fragment 28. check.renal.nutrition
A search of this website.tome indicates Harv’s first focus on renal in 2022 February, under the influence of CKD and ERSD study. WellCare sourced a renal nutritionists without success — clinics knew only dietician for renal nutrition advice
Harv has pursued a plant based diet (PBD) since 2022 — he cancelled his World Cruise for focus. He continues to pursue PBD using PCP and a dietician who advertised renal nutrition, but that segment of health is weak and Harv found non-existent.
As his life.flow evolved into 2024, he has an easy and competent PCP who also now monitors his nephrology, neurology, and cardiology. Harv’s main health-care thrust has been a ten pound weight loss and looking to more weight loss.
His compacted health-care.life.flow has permitted life.flow focus on a more quality oriented retirement, specifically the write of his website tome with a dim scholarly aim.
Functional fragment title moves closer to the precedence network (Theory W) record verb.descriptor.noun structure.
Previous health scribble of chase.ill.health is included here for renal rewrite, and dispersal elsewhare in the bottom-up Contents build.
CKD
common colddementia -- Mild Cognitive Impairment (MCI)itch -- (CKD) Chronic Kidney Diseaseplant-based-diet -- (CKD)potassiumrenal nutrition -- (CKD)stresstestsV8
2024jan11. CKD. Renal Nutrition Forum 2022 • Vol. 41 • No. 1. The benefit of nutrition intervention is to slow chronic kidney disease (CKD) progression and avoid or delay End Stage Kidney Disease (ESKD). Nutrition intervention for people with CKD varies depending on the stage of kidney disease, co-morbidities, and treatment modality (1). Nutrition therapy is individualized with the help of a qualified Registered Dietitian Nutritionist (RDN). (For more information on GFR, kidney disease staging and risk of CKD progression visit: www.kidney.org/atoz/gfr. Accessed March 10, 2022). A review of the literature regarding renal workload associated with animal proteins suggests that vegetable proteins and fruit may be renal protective (6). ... a dietary intake of nuts, low-fat dairy products, and legumes (p <0.001) were protective against CKD in a prospective cohort of 11,952 adults over 23 years (ARIC Study) (8). ... participants suggested a lower mortality in CKD patients implementing a plant-dominant diet. Higher utilization of a plant-based diet was associated with slower GFR decline. Fruits and vegetables are abundant in potassium and magnesium salts of metabolizable anions, including citrate and malate, which consume hydrogen ions when metabolized having an alkaline effect. Adults with CKD 3-5 (not on dialysis and metabolically stable), recommendations are for a low protein diet (LPD) of 0.55-0.60 g/kg/day or very low protein diet (VLPD) of 0.28-0.43 g/kg/day with ketoacid analogues (KAs) to meet protein requirements of 0.55-0.60 g/kg/day. Adequate energy is to prevent protein energy wasting (PEW) in CKD and maintain neutral nitrogen balance (4, 23). Multiple factors influence energy expenditure beyond traditional determinants which include chronic inflammation. Overall health goals should be considered when calculating the energy prescription. Adults with CKD l-5D require 25-35 kcal/kg BW day(21). A LPD with plant-based sources such as whole grains, fruits and vegetables with a high fiber intake of 25-30 g/day has beneficial effects on insulin resistance and glycemic index within the target caloric range and plant-based eating patterns such as vegetarian, Mediterranean-style and the DASH eating pattern assists with the management of diabetes and AlC levels (24-26). Those most adherent to a plant-based diet (strict vegetarians) have the lowest blood pressures documented and multiple studies suggested reduced blood pressure with increased plant consumption (24, 27-28). This is of importance as hypertension and diabetes are the two leading causes of CKD, in adults. Phosphorus accumulation can begin to be seen in CKD Stage 3 when GFR declines to <45 mL min/l .73m2 (29). Phosphorus binders maybe utilized to maintain serum phosphorous levels within normal levels by binding to phosphate in the gut and thereby decreasing absorption, these must be taken in close proximity to meals. Consideration must be taken to both the actual content of phosphorus and the bioavailability in food sources. The availability of potassium binders aids in facilitating potassium homeostasis for patients experiencing hyperkalemia and assists in maximizing the benefits of a plant-based diet (22).
Renal Nutrition Forum 2022 • Vol. 41 • No. 2. www.renalnutrition.org (l), there is increasing evidence supporting inclusion of plant-based protein. Recently there has been enough evidence to support incorporating more plant-based foods overall for persons with CKD l-5D or those at risk for CKD and favoring plant-based proteins as in a plant-based, DASH, or Mediterranean lifestyle that may delay the progression of CKD to end-stage kidney disease (ESKD)(2,3). Through the guidance of a qualified Registered Dietitian Nutritionist (RDN), a proactive and kidney-protective approach utilizing an individualized plant-based nutrition intervention and Medical Nutrition Therapy (MNT) may slow the progression of CKD with the goal tO ultimately delay or avoid ESKD (4, 5). The increasing epidemics of obesity, diabetes, and hypertension compounded by an aging population lends to a higher incidence and prevalence of ESKD, thus interventions aimed at prevention of CKD and the progression of CKD to ESKD are imperative and RDNs play an instrumental role (6). The phrase 'plant-based' has evolved over time and yet a unified term has not been embraced. A plant-based diet consists mostly or entirely of foods derived from plants, including vegetables, grains, nuts, seeds, legumes, and fruits and with few or no animal products. The safety and kidney protective mechanisms of plant-based nutrition are multiple and extend beyond the alkalinity of the diet, which has been reviewed in a multitude of studies analyzing the impacts of metabolic acidosis (MA) on CKD, to demonstrate the protective nature of plant nutrition from the reduction of uremic toxins, a healthy microbiome, the role of fiber to the anti-inflammatory and antioxidant effects (5,l0,2l). Proteins are highly complex, large molecules which though necessary for life, when consumed in high amounts as is noted with Western nutritional practices, partlcularly of animal origin, have deleterious effects on several chronic diseases and are associated with premature mortality(22). One might ponder if a decreased protein intake to a low protein diet (LPD) or very low protein diet (VLPD) with use of ketoanalogues (KAs) is sufficient in reducing toxins and uremic symptoms with progressing CKD (1). Shifting from animal protein to plant protein, not only is kidney protective by delaying the progression of CKD, but it also prevents and treats heart disease and diabetes (13,14,16,25,26). Protein from plant sources has benefits associated with lower dietary acid load, increased fiber content, favorable gut microbiome, reduced renal toxins, and increased micronutrients, all of which are kidney protective. Additionally, the patient's readiness to change must be taken into account (27). An individual who is metabolically stable may benefit with a progressive transition from a plant-dominant LPD (PLADO) diet using LPD of 0.6-0.8 g/kg BW/day, with >50% plant-based protein sources and transition to a LPD and ultimately to a VLPD-plus_KA (4, 27). Metabolic acidosis is not only a consequence of, but a contributor to the progression of kidney disease. Beyond the deleterious effects on CKD, it has effects on skeletal metabolism, insulin resistance, and protein energy wasting (PEW)(29-33). Raphael et al. identified that a higher serum bicarbonate, in the 20 to 30 mEq / L range was associated with a lower risk of worsening kidney function and it's noted in the Chronic Renal Insufficiency Cohort (CRIC) Study that every 1 mEq/L higher serum bicarbonate level was associated with a 3% lower risk of developing ESKD (34-35). Multiple studies by Goraya et al. indicate that fruit and vegetable (F+V) intake of two to four cups per day is an effective means of increasing oral alkali and with positive effects in preservation of GFR (36-38). As mentioned, the Western diet is high in animal protein and additionally, low in natural alkali and this generates a DAL of approximately 1 mEq/kg per day, equating to approximately 50 to 75 mEq / d of DAL per person whereas a vegan or vegetarian has a neutral or even negative DAL (28,39). The Third National Health and Nutrition Examination Survey (NHANES Ill) showed a significantly increased risk for kidney failure for those in the highest tertile of DAL consumption (Relative Hazard 3.04;95% CI)(28,40).
2023dec30. CKD. Nutritional and Dietary Management of Chronic Kidney Disease Under Conservative and Preservative Kidney Care Without Dialysis. Journal of Renal Nutrition, Vol 33, No 6S (November), 2023: pp S56-S66. While dialysis has been the prevailing treatment paradigm for patients with advanced chronic kidney disease (CKD), emphasis o n conservative and preservative management in which dietary interventions are a major cornerstone have emerged. Based on high-quality evidence, international guidelines support the utilization of low-protein diets as an intervention to reduce CKD progression and mortality risk, although the precise thresholds (if any) for dietary protein intake vary across recommendations. There is also increasing evidence demonstrating that plant-dominant low-protein diets reduce the risk of developing incident CKD, CKD progression, and its related complications including cardiometabolic disease, metabolic acidosis, mineral and bone disorders, and uremic toxin generation. In this review, we discuss the premise for conservative and preservative dietary interventions, specific dietary approaches used in conservative and preservative care, potential benefits of a plant-dominant low-protein diet, and practical implementation of these nutritional strategies without dialysis. Nearly four million people in the world have end-stage kidney disease (ESKD) treated with kidney replacement therapy, with the majority (69%) receiving hemodialysis. ... among people living with advanced CKD transitioning to ESKD, there is a high burden of comorbidities, including diabetes (74%), heart failure (59%), depression (33%), and anxiety (10%) as well as symptom burden. ... dietary interventions, in order to reduce estimated glomerular filtration rate (eGFR) decline, optimize health-related quality of life (HRQOL), stabilize metabolic status and mitigate the unpleasant symptoms and complications of uremia. [Google: Blood tests. ... a chemical called creatinine and a waste product called urea.Jan 27, 2022]. Multiple studies show that dialysis, while life-extending, may not always exert the intended effect of restoring health nor improving outcomes in patients with advanced nondial- ysis dependent (NDD) CKD who are transitioning to ESKD. For example, large population-based studies across multiple international cohorts have shown a mortality peak in the initial months following dialysis initiation. Recognizing these limitations of dialysis therapy, the federally mandated Advancing American Kidney Health Initiative unveiled in 2019 has recommended the adoption of treatments that slow or stop CKD progression, 1) low dietary protein intake, largely from plant-dominant protein sources, 2) higher fruit and vegetable consumption, 3) increased die- tary fiber intake, and 4) maintaining adequate caloric intake. For approximately 5 decades, dialysis has been the default treatment strategy for ESKD globally. In 1972, the United States Congress approved the 1972 Medicare End-Stage Renal Disease Program which ended rationing of dialysis due to limited resources the KDOQI guidelines advise that adults with stages 3 to 5 NDD- CKD without diabetes who are metabolically stable should consume 1) a low-protein diet of 0.55-0.60 g/kg body weight/day, or 2) a very-low-protein diet of 0.28-0.43 g/ kg of body weight/day with additional keto acid analogs in order to reduce risk of ESKD and/or death ISRNM experts highlighted that it is reasonable for clini- cians to aim for the lower end of a streamlined target of 0.6 to 0.8 g/kg/day regardless of CKD etiology, consid- ering that 1) lower dietary protein targets (i.e., 0.28- 0.43 g/kg/day) may be challenging to achieve, particularly in geographic catchments without access to keto acid ana- logs and/or kidney dietitians, and 2) in the low dietary pro- tein trials, actual dietary protein intake was generally above 0.6 g/kg/day despite a prescribed target of 0.55 to 0.6 g/ kg/day (Table 2). A large body of evidence has shown that lower dietary protein intake is associated with decreased proteinuria, CKD progression, and uremic complications. While many dietary regimens for CKD are inherently restrictive,28 as well as concerns about the potential risk of protein-energy wasting,45-47 these data suggest that low-protein diets can be safely administered in NDD- CKD, particularly when implemented under the supervi- sion of specialty-trained kidney dietitians There has also been growing emphasis on the avoidance of excessive restriction and the optimization of the palatability and overall quality of life with more patient-centered dietary approaches. the hypothesis that fruits and vegetables may be effective in reducing metabolic acidosis, kidney angiotensin II, and eGFR decline. Participants in the fruits and vegetables arm achieved higher plasma total CO2 levels consistent with improved metabolic acidosis, as compared with the sodium bicarbon- ate arm; both groups experienced improved urine indices of kidney injury without increases in plasma potassium levels after 1 year A patient-centered approach involves a shared understanding of treatment goals, effective commu- nication to alleviate anxieties around food or food miscon- ceptions, individualized advice, and assistance with implementation of dietetic advice in the face of a large symptom burden. In addition, attention to the dietary pattern rather than individual foods is important, and consideration given to the important cultural and social roles of food.
2023oct13. CKD. Protein Needs for People Not on Dialysis. Published:October 12, 2023DOI:https://doi.org/10.1053/j.jrn.2023.10.004 https://www.jrnjournal.org/article/S1051-2276(23)00171-1/pdf Caring for Patients With Advanced Chronic Kidney Disease: Dietary Options and Conservative Care Instead of Maintenance Dialysis. Open Access Published:February 14, 2023DOI:https://doi.org/10.1053/j.jrn.2023.02.002 https://www.jrnjournal.org/article/S1051-2276(23)00022-5/fulltext ... the prevention and treatment of chronic kidney disease (CKD), with a focus on dietary options. Kidney-preserving therapy can prolong the dialysis-free period and preserve residual kidney function, thus patients are asked to adjust their lifestyle and diet, to follow a low- or very low-protein diet, with or without ketoacid analogues. Patient empowerment is vital, including CKD education and involvement in decision making. Most people with CKD will inevitably progress to kidney failure, known as ‘end-stage renal disease’ (ESRD) which is incompatible with life without renal replacement therapy (RRT) in the form of either maintenance dialysis treatment or kidney transplantation.7 An early start to dialysis according to estimated glomerular filtration rate (e.g., 10-15 mL/minute) does not necessarily improve patient outcomes, and can lead to higher costs and lower quality of life.9, 10, 11 CKD is largely preventable and treatable, and often the use of interventions can avoid or postpone adverse outcomes.1,5,13 Thus, interventions to preserve kidney function are increasingly advocated for reasons such as improved healthcare effectiveness and better patient quality of life. An important goal of this approach is to prolong and preserve kidney function, and so defer starting dialysis. In order to achieve this goal patients are asked to change their diet, in particular they are asked to reduce their protein intake (e.g., to a low- or very low-protein diet),14 to eat less salt, and perform regular physical exercise to improve body and organ/system fitness.15,16 Changing diet or building physical exercises into a daily schedule generally means changing lifestyle, and this poses a number of challenges for the patient concerned, his/her caregivers, and healthcare professionals (HCPs). In recent years there has been a paradigm shift in the treatment of CKD away from the dichotomy of dialysis versus no dialysis (conservative or supportive treatments) to include a range of other intermediate options and the use of more integrated approaches. These can be grouped together as preservative management of CKD, defined as a type of life-sustaining conservative management with the primary goal of slowing CKD progression and preserving kidney function for as long as possible, ideally avoiding dialysis altogether.19 Preservation of kidney function can be achieved through non-pharmacological strategies (i.e., dietary and lifestyle adjustments) and/or pharmacological interventions targeting CKD or kidney disease.19 While non-pharmacological strategies (principally dietary and lifestyle interventions) are the main topic of the current article, ... The role of low-protein diets and supplemented very low-protein diets in preservative management of CKD are summarized in Box 1.14,22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36 High-protein diets have gained in popularity in recent years for people seeking weight loss or to ameliorate type-2 diabetes, and in general, high-protein intake can be defined as greater than 1.5 g/kg ideal body weight (bw)/day or dietary proportion of >25% of the daily energy intake, [264#=120kg /1.5=80g protein hi 180#=82/1.5=55g protein hi] though definitions are not always clear.26 However, high-protein diets can cause intraglomerular hypertension, potentially leading to renal hyperfiltration, glomerular injury, and proteinuria, and in time may adversely affect kidney health in populations with or at-risk for CKD.7,26 Moreover, dietary-protein quality as well as quantity may play a role: several observational studies have shown that animal protein, particularly processed red meats, is associated with an increased risk or progression of CKD compared with protein from plants.26,37,38 While red and/or processed meat were associated with increased risk of albuminuria, rapid estimated glomerular filtration rate decline, or both,37,39 reducing the intake of animal protein and increasing the dietary intake of nuts, legumes and low-fat dairy products was associated with a protective effect against the development of CKD.37,38 The recommended dietary allowance for protein intake in a normal healthy adult is 0.8 g/kg bw/day, estimated from mean protein requirements of non-pregnant, non-lactating adults (0.6 g/kg bw/day) including an additional 33% (0.2 g/kg bw/day) safety margin.33 Patients with stable (non-nephrotic, non-inflamed, non-catabolic) non-dialysis dependent CKD have similar protein requirements (i.e., ∼0.6 g/kg bw/day).32,33 As such, provided there is sufficient energy intake (i.e., at least 25 or 30 kcal/kg bw/day) [265#=120kg*30=3600c daily 25=3000c daily], dietary protein intake can be decreased safely to 0.55 to 0.6 g/kg bw/day (low-protein diet) [.55g/kg*82kg=45g protein], and an additional reduction in protein intake to 0.3 to 0.4 g protein/kg bw/day (very low-protein diet) may be achieved with the addition of ketoacid analogue (KA) supplements [.35g*82kg=29g protein + KAs] (in settings where KAs are available) to provide sufficient essential amino acids normally supplied by animal proteins, which are typically scarce in these very low-protein/vegan-like diets.32 The potential role of low-protein diets in patients with CKD has been hampered by fears that restriction of dietary protein may lead to protein-energy wasting (PEW).40 However, most evidence indicates that a carefully controlled low-protein diet or supplemented very low-protein diet, combined with an adequate intake of energy, is more likely to prevent rather than promote PEW.33
2023oct11. CKD. CKD complications negatively affect the QOL scores in 10-year long-term survivors with CKD. CKD guideline-based practices, prevention of ESKD/CVD and management of hypertension, diabetes and hyperuricemia, might contribute to future HRQOL [Health Related QOL] in patients with CKD. Published:October 10, 2023DOI:https://doi.org/10.1053/j.jrn.2023.10.001
2024aug 24w32. common cold. In week 32, Harv experienced what he considered a ‘common cold’— his first in years of memory. It could have been covid from the COA petrie dish, but he thinks not. A triple supply of zinc drops are now ay hand.
He did not jump unto the throat tickle with zinc drops immediately, thus probably the cold lasted days longer.— his Tx a lot of rest, and in ten days a one-cough-does-it day the cold seemingly expired.
2024may22. tests. Weintraub says a stress test should be done if you have symptoms that suggest coronary artery disease, such as shortness of breath or chest pain when you walk. “In these cases, stress tests can be very useful and give us a sense of how extensive coronary artery disease really is,” he says. https://www.washingtonpost.com/wellness/2024/05/20/heart-tests-echocardiograms-stress-test/?utm_campaign=wp_the_optimist&utm_medium=email&utm_source=newsletter&wpisrc=nl_optimist&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F3dcb5b2%2F664dec78db5e8f61965f1dfe%2F598b051fae7e8a68162a1429%2F22%2F40%2F664dec78db5e8f61965f1dfe
2024may01. Chf. Congestive heart failure ... is a serious condition in which the heart doesn’t pump blood as efficiently . ... ... it means that the heart muscle has become less able to contract over time or has a mechanical problem that limits its ability to fill with blood. ... it can’t keep up with the body’s demand, and blood returns to the heart faster than it can be pumped out—it becomes congested, or backed up. This pumping problem means that not enough oxygen-rich blood can get to the body’s other organs. The heart beats faster [67 pulse still 'athletic'] to take less time for refilling after it contracts—but over the long run, less blood circulates, and the extra effort can cause heart palpitations. The heart also enlarges a bit to make room for the blood. The lungs fill with fluid, causing shortness of breath. The kidneys, when they don’t receive enough blood, begin to retain water and sodium, which can lead to kidney failure. With or without treatment, heart failure is often and typically progressive, meaning it gradually gets worse. It’s the most common diagnosis in hospitalized patients over age 65. One in nine deaths has heart failure as a contributing cause. Think fruits and vegetables, low-fat dairy, lean protein such as chicken without the skin, and “good” fats such as those found in olive oil, fish [NEF recommendation] and avocados. Lose pounds .... “Recent research shows that a major portion of the long-term benefit of statin therapy [2024 statin dose doubled] is in the prevention of heart failure by way of preventing heart attacks and coronary events that lead to it,” says Jones. There’s no cure for heart failure. Treatment aims to relieve symptoms and slow further damage. The exact plan depends on the stage and type of heart failure, underlying conditions and the individual patient. Among the components of a treatment plan: ... avoid salt [2024apr stumble leading to 283#] (because of fluid retention) and caffeine (because of heartbeat irregularities). https://www.hopkinsmedicine.org/health/conditions-and-diseases/congestive-heart-failure-prevention-treatment-and-research
In general, more than half of all people with CHF survive for 5 years after diagnosis, according to a 2019 systematic review and meta‐analysis . About 35% survive for 10 years.Sep 10, 2023 (Google 2024may01) Congestive heart failure life expectancy: Prognosis and stages medicalnewstoday.com https://www.medicalnewstoday.com › articles
The table below describes the different classes in the NYHA Functional Classification. (Google 2024may01)
- Class Patient Symptoms
- I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation or shortness of breath.
- II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, shortness of breath or chest pain.
- III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, shortness of breath or chest pain.
- IV Symptoms of heart failure at rest. Any physical activity causes further discomfort.
What not to do if you have congestive heart failure? (Google 2024may01)It's important to work to manage stress and anxiety. They make the heart work harder, which can make symptoms worse. Don't use smoking, drinking, overeating or drugs to cope with stress, as these habits can make your condition worse.Jul 10, 2023Lifestyle Changes for Heart Failure - American Heart Associationheart.orghttps://www.heart.org › treatment-options-for-heart-failure2024mar13. CKD. Abstract Objective Internet search engines and social media websites are prominent and growing sources of dietary information for people with chronic kidney disease (CKD) and their healthcare providers. However, nutrition therapy for CKD is undergoing a paradigm shift, which may lead to inconsistent advice for managing hyperphosphatemia. The aim of this study was to summarize and evaluate online resources for phosphorus-specific nutrition therapy. Design and Methods Patient-facing resources were collected from Google, Yahoo, and Facebook in June-July 2021. Using nine independent search terms, the first 100 hits were reviewed. Dietary advice for food types, food groups, food sub-groups, and individual food items was categorized as “restricted,” “recommended,” “mixed,” and “not mentioned”. Information on publication date, source, and author(s), phosphorus bioavailability and demineralization were also collected. Results After removing duplicates, 199 resources from Google and Yahoo, and 33 from Facebook were reviewed. Resources ranged from 2005 to 2021, and were primarily authored by registered dietitians and medical doctors (65% and 31%, respectively). Dietary advice mostly focused on restricting high-phosphorus foods, and phosphorus additive-based processed foods. Dietary restrictions were generally consistent with the traditional low-phosphorus diet, which targets whole grains, Dairy, and plant-based Protein Foods, although major inconsistencies were noted. Phosphorus bioavailability and demineralization were rarely mentioned (16% and 8%, respectively). Similar findings were found on Facebook, but the limited number of resources limited meaningful comparisons. Conclusion Results showed that online resources for phosphorus-specific nutrition therapy are highly restrictive of heart healthy food items. and contain significant inconsistencies. Given the widespread and increasing use of online resources by people with CKD and healthcare professionals to inform dietary choices, efforts are urgently needed to establish consensus for phosphorus-specific nutrition therapy. Until then, the findings of this study provide a basis for increasing awareness of the potential for confusion arising from online resources. Keywords Chronic kidney disease hyperphosphatemia low-phosphorus diet online resources https://www.jrnjournal.org/article/S1051-2276(24)00033-5/abstract?dgcid=raven_jbs_aip_email
2023dec18. stress. He [Tiger Woods in his 49th year] carded a final-round 61 alongside his 14-year-old son Charlie at the PNC Championship in Orlando on Sunday. "If I'm able to practice and do the things I know I can do, and prepare, I know I can still do it," Woods said. "I can still hit the golf ball. It's just a matter of prepping and get enough reps in and get enough work in and being right physically, and the endurance capability of it. "I haven't had the leg good enough where I've been able to compete and play a lot of rounds. "I can still hit the golf ball. I can still chip. I can still putt. "Granted it's also putting it all together for 72 holes. That's the challenging part of it." Woods' last win on the PGA Tour was at the 2019 Zozo Championship in Japan, which saw him equal Sam Snead's record of 82 Tour victories. https://www.bbc.com/sport/golf/67746601
2023nov18. stress. Can stress cause a heart aneurysm? Over many years, this stress can lead to the bulging of the blood vessel wall. This is the leading factor in the development of aneurysms of the thoracic aorta. At the PCP visit of "aortic aneurysm" my BP was 120.78.68 by machine and 110.70 by the doctor. Conclusion: "My BP is under control -- FINNALY after decades PCP changes settling at the current Rx cocktail. It's been years since I tricycled, and decades since I day-bicycled. I no longer gym-machine exercise for four year now. I have stopped hiking a year or two ago to stop my lower backaches that diclofenac would cure in a half-hour after application. At 85 years my body/mind tells me to take it easy, and I was never able to swim proficiently so I don't. My bet is that this exercise/Rx-retirement-lifestyle will PREVENT my 'heart aneurysm' from rupturing, and thus avoiding 'ill-health chase' therefore DO NOTHING ADDITIONAL." 19 Aortic Aneurysm Symptoms, 7 Causes, Treatment, Survival Rate ... (Google2023nov18) https://www.emedicinehealth.com/aortic_aneurysm/article_em.htm
DO I HAVE A HEART ANEURYSM OR AN AORTA ANEURYSM (LOWER ALONG WITH THE LIVER CYSTS CONCERN?) ?
2023nov03. plant-based-diet. Recently, there has been enough evidence to support incorporating more plant-based foods overall for persons with CKD 1-5D or those at risk for CKD and favoring plant-based proteins as in a plant-based, DASH, or Mediterranean lifestyle that may delay the progression of CKD to end-stage kidney disease (ESKD) (2,3). Through the guidance of a qualified Registered Dietitian Nutritionist (RDN), a proactive and kidney-protective approach utilizing an individualized plant-based nutrition intervention and Medical Nutrition Therapy (MNT) may slow the progression of CKD with the goal to ultimately delay or avoid ESKD (4, 5). The increasing epidemics of obesity, diabetes, and hypertension compounded by an aging population lends to a higher incidence and prevalence of ESKD, thus interventions aimed at prevention of CKD and the progression of CKD to ESKD are imperative and RDNs play an instrumental role (6). The phrase plant-based has evolved over and yet a unified term has not been embraced. A plant-based diet consists mostly or entirely of foods derived from plants, including vegetables, grains, nuts, seeds, legumes, and fruits and with few or no animal products. The safety and kidney protective mechanisms of plant-based nutrition are multiple and extend beyond the alkalinity of the diet, which has been reviewed in a multitude of studies analyzing the impacts of metabolic acidosis (MA) on CKD, to demonstrate the protective nature of plant nutrition from the reduction of uremic toxins, a healthy microbiome, the role of fiber to the anti-inflammatory and antioxidant effects (5,10,21). Proteins are highly complex, large molecules which, though necessary for life, when consumed in high amounts as is noted with Western nutritional practices, particularly of animal origin, have deleterious effects on several chronic diseases and are associated with premature mortality (22). One might ponder if a decreased protein intake to a low protein diet (LPD) or very low protein diet (VLPD) with use of ketoanalogues (KAs) is sufficient in reducing toxins and uremic symptoms with progressing CKD (1) (Table 2). Protein from plant sources has benefits associated with lower dietary acid load, increased fiber content, favorable gut microbiome, reduced renal toxins, and increased micronutrients, all of which are kidney protective. Additionally, the patient's readiness to change must be taken into account (27). An individual who is matabolically stable may benefit with a progressive transition from a plant-dominant LPD (PLADO) diet using LPD of 0.6 - 0.8 g/kg BW/day, with >50% plant-based protein sources and transition to a LPD and ultimately to a VLPD-plus-KA (4, 27). Metabolic acidosis is not only a consequence of, but but a contributor to the progression of kidney disease. Beyond the deleterious effects on CKD, it has effects on skeletal metabolism, insulin resistance, and protein energy wasting (PEW) (29-33). Raphael et al. identified that a higher serum bicarbonate, in the 20 to 30 mEq/L range was associated with a lower risk of worsening kidney function and it's noted in the Chronic Renal Insufficiency Cohort (CRIC) Study that every 1 mEq/L higher serum bicarbonate level was associated with a 3% lower risk of developing ESKD (34-35). Multiple studies by Goraya et al. indicate that fruit and vegetable (F+V) intake of two to four cups per day is an effective means of increasing oral alkali and with positive effects in preservation of GFR (36-38). As mentioned, the Western diet is high in animal protein and additionally, low in natural alkali and this generates a DAL of approximately 1 mEq/kg per day, equating to approximately 50 to 75 mEq/d of DAL per person whereas a vegan or vegetarian has a neutral or even negative DAL (28,39). The Third National Health and Nutrition Examination Survey (NHANES III) showed a significantly increased risk for kidney failure for those in the highest tertile of DAL consumption (Relative Hazard 3.04; 95% CI) (28,40). Plant-based diets generate fewer uremic toxins, reduce proteinuria, and temper GFR decline through a variety of mechanisms other than simply a reduction in protein intake including alterations in the microbiome (44). Renal Nutrition Forum 2022 • Vol. 41 • No.2 www.renalnutrition.org
2022nov22. V8. (Google search 2022nov22T4am) Is V8 juice actually good for you? According to a Healthline report, V8 juice is actually surprisingly nutritious. It's made from a large assortment of vegetables, including tomatoes, carrots, beets, celery, lettuce, parsley, spinach, and watercress.Aug 9, 2020
2022oct. plant-based-diet. “It takes actual planning to ensure nutritional adequacy on a vegan diet,” Kimberlain said. For example, because the digestibility of protein is decreased on a vegan diet, plant protein needs are slightly higher for vegans than for those eating animal foods, Kimberlain explained. That’s why it’s crucial to include a protein source at every meal –- such as tofu, beans, tempeh, nuts and seeds – even at breakfast. [Harv eats red meal every day as his source of “complete” protein] … add hemp seeds, flax seeds or chia seeds … keeps you fuller longer and adds in healthy fats. Because omega-3 rich fish is omitted on vegan diets, omega-3 fatty acids must be obtained from plant sources such as walnuts, flaxseeds, hemp, chia and algae supplements. And iron and zinc are other key minerals that can be tricky to obtain on vegan diets. “Plant-based iron has lower bioavailability so needs are higher,” Kimberlain explained. Lentil soup and nut butters are good sources of plant-based iron. Nuts, grains and soy foods can also provide zinc. But vitamin B12, which naturally originates from animal sources only, is another story. “B12 must be supplemented in the vegan diet,” Palmer said. “If you are vegetarian, you get B12 from eggs. But for someone who is vegan, this is the one nutrient that I would recommend to supplement with,” agreed Kimberlain. … get my blood tested regularly to make sure I am not at risk for any nutrient deficiencies,” Roitman added. Going vegan is a process, not something that happens overnight. Though you may be excited to get started on this new eating style, it’s wise to keep your expectations in check. “It can take anywhere from three to six months to fully convert to vegan,” Kimberlain said. https://www.cnn.com/2020/02/06/health/vegan-how-to-food-drayer-wellness/index.html
2022oct18. dementia. Dementia stage 3: Mild cognitive decline (also called mild cognitive impairment) When memory and cognitive problems become more regular, as well as noticeable to caregivers and family members, a person is said to be suffering from mild cognitive decline, which is also known as mild cognitive impairment (MCI). https://www.aplaceformom.com › articles › dementia-sta.. via Google search 2023apr30
2022week39. itch. This week, itch turns intolerable with front-trunk itch area turning red from scratching. Prior weeks’ numerous applications of Hydrocortisone 2.5% out of ‘cold cream’ jar becomes tedious beyond little benefit of itch relief. Symptom of suicide thought if CKD becomes life-quality intolerable — then red itch takes a second step toward suicide — Harv goes back to allergy medication that Moorjani discontinued at Harv’s first NEF visit. This is done with knowledge that he may be increasing his death-risk due to CKD. (Google search 2022week39: CKD itching)
2019mar18. dementia. Researchers believe that most patients with mild cognitive impairment (MCI) will go on to develop dementia. MCI is a stage between the mental decline seen in normal aging and the onset of early dementia. https://my.clevelandclinic.org › health › diseases › 1799.. via Google search 2023apr30
Potassium. High potassium foods: Limit milk to ½ pint per day (300ml). https://www.kidneycareuk.org/about-kidney-health/living-kidney-disease/kidney-kitchen/lowering-your-potassium-levels/
2022dec06. Water. The participants were tracked with a gold-standard technique called “doubly labeled water,” which uses water laced with tracers that can be used to track the body’s production of carbon dioxide, allowing the researchers to get precise measurements of the participants’ daily energy expenditure. It also allowed them to estimate the amount of water the participants generated from metabolism and the water that they consumed. “It’s really accurate at measuring how many calories you burn each day but also how much water you take in and how much goes out,” Pontzer said. Using this method, the researchers determined how much water the participants lost and replaced each day, a measurement known as water turnover. They found that a person’s daily water turnover was largely determined by their size and their level of body fat, which contains less water than muscle and other organs. The more “fat-free” mass a person has, the more water they need. Since men tend to have larger bodies and less body fat compared to women, they generally use more water. “Men use more water every day because we have a bigger system to keep hydrated,” Pontzer said. The research showed that how much water you need changes over your lifetime. In general, our water needs peak between the ages of 20 and 50 and then decline in parallel with the slowing down of our metabolisms. That’s because the amount of water you need is partly dependent on your metabolism and how many calories you burn. “All of the work that your cells do every day is water-based,” Pontzer said. “The ratio of the amount of water that you use to the number of calories that you burn stays fairly consistent over your life span.” Two other important factors that determine your water needs: Your climate and whether you lead a sedentary lifestyle. People who live in hotter climates and engage in more physical activity have higher levels of water turnover. So how much water should you drink? The answer is simple: Drink when you’re thirsty. Prioritize water, and try to avoid sugary drinks, which can cause metabolic problems. Coffee and tea are fine as well. While the caffeine they contain can increase urination, they will still be hydrating so long as you consume less than 400 milligrams of caffeine, Rosinger said. Keep in mind that you get water from your food as well. Some water-rich foods are fruits, vegetables, beans, yogurt, brown rice, and soups. “If you’re paying attention to your body and drinking when you feel like you need to, then you should be fine,” Pontzer said. https://www.washingtonpost.com/wellness/2022/12/06/eight-cups-daily-water-intake/
2022oct11. stress. There are many biological mechanisms that explain why stress and anxiety can cause people to pack on unwanted pounds. In some cases, gaining weight can itself become a source of stress and stigma that fuels further weight gain. While we can’t eliminate every major source of stress in our lives, we can control — to some extent — the impact it has on our bodies. Scientists have found that there are ways to alleviate stress and retrain your brain to improve your diet and prevent stress-induced weight gain. One side effect of cortisol is that it promotes body fat, especially belly and visceral fat, which is a particularly toxic kind of fat that surrounds internal organs. Studies show that people with higher cortisol levels tend to have a higher body mass index. If you constantly grapple with stress, it can send signals to your body to accumulate fat, said A. Janet Tomiyama, the head of the Dieting, Stress and Health Lab at the University of California at Los Angeles. “Even if you don’t change a single thing that you eat, the fact that you are stressed is going to promote fat deposition,” said Tomiyama, who has studied the mechanisms behind stress and obesity. Even stress from activities we enjoy can lead to overeating. While you can’t always reduce the stress in your life, you can retrain your brain to want better foods when you’re stress eating. “Anytime two things happen at the same time your mind creates a connection between them,” Tomiyama said. “By pairing relaxation and fruit together, your mind starts to see them as the same thing. After a while, you won’t even need to do the six minutes of relaxation: All you’ll need to do is eat the fruit, and you’ll get that same relaxation benefit.” https://www.washingtonpost.com/wellness/2022/10/11/anxiety-stress-eating-comfort-foods/?utm_campaign=wp_post_most&utm_medium=email&utm_source=newsletter&wpisrc=nl_most&carta-url=https%3A%2F%2Fs2.washingtonpost.com%2Fcar-ln-tr%2F38240cc%2F634596f9f3d9003c580cb7f7%2F598b051fae7e8a68162a1429%2F39%2F70%2F634596f9f3d9003c580cb7f7&wp_cu=639b84fe3ddb27af65b99f6cacbf7a23%7CC0DBC114CDAE2BA7E0430100007FAD1A
