What is the difference between antacids, H2 receptor blockers and proton pump inhibitors❓❓❓

Gastrointestinal diseases are common diseases in daily life, and there are many types of treatment drugs, such as gastric acid secretion inhibitors, antacids, gastric mucosal protective drugs, and gastrointestinal motility drugs. They have their own characteristics, different mechanisms of action, indications and usage. Therefore, we must learn to choose more accurately and use drugs rationally according to the characteristics of stomach diseases. Gastric acid secretion inhibitors and antacids are two drugs that are frequently used in digestive tract diseases. Here we briefly describe the differences in their pharmacological mechanisms, indications, usage and dosage, adverse reactions and precautions.

1. Pharmacological mechanisms

Gastric acid secretion inhibitors

    H₂ antagonist:

• It can block H₂ receptors of parietal cells. It inhibits basic gastric acid and nocturnal gastric acid secretion. It also inhibits gastric acid secretion caused by gastrin and M receptor agonists. Studies have shown that H₂ antagonist has a significant inhibitory effect on gastric acid secretion at night, but it has a poor control effect on gastric acid secretion during the day.
• Commonly used drugs: cimetidine, famotidine, ranitidine.
•  Acid suppression strength: famotidine > ranitidine > cimetidine.

    Proton pump inhibitor (PPI)

• It is an H⁺/K⁺-ATPase inhibitor that can inhibit central or peripheral gastric acid secretion. It can effectively inhibit basic gastric acid secretion or various forms of stress-induced gastric acid secretion.
• Commonly used drugs: Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole.
• Acid suppression strength: esomeprazole > rabeprazole > pantoprazole > lansoprazole and omeprazole.

Antacids

• They are weakly alkaline substances, which directly neutralize gastric acid in the stomach after oral administration and increase the pH of the gastric juice to reduce the activity of pepsin (when the pH of the gastric juice is 1.5-2.5, the most active). Antacids such as aluminum hydroxide neutralize gastric acid and cover the gastric mucosa to form a gel-like protective layer to prevent gastric acid and pepsin from invading again.
• Commonly used drugs: aluminum hydroxide, aluminum phosphate, magnesium hydroxide, sodium bicarbonate.

2. Indications

Gastric acid secretion inhibitors

• Acute gastric mucosal disease, gastroesophageal reflux disease, peptic ulcer or bleeding, prevention of stress mucosal injury of upper gastrointestinal tract. PPI can be combined with antibacterial drugs to eradicate Helicobacter pylori.

Antacids

• Relieve stomachache, acid reflux and heartburn caused by hyperacidity. It can be used for functional dyspepsia, chronic gastritis, peptic ulcer or bleeding, acute gastric mucosal lesions and reflux esophagitis.

Different

• Antacids directly neutralize gastric acid and have a quick effect. However, as the stomach empties and cannot neutralize the continuously secreted gastric acid, the duration of action is very short. PPI has a strong, complete and long-lasting acid-inhibiting effect, and its acid-inhibiting ability greatly exceeds that of H₂ antagonist. Usually, the time for antacids to make the stomach pH> 4 is only 4 hours, H₂ antagonist is 8 hours and PPI can reach 18 hours.

3. Dosage

Classification	Drug name	Dosage	Taking time
H2 antagonist	Cimetidine	0.2g/time, 2 times/day, daily dose ≤0.8g	During meal and before bedtime
	Famotidine	20mg/time, 2 times/day, the daily dose is 40mg.	After breakfast, dinner or before bedtime.
	Ranitidine	0.15g/time, 2 times/day	Early morning and before bed
PPI	Esomeprazole	20-40mg/time, 1-2 times/day	1h before meal
	Ilaprazole	5-10mg/time, 1-2 times/day	Take it on an empty stomach in the morning
	Lansoprazole	30mg/time, 1-2 times/day	0.5h before meal
	Omeprazole	20mg/time, 1-2 times/day 0.5h before meal	0.5h before meal
	Pantoprazole	20-40mg/time, 1-2 times/day	1h before meal
	Rabeprazole	10-20mg/time, 1-2 times/day	0.5h before meal
Antacids	Aluminum hydroxide	0.6-0.9g/time, 3 times/day	1h before meal
	Aluminum Phosphate Gel	1-2 packs/time, 2-3 times/day	0.5h before meal
	Sodium bicarbonate	0.3-1g once, 3 times a day.	Before meal

H₂ antagonist has no obvious irritation to gastric mucosa, and its absorption and utilization are basically not affected by gastric contents. Generally, it can be taken after a meal or before going to bed.

Since PPI has an inhibitory effect on the "active pump" on the cell membrane of the gastric parietal cell, it has no effect on the "rest pump" in the cytoplasm, and the proton pump regeneration is mainly completed at night, so the best effect is to take the drug in the morning. PPI can only obtain the maximum acid suppression effect when it acts on food to stimulate the gastric parietal cells to be active. Therefore, it is recommended that PPI be taken 15 to 60 minutes before a meal in the morning.

The purpose of taking antacids is to neutralize excessive stomach acid, so it is generally best to take it half an hour before a meal or when stomach pain occurs.

4. Course of treatment

H₂ antagonist is generally taken continuously for no more than 12 weeks.

PPI is used for gastric ulcer medication for 6 to 8 weeks and duodenal ulcer is 4 weeks. The course of anti-Helicobacter pylori treatment is 10 to 14 days. The course of treatment for gastroesophageal reflux disease should be at least 8 weeks. Preventive use of PPI, elective surgery: Use one dose before surgery and use ≦ 24h after surgery. Fasting or parenteral nutrition: After establishing enteral nutrition, consider stopping PPI.

Antacids are generally taken for no more than 7 consecutive days.

5. Adverse reactions

Gastric acid secretion inhibitors

H₂ antagonist may induce rapid drug resistance during use and may cause gastric acid rebound after stopping. Others include nausea, vomiting, diarrhea, leukopenia, elevated serum transaminase, male sexual dysfunction and breast enlargement, galactorrhea and neuropsychiatric symptoms such as headache, dizziness, hallucinations, mania, etc.

Adverse reactions caused by short-term use of PPI are rare, such as headache, diarrhea, nausea, gastrointestinal flatulence, abdominal pain, constipation, dizziness, itching, and rash, etc., which are generally mild. Long-term treatment (>1 year), long-term overdose (>1.75 times the standard dose) may cause serious adverse reactions, such as osteoporosis and fractures, pneumonia, intestinal infections, iron deficiency anemia, vitamin B12 deficiency, hypomagnesemia and gastric mucosal lesions.

Antacids

Long-term use of aluminum hydroxide can cause severe constipation and even intestinal obstruction. Long-term use of aluminum hydroxide in the elderly can affect the intestinal absorption of phosphate, which can lead to osteoporosis. Large doses of aluminum phosphate can also cause mild constipation. Aluminum salt is absorbed and deposited in the brain, which can cause senile dementia.

Magnesium hydroxide can easily cause diarrhea.

Repetitive use of large doses of sodium bicarbonate can easily cause abdominal distension, sodium retention and secondary gastric acid secretion. Eating dairy products during medication may cause milk-alkali syndrome (manifested by nausea, vomiting, weakness, polyuria, and muscle pain).

6. Precautions

Gastric acid secretion inhibitors

    H₂ antagonist

• Antacids can reduce the concentration of gastric acid and form a protective film on the surface of the ulcer, thereby hindering the absorption and function of H₂ antagonist. Therefore, H₂ antagonist should not be combined with antacids.
• Avoid the combination of H₂ antagonist and PPI unless there is a nighttime acid breakthrough (taking PPI during the day and taking H₂ antagonist before going to bed can significantly reduce the incidence).
• Cimetidine can inhibit the activity of liver cytochrome P450 and can interact with warfarin, phenytoin and other drugs. The dose needs to be adjusted when combined. Ranitidine has a weak effect on liver drug enzymes and famotidine has almost no effect.
• In order to reduce the occurrence of the rebound phenomenon of H₂ antagonist withdrawal, it is generally advocated to stop the drug by the decrement method, such as changing from 2 times a day to once a day, then to once every other day after 1 week, and gradually stop the drug.

    PPI

• PPI needs to be combined with H⁺. It activated in an acidic environment and irreversibly combined with the sulfhydryl group of the proton pump through the disulfide bond. It causes the proton pump is permanently inactivated. Therefore, PPI should not be combined with antacids.
• It has liver enzyme inhibitory effect. Combining with clopidogrel can reduce the efficacy of the latter. Among them, omeprazole has the most obvious inhibitory effect, and PPI with weaker CYP inhibition (such as pantoprazole) may be a better choice.
• Mucosal protective agents such as sucralfate need to form a protective film in an acidic environment. Acid inhibitors increase the pH of the stomach and reduce the efficacy of such drugs. Since mucosal protective agents are attached to the surface of the gastric mucosa, they can affect the activation of PPI. Therefore, the two types of drugs should not be used in combination, and the two should be taken separately.

Antacids

• The main factors affecting the efficacy of antacids include drug neutralization ability, gastric acid secretion and emptying rate. Prolonging the action time of the drug in the stomach can enhance the curative effect, and the prokinetic drug will shorten the residence time of the antacid in the stomach when promoting intestinal motility. Therefore, it is not recommended to take the prokinetic drug and antacid at the same time. In addition, the effect of increasing the frequency of administration is better than increasing the single dose.
• Aluminum can affect the absorption of certain drugs, such as tetracycline, iron, digoxin, cimetidine, etc., when the two are used together, an interval of 1-2h is required.

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How to use Cefdinir?👀

Cefdinir is a semi-synthetic third-generation cephalosporin, which is stable to β-lactamase and has good antibacterial activity against Gram-positive and Gram-negative bacteria. Cefdinir has the advantages of good oral absorption, high antibacterial activity, high blood concentration and wide tissue distribution. It has a good treatment effect on mild to moderate respiratory tract infections and skin and soft tissue infections. It is one of the commonly used clinical antibacterial drugs. Some patients feel very alarmed when they have red urine or red stool after using cefdinir. They may mistakenly think it is hematuria or bloody stool and be confused whether they should continue taking it. The following will explain the precautions for using cefdinir.

1. Strictly comply with medication indications

Before using antibiotics, the first choice should be to clarify whether it is a viral infection or a bacterial infection. Antibacterial drugs can only be applied when a bacterial infection is used. 

Suitable for the following mild and moderate infections caused by sensitive bacteria:

Adults and teenagers

1. Community-acquired pneumonia.
2. Acute attack of chronic bronchitis.
3. Acute maxillary sinusitis.
4. Otitis media.
5. Scarlet fever.
6. Pharyngitis or tonsillitis.
7. Uncomplicated skin and soft tissue infections.

Child

1. Acute otitis media.
2. Pharyngitis or tonsillitis.
3. Uncomplicated skin and soft tissue infections.

2. Dosage

The usual dose for adults is 0.1g once, 3 times a day. The recommended dosage and course of treatment for adults and adolescents (over 13 years old) are as follows: 

• For all infectious diseases, the maximum daily dosage of this medicine is 600mg and 10 days is a course of treatment. One dose daily is equivalent to two doses daily, but twice a day is required for pneumonia and skin infections. If the patient's weight is relatively low, condition is relatively mild or the above-mentioned dosage cannot be tolerated. A 100 mg dose, 3 times a day, can also be used.

Recommended regular dose for children: Orally, 9~18mg/kg a day, taken in 3 divided doses. 

• Children 6 months to 12 years old have acute bacterial otitis media, acute maxillary sinusitis, tonsillitis, pharyngitis, simple skin and soft tissue infections. The dose is 1 time every 12 hours, 7mg/kg each time or 1 time every 24 hours, 14mg/kg each time.
• The dose for children with community-acquired pneumonia is once every 8 hours, 3-6 mg/kg each time, with a maximum dose of 200 mg once.

3. Caution and contraindications

Use with caution:

1. People who have a history of allergies to penicillin or cephalosporin drugs.
2. Those with severe renal impairment.
3. Those with poor eating conditions, non-oral intake of nutrients, severe underlying diseases and cachexia (Vitamin K deficiency may occur when using cefdinir and close observation is required).

Contraindications: 

1. Patients with a history of severe allergies to drugs.

4. Medication method

It can be taken before or after a meal (The absorption of cefdinir after a meal is slightly reduced).

Mainly cause gastrointestinal side effects (such as diarrhea, abdominal pain) and skin side effects (such as rash, itching).

Red urine may appear during medication. When combined with iron-containing foods, red stools may appear. This is normal and you can continue to take the drug.

The following drugs will interact with cefdinir and need to be used at intervals:

• Cefdinir has antibacterial activity, which may reduce the effect of drugs containing live bacteria. If you need to use it in combination, please use it at an interval of 2 hours.
• Medications that need to be taken 2 hours apart: antacids (such as aluminum hydroxide).
• Medicines that need to be taken at least 3 hours apart: iron salt drugs (such as ferrous sulfate, iron citrate, iron hydroxide).
• Medications that need to be taken 4 hours apart: Acetylcysteine.

👉Cefdinir has a broad antibacterial spectrum, high local concentration in inflammatory tissue, high bioavailability, high efficiency and low side effects. It has a good effect on children with mild to moderate infections. Paying attention to the precautions during the administration can ensure the maximum effect of the drug and avoid the risk of medication.

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A few good sleeping habits will improve your quality of life.👍👍👍

When it comes to sleeping habits that are bad for your body, you will definitely think of staying up late. But apart from staying up late, some sleeping habits are actually harmful to the body. And some people think that sleeping habits are good for the body, but it will actually make you tired the more you sleep and it even hurts your body than staying up late. 

Sleeping habits may hurt your body.

1. Get up early

Although early to bed and early to rise is good for your health, sometimes people mistakenly think that getting up early is also good for your health. In fact, waking up early is sometimes more harmful than staying up late. Some people insist on getting up early no matter what time they fall asleep. In fact, this is the same as staying up late. It is because the lack of sleep time will cause the symptoms of lack of sleep. Lack of sleep can cause symptoms such as dizziness, headache, decreased concentration and irritability. Long-term lack of sleep can cause immune dysfunction in the body and increase the risk of dementia, cardiovascular and cerebrovascular diseases, digestive tract diseases and immune diseases. Studies have found that the same sleep time is 4 hours and the state of the participants who slept from 23:00 to 3:00 was worse than that of the participants who slept from 3:00 to 7:00. 

Therefore, it is recommended that you do not seek to get up too early. Sufficient sleep time is the most important thing.

2. Plants in the bedroom

Putting some flowers and plants indoors can not only decorate the bedroom, but also purify the air and relieve tension. However, it is recommended not to put it in the bedroom, especially the headboard. First, green plants only perform respiration at night. At this time, plants absorb oxygen and release carbon dioxide. It is easy for people to stay in an oxygen-deficient environment for a long time and it is difficult to enter deep sleep. It causes continuous fatigue. On the other hand, there may be a large number of molds hidden in the flower-growing soil, which can cause respiratory diseases such as allergies or asthma if placed on the bedside. 

In addition, there are some plants that can make people sick such as insomnia and allergies. It is not recommended to put flowers in the bedroom.

3. Turn on the night light to sleep

For convenience at night, many people will install a night light in the bedroom. Some people will keep it open until dawn. But from a health perspective, the night light should not be on all night. 

When a person sleeps in a dark environment, the pineal gland of the brain secretes a substance (melatonin) closely related to human sleep. Melatonin can induce sleep, enhance immunity, regulate body temperature, eliminate fatigue and make people energetic after waking up. However, turning on the night lights to sleep will produce a kind of "light pressure", which will inhibit the secretion of melatonin. It will affects the body's various endocrine activities. Sleeping with the night light on can also be harmful to your child's eyesight. Because the child's eyelids are relatively thin. They can still sense faint light when they close their eyes. After the daytime activities, the night is the time to get a rest, but the light of the small night light will constantly stimulate the eyes.

It is recommended that you turn off the night light when you sleep, and turn it on when you use it.

4. Use a humidifier while sleeping

As soon as winter arrives, the indoor air becomes very dry. Many people use humidifiers. In order to make the air more humid, many people sleep with a humidifier on all night. In fact, this is actually bad for the body. If indoor air humidity is too high, sweat will not evaporate smoothly, bacteria, dust mites, and mold will also breed, causing respiratory discomfort and severe damage to the health of the lungs. 

In addition, when you are using a humidifier, it is not recommended to add tap water. It is best to add cool boiled water, distilled water or mineral water. This is because the content of magnesium, calcium, chlorine and other substances in tap water is relatively high. Chlorine will be volatilized into the air by the humidifier and long-term use will cause air pollution. Calcium, magnesium and other substances are easy to deposit and form scale. They can block the spray hole of the humidifier. It reduce the humidification efficiency and affect the service life.

It is recommended to change the water of the humidifier daily and it is best to clean it once a week. This can prevent the growth of microorganisms such as molds, thereby avoiding infection with germs.

Some suggestions for improving sleep quality.

1. Eat some sleep-help foods

Eat some sleep aids at dinner, such as bananas, cherries, cheese, pumpkin seeds, scallops, shiitake mushrooms, sunflower seeds, black sesame seeds, etc.

2. Create a good sleeping environment

A quiet, clean and dark environment can help you fall asleep quickly. Therefore, while keeping the bedroom clean, you can choose comfortable, soft pillows and loose pajamas. At the same time, turn off the night light, turn off all kinds of luminous or sound items and close the curtains.

3. Sleep regularly

Irregular sleep time will not only affect the quality of sleep, but may also disrupt the body clock. It makes people feel difficulty concentrating, sleepy during the day, insomnia at night and unable to fall asleep. Adults are best to go to bed before 11 o'clock in the evening, sleep 6-8 hours a day. The nap time should not more than 20-30 minutes. 

Sleep time will vary from person to person. Find out the most suitable sleep time according to your mental and physical state.

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What should I do if my child is often constipated?👦👧

Children have irregular bowel movements and it is very difficult to defecate. What should you do? In fact, constipation in children is very common. If the child's body has no major problems after the examination, it is probably related to improper diet or intestinal dysfunction. This situation can often be resolved by adjusting the children's diet. But how should we adjust the details? The following will explain a little.

Can children with constipation take medicine?

For children with constipation, the most effective and recommended treatment is non-drug methods. It mainly recommend to improve the coordination between the abdomen and pelvic floor muscle tissue. If the child takes laxatives too early, the child may continue to have symptoms of constipation. In fact, there are many reasons for children's constipation, which may be caused by abnormal diet, lack of water, insufficient exercise or intestinal diseases. It is more important to find out the cause of constipation for children's constipation than to use stool laxatives.

First of all, we should observe whether the child has a partial eclipse habit?

Children often have partial eating habits, such as eating only meat, not eating vegetables, drinking very little water every day, or eating snacks instead of regular meals. Children who have a partial eclipse should find ways to encourage them to eat more fruits and vegetables such as making fruits and vegetables into interesting patterns to attract children to eat. You should also try to make children drink more water every day. Children over 1 year old should drink more than 1000 ml of water per day. And you should not let children drink juice or milk instead of drinking water.

In addition, you can try to help your child develop a habit of defecation on time.

If the child does not have the habit of defecation on time, try to help him develop it. For example, let the child sit on the toilet for 5-10 minutes within 20-30 minutes after eating, 1-2 times a day to help the child develop the habit of defecation on time. Especially after breakfast, children are more likely to defecate. 

Posture: When going to the toilet, children should sit with their feet supported and the knees just above the hips. You can use a small stool or a book to achieve this posture.

Breathing training: Breathing training is very helpful to improve the muscles of the pelvic floor and can relax the anal sphincter. It is recommended to teach children to practice the movements of blowing candles and smelling flowers. It can prevent children from holding their breath during defecation.

Regular exercise can also strengthen the child's core strength and accelerate the peristalsis of the intestines.

Adjust the digestive function of the child's gastrointestinal tract.

When children have problems with defecation and indigestion, you can supplement with probiotics to increase the good bacteria in the intestinal tract. When you select probiotics, you can choose Lactobacillus acidophilus and Bifidobacterium species to help adjust the intestinal function. Probiotics can added to warm water for drinking, but the water temperature should not exceed 40°C. At the same time, this can increase the child's drinking water. 

👉If you have tried all of the above methods and the children's constipation has not improved. You are advised to seek medical attention.

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When these signs of cerebral infarction appear, you should be careful.📡📡📡

The brain can control different functions such as language, vision, emotions, breathing, and physical activity. This can be said to be the human CPU. Because its role and functions are very important, it is very necessary for us to prevent brain diseases. But even if we try to protect our brain, as we age, the brain will decline. Cerebral infarction is a common disease of the brain. Cerebral infarction is also called ischemic stroke. This disease is caused by the ischemia of the brain tissue. It leads to necrosis of the brain tissue which can lead to sudden death in severe cases. Even after cerebral infarction is treated, there may still be sequelae such as hemiplegia and inability to take care of yourself. Timely treatment can reduce the chance of sequelae. If the following symptoms occur, you should be alert to cerebral infarction.

1. Headache and dizziness

Headaches and dizziness must have occurred in everyone, especially in middle-aged and elderly people. When the cerebral infarction is about to appear, the brain will also have symptoms first which are dizziness and headache. These two symptoms come very quickly and may return to normal in just a few minutes. This is caused by insufficient blood supply to the brain. If you often have similar problems in the recent period, you must be alert to the occurrence of cerebral infarction.

2. Stiffness on one side of the body and numbness in the face

Stiffness on one side of the body and numbness in the face are the most obvious symptom of a cerebral infarction. The patient will feel abnormal numbness on one side of the face and deviated mouth and eyes. This is because the brain can control the entire body. All the actions and languages we do must pass through the brain. When the brain is abnormal, it will affect the whole body. If there is a sudden deviated mouth and eyes and one side of the body is weak and uncontrollable, these are the major symptoms of a cerebral infarction. Once it occurs, you need to go to the hospital for examination immediately. After the diagnosis is confirmed, appropriate treatment measures should be taken to avoid cerebral infarction further developing.

3. Drooling on one side

This is one of the common signs of patients with cerebral infarction, especially when drooling in sleeping and it is to one side. This is a typical sign of cerebral infarction. Due to cerebral vascular infarction, the nerves of muscles are not coordinated, especially the oral cavity which leads to drooling and difficulty swallowing. 

4. Blurred vision

In addition, cerebral infarction can also cause damage to the optic nerve. It leads to retinal ischemia and hypoxia. Patients will usually experience blurred vision suddenly or the situation in front of the eyes will be dark. It will recover after a few seconds. This is one of the typical signals of cerebral infarction.

👉Once the above four abnormalities occur, it is absolutely necessary to be alert to the onset of cerebral infarction. Especially for middle-aged and elderly people suffering from hyperlipidemia and hypertension. It is very necessary to go to the hospital for examination if there is any abnormality.

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There are something which harm from your bone health.😖😖😖

Bones are an important part of the human body. They have important functions such as support, movement and protection of internal organs. However, bone health will get worse with age. In addition to the inevitable bone loss with age, there are also some foods which harm from your bone health. 

1. Sugar

Although sugar is an important source of human energy and an essential component of the human body, excessive sugar is the source of many diseases. Excessive intake can directly or indirectly lead to following major problems: obesity, diabetes, cerebrovascular and cardiovascular diseases and dental caries. In addition, excessive intake of sugar can also harm the bones. 

• When sucrose is metabolized in the body, it needs to consume a variety of minerals and vitamins, calcium is also one of them.
• Excessive sugar intake will directly affect the intake of other nutrients such as vitamins, dietary fiber, protein and minerals. It results in potassium deficiency, vitamin deficiency and calcium deficiency.
• Children who eat too much sweets are also one of the important reasons for the increase in their fracture rate.

In addition to obvious high-sugar foods such as candy, ice cream, and beverages, there are other foods that actually contain high sugars. Such as: yogurt, nutritious oatmeal, biscuits, nuts, potato chips, various sauces such as ketchup, salad dressing.

2. Salt

The main component of salt is sodium chloride which is mainly distributed in the human body in the form of ions. It content a large number and has a various effect in the human body.

When a person consumes too much salt, it will increase the concentration of sodium ions in the body. There is a competitive relationship between sodium ions and calcium ions in the human body. The increase of sodium ions will accelerate the loss of calcium ions. With the increase of urinary calcium excretion, the amount of bone calcium will decrease. It results in bone diseases such as osteoporosis and fractures. If the calcium content in the diet is low and high-salt food is taken, it will cause negative calcium balance and stimulate the parathyroid glands to increase the secretion of calcitonin. It causes bone loss and leading to hypocalcemia. A long-term high-salt diet will not only harm bones, but also cause different diseases such as cardiovascular and kidney diseases.

In addition to cooking with less salt, also pay attention to eating less high-sodium foods such as seasonings (such as soy sauce, chili sauce), processed foods (such as ham, sausage), and preserved foods (such as kimchi).

3. Alcohol

In addition to hurting the stomach and liver, drinking alcohol can also hurt bones. Drinking too much alcohol can increase the body's cortisol level. Cortisol can directly inhibit bone formation and indirectly stimulate bone resorption. It leads to bone loss. In addition, drinking too much alcohol will also cause an imbalance in the body's calcium nutrition metabolism. This will not only affect the absorption of calcium in food, but also make bone calcium be removed and the amount of calcium excretion greatly increased. It results in severe bone calcium deficiency and ultimately osteoporosis. Long-term heavy drinking will also affect the absorption and utilization of calcium and phosphorus in the intestines. This will reduce bone formation. 

In addition to bone damage, alcohol can also damage the brain, cardiovascular, esophagus, gastrointestinal, liver, prostate and other organs. It can induces diseases of related organs and cause acute and chronic alcoholism and cancer. Therefore, it is better to drink less alcohol.

👉The health of the bones is very important. Poor bone quality will affect people's quality of life, and may even endanger lives. Therefore, we must protect our bones. In addition to supplementing calcium with calcium supplements, you should also pay more attention to your own lifestyle habits.

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The reasons why the blood pressure is sometimes high and low.💞💞💞

For patients with hypertension, blood pressure is the most frequently checked physical sign. But will your blood pressure be sometimes high and low? Will your blood pressure control be unstable? Will your blood pressure fluctuate too much? This situation is actually very common, but what causes this situation? The following reasons are why the blood pressure is sometimes high and low.

To understand the fluctuation range of normal blood pressure.

The blood pressure of a normal person has a fluctuation range and it is not a fixed value. The normal blood pressure range is 90-139mmHg for systolic blood pressure and 60-89mmHg for diastolic blood pressure. If it fluctuates between this range, it is the normal fluctuation range.

To understand the fluctuation rule of blood pressure.

When person woke up in the morning, blood pressure began to rise and achieved the highest at 8:00 to 10:00, then decline slightly. It was another peak period of blood pressure at 16:00 to 18:00. After that, the blood pressure began to drop and it achieved the lowest at 22:00 to 2:00. Therefore, from 8:00 to 10:00 every morning is the time of the highest blood pressure. It is called the morning peak blood pressure. This time is the best time to measure blood pressure.

Whether to follow the doctor's prescription.

Oral antihypertensive drugs should be taken consistently. You should not only take the drugs when the blood pressure rises. Do not stop the drugs immediately after the blood pressure drops. The drugs must keep taking even if your blood pressure is in a normal range. If you only take the drugs when blood pressure rises and stop taking when blood pressure drops, it will cause drastic fluctuations in blood pressure.

Whether to change the drugs frequently.

Some people originally took a drug and their blood pressure was already under control. But when they see someone else taking another medicine and think that the medicine taken by others is better. Then they switch to other medicines by themselves. This will change the original blood pressure. Therefore, never change the medicines yourself.

Take short-acting antihypertensive drugs.

Short-acting antihypertensive drugs have a relatively short time of action and need to be taken 2 to 3 times a day. It will cause fluctuations in blood pressure. Therefore, it always try to choose long-acting antihypertensive drugs. For example, long-acting sustained-release tablets or controlled-release tablets, they are taken once a day. They are more convenient to take and can keep blood pressure stable.

The blood pressure should be measured in a calm state.

If it is after eating, exercise, defecation or emotionally, the blood pressure measured will be higher. Therefore, after waking up in the morning, empty the bladder and urine, then measure the blood pressure in a calm state as the standard.

Long-term mental stress, high pressure and lack of sleep.

If you suffer from sleep deprivation for a long time, even on the basis of taking antihypertensive drugs, it may cause high blood pressure and blood pressure fluctuations. Therefore, in the case of taking antihypertensive drugs and blood pressure is still high, we should also pay attention to improving the quality of sleep.

Drinking and smoking can cause blood pressure fluctuations.

If blood pressure measured after drinking alcohol or smoking, since they can affect blood vessels, thereby affecting blood pressure.

👆The above are the common causes of blood pressure fluctuations. Evaluating the causes of blood pressure fluctuations can help stabilize blood pressure control.

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Do you know that there are some small details about drinking water?

Drinking water is something that people must do every day and no day can be an exception. Otherwise the consequences will be disastrous. Now that the weather is getting colder, what details should you pay attention to when drinking water?

Precautions for the thermos bottle.

There are a lot of acidic substances which are dissolved in natural health tea and traditional Chinese herbal medicine. They may react with the chemical substances contained in the inner wall of the thermos bottle and dissolve into the liquid. Drinking this kind of liquid regularly will not only prevent you from maintaining your health, but will also make your body worse. Some Chinese herbal medicines will ferment in the thermos bottle and produce swelling gas. It causing the air pressure in the thermos bottle to increase sharply. When the bottle is opened again, it will produce a spouting and like explosion effect.

The following 3 kinds of drinks are also not recommended to be put in the thermos bottle:

1. Tea: Tea leaves are easy to ferment under the conditions of high temperature and constant temperature in a thermos bottle. Vitamins are destroyed. Aromatic oils volatilize. Tannins and theophylline are leached in large quantities. These not only reduce the nutritional value of tea, but also makes tea taste bitter and increase harmful substances. 
2. Milk: Storing milk in a thermos bottle can easily cause microbes to multiply rapidly. It leads to corruption. if drinking it, it may causes gastrointestinal discomfort.
3. Carbonated beverages: Some thermos bottles use high-manganese and low-nickel steel as the inner wall. They have poor corrosion resistance. In acidic solution, heavy metals are easy to precipitate. Therefore, carbonated drinks, fruit juices, acidic drinks, etc. should not be packed in this type of thermos bottles.

When using a thermos bottle, you can pour some hot water to preheat it. After that, pour it out and then refill liquid to avoid a sudden increase in air pressure caused by excessive temperature differences. Or lower the liquid temperature to about 70°C before pour it into the thermos bottle.

How much water should you drink every day?

Under normal situations, a normal adult needs 3,000 ml of water per day. The intake of about 1,000 ml through food such as vegetables, fruits and soups. The other part needs to be supplemented by drinking water. Therefore, an average adult needs to drink about 2,000 ml of water per day. In addition, drink more water when you exercise a lot or sweat a lot.

If you want to drink hot water in cold weather, what should you pay attention to?

The weather is cold in winter, and I always want to drink some warm hot water. In fact, too hot water will scald the esophagus and increase the risk of cancer. The International Agency for Research on Cancer lists hot beverages above 65°C as Class 2A carcinogens. Therefore, it is best to let the boiled water sit for a few minutes before drinking it. 

Is there the best time to drink water?

In fact, there is no best time for drinking water. It is recommended to drink water at any time. However, you can pay more attention to these few points in time:

1. Drinking a glass of boiled water after waking up in the morning can increase blood viscosity. It will help prevent heart disease cause by that.
2. Do not drink a lot of water immediately when you sweat a lot after strenuous exercise or work. You can moisten your throat with a little water first and then drink appropriate water after 30 minutes.
3. Drinking a small amount of water before going to bed can prevent the blood viscosity from increasing at night. But do not drink a lot of water, so as not to increase the amount of nocturnal urine and affect the quality of sleep.

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Introduction to the time of taking common antihypertensive drugs.👍👍👍

As more and more people suffer from high blood pressure, antihypertensive drugs have become a common medicine. Hypertension is also a chronic disease and antihypertensive drugs need to be taken for a long time. Therefore, every hypertensive patient should learn how to properly take antihypertensive drugs.

Concept of taking time.

• Fasting: Take 1 hour before a meal or 2 hours after a meal.
• Before meal: Take 15-60 minutes before a meal.
• During meal: Take the medicine after have eaten a little meal and continue to eat after taking the medicine.
• After meal: Take 15-30 minutes after a meal.

The effects of antihypertensive drugs and food intake are mainly considered in two aspects:

1. Does food affect the absorption of drugs?
2. Adverse drug effects: For drugs with gastrointestinal adverse effects, taking the drug after a meal can alleviate the gastrointestinal adverse effects. Antihypertensive drugs basically have no gastrointestinal adverse reactions, so the drugs are generally not related to eating.

1. Angiotensin II receptor blockers

The names of drugs usually end with "-sartan", such as candesartan, irbesartan, losartan, olmesartan, telmisartan, valsartan, etc.

The time of taking these drugs has no significant relation with eating. Some drugs, such as telmisartan and valsartan, can reduce their absorption when taken. But they have no significant effect on the clinical efficacy.

2. Angiotensin-converting enzyme inhibitors

The names of drugs usually end with "-pril", such as benazepril, captopril, enalapril, fosinopril, imidapril, lisinopril, perindopril, ramipril.

Captopril and perindopril can be reduced the absorption by food in the stomach. Therefore, they should be taken 1 hour before a meal. The absorption of other is not affected by food or less affected. Therefore, they can be took before, during or after a meal.

3. α1-blockers

Drug names usually end with "-zosin", such as alfuzosin, doxazosin, terazosin and so on.

Alfuzosin controlled-release tablets should be taken after dinner. Eating can increase its absorption. Taking doxazosin with food can reduce its absorption, but does not affect the efficacy. Terazosin should be taken before going to bed to reduce the risk of orthostatic hypotension.

4. β-blockers

The names of medicines usually end with "-lol", such as bisoprolol, labetalol, metoprolol, propranolol, etc. 

Bisoprolol and labetalol have no influence with eating. Propranolol can be taken on an empty stomach or with food. Its bioavailability will increase when taken with food. 

Since metoprolol ordinary tablets can increase the bioavailability by 40% with eating. It should be taken on an empty stomach to reduce the occurrence of adverse effects. Metoprolol sustained-release tablets has no effect with has a meal.

🔔All β-blockers should not stopped suddenly. It will cause rebound hypertension.

5. Dihydropyridine calcium antagonists

Drug names usually end with "-dipine", such as amlodipine, cilnidipine, felodipine, lacidipine, nifedipine, etc.

Cilnidipine has digestive tract dysfunction and should be taken after a meal. The other drugs can be took before, during or after a meal.

6. Diuretics

Most common diuretics are furosemide, hydrochlorothiazide and spironolactone. The absorption of hydrochlorothiazide and spironolactone can be increased with food. It should be taken during or after meals. Furosemide has no effect with eating.

In order to reduce the occurrence of sleep enuresis, it is recommended to take diuretics in the morning.

👉In addition to the pharmacological effects, adverse reactions, drug absorption and metabolism and other characteristics of different drugs, the taking time of drugs also varies from person to person. Even if the same type of drugs are taken at different times. Different dosage forms of the same drug have different taking time. Some patients have gastrointestinal adverse reactions after taking the medicine, they should choose to take it after meals.

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Why is fasting blood sugar always unstable❓❓❓

Diabetes is a group of metabolic diseases characterized by hyperglycemia. Hyperglycemia is caused by defective insulin secretion or impaired biological effects, or both. Long-term high blood sugar causes chronic damage and dysfunction of various tissues, especially kidneys, blood vessels, heart, eyes and nerves. As a diabetic patient, in addition to using hypoglycemic drugs to control blood sugar, the patient must also monitor and record his blood sugar level. But why the fasting blood sugar of some patients have been sometimes high and sometimes low and they are always unstable, although they have the regular life, medication, diet and exercise arrangements?

Many people misunderstand that blood glucose before breakfast is equaled to fasting blood glucose.

Monitoring intravenous blood glucose in the hospital alone is not enough to understand the patient's condition changes. The doctors cannot formulate a reasonable and effective treatment plan based on that. Therefore, patients need to monitor blood glucose daily at home. 

After many people get up every morning, they usually finish the housework such as brushing their teeth and washing their face, making breakfast, or taking care of the children, and then measure their blood sugar. Many people mistakenly think that fasting blood glucose is the blood glucose level measured after getting up in the morning and taking blood before eating breakfast. In fact, it is not.

The correct meaning of fasting blood sugar.

After a person wakes up, the body will also be in a state of preparation for activity as the brain is awake. The levels of various hormones in the body begin to actively change and the blood sugar level also changes. Especially in patients treated with insulin, the blood sugar level is more likely to rise suddenly and decline suddenly.

In fact, fasting blood sugar is not measured the blood sugar on an empty stomach only. Fasting refers to the blood glucose level measured overnight, fasting for at least 8 hours and immediately after waking up. It can reflect the function of pancreatic islet β cells and generally indicates the secretion function of basic insulin. It is the most commonly used indicator for the detection of diabetes. The normal value should be less than 100mg/dl. If it is between 100-125mg/dl, it is pre-diabetes. If it is above 126mg/dl, it is diabetes.

Therefore, the first thing a diabetic patient should do after waking up is to wash his hands with warm water and then immediately check and record blood sugar. In this way, the fasting blood glucose can be measured accurately. If the fasting blood glucose is measured and there is still some time before breakfast, you can also compare the daily morning fasting blood glucose with the results of the pre-breakfast blood glucose measurement. It can provide a reference for adjusting medication in the future.

Why do the blood sugar before breakfast still need to measure even if the fasting blood glucose was measured?

The patient measures the pre-meal blood sugar can understand the blood sugar changes between meals. Without changing the dosage of drugs, the patient can rely on adjusting the type of food and the amount of food that he eat to ensure a stable blood sugar after a meal.

👉Only by accurately detecting blood sugar, the doctors can adjust the patient's medications and living habits reasonably and accurately. It also can help patients find problems at any time and go to the hospital for medical treatment in time. Accurate blood sugar testing can reduce the risk of diabetes complications. Good blood sugar control can improve the quality of life of patients and improve their physical condition.

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Gout: why does uric acid still raising although control the diet strictly?😵😵😵

Changes in uric acid can be affected by many factors. Although patients with gout have to control their diet, the effect of controlling uric acid is also uncertain. Some patients even usually do not eat seafood and animal offal, and legumes are rarely high, but uric acid is still increasing. Faced with this situation, should the patient take uric acid-lowering drugs?

1. Although patients have controlled their diet, why are the uric acid still increasing?

Hyperuricemia can be divided into 3 types: high uric acid production, poor uric acid excretion and mixed type. Researches found that 90% of primary hyperuricemia belong to the type of poor uric acid excretion. 80% of blood uric acid comes from the body's synthesis and 20% comes from diet. Therefore, the effect of reducing uric acid only by controlling diet is very limited. However, since high sodium salt can affect the excretion of uric acid, patients with gout should control their salt intake.

2. Why do hyperuricemia and gout cause kidney damage?

In patients with hyperuricemia, if urate crystals are deposited in the joints, it will cause gouty arthritis. If urate crystals are deposited in the kidneys, it will cause kidney stones, interstitial nephritis, acute and chronic renal failure. Kidney damage is the second most common comorbidity of hyperuricemia and gout.

3. Blood uric acid is not too high, why do gout attacks?

20% of patients with gout have a family history. There are three major factors that induce gout attacks: 

The blood uric acid level is too high

• According to statistics, the blood uric acid level at the first attack of gout was 527μmol/L for men and 516μmol/L for women. Therefore, when the blood uric acid level is greater than or equal to 540 μmol/L, uric acid-lowering treatment should be started. The blood uric acid should be controlled to be less than 420 μmol/L.

The blood uric acid level fluctuates too much

• A sudden increase in blood uric acid levels can cause gout attacks. In male patients, the most important factor inducing gout attacks is drinking (25.5%), followed by high-purine diet (22.9%). A sudden drop in blood uric acid levels can also cause gout attacks. For the first 3 to 6 months of taking uric acid lowering drugs, colchicine (0.5 to 1 mg/day) should be taken orally to prevent gout attacks.

A sudden cold of limbs

• At a body temperature of 37°C, the saturated solubility of blood urate is 404.5 μmol/L. The lower the temperature, the lower the solubility of urate. When the blood supply of the foot is poor, the temperature of skin and the pH of the tissue fluid are low and under a great pressure. Most of the joints of first time gout are the first metatarsophalangeal joints.

4. Why must patients with gout avoid from alcohol and lose weight?

Alcohol metabolism requires the participation of adenosine triphosphate. The consumption of adenosine triphosphate can directly increase the production of uric acid. Alcohol also leads to an increase in serum lactic acid levels which can reduce uric acid excretion. Therefore, patients with gout must abstain from alcohol. Obesity can lead to insulin resistance which increases kidney reabsorption of uric acid and increases blood uric acid levels. Therefore, obese hyperuricemia and gout patients must lose weight.

Patients with gout should not eat fruits with high fructose content such as oranges, apples, grapefruits, longans, lychees,  persimmons and pomegranates. Patients with gout should not eat more plant foods with high purine content such as shiitake seaweed, mushrooms, asparagus, straw mushrooms, kelp and grain germs.

Lemons, cherries and olives are relatively beneficial to patients with gout.

5. Which uric acid lowering drug is better for patients with gout?

At present, the commonly used clinically for lowering uric acid are febuxostat, allopurinol and benzbromarone. Uric acid-lowering drugs can be selected according to the following 3 points:

1. Uric acid-lowering effect: febuxostat > allopurinol ≈ benzbromarone.
2. Potential cardiovascular event risk: febuxostat > allopurinol.
3. Fatal exfoliative dermatitis: allopurinol (prohibited for those with positive HLA-B*5801 gene).
4. Hepatotoxicity: benzbromarone> allopurinol ≈ febuxostat.

180μmol/L ≤ blood uric acid ＜ 300μmol/L can promote the dissolution of tophi. The control target of blood uric acid in patients with gout is < 360μmol/L. For patients with hyperuricemia without comorbidities, the control target is < 420μmol/L.

6. Should the patient use uric acid lowering drugs?

For all gout patients, it is recommended to start uric acid-lowering drug treatment when blood uric acid is ≥480μmol/L.

Patients with chronic kidney disease, hypertension, diabetes, dyslipidemia, stroke, ischemic heart disease, heart failure and gout whose age of onset is less than 40 years old. It is recommended to start uric acid-lowering drug treatment when blood uric acid is ≥ 420μmol/L.

The glomerular filtration rate of this patient is less than 60ml/min. The uric acid production inhibitor febuxostat or allopurinol can be preferred.

👉When combined medicines, they should be used that do not affect or reduce the level of uric acid.

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