RyChol Archives - MNI Lifestyle

Cholesterol

What is cholesterol?

Cholesterol is a naturally occurring, waxy substance, with many vital roles in the body. These include the synthesis of certain hormones, vitamin D, digestive aids, and forming part of cell membranes.

Collectively, cholesterol and other fats in your blood (known as triglycerides) are called lipids. Each performs unique biological roles and contributes differently to your risk for disease. While there are many medical terms that describe various types of cholesterol abnormalities, the one most commonly used is dyslipidaemia.

Why is high cholesterol dangerous?

High cholesterol can double your risk of cardiovascular disease (CVD) by contributing to atherosclerosis, a build-up of plaques within your arteries. These plaques are made up of excess cholesterol together with fat, calcium, and other substances. Plaques contribute to CVD in a variety of ways, including reducing blood flow to various parts of the body, making the heart work harder and decreasing oxygen supply to tissue.

Enlarged plaques may entirely block an artery, stopping oxygen supply and resulting in the death of the affected muscle or tissue as in the case of a heart attack or stroke. Partial blockage to the heart muscle can cause chest pains (angina) that may also be felt in the neck, shoulders, arms, jaw, or back.

Both heart attack and stroke are life-threatening, and everyone should be aware of their symptoms, as rapid treatment is necessary. Refer to our later section for these symptoms.

Atherosclerosis is known as a silent killer because it causes few or no symptoms, explaining why high cholesterol is often only diagnosed when a major cardiovascular event, such as a heart attack, occurs. Regular check-ups are therefore important – even if you live a healthy life.

What is the difference between ‘good’ and ‘bad’ cholesterol?

Cholesterol is insoluble in blood and must be transported around the body by special molecules called lipoproteins. The two most well-known ‘types’ of cholesterol are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL cholesterol tends to accumulate within arterial walls, which is why it is often referred to as ‘bad’ cholesterol. HDL cholesterol is more efficiently transported to the liver and excreted, and may even help to remove LDL cholesterol from the arteries, helping to lower cholesterol levels. This is why it is often referred to as ‘good’ cholesterol.

What are triglycerides (TGs)?

Most fat in the body exists as triglycerides (TGs). They can be stored (increasing your weight), but a large proportion circulate in the blood stream, transporting fat to various parts of the body. TGs may be formed from fat or carbohydrate, explaining why a high carbohydrate diet is in many cases as detrimental as a high fat diet. A raised TG level is a major risk factor for atherosclerosis and CVD, and could also indicate the presence of other disease conditions, including insulin resistance, diabetes and liver disease.

What causes high cholesterol?

Cholesterol levels are affected by numerous factors. Some are related to an unhealthy lifestyle, but others may result from genetics, increasing age, or other diseases. Atherosclerosis can begin in childhood and risk factors should be managed from an early age. The likelihood of CVD increases with an increase in risk factors.

Lifestyle factors that can contribute to CVD include poor diet, lack of exercise, tobacco, alcohol, certain drugs and even stress. These are generally within our control and are therefore known as modifiable risk factors.

Non-lifestyle factors are termed non-modifiable as they are beyond our control. These include:

Pre-existing disease: metabolic syndrome, insulin resistance, diabetes, thyroid disorders and kidney disease.
Genetics and family history: South Africa has one of the highest incidences of familial hypercholesterolaemia in the world, and in some communities can affect as many as 1 in 75 people. A family history of heart disease also increases the risk of CVD.
Gender: although woman often consider CVD a man’s disease, deaths caused by CVD are second only to HIV/AIDS for both genders.
Age: cholesterol levels generally increase with age. This is especially true for post-menopausal woman.
Cholesterol recycling efficiency: the body recycles cholesterol through the liver via bile. This is transported to the intestines, where up to half is reabsorbed. A high reabsorption rate will result in increased cholesterol levels.
Psychological issues: conditions such as chronic stress, depression, anxiety, and schizophrenia have been associated with increased risk for CVD and dyslipidaemia.

What are the symptoms of a heart attack or stroke?

Rapid intervention decreases the risk of permanent damage, disability and/or death. Seek immediate medical attention if you notice any of the following symptoms in yourself or those around you, especially if they occur in combination.

Symptoms of a heart attack include pain or discomfort, especially in the left or centre of the chest, upper parts of the body such as the arms, back, neck, jaw, or stomach, shortness of breath, cold sweat, nausea or light headedness.

Symptoms of a stroke include sudden numbness in the face, arms, or legs. This is especially diagnostic if the numbness is confined to one side of the body. Other symptoms include severe headaches, confusion, dizziness, loss of balance and difficulty seeing with one or both eyes.

When should I find out what my cholesterol levels are?

Due to the high presence of familial hypercholesterolemia in South Africa, it is important that people are tested from an early age. Healthy people over the age of 20 should test their cholesterol levels at least every four to six years. More frequent testing should be done as you age, if you are overweight, practice an unhealthy lifestyle, or have a family history of CVD. The sooner dyslipidemia is diagnosed and treated, the lower your risk of CVD in the future. So whether you are young or old, thin or fat, man or woman, you should know your blood cholesterol levels.

How do I get my cholesterol level tested, and what do the results mean?

Preliminary screening for cholesterol abnormalities can be done in a point-of-care environment using a finger prick blood sample, which measures total cholesterol. Select clinics now also offer lipogram screenings which measure the different types of cholesterol and TGs. Although total cholesterol can give you an indication of your risk, a full lipogram is important to accurately test your CVD risk and plan an effective intervention strategy. While it is usually required that you fast for 9 hours before doing the test, recent research has suggested that this is not actually necessary.

Cholesterol target levels are based on an individual’s CVD risk, which is calculated according to the presence of the previously mentioned risk factors.

How do I lower my cholesterol?

Lifestyle changes are an important strategy to reduce your risk for CVD, even if you take cholesterol-lowering medication. An early, proactive approach may slow, reduce, or even reverse arterial plaque build-up, thereby further reducing your risk for CVD. These strategies may also prevent the development of other conditions such as metabolic syndrome and cancer.

According to The World Health Organisation (WHO), a 10% reduction in total cholesterol may halve the risk of CVD, and each mmol/L reduction in LDL-C shows a significant reduction in CV related death and disability and is therefore a goal of treatment.

General guidelines for lowering your cholesterol and reducing your risk of CVD are:

1. Eat a healthy diet

Diet is a significant risk factors in a wide range of diseases. Download a free copy of our Cholesterol-modifying dietary guidelines here.

In order to stick to a heathy diet, you should:

Know your fats

Dietary fat intake is one of the most significant contributors to dyslipidemia.

Avoid saturated and trans-fats as well as foods high in cholesterol. Saturated fats include animal fats, especially red meat and dairy, and some plant based fats like coconut and palm oil. Many vegetable oils, fried and processed foods, such as french fries, pies, and fast food are also high in trans-fats.

Poly- and mono-unsaturated fats may be able to reduce your total cholesterol levels. These fats come from plant-based foods, such as olive oil, flax seed oil, avocados and nuts, and extend to fatty fish like salmon, sardines, and mackerel. Many of these are also high in Omega 3 fatty acids, which may improve your lipid profile.

Read food labels

Just because a product is labelled as “low fat”, does not mean that it is healthy. If a food item claims to have no trans-fat, check the ingredients list for hydrogenated or partially hydrogenated vegetable oil, which is just a different name for the same thing. Many low fat foods are also high in sugar, which can be just as detrimental. Excessive amounts of salt can also increase CVD risk.

Avoid diets high in carbohydrates, especially those with a high glycaemic index

Reducing total saturated fat content in your diet is important, but replacing these calories with carbohydrate has been shown to have little to no benefit in terms of cardiovascular health, and is more likely to lead to other conditions such as diabetes and obesity. This is especially true for refined carbohydrates and sugar which may also have an adverse effect on TG levels. Rather replace these calories with healthy fats and protein, and where carbohydrate is used, make sure it is low GI and whole grain.

Eat a diet high in natural, plant based foods

Plants have a wide variety of health benefits. Not only are they a rich source of vitamins and minerals, but they also contain numerous molecules which can help to manage cholesterol and CVD, including polyphenols, fibre, and phytosterols, all of which have been shown to lower cholesterol and the risk for CVD. For example, a diet high in fibre can reduce your cholesterol levels by up to 10%.

In order to maximise the benefit you get from eating plants, make sure that they are raw, or only lightly cooked, and unpeeled where possible, as many of their beneficial compounds can be broken down by heat and occur in the coloured parts or skins of fruits.

It is suggested that at least 5 servings of vegetables and fruit are eaten per day. Despite the health benefits of fruit, they are also high in sugar, and so should not be eaten excessively.

2. Exercise, remain active, and reduce your weight

Exercise and maintaining an active lifestyle are extremely important in all aspects of your health. Physical activity lowers LDL-C, raises HDL-C, improves heart fitness, and other metabolic parameters which reduce your CVD risk. Movement in general is also important, as long periods of inactivity can be just as dangerous as no exercise at all. It is recommended that adults accumulate at least two and a half hours of moderate intensity exercise per week, while children and adolescents get at least an hour a day, and that bouts of inactivity are broken up by movement at least once every hour.

Excess weight is extremely dangerous and adds to your risk for numerous diseases, including insulin resistance, metabolic syndrome, cancer and CVD. Achieving and maintaining a healthy weight may help to lower LDL-C and TG levels, as well as increase HDL-C. A waist circumference over 102cm (men) and 88cm (woman) increases the risk for a wide range of diseases, independent of weight.

3. Stop unhealthy habits

This is especially true in the case of smoking. If you are a smoker, you should quit immediately, and if you are not, avoid any exposure to second hand smoke. Excessive alcohol consumption has also been linked to CVD. Alcohol intake should be limited to no more than two units per day for men and one for woman (1 Unit = 120 ml Wine, 50 ml Dessert wine, 200 ml Beer, 280 ml Lite Beer, 1 Tot Distilled Liquor, 20 ml Cream-Based liqueur).

4. Consult your doctor and remain aware of any other medical or psychological conditions you might have

Treatment and prevention strategies depend on your specific lipid profile and risk factors. Working with your doctor will help provide the optimal solution with regard to your unique lifestyle and risk factors.

In many cases, lifestyle changes alone are not sufficient, and medication may be required. There are a variety of cholesterol-lowering medications available, the most common is a group of drugs known as statins. Each type has been shown to improve cholesterol levels and decrease the risk of heart disease. Cholesterol-lowering drugs have a number of side effects and can interact with other medications and medical conditions, requiring close monitoring by a medical professional. For this reason, they are usually only prescribed in high-risk cases where cholesterol levels become unmanageable or where cardiovascular disease is already present.

5. The role of RyChol

Plant-based ingredients have also been shown to lower lipid levels significantly. RyChol, from the Medical Nutritional Institute (MNI), has been developed to combat high cholesterol.

What does RyChol do?

Independent research has shown that RyChol’s unique blend may help to stabilise blood cholesterol and triglyceride levels by targeting multiple biological pathways.

What does RyChol contain?

RyChol contains a blend of plant-derived (phytochemical) ingredients that have each been recognised to help reduce blood cholesterol levels in a unique and individual manner. Its multi-modal pharmaceutical action is achieved through the selective inhibition of various biochemical pathways involved in saturated fat digestion, cholesterol absorption, as well as cholesterol excretion. The ingredients contained in RyChol are plant-sterols, apple polyphenols, barberry root extract and coenzyme Q10.

Plant- or phytosterols are naturally occurring plant fats that are structurally similar to cholesterol and compete with cholesterol absorbtion in the intestines.
Apples contain several biologically active polyphenols that include the flavonoids and phenolic acids that have been shown to help inhibit the digestion of saturated fat in the digestive tract, thereby helping to reduce the absorption of fat (triglycerides).
Coenzyme Q10 is a fat-soluble anti-oxidant found in meat, fish and dairy, and to a lesser degree, in grains, nuts and certain plants. It is present in most cells, primarily in the mitochondria, where it plays a critical role in ATP production, the body’s most basic energy unit.
Barberry root extract contains a botanical chemical called berberine that is naturally found in the roots, stems and bark of various plants. Berberine has been demonstrated to lower cholesterol levels by increasing cholesterol clearance through the liver. This is achieved through a process called ‘up-regulation’ whereby increased numbers of liver LDL receptors are produced, thereby leading to the accelerated clearance of LDL cholesterol from the system.

Who may benefit from taking RyChol?

RyChol can be used by individuals with a high blood cholesterol level before prescription medication is required. RyChol can be used in combination with most cholesterol-lowering drugs where indicated. Response to treatment is largely determined by good compliance such as ensuring you take the correct dose every day. Check your cholesterol profile after 12 weeks of treatment. As raised cholesterol tends to be a chronic condition, continued use of RyChol may be required.

Medication does not negate the need for a healthy lifestyle. Addressing lifestyle factors efficiently will ensure that you take the lowest dose possible, and that your disease risk is lowered in many other ways too.

Can RyChol be used in conjunction with statins?

Yes, trials done on some of the individual ingredients contained within RyChol, such as phytosterols and berberine, have indicated favourable results when used in conjunction with statins.

What role does MNI play?

1. Products

MNI has developed several natural, plant-based products which aid in combatting risk factors associated with cardiovascular disease (CVD). These can be used individually or in combination with most prescription medications or each other.

RyChol extended-release formulation contains a unique blend of plant-derived phytochemical ingredients known to reduce blood cholesterol, triglyceride, and LDL levels. This unique combination supports multiple pathways involved in the digestion, absorption and clearance of cholesterol and the other detrimental fats from the system.
AntaGolin contains a blend of plant-derived phytochemical ingredients that combats insulin resistance and optimises blood-sugar metabolism. This unique combination supports multiple pathways involved in the input, output and processing of sugars in the body and the optimal regulation of metabolism.
NeuroVance contains a blend of plant-derived phytochemical ingredients that optimise and support healthy brain function by giving your brain a physiological advantage during times of stress without acting as a sedative or stimulant.
NeuroVance Focus is a unique blend of plant-derived phytochemical ingredients, vitamins and minerals that optimises your child’s general health by targeting multiple neurological and immunological functions simultaneously.
RheumaLin contains a unique blend of plant-derived phytochemical ingredients that targets the enzymes that cause the inflammation and optimises joint preservation.
FlamLeve is a natural anti-inflammatory product that combats inflammatory pain and protects the body against the harmful effects of inflammation. This unique combination of plant-derived phytochemical ingredients ensures superior absorption and bioavailability, making FlamLeve 500 times more potent than standard turmeric.

2. Meal plans

Our insulin-friendly (C.A.P.E) meal plan, designed specifically to combat insulin resistance and obesity which are both significant contributors to CVD, can also be applied to cholesterol reduction as unhealthy fats are reduced and healthy fats increased. Download your free copy here.

3. Online information and resources

MNI provides information and training to healthcare practitioners and a number of free information resources to the public, increasing awareness of the most important diseases you or your family might face.

4. MyMNI

MNI recognises that individuals react differently to lifestyle, disease conditions and their response to intervention strategies. You can get more information from the Frequently Asked Questions sections on our website or email us at expert@mnilifestyle.co.za

5. Loyalty reward program

In line with our goal to aid you in managing your risk for various chronic diseases and assist in compliance, MNI offers a FREE MNI product for every 5 of the same MNI products purchased.

To qualify for your free MNI product, all you need to do is send the slips of your 5 MNI products together to loyalty@mnilifestyle.co.za. Read more about our Loyalty Program here.

Sources:

http://www.nhlbi.nih.gov/health/resources/heart/heart-cholesterol-hbc-what-html
http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol_UCM_001220_Article.jsp#.V6sVA_l97Z4
http://www.heartfoundation.co.za/
http://www.who.int/gho/ncd/risk_factors/cholesterol_text/en/ Global Health Observatory (GHO) data
South African Dyslipidaemia Guideline Consensus Statement: A joint statement from the South African Heart Association (SA Heart) and the Lipid and Atherosclerosis Society of Southern Africa (LASSA) South African Family Practice 2015; 57(2):22-31

Triglycerides

What are triglycerides?

Triglycerides are a type of lipid which make up most of the fat found in meats, dairy, cooking oils and your body. Biologically, triglycerides are used for one of two purposes, either directly as energy or for storage of surplus energy as fat. When you think about excess weight, you are essentially talking about a build-up of triglycerides. Triglycerides can be obtained from your diet, or they can be manufactured in your liver from excess calories.

High triglycerides are associated with increased risk of atherosclerosis, heart disease and stroke. They are also inversely associated with HDL (or ‘good’) cholesterol levels. Knowing your triglyceride levels is therefore as important as measuring cholesterol.

Why measure triglycerides?

High triglyceride levels are associated with cardiovascular disease, including atherosclerosis, heart attack and stroke. They are also associated with lower HDL cholesterol and increasingly damaging LDL cholesterol. As with cholesterol, a high triglyceride level only has symptoms once it has caused disease. Testing is therefore the only way to know if you should work at lowering yours. Excess triglyceride is also associated with the presence of a number of other disorders, including diabetes, obesity, liver and kidney disease, thyroid problems and Metabolic Syndrome. Early testing of triglyceride levels is therefore essential to effective management of your health.

How are triglyceride levels tested?

Preliminary screening for cholesterol abnormalities can be done in a point-of care clinic environment using a finger prick blood sample, which measures total cholesterol. Select clinics now also offer lipogram screenings which measures the different types of cholesterol and triglycerides. Although total cholesterol can give you an indication of your risk, a full lipogram is important to accurately test your cardiovascular disease risk and plan an effective intervention strategy. While it is usually required that you fast for 9 hours before doing the test, recent research has suggested that this is not actually necessary.

What do the numbers mean?

Higher levels of triglyceride have been associated with a greater risk of adverse health effects, especially those associated with the Metabolic Syndrome. Understanding your triglyceride levels, and interpreting them together with cholesterol measurements and your other risk factors is paramount to ensuring long-term health. This is a process that should be undertaken together with your doctor.

Triglycerides are measured in millimole per litre of blood (mmol/L). The numbers can be interpreted as follows:

Normal (therapeutic goal) – Less than 1.6 mmol/L. If your triglyceride levels are in this range, you are considered normal. You should aim to get your triglycerides as close to this, and even below, if possible.
Raised – 1.7 to 2.2 mmol/L. Lifestyle changes should be implemented.
High – 2.3 to 5.5 mmol/L. Adopt lifestyle changes urgently. Medication may be required.
Very high – 5.6 mmol/L or above. Lifestyle changes should be implemented immediately. Medication will be required.

How can I improve my triglyceride levels?

The primary method for correcting abnormally high triglyceride levels is lifestyle intervention. Much of the advice overlaps with that prescribed for other conditions associated with Metabolic Syndrome, especially high cholesterol and cardiovascular health. Through following the tips below, therefore, you will not only be actively lowering your triglycerides and improving your heart health, but bettering your health overall.

As with other aspects of general health, it is never too soon to begin practising a healthy lifestyle. Even if your triglycerides are normal, you can lower them further, reduce your risk factors for disease and increase your quality of life, both now and in the future.

If you are required to take medication, making sure to still implement lifestyle changes will further improve your health as well as keep your medication dose low.

Some ways to specifically reduce triglycerides are:

Ensuring you generally eat only as much food as you use for energy. Any extra will be immediately converted to triglyceride and stored as fat.
Losing weight. Fat is itself an accumulation of triglycerides, and can signal to your body to produce more.
Quit smoking. Tobacco smoke affects lipid levels and makes them more likely to cause damage to your arteries.
Restrict carbohydrates, especially heavily processed, high energy sources. These are easily converted to fat and contribute to an array of diseases and disorders.
Restrict saturated fat, the major dietary source of damaging triglycerides. This will involve a reduction in the consumption of animal products.
Increase your consumption of fish, nuts and seeds that contain omega-3 fatty acids and other healthier, monounsaturated oils.
Limit alcohol. Alcohol is high in calories and has a particularly serious effect on triglyceride levels.
Exercise regularly. Regular exercise will use up extra energy and fat as well as improve lipid profiles.
Take a supplement aimed at improving heart health and optimising cholesterol levels.

MNI places emphasis on assisting you with living a better lifestyle and therefore we developed lifestyle support tools:

For more information on how to follow a healthy diet, download our free C.A.P.E Meal Plan (your insulin-friendly meal plan) here.
You can also begin exercising by adopting one of our exercise plans. Download your free copy here.
For further assistance, try our range of products that include unique blends of ingredients that work synergistically to help improve your health outcome. Read more here.

Blood Pressure

What is blood pressure?

Blood pressure is the force which moves blood around your body. Every time your heart beats, it is actually contracting like a pump and pushing blood out of its valves and into your arteries. In order for your blood to flow, your arteries squeeze back, ensuring it moves forward. The strength of this pressure is your blood pressure. How hard your heart pumps, how elastic your arteries are and a number of other factors determine how high or low your blood pressure is.

How is abnormal blood pressure diagnosed?

High blood pressure, or hypertension, is often called the silent killer, as there are usually no symptoms associated with it. Generally, the first sign will be a heart attack, stroke or kidney failure. The only way to know what your blood pressure is, is to have it measured. Low blood pressure, or hypotension, is associated with light headedness or dizziness. If you are in a high risk group or have a family history of high or abnormal blood pressure, it is essential you have your blood pressure tested.

How is blood pressure measured?

Blood pressure is measured using an instrument called a sphygmomanometer. The doctor or nurse will place a rubber armband around your upper arm and inflate it. From here the doctor will measure your blood pressure. The procedure is quick, easy and painless.

The measurement is taken using two numbers, called systolic and diastolic blood pressure. Systolic pressure is the maximum amount of pressure exerted when your heart pumps, and diastolic pressure is the amount of pressure your arteries exert to force blood forward. A blood pressure of 120 over 80, written as 120/80 mmHg, for example, means you have a systolic blood pressure of 120, and a diastolic blood pressure of 80. The units of measurement are mmHg, or millimetres of mercury, a reference to a time when medical pressure gauges used mercury.

Why is abnormal blood pressure problematic?

Blood pressure is tightly controlled in order to keep you healthy. If blood pressure is too low, blood doesn’t move fast enough around your body, and your tissues do not receive enough oxygen and nutrients. If blood pressure is too high, unnecessary stress is placed on your cardiovascular system. High blood pressure makes your heart work harder to pump blood. It also puts extra strain on your arteries and organs, especially your brain and kidneys. High blood pressure may therefore lead to heart attacks and strokes, the risk of which double with every increase of 20 mmHg systolic or 10mmHg diastolic blood pressure, as well as kidney failure and other disorders.

When is a blood pressure measurement abnormal?

It is important to note that high or low blood pressure can only be diagnosed from a number of readings over a period of time. One abnormal reading does not mean you have high blood pressure, but could be a result of some acute stress, illness or a number of other factors.

Blood pressure ranges are categorized as follows (sourced from The Heart and Stroke Foundation of South Africa):

Low blood pressure

In general, low blood pressure is actually desirable. It only becomes problematic when the brain and other organs are not getting enough oxygen. The point at which this happens varies from person to person, and so what constitutes low blood pressure is dependent on your own body.

Symptoms indicating your blood pressure has fallen too low include dizziness, light-headedness and fainting. If you regularly experience these symptoms, see your doctor.

In some cases, blood pressure can fall dangerously low and be life-threatening. If the below symptoms are experienced, seek medical attention:

Confusion, especially in older people
Cold, clammy and pale skin
Rapid, shallow breathing
Fast, weak pulse

Optimal blood pressure (less than 130 / 85 mmHg):

If your blood pressure falls within this range it is normal. Adopt heart-healthy habits or keep them up to ensure your blood pressure does not start to rise.

Elevated blood pressure (130-139 / 86-89 mmHg):

Elevated blood pressure is a sign that a problem could be developing. Although no medications are required at this stage, you should begin to practice a heart-healthy lifestyle. If you’re older than 65, your doctor might recommend treatment to further ensure your blood pressure does not rise.

Mild hypertension (140-159 / 90-99 mmHg):

If you are experiencing mild hypertension, lifestyle changes are essential and doctors may consider including blood pressure medication based on your risk of cardiovascular disease.

Moderate hypertension (160-179 / 100-109 mmHg):

If you have moderate hypertension, doctors will prescribe a combination of blood pressure medications and lifestyle changes. Both are extremely important to ensuring long-term positive health outcomes are reached.

Hypertensive emergency (from 180 / 110 mmHg):

If your blood pressure is higher than 180/110 mmHg and/or you are experiencing the following symptoms, you should seek emergency treatment:

Chest pain
Shortness of breath
Visual changes
Symptoms of stroke, such as paralysis or a loss of muscle control in the face or an extremity
Blood in your urine
Dizziness
Headache

How can I lower my blood pressure and what can I do to prevent it from rising?

Even if your blood pressure is normal, it is still important to ensure you practice heart-healthy habits. As you age, arteries naturally increase in stiffness, plaque builds up inside them and blood pressure increases. This is coupled with the general decline in cardiovascular health with age. Certain other conditions such as diabetes and kidney problems may also contribute.

The following habits will help to lower or prevent a rise in blood pressure, as well as keep you healthy in general:

Reduce salt intake

Sodium (or salt) is part of the natural signalling system keeping blood pressure in check. A diet high in salt can disrupt this balance, leading to an increase in blood pressure. Generally, persons at risk of blood pressure issues shouldn’t consume more than 2300 mg per day. People who already have high blood pressure may need to reduce this even further.

The easiest way to cut down your salt intake is to refrain from adding extra to your food. Instead, make use of herbs and spices to flavour your food. These also have their own positive health benefits. It is also wise to avoid processed foods which are generally high in sodium, as well as foods such as french fries, biltong and others which use salt as flavouring or a preservative. If in doubt, check the nutritional information on the package.

Download our C.A.P.E meal plan for meals and recipes naturally low in sodium.

Reducing caffeine intake

Caffeine and other stimulants can increase blood pressure, partly through increasing heart rate. Reduce intake of caffeine and other stimulants in order to help keep your blood pressure low.

Exercise

Exercising has many benefits, including reducing blood pressure and resting heart rate. It will also improve the health of your heart, arteries and organs, significantly reducing your chances of heart attack, stroke and other cardiovascular disorders. In order to maximise the effectiveness of exercising, it is better to exercise for shorter periods more frequently (at least 30 minutes a day) as opposed to longer periods only once or twice a week. If this is difficult for you, keep in mind that any exercise is better than none – park your car further away from the shop entrance or office, climb the stairs or do some gardening.

Download one of our free exercise plans for simple daily exercise routines.

Note, that it is important to obtain permission from your doctor to exercise if diagnosed with serious hypertension.

Maintaining a healthy weight

Excess weight is one of the chief contributors to cardiovascular disease and high blood pressure. Losing even a few kilograms can make a huge difference to your blood pressure. Adopt a healthy diet and exercise to begin losing weight today.

Try AntaGolin, the C.A.P.E meal plan and our exercise programs to start losing weight today.

Managing stress

Stress naturally increases your heart rate, blood pressure and other contributors to cardiovascular disease. When you are threatened, these serve to improve energy and alertness so you can better deal with the danger. In the modern world, however, this stress is too often chronic, leading to constantly elevated blood pressure and other health issues.

Stress doesn’t have to rule your life and take its toll on your health. Try NeuroVance or NeuroVance Focus today.

Find out how serious your stress levels are with our FREE stress test.

Reducing alcohol intake and quitting smoking

Both alcohol and smoking contribute significantly to cardiovascular disease. Avoiding smoking and excessive alcohol consumption could very well be the difference between having a healthy heart and early cardiovascular disease. Quit smoking as soon as possible and limit your alcohol consumption to only a few drinks per week.

Diet

Diet can both cause and prevent disease, it’s all about what, and how much, you eat. A healthy diet is essential to good health. This is not only in terms of keeping your blood pressure down, but also in avoiding diverse lifestyle diseases, including cardiovascular disorders, diabetes and cancer. Eat a diet high in fruits and vegetables and avoid processed foods. Where possible, foods should be as close to their natural form as possible.

Download our C.A.P.E meal plan for more tips and recipes for a heart-healthy diet.

Pain and inflammation

The link between pain and inflammation

What is Inflammation?

Inflammation is part of a complex biological response serving to help combat infection, restore injured tissues, and neutralise toxins. Besides helping to eliminate the initial cause of cell injury (such as a microbe or toxin), inflammation also helps clear out dead cells and damaged tissues in preparation for tissue repair.

Why can inflammation be harmful to the body?

In order to clear out dead cells and tissues, several different protein-degrading enzymes are produced during the inflammatory process. These enzymes are highly corrosive and dissolve any protein-based tissue, often at an astonishing rate. Protein-degrading enzymes are also the main defensive weapons used by white blood cells to destroy foreign microbial organisms. Since the caustic activity of these enzymes cannot be selectively contained within a specific region, collateral damage to structurally sound tissues commonly occurs. Over time, the rate of tissue damage overtakes the rate of repair, resulting in a nett loss of bodily tissue.

Why is inflammation also the leading cause of chronic pain?

Pain is perceived through specialised nerve cells (neurons) called nociceptors. Situated throughout the entire body, they respond to potentially damaging stimuli by sending pain signals to the brain via the spinal cord. This process, called nociception, is biochemically triggered by several different kinds of signalling molecules produced during inflammation. Chronic inflammation is therefore also the leading cause of both acute and chronic pain.

Painful conditions caused by chronic inflammation:

High Cholesterol

What is High Cholesterol?

Cholesterol is a fat-like substance, naturally found in humans and animals. It has many important functions that are essential to the body. Cholesterol forms part of the basic structure of many hormones, all cell membranes and the insulation layer around nerves.

Although some cholesterol is found on its own in the bloodstream, most cholesterol molecules are bonded to specialised proteins called lipoproteins. The better-known ones are low-density lipoprotein (LDL), and high-density lipoprotein (HDL).

What is the difference between HDL and LDL cholesterol?

Because of certain chemical properties, fat cannot be dissolved in a watery medium unless it undergoes a chemical dispersion process. Called ‘emulsification’, this process allows fatty substances to disperse into a range of micro-droplets varying in size that allows them to remain in suspension.

Besides the portion of cholesterol found on its own in the bloodstream, the majority of cholesterol is contained within micro lipoprotein droplets. These are distinguished by their size, density and the proteins they are composed of. Within its core, ‘Low Density Lipoprotein’ or LDL contains the highest number of cholesterol molecules (estimated at 1500). Its main function is to transport cholesterol from the liver to the peripheral tissues via the bloodstream. Cholesterol bonded to LDL tends to accumulate inside arteries and is therefore ‘bad’ for our bodies. Cholesterol bonded to high-density lipoprotein or HDL, on the other hand, gets transported to the liver, where it is naturally expelled from the system as a component of bile. It is therefore beneficial to the body to have high levels of HDL.

How are blood cholesterol levels controlled?

Blood cholesterol levels are influenced by several metabolic pathways which involve cholesterol production, absorption, transport and reabsorption.

In our diet, cholesterol is mainly derived from food sources that contain animal products. This is because cholesterol is predominantly manufactured by cells of animal origin. Although plants produce miniscule amounts of cholesterol, they produce large amounts of substances that are structurally very similar to cholesterol, called plant- or ‘phytosterols’. The relevance of phytosterols is that they compete with cholesterol for absorption within the intestinal tract, thereby offering a natural protective mechanism that helps to reduce cholesterol absorption.

Although diet plays a crucial role in the development of cardiovascular disease, the actual cholesterol content within the average diet only influences blood cholesterol levels to a small degree. This is because the human body is highly efficient at manufacturing cholesterol itself, using a molecule called ‘Acetyl coenzyme A’ (acetyl-CoA) as a building block. It is estimated that on average, a man weighing about 70 kg will typically produce around 1000 mg of cholesterol per day, a large amount in relative terms.

Although all kinds of cells can produce cholesterol, liver cells are responsible for the majority of production. This is the site of action where the statins, a group of cholesterol-lowering drugs, plays a dominant role. Other sites with higher cholesterol production rates are the intestines, adrenal glands and reproductive organs.

Cholesterol recycling – nowhere to go

Besides cholesterol production, an important factor that influences blood cholesterol levels is the ability of the body to recycle its own cholesterol continually. As a consequence of normal physiology, large amounts of cholesterol are excreted by the liver via bile as a natural waste product. Once this cholesterol arrives in the intestines, up to 50% of it is automatically re-absorbed and therefore recycled back into the system. Since this mechanism contributes to elevated cholesterol blood levels, blocking this pathway has become a new therapeutic target to help control blood cholesterol levels.

What is hardening of the arteries?

Hardening of arteries called ‘atherosclerosis’ in medical terms is a complex process whereby a layer or crust of cholesterol accumulates within an artery. As this layer increases in thickness, the inner passage of the artery, called the lumen, becomes progressively obstructed. This causes a decrease in the amount of blood flowing through the artery. A clot may also easily form inside this diseased and narrowed blood vessel, sealing it off entirely. This event causes heart attacks and strokes.

What role does cholesterol play in predicting cardiovascular disease (CVD)?

Cardiovascular disease, or CVD, is a broad term that refers to many different conditions that affect the heart and blood vessels. The causes of CVD are numerous, but hardening of the arteries (atherosclerosis) and high blood pressure are the most common. Since various risk factors other than cholesterol are involved in the development of CVD, cholesterol cannot really be used to accurately determine CVD risk single-handedly.

However, when it comes to the development of hardening of the arteries, numerous studies have indicated that cholesterol plays a dominant role. Various health authorities have based their predictions on either determining CVD risk, or providing treatment guidelines, on cholesterol, HDL, LDL or HDL/LDL ratios, or other lesser known lipoproteins. Over the years, these have regularly been adjusted in accordance with the publication of new studies. A recent new meta-analysis published in the Journal of the American College of Cardiology (July 2014), suggests that lowering LDL-cholesterol levels to very minor levels does equate to a significant reduction in cardiovascular events. ^[1,2]

What are South African guidelines?

Health authorities in South Africa recommend that in the absence of other risk factors, cholesterol levels should ideally be no higher than 4.9 mmol per litre for total cholesterol and 2.9 mmol/l for LDL cholesterol. If there are other known cardiovascular risk factors present, for example a previous heart attack or diabetes, then the target for LDL should be reduced to 1.8mmol/L, as per the LASSA treatment guidelines.

As cholesterol-related deaths continue to rise, South Africans need to start managing their cholesterol levels far more proactively if they wish to extend their lifespan. The first step is to check your cholesterol levels. Women are particularly bad at doing this, in part because they tend to be under the erroneous impression that heart disease is predominantly a ‘male’ condition. Although cardiovascular disease in children is rare, the pathologic processes underlying hardening of the arteries actually begins in childhood. In a surprise discovery, a recent study conducted at primary-care paediatric clinics in Texas found that one out of three children between the ages of 9 and 11 either had borderline or high cholesterol. It has also been found that the blood cholesterol levels in childhood are the most significant predictor of high cholesterol levels in adults.

How do ‘Saturated’ and ‘Unsaturated’ fats differ from each other?

Several different compounds naturally found in food and in the body are chemically classified as ‘fats’ or ‘lipids’. All fats are made up from smaller components such as ‘triglycerides’. Within a typical Western diet, triglycerides form the dominant source of fat (90%).

Within its structure, each triglyceride contains three fatty acids. Individually, fatty acids are made up of a central chain of carbon atoms, with hydrogen and oxygen atoms attached to this chain. The term ‘saturated’ is used when a fatty acid has no more space for hydrogen atoms and is therefore ‘saturated’ with hydrogen. ‘Monounsaturated’ fatty acids (MUFAs) have one space left, whilst ‘polyunsaturated’ fatty acids (PUFAs) have more than one space available.Due to the fact that these ‘empty spaces’ allow a fatty acid to behave differently in a biochemical manner, they are considered either ‘beneficial’ or ‘detrimental’ to health.

The chemical differences between fatty acids also contribute to taste. ‘Butyric acid’, for example, is one of the saturated fatty acids responsible for the characteristic flavour of butter.

What role does ‘saturated fat’ play in cardiovascular disease (CVD)?

Currently, all leading medical, heart-health and governmental authorities advise that saturated fat is a risk factor for cardiovascular disease (CVD). This includes the World Health Organization, the American as well as British Dietetic Associations, the World Heart Federation, the Food and Drug Administration and the European Food Safety Authority.

However, some recent questions have been raised in medical literature querying this accepted norm. A meta-analysis published in the American Journal of Clinical Nutrition (2010), for example, did not find significant evidence for concluding that dietary saturated fat is necessarily associated with an increased risk of CVD.^[3] In another review published in the Annals of Internal Medicine (2014), the authors concluded that their findings did not necessarily support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fat.^[4]

Other experts have warned that these conclusions could potentially be misleading due to certain omissions based on available data. A central question is what replaces saturated fat if someone reduces the amount of saturated fat in their diet. If it is replaced with refined starch or sugar, which are the largest sources of calories in the typical Western diet, then the risk of heart disease remains the same. However, if saturated fat is replaced with polyunsaturated fat or monounsaturated fat in the form of olive oil, nuts and probably other plant oils, there is still significant scientific evidence that CVD risk will be reduced.

Why have opinions become slightly contentious?

Because the numerous factors that contribute towards health and the burden of disease are multifactorial. Besides consuming fat, various other factors help to determine cardiovascular health. This includes the process of fat digestion and the intake of other nutritional agents that offer proven health benefits.

Large fatty chains in food cannot be absorbed into the system until they are reduced in size. This happens naturally through the action of enzymes during digestion, a process that leads to the separation of chemical bonds that join individual fatty acids. In the human body, this process is controlled by several digestive enzymes called lipases. Fat digestion, called ‘lipolysis’, starts in the stomach and continues in the small intestine by means of the combined action of various fat digestive enzymes. The rate at which fat digestion takes place and how many free fatty acids it supplies can be influenced by many factors. These include the levels of fat digestive enzymes, as well as the presence of agents that reduce the biological efficacy of fat-digestive enzymes, referred to as ‘lipase inhibitors’ in medical terms.

Besides blocking fat digestion, other agents naturally present in food form insoluble bonds with fat in the intestines, thereby allowing fat to leave the system as waste matter. This is where fibre plays a significant role. The plant-fats or phytosterols, on the other hand, directly compete with cholesterol for absorption in the intestines. Besides blocking the uptake of new dietary cholesterol by the system, a more important task is blocking the body’s tendency to reabsorb its own cholesterol excreted through the liver, thereby breaking the cholesterol recycling pathway.

A recent study on participants with known high cholesterol, for example, examined the effects of a reduced saturated fat diet, against a diet containing foods rich in phytosterols and fibre. After six months, this diet resulted in a significantly greater LDL-cholesterol reduction when compared to the low-saturated fat diet, and produced results that almost equalled the reduction in cholesterol levels that were observed in the earlier trials on statins.

‘An apple a day keeps the doctor away’ has been a health message delivered since the 19^th century. Apples, a rich source of phytochemicals such as polyphenols, are widely consumed and many epidemiological studies have linked the consumption of apples to a reduced risk of some cancers, cardiovascular disease, asthma and diabetes. In the laboratory, apples have been found to inhibit cancer cell proliferation, decrease the oxidation of fats and lower the production of cholesterol in intestinal cell cultures.

To determine whether a daily apple could potentially have a similar protective effect against CVD mortality as statins, adults over 50 years old in the UK were prescribed either a statin or an apple a day. In a recent study (December 2013) released by the British Medical Journal (BMJ), researchers from the University of Oxford concluded that apples managed to rival statins in preventative medicine when it comes to lowering the burden of CVD.

From these findings, it becomes clear that the numerous factors that contribute towards health and the burden of disease are complex. Ideally, they should not be reduced into a one-size-fits-all problem or solution.

Which lifestyle changes will help you reduce your CVD risk?

The following lifestyle modifications will help you to reduce your risks significantly:

Avoid any secondary exposure to smoke, and get help to QUIT SMOKING if you are a smoker.
Increase your level of physical activity by any means, even if just moderately.
Try to maintain your body weight as close to your ideal level. Even slight reductions can make a statistically-measurable difference.
Reduce your intake of saturated fats, trans-fats and cholesterol. An easy way to achieve this goal is to avoid processed food and take-aways. (See below)
Increase your intake of heart-healthy foods. This will automatically result in an increase of fibre, unsaturated fats and phytosterols.
Significantly reduce or avoid the intake of refined carbohydrates and sugar.
Consume alcohol in moderation.
Avoid adding salt to your food.
Monitor your cholesterol levels on a regular basis and start doing this from early adulthood.

Which foods are high in ‘saturated fat?’

Various foods contain different proportions of saturated and unsaturated fat. Examples of foods containing a high proportion of saturated fat include animal fat products such as cream, cheese, butter, ghee, lard, and fatty meats. Certain vegetable-based products also have a high saturated fat content. Examples are coconut oil.

Foods to Avoid:

Fatty meats
Processed meats like salami and sausages
Snack foods like chips, crisps and samoosas
Most takeaway foods, especially deep-fried foods
Cakes, biscuits, doughnuts and pastries
Chocolate

Which foods are ‘heart healthy’?

These are foods rich in phytosterols and sticky fibres. Since both these come from plants, a diet rich in plant-based products will ensure that this objective is easily achieved. The richest naturally-occurring sources of phytosterols are vegetable oils and nuts. Cereal-based products, vegetables, fruit and berries, which are not as rich in phytosterols as nuts and vegetable oil, may also be significant sources of phytosterols if consumed in higher quantities. Sources of fibre are all fruits, all vegetables, legumes (peas and beans) and grains (oats, rye and barley).

References

Boekholdt SM, Hovingh GK, Mora S, et al. Very low levels of atherogenic lipoprotein and the risk for cardiovascular events. J Am Coll Cardiol 2014; DOI:10.1016.j.jacc.2014.02.615.
Ben-Yehuda O, DeMaria AN. LDL-cholesterol after the ACC/AHA 2013 guidelines. J Am Coll Cardiol 2014; DOI:10.1016.j.jacc.2014.05.020.
Siri-Tarino PW, Sun Q, Hu FB, Krauss RM (2010). “Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease”. American Journal of Clinical Nutrition 91 (3): 535–546.
Chowdhury R, Warnakula S, Kunutsor S, et al. Association of dietary, circulating, and supplement fatty acids with coronary risk. Ann Intern Med 2014; 160(6):398-406.
Oh K, Hu FB, Manson JE, Stampfer MJ, Willett WC. Dietary fat intake and risk of coronary heart disease in women: 20 years of follow-up of the Nurses’ Health Study. Am J Epidemiol 2005;161:672-9.
American Heart Association, Cholesterol Guidelines
South African Dyslipidaemia Guideline Consensus Statement Vol 102, No 3, (2012)
Health Society of South Africa, Cholesterol Guide, 2014
World Health Organisation, Cardiovascular Disease Program, Avoiding Heart Attacks and Strokes, 2005

Hypertension

What is High Blood Pressure (Hypertension)?

Your blood pressure (BP) is the force exerted by your heart and arteries to keep blood flowing through your body. Your blood pressure is high when that force is excessive.

Most people will experience short bursts of elevated blood pressure at times. This is normal and may be caused by stress, anxiety, excitement, exertion, etc. In fact, an increase in blood pressure can be helpful, enabling you to act quickly, like jumping away from a speeding car, for example.

It’s normal for your blood pressure to rise and fall during the day. But, when it stays elevated over time, this is called hypertension, which is the medical term for high blood pressure.

Blood pressure is recorded using two numbers. The top figure, called the systolic pressure, represents the pressure during the phase of systole, meaning the maximum pressure exerted by the heart when it contracts. The bottom figure, or diastolic pressure, is the pressure exerted during the phase of diastole, when the heart is totally relaxed and being filled with blood. Blood pressure is therefore an indication of the inward force exerted by the arteries, continuously ‘squeezing’ the column of blood due to their elastic nature.

How common is high blood pressure?

High blood pressure is very common. Globally, the overall prevalence of elevated blood pressure in adults aged 25 and over was around 40% in 2008. Due to population growth and ageing, the number of people with uncontrolled hypertension rose from 600 million in 1980 to nearly one billion in 2008.

What causes high blood pressure?

Despite billions of dollars spent on research by the pharmaceutical industry investigating the mechanisms of high blood pressure in order to invent new drugs, the exact cause of hypertension is still not clearly understood. No specific single cause is found in 90-95% of all cases of high blood pressure.

Hypertension is therefore classified as either ‘primary’ or ‘essential’ hypertension (which means high blood pressure with no obvious underlying medical cause) or ‘secondary hypertension’; the remaining 5–10% of cases that are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.

Hypertension can affect anyone, regardless of age, gender or race. The disease processes leading to the development of high blood pressure include narrowing of the arteries, a greater than normal volume of blood, or the heart beating faster or more forcefully than it should. Any of these conditions will cause increased pressure against the artery walls.

There is overwhelming evidence to suggest that lifestyle and body weight plays a major contributing role in hypertension. Blood pressure rises in direct relation to an increase in body weight. Those who are obese are 2-6 times more likely to develop high blood pressure than those of normal weight.

The excessive intake of salt (sodium chloride), especially aggravated by the diminished intake of potassium, causes an impairment of the body’s blood pressure regulating mechanisms. Nutritional factors such as excess alcohol and coffee intake also contribute. Smoking, a lack of exercise and being overweight are all common causes of high blood pressure, with stress being an aggravating factor.

How is hypertension diagnosed?

The Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) uses the following classifications to diagnose hypertension:

	Diastolic BP	Systolic BP
Normal	<120	<80
Pre-hypertension	120 – 139	80 – 89
Hypertension, Stage 1	140 – 159	90 – 99
Hypertension, Stage 2	≥160	≥100

What are the complications of high blood pressure?

Persistent levels of elevated blood pressure are detrimental to your health. It makes your heart work harder, straining it abnormally. The heart eventually becomes enlarged and overworked, losing its ability to pump blood properly, which can lead to heart failure. High blood pressure also damages the lining of your arteries, leading to heart attacks, kidney disease and strokes.

Hypertension is also a major risk factor for stroke, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and chronic kidney disease. A moderately high arterial blood pressure, left untreated, is associated with a shortened life expectancy.

What are the symptoms of high blood pressure?

One of the more sinister aspects of high blood pressure is that you may not know that you have it. In fact, nearly a third of people with hypertension are totally unaware of the condition. This is why it is often referred to as a ‘silent killer’.

The only reliable way to know if your blood pressure is high is through regular check-ups. This is especially important if you have been told that you are at increased risk of developing high blood pressure in the past. For example, you could be at risk if you have a weight problem, are diabetic, have cholesterol abnormalities or have a family history of high blood pressure and/or heart disease.

What lifestyle changes can improve high blood pressure?

You can take the following steps to both prevent and manage high blood pressure by adopting a healthy lifestyle:

Maintain a normal body weight (losing even 5kg can lower your blood pressure)
Reduce dietary salt intake
Engage in regular aerobic physical activity, such as brisk walking (≥30 min per day, most days of the week)
Limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day in women
Consume a diet rich in fruit and vegetables (e.g. at least five portions per day)

Effective lifestyle modification may lower blood pressure as much an individual antihypertensive drug. Combinations of two or more lifestyle modifications can achieve even better results.

What is the link between high blood pressure and the metabolic syndrome?

The metabolic syndrome is a cluster of disease processes that include obesity, hypertension, impaired glucose tolerance/diabetes and abnormal blood cholesterol profiles. Combined, these conditions lead to an increased risk of heart attack, stroke and diabetes.

References

National Institute of Health, National Heart, Lung, and Blood Institute. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7)
JNC 2014 Evidence Based Guidelines for the Management of High Blood Pressure in Adults. JAMA 2014; 311(5):507-520
Guidelines for management of hypertension: report of the fourth working party of the British Hypertension Society, 2004-BHS IV. Journal of Human Hypertension 18 (3): 139–85.

Neck pain and tension headache

What causes neck pain?

Both acute and chronic neck ache is caused by inflammation, a biological process that is initiated and controlled by several different biochemical signalling pathways within the body. Whilst a painful or stiff neck is a common condition that affects up to two-thirds of the general population at some stage of their lives, repetitive or recurrent bouts of neck pain may also indicate that inflammation could slowly be causing permanent, structural damage to the neck. If this is allowed to happen, acute neck pain will become a chronic, permanent feature. In the latest Global Burden of Disease study (GDB 2013), chronic neck pain is ranked the fourth biggest cause of chronic disability in the world, suggesting that early treatment and prevention are too often neglected

Where does neck pain originate from?

The neck consists of several different tissue types which can each be a source of pain. These are:

Vertebrae – segments of bone stacked upon each other that provide strength and structure.
Intervertebral discs – circular pads of pliable soft tissue situated between the vertebrae. These allow for flexibility in all directions.
Ligaments – fibrous bands which keep the vertebra in place.
Nerves (spinal chord) – runs along the spinal column and branches off between each vertebra. These pass information from the brain to the rest of the body.
Muscles – situated on the sides and behind the vertebrae.
Facet joints – small joints covered by cartilage that allow the vertebra to rotate upon each other.

Importantly, all of these tissues can activate the sensation or perception of pain, both individually and in combination. Effective treatment is therefore highly dependent on identifying the exact source of pain, and extremely important as some tissues may be irreversibly damaged by inflammation. For example, whilst muscles are able to recover from inflammation with ease, inflammatory damage done to the intervertebral discs can become a real and permanent problem.

What is the most common cause of acute neck pain?

Muscle inflammation
Whilst most muscles in the body completely relax when they’re not being used, others, called ‘anti-gravity muscles’, work continuously to maintain your posture. A large proportion of muscles in your neck are of this kind, and so are always tense to prevent your head from flopping over. This gives your neck muscles very little time to relax and often contributes to chronic pain, as there is insufficient opportunity to recover. Painful muscle inflammation can be caused by several mechanisms, including sprains, strain, poor posture, falling asleep in an awkward position, or whiplash injury. Another common cause is the use of a computer for prolonged periods of time, which can contribute to chronic muscle spasm and pain. Additionally, anxiety and stress commonly cause increased muscle tension and pain in your neck muscles.

How does muscle inflammation trigger headaches?

A tension headache, also known as a tension-type headache, originates from the neck and radiates around the head in a band like a manner where it creates a frontal, nagging, and pressing headache. Tension-type headaches are the most common form of a headache and account for nearly 90% of all headaches. In the majority of cases, neck muscle inflammation and spasm are the most frequent triggers that both causes and aggravates tension type headaches.

What are the most common causes of chronic neck pain?

Spondylosis or disc prolapse
Spondylosis is a collective term used to describe the combined effects of several degenerative processes that progressively start to affect the spine. It usually begins in one or more of the intervertebral discs situated between the vertebrae and then spreads to surrounding tissues such as ligaments, joints, and bones. Besides causing local pain, an inflamed intervertebral disc may progressively become weakened through continual enzymatic activity caused by inflammation. This corrosive activity makes the disk increasingly more prone to future damage and even collapse. A collapsed disk may cause direct pressure on the nerve roots as they exit the spinal cord between each vertebra, causing a referred pain syndrome during which pain radiates down the shoulder or arm. Tingling or pins and needles are also common symptoms, whilst in a more advanced state, weakness and loss of sensation may occur within the hands or arms.
Osteoarthritis
This is a common condition that mainly affects the integrity of the cartilage, especially as one becomes older. Osteoarthritis mostly affects the small facet joints between the vertebrae, as they are the only cartilage containing structures in the neck. Importantly, the presence of osteoarthritis in the neck is commonly associated with the presence of several other inflammatory conditions, such as spondylosis, where protein containing structures in the spine are simultaneously degraded. Since the neck is predominantly protein-based, these cumulative effects can cause severe impairment and chronic disability over time.

How is neck pain treated?

Step 1 – the alleviation of acute pain to improve the quality of your life and help you to remain functional and productive.
Step 2 – the implementation of preventative self-help strategies to protect you from the permanent structural damage that chronic inflammation may cause to your neck.

Acute pain management for acute neck ache and tension-type headaches

Anti-inflammatory drugs (NSAID’s) – these are good options to assist with acute pain. However, they should all be used with caution over the long-term, since as a class, these drugs pose a significant side-effect risk relating to cardiovascular, gastrointestinal and kidney disease. (Ask your doctor or pharmacist for advice).
Analgesics – paracetamol (acetaminophen) and opiates or opiate derivatives are often required to help alleviate acute pain. These drugs serve as symptomatic relief, lowering the sensation of pain, but do not combat the underlying cause. Opiates may cause drowsiness, constipation and addiction. (Ask your doctor or pharmacist for advice).
Hot or cold packs – applying a heat pack to your neck can help to ease the pain. You can use a microwavable heat pad or a hot-water bottle. Heat dilates the blood vessels which improves blood supply to the back and helps to reduce muscle spasms. Heat also alters the sensation of pain. (Some find cold packs offering better relief – for example, a bag of frozen peas).
Rehabilitation therapies – physiotherapy, biokinetics or chiropractic therapy may prove helpful. A good massage may also assist.

Preventative self-help strategies:

By preserving the integrity and mobility of your neck you are in turn protecting it from the consequences of chronic inflammatory damage over time. Judging from the number of people in the world who become permanently disabled from chronic neck pain, these easy to implement but important strategies will likely prove one of the most worthwhile investments in your overall health.

Stretch your neck
Stretching is a form of physical exercise during which a contracted, tight, or painfully stiff ligament or muscle group is deliberately lengthened in order to improve its elasticity and achieve a more relaxed tone. When done properly, this results in a more comfortable feeling of increased muscle control, flexibility, and range of motion. Regular stretching is an excellent way to alleviate muscle inflammation and pain. This is achieved by gently stretching your neck muscles as you tilt your head up and down, and rotating your head by looking far right and far leftover your shoulders.
Strengthen your neck muscles with exercise
Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and reduce the risk of recurrence. Modern research has demonstrated that many of the benefits of exercise are mediated through the role that muscle tissue plays as an endocrine (hormone-producing) organ. Contracting muscles release multiple substances known as myokines which promote the growth of new tissue and facilitate tissue repair. Myokines also have multiple anti-inflammatory effects, which in turn reduce your overall risk of developing various inflammatory diseases. These anti-inflammatory effects assist locally with inflammation in your neck, as well as systemically in the rest of your body. As with any physical activity, you’ll need to use some common sense when doing these.
Use supplements that naturally reduce inflammation
Various natural molecules derived from plants are highly effective in suppressing pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. A large number of high-level research projects have produced strong evidence that these agents alleviate and potentially help to prevent osteoarthritis, intervertebral disc degeneration, and osteoporosis. These three separate but interlinked conditions are all caused by inflammation and are also the three predominant causes of most cases of chronic back and neck pain. Read more about RheumaLin.
Manage stress better
Since any form of stress will increase the tension in the muscles of your neck and could precipitate tension headaches, you will benefit tremendously from learning how to manage stress.
Correct your posture
A bad posture especially, when sitting or reading is a common cause for neck pain. Ideally you should be sitting with your hips and knees at right angles and you should have good support for your lower back. Hardback, upright chairs or straight-backed rocking chairs are better for your posture than low, soft, upholstered chairs or sofas. Using back supports can help your posture when sitting at home, at work or in the car. If your desk is too low, so that your head is bent forward for long periods, then your neck may be stretched and you may develop muscle pain. Check the height of your desk and the design of your chair at work and at home. Many employers have occupational health specialists who can check that workstations are set up according to your needs. If you do a lot of reading, having the book or papers on a reading frame will often help to correct your posture.
Avoid periods of immobility
Keeping your head in the same position for too long may cause muscle inflammation. Take regular breaks from your desk, driving or any activity where your neck may be held in the same position for an extended period of time, or perform regular stretches during the day.
Choose the correct pillow
Your head and neck should be supported so your head is level with your body in a neutral position. Ideally the pillow should fill in the natural hollow between the neck and shoulders, – a soft or moulded pillow may be useful. A supportive roll inside your pillow case can also be introduced to support the hollow of your neck. Only use enough pillows (usually only one) to keep your head level with your body.
Check your mattress
If your mattress doesn’t give your back proper support, it can also make neck pain worse. Make sure your mattress is relatively firm – a soft mattress could mean that your neck is bent while you sleep.
Massage your neck
A regular and gentle massage of your neck will help alleviate pain and muscle inflammation.

Gout

What Is Gout?

Gout is a form of arthritis caused by the slow but progressive accumulation of uric acid crystals within joints spaces as well as the surrounding soft tissues. For several reasons, the presence of these crystals has the ability to provoke the immune system and activate severe bouts of inflammation, often at a rapid rate.

What are the symptoms of gout?

As compared to other causes of joint inflammation, acute attacks of gout are characterised by agonising pain. The most common symptom of gout is pain and swelling in the first joint of the big toe. This symptom is called ‘podagra’ in medical terms and occurs in about 50% of cases of gout. Other regions that gout may affect are the insteps, ankles, heels, knees, wrists, fingers, and elbows. Episodes of pain are intermittent, and may take weeks or months to reoccur. In a more advanced stage, gout may become chronic and cause permanent symptoms.

What is uric acid?

Uric acid is a natural by-product of the metabolic breakdown of purines, protein-based substance found in DNA and RNA. Uric acid on its own may not pose a problem, but the crystallisation of uric acid within a joint or the adjacent soft tissue leads to gout. This process is directly dependant on blood uric acid levels.

What influences blood uric acid levels?

After production, uric acid is dissolved in the blood and passed through the kidneys where it is eliminated from the body as a natural waste product. If there is an increase in the rate of production of uric acid, or if the kidneys do not eliminate enough uric acid from the body, uric acid blood levels increase, resulting in a condition called hyperuricemia. Uric acid blood levels are therefore dependent on both the production as well as excretion of uric acid.

What causes high blood levels?

Under-excretion of uric acid by the kidney is by far the primary cause of high blood uric acid levels (hyperuricemia) and accounts for about 90% of cases. Various factors contribute to under-excretion, including genetics, diet and certain medication. Overproduction only causes about 10% of cases of hyperuricemia. In this case hyperuricemia may result when a person eats too much high-purine containing food, or eats too much food in general.

How does gout develop?

Based on the blood uric acid levels and the presence of symptoms, gout can be divided into stages:

Stage 1 – Asymptomatic hyperuricemia. (meaning without symptoms)
This is the early stage where a person has elevated uric acid blood levels (hyperuricemia), but displays no other symptoms suggestive of gout. Depending on blood uric acid levels, treatment is usually not required at this stage. This is because hyperuricemia is not considered a disease in itself and may not pose a health risk until symptoms develop.
Stage 2 – Acute gout / acute gouty arthritis.
By now chronically elevated uric acid blood levels has led to the deposition and crystallisation of uric acid within the joint spaces and surrounding soft tissues. This triggers bouts of severe inflammation resulting in intense pain of sudden onset. Acute attacks commonly occur at night and can be triggered by a variety of factors including stressful events, a minor injury, excess alcohol intake, certain medication, or the presence of another illness. Attacks usually subside within 3 to 10 days, even without treatment, and the next attack may not occur for months or even years. As increasing quantities of uric acid crystals start to accumulate within joints and soft tissues over time, attacks occur more frequently and last longer, and may eventually become persisting and chronic. If left untreated, recurrent bouts of inflammation triggered by gout will cause progressive and permanent damage to a joint.
Stage 3 – Chronic tophaceous gout.
If preventative treatment of stage 1 and 2 gout is neglected, the accumulation of uric acid crystals may progress to such a degree that visible lumps of uric acid deposits start forming under the skin. This may also lead to the distortion of a joint. Subcutaneous uric acid deposits are called tophi, hence the term tophaceous gout. When surgically drained, tophi exude a chalky white substance similar to toothpaste in consistency. Chronic tophaceous gout is the most disabling stage of gout. At this stage the disease would most likely have caused permanent damage to the affected joints. High uric acid levels may also affect the kidneys where uric acid kidney stones are formed.

What is “Pseudo-gout”?

Gout is sometimes confused with other forms of arthritis because the symptoms are very similar. One of these conditions is “pseudo-gout” where the pain, swelling, and inflammation also presents in a sudden and severe manner, and thus mimics the symptoms of gout. However, pseudo-gout is caused by the accumulation of calcium phosphate crystals within a joint, not uric acid.

What are the risk factors for gout?

A number of risk factors are associated with hyperuricemia and gout. They include:

Genetics – There is a strong family history of the disease. In most of these cases these individuals excrete less uric acid via their kidneys.
Gender – Men are more commonly affected than women.
Weight – Being overweight increases the risk of developing hyperuricemia and gout through providing more tissue for turnover or breakdown, leading to excess uric acid production.
Alcohol consumption – Too much alcohol can lead to hyperuricemia, since alcohol blocks uric acid excretion by the kidneys.
Diet – Eating too many foods that are rich in purines or eating too much food in general can increase blood uric acid content. (See below).
Medical conditions – Some diseases may cause an excessively rapid turnover of cells, increasing uric acid waste. Some examples are psoriasis, haemolytic anaemia and some forms of cancer.
Medications – Diuretics, aspirin, cyclosporine and levodopa may affect uric acid excretion by the kidneys.

Which foods are high in purine content?

Purines are found in high concentration in meat and meat products, especially internal organs. In general, plant-based diets are low in purines. Specific examples of high-purine foods include anchovies, sardines, herring, mackerel, scallops, liver, kidneys, brains, meat extracts (e.g., Oxo, Bovril), game meats, beer (from the yeast), and gravy.

A moderate amount of purine is also contained in beef, pork, poultry, other fish and seafood, asparagus, cauliflower, spinach, mushrooms, green peas, lentils, dried peas, beans, oatmeal, wheat bran and wheat germ.

How is gout treated?

With proper treatment, most people who experience gout are able to control their symptoms and prevent further deterioration. Treatment aims to ease the pain associated with acute attacks as well as to prevent future episodes. Since gout may also lead to the formation of tophi and kidney stones, focus should also be placed on avoiding the development of these conditions.

Step I – dealing with acute attacks

Prescription medication
The severe pain caused by acute attack of gout can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, or colchicine. In severe cases these can be used in combination. Although effective with reducing inflammation and controlling pain caused by the deposition of uric acid crystals, these drugs have no effect on the amount of uric acid present with the blood stream, soft tissue or joints.

Step 2 – preventing future attacks and protecting your joints from permanent damage

Prescription medication
Since hyperuricemia and gout are chronic conditions, the ideal approach is to lower uric acid levels through either increasing the rate of excretion of uric acid by the kidney, or by lowering the production of uric acid in the body. The drugs probenecid and allopurinol are commonly used for this purpose.
Supplements that help prevent inflammation
In addition to lowering blood uric acid levels with prescription drugs, several natural molecules derived from plants are highly effective in suppressing certain pathways involved in chronic inflammation. These generally have a low side-effect risk, making them an attractive approach when compared to other pharmaceuticals. RheumaLin™ is a novel multi-modal, multi-target anti-inflammatory supplement that consists of two plant extracts, Boswellia bark extract and resveratrol. These naturally derived phytochemical plant-based compounds are widely recognised. They combat inflammation via biochemical mechanisms that are different to those of existing anti-inflammatory drugs. Read more about RheumaLin.