Month: April 2016

Definition/Cause: A heart attack occurs when a clot blocks the blood flow of an artery.  Over time, cholesterol and other substances may build up in the walls of the arteries, causing them to narrow.  During a heart attack, the blood vessel becomes completely blocked, which can lead to organ damage.  Atherosclerosis is the clinical term for  the buildup of cholesterol (plaques) in our arteries.

Risk factors: Factors that may increase your risk of a heart attack include age (males >45 years old, females >55years old); tobacco use; high blood pressure; diabetes; high cholesterol; lack of physical activity; obesity; family history of heart disease; stress; illegal drug use; and history of preeclampsia during pregnancy.

Symptoms: The symptoms that are experienced during a heart attack vary from person to person.  One person may not experience any symptoms, while a heart attack for someone else may be instantly fatal.  Potential symptoms include chest pain, shortness of breath, nausea & vomiting, sweating, fatigue, feelings of anxiety or impending doom, lightheadedness, and dizziness.  If experienced, the severity of symptoms will also vary person to person.

What to do: If you or someone you love is experiencing symptoms of a heart attack, call 911 immediately.  If you have the medication nitroglycerin or aspirin in the home, take them while waiting for the ambulance.  Nitroglycerin helps reduce chest pain, while aspirin helps to prevent your blood from clotting.  Once at the hospital, the doctors will decide the appropriate interventions and medications for treatment.

Prevention:  Manage your risk factors.  If you smoke, consider quitting.   Drink only in moderation.  Strive for 150 minutes of mild/moderate exercise each week.  Make healthy food choices, particularly with regards to your saturated and trans fat intake.  Maintain regular doctor’s visits.  If you are hypertensive, diabetic, and/or have high cholesterol, be sure to take your medications as prescribed.  Make efforts to reduce your stress.

If you have several risk factors, you may also consider discussing adding aspirin to your medication regimen.  Taking a daily aspirin dose of 81-325mg helps to prevent blood clots, which should decrease your risk of heart attack.

Hyperlipidemia is the clinical term for high cholesterol.  Cholesterol is a waxy substance that is found in the fats in our bloodstream.  Our bodies need cholesterol to build healthy cells, but too much cholesterol can increase our risk of heart disease. Excess cholesterol in our blood builds up along the walls of our arteries.  Over time, our arteries begin to harden and narrow, decreasing flow throughout our bodies.  A heart attack or stroke occurs when the blood vessels to either our heart or brain become completely blocked.

Symptoms.  Generally, high cholesterol does not have any symptoms.  Most people are diagnosed after having their bloodwork done at their doctor’s office.

Risk Factors.  Risk factors of high cholesterol include smoking, obesity, poor diet, lack of exercise, high blood pressure, diabetes, and a family history of heart disease.

Cholesterol Goals.  It is recommended that adults get their cholesterol checked at least once every five years.  When you get your labwork done, four different numbers are reported:

• Your total cholesterol score is calculated using the following equation: HDL + LDL + 20% of your triglyceride level.  Ideally, your total cholesterol should be <200mg/dL.
• LDL is our “bad” cholesterol.  The lower your number, the better.  While the latest recommendations no longer identify a specific target goal, traditionally we want our LDL<130mg/dL.  If you are diabetic your ideal LDL<100mg/dL; if you have blood vessel disease such as atherosclerosis, you want your number to be even lower (<70mg/dL).
• HDL is our “good” cholesterol.  HDL absorbs excess cholesterol, and returns it back to our liver where it is then eliminated from our bodies.  Since higher numbers are better, our goal is >40mg/dL.  The best way to increase your HDL is to exercise regularly.
• Triglycerides are a type of fat found in our bodies that increases our risk of heart disease.  Our triglyceride goal is <150mg/dL.

Lifestyle Changes.  If your cholesterol is already elevated or you’ve identified that you have several risk factors which may increase your risk of high cholesterol, there are several lifestyle changes you can begin to make to help lower your cholesterol numbers.

• Avoid foods that are high in cholesterol, trans fats, and/or saturated fats.  Trans fats are found in many processed and fast foods.  Saturated fats are those fats that solidify at room temperature (picture the bacon fat that’s left on your plate after it has cooled).  Cholesterol, trans fats, and saturated fats all increase your cholesterol.  Aim for less than 300mg of cholesterol per day.  Less than 10% of your fat intake should be saturated fat.  Try to eliminate trans fats altogether.  Monounsaturated fats, found in olive, peanut, and canola oils are healthier substitutions.
• Eat more whole grains, fruits, and vegetables.  These foods are high in fiber, which can help to lower your cholesterol.
• Eat heart healthy fish.  Fish like cod, tuna, and halibut have less fat than other meat and poultry.  Other fish like salmon, mackerel, and herring are high in omega-3-fatty acids, which promotes heart health.
• Exercise regularly.  Strive for at least 150 minutes of mild-to-moderate exercise each week.
• Drink in moderation.  As we’ve already learned, ladies should have no more than one drink per day.
• Avoid smoking.  Smoking is damaging to your blood vessels, and further increases your risk of heart disease.

Start making these lifestyle changes today, and you should find that your cholesterol levels improve.  Lowering your cholesterol will help improve your heart health and decrease your risk of heart attack and stroke long-term.

Diabetes.  Sugar diabetes.    Blood sugar.  Blood glucose.  We’ve all heard our grandparents, aunts, and/or uncles use these terms, but what exactly do they mean?  Diabetes is a group of diseases that result in excessive blood glucose (blood sugar) in the bloodstream.  Type 1 diabetes, or juvenile diabetes, occurs when the body is unable to produce insulin.  Type 2 diabetes, which is much more common, occurs when the body fails to produce enough insulin or resists the insulin that it does produce.

So what is insulin?  Insulin  is a hormone produced by your pancreas that regulates the movement of glucose (sugar) into your cells.  When our bodies work normally, we obtain glucose from our diet, or as it is released from our liver.  After digesting our food, that glucose is absorbed into our bloodstream.  Normally insulin operates as a key that allows  glucose to enter our cells and be used as  source of energy.  If our key (insulin) does not work, that glucose remains in our bloodstream.  Our key may be faulty because we either don’t make enough insulin, or our cells have become resistant to it.  Over time, persistently having too much glucose in your bloodstream can lead to serious complications such as blood vessel disease, nerve damage, kidney damage, and vision loss.

Risk factors.  Risk factors for diabetes include being overweight, lack of physical activity, family history of diabetes, African American heritage, increased age, and having had gestational diabetes while pregnant.

Symptoms.  While diabetes is associated with certain symptoms, many people are diagnosed without exhibiting any of them.  Common symptoms include increased thirst, frequent urination, increased hunger, weight loss, fatigue, blurred vision, slow-healing sores, frequent infections, and/or areas of darkened skin.

Diagnosis.  The preferred method for diagnosing diabetes is the hemoglobin A1c test.  Think of this test as a “panoramic view” of your blood glucose as it tells your healthcare provider your average reading over the past three months.  An A1c level of >6.5% on two separate occasions indicates you have diabetes.  A result between 5.7-6.5% is considered prediabetes; a normal result is <5.7%.  Fingersticks are not an ideal diagnostic tool because they are more like a “snapshot”.  They tell us what your blood glucose is at that very moment, which can be greatly affected by what your last meal was, and how recently you ate it.

Prevention/Management.  The single most important mechanism for preventing or managing diabetes is to monitor your diet.  Carbohydrates are the food group that most significantly affect our blood glucose.  This is because when our body digests carbohydrates, they turn into glucose.   When selecting your carbohydrates, try to choose complex carbohydrates.  Complex carbohydrates require more energy during the digestive process, and so less glucose is released into your bloodstream.  Complex carbohydrates include wheat, corn, brown rice, oats, barley, quinoa, oatmeal, beans, peas and lentils.

It is also important that you exercise regularly.  As previously discussed, strive for at least 150 minutes of mild/moderate exercise each week.  Exercise requires energy, which uses up the glucose stored in your cells.

If you are a smoker, give serious thought to quitting.  Both smoking and diabetes are damaging to your blood vessels.  Smoking while diabetic further increases your risk of stoke and heart disease.

Alcohol is high in sugar, and therefore can raise your blood glucose.  It is advised that women try not to exceed one drink per day (no more than two drinks a day for men).

If you’ve already been diagnosed with diabetes, be sure to take your medications daily as prescribed by your doctor.  It is also especially important with diabetes medications that you pay close attention to mealtimes.  Taking your medication while skipping meals may lead to low blood sugar, which can quickly become a dangerous situation.

Management of hyper/hypoglycemia.  Hyperglycemia is elevated blood sugar.  In addition to the symptoms listed above, hyperglycemia may be marked by weakness, confusion, dry mouth, and nausea/vomiting.  If you are feeling hyperglycemic, you should check your blood glucose and take your medication if you missed any doses.  On the other end of the spectrum is hypoglycemia.  Hypoglycemia occurs when your blood sugar is too low.  Symptoms of hypoglycemia include fatigue, paleness, shakiness, sweating, hunger, irritability and confusion.  If feeling hypoglycemic, try consuming a fast-acting carbohydrate such as candy, fruit juice, soda, or glucose tablets.

As the saying goes, “an ounce of prevention is worth a pound of cure.”  So what changes can you start making today to reduce your risk of diabetes?  If you’ve already been diagnosed, remember that while sometimes scary, diabetes is a manageable disease.  And if you start making some healthy lifestyle changes today, there’s a possibility the number of medications you need can be reduced (and in the best cases, stopped altogether)!

Once while leading a Health Promotion group, I asked my patients to explain what “hypertension” was.  I will never forget the veteran who responded, “that’s when you’re too hyper to pay attention!”

Though creative, that answer wasn’t exactly correct.  Hypertension is actually the clinical term for high blood pressure.  So what is blood pressure?  Your blood pressure is the force of blood pushing against the walls of your arteries, the vessels that carry blood from your heart to other parts of your body.  If your blood pressure is persistently elevated, it can damage your heart, leading to heart disease and stroke.

Blood pressure is measured using two numbers.  The top number, called systolic blood pressure, measures the pressure in your arteries when your heart beats or contracts.  The bottom number, called diastolic blood pressure, measures the pressure in your arteries when your heart rests between beats.

Ideally, our blood pressure should be <120/80mmHg.  If your blood pressure is 120-139/80-89, then you would be classified as “prehypertensive.”  Being prehypertensive means that your blood pressure is above goal, but with diet and exercise, you should be able to get it under control.  Anything higher than 140-90 is considered high.

Risk factors.  Risk factors for hypertension include diabetes, a high salt diet, physical inactivity, obesity, excessive alcohol intake, tobacco use, increased age, family history of heart disease, and African-American heritage.

Signs/symptoms.  Generally we do not feel our blood pressure rising, unless it is really extreme.  This is why hypertension is sometimes referred to as “the silent killer.”  It’s important to get your blood pressure checked at every doctor’s visit since you likely won’t experience any symptoms if it is elevated.

Prevention.  Address those risk factors that you can control.  Choose a diet that is high in fruits and vegetables.  Limit your sodium intake to <1500mg/day.  Look for foods labeled “low sodium,” “reduced sodium,” or “no salt added”.  Minimize your intake of canned foods, frozen foods, and processed meats as they are all generally high in sodium.

In addition to monitoring your diet, you can maintain a healthy weight by exercising regularly.  The US Surgeon General recommends 150 minutes of mild/moderate exercise each week.

If you are a smoker, give serious thought to quitting.  Tobacco use raises your blood pressure, and increases your risk of stroke and heart attack.

Alcohol can also raise your blood pressure.  Women should have no more than one drink per day (two drinks for men).

If you are prehypertensive, working to target these risk factors should help to keep you from reaching a state of persistent hypertension.  If you’ve already been diagnosed, these steps, along with taking your prescribed medication everyday, should still be beneficial in keeping your blood pressure at goal.