Monday, July 11, 2016

Beta Cell Dysfunction Five Stages

There are five stages in the progression of diabetes, each of which is characterized by different changes in ß-cell mass, phenotype, and function.

Stage 1 is compensation: insulin secretion increases to maintain normoglycemia in the face of insulin resistance and/or decreasing ß-cell mass. This stage is characterized by maintenance of differentiated function with intact acute glucose-stimulated insulin secretion (GSIS).

Stage 2 occurs when glucose levels start to rise, reaching ~5.0–6.5 mmol/l; this is a stable state of ß-cell adaptation with loss of ß-cell mass and disruption of function as evidenced by diminished GSIS and ß-cell dedifferentiation.

Stage 3 is a transient unstable period of early decompensation in which glucose levels rise relatively rapidly to the frank diabetes of stage 4.

Stage 4 is characterized as stable decompensation with more severe ß-cell dedifferentiation. 

Finally, Stage 5 is characterized by severe decompensation representing a profound reduction in ß-cell mass with progression to ketosis.

Movement across stages 1–4 can be in either direction. For example, individuals with treated type 2 diabetes can move from stage 4 to stage 1 or stage 2. For type 1 diabetes, as remission develops, progression from stage 4 to stage 2 is typically found. Delineation of these stages provides insight into the pathophysiology of both progression and remission of diabetes.

STAGE 1: COMPENSATION

The most common example of compensation is found with the insulin resistance due to obesity, which is accompanied by higher overall rates of insulin secretion  and increased acute glucose-stimulated insulin secretion (GSIS) following an intravenous glucose challenge. Much of the increase in insulin secretion undoubtedly results from an increase in ß-cell mass, as has been found in autopsy studies in humans and numerous rodent models. Beta-Cell mass is normally tightly maintained through a balance of ß-cell birth (ß-cell replication and islet neogenesis) and ß-cell death through apoptosis.
Most of the increase in ß-cell mass with insulin resistance is probably due to increased ß-cell number, but ß-cell hypertrophy may also contribute. It is not yet clear if the higher plasma insulin levels can be entirely explained by the larger ß-cell mass or whether there is also increased secretion per given unit of ß-cell mass. Although compensation is usually thought of in the situation of insulin resistance, similar changes presumably occur in the early stages of autoimmune destruction. As ß-cell mass falls, there must be a signal to increase mass and secretion, which presumably prolong the prediabetic period, which can last for years.
There is much interest in the signal leading to increased ß-cell mass in this situation. The facile, but probably correct, explanation is that there is a feedback loop with insulin resistance producing increased glucose levels that stimulate ß-cell secretion and growth. However, concerns are raised about how this can be compatible with seemingly normal glucose levels. One explanation is that the feedback loop is tightly regulated, like a thermostat that can maintain temperatures within a very narrow range. A molecular mechanism that could facilitate this control is activation of glucokinase in ß-cells, the enzyme that controls the rate of glycolysis, thereby determining insulin secretory rates. Thus, very small elevations in glucose levels could lead to a change in the set point in GSIS that allows maintenance of “normal” plasma glucose levels.

The importance of ß-cell differentiation.

The unique differentiation of ß-cells is responsible for the extraordinary efficiency of these cells in storing and secreting insulin to provide precise regulation of metabolism. With successful compensation for insulin resistance, little change in ß-cell phenotype for the secretory machinery would be expected. The unique specialization of ß-cells is presumably necessary for optimal GSIS; the impressively large acute insulin responses to glucose challenge seen in obesity strongly suggest the phenotype is maintained.
The complexity of this differentiation is far from being understood, but some key features are apparent. The glucose transporter GLUT2 allows rapid equilibration between extra- and intracellular glucose levels. Glucose is phosphorylated by glucokinase with aKm of ~8 mmol/l that allows it to function efficiently within the normal range of plasma glucose concentrations. Glucose metabolism is dominated by glycolysis with pyruvate directed to mitochondria for oxidation. There is little if any gluconeogenesis or lactate production , which should be helpful for maximizing the efficiency of aerobic glycolysis.
The ß-cell also has specialized mitochondrial shuttles. The glycerol phosphate shuttle allows reduced nicotinamide dinucleotide (NADH) to be oxidized by mitochondria, thereby contributing to adenosine triphosphate (ATP) formation. The oxidation of NADH should also enhance glycolytic flux. In ß-cells the malate/pyruvate shuttle may facilitate the generation of NADPH, which could somehow enhance secretion. The need for these shuttles probably explains why ß-cells have very high levels of mitochondrial glycerol phosphate dehydrogenase (mGPDH) and pyruvate carboxylase.
To maintain this degree of specialization, the genes that are highly expressed in ß-cells include those of the secretory products (insulin and islet amyloid polypeptide [IAPP]), key genes for glucose metabolism (GLUT2 and glucokinase), key enzymes for the mitochondrial shuttles (glycerol phosphate dehydrogenase [mGPDH]) and pyruvate carboxylase, and critical transcription factors (PDX-1 and Nkx-6.1). Yet, enzymes that participate in unwanted pathways such as gluconeogenesis and lactate production are expected to be suppressed.
Some of these include phosphoenolpyruvate carboxykinase (PEPCK), glucose-6-phosphatase and fructose-1,6-bisphosphatase, and lactate dehydrogenase. Hexokinase would also be unneeded, so its expression could also be suppressed. Clearly these changes in gene expression are just the tip of the iceberg, and a full picture of ß-cell phenotype awaits gene array studies, which should emerge in the near future.

Maintenance of ß-cell differentiation during stage 1 compensation.

Some experimental data support the concept that much of the ß-cell phenotype is kept intact during successful compensation for insulin resistance. When glucose was infused into rats for 4 days, compensation occurred and glucose levels remained normal during the latter stages of the infusion because of increases in insulin secretion that were accompanied by increased ß-cell mass.
While responding to the increased demand, the ß-cell phenotype, as determined by analysis of a selected group of genes, remained remarkably similar to the control profile. There must have been induction of some genes required for ß-cell replication, but the genes responsible for maintaining the machinery allowing GSIS did not seem to be perturbed. This preservation of phenotype, coupled with an increase in ß-cell mass, is consistent with the exuberant GSIS seen in obesity.

STAGE 2: STABLE ADAPTATION

It is not possible to assign a precise glucose range for this stage of ß-cell adaptation, but fasting levels between 5.0 and 7.3 mmol/l (89–130 mg/dl) are reasonable approximations. In stage 2, ß-cells can no longer be considered to be compensating because truly normal glucose levels can no longer be maintained. However, this stage can be considered stable because, as shown in the Diabetes Prevention Program, individuals at the upper end of stage 2 with IGT progressed to diabetes at the rate of ~11% per year while those who adhered to a diet and exercise regimen progressed at a rate of only 5% per year.
Thus, unless some process, such as autoimmunity, is producing rapid ß-cell destruction, individuals in stage 2 usually evade progression to diabetes for years.
Nonetheless, as glucose levels rise to stage 2, important changes in ß-cell function and differentiation occur. The most striking and best studied is the loss of acute GSIS. The acute phase of secretion occurs ~3–10 min after the start of the glucose infusion and represents the first phase of GSIS. This experimental assessment has the pathophysiological correlate of impaired early insulin release during an oral glucose challenge, which contributes to glucose intolerance. An important study published in 1976 showed that subjects maintained normal acute GSIS as long as fasting plasma glucose levels remained <5 .6="" dl="" l="" mg="" mmol="" p="">
However, acute GSIS dropped drastically when fasting plasma glucose values were above this level and disappeared completely once fasting glucose levels increased to only 6.4 mmol/l (114 mg/dl). This pattern has now been confirmed in countless studies in humans and animals. In contrast to this loss of acute GSIS, the second phase of insulin secretion is partially preserved, and acute insulin responses to nonglucose secretagogues, such as isoproterenol and arginine, remain largely intact.

Loss of GSIS in stage 2: the glucotoxicity hypothesis.

The concept of glucose toxicity is that ß-cells normally function within a narrow range of plasma glucose levels and that even modestly higher glucose levels create an unnatural environment, which leads to alteration in function and most notably a loss of acute GSIS. On the molecular level, the exact mechanisms responsible for this loss of GSIS are not known; however, we postulate that a loss of specialized gene expression leads to complete disruption of the acute phase of GSIS. In contrast, the agents that stimulate insulin release through depolarization (arginine) or cyclic AMP (isoproterenol) work through more ubiquitous and less fragile mechanisms that are maintained.
Although some have proposed that increased free fatty acid (FFA) levels are important for the ß-cell dysfunction of diabetes, these levels correlate poorly with the loss of acute GSIS, whereas the correlation with glucose levels is very precise. This interpretation does not rule out important glucose-driven derangements of lipid pathways in ß-cells that could justify use of the term “lipotoxicity.”

Changes in ß-cell differentiation in stage 2.

The loss of acute GSIS seen in the diabetic state is accompanied by marked changes in ß-cell phenotype demonstrated by changes in gene and protein expression. These changes have been found in islets from both diabetic ZDF rats and rats following partial pancreatectomy in which residual ß-cells are exposed to varying degrees of hyperglycemia The alterations may be thought of as dedifferentiation, or loss of phenotype, in that the highly expressed genes in ß-cells (mentioned above) are downregulated while those that are normally suppressed are upregulated in their expression.
Some of the upregulated genes include glucose-6-phosphatase, fructose-1,6-bisphosphatase, lactate dehydrogenase, and hexokinase. In addition, a stress response is found with a variety of antioxidant, apoptotic, and proapoptotic genes being activated. These are accompanied by a marked increase in the expression of c-myc and activation of nuclear factor (NF)-?B. These changes are consistent with a recent report that interleukin (IL)-1 expression in ß-cells is activated by high glucose levels. Another interesting facet is the presence of ß-cell hypertrophy, which may be a glucose-driven growth response stopping short of replication. Strengthening the hypothesis that these changes are secondary to chronic hyperglycemia are data showing that lowering of the elevated glucose levels with phlorizin, which inhibits renal glucose reabsorption, leads to reversal of virtually all of the changes in gene expression and hypertrophy.
It should be emphasized that some changes of gene expression occur in stage 2, when glucose levels might be considered “normal.” In some rats following a 90% partial pancreatectomy, fed plasma glucose levels of 6.9 mmol/l (124 mg/dl) were maintained over a 14-week period, whereas control rats maintained levels at 5.8 mmol/l (104 mg/dl) over the same time period. When considered in human terms, this increase of only 1.1 mmol/l (20 mg/dl) would probably not have reached the designation of IGT and therefore would be categorized as normal. However, the islets isolated from the pancreatic remnant of these rats 14 weeks after surgery had similar, albeit less marked, changes in gene expression as those of partially pancreatectomized rats with more severe hyperglycemia.
Despite the minimal degree of hyperglycemia, these changes in gene expression correlate with the losses of GSIS seen in this and similar rodent models and in humans, supporting the hypothesis that changes in ß-cell phenotype are responsible for the disruption of GSIS. We recognize that blaming the loss of GSIS on altered phenotype may be an oversimplification. Certainly there could be important changes in signal transduction pathways that could be unrelated to changes in protein levels, but we expect that the changes in phenotype are of fundamental importance. In the future it should be possible to dissect out the many candidates that could contribute to ß-cell dysfunction, such as mitochondrial shuttles, lactate dehydrogenase, glucose-6-phosphatase, uncoupling protein-2, peroxisome proliferator–activated receptor (PPAR)-a, and c-myc.

STAGE 3: UNSTABLE EARLY DECOMPENSATION

We postulate that during progression toward diabetes, stable stage 2 ends and glucose levels rise relatively rapidly from the range of 7.3 mmol/l (130 mg/dl), through an unstable transient stage 3 of decompensation, to a more stable stage 4 at ~16–20 mmol/l (285–350 mg/dl). Thus, individuals headed to type 2 diabetes can remain in stage 2 for many years, but when ß-cell mass becomes inadequate at some critical point, glucose levels rise over a relatively short period of time to stage 4, which may or may not be associated with noticeable symptoms, such as polyuria and weight loss. A similar progression occurs in type 1 diabetes, but stage 2 does not last as long because autoimmune destruction of ß-cells occurs much more rapidly than whatever process is responsible for the ß-cell attrition in type 2 diabetes.
Thus, a child nearing adolescence might be in stage 2, whereupon flu or some other stress might push glucose levels rapidly through stage 3 to stage 4. While in stage 4, the precipitating stress may recede, allowing the child to fall back through stage 3 to stage 2 for a remission, which would only last until further ß-cell destruction results in a return to stage 3 and then stage 4. Stage 4 might not be long lasting because continued ß-cell loss will usually lead to the severe decompensation of stage 5, with propensity to ketoacidosis.
The same pathophysiology probably occurs with pancreas and islet transplantation, in that loss of ß-cells in the grafts would lead to progression through the above stages. While a successful pancreas transplant will typically bring a recipient to stage 1, an islet transplant performed according to the Edmonton approach will usually place recipients in stage 2, where they will remain at risk for later decompensation.

Experimental evidence for the instability of stage 3.

When transplanting islets contained in immunoprotective devices into mice, we noted that a marginal number of islets produced either success with normal blood glucose levels or failure with glucose levels >15 mmol/l (280 mg/dl), with almost no glucose levels in between. A marginal number of syngeneic islets transplanted under the kidney capsule of streptozocin diabetic mice produced a similar pattern of either failure or success, with only a few glucose levels in the stage 3 range (data not shown). This concept was examined again in rats with a marginal reduction of ß-cell mass following a 90% partial pancreatectomy.
Although a spectrum of glucose levels was seen at 4 weeks, the rats showed two distinct outcomes by 14 weeks: they were either near normal (glucose levels of 6.9 mmol/l [124 mg/dl] and 5.8 mmol/l [104 mg/dl] in fed and control rats, respectively) or unequivocally hyperglycemic. Somehow there were forces pushing these rodents to either stage 2 or 4, with their time in stage 3 being only transient.
Support is also provided by studies of islet transplantation in which canine islets were transplanted into the livers of young diabetic dogs. As the recipients matured, rapid decompensation to marked hyperglycemia was seen, presumably a result of the ß-cell mass becoming inadequate to meet the insulin requirements of larger dogs. A recent study in humans also supports the concept that decompensation is not a continuum but can occur in a relatively short period of time.
In studies on a population from the Mexico City Diabetes Study, it was concluded that within a 3-year timeframe the development of diabetes was often rapid rather than gradual. The investigators also thought the rapidity might have been underestimated because some of the subjects were receiving diabetes treatment.

Why is stage 3 unstable?

At some point in stage 2, ß-cells are no longer able to keep glucose levels in the prediabetic range. This failure presumably occurs because of a critical decline of ß-cell mass and/or increase in insulin resistance. We postulate that there is a conspiracy of forces that push glucose levels upward, which include the insulin resistance associated with the diabetic state with its complex gluco- and lipotoxicity influencing the key insulin target tissues (i.e, liver, muscle, and fat). The increases in glucose concentration probably also worsen glucotoxic effects on ß-cells, leading to less efficient insulin secretion.
For example, as insulin mRNA falls with increasing hyperglycemia, there is evidence that insulin biosynthesis becomes rate limiting for secretion. With these factors working synchronously, glucose levels rise to stage 4 but do not immediately progress to stage 5 because enough insulin production continues to prevent severe ketosis. By treating type 2 diabetes with diet, exercise, and drugs, individuals can quickly return to stage 2 and remain in that stable range for a considerable period of time as long as they continue the treatment and have no further decline in ß-cell mass.

Why is the instability of stage 3 not more clinically apparent?

Clinicians often see patients who are asymptomatic and have unremarkable glucose levels at one point and then present with glucose levels in the range of >16 mmol/l (285 mg/dl) with the absence or presence of symptoms. Certainly individuals progressing to type 1 diabetes often rapidly progress to very high glucose levels, but clearly many people with diabetes have glucose levels within the stage 3 range. The most obvious explanation is that external forces can overwhelm the processes that make stage 3 transient (in particular, treatment with oral medications and/or insulin). Even changes in caloric intake and exercise should allow individuals to move in and out of stage 3. Another point is that the transition from stage 2 to stage 4 is not instantaneous; even in our rodent studies progression took a few weeks. Nonetheless, we postulate that stage 3 is by nature transient.

STAGE 4: STABLE DECOMPENSATION

Once individuals progress through stage 3 to the unambiguous diabetes of stage 4, they typically have enough insulin secretion to remain in this stage rather than progressing to ketoacidosis. In most cases this stage lasts a lifetime for people with type 2 diabetes, while the rapid progressive autoimmune destruction of ß-cells in type 1 diabetes can lead to stage 5 relatively quickly. Individuals with failing islet transplants can probably stay in stage 4 for relatively long periods of time if the immunosuppression regimens allow sufficient ß-cell survival.

Changes in ß-cell mass, function, and differentiation in stage 4.

Morphometric studies on postmortem pancreases of people with type 2 diabetes provide convincing evidence that ß-cell mass is reduced to ~50% of that of control subjects. Data generated in rodents suggest ß-cell dedifferentiation is more severe at higher glucose levels, which should result in less efficient insulin secretion. This lack of efficiency fits with insulin secretion studies in type 2 diabetes that have indicated that the capacity for secretion is considerably less than the 50% reduction in ß-cell mass.
Important questions are raised by the finding that a stress response is induced by chronic hyperglycemia. Because the stress response is characterized by the expression of a mixture of proapoptotic, antiapoptotic, and antioxidant genes, it is difficult to know if ß-cells in this situation would be more or less susceptible to the apoptosis. For destruction by autoimmunity and/or transplant rejection, the stress response could make ß-cells either more vulnerable or provide protection.
For type 2 diabetes, this phenotypic change may accelerate ß-cell loss. Even if accelerated, the rate of ß-cell apoptosis in type 2 diabetes is certainly very slow, given the assumption that the ß-cell death rate must be similar to ß-cell birth rate, which is probably considerably less than 1% per day. Even less is known about the rate of neogenesis, which is probably very slow as well. Somehow, regardless of ß-cell loss in typical type 2 diabetes, apoptosis rarely progresses to near-complete loss, which leads to ketosis, even after decades of the disease.
Although it is often assumed that accelerated apoptosis of ß-cells is important for the pathogenesis of type 2 diabetes, limitations in ß-cell replication and/or neogenesis could be just as important. Although some rodent models of diabetes exhibit increased rates of apoptosis, in rats following 90% partial pancreatectomy with glucose levels in the stage 4 range of diabetes, rates of ß-cell replication and the incidence of apoptotic bodies were no different than in control rats.

STAGE 5: SEVERE DECOMPENSATION

In this last stage of diabetes, the marked loss of ß-cells is so severe that people become ketotic and truly dependent on insulin for survival. Glucose levels are typically >22 mmol/l (350 mg/dl) but will vary with eating and hydration. This situation is typically found with type 1 diabetes or patients with pancreas or islet transplants when ß-cells have been mostly destroyed by the immune system. It can also occur in unusual situations, such as exposure to certain toxins or very severe pancreatitis, but it rarely occurs in typical type 2 diabetes.

Alternative Treatment for Insulin Resistance
Given the pathology of insulin resistance, the best alternative strategy is a plant-based diet that reduces your body's production of excess insulin and blood glucose. Ideally, you also want the diet to address the cellular inflammation and weight gain issues.

Such a diet is the Death to Diabetes diet, which addresses the excess insulin, blood glucose, cellular inflammation, and weight gain.

References

Thursday, July 07, 2016

You Got To Be Hongry

You got to be hongry to be successful and step into your greatness.

Listen to this audio file from the DeWayne McCulley Google Site:

Audio File:
https://drive.google.com/file/d/0B49ajlCPoIboZEVkQjFEVE4yWXM/view

Stress Effects on Body

Musculoskeletal System

When the body is stressed, muscles tense up. Muscle tension is almost a reflex reaction to stress — the body's way of guarding against injury and pain.
With sudden onset stress, the muscles tense up all at once, and then release their tension when the stress passes. Chronic stress causes the muscles in the body to be in a more or less constant state of guardedness. When muscles are taut and tense for long periods of time, this may trigger other reactions of the body and even promote stress-related disorders. For example, both tension-type headache and migraine headache are associated with chronic muscle tension in the area of the shoulders, neck and head.
Millions of individuals suffer from chronic painful conditions secondary to musculoskeletal disorders. Often, but not always, there may be an injury that sets off the chronic painful state. What determines whether or not an injured person goes on to suffer from chronic pain is how they respond to the injury. Individuals who are fearful of pain and re-injury, and who seek only a physical cause and cure for the injury, generally have a worse recovery than individuals who maintain a certain level of moderate, physician-supervised activity. Muscle tension, and eventually, muscle atrophy due to disuse of the body, all promote chronic, stress-related musculoskeletal conditions.
Relaxation techniques have been shown to effectively reduce muscle tension, decrease the incidence of certain stress-related disorders, such as headache, and increase a sense of well-being.

Respiratory System

Stress can make you breathe harder. That's not a problem for most people, but for those with asthma or a lung disease such as emphysema, getting the oxygen you need to breathe easier can be difficult.
And some studies show that an acute stress — such as the death of a loved one — can actually trigger asthma attacks, in which the airway between the nose and the lungs constricts.
In addition, stress can cause the rapid breathing — or hyperventilation — that can bring on a panic attack in someone prone to panic attacks.
Working with a psychologist to develop relaxation and breathing strategies can help.

Cardiovascular

The heart and blood vessels comprise the two elements of the cardiovascular system that work together in providing nourishment and oxygen to the organs of the body. The activity of these two elements is also coordinated in the body's response to stress. Acute stress — stress that is momentary or short-term such as meeting deadlines, being stuck in traffic or suddenly slamming on the brakes to avoid an accident — causes an increase in heart rate and stronger contractions of the heart muscle, with the stress hormones — adrenaline, noradrenaline and cortisol — acting as messengers for these effects. In addition, the blood vessels that direct blood to the large muscles and the heart dilate, thereby increasing the amount of blood pumped to these parts of the body and elevating blood pressure. This is also known as the fight or flight response. Once the acute stress episode has passed, the body returns to its normal state.
Chronic stress, or a constant stress experienced over a prolonged period of time, can contribute to long-term problems for heartand blood vessels. The consistent and ongoing increase in heart rate, and the elevated levels of stress hormones and of blood pressure, can take a toll on the body. This long-term ongoing stress can increase the risk for hypertension, heart attack or stroke.
Repeated acute stress and persistent chronic stress may also contribute to inflammation in the circulatory system, particularly in the coronary arteries, and this is one pathway that is thought to tie stress to heart attack. It also appears that how a person responds to stress can affect cholesterol levels.
The risk for heart disease associated with stress appears to differ for women, depending on whether the woman is pre- or post-menopausal. Levels of estrogen in pre-menopausal women appears to help blood vessels respond better during stress, thereby helping their bodies to better handle stress and protecting them against heart disease. Postmenopausal women lose this level of protection due to loss of estrogen, therefore putting them at greater risk for the effects of stress on heart disease.

Endocrine

When the body is stressed, the hypothalamus signals the autonomic nervous system and the pituitary gland and the process is started to produce epinephrine and cortisol, sometimes called the "stress hormones."
Adrenal Glands (near kidneys)
Stress signals from the hypothalamus cause the adrenal cortex to produce cortisol and the adrenal medulla to produce epinephrine. This starts the process that gives your body the energy to run from danger.
Liver
When cortisol and epinephrine are released, the liver produces more glucose, a blood sugar that would give you the energy for "fight or flight" in an emergency. For most of you, if you don't use all of that extra energy, the body is able to reabsorb the blood sugar, even if you're stressed again and again. But for some people — especially people vulnerable to Type 2 diabetes — that extra blood sugar can mean diabetes. Who's vulnerable? The obese and races more inclined to diabetes, such as Native Americans.
Studies show that if you learn how to manage stress, you can control your blood sugar level, sometimes nearly as much as with medication.

Gastrointestinal

Esophagus
When you're stressed, you may eat much more or much less than you usually do. If you eat more or different foods, or increase your use of alcohol or tobacco, you can experience heartburn or acid reflux. Stress or exhaustion can also increase the severity of heartburn pain.
Stomach
When you're stressed, your brain becomes more alert to sensations in your stomach. Your stomach can react with "butterflies" or even nausea or pain. You may vomit if the stress is severe enough. And, if the stress becomes chronic, you may develop ulcers or severe stomach pain even without ulcers.
Bowel
Stress can affect digestion, and what nutrients your intestines absorb. It can also affect how fast food moves through your body. You may find that you have either diarrhea or constipation.

Nervous System

The nervous system has several divisions: the central division involving the brain and spinal cord and the peripheral division consisting of the autonomic and somatic nervous systems. The autonomic nervous system (ANS) has a direct role in physical response to stress and is divided into the sympathetic nervous system (SNS), and the parasympathetic nervous system (PNS).
When the body is stressed, the SNS generates what is known as the "fight or flight" response. The body shifts all of its energy resources toward fighting off a life threat, or fleeing from an enemy. The SNS signals the adrenal glands to release hormones called adrenalin and cortisol. These hormones cause the heart to beat faster, respiration rate to increase, blood vessels in the arms and legs to dilate, digestive process to change and glucose levels (sugar energy) in the bloodstream to increase to deal with the emergency.
The SNS response is fairly sudden in order to prepare the body to respond to an emergency situation or acute stress, short term stressors. Once the crisis is over, the body usually returns to the pre-emergency, unstressed state.
Chronic stress, experiencing stressors over a prolonged period of time, can result in a long-term drain on the body. As the SNS continues to trigger physical reactions, it causes a wear-and-tear on the body. It's not so much what chronic stress does to the nervous system, but what continuous activation of the nervous system does to other bodily systems that become problematic.

Male Reproductive System

The male reproductive system is influenced by the nervous system. The parasympathetic part of the nervous system causes relaxation whereas the sympathetic part causes arousal. In the male anatomy, the autonomic nervous system, also known as the fight or flight response, produces testosterone and activates the sympathetic nervous system which creates arousal.
Stress causes the body to release the hormone cortisol, which is produced by the adrenal glands. Cortisol is important to blood pressure regulation and the normal functioning of several body systems including cardiovascular, circulatory and male reproduction. Excess amounts of cortisol can affect the normal biochemical functioning of the male reproductive system.
Chronic stress, ongoing stress over an extended period of time, can affect testosterone production, sperm production and maturation, and even cause erectile dysfunction or impotence.
Also, when stress affects the immune system, the body can become vulnerable to infection. In the male anatomy, infections to the testes, prostate gland and urethra, can affect normal male reproductive functioning.

Female Reproductive System

Menstruation
Stress may affect menstruation among adolescent girls and women in several ways. For example, high levels of stress may be associated with absent or irregular menstrual cycles, more painful periods and changes in the length of cycles.
Premenstrual Syndrome (PMS)
Stress may make premenstrual symptoms worse or more difficult to cope with and pre-menses symptoms may be stressful for many women. These symptoms include cramping, fluid retention and bloating, negative mood (feeling irritable and "blue") and mood swings.
Menopause
As menopause approaches, hormone levels fluctuate rapidly. These changes are associated with anxiety, mood swings and feelings of distress. Thus menopause can be a stressor in and of itself. Some of the physical changes associated with menopause, especially hot flashes, can be difficult to cope with. Furthermore, emotional distress may cause the physical symptoms to be worse. For example, women who are more anxious may experience an increased number of hot flashes and/or more severe or intense hot flashes.
Sexual Desire
Women juggle personal, family, professional, financial and a broad range of other demands across their life span. Stress, distraction, fatigue, etc., may reduce sexual desire — especially when women are simultaneously caring for young children or other ill family members, coping with chronic medical problems, feeling depressed, experiencing relationship difficulties or abuse, dealing with work problems, etc. 

References:
American Psychological Association (APA) website

Saturday, June 25, 2016

Heart Disease, Heart Attack and Stroke

The circulatory system, which consists of the heart, arteries, veins, capillaries, and blood, is responsible for delivering oxygen and other nutrients to cells throughout the body. The heart’s pumping action forces oxygenated blood from the lungs to reach millions of cells throughout the body via arteries and capillaries. ACardiovascular Systemfter the cells have been nourished, blood returns to the heart through the venous system and is then re-oxygenated in the lungs.
A muscle-vein system, often referred to as the “second heart”, is a system of muscles, veins, and valves in the calf and foot that work together to push deoxygenated blood back up to the heart and lungs. The second heart vein valves act as trapdoors that open and close with each muscle contraction to prevent the backflow of blood.
The major types of vascular disease that affect the circulatory system are cardiovascular disease, which affects the heart (and, is sometimes referred to as heart disease); cerebrovascular disease, which affects the brain; and, peripheral vascular disease, which affects the legs. If blood flow is blocked in one of these areas, it may cause a heart attack, a stroke, or a cramping pain in the leg muscles on exertion (intermittent claudication). When second heart vein valves in the legs become defective or weak, blood can pool in veins causing varicose veins, spider veins, and swelling.

Heart disease is the number one killer in the world. And heart disease can gradually build up as most people live with some form of heart disease for years until one day when they have a heart attack or a stroke. All of the risk factors such as high cholesterol, high blood pressure (hypertension), obesity and diabetes can gradually damage the heart.

Heart disease is one of the top 4 silent killers because heart disease "silently" causes your body (cardiovascular system) to slowly deteriorate and create plaque buildup in the arteries that often goes undetected until there is a sudden heart attack or stroke.  

The Classifications (Stages) of Heart Disease Failure

In order to determine the best course of of therapy, physicians often assess the stage of heart failure according to the New York Heart Association (NYHA) functional classification system. This system relates symptoms to everyday activities and the patient's quality of life.
ClassPatient Symptoms
Class I (Mild)No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).
Class II (Mild)Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitation, or dyspnea.
Class III (Moderate)Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea.
Class IV (Severe)Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.

More Information about Heart Disease

heart attack (or myocardial infarction) occurs when a blockage develops in one of the arteries supplying blood to the heart. A stroke occurs when the blockage develops in one of the arteries supplying blood to the brain. A leg cramping occurs when the leg muscles are not being supplied with enough blood for the physical effort demanded.Heart muscle
In the case of a heart attack or a stroke, a lack of blood stops the heart or brain from working so it shuts down and the body collapses.
In the case of leg cramping, a condition called normal inadequate leg circulation (NIC) can develop when leg valves do not close completely, resulting in feelings of heaviness, a sensation of tension (chiefly located in the calves), restless legs, and edema (swelling).
The ropy, swollen knots known as varicose veins occur when the incompetent valves cause blood to pool in the larger leg veins, forcing them to bulge against the skin surface. This slowing of the blood transit time triggers the clotting response causing pockets to form, trapping blood and resulting in minor clots and inflammation. This condition, called phlebitis, can become life threatening if the clot breaks free and travels to the heart, brain, or lungs.
Heart disease is the number one killer disease in most countries including the United States, where over a million people die each year, one death every 33 seconds. More than 60 million Americans have some form of cardiovascular disease, 50 million have high blood pressure, 12.6 million have coronary heart disease, 1.2 million have heart attacks, and 4.6 million have suffered a stroke. Coronary heart disease and atherosclerosis are the two major degenerative forms of heart disease that account for most of the deaths.
For most people who don’t have diabetes, heart disease speaks loud and clear. Inadequate blood flow to the heart muscle causes a variety of signs and symptoms, such as chest pain or pressure, pounding heartbeat, shortness of breath, jaw or arm pain, and sweating. They know something’s wrong and are more likely to seek help. In people with diabetes, heart disease often doesn’t offer such clues. That type of heart disease is called silent ischemia. The lack of symptoms may give you a false sense of good health. And that may prevent you from seeking medical care or treatment until noticeable and more serious complications have occurred. You may have had a heart attack and not even know it.
Unfortunately, most people with diabetes believe that amputation and blindness are their biggest threats. They aren’t aware that they are at an increased risk of heart attack and stroke. In fact, two out of every three diabetics die from a heart attack or a stroke.
According to a recent study conducted by the Yale University School of Medicine, more than one fifth of patients with Type 2 diabetes have decreased blood flow to the heart, but no symptoms to suggest there is a problem. Known as myocardial ischemia, this serious condition occurs when the heart does not receive enough blood to meet its metabolic needs, usually due to inflammation and plaque build-up in the coronary arteries. When no symptoms are present, this is usually due to “silent” inflammation.
As a result, the risk of sudden death from a heart attack, even though there is no history of heart disease, is as high as the risk in people without diabetes who have had a heart attack. That’s why diabetes is called a heart disease equivalent: Having diabetes is like having survived a heart attack.
Liver and Heart Connection
Although the liver and heart partner together to ensure blood circulates healthfully throughout the body, few people consider the two to be a team. However, research on atherosclerosis confirms a tight connection between liver and heart pathology.
Physiologically, blood and bile intimately tie liver and heart health together:
· Blood – The liver receives 25 percent of the blood pumped by the heart and filters over two quarts of blood a minute. To ensure optimal circulation and filtration, the heart pumps blood while the liver cleans it.
· Bile – To dissolve fat in the blood vessels, the liver produces up to two cups of bile a day. Without bile, our arteries would be as hard as rocks without any hope of circulating blood throughout the heart, liver or remainder of the body.

Kidneys and Heart Connection
The link between the kidneys and heart is more obvious than the link between the liver and heart. In fact, many doctors think of the heart and kidneys as one interlinked body system rather than separate organs. 
The job of your heart is to pump oxygen-rich blood from your lungs to each cell in your body, minute after minute, day after day.  With each heartbeat, blood is pushed through your kidneys for filtering. Your kidneys filter about 200 quarts of blood per day to make about two liters of urine.

To do their work, your kidneys need a constant supply of blood at a normal pressure.  Too little blood or too little pressure can cause acute, sudden kidney failure.  Too much blood or too much pressure can lead to scarring that can cause chronic, permanent kidney disease.
Note: When you have kidney disease, it might not occur to you to have your heart checked out.  Or, if you have heart disease, you might not think to have your kidneys tested.  As it turns out, checking both your heart and your kidneys is a good idea if you have either kind of health problem. Why?  Because diseases that affect the kidneys can also damage your heart—and vice versa.

Key Point: Because of the links with the liver and kidneys, it is imperative that any heart treatment strategy include therapies that cleanse and nourish the liver and kidneys. Unfortunately, most conventional treatment strategies ignore the liver. That's why acomprehensive wellness strategy is so critical to optimizing one's cardiovascular health and overall health.

Symptoms of Cardiovascular (Heart) Disease

Symptoms of cardiovascular (heart) disease vary according to the type of heart disease, and they vary from person to person.
The following is a list of some of the early signs or symptoms of heart disease/stroke:
  • shortness of breath; shortness of breath after exercise;
  • pain or tightness in the chest (angina);
  • swelling (edema) in the legs and feet;
  • pain in one of the legs, usually in the lower leg, with swelling and discoloration;
  • pain in the legs with walking (claudication);
  • heart palpitation, arrhythmia;
  • cold feet and/or cold hands;
  • high C-reactive protein level;
  • high homocysteine level;
  • slurred speech, memory loss, muscle weakness, numbness
Please Note: Women have different symptoms than men because heart disease in women tends to be microvascular (heart disease in the small blood vessels), while in men it's macrovascular (heart disease in the large arteries).
But, you may not exhibit any of these signs. If you do exhibit any of these signs, you should contact your doctor for a physical or check up – to avoid one of the major symptoms of heart disease: sudden death from high stress.
  • Pain, shortness of breath, fatigue. No gender differences
  • Right-side chest discomfort. 4.7 times more likely to be reported by men
  • Throat discomfort. 12 times more likely to be reported by women
  • Discomfort. 2.7 times more likely to be reported by men
  • Dull ache. 3.9 times more likely to be reported by men
  • Pressing on the chest. 7.3 times more likely to be reported by women
  • Vomiting. 3.9 times more likely to be reported by women
  • Indigestion. 3.7 times more likely to be reported by men
Men were also five times more likely than women to recognize their symptoms as being related to their heart, say the researchers.
Note: The 64-slice CT scanner can provide detailed images of the heart and arteries for an easier, non-invasive diagnosis.
Note: If you've been diagnosed with congestive heart failure (CHF),  then, it's important to find out from your doctor, the root cause of your CHF. Knowing the actual root cause will help you and your doctor design an effective treatment protocol. For example, if your CHF was fueled by CAD, hypertension or alcohol-abuse vs. a heart valve dysfunction, the treatment protocol would be entirely different for each scenario.
Also keep in mind that taking certain medications can lead to the development or worsening of congestive heart failure. This is especially true for those drugs that can cause sodium retention or affect the power of the heart muscle, i.e. NSAIDs, certain steroids, some calcium channel blockers, and some diabetic meds (i.e. pioglitazone -- Actos).

Impact of Diabetes on the Heart

According to the Mayo Clinic: “Diabetes damages your cardiovascular system, putting you at increased risk of a sudden heart attack or stroke.” Your risks are higher because of the damage that diabetes can cause to your major arteries, including the blood vessels that supply blood to your heart and brain. Another grave complication is gangrene, due to poor circulation, which usually leads to nerve damage and amputation.
WARNING: If you believe that you are having a heart attack, sit down, call 911, chew an aspirin tablet (if you’re not allergic), take deep breaths to inhale extra oxygen, and cough every few seconds to keep your heart beating at a reasonable rate.
When the circulatory system is working properly, it delivers blood throughout the body, utilizing and providing specific nutrients to all the organs, tissues, and cells of the body. These key nutrients include CoQ10, l-carnitine, Vitamin C, Vitamin E, Omega-3 EFAs, magnesium, folate, and arginine.
But, when there is a chronic deficiency of these or other nutrients, the circulatory system starts to struggle and does not work as effectively. Over time, components of the circulatory system such as the blood vessels may become inflamed and damaged, leading to other health issues such as thick blood, blood clots, cold feet/hands, chronic fatigue, erectile dysfunctionand depression. This puts additional stress on other components of the circulatory system such as the heart, which can lead to a sudden stroke or heart attack.
However, a consistent exercise program and a well-designed nutritional program that addresses these specific nutritional deficiencies can be very beneficial in addressing congestive heart failure (CHF), preventing and reversing heart disease, and other circulatory issues without the need for drugs.
In general, for good heart health, avoid the processed foods, drink raw vegetable juices, and eat more green and bright-colored vegetables such as spinach, kale,  broccoli, red peppers, and pumpkin for the Vitamin C, chlorophyll, folate; and, the reduction of cholesterol and homocysteine. Also, eat wild salmon and sardines for the Omega-3 EFAs. Foods and nutrients such as filtered water, celery, CoQ10, cayenne, ginger, onions, andgarlic nourish and protect and the heart and the cardiovascular system. Refer to the wellness protocol section in Chapter 15  of the Death to Diabetes  book and the Power of Juicing ebook for more details about heart health.
WARNING: If you are having a severe drop in blood pressure and/or dizzy spells (or light-headedness), contact your doctor immediately.
A drop in blood pressure can cause dizziness and fainting when the brain fails to receive an adequate supply of blood. And big drops in blood pressure, especially those caused by uncontrolled bleeding, severe infections or allergic reactions can, be life-threatening.
The drop in blood pressure could be due to one or more of the following:
Medications. Many drugs can cause low blood pressure, including diuretics and other drugs that treat high blood pressure; heart medications such as beta blockers; drugs for Parkinson's disease; tricyclic antidepressants; sildenafil (Viagra), particularly in combination with nitroglycerine; narcotics; and alcohol. Some over-the-counter medications can cause low blood pressure when taken in combination with medications used to treat high blood pressure.
Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure. These conditions may cause low blood pressure because they prevent your body from being able to circulate enough blood.
Endocrine problems. An underactive thyroid (hypothyroidism) or overactive thyroid (hyperthyroidism) can cause low blood pressure. In addition, other conditions, such as adrenal insufficiency (Addison's disease), low blood sugar (hypoglycemia), and in some cases, diabetes, can trigger low blood pressure.
Dehydration. When you become dehydrated, your body loses more water than it takes in. Even mild dehydration can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can all lead to dehydration. Far more serious is hypovolemic shock, a life-threatening complication of dehydration. It occurs when low blood volume causes a sudden drop in blood pressure and a corresponding reduction in the amount of oxygen reaching your tissues. If untreated, severe hypovolemic shock can cause death within a few minutes or hours.
Blood loss. Losing a lot of blood from major injury or severe internal bleeding reduces the amount of blood in your body, leading to a severe drop in blood pressure.
Severe infection (septicemia). Septicemia can happen when an infection in the body enters the bloodstream. Lung, abdomen or urinary tract infections are usually the cause of septicemia. These conditions can lead to a life-threatening drop in blood pressure called septic shock.
Allergic reaction (anaphylaxis). Anaphylaxis is a severe and potentially life-threatening allergic reaction. Common triggers of anaphylaxis include foods, certain medications, insect venoms and latex. Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a drop in blood pressure.
Nutritional deficiencies. A lack of the vitamins B-12 and folate can cause anemia, a condition in which your body doesn't produce enough red blood cells. In addition to making you feel tired because you're not getting enough oxygen, anemia can lead to low blood pressure.
Types of Low Blood Pressure
Low blood pressure on standing up (postural or orthostatic hypotension). This is a sudden drop in blood pressure when you stand up from a sitting position or if you stand up after lying down. Ordinarily, blood pools in your legs whenever you stand, but your body compensates for this by increasing your heart rate and constricting blood vessels, thereby ensuring that enough blood returns to your brain. But in people with postural hypotension, this compensating mechanism fails and blood pressure falls, leading to dizziness, lightheadedness, blurred vision and even fainting.
Postural hypotension can occur for a variety of reasons including dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat, large varicose veins and certain neurological disorders. A number of medications can also cause postural hypotension, particularly drugs used to treat high blood pressure - diuretics, beta blockers, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors - as well as antidepressants and drugs used to treat Parkinson's disease and erectile dysfunction.
Postural hypotension is especially common in older adults, with as many as 20 percent of those over age 65 experiencing postural hypotension. But postural hypotension can also affect young, otherwise healthy people who stand up suddenly after sitting with their legs crossed for long periods or after working for a time in a squatting position.
Low blood pressure after eating (postprandial hypotension). A problem that almost exclusively affects older adults, postprandial hypotension is a sudden drop in blood pressure after eating. Just as gravity pulls blood to your feet when you stand, a large amount of blood flows to your digestive tract after you eat. Ordinarily, your body counteracts this by increasing your heart rate and constricting certain blood vessels to help maintain normal blood pressure.
But in some people these mechanisms fail, leading to dizziness, faintness and falls. Postprandial hypotension is more likely to affect people with high blood pressure or autonomic nervous system disorders such as Parkinson's disease. Lowering the dose of blood pressure drugs and eating small, low-carbohydrate meals may help reduce symptoms.
Low blood pressure from faulty brain signals (neurally mediated hypotension). Unlike orthostatic hypotension - which occurs when you stand up from a sitting or lying position - this disorder causes blood pressure to drop after standing for long periods, leading to symptoms such as dizziness, nausea and fainting.
Although the end result is similar, neurally mediated hypotension differs from orthostatic hypotension in other important respects: It primarily affects young people, for instance, and rather than resulting from failed blood pressure regulation, it seems to occur because of a miscommunication between the heart and the brain. When you stand for extended periods, your blood pressure falls as blood pools in your legs.
Normally, your body then makes adjustments to normalize your blood pressure. But in people with neurally mediated hypotension, nerves in the heart's left ventricle actually signal the brain that blood pressure is too high, rather than too low, and so the brain lessens the heart rate, decreasing blood pressure even further. This causes more blood to pool in the legs and less blood to reach the brain, leading to lightheadedness and fainting.
In addition, the fact that you are tired indicates that your cells are not producing enough energy, and your circulatory system is probably sluggish -- leading to fatigue.
It is imperative that you find out from your doctor what is causing your light-head. I'm not a doctor, but I suspect your problem may have something to do with the side effects of your medications. Unfortunately, your doctor is not going to admit it's the drugs -- he'll say it's your age and your diabetes.
Note: You may want to consider getting a portable blood pressure monitor so you check your blood pressure at home to see how much your blood pressure is dropping.

Signs of a Heart Attack                                                

Despite what you may believe, heart attacks rarely happen “out of the blue.”

In fact, your body may be trying to warn you of an impending heart attack for days, weeks, perhaps even a month or two before it occurs. Unfortunately, by the time you actually recognize you’re suffering a heart attack, it could be too late to prevent death or debilitating heart damage.

Statistics show a clear link between a delay in heart attack treatment and death or disability. That’s why it’s essential to know exactly what your heart is trying to tell you.
Symptoms of a heart attack include:
  • Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone
  • Discomfort radiating to the back, jaw, throat, or arm
  • Fullness, indigestion, or choking feeling (may feel like heartburn)
  • Sweating, nausea, vomiting, or dizziness
  • Extreme weakness, anxiety, or shortness of breath
  • Rapid or irregular heartbeats
During a heart attack, symptoms last 30 minutes or longer and are not relieved by rest or nitroglycerin under the tongue.

Some people have a heart attack without having any symptoms (a "silent" myocardial infarction). A silent MI can occur in anyone, but it is more common among people with diabetes.

After a heart attack, quick treatment to open the blocked artery is essential to lessen the amount of damage. At the first signs of a heart attack, call for emergency treatment (usually 911). The best time to treat a heart attack is within one to two hours of the first onset of symptoms. Waiting longer increases the damage to your heart and reduces your chance of survival.

Keep in mind that chest discomfort can be described in many ways. It can occur in the chest or in the arms, back, or jaw. If you have symptoms, take notice. These are your heart disease warning signs. Seek medical care immediately.

Common symptoms in men and women

Heart disease kills more women than all the cancers combined! But, many women are not aware of this. You should pay particular attention to the following signs if — like more than half of all Americans — you are over 50, have high blood pressure, have high cholesterol, are a smoker or have a family history of heart disease. A heart attack occurs when the blood supply to the heart is blocked, damaging the muscle.  

Note: Chewing aspirin (either one regular or two baby) helps the heart by thinning the blood.

Chest pain: Most people do call 911 or get to the hospital if they feel like they've got an elephant sitting on their chest, but even this most common heart attack symptom may be hard to recognize. It may just feel like a squeezing that lasts more than a few minutes or goes away and comes back. "It may be a chest fullness that they don't recognize as pain," says Tomaselli, who is also chief of cardiology at the Johns Hopkins School of Medicine. "Sometimes it doesn't particularly hurt. It's an uncomfortable sensation." If chest pain lasts more than five minutes, go to the emergency room.
  • Shortness of breath: You may feel you can't catch your breath, even when resting. This breathlessness often occurs before the chest pain.
  • Dizziness or lightheadedness: You may feel as if you will pass out.
  • Cold sweat: Sweating when you are cold or have a chill.

Symptoms more likely in women

Women have a higher risk of dying from a heart attack than men do, partly because they often don't realize they're having a heart attack and partly because they delay getting help.
Women are less likely than men to have the typical "Hollywood heart attack," says Sharonne Hayes, M.D., cardiologist and director of Mayo Clinic's Women's Heart Clinic in Rochester, Minn. Chest pain was not the main symptom in about 46 percent of women who had a heart attack, studies show.
  • Radiating pain in one arm (especially left arm) or both arms, back, neck, abdomen or shoulder blades: Also, chest pain that feels like a pressure on the chest. When the nerves of the heart are irritated because the heart isn't getting enough blood, discomfort or pain can radiate out to many places in the body. The pain often is described as an uncomfortable pressure, tightness or ache. "If you can put a finger on it and say, 'It hurts right here,' that's much less likely to be a heart attack," says Pamela Ouyang, a cardiologist with the Johns Hopkins Bayview Medical Center.
  • Nausea and vomiting: Women are more likely than men to have this symptom, and they may think they have a stomach flu rather than a heart attack.
  • Overwhelming and unusual fatigue: Fatigue is generally a symptom of 21st-century life, so it's often overlooked as a heart attack sign, but it's extremely common, so beware if you're unusually exhausted.
  • Dizziness or lightheadednessYou may feel as if you will pass out.
  • Shortness of breath: You may feel you can't catch your breath, even when resting. This breathlessness often occurs before the chest pain.
  • Jaw pain: Jaw and throat pain are quite common, says Ouyang. She says the feeling can start in the chest and move to the throat — as if someone is choking you — and then to the jaw. But again, it's not always obvious. Sometimes people "go to the dentist, because they think it's a toothache," when they actually had a heart attack.

Which is it? Heart Attack, Heartburn, or Panic Attack?

Sometimes heartburn, a panic attack, indigestion, and other symptoms may feel like a heart attack. 
  • Heart attack vs. heartburnIf you typically have heartburn, and you've just eaten a large or spicy meal, you may want to take an antacid to see whether the pain goes away, advises Ouyang. "If you've never had anything like this before, and particularly if it's quite severe or you have a sweat with it ... then it might be a heart attack."
  • Heart attack vs. panic attack: If you have a history of panic attacks — racing heart or feelings of impending doom — the symptoms may be another panic attack. But if you've never had a panic attack, Hayes says you should be checked out because you don't want to wind up ignoring a real heart attack.
  • Heart attack vs. stable angina: Angina — the pain that comes from insufficient blood flow to the heart — feels similar to a heart attack, but tends to come and go as you exert yourself. "If there is some kind of activity that brings on these symptoms and then you rest and it goes away, that is a classic symptom of angina," Ouyang says. Sweating and shortness of breath are more likely to accompany a heart attack. Angina is often a precursor to a heart attack, so people need to see a doctor and get diagnosed quickly.

Heed the Symptoms!

Heart experts say one reason so many women die is that they often don't heed their symptoms. They may attribute their symptoms to hot flashes, flu, something they ate or their age. When they do realize something might be wrong, they delay getting treatment.
"Women don't call 911," says Sharonne Hayes, M.D., of the Mayo Clinic.
In fact, a 2009 American Heart Association survey found that only half of women say they would call 911 if they thought they might be having a heart attack. "They worry, 'What will the neighbors think?' or 'I've got to finish fixing dinner for my husband,' " Hayes says.
And women are more likely to consult with friends or call the family doctor, which Hayes says can cause a dangerous delay.
Studies also show that women who are diagnosed with a heart attack are more likely to have come to the hospital in a private car.
When people arrive at a hospital by ambulance, they usually get faster treatment, Hayes says.
"Patients should not be sitting at home trying to diagnose a heart attack," Hayes says. "They could die doing that."
Cardiologist Gordon Tomaselli says that often after people have a heart attack, they realize in retrospect they had symptoms days or weeks earlier that they didn't recognize — such as extreme fatigue or throat pain.
But as many as a quarter of all heart attack victims have a heart attack as a first symptom of heart disease.

Heart Symptoms Never to Ignore

One reason why heart disease is so deadly is because so many people are slow to seek help when symptoms arise. Yes, someone gripped by sudden chest pain probably knows to call 911. But heart symptoms aren't always intense or obvious, and they vary from person to person and according to gender.
Because it can be hard to make sense of heart symptoms, doctors warn against ignoring possible warning signs, toughing them out, waiting to see if they go away, or being quick to blame them on heartburn, muscle soreness, or other less serious, non-cardiac causes. That's especially true for men and people over 65, as well as for people with other cardiac risk factors, such as high cholesterol or blood pressure, obesity, smoking, diabetes, or a family history of heart disease.
"The more risk factors you have, the higher the likelihood that a symptom means something is going on with your heart," says David Frid, MD, a cardiologist at the Cleveland Clinic. "People often don't want to admit that they're old enough or sick enough to have heart trouble. Putting off treatment for other medical problems might not be so bad, but a serious heart problem can mean sudden death. It's better to go in and get it evaluated than to be dead."

Twelve (12) Possible Heart Symptoms Never to Ignore

Here are a dozen symptoms that may signal heart trouble.
1. Anxiety. Heart attack can cause intense anxiety or a fear of death. Heart attack survivors often talk about having experienced a sense of "impending doom."
2. Chest discomfort. Pain in the chest is the classic symptom of heart attack, and "the No. 1 symptom that we typically look for," says Jean C. McSweeney, PhD, RN, associate dean for research at the University of Arkansas for Medical Sciences College of Nursing in Little Rock and a pioneer in research on heart symptoms in women. But not all heart attacks cause chest pain, and chest pain can stem from ailments that have nothing to do with the heart.
Heart-related chest pain is often centered under the breastbone, perhaps a little to the left of center. The pain has been likened to "an elephant sitting on the chest," but it can also be an uncomfortable sensation of pressure, squeezing, or fullness. "It's not unusual for women to describe the pain as a minor ache," McSweeney says. "Some women say the pain wasn't bad enough even to take a Tylenol."
Women, more so than men, can also experience a burning sensation in their chest, rather than a pressure or pain.  "Sometimes people make the mistake that the pain comes from a stomach problem," says Nieca Goldberg, MD, clinical associate professor of medicine at the NYU Langone Medical Center in New York City and another expert on women's heart symptoms.
3. Cough. Persistent coughing or wheezing can be a symptom of heart failure -- a result of fluid accumulation in the lungs. In some cases, people with heart failure cough up bloody phlegm. If a person has had multiple heart attacks and now constantly coughs, it may be due to congestive heart failure or even due to a medication. It is imperative to see a doctor, especially a cardiologist.

Most people associate coughing with a lung or airway problem, not with the heart. But patients with heart failure can endure significant coughing not only before treatment, but also because of it.
Since coughing is the body's way of clearing the airway and bronchial passages, it makes sense that it's a prominent symptom of heart failure. In fact, an older term for the condition is "congestive heart failure."
Heart failure occurs most frequently in those over 65 years of age, and it results in the hospitalization of more than a million Americans each year. It has many causes, including high blood pressure, prior heart attack or another form of heart disease and -- in addition to lung congestion -- it is often characterized by swelling, for example, of the legs, feet or abdomen.
The coughing of heart failure can take several forms. A wet, frothy cough that can be tinged pink with blood is very common. So is a dry, hacking cough that doesn't expel mucous. Patients may waken in the middle of the night gasping and coughing. As a result, many prefer to sleep propped up in a semi-reclined position. Heavy wheezing and labored breathing can also accompany coughing spells, and patients may experience a bubbling feeling or whistling sound in their lungs.
Ironically, coughing is also frequently a side effect of a type of medication that's frequently prescribed for heart failure: angiotensin-converting enzyme (ACE) inhibitors, which are also used to treat high blood pressure and other cardiac conditions. They work by dilating the arteries, easing blood flow and decreasing the heart's workload. This class of medications also acts as a diuretic, increasing urine flow and reducing excess fluid that could otherwise contribute to congestion and swelling.
However, many patients who take ACE inhibitors complain of a dry cough and ask to discontinue the medication. In the early 2000s, scientists found that taking an iron supplement helps mitigate this medication-induced coughing because it curbs the production of nitric oxide, which can irritate bronchial passages in the lungs.
Another option for addressing an ACE inhibitor-related cough is switching to an angiotensin II receptor blocker (ARB), which has many of the same advantages as the ACE inhibitor, but the ARB doesn't trigger bothersome coughing. However, because fewer clinical studies have been completed on ARBs, they aren't prescribed as often as ACE inhibitors.
FYI: Chronic coughing is common, so frequent that it rates as one of the most common reasons for seeing a doctor. Although both patients and doctors rightly focus their attention on finding the cough's cause, the cough itself is responsible for significant problems. In addition to worry about the diagnosis, patients experience frustration and anxiety, especially if diagnosis and treatment stretches out over weeks, which is often the case. Coughing interrupts sleep, producing fatigue and impairing concentration and work performance. In this age of scary new viruses, social interactions are likely to suffer. And coughing can also have important physical consequences, ranging from urinary incontinence to fainting and broken ribs. Between medical tests, lost productivity at work, remedies that don't help, and treatments that do, coughing is also expensive.
Smoking is the leading cause of persistent coughing, but, a lingering cough is also a worry for non-smokers. Fortunately, benign problems are responsible for most chronic coughs in non-smokers. Benign or not, persistent coughing can cause worry, embarrassment, exhaustion, and more. That's why chronic coughs should be diagnosed and treated before they linger too long.
Dozens of conditions can cause a recurrent, lingering cough, but the lion's share are caused by just five: postnasal drip, asthma, gastroesophageal reflux disease (GERD), chronic bronchitis, and treatment with ACE inhibitors, used for high blood pressure. Many people have several of these conditions, but in non-smokers, the first three, singly or in combination, account for nearly all chronic coughs. The major causes of long-term coughing are listed below.
4. Dizziness. Heart attacks can cause lightheadedness and loss of consciousness.  So can potentially dangerous heart rhythm abnormalities known as arrhythmias.
5. Fatigue. Especially among women, unusual fatigue can occur during a heart attack as well as in the days and weeks leading up to one. And feeling tired all the time may be a symptom of heart failure.
Of course, you can also feel tired or fatigued for other reasons. How can you tell heart-related fatigue from other types of fatigue?
"If you don't feel well and all the wind is knocked out of your sails, don't try to figure it out on the Internet or from a book," says Goldberg.  "Wasting time is dangerous."
6. Nausea or lack of appetite. It's not uncommon for people to feel sick to their stomach or throw up during a heart attack. And abdominal swelling associated with heart failure can interfere with appetite.
7. Pain in other parts of the body. In many heart attacks, pain begins in the chest and spreads to the shoulders, arms, elbows, back, neck, jaw, or abdomen. But sometimes there is no chest pain -- just pain in these other body areas.  The pain might come and go.
Men having a heart attack often feel pain in the left arm. In women, the pain is more likely to be felt in both arms, or between the shoulder blades.
8. Rapid or irregular pulse. Doctors say that there's nothing worrisome about an occasional skipped heartbeat. But a rapid or irregular pulse -- especially when accompanied by weakness, dizziness, or shortness of breath -- can be evidence of a heart attack, heart failure, or an arrhythmia. Left untreated, some arrhythmias can lead to stroke, heart failure, or sudden death.
9. Shortness of breath. People who feel winded at rest or with minimal exertion might have a pulmonary condition like asthma or chronic obstructive pulmonary disease (COPD). But breathlessness could also indicate a heart attack or heart failure.
"Sometimes people having a heart attack don't have chest pressure or pain but feel extremely short of breath," Goldberg says. "It's like they've just run a marathon when they haven't even moved." During a heart attack, shortness of breath often accompanies chest discomfort, but it can also occur before or without chest discomfort.
10. Sweating. Breaking out in a cold sweat is a common symptom of heart attack. "You might just be sitting in a chair when all of a sudden you are really sweating like you had just worked out," Frid says.
11. Swelling. Heart failure can cause fluid to accumulate in the body. This can cause swelling (often in the feet, ankles, legs, or abdomen) as well as sudden weight gain and sometimes a loss of appetite.
12. Weakness. In the days leading up to a heart attack, as well as during one, some people experience severe, unexplained weakness. "One woman told me it felt like she couldn't hold a piece of paper between her fingers," McSweeney says.

Risk Factors of Heart Disease

Some risk factors for heart disease can be controlled, and some can't. According to the American Heart Association, these are the leading risk factors for heart disease or a heart attack.

Age: More than 83% of people who die from coronary heart disease are 65 or older. Older women are more likely to die of heart attacks within a few weeks of the attack than older men.

Poor diet: Eating a lot of processed foods, animal meat, fast foods and drinking soda, diet soda, and bottled fruit juices will eventually lead to heart disease and/or diabetes. The excess sugar and fat are the 2 main culprits. These combine to create too much fat in your bloodstream, which in turn sets the stage for inflammation and the buildup of arterial plaque, a condition known as arteriosclerosis or heart disease.

Being male: Men have a greater risk of heart attack than women do, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's.

Family history. Those with parents or close relatives with heart disease are more likely to develop it themselves.

Race: Heart disease risk is higher among African Americans, Mexican Americans, American Indians, native Hawaiians, and some Asian Americans compared to Caucasians.

Smoking: Cigarette smoking increases your risk of developing heart disease by two to four times.

High cholesterol: As blood cholesterol rises, so does risk of coronary heart disease. But, cholesterol is not the cause! It's an indicator!

High blood pressure: High blood pressure increases the heart's workload, causing the heart to thicken and become stiffer. It also increases your risk of stroke, heart attack, kidney failure, and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels, or diabetes, the risk of heart attack or stroke increases several times.


Sedentary lifestyle. Inactivity is a risk factor for coronary heart disease.

Excess weight: People who have excess body fat—especially if a lot of it is at the waist—are more likely to develop heart disease and stroke even if they have no other risk factors.

Diabetes: Having diabetes seriously increases your risk of developing cardiovascular disease. About three-quarters of people with diabetes die from some form of heart or blood vessel disease.

Other risk factors: Include Post-menopausal; High C-reactive protein; and, Uncontrolled stress and anger.

What to Do After Having Had a Heart Attack              

Note: If you've had a heart attack, you're at risk of another. Here's what you can do to lower that risk.

Unfortunately, after having a heart attack, your doctor and cardiologist overloads you with a bunch of drugs to manage the symptoms. Some of these drugs are important in the short term, but, not for the long term. Your overall wellness plan should be to gradually wean off these drugs before your body and heart muscle become biochemically dependent on the drugs.  These drugs in combination with not making any diet and lifestyle changes can lead to a second heart attack!

If you've had a heart attack, you probably have coronary artery disease -- check with your cardiologist. Coronary artery disease is the buildup of fatty deposits called plaque in your blood vessels. The good news is that you can prevent new fatty buildup in your coronary arteries and decrease your risk of another heart attack. Use the following steps and get the Death to Diabetes book (or ebook).

Eat Well. Adopting healthier eating habits can help to heal your heart and protect it from future trouble. It can also help you control your weight and prevent or control diabetes.
Today's heart-healthy diet isn't the bland, low-fat, high-carbohydrate diet you've probably been hearing about for years. Not all fats are bad for the heart. Some are actually good for it. And not all carbohydrates are good for your heart, your waistline or the rest of you.
Eating right isn't just about calories. What you eat is important, even if you don't need to lose weight.
A healthy diet:
  • Contains healthy sources of carbohydrates. Eat more vegetables — foods such as broccoli, Brussels sprouts and spinach — to help lower cholesterol, improve blood sugar and insulin levels, control weight, protect the heart, guard against diabetes and keep your digestive system healthy. 
  • Contains healthy fats. Once you've cut way back on saturated fats and avoided trans fats (the unhealthy fats), you can start adding healthy fats to your diet. Healthy fats are polyunsaturated and monounsaturated, i.e. wild salmon, extra virgin olive oil, walnuts.
  • Relies on healthy sources of protein. For a healthier heart, cut back on red meat and switch to cold-water fish. Why? The good fats in fish such as wild salmon, tuna, and sardines protect the heart against erratic rhythms, prevent blood clots, and reduce blood pressure. The American Heart Association now recommends that people with heart disease eat fish once a day (and possibly take Omega-3 EFA supplements). Beans, nuts and seeds are also excellent sources of protein.
  • Includes plenty of vegetables and fruits. These foods provide the key vitamins, minerals, and antioxidants to nourish your heart and cardiovascular system.
  • Contains healthy raw juices. Make sure that you drink at least 1 glass of raw juice in the morning and one in the evening before your meal. Drinking raw juice is like drinking a glass of real vitamins and minerals. Follow the juice recipes in the Death to Diabetes Juicing book. (Note: If you don't like to juice, then, use your blender to make green smoothies).
  • Tastes great. If your meals don't taste great, you probably won't stick with it for long. Use the taste tips in the Death to Diabetes Cookbook.
Maintain a Healthy Weight. No one likes to be called "overweight" or "obese." It suggests that you don't have any willpower. In fact, recent scientific discoveries show that genes play an important role in becoming overweight. While you can't do anything about your genes, you can control your weight through a combination of diet and exercise. Certain medications also may help, although they cannot do the job by themselves, and may have side effects.
If you are overweight, you are not alone. Approximately half of the adults (and a growing number of children) in the United States are overweight. But there is a difference between you and most of those people: You have heart disease, and most of them do not. That makes weight control all the more important for you.
The one-two punch for a healthy weight is, not surprisingly, a good diet and regular exercise.
Get Active. You may be in no mood to exercise after the strain and stress of a heart attack. At first, exercising might be difficult, but it will definitely pay off later. Your doctor can help you to develop a suitable program to get active.
Even if you are not overweight, exercise can reduce high blood pressure, a leading cause of heart disease. Aerobic exercise, such as jogging, biking or brisk walking, at least three to five times a week for at least 30 minutes can prevent high blood pressure and improve overall health.
Stop Smoking. Smoking is very bad for your heart. It increases the development of blockages in the arteries of your heart (atherosclerosis) that lead to heart pain (angina), heart attacks and heart failure. Smoking increases the tendency of your blood to form clots that further block the flow of blood to your heart. And it may increase your risk of dangerous heart rhythms. You have heart disease, and that means you need to quit smoking.
Smokers often fear that because they have smoked for so long it's too late to get any benefit from stopping. Not so. The sooner in life a person quits smoking, the greater benefit he or she will gain. However, almost no matter how long or how heavily a person has smoked, quitting smoking reduces a smoker's risk of disease, and increases life expectancy. For example, smokers who stop smoking after a heart attack reduce their chances of a future heart attack and of dying of heart disease by 25 percent to 50 percent.
Reduce Your Stress. When it comes to stressful life events, heart attacks and serious medical procedures rank right near the top of the list. Heart trouble hammers home the reality that you're not going to live forever. It makes the future hazy for you and those who depend on you. It complicates relationships and work, and sometimes even the simple activities of daily life.
You can combat stress in different ways. One widely used technique is the relaxation response, developed by Harvard Medical School's Herbert Benson, M.D., who directs the Mind/Body Medical Institute in Boston. Here's how to do it:
  1. Sit in a comfortable chair in a quiet room, close your eyes and relax your muscles.
  2. Focus on trying to breathe as evenly as you can. Breathe in slowly and then exhale slowly.
  3. As you breathe, repeat a word aloud or in your mind. Pick something simple like "relax" or "easy." Some people use religious words, others use words that have no meaning, such as the "om" used in transcendental meditation.
  4. Once you establish a rhythm, keep breathing regularly with your muscles relaxed.
Exercise also relieves stress. Twenty minutes or so of an activity that increases your heart rate works best. If that's not possible, a five-minute walk can help. Yoga, tai chi and even stretching also can help to calm you down.
Lower Your BP. High blood pressure is very bad for your heart. It increases the development of blockages in the arteries of your heart (atherosclerosis) that lead to heart pain (angina), heart attacks and heart failure. It also puts a strain on the heart, because it has to pump harder when blood pressure is high.
Warning: After a heart attack or heart surgery, even if your blood pressure is normal, doctors may prescribe you pills to decrease the workload on the heart. These medicines include beta-blockers, ACE inhibitors and angiotensin receptor blockers. Be careful -- these medications can weaken the heart muscle over time!
Lower Your Inflammation & Cholesterol. High levels of inflammation and total cholesterol and of LDL cholesterol in your blood are risk factors for heart disease. Because you have heart disease, it is especially important that you get treatment for elevated cholesterol levels. People who do not have heart disease can lower their cholesterol by changing their diet. Because you have heart disease, your doctor will probably start you on medications, as well as recommending dietary changes.
After a heart attack or surgery, your cholesterol level may actually drop a bit. Your doctor may check your cholesterol before you leave the hospital. Some doctors will wait until you leave the hospital to determine if your cholesterol is elevated before starting you on cholesterol-lowering medicines.
Recent studies indicate that cholesterol-lowering medicines called statins may help people with heart disease but these drugs lead to muscle problems (rhabdomyolosis) and can trigger Type 2 diabetes! Make sure that you take a CoQ10 supplement, but make sure it's not the synthetic form!

Consider a Cardiac Rehabilitation Program.
 If you think you will have difficulty following through on all of the above, ask your doctor if you are eligible for a cardiac rehab program.
Heart Medications. After a heart attack, certain drugs are prescribed by your cardiologist. Drugs are grouped by type or classes. If you have had a heart attack or a procedure to open or bypass a clogged heart artery (coronary artery) you are probably taking at least 2 or 3 of these drugs.
  • Beta-blockers reduce the heart's workload by blocking the stimulating effects of the hormones epinephrine and norepinephrine. Beta-blockers lower blood pressure and protect the heart from developing dangerous heart rhythms. But, long-term use of these drugs can be dangerous.
  • ACE inhibitors block one of the body's chemical systems that raise blood pressure. to help at lowering blood pressure.
  • Aspirin helps to prevent blood clots from forming in the coronary arteries, but, may damage the inner lining of the stomach, leading to internal bleeding!
  • Anticoagulants lower the risk of blood clots in the veins of the legs and inside the chambers of the heart. Doctors prescribe anticoagulants for people who are at above-average risk for blood clots in the legs or heart.
  • Statins lower bad cholesterol (LDL), but, they do not prevent heart attacks and strokes as advertised! Over the past 20 years, the consumption of statin drugs has increased dramatically (75+ million users in the U.S.!), but heart attacks and strokes have increased over that same period of time! Read our web page about the infamous Statin Drug & Cholesterol Hoax.
  • Key Point!: If you're taking a statin drug, make sure that you take CoQ10 to protect your heart. But, make sure that the CoQ10 is not synthetic! 
  • Antibiotics help with some infections, but, some of the popular antibiotics such as the Z-Pak can cause more harm than good! In fact, death is a possibility! Be very careful and do your homework.
  • Warning: The Food and Drug Administration issued a health warning for a widely prescribed antibiotic, commonly known as 'Z-Pack' and says it could trigger potentially irregular heart rhythms in some patients. It's sold as Zithromax or Zmax, but most know it as 'Z-Pack.' It's the most widely prescribed antibiotic for bacterial infections such as bronchitis and pneumonia. However, the Food and Drug Administration warns that it could be deadly for some patients with heart problems.
Please Note: There are many foods and supplements that perform the same functions of these drugs without the dangerous side effects, i.e. arginine, broccoli, cayenne pepper, celery, garlic, ginger, green tea, onions, natto, Omega-3 EFAs, CoQ10. For more details about these foods and supplements, get the Death to Diabetes book/ebook or the How to Prevent a Heart Attack/Stroke ebook.

Congestive Heart Failure (CHF)    

Many disease processes can impair the pumping efficiency of the heart to cause congestive heart failure. In the United States, the most common causes of congestive heart failure are:
  • coronary artery disease,
  • high blood pressure,
  • longstanding alcohol abuse, and
  • disorders of the heart valves.
Less common causes include viral infections of the stiffening of the heart muscle, thyroid disorders, disorders of the heart rhythm, and many others.

Lifestyle Changes as Congestive Heart Failure Treatment

Lifestyle changes that your doctor may recommend as part of treating congestive heart failure include:
  • Follow a plant-based diet low in salt. Salt can cause extra fluid to build up in your body, making your heart failure worse.
  • Limit the amount of fluids that you drink.
  • Weigh yourself every day, and let your doctor know right away if you have a sudden weight gain. This could mean that you have extra fluid building up in your body.
  • Exercise as directed to help build up your fitness level and ability to be more active. 
Your doctor will also tell you to:
  • Lose weight if you are overweight
  • Quit smoking if you smoke
  • Limit the amount of alcohol that you drink.
As the disease progresses, lifestyle changes and regular medications may not be enough to control worsening symptoms. Many people with severe heart failure  must be put in the hospital from time to time. In the hospital, your doctor may prescribe new or special medicines. You also continue to take your regular medicines during this treatment.
 
Your doctor may also order extra oxygen if you continue to have trouble breathing. This oxygen can be given in the hospital and at home.
 
People with very severe heart failure may be considered for a mechanical heart pump or heart transplant.

Note: Refer to this web page for more details about congestive heart failure.

Edema

Edema is the medical term for swelling. It is a general response of the body to injury or inflammation. Edema can be isolated to a small area or affect the entire body. Medications, infections, pregnancy, and many medical problems can cause edema.

Edema results whenever small blood vessels become "leaky" and release fluid into nearby tissues. The extra fluid accumulates, causing the tissue to swell.

Causes of Edema
Edema is a normal response of the body to inflammation or injury. For example, a twisted ankle, a bee sting, or a skin infection will all result in edema in the involved area. In some cases, such as in an infection, this may be beneficial. Increased fluid from the blood vessels allows more infection-fighting white blood cells to enter the affected area.
Edema can also result from medical conditions or problems in the balance of substances normally present in blood. Some of the causes of edema include:
Low albumin (hypoalbuminemia): Albumin and other proteins in the blood act like sponges to keep fluid in the blood vessels. Low albumin may contribute to edema, but isn't usually the sole cause.
Allergic reactions: Edema is a usual component of most allergic reactions. In response to the allergic exposure, the body allows nearby blood vessels to leak fluid into the affected area.
Obstruction of flow: If the drainage of fluid from a body part is blocked, fluid can back up. A blood clot in the deep veins of the leg can result in leg edema. A tumor blocking lymph or blood flow will cause edema in the affected area.
Critical illness: Burns, life-threatening infections, or other critical illnesses can cause a whole-body reaction that allows fluid to leak into tissues almost everywhere. Widespread edema throughout the body can result.
Edema and heart disease (congestive heart failure): When the heart weakens and pumps blood less effectively, fluid can slowly build up, creating leg edema. If fluid buildup occurs rapidly, fluid in the lungs (pulmonary edema) can develop.
Edema and liver disease: Severe liver disease (cirrhosis) results in an increase in fluid retention. Cirrhosis also leads to low levels of albumin and other proteins in the blood. Fluid leaks into the abdomen (called ascites), and can also produce leg edema.
Edema and kidney disease: A kidney condition called nephrotic syndrome can result in severe leg edema, and sometimes whole-body edema (anasarca).
Edema and pregnancy: Due to an increase in blood volume during pregnancy and pressure from the growing womb, mild leg edema is common during pregnancy. However, serious complications of pregnancy such as deep vein thrombosis and preeclampsia can also cause edema.
Cerebral edema (brain edema): Swelling in the brain can be caused by head trauma, low blood sodium (hyponatremia), high altitude, brain tumors, or an obstruction to fluid drainage (hydrocephalus). Headaches, confusion, and unconsciousness or coma can be symptoms of cerebral edema.
Medications and edema: Numerous medications can cause edema, including:
  • NSAIDs ( ibuprofen, naproxen)
  • Calcium channel blockers
  • Corticosteroids (prednisone, methylprednisolone)
  • Pioglitazone  and rosiglitazone
  • Pramiprexole
Most commonly, these medications produce no edema, or mild leg edema.
Symptoms of Edema
Edema symptoms depend on the amount of edema and the body part affected.
Edema in a small area from an infection or inflammation (such as a mosquito bite) may cause no symptoms at all. On the other hand, a large local allergic reaction (such as from a bee sting) may cause edema affecting the entire arm. Here, tense skin, pain, and limited movement can be symptoms of edema.
Food allergies may cause tongue or throat edema, which can be life-threatening if it interferes with breathing.
Leg edema of any cause can cause the legs to feel heavy and interfere with walking. In edema and heart disease, for example, the legs may easily weigh an extra 5 or 10 pounds each. Severe leg edema can interfere with blood flow, leading to ulcers on the skin.
Pulmonary edema causes shortness of breath, which can be accompanied by low oxygen levels in the blood. Some people with pulmonary edema may experience a  cough with frothy sputum.
Treatment of Edema
Treatment of edema often means treating the underlying cause of edema. For example, allergic reactions causing edema may be treated with antihistamines and corticosteroids.
Edema resulting from a blockage in fluid drainage can sometimes be treated by eliminating the obstruction:
  • A blood clot in the leg is treated with blood thinners, and the clot slowly breaks down; leg edema then resolves as fluid drainage improves.
  • A tumor obstructing a blood vessel or lymph flow can sometimes be reduced in size or removed with surgery, chemotherapy, or radiation.
Leg edema related to congestive heart failure or liver disease can be treated with a diuretic (''water pill'') like furosemide (Lasix), but this is only a temporary fix. When urine output increases, more fluid drains from the legs back into the blood. Maintaining a sodium-restricted diet will also help limit fluid retention associated with heart failure or liver disease.

Note: A diuretic may  force your body to urinate, creating a side effect which removes specific minerals from your body, i.e. potassium, magnesium, calcium. Then, your doctor may have you take a supplement that contains the minerals (potassium, magnesium, calcium) that you're losing via the forced uriantion! In addition, these minerals are important to your cardiovascular health!
Edema (Lower Leg Swelling)
The swelling of the legs (edema) may be a sign of heart failure, kidney failure, or liver failure. In these conditions, there is too much fluid in the body. It is critical that you find out from your doctors what they believe is causing your edema!

Some of the causes of the edema include:
-- Being overweight
-- Veins in the legs that cannot properly pump blood back to the heart
-- Blood clot in the leg
-- Increased age
-- Leg infection   

Leg swelling caused by the buildup of fluids in leg tissues is known as peripheral edema. Several body systems help maintain the appropriate balance of fluids, including the circulatory system, the lymphatic system and the kidneys. A problem with any one of these systems may contribute to the buildup of fluids. Gravity can also contribute to the accumulation of fluids in your lower limbs, particularly with prolonged standing or sitting.

In addition, your doctors may not tell you this, but, certain medications may also cause your legs to swell. For example:
  • Blood pressure medicines such as calcium channel blockers (such as nifedipine, amlodipine, diltiazem, felodipine, and verapamil)
  • Antidepressants, including MAO inhibitors (such as phenelzine and tranylcypromine) and tricyclics (such as nortriptyline, desipramine, and amitriptyline)
  • Steroids
  • Hormones like estrogen (in birth control pills or hormone replacement therapy) and testosterone
Some tips that may help:

  • Eat more greens and other plant-based foods
  • Avoid processed foods, fast foods, etc. because they contain hidden salt
  • Follow a low-salt diet, which may reduce fluid buildup and swelling.
  • Raise your legs above your heart while lying down.
  • Exercise your legs. This helps pump fluid from your legs back to your heart.
  • Wear support stockings (sold at most drug and medical supply stores).
  • When traveling, take breaks often to stand up and move around.
  • Avoid wearing tight clothing or garters around your thighs.
  • Lose weight
IMPORTANT! Call your doctor right away if:
  • You have heart disease or kidney disease and the swelling gets worse.
  • You have a history of liver disease and now have swelling in your legs or abdomen.
  • Your swollen foot or leg is red or warm to the touch.
  • You have a fever.
  • You are pregnant and have more than just mild swelling or have a sudden increase in swelling.
Also call your doctor if self-care measures do not help or swelling gets worse.

 

Strokes                                                                        

A stroke, or cerebrovascular accident (CVA), is a condition in which the brain cells suddenly die because of a lack of oxygen. This can be caused by an obstruction in the blood flow, or the rupture of an artery that feeds the brain. The patient may suddenly lose the ability to speak, there may be memory problems, or one side of the body can become paralyzed.

The two main types of stroke include ischemic stroke and hemorrhagic stroke.

An ischemic stroke accounts for about three-quarters of all strokes and occurs when a blood clot, or thrombus, forms that blocks blood flow to part of the brain. If a blood clot forms somewhere in the body and breaks off to become free-floating, it is called an embolus. This wandering clot may be carried through the bloodstream to the brain where it can cause ischemic stroke.

hemorrhagic stroke occurs when a blood vessel on the brain's surface ruptures and fills the space between the brain and skull with blood (subarachnoid hemorrhage) or when a defective artery in the brain bursts and fills the surrounding tissue with blood (cerebral hemorrhage).

Both types of stroke result in a lack of blood flow to the brain and a buildup of blood that puts too much pressure on the brain.

The outcome after a stroke depends on where the stroke occurs and how much of the brain is affected. Smaller strokes may result in minor problems, such as weakness in an arm or leg. Larger strokes may lead to paralysis or death. Many stroke patients are left with weakness on one side of the body, difficulty speaking, incontinence, and bladder problems.

Anyone can have a stroke no matter your age, race or gender. But, the chances of having a stroke increase if a person has certain risk factors, or criteria that can cause a stroke. The good news is that up to 80 percent of strokes can be prevented, and the best way to protect yourself and loved ones from stroke is to understand personal risk and how to manage it. Recently, strokes are on the rise in women.
Risk Factors include:
-- High blood pressure
-- High cholesterol
-- High homcysteine
-- Diabetes
-- Heart disease
-- Overweight by 10 lbs. or more
-- Family history
-- Alcohol, tobacco
-- Excess prescription drug use
-- Migraine headaches
-- Delivering a baby (next 6 weeks)
-- Taking birth control pill for 10 or more years
-- Sedentary lifestyle
-- Poor diet, esp. sugary drinks, fast foods, and processed foods
-- Sudden movement of the neck (kinking the artery)

Symptoms of a Stroke
Within a few minutes of having a stroke, brain cells begin to die and symptoms can become present. It is important to recognize symptoms, as prompt treatment is crucial to recovery. Common symptoms include:
    Dizziness, trouble walking, loss of balance and coordination
    Speech problems
    Numbness, weakness, or paralysis on one side of the body
    Blurred, blackened, or double vision
    Sudden severe headache
    Nausea (in women)
    Sudden onset of hiccups (in women)
    Sudden urge to take a nap

Smaller strokes (or silent strokes), however, may not cause any symptoms, but can still damage brain tissue.

A possible sign that a stroke is about to occur is called a transient ischemic attack (TIA) - a temporary interruption in blood flow to part of the brain. Symptoms of TIA are similar to stroke but last for a shorter time period and do not leave noticeable permanent damage.

Warning:
 You must take action immediately -- call your doctor and get to the hospital.

What to Do After Having Had a Stroke             

Note 1: If you have had a stroke, you're at risk for another stroke. Below is some information that explains what you can do to lower that risk.

Note 2: If you are helping a loved one after having a stroke, you're playing the role of a caregiver. If you really want to help them but maintain your own sanity, we recommend that you get the author's Caregiver's Guide.

Unfortunately, after having a stroke, your doctor and cardiologist overloads you with a bunch of drugs to manage the symptoms. Some of these drugs are important in the short term, but, not for the long term. Your overall wellness plan should be to gradually wean off these drugs before your body and heart muscle become biochemically dependent on the drugs.  These drugs in combination with not making any diet and lifestyle changes can lead to a second stroke that could be worse than the first!

Recovery from stroke is a lifelong process. For many people, recovery begins with formal rehabilitation, which can restore independence by improving physical, mental and emotional functions. It is important for you and your family to know that no matter where you are in your recovery journey, there is always hope.

Recovery & Rehabilitation

Current statistics indicate that there are more than 7 million people in the United States who have survived a stroke or brain attack and are living with the after-effects. These numbers do not reflect the scope of the problem and do not count the millions of husbands, wives and children who live with and care for stroke survivors and who are, because of their own altered lifestyle, greatly affected by stroke.
The very word "stroke" indicates that no one is ever prepared for this sudden, often catastrophic event. Stroke survivors and their families can find workable solutions to most difficult situations by approaching every problem with patience, ingenuity, perseverance and creativity.

Early Recovery

There's still so much we don't know about how the brain compensates for the damage caused by stroke or brain attack. Some brain cells may be only temporarily damaged, not killed, and may resume functioning. In some cases, the brain can reorganize its own functioning. Sometimes, a region of the brain "takes over" for a region damaged by the stroke. Stroke survivors sometimes experience remarkable and unanticipated recoveries that can't be explained. General recovery guidelines show:
  • 10 percent of stroke survivors recover almost completely
  • 25 percent recover with minor impairments
  • 40 percent experience moderate to severe impairments requiring special care
  • 10 percent require care in a nursing home or other long-term care facility
  • 15 percent die shortly after the stroke

Rehabilitation

Rehabilitation actually starts in the hospital as soon as possible after the stroke. In patients who are stable, rehabilitation may begin within two days after the stroke has occurred, and should be continued as necessary after release from the hospital.
Depending on the severity of the stroke, rehabilitation options include:
  • A rehabilitation unit in the hospital
  • A subacute care unit
  • A rehabilitation hospital
  • Home therapy
  • Home with outpatient therapy
  • A long-term care facility that provides therapy and skilled nursing care
The goal in rehabilitation is to improve function so that the stroke survivor can become as independent as possible. This must be accomplished in a way that preserves dignity and motivates the survivor to relearn basic skills that the stroke may have taken away - skills like eating, dressing and walking.

Note: Talk to your doctor for resources in your local area to help in choosing a rehabilitation provider.

How to Prevent a Future Stroke


Having a stroke means greater risk for another (or, recurrent) stroke. The good news is that there are steps you can take to prevent a recurrent stroke.

Here are some statistics concerning recurrent strokes:
  • Within 5 years of a first stroke, the risk for another stroke can increase more than 40%.
  • Approximately 795,000 Americans experience a stroke each year -- about 185,000 of those strokes are recurrent strokes.
  • At least 1 in 4 (25%-35%) of the 795,000 Americans who have a stroke each year will have another stroke within their lifetime.
  • Within 5 years of a first stroke, the risk for another stroke can increase more than 40%.
  • Recurrent strokes often have a higher rate of death and disability because parts of the brain already injured by the original stroke may not be as resilient.
  • Within 5 years of a stroke, 24 percent of women and 42 percent of men will experience a recurrent stroke.
It is essential that you learn how to reduce your risk for a recurrent stroke by making lifestyle changes and managing medical conditions that could your increase stroke risk.

Tips for Managing Recurrent Stroke Risk

Eat a healthy (plant-based) diet — maintaining a diet low in chemicals, calories, saturated fats and trans fats helps manage both obesity and healthy blood glucose and cholesterol levels in the blood, which also reduces risk for stroke.

Increase physical activity 
— it reduces stroke risk. A recent study showed that people who exercise five or more times per week are less likely to have another stroke. 

Manage high blood pressure
 -- this is the most important risk factor for stroke. People who have high blood pressure have one and a half times the risk of having a stroke compared to those who consistently have optimal blood pressure reading of 120/80. Read more information about how to manage high blood pressure on this website.

Manage high cholesterol — cholesterol or plaque build-up in the arteries can block normal blood flow to the brain and cause a stroke and increase risk of heart disease. Controlling your blood glucose and insulin levels will help to lower your cholesterol levels. Avoid statin drugs at all cost (unless you have heart disease). Read more information about how to manage high cholesterol on this website.

Keep diabetes under control — people with diabetes are up to 4 times as likely to have a stroke as someone who does not have the disease. Read more about how to control your diabetes. on this website.

Manage atrial fibrillation (AF) -- this is a type of irregular heartbeat. AF increases your stroke risk 5 times, so it’s important to work with a doctor to control it. Read more about AF.

Stop smoking — it doubles risk for another stroke. 

Control alcohol use — some studies say that drinking more than 2 drinks per day may increase stroke risk by 50 percent. Other studies have indicated that one alcoholic beverage a day may lower a person’s risk for stroke, provided that there is no other medical reason for avoiding alcohol. Talk with a doctor about alcohol use and how it can best be controlled to prevent another stroke.

Remember: The most important first step to controlling risk for recurrent stroke is to change your lifestyle, especially eating healthier, being more active, and reducing the stress in your life. Also, follow a doctor’s advice. Don’t stop taking medicine unless a doctor advises it. Discuss the risk factors listed above with a doctor to determine personal risk levels. Then, learn how to control and manage those risk factors. Nobody has to have another stroke -- take steps toward a preventive lifestyle.

Please Note: There are many foods and supplements that perform the same functions of most drugs without the dangerous side effects, i.e. arginine, broccoli, cayenne pepper, celery, garlic, ginger, green tea, onions, natto, Omega-3 EFAs, CoQ10. For more details about these foods and supplements, get the Death to Diabetes book/ebook or the How to Prevent a Heart Attack/Stroke ebook.