Fenugreek Fights Diabetes, Heart Disease And Obesity

Although fenugreek seeds are used extensively in the recipes of countries in the Middle and Far East, in the West it is not as well known as many other spices. Not only does fenugreek impart a characteristic flavour and tang to food but it also has several very important disease preventing characteristics.

In traditional medicine, fenugreek has been used to treat a number of conditions including diabetes, sore throats, and in poultices used to treat sores and abscesses. Recent investigations into the medicinal properties of this spice suggest it is important not only as a preventive for chronic diseases such as diabetes, but also for enhancing normal physiological processes, especially with respect to athletic performance.

As with most spices it contains many antioxidant and anti-inflammatory compounds such as apigenin, genistein, kaempferol, quercetin, rutin, selenium and superoxide-dismutase. It also contains compounds such as trigonelline that has shown to prevent the degeneration of nerve cells in neuro-degenerative diseases.

Medicinal properties of fenugreek

Cardiovascular disease and blood lipids: Fenugreek has a strong modulating effect on blood lipid levels and can substantially reduce the risk of atherosclerosis. In diabetics, who usually suffer lipid imbalances, it has demonstrated a remarkable ability to lower cholesterol, triglycerides and LDL levels while raising HDL levels.

Another property of fenugreek is the reduction of platelet aggregation which, in turn, dramatically reduces the risk of abnormal blood clotting associated with heart attacks and strokes. Like most spices, fenugreek also contains many important antioxidants and has the added benefit of protecting other dietary and internally produced antioxidants from free-radical damage. This has important cardioprotective benefits, as well as helping to fortify the body against a range of other chronic conditions.

Diabetes: Fenugreek, which has comparable antidiabetic potency to cinnamon, is one of the most valuable spices for the control of glucose metabolism and thus the prevention and treatment of Type II diabetes. Owing to its many properties it helps in the prevention and treatment of diabetes in several ways.

Working in a similar way to the common antidiabetic drug glibenclamide, fenugreek lowers cellular insulin resistance and controls blood glucose homeostasis. It has been shown to lower blood glucose levels of Type II diabetics by as much as 46 percent.

It also increases the levels of several important antioxidants and reduces the damaging oxidation of lipids associated with diabetes.

As an added bonus, fenugreek seeds are a very rich in a type of dietary fibre that modulates post-prandial blood glucose levels by delaying the absorption of sugar in the intestines. This mucilaginous fiber also reduces the absorption of fat and cholesterol from the intestines thus providing additional protection against heart disease and obesity.

Cataracts: Fenugreek is also effective against diabetes-related cataracts which occur commonly in diabetics. The enzymes that control glucose uptake into the lens of the eye do not function normally in diabetics and, as a result, glucose and its metabolites, fructose and sorbitol, accumulate in the lens tissues. The lenses of diabetic patients are also prone damage by enzymes that would normally protect against destructive free radicals, and a combination of these factors leads to the gradual opacification of the lens known as a cataract. As fenugreek has been shown to partially reverse both the metabolic changes in the lens and to reduce the density of the cataract, it is likely to be even more effective as a prophylactic agent against cataract formation in diabetics.

Alzheimer’s and other neuro-degenerative diseases: Fenugreek contains the compound trigonellene that has shown to stimulate the regeneration of brain cells. This property has stimulated further research to see whether it can help in the prevention of diseases such as Alzheimer’s and Parkinson’s diseases.

Sport: One of the greatest difficulties facing athletes who compete in endurance events is maintaining a readily available supply of energy in the body. In order to achieve this, muscle carbohydrate stores, in the form of glycogen, must be continuously replenished. In an event lasting more than one-and-a-half hours, glycogen stores become depleted, and for the remainder of the event the athlete has to rely on external sources of energy, such as high carbohydrate drinks, which are inferior to glycogen as an energy source. Post event re-synthesis of glycogen is also very important, and the two hours immediately following prolonged exercise is the crucial time for this process to occur.

Fenugreek has been shown to have a strong effect on glycogen replenishment; increasing post-event re-synthesis by over 60 percent in some endurance athletes. While its effects on glycogen re-synthesis during an event have yet to be tested, fenugreek is likely to exhibit a similarly beneficial effect during, as well as after, exercise.

Hormones: Fenugreek is one of the richest sources of phytoestrogens and is thus a very useful spice for women who have low oestrogen levels. Phytoestrogens are also thought to help protect against certain types of cancer, and fenugreek may well be proven to have anti-tumourigenic effects should this property be investigated in the future.

Selenium: Fenugreek is one of the richest sources of selenium, which is among the most important antioxidant micronutrients. When consumed regularly, selenium appears to have a protective effect against a range of cancers, including those of the colon, lung and prostate. Recent evidence also shows that selenium helps to prevent the progression of HIV and other chronic viral illnesses.

While other spices like chilies and cinnamon hold the culinary and medicinal headlines, the research into fenugreek is showing us that this spice has health benefits on a par with, or even superior to, those of the better known spices.

However it is important to appreciate that synergism between different spices enhances the bioavailability and efficacy of their respective bioactive compounds. Therefore, to obtain optimum benefit from fenugreek, it is important to use it with other common spices in both the prevention and treatment of disease.

Acai Berry With Heart Medications

Can acai berry mend a broken heart? If the broken heart pertains to a heart disease that continues to be one of the leading causes of deaths, acai may help tame it before it becomes a full blown killer.

Heart diseases encompass a variety of conditions relating to the cardiovascular system. It may involve the ability of your heart to pump out blood, its valves, your blood vessels, and more instances that compromise the function of your heart.

Below are some of the most common heart conditions that warrant urgent attention:

Myocardial Infarction or heart attack
It happens when the cells of the heart die due to the disruption of its blood supply. The formation of cholesterol plaques contributes a great deal to the blockage of the coronary blood vessels. When the blood flow is compromised, there is no delivery of oxygen to the tissues, leading to cell death.

Hypertension or high blood pressure
When it requires more force to get the blood flowing, you get a high blood pressure. It makes the heart work harder to pump blood effectively to all organs in the body. Hypertension can be due to other coexisting diseases such as diabetes, kidney problems, arteriosclerosis, etc. Genetics play a significant role in primary hypertension.

Arteriosclerosis
It involves the blood vessels, particularly the arteries, and its ability to deliver blood to the organs. The arteries in this case have hardened due to the build up of plaques from fatty substances. This makes the vessels less flexible which makes it harder for blood to flow. When the plaques break apart, they travel in the bloodstream towards smaller arteries, where they may cause a complete blockage. This is how it contributes to heart attacks, stroke, and common heart conditions.

High Cholesterol
Chlolesterol makes up a part of the bodys lipids. It is vital to the structure of cells, and in the production of hormones and energy. When the levels go up, it creates problems in the blood vessels. The arteries are hardened and blocked. In turn, the blood pressure rises just to be able to push adequate blood for delivery to the organs. When the heart doesnt receive adequate amount of blood supply, heart attack can occur.

Heart Failure
The heart functions to pump blood into the body. When it fails, it doesnt mean that it has stopped beating. It just lost its ability to function efficiently, affecting all organs in the long run. The blood goes back to the lungs instead of pushing it forward. Breathing becomes laborious. Fluid accumulates in the dependent portions of the body like the feet.

How Can Acai Save You From A Broken Heart?

Acai berry (Euterpe oleracea), a superfood from the Amazon, offers hope for those with heart problems.

Acai is rich in fatty acids, giving it the oily feel. It contains 2 essential fatty acids called Omega 6 (Linoleic acid) and Omega 9 (Oleic acid). The Omega 6 is a polyunsaturated essential fatty acid that lowers both LDL (bad cholesterol) and HDL (good cholesterol) levels. The Omega 9, which is a monounsaturated, essential fatty acid, helps lower only the LDL, while maintaining a good level of HDL.

Acai is also unusually rich in beta-sitosterol, which is a phytosterol that competes with dietary cholesterol for absorption, hence reducing blood cholesterol. The high fiber content of acai berries may likewise reduce bad cholesterol levels.

The dark pigmentation of acai is attributed to anthocyanins, which are potent antioxidants. Even in trace amounts, anthocyanins effectively protect against LDL oxidation. The anti-oxidant properties of acai help heal the cell membranes and linings of arterial wall and help protect the integrity of smaller blood vessels. This prevents the development of arteriosclerosis and the subsequent increase in blood pressure.

Free radicals can speed up the process of arteriosclerosis and aggravate ischemia (the lack of oxygen supply to an organ). With the rich anti-oxidant content of acai, the damaging effects of the free radicals are taken cared of.

Be careful when choosing among the many acai supplements available in the market. The juice form uses other ingredients and preservatives, with only little concentration of acai. It has undergone the irradiation which is something you may want to avoid. The pill form, on the other hand, contains 100% acai, without preservatives. It has not undergone any procedures known to harm your health.

Can I Take Acai Together with my Heart Medications?

With early prevention, acai can lessen your need for expensive heart medications. However, if maintenance drugs should be used, no data has been found as to the drug-drug or drug-food interactions with acai and the common heart conditions.

Be cautious when taking medications containing anti-coagulants or blood thinners because acai contains vitamin k, which exerts the opposite effect.

Potassium is abundant in acai, so you might as well be careful with drugs reacting to potassium:
ACE-inhibitors which are used for the treatment of hypertension. Examples are captopril, enalapril, lisinopril. Potassium levels may increase further with ACE inhibitors especially those with diminished kidney function.
Potassium-sparing diuretics like spironolactone, triamterene, or amiloride may increase potassium levels in the blood.
Heparin which is a blood thinner, used for the prevention of heart attacks. Potassium levels may be further increased with concomitant use of acai, aside from with the antagonistic effect of vitamin K present in acai.
Beta blockers such as metoprolol and propranolol that are used to treat high blood pressure can potentially increase blood potassium levels when mixed with acai.

The high amount of calcium in acai may create potential reactions with certain medications:
Beta-blockers. Calcium may interfere with the blood levels of beta-blockers and vice versa.
Calcium-channel blockers are a class of anti-hypertensives. Calcium may reverse the therapeutic effects of calcium-channel blockers, although studies are conflicting.
Digoxin is used to treat irregular heart rhythms. Calcium may make this drug ineffective.
Anti-cholesterol drug, particularly bile acid sequestrants such as cholestyramine, colestipol, and colesevelam, may interfere with calcium absorption and increase loss of calcium in the urine.

Anti-oxidants in general, are not advised to be taken along with most chemotherapeutic agents that act by producing free radicals to kill the tumor.

There are no documented effects of the above drugs interacting with acai berry supplements, only possible risks. Nonetheless, caution must be taken to avoid untoward reactions.

Chronic Obstructive Pulmonary Disease. Copd

Plan of Attack
Definitions
Epidemiology
Goals of Management
Diagnosis
Managing Stable COPD
Managing Acute Exacerbations of COPD

A disease state characterized by airflow limitation that is not fully reversible. Airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Symptoms, functional abnormalities, and complications of COPD can all be explained on the basis of this underlying inflammation and the resulting pathology.
Definitions
Chronic Bronchitis (clinical)
Sputum production more days than not for at least 3 months a year for at least 2 years
Emphysema (pathologic)
Parenchymal destruction airspace walls distal to terminal bronchioles, without fibrosis
Important: You can have either, but to have COPD you MUST demonstrate obstruction (thus the O in COPD)

Epidemiology
Fourth leading cause of death in U.S.
100,000 American deaths each year
15-20% of chronic smokers develop COPD
2.5% mortality for COPD hospital admissions
COPD with acute respiratory failure:
24% in hospital mortality
59% one year mortality
If you have COPD and PaCO2 > 50mmHg:
67% chance of being alive in 6 months
57% chance of being alive in 12 months

Diagnosis
Symptoms
Dyspnea
Sputum production (especially in the morning)
Recurrent acute chest illnesses
Headache in the morning possible hypercapnia
Cor pulmonale (Right heart failure)

Goals Of Management
Identifying and ameliorating (if possible) the cause of the acute exacerbation
Optimizing lung function by administering bronchodilators and other pharmacotherapy
Assuring adequate oxygenation and secretion clearance
Averting the need for intubation, if possible
Preventing complications of immobility, such as thromboemboli and deconditioning
Addressing nutritional needs at the time of the acute illness, most patients are in negative nitrogen balance, which is exacerbated by steroid therapy

Diagnosis:
Signs
Prolonged expiratory time
Expiratory wheezes
Increased AP diameter of chest
Decreased breath sounds (especially upper lung fields)
Distant heart sounds
End stage: accessory muscles, pursed lip breathing, cyanosis, enlarged liver and pedal edema (in case of cor pulmonale).

Diagnosis
Radiology
Chest X-ray
Hyperinflated lung fields more radiolucent
Bullae, often bilateral upper lobes in smokers
Flat diaphragms (best seen on lateral) and retrosternal airspace can indicate air trapping
High Resolution CT of Chest
Most sensitive to detect above changes
No role in routine care of COPD patients
Can be useful for giant bullous disease surgeries or lung volume reduction surgery planning

Diagnosis
Pulmonary Function Testing
Spirometry: Decreased FEV1/FVC
FEV1 percent predicted defines severity
Lung volumes: Increased TLC, RV, RV/TLC
DLCO: Decreased

Gold Staging Criteria
Stage O: Normal spirometry; chronic sx
Stage 1 (Mild):
FEV1/FVC 80% predicted
Stage 2 (Moderate):
FEV1/FVC
2A: FEV1 50-80% predicted
2B: FEV1 30-50% predicted

Diagnosis
Stage 3 (severe):
FEV1/FVC
FEV1
FEV1

Diagnosis
American Thoracic Society Spirometry
Low FEV1/FVC defines obstruction
FEV1%predicted Category

35-50% Severe
50-60% Moderately Severe
60-70% Moderate
70-80% Mild
80-100% Mild vs. Normal variant
> 100% Normal

Managing Stable COPD
Smoking Cessation Is KEY!
YOUR intervention will make a difference must address at each visit
Medication
Two therapies ONLY have been shown to improve mortality in stable COPD:
1) Smoking Cessation
2) Oxygen Therapy

Bronchodilator Technique
MDIs get better drug deposition than nebs
Use a spacer device with MDIs
Technique is key important for patient and doctor
Inadequate dosing can hamper treatment

Sympathomimetics
Beta-2 selectivity is good
Some additive vs. slightly synergistic effects of combining beta-2 agonist and ipratropium (Combivent)
Some data to support decreased H.influenzae pneumonia incidence with Serevent
Anticholinergic Agents (Atrovent, glycopyrrolate)
Similar ability to bronchodilate (in appropriate doses) as beta-agonists
Also reduces sputum volume; no change in viscosity
Usually under dosed
Recommend 2 (36 mcg) puffs qid
glycopyrrolate which is manufactured for IV/IM use for other indications, is available only “off label” for nebulized use in COPD (1 to 2 mg every two to four hours).
Aminophylline and theophylline are not recommended for the management of acute exacerbations of COPD. Randomized controlled trials of intravenous aminophylline in this setting have failed to show efficacy in excess of that afforded by therapy with inhaled bronchodilators and corticosteroids

Mucokinetic agents
There is little evidence supporting the use of mucokinetic (mucolytic) agents, such as N-acetylcysteine or iodide preparations, in acute exacerbations of COPD. In fact, some drugs of this class may worsen bronchospasm.

Oxygen. Yes.
Demonstrated to improve exercise performance, symptom indices and mortality
Goal in hypercapnic patients for SpO2 need not be greater than 88-90%
Always test COPD patients for oxygenation with ambulation if baseline at rest room air SpO2 ok

Systemic Corticosteroids
Never demonstrated to significantly impact mortality or exercise capacity
Slight improvements in symptom indices
Significant side effects
Rarely of benefit, generally of harm to your patient
Occasionally useful in a small subset failing other therapies AND with demonstrated bronchodilator response on PFTs

Inhaled Corticosteroids
Jury still out
Lots of recent research with some favorable data supporting its use
May be part of standard regimens in the future

Vaccines
Pneumovax, annual flu shots
Chronic antibiotic therapy BAD IDEA
Nutritional status Important
Pulmonary Rehabilitation
Improved exercise capacity, symptom scores
Lung Volume Reduction Surgery
Transplant

Managing Acute Exacerbations of COPD
Common precipitants:
Infection esp viral or bacterial
Acute bronchospasm
Sedation

Who To Admit
Countless studies, few definite answers
Worsening hypoxemia and/or hypercapnia
Otherwise, mostly a clinical decision
Key points to consider:
Oxygen
Bronchodilators
Steroids
Antibiotics

Albuterol:
Neb or MDI neb MAY be better in acute setting, but MDIs have better drug deposition overall
Continuous nebulizer treatments confer no benefit over treatments every 1-2 hours
Generally should avoid subcutaneous beta-agonists
BEWARE: Hypokalemia, tachycardia (occasional)
Levalbuterol still with weak clinical data few situations where it is clinically indicated

ATROVENT (anticholinergic bronchodilator)
Bronchodilation
May decrease secretions
Few significant side effects
Usually significantly under dosed emerging data supports much higher doses than usually used currently

Corticosteroids Parenteral corticosteroids are frequently used in treating acute exacerbations of COPD. Methylprednisolone (60 to 125 mg intravenously, two to four times daily) or the equivalent glucocorticoid dose of other steroid preparations commonly is given.
Corticosteroids Utilization in this setting was initially based upon small randomized trials in which only a minority of patients benefit and the degree of improvement is modest
A randomized, placebo-controlled trial of 271 patients has confirmed the benefits of systemic corticosteroids given for up to 2 weeks to hospitalized patients with COPD exacerbation

Antibiotics
Winnipeg Criteria (give for 2-3 of the following):
Increased cough
Increased purulence
Increased sputum production
Antibiotics accelerate improvement in peak expiratory flow rates and lessen the rate of recrudescence in this setting
Amoxicillin, Doxycycline, TMP/SMX, Azithromycin, Clarithromycin, Levaquin for 10 days

Mucokinetic Agents JUST SAY NO.
N-acetylcysteine is actually contraindicated in patients with airway obstruction
No significant clinical benefit ever demonstrated
Chest PT, intermittent positive pressure breathing and postural drainage may actually be harmful in the setting of acute obstruction

Methylxanthines (Theophylline, Aminophylline)
Not recommended for acute exacerbations
No significant benefit ever demonstrated in large, prospective trials

Oxygen: YES!
Generally a good thing cells like that stuff
If requiring a significant increase in FiO2 over baseline requirement, start hunting for something other than just COPD exacerbation
BEWARE of CO2 RETAINERS! (goal SpO2 90%, PaO2 of 60 to 65 mmHg )
1) Altered V/Q relationships
2) Haldane effect (Hgb*O2 holds less CO2 goes out into plasma)
3) Decreased ventilatory drive (least impt mechanism)

Non-Invasive Positive Pressure Ventilation
BiPAP
Set FiO2, inspiratory (IPAP) and expiratory (EPAP)
Difference between IPAP and EPAP augments tidal volume, therefore improving minute ventilation. CO2 then gets blown off
MORTALITY BENEFIT in patients who will tolerate

Mechanical Ventilation
Respiratory distress
Acidemia that does not correct quickly with therapy
Inability to oxygenate adequately
Often a clinical decision relative to patients work of breathing