Archive For: Health & Wellness

The Enemy Within: Autoimmune Disease is on the Rise

autoimmune-disease-1000x1000-300x300 - The Enemy Within: Autoimmune Disease is on the Rise

A condition that is thought to have tripled in prevalence over the last 50 years, impacting over 23 million people, could justifiably be seen as an epidemic, or at least, a growing health concern. Autoimmune diseases, though, are not often thought of in that way because they manifest as 80+ different illnesses that nevertheless share the same root cause: a malfunctioning
immune system that mistakenly attacks its own tissues. Virtually every human organ system can be impacted: the brain and spinal cord in multiple sclerosis, the skin in psoriasis, the joints in rheumatoid arthritis, the intestines in Crohn’s disease and ulcerative colitis, the insulin-producing cells in the pancreas in Type 1 diabetes, the thyroid in Hashimoto’s disease, among others.

Ironically, 100 years ago, Nobel Prize-winning immunologist Paul Ehrlich, MD, was openly skeptical of a concept in which the body turns on itself, calling it “horror autotoxicus” (literally, the horror of self-toxicity). That set back acceptance of autoimmunity another half century, according to today’s leading neuro-immunologists. Now we are beginning to recognize the pervasiveness of autoimmune disease and develop therapies based on new research into its complex causes.

Notably, the gut, which houses 80 percent of the immune system, has come under increased scrutiny for the role it can play in causing disease. One theory posits that a ‘leaky gut’ may allow undigested food particles, microbes and toxins to enter the blood stream, and trigger inflammation that goes on to
disrupt the proper functioning of the immune system.

There is also a growing consensus that these diseases result from complex interactions between genetic and environmental factors. Autoimmune disease is commonly clustered in families, but may affect different organs. For example, a mother may develop rheumatoid arthritis while her daughter copes with juvenile diabetes, her sister has Hashimoto’s thyroiditis, and her grandmother deals with Graves’ disease. Environment and lifestyle may contribute to the increased incidence of these diseases, including chronic stress.

For the many living with an autoimmune condition, there is hope in the form of new medications, advanced treatments and genuine breakthroughs in the precision medicine approach. Experts predict substantial advances in the next decade, fueled by more than 310 medicines and vaccines for autoimmune diseases already in clinical trials or awaiting review by the Food and Drug Administration (FDA). Options go well beyond simply relieving symptoms or replacing substances destroyed by the disease, including:

  • Therapies to suppress the immune system and preserve organ function, such as methotrexate, used to treat cancer, now also successfully used for rheumatoid arthritis and several other autoimmune diseases.
  • Real progress in biologics, which target specific enzymes and proteins. Monoclonal antibody medicines are being used to block inflammation in rheumatoid arthritis, preventing irreversible joint damage and enabling remission; to inhibit the activity of proteins implicated in Crohn’s and colitis and systemic lupus erythematosus; and are newly approved by the FDA to neutralize inflammatory processes linked to psoriasis.

Running on a parallel and complementary path are natural methods, which continue to gain traction. Areas under investigation include: reducing foods high in sugar and saturated fat, practicing de-stressing techniques, lowering the toxic burden caused by constant exposure to environmental factors and restoring intestinal health with a diet that includes prebiotic and probiotic foods.

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20,000 and You: Unlocking the Genetic Code

Unlocking-the-genetic-code-v1-300x208 - 20,000 and You: Unlocking the Genetic Code

In just the past few years, there has been a significant shift in the practical uses of genetic testing, which examines changes, or variants, in your genes that may lead to illness or disease. Once considered more of an investment in the future and less applicable to individual patient care, opportunities to guide health and lifestyle decisions in the here and now may be tantalizingly close at hand.

“Genetic testing is progressing from an occasionally deployed diagnostic tool to becoming the new founding architecture of a personal health record, and may ultimately become a vital addition to a patient’s clinical portfolio,” explains Calum MacRae, MD, geneticist, Chief of Cardiovascular Medicine at Brigham and Women’s Hospital and in private practice at Boston’s AllCare Medical, whose decades-long focus has been on how to systematically implement genomics discoveries into clinical care.

In broad strokes, three areas are identified through genetic testing: disease carrier states for genes, important to the patient’s immediate family; inherited diseases such as heart disease or cancer; and an emerging predictive utility for drug responses and risk of common diseases. This information forms the foundation of personalized medicine, targeted to a patient’s specific genetic profile. According to Dr. MacRae, a holistic approach will optimize the enormous potential of genetic testing, allowing physicians to engage all their patients to understand their own genomes and build collaborative plans for lifestyle modification, nutritional choices and medications that may prevent or delay disease.

Direct-to-consumer (DTC) testing such as 23andMe has become ever more mainstream and is predicted to grow to a $340 million industry in the next five years. In fact, earlier this year, the FDA began allowing 23andMe to provide DTC testing for increased risk of 10 conditions, including celiac disease, hereditary hemochromatosis, Parkinson’s, alpha-1 antitrypsin deficiency and late-onset Alzheimer’s disease.

However, experts cast a wary eye on DTC testing for a number of reasons. Genetic testing is highly technical and complex and it is still hard to predict who will actually develop common diseases such as diabetes, hypertension, and many cancers from genes alone. For many conditions, a negative DTC test result does not necessarily guarantee low risk because it is believed to be the interaction of complex environmental factors with genes that cause disease. That means all information must be considered in the context of a patient’s environment, lifestyle and family medical history, ideally explored during a one-to-one consultation with a primary care physician.

While there is still much to be uncovered, there is no denying the desire to incorporate personalized medicine in clinical practice is increasing. Scientists are beginning to understand the interplay of genes and environment on disease for about one third of the roughly 20,000 genes we all possess, and the portfolio of knowledge continues to grow rapidly. Even more comprehensive tests that examine numerous genes and variants in an individual’s exome (the protein-making part of the gene), known as next generationgeneration sequencing, will gradually become accessible as the costs associated with them continue to fall. Technologies that enable scientists to alter an organism’s DNA (see below) are being refined. With every advance, we may come closer to realizing the vision of Dr. J. Craig Venter, one of the primary forces behind the original Human Genome project, who said in 2015: “I’m hoping that these next 20 years will show what we did 20 years ago in sequencing the first human genome was the beginning of the health revolution that will have more positive impact in people’s lives than any other health event in history.”

Coming to Terms with Genetic Testing

  • Chromosomal microarray: looks for genetic changes in the genome, sometimes caused by an existing medical condition.
  • Genome editing: technologies that enable scientists to change an organism’s DNA by adding, removing or altering genetic materials at particular locations in the genome. Gaining favor is the newest CRISPR technology, less expensive and more accurate than other genome editing methods.
  •  Single nucleotide polymorphisms or SNPs: the most common type of genetic variation among
    people. They can act as biological markers, helping locate genes associated with disease, and may help predict an individual’s response to certain drugs, susceptibility to environmental factors such as toxins and risk of developing particular diseases.  SNPs can also be used to track inheritance of disease genes within families.
  • Genotyping panels of selected susceptibility variants: often used in DTC genetic tests, and include SNPs that have been associated with common, complex diseases such as type 2 diabetes, autoimmune disease and metabolic traits.
  • Specific single gene tests: performed as part of a focused risk evaluation for heritable disease or for diagnostic considerations e.g. BRCA1 and BRCA2 gene sequencing for carrier identification in at-risk individuals with a strong family history of breast cancer.

Source: Up to Date

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Step Up to the Plate: Nutritionists Weigh in on Healthy Eating

Picturing a healthy meal has never been more accessible, thanks to the ubiquity of visual aids such as MyPlate, successor to the well-known Food Pyramid of the ‘90s. A quick scan of the plate’s
quadrants enables users to see at a glance proportions of vegetables, proteins and other foods recommended for a nutritionally balanced day of eating. Hailed as a significant breakthrough when
it debuted in 2010, for many dietitians and health experts, MyPlate did not go far enough in revamping the American diet. For instance, Harvard’s Healthy Eating Plate limited red meats but not healthy oils, while the American Institute of Cancer Research’s New American Plate relied even more heavily on vegetables and fruits, accounting for fully two thirds of the plate. The most recent federal guidelines, just issued for 2015-2020, now emphasize shifts needed to choose nutrient-dense foods and beverages in place of less healthy options, and the interconnected relationships between each dietary component. Illustrated at right are what a healthy, and even healthier meal, can look like at your table this year.

MyPlate breaks it down:

  • A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
  • Fruits, especially whole fruits
  • Grains, at least half of which are whole grains
  • Fat-free or low-fat dairy, including milk, yogurt, cheese and/or fortified soy beverages
  • A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds and soy products
  • Oils
  • Limited saturated fats and trans fats, added sugars and sodium (less than 2,300 milligrams per day)
  • Alcohol in moderation, up to one drink per day for women and up to two drinks per day for men
  • Physical activity: Weekly, strive for 150 minutes of moderate intensity activity (brisk walking) and 75 minutes of vigorous intensity aerobic activity (swimming laps)

The American Institute of Cancer Research (AICR) offers a portion-controlled diet based on fruits, vegetables, whole grains and other plant-based foods that provide an array of cancer-protective compounds while serving as powerful weight-management tool. According to the AICR, the fiber and water in plant foods gives a feeling of satiety with a minimum of calories. Their main message: maintaining a healthy weight is one of the most important steps you can take to reduce your risk of cancer.

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Got Milk? Or Calcium Supplements? Or Neither?

Calcium, so essential to strong bones and teeth, as well as nerve transmission, muscle contraction and blood clotting, can be in short supply as we age. Exactly how much is needed of this important mineral, and Vitamin D, its companion to ensure optimal absorption, has been the subject of intense scrutiny over several decades. However, a clear cut consensus has yet to be reached from data that is by turns contradictory, reassuring or confusing. A cluster of respected studies have cast doubt on the efficacy of calcium – either in supplements or from dietary sources – in reducing the risk of osteoporosis or bone fractures. Some reports cast supplements in an even more negative light, pointing to potential side effects that range from gastrointestinal issues to increased risk of cardiovascular disease.

A quick look at research highlights, beginning with the study that arguably set the stage for use of calcium supplements in seniors, illustrates why there is still a considerable amount of debate:

  • 1992: Over 18 months, a trial of elderly French women finds the number of fractures was reduced by up to 43 percent among women treated with 1200 mg of calcium and 800 units of vitamin D daily. In subsequent years, the significant levels of vitamin D deficiency of the subjects in this study created uncertainty about applying the results to healthier adults.
  • 1994: Guidelines vary. National Institutes of Health recommends 1500 mg of calcium and 600-800 units of vitamin D per day for post-menopausal women; Institute of Medicine recommends 1200 mg of calcium and 400-600 units of vitamin D daily for those over 50.
  • 2006: Fracture risk not reduced. A report from the Women’s Health Initiative showed that 18,000 postmenopausal women who took calcium supplements and vitamin D were no less likely to break their hips than an equal number who took a placebo pill, although the density of their hip bones increased slightly.
  • 2010: Mixed results on heart issues. A report from the Women’s Health Initiative showed no significant increase in heart problems among 36,000 women who were taking calcium supplements. However a study in the British Medical Journal (BMJ) reported they were associated with an increased risk of heart attack, concluding that “a reassessment of the role of calcium supplements in the management of osteoporosis is warranted.”
  • 2012: No-supplement recommendation. The U.S. Preventive Services Task Force, a panel that advises doctors on matters of public health, stated there is not enough conclusive evidence to recommend taking calcium or vitamin D supplements to prevent fractures in healthy women.
  • 2015: The case against supplements builds. According to a meta-analysis in the BMJ, additional calcium from supplements may build up in the arteries or kidneys, causing heart disease or kidney stone formation. An accompanying editorial reads: “The weight of evidence against such mass medication of older people is now compelling.”

Confusing, to be sure. While the optimal dose has yet to be determined, today’s best guidelines call for calcium intake below 1,600 mg a day for women over 50 and men over 70, and 1,000 mg a day of calcium for those under 50, along with appropriate amounts of vitamin D to enhance absorption. However, experts agree, more is not necessarily better, and supplements should be considered only if the daily goal cannot be met through food sources. In addition, strength training, for arms and upper spine, and weight-bearing exercise such as walking or stair climbing, for legs, hips and lower spine, are essential to build and maintain bone density. Remember: every patient has different needs, and these can change over time.

 

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Aging Well, Aging Healthy…a continuing series

As almost 10,000 Baby Boomers officially become senior citizens each day, the focus on preventing and treating age-related ailments becomes distinctly more urgent. HealthWise presents an ongoing look at research that provides valuable insights to help today’s seniors – and the generations set to follow – create a vibrant next chapter. We began with strategies to keep the aging brain healthy, and continue in this issue with a look at how your senses, specifically taste and smell, are affected by the aging process. Look for the latest on safeguarding your sight and sound in future editions.

A Taste of the Future
Savoring the sweetness of a rich chocolate, breathing in the scent of a fresh burger on the grill…taste and smell trigger the delights of eating by matching odorous molecules in the air with memories stored in your brain.

Taste buds have helped humans since the beginning of time identify foods as sweet, salty, sour, bitter or savory, and provide a warning not to ingest toxic substances. Forever intertwined with smell, food molecules travel through the rear of the nasal cavity to olfactory receptors in the roof of the nose – that is why if you hold your nose and put chocolate in your mouth, you will not taste the chocolate.

An effortless process for most, recognizing tastes and odors is actually cognitively demanding, and for older people, can be extremely challenging, as these capabilities greatly diminish as we age. Although new neurons continue to form in the olfactory region of the brain into adulthood, by age 50, the sense of smell starts to deteriorate rapidly as the number of sensor cells that detect aroma decrease…by age 80, smell detection is reduced by almost 50 percent. There is also a weakening of the nerves that carry the signals to the brain, and in the olfactory bulb, which processes them. In addition, the sense of smell may be diminished by reduced production of mucous, thinning of the nose lining and hormonal changes.
At the same time, the tongue’s taste buds are on the wane, dwindling from a high of 10,000 to just 5,000 in older adults. Dry mouth, caused by a reduced flow of saliva that is commonly seen in the elderly, or from medications such as antihistamines or antidepressants, also cause a loss of taste perception.
Why this matters: The ability to detect odors from spoiled foods, gas leaks and smoke is critical to safety. Taste issues means food becomes less appealing, and unhealthy amounts of sugar or salt may be added to food to make it more palatable, or less food is eaten, potentially leading to nutrition problems.

Preserve, protect and adapt
While there may not yet be a way to completely halt the decline, experts recommend a number of strategies to sharpen your senses of smell and taste and keep them working longer and better:*
Take brisk walks daily…exercise heightens the smell sense.

  • Conduct your own sniff therapy by inhaling the scent of items such as peppermint and cinnamon first thing in the morning, sparking different receptors in the nose to work.
  • Quit smoking…tobacco smoking impairs the ability to identify odors and diminishes the sense of taste.
  • Reduce your risk of head injury by wearing protective helmets during sports and seat belts when riding in the car…trauma to the head can damage olfactory nerves.
  • Treat nasal or sinus infections promptly, a primary cause of smell problems. The same advice holds for treating nasal polyps, small, non-cancerous growths in the nose or sinuses
    that can block the ability of odors to reach olfactory sensory cells.
  • Consider a change in medications that may be affecting your sense of smell, such as anti-allergy medicines.
  • Choose foods that are naturally stronger flavored, such as mustard, pickles, radishes and peppers; add herbs and spices instead of salt. Use sun-dried tomatoes, vinegars, concentrate fruit sauces, extracts of almond, vanilla, citrus juice and peels to enhance tastes. Eat a variety of foods and textures, and change it up at every bite to keep your taste buds firing.
  • Get an annual flu shot to help you avoid respiratory and ear infections that can interfere with taste.
  • Practice good oral hygiene…take care of gum disease, inflammation or infections in the mouth, which can cause taste problems.

Finally, buy safety products, such as a gas detector that sounds an alarm you can hear.

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Salt Shake Down: Sodium Reduction is on the Table

Turkey sandwiches…soups…deli meats. Are these the building blocks of a healthy meal or stealthy contributors of excess sodium? Both, according to experts, but improved versions are in the works, thanks to June 2016 Food and Drug Administration (FDA) recommended guidelines and commitments from food manufacturers and restaurant operators to shake down the salt.

Implicated in a litany of ills from increased risk of heart disease and stroke to higher blood pressure, sodium is one of today’s major targets for elimination in the quest for a healthy diet. According to the Institute of Medicine, reducing sodium intake to 2,300 mg daily can significantly reduce blood pressure, ultimately preventing hundreds of thousands of premature illnesses and deaths. Currently, Americans consume on average, about 3,400 mg a day (a teaspoon and a half), most of it involuntarily.

“While a majority of Americans reports watching or trying to reduce added salt in their diets, the deck has been stacked against them,” the FDA stated. “The majority of sodium intake comes from processed and prepared foods, not the saltshaker.”

The guidelines set targets for reducing sodium over the next decade in the majority of processed and prepared foods, including pizza, deli meats, canned soup, snacks, breads and rolls. Already Nestle has reduced the salt in its pizzas, General Mills reduced sodium in more than 350 products, and Mars Food, Unilever and PepsiCo have pledged to follow suit.

Experts at the Harvard School of Public Health and the American Heart Association urge even further downward pressure on sodium in the diet, recommending a limit of 1,500 mg per day. Dr. Frank Sacks, the Principal Investigator in the groundbreaking Dietary Approaches to Stop Hypertension (DASH) Sodium-Trial, concurs, saying the effect of sodium intake on blood pressure is strong and causal, and called the new guidelines “a tremendous step forward to lower heart attacks and strokes in the US.”

Start shrinking the sodium in your diet with these simple, tasty strategies:

  • Plant-based foods such as carrots, spinach, apples, and peaches, are naturally salt-free.
  • Add sun-dried tomatoes, dried mushrooms, cranberries, cherries, and other dried fruits to salads and foods for bursts of flavor.
  • Enhance soups with a splash of lemon and other citrus fruits, or wine; use as a marinade for chicken and other meats.
  • Avoid onion or garlic salt; instead use fresh garlic and onion, or onion and garlic powder.
  • Try vinegars (white and red wine, rice wine, balsamic). Maximize flavor by adding at the end of cooking time.
  • For heat and spice, try dry mustard, fresh chopped hot peppers and paprika.
    On vegetables:
  • Carrots – Cinnamon, cloves, dill, ginger, marjoram, nutmeg, rosemary, sage
  • Corn – Cumin, curry powder, paprika, parsley
  • Green beans – Dill, lemon juice, marjoram, oregano, tarragon, thyme
  • Tomatoes – Basil, bay leaf, dill, onion, oregano, parsley, pepper
    On meats:
  • Fish – Curry powder, dill, dry mustard, lemon juice, lemongrass, paprika, pepper, saffron
  • Chicken – Poultry seasoning, rosemary, sage, tamarind, tarragon, thyme
  • Pork – Cilantro, garlic, onion, sage, pepper, oregano
  • Beef – Marjoram, nutmeg, paprika, sage, thyme

 

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Bring It Down: Healthy Blood Pressure Numbers May Go Even Lower

If you’ve ever wondered why a blood pressure check is part of almost every visit to a doctor’s office, consider what is communicated through the familiar black cuff in just a few seconds. The force of blood pushing against the walls of the arteries as the heart pumps is a critical measure of how well your heart muscle works – systolic blood pressure (SBP, or the top number of a reading) measures the pressure in the arteries when the heart beats; diastolic blood pressure (DBP, or the bottom number) refers to the pressure in the arteries when the heart muscle is resting between beats and refilling with blood.

Readings that exceed the norm, hypertension or high blood pressure, indicate an increased risk of heart attack, stroke and kidney failure. However, exactly what constitutes ‘normal’ blood pressure for optimal health has been debated and tested for decades, and recommendations have fluctuated over time. While the gold standard is under 120 mm Hg/80 mm Hg, the targets for treating hypertension have varied over the years – less than 140/90 in the 1990s, down to 130/80 in 2003, raised to a controversial 150 or less in 2014, and retreating to less than 140 in 2015.

At the end of 2015, a landmark study of more than 9,300 patients, the Systolic Blood Pressure Intervention Trial (SPRINT), moved the needle down even further. Those who were treated most aggressively to drive down blood pressure to 120/80 experienced a significantly lower risk of cardiovascular events, chronic kidney disease, and death. In fact, the outcomes were so convincing that the trial was actually halted after just three years, much sooner than planned, leading the American Society of Hypertension to state: “The early termination of this trial represents an exciting moment in the history of hypertension treatment.” Still, notes of caution were sounded because multiple medications were required, sometimes causing adverse side effects, and experts
agreed more study was needed to justify changes in clinical practice.  Additional evidence followed this year, with an analysis of adults aged 75 years and older who participated in the SPRINT study. The benefits of lowering blood pressure to 120 were even more pronounced, resulting in a one third reduction in risk of cardiovascular events and death, even among the frailest older patients. This finding could benefit almost six million seniors over 75 with elevated blood pressure, according to the Journal of the American College of Cardiology.

While the outcomes are promising, and point in an even more downward direction, experts have not yet reached a consensus on optimal blood pressure targets. For now, hypertension patients should consult with their doctor to determine whether this lower goal is best for their individual care.
Who’s at risk? Virtually everyone
Even those who don’t have high blood pressure by age 55 face a 90 percent chance of developing it during their lifetime, so learning how to identify, prevent and control hypertension can benefit us all.  Consider these best practices:

Identify.

  • Regular checkups are key, as people can live with high blood pressure for years without experiencing any symptoms while internal damage to other parts of the body may be silently occurring.

Prevent.

  • Keep a healthy weight: in an overweight person, every 2 pounds of weight lost can reduce SBP by 1 mm Hg.
  • Eat well: a diet rich in fruits, vegetables, and lowfat dairy products can reduce SBP by 8 to 14 mm Hg.
  • Limit sodium: (see Nutrition Corner, below)
  • Keep active: 30 minutes of aerobic activity most days of the week can reduce SBP by 4 to 9 mm Hg.
  • Moderate alcohol consumption: for women, a single drink a day may lower SBP by 2 to 4 mm Hg.
  • Quit smoking: not only does smoking raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls.

Control.

  • If lifestyle measures alone are insufficient, your physician will determine the appropriate medication, which may include diuretics, beta-blockers or ACE inhibitors.

The post Bring It Down: Healthy Blood Pressure Numbers May Go Even Lower appeared first on Specialdocs Consultants, LLC.

Bring It Down: Healthy Blood Pressure Numbers May Go Even Lower

If you’ve ever wondered why a blood pressure check is part of almost every visit to a doctor’s office, consider what is communicated through the familiar black cuff in just a few seconds. The force of blood pushing against the walls of the arteries as the heart pumps is a critical measure of how well your heart muscle works – systolic blood pressure (SBP, or the top number of a reading) measures the pressure in the arteries when the heart beats; diastolic blood pressure (DBP, or the bottom number) refers to the pressure in the arteries when the heart muscle is resting between beats and refilling with blood.

Readings that exceed the norm, hypertension or high blood pressure, indicate an increased risk of heart attack, stroke and kidney failure. However, exactly what constitutes ‘normal’ blood pressure for optimal health has been debated and tested for decades, and recommendations have fluctuated over time. While the gold standard is under 120 mm Hg/80 mm Hg, the targets for treating hypertension have varied over the years – less than 140/90 in the 1990s, down to 130/80 in 2003, raised to a controversial 150 or less in 2014, and retreating to less than 140 in 2015.

At the end of 2015, a landmark study of more than 9,300 patients, the Systolic Blood Pressure Intervention Trial (SPRINT), moved the needle down even further. Those who were treated most aggressively to drive down blood pressure to 120/80 experienced a significantly lower risk of cardiovascular events, chronic kidney disease, and death. In fact, the outcomes were so convincing that the trial was actually halted after just three years, much sooner than planned, leading the American Society of Hypertension to state: “The early termination of this trial represents an exciting moment in the history of hypertension treatment.” Still, notes of caution were sounded because multiple medications were required, sometimes causing adverse side effects, and experts
agreed more study was needed to justify changes in clinical practice.  Additional evidence followed this year, with an analysis of adults aged 75 years and older who participated in the SPRINT study. The benefits of lowering blood pressure to 120 were even more pronounced, resulting in a one third reduction in risk of cardiovascular events and death, even among the frailest older patients. This finding could benefit almost six million seniors over 75 with elevated blood pressure, according to the Journal of the American College of Cardiology.

While the outcomes are promising, and point in an even more downward direction, experts have not yet reached a consensus on optimal blood pressure targets. For now, hypertension patients should consult with their doctor to determine whether this lower goal is best for their individual care.
Who’s at risk? Virtually everyone
Even those who don’t have high blood pressure by age 55 face a 90 percent chance of developing it during their lifetime, so learning how to identify, prevent and control hypertension can benefit us all.  Consider these best practices:

Identify.

  • Regular checkups are key, as people can live with high blood pressure for years without experiencing any symptoms while internal damage to other parts of the body may be silently occurring.

Prevent.

  • Keep a healthy weight: in an overweight person, every 2 pounds of weight lost can reduce SBP by 1 mm Hg.
  • Eat well: a diet rich in fruits, vegetables, and lowfat dairy products can reduce SBP by 8 to 14 mm Hg.
  • Limit sodium: (see Nutrition Corner, below)
  • Keep active: 30 minutes of aerobic activity most days of the week can reduce SBP by 4 to 9 mm Hg.
  • Moderate alcohol consumption: for women, a single drink a day may lower SBP by 2 to 4 mm Hg.
  • Quit smoking: not only does smoking raise your blood pressure temporarily, but the chemicals in tobacco can damage the lining of your artery walls.

Control.

  • If lifestyle measures alone are insufficient, your physician will determine the appropriate medication, which may include diuretics, beta-blockers or ACE inhibitors.

The post Bring It Down: Healthy Blood Pressure Numbers May Go Even Lower appeared first on Specialdocs Consultants, LLC.

The Painful New Reality of Opioid Prescriptions

Nothing erodes the quality of life faster than pain and unfortunately more than half of American adults report they live with it on a chronic, recurring basis. That makes it easy to understand why, when seemingly safe, effective opioid drugs became widely available in the 1990s, they were quickly embraced by physicians and patients. Considered one of the most promising developments in pain management in decades, opioids such as oxycodone (OxyContin, for example), hydrocodone (Vicodin) or meperidine (Demerol) had already proved highly effective on a short-term basis to treat acute pain. The mechanisms were clear: opioid molecules travel through the bloodstream into the brain, attach to receptors on the surface of certain brain cells and trigger the release of dopamine in the brain’s reward and pleasure center.

However, what was not known was how patients reacted to these medications when taken daily for weeks, months and years to treat chronic conditions ranging from headaches and stubborn lower back pain to neuropathy, fibromyalgia and severe degenerative joint disease. As use of opioids for chronic pain (defined as lasting longer than three months) became widespread, reports of unwanted side effects emerged, along with doubts about long-term efficacy and optimal outcomes. Most alarmingly, the potential for abuse and addiction materialized into a full-blown crisis, evidenced by stark statistics like these:

  • Opioid prescriptions increased 7.3% from 2007-2012; by 2013, 1.9 million people were reported to be abusing or dependent on opioids. As many as 25% of people prescribed opioids on a long-term basis struggle with addiction.
  • 165,000 Americans died from overdosing on prescription opioids from 1999-2014, climbing from 3 deaths per 100,000 people to 9; the highest rates were seen among 25 to 54-year-old white Americans.

Clearly, sweeping changes were needed, and in response, new recommended guidelines for safer pain management were issued by the Centers for Disease Control (CDC) last spring, and received
strong endorsement from well-respected organizations including the American Academy of Pain Medicine and the American College of Physicians (ACP). According to ACP, the recommendations are “reasonable, based on the best available evidence, and find the right balance between educating about the hazards of opioids while recognizing special circumstances where such medications may be an important part of a treatment plan.” The recommendations specify best practices for dosage levels and usage, and raise awareness of the risks posed to all patients by the drugs. Please note that these are recommendations only and may be altered at the discretion of the physician treating you to fit your unique needs. These include:

  • Non-pharmacologic and non-opioid therapy are preferred for chronic pain. Opioid therapy should be used only if expected benefits for both pain and function are anticipated to outweigh risks.
  • If opioids are used, they should be combined with non-pharmacologic and non-opioid pharmacologic therapy, as appropriate.
  • Physicians should establish treatment goals with their patients before starting opioid therapy, including realistic and clinically meaningful goals for pain and function, and an ‘exit strategy’
    should the therapy need to be discontinued.
  • Use immediate-release opioids instead of extended-release/long-acting opioids.
  • Use the lowest effective dosage, and carefully reassess individual risks and benefits when increasing dosage to ≥50 morphine milligram equivalents per day.
  • Prescribe immediate-release opioids for acute pain in no greater quantity than needed for the expected duration of pain – three days or less will often be sufficient, more than seven days will
    rarely be needed.
  • A frank physician-patient discussion regarding the risks and benefits of opioids should take place before starting therapy. An evaluation of benefits and harms should be scheduled within one to four weeks of starting opioid therapy, and repeated at least every three months. If benefits do not outweigh harms of continued therapy, physicians should explore alternatives (see sidebar) with patients and work with them to gradually taper off to lower doses and ultimately discontinue use.

The post The Painful New Reality of Opioid Prescriptions appeared first on Specialdocs Consultants, LLC.

The Painful New Reality of Opioid Prescriptions

Nothing erodes the quality of life faster than pain and unfortunately more than half of American adults report they live with it on a chronic, recurring basis. That makes it easy to understand why, when seemingly safe, effective opioid drugs became widely available in the 1990s, they were quickly embraced by physicians and patients. Considered one of the most promising developments in pain management in decades, opioids such as oxycodone (OxyContin, for example), hydrocodone (Vicodin) or meperidine (Demerol) had already proved highly effective on a short-term basis to treat acute pain. The mechanisms were clear: opioid molecules travel through the bloodstream into the brain, attach to receptors on the surface of certain brain cells and trigger the release of dopamine in the brain’s reward and pleasure center.

However, what was not known was how patients reacted to these medications when taken daily for weeks, months and years to treat chronic conditions ranging from headaches and stubborn lower back pain to neuropathy, fibromyalgia and severe degenerative joint disease. As use of opioids for chronic pain (defined as lasting longer than three months) became widespread, reports of unwanted side effects emerged, along with doubts about long-term efficacy and optimal outcomes. Most alarmingly, the potential for abuse and addiction materialized into a full-blown crisis, evidenced by stark statistics like these:

  • Opioid prescriptions increased 7.3% from 2007-2012; by 2013, 1.9 million people were reported to be abusing or dependent on opioids. As many as 25% of people prescribed opioids on a long-term basis struggle with addiction.
  • 165,000 Americans died from overdosing on prescription opioids from 1999-2014, climbing from 3 deaths per 100,000 people to 9; the highest rates were seen among 25 to 54-year-old white Americans.

Clearly, sweeping changes were needed, and in response, new recommended guidelines for safer pain management were issued by the Centers for Disease Control (CDC) last spring, and received
strong endorsement from well-respected organizations including the American Academy of Pain Medicine and the American College of Physicians (ACP). According to ACP, the recommendations are “reasonable, based on the best available evidence, and find the right balance between educating about the hazards of opioids while recognizing special circumstances where such medications may be an important part of a treatment plan.” The recommendations specify best practices for dosage levels and usage, and raise awareness of the risks posed to all patients by the drugs. Please note that these are recommendations only and may be altered at the discretion of the physician treating you to fit your unique needs. These include:

  • Non-pharmacologic and non-opioid therapy are preferred for chronic pain. Opioid therapy should be used only if expected benefits for both pain and function are anticipated to outweigh risks.
  • If opioids are used, they should be combined with non-pharmacologic and non-opioid pharmacologic therapy, as appropriate.
  • Physicians should establish treatment goals with their patients before starting opioid therapy, including realistic and clinically meaningful goals for pain and function, and an ‘exit strategy’
    should the therapy need to be discontinued.
  • Use immediate-release opioids instead of extended-release/long-acting opioids.
  • Use the lowest effective dosage, and carefully reassess individual risks and benefits when increasing dosage to ≥50 morphine milligram equivalents per day.
  • Prescribe immediate-release opioids for acute pain in no greater quantity than needed for the expected duration of pain – three days or less will often be sufficient, more than seven days will
    rarely be needed.
  • A frank physician-patient discussion regarding the risks and benefits of opioids should take place before starting therapy. An evaluation of benefits and harms should be scheduled within one to four weeks of starting opioid therapy, and repeated at least every three months. If benefits do not outweigh harms of continued therapy, physicians should explore alternatives (see sidebar) with patients and work with them to gradually taper off to lower doses and ultimately discontinue use.

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