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mcatmemoranda · 3 years

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We have a pt who has rhabdomyolysis from taking a statin and being on the floor for 3 days. She's old, so she had muscle breakdown. The attending is Dr. Giraldo, who is really nice and awesome. He asked me what urine test you use to diagnose rhabdo and I totally forgot about myoglobinuria so I said I wasn't aware. He told me to look it up. Then after we were rounding for a bit, my brain remembered myoglobinuria! So I told him. But now I want to look up the details of diagnosing rhabdo so I can present to him tomorrow. But we also have a pt with CKD who may have kidney stones and the attending and the resident didn't realize that you can diagnose a kidney stone with a non-contrast CT. I remembered learning that last year during my emergency medicine rotation. They had ordered a KUB because they thought you would need to use contrast for the CT and so they didn't want to get the CT because the contrast would hurt the pt's kidney. But you don't use contrast to diagnose nephrolithiasis with CT. So at least I remembered something! This is from UpToDate:

●The clinical manifestations of rhabdomyolysis include myalgias, weakness, red to brown urine due to myoglobinuria, and elevated serum muscle enzymes (including creatine kinase [CK]). The degree of myalgias and other symptoms varies widely, and some patients are asymptomatic. Fever, malaise, tachycardia, and gastrointestinal symptoms may be present. Muscle swelling may occur with rehydration.

This pt was actually tachycardic in the ED. So that tracks.

●The laboratory findings that characterize rhabdomyolysis include an acute elevation in the CK and other muscle enzymes and a decline in these values within three to five days of cessation of muscle injury. The other characteristic finding is the reddish-brown urine of myoglobinuria, but this finding is often absent because of the relative rapidity with which myoglobin is cleared. The serum CK is generally entirely or almost entirely of the MM or skeletal muscle fraction, although small amounts of the MB fraction may be present.

●Other manifestations include fluid and electrolyte abnormalities, many of which precede or occur in the absence of acute kidney injury, and hepatic injury. Hypovolemia, hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia, and metabolic acidoses may be seen. [I think the pt also had hypocalcemia, but it wasn't true hypocalcemia because the albumin was low, so her corrected Ca2+ was in the normal range based on the lab values at the hospital; she did have acidosis too I think]. Hyperkalemia may result in cardiac dysrhythmias. Later complications include acute kidney injury (AKI), hypercalcemia, compartment syndrome, and, rarely, disseminated intravascular coagulation.

●We diagnose rhabdomyolysis in a patient with an acute muscular illness or injury based upon a marked acute elevation in serum CK; the CK is typically at least five times the upper limit of normal and is frequently greater than 5000 international units/L. Key diagnostic laboratory studies include the creatine kinase and urinalysis, including dipstick and microscopic evaluation. Myoglobinuria (present in 50 to 75 percent of patients at the time of initial evaluation) results in a positive test for blood on the urine dipstick but without red blood cells on the microscopic examination of the urine. And for this pt, the UA showed a small amount of blood, so that could have been myoglobin in the urine, but we didn't order a microscopic analysis. She also has a UTI, so that could be from the UTI as well. Also, the other day Dr. Agarwal asked how long you treat UTIs. When in the hospital, you can treat with ceftriaxone until the pt has clinically improved.

●The differential diagnosis depends upon the combination of findings present. It includes myocardial infarction, other causes of red or brown urine, inflammatory myopathy, and local causes of pain, such as deep vein thrombosis or renal colic.

The characteristic triad of complaints in rhabdomyolysis is muscle pain, weakness, and dark urine. Additional symptoms that are more common in severely affected patients include malaise, fever, tachycardia, nausea and vomiting, and abdominal pain. Altered mental status may occur from the underlying etiology (eg, toxins, drugs, trauma, or electrolyte abnormalities).

The hallmark of rhabdomyolysis is an elevation in CK and other serum muscle enzymes. The other characteristic finding is the reddish-brown urine of myoglobinuria, but because this may be observed in only half of cases, its absence does not exclude the diagnosis. Routine lab tests, including complete blood count (CBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), vary greatly depending on the underlying cause of rhabdomyolysis. Infections and crush injuries are associated with marked elevation of the acute phase reactants and peripheral white blood cell (WBC) count, while these markers of inflammation would likely be normal or only minimally raised in patients with other etiologies, such as drug-induced or electrolyte derangements.

Serum CK levels at presentation are usually at least five times the upper limit of normal, but range from approximately 1500 to over 100,000 international units/L. The mean peak CK reported for each of a variety of different causes and for patients with both single and multiple causes ranged from approximately 10,000 to 25,000 in the largest series; exceptions were the three patients with malignant hyperthermia, whose values averaged almost 60,000.

I googled the normal serum CK level:

In a healthy adult, the serum CK level varies with a number of factors (gender, race and activity), but normal range is 22 to 198 U/L (units per liter). Higher amounts of serum CK can indicate muscle damage due to chronic disease or acute muscle injury.

The CK is generally entirely or almost entirely of the MM or skeletal muscle fraction; a small proportion of the total CK may be from the MB or myocardial fraction. The presence of MB reflects the small amount found in skeletal muscle rather than the presence of myocardial disease. Elevations in serum aminotransferases are common and can cause confusion if attributed to liver disease. In one study, aspartate aminotransferase (AST) was elevated in 93.1 percent and alanine aminotransferase (ALT) in 75 percent of rhabdomyolysis cases in which the CK was greater than or equal to 1000 units/L. In only one instance was the ALT greater than the AST, although the AST declines faster than the ALT as the rhabdomyolysis resolves, such that the two may equalize after a few days.

The serum CK begins to rise within 2 to 12 hours following the onset of muscle injury and reaches its maximum within 24 to 72 hours. A decline is usually seen within three to five days of cessation of muscle injury. CK has a serum half-life of about 1.5 days and declines at a relatively constant rate of about 40 to 50 percent of the previous day's value. In patients whose CK does not decline as expected, continued muscle injury or the development of a compartment syndrome may be present.

Urine findings and myoglobinuria — Myoglobin, a heme-containing respiratory protein, is released from damaged muscle in parallel with CK. Myoglobin is a monomer that is not significantly protein-bound and is therefore rapidly excreted in the urine, often resulting in the production of red to brown urine. It appears in the urine when the plasma concentration exceeds 1.5 mg/dL. Visible changes in the urine only occur once urine levels exceed from about 100 to 300 mg/dL, although it can be detected by the urine (orthotolidine) dipstick at concentrations of only 0.5 to 1 mg/dL . Myoglobin has a half-life of only two to three hours, much shorter than that of CK. Because of its rapid excretion and metabolism to bilirubin, serum levels may return to normal within six to eight hours.

Thus, it is not unusual for CK levels to remain elevated in the absence of myoglobinuria. In rhabdomyolysis, myoglobin appears in the plasma before CK elevation occurs and disappears while CK is still elevated or rising. Therefore, there is no CK threshold for when myoglobin appears. As above, rhabdomyolysis does not occur unless CK is elevated five times or more above the upper limit of normal. Routine urine testing for myoglobin by urine dipstick evaluation may be negative in up to half of patients with rhabdomyolysis. Pigmenturia will be missed in rhabdomyolysis if the filtered load of myoglobin is insufficient or has largely resolved before the patient seeks medical attention due to its rapid clearance.

Both hemoglobin and myoglobin can be detected on the urine dipstick as "blood;" microscopic evaluation of the urine generally shows few red blood cells (RBC) (less than five per high-powered field) in patients with rhabdomyolysis whose positive test results from myoglobinuria. Such testing is not a reliable method for rapid detection of myoglobin if RBC are present or in patients with hemolysis due to its lack of specificity for myoglobin. Hemoglobin, the other heme pigment capable of producing pigmented urine, is much larger (a tetramer) than myoglobin and is protein-bound. As a result, much higher plasma concentrations are required before red to brown urine is seen, resulting in a change in plasma color.

Hypocalcemia, which can be extreme, occurs in the first few days because of entry into damaged myocytes and both deposition of calcium salts in damaged muscle and decreased bone responsiveness to parathyroid hormone. During the recovery phase, serum calcium levels return to normal and may rebound to significantly elevated levels due to the release of calcium from injured muscle, mild secondary hyperparathyroidism from the acute renal failure, and an increase in calcitriol (1,25-dihydroxyvitamin D).

Severe hyperuricemia may develop because of the release of purines from damaged muscle cells and from reduced urinary excretion if acute kidney injury occurs.

●Metabolic acidosis is common, and an increased anion gap may be present. Our pt did have an anion gap and I wondered why. I guess it's because there's more uric acid in the blood.

Acute kidney injury — Acute kidney injury (AKI, acute renal failure) is a common complication of rhabdomyolysis. The reported frequency of AKI ranges from 15 to over 50 percent. The risk of AKI is lower in patients with CK levels at admission less than 15 to 20,000 units/L; risk factors for AKI in patients with lower values include dehydration, sepsis, and acidosis. [Our pt had peed a lot and was on the floor for 2 to 3 days, so she was probably dehydrated, increasing her risk for AKI]. Volume depletion resulting in renal ischemia, tubular obstruction due to heme pigment casts, and tubular injury from free chelatable iron all contribute to the development of renal dysfunction. Reddish-gold pigmented casts are often observed in the urine sediment.

Compartment syndrome — A compartment syndrome exists when increased pressure in a closed anatomic space threatens the viability of the muscles and nerves within the compartment. Compartment syndrome is a potential complication of severe rhabdomyolysis that may develop after fluid resuscitation, with worsening edema of the limb and muscle. Lower extremity compartment syndrome can also be a cause of rhabdomyolysis, as may occur after tibial fractures.

Disseminated intravascular coagulation — Infrequently, severe rhabdomyolysis may be associated with the development of disseminated intravascular coagulation due to the release of thromboplastin and other prothrombotic substances from the damaged muscle.

EVALUATION AND DIAGNOSIS

Indications for diagnostic testing — Diagnostic testing should be performed in individuals with:

●Both myalgias and pigmenturia.

●Either myalgias or pigmenturia, with a history suggesting the presence or recent exposure to a potential cause or event.

●The absence of myalgias and pigmenturia in a clinical setting associated with increased risk for rhabdomyolysis, as symptoms may be vague or absent in up to 50 percent of patients. The diagnosis should be suspected following prolonged immobilization [like our pt who was on the floor for 2 to 3 days], in any stuporous or comatose patient, or in a patient who is otherwise unable to provide a medical history and has one or more of the following:

•Muscle tenderness

•Evidence of pressure necrosis of the skin

•Signs of multiple trauma or a crush injury

•Blood chemistry abnormalities suggesting the possibility of increased cell breakdown, such as hyperkalemia, hyperphosphatemia, and/or hypocalcemia

•Evidence of acute kidney injury

●Acute muscle weakness and marked elevation of creatine kinase (CK).

Diagnostic evaluation — We obtain the following key diagnostic laboratory studies:

●Creatine kinase – In addition to elevation of the CK, other muscle enzymes are typically elevated (eg, aldolase, aminotransferases, lactate dehydrogenase), but such testing is not usually necessary to make the diagnosis. However, elevations in aminotransferases or lactate dehydrogenase may suggest the need for CK testing if it has not been performed in a patient in whom such abnormalities may potentially be due to muscle injury rather than hepatic injury or another cause.

●Urinalysis, including dipstick and microscopic evaluation – Evidence of myoglobinuria should be sought by routine urine dipstick evaluation combined with microscopic examination. Testing of the unspun urine or the supernatant of the centrifuged urine will be positive for "heme" on dipstick if myoglobinuria is present, even if red to reddish brown urine is not evident macroscopically. The visual and microscopic examination of the sediment from a fresh urine specimen is required to exclude the presence of red blood cells (RBC) as the cause of positive testing; RBC in an older specimen may hemolyze over time, confounding the results.

In patients with persistent red to reddish-brown urine, myoglobinuria is suggested when the urine tests positive for heme by dipstick after centrifugation, while the plasma has a normal color and tests negative for heme.

Myoglobinuria lacks sensitivity as a test for rhabdomyolysis; it may be absent in 25 to 50 percent of patients with rhabdomyolysis due to the more rapid clearance of myoglobin, compared with CK, following muscle injury. Myoglobin also decreases rapidly in a similar fashion in patients with renal failure, suggesting a role for extrarenal metabolism and clearance in such patients.

We also obtain the following tests, which may help in prompt recognition of other potentially dangerous manifestations, in differential diagnosis, and in identifying the cause:

●Complete blood count, including differential and platelet count

●Blood urea nitrogen, creatinine, and routine electrolytes including potassium

●Calcium, phosphate, albumin, and uric acid

●Electrocardiography

Additional testing, such as evaluation of suspected metabolic myopathy or toxicology screening for drugs of abuse, depends upon the clinical context.

Diagnosis — We make the diagnosis of rhabdomyolysis in a patient with either an acute neuromuscular illness or dark urine without other symptoms, plus a marked acute elevation in serum creatine kinase (CK). The CK is typically at least five times the upper limit of normal, and is usually greater than 5000 international units/L. No absolute cut-off value for CK elevation can be defined, and the CK should be considered in the clinical context of the history and examination findings.

MANAGEMENT

The major issues in the treatment of patients with rhabdomyolysis include:

●Recognition and management of fluid and electrolyte abnormalities, which should be initiated regardless of renal function and which may prevent severe metabolic disturbances and acute kidney injury

●Identification of the specific causes and the use of appropriate countermeasures directed at the triggering events, including discontinuation of drugs or other toxins that may be etiologic factors

●Prompt recognition, evaluation, and treatment of compartment syndrome in patients in whom it is present

#rhabdomyolysis #rhabdo #myoglobinuria #CK #creatine kinase

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theunembarrassedalto · 5 years

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fairest of warnings: medical mysteries, weight talk, general Alex complaining below the cut

so for the past week and a half or so I have been experiencing a variety of weird and somewhat terrifying symptoms - numbness/tingling in my extremities and face, blurred vision, what seems to be increased clumsiness, lightheadedness, fatigue, and most recently a feeling like i am being zapped all over my body by tiny, mild static shocks

so, obviously, because these seem like neurological symptoms, I went to my doctor with a terror in my heart! new provider - I switched bc I wasn’t a fan of my previous one. she did bloodwork which all came back clean except for a high crp, which indicates inflammation somewhere in my body, and a bunch of motor tests, and has essentially said, “we don’t think anything is wrong with you, go to PT to get a stretching routine for your posture” - which, to me, speaks of “we think you’re overweight” (which i am, fine, w/e) “and all your medical problems are a direct result of that” - because I have, all in all, pretty good posture, singing in choirs for as many years as i have will do that! and i have never had any kind of posture issues in the past and i’ve actually lost 10lbs over the past month or so, so theoretically my posture should be better now because i have, you know, less me to carry around

i consulted my mother, who has recommended i make them do a full metabolic panel + autoimmune markers if I can convince them, and who has raised the possibility that my antidepressants may be causing these symptoms because she is notoriously sensitive to weird med side effects and had numbness from an arthritis med she was taking a while back - so i’ve called my dr back to ask for these things and see if we can taper me off my meds which will probably cause my anxiety to go Right the Fuck Up but w/e, not feeling numb and zappy all the time sounds good for now.

they also could be consistent with a Pretty Big Scary Disease but that would require, at least, an MRI to confirm it and there’s no fuckin way they’re going to give me an MRI if i’m just being written off with “go to PT for posture” but I really would rather like one just for the sake of ruling out the Pretty Big Scary Disease

but i just! want to be taken seriously! as a fat woman! who may have health problems other than “you’re fat!” these symptoms are terrifying and i am exhausted all the time!!! how tf will posture cause blurred vision and fatigue? how does it explain the zappy sensation or the numbness without, y know, some kind of damage to my spinal cord?? and they’re not even gonna check??

#tumblr is just my journal basically sorry #personal #tw weight #tw weight loss

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sls-60 · 5 years

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An update on the status of this, and my other RP blogs at present, and the reduction in activity in light of my health: I can’t comfortably RP right now knowing I will let people down from forgetting to reply or not having the literal energy to write. I’ll keep my blogs open and active in that regard, with the intent of coming back, but consider this an official notice of hiatus.

Exact details of what’s happening under the read more. I appreciate it if people could take the time to read to ascertain why I’ve had to make this choice.

My more recent pain flare a few weeks ago turned out to be tbe result in a long-term condition of mine getting worse overall.

I came back from working an out-reach office for work and during the evening my always-there back pain became way worse than normal. Worse than it has ever been since my back problems began in 2001. I thought it was possibly just from being in a car for most of the day and had an early night to try sleep it off.

I went to work the next day barely able to straighten myself upright and only got through thanks to the fact I use a walking aid already. I noticed that my right leg -- the *good* leg -- was numb on the outside all the way down my thigh to my knee; a sensation that normally only occurred when I’d been standing for too long or walked too long.

That weekend I was bedridden with nerve pain so bad it was making my muscles convulse involuntarily in my back, adding to the already bad pain, that I didn’t know what to do with myself.

My new GP ordered bloodwork and a CT scan to try and ascertain what had changed. Results came back with spinal cord compression (three discs affecting it,) and my bloodwork showing high amounts of CRP due to inflammation (in addition to other things not needing to be disclosed here.) I’d never been tested for inflammatory markers or rheumatoid markers despite a family history of both, but the amount of CRP I had gave both myself and my GP an understanding of why my left leg never healed properly, why the sudden spike of pain didn’t resolve itself after a day once the muscles started to swell, and why I have severe hypertension beyond bad genetics for hearts + PCOS.

This change in my condition is permanent.

Current management is trying to reduce pain with nerve pain medications and antispasmodics, as the pain is affecting not just my work life but also any quality of life outside of it. If my discs proceed to further compress/herniate despite other preventative measures I will need to consult a neurosurgeon to try and stop further damage to my spinal cord, or the full loss of sensation in my right leg instead of a permanent numb patch on my outer thigh.

In addition to that, the new medications I’m on, while good for never pain, do affect my already compromised brain chemistry, which has made writing very difficult every time I’ve tried to work on my drafts. It sucks because I feel like I’ve lost one of the few creative outlets I was still able to easily do. I’m sorry for all the threads or promised fics now sitting in limbo; I hate disappointing people.

Right now my focus is to try and look after myself, play things like Final Fantasy XIV with friends during what little lucidity I have some days, and to try and reduce the chances of this getting worse.

If you made it this far: thank you for taking the time to read this.

#; mun stuff #/#//#///#////#/////#medical crap and junk #hiatus

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naturalholisticlivingwellness · 3 years

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Ever heard the saying “You are what you eat”? Well, in the case of inflammation, this is extremely true! Now, some inflammation is a good thing, that’s how your immune system kills off pathogens. The thing is, sometimes that inflammation doesn’t shut off thanks to what we eat.

Here are some foods cause an over inflammatory response.

1. Sugars and High Fructose Corn Syrup

Processed sugar and high fructose corn syrup can cause inflammation thanks to the high amounts of fructose. The small amount in fruits and vegetables is fine, but too much fructose can be dangerous. You see, it is a type of sugar that can only be processed by the liver. Too much causes the liver to become overworked and sluggish and fat to build up. This, of course, leads to an increased risk of obesity, type II diabetes, and some cancers. “Eating a lot of fructose has [also] been linked to… insulin resistance…fatty liver disease…and chronic kidney disease” and “causes inflammation within the endothelial cells that line your blood vessels, which is a risk factor for heart disease”

Some foods I’ve found to contain high fructose corn syrup include many everyday items such as ketchup, soda, pickles, miracle whip, fruit cups, juices, most candies and baked goods. So I always try to get these in organic form or use an alternative like organic raw sugar and raw honey or fruit.

2. Artificial Trans Fat

One of the worse fats you can have is artificial trans fats, not to be confused with the natural trans fats found in animal products.

So what is an artificial trans fat? “They’re created by adding hydrogen to unsaturated fats, which are liquid, to give them the stability of a more solid fat.” Anything with an ingredient that says “partially hydrogenated oils” are these nasty trans fats. These trans fats have been shown to increase disease and inflammatory markers such as high levels of the C-reactive protein. Artificial trans fats are linked with the lowering of good cholesterol and the impairment of the endothelial cells lining the arteries.

Some foods that have these artificial trans fats include almost all fast foods like French fries, fried chicken and burgers, certain varieties of microwave popcorn and margerine/vegetable shortenings, prepackaged cakes, cookies and pastries, and all processed foods that says “partially hydrogenated vegetable oils”.

3. Vegetable and Seed Oils

Some scientists believe that vegetable oils such as soybean oil increases inflammation due to the high the omega-6 content, though omega-6 is necessary for function. There is limited research on this however.

4. Refined Carbohydrates

While high fiber, unprocessed carbs such as grasses, fruits, roots and vegetables are healthy for the human body, processed carbs that have had the fiber and nutrients taken out are not. That fiber is necessary for the balancing blood sugar levels, promotion of a healthy gut biome and allows a person to feel more satiated.

Refined carbs may encourage the growth of pathogens in the gut that increase the risk of diseases like obesity and IBS (irritable bowel syndrome). They also have a higher glycemic index, meaning that they cause a spike in blood sugar and cause an increase in inflammatory markers.

“Refined carbohydrates are found in candy, bread, pasta, pastries, some cereals, cookies, cakes, sugary soft drinks, and all processed foods that contain added sugar or flour.”

5. Excessive Alcohol

While moderate alcohol consumption (2x a day for men and 1x a day for women) can have health benefits such as blood thinning, too much can lead to an increase in the CRP Protein i mentioned earlier and a condition know as “leaky gut”.

6. Processed Meat

Consuming processed meat is associated with an increased risk of heart disease, diabetes, and stomach and colon cancer

Processed meat is meat that has been preserved by means of heat and preservatives, with one such preservative being the “N-nitroso compounds are cancer-causing substances believed to be responsible for some of the adverse effects of processed meat consumption.” This N-nitroso compound is most commonly in the from of nitrate (sodium nitrate). They are also high in advanced glycation end products (AGEs). “AGEs accumulate naturally as you age and are created when certain foods [such as meats] are cooked at high temperatures.”

Some of these processed meats include sausage, bacon, ham, smoked meat, and beef jerky.

I have noticed personally some other items that are inflammatory: inorganic gluten and pasteurized milk. These are not from the foods themselves, but how they are processed. For gluten “it is a common practice among farmers to spray their wheat crops with glyphosate [AKA Round-Up weed killer] immediately prior to harvest—doing so actually kills the plant, which speeds the required drying of the grain.

This is called "desiccation." This practice makes it easier for farmers to time when they harvest their wheat crops and allows for more uniform drying. Samsel and Seneff noted that the incidence of celiac disease and gluten sensitivity has risen dramatically worldwide, but especially in North America and Europe, and they blame the weed-killer glyphosate for this increase.”

For dairy, the process of pasteurization actually kills off beneficial bacteria including the enzyme required for the digestion of milk proteins. “Pasteurized milk is not necessarily any easier on your stomach than raw milk. Because of the denatured protein and destroyed enzymes, it’s likely that the natural enzymes present in raw milk aren’t available in significant quantity. Your pancreas then has to work overtime to produce those enzymes so that you can digest pasteurized milk.”

The pancreas controls blood sugar levels, so it’s logical to assume that highly pasteurized dairy products may play a factor in diabetes.

Sources:

https://www.healthline.com/nutrition/6-foods-that-cause-inflammation

https://www.healthline.com/nutrition/why-is-fructose-bad-for-you

https://www.healthline.com/nutrition/why-processed-meat-is-bad

https://www.healthline.com/nutrition/advanced-glycation-end-products

https://www.verywellhealth.com/weed-killer-roundup-to-blame-3973244

https://draxe.com/nutrition/9-myths-of-pasteurization-or-homogenization-better-options/

you can find the anti inflammatory tincture below

#healthylifestyle #natural living #natural #earthley #healthy lifestyle #inflammation #inflammatory foods

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juniperpublisherscasestudies · 3 years

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Juniper Publishers- Open Access Journal of Case Studies

Dynamics of Frailty as a Geriatric Syndrome

Authored by Esra ATES BULUT

Abstract

Frailty and sarcopenia are new geriatric syndromes which lead to poor outcomes including functional decline, falls, morbidity, hospitalization and mortality. Frailty is a distinctive health state related to the ageing process in which multiple body systems gradually lose their reservation capacity. It is a multidimensional state with interrelated factors in the physical, psychological, social, and environmental domains. It is also associated with other geriatric syndromes in the mood, cognition areas and physical performance. Clinically, diagnosis is based on weight loss, slow walking speed, low muscle strength and physical activity. Due to high frequency among seniors and being a reason of poor health outcomes, accurate diagnosis, and appropriate prevention and treatment strategies should be established.

Keywords: Ageing; Geriatric syndromes; Sarcopenia; Physical dependence

Introduction

Ageing process, frailty and death concepts belong to the mysterious subjects of medicine. Frailty is used currently different clinical meanings: easily broken, damaged, rapidly dying, diminished resistance and strength. It is a gradual process that develops slowly, and the rate of decline accelerates with acute events. Once a person becomes frail, a progressive process proceeds until death [1]. Many health care providers focus on diseases when they evaluate patients. However, frailty does not fit to this approach, and it is not the chief complaint. Patients are usually asymptomatic, or the findings are subtle [2]. Frailty is defined difficulty in restoring the homeostatic balance against stressors with ageing. Frailty has multidimensional state with interrelated factors in the physical, psychological, social, and environmental domains that affect the physiologic reserve of the systems. Furthermore, it is also indicated as a geriatric syndrome characterized by reduced physical function, which may lead to decreased strength, endurance, and increased dependence or mortality [3]. Because of the reduced capacity of the organism, the risk of developing poor health outcomes such as falls, hospitalization, disability, discharge to nursing home and mortality increases [4,5].

Although ageing is considered as frailty in society, every elder is not frail. Prevalence of frailty in subjects aged 65-75 years ranges from 3% to 7% [6]. This rate rises to 32% over the age of 90 years [7]. The prevalence of frailty differs from various ethnic groups and increases with age.

Frailty can be primary or secondary diagnosis. 7% of frail older adults do not have a systemic disease. Moreover, 25% have only one disease [8]. However, an acute event, atherosclerosis, infection, malignancy, depression or the last period of a chronic process may cause frailty. It has been reported increased age, history of cancer, chronic obstructive pulmonary disease, cerebrovascular disease, physiological impairments of inflammatory processes and coagulation are risk factors for frailty [9].

Discussion

Frailty characteristics are associated with overt changes in the four main title: body composition, homoeostatic dysregulation, energetic failure and neurodegeneration. In addition, impaired glucose metabolism, inflammatory biomarkers, and some physiological variables such as markers in clotting pathway contribute the pathophysiologic pathway [7]. Many physiological systems including the central nervous system, the sympathetic nervous system, the endocrine system, the skeletal-muscular system and the immune system are affected. Which system is affected first and what threshold level is needed to develop the clinical situation are the key questions to be answered at the moment.

Age-related skeletal muscle loss or sarcopenia is the main feature of frailty. Preservation of skeletal muscle function requires the interaction of many factors, such as hormones, neurological functions, inflammatory markers, and nutrients [10]. Recent studies showed infiltration of the muscle by fat tissue causes decrease in the muscle strength and mass. It was reported adipose tissue especially visceral fat tissue, can cause some hormonal and inflammatory changes which contribute release of inflammatory cytokines and hormones [7]. Interleukin-6 (IL-6), Tumor Necrosis Factor-α (TNF-α) and other inflammatory mediators cause muscle destruction for energy production [11]. Increasing evidence indicates these markers may cause skeletal muscle loss by inducing apoptotic mechanisms [12]. As a result, metabolically active fat stores establish chronic inflammatory state and increase sarcopenia. Many studies have shown inflammatory markers such as IL-6, CRP, white cells, and macrophage counts are related to frailty [13]. These findings suggest that chronic, low level of inflammatory activity induce frailty. Increased IL-6 causes reduction in bone mineral density, muscle loss, anemia, insulin resistance, hypothalamo-pitiuter-adrenal axis stimulation and impaired immune system regulation [14]. Recent studies reported hyperinsulinemia and hypertriglyceridemia lead to suppression of appetite and nutritional intake. Besides, they may also be associated with cognitive impairment, physical decline and leptin resistance [15].

It was hypothesized cognitive impairment, physical inactivity, visual-hearing loss and incontinence were related to frailty in women [16]. The coexistence of cognitive and physical impairment may be explained by the role of proinflammatory cytokines in the pathophysiology of both conditions [17].

Three main hormones decrease with ageing: growth hormone, sex steroids and adrenocorticoid hormones [18]. Sex steroids and growth hormone affect age-related changes in body composition. IGF-1 plays major role in the development of skeletal muscle cells, however inflammatory cytokines suppress IGF-1 release [19]. Furthermore, dehydroepiandrostenodion sulfate (DHEAS) suppresses inflammation induced by nuclear factor kappa B. Reduced DHEAS and testosterone levels were thought to related to frailty [20,21]. In addition, impaired cortisol diurnal rhythm is associated with increased catabolism, muscle loss, anorexia, and decreased energy expenditure, which are the main building blocks of frailty [22]. Changes in cellular ageing pathways, disruption of telomeric structures, mitochondrial dysfunction, increased free radical production, decreased DNA repair capacity with ageing may explain reduction of multisystem physiological regeneration capacity. Figure 1 summarizes pathophysiology of frailty [23].

Because of the increase the number of older adults who need medical support, and cost of these patients to the healthcare system, it has great importance to determine the biological older patients. In the last two decades, it is desirable to develop biomarkers and scales to distinguish the biological age of older individuals [24]. Therefore, patients should be evaluated not only disease-oriented but also function-oriented.

Fried and his colleagues composed the most frequently used criterion to assess vulnerability. The Fried Physical Frailty Scale is shown in Table 1 [25]. Frailty is defined in this phenotype model as presence of 3 or more of the following: exhaustion, weight loss, low muscle strength, low walking speed, and of low physical activity. The presence of one or two criteria was considered as pre-fail state. The walking speed, muscle strength and physical activity are evaluated by 4-meter walking test, hand grip test (dynamometer) and Minesota Leisure Time Activity questionnaire, respectively. This model successfully predicts poor health outcomes such as falls, disability, hospitalization, and mortality [25].

Due to the difficulty of application the phenotype model in daily clinical practice, various other scales were developed. The FRAIL scale has 5 criteria: fatigue, resistance, ambulation, systemic diseases (ilness) and weight loss [26]. Presence of 1-2 criteria is considered as pre-frail state and 3 or more criteria indicates frailty

The cumulative deficit model was then established by the Canadian Health and Ageing Study. Total 92 basal variables were included in this study, including various findings (e.g. tremor), symptoms (e.g. low mood), disease states, abnormal laboratory values, and disabilities. Vulnerability was assessed by the accumulation of deficiencies in patients. The more deficiencies patients have, the worse frailty status they have [27]. In addition to these scales, other indexes with wider psychosocial contents such as the Groningen and Tilburg Frailty Indicators were also developed [28,29].

A meta-analysis which was conducted between 2009-2015, assessed 29 frailty scales, according to this meta-analysis [30], the Fried physical scale and the deficit index are the most commonly used scales. Fried phenotype model, frailty deficit index, Edmonton frailty scale and clinical frailty scale were found both reliable and well predict clinical results.

Because frailty is more common with increasing age, it is important to apply protective approaches from middle ages. Early recognition and effective treatment strategies have great importance in order to prevent frailty in later life.

Optimal treatment of patients’ systemic medical diseases and stable management of intervening acute conditions constitute the basic principles of frailty treatment [31]. Currently, there is strong evidence that exercise is more beneficial than other interventions in frail patients. Multi-component exercises such as resistance, flexibility, aerobic and balance exercises are useful in the prevention and treatment of frailty. In addition, it is also considered to be the best strategy to prevent the development of disability in the frail patients [32,33]. However, the most effective type, duration and frequency of exercise intervention is uncertain.

Vitamin D support is known to reduce falls, hip fracture and mortality in older adults [34-36]. Vitamin D is also effective on neuromuscular functions [37]. Although, there are no large scale studies, replacement of vitamin D deficiency seems to be effective for the treatment of frailty.

In 2013, consensus for frailty was determined treatment of physical frailty under 4 main headings: [3]

a) Exercise

b) Calorie and protein supplement

c) Vitamin D

d) Prevention of polypharmacy

Conclusion

Prevention of frailty should not only be considered as a necessary intervention for the elderly. Effective prevention of systemic diseases starts at early ages. Promoting healthy lifestyle and improving health services should be considered as main targets for successful ageing. However, primary care practitioners should be aware of frailty and risky individuals should be referred to necessary higher levels of health care service. Furthermore, clinicians should keep frailty on mind in individuals over 70 years with unintentional weight loss. Recognition of frailty identify high risk patients for medical interventions and reduce risk of adverse outcomes. In the future, universal, valid diagnostic criteria should be established, and more detailed studies are needed to clarify the pathophysiology of frailty.

For more articles in Juniper Publishers | Open Access Journal of Case Studies please click on: https://juniperpublishers.com/jojcs/index.php

#Juniper Publishers Contact #Juniper Publishers #Critical Care Medicine #Gastrointestinal Surgery #Obstetrics and Gynaecology #Pharmacology

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sleepguruin · 4 years

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Sleep and Inflammation – A Balancing Act

The relationship shared between sleep and inflammation is very synergic. Sleep can both increase or reduce swelling and vice versa. Further, too much sleep, as well as too little sleep, can trigger inflammation. To keep both the conditions optimal, your body needs to walk a very thin line. Sleep can lead you into sickness by triggering inflammation or worsening an already existing inflammation. On the other hand, sleep can also be your partner in disguise for health and happiness. It can reduce, limit, or even stop inflammation from occurring. You must be wondering why sleep is so essential for reducing inflammation. Or even that how can something as beneficial as sleep trigger inflammation? This article will guide you through the dynamics of the relationship between sleep and inflammation.

What Is Inflammation?

Before embarking upon sleep and its effects on inflammation, you first need to understand the concept of inflammation. A lot of people do not understand the basics of inflammation and the role or effect it has on your body. Inflammation is a complex biological response of your body tissues to foreign particles that harm, destroy, or otherwise damage your body. This response involves the:

Immune system

Blood cells

Molecule mediators

Inflammation is an innate immune response of the body and not part of adaptive immunity. The innate immune response is generic. The immune system responds automatically without much thought behind it. The adaptive response, on the other hand, is a specific response towards the pathogen. It is a much more sophisticated and detailed response. In simple language, inflammation is your body’s way of protecting you. Inflammation stimulates the production of white blood cells and other substances that help your body in case of infections, injuries, or other conditions.

Why Does Inflammation Occur?

Inflammation is your body’s first response to an infection, damage, or hurt. It involves getting the white blood cells to the site of hurt to fight off the external stimuli and begin the task of repair and healing. Inflammation also prevents you from unnecessarily touching the site or being too relaxed with it. This, in turn, prevents any secondary infections from settling in and helps in repairing the damage faster. Further inflammation also leads to joint stiffness and, in some cases, loss of function. This further prevents you from overexerting that area and giving it the rest; it requires for healing to happen effectively and efficiently.

Types of Inflammation

Inflammation is classified under two types as per Harvard Health. This classification is based on the severity and period of the condition. These are:

Acute Inflammation: This is the original response of the body tissues to any external stimuli which damage the body. This involves the movement of plasma and leukocytes from the blood to the injured area. Acute inflammation does not carry forth for a prolonged period and is short-term. Examples of acute inflammation include:

Chronic Inflammation: This is prolonged inflammation, i.e., inflammation over some time. It involves a change in the type of cells present at the damage site. Further, it also involves the destruction and healing of the tissues at the inflammation site at the same time. Some examples of chronic inflammation are:

Skin cuts or scratches

Sore throat

Ingrown toenail

Acute bronchitis

Dermatitis including eczema, rashes, etc

Sinusitis is inflammation of the nasal passage. This can be caused by seasonal allergies.

Inflammatory Arthritis: This includes a variety of medical conditions that have inflammation of the joints like rheumatoid arthritis, lupus, and psoriatic arthritis.

Asthma: This is caused when there is inflammation in the air passages that are responsible for carrying oxygen to the lungs. Inflammation makes these passages narrow and hence makes breathing difficult.

Periodontitis: This is inflammation of the gums, and the teeth support tissues. It is a bacterial infection.

Inflammatory Bowel Disease (IBD): It is also called Crohn’s Disease and Ulcerative colitis. It involves inflammation of the GI tract and eventually leads to damage to the GI tract.

Apart from this, chronic inflammation is also responsible for an increased risk of stroke, diabetes, cardiovascular diseases, and cancer.

Signs of Inflammation

There are five signs and symptoms of inflammation. The signs are very visible and cannot be ignored. These signs are:

Pain: This is the most common sign of inflammation. Inflammation causes pain in the affected area, such as joints, muscles, or skin. Pain makes the areas sensitive and tender to touch. The more chronic and severe the inflammation, the worse the pain you will feel at the site.

Heat: The inflamed area will be warmer to touch than other areas of your body. This is because there is increased blood flow in that area. This increase in the blood flow causes the temperature of that area to be higher than in other areas.

Swelling: When a part of your body is inflamed, it might result in fluid retention. The tissues of that area might accumulate fluid, which causes them to swell. It is important to note in an injury swelling can happen with or even without inflammation.

Redness: It is common to observe redness with inflammation. This is because of the increased blood flow that concentrates the level of blood in blood vessels of that particular area.

Loss of Function: In case of an illness or physical trauma, inflammation can cause loss of function in that organ or area. For example, an inflamed joint due to arthritis or a broken joint cannot be moved properly and sometimes even not at all.

These symptoms are extremely easy to identify. It does not require any study or experience to recognize external inflammation. Ever inflammation of internal organs can easily be identified through the symptom of localized pain and swelling.

Sleep and Inflammation

Now that you understand the whys and what’s of inflammation, the next step is about understanding the complex relationship between sleep and inflammation. Sleep is the naturally recurring state of your body where you minimize the muscle control and activity and concentrate on repair and healing of the body tissues and parts. It is during sleep that most of the healing process in your body takes place. In fact, whenever you come down with any illness or hurt yourself in any way, the advice that comes with any medicine is too taking rest. Your body needs the resting period to repair itself. The same concept applies to inflammation. Remember, inflammation happens when you have been hurt or injured in some way or another. It is your body’s defense mechanism coming into play. Sleep aids your defense mechanism. The connection between sleep, immunity, and inflammation is discussed below:

Regulator: For your defense mechanism to work, your immunity needs to work optimally, and for optimal immunity, your body needs sleep. Hence sleep, immunity, and inflammation are all interrelated. Sleep, the immune system, and inflammation share the common regulator known as the “Circadian Rhythm.”

Your sleep cycle is regulated through the circadian rhythm. This rhythm keeps your body on the sleep-wake cycle and keeps it synchronized. It is also responsible for regulating the immune system in your body. When this circadian rhythm gets disrupted, it disrupts both the sleep cycle and the immune system synchronization. This is turn, makes you more susceptible to inflammation.

Sleep Pattern – Too Much and Too Little

Your sleep pattern, i.e., the number of your snooze hours, matter. Studies show that an average adult needs 7 to 9 hours of sleep. You should aim your sleep hours to be in that bracket. The effects of less and more sleep are discussed below:

Too Much Sleep

The question that everyone loves to ask is whether there is such a thing as too much sleep? Yes, there is such a thing as too much sleep. Too much sleep is also known as oversleeping. Sleep is good for you and your body. It keeps you healthy, but too much sleep can work against you. An average adult needs a maximum of 9 hours of sleep. Anything more and you are slumbering more than what is required by your body. Studies show that too much sleep is linked to inflammation and inflammation-related diseases. The major cause of this is:

C-reactive protein (CRP): This is a blood test systemic inflammation marker. CRP levels rise with inflammation. People who are known to oversleep also tend to have high CRP levels in their bodies, indicating increased inflammation due to oversleeping. Studies show that females oversleeping had 44% higher CRP levels than those sleeping for 7 hours. Another study details that the CRP levels persistently increased by 8% for every hour beyond the 7 – 9 hours bracket of ideal sleep hours.

Too Little Sleep

Getting too little sleep or sleep deprivation can trigger inflammation and cause inflammation to worsen. The medical community is still trying to understand the exact relationship between sleep and inflammation. However, studies are unanimous in maintaining that lack of sleep, even for a single night, is enough to trigger inflammation. The main reasons for this are:

Cytokine: Cytokines are produced by the T – cells in your body. These cytokines are protein molecules that help the T – cells of your immune system to identify and target foreign pathogens and substances in your body that make you sick. Sleep aids in the production of these cytokines.

NF-κB: This is a nuclear factor protein that acts as an inflammation marker. Sleep disturbance, especially poor sleep quality and hours are known to cause a spike in this protein, thereby linking little sleep with increased inflammation.

Stress: Stress is a common by-product of less sleep. Stress and sleep are in a vicious cycle. Less sleep accelerates your stress levels and vice versa. Now studies have linked stress with even inflammation. At a basic biological platform, your body reacts to stress like any other foreign pathogen. It goes into a “fight or flight” mode. This triggers your immune response and leads to increased inflammation.

Gut Health: Gut health is dominated by all microbial life present in your intestines. These “Microbiome” have a big influence on your mental and physical health. Studies show that when your gut health is poor, it contributes to inflammation. This holds for both acute and chronic inflammation.

Poor sleep or lack of sleep, in turn, contributes to an unhealthy gut. It reduces the goof bacteria in your intestines and promotes the bad disease-causing bacteria. Further sleep deprivation causes stress, which is another major factor for an unhealthy gut.

Inflammation and Sleep

It is not just sleep that affects inflammation. The effect goes in the other direction as well. Inflammation, especially chronic inflammation, affects your sleep cycle as well. When you are hurt, down with some ailment or suffer from medical conditions involving inflammation, then chances are you cannot sleep. Pain gets worse during the night, swelling tends to increase, and the joints become stiff and unmanageable. These entire forces combine to make you very uncomfortable, making it difficult to catch up on the snooze factor.

Tips to Maintain a Good Sleep – Inflammation Cycle

The most effective way of ensuring a good relationship between sleep and inflammation is by ensuring that your body gets the optimal hours of sleep it requires. Some ways of achieving that are:

Regulate your Circadian Rhythm by keeping a good schedule. Going to bed on time and waking up at a particular time will ensure that your circadian rhythm is maintained optimally, ensuring optimal sleep and immunity functions.

Take care of your sleep surroundings to ensure favorable sleep.

Keep stimulants in the shape of caffeine, blue/white light exposure, and heavy diet to a minimum at least two hours before sleeping.

Eat a well-balanced nutritious diet rich in carbohydrates, proteins, fiber, and other nutrients.

Catch up on exercises and indulge in activities like yoga and meditation to soothe and calm yourself before sleeping.

Few Doubts Settled

After reading through about the connection shared by sleep and inflammation in your body, you might have certain queries related to the subject. Below are some answers to the frequent questions:

Is Sleep Beneficial To Inflammation

To keep it short, yes. Sleep is very beneficial to the inflammation. Sleep helps by keeping the pro-inflammatory activities that your body might participate in check.

Does Inflammation Worsen During the Night?

Inflammation is known to get worse during the night when you sleep. This is because the levels of an anti-inflammatory hormone known as “Cortisol” naturally drops during the night.

Does Lack of Sleep Affect Inflammation?

Lack of sleep throws the body out of gear. When you do not get enough sleep, the natural synchronization and harmony of your bodily functions get disturbed. This causes your immunity to becoming counter-intuitive. Under sleep deprivation, your immunity might respond by going on overdrive and increasing its response to the affected injury, thereby increasing the inflammation.

Will Drinking Coffee Reduce Inflammation?

Studies have shown coffee to have anti-inflammatory properties. Hence drinking coffee regularly might help in reducing inflammation, but it exercises moderation when consuming coffee. Too much coffee will make you too edgy and excited, causing poor sleep patterns, which will negatively affect your inflammation.

Bottom Line

A lot of people don’t understand the role of inflammation. They think that inflammation is a very natural part of the healing process. And you are right in thinking that. The problem with inflammation arises when there is too little or too much of it. Sleep helps to a great extend in controlling that factor of inflammation. Sleep allows the immunity to function optimally, which in turn allows for optimal levels of inflammation. However, the lack of sleep will exacerbate any existing inflammation. So the trick is not just sleeping but getting the optimal sleep to effectively keep the inflammation in check.

#Sleep and Inflammation

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sandiegohealth533-blog · 4 years

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MCT Oil Facts: SanDiegoHealth.org | By Pablo Garduno

Some Ideas on Mct Oil Dosage You Should Know

More research is needed here, also (). If you are considering a ketogenic diet to assist handle your child's autism, speak to your physician or nutrition expert initially. MCT oil may improve brain function, which might have benefits for people with epilepsy, Alzheimer's illness and autism. MCTs have actually been revealed to have antimicrobial and antifungal results (,, 31).Coconut oil, which consists of a large amount of MCTs, has been shown to minimize the growth of Yeast albicans by 25%.

Premium human research studies are needed prior to stronger conclusions can be made. MCT oil consists of fatty acids that have actually been shown to lower the development of yeast and germs. In general, MCTs may have a variety of antimicrobial and antifungal impacts. Heart illness is a growing issue. Some aspects that increase your threat include high cholesterol, blood pressure, inflammation, being obese and smoking cigarettes.

This may, in turn, assistance reduce your threat of heart disease.A research study of 24 overweight guys found that taking MCT oil integrated with phytosterols and flaxseed oil for 29 days minimized overall cholesterol by 12.5%. However, when olive oil was used instead, the reduction was only 4.7% (). The exact same research study likewise discovered better decreases in LDL or "bad" cholesterol when the MCT oil mixture was contributed to their diet (). Additionally, MCT oil can also increase the production of heart-protective HDL or "great" cholesterol (). It can even considerably decrease C-reactive protein (CRP), an inflammatory marker that increases the threat of heart illness (). Extra studies discovered that MCT-oil-based mixes can have a favorable result on other cardiovascular disease danger elements, too (, ).

Including it to your diet plan could help decrease your threat of cardiovascular disease. MCT oil might also have advantages for those with diabetes (). Many people with type 2 diabetes are obese or obese, which makes diabetes harder to manage. However, MCTs have actually been revealed to lower fat storage and boost fat burning (40). One small Chinese study of 40 individuals with diabetes discovered that those who took in MCT oil daily had significant reductions in body weight, waist area and insulin resistance, compared to those taking corn oil consisting of LCTs (). Another study found that when 10 individuals with diabetes were injected with insulin, they required 30% less sugar to keep typical blood sugar level levels when they took in MCTs, compared to LCTs (). Nevertheless, the same research study did not discover any impact of MCTs on reducing fasting blood glucose levels (). For that reason, other factors such as timing and the quantity of food eaten may influence the effects of MCT oil.

It may also help you manage your blood sugar level. Although MCTs are thought about safe, they may have some drawbacks (). While MCTs can increase the release of hormones that help you feel fuller longer, they may also stimulate the release of hunger hormones in some people (, 43, ). A research study on individuals with anorexia found that MCTs increased the release of two hormonal agents that promote appetite: ghrelin and neuropeptide Y (45). Individuals who took more than 6 grams of MCTs each day produced more of these hormonal agents than those who had less than 1 gram per day - how to use mct oil.

High dosages of MCT oil may increase the amount of fat in your liver in the long term. One 12-week study in mice discovered that a diet plan in which 50% of the fats were MCTs increased liver fat - how to use mct oil. Interestingly, the very same study likewise found that MCTs reduced total body fat and enhanced insulin resistance (). Nevertheless, bear in mind that high doses of MCT oil, such as those in the research study above, are not recommended.

MCTs are high in calories and typically just make up about 510% of your total calorie intake. If you are trying to preserve or reduce weight, you ought to take in MCT oil as part of your overall quantity of fat intake and not as an additional quantity of fat. MCT oil increases the release of hunger hormonal agents, which might cause increased food intake.

Unknown Facts About Mct Oil Reviews

Taking MCT oil might have numerous benefits and really couple of dangers. For starters, it consists of fats that can promote weight-loss by lowering body fat, increasing fullness and potentially improving your gut environment. MCTs are also a terrific source of energy and may combat bacterial development, assistance secure your heart and aid in handling diabetes, Alzheimer's illness, epilepsy and autism.

Nevertheless, as long as you keep to 12 tablespoons daily and utilize it to replace not contribute to your regular fat intake, any unfavorable negative effects are not likely. At the end of the day, MCT oil is a practical method to make the most of all the health benefits MCTs need to offer.

References:

https://sandiegohealth.org/coconut-oil-in-coffee/

https://sandiegohealth.org/best-mct-oil/

#Pablo Garduno #San Diego Health #sandiegohealth.org

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thrivous · 4 years

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I've been reading about the history of genetic research in The Gene by Siddhartha Mukherjee. It introduced me to the idea that genetic variance within a species increases over time. So the variety and combinations of genes in humans is likely to increase as time continues.

Gene analysis technology is allowing us to start personalizing medical treatments for our specific genome. It shows great promise in cancer treatment, pinpointing the interventions that would be effective and have minimal side effects. Now analysts are working toward tailoring supplements to a person’s unique genetic expression.

Genes Influence Omega 3 Supplement Effect

New Study: Fine mapping of genome-wide association study signals to identify genetic markers of the plasma triglyceride response to an omega-3 fatty acid supplementation

These researchers noted that, when someone’s triglyceride levels responded to Omega 3 supplements, there was a significant improvement. But not all people responded. They sought to identify which genes predicted sensitivity to Omega 3.

They started with 208 healthy people from Quebec, Canada, as part of the Fatty Acid Sensor Study. For 6 weeks, participants took a high dose of Omega 3, including 1.9–2.2 g EPA and 1.1 g DHA. This required participants to take 5 fish oil capsules a day! This dose was sure to elicit a response.

At the end of the 6 weeks, researchers determined each person’s change in triglyceride level. And they identified the responders and non-responders.

About 29% of the participants were identified as responders. When the study started, both the responder and non-responder groups had average triglyceride levels within the recommended range. But the responders tended to have levels that were higher within the recommended range.

With supplements, the responder triglyceride level dropped about 45 mg/dL. The non-responder triglyceride level increased about 15 mg/dL, but was still well within the recommended range.

Researchers compared responder DNA to non-responder DNA. They identified 31 sites spread out over 6 genes (IQCJ-SCHIP1, NXPH1, PHF17, MYB, NELL1, SLIT2) that were associated with response to Omega 3 supplements. The genes accounted for almost 50% of the difference in triglyceride level.

The researchers acknowledged recent meta analyses that question the effectiveness of Omega 3 supplements. Using their own results, they concluded that “future studies on n–3 FA and other nutrients should pay more attention to the importance of genetic factors on the interindividual variability in lipid responsiveness.”

Omega 3 Benefits from Fish Oil and Flaxseed May Vary

New Study: A comparison between the effects of flaxseed oil and fish oil supplementation on cardiovascular health in type 2 diabetic patients with coronary heart disease: A randomized, double-blinded, placebo-controlled trial

Participants in this study were under the age of 65. They had type 2 diabetes and coronary heart disease. Researchers focused on measuring the difference in outcomes between fish oil and flaxseed oil supplements.

The 90 participants received either a placebo, 2 g flaxseed oil (800 mg ALA), or 2 g fish oil (500 mg EPA and 300 mg DHA) for 12 weeks.

Both the flaxseed oil and fish oil supplements resulted in decreased insulin levels and increased total antioxidant capacity. Both supplements also decreased inflammation measures.

The flaxseed supplement decreased the inflammation indicator, hs-CRP. The fish oil supplement increased inflammation-fighting glutathione.

Both supplements decreased insulin levels and improved measures of inflammation. The researchers lamented being limited because they did not have the funds to measure blood levels of Omega 3 or gene expression.

Thoughts on Trends in Omega 3 Studies

The human body is not able to make Omega 3 itself. It must be consumed.

Omega 3 is beneficial to health. But the amount and kind to optimize heart health, enhance memory, improve mood, and reduce inflammation is tricky to pinpoint.

The first study, above, points out how general population studies get muddled. And the potential therapies get hidden by genetic variation. Perhaps one person’s point of therapy is another person’s genetic variation.

The FADS1 and FADS2 genes are examples of genes that the second study, above, probably would have looked at. The FADS family of genes are involved in the synthesis and conversion of fatty acids.

Some people may need more Omega 3 than others to get their index high enough. And others may not be able to convert the ALA form to EPA or DHA very efficiently.

I am excited to see more research coming out that identifies which genes influence nutrient requirements and how supplements can be used to work around certain gene variations. Also, more researchers are recognizing that genetic analysis could improve the value of their research.

Meanwhile, make sure you get your Omega 3, check your labs, and tune in to how your body responds to your supplements.

Thrivous

Thrivous developed Omega Cardioprotector to support and enhance healthy heart and circulation function. Each serving of Omega provides 300 mg EPA and 200 mg DHA in 1430 mg Fish Oil, as well as clinical doses of Garlic and Pycnogenol. Each nutrient and each dose is backed by multiple human studies.

Like all Thrivous supplements, Omega passes through rigorous quality control. We test each nutrient multiple times to verify its identity, potency, and safety from microbes and heavy metals. And we openly publish all test results, available for download from the product webpage. This is an exceptional practice in the industry.

Omega also comes with a 100-day money back guarantee. We're confident you'll be happy. But if not, just let us know. We'll refund the full amount that you paid for the product, without requiring a return.

Aging doesn't wait. You shouldn't either. Start investing in your long term heart health. Order Omega today!

Originally published at thrivous.com on November 23, 2019 at 08:39AM.

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didanawisgi · 6 years

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Abstract

Background

Bacterial pleural infection requires prompt identification to enable appropriate investigation and treatment. In contrast to commonly used biomarkers such as C-reactive protein (CRP) and white cell count (WCC), which can be raised due to non-infective inflammatory processes, procalcitonin (PCT) has been proposed as a specific biomarker of bacterial infection. The utility of PCT in this role is yet to be validated in a large prospective trial. This study aimed to identify whether serum PCT is superior to CRP and WCC in establishing the diagnosis of bacterial pleural infection.

Methods

Consecutive patients presenting to a tertiary pleural service between 2008 and 2013 were recruited to a well-established pleural disease study. Consent was obtained to store pleural fluid and relevant clinical information. Serum CRP, WCC and PCT were measured. A diagnosis was agreed upon by two independent consultants after a minimum of 12 months. The study was performed and reported according to the STARD reporting guidelines.

Results

80/425 patients enrolled in the trial had a unilateral pleural effusion secondary to infection. 10/80 (12.5%) patients had positive pleural fluid microbiology. Investigations for viral causes of effusion were not performed. ROC curve analysis of 425 adult patients with unilateral undiagnosed pleural effusions showed no statistically significant difference in the diagnostic utility of PCT (AUC 0.77), WCC (AUC 0.77) or CRP (AUC 0.85) for the identification of bacterial pleural infection. Serum procalcitonin >0.085 μg/l has a sensitivity, specificity, negative predictive value and positive predictive value of 0.69, 0.80, 0.46 and 0.91 respectively for the identification of pleural infection. The diagnostic utility of procalcitonin was not affected by prior antibiotic use (p = 0.80).

Conclusions

The study presents evidence that serum procalcitonin is not superior to CRP and WCC for the diagnosis of bacterial pleural infection. The study suggests routine procalcitonin testing in all patients with unilateral pleural effusion is not beneficial however further investigation may identify specific patient subsets that may benefit.

Discussion

This trial is the largest prospective analysis of serum PCT measurement in patients presenting with unilateral pleural effusions. We have demonstrated that PCT when measured in all patients presenting with unilateral pleural effusion to a tertiary pleural service offers no greater diagnostic utility than WCC or CRP. Furthermore we have found that PCT has no significant prognostic value in pleural infection in terms of predicting 1 year mortality or need for thoracic surgical intervention. CRP and WCC were significantly higher in patients with pleural malignancy who had a co-existing bacterial infection.

Procalcitonin is a peptide precursor for calcitonin which is released by the C-cells of the thyroid gland. Under normal conditions levels of circulating procalcitonin are negligible. Procalcitonin has been studied in a number of scenarios where it has been presented as a test for distinguishing between bacterial infection and other inflammatory insults [8]. Procalcitonin can distinguish between bacterial and aseptic meningitis, identify infectious vs non-infectious exacerbations of chronic obstructive pulmonary disease (COPD) and help predict aetiology and outcome in community acquired pneumonia [9, 12–14]. Procalcitonin has been studied in pleural disease both in the pleural fluid and serum however this is the first study to attempt to characterise the role of serum PCT as an immediate “bed-side” test in all patients presenting with an undiagnosed unilateral effusion.

Signs of pleural infection and pleural inflammation can often be similar and can pose diagnostic difficulties. Commonly used biomarkers such as CRP and WCC are markers of inflammation and can be raised indiscriminately in pro-inflammatory states such as malignancy and infection [10]. Previously pleural fluid PCT has been shown to be inferior to a range of other markers in distinguishing between infected and non-infected effusions as well as being inferior to serum PCT [6, 7, 15, 16]. Serum PCT studies have suggested that higher values could be a useful indicator of pleural infection, however only specifically selected small numbers of patients (<100) have been studied [15]. McCann et al. addressed the issue of inflammation vs infection by comparing PCT and CRP levels before and after a sterile inflammatory insult (talc pleurodesis). The study found that whilst CRP rose significantly (360%) the rise in PCT was less marked (21%); however, this is just one cause of non-infective inflammation and it is yet to be determined whether malignant processes have the same effect on PCT.

We analysed serum PCT, WCC and CRP in consecutive patients presenting to our tertiary referral centre prospectively recruited to a pleural study. Procalcitonin has previously been presented as a marker of infection which can be used to guide the duration of antibiotic therapy [17, 18]. Therefore it was predicted that antibiotic therapy may reduce the ability of PCT to identify infection. In our cohort, 68% of patients (56/80) with pleural infection had received antibiotics in the 2 weeks preceding presentation. We have shown that the use of antibiotics did not significantly affect the diagnostic utility of procalcitonin. It could be suggested that a longer duration of antibiotics (≥7 days) prior to investigation could theoretically hinder the diagnostic ability of procalcitonin. However, we have shown no statistically significant difference in procalcitonin between those patients who received ≥7 days of antibiotics and those who received none (p = 0.48).

The diagnostic ability of PCT in the presence of renal failure has not been conclusively verified. Previous studies have suggested that renal function may interfere with PCT values [19, 20]. We found patients with unilateral pleural effusions secondary to renal failure with no evidence of infection had raised levels of PCT (Table 2). However, only 6 patients were diagnosed with a unilateral pleural effusion secondary to renal failure. Further studies are required to assess the relationship between renal failure and PCT in patients with unilateral pleural effusions.

Predicting outcome in pleural infection is difficult, it has previously been shown there are no reliable clinical, pleural fluid or radiological characteristics that will predict failure of medical therapy upon admission [21]. One of the key diagnostic questions is how to identify those patients who require invasive intervention such as pleural drainage or thoracic surgery. Persistently high inflammatory markers such as CRP and WCC have been shown to be associated with poorer outcomes and the need to perform chest tube drainage [22]. Around 30% of patients can be expected to need thoracic surgery or die as a result of pleural infection [23]. Currently, there is no defined criteria for surgical intervention in pleural infection and the decision to operate remains subjective [1]. Our study has shown no statistically significant difference in PCT, WCC and CRP between patients who required no intervention, chest tube drainage or thoracic surgery. This is in line with previously reported conclusion using the Multicentre Intra-pleural Sepsis Trial (MIST) data [5]. Fig. 4 does show a strong trend between PCT and degree of intervention required and increased sample size may allow sufficient power to identify a statistically significant difference.

Unilateral pleural effusions can have dual pathology with a number of processes contributing to the accumulation of fluid. Pleural malignancy may be complicated by either intra- or extra-thoracic infection. Identifying those patients who may require antibiotics despite a primary malignant process could improve short-term outcomes. Approximately 10% (23/239) of patients with a diagnosis of malignant unilateral pleural effusion also had a co-existing infection at presentation. Our data shows PCT has no significant greater diagnostic utility over WCC or CRP in identifying patients who have pleural infection alongside a malignant process. Furthermore CRP and WCC were found to be significantly higher in patients with a co-existing bacterial infection (p = 0.004 and p = 0.0003 respectively).

#procalcitonin #pulmonology #critical care #internal medicine #family medicine #c-reactive protein #immunology #immune system #controversy #best practices

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ebenpink · 5 years

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Going Mediterranean to prevent heart disease http://bit.ly/2MfnJtZ

There is a mountain of high-quality research supporting a Mediterranean-style diet as the best diet for our cardiovascular health. But what does this diet actually look like, why does it work, and how can we adopt it into our real lives?

What is a Mediterranean diet?

The Mediterranean diet is not a fad. It is a centuries-old approach to meals, traditional to the countries bordering on the Mediterranean Sea. The bulk of the diet consists of colorful fruits and vegetables, plus whole grains, legumes, nuts and seeds, fish and seafood, with olive oil and perhaps a glass of red wine. There is no butter, no refined grains (like white bread, pasta, and rice), and very little red or processed meat (like bacon). There is also an emphasis on sitting down and enjoying a meal among family and friends, as well as avoiding snacking, and getting plenty of activity. It’s not just about the food: it’s a way of being.

What’s a Mediterranean-style diet?

The food part is similar to most other healthful diet approaches in that it’s plant-based. And the recipes do not have to be Italian or Greek, which is why I refer to it as a Mediterranean-style diet. Every meal should have vegetables and fruits as the base. Any grains should be whole grain, like quinoa, brown rice, corn, farro, or whole wheat. Legumes are an excellent source of plant protein, things like lentils, garbanzo, kidney, cannellini, or black beans. Nuts and seeds have protein and healthy fats, and olive oil provides even more healthy fat. Including fish and seafood is traditional, but not required. I advise people not to stress about dairy, poultry, and eggs; these are okay in small amounts. A glass of wine a day may be beneficial, but not for everyone, and there is no reason for non-drinkers to take it up.

Why does this way of eating produce such impressive health benefits?

In a recent study published in JAMA Network Open, researchers looked at data from over 25,000 women over 45 (with an average age of 55) and with no history of heart disease.

Using the baseline dietary questionnaire, a Mediterranean diet “score” was calculated. Basically, there was one point given for each of these nine main components: higher than average intake of fruits, vegetables, whole grains, legumes, nuts, fish, and healthy fats; healthy level of alcohol intake; and lower than average intake of red and processed meats. Participants were divided into groups based on low, medium, and high Mediterranean diet consumption (scores of 0–3, 4–5, and 6–9).

After 12 years average follow-up time, 1,030 participants had some kind of serious cardiovascular issue (including heart attack, angina with stent placement, peripheral vascular disease requiring intervention, or stroke). The women in the medium and high Mediterranean diet groups had significantly lower risk (23% and 28% lower, respectively).

Higher Mediterranean diet scores were also associated with lower body mass index and blood pressure, as well as more optimal lab data like lower inflammatory markers (high-sensitivity CRP), lower diabetes risk (insulin resistance), and a better lipid profile (higher HDL). These findings suggest the pathways through which the diet benefits the body: by decreasing inflammation and promoting healthy blood cholesterol and sugar levels.

How to “go Mediterranean”

Adopting the Mediterranean diet in our busy, high-tech world may seem daunting. But there are tips and tricks to change your eating habits and reduce your risk of heart disease.

My book, Healthy Habits for Your Heart, teaches you the basics of behavior change, as well as step-by-step methods to make these changes happen in your real life. Chapter 5, “Eat For Your Life: Nutrition Habits” takes you through the science-backed recommendations for adopting a heart-healthy, plant-based Mediterranean-style diet. One suggestion is:

Aim for eight servings of fruits and vegetables per day (4 to 5 cups)

Eight servings of fruits and vegetables could look like:

Breakfast: 1 cup of berries

Lunch: 2 cups of lettuce + 1/2 cup tomatoes + 1/2 cup cucumbers + an orange for dessert

If you wanted to get to 10 servings, then add:

Dinner: 1 cup broccoli + 1/2 cup diced peppers + 1/2 cup snow peas (in a stir fry)

Tips to make the habit stick

Start with at least one serving of fruits and/or vegetables with every meal and snack, and increase over time to two or three. You’ll be up to 10 in a matter of weeks!

It’s fine to use frozen fruits and vegetables. High-quality berries, tropical fruits, and mixed vegetables are cheaper than fresh, and can be bought in bulk from the grocery store and stored in the freezer for long periods.

Make breakfast with two (or more) servings of fruits and/or veggies. This gets the good stuff in early in the day. Try my Filling Fruit and Nut Bowl with Greek Yogurt.

Free meal tracker apps like MyFitnessPal or Dr. Michael Greger’s Daily Dozen app can help you get your 10 servings of fruits and veggies daily.

The post Going Mediterranean to prevent heart disease appeared first on Harvard Health Blog.

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jointonline-blog · 4 years

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Which foods are anti-inflammatory?

Vegetable and seed oils are made use of as cooking oils and so are a major component in plenty of processed foods. Some investigate experiments propose that veggie oil's higher omega-six fat product may well endorse inflammation when consumed in superior portions. Nevertheless, the evidence is inconsistent, plus more investigation is needed. Carbohydrates have truly gotten a nasty rap.

Historical human beings taken in significant fiber, unprocessed carbohydrates for centuries in the kind of yards, roots, and fruits (). However, consuming refined carbs may well travel inflammation (,,,, ) (arthritis).Enhanced carbs have experienced nearly all their fiber eradicated. Fiber promotes fullness, boosts blood glucose Management, and feeds the advantageous germs in the intestine.

Superior GI foods raise blood glucose extra promptly than reduced GI foods - arthritis. In a single analysis analyze, more mature grownups who described the highest ingestion of high GI foods were two.9 situations far more almost certainly to die of the inflammatory sickness like Serious obstructive lung ailment (COPD) (). In a very regulated research examine, younger, balanced fellas who ate fifty grams of refined carbohydrates in the kind of white bread expert greater blood glucose degrees and improves in levels of a certain inflammatory marker (). Improved carbs are found out in candy, bread, pasta, pastries, some cereals, cookies, cakes, sugary sodas, and all processed foods which incorporate sugarcoated or flour.

Moderate Alcoholic beverages use continues to be unveiled to offer some overall health advantages. Nevertheless, higher portions could cause significant complications. In a single study, amounts of the inflammatory marker CRP increased in people that took in Alcoholic beverages. The more Liquor they took in, the greater their CRP concentrations amplified (). People who consume closely may perhaps create concerns with bacterial toxins relocating out in the colon and into the human body.

Major Liquor usage could possibly enhance swelling and lead to a "dripping gut" that drives swelling all over Your whole body. Having in processed meat is related to a heightened threat of coronary heart issue, diabetes, and stomach and colon cancer (,, ) (anti-inflammatory). Standard kinds of processed meat include sausage, bacon, ham, smoked meat, and beef jerky.

AGEs are shaped by cooking meats and some other foods at heats. These are recognized to bring about swelling (, ). Of all the disease linked to processed meat ingestion, its Affiliation with colon cancer is the best. Whilst numerous aspects add to colon most cancers, one particular mechanism is thought to become colon cells' inflammatory motion to processed meat (). Processed meat is high in inflammatory substances like AGEs, and its solid Affiliation with colon most cancers may partly be on account of an inflammatory response.

However, you've got a lot more control above facets like your diet plan (mobility). To remain as balanced as you possibly can, hold swelling down by reducing your intake of foods that set off it and having anti-inflammatory foods.

This list of Professional-inflammatory foods will let you decide which foods to limit within your diet program strategy for significantly better wellness. Carolyn Williams, Ph - arthritis. D., R.D. Inflammation is often a hot topic and permanently variable: exploration analyze back links persistent, lower-grade inflammation with A lot of modern big overall health worries, together with coronary heart dilemma, cancer, diabetes and Alzheimer's condition.

However, raising these foods is just one part of the formula. anti-inflammatory. When it considerations reducing persistent inflammation in your body, It can be equally as vital to lessen food items areas That may be activating and intensifying existing swelling. Here i will discuss those best inflammatory foodsand how to minimize them. Americans' utilization of excess sugarcoated is taken into account A serious variable to inflammation, which in turn boosts 1's possible for Long-term illnesses like fat complications, diabetes and cardiovascular disease.

The American Heart Affiliation endorses limiting provided sugars to no more than six teaspoons (about 24 grams) every day for women and no higher than 9 teaspoons (about 36 grams) for guys. Tracking This can be tricky, provided that not all foodstuff labels include sugarcoated - joint ache. The obligatory compliance day to incorporate this for the Nutrition Information label is January 2020 for a great deal of manufacturers.

Look initial to view if the thing is a sweetener, sugar or syrup pointed out (see our listing for all the names for included sugar) (joint discomfort). Then, if you do, look at where it falls on that listing of Lively substances. The closer a sweetener is always to the top from the Energetic ingredient listing, the much less of it the food items incorporates, provided that components are observed in descending purchase by excess weight.

These meats are Also often superior in saturated fat. Exploration has related common intake of processed meats to an increased risk of swelling and some cancers, which lots of hypothesize is undoubtedly an impact of the two nitrates and saturated fats. The science isn't really very clear about precisely what the first Threat in processed meat originates from (nitrates, sat fat or processed meats as a whole), And so the easiest strategies is to limit your total use - joint pain.

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lauramalchowblog · 4 years

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Training for “The COVID-19”

Today we welcome guest author Dr. Ronesh Sinha, internal medicine physician and expert on insulin resistance and corporate wellness, author of The South Asian Health Solution. He is a top rated speaker for companies like Google, Oracle, Cisco and more. Check out his media page for lectures, interviews and articles from Dr. Sinha.

Most of us have been sheltering-in-place for a few months now, and we have evolved into an unprecedented state of fear and hyper-vigilance in this pandemic. After a long period of being cooped up, we are now gradually released into the wild, which introduces us to a whole new level of anxiety. Public health recommendations appear to be flip-flopping regularly, and we are learning on the fly as the situation evolves.

In today’s post, I’d like to share some thoughts on how we can regain some control of our lives. Rather than duck and cover for several more months, we can face this beast head-on. I don’t mean being careless and reckless and not following social distancing and hygiene protocols. Instead, we can adopt a mindset that we will do what is necessary to minimize our risk of a severe COVID-19 outcome. I titled this post “Training for the COVID-19” to help you reframe this pandemic in your mind, and view it like a warrior approaches an enemy on the battlefield or an athlete faces an opponent in a competition.

Cognitive Reframing Coronavirus: From Fear to Readiness

Cognitive reframing isn’t just some touchy-feely behavioral technique. Viewing the world through a more positive lens has a beneficial impact on your immune system, which is potentially relevant to COVID-19. One study shows that participants who were cognitive reappraisers, identified by a 10-item Emotion Regulation Questionnaire, and then exposed to an experimental cold virus (rhinovirus not coronavirus) had reduced nasal cytokine release compared to individuals who were emotional suppressors.1 As you’ll learn in a moment, excessive cytokine release is a crucial mechanism by which COVID-19 imparts significant lung and tissue damage. As with rhinovirus, the nose is a primary portal through which coronavirus accesses our body.

So as you read this post and continue to keep getting bombarded by pandemic news media, remember the lens through which you view this content. Your external world has a direct impact on how your immune system might respond to an infection like COVID-19. Let’s start by summarizing COVID-19’s basic operating system for you.

Fear of the unknown is one of the single most significant stressors to our nervous system. I want you to read this with the attitude that “I will acquire the knowledge I need to understand this virus and defend myself and my loved ones against its effects.” Rather than, “Oh my God, the extra fat around my waistline will be the death of me.”

One way I view our pandemic and its relationship to our individual health is by splitting it into external viral load vs. internal cytokine load. Refer to the image below.

Excerpt from the Free COVID Guide

The left side of the image shows how the COVID-19 virus enters a cell by gaining access through the ACE-2 receptor, which hijacks our cell’s reproductive machinery (think 3D printer). Then, it makes copies of itself. This is the external viral load.

The right side of the image illustrates our immune system response. NLRP3 is an alarm sensor in our cells that gets turned on when an infectious pathogen like COVID-19 knocks on the door of our cells, specifically by attaching to the ACE-2 receptor. Once the alarm sounds, a rush of immune system chemical messengers called cytokines comes rushing inside to thwart the attack. NLRP3 is a critical gatekeeper to the cytokine surge. If you want to learn more about how it works and how it’s connected to other common health conditions, watch my 4-minute explainer video here.

The volume of this cytokine response is what I refer to as the internal cytokine load. An optimal cytokine load would be sufficient to thwart an attack by an outside offender. Still, an overzealous cytokine response (aka “cytokine storm” or “fire”) would damage and destroy our cells through a process called pyroptosis, which is literally cellular death by fire.

I want to highlight that cytokines are not the enemy in this process and are an essential part of our innate immune response. It’s excessive cytokine release that inflicts damage and destruction. Fortunately, our cytokine response is something that we can control through targeted lifestyle changes. Just a reminder that these are the same cytokines I mentioned at the beginning of the post, which were released in excess amounts in the noses of emotional suppressors vs. cognitive reappraisers exposed to the cold virus. So what’s the link with obesity?

Obesity is so intimately tied to our risk of a severe COVID-19 outcome that I refer to this association with the term, “Covesity,” which I write about in detail here.2 Specifically, it’s the central visceral fat (aka “belly fat”) that is an especially insidious storehouse of proinflammatory cytokines like IL-6 and TNF-alpha, which fuel the cytokine fire.

Another reason fat cells may increase risk is through the ACE-2 receptor shown in the above image. Fat cells have an abundance of these receptors, and their affinity for COVID-19 means they may serve as a viral storehouse. So fat cells not only provide more entry points for COVID-19 but also ready access to an ammunition supply of cytokines.

ACE-2 also puts the brakes on the enzyme angiotensin II, which, if left unrestrained, can contribute to the more severe manifestations of COVID-19 (like acute lung injury, heart damage, etc.). Angiotensin II levels appear to rise in severe COVID-19 infections due to a downregulation in ACE-2 (the “brake pedal” for Angiotensin II). In the case of obesity, angiotensin II increases further by visceral fat cells that secrete angiotensin II in addition to the cytokines we just discussed.

So fat cells provide the fuel to ignite the cytokine fire and release excess amounts of angiotensin II, which can further provoke damage and destruction of vital organs. We also know that obesity increases our risk of chronic health conditions like diabetes and high blood pressure, which are additional risk factors for a more severe COVID-19 infection.

Again, I don’t want this information to set you into a state of panic if you are struggling with extra weight or other COVID-19 health risks. I assure you that this is not a disease where the only people left standing at the end of the pandemic will have single-digit body fat percentages and 6-packs. Fit, lean individuals who are experiencing chronic stress and sleep issues might have a higher risk than slightly more substantial, less fit individuals who are physically active and better manage their sleep and stress. No matter where we are in our health journey, we need to identify our own gaps (physical, mental, social, etc.) and make key changes that will markedly reduce our cytokine load and overall risk.

One common question I get during lectures and in the clinic is, “how do I know if my fat is the inflammatory type?” This is an important distinction. Some of us might be above the recommended BMI (body mass index) cutoff, but not have as much inflammatory adipose tissue. In contrast, others might be underweight but have visceral fat cells packed with proinflammatory cytokines. This is why body weight and BMI can often be a misleading marker. Some clues that you might have more inflammatory adipose tissue are below. Just a reminder that NLRP3 is the alarm sensor that COVID-19 turns on and triggers the cytokine surge.

Increased belly fat: ethnic waistline cutoffs are here and to learn more about body fat and the impact of ethnicity, read my post here.

High triglycerides: aim for triglyceride levels to be closer to 100 mg/dL or below

Low HDL (healthy cholesterol): males should target an HDL>40 mg/dL and for females, HDL>50 mg/dL

High triglyceride/HDL ratio is even better than looking at individual triglyceride and HDL, aiming for a ratio of less than 3.0 (lower the better)

Elevated blood glucose (prediabetes, diabetes)

High blood pressure: More recent research is showing that hypertension may be an inflammatory condition and the NLRP3 inflammasome might be a key switch as discussed in this study.3

Fatty liver: Learn more by reading my post here. 4 This mouse study 5 is linked to NAFLD (non-alcoholic fatty liver disease) and blockade of this pathway leads to regression of fatty liver.

Elevated hsCRP: this is a test for inflammation that is not indicated in all patients and can give an elevated result for various reasons. Many of my patients with insulin resistance have elevated hs-CRP, and research 6 mentions the strong link between CRP and NLRP3, where NLRP3 appears to be predictive of elevated hs-CRP levels.

Some of you might recognize many of the items on this list as being criteria for a condition called metabolic syndrome, 7 whose root cause is insulin resistance. Many of us have become disconnected from our health care providers and systems as a result of shelter-in. I strongly encourage you to track the risk numbers applicable to you. For example, I’m putting a growing number of my at-risk patients on continuous glucose monitors (CGMs), especially given studies 8 showing a strong correlation between glucose control and COVID-19 severity. I wrote a detailed post on how to get your health care provider to order a CGM here.

I’m seeing many patients losing track of their waistlines since they’ve been living and working in stretchy pants for months. It might be time to dust off those jeans or work pants, so you regain some waistline awareness. Tracking your risk numbers and making appropriate lifestyle changes is a powerful way to regain control of your health.

Lifestyle Changes

So now that you understand COVID-19’s operating system and COVID-specific risk factors more logically and less emotionally, how do you specifically train for the COVID-19? First, we need to understand what type of event we are preparing for. Is this an event based on strength and power, or is it more of an endurance event?

We know major target sites for COVID are the lungs and heart. When you talk to patients that have had a moderate or severe outcome, they report feeling like being dragged underwater or dropped on top of a mountain and asked to run a marathon. There is a distinct sensation of what we call “air hunger,” and this is something we can actually train for without having to live at least 7,000 ft above sea level.

In other words, surviving and even thriving through COVID-19 likely depends on how fast you can walk or run a mile rather than how much you can squat, deadlift, or bench press. We can improve our tolerance to low oxygen (aka hypoxic) stress if we can improve our aerobic fitness through movement and exercise. Tying this back to cytokines and inflammation – hypoxic stress is a powerful trigger for inflammation. It is mediated by several different chemicals referred to as HIFs (Hypoxia-Inducible Factors) as reviewed in this study. 9 This makes sense given we can live around three weeks without food, three days without water, but only 3 minutes without air.

Any time our body senses a lack of oxygen, the resulting cytokine surge’s intensity and volume are significant. This is a medical code blue or a five-alarm fire signal to our immune system, and there’s a link to our body fat. This study 10 shows that hypoxic (low oxygen) stress specifically unlocks cytokines from fat cells. So, if you are carrying extra inches around the waist and are also aerobically deconditioned, then that’s a double whammy for fueling a cytokine storm.

Now that we understand the type of event we are preparing for, let’s turn to our training plan. I have three main principles for COVID-specific training, which I outline as the “ABCs.” “A” is for Activity, “B” is for Breathing and “C” is for cardio. Most of my patients might be doing one or two of these, but rarely is anyone doing all three. I strongly recommend that you do all three of these to improve your resilience to COVID-19.

Activity: Moving Throughout the Day

For activity, I’m referring to regularly staying active throughout your day since interrupting prolonged sitting has been shown in numerous studies to increase the release of proinflammatory cytokines. You might know this already, but our COVID-19 environment takes on a whole new level of significance. Mark refers to these as “microworkouts”, which you can read about in his post here. I refer to it as exercise snacking (not my term). I am teaching my patients to stock their “exercise pantry” with at least 10 different movements they can perform throughout the day. I have 20+ different work positions and mini-exercises that I do while I’m on business calls or doing creative work.

Personalize your pantry to target problem areas. For example, I have struggled with tight hamstrings for many years, so I’m always working in positions like the one below, which has made a huge difference.

Now, after hours of work, when I decide to do something more intense, my legs are limber, warmed up, and ready to go. Work to me is a combination of a light interval workout with flexibility and warm-up drills that have my body prepped and ready to transition to something more intense at any given moment. My patients that do this are more energetic during work hours and less sore after workouts because they are already warmed up.

For more examples of my work positions, refer to the end of my free Covid Survival Guide here. Since I’m doing lots of remote patient visits now during our medical group’s shelter-in, I’m teaching some of my patients how to integrate workouts into their work hours.

Deep Breathing Exercises

Breathing is next on the list and is the item that is most commonly overlooked from my ABCs. Improved breathing is something we can easily practice at rest as well as during exercise. I’ve been teaching many of my patients to nasal breathe, nasal hum, and even do exercises like alternate or single nostril breathing. Alternate nostril breathing is one of my absolute favorites and I made a video on how to do it here. Even Hillary Clinton swears by it here in her interview with Anderson Cooper.

These types of breathing exercises help activate our diaphragm, which turns on our parasympathetic nervous system (rest or relaxation response) and also improves our breathing mechanics so we can improve oxygenation at rest and during exercise. Recall how I mentioned the sensation of breathlessness or air hunger as being a tremendous stressor to our nervous system that can open the cytokine floodgates, especially from fat tissue.

Despite being a lifelong exerciser, I (like many of my patients) have struggled with aerobic fitness and only recently discovered that a major root cause was a poorly conditioned diaphragm. I’m also a recovering emotional suppressor, and we suppressors tend to bottle up our emotions and breathe more from our chests than our bellies. Emotional suppressors also produce more cytokines and I explain the link in this video here, along with my own strategies on dealing with emotional suppression.

Finally, recall that I mentioned how coronavirus appears to produce a sensation of being dragged under water or dropped on top of a mountain. The physiology of COVID lung disease is complex, but appears to mimic some form of high altitude lung disease. As a result, I’m actually training for it like a high altitude endurance event. Unfortunately I don’t live above 7,000 feet, but am using my high altitude training mask as a substitute. These masks all sold out on Amazon after I did a few interviews and blog posts on the topic, but you can use your medical mask as a hack.

Nasal breathing, single nostril breathing, or using a mask are ways of limiting oxygen intake so your lungs adapt to exercising in a slightly hypoxic environment. I call this “oxygen fasting” which you can read about in more detail in my Oxygen Fasting and Biohacking Breathing post. If you’re not used to it, it will feel suffocating at first, but then you adapt. The reason this is important is that if your lungs are exposed to an infection like novel coronavirus, because you are partially adapted to a lower oxygen environment, it will not be a novel threat that causes a huge surge in stress hormones and cytokines.

Interestingly, right after I submitted the draft for this post I noticed MDA released a guest post on nitric oxide by Nobel Prize winning scientist, Dr.Louis J.Ignarro, where he mentions nasal breathing. I am a HUGE fan of nasal breathing and nasal humming for optimal health, and wrote a detailed post on this a while back which you can read here or just watch my short video on nasal breathing and nitric oxide here.

Back to biohacking breathing, I actually have been using masks as a training tool in my patients. I had an older high risk female patient who absolutely could not tolerate wearing an N95 mask for even a few minutes. By doing some breathing exercises and viewing her mask as an opportunity to improve her aerobic fitness, she increased her “mask tolerance time” enough so she can effortlessly grocery shop and do other errands with her mask in place. This allows her to minimize external viral load exposure by allowing her to comfortably wear her mask more often when needed, while also improving her internal cytokine load and aerobicfitness.

Cardio: Building your Cardio Fitness for COVID-19

Cardio is the final link in the training for COVID-19 protocol, and I already alluded to some of this in the breathing section since the two are intimately linked. The only thing I would really emphasize for type A exercisers like myself, is to not overtrain, especially in our current environment. Mark’s personal story as a former burned out world class endurance athlete definitely had an impact on how I view exercise and fitness. He also introduced me to the work of Phil Maffetone, whose heart rate principles I use and prescribe to patients to help them dose exercise just like we would dose medication. Yes, exercise (like food) is medicine and must be dosed properly to optimize immune system function.

As a result of shelter-in, some of my patients are under-dosing exercise with more sedentary behavior, while my Type A exercisers are overdosing on more high intensity workouts. I am using the extra time to work on range of motion and recovery so I can perform better when I do train. I’ve also been consistently breaking personal bests with daily lower intensity walking milage.

For many of my patients who spent long hours doing the tech commute in Silicon Valley, I tell them that regaining their mornings back can be a gift if they use it the right way. Instead of turning on their car engine to drive to work, they can now fire up their mitochondrial engine first thing in the morning and get some physical activity. This keeps their metabolism revved up so their body’s burning more fat throughout the day, especially if they can do this morning activity in a fasted state.

What About Resistance Training?

You might be asking why I didn’t call out weight training here in my ABCs? I guess I could have added a “D” for deadlifts which I am doing twice a week, but I really wanted to highlight the mechanics and physiology of COVID-19 which makes it prey on the aerobically challenged. If this were a pathogen that tore through skeletal muscle, I’d prioritize my lifts over longer cardio sessions. I love lifting weights and I’m not dissuading individuals from doing weight training, but maybe doing it a little differently than stacking progressively heavier plates on bars.

I’ve encouraged my patients who are no longer going to a gym to focus more on plyometrics and body weight training. A new fun goal I’ve set for myself is increasing my vertical leap so I can be more competitive in grabbing rebounds when I face my teen boys for one-on-one basketball. I also encourage you to set goals aligned with fun and pIay, rather than the more rigid goals of increasing your 1 rep max (1RM). I know I likely compromised my 1RM on weights, but I’ve added a spring to my walking step and running stride I didn’t have before, and that has improved my overall aerobic fitness and energy levels. My patients are also learning different exercises that they can now independently do at home or outdoors, so they are less tethered to an indoor gym or class schedule, and can now get a workout in anytime, anyplace.

A final thought I want to share with you that will hopefully help you view this new world we are living in with a brighter lens is the legacy you plan to leave after we are through this pandemic. Imagine if you had a journal you dusted off from your ancestors who lived through the 1918 pandemic. How inspiring would it be to read about how they endured that event, especially without internet and doorstep delivery of food and virtually any item we need with a few taps of our phone. We complain about the “fear of the unknown,” but we know so much more on a minute-to-minute basis about this virus and its impact than any of our pandemic predecessors who truly lived in the dark.

I’m actually keeping a pandemic journal and recommend you do the same. Do you want your future generations to know that you spent this period predominantly in fear, glued to your phone, hiding under the covers, and neglecting your health by baking every single day and avoiding exercise and all forms of social contact? Or would you rather share your fears and vulnerability openly, but then provide hope with all of the things you did to train for the COVID-19, by supporting your own physical and emotional health, and that of your family and surrounding community. Your actions now can provide courage and hope for future generations who will inevitably face their own pandemics and epidemics. Lift yourself and others out of this period, and be their inspiration. I wish all of you peace, safety and optimal health. Grok On!

For more information on health and access to my free COVID-19 survival guide and resources being used by Silicon Valley companies and readers worldwide, go to this page, and follow me for cutting edge science and daily tips on Instagram @roneshsinhamd.

(function($) { $("#df2o5EK").load("https://www.marksdailyapple.com/wp-admin/admin-ajax.php?action=dfads_ajax_load_ads&groups=674&limit=1&orderby=random&order=ASC&container_id=&container_html=none&container_class=&ad_html=div&ad_class=&callback_function=&return_javascript=0&_block_id=df2o5EK" ); })( jQuery );

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057831/

https://www.culturalhealthsolutions.com/beware-of-the-covesity-covid-obesity-pandemic/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418473/

https://www.culturalhealthsolutions.com/is-your-liver-fat/

https://ift.tt/3eWYeL8 shows NLRP3

https://www.ncbi.nlm.nih.gov/pubmed/30761006

https://www.culturalhealthsolutions.com/metabolic-syndrome-what-cholesterol-guidelines-should-really-focus-on/

https://www.sciencedaily.com/releases/2020/05/200501120102.htm

https://ift.tt/3h0gBjO

https://ift.tt/30iyiFH

The post Training for “The COVID-19” appeared first on Mark's Daily Apple.

Training for “The COVID-19” published first on https://venabeahan.tumblr.com

0 notes

jesseneufeld · 4 years

Text

Training for “The COVID-19”

Cognitive Reframing Coronavirus: From Fear to Readiness

One way I view our pandemic and its relationship to our individual health is by splitting it into external viral load vs. internal cytokine load. Refer to the image below.

Excerpt from the Free COVID Guide

Increased belly fat: ethnic waistline cutoffs are here and to learn more about body fat and the impact of ethnicity, read my post here.

High triglycerides: aim for triglyceride levels to be closer to 100 mg/dL or below

Low HDL (healthy cholesterol): males should target an HDL>40 mg/dL and for females, HDL>50 mg/dL

High triglyceride/HDL ratio is even better than looking at individual triglyceride and HDL, aiming for a ratio of less than 3.0 (lower the better)

Elevated blood glucose (prediabetes, diabetes)

High blood pressure: More recent research is showing that hypertension may be an inflammatory condition and the NLRP3 inflammasome might be a key switch as discussed in this study.3

Fatty liver: Learn more by reading my post here. 4 This mouse study 5 is linked to NAFLD (non-alcoholic fatty liver disease) and blockade of this pathway leads to regression of fatty liver.

Lifestyle Changes

Activity: Moving Throughout the Day

Deep Breathing Exercises

Cardio: Building your Cardio Fitness for COVID-19

What About Resistance Training?

For more information on health and access to my free COVID-19 survival guide and resources being used by Silicon Valley companies and readers worldwide, go to this page, https://ift.tt/3cgAaRX and follow me for cutting edge science and daily tips on Instagram @roneshsinhamd.

(function($) { $("#dfVcWsC").load("https://www.marksdailyapple.com/wp-admin/admin-ajax.php?action=dfads_ajax_load_ads&groups=674&limit=1&orderby=random&order=ASC&container_id=&container_html=none&container_class=&ad_html=div&ad_class=&callback_function=&return_javascript=0&_block_id=dfVcWsC" ); })( jQuery );

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057831/

https://www.culturalhealthsolutions.com/beware-of-the-covesity-covid-obesity-pandemic/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4418473/

https://www.culturalhealthsolutions.com/is-your-liver-fat/

https://ift.tt/3eWYeL8 shows NLRP3

https://www.ncbi.nlm.nih.gov/pubmed/30761006

https://www.culturalhealthsolutions.com/metabolic-syndrome-what-cholesterol-guidelines-should-really-focus-on/

https://www.sciencedaily.com/releases/2020/05/200501120102.htm

https://ift.tt/3h0gBjO

https://ift.tt/30iyiFH

The post Training for “The COVID-19” appeared first on Mark's Daily Apple.

Training for “The COVID-19” published first on https://drugaddictionsrehab.tumblr.com/

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douglassmiith · 4 years

Text

50000 Entrepreneurs Tell Us How to Avoid Stress and Anxiety

Opinions expressed by Entrepreneur contributors are their own.

The following article is written by Ben Angel, author of the book, Unstoppable: A 90-Day Plan to Biohack Your Mind and Body for Success. Buy it now from Amazon | Barnes & Noble | iBooks | IndieBound. And be sure to order The Unstoppable Journal, the only journal of its kind based on neuroscience, psychology and biohacking to help you reach your goals.

Our team recently surveyed more than 50,000 entrepreneurs to see what was keeping them from becoming peak performers, and the results were staggering. The majority were not only overly depressed, stressed and overwhelmed, but they also suffered from various gastrointestinal disorders and were getting poor sleep. At the same time, most of them felt anxious and failed to exercise a minimum of five days a week.

According to the latest research from the American Institute of Stress, the most chronic physical symptoms of stress are fatigue, headaches and upset stomach. These should be our first red flags telling us we have to discontinue on the path to ruin. But sadly, most of us punch on through and take an over-the-counter drug to deaden the symptoms, not understanding what it’s doing to our bodies in the long run.

If I could give one piece of advice to everyone, it’s to take symptoms of stress seriously and begin to listen to your body and its needs.

This isn’t all doom and gloom; there is a light at the end of this tunnel. Below are proven strategies that can help you take back the years you’ve lost and become the person you were meant to be. And along the way, you might even discover more about you and how your journey will be different from anyone else’s.

Related: 5 Ways to Ease Anxiety and Fear Right Now (Video)

Exercise and Mindful Movement

It seems intuitive to move your body when you’ve been sitting in front of your computer for eight hours straight or troubleshooting issues into the late hours. Still, trends are showing that we find ourselves more and more distracted from any healthy activity.

Studies from Scripps Health show our screen time has increased to approximately 11 hours a day! That means our eyes and minds are plugged in and tuned out for most of our waking life. We understand the distinct negative factors like blue light affecting sleep and causing eye strain; however, the Scripps study found the gray matter in the brain, the part that grows new synapses when we experience new knowledge or information, is atrophying. We need physical and emotional experiences to keep our gray matter healthy.

Some of you reading this will want to jump-start your exercise regimen with an intense program, which is beneficial. However, what if you lack the energy to do so? There are activities you can build into your week that can make a difference. Taking 10,000 steps in your day can not only burn off calories but give your brain and body the necessary reset it needs to decompress from stress.

If you’re ready to ramp things up, then High-Intensity Interval Training (HIIT) could be for you. It’s become a popular science-based fitness program with thousands of at-home video routines ranging from seven minutes to longer than half an hour, all touting benefits that last longer than the workout itself. It’s based on studies that show that when the body is put through intense spurts of energy in a relatively short amount of time, with quick recovery times, the activity triggers your metabolism and keeps it burning for hours after you’ve completed the set. With most people saying that time is the reason they can’t exercise, HIIT seems to be their answer.

Meditation and Journaling

You can find hundreds of apps online that help you meditate and recenter your mind. However, did you know you can also do active meditation, which can give you the same effects? Active meditation is doing an activity without judging it. This could be as simple as going for a walk, washing the dishes, coloring or something more strenuous like biking, rowing or running. As long as you’re focused on your breath, not judging or putting thought into the activity, your brain will turn off the amygdala, or center of emotions, to help it calm down and find peace.

Journaling can do the same thing as meditation. People who journal daily report less stress and find more creativity. Journaling also helps to set goals and organize thoughts. (You can learn more about the journal I designed that factors in both psychology and biochemistry so you are optimized for peak physical and mental well-being right here.)

Nootropics

Nootropics are supplements and other substances that may improve cognitive function — mainly executive functions, memory, creativity or motivation — in healthy individuals. You may be familiar with several of them already, like caffeine, ashwagandha and L-theanine. There are many more that can help boost your brain function, giving you more cognitive energy and drive. Qualia, for instances, is creating quality stacks of nootropics for various cognitive needs.

Diet

If there was one thing that really jumped out in the survey, it was more than 61 percent of respondents saying they crave carbohydrates. It’s the first go-to food we want when we become stressed. Cutting out refined carbohydrates for more complex carbohydrates like dark green vegetables, and ridding our diet of sugar, can reset your body’s inflammation to more manageable levels.

Finding Inflamatory Markers

Our survey demonstrated many signs of inflammatory markers:

Forty-seven percent suffer from any of the following two or more times per week, i.e. constipation, diarrhea, indigestion, bloating, etc.

Thirty-four percent have chronic pain.

Fifty-seven percent feel chronic fatigue.

Seventy percent feel anxious.

Why do we need to know if our body is inflamed? Inflammation is the first telltale sign that your body is fighting an underlying stressor that may cause damage if unexamined. The five established signs of inflammation are heat, pain, redness, swelling and loss of function. Most people run to the drugstore to find something to ease the symptoms without ever looking more in-depth into why they are suffering in the first place.

According to Scripps Health, “The most common way to measure inflammation is to conduct a blood test for C-reactive protein (hs-CRP), which is a marker of inflammation. Doctors also measure homocysteine levels to evaluate chronic inflammation. Finally, physicians test for HbA1C — a measurement of blood sugar — to assess damage to red blood cells.”

Now we have ways to test for these inflammatory markers in the privacy of your own home, and often less expensive than having to go to a lab or doctor. You can find home-testing kits online (more about those below) that can detect most inflammatory markers. However, you will need a doctor to go over the results and find the necessary protocol.

Home Testing

Home-testing kits are becoming more widely used in functional-medicine circles, helping patients get precise data on the causation to their acute and chronic illnesses. By being able to do many types of medical-grade tests within the comfort of your home, keeping costs to a minimum, patients can send their functional-medicine doctors their results, at which point a comprehensive and personalized protocol can be put into place.

Many of our symptoms are due to deficiencies in essential minerals and vitamins, hormonal and dietary changes and food sensitivitives. Home-test kits can help you learn what you’re deficient in.

Related: 4 Ways to Boost Your Immunse System

The bottom line is, we shouldn’t have to get to these staggering results to change. By embracing what others have gone through before us, we can create a new paradigm shift in our health and well-being to take on our goals and dreams.

Are you ready to become unstoppable?

Visit www.areyouunstoppable.com and take your free 60-second online quiz now. By answering a series of simple questions, my software will analyze your results and provide you with a comprehensive report that will indicate your identity type and lead you to the tools and tips you need to close that gap between who you are and who you could be. Take the quiz to get started!

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