Limit salt, fat, alcohol intake to keep hypertension at bay

Posted on: Thursday, February 22, 2007

Limit salt, fat, alcohol intake to keep hypertension at bay

By Amy Tousman RD, CDE

 Q. Do I have to avoid salt to lower my blood pressure without medication?

 A. Perfect question for Heart Month. Blood pressure is the force exerted on the walls of the arteries by the flow of blood, similar to the flow of water in a garden hose. It's measured by the amount of blood pumped by the heart compared to the resistance of the artery walls. Known as hypertension, high blood pressure increases the risk for stroke, heart attack and kidney failure.

Salt is only part of the blood pressure picture.  For those with mild hypertension, other dietary changes can be beneficial.  These include increasing food sources of potassium, calcium, and magnesium, limiting saturated fat, controlling your weight, and limiting alcohol.

Eating lots of fruits, vegetables and low-fat dairy products will provide the body with potassium, calcium and magnesium to help reduce blood pressure.

Limiting animal fats and sugars while increasing whole grains helps prevent plaque from accumulating in the arteries. Excess plaque narrows the arteries increasing the workload of the heart.

These changes can lower blood pressure even when salt is not restricted. However, they have an even greater effect when combined with a lowered sodium intake.

In some people, eating too many salty foods increases the amount of water in the blood. This forces the heart to work harder to pump blood, increasing blood pressure. Potassium blunts sodium's effect by forcing salt to be eliminated in the urine. Since this lowers blood pressure, we should eat twice as much potassium as sodium.

The role of calcium and magnesium is poorly understood; however several studies show that when diets are low in these minerals, blood pressure is high.

Losing excess weight, especially belly fat, improves blood pressure. This is the fat that surrounds our organs. The heart must work harder to supply this extra fat with blood. This extra fat can compress the kidneys. The kidneys respond by releasing hormones that increase blood pressure. Exercise can help reduce belly fat.

Drinking more than two alcoholic drinks daily can raise blood pressure. It also makes hypertension more resistant to treatment. Heavy drinking increases frequency of strokes and heart failure. Limit alcohol to two drinks or less daily for men and one drink or less daily for women.

If diet and exercise do not normalize your blood pressure, medication will be needed. Do whatever it takes to control this "silent killer."

Amy Tousman is a registered dietitian and certified diabetes educator. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Bitter melon may lower blood sugar levels for some

Posted on: Saturday, July 17, 2004

PRESCRIPTIONS
Bitter melon may lower blood-sugar levels for some

By Amy Tousman, RD

 Q. Can bitter melon help treat diabetes?

 A. Bitter melon is a vegetable often used in Chinese, Filipino and South Asian dishes. Several substances in bitter melon have been studied in both animals and humans. Results suggest a possible blood-sugar lowering effect. However, this effect may occur only in those whose insulin-producing cells in the pancreas are still functioning to some degree.

Several substances in bitter melon act like insulin in the body. These substances help sugar enter into cells.

Bitter melon also prevents conversion of stored nutrients to sugar and release of this sugar into the blood. Most studies of bitter melon in humans involve few patients and are of short duration. These studies did not use a control group (a group who did not receive bitter melon). Comparing blood-sugar values of those who use bitter melon to those who don't increases the accuracy of the results. Studies have been done primarily in type 2 diabetes. They've shown good results in some participants and no results in others.

There is not enough information to recommend a specific dose. Various forms have been used in research, including powdered, extract, juice, and the cooked vegetable. Some sources recommend eating one small unripe melon daily or drinking 3-6 tablespoons of fresh juice daily with food.

Combining bitter melon with insulin or oral hypoglycemic agents can increase the blood-sugar lowering effects of these medications. Reported adverse effects include hypoglycemia and liver toxicity (in animals). It should not be used in those taking diuretics as it can lower blood potassium.

Bitter melon should not be used by children or pregnant women. The coverings on the bitter melon seeds are toxic in children causing diarrhea, vomiting and death.

In pregnant women, bitter melon can cause vaginal bleeding, premature contractions or miscarriage. The amount of the vegetable's interior normally used in cooking should not cause these problems.

Bottom line: If you are diabetic, eating the vegetable or drinking a small amount of the juice daily shouldn't be harmful. Caution should be used with extracts and supplements.

Until a correct dosage is established, it is not recommended that bitter melon be used as a replacement for insulin or other diabetes medications.

If you are taking insulin or oral hypoglycemic medications such as Glyburide, Starlix, Glucotrol, Amaryl, etc., check with your physician before adding bitter melon. Also, monitor your blood sugar regularly when using bitter melon.

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice..com. This column is not intended to provide medical advice.

Don't believe all you read about Atkins diet

Posted on: Saturday, October 25, 2003

PRESCRIPTIONS
Don't believe all you read about Atkins diet

By Amy Tousman, RD

Q. Is it true that there are finally studies showing I can lose more weight on the Atkins diet than a low-fat diet?

 A. Two studies on the low-carbohydrate Atkins diet published in the New England Journal of Medicine have been the subject of recent news stories.

Media reports stating these studies show eating lots of meats takes off more pounds than avoiding fried foods are missing the point. These stories fail to mention that the pounds are soon regained.

One study compared a low-fat diet with a low-carbohydrate diet in obese subjects. In six months, the Atkins dieters lost 13 pounds while the low-fat group had lost four pounds. This is not a huge difference considering the average start weight in these subjects was 290 pounds.

A similar study was conducted over 12 months. The Atkins group lost more weight for the first six months. However, during the second half of the year, they began regaining the weight. They gained weight faster than the low-fat group. After one year, there were no significant differences in the weight of the two groups.

Reporters who read only the press releases reported that "these studies bolster the Atkins diet." Since when does regaining the weight at the end of a year imply success? Those reporters who actually read the studies reported that "the Atkins Diet may be no better than just cutting fat."

These studies had huge dropout rates in both types of dieters. This affects the results. Atkin's dropouts may have been craving carbohydrates. Low-fat diet dropouts may have wanted to lose weight faster.

As a dietitian who counsels many obese people, I can say there were probably additional reasons why neither diet worked. Many obese people have genetic or emotional reasons why maintaining a weight loss is difficult.

Permanently changing habits is not easy. These results may not apply to someone who is not obese but just wants to lose a few pounds.

Many studies show low-carbohydrate diets are ineffective for long-term weight loss. Meanwhile, the health benefits of plant-based meals containing carbohydrates found in fruits, whole grains, vegetables and starchy beans are well known.

The only regimens that work for life require eating reasonable portions and exercise. And a commitment to do this forever.

Amy Tousman is a registered dietitian.  Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column.

Send questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

That peculiar after-effect of asparagus

Posted on: Thursday, December 6, 2007

PRESCRIPTIONS

That peculiar after-effect of asparagus

 By Amy Tousman RD, CDE

Q. Why does asparagus seem to make my urine smell funny?

A. Asparagus is a healthy, easy to prepare green vegetable. Within a short time after eating it, some folks complain that their urine has a pungent odor, often compared to rotting cabbage. The effects of "asparagus urine" are temporary and harmless.

It is uncertain whether the production of this odor is universal.  Several studies discussed in the April 2001 issue of the journal, Drug Metabolism and Dispositon try to shed light on the issue.  For example, in tests on 800 Britons, approximately 43% produced the odor.  All 103 French citizens tested produced the odor so there may be an ethnic or genetic component at work here.

The situation is more complicated than it appears on the surface. Scientists are unsure whether people have different urinary responses to asparagus or whether some folks just lack the ability to smell the odors produced by asparagus. In a study of 307 Israelis, 90 percent could not smell the asparagus generated odor in urine and in a study of 98 Chinese subjects, 76 percent were unable to detect it even though it was present.

A later American study suggests that both phenomena coexist. Some people are "excretors" (their urine smells after eating asparagus) and some are "nonexcretors" (no smell). Some people are "perceivers" (able to smell the odor), while others are "nonperceivers" (unable to smell the odor, even though it exists).

This complicated issue requires further investigation.

Scientists are still learning what causes "asparagus urine." Many believe the odor is generated by a combination of sulfur compounds produced when certain amino acids in asparagus are broken down during digestion. One study found six sulfur compounds present in the urine of known excretors, but not in nonexcretors. Non-excretors may lack the enzyme needed to break down amino acids in asparagus into the smelly compounds in the urine.

Don't avoid asparagus due to this side effect. It's a powerhouse of nutrients. Asparagus is full of folic acid, vitamins A and C, potassium and fiber.

Several phytonutrients in asparagus have shown promise in inhibiting growth of cancer cells. A substance in asparagus helps strengthen arteries and increases circulation to the lower limbs. Asparagus also contains a substance that helps the intestines produce "friendly bacteria" to improve digestion.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Antibacterial soap not better than usual kind

 Prescriptions

 By Amy Tousman RD, CDE

Posted October 4, 2007

Q. Are antibacterial soaps better than plain soap and water?

A.  Antibacterial soaps are often promoted in advertisements as being better at preventing illness than regular soap.  Many people worried about getting sick don't mind paying more for antibacterial soaps.

Researchers from the University of Michigan's School of Public Health reviewed 27 studies conducted between 1980 and 2006 comparing antibacterial soap to regular soap. Results showed that in concentrations used in home and community settings, washing hands with anti-bacterial soap was no more effective in preventing coughs, congestions, diarrhea, or fever than plain soaps

In fact, antibacterial soaps in the formulations sold to the public do not remove any more bacteria than plain soaps.

The active ingredient in most antibacterial soaps is called triclosan. Triclosan is available in higher concentrations in hospital formulations and therefore may be more effective at killing bacteria in these settings. They still are ineffective against viruses that cause colds and flu.

Another concern is that triclosan may cause some bacteria to become resistant to antibiotics such as amoxicillin, rendering them ineffective. Also, in lab experiments, E. coli bugs (responsible for several food-poisoning outbreaks) showed resistance when exposed to triclosan soap. This means, E. coli could survive in the concentrations used in consumer-formulated antibacterial soaps.

Some bacterial-reduction studies have shown that increased application time shows better results. Folks in these studies spent a longer amount of time washing hands or washed their hands several times in a row. This is not typical in real-world practice.

In September, the Food and Drug Administration ordered Procter and Gamble, makers of Vicks foaming sanitizer for hands, to stop advertising that this product prevents the spread of viruses that cause colds. The FDA will be scrutinizing claims from other companies selling antibacterial soaps containing triclosan as well.

Good hand-washing practices are your best defense against spreading colds and infections.

You should wash your hands for at least 20 to 30 seconds, (the amount of time it takes to sing the song "Row, Row, Row Your Boat"). Rub your hands together while washing to create friction. This helps remove dead skin and dirt that harbors germs. Rinse thoroughly and dry your hands well.

Ultimately, it is more important to wash your hands well than worry about the type of soap you use. Save your money and invest in plain soap.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Adverti-ser, P.O. Box 3110, Honolulu, HI 96802; islandlife@honoluluadvertiser.com; or fax 535-8170. This column is not intended to provide medical advice.

Insulin a common link between Alzheimer's, diabetes

Posted on: Thursday, December 27, 2007

Prescriptions

By Amy Tousman RD, CDE

Insulin a common link between Alzheimer's, diabetes

Q. Is Alzheimer's a type of diabetes?

A. Alzheimer's disease and diabetes may be related to one another through a common link: insulin.

Insulin may be as important to the brain as it is to the rest of the body. Insulin receptors in the brain play a major role in learning and memory.

It's been known for several years that people with diabetes have a greater chance of developing Alzheimer's and other forms of dementia than those without diabetes, but learning how they are connected has been a mystery.

In the body, insulin helps move sugar into our cells to be used as fuel. A condition called insulin resistance disrupts this process by preventing insulin and sugar from entering cells. Insulin resistance is common in folks with pre-diabetes and Type 2 diabetes.

In the brain, insulin helps us make new memories. Brain cells communicate across spaces on nerve cells called synapses. There are special places on the synapses reserved just for insulin, called insulin receptors. When insulin arrives at the nerve cells, it sticks to the receptor. This allows new memories to form.

Inability to form memories is one of the earliest symptoms of Alzheimer's, so the relationship between insulin and its receptors offers scientists some clues.

Scientists at Northwestern University have discovered a toxic protein that interrupts insulin signaling which is crucial for memory formation. This protein, called amyloid-beta-derived diffusible ligands (ADDLs for short), accumulates in the brains of people with Alzheimer's. ADDLs remove insulin receptors from the synapses of nerve cells, leaving insulin without a connecting point. This renders the nerve's cells insulin-resistant and inhibits the brain's ability to store new memories.

In Type 2 diabetes, the body becomes insulin-resistant. In Alzheimer's the brain becomes insulin-resistant. This means neurons in the brain are deprived of glucose, which they need for energy. This is why some experts are calling Alzheimer's Type 3 diabetes.

Researchers are studying medications used to treat Type 2 diabetes to see if they might also work in the brain to prevent or delay Alzheimer's. Other scientists are trying to develop an anti-ADDL therapy.

Insulin resistance and/or uncontrolled diabetes increases Alzheimer's risk more than controlled diabetes.

Eating a healthy diet and exercising can help prevent insulin resistance and diabetes by controlling weight and blood sugar levels.

The end result: less chance of memory problems as we age.

Amy Tousman is a registered dietitian and certified diabetes educator with Nutrition Unlimited in Kailua. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; or islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.

Body controls digestive acids not diet

Posted on: Thursday, June 15, 2006

PRESCRIPTIONS

By Amy Tousman, RD, CDE

Q.  Should I avoid high acid foods to stay healthy?

A. You may have heard that low-acid or "alkaline" diets help you lose weight, increase your energy, and reduce risks of heart disease and cancer. Advocates of these diets claim that eating acidic foods such as oranges and tomatoes cause health problems by altering the pH balance of our blood. Unfortunately, those dishing out this advice have no understanding of human physiology. These claims are entirely untrue.

The pH scale determines acidity by measuring the amount of hydrogen released when a substance is mixed with water. The more hydrogen, the more acidic it is. A pH of 7 is considered neutral, neither acidic nor alkaline. Acidic foods such as lemon juice and vinegar measure around 2 or 3.

Contrary to popular belief, eating acidic foods will not cause your stomach, blood or body cells to become more acidic. During digestion, the stomach becomes very acidic due to the release of hydrochloric acid. Hydrochloric acid has an extremely acidic pH of less than 1. In other words, the stomach is more acidic than the foods you eat. This acidic environment is needed for digestive enzymes to break down food properly. The acid is then neutralized after the food leaves the stomach.

The body maintains a pH range of 7.35 to 7.45. Our bodies have systems in place to keep pH in check. Whenever pH shifts outside the healthy range, the body automatically brings itself back into balance.

For example, if your blood pH starts to become acidic, your breathing rate speeds up, forcing you to blow out more carbon dioxide. This makes your blood less acidic. Neutralizing substances in the blood such as bicarbonate mop up extra hydrogen to prevent pH from becoming too acidic. Lastly, your kidneys eliminate excess acidic substances in the urine.

Deviations from the healthy range can be caused by starvation, kidney disease, or respiratory disorders.

If you have acid reflux disease, you may need to avoid acidic foods. This has nothing to do with blood pH. Acid reflux causes stomach contents to back up into the esophagus. The esophagus doesn't have the protective lining that the stomach has against acids. Acidic foods may aggravate the burning pain this condition causes.

For folks who don't have acid reflux, ignore the acid-food hype. Go eat an orange!

Amy Tousman is a registered dietitian. Hawai'i experts in traditional medicine, naturopathic medicine and diet take turns writing the Prescriptions column. Send your questions to: Prescriptions, Island Life, The Advertiser, P.O. Box 3110, Honolulu, HI 96802; fax 535-8170; e-mail islandlife@honoluluadvertiser.com. This column is not intended to provide medical advice.