The US Surgeon General’s office has released a report emphasizing the importance of making hypertension control a national public health priority. Vice Admiral Jerome Adams, MD, MPH, the 20th US Surgeon General, discusses the report’s background and recommendations.
LOS ANGELES — Modifying 12 risk factors over a lifetime could delay or prevent 40% of dementia cases, according to an updated report by the Lancet Commission on dementia prevention, intervention and care presented at the Alzheimer’s Association International Conference (AAIC 2020).
Twenty-eight world-leading dementia experts added three new risk factors in the new report — excessive alcohol intake and head injury in mid-life and air pollution in later life. These are in addition to nine factors previously identified by the commission in 2017: less education early in life; mid-life hearing loss, hypertension and obesity; and smoking, depression, social isolation, physical inactivity and diabetes later in life (65 and up).
Schneider and commission members recommend that policymakers and individuals adopt the following interventions:
Aim to maintain systolic blood pressure of 130 mm Hg or less from the age of 40.
Encourage use of hearing aids for hearing loss and reduce hearing loss by protecting ears from high noise levels.
Reduce exposure to air pollution and second-hand tobacco smoke.
Prevent head injury (particularly by targeting high-risk occupations).
Limit alcohol intake to no more than 21 units per week (one unit of alcohol equals 10 ml or 8 g pure alcohol).
Stop smoking and support others to stop smoking.
Provide all children with primary and secondary education.
Lead an active life into mid-life and possibly later life.
Reduce obesity and the linked condition of diabetes.
Headache has been with us since Neolithic times, and has caused enough distress to induce our ancestors to scrape holes in their skulls, perhaps to let out the causative Evil Spirits, or maybe a subdural hematoma.
When I was a practicing Allergist, i was sent many headache patients by other Doctors.This was, presumably, because the referring physician thought that their patients had “sinus” headaches. In fact, free standing headache does not commonly come from the sinuses.
Most headaches thought due to ‘sinuses” are in fact “vascular “ headaches. The theory of vascular headaches is that the average diet contains many chemicals that are active on blood vessels. Tyramine, degraded proteins and caffeine are examples. These chemicals, working on the blood vessels, cause irritation and pain. It follows,then, that avoidance of these chemicals would relieve the vascular headaches.
“Vascular headache”, and it’s severe cousin, Migraine headache, is now included under PRIMARY HEADACHE, which also includes Tension headache, and a variety of less common diagnoses. But it is still useful for Treatment, which is why I use the term.
My treatment was a fresh, “health food” diet which avoided preserved foods such as salami, sausages, sauerkraut, leftovers, cheeses, red wine and a variety of other foods likely to have degraded amino acids and Tyramine.
The “mold-free diet” was the published diet closest to listing the suspected foods. The benefit reported from the diet encouraged me to continue recommending it. Vascular headaches are essentially a mild variety of migraine headaches. The foods avoided in the “mold-free diet” are still, after several decades of progress still recognized as migraine triggers.
I encountered only one patient with BRAIN TUMOR in my practice. She had severe, unremitting, gradually increasing headaches over a 4 week period. I called a Neurologist, the type of doctor that treats most severe headaches, who informed me he had NEVER seen a patient with a brain tumor who presented with a headache only, so uncommon it is.
Tension Headaches are milder, and usually can be handled at home. These headaches are usually accompanied by tenderness in the muscles of the back of the neck, or in the temple region, and are brought on by stress.
Hypertension, if extremely high, can cause headache, and can be dangerous, but I never saw a case. Nor did I attend a patient with temporal arteritis, which can also be an emergency.
There are some “red flags” that indicate urgent need for evaluation:
New headache in older patient
New change in headache pattern, or progressively worsening headache
Signs and symptoms of illness ( fever, stiff neck, rash).
Headache triggered by cough or exertion.
Headache in pregnancy or postpartum period
First, worst Headache.
New headaches with AIDS, compromised immunity, or cancer.
Headaches accompanied by mental changes, weakness, or abnormal Neurological signs.
Selective medications are available for some headaches.
Preventative and abortive medications sometimes are helpful for migraine. Antidepressants, tryptans, beta blockers, and corticosteroids are medications best prescribed by specialists.
The tendency to use pain killers, especially narcotics, must be tempered. Frequent use can create additional problems, like ADDICTION. The CAUSE of the headache must be found, if possible, and specifically treated.
Of course, I did find patients with true SINUS HEADACHE, but the headache was accompanied by fever, tenderness over the sinuses, yellow nasal discharge, and other evidence of SINUSITIS, and went away when the infection was treated.
If you have a lot of headaches, and no “red flags” or “risk factors”, you might try a “mold free diet” for a few weeks. Your Nutrition and health would certainly not suffer. And you might have fewer headaches!
Please read the following article for a more complete discussion of this common and annoying problem.
BLOOD VESSELS; it is hard to overestimate their importance. They are literally our lifelines, delivering the oxygen and nutrition necessary for life. We are as old as our blood vessels.
I will divide blood vessels into 4 components with rather separate domains: The Systemic Arterial system, the Pulmonary circulation, the Venous system, and the Lymphatic system, and will discuss these separately.
SYSTEMIC ARTERIAL SYSTEM
The Boy Scouts taught me the pressure points; The radial, at the thumb-side of the wrist, the brachial, on the inside of the upper arm, and the inguinal in the groin area. Pressure on these sites will stop arterial bleeding distally.
You should be able to locate the radial artery pulse, and begin to appreciate its strength and regularity. Strength in case you encounter a person who isn’t moving, and regularity for yourself; many older people develop an irregularity called Atrial Fibrillation, and you might be the first to discover it..
ANEURISMS are swelling of the arteries, and the swelling may thin the arterial wall so that it can burst. A Cerebral aneurysm can burst and cause a stroke-like problem. If an aortic aneurism bursts, the internal blood loss can be fatal.
RAYNAUD’S Phenomenon is fairly common, and consists of an over-reaction to cold, where arteries of the hands constrict, and the fingers get white and cold. Burger’s disease involves small arteries, and often is associated with Raynaud’s. The arteries carry the blood distally (away from the heart), continuing to divide into ever smaller arterioles which terminate in capillaries, which branch out in such an arborization as to supply all cells except cartilage and parts of the eye.
HYPERTENSION develops when the arterioles, under hormonal or neural influence, constrict, increasing the resistance to blood flow, and so the pressure. Increase in sodium retention and therefore the blood volume can also increase pressure.
ATHEROSCLEROSIS is the common disease of western life style. Excessive calories and sedentary life style combined with genetic defects in fatty metabolism produce cholesterol plaques which narrow and stiffen the arteries, often leading to BLOCKAGE of blood flow. Blockage of flow to the HEART, BRAIN, KIDNEYS, BOWEL, or EXTREMITIES each produce their separate disorders of Myocardial Infarction, Stroke, Renal artery Disease. Intestinal ischemic syndrome, and Claudication.
These disorders will each be separately discussed. I have always thought of vascular disease as a special class of CAUSATIVE MECHANISMS when trying to develop a DIFFERENTIAL DIAGNOSIS of a patient’s problems. Blockage to an area results in PAIN or LOSS OF FUNCTION.
Stroke is usually painless with blockage, since the brain has no pain sensors. Blockage of the renal artery often causes complex difficulties including Hypertension, because the kidney is an endocrine organ in addition to its excretory function.
A good Friend and patient showed what careful self-care can accomplish. It all started with a myocardial infarction, the first sign of his blood vessel disease. He had a complication in his workup, and had to have emergency bypass surgery. There had been damage to the heart muscle, with a large reduction in his EJECTION FRACTION.
His cardiologist gave him at most 5 years to live. That was 25 years ago, before the development of the statin drugs. He was given a draconian low cholesterol diet, which he followed exactly. One one visit to the cardiologist, he inquired whether he could have other areas of arterial blockage. His doctor then listened to his neck and discovered a bruit (noise) in the carotid artery, after which he had a Carotid endarterectomy.
In an orthopedist office for back pain, the orthopedist left the room, and my friend noticed in the CT scan report mention of cysts in the kidneys.
The Orthopedist cared mainly about his bones, and had overlooked the “incidental finding”. His brother had died of mesenteric artery blockage from atherosclerosis, he had stomach symptoms, and sure enough he also had arterial blockage to the intestines.
Bottom line: it pays to be an ACTIVE PARTICIPANT in our medical treatment, and even though we all have genetic determinants, we can make our health BETTER with attention to our health, especially SLEEP, DIET and EXERCISE.
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