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For September 21, 2018

  • Systolic BP Reading Important in Hypertension
    Systolic BP Reading Important in Hypertension

    NEW YORK, Sep 23 (Reuters Health) -- Though the importance of the diastolic -- or second number -- in blood pressure (BP) measurement has long been accepted, new results from the ongoing Framingham Heart Study suggest that the systolic reading (the first number) may, in fact, be more useful in diagnosing and managing patients with high blood pressure.

    According to principal investigator, Dr. Daniel Levy of the National Institutes of Health, and colleagues, "our data indicates that systolic blood pressure plays a greater role than diastolic blood pressure in determining both blood pressure stage and eligibility for therapy." Blood pressure is recorded as two numbers separated by a diagonal (130 / 80, for example). The unit of measure in blood pressure is millimeters of mercury, abbreviated as mm Hg. The systolic measure reflects how hard the heart is working during a beat while the diastolic indicates pressure in major arteries when the heart rests between beats. A reading of 140 mm Hg systolic or greater, is considered to represent high blood pressure; the same diagnosis is applied when the diastolic reading is 90 mm Hg or above.

    Conventionally, the diastolic number has been viewed as a more sensitive indicator of hypertension. It is the diastolic reading that commonly influences clinical decision-making regarding degree of disease present, and what therapeutic steps should be taken.

    "The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) classifies blood pressure into stages on the basis of the levels of both systolic (SBP) and diastolic (DBP) blood pressure levels," Levy and colleagues explain in the September issue of Hypertension. "When a disparity exists between SBP and DBP stages, patients are classified into the higher stage ('up-staged')."

    Such disparities are not uncommon, the authors note. Nearly 1,300 of 3,656 study subjects -- or 35.4% -- displayed "disparate levels of systolic blood pressure and diastolic blood pressure." In the current study, this type of disparity presented the researchers with an opportunity to explore which measure, systolic or diastolic, is a better yardstick for identifying and classifying hypertensive individuals.

    The investigators found that "among the entire sample... knowledge of the SBP alone correctly classified the (blood pressure) stage in 96% whereas knowledge of DBP alone correctly classified only 68%."

    In a subset of patients characterized by blood pressure readings that were either at the high end of normal or frankly hypertensive, "knowledge of only the SBP (allowed investigators) to classify (blood pressure stage) correctly in 91% of subjects versus 22% for DBP," according to the report.

    As to the significance of these findings, Levy and his team speculate that "future (blood pressure treatment) guidelines might consider acknowledging a greater role for SBP than for DBP in determining blood pressure stage, risk of cardiovascular events, eligibility for therapy, and benefits of treatment."

    In a statement to the press, officials at the National Institutes of Health's National Heart, Lung, and Blood Institute commented that an update of the JNC-VI blood pressure guidelines will be issued later this year "based on this and other recent research that confirms the importance of identifying, treating, and controlling systolic hypertension."

    "The message from this study is that you cannot ignore systolic pressure," said Dr. Claude Lenfant, director of the National Heart, Lung and Blood Institute in the statement. "For years, treatment strategies have focused on lowering a patient's diastolic pressure... (but) this practice excludes the elderly, who tend to have higher systolic pressures and lower diastolic pressures -- and who have the least-controlled blood pressure of all patients."

    SOURCE: Hypertension 1999;34:381-385.

  • The Scoop on the Atkins Diet
    The Scoop on the Atkins Diet

    (From Phys, August 1999)

    THE DIET: Dr. Atkins' Diet Revolution by Robert C. Atkins, M.D.

    THE CLAIM: Carbohydrates provoke hunger, causing you to overeat and gain weight. If you eliminate carbs and increase protein and fat intake to satisfy hunger instead, your body will thank you for it by losing weight without food cravings.

    THE DOC'S PRESCRIPTION: A meat lover's dream: Thick steaks with slabs of melting butter, crisp bacon, eggs (yolks and all), thick cream instead of milk, mayonnaise-based salad dressings, fried pork rinds and, finally, rich desserts like cheesecake and mocha pie.

    HOW IT'S SUPPOSED TO WORK: Atkins claims that ketosis is the key: Without incoming carbs, your body first burns its carbohydrate stores, and then the protein in its lean muscle tissue for energy, both of which release a lot of water. Your body also starts burning some fat in an inefficient way that creates toxic by-products called ketones. These build up in your bloodstream and need to be processed through your kidneys to be eliminated.

    BUT HOW DO YOU FEEL? Too many ketones in your blood can cause dizziness, headaches, mental confusion, nausea, fatigue, sleep problems and bad breath. Also, high protein intake causes your body to lose calcium, so add weakening bones to the list.

    WHAT'S REALLY HAPPENING: Since your brain and body are designed to get energy primarily from carbohydrates, they view anything else as abnormal food, especially ketones. "Ketosis is a signal that your body has gone into starvation mode," says Howard Flaks, M.D., a bariatric physician (weight loss specialist) based in Beverly Hills, California. When your body thinks it's starving, it slows your metabolism to conserve whatever fuel it can and eats at its own muscle tissue to get at the carbs stored there as glycogen.

    Worse, after you quit the diet, your body fights to turn every bit of food you eat into fat because it doesn't know when you're going to starve again and it needs to build up a bigger reserve than you had before. The result? You gain more fat than you had when you started.

    WHAT TO TELL FRIENDS ON THE DIET: If you lose weight, you'll gain it all back � and more � once you stop the diet. Not planning on quitting the diet? Then don't expect to have healthy kidneys for the long term: Over time, the stress of processing so many ketones can damage your kidneys, causing ketoacidosis or toxic ammonia in your blood, according to Megan McCrory, Ph.D., a researcher in the Energy Metabolism Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging, at Tufts University.

  • Toning Your Body -- and Your Thighs
    Toning Your Body -- and Your Thighs

    For many people -- particularly women -- hips and thighs are trouble spots. Efforts to achieve slim, trim thighs can seem futile, especially since exercise and diet won't necessarily reduce fat in the places you'd like. Though you target your stomach, the excess fat may come off your bottom, or vice versa. Still, dedication to exercise combined with good nutrition will trim fat throughout your body and help you tone all over, including your thighs.

    Cardiovascular and Aerobic Exercise

    Not only does aerobic exercise keep your heart and mind strong, but it can also help to make hips and legs more shapely and stronger. Exercise can't change your DNA: It can only do so much to counteract a genetic disposition to, say, cellulite or a particular leg and hip shape. But a good sweat will keep you healthier and firm up whatever you have inherited from your parents.

    Try weight-bearing forms of aerobic exercise such as running, jogging and brisk walking. If you can't do weight-bearing exercises, the stationary bicycle may suffice. Aim for at least three sessions of 20 minutes or more of aerobic exercise each week, according to the American Council on Exercise. If you're going after long-term weight control, work your way up to at least four sessions of 45 minutes of activity each week. And seek out opportunities for physical activity throughout the day: Take the stairs instead of the elevator, or walk or bicycle to work instead of driving.

    Strength Training

    Many women trying to trim down shy away from strength training because they fear they will "bulk up" -- exactly the opposite of what they want. But unless you are eating a very high-calorie diet, bulking up -- which requires heavy weight-lifting -- is unlikely. The benefits of strength training for hips and thighs are two-fold:

    Your legs will look and feel more toned and shapely. You will be stronger so that aerobic exercise, as well as daily physical activities, will be easier and more fun. Strength training is a type of weight training that emphasizes low weights and high reps, as opposed to the "bulk-up" type of weightlifting. Strength training helps to burn calories more effectively, enabling you to trim body fat. In addition, you'll burn more calories during your aerobic workout and even when you're sleeping because you have more muscle, which is metabolically active.

    Going For It

    There are a wide variety of exercises you can do at a fitness center or with strength-training equipment. Using machines such as the leg press, leg (knee) extension, leg (knee or hamstring) curl and the hip abductor/hip adductor are great ways to get started.

    If you don't have access to equipment, you can use your own body weight as resistance during lower body exercises, which can be very effective in toning and firming calves, hips and thighs.

    Below are a few strengthening exercises to get you started. If you have a health condition that limits your activity, check with your physician before doing any form of exercise. You might also want to consult with an expert trainer at your gym, who can show you how to use the machines safely and effectively.

    Step Up

    Muscles working: Front and back of thighs.

    The position: You will need a stable staircase for this exercise. Stand close to the bottom stair and use the handrail for support with your head up, looking straight ahead.

    The Move: Step completely onto the first stair with one foot. Keeping your weight supported on the front leg without letting your knee come over your toes, bring the other leg up and tap the toes of the back leg on the step and then slowly return to starting position. Repeat while alternating the starting leg until you have completed eight on each leg (one set), rest for a couple of minutes and then repeat one to two more sets.

    Side Leg Raise

    Muscles working: Hips and thighs.

    The position: You will need to lie on the floor on your side with your legs straight and together for this exercise. Bend your bottom leg up behind you slightly (keeping your hips stacked) and put your outside hand out in front of you for balance using your inside hand to support your head.

    The Move: With toes pointing straight ahead, slowly lift your top leg as high as possible, while maintaining straight hips. Then slowly return back to starting position and repeat eight times. Then switch to the other side and do eight repetitions. This is one set. Repeat for a total of two sets.

    Copyright � 1999 by WebMD, Inc. All rights reserved.

  • Osteoporosis
    Although most people think of osteoporosis as a disease of older Americans, steps to prevent it should begin early and continue throughout your life. According to the National Osteoporosis Foundation, a diet with adequate calcium and vitamin D, along with limited alcohol consumption, is part of a healthy lifestyle that can prevent the onset of this disease.

    Calcium is perhaps the most important mineral in building strong bones and preventing osteoporosis. It must be consumed from the diet, because the body does not manufacture it. If you have a calcium deficient diet, your body scavenges for the mineral, stealing it from your bones. Many people understand how important calcium is for children, because their bones are still growing. But calcium is also important for adults; the National Institutes of Health advises adult men to get 1,000 mg. of calcium per day, and 1,500 mg. per day for pre-menopausal women.

    Foods high in calcium include milk and milk products (low-fat and skim milks actually have slightly more calcium than whole milk), cheeses, sardines, salmon, Chinese cabbage, broccoli (especially fresh), soybeans, collards, turnip greens and tofu.

    Calcium absorption and excretion can be affected by what you eat. High caffeine foods, such as coffee, tea and caffeinated sodas, may deplete the body�s stores of calcium, and thus may promote bone loss. Diets high in protein and sodium also increase calcium excretion.

    Along with helping to build strong bones, vitamin D also helps the body absorb calcium. You can get vitamin D in two ways: from exposure to direct sunlight, or through your diet. There are relatively few foods which naturally contain vitamin D. Some good sources are egg yolks, liver and saltwater fish. However, many foods (including milk) are fortified with vitamin D.

    from John Hopkins Health
  • Breakfast: The essential meal
    Breakfast: The essential meal
    By Elizabeth Somer, R.D.

    (WebMD) -- Your mother was right: Breakfast is the most important meal of the day. People who skip breakfast tend to struggle more with weight problems and suffer low energy later in the day when compared to those who take the time to eat.

    If you're a seasoned breakfast skipper, change your ways and start eating breakfast -- even if you aren't hungry. It takes two to three weeks to reset the appetite clock. After that, you should notice a boost in energy and fewer problems with overeating later in the day.


    The eight or more hour time span between dinner and breakfast is the longest span between any of the three meals of the day. In the hours since dinner, and even while sleeping, the body still needs fuel to keep the heart beating, nerves transmitting, eyes blinking and cells dividing. Much of that fuel comes from the readily available stores of glucose in the blood, liver and muscles.

    By sunrise, the body is essentially in a fasting mode, with more than half of the body's glucose usually drained by morning and needing the jump-start that comes from eating a carbohydrate-rich meal. That first meal of the day literally breaks the fast.

    Energy drop

    If you skip breakfast, you might feel fine, full of energy and ready to go for the first few hours after you wake up. That burst of energy typically comes from a mind and body refreshed after a good night's sleep. But this initial burst of energy wears off as the morning's demands add stress to a body already running on empty.

    If you allow even four hours to pass between meals, blood sugar levels drop, resulting in fatigue, poor concentration, irritability and lethargy. Double the time to eight or even 12 hours and you can imagine the energy-draining effects of failing to refuel.

    By afternoon, even if you eat a relatively good lunch in an effort to boost lagging energy levels, it's difficult to regain an entire day's worth of energy that you would have had if you had taken five minutes to eat breakfast.

    A breakfast primer

    What should and shouldn't you eat for breakfast? Avoid high-sugar breakfasts, such as doughnuts and coffee, which provide a quick boost, but leave you feeling drowsy within a few hours. Instead, choose meals with a mix of protein and starch. This will help you to maintain blood sugar levels throughout the morning.

    Some good morning choices include:

    -Whole-grain cereal and milk

    -An English muffin with low-fat cheese and orange juice

    -Nontraditional breakfast foods, such as leftover pizza, soup and toast, or a sandwich

    -Egg substitute and toast

    -whole-wheat toaster waffle topped with fat-free sour cream and fresh blueberries

    -A flour tortilla filled with cottage cheese and fresh fruit, warmed in the microwave

    -A low-fat whole-wheat bran muffin topped with applesauce and yogurt

    -An English muffin topped with one ounce of fat-free cheese and broiled until bubbly, served with a glass of orange juice.

    Elizabeth Somer, R.D., is the author of several books, including "Nutrition for a Healthy Pregnancy," "Food & Mood," "Nutrition for Women: The Compete Guide" and "The Essential Guide to Vitamins and Minerals." She is editor in chief of "Nutrition Alert!" a newsletter that abstracts current nutrition research from more than 6,000 journals.

    Copyright 1999 webmed, Inc. All rights reserved.
  • Hypertension
    Approximately one in four adults suffers from hypertension, or high blood pressure. Commonly called "the silent killer" because it often produces no symptoms, hypertension is responsible either directly or indirectly for about 900,000 deaths per year. It is a major risk factor in developing stroke, heart attack, heart failure and kidney failure. There are several ways you can help prevent high blood pressure through your diet. Perhaps the most important way is to watch your weight--obesity is a key risk factor of high blood pressure. The best way to help prevent high blood pressure through diet is to stick to a low-fat, low-cholesterol regime. Alcohol consumption is second only to excessive weight as a predictor for hypertension. Doctors recommend no more than two drinks a day.

    Some studies also suggest that potassium-rich diets may reduce the risk of stroke if you are being treated for hypertension. One of potassium�s greatest benefits is its ability to rid the body of sodium. The more potassium you eat, the more sodium your body gets rid of--boosting your system which needs to keep sodium under control in order to keep blood pressure at reasonable levels. Although too much potassium can cause trouble, it�s almost impossible to overdose on this mineral if you�re getting it from food. You would have to eat the dietary equivalent of 21 baked potatoes every day to experience such negative effects as cardiac irregularities. That�s why naturally increasing potassium through diet is the best idea. An ideal potassium target is 3,500 mg--the Daily Value set by the Food and Drug Administration and the Food Safety and Inspection Service of the U.S. Department of Agriculture.

    Along with increasing your intake of low-sodium, high-potassium natural foods, such as fruits and vegetables, you should also reduce your intake of high-sodium, low-potassium processed foods. Good low-salt, high-potassium sources include dried beans, lentils and peas; fruit juices and fresh fruits, especially apricots, bananas, cherries, cantaloupes, honeydews, kiwi, mangoes, nectarines, oranges, peaches, raspberries and tangerines; milk and yogurt (remember, you can get the potassium without the fat in skim and fat-free version); fresh vegetables, especially artichokes, bamboo shoots, bean sprouts, broccoli, Brussels sprouts, cabbage, carrots, celery, collards, corn, mushrooms, parsley, parsnips, plantains, potatoes, pumpkins, seaweed, spinach, tomatoes, turnips, water chestnuts and squashes; and whole grains like rye, barley, buckwheat, wheat bran and whole-grain breads.

    There�s also evidence that magnesium and calcium may help to regulate blood pressure. Magnesium can be found in unprocessed whole grain foods, leafy green vegetables, nuts, fish and seafood, dried fruits and poultry. Strong sources of calcium include broccoli and raw cabbage, cooked collards, soy milk, milk and milk products (remember to choose skim or low-fat products), salmon, sardines, raw oysters and tofu.

    Although the issue of whether a high-salt diet causes or aggravates the onset of high blood pressure is still under debate, most doctors and nutritionists agree that Americans get too much salt in their diets: on average, we eat 2 teaspoons full of salt per day; our bodies need less than half a teaspoon. There is no question, however, that once hypertension develops, sodium is off limits. (Salt is about 40 percent sodium, and is our major dietary source of it.) Unfortunately, once you have high blood pressure, a moderate reduction of salt in the diet alone will not usually be enough to lower blood pressure back to normal levels. Along with medication, most doctors recommend a very low sodium diet for people with hypertension.

    Many high-sodium foods are obvious, such as salt-heavy pickles or potato chips. But reducing the salt in your diet is often more difficult than you can imagine, because only about a third of your salt intake depends on how heavy you lean on the salt shaker. Another third is added during the processing of foods, and the last third is found naturally in foods.

    Aside from the obvious high-salt content of foods like olives and sauerkraut, other high-sodium foods to avoid include biscuits and pancakes, pastries and cakes made from self-rising flour mixes, soy sauce, catsup, commercially prepared or canned soups and vegetables, bouillon, ham, sausages, bacon, hot dogs, smoked meats or smoked fish, canned tomato juice, frozen lima beans, frozen peas and fast foods. Also, many carbonated soft drinks are high in sodium; make sure you read the labels and check before drinking them. For example, club soda is fairly high in sodium�30 to 65 mg. per 8 ounces; cola contains about 15 mg. of sodium per 12 ounces; ginger ale has about 26 mg. of sodium per 12 ounces; and seltzer water contains 0 mg. of sodium. Most animal foods have a high content of natural sodium. Even when prepared without added salt, meat, fish, poultry, milk or milk products and eggs have high amounts of sodium and should be minimized

    From John Hopkins Health

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