Why the bone densities of women still declines as they keep taking calcium tablets?😵😵😵

Do you have a habit of taking calcium tablets to prevent osteoporosis? Do you know what ingredients your calcium tablets contain? Do you think your calcium tablets are able to prevent or cure osteoporosis? Actually, it is not simply to prevent osteoporosis as only taking calcium tablets. Let's learn some knowledge about calcium supplement together.

What is osteoporosis?

Osteoporosis is a disorder of bone metabolism. The patient's bone density decreases and makes the bone structure fragile. It can easily lead to fractures and cause pain and other complications. Osteoporosis reduces the patient's ability to take care of itself. Normally, osteoporosis does not have any symptoms. If patient feel pain, it is usually caused by a fracture. The most common fracture sites include the spine, forearm bones and femur. The patient with osteoporosis may fractures due to a slight collision or fall. Even if there is no collision, the spine will also collapse progressively and cause the back bending. It will form hunchback and becomes short. Some patients may also have back pain.

There are some people buy and take the calcium tablets to prevent osteoporosis by themselves. However, their bone density may still decrease and they eventually have osteoporosis. Especially in women, they are easy to have osteoporosis.

There is a patient keep taking the calcium tablets everyday for more than 5 years. She check her bone density in the hospital after she fall down and has fracture. Her bone density has still declined since she started taking the calcium tablets. Her lumbar spine bone mineral density is almost achieved osteoporosis (T-score is -2.1, when T-score <-2.5, it can define to osteoporosis.). Her T-scores of other parts are also at osteopenia level (T-score <-1). 

Why the calcium tablets can't prevent bone loss?

Women are more likely to have osteoporosis than men, but why and why the calcium tablets can't prevent bone loss? The estrogen level is related to osteoporosis. After women enter the perimenopausal period, the  levels of estrogen are declined rapidly. The activity of osteoclasts is enhanced and the bone loss is significantly accelerated. To delay bone loss in postmenopausal women, the key is not to supplement calcium, but to inhibit osteoclast activity as soon as possible. Therefore, the calcium tablets are not enough for women. They may need to use selective estrogen receptor modulators (such as raloxifene) or bisphosphonates (such as alendronate). 

What situations are calcium supplements enough to be taken alone?

Women are before entering to perimenopausal period: The estrogen in the body has not decreased significantly. The activity of osteoclasts is not strong and the bone loss is slow. At this time, taking calcium supplements will help maintain their bone health.

In the interval between bisphosphonate medications or during their medication holidays, they can take calcium supplements: For example, zoledronic acid injection is generally injected once a year and calcium tablets can be taken alone during the interval between two injections. In addition, with the prolonged use of bisphosphonates, the bone density will no longer increases, but adverse effects gradually increase. Therefore, the use of bisphosphonate drugs should be suspended after 3 to 5 years and enter the medication holiday. During the medication holiday, calcium supplements can be taken alone.

👉When taking calcium supplements, combined with active vitamin D is better than only calcium. It can help increase the absorption of calcium, increase bone density and reduce the risk of fractures. Adults need to supplement 800 mg of calcium per day and 1000 mg for over 50-year-old.  

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Let's learn the effect of fruit on various organs of the human body.🍌🍎🍇

As the economy develops and living conditions continue to improve, people pay more and more attention to personal health. It is well known that fruits are beneficial to the human body, but in fact, each kind of fruit has different effects on human organs. Even some fruits have bad effects on certain organs. The following will share the effects of some fruits on the body.

1.  Stomach

Good: Papaya

Papaya contains an enzyme called papain, which can help the body break down meat protein and promote digestion. Papaya may destroy papain after being cooked. It is recommended that you eat papaya raw.

Tips: Eating a small amount of papaya after a meal can help the gastrointestinal tract digest the meat that is difficult to absorb. It also help to prevent gastric ulcers, gastroenteritis, indigestion and other diseases.

Bad: Persimmon

Persimmon contains a lot of tannic acid. If you eat a lot of persimmons on an empty stomach, gastric acid is easy to bond with tannic acid, pectin, cellulose, etc., and gastroliths are quickly formed in the stomach. The gastrolith will damage the gastric mucosa and further stimulate the increase of gastric acid secretion. Smaller gastroliths can be excreted with the stool. However, larger gastroliths may stay in the stomach for a long time and cause a series of stomach upsets.

Tips: Don't eat persimmon on an empty stomach. Don't eat more than 2 persimmons a day. People with indigestion and stomach problems are recommended to eat less.

2. Spleen

The main function of the spleen is to further transform the digested chyme from the stomach into subtle substances to feed the whole body. If the spleen becomes weak, the body lacks nutrition and easily have various diseases. Some people feel full after eating a little bit of food. Somebody have a strong appetite. Some will have constipation and some will have diarrhea and so on.

Good: Pomelo

Chinese medicine believes that pomelo is sweet and sour in taste, cool in nature. It can make the spleen healthy and fasten digestion.

Bad: Pear

In Chinese medicine, pears are cold and cool. People eat too many pears can easily hurt the spleen and stomach, especially for the elderly and children and those with weak spleen and stomach.

Tips: People who often have abdominal pain shouldn't eat too many pears. Healthy people shouldn't eat too many pears at once and one pear a day is more appropriate. In Chinese medicine, cooking the pear can reduce its cold and cool. 

3. Intestine

Good: Dragon fruit

The laxative effect of dragon fruit is due to its rich dietary fiber. Each 100 grams of dragon fruit contains about 2.8 grams of dietary fiber. Banana is always considered very laxative. It only contains only about 1 gram of dietary fiber per 100 grams. It is less than half of dragon fruit.

Tips: The dietary fiber content of white dragon fruit is higher than the red one. If you want to relieve constipation, choose the white one.

Bad: Guava

Guava is also containing a lot of tannic acid. It will combine with the food protein in the stomach to make it hard to be digested. It is easy to be constipated if you eat too much.

Tips: People who have poor bowel movements should avoid to eat guava.

4. Kidney

Good: Grape

Chinese medicine believes that grapes are neutral in nature, sweet and sour taste, which enters the three meridians of the spleen, lungs and kidneys. Usually eating grapes can nourish the kidneys.

Tips: There are many types and colors of grapes, but black grapes are the best for the kidneys.

Bad: Banana

Banana has a relatively high mineral content and the part that exceeds the body's requirement needs to be excreted through the kidneys. This process will bring out a lot of water and increase the burden on the kidneys. Therefore, people shouldn't eat too many bananas at once and up to 1-2 bananas per day.

Tips: It is not recommended to eat only bananas for weight loss. It is really unhealthy and hurts the kidneys. In addition, people with renal insufficiency are best to eat less or not to eat bananas.

5. Liver

Good: Hawthorn fruit

Chinese medicine believes that hawthorn fruit is sour and sweet in taste and mild warm in nature. It is entered to the spleen, stomach and liver meridian. The acid of hawthorn fruit can restrain liver qi and prevent liver qi from becoming too vigorous. The hawthorn fruit enters the stomach. It can enhance the action of enzymes, promote the digestion of meat and help the conversion of cholesterol.

Tips: For people with fatty liver, hawthorn fruit can play a role in digestion and fat removal.

Bad: Durian

Durian contains a lot of sugar and calories. Sugar is metabolized in the liver which converts sugar into fat. It raises triglycerides and causes insulin resistance. It lead to damage the liver.

Tips: Healthy people should eat no more than 2 pieces a day (the edible part is no more than 100g). Patients with obesity, fatty liver, diabetes and hyperlipidemia should not eat as much as possible. If they really want to eat durian, the daily amount should be controlled within 1 small piece.

6. Heart

Good: Apple

The polyphenols and flavonoids contained in apples can  improve the permeability of blood vessels, reduce the fragility of blood vessels and lower blood lipids and cholesterol. Actually, apple have too many benefits to the body. An apple a day keeps the doctor away.😉

Tips: After the apple is heated, the polyphenols and flavonoid antioxidants will be drastically reduced. The heart protection effect will naturally be greatly reduced.

👉Do you like to eat fruit? Hope it can help you when you choose what fruit to eat.😁

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Know the common side effects of commonly used antihypertensive drugs.😎😎😎

Angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor antagonists (ARB), β receptor blocker, dihydropyridine calcium channel blockers (CCB) and diuretics are used commonly antihypertensive drugs in clinical. These antihypertensive drugs have their own characteristics, priority indications and adverse effects.

1. Angiotensin converting enzyme inhibitors (ACEI)

Common drugs: Captopril, enalapril and lisinopril.

Mechanism: It inhibits angiotensin-converting enzyme and block the production of renin-angiotensin II. It also inhibit the degradation of bradykinin and cause a hypotensive effect.

• Adding diuretics or limiting salt intake can increase the antihypertensive effect of ACEI.

Priority indications: Hypertensive patients with chronic heart failure, cardiac insufficiency after myocardial infarction, prevention of atrial fibrillation, metabolic syndrome, diabetic nephropathy, non-diabetic nephropathy, proteinuria or microalbuminuria.

Adverse effects: 

1. Dry cough: About 30% of patients can cause a persistent dry cough. It often gets worse after lying down. Non-smokers and women are more likely to develop dry coughs. Dry cough may be related to increased bradykinin and prostaglandin levels. Non-steroidal anti-inflammatory drugs inhibit prostaglandin synthesis. They can suppress coughing, but increase the risk of kidney damage.
2. Angioedema: It can affect the tongue, glottis, or larynx. It usually occurs within a few hours or 1 week after the medication. If angioedema occurs, patients should be discontinued using ACEI.
3. Hyperkalemia: Bradycardia, nausea and fatigue are the early manifestations. Patients with diabetes and renal insufficiency are more likely to occur.

2. Angiotensin II receptor antagonists (ARB)

Common drugs: Losartan, valsartan, olmesartan and irbesartan.

Mechanism: It blocks angiotensin II receptor (type 1). It cause decreasing secretion of vasopressin, decreasing synthesis and secretion of aldosterone. That exerts vasodilation and antihypertensive effect.

Priority indications: Patients can not tolerate ACEI who can choose ARB.

Adverse effects: 

1. Back pain: ARB antihypertensive drugs can cause back pain. The results of clinical trials showed that the incidence of back pain caused by valsartan was 1.6% and the incidence of joint pain was 1.0%. Different ARB drugs have different incidences of adverse effects in the musculoskeletal system. If musculoskeletal pain occurs when  taking a ARB drug, you can try to alter another ARB drug.
2. Hyperkalemia: Both ACEI and ARB antihypertensive drugs can cause hyperkalemia.

3. β receptor blocker

Common drugs: Metoprolol and atenolol.

Mechanism: It inhibits β receptor. It lead to inhibit myocardial contractility and slow down the heart rate. Therefore, it produces a hypotensive effect.

Priority indications: Patients with tachyarrhythmia, coronary heart disease and chronic heart failure.

Adverse effects: 

1. Slow heartbeat and pulse: β-blockers have greatly variance among individuals and patients should monitor their heart rate. For patients with hypertension and coronary heart disease, the resting heart rate should be slowed down to 50-60 beats/min while controlling blood pressure.
2. Rebound phenomenon: Sudden discontinuation of β blockers can cause severe angina pectoris and even sudden cardiac death. The dose must be gradually reduced under the guidance of a doctor and the entire withdrawal process should take at least 2 weeks.

4. Dihydropyridine calcium channel blockers (CCB)

Common drugs: Felodipine, nifedipine and amlodipine.

Mechanism: It can inhibit the calcium channel on vascular smooth muscle cells. Therefore, it can lead to dilate blood vessels and lowering blood pressure.

Priority indications: Elderly patients with hypertension or isolated systolic hypertension  associated with coronary and carotid atherosclerosis, stable angina and peripheral vascular disease.

Adverse effects: 

1. Constipation: All dihydropyridine calcium channel blockers can cause constipation.
2. Gingival hyperplasia: Felodipine, nifedipine, amlodipine and so on can cause gingival hyperplasia.
3. Increased heart rate: Calcium channel blockers can reflexively cause tachycardia. It can worse heart failure. Except for felodipine and amlodipine, other calcium channel blockers are not recommended for the treatment of patients with hypertension and heart failure.
4. Ankle edema: It is related to the dosage. Elevating the foot can reduce the symptoms of edema. Mainly due to the expansion of the precapillary arterioles, not due to fluid retention. Combined use of ACEI or ARB can reduce the symptoms of edema.

5. Diuretics (Thiazides diuretics)

Common drugs: Chlorothiazide, hydrochlorothiazide and indapamide.

Mechanism: It acts on the ascending limb of Henle's loop and the distal convoluted tubules in the renal cortex. It increases to excrete sodium and urine and reduce blood volume.

Priority indications: Elderly hypertension, isolated systolic hypertension, refractory hypertension, etc.

Adverse effects: 

1. Photosensitivity: It can cause skin rash. Patients taking thiazide diuretics should avoid direct sunlight.
2. Hypokalemia: The main symptoms include nausea, anorexia and fatigue. It can be improved when combined with antihypertensive drugs that may cause hyperkalemia such as ACEI and ARB, but electrolyte levels still need to be monitored regularly.
3. Hyperuricemia: Patients with gout should prohibit using thiazide diuretics. If the blood uric acid level is ≥480μmol/L, it is recommended to change to other antihypertensive drugs.
4. Hypercalcemia: Patients should be cautious when using it in combination with calcium and vitamin D supplements. Thiazide diuretics can reduce urinary calcium excretion and may cause hypercalcemia.

6. Diuretics (Loop diuretics)

Common drugs: Furosemide.

Mechanism: It inhibits the cotransporter of Na⁺⁄ 2Cl^-⁄ K⁺ in the ascending limb of Henle's loop. It reduces the recycle of Na⁺, K⁺ and Cl^- to achieve diuretic effect.

Priority indications: It can take effect quickly. Therefore, it can be used for patients with acute edema symptoms.

Adverse effects: 

1. Hypokalemia and hyperuricemia: Similar to thiazide diuretics.
2. Ototoxicity: Loop diuretics may cause ototoxicity. Be careful when combining with other ototoxic drugs (such as aminoglycoside antibiotics).

7. Diuretics (Potassium-sparing diuretics)

Common drugs: Spironolactone, eplerenone and amiloride.

Mechanism: Spironolactone and eplerenone can antagonist aldosterone. Amiloride blocks sodium ion channels and produces effects similar to aldosterone antagonists.

Priority indications: It often combined with thiazides diuretics or loop diuretics. Aldosterone antagonists usually effect to resistant hypertension (It refers to use 3 or more types of antihypertensive drugs still not achieve the target blood pressure).

Adverse effects: 

1. Hyperkalemia: It can decrease to excrete potassium in urine. Be careful when combined with the drugs that may cause hyperkalemia such as ACEI and ARB.
2. Gynecomastia and Irregular menstrual periods: The chemical structure of spironolactone is similar to some sex hormones. Therefore, spironolactone may cause gynecomastia and Irregular menstrual periods.

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People who love to eat fish may have fewer cerebrovascular diseases.🐟🐟🐟

It is well known that eating more fish is good for the body. Recently, a research show that elderly people who love to eat fish have fewer cerebrovascular diseases. Cerebrovascular disease involves harm to cerebral blood vessels and is a risk factor for stroke and vascular dementia. The University of Bordeaux conducted a large-scale research of the relationship between vascular disease and dementia. 

They analyzed the results of MRI scans of more than 1600 people over 65-year-old who had no history of cardiovascular disease,  dementia or stroke in the research. The participants also filled out a questionnaire about their eating habits. The participants were divided into four groups based on their frequency of eating fish: four or more times a week, two to three times a week, once a week or less than once a week. Then the researchers compared their signs of cerebrovascular disease.

Eating more fish may have fewer cerebrovascular diseases

In the MRI scans, the participants who ate fish more frequently showed fewer signs of damage in their brain than the participants who ate fish less frequently. Compared with the elderly in the study, the association between vascular disease and fish intake was stronger in 65 to 69-year-old people. However, there was no significant connection between vascular disease and fish intake in over 75-year-old people.

Experts believe that for most people, the risk of dementia depends on the different complex factors, such as environmental and genetic factors. People understood which aspects of lifestyle have the greatest influence on brain health. It is the key to enabling them to make the good decisions of their lifestyle. This observational research cannot determine the reason and result relationship. Although the researchers try to control for other factors that may lead to differences in signs of cerebrovascular disease, it is still difficult to clearly ensure the relationship between cerebrovascular disease and the number of fish intake. Based on the study, it is also unclear about the relevance of the findings to long-term brain health. Although fish is a important source of essential fatty acids and the National Health Service in the United Kingdom also recommends eating two servings of fish a week as part of a balanced diet, no single specific food or supplement can be maintaining the brain healthy.

Not smoking, drinking within the recommended range, eating balanced diet, exercising moderately and have a healthy lifestyle are all lead to a healthier brain and body.😁

Reference：

Fish Intake and MRI Burden of Cerebrovascular Disease in Older Adults 11 2021,
10.1212/WNL.0000000000012916; DOI: 10.1212/WNL.0000000000012916

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Do you know what exactly functions of vitamin B complex are in the body?💁💁💁

Vitamin B complex can relieve many diseases, but there are many kinds of vitamin B, such as vitamin B1, B2, B3, B5, B6, B12 and so on. Which one should you take? Or Did you take a wrong one?

1. Vitamin B1- neuritis and beriberi

Vitamin B1 also known as thiamine. It is one of the important coenzymes required for many kinds of metabolism in the body. The lack of vitamin B1 can cause metabolic disorders of lipids and carbohydrates in the body. The main manifestations of diseases include digestive system diseases, beriberi and so on. Beriberi often shows as peripheral neuropathy, paresthesia, muscle weakness, paralysis of the lower limbs, paralysis, fatigue, lack of appetite and enlarged heart.

Recommended supplementary foods: milk, egg yolks, cereals, lean meats, tomatoes, etc.

2. Vitamin B2 - chapped lips and angular cheilitis

Vitamin B2 also known as riboflavin. It is an important component of two coenzymes involved in protein and amino acids. It can enhance the development and growth of skin, hair and cells. The lack of vitamin B2 first shows in the skin. It can cause angular cheilitis, chapped lips, keratitis, seborrheic dermatitis, conjunctivitis, glossitis, leukopenia and so on.

Recommended supplementary food: soybeans, milk, eggs, animal liver and kidney, etc.

3. Vitamin B3 - pellagra and regulate blood lipids

Vitamin B3 is mostly called niacin. It is a essential component of the coenzyme required in the body and participates in different metabolic activities such as glucose-energy conversion, protein metabolism and glycerol formation in the body. The lack of niacin can manifest loss of appetite, pellagra, dermatitis, diarrhea, anemia, dementia, slow growth and other diseases. Niacin also has a strong blood lipid regulation effect and vasodilator effect. It is also used to treat a variety of cardiovascular diseases, such as hyperlipidemia and coronary heart disease. 

Recommended supplementary food: beans, animal offal, etc.

4. Vitamin B5 - celiac disease

Vitamin B5 also known as pantothenic acid. It participates in a variety of metabolisms in the body. It promotes the decomposition of amino acids, sugars and fats. It is also a component of the multi-enzyme complex fatty acid synthase. Because it is widely present in food, pantothenic acid is not easy to lack. Calcium pantothenate is clinically used and can be used to treat celiac disease.

Recommended supplementary food: meat, animal heart and liver, etc.

5. Vitamin B6 - neuritis, vomiting during pregnancy

Vitamin B6 is a coenzyme of a variety of enzymes. It plays an important role in protein metabolism and neurotransmitter synthesis. The lack of vitamin B6 can cause glossitis, chapped lips, stomatitis, insomnia, neurological disorders and many other diseases. It can be used to clinically treat a variety of diseases, such as vomiting during pregnancy, neuritis, leukopenia, adjuvant therapy of liver disease.

Recommended supplementary foods: vegetables, meat, nuts, grains, etc.

6. Folic acid - prevention of fetal congenital neurological malformations

Folic acid is also called vitamin B9. It can constitute a variety of coenzymes and participate in different metabolism in the body. It is an important composition of RNA and DNA. It is the nutrients necessary for the reproduction and growth of the body's cells. It can also promotes the generation and maturation of the cells company with vitamin B12. When folic acid is lacking, it can cause megaloblastic anemia. Folic acid can be used to treat megaloblastic anemia, prevent birth defects in newborns,  hypertension with elevated homocysteine and other diseases.

Recommended supplementary foods: animal liver, fruits, green vegetables, etc.

7. Vitamin B12 - peripheral neuropathy

Vitamin B12 also called cobalamin. It is the only vitamin containing metal elements. Vitamin B12 can increase the utilization rate of folic acid. It promotes the formation of DNA and nucleic acid. It is also an indispensable component for the synthesis of nerve myelin lipoprotein. Deficiency of vitamin B12 can lead to peripheral neuropathy and megaloblastic anemia.

Recommended supplementary foods: eggs, fish, meat, dairy products, etc.

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Grasp the precautions about Atorvastatin calcium.😎😎😎

Atorvastatin calcium is a commonly used statin lipid-lowering drug. Indications are patients with hypercholesterolemia and primary hypercholesterolemia. It is including patients with familial hypercholesterolemia or mixed hyperlipidemia. If diet therapy and other non-drug treatments are not satisfactory, it can be used to treat elevated total cholesterol (TC), elevated low-density lipoprotein cholesterol (LDL-C), elevated apolipoprotein B and triglyceride (TG) increased.

1. Dosage

The usual starting dose is 10 mg once a day and adjust the dose every 4 weeks or longer. The maximum dose is 80 mg once a day.

• It takes at least 4 weeks for statins to achieve the maximum lipid-lowering effect, so the interval between dose adjustments should be 4 weeks or longer.
• Atorvastatin calcium contains very little amount of calcium which does not affect calcium supplementation.

Kidney disease: It neither affect the blood concentration nor affect its lipid-lowering effect. So there is no need to adjust the dose.

• Patients with active liver disease, pregnant women or women of childbearing age who may conceive are prohibited.

Elderly patients (≥65 years old): The blood concentration is about 40% higher than young people. Any dose of atorvastatin can lower low-density lipoprotein (LDL-C) significantly higher than young people.

• When using atorvastatin, the elderly need to pay special attention to adverse muscle reactions. When there is unexplained muscle weakness, muscle tenderness, muscle pain, neck pain, joint swelling, especially when it is accompanied by discomfort or fever, it is necessary to timely medical treatment.

2. Medication time

The half-life of atorvastatin is 14 hours. The half-life of active metabolites is 20-30 hours. The lipid-lowering effect of atorvastatin is mainly (about 70%) related to active metabolites. Compared with the morning administration, the blood concentration of the evening administration is reduced by about 30%. However, no matter when it is administered during the day, its cholesterol-lowering effect is the same.

• The daily dose of atorvastatin can be taken at any time during the day and is not affected by meals.
• The peak time of cholesterol synthesis is from 0:00 to 3:00 and other statins with shorter half-lives need to be taken before going to bed.

3. Lipid-lowering intensity

The lipid-lowering intensity of statins (including atorvastatin) is related to the dose. However, even if the dose is doubled, the lipid-lowering intensity only increases by about 6%.

• Statins can effectively reduce triglycerides. Patients with hypercholesterolemia and high triglycerides should first choose statin lipid-lowering drugs.

Dose-response relationship of Atorvastatin
	10mg	20mg	40mg	80mg
LDL-C	-39%	-43%	-50%	-60%
HDL-C	+6%	+9%	+6%	+5%
TG	-19%	-26%	-29%	-37%
TC	-29%	-33%	-37%	-45%

4. Interaction

Atorvastatin is metabolized by cytochrome CYP3A4. When combined with a strong CYP3A4 inhibitor, the blood concentration and bioavailability of atorvastatin increase.

Grapefruit juice: Avoid taking with grapefruit or grapefruit juice.

Gemfibrozil and Niacin: The risk of myopathy/rhabdomyolysis is increased, so avoid combined with gemfibrozil or niacin.

Combined with Clarithromycin: The initial dose of atorvastatin is 10 mg once a day. The maximum dose is 20 mg once a day.

Combined with Itraconazole: The initial dose of atorvastatin is 10 mg once a day. The maximum dose is 40 mg once a day.

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Obesity should be seen as a potentially chronic disease.🍨🍩🍪

Obesity is not just a physical problem, but a disease that needs attention and treatment. In December 2016, the American Association of Clinical Endocrinologists and the American Endocrinologists Association issued a statement suggesting that a new medical diagnostic term for obesity-based chronic diseases. It was intended to emphasize that obesity affect health and need to control and manage complications as the chronic diseases. 

With the improvement of living standards and changes in lifestyles, the incidence of obesity is showing an obviously increasing. People are paying more and more attention to chronic diseases. The incidences of hypertension, hyperlipidemia and diabetes are also increasing year by year. More researches believe that obesity has become one of the important predisposing factors for many chronic diseases. World Health Organization recognize obesity as the fifth largest risk factor affecting health and can easily lead to many serious complications.

1. Obesity and cardiovascular disease

Obesity can cause the body's fat metabolism disorder which further leads to the occurrence of hyperlipidemia and hypertension. With the increase of BMI, the incidence of hyperlipidemia and hypertension gradually increases.

Adipocytes proliferate and increase in number, the number of insulin receptors on the surface of hypertrophic adipocytes is relatively reduced and insulin affinity decreases. It results in insulin resistance. This may be one of the reasons that obesity leads to abnormal lipid metabolism and causes hyperlipidemia. The mechanism of obesity-induced hypertension may be related to the comprehensive effects of  the immune system, the sympathetic nervous system and the renin-angiotensin system. 

2. Obesity and diabetes

Overweight and obesity are one of the important risk factors related to the onset of diabetes. As the BMI level increases, the risk of disease increases.

The possible mechanism is that excessive eating will cause a large increase in blood sugar and stimulate the islet cells to secrete a large amount of insulin to maintain blood sugar in the normal blood sugar range. It cannot meet the body's requirement for glucose metabolism regulation and cause increased blood sugar. The excess body fat of overweight and obese people leads to the enhancement of fat degradation. Glycogen utilization is impaired, glucose oxidative metabolism decreases and blood sugar rises. In addition, the liver intake of insulin is reduced which leads to an increase in insulin concentration in the body. It leads to hyperinsulinemia and causes down-regulation of insulin receptor expression and insulin resistance.

3. Obesity and hyperuricemia

Uric acid is the end product of purine metabolism which is mainly derived from the enzyme decomposition of nucleic acids and other purine compounds and purine components in food. More and more studies have shown that hyperuricemia is an important component of metabolic syndrome. It has a certain relationship with obesity. Obese people are more likely to suffer from hyperuricemia. Obesity, especially abdominal obesity, is closely related to hyperuricemia. 

The possible mechanisms are: 

1. Too much energy intake, increased purine synthesis in the body and increased uric acid. 

2. Too much eating and too little consumption. It leads to the accumulation of excessive visceral fat and when the liver fatty acid synthesis is hyperactive. It eventually leads to the synthesis of triglyceride and the production of uric acid are hyperactive. 

3. Insulin resistance leads to a decrease in uric acid excretion.

Insulin resistance is one of the main pathophysiological mechanisms of metabolic syndrome and obesity is the theory that leads to the most evidence of insulin resistance.

4. Obesity and other complications

Lungs: The lungs are squeezed by fat. The breathing becomes difficult and it is difficult for the blood to carry out effective oxygen circulation. That can damage the immune system and cause high blood pressure.

Joint: Obesity will increase the weight-bearing of joints such as wrists and knees. It cause osteoarthritis. Obese people are much more likely to develop arthritis than ordinary people.

Intestinal: The fat accumulated around the internal organs will continue to secrete a large number of hormones or chemicals, which will cause changes in metabolism and cause type 2 diabetes. In addition, the secreted hormones can cause endocrine disorders and cause polycystic ovary syndrome, which can have a certain impact on women's future fertility.

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The cognitive of breastfeeding women show better than non-breastfeeding.👶👶👶

It is well known about breastfeeding is good for the babies, but there were few studies have focused on the health effects of breastfeeding on mothers. Recently, a research showed that breastfeeding may also have long-term benefits for the mother's own health. Compared with women who have not breastfed their children, women who have breastfed their children carried out better performance on cognitive ability after the age of 50. 

The relationship between cognitive ability and Alzheimer's disease

Cognitive ability is closely related to the health of the elderly. However, cognitive ability will continue to be declined after the age of 50 and it may also become a important factor in predicting Alzheimer's disease (AD). Alzheimer's disease is one of the main manifestations of dementia and one of the main causes of damage to the health of the elderly. Moreover, women are more likely to suffer from AD than men. 

Breastfeeding benefit to the mother's cognitive ability

There were some studies have found that breastfeeding can help improve baby's emotion, reduce mother's stress and the risk of postpartum depression. This suggests that breastfeeding may be have great benefit to the mother's neurocognitive ability and may strengthen the mother's long-term cognitive ability.

In that research, the researchers investigate more than a hundred women with or with out depression. All participants completed a series of comprehensive psychological tests that measured learning ability, executive function, processing speed and so on. They also answered a questionnaire about their reproductive life history which included the age at they began menstruation, the number of complete and incomplete pregnancies, the length of time each baby was breastfeeding and their menopausal age. None of the participants were diagnosed with dementia or other mental illnesses such as bipolar disorder, alcohol or drug dependence, neurological disorders. They had been prevented to take any psychoactive drugs during the research. There were also no significant differences between depressed and non-depressed participants in terms of age, race, education or other cognition. Whether they were depression, the results also showed that women who had breastfed performed better than women who had not breastfed.

Whether they were depression or not, the results also showed that women who had breastfed was performed better than women who had not breastfed.

Researches need to explore the relationship between breastfeeding history and cognitive performance in a larger and more diverse group of women. It is important to better understand the impact of breastfeeding on women's health.

For more detail, read the research article👇👇👇

Women who breastfeed exhibit cognitive benefits after age 50. https://doi.org/10.1093/emph/eoab027

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Application of glucocorticoids in clinical diseases.👀

The applications of glucocorticoids are very extensive and vary with the dose.
Glucocorticoids secreted under physiological conditions mainly affect the metabolism of substances. It will cause metabolic disorders and death when lacking. When glucocorticoids are pharmacological doses, in addition to affecting substance metabolism, it also have immunosuppressive , anti-inflammatory, detoxify and anti-shock effects.

1. Classification and difference of common glucocorticoids

According to the duration of action, glucocorticoids can be divided into three categories:

Category	Drug	Dose equivalent (mg)	Effective drug duration (hours)
Short-acting	Cortisone	25	8-12
	Hydrocortisone	20
Medium-acting	Prednisone	5	12-36
	Prednisolone	5
	Methylprednisolone	4
Long-acting	Dexamethasone	0.75	36-54
	Betamethasone	0.6

2. Glucocorticoid treatment course and withdrawal

Pulse therapy: The course of treatment is usually less than 5 days. It indicated for rescue of critically ill patients. The drug can be withdrawn quickly.

Short-term treatment: The course of treatment is less than 1 month. It indicated for infection or allergic diseases. Withdraw the drug by gradually reducing.

Medium-term treatment: The course of treatment is during within 3 months. It indicated for long term and multiple organ involvement disease. Withdraw the drug by gradually reducing.

Long-term treatment: The course of treatment is more than 3 months. It indicated for chronic autoimmune diseases, such as systemic lupus erythematosus. Before stopping the drug, the drug treatment should be gradually transitioned to alternate day therapy, then reduce the dose gradually and slowly.

Alternative therapy: Lifetime use. It indicated for primary or secondary chronic adrenocortical insufficiency.

3. Application of glucocorticoids in common diseases

Hyperthyroidism crisis: The level of thyroid hormones is sudden increase in the body. It is always related to the patients with insufficient treatment in severe or chronic hyperthyroidism. 

Treatment: Inorganic iodides, antithyroid drugs, β-receptor blockers and glucocorticoids (glucocorticoids can inhibit the conversion of peripheral T4 to T3).

Graves' ophthalmopathy: It is an organ-specific autoimmune disease related to the thyroid. It mainly manifests as exophthalmos, eyelid contracture, periorbital edema, bulbar conjunctival edema and eyeball activity dysfunction.

Treatment: For mild, the main treatment is to control hyperthyroidism or hypothyroidism. For moderate to severe, intravenous or oral glucocorticoid therapy is the main treatment.

Autoimmune hemolytic anemia: It is caused by lymphocytes function abnormally. Lymphocytes produce antibodies against the red blood cells, which accelerates the destruction of red blood cells in the body.

Treatment: For acute hemolytic attacks, intravenous infusion of dexamethasone or methylprednisolone is the first choice. Oral prednisone is the first choice for milder conditions (Taken in the morning).

Idiopathic thrombocytopenic purpura: The patient produces anti-platelet autoantibodies in the body.

Treatment: Glucocorticoids are the first choice. Immunosuppressants are needed for ineffectiveness and large doses of intravenous γ-globulin are used for severe bleeding.

Aplastic anemia: Abnormal activation and hyperfunction of T lymphocytes cause bone marrow damage.

Treatment: Antithymus/lymphocyte globulin (daily simultaneous application of glucocorticoids to prevent allergic reactions) and cyclosporine are commonly used.

Graft-versus-host disease: It is the most common complication of allogeneic hematopoietic stem cell transplantation and involving a variety of immune cells and inflammatory cytokines.

Treatment: For acute, use glucocorticoids (common use methylprednisolone and prednisone) combined with calcineurin inhibitors. For chronic, use cyclosporine A combined with glucocorticoids.

Nephrotic syndrome: It is characterized by massive proteinuria and it often accompanied by hypoalbuminemia (≤30g/L), edema and hyperlipidemia.

Treatment: Glucocorticoids or combined immunosuppressive agents (cyclophosphamide, cyclosporine A, mycophenolate mofetil, etc.).

Lupus nephritis: It refers to systemic lupus erythematosus complicated by kidney damage. It has varying clinical manifestations, such as hematuria, tubular urine, persistent proteinuria or decreased renal function.

Treatment: Oral glucocorticoid therapy is the main treatment. If it is necessary, glucocorticoid pulse therapy or other immunosuppressive agents should be added.

Adrenal crisis: Acute reduction of adrenal cortex function induced by infection, trauma and other stress conditions or withdrawal of hormones. It leads to high fever, drop in blood pressure and so on. 

Treatment: Intravenous infusion of glucocorticoid (hydrocortisone), correction of dehydration and electrolyte disturbances and treatment of hypoglycemia.

Systemic lupus erythematosus: It is an autoimmune-mediated diffuse connective tissue disease characterized by immune inflammation.

Treatment: For mild, use no or small doses glucocorticoids. For medium, glucocorticoids + other immunosuppressive agents (cyclophosphamide or mycophenolate mofetil). For severe conditions, it is required large doses of glucocorticoids + other immunosuppressive agents. If it is necessary pulse treatment, methylprednisolone can be used.

Bronchial asthma: Asthma is a chronic airway inflammatory disease involving a variety of cells and cellular components.

Treatment: Inhaled glucocorticosteroids (ICS) are the first choice for long-term treatment of asthma. For chronic severe persistent asthma that cannot be controlled by high-dose ICS + LABA (Long-acting beta-agonists, such as formoterol.), low-dose oral glucocorticoid maintenance therapy can be added. Generally use a short half-life glucocorticoids (such as prednisone.), and take it in the morning. 

Idiopathic pulmonary fibrosis (IPF): It is a chronic, progressive and fibrotic interstitial pneumonia of unknown etiology. The median survival time from diagnosis is only 2 to 3 years.

Treatment: Anti-fibrosis agents pirfenidone and nintedanib can delay the decline of pulmonary function in patients with IPF. Patients with acute exacerbations should be treated with glucocorticoids as appropriate and avoiding glucocorticoids in the stable phase is beneficial to prolong the natural progress of the disease.

Ulcerative colitis (UC): Inflammatory bowel disease refers specifically to inflammatory bowel disease of unknown etiology, including ulcerative colitis and Crohn's disease. The cause is unknown and there is no cure for the time being. The lesions of UC were distributed continuously.

Treatment: For mild, use aminosalicylic acid preparations (such as mesalazine). For moderate, adequate aminosalicylic acid preparations are not well controlled and switch to glucocorticoid therapy. Thiopurine drugs can be used for glucocorticoid-ineffective or dependent patients. If the above treatments are ineffective, it should consider using infliximab.

Crohn's disease: Crohn's disease is also an inflammatory bowel disease of unknown etiology and the lesions are distributed in segments.

Treatment: For mild, use aminosalicylic acid preparations (such as mesalazine). For moderate to severe, use glucocorticoid. For those who fail to treat glucocorticoids or sulfa drugs, switch to or add azathioprine, cyclosporine and other immunosuppressive agents Agent. If the above treatments are ineffective, consider using infliximab.

Ankylosing spondylitis: It is a chronic inflammatory disease that mainly affects the sacroiliac joints, spine, paraspinal soft tissues and peripheral joints. It may be accompanied by extra-articular manifestations. In severe cases, spinal deformity and rigidity can occur.

Treatment: First using the drugs  to improve symptoms and disease progress, such as NSAIDs, sulfasalazine and anti-TNFα antagonists. Systemic corticosteroid therapy is generally not recommended. Glucocorticoids are usually used as local adjuvant drugs to improve Symptoms (such as injection into the joint cavity).

Rheumatoid arthritis: It is an autoimmune disease with erosive arthritis as the main clinical manifestation. It can occur at any age.

Treatment: The first choice is methotrexate alone. If it does not achieve treatment effect, it combined with leflunomide, sulfasalazine, and tocilizumab. Patients with moderate/high disease activity, combined with glucocorticoid therapy to quickly control symptoms.

👉When taking glucocorticoids for a long time, calcium and active vitamin D should be supplemented regularly to prevent osteoporosis and femoral head necrosis.

👉Patients with long-term use of glucocorticoids should check their weight, blood pressure, blood lipids, blood sugar, electrolytes, growth and development regularly.

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The use of oral ibuprofen and its precautions.😎😎😎

Ibuprofen is an antipyretic and analgesic which is commonly used clinically. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). It inhibits cyclooxygenase, reduces the synthesis of prostaglandins and produces analgesic and anti-inflammatory effects. It has an antipyretic effect through the hypothalamic body temperature regulation center.

Ibuprofen precaution for children:

Rectal temperature ≥ 39.0°C, oral temperature ≥ 38.5°C, axillary temperature ≥ 38.2°C or fever children who are uncomfortable and depressed due to fever. Ibuprofen or acetaminophen is recommended.

Acetaminophen can be used for children ≥ 2 months and ibuprofen can be used for children ≥ 6 months. Acetaminophen combined with ibuprofen is not recommended for children's fever nor alternate acetaminophen and ibuprofen.

The dose of oral ibuprofen for children is 10mg/kg each time. The shortest interval is 6-8 hours and no more than 4 times within 24 hours. If symptoms are not relieved after taking it for three consecutive days, see a doctor as soon as possible.

Ibuprofen precaution for adults:

1. Anti-arthritis: 0.4g-0.6g each time, 3-4 times a day, the dosage of rheumatoid arthritis is larger than osteoarthritis.

2. Mild to moderate pain: 0.2-0.4g each time every 4-6 hours. The maximum daily dose is 2.4g.

Ibuprofen can weaken the antiplatelet effect of low-dose aspirin. Patients who are taking low-dose aspirin should not use ibuprofen. Use acetaminophen instead of ibuprofen.

Ibuprofen precaution for breastfeeding women:

When breastfeeding women take ibuprofen, no serious adverse reactions have been found in the breastfed infants. The intake of ibuprofen by the breastfed infants is 0.0008% of the mother's dose. Lactating women can use ibuprofen with caution.

Ibuprofen precaution for pregnant women:

Taking ibuprofen in early pregnancy can cause cardiovascular malformations and cleft palate. Taking ibuprofen in late pregnancy can lead to unclosed arterial ducts and myocardial degenerative changes. Therefore, pregnant women should not use ibuprofen.

Common side effects:

Common side effects are nausea, dyspepsia, gastric ulcer bleeding and allergic reactions. Long-term use of ibuprofen can cause kidney damage, bleeding and increase the risk of cardiovascular disease.

It can be taken with food to avoid indigestion or stomach irritation.

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Drinking 100 ml of sugared beverages a day can increase the risk of cancer by 18%!!😱😱😱

Whenever you see a attractive beverage on the supermarket shelves, do you always want to drink a bottle and make yourself happy all day? In fact, the sugar in the drink has sneaked into your body at this time. If you don't control drinking, you may become a high sugar intake group unknowingly. 

So, what exactly is high sugar intake? High sugar intake refers to high added sugar intake. Added sugars include sucrose, sweeteners, honey and fruit juice, which are extracted and refined and added to foods or beverages to improve taste.

Will high sugar intake release "happiness factors" and relieve stress?

The intake of sugar will stimulate our brain to secrete dopamine. Dopamine is a kind of nerve substance that transmits excitement and happiness. It can make people feel happy. Therefore eating sugar can really make people happy and relieve stress.

What are the hazards of high sugar intake to the body?

Short term: High sugar intake will increase systemic inflammation and increase the risk of acne. This is why some people start to get acne after eating a lot of sweets.

Long term: Long-term high sugar intake will increase the risk of dental caries. Studies have found that 3 cups of sugared beverages a day will double the risk of dental caries. The effect of sugar to dental caries is not limited to modern times. In fact, as early as 500 years ago, excessive sugar consumption caused European aristocrats to have dental caries.

High sugar intake will also increase the risk of obesity. It is because added sugar is an "empty calorie food (most calorie and less nutrient in the food)". You are already full but you can still continue to enjoy a dessert after a meal. This is how sugar affects the satiety. Therefore, it is easy to eat too much sugar, which leads to excessive calorie intake and leads to obesity. In addition, high sugar intake can also increase the risk of diabetes. Added sugar can be quickly absorbed by the body and has a great impact on blood sugar fluctuations. Studies have shown that people who consume a lot of sugared beverages have an 18% increase in the risk of type 2 diabetes. 

Why does high sugar intake increase the risk of cancer?

In 2019, a study of more than 100,000 people showed that drinking 100 ml of sugared beverages a day would increase the overall risk of cancer by 18%. The researchers proposed some possible explanations for these results. It was including the effect of sugar in sugared beverages on visceral fat, blood sugar levels and inflammatory. All are associated with increased cancer risk. Long-term high sugar intake can lead to obesity and insulin resistance. It is resulting in oxidative stress, endocrine disorders and immune dysfunction in the body and leading to an increased risk of tumors.

After the tumor has occurred, the cancer cells will use the anaerobic glycolysis as the main energy supply method. So ordinary people and tumor patients both should control the intake of added sugar.

How to reduce sugar intake?

The World Cancer Research Fund (WCRF) and the American Cancer Institute (AICR) put forward the top ten recommendations for cancer prevention which include "limit the intake of sugared beverages."

We must learn to say goodbye to sweetness, reduce the intake of disserts and sweet drinks, eat more complex carbohydrates (coarse grains), drink more boiled water, lemonade or soda water.

Learn to look at the nutrient composition table on the food packaging to find out the hidden sugar.

If you really want to eat something sweet, we can choose fruit. While providing sweetness, it also provides vitamins, minerals and dietary fiber that are beneficial to health. 100% fruit juice is also a sugared beverage, so it is not recommended to use fruit juice instead of fruit. We can also choose suitable sugar substitute products and see if there are low-sugar/no-sugar products as alternatives when purchasing.

Try to reduce sugar intake, keep you healthy.👍

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