiratory system cannot perform its usual functions.

Potential causes include:

disorders of the spine, such as scoliosis inhalation injuries, such as inhaling smoke from fires or fumes lung-related conditions, such as acute respiratory distress syndrome (ARDS), cystic fibrosis, chronic obstructive pulmonary disease (COPD), pneumonia, or a pulmonary embolism nerve or muscle conditions that affect a person's ability to breathe, such as ALS, muscular dystrophy, spinal cord injuries, or stroke an overdose from drugs or alcohol trauma to the chest, such as after a car accident

Determining the cause of acute respiratory failure helps a doctor determine the most appropriate treatments.

Types Doctors typically classify acute respiratory failure as one of four types: Type 1 Doctors call this hypoxemic respiratory failure. It means that a person is not exchanging oxygen properly in their lungs. This may be due to swelling or damage to the lungs. A person with type 1 acute respiratory failure has very low oxygen levels. Type 2 In a person with type 2 acute respiratory failure, the lungs are not removing enough carbon dioxide, which is a gas and a waste product. The lungs usually exchange carbon dioxide for fresh oxygen. This type of respiratory failure causes carbon dioxide levels to be high. It may result from a drug overdose that has caused a person to breathe too slowly, or because of lung damage from smoking, which causes COPD. Type 3 Doctors refer to this as perioperative respiratory failure. It occurs when a person has had surgery, and the small airways in the lungs have closed in greater numbers. Factors such as pain or stomach surgery, which places higher pressure on the lungs, can also contribute to this type of respiratory failure. Type 4 Type 4 respiratory failure is a shock state. It means that the body cannot adequately provide oxygen and maintain blood pressure on its own. This can result from serious illness or injury, such as when a person loses too much blood. Thank you for supporting Medical News Today Diagnosis A doctor will take into account a person's symptoms, as well as their laboratory and imaging results when diagnosing the cause of acute respiratory failure. They may use an arterial blood gas, or ABG, test. This involves drawing blood from an artery and testing the levels of oxygen and carbon dioxide. A doctor can use ABG results to determine if a person has type 1 or type 2 respiratory failure. Symptoms Acute respiratory failure tired
Appearing very sleepy is a symptom of acute respiratory failure. Symptoms may include changes in a person's appearance, ease of breathing, and how they act. Examples of symptoms include: appearing very sleepy a blue tinge to a person's fingernails, lips, or skin confusion irregular heart rhythms passing out rapid breathing shortness of breath Generally, the symptoms of acute respiratory failure depend on the underlying cause. Potential complications Acute respiratory failure can be fatal. According to a presentation on the website of the American Thoracic Society, about 360,000 people experience acute respiratory failure each year in the United States. Approximately 36 percent of these individuals die during a hospital stay. This figure may be higher, depending on the underlying cause. For example, authors of a study in the European Respiratory Review estimate that people in the hospital with the most severe form of ARDS have a 42 percent mortality rate. An episode of acute respiratory failure can cause damage to the lungs that requires a person to carry oxygen with them at all times. Some people require a tracheotomy, which creates a hole in the neck below the vocal cords to assist in breathing in the long term. Thank you for supporting Medical News Today Treatment Treatments for acute respiratory failure depend on the underlying cause. For example, respiratory failure from scoliosis may require surgical correction of the spine to enable the lungs and heart to work more efficiently. A person with acute respiratory failure will typically require extra oxygen. This may come in the form of mechanical ventilation, which involves a doctor inserting a plastic tube down a person's windpipe. The tube sits below the vocal cords and can deliver oxygen and pressure to inflate the lungs more effectively. Doctors typically use this method of delivering oxygen until they can slow, resolve, or reverse the underlying cause of respiratory failure. Other acute respiratory failure treatment strategies include: medications, such as antibiotics to treat infections and diuretics to reduce the mount of fluid in the lungs and body chest wall oscillation or vibration to loosen mucus in the lungs prone ventilation, which involves placing a person on their stomach and providing oxygen through a ventilator. extracorporeal membrane oxygenation, which involves using a cardiopulmonary bypass machine to take blood from the body and provide oxygen to reduce the workload on the heart and lungs A doctor may also prescribe medications to sedate a patient, making breathing with the ventilator easier to tolerate. Because acute respiratory failure is such a serious condition, treatments can take time and may be intensive. Prevention Acute respiratory failure smoking
Refraining from smoking cigarettes can help protect the lungs. Not all causes of acute respiratory failure, such as trauma, are preventable. However, in the case of pneumonia and some other airway-related illnesses, a person can take some steps to protect their lungs. These include: refraining from smoking cigarettes, which can damage the lungs seeing a doctor at early signs of a bacterial infection, such as a fever, cough, and high mucus production taking all medications a doctor prescribes to keep the heart and lungs healthy if necessary, using assistive devices to maintain oxygen levels, such as continuous positive airway pressure masks, which a person can wear at home engaging in appropriate levels of physical activity to enhance lung function If a person has a history of lung problems and hospitalization, they should talk to their doctor about strategies to enhance their overall health. Takeaway Acute respiratory failure is a serious medical condition that has many possible underlying causes. Symptoms include confusion, rapid breathing, and shortness of breath. Seek immediate medical attention at the first signs of respiratory failure to prevent the illness from worsening.
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