ACE inhibitor

Water Will Help You With Weight Loss – Here Are the Most Current Fact-Based Reasons Why

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Water Will Help You With Weight Loss - Here Are the Most Current Fact-Based Reasons Why

Gaining weight is easy..taking it off is another matter.  There are certain action steps that we can take in our daily lives to help us achieve weight loss or any goal.  Assuming the goal is weight loss, drinking water each day is one action step towards that goal.  The trick is to be consistent and and follow-through.

How Does Water Help Promote Weight Loss?

The role water plays in weight loss is very important and here’s why: The kidneys require water to function properly and to expel toxins from the body.  When there is a lack of fluid (water), the kidneys can’t perform well and it needs the assistance of the liver.  The liver then, has the added burden of detoxing the body when it should be metabolizing fat stores.  This means that the liver is not metabolizing the fat in your body like it should be, thus, fat stores remain in the body and weight loss ceases.

What is the Most Recent Research?

There is abundant research showing water’s effect on fat metabolism in the body.  One such study (International Journal of Obesity, 2009) looked at whether weight loss was seen with the use of an ACE-Inhibitor – an ACE-Inhibitor reduces blood pressure.  They noted that rats given the ACE-Inhibitor in the study had lost fat despite eating the same amount.  The reason for this, they concluded, is that the rats treated with the ACE-Inhibitor drug drank twice as much water as untreated rats. Hydrated cells allow for better fat metabolism.  Dehydrated cells reduce their ability to take-up glucose. This inability to utilize glucose slows down our metabolism and energy allowing for weight gain.

Two recent studies (Boschmann M,, Steiniger J, 2003) using humans showed that when blood is diluted through water intake, the breakdown of fat (Lipolysis) in the body is promoted.  This further supports the notion that water, indeed, is a useful fat loss tool.

Dr. Michael Boschmann found that by drinking 500 ml of water, increased metabolic rate by 30% in both men and women.  The increase was observed 10 minutes after the consumption of water and the metabolic increase was sustained for over an hour!  They attributed this to the increased metabolic action of room temperature water warming-up to body temperature.  Additionally,  the large amount of water that dilutes the blood, promotes the release of adrenalin and norepinephrine to handle this demand. This metabolic process increases heat production and thus, burns calories.

Water Suppresses Your Appetite

Water acts as an appetite suppressant which helps prevent overeating, thus promoting weight reduction.  People who do not include water as part of their fat loss arsenal, are much hungrier because the brain has trouble differentiating between hunger and thirst.  This is why we tend to think we are hungry when in actuality, we are thirsty.

It is true that there is no one action that will promote fat loss, it is a combined strategy of consuming fewer calories, exercise, adequate sleep and hydration.  Remember to stay fully hydrated throughout the day with a minimum intake of 8 eight oz. glasses of water each day.

Novel agent outperforms ACE inhibitor in large HF trial

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The investigational agent LCZ696, an angiotensin receptor-neprilysin inhibitor (ARNI), has demonstrated superior efficacy to a widely used ACE inhibitor in the treatment of patients with chronic heart failure, according to a study presented at the recent European Society of Cardiology (ESC) Congress in Barcelona, Spain.

In the PARADIGM-HF* trial, LCZ696, a combination of the ARB valsartan and neprilysin inhibitor sacubitril, showed a significant 20 percent greater effect over enalapril 20 mg/day in reducing cardiovascular death or hospitalization for heart failure (21.8 vs 26.5 percent; p=0.0000002). [N Engl J Med 2014, e-pub 30 Aug, DOI: 10.1056/NEJMoa1409077]

When components of the composite primary endpoint were analyzed separately, LCZ696 demonstrated a 20 percent greater reduction in cardiovascular death (13.3 vs 16.5 percent; p=0.00004) and a 21 percent greater reduction in hospitalization for heart failure (12.8 vs 15.6 percent; p=0.0004) compared with enalapril.

“The trial was stopped early in April, after a median follow-up of 27 months, for an overwhelming benefit of LCZ696 on cardiovascular mortality,” said co-principal investigator Dr. Milton Packer of the Southwestern Medical Center in Dallas, Texas, US.

The ARNI also reduced all-cause mortality, a secondary endpoint of the trial, by an incremental 16 percent compared with enalapril (17 vs 19.8 percent; p<0.0001).

Symptoms and physical limitations of heart failure, measured on the Kansas City Cardiomyopathy Questionnaire (KCCQ) at 8 months, significantly improved in patients receiving LCZ696 vs enalapril (KCCQ score, -2.99 vs -4.63; p=0.001).

“Enalapril 20 mg/day is the current gold-standard therapy in CHF. Results of the PARADIGM-HF trial provide compelling evidence that LCZ696 should replace current use of ACEIs and ARBs in the management of patients with mild to moderately severe CHF,” said Packer.

“The major benefit of LCZ696 is that it changes the natural course of CHF,” he pointed out. “It doubles the benefit of current cornerstone treatment with ACEIs, which reduce cardiovascular death by 18 percent vs placebo.”

The PARADIGM-HF trial included 8,399 patients with class II to IV heart failure and an ejection fraction of 40 percent or below. The patients were randomized to receive LCZ696 200 mg twice daily (n=4,187) or enalapril 10 mg twice daily (n=4,212), in addition to recommended therapy.

“LCZ696 was better tolerated than enalapril,” reported Packer. “It was less likely than enalapril to cause cough, hyperkalemia or renal impairment, and less likely to be discontinued due to an adverse event.”

“Although more symptomatic hypotension was reported with LCZ696, this rarely required treatment discontinuation,” he continued. “Importantly, LCZ696 was not associated with an increased risk of serious angioedema, which was the main safety concern observed with a related medication known as omapatrilat in another trial.”

The survival advantage demonstrated in the trial has prompted the US FDA to grant Fast Track status to LCZ696. Its developer Novartis expects the FDA review to be completed by the end of 2014.

New Recommendations for Hypertension Management Released.

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New recommendations published online in the Journal of the American Medical AssociationExternal Link aim to provide guidance on the management of patients with hypertension. More specifically, the recommendations focus on when medication should be started in patients, the best choices for medications to begin treatment; and communicating achievable blood pressure goals to patients.

“Patients want to be assured that blood pressure (BP) treatment will reduce their disease burden, while clinicians want guidance on hypertension management using the best scientific evidence. This report takes a rigorous, evidence-based approach to recommend treatment thresholds, goals, and medications in the management of hypertension in adults,” the report authors note.

The report, written by panel members appointed to the Eighth Joint National Committee, notes there is strong evidence to support treating hypertensive persons aged 60 years or older to a BP goal of less than 150/90 mm Hg and hypertensive persons 30 through 59 years of age to a diastolic goal of less than 90 mm Hg. However, given insufficient evidence in hypertensive persons younger than 60 years for a systolic goal, or in those younger than 30 years for a diastolic goal, the panel recommends a BP of less than 140/90 mm Hg for those groups. “The same thresholds and goals are recommended for hypertensive adults with diabetes or nondiabetic chronic kidney disease (CKD) as for the general hypertensive population younger than 60 years,” the report notes.

In general, the report authors note that the 140/90 mm Hg definition from Joint National Committee 7 “remains reasonable” and recommend that lifestyle interventions be used for everyone with blood pressures in this range. “For all persons with hypertension, the potential benefits of a healthy diet, weight control, and regular exercise cannot be overemphasized,” they said. “These lifestyle treatments have the potential to improve BP control and even reduce medication needs.”

Also in the report, the authors note there is moderate evidence to support initiating drug treatment with an angiotensin-converting enzyme inhibitor, angiotensin receptor blocker, calcium channel blocker, or thiazide-type diuretic in the nonblack hypertensive population, including those with diabetes. In the black hypertensive population, including those with diabetes, a calcium channel blocker or thiazide-type diuretic is recommended as initial therapy. Additionally, there is moderate evidence to support initial or add-on antihypertensive therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in persons with CKD to improve kidney outcomes.

Moving forward, the authors point out that an algorithm included as part of the recommendations will facilitate implementation and be useful to busy clinicians. They also suggest that “the strong evidence base of this report be used to inform quality measures for the treatment of patients with hypertension.”

Practice guidelines are traditionally promulgated by the government or by learned medical professional societies. The JAMA paper is a report of a group experts in the field of hypertension, but it does not carry the endorsement of any organized body. Moving forward, these recommendations will be taken into account in the coming year as the ACC/AHA Task Force on Practice Guidelines moves forward with developing the collaborative model to update the national hypertension guidelines in partnership with the National Heart, Lung, and Blood Institute (NHLBI). According to the ACC and the American Heart Association (AHA), once a writing group is appointed, there will be an extensive science and evidence review process, followed by draft recommendations that will undergo a peer and stakeholder review. Once the review process is complete, the ACC/AHA and partnering organizations will publish the guidelines in 2015 for clinicians to follow as the national standard for hypertension prevention and treatment.

The ACC, AHA and the Centers for Disease Control and Prevention released a scientific advisory on the effective approach to hypertension in November that encourages use of enhanced, evidence-based, blood pressure treatment systems for providers, including standardization of protocols and algorithms, incentives for improved performance based on achieving and maintaining patients at blood pressure goals, and technology-facilitated clinical decision support and feedback.

Some Antihypertensives Linked to Breast Cancer Risk.

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 The first observational study of long-term antihypertensive use and breast cancer risk has found that calcium-channel blockers are associated with a more than 2-fold increased risk and that angiotensin-converting-enzyme (ACE) inhibitors are associated with a reduced risk.

These findings come from a study published online August 5 inJAMA Internal Medicine.

Women who had taken calcium-channel blockers for 10 years or more had more than double the usual risk for invasive ductal breast carcinoma (IDC) (odds ratio [OR], 2.4) and for invasive lobular breast carcinoma (ILC) (OR, 2.6). The researchers also observed a possible association between the long-term use of ACE inhibitors and reduced risks for both IDC (OR, 0.7) and ILC (OR, 0.6), although the risk estimate for IDC was within the limits of chance.

No Changes in Clinical Practice Recommended Yet

“We don’t think this should change clinical practice in any way. It was the first study of long-term antihypertensive use. It was an observational study, not a clinical trial. We can suggest an association, but we cannot infer any causal relation at this point,” lead author Christopher Li, MD, PhD, from the Fred Hutchinson Cancer Research Center in Seattle, told Medscape Medical News.

Dr. Li and colleagues interviewed women 55 to 74 years of age from the Puget Sound region — 880 with IDC, 1027 with ILC, and 856 without cancer (control group). Participants were interviewed in person to establish detailed histories of hypertension and heart disease and risk factors for cancer, including family history, obesity, smoking, and alcohol use. The researchers gathered data on the use of antihypertensive drugs, including beginning and end dates of use, drug names, dose, route of administration, pattern of use, and indication.

The antihypertensives included ACE inhibitors, angiotensin-receptor blockers, beta blockers, calcium-channel blockers, diuretics, and combination antihypertensive preparations, regardless of indication.

Calcium-channel blockers are among the most frequently prescribed medications in the United States; they accounted for nearly 98 million of the more than 678 million prescriptions filled in 2010.

Subjects who had used antihypertensives for 6 months or longer and were still using them were classified as current users, subjects who had used them for 6 months but were no longer using them were classified as former users, and subjects who had used them for less than 6 months were classified as short-term users.

In the regression analyses, potential confounders included age, county of residence, other commonly used medications, comorbid conditions (cardiovascular disease, diabetes, hyperlipidemia, depression), alcohol use, and estrogen-receptor status.

Increased Risk After 10 Years

“In examining duration effects for current users, we found an increased risk only in relation to the use of calcium-channel blockers for 10 years or longer, and an increased risk was observed for both IDC (OR, 2.4; 95% confidence interval [CI], 1.2 – 4.9; P = .04 for trend) and ILC (OR, 2.6; 95% CI, 1.3 – 5.3; P = .01 for trend). This association with 10 years or longer of current calcium-channel blocker use did not vary appreciably when results were further stratified by estrogen-receptor status,” the researchers report.

Dr. Li told Medscape Medical News that they were surprised by the magnitude of the risk associated with calcium-channel blockers and by the decrease associated with ACE inhibitors.

“We expected that we might see some increase in breast cancer risk with calcium-channel blockers, but not a more than doubling of the risk,” Dr. Li said. “The suggestion of an association between ACE inhibitors and reduction in breast cancer risk was a very unexpected finding and is worthy of follow-up.”

The mechanism behind the apparent calcium-channel blocker effect is not known, Dr. Li explained, but some researchers suspect that these drugs might increase cancer risk by inhibiting apoptosis.

“First-Rate Study,” But Confirmation Needed

“The data are persuasive because this was a first-rate study: it was population-based, large (1900 case patients and 856 controls), identified cases from the Seattle-area SEER surveillance system, had a high (80%) case response rate, and used best practices in ascertaining medication use from study participants,” Patricia F. Coogan, ScD, from the Slone Epidemiology Center at Boston University, writes in a related commentary.

“Given these results, should the use of calcium-channel blockers be discontinued once a patient has taken them for 9.9 years? The answer is no, because these data are from an observational study, which cannot prove causality and by itself cannot make a case for change in clinical practice,” Dr. Coogan explains.

“If the 2- to 3-fold increase in risk found in this study is confirmed, long-term calcium-channel blocker use would take its place as one of the major modifiable risk factors for breast cancer. Thus it is important that efforts be made to replicate the findings,” Dr. Coogan notes.

“We are cautious and don’t want to read too much into this, since this was the first study to look at long-term use of these medications. We need to see confirmation of the study before making any clinical recommendations,” Dr. Li emphasized.

Source: Medscape.com

Lowering Your Blood Pressure Using Drugs May Increase Your Risk of Death, Study Shows .

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Hypertension is dangerous if uncontrolled, increasing your risk for heart attack and stroke. But using drugs to lower your blood pressure may shorten your lifespan instead of extending it, according to the results of a University of Florida study.

The study, published in the Journal of the American Medical Association,1 suggests that when it comes to blood pressure medication, less is more.

This is another example of using drugs to “Band Aid” a health problem without addressing the underlying cause. There is a major difference between achieving a healthy blood pressure number by eating well, exercising and managing stress, versus “forcing” your body to produce that number with a drug.

Drugs promised to be safe have, on many occasions, done more harm than good, yet blood pressure medications join sleeping pills and painkillers as some of the most popular drugs in America.

Be Careful—Blood Pressure Drugs May Backfire On You

The featured study was performed on individuals age 50 and up who had been diagnosed with both type 2 diabetes and CAD (coronary artery disease). The standard hypertension guidelines for diabetics suggest maintaining a systolic blood pressure under 130 mm Hg, but there is little data for the growing number of diabetics who also have CAD. This study aimed at filling that informational gap.

Each person in the study received one or more blood pressure medications (a combination of calcium antagonist, beta-blocker, ACE inhibitor, and diuretic) in whatever combination required to achieve a systolic blood pressure less than 130 mm Hg.

Researchers discovered that tighter control of blood pressure in these patients was NOT associated with better outcomes! The uncontrolled group fared worst, which wasn’t surprising. But the group whose systolic blood pressure was held between 130 and 140 actually showed a slightly lower risk of death than the group whose systolic was maintained at the recommended level—under 130 mm Hg. The authors write:2

“In this observational study, we have shown for the first time, to our knowledge, that decreasing systolic BP to lower than 130 mm Hg in patients with diabetes and CAD was not associated with further reduction in morbidity beyond that associated with systolic BP lower than 140 mm Hg, and, in fact, was associated with an increase in risk of all-cause mortality. Moreover, the increased mortality risk persisted over the long term.”

Tight Control Group

12.7 percent risk for death

Usual Control Group

12.6 percent risk for death

Uncontrolled Group

19.8 percent risk for death

Is It ‘Pharmageddon’?

This isn’t the first time pharmaceutical drugs have backfired. In fact, prescription drugs now kill more people than illegal drugs. Death by prescription drugs is a 21st-century epidemic, now killing even more Americans than motor vehicle accidents.

Drug fatalities more than doubled for teens and young adults between 2000 and 2008, and more than tripled among people age 50 to 69. It’s estimated there are 450,000 preventable adverse events related to medications in the U.S. every year, accounting for a substantial proportion of emergency room visits.

In a June 2010 report in the Journal of General Internal Medicine, almost a quarter of a million deaths resulted from in-hospital medication errors between the 1976 and 2006, based on a review of 62 million death certificates.

This doesn’t include the people who died after taking drugs exactly as prescribed! And when you add in deaths from hospital-acquired infections, unnecessary medical procedures, and adverse surgical outcomes, conventional medicine should top the list of the leading causes of death in the United States.

The Little-Known Connection Between Carbohydrates and Your Blood Pressure.

The good news is, the vast majority of you don’t need prescription drugs to normalize your blood pressure. In most cases, hypertension can be reversed with a few basic adjustments to your diet and lifestyle.

Are you on a high grain, low fat regimen? If so, I have bad news for you. This nutritional regimen is a prescription for many to develop hypertension. For years I’ve been advocating avoiding wheat, and this advice is finally making its way into the mainstream. The LA Times just featured an article discussing how wheat (and low-fat diets) contribute to inflammation, heart disease, diabetes, joint pain and many other chronic health problems. Cardiologist William Davis is quoted as saying:3

“Eat more fat. Eat as little grain as possible. Grains don’t really belong in the human experience.”

This is not new information. Scientific research published way back in 1998 in the journal Diabetes reported that nearly two-thirds of the test subjects who were insulin resistant also had high blood pressure. Insulin resistance is directly attributable to a high sugar, high grain diet, especially if accompanied by inadequate exercise.

So, chances are that if you have hypertension, you also have poorly controlled blood sugar levels, because these two problems often go hand in hand. As your insulin level increases, so does your blood pressure.

Along with excessive carbohydrates, most people are consuming inadequate dietary fats, in terms of both quality and quantity. Contrary to what you’ve been told, glucose is not the preferred fuel of human metabolism—fat is. And fat doesn’t make you fat—excess carbohydrates make you fat. I believe that most people would benefit by consuming around 50 to 70 percent of their diet as beneficial fats. Sources of healthy fats include

Olives and Olive oil (for cold dishes)

Coconuts, and coconut oil (for all types of cooking and baking)

Butter made from raw grass-fed organic milk

Raw nuts, such as, almonds or pecans

Organic pastured egg yolks

Avocados

Pasture finished meats

Palm oil (make sure it’s the eco-friendly variety!)4

Unheated organic nut oils

My Prescription for Achieving Healthy Blood Pressure WITHOUT Drugs

  • Replace most of your carbs with non-starchy vegetables and replace the lost calories with healthy fats as mentioned above
  • Normalize your omega 6:3 ratio. Both omega-3 and omega-6 fats are essential for your health. Most Americans, however, are getting too much omega-6 and too little omega-3 in their diets. Consuming omega-3 fats is one of the best ways to re-sensitize your insulin receptors if you suffer from insulin resistance. Omega-3 fats are also important for strong cell membranes and good arterial elasticity. The best sources of omega-3 fats are fish and animal products. Unfortunately, most fresh fish today contains dangerously high levels of mercury. Your best bet is to find a safe source of fish, or if this proves too difficult, supplement with a high quality krill oil.
  • Eliminate caffeine. The connection between caffeine consumption and high blood pressure is not well understood, but there is ample evidence to indicate that if you have hypertension, coffee and other caffeinated drinks and foods can ex­acerbate your condition.
  • Consume fermented foods. Disturbances in gut flora appear to be a significant factor in the development of heart disease, as well as in many other chronic health problems. The best way to optimize your gut flora is by including some naturally fermented foods in your diet, such as sauerkraut and other fermented vegetables, yogurt, kefir, cheese and natto. Fermented foods (especially gouda and edam cheeses) are an important source of vitamin K2, which plays a crucial role in protecting your heart and brain.
  • Optimize your vitamin D level. Vitamin D deficiency has been linked to metabolic syndrome, as well as to high blood pressure. Vitamin D is a negative inhibitor of your body’s renin-angiotensin system (RAS), which regulates blood pressure. If you’re vitamin D deficient, it can cause inappropriate activation of your RAS, which may lead to hypertension. Ideally, you’ll want to get your vitamin D by safely exposing your skin to the sun, or using a safe tanning bed. If those are not possible, then consider taking a vitamin D3 supplement.
  • Make exercise a priority. A comprehensive exercise regimen such as my Peak Fitness program is very important in maintaining a healthy cardiovascular system. Your routine should incorporate high-intensity burst-type exercises and weight training one to three times a week, as these have been shown to be even more effective than aerobic exercises at reducing your risk of dying from a heart attack.
  • Get Grounded. Lack of grounding, due to widespread use of rubber or plastic-souled shoes, is likely contributing to chronic inflammation today. When you walk on the earth barefoot there is a massive transfer of beneficial electrons rom the Earth into your body. Experiments show that walking barefoot outside improves blood viscosity and blood flow, which help regulate blood pressure.So, do yourself a favor and put your bare feet upon the sand or dewy grass to harness the healing power of the Earth.
  • Manage your stress. It’s a well-known fact that stress elevates blood pressure, so controlling stress is an essential element of good heart health. My preferred stress-busting tool is Emotional Freedom Techniques (EFT), which is easy to learn and easy to use. However, you might find other methods like yoga, meditation, or prayer, equally effective.

Final Words

High blood pressure is reaching epidemic proportions in the Western world. Hypertension is best addressed using a natural approach, as opposed to a cocktail of prescription drugs that may actually backfire on you. One study showed that tighter control of blood pressure using pharmaceutical drugs is NOT associated with better outcomes and in fact may shorten your lifespan. Lifestyle changes, with particular emphasis on normalizing your insulin levels, will put you on the safest and most reliable path toward optimal health.

Source: mercola.com

ACE Inhibitor, ARB, or Both in Diabetic Renal Disease?

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Dual therapy with angiotensin-converting–enzyme inhibitors plus angiotensin-receptor blockers was no better than monotherapy.

Some clinicians prescribe combinations of angiotensin-converting–enzyme (ACE) inhibitors plus angiotensin-receptor blockers (ARBs) for patients with type 2 diabetes, on the premise that dual blockade of the renin–angiotensin system will slow progression of diabetic nephropathy more effectively than single-agent therapy. In this study, researchers randomized 133 type 2 diabetic patients with nephropathy to receive lisinopril (titrated to 40 mg daily), irbesartan (titrated to 600 mg daily), or combined therapy (titrated to 20 mg and 300 mg, respectively). Inclusion criteria included stage 2 or 3 kidney disease and urine protein-creatinine ratio >300 mg/g. At baseline, mean blood pressure was 153/81 mm Hg, and mean serum creatinine level was 1.5 mg/dL.

After a median follow-up of 32 months, the incidence of the primary composite endpoint (50% increase in serum creatinine level, progression to end-stage renal disease, or death) was virtually identical in the three groups ({approx}30%). Frequencies of each of the three individual endpoints and degree of blood pressure lowering also were similar in all groups.

Comment: This study, although small, suggests that combining an ACE inhibitor and an ARB confers no benefit in type 2 diabetic patients with nephropathy. Recall that, in the huge ONTARGET trial (in which enrolled patients had atherosclerotic disease or diabetes), an ACE inhibitor plus an ARB also failed to delay progression of renal dysfunction compared with an ACE inhibitor alone (JW Gen Med Sep 2 2008).

Source: Journal Watch General Medicine

ACE Inhibitor Use Lowers Risks for Pneumonia.

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A meta-analysis showed that angiotensin-converting–enzyme inhibitors, but not angiotensin-receptor blockers, lowered risk.

Many patients (as many as one third) who take angiotensin-converting–enzyme (ACE) inhibitors develop coughs. However, an enhanced cough reflex might lower risk for pneumonia. In this meta-analysis of 37 studies (18 randomized trials, 11 cohort studies, and 8 case-control studies), investigators evaluated the association between use of ACE inhibitors or angiotensin-receptor blockers (ARBs) and risk for pneumonia.

Overall, use of ACE inhibitors was associated with a significant 34% lower risk for pneumonia compared with no use of ACE inhibitors and a significant 30% lower risk for pneumonia compared with ARB use. Subgroup analyses of patients with stroke or heart failure yielded similar results. Finally, use of ACE inhibitors compared with no use was associated with a significant 27% lower risk for pneumonia-related death.

Comment: In this study, ACE inhibitor use was associated with attenuation of risks for pneumonia and pneumonia-related death. The authors suggest that “patients taking ACE inhibitors who develop cough should, providing that cough is tolerable, persist with treatment.” Although this suggestion is reasonable (especially because ACE inhibitors confer considerable cardiovascular benefit), many patients with ACE inhibitor–related cough find this side effect too annoying or disruptive to continue taking the drug.

Source: Journal Watch General Medicine