Osteoarthritis causes pain or dysfunction in 20% of the elderly, and is often present in

those aged 40 (US figures). Although NSAIDs are widely used, these are associated with
adverse effects. Non-pharmacological interventions for pain relief and function include
superficial and deep heat, cold, exercise, weight loss, acupuncture, transcutaneous
electrical nerve stimulation (TENS), low energy laser, vibration, topically applied
creams, pulsed electromagnetic fields and orthotic devices.

Diathermy (deep heat) followed by exercise

One evaluator-blind trial compared short-wave diathermy and exercise with exercise
alone in 42 patients over 4 weeks. There was no benefit of diathermy over control on any
measure.

One double-blind trial compared ultrasound with sham ultrasound in 74 patients over 4-6
weeks. There was no benefit of ultrasound over placebo on any measure.

Exercise

One pseudo-randomised trial compared quadriceps strengthening exercises plus

diathermy with diathermy alone in 61 patients over variable follow-up periods. There was
a statistically significant 10% therapeutic gain in the exercise group on a measure of
functional incapacity (including pain), and a significant improvement in muscle strength.

One trial of 120 patients with hip, knee or ankle osteo- or rheumatoid arthritis compared
two different types of aerobic exercise plus a stretching and strengthening exercise
programme with a stretching and strengthening exercise programme alone. Aerobic
exercise was either pool activity or walking, and the programme was 3 times weekly for
12 weeks. There were no group differences in pain relief. There were significant benefits
of aerobic exercise (both types) on aerobic capacity and all subscales of the Arthritis
Impact Measurement Scale (AIMS) (i.e. physical activity, anxiety and depression).

One non-blind trial of 102 patients compared an eight week programme of lectures, group
discussions, supervised light stretching and strengthening followed by up to 30 minutes
of walking with routine care and telephone follow-ups. There was a significant
improvement with exercise compared with control in measures of pain, walking test,
AIMS subscales for physical activity, and for arthritis impact.

An estimated 29 million Americans have osteoarthritis (OA), a painful condition that

occurs when the cartilage cushioning joints breaks down, allowing the bones to rub
together. The most common form of arthritis, OA typically affects people over age 45.

While medication can help relieve the pain, swelling and loss of movement associated with
osteoarthritis, guarding your joints from the wear and tear that contributes to the medical
condition is the best strategy.
Preventing osteoarthritis is a lifelong commitment, says Dr. Joel Silverfield, who
specializes in the treatment of arthritis in Tampa, Fla. "That begins with understanding
your risk of developing OA.

"Some people just have better cartilage than others," Dr. Silverfield adds. If you inherit a
tendency for cartilage that is defective or brittle or thin, it can wear out sooner. "That’s
why some people are 80 and don’t have OA and others get it in their 30s," he explains.

The joint at the base of the thumb is the most common site for osteoarthritis. That’s
because over a lifetime, the thumb is a hard-working joint. While it also commonly occurs
in the hips, knees, feet and hands, OA can develop in any joint in the body.

Here’s to joint health

"Keeping your weight in a normal range reduces stress on your knees and hips," says Dr.
Silverfield, who suffers from a type of spinal arthritis that motivates him to manage his
weight. "Extra weight means extra wear and tear, and that leads to pain."

Gerry Chrisman, 62, was in her 40s when she saw her doctor about knee pain. "He started
talking about surgery, but I told him I didn’t do surgery, so his alternative was to lose 20
pounds," she says. By watching her diet and exercising, Chrisman eventually lost 45
pounds. "Now I don’t have any pain in my knees," says the Grain Valley, Mo. (pop. 5,160),
resident.

Staying physically active is the No. 1 thing to keep arthritis pain at bay, so Chrisman
teaches water aerobics classes for others with arthritis. "I saw my father-in-law become an
invalid as a result of arthritis," she says. "I decided that that wasn’t going to happen to
me."

Give your joints a break

Preparing your muscles for any activity with warm-up exercises is another prevention
strategy, Dr. Silverfield says. These can include stretching your arms and legs and gently
rotating joints to increase circulation.

Using safety and support equipment also can help. Even the most skilled rollerblader can
take a spill that can damage joints. Tennis players and runners who wear well-constructed
shoes are investing in the life-long function of their knees and hips. Always wearing a
seatbelt in the car can protect joints from injury should an accident occur.

While being active is good for joints, it’s also true that too much of the same activity can
wear them out, contributing to osteoarthritis, Dr. Silverfield says. Repetitive tasks,
whether it’s operating the mouse on your computer, knitting or standing for long periods,
wear on joints. So mix it up, if you can. Learn to mouse with either hand. Take breaks
every 15 to 20 minutes. Press the palms of your hands together at chest level, then flip
your hands over so the knuckles are facing and press again. Then shake your hands briskly.

If your job requires standing in one spot, add a rubberized mat and a small stool to prop
one foot on. Then shift your position every few minutes and switch feet on the stool. Ease
your back by stretching from side to side and extending your arms overhead.
"OA doesn’t have to control your life," Dr. Silverfield says. "Protect your joints from injury,
stay active and keep an eye on the scale. When you do, you reduce your risk of developing
OA."

For more information on osteoarthritis, call the Arthritis Foundation at (800) 568-4045 or
log on to www.arthritis.org.

Worst Seven Foods for Health and Longevity

• Butter
• Cheese
• Potato Chips and French Fries
• Doughnuts
• Salt
• Sausage, hot dogs
• Pickled, smoked or barbequed meat

We live in an age of disease. It seems like everyone is popping a pill nowadays. And kids
are taking the brunt of it. From ADHD and to ADD—surely, something is wrong with
your child! But all these new-fangled conditions are overshadowing traditional maladies
like asthma. Just like a Hollywood agent, “Sorry baby, you ain’t hip anymore.”

Maybe that’s why new federal guidelines are coming out this summer urging doctors to
pay closer attention to children with asthma. Lauran Neergaard of the Associated Press
has more:

Federal guidelines due this summer are expected to urge doctors to more closely monitor
whether treatment is truly controlling everyday symptoms and improving patients' quality
of life — and to adjust therapy until it does.

Already, a campaign is under way to teach patients to recognize they need better help,
and to tell them how to convey that to a doctor. If the doctor's happy that you've had no
flare-ups but doesn't know you had to quit playing soccer to do it, you're not achieving
good control.

Too often, physicians don't realize how severe symptoms are, says Dr. Jill Halterman, a
pediatric asthma specialist at the University of Rochester. With children, their own
parents may underestimate symptoms.

It's more complicated than denial: When wheezing while running or waking up at night
coughing has been routine for years, people may not know to complain.

"It may be part of what they view as normal," says Halterman, who is studying the
control gap. "We're hoping we can change that so the goal can really be for the child to
have no symptoms and no limitations on activities."
Now, I’m sure every kid with chronic asthma wants to live without symptoms and have
no limitations, but what if they could go one step further? What if they could knock their
asthma out of the box? Impossible? Not so according to Dr. Fuhrman. In Disease-Proof
Your Child he explains that nutritional excellence is a sure-fire way to shake asthma at its
foundation:

Eating protein-rich and fat-rich foods of animal origin—meat, cheese, fried food, and
saturated fat—is associated with a higher prevalence of both allergies and asthma.1
Eating in fast food restaurants and eating a lower intake of vegetables and other fiber-rich
foods has been implicated by numerous studies. The same studies also show that the
children in the lowest third of vitamin E intake were found to have three times the
incidence of asthma compared to those children in the highest third of vitamin E intake.2
Vitamin E is a fat-soluble vitamin found in greens, raw nuts, and seeds; it is not found in
animal products. The consumption of white bread, butter, and margarine has also been
noted to be strongly associated with asthmatic symptoms.3

The same pattern emerges. What is needed to battle the development of asthma allergies
is the same adequate intake of omega-3 fat as well as diet rich in fruits and vegetables.
Eating high antioxidant- and phytochemical-containing foods is related to lower
occurrence of childhood allergies and asthma.4 Nutritional excellence can normalize an
excessive inflammatory response. The inflammatory cascade release chemicals that
attract white blood cells and fluid into the area, which results in the tightness and
swelling that create the symptoms of asthma. When nutrient intake is low, the lung
tissues become overly sensitive to irritating stimuli.

In a previous post Dr. Fuhrman talks about a young asthma sufferer who achieved great
results with nutritional excellence. From Asthma Can Often Be Controlled With Proper
Nutrition:

Jonathan was an excellent student and was keenly interested in learning how what he ate
affected his health and his breathing problem. At the initial visit to my office, Jonathan
was instructed on using a spacer with an inhaler and was taken off his three times a day
nebulizer treatments. I told him his recovery hinged on the amount of green vegetables he
was capable of eating. He was more than cooperative. This eight-year-old said to me, "I
will eat dirt if you can fix my breathing." So I said, "How about if I give you great-tasting
real food to fix your asthma. You can be a lot better within a year." Jonathan is now in
fourth grade. It took about eight months until he no longer required any medication. He is
now the picture of health and uses no inhalers or other asthma medications.

Also, according to Dr. Fuhrman breastfeeding is an important part of stopping the

development of asthma in children. Here’s a couple of posts talking about that:

• Childhood Asthma and Allergies

• NY Times: Breastfeed for Better Health
Continue Reading
Wednesday, April 11, 2007 Posted By Gerald Pugliese In Full Text Feed , Healthy Food ,
Hurtful Food , Research

Eating Together is Better

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Growing up we never watched television and ate dinner at the same time. Now that I live
alone I still don’t. And it’s a good thing. Because according to a new study, you eat better
when you’re not watching the tube. Amanda Gardner of HealthDay News reports:

For this study, more than 1,300 parents or guardians of children participating in New
York's Special Supplemental Nutrition Program for Women, Infants and Children were
surveyed on how many days a week the family ate dinner together, the number of days
each week the TV was turned on during dinner, and how often fruits and vegetables were
served.

More fruits and vegetables were served on the nights families ate dinner as a unit.
Servings of fruits and vegetables decreased each night the TV was turned on during the
meal. Neither eating together nor having the television on seemed to have any
relationship with servings of milk.

Fruits and vegetables are important components of any healthful diet and have been
associated with decreased cardiovascular disease and certain types of cancer.

Are Dairy Products the Answer to Osteoporosis?

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Written by Dr. Fuhrman’s colleague Anna Quisel, M.D. for the July 2003 edition of
Healthy Times:

As a woman and a breast-feeding mother, I almost feel guilty when someone asks, “You
don’t drink milk? How do you get your calcium?” As people learn more about the
problems associated with osteoporosis, interest in calcium is skyrocketing. That’s the
good news. The bad news is that the dairy industry has done a terrific job of promoting
dairy products as the only adequate dietary source of calcium. Dairy products are far
from the solution, and may very well be a cause of the problem.

Adequate amounts of calcium are necessary for high-level health. Calcium is necessary
for heart muscle contraction, skeletal muscle contraction, the action of most hormones in
the body, and bone strength. Because calcium is so crucial to survival, our bodies
carefully regulate the amount of it in our blood. We even have a back-up reservoir of
calcium available at all times—our bones.

Calcium reservoir
To keep a constant level of calcium in the blood, our bodies are continually adding and
removing calcium to the bloodstream. When there is extra calcium in the bloodstream,
the body removes some of it and stores it in the bones. When there is too little, the body
takes calcium from the bones and adds it to the bloodstream.

It works like this: When serum calcium levels fall, a hormone called parathyroid
hormone, produced in four small glands attached to the thyroid gland, stimulates
osteoclasts. The osteoclasts break down bone and release calcium. When calcium is
plentiful, a hormone called calcitonin, made in the thyroid, stimulates osteoblasts, cells
that store calcium by building bones.

For a long time, scientists thought this was the whole story—if you don’t get enough
calcium, your body will withdraw calcium from your bones, and eventually you will
develop osteoporosis. But the story is turning out to be more complex.

High intake, weak bones

Much to the chagrin of the dairy industry, scientists have discovered that more calcium
isn’t better. In fact, the countries around the world with the highest rates of calcium
intake—including the U.S. and Canada—have the highest rates of hip fractures among
the elderly. The largest source of calcium in these countries is dairy products. In one of
the largest studies of diet and health ever undertaken in the U.S., the Nurse’s Health
Study, researchers found that high total calcium intake and milk consumption did not
protect against osteoporotic fractures.1 In a comprehensive review of all studies of dairy
intake and bone strength in 2000, researchers concluded “that the body of scientific
evidence appears inadequate to support a recommendation for daily intake of dairy foods
to promote bone health in the general U.S. population.”2

Japanese women have lower total calcium intake than U.S. women at about 400-500 mg
per day from soy products, vegetables, and small fish bones—yet they have lower rates of
hip fracture despite having smaller bones.3 So high calcium intake alone, especially when
the source of calcium is dairy products, does not ensure bone strength. Even bone mineral
content (the amount of calcium- phosphate in bones) does not necessarily determine risk
of fracture. This mineral-content finding is very important because physicians currently
assess risk for bone fractures using x-ray measurement of bone mineral content.

Building strong bones

Adopting an Eat to Live-style diet is crucial for strong bones. Vegetables, beans, fruits,
and nuts are the best sources of calcium, potassium, vitamin K, magnesium, and
vegetable protein, as well as the phytochemicals (such as isoflavones) and micronutrients
that are gaining recognition as important for bones. Keep in mind that the current U.S.
daily calcium recommendation of 1200 to 1500 mg for postmenopausal women is an
attempt to offset the ill effects of the typical vegetable-and nutrient deficient American
diet, which is laden with salt, caffeine, and junk-food. Sadly, even this attempt to flood
the body with extra calcium to compensate for poor nutrition has not been proven to
prevent fractures.4 (Check out Get Some Veggie Calcium for good sources of calcium.)

Weight bearing and resistance exercise are extremely important to bone strength, and can
reverse osteoporosis even in postmenopausal women.5 Walking is particularly important
to hip bone strength.

Vitamin D might be more important to bone strength than calcium. Vitamin D promotes
the uptake of calcium from the intestines and also increases bone building. The sun is
probably our best source of vitamin D. Vitamin D needs are probably met with 15
minutes of exposure in the middle of the day three times per week. Many studies have
shown that vitamin D supplements increase bone density in postmenopausal women;
however, a recent comprehensive review of the subject determined that the efficacy of
vitamin D supplements had not been proven.6 If you haven’t had your vitamin D blood
levels checked, you might consider it so that you can increase your sun exposure or add a
supplement if necessary.

Avoid toxins. The ingestion of animal protein—especially when combined with low
vegetable intake, steroids, caffeine, cigarettes, vitamin A (retinol—found only in animal
foods, fortified foods, and vitamin pills), and salt all have been associated with weak
bones.

Rather than letting your bones weaken as you age, you can strengthen them and keep
them strong.

Our bones are composed of a porous network of calcified bridges called a trabecula
network, which under an electron microscope looks like the inside of a sponge. This
network of connecting bridges continually breaks and rebuilds with normal wear and tear
as a result of the activities of daily living.

When use and weight-bearing activities are increased, many of these bridges break, but
then are rebuilt—thicker and stronger. In fact, they grow and thicken in response to the
stresses placed on them. With little muscle stress on the joint, they lose density and
become thin and fragile. The strength and density of bone over time is directly
proportional to the muscle strength moving that fulcrum. Just as muscles build with
regular exercise, the bone strengthens too, right along with the muscle. In fact, a good test
for bone strength is muscle strength.

Unfortunately, most women in America and other modern countries have relatively
sedentary lives. Even women who do regular exercise and walk are susceptible, since
most popular exercises do not adequately stress the spine with enough stimuli for bone
growth. Having a healthy, erect spine is extremely important for digestion and overall
health. Activities that exercise and strengthen the spine include digging, shoveling,
carrying toddlers, using rowing machines, and doing back extension exercises. Scientific
studies also have demonstrated that wearing a weighted vest can have a powerful
protective effect.1

Because vitamin D increases the absorption of calcium in the gastrointestinal tract and
stimulates osteoblastic (bone-building cells) activity, vitamin D has been generating lots
of interest lately in the medical literature. Borderline low levels of vitamin D have been
found to be very common in the United States and Canada.

Medical studies show taking vitamin D is more effective than taking extra calcium for
osteoporosis. In a recent 3-year prospective multi-center study, 622 women with
osteoporosis, 50 to 79 years of age, who had one or more compression fractures of their
spine, were randomly assigned to receive 25 mcg of calcitriol (900 IU vitamin D) or 1000
mg calcium for three years. In the third year, the vitamin D-supplemented group had 9
fractures per 100 women, and the calcium-treated group had 31.5.The difference in effect
also was evident after two years.

The take-home message here is that curtailing habits that cause calcium wasting in the
urine and monitoring vitamin D for adequate intake are more important than taking extra
calcium. Attention to vitamin D status is most critical in those not getting regular
sunshine. The most effective prescription for preventing and reversing osteoporosis
involves diet-style modifications, extra vitamin D intake, and an effective exercise
program.

Osteoarthritis
Description
Most important nutrients: Beta-carotene, Vitamin C, Vitamin D, Vitamin E,
Niacin, Omega 3 fatty acids, Boron
Most important foods: Fish, Ginger
Avoidances:
Osteoarthritis - Day 1
Breakfast Nutritional Profile

• Pineapple orange papaya salad

Calories 1874
• Poached eggs over steamed collard greens
Calories from fat 35%
Snack
Fiber 40 g
• 8 fl oz plain yogurt Vitamin A-RE 362%
• 1 tbsp flax seed
• 1 tbsp walnuts Beta-carotene 15514 mcg
• 1 tbsp dried figs
• ½ tsp ginger Vitamin C 380%

Vitamin D 122%
Lunch
Vitamin E 117%
• Warm quinoa salad
Niacin 255%
• Asparagus salad
 Boron 1.5 mcg
Dinner
Omega 3 EFA 4.1 grams
• Shiitake mushroom soup
• Baked chicken breast with honey mustard sauce

• Healthy mashed sweet potatoes

Osteoarthritis - Day 2
Breakfast Nutritional Profile

• Perfect oatmeal
Calories 1810
• 1 cup fruit salad:
o papaya Calories from fat 34%
o blueberries
o sprinkled with grated fresh ginger Fiber 44 g

Vitamin A-RE 308%

Snack

Beta-carotene 13886 mcg

• Rice cake
• 1 tbsp sunflower seed butter Vitamin C 487%
• Small pear
Vitamin D 168%

Lunch Vitamin E 122%

• Golden squash soup Niacin 100%

• Soy bean and fennel salad
Boron 2.8 mcg

Dinner Omega 3 EFA 6.3 grams

• Baked salmon and walnut patties with red bell pepper

sauce
• Sauteed greens
• ¾ cup quinoa

• Blackberry tart

Osteoarthritis - Day 3
Breakfast Nutritional Profile

• 1½ cup fruit salad:

Calories 1888
o cantaloupe
o strawberries Calories from
o papaya 33%
fat
o sprinkled with fresh grated ginger
• 8 oz yogurt Fiber 41 g
• 1 tbsp flax seeds
Vitamin A-RE 114%
• Whole wheat toast
• 1½ tbsp almond butter Beta-carotene 5050 mcg

Snack Vitamin C 275%

 Vitamin D 89%
• Banana
• ½ cup trail mix: Vitamin E 164%
o sunflower seeds
o pumpkin seeds Niacin 228%
o raisins
Boron .08 mcg

Lunch Omega 3 EFA 10.46 grams

• Tuna salad:
o 1 cup romaine
o ½ cup collard greens
o ½ cup turnip greens
o ¼ cup navy beans
o ¼ cup sliced fennel
o ¼ cup pear
o 1/8 cup onions
o Small can tunafish packed in water
• Dressing:
o 1 tbsp flax seed oil
o ½ tsp turmeric
o ½ tsp cumin
o 2 rye crackers

Dinner

• 4 oz roasted turkey breast

• 1 cup quinoa
• 1 cup winter squash puree

• 6 asparagus spears with 1 tbsp sesame seeds

Osteoarthritis - Day 4
Breakfast Nutritional Profile

• Breakfast shake:
Calories 1998
o 1 cup soymilk
o 4 oz yogurt Calories from fat 30%
o ½ cup blueberries
o ½ frozen banana Fiber 49 g
o 1 tbsp flax seeds
o ½ tbsp flaxseed oil Vitamin A-RE 327%
• 1 rice cake
Beta-carotene 14838 mcg
• 1 tbsp sunflower butter
Vitamin C 500%
Snack
Vitamin D 51%
• Fruit salad:
Vitamin E 167%
o 2 kiwifruit
o ¼ cup raspberries Niacin 200%

Lunch Boron --- mcg

 Omega 3 EFA 7.34 grams
• 3 oz baked marinated tempeh
• 1 cup brown rice
• 2 cups healthy sautéed veggies:
o chard
o broccoli
o collards with 1 tsp garlic
• Dressing:
o 1 tbsp olive oil
o 1 tbsp sesame seeds
o 1 tsp ground ginger
o 1/8 tsp cayenne pepper

Dinner

• 6 oz halibut
o topped with 4 shrimp
o ½ cup pineapple-papaya salsa
• ¾ cup barley
• 1 cup brussel sprouts

• 1 small sweet potato with 1 tbsp sliced almonds

Osteoarthritis

Osteoarthritis, a crippling joint disease that affects more than 20.7 million
people in the United States, occurs when inflammation damages joint
lubrication and cartilage.

Although early symptoms may be mild or barely noticeable, the condition

eventually progresses causing a great deal of pain. Osteoarthritis also leads
to disability as the damaged joint is no longer able to move properly.

Fortunately, there are certain nutrients and foods that may help to halt the
progression osteoarthritis before it becomes severe as well as helping to
reduce the pain and inflammation associated with it.

Eat more

• Cold water fish such as salmon, tuna, herring, mackerel and halibut.
• Organically grown fruits and vegetables
• Nuts and seeds
• Whole grains
• Ginger

Avoid highly refined products such as white rice, white bread and white
pasta, excessive saturated fats and foods which contain trans fats.

• Description
• Dietary Causes
• Nutrient Needs
 • Nutrient Excesses
• Recommended Diet
• References

Description

What Is Osteoarthritis?

Osteoarthritis, one of the most common forms of arthritis in the United

States, is the 8th leading cause of disability in the world. Over 20.7 million
Americans are afflicted with the condition, and approximately 100,000 are
unable to walk as a result.

In 1989 alone, around 30,000 hip replacement and 70,000 knee replacement
surgeries were done to treat osteoarthritis. The pain and disability caused by
osteoarthritis has a major impact on the lives of those suffering with this
disease.

Being unable to move certain joints properly can make tasks of normal living
very difficult. Osteoarthritis patients may be unable to walk up stairs, button
their clothes, or even brush their hair, things that most people take for
granted. Slowing the progression of this condition through simple dietary
changes may help prevent these long-term consequences.

Symptoms

Osteoarthritis symptoms are initially very mild. In fact, researchers have

found that only about 50% of people with early signs of osteoarthritis on X-
ray have noticeable symptoms.

The symptoms may worsen over time as the condition progresses and the
joint damage continues. Osteoarthritis tends to occur mainly in the hands,
knees, elbows, hips, and spine.

Symptoms of osteoarthritis include:

• Grinding sensation during joint movement
• Pain with joint movement
• Joint stiffness
• Joint swelling
• Deformity of the joint (usually occurs later in the condition)
• Reduced mobility of the joint
• A feeling of joint instability

Many osteoarthritis patients take pain-killers such as aspirin, acetaminophen,

or ibuprofen. While these may be helpful for temporarily reducing pain, they
have not been shown to prevent the progression of osteoarthritis, and may
even cause the damage to progress more quickly. In addition, some of these
medications can be rough on the digestive tract, leading to symptoms that
range from mild stomach upset to ulceration and bleeding.

If you're taking pain-killers and start to experience severe stomach pain,

vomiting, vomiting of blood, generalized weakness, a change in the color of
your stools to very dark or black, or if you see blood in your stools, you
should contact your doctor immediately as these may be signs of bleeding of
the digestive tract, which can be a serious medical condition.

The Disease Process

What causes a normal, healthy joint to become swollen, painful and

debilitated? The process may be a slow and gradual one that takes many
years to have an impact.

A healthy joint, the part of the body that connects two bones, contains
several main components. The first component includes the ends of the
bones themselves. These bone endings are lined with a rubbery, cushiony
material called cartilage, which prevents bones from grinding or smashing
together. Since cartilage is flexible, it can withstand the pressure of joint
movement and bounce right back into its original form without any damage.

The outside of the joint is wrapped in connective tissue. The connective

tissue is strong enough to hold the joint together, but thin and light enough
to allow the joint to move properly. Lining the inside of the joint is the
synovial membrane, a thin layer of cells that produce fluid to keep the joint
moist and lubricated, so it can glide and move easily.

The synovial fluid also provides the cartilage cells with oxygen and nutrients
since the joint itself contains no blood vessels. (In all other parts of the body,
nutrients and oxygen are delivered via the bloodstream.)

In a joint stricken with osteoarthritis, however, an inflammatory process is

taking place. When inflammation occurs, the cells of the joint, including the
synovial and cartilage cells, produce chemicals that lead to an increase in
free radicals. These free radicals are dangerous substances that can attack
and damage the cartilage and synovial membrane of the joint.

As time goes by, the cartilage starts to wear away, the synovial membrane
dries out, and the synovial fluid disappears. With the cartilage gone, the ends
of the bones start to grind together. This causes the ends of the bone to
become thicker and harder.

Eventually, the ends of the bones start to grow cysts and sharp, bony spikes,
called osteophytes, that may stick out into the joint space and severely
hamper the movement of the joint. In the end, the joint is painful, unable to
move properly, and deformed from the inflammation and bony osteophytes.
Causes

The exact cause of osteoarthritis is still considered to be unknown, though

several theories exist as to what may happen to start the condition.
Generalized osteoarthritis of the hands, knees, and spine seems to have a
genetic component as it tends to run in families. However, genetics doesn't
seem to play a role in other forms of osteoarthritis and certainly isn't the
whole picture.

Osteoarthritis of the knees and hands seems to occur more commonly in

people who are obese, though it is not clear why this is the case.
Researchers think there may be certain hormones produced by fat cells that
may lead to joint problems. It has been shown that obese people who lose
weight, even as little as 10 pounds, can greatly reduce their risk of
developing osteoarthritis and even reduce the pain of osteoarthritis.

Another possible cause of osteoarthritis is joint trauma. People who do a lot

of high-intensity exercise or who do activities that frequently injure their
joints, like professional or competitive athletes, tend to wind up with this
condition after a while.

Researchers believe that repetitive stress and injury to the joint eventually
leads to inflammation that causes damage. Moderate exercise is beneficial,
especially for those trying to lose weight, and is therefore recommended.
Exercise that damages or causes pain in the joints, however, is excessive and
should be toned down.

Dietary Causes

A diet that is generally low in essential nutrients has been shown to

contribute to the development or progression of osteoarthritis. Basically, this
translates to a diet high in refined products like white rice, white bread, white
pasta, and saturated and trans-fats, and low in nutrient-rich foods like
vegetables, fruits, legumes, fish, whole grains, and lean meats.

Refined foods such as white rice and baked goods made from white flour
have been stripped of the vast majority of their nutrients. Although small
amounts of some nutrients, like certain B-vitamins, are added back in to
prevent wide-spread deficiencies, this so-called "enrichment" is comparable
to taking away a dollar and giving back two cents. Fatty foods like potato
chips or french fries are not only high in calories, but low in essential
nutrients.

Unfortunately, these refined and high-fat foods make up much of the

"Standard American Diet" (appropriately abbreviated as SAD). Replacing
these refined, nutrient-poor foods with whole, healthy foods can help reduce
risk of osteoarthritis.
In addition, research studies have shown that certain nutrients, such as
vitamin D, vitamin C, beta-carotene, and niacin, may be able to reduce the
progression of osteoarthritis. Consumption of foods rich in these nutrients
may help delay or even prevent the disability that can occur from this
condition.

Certain other nutrients, such as vitamin E, boron, niacinamide, and omega-3

fatty acids, may actually help reduce the pain and swelling that comes with
osteoarthritis. As a result, patients may be able to decrease their use of pain-
killers, which can have nasty side-effects, by consuming healthy foods rich in
these nutrients.

Nutrient Needs

Foods That May Help Include:

Whole Foods

To nourish your joints, try a big bowl of steaming oatmeal sprinkled with
cinnamon, add some raisins, diced apple, toasted pumpkin seeds, and
chunks of banana. Wash it down with a tall glass of cold orange juice. This
nutrient-dense fiber-rich breakfast can give you all the energy you need until
lunchtime.

Instead of deli meat on white bread for lunch, treat your joints to a salad of
mixed greens, diced carrot and tomato, a handful or two of nutty chickpeas,
and some white meat chicken strips, topped off with an olive oil, balsamic
vinaigrette dressing and a sprinkling of grated parmesan cheese. Add a
peach or some melon or a cup of yogurt for a snack or two during the day.

Greasy fast food burgers and fries doused in sugar-laden ketchup for dinner?
Not for your joints! They'll be pampered with fragrant brown rice, flaky baked
salmon seasoned with a fresh garlic, rosemary sauce, and steamed sweet
potato, or butternut squash, and snow peas. To start, a crisp spinach salad
topped with walnuts and fresh romano cheese.

Contrary to popular belief, healthy food is not about bran muffins and celery
sticks. There are many different whole foods, from vegetables to meats and
dairy products, available these days that can help you pack in the nutrients
that feed your joints.

Whole foods contain the nutrients necessary for joint health: vitamins such
as vitamin C, vitamin D, vitamin A, the B vitamins, vitamin K, and folic acid;
minerals like calcium, magnesium, selenium, zinc, and iron; and other
beneficial nutrients such as bioflavonoids and beta-carotene.

The best way to protect your joints is to eat a wide variety of nutritious
foods. You have a much better chance of getting all the vitamins and
minerals you need if your diet includes an assortment of different foods, than
if you eat the same thing every day. If you're trying to lose weight, nothing
works better than replacing the high fat, high sugar, high starch American
diet with meals centered around fresh fruits, vegetables, whole grains,
legumes, fish, and lean meats.

Fish

Remember that piece of succulent baked salmon? Evidence suggests that fish
may be helpful in osteoarthritis. Fish, especially cold water fish like salmon,
mackerel, halibut, herring, tuna, sardines, and cod, have high levels of
omega-3 fatty acids. These omega-3 fats are used by the body to make
substances that reduce inflammation.

Fish is also a wonderful and delicious source of essential protein, which is

needed for the repair of damaged joints. Some fish also contain vitamin D, a
critical nutrient for strong, healthy bones that can help prevent the
progression of osteoarthritis. Eat fish often, as it may help ease the
symptoms of osteoarthritis as well as improve your overall health.

Ginger

Add some zest to your salad dressing with fresh ginger. Some people with
osteoarthritis report that using ginger regularly helps reduce the pain and
swelling in their joints. Ginger contains active components that stop the body
from producing inflammatory substances that add to inflammation in the
joints.

A versatile spice that adds an exotic bite to any meal, ginger can transform
practically any dish from mundane to exceptional. Try mincing a sliver of
fresh ginger for a topping on steamed vegetables, meats, fish, baked fruit,
and fresh salads. While fresh ginger is the most flavorful, dried ginger may
also be beneficial.

Nutrients in Food That May Help Include:

To Reduce the Risk or Progression of Osteoarthritis
Vitamin D

When osteoarthritis patients get plenty of vitamin D in their diets, their joint
damage progresses more slowly. In contrast, people who don't get enough
vitamin D, have more rapidly occurring joint damage, leading rapidly to
disability. Vitamin D not only helps prevent the breakdown of cartilage, it's
necessary for rebuilding healthy cartilage and maintaining strong bones.
Shrimp and fortified milk are two very good sources of vitamin D.

Vitamin C
Vitamin C is a powerful antioxidant in the body. By neutralizing free radicals,
vitamin C helps reduce inflammation and damage that occurs in
osteoarthritis.

Vitamin C is also necessary for the production of healthy connective tissue

and cartilage, and may even be able to help undo some of the damage that
has already been done. The osteoarthritis of patients who get plenty of
vitamin C in their diets seems to progress more slowly compared to people
who have diets low in vitamin C.

Excellent food sources of vitamin C include broccoli, parsley, bell peppers,

strawberries, cauliflower, lemons, mustard greens, Brussels sprouts, papaya,
kale, cabbage, spinach, kiwifruit, cantaloupe, oranges, grapefruit, tomatoes,
chard, collard greens, raspberries, peppermint leaves, asparagus, celery,
fennel bulb, pineapple, and watermelon.

Beta-carotene

Beta-carotene is another powerful antioxidant. Like vitamin C, beta-carotene

helps destroy free radicals before they can cause excessive damage to joints.
A diet rich in beta-carotene also helps slow the progression of osteoarthritis.

Fortunately, beta-carotene is easy to spot because it gives fruits and

vegetables, such as apricots,and carrots, their bright orange color.

Excellent food sources of beta-carotene include sweet potatoes, carrots, kale,

winter squash, collard greens, chard, cantaloupe, mustard greens, romaine
lettuce, spinach, parsley, cayenne pepper, peppermint leaves, Brussels
sprouts, tomatoes, broccoli, asparagus, and apricots.

Niacin

Niacin, also known as vitamin B-3, plays many roles in the body and is
needed for healthy cells. Although researchers aren't quite sure why, a diet
high in niacin may help protect people from ever developing osteoarthritis in
the first place. Some studies show that niacin may cut osteoarthritis risk in
half.

Excellent food sources of niacin include crimini mushrooms and tuna. Very
good sources include salmon, chicken breast, asparagus, halibut and
venison.

To Reduce the Pain of Osteoarthritis

Vitamin E

Vitamin E, like vitamin C and beta-carotene, is yet another antioxidant that

helps eliminate damaging free radicals. Vitamin E is also very good at
reducing inflammation, which contributes to the problems in osteoarthritis.
Studies have shown that osteoarthritis sufferers with high intakes of vitamin
E report a significant reduction in their pain. Many are even able to reduce
the amount of pain-killers they need to take. Mustard greens, chard, turnip
greens, and sunflower seeds are a few excellent sources of vitamin E.

Boron

In Australia, boron has been a very popular remedy for osteoarthritis for
many years. It's especially useful in areas where the diet tends to be low in
boron, which can occur if the soil contains low levels of boron, or if people
are eating diets that are low in boron-rich foods.

Boron is needed in the body for the production of many substances, including
hormones and vitamin D, both of which are very important for healthy bones
and joints.

Omega-3 Fatty Acids

Omega-3 fatty acids have been shown in some studies to reduce the pain of
osteoarthritis. When the diet contains plenty of these essential fats, the cells
make less of the pro-inflammatory substances and more of the anti-
inflammatory substances.

By reducing inflammation, omega-3 fats help prevent the damage to the

cartilage and connective tissue that usually occurs in osteoarthritis.

Excellent food sources of omega-3 fatty acids include flax seeds, walnuts and
salmon.

Niacinamide

Some studies show that niacinamide can improve symptoms of osteoarthritis

and may be able to reduce the amount of pain-killers needed. To date,
researchers are not sure exactly how niacinamide, which has many different
functions in the body, is able to help with osteoarthritis.

Nutrient Excesses

Substances to Avoid

Vitamin A and Retinoids

People who take very high doses of vitamin A for a very long time tend to
wind up with joint pain and damage that looks a lot like osteoarthritis. These
high doses could not be obtained from diet alone and are also much higher
than doses that appear even in multivitamins.
This means that only people who are taking extra vitamin A as a supplement
are at risk. Also, certain medications typically used for skin conditions are
made from vitamin A-like chemicals called retinoids. Retinoids may also
cause joint damage. If you are taking medications like these, you may want
to talk to your doctor about the possibility of joint problems with long-term
use.

Iron

Genetic hemochromatosis is a hereditary condition that occurs mostly in

people of Caucasian descent. People with this condition absorb more iron
than they need and then store it in their bodies. As much as 80% of people
with this condition, also called iron-overload, develop osteoarthritic joint
changes if they consume too much iron. If they continue to get too much
iron, it can build up in their organs and cause severe organ damage.

Typically, the amount of iron found in a healthy, balanced diet is not enough
to cause problems. However, iron supplements should be avoided by persons
at risk for osteoarthritis, even iron-containing multivitamins, unless a doctor
has specifically recommended iron supplementation.

Recommended Diet

What should you eat if you have osteoarthritis or are trying to avoid getting
it? The best advice is to eat a varied diet high in necessary nutrients.

A diet filled with a variety of fresh fruits and vegetables, beans and peas,
nuts and seeds, whole grains, lean meats, and especially cold-water, wild-
caught fish is sure to provide you with all the nutrients that are important in
maintaining overall health and flexible, healthy joints.

This way of eating may help halt the progressive damage of osteoarthritis, as
well as help you cut back on the amount of pain-killers you need by reducing
pain and swelling.

Throwing a little bit of ginger into your cooking for some added zip may
further reduce symptoms.

Stop giving your joints SAD (Standard American Diet) foods. Leave the
refined white flour, fat-laden products on the shelf, and switch to foods rich
in the nutrients your joints need. Flexibility in your diet will translate to
flexibility in your joints.
Hypertension (high blood pressure)

Hypertension is a consistent elevation in blood pressure. "Blood pressure"

signifies the resistance produced each time the heart beats and sends blood
coursing through the arteries. Between beats, the heart relaxes, and blood
pressure drops. The lowest pressure is referred to as the diastolic pressure.
The peak pressure exerted by this contraction is the systolic pressure. A
normal blood pressure reading for an adult is: 120 (systolic) / 80 (diastolic).

Hypertension is a major risk factor for a heart attack and is generally

regarded as the greatest risk factor for a stroke. Hypertension (high blood
pressure) is aptly called "a silent killer," because people are often unaware of
having hypertension until a stroke or heart event brings the message home.

The physiological changes related to hypertension can frequently be related

to lifestyle patterns that are easily modifiable. For example, being overweight
may contribute to hypertension, because it increases the work required by
the heart. Making healthy eating choices can be an important, easy and
enjoyable step towards maintaining healthy blood pressure levels.

Eat more

• Cold water fish such as salmon, tuna, herring, mackerel and halibut for their beneficial
omega 3 fatty acid
• Onions and garlic
• Olive oil
• Celery
• Organically grown fruits and vegetables, especially leafy greens and cruciferous vegetables
such as broccoli, cauliflower and cabbage
• Whole grains
• Legumes
• Potatoes

Avoid saturated fat, sugar, caffeine, alcohol, excess sodium

• Description
• Dietary Causes
• Nutrient Needs
• Nutrient Excesses
• Recommended Diet
• References

Description
What is Hypertension?

Elevated blood pressure is a major risk factor for a heart attack and is
generally regarded as the greatest risk factor for a stroke. "Blood pressure"
signifies the resistance produced each time the heart beats and sends blood
coursing through the arteries.

The peak pressure exerted by this contraction is the systolic pressure.

Between beats, the heart relaxes, and blood pressure drops. The lowest
pressure is referred to as the diastolic pressure. A normal blood pressure
reading for an adult is: 120 (systolic) / 80 (diastolic).

High blood pressure is divided into different levels:

• Borderline (120-160/90-94)
• Mild (140-160/95-104)
• Moderate 140-180/105-114)
• Severe (160+/115+)

Physicians are primarily concerned with diastolic pressure (the second

number in the blood pressure reading), but systolic pressure is also
important. Individuals with a normal diastolic pressure (under 82 mm Hg)
but elevated systolic pressure (over 158 mm Hg) have double the risk of
death due to heart attack or stroke compared to individuals with normal
systolic pressures (under 130 mm Hg).

Blood pressure typically goes up as a result of stress or physical activity, but

in a person with high blood pressure, is elevated even at rest.

Over sixty million Americans have high blood pressure, including more than
half of all Americans aged 65-74 years, and almost three-fourths of all
African-Americans in the same age group.

Most patients with high blood pressure are in the borderline-to-moderate

range, a group in which almost all cases of high blood pressure can be
brought under control through changes in diet and lifestyle. In fact, in cases
of borderline-to-mild hypertension, healthful changes in diet and lifestyle
(discussed below) have proven superior to drugs in head-to-head
comparisons.

In addition, in some people, the drugs typically prescribed to lower blood

pressure produce the very thing they are trying to prevent: a heart attack.
Several well-designed long-term clinical studies have found that people who
take blood-pressure-lowering drugs (typically diuretics and/or beta-blockers)
actually suffer from unnecessary side effects (e.g., fatigue, headaches, and
impotence), including an increased risk of heart disease.

Frequent Signs and Symptoms

 • Usually none--blood vessels do not have nerves, so no symptoms are felt until the condition
becomes severe
• Typically discovered as part of a routine check up

A hypertensive crisis may be indicated by:

• Headache, drowsiness, confusion
• Numbness and tingling in hands and feet
• Coughing blood; nosebleeds
• Severe shortness of breath
• Vague but intense feeling of discomfort

Related Tests

• Blood pressure screening (In addition to physicians' offices, blood pressure may sometimes
be checked at pharmacies, fire stations, and public health offices. There are also simplified
home systems.)
• Blood lipids, blood triglycerides, blood insulin or oral insulin tolerance (Syndrome X testing)
• Methionine loading test (for high homocysteine levels)

Dietary Causes

Sodium and potassium

Excessive consumption of dietary sodium (from table salt), coupled with

diminished dietary potassium, is a common cause of high blood pressure,
especially in "salt-sensitive" individuals. Numerous studies have shown that
sodium restriction alone does not improve blood pressure control in most
people, but must also be accompanied by a high potassium intake.

In our society, only 5 percent of sodium intake comes from the natural
ingredients in food. Prepared foods contribute 45 percent of our sodium
intake, 45 percent is added in cooking, and another 5 percent is added as a
condiment. All the body requires in most instances is the salt that is naturally
present in food.

Most Americans have a sodium-to-potassium ratio greater than 2:1, meaning

that most people ingest twice as much sodium as they do potassium.
Researchers recommend a dietary sodium-to-potassium ratio of less than 1:5
to maintain health. This is 10 times the average intake of potassium, yet
even this may not be optimal. A natural diet rich in fruits and vegetables can
produce a sodium-to-potassium ratio of under 1:100, as most fruits and
vegetables have a sodium-to-potassium ratio of less than 1:50.

Calcium, magnesium, and vitamin C

Epidemiological and clinical studies have found numerous links between

inadequate amounts of these three nutrients and high blood pressure.

Saturated fats
A high intake of saturated fats has been conclusively linked to high
cholesterol levels and atherosclerosis. These "hard" fats become incorporated
within the walls of blood vessels, which then lose their elasticity.

Essential fats

Population and autopsy studies have demonstrated that people who consume
a diet rich in omega-3 essential fats from either fish or vegetable sources
have the lowest degree of cardiovascular disease and, conversely, those who
consume the least omega-3 essential fats have the highest degree of
cardiovascular disease.

Sugar

A high intake of sugars in the diet is an almost sure ticket to increased blood
lipid and sugar levels, because sugars deplete the body of vitamins and
minerals necessary for controlling lipid and sugar levels as well as for
protecting the blood vessels. Excess blood sugar can also cause direct
damage to blood cells and arterial walls, an effect much like accelerated
aging.

Dietary fiber

Fiber in the diet is an absolute key in helping control blood levels of lipids and
sugar, and a low dietary intake of fiber is associated with atherosclerosis
(hardening of the arteries).

Caffeine and nicotine

Caffeine (and nicotine--another reason not to smoke) is a stimulant that

promotes the body's stress response, releasing hormones that rapidly elevate
blood pressure.

Alcohol

In susceptible individuals, even moderate alcohol consumption causes a

steep rise in blood sugar and increases the production of free radicals, both
of which damage arteries and can contribute to chronically elevated blood
pressure.

Nutrient Needs

Essential fats

Over sixty double-blind studies have demonstrated that either fish oil
supplements or flaxseed oil, the two best sources of omega-3 essential fats,
are very effective in lowering blood pressure. Fish oils have typically
produced a more pronounced effect than flaxseed oil because the dosage of
fish oils used was quite high (equal to ten capsules daily).
Flaxseed oil may be the better choice for lowering blood pressure, especially
when cost-effectiveness is considered. Along with reducing the intake of
saturated fat, 1 tablespoon per day of flaxseed oil should lower both the
systolic and diastolic readings by up to 9 points.

Potassium

Several studies show that potassium supplementation alone can produce

significant reductions in blood pressure in hypertensive subjects. Typically,
these studies have utilized dosages ranging from 2.5 to 5.0 grams of
potassium per day. Significant drops in both systolic and diastolic values
have been achieved.

In one study, potassium supplementation lowered systolic blood pressure an

average of 12 points and diastolic blood pressure an average of 16 points.
Potassium supplementation may be especially useful in the treatment of high
blood pressure in persons over the age of sixty-five, who often do not fully
respond to blood-pressure-lowering drugs.

In one double-blind study of eighteen patients whose average age was 75,
with a systolic blood pressure of greater than 160 mm Hg and/or a diastolic
blood pressure of greater than 95 mm Hg, those who received potassium
chloride (supplying 2.5 grams of potassium) each day for four weeks
experienced a drop of 9 points in systolic and 7 points in diastolic pressure-
comparable results to drug therapy without its negative side effects.

Using foods or food-based potassium supplements to meet the human body's

high potassium requirements rather than pills is suggested, since potassium
salts can cause nausea, vomiting, diarrhea, and ulcers when given in pill
form at high dosages. These effects are not seen when potassium levels are
increased through diet only.

Caution: Check with your physician before taking potassium. Individuals with
kidney disease do not handle potassium in the normal way and are likely to
experience heart disturbances and other consequences of potassium toxicity.

Potassium supplementation is contraindicated when using a number of

prescription medications, including digitalis, potassium-sparing diuretics, and
the angiotensin-converting-enzyme-inhibitor class of blood-pressure-lowering
drugs. People with kidney disease or severe heart disease should not take
magnesium or potassium unless under the direct advice of a physician.

Magnesium

Magnesium is second only to potassium in its concentration within cells and

interacts with potassium in many body systems. Studies suggest that low
levels of potassium within cells may be the result of low magnesium intake.
Population studies provide considerable evidence that a high intake of
magnesium is associated with lower blood pressure. Numerous studies have
demonstrated an inverse correlation between water "hardness" (water high
in magnesium) and high blood pressure. Where magnesium content of the
water was high, there were fewer cases of high blood pressure and heart
disease.

Similarly, studies have found that when dietary intakes of magnesium were
high, blood pressure was lower. Magnesium supplementation is particularly
helpful in lowering blood pressure if:

• An individual is taking a diuretic, since diuretics cause magnesium depletion.

• High blood pressure is associated with a high level of renin, an enzyme released by the
kidneys that leads to the formation of chemicals that cause blood vessels to constrict and
blood pressure to increase.
• An individual has elevated intracellular sodium or decreased intracellular potassium levels
(as measured by red blood cell studies).

Absorption studies indicate that magnesium is easily absorbed orally,

especially in the citrate form. In addition, while inorganic magnesium salts
(like magnesium oxide) often cause diarrhea at higher dosages, organic
forms of magnesium (magnesium citrate or aspartate) generally do not.

Vitamin C and flavonoids

Studies have shown that the higher the intake of vitamin C the lower the
blood pressure. One of the ways vitamin C helps keep blood pressure in the
normal range is by promoting the excretion of lead.

Chronic exposure to lead from environmental sources, including drinking

water, is associated with high blood pressure and increased cardiovascular
mortality. Areas with a soft water supply have higher lead concentrations in
drinking water due to the acidity of the water. Soft water is also low in
calcium and magnesium-two minerals that protect against high blood
pressure.

Flavonoids (which co-occur naturally with vitamin C in many colorful fruits

and vegetables) support the antioxidant actions of vitamin C and help
strengthen and protect the inner lining of blood vessels.

Vitamin E

Of all the antioxidants, the fat-soluble antioxidant, vitamin E may offer the
most protection against hardening of the arteries because it is easily
incorporated into the LDL-cholesterol molecule where it prevents free radical
damage. Vitamin E not only reduces LDL peroxidation, but it also improves
plasma LDL breakdown, inhibits excessive platelet aggregation, increases
HDL-cholesterol levels, and increases the breakdown of fibrin, a clot-forming
protein.
Coenzyme Q10

Coenzyme Q10 or CoQ10 is an essential component of the mitochondria-the

factories where energy is produced in our cells. Although CoQ10 can be
synthesized within the body, deficiency has been found in 39% of patients
with high blood pressure.

In several studies, CoQ10 has been shown to lower blood pressure

approximately 10% in patients with hypertension; however, not until after
four to twelve weeks of therapy. CoQ10 seems to lower blood pressure by
lowering cholesterol levels and stabilizing the vascular system via its
antioxidant properties. These actions reduce resistance to blood flow through
the arteries.

Vitamin B3 (niacin)

Niacin is extremely important for controlling blood lipid levels and for proper
metabolism of carbohydrates and fats. Timed-release niacin may be
employed to avoid flushing. Liver toxicity may occur with high doses of
niacin.

Folic acid, vitamins B6 and B12, and choline

These B-complex-related vitamins make significant contributions to the

normal function of the innermost layer of the blood vessels, which is
necessary for maintaining normal blood pressure. They are also necessary for
our bodies to be able to metabolize homocysteine into other, useful
compounds. An intermediate product of normal cellular metabolism,
homocysteine accumulates-if not converted into methionine or cysteine via
the action of folic acid and vitamins B12 and B6-and can damage the blood
vessels, keeping them in a constant state of injury.

In addition to its role in clearing homocysteine, folic acid (also called folate)
is an essential performer in the intricate biochemical dance through which
our blood vessels are instructed to be more elastic, to dilate and relax.

Folate plays a role in blood vessel tone because it affects the production of
one of the most important agents controlling blood vessel elasticity-nitric
oxide. Nitric oxide, which is produced in the vascular endothelium (the lining
of the blood vessels), is made from the essential amino acid (protein building
block), arginine.

In the endothelium, arginine is converted into citrulline through the action of

an enzyme called endothelial nitric oxide synthase or eNOS for short. This
process is brought about through the action of a coenzyme called
tetrahydrobiopterin. And tetrahydrabiopterin is made in the body through a
pathway that requires folate in the form in which it is active in the body,
which is called 5-methyltetrahydrofolate or 5MTHFR.
Without adequate folate, 5MTHFR cannot be produced. Without 5MTHFR,
tetrahydrabiopterin cannot be produced. And without tetrahydrabiopterin, the
process through which cirtuline is converted into NO cannot occur. Without
NO, our blood vessels fail to dilate properly. This is one of the primary
reasons why diets rich in folic acid, such as the Mediterranean and DASH
diets, are able to lower high blood pressure as effectively as first generation
hypertensive drugs.

Folic acid is so important for cardiovascular function that a major 1995 study
concluded that 400 micrograms per day of folic acid could prevent 28,000
cardiovascular deaths per year in the United States. The average daily intake
of folic acid is 280 to 300 micrograms, about half of which is absorbed.

Research published in the January 2005 issue of JAMA, the Journal of the
American Medical Association, continues to underscore how important a diet
centered around folate-rich leafy greens, cruciferous vegetables and legumes
is for healthy blood pressure.

Researchers at Harvard Medical School and Brigham Young Women's Hospital

in Boston, Massachusetts, worked together to conduct two very large
prospective studies, one of 93,803 younger women (27 to 44 years) and a
second including 62,260 older women (43 to 70 years). Both groups were
drawn from women in the Nurses Health Study. All study participants were
free of hypertension when the research began, and both groups of women
were followed for 8 years.

The results: Women consuming high amounts of folate (dietary folate plus
folic acid-containing supplements) had a significantly decreased risk of
hypertension.

Younger women getting at least 800 micrograms of folate daily had a 45%
lower risk of developing high blood pressure compared to women consuming
less than 200 micrograms per day.

Older women who consumed at least 800 micrograms of folate daily had a
39% lower risk of developing hypertension.

Another study published in the May 2005 Journal of the American College of
Cardiology suggests folate's effects are so powerful it can even be used in
very high doses to acutely lower blood pressure in men and women with
coronary artery disease.

Though small, this was a very good study-a double-blind, placebo-controlled,

crossover trial that involved 13 men and one woman with significant
coronary artery disease (>50% stenosis in at least one coronary artery).

Giving these subjects high dose folic acid (30 mg in two divided doses, 10-12
hours and 1 hour before testing) effectively lowered their blood pressure (5-
mm Hg) and significantly increased blood flow to the heart by 49%, and
dilator reserve (the difference between peak blood flow to the heart and
resting blood flow to the heart) by 83%! Folate is abundant in a wide variety
of vegetables. Excellent sources include leafy greens (romaine lettuce,
spinach, collard greens, mustard greens), cruciferous vegetables (broccoli,
cauliflower), and lentils. Very good sources include most beans (black,
garbanzo, pinto, navy, green beans), Brussels sprouts, celery, red bell
peppers summer squash, cabbage and fennel.

Substances and conditions that can negatively affect folic acid, vitamin B12,
and vitamin B6 status include methotrexate, phenytoin, theophylline,
dopamine, Isoniazid, tartrazine (yellow dye #5), insufficient stomach acid,
intestinal flora imbalances, diarrhea, and smoking.

L-arginine

L-arginine is a common amino acid from food, but its importance increases in
those with hypertension. In the body (specifically within those hard-working
blood vessels) it is converted into nitric oxide, a chemical that helps keep the
inner walls of blood vessels smooth and normally allows blood vessels to
relax (among many other extremely important functions).

Individuals with hypertension have a harder time maintaining normal nitric

oxide levels, which may also relate to other significant health issues such as
diabetes and heart problems. The kidneys are particularly sensitive to the
levels of l-arginine, nitric oxide, and related chemicals. Stressful experiences
and aging may also result in lower l-arginine levels.

Dietary intake levels of l-arginine vary considerably, but they range from 1 to
over 4 grams per day. The consumption of nuts, which contain relatively high
levels of arginine, has a very strong negative correlation to the risk of
coronary events.

Soy flour, wheat bran, hazelnuts, and walnuts all contain high levels of both
arginine and folic acid. Fish contains high levels of arginine and essential fats.
A major source of dietary arginine in the Western diet is meat; however,
meat also contains high levels of saturated fats as well as methionine, the
precursor to homocysteine. Soy flour, wheat bran, and most nuts contain
relatively low levels of methionine. It is advisable to limit arginine intake in
those with active or latent herpes simplex or herpes zoster infections.

Extra Virgin Olive Oil

It's likely the abundance of polyphenols in extra virgin olive oil, rather than
its monounsaturated fatty acids, are responsible for its well known
cardiovascular benefits.
Research conducted by Dr. Juan Reno and colleagues at the Reina Sofia
University Hospital, Cordoba, Spain, and published in the November 2005
issue of the Journal of the American College of Cardiology, investigated the
effects of virgin olive oil on endothelial function in 21 volunteers with high
cholesterol levels.

The endothelium, although just a one-cell thick layer of flat cells that lines
the inner wall of all blood vessels, may be the critical player in cardiovascular
health. Among its many functions, the endothelium orchestrates the
mechanics of blood flow, and regulates blood clot formation and the adhesion
of immune cells to the blood vessel wall (one of the first steps in the
formation of plaque).

Normally, after a meal, endothelial function is impaired for several hours.

Blood vessels become less elastic promoting a rise in blood pressure, and
blood levels of free radicals potentially harmful to cholesterol (lipoperoxides
and 8-epi prostaglandin-F2) increase.

But when the subjects in this study ate a breakfast containing virgin olive oil
with its normal high phenolic content (400 ppm), their endothelial function
actually improved, blood levels of nitric oxide (a blood vessel-relaxing
compound produced by the endothelium) increased significantly, and far
fewer free radicals were present than would normally be seen after a meal.

When they ate the same breakfast containing the same type of virgin olive oil
with its phenolic content reduced to 80 ppm, the beneficial effects were
virtually absent, and concentrations of cholesterol-damaging free radicals
increased. The results of this study underscore the importance of knowing
how to select, store and serve your olive oil to maximize its polyphenol
content. For all the information you need, see our How to Select and Store
section in Olive oil.

Kukoamines-Phytonutrient Compounds in Potatoes

UK scientists at the Institute for Food Research have identified blood

pressure-lowering compounds called kukoamines in potatoes. Previously only
found in Lycium chinense, an exotic herbal plant whose bark is used to make
an infusion in Chinese herbal medicine, kukoamines were found in potatoes
using a new type of research called metabolomics.

Until now, when analyzing a plant's composition, scientists had to know what
they were seeking and could typically look for 30 or so known compounds.
Now, metabolomic techniques enable researchers to find the unexpected by
analyzing the 100s or even 1000s of small molecules produced by an
organism.

"Potatoes have been cultivated for thousands of years, and we thought

traditional crops were pretty well understood," said IFR food scientist Dr Fred
Mellon, "but this surprise finding shows that even the most familiar of foods
might conceal a hoard of health-promoting chemicals." Another good reason
to center your diet around the World's Healthiest Foods!

In addition to potatoes, researchers looked at tomatoes since they belong to

the same plant family-Solanaceae-as Lycium chinense. Metabolomic assays
also detected kukoamine compounds in tomatoes. The IFR scientists found
higher levels of kukoamines and related compounds than some of the other
compounds in potatoes that have a long history of scientific investigation.
However, because they were previously only noted in Lycium chinense,
kukoamines have been little studied. Researchers are now determinining
their stability during cooking and dose response (how much of these
compounds are needed to impact health).

Nutrient Excesses

Excessive intakes of particular nutrients are clearly related to the

development of hypertension; generally, the greater the quantity in which
these nutrients appear in foods, the more these foods are processed. The
most significant excesses include:

• Calories contribute to excess weight and a greater burden of disposing of unnecessary

nutrients into circulating blood lipids and body fat.
• Saturated fats, which may be deposited into circulating blood lipids and in the delicate inner
layers of blood vessels, decreasing their elasticity, integrity, and healing capacity.
• Sodium-because it is added to foods, it frequently occurs in a much higher proportion than
minerals (especially potassium and magnesium) that help balance the actions of sodium in
the body.

Another increasingly important possibility is the ingestion of heavy metals

and other toxins that affect the function of the blood vessels. Significant
among these are lead, mercury, and cadmium.

Lead can occur in high levels in tap water, in old, peeling paint, and after
sanding wood floors. Mercury can occur in high levels in some types of fish
and is also present in amalgam tooth fillings.

Cadmium can occur in high levels in air near highways and is also present in
some batteries. These heavy metals are difficult for the body to excrete, and
can remain in the body and affect function for years.

Recommended Diet

Relationships Found between Food Groups and High Blood Pressure

In research published in the December 2005 issue of the American Journal of

Clinical Nutrition, Lyn Steffen and colleagues from the University of
Minnesota, looked at possible associations between the risk of developing
high blood pressure in young black and white men and women and a diet
high in plant foods (fruit, vegetables, whole and refined grains, nuts and
legumes), dairy products (milk, cheese, yoghurt, and dairy desserts), and/or
meat and other animal products (red and processed meat, poultry, fish and
eggs).

Earlier studies have shown that diet can significantly affect blood pressure.
Specifically, diets rich in fruit and vegetables and/or low-fat dairy products,
or low in saturated fats have been associated with a lowered risk of high
blood pressure, while diets in which consumption of beef, veal, lamb and
poultry is high have been associated with a greater risk of high blood
pressure. This latest study looked at the diets of young adults, and their risk
of developing high blood pressure.

The study included 4,304 people (883 black men, 1,249 black women, 989
white men and 1,183 white women) aged 18-30 years when the study
began. Participants' diets and blood pressure were evaluated at baseline and
after 7 and 15 years. High blood pressure was defined as a systolic BP ≥ 130
mm/Hg and a diastolic BP ≥ 85 mm/Hg. After 15 years, 23.2% of
participants had higher than normal blood pressure: 13.7% had hypertension
and 9.4% had blood pressure that while still considered "normal," was at the
high end of the normal range. Of those who developed high blood pressure,
64% were black men and women.

Analysis of the study participants' diets revealed that a diet high in plant
foods-vegetables, whole grains, fruit and nuts-was associated with a 36%
lower risk of high blood pressure. Milk, dairy products and eggs were also
inversely related to high blood pressure.

Frequent consumption of red and processed meats, however, increased risk

of high blood pressure in both the black and white men and women. Those
eating red or processed meat once or twice a day had a 20-40% higher risk
of developing high blood pressure compared to those eating red or processed
meat an average of once every other day.

Eating fish or poultry was not found to be related to high blood pressure, but
eating eggs 1-3 times per week was associated with an 11-21% drop in
hypertension risk.

While researchers are not yet clear why eggs and plant and dairy foods are
protective, they think the rich variety of nutrients in these foods, such as
phytonutrients, fiber, magnesium, potassium and calcium, are the likely
reason.

The increase in hypertension risk seen with red and processed meats may be
due to their high levels of saturated fat, sodium and nitrates, or it may be
that red and processed meat is not harmful in itself, but is displacing other
healthier foods from the diet. If you or someone you love is at risk for or has
high blood pressure, play it safe. Limit red and processed meats to just a
couple of servings a week. Rely on eggs, low-fat dairy products, fish and
poultry as your primary sources of animal protein, and enjoy a
Mediterranean-style diet, which is naturally high in plant foods.

General Guidelines:

• Increase your consumption of plant foods-vegetarians generally have lower blood pressure
and a lower incidence of high blood pressure and other cardiovascular diseases than non-
vegetarians. Vegetarians and non-vegetarians consume similar amounts of sodium, but
vegetarians consume more potassium, complex carbohydrates, essential fatty acids, fiber,
calcium, magnesium, and vitamin C, and less saturated fat and refined carbohydrates, all of
which have been shown to have a favorable influence on blood pressure.
• Increase your consumption of green leafy vegetables, which are fat-free, rich sources of
calcium and magnesium, both of which have beneficial effects on blood pressure.
• Increase your consumption of whole grains and legumes: A high fiber diet can help lower
cholesterol levels.
• Increase your consumption of broccoli and citrus fruits, which are rich in vitamin C.
Population-based and clinical studies show that the higher the intake of vitamin C, the
lower the blood pressure.
• Consume 4 ribs of celery daily. A compound found in celery, 3-n-butyl phthalide, has been
shown to lower blood pressure experimentally. In animals, a very small amount of 3-n-
butyl phthalide lowered blood pressure by 12-14 percent, and also lowered cholesterol
levels by about 7 percent. Four ribs of celery supply the equivalent dose in humans. If you
are worried about your celery naturally containing too much sodium, it's unlikely that you
need to. The amount of natural sodium found in 4 stalks of celery is about 200-400
milligrams depending on the size of the stalk, and that's likely to be an amount you can fit
fairly easily into a meal plan well-suited to blood pressure regulation.
• Consume both garlic and onions liberally: The sulfur-containing compounds in garlic and
onions have been shown to lower blood pressure in cases of hypertension. Garlic
supplements may also be of benefit.
• Avoid saturated fats (found mainly in animal products), margarine and foods containing
trans-fatty acids (found in processed foods)-a great deal of research links these fats to
heart disease, strokes, and cancer.
• Rely on eggs, low-fat dairy products, fish and poultry as your primary sources of animal
protein. Limit consumption of red and processed meats to no more than 2 servings per
week.
• Avoid processed foods-their primary ingredients (sugars, refined carbohydrates, and trans-
fats) elevate cholesterol levels, blood pressure, and the risks for obesity and diabetes.
• Increase your consumption of omega-3 essential fats by consuming flaxseed oil (1
tablespoon per day) and/or eating cold-water fish-salmon, mackerel, tuna, herring, halibut
(4 ounces at least 3 times weekly). These fats "thin" the blood and can have numerous
beneficial effects on cardiovascular health.