Ultimate Guide to Family Health

By Linda Friedland

The Ultimate Guide to Family Health is a comprehensive, easy-to-use medical guide for South Africans: how to prevent illness, major health threats and what to do about them, common medical conditions, symptoms and treatment options, children's health and childhood illnesses, men's health problems, women's health problems, first aid and trauma. Make sure that you have reliable information at your fingertips to ensure optimal health for your family.

• Language: English
• Publisher: Tafelberg
• Release date: May 20, 2015
• ISBN: 9780798159074

Linda Friedland

Linda Friedland is a medical doctor, sought-after author, media personality and internationally recognised speaker. She is married and is the mother of five children.

Book preview

Ultimate Guide to

Family Health

Dr Linda Friedman

Human & Rousseau

The layout in this digital edition of Ultimate Guide to Family Health may differ from that of the printed version, depending on the settings on your reader. The layout displays optimally if you use the default setting on your reader. Readers can experiment with the settings to have the text displayed differently.

This family health guide is dedicated to my family with blessings for ‘ultimate health.’ To my husband, Peter, my children, Gavi, Lee, Leora, Yael, Aaron and Benjamin, and my parents, Boomie and Julie Abramowitz, and Selma Friedland.

"He who has health, has hope.

And he who has hope, has everything."

African proverb

PART 1

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MAJOR HEALTH THREATS

•Cardiovascular disease

An overview of heart disease

Hypertension (high blood pressure)

Stroke

•Diabetes

•Cancer(see Parts 2, 3, 4, 5 and 6)

•HIV and Aids

•Depression and anxiety

Although certain illnesses are beyond your control, over 70% of the factors that determine whether you will become ill are within your power to manage. Your lifestyle choices have a profound effect on the development of most of the major health threats that you face. Heart disease is the number one killer of men and women throughout the developed world. The good news is that most of the risk factors − abdominal obesity, high blood sugar, high cholesterol, high blood fats, high blood pressure, smoking and excessive stress − are indeed preventable. Early diagnosis is key. There are 250 million diabetes sufferers worldwide, as many as 50% of whom are unaware that they are diabetic. Clinical depression is fast becoming one of the world’s major epidemics and a global health crisis affecting over 150 million people worldwide. Cancer is always a major concern. A high level of awareness is important, as are recent innovations in medical technology, which have led to earlier diagnosis and better treatment. The HIV pandemic is a concern worldwide, but is of particular importance in southern Africa, where it is a health issue of critical proportions.

CARDIOVASCULAR DISEASE

Cardiovascular disease (CVD) is the term used for heart conditions, stroke and blood vessel diseases.

The same factors that place you at risk for obstruction of heart vessels (and therefore for heart attacks) affect the arteries throughout your body. Obstruction of vessels in the lower limbs will result in peripheral vascular disease and those in the neck and brain vessels in cerebrovascular disease, which can manifest as strokes.

Cardiovascular diseases are classified as chronic diseases of lifestyle. This means they arise predominantly as a result of bad lifestyle choices, such as an unhealthy diet, smoking and lack of exercise. There is certainly a familial and genetic component, but by far the most important factors are the choices you make.

AN OVERVIEW OF HEART DISEASE

According to the World Health Organization, cardiovascular disease is the leading cause of death in developed countries and is increasing dramatically in emerging economies too.

In South Africa there is one death every 16 minutes from heart disease, and one in four women over the age of 60 and one in three men suffer from coronary heart disease, according to the Heart and Stroke Foundation of South Africa.

As far as examples of developed nations are concerned, it is the leading cause of death in Australia and kills one Australian nearly every ten minutes.

Approximately 80 million Americans (i.e. one in three adults) have one or more types of cardiovascular disease (Framingham heart study [FHS], Bethesda, Maryland, 2007).

Heart disease quiz

Do this simple quiz to test your knowledge.

1.Atherosclerosis is:

a.Hardening of the arteries.

b.Another name for a heart attack.

c.A type of cholesterol.

d.A diagnostic test.

2.Angina is:

a.Not the same thing as a heart attack.

b.The same thing as a heart attack.

c.An especially severe heart attack.

3.Women:

a.Are less likely to survive a heart attack than men.

b.Are more likely to have a heart attack than men.

c.Seldom have heart attacks.

4.People who smoke:

a.Are two to six times more likely to have a heart attack than non-smokers.

b.Are not at a higher risk of a heart attack if they smoke filter-tipped cigarettes.

c.Have a slightly higher risk of having a heart attack than non-smokers.

Results: If you answered a to all four questions, you already know some important things about heart disease, but do read on!

EXPLANATIONS AND DEFINITIONS

Cardiovascular disease

CVD refers to any disease of the heart and blood vessels. The most common are diseases of the heart muscle, heart attacks, strokes, heart failure and heart disease caused by high blood pressure.

Heart attack

A heart attack is also known as a myocardial infarction (MI). When the arteries of the heart become too narrow from (atherosclerotic) deposits or if a clot forms, blood flow to the heart muscle is restricted. The heart muscle is left without oxygen, causing death of a section of the muscle. This leaves the heart unable to pump sufficient blood to the rest of the body. A heart attack is characterised by sudden severe chest pain that may spread into the neck, jaw and down the arms. It may also be accompanied by sweating, nausea, shortness of breath and dizziness.

Heart failure

Heart failure is caused by the inability of the heart to pump blood efficiently around the body. This occurs because of damage to the heart muscle as a result of various diseases. The circulation becomes slow, causing excess fluid to be retained in the body. The fluid may accumulate in the lungs in the case of left heart failure (LHF) and in the lower limbs in right heart failure (RHF)

Stroke

A stroke, also known as a cerebrovascular accident (CVA), occurs when the blood flow to the brain is interrupted. This may happen when a blood vessel to the brain becomes blocked by a blood clot or ruptures, causing bleeding. The affected brain cells then start to die because of a lack of oxygen and nutrients. The manifestations of a stroke vary according to its severity. It may be very mild, causing mild weakness in a limb, or much more severe, causing paralysis and, in extremely severe cases, coma and death.

Coronary artery disease (CAD) and ischaemic heart disease (IHD)

The arteries that supply blood to the heart muscle are the coronary arteries. CAD occurs when these arteries become hardened and narrowed because of a build-up of fatty deposits (atheroma) in the cells lining the vessel wall. This build-up is known as atherosclerosis. These fatty deposits build up gradually, narrowing the insides of the coronary arteries and allowing less blood to flow through them. Eventually, blood flow to the heart muscle is reduced. This results in oxygen deprivation for the heart muscle, which leads to ischaemic heart disease and damage to the heart muscle.

How coronary artery disease occurs

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Angina

Angina is the term used for pain in the left side of the chest, which occurs on exertion, such as walking up stairs, when the coronary vessels are partially blocked and too little oxygen reaches the heart. It is experienced as chest pain or discomfort that feels like a pressing or crushing pain in the chest, which sometimes spreads into the jaw, neck, shoulders or arms – or even through to the back. Angina is usually aggravated by exercise and even by emotional turmoil and is caused when insufficient blood reaches the heart muscle. Angina reveals that atherosclerosis (plaque build-up) is present in the coronary vessels. The term is also used when symptoms suggest a heart attack, but hospital tests do not support the diagnosis – that is, no muscle damage is revealed on the electrocardiogram (ECG), or blood-enzyme tests are negative.

If it is the first time you have experienced this type of pain, the doctor will perform an ECG and possibly also a stress ECG to confirm the diagnosis. A stress/exercise ECG requires you to walk on a treadmill while the doctor checks for changes in the ECG pattern. If you are diagnosed with angina, it is important to be closely monitored by your doctor and to begin taking the correct medication.

Atherosclerosis

Atherosclerosis, the hardening and narrowing of the arteries, is caused by the slow build-up of plaque on the inside of artery walls. Atherosclerosis is a slow, progressive disease that may start in childhood, and can eventually impede the blood flow through the arteries of the brain, heart, kidneys, and the arms and legs. In the worst-case scenario the blood flow to these organs can be blocked off.

Cardiomyopathy

Cardiomyopathy refers to diseases of the heart muscle. With cardiomyopathy, the heart muscle becomes enlarged or abnormally thick or rigid, resulting in the inability of the heart to function as an effective pump for blood to the body.

WHO IS AT RISK FOR DEVELOPING HEART DISEASE?

It is a mistake to think that heart disease is a predominantly male concern. Heart disease is the number-one killer of both men and women in most parts of the world. Ten times more women die from heart attacks than from breast cancer every year. However, women are generally protected from heart attacks before the age of 50 (or menopause) by the female hormone oestrogen, which decreases rapidly at the menopause. See more under Risk factors for heart disease.

Coronary artery disease does not just suddenly happen when you reach a certain age. Unhealthy lifestyle habits, such as smoking, obesity, inactivity and bad nutrition, and possibly your mindset and emotions, help lay down the fatty deposits in your arteries throughout your life.

These changes can already be found in children as young as eight. The poor lifestyle habits begin to damage vessels from childhood, so it is important to be watchful of your children’s lifestyle factors too.

WHAT HAPPENS DURING A HEART ATTACK?

A myocardial infarction, commonly called a heart attack or a coronary, means that one or more of the vessels have become blocked enough to completely cut off blood (and oxygen) supply to the heart muscle. A portion of the heart muscle dies in the process. If enough of the heart muscle dies, sudden collapse and death will occur.

During a heart attack, heart muscle cells die and burst open, releasing certain proteins and enzymes into the bloodstream. Blood tests can measure the amount of these enzymes in the bloodstream. Higher than normal levels are evidence of a heart attack.

With a little knowledge about your heart and what is good and bad for it, you can significantly reduce your risk of heart disease.

Risk factors for heart disease:

•Smoking

•High blood pressure

•High cholesterol and lipids (fats)

•Obesity

•Physical inactivity

•Family history

•Diabetes

•Stress

Each factor is a risk on its own, but the more risk factors you have, the greater your risk. If you smoke, have high blood pressure and high cholesterol your risk of experiencing a heart attack is five times higher than that of someone without these factors. It is vital that screening be done for all the risk factors because a number are so-called silent killers – there are no symptoms and, therefore, no warning signs.

SMOKING

People who smoke are two to six times more likely to suffer a heart attack than non-smokers and the risk increases with the number of cigarettes smoked per day.

HIGH BLOOD PRESSURE

Even slightly raised blood pressure can double your risk of coronary heart disease. High blood pressure also increases your chance of stroke, congestive heart failure and kidney disease. Make sure you treat your high blood pressure with the correct medication and make the necessary lifestyle changes.

CHOLESTEROL

More than half of people over 55 years need to lower their blood cholesterol.

OBESITY AND OVERWEIGHT

Overweight individuals are much more likely to develop heart-related disease, even if they have no other risk factors. The more overweight you are, the higher your risk of heart disease.

PHYSICAL INACTIVITY

Sedentary individuals are at greater risk of developing cardiovascular illnesses. Dynamic movement and moderate exercise are essential components of a healthy heart and vessels.

FAMILY HISTORY AND GENES

A family genetic history of heart disease is indeed a risk factor, but holds equal weight with the risk factors you can control, such as smoking, diabetes, weight, activity levels, blood pressure and cholesterol.

DIABETES

Diabetes is a serious disorder that raises the risk of coronary heart disease. After the age of 45, twice as many women as men develop diabetes. The risk of death from heart disease is about three times higher in individuals with diabetes. While there is no cure, there are important steps you can take to improve your condition, including physical activity and weight loss. Read more about diabetes.

STRESS, PERSONALITY AND EMOTIONS

There is an abundance of clinical research demonstrating a link between these factors and heart disease. Stress is certainly an exacerbating factor in the development of heart disease. A strong link between a hostile, hurried personality and cardiac disease has been demonstrated. A tendency to bottle up emotions and build up resentment and anger is seen frequently in sufferers of heart disease. Expressing emotions healthily and giving and receiving love have been shown to be important in the prevention and healing of heart disease. However, these factors must not be taken in isolation, but as part of all the factors involved.

WOMEN

A woman’s risk of a heart attack is minimal until she reaches menopause, when it becomes equal to that of a man. You need to take special care of your heart throughout your life, but especially once you reach menopause. Prior to menopause, women are mostly protected from heart disease by the hormone oestrogen. Oestrogen helps keep a woman’s arteries free of atherosclerotic plaque (fatty substances, cholesterol and cellular waste build-up). Hormone replacement therapy (HRT) used to be thought to have a protective effect, but this was refuted by the initial findings of the Women’s Health Initiative (WHI) and the Million Women Study. This research was originally performed among older postmenopausal women with a mean age of 60. Very new research on young postmenopausal or post-hysterectomy women has demonstrated that oestrogen in HRT seems to reduce the formation of atherosclerotic plaques and calcification of arteries, and, therefore, shows a protective effect on slightly younger women, but it is still not conclusive.

However, women are more likely than men to die from a first heart attack and are more likely to have a second one. The reason for this is that women are not as alert to the symptoms of heart disease and do not respond and call for help as quickly as men. Do not ignore chest pain, shortness of breath, or palpitations. Women experiencing angina or a heart attack often present with a slightly different type of chest pain.

Ischaemic heart pain in men

In men, the pain is typically a heavy, pressing pain experienced on the left side and may radiate into the jaw, shoulder, arm and back.

Ischaemic heart pain in women

Women often experience the pain of a heart attack as a burning sensation, and dismiss it as indigestion.

WHAT CAN YOU DO TO PREVENT HEART DISEASE?

If you have any risk factors for heart disease, be sure to manage them actively. If you have a family history of heart disease, make sure you are extra careful about your diet, weight and exercise and that you do not smoke or consume excessive alcohol. Have baseline screening done of your blood pressure, glucose and cholesterol. If there are any abnormalities, be certain that you are taking all possible steps to normalise levels.

What can you do right now?

•Eat a healthy diet.

•Stop smoking.

•Reduce your cholesterol level.

•Reduce high blood pressure.

•Lose weight to get your BMI (body mass index) within the normal range and reduce your body fat percentage.

ARE THERE PREVENTIVE MEDICATIONS?

If you are at a high risk, there are simple preventive medications that you could take, but please do discuss these with your doctor first.

Aspirin

Ask your doctor about taking a daily mini-aspirin, such as Ecotrin. This has a protective effect by thinning the blood and preventing clotting. The dosage is about 80 micrograms, or half to a quarter of a normal aspirin dosage. You cannot take this if you have any evidence of duodenal or gastric inflammation or ulcers. Keep in mind that aspirin is indeed a drug with side effects, and never start taking it without first consulting your doctor.

Antioxidants

Researchers at the Cleveland Clinic in the US conducted a very large meta-analysis study, an overview of the best designed, largest studies of antioxidants. Their findings were recently published in the prestigious journal The Lancet.

They analysed results of studies that used mainly vitamin E and betacarotene. Researchers looked for the effect of antioxidant vitamins on death rates, either from cardiovascular disease or from any other cause. Vitamin E did not provide any benefit in lowering mortality compared with control treatments, and it did not significantly reduce the risk of cardiovascular death or stroke. Although supplements did not prove beneficial in avoiding heart problems, foods that are sources of antioxidants are still recommended by the American Heart Association. What is quite clear is that antioxidants in their natural state demonstrate benefits. Lycopene present in bright-red tomatoes, capsaicin in peppers, sulphoraphane in broccoli, flavonoids in berries, as well as procyanidins and resveratrol in grapes and red wine, all have a profound effect on mopping up free radicals and boosting immunity, and have a protective effect on your body and heart.

Folic acid

This is a supplement which was thought to reduce some of the risk factors associated with heart disease. However, the American Heart Association’s latest research reveals that folic acid has little, if any, effect on preventing heart disease.

IF YOU ALREADY HAVE HEART DISEASE

If you have existing coronary artery disease you need to be carefully monitored by your physician, with regular clinical check-ups, ECGs, stress ECGs and echocardiography. You will also be put on appropriate medication according to your needs.

You may be prescribed one or more of the following medications:

•Cholesterol-lowering medication

•Anti-hypertensives

•Aspirin

•Calcium channel blockers

•Beta blockers

•Nitrates

WHAT TO EXPECT AT YOUR VISIT TO THE DOCTOR

1.A thorough medical history will be taken.

2.A full examination will be performed.

3.An ECG will be done.

WHAT IS AN ECG?

An ECG, or electrocardiogram, is a record of the electrical activity of your heart as it contracts and relaxes. There are two types of ECG: an ECG performed at rest and a stress ECG, also sometimes called an effort ECG. For many people (even those with some symptoms) the ECG at rest is normal. This is not surprising because the symptoms of angina occur with effort or stress, and, therefore, the heart needs to be tested during exertion.

WHEN WILL I NEED A SPECIALIST AND WHAT SHOULD I EXPECT?

If you have abnormalities or very high risk factors, you may be referred to a heart specialist, called a cardiologist. The cardiologist will examine you and will certainly perform an effort ECG so that problems can be determined. Blood pressure and any symptoms are also measured and recorded during this test.

The cardiologist may also do an echocardiogram. This is an ultrasound scan used to evaluate the shape, strength and structure of the heart. In severe cases coronary angiography may be done. This is a test to explore the coronary arteries. A fluid is injected into the artery of a leg or arm through a fine tube. The heart and blood vessels are then filmed by X-ray while the heart pumps. The pictures will show exactly where the vessels are blocked. This is the most accurate way to assess the presence and severity of coronary disease.

AM I HAVING A HEART ATTACK?

If you have heart disease it is important to know the symptoms of a heart attack so that you can get immediate medical help. (See the box below.)

Symptoms of a heart attack

The warning signs of a heart attack include:

•The sensation of a heavy weight on your chest, or the feeling of it being compressed with a vice. Some describe the sensation as a stabbing or burning similar to heartburn.

•Pain that lasts from half an hour to several hours.

•Shortness of breath.

•A sensation of pain radiating down the arms (particularly the left arm).

•Pain that may also radiate to the teeth, jaw, neck, back or shoulders.

•A tingling sensation in the hand.

•Men often describe chest pressure as localised, whereas women describe it as diffuse.

Other symptoms include:

•Nausea

•Vomiting

•Indigestion

•Palpitations

•Cold perspiration

•Weakness

•Dizziness

•Coughing

•Fainting

Some people, particularly those with diabetes or who are over 75, may not ex­perience pain at all. Instead they may note a sensation of indigestion accompanied by a shortness of breath.

Not all heart attacks begin with a sudden crushing pain on the left side of the chest. For some, the pain is atypical; it may feel like indigestion or a diffuse burning in the chest. The pain may also be felt only in the arm, back or jaw.

Don’t ignore it. Get someone to call an ambulance or get you to hospital as soon as possible. You need to get to a hospital with intensive care units immediately.

Don’t hesitate to call for medical help if you suspect you or someone else may be having a heart attack. Blood tests should be done immediately. Continuous monitoring by ECG is also necessary.

CHANGING HABITS IS THE KEY

Changing one’s habits is not easy, but experience and research show that it works.

Is it ever too late to quit smoking?

The good news is that regardless of your age, stopping smoking will dramatically cut your risk of a heart attack. Even if you have already had a heart attack, you will benefit from quitting, as the risk of a second attack is cut by 50% or more after you stop smoking.

What to do about blood pressure

Because blood pressure (BP) is so variable, it should be checked on several different occasions before a diagnosis of high blood pressure is made. If your BP is not too high, you may be able to control it entirely through weight loss (if you are overweight), regular physical activity and cutting down on sodium (salt) intake. In addition to the obvious step of adding less table salt to your food, using fewer sauces, mixes and instant products may help. If you require medication, make sure you comply with your prescription.

Check your cholesterol

It is a good idea for all adults to have a baseline blood cholesterol check. It really becomes significant to check regularly after the age of 45. While your body needs cholesterol to function normally, it usually produces enough to meet all these needs. Too much saturated fat and cholesterol in your diet raises the level of cholesterol in your blood. Over the years, this excess is deposited on the walls of the (coronary) arteries that supply blood to your heart, as well as many other arteries around the body. These deposits make the vessels narrower, and limit blood flow. With the possibility of complete occlusion (blockage) of one or more of these vessels, or more commonly a clot and/or rupture of the plaque, the threat of heart disease and heart attack becomes real.

Don’t wait with your weight

Being overweight contributes not only to cardiac disease, but also to other significant illnesses, such as diabetes and cancer. Fortunately, all these factors can be improved with weight loss. It is never easy to lose weight, but do it sensibly. For lasting results aim to lose no more than half a kilogram per week. Adjust your diet to include a wide variety of low-fat, low-kilojoule nutritious foodstuffs in moderate amounts, protein (fish and lean chicken) and limited quantities of good-quality fat (monounsaturates, such as olive oil).

Regular activity

Inactivity increases your risk of heart disease. As little as 30 minutes of moderate exercise at least three times a week helps protect your heart from disease. Brisk walking, cycling or even vigorous gardening can do the trick. Be sure to check with your doctor before beginning an exercise programme.

Use these exercise guidelines:

•Go slow! Start slowly, take time to warm up, stretch and, at the end of the session, cool down at a slower pace.

•Listen to your body. Some stiffness is normal at first, but if you hurt a joint or muscle, stop the activity to allow healing for a few days.

•Pay attention to warning signals. Al­though physical activity will strengthen your heart, some types of activity may worsen existing heart problems. Dizziness, a cold sweat, chest pain or fainting need immediate medical attention.

•Keep at it.

The alcohol story

Several studies have shown that moderate drinkers (one glass of wine/tot per day) are less likely to develop heart disease. If you do not drink, this is not a recommendation to start using alcohol. If you are pregnant, or have any medical conditions, alcohol can be extremely harmful. More than one drink a day (i.e. a glass of wine or a tot of spirits) can raise blood pressure, and binge drinking can lead to a stroke. People who drink heavily on a regular basis have higher rates of heart disease.

Oral contraceptives

If you take birth-control pills, you should get your blood pressure checked regularly because oral contraceptives (OCs) can increase blood pressure. If you use OCs and are diabetic, it is even more important to have regular blood pressure tests. If you have had any problem with blood clots, stroke or a heart attack, then oral contraceptives are probably not a safe choice for you.

Aspirin, the wonder drug?

This well-known medication has been shown to assist in preventing and even treating heart attacks. A tiny daily dose of aspirin (80 micrograms) has shown in extensive research to lower the risk of heart attack and prevent a second heart attack in high-risk individuals. Keep in mind that aspirin is a strong drug, however, with potential side effects, such as gastrointestinal inflammation. Never start taking it without first consulting your doctor.

CARDIOMETABOLIC SYNDROME – THE REALITY

Heart disease is not just about the heart. It is about the entire body’s vasculature. That means it includes the vessels in your neck going up to your brain, the vessels going down to your feet and all the others in between. When some damage or atherosclerosis is evident in coronary vessels, there will be damage to all the vessels (specifically arteries) all over the body.

In addition to this, heart disease is often associated with and closely linked to other conditions, particularly diabetes. Some specialist physicians talk of diabetes as a subsection of cardiac disease.

Cardiometabolic syndrome is a cluster of risk factors that puts a person at risk for developing Type 2 diabetes and heart disease. This is a relatively new term for these interconnected conditions.

The cardiometabolic syndrome cluster of features is:

•High blood pressure

•High cholesterol and triglycerides

•High LDL cholesterol

•Low HDL cholesterol

•Type 2 diabetes

•Abdominal obesity

HYPERTENSION

High blood pressure, or hypertension, usually causes no symptoms even as it reaches dangerous levels and causes damage to your blood vessels and your heart.

Up to half of all people with hypertension are either untreated or do not know that they have this problem.

WHAT EXACTLY IS BLOOD PRESSURE?

Blood pressure refers to the pressure that builds up as your blood is pumped out of your heart. It is extremely important to have your blood pressure checked regularly, especially as you get older, because high blood pressure can cause damage to your heart and is a risk factor for developing a stroke. The reason that high blood pressure is so dangerous is that, even at extremely high levels, you may experience no symptoms at all. It is for this reason that high blood pressure (hypertension) is called the silent killer.

The strange thing is that in the vast majority of cases, no cause can be found for high blood pressure. This is called essential hypertension. In about 10% of cases the hypertension is due to a particular cause, such as kidney disease or obstruction, and then it is called secondary hypertension.

Hypertension quiz

Do this simple quiz to test your knowledge.

1.Which of these is NOT a risk factor for high blood pressure?

a.Exercise

b.Family history

c.Obesity

d.Excessive stress

2.Untreated hypertension (high blood pressure) can cause:

a.Damage to blood vessels, heart attack and stroke

b.Osteoporosis

c.Cancer

3.How often should you have your blood pressure checked?

a.Every time you see a healthcare professional, or at least every two years

b.When you turn 40

c.When you turn 50

4.What is considered a normal blood pressure level?

a.120/80

b.140/90

c.160/100

Results: Well done if you answered a to all the questions.

Blood pressure is the measurement of force applied to artery walls

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HYPOTENSION

There is a condition of low blood pressure called hypotension, which some people seem to experience intermittently. Low blood pressure is of absolutely no significance, other than the fact that it may cause some dizziness and faintness. You should increase your fluid intake and, possibly, increase salt intake slightly. In very few instances, where the symptoms are severe, one can use a medication called Effortil to correct the blood pressure. It is good for your blood vessels and heart if your blood pressure is on the lower side of normal.

WHAT TO DO ABOUT HIGH BLOOD PRESSURE

Whatever life stage you find yourself at right now, make sure you have your blood pressure checked to establish a baseline reading. This is an easy, noninvasive investigation that can be done by your doctor or the clinic nurse. If your blood pressure is raised, it is important to have at least two or three readings on separate occasions by the same person before a diagnosis of high blood pressure is made. If it is normal, and you are under 40, you could get it checked every two to five years. After 45, you should have it checked yearly.

High blood pressure usually causes no symptoms at all, but may cause some dizziness and headaches.

TREATMENT OF HIGH BLOOD PRESSURE

Hypertension is best managed with a combination of lifestyle changes, such as weight loss, exercise and diet (salt restriction) as well as effective medication.

Lose weight

If you are overweight, your blood pressure will most certainly drop when you shed those extra kilos.

Stop smoking

Smoking will worsen your blood pressure and increase your risk of stroke substantially.

Exercise

Regular moderate exercise can help reduce existing hypertension and prevent you ever developing high blood pressure, even if you have a genetic predisposition.

Cut down on alcohol

Alcohol certainly causes a rise in your blood pressure.

Folate

Research has demonstrated that folic acid, already known for its power to prevent birth defects, also appears to reduce the risk of high blood pressure in all ages, said Dr John Forman at the October 2004 American Heart Association (AHA) conference in Chicago. Newer research from the AHA reveals that folate does not appear to reduce the risk of heart attack, although it does seem to help with blood pressure.

Manage your stress

Any stress will increase your blood pressure. This is evident by observing the rise in blood pressure with the simple (minimally stressful) experience of having your blood pressure checked by the doctor. Unrelenting, continuous high stress will keep your blood pumping at a much higher pressure than it needs to be. Even if you are on medication for significant hypertension, engaging in a regular stress-relieving practice, such as meditation, will reduce it.

Diet

Heard of the DASH diet? This is a diet recommended by the American Heart Association, which has been implemented and studied extensively. DASH stands for dietary approaches to stop hypertension. It has been shown to reduce blood pressure significantly and in some studies by as much as that of the control groups on medication. It has also been shown to improve general heart health.

The DASH diet recommendations:

•7–9 servings of fruit and vegetables per day

•2–3 servings of fat-free or low-fat dairy

•5–6 servings of low-GI, high-fibre grains, starch (such as butternut) or root vegetables (such as carrots and beetroot)

•1–2 servings of animal protein, such as chicken, fish and lean meat (occasionally)

•Less than a teaspoon of salt a day

Low-salt diet

Researchers have shown that eating a low-salt diet can protect the arteries from stiffening, reduce high blood pressure and may even help prevent its onset in the first place. The DASH diet recommends limiting salt intake to under 2 400 mg, which is less than a teaspoon a day. Some recommend less than half a teaspoon a day. The problem is that there is an enormous amount of salt added to processed food, soups, condiments, tomato sauce, soya sauce, tinned vegetables, pickles, crisps and pretzels. The list goes on and on. The secret is to significantly limit these processed foods.

PRE-HYPERTENSION

The readings for high blood pressure have recently been modified. A normal blood pressure reading is 120/80 mmHg. The upper level is called the systolic pressure, which is the pressure when the heart is pumping out the blood. The lower level is called the diastolic pressure, which is the pressure when your heart is between beats, or when it is in a resting state.

Until recently, it was accepted that as you get older your blood pressure will go up owing to some thickening of vessels. So, for a 60-year-old, a blood pressure of 140/90 was acceptable. If the blood pressure in this 60-year-old was more than 140 systolic or more than 90 diastolic on three separate occasions, measured by the same doctor the diagnosis of hypertension was made.

However, newer research has revealed that it is not desirable to reach those levels.

If your systolic pressure is between 120 and 140 and your diastolic pressure is between 80 and 94 at any age, you are classified as being pre-hypertensive. This means that you are more than likely to become hypertensive and that your risk for heart disease, vessel damage and stroke is higher than that of the normal blood pressure population. Obviously, your risk is not nearly as significant as it would be with established hypertension, but pre-hypertension is something to look out for.

MEDICAL TREATMENT OF HYPERTENSION

Hypertension is not a condition that can be ignored and must be taken very seriously. This is not a condition to treat with alternative remedies. If you have high blood pressure, you are at risk for heart attack, stroke and cardiovascular damage. Yes, you should attempt to lose weight and exercise regularly. The chances are that these strategies together with the DASH diet will bring your blood pressure down to normal if you have only moderate hypertension.

However, if you have severe hypertension, or if the above approaches do not bring your blood pressure down sufficiently, you definitely need medication. Your doctor will start slowly with the medication. Even if you have extremely high blood pressure, it is important to bring it down slowly. Trying to get blood pressure down quickly can be dangerous and should only be done in emergency situations in hospital under the care of specialists.

It is important to know that all anti-hypertensives have some side effects, including dizziness or headache, so make sure you find one that has the fewest or no side effects for you.

The most common anti-hypertensives include:

Diuretics

These are often called water pills, because they cause you to excrete extra fluid through the urine. As your blood volume decreases, your blood pressure decreases too.

Beta-blockers

These slow the heart rate and lower the blood pressure by blocking your beta receptors. They have been around for many years and some doctors still choose them over the newer forms of medication. Fatigue is a possible side effect.

ACE inhibitors and calcium channel blockers

These cause the blood vessels to dilate, that is, open up more, allowing the blood to flow with less intensity. They either inhibit a substance called angiotensin converting enzyme (ACE) or block calcium channels.

STROKE

Stroke is a term used to describe the interruption of blood flow to an area of the brain.

It occurs equally in men and women and is the third leading cause of death and the leading cause of adult disability in many countries throughout the world – a fact that is generally ignored by the world’s media.

A stroke is a medical emergency and can cause permanent neurological damage, complications and death if not promptly diagnosed and treated.

The underlying conditions of a stroke (called cerebrovascular disease) are usually present for many years before a stroke occurs, although the symptoms of a stroke may occur suddenly. A stroke is a catastrophic event because it results in often irreversible damage to an area of the brain. This usually leads to paralysis of one side of the body, normally affecting the face, arm and leg, as well as possible speech damage.

WHAT BRINGS ABOUT A STROKE?

Either a clot in a vessel or a bleed into the brain causes a stroke to occur. A clot may form in a major blood vessel supplying the brain region. When a clot blocks blood flow to vital tissue in the brain, a stroke will occur. This is the same mechanism as a heart attack. Alternatively, when a blood vessel bursts or leaks, bleeding into the brain occurs. This bleeding, known as a haemorrhage, is usually due to prolonged high blood pressure. Some of the risk factors for stroke are the same as for heart disease.

How a stroke occurs

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Risk factors for stroke:

•High blood pressure – the most important modifiable risk factor for stroke

•High cholesterol

•Diabetes

•Family history

•Smoking

•Obesity

•Physical inactivity

•Clotting dysfunction

•Bleeding dysfunction

•Previous stroke or TIA (transient ischaemic attack)

•Heavy alcohol intake

•A diet high in salt and fat

WARNING SIGNS

It is important to be able to recognise the warning signs in order to get urgent medical help as quickly as possible. The warning signs or symptoms of a stroke may occur alone or in combination. They may last a few seconds or up to 24 hours, and then disappear. The severity of the symptoms depends on the area of the brain affected and the cause.

Stroke symptoms develop very quickly – within minutes. The symptoms of a stroke depend on the site of the bleed or the clot and, therefore, the amount of damage. The severity of symptoms varies significantly from patient to patient.

Possible stroke symptoms:

•Numbness or weakness in the face, arm or leg

•Difficulty speaking or understanding

•Sudden severe dizziness

•Sudden blurred vision in one or both eyes

•Sudden loss of balance

•Rapid onset of difficulty swallowing

•Severe or abrupt onset of headache

•Confusion

•Unconsciousness

THE FAST TEST

The FAST test is an easy way to recognise and remember the signs of a stroke or TIA. Using the FAST test involves answering three simple questions.

FAST stands for:

•Facial weakness: Can the person smile? Have their eyes or mouth drooped?

•Arm weakness: Can the person raise both arms?

•Speech difficulty: Can the person speak clearly and understand what you say?

•Time to act – act FAST.

If the person has a problem with any of these functions, call an ambulance immediately.

HOW IS THE DIAGNOSIS MADE?

The diagnosis of a stroke is made from:

•clinical signs – by a neurologist’s thorough examination;

•with scans, including CT (computerised tomography) and MRI (magnetic resonance imaging);

•and occasionally with what is called arteriography (using dyes and contrast mediums).

THE TREATMENT OF A STROKE

It is very important to get the person to hospital as quickly as possible if you suspect a stroke may be happening. The patient may be admitted to an intensive care unit (ICU) initially. The treatment of stroke involves a multidisciplinary team approach including:

•Nursing care

•Physician and ICU specialist

•Specialist neurologist

•Physiotherapist

•Occupational therapist

•Speech therapist if speech or swallowing is affected

•Psychologist

•Social worker

Medication will be prescribed for the patient. If the cause of the stroke is a clot rather than a bleed, blood thinners may be used, including aspirin and anticoagulants in some patients. The anticoagulants are likely to be warfarin or heparin or something called Clexane. Blood pressure medication may also be prescribed because blood pressure control is vital in such a situation.

It is extremely important to involve the whole multidisciplinary team in the care and rehabilitation of a stroke patient. Assisted-living devices, such as wheelchairs, walkers and canes, may also be required. What is more, in addition to the physical trauma of a stroke, more than a third of patients experience significant depression.

What is a TIA?

A transient ischaemic attack (TIA) mimics a stroke in that the symptoms and signs may be identical but it is temporary and resolves completely within 24 hours.

•Transient – the symptoms pass and usually last for less than 24 hours.

•Ischaemic – blockage of blood flow to part of the brain.

•Attack – sudden onset of symptoms, which vary depending on which part of the brain is deprived of blood.

TIAs are caused by a temporary cut in blood supply to the brain, due to the partial blockage of an artery by a blood clot or spasm of the vessel. A TIA may be a warning of an impending stroke. A person who has had a TIA is certainly at greater risk of having a stroke or heart attack. It is important to discuss with your doctor ways to reduce the chance of suffering a stroke.

STROKE PREVENTION

Many stroke risk factors are related to your lifestyle, so you have the power to reduce your risk. However, some risk factors, such as gender, age and family history, cannot be controlled so it is important to do as much as possible to improve the modifiable risk factors like smoking and poor diet.

Quit smoking

Smoking can double or even quadruple your risk of stroke. Clots are more likely to form because smoking thickens the blood and makes the platelets much more sticky. Cigarette smoke also causes the arteries to constrict and the narrower opening makes it harder for the thickened blood to move through.

Manage your diabetes

A person with diabetes is around twice as likely to have a stroke as someone of the same age who doesn’t have diabetes. It is very important that your diabetes and sugar level are kept under tight control because high sugar levels contribute to the development of atherosclerosis.

Keep cholesterol levels normal

Blood cholesterol contributes to the formation of atheroma, which sticks to artery walls and leads to atherosclerosis. (Refer to the section on heart disease for more information.)

Eat a healthy diet

Various studies show that diet is an important risk factor in the development of stroke. Limit your salt intake and cut out or reduce sugary and fatty foods.

Exercise regularly

A sedentary lifestyle increases obesity, high blood pressure and high blood cholesterol levels, which are all important risk factors for stroke.

Avoid heavy drinking

Some studies have indicated that drinking moderate amounts of alcohol (such as one or two standard drinks per day) can actually reduce the risk of stroke. However, people who drink heavily are three times more likely to have a stroke, regardless of their age. It is, therefore, important to limit your alcohol intake.

There is also evidence from a large meta-analysis (combined results of several studies) that folic acid supplementation may reduce the incidence of stroke by up to 20%.

DIABETES

Diabetes is a misunderstood and feared condition. Although significant advances have been made in the treatment and management of diabetes, it is still a serious illness. Notwithstanding this, it can almost always be well controlled and managed through lifestyle changes and medication.

The real worry with diabetes is that although there are 250 million sufferers worldwide, 50% of all people with diabetes are unaware of their condition.

HOW WOULD I KNOW IF I HAD DIABETES?

If you have any of the following symptoms for more than a week, see your doctor. A screening urine test as well as a blood glucose level test should be done:

•Excessive thirst

•Markedly increased appetite

•Very frequent urination

•Dizziness

•Weight loss without dieting

•Recurrent urinary tract infections

•Dry mouth

•Vomiting, diarrhoea

•Blurred vision

WHAT EXACTLY IS DIABETES?

Diabetes is a metabolic disease that affects your body’s ability to manufacture or respond to insulin. This means that either your pancreas is unable to produce insulin, or the insulin that is produced cannot be used by your cells.

Sugar (glucose) is required by all the tissues of your body to be used for energy.

Insulin is the hormone that facilitates the movement of glucose from the bloodstream into the cells – it acts as a gatekeeper to the cell walls.

When insulin is in short supply, your cells don’t get the sugar they need and the sugar accumulates in the blood. When glucose accumulates in the blood, it becomes toxic for your body.

Insulin allows movement of glucose from bloodstream to cells

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HOW TO PREVENT DIABETES

The exact cause of diabetes continues to be a mystery, although both genetics and environmental factors, such as obesity and lack of exercise, appear to play a role. If you are concerned that you may be at risk, or have a family history of the condition, there are a number of things you can do to avoid developing diabetes.

Control your weight

Obesity increases the risk of insulin resistance. When your cells can no longer respond to insulin, glucose cannot be transported into the cells. When the insulin becomes ineffective, glucose levels rise. The glucose remains in the blood and starts to poison blood vessels, nerves and the pancreas.

Exercise

Exercise is one of the best strategies both for treating existing diabetes as well as preventing diabetes from occurring. It modifies insulin resistance and allows sugar to move from the blood into the muscles. Exercise makes your body less resistant to insulin so that more glucose is taken from the blood into the cells. Exercise also helps you maintain a healthy weight and may assist in losing weight and reducing blood pressure.

Best nutrition

You have heard this so many times, but it really is true. If you continue to eat processed food, refined sugar and foods with a high fat content, you are putting yourself into the high-risk category. There is more to good nutrition than just cutting out desserts and sweets. It is about eating high fibre, wholegrain, low-GI foods; fresh vegetables and fruit; and good fats (e.g. omega-3, olive and flaxseed oils). A few studies have demonstrated that people taking in high fibre have better blood sugar control.

What is the glycaemic index?

The glycaemic index (GI) is the measure of the rate at which sugar (glucose) enters the bloodstream after eating carbohydrates. The slower the rate, the better for energy sustainability and healthy metabolic function. Low GI foods are transported into the bloodstream slowly, whereas high GI foods trigger a rapid rise in blood sugar. The cut-off index level is 55. Below 55 is considered low GI, while foods with a GI above 55 are regarded as having a high GI.

TYPES OF DIABETES

Type 1 diabetes (insulin-dependent diabetes)

When someone has type 1 diabetes, the cells of the pancreas have been damaged and it is therefore unable to make insulin, so there is little or no insulin available. It is the rarer form of the disease and accounts for only about 10% of sufferers. Type 1 diabetes is an inherited or genetic condition that usually appears during childhood or adolescence.

Type 2 diabetes (non-insulin-dependent diabetes)

Type 2 diabetes is the most common form of diabetes, accounting for 90% of sufferers. In this type of diabetes the cells have become resistant to insulin and the body cannot respond to or utilise the insulin properly.

Another name for type 2 diabetes is adult onset diabetes, as it usually develops after the age of 35. Although there is a genetic component and family history is a risk factor, your susceptibility increases if you are overweight and more so if you are obese. What is frightening is that we are seeing more and more obese children developing type 2 diabetes.

RISK FACTORS FOR DIABETES

Family history

If you have a family history of diabetes, watch out for the signs and symptoms listed (How would I know if I had diabetes?).

Obesity

This is an important risk factor for diabetes. Expanded fat cells become unresponsive to insulin. Ensure that you do not gain excessive weight and that your diet is wholesome and nutritious.

Gestational diabetes

If you have had what is called gestational diabetes – a type of diabetes that occurs during pregnancy and then disappears after birth, you may be at increased risk of developing type 2 diabetes.

WHAT TO DO IF YOU HAVE DIABETES

The most important goal in the management of diabetes is to ensure that you maintain the best possible glucose control and that you attempt to prevent organ damage. This means keeping your glucose levels as close to normal as possible. This requires a combination of medication (oral and/or injected insulin) and lifestyle strategies. This is one of those diseases for which lifestyle strategies are as important as medication. It is also a disease where self-management is imperative. Although you require a good doctor and health team to monitor and advise you, much of the care is in your own hands.

With diabetes, lifestyle strategies are as important as insulin and medication.

GOOD CONTROL

If you are diabetic, make sure you are completely in control of your condition. The most important aspect of diabetes is ensuring that you take control of your health and blood glucose level.

Self-monitoring

Do daily monitoring of your blood glucose levels with a home glucose monitor. You can do this at home. You must keep a record. Either your doctor or a diabetes nurse will teach you exactly how to do this.

It is important that you also get other risk factors under control. People with diabetes have a higher risk of heart attack and stroke, so keep a check on your blood pressure and cholesterol. Also look after your gums and teeth as gum disease may worsen your control of diabetes. It is not completely understood why there is this link, but it may be related to chronic bacterial infection in your mouth, which may trigger and worsen insulin resistance.

Doctor monitoring

You should see your doctor every six months or yearly if all aspects of your diabetes are well controlled. Your doctor will check your long-term glucose control with blood tests. Your doctor will also look for kidney problems by checking your urine for protein. Blood creatinine and urine protein levels will indicate signs of kidney damage. It is also important to undergo annual eye check-ups, preferably with an eye specialist.

Blood sugar levels

You need to ensure that your doctor monitors you regularly and that your blood sugar levels are stable in an effort to prevent the onset of organ damage.

Blood pressure

Keep a close check (with your doctor’s assistance) on your blood pressure.

Eyes, kidney and heart

These are all organs that can be damaged with high blood sugar levels and long-term diabetes. At each visit your doctor should be checking your eyes (retinal vessels) with an ophthalmoscope.

Feet

With diabetes, you may be prone to problems with circulation or loss of feeling in your feet. Inspect your feet for red, cracked skin, infections and calluses or blisters and see your doctor if you see signs of infection. Untreated, even minor cuts or infections can lead to serious medical problems in diabetics. Your doctor should be checking your legs for decreased sensation of the peripheries, weak pulses and blisters, ulcers or infections.

Below normal blood pressure and cholesterol levels

Many diabetes specialists today try to get your blood pressure and cholesterol levels below normal. Try to ensure that your blood pressure is under 130/85 and that your cholesterol level is below 5.

Exercise

This is one of the most important aspects of your self-care. Exercise makes your muscles more sensitive to insulin, which improves the way your body metabolises sugar. Exercise will also help keep your weight under control and reduce your risk of heart disease – a special concern for people with diabetes.

Lose weight, eat right

If you are overweight, you should try hard to lose weight. Four out of five people with type 2 diabetes are overweight, and you will certainly improve the control of your diabetes and even reduce your medication if you lose weight. Reduce your energy intake and eat the best-quality low-fat diet possible. Eat only a moderate amount of carbohydrates and only low-GI carbohydrates. Add fibre to your diet in the form of pulses, grains, fresh fruit and vegetables, since this may help regulate blood sugar. It is a good idea to be monitored by a dietician; and it is even better if a whole team, including a doctor, dietician and exercise trainer, puts together a holistic plan for you.

Manage depression

Diabetics are twice as likely to suffer from depression as non-diabetics. Although the reasons for this are not completely understood, it is important that you talk to your doctor if you suspect you may be feeling depressed (see Depression and anxiety). Counselling support, psychotherapy and antidepressant medication may be necessary for a period. If you are feeling depressed you are far less likely to be conscientious about your eating and exercise plan, which is important to your long-term health.

Screening

The most important regular screenings for diabetics are:

•Blood sugar level by means of self-monitoring

•Monitoring of HbA1C by doctor (an indicator of long-term control of sugar)

•Checking for sores or ulcers

•Eye checks

•Blood lipids (cholesterol, HDL and LDL)

•Blood pressure

OTHER POSSIBLE STRATEGIES

Statins

Many doctors are prescribing statins for diabetics, even if their cholesterol is not high. Statins are cholesterol-lowering medications which have been shown to reduce the inflammation and damage to artery walls and, therefore, minimise the risk of strokes and heart attacks. Statins work by raising the good cholesterol called HDL (high-density lipoprotein). They also help reduce other materials that are damaging to the vessel walls, says Dr David Sullivan, associate professor at the Royal Prince Alfred Hospital in Sydney, Australia. A study called the JUPITER trial, which took place over five years and was presented at the 2009 American Heart Association conference, demonstrated that heart attacks, stroke and the need for bypass surgery were halved in people who regularly took a statin.

Chromium supplement

Not everyone agrees with this, but tests show that people with diabetes may have lower blood levels of chromium. Your body may need chromium to be able to respond to insulin. It is sometimes difficult to get sufficient amounts of chromium from food, so look for a multivitamin that supplies the recommended amount for chromium: 50 to 200 micrograms daily.

Alpha lipoic acid

Although research into supplements has demonstrated mixed results, there is some evidence to suggest that alpha lipoic acid, the cofactor in the production of energy from glucose inside cells, may help prevent cells from becoming insulin-resistant. The dose recommended for prevention is 100 mg per day and for people with existing diabetes, possibly 400 mg. But please talk to your doctor first.

Vitamin C and B-group vitamins

These vitamins have also been recommended, but there is no strong medical research backing their use in controlling diabetes.

Alternative therapies

Mainstream doctors dismiss most of these remedies. Exercise caution when it comes to herbal and naturopathic remedies that may interfere with your insulin or oral hypoglycaemic agents. However, there is absolutely no reason why you should not have reflexology therapy or learn a relaxation technique.

INSULIN RESISTANCE

This means that your cells become unable to respond to insulin so that glucose cannot be transported from the blood into the cells and blood glucose levels rise. The glucose starts to poison blood vessels, nerves and the pancreas.

As few as 8–10 excess kilograms of body weight can make you insulin-resistant. An interesting and most important factor is that insulin resistance is more likely to occur when body fat is mainly around the abdomen. It is less of a problem around the buttocks and thighs, but any extra fat may contribute. In order to lose weight, please do not be tempted by crash or fad diets – or any other method of quick weight loss. These diets cause nutritional deficiencies, bone loss and loss of muscle, which slows down the metabolism, making it harder to keep your weight down and makes future weight reduction even more difficult.

Eat small portions of good-quality food. Concentrate on low-fat (choosing good fats), low-GI food, good protein, vegetables and some pulses. Combined with a regular exercise programme, you should be able to lose weight