Interest in improving our heart and circulation has never been greater than in our world today. Coronary heart disease leads all other causes of death. Circulatory conditions (including stroke) take even more lives, and force millions into premature retirement, disability, or nursing home care.

Thus the prevention and treatment of cardiovascular disease deserves our utmost attention. The fact is that about 750,000 die annually in the United States from heart disease and over 260,000 by stroke. These are prime reasons why the United States today is nowhere near the top of the list (actually 19th) for life expectancy in men compared to other world nations.

For women we are 10th from the top of lifespan leaders. Heading the list of degenerative diseases, these fearsome afflictions of the circulation clamor for attention. The human heart is without doubt the world’s most amazing pump. About the size of a fist in the average man and weighing less than one pound, it pumps every day the equivalent of 7,000 quarts of blood!

This precious fluid, weighing about seven tons, distributes itself through more than 60,000 miles of blood vessels in an average person. During our lifetime, the heart beats two and one half billion times, resting only between beats, and moves some 75,000,000 gallons of blood with all its life-sustaining oxygen and various nutrients!

In actuality, the four chambers of your heart constitute four pumps, with two pairs working in series, From the vascular circulation of your body — head, arms, legs, internal organs —blood is brought to the right atrium. Here is located the pacemaker, which begins an electrical impulse every second and initiates the beat of your entire heart, Blood is then pumped into the right ventricle and distributed to both lungs through the pulmonary arteries.

Here your blood receives oxygen and gives off carbon dioxide, the two principle gases exchanged in respiration. The fresh, oxygenated blood then returns to the heart, this time through pulmonary veins to the left atrium. Blood is thoroughly mixed in this chamber, since some of the blood cells received more oxygen than from other parts of the lungs, depending upon the posture and depth of respiration.

Blood then passes through the mitral valve, into the left ventricle, the strongest portion of the heart muscle. Your heartbeat then contracts and propels blood through the aortic semi-lunar valve into the aorta, whence it is distributed to the extremities, brain, and all internal organs.

Oxygen in the blood is delivered to cells, aiding the body in respiration, while the waste products carried by the same fluids and blood cells return through the veins to complete the cycle. A number of diseases can occur affecting this marvelously designed circulatory system. The heart can be affected by inherited or congenital disease.

The aftermath of infection with Streptococcal organism can produce a condition known as rheumatic fever with its feared complication, carditis. This may damage heart valves, producing lifelong disability. Infections, as well as malignancies (cancer), can involve the heart.

By far the most common affliction is arteriosclerosis, a degenerative disorder affecting the arteries. Since the heart muscle receives blood through its own special system of coronary arteries, it is certainly true for this organ, as for the whole body that “The life of the flesh is in the blood.”

How to Evaluate the Heart

Many signs can reveal the existence of impaired circulation. The color of the body is extremely important. Since skin color is partially due to blood circulating just beneath it, it is important to compare skin hues in areas where your skin is particularly thin. The conjunctiva of the lower eyelid, the lips, the fingernail beds, and the palms are often valuable indicators of the state of your oxygen supply.

A dusky color or bluish cast (cyanosis) indicates an inadequate supply of oxygen in the blood. Cyanosis may be seen in congenital heart afflictions, as is the case with “blue babies.” Sometimes cyanosis develops when the blood is too thick (hemoconcentration) and the flow is sluggish.

Frequently in advanced heart failure, cyanosis will be seen. Deep breathing, sitting upright, or administering oxygen may correct this problem. The pulse should be examined; remember my description in Chapter One. It is normally regular and equal from side to side in the respective wrist arteries.

Your blood pressure can also indicate the general state of the circulation, as well as the force of contraction in your heart itself. The veins along side your neck also are indicators of cardiac function. Normally little pulse waves are seen, but unusual distention usually means that the right side of the heart is unable to keep up with the demand. Examine the jugular veins particularly when a patient is sitting upright.

Finally, your heart itself is evaluated by first looking at the chest to see if there are unusual pulsations, then feeling with the hand to detect unusual vibrations or heaves, and finally listening with a stethoscope.

The presence of turbulence as the blood flows through the valves is reflected in sounds called murmurs. These can occur during either phase of the heart cycle. Considerable practice is needed to hear these specific sounds and understand their meaning.

Diagnostic tests are frequently performed to evaluate the efficiency of the heart. A chest x-ray can determine enlargement of one or more chambers. The electrocardiogram provides an excellent look at your electrical activity during each cardiac contraction.

During exercise your heart rate should increase. An evaluation of the pulse and blood pressure during mild exercise on a motorized treadmill or bicycle (called a stress test) can be extremely helpful in assessing the dynamic function of this marvelous organ.

More specialized tests are done in hospitals today, using x-rays, flow studies involving radioactive isotopes, Thallium scanning procedures, and the coronary angiogram which x-rays the heart in rapid sequence while a radiopaque dye is simultaneously injected into a coronary artery or blood vessel. This helps to visualize the heart chambers and vessels, and may indicate the need for surgery.

Arteriosclerosis

Hardening of the arteries, or arteriosclerosis, is the most common cause of serious heart disease today. This condition primarily affects your coronary arteries and large vessels. It is a disease intimately related to our fast-paced lifestyle, and principally involves the type of food eaten and other unhealthful habits formed.

Arteriosclerosis actually begins in early childhood. Thus our preventive efforts must be directed toward infants and children to truly prevent the relentless progression of this degenerative condition. Arteriosclerosis develops as our dietary fat intake increases.

The modern unhealthful, refined diet uses large amounts of grease, oil, sugar, soft drinks, and desserts producing a state in the blood known as hyperlipidemia. The sluggish circulation of this excess fat promotes deposits in the walls of the arteries.

Normal arteries have three layers, the middle one being muscular and the inner and outer layers being thin, delicate linings. Cholesterol enters the inner cells and deposits throughout the first two layers of the artery. This frequently occurs where there is a division or bend in the vessel.

The habit of smoking is especially harmful, as carbon monoxide in mainstream cigarette smoke tends to open these tiny lining (endothelial) cells and actually creates openings in the vessel wall, enabling cholesterol to penetrate more easily. As the years go by, this cholesterol plaque builds up, becoming thicker and eventually obstructing the vessel.

Roughness in the lining cell creates more turbulence, which adds to the danger of thrombosis, or sudden clot formation in the vessel, That is the event which is known as a heart attack, or myocardial infarction. It is not known why some individuals tend to form these deposits in the heart more readily, while others select out the brain, the aorta, or other vascular structures.

Nevertheless, arteriosclerosis is affecting nearly every American and was even significant in 70% of the American youth killed in action during the Korean War. For reasons of lifestyle, mostly lower animal fat intake, few Koreans or Japanese get coronary heart disease.

The picture changes rapidly, though, when they move to Hawaii or the continental USA. A number of risk factors are directly associated with the development of arteriosclerosis and the inherent risk of coronary heart disease. Obesity, afflicting over one third of all adults, is directly associated with heart risk.

Every five pounds of extra body fat requires four extra miles of blood vessels just to keep the cells nourished. Not only consult height and weight charts, but also measure skin folds to evaluate a person’s obese potential. If the fold of pinched abdominal skin is an inch or more thick, men are definitely obese; for women the skin fold measure allowed is 1½ inches.

Insurance statistics show the obese individual to be at high risk, not only for cardiac disease, but also for several types of cancer, diabetes, gallstones, and numerous other health problems. America’s overweight now number over 50 million people, still growing both in population and total accumulated pounds.

Excess calories in the diet are either burned up or stored, but all calories must be accounted for. Our appetite problem is right in the center of a major preventive health program today.

Smoking directly causes an increased risk for coronary heart disease. Nicotine, the addictive alkaloid in tobacco, abnormally speeds the heart rate and raises the blood pressure. Carbon monoxide, as mentioned above, “shoots holes” in the artery walls for cholesterol to enter.

An average tobacco smoker, according to the Framingham study has three times the risk for a heart attack and more than a 75% increased chance of dying from one! With increasing nonsmoking years, these risks fall gradually to normal for the exsmoker.

Hypertension or high blood pressure is a major risk factor in both heart attacks and strokes. The extra load imposed upon the heart as it pumps against increased resistance is a major factor in congestive heart failure, which may occur either gradually or in association with a sudden heart attack.

This problem will be considered below, as it frequently is preventable. The sedentary habits of Americans have also come under scrutiny. Inactivity is another major risk for the development of heart disease. Exercise is protective in many ways.

It not only improves the peripheral circulation elsewhere in the body, but also lowers the resting pulse rate, improves the volume of blood delivered with each heartbeat, and dilates the coronary arteries, both large and small. Many research studies comparing active with sedentary workers have demonstrated numerous protective benefits of moderate exercise in avoiding a fatal heart attack.

Walking is especially beneficial. Nearly everyone can do it, too. Other factors, such as the excessive intake of sugar, a positive family history for heart disease, longstanding presence of diabetes, advanced age, and male gender are related to a higher risk. Some of these can be modified in a healthful way.

Because dietary prevention is so important concerning the risk of coronary heart disease, we wish to spend more time on this vital yet controversial factor. Several simple principles must be understood and applied by anyone desiring to have a healthy heart. First of all, our dietary fat intake must be reduced.

The average American takes in daily over 40% of his or her calories as fat. Half this much fat (10 to 20%) would definitely be more optimal. This would of necessity involve the elimination of many unnecessary fats, such as butter, fried greasy foods, flesh meats, rich pastries, oily salad dressings, and the excessive use of cheese, all having increased in Western dietaries over the past two decades.

An intelligent return to natural foods, such as whole grain cereals, and the increased use of fruits and vegetables, will aid you greatly in reducing fat intake. One fringe benefit of this adjustment will be the increased intake of fiber. Bran, found abundantly in whole grains and legumes, is an excellent source of dietary fiber.

Increasing your fiber intake has been shown to help with elimination of cholesterol from arteries via your liver and the intestinal tract. Plant sterols present in whole grains and some vegetables will inhibit in a competitive fashion the absorption of cholesterol from the intestines.

All these changes will make your food more interesting and grant much improved health for heart, brain, and longevity. Most shoppers are aware that cholesterol is always of animal origin. With increased meat being used, the intake of fruits and vegetables as dietary staples have fallen off conspicuously for the average household.

The richest source of food cholesterol is the yoke of an egg, over 230 mg. in one of medium size. The butterfat portion of milk and all derived milk products— such as cheese, butter, ice cream and cottage cheese—contain cholesterol. Meats, especially those rich in fat, are exceptionally abundant in cholesterol.

Even poultry and fish are not excepted. The more cholesterol you take into your body, the higher the level blood cholesterol is likely to be. This accelerates the development of arteriosclerosis. I advise that as much as possible all dietary sources of cholesterol be eliminated.

Then comes the good news; for most people coronary heart disease can begin to regress. Actually, contemporary and very encouraging data is available to show that the cholesterol problem is in fact reversible. First you should begin with a change in diet and curtailment in the type of fat eaten.

By lowering the total fat intake and eliminating cholesterol, your special protein-fat carriers, called lipoproteins, are mustered to mobilize cholesterol for transportation to the liver and eventual excretion in the bile. Modern measurements of blood HDL (high-density lipoprotein) cholesterol have enabled even more accurate prediction of the state of this efficient cleansing mechanism.

Second, the avoidance of excess calories and refined sugars also helps combat the problem of fat deposition in the vascular structures. Combining a natural diet with adequate exercise will increase the preventive dividends. With your general decrease in the use of fat, it is time next to take a look at oil.

Biochemists agree that some fat is needed in the diet. For most people this can be obtained entirely from non-animal sources, such as nuts, olives, or avocados. In areas where these are scarce, in colder climates, or for extremely active occupations where more calories are needed, some vegetable fats could be taken in their refined form.

Usually these are combined in the cooking process, as in making bread. Certain fats, however, are clearly better from the standpoint of cholesterol control. Measuring the ratio of polyunsaturated to saturated fat (P: S Ratio) will help to establish the relative risk or benefits of certain seed oils.

Corn, safflower, and soy oils are the best from the standpoint of polyunsaturated fats. The monounsaturated fats found in olives and olive oil convey a protective benefit on the heart and arteries. Peanut and cottonseed oil are of lesser value. It is crucial to avoid entirely the consumption of shortening, lard, and butter, for these hardened fats will always tend to increase the cholesterol content of the blood.

Recipe books are available, which enable the average cook to lower greatly total fat consumption as well as choose the most healthful sources. Signs and symptoms of heart disease challenge medical experts as well as laymen to find an accurate diagnosis. Chest pain is usually one of two principal qualities in heart disease.

One type, called angina pectoris, is a transient pain, usually described as a pressure, aching, or squeezing in the area behind the left breast and associated with exercise. It may come on gradually as in walking up a hill or while mowing the lawn, or the pain may be triggered by stress, as in watching violent sports on television or by getting into an argument.

Sometimes angina may arise after a heavy meal, because of the increased workload that digestion imposes on the heart. When exercise is a triggering factor, rest will within minutes relieve the pain. Sometimes an improvement of circulation results in the hands or feet by immersion in warm water to accelerate this relief process.

In fact, it is important to keep the extremities warm when exercising on a cold day, to avoid chilling and thus reduce congestion around the heart. The heart attack, or acute myocardial infarction, presents suddenly with chest pain of a much different character.

Although in the elderly this serious event may occur silently, for most younger individuals a sudden heart attack produces definite symptoms. Occasionally, however, it may resemble heartburn, a digestive problem, or may be thought to be related to indigestion. Classically the pain of a heart attack is located beneath the breastbone or left portion of the chest.

Patients describe their chest pain as vise-like, squeezing, a tense, aching pain that at times radiates into the left shoulder or arm, or up into the neck or jaw. This pain persists, sometimes for hours, and may be associated with collapse or a catastrophic sudden death. About two out of seven individuals having an acute heart attack will die before reaching the emergency room.

Your physician’s advice can be reassuring, and is particularly beneficial in establishing a prompt and accurate diagnosis. Electrocardiograms and blood tests for heart enzymes can aid in establishing the diagnosis. Temporary monitoring of the heart rhythm may be essential to observe for threatening signs of rhythm abnormality (arrhythmia).

With our modern technologic emphasis on cardiopulmonary resuscitation and emergency care, many lives have been spared. Nevertheless, it remains questionable whether our state-of-the-art coronary care units considered so essential in the United States do significantly reduce mortality from these attacks.

In Great Britain, many heart attacks are treated at home, and with careful observation, rest and home nursing care, survival is about the same. Usually the sufferer of a heart attack is well advised to stay in bed.

With frequent movement of arms and legs to prevent blood clots (thrombosis) and deep breathing exercises to keep the lungs ventilated (preventing atelectasis— collapsed air sacs in the lungs), bed rest provides the safest treatment for each acute episode.

Oxygen is usually administered and vital signs carefully monitored to detect any rhythm disturbances or signs of heart failure. Serve the patient a liquids only diet for a day or two, then a gradual progression to healthful solid foods at regular intervals (5 or 6 hours between each meal).

Recommended exercise consists of steady, progressive activity in the room, then inside the home, and finally carefully supervised cardiac reconditioning through prescribed outdoor exercises such as walking. These methods will enable most of afflicted heart patients to return to their desired level of function, eventually enjoying as good if not better health than before the heart attack.

We have seen this happen in reconditioning centers around the country, including at Poland Spring. Cardiac preventive exercises today are taking many forms. Although some doctors recommend no specific program, most physicians believe in exercise, Many are enthusiastic about fitness, some even joggers.

Because of the orthopedic disadvantages, the risks, and the lack of objective data that running really saves lives. I believe that our main emphasis should be on walking. After a brief warm-up period, the fitness walker can begin at his most comfortable leisurely pace, then gradually increase the time, distance, and speed of this activity.

Dr. Kenneth Cooper’ s “Aerobics” program, Dr. Dean Ornish’s books, and many other popular books on heart disease prevention contain guidelines for the prudent approach to heart reconditioning.

Years of experience at both the Wildwood Lifestyle Center & Hospital and the Poland Spring Health Institute have convinced me that walking is your best overall protective exercise for the heart, the nerves, healthy blood vessels, optimum weight control, and normalizing the blood pressure for optimum prevention of arteriosclerosis.

Any physical activity must be pursued regularly with enthusiasm and consistency in order to be effective, however. Noncompetitive sports, swimming, bicycle riding, and cross-country skiing, wood chopping, and gardening make excellent seasonal variations to the daily walk.

Congestive Heart Failure

When one side of the heart pumps less than the other side, congestion results. Usually the left portion of the heart first becomes weak, forcing the blood to back up into the lungs, with resulting congestion. Shortness of breath associated with cough, the coughing of blood (hemoptysis), or inability to lie flat in bed will result from this type of passive congestion.

When the right heart chambers are unable to keep up with the pumping load, congestion develops in the general circulation. Distention of the neck veins ensues, with swelling of the liver and retention of fluid in the abdomen (ascites), the legs, and the ankles.

Sometimes an unusually ruddy complexion will result, with cyanosis in more serious cases. Symptoms of shortness of breath on exertion will be followed by nocturnal episodes of air hunger. The patient may be unable to sleep lying down, and require a recliner lounge chair, or he may sleep in bed propped on several pillows.

His weight increases rapidly, due to fluid retention. If treatment is not received promptly, acute pulmonary edema may develop, requiring emergency hospitalization. Common causes of congestive heart failure include hypertension, with its frequent problem of excessive salt intake, and arteriosclerosis.

Less common causes are thiamine (B1) deficiency, hyperthyroid conditions, heart muscle inflammation (myocarditis, usually viral), or tumors involving the heart. Bed rest in the acute stage requires a limitation of exercise, associated with strict control of dietary salt intake and, for serious complications, even fluid restriction.

These remedies will bring relief for most cases of heart failure. A careful investigation into the causes will generally provide a basis for more specific therapy. Warmth to the extremities, a calm peaceful mind, and the avoidance of drugs that adversely affect the cardiac rhythm will likewise prove beneficial.

Kidney function can be enhanced with hot packs across the low back. Ice packs over the heart can slow its rate in most cases, except the rhythm disorder called atrial fibrillation. Unusual irregular pulses and very rapid heart rates should be evaluated by a physician. Of great importance in congestive heart failure, as in treatment of hypertension, is a strict limitation of sodium intake.

I have seen in my institution many heart patients recover from congestive failure on a salt restricted diet. Sometimes they improve only to indulge in salt again through ignorance or habit when returning home. Then, promptly, their fluid retention and heart failure return. Appetite control, knowledge of nutrition, and carefulness in exercise are fundamental to properly maintain a healthful circulation.

High Blood Pressure

Medical authorities estimate that from 15-25% of Americans suffer from high blood pressure or hypertension. Our most conservative figure in this country is already over 25 million persons with hypertension. No single cause for this is proven. It appears that there are numerous types of hypertension, some related to chronic diseases and other patients with causes potentially reversible.

Salt ingestion is well known to be a risk factor in causing high blood pressure. More then four thousand years ago a Chinese by the name of Ch’i Po noted the “If too much salt is used in the food, the pulse hardens.” The average American consumes from 6-13 grams of salt daily.

Some in Western countries and many in the Orient use as much as 18-24 grams of salt a day! The incidence of high blood pressure in a population is increased in proportion to the sodium intake of the diet. The Japanese illustrate this, with increasing strokes as their major cause of death.

Sodium chloride, or table salt, is hidden in many foods—soups, canned vegetables, crackers, dried meats. It consists of about 40% sodium and 60% chloride. A teaspoon of salt contains about 2.3 grams of sodium. Your body needs only 220 milligrams (about a 10th of a teaspoon) of sodium a day.

Most experts recommend that you consume no more than a teaspoon of salt a day in your diet. Too much salt gets sprinkled on our food, often before even tasting it. Another portion appears in particularly salty types of foods, such as potato chips, salted nuts, and other snack foods.

Prepared foods usually have their ingredients listed on the label in order of their proportion. Read the labels carefully; they may even have an analysis of sodium content printed with other nutrient values. Not only is salt a problem, but other substances, such as baking soda, monosodium glutamate, and other sodium containing food additives will supply hidden forms of dietary salt.

First, eliminate all added salt at the table—just remove the salt shaker. Next, cut back on excessively salty foods. These can easily bring down your sodium intake to approximately two grams per day. When you do buy processed foods read the labels.

Choose those foods that are lower in sodium. Further restrict sodium by avoiding milk and milk products, even salty vegetables, such as celery, beets, and leafy greens. If you plan carefully, and use only salt-free breads and cereals, it will be possible to lower the sodium intake to one gram.

Periodically, for patients in congestive heart failure, even a stricter regulation of salt intake is necessary to prevent fluid retention and to lower the blood pressure. Fruit and most natural vegetables are very low in sodium. More and more dietetic foods are supplying the needs for convenience in packaging without the danger of hidden sodium content.

Symptoms of hypertension are variable. Most patients with high blood pressure have no symptoms at all. In actuality, well over half of the cases of high blood pressure in the Unites States are presently undetected. Physical symptoms such as headache, nosebleeds, visual disturbance, and signs of heart failure or kidney disease coexist in conjunction with high blood pressure.

Home measurement of blood pressure is simple and becoming more convenient. Nearly all pharmacies carry blood pressure cuffs (the sphygmomanometer) for home use, together with detailed directions. And coin operated blood pressure machines are available in many shopping centers.

Numerous less common types of hypertension are surgically curable. Tumors of the adrenal gland, such as the adrenaline producing pheochromocytoma and cortisone producing adenomas can cause hypertension, among other symptoms.

A third type of adrenal tumor produces the hormone aldosterone, which increases sodium retention, thereby elevating the blood pressure. Chronic diseases of the kidneys, due whether to infection, nephritis, or congenital cysts can cause hypertension.

Arteriosclerosis, which narrows the arteries to one or both kidneys, can also trigger a reninangiotensin hormonal cycle that results in high blood pressure. Specialized tests are needed to diagnose these “curable” hypertensive diseases. Nevertheless, all of these together comprise only 5% of the total hypertensive patients.

In addition to a salt restricted diet, the individual with hypertension must learn to control stress. Our emotions are profoundly related to the incidence of hypertension. Furthermore, these tendencies are aggravated by excessive noise, a harried schedule, lack of sleep, and lack of exercise. Most of the time, fortunately, adherence to these simple preventives can help a person regain good control of his blood pressure.

Stroke

In the United States more than 200,000 people die annually from stroke. Many more are handicapped for life, and spend months to years in nursing homes. Stroke, formerly called apoplexy, now goes by the more modern term cerebrovascular accident. It is the culmination or combination of several health problems.

Thrombosis, blood clotting, involving one of the major arteries to the brain, or a smaller artery within the brain can affect neurologic function and produce serious symptoms. Blood clots may form elsewhere in the body and break off, forming an embolus. Going to the brain as a “cerebral embolism” initiates another type of stroke.

In younger people a sudden hemorrhage in the brain may produce a stroke; it may be associated either with congenital defects in the artery wall (aneurysm) or some episode of trauma. The symptoms of a stroke can vary widely. The mildest ones involve temporary slurring of speech, dizziness, and weakness in a hand or arm, numbness.

They may occur suddenly, then clearing within minutes to hours. This is called a transient ischemic attack (T.I.A.) and indicates the risk of more serious and more permanent damage, as well as the definite presence of arteriosclerosis. The first major stroke usually occurs in the midportion to one hemisphere of the patient’s brain.

Usually one side is affected, with paralysis or weakness in an arm or leg. Sometimes both the arm and leg are involved, producing one-sided paralysis called hemiplegia. Occasionally some facial muscles will be involved as well. If the brain damage is on the dominant side— usually the left in a right-handed person — the speech will be impaired also.

Recovery from a stroke represents a triumph of determination on the part of the patient, and wisdom and skill by the rehabilitative medical team. Rehabilitation is often a costly and prolonged procedure, with hospitalization in the acute stage and long-term physical therapy for vocational re-education in most activities, including the use of wheelchairs, walkers, braces, canes, and a gradual return to normal activities.

Local heart associations have informative literature concerning the treatment in a home-like setting for a person who has had a stroke. Continued effort for many months is frequently rewarded by the recovery of a loved one to productivity and self respect. The prevention of stroke primarily falls into the dimensions of diet and other lifestyle changes.

Control of stress, adequate daily exercise, and a balance between mental and physical labor are extremely important. Some time each day should be spent outdoors, especially if your work is basically sedentary. The diet should be limited in sodium to a maximum of 2 to 3 grams of salt intake daily.

Your low fat vegetarian diet helps maintain the blood cholesterol as low as possible. These measures will prevent a gradual buildup of cholesterol plaques, leading to arteriosclerosis in your brain arteries. Home treatment of stroke is an outstanding ministry for nurses, well worth your thought and study.

Anemias

Because of television advertising of vitamins and the contemporary dependence on supplements, anemia has almost become a household word. Lowering of hemoglobin and/or scarcity of red blood cells in the circulation manifests this condition. The delivery of oxygen to the cells is impaired, and predictable symptoms will result.

Most causes of anemia are still nutritional. The nutrients necessary for the formation of red blood cells by our bone marrow are usually available in a varied vegetarian diet. Adequate quantities of iron, folic acid, vitamin B12, and protein are especially necessary.

Each one of these nutrients can become the limiting factor in blood production and, when deficient for a period of time, can produce anemia. The symptoms of anemia are frequently profound fatigue, dizziness, particularly on arising suddenly, limited exercise tolerance, and pallor or paleness to the skin.

Many physicians can estimate the degree of anemia by looking within the individual’ s lower eyelid (conjunctiva). Hemoglobin determination involves the laboratory; measuring the red blood cell count and hematocrit (the percent ratio of blood cells to whole blood) are useful to evaluate the extent of anemia.

Microscopic view of the red blood cells may give some hint concerning the cause. The iron level in your blood, serum vitamin B12, and other similar factors can be measured in most laboratories. Iron deficiency is the most common cause of anemia. This is seen most commonly in lower socioeconomic classes of society.

A diet that is low in greens and whole grain cereals will be more likely to lack iron and produce anemia. Babies are normally born with high hemoglobin, but receive some iron from their mother’ s milk. Those on cow’ s milk without supplemental iron will develop progressive anemia.

Some of this may be “physiologic”, but most of it can be prevented with appropriate baby formula. Iron-rich foods include dark green vegetables such as spinach, kale, broccoli, and chard. Whole wheat and other unrefined grains contain iron, and in “enriched” flour most of the lost iron is replaced.

Certain fruits, such as grapes, raisins, strawberries, and blackberries contain liberal amounts of iron. These are the best food sources and can adequately nourish a growing child, adult, or even mothers during pregnancy. The use of iron kettles in cooking will also add iron, particularly when boiling acid fruits or sauces.

Some iron may be available in community water supplies. The adequate intake of Vitamin B12 has stirred many controversies among vegetarians. It is well established that some vegetables fresh from the ground many contain trace amounts of vitamin B12 or cobalamin.

However, the B12 availability is no where near adequate for normal nutrition. Some B12 is made by bacteria in the colon, but it is not known that this will be adequately absorbed. Most dietary Vitamin B12 is obtained from foods of animal origin, particularly milk and eggs. This is made available to our bodies for absorption by intrinsic factor, supplied in the stomach.

The vitamin B12 is then absorbed in the small intestine and stored for long periods in the liver. In actuality, most individuals can thrive without B12 for many years before developing symptoms of the deficiency. Unfortunately for the few, neurologic problems can develop with tingling, numbness, weakness in the extremities, due to degenerative breakdown in the posterior portion of the spinal cord.

Some functional deficit may remain permanently, even though the anemia is reversed. Folic acid deficiency can produce a similar anemia, but without the neurologic problems. This B vitamin is seldom deficient, though, except in certain disease states involving malabsorption.

The individual who is eating a total vegetarian diet, without milk, eggs, or other animal foods would do well to obtain some source of vitamin B12 as a tablet, an injection, or in various fortified foods at least every month. Thorough chewing of any B12 vitamin supplements assists absorption.

There appears to be a second hormone in the saliva to assist this process. Other causes of anemia include chronic blood loss from heavy menstruation or hidden (occult) bleeding in the intestinal tract. Older individuals should definitely have a complete examination if anemia is discovered, to exclude the possibility of undetected cancer.

During the menstrual years, a woman may lose excessive blood in the monthly period and, not obtaining adequate replacement, could develop anemia. Iron is occasionally needed in supplemental form during pregnancy to correct a developing anemia that results in dizzy spells or weakness. Any persistent anemia not related to blood loss or nutritional deficiency, and refractive to simple therapy, should be investigated by a physician.

Chronic disease of the kidneys, acute or chronic leukemia, or abnormal destruction of the blood cells (hemolysis) may require examination of the bone marrow and a careful medical investigation to discover and remove their causes. Most anemias can be treated and cured, the detective work involved providing a challenge to every medical diagnostician.

Varicose Veins

Abnormal dilation of leg veins may occur from many causes. Varicose veins usually appear on the surface of the skin. Most common in the legs, they may also occur in the entire lower extremity, the perineum, the pelvis, or the abdomen. Dilation of rectal veins are usually called hemorrhoids, while in the scrotum, they are termed a varicocele.

The late Dr. Dennis Burkett of England taught for decades that varicose veins result from a deficient intake of fiber in the diet. This creates, he said, the necessity for increased straining, thus elevating the abdominal pressure, and stretching the veins. While this may constitute one cause, I believe that there are many causes of varicose veins.

Some of these follow episodes of hrombophlebitis, an inflamed blood clot in the same involved veins. Unwisely wearing tight constricting garments around the upper thigh or waist, as well as prolonged sitting or standing, can promote the development of unwelcome varicosities.

They are usually aggravated by pregnancy or any other condition that raises the pressure within the abdomen. Although some writers think that vitamin E is curative, scientific evidence is presently inconclusive. We know that exercise and the use of whirlpool baths are beneficial in chronic disease involving the veins.

An increase of fiber in the diet will provide better elimination, decreasing the need for straining with unnatural elevation of the abdominal pressure. Symptoms of aching in the legs or unsightly deformities of the skin can be treated with the wearing of elastic support hose.

These should be of a surgical quality and appropriately fitted to the patient’ s size. Jobst company will custom design your hose after careful measurement, if you want the best, most expensive product. Many people with varicose veins below the knee should wear support stockings up to the knee, while others require a fulllength hose to appropriately compress the veins and prevent them from dilating further.

Occasionally, surgery is indicated, called a vein stripping and ligation, to remove the offenders. Most varicose veins, nonetheless, can be treated at home. One dreadful complication that patients fear is the varicose ulcer, usually developing on the inner side of the ankle, below a varicose vein.

This needs urgent treatment to reduce the hazard of infection and promote rapid healing. Bed rest is combined with elevation of the affected limb, together with hot and cold soaks, and careful antiseptic cleansing of the ulcer. This method, even at home, will usually promote rapid healing.

Swelling in the ankles needs to be reduced by the combined influence of gravity (elevate the legs) and salt restriction. At times a topical application of vitamin E, aloe vera, or the healing effect of oxygen administered with a plastic bag around the foot can help to promote more rapid healing.

Thrombophlebitis

Clots may form at any time in stagnant or injured veins. The smallest veins on the skin surface become red and tender. Inflammation of the veins, with clotted blood inside obstructing flow, is called thrombophlebitis. This condition does not constitute a great threat to health, however, and responds to a few days of bed rest with elevation of the extremity and frequent application of moist, hot compresses.

Deep vein thrombosis is more serious. As the clot extends into a deeper vein, it may break off or fragment, migrating through the larger veins to the lungs. A sudden clot in the lungs, pulmonary embolism, may tragically be fatal. Usually an embolism produces chest pain, cough, and some transient shortness of breath.

Hot packs and bed rest are helpful in the management of this type of acute thrombosis. The diet must be very low in fat, particularly eliminating any meat or swine’s flesh, since the chemicals derived from these toxic foods tend to promote clot formation.

Platelets in the blood, which normally being protective and serve to prevent bleeding, will become sticky and adhere to one another, increasing the tendency for thrombosis to occur. The use of estrogen supplements and oral contraceptives significantly increases the risk of thrombosis. Tobacco also produces spasm of the vessels, compromising the circulation, and may trigger development of an abnormal clot within a blood vessel.