Heart Health. The heart beats about 2.5 billion times over an individual’s lifetime, pushing millions of gallons of blood to every part of the body. This steady flow carries oxygen, fuel, hormones, other compounds, and essential cells. It also takes away the waste products of metabolism. However, when the heart stops, the essential functions fail.
Given the heart’s never-ending workload, it can also fail. It can be brought down by a poor diet, lack of exercise, smoking, infection, unfortunate genes, and more. One of the key problems is atherosclerosis. This is the accumulation of cholesterol-rich plaque inside the arteries. This plaque can limit blood flow through the arteries, coronary arteries, and other arteries throughout the body. When a plaque breaks apart, it can cause a heart attack or stroke.
Although many develop some form of cardiovascular disease (diseases affecting the heart and blood vessels) as they get older, a healthy lifestyle, especially when starting early, goes a long way to prevent cardiovascular disease. In addition, lifestyle changes and medications can help heart-harming illnesses, like high blood pressure or high cholesterol, before they cause damage. And there are medications, operations, and devices that can help support heart health if damage occurs.
Can healthy noodle alternatives and heart-healthy ingredients help make cholesterol-friendly pasta dishes for individuals trying to lower and manage cholesterol levels?
Pasta and Cholesterol
Pasta, like other refined carbohydrates such as white bread and rice, can increase cholesterol levels. Although pasta does not contain cholesterol, it is high in carbohydrates, which can increase the amount of calories and fat in one’s diet and contribute to high cholesterol levels. Since some types of carbohydrates can affect cholesterol levels, the goal is to eat the right pasta and healthier sauces and sides. Even for those following a cholesterol-lowering diet, there’s no reason you can’t enjoy meals containing pasta occasionally.
The Pasta and Cholesterol Link
Pasta made from white flour is considered a refined carbohydrate because it is high in carbs and low in fiber. Research has shown that a diet high in refined carbohydrates is associated with increased levels of triglycerides and LDL (unhealthy) cholesterol in the blood. (Yu, D. et al., 2013) (Bhardwaj B., O’Keefe E. L., and O’Keefe J. H. 2016) High levels of blood fats increase the risk of developing heart disease. Examples of refined carbohydrates include:
White rice
Breakfast cereals
Potato Chips
White bread
Pastries
Pizza
One cup of dry pasta has 0 milligrams of cholesterol but is high in carbohydrates, with around 43 grams per serving (U.S. Department of Agriculture, 2018). Eating foods high in saturated fats and refined carbohydrates can raise cholesterol levels.
Choosing Healthy Alternatives
Choosing healthier options that are cholesterol-friendly can make pasta healthy. Pasta labeled whole wheat or whole grain is darker than white flour pasta, which contains more fiber and can lower cholesterol levels and reduce the risk of heart disease. (American Heart Association, 2024) The label will show the carbohydrate and fiber content per serving.
Alternatives
Alternatives that are lower in carbohydrates and/or higher in protein and fiber include:
Spaghetti squash
Spiralized vegetables like zucchini, carrots, and butternut squash.
Shirataki noodles are made from the konjac plant.
Chickpea pasta
Black bean pasta
Red lentil pasta
Edamame pasta
Vegetables
Vegetables are heart-healthy and are a great addition to pasta dishes. Vegetables that pair well with pasta include:
Peppers
Onion
Zucchini
Spinach
Broccoli
Asparagus
Add a few olives, which contain healthy monounsaturated fats. (Rocha J., Borges N., and Pinho O. 2020) Mix vegetables and pasta in equal amounts to create a lower-carb, fiber-dense dish that will keep cholesterol levels low and maintain a healthy heart.
Cheese and Low-Fat Cheese
It is common to incorporate cheese. While cheese contains calcium and adds flavor and texture, it also adds saturated fat. The American Heart Association recommends that saturated fats make up less than 6% of daily calories because of their role in heart health and high cholesterol risks. (American Heart Association, 2024) Instead, use a small amount of cheese, such as Romano or cheddar, and add a small amount of low-fat cheese that includes:
Parmesan cheese
Part-skim mozzarella cheese
Low-fat ricotta
Low-fat cottage cheese
Lean Meats
Sausage and ground beef are common additions but are also a source of saturated fat that could raise cholesterol levels. (American Heart Association, 2024) So, when possible, limit red meat and sausage or use a low-fat sausage alternative that is chicken or turkey-based, and add heart-healthy options, which include:
Beans
Shrimp
Turkey
Chicken
Salmon
Make It Herbaceous and Spicy
Spices can enhance the taste of a dish. Many herbs and spices commonly used in pasta dishes, such as parsley, oregano, garlic, and basil, contain healthy nutrients and don’t add any fat or calories. Spice up a pasta dish to taste with a little heart-healthy olive oil and spices to create a light coating on the noodles. (Rocha J., Borges N., and Pinho O. 2020) One tablespoon of olive oil contains nearly 120 calories and 14 grams of fat. (U.S. Department of Agriculture, 2019)
Healthy Sauces
Sauces are important, but an unhealthy one can introduce extra sugar and fat. Plenty of healthy sauces are at the store, but check the label as some contain extra salt, sugar, and fat, which are not heart-healthy. (U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015) Try to limit the use of creamy sauces, such as cheese and alfredo sauces, as they are a source of added fat and are high in saturated fat. An alternative is to dress the pasta with sautéd olive oil and sliced cherry tomatoes. Sauteing helps soften the tomatoes and release extra flavor into the oil.
Injury Medical Chiropractic and Functional Medicine Clinic
So, experiment with healthy pasta, various vegetables, lean meat, and healthy sauces to add flavor and make your next pasta dish delicious and cholesterol-friendly. Injury Medical Chiropractic and Functional Medicine Clinic focuses on and treats injuries and chronic pain syndromes through personalized care plans that improve ability through flexibility, mobility, and agility programs to relieve pain. Our providers use an integrated approach to create customized care plans for each patient and restore health and function to the body through nutrition and wellness, functional medicine, acupuncture, Electroacupuncture, and sports medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician best suited for them. Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Chiropractic, Fitness, and Nutrition
References
Yu, D., Shu, X. O., Li, H., Xiang, Y. B., Yang, G., Gao, Y. T., Zheng, W., & Zhang, X. (2013). Dietary carbohydrates, refined grains, glycemic load, and risk of coronary heart disease in Chinese adults. American journal of epidemiology, 178(10), 1542–1549. doi.org/10.1093/aje/kwt178
Bhardwaj, B., O’Keefe, E. L., & O’Keefe, J. H. (2016). Death by Carbs: Added Sugars and Refined Carbohydrates Cause Diabetes and Cardiovascular Disease in Asian Indians. Missouri medicine, 113(5), 395–400.
Can incorporating selenium-rich foods into one’s diet improve overall health?
Selenium
Selenium is a chemical element and a micronutrient with antioxidant properties that protect cells from damage and increase immune function (University of Florida Health, 2023). It has also been linked to heart health and longevity. Most individuals in the U.S. can acquire a healthy amount of selenium through a balanced diet. Research has shown that selenium supports healthy aging and reduces the risk of heart disease. (Alehagen U. et al., 2021) (Zhang Y. et al., 2024) A recent study found a region in China where residents have sustained longevity with soil that is rich with selenium. (Li B. et al., 2024) The body does not produce the chemical, so it must be obtained through food or supplements. (National Institutes of Health Office of Dietary Supplements, 2024) However, excessive amounts can build up in the body and be toxic, causing gastrointestinal problems, hair loss, kidney failure, neurological issues, and death. (National Institutes of Health Office of Dietary Supplements, 2024)
Only A Small Amount Is Needed
The body only needs small amounts of selenium to support bodily functions, including thyroid hormone metabolism and antioxidant defense. Most adults need 55 micrograms daily, and pregnant and lactating adults require an additional 5–15 micrograms daily (National Institutes of Health Office of Dietary Supplements, 2024). Individuals can get selenium from many food sources, including Brazilian nuts, meat, seafood, vegetables, and grains. A large hard-boiled egg comprises 15 micrograms, a cup of cooked spaghetti provides 33 micrograms, and 3 ounces of cooked shrimp offer 42 micrograms of selenium. (National Institutes of Health Office of Dietary Supplements, 2024)
Individuals who eat healthy and eat various foods will meet their selenium needs. However, in some parts of the world, poor selenium soil may not provide enough of this mineral for individuals through their diet. (National Institutes of Health Office of Dietary Supplements, 2024) Low selenium intake is linked to a heart condition called Keshan disease, which may weaken the heart’s ability to pump blood. (National Library of Medicine, 2023) However, individuals are recommended not to take more than 400 micrograms daily.
Longevity
Various researchers are trying to understand the link between selenium and aging. A study associated dietary intake with increased telomere length (protein structures at the ends of chromosomes that protect DNA and help control cell division), a biological marker that may indicate aging and other health conditions. (Liang C. et al., 2024) Shorter telomeres generally indicate aging and disease progression. Another study suggests moderate amounts of dietary selenium may protect against cardiovascular disease and death. However, the observational study included data from over 25,000 adults but did not prove a cause-and-effect relationship between selenium and improved longevity. (Zhang Y. et al., 2024) Further research is needed before experts recommend selenium as an anti-aging dietary component.
Injury Medical Chiropractic and Functional Medicine Clinic
Selenium helps with cell growth and thyroid function and is known to increase immune system function. However, avoiding excessive intake is important, as high levels can be harmful. Injury Medical Chiropractic and Functional Medicine Clinic providers use an integrated approach to create customized care plans for each patient and restore health and function to the body through nutrition and wellness, chiropractic adjustments, functional medicine, acupuncture, Electroacupuncture, and various medicine protocols. If the individual needs other treatment, they will be referred to a clinic or physician, as Dr. Jimenez has teamed with top surgeons, clinical specialists, medical researchers, nutritionists, and health coaches to provide the most effective clinical treatments.
Alehagen, U., Opstad, T. B., Alexander, J., Larsson, A., & Aaseth, J. (2021). Impact of Selenium on Biomarkers and Clinical Aspects Related to Ageing. A Review. Biomolecules, 11(10), 1478. doi.org/10.3390/biom11101478
Zhang, Y., Meng, S., Yu, Y., Bi, L., Tian, J., & Zhang, L. (2024). Associations of dietary selenium intake with the risk of chronic diseases and mortality in US adults. Frontiers in nutrition, 11, 1363299. doi.org/10.3389/fnut.2024.1363299
Li, B., Liu, X., Yu, T., Lin, K., Ma, X., Li, C., Yang, Z., Tang, Q., Zheng, G., Qin, J., & Wang, Y. (2024). Environmental selenium and human longevity: An ecogeochemical perspective. Chemosphere, 347, 140691. doi.org/10.1016/j.chemosphere.2023.140691
Liang, C., Zhao, R., Du, J., Zhao, G., & Zhang, Y. (2024). The association between dietary selenium intake and telomere length in hypertension. Journal of clinical hypertension (Greenwich, Conn.), 26(8), 990–996. doi.org/10.1111/jch.14861
Can Tabata training help burn more calories during and after workouts for individuals who do interval training?
Tabata Training
Also known as the Tabata Protocol, Tabata training can bring variety to workouts, burn more calories, and get more out of exercise time. This workout is a form of high-intensity interval training, or HIIT, designed to increase heart rate in the hard anaerobic zone for short periods. The intervals are short, the workouts are fast, and the body benefits. The recommendation is to add Tabata training once a week to see how the body responds.
Protocol Format
This HIIT workout is so effective because of the work-to-rest ratio. Individuals only get 10 seconds of rest between each 20-second session of exercise. That short interval is insufficient to recover fully, but it is great for building endurance and getting in shape. The format consists of:
Twenty seconds of a very high-intensity exercise – sprints, burpees, squat jumps, etc.
Tabata training can improve two of the body’s main energy systems. It targets the anaerobic energy system responsible for short, high-intensity exercises like sprints and the aerobic energy system for endurance exercises like long, slow running. In traditional interval training, moderate intensity and steady-state cardio target the aerobic system. Still, unless the individuals work way out of their comfort zone, they don’t necessarily improve the anaerobic system. (Astorino, T. A. et al., 2012) However, high-intensity interval training with a rest period shorter than the work period can target both systems, providing benefits for athletes and fitness enthusiasts. (Tabata, I. et al., 1996)
Safety Precautions
However, these workouts are not for everyone. Tabata training is advanced and best suited to athletes and experienced fitness enthusiasts. Beginners should start with lighter interval training and gradually work their way up to this level of intensity. Try 20 seconds on/10 seconds off with easier exercises like walking or low-impact moves like marching in place, step touches, or knee lifts.
Workout Tips
Individuals can do Tabata training with almost any activity or cardiovascular machine. This Tabata cardio workout includes a variety of bodyweight exercises that, if done at full intensity, will increase heart rate.
Warm-Up
Before trying this type of workout, ensure the body is thoroughly warmed up for at least 10 minutes.
Start Slow
Individuals new to this type of training start with 5 to 6 cycles of each exercise and increase rest to 20 or 30 seconds.
As the body gets used to the workout and builds stamina, gradually shorten the rest periods and increase the number of cycles.
Rest Between Sets
Individuals who do more than one Tabata set as many workouts call for rest for at least 60 seconds between sets.
Monitor Intensity Frequently
Intensity accumulates through each cycle, peaking at the end of the workout when muscles are tired, and form becomes sloppy, increasing the risk of injury.
Take Rest Days
The recommendation is that the workout be done no more than 1 to 2 times a week, with rest in between, to avoid overtraining and injury.
Listen to your body when doing any high-intensity exercise. High-intensity interval training is very taxing on the body, so it’s easy to overdo it if you’re not careful. If you feel too breathless, extend recovery times or take extra breaks. If you are in pain or discomfort, take a break, try different exercises, or stop for the day.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic treats patients’ injuries and chronic pain syndromes. We focus on improving ability through flexibility, mobility, and agility programs tailored to the individual. We use in-person and virtual health coaching and comprehensive care plans to ensure every patient’s personalized care and wellness outcomes. Our providers use an integrated approach to create customized care plans that include Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. Our goal is to relieve pain naturally by restoring health and function to the body. If he feels the individual needs other treatment, they will be referred to a clinic or physician best suited for them as Dr. Jimenez has teamed up with the top surgeons, clinical specialists, medical researchers, and premier rehabilitation providers to provide our community with the best clinical treatments.
Improving Athletic Performance Through Chiropractic
References
Emberts, T., Porcari, J., Dobers-Tein, S., Steffen, J., & Foster, C. (2013). Exercise intensity and energy expenditure of a tabata workout. Journal of sports science & medicine, 12(3), 612–613.
Tabata, I., Nishimura, K., Kouzaki, M., Hirai, Y., Ogita, F., Miyachi, M., & Yamamoto, K. (1996). Effects of moderate-intensity endurance and high-intensity intermittent training on anaerobic capacity and VO2max. Medicine and science in sports and exercise, 28(10), 1327–1330. doi.org/10.1097/00005768-199610000-00018
Astorino, T. A., Allen, R. P., Roberson, D. W., & Jurancich, M. (2012). Effect of high-intensity interval training on cardiovascular function, VO2max, and muscular force. Journal of strength and conditioning research, 26(1), 138–145. doi.org/10.1519/JSC.0b013e318218dd77
“Can understanding moderate exercise and how to measure the amount of exercise help expedite individuals’ health goals and well-being?”
Moderate Exercise
Various physical activity guidelines recommend regular, moderate exercise for achieving and maintaining health and wellness. Getting the minimum, moderate weekly physical activity can help prevent disease, increase mental well-being, support weight loss and maintenance, and improve quality of life.
Moderate-intensity cardiovascular exercise includes – brisk walking, yard work, mopping, vacuuming, and playing various sports that require consistent movement.
When engaged in moderate exercise, individuals should breathe harder but still be able to carry a conversation. (American Heart Association, 2024)
The talk test is a way to monitor whether the exercise is at moderate intensity.
A heart rate chart or calculator can determine an individual’s maximum heart rate.
To measure heart rate mid-exercise, individuals can take their pulse or use a heart rate monitor, app, fitness tracker, or smartwatch to ensure they stay at a moderate intensity.
MET
M.E.T. stands for Metabolic Equivalent for Task and refers to the amount of oxygen the body uses during physical activity.
Assigning METs to an activity allows individuals to compare the amount of exertion an activity takes.
This works for individuals with different weights.
During moderate physical activity, breathing and heart rate increase, and the body burns around 3.5 to 7 calories a minute.
The actual number burned depends on your weight and fitness level.
The body uses 1 MET for basic functions like breathing.
Grades of activity:
1 MET – Body at rest
2 METs – Light activity
3-6 METs – Moderate activity
7 or more METs – Vigorous activity
Perceived Exertion Scale
Individuals can also check their activity level using the Borg Rating of Perceived Exertion scale/RPE. (Centers for Disease Control and Prevention, 2022) Using this scale involves monitoring how an individual feels about how hard their body is working during physical activity. The scale starts at 6 and ends at 20. A perceived exertion between 11 and 14 is considered moderate physical activity.
6 – No exertion – sitting still or sleeping
7-8 – Extremely light exertion
9-10 – Very light exertion
11-12 – Light exertion
13-14 – Somewhat hard exertion
15-16 – Heavy exertion
17-18 – Very heavy exertion
20 – Maximum exertion
Examples
Many activities are counted as moderate-intensity exercise. Choose some appealing and learn to add them to a weekly routine.
Ballroom dancing
Line dancing
Gardening
House chores that get the heart pumping.
Softball
Baseball
Volleyball
Doubles tennis
Brisk walking
Light jogging
Walking or jogging on a treadmill
Using an elliptical trainer
Bicycling under 10 miles an hour on ground level
Leisurely swim
Water aerobics
Mobility Challenges
Individuals with mobility issues can achieve moderate intensity using a manual wheelchair or a handcycle and swimming or water aerobics.
Individuals who can use their legs but can’t tolerate walking or jogging can try bicycling or swimming.
Getting More Exercise
There are different ways to incorporate and increase moderate physical activities. These include:
10-minute Activity Bursts
Walk briskly for at least 10 minutes at a time.
Walk at an easy pace for a couple of minutes.
Pick up the pace for 10 minutes.
Try to walk during work breaks or lunch and/or before or after work.
Walking Workouts
Individuals can walk indoors, outdoors, or on a treadmill.
Proper posture and walking techniques make it easier to achieve a brisk pace.
Once comfortable walking briskly for 10 minutes, begin to extend walking time.
Try different walking workouts that offer fast walks, jogging intervals, and/or adding hills or treadmill inclines.
New Activities
Individuals are recommended to experiment with various exercises to find what works for them.
Consider roller skating, blading, or skateboarding to increase heart rate.
Moderate physical activity will get and keep the body in shape. Individuals should not become distressed if they can only do a little at first. Allow time to build endurance and gradually make time each day for enjoyable physical activities.
For individuals looking to improve heart health, can consuming prunes help support cardiovascular health?
Prunes and Heart Health
Prunes, or dried plums, are fiber-rich fruits that are more nutrient-dense than fresh plums and help digestion and bowel movement. (Ellen Lever et al., 2019) New research suggests they could offer more than digestion and constipation relief, according to new studies presented at the American Society for Nutrition. Eating prunes daily can improve cholesterol levels and reduce oxidative stress and inflammation.
Eating five to 10 prunes a day may support heart health.
Heart health benefits of regular consumption were seen in men.
In older women, regularly eating prunes had no negative effect on total cholesterol, blood sugar, and insulin levels.
Another study found that eating 50–100 grams or five to ten prunes daily was associated with reduced heart disease risks. (Mee Young Hong et al., 2021)
The reductions in cholesterol and inflammation markers were because of improvements in antioxidant levels.
The conclusion was that prunes can support cardiovascular health.
Prunes and Fresh Plums
Although studies have suggested that prunes can support heart health, that doesn’t mean fresh plums or prune juice can offer the same benefits. However, there are not many studies on the benefits of fresh plums or prune juice, but it is possible that they would. However, further research is needed. Fresh plums that have been dried in hot air improve the nutritional value and shelf life of the fruit, which could be the reason the dried version retains more nutrients. (Harjeet Singh Brar et al., 2020)
Individuals may have to eat more plums to acquire the same benefits.
Eating 5–10 prunes seems to be easier than trying to equal the same amount, or more, of fresh plums.
But either option is recommended instead of prune juice as whole fruits have more fiber, make the body feel fuller, and are lower in calories.
Benefits For Young Individuals
Most of the research has been conducted on postmenopausal women and men over 55, but younger individuals can also benefit from eating prunes. A diet that is rich in fruits and vegetables is considered healthy, so adding prunes to one’s diet will add to health benefits. For individuals who don’t like prunes, fruits like apples and berries are also recommended for heart health. However, fruits only make up one part of the diet, and it is important to focus on a balanced diet with vegetables, legumes, and heart-healthy oils. Prunes contain a lot of fiber, so individuals are recommended to add them slowly into their daily routine, as adding too much at once can lead to cramping, bloating, and/or constipation.
Conquering Congestive Heart Failure
References
Lever, E., Scott, S. M., Louis, P., Emery, P. W., & Whelan, K. (2019). The effect of prunes on stool output, gut transit time and gastrointestinal microbiota: A randomised controlled trial. Clinical nutrition (Edinburgh, Scotland), 38(1), 165–173. doi.org/10.1016/j.clnu.2018.01.003
Hong, M. Y., Kern, M., Nakamichi-Lee, M., Abbaspour, N., Ahouraei Far, A., & Hooshmand, S. (2021). Dried Plum Consumption Improves Total Cholesterol and Antioxidant Capacity and Reduces Inflammation in Healthy Postmenopausal Women. Journal of medicinal food, 24(11), 1161–1168. doi.org/10.1089/jmf.2020.0142
Harjeet Singh Brar, Prabhjot Kaur, Jayasankar Subramanian, Gopu R. Nair & Ashutosh Singh (2020) Effect of Chemical Pretreatment on Drying Kinetics and Physio-chemical Characteristics of Yellow European Plums, International Journal of Fruit Science, 20:sup2, S252-S279, DOI: 10.1080/15538362.2020.1717403
Postural orthostatic tachycardia syndrome is a medical condition that causes lightheadedness and palpitations after standing. Can lifestyle adjustments and multidisciplinary strategies help reduce and manage symptoms?
Postural Orthostatic Tachycardia Syndrome – POTS
Postural orthostatic tachycardia syndrome, or POTS, is a condition that varies in severity from relatively mild to incapacitating. With POTS:
The heart rate increases dramatically with body position.
This condition often affects young individuals.
Most individuals with postural orthostatic tachycardia syndrome are women between the ages of 13 and 50.
Some individuals have a family history of POTS; some individuals report POTS began after an illness or stressor, and others report it began gradually.
It usually resolves over time.
Treatment can be beneficial.
Diagnosis is based on assessing blood pressure and pulse/heart rate.
Symptoms
Postural orthostatic tachycardia syndrome can affect young individuals who are otherwise healthy and can begin suddenly. It usually happens between the ages of 15 and 50, and women are more likely to develop it than men. Individuals can experience various symptoms within a few minutes of standing up from a lying or seated position. The symptoms can occur regularly and daily. The most common symptoms include: (National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center. 2023)
Anxiety
Lightheadedness
A feeling like you’re about to pass out.
Palpitations – sensing rapid or irregular heart rate.
Dizziness
Headaches
Blurred vision
Legs turn to reddish-purple.
Weakness
Tremors
Fatigue
Sleep problems
Trouble concentrating/brain fog.
Individuals may also experience recurrent episodes of fainting, usually without any trigger/s other than standing up.
Individuals can experience any combination of these symptoms.
Sometimes, individuals cannot handle sports or exercise and may feel light-headed and dizzy in response to mild or moderate physical activity, which can be described as exercise intolerance.
Associated Effects
Postural orthostatic tachycardia syndrome can be associated with other dysautonomia or nervous system syndromes, like neurocardiogenic syncope.
Individuals are often co-diagnosed with other conditions like:
Chronic fatigue syndrome
Ehlers-Danlos syndrome
Fibromyalgia
Migraines
Other autoimmune conditions.
Bowel conditions.
Causes
Usually, standing up causes blood to rush from the torso to the legs. The sudden change means less blood is available for the heart to pump. To compensate, the autonomic nervous system sends signals to the blood vessels to constrict to push more blood to the heart and maintain blood pressure and a normal heart rate. Most individuals do not experience significant changes in blood pressure or pulse when standing up. Sometimes, the body is unable to perform this function correctly.
If blood pressure drops from standing and causes symptoms like lightheadness, it is known as orthostatic hypotension.
If the blood pressure remains normal, but the heart rate gets faster, it is POTS.
The exact factors that cause postural orthostatic tachycardia syndrome are different in individuals but are related to changes in:
The autonomic nervous system, adrenal hormone levels, total blood volume, and poor exercise tolerance. (Robert S. Sheldon et al., 2015)
Autonomic Nervous System
The autonomic nervous system controls blood pressure and heart rate, which are the areas of the nervous system that manage internal bodily functions like digestion, respiration, and heart rate. It is normal for blood pressure to drop slightly and the heart rate to speed up a little when standing. With POTS, these changes are more pronounced.
POTS is considered a type of dysautonomia, which is diminished regulation of the autonomic nervous system.
Several other syndromes are also thought to be related to dysautonomia, like fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome.
It isn’t clear why the syndrome or any of the other types of dysautonomia develop, but there seems to be a familial predisposition.
Sometimes the first episode of POTS manifests after a health event like:
Pregnancy
Acute infectious illness, for example, a severe case of influenza.
An episode of trauma or concussion.
Major surgery
Diagnosis
A diagnostic evaluation will include a medical history, a physical examination, and diagnostic tests.
The healthcare provider will take blood pressure and pulse at least twice. Once while lying down and once while standing.
Blood pressure measurements and pulse rate lying down, sitting, and standing are orthostatic vitals.
Typically, standing up increases the heart rate by 10 beats per minute or less.
With POTS, heart rate increases by 30 beats per minute while blood pressure remains unchanged. (Dysautonomia International. 2019)
The heart rate stays elevated for over a few seconds upon standing/usually 10 minutes or more.
Symptoms happen frequently.
Lasts more than a few days.
Positional pulse changes are not the only diagnostic consideration for postural orthostatic tachycardia syndrome, as individuals can experience this change with other conditions.
During this test, blood pressure and pulse are measured several times when lying on a table and when the table is moved to an upright position.
Differential Diagnosis
There are various causes of dysautonomia, syncope, and orthostatic hypotension.
Throughout the evaluation, the healthcare provider may look at other conditions, like dehydration, deconditioning from prolonged bed rest, and diabetic neuropathy.
Medications like diuretics or blood pressure medication can cause similar effects.
Treatment
Several approaches are used in managing POTS, and individuals may require a multidisciplinary approach. The healthcare provider will advise regularly checking blood pressure and pulse at home to discuss the results when going in for medical checkups.
Fluids and Diet
Drinking non-caffeinated fluids can keep the body hydrated.
A healthcare provider can calculate the right amount of fluids that are needed each day.
Overnight dehydration is common, so it is especially important to drink fluids first thing in the morning, preferably before getting out of bed and standing.
Exercise and physical therapy can help the body learn to adjust to an upright position.
Because it can be challenging to exercise when dealing with POTS, a targeted exercise program under supervision may be required.
An exercise program may begin with swimming or using rowing machines, which do not require upright posture. (Dysautonomia International. 2019)
After a month or two, walking, running, or cycling may be added.
Studies have shown that individuals with POTS, on average, have smaller cardiac chambers than individuals who don’t have the condition.
Regular aerobic exercise has been shown to increase cardiac chamber size, slow heart rate, and improve symptoms. (Qi Fu, Benjamin D. Levine. 2018)
Individuals must continue an exercise program for the long term to keep symptoms from returning.
Medication
Prescription medications to manage POTS include midodrine, beta-blockers, pyridostigmine – Mestinon, and fludrocortisone. (Dysautonomia International. 2019)
Ivabradine, used for the heart condition of sinus tachycardia, has also been used effectively in some individuals.
Conservative Interventions
Other ways to help prevent symptoms include:
Sleeping in the head-up position by elevating the head of the bed off the ground 4 to 6 inches utilizing an adjustable bed, blocks of wood, or risers.
This increases the blood volume in circulation.
Performing countermeasure maneuvers like squatting, squeezing a ball, or crossing the legs. (Qi Fu, Benjamin D. Levine. 2018)
Wearing compression stockings to prevent too much blood from flowing into the legs when standing can help avoid orthostatic hypotension. (Dysautonomia International. 2019)
Conquering Congestive Heart Failure
References
National Institutes of Health. National Center for Advancing Translational Sciences. Genetic and Rare Diseases Information Center (GARD). (2023). Postural orthostatic tachycardia syndrome.
Sheldon, R. S., Grubb, B. P., 2nd, Olshansky, B., Shen, W. K., Calkins, H., Brignole, M., Raj, S. R., Krahn, A. D., Morillo, C. A., Stewart, J. M., Sutton, R., Sandroni, P., Friday, K. J., Hachul, D. T., Cohen, M. I., Lau, D. H., Mayuga, K. A., Moak, J. P., Sandhu, R. K., & Kanjwal, K. (2015). 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart rhythm, 12(6), e41–e63. doi.org/10.1016/j.hrthm.2015.03.029
Dr. Jimenez, D.C., presents what you need to know about venous insufficiency. Many factors and lifestyle habits cause an effect on our bodies, which can lead to chronic disorders that can impact our musculoskeletal system and potentially lead to pain-like symptoms associated with chronic conditions. In this presentation, we will look at what venous insufficiency is, the symptoms, and how to prevent venous insufficiency from affecting the lower extremities. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with Lyme disease. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer
What Is The Venous System?
Dr. Alex Jimenez, D.C., presents: So we will go over tackling common cardiovascular problems and venous insufficiency. So let’s discuss this common complication in our practices: venous insufficiency and the functional medicine approach. So if you look at venous or blood flow, you look at the heart. The heart will pump blood to the arteries and the arterials, the arteries and arterials will pump to capillary beds, and venules will go to veins. Veins will then move the blood to the subclavian vein, and the lymph ducts will also drain in the subclavian vein.
The subclavian vein will then go into the heart, and in the process, it continues and circulates. The big difference between veins and arteries is that arteries have muscles within them, and the muscles will contract, regulate blood pressure, and help keep the blood flowing. But veins do not have that luxury. Veins will depend on our skeletal muscles around them; if we contract them a lot, we’re helping with circulation. So, being active, moving around, and flexing our muscles will keep the pressure in the superficial system to about 20 to 30. And then, when it starts going to the deeper system with the valves, what happens is that the valves will stop blood from flowing back. So the blood can only go in one direction.
And that is basically to have a healthy venous system. You want to be often exercising, and you want to have that higher venous pressure and flow. So what is the pathophysiology of chronic venous insufficiency? You have incompetent valves, or you can have incompetent valves, you can have thrombosis, and you can have obstruction. And that can lead to elevated venous pressure. High venous pressure can lead to vein dilation, skin changes, and ulceration, but also elevated venous pressure can worsen incompetent valves, thrombosis, and obstruction. And then you get this vicious cycle, and usually, it’s the lower extremities; they get worse and worse. So if you want to look at the contributing factors, look at the functional medicine matrix. Venous insufficiency pathogenesis hits many places on the functional medicine matrix, multiple places we can look at in the lower body extremities.
Venous Insufficiency & Its Signs
Dr. Alex Jimenez, D.C., presents: So what are the clinical manifestations of venous insufficiency? The symptoms are limb itching, heaviness, fatigue, particularly in the legs, pain in the legs, swelling, and tightness. The skin can get dry and become irritated. You might not be dealing with autoimmunity if you have this dry, irritated skin. You might be dealing with venous insufficiency. They can get muscle cramps. So your muscle cramps might not be a magnesium deficiency. Your muscle cramps might be venous insufficiency pain worse when standing or seated with their legs dangling. So when you’re sitting, the legs are dangling, and the pain improves when you elevate your legs and walk. And that actually can differentiate from arterial insufficiency. Remember, you get claudication in peripheral artery disease and arterial insufficiency. That’s when you walk and exert yourself. And because the blood vessels going to the muscles and the legs are tighter because of atherosclerosis, you get pain from walking.
Whereas venous insufficiency is the other side of the system, you walk and start feeling better. Why? Because those muscles are pumping the veins and moving blood through instead of the blood just being stagnant and sitting there. So edema you can get, which is swelling. Stasis dermatitis, which is dermatitis, red and swelling, and inflamed varicose veins, can be seen in this picture. Now the diagnosis is usually made by clinical signs and symptoms. So the clinical signs, what are the signs to look out for? For this part, go to your favorite search engine and look up every one of these symptoms that we mentioned so you know what it looks like. We are sure you’ve seen it before, but remind yourself what these things look like so that it can help you; it can help you when you’re diagnosing and looking at your patients.
Lymphodematosclerosis
Dr. Alex Jimenez, D.C., presents: Suppose a person has varicose veins. You can have lymphodematosclerosis, which is the champagne bottle sign. When you search that, look at that and see how the leg will look like an upside-down champagne bottle. Why? Because there’s a lot of fibrosis and hard tissue, and that tissue is holding that blood. You can’t get much edema, and you can’t get much swelling because it’s so tight, the blood can’t move in there. So look up the champagne bottle, not just the regular one, but look up a champagne bottle or lymphodematosclerosis, and you will remember that image when you see it. Then you will remember that image. You can get ulcerations because there’s decreased blood movement. So you get ulcers, and you can get hyperpigmentation. We see this often when you have a darkened skin color in the lower extremities from the constant fluid or blood leaking.
That’s hemosiderin deposits or iron deposits from popping blood cells. And you can get skin atrophy. So by typing these clinical signs on the internet that correlate with venous insufficiency, you have a good visual of what these things look like. So what is the functional medicine treatment plan? We’re going to look at the risk factors of chronic venous insufficiency, and we’re going to look at the adaptable ones, and based on that, we can give patients recommendations and plans. So obesity works on decreasing fat, sedentary life, being active, checking estrogen and hormone levels, and reducing estrogen and increasing progesterone. If you have to get out of that estrogen dominance, we want to look at those risk factors, see which ones are adjustable, and start working with them.
Ways To Reduce Venous Insufficiency
Dr. Alex Jimenez, D.C., presents: So you have this person with venous insufficiency. Check on their obesity levels, so you work on lowering their body fat and see if they have a sedentary lifestyle and getting them moving high. Check their hormone levels and see where their estrogen levels are regulated. If you check the IFM hormone module, check it out because it has some really good information on how to balance hormones in a functional medicine way. Make sure that they’re standing for a short period. At least occasionally, have them walk around, and you can have them set a timer. So every so often, every 20, 30 minutes, they walk around to keep their legs and blood flow moving. Work on decreasing smoking. And mentioning these risk factors to the patient can make them aware that this can worsen their venous insufficiency. Other conservative therapies include leg elevation. So have them lay down by putting their legs up to allow gravity to help push the blood down. Compression therapy. So have them wear compression stockings and stasis dermatitis; sometimes, you must use topical dermatologic steroids and some of those agents, which can be helpful there.
You may consider earthing. There was a research study that showed that if you put your feet on the ground outside barefoot, not in the insulated houses, then what can happen is, is the viscosity of your red blood cells will decrease. So the red blood cells will clump less, and you can have better movement and circulation. Pharmacological therapies and supplementations to target venous insufficiency. So what can we do while we’re looking at doing two things? We want the venous tone to be improved. So you want to tighten those veins up. On the arteries, you want to loosen them up. Usually, when an individual has hypertension, we want the veins to tighten those bad boys up so that circulation can happen. And then you want to improve the flow. You want the blood to be able to flow through the veins better.
Supplements For Venous Tone
Dr. Alex Jimenez, D.C., presents: So let’s take a look at the venous tone. This is one of the places where we’re ahead of the game in functional and integrative medicine because if you look at the conventional literature, even up-to-date research, many people are using up-to-date now to see how often they diagnose weak venous tone. So we can take a look at that. But if you look at what you can do for venous tone? It has two supplements. Regarding venous tone and increasing venous tone, two supplements can support the venous system: horse-chestnut seed extract (Escin) and diosmin.
So those are the two things that are mentioned. And we, in functional and integrative medicine, are more prepared to deal with this because we know about pharmacy grade; we learn about giving them a good product that is third-party tested and doesn’t have those toxic fillers and whatnot. The second way of treating venous insufficiency from a medical point of view is by improving venous flow. You want blood viscosity to be thinner. You don’t want the blood not to be as prone to clotting so the blood can flow easier. So here are some agents you can use. You can use aspirin; you can use pentoxifying; you can use nattokinase, which can help lower fibrinogen. Regarding venous insufficiency, it can cause the body to have high fibrinogen. So nattokinase can help lower elevated fibrinogen.
Conclusion
Dr. Alex Jimenez, D.C., presents: If they’re not on aspirin or any blood thinners and have high fibrinogen and venous insufficiency, it might also be a good one to put somebody on omega-3s. We are trying to get their omega-3 levels up, and they are useful when optimizing help with venous flow. You’re going to have people to come and see you, and you’re going to be treating them for other things. And because you’re functional medicine, you’re part of the cool club; what’s going to happen is they’re not even going to tell you about their venous insufficiency, and it’s going to get better just because of the treatments that you’re doing. And it will be epic. And if all else fails, you refer to associated medical specialists to help your patient. So, in conclusion, take care of your veins and look for the signs to prevent venous insufficiency from causing more issues in the lower extremities, and utilize vitamins and supplements to reduce the pain and inflammation in the muscles and joints.
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