Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness. This includes:
Older adults
People who have serious chronic medical conditions like:
Heart disease
Diabetes
Lung disease
Get ready for COVID-19 now
Take actions to reduce your risk of getting sick
If you are at higher risk for serious illness from COVID-19 because of your age or because you have a serious long-term health problem, it is extra important for you to take actions to reduce your risk of getting sick with the disease.
Stock up on supplies.
Take everyday precautions to keep space between yourself and others.
When you go out in public, keep away from others who are sick, limit close contact and wash your hands often.
Avoid crowds as much as possible.
Avoid cruise travel and non-essential air travel.
During a COVID-19 outbreak in your community, stay home as much as possible to further reduce your risk of being exposed.
Have supplies on hand
Contact your healthcare provider to ask about obtaining extra necessary medications to have on hand in case there is an outbreak of COVID-19 in your community and you need to stay home for a prolonged period of time.
If you cannot get extra medications, consider using mail-order for medications.
Be sure you have over-the-counter medicines and medical supplies (tissues, etc.) to treat fever and other symptoms. Most people will be able to recover from COVID-19 at home.
Have enough household items and groceries on hand so that you will be prepared to stay at home for a period of time.
Three physicians from Johns Hopkins University, in Baltimore, MD, have joined efforts to write an article outlining key action points that the United States healthcare community should take in response to COVID-19.
Drs. Amesh A. Adalja, Eric Toner, and Thomas V. Inglesby wrote the paper, titled “Priorities for the U.S. Health Community Responding to COVID-19.”
The doctors are all from the Johns Hopkins Center for Health Security, as well as the university’s Department of Environmental Health and Engineering.
Appearing in the journal JAMA, the article draws from experiences with similar epidemics — such as the 2009 influenza pandemic, the SARS epidemic in 2003, and the avian influenza A epidemic in 2005 — to outline key measures that the U.S. government and healthcare sector should take to deal with the new coronavirus.
Hospitals, clinics, and other facilities
First, write the authors, healthcare institutions should update preparedness plans that had been developed for the previous epidemics.
“Broadly speaking, those plans addressed the protection of healthcare workers, how to deal with staffing shortages, surges in patient numbers, triage issues, and management of scarce resources,” write Dr. Adalja and colleagues.
Second, hospitals and clinics, which have “critical roles” in the response to COVID-19, must establish clear “protocols for triaging and isolating patients suspected of having infection in emergency departments and urgent care centers.”
Importantly, write the authors, “Similar procedures need to be established in outpatient clinics, dialysis centers, and other medical facilities — especially nursing homes, assisted living centers, and long-term care facilities with particularly vulnerable populations.”
This is to prevent COVID-19 from disrupting regular treatments in medical care units, which would “compound the direct morbidity and mortality of the disease.”
Healthcare workers and ICU units
Protecting healthcare workers is another key priority in the COVID-19 response. This will require the use of personal protective equipment, updated hospital administrative policies, and special training of hospital staff, the authors note.
A considerable number of patients are likely to be severely ill, so hospitals must pay specific attention to preparing their intensive care units (ICUs), Dr. Adalja and colleagues write, explaining:
“This planning includes evaluation of ICU bed capacity, the ability to augment ICU-level bed space with alternative care sites such as step-down units and postanesthesia care units, mechanical ventilator stock and supply chains, and the logistics of isolating and cohorting patients.”
“Many hospitals operate at or near capacity already, and even an above-average flu season can cause operational disruption,” the authors point out.
Finally, the team emphasizes that — even though too little is currently known about COVID-19, and healthcare professionals will have to adapt their clinical approaches as more information becomes available — sticking to existing guidelines for pneumonia, sepsis, and acute respiratory distress syndrome (ARDS) is the best course of action.
“This may include the use of investigational antiviral or monoclonal antibody therapy,” the authors note.
More diagnostic tests needed ‘rapidly’
Furthermore, they write, clinicians must “rapidly” extend their diagnostic testing.
“To better understand the burden of COVID-19, medical and public health experts need to expand testing to all patients who have unexplained ARDS or severe pneumonia and ultimately to patients who have mild symptoms consistent with COVID-19.”
The researchers explain that the Centers for Disease Control and Prevention (CDC) — which initially performed all diagnostic tests — and public health labs do not have the capacity to perform testing on the scale that is necessary right now.
“To reach a high level testing capacity will require the major clinical diagnostic companies to develop and manufacture testing kits at large scale. Diagnostic companies may simply be able to add SARS-CoV-2 to existing nucleic acid–based respiratory viral panels or create standalone tests. Ideally, such diagnostic tests would be rapid,” the article cautions.
Also, serological assays, blood tests for specific antibodies, are necessary to help determine an accurate case fatality rate and for monitoring purposes, the authors point out.
Public health and social distancing
“From the outset, SARS-CoV-2 posed a near-impossible challenge for containment,” the team writes.
This is because the virus transmits very effectively; the authors note that the virus was “surreptitiously spreading for at least 6 weeks” and that it has “an epidemic doubling time of about 1 week.”
“As more and more countries report cases, including those with no link to the disease epicenter, it is clear that there are many more unrecognized cases in the world and that community transmission is happening in many countries.”
– Dr. Amesh A. Adalja et al.
Public health measures such as providing rapid diagnoses and isolating people with the virus are the most important actions that can slow the spread of SARS-CoV-2.
Tracking the contacts of people with the virus and placing them in quarantine may also be effective at this early stage of the epidemic.
“However, beyond a certain threshold, it will no longer be feasible to track all contacts.” At this point, actions classified as “social distancing” may be necessary. These include “cancellation of large gatherings, telecommuting to work when feasible, and school closures.”
However, such measures would come at a cost that must be accounted for. For instance, school closures would mean that “Many children who depend on school meals will not receive them, and many single parents will be out of the workforce.”
Finally, in addition to communicating health measures that everyone should take to reduce the spread of the infection, “It will also be important to communicate […] that persons who test positive for this virus but who do not need hospital care should stay at home while they are ill and not go to hospitals.”
“Hospitals may have serious challenges in handling the number of people who do need acute care, so it will be important for those who are infected but otherwise well to not contribute to hospital demands.” Dr. Adalja and colleagues conclude:
“Preparation will take time, so healthcare and public health systems need to move quickly forward in their efforts to be ready to confront this disease around the country.”
For information on how to prevent the spread of coronavirus, this CDC page provides advice.
The emergence and rapid increase in cases of coronavirus disease 2019 (COVID-19), a respiratory illness caused by a novel coronavirus, pose complex challenges to the global public health, research and medical communities, write federal scientists from NIH’s National Institute of Allergy and Infectious Diseases (NIAID) and from the Centers for Disease Control and Prevention (CDC).
In response to the outbreak, the United States and other countries instituted temporary travel restrictions, which may have slowed the spread of COVID-19 somewhat, the authors note. However, given the apparent efficiency of virus transmission, everyone should be prepared for COVID-19 to gain a foothold throughout the world, including in the United States, they add. If the disease begins to spread in U.S. communities, containment may no longer be a realistic goal and response efforts likely will need to transition to various mitigation strategies, which could include isolating ill people at home, closing schools and encouraging telework, the officials write.
“The COVID-19 outbreak is a stark reminder of the ongoing challenge of emerging and re-emerging infectious pathogens and the need for constant surveillance, prompt diagnosis and robust research to understand the basic biology of new organisms and our susceptibilities to them, as well as to develop effective countermeasures,” the authors conclude.
Here’s what you can do:
Avoid close contact with people who are sick.
Avoid touching your eyes, nose, and mouth.
Stay home when you are sick.
Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.
Keep your hands clean, and keep your distance from sick people
Unless you are already infected, face masks won’t help you
Stock up on home supplies, medicine and resources
Prepare your family, and communicate your plan
With your children, keep calm and carry on — and get the flu shot
About to go on vacation? Consider your destination and how you feel about risk
MRI scans shows showing the average measurable difference in white matter brain damage in people with low inflammatory blood test scores (below median) and those with high scores (above median).
A UCLA-led study has found that levels of six proteins in the blood can be used to gauge a person’s risk for cerebral small vessel disease, or CSVD, a brain disease that affects an estimated 11 million older adults in the U.S. CSVD can lead to dementia and stroke, but currently it can only be diagnosed with an MRI scan of the brain.
“The hope is that this will spawn a novel diagnostic test that clinicians can start to use as a quantitative measure of brain health in people who are at risk of developing cerebral small vessel disease,” said Dr. Jason Hinman, a UCLA assistant professor of neurology and lead author of the paper, which is published in the journal PLoS One.
CSVD is characterized by changes to the brain’s white matter—the areas of the brain that have a high concentration of myelin, a fatty tissue that insulates and protects the long extensions of brain cells. In CSVD, small blood vessels that snake through the white matter become damaged over time and the myelin begins to break down. This slows the communication between cells in the brain and can lead to problems with cognition and difficulty walking. And if the blood vessels become completely blocked, it can cause stroke.
The disease is also associated with a heightened risk for multiple forms of dementia, including Alzheimer’s disease.
Typically, doctors diagnose CSVD with an MRI scan after a person has experienced dementia or suffered a stroke. About a quarter of all strokes in the U.S. are associated with CSVD. But many cases of the disease go undiagnosed because of mild symptoms, such as trouble with walking or memory, that can often be attributed to normal aging.
In the new study, Hinman and colleagues focused on six proteins related to the immune system’s inflammatory response and centered on a molecule called interleukin-18, or IL-18. They hypothesized that inflammatory proteins that damage the brain in CSVD may be detectable in the bloodstream.
The researchers measured the levels of the proteins in the blood of 167 people whose average age was 76.4, and who had either normal cognition or mild cognitive impairment. As part of their voluntary participation in the study, 110 participants also underwent an MRI brain scan and 49 received a more advanced scan called diffusion tensor imaging.
People whose MRI or diffusion tensor imaging tests showed signs of CSVD had significantly higher levels of the six blood proteins, the researchers discovered. If a person had higher-than-average levels of the six inflammatory proteins, they were twice as likely to have signs of CSVD on an MRI scan and 10% more likely to very early signs of white matter damage. Moreover, for every CSVD risk factor that a person had—such as high blood pressure, diabetes, or a previous stroke—the inflammatory protein levels in their blood were twice as high, on average.
To confirm the results, the team performed the blood test in a group with a much higher risk for CSVD: 131 people who visited a UCLA Health emergency department with signs of stroke. Once again, the blood test results were correlated with white matter changes in the brain that were detected by an MRI.
“I was pleasantly surprised that we were able to associate blood stream inflammation with CSVD in two fairly different populations,” Hinman said.
In MRI reports, the changes in the brain’s white matter caused by CSVD are usually only categorized in general terms—as mild, moderate or severe. The blood test is a step forward, Hinman said, because it provides a more quantitative scale for evaluating the disease. That means the blood test can be used to follow the progression of the disease or to identify people who are candidates for prevention efforts or treatments for CSVD.
“We’re hopeful that this will set the field on more quantitative efforts for CSVD so we can better guide therapies and new interventions,” Hinman said.
Officials in China are racing to contain a deadly new strain of virus that has infected more than 2,700 people and left at least 81 dead. Chinese officials have blocked all transportation in and out of the city of Wuhan and surrounding areas, where the outbreak of the “2019 novel coronavirus” or “2019-nCoV” originated.
Five cases of the illness have been confirmed in the United States — all in people who had recently traveled from Wuhan, China. U.S. health officials confirmed the first case on Tuesday, involving a man in his 30s in Seattle. The second case was confirmed Friday in a woman in her 60s in Chicago. Health officials said she was “doing well.” Over the weekend, two additional cases were confirmed in California and one in Arizona.
The U.S. Centers for Disease Control and Prevention said Friday that more than 60 people in 22 states were being monitored for possible infection.
China locks down cities in unprecedented effort to contain coronavirus
Health officials believe the virus was initially transmitted from animals to humans, but that human-to-human transmission of the flu-like illness is now occurring.
What is a coronavirus?
Coronaviruses are a large group of viruses that can cause illnesses as minor as a cold, or as serious as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), according to the World Health Organization. They often present with pneumonia-like symptoms.
The viruses can be transmitted from animals to humans; the virus that causes SARS, for example, was originally transmitted to humans from a cat-like animal called a civet. But in some instances, as appears to be the case with this new strain of coronavirus, they can also be transmitted between humans.
The World Health Organization said there are multiple known coronaviruses circulating in animals that have not yet been transmitted to humans.
How did the new strain start?
The outbreak began in Wuhan, a city of 11 million people. Many of the early patients were reportedly linked to Hua Nan Seafood Wholesale Market, a large seafood and animal market in the city, according to CBS News’ Ramy Inocencio. But since then, a rising number of people have apparently contracted the virus without exposure to the market.
The market was closed on January 1, 2020 for “environmental sanitation and disinfection,” according to the World Health Organization.
How many people have died?
At least 81 people have died from the illness, according to Chinese officials. Most of those deaths occurred in Wuhan, which is in the central Hubei province. The first death was reported January 9.
Where is it?
While the virus originated around Wuhan, cases have also been reported in Thailand, Taiwan, Japan, South Korea, Vietnam, Malaysia, Nepal, Singapore, the U.S., Australia and France.
How is it transmitted?
It’s well-established that coronaviruses can spread from animals to humans, according to the World Health Organization. But health officials confirmed there have been cases in which this virus has spread from human to human.
Chinese state-run media quoted Zhong Nanshan, a scientist at the China’s National Health Commission, as saying such transmission was “affirmative.” The scientist did not say how many cases were the result of human-to-human transmission — but in one case, a hospital patient is said to have infected 14 medical workers, reports Inocencio.
What’s being done to stop the spread?
The World Health Organization convened an emergency committee on the virus in Geneva, Switzerland. It said Thursday that the outbreak does not rise to the level of being designated an international public health emergency, but WHO will continue working with nations to contain it.
Meanwhile in the U.S., the CDC deployed public health workers to screen passengers arriving from Wuhan at five major ports of airline entry: New York-JFK, Los Angeles, San Francisco, Atlanta and Chicago-O’Hare.
The CDC said it has developed a test to diagnose the virus. Currently, that test must be administered at the CDC, but the organization is working to share the test with domestic and international partners.
In Hong Kong, which was ravaged by SARS in 2002 and 2003, hospitals upped their alert level to “serious” and implemented temperature checkpoints for inbound travelers.
While China has closed transportation in and out of Wuhan and 12 other cities, there are concerns that as hundreds of millions of people travel around the country to celebrate the Chinese New Year, the virus could spread even faster.
“I feel like I’m being poisoned.” I will never forget the night I told my parents that I thought my breast implants were the cause of a decade’s worth of unexplained medical phenomena.
What started as a sudden onset of panic attacks 7 years ago transformed into a laundry list of debilitating mental and physical ailments that I was forced to cope with daily.
The day before my explant surgery, I tallied 49 symptoms that I was actively experiencing. I had received misdiagnoses of mental health conditions, such as panic disorder, anxiety disorder, depression, PTSD, and most recently, bipolar disorder.
I struggled with bouts of extreme insomnia, where I wouldn’t sleep at all for 2 to 3 days on end.
Doctors had prescribed pretty much every combination of SSRIs, benzos, stimulants, and sleep medications on the market. The slew of debilitating side effects from these drugs landed me in the ER too many times to count.
Physically, I experienced an onset of sudden food intolerances and allergies that caused digestive issues, such as acid reflux, GERD, and gastritis.
I lived with symptoms of autoimmune diseases, such as joint pain, swollen lymph nodes, and liver and kidney dysfunction, all with no conclusive diagnosis.
My feet and hands turned purple and were ice cold to the touch. My hair fell out in clumps in the shower, and the strands that remained were dry and brittle. My blood tests showed abnormal liver and kidney function, and my kidney grew a mass twice the size of itself. I experienced other unexplained symptoms, such as skin rashes, migraines, brain fog, and numbness and tingling in extremities.
The surgery changed everything
My entire life suffered from the toxic blow of this unexplained condition. Before I got sick, I was a college senior at USC, on the Dean’s list, with an abundance of friends. I was in a healthy relationship and involved in every extracurricular activity I could fit into my overpacked schedule.
I was headed to Nashville upon graduation to pursue my dream job of working in the entertainment industry. I was free of mental and physical ailments. It was the last time I can remember being effortlessly happy. I continually asked myself, “What happened to my old life? Will I ever get it back?”
From the outside looking in, it’s hard to understand. From the inside looking out, it’s hard to explain.
It’s difficult to put into words the dichotomy my life had become because, on the outside, I looked fine, but inside, my body was waging war on itself. The truth is that this illness took everything from me that I once recognized, admired, and valued about myself. My life bore no resemblance to the version I left behind almost a decade ago.
I spent entire days stuck in bed, ruminating on to-do lists I didn’t have the energy or motivation to begin, let alone complete. I got so anxious at times that I wanted to crawl out of my skin. Each day I woke up with the hope that today would be the beginning of a new start. I put in what felt like 150% effort, while I watched others coast along.
I went to bed every night with the notion that I hadn’t achieved nearly enough. I chalked it up to another day inside a body that wouldn’t work and a mind that couldn’t stop ruminating on the pain.
I fight for my health every day in a way most people don’t understand. I’m not lazy; I am a warrior.
At the height of my illness, I was taking five prescription medications to manage the mental symptoms alone. I was taking meds to wake up, meds to concentrate, meds to relax, and meds to fall asleep.
My entire life was chemically induced, and none of my emotions felt like my own. I was also a regular in the emergency room, thanks to the physical symptoms that accompanied this illness.
Most recently, I was brought in for stroke symptoms and unexplained bleeding from my mouth. After hours of bloodwork and imaging, I was sent home with a generic, temporary Band-Aid in the form of steroids, Benadryl, and a prescription for Xanax, but no answers.
From rock bottom came the answers
I am learning to be thankful for my rock bottom, as it was the catalyst that brought me the answers I was seeking.
I went home that night, and at an all-time low, I put out a desperate Facebook post explaining my situation. I was met with a reply from a college friend, directing me to Breast Implant Illness and Healing by Nicole.
After hours of scrolling through tens of thousands of women’s stories that sounded all too familiar to me, I reached a verdict. I was sure that my breast implants were the culprit.
“Save yourself a surgery,” the plastic surgeon who fitted my implants told me when I enquired about having my 7-year-old Mentor-brand, textured, silicone breast implants removed.
“I have been in practice for over 30 years, and you are the first person who has ever wanted them taken out. You aren’t going to like the way you look without them, and you will want them put back in.”
“I strongly believe that the proper removal of my breast implants was key to my recovery.”
I still have regrets about that day. After weeks of self-conducted research, I regret not bringing him the facts I had uncovered about certain implants. Some silicone breast implants contain carcinogens, neurotoxins, and cleaning agents, among other things.
Now, I don’t claim to have an MD, but it’s hard to believe that the almost identical symptoms that myself and thousands of other women with breast implants experienced were merely a coincidence.
There is a growing body of research suggesting that breast implants can cause autoimmune disorders in some women. The Food and Drug Administration (FDA) released a worldwide recall of Allergan textured breast implants last month in a bid “to protect women from breast implant-associated anaplastic large cell lymphoma.”
If you have breast implants, don’t panic. First, focus on identification of your symptoms and then move to explant.
I strongly believe that the proper removal of my breast implants was key to my recovery. An international list of recommended explant surgeons can be found here.
The detoxification process can take up to 2 years, so even though I have removed the source of my suffering, the symptoms still come and go like a clingy house guest who doesn’t pick up on social cues.
Recovery and rediscovering myself
I am now 2 months post-op and am already seeing improvements. Before my surgery, I had bloodwork done, and my liver enzymes were indicative of someone with lifelong alcohol dependency. Recently, my bloodwork has miraculously normalized.
The symptoms seem to be falling away one by one. The physical symptoms I mentioned, such as skin rashes, stroke symptoms, flu symptoms, and liver and kidney issues, have all gone. I have lost 30 pounds already, all of which was inflammation weight. I have even started weening myself off of antidepressants, as I feel so much stronger mentally.
For the first time in a decade, when I look in the mirror, I recognize the person staring back at me. We all have the same hours in a day, and this illness has taught me how to live them with purpose, to treasure every alert moment, and relish every second of pain free bliss. My perspective is shifting from hopeless to limitless.
The best part about recovery is when we get to rediscover ourselves, to find our passion, and to find our purpose.
I am still learning how to be thankful for my struggle because, without it, I wouldn’t have stumbled across my strength. I am learning that I’m not a victim for sharing my story, but a survivor setting the world on fire with my truth.
I am no longer ashamed of my journey, as I have emerged with an appreciation, a sensitivity, and an understanding of life that fills me with compassion, gentleness, and a deep loving concern for others.
In a society that profits from your self-doubt, liking yourself is a rebellious act.
I have learned the hard way never to let external factors dictate my sense of self-worth. If you needed to hear this today, you are beautiful just the way you are.
Your sheer existence is a miracle, and the sooner you accept that and start creating your life accordingly, the better.
A team at George Mason University, Fairfax, VA, has uncovered another electronic cigarette health concern. This time, it relates to stroke risk.
In recent years, the popularity of e-cigarettes has soared.
A 2016 study found that 10.8 million adults in the United States were current e-cigarette users. It is common for people to switch from traditional cigarettes to the e-variety because they think they are a healthier option.
But newly issued health warnings have pointed to the potential risks of smoking e-cigarettes. In June 2019, the U.S. saw an outbreak of lung injuries associated with e-cigarettes.
Experts believe that vitamin E acetate — an ingredient found in some e-cigarettes containing THC — may be the link.
In December 2019, the Centers for Disease Control and Prevention (CDC) reported that more than 2,500 individuals from the U.S., Puerto Rico, and the U.S. Virgin Islands were hospitalized or died as a result of using vapes, e-cigarettes, or associated products.
One study that appears in PNAS found that nicotine from e-cigarette smoke caused lung cancer in mice as well as precancerous growth in the bladder.
However, a second study, appearing in the Journal of the American College of Cardiology, noted a significant improvement in vascular health within a month of a traditional smoker switching to e-cigarettes.
A trend among the young
Despite their nicotine content, the variety of e-cigarette flavors available has led to the products becoming a trend among young adults. There is also a concern this habit could lead to conventional cigarette smoking.
Equally worrying findings have come from a new study that appears in the American Journal of Preventive Medicine. The study found that young adults smoking both traditional and e-cigarettes face a significantly higher risk of stroke.
Using data from the 2016-17 Behavior Risk Factor Surveillance System (BRFSS), the study examined smoking-related responses from a total of 161,529 people aged between 18 and 44.
Just over half of the respondents were female, with 50.6% identifying as white and just under a quarter identifying as Hispanic.
The team calculated the adjusted odds ratios for strokes among those who currently smoked, former smokers who now used e-cigarettes, and people who used both.
“It’s long been known that smoking cigarettes is among the most significant risk factors for stroke,” says lead investigator Tarang Parekh from George Mason University.
“Our study shows that young smokers who also use e-cigarettes put themselves at an even greater risk.”
Tarang Parekh
An important message and a ‘wake-up call’
The study identified that young adults who smoked both traditional and e-cigarettes were almost twice as likely to have a stroke compared with conventional cigarette smokers.
This risk rose to almost three times as likely when compared with non-smokers. Results also showed there was no clear advantage to switching from traditional cigarettes to e-cigarettes.
However, people using e-cigarettes who had never smoked before did not display an increased stroke risk. This may be down to factors including young age and normal heart health.
This study relied on self-reported data, which is a limitation. However, the findings prove the need for large-scale, long-term studies to confirm which detrimental health effects e-cigarettes are causing and which ingredients are responsible.
“This is an important message for young smokers who perceive e-cigarettes as less harmful and consider them a safer alternative,” Parekh states.
According to Parekh, the results are “a wake-up call” for policymakers to urgently regulate e-cigarette products “to avoid economic and population health consequences.”
“We have begun understanding the health impact of e-cigarettes and concomitant cigarette smoking, and it’s not good.” Tarang Parekh
In this special feature, we collate some of the most intriguing hypertension studies from 2019. We particularly focus on nutrition, risk factors, and hypertension’s relationship with dementia.
Today, in the United States, around 1 in 3 adults has high blood pressure, which doctors also call hypertension.
Hypertension increases the risk of cardiovascular events, such as stroke and coronary disease, and, if doctors don’t treat it, it can reduce lifespan.
Because it is worryingly prevalent, and because the physical ramifications can be significant, scientists are plowing a great deal of effort into understanding hypertension.
Although people first identified hypertension as a medical condition thousands of years ago, scientists are still picking away at the details.
Research that scientists completed in 2019 has thrown out some exciting and, in some cases, unexpected findings. For instance, a paper appearing in February concluded that, for women over 80 years of age, having “normal” blood pressure had an increased risk of mortality when compared with individuals with high blood pressure.
Elsewhere, Greek scientists concluded that napping might help reduce blood pressure. “Midday sleep appears to lower blood pressure levels at the same magnitude as other lifestyle changes,” explains one of the researchers, Dr. Manolis Kallistratos.
Another surprising study, which scientists presented at the 83rd Annual Scientific Meeting of the Japanese Circulation Society, concluded that needing to urinate multiple times at night might be a sign of hypertension.
The role of nutrition
The food that we eat has a huge impact on our overall health; that goes without saying. The America Heart Association, for instance, suggest that eating a diet rich in fruits and vegetables and avoiding products with high levels of salt and fat can help keep blood pressure in check.
Over the past few years, interest in nutrition, in general, has skyrocketed. More and more, scientists are focusing on individual foods or food compounds that can directly benefit health. So, although poor diet is a well-known risk factor for hypertension, researchers in 2019 drilled down deeper.
Specific foods and supplements
One study appearing in 2019 investigated the impact of consuming walnuts on blood pressure. It concluded that the individuals who ate an experimental walnut-heavy diet experienced a significant reduction in blood pressure.
In these types of studies, it is worth digging a little deeper; often, industry or organizations who might stand to benefit from positive results are funding them. The walnut study above, for instance, was partly funded by the California Walnut Commission.
This observation does not mean that we should dismiss the results out of hand, but it provides pause for thought.
Another recent study concentrated on spirulina, which is the dried biomass of a bacterium called Spirulina platensis. Manufacturers can add it to foods, and some people take it as a supplement.
Earlier experiments hinted at spirulina’s potential to reduce hypertension, and in the most recent study, they attempted to find out why this might be.
The scientists concluded that a protein that the digestion of spirulina produces causes blood vessels to relax. The authors hope that this protein, known as SP6, might one day be useful in the treatment of hypertension.
Preservatives, additives, and water
Rather than focus on specific foods, a further study looked at the impact of buying food from local retailers rather than supermarkets.
The authors theorized that by eating local produce, individuals would avoid consuming the various preservatives and additives that keep food “fresh” over long distances.
Although the study was relatively small, the authors found that after 6 months, those who consumed local produce had lower levels of visceral fat, improved depression scores, and reduced systolic blood pressure.
Approaching from a different angle, a team of scientists recently asked whether drinking water that is high in minerals might reduce blood pressure.
To investigate, they focused on people living in a coastal region of Bangladesh. Drinking water there varies in salinity. In areas of high salinity, the water contains greater quantities of sodium, which we know increases blood pressure. However, the same water also includes more magnesium and calcium, both of which reduce blood pressure.
The authors concluded that higher salinity levels decreased blood pressure overall; they write that “the [blood pressure]-lowering effects of [calcium] and [magnesium] counteracted the harmful effects of [sodium].
Causes and risk factors
Some risk factors for hypertension are fairly well established; they include drinking excessive amounts of alcohol, smoking tobacco, stress, and obesity. However, because high blood pressure is so common, there are likely to be many more factors at play.
Similarly, although scientists know which lifestyle and dietary factors influence blood pressure, they are not entirely sure how they cause the changes.
Understanding why and how blood pressure arises in some people and not others is essential and could, potentially, lead to innovative ways of treating or preventing hypertension.
Some scientists are exploring possible risk factors which, at face value, seem unlikely. For instance, one paper, appearing in the Journal of Public Health in June, examined the role of where people live.
Earlier studies found an association between exposure to air pollution and hypertension risk, and this latest work confirms those earlier suspicions and takes it a step further.
As expected, the researchers found a relationship between air pollution and hypertension; however, the increase in risk was only significant for those who were living in multi-family homes, such as blocks of flats.
The authors believe that this might be due to several factors, for instance, living in close quarters with other people may be more stressful or more noisy. This study provides a glimpse of the complex realm of potential elements that might influence blood pressure.
Oral hygiene
Bizarrely, one group of scientists recently investigated how mouthwash might influence hypertension risk.
Publishing their findings in the journal Frontiers in Cellular and Infection Microbiology, the authors conclude that mouthwash kills “good bacteria” in the mouth. These good bacteria produce nitric oxide (NO), which is important for blood vessel health.
NO acts as a vasodilator, which means it causes the muscles that line blood vessels to relax, thereby widening the vessels and reducing blood pressure.
In particular, the scientists concentrated on the chemical chlorhexidine, which they found in some mouthwashes.
According to the authors, they demonstrated that “twice-daily chlorhexidine usage was associated with a significant increase in systolic blood pressure after 1 week of use, and recovery from use resulted in an enrichment in nitrate-reducing bacteria on the tongue.”
Still focusing on the oral region, a 2019 review looked for links between gum disease and hypertension. They showed that individuals with severe periodontitis — a form of gum disease — had a 49% increased risk of hypertension.
Senior author Prof. Francesco D’Aiuto explains their results in a nutshell: “We observed a linear association — the more severe periodontitis is, the higher the probability of hypertension.”
The role of zinc
Another project investigated the role of zinc in maintaining blood pressure at healthy levels. Over the years, researchers have noted links between low zinc levels and an increased risk of high blood pressure, but the precise mechanism has been tough to pin down.
The latest research identified the key player in this interaction between zinc and blood pressure; according to the authors, the sodium chloride cotransporter (NCC) in the kidney is the lynchpin. The NCC is responsible for pumping sodium back into the body, thereby preventing it from being excreted in the urine.
Zinc interacts with the NCC: when zinc is present, the NCC is less active, meaning that the body retains less sodium. This is important because high sodium levels — from consuming too much salt, for instance — are factors in increasing the risk of hypertension.
The authors hope that this new knowledge will help improve treatment and write:
“Understanding the specific mechanisms by which [zinc deficiency] contributes to [blood pressure] dysregulation may have an important effect on the treatment of hypertension in chronic disease settings.”
Hypertension and dementia
Scientists have identified a relationship between hypertension and vascular dementia. The association makes sense because vascular dementia can occur following stroke, and hypertension is a risk factor for stroke.
However, it also appears that hypertension might increase the risk of other types of dementia, including Alzheimer’s disease.
A study appearing in June this year found that a common blood pressure drug — nilvadipine — slowed the progress of Alzheimer’s disease by improving blood flow in the brain.
Specifically, the research team showed that people who took the medication had a 20% increase in blood flow in the hippocampus, a brain region vital for memory and learning, in comparison to those who did not take nilvadipine.
Patterns throughout life
Other scientists have looked at fluctuations in blood pressure and their possible role in dementia. For instance, one investigation that recruited participants who were living with Alzheimer’s disease found that the condition progressed quicker in those whose blood pressure fluctuated most.
“More fluctuations [in blood pressure] might affect whether cognitive function declines more slowly or rapidly.”
Senior author Dr. Jurgen Claassen
With a similar theme, another group of scientists observed the pattern of blood pressure across decades. The authors summarize their findings:
“[A] pattern of sustained hypertension from middle to late life and a pattern of midlife hypertension followed by late-life hypotension were associated with an increased risk for subsequent dementia, compared with participants who maintained normal blood pressure.”
Another project that charted hypertension over a lifespan found that individuals with high or rising blood pressure between 36 and 53 years of age were more likely to have white matter lesions and a smaller brain volume in later life.
The authors hope that these findings will inspire both doctors and the public to check and take charge of their blood pressure sooner rather than later.
As 2020 rolls into view, hypertension is sure to stay high on the medical research agenda. As science gradually untangles hypertension’s causes and mechanisms, managing and minimizing this highly prevalent condition must draw ever closer.
As the incidence of diabetes continues to increase globally, the fight against this chronic condition continues. New research explains not only what triggers type 2 diabetes but also how to reverse the condition. The findings also shed light on what leads to remission after reversal for some people.
Between 1980 and 2014, the number of people living with diabetes across the world increased from about 108 million to 422 million.
As many as 90% of these individuals have type 2 diabetes.
Pharmacological interventions have done little to stop what some have referred to as the diabetes pandemic.
Lifestyle interventions, however, may succeed where other approaches have failed.
A couple of years ago, Medical News Today reported on the first results of a clinical trial, which showed that intensive weight loss programs could help people with type 2 diabetes achieve remission without taking any medication.
The trail was called the Diabetes Remission Clinical Trial (DiRECT), and one of its co-leaders was Prof. Roy Taylor from Newcastle University in the United Kingdom.
But how does this remission occur, and can it last in the long term? Why do some people achieve lasting remission while for others, the condition returns?
Prof. Taylor set out with his team to answer these questions, using data from the DiRECT trial and applying cutting-edge imaging and blood monitoring techniques.
The researchers published their findings in the journal Cell Metabolism.
Testing the ‘twin cycle hypothesis’
The study aimed to test — and confirm — the so-called twin cycle hypothesis, which Prof. Taylor and team put forth more than a decade ago.
The theory proposed that type 2 diabetes results from the accumulation of fat in the liver, which induces insulin resistance and increases blood sugar production.
These effects, in turn, increase plasma insulin levels, precipitating “a self-reinforcing cycle” in which insulin stimulates fat production.
These increased levels of liver fat cause the lipids to overspill into several tissues, including the pancreas.
Beta-cells, which are responsible for creating insulin, are located in the pancreas. “Long-term exposure to saturated fatty acids is harmful to [beta]-cells,” write the authors.
In the present study, the authors investigated the predictions of the twin cycle hypothesis 2 years into the DiRECT trial.
The researchers wanted to “describe the pathophysiologic processes underlying the recurrence of type 2 diabetes in the group that initially achieved remission but then relapsed back to diabetes.”
To this end, the researchers quantified intra-organ and abdominal fat using cutting-edge MRI scans at 12 and 24 months. They looked at pancreatic and liver fat, specifically.
The analysis included measurements of glucose, HbA1c, high-density lipoprotein (HDL) cholesterol, and triglycerides. The team also analyzed fatty acids, insulin secretion, and beta-cell function.
When liver fat ‘clogs up’ the pancreas
The study revealed that the majority of the trial participants maintained remission over the 2 years but that this was only possible if liver triglycerides and fat in the pancreas remained low.
Specifically, almost 9 out of 10 participants who managed to lose 15 kilograms or more in the DiRECT trial reversed their condition.
After 2 years, more than one-third of these individuals had been free of diabetes and the need for diabetes medication for at least 24 months.
A small group, however, experienced relapse, which was associated with a return to high liver triglycerides and high intrapancreatic fat levels.
Prof. Taylor explains: “We saw that when a person accumulates too much fat, which should be stored under the skin, then it has to go elsewhere in the body. The amount that can be stored under the skin varies from person to person, indicating a ‘personal fat threshold’ above which fat can cause mischief.”
“When fat cannot be safely stored under the skin, it is then stored inside the liver and overspills to the rest of the body, including the pancreas. This ‘clogs up’ the pancreas, switching off the genes [that] direct how insulin should effectively be produced, and this causes type 2 diabetes.”
Prof. Roy Taylor
‘Diet and persistence’ can reverse diabetes
“This means we can now see type 2 diabetes as a simple condition where the individual has accumulated more fat than they can cope with,” continues the author, stressing the hopeful implications of this finding.
“Importantly, this means that through diet and persistence, patients are able to lose the fat and potentially reverse their diabetes. The sooner this is done after diagnosis, the more likely it is that remission can be achieved.”
“For the first time,” conclude Prof. Taylor and team in their paper, “we are able to report the underlying physiologic changes during a full cycle of disease reversal and re-emergence.”
In the U.K., the National Health Service (NHS) will roll out a program that will test the weight loss therapy in thousands of people living with type 2 diabetes.
In a new study, researchers have found the mechanisms through which high levels of blood lipids could lead to inflammation and, over time, more serious consequences, such as organ damage.
Inflammation is both caused by and a risk factor for many conditions. These include obesity, diabetes, and cardiovascular problems.
One of the greatest reasons for inflammation is infection. When the body senses that dangerous foreign microorganisms, such as bacteria, have entered it, it unleashes an immune response. Inflammation is a key part of that response.
This turn of events is natural and usually helps maintain a state of health. Sometimes, however, inflammation occurs for reasons other than infection, and it may persist abnormally, leading to different types of damage.
In a new study, the results of which feature in the journal Nature Immunology
,Dr. Timo Speer and colleagues — from Saarland University in Saarbrücken, Germany — closed in on a factor that they say causes unhealthful inflammation: high triglyceride levels, which are a measure of blood fat.
The study uncovered the mechanisms through which high blood fat can lead to inflammation — which, in turn, can affect other biological processes, potentially leading to organ and blood vessel damage.
High blood fats linked to higher death risk
The researchers conducted their study first in vitro, and then in mouse models, before studying the relevant mechanisms in human participants. They focused their research on a key inflammasome complex: nod-like receptor family pyrin domain-containing 3 (NLRP3).
This is a protein complex that plays a crucial role in activating the body’s immune response. Dr. Speer and team wanted to find out what could mistakenly set NLRP3 into motion. Their preliminary efforts revealed that abnormally high lipid levels — and, specifically, high levels of triglycerides — were responsible for harmful inflammation.
How? The researchers found that apolipoprotein C3 — a protein the liver secretes that is also present on triglyceride-rich lipoproteins — activates NLRP3, thereby triggering inflammation.
In mouse models, high apolipoprotein C3 concentrations led to organ damage, the researchers saw.
Working with human participants — some with chronic kidney disease and some with a history of heart attack — the researchers found that higher apolipoprotein C3 may contribute to kidney damage as well as vascular problems.
High apolipoprotein C3 levels were also associated with an increased risk of mortality from all causes.
“Our work has involved studying a special group of lipids, the triglycerides. We’ve been able to show that when these naturally occurring fats are present at elevated concentrations they can alter our defence cells in such a way that the body reacts as if responding to a bacterial infection,” explains Dr. Speer.
“This leads to inflammation, which, if it becomes chronic, can damage the kidneys or cause atherosclerosis — the narrowing of arteries due to a buildup of deposits on the inner arterial wall. And atherosclerosis is one of the main causes of heart attacks and strokes.”
Dr. Timo Speer
These findings, the researchers argue, suggest that by targeting excessive apolipoprotein C3, specialists may eventually be able to fight unhealthful inflammation.
It will also be important, they say, to focus on the ways in which diet can affect levels of blood fats. “Put another way, we can now say that adopting a low fat diet can significantly extend the life expectancy of high risk patients, such as those with diabetes or those whose blood pressure is too high,” notes Dr. Speer.
This is because blood triglyceride levels tend to increase in people with high fat diets.
“As a result of biochemical changes, the triglycerides develop toxic properties that activate the body’s innate immune system. This initiates a series of self-destructive processes, including those in which the walls of the arteries are attacked and the blood vessels become occluded, reducing blood flow,” Dr. Speer adds.
Nevertheless, he concludes that he and his colleagues “hope that their results will help in developing new strategies for treating and preventing these life threatening diseases.”
