Best Weight Loss Programs That Work

The 3 Week Diet

3 Week Diet is a program that covers the weight loss trifecta of dieting, exercise, and motivation and is intended to produce extremely quick fat loss results, guaranteeing to shed off 12 to 23 pounds in only 21 days. Expect this program to change your eating habits, teach you to follow a strict eating program that restricts carbohydrates while utilizing strategic protein consumption, go on an exercise habit, and keep a close eye on your progress. Brian Flatt who is health coach and nutritionist discovered these quick weight loss secrets after 12 years of research. Lots of people successfully burn fat with the help of these secrets. The main secret behind this program is signaling body to burn stored fat for energy and then creating starvation mode into the body. When body enters into starvation mode then body will burn stored fat for fueling liver, heart and other organs of the body. This is completely safe, natural and scientific proved weight loss technique. More here...

The 3 Week Diet Overview

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US Government agencies that regulate dietary supplements

We consumers tend to believe that products sold over the counter are protected by governmental safeguards and therefore are safe for us to use. That is not the case. With current U.S. federal laws, consumer protection and enforcement agencies cannot protect against contaminated products, false indications of miracle results, and other dangers inherent in dietary and herbal supplements.

The RDAs Recommended Dietary Allowances

The Recommended Dietary Allowances (RDAs) are standards set by an expert committee known as the Food and Nutrition Board of the National Academy of Sciences National Research Council. These recommendations list the average daily requirements for a variety of nutrients (in other words, vitamins and minerals) and are intended for healthy people.

The DRIs Dietary Reference Intakes

Because scientific knowledge regarding diet and health has increased, the Food and Nutrition Board has recently expanded its framework and developed the Dietary Reference Intakes (DRIs) for several vital nutrients. It is forecasted that over the next three to four years additional groups of nutrients including phtyoestrogens, antioxidants and phytochemicals will also be slated for review toward DRI development. These new DRI standards include the RDAs as goals for intakes, plus three new reference values the estimated average requirement (EAR), the tolerable upper limit (UL), and the adequate intake (AI). On the two reference charts provided here, you'll notice that some nutrients are listed as DRIs, some as RDAs, an some as AIs a bit confusing but all you'll need to understand is the actual recommended amount.

Obesityprone dogs and cats

Obesity is the most common nutritional disease in the Western world in both pets and their owners. A staggering 50 of dogs and cats in the UK are considered to be above their ideal weight. This means that every other dog and cat owner you speak to in your practice will have a pet that might benefit from a weight-management product. When discussing weight control it should be remembered that many owners might feel guilty that their pet has become overweight. You are as much counselling them as giving nutritional advice for their pet. True obesity, where the pet is more than 15 over the ideal body weight, is considered to be a clinical condition and requires careful weight reduction under the guidance of a veterinary surgeon. This is important, since severe obesity can contribute to many other clinical conditions that would require veterinary attention. Also, in a few rare cases the weight gain may be due not to the accumulation of fat but to pregnancy, fluid retention, the growth of a...

Overweight or obesity

One common problem is an overestimation of the amount of work a horse is doing. NRC (1989) considers that light work consists of Western and English pleasure riding, bridle-path hacking and equitation medium work consists of ranch work, roping, cutting, barrel racing and jumping heavy work includes horses in race training. The recommendation is to increase the energy content of the daily ration by 1.25, 1.50 and 2.00 times the maintenance requirement as appropriate. The horse doing a few hours hacking a week can probably be considered to be at little more than maintenance, especially if stabled and not requiring any energy for foraging food in a field. Horses cannot be considered to be in medium or hard work until they are doing considerable amounts of fast work, such as regular hunting, endurance work or 3-day eventing. It is always better to err on the side of safety and keep the rations below what appears to be recommended. If the horse starts to lose weight, additional food can...

Dietary recalls andor records

There are several methods used for studies on dietary intake, both retrospective and prospective, based on anything from personal interviews, records and use of food frequency questionnaires to the double portion technique. Each of them has its pros and cons as illustrated in Table 2.4.4. There is no single golden method for estimation of the dietary intake without error, and the goal of the study is of utmost importance when selecting the optimal method for dietary assessment. Furthermore, different types of errors have different effects in analysis and interpretation. Consequently, data collected by means of one dietary assessment in order to study the intake of one nutrient may not necessarily be as valid in evaluation of the intake of another nutrient. The retrospective methods comprise dietary interviews in order to describe dietary habits from a longer-term perspective. This calls for a skilled interviewer and is time consuming. They can also be based on Table 2.4.4 Summary of...

Validation of dietary assessments

Dietary assessment methods will almost without exception result in an underestimation of energy intake. Energy turnover should consequently be evaluated on the basis of studies of energy expenditure based on calculated BMR with the addition of a relevant PAL factor, which is based on the lifestyle including physical activity, and only in exceptional circumstances on determinations of energy intake. The energy equation fulfils the first law of thermodynamics energy cannot be created nor destroyed, it can only be transferred from one form to the other. Available energy from energy intake and tissue breakdown must balance energy turnover if body weight is stable and body composition unchanged over a certain length of time. Thus an objective and reliable reference against which to validate data obtained on dietary intake can be based on a com

Daily intake and food habits in athletes

Interestingly numerous published food intake studies in elite athletes are based on dietary assessments where the energy intakes are remarkably low. If the data from their training logs are compared to calculated energy turnover from anthropometric data, the discrepancy is obvious and the use of various forms of compensation for energy adjustments have been proposed. Whether athletes have a tendency to reduce their BMR values as a compensation for insufficient energy intake is still an open question. An increased BMR would in fact have been expected, as both the lower fat content of an athlete's body compared to that of an untrained individual and the excessive postexercise oxygen consumption (EPOC) should lead to an increased BMR. Data on energy intake from any dietary assessment in athletes who maintain a constant body weight, which does not exceed the minimal energy require ment based on BMR and a suitable PAL factor, cannot be considered accurate for analysis of the relationship...

Overweight and obesity

The most commonly used measure to define overweight and obesity is body mass index (BMI, in kg m2). Currently the most widely accepted cut-off point for overweight is BMI > 25.0 and for obesity BMI > 30. BMIs in the range of 25.0-29.9 indicate only overweight, but not obesity. BMIs> 30.0 assume that persons categorized at this level are obese, i.e. overweight because of excess adiposity. Overweight and obesity constitute an important health problem because of two reasons. First, the risk of a number of somatic disorders as well as psychological and social consequences increases sharply with increasing overweight and obesity 56-58 . However, part of the increased morbidity and mortality associated with increased BMI may not be due to excess fat per se but to physical inactivity and low fitness associated with and probably causally related to overweight and obesity 59,60 . Secondly, overweight and obesity are very common and increasingly prevalent conditions in European as well as...

Interactions between dietary fat and physical activity

In a number of countries the prevalence of obesity has continued to rise despite a reduction in the proportion of calories from fat in the national diet. Having been observed in the USA, this phenomenon has been named 'The American Paradox' 14 . Among the explanations suggested for this apparent contradiction have been a concomitant overriding effect of decreasing physical activity, overconsumption of highly palatable, energy-dense, carbohydrate-rich, low-fat products, underreporting of fat consumed in dietary surveys, and obesity being an infectious disease caused by an adenovirus. It should be stressed, however, that a high dietary fat content is unlikely to be the only environmental factor responsible for obesity. A sedentary lifestyle with a low level of energy expended on physical activities is another causative factor, which interacts with dietary fat content. It has been demonstrated that dietary fat tolerance is greatly lowered by a sedentary lifestyle, even in non-obese...

Dietary Principles and Weight Loss

It is not necessary to attempt weight loss before instituting medical therapy, especially since weight loss alone may not provide any glycemic control in highly insulin-deficient patients. However, a multifaceted approach with education, reduced energy, and fat-calorie intake, increased regular physical activity, and other lifestyle changes can produce long-term weight loss and glycemic improvement. Less need for calories in elderly patients leads to obvious dietary changes. Of note, patients should not avoid breads and other starches in fact, complex carbohydrates are an important part of the modern approach to diabetes.

Dietary Recommendations

The 2008 ADA guidelines considered the risk and advisable intake of carbohydrates, fats, proteins, and other food ingredients. Monitoring carbohydrate by counting, exchanges, or experience-based estimation remains a key strategy in achieving glycemic control. Saturated fat should be less than 7 of calories, and there should be minimal trans fat. Total cholesterol should be less than 200 mg daily. Higher fiber intake may improve glycemic control thus fiber intake should be at least 14 g 1000 calories daily. Sugar, alcohols, and nonnutritive sweeteners are safe when consumed within daily levels established by the Food and Drug Administration (FDA). Usual dietary protein of 15 to 20 of calories is appropriate in diabetes in the absence of significant renal insufficiency. Reduction of protein intake to 0.8 to 1.0 g kg day in diabetic individuals with early stages of chronic kidney disease, and to less than 0.8 g kg day in later stages, may improve renal function. High-protein diets (>...

Dietary prevention of food allergies and atopic dermatitis

Elimination diets have long been an integral part in the treatment and secondary prevention of food allergies and AD.30,123 There may also be a role for the delayed introduction of high-risk weaning foods, such as egg and peanut, as part of the primary prevention of food sensitization. However, while these dietary interventions may reduce the frequency of manifestations of food allergy during the period of diet exclusion, there is no conclusive evidence they prevent the development of food allergy or hasten the induction of tolerance.124

Patient Counseling on Dietary Changes

Many chronic conditions have dietary implications, and dietary change is required for the condition to improve. For example, obesity involves calorie reduction diabetes involves changes in food types eaten, portions, and spacing of eating episodes and hypertension often involves sodium restriction. Thus, it is important to focus on the behavior necessary (e.g., reducing intake of simple carbohydrates) to reach the outcome (improved HbA1c levels). Often, dietary advice involves the patient being told to do the outcome, such as lose some weight or improve A1c. Although important goals, these should not be confused with what action a patient can take. A patient cannot stand still and lose weight but can only change eating patterns and increase physical activity (behaviors). In communicating with patients, it is important to state not only the desired outcome and why (e.g., It is important to get your hemoglobin A1c below 7 so that you can reduce the chance that you will have...

Risk factor obesity

Maps Body mass index Lakka HM, Lakka TA, Tuomilehto J, Salonen JT. Abdominal obesity is associated with increased risk of acute coronary events in men. European heart journal, 2002,23 706-713 (cited in Sowers JR. Obesity as a cardiovascular risk factor. American journal of medicine, Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbidity and mortality associated with the metabolic syndrome. Diabetes care, 2001, 24 683-689 (cited in Sowers JR. Obesity as a cardiovascular risk factor. American journal of medicine, Overweight and obesity defining overweight and obesity WHO expert consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet, 2004, 363 157-63. Eckel RH, Krauss RM. American Heart Association call to action obesity as a major risk factor for coronary heart disease. Circulation, 1998, 97 2099-2100. Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Mamun AA, Bonneux L. Obesity in adulthood and its...

Weight Management Motorize Your Metabolism

We close this chapter on imbalances with perhaps our country's greatest health challenge weight management. We look in a mirror, step on a scale, or put on our bathing suit, and what runs through our minds Too fat Too thin Body imaging is a large-scale issue in this country and goes well beyond the scope of this chapter. Weight management is at a crisis level in our country. It is estimated by the U.S. Centers for Disease Control and Prevention that one-third of Americans are 20 percent or more overweight, which qualifies them as being obese. National surveys show that 25-50 percent of adults are on diets and spend about 30 billion each year on them. Unfortunately, a lot of that money goes to waste without the proper lifestyle changes. Two-thirds of those who lose weight will gain it back during the next three to five years. The average human body has 30-40 billion fat cells, which are genetically geared for helping you store unused calories. It's simple Use those calories, or they go...

Whats the Best Diet Anyway

If you're looking for a quick fix, this chapter is not going to help you. The bottom line is that people should lose weight eating the very same healthy foods that they will continue to eat after they have lost the weight that is, moderate amounts of carbs coming from whole grains, fruits and vegetables, low-fat dairy, and lean sources of protein foods. Makes perfect sense, right To lose weight forever, you must work on changing your eating behavior forever. Read through and try my bubble plan. You've got nothing to lose except some unwanted pounds and perhaps a lifetime of professional dieting.

Elderly Patients with Obesity

The majority of obese patients are 40 to 59 years of age. However, the prevalence of obesity in older adults is increasing therefore, it should not be surprising that more cardiovascular risk factors are present in this group of individuals. Additionally, obesity is a major predictor of functional limitation and mobility problems in older persons. Age alone should not prejudice the clinician from treating geriatric patients, whereas the benefits of cardiovascular health and functionality should be considered. Treatments should be initiated that minimize adverse effects on bone health and nutritional status and should include dietary and activity modifications.6

Herbs and Other Dietary Supplements

In 1994, in response to pressure from both consumers and the supplement industry, the U.S. Congress passed the Dietary Supplements Health and Education Act (DSHEA). Under DSHEA, herbs, vitamins, minerals, and other natural health products are regulated differently from pharmaceuticals. After passage of DSHEA, the supplement market boomed, with sales climbing from 8.8 billion in 1994 to 15.7 billion in 2000 (Blendon et al., 2001) and 21 billion in 2008 (Thurston, 2008).

The Role of Obesity in ROS Generation and Male Infertility

Aim To discuss the relationship between obesity and male infertility, specifically exploring the role of reactive oxygen species (ROS) production in obesity and the subsequent generation of oxidative stress, as well as abnormal hypothalamus-pituitary-gonadal regulation associated with obese males. Results Both enhanced ROS generation and abnormal hormonal regulation due to obesity are strongly correlated to suboptimal semen quality and, thus, reduced male reproductive potential. Conclusion The continuing rise and prevalence of both obesity and declining male sperm count all over the world call for additional research and a greater awareness to obesity as a potential etiology of male infertility. Keywords Male infertility Obesity Reactive oxygen species Oxidative stress Hormones

Current Dietary Guidance

The latest version of the public health dietary guidance program was introduced in 2010. This is in connection with the MyPyramid food guidance system (www.MyPyramid.gov). The MyPyramid recommendations are based on the following The new food pyramid has an interactive interface, allowing for customization of the food plan as well as key concepts into a visual image (see Web Resources). Although there is general agreement, many argue that the recommendations are vague and that food amounts and groupings are inappropriate. The major addition in this version of the food guidance system has been physical activity, which seems to be critical in the considerations of diet and the balancing of energy needs with intake. The overarching concepts of the 2010 Dietary Guidelines (www.dietaryguidelines.gov) explain the educational framework for the MyPyramid, as follows Maintain calorie balance over time to achieve and sustain a healthy weight. There are more than 23 key recommendations in the...

Obesity and Male Infertility

Infertility Obesity Mechanism

BMI has been found to be associated with altered sperm parameters in numerous reports. In a recent study investigating factors related to semen quality, the prevalence of infertility in obese men was found to be three times greater than in male partners of couples with idiopathic or female-factor infertility 12 . Moreover, sperm density and total count was shown to have a statistically significant negative correlation to increasing BMI 12 . Another study looked at normozoospermic partners in an infertile population and reported a reduction in sperm concentration among men with BMI greater than 30 kg m2 when compared to leaner members of the study group 23 . Kort et al. further examined the relationship between sperm parameters and BMI in a generally overweight selection of subjects 24 . After 520 semen samples were subjected to analysis, semen quality and the number of normal sperm per ejaculate exhibited declines with increasing BMI 24 . On the other hand, when obesity was expressed...

Eating Habits

If you have anorexia, you hate fat (maybe even fear it) and deny yourself the right to eat the way most people do. You may ban red meats and processed meats (such as bologna and hot dogs) from your diet altogether and restrict yourself to eating small amounts of white meat, poultry, and non-fatty fish. You cut out foods such as mayonnaise, peanut butter, hard cheeses, butter and margarine, and avoid sweets and desserts, processed breads and sugary cereals. If confronted, you justify your food choices by saying you know a lot about nutrition and you're just eating healthy by cutting down on fats and cholesterol in your diet. You probably allow yourself certain safe foods such as low-calorie vegetables, crunchy fruits such as apples, salads with vinegar (balsamic is a favorite) or no-oil salad dressings, plain popcorn, unsalted rice cakes, low-fat cottage cheese, and nonfat yogurt, but only in limited amounts. Many of you say that you are vegetarian so many, in fact, that a study...

Dietary Fiber

Vegetables are extremely complex mixtures of natural, organic chemicals. Some believe that, rather than fiber, the green and yellow vegetables that are the principal sources of carotenoids in our diet may provide protection against colon cancer. The protective factors could also be other chemicals found in some vegetables more than others. For example, there is a class of compounds, including pectins and gums, that are not digested in the small intestine along with starch, but are rapidly fermented by bacteria when they reach the colon. They are now subsumed within the overall term dietary fiber, though they may in some respects produce effects that differ from those of the largely unfermented cellulose.

Obesity

Obesity was initially believed to be a relative contraindication to laparoscopic surgery. An early multicenter series of 125 patients with a body mass index > 30 undergoing various laparoscopic procedures, including 14 laparoscopic nephrectomies, documented a complication rate of 22 intraoperatively and 26 postoperatively (11). With increased laparoscopic operative experience, more recent studies have shown otherwise (12). In a retrospective single center study involving 69 nonobese and 32 obese (body mass index > 30) patients undergoing laparoscopic nephrectomy, Fugita et al. reported equivalent operative times, complication rates, conversion rates, and postoperative recovery course (12). In another study involving 40 patients undergoing laparoscopic donor nephrectomy, outcomes and complication rates were similar between obese and nonobese patients (13). Obesity is not a contraindication for laparoscopic nephrectomy. Laparoscopic nephrectomy is both feasible and efficacious in...

Dietary fibre

Dietary fibre, or roughage, consists of a group of indigestible polysaccharides such as cellulose, lignin and pectin. They are the main constituents of plant cell walls and are relatively indigestible within the gut of dogs and cats. In these species the role of fibre in the diet is to provide bulk to the faeces, regularizing bowel movements and helping to prevent constipation and diarrhoea. Fibre also has therapeutic uses in the treatment of fibre-responsive diseases. Since fibre is largely indigestible it decreases the energy content of the diet and so has a role in the correction and prevention of obesity.

Dietary factors

Poor dietary habits contribute to the development of other stroke risk factors such as obesity, diabetes, hypertension and dyslipidemia. The Global Burden of Disease study 2000 estimates that in Europe 4.4 of total disability-adjusted life years (DALYs) lost are attributed to low fruit and vegetable intake and another 7.8 to overweight and obesity 62 . Changes in dietary habits therefore have high potential for reducing stroke risk. Different foods and nutrients have been suggested to influence stroke risk via several mechanisms, e.g. by influencing blood pressure, insulin resistance, inflammation risk, platelet function, endothelial function and oxidation 63 . Observational studies found an association between sodium intake and stroke mortality 72 . This association is at least partly mediated by the well-studied positive relationship between salt intake and blood pressure 73 . A reduction in salt intake in hypertensive persons (median urinary sodium reduction by 78mmol day or 4.6 g...

Dietary Details

The current dietary principles recommended by ADA are the same as those of the American Heart Association (AHA). The caloric content should be that which will permit a patient with type 2 diabetes to attain a body mass index (BMI) of 25 kg m2. With gender, height, weight, and age known, the basal daily caloric requirement and the desired weight can be obtained from standard online calculators. A simpler method, for patients with routine and not intensely physical activities, is to estimate the daily caloric expenditure by multiplying the ideal weight in kilograms by 30 calories kg. Weight loss can be safely achieved if the patient is taught how to reduce caloric intake by 100 calories per day for each 10 pounds of desired weight loss over 1 year. National Institutes of Health guidelines advocate that weight changes be methodically accomplished over long periods. This will preclude acute energy shifts that could cause gallstones, gout, and depression and have 95 likelihood of...

Dietary

A LCD is essential for weight-loss management in overweight and obese patients. The Step-1 Diet (Table 102-5) is a LCD recommended as part of an obesity education initiative from the National Heart, Lung, and Blood Institute.6 In general, the Step-1 Diet restricts daily calories to a range of 1,000 to 1,200 kcal (4,184-5,021 kJ day) for women weighing less than 75 kg (165 lb) and 1,400 to 1,600 kcal (5,858-6,694 kJ day) for all others. However, this daily limit should be considered after assessing a patient's normal daily caloric intake and ensuring that the initial caloric restriction does not exceed 500 to 1,000 kcal (2,092-4,184 kJ day). For example, a male patient who consumes 3,000 kcal (12.552 kJ day) should not reduce his daily caloric intake to less than 2,000 kcal (8,368 kJ day) when initially implementing a dietary program. Further reduction to the target of 1,600 kcal (6,694 kJ day) can be attempted once the patient has reduced calories successfully as initially recommended...

Morbid Obesity

Obesity accentuates many of the physiologic and anatomic changes of pregnancy. For example, there is less pulmonary reserve because functional residual capacity is smaller and oxygen consumption is higher than in the nonobese parturient. Similarly, cardiac output and blood volume are increased in obese individuals. There is a higher incidence of comorbidity (e.g., hypertension and diabetes mellitus), and a higher incidence of difficult airway. Obese parturients are more at risk for hypoventilation and oxygen desaturation after opioid administration. They are at increased risk for cesarean delivery. Obesity increases the risk of anesthesia-related maternal death during cesarean section. Finally, associated fetal problems include macrosomia, shoulder dystocia, and birth trauma. For the obese parturient, there are several considerations when regional anesthesia is being chosen for cesarean delivery. Patient positioning may have a profound impact on respiratory and hemodynamic stability,...

Growth and Development

Children are monitored for physical, motor, cognitive, and psychosocial development through clinical recognition of timely milestones during routine well-child visits. As a newborn continues to progress to infant, child, and adolescent stages, different variables are monitored to assess growth compared to the general population of similar age and size. The Centers for Disease Control and Prevention (CDC) Growth Charts (Fig. 3-1) are used to plot head circumference, weight, length or stature, and body mass index for a graphical representation of a child's growth compared to the general pediatric population.6 These tools assess whether a child is meeting the appropriate physical growth milestones, thereby allowing identification of nutritional issues such as poor weight and height gain (e.g., failure to thrive).

Routes of Administration and Drug Formulations

When oral drug therapy is needed, one must also consider the type of dosage form available. Children less than 6 years of age are often not able to swallow oral tablets or capsules and may require oral liquid formulations. The child's ability to swallow a solid dosage form should be determined before selecting a drug product. Not all oral medications, especially those unapproved for use in infants and children, have a commercially available liquid dosage form. Use of a liquid formulation compounded from a solid oral dosage form is an option, when data are available. Factors such as stability, suspendability, dose uniformity, and palatability should be considered when compounding a liquid formulation. Commonly used suspending agents include methylcellulose and carboxymethylcellulose (e.g., Ora-Plus). Palatability of a liquid formulation can be enhanced by using simple syrup or OraSweet. If no dietary contraindications or interactions exist, doses can be mixed with food items such as pud

Regular physical training benefits and drawbacks

For more than 5000 years, systematic exercise or sports have been carried out worldwide, and one can easily consider the average individual living today as being much more inactive than they were in the past. It is becoming more and more scientifically documented that physical inactivity is a major risk factor for disease and premature death, and that the magnitude of this lies on the level of other risk factors like smoking, obesity or drinking. Studies have uniformly concluded that being active or beginning physical activity even at an advanced age, will positively influence risk factors for development of inactivity-associated diseases. In spite of the fact that acute training is associated with a transient increased risk of cardiac arrest, taken in the population as a group, as well as the costly treatment of sports injuries, socio-economic calculation has found that, for the recreational athlete, these drawbacks are far outweighed by the cost-saving benefits of physical training...

Autoregulatory Mechanisms

For example, an excess of dietary iodide leads to autoregulated inhibition of iodide uptake into the follicular cells, whereas iodide deficiency results in increased iodide transport and uptake. Large doses of iodide have more complex effects, including an initial increase followed by a decrease in organification, the so-called Wolff-Chaikoff effect.46 Excess iodide also inhibits, at least initially, the release of stored thyroid hormone from the thyroid follicle.

Balancing Treatment of Disease and Promotion of Health

Health is largely a result of positive lifestyle behaviors that are often challenging to change. Addressing issues such as smoking, obesity, substance abuse, and inactivity can reduce premature death by 40 (McGinnis et al., 2002 Schroeder, 2007). Positive lifestyle behaviors not only prevent premature death but also extend the average life expectancy by 14 years (Khaw et al., 2008). Currently, approximately 4 cents of every dollar spent for health care goes toward prevention and public health, with 96 spent on treating established disease (Lam-brew, 2007). Two thirds of chronic disease is behavior related and could be mitigated by working interprofessionally to help guide patients toward healthy choices (McGinnis et al., 2002).

Who Should Compose the Health Team

The family physician knows the population of the community served and their specific health care needs. This insight will define the professionals who will be of most benefit for health creation (promotion). For example, obesity is a significant health threat in many locales. A team of professionals working together toward sustained optimal weight for patients might include a registered dietician, an exercise physiologist, and a psychologist or mind-body practitioner, to understand the interplay between stress and eating. The process to develop a health-oriented team for musculoskel-etal health (back pain) is summarized in Table 2-4. persons and overweight youths, to prevent the expression of a disease that is often the result of lifestyle choices.

The Burden Of The Disease

The diagnostic criteria for diabetes recommended by the ADA are presented in Table 2-1. In the absence of unequivocal hyperglycemia, one of these criteria must be confirmed on a subsequent day to establish the diagnosis. Although the plasma level of hemoglobin A1c (HbA1c) reflects mean plasma glucose concentrations over the preceding 2 to 3 months, the use of this parameter for the diagnosis of diabetes is currently not recommended.7 Before the development of diabetes, subjects pass through a stage of impaired glucose metabolism characterized by impaired fasting glucose (IFG) levels or impaired glucose tolerance (IGT) (see Table 2-1). These two metabolic disturbances predispose to diabetes and CVD and were recently grouped in the term prediabetes. A cluster of lipid and non-lipid risk factors of metabolic origin mediated by insulin resistance, such as pathologic glucose metabolism, obesity, hypertension, and dyslipidemia, was designated the metabolic

Diagnostic Criteria For Diabetes Prediabetes And Metabolic Syndrome

Central obesity (ethnicity-specific) PLUS any Obesity BMI, body mass index HDL, high-density lipoprotein IDF, International Diabetes Federation IGT, impaired glucose tolerance NCEP ATP III, Adult Treatment Panel III of the National Cholesterol Education Program WHO, World Health Organization. BMI, body mass index HDL, high-density lipoprotein IDF, International Diabetes Federation IGT, impaired glucose tolerance NCEP ATP III, Adult Treatment Panel III of the National Cholesterol Education Program WHO, World Health Organization.

Early Urban Environments

Before the domestication of various kinds of birds and mammals, hunter-gatherer societies had little everyday contact with large numbers of animals except, in some cases, dogs. As humans learned to contain, control, and breed pigs, sheep, cattle, goats, horses, and fowl, however, they were forced to share those animals' environments. Although their dietary protein intake thus increased, so too did their exposure to pox viruses, distemper, measles, influenza, and other maladies, all diseases carried by the newly domesticated creatures in their midst.

Solving the Pyramid Puzzle

In 1992, the United States Department of Agriculture (USDA) created the Food Guide Pyramid, an updated version of the familiar basic four food groups that have been drilled into your head since the first grade. I'm sure you've seen this colorful Egyptian triangle on the packages of products in the grocery store and on the back of your favorite cereal box. This visual approach to nutrition, a general outline of what you should eat each day, makes healthy eating a lot less complicated. Although individuals vary in their specific requirements, the Food Guide Pyramid provides solid information on do's and don'ts for the general population. The Food Guide Pyramid emphasizes the importance of eating a variety of foods from the five main food groups. (That's right The USDA separated fruits and vegetables into two different groups.) It also limits the amount of fats, oils, and sweets in your diet. Here's the cast 1. Breads, cereal, rice, and pasta group Foods that come from grains sit at the...

Etiology of Iodine Deficiency

Low supply of dietary iodine is the main cause of development of endemic goiter. Because it is difficult to measure the iodine content of foods, the adequacy of dietary iodine is usually determined by the measurement of urinary excretion of iodine. This measurement represents the ratio between concentrations of iodine and creatinine in casual urine samples.13 Two or more casual urine samples from the same individual taken on consecutive days are recommended to allow for variation in creatinine content.14 Experience has shown that the iodine concentration in early-morning urine specimens adequately reflects an individual's iodine status. In addition, iodine concentration per liter of urine bears a 1 1 relationship with iodine per gram of creatinine and is now adopted as the standard in field studies by WHO.3 Measuring iodine concentration per liter of urine helps avoid the cumbersome measurement and calculation of the iodine-creatinine ratio. In nonendemic areas, the urinary iodine...

Other Contributing Processes and Factors

Many other processes are proposed to contribute to the development of hypertension, including obesity, physical inactivity, insulin resistance, potassium and magnesium depletion, chronic moderate alcohol consumption, and transient effects of cigarette smoking and caffeine intake.9 The assessment of global cardiovascular risk in all hypertensive patients should be part of the management plan while also pursuing target BPs through nonpharmacologic and pharmacologic means. Regardless of the initiat

Clinical Presentation And Coexisting Risk Factors

Appropriate technique in measuring BP is a vital component to the diagnosis and continued management of hypertension in the outpatient setting. Accurate measurement of a patient's BP identifies and controls for factors that may influence the variability in the measure. Failure to consider how each of these factors may influence BP measurement results in significant variation in measurements, leading to misclas-sification or inaccurate assessments of risk. Factors including body position, cuff size, device selection, auscultatory technique, and dietary intake prior to the clinic visit may contribute to such inaccuracies. Clinicians should instruct patients to avoid exercise, alcohol, caffeine, or nicotine consumption 30 minutes before BP measurement. Patients should be sitting comfortably with their back supported and arm free of con-strictive clothing with legs uncrossed and feet flat on the floor for a minimum of 5 minutes before the first reading.

Pathophysiology of Endemic Goiter

Endemic goiter is the end result of the physiologic and morphologic changes in the thyroid gland as an adaptation to an insufficient supply of dietary iodine. When iodine intake is low, thyroid hormone synthesis is impaired. This impairment leads to an increased thyroidal clearance of iodide from the plasma and decreased urinary excretion of iodide, an adaptation toward iodine conservation.

Revascularization In Diabetic Patients With Stable Coronary Disease

In addition to increased periprocedural morbidity and mortality, as well as long-term mortality, diabetes is associated with an increased rate of repeat revascularization after CABG. A prospective analysis on 26,927 patients who were contacted every 5 years up to 25 years after CABG at a single institution in the United States identified diabetes as an independent predictor of subsequent coronary revasculariza-tion (Fig. 2-6).60 As part of the metabolic syndrome, diabetes is frequently associated with obesity, hypertension, and hypertriglyceridemia. The impact of these four factors (the deadly quartet) on 8-year mortality after CABG was assessed in a single-center database that included 6428 patients.61 Compared with individuals who had no risk factors, the HR for mortality increased from 1.6 among those with one risk factor to 3.9 for those with four risk factors. The yearly mortality rate ranged from 1 in patients with

The Mediterranean Pyramid A Different Type of Build

Gaining a lot of attention in recent years, the Mediterranean eating style has become a popular trend all over the world. This pyramid is based on the dietary traditions of Crete, much of the rest of Greece, and southern Italy. The Mediterranean Food Pyramid that represents this diet has long stood the test of time as being compatible with excellent health. The Mediterranean Pyramid variation, is another tested, proven cultural model for healthy eating. The Traditional Healthy Mediterranean Diet Pyramid The Traditional Healthy Mediterranean Diet Pyramid Regular physical activity at a level to promote a healthy weight, fitness, and well-being.

What to Expect on Your First Visit Does It Hurt

The first thing your acu-pro will do is look at your general appearance and vitality. Are you a vibrant, assertive person with plenty of outward energy, or do you come across as weak and frail These are the first general observations that he or she will make. Your body type may also be noted. If you are overweight, you're more likely to be affected by illnesses stemming from disorders of dampness, while being too thin means you might be prone to imbalances of yin energies (see Chapter 6, How You Get Sick The Good, the Bad, and the Ugly).

Patient Care and Monitoring

Conduct a medication history (prescription, over-the-counter, and dietary supplements) to determine conditions or causes of hypertension. Does the patient take any medications, supplements, herbal products, or foods that may elevate SBP or DBP Does the patient have drug allergies

What is a sports injury

A 'sports injury' can be defined as an injury that occurs during sporting activities or exercise. This can be broadened to include injuries affecting participation in sports and exercise and affecting athletes of all ages and all levels of performance. Patients who seek medical attention at sports injury clinics represent the spectrum from top professional to recreational athletes. Even though we can identify the mechanism of an injury and its pathoanatomical correlate or diagnosis, its consequences may be very different for different athletes. If you are a professional player, there may be loss of earnings and the risk of losing your contract and even your career. If you are a club manager, it may mean losing an important player, perhaps at a crucial time, and the financial costs of a replacement player. If you are the team doctor, physiotherapist, fitness trainer or coach, you will want to know how the injury will affect your plans for the players' ongoing dietary and physical...

Intrinsic Risk Factors

Intrinsic risk factors for pressure ulcer development include age, conditions that impair mobility, malnutrition, and sensory impairment. Skin changes associated with aging (e.g., epidermal thinning, diminished vascularity) increase the susceptibility of older persons to shearing forces, pressure, and friction. Immobility can cause infrequent position changes, thus exposing an older person to prolonged pressure. Malnutrition, specifically an inadequate intake of calories or protein, has been associated with the development of pressure sores (Thomas, 2001). AHCPR (1994) defines clinically significant malnutrition as a serum albumin level of less than 3.5 mg dL, a total lymphocyte count of less than 1800 cells mm3, or body weight less than 80 of ideal weight. Supplementation of micronutrients involved in skin healing, such as ascorbic acid and zinc, has not been shown to prevent pressure sores or improve rates of healing. Sensory impairment, such as in diabetic neuropathy, can prevent...

Precipitating and Exacerbating Factors in HF

The clinician must identify potential pharmacologic and dietary reversible causes of HF exacerbations including prescription and nonprescription drug therapies, dietary indiscretions, and medication nonadherence. Nonadherence with dietary restrictions or chronic HF medications deserves special attention, as it is the most common cause of acute decompensation and can be prevented. As such, an accurate history regarding diet, food choices, and the patient's knowledge regarding sodium and fluid intake (including alcohol) is valuable in assessing dietary indiscretion. Nonadherence with medical recommendations such as laboratory and other follow-up appointments can also be indicative of nonadherence with diet or medications.

Breakfast with a Bang

Incidentally, breakfast also helps you control your weight. Eating a smart breakfast can help regulate your appetite throughout the day so you eat in moderation during lunch and dinner. Have you ever skipped breakfast to save calories, only to find yourself so hungry by lunch that you overeat So much for tha diet. Start your day off smart Schedule time fo breakfast.

Associated Neurological Findings

Assessment of vital signs, preferably performed prior to administration of medications, is very important. Fever should always be construed as a sign of organic disease and should trigger consideration of a spinal tap. In a patient taking a neuroleptic, fever may accompany the neuroleptic malignant syndrome and may warrant consideration of this diagnosis. Once the vital signs are known, the general physical examination should be performed with the aim of identifying contributory factors to a behavior disorder. The general appearance may reveal obesity or cachexia. Central obesity and hirsutism suggest endocrine derangements, whereas hair loss may indicate lupus, thyroid disease, or simply an unrelated skin condition. Weight loss may be evident by excessive skin folds or a cachectic appearance and may accompany depressive syndromes. Changes in skin color may suggest endocrine disorders or a neurocutaneous syndrome. Evaluation of the head may reveal evidence of trauma or gingival...

Control and Treatment of Contributing Disorders

All causes of HF must be investigated to determine the etiology of cardiac dysfunction in a given patient. Because the most common etiology of HF in the United States is ischemic heart disease, assessment for cardiac ischemia, which may include stress testing, echocardiography, and or coronary angiography is warranted in the majority of patients with a history suggestive of underlying CAD. Revascularization of those with significant CAD may help restore some cardiac function in patients with reversible ischemic defects. Aggressive control of hypertension, diabetes, and obesity is also essential because each of these conditions can cause further cardiac damage. Surgical repair of valvular disease or congenital malformations may be warranted if detected. Because clinical HF is partly dependent on metabolic processes, correction of imbalances such as thyroid disease, anemia, and nutritional deficiencies is required. Other more rare causes such as autoimmune disorders or acquired...

Nonpharmacologic Interventions

It is imperative that patients recognize the role of selfmanagement in HF. Nonpharmacologic treatment involves dietary modifications such as sodium and fluid restriction, riskfactor reduction including smoking cessation, timely immunizations, and supervised regular physical activity. Patient education regarding monitoring symptoms, dietary and medication adherence, exercise and physical fitness, risk factor reduction, and immunizations are important for prevention of AHF exacerbations. Dietary modifications in HF consist of initiation of an AHA step II diet as part of cardiac risk factor reduction, I sodium restriction, and sometimes fluid restriction. As sodium and water retention is a compensatory mechanism that contributes to volume overload in HF, salt and fluid restriction is often necessary to help avoid or minimize congestion. The normal American diet includes 3 to 6 g of sodium per day. Most patients with HF should limit salt intake to a maximum of 2 g day. Patients should be...

Other Pharmacologic Approaches

Currently, there are two additional areas of strong interest in research clinical application in the field of diabetes and cardiovascular disease. The first is optimization of blood glucose control, either by continuous insulin therapy and glycemic monitoring (closed loop) or by new therapeutic agents such as glucagon-like peptide-1 agonists and dipeptyl-peptidase-IV inhibitors. Second, endocannabinoid receptor antagonists have been shown to improve obesity and the overall cardiovascular risk profile. However, it remains to be determined whether these strategies may lead to a reduction in macrovascular or microvascular complications in diabetes.

Energy expenditure during exercise

The total energy expenditure (TEE) of an adult person averages 10000-13000kJ 24h. Individuals with physically very demanding occupations may reach values of 17000-19000kJ 24h. The TEE is made up of three components the BMR, the dietary-induced thermogenesis (DIT) and the activity-dependent energy expenditure (Table 1.2. i). The BMR is normally the largest component of TEE, averaging 7000-8200 kJ 24 h in men and 5800-6200 kJ 24 h in women. The DIT, which is defined as the extra energy consumption resulting from a meal, normally accounts for one tenth of the TEE. DIT is largest after a protein meal, where it amounts to 18-25 of the energy contained in the meal, but considerably smaller for meals containing carbohydrates (4-7 ) and fat (2-4 ) 24 . The remaining part of the TEE is the activity-dependent energy expenditure (AEE), which can be calculated based on the 19.7 and 21.2 kJ of energy released for each liter of oxygen consumed during fat and carbohydrate oxidation, respectively...

Points To Remember When Measuring Blood Pressure

Always have a cuff of proper size for the arm, especially for very obese individuals. The width of the bladder in the cuff should be roughly 40 of the arm circumference. In most patients (normal size) a 5 in wide cuff would be the appropriate choice. Too wide a cuff may lead to erroneous recognition of the onset of the Korotkoff sounds because the site of auscultation may be too distal to the site of actual occlusion of the artery. This may make the Korotkoff sounds too soft to be heard and may result in underestimation of the pressure. A narrow cuff will allow overdistension of the bladder of the cuff before actual occlusion of the brachial artery can occur. Some of the pressures applied may be spent in distending the bladder rather than compressing the artery. This will lead to an over-estimation of the systolic and even the diastolic pressures. A larger cuff (8 in wide) is needed in obese patients where the arm circumference is more than 35 cm (18,19). The bladder of the cuff...

Gender men and post menopausal women

Patients with multiple risk factors, particularly those with diabetes, are at the greatest risk for IHD. While there are alternative definitions for metabolic syndrome, it is generally considered as a constellation of cardiovascular risk factors related to hypertension, abdominal obesity, dyslipidemia, and insulin resistance. Metabolic syndrome increases the risk of developing IHD and related complications by twofold.6 According to the American Heart Association, patients must meet at least three of the following criteria for the diagnosis of metabolic syndrome

To Artificially Sweeten or

A more popular reason for using artificial sweeteners is saving calories. However, this notion might not be as effective as you think. Although it is true that diet soft drinks and other artificially sweetened foods can save you a lot of sugar calories, several studies have shown that people who save calories with these diet foods usually wind up eating those saved calories somewhere else. Pretty ironic, huh Other studies suggest that artificial sweeteners might, in fact, make you hungrier. Did you know that a real sugar packet (that's 1 teaspoon) has only 16 calories You can easily burn that off walking an extra flight of stairs. It's certainly something to think about the next time you grab artificial sweetener.

Conflict Between Different Motivational Systems

Although inner conflict has generally been understood in terms of an id-ego or drive defense model, the fact is diat other conflicts between different motivational systems play an important role in biological and psychological life. An obvious mundane example is the conflict between hunger and the desire to avoid obesity. Another example among animals as well as humans is the conflict between aggression and competition on the one hand and cooperation and friendship on the other.

Nutrition Heal with the Energy of Food

Oriental Medicine recognizes how important food and nutrition are to our health. Sun Shu Mao in 652 c.E. wrote a book, One Thousand Ounces of Gold Classic no, he didn't charge that much to buy it, but he did believe that human life and health was worth that much. His book detailed acupuncture, herbal, and dietary treatments for various common ailments of the times.

Assessment ofArterial Occlusion

In the lower extremity, if the blood pressure is found to be equal to or lower than in the arm, then obstructive arterial disease must be considered. The obstruction may be at the level of the aorta, the iliac, or the femoral. Blood pressure measurement in the lower extremity can be carried out by using a larger cuff (8 in wide) over the thigh and auscultating over the popliteal artery. This is best done with the patient lying prone. This method probably is more accurate but may be difficult in very obese patients. To obtain a reasonably accurate systolic blood pressure in the leg, a regular cuff can be employed above the ankle and the posterior tibial or the dorsalis pedis pulses can be palpated. When the pedal pulses are not easily felt, an ultrasound Doppler probe can be used to detect the flow and assess the peak systolic pressure. When comparisons are made, one should compare the peak pressures obtained by the same technique between the upper and the lower extremities. If one...

Characteristics of Stroke

Apart from age, the most important risk factor for CVD is arterial hypertension. Control of severe and moderate, and even mild, hypertension has been shown to reduce stroke occurrence and stroke fatality. Cardiac impairment ranks third, following age and hypertensive disease. At any level of blood pressure, people with cardiac disease, occult or overt, have more than twice the risk of stroke. Other risk factors are cigarette smoking, increased total serum cholesterol, blood hemoglobin concentration, obesity, and use of oral contraceptives.

Regulatory Issues Whos Minding the Store

When you go to the drug store for aspirin today, you can be reasonably sure that what you're buying is safe and that it contains no more or less than what the package says it contains. It was not always that way with pharmaceuticals, and it still is not that way with most health-food products and dietary supplements sold in health-food stores, supermarkets and pharmacies. Despite continuing concern on the part of the Federal Trade Commission (FTC), Food and Drug Administration (FDA) officials and others who work in the public interest, there are still no across-the-board standards or federal laws governing the quality of food supplements, herbs, and other products marketed with claims for improving health benefits. Caveat emptor let the buyer beware is the only rule governing the purchase of many products used as health foods or dietary supplements. What you think you are buying is not necessarily what you get. The new requirements dealt squarely with the problem that the thalidomide...

The Supplement Shambles

Although the public needed the protection provided by accurate labeling, proof of safety and evidence of benefit, the food supplement industry effectively prevented such legislation from being passed in the U.S. Congress in 1994. It accomplished this with a successful multimillion-dollar campaign urging Americans to Write to Congress today, or kiss your supplements good-bye This false message resulted in the Dietary Supplement and Health Education Act of 1994, which created a protected new category for the estimated 20,000 vitamins, herbs, minerals, and anything else that had been sold as a supplement before October 1994. Top experts in herbal medicine and dietary supplements decried the lack of public protection. The 1994 regulations took good care of the multibillion-dollar supplements industry, but many scientific reviews concluded that they left the public in the lurch. Here's what the November 1995 issue of Consumer Reports said about what that law allowed Products can be sold...

Patient Encounter 2 Part 2

BA is discharged home on warfarin therapy. She was referred to a local area antith-rombosis center for monitoring of her oral anticoagulation therapy and has been maintained on warfarin 6 mg daily for the last 3 months. The patient presents today for a routine visit for anticoagulation monitoring and her INR is 8.3. She reports that 6 days ago she was started on metronidazole 500 mg by mouth twice daily, which was prescribed by her primary care physician for a vaginal infection. In addition, the primary care physician told the patient that her thyroid gland was enlarged and ordered some lab tests to determine if she has a thyroid problem. The patient has not heard what the results are. She also reports that her intake of vitamin K-rich foods (spinach, broccoli, and cabbage) has increased significantly over the last month because she is trying to lose weight. BA has no other complaints today and denies any signs or symptoms of bleeding.

When Is Endotracheal Intubation Necessary

Important reasons to use an endotracheal tube is to protect your lungs from aspiration pneumonia. When the endotracheal tube is in the trachea with the cuff up, aspiration pneumonia is exceedingly unlikely. Patients at high risk of aspiration (e.g., morbid obesity, pregnancy, hiatal hernia, bowel obstruction, etc.) may require an endotracheal tube even for brief procedures.

The Psychosomatic Patient

There are many ways of dealing with psychosomatic patients. First, identify the disorder Do not miss the possible diagnosis of an affective or anxiety disorder. Treatment of somatization is directed toward teaching the patient to cope with the psychological problems. Be aware that somatization operates unconsciously the patient really is suffering. Above all, the patient should never be told that his or her problem is ''in your head.'' Anxiety, fear, and depression are the main psychological problems associated with psychosomatic illness. The list of associated common symptoms and illnesses is long and includes chest pain, headaches, peptic ulcer disease, ulcerative colitis, irritable bowel syndrome, nausea, vomiting, anorexia nervosa, urticaria, tachycardia, hypertension, asthma, migraine, muscle tension syndromes, obesity, rashes, and dizziness. Answers to an open-ended question such as ''What's been happening in your life '' often provide insight into the problems.

Effectiveness of Early Detection and Intervention

The USPSTF (2008) recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135 80 mm Hg. AAFP (2009) concurs with this recommendation. ACOG recommends FPG testing for women beginning at age 45 years, with an interval of 3 years. On the basis of expert opinion, ADA recommends screening every 3 years to detect prediabetes (IFG or IGT) or diabetes in persons age 45 and older, particularly in those with BMI of 25 kg m2 or greater. Screening is recommended in those overweight individuals younger than 45 years with one additional risk factor, including inactivity, family history of type 2 diabetes mellitus, membership in a high-risk ethnic group, gestational diabetes, hypertension, dyslipidemia, impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), or a history of vascular disease (ADA, 2009).

Accuracy of Screening Tests

There are two major components of screening for osteoporosis assessment of risk factors and BMD measurement. Older age, low body mass index (BMI), and not using estrogen replacement are associated with increased risk of osteoporosis and fracture. Other risk factors include white or Asian ancestry, positive family history, tobacco use, and low levels of weight-bearing physical activity (Melton et al., 1989). The WHO FRAX is a common assessment tool.* Other specific instruments, such as the Osteoporosis Risk Assessment Instrument (ORAI) and the Simple Calculated Osteoporosis Risk Estimation (SCORE) tool, use these risk factors to identify women at increased risk for fracture or low BMD. The ORAI has sensitivity of 94 and specificity of 41 , and the SCORE has sensitivity of 91 and specificity of 40 (Nelson and Helfand, 2002).

Burden of Disease

Obesity is a substantial health problem in the United States, and the percentage of the population who is overweight or obese continues to rise. Defined as a BMI of 30 or higher, the prevalence of obesity in adults in the United States has increased from 13 to 27 over the past 40 years (McTigue et al., 2003). The prevalence of overweight rose from 31 to 34 . Obesity and overweight are associated with an increased risk of CHD, hypertension, stroke, type 2 diabetes, sleep apnea, musculoskeletal disorders, gallbladder disease, and several types of cancer. Obesity is associated with a decreased quality of life and social stigmatization.

Musculoskeletal system

The skeleton represents only 7-8 of the body weight and the bones are thinner and much more fragile than those of the cat, whose skeleton occupies 12-14 of the body weight. Incorrect or clumsy handling of the animal may cause fractured limbs or spine. In addition, older rabbits, those that are overweight or those not given sufficient exercise may develop osteoporosis or thinning of the cortex.

Physiology and Pharmacology

Levothyroxine treatment relies on a negative feedback on pituitary thyrotropin production. In euthyroid humans, 20 of circulating 3,5,3'-triiodothyronine (T3) is produced in the thyroid gland and 80 is formed extrathyroidally by monodeiodination of T4, largely in the liver and kidney under the action of a selenium-dependent type I deiodinase, a selenoprotein.21 The presence of selenocysteine renders the conversion of T4 to T3 sensitive to dietary selenium levels.22 T3 is the principal functioning thyroid hormone binding to a nuclear receptor (T3 receptor) and regulating transcription of thyroid hormone-responsive genes.23

Types of cardiovascular disease

Blood clots in the leg veins, which can dislodge and move to the heart and lungs. Riskfactors Surgery, obesity, cancer, previous episode of DVT, recent childbirth, use of oral contraceptive and hormone replacement therapy, long periods of immobility, for example while travelling, high homocysteine levels in the blood.

Emerging and Life Habit Risk Factors

In addition to the five major risks, the ATP III guidelines recognize other factors that contribute to CHD risk. These are classified as life-habit risk factors and emerging risk factors. Life-habit risk factors, consisting of obesity, physical inactivity, and an atherogenic diet, require direct intervention. For example, emerging risk factors are lipopro-tein(a), homocysteine, prothrombotic proinflammatory factors, lipoprotein-associated phospholipase A2 (Lp-PLA2), and C-reactive protein (CRP). CRP is a marker of low-level inflammation and appears to help in predicting CHD risk beyond LDL choles-

Counseling and Anticipatory Guidance

Preventive care of adolescents emphasizes anticipatory guidance and counseling. Important topics to discuss include sexual activity alcohol, tobacco, and drug use healthy eating and physical activity injury prevention and mental health. The evidence of the benefits of screening and counseling for these conditions in adolescence is not clear. The clinician must also ensure that immunizations are delivered to the adolescent according to the recommended schedule. Vaccination against hepatitis B should be administered if it was not given during infancy, and boosters for varicella measles, mumps, rubella (MMR) tetanus, diphtheria, and pertussis are given as determined by the schedule. Adolescents, especially college students, are at increased risk for meningococ-cal meningitis. The risks of disease and the risks and benefits of immunization should be discussed with prospective college students.

Social winners and losers

We are alone among the great apes in actively enjoying being in water, and join with sea-dwelling mammals in having the ability to cry. We are born with a natural diving reflex, which, on the contact of the face with cold water, slows the heart rate and metabolism. In infants this is also combined with a reflex producing natural, anti-drowning, breath-holding and swimming movements. Is there a single model of what has happened in our evolutionary past which can explain all these features One particularly intriguing theory is that of the aquatic ape. This is based on the observation that many of the differences between ourselves and our ape cousins can be explained by an ancestral past spent in or near sea and fresh water. Wading through water requires a vertical posture, freeing up the arms, and some apes are observed to do this in the wild. Having free arms allows the development of hands that manipulate objects rather than simply being used for locomotion. Our body proportions are a...

The Cholesterol Connection and Heart Disease

If you've ever read a nutrition label, you know that dietary fat and cholesterol make up two very different categories. In fact, they are even measured in different units fat is shown in grams, whereas cholesterol is shown in milligrams. We've already explored the facts on fat now it's time for cholesterol.

What It Can Do for You

There are important distinctions between dietary supplements in the form of the vitamin pill that many take each morning, and products aimed at treating illness. A daily vitamin tablet is unnecessary if you eat a healthful, balanced diet, but it will help those whose diets do not provide the necessary nutrients or who have special needs, such as calcium with D to protect against osteoporosis.

With anorexia you lose the ability to see yourself as others see you

You may have trouble understanding or agreeing with their concerns for your health and well being. You think you're on your way to achieving a very important goal and assume everyone who challenges you is jealous. You're able to ignore the reactions and rejection of people who have been part of your life, because the anorexia makes you believe you're strong and superior, in spite of the fact that others see and say that it's making you ill. However physically ill or weak you feel when you're starving yourself this way, however lonely and isolated you are, such things are secondary to the sense of power you believe you have over yourself and your hunger. And because they're secondary, you don't try to fix them.

Mechanical instability

Although taping does seem to improve mechanical instability, it is important to note that the restricting effect is lost after varying periods of exercise. For example, 40 of the effect of taping was lost after 10 minutes of vigorous general circuit exercises (Rarick et al 1962). Approximately 50 was lost after 15 minutes of standard vigorous exercises (Frankeny et al 1993), there was a 20 decrease after 20 minutes of stop start running (Larsen 1984), 37 loosening in total passive range of motion after 20 minutes of volleyball training (Greene & Hillman 1990), 10-20 restriction loss in all movements except dorsiflexion after 60 minutes of squash (Myburgh et al 1984) and a 14 loss of inversion restriction after 30 minutes of exercise (Alt et al 1999). It has also been found that the greater the subject's weight, height and body mass index, the less effective the tape is in controlling supination and ankle plantarflexion after 30 minutes of exercise (Meana et al 2007).

Your Cholesterol Report Card

Although it's certainly not in your favor to have clogged arteries, don't give away your prized possessions yet. In fact, most people have tremendous control over lowering their numbers by limiting the fats and oils in their diet, increasing foods rich in soluble fiber, losing weight if it's warranted, and becoming more physically active.

Concluding Thoughts

The public is fascinated with weight reduction and is quick to buy books on fad diets, drugs to suppress appetite, and cures for disease. Most of these do little for patients except cost them money. Instead, a good health-care provider should inform patients how to eat healthily. Any good diet should accomplish the following Kushner RF Roadmaps for Clinical Practice Case Studies in Disease Prevention and Health Promotion-Assessment and Management of Adult Obesity A Primer for Physicians. Chicago, American Medical Association, 2003. Available at accessed June 3, 2008. Kushner RF, Roth JL Assessment of the obese patient. Endocrinol Metab Clin North Am 32 915, 2003. National Institutes of Health and National Heart, Lung, and Blood Institute Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Rockville, Md U.S. Department of Health and Human Services, Public Health Service, 1998. National Institutes of Health, National Heart, Lung, and...

Induction as Scientific Methodology

Variability Centrality People are more willing to project predicates that tend to be invariant across category instances than variable predicates. For example, people who are told that one Pacific island native is overweight tend to think it is unlikely that all natives of the island are overweight because However, sensitivity to variability does not imply that people consider the variability of predicates in the same deliberative manner that a scientist should. This phenomenon could be explained by a sensitivity to centrality (Sloman, Love, & Ahn, 1998). Given two properties A and B, such that B depends on A but A does not depend on B, people are more willing to project property A than property B because A is more causally central than B, even if A and B are equated for variability (Hadjichristidis, Sloman, Stevenson, & Over, 2004). More central properties tend to be less variable. Having a heart is more central and less variable among animals than having hair. Cen-trality and...

Fasting and Juice Therapies

Fasting was practiced in many ancient cultures around the world, but usually not in efforts to enhance health. Reasons for engaging in fasts included self-deprivation, demonstration of spiritual obedience, expression of grief, the practice of cultural and religious ritual, and helping to generate hallucinations. Controlled, modified fasting under medical supervision also is used occasionally to help extremely obese people lose weight.

Associated Medical Findings

Proptosis or periorbital fullness suggests an orbital process such as Graves' disease, orbital meningioma, or orbital pseudotumor. The patient's general appearance may suggest an underlying chromosomal, endocrinological, or metabolic disorder. For instance, the disfiguring frontal bossing and enlargement of the mandible and hands are characteristic of acromegaly associated with a growth hormone-secreting pituitary adenoma. The heart rate, blood pressure, and carotid and cardiac examinations are important in any patient with a possible ischemic event. Patients with pseudotumor cerebri tend to be young females with obesity or a history of recent weight gain. Skin lesions such as erythema migrans (Lyme disease) or malar rash (systemic lupus erythematosus), and abnormal discolorations, such as cafe(c)-au-lait spots and axillary freckling (neurofibromatosis), or hypopigmented ash-leaf spots (tuberous sclerosis) also may be helpful in guiding the evaluation of patients with visual...

Milk genomics a contemporary approach to milk composition

Trends in the consumer market are driving an increased focus on the health and dietary functions of food products, and there is an emerging market for milk-derived products. The major focus in dairy is on milk proteins, which are rich in bio-active properties and may therefore be particularly valuable to dairy processors and suppliers providing specialist milk to specification. This area of product development is poised to undergo a significant expansion based on the bovine genome sequencing project.

Circulating factors that influence bone cell function

More recently, a mechanism of hypothalamic control of bone metabolism has been demonstrated. In contrast to the metabolic pathways of PTH and vitamin D, factors are secreted by bone cells and then themselves in turn affect overall bone metabolism through a centrally mediated mechanism. Leptin, a small polypeptide hormone, is secreted by osteoblasts. Its direct effects are thought to be through control of body weight, while its indirect effects may be through modification of gonadal function via interactions within the hypothalamus 1 . In animal studies, mice with leptin deficiency demonstrated obesity, hypo-gonadism, and increased bone formation and bone mass. This newly discovered interrelationship between the central nervous system and bone metabolism offers an exciting new frontier in the understanding and possible treatment of metabolic bone disorders such as osteoporosis.

The Fat Phohic Generation

It might sound funny, but it's no laughing matter to be completely preoccupied with fat. Certainly, a low-fat diet is an essential part of being healthy however, taking this concept to radical extremes can place serious restraints on social eating, let alone set you up for a serious eating disorder. If your reason is weight control, think again. Some fat is fine, and I promise you can maintain your ideal body weight (within reason, of course) and still allow yourself to enjoy foods with fat every once in a while. In fact, joining a fat-free cult doesn't necessarily mean that you automatically lose weight. Quite frequently, I meet clients who cannot seem to drop an aggravating 5 or 10 pounds even while following a strictly fat-free regimen. How can that be

Agerelated bone loss and osteoporosis

The cellular mechanism of type II osteoporosis is mul-tifactorial. A major factor is probably progressive dietary calcium deficiency 3 . As patients age, appetite can become suppressed, leading to lower intake of foods rich in The cumulative effect of normal aging, dietary calcium deficiency, and lower activity is the upregulation of bone resorption and downregulation of bone formation. While it is commonly held that these effects are mediated by stimulation of osteoclasts and inhibition of osteoblasts, the exact mechanisms by which they lead to age-related bone loss is still not well understood.

Feeling a Bit Waterlogged

Try performing this test Record your weight one morning. Then, before going to bed that night, eat a large serving of heavily salted popcorn or sushi doused in soy sauce (drink a lot of water). Weigh yourself again the next morning. It is amazing how much water that salt can retain. All you dieters out there, remember that this is water weight not fat weight. Don't panic it will be gone in a couple of hours.

Target Characteristics

Once a person is categorized as a member of a group, the nature of the stigmatizing elements that characterize the social category strongly influence whether and how discrimination will occur. As suggested earlier, the extent to which a person's membership in a negatively viewed outgroup (i.e., a stigmatized group) is perceived to be controllable is one of the strongest determinants of whether individuals will openly express negative feelings and beliefs and discrimination (Weiner, 1995). Those who possess stigmas that are perceived to be more controllable (e.g., homosexuality, obesity, alcoholism) particularly when the person's failure to exercise control is seen as violating cultural values, such as the Protestant Ethic (Crandall & Martinez, 1996) are regarded much more negatively and are generally the targets of open discrimination. In contrast, when group membership is perceived to be uncontrollable (e.g., as with stigmatizing conditions such as physical disabilities)...

Straight Facts About Bulimia

Bulimia is another eating disorder that can be harmful to your physical and mental health like anorexia, it can result in death. Also, like anorexia, it is fueled by a dual obsession with both thinness and food. In fact, these two eating disorders have been called Cinderella's stepsisters and are often referred to as flip sides of the same coin. Unlike anorexia, which prompts you to starve yourself, bulimia (which literally means ox hunger) is most often a binge-purge pattern in which you feel an overwhelming urge to binge (eat a large amount of food in a short period of time) and then an equally overwhelming urge to purge (eliminate) from your body whatever foods and liquids were consumed during the binge. vomit), diuretics (chemicals that rid your body of fluids), enemas, diet pills, or a combination of these. Any method a bulimic person uses to purge is potentially dangerous, because it can have serious physical and emotional consequences. Bulimic hunger is most often emotionally...

Fibromyalgia Tired of Being Sick and Tired

Acupuncture, massage, and Chinese herbal medicine are recommended as effective treatments by the Fibromyalgia Network (see Appendix D, State and National Organizations)- The Network is an organization that provides information to patients with this potentially debilitating condition. Moxi-bustion or infrared heat treatments are also useful in driving out the cold. Nutritional supplements such as antioxidants (coenzyme Q10, vitamins E and C) are helpful in managing this condition, as are dietary changes to eliminate dampness and build immunity.

Risk factors start in childhood and youth

Although cardiovascular diseases typically occur in middle age or later, risk factors are determined to a great extent by behaviours learned in childhood and continued into adulthood, such as dietary habits and smoking. Throughout the world, these risks are starting to appear earlier. Physical activity decreases markedly in adolescence, particularly in girls. Obesity has increased substantially, not only in Europe and North America, but also in traditionally slender populations such as the Chinese and Japanese. Type 2 diabetes was previously rare in children, but is increasing in adolescents in, for example, North America, Japan and Thailand. Markers of CVD can be seen in young children. Post-mortems of children who died in accidents have found fatty streaks and fibrous plaques in the coronary arteries. These early lesions of atherosclerosis were most frequently found in children whose risk factors included smoking, elevated plasma lipids, high blood pressure and obesity. Percentage...

Monitoring Of Respiratory Function

When combined technique of light general anesthesia, regional anesthesia, and sedation is used, a pulse oximeter is mandatory, especially in patients with a history of sleep apnea or snoring, significant obesity, and orofacial or neck disturbances. The pulse oximeter can determine the moment when the O2 saturation falls. To prevent this undesirable situation, respiratory rate interval monitoring can be used to detect the effect of opioids on the respiratory center. Apnea alarms are also useful if breathing is not detected over a predetermined period of time. A breath interval varies between 0.9 minute and 1.4 minutes and is a useful and reproducible method of monitoring the duration of opioid effect in anesthetized patients who can breathe spontaneously when surgical stimulation is not affecting the CNS. These data can provide information on the duration of action of fentanyl and can help to determine the correct dosage.123

Nonpharmacologic Therapy

Although most patients do not respond to lifestyle changes alone, the importance of maintaining these lifestyle changes throughout the course of GERD therapy should be stressed to selected patients on a routine basis. The most common lifestyle changes that a patient should be educated about include (a) losing weight and (b) elevating the head of the bed if symptoms are worse when recumbent. Elevating the head of the bed about 6 to 10 in. (15-25 cm) with an undermattress foam wedge (not just elevating

How Much Sodium Is Recommended

Many question the one size fits all recommendation because not everyone is saltsensitive. However, there is no test for salt sensitivity therefore, it makes sense for everyone to play it safe and follow a prudent approach. Most health professionals recommend limiting your intake of sodium to no more than 2,400 milligrams per day. This includes both the salt you add and the sodium that is already present in foods you eat. Become familiar with the following list of high-sodium foods, and learn to balance your diet so you don't go sodium overboard. Note, if you have high blood pressure, your doctor might prescribe a more severe sodium restriction.

Other Causative Factors

Dietary factors such as coffee, tea, cola, beer, and a highly spiced diet may cause dyspepsia, but they have not been shown to independently increase PUD risk. Although caffeine increases gastric acid secretion and alcohol ingestion causes acute gastritis, there is inconclusive evidence to confirm that either of these substances are independent risk factors for peptic ulcers.

Keep Your Weight In Check During The Holidays

Keep Your Weight In Check During The Holidays

A time for giving and receiving, getting closer with the ones we love and marking the end of another year and all the eating also. We eat because the food is yummy and plentiful but we don't usually count calories at this time of year. This book will help you do just this.

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