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Hepatitis C virus (HCV) and HIV causes inflammation, affecting organs, bones and cardiovascular system

Viral infection with hepatitis C virus (HCV) and HIV causes inflammation, a natural response by the immune system as it seeks to deal with invading germs. However, sometimes the sheer number of germs overwhelms the immune system or at other times the germs are able to subvert the immune system’s response to infection. In such cases, the germs spread and infection takes hold. This can be the case with viral infections and when such an infection becomes established in the body, it becomes a chronic infection.
Even in cases of chronic viral infections the immune system tries to fight the infection, but inflammation that may have been useful in the initial stages of exposure becomes a problem if it is sustained over the long-term.
The immune system and its cells are widely distributed throughout the body and found within many organ-systems such as the following:
• brain
• bones
• cardiovascular system
• liver
• lungs
• kidneys
A chronic viral infection with its associated inflammation of the immune system is likely to cause inflammation-related problems for these organ-systems.
HCV and bones
The inflammation caused by chronic HCV infection affects the liver, causing this organ to become dysfunctional and injured. HCV can also cause other problems; for instance, some studies have found thinner-than-normal bones in some HCV-positive people.
Some researchers think that this problem of bone thinning in HCV infection arises in part because of complications of liver injury and chronic liver inflammation. An injured and inflamed liver could result in reduced levels of the hormones estrogen and testosterone. These hormones play an important role in maintaining the health of bones. Also, a dysfunctional liver may not be able to convert vitamin D to its active form. This may affect the body’s ability to absorb and retain nutrients such as calcium and phosphorus, which are needed to build bones.
HIV and bones
Potent combination anti-HIV therapy (commonly called ART or HAART) can also temporarily decrease the thickness of bones (called bone mineral density) in the first few years of use. However, after this, bone mineral density tends to stabilize. The reason for the initially decreased bone mineral density under ART is not yet clear. But the benefits of ART continue to greatly outweigh the risks.
Focus on the hips
A team of researchers in the U.S. has grown concerned about the strength of bones in the hips of people with HCV, HIV or both viral infections. Among HIV-negative people, when hip bones/joints become broken their survival subsequently decreases. Moreover, the U.S. researchers noted:
“Hip fractures cause significant pain and disability and typically require an emergency department visit, hospitalization, surgery and rehabilitation stay, resulting in substantial healthcare costs.”
The U.S. research team (based at the University of Pennsylvania) conducted a massive study of three million people, both with and without different viral infections. They found that people co-infected with HIV and HCV were at greatest risk of hip fracture compared to participants with HCV infection alone (monoinfection) or to people who had neither infection.
This study underscores the need to understand why thinning bones, particularly in the hips, occur in people with HIV, HCV or both. Furthermore, ways to improve the bone health of people with chronic viral infections are needed.
Study details
Researchers at hospitals in Philadelphia and Boston collaborated on a massive cohort study, analysing health related-information collected from adults using the U.S. Medicaid program in the following states:
• California
• Florida
• New York
• Ohio
• Pennsylvania
The research team compared data assembled on each person with HCV monoinfection, HIV monoinfection and both infections (co-infection) and compared them to health-related data collected from up to 10 randomly selected people without viral infections.
The researchers analysed data collected from more than three million people distributed as follows:
• HCV monoinfection – 276,901 participants
• HIV monoinfection – 95,827 participants
• HIV-HCV co-infection – 36,950 participants
• uninfected people – 2,744,075 participants
On average, participants were in their early 40s, and 60% were men and 40% women. They were monitored for up to seven years.
Results—Other conditions and medicines
The study team found that it was relatively common for HCV-positive people to have been diagnosed with conditions that were either associated with severely thin bones (osteoporosis) or a risk of falling, including the following:
• alcoholism
• asthma
• cardiovascular disease
• type II diabetes
• kidney disease
• excessive levels of parathyroid hormone
• rheumatoid arthritis
They also found that participants with HCV monoinfection were more likely than other groups in the study to have received medicines associated with thinning bones, including the following drugs:
• corticosteroids
• a group of acid-reducing agents called proton pump inhibitors
Results—Comparing fracture risks between people with and without HCV
Overall, HCV-positive people had a 47% increased risk of hip fracture compared to uninfected people. However, it is important to note that this risk varied, in some cases, by factors such as age and gender among HCV-positive people, as follows:
Age – more than 70 years
No increased risk of hip fractures due to HCV monoinfection were seen.
Age – less than 70 years
There was an increased risk for hip fracture due to HCV monoinfection.
Age – 18 to 39 years
There was nearly a four-fold increased risk for hip fracture among women and slightly more than a two-fold increased risk for men.
Results—Comparing fracture risks between co-infected and uninfected people
Overall, ART-treated participants had a greater risk for hip fracture (about two-fold) compared to uninfected people. In general, for co-infected men and women fracture risk rose with age.
Results—Comparing fracture risks between co-infected people and people with HIV monoinfection
Overall, ART-using co-infected participants had a greater risk for hip fracture than ART-using participants with HIV monoinfection. This increased risk differed by gender, with co-infected ART-using women having a 76% increased risk and co-infected ART-using men having a 36% increased risk for hip fracture.
Results—Comparing fracture risks between co-infected people and people with HCV monoinfection
Among all HIV-HCV co-infected people, there was a 38% increased risk for hip fracture compared to HCV-monoinfected people.
Key findings
1. HIV-HCV co-infected people who use ART have increased risk for hip fractures compared to the following groups of people:
• HCV monoinfection
• HIV moninfection + use of ART
• people who have neither HIV nor HCV
2. HCV-monoinfected people have increased risk for hip fracture compared to people without HCV (or HIV) who are under the age of 70.
Viral infections and bones
Researchers are not certain why there was an increased risk for hip fractures among HCV-positive people. We have already mentioned the potential impact of chronic inflammation and liver injury on bone health. However, more research needs to be done to fully understand the general impact of chronic HCV infection on bone health.
Other factors that could have affected bone health
The research team noted that certain factors that are relatively common among some HCV-positive people could also play a role in the loss of bone mineral density, including the following:
• use of street drugs
• smoking
• excessive intake of alcohol
• poor nutrition
• length of time infected with HCV or HIV
Their data set did not include these missing factors and that is one weakness that may have affected the study’s conclusions.
Focus on HIV and its treatment
Other studies have found that HIV-positive people (and even some people at high risk for HIV infection) tend to have reduced bone mineral density. The reason(s) for this are not clear. Chronic HIV infection also causes inflammation that is only partially reduced with treatment. Less-than-optimal levels of vitamin D are also relatively common in HIV-positive people. Deficiencies of testosterone, reduced muscle mass and perhaps other factors could play a role in thinning bones as well.
The researchers attempted to assess the impact on bone health of anti-HIV drugs that were prescribed for participants’ initial treatment. However, due to built-in limitations of the study’s retrospective design, researchers cannot draw firm conclusions about the long-term impact of such drugs on the risk of hip fracture.
Size and strengths
The study is unusual because of its immense size, and this is a great strength. That the researchers compared different groups of people with and without different viral infections is another strength. The study’s findings are generally sound—there is an increased risk for hip fractures among people with HCV infection, including people who are co-infected with HCV and HIV. A previous French study has also found an increased risk for fractures among co-infected people.
Now other research teams need to investigate precisely why HCV is associated with reduced bone mineral density and explore interventions that can improve bone health in people with HCV monoinfection as well as those with HCV-HIV co-infection.
Resources:
TreatmentUpdate 189 – issues related to bone health
Boning up on bone health—The Positive Side
Good to the bone—The Positive Side
Osteoporosis Canada
Sean R. Hosein
REFERENCES:
1. Lo Re V 3rd, Volk J, Newcomb CW, et al. Risk of hip fracture associated with hepatitis C virus infection and hepatitis C/human immunodeficiency virus coinfection. Hepatology. 2012 Nov;56(5):1688-98.
2. Li Vecchi V, Soresi M, Giannitrapani L, et al. Dairy calcium intake and lifestyle risk factors for bone loss in HIV-infected and uninfected Mediterranean subjects. BMC Infectious Diseases. 2012 Aug 15;12:192.
3. Walker Harris V, Sutcliffe CG, et al. Hip bone geometry in HIV/HCV-co-infected men and healthy controls. Osteoporosis International. 2012 Jun;23(6):1779-87.
4. Collin F, Duval X, Le Moing V, et al. Ten-year incidence and risk factors of bone fractures in a cohort of treated HIV1-infected adults. AIDS. 2009 May 15;23(8):1021-4.
5. Grijsen ML, Vrouenraets SM, Wit FW, et al. Low bone mineral density in men who have sex with men regardless of HIV status. Journal of Infectious Diseases. 2012; in press.

http://www.catie.ca/en/catienews/2012-11-22/viral-infections-hep-c-and-hiv-linked-hip-fractures

For energy metabolism, consume protein- rich foods (6 functional amino acids); brain uses 20% of the energy from food

Energy MetabolismOf the 20 amino acids required for protein synthesis, six of them (arginine, cysteine, glutamine, leucine, proline, and tryptophan), collectively known as the functional amino acids, regulate key metabolic pathways involved in cellular growth, and development, as well as other important biological processes such as immunity and reproduction.

Note:
Intense exercise decreases the plasma glutamine concentration and this may be related to immunosuppression.
Several researches found the efficacy of L-arginine and nitric oxide on penile erection, fixing erectile dysfunction.
For example, leucine activates mTOR signaling and increases protein synthesis, leading to lymphocyte proliferation. Therefore, a lack of leucine can compromise immune function. Metabolic pathways interrelated with the biosynthesis and degradation of these amino acids include vitamin and cofactor biosynthesis (such as SAM or S-Adenosyl Methionine) as well as neurotransmitter metabolism (such as glutamate).

Leucine food sources Leucine content (grams/ 100 gram food)
Soybeans, mature seeds, raw 2.97
lentils, raw 2.03
cowpea, catjang, mature seeds, raw 1.83
Beef, round, top round, separable lean and fat, trimmed to 1/8″ fat, select, raw 1.76
Beef, top sirloin, separable lean only, trimmed to 1/8″ fat, choice, raw 1.74
Peanuts, all types, raw 1.67
Salami, Italian, pork 1.63
Fish, salmon, pink, raw
1.62
Crustaceans, shrimp, mixed species, raw 1.61
Chicken, broilers or fryers, thigh, meat only, raw 1.48
Nuts, almonds 1.47
Egg, yolk, raw, fresh 1.40
Chickpeas (garbanzo beans, bengal gram), mature seeds, raw 1.37
Seeds, sesame butter, tahini, from raw and stone ground kernels 1.36
Chicken, broilers or fryers, wing, meat and skin, raw 1.29
flax seed, raw
1.24
Nuts, walnuts, english 1.17
Egg, whole, raw, fresh 1.09
Egg, white, raw, fresh 1.02
Sausage, Italian, pork, raw 0.96
Milk, sheep, fluid 0.59
Pork, fresh, separable fat, raw 0.40
Hummus 0.35
Milk, goat, fluid 0.31
Milk, whole, 3.25% milkfat 0.27
Soy milk, fluid 0.24
asparagus 0.13
Snap beans, green, raw 0.11
Milk, human, mature, fluid 0.10

Amino Acid L-Arginine, Nitric Oxide, and Erectile Dysfunction
Last Updated on Thursday, 05 April 2012 15:20
According to the National Health Institute (NIH) Consensus Development Panel on Impotence, erectile dysfunction (ED) is defined as the persistent inability to achieve and/or maintain an erection sufficient for satisfactory sexual performance.
Causes of erectile dysfunction may be psychological and physiological factors (neurogenic, vascular, endocrine causes). It may also be a side effect of drugs and a symptom of health complications such as diabetes.
Penile erection occurs as a result of increased blood inflow to the penis, engorgement with blood, and decreased outflow of blood from the penis. Primarily, this process is mediated by nitric oxide, which is a neurotransmitter and vasodilator. Nitric oxide is synthesized from L-arginine.

Several researches on the efficacy of L-arginine and nitric oxide on penile erection, fixing erectile dysfunction, have reported positive effects of both chemicals in stimulating and maintaining erection. For example, a study reported that 80 % of men (out of 40, age group 25 – 45) with erectile dysfunction treated with L-arginine (dosage: 1.7 g/ day) and Pycnogenol, an extract from French maritime pine bark (Pinus pinaster), (dosage: 80 mg/day) recovered from their erectile dysfunction after one month of treatment. Pycnogenol, also an antioxidant, stimulates synthesis of nitric oxide from L-arginine. The researchers reported that there was no side effect associated with the supplements.

In another double-blind, placebo-controlled, clinical research on the effect and safety of the combination of 6 g of L-arginine glutamate and 6 mg of yohimbine hydrochloride with that of 6 mg of yohimbine hydrochloride alone and that of placebo alone, for the treatment of erectile dysfunction (ED), it was reported that combined oral administration of the L-arginine glutamate ( 6 g) and yohimbine (6 mg) was effective in improving erectile function in patients with mild to moderate erectile dysfunction (ED).

Herbs and sexuality:
Yohimbe: health benefits and side effects
Ginseng: health benefits and side effects
Ginkgo Biloba: health benefits and side effects

Erectile dysfunction related articles:
What is erectile dysfunction? How does erection occur?
What are the causes of erectile dysfunction?
What are the treatments for erectile dysfunction?

References:

Stanislavov, R. and Nikolova. 2003. Treatment of Erectile Dysfunction with Pycnogenol and L-arginine. Journal of Sex and Marital Therapy, 29(3): 207 – 213.

Basu, A. and Ryder, R. E. J. 2004. New Treatment Options for Erectile Dysfunction in Patients with Diabetes Mellitus. Drugs, 64(23): 2667 – 2688.

Toda, N. Ayajiki, K. Okamura, T. 2005. Nitric Oxide and Penile Erectile Function. Pharmacology and Therapeutics, 106: 233 – 266.

Lebret, T., Hervéa, J. M., Gornyb, P., Worcelc, M. and Botto, H. 2002. Efficacy and Safety of a Novel Combination of L-Arginine Glutamate and Yohimbine Hydrochloride: A New Oral Therapy for Erectile Dysfunction. European Urology 41(6): 608-613.

Functions of non-essential amino acids

The following list includse the 12 non-essential amino acids. Included is a some of the functions and benefits and side effects (if any) of the amino acids.

Alanine: Removes toxic substances released from breakdown of muscle protein during intensive exercise. Side effects: Excessive alanine level in the body is associated with chronic fatigue.
Cysteine: Component of protein type abundant in nails, skin and hair. It acts as antioxidant (free radical scavenger), and has synergetic effect when taken with other antioxidants such as vitamin E and selenium.
Cystine: The same as cysteine, it aids in removal of toxins and formation of skin.
Glutamine: Promotes healthy brain function. It is also necessary for the synthesis of RNA and DNA molecules.
Glutathione: Is antioxidant and has anti-aging effect. It is useful in removal of toxins.
Glycine: Component of skin and is beneficial for wound healing. It acts as neurotransmitter. The side effect of high level glycine in the body is that it may cause fatigue.
Histidine: Important for the synthesis of red and white blood cells. It is a precursor for histamine which is good for sexual arousal. Improve blood flow. Side effects of high dosage of histidine include stress and anxiety.
Serine: Constituent of brain proteins and aids in the synthesis of immune system proteins. It is also good for muscle growth.
Taurine: Necessary for proper brain function and synthesis of amino acids. It is important in the assimilation of mineral nutrients such as magnesium, calcium and potassium.
Threonine: Balances protein level in the body. It promotes immune system. It is also beneficial for the synthesis of tooth enamel and collagen.
Asparagine: It helps promote equilibrium in the central nervous system—aids in balancing state of emotion.
Apartic acid: Enhances stamina, aids in removal of toxins and ammonia from the body, and beneficial in the synthesis of proteins involved in the immune system.
Proline: plays role in intracellular signalling.
L-arginine: plays role in blood vessel relaxation, stimulating and maintaining erection in men, production of ejaculate, and removal of excess ammonia from the body.

A list of sample of high or low protein food sources is below:
Protein food source Estimated protein content
½ cup tofu
14 g
½ cup legumes 7 g
2 ounce lean meat, fish, poultry 14 g
1-2 ounces of nuts 14 g
1 slice of bread 3 g
1 cup raw vegetables 2 g

Maintenance of Immunity
It is generally believed that moderate exercise enhances immunocompetence and is effective for the prevention of inflammatory diseases, infection, and cancer, while excessive physical activity leads to immunosuppression and an increase of inflammatory and allergic disorders.

Susceptibility to infections following excessive physical activity is ascribed to an increase in the production of immunosuppressive factors such as adrenocortical hormones and anti-inflammatory cytokines, leading to a decrease in the number and activity of circulating natural killer cells and T cells as well as a lower IgA concentration in the saliva.
Therefore, athletes performing high-intensity training are exposed to the risk of impaired immunocompetence. Intake of carbohydrates during prolonged exercise at submaximal intensity attenuates the increase of plasma cortisol and cytokine levels after exercise, which could lead to the inhibition of immunosuppression.
Vitamin C and vitamin E have actions that promote immunity, and are essential for T cell differentiation and for maintenance of T cell function.
However, there is limited evidence about the effects of vitamins supplementation on immune function in relation to exercise.
Glutamine is an important energy source for lymphocytes, macrophages, and neutrophils, and is also an essential amino acid for the differentiation and growth of these cells.
Intense exercise decreases the plasma glutamine concentration and this may be related to immunosuppression.
Castell et al. reported that athletes who ingested glutamine had a lower infection rate after a marathon compared with the placebo group. They also demonstrated that intake of glutamine resulted in an increase of the T-helper/T-suppressor cell ratio.
Furthermore, glutamine enhances the activity of intestinal enterobacteria and inhibits the production of cytokines involved in inflammation or immunosuppression.
Conclusion
Due to a social background that includes changes of dietary habits, an aging population, and increased medical costs, people have shown a growing interest in health and have come to expect complex and diverse actions of foods.
In recent years, various food factors that fulfill such requirements have been evaluated scientifically to determine whether they are any physiological effects like prevention of diseases.

In the sports market, a variety of functional foods are available, but among these functional foods, some have not clearly demonstrated any efficacy and others are advertised with inappropriate and exaggerated claims, so consumers are often confused. Some of the food components described in this article should be studied further because of differing views with regard to their efficacy in different reports.

Furthermore, the effectiveness of the components may differ according to gender, between individuals, and with the mode of ingestion, so that the optimum method of intake the quantity and quality of foods to be ingested, and the timing of their intake need to be established in accordance with the purpose of using each food or food component, after understanding the physiological changes by exercise.

In the future, guidelines for the use and evaluation system of sports functional foods should be established with backing by clear scientific evidence related to the individual foods.
Wataru Aoi1 ,2 , Yuji Naito3 and Toshikazu Yoshikawa2 ,3
1Research Center for Sports Medicine, Doshisha University, Kyoto 602-8580, Japan
2Department of Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
3Department of Medical Proteomics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan

Nutrition Journal 2006, 5:15 doi:10.1186/1475-2891-5-15

Iodine prevents cancer growth; up avocado and reduce caffeine intake to prevent Thyroid cancer

The thyroid gland synthesizes thyroid hormones and iodine is an essential trace mineral that is crucial for the thyroid to function properly. An adequate amount of iodine in your diet ensures the thyroid is able to manage metabolism, detoxification, growth and development.
Research has shown that a lack of dietary iodine may lead to enlargement of the thyroid gland, lethargy, fatigue, weakness of the immune system, slow metabolism, autism, weight gain and possibly even mental states such as anxiety and depression.
The good news is that there are many popular foods with iodine, all of which are easy to incorporate into your daily diet.
The Recommended Daily Allowance (RDA) for iodine is 150 micrograms daily for everybody over the age of 14. The RDA for children ages 1-8 is 90/mcg every day, ages 9-13 is 120/mcg every day. If you’re pregnant or breastfeeding, it is recommended that you get 290/mcg every day.

1. Sea Vegetables

The ocean hosts the largest storehouse of iodine foods, including Kelp, Arame, Hiziki, Kombu, and Wakame. Kelp has the highest amount of iodine of any food on the planet and just one serving offers 4 times the daily minimum requirement. 1 tablespoon of Kelp contains about 2000/mcg of iodine, 1 tablespoon of Arame contains about 730/mcg of iodine, 1 tablespoon of Hiziki contains about 780/mcg of iodine, 1 one inch piece of Kombu contains about 1450/mcg of iodine, 1 tablespoon of Wakame contains about 80/mcg of iodine. I recommend sprinkling these into soups or salads.

2. Cranberries

This antioxidant rich fruit is another great source of iodine. About 4 ounces of cranberries contain approximately 400/mcg of iodine. I recommend buying fresh organic berries or juice. If you buy cranberry juice from the store, be aware of how much sugar it contains.

3. Organic Yogurt

A natural probiotic, yogurt is an excellent iodine food you should add to your diet. One serving holds more than half of your daily needs. 1 cup contains approximately 90/mcg of iodine. Other than yogurt, here is a list of probiotic foods you should consider incorporating into your diet for added health benefits.

4. Organic Navy Beans

Many beans are a great food source of iodine and navy beans may top the list. Just 1/2 cup of these beans contain about 32/mcg of iodine. Beans aren’t just an iodine food, they are also incredibly high in fiber.

5. Organic Strawberries

This tasty red fruit packs up to 10% of your daily iodine needs in just a single serving. One cup of fresh strawberries has approximately 13/mcg of iodine. Try buying fresh, organic strawberries from your local farmer’s market, they do not disappoint!

6. Himalayan Crystal Salt

This form of salt, also known as gray salt, is an excellent source of naturally-occurring iodine. While many types of table salt are iodine-enriched, they are also stripped of all their natural health properties and are chemically processed. Just one gram of himalayan salt contains approximately 500/mcg of iodine.

7. Dairy Products

Milk and cheese are good sources of iodine, just one cup of milk holds around 55/mcg. To avoid many of the negative digestive effects of eating cow’s milk and cheese, I personally would recommend opting for raw organic goat’s milk and goat’s cheese; a healthier alternative for extracting iodine from dairy.

8. Potatoes with skin

The common potato is an easy addition to most meals and is one of the richest sources of iodine in the vegetable kingdom. Leave the skin on and one medium-sized baked potato holds 60/mcg of iodine.

9. Good foods stimulating thyroid tissue: Some foods and drinks have an opposite effect on the thyroid gland; that is, they stimulate thyroid function rather than suppressing it, examples being avocado and saturated fat.

Iodine Supplements

If you’re not a fan of the iodine foods listed above, then you can always take an iodine supplement. There are many different types of iodine supplements on the market, so knowing the differences between each is vital. I recommend a transformative nano-colloidal detoxified nascent iodine supplement, which the body is quickly able to turn into its own effective mineral iodides for maximum absorption.
-Dr. Edward F. Group III, DC, ND, DACBN, DABFM
Note: Avoid Bromine (new car, swimming pools, other products), toxic metals, and Goitrogenic (raw) foods, plants with pesticides and chemical sprays and hormone-feed animal meat/products.

Goitrogenic drugs and chemicals

Chemicals that have been shown to have goitrogenic effects include:
• Sulfadimethoxine, propylthiouracil, potassium perchlorate, and iopanoic acid.[1]
• Some oxazolidines such as goitrin.
• Thiocyanate overload in Central Africa, especially if also in conjunction with selenium deficiency. Reliance on cassava as a carbohydrate provides a source of thiocyanate in some areas.
• Ions such as thiocyanate and perchlorate decrease iodide uptake by competitive inhibition and, as a consequence of reduced thyroxine and triiodothyronine secretion by the gland, cause, at low doses, an increased release of thyrotropin (by reduced negative feedback), which then stimulates the gland.
• Amiodarone inhibits peripheral conversion of thyroxine to triiodothyronine; also interferes with thyroid hormone action.
• Lithium inhibits thyroid hormone release.
• Phenobarbitone, phenytoin, carbamazepine, rifampin induce metabolic degradation of triiodothyronine (T3) and thyroxine (T4).

Goitrogenic foods
Certain raw foods (cooking partially inactivates the goitrogens, except in the cases of soy and millet) have been identified as lightly goitrogenic. These foods include:
• Cassava and Cabbage both due to the foods containing thiocyanate
• Soybeans (and soybean products such as tofu, soybean oil, soy flour, soy lecithin)
o Other foods containing genistein have been implicated as interfering with thyroid peroxidase in laboratory rats.
• Pine nuts
• Peanuts
• Millet
• Pears
• Peaches
• Spinach
• Bamboo shoots
• Sweet Potatoes
• Vegetables in the genus Brassica
o Bok choy
o Broccoli
o Broccolini (Asparations)
o Brussels sprouts
o Cabbage
o Canola
o Cauliflower
o Chinese cabbage
o Choy sum
o Collard greens
o Horseradish
o Kai-lan (Chinese broccoli)
o Kale
o Kohlrabi
o Mizuna
o Mustard greens
o Radishes
o Rapeseed (yu choy)
o Rapini
o Rutabagas (swedes)
o Tatsoi
o Turnips

Thyroid hyperplasia has been demonstrated in mice:

Despite being generally a stimulant, caffeine acts on thyroid function as a suppressant. Indeed some studies on rats suggest that excess caffeine in conjunction with a lack of iodine may promote the formation of thyroid cancers.
You have all heard of how caffeine can be addictive. Did you know that caffeine has other negative effects as well? Caffeine activates the hormones cortisol, and epinephrine. These are stress hormones produced in the adrenals.

Small increases of cortisol and epineprhine can have positive effects such as energy bursts, heightened memory, and a lower sensitivity to pain. High levels for a prolonged duration can suppress thyroid function, decrease bone density and muscle tissue, imbalance blood sugar levels (hyperglycemia), increase blood pressure, increase abdominal fat, increase heart rate, slow digestion etc.

You would think that our endocrine system would release relaxation hormones in order to maintain homeostasis, but in a world of deadlines we often experience chronic stress; thus, keeping our cortisol and epinephrine levels quite elevated.

Adrenaline (epinephrine) increases heart rate, respiration and blood pressure. The liver responds to this by releasing glucose. This release in glucose causes sugar spikes, increasing your energy levels to create a caffeine “buzz”.
This activates your pleasure centers and contributes to caffeine addictions.

Caffeine leads to a crash because it exhausts the adrenals, fluctuates blood-sugar levels and depletes many vitamin and mineral stores (e.g. lowers the body’s ability to absorb iron and calcium). Eventually the adrenal glands become overworked and less able to respond to stress forcing your body to need more caffeine.

References:
Medline Plus. Iodine. 2013 February 02 http://www.nlm.nih.gov/medlineplus/druginfo/natural/35.html

Health coach and Senior care specialist in the bay area, Connie Dello Buono, motherhealth@gmail.com and text 408-854-1883

Patients with Parkinson’s in the hospital: risks for OTC meds, falls, aspiration pneumonia

Some commonly prescribed drugs — including Compazine and Phenergan for nausea, and Reglan to stimulate bowel function after surgery — actually block dopamine and worsen symptoms in patients with Parkinson’s. Then they are at risk for falls and fractures and for aspiration pneumonia in the hospital.

Any infection can lead to delirium, because Parkinson’s patients have lowered cognitive reserve. But the drug Haldol, which hospitals frequently use to reduce confusion, is also a dopamine blocker. “Haldol is the worst drug you can give a Parkinson’s patient,” Dr. Okun said. Over all, “it can be a real mess.”

With proper treatment, most Parkinson’s patients can live long and good lives, “but stressing them with a fall or an infection or anesthesia can make them fall apart,” he said, turning supposed in-and-out hospitalizations into weeks of illness and decline. Not everyone is as lucky as Roger Anderson.

 

http://.www.nytimes.com

—————

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Connie is looking for partners globally and in 50 US states.  Call 408-854-1883 ; motherhealth@gmail.com

 

Metabolic responses to high protein diet in Korean elite bodybuilders with high-intensity resistance exercise coupled with potassium and calcium intake

The study concluded that increased urinary excretion of urea nitrogen and creatinine might be due to the high rates of protein metabolism that follow high protein intake and muscle turnover.
The obvious evidence of metabolic acidosis in response to high protein diet in the subjects with high potassium intake and intensive resistance exercise were not shown in this study results.
However, the study implied that resistance exercise with adequate mineral supplementation, such as potassium and calcium, could reduce or offset the negative effects of protein-generated metabolic changes.
The study provides preliminary information of metabolic response to high protein intake in bodybuilders who engaged in high-intensity resistance exercise.
Further studies will be needed to determine the effects of the intensity of exercise and the level of mineral intakes, especially potassium and calcium, which have a role to maintain acid-base homeostasis, on protein metabolism in large population of bodybuilders.

High protein diet has been known to cause metabolic acidosis, which is manifested by increased urinary excretion of nitrogen and calcium. Bodybuilders habitually consumed excessive dietary protein over the amounts recommended for them to promote muscle mass accretion. This study investigated the metabolic response to high protein consumption in the elite bodybuilders. Methods: Eight elite Korean bodybuilders within the age from 18 to 25, mean age 21.5 +/- 2.6. For data collection, anthropometry, blood and urinary analysis, and dietary assessment were conducted.
Results: They consumed large amounts of protein (4.3 +/- 1.2 g/kg BW/day) and calories (5,621.7 +/- 1,354.7 kcal/day), as well as more than the recommended amounts of vitamins and minerals, including potassium and calcium. Serum creatinine (1.3 +/- 0.1 mg/dl) and potassium (5.9 +/- 0.8 mmol/L), and urinary urea nitrogen (24.7 +/- 9.5 mg/dl) and creatinine (2.3 +/- 0.7 mg/dl) were observed to be higher than the normal reference ranges. Urinary calcium (0.3 +/- 0.1 mg/dl), and phosphorus (1.3 +/- 0.4 mg/dl) were on the border of upper limit of the reference range and the urine pH was in normal range.

HYERANG KIM
JOURNAL OF THE INTERNATIONAL SOCIETY OF SPORTS NUTRITION810-, 20111550-2783

Beet Juice, relaxes the tone of blood vessels, lowering BP and good for mouth, gut and skin infection

Beetroot_juice_Nitrate_11-_website_fact_sheetbeets juice lowers bp

A cup of beetroot juice a day, or a generous helping of green vegetables, may help lower blood pressure, a new British study finds.
The findings come from a small study of 15 men and women with high blood pressure, published in the journal Hypertension on April 15.

Swallowing of nitrite into the acidic stomach environment starts the process in which nitrite is processed into nitric oxide, an important element in:

• relaxing the tone of blood vessels, regulating blood pressure, prevents susceptibility of vessels to vascular disease and tissue oxygenation
• regulating platelet aggregation, reducing risk of atherosclerosis
• providing immune system activities, reduced mouth, gut and skin infection

Dr Amrita Ahluwalia (Barts and the London School of Medicine and Dentistry, UK) and colleagues have a track record of studying the interaction between dietary sources of biologically inert nitrate (NO3) and oral microflora, which converts the NO3 into bioactive nitrite (NO2). Circulating NO2 is known to cause vasodilation and lower blood pressure. Ahluwalia et al have previously proposed a pathway for nitrate-nitrite conversion, showing that beet juice, after coming into contact with human saliva, increases levels of plasma nitrate and nitrite and leads to significant blood-pressure decreases in healthy volunteers.
In their latest study, published online April 15, 2013 in Hypertension, Ahluwalia and colleagues, including senior author Dr Suborno Ghosh (Queen Mary University of London, UK) turned again to beetroot, which, along with green leafy vegetables, has high concentrations of inorganic nitrate. In a mouse model of hypertension, investigators first established a threshold nitrite dose at which blood pressure decreased in the hypertensive mice, but not in normotensive control mice. At higher doses, however, both strains of mice saw blood-pressure decreases.
The authors then tested the beet-juice effects in 15 hypertensive, drug-naive patients, randomized to either 250 mL of inorganic nitrate-rich beetroot juice or an equal volume of water. The “dose” of juice elevates nitrite levels approximately 1.5 fold–a rise previously shown to have no significant BP-lowering effect in subjects with normal blood pressure.
In patients who drank the juice, systolic blood pressure dropped by a mean of 11.2 mm Hg between three and six hours after consumption (vs 0.7 mm Hg in subjects who drank water). By 24 hours, clinic systolic BP remained significantly lower in the beet-juice group and roughly 7.2 mm Hg lower than baseline. Peak drop in diastolic BP also occurred within the first six hours, dropping by a mean of 9.6 mm Hg. Pulse-wave velocity also decreased in the beet-juice group, but not in the controls.
“Our observations . . . support the concept of dietary nitrate supplementation as an effective, but simple and inexpensive, antihypertensive strategy,” the authors conclude.
To heartwire , Ahluwalia underscored the finding that nitrate in beets appears to be even more potent in hypertensives than in normotensives. “In this new study we used a dose that had little to no effect upon blood pressure in healthy volunteers; in contrast, this dose caused a substantial decrease in blood pressure (~12 mm Hg) in the patients, suggesting that dietary nitrate is more potent, and therefore potentially one needs less to produce an important blood-pressure–lowering effect.”
Read more: http://www.nydailynews.com/life-style/health/beetroot-juice-day-heart-doc-study-article-1.1319132#ixzz2Qkqmnsmu

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Connie Dello Buono ; motherhealth@gmail.com

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Know and report any drug-related side effects to your doctor

Know and report any drug-related side effects to your doctor

Migraines, rashes, allergies, and other symptoms should be reported to your doctor for new/added drugs in your regimen.
Caregivers should monitor clients for daily reactions and other side effects from medications.

Curcumin: anti-parasitic, antispasmodic, anti-inflammatory, gastrointestinal effects, inhibits carcinogenesis and cancer growth

• New research showed that curcumin, the active ingredient in the curry spice turmeric, possesses potent anti-inflammatory and anti-arthritic properties.
• A highly bioavailable form of curcumin was more effective in alleviating rheumatoid arthritis (RA) symptoms than the NSAID drug Voltaren
• While no one in the curcumin group withdrew from the study due to side effects, 14 percent of those in the NSAID group did so, as NSAIDs often cause serious adverse effects, including ulcers and heart problems

About Curcumin

There are several data in the literature indicating a great variety of pharmacological activities of Curcuma longa L. (Zingiberaceae), which exhibit anti-inflammatory, anti-human immunodeficiency virus, anti-bacteria, antioxidant effects and nematocidal activities. Curcumin is a major component in Curcuma longa L., being responsible for its biological actions. Other extracts of this plant has been showing potency too.
In vitro, curcumin exhibits anti-parasitic, antispasmodic, anti-inflammatory and gastrointestinal effects; and also inhibits carcinogenesis and cancer growth. In vivo, there are experiments showing the anti-parasitic, anti-inflammatory potency of curcumin and extracts of C. longa L. by parenteral and oral application in animal models [1].

Dr. Marion Chan’s laboratory[2]

Dr. Marion Chan’s laboratory is interested in understanding mechanisms that resolve inflammation. She and her team have developed two model systems in mice which, in combination, allows study of these mechanism at the cellular and the whole organism levels. This work has implications for a wide spectrum of disease states, which is now thought to involve a chronic neuroinflammatory response.

Chan’s laboratory was the first to show that there is an active mechanism of resolution underlying remission and relapse in murine collagen-induced arthritis (CIA), a well-accepted model of rheumatoid arthritis in humans. Her findings indicated that COX inhibitors will interfere with the resolution process, resulting in chronic inflammation. (This is a critical issue because COX-2 inhibitors are widely used for treating many inflammatory diseases.) Her current work centers on elucidating the details of this mechanism. The immediate focus is on the eicosanoids synthesized from arachidonic acid through the COX and lipoxygenase (LOX) pathways. Many of these bioactive lipids are ligands for peroxisome proliferator-activated receptor (PPAR), a group of nuclear factors that serve as targets for diabetes, obesity, vascular disease, and other inflammatory diseases.

One of the characteristics of PPARγ is that it primes monocytes to differentiate into alternatively activated M2 phenotype. This subclass of macrophages expresses scavenger receptors for apoptotic cells, produces transforming growth factor β and IL-10, and has been ascribed vital roles in the clearance of apoptotic neutrophils and wound repair. They are likely the initiators of resolution, in contrast to the classically activated macrophages (M1) that induce inflammation.

The second murine model of inflammation looks at leishmaniasis, a parasitic infection that produces inflammation and affects 12 million people worldwide. The etiological agent is a parasitic protozoan that infects the bone marrow, liver, skin, and spleen of susceptible individuals chronically. The parasite lives and replicates within macrophages. The Chan group is investigating whether the parasite harnesses resolution mechanisms to maintain the life-long infection. The hypothesis is that, upon infection, Leishmania polarizes macrophages towards the alternatively activated M2 phenotype that produce arginase, instead of the classically activated M1 macrophages that express inducible nitric oxide synthase. Consequently, arginine, the common substrate of the two enzymes, diverge from producing the parasiticidal nitric oxide. Among the dietary compounds studied in the laboratory, curcumin is a PPARγ activator and agonist. This anti-inflammatory molecule increases parasite burden in Leishmania donovani-infected mice.

Tips for Increasing Your Absorption of Curcumin [3]

• If you want to give curcumin a try for RA, it is widely available in supplement form, but relatively high doses are required to achieve its therapeutic effects, and curcumin is generally not absorbed that well. Typical therapeutic doses are up to three grams of bioavailable curcumin extract, three to four times daily, and this is difficult to achieve using standard curcumin powders.
• One alternative is to make a microemulsion by combining a tablespoon of curcumin powder with 1-2 egg yolks and a teaspoon or two of melted coconut oil. Then use a hand blender on high speed to emulsify the powder.
• Another strategy you can use to increase absorption is to put one tablespoon of the curcumin powder into a quart of boiling water. It must be boiling when you add the powder, as it will not work as well if you put it in room temperature water and heat the water and curcumin together.
• After boiling it for 10 minutes you will have created a 12% solution and you can drink this once it has cooled down. The curcumin will gradually fall out of the solution over time and in about six hours it will be a 6% solution, so it is best to drink the water within four hours. It does have a woody taste, but this is done more for therapeutic benefits than flavor.

About Cyclooxygenases (COXs)

Cyclooxygenases (COXs), also known as prostaglandin H synthases, are fatty acid oxygenases that contain about 600 amino acid residues and act on arachidonic acid to generate prostaglandins (PG). All vertebrates contain two COX genes: one encoding the constitutive COX-1 and another inducible COX-2. COX-1 and COX-2 share approximately 60-65% amino acid identity. These COX isoforms are bifunctional hemoproteins that catalyze both the bioxygenation of arachidonic acid to form PGG2 and the peroxidative reduction of PGG2 to form PGH2. Hence, the catalytic domain of COX is considered to contain both cyclooxygenase and peroxidase active sites. The peroxidase site is required for the activation of heme groups that participate in the cyclooxygenase reaction.

About growth factor-beta and interleukin-10

Contextual regulation of inflammation: a duet by transforming growth factor-beta and interleukin-10
Transforming growth factor-beta (TGF-beta) and interleukin-10 (IL-10) are regulatory cytokines with pleiotropic roles in the immune system. The prominent function of TGF-beta is to maintain T cell tolerance to self or innocuous environmental antigens via its direct effects on the differentiation and homeostasis of effector and regulatory T cells. A critical route for the regulation of T cells by TGF-beta is via activation of a T cell-produced latent form of TGF-beta1 by dendritic cell-expressed avbeta8 integrin. IL-10 operates primarily as a feedback inhibitor of exuberant T cell responses to microbial antigens. T cells are also the principal producers of IL-10, the expression of which is regulated by IL-27, IL-6, and TGF-beta. The collective activity of TGF-beta and IL-10 ensures a controlled inflammatory response specifically targeting pathogens without evoking excessive immunopathology to self-tissues [4].

References
1. Biological activities of Curcuma longa L. Araújo CC, Leon LL. Laboratório de Biologia de Tripanosomatídeos, Instituto Oswaldo Cruz-Fiocruz, 21045-900 Rio de Janeiro, RJ, Brasil. cacaraujo@hotmail.com
2. Chan
Chan MM, Huang HI, Mattiacci JA, Fong D. Modulation of cytokine gene expression by curcumin. In “Food Factors in Health Promotion and Disease Prevention”, ed. Shahidi F, Ho C-T, Watanabe S, Osawa T. American Chemical Society Press, Washington D.C., pp. 86-99, 2003.
Chan MM, Fong D. Modulation of the nitric oxide pathway by natural products. In Nitric Oxide in Inflammation and Tissue Injury (Laskin J, Laskin D, eds.). Marcel Dekker, Inc., New York, NY, 1999.
Chan MM. Inhibition of tumor necrosis factor by curcumin, a phytochemical. Biochem Pharmacol. 1995 May 26;49(11):1551-6.
Chan MM, Fong D. 1994. Anti-inflammatory and cancer preventive immuno-modulation through the diet: The effects of curcumin on T lymphocytes. In “Food Phytochemicals for Cancer Prevention”, ed. Huang M-T, Ho C-T, American Chemical Society Press, Washington D.C., pp. 222-230.
Chan MM, Fong D. Plant microtubule inhibitors against trypanosomatids. Parasitol Today. 1994 Nov;10(11):448-51.
Chan MM, Grogl M, Chen CC, Bienen EJ, Fong D. Herbicides to curb human parasitic infections: in vitro and in vivo effects of trifluralin on the trypanosomatid protozoans. Proc Natl Acad Sci U S A. 1993 Jun 15;90(12):5657-61.
Chan MM. T cell response in murine Leishmania mexicana amazonensis infection: production of interferon-gamma by CD8+ cells. Eur J Immunol. 1993 May;23(5):1181-4.
Chan MM, Fong D. Inhibition of leishmanias but not host macrophages by the antitubulin herbicide trifluralin. Science. 1990 Aug 24;249(4971):924-6.
Recent Medically Related Publications, Obtained from PubMed (Click on PubMed ID to view abstract)

22536211. Chan MM, Fong D, The Interplay of PPARs with Parasites and Related Intracellular Pathogens. PPAR Res 2012:(624845)2012

22448168. Chan MM, Adapala N, Chen C, Peroxisome Proliferator-Activated Receptor-?-Mediated Polarization of Macrophages in Leishmania Infection. PPAR Res 2012:(796235)2012

20435922. Chan MM, Moore AR, Resolution of inflammation in murine autoimmune arthritis is disrupted by cyclooxygenase-2 inhibition and restored by prostaglandin E2-mediated lipoxin A4 production. J Immunol 184:11(6418-26)2010 Jun 1

20169106. Chan MM, Evans KW, Moore AR, Fong D, Peroxisome proliferator-activated receptor (PPAR): balance for survival in parasitic infections. J Biomed Biotechnol 2010:(828951)2010

18794851. Adapala N, Chan MM, Long-term use of an antiinflammatory, curcumin, suppressed type 1 immunity and exacerbated visceral leishmaniasis in a chronic experimental model. Lab Invest 88:12(1329-39)2008 Dec

16402374. Chan MM, Soprano KJ, Weinstein K, Fong D, Epigallocatechin-3-gallate delivers hydrogen peroxide to induce death of ovarian cancer cells and enhances their cisplatin susceptibility. J Cell Physiol 207:2(389-96)2006 May

15772867. Chan MM, Adapala NS, Fong D, Curcumin overcomes the inhibitory effect of nitric oxide on Leishmania. Parasitol Res 96:1(49-56)2005 Apr

12632163. Chan MM, Bulinski JC, Chang KP, Fong D, A microplate assay for Leishmania amazonensis promastigotes expressing multimeric green fluorescent protein. Parasitol Res 89:4(266-71)2003 Mar

12447990. Chan MM, Fong D, Soprano KJ, Holmes WF, Heverling H, Inhibition of growth and sensitization to cisplatin-mediated killing of ovarian cancer cells by polyphenolic chemopreventive agents. J Cell Physiol 194:1(63-70)2003 Jan

11841782. Chan MM, Antimicrobial effect of resveratrol on dermatophytes and bacterial pathogens of the skin. Biochem Pharmacol 63:2(99-104)2002 Jan 15

11020457. Chan MM, Mattiacci JA, Hwang HS, Shah A, Fong D, Synergy between ethanol and grape polyphenols, quercetin, and resveratrol, in the inhibition of the inducible nitric oxide synthase pathway. Biochem Pharmacol 60:10(1539-48)2000 Nov 15

9714315. Chan MM, Huang HI, Fenton MR, Fong D, In vivo inhibition of nitric oxide synthase gene expression by curcumin, a cancer preventive natural product with anti-inflammatory properties. Biochem Pharmacol 55:12(1955-62)1998 Jun 15

9393670. Chan MM, Fong D, Ho CT, Huang HI, Inhibition of inducible nitric oxide synthase gene expression and enzyme activity by epigallocatechin gallate, a natural product from green tea. Biochem Pharmacol 54:12(1281-6)1997 Dec 15
3. http://articles.mercola.com/sites/articles/archive/2012/06/13/the-spice-that-is-better-than-drugs-for-ra.aspx
4. Li MO, Flavell RA. Immunology Program, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. lim@mskcc.org

<Connie Dello Buono ; motherhealth@gmail.com

Yelp Caregivers in the Bay area – Motherhealth

Have your own health nutrition site. We will train you for free as health ambassadors:

  1. Prevent Diabetes and chronic disease by stopping sugar addiction with a support group

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Email Connie ->  motherhealth@gmail.com or text 408-854-1883 for more info for your nutrition business online

  1. Cell repair thru biogenesis with COQ10 for all statin users and those who wants cell energy at the mitochondria level of your cells.

Wanted Sports Nutrition independent reps or Ambassador at USA, Sweden and Australia at http://gogyv.com/clubalthea/

Red onion, red-leaf lettuce, curly kale, orange sweet potatoes have highest anti-obesity potential , boiling reduces the levels of phytochemicals from 50-75%, steaming veggies preserves anti-obesity phytochemicals

veggies
Steam cooking resulted in slight increases in concentration of phenolic acids in sweet potatoes.

Frying onions in sunflower oil resulted in a reduction of 21% and 15% reduction in levels of quercetin glycosides in boiling onions for only 5mins.

Chlorogenic acid levels in re-leafed lettuce were distributed across the colored tissues, containing three times the level in green tissue and 8 times that of white midrib tissue.

Broccoli sprouts possesses epithiospecifier proteins which direct glucosinolate breakdown to the non-bioactive nitriles at the expense of isothiocyanate formation.
• Cruciferous vegetables contain vitamins, minerals, other nutrients, and chemicals known as glucosinolates.
• Glucosinolates break down into several biologically active compounds that are being studied for possible anticancer effects.
• Some of these compounds have shown anticancer effects in cells and animals, but the results of studies with humans have been less clear.
• Cruciferous vegetables are part of the Brassica genus of plants. They include the following vegetables, among others:
• Arugula
• Bok choy
• Broccoli
• Brussels sprouts
• Cabbage
• Cauliflower
• Collard greens • Horseradish
• Kale
• Radishes
• Rutabaga
• Turnips
• Watercress
• Wasabi
During food preparation, chewing, and digestion, the glucosinolates in cruciferous vegetables are broken down to form biologically active compounds such as indoles, nitriles, thiocyanates, and isothiocyanates (1). Indole-3-carbinol (an indole) and sulforaphane (an isothiocyanate) have been most frequently examined for their anticancer effects.

Indoles and isothiocyanates have been found to inhibit the development of cancer in several organs in rats and mice, including the bladder, breast, colon, liver, lung, and stomach (2, 3). Studies in animals and experiments with cells grown in the laboratory have identified several potential ways in which these compounds may help prevent cancer:

• They help protect cells from DNA damage.
• They help inactivate carcinogens.
• They have antiviral and antibacterial effects.
• They have anti-inflammatory effects.
• They induce cell death (apoptosis).
• They inhibit tumor blood vessel formation (angiogenesis) and tumor cell migration (needed for metastasis).
Researchers have investigated possible associations between intake of cruciferous vegetables and the risk of cancer. The evidence has been reviewed by various experts. Key studies regarding four common forms of cancer are described briefly below.
• Prostate cancer: Cohort studies in the Netherlands (4), United States (5), and Europe (6) have examined a wide range of daily cruciferous vegetable intakes and found little or no association with prostate cancer risk. However, some case-control studies have found that people who ate greater amounts of cruciferous vegetables had a lower risk of prostate cancer (7, 8).
• Colorectal cancer: Cohort studies in the United States and the Netherlands have generally found no association between cruciferous vegetable intake and colorectal cancer risk (9-11). The exception is one study in the Netherlands—the Netherlands Cohort Study on Diet and Cancer—in which women (but not men) who had a high intake of cruciferous vegetables had a reduced risk of colon (but not rectal) cancer (12).
• Lung cancer: Cohort studies in Europe, the Netherlands, and the United States have had varying results (13-15). Most studies have reported little association, but one U.S. analysis—using data from the Nurses’ Health Study and the Health Professionals’ Follow-up Study—showed that women who ate more than 5 servings of cruciferous vegetables per week had a lower risk of lung cancer (16).
• Breast cancer: One case-control study found that women who ate greater amounts of cruciferous vegetables had a lower risk of breast cancer (17). A meta-analysis of studies conducted in the United States, Canada, Sweden, and the Netherlands found no association between cruciferous vegetable intake and breast cancer risk (18). An additional cohort study of women in the United States similarly showed only a weak association with breast cancer risk (19).
A few studies have shown that the bioactive components of cruciferous vegetables can have beneficial effects on biomarkers of cancer-related processes in people. For example, one study found that indole-3-carbinol was more effective than placebo in reducing the growth of abnormal cells on the surface of the cervix (20).
In addition, several case-control studies have shown that specific forms of the gene that encodes glutathione S-transferase, which is the enzyme that metabolizes and helps eliminate isothiocyanates from the body, may influence the association between cruciferous vegetable intake and human lung and colorectal cancer risk
(21-23).

http://www.cancer.gov/cancertopics/factsheet/diet/cruciferous-vegetables
Flavone content of veggies
Luteon Apigenin
Celery leaf 200 750
Globe artichoke 75 100
Capsicum green 21 nd
Parsley 3 119
Broccoli 8 nd
Sweet potato leaves, purple 4 nd

Selected References
Hayes JD, Kelleher MO, Eggleston IM. The cancer chemopreventive actions of phytochemicals derived from glucosinolates. European Journal of Nutrition 2008;47 Suppl 2:73-88. [PubMed Abstract]
Hecht SS. Inhibition of carcinogenesis by isothiocyanates. Drug Metabolism Reviews 2000;32(3-4):395-411. [PubMed Abstract]
Murillo G, Mehta RG. Cruciferous vegetables and cancer prevention. Nutrition and Cancer 2001;41(1-2):17-28. [PubMed Abstract]
Schuurman AG, Goldbohm RA, Dorant E, van den Brandt PA. Vegetable and fruit consumption and prostate cancer risk: a cohort study in The Netherlands. Cancer Epidemiology, Biomarkers & Prevention 1998;7(8):673-680. [PubMed Abstract]
Giovannucci E, Rimm EB, Liu Y, Stampfer MJ, Willett WC. A prospective study of cruciferous vegetables and prostate cancer. Cancer Epidemiology, Biomarkers & Prevention 2003;12(12):1403-1409. [PubMed Abstract]
Key TJ, Allen N, Appleby P, et al. Fruits and vegetables and prostate cancer: no association among 1104 cases in a prospective study of 130544 men in the European Prospective Investigation into Cancer and Nutrition (EPIC). International Journal of Cancer 2004;109(1):119-124. [PubMed Abstract]
Kolonel LN, Hankin JH, Whittemore AS, et al. Vegetables, fruits, legumes and prostate cancer: a multiethnic case-control study. Cancer Epidemiology, Biomarkers & Prevention 2000;9(8):795-804. [PubMed Abstract]
Jain MG, Hislop GT, Howe GR, Ghadirian P. Plant foods, antioxidants, and prostate cancer risk: findings from case-control studies in Canada. Nutrition and Cancer 1999;34(2):173-184. [PubMed Abstract]
McCullough ML, Robertson AS, Chao A, et al. A prospective study of whole grains, fruits, vegetables and colon cancer risk. Cancer Causes & Control 2003;14(10):959-970. [PubMed Abstract]
Flood A, Velie EM, Chaterjee N, et al. Fruit and vegetable intakes and the risk of colorectal cancer in the Breast Cancer Detection Demonstration Project follow-up cohort. The American Journal of Clinical Nutrition 2002;75(5):936-943. [PubMed Abstract]
Michels KB, Edward Giovannucci, Joshipura KJ, et al. Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers. Journal of the National Cancer Institute 2000;92(21):1740-1752. [PubMed Abstract]
Voorrips LE, Goldbohm RA, van Poppel G, et al. Vegetable and fruit consumption and risks of colon and rectal cancer in a prospective cohort study: The Netherlands Cohort Study on Diet and Cancer. American Journal of Epidemiology 2000;152(11):1081-1092. [PubMed Abstract]
Neuhouser ML, Patterson RE, Thornquist MD, et al. Fruits and vegetables are associated with lower lung cancer risk only in the placebo arm of the beta-carotene and retinol efficacy trial (CARET). Cancer Epidemiology, Biomarkers & Prevention 2003;12(4):350-358. [PubMed Abstract]
Voorrips LE, Goldbohm RA, Verhoeven DT, et al. Vegetable and fruit consumption and lung cancer risk in the Netherlands Cohort Study on diet and cancer. Cancer Causes and Control 2000;11(2):101-115. [PubMed Abstract]
Chow WH, Schuman LM, McLaughlin JK, et al. A cohort study of tobacco use, diet, occupation, and lung cancer mortality. Cancer Causes and Control 1992;3(3):247-254. [PubMed Abstract]
Feskanich D, Ziegler RG, Michaud DS, et al. Prospective study of fruit and vegetable consumption and risk of lung cancer among men and women. Journal of the National Cancer Institute 2000;92(22):1812-1823. [PubMed Abstract]
Terry P, Wolk A, Persson I, Magnusson C. Brassica vegetables and breast cancer risk. JAMA 2001;285(23):2975-2977. [PubMed Abstract]
Smith-Warner SA, Spiegelman D, Yaun SS, et al. Intake of fruits and vegetables and risk of breast cancer: a pooled analysis of cohort studies. JAMA 2001;285(6):769-776. [PubMed Abstract]
Zhang S, Hunter DJ, Forman MR, et al. Dietary carotenoids and vitamins A, C, and E and risk of breast cancer. Journal of the National Cancer Institute 1999;91(6):547-556. [PubMed Abstract]
Bell MC, Crowley-Nowick P, Bradlow HL, et al. Placebo-controlled trial of indole-3-carbinol in the treatment of CIN. Gynecologic Oncology 2000;78(2):123-129. [PubMed Abstract]
Epplein M, Wilkens LR, Tiirikainen M, et al. Urinary isothiocyanates; glutathione S-transferase M1, T1, and P1 polymorphisms; and risk of colorectal cancer: the Multiethnic Cohort Study. Cancer Epidemiology, Biomarkers & Prevention 2009;18(1):314-320. [PubMed Abstract]
London SJ, Yuan JM, Chung FL, et al. Isothiocyanates, glutathione S-transferase M1 and T1 polymorphisms, and lung-cancer risk: a prospective study of men in Shanghai, China. Lancet 2000;356(9231):724-729. [PubMed Abstract]
Yang G, Gao YT, Shu XO, et al. Isothiocyanate exposure, glutathione S-transferase polymorphisms, and colorectal cancer risk. American Journal of Clinical Nutrition 2010;91(3):704-711. [PubMed Abstract]

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Call for part time or full time business or job 408-854-1883 in financial planning, college planning, retirement planning and helping others with their idle money to work for them at 13%, tax free, safe and secured with free health benefits

 

Reduced level of calcium, lipids, proteins, nucleic acids and glycogen levels in mice liver due to aluminium exposure

Determination of aluminium induced metabolic changes in mice liver: A Fourier transform infrared spectroscopy study.
In this study, we made a new approach to evaluate aluminium induced metabolic changes in liver tissue of mice using Fourier transform infrared spectroscopy analysis taking one step further in correlation with strong biochemical evidence.
This finding reveals the alterations on the major biochemical constituents, such as lipids, proteins, nucleic acids and glycogen of the liver tissues of mice. The peak area value of amide A significantly decrease from 288.278±3.121 to 189.872±2.012 between control and aluminium treated liver tissue respectively.
Amide I and amide II peak area value also decrease from 40.749±2.052 to 21.170±1.311 and 13.167±1.441 to 8.953±0.548 in aluminium treated liver tissue respectively. This result suggests an alteration in the protein profile.

The absence of olefinicCH stretching band and CO stretching of triglycerides in aluminium treated liver suggests an altered lipid levels due to aluminium exposure. Significant shift in the peak position of glycogen may be the interruption of aluminium in the calcium metabolism and the reduced level of calcium.
The overall findings exhibit that the liver metabolic program is altered through increasing the structural modification in proteins, triglycerides and quantitative alteration in proteins, lipids, and glycogen. All the above mentioned modifications were protected in desferrioxamine treated mice.
Histopathological results also revealed impairment of aluminium induced alterations in liver tissue. The results of the FTIR study were found to be in agreement with biochemical studies and which demonstrate FTIR can be used successfully to indicate the molecular level changes.

Sivakumar S, Sivasubramanian J, Khatiwada CP, Manivannan J, Raja B. Spectrochim Acta A Mol Biomol Spectrosc. 2013 Mar 21;110C:241-248. doi: 10.1016/j.saa.2013.03.056
Department of Physics, Annamalai University, Annamalai Nagar 608 002, Tamil Nadu, India. Electronic address: girihari777@yahoo.com.

About desferrioxamine, a chelating agent to get rid of excess iron or other metals in the bodyDesferal injections contain the active ingredient desferrixoamine mesilate, which is a type of medicine called a chelating agent.
Desferrioxamine is a medicine that binds to excess iron in the body. It is then excreted in the urine and faeces, thereby reducing iron levels in the body.
Iron is an essential part of haemoglobin, the oxygen-carrying pigment found in red blood cells. In normal situations, iron balance is tightly controlled. Most average diets supply adequate amounts of iron and any amounts excess to requirements are excreted. In certain circumstances, the normal control mechanisms are overwhelmed, leading to an accumulation of iron in the body (iron overload). Iron builds up in the cells of the kidneys, heart, liver, brain and other organs, and can cause congestive heart failure, cirrhosis of the liver and diabetes if left untreated.
Iron overload occurs most commonly as a result of repeated blood transfusions. These might be necessary to treat bone marrow failure (eg caused by radiation, chemotherapy, viruses or hereditary reasons) or blood disorders like thalassaemia or anaemias. Or it may be as a result of iron storage disease, eg haemochromatosis. In this condition, excessive amounts of iron are absorbed from the gut and deposited in the tissues.
Iron overload can also occur as the result of iron overdosage (iron poisoning).
Desferrioxamine is given to bind to and remove excess iron in all these situations.

Read more: http://www.netdoctor.co.uk/heart-and-blood/medicines/desferal.html#ixzz2QZimUf5i

Connie’s comments: Alzheimer’s and Parkinson’s diseases are believed to be be caused by metal toxins such as aluminum. Use stainless steel cooking pots and pans.

—————————

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Connie Dello Buono

Connie Dello Buono ; motherhealth@gmail.com

Call for part time or full time business or job 408-854-1883 in financial planning, college planning, retirement planning and helping others with their idle money to work for them at 13%, tax free, safe and secured with free health benefits

 

Exercise training induced significant improvement in sleep quality in postmenopausal women

The study concluded that exercise training induced significant improvement in subjective sleep quality in postmenopausal women, with even a low dose of exercise resulting in greatly reduced odds of having significant sleep disturbance.

The study investigated whether a dose-response relationship existed between exercise and subjective sleep quality in postmenopausal women. This objective represents a post hoc assessment that was not previously considered.

The parallel-group randomized controlled trial consisting of 437 sedentary overweight/obese postmenopausal women and conducted in a clinical exercise physiology laboratory in Dallas, Texas.
Exercise dosages were structured to elicit energy expenditures of 4, 8 or 12 kilocalories per kilogram of body weight per week (KKW), respectively. Analyses were intent to treat.

RESULTS:
Change in the Medical Outcomes Study Sleep Problems Index score at 6 months significantly differed by treatment group (control: -2.09 , 4 KKW: -3.93 (-5.87 to -1.99), 8 KKW: -4.06 (-6.45 to -1.67), 12 KKW: -6.22 (-8.68 to -3.77)), with a significant dose-response trend observed (p=0.02). Exercise training participants had lower odds of having significant sleep disturbance at postintervention compared with control (4 KKW: OR 0.37 , 8 KKW: 0.36 , 12 KKW: 0.34 (0.16 to 0.72)). The magnitude of weight loss did not differ between treatment conditions. Improvements in sleep quality were not related to changes in body weight, resting parasympathetic control or cardiorespiratory fitness.

Kline CE, Sui X, Hall MH, Youngstedt SD, Blair SN, Earnest CP, Church TS. BMJ Open. 2012 Jul 12;2(4). pii: e001044. doi: 10.1136/bmjopen-2012-001044. Print 2012.
Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

High blood pressure more in men and higher diabetes rate in women, Nigerian study

The study demonstrated lower prevalence of obesity and hypertension when compared with earlier results from the southern part of Nigeria, but showed an increase in the prevalence of diabetes mellitus, more in women than men.
A prospective cross-sectional study determines the prevalence of some risk factors of coronary heart disease (CHD) in a rural Nigerian population around Maiduguri in the north eastern part of Nigeria. Five hundred randomly selected subjects, consisting of 278 males and 222 females.
Anthropometric parameters such as weight, height, body mass index and blood pressure were measured. Also fasting blood concentration of glucose, total cholesterol (Tc) and high density cholesterol (HDL-c) were measured.
Various parameters were compared between males and females with the following results:
• Prevalence of hypercholesterolaemia was zero because no subjects had values greater than 5.2 mmol/1.
• Prevalence of diabetes mellitus was 2.6% and being higher among females.
• Mean fasting blood glucose was significantly higher in females (6.2 mmol/1) than males (4.2 mmol/1).
• Overall prevalence of obesity was 2%, with 1.2% in males and 3.2% in females.
• High blood pressure was observed in 15.2% of the subjects, with it being more among males (19.1%) than females (10.3%).
Okesina AB, Oparinde DP, Akindoyin KA, Erasmus RT. East Africa Medical Journal. 1999 Apr;76(4):212-6.
Department of Chemical Pathology, Faculty of Medicine, University of Transkei, Umtata, South Africa.

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Heart Disease, more in women

cardio chart

heart disease

A chart shows 950,000 heart-related deaths of which 500K are women and 450K are men.
Pattern: Women erode, men explode (MRI picture )
Therapy: from female stem cells

Knowing the warning signs and symptoms of a heart attack is key to preventing death, but many people don’t know the signs.
In a 2005 survey, most respondents—92%—recognized chest pain as a symptom of a heart attack. Only 27% were aware of all major symptoms and knew to call 9-1-1 when someone was having a heart attack.

About 47% of sudden cardiac deaths occur outside a hospital. This suggests that many people with heart disease don’t act on early warning signs.
Heart attacks have several major warning signs and symptoms:
• Chest pain or discomfort.
• Upper body pain or discomfort in the arms, back, neck, jaw, or upper stomach.
• Shortness of breath.
• Nausea, lightheadedness, or cold sweats.

Race of Ethnic Group % of Deaths
African Americans 24.5
American Indians or Alaska Natives 18.0
Asians or Pacific Islanders 23.2
Hispanics 20.8
Whites 25.1
All 25.0
http://www.cdc.gov/HeartDisease/facts.htm

Healing ways:
• Live and choose stress-free lifestyle with active whole body movements: yoga, dancing, running, walking, surrounded by loving relationships
• Make fruits and vegetables a major part of the diet. Five servings a day may seem overwhelming, but it really can be made simple. Every time you get hungry, find a fruit or vegetable as the main constituent. Add everything else for flavor. There are so many free resources on the internet for finding recipes to make them flavorful. Buy a variety of colors to make sure you get all nutrients and anti-oxidants, and always make sure they are organic.
• Garlic and onions. Garlic and onions are rich in compounds that lower cholesterol and prevent blood clotting. They are also a wonderful addition to flavor vegetables. Garlic should be chopped finely, then let sit for 5-10 minutes before cooking to release the healing compound alliicin. Always add the garlic during the last minutes of cooking. Garlic from whole foods, check out aged garlic.
• Omega-3 fatty acids are important to so many functions of our body, but are rare in our diet. Wild Alaskan salmon and sardines are a good source, eat them a couple days a week. Walnuts are a good source, as are flaxseeds. Add flaxseed oil and walnuts (soaked) to your salads. Pastured cows where eating grass is a major part of their diet carry omega-3’s in their dairy and meat.
• Monounsaturated fats. Olive oil is a monounsaturated fat and has been proven to be beneficial to the heart and prevent arterial disease. Use it as your major source for stir-frying vegetables. Make sure it is cold pressed, unrefined, virgin, and organic.
• Linoleic Acids. Linoleic acids are necessary to metabolize fats and cholesterol. They are good for the heart and the skin. One form is GLA found in evening primrose and borage seed oil (Make sure these are cold-pressed and unrefined. The other form is DGLA found in sunflower seeds and pumpkin seeds. An easy way to get these important fats in your diet is to make a salad oil of olive, borage or primrose oil, & flaxseed oil with chopped garlic, lemon or vinegar (for the acid), and add soaked sunflower, pumpkin seeds, or walnuts to the salad greens and red cabbage, and any other veggies and fruits you want to include.
• Whole grains. Whole grains have been proven to cut the risk of heart disease. Fresh fruits and vegetables provide a good source of the fiber needed. All refined grains turn into sugar. Make brown rice, barley, oats, and dried beans a part of your diet. I have to make an important side note here. All grains, legumes and nuts should be soaked overnight before eating to remove anti-nutrients and become more digestible. This was a normal step of food preparation that has been lost in our fast-paced industrial society.
• Protein is important for the building blocks of all cells, including the heart and veins. Poultry, fish, meats, cheese, eggs, dairy, nuts, and legumes are the major sources of protein. Add a protein source to every meal.
• Folic acid and the B vitamins improve heart health. Nutritional yeast and bee pollen should become a daily part of your diet. Drink organic fresh green juice daily.

The genes are similar to those of our ancestors. Aborigines and Polynesians are virtually identical genetically to their traditional ancestors of recent generations. The Aborigines and Polynesians who eat traditional food do not get cancer (see e.g, the Kitava study by Staffan Lindberg).
However our diet is only 25% of Paleolithic foods, exercise les, sunlight is less, toxins and viruses more. As far as evolution goes, Europeans have made a few adaptations, Maori and Aborigine very few. So Europeans have less genetic factor in disease than Aborigines and Maori. Things are the opposite to what they think.

If everybody smoked, then we would think that lung cancer was a genetic illness.
everyone is loaded with salt, which is the cause of hypertension- people still get money to look for the genetic “root” of hypertension. Everyone eats Neolithic food, which is the main cause of cancer, thus we wrongly look for a genetic root.
Epidemiologist Geoffrey Rose:

If everyone smoked 20 cigarettes a day, then clinical, case-control and cohort studies alike would lead us to conclude that lung cancer was a genetic disease; and in one sense that would be true, since if everyone is exposed to the necessary agent, then the distribution of cases is wholly determined by individual susceptibility. The hardest cause to identify is the one that is universally present, for then it has no influence on the distribution of disease.
Rose G. Sick individuals and sick populations. Int. J. Epidemiology 1985;14:32–8

The Lyon Heart study proved that a good diet high in greens would not only reduce heart attack by 70% but also reduce cancer by 50%. Hunter gatherers get under 1% of our cancer rate, until they start eating our food. Every second cancer patient today would not have cancer if everyone ate according to the Lyon Heart study. 99% would not have cancer if they ate a Paleolithic diet.

Your skin, eyes, nails and oral health can show signs of heart disease.The oral cavity is an important anatomical location with a role in many critical physiologic processes, such as digestion, respiration, and speech. It is also unique for the presence of exposed hard tissue surrounded by mucosa. The mouth is frequently involved in conditions that affect the skin or other multiorgan diseases. In many instances, oral involvement precedes the appearance of other symptoms or lesions at other locations.

Amyloidosis is the deposition of amyloid proteins in body tissues leading to tissue damage. Amyloidosis is classified as either primary or secondary. The former results from multiple myeloma[34] or an idiopathic disease, while the latter is a sequela of a chronic or inflammatory disease process. These classifications are based on the type of fibrillar protein deposited. The primary form usually affects the skin, heart, tongue, and GI tract, while the secondary form, although more common, has no cutaneous manifestations.
Systemically, patients with primary amyloid light chain amyloidosis present with fatigue, weight loss, and symptoms specific to the organs involved. The kidneys and heart are the most common organs involved, demonstrating renal failure and aggressive congestive heart failure. CNS manifestations are absent, but peripheral neuropathies are common.[35]
The most common oral manifestation of amyloidosis is macroglossia, which occurs in 20% of patients. The enlarged tongue demonstrates lateral ridging due to teeth indentation.[35] Although pain is not usually present, enlargement, firmness, and loss of mobility are common. Grossly, the tongue may be firm and appear relatively normal or it may have yellow nodules on the lateral surface. Interference with taste has also been reported in some patients, and hyposalivation may result from amyloid deposition in the salivary glands. Submandibular swelling occurs subsequent to tongue enlargement and can lead to respiratory obstruction. Rarlely, oral ulceration may present[36] .
Microscopic examination of a biopsy sample from an enlarged tongue reveals the characteristic amorphous fissured appearance of amyloid in the tissues; a green negative birefringence is depicted when polarized light is shone on tissue stained with Congo red. The most common protein type deposited in the oral cavity is amyloid. The detection of AL in a patient warrants further evaluation for possible multiple myeloma. Of patients with multiple myeloma, 7-20% have amyloid deposition. The presence of myeloma yields a poor prognosis for the patient.

http://emedicine.medscape.com/article/1081029-overview#a30

 

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Collected by
Connie Dello Buono
Email to own your agency in retirement and college planning : motherhealth@gmail.com
408-854-1883

 

Preventive care of chronic thromboembolic pulmonary hypertensive (CTPH); prevalent in older women

Surgery is the principal therapy but knowing signs and symptoms will help you with CTPH.

The Pulmonary Circulation
The pulmonary circulation is made up of the blood vessels that carry oxygen-rich blood through the lungs (the pulmonary system). As the blood flows though the lungs, it loads up with oxygen and loses the carbon dioxide it is carrying. Then, the oxygen-rich blood returns to the heart through the left upper chamber (atrium), flows into the left lower chamber (ventricle) and out through the aorta to all cells in the body.

Once the oxygen is lost from the blood, the veins carry it back to the heart from all over the body. It flows into the heart’s right atrium. After the atrium is filled with blood, it squeezes (contracts) and sends the blood into the right ventricle. When the right ventricle fills and contracts, it pushes blood into the pulmonary artery. The pulmonary artery goes into the lungs through the pulmonary circulation.

Chronic is a medical term that describes a disease or condition that continues for a period of months or years.

A Pulmonary Thromboembolism refers to the clots that travel from veins in the body (emboli) and clog the arteries in the lungs. Once lodged in the lung arteries, they can cause more clots to form (thrombosis) and add more resistance to the blood flow through the lung.
This increased resistance from the clots increases the pressure inside the lungs. The medical term for increased pressure is Hypertension. Combining these key words gives us the meaning of chronic thromboembolic pulmonary hypertension: High blood pressure in the pulmonary arteries that lasts six months or longer. The condition often happens after there is a pulmonary embolism.

What causes CTEPH?
When the body cannot resorb a pulmonary embolism (PE), it can trigger CTEPH. However, up to half of all patients with CTPEH do not have a history of PE. In 2008, the World Council on Pulmonary Embolism reported that approximately 2 to 4 percent of people with PE develop CTEPH. It is a relatively rare disease. Only about 5,000 people in the United States are diagnosed with CTEPH each year. Because many patients with CTEPH have no history of PE, or don’t know they have PE, it can be overlooked or not suspected.

Risk factors for PE and CTEPH
Risk factors for pulmonary embolism include:
• Long periods of inactivity. This can include bed rest due to surgery or illness, or even a long trip by car or plane.
• Certain types of surgery, such as joint replacement of the hip or knee
• Older age
• Certain diseases, including peripheral artery disease, heart disease and cancer
• Family or personal history of blood clots
• Smoking
• Obesity
• A history of taking synthetic estrogen in the form of birth control pills or hormone replacement therapy
The risk factors for developing CTEPH include:
• Large PE or more than one episode of PE
• Previous surgical removal of the spleen
• Chronic inflammatory diseases, such as inflammatory bowel disease and osteomyelitis
• History of cancer
• Female sex
• Hypercoagulability disorders

What are the symptoms of CTEPH?
Many people who develop pulmonary hypertension after PE go through a so-called “honeymoon period” when they do not have any symptoms. When symptoms develop, they are vague and non-specific in the early stages of the disease. These include:
• Shortness of breath with exercise
• Chest discomfort
• Fatigue

Symptoms of later-stage disease include fainting and signs of right heart failure, such as fluid retention (edema) and blue-tinged fingers and toes (cyanosis).
Some patients with CTEPH never have any early symptoms. Most times, the disease is discovered in these patients when they develop late-stage symptoms or during an autopsy.

CTEPH is a unique and curable form of PH. Unlike PAH, the principal therapy is surgery. Without surgery, patients with CTEPH have a poor prognosis and succumb to right heart failure. Despite advances in CT, the screening test of choice for CTEPH remains a VQ scan. Even a single segmental perfusion defect in a patient with PH or unexplained dyspnea should alert the clinician to the possibility of chronic thromboembolic disease. Pulmonary endarterectomy remains an effective and relatively safe surgery if performed at an experienced center. Current data do not support medical treatment with PAH-approved therapies either in lieu of or as bridge to pulmonary endarterectomy. Whether a subset of patients with predominantly small-vessel disease can benefit from medical therapy is unknown. The difficulty, however, remains in identifying the subset of patients with significant inoperable, small-vessel disease prior to endarterectomy. Until a more objective, reliable preoperative test emerges to assist with predicting postoperative hemodynamic results, all patients with CTEPH should be considered for surgery.

Chronic Thromboembolic Pulmonary Hypertension: Summary
Nick H. Kim, MD
Faculty and Disclosures
http://www.medscape.org/viewarticle/556058_6

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Connie Dello Buono
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