Alzheimer’s disease begins at the synapse, the space where neurons connect. The biggest bad guy in this disease is a sticky protein called beta-amyloid. Either too much is made or not enough is cleared away, and as beta-amyloid accumulates, it creates a gooey clog in the synapse, preventing the neurons that meet there from communicating. As a result, the information those neurons carry can’t be transmitted or retrieved. The beta-amyloid “goo” prevents these two neurons from “talking” to each other. We notice this molecular event because we forget something.
When too much beta-amyloid causes the synapse to fail, we begin to see the symptoms of Alzheimer’s. There are many risk factors that can contribute to having too much beta-amyloid. What are these risk factors?
First, let’s imagine a seesaw-style scale and the risk factors, which each vary in weight, are being piled on one arm of the scale. When that arm hits the floor, we have Alzheimer’s.
Risk Factors
1. Age
The biggest risk factor for developing Alzheimer’s is age. For reasons we still don’t entirely understand, as we get older, we accumulate more beta-amyloid. The chances of being diagnosed with Alzheimer’s increase steadily as we age. Right now, the risk of Alzheimer’s doubles every year after the age of 65. About half of people who are 85 and older have Alzheimer’s.
2. Genetics
Another risk factor is genetics. There is a rare form of Alzheimer’s called Familial Alzheimer’s, which always begins well before the age of 65 (typically in the 40s and 50s) and runs in families, that is autosomal dominant. This means that a single genetic mutation causes the disease. Picture the seesaw scale again. Genetic mutation is the only risk factor on the scale, and the arm is sitting on the floor.
Scientists have discovered three genetic mutations that cause this early-onset Familial Alzheimer’s. All three of these mutations result in molecular changes that cause an excess of beta-amyloid.
But this type of genetic risk factor is relatively rare, accounting for only about 5%of Alzheimer’s cases. The contribution of genetic risk factors to the development of Alzheimer’s for the vast majority of cases weighs much less on the scale, tipping the arm only a little bit.
For example, ApoE4 is a known genetic risk factor for Alzheimer’s. Forty to 65% of people with Alzheimer’s carry at least one copy of this mutation. But you can have two copies of this mutation (one inherited from each parent) and not have the disease. Again, imagine the arm of the scale tipped a bit with each copy of this mutation, but the arm is still well above the floor. Likewise, you can have zero copies of ApoE4 but have Alzheimer’s. The arm of your scale would be free of ApoE4 but piled high with other risk factors that tipped the scale over, leading to expression of the disease.
3. Head Trauma
Prior experience with head trauma, especially if consciousness was lost, increases the risk of developing Alzheimer’s. Always wear a seat belt and helmets.
4. Diabetes
In a recent study out of Japan that looked at over 1000 men and women over the age of 60, it was found that people with diabetes (especially type 2) were twice as likely to develop Alzheimer’s. Researchers are now trying to understand the molecular mechanisms that link diabetes to Alzheimer’s. It’s thought that the link may be twofold.
Nerve cells require a lot of energy to do the work of communicating. They get this energy from oxygen and glucose in the blood. With diabetes, cells lose their ability to respond to insulin, the molecule that transports glucose from the blood into the neurons, and so neurons have to cope with less glucose. Diabetes also often leads to damaged blood vessels, which compromises the delivery of oxygen to the nerves in the brain. Neurons already struggling to communicate despite too much beta-amyloid may lose the battle if glucose and oxygen are deprived.
Think of the scale arm with a bunch of risk factors piled on it. It’s hovering above ground but fighting to maintain that position. Things aren’t looking good for that synapse, but it’s still managing to function. Those neurons are still able to talk to each other. We aren’t showing any symptoms of Alzheimer’s yet. Add diabetes, and less oxygen and glucose to provide the energy the neurons need, and the scale arm goes crashing to the ground. Now we have Alzheimer’s.
5. Cardiovascular Disease
Eighty percent of people with Alzheimer's disease also have cardiovascular disease. Scientists are trying to better understand the link between heart health and Alzheimer’s disease, but we do know a few things about this relationship.
Cholesterol drives the production of beta-amyloid. For a brain that is already struggling to keep beta-amyloid levels in check, high cholesterol can be a risk factor that tips the scale. Doctors prescribe statins for people diagnosed with Alzheimer’s to help keep cholesterol levels down.
Again, the neurons in your brain need a lot of oxygen to do their job. If you have high blood pressure and if you have plaques in your blood vessels, your blood vessels are less efficient at delivering this oxygen to your brain. Not enough oxygen can be the weight that tips the Alzheimer’s scale.
All the risk factors for heart disease (things like poor diet, lack of exercise) are also risk factors for Alzheimer’s. And this means that things like a healthy, Mediterranean diet (whole grains, red and purple fruits and vegetables, fish, nuts) and exercise may not only protect the heart, they may protect us from Alzheimer’s. In fact, in animal studies, exercise has been shown to clear beta-amyloid better than any pharmaceutical we know of. Think of diet and exercise as weights on the other arm of the scale.
There is currently no cure for Alzheimer’s, but understanding these risk factors offers us some good news. While we can’t do anything about getting older or the genes we’ve inherited from our parents, eating smart, keeping cholesterol levels and blood sugar low, exercising, wearing a helmet when bicycling or skiing, and wearing a seat belt in the car are among the things we can do to keep the arm of the Alzheimer’s scale from tipping to the ground.
Showing posts with label cardiovascular disease. Show all posts
Showing posts with label cardiovascular disease. Show all posts
Monday, February 27, 2012
Friday, December 23, 2011
Should I Pick Up the Pace?
Q: My doctor told me that I need to get more aerobic exercise, but I hate going to the gym! I do like to walk, but how fast and how long should I go to improve my cardiovascular health?
A:
I understand exactly what you mean about going to the gym; I'm not a big fan of it either. Personally, I prefer to exercise outdoors or at home. And like you, I really enjoy walking.
Recently, I've begun recommending what's known as interval walking to many of my patients. With interval walking, you alternate between short bursts of intensive effort and easier recovery periods, as opposed to walking at a steady, continuous, and potentially monotonous pace. In fact, studies show that you can get better results in 20 minutes of interval exercise than you would in an hour of steady-state exercise. And you can apply the principles of interval walking to a treadmill or elliptical trainer, to biking or swimming, or even to doing jumping jacks in your living room.
So how do you do interval walking? Instead of walking at a constant pace for your entire workout, as you've probably been doing, you should mix it up. That is, after a three-minute warm-up where you walk at an easy or moderate pace, you should alternate short bursts of very fast walking (15 to 60 seconds, depending on your conditioning) with recovery periods of slower walking after each fast burst. You can repeat each interval six to 12 times, or more depending on your fitness level. Aim for walking a total of 20 minutes to start. In general, the more intense the workout (in other words, the faster you go), the shorter the duration of that interval and the longer the recovery period. Conversely, when you're not working as hard, your work period will be longer and your recovery period will be shorter. For example, if you like taking an hour-long walk on weekends, you can certainly do intervals, but don't try to spend the entire hour working at high intensity. And always end with a two-minute cooldown at an easy pace.
I recommend that you do interval walking every other day, alternating it with some core-strengthening exercises. Not only will this type of walking improve your cardiovascular health, it will boost your metabolism so you burn more calories and fat, and that translates into faster weight loss.
Interval training is not only for the very fit. It works just as well for people who are less fit, and is even being used to help cardiac patients and people with lung disease get back in shape. That said, I do recommend that you talk with your doctor before embarking on this or any other exercise program.
A:
I understand exactly what you mean about going to the gym; I'm not a big fan of it either. Personally, I prefer to exercise outdoors or at home. And like you, I really enjoy walking.
Recently, I've begun recommending what's known as interval walking to many of my patients. With interval walking, you alternate between short bursts of intensive effort and easier recovery periods, as opposed to walking at a steady, continuous, and potentially monotonous pace. In fact, studies show that you can get better results in 20 minutes of interval exercise than you would in an hour of steady-state exercise. And you can apply the principles of interval walking to a treadmill or elliptical trainer, to biking or swimming, or even to doing jumping jacks in your living room.
So how do you do interval walking? Instead of walking at a constant pace for your entire workout, as you've probably been doing, you should mix it up. That is, after a three-minute warm-up where you walk at an easy or moderate pace, you should alternate short bursts of very fast walking (15 to 60 seconds, depending on your conditioning) with recovery periods of slower walking after each fast burst. You can repeat each interval six to 12 times, or more depending on your fitness level. Aim for walking a total of 20 minutes to start. In general, the more intense the workout (in other words, the faster you go), the shorter the duration of that interval and the longer the recovery period. Conversely, when you're not working as hard, your work period will be longer and your recovery period will be shorter. For example, if you like taking an hour-long walk on weekends, you can certainly do intervals, but don't try to spend the entire hour working at high intensity. And always end with a two-minute cooldown at an easy pace.
I recommend that you do interval walking every other day, alternating it with some core-strengthening exercises. Not only will this type of walking improve your cardiovascular health, it will boost your metabolism so you burn more calories and fat, and that translates into faster weight loss.
Interval training is not only for the very fit. It works just as well for people who are less fit, and is even being used to help cardiac patients and people with lung disease get back in shape. That said, I do recommend that you talk with your doctor before embarking on this or any other exercise program.
Saturday, September 3, 2011
Real life: 'They think it's witchcraft'
The issue of diabetes in Haiti -- where one is 16 suffers from the illness -- has a unique set of problems
Monday August 01 2011
If Jean Bernadette (56) hadn't discovered she was diabetic, she would probably be dead by now. In Haiti, where the health focus remains fixated on infectious diseases like HIV, Non-Communicable Diseases (NCDs) like diabetes are often detected late, when patients need extensive and expensive hospital care.
Yet, cardiovascular diseases and diabetes rank first and fourth in Haiti respectively, while HIV-AIDS now sits well below them in 10th position.
Jean Bernadette got diabetes 15 years ago. However, like many Haitians, she hasn't had access to the right medication or treatment.
Pointing to a gap in her right foot she tells me: "Six months ago I had to go to hospital to have a surgeon cut it off."
A study released by the General Hospital in Port-au-Prince in 2009 shows that more than 50pc of patients in the capital have diabetic foot, with ulcers and infections in the feet standing out as the major source of death in these patients.
According to 2006 figures supplied by the Haitian Foundation for Diabetes and Cardiovascular Diseases (FHADIMAC), a private organisation affiliated to the International Diabetes Federation (IDF), one in every 16 Haitians is diabetic.
To add to the problem, FHADIMAC's Vice-President Dr Philippe Larco explains, "the concept of a chronic disease is not understood in Haiti.
"People think that it is supernatural, some kind of witchcraft, and there is nothing you can do against it. This is a big challenge for our healthcare teams in terms of the compliance of the patient with the treatment."
In addition to such challenges lie a lack of proper funding, data collection, surveillance, available medication and treatment.
These vital pieces in the Haitian health puzzle are all scarce commodities for diabetics, as the country's health development continues to be tied almost exclusively to more visible and campaign-ready infectious diseases like HIV, malaria and tuberculosis.
Dr Larco explains that the "cost of medication is too high and patients simply cannot afford it".
"With more than 60pc of the population living on less than €1.50 a day, it is very difficult for a family to buy insulin on a regular basis and many of them let a parent die because the economic burden is too great."
Both of Jean Bernadette's parents were diabetics and died from cardiovascular-related complications. Her father developed chronic kidney disease and her mother died from a heart attack that she believes stemmed from years of high blood pressure.
She shows me a diabetic glucose monitor that FHADIMAC gave her last year when they began screening for diabetic patients in the post-earthquake camps.
Unfortunately she doesn't have any test strips to use with the monitor. "I can't check my sugars without strips but I can't afford them either," she explains.
Vicious circle
Dr Larco says that a vicious circle exists where the international community doesn't fund these silent, invisible diseases and thus "NCDs don't end up on the list of priorities for the Haitian Ministry of Health which in turn blocks funding activities related to NCDs," he says.
According to the charity UNAIDS, in 2010 up to $145m (€100m) was used to target HIV prevention, medication and management in Haiti.
As for diabetes, less than $15m (€10.5m) was used. The country has one of the lowest expenditure rates on diabetes in the Americas with only $48 spent per person.
Ironically, the earthquake at the start of last year did spark some positive change for diabetics in Haiti, with more funding becoming available for the cause.
In April this year, FHADIMAC began work on a two-year project in conjunction with the World Diabetes Foundation to open up 12 new diabetic clinics. Mobile clinics will also be set up for patients in remote rural areas. They will all carry out basic glucose testing along with eye and feet exams.
Following the earthquake, international organisations such as Medecins Sans Frontieres (MSF) have had a strong presence in the country. Dr Andre Munger, the medical chief at one of MSF's trauma hospitals in the outskirts of Port-au-Prince, says they "are now starting to take action because of the health catastrophe posed by non-communicable diseases like diabetes".
Later this year, MSF aim to carry out a new survey on the number of people suffering from diabetic and cardiovascular complications in Haiti. "Without proper data and statistics we'll never be able to address these issues properly," Dr Munger explains.
In order to bring this work on to the international stage and begin to tap into possible new sources of funding, FHADIMAC will present its plan at a UN summit in New York in September.
For many diabetics and other NCD patients like Jean Bernadette, such efforts could be the difference between life and death.
Monday August 01 2011
If Jean Bernadette (56) hadn't discovered she was diabetic, she would probably be dead by now. In Haiti, where the health focus remains fixated on infectious diseases like HIV, Non-Communicable Diseases (NCDs) like diabetes are often detected late, when patients need extensive and expensive hospital care.
Yet, cardiovascular diseases and diabetes rank first and fourth in Haiti respectively, while HIV-AIDS now sits well below them in 10th position.
Jean Bernadette got diabetes 15 years ago. However, like many Haitians, she hasn't had access to the right medication or treatment.
Pointing to a gap in her right foot she tells me: "Six months ago I had to go to hospital to have a surgeon cut it off."
A study released by the General Hospital in Port-au-Prince in 2009 shows that more than 50pc of patients in the capital have diabetic foot, with ulcers and infections in the feet standing out as the major source of death in these patients.
According to 2006 figures supplied by the Haitian Foundation for Diabetes and Cardiovascular Diseases (FHADIMAC), a private organisation affiliated to the International Diabetes Federation (IDF), one in every 16 Haitians is diabetic.
To add to the problem, FHADIMAC's Vice-President Dr Philippe Larco explains, "the concept of a chronic disease is not understood in Haiti.
"People think that it is supernatural, some kind of witchcraft, and there is nothing you can do against it. This is a big challenge for our healthcare teams in terms of the compliance of the patient with the treatment."
In addition to such challenges lie a lack of proper funding, data collection, surveillance, available medication and treatment.
These vital pieces in the Haitian health puzzle are all scarce commodities for diabetics, as the country's health development continues to be tied almost exclusively to more visible and campaign-ready infectious diseases like HIV, malaria and tuberculosis.
Dr Larco explains that the "cost of medication is too high and patients simply cannot afford it".
"With more than 60pc of the population living on less than €1.50 a day, it is very difficult for a family to buy insulin on a regular basis and many of them let a parent die because the economic burden is too great."
Both of Jean Bernadette's parents were diabetics and died from cardiovascular-related complications. Her father developed chronic kidney disease and her mother died from a heart attack that she believes stemmed from years of high blood pressure.
She shows me a diabetic glucose monitor that FHADIMAC gave her last year when they began screening for diabetic patients in the post-earthquake camps.
Unfortunately she doesn't have any test strips to use with the monitor. "I can't check my sugars without strips but I can't afford them either," she explains.
Vicious circle
Dr Larco says that a vicious circle exists where the international community doesn't fund these silent, invisible diseases and thus "NCDs don't end up on the list of priorities for the Haitian Ministry of Health which in turn blocks funding activities related to NCDs," he says.
According to the charity UNAIDS, in 2010 up to $145m (€100m) was used to target HIV prevention, medication and management in Haiti.
As for diabetes, less than $15m (€10.5m) was used. The country has one of the lowest expenditure rates on diabetes in the Americas with only $48 spent per person.
Ironically, the earthquake at the start of last year did spark some positive change for diabetics in Haiti, with more funding becoming available for the cause.
In April this year, FHADIMAC began work on a two-year project in conjunction with the World Diabetes Foundation to open up 12 new diabetic clinics. Mobile clinics will also be set up for patients in remote rural areas. They will all carry out basic glucose testing along with eye and feet exams.
Following the earthquake, international organisations such as Medecins Sans Frontieres (MSF) have had a strong presence in the country. Dr Andre Munger, the medical chief at one of MSF's trauma hospitals in the outskirts of Port-au-Prince, says they "are now starting to take action because of the health catastrophe posed by non-communicable diseases like diabetes".
Later this year, MSF aim to carry out a new survey on the number of people suffering from diabetic and cardiovascular complications in Haiti. "Without proper data and statistics we'll never be able to address these issues properly," Dr Munger explains.
In order to bring this work on to the international stage and begin to tap into possible new sources of funding, FHADIMAC will present its plan at a UN summit in New York in September.
For many diabetics and other NCD patients like Jean Bernadette, such efforts could be the difference between life and death.
Thursday, March 10, 2011
Whole-Fat Milk and Cheese Can Lower Diabetes Risk
The incidence of Type 2 diabetes declined significantly as levels of a fatty acid found in whole-fat dairy products increased....
Adults with the highest levels of trans-palmitoleic acid had a 60% lower diabetes incidence compared with individuals who had the lowest levels. Higher levels of the fatty acid also were associated with a more favorable metabolic profile.
Multivariate analyses of demographic, clinical, and lifestyle factors showed that whole-fat dairy consumption had the strongest association with levels of trans-palmitoleate. However, the authors remained circumspect about the association.
Dariush Mozaffarian, MD, DrPH, of the Harvard School of Public Health, and coauthors wrote in conclusion that, "Our results demonstrate an inverse relationship between levels of trans-palmitoleate and metabolic risk factors and diabetes incidence."
"The small differences in trans-palmitoleate levels raise questions about whether this is the active compound or a marker for some other, unknown protective constituent of dairy or other ruminant foods."
The findings support previous evidence of favorable associations between whole-fat dairy consumption and metabolic factors. The authors speculated that trans-palmitoleate could exert effects on pathways related to insulin resistance, dyslipidemia, and hepatic fat synthesis.
A product of endogenous fat synthesis, circulating palmitoleic acid has been associated with protection against insulin resistance and metabolic dysregulation in experimental models. Studies in humans, however, have yielded mixed results, the authors wrote in the introduction to their findings.
Efforts to study circulating palmitoleic acid have been confounded by the effects of endogenous synthesis and metabolism. The trans isomer of palmitoleate represents an endogenous source of the fatty acid and avoids confounding endogenous effects. Derived primarily from naturally occurring dairy and other ruminant trans fats, trans-palmitoleate is not associated with increased cardiovascular risk, in contrast to trans fats derived from partially hydrogenated oils.
"In fact, several studies have demonstrated inverse associations between dairy consumption and risk for insulin resistance, the metabolic syndrome, or diabetes," the authors continued. "To our knowledge, no previous studies have evaluated a potential role of trans-palmitoleate in metabolic risk."
The patient cohort of the Cardiovascular Health Study provided an opportunity to examine associations between trans-palmitoleate, metabolic risk factors, and risk of Type 2 diabetes. Mozaffarian and coauthors analyzed data on 3,736 study participants, all of whom were 65 or older and were identified from Medicare eligibility lists.
Baseline assessments included physical examination, diagnostic testing, questionnaires about health status, and laboratory evaluation that included measurement of 45 different fatty acids. Study participants were followed for 10 years, including annual clinic visits and interim telephone calls.
Laboratory results showed that trans-palmitoleate accounted for an average of 0.18% of total fatty acid. Levels had a strong correlation with known biomarkers of dairy-fat consumption but a weak correlation with biomarkers of partially hydrogenated oils.
Whole-fat dairy consumption had the strongest association with trans-palmitoleate levels. Separate analyses of different types of dairy foods further refined the association by showing that levels of the fatty acid were most closely associated with whole-milk consumption. Levels of trans-palmitoleate were not significantly related to consumption of carbohydrates, protein, red meat, or low-fat dairy foods.
In multivariate analyses, higher trans-palmitoleate levels were significantly associated with:
Lower body mass index (-1.8%, P=0.058)
Smaller waist circumference (-1.8%, P=0.009)
Higher levels of HDL cholesterol (1.9%, P=0.043)
Lower triglyceride levels (-19.0%, P<0.001)
Lower total cholesterol:HDL ratio (-4.7%, P<0.001)
Lower levels of C-reactive protein (-13.8%, P=0.050)
Lower fasting insulin levels (-13.3%, P=0.001)
Less insulin resistance by homeostasis model (-16.7%, P<0.001)
During follow-up, 304 study participants developed new-onset diabetes. In adjusted analyses, comparison of trans-palmitoleate quintiles showed that participants in quintiles 4 and 5 had diabetes hazard ratios of 0.44 and 0.36, respectively, compared with quintile 1 (P<0.001 for trend).
"Each higher standard deviation of trans-palmitoleate was associated with a 28% lower risk of diabetes," the authors wrote.
Acknowledging limitations of the study, Mozaffarian and colleagues noted that trans-palmitoleate levels were measured at a single point in time and that food intake was based on self-reports. They also pointed out that causality cannot be determined due to the possibility of residual confounding and that "the small differences in trans palmitoleate levels raise questions about whether this is the active compound or a marker for some other, unknown protective constituent of dairy or other ruminant foods."
Adults with the highest levels of trans-palmitoleic acid had a 60% lower diabetes incidence compared with individuals who had the lowest levels. Higher levels of the fatty acid also were associated with a more favorable metabolic profile.
Multivariate analyses of demographic, clinical, and lifestyle factors showed that whole-fat dairy consumption had the strongest association with levels of trans-palmitoleate. However, the authors remained circumspect about the association.
Dariush Mozaffarian, MD, DrPH, of the Harvard School of Public Health, and coauthors wrote in conclusion that, "Our results demonstrate an inverse relationship between levels of trans-palmitoleate and metabolic risk factors and diabetes incidence."
"The small differences in trans-palmitoleate levels raise questions about whether this is the active compound or a marker for some other, unknown protective constituent of dairy or other ruminant foods."
The findings support previous evidence of favorable associations between whole-fat dairy consumption and metabolic factors. The authors speculated that trans-palmitoleate could exert effects on pathways related to insulin resistance, dyslipidemia, and hepatic fat synthesis.
A product of endogenous fat synthesis, circulating palmitoleic acid has been associated with protection against insulin resistance and metabolic dysregulation in experimental models. Studies in humans, however, have yielded mixed results, the authors wrote in the introduction to their findings.
Efforts to study circulating palmitoleic acid have been confounded by the effects of endogenous synthesis and metabolism. The trans isomer of palmitoleate represents an endogenous source of the fatty acid and avoids confounding endogenous effects. Derived primarily from naturally occurring dairy and other ruminant trans fats, trans-palmitoleate is not associated with increased cardiovascular risk, in contrast to trans fats derived from partially hydrogenated oils.
"In fact, several studies have demonstrated inverse associations between dairy consumption and risk for insulin resistance, the metabolic syndrome, or diabetes," the authors continued. "To our knowledge, no previous studies have evaluated a potential role of trans-palmitoleate in metabolic risk."
The patient cohort of the Cardiovascular Health Study provided an opportunity to examine associations between trans-palmitoleate, metabolic risk factors, and risk of Type 2 diabetes. Mozaffarian and coauthors analyzed data on 3,736 study participants, all of whom were 65 or older and were identified from Medicare eligibility lists.
Baseline assessments included physical examination, diagnostic testing, questionnaires about health status, and laboratory evaluation that included measurement of 45 different fatty acids. Study participants were followed for 10 years, including annual clinic visits and interim telephone calls.
Laboratory results showed that trans-palmitoleate accounted for an average of 0.18% of total fatty acid. Levels had a strong correlation with known biomarkers of dairy-fat consumption but a weak correlation with biomarkers of partially hydrogenated oils.
Whole-fat dairy consumption had the strongest association with trans-palmitoleate levels. Separate analyses of different types of dairy foods further refined the association by showing that levels of the fatty acid were most closely associated with whole-milk consumption. Levels of trans-palmitoleate were not significantly related to consumption of carbohydrates, protein, red meat, or low-fat dairy foods.
In multivariate analyses, higher trans-palmitoleate levels were significantly associated with:
Lower body mass index (-1.8%, P=0.058)
Smaller waist circumference (-1.8%, P=0.009)
Higher levels of HDL cholesterol (1.9%, P=0.043)
Lower triglyceride levels (-19.0%, P<0.001)
Lower total cholesterol:HDL ratio (-4.7%, P<0.001)
Lower levels of C-reactive protein (-13.8%, P=0.050)
Lower fasting insulin levels (-13.3%, P=0.001)
Less insulin resistance by homeostasis model (-16.7%, P<0.001)
During follow-up, 304 study participants developed new-onset diabetes. In adjusted analyses, comparison of trans-palmitoleate quintiles showed that participants in quintiles 4 and 5 had diabetes hazard ratios of 0.44 and 0.36, respectively, compared with quintile 1 (P<0.001 for trend).
"Each higher standard deviation of trans-palmitoleate was associated with a 28% lower risk of diabetes," the authors wrote.
Acknowledging limitations of the study, Mozaffarian and colleagues noted that trans-palmitoleate levels were measured at a single point in time and that food intake was based on self-reports. They also pointed out that causality cannot be determined due to the possibility of residual confounding and that "the small differences in trans palmitoleate levels raise questions about whether this is the active compound or a marker for some other, unknown protective constituent of dairy or other ruminant foods."
Saturday, March 5, 2011
Can Diabetes Be Cured?
Q: I'm 47 years old and was recently diagnosed with diabetes. I'm about 25 pounds overweight and lead a sedentary lifestyle, but I'm starting a diet and an exercise program. Will my diabetes go away if I lose weight, watch my diet, and exercise regularly?
— Mary, Kansas City
A: It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetes
The length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
— Mary, Kansas City
A: It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetes
The length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
Thursday, February 3, 2011
Exploring The Potential Of Procedures That Address Venous Ulcer Etiology
The complexity of venous ulcerations leads to prolonged healing and doubt. Clinicians have traditionally treated venous wounds with debridement, multi-layer compression dressings and skin grafts.
Most of the literature focuses on various topical ointments, the use of allogenic grafting, compression therapies, etc. Unfortunately, there is little research on addressing the etiology of venous wounds. Understanding and treating the etiology in all aspects of medicine is imperative in order to achieve a successful result.
Venous insufficiency is a condition in which veins do not adequately return blood back to the central system. In the lower extremity, both the superficial and deep vein systems of the legs utilize valves to ensure cephalad flow. The deep vein system also uses muscular contraction to assist in pumping the blood upward. A perforating vein is a vein that penetrates a fascial plane and may connect the superficial venous system to the deep vein system or connect greater saphenous veins to small saphenous veins.
Over time, various risks factors such as heredity, hormones, pregnancy and prolonged standing cause the smooth muscle in the vein’s wall to relax. When this occurs, there is an inability of the vein valves to approximate. In the legs, the normal flow opposes gravity. However, with insufficiency, the blood refluxes and backflow occurs to the ankles. In severe cases, blood pooling leads to edema, hyperpigmentation, loss of skin turgor and ulceration. An ulcer can also occur after a varicose vein opens and causes bleeding.
Consider a patient who presents with a venous ulceration. In most cases, these patients receive wound care and compression therapy. One does not usually perform an ultrasound. Ultrasound is crucial in finding out where the insufficiency lies and which veins lead to the ulceration. It is imperative that the physician or registered vascular technician evaluates both the deep vein and superficial vein systems for reflux. Just scanning the deep vein system for a thrombus would be incomplete and will not identify the pathology involved.
Direct attention to the lower extremities while the patient is standing. Evaluate the deep vein system, including the femoral, popliteal, tibial and peroneal veins, and look for the presence of a thrombus and reflux. In the superficial system, test the greater and small saphenous veins as well as anterior and posterior circumflex and perforating veins.
In general, one should utilize the following guidelines to identify insufficiency in the superficial system: a greater saphenous vein larger than 0.4 cm in diameter, longer than 0.5 seconds of reflux and a small saphenous or perforating vein larger than 0.3 cm in diameter and 0.5 seconds of reflux. If varicosities are present, one can follow the varicosities towards their tributary. This is called vein mapping.
With the presence of a venous ulcer, the ultrasonographer will be able to scan over the ulcer and trace it back to the insufficient vein. The ulcer is usually a direct extension from a superficial varicosity. However, the underlying etiology is a result of insufficiency of the superficial, deep or perforating vein system. By addressing the insufficient vein either through ultrasound guided chemical ablation or endovenous ablation, venous ulcerations heal on an average of four weeks barring that no infection is present.
Key Insights On Ultrasound Guided Chemical Ablation
Ultrasound guided chemical ablation is a treatment in which one injects a sclerosant into the refluxing vein. The two most common sclerosants are sodium tetradecyl sulfate (Sotradecol, Angiodynamics), which recently received FDA approval, and polidocanol (Asclera, Merz). Traditional saline injections are not strong enough to treat large veins and should be reserved for cosmetic spider and reticular veins only.
With ultrasound guidance, inject liquid sclerosant or foam sclerosant (sclerosant mixed with air or CO2) into the insufficient vein. Foam has become widely accepted for its advantages. Foam solution makes more contact with the vein wall due to increased surface area properties, disperses quicker and stays in the vein longer than liquid. Furthermore, one can easily visualize and follow the solution on ultrasound during treatment. With sclerotherapy treatment, the chemical damages the vessel wall. The vein hardens and the body breaks it down. Larger and deeper veins will harden, thicken and shrink but may not disappear altogether.
One does not directly inject the ulceration but rather the insufficient vein along its course. If one performs ultrasound chemical ablation alone, it will take a few treatments before treatment addresses the veins at the ulceration site. Accordingly, this method usually occurs after an ablative procedure. Only perform this treatment on the superficial and perforating vein systems. Do not inject the deep venous system.
A Closer Look At Endovenous Laser Ablation
Endovenous laser or radiofrequency ablation is a procedure that closes the long segment of the insufficient vein. First access the insufficient vein under the guidance of ultrasound. Through the access needle, insert a guide wire. Remove the needle and place a dilator and sheath over the wire and into the vessel. Remove the wire and the dilator, and leave the sheath in the vein. Proceed to instill a fiber optic laser or catheter for radiofrequency. Confirm the placement of the fiber or cathode exiting the end of the sheath. Be sure to avoid superficial/deep vein junctions by at least 1.5 inches.
Then deliver anesthetic agents mixed with saline, creating what is known as a sea of tumescence. After administering adequate anesthetic, remove the sheath along with the laser and/or catheter while delivering laser energy or radiofrequency. One must apply enough laser energy or radiofrequency to the vein in order to create appropriate closure and stop the flow through the insufficient portion. After the procedure, the patient wears compression stockings and bandages over the ulceration for approximately one week.
Follow-up with the patient includes the use of post-procedure ultrasound to confirm the success of the procedure (namely ensuring there is no deep thrombus) and mapping the vein to the ulcerated site.
Perform traditional debridement and have the patient wear compression dressings for two weeks. After the two-week period, if the ulceration has not already healed, ultrasound guided chemical ablation may close any remaining branches of veins that have reflux flow. Do not inject sclerosant directly through the ulceration. It is imperative to treat any and all vessels leading to the ulceration but it is not necessary to treat all superficial vein structures if insufficiency is not present.
Over the course of therapy, the ulceration will decrease in size and the vessels will become hardened. Perform injections every three to four weeks. Four to six sessions may be needed to complete the course of therapy. On ultrasound, these vessels will not be able to compress and there is no filling on color flow Doppler.
Final Thoughts
It is important to note that once an individual has venous insufficiency, it does not go away and may in fact affect other veins. Other veins may become insufficient due to increased load and hypertension, and new vessels can develop. This process is called neovascularization. It is necessary to perform maintenance and follow-up care to ensure a new ulceration does not develop.
Performing procedures to improve and control the chronic venous insufficiency should be the focus of venous ulcer healing. Depending on the size and healing potential of the patient, the wound healing time is significantly shorter. This positively affects all aspects of patient care including increased patient adherence, decreased risk of infection, decreased healthcare costs and more efficient medical care.
Most of the literature focuses on various topical ointments, the use of allogenic grafting, compression therapies, etc. Unfortunately, there is little research on addressing the etiology of venous wounds. Understanding and treating the etiology in all aspects of medicine is imperative in order to achieve a successful result.
Venous insufficiency is a condition in which veins do not adequately return blood back to the central system. In the lower extremity, both the superficial and deep vein systems of the legs utilize valves to ensure cephalad flow. The deep vein system also uses muscular contraction to assist in pumping the blood upward. A perforating vein is a vein that penetrates a fascial plane and may connect the superficial venous system to the deep vein system or connect greater saphenous veins to small saphenous veins.
Over time, various risks factors such as heredity, hormones, pregnancy and prolonged standing cause the smooth muscle in the vein’s wall to relax. When this occurs, there is an inability of the vein valves to approximate. In the legs, the normal flow opposes gravity. However, with insufficiency, the blood refluxes and backflow occurs to the ankles. In severe cases, blood pooling leads to edema, hyperpigmentation, loss of skin turgor and ulceration. An ulcer can also occur after a varicose vein opens and causes bleeding.
Consider a patient who presents with a venous ulceration. In most cases, these patients receive wound care and compression therapy. One does not usually perform an ultrasound. Ultrasound is crucial in finding out where the insufficiency lies and which veins lead to the ulceration. It is imperative that the physician or registered vascular technician evaluates both the deep vein and superficial vein systems for reflux. Just scanning the deep vein system for a thrombus would be incomplete and will not identify the pathology involved.
Direct attention to the lower extremities while the patient is standing. Evaluate the deep vein system, including the femoral, popliteal, tibial and peroneal veins, and look for the presence of a thrombus and reflux. In the superficial system, test the greater and small saphenous veins as well as anterior and posterior circumflex and perforating veins.
In general, one should utilize the following guidelines to identify insufficiency in the superficial system: a greater saphenous vein larger than 0.4 cm in diameter, longer than 0.5 seconds of reflux and a small saphenous or perforating vein larger than 0.3 cm in diameter and 0.5 seconds of reflux. If varicosities are present, one can follow the varicosities towards their tributary. This is called vein mapping.
With the presence of a venous ulcer, the ultrasonographer will be able to scan over the ulcer and trace it back to the insufficient vein. The ulcer is usually a direct extension from a superficial varicosity. However, the underlying etiology is a result of insufficiency of the superficial, deep or perforating vein system. By addressing the insufficient vein either through ultrasound guided chemical ablation or endovenous ablation, venous ulcerations heal on an average of four weeks barring that no infection is present.
Key Insights On Ultrasound Guided Chemical Ablation
Ultrasound guided chemical ablation is a treatment in which one injects a sclerosant into the refluxing vein. The two most common sclerosants are sodium tetradecyl sulfate (Sotradecol, Angiodynamics), which recently received FDA approval, and polidocanol (Asclera, Merz). Traditional saline injections are not strong enough to treat large veins and should be reserved for cosmetic spider and reticular veins only.
With ultrasound guidance, inject liquid sclerosant or foam sclerosant (sclerosant mixed with air or CO2) into the insufficient vein. Foam has become widely accepted for its advantages. Foam solution makes more contact with the vein wall due to increased surface area properties, disperses quicker and stays in the vein longer than liquid. Furthermore, one can easily visualize and follow the solution on ultrasound during treatment. With sclerotherapy treatment, the chemical damages the vessel wall. The vein hardens and the body breaks it down. Larger and deeper veins will harden, thicken and shrink but may not disappear altogether.
One does not directly inject the ulceration but rather the insufficient vein along its course. If one performs ultrasound chemical ablation alone, it will take a few treatments before treatment addresses the veins at the ulceration site. Accordingly, this method usually occurs after an ablative procedure. Only perform this treatment on the superficial and perforating vein systems. Do not inject the deep venous system.
A Closer Look At Endovenous Laser Ablation
Endovenous laser or radiofrequency ablation is a procedure that closes the long segment of the insufficient vein. First access the insufficient vein under the guidance of ultrasound. Through the access needle, insert a guide wire. Remove the needle and place a dilator and sheath over the wire and into the vessel. Remove the wire and the dilator, and leave the sheath in the vein. Proceed to instill a fiber optic laser or catheter for radiofrequency. Confirm the placement of the fiber or cathode exiting the end of the sheath. Be sure to avoid superficial/deep vein junctions by at least 1.5 inches.
Then deliver anesthetic agents mixed with saline, creating what is known as a sea of tumescence. After administering adequate anesthetic, remove the sheath along with the laser and/or catheter while delivering laser energy or radiofrequency. One must apply enough laser energy or radiofrequency to the vein in order to create appropriate closure and stop the flow through the insufficient portion. After the procedure, the patient wears compression stockings and bandages over the ulceration for approximately one week.
Follow-up with the patient includes the use of post-procedure ultrasound to confirm the success of the procedure (namely ensuring there is no deep thrombus) and mapping the vein to the ulcerated site.
Perform traditional debridement and have the patient wear compression dressings for two weeks. After the two-week period, if the ulceration has not already healed, ultrasound guided chemical ablation may close any remaining branches of veins that have reflux flow. Do not inject sclerosant directly through the ulceration. It is imperative to treat any and all vessels leading to the ulceration but it is not necessary to treat all superficial vein structures if insufficiency is not present.
Over the course of therapy, the ulceration will decrease in size and the vessels will become hardened. Perform injections every three to four weeks. Four to six sessions may be needed to complete the course of therapy. On ultrasound, these vessels will not be able to compress and there is no filling on color flow Doppler.
Final Thoughts
It is important to note that once an individual has venous insufficiency, it does not go away and may in fact affect other veins. Other veins may become insufficient due to increased load and hypertension, and new vessels can develop. This process is called neovascularization. It is necessary to perform maintenance and follow-up care to ensure a new ulceration does not develop.
Performing procedures to improve and control the chronic venous insufficiency should be the focus of venous ulcer healing. Depending on the size and healing potential of the patient, the wound healing time is significantly shorter. This positively affects all aspects of patient care including increased patient adherence, decreased risk of infection, decreased healthcare costs and more efficient medical care.
Friday, January 21, 2011
Can Diabetes Be Cured?
Q: I'm 47 years old and was recently diagnosed with diabetes. I'm about 25 pounds overweight and lead a sedentary lifestyle, but I'm starting a diet and an exercise program. Will my diabetes go away if I lose weight, watch my diet, and exercise regularly?
— Mary, Wichita
A:It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetesThe length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100 mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
— Mary, Wichita
A:It is wonderful that you are changing your lifestyle to become healthier! This will benefit you greatly, not only in controlling your blood sugar but also in improving your cholesterol levels, strengthening your bones, and improving your heart function. These changes come with a long list of health benefits, but whether they will allow you to stop taking medicines completely depends on several factors:
The primary cause of your diabetesThe length of time that you had undiscovered, or "hidden," diabetes
The length of time you've had diagnosed diabetes
How well your pancreas is functioning, including how much insulin it is producing, and the extent of insulin resistance associated with excess weight
As you probably know, the cause of diabetes among most adults is twofold. It's caused by insulin resistance resulting from excess weight, and inadequate insulin production in the pancreas. These two causes are also interrelated. Many people whose diabetes is primarily the result of excess weight and insulin resistance can potentially reduce their glucose levels by losing a significant amount of weight and controlling their sugar levels through diet and exercise alone. This assumes that their pancreas is still producing an adequate amount of insulin.
A good number of diabetics, however, have the illness but don't know it for at least five years before diagnosis. This is crucial because over time, the insulin-producing cells in the pancreas decline in function. Often, by the time a patient is diagnosed, a critical number of cells have stopped producing insulin entirely. There is no way to reverse this. If your diabetes is diagnosed early in the disease process, however, aggressive management may help you prevent further loss of function in those cells. This means maintaining your fasting glucose levels below 100 mg/dl and your after-meal (two hours after) levels below 140 mg/dl. This is the same for morning and evening glucose levels.
It is also entirely possible for some people to control their blood glucose with diet alone. I have a few patients who have been able to do so. All are producing adequate insulin, have lost weight or are within their ideal body-weight range, and watch their diets.
Thursday, January 20, 2011
Diabetes + Depression Increases Risk of Dying from Heart Disease
Depression and diabetes appear to be associated with a significantly increased risk of death from heart disease and risk of death from all causes over a six-year period for women....
Depression affects close to 15 million U.S. adults each year and more than 23.5 million U.S. adults have diabetes, according to background information in the article. Symptoms of depression affect between one-fifth and one-fourth of patients with diabetes, nearly twice as many as individuals without diabetes. Diabetes and its complications are leading causes of death around the world.
An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 78,282 women aged 54 to 79 in 2000 who were participating in the Nurses' Health Study. The women were classified as having depression if they reported being diagnosed with the condition, were treated with antidepressant medications or scored high on an index measuring depressive symptoms. Reports of Type 2 diabetes were confirmed using a supplementary questionnaire.
During six years of follow-up, 4,654 of the women died, including 979 who died from cardiovascular disease. Compared with women who did not have either condition, those with depression had a 44 percent increased risk of death, those with diabetes had a 35 percent increased risk of death and those with both conditions had approximately twice the risk of death.
When considering only deaths from cardiovascular disease, women with diabetes had a 67 percent increased risk, women with depression had a 37 percent increased risk and women with both had a 2.7-fold increased risk.
"The underlying mechanisms of the increased mortality risk associated with depression in patients with diabetes remains to be elucidated," the authors write. "It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients and isolation from the social network." In addition, diabetes and depression are both linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle, and depression could trigger changes in the nervous system that adversely affect the heart.
"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," the authors conclude.
Depression affects close to 15 million U.S. adults each year and more than 23.5 million U.S. adults have diabetes, according to background information in the article. Symptoms of depression affect between one-fifth and one-fourth of patients with diabetes, nearly twice as many as individuals without diabetes. Diabetes and its complications are leading causes of death around the world.
An Pan, Ph.D., of the Harvard School of Public Health, Boston, and colleagues studied 78,282 women aged 54 to 79 in 2000 who were participating in the Nurses' Health Study. The women were classified as having depression if they reported being diagnosed with the condition, were treated with antidepressant medications or scored high on an index measuring depressive symptoms. Reports of Type 2 diabetes were confirmed using a supplementary questionnaire.
During six years of follow-up, 4,654 of the women died, including 979 who died from cardiovascular disease. Compared with women who did not have either condition, those with depression had a 44 percent increased risk of death, those with diabetes had a 35 percent increased risk of death and those with both conditions had approximately twice the risk of death.
When considering only deaths from cardiovascular disease, women with diabetes had a 67 percent increased risk, women with depression had a 37 percent increased risk and women with both had a 2.7-fold increased risk.
"The underlying mechanisms of the increased mortality risk associated with depression in patients with diabetes remains to be elucidated," the authors write. "It is generally suggested that depression is associated with poor glycemic control, an increased risk of diabetes complications, poor adherence to diabetes management by patients and isolation from the social network." In addition, diabetes and depression are both linked to unhealthy behaviors such as smoking, poor diet and a sedentary lifestyle, and depression could trigger changes in the nervous system that adversely affect the heart.
"Considering the size of the population that could be affected by these two prevalent disorders, further consideration is required to design strategies aimed to provide adequate psychological management and support among those with longstanding chronic conditions, such as diabetes," the authors conclude.
Wednesday, December 22, 2010
What Is Peripheral Artery Disease?
Peripheral artery disease (PAD) can sometimes go undetected, so it's important to know the symptoms. Plus, learn about the possible complications of PAD and how the condition is treated.
Restricted blood flow anywhere in your body can be a serious health problem that can ultimately affect your heart. When blood flow to the legs is reduced, the condition is called peripheral artery disease, or PAD, explains Joshua A. Beckman, MD, director of the Cardiovascular Fellowship Program at Brigham and Women's Hospital and assistant professor at Harvard Medical School in Boston. PAD occurs when arteries in the legs become hardened due to the build-up of plaque (cholesterol and other fatty substances) — a condition called atherosclerosis.
Who Develops PAD
"PAD often develops in people who smoke or have diabetes," says Dr. Beckman. In addition, it is commonly found in people who are between the ages of 50 and 69. In people above the age of 65, approximately 20 percent of men and 16 percent of women have PAD.
Other risk factors for PAD include:
Having high blood pressure
Having high cholesterol
Having a history of heart disease
Undergoing hemodialysis to treat kidney disease
Having had a stroke
"About half of the people who have PAD do not have specific symptoms and have no way to know they have the disease," says Beckman. "Of the half that do have symptoms, the majority describe feeling discomfort in an area like the calf, hip or thigh while walking."
If you have any of the risk factors for PAD, you should ask your doctor about PAD even if you aren’t experiencing symptoms. Your doctor can still diagnose PAD through one or more tests.
Signs of PAD
The pain people with PAD experience while walking is called intermittent claudication. You may feel a burning, aching, heaviness, or leaden feeling because the exercising muscle is demanding more blood than can be delivered due to poor blood flow in the legs. "The discomfort occurs only with walking and is typically relieved with a few minutes of rest," says Beckman.
It can be easy to discount this pain as arthritis, a result of aging, or an injury from exercise. But if you continue to notice these symptoms when you walk, and they stop when you rest, PAD could be the reason.
When PAD worsens and blood flow is severely restricted, the feet and legs may be painful even without exercise.
Risks of Untreated PAD
Untreated PAD can lead to heart attack or stroke. People with untreated PAD are six to seven times more likely to experience heart attack or stroke than those without the disease. Beckman estimates that the risk of death in those with untreated PAD is 15 to 30 percent over five years.
Amputation is also a risk of untreated PAD, though it isn't common in either people who do not experience PAD symptoms or in those who experience intermittent pain. But between 1 and 2 percent of people with PAD may either experience severe pain in their legs while resting, a wound on their foot that won't heal, or even gangrene, says Beckman. Then amputation is a more serious threat unless action is taken.
Treating PAD
Treatment for PAD usually entails a combination of prescribed medication and a healthier lifestyle to manage atherosclerosis, lower cholesterol and blood pressure levels, and improve blood flow in your legs.
Here are steps your doctor may recommend to treat and manage PAD:
Quit smoking
Take medications to manage contributing health problems, like high cholesterol and high blood pressure
Take anti-clotting medications to prevent blood clots
Walk and get other exercise frequently
Achieve and maintain a healthy body weight
Eat a healthy diet of low-cholesterol, low-fat, and low-calorie foods
In some cases, blockages in the legs may need to be opened up with a catheter in a procedure called angioplasty and propped open with a small tube called a stent. In cases of severe PAD, bypass surgery may be needed to reroute blood flow in the legs.
By Diana Rodriguez
Medically reviewed by Pat F. Bass III, MD, MPH
Restricted blood flow anywhere in your body can be a serious health problem that can ultimately affect your heart. When blood flow to the legs is reduced, the condition is called peripheral artery disease, or PAD, explains Joshua A. Beckman, MD, director of the Cardiovascular Fellowship Program at Brigham and Women's Hospital and assistant professor at Harvard Medical School in Boston. PAD occurs when arteries in the legs become hardened due to the build-up of plaque (cholesterol and other fatty substances) — a condition called atherosclerosis.
Who Develops PAD
"PAD often develops in people who smoke or have diabetes," says Dr. Beckman. In addition, it is commonly found in people who are between the ages of 50 and 69. In people above the age of 65, approximately 20 percent of men and 16 percent of women have PAD.
Other risk factors for PAD include:
Having high blood pressure
Having high cholesterol
Having a history of heart disease
Undergoing hemodialysis to treat kidney disease
Having had a stroke
"About half of the people who have PAD do not have specific symptoms and have no way to know they have the disease," says Beckman. "Of the half that do have symptoms, the majority describe feeling discomfort in an area like the calf, hip or thigh while walking."
If you have any of the risk factors for PAD, you should ask your doctor about PAD even if you aren’t experiencing symptoms. Your doctor can still diagnose PAD through one or more tests.
Signs of PAD
The pain people with PAD experience while walking is called intermittent claudication. You may feel a burning, aching, heaviness, or leaden feeling because the exercising muscle is demanding more blood than can be delivered due to poor blood flow in the legs. "The discomfort occurs only with walking and is typically relieved with a few minutes of rest," says Beckman.
It can be easy to discount this pain as arthritis, a result of aging, or an injury from exercise. But if you continue to notice these symptoms when you walk, and they stop when you rest, PAD could be the reason.
When PAD worsens and blood flow is severely restricted, the feet and legs may be painful even without exercise.
Risks of Untreated PAD
Untreated PAD can lead to heart attack or stroke. People with untreated PAD are six to seven times more likely to experience heart attack or stroke than those without the disease. Beckman estimates that the risk of death in those with untreated PAD is 15 to 30 percent over five years.
Amputation is also a risk of untreated PAD, though it isn't common in either people who do not experience PAD symptoms or in those who experience intermittent pain. But between 1 and 2 percent of people with PAD may either experience severe pain in their legs while resting, a wound on their foot that won't heal, or even gangrene, says Beckman. Then amputation is a more serious threat unless action is taken.
Treating PAD
Treatment for PAD usually entails a combination of prescribed medication and a healthier lifestyle to manage atherosclerosis, lower cholesterol and blood pressure levels, and improve blood flow in your legs.
Here are steps your doctor may recommend to treat and manage PAD:
Quit smoking
Take medications to manage contributing health problems, like high cholesterol and high blood pressure
Take anti-clotting medications to prevent blood clots
Walk and get other exercise frequently
Achieve and maintain a healthy body weight
Eat a healthy diet of low-cholesterol, low-fat, and low-calorie foods
In some cases, blockages in the legs may need to be opened up with a catheter in a procedure called angioplasty and propped open with a small tube called a stent. In cases of severe PAD, bypass surgery may be needed to reroute blood flow in the legs.
By Diana Rodriguez
Medically reviewed by Pat F. Bass III, MD, MPH
Wednesday, December 8, 2010
Diet for Hypertension and Cardiovascular Disease?
Q: What's a good diet for a 45-year-old male who has hypertension, cardiovascular disease, and is overweight?
— Diane, Indiana
A:
The DASH diet is the best diet for these conditions and has been tested and proven to lower blood pressure and lipid levels. DASH stands for Dietary Approaches to Stop Hypertension and is really one of the only diets based on sound science. It calls for lean protein, low-fat dairy, lots of fruits and vegetables, and whole grains — and about 25 percent of its total daily calories come from mostly good fats, like olive and canola oils. The DASH diet is recommended by NIH (National Institutes of Health) and NHLBI (National Heart, Lung, and Blood Institute) to reduce blood pressure and maintain a good weight. So this in fact is the perfect diet for someone who is overweight and has hypertension and cardiovascular disease. It is very similar to other healthy diets that the government recommends, and is very easy to follow because it calls for making sure you give yourself a certain number of servings of lean protein, fresh fruits and vegetables, whole grains, and low-fat dairy per day. There are Web sites available that will teach you how to know how many servings of each food you need per day based on your body weight, but in general the DASH diet recommends nine servings of fruits and vegetables per day, two to three servings of low-fat dairy and protein, and five to six servings of whole grains
— Diane, Indiana
A:
The DASH diet is the best diet for these conditions and has been tested and proven to lower blood pressure and lipid levels. DASH stands for Dietary Approaches to Stop Hypertension and is really one of the only diets based on sound science. It calls for lean protein, low-fat dairy, lots of fruits and vegetables, and whole grains — and about 25 percent of its total daily calories come from mostly good fats, like olive and canola oils. The DASH diet is recommended by NIH (National Institutes of Health) and NHLBI (National Heart, Lung, and Blood Institute) to reduce blood pressure and maintain a good weight. So this in fact is the perfect diet for someone who is overweight and has hypertension and cardiovascular disease. It is very similar to other healthy diets that the government recommends, and is very easy to follow because it calls for making sure you give yourself a certain number of servings of lean protein, fresh fruits and vegetables, whole grains, and low-fat dairy per day. There are Web sites available that will teach you how to know how many servings of each food you need per day based on your body weight, but in general the DASH diet recommends nine servings of fruits and vegetables per day, two to three servings of low-fat dairy and protein, and five to six servings of whole grains
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