I am a 52 year old male recently diagnosed with high blood pressure. I have been told by my doctor to monitor my blood pressure but what exactly do those numbers mean?

Hypertension and Heart Disease

First of all, here are some of the basics about hypertension.  Blood pressure (BP) is simply defined as the pressure the blood exerts on the walls of the blood vessels.  Hypertension is elevated blood pressure (above 140/90). Blood pressure is normally expressed as a number over a number (___/___).  The top number is the systolic blood pressure, a measurement taken while the heart is contracting.  The diastolic blood pressure is the bottom number, taken while the heart is relaxing.  A “normal” BP is less than 120/80.  A BP that is 120-139/80-89 is considered pre-hypertension.  Stage I hypertension is a BP ranging from 140-159/90-99 and Stage II is >160 / >100.

Why is this all so important?

Hypertension (HTN) can cause damage to many body organ systems.  It can cause damage to the brain, kidneys, eyes, lungs, reproductive system and of course the cardiovascular system.  For this discussion we will focus on the heart and blood vessels.

The heart is a pump, and its job is to pump the blood out of the heart into the blood vessels.  The heart has to overcome the force (BP) in the blood vessels to pump effectively.  The higher the BP is, the greater the workload on the heart, and this can lead to damage over time.  The harder the heart muscle has to work, the bigger it gets and that can eventually lead to a condition called left ventricular hypertrophy.  HTN can cause heart attacks and cause heart failure as the heart muscle gives out.

Hypertension damages the blood vessels by causing microscopic tears and scars in the vessel walls.  The damaged blood vessels collect more fat and cholesterol, which leads to plaque formation.  Over time the plaque causes the vessels to narrow and harden, a term called atherosclerosis.  Blood clots can form in these narrowed vessels and block the blood flow to the heart or other tissues.  When blood vessels are blocked and blood is not reaching the tissues, damage can occur causing heart attack, stroke and damage to the organs.

A person may not necessarily know that they have high BP — all too often we find out when it is too late and damage has been done.  This is why sometimes HTN is referred to as the “silent killer.”  Here are some scary statistics… For every 20/10 increase in blood pressure (over 115/75), it is estimated that the risk of heart disease doubles!  According to the American Heart Association, 77% of Americans treated for a first stroke have BP over 140/90; 69% of Americans who have a first heart attack have BP over 140/90; 74% of Americans with congestive heart failure have blood pressure over 140/90.

What is the moral of the story?  Know your BP numbers – have it checked often and keep track of it.  When you are at a normal BP, do your best to maintain it!  If you are in the pre-hypertension stage, work hard to get that BP down by diet and exercise.  If you are a person with HTN, take your medications as directed, make lifestyle changes and keep in regular contact with your health care provider to stay as healthy as you can!

answer submitted by: Melissa Leguillon, APN CNP, Nurse Practitioner, Cardiovascular Services

I am a 53 years old and was told by a girlfriend that women can present differently than men when they are experiencing a heart attack. Is this true?

Typically when we think of someone having a heart attack, or a myocardial infarction (MI), we think of the person clutching their chest and collapsing in pain.  This is often how a MI is portrayed on TV and in movies, but in reality a MI can be much more subtle.  Crushing-drop-to-the-ground type of chest pain may not always be a part of a MI. 

Chest pain that is “typical” for a MI is pain that is located in the sternum (breast bone) or left side of the chest.  Pain may radiate to the left arm, the jaw, neck or back.   Stable angina (chest pain) typically begins with exertion or stress and is relieved after a few minutes of rest or nitroglycerin.  Unstable angina is unpredictable and often occurs at rest.  Unstable angina may be longer lasting and more severe than stable angina.  Pain may be described in many ways – pressure, burning, heaviness, crushing – to name a few.  No chest pain should be ignored, so if a person is experiencing chest pain, they need to call 911 or go to the nearest emergency room.

Chest pain may be accompanied by other symptoms such as palpitations (“heart racing” or fluttering sensations), shortness of breath, fatigue, nausea or vomiting, dizziness or lightheadedness, sweating or cold sweats.  Some people may not experience chest pain as part of their MI and may just experience some the symptoms listed above. Again, symptoms that are out of the norm or that may signal a MI should not be ignored… seek emergency care.

A person may be fortunate enough to experience warning signs of a heart attack that are more subtle and gradual.  It may begin as a tired feeling or a sense of discomfort.  People may experience discomfort in the chest, arms, back, jaw or other areas of the upper body.  Fatigue or an inability to keep up with normal activities may also give a hint that there may be trouble.  A person who is experiencing these symptoms should seek the advice of a health care professional.

What about women?  What are the signs and symptoms of a heart attack for women? 

According to the American Heart Association, chest pain is still the most common symptom of a MI in a woman.  However, women are more likely to experience other symptoms as well, such as shortness of breath, nausea or vomiting and jaw or back pain.  Women may mistakenly think that they cannot have a heart attack…  “It is a man’s disease” or “I am too young to have a heart attack” or “I am sure these symptoms are caused by something else”.  Women who are going through hormonal changes may grow accustomed to abnormal sensations and discomfort.  Women are often accustomed to taking care of others and not themselves.  Although a woman may not believe they are at risk for heart disease or heart attack, heart disease is still the number one killer of women.  So, if a woman is experiencing chest pain or other symptoms that may be warning signs of a heart attack, she should seek emergency medical care. 

Answer submitted by Melissa Leguillon, APN, CNP, Nurse practitioner, Cardiovascular Services at Provena Mercy Medical Center.

I have two daughters in their early 20s who visit the tanning beds quite often and it makes me uneasy. How dangerous are tanning beds? Are they worse than smoking?

The World Health Organization and numerous other health care agencies (both government and private) have established that tanning beds are detrimental to health.

The UVA & UVB radiations emitted by the beds are carcinogenic for the skin. They can damage the DNA of skin cells leading to skin cancer. The rays also accelerate skin aging due to loss of elasticity and can cause eye damage.  The rays have a cumulative effect over the years; the longer the exposure,  the greater are the risks of development of skin malignancies, especially in a person under 30.  Certain connective tissue diseases like Lupus, can exacerbate after use of tanning in beds or sun bathing.

However, comparing the use of tanning beds to smoking is like comparing apples to oranges. Both are carcinogenic,  but affect different body systems which cause cancer by different mechanisms.

Answer submitted by Dr. Nidhi Tiwari who specializes in Internal Medicine and is with Provena Medical Group and is a member of the Provena Mercy Medical Center Medical Staff.

It Has Been Said that the Princess-To-Be is Following the “Dukan Diet.” What Exactly is the Dukan Diet?

The Dukan Diet was developed by French nutritionist and medical doctor Pierre Dukan over ten years ago and has gained incredible popularity since its creation. The media reports that millions of French women follow this diet to maintain their figures, as well as celebrities and models. Until recently the diet has only been available inFrance but the English version of The Dukan Diet officially became available in 2010. The U.S.version recently became available just this month of April 2011.

The Dukan Diet is similar to the popular Atkins diet in that it is based around eating high-protein foods while severely limiting all carbohydrates including fruits, starchy vegetables, legumes and whole grains. Unlike the Atkins diet, the emphasis is on sources of protein that are low in fat such as fish, poultry and reduced-fat dairy products. The Dukan diet includes four phases: the Attack phase, the Cruise phase, the Consolidation phase, and finally the Stabilization phase.

The Attack phase is followed for one to ten days and dieters are told they can expect to lose between seven and ten pounds within the first five days. During this phase dieters consume only protein foods that may be seasoned with condiments that do not contain fat or carbohydrates Dieters are warned that they may experience bad breath and a dry mouth during this phase, which may be alleviated to some degree by drinking more water.

In the Cruise phase of the Dukan Diet, days of protein only are alternated with days of protein and vegetables. The types of vegetables allowed in this phase are limited to those that do not contain starch such as lettuce, spinach, celery, cucumber, asparagus and tomato. Vegetables can be consumed raw, steamed, or in soups and stews.

The Consolidation phase is the maintenance phase and commences once you have achieved your goal weight. You will continue to base your diet on protein and vegetables but are also allowed one portion of fruit as well as two slices of whole-grain bread each day. In addition you are permitted one extra serving of a carbohydrate food per week, which may include foods like pasta or rice. In this phase of the Dukan Diet you are also allowed one ‘celebration meal’ each week, which is increased to twice a week after you have been in phase three for a while.

The final Stabilization phase is the ongoing lifestyle phase of the Dukan Diet. In this phase you are instructed to go back to eating whatever you like while continuing to use the rules of the Consolidation Phase as a guideline. One day of the week dieters are instructed to eat only protein.

Just like any other diet, there are pros and cons to the Dukan Diet. Some pros include fast results in the first phase which can boost motivation, no calorie counting required, the diet includes vegetarian options, a meal plan, and recipes, and the “celebration meals” in the final phases of the diet can help psychologically to improve adherence to diet.

Some cons of the Dukan diet include that it is highly restrictive and requires elimination of healthy foods including fruit, grains, legumes, and nuts. Some dieters may experience mood swings and fatigue. Dieters may also experience constipation, headaches, and bad breath on high protein diets, and the diet is not suitable for people with a history of gout, kidney disease, high cholesterol, or eating disorders. Furthermore, dietary boredom is highly likely due to the limited food choices, especially for those who don’t enjoy eating animal products, and the diet also encourages consumption of artificial sweeteners and diet soda.

In conclusion, the Dukan Diet is an extreme approach that emphasizes low-fat protein. While dieters can expect to lose weight following this plan, it is highly likely that weight will be regained upon a return to normal eating habits. The best way to approach weight loss is to eat a variety of healthy foods which include fruits, vegetables, whole grain breads and cereals, healthy fats and low fat protein foods, and to maintain good portion control. Exercise is also important as well for overall health and wellness and can accelerate weight loss. Restriction of certain foods or food groups is not recommended due to the high possibility of feeling deprived and overeating or bingeing on that type of food and regaining any weight lost.

Answer submitted by Mia Handell, registered and licensed dietitian at Provena Mercy Medical Center.

Who has the greatest risk for developing Diabetes?

Certain ethnic groups are more at risk for developing diabetes.  African Americans are one of these groups.  Being overweight is another significant risk factor for developing type 2 diabetes. 

Who is at greater risk for developing Type 2 diabetes?  

• People with impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)
• People over age 45
• People with a family history of diabetes
• People who are overweight
• People who do not exercise regularly
• People with low HDL cholesterol or high triglycerides, high blood pressure
• Certain racial and ethnic groups (e.g., Non-Hispanic Blacks, Hispanic/Latino Americans, Asian Americans and Pacific Islanders, and American Indians and Alaska Natives)
• Women who had gestational diabetes, or who have had a baby weighing 9 pounds or more at birth

 Visit stopdiabetes.com to take the FREE Diabetes Risk Test.

If you believe you are risk, you may want to schedule an appointment with a physician for a physical exam.  Part of that exam would most likely include a blood test to check if you have diabetes.

Answer submitted by Rita Smith, RN, MSN, CDE, Certified Diabetes Educator at the Provena Mercy Medical Center for Diabetic Wellness.

I have seen so many products advertised as “gluten free” What does this mean? Is it healthier? Should I be purchasing these products?

Gluten is a protein found in wheat, rye, and barley and can be found in a large variety of foods that we eat.  Gluten-free nutrition therapy is only indicated for individuals who suffer from gluten intolerance or have a condition called celiac disease. Celiac disease is an autoimmune ailment in which a person is unable to metabolize gluten and causes symptoms including diarrhea, weight loss, abdominal distention, and electrolyte depletion.

Today, many people who have not been diagnosed with celiac disease and experience no symptoms have given up gluten in an attempt to lose weight. A gluten free diet eliminates any food containing wheat, barley or rye. Bread, pizza, pasta, most cereals, cookies and cakes made with traditional white or whole wheat flour all contain gluten, so therefore are not allowed on a gluten-free diet.  Gluten is also present in not so obvious products as well including many soups, pasta sauces, salad dressings, packaged meals and frozen dinners which contain gluten in the form of soy sauce, barley malt or modified food starch. A strict gluten free diet requires you to study food labels to avoid gluten-containing ingredients.

 The demand for gluten free products is very high and there are more products on the market today that are “gluten-free.” Gluten-free products were not readily available in the past. The little amount of gluten-free foods that were available in the past did not taste very good. Going gluten free is easier than ever nowadays because of improvements in labeling and greater awareness. Stores such as Whole Foods even have specific shopping guides for gluten free shoppers.

 A gluten-free diet that eliminates refined flour and simple sugars (such as those found in packaged cookies and snacks) will improve health and help with weight loss. Many people report feeling better and more energized after giving up gluten. For these reasons, people who do not have gluten intolerance may follow a gluten-free diet to aid in weight loss. However those who follow a gluten-free diet for weight loss still need to be careful because gluten-free products may still contain a significant amount of calories. In fact, some gluten-free products have more calories than their gluten-containing counterparts because of added sugars and the presence of white rice flour and potato starch. Gluten-free on a label does not mean that a product is low calorie or healthful.

In conclusion, if your doctor prescribes you a gluten-free diet, you must follow it. If you follow a gluten-free diet for weight loss, it is important to still follow sound nutritional practices which means including a variety of fruits and vegetables, lean meats and proteins, and limiting refined sugars and fatty/fried foods.

Answer submitted by Mia Handell, registered and licensed dietitian at Provena Mercy Medical Center.

Is there anything I can do to improve my posture and what are the long term consequences to having bad posture?

The long term consequences of poor posture can be neck or back pain, a stooped appearance, rounded shoulders with forward head, and in some cases balance difficulties when walking.  We have all seen those people who are slumped over as they walk.  

Good posture gives us a more pleasant appearance.  Our clothing will fit better and it can be easier to breath since the lungs have more room to expand.

The best thing you can do to improve your posture is to be aware of it.   It takes conscious thought to maintain proper posture, but there are a few things that can help.

•  Each time you pass a surface where you can see your reflection, look and think about how you are moving.
• As you are sitting in a chair or at the computer, sit upright, use the back of the chair. 
• A couple of simple exercises may help:  squeezing your shoulder blades together 10 times-3 sessions per day or rolling your shoulders backwards (not forwards) 10 times-3 sessions per day.
• Lastly, keep your chin tucked in. Take a deep breath and relax your shoulders. 

If you do these simple things, you will be able to maintain good posture.

Answer submitted by Jill Luminais PT CEASII, a Senior Physical Therapist and a Certified Ergonomic Specialist at Provena Mercy Medical Center.

I lost my job 10 months ago and now have no routine and find it hard to stay motivated. What can I do to keep my spirits up?

Unfortunately, with this economy you are not alone.  Losing your job can be a shock to your system.  When you lose your job, you will experience a series of losses.  The loss of income can be devastating.   You may feel the loss of social contact and miss the work friendships you have made.  It is very common to lose self-esteem when you lose your position and are unemployed.

 One of the first things you should do is take a realistic look at your finances.  See where you can cut back.  Cancel services that you do not need such as expensive cable tv and movie stations.  Check out low cost or no cost social activities at your local park district and library.  It is important to stay socially connected so you don’t feel isolated.  Often people feel a greater sense of self worth when they volunteer in their community.

 It is important to establish a new routine.  Don’t sleep in and don’t watch tv all day long.  Wake up in the morning, get dressed and approach your job search as if it was your new full-time job.  Keep regular hours and set clear goals for yourself such as callling a set number of contacts who may help with finding a new position.  Set time in your day to exercise.  You do have the time now to take a walk regularly and you’ll want to be in great shape when you arrive at your new job. 

 Remember to talk to family and friends.  It can be helpful to let others know how you are feeling.  Your family and friends can help support you emotionally (and perhaps financially) in this difficult time and they may have some excellent ideas and contacts to help you find a new position. 

 If you find yourself losing hope, feeling depressed, unable to sleep, drinking too much or having suicidal thoughts do not hesitate to seek help immediately.  Provena Mercy’s Behavioral Health Services offers free mental health assessments.  Call 1-630-801-2657 to schedule a confidential asssessment.

Answer submitted by Carol Doyle, Director of Business Development & Licensed Clinical Social Worker from  Provena Mercy Medical Center Behavioral Health Services.

Sugar Vs. Artificial Sweeteners- What Do I Need to Know?

Sweets are everywhere and they seem to grow exponentially during the holiday season. With so many extra temptations, it is especially nice to get through the holidays without any weight gain.  One common tactic is to avoid sugar, replacing it with artificial sweeteners.    But, how does this affect our health?    

Many people try to avoid sugar in their diet without understanding the effects of sugar.    People tend to choose to eat fat-free or sugar-free foods because they think they are “safe.”  However, if they overeat these so-called “safe” foods, they will still end up gaining weight because weight gain is caused by eating too many calories. People try to avoid sugar for several reasons including prevention of cavities, and the belief that all simple carbohydrates are “bad.”  All carbohydrates are technically sugar. Before your body will use the carbohydrates in table sugar, a baked potato, or an apple, it must break this carbohydrate down into glucose which is the form of sugar that your body can burn for energy.

For the average person, there’s nothing wrong with sugar per se, unless all the sweet foods in your daily diet are keeping you from eating and drinking the nutritious foods you need. But for people who are trying to lose weight, or have to watch their blood sugar because of diabetes, too much sugar can be a problem. That’s where artificial sweeteners can come in handy. According to the International Food Information Council, these low-calorie sweeteners are safe to use, provide sweetness without calories, and provide a choice of sweet foods.

The FDA has approved five artificial sweeteners which are: acesulfame potassium (Sunett), aspartame (NutraSweet or Equal), sucralose (Splenda), D-Tagatose (Sugaree), and saccharin (Sweet ‘N Low).   A lot of research has been done on these sweeteners to determine their safety. There has been criticism regarding saccharin because of research done in the 1970s that said that the use of these sweeteners can cause cancer in rats, however, further extensive research has been done since and it has been proven that several things that happen in animals cannot happen in humans, and saccharin has been deemed safe to use.

Aspartame is another sweetener that has had criticism. Some blame aspartame for causing brain tumors and chronic fatigue syndrome which is not true. The only people for whom aspartame is a medical problem are those with the genetic condition known as phenylkenoturia (PKU), a disorder of amino acid metabolism. Those with PKU need to keep the levels of phenylalanine in the blood low to prevent mental retardation as well as neurological, behavioral, and dermatological problems. Since phenylalanine is one of the two amino acids in aspartame, people who suffer from PKU are advised not to use it. Some people can be sensitive to sweeteners and experience symptoms such as headaches and upset stomach, but otherwise, there is no credible information that aspartame — or any other artificial sweetener — causes brain tumors, or any other illness.

Another sweetener that has become very popular is Stevia, however it is not yet FDA approved so it cannot be sold as an artificial sweetener. Stevia can be, and is, only sold as a dietary supplement. More research needs to be done on Stevia so it is recommended to be cautious when considering the use of it.

Sugar alcohol is different than regular sugar. You may see an ingredient list have words such as sorbitol, xylitol, isomalt, or mannitol. These are different types of sugar alcohols. They are a form of artificial sweetener, however each of these sweeteners occurs naturally in various plants. Some sugar alcohols can be just as sweet as sugar. The main appeal of sugar alcohols is that they have fewer calories than the more common sugars such as sucrose and fructose. They can also serve as texturizers which can lend the same kind of moistness and chewiness they would have if sugar were uses. They also decrease the incidence of cavities! You may have seen some chewing gums like “Trident” advertising that chewing their gum decreases tooth decay. This is because of the xylitol (sugar alcohol) that is in the gum. The reason sugar alcohols are lower in calories is that our bodies cannot digest them as quickly or as completely as sugars. If sugar alcohols are consumed in moderation they have little or no effect on blood sugar levels, which makes them appealing to people are trying to lower their sugar intake. But the one downside of the sugar alcohols, is that the lack of digestibility of them can have a laxative effect, which can cause side effects such as gas and in severe cases causing diarrhea.

 Since sweeteners are so much sweeter than sugar, a very small amount is needed to achieve the same sweetness one gets from sugar. If used normally, the amounts you take in are so minuscule as to be of no concern at all. The main purpose of artificial sweeteners is to help people reduce caloric intake and/or control diabetes. If you don’t need to watch your calories or your blood sugar, there is no real reason to use the sweeteners unless you just happen to like the taste. But if you need to control your sugar and caloric intake, artificial sweeteners are a safe, effective way to do that.

Answer submitted by Mia Handell, registered and licensed dietitian at Provena Mercy Medical Center.

I try to incorporate a lot of protein in my diet and I love to eat protein bars as a quick, filling and healthy snack. Are protein bars really a healthy snack? What is the key to finding the best protein bars?

The typical American diet provides adequate protein, and in most instances more than the recommended daily allowance (RDA) of protein. The RDA represents the minimum amount of protein needed to fulfill the protein needs of the average healthy adult. This value is equal to 0.8 grams of protein per kilogram of bodyweight. You don’t hear a whole lot about protein deficiency in the United States as most Americans consume plenty of meat and dairy which are high protein foods.  There are several instances when protein needs are higher, for example, in growing children, pregnant and lactating women, the elderly, and anyone undergoing severe stress (trauma, hospitalization, surgery), disease or disability.

In today’s on-the-run society, where sitting down for a meal may seem impossible at times, the emergence of nutrition or protein bars may seem to be a viable substitution.  Although these meal or snack bars used to be mainly consumed by serious athletes, now anyone who feels the need for an energy boost may keep a few with them at home, at work, or in their cars. As anyone can tell when shopping at the grocery store, there are now several different brands of nutrition bars, however, not all bars are created equal. These energy bars are certainly great for people who are constantly on the go, and they are a convenient alternative for someone who would otherwise grab a donut or a fast food hamburger. Especially if you are physically active, you wouldn’t put a turkey sandwich in your pocket if you were on a long bike ride, but you could easily bring an energy bar along.  Though most of the bars are fine, some can be high in fat and sugar. Some may have as much fat and sugar as a candy bar, so it is best to use them in moderation. Though nutrition bars are handy, don’t let them replace whole foods in your diet. It may be better to eat an apple or a handful of nuts as a quick snack.

When shopping for a nutrition bar, a number of factors may influence your selection including taste, calories, fat grams, etc. For example, look for a bar that is less than 5 grams of fat. When evaluating fiber content of the energy bars, aim for 3 to 5 grams of fiber. You want to watch for calories particularly if you are watching your weight. Some meal bars contain 150-200 calories, while others contain 300-400 calories. If you are looking for a meal replacement bar, choose one that has 15 or more grams of protein, along with some fiber, and fortified with vitamins and minerals. It would be best to consume some real food with the bars such as a piece of fruit or a small salad.

Some healthy ways to incorporate more protein in your diet include:

• Spread peanut butter on your bagel or toast in the morning instead of regular butter or margarine.
• Prepare scrambled eggs using only the egg whites to eliminate the extra saturated fat and cholesterol that comes with the egg yolk.
• Top your salad with grilled chicken breast, beans, and low-fat cheese.
• Try a handful of nuts for a healthy snack

Answer submitted by Mia Handell, registered and licensed dietitian at Provena Mercy Medical Center.