A person whose blood pressure is usually normal has an appointment at a clinic or medical center. There is a bit of anxiety about the visit. Anxiety elevates blood pressure, and having it checked is a routine procedure.

Blood pressure is taken by a physician or other provider who often wears a white coat that symbolizes medical professionalism. The reading is higher than it normally would be when not in a clinical setting. The presumed result: white coat syndrome.

Until recently, white coat syndrome had been considered a temporary spike—no harm, no foul. But not anymore.

Real—Dangerous for Some

White coat syndrome/hypertension was first described more than 40 years ago. Since then, multiple studies have confirmed that it’s a real thing. The original scenario is the same—anxiety can elevate blood pressure in a clinical setting. But current research suggests that white coat syndrome may also be a symptom of something more concerning.

In February 2022, a review of studies in the journal Hypertension became the first to provide evidence that white coat syndrome in patients (with no previous organ damage) had an increased risk of mortality, new hypertension, and new organ damage. This study and others have resulted in a decidedly different approach to white coat syndrome diagnosis and treatment. (https://www.ahajournals.org/doi/full/10.1161/HYPERTENSIONAHA.121.18792)

Blood Pressure—How High is Too High?

To be clear, white coat hypertension for most people is still a one-time event that needs attention only in combination with other cardiovascular conditions. According to Cleveland Clinic and other medical centers, the syndrome affects 15-30 percent of people who already have high blood pressure. Patients who don’t normally have high blood pressure can also have the syndrome. (https://my.clevelandclinic.org/health/diseases/23989-white-coat-syndrome)

The definition of high blood pressure has been a moving target and remains a number that your physician determines is right for you. The American Heart Association defines “normal” as less than 120 for the upper (systolic) number; less than 80 for the bottom (diastolic) number. “Elevated” is 120-129 over 79 or less. For numbers defining three advanced stages of hypertension, go to https://www.heart.org/en/health-topics/high-blood-pressure.

The definition of normal can change, depending on a person’s age and health conditions. The AHA’s guideline for those 65 and older is lower than 130/80.  Normal for patients over the age of 80 may be higher.

Diagnosis— Multiple Readings

Diagnosis of white coat syndrome requires at least three separate blood pressure readings at a clinic, as well as elevated numbers when checked at home. Home blood pressure kits and regular checks are a good idea, regardless of the white coat issue.

When you take your blood pressure (BP) at home, follow these CDC guidelines: 1) nothing to eat or drink 30 minutes before taking BP; 2) empty bladder; 3) feet flat on the floor, legs uncrossed; 4) arm resting on a surface, chest high; 5) cuff snugly against bare skin, not over clothing; 6) no talking; 7) same time every day; 8) at least two readings, 1-2 minutes apart. (https://universityhealthnews.com/daily/heart-health/how-to-get-an-accurate-blood-pressure-reading/)

Treatment—Lifestyle Changes, Medications

If blood pressure is found to be slightly elevated—your doctor makes that call—you may be asked to consider lifestyle changes. You’ve heard them; all easier said than done. Here’s a review:

• Lose weight.
• Sit less, exercise more.
• Eat more fruits and vegetables, less red meat and processed foods.
• Limit daily salt intake to 2300 mg.
• Don’t smoke.
• Work on managing stress. (https://universityhealthnews.com/daily/stress-anxiety/how-to-deal-with-stress/)

If your blood pressure is more than slightly elevated, your doctor may prescribe medications to lower it. Examples are diuretics, alpha- and beta-blockers, ACE inhibitors, and calcium blockers. The Hypertension study mentioned earlier also found that patients with white coat syndrome who take medications to control blood pressure don’t have elevated risks of cardiovascular disease.

Antihypertensive drugs carry risks, mostly mild, for some patients. Ask your doctor about medications that might lower your blood pressure too much. Hypotension, as it’s called, could cause dizziness, lightheadedness, passing out, weakness, nausea, and other symptoms.

How low is too low? The National Library of Medicine says that while there is no universally-accepted standard, blood pressure readings under 90/60 indicate hypotension.

White Coat Syndrome—Answers and Actions

It’s real—well documented. It can be dangerous for some, leading to a variety of conditions that require medical intervention. High blood pressure, whether conventional or white coat, is treatable. It starts with lifestyle changes, and for more serious cases, advances to effective and safe antihypertensive medications.

Don’t dismiss white coat hypertension if it shows up at your next doctor’s appointment. Have it checked or regularly check it yourself.

Other Helpful Links from University Health News

https://universityhealthnews.com/daily/heart-health/uhn-blog-whats-the-right-blood-pressure-for-you-it-depends/

https://universityhealthnews.com/daily/heart-health/is-the-blood-pressure-reading-from-your-doctors-visit-accurate/

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A: Protein is important at any stage in life, and perhaps even more so in our senior years. It is true, as we age, we do not assimilate (absorb) the protein we eat as well as when we were younger since our digestive tract has gone through years of “wear and tear,” so to speak. So, yes, we do want to aim for 1.2 grams of protein per kilogram of body weight when we are older (e.g., a 140-pound person needs about 75 grams of protein/day). With that said, it is also true that as we age, like the digestive tract, our kidneys have a harder time expelling waste from the body due to long-standing hypertension and/or just age in general. So, we also need to eat proteins that are gentle on the kidneys. Plant-based proteins are good at accomplishing this goal. If we eat complementary plant-proteins (e.g., beans with rice) and a wide-variety of plant-proteins (e.g., tofu, edamame, both of which contain all nine essential amino acids), and small amounts of egg, older adults can achieve their protein needs without causing further damage to their kidneys. In addition, eating a low-sodium diet (to control blood pressure and hypertension) and keeping good control of our blood sugar levels (if we have diabetes or prediabetes) can also go a long way to protect our kidneys. The biggest contributor to kidney disease in the U.S. is hypertension, followed by diabetes.

— Dana Ellis Hunnes, UCLA Senior Dietitian Supervisor, Adjunct Assistant Professor

Advisory Board Member

Dana Hunnes, RD, MPH, PhD
Senior Dietitian Supervisor, UCLA Medical Center

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The exact type of therapy is different for everyone and depends on what types of disabilities were cause by the stroke. These may include:

• Paralysis or weakness
• Trouble with mental abilities, called cognitive disability
• Trouble speaking or swallowing
• Numbness or pain
• Bowel or bladder incontinence
• Mental health, especially depression

Treating these disabilities takes a team of health care providers that include medical doctors, neurologists, physical therapists, occupational therapists, speech therapists, and mental health providers.

Stroke Recovery Stages

Stages of stroke recovery are used by physical therapists to decide the best type of therapy for people with paralysis or weakness. These stages do not apply to other stroke disabilities. Not everyone will make it through these stages towards normal movement. The stages of movement recovery are:

• No ability to move part of your body affected by the stroke, called no voluntary movement
• Movement that comes back but is jerky and poorly controlled, called spasticity
• More voluntary control of movement
• Return of more movement and control without spasticity
• Loss of spasticity
• Return to normal movement

Learn the signs of a stroke to receive the help you need when a stroke occurs.

Stroke Recovery Time

The stroke recovery timeline begins as soon as possible, sometimes on the first hospital day. A stroke care team evaluates the effects of the stroke and the type of therapy and therapists that will be needed. Together they develop a stroke rehabilitation plan. Therapy sessions may occur up to six times during an average hospital stay of five to seven days.

During the first few weeks after the stroke, rehabilitation is focused on regaining activities of daily living. Depending on the plan, this time may be spent in a rehabilitation facility or at home with outpatient rehabilitation.

The first three months after a stroke are the most important time, when most of recovery will occur. During this time there can be spontaneous recovery that is independent of physical therapy. This is causes by recovery of brain cells due to return of blood supply, called reperfusion.

After six months, most recovery is complete although there may still be some recovery for a year or more. Mental health disability is common in the year after a stroke. One-third of people will suffer from depression after a stroke. Studies show that depression is 70 percent higher after a stroke than a heart attack.

About 50 percent of people will still be left with significant disability. Stroke is the number one cause of severe disability for Americans. For these people, stroke recovery includes a lifetime of adjusting to their disabilities and learning to make the best of the abilities they still have.

Long Term Recovery for All Stroke Survivors

One of the greatest dangers for all survivors is the risk of a repeat stroke. One in four strokes are recurrent. There are about 800,000 strokes in the U.S. every year and about 200,000 are repeat strokes. The good news is according to the American Stroke Association, up to 90 percent of these can be prevented with medications and lifestyle changes. Medications may include blood thinning medication, blood pressure medication, and statin drugs to reduce bad cholesterol. The CDC, advises these as the most important lifestyle changes:

• Working with health care providers to control blood pressure, blood sugar, and cholesterol
• Not smoking and using alcohol only in moderation
• Eating a heart healthy diet
• Maintaining a healthy weight with diet and exercise appropriate for your ability

For more on strokes, purchase the Cleveland Clinic Annual Report on Strokes.

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How much caffeine is too much?

The safe limit of caffeine for adults is 400 milligrams, which is about four cups of coffee, 10 caffeine colas, or two energy shots. Frequent coffee drinkers can tolerate more and for people who rarely drink coffee or are very sensitive to caffeine, less can be too much. For more on caffeine tolerance, read Can I Build a Tolerance to Caffeine. The limit of caffeine for pregnancy is 200 milligrams per day.

There is no safe limit of caffeine for children under age 12. Children ages 12 to 18 are advised to avoid caffeine energy products and limit caffeine from other sources to 100 milligrams (about 2 cans of caffeinated soda) per day.

Signs and symptoms of too much caffeine can include:

• Headache
• Nausea or loss of appetite
• Anxiety, agitation, and irritability
• Insomnia
• Palpitations
• Tremors
• Sweating and flushing
• Frequent urination

A dangerous caffeine overdose is unlikely from common sources of caffeine, but concentrated caffeine in energy shots, caffeine energy drinks, and powdered caffeine can cause an overdose and can be life threatening. Powdered caffeine is found in some supplements and can be purchased online. One teaspoon is equal to the caffeine in 28 cups of coffee.

Learn more about how too much caffeine can affect your brain function.

How long does it take to get caffeine out of your system?

Caffeine is broken down in your liver and excreted in your urine. It usually reaches its peak effects in about 45 minutes. After about 5 hours, half of the caffeine in your system will be eliminated, so symptoms of too much will usually be gone in four to five hours.

The best way to avoid too much caffeine is limit the amount. Remember that caffeine is also found in tea and chocolate. Try a decaffeinated soda or an herbal tea. Some over-the-counter (OTC) medications and supplements can add to your caffeine level. OTC medications for menstrual pain and migraine headache often have caffeine. Watch out for the supplements echinacea, yerba mate, and guarana.

There is not much you can do to speed up the process of getting caffeine out of your system, but you may be able to reduce the uncomfortable symptoms with these tips:

• Drink lots of water. This will avoid dehydration caused by frequent urination and may help flush some of the caffeine out of your system.
• Frequent urination may lower blood minerals called electrolytes. Replace them with a sports beverage like Gatorade or an electrolyte replacement fluid like Pedialyte.
• Stop adding any more caffeine from sources like chocolate or soda.
• Walk it off with walking exercise. This will lower your stress and anxiety.
• Trigger your inner relaxation response with deep breathing or a mind body exercise.

When cutting out caffeine completely, understand the symptoms of caffeine withdrawal.

When should you to get medical attention after consuming too much caffeine?

Symptoms of too much caffeine don’t need medical care, but if you have these symptoms along with confusion, hallucination, chest pain, shortness of breath, severe vomiting, or a seizure, seek medical help right away. You could have a serious caffeine overdose which needs to be treated as an emergency. Treatment may include breathing support, intravenous fluids, and medications to control blood pressure, heart rate, vomiting, and anxiety until the caffeine works its way out of your system.

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“A stroke may produce life-changing consequences. It may impair your ability to function so severely that you become incapable of caring for yourself, which is why stroke is a leading cause of nursing home admissions,” says Dana Leifer, MD, a neurologist at Weill Cornell Medicine. “That’s why it is very important to take preventive action by addressing any stroke risk factors you have. Control of high blood pressure, high cholesterol, and diabetes can significantly reduce the risk of stroke. Proper treatment of atrial fibrillation is also very important And if you smoke, it is essential to stop smoking.”

Risk Factors

Common risk factors for stroke include:

• Eating an unhealthy diet
• Getting little or no exercise
• Having atrial fibrillation or any type of cardiovascular disease, including coronary artery or heart disease and peripheral artery disease
• Having high blood pressure
• Having high total and/or LDL cholesterol
• Having diabetes
• Being overweight Smoking tobacco.

Preventive Strategies

Making healthy lifestyle choices, addressing conditions that affect your cardiovascular health, maintaining a healthy weight, and not smoking will significantly lower your risk of stroke.

➊ Choose a healthy eating pattern.

A Mediterranean-style diet, which contains plenty of whole, plant-based foods such as legumes (beans, peas, and lentils), vegetables, fruits, whole grains, and nuts, has been shown to lower stroke risk. Another key feature of a Mediterranean-style diet is that olive oil is the primary fat used for cooking. The typical “Western” diet, which is high in red and processed meats, sweets, fried and fast foods, and highly processed foods, is linked with a higher stroke risk. For more details, see What You Can Do.

➋ Get and stay physically active.

Women who are sedentary (get no exercise) have a 25 to 30 percent higher risk of stroke than physically active women. Aim for at least 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic activity each week. If you can’t get that much in, do whatever you can; even five or 10 minutes will provide some benefit.

Do activities that you enjoy; you’re much more likely to stick with an exercise regimen if you’re doing something you like. Any activity that gets your heart rate up and keeps it up will be beneficial. Aerobic activities include brisk walking, bicycling, jogging, dancing, swimming, rowing, and using an elliptical machine.

➌ Get treatment for atrial fibrillation (A-fib) and any other cardiovascular conditions.

Having A-fib, an irregular heart rhythm, can increase the risk of stroke by more than 400 percent. If you have A-fib, follow your cardiologist’s instructions. The same recommendation applies if you have any type of heart or vascular disease and/or you’ve previously had a heart attack or a transient ischemic attack (a mini-stroke). Even if you are taking medication, exercise, healthy eating, and quitting smoking if you smoke will be part of your treatment program.

➍ Control blood pressure, cholesterol, and blood glucose.

Following a heart-healthy eating pattern and getting regular physical activity will help you lower your blood pressure, your total and LDL cholesterol, and your blood glucose level. Many people will also require medication to get their numbers to healthy levels.

If you are prescribed medication, take it exactly as recommended. If you have problematic side effects, report them to your doctor and discuss other possible options, but don’t just stop your medication. Also make sure to attend regular follow-up visits with your doctor so he or she can monitor your progress.

If you cannot afford your medication, tell your doctor or pharmacist; samples or coupons may be available. Some medications are provided free or at low cost by the pharmaceutical companies.

➎ Shed some pounds if you are overweight or obese.

If you’ve repeatedly tried and failed to lose weight on your own, ask your doctor for a referral to a registered dietitian nutritionist who specializes in weight loss. Medicare and some insurance companies now cover obesity treatment, which may include nutrition education, tools and strategies for changing the way you eat, and/or weight-loss medications.

➏ If you smoke, quit.

Even if you’ve been smoking for decades, quitting cigarettes now will still provide significant health benefits. Ask your doctor for a referral to a smoking cessation program, and go to https://smokefree.gov to access free programs that can help you quit. Taking these steps may be challenging, but it’s nothing compared to the difficulties a stroke will cause. When you’re ordering broiled fish instead of a T-bone, taking your medication, or putting on your walking shoes, remind yourself that you are reducing your chances of having long-term disabilities, and you may even be saving your own life.

Know the Symptoms of Stroke

Signs that indicate a possible stroke include sudden onset of weakness, tingling, or numbness on one side of the body; blurred or double vision or loss of vision in one or both eyes; slurred or garbled speech, or trouble understanding someone else’s speech; loss of balance or difficulty walking; drooping or numbness on one side of your face; or sudden severe headache or dizziness.

“If you have any of these symptoms, get to an emergency room as quickly as possible,” urges Dr. Leifer. Don’t drive yourself, and call 911 immediately; the faster you get treatment, the better your chances are of avoiding permanent loss of function.

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A recent news release (Aug. 22) from the American Diabetes Association (ADA) highlights the link between diabetes and hearing loss. Hearing loss is twice as common among people with diabetes as it is in people who do not have diabetes. Experts posit that the link may be connected to the damage diabetes exerts on blood vessels. The condition also damages nerves, and this may interfere with the transmission of nerve signals that carry sound to the brain. Signs of hearing loss include having to ask others to repeat themselves during conversations, problems hearing others in noisy surroundings like restaurants, and trouble hearing higher-pitched voices (such as those of women and children). If you suspect you may have impaired hearing, consult an audiologist (also see our cover article on sensory loss).

Mount Sinai Study Investigates “Polypill” for Heart Patients

A recent Mount Sinai study suggests that a three-drug medication known as a “polypill” is highly effective at preventing secondary adverse cardiovascular events in people who have previously had a heart attack. Standard therapy for these individuals includes three different drugs: an antiplatelet agent (like aspirin), the ACE inhibitor ramipril (Altace®) or a similar drug to control blood pressure, and a lipid-reducing drug, such as a statin. Fewer than 50 percent of people who are prescribed these drugs after a heart attack consistently adhere to this medication regimen. The study (New England Journal of Medicine, Aug. 26) included 2,499 people, average age 76, who were randomly assigned to receive standard therapy or the polypill. Over an average three-year follow-up, participants taking the polypill had a higher level of treatment adherence than those in the control group. They also had a 24 percent lower risk of death from cardiovascular causes, nonfatal heart attack, nonfatal stroke, and need for emergency coronary revascularization (the restoration of blood flow through a blocked coronary artery). The polypill is now under consideration for approval by the U.S. Food & Drug Administration.

Avoid Skin-Lightening Products for Age Spots

If you have what are commonly referred to as “age spots”—brown patches on your skin that are larger than freckles and which often occur on the face, hands, and arms—don’t be tempted by “skin lightening” products that claim to fade these marks and others. A recent U.S. Food & Drug Administration safety alert (Aug. 30) warns that over-the-counter sale of these products is illegal because they often contain hydroquinone and mercury. Both can build up in the body and cause serious side effects, including facial swelling, permanent skin discoloration, and damage to the lungs, kidneys, skin, and eyes. Check with your dermatologist before using any product marketed as a skin lightener.

Processed Foods and Colorectal Cancer

Researchers writing in The BMJ, Aug. 31, say that men who consume large amounts of ultra-processed foods have a significantly greater risk of colorectal cancer than those who eat smaller amounts of these foods. The 25-year study included more than 200,000 people, about 46,000 of whom were men. Participants filled in food frequency questionnaires every four years. During follow-up, 1,922 cases of colorectal cancer occurred in women, and 1,294 occurred in men. Compared with men in the lowest fifth of ultra-processed food consumption, men in the highest fifth of consumption had a 29 percent greater risk of developing colorectal cancer. The strongest food associations were with processed meats (sausages, bacon, ham, and fish cakes), but higher consumption of sugar-sweetened beverages, like soda, also was associated with an increased risk of colorectal cancer in men. No link was seen between ultra-processed food consumption and colorectal cancer risk in women— however, women who consumed more ready-to-eat meals were at increased risk for colorectal cancer.

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1.They are often based on insufficient information.

Some lists are based on research and measurable, complete facts, but many are simply opinion pieces or collections of ideas. “The information in lists is frequently drawn from a small selection of studies that may not be representative of the totality of the data,” says Alice H. Lichtenstein, DSc, professor at the Friedman School and executive editor of Tufts Health & Nutrition Letter, .

Additionally, lists of foods to eat (or avoid) generally don’t consider one’s whole dietary pattern. “We don’t consume isolated foods in a vacuum,” says Lichtenstein. “If one food is a healthy choice, it can’t make up for an overall unhealthy dietary pattern. Nor can consuming an occasional treat ruin the positives of an overall pattern of good choices.”

What to Do: Find trustworthy sources of information (like the Tufts Health & Nutrition Letter!). Make sure the goal of the organization providing the information is to educate, not to sell something or promote certain foods.

“Media articles can help you keep up with the latest information,” says Dariush Mozaffarian, MD, DrPH, dean for policy at the Friedman School and editor-in-chief of this newsletter, “but keep in mind that news organizations are under pressure to recruit readers and get ‘clicks.’ This increases the temptation to exaggerate the importance or surprise factor of any new finding. Nutrition research is notoriously complex, requiring careful consideration of study design, populations, interventions, and other factors like genetics, the gut microbiome, and the environment. Conflicting or contradictory results are therefore common. Expertise is required to review and take into consideration all the research on a topic and understand the total weight of the evidence.” Helpful nutrition information is therefore most likely to come from university scientists who can accurately review and integrate all the information available, as well as from reputable health advocacy organizations like the U.S. Dietary Guidelines scientific committees and other national organizations like the American Heart Association, American Cancer Society, American Diabetes Association, Academy of Nutrition and Dietetics, and American Society for Nutrition.

“Look for common conclusions and recommendations from all these sources: universities, the media, and multiple respected national organizations,” says Mozaffarian, “and always keep in mind, as in any science, when new information emerges, recommendations are reevaluated and sometimes modified. That is the nature of science.”

2.They necessarily oversimplify.

Listicles are designed to be short, readable, and entertaining. They are not a good format for capturing pros and cons, digging deep, or exploring complicated ideas. Presenting information in a simple, understandable way can be helpful, but only when that information is complete and free from bias.

For an example of how lists oversimplify complex information, let’s look at bananas which often top lists of “the worst fruits you can eat.” These portable fruits are an excellent source of potassium (which helps control blood pressure) and fiber. They also provide a healthy dose of vitamin C, vitamin B6, magnesium, and manganese. Although some sources state bananas cause weight gain, there is no evidence to support that claim (and some evidence to the contrary). While some lists claim bananas are bad for digestion, they are on a short list of foods typically recommended as easyto- digest for people with diarrhea and/or vomiting and help replenish electrolytes lost with these ailments. While it is true that bananas are high in natural sugars, they are also high in resistant starch—a type of carbohydrate that is not broken down in the small intestines. Similar to fiber, resistant starch slows the release of sugars into the bloodstream and feeds beneficial gut bacteria. (The less ripe the banana is, the more resistant starch it has.) “As with other fruit, very ripe bananas may raise blood sugar more than less ripe fruit, but the fiber in the fruit should slow down absorption of the sugars,” says Richard Siegel, MD, co-director or the Diabetes and Lipid Center at Tufts Medical Center. “I feel that any whole unprocessed fruit, including bananas, is fine for anyone to eat as part of a balanced diet. People (with or without diabetes) should aim for several servings of whole fruit spread out over the course of the day. I would not call a banana a ‘worst’ food. I eat one myself on most days of the week.”

In addition to running the risk of oversimplifying, lists also suggest “number one” is the best (or worst). “Are they really presenting the best, then the next best,” says Lichtenstein, “or just a list of related items?”

What to Do: Look for detailed information. The list should explore pros and cons, mention conflicting research if there is any, and acknowledge any generalizations being made. Following the advice presented above for finding trustworthy sources can help.

3.They may encourage limiting choices within and between food groups.

Placing a food at the top of a list may make it seem like it’s head and shoulders above other foods in its food group. “In fact, there is tremendous overlap in the nutrients in similar foods,” says Lichtenstein. “For example, all berries provide fiber and generally similar vitamins and minerals. Hence, it is unlikely one type of berry will be significantly better for you than another type of berry. Likewise, eating fish is a good choice. Splitting hairs over which fish is the best is not helpful. What if you don’t like that type of fish, it’s not available in your area, or doesn’t fit in your food budget?”

Even if you love the top-ranked foods, emphasizing them too heavily in your dietary intake can cut out other choices that might add nutritional variety. Yes, berries are great choices, but the nutrient content of many other fruits, like citrus fruits, pineapple, kiwis, cherries, and mangos, for example, is also excellent.

Variety between food groups may be even more important than variety within food groups when it comes to getting all the essential nutrients. “Eating a variety of food groups helps to ensure balanced intake of important nutrients,” says Lichtenstein. “For example, many fruits and vegetables are rich in vitamins A and C, but low in vitamin B12. Dairy products are rich in calcium and riboflavin but low in iron. Seafood, chicken, meat, dairy and eggs supply B12 and iron.” (Those following strict vegan diets may find it challenging to meet their B12 requirements since this vitamin is only found in animal products. Fortified breakfast cereals and other fortified foods are option for this vitamin, but supplements may be necessary.)

What to Do: You don’t have to make a single food a big part of your diet (or exclude it entirely) just because it is listed as particularly good (or particularly bad) for your health. Don’t like that “best” food? Eat something else from that food group instead. “For sustained improvements in one’s diet,” says Lichtenstein, “it’s important to incorporate foods one enjoys and that are available.”

An overall healthy dietary pattern is best. This means making choices over time that emphasize fruits, vegetables, nuts/seeds, beans/lentils, whole grains, fish, and yogurt and limit red meat, processed meats, and foods high in sodium, sugar, and refined starches. Thinking in terms of a pattern of eating instead of a strict list of foods or food groups to eat or exclude gives you leeway to include a variety of foods you enjoy. Eat a variety of healthy foods across and within different food groups to make sure you get the wide range of the nutrients your body needs.

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Dehydration Defined. Dehydration occurs when you lose more fluid than you take in. It can lead to everything from minor cramps and heat exhaustion to seizures and potentially life-threatening heatstroke or shock.

Thirst is one way the body alerts us of low fluid levels. “Drink to satisfy your thirst,” says Klemens Meyer, MD, a nephrologist and director of Dialysis Services at Tufts Medical Center. Other symptoms are fairly general and include dry lips, mouth, or tongue; headache, dizziness, or lightheadedness; fatigue or lethargy; lack of focus; muscle weakness or muscle cramps; and rapid breathing. Urine color is a possible indicator of hydration in children and young adults, but not necessarily in older adults. When hydrated, urine is light and straw-like in color. Very dark colored urine is a sign of dehydration. “If your urine is dark, drink water to make it lighter, but not so much that it looks like water,” says Meyer.

Dehydration Risks. We normally lose fluid in sweat, urine, and our breath. Other causes of fluid loss include diarrhea and vomiting. Illness and certain medications (including laxatives, oral medications for type 2 diabetes, and diuretics) can increase risk for dehydration. Athletes who sweat a lot for a significant period of time require increased fluid intake.

“Although thirst is a good indicator to drink water to prevent dehydration in most people,” Meyer says, “the very young and the very old may be the exception.” Infants and young children, who don’t have a lot of body mass, are sensitive to even small amounts of fluid loss, and they don’t have the ability to clearly express their thirst. The body’s fluid volume decreases with age, and so can the ability to sense thirst, so older adults are at higher risk of becoming dehydrated. On top of that, studies show adults ages 60 and older consume about two fewer cups of fluid a day than younger individuals.

How to Hydrate. Fluid needs depend on many factors, including body size, age, activity level, climate, and diet. Because needs are so individual, there are no recommended intake levels that apply to everyone. Instead, the U.S. National Academies of Sciences Institute of Medicine has set an “Adequate Intake” level. In addition to the fluids we get from foods (especially fruits and vegetables), men should, on average, consume at least 12 cups of fluid a day from water and other beverages. Women should have a minimum of nine cups. Consider putting that much water in a container at the start of the day and trying to get through it by day’s end.

Water is a great choice, but other unsweetened beverages, such as low-fat or fat-free milk and fortified soy beverage, can support fluid intake while helping us reach our dietary intake recommendations for different food groups and nutrients. While electrolyte drinks are advertised to help keep you hydrated, studies have shown electrolyte loss through typical physical activity is generally small, so these (often sweet) beverages are unnecessary for most situations.

Spruce up water with a splash of fruit juice or slices of fresh or frozen fruits and/ or fresh herbs. Try a sparkling or mineral water for a change (just be sure there are no added sugars). Unsweetened coffee and tea are good options as well and can be served over ice. Almost all fruits and vegetables have high water contents, so include plenty of water-rich seasonal or frozen fruits and vegetables, like watermelon, strawberries, cucumbers, celery, and tomatoes in your dietary intake.

Take the heat off this summer by ensuring you consume refreshing fluids and water-rich produce, and be on the lookout for signs of dehydration.

The post Hydrating for Health appeared first on University Health News.

The broad term for cognitive impairment triggered by changes in blood flow is vascular dementia, but many experts in the field say a more accurate description is “vascular contributions to impairment and dementia” (VCID), which encompasses brain changes both mild and severe related to blood flow.

But unlike the early symptoms of Alzheimer’s disease (AD), which primarily include memory problems and sometimes non-memory concerns, such as impaired reasoning and difficulty finding the right words in conversation, memory loss isn’t always an early sign of VCID. Initial symptoms often include confusion, impaired executive function (planning, organizing and decision making), and noticeable changes in mood and behavior.

Neurologist Anand Viswanathan, MD, PhD, with the Memory Disorders Unit at Massachusetts General Hospital and the Massachusetts Alzheimer’s Disease Research Center, explains one theory of why mood and executive function are so often affected early on: blood flow problems in the brain affect networks that involve several regions of the brain. In AD, the neighboring memory centers of the hippocampus and entorhinal cortex are usually the first areas of the brain to undergo a change. Damage to other parts of the brain usually occurs later on as AD progresses.

“Memory loss isn’t as prominent as it is in Alzheimer’s, and the speculation is that it is because the damage isn’t centered in one region,” Dr. Viswanathan says of VCID. “The higher brain processes involving executive function and mood, as well as gait, involve multiple brain regions.”

But VCID can eventually produce a wide range of symptoms, depending on the cause, location, and severity of vascular injury to the brain.

Causes of VCID

Three of the main causes of vascular cognitive impairment include:

• Atherosclerosis
• Stroke
• Silent vascular brain injury (or silent strokes)

Atherosclerosis is the formation of plaques along the inner walls of arteries. The plaques are made up of cholesterol, fats, calcium, fibrin (a bloodclotting material), and waste materials. Atherosclerosis can occur anywhere from the brain to the feet. It causes the arteries to become less elastic, and it narrows the channel through which blood can flow, reducing the volume of oxygen-rich blood circulating in various parts of the body. Atherosclerosis in the brain doesn’t always cause symptoms, but it can lead to brain cell injury
or even death.

The two main types of strokes are hemorrhagic and ischemic. A hemorrhagic stroke occurs when an artery leaks or ruptures. Ischemic strokes, which make up more than 80 percent of all strokes, occur when blood flow through an artery supplying the brain becomes blocked.

A silent stroke is usually caused by a blood clot that temporarily interrupts blood flow in the brain. You may never know you had one or more silent strokes because there are no obvious symptoms. But over time, the cumulative effect of silent strokes can affect cognition or other brain functions. It’s estimated that by the age of 80 about one in four people has had at least one silent stroke.

Reducing Your Risk

Preserving the health of your body’s vast vascular network means adopting a lifestyle that provides benefits far beyond a healthy brain. “Reducing the risk of vascular lesions that contribute to VICD includes treating high blood pressure and diabetes and quitting smoking,” Dr. Viswanathan says, adding that these steps also support the heart, lungs and your overall health.

At the top of the to-do list for vascular health is maintaining a healthy blood pressure. High blood pressure is undertreated in about 30 to 40 percent of people with hypertension, and Dr. Viswanathan notes that those numbers haven’t changed much in 20 years. But he adds that one way to make sure your blood pressure is being properly treated is to buy and use a home blood pressure monitoring kit. By taking your blood pressure regularly and reporting the numbers to your doctor, you both can see how well treatment is working and whether changes are needed.

If you aren’t currently taking medication for hypertension, observing spikes in blood pressure at home or a steady increase in your blood pressure can alert you and your physician that some intervention may be necessary. Home monitoring may also reveal whether you are experiencing low blood pressure (hypotension), which can lead to insufficient blood flow to the brain. “There is some evidence that low blood pressure in late life may actually increase the risk of cognitive impairment,” Dr. Viswanathan says, adding that determining safe low and high numbers can be challenging.

Many older adults, for example, function quite well with blood pressure that is slightly above the recommended level of 120/80 millimeters of mercury (mmHg). Likewise, some older adults may thrive with blood pressure slightly below that figure.

In addition to medications that help control blood pressure, the following strategies should also be employed:

• Get at least 150 minutes a week of aerobic exercise.
• Follow a Mediterranean-style diet or other eating plan that focuses on fruits, vegetables, whole grains, lean proteins and little saturated fat, sodium, and added sugars.
• Maintain a healthy weight. If you are overweight or obese, losing just 10 pounds can result in a lower blood pressure for many people.
• Manage your stress.

And if you smoke, talk with your doctor about programs in your community and nicotine-replacement products or other therapies designed to help people quit smoking.  If you have tried before and been unsuccessful, just know that it often takes five or six attempts for someone to be successful and quit cigarettes for good. Smoking damages blood vessels, reduces blood oxygen levels, and increases inflammation— all factors that contribute to cognitive impairment. Elevated glucose (sugar) levels in the blood can also injure blood vessels. Research suggests that blood glucose levels that haven’t yet risen to the threshold that defines diabetes may already be causing damage. There are several tests used to diagnose diabetes, but two common screenings are a glycated hemoglobin (A1C) test and a fasting blood glucose test. An A1C level of at least 6.5 percent on two tests indicates diabetes, as do two fasting blood glucose test results of at least 126 milligrams per deciliter (mg/dL).

Keep Your Mind Interested

Preserving brain health is more than just a matter of healthy circulation. Dr. Viswanathan advises his patients to spend time in cognitively engaging activities to fuel the birth of new brain cells and activate your neural networks.

“Find something you’re really interested in and which also requires true personal engagement. These are activities where you learn new skills, acquire new knowledge, or put yourself in challenging situations that require personal growth,” Dr. Viswanathan recommends. “It could be making large-scale photographs, becoming an elite gardener, or being the best tennis player in your age group. The idea is that if you have something like this in your life, you’ll talk about it with friends, you’ll do research, and you’ll get out to work on it. That kind of social activity is really important. Just remember, there is no one-size-fits-all activity. If it’s special to you, then it’s worth doing.”

Looking Ahead

Reducing the impact of vascular disease on cognition is the goal of research efforts around the world. MGH is leading the way in two major projects. The first is a research program funded by the National Institutes of Health called the MarkVCID consortium. MGH is the coordinating center of this multimillion-dollar research effort. It consists of numerous prominent research groups across the country working on ways to better predict and diagnose small blood vessel disease in the brain and to develop a greater understanding of how it contributes to VCID.

MGH is also leading another NIHfunded collaborative effort called DISCOVERY (Determinants of
Incident Stroke Cognitive Outcomes and Vascular Effects on RecoverY). The goal is to better understand the mechanisms of post-stroke cognitive impairment, with the ultimate aim of developing personalized treatments that will reduce rates of stroke-induced cognitive and functional disability.

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Hydrate! While all kinds of beverages and many foods provide us with fluids, water is the best drink to keep us hydrated. There is no recommended daily intake level for water, as needs vary with many factors, including ambient temperature, activity level, and types of foods in the diet. Be aware that older adults are at an increased risk for dehydration because they may not sense the need for fluids in response to their bodies’ hydration state as well as they did when they were younger.

The commonly stated goal of drinking eight (eight-ounce) cups of water a day has no firm scientific basis, but it is generally considered a reasonable goal. One way to tell if you’re getting enough fluid is to pay attention to your urine: dark urine indicates inadequate hydration.

Water Choices: Bottled waters are now the number one beverage in the U.S. These products come at a cost—both financial and environmental—so knowing what you’re getting and weighing your options carefully is important.

• Tap water from public water systems is regulated by the Environmental Protection Agency (EPA). Routine testing of public water is required, and test results must be made available to the public. If your water comes from a well, the Centers for Disease Control and Prevention recommends having it tested once a year. Although U.S. drinking water is among the safest and most reliable in the world, it is not without controversy. Many people choose to use a whole house, under-sink, refrigerator, or pitcher-based filter system at home.
• Spring water, according to the U.S. Food and Drug Administration (FDA), must be “derived from an underground formation from which water flows naturally to the surface” and cannot be altered. (Complaints have been raised against some manufacturers claiming fraudulent labelling.) “Glacier water” is typically runoff from a melting glacier (or glacier ice melted at a processing facility), but this is largely an unregulated term.
• Mineral water, like spring water, originates from a protected underground water source that rises to the surface. According to the FDA, mineral water must contain at least 250 parts-permillion total dissolved solids, such as calcium, magnesium, zinc, and sodium. Flavor profile varies with the mineral make-up, and some mineral waters are effervescent from naturally occurring gases.
• Purified water may come from any source (including a tap). It is purified by methods such as carbon filtration or reverse osmosis. Be aware that much of the water we buy in plastic bottles is simply tap water that has been filtered—often in ways similar to what can be accomplished more cheaply with a home filter.
• Distilled water is a type of purified water from which all natural components have been removed. Distilled water prevents mineral buildup in appliances, for example, but it lacks beneficial nutrients and is not the best choice for human consumption.
• Alkaline water has been treated to have a higher pH level than most tap or bottled waters. Proponents claim it helps keep the body “in balance” and provides health benefits, but there is very limited research to support these claims. The kidneys naturally keep the body’s acid/base ratio in balance. Eating more plant foods and less animal protein is a science-backed way of making the kidneys’ job easier.
• Electrolyte waters have added minerals, such as sodium, potassium, and magnesium. This category can include sports drinks (which generally contain added sugars in addition to minerals) and preparations specifically marketed for hydration during illness, such as Pedialyte®. All waters (except distilled) contain some electrolytes. The concentrations of minerals in so-called “electrolyte water” vary by brand. While these products may be useful to athletes who are sweating profusely or people with stomach viruses, they are not necessary for normal hydration.
• Flavored waters typically use natural or artificial fruit flavors for a change of pace from “plain” water. Look for brands without added sweeteners, or, better yet, make them at home (see recipe, below).
• Sparkling waters are a better choice than carbonated sugar-sweetened beverages when you’re in the mood for a fizzy drink. The bubbles in these drinks come from the addition of carbon dioxide. This category includes club soda (which is infused with minerals, including sodium), tonic water (with added minerals and quinine, which imparts a bitter taste), and seltzers. Seltzers are often enhanced with natural fruit flavorings, artificial flavorings, or sometimes a small amount of fruit juice. They are generally unsweetened, but always scan the label to be sure there are no added sugars.

Costs and Concerns: Bottled water is much more expensive than tap water, and the costs don’t begin at the cash register. There is a steep environmental cost to using fossil fuels to make plastic water bottles, and a reported 86 percent of them end up as garbage or litter. Research into possible health impacts of the chemicals that leach from plastic bottles into beverages is ongoing. Municipal drinking water is required to undergo more rigorous and frequent safety testing and monitoring than bottled water (although we must acknowledge notable lapses in safety, such as Flint, Michigan).

Homemade flavored water or plain seltzer with a splash of fruit juice are a great choice for a change of pace. If you do choose bottled or canned varieties, be sure to recycle the containers. All in all, filtering tap water at home and carrying a reusable water bottle is a better choice for the environment—and all that’s necessary for healthy hydration.

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