Common Hospital Blood Pressure Mistake (Don’t Let This Happen To You Or A Loved One)
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There’s a major issue in healthcare, Dr. Suneel Dhand tells us, pertaining to the overtreatment of hypertension in hospitals. Here’s how to watch out for it and know when to question it:
Under pressure
When patients, particularly from older generations, are admitted to the hospital, their blood pressure often fluctuates due to illness, dehydration, and other factors. Despite this, they are often continued on their usual blood pressure medications, which can lead to dangerously low blood pressure.
Why does this happen? The problem arises from rigid protocols that dictate stopping blood pressure medication only if systolic pressure is below a certain threshold, often 100. However, Dr. Dhand argues that 100 is already low*, and administering medication when blood pressure is close to this can cause it to drop dangerously lower
*10almonds note: low for an adult, anyway, and especially for an older adult. To be clear: it’s not a bad thing! That is the average systolic blood pressure of a healthy teenager and it’s usually the opposite of a problem if we have that when older (indeed, this very healthy writer’s blood pressure averages 100/70, and suffice it to say, it’s been a long time since I was a teenager). But it does mean that we definitely don’t want to take medications to artificially lower it from there.
Low blood pressure from overtreatment can lead to severe consequences, requiring emergency interventions to stabilize the patient.
Dr. Dhand’s advice for patients and families is:
- Ensure medication accuracy: make sure the medical team knows the correct blood pressure medications and dosages for you or your loved one.
- Monitor vital signs: actively check blood pressure readings, especially if they are in the low 100s or even 110s, and discuss any medication concerns with the medical team.
- Watch for symptoms of low blood pressure: be alert for symptoms like dizziness or weakness, which could indicate dangerously low blood pressure.
For more on all of this, enjoy:
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Want to learn more?
You might also like to read:
The Insider’s Guide To Making Hospital As Comfortable As Possible
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What Does “Balance Your Hormones” Even Mean?
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Hormonal Health: Is It Really A Balancing Act?
Have you ever wondered what “balancing your hormones” actually means?
The popular view is that men’s hormones look like this:
Testosterone (less) ⟷ Testosterone (more)
…And that women’s hormones look more like this:
♀︎ Estrogen ↭ Progesterone ⤵︎
⇣⤷ FSH ⤦ ↴ ☾ ⤹⤷ Luteinizing Hormone ⤦
DHEA ↪︎ Gonadotrophin ⤾
↪︎ Testosterone? ⥅⛢
Clear as mud, right?
But, don’t worry, Supplements McHerbal Inc will sell you something guaranteed to balance your hormones!
How can a supplement (or dietary adjustment) “balance” all that hotly dynamic chaos, and make everything “balanced”?
The truth is, “balanced” in such a nebulous term, and this is why you will not hear endocrinologists using it. It’s used in advertising to mean “in good order”, and “not causing problems”, and “healthy”.
In reality, our hormone levels depend on everything from our diet to our age to our anatomy to our mood to the time of the day to the phase of the moon.
Not that the moon has an influence on our physiology at all—that’s a myth—but you know, 28 day cycle and all. And, yes, half the hormones affect the levels of the others, either directly or indirectly.
Trying to “balance” them would be quite a game of whack-a-mole, and not something that a “cure-all” single “hormone-balancing” supplement could do.
So why aren’t we running this piece on Friday, for our “mythbusting” section? Well, we could have, but the more useful information is yet to come and will take up more of today’s newsletter than the myth-busting!
What, then, can we do to untangle the confusion of these hormones?
Well first, let’s understand what they do, in the most simple terms possible:
- Estrogen—the most general feminizing hormone from puberty onwards, busiest in the beginning of the menstrual cycle, and starts getting things ready for ovulation.
- Progesterone—secondary feminizing hormone, fluffs the pillows for the oncoming fertilized egg to be implanted, increases sex drive, and adjusts metabolism accordingly. Busiest in the second half of the menstrual cycle.
- Testosterone—is also present, contributes to sex drive, is often higher in individuals with PCOS. If menopause is untreated, testosterone will also rise, because there will be less estrogen
- (testosterone and estrogen “antagonize” each other, which is the colorfully scientific way of saying they work against each other)
- DHEA—Dehydroepiandrosterone, supports production of testosterone (and estrogen!). Sounds self-balancing, but in practice, too much DHEA can thus cause elevated testosterone levels, and thus hirsutism.
- Gonadotrophin—or more specifically human chorionic gonadotrophin, HcG, is “the pregnancy hormone“, present only during pregnancy, and has specific duties relating to such. This is what’s detected in (most) pregnancy test kits.
- FSH—follicle stimulating hormone, is critical to ovulation, and is thus essential to female fertility. On the other hand, when the ovaries stop working, FSH levels will rise in a vain attempt to encourage the ovulation that isn’t going to happen anymore.
- Luteinizing hormone—says “go” to the new egg and sends it on its merry way to go get fertilized. This is what’s detected by ovulation prediction kits.
Sooooooo…
What, for most women, most often is meant by a “hormonal imbalance” is:
- Low levels of E and/or P
- High levels of DHEA and/or T
- Low or High levels of FSH
In the case of low levels of E and/or P, the most reliable way to increase these is, drumroll please… To take E and/or P. That’s it, that’s the magic bullet.
Bonus Tip: take your E in the morning (this is when your body will normally make more and use more) take your P in the evening (it won’t make you sleepy, but it will improve your sleep quality when you do sleep)
In the case of high levels of DHEA and/or T, then that’s a bit more complex:
- Taking E will antagonize (counteract) the unwanted T.
- Taking T-blockers (such as spironolactone or bicalutamide) will do what it says on the tin, and block T from doing the jobs it’s trying to do, but the side-effects are considered sufficient to not prescribe them to most people.
- Taking spearmint or saw palmetto will lower testosterone’s effects
- Scientists aren’t sure how or why spearmint works for this
- Saw palmetto blocks testosterone’s conversion into a more potent form, DHT, and so “detoothes” it a bit. It works similarly to drugs such as finasteride, often prescribed for androgenic alopecia, called “male pattern baldness”, but it affects plenty of women too.
In the case of low levels of FSH, eating leafy greens will help.
In the case of high levels of FSH, see a doctor. HRT (Hormone Replacement Therapy) may help. If you’re not of menopausal age, it could be a sign something else is amiss, so it could be worth getting that checked out too.
What can I eat to boost my estrogen levels naturally?
A common question. The simple answer is:
- Flaxseeds and soy contain plant estrogens that the body can’t actually use as such (too incompatible). They’ve lots of high-quality nutrients though, and the polyphenols and isoflavones can help with some of the same jobs when it comes to sexual health.
- Fruit, especially peaches, apricots, blueberries, and strawberries, contain a lot of lignans and also won’t increase your E levels as such, but will support the same functions and reduce your breast cancer risk.
- Nuts, especially almonds (yay!), cashews, and pistachios, contain plant estrogens that again can’t be used as bioidentical estrogen (like you’d get from your ovaries or the pharmacy) but do support heart health.
- Leafy greens and cruciferous vegetables support a lot of bodily functions including good hormonal health generally, in ways that are beyond the scope of this article, but in short: do eat your greens!
Note: because none of these plant-estrogens or otherwise estrogenic nutrients can actually do the job of estradiol (the main form of estrogen in your body), this is why they’re still perfectly healthy for men to eat too, and—contrary to popular “soy boy” social myths—won’t have any feminizing effects whatsoever.
On the contrary, most of the same foods support good testosterone-related health in men.
The bottom line:
- Our hormones are very special, and cannot be replaced with any amount of herbs or foods.
- We can support our body’s natural hormonal functions with good diet, though.
- Our hormones naturally fluctuate, and are broadly self-correcting.
- If something gets seriously out of whack, you need an endocrinologist, not a homeopath or even a dietician.
In case you missed it…
We gave a more general overview of supporting hormonal health (including some hormones that aren’t sex hormones but are really important too), back in February.
Check it out here: Healthy Hormones And How To Hack Them
Want to read more?
Anthea Levi, RD, takes much the same view:
❝For some ‘hormone-balancing’ products, the greatest risk might simply be lost dollars. Others could come at a higher cost.❞
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Zuranolone: What to know about the pill for postpartum depression
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In the year after giving birth, about one in eight people who give birth in the U.S. experience the debilitating symptoms of postpartum depression (PPD), including lack of energy and feeling sad, anxious, hopeless, and overwhelmed.
Postpartum depression is a serious, potentially life-threatening condition that can affect a person’s bond with their baby. Although it’s frequently confused with the so-called “baby blues,” it’s not the same.
The baby blues include similar, temporary symptoms that affect up to 80 percent of people who have recently given birth and usually go away within the first few weeks. PPD usually begins within the first month after giving birth and can last for months and interfere with a person’s daily life if left untreated. Thankfully, PPD is treatable and there is help available.
On August 4, the FDA approved zuranolone, branded as Zurzuvae, the first-ever oral medication to treat PPD. Until now, besides other common antidepressants, the only medication available to treat PPD specifically was the IV injection brexanolone, which is difficult to access and expensive and can only be administered in a hospital or health care setting.
Read on to find out more about zuranolone: what it is, how it works, how much it costs, and more.
What is zuranolone?
Zurzuvae is the brand name for zuranolone, an oral medication to treat postpartum depression. Developed by Sage Therapeutics in partnership with Biogen, it’s now available in the U.S. Zurzuvae is typically prescribed as two 25 mg capsules a day for 14 days. In clinical trials, the medication showed to be fast-acting, improving PPD symptoms in just three days.
How does zuranolone work?
Zuranolone is a neuroactive steroid, a type of medication that helps the neurotransmitter GABA’s receptors, which affect how the body reacts to anxiety, stress, and fear, function better.
“Zuranolone can be thought of as a synthetic version of [the neuroactive steroid] allopregnanolone,” says Dr. Katrina Furey, a reproductive psychiatrist, clinical instructor at Yale University, and co-host of the Analyze Scripts podcast. “Women with PPD have lower levels of allopregnenolone compared to women without PPD.”
How is it different from other antidepressants?
“What differentiates zuranolone from other previously available oral antidepressants is that it has a much more rapid response and a shorter course of treatment,” says Dr. Asima Ahmad, an OB-GYN, reproductive endocrinologist, and founder of Carrot Fertility.
“It can take effect as early as on day three of treatment, versus other oral antidepressants that can take up to six to 12 weeks to take full effect.”
What are Zurzuvae’s side effects?
According to the FDA, the most common side effects of Zurzuvae include dizziness, drowsiness, diarrhea, fatigue, the common cold, and urinary tract infection. Similar to other antidepressants, the medication may increase the risk of suicidal thoughts and actions in people 24 and younger. However, NPR noted that this type of labeling is required for all antidepressants, and researchers didn’t see any reports of suicidal thoughts in their trials.
“Drug trials also noted that the side effects for zuranolone were not as severe,” says Ahmad. “[There was] no sudden loss of consciousness as seen with brexanolone or weight gain and sexual dysfunction, which can be seen with other oral antidepressants.”
She adds: “Given the lower incidence of side effects and more rapid-acting onset, zuranolone could be a viable option for many,” including those looking for a treatment that offers faster symptom relief.
Can someone breastfeed while taking zuranolone?
It’s complicated. In clinical trials, participants were asked to stop breastfeeding (which, according to Furey, is common in early clinical trials).
A small study of people who were nursing while taking zuranolone found that 0.3 percent of the medication dose was passed on to breast milk, which, Furey says, is a pretty low amount of exposure for the baby. Ahmad says that “though some data suggests that the risk of harm to the baby may be low, there is still overall limited data.”
Overall, people should talk to their health care provider about the risks and benefits of breastfeeding while on the medication.
“A lot of factors will need to be weighed, such as overall health of the infant, age of the infant, etc., when making this decision,” Furey says.
How much does Zurzuvae cost?
Zurzuvae’s price before insurance coverage is $15,900 for the 14-day treatment. However, the Policy Center for Maternal Mental Health says insurance companies and Medicaid are expected to cover it because it’s the only drug of its kind.
Less than 1 percent of U.S. insurers have issued coverage guidelines so far, so it’s still unknown how much it will cost patients after insurance. Some insurers require patients to try another antidepressant first (like the more common SSRIs) before covering Zurzuvae. For uninsured and underinsured people, Sage Therapeutics said it will offer copay assistance.
The hefty price tag and potential issues with coverage may widen existing health disparities, says Ahmad. “We need to ensure that we are seeking out solutions to enable wide-scale access to all PPD treatments so that people have access to whatever treatment may work best for them.”
If you or anyone you know is considering suicide or self-harm or is anxious, depressed, upset, or needs to talk, call the Suicide & Crisis Lifeline at 988 or text the Crisis Text Line at 741-741. For international resources, here is a good place to begin.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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Glycemic Index vs Glycemic Load vs Insulin Index
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How To Actually Use Those Indices
Carbohydrates are essential for our life, and/but often bring about our early demise. It would be a very conveniently simple world if it were simply a matter of “enjoy in moderation”, but the truth is, it’s not that simple.
To take an extreme example, for the sake of clearest illustration: The person who eats an 80% whole fruit diet (and makes up the necessary protein and fats etc in the other 20%) will probably be healthier than the person who eats a “standard American diet”, despite not practising moderation in their fruit-eating activities. The “standard American diet” has many faults, and one of those faults is how it promotes sporadic insulin spikes leading to metabolic disease.
If your breakfast is a glass of orange juice, this is a supremely “moderate” consumption, but an insulin spike is an insulin spike.
Quick sidenote: if you’re wondering why eating immoderate amounts of fruit is unlikely to cause such spikes, but a single glass of orange juice is, check out:
Which Sugars Are Healthier, And Which Are Just The Same?
Glycemic Index
The first tool in our toolbox here is glycemic index, or GI.
GI measures how much a carb-containing food raises blood glucose levels, also called blood sugar levels, but it’s just glucose that’s actually measured, bearing in mind that more complex carbs will generally get broken down to glucose.
Pure glucose has a GI of 100, and other foods are ranked from 0 to 100 based on how they compare.
Sometimes, what we do to foods changes its GI.
- Some is because it changed form, like the above example of whole fruit (low GI) vs fruit juice (high GI).
- Some is because of more “industrial” refinement processes, such as whole grain wheat (medium GI) vs white flour and white flour products (high GI)
- Some is because of other changes, like starches that were allowed to cool before being reheated (or eaten cold).
Broadly speaking, a daily average GI of 45 is considered great.
But that’s not the whole story…
Glycemic Load
Glycemic Load, or GL, takes the GI and says “ok, but how much of it was there?”, because this is often relevant information.
Refined sugar may have a high GI, but half a teaspoon of sugar in your coffee isn’t going to move your blood sugar levels as much as a glass of Coke, say—the latter simply has more sugar in, and just the same zero fiber.
GL is calculated by (grams of carbs / 100) x GI, by the way.
But it still misses some important things, so now let’s look at…
Insulin Index
Insulin Index, which does not get an abbreviation (probably because of the potentially confusing appearance of “II”), measures the rise in insulin levels, regardless of glucose levels.
This is important, because a lot of insulin response is independent of blood glucose:
- Some is because of other sugars, some some is in response to fats, and yes, even proteins.
- Some is a function of metabolic base rate.
- Some is a stress response.
- Some remains a mystery!
Another reason it’s important is that insulin drives weight gain and metabolic disorders far more than glucose.
Note: the indices of foods are calculated based on average non-diabetic response. If for example you have Type 1 Diabetes, then when you take a certain food, your rise in insulin is going to be whatever insulin you then take, because your body’s insulin response is disrupted by being too busy fighting a civil war in your pancreas.
If your diabetes is type 2, or you are prediabetic, then a lot of different things could happen depending on the stage and state of your diabetes, but the insulin index is still a very good thing to be aware of, because you want to resensitize your body to insulin, which means (barring any urgent actions for immediate management of hyper- or hypoglycemia, obviously) you want to eat foods with a low insulin index where possible.
Great! What foods have a low insulin index?
Many factors affect insulin index, but to speak in general terms:
- Whole plant foods are usually top-tier options
- Lean and/or white meats generally have lower insulin index than red and/or fatty ones
- Unprocessed is generally lower than processed
- The more solid a food is, generally the lower its insulin index compared to a less solid version of the same food (e.g. baked potatoes vs mashed potatoes; cheese vs milk, etc)
But do remember the non-food factors too! This means where possible:
- reducing/managing stress
- getting frequent exercise
- getting good sleep
- practising intermittent fasting
See for example (we promise you it’s relevant):
Fix Chronic Fatigue & Regain Your Energy, By Science
…as are (especially recommendable!) the two links we drop at the bottom of that page; do check them out if you can
Take care!
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Natural Remedies and Foods for Osteoarthritis
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Natural solutions for osteoarthritis. Eg. Rosehip tea, dandelion root tea. Any others??? What foods should I absolutely leave alone?❞
We’ll do a main feature on arthritis (in both its main forms) someday soon, but meanwhile, we recommend eating for good bone/joint health and against inflammation. To that end, you might like these main features we did on those topics:
- We Are Such Stuff As Fish Are Made Of (collagen for bone and joint health)
- The Bare-Bones Truth About Osteoporosis (eating for bone health generally)
- Keep Inflammation At Bay (dietary tips for minimizing inflammation—also, our all-time most popular article to date!)
Of these, probably the last one is the most critical, and also will have the speediest effects if implemented.
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Superfood Kale & Dill Pâté
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Most of us could do with eating more greens a lot of the time, but it’s not always easy to include them. This kale and dill pâté brings a healthy dose of green in luxurious style, along with abundant phytochemicals and more!
You will need
- 2 handfuls kale, stalks removed
- 1 cup soft cheese (you can use our Healthy Plant-Based Cream Cheese recipe if you like)
- 2 tbsp fresh dill, chopped
- 1 tsp capers
- 1 tsp black pepper, coarse ground
- ½ tsp MSG, or 1 tsp low-sodium salt
Method
(we suggest you read everything at least once before doing anything)
1) Steam the kale for about 5 minutes or until wilted and soft. Run under cold water to halt the cooking process.
2) Combine all the ingredients, including the kale you just blanched, in a food processor and blitz to make a smooth pâté.
3) Serve with oatcakes or vegetable sticks, or keep in the fridge to enjoy it later:
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
Take care!
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Quick Healthy Recipe Ideas
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
“It was superb !! Just loved that healthy recipe !!! I would love to see one of those every day, if possible !! Keep up the fabulous work !!! ”
We’re glad you enjoyed! We can’t promise a recipe every day, but here’s one just for you:
Don’t Forget…
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Learn to Age Gracefully
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