health

New Blood Pressure Guidelines Leave Many Confused and Concerned

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 30th, 2017

Dear Doctor: I'm so confused by the new blood pressure guidelines. Yesterday, my blood pressure was normal. With the new guidelines, though, I'm now considered to have high blood pressure. Is my doctor going to put me on medication?

Dear Reader: Ever since the new blood pressure guidelines were released by the American College of Cardiology and the American Heart Association in November, we've been getting quite an earful. We're hearing not only from our patients, but from family and friends as well. People are surprised, upset, worried and, as you state in your letter, just plain confused.

The truth is that blood pressure goals have long been (and quite likely will always remain) controversial among the medical community. Back in 2014, when a panel of medical experts loosened blood pressure guidelines for some older Americans, there was an immediate backlash. Now, with guidelines being tightened, the debate has erupted again. Rather than focus on the history of blood pressure guidelines and the various schools of thought behind each iteration, we think it's more useful to talk about where things stand now, how the current guidelines affect us and what changes each of us can make to get better numbers.

Heart disease, which accounts for one quarter of all deaths in the United States, is the leading cause of death among both women and men. High blood pressure, or hypertension, is second only to smoking as a preventable cause of heart attack and stroke. At this time, guidelines state that normal blood pressure falls into a range below 120/80. The top number, known as systolic pressure, refers to the pressure in your arteries as your heart contracts. The bottom number is diastolic pressure, which is the pressure in your arteries between heartbeats. When taken together, the numbers offer a snapshot of your cardiac health.

People with a top number that falls between 120 and 129, and whose bottom number falls below 80, are considered to have "elevated" blood pressure. A top number of 130 to 139, and a bottom number of between 80 and 89, is considered to be stage 1 high blood pressure. Readings greater than 140/90 are stage 2 high blood pressure. Both stage 1 and 2 require medication.

Part of the uproar over these new guidelines is they are likely to push close to half of all Americans out of the normal range. However, this doesn't automatically mean blood pressure medication for everyone. In fact, the aim of the guidelines update is to give people ample warning of pending blood pressure problems. Because it has no obvious symptoms, high blood pressure is known as the silent killer. By catching changes early, people with elevated blood pressure can take steps to achieve healthier numbers through lifestyle changes and interventions.

-- Lose weight.

-- Stop smoking.

-- Exercise regularly.

-- Watch your diet.

-- Cut back on salt.

-- Limit alcohol.

-- Cut back on caffeine.

-- Reduce stress.

-- Keep regular track of your blood pressure.

We're sure you've heard this all before. But knowing what to do isn't the same as actually doing it. We believe this is an important discussion, so we'll be back next week with details about how and why each of these steps is important to your good health.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Mushrooms Known for Antioxidant and Anti-Inflammatory Properties

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 29th, 2017

Dear Doctor: I thought mushrooms were kind of a nonstarter from a nutritional standpoint, but now I read they are the best source of the antioxidants linked to anti-aging. Have I underestimated their health benefits? They're kind of icky, but I'll eat them if I have to.

Dear Reader: "Icky and slimy" was the way I described mushrooms as a kid. I would push them to the edge of my plate, hoping my mom wouldn't notice my disgust for the fungi. Eventually, however, I started to like them and now enjoy many species of edible mushrooms. They're low in calories, have a small degree of protein, are a good source of fiber and contain multiple B vitamins and selenium. But decrease aging?

It's true that mushrooms contain many antioxidants, including glutathione and ergothioneine. That seems to be where these claims start. Glutathione helps protect and repair cells damaged by everyday life, pollution and harmful influences. Although deficiency can lead to multiple health problems, it isn't known whether supplementation can help people without a deficiency. Ergothioneine is found throughout the human body and in black beans, kidney beans -- even mushrooms. Although ergothioneine has shown antioxidant properties in the laboratory, little is known of its physiological role in humans.

One recent study, likely the one you read about, measured the amounts of these antioxidants in different mushrooms. The authors found that higher levels of ergothioneine correlated with higher levels of glutathione. Maitake mushrooms had high levels of glutathione, for example, while chanterelles had the lowest amounts of both glutathione and ergothioneine. Porcini and yellow oyster mushrooms had the highest amounts of ergothioneine. Regular white, crimini and portabella mushrooms had relatively low levels of both antioxidants. Some news coverage of this study extrapolated by linking levels of antioxidants to an impact on aging.

That may be a stretch, but mushrooms do have immune-stimulating and anti-inflammatory properties. For example, mushrooms contain arginine, which has been shown to inhibit the growth of tumor cells and decrease the rate of cancer metastasis. Some edible mushrooms also contain fatty acids and lectins that decrease inflammation and may inhibit growth of tumors such as breast cancer. Further, phytochemicals in mushrooms such as indoles, phenols and terpenoids have been shown to decrease inflammation. All these compounds are potentially important because chronic inflammation can lead to cancer and vascular disease, even as inflammation and oxidation can lead to harmful effects on nerve cells in the brain.

The effects on the brain bring us to one of the biggest worries in aging: the risk of dementia. Countries such as Italy and France, which have high dietary amounts of ergothioniene, have substantially lower rates of Alzheimer's and Parkinson's disease compared to countries such as the United States with low amounts of dietary ergothionene.

Now, all this information about mushrooms and their link to health and aging is far from conclusive. In fact, it may be wishful thinking.

Yes, mushrooms contain many compounds, including antioxidants, which are good for your health, but so do many foods, such as berries, oranges, plums, grapes, kale, spinach, Brussels sprouts and broccoli. Perhaps you should simply add mushrooms to this list.

In other words, give them a try. You may find some varieties more appealing than the typical white mushrooms, and you may be surprised, as I was, that you like the taste.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Learning Portion Size Is Important When Choosing Proteins

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 28th, 2017

Dear Doctor: Would you please explain what "grams of protein per pound of body weight" etc. actually LOOKS like on someone's dinner plate? I think a lot of readers would love to have a visual for how much protein we are supposed to be eating.

Dear Reader: We're so glad you've brought up portion size. Along with eating from a well-balanced range of food groups, it's the factor that has the greatest impact on nutrition, good health and weight control. And you're right -- there's definitely room for an "aha!" moment regarding portion size.

Protein is the major building block of our bodies. Bone, muscle, cartilage, hormones, antibodies, membranes, chemical messengers, skin and blood all need protein to function. As with so many areas of nutrition, how much protein we need is a subject of ongoing debate.

In our recent column about protein, we cited the figure of 0.36 grams of protein per pound of body weight, which is the current Recommended Dietary Allowance, or RDA. That's considered the minimum needed for all systems to function well. Newer research seems to be leaning to somewhat higher numbers. We'll keep an eye on that for you and report back if things change significantly.

As for what a protein portion looks like on the plate, it depends on what type of protein you're talking about. Poultry, fish, beef, pork, eggs and milk products fall into a category known as "complete proteins." That means they contain the essential amino acids, which are nine amino acids that our bodies need but cannot manufacture.

A serving of meat or fish is generally considered to be 3 ounces. That's about the size of a deck of playing cards. Depending on the type of meat or fish, you're getting about 20 to 25 grams of protein per 3-ounce serving. A 1.5-ounce serving of cheese has in the neighborhood of 10 grams of protein, depending on the type. That's about the size of an index and middle finger held together.

Most of the other natural sources of protein, such as dried beans, rice, legumes, seeds, grains and many vegetables, either lack one or more of the essential amino acids, or are low on them. These are considered to be "incomplete" proteins. However, as vegans and vegetarians can attest, these so-called incomplete proteins can easily be mixed together in delicious combinations that make up for their various deficits.

A serving size of cooked beans, legumes or grain is a half-cup, or about the amount that would fit into an empty cupcake wrapper. A loosely cupped hand holds about an ounce of nuts. A tablespoon of peanut butter is about the size of the first joint of your thumb. For a 3-ounce serving of tofu, which has 7 grams of protein, we return to the visual of a deck of playing cards.

Once you start paying attention, learning portion sizes becomes easier. Just be sure to take variables like fat, salt and carbs into consideration when choosing your proteins.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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