Not All Fat is Created Equal...

Your health is, in many ways, determined by the size of your GUT.  

While fat around the hips (“pear” body shape) is metabolically innocent, but the fat inside the belly (“apple” body type) can be truly dangerous and, potentially, life-threatening. Abdominal obesity or Abdobesity is defined in men as a waist circumference of 40 inches or more and, in women, 35 inches or more and is linked to type 2 diabetes and heart disease.

While a Body Mass Index (BMI) above 30kg/m2 defines obesity, the two conditions (abdobesity and obesity) do not always coexist, as is the case of a “pear” type person or a muscular person that weighs a lot but the above-average weight consists mainly of lean protein (muscle).

The fat confined in our belly is dangerous, in part because it is directly connected to our liver, the main factory of our metabolism. A “highway” called portal vein, allows for constant traffic of belly fat to the liver, turning the liver into a factory of “fat bullets” that bombard our arteries, giving rise to cholesterol plaques. Those plaques mature over the years and became inflamed and unstable, resulting in heart attacks, strokes or even sudden death. As the belly fat affects our entire metabolism, it contributes to diabetes, a serious disease with multiple complications of its own, including heart attacks, strokes, blindness, and kidney failure. Overeating and under exercising can lead to a flabby gut (abdobesity). That spare tire may be more than too much chocolate - it is the prelude of a series of potentially deadly medical conditions.

Sometimes you hear people refer to their “core”.  Your core is more than just your stomach. The core is a complex series of muscle that are essential for core stability and spine protection. It’s important to achieve core stability to protect the spine and surrounding musculature from injury.  The skin fat that surrounds the muscles and the stomach is not medically dangerous, but the deep belly fat, the one inside your belly muscles can cause health trouble. This deep belly fat, beyond contributing to diabetes and heart disease, it also makes it hard to strengthen the core and can lead to chronic low-back pain.

Most individuals with abdobesity were probably much thinner as young children. Some started putting on weight as kids, others as adolescents, and many as adults. Although every person’s metabolism is different (in part due to different rates of food absorption by the gut), healthy people will not become obese without taking in more calories than they burn.

So what can you do to lose that spare tire? There are a few things to kick start the process. Of course a healthy lifestyle (eating healthy and exercise) are the key.

Five ways to help reduce that gut are:

• Don't Eat Sugar and Avoid Sugar-Sweetened Beverages
• Eat the right amount of Lean Protein
• Cut the Bad Carbs From Your Diet
• Eat Foods Rich in Fiber
• Eat Good Fats
• Exercise almost Daily

It is important to add some specifics about the stomach; It produces hydrochloric acid that serves as a first line of defense for the immune system by killing off bacteria and viruses that may enter with the food you eat. Stress can upset your stomach, and not just discomfort. As the central nervous system, through its “subsidiaries”, controls the function of your stomach, stress can often upset these organs, contributing to discomfort, acid reflux, gas, bloating or diarrhea.

So keeping your tummy healthy is important to your overall health. It would be wonderful to have “6 pack abs”, but the health beyond it is important. If your belly is hanging over your belt, take it seriously, as this may be the only obvious sign that other medical problems may be going on in your body. A big belly can be “hiding” prediabetes or diabetes, high cholesterol or high blood pressure, conditions that predispose to serious complications, like heart attacks, stroke and kidney failure. Adopt a healthy lifestyle and ask your doctor about what should be done to help you lose that weight and, even more importantly, to protect your arteries, your liver and your life.

To your health!

Dr. Anthony

If YOU know how your body works then…

“Know thyself “

• An ancient Greek aphorism that appeared in the Temple of Apollo in Delphi and was also inscribed-in Latin- over the Oracle’s door in the 1999 film “Matrix”.
• A maxim that has been attributed to ancient philosophers.
• Benjamin Franklin wrote: "There are three things extremely hard: steel, a diamond, and to know one's self."

Understanding our self, our feelings, our emotions, and what motivates our behavior is or should be an important goal in life. But what does it practically mean in the areas of health, wellness and prevention?

Knowing how our body works helps us understand what is important in keeping it healthy. In order to keep our arteries healthy and avoid heart attacks and stroke, for example, we should care about what we put into our mouth (diet), as this stuff is absorbed by our gut and enters the arteries and heart circulation, with potential salutary (fruits and vegetables filled with antioxidants) or destructive effects (frequent intake of red meat, fast food or cold cuts, filled with unhealthy fats). A healthy metabolism supports healthy arteries and its pillars are a combination of healthy diet and near-daily exercise, including both cardio- and muscle building through light weights. As another example, knowing that one of our immediate family members has type 2 diabetes means that our own pancreas cells that produce insulin are probably not very durable, so we better watch it and avoid becoming obese or eating too many cookies and desserts, or else!

Listen to your body -- once you know it well enough, you can pick up on its cues.

As it is true that no one can know our feelings or emotions better than ourselves, we can also be the best barometers of our physical health. Many times we know when something is “out of whack”, without being able to pinpoint to the exact, precise cause or details. Such knowledge or “gut feeling” may prompt us to make changes in our lifestyle or even visit our doctor.  Speaking about doctors, there must be the right “chemistry” between us and our health care provider.

There are several ways to advocate for yourself.

1. Ask question’s - It is ok to arrive at your doctor’s office with a list of questions.  The better organized you are they better it will be for you and your health care provider.

2. Second opinion - It may be appropriate to get a second opinion. That is why when it comes to YOUR health, you are allowed to talk to several medical professionals about the concerns you have.

3. Be honest - Feel comfortable telling the truth without hiding anything or fearing that will be chastised for doing so.  The old saying Honesty is the best Policy certainly applies here.

4. Not the Right Match - In case we sense that our doctor is not the right match, we should not hesitate to find another provider.

Knowing our body will help us shape and keep our healthiest version of ourselves. Whereas the general principles of a healthy lifestyle may be, more or less, the same for all of us, the details of how to get there are different. This should come as no surprise as no two individuals are the same, not even monozygotic twins.  We have recently spoken to a woman who joined a gym and felt pressured to take a yoga class, as her friends raved about it and she, herself read about its benefits. However, after trying it, she found that yoga was not for her. She did not enjoy it; she felt it was something like a chore she had to attend. As she was not getting the most out of it, she tried something else. She found that a toning class using light weights was more her style. What works for one person does not work for all.

We need not worry if we do not look like the supermodels in the magazines or that bodybuilder at the gym. Actually, this may be a good thing. Some supermodels smoke like a chimney, in order to control their appetite and eat less (smoking is worse than obesity) and many bodybuilders use anabolic steroid drugs that seriously undermine their health. Keep in mind that the weight we carry around our hips is not nearly as bad for our metabolism as our belly weight. In pursuit of a healthy diet, some may be able to follow a strict program and count calories, while others find it easier to just eat healthy. Remember that a diet is good only if we keep it in the long run. And that is okay to be different! If everyone was exactly the same - wouldn’t that make for a boring world?

Listen to your body and watch your body. If you see or notice changes, take action. In today’s busy society it is easy to put everyone else first: kids, spouse, job, even your pet! But YOU have to take care of YOU. Also, do not forget to reward yourself from time to time. Embrace your differences, and work to be the healthiest version of YOU that you can be!

Here’s to your Health!!

Dr. Anthony

AND THE WINNER IS... Balanced Eating vs. Detoxing & Diets

Healthy lifestyle, including healthy diet, is one of the main pillars of wellness and disease prevention and a key to a long- as disease-free as possible- and happy life. For healthy diet and healthy lifestyle to be effective, they must be practiced consistently with only occasional transgressions ( less than 10% of the time).

Given the importance of healthy diet, both the general public and scientists want to know which one is the best. The choice is not easy as so many diets are touted as the absolute best, while the scientific evidence supporting these claims may be lacking. The mere fact that celebrities follow and promote a diet should not be seen as evidence of its true superiority.

On this article we will examine a number of proposed short-term diets that belong to the “Detox” category. These are brief diets, running from as short as three days up to six weeks, and are supposed to “cleanse” our body from toxins and help us get a new, healthy beginning in life. They are also used as a jump-start for weight loss. Some diets work (in terms of losing weight) if you follow them to the letter. Are these diets a true winner or just fads, hype or a new trend? Is it realistic to think you will NEVER eat bread in any form again?

While some people may think that “cleansing” is a new concept, Pharaohs’ doctors in Ancient Egypt used to recommend enemas (colon cleansing or purging) as a way of removing toxins from the body. As an idea, it is appealing, but is it really working or necessary? Consider that our body has very sophisticated mechanisms in place, mostly through our liver, kidneys and immune system  to cleanse itself constantly from toxins and waste products. In 2011, researchers at Georgetown University conducted a comprehensive review of the medical literature and found absolutely no scientific support of the practice of detoxifying the colon.

It is true that several individuals feel better after a detox period but is this a “placebo effect”? Mayo Clinic reports that there is little scientific evidence that a detox diet actually eliminates toxins from your body.

While there is wide variation among detox diets, most of them eliminate highly processed foods. Some suggest fasting and allow only drinking natural juices. Others allow you to eat only raw vegetables and avoid sugar.  Certain diets require you to cut out carbohydrates, but in the same token other “fatty foods” are allowed.  One patient we have spoken to said she was in Las Vegas with a friend and at the breakfast buffet, the friend had bacon piled high on her plate, but you would not catch her dead with a piece of toast. Is that a good way to eat?

Here are some examples of foods prohibited by several detox diets:

• Processed, boxed or canned food
• Table sugar or foods or drinks with added sugar
• Refined vegetable oils
• Artificial sweeteners, preservatives, additives, or coloring
• Flour-based foods
• Grains (rice, oats, quinoa); some diets, though, allow non-gluten grains like rice and quinoa
• Beans and legumes (also allowed by many detox diets)
• Dairy
• Coffee and anything caffeinated
• Alcohol

Examples of recommended foods by several detox diets include:

• Fruits (excluded by some)
• Vegetables
• Non-gluten containing grains (rice, quinoa)
• Beans and legumes
• Nuts and seeds
• Oils (olive oil, hemp oil)
• Probiotic-rich organic yogurt and kefir
• Dairy substitutes
• Green tea
• Water

For “juicing”,  lemonade with spices and plant-based (for example with spinach or kale) drinks are recommended.

Some elements of detox diets are shared by traditional Western Medicine and Nutrient Science, like fruits and vegetables, whole grains, lots of water, avoiding sugary beverages, and opting for foods prepared from scratch with natural elements rather than packaged or processed food.

There are some important differences between Traditional Medicine and detox diets, however. Traditional Medicine and Nutrient Science do not advocate fasting; they recommend low-fat dairy products, accept up to five eggs per week and up to five cups of coffee per day. Healthy fats, as contained in fish, nuts, olive and canola oil, avocado and dark chocolate are also recommended by Traditional Medicine but prohibited by several detox diets.

While many of the detox diets are not dangerous (it is very possible that people who feel better after a detox cleansing period do so because they have avoided sugar and processed food), extreme fasting and drinking only juices for prolonged periods of time may harm your health.

Eating a balanced diet is better for you and easier! Whole grains won’t kill you; and lean meats/protein, whole unprocessed foods, and foods low in salt, fat and sugar are the way to go. Foods full of nutrients, vitamins, minerals, fiber and antioxidants work like medicine, supporting and preserving our health.

Think before diving into that new diet craze or a detox diet and talk to your doctor before embarking upon those diets. Keep in mind that, both for the purpose of weight loss and healthy metabolism, what is more important is consistency in the long run, not just extreme measures over a few days or weeks that allow you to go back to indiscriminate eating.

Eating healthy, exercising, getting restful sleep and making smart choices are the way to a healthy life. Making healthier choices and eating a balanced diet is the real reason for feeling good and healthy!

It is not always easy, but remember -you are in charge of YOUR health.

To your health!

Dr. Anthony

Why HEALTHY employees will SAVE your Business money!

Employees’ health and happiness appear to be a win-win situation for the employees and their employers. Healthy employees and those who are happy at work not only perform better but they also cost less. This is the conclusion of a six-year study conducted by health insurance company Humana and the University of Michigan's Ross School of Business.

It is a fact that more and more organizations work to advance the health and happiness of their employees, anticipating better performance, productivity and personnel retention. Companies are now offering incentives, rewards, reduced fees and more to help their employees reach their healthcare goals and stay healthy and happy.  Employers know, for example, that employees who are obese, have a higher rate to develop diabetes and heart disease, and those who smoke are more likely to develop heart disease, emphysema or cancer. These diseases result in reduced productivity, absenteeism, reduced sense of well-being and increased health care costs for the company, both in the short and the long run.

According to two Harvard School of Public health (HSPH) experts, many employers believed they could reduce their health care costs by influencing employees to adopt healthier lifestyles. One example is the state of Alabama, where state employees were used to paying zero toward their health care premium.  A few years ago that changed when they were made to pay a $50 dollar monthly premium – unless certain incentives were met.  Employees who did not use tobacco got a $25 dollar discount.  $25 dollar wellness premium discounts were offered for employees who met standards for important health markers like blood pressure, cholesterol, glucose, and BMI.  Other employees were able to receive a voucher that covers the co-payment for a doctor’s visit. As of 2011, employees could receive a discount if they have shown that they are within set boundaries, or are taking steps to get healthier.

Other companies offer incentives such as paid gym memberships, free health coaching or points to redeem for rewards or prizes. The point system could work after the employees show their attendance at a gym, enroll in a diet program that helps them choose healthy foods and meals, or “weigh-ins” that show progress at the place of business. Points can be turned in for prizes like gym bags, t-shirts, gift cards, acknowledgement of the employee in the company newsletter and even paid time off.

Some insurance companies are also offering health related programs at discounted rates or free to employees. Things like acupuncture, massage therapy, chiropractic and herbal supplements may be covered according to Jo-Ann Laing, author of The Consumer’s Guide to Health Savings Accounts.  Gohealthinsurance.com reports breast reduction surgery could be covered if causing health problems.

Just how much money is lost to poor health? The Integrated Benefits Institute, which represents major U.S. employers and business coalitions, says the U.S. economy loses  $576 billion dollars a year due to poor health. According to a Forbes story released in 2012,  $227 billion of this money is due to lost productivity from employees being absent from work (absenteeism) or showing up to work ill (“presenteeism”), and therefore not performing at their best. Between absenteeism due to illness and the cost of disability and workers’ compensation, poor health costs the U.S. economy more than half a trillion dollars a year, according to a new study by a nonprofit research organization.

Due to the high economic costs and the potential huge benefits if this cost is curtailed, employee happiness, well-being and health are the focus of very intensive research.

To your health!

- Dr Anthony

Should you integrate Eastern Medicine into your lifestyle?

Traditional Chinese Medicine (TCM), part of Eastern as distinguished from Western Medicine, has been practiced for thousands of years and focuses on HEALTH and WELL BEING through the cultivation of harmony within our lives, according to a University of Minnesota article. Concepts like ying and yang and balance as a condition of healthy living are of central importance to TCM.

While the holistic approach to wellness, health and disease is intuitively appealing, the specific methods of diagnosis and treatment that TCM uses are highly debatable. TCM methods are not subject to as rigorous a data analysis as the ones used in Western Medicine.  Biology is very complex and no statistical method can do perfect justice, whether it is Western or Eastern Medicine.

TCM includes herbs, acupuncture, massage and focusing on the whole body. Listening to one’s body is also regarded highly important. TCM leans toward prevention and wellness, not just diagnosing a problem.  According to Psychology Today, Western Medicine lies in “the newest is the best” camp. Eastern Medicine (like TCM) followers look to their doctor for experience and guidance and consider wellness a lifelong practice.

In the western world, especially in the United States, many doctors are quick to prescribe medicine. More often than not the diagnosis is not 100% determined, but doctors are trying to find a “fix”, something their patients have learned to expect or even demand. Western Medicine emphasizes the use of medications or procedures to stop the pain and suffering. Eastern Medicine practitioners claim that they want to get to the bottom of the issue- and diagnose the problem first - THEN provide a treatment. They believe that sometimes the best treatment is not a man made drug; this attitude is shared by increasingly more practitioners of Western Medicine. Additionally, more and more western physicians are embracing certain eastern practices. Acupuncture has been offered to help stop nausea and vomiting associated with surgery or chemotherapy and for chronic low back pain or even as an adjunct in attempts to quit smoking.  One US hospital has offered a chair massage before imaging examinations at their department of radiology as a way to help calm patients.  

Of course, when it comes to YOUR HEALTH - remember YOU are your own best advocate. You are free to choose a physician who keeps an open mind and is willing to embrace or try eastern medicines, if good evidence supports it. Prevention IS the best medicine, and a holistic approach is the most appropriate one; perhaps these are the principles in Chinese philosophy and TCM that merit further investigation and consideration. As long as professional organizations certify practitioners of eastern medicine using acceptable standards, why not find  a doctor willing to use TCM techniques?

One needs to consider that both Western Medicine drugs and Eastern Medicine herbals can have significant side effects and cause harm. Further scientific research is necessary to help incorporate practices of Eastern and TC Medicine into mainstream Western Medicine.

It is YOUR BODY - YOUR WELLNESS should be priority #1!

To Your health!

Dr. Anthony

Don’t just SIT there - it could be harmful to your health!

Sitting for a long period of time can be hazardous to your health. There are healthy alternatives to sitting, even if your job is traditionally a sedentary one. Many tips are available to keep you on your feet and healthy.

A Mayo Clinic report suggests that sitting for a significant period of time is not even offset by a few hours a week at the gym. More moving is necessary to keep your body burning calories. A study shows that sitting too much can actually cut your life short.  The risk of diabetes increases, HDL cholesterol production lessens and enzymes that break down fat drop by up to 90-percent. Your blood pressure can also go up by sitting.

Sitting can be bad for your heart. While sitting, muscle burns less fat and blood moves more slowly to allow-in the long run- fatty acids to clog the heart. If you are hoping for the six pack abs, don’t sit for so long. The abdominal muscles are not engaged when sitting, and can also lead to poor posture. The curvature of the back can contribute to spine problems, strained neck and sore shoulders or back. Poor circulation in your legs can present a host of issues as well, from deep vein thrombosis (blood clots) to varicose veins to swollen ankles.

People who sit to watch TV or use handheld devices are in the same boat as those who sit to work.  A study compared adults who watch more than 4 hours sitting in front  of a TV with those who sat for only 2. Those who sat for the longer period of time showed a significant increased risk of events associated with cardiovascular disease. These data are also applicable to sitting in front of your computer or any kind of screen.

Sitting can be bad for your brain too. Movement pushes fresh oxygen and blood to the brain, releasing chemicals to help thought and mood. A “stale” brain can also cause clots to cause a stroke. The average US adult sits for 8 hours a day; high school students, although they sit less, they are also affected.  A study found high school students who stood in class instead of sitting improved their test scores by  20 percent.

So what can you do to break up all this sitting? Here are some ideas for those who sit for work. Instead of a regular chair, opt for an exercise ball. The instability of the ball will keep you on the move and make for better ab muscles and hip flexors; using the ball may also alleviate back pain. But use caution - the ball needs to be properly inflated and your posture should not injure your lower back.

Another option is the treadmill desk. One study in 2011 found that those who used a treadmill desk reduced their hip and waist size by about 2 inches. A variable-height desk, a standing desk or an indo-board (a type of balancing board) are some other alternatives.

There are many easy options to get up and get moving. Take calls while standing, hold meetings while walking, get up and do a few laps around the office. Making the most of your lunch break can be helpful: gather a few co-workers and use half the break to eat and the other half to walk. If you sit when watching TV, use the commercial breaks to get up and move; I have my TV in front of my treadmill and I exercise the entire time I watch my favorite show.  There are so many good solutions to break the vicious sitting cycle. You just have to remember to do it and be creative!  

To your health!  

Anthony Pothoulakis, MD, FACC

Arteries in Harmony

When you hear “diabetes” what comes to mind?

When you hear “diabetes” what comes to mind? Most people think high blood sugar along with images of obesity, cookies, and desserts. Elevated blood sugar is indeed a prominent and obvious part of diabetes.  Patients see it for themselves as they check their blood sugar; they also experience first hand symptoms of out- of- control blood sugar like excessive urination, unquenchable thirst and even coma that sends them to the intensive care unit.

However, diabetes is more than just high blood sugar, it’s a disease of the arteries. Seven out of ten diabetic deaths are due to heart attacks and strokes, not elevated blood sugar. Diabetes makes all our arteries, large and small, much more sensitive to normal wear and tear. Artery damage due to smoking, high blood pressure, and high cholesterol is more susceptible as well.  Merely controlling blood sugar level and keeping A1c at no more than 7%, although necessary, is hardly enough to protect diabetics from the most feared complications of their disease.

So, what can diabetic patients do to get maximum protection of their arteries? Consistently practice a healthy lifestyle (NO smoking cigarettes, keep a healthy diet, and near-daily exercise) AND keep blood pressure low AND take statins AND, possibly, a low-dose (81 mg) aspirin (provided that there are no stomach or serious bleeding problems). Medications like lisinopril or losartan are also important in protecting the kidneys which can commonly fail in diabetes.  Additionally, some new non-statin cholesterol-lowering medications (Praluent and Repatha) are available but at a cost of approximately ten thousand dollars (US) per year of treatment.

Artery testing, especially testing of the heart arteries, is another element of good diabetic care. Within diabetes the nerves that signal heart pain do not work properly, so it’s not unusual for a diabetic patient to have significant clogging of the heart arteries without experiencing any chest pain. Due to this, the doctor may recommend a stress test from time to time. Diabetic patients need to create a partnership with their physicians in order to reap the full benefits of diabetes education and disease prevention.

Anthony Pothoulakis, MD, FACC

Do you know what Statins are? If not, you should ….

Statins: the Pros and Cons of a Heavyweight

Statins are life saving medications, literally. In the fight against heart disease, they are credited with reversing the tide of rising heart attacks. Of course, the decline in smoking and better use of blood pressure medications has helped with the reduced rate of heart attacks. The good news is that, since 1996, for the first time in over a century, we have seen a decline in heart attacks by 40-percent.

Statins are a group of medications that lower the bad (LDL) cholesterol and reduce inflammation in our arteries. They help stabilize cholesterol plaques that frequently (and permanently) reside in our heart and brain arteries. Statins keep the blood flowing and reduce heart attacks and strokes by 30 to 40 percent.

Since statins are a true heavyweight champion of modern medicine, they are among the most widely prescribed medications in the US (almost 20 million patients use them). Although they generally have a very good safety track record, statins also have a dark side.

The greatest problem with statins is that they are not muscle friendly. About one in five statin users develops muscle aches, pains or stiffness that, although not life-threatening, can cause discomfort and suffering. To many affected statin users, these symptoms make the expected benefits not worthwhile. Other negative aspects of statin use are much more rare and include severe liver damage (one in a million), kidney failure (one in ten thousand), or type 2 diabetes (one in a thousand).

For some individuals healthy choices may include statins, on top of a  healthy lifestyle. The decision to start statins (and continue them for the rest of your life) should be based on your particular risk for developing heart attack or stroke. Individuals with the highest risk include (but are not limited to) those who have:

• already suffered a heart attack, a stroke or mini stroke
• undergone bypass surgery or stent placement
• either type 1 or type 2 diabetes
• an LDL cholesterol above 190 mg/dl.

As you discuss with your doctor whether statins are right for you, you need to weigh the good and the bad when it comes to the side effects of statins. You must consider how statins can help your arteries and prevent life-threatening conditions that may be points of no return, like heart attacks and strokes.

Keep in mind that doctors routinely check (through a simple blood test) for severe liver or muscle damage. They may also recommend over the counter supplements (like Coenzyme Q-10 or Vitamin D) that can protect against muscle aches. Doctors also warn their patients that, in case of severe muscle aches or dark-color urine, they should promptly stop taking statins.

The list of the currently available statin medications includes:

• Crestor (rosuvastatin)
• Lescol (fluvastatin)
• Lipitor (atorvastatin)
• Livalo (pitavastatin)
• Mevacor (lovastatin)
• Pravachol (pravastatin)
• Zocor (simvastatin).
• Advicor (lovastatin/niacin extended-release)
• Simcor (simvastatin/niacin extended-release)
• Vytorin (simvastatin/ezetimibe).

Good health to you!

Anthony Pothoulakis, MD, FACC

Are you self-monitoring your blood pressure?

You are as old as your arteries, even if you think you are only as old as you feel or look. And blood pressure is one of the key factors that determine your artery health. For this reason, knowing your true blood pressure is important to both you and your doctor. Many people suffer from “white coat syndrome” where they are nervous at the doctor’s office. This may result in a blood pressure measurement that is higher than your true blood pressure, whereas your home numbers are likely to be more accurate. Monitoring your blood pressure at home and on a regular basis is the best way to know your true blood pressure. This way, you will give your physician a fuller picture of your blood pressure fluctuations over an extended period of time. Also you will be an important participant to your own health care, a true partner to your doctor.

A blood pressure reading has a top number (systolic) and bottom number (diastolic). To fall into the normal range, your blood pressure should be less than 120 over 80. Prehypertension, which is borderline high blood pressure is 120-139 over 80-89. (Stage one) Mildly elevated high blood pressure is 140-159 over 90-99; and (stage two or) severely elevated high blood pressure is a reading of 160 and above over 100 and above.

Both diabetes and chronic kidney disease make your arteries more sensitive to the bad effects of high blood pressure. Many doctors believe that for these patients the blood pressure should be kept at less than 130 over 80. On the other side, for people over the age of 60, some medical professionals suggest that a top number up to 150 is acceptable. Be aware that as we age the elasticity of our aorta (the largest artery highway that starts at the heart and divides to branches that distribute the blood all over the body) declines. This declining elasticity of the aorta is frequently responsible for a low bottom number (diastolic blood pressure) observed in older individuals.

Blood pressure fluctuates all the time. It is generally higher early in the morning (its highest value is actually one to two hours before we even wake up) and between six and nine in the evening. If the blood pressure between your two arms differs by more than 10 points (mm Hg), record the higher number of the two. There are also specific factors that may cause your blood pressure to temporarily rise. For example, blood pressure rises as a result of:

• Stress
• Exercise or even ordinary physical activity at home or at work
• Caffeine
• Certain medicines
• Smoking
• Cold temperatures

Avoiding as many of these factors as you can when taking your blood pressure will help improve the accuracy of your overall numbers. Depending on the situation, your doctor may want you to check your blood pressure several times during the day to determine how wide the fluctuations are.

Before Checking Your Blood Pressure find a relatively quiet place. Make sure that you are relaxed and comfortably seated. Be sure to have recently emptied your bladder since a full bladder may affect the reading. Remove any tight-sleeved clothing or roll up the sleeve on your arm (if you are using a blood pressure cuff that fits your elbow). How and where you sit is important in an accurate reading. Before taking your blood pressure, rest in a chair next to a table for 5 minutes. Your arm should comfortably rest at heart level. Sit up straight with your back against the chair, legs uncrossed. Rest your forearm on the table with your palm facing up. If your are using a blood pressure cuff that fits your wrist, keep your wrist at the level of your heart.

Is Skinny Really Healthy?

The obesity epidemic is real and has been for the last twenty-five years. Now it is spreading well outside the boundaries of developed nations. It brings along health concerns: type 2 diabetes, heart disease, stroke, and destroyed knee joints. There have been strong and concerted attempts to cure this epidemic and promote the image of a healthy, non-obese human body. But is becoming skinny at all costs the right answer?

Skinny or normal weight individuals who workout almost daily and eat right can also be suffering poor health. It is not unusual for normal or low to normal weight individuals, to have a very high LDL (the bad cholesterol) or high blood pressure. These conditions depend on heredity and aging as much as they do on lifestyle. Unfortunately, a great body is easier to see and detect than high LDL or high blood pressure. If one or both of those conditions has been a problem for years and goes undetected, it could destroy arteries and hearts beyond repair. Furthermore, many health conscious individuals who are thin, fit and eat healthy, have strong convictions against taking anything that is not natural; they are among the hardest to persuade that a pill might be medically necessary for them.

Muscular individuals may not appear skinny but are certainly healthy. If their muscle comes without belly fat, they are doubly healthy. First, they are spared of the toxic effects of belly fat. Second, muscle is metabolically wonderful. It will burn calories even when we are asleep and suck in excess fatty acids and blood sugar. Third, muscle is essential for exercise and later in life, for simply staying functional and able to walk. One caveat: lifting very heavy weights may raise the blood pressure to unsafe high levels and can destroy our aorta and heart, thus it is not recommended.

There are several conditions that can be even more destructive to our health than obesity.

Smoking is number one. The use of tobacco products, in any way or form, can destroy our arteries and cause heart attacks, stroke, heart failure and an assortment of cancers. Smoking can cause you to stop breathing, due to emphysema. This is irreversible. Since smoking reduces appetite, it is not unusual for smokers to have great figures. If these smokers could only see their insides. The ragged terrain of their arteries and their cancer cells in the making are not a trade off for a shapely body!

Trying to become skinny is not the “end all be all”. We know there are negative health consequences of anorexia and an extremely low body weight (a BMI below 18.5 or a waist circumference below 29 inches for men or 25 for women). In an all- out- war against the obesity epidemic and the ravages that come with it, we should see optimal body weight in the right perspective: desirable. Skinny is neither an absolute guarantee of health nor a goal in itself to be conquered at any cost or through any means. To your Health!