Constipation increases your risk of a heart attack, new study finds – and not just on the toilet

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If you Google the terms “constipation” and “heart attack” it’s not long before the name Elvis Presley crops up. Elvis had a longstanding history of chronic constipation and it’s believed he was straining very hard to poo, which then led to a fatal heart attack.

We don’t know what really happened to the so-called King of Rock “n” Roll back in 1977. There were likely several contributing factors to his death, and this theory is one of many.

But after this famous case researchers took a strong interest in the link between constipation and the risk of a heart attack.

This includes a recent study led by Australian researchers involving data from thousands of people.

Elvis Presley was said to have died of a heart attack while straining on the toilet. But is that true? Kraft74/Shutterstock

Are constipation and heart attacks linked?

Large population studies show constipation is linked to an increased risk of heart attacks.

For example, an Australian study involved more than 540,000 people over 60 in hospital for a range of conditions. It found constipated patients had a higher risk of high blood pressure, heart attacks and strokes compared to non-constipated patients of the same age.

A Danish study of more than 900,000 people from hospitals and hospital outpatient clinics also found that people who were constipated had an increased risk of heart attacks and strokes.

It was unclear, however, if this relationship between constipation and an increased risk of heart attacks and strokes would hold true for healthy people outside hospital.

These Australian and Danish studies also did not factor in the effects of drugs used to treat high blood pressure (hypertension), which can make you constipated.

Man sitting on toilet, clutching tummy with one hand, holding toilet roll in other
Researchers have studied thousands of people to see if there’s a link between constipation and heart attacks. fongbeerredhot/Shutterstock

How about this new study?

The recent international study led by Monash University researchers found a connection between constipation and an increased risk of heart attacks, strokes and heart failure in a general population.

The researchers analysed data from the UK Biobank, a database of health-related information from about half a million people in the United Kingdom.

The researchers identified more than 23,000 cases of constipation and accounted for the effect of drugs to treat high blood pressure, which can lead to constipation.

People with constipation (identified through medical records or via a questionnaire) were twice as likely to have a heart attack, stroke or heart failure as those without constipation.

The researchers found a strong link between high blood pressure and constipation. Individuals with hypertension who were also constipated had a 34% increased risk of a major heart event compared to those with just hypertension.

The study only looked at the data from people of European ancestry. However, there is good reason to believe the link between constipation and heart attacks applies to other populations.

A Japanese study looked at more than 45,000 men and women in the general population. It found people passing a bowel motion once every two to three days had a higher risk of dying from heart disease compared with ones who passed at least one bowel motion a day.

How might constipation cause a heart attack?

Chronic constipation can lead to straining when passing a stool. This can result in laboured breathing and can lead to a rise in blood pressure.

In one Japanese study including ten elderly people, blood pressure was high just before passing a bowel motion and continued to rise during the bowel motion. This increase in blood pressure lasted for an hour afterwards, a pattern not seen in younger Japanese people.

One theory is that older people have stiffer blood vessels due to atherosclerosis (thickening or hardening of the arteries caused by a build-up of plaque) and other age-related changes. So their high blood pressure can persist for some time after straining. But the blood pressure of younger people returns quickly to normal as they have more elastic blood vessels.

As blood pressure rises, the risk of heart disease increases. The risk of developing heart disease doubles when systolic blood pressure (the top number in your blood pressure reading) rises permanently by 20 mmHg (millimetres of mercury, a standard measure of blood pressure).

The systolic blood pressure rise with straining in passing a stool has been reported to be as high as 70 mmHg. This rise is only temporary but with persistent straining in chronic constipation this could lead to an increased risk of heart attacks.

Doctor wearing white coat checking patient's blood pressure
High blood pressure from straining on the toilet can last after pooing, especially in older people. Andrey_Popov/Shutterstock

Some people with chronic constipation may have an impaired function of their vagus nerve, which controls various bodily functions, including digestion, heart rate and breathing.

This impaired function can result in abnormalities of heart rate and over-activation of the flight-fight response. This can, in turn, lead to elevated blood pressure.

Another intriguing avenue of research examines the imbalance in gut bacteria in people with constipation.

This imbalance, known as dysbiosis, can result in microbes and other substances leaking through the gut barrier into the bloodstream and triggering an immune response. This, in turn, can lead to low-grade inflammation in the blood circulation and arteries becoming stiffer, increasing the risk of a heart attack.

This latest study also explored genetic links between constipation and heart disease. The researchers found shared genetic factors that underlie both constipation and heart disease.

What can we do about this?

Constipation affects around 19% of the global population aged 60 and older. So there is a substantial portion of the population at an increased risk of heart disease due to their bowel health.

Managing chronic constipation through dietary changes (particularly increased dietary fibre), increased physical activity, ensuring adequate hydration and using medications, if necessary, are all important ways to help improve bowel function and reduce the risk of heart disease.

Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Hazelnuts vs Cashews – Which is Healthier?

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    Our Verdict

    When comparing hazelnuts to cashews, we picked the hazelnuts.

    Why?

    It’s close! This one’s interesting…

    In terms of macros, hazelnuts have more fiber and fats, while cashews have more protein and carbs. All in all, all good stuff all around; maybe a win for one or the other depending on your priorities. We’d pick hazelnuts here, but your preference may vary.

    When it comes to vitamins, hazelnuts have more of vitamins A, B1, B2, B3, B5, B6, B9, C, and E, while cashews have more vitamin K. An easy win for hazelnuts here, and the margins weren’t close.

    In the category of minerals, hazelnuts have more calcium, manganese, and potassium, while cashews have more copper, iron, magnesium, phosphorus, selenium, and zinc. This is a win for cashews, but it’s worth noting that cup for cup, both of these nuts provide more than the daily requirement of most of those minerals. This means that in practical terms, it doesn’t matter too much that (for example), while cashews provide 732% of the daily requirement for copper, hazelnuts “only” provide 575%. So while this category remains a victory for cashews, it’s something of a “on paper” thing for the most part.

    Adding up the sections (ambivalent + clear win for hazelnuts + nominal win for cashews) means that in total today we’re calling it in favour of hazelnuts… But as ever, enjoy both, because both are good and so is diversity!

    Want to learn more?

    You might like to read:

    Why You Should Diversify Your Nuts

    Take care!

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  • The Sweet Truth About Glycine

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Make Your Collagen Work Better

    This is Dr. James Nicolantonio. He’s a doctor of pharmacy, and a research scientist. He has a passion for evidence-based nutrition, and has written numerous books on the subject.

    Controversy! Dr. DiNicolatonio’s work has included cardiovascular research, in which field he has made the case for increasing (rather than decreasing) the recommended amount of salt in our diet. This, of course, goes very much against the popular status quo.

    We haven’t reviewed that research so we won’t comment on it here, but we thought it worth a mention as a point of interest. We’ll investigate his claims in that regard another time, though!

    Today, however, we’ll be looking at his incisive, yet not controversial, work pertaining to collagen and glycine.

    A quick recap on collagen

    We’ve written about collagen before, and its importance for maintaining… Well, pretty much most of our body, really, buta deficiency in collagen can particularly weaken bones and joints.

    On a more surface level, collagen’s also important for healthy elastic skin, and many people take it for that reason alone,

    Since collagen is found only in animals, even collagen supplements are animal-based (often marine collagen or bovine collagen). However, if we don’t want to consume those, we can (like most animals) synthesize it ourselves from the relevant amino acids, which we can get from plants (and also laboratories, in some cases).

    You can read our previous article about this, here:

    We Are Such Stuff As Fish Are Made Of

    What does he want us to know about collagen?

    We’ll save time and space here: first, he’d like us to know the same as what we said in our article above

    However, there is also more:

    Let’s assume that your body has collagen to process. You either consumed it, or your body has synthesized it. We’ll skip describing the many steps of collagen synthesis, fascinating as that is, and get to the point:

    When our body weaves together collagen fibrils out of the (triple-helical) collagen molecules…

    • the cross-linking of the collagen requires lysyl oxidase
    • the lysyl oxidase (which we make inside us) deanimates some other amino acids yielding aldehydes that allow the stable cross-links important for the high tensile strength of collagen, but to do that, it requires copper
    • in order to use the copper it needs to be in its reduced cuprous form and that requires vitamin C
    • but moving it around the body requires vitamin A

    So in other words: if you are taking (or synthesizing) collagen, you also need copper and vitamins A and C.

    However! Just to make things harder, if you take copper and vitamin C together, it’ll reduce the copper too soon in the wrong place.

    Dr. DiNicolantonio therefore advises taking vitamin C after copper, with a 75 minutes gap between them.

    What does he want us to know about glycine?

    Glycine is one of the amino acids that makes up collagen. Specifically, it makes up every third amino acid in collagen, and even more specifically, it’s also the rate-limiting factor in the formation of glutathione, which is a potent endogenous (i.e., we make it inside us) antioxidant that works hard to fight inflammation inside the body.

    What this means: if your joints are prone to inflammation, being glycine-deficient means a double-whammy of woe.

    As well as being one of the amino acids most key to collagen production, glycine has another collagen-related role:

    First, the problem: as we age, glycated collagen accumulates in the skin and cartilage (that’s bad; there is supposed to be collagen there, but not glycated).

    More on glycation and what it is and why it is so bad:

    Are You Eating Advanced Glycation End-Products? The Trouble Of The AGEs

    Now, the solution: glycine suppresses advanced glycation end products, including the glycation of collagen.

    See for example:

    Glycine Suppresses AGE/RAGE Signaling Pathway and Subsequent Oxidative Stress by Restoring Glo1 Function

    With these three important functions of glycine in mind…

    Dr. DiNicolantonio therefore advises getting glycine at a dose of 100mg/kg/day. So, if you’re the same size as this rather medium-sized writer, that means 7.2g/day.

    Where can I get it?

    Glycine is found in many foods, including gelatin for those who eat that, eggs for the vegetarians, and spinach for vegans.

    However, if you’d like to simply take it as a supplement, here’s an example product on Amazon

    (the above product is not clear whether it’s animal-derived or not, so if that’s important to you, shop around. This writer got some locally that is certified vegan, but is in Europe rather than N. America, which won’t help most of our subscribers)

    Note: pure glycine is a white crystalline powder that has the same sweetness as glucose. Indeed, that is how it got its name, from the Greek “γλυκύς”, pronounced /ɡly.kýs/, meaning “sweet”. Yes, same etymology as glucose.

    So don’t worry that you’ve been conned if you order it and think “this is sugar!”; it just looks and tastes the same.

    That does mean you should buy from a reputable source though, as a con would be very easy!

    this does also mean that if you like a little sugar/sweetener in your tea or coffee, glycine can be used as a healthy substitute.

    If you don’t like sweet tastes, then, condolences. This writer pours two espresso coffees (love this decaffeinated coffee that actually tastes good), puts the glycine in the first, and then uses the second to get rid of the sweet taste of the first. So that’s one way to do it.

    Enjoy (if you can!)

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  • Future-Proof Your Brain

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    This is Kimberly Wilson. She’s a psychologist, not a doctor, and/but her speciality is neurophysiology and brain health.

    Here’s what she wants us to know…

    Avoid this very common killer

    As you’re probably aware, the #1 killer in the US is heart disease, followed by COVID, which effectively pushed everything down a place. Thereafter, we see cancer, followed by accidental injuries, stroke, and dementia (including Alzheimer’s).

    Over in the UK, where Wilson is from, dementia (including Alzheimer’s disease) is the #1 killer, followed by heart disease and then respiratory diseases (including COVID), and then stroke, then cancer.

    As ever, what’s good for the heart is good for the brain, so many of the same interventions will help avoid both. With regard to some of the other differences in order, the reasons are mostly due to differences in the two countries’ healthcare systems and firearms laws.

    It’s worth noting, though, that the leading cause of death in young people (aged 15–19) is suicide in the UK; in the US it’s nominally accidental injuries first (e.g. accidental shootings) with intentional suicide in the second spot.

    In other words… Young or old, mental health is a serious health category that kills literally the most people in the UK, and also makes the top spots in the US.

    Avoid the early killer

    Given the demographics of most of our readership, chances are you’ve already lived past your teens and twenties. That’s not to say that suicide is no longer a risk, though, and it’s also worth noting that while mental health issues are invisible, they’re still physical illnesses (the brain is also an organ, after all!), so this isn’t something where you can simply “decide not to” and that’s you set, safe for life. So, please do continue to take good care in that regard.

    We wrote about this previously, here:

    How To Stay Alive (When You Really Don’t Want To)

    Avoid the later killer

    Wilson talks about how a recent survey found that…

    • while nearly half of adults say dementia is the disease they fear most,
    • only a third of those thought you could do anything to avoid it, and
    • just 1% could name the 7 known risk factors.

    Quick test: can you name the 7 known risk factors?

    Please take a moment to actually try (this kind of mental stimulation is good in any case), and count them out on your fingers (or write them down), and then

    When you’re ready: click here to see the answer!

    How many did you get? If you got them all, well done. If not, then well, now you know, so that’s good.

    So, with those 7 things in mind, the first obvious advice is to take care of those things.

    Taking an evidence-based medicine approach, Wilson recommends some specific interventions that will each improve one or more of those things, directly or indirectly:

    Eating right

    Wilson is a big fan of “nutritional psychiatry” and feeding one’s brain properly. We wrote about this, here:

    The 6 Pillars Of Nutritional Psychiatry

    As well as agreeing with the obvious “eat plenty of fiber, different-colored plants, and plenty of greens and beans”, Wilson specifically also champions getting enough of vitamins B9, B12, and D, as well as getting a healthy dose of omega-3 fatty acids.

    She also recommends intermittent fasting, if that’s a reasonable option for you—but advocates for not worrying about it, if it’s not easy for you. For example, if you are diabetic, or have (or have a history with) some kind of eating disorder(s), then it’s probably not usefully practicable. But for most people, it can reduce systemic inflammation, which means also reducing neuroinflammation.

    Managing stress right

    Here she advocates for three main things:

    1. Mindful meditation (see: Evidence-Based, No-Frills Mindfulness)
    2. Psychological resilience (see: Building Psychological Resilience)
    3. Mindful social media use (see: Making Social Media Work For Your Mental Health)

    Managing money right

    Not often we talk about this in a health science publication as opposed to a financial planning publication, but the fact is that a lot of mental distress, which goes on to have a huge impact on the brain, is rooted in financial stresses.

    And, of course, it’s good to be able to draw on financial resources to directly fund one’s good health, but that is the secondary consideration here—the financial stress is the biggest issue, and you can’t CBT your way out of debt, for example.

    Therapists often face this, and what has been referred to informally by professionals in the field as “Shit Life Syndrome”—and there’s only so much that therapy can do about that.

    We’re not a financial publication, but one recommendation we’ll drop is that if you don’t currently have budgeting software that you use, this writer personally uses and swears by YNAB (You Need A Budget), so maybe check that out if you don’t already have everything covered in that regard. It’s not free, but there is a 34-day free trial.

    Therapy can be very worthwhile nonetheless

    Wilson notes that therapy is like non-invasive brain surgery (because of neuroplasticity, it’s literally changing physical things in your brain).

    It’s not a magic bullet and it’s not the right choice for everyone, but it’s worth considering, and even self-therapy can yield benefits for many:

    The Gym For Your Mental Health: Getting The Most Out Of Therapy

    Sleeping right

    Sleep is not only critical for health in general and brain health in particular, it’s also most of when our glymphatic system does clean-up in the brain (essential for avoiding Alzheimer’s & Parkinson’s, amongst other diseases):

    How To Clean Your Brain (Glymphatic Health Primer)

    Want to know more from Kimberley Wilson?

    We reviewed a book of hers recently, here:

    Unprocessed: What your Diet Is Doing To Your Brain – by Kimberley Wilson

    However, much of what we shared today was sourced from another book of hers that we haven’t reviewed yet but probably will do one of these days:

    How to Build a Healthy Brain: Reduce stress, anxiety and depression and future-proof your brain – by Kimberley Wilson

    Enjoy!

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  • No Bad Parts – by Dr. Richard Schwartz

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We’ve previously reviewed Dr. Schwartz’s “You Are The One You’ve Been Waiting For” and whereas that book doesn’t require having read this one, this one would be an excellent place to start, as it focuses on perhaps the most important core issues of IFS therapy.

    We all have different aspects that have developed within us for different reasons, and can generally “become as though a different person when…” and some condition that is met. Those are our “parts”, per IFS.

    This book makes the case that even the worst of our parts arose for reasons, that they often looked after us when no other part could or would, and at the very least, they tried. Rather than arguing for “so, everything’s just great”, though, Dr. Schwartz talks the reader through making peace with those parts, and then, where appropriate, giving them the retirement they deserve—of if that’s not entirely practical, arranging for them to at least take a seat and wait until called on, rather than causing problems in areas of life to which they are not well-suited.

    Throughout, there is a good balance of compassion and no-bullshit, both of which are really necessary in order to make this work.

    Bottom line: if there are parts of you you’re not necessarily proud of, this book can help you to put them peacefully to rest.

    Click here to check out No Bad Parts, and take care of yours!

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  • Easing Lower Back Pain

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    Lower back pain often originates from an unexpected culprit: your pelvis. Similar to how your psoas can contribute to lower back pain, when your pelvis tilts forward due to tight hip flexors, it can misalign your spine, leading to discomfort and pain. As WeShape shows us in the below video, one simple stretch can help realign your pelvis and significantly ease lower back pain.

    Why Your Pelvis Matters

    Sitting for long periods causes your hip flexors to shorten, leading to an anterior pelvic tilt. This forward tilt puts pressure on your spine and SI joint, causing pain and discomfort in the lower back. To help resolve this, you can work on correcting your pelvic alignment, helping to significantly reduce this pressure and alleviate related pain. And no, this doesn’t require any spinal cord stimulation.

    Easy Variations for All

    A lot of you recognise the stretch in this video; it’s quite a well-known kneeling stretch. But, unlike other guides, WeShape also provides a fantastic variation for those who aren’t mobile enough for the kneeling variation

    So, if you can’t comfortably get down on the ground, WeShape outlines a brilliant standing variation. So, regardless of your mobility, there’s an option for you!

    See both variations here:

    Excited to reduce your lower back pain? We hope so! Let us know if you have any tips that you’d like to share with us.

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  • PFAS Exposure & Cancer: The Numbers Are High

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    PFAS & Cancer Risk: The Numbers Are High

    Dr Maaike Van Gerwen studies the effects of exposure to PFAS on cancer development.
    Image Credits Mount Sinai

    This is Dr. Maaike van Gerwen. Is that an MD or a PhD, you wonder? It’s both.

    She’s also Director of Research in the Department of Otolaryngology at Mount Sinai Hospital in New York, Scientific Director of the Program of Personalized Management of Thyroid Disease, and Member of the Institute for Translational Epidemiology and the Transdisciplinary Center on Early Environmental Exposures.

    What does she want us to know?

    She’d love for us to know about her latest research published literally today, about the risks associated with PFAS, such as the kind widely found in non-stick cookware:

    Per- and polyfluoroalkyl substances (PFAS) exposure and thyroid cancer risk

    Dr. van Gerwen and her team tested this several ways, and the very short and simple version of the findings is that per doubling of exposure, there was a 56% increased rate of thyroid cancer diagnosis.

    (The rate of exposure was not just guessed based on self-reports; it was measured directly from PFAS levels in the blood of participants)

    • PFAS exposure can come from many sources, not just non-stick cookware, but that’s a “biggie” since it transfers directly into food that we consume.
    • Same goes for widely-available microwaveable plastic food containers.
    • Relatively less dangerous exposures include waterproofed clothing.

    To keep it simple and look at the non-stick pans and microwavable plastic containers, doubling exposure might mean using such things every day vs every second day.

    Practical take-away: PFAS may be impossible to avoid completely, but even just cutting down on the use of such products is already reducing your cancer risk.

    Isn’t it too late, by this point in life? Aren’t they “forever chemicals”?

    They’re not truly “forever”, but they do have long half-lives, yes.

    See: Can we take the “forever” out of forever chemicals?

    The half-lives of PFOS and PFOA in water are 41 years and 92 years, respectively.

    In the body, however, because our body is constantly trying to repair itself and eliminate toxins, it’s more like 3–7 years.

    That might seem like a long time, and perhaps it is, but the time will pass anyway, so might as well get started now, rather than in 3–7 years time!

    Read more: National Academies Report Calls for Testing People With High Exposure to “Forever Chemicals”

    What should we use instead?

    In place of non-stick cookware, cast iron is fantastic. It’s not everyone’s preference, though, so you might also like to know that ceramic cookware is a fine option that’s functionally non-stick but without needing a non-stick coating. Check for PFAS-free status; they should advertise this.

    In place of plastic microwaveable containers, Pyrex (or equivalent) glass dishes (you can get them with lids) are a top-tier option. Ceramic containers (without metallic bits!) are also safely microwaveable.

    See also:

    Here’s a List of Products with PFAS (& How to Avoid Them)

    Take care!

    Don’t Forget…

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