Healthier than antioxidants in dietary supplements ANTIOXIDANTS Antioxidants are natural substances that prevent or inhibit oxidation and may protect cells from the damaging effects of oxygen free radicals, some forms of cancer, and reperfusion injuries. Diets high in vegetables and fruits are good sources of antioxidants and have health benefits. Antioxidants are found in citrus fruits (vitamin C), nuts (vitamin E), carrots (beta carotene), tomatoes (lycopene), chile peppers (capsanthin), berries (anthocyanin), and leafy green vegetables (lutein and zeaxanthin). Free radicals, oxidative stress, and antioxidants Free radicals are highly unstable molecules that form naturally when the body converts food into energy. They are also caused by environmental exposure to cigarette smoke, air pollution, and sunlight. Free radicals may induce oxidative stress, a process that can trigger cell damage and is thought to play a role in a variety of diseases, including cancer, cardiovascular disease, diabetes, Alzheimer’s disease, Parkinson’s disease, cataracts, and age-related macular degeneration. Antioxidant molecules have been shown to counteract oxidative stress in laboratory experiments, although it is debated whether consuming large amounts of antioxidants in supplement form actually benefits health. Consuming antioxidant supplements in excessive doses may in fact be harmful. THE SCIENCE Decades of dietary research findings suggest that antioxidant-rich foods help protect against disease. In observational studies, people who ate more vegetables and fruits were at lower risk for cardiovascular disease, stroke, cancer, and cataracts, although such studies do not control for the effects of other health-related factors including exercise, smoking, lifestyle, and disease risk. In laboratory experiments, antioxidants interacted with free radicals and stabilized them, thus preventing free radicals from causing cell damage. Rigorous scientific studies involving more than 100,000 subjects investigated whether antioxidant supplements helped prevent chronic disease, and in most cases antioxidant supplements did not reduce the risk of developing disease. Concerns have not been raised about the safety of antioxidants in food, but high-dose antioxidant supplements may be linked to health risks. Supplementing with high doses of beta carotene may increase the risk of lung cancer in smokers. Supplementing with high doses of vitamin E may increase the risk of prostate cancer and hemorrhagic stroke. Evidence on antioxidant supplement use during cancer treatment is conflicting. The National Cancer Institute recommends that cancer patients talk to their healthcare providers before taking supplements. Recent NCCIH and NIH studies on antioxidants:
 ANTIOXIDANTS IN FOOD Vegetables and fruits are rich sources of antioxidants. There is good evidence that a diet abundant in vegetables and fruits is healthy. Research has shown that people who eat more vegetables and fruits are at lower risk for several diseases; however, these results may be related to the amount of antioxidants in vegetables and fruits, to other components of these foods, to other factors in people’s diets, or to other lifestyle choices. Health facts
ANTIOXIDANTS IN SUPPLEMENTS Antioxidant supplements do not replace a healthy diet or conventional medical care. Before considering a dietary supplement, get information from reliable sources. Antioxidant supplements cannot replace antioxidants consumed in foods The large doses of antioxidants used in supplementation studies are not the same as the smaller amounts of antioxidants consumed in foods. Differences in the chemical composition of antioxidants in foods versus those in supplements may influence their effects. For example, eight chemical forms of vitamin E are present in food, while vitamin E supplements typically include only one chemical form — alpha-tocopherol. Safety concerns with antioxidant supplements
TO LEARN MORE: NCCIH Clearinghouse complementary and integrative health approaches https://nccih.nih.gov/ PubMed®, National Library of Medicine abstracts from scientific and medical journals https://pubmed.ncbi.nlm.nih.gov/ U.S. Department of Agriculture on antioxidants and phytonutrients in foods https://www.nutrition.gov/topics/whats-food/phytonutrients Disclaimer: Tell all of your healthcare providers about any complementary health approaches you use, to manage your health and to ensure coordinated and safe care.
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Healthcare for patients with limited English proficiency OPEN LETTER TO GOVERNORS AND HOSPITALS The Certification Commission for Healthcare Interpreters (CCHI) has issued an open letter to governors and hospital associations to raise awareness about the safety of healthcare interpreters and language access services for patients with limited English proficiency (LEP) and their families, as well as the safety of all healthcare workers during the current unprecedented COVID-19 pandemic. Healthcare interpreters work in close quarters and in close proximity to patients and the safety of all workers with direct patient contact must be the number one priority. This includes physicians, nurses, allied professionals, and face-to-face/on-site healthcare interpreters. PERSONAL PROTECTIVE EQUIPMENT The open letter reminds hospitals and healthcare systems that face-to-face/on-site healthcare interpreters should be provided the same level of protection and use of personal protective equipment (PPE) as any healthcare provider for whom they are interpreting while also recognizing that PPE shortages may necessitate certain limiting measures. It is extremely important for managers to have transparent and honest conversations with interpreters and collectively come to an understanding on when and to whom PPE is provided. ALTERNATIVES TO ON-SITE INTERPRETATION When PPE is not available there are alternatives to face-to-face/on-site interpretation. Ultimately, if appropriate PPE is not available for an interpreter, then alternatives must be provided to both reduce the spread of the coronavirus by interpreters and ensure their personal safety. Unlike most healthcare providers, interpreters work in different departments, different facilities, and even different campuses throughout the day. Their inadequate protection will result in spreading the virus not only in the community and to their families but also to other healthcare workers and patients within and outside a specific facility. REMOTE INTERPRETING The CCHI recommends that all hospitals, health systems, clinics, and healthcare providers deploy remote interpreting for most of their interactions with LEP patients and their families, as the primary modality for delivery of language access services in the time of this pandemic. The implementation of remote interpreting may take time and require certain information technology solutions as well as evaluation for compliance with laws and regulations. However, the implementation of remote interpreting will allow facilities to reserve much needed PPE for healthcare professionals who must be in direct contact with patients. Furthermore, face-to-face interpreters have a higher risk of becoming a vector of infection even with the appropriate use of PPE due to the mobility of their job. When institutions utilize telemedicine and telehealth options for providing care, they must incorporate remote interpreting into these solutions to ensure equal access to healthcare for limited English proficiency patients. HOW TO IMPLEMENT REMOTE INTERPRETING Remote interpreting may be implemented in the following ways:
A BRIEF NOTE ON CONFERENCE INTERPRETING The International Association of Conference Interpreters (AIIC) has issued best practices for interpreters during the COVID-19 crisis. AIIC's Technical and Health Committee and Taskforce on Distance Interpreting specify rules on social distancing in interpreting booths, social distancing for sign language teams, disinfection, and the use of disposable gloves and personal headset covers. REFERENCES CCHI Open Letter on Ensuring Healthcare Interpreters’ Safety during the COVID-19 Pandemic. April 3, 2020. https://cchicertification.org/covid-19/covid-19-update/. AIIC Taskforce on Distance Interpreting, Technical Committee. "AIIC best practices for interpreters during the Covid-19 crisis.” aiic.net March 17, 2020. http://aiic.net/p/8956.  The connection between psychological and cardiovascular health BEHAVIORAL CARDIOLOGY In medical treatment today, heart health requires more than blood pressure control or the right pharmacologic therapy. Doctors advise lifestyle modifications in the form of diet and exercise yet may encounter resistance. Patients must be willing to comply with lifestyle modifications and often such motivation is tied to their psychological health. If a patient already has underlying depression, then news of serious cardiovascular disease may deepen such depression and dampen motivation. Behavioral cardiology looks at the links between behavioral and psychosocial factors and the origin and progression of coronary heart disease. Randal Thomas notes in Behavioral Cardiology: Where the Heart and Head Meet (U.S. Cardiology Review, 2006) “Results of recent clinical research have strengthened the understanding and management of the links between psychological health and heart health, and have moved the field of behavioral cardiology steadily closer into the mainstream of current clinical cardiology.” Thomas notes the importance of behavioral cardiology: Adverse psychosocial factors are common in persons with coronary artery disease and up to 50% of survivors of myocardial infarction present with significant anxiety and/or depressive disorders. These adverse psychosocial factors can significantly worsen coronary artery disease risk and prognosis. Moreover, psychosocial health status is generally responsive to behavioral and pharmacologic therapies. CARDIOLOGISTS ALERT TO PSYCHOLOGICAL AND CARDIOVASCULAR FACTORS Physical and emotional factors contribute to feelings of overwhelming depression and hopelessness in a vulnerable patient who has recently experienced a heart attack. This presents an unusual dilemma in current cardiovascular healthcare. The cardiologist must treat the underlying disease and the risk of heart disease and at the same time be aware of related psychosocial factors, such as hostility and anxiety. Treatments that effectively treat both psychosocial and coronary artery disease outcomes can be elusive. The cardiologist is often the first to see a patient during and after cardiovascular events at a time when adverse psychosocial factors may become more visible and patients are more open to therapeutic recommendations. The cardiologist's challenge is to identify coexisting heart disease and psychological distress, and then successfully intervene and initiate the early steps of psychosocial care. PSYCHOSOCIAL FACTORS THAT INCREASE THE RISK OF HEART DISEASE As important as smoking, high blood pressure, obesity, and cholesterol, psychological factors may be the final insult resulting in a heart attack or stroke. Psychological factors contribute to atherosclerosis, the slow, corrosive process that damages artery walls. Depression, stress, loneliness, pessimistic outlook, and other psychosocial factors influence heart health. Conversely, heart disease affects the brain and the mind. DEPRESSION Symptoms of depression, as well as full-blown major depression, contribute to heart disease. The prognosis is worse for people who become depressed after a heart attack or stroke, heart surgery, or the onset of heart failure. ANGER AND HOSTILITY Atherosclerosis seems to advance faster in people who score high on anger or hostility scales. Anger may even initiate heart attacks. In the Harvard-based Determinants of Myocardial Infarction Onset Study, one in every 40 heart attack survivors reported an "episode of anger" in the two hours before the attack. ANXIETY Intense anxiety associated with fear of enclosed places, heights, and crowds may set off a sudden cardiac arrest. These often-fatal heart attacks happen when the heartbeat abruptly turns fast and uncoordinated. LACK OF SOCIAL SUPPORT Among heart attack survivors, social isolation is almost as important as high cholesterol, high blood pressure, and smoking in the prediction of long-term survival. CHRONIC STRESS Constant stress from work, financial problems, a troubled marriage, taking care of sick family members, or even living in an unsafe neighborhood have been linked to the development of heart disease and poor prognosis. SUDDEN EMOTIONAL STRESS Sudden emotional turmoil can trigger a temporary but serious heart condition also known as broken heart syndrome or stress cardiomyopathy, in which stress hormones stun the cells of the heart. Researchers have documented broken heart syndrome after a death in the family, a divorce, a surprise (even a good surprise), a robbery, a car accident, or other physically draining event. HEALTHY BEHAVIOR IS GROUNDED IN EMOTIONAL STATE Healthcare providers agree that our health behaviors are grounded in the larger context of our emotions, moods, and even parts of our personality. Stress, loneliness, depression, and anxiety all exact a toll. Dr. Alan Rozanski divides the behavioral risk factors for coronary heart disease into physical health behaviors, negative emotions and negative mental mindsets, chronic stress, social isolation and poor social support, and lack of sense of purpose. "Negative psychosocial factors promote illness by fostering negative health behaviors and by their direct pathophysiological effects," he says. "These effects can vary according to the type of psychosocial stress, but as a group they include induction of autonomic dysfunction, heightened cardiovascular reactivity, insulin resistances, central obesity, increased risk for hypertension, endothelial and platelet dysfunction, and unfavorable alterations in brain plasticity and cognitive function.” POSITIVE AND NEGATIVE FEEDBACK LOOPS OFFER TREATMENT OPPORTUNITY Psychosocial factors form part of positive and negative feedback loops, which offer opportunities for overall approaches to treatment. Transforming one component of the negative feedback loop may create a positive feedback loop. For example, treating depression can improve health behaviors, reduce stress, improve social performance, and increase sense of purpose. Exercise reduces heart rate, blood pressure, and cortisol and glucose responses to psychosocial stress, and it buffers the relationship between depression and inflammation.  LIFESTYLE MODIFICATIONS FOR HEART HEALTH
Primary prevention measures and lifestyle interventions offer hope for the heart patient. They include: Healthy and balanced diet Reduced salt intake, increased potassium intake Weight loss Smoking cessation Appropriate exercise (moderate intensity, such as a 30-minute daily walk) Stress reduction Lipid regulation Aspirin Behavioral interventions including talk therapy, antidepressant therapy, and mindfulness practices Behavioral interventions such as talk therapy, antidepressant therapy, and mindfulness practices relieve mental stress and maintain emotional balance. Treating heart disease by treating mood and emotion holds promise. Lifestyle interventions offer both physical and emotional benefits, and success with one modification may improve the patient's outlook in other areas. Habits good for the heart seem to be good for the mind and brain as well. Ask anyone who exercises regularly about the mental benefits of exercise! |
