The next time you have a check-up, don’t be surprised if your doctor hands you a prescription to walk. Yes, this simple activity that you’ve been doing since you were about a year old is now being touted as “the closest thing we have to a wonder drug,” in the words of Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention.

Of course, you probably know that any physical activity, including walking, is a boon to your overall health. But walking in particular comes with a host of benefits. Here’s a list of five that may surprise you.

1. It counteracts the effects of weight-promoting genes. Harvard researchers looked at 32 obesity-promoting genes in over 12,000 people to determine how much these genes actually contribute to body weight. They then discovered that, among the study participants who walked briskly for about an hour a day, the effects of those genes were cut in half.

2. It helps tame a sweet tooth. A pair of studies from the University of Exeter found that a 15-minute walk can curb cravings for chocolate and even reduce the amount of chocolate you eat in stressful situations. And the latest research confirms that walking can reduce cravings and intake of a variety of sugary snacks.

3. It reduces the risk of developing breast cancer. Researchers already know that any kind of physical activity blunts the risk of breast cancer. But an American Cancer Society study that zeroed in on walking found that women who walked seven or more hours a week had a 14% lower risk of breast cancer than those who walked three hours or fewer per week. And walking provided this protection even for the women with breast cancer risk factors, such as being overweight or using supplemental hormones.

4. It eases joint pain. Several studies have found that walking reduces arthritis-related pain, and that walking five to six miles a week can even prevent arthritis from forming in the first place. Walking protects the joints — especially the knees and hips, which are most susceptible to osteoarthritis — by lubricating them and strengthening the muscles that support them.

5. It boosts immune function. Walking can help protect you during cold and flu season. A study of over 1,000 men and women found that those who walked at least 20 minutes a day, at least 5 days a week, had 43% fewer sick days than those who exercised once a week or less. And if they did get sick, it was for a shorter duration, and their symptoms were milder.

One night, you're in a bad neighborhood. A grungy thug comes out of nowhere and starts chasing you down the block. Suddenly, you are able to run faster and longer than you thought you ever could. And this is because your sympathetic nervous system has taken charge, which stimulates your adrenal glands to work harder.

But say you have a work assignment that is due the next day, the baby is crying even though you need to get dinner ready for your guests, your other child is screaming at you, and the TV is on full blast in the other room. Your body still interprets this as being under severe stress. The sympathetic nervous system has a hard time shutting off, the adrenal glands are overworking, and problems occur. Unfortunately, modern life often has overstimulation and a lot of pressures and difficulties that keep the sympathetic nervous system in fight-or-flight mode continually.

So where exactly are the adrenal glands? The kidneys are located in the lower back region, right around the second lumbar section of the spine just under your waistline, depending on the person. The adrenal glands are situated right above the kidneys.

The body is a whole universe with an extensive communication network. The body's nervous system breaks down into two parts: the central nervous system and the peripheral nervous system. The autonomic nervous system is part of the peripheral nervous system. The autonomic nervous system is responsible for involuntary movements and actions. It controls heartbeats, breathing, digesting, sweating, crying, etc. It is divided into the sympathetic and the parasympathetic nervous systems.

The sympathetic nervous system controls the fight-or-flight response. This means how your body responds to emergency and stressful situations. When the sympathetic nervous system is switched on your parasympathetic nervous system is switched off so that your body can cope with the emergencies more efficiently. When the sympathetic nervous system is on your heart rate increases, you sweat, your pupils dilate, and your body shuts down your digestion system so that it can focus on dealing with the emergency.

The parasympathetic nervous system kicks in when the sympathetic nervous system switches off. Your heart rate returns to normal, your digestion system starts back up, and body functions return to normal.

Although the nervous system's main communicators as neurons, the endocrine system's main communicators are chemical messengers known as hormones. Hormones are carried in the bloodstream to specific areas of the body, including organs and body tissues. Some of the most important endocrine glands include the pineal gland, the hypothalamus, the pituitary gland, the thyroid, the ovaries, and the testes.

When the sympathetic nervous system has been in flight-or-fight too long, it affects the hormones of the adrenal system. Too little or too much of the hormones can lead to adrenal fatigue and because of the way this fatigue impacts the body, it can lead to illness. This process of adrenal fatigue does not happen all at once. Instead, it is a gradual breakdown in the body.

The Three Phases of Stress

In 1956, endocrinologist Dr. Hans Selye developed a key concept in the study of stress and its effects on the body, which he termed, the general adaptation syndrome. In the general adaptation syndrome, the body passes through three phases in the way it copes with stress:

1. Alarm Phase
2. Resistance Phase
3. Exhaustion Phase

1. Alarm Phase
In the alarm phase, the adrenal glands increase the amount of hormonal secretions in an attempt to maintain homeostasis (normal functioning of the body). The sympathetic nervous system is in excess. When the sympathetic nervous system is on and the parasympathetic nervous system is off, there will be a deficiency with digestion, the sex organs, the urinary tract, and less energy is being sent to these systems in order to deal with the more immediate crisis. That means blood is shunted away from hands, skin, feet, and the digestive tract (stomach and intestines) to the brain and the immediately important organs in the torso like the heart.

This can cause those raised knotted shoulders, tight upper back and neck, chills along the spine, clammy hands, cold feet, increased heart rate, a tight locked pelvis, and tight leg muscles. A good example of this is in someone who has just had a car accident - a hugely stressful event. Just as their body responds to stress by causing the upper back and legs to tighten, the muscles are jerked quickly, causing injury that can take time to heal. On the other hand, the body does this to stay alive, so that the heart can keep pumping blood even under poor circumstances, and so the person won't feel pain as quickly - that's the beauty of the sympathetic nervous system's response. In the alarm phase, stress is relatively short lived and the return back to homeostasis is with ease.

A list of what happens during a fight-or-flight response:

• The sympathetic nervous system response goes into excess as the body mobilizes by bringing large amounts of glucose and oxygen to the organs to ward off danger.
• Non-essential parasympathetic functions like digestive, urinary, and reproductive systems are inhibited.
• Adrenocorticol secretion rises sharply, raising the blood pressure and producing symptoms of sympathetic system hyperactivity.

Symptoms: Shortness of breath, palpitations, emotional instability, headache, back pain, decrease in frequency and quantity of urination, insomnia, lack of appetite, dizziness, nausea, eye pain, cold hands and feet, tight neck and upper back muscles.

Options on how to treat this stage:

• B-Vitamins: B-Vitamins help the body deal with stress better. Deficiencies in B Vitamins can cause muscle cramping and depression, but certain B Vitamins (for example, B-5) are also necessary for adrenal gland function.
• Magnesium: Magnesium can help both the skeletal and smooth muscle cramping that can be experienced as a result of stress. Because magnesium relaxes muscle, it can be helpful for stress-induced Anxiety or asthma attacks, and for lowering blood pressure.
• Electrolytes: After a stressful event or exercise, electrolytes like sodium and potassium can be lowered as well and these electrolytes are necessary for fluid balance in the tissues and regulating transport along cell walls. Also, sodium is closely involved in the regulation of the adrenals. Lack of sodium and potassium can cause swelling, as well as muscle weakness, fatigue, muscle cramps, fatigue, and mental confusion. If you have hypertension, you should check with your doctor about this because there may be a correlation between potassium deficiency and high sodium consumption in the diet of hypertensive patients.
• Vitamin C: Among other reasons to take Vitamin C (there's a list!) ACTH stimulation causes marked loss of ascorbic acid from the adrenal cortex. ACTH is what stimulates cortisol production when there is stress.
• Cutting down on coffee consumption: Coffee stimulates the adrenal glands, so if you are having problems with stress, this would be an important thing to cut down on. Try going without the afternoon cup and just having one cup in the morning.
• Drinking Water: Drinking water is important for treating stress as your body needs it for virtually every function so it's easier for your body to bounce back if it's hydrated. If you haven't been drinking water, you can begin drinking more along with taking in essential fatty acids and lecithin.
• Lecithin: Lecithin helps cell walls repair tissue and helps organ hydration and function.
• Essential fatty acid (EFA): EFAs attract water to dehydrated cells and connective tissue and maintain cell hydration.
• Meditation: Meditating for at least 5 minutes a day will help the body to relax, mitigating the effects of stress and keeping you from moving to stage 2.
• L-Theanine: If you have sudden high spikes of stress leading to extreme stress symptoms this is a great supplement. A good example is if you have test Anxiety, panic attacks, extreme sweating, and blanking out in stressful situations. L-Theanine is an amino acid taken from tea leaves, such as green tea, that creates a sense of relaxation 40 minutes after ingestion. This works in two different ways. It stimulates the production of alpha brain waves, creating a state of deep relaxation and mental alertness similar to what is achieved through meditation. It is also involved in the formation of gamma amino butyric acid (GABA), which influences two other neurotransmitters, dopamine and serotonin, producing the key relaxation effect.
• Rhodiola Rosea root: Rhodiola rosea root supports the functioning of the adrenal glands and encourages a healthy response to physical, emotional, and mental stress by normalizing cortisol levels and other stress-related hormones. If used regularly, it enhances the body's natural resistance and adaptation to stressful influences. In some people it can make you hyper, so take with caution.

2. Resistance Phase
According to Hans Selye, M.D., traumatic situations cause an elevated function of the adrenal glands. If this elevated activity is prolonged, the adrenal gland will be overworked and become exhausted, and thus be unable to release adequate amounts of adrenal hormones, such as cortisol and epinephrine.

In the resistance phase, constantly reacting to stress leaves the body depleted, leading to a general decrease in overall resistance to illness, inflammation, and pain. Stress is wearing the body out even though the body is still resisting it. There is constant energy being sent by the adrenals and sympathetic nervous system to only the most important organs for a flight-or-fight circumstance. For example, since digestion is a parasympathetic function, undigested food begins to enter the colon, causing gas and bloating, and as the body can't pull the nutrients out of food as efficiently, there are less number of important nutrients to keep the body healthy and pain free. Secretion of the adrenal hormones is initially still high, but slows down as they begin to wear out. The sympathetic nervous system weakness leads to sympathetic deficiency. The parasympathetic nervous system begins to become more dominant as it attempts to compensate.

The parasympathetic nervous system will switch on and take over, but not because the sympathetic nervous system has switched off, but because it's so exhausted that the parasympathetic nervous system has to pick up the slack so the body can function. What occurs is a constriction of blood vessels such as capillaries and arteries in the brain, excitement of the digestive system, and adrenal gland deficiency along with a whole host of problems listed below.

What happens during the Resistance Phase?
-Parasympathetic dominance
-Sympathetic exhaustion
-Adrenal gland exhaustion

What kind of patient has moved from the Alarm Phase to the Resistance Phase?

• The adrenal gland exhaustion sign is most active on those who have suffered or are suffering from shock, trauma, or extreme stress.
• This could be a person under chronic stress, who has a sudden trauma or a big life change.
• This could be a person under chronic stress who has had past trauma that still challenges them in some way (car accidents, sexual abuse, child abuse, psychological abuse, fear of death).
• People may have also had many children or many abortions, have had surgery(s), a history of chronic disease and pain. Also, drug abuse or a history of strong medication can lead to this stage.

Symptoms:

• Feeling tired, low back pain, shoulder pain and muscular tightness in whole body. Other symptoms include lack of sweat (except on palms of hands), cold lower back, cold abdomen, cold extremities.
• Upper respiratory tract symptoms: Constriction of airways and wheezing, shortness of breath and coughing. Allergic asthma may have presented itself in the alarm phase but is more typical in the resistance phase.
• Urinary Tract symptoms: Parasympathetic system dominance can stimulate contraction of the bladder, causing frequent urination.
• Gastrointestinal symptoms: abdominal pain, cramps, diarrhea, excessive salivation and gas.

Options on how to treat this stage:

All the recommendations from Stage 1 will help, but here are a few more for the more severe stage 2. All of these should be checked out with a doctor first as you may be having more severe symptoms stemming from stress (for example, high blood pressure):

• Holy Basil: Holy Basil is an Ayurvedic herb that supports a healthy response to stress, nourish the mind, and elevate the spirit. It contains a variety of constituents, including eugenol, camphor, caryophyllene, ursolic acid, luteolin and apigenin that function collectively to normalize stress hormones and enhance adrenal function.
• Ashwaganda: Ashwaganda is an Ayurvedic herb and an adaptogen that supports mental and physical Vitality and stamina. It contains steroidal compounds and additional chemical constituents that advance the body's natural resistance and adaptation to stressful influences. It supports mental endurance, promotes total metabolic efficiency and encourages an overall sense of well-being.
• Schizandra berries: Schizandra (Wu Wei Zi in Chinese medicine) is an adaptogen that promote overall health and Vitality, enhances the body's natural resistance to stressful influences, supports mental endurance and promote overall metabolic efficiency. This is also an astringent herb, so it may help if diarrhea and having to urinate too often are symptoms.
• Try different relaxation techniques: Meditation, deep breathing, long hot baths, relaxing yoga classes, journaling. You need to find something that relaxes you that you can do every day. This seems simple but is a great help for your body.
• Avoid sodium: Avoid sodium if high blood pressure is a symptom. In restoration of the adrenal gland function, typically one should include potassium rich foods and avoid foods that are too high in sodium.
• Cut out coffee completely: Coffee stimulates the adrenal glands and in this phase, they are over-stimulated. At this point, you need to do everything you can to calm them, so this is the time where you actually should consider not just cutting down on coffee, but quitting entirely.
• Cut out smoking: Smoking inhibits the ability of your lungs to breathe so it can be really important to quit at this phase.
• Cut out or significantly lower sugar: The injury to the sympathetic nervous system and adrenal gland weakness can affect the way your body metabolizes glucose. This may be especially important if you are diabetic (chromium increases the ability of your body to metabolize glucose, so this may be something to look into if that's a problem). Sugar will also increase inflammation.
• Watch out for inflammation symptoms: Increases in body pain, sudden muscular tension, allergy attacks, and new food allergies - all of these are signs of inflammation which are common in this stage. Turmeric /curcumin can help with this, as can essential fatty acids, but the inflammation may be happening because stress is affecting the body.
• Ginger: Ginger is very warming, and if you are constantly feeling cold due to stress, this would be a great tea to make you can buy ginger at any grocery store and slice a few pieces to make tea out of. It works in soups too.
• Bitters: Bitters might be good to take at this time if digestion and elimination is a large problem.
• Overstimulation: If you are experiencing an inability to relax even when exhausted, you might try making a tea out of linden flowers, skullcap, passionflower, and chamomile, but make sure you aren't driving and have a night of relaxation and sleep ahead of you.

Stage 3: Exhaustion Stage
- This stage occurs only when stress is extremely severe or when it continues over a long period of time.
- If stress continues to this level, cortisol secretion increases above normal rate and may even surpass levels produced by alarm reaction. However, the body's adaptive mechanisms are not adapting, they are decreasing.
- The body is not able to successfully cope with the stressor.

Possible Consequences of Exhaustion Phase:

• Arthritis, arteriosclerosis, nephrosclerosis, gastrointestinal ulcers, hypertension, etc.
• Prolonged exposure to high levels of cortisol and other hormones involved in the resistance reaction causes wasting muscle, suppression of immune system, and pancreatic beta cells.
• Even if changes are made in lifestyle now, resistance reactions persist even after stressor is gone.
• Serious diseases like Cushing's syndrome and adrenal diabetes may occur.
• Due to the fact that the body's systems are very much out of homeostasis, a multitude of problems may now occur and so we won't discuss natural remedies and supplements as this is the more emergency stage where you must work with a doctor.

Sources

- Bodymind Energetics Towards a Dynamic Model of Health. By Mark Seem, Ph.D.
- Kiiko Matsumoto's Clinical Strategies Volume 1. By Kiiko Matsumoto and David Euler
- Principles of Anatomy and Physiology. By Tortora and Derrikson
- The Ciba Collection of Medical Illustrations, Volume 4, Endocrine System and Selected Metabolic   Diseases. By Frank H. Netter, M.D.
- Color Atlas of Human Anatomy. By R.M.H. McMinn and R.T. Hutchings
- The Stress of Life. By Hans Selye, M.D.
- Natural Health Complete Guide to Medicinal Herbs. By Penelope Ody, MNIMH
- Medical Nutrition From Marz, 2nd Edition. By Russell B. Marz, N.D., M.Ac.O.M

More Heart-Healthy Advice

Stroke is the interruption of blood to the brain. This may be due to blockage of a blood vessel in the brain or rupture of a blood vessel, causing bleeding in the brain or into the space surrounding the brain. The most common type of stroke is ischaemic, caused by a blood clot blocking an artery or blood vessel. The brain cells in the immediate area die and those in the surrounding areas are affected by the reduced blood flow. Once brain cells die, their functions die with them.

An estimated 150,000 people have a stroke in the UK each year.Stroke accounts for around 53,000 deaths each year in the UK. Stroke is the third most common cause of death in England and Wales, after heart disease and cancer. Stroke accounts for 9 per cent of all deaths in men and 13 per cent of deaths in women in the UK. Stroke has a greater disability impact than any other chronic disease. Over 300,000 people are living with moderate to severe disabilities as a result of stroke. The direct cost of stroke to the NHS is estimated to be £2.8 billion. The cost to the wider economy is £1.8 billion. The informal care cost is £2.4 billion. Stroke patients occupy around 20 per cent of all acute hospital beds and 25 per cent of long term beds. Stroke units save lives: for stroke patients general wards have a 14% to 25% higher mortality rate than stroke units. Each year over 130,000 people in England and Wales have a stroke. About 10,000 of these are under retirement age.

Stroke is influenced by different risk factors. Some of these – age, gender and family history – are beyond your control. However, you can substantially reduce your overall risk by making healthy changes to your diet and lifestyle.

TIA or transient ischaemic attack
A transient ischaemic attack (TIA) is often called a ‘mini stroke’. It is a powerful warning that a severe stroke may follow. The symptoms are identical to those of a full stroke, but disappear in a few minutes and last no longer than 24 hours. A TIA can appear hours, days, weeks or months before a full stroke but is more common within days or a few weeks. Just like full strokes, TIAs need emergency treatment and should not be ignored.

Warning signs
Stroke is a medical emergency. The longer a stroke remains untreated, the greater the degree of stroke-related brain damage. The warning signs of both stroke and TIA include:

• Sudden blurred or decreased vision in one or both eyes

• Numbness, weakness or paralysis of the face, arm or leg

• Difficulty speaking or understanding

• Dizziness, loss of balance

• Difficulty swallowing

• Severe headache.

High blood pressure
Blood pressure is a measurement of the force your blood puts on blood vessel walls as it travels through your body. High blood pressure is medically known as ‘hypertension’ and is one of the most important risk factors in stroke.

Normal blood pressure is around 120/80. High-normal blood pressure is between 120/80 and 140/90. If your blood pressure is consistently over 140/90, you have high blood pressure. The levels for normal blood pressure are a guide only. In general the lower your blood pressure, the lower your risk of stroke. Your doctor can talk to you about your blood pressure and risk of stroke and may recommend treatment if required.

You can control hypertension by reducing your weight, exercising regularly, eating a low salt, low fat and high fibre diet, and taking antihypertensive medication (if necessary).

Cigarette smoking
Smoking can increase your risk of stroke by increasing blood pressure and reducing oxygen in the blood. Seek advice on how to quit smoking by calling the NHS Free Smoking Helpline: 0800 022 4 332 Monday to Friday 9am to 8pm, Saturday and Sunday 11am to 5pm for guidance and support.

Diabetes
Diabetes can damage your entire circulatory system and is a risk factor for stroke. Type 1 usually occurs from a young age and is treated with insulin injections. Type 2 usually occurs from 30 years of age onwards and is treated with either tablets or, in some cases, insulin. Talk to your doctor about controlling diabetes if you are diabetic.

Other important risk factors
Other factors that can increase your risk of stroke include:

High cholesterol
High cholesterol is a contributing factor to blood vessel disease, which often leads to stroke. To reduce cholesterol in your blood, eat foods low in saturated fat. Choose lean meats and low fat dairy products. Your doctor may prescribe medication to lower your cholesterol but diet changes and exercise are still important.

Obesity
Being overweight or obese can increase the risk of stroke. Too much body fat can contribute to high blood pressure and high cholesterol and may lead to heart disease and type 2 diabetes. If you are unable to maintain your weight within recommended levels, ask a doctor or nutritionist for help.

Alcohol
Your risk of stroke may be reduced with moderate alcohol intake (one to two glasses a day). Excessive amounts of alcohol can raise blood pressure and increase your risk of stroke.
Diet and exercise
A diet low in fat and salt will reduce your risk of stroke. Eating a balanced diet of fresh foods (wherever possible) is recommended. Avoid processed or canned foods as they can be high in sodium, or salt. Check a food’s sodium content in the list of ingredients on the label (low salt food has a level of less than 120mg/100g).

A good balance between exercise and food intake is important to maintain a healthy body weight. People who participate in moderate activity are less likely to have a stroke. Try to build up to at least 30 minutes of moderate physical activity most days of the week. Talk to your doctor about an exercise program – people with high blood pressure should avoid some types of exercises.

Irregular pulse (atrial fibrillation)
You are more at risk of stroke if you have an irregular pulse due to the condition atrial fibrillation (AF). Your doctor can diagnose this condition and advise you on how best to manage this if it happens. If you experience symptoms such as palpitations, weakness, faintness or breathlessness, it is important to see a doctor for diagnosis and treatment.

Risk factors beyond your control
Stroke is influenced by some risk factors that are outside a person’s control. These include:

• Age – the majority of people who suffer from stroke are 65 years or older.

• Gender – men are at higher risk than women.

• Family history – a family history of cerebrovascular disease may make you more susceptible to stroke.

Statistics on stroke
Each year over 130,000 people in England and Wales have a stroke:

• One in three people die within a year of having a stroke.

• Stroke kills more women than breast cancer.

• Almost one in five people who experience a stroke are under the age of 55.

• Men are more likely to suffer a stroke and at a younger age.

Things to remember

• Stroke may occur due to blockage of a blood vessel in the brain or rupture of a blood vessel, causing bleeding in the brain or into the space surrounding the brain.

• Many strokes are avoidable and can be caused by unhealthy diet and lifestyle choices.

• Some of the major risk factors for stroke include high blood pressure, cigarette smoking and diabetes.

Stroke prevention

Strokes can be fatal but the risk can be reduced. Many stroke risk factors are lifestyle related, so everyone has the power to reduce their risk of having a stroke. Some stroke risk factors, such as gender, age and family history, can’t be controlled.

Lifestyle factors that increase your risk of stroke include high blood pressure, smoking, diabetes, high blood cholesterol levels, heavy drinking, a diet high in salt and fat and lack of exercise. You can reduce your risk of having a stroke by making a few simple lifestyle changes.

Causes of stroke
‘Stroke’ is a term used to describe the interruption of blood flow to an area of the brain. This can occur in the following ways:

• Haemorrhagic stroke – an artery may rupture and cause bleeding into the brain tissue.

• Ischaemic stroke caused by atherosclerosis – an artery may become blocked by progressive thickening of its walls.

• Ischaemic stroke caused by embolism – a clot blocks an artery and prevents blood getting to part of the brain.

The brain cells in the immediate area are killed because they are deprived of oxygen. The dead area that results from stroke is known as an infarct. Without prompt medical treatment, the area of brain cells surrounding the infarct will also die.

Risk factors
Some stroke risk factors can’t be controlled. These include gender, age and family history. However, many stroke risk factors are lifestyle related. Everyone can reduce their risk of having a stroke by making a few simple lifestyle changes.

Lifestyle-related factors that increase your risk of stroke include:

• High blood pressure

• Cigarette smoking

• Diabetes

• High blood cholesterol levels

• Heavy drinking

• High fat, low fibre diet

• Lack of exercise.

It has been reported that the use of some birth control pills may increase a woman’s risk of stroke, but the evidence is limited.

Reduce high blood pressure
High blood pressure (hypertension) is the most significant risk factor for stroke. Blood pressure refers to the pressure inside the arteries. Hypertension means that the blood is exerting more pressure than is normal or healthy. Over time, this weakens and damages blood vessel walls, which can lead to cerebral haemorrhage.
Hypertension may also cause thickening of the artery walls, resulting in narrowing and eventual blockage of the vessel (ischaemic stroke). In atherosclerosis (hardening of the arteries), the pressure of your pumping blood could ‘hose off’ debris from damaged artery walls. The circulating debris (embolism) can cause a stroke by lodging in and blocking a blood vessel of the brain.

Strategies to reduce high blood pressure include:

• Check your blood pressure regularly and know your numbers.

• Maintain a healthy weight for your height.

• Exercise regularly.

• Choose a low fat, high fibre diet.

• Reduce or eliminate salt from your diet.

• Limit your alcohol intake to two or less standard drinks per day.

• Stop smoking.

• Take antihypertensive medications to help control high blood pressure.

Quit smoking
Smoking can double or even quadruple your risk of stroke. Some of the chemical ingredients in cigarette smoke (such as nicotine and carbon monoxide) accelerate the process of atherosclerosis. Clots are more likely to form because smoking thickens the blood and makes clotting factors, such as platelets, much more ‘sticky’. Cigarette smoke forces arteries to constrict – a narrowed diameter makes it harder for the thickened blood to move through the vessels.

Strategies to quit smoking include:

• Seek advice on how to quit smoking by calling the NHS Free Smoking Helpline: 0800 022 4 332 Monday to Friday 9am to 8pm, Saturday and Sunday 11am to 5pm for guidance and support or see your doctor for information and advice.

• Decide on a strategy, such as ‘cold turkey’ or using nicotine replacement therapy.

• Keep a smoking diary so that you are aware of your smoking triggers (such as stress or boredom).

• Decide on a quit date.

• Ask your family and friends for support.

• Don’t be discouraged by a slip-up. If you smoke a cigarette, put it behind you and keep going.

Manage your diabetes
Diabetes is a chronic condition in which the body is unable to utilise blood sugar. A person with diabetes is around twice as likely to have a stroke as someone of the same gender and age who doesn’t have diabetes. This is because the high blood sugar levels contribute to the development of atherosclerosis. It is very important that diabetes be kept under control.

Strategies to reduce the effects of diabetes include:

• See your doctor regularly for check-ups.

• Monitor your blood sugar levels regularly.

• Maintain a healthy weight for your height.

• Exercise regularly.

• Choose a low fat, high fibre diet.

• If you are on medication, make sure you are taking it correctly.

Keep cholesterol levels in check
Cholesterol is a fat-like substance that is made by the human body. It has many essential roles to play, but it becomes a problem if levels in the blood are too high. Blood cholesterol contributes to the formation of a substance called atheroma, which sticks to artery walls and leads to atherosclerosis.

Strategies to lower blood cholesterol levels include:

• Have your blood cholesterol levels checked regularly by your doctor.

• Switch to a high fibre diet.

• Reduce your intake of saturated fats (commonly found in animal products).

• See your doctor for information and advice. Medications may be recommended.

Avoid heavy drinking
Some studies have indicated that drinking moderate amounts of alcohol (such as one or two standard drinks per day) can actually reduce the risk of stroke. However, people who drink heavily are three times more likely to have a stroke, regardless of their age. It is important to limit your alcohol intake.

Suggestions include:

• Limit your consumption to no more than two standard drinks per day.

• Have at least two alcohol-free days every week.

• See your doctor for information and referral if you are finding it difficult to limit your alcohol intake.

Eat a healthy diet
Various studies show that diet is an important risk factor in the development of stroke. Suggestions include:

• Limit or moderate salt intake.

• Choose fresh rather than processed foods.

• Increase your intake of vegetables, fruit and whole grains.

• Cut out or reduce sugary and fatty foods like cakes, lollies and junk food.

• See a dietitian who can help you plan a well-balanced low fat, high fibre diet.

Exercise regularly
A sedentary lifestyle increases the likelihood of obesity, high blood pressure and high blood cholesterol levels. These are all important risk factors for stroke.

Suggestions include:

• See your doctor for a check-up if you haven’t exercised for a while.

• Choose a range of activities you enjoy.

• Start your new exercise program slowly and only increase the intensity and duration as you become fitter.

• Exercise with a friend or join a team sport to add a fun social element to the activity.

• Remember to warm up and cool down.

• Contact a physiotherapist or gymnasium instructor for advice and information regarding appropriate exercise.

• Try to get moderate exercise for at least 30 minutes on (at least) five days of the week.

Things to remember

• A stroke interrupts blood flow to an area of the brain.

• Most stroke risk factors are lifestyle related, so everyone has the power to reduce their risk of having a stroke.

• Some stroke risk factors, such as gender, age and family history, can’t be controlled.

• Lifestyle factors that increase your risk of stroke include high blood pressure, smoking, diabetes, high blood cholesterol levels, heavy drinking, high salt and high fat diet and lack of exercise.

Salt

Salt is a chemical compound (electrolyte) made up of sodium and chloride. It is commonly used to preserve and flavour foods, and is the main source of sodium in our diet. A small amount of salt is important for good health – it helps to maintain the correct volume of circulating blood and tissue fluids in the body. However, most people consume much more sodium than they need for good health.

The kidneys are the main regulators of sodium levels in the body. Too much sodium can cause high blood pressure and many other health conditions. On the other hand, if sodium levels drop too low, the hormone aldosterone is released and this increases the amount of sodium held in the body by reducing the amount lost in urine. Excessive sodium loss is very rare, but low sodium levels in the body can be dangerous if not treated.

Many of us in the UK eat much more salt than we need
As part of its continued drive to reduce people’s risk of developing coronary heart disease, the Food Standards Agency has today published revised, voluntary salt reduction targets for industry to meet by 2012. More challenging targets for 2012 have been set for 80 categories of foods, to ensure the momentum in reducing salt levels is maintained by food retailers and manufacturers. The revised targets also reflect the Agency’s long-term commitment to reducing the daily average population intake of salt to 6g a day. Around 75% of the salt we eat is already in everyday foods. The targets have been set for foods that make the greatest contribution of salt to our diet, such as bread, meat products and cereals, as well as convenience foods such as pizza, ready meals and savoury snacks.

High sodium intake and blood pressure
The scientific literature linking sodium intake to blood pressure is extensive and dates back more than 100 years. Populations with a high average salt intake have a higher average blood pressure and higher levels of hypertension (high blood pressure).

Reducing the amount of salt you have will lower high blood pressure – the extent depends on your age and blood pressure. People with high blood pressure, diabetes or chronic kidney disease, and those who are older or overweight, are particularly susceptible to the effect of too much sodium on blood pressure. However, sodium reduction may not lower blood pressure in younger people with low or normal blood pressure.

High sodium intake and other health conditions
Excessive sodium intake has also been linked to other conditions, such as:

• Heart failure

• Kidney problems and kidney stones

• Oedema

• Stroke

• Gastric cancer

• Left ventricular hypertrophy

• Osteoporosis.

A high level of salt intake increases the amount of calcium excreted in the urine, which may also contribute to osteoporosis and increased risk of fracture.

The balance of sodium and water in the body can also be disrupted if there is not enough water. This may be caused by a damaged thirst mechanism or by limited access to water. Hypernatremia is a very serious condition that occurs when your sodium levels rise above 145mEq/L. It can lead to death. A major symptom is thirst and treatment usually involves controlled water replacement.
Salt loss is rare but can be dangerous
The body loses salt through urine, perspiration, vomiting and diarrhoea. If too much salt is lost, the level of fluid in the blood will drop. Hyponatremia is a condition that occurs when the sodium in your blood falls below the normal range of 135–145 milliequivalents per litre (mEq/L). In severe cases, low sodium levels in the body can lead to muscle cramps, nausea, vomiting and dizziness. Eventually lack of salt can lead to shock, coma and death.

Severe salt loss is very unlikely to happen because our diets contain more than enough salt. The only time this is likely to occur is when someone has acute gastroenteritis (causing vomiting and diarrhoea), severe sweating or water intoxication (from drinking too much water).

Muscle cramps need water not salt
Some people believe that salt has to be replaced during hot weather or strenuous exercise to avoid muscle cramps. This is not correct. What you need to replace is water. The human body can happily survive on just one gram of salt a day, as hormones keep a check on sodium levels and make adjustments for hot weather. A genuine sodium shortage brought on by hot weather or exercise is extremely rare, even among hard-working athletes.

The muscle cramps that sometimes follow a bout of sweating are due to dehydration, not lack of salt. To prevent cramps, drink plenty of water on hot days and before, during and after exercise. This will also help to even out the water–sodium ratio in the body.

Sodium and potassium in the body
Potassium is important for the nerves, muscles and heart to work properly. It also helps to lower blood pressure. However, some people with kidney disease, or who are taking some medications, need to be careful not to get too much potassium in their diet.

Our bodies are designed for a high potassium diet, not a high salt diet. Food processing tends to lower the potassium levels in many foods while increasing the sodium content. So it is better to eat unprocessed foods such as fruit, vegetables, wholegrain breads and cereals. Foods high in potassium include bananas, apricots, mushrooms and spinach.

Sodium in food
Many foods – whole grains, meat and dairy products – naturally contain traces of sodium, while processed foods tend to contain a lot of salt. Some foods contain higher amounts of salt than you may expect. For example:

• A jam sandwich has approximately 30 per cent less salt that a marmite sandwich because most of the salt comes from the bread.

• Sea salt, onion, celery or garlic salts are not low sodium substitutes.

• A bowl of cornflakes has about the same amount of salt as a small packet of plain chips.

• Some sweet biscuits contain as much or more salt than savoury biscuits.

• Ricotta, cottage, mozzarella and Swiss cheeses are lower in salt than most other cheeses.

Reducing salt in our diet
Some suggestions for reducing the amount of salt in our diet include:

• Avoid adding salt to cooking and at the table.

• Choose reduced salt bread and breakfast cereals – bread is a major source of sodium in the diet.

• Avoid high salt foods.

• Cut back on processed foods.

• Cut back on takeaway and fast foods.

• Buy fresh vegetables rather than canned.

• Buy ‘low salt’ (contains less than 120mg/100g) or ‘salt free’ versions of commonly used foods, such as commercial sauces.

• Use herbs and spices such as garlic, oregano and lemon juice to add flavour to meals.

Fortunately, nutrition labels on food packaging now make this a lot easier. Nutritional information labels are usually on the back of the packaging. Look at the figure for salt per 100g:

• High is more than 1.5g salt per 100g (or 0.6g sodium). May display a red traffic light.

• Low is 0.3g salt or less per 100g (or 0.1g sodium). May display a green traffic light.

Many foods also display information on the salt content on the front of the packaging. This may show the salt content as a percentage of your Guideline Daily Amount, or display a traffic light to show whether the food is low, medium or high in salt. Where traffic lights are used, red means high: leave these foods for an occasional treat, and aim to eat mainly foods that are green or amber.

If the amount of salt per 100g is in between 0.3g and 1.5g, that is a medium level of salt, and the packaging may display an amber traffic light.

Some people believe that sea salt is a healthier alternative to normal table salt, but both are composed of sodium chloride.

Avoid processed foods
High salt foods that should be eaten sparingly include:

• Most ‘fast’ foods, such as pizza

• Most snack foods, such as potato chips

• Processed meats, such as sausages, salami, hot dogs and luncheon meats

• Canned vegetables

• Dehydrated or packet foods, such as instant pasta or soups

• Pre-packaged sauces and condiments, such as tomato sauce and soy sauce, and processed tomato products in general

• White bread and bread rolls.

Iodine
Our bodies need iodine to make sure our thyroid gland and the hormones that regulate our metabolism work normally. Iodised salt is probably the most common source of iodine for Australians and can provide enough iodine to avoid low thyroid activity. Another good way to make sure you get enough iodine is to eat seafood at least once a week.

This is especially important for pregnant women, who may need a dietary supplement, as low iodine may cause intellectual disability for the child. However, some types of fish contain high levels of mercury, which is dangerous to a developing foetus. Take care when choosing the types of fish you eat during pregnancy to reduce this risk.

Vegetarians or people who do not eat seafood can get iodine from multivitamin supplements.

Things to remember

• Salt is needed by the body to help regulate fluid levels.

• You don't have to add salt to food to be eating too much: 75% of the salt we eat is already in food when we buy it.

• A diet high in salt has been linked to high blood pressure.

When exercising, it's important to monitor your intensity to make sure you're working at a pace that is challenging enough to help you reach your goals, but not so hard that you blow a lung. One way to do that is to use a Perceived Exertion Scale. The standard is the Borg Scale of Perceived Exertion, which ranges from 0-20. For everyday workouts we can use the scale outlined below. In general, for most workouts you want to be at around Level 5-6. If you're doing interval training, you want your recovery to be around a 4-5 and your intensity blasts to be at around 8-9. As you'll see below, working at a level 10 isn't recommended for most workouts. For longer, slower workouts, keep your PE at Level 5 or lower.

• Level 1: I'm watching TV and eating bon bons
• Level 2: I'm comfortable and could maintain this pace all day long
• Level 3: I'm still comfortable, but am breathing a bit harder
• Level 4: I'm sweating a little, but feel good and can carry on a conversation effortlessly
• Level 5: I'm just above comfortable, am sweating more and can still talk easily
• Level 6: I can still talk, but am slightly breathless
• Level 7: I can still talk, but I don't really want to. I'm sweating like a pig
• Level 8: I can grunt in response to your questions and can only keep this pace for a short time period
• Level 9: I am probably going to die
• Level 10: I am dead