Saturday, May 24, 2008

Home BP Monitoring

Guidelines Urge Home BP Monitoring for Patients with Hypertension

Patients with hypertension should be encouraged to take regular readings with home blood pressure monitors — just as those with diabetes check their blood glucose — according to a new scientific statement released online by the American Heart Association, the American Society of Hypertension, and the Preventive Cardiovascular Nurses Association.

The article includes an algorithm for using home BP measurements to aid in clinical decision-making. To that end, patients with elevated BP at the office should take home measurements at least 12 times over a week. The preferred devices attach to the upper (usually nondominant) arm, have cuffs that inflate automatically, use oscillometric detection, and store results in memory.

Patients should bring their home monitors to the office to ensure they are using the proper technique and to calibrate their devices.


source: physician's first watch


Wednesday, May 21, 2008

Cholesterol Lowering Foods

Cholesterol: The top 5 foods to lower your numbers

Diet can play an important role in lowering your cholesterol. Discover five foods that can lower your cholesterol and protect your heart.

Can a bowl of oatmeal help prevent a heart attack? How about a handful of walnuts, or even your baked potato topped with some heart-healthy margarine? A few simple tweaks to your diet — like these — may be enough to lower your cholesterol to a healthy level and help you stay off medications.

Oatmeal and oat bran

Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the "bad" cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, psyllium, barley and prunes.

Soluble fiber appears to reduce the absorption of cholesterol in your intestines. Ten grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you'll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran.

Walnuts, almonds and more

Studies have shown that walnuts can significantly reduce blood cholesterol. Rich in polyunsaturated fatty acids, walnuts also help keep blood vessels healthy and elastic. Almonds appear to have a similar effect, resulting in a marked improvement within just four weeks.

A cholesterol-lowering diet in which 20 percent of the calories come from walnuts may reduce LDL cholesterol by as much as 12 percent. But all nuts are high in calories, so a handful (no more than 2 ounces or 57 grams) will do. As with any food, eating too much can cause weight gain, and being overweight places you at higher risk of heart disease. To avoid gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.

Fish and omega-3 fatty acids

Research has supported the cholesterol-lowering benefits of eating fatty fish because of its high levels of omega-3 fatty acids. Omega-3 fatty acids also help the heart in other ways such as reducing blood pressure and the risk of blood clots. In people who have already had heart attacks, fish oil — or omega-3 fatty acids — significantly reduces the risk of sudden death.

Doctors recommend eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in mackerel, lake trout, herring, sardines, albacore tuna and salmon. However, to maintain the heart-healthy benefits of fish, bake or grill it. If you don't like fish, you can also get omega-3 fatty acids from foods like ground flaxseed or canola oil.

You can take an omega-3 or fish oil supplement to get some of the beneficial effects, but you won't get all the other nutrients in fish, like selenium. If you decide to take a supplement, just remember to watch your diet and eat lean meat or vegetables in place of fish.

Olive oil

Olive oil contains a potent mix of antioxidants that can lower your "bad" (LDL) cholesterol but leave your "good" (HDL) cholesterol untouched.

The Food and Drug Administration recommends using about 2 tablespoons (23 grams) of olive oil a day to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade, or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat.

Some research suggests that the cholesterol-lowering effects of olive oil are even greater if you choose extra-virgin olive oil, meaning the oil is less processed and contains more heart-healthy antioxidants. But avoid "light" olive oils. This label usually means the oil is more processed and lighter in color, not fat or calories.

Foods fortified with plant sterols or stanols

Foods are now available that have been fortified with sterols or stanols — substances found in plants that help block the absorption of cholesterol.

Margarines, orange juice and yogurt drinks fortified with plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce (237 milliliters) servings of plant sterol-fortified orange juice a day.

Plant sterols or stanols in fortified foods don't appear to affect levels of triglycerides or of "good" high-density lipoprotein (HDL) cholesterol. Nor do they interfere with the absorption of the fat-soluble vitamins — vitamins A, D, E and K.

The American Heart Association recommends foods fortified with plant sterols for people with levels of LDL cholesterol over 160 milligrams per deciliter (4.1 mmol/L).

Consider your diet first

Before you make other changes to your diet, think about cutting back on the types and amounts of fats you eat, which can raise your cholesterol. That way, you'll improve your cholesterol levels and health overall.

When cutting fat from your diet, focus on saturated and trans fats. Saturated fats, like those in meat and some oils, raise your total cholesterol. Trans fats, which are sometimes used to make store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels because they raise low-density lipoprotein (LDL), the "bad" cholesterol and lower high-density lipoprotein (HDL), "good" cholesterol. You should try to limit the number of calories you eat daily to less than 10 percent from saturated fat, and eliminate as many trans fats from your diet as possible.

source: from Mayoclinic.com

Vary Your Exercise to Maximise impact

Walk Out On Your Favorite Exercise

There's a lot to be said for being faithful to one thing. But not when it comes to this: exercise.

So don't just walk. Hop, skip, jump, and gallop, too! Doing more than four different activities a week protects your brain as well as your body.

Your Brain on Exercise
And the rewards will be sweet, not just sweaty. In a study of more than 3,000 people 65 and older, those who engaged in four or more physical activities a week were less likely to develop dementia than those who did one or none (assuming they hadn't inherited a gene linked to Alzheimer's disease). Being active defends your brain in half a dozen ways -- from keeping your neurons sharp to releasing mind-enhancing hormones. Here are three more reasons to cross-train.

A Walk . . . and Then Some
Already walking 30 minutes a day? Good for you. Now, dust off the stationary bike, and push the lawn mower around the yard, too. Any type of physical activity counts -- from line dancing to training your dog. Doing more than four yet? Here's a little help to nudge you over the edge: Get the lowdown on all the bodywide benefits of aerobic exercise. RealAge Benefit: Exercising regularly, expending at least 3,500 calories of energy a week, can make your RealAge 3.4 years younger.

Wednesday, May 14, 2008

Breast Cancer Diagnosis Improved

Physician's First Watch for May 14, 2008
David G. Fairchild, MD, MPH, Editor-in-Chief

Adding Ultrasound to Mammography Identifies More Cancers — but Also Yields More False-Positives




Ultrasonography, when added to mammographic screening, increases the number of breast cancers found in high-risk women — but at the cost of increased false-positives — researchers report in JAMA.

More than 2600 high-risk women underwent both mammography and ultrasonography, in random order. If either test was positive, then both results were examined and interpreted together. By 1-year follow-up, 40 participants were diagnosed with breast cancer, 8 of whom tested negative with both techniques.

Of the cancers detected during screening, mammography's diagnostic yield was 7.6 per 1000 women screened; when combined with ultrasound, the yield was 11.8. Mammography's false-positive rate was 4.4%; ultrasound's, 8.1%; and for combined modalities, 10.4%.

An editorialist writes that despite the high number of false-positives, what high-risk women "probably fear most is a late diagnosis." That, she continues, is "the real threat they want to be protected against, not false-positive diagnoses."

JAMA article (Free)

Thursday, May 1, 2008

Water: How much should you drink every day?

Water is essential to good health, yet needs vary by individual. These guidelines can help ensure you drink enough fluids.

By Mayo Clinic Staff

How much water should you drink each day? A simple question with no easy answers. Studies have produced varying recommendations over the years, but in truth, your water needs depend on many factors, including your health, how active you are and where you live.

Though no single formula fits everyone, knowing more about your body's need for fluids will help you estimate how much water to drink each day.

Health benefits of water

Water is your body's principal chemical component, making up, on average, 60 percent of your body weight. Every system in your body depends on water. For example, water flushes toxins out of vital organs, carries nutrients to your cells and provides a moist environment for ear, nose and throat tissues.

Lack of water can lead to dehydration, a condition that occurs when you don't have enough water in your body to carry out normal functions. Even mild dehydration can drain your energy and make you tired.

How much water do you need?

Every day you lose water through your breath, perspiration, urine and bowel movements. For your body to function properly, you must replenish its water supply by consuming beverages and foods that contain water.

Several approaches attempt to approximate water needs for the average, healthy adult living in a temperate climate.

  • Replacement approach. The average urine output for adults is about 1.5 liters (6.3 cups) a day. You lose close to an additional liter of water a day through breathing, sweating and bowel movements. Food usually accounts for 20 percent of your total fluid intake, so if you consume 2 liters of water or other beverages a day (a little more than 8 cups) along with your normal diet, you will typically replace the lost fluids.
  • Eight 8-ounce glasses of water a day. Another approach to water intake is the "8 x 8 rule" — drink eight 8-ounce glasses of water a day (about 1.9 liters). The rule could also be stated, "drink eight 8-ounce glasses of fluid a day," as all fluids count toward the daily total. Though the approach isn't supported by scientific evidence, many people use this basic rule as a guideline for how much water and other fluids to drink.
  • Dietary recommendations. The Institute of Medicine advises that men consume roughly 3 liters (about 13 cups) of total beverages a day and women consume 2.2 liters (about 9 cups) of total beverages a day.

Even apart from the above approaches, if you drink enough fluid so that you rarely feel thirsty and produce 1.5 liters (6.3 cups) or more of colorless or slightly yellow urine a day, your fluid intake is probably adequate.

Factors that influence water needs

You may need to modify your total fluid intake depending on how active you are, the climate you live in, your health status, and if you're pregnant or breast-feeding.

  • Exercise. If you exercise or engage in any activity that makes you sweat, you need to drink extra water to compensate for the fluid loss. An extra 400 to 600 milliliters (about 1.5 to 2.5 cups) of water should suffice for short bouts of exercise, but intense exercise lasting more than an hour (for example, running a marathon) requires more fluid intake. How much additional fluid you need depends on how much you sweat during exercise, the duration of your exercise and the type of activity you're engaged in.

    During long bouts of intense exercise, it's best to use a sports drink that contains sodium, as this will help replace sodium lost in sweat and reduce the chances of developing hyponatremia, which can be life-threatening. Also, continue to replace fluids after you're finished exercising.

  • Environment. Hot or humid weather can make you sweat and requires additional intake of fluid. Heated indoor air also can cause your skin to lose moisture during wintertime. Further, altitudes greater than 8,200 feet (2,500 meters) may trigger increased urination and more rapid breathing, which use up more of your fluid reserves.
  • Illnesses or health conditions. Signs of illnesses, such as fever, vomiting and diarrhea, cause your body to lose additional fluids. In these cases you should drink more water and may even need oral rehydration solutions, such as Gatorade, Powerade or CeraLyte. Also, you may need increased fluid intake if you develop certain conditions, including bladder infections or urinary tract stones. On the other hand, some conditions such as heart failure and some types of kidney, liver and adrenal diseases may impair excretion of water and even require that you limit your fluid intake.
  • Pregnancy or breast-feeding. Women who are expecting or breast-feeding need additional fluids to stay hydrated. Large amounts of fluid are used especially when nursing. The Institute of Medicine recommends that pregnant women drink 2.3 liters (about 10 cups) of fluids daily and women who breast-feed consume 3.1 liters (about 13 cups) of fluids a day.

Beyond the tap: Other sources of water

Although it's a great idea to keep water within reach at all times, you don't need to rely only on what you drink to satisfy your fluid needs. What you eat also provides a significant portion of your fluid needs. On average, food provides about 20 percent of total water intake, while the remaining 80 percent comes from water and beverages of all kinds.

For example, many fruits and vegetables, such as watermelon and tomatoes, are 90 percent to 100 percent water by weight. Beverages such as milk and juice also are composed mostly of water. Even beer, wine and caffeinated beverages — such as coffee, tea or soda — can contribute, but these should not be a major portion of your daily total fluid intake. Water is one of your best bets because it's calorie-free, inexpensive and readily available.

Staying safely hydrated

It's generally not a good idea to use thirst alone as a guide for when to drink. By the time you become thirsty, it's possible to already be slightly dehydrated. Further, be aware that as you get older your body is less able to sense dehydration and send your brain signals of thirst. Excessive thirst and increased urination can be signs of a more serious medical condition. Talk to your doctor if you experience either.

To ward off dehydration and make sure your body has the fluids it needs, make water your beverage of choice. Nearly every healthy adult can consider the following:

  • Drink a glass of water with each meal and between each meal.
  • Hydrate before, during and after exercise.
  • Substitute sparkling water for alcoholic drinks at social gatherings.

If you drink water from a bottle, thoroughly clean or replace the bottle often.

Though uncommon, it is possible to drink too much water. When your kidneys are unable to excrete the excess water, the electrolyte (mineral) content of the blood is diluted, resulting in low sodium levels in the blood, a condition called hyponatremia. Endurance athletes, such as marathon runners, who drink large amounts of water are at higher risk of hyponatremia. In general, though, drinking too much water is rare in healthy adults who consume an average American diet.

If you're concerned about your fluid intake, check with your doctor or a registered dietitian. He or she can help you determine the amount of water that's best for you.

By Mayo Clinic Staff