How to better supplement calcium?🐄🐄🐄

Calcium deficiency can cause many physiological problems. Not only does it affect bones and teeth, it also affects multiple organs and systems. Calcium deficiency can also cause cramps, numbness of hands and feet, rough itchy skin, palpitations, insomnia, blurred vision, etc. With the public's attention to health, more and more people realize the importance of calcium supplementation. Therefore, here will explain how to better supplement calcium.

Supplement calcium through diet.

Calcium in food is easier to absorb and utilize than calcium supplements. Therefore, diet is the best source of calcium. Calcium supplementation is not necessary if dietary calcium supplementation can achieve the daily requirement. 

• Milk and various dairy products (such as yogurt, cheese, etc.) have high calcium content and are easy to absorb. They are the most ideal source of calcium. Drinking about 300 ml of milk every day can supplement about 300 mg of calcium. 
• Beans and soy products, including soybeans, lentils, edamame, broad beans, and tofu, are also good calcium-supplementing foods. 100 grams of soybeans contain up to 191 mg of calcium. 100 grams of tofu can contain up to 164 mg of calcium.
• Other foods high in calcium include kelp, seaweed, dried shrimp, various nuts (hazelnuts, peanuts, etc.), sesame paste, peanut butter, etc. However, it is not advisable to eat too much dried shrimp, otherwise it will cause excessive sodium intake.

In addition, egg yolks are rich in vitamin D. It promotes the absorption of calcium. It can be eaten with other high-calcium foods. Sun exposure can also promote calcium absorption.

Differences in calcium supplements.

Calcium supplementation should be based on diet, supplemented by calcium supplements. If you can't get enough calcium from food, you need calcium supplements. Calcium is not the more expensive the better. It needs to be selected reasonably according to your own situation.

Calcium supplements should be high in calcium content, easy to absorb, less irritating to the stomach and cheap. 

Calcium content of various calcium supplements:

Calcium intake is calculated as calcium element. Different types of calcium supplements have different levels of calcium element. The content of calcium element is also a reference indicator for choosing calcium supplements. 

The calcium element content of calcium carbonate is about 40%. The calcium element content of calcium citrate is about 21%. The calcium element content of amino acid chelated calcium is about 20%. The calcium element content of calcium lactate is about 13%. The calcium element content of calcium gluconate is about 10%.

• 1 tablet of calcium carbonate 1500 mg contains 600 mg of calcium element (1500 mg × 40% = 600 mg). The usage is 1 tablet each time, 1 to 2 times daily.
• 1 tablet of calcium citrate 500 mg contains 100 mg of calcium element (500 mg × 20% = 100 mg). The usage is 2 to 4 tablets each time, 3 times a day.
• 1 tablet of calcium gluconate 500 mg contains 50 mg of calcium element (500 mg × 10% = 50 mg). The usage is 4 to 8 tablets each time, 3 times a day.

Absorbability of various calcium supplements.

The absorption rate of various calcium supplements is about 30%. The absorption of calcium is affected by many factors. 

• The absorption of calcium is related to the intake. Excessive intake at one time can affect calcium absorption.
• Calcium carbonate must be dissociated into calcium ions by gastric acid before it can be absorbed by the intestine. Therefore, it is best to take it after a meal. Patients with insufficient gastric acid or taking gastric acid suppressing drugs (such as cimetidine, omeprazole) should choose calcium supplements with good water solubility, such as calcium lactate and calcium gluconate.
• Vitamin D aids in the absorption of calcium . Therefore, calcium supplements containing vitamin D have a higher absorption rate.
• Taking vegetables or fruits containing rich oxalic acid together with calcium supplements will affect the absorption of calcium.

Do calcium supplements have side effects?

Inorganic salt calcium supplements (such as calcium carbonate, calcium phosphate) have high calcium content, but they have poor solubility. They are usually alkaline and require more stomach acid to break down and absorb. Therefore, it is easy to cause gastrointestinal adverse reactions such as bloating, indigestion and constipation.

Organic acid calcium supplements (such as calcium citrate, calcium lactate, and calcium gluconate) have low calcium content, but they have good water solubility and are easily absorbed. They have minimal gastrointestinal reactions. Therefore, patients with poor gastrointestinal function are usually recommended to use organic acid calcium supplements.

How to better supplement calcium?

Time: 

The best time to take is after meals and at night before going to bed. 

• An acidic environment facilitates the absorption of calcium. Food can stimulate gastric acid secretion. It is best to take calcium supplements about 1 hour after meals (even for patients with insufficient gastric acid, taking calcium supplements after meals can achieve normal calcium absorption). It can also reduce the irritation of calcium supplements to the gastrointestinal tract.
• At late night, the blood calcium concentration of the human body is the lowest and the absorption rate of calcium is the highest. Therefore, the calcium supplement at night is taken before going to bed and the absorption effect is better.

Low intensity and high frequency: 

Study found that the absorption rate of calcium in divided doses daily was significantly better than that of once daily (more than 20% higher). Therefore, it is recommended to take 3 to 4 times a day, and the amount of calcium supplementation per time should not exceed 200 mg.

Take it alone:

Calcium supplements are better absorbed when taken alone. It should not be taken at the same time as iron, zinc or multivitamins (which contain minerals such as phosphorus, zinc, iron). They have the potential to affect the absorption of calcium. At the same time, try to avoid taking it with high-calcium foods such as milk and soy products, so as to avoid excessive calcium supplementation at one time and affect calcium absorption.

Take with Vitamin D:

Vitamin D can promotes the absorption of calcium. Foods rich in vitamin D include egg yolk, cod liver oil, animal liver and so on. Human skin contains 7-dehydrocholesterol. It can be converted into vitamin D when exposed to sunlight. Therefore, regular sun exposure can promote the absorption of calcium.

Chew and take:

The surface area of calcium supplements increases after being chewed, which facilitates better absorption. Therefore, if it is possible, chew calcium supplements before taking them.

Other.

Patients with diabetes should avoid taking calcium containing sugars (such as calcium gluconate or excipients containing sugars). Coffee, carbonated beverages and alcohol can affect calcium absorption, so it is recommended to drink less or not. Some green vegetables (such as spinach, celery, leeks, cauliflower, spinach, etc.) contain more oxalic acid. It can combine with calcium in food to form water-insoluble calcium oxalate, thereby affecting the absorption of calcium. Therefore, when eating such vegetables, it should be boiled in water to destroy the oxalic acid before cooking.

In addition, calcium supplementation is only used to prevent osteoporosis, not to treat it. If the patient already has osteoporosis, calcium supplementation alone is not enough. It should be under the guidance of a doctor and accept the treatment of anti-osteoporosis drugs.

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Some things can cause rhabdomyolysis.💪💪💪

In recent years, there have been reports of rhabdomyolysis caused by the consumption of a large amount of fish, seafood and crayfish. This brings rhabdomyolysis into the spotlight. Although the main cause is unknown, it may be caused by a biological toxin. Under normal circumstances, fish and shrimp do not contain this toxin. The toxin may enter the body of fish and shrimp under special circumstances, such as the waters where the fish and shrimp are contaminated by certain viruses and bacteria. In fact, only a few people suffer from rhabdomyolysis due to eating seafood. There are a variety of other causes, such as excessive exercise, muscle squeezing, excessive heat and cold temperatures, drugs and heavy drinking, and other bacterial or viral infections that can lead to rhabdomyolysis.

What is Rhabdomyolysis?

Rhabdomyolysis refers to a series of striated muscle damage caused by a variety of inherited or acquired diseases that affect the striated muscle cell membrane, membrane channels and their energy supply. Rhabdomyolysis is often accompanied by acute renal failure and metabolic disorders.

Excessive exercise causes rhabdomyolysis.

The vast majority of young patients with rhabdomyolysis are caused by exercise. It is common in people who do not exercise regularly and suddenly exercise. Most people think that excessive exercise will only cause backache and leg pain the next day, and it will be fine after a rest. However, in recent years, as more and more people exercise and weight training, the incidence of exercise-induced rhabdomyolysis has been increasing, and 48% of patients require hospitalization. Rhabdomyolysis can be mild or severe. Mild patients only need appropriate rehydration. In severe cases, acute kidney injury, multiple organ failure and even sudden death can occur. Therefore, exercise should be moderate, and must pay attention to observation after exercise. When there is muscle swelling and pain, the pain cannot be relieved after rest, and there is oliguria, no urine or even soy sauce-colored urine, be sure to seek medical attention in time.

Be sure to drink enough water before and after exercise. Because only the adequate amount of water intake can ensure that the metabolites, toxins and contents caused by cell destruction produced in the body are excreted through the urine. It will not lead to the accumulation of toxins in the body and produce some adverse reactions. In addition, the exercise intensity should be reasonably arranged according to the individual physical condition. Exercise should gradually increase the amount of exercise, avoid sudden excessive exercise.

What drugs can cause rhabdomyolysis?

Hypolipidemic drug:

HMG-CoA reductase inhibitors (Statins): Such as simvastatin, pravastatin, atorvastatin, etc. These drugs are effective in lowering total cholesterol and low-density lipoprotein. Statins can cause myopathy. It includes myalgia, myositis and rhabdomyolysis. The incidence of muscle discomfort varies among statins. It is generally around 5%, so this type of drug is also called a muscle poisoning drug.

Fibrates: Such as fenofibrate, bezafibrate, etc. These drugs mainly lower triglycerides and very low density lipoproteins. The combination of statins and fibrates increases the incidence of myopathy and rhabdomyolysis.

Anti-infective drugs:

Quinolone antibiotics (eg, ciprofloxacin, levofloxacin) can increase the risk of tendonitis and tendon rupture. It can worsen muscle weakness in people with myasthenia gravis. Minors under the age of 18 should avoid use.

Anti-hepatitis virus drugs:

Such as lamivudine and telbivudine. These drugs can cause damage to the musculoskeletal system. It manifests as myalgia, arthralgia, elevated creatine phosphokinase, rhabdomyolysis and spasticity.

β2 receptor agonists:

Such as terbutaline, salbutamol, etc. This class of drugs is the first-choice treatment for asthma. They can selectively stimulate airway β2 receptors, dilate bronchi and improve respiratory function. About 30% of the cases of oral administration of terbutaline consistently have varying degrees of muscle tremor. Its mechanism is related to the excitation of β2 receptors in slow-twitch fibers of skeletal muscle. This accelerates muscle contraction and disrupts the fusion between fast and slow twitching fibers. Severe overdose may develop rhabdomyolysis and renal failure.

Medications that can cause hypokalemia:

Such as furosemide, hydrochlorothiazide, indapamide, amphotericin B, etc. Hypokalemia is a trigger for muscle dissolution. Therefore, the long-term application of potassium-scavenging drugs can cause rhabdomyolysis.

Narcotic psychotropic drugs:

Such as opioids, barbiturates, phenothiazines, succinylcholines, etc. These drugs can cause coma when taken in large quantities. This can damage the muscles under prolonged pressure, which can lead to rhabdomyolysis.

Other:

Such as theophylline, amiodarone, donepezil, colchicine, diphenhydramine, etc. These drugs can also cause rhabdomyolysis.

Rhabdomyolysis, regardless of the cause, should be treated as soon as possible to avoid delays in treatment.

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The difference between imipenem, meropenem and biapenem.👀

Carbapenems are a class of atypical β-lactam antibiotics with the broadest
antibacterial spectrum. They have strong antibacterial activity against Gram-positive, Gram-negative, and anaerobic bacteria. At present, imipenem, meropenem and biapenem are commonly used in clinical practice. Carbapenems bind to a variety of bacterial penicillin binding proteins (PBPs). This will prevent the synthesis of the cell wall and play a role, which has a relatively significant post antibiotic effect (PAE).

Characteristics of imipenem, meropenem and biapenem.

Imipenem: It is the first carbapenem approved for clinical use. It is metabolically inactivated by dehydrogenase I (DHP-I) in human kidney epithelial cells. Therefore, a specific enzyme inhibitor, cilastatin, was added to block the metabolism of imipenem in the kidneys, thereby ensuring sufficient antibacterial concentration of imipenem in urine. At the same time, cilastatin can also prevent imipenem from entering renal tubular epithelial cells to reduce its excretion and reduce renal toxicity. Imipenem and Cilastatin are β-lactamase stable. It has a broad antibacterial spectrum. It has strong activity against most Gram-positive and Gram-negative bacteria.

Meropenem: It is more stable to DHP-I and more active against Gram-negative bacteria than imipenem, especially Pseudomonas aeruginosa. Meropenem easily penetrates the blood-brain barrier and can effectively treat intracranial infections. At the same time, it has no affinity for γ-aminobutyric acid receptors. Its safety in the central nervous system is better than that of imipenem. It is more suitable for the treatment of the elderly, children and patients with central nervous system infection or severe infection accompanied by mental symptoms.

Biapenem: Compared with other carbapenems, it has lower nephrotoxicity and central nervous system toxicity.

• Anti-Gram-positive bacteria activity: Imipenem > Biapenem, Meropenem.
• Anti-Gram-negative bacteria activity: Meropenem > Biapenem > Imipenem.
• Anti-Pseudomonas aeruginosa activity: Meropenem = Biapenem > Imipenem.
• Anti-anaerobic activity: Biapenem > Imipenem = Meropenem.

Carbapenems are generally resistant to Stenotrophomonas maltophilia (chromosome-mediated β-lactamase that candhydrolyze carbapenems), Burkholderia cepacia, Enterococcus faecium, oxacillin-resistant Staphylococcus aureus and so on are ineffective.

Dosage of imipenem, meropenem and biapenem.

Imipenem/Cilastatin: 1-2 g in 3-4 divided doses daily is recommended for most infections. The maximum dose is 4g per day. It does not require a skin test. Patients with renal insufficiency require dose adjustment.

Meropenem: The recommended dose is 0.5 or 1 g every 8 hours. Meningitis patients 2g every 8 hours. The maximum dose is 6g per day. It does not require a skin test. Patients with renal insufficiency require dose adjustment.

Biapenem: The recommended dose is 0.3 g every 12 hours. The maximum dose is 1.2g per day. It does not require a skin test. Patients with renal insufficiency require dose adjustment.

Precautions of imipenem, meropenem and biapenem.

Imipenem/Cilastatin: When the dose is ≤ 0.5g, the intravenous infusion time should be no less than 20-30 minutes. When the dose is > 0.5g, the intravenous infusion time should not be less than 40-60 minutes. It has partial cross-allergic reactions with other β-lactams, penicillin, and cephalosporins. When it is combined with sodium valproate, it causes the sodium valproate concentration to decrease. This will increase the risk of seizures. Furthermore, increasing the dose of sodium valproate was not sufficient to overcome the interaction between them. Imipenem/Cilastatin can cause central nervous system accumulation and lead to psychiatric symptoms. It may also cause pseudomembranous colitis. If using imipenem/cilastatin while breastfeeding, breastfeeding should be discontinued.

Meropenem: Intravenous push time should be greater than 5 minutes. It has partial cross-allergic reactions with other β-lactams, penicillin, and cephalosporins. When it is combined with sodium valproate, it causes the sodium valproate concentration to decrease. This will increase the risk of seizures. It also competes with probenecid to activate tubular secretion and inhibit renal metabolism. This results in prolonged half-life of meropenem and increased plasma concentrations. Patients with a history of epilepsy or central nervous system dysfunction are more likely to develop central nervous system symptoms. It may also cause symptoms of vitamin K deficiency. If using meropenem while breastfeeding, breastfeeding should be discontinued.

Biapenem: The intravenous infusion time should be 30-60 minutes each time. It has partial cross-allergic reactions with other β-lactams, penicillin, and cephalosporins. When it is combined with sodium valproate, it causes the sodium valproate concentration to decrease. It can cause epileptic seizures. Patients with a history of epilepsy or central nervous system dysfunction are more likely to develop central nervous system symptoms. It may also cause symptoms of vitamin K deficiency. Safety during breastfeeding has not been established.

Clinical application characteristics of imipenem, meropenem and biapenem.

Imipenem/Cilastatin: When it comes into contact with bacteria, it turns the bacteria into a spherical shape. The endotoxin released by bacteria is reduced and the initial bactericidal effect is extremely strong. It is widely distributed in the body. It can cross the placental barrier, but it cannot cross the blood-brain barrier. It can cause central nervous system toxicity, so it should not be used in the treatment of meningitis. Its sterilization speed is fast. 1 hour bactericidal activity is twice that of meropenem. It is ineffective against vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus. The activity against gram-positive bacteria is stronger than that of meropenem.

Meropenem: When it comes into contact with bacteria, it swells the bacteria. Bacteria release a lot of endotoxin, and the initial bactericidal effect is poor. It can cross the blood-brain barrier. It can reach effective concentrations in cerebrospinal fluid. Common adverse reactions are similar to imipenem, but it may have a slightly lower risk of seizures than imipenem. Meropenem is the first choice for patients with renal insufficiency and central nervous system disease. The activity against Acinetobacter baumannii is lower than that of imipenem. However, the ability to resist Gram-negative bacteria is 2-16 times that of subpulmonary penem and the anti-Pseudomonas aeruginosa effect is 2-4 times that of imipenem.

Biapenem: When it comes into contact with bacteria, it turns the bacteria into a spherical shape. The endotoxin released by bacteria is reduced and the initial bactericidal effect is extremely strong. Multiple doses do not accumulate in the body. It is ineffective against Enterococcus faecium and methicillin-resistant Staphylococcus aureus. Its antibacterial activity is similar to meropenem. The activity of inhibiting Pseudomonas aeruginosa and anaerobic bacteria is 2-4 times that of imipenem. It has extremely low nephrotoxicity and CNS toxicity compared to other carbapenems. It does not induce epilepsy. It can be used in the treatment of bacterial meningitis. Adverse reactions are also relatively few.

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You should know these things about vitamin B6.👌👌

Vitamin B6 is one of the most widely used vitamin B drugs. What diseases can vitamin B6 be used for prevention and cure? How should vitamin B6 be used? Are there any side effects of vitamin B6? You should know the answers to these questions.👍

Vitamin B6 (Pyridoxine)

What diseases can vitamin B6 be used for?

Vitamin B6 is an important coenzyme in the metabolic transformation of certain amino acids, such as glutamic acid, tryptophan, methionine and dopa.

• Vitamin B6 deficiency: This may be due to excessive processing of food and resulting in the loss of vitamin B6. It can manifest as chapped lips, glossitis, seborrheic dermatitis, and pellagra. It can manifest as chapped lips, glossitis, seborrheic dermatitis, and pellagra. It can be used daily 10-20mg of vitamin B6 for 3 weeks.
• Peripheral neuritis caused by isoniazid: The intermediate metabolite of isoniazid (isoniazone) forms soluble complexes with vitamin B6. This increases the excretion of vitamin B6 by the kidneys. The preventive dose is 10-50 mg of vitamin B6 daily. In the case of isoniazid poisoning, 1000 mg of vitamin B6 (intravenous or intramuscular injection) should be given for every 1000 mg of isoniazid. A daily dose of isoniazid ≤ 5 mg/kg rarely causes vitamin B6 deficiency.
• Hyperhomocysteinemia: Monotherapy is vitamin B6 50-200 mg daily. Combination therapy was vitamin B6 100 mg and folic acid 0.5 mg daily.

In addition, some drugs can also cause vitamin B6 deficiency.

• Antitumor drugs: cytarabine, doxorubicin, docetaxel, lapatinib, capecitabine, etc.
• Immunosuppressants: hormones, cyclosporine, cyclophosphamide, etc.
• Antihypertensive drugs: Hydralazine.
• Antituberculosis drugs: isoniazid, cycloserine.
• Other drugs: Contraceptives and anticonvulsants.

Vitamin B6 cannot be combined with levodopa. It is mainly because vitamin B6 promotes the peripheral conversion of levodopa to dopamine. It reduces the effects of levodopa. However, vitamin B6 can be used in combination with levodopa + benserazide or levodopa + carbidopa. It is mainly because decarboxylase inhibitors (benserazide, carbidopa) reduce the effects of vitamin B6.

Diseases that should not be treated with high doses of vitamin B6.

Vitamin B6 has not proven effective for the following conditions, such as acne and other skin diseases, alcoholism, asthma, kidney stones, mental illness, migraine, premenstrual tension, stimulation of milk secretion, loss of appetite. It is not appropriate to use large doses of vitamin B6 to treat the above-mentioned unproven effective diseases.

Vitamin B6 can cause neurotoxicity.

Vitamin B6 is a pyridine substance. These substances have obvious neurotoxicity. Long-term, excessive use of vitamin B6 can cause peripheral neuritis, abnormal nerve paresthesia, gait instability, numbness of hands and feet, etc. The recommended dosage of vitamin B6 tablets is 10-20 mg per day for adults. It must be taken at the recommended dose. Do not overdose and stop taking the drug after 3 weeks.

Physicians should exercise caution when using vitamin B6 to treat vomiting of pregnancy.

Vitamin B6 has been widely used for vomiting during pregnancy. The recommended usage is oral vitamin B6 3-4 times a day, 10-25mg each time. However, pregnant women receiving large amounts of vitamin B6 can cause vitamin B6-dependent syndrome in newborns. Pregnant women must use it under the guidance of a doctor and do not take it without authorization. The drug should also be discontinued after 3 weeks of treatment. Vitamin B6-dependent syndrome is an inborn structural and functional defect of the metabolic enzyme kynurenase. The activity of that enzyme is only 1% of normal. Vitamin B6 includes six interconvertible pyridoxine, pyridoxamine, pyridoxal and their respective 5-phosphates. Pyridoxal 5-phosphate is an important part of this group. It participates in the metabolism of amino acids, proteins, lipids, nucleic acids and glycogen in vivo as a coenzyme of the enzyme system in decarboxylation and transamination. If it is lacking, it can cause convulsions and peripheral nerve disorders. Therefore, vitamin B6 deficiency can cause biochemical and physiological abnormalities. The need for vitamin B6 in children with this disease is 5 to 10 times that of normal children. A lack of vitamin B6 in the diet during pregnancy can cause seizures in newborns. In addition, because pregnant mothers take excessive doses of vitamin B6 during the pregnancy reaction period. It may also cause the baby to still need to rely on a larger amount of vitamin B6 after birth.

Storage of vitamin B6.

Vitamin B6 is easily soluble in water and gradually deteriorates when exposed to light. Therefore, it requires shading and sealed storage.

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Grapes may protect against heart attack and stroke.🍇🍇🍇

Grapes are a very popular fruit. It can be eaten directly, made into raisins, or
made into wine. Grapes contain minerals calcium, potassium, phosphorus, iron and a variety of vitamins such as vitamin B1, vitamin B2, vitamin B6, vitamin C and vitamin P. It also contains a variety of amino acids required by the human body. Regular consumption of grapes is of great benefit to neurasthenia and excessive fatigue. A recent study led by professor Zhaoping Li, a nutritionist and professor of medicine at the David Geffen School of Medicine at UCLA, showed that eating grapes can increase the diversity of gut bacteria and reduce lower cholesterol levels in the blood.

Eating grapes can significantly increase the diversity of gut bacteria.

The researchers found that eating grapes significantly increased the diversity of bacteria in the gut, which is thought to be essential for a strong immune system. In addition, eating grapes can significantly reduce cholesterol levels. Cholesterol is a fat-like substance in our blood that clogs arteries and causes heart disease. Eating grapes has also been found to reduce bile acid levels. Bile acids play an integral role in metabolizing or processing cholesterol. Some fruits like grapes and apples are known to contain antioxidants called polyphenols (which are organic compounds found naturally in plants) that keep blood vessels healthy for good circulation. Polyphenols and other phytochemicals can also lower and help control blood sugar and blood pressure levels, and reduce chronic inflammation. High blood sugar and blood pressure are risk factors for heart disease.

Professor Li said it was good news that they found that grapes can be beneficial to gut bacteria. Because a healthy gut is vital to good health. This research could deepen their knowledge and expand the range of grapes' health benefits. The study also reinforces possible evidence for the heart-healthy benefits of cholesterol-lowering grapes.

Eating grapes has beneficial effects on glucose and lipid metabolism as well as the integrity of the intestinal lining.

For the study, based on fecal samples from older adults, the researchers analyzed their microbiomes ( which contain the trillions of microbes). A total of 19 healthy subjects in the study consumed a low polyphenol and low fiber diet for 4 weeks. For another four weeks, they took 46 grams of grape powder daily for four weeks while continuing to eat a diet low in fiber and polyphenols. Fecal and urine samples were collected before and at the end of the grape powder supplementation period. After eating grape powder for four weeks, the researchers measured an increase in microbial diversity in their samples. Akkermansia bacteria were found among the increased beneficial bacteria. It's a bacterium of interest to researchers. Because of its beneficial effects on glucose and lipid metabolism as well as the integrity of the intestinal lining. In addition, they observed a drop in blood cholesterol. It included a 6.1% drop in total cholesterol and a 5.9% drop in LDL cholesterol. They also found a 40.9% reduction in bile acids. They are steroid acids that involved in cholesterol metabolism. The researching team said the findings suggest a promising new role for grapes in gut health and reinforce the benefits of grapes for heart health. 

Flavonoids have a positive effect on blood pressure levels.

Previous research has also shown a link between eating grapes in many forms (including red wine) and heart benefits. In 2021, research teams from Germany and Northern Ireland found that drinking three 125ml glasses of red wine a week could lower blood pressure. Another phytochemical called flavonoids appears to have a positive effect on blood pressure levels, according to the team. Flavonoids are a rich nutrient found in fruits, vegetables, tea and other plant foods. 

In the past, researchers have also done related experiments. Back in 2010, researchers at the University of Michigan studied mixing common table grape powder (a mixture of green, red and black grapes) into the diets of lab rats as a part of a high-fat diet and observed the effect after consumption in rats. After three months, the rats that received the grape powder-enriched diet had lower blood pressure, better heart function, and lower markers of inflammation in the heart and blood, compared with the rats that didn't receive the grape powder.

For more detail, you can read this article.👇

Jieping Yang et al, Effect of Standardized Grape Powder Consumption on the Gut Microbiome of Healthy Subjects: A Pilot Study, Nutrients (2021). DOI: 10.3390/nu13113965

The link to download the article.

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What you should know about rivaroxaban?👀

Rivaroxaban is a new oral anticoagulant. It has been widely used in theprevention and treatment of venous thromboembolic disease, and stroke prevention in non-valvular atrial fibrillation. In order to use rivaroxaban more rationally, you need to know at least this knowledge.

The differences between rivaroxaban and other oral anticoagulants.

Commonly used oral anticoagulants include warfarin, dabigatran, rivaroxaban and apixaban. Among them, dabigatran, rivaroxaban, apixaban and so on. are called new oral anticoagulants (NOAC).

Warfarin exerts its anticoagulant effect mainly by inhibiting the synthesis of coagulation factors II, VII, IX and X. Because warfarin has no effect on synthetic clotting factors, its onset of action is slower.

Rivaroxaban mainly exerts its anticoagulant effect by inhibiting the activity of coagulation factor Xa and reducing the synthesis of thrombin. Since it does not affect the thrombin activity that has been generated, it has little effect on the physiological hemostatic function.

Dabigatran exerts its anticoagulant effect mainly by directly inhibiting the activity of thrombin.

Pathogenesis of pulmonary embolism and stroke.

Pulmonary embolism (PE) includes tumor embolism, air embolism, amniotic fluid embolism, fat embolism, and pulmonary thromboembolism (PTE). PTE is the most common type of PE. In clinical practice, PE is usually referred to as PTE.

Deep vein thrombosis (DVT) often occurs in the deep veins of the lower extremities or pelvis. It is the leading cause of pulmonary embolism. Once the deep vein thrombosis is dislodged. The thrombus can return to the right heart through the veins and then enter the pulmonary artery. This can cause a pulmonary embolism.

In patients with atrial fibrillation, blood tends to stagnate in the atria and form clots. Once the atrial thrombus is dislodged, it can enter the carotid artery and cause a stroke. About 20% of ischemic strokes are caused by atrial thrombus.

Clinical application of rivaroxaban

Factors such as slow blood flow, vascular endothelial injury, and blood hypercoagulability can trigger deep vein thrombosis. For example, some patients who have had a successful hip or knee replacement surgery die suddenly a few days after the procedure. This was most likely because the patient developed deep vein thrombosis after surgery. The thrombus dislodges and causes a pulmonary embolism that leads to death.

• To prevent venous thrombosis after hip or knee replacement: The first dose should be used between 6-10 hours after surgery. The recommended dose is 10 mg once a day. For hip surgery patients, the course of treatment is 35 days. For knee surgery patients, the course of treatment is 12 days.
• To treat or reduce the risk of recurrence of deep vein thrombosis and pulmonary embolism: For the first 1-21 days, 2 times a day, 15mg each time. After 22 days, 1 time a day, 20 mg each time. The course of treatment is at least 3 months.
• Reduced risk of stroke and systemic embolism in non-valvular atrial fibrillation: The recommended dose is 20 mg once daily and long-term treatment is required.

The differences between different dosage formulations of rivaroxaban.

Rivaroxaban tablets are available in three doses: 10mg, 15mg and 20mg. Rivaroxaban tablets are different from most medicines. Different doses of rivaroxaban tablets are used in different ways.

• Rivaroxaban Tablets 10mg: Food does not affect the absorption of rivaroxaban tablets 10mg. It is almost completely absorbed whether on an empty or full stomach. Its bioavailability is 80-100%.
• Rivaroxaban Tablets 15 and 20mg: Food can promote its absorption. Compared with taking the medicine on an empty stomach, the bioavailability of the medicine on a full stomach can be increased by 39%, and the peak concentration can be increased by 76%.

If the patient cannot swallow the whole tablet, rivaroxaban tablet can be crushed before taking the medicine, mix it with applesauce and take it orally immediately.

For missed doses:

• For the once-daily dose, missed doses should be made up immediately. However, the dose should not be doubled within 1 day in order to make up the dose.
• For treat or reduce the risk of recurrence of deep vein thrombosis and pulmonary embolism, the dose for the first 1-21 days requires a total daily dose of 30 mg. Therefore, if you miss a dose, you may need to take two 15mg tablets at a time.

Side effects of rivaroxaban:

The anticoagulant effect of rivaroxaban is predictable, with a wide therapeutic window, no accumulation after multiple doses, and few drug and food interactions. Therefore, routine coagulation monitoring is not required.

Its main adverse reaction is bleeding. It can present as minor bleeding, severe bleeding, or life-threatening bleeding. Rivaroxaban is rapidly absorbed, and the peak plasma concentration takes 2 to 4 hours. In severe bleeding, the time after taking the drug should be considered to determine whether gastric lavage is required.

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Some main points about drinking water.💧💧💧

Drinking plenty of water is good for your health. This is well known. But there
are some precautions when drinking water. In some cases, drink plenty of water. In some cases, you should drink less water. In some cases, you should not drink water. And you can add some honey, lemon, etc. to the water, which can have other effects.

You can drink a glass of boiled water when you wake up in the morning, which can help with bowel movements.

After a night of sleep, your body metabolizes a lot of water when you wake up in the morning. Drinking about 450 ml of boiled water at this time can not only help defecation, maintain blood vessels, but also have certain benefits in preventing colds, pharyngitis and certain skin diseases.

Drinking boiled water before bathing can protect blood vessels.

The skin wicks away perspiration when taking a hot bath. This causes the body to lose water. If you don't hydrate in time, it is easy to develop hypotension, causing dizziness, collapse and fainting. If the body loses too much water at once, it is easy to cause the blood viscosity to increase. For some people with cardiovascular and cerebrovascular diseases, there is also a risk of cerebral infarction and myocardial infarction. Drinking a glass of about 200 ml of plain water before bathing can store water for the body to prevent loss of water during bathing.

Drink warm boiled water before going to bed to prevent gout attacks.

In winter, some people will turn on the heating to sleep. This will make the indoor air more and more drier. Therefore, drinking a glass of boiled water before going to bed can moisturize the respiratory tract, which is especially important for people with respiratory diseases. Furthermore, gout attacks often occur at night. Drinking a glass of water before going to bed can also reduce the concentration of uric acid and prevent gout attacks.

👇However, in some cases you should not drink water.

When taking some medicines, you should not drink water.

In most cases, drink water when taking medicine. However, some drugs are special. Drinking more water will not only reduce their efficacy, but may also induce drug-induced diseases. The following types of drugs are common:

• Some medicines for stomach ulcers: Some medicines for gastric ulcers are either swallowed directly without drinking water, or chewed and swallowed dry, or only a very small amount of water is required for the medicine to be swallowed into the stomach. After these drugs enter the stomach, they will form a dense protective film covering the damaged (already ulcer) gastric mucosa to protect that gastric wall.
• Some cough medicine, cough syrup: In order to improve the efficacy of the medicine, the cough suppressant is specially made into a thicker shape, so that the medicine can adhere to the inflamed throat after taking it, and directly act on the diseased part, thereby playing an anti-inflammatory and therapeutic effect. If you drink plenty of water, it will flush out the active ingredients of the cough medicine sticking to the throat and trachea, reducing the therapeutic effect.
• Antiangina drugs: When taking it, you should chew the tablet directly, put it under the tongue, and do not drink water. Because the capillaries under the tongue are rich, they can quickly absorb into the blood and exert the effect of medicine. Do not swallow and do not drink water after it has been sublingual.

The drug instructions have detailed usage and you should read it carefully before taking the drug and take it as required.

It is not recommended to drink water during exercise or just after exercise.

Many people drink a lot of water immediately after exercising, but this is actually bad for their health. During exercise, the functional status of each organ is adjusted. Organs related to exercise energy, such as the heart and lungs will be strengthen, the digestive and absorption functions of the gastrointestinal tract will be relatively weakened, and the rate of gastric emptying will decrease. Therefore, drinking a lot of water quickly at this time can easily cause water retention in the stomach. This can cause discomfort such as bloating, stomach pain, and nausea, and the burden on the kidneys and heart will also increase. Moreover, sodium is lost with sweat when sweating. If you drink a lot of water but do not pay attention to sodium supplementation, it is easy to cause hyponatremia. Severe hyponatremia can cause brain edema and pulmonary edema, damage the function of the brain and lungs, and even cause death. 

It is recommended to drink 400-600 ml of plain boiled water 1 to 2 hours before exercise, in divided doses. During exercise, if you feel thirsty, you can refill 100-200 ml every 15-30 minutes. Rehydration drinks should contain less than 6% sugar. If the exercise time is longer than 1 hour, it should also contain 0.5 to 0.7 grams per liter of sodium.

How much water should people drink every day?

Under normal circumstances, a normal adult needs 3000 ml of water per day. Through food, such as soup, vegetables and fruits, you can consume about 1000ml, and the rest needs to be supplemented by drinking water. Therefore, an average adult needs to drink about 2000 ml of water per day. In addition, drink plenty of water if you exercise a lot and sweat a lot.

The water temperature should not be too high.

Too cold or hot water is not good for your health. Drinking too hot water often can damage the esophagus and cause serious cancer. If the water temperature is too low, it will irritate the intestines and stomach. It can cause rapid contraction of gastric mucosal blood vessels, which can easily cause gastrointestinal discomfort and even diarrhea, especially for those with weak stomachs.

It is recommended that when the weather is hot, the water temperature can be close to room temperature. When the weather is cold, the water temperature can be slightly higher, but it should not exceed 40°C.

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People with constipation can eat more these foods.🌿🌿🌿

Constipation means that you have fewer bowel movements than normal. The stool will be dry and hard, and it will be difficult to defecate. Normal people usually defecate 1-2 times a day or once every 1-2 days. People with constipation generally have less than 3 times a week. It is one of the common problems of modern people. Even if it is not long-term constipation, most people will have tried to have poor bowel movements. Failure to excrete stool will not only make you feel bloated and uncomfortable. Constipation will increase the time you spend sitting on the toilet. If it takes too long, it will easily cause problems such as hemorrhoids. Frequent use of laxatives or enema can cause dependence. Therefore, the following will introduce some foods that can help defecation and relieve constipation.

1. Sweet potato leaves.

Sweet potato leaves were generally used as food for livestock in the past, but now it has become a popular healthy food. The most prominent function of sweet potato leaves is to help defecate. Sweet potato leaves are rich in dietary fiber. It can speed up the movement of food in the intestines and stomach and has the effect of cleaning the intestines. In addition, the nutrition of sweet potato leaves should not be underestimated. Compared with common vegetables, the content of minerals and vitamins in sweet potato leaves are superior, and the carotene content is even higher than that of carrots. It is worth mentioning that sweet potato leaves are rich in flavonoids. Flavonoids can combine with oxygen free radicals in the human body. This makes it have a variety of health effects such as anti-oxidation, improving human immunity, delaying aging, and preventing cancer.

2. Kelp.

Kelp is rich in polysaccharides and dietary fiber. It can promote stomach movements and bowel movements, prevent the reabsorption of bile acids, and make them excrete with feces. In addition, kelp is also rich in iodine. This is a very good food for pregnant women and breastfeeding mothers. During pregnancy and breastfeeding, the iodine requirement has increased by about twice as compared to usual, that is, the daily requirement is more than 200 micrograms. During pregnancy and breastfeeding, the iodine requirement has increased by about twice as compared to usual, that is, the daily requirement is more than 200 micrograms. Iodine supplementation through diet is the most useful. During this period, they can eat kelp, seaweed or other algae one more time a week.

In addition, when washing kelp, it should not be soaked for too long. The iodine, mannitol, potassium and vitamins in kelp are all in the epidermis of kelp. If it is soaked for too long, the nutrients will tend to be particularly lost. After the dried kelp is moistened with water, wash the soil and cook immediately instead of soaking it in water. If it is soaked after washing, the soaking water and kelp should be cooked together.

3. Dragon fruit.

Dragon fruit is a kind of fruit that can help defecation very much. Each 100 grams of white dragon fruit contains about 2 grams of dietary fiber. This exceeds the 1.2 grams contained in bananas and the 1.6 grams contained in apples. The dietary fiber can promote gastrointestinal motility and bowel movements. It leads to help defecation and relieve constipation. Therefore, if people with constipation eat more dragon fruit, they can alleviate the problem of constipation.

4. Oat.

The most prominent nutrient in oats is its rich β-glucan. It is a soluble dietary fiber. Oat can promote gastrointestinal motility and help defecation. Moreover, after people ate oatmeal, it will make them feel full easier. It has the effect of weight loss. However, there are many kinds of oat on the market, which one should you choose? It is generally recommended to consume the original oatmeal. Although instant oatmeal is more convenient and delicious to eat, it is more recommended to consume original oatmeal in terms of nutrition. The original oatmeal has a poor taste, needs to be cooked, and is troublesome to eat. However, the original oatmeal retains almost all the nutrients of oats. It does not add other substances, such as flavoring agents, preservatives, etc. This is more conducive to human health.

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Some medicines should not be taken with hot water.🌞🌞🌞

When people take medicine, they are concerned about the usage and dosage of the medicine. But in fact, there are also requirements for the water temperature for taking the medicine. Granules, effervescent tablets, dry suspensions, and powders are commonly used clinical dosage forms, especially suitable for children. However, some medicines will have physical and chemical reactions when exposed to heat, which will affect the efficacy and safety. Therefore, it is not suitable to take hot water (>40°C).

1. Vitamins.

Some vitamins, such as vitamin B1, vitamin B2 and vitamin C, are unstable in nature. They are susceptible to oxidation-reduction decomposition when exposed to heat and lose their efficacy. 

Vitamin C: Health products containing vitamin C should also be taken with cold water or warm water. Especially effervescent tablets, should be taken with a glass of cold water or warm water (about 200 ml).

2. Live bacteria preparation.

Under normal circumstances, live bacteria are not resistant to high temperatures. If it is brewed with boiling water or taken, the living bacteria will be killed and the therapeutic effect will be lost. 

• Live Combined Bacillus Subtilis and Enterococcus Faecium: It should be taken with warm boiled water or milk below 40℃. Granular preparations can be taken directly.
• Live Bacillus Licheniformis Preparation: It should be taken with warm water (≤40℃) or milk. When people with dysphagia are taking live Bacillus licheniformis capsules, they can open the capsules and mix the powder with a small amount of warm water (≤40°C) or milk before taking it.

3. β-lactam antibiotics:

β-lactam antibiotics are easily hydrolyzed. Their hydrolyzed substances will not only lose antibacterial activity, but also increase the risk of allergic reactions. when you take β-lactam antibiotics (Especially granules or suspension formulations), you should pay more attention. Commonly used β-lactam antibiotic granules include amoxicillin granules, amoxicillin clavulanate potassium granules, cefixime granules, cefpodoxime proxetil granules and so on.

• Amoxicillin granules: It should be taken with cold boiled water and should be taken as soon as possible.
• Azithromycin dry suspension, granules: Azithromycin is unstable. Pour it into a glass, add an appropriate amount of cold boiled water, dissolve and shake well before taking it orally.

4. Digestive enzymes.

Enzymes are active proteins that will denature and solidify when exposed to heat. This can lead to decreased or loss of efficacy. Commonly used enzyme drugs include pepsin granules, yeast tablets, multi-enzyme tablets, pepsin mixture, and compound amylase oral solution.

• Compound pepsin granules: It needs to be sealed and stored in a cool and dry place (not exceeding 20°C). It should not be taken with hot water.

5. Herbal medicines or Chinese patent medicines containing volatile oil.

Herbal medicines contain fennel, ageratum, dried ginger, mint, borneol, turmeric, nutmeg, nepeta and so on. The volatile oil in them has a greater medicinal value and is easy to volatilize and decompose when exposed to heat. Many Chinese patent medicine granules and granules also contain volatile oil.

6. Cough Syrup.

Such as cough and phlegm syrup, compound licorice mixture, Chuanbei loquat ointment and so on. They are a class of medicines prepared by dissolving cough and anti-inflammatory ingredients in syrup or extract. After the patient takes it, the syrup or extract covers the surface of the inflamed pharyngeal mucosa to form a protective film, which is convenient for quick control of cough and relief of symptoms. If it is taken with hot water, the viscosity of the syrup will be reduced and the efficacy of the protective film will be affected. It is also recommended not to drink water immediately after taking them.

7. Capsule drugs.

Hot water may melt the capsules quickly and lose their efficacy. It may also cause side effects such as damage to the esophagus and gastric mucosa.

8. Lozenges.

Lozenges only need to be in the mouth. After it slowly melts, the medicine can act on the lesion and it don't need to be taken with water. The same is true for sublingual lozenges. You only need to press the pill under the tongue, and it will be effective soon after it melts, and you don't need to drink water to take it.

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Energy may be an important factor to Alzheimer's disease.💥💥💥

Alzheimer's disease is a common chronic neurological disease in the elderly, which is caused by patients with extensive cerebral cortex atrophy and degenerative diseases. It is mainly dysfunction and behavioral personality disorder. The early manifestations are progressive memory loss and decreased temporal and spatial orientation. In the late stage, he can't take care of himself, and even has difficulty eating, incontinence of urine and feces, unknowing pronunciation, and finally in a vegetative state. This will require dedicated care and will bring a great burden to the family. Researchers at the University of Adelaide in Australia have found out a relationship between the route of cells produce energy for brain function and the mutant genes of patient with Alzheimer's disease. They published this finding that can prompt people to further study this relationship. This may be regarded as the basic and potential pathogenic factor of human Alzheimer's disease in the early stage.

What did the study do?

In this study, the researchers analyzed genetic mutations in the brains of younger adult zebrafish that are associated with early-onset Alzheimer's disease. The zebrafish were chosen as the research object because their family is very large, which makes it easier to detect subtle effects through them. The research team uses mathematical analysis and advanced genetic technology. They compared the gene activity of zebrafish and found subtle differences between normal fish and mutant fish. Although the researchers found that different mutations in distinct genes can have many various effects on the function of fish brain cell, they also found that mutations in Alzheimer's disease can affect a very important function of cell, which is the utilize of oxygen in the cell to make energy.

The lead researcher of this study, Dr. Karissa Barthelson, thinks that this discovery is very interesting. Because they know that when Alzheimer's disease is finally progressed, people's brains will become severely lacking in energy. After they discovered the results of above research, they took this research to a deeper level. They knew that a research team had studied an important Alzheimer's disease-related gene in mice. They reanalyzed the research data of that research team. After reanalysis, they can see similar results. This strengthened their confidence in the results of their research. They believe that their research has discovered a basic, early pathogenic factor for Alzheimer's disease of  human. 

Prospects for the future.

The brain is composed of many different types of cells. These cells have complex ways of producing and sharing energy. The following, the research team at the University of Adelaide wants to study how Alzheimer's disease genetic mutations affect these different cell types. They are very satisfied that this study has found out an important and common early factor that induces the development of Alzheimer's disease. 

The researchers pointed out that the cost of Alzheimer's disease to society is very huge. Not only does it take human and financial resources to take care of those who cannot take care of themselves, but as the patients' cognitive and memory decline, they will also lose the relationship with their relatives and friends. 

Energy manufacturing is the most constitutional and basic cell activity that supports all other functions, especially in highly activated organs such as the brain. If people can understand in detail what is wrong with the utilize of oxygen and energy production. We may discover a method to stop the Alzheimer's disease before it starts. This will greatly benefit the elderly population.

My thoughts

Alzheimer's disease is a disease that lacks a cure. For some family members of patients, they may be even more painful than the patient during the long-term care of the patient. Therefore, they may begin to seek the help of professional elderly care institutions and nursing staff. This will increase their financial burden. Under the influence of these pressures, those family members are exhausted physically and mentally, and then suffer from illnesses. Although the US Food and Drug Administration approved Biogen's new drug for Alzheimer's disease, aducanumab, in mid-2021, the target, efficacy and price of this drug have been controversial. In addition, its treatment procedures are also very complicated. Its sales in the third quarter of 2021 were far worse than expected. Therefore, this discovery may provide a new idea to develop drugs for Alzheimer's disease.

If you want to know more detail, please read this article below👇:

Karissa Barthelson, Morgan Newman, Michael Lardelli; Brain transcriptomes of zebrafish and mouse Alzheimer's disease knock-in models imply early disrupted energy metabolism. Dis Model Mech 2021; dmm.049187. doi: 

https://doi.org/10.1242/dmm.049187

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How to choose valsartan and valsartan combined with hydrochlorothiazide?😵😵😵

Valsartan and hydrochlorothiazide tablets are commonly used clinically combined preparations. Clinically, what is the difference between valsartan hydrochlorothiazide and valsartan? Which one should I choose? How to use valsartan and hydrochlorothiazide correctly?

1. How to use valsartan and hydrochlorothiazide tablet?

Currently, there is only one dose of valsartan and hydrochlorothiazide tablets (80mg/12.5mg), each containing 80mg of valsartan and 12.5mg of hydrochlorothiazide.

Dosage: One tablet each time, once a day. The maximum antihypertensive effect can be achieved within 2 to 4 weeks of taking the medicine. According to the efficacy of the drug, the dosage can be adjusted every 1 to 2 weeks.

Because hydrochlorothiazide can cause hyperuricemia, hyperlipidemia and hyperglycemia. They are related to the dosage. If the blood pressure still fails to reach the target after 4 weeks, the patient should not increase the dosage without authorization, and adjust the medication regimen under the guidance of the doctor. Food does not affect the absorption of hydrochlorothiazide. Although food can significantly reduce the absorption of valsartan, valsartan can be taken with or without food. In order to reduce blood pressure fluctuations, patients should take the medication at a fixed time, either before or after meal. For most patients, in order to avoid increased nocturia, it is recommended to take it in the morning.

2. The combination of valsartan and hydrochlorothiazide can exert the effect of 1+1>2.

Complementary mechanisms to reduce blood pressure:

Valsartan belongs to angiotensin II receptor antagonist. It can block the effect of angiotensin II. Angiotensin II is one of the important active ingredients of the renin-angiotensin-aldosterone system. It binds to specific receptors on cell membranes of various tissues and exerts different physiological effects, including direct or indirect regulation of blood pressure. Angiotensin II is a strong vasoconstrictor substance. It can exert a direct effect of raising blood pressure. It can also promote the reabsorption of sodium and stimulate the secretion of aldosterone. In addition, valsartan is a specific angiotensin II receptor antagonist. It does not inhibit angiotensin converting enzyme. This enzyme converts angiotensin I into angiotensin II and degrades bradykinin. The retention of bradykinin can cause coughing. Therefore, valsartan does not cause coughing.

Hydrochlorothiazide excretes natriuresis and diuresis. It can reduce blood volume. At the same time enhance plasma renin activity. This stimulates the production of angiotensin I and II. Hydrochlorothiazide mainly acts on the proximal end of the distal convoluted tubule. It inhibits sodium chloride transport at the proximal end of the distal convoluted tubule and inhibits the cotransport of sodium and chloride ions. This directly increases the excretion of sodium and chlorine, and indirectly reduces blood volume. Then increase plasma renin activity, aldosterone secretion and potassium excretion. This lowers the blood potassium concentration. Renin-angiotensin-aldosterone system is depending on angiotensin II. Combination with angiotensin II receptor antagonists can reduce blood potassium loss associated with thiazide diuretics.

Reduce the incidence of hypokalemia:

Hydrochlorothiazide promotes sodium and potassium ion exchange and aldosterone secretion. This increases the excretion of potassium ions, which can cause hypokalemia.

Valsartan inhibits the release of aldosterone mediated by angiotensin II and reduces potassium excretion, which can reduce the risk of hydrochlorothiazide-related hypokalemia.

3. How to choose valsartan or valsartan combined with hydrochlorothiazide?

For blood pressure less than 160/100mmHg, valsartan can be used.

Patients with blood pressure ≥160/100mmHg or higher than the target blood pressure of 20/10mmHg should prefer valsartan and hydrochlorothiazide.

People who are allergic to sulfanilamide drugs should not use valsartan and hydrochlorothiazide tablets. Patients with hyperuricemia and hypercalcemia should avoid valsartan and hydrochlorothiazide tablets.

4. Precautions for valsartan and hydrochlorothiazide tablets.

Valsartan and hydrochlorothiazide tablets can still cause hypokalemia:

In addition to hypokalemia, hydrochlorothiazide can also cause hypomagnesemia, hyponatremia and so on. Therefore, electrolyte levels should be monitored regularly during medication.

When combined with calcium supplements and vitamin D, valsartan and hydrochlorothiazide tablets should be used with caution:

Thiazide diuretics can reduce calcium secretion and increase blood calcium levels. During medication, if calcium supplements and/or vitamin D are used, serum calcium levels should be monitored. If it is necessary, adjust the dosage of calcium supplements and vitamin D.

Hydrochlorothiazide can cause photosensitivity rashes, moss-like reactions, and lupus erythematosus. Patients should avoid exposure to the sun during medication. Hydrochlorothiazide can reduce glucose tolerance. Patients with latent diabetes mellitus may have symptoms. Therefore, diabetics may need to adjust the dose of hypoglycemic drugs.

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Ten foods that can help lower blood lipids.🌽🍎🍠

Hyperlipidemia is a common disease at present. Due to the many pathogenic factors of hyperlipidemia, it is easy to cause a variety of serious complications, such as high blood pressure and other cardiovascular diseases. Poor eating habits in life are also a major factor in increasing blood lipids. Therefore, while medication is used to reduce blood lipids, dietary improvement can better assist in the treatment of blood lipid reduction. Here are ten foods that can help lower blood lipids:

1. Oats:

Oats have the effect of lowering cholesterol and blood lipids. Because oats contain rich soluble dietary fiber that other grains do not have. This fiber is easily absorbed by the human body and has low calories. It is not only conducive to weight loss, but also suitable for the dietary needs of people with heart disease, high blood pressure, hyperlipidemia and diabetes.

Oats

2. Corn:

Corn is rich in calcium, phosphorus, magnesium, iron, selenium, vitamins A, B1, B2, B6, E, carotene, etc., and is also rich in fiber. Regular consumption of corn can lower cholesterol and soften blood vessels. It can prevent cardiovascular disease. It also has an adjuvant therapeutic effect on cholecystitis, gallstones and diabetes.

Corn

3. Onion and garlic:

Onions contain compounds such as alliin and thiol, which help to dissolve blood clots. Moreover, onions contain almost no fat, so they can inhibit the increase in cholesterol caused by a high-fat diet and help improve atherosclerosis. Garlic can lower serum total cholesterol. The secondary metabolite of allicin, methpropylene trisulfide, can prevent thrombosis.

Onion and garlic

4. Yam:

Yam contains mucus protein. Mucin can prevent fat deposition in the cardiovascular system, maintain blood vessel elasticity, prevent arteriosclerosis, reduce subcutaneous fat deposition, and avoid obesity. Moreover, the dopamine in yam has the function of dilating blood vessels and improving blood circulation.

Chinese Yam

5. Sweet potato:

Sweet potato has a strong effect of lowering blood cholesterol, maintaining blood acid-base balance, delaying aging, and preventing cancer and cancer. Sweet potatoes are rich in dietary fiber and gums, which help defecation substances. It can help remove useless substances from the intestines.

Sweet potato

6. Kelp:

Kelp can be said to be a vegetable from the ocean. Its low-calorie and low-fat characteristics have attracted the attention of nutritionists. Algae contain phytochemicals such as plant polysaccharides. They have many physiological functions such as anti-oxidation, regulating immunity, suppressing tumor, anti-infection, lowering cholesterol, delaying aging and so on. Because of the high water content of the alginate in kelp, it can form a gel-like substance in the intestine, so it helps to eliminate toxins and prevents constipation and intestinal cancer.

Kelp

7. Tremella:

Tremella is a nourishing food. It is rich in dietary fiber, which can strengthen gastrointestinal motility and reduce fat absorption. Tremella polysaccharide is a plant polysaccharide, which has the functions of lowering cholesterol, enhancing immunity, anti-tumor, anti-aging and beauty moisturizing.

Tremella

8. Celery:

Celery has the effects of detoxification, invigorating the stomach, protecting the liver, reducing phlegm, removing edema, calming blood pressure, reducing weight and fat. Celery is more suitable for patients with cough and excessive sputum, viral hepatitis, hypertension, hyperlipidemia, coronary heart disease, vascular sclerosis, urinary tract infection, sore swelling, pharyngitis, and so on.

Celery

9. Hawthorn:

The pectin contained in hawthorn is soluble dietary fiber, which has the effect of lowering cholesterol and preventing atherosclerosis. Eating hawthorn can remove oil and greasiness and promote digestion.

Hawthorn

10. Apple:

Apple is one of the very good fruits. It is healthy and low in calories. Because apples are rich in dietary fiber, pectin. Pectin basically contains no calories. It just passes through the human body. But every time it passes through the human body, it always takes away something, such as fat and oil. This will help to remove oil and lose weight. Moreover, it will also make the skin brighter and moisturized.

Apple

In addition, if you suffer from cardiovascular problems such as hyperlipidemia and high blood pressure, you should be careful not to eat greasy and spicy foods, eat less high-cholesterol, high-protein foods, and not eat animal fat, animal offal, etc. Try not to smoke or drink. You should have a light diet, eat more fruits and vegetables, maintain a good attitude and mood, and the effect of lowering blood pressure will be more ideal.

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Will metformin harm the liver and kidneys❓❓❓

Metformin was originally just a blood sugar lowering drug, but it was later
discovered to have many other effects, such as anti-aging, anti-cancer, etc., and it has been widely discussed (the medication should follow the doctor's guidelines and do not use it indiscriminately). Although with the advent of SGLT2 inhibitors, metformin has been replaced by SGLT2 inhibitors to a certain extent, metformin is still the drug of choice for type 2 diabetes in general. The vast majority of drugs will have some damage to the liver or kidneys. Many people would also think that metformin also harms the liver and kidneys. Will metformin harm the liver and kidneys?

Why do many people think that metformin harms the liver and kidneys?

In fact, the doctor prescribes oral hypoglycemic drugs for a newly diagnosed type 2 diabetes patient. According to the guidelines, if there are no contraindications, metformin should be recommended first. At this time, the doctor will ask the patient if he has any problems with the liver and kidney function, and may even check the liver and kidney function. As a result, many patients think that metformin will harm the liver and kidneys, so doctors will ask about their liver and kidney function. Of course, the doctor will explain to the patient that it is not that metformin hurts the liver and kidneys, but that patients with poor liver and kidney function may not be suitable for this medicine. However, doctors often do not have much time to explain the reasons to patients in detail, and most patients often fail to understand this highly specialized content. Therefore, patients will only remember the first impression that metformin may harm liver and kidney function. Then pass on the impression they remembered to others.

Why do doctors ask about liver and kidney function?

In fact, metformin neither hurts the liver nor the kidneys, and even some studies have shown that metformin can improve the liver and kidney function of some patients in some cases. So, why should doctors pay special attention to the patient's liver and kidney function when prescribing metformin? 

• Renal function: Metformin is mainly excreted from urine in its original form and cleared quickly. Therefore, metformin itself does not damage the kidneys. Since the launch of metformin, a large number of clinical and practical data accumulated in the past 100 years have also proved this point. Therefore, metformin does not harm the kidneys. However, in patients with renal insufficiency, the renal clearance of metformin decreases and the elimination half-life is prolonged, which leads to an increase in plasma metformin concentration and an increased risk of lactic acidosis. Therefore, patients with renal insufficiency need to adjust the dosage or discontinue according to the renal function when using metformin.
• Liver function: Metformin is not metabolized by the liver in the body, nor degraded in the body, and does not require liver detoxification, so it will not increase the burden on the liver, and it has no liver toxicity. It will not cause liver damage when used within the recommended dose. Therefore, metformin does not hurt the liver. The reason why doctors ask about liver function before prescribing metformin is that severely impaired liver function will significantly limit the patient's liver's ability to clear lactic acid. Therefore, the guidelines recommend that serum transaminase exceeds 3 times the upper limit of normal or severe liver insufficiency Of patients should avoid the use of metformin. 

Therefore, it is not that metformin harms liver and kidney function, but that the patient's existing liver and kidney function problems may affect the use of metformin.

Can't you take metformin if you have problems with liver and kidney function?

Not all patients with liver and kidney problems cannot use metformin. For example, for patients with type 2 diabetes who have normal renal function but have a small or large amount of albuminuria, metformin is still the first choice. For another example, patients with type 2 diabetes with hepatitis B or cirrhosis can also take metformin if they do not have severe liver insufficiency. However, it needs to be used under the guidance of a doctor, and follow the doctor's advice for regular liver and kidney function monitoring. Metformin has more than 60 years of global clinical application experience and its safety has been fully tested. Years of clinical studies have fully confirmed that metformin has a strong anti-diabetic effect, weight loss, cardiovascular protection, blood lipid improvement, tumor risk reduction, anti-aging, anti-inflammatory, improved intestinal flora, safety and tolerance, and high cost-benefit ratio and other advantages. This also makes metformin widely used by doctors. 

Metformin does not increase the risk of hypoglycemia when used alone, and it does not harm the liver or the kidneys. Long-term use does not increase the risk of hyperlactic acidemia or lactic acidosis. A common side effect of metformin is gastrointestinal discomfort. Metformin sustained-release tablets can solve this problem well.

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