tag:theconversation.com,2011:/fr/topics/blood-pressure-892/articlesBlood pressure – The Conversation2024-03-17T08:42:31Ztag:theconversation.com,2011:article/2242862024-03-17T08:42:31Z2024-03-17T08:42:31ZAlmost 50% of adult South Africans are overweight or obese. Poverty and poor nutrition are largely to blame<p><a href="https://www.who.int/health-topics/malnutrition#tab=tab_1">Malnutrition</a>, in all its forms, includes undernutrition (wasting, stunting, underweight), inadequate vitamins or minerals, overweight and obesity. </p>
<p>South Africa has undergone a nutritional transition over the past 30 years characterised by the <a href="https://www.researchgate.net/publication/378313186_National_Food_and_Nutrition_South_Africa">triple burden</a> of malnutrition: households are simultaneously experiencing undernutrition, hidden hunger, and overweight or obesity due to nutrient-poor diets.</p>
<p>Results of the first in-depth, nationwide <a href="https://www.researchgate.net/publication/378313186_National_Food_and_Nutrition_South_Africa">study</a> into food and nutrition since 1994, the National Food and Nutrition Security Survey, found almost half the adult population of South Africa were overweight or obese. </p>
<p>While there was sufficient food to feed everyone through domestic production and imports, many families and individuals went to bed on empty stomachs.</p>
<p>Due to <a href="https://www.gov.za/news/media-statements/statistics-south-africa-quarterly-labour-force-survey-quarter-three-2023-14#:%7E:text=The%20official%20unemployment%20rate%20was,the%20second%20quarter%20of%202023.">high unemployment figures</a>, families relied on social grants to buy basic food items. Many tended to buy food with little nutritional value to avoid hunger. </p>
<p>The survey, conducted by the Human Sciences Research Council, was commissioned by the Department of Agriculture, Land Reform and Rural Development to map hunger and malnutrition hotspots in the country. </p>
<p>Data was collected from more than 34,500 households between 2021 and 2023. Close to 100 indicators were used to compile the report. </p>
<h2>Overweight or obese: what’s the difference?</h2>
<p>Carrying excess weight poses a number of health risks. It increases the dangers of high blood pressure, high triglyceride levels, coronary heart disease, stroke, type 2 diabetes, osteoarthritis, sleep apnoea, and respiratory problems.</p>
<p>People are <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:%7E:text=For%20adults%2C%20WHO%20defines%20overweight,than%20or%20equal%20to%2030">overweight</a> if their body mass index, a measure of body fat based on height and weight, is greater than 25. </p>
<p><a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:%7E:text=For%20adults%2C%20WHO%20defines%20overweight,than%20or%20equal%20to%2030">Obese</a> adults have a body mass index greater than 30.</p>
<h2>Key facts</h2>
<p>Some of the significant findings were:</p>
<ul>
<li><p>69% of obese adults lived in food insecure households where families had little dietary choices and were forced to eat food with little nutritional value. </p></li>
<li><p>More than two-thirds (67.9%) of females were either overweight or obese. There were higher incidences of obesity among women than men.</p></li>
<li><p>Adults aged 35 to 64 years had a significantly greater prevalence of obesity than younger age groups. This could be explained by differences in <a href="https://faseb.onlinelibrary.wiley.com/doi/full/10.1096/fj.202101930R">metabolism</a> and the fact that youngsters are more active than adults. </p></li>
<li><p>KwaZulu-Natal reported a higher prevalence of obesity (39.4%) compared to the other provinces. More research is needed to explore this finding and whether cultural factors are behind this.</p></li>
</ul>
<p>The survey period overlapped with the tail-end of COVID-19. Focus group discussions took place in all districts where data was collected to assess the effects of the pandemic. </p>
<p>The survey found that the swift responses by government through various relief programmes significantly reduced the exposure of families to extreme poverty and food insecurity during this period.</p>
<h2>Moving forward</h2>
<p>Obesity is a global problem. A <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02750-2/fulltext">new study</a> released by the Lancet showed that, in 2022, more than 1 billion people in the world were living with obesity. </p>
<p>Worldwide, obesity among adults had more than doubled since 1990, and had quadrupled among children and adolescents (5 to 19 years of age). </p>
<p>The Human Sciences Research Council made the following recommendations to help address malnutrition in South Africa: </p>
<ul>
<li><p>focus on areas with high levels of malnutrition</p></li>
<li><p>encourage families to produce their own food to supplement social grants</p></li>
<li><p>invest in food banks at fruit and vegetable markets strategically located close to vulnerable households</p></li>
<li><p>help extremely poor households survive seasonal hunger</p></li>
<li><p>launch campaigns to educate the public on the benefits of consuming nutrient-rich foods and dietary diversity.</p></li>
</ul>
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<strong>
Read more:
<a href="https://theconversation.com/research-shows-shocking-rise-in-obesity-levels-in-urban-africa-over-past-25-years-90485">Research shows shocking rise in obesity levels in urban Africa over past 25 years</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/224286/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thokozani Simelane does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>South Africa’s national survey of food and nutrition security identifies the areas most in need.Thokozani Simelane, Professor of Practice, Human Sciences Research CouncilLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2236762024-03-13T14:23:30Z2024-03-13T14:23:30ZAre you sitting too long in your office job? South African study offers some health tips<p>Sedentary behaviour can result in chronic health conditions such as obesity and heart diseases, bad news for the millions of office workers who are forced to sit behind their desks every day.</p>
<p>In its simplest form, the term “sedentary behaviour” describes sitting for too long and not breaking this up with movement. </p>
<p>Sitting for more than one hour without a break can be considered as <a href="https://doi.org/10.1007/s40279-023-01915-z">too much</a> sitting time.</p>
<p>Existing evidence shows that about 25% of adults and over 75% of adolescents worldwide are not meeting the World Health Organization physical activity recommendations.</p>
<p>The WHO’s latest <a href="https://www.who.int/publications/i/item/9789240015128">guidelines on physical activity and sedentary behaviour</a> recommend physical inactivity by around 15% in all age groups by 2030.</p>
<p>The WHO guidelines, released in 2020, are <a href="https://doi.org/10.1136/bjsports-2020-102955">particularly important</a> for office workers who spend a significant portion of their work day sitting. </p>
<p>As a specialist in the epidemiology of physical activity I took part in a new study into sedentary behaviour among a group of office-based workers in South Africa. </p>
<p>We found that conscious movement – even if this means standing instead of sitting – helped office workers stay healthy.</p>
<h2>What we found</h2>
<p>In our <a href="https://doi.org/10.1177/15598276231210479">study</a>, published in the American Journal of Lifestyle Medicine, colleagues and I collected data from 122 office workers based in Johannesburg. </p>
<p>The majority of the participants were female (68%) with an average age of 40 years. All had completed high school.</p>
<p>We measured body mass index, waist circumference, blood pressure and other key medical indicators of health and wellbeing.</p>
<p>Participants were asked to record their own sitting times. </p>
<p>We also used wrist-worn <a href="https://www.sciencedirect.com/topics/engineering/accelerometer-sensor">accelerometers</a> to collect data. This innovative method gave us a more accurate understanding of physical activity and sedentary behaviour compared to self-reported questionnaires.</p>
<p>The self-reported data by participants averaged 1.3 hours a day sitting for mealtimes, 3.9 hours a day related to work, 1.4 hours a day for transport, 1.7 hours a day for screen time, and 3.4 hours a day for other activities. This amounted to about 12 hours of sitting per day. </p>
<p>This was significantly higher than the three hours a day recorded by accelerometers. The discrepancy could partly be explained by participants – consciously or unconsciously – feeling more motivated to move when wearing these smart devices.</p>
<p>The blood pressure, cholesterol and <a href="https://medlineplus.gov/lab-tests/triglycerides-test/#:%7E:text=A%20triglycerides%20test%20is%20used,the%20risk%20of%20heart%20disease.">serum triglyceride levels</a> of our study participants were within normal ranges.</p>
<p>This finding is encouraging because they seemed to be at less risk of cardiovascular diseases. It could possibly be explained by the fact that these office workers were engaged in light physical activity for about two hours a day.</p>
<p>This also supports the WHO’s message emphasising that any movement is better than none. </p>
<p>They engaged in moderate to vigorous physical activity for about 50 minutes a day. This was less than the WHO recommendation of at least 60 minutes of moderate to vigorous physical activity a day. </p>
<p>In terms of overall health for South African office workers, our findings show that conscious efforts to move during the day can help them keep them healthier.</p>
<h2>Keep standing and keep moving</h2>
<p>Light intensity physical activity, sometimes referred to as gentle exercise, can include movement such as getting up, and walking to make a cup of coffee.</p>
<p>Office workers should stand whenever possible, as there is a growing body of evidence showing that standing is better than prolonged sitting, particularly for <a href="https://doi.org/10.1177/2047487317752186">energy expenditure</a> and reducing the risk of <a href="https://doi.org/10.1016/s0140-6736(16)30370-1">cardiovascular disease</a>.
It also activates muscle activity. </p>
<p>In practical terms, light physical activities during the workday could include:</p>
<ul>
<li><p>standing up to take a break</p></li>
<li><p>using a standing workstation</p></li>
<li><p>standing during meetings. </p></li>
</ul>
<p>Moderate to vigorous physical activities could include:</p>
<ul>
<li><p>using the stairs instead of the lifts</p></li>
<li><p>parking further from the office building entrance and walking at a brisk pace to the entrance</p></li>
<li><p>introducing fun activity breaks</p></li>
<li><p>engaging in various types of activities at a private gym close to work.</p></li>
</ul>
<p>Office workers should make conscious efforts to engage in physical activities during recreational times. </p>
<p>These could include: </p>
<ul>
<li><p>participating in weekly park runs</p></li>
<li><p>walking groups</p></li>
<li><p>structured sporting activities such as organised cycling, especially with safety and security in mind.</p></li>
</ul>
<p>In general, the more physically active people are, the better the health outcomes. </p>
<h2>Moving forward</h2>
<p>By 2021 worldwide obesity had nearly <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">tripled</a> since 1975.</p>
<p>Physical inactivity is the leading modifiable risk factor for cardiometabolic diseases and all-cause mortality.</p>
<p>Studies such as ours help policymakers, businesses and companies formulate strategies to keep office workers healthier, promote a positive work-life balance and contribute to a more efficient work environment.</p>
<p>Our research underscores the urgent need to include more opportunities for movement into our everyday lives, especially important for South African office workers. </p>
<p>More studies from the global south are needed to develop context-relevant workplace interventions that can be easily integrated into employee health and wellness policy.</p><img src="https://counter.theconversation.com/content/223676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philippe Gradidge receives funding from the National Research Foundation (South Africa) and The South African Medical Research Council.</span></em></p>Office workers are sedentary for hours at a time. Our research looked at what they should do to stay healthy.Philippe Gradidge, Associate Professor, Department of Exercise Science and Sports Medicine, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2245912024-03-12T12:29:23Z2024-03-12T12:29:23ZSalty foods are making people sick − in part by poisoning their microbiomes<figure><img src="https://images.theconversation.com/files/580543/original/file-20240307-30-s3d9jw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1729%2C1732&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Salt has taken over many diets worldwide -- some more than others.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/salt-on-pile-royalty-free-image/115788609">ATU Images/The Image Bank via Getty Images</a></span></figcaption></figure><p>People have been using salt since the <a href="https://doi.org/10.1007/978-1-349-21841-7">dawn of civilization</a> to process, preserve and enhance foods. In <a href="https://www.sidestone.com/books/archaeology-of-salt">ancient Rome</a>, salt was so central to commerce that soldiers were paid their “salarium,” or salaries, in salt, for instance. </p>
<p>Salt’s value was in part as a food preservative, keeping unwanted microbes at bay while <a href="https://doi.org/10.1002/bit.260090302">allowing desired ones to grow</a>. It was this remarkable ability to regulate bacterial growth that likely helped spark the <a href="https://www.jstor.org/stable/26017985">development of fermented foods</a> ranging from sauerkraut to salami, olives to bread, cheese to kimchi.</p>
<p>Today, salt has become ubiquitous and highly concentrated in <a href="https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/sodium-sources">increasingly processed diets</a>. The evidence has mounted that too much salt – specifically the sodium chloride added to preserve and enhance the flavor of many highly processed foods – is <a href="https://www.npr.org/sections/health-shots/2021/10/13/1045651839/eating-too-much-salt-is-making-americans-sick-even-a-12-reduction-can-save-lives">making people sick</a>. It can cause <a href="https://doi.org/10.1016/j.jacc.2019.11.055">high blood pressure</a> and contribute to <a href="https://doi.org/10.1056/NEJMoa2105675">heart attacks and stroke</a>. It is also associated with an increased risk of developing <a href="https://doi.org/10.3390%2Fnu14204260">stomach</a> and <a href="https://doi.org/10.1093%2Fcdn%2Fnzz030.P05-039-19">colon cancer</a>, <a href="https://doi.org/10.1080/00016489.2024.2315302">Ménière’s disease</a>, <a href="https://doi.org/10.1038/s41598-022-18830-4">osteoporosis</a> and <a href="https://doi.org/10.1038/nrneph.2018.23">obesity</a>.</p>
<p>How might a substance previously thought <a href="https://www.worldhistory.org/article/1342/the-salt-trade-of-ancient-west-africa/">worth its weight in gold</a> have transformed into something <a href="https://doi.org/10.1038%2Fs41371-022-00690-0">many medical institutions</a> consider a <a href="https://doi.org/10.1001/jama.2017.0947">key predictor of disease</a>?</p>
<p>Salt lobbyists may be one answer to this question. And as <a href="https://gastro.uw.edu/people/faculty/damman-c">a gastroenterologist</a> and research scientist at the University of Washington, I want to share the mounting evidence that microbes from the shadows of your gut might also shed some light on how salt contributes to disease.</p>
<h2>Blood pressure cookers</h2>
<p>Sodium’s role in blood pressure and heart disease results largely from its regulating the <a href="https://doi.org/10.1161/01.CIR.53.4.589">amount of water inside your blood vessels</a>. In simple terms, the more sodium in your blood, the more water it pulls into your blood vessels. This leads to higher blood pressure and subsequently an increased risk for heart attack and stroke. Some people may be <a href="https://doi.org/10.1038/s41371-020-00407-1">more or less sensitive</a> to the effects salt has on blood pressure.</p>
<p>Recent research suggests an additional way salt may <a href="https://doi.org/10.1038/s44161-022-00204-8">raise blood pressure</a> – by altering your gut microbiome. Salt leads to a decrease in <a href="https://doi.org/10.3390%2Fnu14061171">healthy microbes</a> and the <a href="https://doi.org/10.3390%2Fnu10091154">key metabolites</a> they produce from fiber. These metabolites <a href="https://doi.org/10.1038/s44161-022-00204-8">decrease inflammation</a> in blood vessels and <a href="https://doi.org/10.1161/HYPERTENSIONAHA.122.18558">keep them relaxed</a>, contributing to reduced blood pressure.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580552/original/file-20240307-18-c1oq15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Salt shaker next to a blood pressure cuff" src="https://images.theconversation.com/files/580552/original/file-20240307-18-c1oq15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580552/original/file-20240307-18-c1oq15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580552/original/file-20240307-18-c1oq15.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580552/original/file-20240307-18-c1oq15.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580552/original/file-20240307-18-c1oq15.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580552/original/file-20240307-18-c1oq15.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580552/original/file-20240307-18-c1oq15.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Extra salt may contribute to high blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/blood-pressure-cuff-and-salt-royalty-free-image/86495796">Jupiterimages/Stockbyte via Getty Images</a></span>
</figcaption>
</figure>
<p>With the exception of certain organisms that thrive in salt <a href="https://doi.org/10.1038/s41366-018-0201-3">called halophiles</a>, high levels of salt can <a href="https://www.sciencefocus.com/nature/why-does-salt-have-antibacterial-properties">poison just about any microbe</a>, even ones your body wants to keep around. This is why people have been using salt for a long time to <a href="https://www.ncbi.nlm.nih.gov/books/NBK50952/">preserve food</a> and keep unwanted bacteria away.</p>
<p>But modern diets often have too much sodium. According to the World Health Organization, healthy consumption amounts to less than <a href="https://www.who.int/news-room/fact-sheets/detail/salt-reduction">2,000 milligrams</a> per day for the average adult. The global mean intake of <a href="https://www.who.int/news-room/fact-sheets/detail/salt-reduction">4,310 milligrams</a> of sodium has likely increased the amount of <a href="https://doi.org/10.1038/ki.1985.38">salt in the gut</a> over healthy levels.</p>
<h2>Salt of the girth</h2>
<p>Sodium is connected to health outcomes <a href="https://doi.org/10.1016%2Fj.jacc.2014.12.039">other than blood pressure</a>, and your microbiome may be playing a role here, too.</p>
<p>High sodium diets and higher <a href="https://doi.org/10.1038/s41366-018-0201-3">sodium levels in stool</a> are significantly linked to <a href="https://doi.org/10.1111/dom.14980">metabolic disorders</a>, including elevated <a href="https://doi.org/10.2147/DMSO.S338915">blood sugar</a>, <a href="https://doi.org/10.1002%2Ffsn3.2781">fatty liver disease</a> and <a href="https://doi.org/10.4162%2Fnrp.2023.17.2.175">weight gain</a>. In fact, one study estimated that for every one gram per day increase in dietary sodium, there is a 15% <a href="https://doi.org/10.1016/j.nutres.2018.04.008">increased risk of obesity</a>. </p>
<p>A gold-standard dietary study from the National Institutes of Health found that those on a diet of ultraprocessed foods over two weeks ate about <a href="https://doi.org/10.1016/j.cmet.2019.05.008">500 more calories and weighed about 2 pounds more</a> compared with those on a minimally processed diet. One of the biggest differences between the two diets was the extra 1.2 grams of sodium consumed with the ultraprocessed diets.</p>
<p>A leading explanation for why increased salt may lead to weight gain despite having no calories is that <a href="https://doi.org/10.1016/j.physbeh.2008.04.008">sodium increases cravings</a>. When sodium is combined with simple sugars and unhealthy fats, these so-called <a href="https://doi.org/10.1002/oby.22639">hyperpalatable foods</a> may be linked to <a href="https://doi.org/10.1016/j.appet.2021.105592">fat gain</a>, as they are particularly good at stimulating the <a href="https://doi.org/10.1155%2F2016%2F7238679">reward centers</a> in the brain and <a href="https://doi.org/10.3945/ajcn.111.020164">addictionlike</a> eating behaviors.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580540/original/file-20240307-28-lr4cr3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of a chef's hand dispensing a pinch of salt" src="https://images.theconversation.com/files/580540/original/file-20240307-28-lr4cr3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580540/original/file-20240307-28-lr4cr3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580540/original/file-20240307-28-lr4cr3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580540/original/file-20240307-28-lr4cr3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580540/original/file-20240307-28-lr4cr3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580540/original/file-20240307-28-lr4cr3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580540/original/file-20240307-28-lr4cr3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many people could do with a pinch less of salt.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/close-up-of-a-chef-adding-salt-into-his-recipe-royalty-free-image/1339981307">skynesher/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>Salt may also connect to cravings via a short circuit in the gut microbiome. Microbiome metabolites stimulate the release of a <a href="https://theconversation.com/your-body-already-has-a-built-in-weight-loss-system-that-works-like-wegovy-ozempic-and-mounjaro-food-and-your-gut-microbiome-220272">natural version</a> of weight loss drugs Wegovy and Ozempic, the gut hormone GLP-1. Through GLP-1, a healthy microbiome can control your appetite, blood sugar levels and your body’s decision to burn or store energy as fat. Too much salt may interfere with its release.</p>
<p>Other explanations for salt’s effect on metabolic disease, with varying amounts of evidence, include increased <a href="https://doi.org/10.1097%2FMNH.0000000000000152">sugar absorption</a>, increased <a href="https://doi.org/10.1093/cvr/cvac160">gut-derived corticosteroids</a> and a <a href="https://doi.org/10.1073/pnas.1713837115">sugar called fructose</a> that can lead to fat accumulation and decreases in <a href="https://doi.org/10.3390%2Fnu14020253">energy use for heat production</a>.</p>
<h2>Desalin-nations</h2>
<p>While many countries are implementing <a href="https://doi.org/10.1093/advances/nmab008">national salt reduction initiatives</a>, sodium consumption in most <a href="https://www.hsph.harvard.edu/magazine/magazine_article/wheres-the-salt/">parts of the world</a> remains on the rise. Dietary salt reduction in the <a href="http://dx.doi.org/10.15585/mmwr.mm7042a4">United States</a> in particular remains behind the curve, while many <a href="https://doi.org/10.1016/j.nfs.2015.03.001">European countries</a> have started to <a href="https://doi.org/10.1093/eurheartj/ehab274">see benefits</a> such as lower blood pressure and fewer deaths from heart disease through initiatives like improved <a href="https://www.iarc.who.int/wp-content/uploads/2021/09/IARC_Evidence_Summary_Brief_2.pdf">package labeling</a> of salt content, reformulating foods to limit salt and even salt taxes. </p>
<p>Comparing the nutrition facts of fast-food items <a href="https://doi.org/10.1503/cmaj.111895">between countries</a> reveals considerable variability. For instance, <a href="https://www.npr.org/sections/thesalt/2012/04/16/150728142/fast-food-in-the-u-s-has-way-more-salt-than-in-other-countries">McDonald’s chicken nuggets</a> are saltiest in the U.S. and even <a href="https://www.coca-cola.com/us/en/brands/coca-cola/products/original#accordion-c55f229edc-item-93131ee8b3">American Coke</a> contains salt, an ingredient it <a href="https://world.openfoodfacts.org/cgi/search.pl?search_terms=coca+cola&search_simple=1&action=process">lacks in other countries</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/580549/original/file-20240307-24-bxdz7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Hand shaking salt on a packet of fries beside a soft drink" src="https://images.theconversation.com/files/580549/original/file-20240307-24-bxdz7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580549/original/file-20240307-24-bxdz7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580549/original/file-20240307-24-bxdz7t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580549/original/file-20240307-24-bxdz7t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580549/original/file-20240307-24-bxdz7t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=529&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580549/original/file-20240307-24-bxdz7t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=529&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580549/original/file-20240307-24-bxdz7t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=529&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some fast foods have more salt than others.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/excess-salt-being-added-to-chips-french-fires-royalty-free-image/1069612086">Peter Dazeley/The Image Bank via Getty Images</a></span>
</figcaption>
</figure>
<p>The <a href="https://www.npr.org/sections/thesalt/2019/03/30/707747077/after-a-century-a-voice-for-the-u-s-salt-industry-goes-quiet">salt industry</a> in the U.S may have a role here. It lobbied to prevent government regulations on salt in the 2010s, not dissimilar from what the <a href="https://doi.org/10.1111%2Fj.1468-0009.2009.00555.x">tobacco industry did with cigarettes</a> in the 1980s. Salty foods sell well. One of the key voices of the salt industry for many years, the now-defunct <a href="https://thehill.com/regulation/healthcare/281914-salt-lobby-warns-sodium-reduction-will-endanger-public-health/">Salt Institute</a>, may have confused public health messaging around the importance of salt reduction by emphasizing the <a href="https://www.acc.org/About-ACC/Press-Releases/2023/02/22/20/42/Too-Little-Sodium-Can-be-Harmful-to-Heart-Failure-Patients">less common</a> instances where restriction can be dangerous.</p>
<p>But the evidence for reducing salt in the general diet is mounting, and institutions are responding. In 2021, the U.S. Department of Agriculture issued <a href="https://www.fda.gov/regulatory-information/search-fda-guidance-documents/guidance-industry-voluntary-sodium-reduction-goals">new industry guidance</a> calling for a <a href="https://www.fda.gov/food/food-additives-petitions/sodium-reduction#">voluntary gradual reduction of salt</a> in commercially processed and prepared foods. The <a href="https://www.npr.org/sections/thesalt/2019/03/30/707747077/after-a-century-a-voice-for-the-u-s-salt-industry-goes-quiet">Salt Institute</a> dissolved in 2019. Other organizations such as the <a href="https://affi.org/affi-statement-on-fda-release-of-voluntary-sodium-reduction-goals/">American Frozen Food Institute</a> and major ingredient <a href="https://www.cargill.com/salt-in-perspective/new-report-outlines-how-us-food-companies-can-improve-offerings">suppliers such as Cargill</a> are on board with lowering dietary salt.</p>
<h2>From add-vice to advice</h2>
<p>How can you <a href="https://theconversation.com/hangry-bacteria-in-your-gut-microbiome-are-linked-to-chronic-disease-feeding-them-what-they-need-could-lead-to-happier-cells-and-a-healthier-body-199486">feed your gut microbiome</a> well while being mindful of your salt intake?</p>
<p>Start with limiting your consumption of highly processed foods: salty meats (such as fast food and cured meat), salty treats (such as crackers and chips) and salty sneaks (such as soft drinks, condiments and breads). Up to <a href="https://www.fda.gov/food/nutrition-education-resources-materials/sodium-your-diet">70% of dietary salt</a> in the U.S. is currently consumed from packaged and processed foods. </p>
<p>Instead, focus on foods low in added sodium and sugar and high in potassium and fiber, such as unprocessed, plant-based foods: beans, nuts, seeds, whole grains, fruits and vegetables. <a href="https://doi.org/10.1080/10408398.2017.1383355">Fermented foods</a>, though often high in sodium, may also be a <a href="https://doi.org/10.1016/j.cell.2021.06.019">healthier option</a> due to high levels of <a href="https://doi.org/10.1038/s41598-019-53242-x">short-chain fatty acids</a>, <a href="https://theconversation.com/fiber-is-your-bodys-natural-guide-to-weight-management-rather-than-cutting-carbs-out-of-your-diet-eat-them-in-their-original-fiber-packaging-instead-205159">fiber</a>, <a href="https://gutbites.org/2024/01/18/like-fiber-polyphenols-in-food-boost-glp-1-ignite-mitochondria-help-coordinate-metabolic-health/">polyphenols</a> and potassium.</p>
<p>Finally, consider the balance of dietary sodium and potassium. While sodium helps keep fluid in your blood vessels, potassium helps keep fluid <a href="https://gutbites.org/2024/03/02/too-much-or-too-little-salt-balanced-advice-on-sodium-to-potassium-ratios/">in your cells</a>. Dietary sodium and potassium are best consumed <a href="https://gutbites.org/carb-fiber-ratio-calculator/#NCS">in balanced ratios</a>.</p>
<p>While all advice is best taken with a grain of salt, your microbiome gently asks that it just not be large.</p><img src="https://counter.theconversation.com/content/224591/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christopher Damman is on the scientific advisory board at Oobli and One BIO.</span></em></p>Salt is an essential nutrient that has helped civilizations flavor and preserve their foods for millennia. Too much dietary salt, however, is linked to a host of health problems.Christopher Damman, Associate Professor of Gastroenterology, School of Medicine, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2239092024-03-04T13:26:22Z2024-03-04T13:26:22ZSouth Africa has more than 4 million people living with diabetes – many aren’t getting proper treatment<p>Diabetes is a chronic condition that affects how the body turns food into energy. </p>
<p>In South Africa there has been a notable <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199430/">rise in the prevalence of type 2 diabetes</a> in recent years, due to changing diets. People are consuming more processed foods, sugary drinks and high-calorie meals. </p>
<p>Other factors are the lack of physical activity and high levels of obesity. </p>
<p><a href="https://theconversation.com/over-12-of-south-african-adults-have-diabetes-education-is-critical-to-achieve-good-outcomes-194502">Type 2 diabetes</a> is the most common form, making up 90% of cases. With this type, the body produces insulin but can’t use it effectively. It typically affects overweight adults with a family history of the condition.</p>
<p>Approximately one in nine South African adults have diabetes, totalling around <a href="https://diabetesatlas.org/data/en/country/185/za.html">4.2 million individuals</a>. </p>
<p>Diabetes is also the leading cause of death <a href="https://www.statssa.gov.za/publications/P03093/P030932017.pdf">among women</a> in the country. </p>
<p>As public health specialists and clinicians focusing on diabetes, we <a href="https://www.tandfonline.com/doi/full/10.1080/16089677.2024.2311497">researched</a> the standard of primary care that people living with type 2 diabetes receive in South Africa. </p>
<p>We found that the management of diabetes falls short of optimal standards, putting individuals at risk of the many side effects associated with diabetes.</p>
<h2>What we found and why it matters</h2>
<p>We examined 479 medical records of individuals diagnosed with type 2 diabetes across 23 primary healthcare facilities in the Tshwane district of Gauteng province. </p>
<p>The majority of patients were women. Patients had been living with diabetes for an average of 5.5 years. The average age was 58 years.</p>
<p>When it comes to managing diabetes, there are targets for blood glucose, blood pressure and cholesterol. We used guidelines set out by the <a href="https://www.semdsa.org.za/for-members/guidelines">Society for Endocrinology, Metabolism and Diabetes South Africa</a> for this study. </p>
<p>Our audit found a significant number of patients with type 2 diabetes were not receiving adequate treatment. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/over-12-of-south-african-adults-have-diabetes-education-is-critical-to-achieve-good-outcomes-194502">Over 12% of South African adults have diabetes - education is critical to achieve good outcomes</a>
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</em>
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<p>Only 23% of patients met the glucose target. This meant more than 70% of the patients were at risk of serious health complications.</p>
<p>Patients attended clinic visits regularly, yet they experienced prolonged periods of <a href="https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/hyperglycaemia-high-blood-sugar/">hyperglycaemia</a> (high blood sugar levels).</p>
<p>We also found that healthcare providers often displayed <a href="https://diabetes.medicinematters.com/quality-of-life/type-2-diabetes/tackling-clinical-inertia-the-role-of-patient-engagement/15918202">clinical inertia</a>. In other words, they failed to set targets or to initiate or adjust treatment to achieve these goals. They delayed starting or changing a patient’s treatment plan, even when it was clear the current plan wasn’t working well.</p>
<p>Factors contributing to clinical inertia included a uniform treatment approach not suited to all patients, limited treatment options and an inadequately equipped healthcare system. </p>
<p>Given the absence of comprehensive surveillance systems like <a href="https://link.springer.com/article/10.1007/s00592-020-01576-8">diabetes registries</a>, studies serve as the primary source of information regarding the implementation and quality of diabetes care in South Africa. </p>
<p>Our results aligned with various studies conducted across South Africa, including one about <a href="https://doi.org/10.1016/j.pcd.2014.05.002">a decade ago within the same district</a>.</p>
<p>A more recent study of 116,726 patients in <a href="https://doi.org/10.1016/j.pcd.2022.05.011">Cape Town</a> found three-quarters of participants had poor glycaemic control as blood sugar levels were not being managed well.</p>
<p>These consistent findings highlight the extra effort needed to overcome clinical inertia to improve diabetes care in South Africa.</p>
<h2>High cost of poor treatment</h2>
<p>For poorly managed patients, diabetes can lead to <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">severe health complications</a>, such as nerve damage, kidney issues, heart disease, stroke, vision impairment and mental health disorders.</p>
<p>For society as a whole, suboptimal diabetes care places a strain on the healthcare system and contributes to higher healthcare costs. </p>
<p>Another consequence is <a href="https://link.springer.com/article/10.1007/s11892-019-1124-7">loss of productivity</a> due to absenteeism from work and even disability, which has an <a href="http://www.samj.org.za/index.php/samj/article/view/13330/9830">economic impact on the country</a>.</p>
<h2>Ways forward</h2>
<p>Monitoring the quality of diabetes care and evaluating the effectiveness of therapies and treatment in clinical practice is a challenge in South Africa. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/diabetes-is-a-ticking-time-bomb-in-sub-saharan-africa-149766">Diabetes is a ticking time bomb in sub-Saharan Africa</a>
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</em>
</p>
<hr>
<p>New strategies could include: </p>
<ul>
<li><p>adopting individualised patient-centred management with access to a wider choice of glucose-lowering drugs </p></li>
<li><p>addressing clinical inertia and the failure to intensify therapy when indicated </p></li>
<li><p>building a health system that caters for the needs of South Africans with diabetes.</p></li>
</ul>
<p>Inadequate treatment for the country’s many people living with diabetes has devastating consequences, not just for individuals and their families, but for the country’s health system at large.</p><img src="https://counter.theconversation.com/content/223909/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Rheeder received research funding from Eli Lilly Global health partnerships (2019-2023)</span></em></p><p class="fine-print"><em><span>Patrick Ngassa Piotie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Healthcare workers in South Africa aren’t always well equipped to treat diabetes. This has devastating consequences for patients.Patrick Ngassa Piotie, Project Manager, University of Pretoria Diabetes Research Centre, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172872024-02-04T19:09:37Z2024-02-04T19:09:37ZHow much weight do you actually need to lose? It might be a lot less than you think<figure><img src="https://images.theconversation.com/files/572339/original/file-20240131-15-eetcro.jpg?ixlib=rb-1.1.0&rect=81%2C0%2C5381%2C3260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overweight-woman-drink-water-during-morning-1079331911">Flotsam/Shutterstock</a></span></figcaption></figure><p>If you’re one of the <a href="https://www.finder.com.au/new-years-resolutions-statistics">one in three</a> Australians whose New Year’s resolution involved losing weight, it’s likely you’re now contemplating what weight-loss goal you should actually be working towards. </p>
<p>But type “setting a weight loss goal” into any online search engine and you’ll likely be left with more questions than answers.</p>
<p>Sure, the many weight-loss apps and calculators available will make setting this goal seem easy. They’ll typically use a body mass index (BMI) calculator to confirm a “healthy” weight and provide a goal weight based on this range.</p>
<p>Your screen will fill with trim-looking influencers touting diets that will help you drop ten kilos in a month, or ads for diets, pills and exercise regimens promising to help you effortlessly and rapidly lose weight. </p>
<p>Most sales pitches will suggest you need to lose substantial amounts of weight to be healthy – making weight loss seem an impossible task. But the research shows you don’t need to lose a lot of weight to achieve health benefits. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-you-be-overweight-and-healthy-182219">Can you be overweight and healthy?</a>
</strong>
</em>
</p>
<hr>
<h2>Using BMI to define our target weight is flawed</h2>
<p>We’re a society fixated on numbers. So it’s no surprise we use measurements and equations to score our weight. The most popular is BMI, a measure of our body weight-to-height ratio. </p>
<p>BMI classifies bodies as underweight, normal (healthy) weight, overweight or obese and can be a useful tool for weight and health screening. </p>
<p>But it shouldn’t be used as the single measure of what it means to be a healthy weight when we set our weight-loss goals. This is <a href="https://theconversation.com/using-bmi-to-measure-your-health-is-nonsense-heres-why-180412">because</a> it: </p>
<ul>
<li><p>fails to consider two critical factors related to body weight and health – body fat percentage and distribution</p></li>
<li><p>does not account for significant differences in body composition based on gender, ethnicity and age.</p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1520959736476274690"}"></div></p>
<h2>How does losing weight benefit our health?</h2>
<p>Losing just 5–10% of our body weight – between 6 and 12kg for someone weighing 120kg – can significantly improve our health in four key ways.</p>
<p><strong>1. Reducing cholesterol</strong></p>
<p>Obesity increases the chances of having too much low-density lipoprotein (LDL) cholesterol – also known as bad cholesterol – because carrying excess weight changes how our bodies produce and manage lipoproteins and triglycerides, another fat molecule we use for energy.</p>
<p>Having too much bad cholesterol and high triglyceride levels is not good, narrowing our arteries and limiting blood flow, which increases the risk of heart disease, heart attack and stroke.</p>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4987606/">research</a> shows improvements in total cholesterol, LDL cholesterol and triglyceride levels are evident with just 5% weight loss.</p>
<p><strong>2. Lowering blood pressure</strong></p>
<p>Our blood pressure is considered high if it reads more than 140/90 on at least two occasions. </p>
<p>Excess weight is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">linked to</a> high blood pressure in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7082272/">several ways</a>, including changing how our sympathetic nervous system, blood vessels and hormones regulate our blood pressure.</p>
<p>Essentially, high blood pressure makes our heart and blood vessels work harder and less efficiently, damaging our arteries over time and increasing our risk of heart disease, heart attack and stroke. </p>
<figure class="align-center ">
<img alt="Older man takes his blood pressure at home" src="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572342/original/file-20240131-17-x809b1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Losing weight can lower your blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hypertension-older-age-senior-black-man-2066841269">Prostock-studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Like the improvements in cholesterol, a 5% weight loss <a href="https://onlinelibrary.wiley.com/doi/10.1002/oby.21358">improves</a> both systolic blood pressure (the first number in the reading) and diastolic blood pressure (the second number). </p>
<p>A <a href="https://www.ahajournals.org/doi/10.1161/01.hyp.0000094221.86888.ae">meta-analysis of 25 trials</a> on the influence of weight reduction on blood pressure also found every kilo of weight loss improved blood pressure by one point.</p>
<p><strong>3. Reducing risk for type 2 diabetes</strong></p>
<p>Excess body weight is the primary manageable risk factor for type 2 diabetes, particularly for people carrying a lot of visceral fat around the abdomen (belly fat).</p>
<p>Carrying this excess weight can cause fat cells to release pro-inflammatory chemicals that disrupt how our bodies regulate and use the insulin produced by our pancreas, leading to high blood sugar levels. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-i-actually-target-areas-to-lose-fat-like-my-belly-205203">Can I actually target areas to lose fat, like my belly?</a>
</strong>
</em>
</p>
<hr>
<p>Type 2 diabetes can lead to serious medical conditions if it’s not carefully managed, including damaging our heart, blood vessels, major organs, eyes and nervous system.</p>
<p><a href="https://www.nejm.org/doi/full/10.1056/nejmoa012512">Research</a> shows just 7% weight loss reduces risk of developing type 2 diabetes by 58%.</p>
<p><strong>4. Reducing joint pain and the risk of osteoarthritis</strong></p>
<p>Carrying excess weight can cause our joints to become inflamed and damaged, making us more prone to osteoarthritis. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/21425246/">Observational studies</a> show being overweight doubles a person’s risk of developing osteoarthritis, while obesity increases the risk fourfold.</p>
<p>Small amounts of weight loss alleviate this stress on our joints. <a href="https://pubmed.ncbi.nlm.nih.gov/15986358/">In one study</a> each kilogram of weight loss resulted in a fourfold decrease in the load exerted on the knee in each step taken during daily activities.</p>
<figure class="align-center ">
<img alt="Man on bathroom scales" src="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572344/original/file-20240131-17-5phiyx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Losing weight eases stress on joints.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-feet-on-scale-bathroom-1030174888">Shutterstock/Rostislav_Sedlacek</a></span>
</figcaption>
</figure>
<h2>Focus on long-term habits</h2>
<p>If you’ve ever tried to lose weight but found the kilos return almost as quickly as they left, you’re not alone.</p>
<p>An <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5764193/">analysis</a> of 29 long-term weight-loss studies found participants regained more than half of the weight lost within two years. Within five years, they regained more than 80%.</p>
<p>When we lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several <a href="https://pubmed.ncbi.nlm.nih.gov/25896063/">physiological responses</a> to defend our body weight and “survive” starvation. </p>
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Read more:
<a href="https://theconversation.com/whats-the-weight-set-point-and-why-does-it-make-it-so-hard-to-keep-weight-off-195724">What's the 'weight set point', and why does it make it so hard to keep weight off?</a>
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<p>Just as the problem is evolutionary, the solution is evolutionary too. Successfully losing weight long-term comes down to:</p>
<ul>
<li><p>losing weight in small manageable chunks you can sustain, specifically periods of weight loss, followed by periods of weight maintenance, and so on, until you achieve your goal weight </p></li>
<li><p>making gradual changes to your lifestyle to ensure you form habits that last a lifetime.</p></li>
</ul>
<p>Setting a goal to reach a healthy weight can feel daunting. But it doesn’t have to be a pre-defined weight according to a “healthy” BMI range. Losing 5–10% of our body weight will result in immediate health benefits.</p>
<p><em>At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can <a href="https://redcap.sydney.edu.au/surveys/?s=RKTXPPPHKY">register here</a> to express your interest.</em></p><img src="https://counter.theconversation.com/content/217287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Nick Fuller works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program.</span></em></p>Weight loss can seem like an impossible, unachievable task. But you don’t need to lose a lot of weight to start noticing the health benefits.Nick Fuller, Charles Perkins Centre Research Program Leader, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1941532023-11-27T19:27:23Z2023-11-27T19:27:23ZRepeated concussions can alter heart activity and impact the ‘heart-brain’ axis<figure><img src="https://images.theconversation.com/files/513107/original/file-20230302-16-tocrry.jpg?ixlib=rb-1.1.0&rect=114%2C122%2C2510%2C1803&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Exploring the interaction between the heart and the brain, known as the heart-brain axis, has shown how heart function changes due to a concussion.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/repeated-concussions-can-alter-heart-activity-and-impact-the-heart-brain-axis" width="100%" height="400"></iframe>
<p>Mild traumatic brain injury or sport-related concussions occur frequently in contact sports such as football, rugby and ice hockey. A concussion doesn’t just affect the brain; <a href="https://doi.org/10.3390/brainsci7080100">it results in stress to the entire body</a>. </p>
<p>In our laboratory comprised of exercise scientists and clinicians, we focus on studying heart function in patients with a concussion. After a concussion, there are increased demands on the body to maintain proper brain activity. To compensate for these demands, there are changes in heart function.</p>
<p>We have explored this interaction between the heart and the brain, known as the heart-brain axis, and have identified how heart function changes due to a concussion. For example, a hit to the head can send signals to the heart that <a href="https://doi.org/10.1111/cpf.12487">shifts the body to a stressful “fight-or-flight” mode</a>. This increases the stress on the body by causing a change in heart function.</p>
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Read more:
<a href="https://theconversation.com/concussion-is-more-than-sports-injuries-whos-at-risk-and-how-canadian-researchers-are-seeking-better-diagnostics-and-treatments-189899">Concussion is more than sports injuries: Who's at risk and how Canadian researchers are seeking better diagnostics and treatments</a>
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<p>This mechanism is related to what we would describe as a neuro-autonomic cardiovascular dysfunction. This means that problems with the autonomic nervous system (ANS) are causing altered signals going to the heart. </p>
<p>The ANS controls things that we don’t actively think about like breathing, digestion and heart function. The ANS is also <a href="https://doi.org/10.1111/cpf.12487">responsible for controlling the rhythm of a heartbeat</a>.</p>
<h2>Changes in systole following a concussion</h2>
<p>Each heartbeat contains both a heart muscle contraction (systole) and relaxation (diastole) phase. That’s why a <a href="https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/blood-pressure/art-20050982">blood pressure reading results in two numbers</a>: the systolic and diastolic pressures. Systolic blood pressure, which is usually listed at the top of a blood pressure reading, is generated by the heart as it contracts, pushing out blood during each heartbeat. </p>
<p>Approximately 120 mmHg is a good systolic number, and the blood pressure varies with each heartbeat. These variations between heartbeats in systolic blood pressure is known as blood pressure variability, and it is a measure that provides information about stress on the body.</p>
<figure class="align-center ">
<img alt="Illustration of a heart rhythm and a brain and a heart" src="https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=343&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=343&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=343&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=431&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=431&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559964/original/file-20231116-15-2k6zrn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=431&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Within five days after sustaining a concussion, systole — the phase of the heartbeat when the heart muscle contracts to allow blood to flow into the body — is impaired, with the heart contracting for a shorter period of time during each heart beat.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Concussion can also alter blood pressure. Since blood pressure can also be influenced by breathing, we controlled breathing rates in concussed athletes when conducting tests within five days of injury. We showed that <a href="https://doi.org/10.3390/life12091400">blood pressure variability is suppressed during concussion</a>. </p>
<p>Within five days after sustaining a concussion, systole — the phase of the heartbeat when the heart muscle contracts to allow blood to flow into the body — is impaired, with the heart contracting for a shorter period of time during each heart beat. This has the potential to lower the efficiency with which blood is pumped from the heart. </p>
<p>Furthermore, there is <a href="https://doi.org/10.1080/15438627.2022.2102918">elevated stress on the heart</a>, causing it to squeeze harder to get blood into the body. These changes are typically transient and return to normal as concussion symptoms alleviate.</p>
<h2>Long-term concussion symptoms</h2>
<p>Concussion symptoms such as headache and pressure build-up in the head reflect the ANS not working properly. These symptoms can last if the brain is injured. Research suggests that a history of repeated concussions can have long-lasting effects. Specifically, those with a history of at least three concussions <a href="https://doi.org/10.1080/02699052.2022.2109737">show altered oxygen activity in the brain</a>.</p>
<p>Each heartbeat provides blood and oxygen to the brain. Therefore, heart complications can result in altered brain activity. This is evident during strenuous activity such as repeated squat-stand manoeuvres (10-second squat, then a 10-second stand, repeated 15 times), which <a href="https://doi.org/10.1080/02699052.2022.2109737">can result in reduced brain oxygen in those with a history of concussion</a>. This reduction in brain oxygen activity can be <a href="https://doi.org/10.3390/brainsci12111443">associated with elevated stress on the heart due to the concussion</a>.</p>
<p>Similarly, in our lab, four women suffering from post-concussion syndrome (symptoms that last for months or even years after a concussion) presented with <a href="https://doi.org/10.1139/cjpp-2021-0395">decreased systolic blood pressure variability</a>. Monitoring heart function in patients with sustained concussion complications can aid with recovery.</p>
<p>In another case study, a male patient had a history of multiple concussions that elicited heart complications. Remarkably, treatment of the heart issues alleviated all concussion symptoms in a matter of days when the patient’s cardiologist <a href="https://doi.org/10.1155/2020/7154120">treated him with the heart medication amiodarone, which is used to treat heart rhythm problems</a>.</p>
<p>Specifically, our case study presented a patient with almost 20 per cent abnormal heartbeats, which is very unusual. The stress on the heart stresses the body, which can worsen the concussion symptoms. This is the first report of a patient in whom treatment of abnormal heartbeat cleared concussion symptoms.</p>
<p>There is still limited research about the heart-brain axis. For example, it is known that <a href="https://www.heart.org/en/news/2020/02/04/chronic-stress-can-cause-heart-trouble">stress and anxiety are risk factors for heart disease</a>. For concussion, a hit to the head can send signals to the heart, resulting in higher stress levels on the heart. As shown in our research, the higher stress levels on the heart can be <a href="https://doi.org/10.3390/life12091400">measured by systolic blood pressure activity</a>. More research is being done to better understand the heart-brain axis.</p>
<h2>Future research and potential treatment options</h2>
<p>Research is beginning to investigate how compounds from the cannabis plant, such as cannabidiol (CBD), may help concussion recovery. For example, four female patients between the ages of 42 and 52 suffering from post-concussion syndrome consumed CBD oil under guidance from their physician. This was followed by improvements in their <a href="https://doi.org/10.1139/cjpp-2021-0395">systolic blood pressure variability</a>. Furthermore, their concussion symptoms improved, leading to reduced perception of anxiety. </p>
<p>This led us to complete a literature review on the implications of cannabinoids, such as CBD, on concussion. Our findings suggest that <a href="https://doi.org/10.1017/cjn.2020.23">cannabinoid therapy may have a beneficial effect on concussion recovery</a>.</p>
<p>We have recently been funded by the National Football League/National Football League Players Association to <a href="https://www.nfl.com/playerhealthandsafety/health-and-wellness/pain-management/nfl-awards-1-million-to-study-impact-of-cannabis-and-cbd-on-pain-management">study CBD’s potential influence on brain-heart function and effect on concussion symptoms</a>. This will enable us to better understand how these cannabinoids may influence the heart-brain axis relationship.</p><img src="https://counter.theconversation.com/content/194153/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>J. Patrick Neary receives funding from the National Football League/National Football League Players Association for his cannabinoid and concussion research. </span></em></p><p class="fine-print"><em><span>Jyotpal Singh and Payam Dehghani do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Concussion doesn’t just affect the brain, but the whole body. The interaction of the ‘heart-brain axis’ means that as the brain works to heal its injury, it puts extra stress on the heart.Jyotpal Singh, Postdoctoral fellow, Kinesiology & Health Studies, University of ReginaJ. Patrick Neary, Professor, Faculty of Kinesiology & Health Studies, University of ReginaPayam Dehghani, Associate Professor, Cardiology, University of SaskatchewanLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2146892023-10-10T20:17:14Z2023-10-10T20:17:14ZMaking preventive care fair: New approaches like self-testing at home can save lives and promote health equity<figure><img src="https://images.theconversation.com/files/553014/original/file-20231010-19-axrszd.jpg?ixlib=rb-1.1.0&rect=6%2C121%2C4217%2C3262&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Justice in access to life-saving preventive care requires reaching out to those who need the most support.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/making-preventive-care-fair-new-approaches-like-self-testing-at-home-can-save-lives-and-promote-health-equity" width="100%" height="400"></iframe>
<p>A fresh approach to preventive care is overdue to make health outcomes more fair. <a href="https://www.canada.ca/en/public-health/services/publications/science-research-data/key-health-inequalities-canada-national-portrait-executive-summary.html">Inequities based on racialization, income and gender mean that we need to urgently change the way care is provided</a>. Lives hang in the balance, especially for those who face barriers to care.</p>
<p>We worked with a national panel of colleagues and patients, all knowledgeable about health equity and many with lived experience of disadvantages, <a href="https://doi.org/10.1503/cmaj.230237">to develop guidance</a> on how to ensure everyone gets the preventive care they need, like cancer screening. It’s easy to bemoan inequities and idly suggest things should be different — our focus was on the specific actions that need to be taken.</p>
<h2>Home testing</h2>
<p>Outdated ways of providing care — like expecting patients to attend a clinic for a pelvic exam that is, at best, uncomfortable, and at worst, traumatizing, for cervical cancer screening — can lead to poor outcomes. In the case of cervical cancer screening, those outcomes can include delayed diagnosis of cervical cancer.</p>
<p><a href="https://doi.org/10.1001/jama.2018.10400">Self-testing for the virus that causes cervical cancer is at least as accurate</a> as the traditional approach of Pap tests that require a pelvic exam. Some patients avoid pelvic exams due to the inconvenience and discomfort, and survivors of sexual abuse might opt out of screening to avoid being re-traumatized. </p>
<p>The technology needed for self-testing has been <a href="https://www.cfp.ca/content/63/8/597?ijkey=fe09b8f3b9cb538fd1811755f762ff68d022894c&keytype2=tf_ipsecsha">around for years</a>. Studies have shown that it <a href="https://doi.org/10.1186/s12905-023-02174-w">helps connect people with care</a> in addition to being cost-effective. While the main benefit of self-testing is better access to screening for patients, avoiding visits also frees up physician time. </p>
<figure class="align-center ">
<img alt="A clinic waiting room with two women sitting in chairs and a person in scrubs approaching" src="https://images.theconversation.com/files/553015/original/file-20231010-15-278id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553015/original/file-20231010-15-278id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553015/original/file-20231010-15-278id.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553015/original/file-20231010-15-278id.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553015/original/file-20231010-15-278id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553015/original/file-20231010-15-278id.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553015/original/file-20231010-15-278id.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More equitable approaches, such as self-testing, can replace some outdated procedures that require clinic visits.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Skin testing for tuberculosis exposure — which requires an initial visit to implant the test in the forearm, and a return visit two or three days later to read the test — is another example of an old practice that can take a back seat to a more efficient approach. </p>
<p>Many people who have made two trips for a skin test might be surprised to learn there is a <a href="https://doi.org/10.1080/24745332.2022.2036503">blood test that is likely more accurate, especially for those who have been vaccinated</a>. The test is not expensive or new. It can be done today. But, like self-testing for cervical cancer, it needs to be publicly funded for everyone. </p>
<p>Self-testing for HIV can also remove the need for patients to attend an appointment and wait to receive a result. The answer can be <a href="https://maphealth.ca/hiv-oral-self-test/">available in minutes and with tests that are available from vending machines as part of a pilot program</a>. </p>
<p>With self-testing, there is also no need for patients to worry about being asked leading questions or being judged by a doctor when they request a test. Self-testing for HIV is an example of an innovation that can help both individuals and the population by reducing the spread of HIV. </p>
<h2>Better access to screening</h2>
<p><a href="https://canadiantaskforce.ca/guidelines/published-guidelines/depression/">Current guidelines</a> in Canada assume that people will receive periodic assessments of their mental health. But we know that many people <a href="https://doi.org/10.1503/cmaj.1096049">do not receive routine primary care</a>. We also know that income, as well as other social factors such as <a href="https://www.canada.ca/en/public-health/services/publications/science-research-data/key-health-inequalities-canada-national-portrait-executive-summary.html">racialization and gender identity, can determine access to care</a>, in part because some face discrimination within the health-care system. </p>
<p>For these reasons, we recommend routine screening for depression for people experiencing disadvantages.</p>
<figure class="align-center ">
<img alt="A woman in a white coat taking an older man's blood pressure" src="https://images.theconversation.com/files/553016/original/file-20231010-24-upls4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553016/original/file-20231010-24-upls4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553016/original/file-20231010-24-upls4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553016/original/file-20231010-24-upls4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553016/original/file-20231010-24-upls4u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553016/original/file-20231010-24-upls4u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553016/original/file-20231010-24-upls4u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Blood pressure checks every three to five years — together with a comprehensive assessment of cardiovascular risk — can help ensure people have appropriate access to life-saving medicines that have helped to extend life expectancy.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>Likewise, we suggest that people experiencing disadvantages be screened for colorectal cancer starting at age 45 years, while the <a href="https://canadiantaskforce.ca/guidelines/published-guidelines/colorectal-cancer/">recommendation for the general population is to start at age 50</a>. </p>
<p>Our recommendation for an earlier start is based on the fact that earlier screening <a href="https://doi.org/10.1001/jama.2021.6238">prevents deaths</a>, there are <a href="https://pubmed.ncbi.nlm.nih.gov/34128915/">disparities in cancer outcomes based on social factors</a>, and screening does not always start when patients are first notified. </p>
<p>High blood pressure is sometimes referred to as a “silent killer” because it usually causes no symptoms but it <a href="https://www.canada.ca/en/public-health/services/diseases/heart-health/high-blood-pressure.html">can result in a heart attack or a stroke</a>. We recommend blood pressure checks every three to five years — together with a comprehensive assessment of cardiovascular risk — to ensure people have appropriate access to life-saving medicines that have helped to extend life expectancy.</p>
<h2>Justice in access to care</h2>
<p>In an ideal world, guidance that prioritizes the health of those facing discrimination and disadvantages would not be needed. Life would be fair, care would be equitable and health outcomes would be level. But our world is not ideal. </p>
<p>We can actually achieve something better than “equal” treatment; we can achieve justice when it comes to access to life-saving preventive care by reaching out to those who need the most support.</p>
<p>One part of that is empowering patients and members of the public by informing them about the care they should be offered. You can visit <a href="https://www.screening.ca/">screening.ca</a> to be provided with a custom list of recommended interventions based on your age and answers to some yes-or-no questions.</p>
<p>Focusing on the needs of those who are treated unfairly could ultimately lead to improvements for everyone. Once the capacity of HPV testing is increased, self-testing will likely become a <a href="https://doi.org/10.1503/cmaj.211568">standard approach to cervical cancer screening, as it already has in Australia</a>. We could start with preventive care in redesigning health care for those who need it the most.</p>
<p>We also need to reflect on why the unfair status quo has persisted for so long. <a href="https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/science-research/key-health-inequalities-canada-national-portrait-executive-summary/hir-full-report-eng.pdf">Governments</a> and large <a href="https://www.canada.ca/en/public-health/services/health-promotion/healthy-living/creating-a-healthier-canada-making-prevention-a-priority.html">health-care institutions</a> have all made grand statements about the need to tackle sexism, racism, ableism and other forms of discrimination. It is long past time for those institutions to fund and support specific actions to help those who have been disadvantaged by previous inaction.</p><img src="https://counter.theconversation.com/content/214689/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nav Persaud receives funding from the Canadian Institutes of Health Research, the Canada Research Chairs program and the Ontario SPOR Support Unit. </span></em></p><p class="fine-print"><em><span>Aisha Lofters receives funding from the Canadian Institutes of Health Research, the Canadian Cancer Society, the Peter Gilgan Centre for Women's Cancers at Women's College Hospital, and Pfizer/ReThink Breast Cancer. </span></em></p>Cancer screening and other routine primary care can help address inequities if we choose to leave the unfair status quo behind.Nav Persaud, Canada Research Chair in Health Justice, University of TorontoAisha Lofters, Associate professor, Department of Family & Community Medicine, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2109132023-08-04T15:54:33Z2023-08-04T15:54:33ZPlanks and wall sits are best for lowering blood pressure – here are six more reasons they’re such great exercises<figure><img src="https://images.theconversation.com/files/541216/original/file-20230804-15-p7nvgb.jpg?ixlib=rb-1.1.0&rect=1365%2C0%2C3461%2C2532&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Isometric exercises can be performed pretty well anywhere at anytime.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/concentrated-sporty-young-woman-doing-bodyweight-2340371023">BearFotos/ Shutterstock</a></span></figcaption></figure><p>If you were told to do more exercise to lower your blood pressure, you might think you’d need to break out your running gear or hit the weights. But one of us (Jamie) <a href="https://bjsm.bmj.com/content/early/2023/07/02/bjsports-2022-106503">recently published research</a> that found exercises that you hold in a static position, such as planks and wall sits, are actually the best way to reduce blood pressure.</p>
<p>This kind of “isometric” exercise involves contracting a specific muscle or muscle group and holding it so the length of the muscle doesn’t change throughout the exercise.</p>
<p>But lower blood pressure is only one of the benefits of doing this type of exercise.</p>
<h2>1. They improve heart health</h2>
<p>Jamie’s recent work looked at 270 randomised controlled trials involving a total of over 15,000 participants. It found that the best way to lower blood pressure was to perform an average of three isometric sessions per week.</p>
<p>Each session consisted of four two-minute bouts of isometric exercises, with a one-to-four minute rest period between each. The resulting blood pressure reduction was comparable to that seen in people taking standard blood pressure medication.</p>
<p>Jamie’s research group has also shown that isometric exercise improves the <a href="https://link.springer.com/article/10.1007/s00421-021-04882-3">function, structure and mechanics of our heart</a>, the <a href="https://physoc.onlinelibrary.wiley.com/doi/10.14814/phy2.15690">health of our vascular system</a> and the performance of our <a href="https://journals.lww.com/jhypertension/Abstract/2022/11000/Mechanisms_for_blood_pressure_reduction_following.23.aspx">autonomic nervous system</a>. All of these changes are important for good cardiovascular health and lower risk of disease.</p>
<p>Although it’s a complicated area of science, the reason isometrics may be so effective for our cardiovascular health is due to the unique nature of holding a static muscle contraction. This compresses the blood vessels – and then on release of the isometric hold, leads to greater blood flow to the previously compressed vessels.</p>
<h2>2. They improve joint health</h2>
<p>Our ligaments play an essential role in stabilising our joints when we move. But injuries can happen if we put too much pressure on a ligament, such as an awkward single-leg landing when jumping. <a href="https://www.sciencedirect.com/science/article/pii/S1060187215001082">Anterior cruciate ligament (ACL)</a> rupture is one example of a ligament injury that has a significant health impact.</p>
<p>But our muscles play an important role in reducing the force placed on our ligaments by helping <a href="https://eprints.mdx.ac.uk/22543">create stability</a> around a joint. And research shows that training certain muscle groups through isometric exercises can help to reduce pressure on certain ligaments. </p>
<p>For example, one study found that <a href="https://www.sciencedirect.com/science/article/pii/S1050641113002423">training the hamstrings</a> (the group of muscles that run along the back of your thigh from hip to knee) helped reduce pressure on the ACL. This may help prevent injuries to this ligament in the future.</p>
<h2>3. They help address muscle imbalances</h2>
<p>It’s common for the muscles on one side of your body to be stronger than the other. Known as limb dominance, this partly happens due to something called <a href="https://journals.lww.com/nsca-scj/Abstract/2021/06000/Assessing_Interlimb_Asymmetries__Are_We_Heading_in.8.aspx">laterality</a>, our preference to use one side of the body over the other. </p>
<p>It can also happen as a result of your body adapting to the demands of sports (or other activites) which require skills that place greater demand on one side of the body, such as <a href="https://journals.lww.com/nsca-jscr/Fulltext/2016/04000/The_Presence_of_Bilateral_Imbalance_of_the_Lower.14.aspx">football</a>, <a href="https://meridian.allenpress.com/jat/article/49/3/338/191318/Strength-Asymmetry-of-the-Shoulders-in-Elite">volleyball</a> and <a href="https://meridian.allenpress.com/jat/article/44/1/39/110818/Explosive-Strength-Imbalances-in-Professional">basketball</a>. </p>
<p>While there’s typically nothing wrong with the muscles on one side of the body being stronger than the other, it may increase <a href="https://e-space.mmu.ac.uk/626530/">risk of injury</a> and may also affect an athlete’s performance. But doing unilateral (one-sided) isometric exercises – such as the split squat or side plank – may help reduce strength differences between limbs as they target one side of the body.</p>
<h2>4. They improve performance</h2>
<p>Isometric exercises are effective for <a href="http://holmesplace20prod.s3.eu-central-1.amazonaws.com/%5Bobject%20Promise%5D_Art_Brief%20Review_Effects%20of%20Isometric%20Strength%20Training%20on%20Strength.pdf">improving strength</a> in specific fixed positions. This is because isometric exercises have the ability to activate <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/sms.13375?casa_token=XbyjfswW3VUAAAAA%3Ag9YKPb9CeIdUl5T8lIgAlvM8AjcPWBVxQsJ5h_8-DchPdFajjfQxe2OjcRZGJFYVI8v1n2RIzlFM">very specific muscles or muscle groups</a>. </p>
<p>Isometrics often mimic challenging positions such as the sticking point at the bottom of a squat, maintaining a scrummage in rugby or removing the lid off a jam jar. This means they can help to build the strength required to tolerate the load placed upon the body during exercise, sport and every day life. This may improve athletic performance or physical function in daily life.</p>
<figure class="align-center ">
<img alt="A man performs the wall sit exercise in his office." src="https://images.theconversation.com/files/541214/original/file-20230804-21-lv8jwo.jpg?ixlib=rb-1.1.0&rect=12%2C12%2C8223%2C5469&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541214/original/file-20230804-21-lv8jwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541214/original/file-20230804-21-lv8jwo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541214/original/file-20230804-21-lv8jwo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541214/original/file-20230804-21-lv8jwo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541214/original/file-20230804-21-lv8jwo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541214/original/file-20230804-21-lv8jwo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Isometric exercises can be easily adjusted to best suit you.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-businessman-leaning-on-wall-doing-1079108474">Andrey_Popov/ Shutterstock</a></span>
</figcaption>
</figure>
<h2>5. They’re easily tolerated</h2>
<p>Isometric exercises are often used as part of physiotherapy and sports therapy rehabilitation programmes for people recovering from musculoskeletal injuries. This is because they can be performed with limited mobility and <a href="https://journals.lww.com/clinicalpain/Abstract/2016/02000/Do_Pain_related_Beliefs_Influence_Adherence_to.10.aspx">where pain</a> may be a limiting factor. </p>
<p>As isometric exercises are performed in a static position, it can be more tolerable than exercises which require a lot of movement. Similarly, those with limited mobility can choose a comfortable position to perform the exercise, such as adjusting the height of a wall squat if they have limited hip mobility.</p>
<h2>6. They’re time efficient</h2>
<p>Most studies which have investigated the benefits of isometric exercises for <a href="https://www.nature.com/articles/s41440-022-01019-7">heart health</a> have only required participants to do a <a href="https://pubmed.ncbi.nlm.nih.gov/30817465/">total of eight minutes of exercise per session</a>. This would equate to around four sets of isometric exercises, with each exercise held for around two minutes. You would then rest between one and four minutes between sets. </p>
<p><a href="https://bjsm.bmj.com/content/56/9/506">Numerous studies</a> also show these exercises only need to be performed three times a week for three weeks in order to see beneficial changes. This makes isometric exercises easy to fit into even the busiest schedules. </p>
<h2>Getting started</h2>
<p>Isometric exercise can be performed pretty well anywhere since they only use your body weight to challenge your muscles. </p>
<p>If you aren’t sure where to begin when it comes to <a href="https://www.healthline.com/health/fitness-exercise/isometric-exercises">isometric exercises</a>, some good examples include wall squats (pretending like you’re sitting in a chair but with your back pressed against a wall) and planks (resting on your forearms and tip-toes, with your stomach raised above the ground and held level). </p>
<p>It’s also recommended you consult with a healthcare practitioner before starting your new exercise plan to ensure it’s safe and effective.</p><img src="https://counter.theconversation.com/content/210913/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Isometric exercises are great for your heart, joints and physical function in daily life.Alex Walker, Lecturer in Sports Therapy, University of East LondonJamie Edwards, Lecturer in Exercise Physiology, University of East LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2082022023-07-20T08:03:37Z2023-07-20T08:03:37ZWhat is atrial fibrillation, the heart condition US President Joe Biden lives with?<p>US President Joe Biden <a href="https://www.whitehouse.gov/wp-content/uploads/2023/02/Health-Summary-2.16.pdf">has</a> the heart condition atrial fibrillation. This increases his risk of having a stroke <a href="https://www.stroke.org.uk/what-is-stroke/are-you-at-risk-of-stroke/atrial-fibrillation">five-fold</a> and <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">doubles</a> the risk of a heart attack or dementia.</p>
<p>More than <a href="https://journals.sagepub.com/doi/full/10.1177/1747493019897870?casa_token=xNrhAk_qBIQAAAAA%3A2DRaB1b1avVWKJFlBsKmEgRYXienljZDL4qhdajIGcOp4F4MwX9r_77vySuqdNS7pzHbY9RiZXuwkpw">37.5 million</a> people globally also have atrial fibrillation, but many don’t realise they have it. </p>
<p>For most, the condition has few symptoms and does not limit daily life. However, identifying it and treating it is the only way to reduce its serious health consequences.</p>
<p>Our research, <a href="https://heart.bmj.com/content/early/2023/07/03/heartjnl-2023-322602">just published</a> in the journal Heart, looks at the importance of managing blood pressure in reducing such risks.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-do-my-blood-pressure-numbers-mean-29212">Health Check: what do my blood pressure numbers mean?</a>
</strong>
</em>
</p>
<hr>
<h2>What is atrial fibrillation?</h2>
<p>Atrial fibrillation is when the heart <a href="https://www.heartfoundation.org.au/bundles/your-heart/atrial-fibrillation">beats irregularly</a>, sometimes fast, sometimes slow. It’s the <a href="https://journals.sagepub.com/doi/full/10.1177/1747493019897870?casa_token=xNrhAk_qBIQAAAAA%3A2DRaB1b1avVWKJFlBsKmEgRYXienljZDL4qhdajIGcOp4F4MwX9r_77vySuqdNS7pzHbY9RiZXuwkpw">most common</a> heart rhythm disorder and is more common as you get older. But some people develop it in their 30s and 40s.</p>
<p>The abnormal heart rhythm starts in the top chambers of the heart, meaning the heart does not propel the blood forward properly. This, and the erratic movements of these heart chambers, result in blood pooling, and occasionally clots.</p>
<p>The heart can go into atrial fibrillation for short periods of time, and then return to normal rhythm, or stay in this abnormal heart rhythm continuously.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/UOkseyF-wrA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Here’s what happens if you have atrial fibrillation and your heart beats irregularly.</span></figcaption>
</figure>
<h2>How do I know if I have it?</h2>
<p>Some people have lots of symptoms, such as heart palpitations (a feeling of fluttering or pounding heart), breathlessness or even discomfort, and know exactly when they have gone into atrial fibrillation. Their symptoms can stop what they would normally do. But others have no symptoms and don’t know they have atrial fibrillation. We know very little about why some people have symptoms and others do not.</p>
<p>If you have symptoms, discuss these <a href="https://academic.oup.com/eurheartj/article/42/5/373/5899003?login=false">with your GP</a>. Your GP will ask about triggers for your symptoms, your general health and other risk factors, and will likely organise an <a href="https://www.heartfoundation.org.au/bundles/your-heart/medical-tests-for-heart-disease">electrocardiogram</a> (also called an ECG). This is a type of non-invasive test where 12 leads are attached to your chest to measure the electrical activity of the heart.</p>
<p>Generally, your GP will refer you to a cardiologist (heart specialist) or a hospital clinic if they suspect you have a heart rhythm problem, including atrial fibrillation, for further testing and treatment.</p>
<p>Some people say you can detect atrial fibrillation using <a href="https://theconversation.com/should-you-really-use-your-smartwatch-or-fitness-wearable-to-monitor-your-heart-194060">consumer wearables</a>, such as smartwatches. However, it’s not clear how accurate these are.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health worker with ECG trace in hand, man lying on hospital bed in background" src="https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536191/original/file-20230707-25-yl4bur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An ECG measures the electrical activity of your heart.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/electrocardiogram-ecg-hand-clinic-cardiology-heart-566691763">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-this-love-or-an-arrhythmia-your-heart-really-can-skip-a-beat-when-youre-in-love-176537">Is this love ... or an arrhythmia? Your heart really can skip a beat when you're in love</a>
</strong>
</em>
</p>
<hr>
<h2>What happens after you’re diagnosed?</h2>
<p>Once diagnosed with atrial fibrillation, you will be assessed for serious potential complications, such as an increased risk of stroke.</p>
<p>You’ll be advised to manage any risk factors that worsen atrial fibrillation and increase your risk of stroke. This includes cutting down on alcohol, managing your weight and doing more exercise.</p>
<p>Some people at higher risk of a stroke will be started on blood thinning medicines. Some people may also need to take medicines to control their heart rhythm or have a procedure called “ablation”. This is when wires are passed into the heart to identify and treat the electrical origin of the condition.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-should-my-heart-rate-be-and-what-affects-it-98945">What should my heart rate be and what affects it?</a>
</strong>
</em>
</p>
<hr>
<h2>How about high blood pressure?</h2>
<p>More than <a href="https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.117.311402#:%7E:text=Hypertension%20ultimately%20increases%20the%20risk,%25%20to%2080%25%20of%20individuals">three in five</a> people with atrial fibrillation also have high blood pressure (hypertension). This is another major cause of stroke and heart attack. So managing blood pressure is very important.</p>
<p>In our <a href="https://heart.bmj.com/content/early/2023/07/03/heartjnl-2023-322602">new research</a>, we analysed data from the electronic medical records from about 34,000 Australian GP patients with both atrial fibrillation and hypertension. We found one-in-three had poorly controlled blood pressure. This places a group already at a high risk of stroke at an even greater risk.</p>
<p>When someone’s blood pressure is poorly controlled, this is usually because their medicines are not adequately bringing down their blood pressure. This could be because doctors are not increasing the number of different types of medicine when needed, or because patients cannot afford their medicines, or forget to take them.</p>
<p>We also found that people who visited the same GP regularly were more likely to have their blood pressure controlled, so were at lower risk of stroke.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Female doctor checking blood pressure of older male" src="https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537245/original/file-20230713-15-lr4gwj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Our research highlighted the importance of seeing the same GP regularly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-doctor-wearing-white-uniform-1805492158">Shutterstock</a></span>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-recognise-a-stroke-and-what-you-should-know-about-their-treatment-63651">How to recognise a stroke and what you should know about their treatment</a>
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<h2>Why is this important?</h2>
<p>It is important people at the highest risk of stroke – such as those with both atrial fibrillation and high blood pressure – are receiving appropriate treatment to minimise their risk.</p>
<p>Strokes, heart attacks and dementia are still leading causes <a href="https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death">of death</a> and <a href="https://www.aihw.gov.au/reports/burden-of-disease/australian-burden-of-disease-study-2022/contents/summary#">ill health</a> in Australia. Prevention is so much better than treating them when they develop.</p><img src="https://counter.theconversation.com/content/208202/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ritu Trivedi is a recipient of the Commonwealth Government Research Training Program Stipend Scholarship to support her PhD studies.</span></em></p><p class="fine-print"><em><span>Clara Chow receives funding from National Health and Medical Research Council. Dr Chow is affiliated with the Cardiac Society of Australia and New Zealand. </span></em></p><p class="fine-print"><em><span>Liliana Laranjo receives funding from the National Health and Medical Research Council. </span></em></p>This common heart condition puts you at increased risk of having a stroke, especially if you also have high blood pressure. But our new research shows what you can do to lower your risk.Ritu Trivedi, PhD Student, University of SydneyClara Chow, Cardiologist at Westmead Hospital; Director of the Westmead Applied Research Centre, University of SydneyLiliana Laranjo, Senior Lecturer in Digital Health and Community and Primary Health Care Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2063922023-05-25T00:43:48Z2023-05-25T00:43:48ZTina Turner had a history of high blood pressure and kidney disease. Here’s how one leads to the other<p>Legendary singer Tina Turner, who <a href="https://www.abc.net.au/news/2023-05-25/singer-tina-turner-has-died-aged-83/102389716">died this week</a> at the age of 83 after a long illness, has <a href="https://www.showyourkidneyslove.com/articles/tina-turner/">written about</a> her history of high blood pressure and kidney disease, leading to a kidney transplant.</p>
<p>Turner should be applauded for her willingness to share her <a href="https://www.instagram.com/p/CpkhvaFBS0K/?utm_source=ig_web_copy_link&igshid=MzRlODBiNWFlZA%3D%3D">medical history</a> to publicise the importance of looking after your kidneys, just months before she died.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CpkhvaFBS0K/?utm_source=ig_web_copy_link\u0026igshid=MzRlODBiNWFlZA%3D%3D","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<p>Turner’s family has not confirmed how she died. But Turner’s openness with her long-standing illness is a reminder for us all to keep an eye on our blood pressure, and to control it, if we are to avoid complications.</p>
<p>Here’s why controlling your blood pressure is so important and what can happen if we don’t.</p>
<h2>Why is high blood pressure linked to kidney disease?</h2>
<p>There’s a bi-directional relationship between blood pressure and kidney disease. </p>
<p>That means high blood pressure increases the risk for kidney disease and once you have kidney disease, it further promotes high blood pressure. It’s a vicious cycle.</p>
<p>In some cases, it’s hard to determine which one came first. </p>
<p>Uncontrolled blood pressure exerts a lot of pressure on the kidney. That leads to scarring and damage. If we looked inside the kidney, we’d see large areas of scarring. Once you have scarring, that tissue isn’t working properly and can start to leak protein into the urine. That then pushes up the risk of progressive kidney disease, leading to kidney failure, heart disease and premature death.</p>
<p>The kidney itself is integral to maintaining blood pressure. Kidneys obviously maintain fluid balance by passing urine, but they also have important hormonal jobs which are vital to maintaining blood pressure.</p>
<p>So, once you get kidney disease, blood pressure can be really hard to manage. It’s like a hammer and nail, and the nail is the kidney. If you have high blood pressure, the hammer is hitting the nail really, really hard.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-do-my-blood-pressure-numbers-mean-29212">Health Check: what do my blood pressure numbers mean?</a>
</strong>
</em>
</p>
<hr>
<h2>Are there certain symptoms to look out for?</h2>
<p>Both high blood pressure and kidney disease are what we call “clinically silent”, so many people don’t realise they have problems until it is very far along. </p>
<p>Often a person with high blood pressure has no symptoms. There are times, in extreme cases, where people may get headaches or a feeling of thumping in the head. But their first sign may be a stroke or heart attack or some other major complication. That’s why checking blood pressure on a regular basis is smart.</p>
<p>For kidney disease, you can lose up 90% of kidney function before symptoms develop. They can be clinically silent right up until kidney failure. When symptoms do arrive, they can be very vague – things like poor concentration or feeling tired. </p>
<p>Often people just put it down to winter, being busy or getting older. </p>
<p>So we recommend screening for kidney disease if you have high blood pressure, diabetes, heart disease, excess abdominal weight, a history of smoking, acute kidney injury or a family history of kidney disease. This should be done on a one- to two-year basis.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kidneys-are-amazing-for-all-they-do-be-sure-to-look-after-yours-30966">Kidneys are amazing for all they do, be sure to look after yours</a>
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</em>
</p>
<hr>
<h2>What are the treatments?</h2>
<p>In the past five years, there have been a swathe of newer medicines that bring down blood pressure and protect the kidney. For around 20 years, we have had a class of drugs called renin-angiotensin system blockade (usually just shortened to RAS blockade).</p>
<p>But more recently, we have a new group of medicines called <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors#:%7E:text=SGLT2%20inhibitors%20are%20a%20class,canagliflozin%2C%20dapagliflozin%2C%20and%20empagliflozin.">SGLT2 inhibitors</a>, which have really changed the landscape of kidney disease. The Therapeutic Goods Administration has just approved another medicine called finerenone, which is a non-steroidal MRA. </p>
<p>These have all been shown to protect the kidney, as opposed to just treating symptoms. They slow the progression of the disease and have shifted the paradigm to kidney preservation. </p>
<p>And it’s really crucial you address the lifestyle factors that increase your risk.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-chronic-kidney-disease-and-why-are-one-in-three-at-risk-of-this-silent-killer-81942">Explainer: what is chronic kidney disease and why are one in three at risk of this silent killer?</a>
</strong>
</em>
</p>
<hr>
<h2>How can I reduce my risk?</h2>
<p>Don’t smoke. Being a smoker significantly increases your risk of high blood pressure and kidney disease.</p>
<p>Eat a nutrient-dense diet, including fresh, whole foods that are in season and avoid ultra-processed food and sugar. This approach will help to control blood pressure and protect the kidney. </p>
<p>Do all the usual things – get good sleep, maintain an active lifestyle and manage your stress. If you have a family history of kidney disease, that may prompt you to get checked. </p>
<p>Do the <a href="https://kidney.org.au/kidneyrisktest/">Kidney Health Australia quiz</a> and if you are deemed to be at risk, go to your GP to get a kidney health check. That involves a blood pressure check, urine test and a blood test.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-can-your-doctor-tell-from-your-urine-74990">Health Check: what can your doctor tell from your urine?</a>
</strong>
</em>
</p>
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<h2>Kidney disease is becoming more common</h2>
<p>The number of people with kidney failure is increasing dramatically. <a href="https://www.aihw.gov.au/news-media/media-releases/2021/august/recipients-of-kidney-replacement-therapy-more-than">According</a> to the Australian Institute of Health and Welfare, the number of Australians receiving kidney replacement therapy (either on dialysis or living with a transplant) more than doubled between 2000 and 2020, from 11,700 to 27,700. Over half of those receiving kidney replacement therapy were on dialysis.</p>
<p>While a kidney transplant improves quality of life and can extend a person’s life, it’s important to remember that high blood pressure can still persist and often requires ongoing treatment.</p><img src="https://counter.theconversation.com/content/206392/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karen Dwyer is Clinical Director of Kidney Health Australia. She has received honorarium from AstraZeneca, Boehringer Ingelheim and Bayer. She is on the clinical advisory committee for GMHBA. She has a current research grant through Servier.</span></em></p>What’s the relationship between high blood pressure and kidney disease, and how can they be prevented?Karen Dwyer, Professor, School of Medicine, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2013542023-03-23T17:33:36Z2023-03-23T17:33:36ZWhy sitting with crossed legs could be bad for you<figure><img src="https://images.theconversation.com/files/516946/original/file-20230322-427-il74jk.jpg?ixlib=rb-1.1.0&rect=22%2C8%2C2973%2C1980&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sitting with legs crossed for prolonged periods may have negative health effects, expert warns.</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-man-using-a-laptop-8553844/">Polina Tankilevitch/Shutterstock</a></span></figcaption></figure><p>Are you sitting comfortably? Just pause for a moment and without adjusting, notice your posture. What are your legs doing? Are they crossed? And are you a right or left crosser? Some <a href="https://pubmed.ncbi.nlm.nih.gov/8084429/">62% of people</a> cross right over left, 26% go the other way and 12% have no preference. </p>
<p>There are typically two ways to sit in a chair and cross your legs, one is at the knee and the other is at the ankle. But as comfy as it may be to sit with your legs crossed, is it bad for your health and posture? Let’s take a look at the evidence.</p>
<p>For a start, research shows that sitting cross-legged can increase the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370107/">misalignment of the hips</a>, with one being higher than the other. </p>
<p>And it <a href="https://cdnsciencepub.com/doi/10.1139/apnm-2018-0339">changes the speed</a> at which blood moves through the blood vessels in the lower limbs, which can increase the risk of blood clots.</p>
<p>Most of the research suggests crossing at the knees is worse than the ankles. Indeed, sitting this way can cause an increase in your blood pressure due to the pooling of blood in the veins and your heart having to work against this. And this can increase the risk of damage to your blood vessels, which is why when you get your blood pressure taken you should have your <a href="https://www.tandfonline.com/doi/abs/10.1080/08037050410000903">feet flat on the floor</a>.</p>
<h2>Effect on the body</h2>
<p>The longer and more often you sit cross-legged, the more likely it is that you’ll have long-term changes in the muscle lengths and bone arrangements in your pelvis. And due to the way your skeleton is linked together, leg crossing can also cause misalignment of the spine and shoulders. </p>
<p>Your head position can potentially become out of alignment due to changes in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4905931/">bones of the neck</a>, as the spine compensates to keep your centre of gravity above the pelvis.</p>
<p>Your neck can also be affected due to one side of the body being weaker than the other. The same imbalance can be seen in the muscles of the pelvis and lower back as a result of poor posture and stresses and strains caused by sitting cross-legged.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-have-weaker-bones-than-our-hunter-gatherer-ancestors-this-is-what-you-can-do-about-it-105016">We have weaker bones than our hunter-gatherer ancestors – this is what you can do about it</a>
</strong>
</em>
</p>
<hr>
<p>The pelvis may also become misaligned due to the prolonged stretching of the gluteal (bum) muscles on one side, meaning that they become weaker.</p>
<p>Sitting with the legs crossed for a long time increases the likelihood of scoliosis (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5140821/">abnormal alignment of the spine</a>) and other deformities. It can also cause <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604828/">greater trochanteric pain syndrome</a>, a common and painful condition that affects the outer side of the hip and thigh.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/516950/original/file-20230322-1056-e3oozo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516950/original/file-20230322-1056-e3oozo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516950/original/file-20230322-1056-e3oozo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516950/original/file-20230322-1056-e3oozo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516950/original/file-20230322-1056-e3oozo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516950/original/file-20230322-1056-e3oozo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516950/original/file-20230322-1056-e3oozo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Say goodbye to leg-crossing.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-dog-sitting-under-the-table-5990704/">Pexels/Cottonbro studio</a></span>
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<p>Research also shows that sitting with legs crossed can put the peroneal nerve, also known as the fibular nerve, in your lower leg at risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730027/">compression and injury</a>. This typically manifests as a weakness when trying to lift the little-toe side of the foot as well as the more <a href="https://www.ncbi.nlm.nih.gov/books/NBK549859/">concerning foot drop</a> – where the whole of the foot <a href="https://www.bmj.com/content/350/bmj.h1736">hangs down</a>. Though in most cases, this is short-lived and returns to normal within a few minutes.</p>
<p>There’s also evidence that crossing the legs could affect sperm production. This is because the temperature of the testicles needs to be between <a href="https://www.tandfonline.com/doi/full/10.1080/19396368.2022.2074325">2°C and 6°C</a> below standard body temperature. Being seated increases the temperature of the testicles by 2°C and crossing your legs can increase the temperature of the testes by as much as <a href="https://onlinelibrary.wiley.com/doi/pdf/10.2164/jandrol.106.000646">3.5°C</a>. And <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737001/">studies suggest</a> that an <a href="https://pubmed.ncbi.nlm.nih.gov/31841801/">increase in scrotum or testicle temperature</a> can reduce both sperm count and quality.</p>
<p>It’s also worth noting that due to differences in the <a href="https://anatomypubs.onlinelibrary.wiley.com/doi/10.1002/ar.23552">anatomy</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407338/">of men and women</a> it’s probably much easier for women to sit cross-legged – particularly because men have a reduced <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5425325/">range of motion</a> at the hip.</p>
<h2>Legs and joints</h2>
<p>But research does indicate that sitting with legs crossed can be beneficial for some people. One small study from 2016, for example, found that for people who have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8687568/">one leg longer than the other</a>, sitting crossed-legged can help to adjust the height of the two sides of the pelvis, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5140821/">improving alignment</a>. </p>
<p>Sitting with legs crossed also appears to <a href="https://pubmed.ncbi.nlm.nih.gov/8578373/">reduce the activity</a> of some muscles, particularly the oblique muscles (those beneath the skin where you put your hands on your hips) compared to sitting with legs forward. This may help relax your core muscles and prevent over-exertion. </p>
<figure class="align-center ">
<img alt="Woman sitting in meditation pose." src="https://images.theconversation.com/files/516953/original/file-20230322-1527-1ribfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516953/original/file-20230322-1527-1ribfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516953/original/file-20230322-1527-1ribfs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516953/original/file-20230322-1527-1ribfs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516953/original/file-20230322-1527-1ribfs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516953/original/file-20230322-1527-1ribfs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516953/original/file-20230322-1527-1ribfs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">But what about the lotus position?</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/photo-of-woman-doing-yoga-while-sitting-on-rock-3820380/">Pexels/Rfstudio</a></span>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sitting-on-the-floor-vs-sitting-on-a-chair-which-is-better-for-you-141164">Sitting on the floor vs sitting on a chair – which is better for you?</a>
</strong>
</em>
</p>
<hr>
<p>Similarly, there is evidence that sitting cross-legged <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7370107/">improves</a> the stability of the sacroiliac joints (responsible for transferring weight between the spine and legs).</p>
<p>And of course, the famous yoga or meditation pose (lotus position) sees people sitting on the floor with legs crossed. Though there is limited data as to whether long periods of time spent in this position may lead to some of the issues that sitting cross-legged in a chair causes. Indeed, for many people <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081169/">yoga offers huge benefits</a> – even those who already have knee issues.</p>
<p>So the verdict? It’s probably better to avoid crossing your legs if you can. Though that said, many of the risk factors associated with crossing your legs are likely exacerbated by other underlying issues such as <a href="https://theconversation.com/sitting-on-the-floor-vs-sitting-on-a-chair-which-is-better-for-you-141164">sedentary lifestyles</a> and obesity. So with this in mind, the main advice is to not sit still in the same position for too long and to keep regularly active.</p><img src="https://counter.theconversation.com/content/201354/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Taylor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The science behind why crossing your legs while sitting could be detrimental to your health.Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1987262023-02-17T13:24:28Z2023-02-17T13:24:28ZMany Americans wrongly assume they understand what normal blood pressure is – and that false confidence can be deadly<figure><img src="https://images.theconversation.com/files/509638/original/file-20230213-6328-ss2pwm.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C8167%2C5464&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">High blood pressure has no symptoms, so you could have it and not be aware.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-measuring-blood-pressure-to-a-smiling-woman-royalty-free-image/1344792109?phrase=patient%20taking%20blood%20pressure&adppopup=true">nortonsx/iStock via Getty Images Plus</a></span></figcaption></figure><p>Stunning as it may sound, nearly half of Americans ages 20 years and up – or more than 122 million people – have high blood pressure, according to a <a href="https://doi.org/10.1161/CIR.0000000000001123">2023 report from the American Heart Association</a>. And even if your numbers are normal right now, they are <a href="https://doi.org/10.1161/CIR.0000000000001123">likely to increase as you age</a>; more than three-quarters of Americans age 65 and older have high blood pressure. </p>
<p>Also known as hypertension, high blood pressure is a major risk factor for heart disease and stroke. </p>
<p>Our research has found that most Americans don’t know the normal or healthy range for blood pressure – yet strikingly, they think they do. And that is cause for serious concern. </p>
<p>We are a <a href="https://scholar.google.com/citations?user=JjiiTkcAAAAJ&hl=en">health communications expert</a> and <a href="https://scholar.google.com/citations?user=EMn7HdcAAAAJ&hl=en">a cardiologist</a>. <a href="https://scholar.google.com/citations?user=NgqnSJMAAAAJ&hl=en">Together with our</a> <a href="https://www.gim-crhc.pitt.edu/people/tamar-krishnamurti-phd">health communication collaborators</a>, we surveyed more than 6,500 Americans about their knowledge of blood pressure. They were recruited through the <a href="https://uasdata.usc.edu/index.php">Understanding America Study</a>, a nationally representative sample of U.S. residents. </p>
<p>In our new study, published in January 2023, we found that <a href="https://doi.org/10.1177/0272989X221148196">64% expressed confidence in their understanding of blood pressure numbers</a> – but only 39% actually knew what normal or healthy blood pressure is.</p>
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<figcaption><span class="caption">A healthy diet, more exercise and less salt and alcohol are all ways to improve your blood pressure numbers.</span></figcaption>
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<h2>False confidence, deadly consequences</h2>
<p>Such false confidence can be harmful because it may prevent people from seeking care for high blood pressure. After all, if you think it’s normal, why bother talking to your doctor about your blood pressure?</p>
<p>Part of the reason for this overconfidence begins in the doctor’s office. Typically, a nurse brings over a blood pressure cuff, straps it on your upper arm and takes a reading. The nurse may announce the result, remove the cuff and record it for the doctor. </p>
<p>When the doctor arrives, the session may well move on to other matters without a word about the blood pressure reading. This likely happens because your doctor wants to focus on how you’re feeling and why you’re there. But as a result, you may leave your appointment thinking your blood pressure is fine, even if it’s not. </p>
<p>About 70% of Americans will <a href="https://doi.org/10.1016/j.jacc.2017.11.006">have high blood pressure in their lifetimes</a>. What’s more, only 1 in 4 patients with hypertension <a href="https://www.cdc.gov/bloodpressure/docs/SG-CTA-HTN-Control-Report-508.pdf">have their blood pressure under control</a>. And because high blood pressure usually has no symptoms, <a href="https://www.fda.gov/drugs/special-features/high-blood-pressure-understanding-silent-killer#:%7E">you can have it without knowing it</a>. </p>
<p>To lower your risk of heart attacks and strokes, it’s critical to understand your blood pressure readings. This is especially true for patients with conditions such as heart disease, kidney disease and diabetes. </p>
<h2>What the numbers mean</h2>
<p>Blood pressure <a href="https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings">is reported with two numbers</a>. The first number is your <a href="https://www.cdc.gov/bloodpressure/about.htm#:">systolic blood pressure</a>; it measures the pressure in arteries when the heart beats. The second number, your <a href="https://www.cdc.gov/bloodpressure/about.htm#:">diastolic blood pressure</a>, measures the pressure in your arteries between heartbeats. </p>
<p><a href="https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings">Normal or healthy blood pressure</a> is less than 120/80 millimeters of mercury (mm Hg) for adults. This is a unit of measurement that stems from early blood pressure monitors, which looked at how far your blood pressure could push a column of liquid mercury. For most patients, lower tends to be better. </p>
<p>Stage 1 hypertension, which is the lower stage of high blood pressure, begins at 130/80. Stage 2 hypertension, which is the more severe stage of high blood pressure, begins at 140/90. Both numbers are critically important, because every increase of 20 millimeters of mercury in systolic blood pressure, or 10 in diastolic blood pressure, doubles a person’s chances <a href="https://doi.org/10.1161/HYP.0000000000000065">of dying from a heart attack or stroke</a>. </p>
<p><iframe id="8KpwZ" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/8KpwZ/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>10 tips for healthier blood pressure</h2>
<p>To avoid false confidence, ask about your blood pressure at every doctor’s visit, and find out what the numbers mean. If your blood pressure is above the normal or healthy range, then the American Heart Association recommends the following 10 tips.</p>
<ol>
<li><p>Talk with your doctor. <a href="https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/partnering-with-your-doctor-to-treat-high-blood-pressure">If your blood pressure is high</a>, ask your doctor about strategies for lowering it, and how you can track your blood pressure at home. </p></li>
<li><p>Eat a heart-healthy diet. Vegetables, fruit, whole grains, low-fat dairy products, skinless poultry and fish, nuts and legumes, and olive oil <a href="https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/managing-blood-pressure-with-a-heart-healthy-diet">are all good for your heart</a>. Red meat, saturated and trans fats and ultraprocessed foods are unhealthy for your heart.</p></li>
<li><p>Cut back on salt, which increases blood pressure. The Dietary Guidelines for Americans recommend <a href="https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf">no more than 2,300 milligrams of sodium per day</a> – that’s less than one teaspoon – but the U.S. Food and Drug Administration reports that the <a href="https://www.fda.gov/food/food-additives-petitions/sodium-reduction">average American takes in about 3,400 milligrams daily</a>, roughly 50% more than recommended. Even if you don’t add any salt to your meals, you may still get too much from <a href="https://theconversation.com/ultra-processed-foods-like-cookies-chips-frozen-meals-and-fast-food-may-contribute-to-cognitive-decline-196560">ultraprocessed foods</a>. One serving of canned chicken noodle soup <a href="https://www.progresso.com/products/traditional-chicken-noodle/">has 680 milligrams of sodium</a>. One Big Mac from McDonald’s <a href="https://www.mcdonalds.com/us/en-us/product/big-mac.html#accordion-c921f9207b-item-842cb18782">has 1,010 milligrams of sodium</a>. </p></li>
<li><p>Limit your alcohol use. Whether it’s beer, wine or spirits, <a href="https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/limiting-alcohol-to-manage-high-blood-pressure">alcohol increases your blood pressure</a>. It’s <a href="https://theconversation.com/alcohol-use-is-widely-accepted-in-the-us-but-even-moderate-consumption-is-associated-with-many-harmful-effects-196106">better to not drink alcohol</a>, but if you do, observe the limits recommended by the <a href="https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf">Dietary Guidelines for Americans</a>. For women, that’s one drink per day at the very most. For men, it’s two drinks per day at most. One drink is 12 ounces of beer, 4 ounces of wine, 1.5 ounces of 80-proof spirits or 1 ounce of 100-proof spirits. </p></li>
<li><p>Be more physically active. Just two and a half hours per week of physical activity <a href="https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/getting-active-to-control-high-blood-pressure">can help lower blood pressure</a>. For example, that’s a 30-minute walk five days a week. You might also switch up your physical activity by swimming, lifting weights, doing yoga or going dancing.</p></li>
<li><p>Maintain a healthy weight. Even losing a few pounds can <a href="https://doi.org/10.1161/HYP.0000000000000065">help manage high blood pressure in people who are overweight</a>. Ask your doctor about a healthy approach to weight loss. </p></li>
<li><p>Manage stress, which is bad for your blood pressure. While stress relief <a href="https://doi.org/10.1161/HYP.0000000000000065">doesn’t always lower blood pressure</a>, bringing down your stress level can help you feel better. The Mayo Clinic recommends <a href="https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress-relievers/art-20047257">several ways to manage stress</a>, including learning to say no sometimes, spending time with family and friends and meditating.</p></li>
<li><p>If you smoke, vape or both: Quit now. Both are bad for <a href="https://www.independent.co.uk/news/health/vaping-cigarettes-smoking-heart-disease-b2211724.html">your heart and blood vessels</a> and <a href="https://www.healthline.com/health/high-blood-pressure-hypertension/smoking-and-hypertension">contribute to high blood pressure</a>. Quitting smoking may reduce your heart disease risk to <a href="https://doi.org/10.1136/openhrt-2015-000358">nearly the same level</a> as people who never smoked. And the benefits of quitting start right away. A recent study found that after just 12 weeks, people who quit <a href="https://doi.org/10.1093/ehjci/ehaa946.3019">had lower blood pressure</a> than when they were still smoking. The Centers for Disease Control and Prevention has <a href="https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/index.html">recommendations for programs and medication</a> that can help you quit.</p></li>
<li><p>Take medication, which is often recommended for people with stage 2 hypertension, and for some with stage 1 hypertension, including those who also have heart disease, kidney disease or diabetes. Most patients <a href="https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/what-you-should-know-about-high-blood-pressure-and-medications">need two to three medications to lower blood pressure</a> to normal or healthy levels. A recent meta-analysis demonstrated that lowering systolic blood pressure by 5 mm Hg through medication <a href="https://doi.org/10.1016/S0140-6736(21)00590-0">reduces the risk of major cardiovascular events by about 10%</a>, irrespective of baseline blood pressure or previous diagnosis of cardiovascular disease. </p></li>
<li><p>Track your blood pressure at home. The American Heart Association recommends an <a href="https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings/monitoring-your-blood-pressure-at-home">automatic, validated cuff-style monitor</a> that goes on your upper arm. A record of readings taken over time can help your doctor adjust your treatments as needed.</p></li>
</ol>
<p>High blood pressure is a silent killer. Being proactive and knowing your numbers can be a lifesaver.</p><img src="https://counter.theconversation.com/content/198726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wändi Bruine de Bruin received funding for this study from USC's Roybal Center for Behaviorial Interventions in Aging (supported by the National Institute on Aging, 5P30AG024968), USC's Center for Economic and Social Research, and USC's Schaeffer Center for Health Policy and Economics. Co-author Yasmina Okan was partly supported by a Ramón y Cajal Fellowship (RYC2020-028857-I) financed by MCIN/AEI/10.13039/501100011033 and by The FSE Invests in your Future. The funding agreements ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. </span></em></p><p class="fine-print"><em><span>Mark Huffman has received travel support from the American Heart Association and World Heart Federation. Mark Huffman has an appointment at The George Institute for Global Health, which has a patent, license, and has received investment funding with intent to commercialize fixed-dose combination therapy through its social enterprise business, George Medicines. Mark Huffman has pending patents for heart failure polypills.</span></em></p>Nearly half of all Americans ages 20 and up have high blood pressure. Yet research shows that most people in the US don’t know the cutoff numbers for healthy blood pressure.Wändi Bruine de Bruin, Professor of Public Policy, Psychology and Behavioral Science, USC Sol Price School of Public Policy, USC Dornsife College of Letters, Arts and SciencesMark Huffman, Professor of Medicine, Washington University in St. LouisLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1948982022-12-26T20:52:15Z2022-12-26T20:52:15ZHeart rate variability – what to know about this biometric most fitness trackers measure<figure><img src="https://images.theconversation.com/files/500755/original/file-20221213-14408-pvtw3d.jpg?ixlib=rb-1.1.0&rect=1047%2C901%2C6039%2C3884&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An increase in this particular biometric is a good thing.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-man-using-smartwatch-in-bed-royalty-free-image/1371086366">visualspace/E+ via Getty Images</a></span></figcaption></figure><p>Your heart beats <a href="https://www.pbs.org/wgbh/nova/heart/heartfacts.html">around 100,000 times every day</a>. <a href="https://theconversation.com/tracking-your-heart-rate-5-questions-answered-about-what-that-number-really-means-124066">Heart rate</a> is a key marker of cardiovascular activity and an important vital sign. But your pulse is not as steady as a precision clock – nor would you want it to be.</p>
<p><a href="https://scholar.google.com/citations?hl=en&user=uXcM0scAAAAJ">As a cardiovascular physiologist</a>, I measure heart rate in nearly every experiment my students and I perform. Sometimes we use an <a href="https://medlineplus.gov/lab-tests/electrocardiogram/">electrocardiogram</a>, such as you’d see in a medical clinic, which uses sticky electrodes to measure electrical signals between two points of your body. Other times we use a chest strap monitor, like ones you might see on someone at the gym, which also detects heartbeats based on electrical activity.</p>
<p>As wearable technology has grown more popular, it’s not just researchers and cardiologists who are paying attention to heart rate. You might be monitoring your own all day long via a fitness tracker you wear on your wrist. This kind of wearable device <a href="https://help.fitbit.com/articles/en_US/Help_article/1565.htm">uses green light to detect blood flow</a> beneath your skin and deduces your heart rate.</p>
<p>Here are what heart rate and other measurements derived from this biometric can tell you about your body’s health.</p>
<h2>Pumping blood where it needs to go</h2>
<p>The heart’s primary job is to contract and generate pressure that helps pump blood to the lungs to be oxygenated and then on to the rest of the body to deliver oxygen and other nutrients. Heart rate is simply how fast your heart is beating. Sometimes called a pulse rate, it’s normally presented in beats per minute. You can <a href="https://www.health.harvard.edu/heart-health/want-to-check-your-heart-rate-heres-how">count your own heart rate</a> by feeling for your pulse inside your wrist or behind your jaw. </p>
<p>When your body demands more oxygen, such as during exercise, heart rate will increase along with the increasing workloads.</p>
<p>While many people are familiar with tracking their heart rate during exertion, the heart rate at rest can also provide valuable information. The two parts of the <a href="https://www.webmd.com/heart/what-is-heart-rate-variability">autonomic nervous system</a>, the sympathetic and parasympathetic, influence resting heart rate. The sympathetic branch helps coordinate your body’s stress response. The more active it is, the higher it dials up your heart rate, preparing you for fight or flight. </p>
<p>The parasympathetic branch of your nervous system is responsible for keeping lots of your body’s functions running smoothly while you’re at ease. Via the vagus nerve that runs from the brain all the way to the abdomen, the parasympathetic nervous system actively slows the heart down to resting values between <a href="https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure/all-about-heart-rate-pulse">60 and 100 beats</a> per minute for the average healthy adult. Without any parasympathetic activity putting the brakes on the sympathetic nervous system’s signals, your heart would beat at approximately 100 beats per minute. </p>
<p>A lower resting heart rate indicates an efficient heart and a higher level of parasympathetic activity. When you’re at rest your nervous system is ideally minimizing sympathetic activity, so you’re conserving energy and avoiding unnecessary stress to the body.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="chart of red peaks of a heartbeat at slightly different intervals" src="https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=274&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=274&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=274&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=344&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=344&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500523/original/file-20221212-119183-4pofku.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=344&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The chart of a heart rate reveals tiny differences in spacing between the peaks representing heartbeats.</span>
<span class="attribution"><span class="source">YitzhakNat via Wikimedia Commons</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Time between each heartbeat</h2>
<p>One specific way to understand the balance of the nervous system’s influence on heart rate is to look at <a href="https://my.clevelandclinic.org/health/symptoms/21773-heart-rate-variability-hrv#:%7E:text=Heart%20rate%20variability%20is%20where,issues%20like%20anxiety%20and%20depression.">heart rate variability</a>, or HRV – the slight fluctuation in the time between each heartbeat. Even if your heart rate is 60 beats a minute, that doesn’t mean your heart is pumping exactly once every second.</p>
<p>Less variability is a sign that your body is under greater stress and that the balance in your autonomic nervous system is tipping toward the sympathetic branch being in charge. Greater variability suggests you’re more relaxed and your parasympathetic nervous system is in control. </p>
<p>For nearly 30 years, scientists have been interested in <a href="https://doi.org/10.1161/01.CIR.93.5.1043">how to measure and interpret HRV</a>, specifically as it relates to this balance of autonomic control.</p>
<p>The clinical utility of HRV emerged in patients following cardiac events, but researchers are now considering how this measure can help explain patient outcomes in a range of <a href="https://doi.org/10.2147/VHRM.S279322">cardiac</a>, <a href="https://doi.org/10.1371/journal.pone.0195166">endocrine</a> and <a href="https://doi.org/10.1016/j.jad.2018.04.071">psychiatric</a> disorders.</p>
<p>More recently, researchers have investigated <a href="https://doi.org/10.15420/aer.2018.27.2">how to use HRV</a> in <a href="https://doi.org/10.15420/aer.2018.30.2">athletic training and prognosis of medical conditions</a>.</p>
<p>Several fitness wearables also report <a href="https://support.whoop.com/WHOOP_Data/Recovery__HRV/What_is_Heart_Rate_Variability_(HRV)%3F">heart rate variability</a>, either as a <a href="https://support.ouraring.com/hc/en-us/articles/360025441974-An-Introduction-to-Heart-Rate-Variability#:%7E:text=How%20Oura%20Measures%20HRV,samples%20measured%20while%20you%20sleep.">stand-alone metric</a> or used in the calculation of “readiness” or “recovery” scores. <a href="https://doi.org/10.1055/a-1864-9726">Endurance athletes now commonly track HRV</a> as one way to monitor their overall physiological state.</p>
<p>Researchers have started checking which <a href="https://doi.org/10.3390/s22166317">commercially available wearable devices are most reliable and accurate</a> at measuring HRV, which can vary from tracker to tracker. Many of these devices use colored lights, or optical sensors, to measure pulse rate and other variables at the wrist or finger. Unfortunately, the <a href="https://www.statnews.com/2019/07/24/fitbit-accuracy-dark-skin/">accuracy of this method can vary based on skin type and skin color</a>. It is important that companies include diverse populations in the design, testing and validation of these products to help address potential racial health disparities.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman doing standing pose on yoga mat" src="https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500758/original/file-20221213-19390-g5huck.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Another health benefit of stress-busting activities can be an increase in heart rate variability.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-standing-on-yoga-mat-in-warrior-pose-while-royalty-free-image/1397801043">David Espejo/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>Nudging HRV in a good direction</h2>
<p>One of the biggest influences on heart rate variability is stress; along with increased sympathetic nervous system activity, stress is associated with lower HRV. Stress-reducing interventions, <a href="https://my.clevelandclinic.org/health/treatments/13354-biofeedback">biofeedback</a> and <a href="https://doi.org/10.1016/s0828-282x(10)70395-0">increased fitness</a> can increase heart rate variability. Remember, an increase is good for this metric. Overall, <a href="https://www.webmd.com/heart/what-is-heart-rate-variability#091e9c5e82171840-2-4">heart rate variability depends on</a> a range of physiological, psychological, environmental, lifestyle and nonmodifiable genetic <a href="https://doi.org/10.3389/fpubh.2017.00258">factors</a>.</p>
<p>The most useful way to consider heart rate variability as a metric is to look at data trends. Are there consistent changes in HRV in either direction? Examine these changes alongside other health factors such as fitness, mood, illness, sleep and dietary intake to see if you can draw any conclusions about lifestyle modifications you may want to make.</p>
<p>In general, the <a href="https://www.va.gov/WHOLEHEALTHLIBRARY/tools/heart-rate-variability-and-arrhythmias.asp">same approaches</a> you would take to lowering resting heart rate can also improve heart rate variability, such as increasing cardiovascular fitness, maintaining a healthy weight, reducing stress and getting sufficient sleep.</p>
<p>It’s important to remember that heart rate variability is the normal, healthy, very slight fluctuation of timing of heartbeats – just milliseconds of difference from beat to beat. More dramatic changes in heart rhythms or the way in which the heart contracts, known as <a href="https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668">arrhythmias</a>, may signal a more serious condition that requires medical attention.</p><img src="https://counter.theconversation.com/content/194898/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne R. Crecelius does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Tiny fluctuations in the time between each beat of your heart can provide clues about how much stress your body is experiencing.Anne R. Crecelius, Associate Professor of Health and Sport Science, University of DaytonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1945022022-11-14T10:44:38Z2022-11-14T10:44:38ZOver 12% of South African adults have diabetes - education is critical to achieve good outcomes<figure><img src="https://images.theconversation.com/files/494927/original/file-20221112-29604-1ypgsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Type 2 diabetes mostly affects adults of a certain age.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p><em>Over <a href="https://www.up.ac.za/tshwane-insulin-project-tip/news/post_2937261-world-diabetes-day-up-insulin-project-acknowledges-crucial-role-of-nurses-in-managing-the-disease">12%</a> of adults in South Africa have diabetes. Since 2019, researchers at the University of Pretoria have been working on the <a href="https://www.up.ac.za/diabetes-research-centre/article/3107624/tshwane-insulin-programme-tip">Tshwane Insulin Project</a>. The project consists of delivering training workshops on comprehensive diabetes and hypertension management in primary care. The researchers also provide technical assistance to healthcare professionals to improve diabetes care. The Conversation Africa spoke to project manager Dr Patrick Ngassa Piotie about what diabetes is and why it’s so difficult to manage.</em></p>
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<h2>What is diabetes?</h2>
<p>Diabetes mellitus, or <a href="https://www.who.int/news-room/fact-sheets/detail/diabetes">diabetes</a>, refers to a group of conditions that affect how the body uses blood glucose (sugar). Diabetes occurs when the pancreas is no longer <a href="https://www.idf.org/aboutdiabetes/what-is-diabetes.html">able to make insulin</a>, or when the body cannot make good use of the insulin it produces. This leads to elevated glucose levels in the blood. Over time, high blood glucose levels cause damage to the body and the failure of various organs.</p>
<p>There are different types of diabetes. Type 2 is the most common. It accounts for 90% of all cases. With type 2, the body is still able to produce insulin but can’t use it correctly. Type 2 diabetes mostly affects adults of a certain age, who are overweight, don’t exercise, and have a family history of diabetes.</p>
<p>Type 1 diabetes can develop at any age, but it occurs most frequently in children and adolescents. With type 1 diabetes, the pancreas produces very little to no insulin. This means people who have type 1 diabetes need insulin daily to maintain blood glucose levels. </p>
<p>Lastly, there’s diabetes that occurs during pregnancy – gestational diabetes. It affects both mother and child, but usually disappears after pregnancy.</p>
<p>Pre-diabetes is a reversible condition. It happens when blood glucose levels are higher than normal, but <a href="https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444">not high enough to be called diabetes</a>. It can lead to diabetes unless measures such as lifestyle modifications are taken to prevent it.</p>
<p>The symptoms of diabetes are linked to the high levels of sugar in the blood. They include feeling tired and weak, feeling more thirsty than usual, urinating often, or losing weight without trying. Other symptoms such as blurry vision, recurring infections or slow-healing sores are signs of an advanced stage of the disease.</p>
<h2>How is it managed?</h2>
<p>This depends on the type of diabetes. For example, people with type 1 diabetes need daily insulin injections. The management of type 2 diabetes consists of adopting a healthy lifestyle including increased physical activity and healthy diet. However, type 2 diabetes is a progressive disease. This means that, as the condition progresses, people with type 2 diabetes will need oral drugs and/or insulin to keep their blood glucose levels under control.</p>
<p>Managing diabetes is not just about keeping the blood glucose levels within normal ranges. Often, people with diabetes and healthcare professionals must control the blood pressure and cholesterol levels as well. In addition, a key aspect of managing diabetes is to prevent complications by protecting target organs such as the kidneys and the heart, or the feet.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/technology-and-home-visits-can-help-south-africans-with-diabetes-cope-with-insulin-186000">Technology and home visits can help South Africans with diabetes cope with insulin</a>
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<p>At the <a href="http://www.diabetes.up.ac.za">University of Pretoria Diabetes Research Centre</a>, we have developed an acronym that summarises our approach to good diabetes care: the <a href="https://www.up.ac.za/media/shared/856/ZP_Resources/living-with-diabetes_starting-insulin.zp225902.pdf">four “Bs” and four “Cs”</a> or 4Bs 4Cs.</p>
<p>The 4Bs are critical elements to control diabetes:</p>
<ul>
<li><p>Blood pressure control</p></li>
<li><p>Blood glucose control</p></li>
<li><p>Blood cholesterol control</p></li>
<li><p>Breathe air, don’t smoke</p></li>
</ul>
<p>The 4Cs are important tests that people with diabetes should receive every year:</p>
<ul>
<li><p>Check eyes, with a diabetic eye screening – a specific test to check for eye problems caused by diabetes</p></li>
<li><p>Check mouth, by going to the dentist</p></li>
<li><p>Check kidneys, with a laboratory test</p></li>
<li><p>Check feet, with a simple easy-to-do foot exam.</p></li>
</ul>
<p>To manage diabetes, healthcare professionals need the full participation of people with diabetes and their families. That is why it’s important that people with diabetes and their families receive <a href="https://www.semdsa.org.za/">diabetes education</a>. People with diabetes must be <a href="https://worlddiabetesday.org/about/theme/">equipped</a> with the skills to navigate self-management decisions and activities. </p>
<h2>What are the main challenges in managing the condition?</h2>
<p>In South Africa, most people with diabetes rely on the public health system for care. This system is overburdened, overstretched and under-resourced. These systemic challenges have an impact on the delivery of diabetes care, despite the availability of diabetes medication – including insulin – free of charge at primary care clinics.</p>
<p>Healthcare professionals often don’t have time for diabetes education because of long queues and congested health facilities. As a result, people with diabetes <a href="https://pubmed.ncbi.nlm.nih.gov/28156143/">don’t receive the education they need</a>. This, in turn, means people don’t have a good understanding of their condition, which affects their ability to adopt appropriate self-management behaviours, and to adhere to their medication.</p>
<p>Research conducted in South Africa has consistently shown that healthcare workers <a href="https://pubmed.ncbi.nlm.nih.gov/32242428/">don’t comply with diabetes management guidelines</a>. They also fail to implement the recommended processes of care such as measurements of body mass index, waist circumference or weight.</p>
<p>Having paper-based medical records instead of electronic medical records is an additional barrier. The medical records are often lost or misplaced. In a context where healthcare professionals rotate often between departments, it becomes difficult to preserve patient history and to ensure continuity of care. A paper-based system makes it difficult to implement structured diabetes care.</p>
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Read more:
<a href="https://theconversation.com/our-research-shows-gaps-in-south-africas-diabetes-management-programme-160275">Our research shows gaps in South Africa's diabetes management programme</a>
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<p>South African <a href="https://pubmed.ncbi.nlm.nih.gov/35532128/">studies</a> have found that screening for diabetes-related complications is lacking. For example, healthcare professionals are <a href="https://www.diabetessa.org.za/challenges-facing-sa-in-the-fight-against-diabetic-retinopathy/">not able to screen patients for eye problems</a> caused by diabetes. Diabetic eye screening requires a specific camera that is not available in most clinics and community health centres. </p>
<h2>How can these be addressed?</h2>
<p><a href="https://guidelines.diabetes.ca/cpg">Diabetes care</a> should be structured, evidence-based and facilitated by a multidisciplinary team trained in diabetes management.</p>
<p>South Africa’s health system should be strengthened. Investments are needed to improve the delivery of diabetes care. There is a pressing need for the continuous training of healthcare professionals in diabetes management.</p>
<p>Because of the heavy workload on primary care nurses and doctors, allied healthcare workers, community health workers and health promoters should be trained to carry out non-clinical duties like diabetes education and support.</p>
<p>The recognition and integration of diabetes educators within the public healthcare system should be a priority. This will ensure that diabetes education becomes systematic and consistent. It should be repeated at regular intervals. Families of people living with diabetes should also be involved and receive diabetes education because their support is crucial.</p>
<p>Technology, digital health solutions and telehealth can improve the delivery of quality diabetes care. Clinical information systems such as electronic medical records and electronic patient registries can have a positive impact on evidence-based diabetes care. Those systems should be introduced as a matter of urgency.</p>
<h2>What are some of the key lessons from the Tshwane Insulin Project so far?</h2>
<p>The use of digital health, enhancing the role played by community health workers and following patients proactively are some of the <a href="https://pubmed.ncbi.nlm.nih.gov/34733467/">innovations that were introduced</a>.</p>
<p>Most healthcare professionals are eager to embrace change and new knowledge. And people with diabetes and their families were appreciative of the education they were receiving. They qualified it as life changing.</p>
<p>Improving diabetes care and outcomes in South Africa will require a strong will and unwavering support from the health authorities, the introduction of clinical information systems, the use of technology and digital solutions, advocacy and accountability.</p><img src="https://counter.theconversation.com/content/194502/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Patrick Ngassa Piotie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Improving diabetes care in South Africa requires strong will and support from health authorities, introduction of clinical information systems, the use of technology and digital solutions.Patrick Ngassa Piotie, Project Manager, University of Pretoria Diabetes Research Centre, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1835912022-06-08T12:33:31Z2022-06-08T12:33:31ZNo, Latinos don’t actually have less heart disease – a new large study refutes the longstanding ‘Latino paradox’<figure><img src="https://images.theconversation.com/files/467233/original/file-20220606-20-3pn9ey.jpg?ixlib=rb-1.1.0&rect=233%2C0%2C4958%2C3362&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For at least three decades, studies have shown that Latinos have better heart health than other people, but new research calls that into question. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/grandmother-teaching-granddaughter-to-cook-in-royalty-free-image/1312462880?adppopup=true">The Good Brigade/DigitalVision via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em> </p>
<h2>The big idea</h2>
<p>Latinos may have higher rates of heart disease than previously thought, refuting a well-accepted idea known as the “Latino paradox,” according to a <a href="https://doi.org/10.1007/s11606-022-07625-y">new study that I was involved in</a>.</p>
<p>The crux of the Latino paradox is as follows: A broad body of research shows that Latinos have <a href="https://www.diabetesresearch.org/file/national-diabetes-statistics-report-2020.pdf">higher rates of diabetes</a>, <a href="https://doi.org/10.1001/jama.2020.14590">obesity</a> and <a href="https://doi.org/10.1097/HCO.0000000000000636">uncontrolled blood pressure</a> and <a href="https://doi.org/10.1161/JAHA.115.001867">cholesterol levels</a> than non-Hispanic white people. So naturally, it would follow that Latino people should also have higher levels of cardiovascular disease. </p>
<p>But for the past 30 years, <a href="https://doi.org/10.2105/AJPH.2012.301103">a wide body of studies</a> has found the opposite: Despite greater risk factors for heart disease, Latinos have lower mortality from rates of heart disease than non-Latino people. </p>
<p>We found, however, that both Latino men and women have significantly higher rates of heart disease than non-Hispanic whites. In fact, for men we found rates of heart disease that were even slightly higher than among Black people, a group with <a href="https://doi.org/10.1161/cir.0000000000000534">the highest rates of heart disease</a>. We found that 9.2% of Latinos had a diagnosis of heart disease, compared with 8.1% among Black people and 7.6% among non-Hispanic white men. </p>
<p>To do the analysis, we used data from <a href="https://doi.org/10.1056/NEJMsr1809937">the All of Us research program</a>, which seeks to enroll at least 1 million people from diverse backgrounds over the next few years. We examined medical record data from the more than 200,000 people who have already signed up for the program, <a href="https://doi.org/10.1371/journal.pone.0234962">including over 40,000 Latinos</a>. </p>
<p>Going into the study, we assumed that we would find evidence in support of the Latino paradox. Prior data on the paradox was based mostly on mortality records or self-reporting, both of which have inherent limitations. For example, without an autopsy, it is often hard to know for certain what led to a person’s death. People also may not be aware that they had heart disease, especially if they have not seen a doctor in a long time.</p>
<p>Instead, our work looked at medical records and examined diagnoses of heart disease as determined by a physician during health care visits. We think this is a novel approach, as it uses more robust data to examine this issue. </p>
<h2>Why it matters</h2>
<p>The widely accepted <a href="https://doi.org/10.1016/j.ejim.2013.09.003">“Latino paradox</a>” has been studied extensively. And until now, most <a href="https://doi.org/10.1016/j.pcad.2014.09.001">studies have supported it</a>, though none have found a <a href="https://theconversation.com/the-cheerful-lexicon-of-the-spanish-language-may-help-solve-a-health-mystery-called-the-hispanic-paradox-173598">concrete explanation for it</a>. Medical and public health students are often taught about it as an unexplained phenomenon. But our study, using the largest research cohort of Latinos in the United States, seems to refute the paradox.</p>
<p>The implications are critical because they suggest that like all groups, Latinos still need to take care of themselves by eating healthily, exercising regularly, watching their weight, avoiding smoking and getting regular check-ups. Those with diabetes, hypertension or cholesterol, need to make sure those conditions are well-controlled. </p>
<p>These seemingly straightforward messages are the ones that doctors have been telling all of their patients for decades. Yet this study makes it clear that Latinos don’t get a free pass when it comes to heart disease and that they also need to follow health guidelines. And our study highlights the ongoing need for culturally tailored cardiovascular health programs for the Latino community. </p>
<h2>What is still unknown</h2>
<p>Although our study analyzed data from the largest existing cohort of Latinos, we do not think ours is the definitive word on the topic. More research is needed, and we need to continue to think creatively about how to get at these questions. It is also important to keep in mind that Latino populations are not homogeneous. Latinos come from many different parts of Latin America, where diets, customs and lifestyles are all unique.</p>
<p>For that reason, our team is interested in looking at health data focused on Latino subgroups, as well as comparing U.S.-born Latinos with immigrants. We also hope to examine the Latino paradox when it comes to other conditions such as cancer, which research has also shown occurs <a href="https://doi.org/10.3322/caac.21695">less frequently among Latinos than other groups</a>. That is another paradox that we need to reexamine.</p><img src="https://counter.theconversation.com/content/183591/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Olveen Carrasquillo receives funding from National Institutes of Health (NIH) and Patient Centered Outcomes Research Institute (PCORI).</span></em></p>It has long puzzled researchers why Latinos seem to have lower rates of heart disease than their non-Latino counterparts, even though they have higher risk factors for heart disease.Olveen Carrasquillo, Professor of Medicine and Public Health Sciences, University of MiamiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1572352022-01-04T19:13:15Z2022-01-04T19:13:15Z4 plant-based foods to eat every week (and why science suggests they’re good for you)<figure><img src="https://images.theconversation.com/files/436253/original/file-20211208-140109-1hurlbt.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4500%2C2997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As a laureate professor in nutrition and dietetics people often ask – what do you eat? </p>
<p>Plant-based foods are good sources of healthy nutrients. These include different types of dietary fibre, vitamins, minerals, and a range of “<a href="https://theconversation.com/phytonutrients-can-boost-your-health-here-are-4-and-where-to-find-them-including-in-your-next-cup-of-coffee-132100">phytonutrients</a>”, which plants produce to help them grow or protect them from pathogens and pests.</p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33951994/">review of research published in May 2021</a> looked at 12 studies with more than 500,000 people who were followed for up to 25 years. It found those who ate the most plant foods were less likely to die from any cause over follow-up time periods that varied across the studies from five to 25 years, compared to those who ate the least.</p>
<p>Here are four versatile and tasty plant foods I have on my weekly grocery list, and the research showing why they’re good for you.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/plant-rich-diets-may-help-prevent-depression-new-evidence-103898">Plant-rich diets may help prevent depression – new evidence</a>
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</em>
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<h2>1. Tomatoes</h2>
<p>Tomatoes are a berry fruit (not a vegetable). They’re rich in vitamin C and “<a href="https://en.wikipedia.org/wiki/Lycopene">lycopene</a>”, which is a carotenoid. Carotenoids are pigments produced by plants and give vegetables their bright colours. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/32243013/">review of six trials</a> asked people to consume tomato products equivalent to 1-1.5 large tomatoes or 1-1.5 cups of tomato juice daily for about six weeks.</p>
<p>The researchers found people who did this had reduced blood levels of triglycerides (a type of fat in your blood that <a href="https://pubmed.ncbi.nlm.nih.gov/31530008/">increases heart disease risk</a>), as well as lower total and “bad” cholesterol levels, compared to those who didn’t have any tomatoes.</p>
<p>These people also had increased levels of “good cholesterol”.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/love-meat-too-much-to-be-vegetarian-go-flexitarian-73741">Love meat too much to be vegetarian? Go 'flexitarian'</a>
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<p>Another review of 11 studies tested the <a href="https://pubmed.ncbi.nlm.nih.gov/33676812/">effect of tomatoes and lycopene on blood pressure</a>.</p>
<p>Researchers found consuming any tomato products led to a large decrease in systolic blood pressure (the first number that measures the pressure at which the heart pumps blood).</p>
<p>However, there was no effect on the diastolic pressure (the second number which is the pressure in the heart when it relaxes).</p>
<p>In the group who had high blood pressure to begin with, both systolic and diastolic blood pressure decreased after eating tomato products compared to placebos.</p>
<figure class="align-center ">
<img alt="Tomatoes" src="https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435741/original/file-20211206-25-1dfc2id.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tomatoes are high in vitamin C and other important healthy nutrients.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/29317772/">review of studies</a> included a total of 260,000 men and found those with the highest intakes of cooked tomatoes, tomato sauces and tomato-based foods (equivalent to around one cup per week) had a 15-20% lower risk of developing prostate cancer compared to those with the lowest tomato intakes. Keep in mind correlation doesn’t necessarily mean causation, though. </p>
<p><strong>Recipe tips</strong></p>
<p>Keep canned tomatoes in the cupboard and add to pasta sauce, casseroles and soup. Make your own sauce by roasting tomatoes and red capsicum with a splash of olive oil and balsamic vinegar, then puree with a spoon of chilli paste or herbs of your choice. Keep in the fridge.</p>
<p>Try our fast tomato <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/keywords--tomato">recipes at No Money No Time</a>, a site full of dietary advice and recipes founded by my team at the University of Newcastle. </p>
<h2>2. Pumpkin</h2>
<p>Pumpkin is rich in beta-carotene, which is also a carotenoid (plant pigment). It gets converted into vitamin A in the body and <a href="https://pubmed.ncbi.nlm.nih.gov/24782580/">is used in the production of antibodies that fight infection</a>. It’s also needed to maintain the integrity of cells in eyes, skin, lungs and the gut. </p>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/30475962/">review of studies that followed people over time</a> looked at associations between what people ate, blood concentrations of <a href="https://en.wikipedia.org/wiki/Beta-Carotene">beta-carotene</a> and health outcomes.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/carrots-and-pumpkin-might-reduce-your-risk-of-cancer-but-beware-taking-them-in-pill-form-75537">Carrots and pumpkin might reduce your risk of cancer, but beware taking them in pill form</a>
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</em>
</p>
<hr>
<p>People who had the highest intakes of foods rich in beta-carotene (such as pumpkin, carrots, sweet potato and leafy greens) had an 8-19% lower relative risk of having coronary heart disease, stroke, or dying from any cause in studies over 10 years or more compared to those with the lowest intakes.</p>
<p><strong>Recipe tips</strong></p>
<p>Pumpkin soup is a favourite. Try our <a href="https://nomoneynotime.com.au/healthy-easy-recipes/design-your-own-pumpkin-soup">design-your-own</a> soup recipe.</p>
<p>Heat oven to 180°C, chop the pumpkin into wedges, drizzle with olive oil, roast till golden. Speed it up by microwaving cut pumpkin for a couple of minutes before roasting.</p>
<figure class="align-center ">
<img alt="Carrots, pumpkins, sweet potato and other vegetables" src="https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=420&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=420&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=420&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=528&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=528&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435743/original/file-20211206-27-12a8ug6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=528&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pumpkins, carrots and sweet potato have high levels of beta-carotene, which has health benefits.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>3. Mushrooms</h2>
<p>Mushrooms are rich in nutrients with strong antioxidant properties.</p>
<p>The body’s usual processes create <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/antioxidants">oxidative stress</a>, which generates “free radicals”. These are small particles that damage cells walls and cause the cells to die.</p>
<p>If these aren’t neutralised by antioxidants, they can trigger inflammation, contribute to ageing and development of some cancers. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-antioxidants-and-are-they-truly-good-for-us-86062">What are antioxidants? And are they truly good for us?</a>
</strong>
</em>
</p>
<hr>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33724299/">review of 17 studies on mushrooms and health</a> found people who ate the most mushrooms had a 34% lower risk of developing any type of cancer compared to those with lowest intakes. For breast cancer, the risk was 35% lower. Though, again, correlation doesn’t necessarily mean causation.</p>
<p>Across the studies, a high mushroom intake was equivalent to eating a button mushroom a day (roughly 18 grams).</p>
<p><strong>Recipe tips</strong></p>
<p>Check out our <a href="https://nomoneynotime.com.au/healthy-easy-recipes/basic-mushroom-baby-spinach-side">mushroom and baby spinach stir-fry recipe</a>. It makes a tasty side dish to serve with scrambled or poached eggs on toast. </p>
<h2>4. Oats</h2>
<p>A <a href="https://pubmed.ncbi.nlm.nih.gov/33296453/">review of ten studies</a> tested the effects on blood sugar and insulin levels from eating intact oat kernels, thick rolled oats or quick rolled oats compared to refined grains.</p>
<p>These found eating intact oat kernels and thick rolled oats led to significant reductions in blood glucose and insulin responses, but not after eating quick rolled oats.</p>
<p>This is likely due to the longer time it takes for your body to digest and absorb the less-processed oats. So it’s better to eat whole grain oats, called groats, or rolled oats rather then quick rolled oats.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/phytonutrients-can-boost-your-health-here-are-4-and-where-to-find-them-including-in-your-next-cup-of-coffee-132100">Phytonutrients can boost your health. Here are 4 and where to find them (including in your next cup of coffee)</a>
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</em>
</p>
<hr>
<p>Oats are a good sources of <a href="https://pubmed.ncbi.nlm.nih.gov/34828872/">beta-glucan</a>, a soluble fibre shown to help lower blood cholesterol levels.</p>
<p>Across <a href="https://pubmed.ncbi.nlm.nih.gov/27724985/">58 studies where people were fed a special diet</a> containing about 3.5 grams of oat beta-glucan a day, “bad” cholesterol levels were significantly lower compared with control groups.</p>
<p>The impact of oats <a href="https://pubmed.ncbi.nlm.nih.gov/25668347/">on blood pressure has been tested in five intervention trials</a> which showed a small, but important, drop in blood pressure.</p>
<p><strong>Recipe tips</strong></p>
<p>You can eat rolled oats for breakfast year round.</p>
<p>Eat them as <a href="https://nomoneynotime.com.au/healthy-easy-recipes/filter/keywords--oats">muesli in summer or porridge in winter</a>, add to meat patties, mix with breadcrumbs for coatings or add to fruit crumble toppings.</p><img src="https://counter.theconversation.com/content/157235/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She has received research grants from NHMRC, ARC, MRFF, Hunter Medical Research Institute, Diabetes Australia, Heart Foundation, Bill and Melinda Gates Foundation, nib foundation, Rijk Zwaan Australia, WA Dept. Health, Meat and Livestock Australia, and Greater Charitable Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers, the Sax Institute and the ABC. She was a team member conducting systematic reviews to inform the Australian Dietary Guidelines update and the Heart Foundation evidence reviews on meat and dietary patterns.</span></em></p>As a laureate professor in nutrition and dietetics, people often ask me what I eat. Here are four plant-based foods I have on my weekly grocery list.Clare Collins, Laureate Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1552752021-02-18T13:43:16Z2021-02-18T13:43:16ZAir filters can scrub out pollutants near highways, reduce blood pressure<figure><img src="https://images.theconversation.com/files/384847/original/file-20210217-17-m3ta4h.jpg?ixlib=rb-1.1.0&rect=107%2C123%2C2499%2C1373&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Busy highways are large sources of air pollution. </span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Typical_Weekend_Traffic_on_IH_35_Downtown_Austin_2019.jpg">Larry D. Moore via Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>For people living near busy highways, using air filters indoors results in <a href="https://doi.org/10.1161/HYPERTENSIONAHA.120.15580">short-term improvements to blood pressure</a>, according to a new study <a href="https://scholar.google.co.uk/scholar?as_q=&num=10&btnG=Search+Scholar&as_epq=&as_oq=&as_eq=&as_occt=any&as_sauthors=%22Doug+Brugge%22&as_publication=&as_ylo=&as_yhi=&as_allsubj=all&hl=en">I co-authored</a>.</p>
<p>Next to busy highways and major roadways, there are <a href="https://doi.org/10.1016/j.atmosenv.2012.06.088">high concentrations of air pollution</a> – including exceptionally tiny, invisible and odorless ultrafine particles from burning fuel. My colleagues <a href="https://scholar.google.com/citations?user=xA1QrtwAAAAJ&hl=en&oi=ao">Neelakshi Hudda</a>, <a href="https://publichealth.tufts.edu/people/faculty/misha-eliasziw">Misha Eliasziw</a> and I tested how using air filters indoors near a highway can reduce exposure to ultrafine and other particulate pollutants – and what effect that has on blood pressure. </p>
<p>Our team tested 77 participants over three two-hour sessions in a room next to a busy highway. We manipulated the level of air pollution in the room using portable air filters, windows and doors to create low, medium and high exposures to ultrafine and other particles. We measured the blood pressure of study participants every 10 minutes. </p>
<p>Our study found that blood pressure is dose-dependent on exposure to ultrafine particles – the higher the levels of pollution, the higher a person’s blood pressure. Importantly, we also found that air filters can effectively reduce this pollution and reduce the associated blood pressure increases.</p>
<p>The difference in blood pressure between high and low exposures was relatively small, below 3 mm of mercury. However, even this <a href="https://doi.org/10.1056/NEJMoa1803180">small change could affect risk of heart attacks and strokes</a> if sustained over periods longer than our two-hour sessions. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384849/original/file-20210217-23-kzght6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Air filter with arrows showing air flowing in the side and out the top." src="https://images.theconversation.com/files/384849/original/file-20210217-23-kzght6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384849/original/file-20210217-23-kzght6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384849/original/file-20210217-23-kzght6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384849/original/file-20210217-23-kzght6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384849/original/file-20210217-23-kzght6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384849/original/file-20210217-23-kzght6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384849/original/file-20210217-23-kzght6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Air filters can remove ultrafine particles that increase blood pressure.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/digital-composite-image-of-air-purifier-amidst-royalty-free-image/1156432743?adppopup=true">Anass Bachar/EyeEm via Getty Images</a></span>
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</figure>
<h2>Why it matters</h2>
<p>A lot of research has linked living <a href="https://www.doi.org/10.1097/01.ede.0000362629.45350.e3">close to heavily trafficked roadways</a> with <a href="https://www.healtheffects.org/publication/traffic-related-air-pollution-critical-review-literature-emissions-exposure-and-health">adverse health outcomes</a>. Researchers also know that <a href="https://doi.org/10.1161/CIR.0b013e3181dbece1">particulate air pollution affects cardiovascular health</a>, but most work has focused on larger particles, called PM2.5. </p>
<p>My colleagues and I are contributing to the <a href="https://cafeh.squarespace.com/">Community Assessment of Freeway Exposure and Health</a>, which focuses on much smaller ultrafine particles. There is currently no regulation regarding emissions of ultrafine particles, and they have not been studied in as much detail as PM2.5. Our work and other studies have found that they are associated <a href="https://doi.org/10.1016/j.envint.2016.03.013">with biomarkers of increased inflammation</a> and <a href="https://dx.doi.org/10.1186%2Fs12940-018-0379-9">increased blood pressure</a>. </p>
<p>Motor vehicles will continue to emit pollution for a long time. Since the source of these pollutants isn’t going away anytime soon, I think one good way to try to improve the health of people living near busy roads is by <a href="https://ww2.arb.ca.gov/sites/default/files/classic//research/apr/past/11-311.pdf">cleaning the air in their houses</a>. Our study suggests that air filters can do this in a way that meaningfully lowers blood pressure.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/384850/original/file-20210217-17-1igtjdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People walking down a city street with cars." src="https://images.theconversation.com/files/384850/original/file-20210217-17-1igtjdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384850/original/file-20210217-17-1igtjdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384850/original/file-20210217-17-1igtjdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384850/original/file-20210217-17-1igtjdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384850/original/file-20210217-17-1igtjdr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=494&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384850/original/file-20210217-17-1igtjdr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=494&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384850/original/file-20210217-17-1igtjdr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=494&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Air filters lower blood pressure in the confines of a home, but it is unknown if this effect holds over time.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/view-from-above-of-traffic-in-streets-of-dumbo-royalty-free-image/1089337190?adppopup=true">Busà Photography/Moment via Getty Images</a></span>
</figcaption>
</figure>
<h2>What isn’t known</h2>
<p>This work is promising, but the tightly controlled setting of the study might not translate into benefits for people going about their daily lives. </p>
<p>For people who stay home and have their windows closed most of the time, it seems likely that air filters would have a beneficial reduction in their blood pressure similar to what we saw in our study. But many people leave their homes for extended periods for work or school. Whether there will be enough reduction in blood pressure to result in health benefits in these cases remains to be seen.</p>
<h2>What’s next</h2>
<p>My colleagues and I are currently enrolling participants for a new study exploring whether there are benefits from placing air filters in people’s homes in real–life scenarios.</p>
<p>The participants in this new study will receive both real and sham air filters and alternate using them for one month at a time each. Our team will measure the participants’ blood pressure at the start and end of each month and then compare the same person’s blood pressure from month to month to see if the air filters really lower blood pressure. The results of this study should help us determine whether air filters can produce long-term reductions in blood pressure for those living near highways.</p><img src="https://counter.theconversation.com/content/155275/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Doug Brugge receives funding from the National Institute of Environmental Health Sciences. </span></em></p>Living next to a highway is not great for health, but a new study shows that running air filters indoors can remove tiny particles of pollution and lower blood pressure.Doug Brugge, Professor and Chair of Public Health Science and Community Medicine, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1470012020-10-26T12:00:34Z2020-10-26T12:00:34ZThe spooky and dangerous side of black licorice<figure><img src="https://images.theconversation.com/files/363719/original/file-20201015-13-1edro0h.jpg?ixlib=rb-1.1.0&rect=10%2C40%2C6689%2C4416&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Black licorice gets its distinctive flavor from licorice root.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/heap-of-licorice-roots-and-black-salt-licorice-royalty-free-image/1171067902?adppopup=true">PicturePartners/Getty Images</a></span></figcaption></figure><p>Black licorice may look and taste like an innocent treat, but this candy has a dark side. On Sept. 23, 2020, it was reported that black licorice was the culprit in the <a href="https://apnews.com/article/archive-04cf918055b735ea69483dd00e281253">death of a 54-year-old man in Massachusetts</a>. How could this be? Overdosing on licorice sounds more like a twisted tale than a plausible fact.</p>
<p>I have a longstanding interest in how chemicals in our food and the environment affect our body and mind. When something seemingly harmless like licorice is implicated in a death, we are reminded of the famous proclamation by Swiss physician Paracelsus, the Father of Toxicology: “All things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison.”</p>
<p><a href="https://wjsulliv.wixsite.com/sullivanlab">I am a professor</a> in the department of pharmacology and toxicology and <a href="https://authorbillsullivan.com">author of the book</a> “<a href="https://www.nationalgeographicpartners.com/press/2019/10/-pleased-to-meet-me--genes--germs--and-the-curious-forces-that-m/">Pleased to Meet Me: Genes, Germs, and the Curious Forces That Make Us Who We Are</a>.” </p>
<h2>The root of the problem</h2>
<p>The unfortunate man who succumbed to excessive black licorice consumption is not alone. There are a smattering of similar case reports in medical journals, in which patients experience <a href="https://pubmed.ncbi.nlm.nih.gov/26380428/">hypertension crisis</a>, <a href="https://doi.org/10.5414/cn107011">muscle breakdown</a> or even death. Adverse reactions are most frequently seen in people over the age of 40 who are eating far more black licorice than the average person. In addition, they are usually consuming the product for prolonged periods of time. <a href="https://doi.org/10.1056/NEJMcpc2002420">In the most recent case</a>, the Massachusetts man had been eating a bag and a half of black licorice every day for three weeks.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/365280/original/file-20201023-18-upsl27.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/365280/original/file-20201023-18-upsl27.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/365280/original/file-20201023-18-upsl27.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=736&fit=crop&dpr=1 600w, https://images.theconversation.com/files/365280/original/file-20201023-18-upsl27.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=736&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/365280/original/file-20201023-18-upsl27.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=736&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/365280/original/file-20201023-18-upsl27.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=925&fit=crop&dpr=1 754w, https://images.theconversation.com/files/365280/original/file-20201023-18-upsl27.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=925&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/365280/original/file-20201023-18-upsl27.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=925&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"><em>Glycyrrhiza glabra</em> is a species native to Eurasia and North Africa from which most confectionery licorice is produced.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/a/a4/Glycyrrhiza_glabra_-_K%C3%B6hler%E2%80%93s_Medizinal-Pflanzen-207.jpg">Franz Eugen Köhler, Köhler's Medizinal-Pflanzen via Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Licorice is a flowering plant native to parts of Europe and Asia. Its scientific name, <em>Glycyrrhiza</em>, is derived from the Greek words “glykos” (sweet) and “rhiza” (root). The aromatic and sweet extract from its root has long been used as an herbal remedy for a wide variety of health maladies, from heartburn and stomach issues to sore throats and cough. However, there is <a href="https://www.fda.gov/consumers/consumer-updates/black-licorice-trick-or-treat">insufficient evidence to support that licorice is effective in treating any medical condition</a>.</p>
<p>Glycyrrhizin (also called glycyrrhizic acid) is the chemical in black licorice that gives the candy its signature flavor, but it also leads to its toxic effects. </p>
<p>Glycyrrhizin mimics the hormone <a href="https://www.yourhormones.info/hormones/aldosterone/">aldosterone</a>, which is made by the adrenal glands when the body needs to retain sodium and excrete potassium. Sodium and potassium work together as a kind of cellular battery that drives communication between nerves and the contraction of muscles. Too much glycyrrhizin upsets the balance of these electrolytes, which can raise blood pressure and disturb the heart’s rhythm. Other symptoms of excessive licorice intake include swelling, muscle pain, numbness and headache. Examination of the man who died from consuming too much licorice revealed that he had <a href="https://doi.org/10.1056/NEJMcpc2002420">dangerously low levels of potassium, consistent with glycyrrhizin toxicity.</a></p>
<p>It should be noted that a number of licorice-based foods do not contain real licorice, but use a flavoring substitute called anise oil, which does not pose the dangers discussed here. In addition, despite its name, <a href="https://www.livestrong.com/article/537724-black-licorice-vs-red-licorice/">red licorice rarely contains licorice extract</a>. Instead, red licorice is infused with chemicals that impart its cherry or strawberry flavor.</p>
<p>Products that contain real licorice are usually labeled as such, and list licorice extract or glycyrrhizic acid among the ingredients. Be advised that some products, such as black jelly beans or Good & Plenty, are mixtures of different candies that contain both anise oil and licorice extract.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/365294/original/file-20201023-23-1uee3ur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/365294/original/file-20201023-23-1uee3ur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=195&fit=crop&dpr=1 600w, https://images.theconversation.com/files/365294/original/file-20201023-23-1uee3ur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=195&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/365294/original/file-20201023-23-1uee3ur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=195&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/365294/original/file-20201023-23-1uee3ur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=245&fit=crop&dpr=1 754w, https://images.theconversation.com/files/365294/original/file-20201023-23-1uee3ur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=245&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/365294/original/file-20201023-23-1uee3ur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=245&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Red licorice is sickly sweet but safe to eat.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/wall-of-licorice-royalty-free-image/103742661?adppopup=true">Darren Boucher/Getty Images</a></span>
</figcaption>
</figure>
<h2>Hidden dangers that increase risk</h2>
<p>Glycyrrhizin has the distinct licorice flavor and is <a href="https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=19&contentid=Licorice">50 times sweeter than sugar</a> and has been used in other types of candy, soft drinks, tea, Belgian beers, throat lozenges and tobacco. This can make it challenging to keep track of how much glycyrrhizin has been consumed, and a combination of these products could trigger adverse effects.</p>
<p>Some people take dietary or health supplements that already contain licorice, which increases the risk of toxic effects from eating black licorice candy. Certain medications such as <a href="https://doi.org/10.5414/cn107011">hydrochlorothiazide</a> are diuretics that cause increased urination, which can lower potassium levels in the body. Glycyrrhizin also lowers potassium levels, further disrupting the balance of electrolytes, which can produce muscle cramps and irregular heart rhythms.</p>
<p>People with certain preexisting conditions are more susceptible to black licorice overdose. </p>
<p>For example, patients who already have low potassium levels (hypokalemia), high blood pressure or heart arrhythmia are likely to have greater sensitivity to the effects of excessive licorice. Those with liver or kidney deficiencies will also retain glycyrrhizin in their bloodstream for longer times, increasing their risk of experiencing its adverse effects.</p>
<h2>What to do?</h2>
<p>If you’re a fan of black licorice, there is no need to ban it from your pantry. Eaten in small quantities from time to time, licorice poses no significant threat to otherwise healthy adults and children. But it is advisable to monitor your intake.</p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>With Halloween approaching, be sure to remind your kids that candy is a “<a href="https://www.heart.org/idc/groups/heart-public/@wcm/@global/documents/downloadable/ucm_305557.pdf">sometimes food</a>,” especially the black licorice. The <a href="https://www.fda.gov/consumers/consumer-updates/black-licorice-trick-or-treat">FDA has issued warnings</a> about the rare but serious effects of too much black licorice, advising that people avoid eating more than two ounces of black licorice a day for two weeks or longer. The agency states that if you have been eating a lot of black licorice and experience an irregular heart rhythm or muscle weakness, stop eating it immediately and contact your health care provider.</p>
<p>Some scientists have further cautioned against the routine use of licorice in the form of a dietary supplement or tea for its alleged health benefits, including the treatment of cough <a href="https://doi.org/10.1002/emp2.12411">associated with COVID-19</a> or other respiratory infections. A <a href="https://doi.org/10.1177/2042018812454322">review article from 2012</a> warned that “the daily consumption of licorice is never justified because its benefits are minor compared to the adverse outcomes of chronic consumption.”</p>
<p><em>Article updated to mention concerns about using licorice as a COVID-19 treatment.</em></p><img src="https://counter.theconversation.com/content/147001/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Sullivan does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Who knew that black licorice had a dark side? A scientist explains when this treat becomes a threat.Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1449712020-09-28T15:03:53Z2020-09-28T15:03:53ZWhy is race still in the British blood pressure guidelines?<figure><img src="https://images.theconversation.com/files/358420/original/file-20200916-24-7ojr3l.jpg?ixlib=rb-1.1.0&rect=0%2C18%2C6221%2C3246&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/blood-pressure-measurement-384543322">Visual Generation/Shutterstock</a></span></figcaption></figure><p>I looked around the lecture theatre and scribbled down what the lecturer had said: <strong>ABCD</strong>. <strong>A</strong>CE inhibitors (angiotensin-converting enzyme inhibitors), <strong>B</strong>eta blockers, <strong>C</strong>alcium channel blockers and (thiazide) <strong>D</strong>iuretics. These were the four groups of drugs used to treat high blood pressure (hypertension) – except there were exceptions. </p>
<p>We didn’t use beta blockers anymore and ACE inhibitors don’t work for black people, specifically black African or Afro-Caribbean people. The lecturer explained to us that all black people were inherently less likely to respond to ACE inhibitors. This is what I learned at medical school, and this is what medical students still learn today. Now, as a practising GP, this is <a href="https://www.nice.org.uk/guidance/ng136">the guidance</a> we use every day (click to make them bigger).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/357526/original/file-20200910-22-lv17x2.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/357526/original/file-20200910-22-lv17x2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/357526/original/file-20200910-22-lv17x2.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/357526/original/file-20200910-22-lv17x2.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/357526/original/file-20200910-22-lv17x2.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/357526/original/file-20200910-22-lv17x2.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/357526/original/file-20200910-22-lv17x2.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/357526/original/file-20200910-22-lv17x2.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption"></span>
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</figure>
<p>On the other hand, in <a href="https://www.heart.org/en/health-topics/high-blood-pressure/high-blood-pressure-toolkit-resources">the US blood pressure guidance</a>, there is no mention of race. Why the disparity? Do black people really react to blood pressure drugs differently from white people? Are black bodies different from white bodies? </p>
<p>Speculation on why black people have higher blood pressure than white people is often attributed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1694537/">a genetic adaptation to slavery</a>: specifically, salt retention allowed black people to survive long trips on slave transportation ships across the Atlantic Ocean. The implication that there are <a href="https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.118.11064">inherent biological differences</a> between black people and members of other races has entered blood pressure medication guidance. Black people are labelled “low-renin responders” so are less likely to respond to ACE inhibitors. But there are several things wrong with this idea:</p>
<ol>
<li><p>The highest quality <a href="https://ssom.luc.edu/media/stritchschoolofmedicine/publichealthsciences/documents/kc2010.pdf">evidence</a> (a meta-analysis) found a small but statistically significant 4mmHg (millimetres of mercury) difference between the response to ACE inhibitors between black people and white people. If black people were all poor responders to this drug, you would expect the difference to be far bigger.</p></li>
<li><p>There is <a href="https://journals.sagepub.com/doi/10.1177/1060028018779082">conflicting evidence</a> on whether ACE inhibitors are beneficial or detrimental in terms of heart disease outcomes for black people. If they didn’t work that well, surely there would be no change or a clear detriment. </p></li>
<li><p>Even if black people are inherently different from white people, what medication should a person receive if they have a black parent and a white parent? What if they have a grandparent of African heritage? Using the “one-drop rule” – where any person with even one ancestor of black ancestry is considered black – could be problematic as very few people can trace their ancestry back a few generations. This means it is difficult to rule out any African or Caribbean heritage in anyone’s lineage. A commercial genetics test <a href="https://www.vox.com/science-and-health/2019/1/28/18194560/ancestry-dna-23-me-myheritage-science-explainer">probably won’t help you</a>.</p></li>
<li><p>Recent genetic research consistently shows that there are greater genetic differences between members of the <em>same</em> race compared with members of <em>different</em> races, looking <a href="https://www.genetics.org/content/176/1/351">generally</a> and <a href="https://www.cell.com/ajhg/fulltext/S0002-9297(14)00355-3">specifically</a> at African-Americans. </p></li>
<li><p>The social and economic circumstances and the environment in which a person lives has <a href="https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1749-6632.1999.tb08123.x">a greater effect</a> on health than biological or genetic factors. So could there be an alternative explanation for why black people have higher blood pressure compared with white people? Could <a href="https://journals.lww.com/jhypertension/Abstract/2015/02000/Socioeconomic_status_and_hypertension__a.4.aspx">poverty</a>, <a href="https://www.ahajournals.org/doi/10.1161/JAHA.119.012139">stress</a> or <a href="https://doi.apa.org/doiLanding?doi=10.1037%2Fa0033718">perceived racism</a> be reasonable explanations?</p></li>
</ol>
<h2>Decolonising medicine</h2>
<p>Medicine is not objective; scientific research is conducted by people who bring their own perspectives. These biases colour the way research is conducted, the way data is analysed and the way conclusions are drawn. Perhaps it’s time for an overhaul.</p>
<p>The reform of medical curricula is called “<a href="https://jme.bmj.com/content/medethics/46/4/265.full.pdf?casa_token=Y46tD5ZfqT4AAAAA:p0lNvoyEVeq6_FjcYk_xB8kRfynjdYgTEu6CNHWBsLxe14OgUkrSsTkJJVkLqHLsML1B1jtFoWY">decolonisation</a>” where the impact of history and colonisation is examined so medicine can better meet the needs of people who come from ethnic minorities. In a recent example, medical student <a href="https://twitter.com/malone_mk">Malone Mukwende</a> wrote a <a href="https://www.blackandbrownskin.co.uk/mindthegap">textbook</a> to help doctors recognise skin conditions on black and brown skin. This is significant since skin conditions in medicine are almost exclusively taught on white skin.</p>
<p>Where it comes to blood pressure research, a more holistic approach is needed to involve other sectors, such as genetics and social sciences. The <a href="https://www.nice.org.uk/guidance/ng136">UK blood pressure guidelines</a> need to be re-examined as does much of medicine. This re-examination will challenge assumptions and the objectivity of medical research. This may fill some members of the medical profession and the public with dread as this adds to further <a href="https://www.bmj.com/content/370/bmj.m3349">uncertainty</a> during a global pandemic. Perhaps this is the beginning of a change that will lead to a fairer health system for all.</p><img src="https://counter.theconversation.com/content/144971/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am an In-Practice Fellow supported by the Department of Health and Social Care and the National Institute for Health Research.
The views expressed in this publication are my own and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.
I have not been paid any honoraria to promote Angela Saini's book "Superior: the rise of race science".</span></em></p>Decolonising medicine will create a fairer healthcare system for all.Dipesh Gopal, Honorary Research Fellow, General Practice, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1449212020-09-23T10:50:51Z2020-09-23T10:50:51ZBlood pressure medications decrease death and severe disease in COVID-19 patients<figure><img src="https://images.theconversation.com/files/359302/original/file-20200922-24-87r9dv.jpg?ixlib=rb-1.1.0&rect=176%2C77%2C7172%2C4825&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-adult-measuring-blood-pressure-521817334">Rawpixel.com/Shutterstock</a></span></figcaption></figure><p>At the start of the pandemic, there was concern that certain drugs for high blood pressure might be linked with worse outcomes for COVID-19 patients. </p>
<p>Because of how the drugs work, it was feared they would make it easier for the coronavirus to get inside the body’s cells. Nevertheless, many national medical societies <a href="https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19">advised</a> <a href="https://www.escardio.org/Councils/Council-on-Hypertension-(CHT)/News/position-statement-of-the-esc-council-on-hypertension-on-ace-inhibitors-and-ang">patients</a> to continue taking their medication. </p>
<p>With the potential for a second wave, it was essential to investigate whether patients could safely continue using these drugs. So, our team at the University of East Anglia set out to discover what effect they have on the progress of COVID-19.</p>
<p>Instead of putting patients at risk, <a href="https://link.springer.com/article/10.1007/s11883-020-00880-6">we found</a> that these medications actually lower the risk of death and severe disease in COVID-19 patients.</p>
<h2>Bad outcomes cut by one-third</h2>
<p>We pooled data from 19 relevant COVID-19 studies that included patients taking two particular types of blood pressure medication: angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). This allowed us to look at the outcomes of more than 28,000 COVID-19 patients to assess the effects of these drugs.</p>
<p>ACEIs and ARBs work by acting on the renin-angiotensin-aldosterone system (RAAS), which is essential for regulating blood pressure and the balance of fluids and electrolytes. These drugs were also thought to potentially increase the expression of a protein found on the surface of cells called angiotensin-converting enzyme 2 (ACE2).</p>
<figure class="align-center ">
<img alt="A box of capsules of valsartan, an angiotensin receptor blocker" src="https://images.theconversation.com/files/359306/original/file-20200922-24-tpd08s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/359306/original/file-20200922-24-tpd08s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/359306/original/file-20200922-24-tpd08s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/359306/original/file-20200922-24-tpd08s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/359306/original/file-20200922-24-tpd08s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/359306/original/file-20200922-24-tpd08s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/359306/original/file-20200922-24-tpd08s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">ARBs like valsartan help lower blood pressure by widening the blood vessels.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/manchester-uk-august-30-2019-box-1491667235">AnthonyWR/Shutterstock</a></span>
</figcaption>
</figure>
<p>Apart from helping regulate blood pressure, the <a href="https://theconversation.com/ace2-the-molecule-that-helps-coronavirus-invade-your-cells-138369">ACE2 protein</a> is also what allows the coronavirus to enter the body’s cells. This is why there were concerns about patients using these drugs. If the medications increased the amount of ACE2 present on cells, it was suspected they would make it easier for the virus to infect them, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7258639/">worsening a patient’s condition</a>.</p>
<p>But when we looked at the outcomes of patients taking ACEIs and ARBs compared with those not on these medications, this wasn’t the case. </p>
<p>We found no evidence that these medications might increase the severity of COVID-19 or the risk of death. On the contrary, among patients taking ACEIs and ARBs that had been prescribed to treat high blood pressure, there was actually a significantly lower risk of death, being admitted to intensive care or being put on ventilation. We observed a reduction of such events by one-third in this group. </p>
<p>It may be that these medications actually have a protective role – particularly in patients with high blood pressure.</p>
<h2>What’s behind this effect?</h2>
<p>It’s not clear why patients taking ACEIs and ARBs experienced less severe disease, but there are a couple of points to consider.</p>
<p>The first is that while theoretically these drugs were thought to increase ACE2 levels, there’s <a href="https://www.sciencedirect.com/science/article/pii/S1043661820311415">no convincing evidence</a> that this actually happens. We don’t have any <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184165/">clinical data</a> on the effects of these drugs on ACE2 expression in human tissue. </p>
<p>And even if these drugs do increase ACE2 levels in cells, not all of it is surface-bound. Additional ACE2 that appears elsewhere in the cell might not function as an entry point for SARS-CoV-2.</p>
<figure class="align-center ">
<img alt="SARS-CoV-2 binding to an ACE2 receptor" src="https://images.theconversation.com/files/359310/original/file-20200922-16-1pbv077.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/359310/original/file-20200922-16-1pbv077.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/359310/original/file-20200922-16-1pbv077.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/359310/original/file-20200922-16-1pbv077.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/359310/original/file-20200922-16-1pbv077.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/359310/original/file-20200922-16-1pbv077.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/359310/original/file-20200922-16-1pbv077.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The spike proteins (orange) on the surface of SARS-CoV-2 bind to ACE2 (green) to allow the virus entry into the cell.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/sarscov2-viruses-binding-ace2-receptors-on-1701661801">Kateryna Kon/Shutterstock</a></span>
</figcaption>
</figure>
<p>There’s also a second potentially relevant piece of information. Infection with SARS-CoV-2 may also lead to an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7468676/">overreaction of the RAAS pathway</a> – which is what these blood pressure drugs target – and inflammation. This increased inflammatory process is thought to be the culprit for acute lung injury and can lead to worsening pneumonia and <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2008975">acute respiratory distress syndrome</a>. Hence, it might be that taking medications that inhibit the RAAS system prevents such a sequence of events and improves clinical outcomes in COVID-19.</p>
<p>What we do know is that our study provides substantial evidence that patients should continue using these medications during the pandemic, as they are safe. We haven’t investigated whether starting these tablets in acutely ill COVID-19 patients will improve their outcomes, but this is now the subject of a randomised controlled trial.</p><img src="https://counter.theconversation.com/content/144921/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vassilios Vassiliou has received funding from the Rosetrees Trust, the Norfolk Heart Trust and the UK National Institute for Health Research (NIHR). </span></em></p><p class="fine-print"><em><span>Ranu Baral does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Although they remain untested as a treatment, this suggests these drugs could be used as a therapeutic against the coronavirus.Vassilios Vassiliou, Senior Clinical Lecturer in Cardiovascular Medicine, University of East AngliaRanu Baral, Visiting Researcher (Academic Foundation Doctor FY2), University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1393422020-06-17T14:27:35Z2020-06-17T14:27:35ZHIV and high blood pressure in pregnancy: we’re tracing the connections<figure><img src="https://images.theconversation.com/files/341262/original/file-20200611-80762-su04vn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In South Africa, both HIV and pre-eclampsia are a burden to maternal health.</span> <span class="attribution"><span class="source">GettyImages</span></span></figcaption></figure><p>The vast majority of women dying from pregnancy-related conditions are in sub-Saharan Africa and Southern Asia. In <a href="https://www.who.int/news-room/fact-sheets/detail/maternal-mortality">2017</a>, about 86% of global maternal deaths occurred in these regions. </p>
<p>The leading cause of maternal deaths is hypertension, or high blood pressure. This condition is also known as pre-eclampsia. It needs to be detected early through regular medical checkups, but developing countries don’t always have the resources to offer these to pregnant women. </p>
<p>In South Africa, both HIV and pre-eclampsia are a burden to maternal health. The highest <a href="https://www.nicd.ac.za/wp-content/uploads/2019/07/Antenatal_survey-report_24July19.pdf">prevalence</a> (41.1%) of HIV infection in pregnant women occurs in the province of KwaZulu-Natal. Pre-eclampsia is also common <a href="https://www.tandfonline.com/doi/abs/10.1080/10641955.2016.1193190?journalCode=ihip20">(12%)</a> here.</p>
<p>Pre-eclampsia is the development of hypertension after the 20th week of pregnancy in a woman who previously had normal blood pressure. According to the <a href="https://isshp.org/guidelines/">latest guidelines</a> of the International Society for the Study of Hypertension in Pregnancy, a diagnosis is based on a blood pressure reading greater than 140/90 mmHg. This is why it’s vital that blood pressure is monitored throughout the pregnancy. </p>
<p>If left untreated, pre-eclampsia progresses to eclampsia. This can lead to severe high blood pressure associated with seizures. The baby has to be delivered as an emergency – which is why timely diagnosis is vital. </p>
<p>I am conducting <a href="https://link.springer.com/article/10.1007/s11906-019-0970-7">research</a> on HIV-positive women with pre-eclampsia. My findings should expand on the current science of high blood pressure in pregnancies complicated with HIV. As well as contribute to early detection of this condition in pregnant women. </p>
<h2>Blood vessels</h2>
<p>Pregnancy changes every organ in a woman’s body. Most of these changes are associated with the placenta, which is attached to the wall of the uterus. The placenta is a network of blood vessels that provide oxygen and nutrients to the foetus and remove waste. </p>
<p>When the placenta develops normally, new blood vessels sprout from existing ones. Cells of the placenta infiltrate the vessels allowing them to become wider. As a result, there is a larger space for blood to flow. The process of creating new blood vessels is called angiogenesis and it’s put in motion by special proteins called <a href="https://pubmed.ncbi.nlm.nih.gov/25659427/">angiogenic factors</a>. These proteins include the vascular endothelial growth factor (VEGF) and placental growth factor (PlGF).</p>
<p>In pre-eclampsia, the blood vessels of the placenta remain narrow as there aren’t enough cells for invasion. There is less oxygen available and a reduced blood flow causes stress to the placenta. In response, the placenta produces excessive amounts of proteins known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063446/">anti-angiogenic</a> factors. The most common protein is soluble fms-like tyrosine kinase 1 (sFlt-1), among others. </p>
<p>These proteins are released into the mother’s blood and become harmful. The sFlt-1 protein is partly responsible for vessels not developing normally, leading to an increase in blood pressure as there is limited space in which the blood flows. At this point, both the mother and baby are at risk.</p>
<p>There are now higher levels of the protein sFlt-1 in the maternal blood than the proteins involved in normal vessel formation. This is known as an angiogenic imbalance. The sFlt/PlGF ratio is the first test for early detection of pre-eclampsia. </p>
<p>We assume that in the case of women with HIV, an additional factor <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2712328/">interferes</a> with the normal development of blood vessels. That is a protein called <em>Tat</em>. When the HIV virus enters the bloodstream in pregnant women, the <em>Tat</em> protein is able to recognise another protein similar to itself, VEGF. The <em>Tat</em> protein binds on to VEGF and VEGF can no longer perform its function. This lowers VEGF levels necessary for healthy vessel formation for normal blood flow. </p>
<p>Scientists investigate specific genes to determine if they are related to developing a disease. In the case of pre-eclampsia, there hadn’t been many advances in the field of gene discovery until 2017. Using foetal blood, a group of scientists across Europe discovered that a gene called <a href="https://www.nature.com/articles/ng.3895">Flt-1</a> is associated with an increased risk of developing pre-eclampsia in a population from Norway and Finland. </p>
<p>In a bid to expand the knowledge base on the subject I chose to do my <a href="https://link.springer.com/article/10.1007/s11906-019-0970-7">PhD research</a> on the gene. It encodes the protein sFlt-1 which is the source of the trouble in placenta. To assess the risk, we are using a similar approach to this European study to investigate Flt-1 in maternal blood. This is the first time the gene is being studied in a population affected by HIV. All HIV-positive women in the study are on antiretrovirals. </p>
<h2>Antiretroviral therapy in pregnancy</h2>
<p>Part of our inquiry is to look into the effects of antiretroviral therapy on high blood pressure in pregnancy. Pre-eclampsia and HIV are both immune diseases so we assume there should be common link.</p>
<p>During pregnancy, changes in the immune system are a challenge to the placenta and foetus. For the mother, the foetus is now recognised as a foreign invader. Both the placenta and foetus need to be protected from the activation of the mother’s immune response. As a result, her immunity is increased during pregnancy to prevent rejection of the foetus as a foreign tissue. </p>
<p>The foetus needs to survive these changes and adapt to the mother’s immune response. The incompatibility of both immune systems plays a role in the development of pre-eclampsia. The mother develops an abnormal immune response to the placenta with heightened immunity and an increase in inflammatory cells.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/30276649/">Research</a> suggests that women receiving antiretroviral therapy may have a higher risk of developing pre-eclampsia. But the science remains unclear. Some <a href="https://link.springer.com/article/10.1007/s11906-019-0970-7">studies</a> found that antiretroviral therapy had no impact on pre-eclampsia development. More research is needed to confirm whether antiretroviral therapy is a risk indicator for pre-eclampsia.</p><img src="https://counter.theconversation.com/content/139342/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sayuri Padayachee receives funding from The National Research Foundation. </span></em></p>Reducing maternal deaths in developing countries relies on the ability of health systems to swiftly identify and manage women at high risk.Sayuri Padayachee, PhD Candidate, University of KwaZulu-NatalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1383692020-05-12T14:08:49Z2020-05-12T14:08:49ZACE2: the molecule that helps coronavirus invade your cells<figure><img src="https://images.theconversation.com/files/334345/original/file-20200512-175241-1n8h2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>The more we learn about the science behind COVID-19, the more we are beginning to understand the vital role a single molecule in our bodies plays in how we contract the disease. </p>
<p>That molecule, angiotensin-converting enzyme 2, or ACE2, essentially acts as a port of entry that allows the coronavirus to invade our cells and replicate. It occurs in our lungs, but also in our <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/path.1570">heart, intestines, blood vessels and muscles</a>. </p>
<p>And it may be behind the vastly different death rates we are seeing between men and women. </p>
<h2>What is ACE2?</h2>
<p>ACE2 is an enzyme molecule that connects the inside of our cells to the outside via the cell membrane. </p>
<p>In normal physiology, another enzyme called ACE alters a chemical, angiotensin I, and converts it into angiotensin II, which causes blood vessels to constrict. The tightening of the blood vessels leads to an increase in blood pressure. </p>
<p>That’s when the ACE2 molecule comes in: to counteract the effects of ACE, causing blood vessels to dilate and lowering blood pressure.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/334347/original/file-20200512-175268-dg3uio.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/334347/original/file-20200512-175268-dg3uio.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/334347/original/file-20200512-175268-dg3uio.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/334347/original/file-20200512-175268-dg3uio.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/334347/original/file-20200512-175268-dg3uio.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/334347/original/file-20200512-175268-dg3uio.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/334347/original/file-20200512-175268-dg3uio.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/334347/original/file-20200512-175268-dg3uio.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The spikes that make up the ‘crown’ of coronavirus bind to ACE2 enzymes to get into our cells.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>You may have seen illustrations of the virus that show distinct spikes around the surface of the virus, which form part of the “crown” or “corona” that gives the virus its name. These spikes are called <a href="https://www.uniprot.org/uniprot/P59594">S1 proteins</a>, and they are what bind to the ACE2 molecule on our cells.</p>
<p>The virus is then able to invade the cell by a process called endocytosis – where the cell membrane engulfs the virus and internalises it within a bubble called an endosome. </p>
<p>Once inside the cell, the virus interacts with the host cells’ genetic machinery, taking advantage of the existing structure to replicate extensively.</p>
<p>SARS-CoV-2, the virus behind COVID-19, has a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7164637/pdf/367_1260.pdf">high binding capacity</a> for ACE2 – between ten and 20 times more that of the original Sars virus. This means it is much easier for SARS-CoV-2 to get into human cells compared to the original coronavirus, making it more infectious overall.</p>
<h2>ACE2 and COVID-19</h2>
<p>But there is still conflicting evidence on the precise role ACE2 plays in coronavirus infections. </p>
<p>In some cases, it can actually be of benefit: ACE2 has been shown to <a href="https://physoc.onlinelibrary.wiley.com/doi/full/10.1113/expphysiol.2007.040048">reduce injury to the lung tissue</a> in cases of the original Sars virus in mice by doing its job and causing blood vessels to dilate. </p>
<p>In another mouse study, however, the binding of the Sars spike protein to ACE2 was shown to <a href="https://journals.lww.com/shockjournal/Fulltext/2016/09000/Pulmonary_Angiotensin_Converting_Enzyme_2__ACE2_.3.aspx">contribute to lung damage</a>. </p>
<p>When it comes to the current coronavirus, early studies have shown that the introduction of a human-made form of ACE2 to human cells can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181998/pdf/main.pdf">block the early stages of infection</a> by binding the spike protein, preventing it from entering the cells. ACE2 thus acts both as an entry port to cells but also as a mechanism to protect the lung from injury. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/334334/original/file-20200512-175235-iqlz4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/334334/original/file-20200512-175235-iqlz4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/334334/original/file-20200512-175235-iqlz4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=469&fit=crop&dpr=1 600w, https://images.theconversation.com/files/334334/original/file-20200512-175235-iqlz4o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=469&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/334334/original/file-20200512-175235-iqlz4o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=469&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/334334/original/file-20200512-175235-iqlz4o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=589&fit=crop&dpr=1 754w, https://images.theconversation.com/files/334334/original/file-20200512-175235-iqlz4o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=589&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/334334/original/file-20200512-175235-iqlz4o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=589&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The structure of the ACE2 molecule.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Protein_ACE2_PDB_1r42.png">Emw</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>ACE2 and the male death toll</h2>
<p>It’s well established that COVID-19 affects men and women differently. Out of a representative sample of 1,099 patients in China, <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2002032">58% were men and 42% were women</a>. Data from China has also shown that men die of COVID-19 at a <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2020.00152/full">rate two and a half times that of women</a>. </p>
<p>Similar figures have been observed in the <a href="https://www.nytimes.com/2020/04/07/health/coronavirus-new-york-men.html">US</a> and 60% of deaths in <a href="http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/weekly-surveillance-report">Europe</a> have been men.</p>
<p>We don’t yet fully understand why men die of COVID-19 in higher numbers than women, but it’s possible ACE2 plays a role. </p>
<p>A large study of two independent populations of heart failure patients was recently published in which ACE2 concentrations were found to be <a href="https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa373/5834647">significantly higher in men than in women</a>. This could explain why men may be more at risk than women of COVID-19 infection and of dying from the disease.</p>
<h2>ACE2 and other conditions</h2>
<p>The other important factor in the outcome of patients is the presence of <a href="https://jamanetwork.com/journals/jama/fullarticle/2762130">underlying health problems</a>.</p>
<p>Recently, ACE2 has been identified in different cells of the heart. There are a <a href="https://academic.oup.com/cardiovascres/article/doi/10.1093/cvr/cvaa078/5813131">greater number of ACE2 receptors</a> on the surface of cells in the heart muscle in people with established cardiovascular disease compared to those without disease. </p>
<p>This may result in a greater number of virus particles <a href="https://theconversation.com/coronavirus-severe-forms-of-the-disease-can-damage-the-heart-136352">entering the heart cells </a> in COVID-19 patients with established heart diseases.</p>
<p>Given the role ACE2 plays in regulating blood pressure, there are also concerns about how it affects COVID-19 patients with hypertension. Men are more likely to have hypertension than women, especially under the age of 50. </p>
<p>Two particular drugs to reduce hypertension also affect ACE and ACE2. These are angiotensin converting enzyme inhibitors, or ACEi, and angiotensin receptor blockers, known as ARBs. In animal studies, both of these drug types <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095949/pdf/41591_2005_Article_BFnm0805821.pdf">increase the production of the ACE2 enzyme</a> and so may increase the severity of COVID-19 infection. </p>
<p>Small independent studies have examined the effect of these treatments on COVID-19 with <a href="https://journals.sagepub.com/doi/pdf/10.1177/2047487320918421">conflicting results</a>. However, a <a href="https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.317134">recent study</a> on the subject has demonstrated that COVID-19 patients with untreated hypertension have a higher risk of death compared to those being treated with ACEi or ARBs. </p>
<p>That’s why many <a href="https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concerns-re-using-raas-antagonists-in-covid-19">professional societies</a> are <a href="https://www.ema.europa.eu/en/news/ema-advises-continued-use-medicines-hypertension-heart-kidney-disease-during-covid-19-pandemic">advising people</a> with high blood pressure to continue using their medicines during the crisis. </p>
<p>The role that ACE2 plays in COVID-19 is important in our understanding of the disease and could be used as a target for therapy. Drugs could be designed to block the receptor function of ACE2, but also there is promise in using the molecule itself in preventing entry of the virus into cells. </p>
<p>This would protect organs such as the lung, heart, kidney and intestine from extensive damage, and hopefully reduce mortality.</p><img src="https://counter.theconversation.com/content/138369/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David C Gaze is affiliated with The Association for Clinical Biochemistry and Laboratory Medicine; The American Association of Clinical Chemistry; Royal Society of Medicine; Pathological Society of Great Britain & Ireland; European Society of Pathology. </span></em></p>A molecule responsible for lowering our blood pressure also helps coronavirus get into our cells and replicate. And it occurs more in men than in women.David C. Gaze, Lecturer in Clinical Biochemistry, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1359582020-04-23T05:19:31Z2020-04-23T05:19:31ZHow to manage your blood pressure in isolation<figure><img src="https://images.theconversation.com/files/329938/original/file-20200423-47799-1qzgwri.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C997%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mens-health-check-blood-pressure-heart-560263513">Shutterstock</a></span></figcaption></figure><p>Maintaining healthy blood pressure is <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13741">important</a> during (and after) the coronavirus pandemic.</p>
<p>With about <a href="https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia/high-blood-pressure-statistics">one in three</a> Australian adults having high blood pressure, many people will be needing to monitor their own blood pressure in isolation.</p>
<p>So it’s a great time to make sure you’re accurately measuring and optimally managing your blood pressure at home.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-what-do-my-blood-pressure-numbers-mean-29212">Health Check: what do my blood pressure numbers mean?</a>
</strong>
</em>
</p>
<hr>
<h2>When it comes to blood pressure, home really is better</h2>
<p>Blood pressure measurements taken at home are a <a href="https://www.ncbi.nlm.nih.gov/pubmed/16965721">better indication</a> of your true blood pressure. They’re also a better indication of your risk of <a href="https://link.springer.com/article/10.1007/s11886-013-0413-z">heart attack and stroke</a> than measurements doctors take in their surgeries or in hospital.</p>
<p>Blood pressure readings by doctors are generally even higher than those measured by other health professionals, <a href="https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.109.141879?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed">such as nurses</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-should-measure-our-own-blood-pressure-53928">Why we should measure our own blood pressure</a>
</strong>
</em>
</p>
<hr>
<p>This is due to the “white coat” effect, where a doctor’s presence can lead to your blood pressure (and heart rate) rising, something we’ve known about since the <a href="https://www.sciencedirect.com/science/article/pii/S0140673683922444?via%3Dihub">1980s</a>.</p>
<p>So today’s <a href="https://www.heartfoundation.org.au/images/uploads/publications/PRO-167_Hypertension-guideline-2016_WEB.pdf">guidelines</a> recommend doctors confirm someone has high blood pressure using methods outside the clinic.</p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671913/">ideal method</a> while in isolation is to measure your blood pressure using your own device.</p>
<h2>How do I measure my blood pressure at home?</h2>
<p>Your blood pressure <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278896/">can vary</a> depending on whether you’re talking, exercising or under stress, or if there is a change in the temperature. It can also vary depending on your posture, whether you’ve just eaten, taken medication, drunk a coffee or smoked.</p>
<p>So it’s important to measure your blood pressure at home the <a href="https://www.racgp.org.au/afp/2016/januaryfebruary/how-to-measure-home-blood-pressure-recommendations-for-healthcare-professionals-and-patients/">correct way each time</a>, otherwise your readings might be incorrect or misleading:</p>
<ul>
<li><p><strong>use a validated device</strong>, one that has been rigorously tested for accuracy. <a href="https://www.ncbi.nlm.nih.gov/pubmed/32275193">Most devices</a> available in Australia have not been validated. You can check if yours is <a href="https://www.menzies.utas.edu.au/documents/pdfs/Blood-pressure-devices.pdf">here</a>.
Use an upper arm device (not a wrist cuff or one you wear on a wristband) with a correct cuff size (within the range indicated on the cuff). If you don’t want to buy a device, you can hire or borrow one from some pharmacies and medical clinics</p></li>
<li><p><strong>take measures at around the same time</strong>, morning and evening, over seven days (five day minimum). Measure before taking medication, food or exercise, and as advised by your doctor (for instance, before visiting the doctor or after a medication change)</p></li>
<li><p><strong>don’t smoke or drink caffeine</strong> 30 minutes before measuring, and don’t measure if you’re uncomfortable, stressed or in pain</p></li>
<li><p><strong>sit quietly for five minutes</strong> before measuring, without talking or distractions from other people or television</p></li>
<li><p><strong>sit correctly</strong>, with feet flat on the floor, legs uncrossed, upper arm bare, arm supported with cuff at heart level, and back supported.</p></li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/329665/original/file-20200422-39196-18e2hc6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/329665/original/file-20200422-39196-18e2hc6.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=599&fit=crop&dpr=1 600w, https://images.theconversation.com/files/329665/original/file-20200422-39196-18e2hc6.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=599&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/329665/original/file-20200422-39196-18e2hc6.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=599&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/329665/original/file-20200422-39196-18e2hc6.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=753&fit=crop&dpr=1 754w, https://images.theconversation.com/files/329665/original/file-20200422-39196-18e2hc6.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=753&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/329665/original/file-20200422-39196-18e2hc6.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=753&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<ul>
<li><p><strong>take two measures, one minute apart</strong></p></li>
<li><p><strong>record each measure</strong> in a <a href="https://www.racgp.org.au/download/Documents/AFP/2016/January/February/Fig2_Home_BP_diary.pdf">paper diary</a> or <a href="https://www.racgp.org.au/afp/2016/januaryfebruary/how-to-measure-home-blood-pressure-recommendations-for-healthcare-professionals-and-patients/">electronic spreadsheet</a></p></li>
<li><p><strong>provide your doctor with your readings</strong>, by email or via telehealth, such as videocalling.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-can-you-use-a-telehealth-consult-for-and-when-should-you-physically-visit-your-gp-135046">What can you use a telehealth consult for and when should you physically visit your GP?</a>
</strong>
</em>
</p>
<hr>
<h2>What else can I do to manage my blood pressure in lockdown?</h2>
<p>While high blood pressure <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13741">is mainly caused</a> by unhealthy environments, lifestyles and behaviours, you can modify some of these at home to <a href="https://jamanetwork.com/journals/jama/fullarticle/195419">lower your blood pressure</a>, thus lowering the risk of heart disease.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jch.13741">About 30%</a> of high blood pressure relates to eating too much salt, which can be <a href="https://www.heartfoundation.org.au/healthy-eating/food-and-nutrition/salt">hidden in many foods</a>.</p>
<p>A <a href="https://www.heartfoundation.org.au/healthy-eating">balanced diet</a> low in salt, high in fruit, vegetables and wholegrains, as well as healthy proteins, can help control blood pressure and improve your overall heart health. </p>
<p>Being at home means you can prepare food from the basic ingredients, avoiding the high salt, fats and sugars found in processed foods.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/seven-things-to-eat-or-avoid-to-lower-your-blood-pressure-63940">Seven things to eat or avoid to lower your blood pressure</a>
</strong>
</em>
</p>
<hr>
<p>Maintaining a <a href="https://www.heartfoundation.org.au/your-heart/know-your-risks/healthy-weight">healthy weight</a> and having an <a href="https://www.heartfoundation.org.au/active-living">active life</a> with regular physical activity and decreased sitting time is good for your blood pressure and overall health. </p>
<p>Leaving the house for exercise is one of the few excuses you have available to you during lockdown.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/for-older-people-and-those-with-chronic-health-conditions-staying-active-at-home-is-extra-important-heres-how-135322">For older people and those with chronic health conditions, staying active at home is extra important – here's how</a>
</strong>
</em>
</p>
<hr>
<p>People who regularly walk for as little as <a href="https://www.sciencedirect.com/science/article/pii/S0140673611607496?via%3Dihub">15 minutes a day</a> are more likely to live longer than people who are inactive. That’s irrespective of age, sex or risk of heart disease.</p>
<p>Limiting how much <a href="https://www.healthdirect.gov.au/managing-your-alcohol-intake">alcohol you drink</a> and <a href="https://au.reachout.com/articles/how-to-quit-smoking">quitting smoking</a> are also important.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worried-about-your-drinking-during-lockdown-these-8-signs-might-indicate-a-problem-136289">Worried about your drinking during lockdown? These 8 signs might indicate a problem</a>
</strong>
</em>
</p>
<hr>
<h2>Still check in with your doctor</h2>
<p>If your doctor starts you on medication to lower your blood pressure, this will <a href="https://www.sciencedirect.com/science/article/pii/S0140673615012258?via%3Dihub">lower your risk</a> of a heart attack and stroke. So it’s important to stick with your treatment while in isolation, unless instructed to stop.</p>
<p>Don’t avoid a trip to your GP, or a telehealth consultation, should your blood pressure remain high.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/even-in-a-pandemic-continue-with-routine-health-care-and-dont-ignore-a-medical-emergency-136246">Even in a pandemic, continue with routine health care and don't ignore a medical emergency</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/135958/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>James Sharman has received funding related to blood pressure research from the National Health & Medical Research Council of Australia, the National Heart Foundation of Australia and other funding bodies. His university has received equipment and funding for research from companies that manufacture blood pressure devices, but he has no personal financial interests in any companies relating to blood pressure.</span></em></p><p class="fine-print"><em><span>Mark Nelson receives funding from National Health and Medical Research Council of Australia, the National Institutes for Health, and the National Heart Foundation of Australia. </span></em></p><p class="fine-print"><em><span>Markus Schlaich receives funding from NHMRC, NHF and pharmaceutical industry. </span></em></p>Measure your blood pressure at home, check in with your GP, and keep an eye on your diet and exercise.James Sharman, Professor of Medical Research and Deputy Director, Menzies Institute for Medical Research., University of TasmaniaMark Nelson, Head, Discipline of General Practice, University of TasmaniaMarkus Schlaich, Dobney Chair in Clinical Research and Winthrop Professor, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1338562020-04-02T12:32:07Z2020-04-02T12:32:07ZWhat the coronavirus does to your body that makes it so deadly<figure><img src="https://images.theconversation.com/files/324371/original/file-20200331-65509-1ozcmry.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2096%2C1734&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">SARS-CoV-2 virus particles (pink dots) on a dying cell</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nihgov/49692246187/in/photostream/">National Institute of Allergy and Infectious Diseases, NIH</a></span></figcaption></figure><p>COVID-19 is caused by a coronavirus called SARS-CoV-2. Coronaviruses belong to a group of viruses that infect animals, from peacocks to whales. They’re named for the bulb-tipped spikes that project from the virus’s surface and give the appearance of a corona surrounding it.</p>
<p>A coronavirus infection usually plays out one of two ways: as an infection in the lungs that includes some cases of what people would call the common cold, or as an infection in the gut that causes diarrhea. COVID-19 starts out in the lungs like the common cold coronaviruses, but then causes havoc with the immune system that can lead to long-term lung damage or death.</p>
<p>SARS-CoV-2 is genetically very similar to other human respiratory coronaviruses, including SARS-CoV and MERS-CoV. However, the subtle genetic differences translate to significant differences in how readily a coronavirus infects people and how it makes them sick.</p>
<p>SARS-CoV-2 has all the <a href="https://www.ncbi.nlm.nih.gov/labs/virus/vssi/#/virus?SeqType_s=Nucleotide&VirusLineage_ss=SARS-CoV-2,%20taxid:2697049">same genetic equipment</a> as <a href="https://www.ncbi.nlm.nih.gov/labs/virus/vssi/#/virus?SeqType_s=Nucleotide&VirusLineage_ss=Severe%20acute%20respiratory%20syndrome-related%20coronavirus,%20taxid:694009&CollectionDate_dr=2002-01-01T06:00:00.000Z%20TO%202019-03-28T05:00:00.000Z">the original SARS-CoV</a>, which caused a global outbreak in 2003, but with around 6,000 mutations sprinkled around in the usual places where coronaviruses change. Think whole milk versus skim milk. </p>
<p>Compared to other human coronaviruses like <a href="https://www.ncbi.nlm.nih.gov/labs/virus/vssi/#/virus?SeqType_s=Nucleotide&VirusLineage_ss=Middle%20East%20respiratory%20syndrome-related%20coronavirus%20(MERS-CoV),%20taxid:1335626&CollectionDate_dr=2002-01-01T06:00:00.000Z%20TO%202019-03-28T05:00:00.000Z">MERS-CoV</a>, which emerged in the Middle East in 2012, the new virus has customized versions of the same general equipment for invading cells and copying itself. However, SARS-CoV-2 has a totally different set of genes called accessories, which give this new virus a little advantage in specific situations. For example, MERS has a particular protein that shuts down a cell’s ability to sound the alarm about a viral intruder. SARS-CoV-2 has an unrelated gene with an as-yet unknown function in that position in its genome. Think cow milk versus almond milk.</p>
<h2>How the virus infects</h2>
<p>Every coronavirus infection starts with a virus particle, <a href="https://viralzone.expasy.org/764?outline=all_by_species">a spherical shell that protects a single long string of genetic material</a> and inserts it into a human cell. The genetic material instructs the cell to make around 30 different parts of the virus, allowing the virus to reproduce. The <a href="https://doi.org/10.1016/j.cell.2020.02.058">cells that SARS-CoV-2 prefers to infect</a> have a protein called ACE2 on the outside that is important for regulating blood pressure. </p>
<p>The infection begins when the long spike proteins that protrude from the virus particle <a href="https://doi.org/10.1126/science.abb2762">latch on to the cell’s ACE2 protein</a>. From that point, the spike transforms, unfolding and refolding itself using coiled spring-like parts that start out buried at the core of the spike. The reconfigured spike hooks into the cell and crashes the virus particle and cell together. This forms a channel where the string of viral genetic material can snake its way into the unsuspecting cell. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/324385/original/file-20200331-65522-1p44ugf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/324385/original/file-20200331-65522-1p44ugf.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=433&fit=crop&dpr=1 600w, https://images.theconversation.com/files/324385/original/file-20200331-65522-1p44ugf.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=433&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/324385/original/file-20200331-65522-1p44ugf.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=433&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/324385/original/file-20200331-65522-1p44ugf.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=544&fit=crop&dpr=1 754w, https://images.theconversation.com/files/324385/original/file-20200331-65522-1p44ugf.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=544&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/324385/original/file-20200331-65522-1p44ugf.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=544&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An illustration of the SARS-CoV-2 spike protein shown from the side (left) and top. The protein latches onto human lung cells.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:6VSB_spike_protein_SARS-CoV-2_homotrimer.png">5-HT2AR/Wikimedia</a></span>
</figcaption>
</figure>
<p>SARS-CoV-2 spreads from person to person by close contact. The <a href="https://www.nytimes.com/2020/03/09/opinion/coronavirus-south-korea-church.html">Shincheonji Church outbreak in South Korea</a> in February provides a good demonstration of how and how quickly SARS-CoV-2 spreads. It seems one or two people with the virus sat face to face very close to uninfected people for several minutes at a time in a crowded room. Within two weeks, several thousand people in the country were infected, and more than half of the infections at that point were attributable to the church. The outbreak got to a fast start because public health authorities were unaware of the potential outbreak and were not testing widely at that stage. Since then, authorities have worked hard and the number of <a href="https://www.nbcnews.com/news/world/how-south-korea-flattened-its-coronavirus-curve-n1167376">new cases in South Korea has been falling steadily</a>. </p>
<h2>How the virus makes people sick</h2>
<p>SARS-CoV-2 grows in type II lung cells, which secrete a soap-like substance that helps air slip deep into the lungs, and in cells lining the throat. As with SARS, most of the damage in COVID-19, the illness caused by the new coronavirus, is caused by the immune system carrying out a scorched earth defense to stop the virus from spreading. Millions of cells from the immune system invade the infected lung tissue and <a href="https://doi.org/10.1016/j.jinf.2020.02.017">cause massive amounts of damage</a> in the process of cleaning out the virus and any infected cells.</p>
<p>Each COVID-19 lesion ranges from the size of a grape to the size of a grapefruit. The challenge for health care workers treating patients is to support the body and keep the blood oxygenated while the lung is repairing itself. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/BtN-goy9VOY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">How SARS-CoV-2 infects, sickens and kills people.</span></figcaption>
</figure>
<p>SARS-CoV-2 has a sliding scale of severity. Patients under age 10 seem to clear the virus easily, most people under 40 seem to bounce back quickly, but <a href="https://doi.org/10.15585/mmwr.mm6912e2">older people suffer from increasingly severe COVID-19</a>. The ACE2 protein that SARS-CoV-2 uses as a door to enter cells is also important for regulating blood pressure, and it does not do its job when the virus gets there first. This is one reason COVID-19 is more severe in people with high blood pressure.</p>
<p>SARS-CoV-2 is <a href="https://www.npr.org/sections/goatsandsoda/2020/03/20/815408287/how-the-novel-coronavirus-and-the-flu-are-alike-and-different">more severe than seasonal influenza</a> in part because it has many more ways to stop cells from calling out to the immune system for help. For example, one way that cells try to respond to infection is by making interferon, the alarm signaling protein. SARS-CoV-2 blocks this by a combination of camouflage, snipping off protein markers from the cell that serve as distress beacons and finally shredding any anti-viral instructions that the cell makes before they can be used. As a result, COVID-19 can fester for a month, causing a little damage each day, while most people get over a case of the flu in less than a week.</p>
<p>At present, the transmission rate of SARS-CoV-2 is <a href="https://theconversation.com/r0-how-scientists-quantify-the-intensity-of-an-outbreak-like-coronavirus-and-predict-the-pandemics-spread-130777">a little higher than that of the pandemic 2009 H1N1</a> influenza virus, but SARS-CoV-2 is <a href="https://www.livescience.com/covid-19-pandemic-vs-swine-flu.html">at least 10 times as deadly</a>. From the data that is available now, COVID-19 seems a lot like severe acute respiratory syndrome (SARS), though it’s less likely than SARS to be severe. </p>
<h2>What isn’t known</h2>
<p>There are still many mysteries about this virus and coronaviruses in general – the nuances of how they cause disease, the way they interact with proteins inside the cell, the structure of the proteins that form new viruses and how some of the basic virus-copying machinery works.</p>
<p>Another unknown is how COVID-19 will respond to changes in the seasons. The <a href="https://www.cdc.gov/flu/about/season/flu-season.htm">flu tends to follow cold weather</a>, both in the northern and southern hemispheres. Some other human coronaviruses spread at a low level year-round, but then <a href="https://www.medscape.com/answers/302460-86798/what-are-the-seasonal-patterns-of-rhinoviral-coronaviral-enteroviral-and-adenoviral-upper-respiratory-tract-infections-uris">seem to peak in the spring</a>. But <a href="https://dx.doi.org/10.1073%2Fpnas.0900933106">nobody really knows for sure</a> why these viruses vary with the seasons. </p>
<p>What is amazing so far in this outbreak is all the good science that has come out so quickly. The research community learned about <a href="https://doi.org/10.1016/S0140-6736(20)30251-8">structures of the virus spike protein and the ACE2 protein</a> with part of the spike protein attached just a little over a month after the genetic sequence became available. I spent my first 20 or so years working on coronaviruses without the benefit of either. This bodes well for better understanding, preventing and treating COVID-19.</p>
<p>[<em>Get facts about coronavirus and the latest research.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=upper-coronavirus-facts">Sign up for our newsletter.</a>]</p><img src="https://counter.theconversation.com/content/133856/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benjamin Neuman does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The new coronavirus, SARS-CoV-2, spreads faster than the H1N1 influenza virus and is much deadlier. SARS-CoV-2 is particularly skilled at keeping cells from calling out for help.Benjamin Neuman, Professor of Biology, Texas A&M University-TexarkanaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1258092019-10-31T18:54:14Z2019-10-31T18:54:14ZWhat time of day should I take my medicine?<figure><img src="https://images.theconversation.com/files/299592/original/file-20191030-17868-1jqgbz6.jpg?ixlib=rb-1.1.0&rect=3%2C1%2C1019%2C680&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Does it matter if you take your medicine morning, noon or night? That depends on a number of factors.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/various-pills-capsules-organizer-clock-on-1254773287?src=lTNi4XfRk7QXoxYjmhO84g-1-31&studio=1">from Kat Ka/www.shutterstock.com</a></span></figcaption></figure><p>Whether you need to take a drug at a specific time of day depends on the medication and the condition you are treating. For some medicines, it doesn’t matter what time you take it. And for others, the pharmacist may recommend you take it at the same time each day. </p>
<p>But we estimate that for around 30% of all medicines, the time of day you take it <em>does</em> matter. And a <a href="https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478">recent study</a> shows blood pressure medications are more effective if you take them at night.</p>
<p>So, how do you know if the timing of your medication is critical?</p>
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Read more:
<a href="https://theconversation.com/health-check-what-should-you-do-with-your-unused-medicine-81406">Health Check: what should you do with your unused medicine?</a>
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<h2>When timing doesn’t matter</h2>
<p>In most cases, it’s not important when you take your medicine. For instance, you can take non-drowsy antihistamines for hay fever, or analgesics for pain when you need them. It doesn’t matter if it is morning, noon or night.</p>
<p>What is more important is the time interval between each dose. For instance, paracetamol needs to be taken at least four hours apart, any closer and you run the risk of taking a toxic dose.</p>
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Read more:
<a href="https://theconversation.com/australia-has-a-paracetamol-poisoning-problem-this-is-what-we-should-be-doing-to-reduce-harm-122532">Australia has a paracetamol poisoning problem. This is what we should be doing to reduce harm</a>
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<p>Even when a medication <em>doesn’t need</em> to be taken at a particular time, the pharmacist may still recommend you take it at the same time every day anyway.</p>
<p>This daily pattern helps remind you to take it. An example is taking the oral contraceptive at the same time each day, simply out of habit.</p>
<p>For the <a href="https://www.nps.org.au/medicine-finder/microlut-tablets">mini pill</a>, taking it at the same time is actually necessary. But the actual time of day can be whatever works best for you.</p>
<h2>When does it matter?</h2>
<p>It may seem fairly obvious to take some medicines at particular times. For example, it makes sense to taking sleeping medications, such as <a href="https://www.healthdirect.gov.au/temazepam">temazepam</a>, at night before you go to bed.</p>
<p>Some antidepressants, such as <a href="https://www.nps.org.au/medicine-finder/endep-tablets">amitryptyline</a> or <a href="https://www.nps.org.au/medicine-finder/avanza-tablets">mirtazapine</a>, have drowsy side effects. So it also makes sense to take them at night.</p>
<p>For other medicines, taking them in the morning is more logical. This is true for diuretics, such as <a href="https://www.nps.org.au/medicine-finder/lasix-tablets">furosemide</a>, which helps you get rid of excess fluid via your urine; you don’t want to be getting up in the night for this.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/299119/original/file-20191029-183151-s0hjfe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/299119/original/file-20191029-183151-s0hjfe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/299119/original/file-20191029-183151-s0hjfe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/299119/original/file-20191029-183151-s0hjfe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/299119/original/file-20191029-183151-s0hjfe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/299119/original/file-20191029-183151-s0hjfe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/299119/original/file-20191029-183151-s0hjfe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/299119/original/file-20191029-183151-s0hjfe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">When a medicine needs to be taken at a specific time, this will be indicated on the box.</span>
<span class="attribution"><span class="source">Author provided</span></span>
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</figure>
<p>For other medications, it’s not obvious why they have to be taken at a particular time of day. To understand why, we have to understand our circadian rhythm, our own internal body clock. Some systems in our body work at different times of day within that rhythm.</p>
<p>For instance, the enzymes controlling cholesterol production in your liver are most active at night. So there may be some benefit to taking lipid (cholesterol) lowering drugs, such as <a href="https://www.nps.org.au/medicine-finder/zocor-tablets">simvastatin</a>, at night.</p>
<p>Finally, sometimes it’s important to take medications only on particular days. <a href="https://www.nps.org.au/medicine-finder/dbl-methotrexate-tablets">Methotrexate</a> is a medicine used for rheumatoid arthritis and severe psoriasis, and the timing of this medication is critical. </p>
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Read more:
<a href="https://theconversation.com/what-is-rheumatoid-arthritis-the-condition-tennis-champion-caroline-wozniacki-lives-with-119537">What is rheumatoid arthritis, the condition tennis champion Caroline Wozniacki lives with?</a>
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<p>You should only take it on the same day once a week, and when taken this way it is quite safe. But if you mistakenly take it daily, as happened recently with <a href="https://www.meridianlawyers.com.au/insights/medication-misadventure-methotrexate-reminder-pharmacists-exercise-independent-judgment-safety-prescribed-medicine/">a patient in Victoria</a>, then it can cause serious illness or even <a href="https://www.smh.com.au/healthcare/worrying-rise-in-accidental-overdose-of-prescription-drug-methotrexate-20160606-gpcaz3.html">death</a>.</p>
<h2>What about blood pressure medicines?</h2>
<p>One of the ways the body regulates blood pressure is through a pathway of hormones known as the <a href="http://pharma.bayer.com/en/innovation-partnering/research-and-development-areas/cardiovascular/the-raas-system/#targetText=The%20renin%2Dangiotensin%2Daldosterone%20system%20(RAAS)%20is%20a,release%20an%20enzyme%20called%20renin">renin, angiotensin and aldosterone system</a>.</p>
<p>This system responds to various signals, like low blood pressure or stressful events, and controls blood volume and the constriction of blood vessels to regulate your blood pressure.</p>
<p>Importantly, this system is more active while you’re asleep at night. And a <a href="https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz754/5602478">recent study</a>, which found blood pressure medication is more effective at night,
may change the way we use medicines to treat high blood pressure.</p>
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Read more:
<a href="https://theconversation.com/health-check-what-do-my-blood-pressure-numbers-mean-29212">Health Check: what do my blood pressure numbers mean?</a>
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<p>Two types of drugs typically prescribed to lower blood pressure are <a href="http://www.bloodpressureuk.org/BloodPressureandyou/Medicines/Medicinetypes/ACEInhibitors">angiotensin converting enzyme (ACE) inhibitors</a>, such as <a href="https://www.nps.org.au/medicine-finder/apo-perindopril-arginine-tablets">perindopril</a>, and <a href="http://www.bloodpressureuk.org/BloodPressureandyou/Medicines/Medicinetypes/ARBs">angiotensin receptor blockers</a> (known as ARBs), such as <a href="https://www.nps.org.au/medicine-finder/irbesartan-an-tablets">irbesartan</a>. These drugs dilate blood vessels (make them wider) to reduce your blood pressure.</p>
<p>Until now, doctors and pharmacists have often advised patients to take these medications in the morning, assuming it’s good to have a hit of the drugs when you’re up and about.</p>
<p>But this study found taking blood pressure medications at night produced a significant reduction (45%) in heart disease, including fewer strokes, heart attacks and heart failure compared to taking them in the morning.</p>
<p>Taking them at night also meant people’s blood pressure was better controlled and their kidneys were healthier.</p>
<p>So if you take one of these drugs to control your blood pressure and aren’t sure what you should do, talk to your pharmacist or doctor. While evidence is building to support taking them at night, this might not be appropriate for you.</p>
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Read more:
<a href="https://theconversation.com/health-check-is-it-ok-to-chew-or-crush-your-medicine-39630">Health Check: is it OK to chew or crush your medicine?</a>
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<img src="https://counter.theconversation.com/content/125809/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Associate Professor Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is Fellow of the Royal Australian Chemical Institute and a member of the Australasian Pharmaceutical Science Association. Nial is also a director of the medicinal cannabis company Canngea Pty Ltd and a Standards Australia committee member for sunscreen agents.</span></em></p><p class="fine-print"><em><span>Andrew Bartlett is a member of the Australian College of Pharmacy</span></em></p>For most medicines, it doesn’t matter when you take them. But others work best at particular times.Nial Wheate, Associate Professor | Program Director, Undergraduate Pharmacy, University of SydneyAndrew Bartlett, Associate Lecturer Pharmacy Practice, University of SydneyLicensed as Creative Commons – attribution, no derivatives.