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World Hypertension Day


Did you recently hear on the news that your previously “normal” blood pressure is now considered “high” and recommended new medical interventions? If so, you may want to hold off until you discuss this with your physician further, says a new report in JAMA Internal Medicine.

According to the University of Sydney and Bond University, getting more aggressive with your treatment could have unintended consequences. By lowering the threshold for drug treatment of adults considered at risk of extreme high blood pressure from 140/80 mmHg to 130/80, patients are at greater risk for medication side effects and feelings of anxiety and depression due to worry about the diagnosis. There’s also the concern that if there’s a switch in health insurance you could suddenly find yourself with a pre-existing condition.

There are other good reasons to not get more aggressive about treatment—the report says that as many as 80 percent of people who get medication receive no increased benefit against cardiovascular disease. How to know if you’re in the other 20 percent? Check with your doctor. Your health history is necessary to determine whether going on medication will be beneficial.

In the meantime, everyone can take proactive steps to improve their blood pressure. Here are a few ideas:

Drop the weight. There’s a reason doctors mention this frequently—you can reduce your blood pressure by about 1 millimeter of mercury (mmHG) with each kilogram (2.2 pounds) you lose.

• Watch your waistline. Carrying extra pounds around your waist can increase the risk of high blood pressure. For men, that means a waist of 40 inches or more; for women, 35 inches and over.

Check your snoring. For some people, snoring and waking up suddenly during the night can be signs of sleep apnea. Disrupted breathing from sleep apnea can raise your blood pressure, so it’s a good idea to get this checked out. Fortunately, losing weight can markedly improve sleep apnea.

Get moving. You know the drill; 30 minutes of exercise a day can improve your blood pressure. You can even break it up—new studies say that three, 10-minute bouts of exercise are also valuable. And strength training counts and is good for your bone health as well.

Shop the produce section. Increasing your consumption of fruit and vegetables, especially those rich in potassium, can help your blood pressure. And don’t forget the Dietary Approaches to Stop Hypertension (DASH) diet if you’d like more help.

Cut the salt. Even a small reduction in your sodium intake can make a big difference in your blood pressure, especially if you’re salt sensitive. For more on this, take a look at my earlier column on reducing sodium.

Happy Half-Hour? While one drink a day for women and two for men can help your blood pressure, more than that can raise it and make your medications less effective.

Quit smoking. Your blood pressure increases for every minute you smoke. So get some help and quit.

Dr. Nieca’s tip: A doctor who knows you and your health history will be the best judge as to whether you need to go on medication for your blood pressure. In the meantime, the tips above are a great way to keep your readings in the safety zone.

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When it comes to exercise, every little bit helps

The common wisdom when it comes to exercise is that it must be sustained for at least 30 minutes to get any sort of value. Far too frequently in my practice I hear patients say, “I just don’t have the time to dedicate to an exercise routine.” But, as I’ve been saying for years, every little bit helps—and now there’s a major study that confirms this in the Journal of the American Heart Association.

Gretchen Reynolds in The New York Times wrote about how the 2008 federal exercise guidelines recommending 30 minutes of sustained activity five times a week to reduce the risk of disease or premature death didn’t support the advantages of multiple, smaller bursts of activity because they didn’t seem to improve endurance. However the new study shows that moving does have a direct effect on longevity. In other words, the more you move, the more you cut your mortality risk.

The bottom line is that ALL physical activity counts. So here are some ideas to get you moving to improve your cardiovascular health.

  • Dogs are a physician’s best friend. Nothing beats a canine companion to make sure you get several 10-minute walks a day.
  • Park on the other side of the lot. Sneak in a short walk by parking in the furthest spot from the store or a few blocks from your destination.
  • How big is that big box store? The next time you shop in one of those huge stores, walk the perimeter of the store to check out the aisles before you start shopping. Bonus points if you go up and down every aisle.
  • Walk it off. Just had a nice meal at a restaurant? Take a stroll around the block before you head home. It will also make the trip home far more comfortable.
  • Take the stairs. If you’re able, making it a habit of taking the stairs will not only sneak in more exercise, it will help with your endurance.

And for those of you who go for a long walk every day—keep it up. Every type of exercise counts.

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Why Breakfast Still Matters

Diet fads come and go, but the latest one could actually be dangerous to your health—intermittent fasting, usually expressed by skipping breakfast. I recently spoke on The Doctors to discuss this trend and how it affects your cardiovascular health.

There are many reasons that I favor a healthy breakfast, including:

  • Studies show an association between skipping breakfast and obesity, thought to be linked to impulsive snacking during the day to slake hunger pains.
  • Eating breakfast is the first step to planning a healthier lifestyle and making better choices.
  • Eating more food earlier in the day when you’re most active is an excellent way to control weight. The old adage: eat breakfast like a king, lunch like a prince and dinner like a pauper, still has merit.
  • Studies show that regularly eating a healthy breakfast helps schoolchildren do better on tests.

But can skipping breakfast actually be dangerous? As my colleague, nutritionist Robert Ferguson, pointed out on The Doctors, if you are one of the 1.5 million Americans who develop undiagnosed type 2 diabetes per year, fasts can cause low blood sugar, which in turn can lead to lightheadedness and even fainting. Since most people don’t think of skipping a meal as being in the same vein as starting a new diet, too few people will check with their doctor first. ALWAYS check with your doctor before fasting.

The key to making breakfast part of a healthy lifestyle is making wise food choices. For example, eating eggs for breakfast is fine for people with healthy cholesterol, but be careful about what you eat with them. Adding fried potatoes, fatty meats such as sausage or bacon, and toast with butter greatly increases the saturated fat and calories. Instead, how about trying the Middle Eastern dish of shakshuka—eggs poached in a sauce made from tomatoes, onions and peppers? Or take a page from the Pacific Northwest toast craze and top a slice of grilled sourdough with a poached egg, arugula and a dash of hot sauce. As long as you have something from each food group with your meal you can’t go wrong.

No time in the morning? Try one of these super easy, make-ahead breakfasts that you can take with you:

  • Steel-cut oatmeal. You can make this in a slow-cooker, but for ultimate ease, add half-cup of oats to 2 cups of rapidly boiling water. Let boil for one minute and then put on the lid and take it off the heat. Allow it to sit overnight. In the morning pack up a few jars with the oats, milk of your choice, some fruit and perhaps a teaspoon of chopped nuts. Reheat in your office microwave.
  • Refrigerator oats. This recipe is reminiscent of European museli. Add a half-cup of rolled oats to a pint jar along with a half-cup of low-sugar yogurt or kefir, and a half-cup of the milk of your choice. Kick it up with a half-cup of berries or diced fruit and a teaspoon of toasted nuts or seeds. Stir well and refrigerate overnight.
  • Omelet muffins. Did you know you can make mini omelets in muffin tins? Beat eight eggs with 2 tablespoons of ice cold water. In the tins add some chopped veggies (bell peppers and asparagus are particularly good), a little baby spinach, maybe a teaspoon of low-fat cheese or chopped, cooked lean meat such as turkey. Pour the egg mixture evenly between the cups. Bake for 20 minutes at 350 degrees. When cool, pop two into a baggie and you’re good to go.

Try making a nutritious breakfast part of your healthy lifestyle. It can make the start of heart-healthy habits for 2018.

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Keeping those New Year’s Resolutions Going

Stop me if you heard this one: You hit the gym with great motivation after New Year’s, determined to work off all the Christmas cookies, ham, latkes, pot roast, eggnog and cocktails. You signed up for yoga, cut out sugar, bought a lot of kale and started drinking eight glasses of water a day.

Now, two weeks in your willpower is waning. The kale is lying limp in your vegetable drawer. You’re craving hot cocoa and pasta. And it’s so cold outside and so dark when the alarm goes off at 6 a.m. all you want to do is stay curled up in bed watching Netflix and eating comfort food.

“It’s only January,” you tell yourself. “I have plenty of time to get into beach shape before summer.”

Instead of putting your fitness resolutions on hold, there are ways to get back into shape that will not only help you look better, but feel better and help you ditch the winter blues.

  • Easy does it. Ignore anyone who says you have to be able to run a mile right from the start. Starting slowly and building over time will increase your confidence and your endurance.
  • Every step counts. Not a gym rat but not happy about walking in the cold? Many malls welcome walkers in the morning—or do a few laps while window shopping during your lunch hour.
  • Eat good to feel good. Eating a healthier diet doesn’t mean deprivation. You can enjoy the foods you’re craving in the cold by using healthier ingredients and being aware of portion size. And this is a good time to make sure you’re getting the nutrients you need to fight the winter blues and keep your immune system humming.
  • Netflix is your friend. That Netflix series you want to binge on can become your workout buddy. Bring your tablet to the gym and make it a rule that you can only watch while you’re on the treadmill or elliptical.
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How to Cut the Salt for Your Heart and Your Health

I was recently on The Doctors to set the record straight about what too much salt does to our bodies. Studies show that high-salt diets are responsible for 57,000 deaths per year and I have patients who wouldn’t survive such a diet. Anyone who is sodium sensitive, has salt-reactive high blood pressure, diabetes or heart disease needs to limit their salt intake. The same goes for people with a family history of hypertension, which is found in many African-American families. Also, some people become more sodium sensitive as they age and there’s no way to know who these people are before they develop high blood pressure. The easiest preventive? Cut back on salt, especially salt in processed foods. Too much sodium can increase your risk of stroke, heart failure, osteoporosis, stomach cancer and kidney disease.

So how much salt is too much? The safest amount is 1,500 mg, especially if you are in an at-risk group. However, the current USDA guideline allows one teaspoon or 2,300 mg per day for a healthy adult. Although I’d like it to be lower, it’s an improvement over the 3,400 mg of sodium consumed by the average American every day.

Here’s how to get started cutting back on sodium:

  • Eat clean. Skip the processed and prepared foods (one 3-ounce serving of supermarket rotisserie chicken has 279 mg of sodium) and concentrate on getting more fruits, vegetables, whole grains, lean protein and healthy fats.
  • Make it yourself. Packaged food makers cut corners by adding salt and sugar. They’re cheap, addictive and allow manufacturers to substitute cheaper ingredients without being noticed. Learn to make your favorite foods yourself with quality ingredients. You’ll use less salt and greatly improve flavor.
  • Taste your food. Too many people reach for the salt shaker without even tasting their food. If you follow my advice and make it yourself with little or no salt, a slight sprinkling of sea or kosher salt on top will hit your taste buds in all the right places and still significantly reduce sodium.
  • Let your taste buds recalibrate. It will take awhile before you start to appreciate food with less salt. However, you can train your taste buds to appreciate food that’s not swimming in sodium.
  • Beware of fad foods. The latest food fad is ramen, but this can be loaded with sodium. Toss the flavoring packet and make your own broth at home with low-sodium chicken stock and lots of veggies.
  • Read the label. Before you buy anything, make sure you check the label. I’m deeply appreciative of the recently improved FDA labeling. You might be amazed at how loaded with sodium unexpected thing can be. Some culprits include salted caramel ice cream, breakfast cereals and breads.
  • Spice it up. Just because you’re skipping the salt doesn’t mean your food can’t be muy caliente. Just use fresh chilies or add a dash of cayenne or hot paprika. Canned chilies and bottled hot sauce is often loaded with sodium. Or add some heat with cumin, turmeric, coriander and nutmeg. And don’t forget the flavor boost from onions, shallots, fresh ginger and garlic.
  • Go for the green. There’s nothing like herbs to add real flavor to any dish. Supermarkets sell fresh herbs year round and they alos do great growing in containers. For extra flavor, whip together the Italian condiment gremolata—a chopped herb condiment made from parsley, lemon peel and garlic. You’ll never miss the salt.

Dr. Nieca’s Tip: You don’t have to sacrifice convenience by cutting out the salt. Roast a second fresh chicken on Sunday with the classic flavors of rosemary, garlic and lemon tucked under the skin. You’ll have flavorful chicken to use all week without a speck of added salt.

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How Old Are Your Arteries?

A few gray hairs here, a few wrinkles there around the eyes are treated as tell-tale signs of aging; worthy of time, effort, and expense to slow down the process, to the extent practicable.

A similar connection may be made to high blood pressure and vascular aging. Blood vessels stiffen as you get older and increase the resistance to blood being pumped out of your heart. This increased resistance results in high blood pressure.

In an interview with Consumer Reports for the June 2017  issue of Journal Hypertension, I discussed healthy vascular aging. The research showed that more than 30% of people in their 50’s had signs of vascular aging; only 1% over 70 had healthy vascular aging.

The benefits of paying attention to high blood pressure, as soon as it appears cannot be over-stated.  Those pesky gray hairs and crows’ feet lines can be left alone or camouflaged; healthy vascular aging requires your most serious attention.

Here is some good news you can use from the reported research: healthy aging is more likely for women who are leaner, non- diabetic or taking cholesterol medication.  Colorful fruits are winners! They are an important part of the Mediterranean style DASH diet together with exercise to  help lower blood pressure. A healthy lifestyle also helps to promote healthy vascular aging.

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Santa Barbara is Refreshing!

Last month I crossed the country to Santa Barbara, for a dream vacation, with my husband; a weeklong retreat from city life that pushed us to relax our minds while working the rest of the body.

We hiked in good walking shoes, we soaked ourselves in sunscreen—even on cloudy days. We carried plenty of water bottles—and remembered to stay hydrated all day. We walked along the beaches and hiked   rocky and steep trails. My hiking sticks offer an upper body work out, to boot.

It was exercise with a double benefit; fabulous fun that helps lower a multitude of health risks, including heart attack, stroke and high blood pressure. The big bonus was my husband Robert’s talented and clever photographic eye. We have beautiful memories and proof that I practice what I preach!

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How can I control my blood pressure?


Blood pressure control is generally achieved by a combination of exercise and a heart healthy diet. For most people, The DASH diet is among the most effective diets to keep blood pressure under control. Those veggies are also good for the waistline!  More generally, diet in combination with physical activity, weight loss, lowering alcohol and meditation generally contribute to productive control of blood pressure.

Blood pressure that measures 140 over 90 or higher requires a doctor’s attention and personal medical advice. Sometimes (even with a healthy lifestyle,  blood pressure medications may be advised by your doctor in conjunction with diet and exercise.