ReportWire

Tag: heart failure

  • What to know about melatonin use and heart failure

    [ad_1]

    (CNN) — Long-term use of melatonin supplements may be linked with a higher risk of heart failure, according to new research — but does that mean people taking it as a sleep aid should stop using it now?

    In a review of electronic medical records, thousands of adults who had chronic insomnia and took melatonin for a year or longer had a 90% higher chance of heart failure over the next five years, compared with participants who had the same health factors but didn’t take melatonin. Melatonin users were also more than three times as likely to be hospitalized for heart failure and about twice as likely to die from any cause.

    But experts suggest holding off on seeing melatonin as a definite danger. The research had significant limitations, was not designed to be able to prove cause and effect, and contradicts previous studies that indicated positives for heart health.

    The research also hasn’t yet been peer-reviewed or published in a journal but will be presented at the American Heart Association’s Scientific Sessions 2025 meeting taking place November 7-10.

    “Melatonin supplements are widely thought of as a safe and ‘natural’ option to support better sleep, so it was striking to see such consistent and significant increases in serious health outcomes, even after balancing for many factors,” Dr. Ekenedilichukwu Nnadi, lead research author and chief resident in internal medicine at SUNY Downstate/Kings County Primary Care in Brooklyn, said in a news release.

    However, “while the association we found raises safety concerns about the widely used supplement, our study cannot prove a direct cause-and-effect relationship,” Nnadi said. “This means more research is needed to test melatonin’s safety for the heart.”

    Naturally occurring melatonin in the brain is a hormone produced by the pineal gland in response to darkness, to help the body wind down for sleep.

    The melatonin in supplements can be extracted from the pineal glands of animals or synthetically produced via a chemical process.

    In the United States, because melatonin is sold as a dietary supplement, manufacturers aren’t subject to the level of scrutiny involved in the US Food and Drug Administration’s safety measures and approval processes for drugs. This means melatonin supplements can contain significantly more of the active ingredient than advertised or necessary, as well as harmful hidden additives.

    Chronic insomnia, experienced by 10% of the global population, is defined by taking more than 30 minutes to fall asleep or fall back to sleep up to three times weekly for more than three months. It can lead to problems with memory, daytime energy, mood, thinking and concentration, work or school performance, and one’s social life.

    A doctor can help one determine whether insomnia is occurring on its own or because of an underlying factor, such as a medical condition or stressful life circumstance, and therefore determine the best ways to treat it — whether that’s adjusting your sleep routine, undergoing therapy for mental or emotional distress or cognitive behavioral therapy for insomnia, taking medication, or treating a medical condition.

    Melatonin use and heart health

    Melatonin supplements are often marketed as a safe sleep aid, but there hasn’t been sufficient data on long-term safety for cardiovascular health, the authors said.

    The research team assessed more than 130,000 adults with health records in the TriNetX Global Research Network, a large international electronic database. They were about 55 years old on average, and 61.4% were women. Participants with melatonin use documented in medication entries in their health records for more than a year were classified as the melatonin group, whereas those without any record of melatonin use were in the “non-melatonin group.”

    These factors lend themselves to a few important limitations, the authors and independent experts pointed out.

    The database includes patients in countries that require a prescription for melatonin, such as the United Kingdom, and those that don’t, including the United States — so the control group may unknowingly include adults who take melatonin without a prescription, which wouldn’t be reflected in their medical records, Dr. Carlos Egea, who wasn’t involved in the research, said in a statement provided by the Science Media Centre. Egea is president of the Spanish Federation of Sleep Medicine Societies.

    The researchers also didn’t have details on the severity of participants’ insomnia or whether they had any mental health issues, both of which can influence melatonin use and heart health risks, Nnadi said.

    Insomnia has been associated with a higher risk of having a heart attack or stroke. Disrupted circadian rhythms — our body clocks in which melatonin plays a role — and insufficient sleep have been linked with greater odds of cardiovascular issues including heart failure.

    Other limitations include a lack of information on dosage, the Council for Responsible Nutrition, a trade association for the dietary supplement and functional food industry, said in a statement. “Decades of consumer experience and multiple clinical studies indicate that low-dose, short-term supplementation is safe for healthy adults when used as directed,” the association added.

    The research challenges previous studies, including a March analysis of four studies that found melatonin supplementation improved heart failure patients’ quality of life and cardiac function, Egea said.

    Melatonin is also an antioxidant, and antioxidants help protect against damage to DNA by oxidative stress, an imbalance between free radicals and antioxidants in the body.

    Before you take sleep aids

    Many people turn to melatonin as a short- or long-term solution to sleep woes. But for some people, the supplement has been linked to various side effects including headaches, nausea, dizziness, drowsiness, stomach aches, confusion or disorientation, tremors, low blood pressure, irritability, mild anxiety and depression.

    Before resorting to supplements, “speak to your doctor first about, for one, getting a proper diagnosis for your sleep difficulty and then discussing the appropriate course of treatment,” Dr. Marie-Pierre St-Onge, director of the Center of Excellence for Sleep & Circadian Research in the department of medicine at Columbia University Irving Medical Center, said in the American Heart Association news release. “People should be aware that (melatonin) should not be taken chronically without a proper indication.”

    Healthy sleep hygiene involves limiting light exposure, screen time and consumption of food and alcohol in the few hours before bed. Your bedroom should be dark, cool and quiet.

    If you still choose to supplement melatonin, pharmaceutical grade melatonin is best, experts told CNN in a 2022 report — look for a stamp showing that the independent nonprofit US Pharmacopoeia’s Dietary Supplement Verification Program has tested the product.

    [ad_2]

    Kristen Rogers and CNN

    Source link

  • Eating to Keep Ulcerative Colitis in Remission  | NutritionFacts.org

    [ad_1]

    Plant-based diets can be 98 percent effective in keeping ulcerative colitis patients in remission, far exceeding the efficacy of other treatments.

    “One of the most common questions physicians treating patients with IBD [inflammatory bowel disease] are asked is whether changing diet could positively affect the course of their disease.” Traditionally, we had to respond that we didn’t know. That may now be changing, given the “evidence in the literature that hydrogen sulfide may play a role in UC,” ulcerative colitis. And, since the sulfur-containing amino acids concentrated in meat cause an increase in colonic levels of this rotten egg gas, perhaps we should “take off the meat.” Indeed, animal protein isn’t associated only with an increased risk of getting inflammatory bowel disease in the first place, but also IBD relapses once you have the disease.

    This is a recent development. “Because the concept of IBD as a lifestyle disease mediated mainly by a westernized diet is not widely appreciated, an analysis of diet in the follow-up period [after diagnosis] in relation to a relapse of IBD has been ignored”—but no longer. Ulcerative colitis patients in remission and their diets were followed for a year to see which foods were linked to the return of their bloody diarrhea. Researchers found that the “strongest relationship between a dietary factor and an increased risk of relapse observed in this study was for a high intake of meat,” as I discuss in my video The Best Diet for Ulcerative Colitis Treatment.

    What if people lower their intake of sulfur-containing amino acids by decreasing their consumption of animal products? Researchers tried this on four ulcerative colitis patients, and without any change in their medications, the patients experienced about a fourfold improvement in their loose stools. In fact, they felt so much better that the researchers didn’t think it was ethical to try switching the patients back to their typical diets. “Sulfur-containing amino acids are the primary source of dietary sulfur,” so a “low-sulfur” diet essentially means “a shift from a more traditional western diet (high in animal protein and fat, and low in fiber) to more of a plant-based diet (high in fiber, lower in animal protein and fat).” “Altogether, westernized diets are pro-inflammatory, and PBD [plant-based diets] are anti-inflammatory.”

    What can treatment with a plant-based diet do after the onset of ulcerative colitis during a low-carbohydrate weight-loss diet? A 36-year-old man lost 13 pounds on a low-carb diet, but he also lost his health; he was diagnosed with ulcerative colitis. When he was put on a diet centered around whole plant foods, his symptoms resolved without medication. He achieved remission. That was just one case, though. Case reports are akin to glorified anecdotes. The value of case reports lies in their ability to inspire researchers to put them to the test, and that’s exactly what they did.

    Until then, there had never been a study published that focused on using plant-based diets for treating ulcerative colitis. Wrote the researchers, a group of Japanese gastroenterologists, “We consider that the lack of a suitable diet is the biggest issue faced in the current treatment of IBD. We regard IBD as a lifestyle disease caused mainly by our omnivorous (Western) diet. We have been providing a plant-based diet (PBD) to all patients with IBD” for more than a decade and have published extraordinary results, far better than have been reported elsewhere in the medical literature to date. (I profiled some of their early work in one of the first videos that went up on NutritionFacts.org.) The researchers found a plant-based diet to be “effective in the maintenance of remission” in Crohn’s disease by 100 percent at one year and 90 percent at two years. What about a plant-based diet for relapse prevention in ulcerative colitis?

    “Educational hospitalization” involved bringing patients into the hospital to control their diet and educate them about the benefits of plant-based eating (so they’d be more motivated to continue it at home). “Most patients (77%) experienced some improvement, such as disappearance or decrease of bloody stool during hospitalization.” Fantastic!

    Here’s the really exciting part. The researchers then followed the patients for five years, and 81 percent of them remained in remission for the entire five years, and 98 percent kept the disease at bay for at least one year. That blows away other treatments. Those relapse rates are far lower than those reported with medication. Under conventional treatment, other studies found that about half of the individuals relapse, compared to only 2 percent of those taught to eat healthier.

    “A PBD was previously shown to be effective in both the active and quiescent stages of Crohn’s disease. The current study showed that a PBD is effective in both the active and quiescent stages of UC as well.” So, the researchers did another study on even more severely affected cases with active disease and found the same results, with plant-based eating beating conventional drug therapy by far. People felt so much better that they were still eating more plant-based food even six years later. The researchers conclude that a plant-based diet is effective for treating ulcerative colitis to prevent a relapse.

    Why? Well, plant-based diets are rich in fiber, which feeds our good gut bugs. “This observation might partly explain why a PBD prevents a variety of chronic diseases. Indeed, the same explanation applies to IBD, indicating that replacing an omnivorous diet with a PBD in IBD is the right approach.” 
     
    It’s like using plant-based diets to treat the cause of heart disease, our number one killer. Plant-based eating isn’t only safer and cheaper, but it also works better with no noted adverse side effects. Let’s compare that to the laundry list of side effects of immunosuppressants used for ulcerative colitis, like cyclosporine, which you can see below and at 5:40 in my video. 

    We now have even fancier drugs costing about $60,000 a year, about $5,000 a month, and they don’t even work very well; clinical remission at one year is only about 17 to 34 percent. And, instead of no adverse side effects, the drugs can give us a stroke, give us heart failure, and can even give us cancer, including a rare type of cancer that often results in death. Also, a serious brain disease known as progressive multifocal leukoencephalopathy, which can kill us, and for which there is no known treatment or cure. One drug lists an “increased risk of death” but touts that it’s just “a small pill” in an “easy-to-open bottle.” I’d skip the pills (and their potential side effects) and stick with plant-based eating.

    Doctor’s Note:

    If you missed the previous video, see Preventing Inflammatory Bowel Disease with Diet and stay tuned for The Best Diet for Crohn’s Disease Treatment, coming up next. 
     
    Check the related posts below for some older videos on IBD that may be of interest to you.

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • Science Give Marijuana Users Some Good Heart News

    Science Give Marijuana Users Some Good Heart News

    [ad_1]

    Science continues to prove cannabis has medical benefits…and more people are acknowledging the value of the plant

    As the debate about marijuana being rescheduled continues, science continues to prove cannabis has medical benefits. While more research needs to be done in a variety of areas, medical organizations are coming around to the data regarding the plant’s help in medical conditions. And now science give marijuana users some good heart news.

    Heart disease is the leading cause of death of women, men, and people of most racial and ethnic groups. Known as the silent killer, it can strike without advance notice, killing over 600,000 in the US and Canada alone. But science has come a long way in matter of open heart surgery and other key elements around heart health.

    RELATED: What We Know About Medical Marijuana’s Effect On Heart Disease

    Despite the negative perception about cannabis, it is alcohol which aggravates cardio problems. Heavy drinking is linked to heart conditions. Excessive alcohol intake can lead to high blood pressure, heart failure or stroke. It can also contribute to cardiomyopathy, a disorder that affects the heart muscle.

    Photo by LPETTET/Getty Images

    While heavy marijuana use can cause complications with the cardiovascular system, it seems light to moderate use can have a least one benefits.  A study conducted by the American Heart Association shows cannabis users had a lower risk of A-fib. Researchers compared the health, length of hospital stay and mortality rates of cannabis users and non-users.

    They observed significantly reduced odds of atrial fibrillation (Afib) among cannabis users.  Not only that, patients who were cannabis users were also less likely to die in the hospital. Also surprising to researchers was the fact that cannabis users also had shorter hospital stays than non-cannabis users. 

    AFib is an irregular and often very rapid heart rhythm. An irregular heart rhythm is called an arrhythmia. AFib can lead to blood clots in the heart. The condition also increases the risk of stroke, heart failure and other heart-related complications.The intensive study revealed contrary to some pronouns evidence, the large prospective cohort study failed to reveal any evidence that cannabis use was associated with an increased risk of A-fib.

    Despite the good news, more research needs to be done and the federal government needs to recognize the benefits of the plant. Only then will it become part of the mainstream treats of heart disease, cancer and more. 

    [ad_2]

    Amy Hansen

    Source link

  • How to Treat High Lp(a), an Atherosclerosis Risk Factor  | NutritionFacts.org

    How to Treat High Lp(a), an Atherosclerosis Risk Factor  | NutritionFacts.org

    [ad_1]

    What could help explain severe coronary disease in someone with a healthy lifestyle who is considered to be at low cardiovascular disease risk? A young man ended up in the ER after a heart attack and was ultimately found to have severe coronary artery disease. Given his age, blood pressure, and cholesterol, his ten-year risk of a heart attack should have only been about 2 percent, but he had a high lipoprotein(a), also known as Lp(a). In fact, it was markedly high at 80 mg/dL, which may help explain it. You can see the same in women: a 27-year-old with a heart attack with a high Lp(a). What is Lp(a), and what can we do about it? 

    As I discuss in my video Treating High Lp(a): A Risk Factor for Atherosclerosis, Lp(a) is an “underestimated cardiovascular risk factor.” It causes coronary artery disease, heart attacks, strokes, peripheral arterial disease, calcified aortic valve disease, and heart failure. And these can occur in people who don’t even have high cholesterol—because Lp(a) is cholesterol, as you can see below and at 1:15 in my video. It’s an LDL cholesterol molecule linked to another protein, which, like LDL, transfers cholesterol into the lining of our arteries, contributing to the inflammation in atherosclerotic plaques. But “this increased risk caused by Lp(a) has not yet gained recognition by practicing physicians.” 

    “The main reason for the limited clinical use of Lp(a) is the lack of effective and specific therapies to lower Lp(a) plasma levels.” Because “Lp(a) concentrations are approximately 90% genetically determined,” the conventional thinking has been you’re just kind of born with higher or lower levels and there isn’t much you can do about it. Even if that were the case, though, you might still want to know about it. If it were high, for instance, that would be all the more reason to make sure all the other risk factors that you do have more control over are as good as possible. It may help you quit smoking, for example, and motivate you to do everything you can to lower your LDL cholesterol as much as possible.  

    Lp(a) levels in the blood can vary a thousand-fold between individuals, “from less than 0.1 mg/dL to as high as 387 mg/dL.” You can see a graph of the odds of heart disease at different levels in the graph below and at 2:20 in my video. Less than 20 mg/dL is probably optimal, with greater than 30 to 50 mg/dL considered to be elevated. Even when the more conservative threshold of greater than 50 mg/dL is used, that describes about 10 to 30 percent of the global population, an estimated 1.4 billion people. So, if we’re in the one in five people with elevated levels, what can we do about it? 

    The way we know that Lp(a) causes atherosclerosis is that we can put it to the ultimate test. There is something called apheresis, which is essentially like a dialysis machine where they can take out your blood, wash out some of the Lp(a), and give your blood back to you. And when you do that, you can reverse the progression of the disease. As you can see in the graph below and at 3:06 in my video, atherosclerosis continues to get worse in the control group, but it gets better in the apheresis group. This is great for proving the role of Lp(a), but it has limited clinical application, given the “cost, limited access to centers, and the time commitment required for biweekly sessions of 2 to 4 h each.” 

    It causes a big drop in blood levels, but they quickly creep back up, so you have to keep going in, as you can see in the graph below and at 3:26 in my video, costing more than $50,000 a year. 

    There has to be a better way. We’ll explore the role diet can play, next.  

    I’ve been wanting to do videos about Lp(a), but there just wasn’t much we could do about it until now. So, how do we lower Lp(a) with diet? Stay tuned for the exciting conclusion in my next video.

    What can we do to minimize heart disease risk? My video How Not to Die from Heart Disease is a good starting point. 

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • Cause of death for celebrated Dearborn music journalist Kevin Ransom revealed

    Cause of death for celebrated Dearborn music journalist Kevin Ransom revealed

    [ad_1]

    Kevin Ransom, a renowned freelance journalist from Dearborn celebrated for his engaging and unforgettable music writing, died from hypertensive cardiovascular disease, Wayne County officials told Metro Times on Thursday.

    Ransom was 69 years old when police found him dead at his home on June 1.

    The Wayne County Medical Examiner’s Office said his death was from natural causes.

    Ransom was forced into retirement about a decade ago when he began experiencing chronic fatigue syndrome and severe sleep apnea. In 2015, numerous bands came together to perform a benefit concert for Ransom at the Ark in Ann Arbor. That same year, Ransom also launched a GoFundMe campaign to help pay for his most basic needs.

    Because of his health problems, Ransom had gained a lot of weight but recently lost about 30 pounds by adopting a new diet and cutting out alcohol, according to his friend Matt Roush, a longtime tech journalist who is now managing editor of Lawrence Technological University’s media services for Yellow Flag Productions.

    In the latter stages of his life, Ransom lost touch with his family and many of his friends, and a funeral was never held.

    Although Ransom was a prolific writer on numerous subjects, he was most known for his compelling, in-depth music writing. He admired local music and helped shine a light on bands that weren’t yet nationally known. He was particularly fond of folk, roots, blues, alternative, and 1960s rock.

    Ransom also wrote about the auto industry, entertainment, business, the environment, and general features. His work appeared in more than two dozen publications, including Rolling Stone, The Detroit News, Ann Arbor News, Guitar Player, Automotive News, Heritage Newspapers, and Ford World.

    He had been a freelance reporter for decades.

    Despite his popularity among music fans, Ransom had financial troubles. He lived in a modest bungalow in Dearborn, which was originally built by his grandparents in 1949. He bought the house in 2002 after the death of his grandmother.

    In the years before his death, Ransom sported a big, white flowing beard.

    [ad_2]

    Steve Neavling

    Source link

  • Are Branched-Chain Amino Acids Good for Us?  | NutritionFacts.org

    Are Branched-Chain Amino Acids Good for Us?  | NutritionFacts.org

    [ad_1]

    I discuss why we may not want to exceed the recommended intake of protein.

    Diabetes isn’t just about the amount of body fat, but also the distribution of body fat. At 0:26 in my video Are BCAA (Branched-Chain Amino Acids) Healthy?, you can view cross-sections of thighs from two different patients using MRI. In the images, the fat shows up as white and the thigh muscle is black. At first glance, you might think the bottom cross-section has more fat since it’s ringed with more white. That is the subcutaneous fat, the fat under the skin. But, if you look at the top cross-section, you’ll see how the middle of the thigh muscle is more marbled with fat, like those really fatty Japanese beef steaks. That is the fat infiltrating into the muscle. In the graph below and at 0:48 in my video, the two cross sections are colored so you can see the different types of fat: the fat infiltrating the muscle in red, the fat between the muscles in green, and subcutaneous fat outside of the muscles and under the skin in yellow. If you add up all three types of fat, both of those thighs actually have the same amount of fat—just distributed differently.

    This seems to be the critical factor in terms of determining insulin resistance, the cause of type 2 diabetes. Researchers found that the subcutaneous adipose tissue, the fat right under the skin, was not associated with insulin resistance. Going back to the two cross sections, as seen below and at 1:20 in my video, it is healthier to have the bottom thigh with the thicker ring of subcutaneous fat but less fat infiltrating muscle than the top thigh with more fat present in the muscle.

    Is it possible a more plant-based diet also affects a more healthful distribution of fat?

    We now know the effect of a vegetarian diet versus a conventional diabetic diet on thigh fat distribution in patients with type 2 diabetes. Researchers took 74 people with diabetes and randomly assigned them to follow either a vegetarian diet or a conventional diabetic diet. Both diets were calorie-restricted by the same number of calories. The vegetarian diet was also egg-free, and dairy was limited to a maximum of one serving of low-fat yogurt a day. What did the researchers find? The reduction in the more benign subcutaneous fat was comparable; it was about the same in both groups. However, the more dangerous fat—the fat lodged inside the muscle itself—“was reduced only in response to a vegetarian diet.” So, even getting the same number of calories, there can be a healthier weight loss on a more plant-based diet.

    Those eating strictly plant-based also had lower levels of fat stuck inside the individual muscle fibers themselves, which may help explain why vegans in particular are often found to have the lowest odds of diabetes. It is not just because vegans are generally slimmer either. Even if you match subjects pound for pound, there is significantly less fat inside the muscle cells of vegans compared to omnivores. This is a good thing, since storing fat in muscle cells “may be one of the primary causes of insulin resistance,” which is what’s behind both prediabetes and type 2 diabetes. On the other hand, if you put someone on a high-fat diet, the fat in their muscle cells shoots up by 54 percent in just a single week.

    What about a high-protein diet? That may undermine one of the principal benefits of weight loss: eliminating the weight-loss-induced improvement in insulin resistance. Researchers put obese individuals on a calorie-restricted diet of less than 1,400 calories a day until they lost 10 percent of their body weight. Half of the participants were getting more of a regular protein intake (73 grams a day), and the other half were on a higher-protein diet (about 105 daily grams). Normally, if you lose 10 percent of your body weight, your insulin resistance improves. That’s why it is so critical for obese individuals with type 2 diabetes to lose weight. However, the beneficial effect of a 10 percent weight loss was eliminated by the high protein intake. Those extra 32 grams of protein a day abolished the weight-loss benefit. “The failure to improve…insulin sensitivity in the WL-HP [weight-loss high-protein] group is clinically important because it reflects a failure to improve a major pathophysiological [cause-and-effect] mechanism involved in the development of T2D,” type 2 diabetes. In summary, the researchers concluded that they demonstrated “the protein content of a weight loss diet can have profound effects on metabolic function.” 

    Is this true of any protein? As you can see below and at 4:19 in my video, if you split it between animal protein versus plant protein, following people over time, intake of animal protein is associated with an increased risk of diabetes in most studies.

    Intake of plant protein, however, appears to have either a neutral or even protective association with diabetes, as shown below and at 4:25 in my video. 

    Those were just observational studies, though. People who eat a lot of animal protein might have many unhealthy behaviors. However, you see the same thing in randomized, controlled, interventional trials, where you can improve blood sugar control just by replacing sources of animal protein with plant protein.

    We think it may be the branched-chain amino acids concentrated in animal protein. Higher levels in the bloodstream are associated with obesity and the development of insulin resistance. As you can see below and at 5:00 in my video, we may be able to drop our levels by sticking to plant proteins, but you don’t know if that has metabolic effects until you put it to the test. 

    Ruining the suspense, researchers titled their study: “Decreased Consumption of Branched-Chain Amino Acids Improves Metabolic Health.” They demonstrated that “a moderate reduction in total dietary protein or selected amino acids can rapidly improve metabolic health,” and this included improving blood sugar control, while also decreasing body mass index (BMI) and body fat. As you can see at 5:27 in my video, the protein-restricted group was eating hundreds more calories per day, significantly more calories than the control group, so they should have gained weight. But, no. They lost weight! After about a month and a half, they were eating more calories but lost more weight—about five more pounds than participants in the control group who were eating fewer calories, as you can see at 5:38 in my video. What’s more, this “protein restriction” had people eat the recommended amount of protein per day, about 56 daily grams. They should have been called the normal protein group or the recommended protein group instead, and the group eating more typically American protein levels and suffering because of it should have been called the excess protein group. Just sticking to the recommended protein intake doubled the levels of a pro-longevity hormone called FGF21, too, but we’ll save that for another discussion.

    To better understand the negative impact of omnivores getting too much protein relative to vegetarians, see my video Flashback Friday: Do Vegetarians Get Enough Protein?.

    I have several additional videos and blogs that may help explain some of the benefits of plant-based proteins. Check in the related posts below.

    Of course, the best way to treat type 2 diabetes is to get rid of it by treating the underlying cause, as described in my video How Not to Die from Diabetes. 

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • The Efficacy of Weight-Loss Supplements  | NutritionFacts.org

    The Efficacy of Weight-Loss Supplements  | NutritionFacts.org

    [ad_1]

    Are there any safe and effective dietary supplements for weight loss?

    In a previous discussion, I noted that an investigation found that four out of five bottles of commercial herbal supplements bought at major U.S. retailers—GNC, Walgreens, Target, and Walmart—didn’t contain any of the herbs listed on their labels, instead “often containing little more than cheap fillers like powdered rice, asparagus and houseplants…”

    You might hope your supplement just contains houseplants. Weight-loss supplements are infamous for being “adulterated with prescription and over-the-counter” drugs. In a sampling of 160 weight-loss supplements that “were claimed as 100% natural,” more than half were tainted with drugs and active pharmacological ingredients, ranging from antidepressants like Prozac to erectile dysfunction medications like Viagra. Diuretic drugs are frequent contaminants, which makes sense. In my previous videos on ketogenic diets, I talk about rapid water loss being “the $33-billion diet gimmick” that has sold low-carb diets for more than a century. But why the Viagra?

    At least the spiked Viagra and Prozac are legal drugs. Researchers in Denver tested every weight-loss supplement they could find within a ten-mile radius. Alarmingly, they found that a third were adulterated with banned ingredients. The most common illegal adulterant of weight-loss supplements is sibutramine, which was sold as Meridia before it was yanked off the market back in 2010 for heart attack and stroke risk. Now, it is also blamed for cases of slimming supplement–induced psychosis.

    An analysis of weight-loss supplements bought off the internet that were advertised with claims like “purely natural products,” “harmless,” or “traditional herbal” found that a third of them contained high doses of the banned drug sibutramine and the rest had caffeine. Wouldn’t you be able to tell if caffeine was added to a supplement? Perhaps not, if it also had temazepam, a controlled substance (benzodiazepine) “downer” sedative found in half of the caffeine-tainted supplements.

    Doesn’t the FDA demand recalls of adulterated supplements? Yes, but they often just pop back up on store shelves. Twenty-seven supplements were purchased at least six months after recalls were released, and two-thirds still contained banned substances. That’s 17 out of 27 with the same pharmaceutical adulterant found originally, and 6 containing one or more additional banned ingredients. Aren’t the manufacturers penalized for noncompliance? Yes, but “the fines for violations are small compared to the profits.”

    One of the ways supplement makers can skirt the law is by labeling them as “not intended for human consumption because it shifts the responsibility from the seller to the user”—for example, labeling the fatal fat-burner DNP as “an industrial- or research chemical.” This is how designer street drugs can be sold openly at gas stations and convenience stores as “bath salts.” Another way is to claim synthetic stimulants added to slimming supplements are actually natural food constituents, like listing the designer drug dimethylamylamine (DMAA) as “geranium oil extract.” The FDA banned it in 2012 after it was determined that DMAA “was not found in geraniums.” Who eats geraniums anyway? Despite being tentatively tied to cases of sudden death and associated with hemorrhagic stroke, DMAA has continued to be found in weight-loss supplements with innocuous names like Simply Skinny Pollen made by Bee Fit with Trish.

    There is little doubt that certain banned supplements, like ephedra, could help people lose weight. “There’s only one problem, and it’s a big one: This supplement may kill you,” wrote a founding member of the American Board of Integrative Medicine.

    Are there any safe and effective dietary supplements for weight loss? As I discuss in my video Friday Favorites: Are Weight-Loss Supplements Safe and Effective?, when popular slimming supplements were put to the test in a randomized placebo-controlled trial, not a single one could beat out placebo sugar pills. “A systematic review of systematic reviews” of diet pills came to a similar conclusion: None appears to generate appreciable impacts “on body weight without undue risks.” That was the conclusion reached in a similar review out of the Weight Management Center at Johns Hopkins, which ended with: “In closing, it is fitting to highlight that perhaps the most general and safest alternative/herbal approach to weight control is to substitute low-energy density [low-calorie] foods for high-energy density and processed foods, thereby reducing total energy intake.” In other words, eat more whole plant foods and fewer animal foods and junk. “By taking advantage of the low-energy density [low-calorie] and health-promoting effects of plant-based foods, one may be able to achieve weight loss, or at least assist weight maintenance without cutting” down on the volume of food consumed or compromising its nutrient value.

    Learn more about the risks of supplements in my video Are Weight Loss Supplements Safe?.

    I referred to a keto diet video I did, check out the related posts below the links to other videos and blogs in that series.

    Learn more about optimal weight loss in my book, How Not to Diet. 

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • The Safety of Weight-Loss Supplements  | NutritionFacts.org

    The Safety of Weight-Loss Supplements  | NutritionFacts.org

    [ad_1]

    Only 2 out of 12 supplement companies were found to have weight-loss products that were even accurately labeled.

    According to a national survey, one-third of adults who have made serious attempts at weight loss have tried using dietary supplements, for which Americans spend billions of dollars every year. Most people mistakenly thought that over-the-counter appetite suppressants, herbal products, and weight-loss supplements had to be approved for safety by a governmental agency, like the U.S. Food and Drug Administration (FDA), before being sold to the public or at least include some kind of warning on the label about potential side effects. Nearly half even thought they had to demonstrate some sort of effectiveness. None of that is true.

    As I discuss in my video Friday Favorites: Are Weight Loss Supplements Safe and Effective?, the “FDA has estimated that dietary supplements cause 50,000 adverse events annually,” most commonly liver and kidney damage. Of course, prescription drugs don’t just have adverse effects; they kill more than 100,000 Americans every year. But, you at least notionally have the opportunity to parse out the risks versus benefits of prescription drugs, thanks to testing and monitoring requirements typically involving thousands of individuals.

    When the manufacturer of Metabolife 356, a supplement containing ephedrine, had it tested on 35 people, only minor side effects were found, such as dry mouth, headache, and insomnia. However, once unleashed on a broad population, nearly 15,000 adverse effects were reported, including heart attacks, strokes, seizures, and deaths, before it was pulled from the market.

    Given the lack of government oversight, there is no guarantee that what’s on the label is even in the bottle, as you can see in the graph below and at 1:55 in my video. FDA inspectors have found that 70 percent of supplement manufacturers violated so-called Good Manufacturing Practices, which are considered the minimum quality standards. This includes things like basic sanitation and ingredient identification. Not 7 percent in violation, but 70 percent.

    DNA testing of herbal supplements across North America found that most could not be authenticated. In a significant percentage of the supplements tested, the main labeled ingredient was missing completely and substituted with something else. For example, a so-called St. John’s wort supplement contained nothing but senna, a laxative that can cause anal blistering. Only 2 out of 12 supplement companies had products that were accurately labeled.

    This problem isn’t limited to fly-by-night phonies in some dark corner of the internet either. The New York State Attorney General commissioned DNA testing of 78 bottles of commercial herbal supplements sold by Walgreens, Walmart, Target, and GNC “and found that four out of five…did not contain any of the herbs on their labels.” Instead, the capsules “often contained little more than cheap fillers like powdered rice, asparagus and houseplants…”

    What about weight-loss medications? See Are Weight Loss Pills Safe? and Are Weight Loss Pills Effective?. Also, see related posts below.

    Take a deep dive into the best way to lose weight with my book How Not to Diet. 

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • The Safety of Fasting to Lose Weight  | NutritionFacts.org

    The Safety of Fasting to Lose Weight  | NutritionFacts.org

    [ad_1]

    Why should fasts lasting longer than 24 hours and particularly for three or more days only be done under the supervision of a health professional and preferably in a live-in clinic? 
     
    Fasting for a week or two can actually interfere with the loss of body fat, as shown at the start of my video Is Fasting for Weight Loss Safe?. But, eventually, after the third week of fasting, fat loss starts to overtake the loss of lean body mass in obese individuals, as seen in the graph below and at 0:14 in my video. Is it safe to go that long without food? 

    Proponents speak of fasting as a cleansing process, but some of what is being purged from our bodies are essential vitamins and minerals. People who are heavy enough can fast up to 382 days without calories, but no one can go even a fraction of that long without vitamins. Scurvy, for example, can be diagnosed within as few as four weeks without any vitamin C. Beriberi, deficiency of thiamine (vitamin B1), may start even earlier in fasting patients. And, once it manifests, it can result in brain damage within days, which can eventually become irreversible.  
     
    Even though fasting patients report problems such as nausea and indigestion after taking supplements, all of the months-long fasting cases I’ve discussed previously were given daily multivitamins and mineral supplementation as necessary. Without supplementation, hunger strikers and those undergoing prolonged fasts for therapeutic or religious purposes (like the Baptist pastor hoping “to enhance his spiritual powers for exorcism”) have ended up paralyzed, become comatose, or worse. 
     
    Nutrient deficiencies aren’t the only risk. After reading about all of the successful reports of massive weight loss from prolonged fasting in the medical literature, one doctor decided to give it a try with his patients. Of the first dozen he tried it on, two died. In retrospect, the two patients who died had started out with heart failure and had been on diuretics. Fasting itself produces pronounced diuresis, meaning loss of water and electrolytes through the urine, so it was the combination of fasting on top of the water pills that likely depleted their potassium and triggered their fatal heart rhythms. The doctor went out of his way to point out that both of the people who died started out “in severe heart failure, complicated by gross obesity; but both had improved greatly whilst undergoing starvation therapy.” That seems like a small consolation since they were both dead within a matter of weeks. 
     
    Not all therapeutic fasting fatalities were complicated by concurrent medication use, though. One researcher writes: “At first he did very well and experienced the usual euphoria…His pulse, blood pressure, and electrolytes remained satisfactory, but in the middle of the third week of treatment, he suddenly collapsed and died. This line of treatment is certainly tempting because it does produce weight loss and the patient feels so much better, but the report of case-fatalities”—the whole part about killing people—“must make it a very suspect line of management.” 
     
    Contrary to the popular notion that the heart muscle is specially spared during fasting, the heart appears to experience similar muscle wasting. This was “described in the victims of the Warsaw ghetto” during World War II in a remarkable series of detailed studies carried out by the ghetto physicians before they themselves succumbed. In a case entitled “Gross Fragmentation of Cardiac Fiber After Therapeutic Starvation for Obesity,” a 20-year-old woman successfully “achieved her ideal weight” after losing 128 pounds by fasting for 30 weeks. “After a breakfast of one egg,” she had a heart attack and died. On autopsy, as you can see below and at 3:44 in my video, the muscle fibers in her heart showed evidence of widespread disintegration. The pathologists suggested that fasting regimens “should no longer be recommended as a safe means of weight reduction.” 
    Breaking the fast appears to be the most dangerous part. After World War II, as many as one out of five starved Japanese prisoners of war tragically died following liberation. Now known as “refeeding syndrome,” multiorgan system failure can result from resuming a regular diet too quickly. This is because there are critical nutrients such as thiamine and phosphorus that are used to metabolize food. Therefore, in the critical refeeding window, if too much food is taken before these nutrients can be replenished, demand may exceed supply. Whatever residual stores you still carry can be driven down even further, with potentially fatal consequences. This is why rescue workers are taught to always give thiamine before food to victims who have been trapped or otherwise unable to eat. Thiamine is responsible for the yellow color of “banana bags,” a term you might have heard used in medical dramas to describe an IV fluid concoction often given to malnourished alcoholics to prevent a similar reaction. (You can see a photo of them below and at 4:53 in my video.) Anyone “with negligible food intake for more than five days” may be at risk of developing refeeding problems. 
    Medically-supervised fasting has gotten much safer now that there are proper refeeding protocols. We now know what warning signs to look for and who shouldn’t be fasting in the first place, such as those who have advanced liver or kidney failure, porphyria, uncontrolled hyperthyroidism, and pregnant and breastfeeding women. The most comprehensive safety analysis of medically supervised, water-only fasting was recently published by the TrueNorth Health Center in California. Out of 768 visits to its facility for fasts up to 41 days, were there any adverse events? There were 5,961 of them! Most of these were mild, known reactions to fasting, such as fatigue, nausea, insomnia, headache, dizziness, upset stomach, and back pain. Only two serious events were reported, and no fatalities. You can see the chart below and at 5:58 in my video. 
    “Fasting periods lasting longer than 24 hr, and particularly those lasting 3 or more days, should be done under the supervision of a physician and preferably in a [live-in] clinic.” In other words, don’t try this at home! This is not just legalistic mumbo-jumbo. For example, normally, your kidneys dive into sodium conservation mode during fasting, but should that response break down, you could rapidly develop an electrolyte abnormality that may only manifest with non-specific symptoms, like fatigue or dizziness, which could easily be dismissed until it’s too late. 
     
    The risks of any therapy must be premised on the severity of the disease. The consequences of obesity are considered so serious that effective therapies could have “considerable acceptable toxicity.” For example, many consider major surgery for obesity to be a justifiable risk, but the keyword is effective. 
     
    Therapeutic fasting for obesity has largely been abandoned by the medical community not only because of its uncertain safety profile but its questionable short- and long-term efficacy. Remember, for a fast that only lasts a week or two, you might be able to lose as much body fat or even more on a low-calorie diet than a no-calorie diet. 
     
    Fasting for a week or two can actually interfere with the loss of body fat. For more background on this, see Is Fasting Beneficial for Weight Loss? and Benefits of Fasting for Weight Loss Put to the Test.
     
    If you’re wondering what the best way to lose weight is, I wrote a whole book about it! Check out How Not to Diet. 
     
    Interested in learning more about fasting? See related videos below. 

    [ad_2]

    Michael Greger M.D. FACLM

    Source link

  • High-Salt Diet a Danger Even With Normal Blood Pressure

    High-Salt Diet a Danger Even With Normal Blood Pressure

    [ad_1]

    April 10, 2023 – It is well-known that high blood pressure is a risk factor for heart attacks and strokes.

    Now, new research from Sweden has shown that too much salt in the diet is an important risk factor for clogged arteries in the neck and heart, increasing the risk of heart attacks and strokes even if you don’t have high blood pressure.

    The study was published online in European Heart Journal Open.

    The finding raises the possibility that salt could cause damage even before someone develops high blood pressure, said study author Jonas Wuopio, MD, of the Karolinska Institutet, Huddinge, and Clinical Research Center at Uppsala University in Sweden.

    Salt is bad for heart health because of its link to high blood pressure, also known as hypertension, but the role salt plays in the development of plaque in the arteries has not been examined, Wuopio said.

    “Ours is the first study to examine the association between a high salt intake and hardening of the arteries in both the head and neck. The association was linear, meaning that each rise in salt intake was linked with more atherosclerosis,” he said.

    The study included 10,778 adults ages 50 to 64. The research team measured the amount of salt found in the their urine to estimate their salt consumption. 

    The researchers then captured images of the arteries of the heart to check for calcium and blockages or stenosis, and ultrasound to detect blockages in the carotid arteries in the neck.

    They found that the more salt people consumed, the higher their risk of calcifications in the heart and neck arteries. 

    The findings were seen even after the researchers excluded people with high blood pressure.

    “This means that it’s not just patients with high blood pressure or heart disease who need to watch their salt intake,” Wuopio said.

    He tells his patients to follow guidance from the World Health Organization and other groups to limit salt to about a teaspoon a day. 

    “It can be hard to estimate how much salt we eat, so I advise patients to limit the use of table salt, or to replace salt with a salt substitute,” he said.

    Food is Medicine

    The lower you can get your blood pressure, the better, said Alon Gitig, MD, an assistant professor and director of cardiology for Mount Sinai Doctors in Westchester, NY. 

    “Everybody knows that high blood pressure is associated with future cardiovascular disease risk, but what many don’t realize is that that risk starts to increase” even at the upper end of what is considered normal. “Most of the people in the U.S. over the age of 60 have hypertension,” Gitig said.

    A good way to lower your blood pressure is through diet, exercise, and maintaining a healthy weight, he said.

    The Dietary Approaches to Stop Hypertension (DASH) diet – which suggests several servings of fruits and vegetables a day, with few refined carbohydrates, flour, and sugar – has been shown in a study to dramatically lower blood pressure, Gitig said.

    “There are two reasons for that. One is that fruits and vegetables have many phytonutrients that are good for our arteries. The other is that most of U.S. adults have insulin resistance, and insulin resistance leads to high blood pressure,”  he said. 

    Eating more fruits and vegetables and lean meats while limiting sugar and flour will improve insulin resistance. Do that, Gitig said, “and you can bring your blood pressure down that way.”

    [ad_2]

    Source link

  • 11 Possible Heart Symptoms You Shouldn’t Ignore

    11 Possible Heart Symptoms You Shouldn’t Ignore

    [ad_1]

    If something went wrong with your heart, would you know it?

    Not all heart problems come with clear warning signs. There is not always an alarming chest clutch followed by a fall to the floor like you see in movies. Some heart symptoms don’t even happen in your chest, and it’s not always easy to tell what’s going on.

    “If you’re not sure, get it checked out,” says Charles Chambers, MD, director of the Cardiac Catheterization Laboratory at Penn State Hershey Heart and Vascular Institute.

    That’s especially true if you are 60 or older, are overweight, or have diabetes, high cholesterol, or high blood pressure, says Vincent Bufalino, MD, an American Heart Association spokesman. “The more risk factors you have,” he says, “the more you should be concerned about anything that might be heart-related.”

    Especially watch out for these problems:

    1. Chest Discomfort

    It’s the most common sign of heart danger. If you have a blocked artery or are having a heart attack, you may feel pain, tightness, or pressure in your chest.

    “Everyone has a different word for that feeling,” Chambers says. “Some people say it’s like an elephant is sitting on them. Other people say it’s like a pinching or burning.”

    The feeling usually lasts longer than a few minutes. It may happen when you’re at rest or when you’re doing something physical.

    If it’s just a very brief pain — or if it’s a spot that hurts more when you touch or push on it — it’s probably not your heart, Chambers says. You should still get it checked out by a doctor. If the symptoms are more severe and don’t go away after a few minutes, you should call 911.

    Also, keep in mind you can have heart problems — even a heart attack — without chest pain. That’s particularly common among women.

    2. Nausea, Indigestion, Heartburn, or Stomach Pain

    Some people have these symptoms during a heart attack. They may even vomit, Chambers says.

    Women are more likely to report this type of symptom than men are.

    Of course, you can have an upset stomach for many reasons that have nothing to do with your heart. It could just be something you ate, after all. But you need to be aware that it can also happen during a heart attack.

    So if you feel this way and you’re at risk for heart problems, let a doctor find out what’s going on, especially if you also have any of the other symptoms on this list.

    3. Pain that Spreads to the Arm

    Another classic heart attack symptom is pain that radiates down the left side of the body.

    “It almost always starts from the chest and moves outward,” Chambers says. “But I have had some patients who have mainly arm pain that turned out to be heart attacks.”

    4. You Feel Dizzy or Lightheaded

    A lot of things can make you lose your balance or feel faint for a moment. Maybe you didn’t have enough to eat or drink, or you stood up too fast.

    But if you suddenly feel unsteady and you also have chest discomfort or shortness of breath, get medical help right away.

    “It could mean your blood pressure has dropped because your heart isn’t able to pump the way it should,” Bufalino says.

    5. Throat or Jaw Pain

    By itself, throat or jaw pain probably isn’t heart related. More likely, it’s caused by a muscular issue, a cold, or a sinus problem.

    But if you have pain or pressure in the center of your chest that spreads up into your throat or jaw, it could be a sign of a heart attack. Call 911 and seek medical attention to make sure everything is all right.

    6. You Get Exhausted Easily

    If you suddenly feel fatigued or winded after doing something you had no problem doing in the past — like climbing the stairs or carrying groceries from the car — make an appointment with your doctor right away.

     

    “These types of significant changes are more important to us than every little ache and pain you might be feeling,” Bufalino says.

     

    Extreme exhaustion or unexplained weakness, sometimes for days at a time, can be a symptom of heart disease, especially for women.

    7. Snoring

    It’s normal to snore a little while you snooze. But unusually loud snoring that sounds like a gasping or choking can be a sign of sleep apnea. That’s when you stop breathing for brief moments several times at night while you are still sleeping. This puts extra stress on your heart.

    Your doctor can check whether you need a sleep study to see if you have this condition. If you do, you may need a CPAP machine to smooth out your breathing while you sleep.

    8. Sweating

    Breaking out in a cold sweat for no obvious reason could signal a heart attack. If this happens along with any of these other symptoms, call 911 to get to a hospital right away. Don’t try to drive yourself.

    9. A Cough That Won’t Quit

    In most cases, this isn’t a sign of heart trouble. But if you have heart disease or know you’re at risk, pay special attention to the possibility.

    If you have a long-lasting cough that produces a white or pink mucus, it could be a sign of heart failure. This happens when the heart can’t keep up with the body’s demands, causing blood to leak back into the lungs.

    Ask your doctor to check on what’s causing your cough.

     

    10. Your Legs, Feet, and Ankles Are Swollen

    This could be a sign that your heart doesn’t pump blood as effectively as it should.

    When the heart can’t pump fast enough, blood backs up in the veins and causes bloating.

    Heart failure can also make it harder for the kidneys to remove extra water and sodium from the body, which can lead to bloating.

    11. Irregular Heart Beat

    It can benormal for your heart to race when you are nervous or excited or to skip or add a beat once in a while.

    But if you have started feeling palpitations, check in with your doctor. Call 911 if you have palpitations or an irregular heartbeat that persists or if you also have any chest pain or pressure, dizziness, or shortness of breath.

    “In most cases, it’s caused by something that’s easy to fix, like too much caffeine or not enough sleep,” Bufalino says. But occasionally, it could signal a condition called atrial fibrillation that needs treatment. So ask your doctor to check it out.

    [ad_2]

    Source link

  • Staying Active With Advancing Heart Failure

    Staying Active With Advancing Heart Failure

    [ad_1]

    By Richard Josephson, MD, as told to Stephanie Watson

    Back in the middle of the 20th century, there was a concern that people with cardiovascular disease could hurt themselves if they exercised. People with heart failure used to be confined to their bed for long periods of time. Now we know that exercise, when done safely, doesn’t damage the heart. It can actually protect the heart and lower the chances of future problems.

    In most people with heart failure, the main symptom is exercise intolerance, which people often describe as fatigue or shortness of breath. You may feel tired, be unable to work, or have trouble just walking down the street or around your home. Staying active can help your body work better.

    While you can begin to exercise on your own, I don’t recommend it. It’s safer for people with heart failure to exercise in a place where they’re monitored and supported during training. That’s where cardiac rehabilitation can help.

    What is cardiac rehabilitation?

    Cardiac rehabilitation is a supervised program that helps you do more and feel better while you’re doing it. It helps condition your body to work harder, so that you can do tasks, chores, and activities with far fewer symptoms. It may also make it less likely that you’ll go to the hospital. It can also help you live longer.

    The core of this program is exercise-based therapy. That’s typically aerobic exercise, with some resistance or strength training. Often flexibility and balance is part of it, too. Cardiac rehab also covers nutrition and diet, and it offers education about the heart failure disease process and treatment.

    One of the key things is that it’s individualized. The difference between taking part in a cardiac rehab program and doing a Zumba or spin class at your local gym is that the exercise program is tailored to you. The other key feature is that it is supervised and directed by knowledgeable health care providers.

    First, you go through an evaluation to check your abilities and limitations. Then the staff creates an individualized program, with some input from you.

    A health team will supervise your program, including a doctor, nurses, and exercise physiologists, with some help from dietitians and psychologists or counselors. The staff will monitor your symptoms and vital signs like your blood pressure, EKG, and blood oxygen levels to make sure you’re exercising safely.

    Your cardiologist or primary care doctor should also be involved. You’ll need to get an order from one of your doctors to take part in a cardiac rehab program, and they may monitor your progress while you’re in it.

    What types of exercise are best for people with heart failure?

    Aerobic exercise is the foundation of physical activity for heart failure. That includes any kind of exercise that gets your heart pumping and makes your body need more oxygen. It generally involves using large muscle groups like your upper arms and legs.

    Swimming, walking, or riding a bicycle all count as aerobic exercise. These are good additions to your cardiac rehab sessions, and you can continue them after you finish your program. Do whatever type you like best, so that you know you’ll stick with it over the long term.

    Other types of exercise can be beneficial, too, including strength training. Yoga and tai chi help with balance and flexibility. They can also be very calming. 

    How often should you exercise, and for how long?

    To improve your cardiovascular health, you want to exercise for at least 20 minutes a day, 3 to 4 days a week. While more exercise may be better, there’s probably not much benefit to going beyond 60 minutes a day. If you do want to spend an hour exercising, you can do aerobics for 45 minutes and strength training or flexibility exercises for 15 minutes.

    People who are just starting out may only be able to exercise for 5 minutes at a time. That’s fine. Do 5 minutes of exercise, rest, and then do another 5 minutes of exercise. Ultimately you can aim for the full 20 minutes.

    Most cardiac rehab programs happen three times a week over several months, for about 36 sessions in total. Over that time, the intensity of the exercise goes up gradually, which is important for helping your heart work better. If you walked on a treadmill for the same amount of time and at the same setting for years, you’d never get more fit.

    Who shouldn’t exercise?

    If you can barely get out of bed or walk around the room without the help of a walker, you’re not a good candidate for exercise or cardiac rehabilitation. That doesn’t mean you won’t ever be able to exercise. You can do physical therapy for a few weeks to improve your balance, strength, and walking ability. Once you feel stronger, then you can enroll in cardiac rehab.

    What symptoms should make me stop exercising?

    If you feel tired or short of breath at an unusually low level of exercise, that should be a red flag. For example, if you can normally exercise for 10 minutes, and now you’re getting short of breath after 2 minutes, tell your doctor or exercise physiologist.

    More potentially dangerous symptoms are things like lightheadedness or dizziness, chest pressure or pain, and an irregular heart rate. A cardiovascular rehab program should monitor for those kinds of symptoms. If the staff checks your blood pressure, heart rate, and oxygen level and finds that your measurements are OK, you should be able to continue exercising.

    [ad_2]

    Source link

  • What Does Ejection Fraction Have to Do With Heart Failure?

    What Does Ejection Fraction Have to Do With Heart Failure?

    [ad_1]

    By Steven Schiff, MD, as told to Stephanie Booth

    My patients’ concerns about heart failure are usually, “What is my prognosis?” “What are the treatments, like medication and surgery, that are available to me?” But some people will ask me for their ejection fraction (EF) number if they’ve read about it, or had it discussed with them. This is especially true if they want to know if it’s changing over time.

    What is EF?

    EF is one of many measurements of how well your heart works.  It measures the active pump function of your heart when it contracts and pumps blood out of your heart and into your arteries. 

    Technically, EF is the percentage (fraction) of blood that is ejected from your heart as it contracts. (This is also known as the stroke volume). 

    Mathematically, EF is the amount of blood pumped with each beat, divided by the amount of blood in the chamber when it’s filled. 

    Your heart has two phases for each heartbeat:

    • A filling phase (diastole)
    • A contraction or emptying phase (systole) 

    Therefore, EF is the stroke [contracted] volume/diastolic volume.

    What does EF have to do with heart failure?

    A low ejection fraction lets a doctor know that the active pumping phase of the heart isn’t working. It’s usually tied to some, but not all, types of heart failure. 

    Heart failure with a low EF is called “systolic” heart failure.

    How is EF measured?

    EF is usually measured, with an echocardiogram or cardiac ultrasound. It can also be measured during a heart angiogram and catheterization. That’s when catheters (tubes) are put inside of you through an artery, into your heart chambers. 

    Other measurement techniques include:

    • Cardiac MRI
    • Cardiac nuclear scans
    • Cardiac CT scans 

    All of these techniques are estimates, and can show slightly different results in the same person.

    What do EF numbers mean?  

    Normal EF is in the range of 55% to 70%.  As the percentage falls, it tells the doctor that the heart failure is getting worse. In general, if the EF falls below 30%, it’s relatively severe.  A reading of 20% or below is very severe heart failure. 

    It’s important to know that there’s not always a perfect correlation between symptoms and the EF. In addition, an EF above 75% is considered too high, and can be a problem as well.

    How can your EF help manage your heart health?

    Your EF can be a way of assessing the status and progression of heart failure over time, as well as a way to track the benefits of various heart failure treatments.

    For instance, you may be told your EF, then start on medication or go for surgery, and may want to know: “Did my EF go up or down?” We can track serial measurements of EF (usually by echocardiogram) to see if your treatment is helping.

    How can you have normal EF and heart failure?

    Heart failure with a normal EF is happening more and more often. It’s generally related to the filling phase of the heart’s cycle of filling and emptying. It is called “diastolic heart failure.”

    Normal hearts are very compliant. This means that they fill easily, at relatively low pressures. Sometimes, even though the heart contracts normally (normal EF), it might need higher pressure to fill for each beat. 

    If so, you can have symptoms of heart failure even though your heart contracts normally, with a normal EF. You could have fluid accumulation and overload. We see this most frequently in people with untreated high blood pressure.

    Should you find out your EF?

    Most people without cardiac issues don’t need to know their EF.

    If you’re simply worried about this, ask your doctor if you should be concerned. A simple echocardiogram will provide a good estimate.

    The most important thing to know, if you have been told of heart failure, is what the underlying cause is. That will affect your prognosis, treatment, testing and follow-up. 

    Among the most common causes [of heart failure] are:

    • Coronary artery disease
    • Heart attacks
    • High blood pressure
    • Heart valve problems 

    Once you’ve been given a heart failure diagnosis, you should be seen by a cardiologist for a careful review of your underlying causes, the status of your heart failure, your current treatment, follow up, and prognosis.

    [ad_2]

    Source link

  • Despite Progress, Black Americans See Heart Health Disparities

    Despite Progress, Black Americans See Heart Health Disparities

    [ad_1]

    Feb. 22, 2023 – It was week 17 of what should have been a typical Monday Night Football showdown featuring the Buffalo Bills and the Cincinnati Bengals. But Bills safety Damar Hamlin’s tackle of Bengals receiver Tee Higgins may ultimately have been a game changer – not only for football, but for heart disease disparities in the U.S. as well.

    Hamlin, 24, who had sudden cardiac arrest after getting hit in the chest by Higgins’s right shoulder during the first quarter of the Jan. 2 matchup, was down for roughly 19 minutes while first responders did cardiopulmonary resuscitation (CPR) and used an automated external defibrillator (AED) to restart his heart. The incident – which has focused attention on a rare condition (commotio cordis) and the importance of public action – may also be a turning point for a community that has long been in the spotlight for having poor heart health: Black Americans.

    “Even though we’ve made tremendous progress in reducing the burden of heart attack and stroke, we need a different approach to get everyone’s attention,” says Clyde Yancy, MD, chief of cardiology and vice dean for diversity and inclusion at Northwestern Medicine in Chicago, and past president of the American Heart Association.

    “Case in point is the episode with Damar Hamlin; everybody in the country is now aware of the benefit of CPR,” he says. “We haven’t always been able to leverage a moment that gets the attention of the community in such a rapid and robust way.”

    This especially true of many Black Americans, for whom community support for health and wellbeing is common.   

    “That’s the beginning of change that can happen across the board,” Yancy says.

    Persisting Disparities, Social Ties

    Black adults continue to have the highest rates of hypertension (high blood pressure) and have related complications at an earlier age, according to the American Heart Association. 

    Increased rates of heart failure, stroke, and narrowed blood vessels that reduce blood flow to the limbs (peripheral artery disease) also disproportionately affect Black Americans, even though overall rates of coronary heart disease are not significantly different than those found in white peers. 

    Moreover, recent findings from the ongoing Multi-Ethnic Study of Atherosclerosis (hardening of the arteries) show that compared with white, Chinese, and Hispanic people, Black people had the highest rates of dying from all causes, and after adjusting for age and sex, a 72% higher risk of dying from heart disease vs. white peers.

    “Once we adjusted for social determinants of health, the differences between Blacks and whites for the likelihood to die nearly went away,” explains Wendy Post, , MD, a professor of cardiology at Johns Hopkins Medicine in Baltimore and lead author of the study. “Meaning that if we had the same environment, we probably would have similar mortality rates.”

    With regard to “environment,” Post is referring to the impact of non-medical factors on health outcomes, better known as social determinants of health. More and more, research is focusing on how these factors tend to sustain health inequities and worse cardiovascular outcomes in Black Americans. 

    “We’re beginning to understand that this significant increase in cardiovascular disease is due to significant differences in social determinants of health. This can include everything from access to routine health care, insurance coverage, medications and, also, food supply and access to healthy food,” says Roquell Wyche, MD, a Washington, DC-based cardiologist. 

    Wyche explains that social determinants of health can also “include housing, access to a healthy environment that facilitates exercise, where a person can feel safe in their environment, socioeconomic status, work and job security, and transportation. All of these have significant impacts on cardiovascular health, and African-Americans experience greater social disadvantages across all of these determinants.” 

    Currently, the World Health Organization estimates that social determinants of health are responsible for as much as 55% of health outcomes overall. 

    Quentin Youmans, MD, a cardiology fellow at Northwestern Medicine Bluhm Cardiovascular Institute in Chicago, echoes Wyche, pointing to rates of high blood pressure in the Black community as an example. 

    “When we think about the main primary contributor for poor health and cardiovascular health, we think about hypertension as being one of the primary causes in Black Americans. And it’s not just the prevalence of hypertension; we know that Black patients, even if they have a diagnosis, are less likely to have their blood pressures controlled,” he says.

    “This [hypertension] is a very insidious disease” that can be undiagnosed and may not cause symptoms until a patient goes to the doctor with either cardiovascular disease or a stroke. “And, so, because of these factors that contribute to not having access to care, patients may have hypertension for longer.”

    Importantly, access to care includes access to proven treatments. A National Institutes of Health-supported study published last month in Circulation: Heart Failure showed that Black patients treated at heart failure specialty centers were roughly half as likely to receive evidence-based, life-changing therapies (such as transplants or mechanical blood pumps known as ventricular assist devices, or VADs) as white adults.

    But when the researchers accounted for things that affect health outcomes, including disease severity and social determinants of health such as education, income, and insurance, disparities remained, even when patients expressed the same preference for lifesaving treatments. In their discussion, the study authors also suggested that unconscious bias and structural racism also contribute to how these health determinants play out across many conditions.

    “We need to look at and see how structural racism is really affecting African Americans, particularly in social determinants of health,” notes Wyche, who’s also leadership development chair for the American Heart Association’s Greater Washington Region Board of Directors. 

    Still, this is not to say that genetics are not important, but even a family tendency to have conditions linked to heart disease – such as type 2 diabetes – have direct ties to determinants of health. For example, poor access to healthy food or the ability to afford medicine can worsen diabetes or, more importantly, the ability to reverse prediabetes (the stage before diabetes) with lifestyle changes. Currently, the American Heart Association estimates that Black American men get diabetes 1.5 times more often than white men, and Black women 2.4 times more often than white women. 

    A Path Forward

    Structural racism and even unconscious bias play key roles in keeping up poor heart health outcomes in African Americans. Yancy emphasizes how the preponderance of heart disease is both a risk and an opportunity.

    “We know strategies that work; we have evidence that demonstrates that we can change the arc of this disease burden, and we can improve outcomes,” he says. “So, the greatest risk, the greatest need truly is in those who are self-described as African American or Black. But the greatest opportunity exists there as well if we deploy those things that we know to be true based on sound evidence.” 

    Yancy explains that in 2010, he helped lead American Heart Association efforts to drive change through the creation of “Life’s Simple 7” (updated in 2022 to Life’s Essential 8), which is a guidepost for achieving better heart health outcomes by changing certain behaviors and key measures of cardiovascular disease: diet, sleep, physical activity, smoking cessation, weight management, cholesterol, blood sugar, and blood pressure. 

    “Primordial prevention, which is prevention of risk itself, is a key consideration,” he says. “This really gets to the root cause of why we see hypertension and diabetes – so much of this is related to early childhood dietary decisions and physical activity.”

    Now, he says, “we just have to adopt the will to make changes at the community level.”

    One strategy, Wyche says, is to seek medical care in early adulthood, both to establish some sort of prevention strategy before disease develops, and to learn if risk factors such as high blood pressure or high cholesterol are already starting to drive full-blown conditions.

    “Just as annual routine medical care is key, we are noticing that particularly in African American women as early as their 20s, that they’re showing evidence of cardiovascular disease.” 

    Another strategy is to recognize that social determinants of health and related health outcomes are commonly found across generations and families, and to see it as an opportunity.

    “The main thing that comes to mind is engaging not just the patient, but recognizing that risk can sometimes be generational,” says Youmans. “If we can shift our focus [from] the individual patient and think about generations and entire families, then we might be able to encourage more people to follow the recommendations needed to achieve ideal or optimal health.”

    Yancy, Youmans, Post, and Wyche remain optimistic, even amid the disparities in health care access and outcomes – and increased public attention their link to oppressive structures and policies – that both COVID-related disruptions and Black Lives Matter, respectively, have brought to the fore. 

    “I believe that we’ve gone through a generational movement,” says Yancy. “I think that in 10 years, we’ll see the positive yield of transformational experiences in the last 3 years with a more diversified workforce, a workforce that is more aware of the disease burden in the community members, community members that recognize the maladies of their own social environment, and leaders seeking change vis-a-vis public policy for change.”

    [ad_2]

    Source link

  • Heart Failure Risk: Where You Live, What You Look Like, and Where You Come From

    Heart Failure Risk: Where You Live, What You Look Like, and Where You Come From

    [ad_1]

    Photo Credit: Alistair Berg / Getty Images

    SOURCES:

    Bani Azari MD, PhD, founding medical director, program for cardiac genetics, genomics and precision medicine, Northwell Health; member, National Medical Hispanic Association, Hempstead, NY.

    Sabra Lewsey, MD, MPH, cardiologist specializing in heart failure and assistant professor, Johns Hopkins University School of Medicine, Baltimore, MD.

    Nilay S. Shah, MD, MPH, assistant professor of medicine (cardiology) and preventive medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.

    Rigved Tadwalkar, MD, cardiologist, Providence Saint John’s Health Center, Santa Monica, CA.

    CDC: “What is Health Literacy?” 

    American Heart Association: “Stroke, heart failure death rates accelerating in some Hispanic adults,” “Adult obesity, inactivity, associated with Black and Hispanic communities.”

    North Carolina Institute of Medicine: “Just What Did the Doctor Order? Addressing Low Health Literacy in North Carolina.”

    American Journal of Managed Care: “Solving the Physician Diversity Problem.”

    Occupational Safety and Health Administration: “Long Work Hours, Irregular or Extended Shifts, and Worker Fatigue.”

    Population Reference Bureau: “A Demographic Profile of U.S. Workers Around the Clock.”

    Johns Hopkins Magazine: “Research Shows Food Deserts More Abundant In Minority Neighborhoods.”

    Commonwealth Fund: “Inequities in Health and Health Care in Black and Latinx/Hispanic Communities: 23 Charts.”

    Nurse Practitioner: “Low Health Literacy.”

    Journal of the American Heart Association: “Association Between Community‐Level Violent Crime and Cardiovascular Mortality in Chicago: A Longitudinal Analysis.”

    Circulation:Heart Failure: “Social Constructs and the Making of Social Determinants of Health: A Pathway for Equity Interventions to Change Heart Failure Outcomes.”

    [ad_2]

    Source link

  • Equal Access to Heart Failure Treatment for All

    Equal Access to Heart Failure Treatment for All

    [ad_1]

    If you have heart failure, the right treatment can make all the difference in improving your symptoms and extending your life. Treatments range from lifestyle changes like cutting back on salt to a heart transplant for the most serious cases of heart failure.

    In the U.S., heart failure is more common among Black and Hispanic people than among white people. Black people are more likely to have heart failure at a younger age and lose their lives to the disease. Kelly McCants, MD, a cardiologist with Norton Healthcare in Louisville, KY, calls it the “40/40 club.” 

    “Forty percent of heart failure diagnoses in our hospital happen in African Americans under the age of 40.” McCants says this startling statistic is similar to heart failure rates in other big cities with large Black populations. 

    Besides these health challenges, Black and Latino people face major hurdles to getting treatment for heart failure. Research shows these groups are less likely to get:

    • Care from a cardiologist when they’re in the hospital and critically ill from heart failure
    • Advanced heart failure therapies like a heart transplant
    • A doctor’s referral for a cardiac rehabilitation program 
    • Surgery to implant cardiac devices

    The reasons for these health disparities are complex. Things like your health insurance status, bias in the health care system, and lack of representation in clinical research all play a role. Addressing these barriers can help Black and Hispanic people gain equal access to treatment.

    Removing Barriers to Heart Failure Treatment

    Know your numbers

    The first step to accessing treatment for heart failure is to understand your chances of getting the disease. You’re more likely to have heart failure if you have conditions like high blood pressure or diabetes. And some minority groups live with these conditions more often.

    McCants, who is also executive director of Norton Healthcare’s Advanced Heart Failure and Recovery Program and the Institute for Health Equity, says many Black and Hispanic people don’t know if they have high blood pressure, a major cause of heart failure. “We’re usually unaware of our [blood pressure] targets in terms of the 120 over 80.”

    High blood pressure is a “silent killer,” so the only way to know if you have it is to check your numbers routinely. Your doctor can tell you how often to check your blood pressure. You can do it quickly at the doctor’s office, a pharmacy, or – with the right equipment – even at home.

    Paying for health care

    When your doctor says you have heart failure, one of the first questions you may ask is how you’re going to afford heart failure treatment. A heart failure diagnosis often requires expensive medicines, frequent hospital visits, and close tracking by doctors. 

    The cost of health care is a critical concern for many people, especially for those who have less money. Data show that people of color people are more often uninsured or underinsured and live in poverty than white people. 

    “When patients are faced with a choice of either taking medication or having money for food, that’s where it becomes a very difficult balance,” says Jim Cheung, MD, a cardiologist and electrophysiologist with Weill Cornell Medicine in New York. 

    The more serious your condition, the more expensive treatment can get. One example: a heart transplant. If you have advanced heart failure, you may need a new heart from a donor, a surgery that costs more than $1.6 million. Transplant centers need proof of health insurance or other financial resources before they will even put you on a waitlist for a new heart.

    The Affordable Care Act (ACA) and Medicaid expansion have improved access to treatment for many. One study found a 30% increase in the number of African Americans added to heart transplant lists in states that expanded Medicaid. The number of Hispanics on these lists grew as well but only a little. 

    Bias in the health care system

    Your race or ethnicity can also impact how health care professionals treat you for medical conditions, including heart failure. For decades, scientific research has shown that minority groups have fewer medical procedures and get poorer care than white people. This is due, in part, to unconscious bias by health care professionals.

    Researchers looked at how your race influences doctors’ decision-making about advanced heart failure therapies. Overall, race doesn’t seem to play a role in whether doctors suggest different treatments. But if you’re Black, doctors are less likely to propose a heart transplant, especially older doctors.

    Research shows your chances of better health outcomes rise when you identify with and trust the person treating you. “It sure does help when culturally you can identify [with your provider] — if you have similar lived experiences or come from similar backgrounds,” McCants says. “As health care systems and providers, we ought to mirror the communities that we serve.”

    “I think that will do a lot to reduce communication problems between physicians and patients,” Cheung says. 

    Unfortunately, it may not always be possible for Black and Hispanic people to visit a cardiologist who looks like them. Underrepresented minorities make up less than 8% of cardiologists in the U.S.

    Representation in clinical trials

    Researchers carry out clinical trials to learn if a new or existing medical treatment works or has any harmful side effects. These studies rely on volunteers to test therapies and treatments. The results determine which medications and other treatments doctors will prescribe to all their patients. 

    But the study participants aren’t always a good representation of all patients. There are often far more white people in these studies than Black or Hispanic people. Sometimes, the study results don’t even report the races or ethnicities of the study participants. In those cases, doctors have no way of knowing whether the treatments work equally well for people of all racial and ethnic backgrounds.

    Blacks and Hispanics have long lacked representation in clinical trials for heart failure therapies. This is despite having higher rates of the disease. Clinical trials that include more racial and ethnic minorities “give us great insight into the impact of therapies on our patients,” Cheung says. “And not just some patients, but all of our patients.”

    In late 2022, the U.S. Congress passed legislation that calls for more diversity in clinical trials. It requires drug sponsors to submit a diversity action plan to the FDA. The plan must include the sponsor’s enrollment goals and how they plan to meet them. This could begin to pave the way toward research discoveries that apply to people of all colors and not just some. 

    [ad_2]

    Source link

  • What I’ve Learned From My Heart Failure Patients

    What I’ve Learned From My Heart Failure Patients

    [ad_1]




    Treating Heart Failure: What I’ve Learned From My Patients

































    091e9c5e820faac4091e9c5e820faac4FED-Footermodule_FED-Footer_091e9c5e820faac4.xmlwbmd_pb_templatemodule0144002/02/2021 01:57:340HTML















    [ad_2]

    Source link

  • Innovations in Heart Failure Care

    Innovations in Heart Failure Care

    [ad_1]




    Heart Failure: Innovations in Care

































    091e9c5e820faac4091e9c5e820faac4FED-Footermodule_FED-Footer_091e9c5e820faac4.xmlwbmd_pb_templatemodule0144002/02/2021 01:57:340HTML















    [ad_2]

    Source link

  • NFL Player May Face Neurological Risks After Cardiac Arrest

    NFL Player May Face Neurological Risks After Cardiac Arrest

    [ad_1]

    Jan. 3, 2023 — What can happen if your brain loses oxygen for an extended period?

    During Monday night’s Buffalo Bills vs. Cincinnati Bengals game, NFL fans watched nervously as Bills safety Damar Hamlin lay flat on this back surrounded by medical personnel, teammates, and coaching staff. 

    Hamlin, 24, had just tackled a Bengals receiver late in the opening quarter when he stood up and immediately collapsed.

    The Buffalo Bills, in a statement, said Hamlin had experienced cardiac arrest on the field and is sedated and in critical condition at University of Cincinnati Medical Center. 

    Cardiac arrest is when there is an electrical malfunction to the heart — which can create an irregular heartbeat– and the heart’s pumping function is compromised, according to Laxmi Mehta, MD, director of preventive cardiology and women’s cardiovascular health at the Ohio State University Wexner Medical Center. When this happens, there is not effective pumping of blood to organs, including the brain and lungs, and severe damage can occur. 

    Hamlin had his heartbeat restored on the field after nearly 10 minutes of CPR and oxygen via an AED machine, better known as a defibrillator, a medical device that delivers an electrical shock to help your heartbeat return to normal rhythm, according to reports.

    Since crucial information of Hamlin’s condition has yet to be released publicly, certain — now widely circulated — details of Hamlin’s injuries can still be deemed “speculation,” Mehta says. Therefore, while Hamlin may have received CPR and oxygen assistance for several minutes, we can’t be certain “he didn’t get adequate [oxygen] flow.”  

    “The point of doing CPR is you’re doing those chest compressions — you’re forcing the heart to pump. So we would assume he had a circulation of blood flow to the brain. But if people don’t get CPR done in a timely fashion, or if they don’t get effective chest compressions, then yes, there can be a lack of adequate blood flow, lack of oxygen, and can cause some brain damage,” she says.

    This phenomenon, called anoxic brain injury, can result in stroke-like effects, including seizures, the inability to move certain body parts, slurred speech, and trouble forming sentences, says Mehta. 

    Check back for more updates on this story.

    [ad_2]

    Source link

  • Financial Planning for Heart Failure

    Financial Planning for Heart Failure

    [ad_1]




    Heart Failure Financial Planning

































    091e9c5e820faac4091e9c5e820faac4FED-Footermodule_FED-Footer_091e9c5e820faac4.xmlwbmd_pb_templatemodule0144002/02/2021 01:57:340HTML















    [ad_2]

    Source link