E.D. Education

It used to be called impotence. But thanks to the proliferation of drug industry advertisements that now threaten to overwhelm our television programs, today we know it as erectile dysfunction, or, more discreetly, simply as E.D. Whatever you want to call it, though, it’s the man’s inability to achieve or maintain an erection sufficient to satisfy him or his partner during intercourse.

When it occurs in young men, it’s usually just a matter of momentary anxiety. In middle-aged men, it’s often caused by stress, guilt, or overwork. In fact, most men experience it at some point in their lives by age forty, though usually only briefly, and they are not psychologically affected by it.

But it gets more common with age, and for some men – as many as 30 million of them according to the drug companies – it occurs frequently and causes serious emotional and relationship problems.

In many cases, E.D. is due to the deterioration of the blood vessels that carry blood into the penis. A host of things can cause this deterioration, including nicotine, which narrows the blood vessels, excessive alcohol, and certain prescription drugs, notably antidepressants. Some physical problems can contribute to the deterioration, too, such as diabetes, high blood pressure, and obesity.

If you have difficulty getting an erection, get help. Discuss it with your partner, and consult your doctor, who will help you find the cause of your E.D. Treatment will, of course, depend on the cause. Though there are a number of mechanical devices that can help men get a better erection, including splints, rings, and pumps, it’s the E.D. drugs that have revolutionized the treatment of this problem. They work well for most men, and if one drug doesn’t work for you, try one of the others – but always work with a doctor’s guidance since the drugs can have significant side effects.

Type 2 Diabetes: The Choice is Yours

The statistics for type 2 diabetes are staggering. There are about 20 million Americans with type 2 diabetes, a high sugar condition caused by poor nutrition, being obese, and a lack of exercise—factors that can all mostly be prevented.

About two-thirds of the people with type 2 diabetes have been diagnosed, which leaves about 6 million people walking around with undiagnosed diabetes. That’s a huge number of people who have a very serious disease and don’t know it. And that makes type 2 diabetes, like hypertension, another silent killer.

Unlike type 1 diabetes, type 2 diabetes is not a failure of the pancreas, but an inability to produce adequate amounts of insulin for a body that is out of control. On top of that, the insulin that is being produced is not acting the way it should, a situation called insulin resistance that occurs when the insulin can no longer stimulate the cells to process the sugar in the blood. This causes the sugar to build up in the blood, ultimately doing damage to the heart, eyes, and kidneys, and creating small-vessel disease.

Type 2 diabetes is now an epidemic, and if not corrected in this generation, it will probably be responsible for most of the strokes, hypertension, and cardiovascular disease that we will encounter in our sixties and seventies. Type 2 diabetes is especially common among African Americans, Latinos, Native Americans, and certain Asian populations.

Most people develop type 2 diabetes because they are overweight. Basically the human body does two things: it takes in calories, and it burns calories. When you consistently bring in more calories than you burn off, all those extra calories turn into fat. That fat first gets stored in the abdomen and the intestines, and then it begins to infiltrate the muscle mass of our body. And what you end up with looks very much like a marbleized piece of sirloin that you see at the butcher shop. That marbleization is one of the hallmarks of people with type 2 diabetes.

If you keep piling on the extra calories, the pancreas, whose function begins to slow down anyway with age, is no longer able to meet the demand for large quantities of insulin needed to metabolize all that sugar in the blood.

If you were to lose weight, a significant amount of weight, I mean, your type 2 diabetes could disappear almost overnight. Yes, it’s that simple. I, myself, was a diabetic. I had very elevated sugars. I was overweight, excessively stressed, and exercise-phobic. I had a very clear, black-and-white case of type 2 diabetes. So I lost 50 pounds; I now exercise three times a week, and I’ve maintained that weight loss.

Today, I am no longer diabetic. If, like me, you have not had type 2 diabetes for very long, and if you can overcome it by simple weight loss, you will end up with no permanent damage to your organs.

If you have any choice in the matter, diabetes is a road you don’t want to go down. Just to give you an idea, here are a few numbers:

–Heart disease from diabetes accounts for 65 percent of deaths in diabetics.

–The risk of stroke is two to four times higher in diabetic patients than in nondiabetics.

–Seventy-three percent of adults with diabetes have hypertension.

–Diabetic retinopathy, which is damage to the vessels of the retina, creates about 24,000 cases of blindness in America every year.

–Diabetes is the leading cause of kidney failure.

–One-third of people with diabetes have gum disease.

–About 10 percent of pregnant women who are diabetic may experience a spontaneous abortion or have children with major birth defects, including spina bifida.

–About 82,000 people lost a foot or a leg last year because of diabetes.

The list of damage diabetes does to the body is virtually endless. If you are a diabetic, you must learn to prevent complications and stay ahead of the game. Being a diabetic is a full-time job, and there are several measures you will have to take to ensure you keep your health on track.

You will constantly have to monitor your cardiovascular risks by monitoring your blood pressure and keeping it under control.

You will have to watch your cholesterol levels.

You will have to visit your ophthalmologist regularly to ensure you don’t development retinopathy.

You will need very comprehensive dental and foot care.

But, most important, you will have to monitor and control your sugar levels. Several times a day you must take a glucose reading either by using Accu-Chek or doing a finger prick. You will look at your morning sugar and at your sugar two hours after you eat. For the most part you want your morning sugar to be less than 100 milligrams per deciliter, and you want your postdinner values, usually two hours after you eat, to be 120 and 130 milligrams per deciliter.

If your sugar is high, you will need either to inject yourself with insulin or to take an oral hypoglycemic. This kind of supply-and-demand treatment model may soon give way to more convenient methods, made possible by new research into diabetes. Devices are now being developed in which a sensor that continuously monitors your sugar levels triggers a tiny pump when your blood sugar is elevated to release small doses of insulin.

Other new research is focusing on the possibility of transplanting the pancreatic cells, called isolet cells, into those who need them, in the hope of restimulating insulin production inside their body and minimizing the amount of insulin that needs to be injected. The hope is that this research will one day lead to a cure, whereby insulin will once again be naturally produced in the body. But as of right now, diabetes is not cured; it is treated.

Diabetes can be managed. Ultimately, if you’re talking about juvenile diabetes and you start very early in the game by getting diagnosed and getting effective treatment, you can probably expect a normal life expectancy, but it’s a very dedicated type of life.

If you are now in your forties and you develop type 2 diabetes, and you continue for a decade or more without any checks and balances, it’s very unlikely that you’ll make it into your late seventies or eighties. There’s just not enough time in the pot. In other words, if you are 40 years old, 50 or more pounds overweight, with high blood sugar levels and high cholesterol, and you don’t exercise and you don’t watch what you eat, you will without doubt see the effects 10 to 15 years from now.

By the time you’re in your sixties, you will most likely have hypertension, stroke, and cardiovascular disease. Don’t go there.

Sweet Questions

“I’m a fifty-five-year-old woman with two married daughters. We all have a sweet tooth in our family, and I’m worried that we might all become diabetic. Can people who eat a lot of sweets become diabetic?”

No. If you exercise and for the most part follow a balanced diet, you can like sweets and not become diabetic.

“Can people with diabetes eat sweets?”

If it’s part of a healthy lifestyle involving a good diet and exercise, a diabetic can eat sweets.

“Can you catch diabetes from someone else?”

No, though some people think they can. Diabetes is probably largely a matter of genetics for Type 1 and lifestyle factors for Type 2.

“Are people with diabetes more likely to get colds or other illnesses?”

No. Your immune system is not compromised when you have diabetes. However, people with diabetes should get regular flu shots because any infection can interfere with blood-sugar management.

Stroke: Know the Signs, Save Lives

Your heart is not the only potential victim of cardiovascular disease. Your brain can be, too. Stroke is a type of cardiovascular disease that affects the arteries leading to and within the brain. A stroke occurs when the blood vessels that carry the oxygenated blood and nutrients to the brain are either blocked by a clot or break.

This prevents the brain from getting the oxygen and nutrients it needs, and within minutes to a few hours brain cells begin to die. Every 45 seconds someone in the United States has a stroke, and every three minutes someone dies of stroke. That’s about seven hundred thousand strokes a year, of which about 160,000 result in fatalities.

I can’t stress enough how important it is to learn how to recognize the symptoms of stroke because it can save your life or the life of someone you know. The most characteristic symptom is a sudden numbness, weakness, or paralysis of the face, arm, or leg, usually on one side of the body. Other symptoms include loss of speech or trouble talking, blurry vision, double vision, decreased vision, dizziness, loss of balance and coordination, an out-of-the-blue bolt of pain, headache, vomiting, or altered consciousness and disorientation or memory loss. Usually these symptoms strike suddenly and without warning.

It is important to recognize the signs and symptoms of stroke because every minute counts when it comes to treating one. The longer a stroke goes untreated, the greater the damage and potential disability. So if you have any of the signs and symptoms of stroke, it is important to get help immediately.

Eighty percent of strokes are ischemic, which means they are caused by an obstruction from a blood clot or particle of cholesterol plaque that reduces the blood flow to the brain. The brain cells die within minutes of this happening. There are two types of ischemic stroke. Thrombotic strokes are caused by clots that originate in the arteries that supply the brain, like the neck arteries, or the arteries within the head itself. Embolic strokes originate from blood clots that form away from the heart but are swept up through the bloodstream and into the narrow arteries of the brain.

The other 20 percent of strokes are hemorrhagic; they occur when a blood vessel in the brain leaks or breaks. The most common risk factor for hemorrhagic stroke is uncontrolled hypertension, though it can also be caused by an anatomical weakness of the blood vessel itself, that is, an aneurysm, or by an abnormal connection of the arteries and veins in the brain.

There are several risk factors for stroke.

People who have transitory ischemic attacks—a temporary halt to the flow of blood to the brain—have a ninefold increase of developing a full-blown stroke. At higher risk are those who have a family history of stroke, are older (the older we get, the greater the chance of stroke), and are African American, partly due to the high prevalence of high blood pressure and diabetes among the black community.

Other factors include hypertension, high cholesterol, cigarette smoking, diabetes, obesity, cardiovascular disease, and high homocysteine levels. Homocysteine is an amino acid in the blood, and people with elevated homocysteine levels have a higher risk of stroke. Women taking birth control pills or hormone replacement therapy may also be at higher risk for stroke.

The good news is that there actually are some things you can do to avoid being a victim of stroke. Even though you cannot do anything about your race, your sex, your family history, or your age, since cardiovascular disease and stroke go hand in hand, you certainly can look at your risk factors for heart disease and hypertension and focus on early screening.

Get your blood pressure checked; learn what your body mass index is; and check your cholesterol and glucose levels every two to five years.

Exercise, manage your stress, limit your alcohol consumption, don’t smoke, and stay away from foods with saturated fats.

Take a vitamin B complex, like B6, B12, and folic acid, which are essential in helping to reduce the levels of homocysteines in the body.

Don’t take illicit drugs, like cocaine, which may trigger a stroke.

People with risk factors for stroke should consider a brain-healthy diet that includes several servings daily of fruit and vegetables with nutrients rich in potassium, folate, and antioxidants. Eat foods high in soluble fiber, like oatmeal, to help reduce cholesterol, as well as foods rich in calcium and soy that help reduce your bad cholesterol and raise your good cholesterol. Foods rich in omega-3 fatty acids, which include, of course, plant oils, salmon and other cold-water fish like tuna, are also good weapons in the battle against stroke.

When it comes to the treatment of strokes, some hospitals have actually established special stroke emergency rooms that are manned by a multidisciplinary team well versed in their diagnosis and treatment. Whoever the doctor is, however, he or she must first determine the type of stroke and its location before treating it.

A wide variety of diagnostic tests are available to the doctor, and they all fall into one of three categories: imaging tests, which provide a better-than–X-ray picture of the brain; electrical tests, which record the impulses in the brain; and blood flow tests, which show any problem that may be causing changes in blood flow to the brain.

Essentially, all emergency room doctors will attempt to improve and restore blood flow to the brain of a stroke victim. One way to do that is by injecting a clot-bursting drug, or thrombolytic, that helps dissolve the clot. Other techniques include performing a surgical procedure such as a carotid endarterectomy, in which the surgeon opens the carotid arteries and removes the plaque from them, or angioplasty, in which a balloon-tipped catheter dilates the arteries to improve the blood flow.

Once a stroke has been diagnosed and treated, most individuals end up taking preventive medicines to minimize the chances of recurrence. Some may receive antiplatelet drugs to make platelet cells in the blood less sticky and less likely to form a clot, or anticoagulants, which again prevent the blood from clotting. In cases of hemorrhagic stroke, where a blood vessel has ruptured, surgical intervention is needed to minimize further bleeding by clipping, cauterizing, or removing the clot and any vessel that is actively bleeding.

Stroke survivors must cope with a life-changing experience. They are often significantly disabled and, as a result, need a strong support system. Usually the support system is a team of rehabilitation doctors, which might include a psychiatrist, a dietitian, an occupational therapist, a physical therapist, a speech therapist, and social workers.

A stroke victim has to deal with impaired movement, which has implications for walking, balancing, speaking, swallowing, and breathing; bladder and bowel dysfunction; and diminished sex drive—as well as all the emotional issues that result from those problems. A stroke victim’s family is also profoundly affected because they now have to take part in caring for the individual.

Stroke can change your life completely, so learn to recognize it and treat it urgently to minimize the terrible disabilities it can inflict on its victims.

The Other Victims of Stroke

The obvious result from a major stroke is devastating disability—such as speech impairment, weak hand and leg movement, and depression. But a stroke can also have an indirect effect on the health of the victim’s family and friends.

Imagine a very strong and vibrant man who has never been sick, who has been a good husband and provider, who has been a great father. His family, and especially his wife of 45 years, marveled at his strength. He was healthy and looking forward to a peaceful and blessed retirement. Then one day he suffered a major stroke, which left him unable to speak and walk. For the family, the confusion and shock were intense. How could this have happened?

This is not a fictional story. It happened in my family. When I first met my future father-in-law, I never imagined that one day his life would end up in such a way. However, this same scenario is played out over and over again in many families across the United States and around the world.

All of a sudden, responsibilities that were the stroke victim’s are now delegated to other members of the family, and in some cases the majority of the responsibilities falls on the spouse. From everyday things like shopping or paying bills to new responsibilities like making daily trips to the rehabilitation center; feeding, bathing, and keeping up with all the medications; and becoming a motivational guru.

All of this can have a tremendous impact on the caregiver’s health. Suddenly, what was once an ordinary life becomes an extraordinary one burdened by the pressure and eased by the love for the ailing family member. We doctors sometimes forget about the families, and that’s a big mistake. When dealing with stroke survivors, focusing on the family as a whole is always important. We must listen, support the changes that are needed, and monitor stress and the effect that it has on the people taking care of stroke survivors.

Family members take care of one another; they become the pillars of health care in the home and improve the outcome that any therapy in the hospital could bring. I remember the look of my mother-in-law as she dealt with her husband’s disabilities, a look of love, duty, and compassion. But we must always make sure that, as we take care of others, we take care of ourselves.

If you don’t take care of your own health, you may very well end up being unable to take care of the person you love. So stay healthy. They don’t say “in sickness and in health” for nothing.

Doing It, or Not?

One reason—if not the main reason—we diet and exercise is that we want to look good to the opposite sex (or maybe the same sex).

And, of course, one reason—if not the main reason—we want to do that is to be attractive to our (real or imagined) sexual partner.

Now, what does any of this have to do with health, you wonder? The answer is, plenty. A healthy sex life improves your overall quality of life. It improves your immune system because it significantly relieves stress. Good physical exercise burns calories, and it improves your mood by pumping endorphins into your bloodstream that make you feel good. It also plays a key role in keeping couples together, so the benefits of sex are innumerable.

But once you get on into your forties, you might find your sex drive shifting into a lower gear. This diminished or lack of sex drive is more common in women than it is in men. Even men with erectile dysfunction usually have a normal sex drive. While libido problems can be either physical or psychological, the root causes tend to be the same in both sexes. Alcoholism is the main physical factor responsible for a decreased libido; another is drug abuse, of cocaine, for example.

Obesity and anemia are other potential physical problems. And there are certain tumors of the pituitary gland that increase the hormone prolactin, which lowers the libido. Some prescribed medications, especially antidepressants, lower the level of the hormone testosterone, which is needed by both sexes to maintain an adequate sex drive. Psychological factors influencing libido include depression, stress, and confusions about sexual orientation.

Anyone with a lack of sexual desire should first try to take these factors out of the equation. So if you’re drinking excessively, overweight, depressed, or taking medications, these issues need to be dealt with to resolve a flagging libido. Counseling can help with the psychological problems of sexual hang-ups, depression, or stress.

There is no magic remedy for the loss of sexual libido. Though testosterone has been identified as a key hormone that improves sexual appetite in women, doctors who have been giving women testosterone supplements for the past 30 years have found that it has little effect on their libido, while it sometimes causes facial hair growth, a deepened voice, and an enlargement of the clitoris.

I have no doubt that one day there will be a libido pill for women and men, as I’m sure the drug companies are hard at work on this potentially lucrative solution.

There are a number of other sexual problems that women may experience at any age. One is dyspareunia, or painful sexual intercourse. Any part of the genitals can cause pain during sex, including the skin around the vagina. Vaginal infections, like yeast infections or viral infections, are a common cause, and the pain can be felt when either a tampon or penis is inserted into the vagina. It can also occur from just sitting or wearing pants. To treat dyspareunia, physicians may recommend hormone creams, dilators to help stretch the vagina, Kegel exercises, or, in rare cases, antidepressants.

Another potential cause of dyspareunia is vaginismus, an involuntary contraction of the vaginal muscles that may prevent insertion of the penis during intercourse. The diagnosis of vaginismus is usually problematic because it’s often difficult to separate the physical pain with the emotional anxiety of experiencing that pain; in other words, just the fear of the pain can cause vaginismus.

Any woman complaining of these symptoms should be taken seriously. A doctor must conduct a physical examination to eliminate the possibility of such physical causes as infections, fibroids, or anatomical deformities of the uterus, ovaries, or vagina. Even vaginal dryness can cause painful sex. A decrease in estrogen at menopause can cause the vaginal walls to become dry, creating a discomfort or pain during intercourse.

If there are no treatable physical conditions, it’s important to discuss the woman’s feelings as well as the physical situations that lead to this type of discomfort. Some women have a very positive attitude toward sex; other women have had negative sexual experiences that play a significant role in their fears and negative feelings about sex.

Some women may have a history of sexual abuse, rape, or trauma, for instance; these things need to be identified in a very delicate way. Treatment of vaginismus usually involves practicing relaxation techniques and doing Kegel exercises to relax the vaginal muscles. At home, one exercise that may prove beneficial is to have your partner gradually insert a dilator into your vagina. This must be done at a pace with which you feel comfortable until the pain and discomfort are overcome. Partner, doctor, and patient all have to be in sync for this type of therapy to be successful.

Many women experience discomfort or pain at the time of their period. This pain is caused by contractions of the muscle of the uterus during menstruation that occur due to the release of the prostaglandins, which are hormones that are produced in the lining of the uterus. For most women these menstrual contractions are neither severe nor disabling. But some women experience significant menstrual pains called dysmenorrhea.

Women suffering from dysmenorrhea should exercise, get plenty of sleep, and avoid stress. Over-the-counter painkillers can minimize the amount of prostaglandins released, and they usually help reduce the pain. If the painkillers are not effective, your doctor will have to look for other things that are causing the pain. And ultrasound is sometimes used in such cases to make sure you don’t have any other medical conditions, like pelvic inflammatory disease, endometriosis, or fibroids.

Dr. Manny’s Freedom Diet

One recent survey of Americans on body image found that more than half of all men and women would rather lose their job than gain an extra seventy-five pounds. And nearly 20 percent of the population would give up, or consider giving up, 20 IQ points to have the perfect body.

Obviously, weight and the way we are perceived is an important factor in our daily lives. It’s not surprising then that dieting is on the minds of so many people these days, particularly as people get on in their forties, when the metabolism begins to slow and the pounds begin to add up. So which diet is best? I’ll tell you.

First, let’s look at some of the big blockbuster diets that have appeared over the past decade or so—the South Beach Diet, the Atkins Diet, the Mediterranean Diet, and so on. Each one of these diets has simply incorporated a different method of teaching you about nutrition in order to get you to lose weight. Each one gives you something to focus on, a behavior to motivate you, which is great because, after all, to lose weight you have to change your thinking.

But if you look at the fundamentals, the underlying theme of each diet is calories. Whether you do Atkins, South Beach, or Dr. Phil, it’s really all about calories.

When reviewed carefully, most diets are really nothing more than low-calorie nutrition plans disguised by clever marketing gimmicks. Scientific-sounding “facts” and hocus-pocus “research” are just ornaments on the diet tree. Diet-plan marketers go to great lengths to explain how their diet can work for everyone, or claim that it is carbohydrate intake or fat intake—or whatever the bad intake of the day is—that’s the culprit.

However, the bottom line is that the only way to lose weight is to have a caloric deficit, which occurs only when you burn more calories than you consume.

The average American today consumes 300 more calories per day today than did the average American of 30 years ago. Today’s average American also burns 260 fewer calories each day due to increased automation, technology, and sedentary occupations. Put those numbers together, and it becomes rather obvious why America’s waistline is growing at an alarming rate.

Check Your BMI

The BMI can tell you if you are underweight, normal, overweight, or obese. Adults 20 years old and older can calculate their BMI with this formula:

BMI = your weight/pds divided by height/in x height/in x 703

You are UNDERWEIGHT, if your BMI is below 18.5.

You are of NORMAL WEIGHT, if your BMI is between 18.5 and 24.9.

You are OVERWEIGHT, if your BMI is between 25.0 and 29.9.

You are OBESE, if your BMI is 30.0 or more.

So here is Dr. Manny’s Freedom Diet. If you really want to lose weight, you have to do two things: eat fewer calories and burn more calories. This is not an optional “either/or” plan but an “and” plan. Of course, the calories you eat should be healthy calories. That’s all. Eat less. Exercise more. It really is that simple.

Fight obesity. Spread the word.

Exercise

People spend an enormous amount of time trying to find the perfect exercise, and while they’re doing that, their clock is ticking. Any physical activity is great, though the best kinds of exercise for you are those like walking, swimming, running, hiking, and skiing—all of which have a “global” impact on your body and mind.

Most important, you should stick to the exercise of your choice and do it regularly. If you adhere to those two principles, you’re going to burn calories, feel better, improve your metabolism, and benefit your health.

Any activity you do during the day—from climbing stairs, to housecleaning, to watching TV—will, of course, burn calories. But those activities don’t provide the necessary continuity, and I think the essence of getting into shape and having a good metabolism has to do with a continuity of exercise.

In other words, it’s better to burn 120 calories a day, seven days a week, doing your favorite exercise, for example, than to burn 800 calories doing the housework once a week. It’s the exercise regimen that has an impact on your health, not necessarily the intensity.

Burn, Baby, Burn

Estimated number of calories burned per minute based on an individual weighing about 150 pounds:

Sitting: 1

Talking on phone: 1

Sleeping: 1

Driving: 2

Housework: 3

Cooking: 3

Washing dishes: 3

Stretching: 4

Sex (active): 5

Walking (3 mph): 5

Calisthenics (moderate): 5

Ballroom dancing (fast): 6

Gardening: 6

Swimming (moderate): 7

Aerobics (low impact): 7

Hiking: 7

Jogging: 8

Stair step machine: 8

Bicycling (12 to 14 mph): 10

Basketball (full court): 12

Running (10 mph): 20

To easily calculate how many calories you burn in a day, go to www.healthstatus.com and click on “Calculators” then “Calories Burned.”

It is also very important to drink adequate amounts of fluid when you exercise. You need to drink about a half cup of water for every fifteen minutes of vigorous exercise. People think that muscle cramps during exercise are caused by a shortage of electrolytes, but that’s not true. You get muscle cramps because of water loss and dehydration. Drink that water!

Hypertension: The Silent Killer

Hypertension is known as the silent killer for good reason. Some 50 million Americans have high blood pressure and one-third of those don’t even know it, despite the fact that it’s very easy to diagnose.

Hypertension kills some 40,000 Americans each year, and another 200,000 die annually of a high-blood-pressure-related illness. People with hypertension are seven times more likely to have a stroke, six times more likely to have congestive heart failure, and three times more likely to develop a heart attack.

In all, hypertension claims more lives per year in the United States than cancer. Those numbers are doubly sad: first, because they are so high, and second, because they could easily be so much lower. More than half of the people with hypertension are not receiving treatment at all, and one-quarter of them are being inadequately treated. Only about one-fifth are receiving the proper treatment to control their blood pressure.

There are two types of hypertension. More than 90 percent of all cases of hypertension involve what is known as essential hypertension, which is high blood pressure without a definite cause. The rest, fewer than 10 percent of the cases, have a known cause; this is known as organic hypertension, or secondary hypertension. Organic hypertension occurs when a specific disease, such as a tumor of the kidneys, vascular disease, or hormonal disease, causes your blood pressure to be elevated.

When we talk about blood pressure, we are referring to a comparison of the blood pressure when the heart is beating versus the pressure when the heart is resting. A blood pressure reading is represented as the systolic (or beating pressure) over the diastolic (or resting) pressure. A normal blood pressure is anything lower than 120 over 80. But if you are 140 over 90 or above, you have high blood pressure. Anything in between the two sets of numbers is considered prehypertensive.

How can you tell you have high blood pressure? Certainly not by your symptoms; most people with hypertension don’t have any. But any qualified health professional can measure your blood pressure in a very non-evasive way using a blood pressure machine. Of course, if your blood pressure is very high, you will have symptoms like nose bleeds, irregular heartbeats, headaches, and dizziness.

Hypertension affects more males than females and more blacks and Latinos than whites. The lifestyle characteristics that can put you at risk of developing hypertension include obesity, lack of exercise, a diet rich in sodium, and excessive alcohol consumption. Smoking raises blood pressure as well. Genetic factors may be involved, too, as some individuals have a family history of hypertension.

In younger women, hypertension is sometimes associated with birth control pills. Other medications that can give you high blood pressure include some nonsteroid anti-inflammatories, cold remedies, decongestants, and appetite-suppressant pills.

Your diet plays a very significant role in blood pressure. Foods high in cholesterol thicken the blood with fat, and that forces the heart to work harder, thereby raising your blood pressure. As the heart works harder to push that blood through, the heart becomes larger because it has to expand more to grab enough volume in order to squeeze the blood out of its chambers. If the heart has to work harder, the heart and the arteries come under tremendous pressure and stress, and this, of course, weakens the heart. It also means that organs like the kidneys and eyes and liver don’t get enough oxygenated blood, which causes cell damage to those organs that ultimately damages them.

A high salt intake also makes you retain more water in your vascular system, and that, too, increases your blood pressure. To reduce your risk of high blood pressure, the American Heart Association (AHA) suggests that you ingest no more than 2,400 milligrams of sodium a day. That’s just one and a quarter teaspoons of salt per day, and it mounts up faster than you think; many foods, especially prepared foods, contain large amounts of sodium. And then there is all the salt we actually add to our food.

Being overweight is also a fundamental factor in developing high blood pressure. Conversely, losing weight is one of the essential ways of improving your blood pressure. Lack of exercise and physical inactivity is another risk factor for heart disease. This means that exercising will improve your cardiac performance, making your heart work better, thus lowering your blood pressure.

Stress has also been linked to hypertension: it narrows the blood vessels, thereby causing high blood pressure, so it is vital for people who have high blood pressure to learn how to manage their stress.

The treatment of high blood pressure involves making dietary changes, losing weight, lowering cholesterol, practicing relaxation and meditation techniques, and getting some exercise. If these don’t work, there are medications that can specifically target the kind of hypertension you have.

So how do we prevent high blood pressure?
Number one, watch your weight. If you are 30 percent above your ideal body weight, you’ve got a problem and are more likely to develop high blood pressure.

Second, if you’re drinking excessively—more than three hard drinks a day—this also is a problem.

Third, watch your salt intake; eat fewer processed foods. If you go out to eat, ask your wait person if the kitchen can reduce the amount of salt in your order. Eat a balanced diet. Consume foods that can help lower your cholesterol, like vegetables and grains.

Don’t smoke; nicotine is a major vasoconstrictor.

Exercise regularly; try to do 30 minutes’ worth of aerobic activities three to four times a week.

The bottom line on hypertension is to do your best to prevent it. If you can’t, identify it, and then treat it. Whatever you do, don’t become a statistic like so many other Americans.