Diabetes Mellitus - Types of Diabetes - Causes, Symptoms, and Treatments

Diabetes mellitus often simply referred to as diabetes is a disease in which your blood glucose, or sugar, levels are too high, as a result of the body either not producing enough insulin, or because body cells do not properly respond to the insulin that is produced. Insulin is a hormone produced in the pancreas which enables body cells to absorb glucose, to turn into energy. If the body cells do not absorb the glucose, the glucose accumulates in the blood (hyperglycemia), leading to various potential medical complications.

Diabetes Causes

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:

* A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
* An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.

People with diabetes have high blood sugar. This is because:

* Their pancreas does not make enough insulin
* Their muscle, fat, and liver cells do not respond to insulin normally
* Both of the above

Diabetes Types

There are many types of diabetes, the most common of which are:

* Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin.
* Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency.
* Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM.

Type 1 diabetes



Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency. This type of diabetes can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss is a T-cell mediated autoimmune attack.

Type 1 diabetes is usually diagnosed in childhood. Many patients are diagnosed when they are older than age 20.Daily injections of insulin are needed. The exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role.

Type 2 diabetes



Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. Type 2 diabetes is the most common type.

It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin.

In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses, the impairment of insulin secretion occurs, and therapeutic replacement of insulin may sometimes become necessary in certain patients.

Gestational diabetes



Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life.

Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.

Other types

Pre-diabetes indicates a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. Many people destined to develop type 2 diabetes spend many years in a state of pre-diabetes which has been termed "America's largest healthcare epidemic,"

Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.

Diabetes Symptoms

High blood levels of glucose can cause several problems, including:

* Blurry vision
* Excessive thirst
* Fatigue
* Frequent urination
* Hunger
* Weight loss

However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all.

Symptoms of type 1 diabetes:

* Fatigue
* Increased thirst
* Increased urination
* Nausea
* Vomiting
* Weight loss in spite of increased appetite

Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting.

Symptoms of type 2 diabetes:

* Blurred vision
* Fatigue
* Increased appetite
* Increased thirst
* Increased urination

Diabetes Treatment

The immediate goals are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital.

The long-term goals of treatment are to:

* Prolong life
* Reduce symptoms
* Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs

These goals are accomplished through:

* Blood pressure and cholesterol control
* Careful self testing of blood glucose levels
* Education
* Exercise
* Foot care
* Meal planning and weight control
* Medication or insulin use

There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms.

LEARN THESE SKILLS

Basic diabetes management skills will help prevent the need for emergency care. These skills include:

* How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)
* What to eat and when
* How to take insulin or oral medication
* How to test and record blood glucose
* How to test urine for ketones (type 1 diabetes only)
* How to adjust insulin or food intake when changing exercise and eating habits
* How to handle sick days
* Where to buy diabetes supplies and how to store them

After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. Review and update your knowledge, because new research and improved ways to treat diabetes are constantly being developed.

SELF-TESTING



If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications.

The American Diabetes Association recommends keeping blood sugar levels in the range of:

* 80 - 120 mg/dL before meals
* 100 - 140 mg/dL at bedtime

Your doctor may adjust this depending on your circumstances.

WHAT TO EAT

You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can help you plan your dietary needs.

People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low.

People with type 2 diabetes should follow a well-balanced and low-fat diet.

HOW TO TAKE MEDICATION

Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs.

People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use inhaled insulin. See also: Type 1 diabetes

Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. See also: Type 2 diabetes

Medications may be switched to insulin during pregnancy and while breastfeeding.

Gestational diabetes may be treated with exercise and changes in diet.

EXERCISE

Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly.

Here are some exercise considerations:

* Always check with your doctor before starting a new exercise program.
* Ask your doctor or nurse if you have the right footwear.
* Choose an enjoyable physical activity that is appropriate for your current fitness level.
* Exercise every day, and at the same time of day, if possible.
* Monitor blood glucose levels before and after exercise.
* Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise.
* Carry a diabetes identification card and a cell phone in case of emergency.
* Drink extra fluids that do not contain sugar before, during, and after exercise.

You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low.

FOOT CARE

People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body's ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur.

If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations.

To prevent injury to the feet, check and care for your feet every day.

Possible Complications

Emergency complications include:

* Diabetic hyperglycemic hyperosmolar coma
* Diabetic ketoacidosis

Long-term complications include:

* Atherosclerosis
* Coronary artery disease
* Diabetic nephropathy
* Diabetic neuropathy
* Diabetic retinopathy
* Erection problems
* Hyperlipidemia
* Hypertension
* Infections of the skin, female urinary tract, and urinary tract
* Peripheral vascular disease
* Stroke


Source:health.nytimes

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Psoriatic Arthritis Symptoms and Treatment Solutions | Psoratic Arthritis Pain Relief

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Psoriatic arthritis is a specific condition in which a person has both psoriasis and arthritis. Psoriasis is a skin condition characterized by red, scaly raised areas. It may occur in localized areas or all over the body. In some cases, arthritis may develop before the skin disease is apparent. A person with psoriasis generally has patches of raised red skin with scales. The affected skin looks different depending on the type of psoriasis the individual has. Arthritis is joint inflammation.

Psoriatic arthritis is an autoimmune disease, meaning that your cells and antibodies (part of your immune system) fight your own tissues. Rarely, a person can have psoriatic arthritis without having obvious psoriasis. Usually, the more severe the skin symptoms are, the greater the likelihood a person will have psoriatic arthritis.

Psoriatic Arthritis Causes

The cause of psoriatic arthritis is currently unknown. It may have a combination of genetic (family), environmental, and immune causes. About 40% of people with psoriasis or psoriatic arthritis have a close relative with the condition. Some cases of psoriasis may be linked to infections.

Variable Symptoms of Psoriatic Arthritis

There are typically 6 variants of psoriatic arthritis:

1. Swelling of both the joint and tendon so that the involved toe or finger resembles a sausage.
2. Involvement of the joints next to the finger nails - often those nails will contain tiny pits.
3. Similar appearance to rheumatoid arthritis (RA) - eg. symmetrical involvement of the hands, feet, knees or ankles.
4. Involvement of the spine - typically associated with the HLA-B27 gene.
5. A very destructive, deforming arthritis - rare.
6. Associated with the HIV infection - while uncommon, this typically occurs with a very severe form of psoriasis
   

Patterns of joint pain in psoriatic arthritis

Doctors have identified five types of psoriatic arthritis, and you may experience several of them over time. They include:

1. Pain in joints on one side of your body. The mildest form of psoriatic arthritis, called asymmetric psoriatic arthritis, usually affects joints on only one side of your body or different joints on each side — including those in your hip, knee, ankle or wrist. Fewer than five joints are generally involved, and they're often tender and red. When asymmetric arthritis occurs in your hands and feet, swelling and inflammation in the tendons can cause your fingers and toes to resemble small sausages (dactylitis).

2. Pain in joints on both sides of your body. Symmetric psoriatic arthritis usually affects five or more of the same joints on both sides of your body. More women than men have symmetric psoriatic arthritis, and psoriasis associated with this condition tends to be severe.



3. Pain in your finger joints. Distal interphalangeal (DIP) joint predominant psoriatic arthritis is rare and occurs mostly in men. This type of arthritis affects the small joints closest to the nails (distal joints) in the fingers and toes. The nails, too, often show classic signs of psoriasis, including thickening, pitting and discoloration.

4. Pain in your spine. This form of psoriatic arthritis, called spondylitis, can cause inflammation in your spine as well as stiffness and inflammation in your neck, lower back or sacroiliac joints. Inflammation can also occur where ligaments and tendons attach to your spine. As the disease progresses, movement tends to become increasingly painful and difficult.

5. Destructive arthritis. A small percentage of people with psoriatic arthritis have arthritis mutilans — a severe, painful and disabling form of the disease. Over time, arthritis mutilans destroys the small bones in your hands, especially the fingers, leading to permanent deformity and disability.

Psoriatic Arthritis Treatments and Pain Relief

No cure exists for psoriatic arthritis, so treatment focuses on controlling inflammation in your affected joints to prevent joint pain and disability. Often, a multidisciplinary approach is used to treat both skin and joint symptoms.

Medications
Medications commonly used to treat psoriatic arthritis include:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs). Drugs such as aspirin and ibuprofen (Advil, Motrin, others) may help control pain, swelling and morning stiffness, and they're usually the first treatment tried for psoriatic arthritis. Prescription NSAIDs provide higher potencies than do over-the-counter drugs. But all NSAIDs can irritate your stomach and intestine, and long-term use can lead to ulcers and gastrointestinal bleeding.

Other potential side effects include damage to your kidneys, fluid retention and heart failure. In addition, NSAIDs may worsen skin problems. Still, these medications may be a good option for people with minor joint pain and stiffness.

2. Corticosteroids. If you have mild psoriatic arthritis, your doctor might recommend corticosteroids to control infrequent joint pain flares. Corticosteroids can be taken orally, or they can be injected directly into aching joints. Corticosteroid injections provide almost immediate relief and improve range of motion — sometimes for months. But because injected steroids can cause damage, their use is usually limited.

3. Disease-modifying antirheumatic drugs (DMARDs). Rather than just reducing pain and inflammation, this class of drugs helps limit the amount of joint damage that occurs in psoriatic arthritis. But because DMARDs act slowly, you may not notice the effects for weeks or even months. For that reason, your doctor may prescribe a pain reliever, such as aspirin, in addition to a DMARD. Examples of DMARDs include sulfasalazine (Azulfidine) and methotrexate. The latter, particularly, has potentially serious side effects, including lung disease and liver problems. Taking folic acid with methotrexate can relieve certain side effects such as a sore mouth and an upset stomach.

4. Immunosuppressant medications. These medications act to suppress your immune system, which normally protects your body from harmful organisms, but which attacks healthy tissue in people with psoriatic arthritis. Commonly used immunosuppressants include azathioprine (Imuran), cyclosporine (Sandimmune, Neoral) and leflunomide (Arava).

Immunosuppressants can have potentially dangerous side effects and usually are used in only the most severe cases of psoriatic arthritis. Because they suppress the immune system, all such drugs can lead to anemia and an increased risk of serious infection. And many of them can cause liver and kidney problems.

5. TNF-alpha inhibitors. Your doctor may recommend tumor necrosis factor-alpha (TNF-alpha) inhibitors if you have severe psoriatic arthritis. These drugs block the protein that causes inflammation in some types of arthritis. Drugs in this category include etanercept (Enbrel), adalimumab (Humira) and infliximab (Remicade). TNF-alpha inhibitors can improve signs and symptoms of psoriasis, as well. All carry a risk of serious side effects, however, including some that can be life-threatening. Be sure to discuss with your doctor whether the benefits you'll receive from these medications outweigh the risks. Keep in mind that these treatments, which must be injected, are very expensive, often costing thousands of dollars per treatment. If you and your doctor decide to use TNF inhibitors, check with your insurance company about coverage.

More severe arthritis requires treatment with more powerful drugs called disease-modifying antirheumatic drugs (DMARDS) such as:

* Leflunomide
* Methotrexate
* Sulfasalazine

New medications that block an inflammatory protein called tumor necrosis factor (TNF) are becoming the treatment of choice. These include:
* Adalimumab (Humira)
* Etanercept (Enbrel)
* Infliximab (Remicade)

Occasionally, particularly painful joints may be injected with steroid medications.

In rare cases, surgery to repair or replace damaged joints is needed.

Your doctor may suggest a healthy mix of rest and exercise. Physical therapy may help increase movement of specific joints. You may also use heat and cold therapy.

Surgery

Although surgery is rarely performed for psoriatic arthritis, your doctor may recommend some form of joint operation when other treatments fail to relieve your symptoms. Surgeons use various procedures to ease pain and restore mobility. Because these operations pose some risks, be sure you thoroughly discuss your options with your doctor.

Source:
- emedicinehealth
- mayoclinic

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Acid Reflux During Pregnancy

Gastroesophageal reflux disease occurs in up to 50% of pregnant women. Many women experience heartburn for the first time during pregnancy — and though it's common and generally harmless, it can be quite uncomfortable.



Heartburn (also called acid indigestion or acid reflux) is a burning sensation that often extends from the bottom of the breastbone to the lower throat. It's caused by some of the hormonal and physical changes in your body.

During pregnancy, the placenta produces the hormone progesterone, which relaxes the smooth muscles of the uterus. This hormone also relaxes the valve that separates the esophagus from the stomach, allowing gastric acids to seep back up, which causes that unpleasant burning sensation. Additionally, the growing fetus causes an increase in intra-abdominal pressure, resulting in an increase in the development of reflux.

Progesterone also slows down the wavelike contractions of your esophagus and intestines, making digestion sluggish. Later in pregnancy, your growing baby crowds your abdominal cavity, pushing the stomach acids back up into the esophagus.

Many women start experiencing heartburn and other gastrointestinal discomforts in the second half of pregnancy. Unfortunately, it usually comes and goes until your baby is born.

It can be tough when you get pregnant. Acid reflux during pregnancy can be one problem that you will have to take care of. The discomforts are common when you are pregnant and some time you may even get pain. You can not use medicine since you are now pregnant. Most of medicines are not tested to the pregnant ladies to prove their safety. They can not do that. You have to bear in mind that using medicines is not safe.

Read more Acid Reflux During Pregnancy

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Medication for Osteoporosis | Preventing Osteoporosis

What is Osteoporosis? |The Definition of Osteoporosis

Osteoporosis is a disease in which bones become fragile and more likely to break. Osteoporosis leads to literally abnormally porous bone that is more compressible like a sponge, than dense like a brick.



Normal bone is composed of protein, collagen, and calcium all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone fracture. The fracture can be either in the form of cracking (as in a hip fracture), or collapsing (as in a compression fracture of the vertebrae of the spine) and wrist. If not prevented or if left untreated, osteoporosis can progress painlessly until a bone breaks.

In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones. Although it's often thought of as a women's disease, osteoporosis also affects many men.

The Symptoms of Osteoporosis

The osteoporosis condition can be present without any symptoms for decades, because osteoporosis doesn't cause symptoms unless bone fractures. Some osteoporosis fractures may escape detection until years later. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. Then the symptoms are related to the location of the fractures.

Fractures of the spine (vertebra) can cause severe "band-like" pain that radiates around from the back to the side of the body. Over the years, repeated spine fractures can cause chronic lower back pain as well as loss of height or curving of the spine, which gives the individual a hunched-back appearance of the upper back, often called a "dowager hump."

A fracture that occurs during the course of normal activity is called a minimal trauma fracture or stress fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb.

Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of trivial accidents. Hip fractures may also be difficult to heal after surgical repair because of poor bone quality.

Symptoms occur late in the disease and they are:


- Loss of height as a result of weakened spines. A person may find that his/her clothes are no longer fitting and their pants looking longer. Patients may loose as much as 6 inches in height.

- Cramps in the legs at night

- Bone pain and tenderness

- Neck pain, discomfort in the neck other than from injury or trauma

- Persistent pain in the spine or muscles of the lower back

- Abdominal pain

- Tooth loss

- Rib pain

- Broken bones

- Spinal deformities become evident like stooped posture, an outward curve at the top of the spine as a result of developing a vertebral collapse on the back.

- Fatigue

- Periodontal disease

- Brittle fingernails

Symptoms of bone weakness from advanced osteoporosis:

* Thin bones
* Brittle bones
* Weak bones
* Fractures
* Fracturing easily
* Backache
* Loss of height
* Spine deformation

What Causes of Osteoporosis?



Osteoporosis occurs when there is an imbalance between new bone formation and old bone resorption. The body may fail to form enough new bone, or too much old bone may be reabsorbed, or both.

Two essential minerals for normal bone formation are calcium and phosphate. Throughout youth, the body uses these minerals to produce bones. Calcium is essential for proper functioning of the heart, brain, and other organs. To keep those critical organs functioning, the body reabsorbs calcium that is stored in the bones to maintain blood calcium levels. If calcium intake is not sufficient or if the body does not absorb enough calcium from the diet, bone production and bone tissue may suffer. Thus, the bones may become weaker, resulting in brittle and fragile bones that can break easily.

Usually, the loss of bone occurs over an extended period of years. Often, a person will sustain a fracture before becoming aware that the disease is present. By then, the disease may be in its advanced stages and damage may be serious.

The leading cause of osteoporosis is a lack of certain hormones, particularly estrogen in women and androgen in men. Women, especially those older than 60 years of age, are frequently diagnosed with the disease. Menopause is accompanied by lower estrogen levels and increases a woman's risk for osteoporosis. Other factors that may contribute to bone loss in this age group include inadequate intake of calcium and vitamin D, lack of weight-bearing exercise, and other age-related changes in endocrine functions (in addition to lack of estrogen).

Other conditions that may lead to osteoporosis include overuse of corticosteroids (Cushing syndrome), thyroid problems, lack of muscle use, bone cancer, certain genetic disorders, use of certain medications, and problems such as low calcium in the diet.

What are the Risk Factors for Developing Osteoporosis?

Factors that will increase the risk of developing osteoporosis are:

* Female gender; especially women who are thin or have a small frame, as are those of advanced age.

* Caucasian or Asian race; especially those with a family member with osteoporosis, have a greater risk of developing osteoporosis than other women.

* Thin and small body frames;

* Family history of osteoporosis (for example, having a mother with an osteoporotic hip fracture doubles your risk of hip fracture);

* Personal history of fracture as an adult;

* Cigarette smoking; eating disorders such as anorexia nervosa or bulimia, low amounts of calcium in the diet, heavy alcohol consumption, inactive lifestyle, and use of certain medications, such as corticosteroids and anticonvulsants, are also risk factors.

* Excessive alcohol consumption;

* Lack of exercise;

* Diet low in calcium;

* Poor nutrition and poor general health;

* Malabsorption (nutrients are not properly absorbed from the gastrointestinal system) from conditions such as celiac sprue;

* Low estrogen levels (such as occur in menopause or with early surgical removal of both ovaries);

* Chemotherapy can cause early menopause due to its toxic effects on the ovaries;

* Amenorrhea (loss of the menstrual period) in young women also causes low estrogen and osteoporosis; Amenorrhea can occur in women who undergo extremely vigorous training and in women with very low body fat (example: anorexia nervosa);

* Chronic inflammation, due to diseases (such as rheumatoid arthritis and chronic liver diseases);

* Immobility, such as after a stroke, or from any condition that interferes with walking;

* Women who are postmenopausal, including those who have had early or surgically induced menopause, or abnormal or absence of menstrual periods are at greater risk.

* Hyperthyroidism, a condition wherein too much thyroid hormone is produced by the thyroid gland (as in Grave's disease) or is caused by taking too much thyroid hormone medication;

* Hyperparathyroidism, a disease wherein there is excessive parathyroid hormone production by the parathyroid gland (a small gland located near the thyroid gland). Normally, the parathyroid hormone maintains blood calcium levels by, in part, removing calcium from the bone. In untreated hyperparathyroidism, excessive parathyroid hormone causes too much calcium to be removed from the bone, which can lead to osteoporosis;

* Vitamin D deficiency. Vitamin D helps the body absorb calcium. When vitamin D is lacking, the body cannot absorb adequate amounts of calcium to prevent osteoporosis. Vitamin D deficiency can result from lack of intestinal absorption of the vitamin such as occurs in celiac sprue and primary biliary cirrhosis;

* Certain medications can cause osteoporosis. These include long-term use of heparin (a blood thinner), anti-seizure medications phenytoin (Dilantin) and phenobarbital, and long term use of oral corticosteroids (such as Prednisone).

How is Osteoporosis Diagnosed?

An examination to diagnose osteoporosis can involve several steps that predict your chances of future fracture, diagnose osteoporosis, or both. It might include:

1. An Initial Physical Exam

2. Various X Rays that detect skeletal problems. A routine x-ray can reveal osteoporosis of the bone, which appears much thinner and lighter than normal bones. Unfortunately, by the time x-rays can detect osteoporosis, at least 30% of the bone has already been lost. In addition, x-rays are not accurate indicators of bone density. The appearance of the bone on x-ray is often affected by variations in the degree of exposure of the x-ray film.

3. Laboratory Tests that reveal important information about the metabolic process of bone breakdown and formation. A number of lab tests may be performed on blood and urine samples. The results of these tests can help your doctor identify conditions that may be contributing to your bone loss.

The most common blood tests evaluate:

* blood calcium levels
* blood vitamin D levels
* thyroid function
* parathyroid hormone levels
* estradiol levels to measure estrogen (in women)
* follicle stimulating hormone (FSH) test to establish menopause status
* testosterone levels (in men)
* osteocalcin levels to measure bone formation.

The most common urine tests are:

* 24-hour urine collection to measure calcium metabolism
* tests to measure the rate at which a person is breaking down or resorbing bone.


4. A Bone Mineral Density test to detect low bone density. A bone mineral density (BMD) test is the best way to determine your bone health. BMD tests can identify osteoporosis, determine your risk for fractures, and measure your response to osteoporosis treatment.

The Treatment of Osteoporosis | Medications for Osteoporosis | Prevention of Osteoporosis

Because osteoporosis is difficult to reverse, prevention is the key to treatment.



Calcium and vitamin D are needed for strong bones. If calcium intake is not sufficient or if the body cannot absorb enough calcium, bone tissues become weaker. Throughout life calcium intake is important for bone formation. Vitamin D plays a crucial role in calcium absorption. Building strong bones by eating calcium-rich foods, maintaining a well-balanced diet and exercising during childhood and adolescence can be the best defense against osteoporosis.

Menopausal hormone replacement therapy -- either estrogen alone or a combination of estrogen and progestin -- was used for prevention and treatment of osteoporosis. However, in July 2002, a landmark study revealed that hormone therapy increases the risk of breast cancer, heart disease, and stroke in some women. Hormone replacement therapy is known to help preserve bone and prevent fractures, but is not generally recommended at this point for osteoporosis because the risks are thought to outweigh the benefits.

In women who have been on hormone replacement therapy in the past and then stopped it, the bone begins to thin again -- at the same pace as during menopause.

Evista is an osteoporosis drug that has some actions similar to estrogen, such as the ability to maintain bone mass. However, studies have shown that it doesn't increase the risk of breast or uterine cancers like estrogen. Evista can cause blood clots and often increases hot flashes.

Actonel, Boniva, and Fosamax (also available as generic) treat osteoporosis by inhibiting cells that break down bone and slowing bone loss. Actonel and Fosamax are usually taken once a week while Boniva is taken once a month. There are strict ways to take these medications, since if taken incorrectly, they can lead to ulcers in the esophagus.

Another new osteoporosis medication is Reclast, which is given as a once-yearly 15-minute infusion in a vein. Reclast is said to increase bone strength and reduce fractures in the hip, spine and wrist, arm, leg, or rib.

Forteo is a new medication used for the treatment of osteoporosis in postmenopausal women and men who are at high risk for a fracture. A synthetic form of the naturally occurring parathyroid hormone, Forteo is the first drug shown to stimulate new bone formation and increase bone mineral density. It is self-administered as a daily injection for up to 24 months. Side effects include nausea, leg cramps, and dizziness.

Calcitonin is another treatment option for osteoporosis. Calcitonin is a naturally occurring hormone that inhibits bone loss. It is available as a nasal spray or injection and is quite expensive. Undesirable side effects include nausea and skin rashes.

Calcium Supplements

The following calcium intake has been recommended by The National Institutes of Health Consensus Conference on Osteoporosis for all people, with or without osteoporosis:

* 800 mg/day for children ages 1 to 10

* 1000 mg/day for men, premenopausal women, and postmenopausal women also taking estrogen

* 1200 mg/day for teenagers and young adults ages 11 to 24

* 1500 mg/day for post menopausal women not taking estrogen

* 1200mg to 1500 mg/day for pregnant and nursing mothers

* The total daily intake of calcium should not exceed 2000 mg

Daily calcium intake can be calculated by the following method:

1. Excluding dairy products, the average American diet contains approximately 250 mg of calcium;

2. There is approximately 300 mg of calcium in an 8-ounce glass of milk;

3. There is approximately 450 mg of calcium in 8 ounces of plain yogurt;

4. There is approximately 1300 mg of calcium in 1 cup of cottage cheese;

5. There is approximately 200 mg of calcium in 1 ounce of cheddar cheese;

6. There is approximately 90 mg of calcium in ½ cup of vanilla ice cream;

7. There is approximately 300 mg of calcium in 8 ounces of calcium-fortified orange juice.

Vitamin D

An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength. However, vitamin D and calcium alone are not sufficient treatment for osteoporosis. They are given in conjunction with other treatments. Vitamin D is important in several respects:

* Vitamin D helps the absorption of calcium from the intestines.

* A lack of vitamin D causes calcium-depleted bone (osteomalacia), which further weakens the bones and increases the risk of fractures.

* Vitamin D, along with adequate calcium (1200 mg of elemental calcium), has been shown in some studies to increase bone density and decrease fractures in older postmenopausal, but not in premenopausal or perimenopausal women.

Osteoporosis Prevention Through Nutrition and Diet

To ensure that people are getting enough calcium to build and maintain strong bones, doctors recommend eating plenty of calcium-rich foods, such as nonfat milk, low-fat yogurt, broccoli, cauliflower, salmon, tofu, and leafy green vegetables.

According to a panel convened by the National Institutes of Health, women who are still menstruating, or who are postmenopausal but taking hormone replacement therapy, should get 1,000 mg of calcium each day. This jumps to 1,200 to 1,500 mg per day for pregnant or breastfeeding women. Postmenopausal women not on hormone replacement therapy should get 1,500 mg/day.

Recommended daily intake for men is 1,000 mg per day (25 to 65 years of age) and 1,500 mg per day from age 65 and up. One 8-ounce glass of skim milk has the same amount of calcium as whole milk, 300 mg.

Because most women take in only half or a third as much calcium as they need through their diet, most doctors recommend calcium supplements to make up the difference. Calcium supplements are available in many forms, but calcium citrate and calcium gluconate appear to be more effective at reducing bone loss.

To help the body absorb calcium, doctors suggest taking vitamin D (400 to 800 IU daily) supplements.

Calcium supplements can inhibit the absorption of certain drugs. Check with your doctor before beginning calcium supplements. You may need to take your supplements at a different time than your other medications.

Other Dietary Ways to Maintain Bone

In addition to eating calcium-rich foods, you should also avoid phosphorus-rich ones, which can promote bone loss. High-phosphorus foods include red meats, soft drinks, and those with phosphate food additives. Excessive amounts of alcohol and caffeine are also thought to reduce the amount of calcium absorbed by the body and should be avoided.

To help keep estrogen levels from dropping sharply after menopause, and thus help prevent osteoporosis, some practitioners advise postmenopausal women to consume more foods containing plant estrogens, especially tofu, soybean milk, and other soy products. However, there is no evidence to prove that these foods help prevent or delay the onset of osteoporosis.
At-Home Remedies

Here are two easy ways to increase the amount of calcium in your diet:

* Add nonfat dry milk to everyday foods and beverages, including soups, stews, and casseroles. Each teaspoon of dry milk adds about 20 mg of calcium to your diet.

* Add a little vinegar to the water you use to make soup stock from bones. The vinegar will dissolve some of the calcium out of the bones, for a calcium-fortified soup. A pint can contain as much as 1,000 mg of calcium.

Osteoporosis Prevention Through Exercise

Not only must you get enough calcium in your diet, you must also exercise to maintain strong bones. Studies have shown that weight-bearing exercises -- those that put stress on bones, such as running, walking, tennis, ballet, stair climbing, aerobics, and weightlifting -- reduce bone loss and help prevent osteoporosis. To benefit from the exercise, you must do it at least three times per week for 30 to 45 minutes. Although swimming and bicycle riding are great cardiovascular exercises, they do not appear to prevent osteoporosis because they do not put enough stress on bones.

resource :
- medicinenet
- emedicinehealth
- endocrineweb
- webmd

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Lumbar Spine Surgery | Lumbar Spinal Stenosis

By: Peter F. Ullrich, Jr., MD



Lumbar spine surgery is meant to help alleviate lower back pain conditions which can be caused from disc damage (i.e. degenerative disc disease, herniated disc) or other lumbar spine conditions (i.e. spondylolisthesis). Surgery should be a last resort for dealing with back problems and back pain issues. This page provides an in-depth, up-to-date list of resources and information on decompression surgery topics, including decompression, microdiscectomy, and other lumbar spine surgery options

Understanding Lumbar Spine Trauma

By : Eeric Truumees, MD
Spine Surgeon, William Beaumont Hospital, Royal Oak, MI
Orthopaedic Director, Gehring Biomechanics Laboratory, Royal Oak, MI



The spine


The spinal column consists of 33 vertebrae (figure 1A):

* 7 cervical (neck)(figure 1B)

* 12 thoracic (each connects to the 12 pairs of ribs)

* 5 lumbar (low back)

* 5 sacral (in an adult they are joined together as one bone called the sacrum, which does not contain any discs)

* 4 coccygeal (joined to form the single coccyx, also called the tailbone)

Sadly, trauma to the low back (lumbar spine) is common. People find hundreds of ways to injure their low back: car accidents, sports injuries, workplace injuries, falls, and violence. Doctors divide lumbar spine injuries into two broad categories, low and high energy. An example of a low energy injury would be a fender bender in which one car is stopped and the other is going 5 miles per hour. This type of collision or a fall while in the shower can cause low back pain, but the types of injuries seen are very different from a high speed collision in which the passenger is ejected from the car. Knowing exactly what happened to you helps the doctor figure out exactly what type of back injury you have. Another important element lies in any risk factors you may have for back injuries. For example, patients with soft bone (osteoporosis) may break their spine with less energy than someone with strong, healthy bone.

Low back spine injuries are also divided by the part of the back that was damaged. Injuries can affect the bone (fractures), the disks (herniations), ligaments (sprain), or muscles (strain). Each of these tissues has different needs while healing and some take longer than others. Doctors will list the level or levels affected. L1 (Lumbar 1) is at the top of the low back, L5 is at the bottom. Below the lumbar vertebrae is the sacrum.

Next, spine surgeons grade the severity of injury. For example, fractures range from simple compression fractures, where the bone collapses upon itself like a Styrofoam cup getting squashed together, to burst fractures, when pieces of bone explode out into the tissues around the spine, including the nerves and spinal cord. The worst of these injuries are called fracture-dislocations. Here, the bone breaks but, because the ligaments are torn as well, the bones slide away from each other. This situation is very unstable and almost always needs surgery.

Often, how a back injury is treated will depend on whether the nerves or spinal cord are involved. Luckily, many low back injuries will not involve the spinal cord, which ends in the upper part of the low back (at the L1-2 disk). The lowest part of the cord is called the conus medullaris. If this part of the cord is injured, patients will have trouble with bowel, bladder, and sexual function.

Below the conus medullaris are individual nerves (the cauda equina). While nerve injuries are not usually as devastating as spinal cord problems, pressure on many nerves at once (called cauda equina syndrome) is an emergency because long term leg weakness and bowel and bladder problems often results. Injury to a single nerve (sciatica or radiculopathy) may be intensely painful, but is less likely to cause major, permanent problems. If the part of the leg that that nerve goes to is weak, surgery will often be recommended, as it is with patients with spinal cord or cauda equina problems.

Strains, while painful, do not usually affect the nerves or the stability of the spine. Sometimes braces are used. Usually patients will require physical therapy to regain back strength. Most of these problems get better over 6 to 12 weeks.

Sprains or injuries to the spine ligaments may be relatively simple injuries and treated like strains. Sometimes, however, one of the major stabilizing ligaments of the spine is injured and surgery is needed to prevent the spine from slipping. That problem is more common in the neck than the low back.

In the low back, most serious injuries involve fracture of the spine or a disc herniation. Many of these can be treated non-operatively. More instability, collapse or nerve involvement leads to surgery. The goals of surgery are typically to take the pressure off the cord and nerves, improve the alignment of the spine, and to provide stability. Many injuries don’t include all three problems. But, for major alignment and stability problems, surgical correction often requires screws and rods to hold the spine back together. Bone grafts are used to allow the patients bones to heal together (fusion).

In some cases, the need for surgery is clear from the start (for example, the patient is getting weaker and weaker). Other times, an attempt is made to get the injury, a fracture for example, to heal in a brace. If the spine heals as expected, the brace is removed and therapy is started. If the spine fails to heal or the spine continues to collapse, surgery will be recommended. This can occur weeks or months after the initial injury.

In trauma, surgery may need to be performed from the front of the spine. Here an incision is made along the side of the abdomen. Sometimes one of the lower ribs is removed. This allows the surgeon direct access to the big vertebral body (the main bone of the spine). Broken fragments of bone can be removed and a strut of bone or a metal cage can be put it to keep the spine aligned. In other cases, an incision is made in the middle of the back and screws and rods are used to hold the spine. Smaller pieces of bone graft are placed along the spine to encourage it to heal together. For particularly severe or unstable injuries, surgery from both the front and the back of the spine is performed. The details about the various types of surgeries performed are available on this website.

Understanding Spinal Stenosis



By : Chris Sliva, MD

Spinal stenosis occurs when the available space for nerves is decreased and in the lower back when nerves traveling through the lumbar spine, en route to the legs, become compressed. It is usually a degenerative condition usually seen as part of the normal aging process that develops in patients 60 years and older. The condition, while rare, can occur in younger patients who have a congenitally narrow spinal canal.

Common symptoms of spinal stenosis include a deep aching pain or cramping sensation in the lower back or buttocks. Frequently, these symptoms radiate into one or both thighs and legs and this develops with walking or other activity. Symptoms are generally relieved through sitting, lying down or by bending at the waist. In rare cases, patients can lose motor function and sensation in the legs.

It is not uncommon for patients to have an x-ray as part of their initial diagnostic testing. X-rays can diagnose other common conditions associated with spinal stenosis such as arthritis (spondylosis) or spinal instability (spondylolisthesis) and help rule out other problems such as a fracture or a tumor in the vertebrae. Unfortunately, x-rays cannot visualize spinal nerves; therefore, a magnetic resonance imaging (MRI) study is utilized to detect spinal stenosis. For patients unable to undergo an MRI due to implanted devices such as pacemakers or a CT (computerized tomography), a myelogram may be used.

Usually, initial treatments are non-surgical. These include nonsteroidal anti-inflammatory medication, physical therapy and occasionally, epidural steroid injections. This approach may provide permanent or temporary relief. When symptoms are severe and progressive, surgery is indicated and it is usually recommended when back and leg pain limits normal activity and impairs quality of life.

There are several different surgical procedures and the choice of which is influenced by the severity and type of disease. The mainstay of treatment for spinal stenosis is a decompressive lumbar laminectomy to remove bone and soft tissue that is pressing on the nerves. In some patients, spinal instability make may it necessary for a fusion to be performed.

Following the surgical procedure, most patients notice relief of their leg discomfort and are able to walk longer distances. Physical therapy may be necessary for six to eight weeks after surgery for strengthening and conditioning.

It is most important to make an informed decision about your treatment. The potential benefits of surgery must be balanced with the risks for each individual patient in conjunction with any available treatment alternatives. Your spine surgeon will help you to determine whether or not you are a good candidate for surgery.

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High Cholesterol Disease

What is Cholesterol?



Also called: HDL, Hypercholesterolemia, Hyperlipidemia, Hyperlipoproteinemia, LDL.

Cholesterol is a fatty molecule that is manufactured by your liver. You need cholesterol in order to help you manufacture certain types of hormones. Cholesterol is a waxy, fatlike substance that your body needs to function normally. Cholesterol is naturally present in cell walls or membranes everywhere in the body, including the brain, nerves, muscles, skin, liver, intestines, and heart.

Your body uses cholesterol to produce many hormones, vitamin D, and the bile acids that help to digest fat. It takes only a small amount of cholesterol in the blood to meet these needs. If you have too much cholesterol in your bloodstream, the excess may be deposited in arteries, including the coronary (heart) arteries, where it contributes to the narrowing and blockages that cause the signs and symptoms of heart disease.

The main risk associated with high cholesterol is coronary heart disease (CHD). Your blood cholesterol level has a lot to do with your chances of getting heart disease. If cholesterol is too high, it builds up in the walls of your arteries. Over time, this buildup (called plaque) causes hardening of the arteries (atherosclerosis). Atherosclerosis causes arteries to become narrowed, slowing blood flow to the heart. Reduced blood flow to the heart can result in angina (chest pain) or in a heart attack in cases when a blood vessel is blocked completely.

A simple blood test checks for high cholesterol. Simply knowing your total cholesterol level is not enough. A complete lipid profile measures your LDL (low-density lipoprotein [the bad cholesterol]), total cholesterol, HDL (high-density lipoprotein [the good cholesterol]), and triglycerides—another fatty substance in the blood. Government guidelines say healthy adults should have this analysis every 5 years.

From The American Heart Association:
What’s the Difference Between LDL and HDL Cholesterol?

Why is LDL cholesterol considered “bad”?

When too much LDL cholesterol circulates in the blood, it can slowly build up in the inner walls of the arteries that feed the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog those arteries. This condition is known as atherosclerosis. If a clot forms and blocks a narrowed artery, it can cause a heart attack or stroke. The levels of HDL cholesterol and LDL cholesterol in the blood are measured to evaluate the risk of having a heart attack. LDL cholesterol of less than 100 mg/dL is the optimal level. Less than 130 mg/dL is near optimal for most people. A high LDL level (more than 160 mg/dL or 130 mg/dL or above if you have two or more risk factors for cardiovascular disease) reflects an increased risk of heart disease. That’s why LDL cholesterol is often called “bad” cholesterol.

Why is HDL cholesterol considered “good”?

About one-third to one-fourth of blood cholesterol is carried by high-density lipoprotein (HDL). HDL cholesterol is known as the “good” cholesterol because a high level of it seems to protect against heart attack. (Low HDL cholesterol levels [less than 40 mg/dL] increase the risk for heart disease.) Medical experts think that HDL tends to carry cholesterol away from the arteries and back to the liver, where it’s passed from the body. Some experts believe that HDL removes excess cholesterol from plaque in arteries, thus slowing the buildup.



What is Lp(a) cholesterol?

Lp(a) is a genetic variation of plasma LDL. A high level of Lp(a) is an important risk factor for developing fatty deposits in arteries prematurely. The way an increased Lp(a) contributes to disease isn’t understood. The lesions in artery walls contain substances that may interact with Lp(a), leading to the buildup of fatty deposits.

The triglyceride connection

Triglyceride is a form of fat. It comes from food and is also made in your body. People with high triglycerides often have a high total cholesterol, a high LDL cholesterol and a low HDL cholesterol level. Many people with heart disease also have high triglyceride levels. People with diabetes or who are obese are also likely to have high triglycerides. Triglyceride levels of less than 150 mg/dL are normal; levels from 150–199 are borderline high. Levels that are borderline high or high (200–499 mg/dL) may need treatment in some people. Triglyceride levels of 500 mg/dL or above are very high. Doctors need to treat high triglycerides in people who also have high LDL cholesterol levels.

High Cholesterol Causes and Risk.

Causes :

Several drugs and diseases can bring about high cholesterol, but, for most people, a high-fat diet and inherited risk factors may be the main causes. Your doctor will rule out the possibility that you have an underactive thyroid or kidney or liver disease.

* Heredity: Your genes influence how high your LDL (bad) cholesterol is by affecting how fast LDL is made and removed from the blood. One specific form of inherited high cholesterol that affects 1 in 500 people is called familial hypercholesterolemia, which often leads to early heart disease. But even if you do not have a specific genetic form of high cholesterol, genes play a role in influencing your LDL cholesterol level.

* Weight: Excess weight may modestly increase your LDL (bad) cholesterol level. If you are overweight and have a high LDL cholesterol level, losing weight may help you lower it. Weight loss especially helps to lower triglycerides and raise HDL (good) cholesterol levels.

* Physical activity/exercise: Regular physical activity may lower triglycerides and raise HDL cholesterol levels.

* Age and sex: Before menopause, women usually have lower total cholesterol levels than men of the same age. As women and men age, their blood cholesterol levels rise until about 60-65 years of age. After about age 50 years, women often have higher total cholesterol levels than men of the same age.

* Alcohol use: Moderate (1-2 drinks daily) alcohol intake increases HDL (good) cholesterol but does not lower LDL (bad) cholesterol. Doctors don't know for certain whether alcohol also reduces the risk of heart disease. Drinking too much alcohol can damage the liver and heart muscle, lead to high blood pressure, and raise triglyceride levels. Because of the risks, alcoholic beverages should not be used as a way to prevent heart disease.

* Mental stress: Several studies have shown that stress raises blood cholesterol levels over the long term. One way that stress may do this is by affecting your habits. For example, when some people are under stress, they console themselves by eating fatty foods. The saturated fat and cholesterol in these foods contribute to higher levels of blood cholesterol.

Risk Factor:

You're more likely to have high cholesterol that can lead to heart disease if you have any of these risk factors:

* Smoking. Cigarette smoking damages the walls of your blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower your level of HDL, or "good," cholesterol.
* Obesity. Having a body mass index (BMI) of 30 or greater puts you at risk of high cholesterol.
* Poor diet. Foods that are high in cholesterol, such as red meat and full-fat dairy products, will increase your total cholesterol. Eating saturated fat, found in animal products, and trans fats, found in some commercially baked cookies and crackers, also can raise your numbers.
* Lack of exercise. Exercise helps boost your body's HDL "good" cholesterol while lowering your LDL "bad"cholesterol. Not getting enough exercise puts you at risk of high cholesterol.
* High blood pressure. Increased pressure on your artery walls damages your arteries, which can speed the accumulation of fatty deposits.
* Diabetes. High blood sugar contributes to higher LDL cholesterol and lower HDL cholesterol. High blood sugar also damages the lining of your arteries.
* Family history of heart disease. If a parent or sibling developed heart disease before age 55, high cholesterol levels place you at a greater than average risk of developing heart disease.

Risk Factor Information

Rare cases of memory loss have been reported in people taking cholesterol-lowering statin drugs, such as Lipitor. But these reports were anecdotal and have not been substantiated by formal testing of cognitive function. In most of these cases, memory improved after the individuals stopped taking the statins. However, it's not clear whether the statin drugs caused the memory loss.

Decreased metabolism associated with underactive thyroid (hypothyroidism) causes high cholesterol. Treatment of hypothyroidism with thyroid hormone may improve cholesterol levels. If you have high cholesterol — especially if you have no previous history of high cholesterol — your doctor may recommend checking your thyroid hormone levels to see if an underactive thyroid is causing or contributing to the problem.

LDL contains the highest amount of cholesterol. HDL contains the highest amount of protein. VLDL contains the highest amount of triglyceride, a blood fat. Like LDL cholesterol, VLDL cholesterol is considered a type of "bad" cholesterol because elevated levels are associated with an increased risk of coronary artery disease.
By lowering your triglyceride levels, you also lower your VLDL cholesterol levels. Healthy lifestyle changes such as losing excess weight and exercising regularly can help lower triglyceride levels. Also, avoid sugary foods and alcohol, which have a particularly potent effect on increasing triglycerides.

© 1998-2007 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "Mayo Clinic Health Information," "Reliable information for a healthier life" and the triple-shield Mayo logo are trademarks of Mayo Foundation for Medical Education and Research.

High Cholesterol Symptoms and Signs



High cholesterol is usually discovered on routine screening and has no symptoms. It is more common if you have a family history of it, but lifestyle factors (such as eating a diet high in saturated fat) clearly play a major role.

If you have a routine blood test during a physical exam or while attending a health fair or screening at a shopping center, your blood may reveal a high total cholesterol level, which would require further testing to determine your LDL, HDL, and triglyceride levels (this is known as a lipid panel).

The National Cholesterol Education Program guidelines suggest that everyone aged 20 years and older should have their blood cholesterol level measured at least once every 5 years. It is best to have a blood test called a lipoprotein profile to find out your cholesterol numbers. This blood test is done after a 9- to 12-hour fast and gives information about the following items:

Your Total Blood (or Serum) Cholesterol Level

Less than 200 mg/dL: Desirable
If your LDL, HDL and triglyceride levels are also at desirable levels and you have no other risk factors for heart disease, total blood cholesterol below 200 mg/dL puts you at relatively low risk of coronary heart disease. Even with a low risk, however, it’s still smart to eat a heart-healthy diet, get regular physical activity and avoid tobacco smoke. Have your cholesterol levels checked every five years or as your doctor recommends.

200–239 mg/dL: Borderline-High Risk
If your total cholesterol falls between 200 and 239 mg/dL, your doctor will evaluate your levels of LDL (bad) cholesterol, HDL (good) cholesterol and triglycerides. It's possible to have borderline-high total cholesterol numbers with normal levels of LDL (bad) cholesterol balanced by high HDL (good) cholesterol. Work with your doctor to create a prevention and treatment plan that's right for you. Make lifestyle changes, including eating a heart-healthy diet, getting regular physical activity and avoiding tobacco smoke. Depending on your LDL (bad) cholesterol levels and your other risk factors, you may also need medication. Ask your doctor how often you should have your cholesterol rechecked.

240 mg/dL and over: High Risk
People who have a total cholesterol level of 240 mg/dL or more typically have twice the risk of coronary heart disease as people whose cholesterol level is desirable (200 mg/dL). If your test didn’t show your LDL cholesterol, HDL cholesterol and triglycerides, your doctor should order a fasting profile. Work with your doctor to create a prevention and treatment plan that's right for you. Whether or not you need cholesterol-regulating medication, make lifestyle changes, including eating a heart-healthy diet, getting regular physical activity and avoiding tobacco smoke.

Your HDL (Good) Cholesterol Level

With HDL (good) cholesterol, higher levels are better. Low HDL cholesterol (less than 40 mg/dL for men, less than 50 mg/dL for women) puts you at higher risk for heart disease. In the average man, HDL cholesterol levels range from 40 to 50 mg/dL. In the average woman, they range from 50 to 60 mg/dL. An HDL cholesterol of 60 mg/dL or higher gives some protection against heart disease.

People with high blood triglycerides usually also have lower HDL cholesterol and a higher risk of heart attack and stroke. Progesterone, anabolic steroids and male sex hormones (testosterone) also lower HDL cholesterol levels. Female sex hormones raise HDL cholesterol levels.

Your LDL (Bad) Cholesterol Level

The lower your LDL cholesterol, the lower your risk of heart attack and stroke. In fact, it's a better gauge of risk than total blood cholesterol. In general, LDL levels fall into these categories:

LDL Cholesterol Levels
Less than 100 mg/dL	Optimal
100 to 129 mg/dL	Near Optimal/ Above Optimal
130 to 159 mg/dL	Borderline High
160 to 189 mg/dL	High
190 mg/dL and above	Very High

Your Triglyceride Level

Triglyceride is a form of fat. People with high triglycerides often have a high total cholesterol level, including high LDL (bad) cholesterol and low HDL (good) cholesterol levels.

Your triglyceride level will fall into one of these categories:

* Normal: less than 150 mg/dL
* Borderline-High: 150–199 mg/dL
* High: 200–499 mg/dL
* Very High: 500 mg/dL

A triglyceride level of 150 mg/dL or higher is one of the risk factors of metabolic syndrome. Metabolic syndrome increases the risk for heart disease and other disorders, including diabetes.

By : American Heart Association

Medical Treatment

Several types of medicine are used to treat high cholesterol levels. Your doctor will decide which type of medicine is right for you. He or she may prescribe more than 1 of these drugs at a time because combinations of these medicines can be more effective.

Statins (also called HMG-CoA reductase inhibitors) slow down your body's production of cholesterol. These drugs also remove cholesterol buildup from your arteries (blood vessels). Examples of statins include atorvastatin (brand name: Lipitor), fluvastatin (brand name: Lescol), lovastatin (brand names: Altocor, Mevacor), pravastatin (brand name: Pravachol), rosuvastatin (brand name: Crestor) and simvastatin (brand name: Zocor).

Resins (also called bile acid sequestrants) help lower your LDL cholesterol level. Some examples of bile acid sequestrants include cholestyramine (brand names: Prevalite, Questran), colesevelam (brand name: Welchol) and colestipol (brand name: Colestid).

Fibrates (also called fibric acid derivatives) help lower your cholesterol by reducing the amount of triglycerides (fats) in your body and by increasing your level of "good" cholesterol (also called HDL, or high-density lipoprotein). Some examples of fibrates include fenofibrate (brand names: Antara, Lofibra, Tricor) and gemfibrozil (brand name: Lopid).

Niacin (also called nicotinic acid) is a B vitamin. When given in large doses, it can lower your levels of triglycerides and LDL cholesterol, and increase your HDL cholesterol level. Even though you can buy niacin without a prescription, you should not take it to lower your cholesterol unless your doctor prescribes it for you. It can cause serious side effects. There are 2 types of nicotinic acid: immediate release and extended release.

Cholesterol absorption inhibitors help lower your cholesterol by reducing the amount that is absorbed by your intestines. Ezetimibe (brand name: Zetia) is a cholesterol absorption inhibitor. This type of medicine is often given in combination with a statin. The combination of ezetimibe and simvastatin (brand name: Vytorin) is an example.

Hormone replacement therapy: The risk of heart disease is increased in women after menopause. The increasing risk may be related to loss of estrogen that comes with menopause. Previously, women might have been treated with hormone replacement therapy (replacing the estrogen and perhaps progestin).

Source:
Written by familydoctor.org editorial staff.

Cholesterol: The top 5 foods to lower your numbers



Can a bowl of oatmeal help prevent a heart attack? How about a handful of walnuts, or even your baked potato topped with some heart-healthy margarine? A few simple tweaks to your diet — like these — may be enough to lower your cholesterol to a healthy level and help you stay off medications.

1. Oatmeal and oat bran

Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the "bad" cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, psyllium, barley and prunes.

Soluble fiber appears to reduce the absorption of cholesterol in your intestines. Ten grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you'll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran.

2. Walnuts, almonds and more

Studies have shown that walnuts can significantly reduce blood cholesterol. Rich in polyunsaturated fatty acids, walnuts also help keep blood vessels healthy and elastic. Almonds appear to have a similar effect, resulting in a marked improvement within just four weeks.

A cholesterol-lowering diet in which 20 percent of the calories come from walnuts may reduce LDL cholesterol by as much as 12 percent. But all nuts are high in calories, so a handful (no more than 2 ounces or 57 grams) will do. As with any food, eating too much can cause weight gain, and being overweight places you at higher risk of heart disease. To avoid gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds.

3. Fish and omega-3 fatty acids

Research has supported the cholesterol-lowering benefits of eating fatty fish because of its high levels of omega-3 fatty acids. Omega-3 fatty acids also help the heart in other ways such as reducing blood pressure and the risk of blood clots. In people who have already had heart attacks, fish oil — or omega-3 fatty acids — significantly reduces the risk of sudden death.

Doctors recommend eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in mackerel, lake trout, herring, sardines, albacore tuna and salmon. However, to maintain the heart-healthy benefits of fish, bake or grill it. If you don't like fish, you can also get omega-3 fatty acids from foods like ground flaxseed or canola oil.

You can take an omega-3 or fish oil supplement to get some of the beneficial effects, but you won't get all the other nutrients in fish, like selenium. If you decide to take a supplement, just remember to watch your diet and eat lean meat or vegetables in place of fish.

4. Olive oil

Olive oil contains a potent mix of antioxidants that can lower your "bad" (LDL) cholesterol but leave your "good" (HDL) cholesterol untouched.

The Food and Drug Administration recommends using about 2 tablespoons (23 grams) of olive oil a day to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade, or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat.

Some research suggests that the cholesterol-lowering effects of olive oil are even greater if you choose extra-virgin olive oil, meaning the oil is less processed and contains more heart-healthy antioxidants. But avoid "light" olive oils. This label usually means the oil is more processed and lighter in color, not fat or calories.

5. Foods fortified with plant sterols or stanols

Foods are now available that have been fortified with sterols or stanols — substances found in plants that help block the absorption of cholesterol.

Margarines, orange juice and yogurt drinks fortified with plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams — which equals about two 8-ounce (237 milliliters) servings of plant sterol-fortified orange juice a day.

Plant sterols or stanols in fortified foods don't appear to affect levels of triglycerides or of "good" high-density lipoprotein (HDL) cholesterol. Nor do they interfere with the absorption of the fat-soluble vitamins — vitamins A, D, E and K.

The American Heart Association recommends foods fortified with plant sterols for people with levels of LDL cholesterol over 160 milligrams per deciliter (4.1 mmol/L).

Consider your diet first

Before you make other changes to your diet, think about cutting back on the types and amounts of fats you eat, which can raise your cholesterol. That way, you'll improve your cholesterol levels and health overall.

When cutting fat from your diet, focus on saturated and trans fats. Saturated fats, like those in meat and some oils, raise your total cholesterol. Trans fats, which are sometimes used to make store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels because they raise low-density lipoprotein (LDL), the "bad" cholesterol and lower high-density lipoprotein (HDL), "good" cholesterol. You should try to limit the number of calories you eat daily to less than 10 percent from saturated fat, and eliminate as many trans fats from your diet as possible.

By Mayo Clinic Staff
May 10, 2008

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