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Worried about whether being physically active just on weekends can make a difference in health if the rest of the week is spent sitting all day? Well, there is good news! Being a "weekend warrior" (one who exercises or is active only one or two days a week) may also offer health benefits according to a new study (associated with lower death rates from all causes, cancer, and cardiovascular disease).

Current government guidelines recommend at least 150 minutes per week of moderate-intensity activity (such as brisk walking or tennis), or at least 75 minutes per week of vigorous activity (such as jogging or swimming laps), or equivalent combinations of moderate and vigorous physical activity. From Science Daily:

'Weekend warriors' have lower risk of death from cancer, cardiovascular disease

Physical activity patterns characterized by just one or two sessions a week may be enough to reduce deaths in men and women from all causes, cardiovascular disease (CVD) and cancer, regardless of adherence to physical activity guidelines, a new study of over 63,000 adults reports. The finding suggests that less frequent bouts of activity, which might fit more easily into a busy lifestyle, offer significant health benefits, even in the obese and those with medical risk factors.

Regular physical activity is associated with lower risks of death from all causes, cardiovascular disease and cancer, and has long been recommended to control weight, cholesterol, and blood pressure. The World Health Organization recommends that adults do at least 150 minutes per week of moderate-intensity activity, or at least 75 minutes per week of vigorous-intensity activity, or equivalent combinations.

But research is yet to establish how the frequency and total weekly dose of activity might best be combined to achieve health benefits. For example, individuals could meet current guidelines by doing 30 minutes of moderate-intensity physical activity five days of the week or 75 minutes of vigorous-intensity physical activity on just one day of the week. Those who do all their exercise on one or two days of the week are known as 'weekend warriors'. 

Looks like exercise, even 20 minutes of moderate activity such as brisk walking, has beneficial anti-inflammatory health effects. Inflammation is part of the body's normal immune response - it is the body's attempt to heal itself after an injury and tissue damage, and to defend itself against infection from foreign invaders, such as viruses and bacteria.

However, chronic inflammation (e.g., what can occur in obesity, diabetes, and poor lifestyle) can lead to serious health issues and is linked to cancer, heart disease, etc. So lowering chronic (systemic) inflammation is good. From Science Daily:

Exercise ... It does a body good: 20 minutes can act as anti-inflammatory

It's well known that regular physical activity has health benefits, including weight control, strengthening the heart, bones and muscles and reducing the risk of certain diseases. Recently, researchers at University of California San Diego School of Medicine found how just one session of moderate exercise can also act as an anti-inflammatory. The findings have encouraging implications for chronic diseases like arthritis, fibromyalgia and for more pervasive conditions, such as obesity.

The study, recently published online in Brain, Behavior and Immunity, found one 20-minute session of moderate exercise can stimulate the immune system, producing an anti-inflammatory cellular response. The brain and sympathetic nervous system -- a pathway that serves to accelerate heart rate and raise blood pressure, among other things -- are activated during exercise to enable the body to carry out work. Hormones, such as epinephrine and norepinephrine, are released into the blood stream and trigger adrenergic receptors, which immune cells possess. This activation process during exercise produces immunological responses, which include the production of many cytokines, or proteins, one of which is TNF -- a key regulator of local and systemic inflammation that also helps boost immune responses.

The 47 study participants walked on a treadmill at an intensity level that was adjusted based on their fitness level. Blood was collected before and immediately after the 20 minute exercise challenge."Our study shows a workout session doesn't actually have to be intense to have anti-inflammatory effects. Twenty minutes to half-an-hour of moderate exercise, including fast walking, appears to be sufficient," said Hong.

Inflammation is a vital part of the body's immune response. It is the body's attempt to heal itself after an injury; defend itself against foreign invaders, such as viruses and bacteria; and repair damaged tissue. However, chronic inflammation can lead to serious health issues associated with diabetes, celiac disease, obesity and other conditions.

The wonderful blog posts of Dr. John Mandrola (physician, blogger, and columnist at Medscape) are always thoughtful, and this latest points out things a number of studies have pointed out for a while. Which is to stop obsessing or focusing on "preventive tests" and screenings and numbers, and instead focus on a healthy lifestyle - which means getting regular exercise or physical activity, don't smoke cigarettes, maintaining a healthy weight, and eating a healthy diet with lots of fruits, vegetables, nuts, seeds, whole grains, and legumes (think Mediterranean-style diet).

Don't want overdiagnosis and overtreatment (here, here, here, and here). Excerpts from Dr. John M:

I am changing…

The main thing that has changed about me is my views as a doctor, especially when it comes to dealing with people who complain of nothing. Medicine is most pure when we treat people with illness. The infirmed come to us with a problem and we use our intelligence, experience and procedural skills to help them. It’s immensely gratifying. The joy of helping people still negates the stifling burden of administrative nonsense. I’ll do your damn corporate safety modules one more year because helping sick people get well feels so good.

But when people complain of nothing, our first job is to do no harm. I know prevention of disease is better than treating it, but the process of prevention gets dicey. When we prescribe things (screening tests, statins, aspirin, diabetes drugs etc) to people who complain of nothing, we should have the highest evidence these therapies deliver benefit. Too often, we cite eminence rather than evidence.

I’ve come to believe the medical profession is too paternalistic, too arrogant. I fear the medicalization of the human condition. These days, I order fewer tests. Medical tests put people into the “system,” on the metaphorical train of healthcare. This train accelerates quickly, and it’s often hard to get off. Even a simple echo scares me. I could tell you stories.

More often than not, I tell patients to stop checking their “numbers.” If they insist on health numbers, I favor three–the scale, the belt size and a Timex to measure walking speed.

A 2002 article from Dr. David Sackett (a pioneer of evidence-based medicine) perfectly captures my views on preventive medicine. It’s called The Arrogance of Preventive Medicine. It’s worth a look, now more than ever.

 Image result for human heart in human body wikipedia Heart attacks run in the family? Does this mean you are doomed to also have a heart attack? Well, the good news from a large study is that a healthy lifestyle (with at least 3 of these 4 behaviors: not currently smoking, not being obese, regular physical activity at least once per week, and eating a good diet)  lowers the risk of a heart attack by nearly 50% even in those with a high genetic risk for heart attacks. (This is compared to those with an unhealthy lifestyle, which is none or only one healthy behavior.)  In this study a healthy diet was one with lots of fruits, nuts, vegetables, whole grains, fish, and dairy products, and a reduced amount of refined grains, processed meats, red meat, sugar-sweetened beverages, and trans fats.

The researchers also reversed the question and asked: "If you happen to inherit good genes, can a bad lifestyle offset that? We actually found yes." The risk of heart attack is also reduced nearly 50% in those people with good genes and a good lifestyle. BOTTOM LINE: Healthy lifestyle counts, no matter whether heart disease and heart attacks run in the family or not. There is an interaction between the two, From Science Daily:

Following a healthy lifestyle can greatly reduce genetic heart attack risk

It is well known that following a healthy lifestyle -- not smoking, avoiding excess weight and getting regular exercise -- can reduce the risk of heart disease. But what about people who have inherited gene variants known to increase risk? A study led by Massachusetts General Hospital (MGH) investigators has found that, even among those at high genetic risk, following a healthy lifestyle can cut in half the probability of a heart attack or similar event

"The basic message of our study is that DNA is not destiny," says Sekar Kathiresan, MD...."Many individuals -- both physicians and members of the general public -- have looked on genetic risk as unavoidable, but for heart attack that does not appear to be the case."  

In order to investigate whether a healthy lifestyle can mitigate genetic risk, the multi-institutional research team analyzed genetic and clinical data from more than 55,000 participants in four large-scale studies. Three of these studies....followed participants for up to 20 years. Each participant in the current analysis was assigned a genetic risk score....The investigators used four AHA-defined lifestyle factors -- no current smoking; lack of obesity (defined as a body mass index less than 30); physical exercise at least once a week; and a healthy dietary pattern -- to determine a lifestyle score, whether participants had a favorable (three or four healthy factors), intermediate (two factors) or unfavorable (one or no healthy factors) lifestyle.

Across all three prospective studies, a higher genetic risk score significantly increased the incidence of coronary events -- as much as 90 percent in those at highest risk. While known risk factors such as a family history and elevated LDL cholesterol were also associated with an elevated genetic risk score, genetic risk was the most powerful contributor to cardiac risk. Similarly, each healthy lifestyle factor reduced risk, and the unfavorable lifestyle group also had higher levels of hypertension, diabetes and other known risk factors upon entering the studies.

Within each genetic risk category, the presence of lifestyle factors significantly altered the risk of coronary events to such an extent that following a favorable lifestyle could reduce the incidence of coronary events by 50 percent in those with the highest genetic risk scores. Among participants in the BioImage study, both genetic and lifestyle factors were independently associated with levels of calcium-containing plaque in the coronary arteries, and healthy lifestyle factors were associated with less extensive plaque within each genetic risk group. [Original study]

Magnesium is a mineral found in the human body that is necessary for good health. New research analysed 40 studies and found that a diet rich in magnesium is associated with a reduced risk of stroke, heart failure, diabetes, and death ("all cause mortality").

Even though there are many magnesium rich foods, it is estimated that many people don't get enough magnesium in the diet, especially if they eat a lot of processed, low-fiber foods. Current Recommended Dietary Allowances (RDAs) are 320 mg daily for adult females and 420 mg daily for adult males (NIH magnesium fact-sheets - here and here). Especially good sources of magnesium are green leafy vegetables, legumes (beans), nuts, seeds, chocolate, and whole grains. In general, foods containing dietary fiber provide magnesium.From EurekAlert:

Dietary magnesium associated with reduced risk of heart disease, stroke and diabetes

A diet rich in magnesium may reduce the risk of diseases including coronary heart disease, stroke and type-2 diabetes according to a new meta-analysis published in the open access journal BMC Medicine. This analysis of the evidence on dietary magnesium and health outcomes is the largest to date, involving data from more than one million people across nine countries.

The researchers, from Zhejiang University and Zhengzhou University in China, found that people in the highest category of dietary magnesium consumption had a 10% lower risk of coronary heart disease, 12% lower risk of stroke and a 26% lower risk of type-2 diabetes compared to those in the lowest category. Their results also indicate that an extra 100 mg per day of dietary magnesium could also reduce risk of stroke by 7% and type-2 diabetes by 19%.

Magnesium is vital for human health and normal biological functions including glucose metabolism, protein production and synthesis of nucleic acids such as DNA. Diet is the main source of magnesium as the element can be found in foods such as spices, nuts, beans, cocoa, whole grains and green leafy vegetables.

Original study. from BMC Medicine: Dietary magnesium intake and the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality: a dose–response meta-analysis of prospective cohort studies

Increasing dietary magnesium intake is associated with a reduced risk of stroke, heart failure, diabetes, and all-cause mortality, but not CHD [coronary heart disease] or total CVD [cardiovascular disease]. These findings support the notion that increasing dietary magnesium might provide health benefits....Magnesium is essential to all living organisms, as it controls the function of many crucial enzymes, including those that utilize or synthesize ATP ....

A large review of nut studies found that people eating a daily handful of nuts (about 20 g) have a lower risk of heart disease, cancer, stroke, premature death, and death from respiratory disease, type 2 diabetes, and infectious disease. Truly impressive. Benefits seem to be for all nuts, and also peanuts - which are called nuts, but are actually legumes (other posts about nut consumption benefits). An earlier post discussed how some of these effects could be to nuts lowering systemic inflammation throughout the body. Bottom line: try to eat a handful of nuts every day or most days a week for your health. And make it a variety of nuts - walnuts, almonds, hazelnuts, cashews, pistachios, pecans, Brazil nuts, and peanuts. From Science Daily:

A handful of nuts a day cuts the risk of a wide range of diseases

A large analysis of current research shows that people who eat at least 20g of nuts a day have a lower risk of heart disease, cancer and other diseases. The analysis of all current studies on nut consumption and disease risk has revealed that 20g a day -- equivalent to a handful -- can cut people's risk of coronary heart disease by nearly 30 percent, their risk of cancer by 15 percent, and their risk of premature death by 22 percent. An average of at least 20g of nut consumption was also associated with a reduced risk of dying from respiratory disease by about a half, and diabetes by nearly 40 percent, although the researchers note that there is less data about these diseases in relation to nut consumption.

The study, led by researchers from Imperial College London and the Norwegian University of Science and Technology, is published in the journal BMC Medicine. The research team analysed 29 published studies from around the world that involved up to 819,000 participants, including more than 12,000 cases of coronary heart disease, 9,000 cases of stroke, 18,000 cases of cardiovascular disease and cancer, and more than 85,000 deaths. While there was some variation between the populations that were studied....the researchers found that nut consumption was associated with a reduction in disease risk across most of them.

The study included all kinds of tree nuts, such as hazel nuts and walnuts, and also peanuts -- which are actually legumes. The results were in general similar whether total nut intake, tree nuts or peanuts were analysed. What makes nuts so potentially beneficial, said Aune, is their nutritional value: "Nuts and peanuts are high in fibre, magnesium, and polyunsaturated fats -- nutrients that are beneficial for cutting cardiovascular disease risk and which can reduce cholesterol levels. "Some nuts, particularly walnuts and pecan nuts are also high in antioxidants, which can fight oxidative stress and possibly reduce cancer risk. Even though nuts are quite high in fat, they are also high in fibre and protein, and there is some evidence that suggests nuts might actually reduce your risk of obesity over time."

The study also found that if people consumed on average more than 20g of nuts per day, there was little evidence of further improvement in health outcomes. [ORIGINAL STUDY]

  It turns out that scurvy and vitamin C deficiency is still around these days. Scurvy is a disease resulting from a lack of vitamin C. Most animals can synthesize vitamin C, but not humans. We must eat foods containing vitamin C to get the vitamin.

Vitamin C deficiency results in defective formation of collagen and connective tissues (in our bones, skin, tendons, muscles), and symptoms may include weakness, feeling tired, curly hair, sore arms and legs, bruising, bleeding gums, and impaired wound healing.

A recent small Australian study looked at diabetic persons with chronic foot wounds (foot ulcers that didn't heal after several months). Their vitamin C levels were tested and if found to be low, then they were given vitamin C supplements of 500 or 1000 mg daily, and the result was that within 2 to 3 weeks the wounds were healed. The one person with a zinc deficiency was given 50 mg daily of zinc supplement and that wound also promptly healed.

Treatment of scurvy is by taking vitamin C supplements (the Mayo Clinic recommends taking 400 to 1000 milligrams of vitamin C  daily for one week). Vitamin C deficiency can be easily prevented by a diet that includes fruits and vegetables. The recommended daily intake for adult women is 75 milligrams and for adult men it is 90 milligrams, which can be easily met by eating fruits and vegetables, especially if they are fresh (uncooked).

Good sources of vitamin C include: oranges, lemons, kiwi fruit, black currants, papaya, guava, pineapple, mango, strawberries, and vegetables such as bell peppers (red, yellow, green), tomatoes, potatoes, kale, brussels sprouts, and broccoli. It is possible to be vitamin C deficient even if the person is of normal weight or overweight - it all comes down to the diet and whether fruits and vegetables are eaten. Bottom line: Eat some daily!

From Medical Xpress: Poor diet sees scurvy reappear in Australia

Scurvy, a disease historically associated with old-world sailors on long voyages, is making a surprise comeback in Australia, with health officials Tuesday revealing a rare spate of cases. Caused by vitamin C deficiency, the condition used to be a common—and often fatal—curse among seafarers who went months without fresh fruit and vegetables.  ...continue reading "Poor Diets May Lead To Vitamin C Deficiency"

An interesting study that showed that when gut microbes are deprived of dietary fiber (their food) they start to eat the natural layer of mucus that lines the colon. (The colon is part of the large intestine). This is important because the colon's mucus layer normally acts as a barrier to pathogenic microbes. Yes, it was done in mice, but the researchers feel that this study accurately models what also happens in humans. Their conclusion: when the microbes in the gut don't get enough dietary fiber from plants (such as whole grains, fruits, vegetables, seeds, nuts), then the microbes feed on the colon's mucus layer, which results in inflammation and makes the colon more vulnerable to pathogenic (disease causing) microbes. This is what some people refer to as "leaky gut".

Research shows that changes in the diet (high fiber vs low fiber) quickly results in changes in the gut microbes in humans and rodents - so it's important to consistently eat a lot of a variety of plant fiber. Currently the recommended daily fiber intake for adults is for 28 to 35 grams (chart of some high fiber foods). They found that some bacteria strains flourished the best in low or no fiber conditions and it was these bacteria that were involved in breaking down the mucus layer. The research also showed that what are called "prebiotics" (purified forms of soluble fiber similar to what some processed foods and supplements contain) also resulted in thinning of the colon's mucus layer - they did not properly feed the gut microbes. From Medical Xpress:

High-fiber diet keeps gut microbes from eating colon's lining, protects against infection

It sounds like the plot of a 1950s science fiction movie: normal, helpful bacteria that begin to eat their host from within, because they don't get what they want. But new research shows that's exactly what happens when microbes inside the digestive system don't get the natural fiber that they rely on for food. Starved, they begin to munch on the natural layer of mucus that lines the gut, eroding it to the point where dangerous invading bacteria can infect the colon wall. In a new paper in Cell, an international team of researchers show the impact of fiber deprivation on the guts of specially raised mice. The mice were born and raised with no gut microbes of their own, then received a transplant of 14 bacteria that normally grow in the human gut. 

The findings have implications for understanding not only the role of fiber in a normal diet, but also the potential of using fiber to counter the effects of digestive tract disorders. "The lesson we're learning from studying the interaction of fiber, gut microbes and the intestinal barrier system is that if you don't feed them, they can eat you," says Eric Martens, Ph.D., an associate professor of microbiology at the University of Michigan Medical School....Using U-M's special gnotobiotic, or germ-free, mouse facility, and advanced genetic techniques that allowed them to determine which bacteria were present and active under different conditions, they studied the impact of diets with different fiber content - and those with no fiber. They also infected some of the mice with a bacterial strain that does to mice what certain strains of Escherichia coli can do to humans - cause gut infections that lead to irritation, inflammation, diarrhea and more.

The result: the mucus layer stayed thick, and the infection didn't take full hold, in mice that received a diet that was about 15 percent fiber from minimally processed grains and plants. But when the researchers substituted a diet with no fiber in it, even for a few days, some of the microbes in their guts began to munch on the mucus.They also tried a diet that was rich in prebiotic fiber - purified forms of soluble fiber similar to what some processed foods and supplements currently contain. This diet resulted in the same erosion of the mucus layer as observed in the lack of fiber.

The researchers also saw that the mix of bacteria changed depending on what the mice were being fed, even day by day. Some species of bacteria in the transplanted microbiome were more common - meaning they had reproduced more - in low-fiber conditions, others in high-fiber conditions. And the four bacteria strains that flourished most in low-fiber and no-fiber conditions were the only ones that make enzymes that are capable of breaking down the long molecules called glycoproteins that make up the mucus layer....  Just like the mix of bacteria, the mix of enzymes changed depending on what the mice were being fed, with even occasional fiber deprivation leading to more production of mucus-degrading enzymes.

Images of the mucus layer, and the "goblet" cells of the colon wall that produce the mucus constantly, showed the layer was thinner the less fiber the mice received. While mucus is constantly being produced and degraded in a normal gut, the change in bacteria activity under the lowest-fiber conditions meant that the pace of eating was faster than the pace of production - almost like an overzealous harvesting of trees outpacing the planting of new ones. 

When the researchers infected the mice with Citrobacter rodentium - the E. coli-like bacteria - they observed that these dangerous bacteria flourished more in the guts of mice fed a fiber-free diet. Many of those mice began to show signs of illness and lost weight. When the scientists looked at samples of their gut tissue, they saw not only a much thinner or even patchy mucus later - they also saw inflammation across a wide area. Mice that had received a fiber-rich diet before being infected also had some inflammation but across a much smaller area. [Original study]

A thick mucus layer (green), generated by the cells of the colon's wall, provides protection against invading bacteria and other pathogens. This image of a mouse's colon shows the mucus (green) acting as a barrier for the "goblet" cells (blue) that produce it. Credit: University of Michigan

Study after study finds negative health effects from air pollution, such as heart disease (here, here, and here). Now two more studies found that living in areas with high air pollution is linked to a higher stroke risk. One study (done in Japan) found an increase of ischemic stroke on the same day as exposure to high levels of air pollution, while the other (done in London, UK) found a higher risk of death after stroke (especially ischemic strokes) in patients who live in areas of high air pollution. This was especially pronounced with exposure to smaller or fine particulate matter (PM2.5)- which is found in high quantities in vehicle exhaust fumes.

It is thought that the fine particles in the air (PM2.5) contribute to the development of potentially fatal diseases various ways - by causing chronic inflammation, and also because they slip past the body's defenses and can be absorbed deep into the lungs and bloodstream. They are not sneezed or coughed out the way larger natural particles, like airborne soil and sand, are removed from the body's airways. What can be done? Other studies have found that when air pollution is reduced, than the risk of death is reduced. So yes, pollution controls on vehicles such as trucks and buses are good. And just think how much air pollution will be reduced when electric vehicles replace current gas powered cars and trucks. From Medscape:

Air Pollution Linked to Higher Stroke Mortality

More evidence showing that living in areas with high levels of air pollution is linked to a higher stroke risk has come from two new studies. Both studies are published online in the journal Stroke. The first, from the United Kingdom, shows a higher risk for death after a stroke in patients who live in areas of high air pollution, and the other, a Japanese study, suggests a higher risk for a new stroke the same day as exposure to high levels of air pollution.

"We have shown a significantly increased risk of death after stroke in patients who had long-term exposure to high levels air pollution before their stroke occurred," senior author of the UK study, Charles Wolfe, MD.... "This was particularly pronounced for high exposure to smaller particulate matter — particles below 2.5 μm in diameter (PM2.5) — which are found in high quantities in exhaust fumes." For the study, Professor Wolfe and colleagues analyzed data from the South London Stroke Register, a population-based register covering an urban, multiethnic population.....Results showed an increased risk for death up to 5 years after stroke in patients living in areas of high air pollution.

"While this study adds to the evidence linking air pollution to cardiovascular disease, it cannot prove causality as it has an observational design," Professor Wolfe commented...."So it is difficult to say for certain that it is the air pollution that is responsible but there are many studies now that have shown similar associations," he said. He noted that the smaller particles (PM2.5) were associated with a worse effect on mortality and this correlated with biological studies that have shown a greater inflammatory effect of small particulate matter vs larger particulate matter on the vessel wall. "Our study suggests that people who have previously had an ischemic stroke, but not a hemorrhagic stroke, may be more vulnerable and at a higher risk of death to chronic, long-term exposure of PM," they conclude.

The Japanese study, by lead author Ryu Matsuo, MD, PhD, Department of Health Care Administration and Management Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, and colleagues, looked at acute exposure to air pollution and shows a small increase in the risk of having a stroke within a day of high exposure to pollution. For the study, the researchers analyzed data on 6885 ischemic stroke patients from a multicenter hospital-based stroke registry in Japan who were previously independent and hospitalized within 24 hours of stroke onset.

Professor Wolfe said his group have conducted a similar study looking at exposure of air pollution in the year before stroke, which showed a 23% increase in stroke risk in those exposed to higher levels of PM2.5. 

Uh oh - once again a drug taken for a common problem (heartburn) is linked to an unexpected negative health effect (higher risk of strokes). Millions of Americans take proton pump inhibitors  (PPIs) to treat acid reflux and heartburn. They are among the most prescribed drugs in the United States, are frequently taken for long periods of time, and are available over the counter. But according to preliminary research presented at a 2016 American Heart Association conference, these medications may also increase the risk of ischemic stroke. Ischemic strokes, which are the most common type of stroke, occur when a blood clot cuts off blood flow to the brain.

Earlier research has linked proton pump inhibitors to increased risk of dementia in older patients, disruption of gut microbes, increased risk of C. difficile infections, and kidney disease. Stomach acid seems to play a role in the normal balance of microbes in the digestive system. When someone takes PPIs it lowers their amount of stomach acid, and so disrupts the gut microbial community (and these changes last for at least a month after discontinuing the drug).

The research was conducted in Denmark among a quarter-million patients who suffered from stomach pain and indigestion, and were taking one of four PPIs: Prilosec, Protonix, Prevacid or Nexium. Overall, they found that ischemic stroke risk increased by 21% among patients who were taking a PPI. The researchers found either no increased risk or minimal increased risk of stroke when taking low doses of PPIs. But at the highest doses of PPIs, they found that stroke risk increased from 30% (Prevaacid) to a high of 94% (Protonix). Another group of medications used to treat heartburn - called H2 blockers - were not linked to increased stroke risk.

Hey, what this research suggests is that not everything should be treated with pills. Medical professionals agree: the safest and best way to reduce heartburn is by making some lifestyle changes. Eat smaller meals (and not right before bedtime), lose weight if needed, don't eat very fatty meals, drink less alcohol, and don't smoke. From EurekAlert:

Popular heartburn medication may increase ischemic stroke risk

A popular group of antacids known as proton pump inhibitors, or PPIs, used to reduce stomach acid and treat heartburn may increase the risk of ischemic stroke, according to preliminary research presented at the American Heart Association's Scientific Sessions 2016.

"PPIs have been associated with unhealthy vascular function, including heart attacks, kidney disease and dementia," said Thomas Sehested, M.D., study lead author and a researcher at the Danish Heart Foundation in Copenhagen, Denmark. "We wanted to see if PPIs also posed a risk for ischemic stroke, especially given their increasing use in the general population." Ischemic stroke, the most common type of stroke, is caused by clots blocking blood flow to or in the brain.

Researchers analyzed the records of 244,679 Danish patients, average age 57, who had an endoscopy -- a procedure used to identify the causes of stomach pain and indigestion. During nearly six years of follow up, 9,489 patients had an ischemic stroke for the first time in their lives. Researchers determined if the stroke occurred while patients were using 1 of 4 PPIs: omeprazole (Prilosec), pantoprazole (Protonix), lansoprazole (Prevacid) and esomeprazole (Nexium).

For ischemic stroke, researchers found:Overall stroke risk increased by 21 percent when patients were taking a PPI. At the lowest doses of the PPIs, there was slight or no increased stroke risk. At the highest dose for these 4 PPI's, stroke risk increased from 30 percent for lansoprazole (Prevacid) to 94 percent for pantoprazole (Protonix). There was no increased risk of stroke associated with another group of acid-reducing medications known as H2 blockers, which include famotidine (Pepcid) and ranitidine (Zantac).

Authors believe that their findings, along with previous studies, should encourage more cautious use of PPIs. Sehested noted that most PPIs in the United States are now available over the counter. Doctors prescribing PPIs, should carefully consider whether their use is warranted and for how long: "We know that from prior studies that a lot of individuals are using PPIs for a much longer time than indicated, which is especially true for elderly patients."