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ALCOHOL

GENERAL RESEARCHLIFESTYLE

ALCOHOL AND THE RISK FOR HYPERTENSION

Do you know what is funny? How people think alcoholic beverages can be taken without caution because most of them seem to be bitter.

So, you see people taking bottles/cans of beer, and shots of spirits at a sitting, feeling it won’t be detrimental to their health.

Our work-hard-party hard kind of lifestyle has made it possible for the risk of hypertension to be increased especially among youths. Hypertension is a lifestyle disease, so we must all be able to look at our lifestyle and make a change to it.

Also, the idea that alcohol is a stress reliever, makes it possible for people to consume without caution which in turn hurts the liver and brain, possibly leading to hypertension

WHAT IS THE LINK BETWEEN ALCOHOL INTAKE AND HYPERTENSION?

Alcohol is one of the modifiable ways to reduce hypertension. The link between alcohol and hypertension is clear as alcohol is a major contributory factor in hypertension

Studies have shown that taking more than three alcoholic drinks a day can increase the chance of developing hypertension in later life by up to 75%.

Alcohol has both direct and indirect links to hypertension: It can cause you to gain weight which is linked to hypertension, and it can also directly affect your blood pressure readings.

Furthermore, alcohol may stimulate adrenals which release adrenaline. When adrenaline is released, it leads to increased cardiac output, increased heart rate, and increased systolic blood pressure.

BUT RED WINE IS GOOD FOR MY HEART?

Well, several past studies have made this popular. The idea behind this is that grapes used in making red wine contain reservatol and can help keep the heart and provide other benefits. But truly, the amount of reservatol in red wine is affected by the processing, fermentation, and even aging of wine and cannot be sufficient to provide any heart health benefits as purported.

It is important to pay attention to your lifestyle: quit binge drinking, reduce or stop consumption of alcohol if you’re on blood pressure medications or have a family history, try abstinence!

SOURCES:

– https://www.medanta.org/patient-education-blog/the-truth-about-alcohol-and-hypertension/#:~:text=Drinking%20too%20much%20alcohol%20can,doubles%20the%20risk%20of%20hypertension.

– https://pubmed.ncbi.nlm.nih.gov/18259032/

– https://www.drugsandalcohol.ie/24301/1/Alcohol-and-Hypertension_Factsheet.pdf

– https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4038773/#:~:text=It%20is%20possible%20that%20alcohol,oxidative%20injury%20to%20the%20endothelium.

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DIET THERAPY OF DISEASES

Cholelithiasis: Treatment Options

Stones form in different organs in the body due the retention of excess types of minerals in the body that can easily crystallise if there is insufficient fluid around to dissolve them.
Cholelithiasis is one condition that affects the bile duct and gall bladder. In cholelithiasis, hard stones composed of cholesterol or bile pigments form in the gall bladder (choleccystolithiasis) or in the bile duct (choledocholithiasis). In the US alone, about 9% of women and 6% of men have gallstones, and most are asymptomatic. While in the south western region of Nigeria, Ibadan, the prevalence of cholelithiasis is 2.1%.
When the concentration of cholesterol rises to the point of supersaturation, crystallization occurs. In other parts where stones form, stones could be composed of calcium, oxalate, uric acid, struvite. But in this case, stones are composed of cholesterol. A sludge containing cholesterol, mucin, calcium salts, and bilirubin forms, and, ultimately, stones develop. This occur when the concentration of cholesterol rises so high to the point of supersaturation. Normally, in bile, cholesterol leves are at equilibrium with bile salts and phosphatidylcholine.
Although gallstones are typically asymptomatic (they show no symptoms), some cause biliary colic, in which stones intermittently obstruct the neck of the gallbladder and cause episodes of abdominal pain. Chronic obstruction may result in cholecystitis (infection and inflammation of the gallbladder) or cholangitis (infection and inflammation of the common bile duct). Both of which are very serious and, if untreated, may result in sepsis, shock, and death.

Presenting symptoms include episodic right-upper-quadrant or epigastric pain, which often occurs in the middle of the night after eating a large meal and may radiate to the back, right scapula, or right shoulder. Diaphoresis, nausea, vomiting, dyspepsia, burping, and food intolerance (especially to fatty, greasy, or fried foods; meats; and cheeses) are common. More severe symptoms, including fever and jaundice, may signify cholecystitis or cholangitis.

What Are the Possible Risk Factors?
1. Family history: there is every tendency to develop gallstones if there is a family history. In short, it is twice as more in rates.

2. Increasing age: Gallstones are mostly very common in individuals above the age of 40.

3. Female sex: with the presence of the hormone estrogens in female, they are more likely to develop gall stones at all age groups. This increased risk is most notable in young women, who are affected 3-4 times more often than men of the same age.

4. Elevated estrogen and progesterone: During pregnancy, oral contraceptive use, or hormone replacement therapy, estrogen and progesterone induce changes in the bile duct that predispose one to gallstones.

5. Obesity: Due to the elevated secretion and production of cholesterol in obese individual, they are at high risk of developing gall stones.

6. Rapid weight loss: Bariatric surgery and very-low-calorie diets adopted for weight loss regimes can increase risk of gallstone formation, possibly due to increased concentrations of bile constituents.

7. Diabetes mellitus: Hepatic insulin resistance and high triglycerides may increase risk of gallstones.

8. Gallbladder stasis: When bile remains in the gallbladder for an extended period, supersaturation can occur. Gallbladder stasis is associated with diabetes mellitus, total parenteral nutrition (probably due to lack of enteral stimulation), vagotomy, rapid weight loss, celiac sprue, and spinal cord injury.

9. Cirrhosis: Cirrhosis i.e scarring of the liver tissues, increases the risk of developing gall stones 10 times more.

10. Medications: Drugs implicated in the development of cholelithiasis include clofibrate, octreotide, and ceftriaxone.

11. Physical inactivity: Exercise may reduce gallstone risk. Findings from the Health Professionals Follow-Up Study suggested that the risk of symptomatic cholelithiasis could be reduced by 30 minutes of daily aerobic exercise. Young or middle-aged men (65 years or younger) who were the most physically active had half the risk for developing gallstones, compared with those who were least active. In older men, physical activity cut risk by 25%. Physical activity is also associated with reduced gallstone risk in women.

How can it be Diagnosed?
Laboratory tests include complete blood count (CBC), liver function tests, amylase, and lipase.

– Right-upper-quadrant (trans-abdominal) ultrasound will reveal the presence of gallstones and show evidence of cholecystitis, if present.

– Hydroxy iminodiacetic acid (HIDA) scan is sometimes indicated to rule out cystic duct obstruction and acute cholecystitis.

– Endoscopic retrograde cholangiopancreatography (ERCP) or magnetic resonance cholangiopancreatography (MRCP) assesses the presence of gallstones within the bile ducts. ERCP can also be used to extract stones when they are found, preventing the need for surgery.

Are there Treatment options?
Asymptomatic gallstones are generally not treated. Cholecystectomy (surgical removal of the gall bladder) is the treatment of choice for symptomatic disease.

Oral bile acids (e.g., ursodeoxycholic acid) can be used to dissolve small stones and stone fragments. However, they are not really efficient as the stones typically reoccur.

It is helpful to avoid large, fatty meals, as a large caloric load is the most likely trigger for biliary colic symptoms.

Long-term statin use has been associated with a reduced risk of gallstone development.

Nutritional Considerations
Gallstones are strongly related to high-fat, low-fibre diets. In areas like Asia and Africa populations which have plant-based diets as traditional diets. An abundance of high protein and high saturated fatty diets are risk factors to developing gallstones. Diets low in dietary fibre, especially the westernized diets play a major role in the development of gall stones. The following factors are associated with reduced risk of gallstones:

– Plant-based diets: Both animal fat and animal protein may contribute to the formation of gallstones. According to research, up to 90% of gallstones are cholesterol. This totally suggests that a change diet (e.g., reducing dietary saturated fat and cholesterol and increasing soluble fibre) may reduce the risk of gallstones.
“Vitamin C, which is found in plants and is absent from meat, affects the rate-limiting step in the catabolism of cholesterol to bile acids and is inversely related to the risk of gallstones in women”
In a 12-year prospective cohort study among US men, individuals consuming the most refined carbohydrates have a 60% greater risk for developing gallstones, compared with those who consumed the least. Conversely, in a 1998 cross-sectional study of men and women in Italy, individuals eating the most fiber (particularly insoluble fiber) have a 15% lower risk for gallstones compared with those eating the least.

– Avoidance of excess weight: staying within a healthy BMI results in reduced risks of developing gall stones as obesity is a huge factor to increased risk. Those with BMI above 30 kg/m2 should endeavour to shed some few extra pounds to reduce their risk.

– Weight cycling: simply meaning repeatedly intentionally losing and unintentionally regaining weight. This cycle increases the likelihood of cholelithiasis.

– Moderate alcohol intake: alcohol consumption, especially when it is too much, has always been linked to different types of ailments; gallstone formation isn’t left out.

SUMMARY
Adopting western diets totally puts you at risk of developing gall stones. A diet rich in antioxidants, fibre, anti-inflammatory substances keeps you at reduced risk rate.
Stones make life very unbearable, you should be very conscious about your diet and lifestyle.

SOURCES
Biddinger SB, Haas JT, Yu BB, et al. Hepatic insulin resistance directly promotes formation of cholesterol gallstones. Nat Med. 2008;14(7):778-82. [PMID:18587407]
Leitzmann MF, Giovannucci EL, Rimm EB, et al. The relation of physical activity to risk for symptomatic gallstone disease in men. Ann Intern Med. 1998;128(6):417-25. [PMID:9499324]
Leitzmann MF, Rimm EB, Willett WC, et al. Recreational physical activity and the risk of cholecystectomy in women. N Engl J Med. 1999;341(11):777-84. [PMID:10477775]
Erichsen R, Frøslev T, Lash TL, et al. Long-term statin use and the risk of gallstone disease: A population-based case-control study. Am J Epidemiol. 2011;173(2):162-70. [PMID:21084557]
Bodmer M, Brauchli YB, Krähenbühl S, et al. Statin use and risk of gallstone disease followed by cholecystectomy. JAMA. 2009;302(18):2001-7. [PMID:19903921]
Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87. [PMID:22570746]
Ahmed A, Cheung RC, Keeffe EB. Management of gallstones and their complications. Am Fam Physician. 2000;61(6):1673-80, 1687-8. [PMID:10750875]
Pixley F, Wilson D, McPherson K, Mann J. Effect of vegetarianism on development of gall stones in women. Br Med J (Clin Res Ed) . 1985;291:11-12.
Tsai CJ, Leitzmann MF, Willett WC, et al. Fruit and vegetable consumption and risk of cholecystectomy in women. Am J Med. 2006;119(9):760-7. [PMID:16945611]
Simon JA, Hudes ES. Serum ascorbic acid and gallbladder disease prevalence among US adults: the Third National Health and Nutrition Examination Survey (NHANES III). Arch Intern Med. 2000;160(7):931-6. [PMID:10761957]

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DIET THERAPY OF DISEASES

NUTRITION IN HEPATITIS

OVERVIEW
Everything you eat and drink has to go through your liver in order to change food substances into stored energy and chemicals which are necessary for life. Your liver makes nutrients available so your body can use them to build cells, give you energy, and maintain normal body functions.

The liver is responsible for:
– removing toxins from drugs and alcohol from the body
– metabolizing fat
– excretion of bilirubin (a product of broken-down red blood cells), cholesterol, hormones, and drugs
– breakdown of carbohydrates, fats, and proteins
– activation of enzymes, which are specialized proteins essential to body functions
– storage of glycogen (a form of sugar), minerals, and vitamins (A, D, E, and K)
– synthesis of blood proteins, such as albumin
– synthesis of clotting factors

HOW DIET AFFECTS THE LIVER
An unhealthy choice in diet can sometimes give the liver to much work to do thereby leading to a liver failure. If your diet provides too many calories, you will gain weight. Being overweight is linked to the buildup of fat in the liver, called “fatty liver.” Toxins, such as alcohol, damage the liver over time.
One very common liver disease (failure) is hepatitis.
Hepatitis refers to a common inflammation of the kidneys caused mostly by viral infections and other factors as toxins, auto immune diseases and alcohol.
There are different types of hepatitis and are all differentiated by Alphabets A-G.
According to the Centers for Disease Control and Prevention (CDC)Trusted Source, approximately 4.4 million Americans are currently living with chronic hepatitis B and C. Many more people don’t even know that they have hepatitis.
There are 5 types of viral infections with 5 distinct types of viruses:

Hepatitis A
Hepatitis A is caused by an infection with the hepatitis A virus (HAV). This type of hepatitis is most commonly transmitted by consuming food or water contaminated by feces from a person infected with hepatitis A.

Hepatitis B
Hepatitis B is transmitted through contact with infectious body fluids, such as blood, vaginal secretions, or semen, containing the hepatitis B virus (HBV). Injection drug use, having sex with an infected partner, or sharing razors with an infected person increase your risk of getting hepatitis B.
It’s estimated by the CDC that 1.2 million people in the United States and 350 million people worldwide live with this chronic disease.

Hepatitis C
Hepatitis C comes from the hepatitis C virus (HCV). Hepatitis C is transmitted through direct contact with infected body fluids, typically through injection drug use and sexual contact. HCV is among the most common bloodborne viral infections in the United States. Approximately 2.7-3.9 million people currently living with a chronic form of this infection.

Hepatitis D
Also called delta hepatitis, hepatitis D is a serious liver disease caused by the hepatitis D virus (HDV). HDV is contracted through direct contact with infected blood. Hepatitis D is a rare form of hepatitis that only occurs in conjunction with hepatitis B infection. The hepatitis D virus can’t multiply without the presence of hepatitis B. It’s very uncommon in the United States.

Hepatitis E
Hepatitis E is a waterborne disease caused by the hepatitis E virus (HEV). Hepatitis E is mainly found in areas with poor sanitation and typically results from ingesting fecal matter that contaminates the water supply. This disease is uncommon in the United States. However, cases of hepatitis E have been reported in the Middle East, Asia, Central America, and Africa, according to the CDC .

COMMON SYMPTOMS OF HEPATITIS
• fatigue
• flu-like symptoms
• dark urine
• pale stool
• abdominal pain
• loss of appetite
• unexplained weight loss
• yellow skin and eyes, which may be signs of jaundice

DIAGNOSIS OF HEPATITIS
Hepatitis can be diagnosed by liver function test, blood test, ultra sound, liver biopsy. The doctor always checks for risk before deciding what method to adopt in diagnosis.

TREATMENT OPTIONS FOR HEPATITIS
All types of hepatitis require either anti-viral vaccination, hydration if there is diarrhea (especially in type A), and nutrition.
Currently, there is no vaccination for Hepatitis C. Those that develop cirrhosis during the course of this would require a liver transplant.
Acute cases like Hepatitis E usually don’t require vaccination or treatment as they go on their own if the individual heeds to lifestyle modification by a professional.

RISK FACTORS
These include contact with an infected person (either living in close contact or sexual contact), poor hygiene, traveling to areas with inadequate sanitation, contaminated food (especially shellfish), and illicit drug use. Also, Patients with underlying liver disease (e.g., autoimmune hepatitis, hemochromatosis, Wilson’s disease, alpha-1 antitrypsin deficiency) are at increased risk of developing symptomatic hepatitis.
Alcohol use, smoking, HIV infection, and fatty liver are risk factors for progression of hepatitis.

NUTRITION AND HEPATITIS
Dietary management in hepatitis involves more of a lifestyle modification and hygienic approach.
Hygiene and sanitation: you should be careful of what you eat as a travller as you can pick up the virus from under cooked and contaminated foods. Make sure you heat food appropriately.

Avoiding contaminated shellfish and game meats.

Avoiding high-iron foods and iron supplements. Hepatitis C progression occurs in patients as a result of accelerated hepatic iron uptake and the oxidative stress caused by iron-catalyzed free radical production. Along with phlebotomy, a low-iron diet helps lower the risk for hepatocellular carcinoma (HCC) in these patients.

Nutritional supplementation may be required. Treatment with interferon (IFN) has shown to be very effective especially in Hep C patients. Research has it that it could help in weight reduction as it reduces appetite.

A low-fat, low-cholesterol diet may be helpful. Chronic hepatitis C (CHC) infection increases the risk for hepatic steatosis. A higher intake of dietary cholesterol contributes to this problem and is associated with the progression of hepatitis C-related liver disease. A dietary regimen that is reduced in fat (23% of calories) and cholesterol (185 mg/d) is adviced to help in the management of this Hepatitis.

Adequate vitamin D status. Vitamin D deficiency is common in patients with chronic liver disease, and these patients may have a reduced ability to convert vitamin D to its active form. An inverse relationship seems to exist between vitamin D concentrations and viral load in patients with CHC. Deficiency significantly lowers the chance for a sustained virological response to pegylated interferon and ribavirin, and vitamin D supplementation improves the probability of response to treatment.

Avoidance of extremes in B12 status. Adequate B12 status helps with clearance of hepatitis C from the circulation of infected patients. However, overly high serum B12 levels may also foster viral replication and are associated with concentrations of hepatitis C RNA levels.

Coffee consumption and chronic hepatitis C. Coffee consumption may be helpful, reducing oxidative DNA damage, increasing death of virus-infected cells, stabilizing chromosomes, and reducing fibrosis.

HOW HEPATITIS C AFFECTS DIET
If you have hepatitis, you usually don’t need a special diet. Just trying to eat healthy, maintain a healthy weight, and avoid alcohol is all that is needed. Its mostly lifestyle modification. Though, in severe cases, there might be nutrient restrictions especially fat restriction.
There are special cases, however, when hepatitis C can affect the diet:
• Patients with cirrhosis
As liver disease progresses, patients may lose their appetite and become so tired they have a hard time eating. They may become very thin and poorly nourished and be less able to fight off disease. They may need to limit salt in their diet to prevent their body from putting fluid into their legs and abdomen.
• Other medical conditions and diet
People who have other medical conditions may need other specific changes in their diet. Conditions that warrant specific dietary restrictions include high blood pressure, heart disease, diabetes mellitus, high cholesterol, celiac sprue or chronic kidney disease.

EATING TIPS
People with hepatitis C don’t need to follow a special “hepatitis C diet.” The advice that an average, healthy person gets will work just as well for people with hepatitis C, unless those people also have cirrhosis or another condition, such as diabetes, HIV, or kidney disease.
General dietary advice:
• Eat regular, balanced meals
• Maintain healthy calorie intake
• Eat whole-grain cereals, breads, and grains
• Eat lots of fruits and vegetables
• Get adequate protein
• Go easy on fatty, salty, and sugary foods
• Drink enough fluids
• Reach and maintain a healthy weight
Cautions:
• Avoid alcohol
• Be careful with dietary supplements
Herbal products
Just because something is “natural” doesn’t mean it is harmless. Certain herbs, including Kava-Kava and pennyroyal, can cause liver damage.
Endeavour to always talk to your doctor before taking megavitamin therapy, herbal products, or any other dietary supplement. Remember, your first concern should be safety.
SOURCE: https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342052/all/Viral_Hepatitis
https://www.hepatitis.va.gov/hcv/patient/diet/single-page.asp#:~:text=If%20you%20have%20hepatitis%2C%20you,is%20all%20that%20is%20needed.&text=As%20liver%20disease%20progresses%2C%20patients,have%20a%20hard%20time%20eating.

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