The American College of Sports Medicine and the American Heart Association have released new guidelines for physical activity that recommend that healthy adults ages 18 to 65 exercise a minimum of five days per week in order to promote health and prevent disease.

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Abnormal lipids (fats) in the blood are considered one of the major risk factors for cardiovascular disease, a leading cause of premature death.  Conventional wisdom has been to evaluate blood lipids after abstaining from food for 12 hours. 

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Hypertension is defined as a repeated blood pressure (BP) reading of greater than 150/90 mm Hg (mercury). There are two types of hypertension: primary (aka essential or idiopathic, which means no particular cause can be identified) and secondary, which means due to some definable cause such as kidney failure or atherosclerosis.

About 89% of cases are considered to be primary hypertension, and while no specific cause can be singled out as the culprit, many factors are implicated in the development of primary, or essential hypertension. Some of the recognized risk factors include family history, environment (family size, crowding, eating patterns, occupation, obesity), salt ingestion and sensitivity (there is controversy over whether the sodium or chloride part of the salt molecule is the principal factor), race (blacks have more primary hypertension and more morbidity and mortality than whites), hyperlipidemia, smoking, and diet.

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The standard definition of high cholesterol is having an excess of cholesterol in the blood, usually more than 200 mg/dl, although many doctors are now citing 180 mg/dl as the maximum of the reference range.

The reason you have “high cholesterol” is probably because you have eaten too much saturated fat (from animals) over the years. Some people, however, have an inherited type of high cholesterol. For more information on familial hypercholesterolemia please see the conventional diagnosis section.

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Fats, or lipids, are essential to good health. Fats serve as a concentrated source of energy. Each gram of fat supplies 9 calories, whereas protein and carbohydrate supplies 4 calories each per gram. Fatty tissue in the body helps to hold the organs and nerves in place and protects them against traumatic injury. The layer of fat just below the skin insulates the body and maintains a steady temperature. Fats allow for the absorption of the fat-soluble vitamins (A, D, E and K). In the stomach, fats depress enzymatic activity thus slowing the emptying of the stomach after a meal and providing the felling of fullness (satiety) after eating. Fats are also terrific carriers of flavor, so add to the good taste of foods. Having said all that, Americans tend to consume way more fat calories than is necessary for optimal health. Most of the increase in fat consumption in America over the past 25 years represents an increase in the consumption of salad dressing and fried foods. The average American diet consists of 40% fat, 30% protein and 30% carbohydrate. A better ratio for good health would be 10-15% fat, 20-30% protein and 55-70% carbohydrate.

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Why is heart disease the number one killer of the Western world? Because we Westerners love to eat fats that are solid at room temperature. Butter, marbled steak, cheese, lard. Lard? It’s in most commercially available baked goods. “Heart disease” covers a lot of territory: high blood pressure (more technically know as hypertension), congestive heart failure, coronary heart disease, arrhythmias, angina and myocardial infarctions. Many of these are due to a combination of high blood pressure and so-called hardening of the arteries. “Hardening of the arteries actually means narrowing of the space inside the arteries. Our arteries are responsible for carrying freshly oxygenated blood out of the heart, into the tissues. So, less blood flow means less oxygen to our hands, feet, internal organs, and ultimately starving the brain. The culprits causing the stenosis, meaning narrowing of the vessels, are basically “bad” cholesterol (low density lipoproteins and very LDL’s) and the cellular debris of inflammatory reactions. For you science whizzes, high blood pressure is a function of “cardiac output” (the pliability of the heart muscle plus actual blood volume) multiplied by “peripheral vascular resistance”, which refers to the viscosity of the blood and the openess of the arteries.

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Strokes are brief episodes involving a lack of oxygenated blood flowing to the brain (90% are ischemic infarctions), or a sudden bleed within the brain tissue (10% are hemorrhagic) which causes permanent damage to the effected area of the central nervous system. In a classic stroke, the neurologic defects continue to expand for 24-48 hours after the infarction occurs (”stroke in evolution”). The most frequently seen stroke is called a “completed stroke,” whose symptoms develop rapidly and maximally within a few minutes to an hour. The term “completed stroke” also refers to the fully established neurologic deficits after the stroke, whether from the acute or gradual kind. Neurologic symptoms solely relate to the area of cerebral infarction.

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