Tag Archives: DASH diet

Insane Medicine – High Blood pressure and the new Rules

Insane Medicine - Blood pressure cuff
Insane Medicine – Blood pressure cuff
  • Blood pressure is force that is exerted on your arteries with every heart beat, with the systolic pressure (top number) being the peak pressure the moment the hear contracts, while the diastolic number (bottom number) is the pressure when the heart relaxes. There is always residual pressure in the circulatory system when the heart is at rest due to the elastic, expansile ability of veins and arteries in the cardiac cycle that expand and collapse with each heart beat.
  • normal blood pressure is anything less than 120/80
  • When a person develops high blood pressure, that puts stress on the vital organs inside the body, especially the brain, heart, and kidneys. This increases your risk of stroke, heart disease, and kidney failure. Vascular dementia due to damaged vessels and strokes in the brain results in dementia.
  • As people age, high blood pressure becomes more and more common, with ~70% having high blood pressure by the age of 65-74.
  • There have been recent changes in the blood pressure goals per a recent report by JNC-8.  If you are age 60 or older, any blood pressure up to 150/90 mm of Hg is acceptable, unless you have diabetes, in which case 140/90 mm Hg is the acceptable goal. This new goal has not been accepted by all the medical authorities.
  • The American Society on Hypertension (ASH) suggests that patients age 80 and over should be allowed to have a blood pressure up to 150/90, unless they have high risk issues like diabetes or kidney disease, in which the 140/90 upper limit should be used. If the person is less than age 80, then 140/90 is the upper limit of acceptable and probably a goal of 130/80 should be used if they have poor heart function or kidney disease.
  • Which target should you be using? Ask your doctor, but it seems reasonable to be more aggressive with blood pressure treatment if you have diabetes, kidney disease, protein in your urine, or heart disease.
  • Lowering a person’s blood pressure too low may make them dizzy when they stand or even pass out due to low blood pressure. This is something we want to avoid!
  • First line treatment includes lifestyle changes such as dietary modifications such as reducing salt intake and eating more antioxidant-rich fruits and vegetables. Physical activity is a key component as well.
  • Have your doctor check for possible secondary causes of high blood pressure such as ‘white-coat’ hypertension (stress in the doctor’e office that goes away when you measure blood pressure at home). Also medications such as prednisone, or over-the-counter agents for colds and cough can increase blood pressure. Have your doctor review your non-prescribed medicines.
  • Have your doctor consider looking for thyroid disorders, kidney disorders, or sleep apnea that can elevate blood pressure.
  • Keep track of your home blood pressure with a home blood pressure cuff that is properly calibrated and used. This can be more accurate when properly done than a doctor’s office single reading of blood pressure.
  • For those who need medications, doctors will start low and titrate medication upwards slowly. There is more evidence that ACE inhibitors or ARB inhibitors mixed with amlodipine ( a calcium channel blocker) are excellent first line therapies. Beta blockers are not in favor for primary or secondary use unless there is some specific reason to be taking them (such as heart disease). Be prepared to take two or even three medicines to control your blood pressure.
  • Again, the best treatments to start with are lifestyle modifications! Lose weight, take in less salt. Consider following the DASH diet!

The DASH diet to help control high blood pressure:  http://dashdiet.org/

Insane Medicine – A manual for care of your Brain: Part 1

Insane Medicine - Brain matters
A chimpanzee Brain in a jar.
  • Alzheimer’s disease presents with plaques and tangles in the brain, the plaques being clumps of a protein fragment, beta-amyloid, and the tangles being misshaped ‘tau’ proteins. These can be present in people and yet the individual does not show signs of dementia. Thirty percent of people over age 70 have elevated beta-amyloid but are cognitively normal.
  • Neurofibrillary tangles damage neurons and synapses, disrupting the architecture of the brain. It may take more than 10 years before amyloid deposition begins and symptoms of dementia start.
  • Damaged blood vessels in the form of small strokes add on to the problem of dementia. Some 20 percent of the elderly have had ‘silent’ strokes and do not have any knowledge of it. These small strokes further the destruction of the brain’s architecture, leading to vascular dementia.
  • Risk factors for vascular damage include smoking, high blood pressure, and diabetes.
  • Watch your blood pressure!
  • High blood pressure is a huge risk factor for later cognitive impairment. Why? Small strokes cut off blood flow to brain tissue due to uncontrolled blood pressure and diabetes, destroying brain architecture and function. On an MRI, bright white matter areas of hyper-intensities represent areas of damage, in which neurons cannot connect well with one another. Patients with uncontrolled blood pressure tend to have more hyper-intensities, representing compromised brain functioning.
  • Control your diabetes and sugar intake.
  • Type 2 diabetes in a strong risk factor for dementia. People with this problem are insulin resistant, mostly due to obesity. High levels of insulin in the blood correlate with more rapid cognitive decline, possibly due to less brain insulin as a result of decreased receptors for insulin in the blood-brain barrier. This results in less insulin entry into the brain. Insulin may help clear the toxic beta-amyloid from the brain.
  • Insulin receptors in the brain seem to localize in areas that are important for the formation of new memories. When the receptors decrease, memory seems to get impaired. Intranasal insulin may have a positive effect on cognitive abilities in patients with memory impairment, but studies are ongoing.
  • What to do: Lose weight and exercise more. Evidence from studies show that patients  who had a diet low in saturated fats and carbohydrates with a low glycemic index had lower beta-amyloid levels in the brain CSF, which surrounds and bathes the brain) So eat less saturated fats and sugars!
  • Exercise! Executive functioning (the ability to plan and make decisions, correct errors, and respond to new information) is improved by exercise. Executive functioning is lost in cognitive impairment and Alzheimer’s disease. People who move and exercise, especially over their lifetime, have a lower risk of dementia. Sedentary people have less blood flow to the distant blood vessels in their brain and that makes them vulnerable. Exercise may expand brain volume and protect blood vessels in the brain. It helps with stress, insulin levels, and many other parameters in good ways.
  • Keep your brain active! People who are involved with mentally stimulating activities, like reading, going to classes, playing games) have a lower risk of dementia. This cognitive reserve may protect against the onset of symptoms.
  • Caffeine may protect your brain! There is evidence that up to 500 mg of caffeine a day was helpful in preservation of memory. Caffeine may reduce amyloid burden.
  • Blueberries and strawberries may reduce memory decline. Aim for at least one serving of blueberries a week and two of strawberries.
  • Increase the amount of fish in your diet! Dark-meat fish, such as swordfish, salmon, mackerel, sardines,) are excellent in certain measures of cognition. Omega-3 fats  alone (which are present in high amounts in fish)  have not been shown to help dementia.
  • Avoid sleep restriction! Get plenty of sleep! Sleep seems to expand the area between brain cells making it easier to clear beta-amyloid and toxins from the brain, sleep disruption impairs this capability.
  • DASH diet: A healthy diet that includes fruit, vegetables, fiber, low sugar content, and low saturated fat, helps with blood pressure and overall health. The American Heart Association recognizes this diet as being effective in a number of health scores.
  • Consider the Mediterranean Diet. More on this diet later.
  • Antioxidant vitamins, such as vitamin E/C/beta-carotene, B vitamins, phosphatidyl serine, ginkgo, huperzin-A, and other supplements have been found to be ineffective in preventing memory decline and dementia.
  • Insane Medicine - Plaques in the brain - what a pain
    Insane Medicine – Plaques in the brain – what a pain!
  • http://dashdiet.org/    – this is a link to the DASH diet – a heart-healthy option
  • http://www.nhlbi.nih.gov/health/health-topics/topics/dash/
  • http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456  – Mayo clinic presents the DASH diet

Phosphorus in our diet: A problem or a marker for a bad diet?

  • Phosphorus is found in a wide variety of foods, both processed and unprocessedPhosphorus
  • It is found in meats, nuts, seeds,, whole grains, seafood, and poultry.
  • Additives in the form of phosphates are another form of phosphorus that we ingest. The inorganic form like this is readily absorbed. They are used as leavening agents, stabilizers, flavor enhancers, emulsifiers, and moisture binders in many food products.
  • Sodas, in particular, Colas are sources of phosphates.
  • Basically any processed food is generally filled with extra phosphorus.
  • We need Phosphorus for energy metabolism, regulating calcium, genetic information, and cell maintenance.
  • Too much phosphorus can increase the risk of cardiovascular events, bone loss, and kidney failure.
  • The RDA is 700 mg a day. Amounts over 1400 mg a day are associated with increased risk of mortality even in healthy people.
  • The type of food and it’s phosphorus load may play a role in the extent of problems. Phosphorus in an inorganic form is absorbed quickly and is present in processed food . This along with phosphorus present in meat products seems to pose an increased risk. In milk and dairy products, which have calcium and phosphorus in large amounts, there is not as much danger. In fact, dairy products lower high blood pressure.
  • Colas contain a lot of phosphorus, and this may result in displacement of calcium in the body, resulting in low bone density and fractures.
  • High phosphorus intake may increase risk for osteoporosis.
  • A hormone, FGF-23 may be increased in patient who consume a lot of phosphorus. This hormone  may cause cardiovascular problems such as calcification of the arteries and stiffening of the arteries.
  • Excess phosphorus may be associated with cancer and type 2 diabetes risk.
  • In short, decrease your processed food intake, cola consumption, and consider following the DASH diet (Dietary Approaches to Stop Hypertension)
Dash Diet Pyramid
Dash Diet Pyramid