Live Healthy. Live Well.
These articles cover all aspects of healthy living -- from cutting-edge health research to day-to-day helps that allow you to live healthy...live well.
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HEALTH NEWS
“Live healthy...Live well”
Dedicated to providing pertinent information on health, fitness, and nutrition to foster a culture of wellness among Southwest Airlines flight crews and their families.
by Larry Kline
email: livehealthy-livewell@cox.net
YOU’RE ONLY AS OLD AS YOUR ARTERIES – as we age, the aorta, carotids, and other large arteries that keep oxygen-rich blood flowing through the body lose some of their capacity to widen or narrow – they become less compliant.
With aging, arterial compliance declines and arterial stiffness increases. Arteries are most supple at about age 30 and then start stiffening. Factors that contribute to this declining function include:
Rigid walls. The two main structural proteins in the large artery walls are collagen and elastin. Collagen provides the “scaffolding” that holds the arteries together, and elastin gives the blood vessels the elasticity that they need to manage the flow of blood.
As people get older, collagen becomes more abundant in artery walls. Over time, strands of collagen tend to bind (cross link) with other collagen strands. Both combine to make the large arteries more rigid. If there is extra glucose (blood sugar) in the blood, cross-linking increases as the glucose binds to the collagen to form advanced glycation end-products, or AGEs. As the years go by, the elastin proteins stretch out and eventually start to rupture. That makes the arteries lose even more flexibility.
Damaged linings. Not only do the walls of the arteries get stiffer as they age, the arterial lining also gets stiffer. The endothelium is the inner lining of cells in all of the arteries in the body. It regulates where blood flows and how much blood flows to the organs as needed, and it maintains the blood in a fluid state so that it does not clot.
Endothelial cells produce nitric oxide, a gas that relaxes and dilates blood vessels. An impaired lining produces less nitric oxide, which leads to less flexible arteries. Nitric oxide not only relaxes and dilates blood vessels, but also prevents platelets and white blood cells from sticking to blood vessel walls. Less nitric oxide leads to more plaque buildup in artery walls, which means that the lining produces even less nitric oxide, which leads to more plaque buildup in artery walls – a cycle that increases cardiovascular risk in people.
Age is a major factor in this decline. All other risk factors that are known to lead to coronary heart disease also have been shown to hinder endothelial function. High blood pressure, cigarette smoking, diabetes, high cholesterol, being overweight, or not doing enough exercise all contribute to arterial decline. If the endothelium is abnormal, it means that the cumulative load of risk factors and lifestyle has led to damage to the arteries which greatly increases the risk of developing heart disease or heart failure, heart attack, or stroke.
The endothelium is a “barometer” of the health of the blood vessels because it is one of the first things to go wrong on the path to atherosclerosis, which is the underlying cause of heart attack and the most common form of stroke.
LDL cholesterol inside the artery walls is generally removed by HDL particles. If the HDL cannot keep up, the LDL causes the arteries to narrow and stiffen. As the excess cholesterol builds up, white blood cells enter the artery wall to remove these “invaders.” But excess LDL can engorge the white blood cells and turn them into foam cells, triggering inflammation, causing more repair cells to enter the artery wall, creating more plaque. A cap forms over damaged artery walls. If the cap ruptures, the plaque may ooze out and trigger the formation of a blood clot which could block the artery resulting in a heart attack or stroke.
THE CONSEQUENCES
Scientists are learning that stiffening arteries can often be detected (in the research laboratory) long before any symptoms of disease appear, and that can predict who will develop cardiovascular disease. Risk factors include:
High blood pressure. If your arteries are stiff, the heart has to work harder to pump blood. Nine out of ten people will develop high blood pressure if they live long enough. Most of this is systolic hypertension that is directly due to arterial stiffening. (Systolic pressure is the maximum pressure on the arteries when the heart contracts and pushes blood out – it is the top number in a blood pressure reading).
It is now recognized that increased systolic blood pressure with age is really the blood pressure change that is linked mostly to premature death in adults over 50. When arteries are stiff, blood pumped from the heart moves so quickly through them to the extremities that the pulse wave that is generated bounces back to the heart while the heart is still contracting which adds to systolic pressure.
Heart attacks and strokes. Arterial stiffness is as powerful a predictor of future cardiovascular disease risk in older adults as LDL cholesterol or any of the major conventional risk factors. Meta-analysis pooled the results of 17 international studies that tracked nearly 16,000 people for an average of eight years. Those who entered the studies with the stiffest arteries but without signs of heart disease were twice as likely to later die from a heart attack or stroke as those who entered the studies with the most supple arteries.
Cognitive decline. If the arteries cannot expand and contract easily, they cannot shield the smaller blood vessels from the regular high-pressure bursts of blood that leave the heart. These pressure spikes may damage the brain.
Several studies on aging have shown that those with stiffer arteries were more likely to show declines in verbal learning skills and memory over the next decade than those who started out with less-stiff arteries.
HOW CAN YOU TELL?
It is not possible to take a sample of the arterial wall in a study of living people, so samples have been taken during autopsies and these results have been compared and analyzed. For indirect measurements of arterial stiffness, a patient lies down while electrodes are placed on the skin along two arteries. Data is recorded on how fast it takes for a pulse to travel between two points (pulse wave velocity). The greater the velocity - the stiffer the artery. Since stiff arteries cannot expand well, they pinch the blood flow and send it shooting through at a faster speed.
Endothelial function is typically measured with something called flow-mediated dilation, which uses ultrasound to see how wide an artery opens after being deprived of blood with a cuff that is tightened on the arm. If people have impaired endothelial function, their arteries won’t widen as much during the test.
WHAT YOU CAN DO
Regular aerobic exercise may have the greatest effect on arterial stiffness. If you compare older adults who do regular aerobic exercise with older sedentary adults, those who exercise regularly have more-compliant arteries and less stiffening. Using pulse wave technology, scientists have found that the arterial stiffness in exercisers (the youngest being 54) was no different than the arteries of sedentary people aged 20 to 44.
During exercise, the physical force of blood accelerates through the arteries causing the endothelial cells to release nitric oxide. This has beneficial effects on the wall of the artery that results in an anti-stiffness effect. Studies in older test subjects who have stiff large arteries show that daily walking can lead to a 25 percent improvement in arterial stiffening within three months. The beneficial effects last as long as the person continues daily exercise.
Exercise can also help improve endothelial function in sedentary adults. Again, test subjects who exercised daily for three months realized about a 30 percent improvement, comparable to that of people their own age who ran regularly. These improvements in arterial health were achieved with moderate-intensity walking that can be safely performed by most if not all sedentary healthy adults.
Strength-training can actually increase arterial stiffening, due to the increased blood pressure that occurs temporarily. Many physicians recommend combining strength training with aerobic exercise. Older adults need to incorporate resistance-training to their exercise session for muscle preservation. The combination of aerobic training and strength training can maintain muscle mass and arterial flexibility. A 2006 Japanese study showed the arterial compliance of people who did resistance training for four months declined by 20 percent, while the arterial compliance of those who combined aerobics with resistance training did not change.
Diet: The following factors affect arterial health:
SODIUM. The component of the diet with the most evidence for slowing arterial stiffening is sodium. Sodium restriction has a very powerful effect on the arteries. Cutting the average sodium intake of U.S. adults in half results in a 25 to 30 percent improvement in the stiffness of the arteries in just one week. One study had adults in their 60s who had systolic hypertension (148/84) slash daily sodium intake from 3,100 milligrams a day to 1,300 mg/day. Carotid artery compliance increased by 27 percent after one week and by 46 percent after two weeks
SATURATED FAT. Endothelial function drops quickly after a fatty meal. Within three hours of consuming a meal heavy with saturated fats, endothelial function can decrease by half compared to those consuming a similar meal without the saturated fats, and the arteries look similar to the arteries of a person who has heart disease.
Saturated fat and trans-fat are the worst for arteries. Polyunsaturated fats seem to be much less damaging and monounsaturated fats like those found in olive oil seem to be healthful.
VEGETABLES. A study from the United Kingdom showed that after two months of people eating various amounts of daily fruits and vegetables those who ate the most fruits and vegetables had the best endothelial function – function improved by 6 percent for each daily serving of a vegetable or fruit consumed.
POTASSIUM. Consuming potassium in a supplement (2,500 mg/day) for four weeks improved endothelial function and arterial compliance in test subjects with mild hypertension, compared with those who took a placebo. The best source of potassium is fruits and vegetables.
FISH OIL. The omega-3 fats in fish oil can improve endothelial function. People with high cholesterol (average 255) given daily fish oil capsules improved their arterial compliance by almost 40 percent compared to those who consumed a placebo.
Weight. Weight gain is associated with increases in pulse wave velocity. Weight gain and obesity is considered a form of accelerated aging with regard to the blood vessels. Losing weight improves arterial compliance.
THE BOTTOM LINE
For optimal cardiovascular health, get regular exercise, cut back on sodium, saturated and trans-fats, eat a diet heavy with fruits and vegetables, eat two servings of seafood a week and maintain a healthy weight. Nutrition Action Healthletter 10/2010, Men’s Health 9/10.
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Monday, August 1, 2011
Health News
HEALTH NEWS
“Live healthy...Live well”
Dedicated to providing pertinent information on health, fitness, and nutrition to foster a culture of wellness among Southwest Airlines flight crews and their families.
by Larry Kline
email: livehealthy-livewell@cox.net
Past issues of “Health News” are available at http://livehealthy-livewell.blogspot.com/. It includes a search engine; just enter a key word to find past articles. LK
DUMBBELLS vs BARBELLS vs MACHINES – when an exerciser uses dumbbells, you have to lift and balance two objects so the smaller stabilizing muscles have to work harder. Machines are at the other end of the exercise spectrum. When you use a machine for a chest press, it keeps the weight steady for you, which makes it possible for you to activate more of your larger muscles and lift many more pounds than you would be able to with free weights. The machine exercise may allow one to bulk up faster. However if you train using only machines, the smaller stabilizers will be neglected and that may lead to injuries. Instead, sculpt your muscles by using all three options. You do not have to do all three options every exercise session, but if you do, always progress from the least (dumbbell) to the most stable (machines). As an example, to work your chest, go from the dumbbell bench press to the barbell bench press, and finish with the machine chest press. Men’s Health 4/11.
PAIN RELIEVERS AND E.D. – men who regularly take pain relievers such as ibuprofen and aspirin may be at increased risk for erectile dysfunction reveals a recent study. Men who use non-steroidal anti-inflammatory drugs (NSAIDs) three times a day for more than three months are at a 22 percent increased risk of erectile dysfunction. More than 30 million people a day take these prescription and OTC pain relievers.
Regular users were about 2.4 times more likely to have erectile dysfunction than men who did not use those drugs regularly or at all. However, NSAID use has been shown to reduce risk of heart disease and has many other proven benefits. The study’s authors say that generally treating someone (with NSAIDs) to improve blood flow should potentially make erections better, but NSAIDs may also hinder other pathways involved in healthy erectile function. Journal of Urology.
ADVICE FOR JOINT PAIN: GET MOVING – doctors increasingly are recommending physical activity to help osteoarthritis patients, overturning the more traditional medical advice for people to take it easy to protect their joints.
The new treatment approach comes as osteoarthritis, a degenerative joint disease once considered a problem of old age, has begun showing up in more middle-aged and young adults as a result of obesity and sports injuries. Studies have shown that weight loss, combined with exercises aimed at improving joint function and building up muscles that support the joints, can significantly improve patients’ health and quality of life compared with medication alone.
The most dangerous exercise you can do when you have arthritis is none. Since each pound of extra body weight adds the equivalent of four pounds to the knees, even a small loss of weight can cut in half the risk of knee osteoarthritis for women, who are at higher risk than men, studies show.
Osteoarthritis, which can affect knees, hips, feet, hands and other parts of the body, occurs when the cartilage that cushions the spaces between the joints wears away. The disease affects some 27 million Americans and leads to 632,000 surgical joint replacements a year. It is the most common cause of disability for U.S. adults, according to the non-profit Arthritis Foundation. That number is expected to grow as the population ages: One in two adults will develop knee osteoarthritis before age 85, and the risk increases to two in three adults who are obese.
Prescription and over-the-counter non-steroidal anti-inflammation drugs help reduce pain, swelling and inflammation, but can cause stomach distress and ulcers – and for some people an increased risk of heart attack. Scientists are working to develop new drugs and treatments to rebuild cartilage and slow the progress of osteoarthritis, but these new therapies could be a decade away.
The CDC says obesity prevention, physical activity programs and self-management education courses in local communities offer the best chances of limiting the damage from osteoarthritis. Self-management programs typically involve classes that instruct people on the best exercises for strengthening muscles that support the joints and for enhancing flexibility to keep joints from regularly seizing up. As important, patients are taught which exercises not to do to avoid exacerbating the problem.
Even mild exercise can be painful for osteoarthritis patients. But with time, doctors say the benefits accumulate as reduced pain and greater mobility. Strengthening the muscles around the knees or hip can help support the joints and take over some of the shock-absorbing functions play by cartilage. Stronger muscles can also hold the joints in the most functional and least painful position. Regular activity can also replenish lubrication to the cartilage of the joint to reduce stiffness and pain. And aerobic activity such as swimming that does not put heavy stress on the hips, knees and spine can reduce inflammation in the joints, as well as improving overall fitness and weight control.
The CDC says self-management education has been shown to help the health of an adult with doctor-diagnosed arthritis by 15 to 30 percent compared to medication alone.
Younger patients are seeking medical care for osteoarthritis because of more obesity and injuries. There appears to be a large rise in injuries to the anterior cruciate ligament, or ACL, in the knee, most commonly seen among soccer players. Some 50 to 80 percent of players with an ACL tear go on to develop osteoarthritis. But studies have shown that such injuries can be avoided with training programs that focus on landing and decelerating in a more controlled fashion.
Americans spend about $850 million a year over OTC joint health supplements like glucosamine, a component of cartilage derived from shellfish, and chondroitin, component of connective tissue that in supplements usually comes from cow or pork byproducts.
The largest study of such supplements, the Glucosamine/Chondroiton Arthritis Interventional Trial of 2006, showed statistically significant relief for 22 percent of the participants who suffered from moderate to severe knee pain. But there was no difference in pain relief compared with a placebo among the 78 percent of participants with mild pain. In an ancillary study in 2008, the supplements fared no better than a placebo in slowing loss of cartilage in osteoarthritis of the knee.
The CDC’s surveys show that doctors have lagged behind federal recommendations to counsel osteoarthritis patients on the benefits of exercise and self-management programs. The medical system has been focused on repairing patients and not getting them to manage themselves to avoid disability. Patients may worry that if they exercise the pain is going to get worse.
Exercises recommended to improve joint flexibility include slow stretching and strengthening movements. Some patients experience joint pain initially, but continued exercises does help ease joint pain. Weight loss also aids in achieving a better quality of life for arthritis sufferers. WSJ 4/12/11.
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