Diet vs Exercise in Obese Older Patients With HFPEF . Exercise intolerance is the primary symptom of chronic HFPEF and a major determinant of reduced quality of life (QOL). Objective. To determine whether caloric restriction (diet) or aerobic exercise training (exercise) improves exercise capacity and QOL in obese older patients with HFPEF. Design, Setting, and Participants. Randomized, attention- controlled, 2 . Of 5. 77 initially screened participants, 1. Of these, 9. 2 participants completed the trial. ![]() Exercise attendance was 8. SD, 1. 4%) and diet adherence was 9. SD, 1%). By main effects analysis, peak V. The combination of exercise + diet was additive (complementary) for peak V. There was no statistically significant change in MLHF total score with exercise and with diet (main effect: exercise, . The change in peak V. ![]() There were no study- related serious adverse events. Body weight decreased by 7% (7 kg . Neither intervention had a significant effect on quality of life as measured by the MLHF Questionnaire. Trial Registration. Identifier: NCT0. Introduction. Heart failure with preserved ejection fraction (HFPEF) is the most rapidly increasing form of heart failure, occurs primarily in older women, and is associated with high rates of morbidity, mortality, and health care expenditures. However, its pathophysiology is poorly understood, and medication trials to date have been neutral. Most previous HFPEF trials focused on mediating the long- term consequences of hypertension. However, obesity is also an independent risk factor for development of heart failure,2,3 and more than 8. HFPEF are overweight or obese. Increased adiposity promotes inflammation, hypertension, insulin resistance, and dyslipidemia and impairs cardiac, arterial, skeletal muscle, and physical function; 6- 8 all of which are common in HFPEF and contribute to its pathophysiology. It was recently shown that the severity of exercise intolerance, the primary symptom and major contributor to reduced quality of life (QOL) in patients with chronic HFPEF, is significantly correlated with increased body adiposity and skeletal muscle adipose infiltration. In obese older individuals without heart failure, weight loss via dietary caloric restriction (diet) improves left ventricular hypertrophy and diastolic function; exercise capacity; glucose, lipid, and blood pressure control; inflammation markers; body composition; and skeletal muscle function. ![]() However, diet is controversial in patients with heart failure; observational studies suggest overweight or mildly to moderately obese patients with heart failure (including HFPEF specifically) survive longer than those who are normal weight or underweight. There have been no studies of diet in any type of heart failure and current HFPEF management guidelines do not include diet. The objective of this study was to conduct a randomized, single- blind, attention- controlled trial to examine the effects of diet, alone and combined with aerobic exercise training (exercise), on exercise capacity measured as peak exercise oxygen consumption per unit time (V. Participants provided written informed consent. Major exclusion criteria were left ventricular segmental wall motion abnormalities and significant ischemic or valvular heart disease, pulmonary disease, anemia, or other disorder that could explain the participants’ heart failure symptoms. ![]() Participants were clinically stable, had no significant change in cardiac medications for 4 weeks, and were not undergoing regular exercise or diet. Muscle quality was calculated as leg power divided by thigh muscle area (W/cm. MRI. Heart failure–specific QOL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ; range 0- 1. QOL) and general QOL was assessed with the 3. Short- Form Health Survey (SF- 3. QOL). 1. 5,1. 6,2. ![]() ![]() Sofosbuvir (Sovaldi) - Gilead U.S. Patient Assistance Program; Abbvie - Vikiera Pak Patient Support Program; Merck Zepatier Patient Assistance Program. We researched the OxyElite Pro ingredients to give you the details you need. Norcoclaurine. Norcoclaurine, also known as Higenamine, is a chemical that is found in a. Doppler echocardiograms were performed and analyzed per American Society of Echocardiography recommendations. Doppler left ventricular filling patterns and pulse- wave velocity were assessed as described. Left ventricular mass and volumes were assessed by cardiac MRI from multislice, multiphase gradient- echo sequences that were traced manually and calculated by summation. Blood was collected after overnight fasting and stored at . B- type natriuretic peptide (BNP) was measured by radioimmunoassay (Phoenix Pharmaceuticals). High- sensitivity C- reactive protein and plasma interleukin 6 were measured by enzyme- linked immunosorbent assays (e. ![]() ![]() Methods in the Supplement). Personnel performing the outcome measures were blinded to participant group. For practical considerations, an exception was for cardiopulmonary exercise testing, for which the supervising physician and staff were blinded to the baseline (prerandomization) results. To minimize bias, standardized procedures known to elicit maximal exercise performance were used, including a standardized protocol, guidance by the respiratory exchange ratio (RER, an objective indicator of effort) and Borg scale of perceived exertion, and reading of a standardized participant instruction script prior to each exercise test. No blocking across time was used. In comments reportedly made during a press briefing for her new movie SALT, Angelina Jolie discussed her bad experiences with a vegan diet. Piyush Dimri April 18, 2016. It have been following you from quite a long time. I really liked your idea about LCHF diet and your pursuit of cracking insulin. Scott December 28, 2011. Fascinating stuff here. The nutritional ketosis approach makes some sense to me, from the perspective of human evolution (I’m an. IMPAIRED BED MOBILITY. Limitation of independent movement from one bed position to another. DEFINING CHARACTERISTICS. Impaired ability to perform the. Histamine is a neurotransmitter which is involved in our local immune response. Here is a quote from an excellent post by That Paleo Guy on Histamine Intolerance. Success Stories. Information on this website is not to be used as medical advice. Permission has been given to print the following. Participants prepared their own breakfast from a menu. Individual energy needs were calculated from resting metabolic rate (CCM Express, MGC Diagnostics) following an overnight fast and an activity factor based on self- reported daily activity. Prescribed calorie intake deficits were approximately 4. The diet provided approximately 1. Participants were provided daily calcium supplements (6. Participants randomized to control received neither diet nor exercise interventions and voluntarily agreed to not make diet or exercise changes during the 2. They received telephone calls every 2 weeks from staff in an attempt to match that received by participants in the diet and exercise groups. The study was a 2 . The trial was designed to have 2 co–primary outcomes, the performance measure peak V. All available outcome data were analyzed in an intention- to- treat analysis. The analysis testing the main effects of diet and exercise and their interaction was performed using analysis of covariance with the baseline measure of the outcome measure, sex, and . This method adjusts for differences in the means of the baseline measure of the outcome and other predictor covariates to estimate what the mean in each level of the factor would be had both groups had the same overall mean of the covariates in the model. This method is equivalent to multiple imputation of missing data with the covariates as predictors and infinite iterations. We also performed sensitivity analyses to assess the effect of missing data. The least squares means were presented along with either the standard error or 9. CI. The main effect of each intervention, which is the difference in the LS means between the 2 levels of each of the factors (exercise and diet) is presented along with its 9. CI and a P value. Based on a previous study of participants with heart failure, sample size calculations indicated that 8. V. Allowing for up to 2. Because the test for interaction between the 2 factors, which is a linear contrast between the 4 individual group means, has low power, the 2 interventions were considered additive (complementary) only if the P value for intervention was . Baseline participant characteristics are presented as mean and standard deviation or frequency and percent. Associations between changes in exercise capacity and other variables were made by Pearson correlations. See the Supplement for additional details on sample size, effect size, testing for interaction, multiple comparisons, multiple stepwise regression, and missing data. Ultimately, 1. 00 participants with HFPEF (mean . Of these, 9. 2 participants (exercise, 2. Figure 1). Participant characteristics were generally in accord with those observed in population studies, with predominantly women (n = 8. Table 1). Diet and exercise were additive (complementary) and together produced an increase in peak V. The co–primary measure of QOL as measured by the MLHF total score was not significantly different with exercise and with diet (main effect: exercise, . Mean peak RER values were more than 1. There was an exercise . There were no other significant exercise . With diet, muscle quality significantly improved (main effect, 0. W/cm. 2 . There were no significant exercise . With diet main effect analysis, the DXA measures of lean body mass (. With diet main effect analysis, MRI measures of thigh subcutaneous fat (. There was no change in pericardial or epicardial fat. There were no significant exercise . No other cardiac MRI or Doppler echocardiography measure was significantly changed (Table 3; e. Table 3 in the Supplement). Arterial pulse- wave velocity was unchanged by either diet or exercise (Table 3). The reduction in high- sensitivity C- reactive protein correlated with the reduction in weight (r = 0. P = . 0. 05). With diet but not exercise, there were significant reductions in total cholesterol (to convert cholesterol to mmol/L, multiply by 0. Similar results were observed with exercise time as the exercise capacity variable. Multiple stepwise regression showed that sex and change in total mass were the only independent predictors of change in peak V. Further details regarding attendance and progression are in the Supplement. The average actual caloric intake deficit was . Dietary adherence (actual vs prescribed calorie level) from recorded food logs was 9. SD, 1%) for both diet groups. Three participants had a total of 6 hospitalizations, all judged unrelated to study participation: 1 participant was hospitalized for pancreatitis (exercise group), 1 participant had 3 hospitalizations for heart failure exacerbation or dyspnea (exercise + diet group), and 1 participant had 2 hospitalizations for leg edema, pain, and erythema (control group). There were no deaths. The combination of diet with exercise, the only intervention previously shown to improve exercise capacity in HFPEF,1. Ways To Lower Blood Pressure By Changing Your Diet. Banana. Stock/Banana. Stock/Thinkstock. This is a guest post by Laura Schoenfeld, a Registered Dietitian with a Master’s degree in Public Health, and staff nutritionist and content manager for Chris. Kresser. com. You can learn more about Laura by checking out her blog or visiting her on Facebook. High blood pressure, also known as hypertension, is a serious and common condition that can lead to life- threatening diseases such as heart attack, stroke, heart or kidney failure, and more. While 1 in 3 American adults have high blood pressure, this condition only affects 3% or less of hunter- gatherer populations that are following a traditional diet and lifestyle. Much like high cholesterol, elevated blood pressure (even in the prehypertension stage) is a sure sign of other problems going on in the body. By addressing underlying issues with diet and lifestyle changes, you may be able to reduce your blood pressure without resorting to drug treatment. This article will address six dietary changes you can make to help lower your blood pressure naturally. Please defer to your doctor’s advice here!)These 6 simple diet changes can help lower your blood pressure without using drugs. Reduce excessive carbohydrate intake, especially refined carbs and sugars. One of the most significant contributors to high blood pressure is high blood sugar and insulin resistance. Chronically high blood sugar, hyperinsulinemia, and high triglycerides are far more common in individuals with hypertension than those with normal blood pressure, and one of the major contributors to all three of these conditions is an excess intake of carbohydrate, particularly refined grains and sugars. And don’t think switching to Diet will help either, since artificially- sweetened beverages also contribute to hypertension. Be sure to adjust your carbohydrate intake to your needs and health goals, and get your carbohydrates from nutrient- dense whole foods like fruits and starchy vegetables. Increase intake of beneficial minerals like potassium, magnesium, and calcium. While most conventional medical professionals will recommend sodium restriction as the primary method for blood pressure reduction, it appears that focusing on eating foods rich in other macrominerals is more beneficial than strictly focusing on avoiding sodium. Further, as Chris has shown in his series on the salt myth, restricting sodium to the levels recommended by the American Heart Association may actually be causing more harm than good. Click to expand table. I’ve included a chart of the Paleo foods richest in potassium to help guide you in increasing potassium intake (this chart is from the bonus chapter on hypertension from Chris’s new book, Your Personal Paleo Code; published in paperback as The Paleo Cure in December 2. Those with hypertension should aim to get at least 4,7. If you have hypertension and are unsure about the adequacy of your potassium intake, I recommend using a food diary for 3 days and analyzing your average potassium intake. Also, don’t go too low carb when reducing your carbohydrate intake – many of the best sources of potassium and magnesium are starchy vegetables like white and sweet potatoes, or fruits like plantains and bananas. White potatoes are especially good sources of blood pressure- lowering minerals like potassium and magnesium; hypothetically you could eat three large baked potatoes per day to easily meet your potassium needs while only consuming around 1. While eating a potato at each meal isn’t necessary to get adequate potassium, I do think those who eat “strict” Paleo should consider reintroducing white potatoes if tolerated. Also, those eating “strict” Paleo may be missing out on significant sources of calcium from dairy products, and calcium intake is another important predictor of high blood pressure and cardiovascular events. Keep a 3- day food diary to check on your intake; if you’re falling short of the minimum 6. Eat grass- fed dairy products like ghee, butter, and cheese. Beyond being a good source of calcium, full- fat grass- fed dairy has another contribution to the treatment of hypertension: vitamin K2. While this nutrient is hardly discussed by conventional medical professionals, preliminary data suggests K2 may be one of the most important nutrients to include in a disease- preventing diet. While there haven’t yet been any studies directly measuring K2’s effects on blood pressure, logic would suggest that this nutrient could help prevent high blood pressure by reducing vascular stiffness and arterial calcification. Pure Indian Foods is my favorite brand of ghee, but you can also eat butter, cheese, and full- fat yogurt or kefir from grass- fed cows to get adequate K2. All the more reason to drink full- fat kefir!)If you’re completely dairy intolerant or allergic, you can supplement with vitamin K2. My favorite supplement is one that contains the three fat soluble nutrients, A, D, and K2, in balanced form, which is the way these vitamins must be taken to support optimal health. If isolated nutrients aren’t your style, you can also take the Extra Virgin Cod Liver Oil from Rosita. Eat at least one pound of fatty fish per week. Fatty fish is high in essential omega- 3 fats, and these fats have been shown to reduce the risk of hypertension and cardiovascular events in multiple studies. Also, certain fatty fish like halibut and wild salmon are high in potassium, as seen in the chart above. This demonstrates the benefit of choosing whole- foods over supplements when it comes to preventing disease; many foods have multiple and possibly synergistic effects that can provide significant health benefits over supplements containing their individual components. Eating one pound (1. Drink tea. Habitual tea drinking may help reduce blood pressure, as demonstrated by research mostly conducted in regions where tea is a significant component of the daily diet. I recommend making a large jug of iced, unsweetened hibiscus tea and drinking it in place of water for at least 3 cups of fluid. Add a little honey or stevia if you prefer sweetness, but this tea is delicious on its own. Hawthorn tea may also be effective as a blood pressure- reducing beverage, and the plant has been used to treat heart disease as far back as the 1st century. Dosing guidelines have not been established, but three cups a day is recommended by some health professionals. Gotu kola tea may be another helpful tea in lowering blood pressure, specifically in the case of venous insufficiency. Again, three cups daily is the current recommendation for this tea. Finally, oolong and green tea may be beneficial for lowering high blood pressure. One study of more than 1,5. Eat more beets. Some researchers hypothesize that a major reason the DASH diet is beneficial for lowering blood pressure is that the content of inorganic nitrate in certain vegetables and fruits provides a physiologic substrate for reduction to nitrite, nitric oxide, and other metabolic products that produce vasodilation, decrease blood pressure, and support cardiovascular function. Beets are high in nitrates, which, as suggested above, may reduce blood pressure by improving vasodilation. Other foods high in nitrates include celeriac, Chinese cabbage, endive, fennel, kohlrabi, leek, parsley, celery, cress, chervil, lettuce, spinach, and rocket. If you’re looking for an even healthier form of beet juice, you can also drink beet kvass, which provides probiotics in addition to hypertension- fighting nitrates. It’s an acquired taste for sure, but one that might be helpful to acquire if you’re suffering from hypertension that hasn’t responded to a healthier diet and/or weight loss. Of course, there are many more recommendations for how to lower blood pressure, including strategic exercise, restful sleep, sun exposure, and meditation, yoga, or other stress management practices. There are also several different supplements that can aid in further lowering blood pressure once these dietary and lifestyle strategies have been made. Chris has written a great bonus chapter on high blood pressure in his new book, Your Personal Paleo Code (published in paperback as The Paleo Cure in December 2. Share your story in the comments below! Like what you’ve read? Sign up for FREE updates delivered to your inbox. I hate spam too. Your email is safe with me.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
November 2017
Categories |