Black Diarrhea

Black Diarrhea: Could this be internal bleeding?

When you have black diarrhea, your first concern should be internal bleeding. Black diarrhea could be a sign of bleeding in your upper digestive tract. To understand how you get black diarrhea form upper digestive tract bleeding, you need to review the basic anatomy of our digestive tract.

GI tract: black diarrhea

GI tract: black diarrhea

As you can see in the picture, your food pipe goes down to your stomach. Your stomach connects to your small intestine. The upper part of your small intestine is called Duodenum. Your small intestine is about 20 feet long and lies curled up in your abdomen. It connects to your large intestine before opening up into your rectum. The large intestine or colon is about 5 feet long and has three distinct parts, the ascending on the right, transverse in the middle and descending in the left.

Your digestive tract is also called gastrointestinal tract or GI tract. Bleeding in your GI tract is called GI bleeding. GI bleeding is usually divided into two types- upper GI bleeding and lower GI bleeding. Any bleeding that happens in your food-pipe, stomach or upper part of the small intestine is called upper GI bleeding. With upper GI bleeding, blood has to travel at least 25 feet before it shows up in your diarrhea. When going down the pipe, blood gets digested and turns darker and darker. It eventually comes out as black diarrhea. You need to lose at least 2 ounces of blood in your upper GI tract for it to reach all the way down to cause black diarrhea. The amount of time it takes for that blood to make that journey could be as fast as 5 hours or as slow as 20 hours.

Black diarrhea and actual stool color:

black diarrhea stool color

black diarrhea stool color

The actual color of your stool is very important when trying to decide the cause of your black diarrhea. Black diarrhea from bleeding in your upper GI tract is really black. It is not brownish or blackish. Dark stool is not the same as actual black stool. This picture shows how black the black diarrhea from upper GI tract should look like. The consistency of black diarrhea from upper GI bleeding is like that of actual tar, the dark thick flammable liquid used in road making. That is why it is commonly referred as “black tarry stool.” The medical name of black tarry stool is melena. If you have black diarrhea and your stool looks like black tar, you need to be concerned about upper GI bleeding.

Black diarrhea vs. bloody diarrhea:

Black diarrhea is made up of digested blood and usually comes from high up in the digestive tract. If the diarrhea looks like blood, it usually comes from the lower part of the digestive tract. The brightness of the red diarrhea usually corresponds with the proximity of the bleeding point from your rectum. If it is bright red, it could be coming from your rectum or very near your rectum. If it is slightly dull red, it may be coming from a bit higher up in your colon.

However, this rule does not apply if you have a massive upper GI bleeding. When you lose large amount of blood at once, not all of it gets digested as it rushes down the 25 feet pathway. The blood that gets out in your diarrhea may not be black at first. It may even look like fresh red blood.

Now we will look at different specific situations when you may have back diarrhea and what those could mean.

Black diarrhea with dizziness lightheadedness

This is a very dangerous sign. If you have back diarrhea and you feel dizzy and lightheaded, you need to call 911 or have someone take you to the nearest ER right away. When you lose a large amount of blood, the volume of blood still circulating in your body goes down. As long as the blood loss is 10% or less of your blood, your body can compensate for it, and you may not feel anything. Average blood volume of a person is roughly 4/5 of a gallon or about 102 ounces. If you are healthy, you may lose about 10 ounces of blood without feeling anything. However, when you lose more than that, your body may have hard time maintaining good circulation. Your blood pressure starts to go down and your heart starts to beat faster. When that happens, you feel dizzy and lightheaded.

If you are dizzy and lightheaded, and have black diarrhea, that puts you at a serious life threatening emergency in more than one ways. First, having black diarrhea means that the bleeding started at least 4 hours before you noticed it. Second, feeling lightheaded at that point in time means that you are probably still bleeding. If you do not seek emergent care in that situation, your body may collapse quickly. Without treatment, this kind of massive upper GI bleeding can be fatal. Black diarrhea with dizziness and lightheadedness can result from any type of GI hemorrhage discussed below as long as the amount of blood loss is significantly high.

Black diarrhea a day after stomach pain

You had some stomach pain last night. It was a burning pain in the middle of your stomach just below your chest. You felt very nauseated with the pain but did not vomit. You went to bed feeling very sick. You slept well and woke up fresh in the morning. You do not have any pain in your stomach anymore. You feel like you need to have a bowel movement. You go to the toilet and notice large amount of very dark black diarrhea. You do not have any other symptoms and you do not know what you should do next.

That is a common experience of patients presenting with GI bleeding from stomach ulcer. If it is not a massive bleeding, the blood in your stomach may only make you nauseated. You do not always vomit blood. That blood slowly moves down your GI tract. The bleeding may stop on its own after an hour or so. However, you do not notice the black diarrhea until significant time has passed.

You still need to go to ER in this situation because you may start to bleed again. You also do not know how much blood you have already lost. In this situation, the black diarrhea you have may just be the tip of an iceberg. The rest of the blood you lost may still be inside your GI tract. When you lose blood, your first lose blood volume. If you lost 10 ounces of blood you will have 92 (102-10) ounces of blood remaining in your blood vessels. At first, the concentration of red blood cells in your blood stays the same. Your body has about 2.9 gallons of water in the space called extracellular space. This is the space between your blood vessels and your other organ cells. Water can flow in and out between blood vessels and this space. However, it may take up to 24 hours for the extracellular fluid to replace the volume of blood lost.

When your blood volume is restored, your blood becomes dilute. The number of red blood cells in each ounce of your blood goes down. This reduction in concentration of your blood count is called anemia.

You will most likely be admitted to the hospital if you go to ER with black diarrhea. To appreciate the actual degree of blood loss, they will make serial measurements of your blood count while watching you closely. Your first blood count may be normal or near normal despite significant amount of blood loss. They will give you fluid infusions through your veins to restore your blood volume faster. That way, subsequent blood tests will reflect the actual degree of anemia. It helps them prepare for blood transfusion if you need it. They will also start you on medication to decrease the secretion of acid in your stomach. This will help to prevent further bleeding form your stomach ulcer.

Although, we described your black diarrhea a day after stomach pain as stomach ulcer bleeding, you may have exact same presentation with an ulcer in the upper part of your small intestine or duodenum.

Black diarrhea after taking certain medications:

The medications you take can cause black diarrhea in three different ways.

  1. They may increase the risk of bleeding everywhere in your body
  2. They may increase your chance of stomach ulcer
  3. They may color your stool black

Blood thinners such as warfarin increase the chances of bleeding everywhere in your body. Your GI tract is no exception. Here is list of common medications that increase your bleeding tendency:

  1. Coumadin (Warfarin)
  2. Pradaxa (Dabigatran)
  3. Lovenox( Enoxaparin)
  4. Eliquis (Apixaban)
  5. Plavix (Clopidogrel)
  6. Xarelto (rivaroxaban)
  7. Persantine (Dipyridamole)
  8. Effient (Prasugrel)
  9. Brilinta  (Ticagrelor)
  10. Savaysa (Edoxaban)

Certain medications increase your risk of having stomach ulcers and may directly cause upper GI bleeding. Here is a list of such medications:

  1. Naproxen
  2. Ibuprofen
  3. Ketoprofen
  4. Flurbiprofen
  5. Oxaprozin
  6. Diclofenac
  7. Etodolac
  8. Indomethacin
  9. Tolmetin
  10. Sulindac

There are some medications that may color your stool black. If you know you have taken one of these types of medications, you may reassure yourself that your black diarrhea does not represent GI bleeding. The two main types of medications that cause black diarrhea without bleeding are Iron containing medications and Bismuth containing medications.

Here are examples of Iron containing medications that may cause black diarrhea:

  1. Ferretts
  2. Ferrimin
  3. Ferrocite
  4. Hemocyte
  5. BProtected Pedia Iron
  6. Fer-In-Sol
  7. Fer-Iron
  8. FeroSul
  9. Ferro-Bob
  10. FerrouSul
  11. Iron Supplement Childrens
  12. Slow Fe
  13. Slow Iron
  14. Slow R Ferate
  15. Fergon
  16. Elease Iron

Here are examples of Bismuth containing medication that may cause black diarrhea:

  1. Bismatrol Maximum Strength
  2. Bismatrol
  3. Diotame
  4. Geri-Pectate
  5. Kao-Tin
  6. Peptic Relief
  7. Pepto-Bismol To-Go
  8. Pepto-Bismol
  9. Pink Bismuth
  10. Stomach Relief Max St
  11. Stomach Relief Plus
  12. Stomach Relief
  13. Devrom

Symptoms of bronchitis

What is bronchitis?

Bronchitis is inflammation of your bronchi. It is usually caused by bronchial infection. To understand the symptoms of bronchitis, lets look at what bronchi are.

bronchitis symptoms inflammation of bronchi

bronchitis symptoms inflammation of bronchi

The word “bronchi” is the plural form of bronchus. A bronchus is any of the larger branches of the air-pipe that carries air in and out of your lungs. Here is a diagram of your lungs. The main pipe goes down to your lungs and divide into two main branches: the left bronchus and the right bronchus. As you can see in the picture, they give out further branches inside each lung. Any one of these branches is a bronchus. As the bronchi branch out, they become thinner and smoother. When you have bronchitis, the inside of the bronchi get irritated and you have cough. As the irritation gets worse, the inner lining of your bronchi swell up. They produce more mucus and you cough up copious amount of sputum.

What causes bronchitis?

Most of the times, bronchitis is caused by viruses. The same viruses that cause common cold can cause bronchitis. However, some bacteria and other microorganisms have been known to cause bronchitis. Of the virus that cause bronchitis, influenza A and influenza B virus deserve special mention. These are the viruses that cause influenza or the flu. These are important because bronchitis caused by flu virus than be more serious and may need timely and specific treatment.

How do you get bronchitis?

Bronchitis is communicable disease. The organisms that cause bronchitis can be spread out just like common cold. You catch the infection by inhaling the organism that are floating in the air after an infected person coughs or sneezes near you. It can also be transmitted by close contact with the infected person.

However, there are two factors that determine whether you develop bronchitis after catching the bug: your immunity and the contagiousness of the particular organism.

Some viruses are very contagious and successfully produce symptoms of bronchitis in a new host whereas others are less effective in doing so. Your immunity to the particular organism as well as the overall strength of your immune system also play a role in whether you get bronchitis symptoms from the infection.

Symptoms of bronchitis after a common cold

The symptoms of bronchitis may not be different from symptoms of common cold for the first five days. You may start with a runny nose, sneezing and cough. You may feel tired. You may also have sore throat or mild headache or even low grade fever. When we talk about treatment of bronchitis, I will refer to these symptoms as “cold type symptoms”. Most of the times, the only thing distinguishes bronchitis from common cold is the duration of symptoms. When your cough lasts for more than 5 days after an episode of common cold, you have acute bronchitis.

This is why many people think of bronchitis as “chest cold”. When you have bronchitis after a cold, you feel like your cold symptoms have gone deeper into your chest. You start coughing more and produce plenty of phlegm. If you look at the picture of the lungs and your bronchi, you can see that your feeling about bronchitis being a chest cold is correct. The same virus that initially caused irritation and inflammation in your nose and your throat goes down deeper into your chest and cause chest cold or bronchitis. The chest cold symptoms from bronchitis usually last from one to three weeks.

Symptoms of bronchitis from influenza virus

Infection with the flu virus causes more severe symptoms than common cold. It starts abruptly. Unlike common cold, you know the exact time of day your flu symptoms start. You may start with high fever, body aches and fever. You may also have cough, runny nose, sore throat and headache. If your flu gets better after a few days without chest cold symptoms, you may only have uncomplicated flu. When you have worsening cough with lots of phlegm along with other symptoms of flu, you have bronchitis caused by the flu virus. Flu virus can also spread all the way down to your lungs and can cause infection of the lungs called pneumonia.

Symptoms of bronchitis from bacterial infection

Viruses cause most of the cases of bronchitis but there are two important bacteria that may cause symptoms of bronchitis similar to that caused by viruses.

The first one is called Mycoplasma pneumoniae. This is the same bacteria that cause walking pneumonia. However, most infections with this organism only result in bronchitis and not walking pneumonia. In addition to other symptoms of bronchitis, Mycoplasma bronchitis patients frequently complain about cough that won’t go away. Their cough is persistent and mostly dry without much phlegm production. The onset of symptoms is usually very slow and may last for weeks. Some people with bronchitis from Mycoplasma eventually develop walking pneumonia.

The other important bacteria that can cause bronchitis are called Pertussis. This is the same type of bacteria that cause whooping cough. Before widespread vaccination against these bacteria they caused the classic symptoms of whooping cough. However, in the post vaccination era, most people have some immunity against them and they only have persistent distressful cough.

Bronchitis vs. pneumonia

The main difference between bronchitis and pneumonia is the depth of infection. The inflammation from bronchitis is limited to your bronchi but it reaches deeper into the air sacs in your lungs when you have pneumonia. Due to the involvement of deeper parts of your lungs, you may have additional symptoms with pneumonia. You may have shortness of breath or even chest pain with coughs and deep breaths. You may also have fevers and chills with bacterial pneumonia. It is important to distinguish between bronchitis and pneumonia because pneumonia symptoms often required specific treatment.

Acute bronchitis vs. chronic bronchitis

The symptoms of bronchitis we discussed so far are from acute bronchitis. Chronic bronchitis is a whole different disease. When you have daily cough with significant phlegm for at least three months, you may have chronic bronchitis. Unlike acute bronchitis, chronic bronchitis may not be caused by infection. Smoking cigarettes is the most common cause of chronic bronchitis. Other irritants such as dust and fumes may also cause it. People with chronic bronchitis frequently have some degree of airflow obstruction and wheezing on top of cough and phlegm.

Chronic bronchitis is common in smokers and is a part of the Chronic Obstructive Pulmonary Disease (COPD) syndrome. If you want to learn more about chronic bronchitis, you can read this article about smokers cough and COPD.

Treatment of bronchitis symptoms

Chest cough stay home or call doctor

Chest cough stay home or call doctor

Symptoms of bronchitis may or may not need specific treatment depending on the particular situation. In some cases, simple home remedy may suffice. I will review a few specific situations and describe the appropriate coarse of action. Remember, this only applies to you if you are a relatively healthy adult with no medical condition that would compromise your immune system. If you have cancer, HIV or other diseases that can compromise your immunity, you need to call your doctor for any new symptom.

1. Cough with sputum production and cold type symptoms with no high fever: This is most likely viral infection of your upper airway with or without involvement of your bronchus. You do not need any x-ray or specific treatment. You can take over the counter cold medications and drink plenty of fluids at home.

2. Chest cold symptoms after common cold: You still do not need any specific diagnosis or treatment if you are an otherwise healthy adult. You can simply take Aspirin or Tylenol at home. However you need to see your doctor if you have any of these symptoms associated with your chest cold: fevers, chills, weakness, wheezing, chest pain or shortness of breath.

3. Abrupt onset chest cold with fever during the flu season: This could be influenza. If your symptoms are severe, seek medical attention as soon as you can. If you get diagnosed within 48 hours, you may benefit from specific antiviral treatment

4. Chest cold symptoms with constant troubling cough that won’t go away: If your symptoms are troubling, it is better to seek medical attention to make sure you don’t have any specific reason for the cough that needs treatment.

What are triglycerides?

What are triglycerides: a review of basic chemistry

Do not worry; I will not be talking “chemistry” here. I will simply explain the basic concept of what triglycerides are made of. I will use plain simple English so that anyone with no prior knowledge of chemistry can understand what triglycerides are. Simply speaking, triglycerides are fats, plain and simple. They are household substances present everywhere. Here are some examples of triglycerides you can find in the grocery store and kitchen.

What are triglycerides? simply fats

What are triglycerides? simply fats

Triglycerides are called “fat” when they are solid and called “oil” when they are liquid. Animal fat, olive oil, corn oil, butter, whale oil, fish oil, belly fat Chemically, the main component of all these substances is triglycerides.

Why are all these triglycerides so different? They are all made out of different components. Basically they are different triglycerides. The only common component in all the triglycerides is glycerol. It is also a household substance that you may have seen or used. Here is a picture of a beaker of glycerol.

Triglycerides from glycerin

Triglycerides from glycerin

Commercially, it is called glycerin. Chemically, the correct name of Glycerin is Glycerol.

So, what are triglycerides made of? You do not need any sophisticated knowledge of chemistry to understand what triglycerides are made of. It is very simple. Just remember “Tri” and “Glycerin”. It is made up of three fatty acids and one glycerol.

Fatty acid 1Fatty acid 2Fatty acid 3 + Glycerine = Triglycerides

So, what are fatty acids? Fatty acids are the basic components of any fat. What fatty acid that particular molecule of triglyceride is made up of, is what makes it different from any other triglyceride. Each fatty acid in any particular triglyceride can have a unique structure. In, essence, a fatty acid is simply an organic compound made up of carbon, hydrogen and oxygen. The structure and number of oxygen molecules in any fatty acid is the same. It is the number and layout of carbon and hydrogen molecules that give each fatty acid its unique property. The three unique fatty acids present in any molecule of a triglyceride give that particular triglyceride a unique property.

Fatty acid=2 oxygen + x-carbon+ y-hydrogen,

where x and y are different for each unique fatty acid .

In summary, what are triglycerides? Triglycerides are fats, made up of one molecule of glycerin and three molecules of unique fatty acid.

What are triglycerides: a review of fat digestion and absorption

Triglycerides are important in digestion and absorption of fat and related compounds in your digestive tract. The triglycerides in your food cannot enter your blood directly without processing. Your digestive enzymes break the triglycerides down into smaller parts.

Triglycedide breakdown in intestine

Triglycedide breakdown in intestine

As you can see, this breakdown results in free fatty acid and 2-mono-glycerides. If the free fatty acid released from the breakdown of triglyceride in food has less than 12 carbons, it is directly absorbed into the blood. From there, it is taken directly to your liver for processing.

If the fatty acid released has more than 12 carbons, it is too large for direct absorption. It has to be packaged into a special ball. The cells in your small intestine do this actively. They take those fatty acids and the 2 –mono-glycerides and combine them back into triglycerides and package them with cholesterol and special protein into a package called “chylomicron”.

Triglyceride packaged into lipoprotein

Triglyceride packaged into lipoprotein

These packages eventually make their way into your blood. Triglycerides are always carried inside one of these kinds of packages because they do not dissolve in blood. This should mot come as a surprise to you because you already know that triglycerides are basically fat. You know fat and water do not mix. To make triglycerides soluble in water, it has to be packages carefully. Your body makes these packages in a way that the non-water soluble fat is inside the package and does not come in direct contact with water. On the outside, these packages are coated with water-soluble proteins. These proteins are called Apo proteins and these packages are called lipoproteins.

These names may sound very strange and unfamiliar to you but you will soon find that these packages are what make your cholesterol good or bad. When we talk about good cholesterol and bad cholesterol, we are mainly talking about what kind of package that cholesterol is packed in.

Here is brief review of the these terms:

  1. Apo-protein: the protein that encloses fat (triglyceride) and cholesterol to make them soluble in water
  2. Lipo-protein: the whole package of protein, fat and cholesterol. The package is what makes cholesterol good or bad
  3. Chylomicron: A kind of, Apo-protein fat and cholesterol package that carries triglycerides out of your intestine

We do not hear much about Chylomicron because it is not one of the packages that is usually measures when you get your cholesterol checked. This package only exists in your blood to transport triglyceride and cholesterol out of your intensities. Therefore, it only exists in blood after you eat. There are no Chylomicrons in blood when you get your cholesterol checked after an overnight fast. That is exactly why they usually want to you not eat anything in the morning before you get your cholesterol checked.

These particular packages (Chylomicrons) carry triglyceride absorbed from your intestine to three different places:

  1. Fat cells in your body
  2. Muscle cells in your active muscles
  3. Liver

The fat cells open these packages and dissolve them to use the fatty acid again . Muscle cells open these packages and burn the fat as fuel. We will talk about what liver does with these packages in the next section because it is very important.

What are triglycerides and what liver does with them?

Triglycerides in liver may be brand new product manufactured from scratch or could be simply repackaged product made from the package arriving from intestine. When liver opens the package arriving from intestine (Chylomicron), it dissolves it completely. It also breaks down the triglycerides into fatty acids. The fate of these fatty acids will be the same as that of the fatty acid made in liver from scratch.

Your liver can manufacture fatty acids from scratch. You do not have to eat fatty food to have fat inside your body. If you eat more carbohydrate than you can burn, liver weaves those carbohydrate molecules together and manufactures fatty acids from scratch.

Before I explain what liver does with these fatty acids, I want to point out an interesting practical implication of what we just learned so far. We learned that the fat in out food gets packaged out and sent to muscle, fat or liver. If you are active and your muscles are energy hungry, they take up a big chunk of the fat and burn them. If you are sedentary and your liver is already full of fatty acid, your fat cells takes up most of the package and you build up belly fat. This is one of the ways you can build fat deposit in your body. However, you do not need to eat fat to get fat, as you will soon discover.

Your liver has the capability to turn carbohydrate into fatty acid but it also has the capability to break down fatty acid into carbohydrate. Your liver essentially works this based on supply and demand. If your body is active and asking for more fuel, liver breaks down fatty acid and releases them as glucose in the blood. Your muscles then use this glucose as fuel. If you body gets more carbohydrate than it needs, your liver takes up the glucose from your blood and uses it to make fatty acid. Now, you can see that fat deposit in your body depends on how much total calories you eat and how much total calories you burn. It does not depend on how much fat you eat. You don’t need to eat fat to get fat.

triglyceride transport in liver

triglyceride transport in liver

What does liver do with the rest of the fatty acid? It packages them and sends them out. The process is similar to what your intestine did but the packaging is different. Liver uses different kind of Apo-protein than the intestines. Liver packs the fatty acid and cholesterol using this protein to make the package of Lipo-protein. This Lipo protein is called VLDL. Yes, the LDL in VLDL is the LDL that we all recognize as the bad cholesterol. VLDL simply means Very Low Density Lipo-protein. This package, VLDL, is the precursor to the infamous bad cholesterol LDL. LDL simply means Low Density Lipo-protein. VLDLs get out of the liver and circulate throughout the body supplying triglyceride to any body organ that needs it. The body organs dissolve the triglycerides in VLDL and take them up as fatty acids and use them as needed. When enough triglyceride is used up, the density of VLDL gets higher. Cholesterol is heavier than triglyceride. VLDL is made of protein, triglycerides and cholesterol. When the proportion of triglycerides goes down, the density of VLDL goes up and it becomes LDL.

The main function of LDL is to deposit cholesterol in body organs that needs them. It is the bad cholesterol because it promotes the deposition of cholesterol into cells. It can deposit cholesterol into your arteries when there are other risk factors into play. Cholesterol itself is not a bad substance. It is one of the most important raw materials needed for certain organs to make vital hormones and other substances. For example, you testis cannot make testosterone if it does not get cholesterol.

Cholesterol is so essential that your liver makes it from scratch everyday. Your liver can also get rid of used up or excess cholesterol by converting them into bile. Liver then excretes that bile into your intestine. You do not necessarily get high cholesterol by eating diet high in cholesterol. The problem is usually in the packaging and transport of cholesterol. LDL is the bad guy because it can take cholesterol to where it is not needed and cause problems.

What are triglycerides: how excess triglycerides are sent back to your liver

The triglycerides in your fat tissue are there to be used as fuel when needed. When your energy expenditure is not met by your calorie intake, your body signals your fat cells to release their reserve of triglycerides. In response, your fat cells dissolve the triglycerides into fatty acids and tag them with proteins. They are then released into your blood. These are free fatty acids, not triglycerides. They can be taken up and used as fuel in different organs. They can also be taken back to liver. When fatty acids are back in the liver, their fate is again decided by your liver based on your body’s needs.

This essentially sums up what triglycerides are and how they are transported and used in the body. Before I discuss the potential harmful role of high levels of triglycerides, I want to briefly talk about good cholesterol. Although good cholesterol does not have much role in the metabolism of triglycerides, I am sure you are curious about them. It also does not feel right to not talk about good cholesterol after taking about bad cholesterol.

As you may have guessed, good cholesterol is not actually cholesterol. It is the package in which cholesterol is packaged. The HDL or high-density lipoprotein is the cholesterol package that picks up cholesterol from different parts of your body and returns them to your liver. HDLs are the good guys because they essentially clean up the mess left by LDLs. HDLs promote picking up cholesterol from your body when it is not needed. The Apo-protein for making HDL package is made by your liver. However, the assembly of the actual package is complex and occurs in different parts of the body. While making the package the Apo-protein destined to make HDL picks up cholesterol from different places. It also picks up cholesterol from chylomicrons if there is excess cholesterol in it.

When you eat a diet high in cholesterol, that cholesterol is packaged in Chylomicrons along with the triglycerides. The HDL Apo-protein picks them up and prevent them from getting where they are not needed. This dietary cholesterol eventually goes to your liver where its fate is decided based on what your body needs at that time. If your organs need cholesterol to make hormones, liver sends them out with LDL. If they don’t, liver turns them into bile.

Now you understand why HDL is the protective package. It not only promotes removal of cholesterol from tissues but also helps with safe handling of cholesterol in your diet.

What are triglycerides: the potential harmful effects

Just like cholesterol, triglycerides are not harmful substances to begin with. It is the handling and metabolism of triglycerides that has the potential to cause problems. When you get your cholesterol checked, you see numbers for total cholesterol, HDL-the good cholesterol, LDL-the bad cholesterol and a separate number for triglycerides. As you now understand, triglycerides are not cholesterol. It is checked along with cholesterol when your doctor orders a lipid panel. Cholesterol and triglycerides are both lipids, which is another word for fat-like substance.

High levels of triglycerides have been associated with increased risk of plaque formation in your arteries but it is still not clear if they are the cause of those plaques. Some researchers believe that the association is not causative. They think the same defect in your body that causes your triglycerides to get high in the first place is the cause of actual plaque formation. In other words, they think something else causes both plaques and high triglycerides. There is a lot of controversy and conflicting opinion on this topic even among experts. However, recent trend is to think of high triglycerides as a part of the bigger problem and find out what may have caused it. Even the latest guidelines from American Heart Association (AHA) says that if your triglyceride level is higher than 500, your doctor needs to first investigate what might have caused the elevation before simply starting medication to lower it down. On the actual paper, it lists a few possible causes of high triglyceride your doctor needs to think about.

Here are a few of them:

1. Excessive weight gain,

2. Very low fat diets,

3. High intake of refined carbohydrates,

4. Excessive alcohol intake

5. Certain medications

6. Certain kidney problems

7. Uncontrolled Diabetes

8. Thyroid problems

9. Obesity

The one interesting point on the list is about very low fat diet. That may sound surprising but when we look at how our body handles triglycerides, it makes sense. We saw that liver makes triglycerides when our food does not have enough fat. Very low fat diet may stimulate liver to make excessive amount of triglycerides. Also, very low fat diet is usually associated with increased proportion of carbohydrates. When liver gets the excessive carbs, it has to covert them to triglycerides and send them out with VLDL. This can raise your triglycerides.

Overall, triglycerides may play a role in causing plaques in your arteries but they usually do so in collaboration with high LDL or bad cholesterol. If both bad cholesterol and triglycerides are elevated, you need to focus on bad cholesterol (LDL) first and then address the high triglyceride problem. Recent recommendation from many experts is to look at the overall risk of heart disease before making treatment decisions. There is less focus on the numbers than on the overall risk profile.

What are triglyceride levels and how they are measured?

In the United States, the unit frequently used for measurement of triglycerides is mg/dl. That means milligrams per deciliter. A milligram is a one-thousandth of a gram. A deciliter is one tenth of a liter. If your triglyceride, level is reported as 100mg/dl, you have 1 grams (100 x 10 divided by 1000) of triglyceride in every liter of your blood. In US customary units, that translates to about 1/8th of an ounce of triglycerides in a gallon of blood (0.035 divided by 0.264). Since you have about 4/5 of a gallon of blood in your body, a triglyceride level of 100mg/dl also means that you have about 1/10th of an ounce of fat (4/5 times 1/8) running in your body.

From our calculation you see that every 100mg/dl of your triglyceride number corresponds to about 1/10 of an ounce of fat (triglyceride) flowing in your blood. This will help you imagine the amount of fat running in your blood when we talk about specific blood triglyceride levels.

What are triglycerides levels in a normal people? Well, normal is a relative term here. The exact levels of triglycerides vary widely in the general population. Here is the distribution of fasting triglycerides level in the United States based on the latest publish data:

  • People with triglyceride level of 1000mg/dl or more: 0.4%
  • People with triglyceride level of 500mg/dl or more: 1.7% People with triglyceride level of 200mg/dl or more: 18%
  • People with triglyceride level of 150mg/dl or more: 33%

There is no valid, proven, universally acceptable and useful way to classify triglyceride levels into different categories.

Here is an empiric classification used by many authors:

  • Normal fasting triglyceride level: less than 150mg/dl
  • Borderline high fasting triglyceride level: 150-199mg/dl
  • High fasting triglyceride level: 200-499 mg/dl
  • Very high fasting triglyceride level: greater than 500mg/dl

However, this classification is not very useful and gives you false impression about the significance of high fasting blood triglyceride level. I have used “fasting “ level in all discussion related to triglyceride levels because triglyceride levels can vary greatly after a meal. As you remember, fat in your food is carried by the chylomicrons from your stomach into the blood. The triglyceride in chylomicrons can fluctuate based on what kind of meal you had. We do not want to measure this triglyceride. We only want to measure the triglyceride that liver sends out in the VLDL packages because that level is relatively stable in a person.

A more useful classification of high triglyceride is as follows:

  • First category: Serum triglyceride between 150-500mg/dl
  • Second category: Serum triglyceride between 501-1000mg/dl 3.
  • Third category: Serum triglyceride greater than 1000

What are triglycerides: levels between 150mg/dl-500mg/dl

If you are in this category, you need to focus on your overall risk of heart disease than worry about your triglyceride levels. Yes, higher number of triglyceride has known association with increased incidence of heart disease but there is no evidence that it causes heart disease by itself.

The more important fact is: there is no evidence that taking medicine to lower your triglyceride in this category helps to reduce your risk of heart attacks.

From recent years of research, it is clear that bad cholesterol (LDL) reducing medications called statins reduce heart attacks unequivocally. If you have high risk factors for heart attack, they now recommend that you take these medications regardless of your actual cholesterol level. This recommendation applies to you too. The statin medication may not reduce your triglyceride level much but it will reduce your risk of having a heart attack.

Triglyceride level in this range does not need to be reduced with specific triglyceride lowering medication. However, it is beneficial to do other things that reduce both your heart attack risks and your triglyceride level. Unlike bad cholesterol, triglycerides respond very well to lifestyle modification.

Here are some of the proven things you can do reduce your triglyceride as well as reduce your risk of heart attack:

  1. Exercise more
  2. Avoid low fat diet
  3. Reduce intake of processed carbs
  4. Stop smoking
  5. Decrease alcohol intake
  6. Lose weigh
  7. Reduce stress

These things sound like common sense or something you would hear in a talk show, but they are certainly more beneficial than taking medication to lower triglyceride just to treat the number. If you need to take medication, take medicine that would attack the bad cholesterol, not triglyceride.

What are triglycerides: levels between 501 and 1000 mg/dl

If your triglyceride level is in this range, you are in the “grey zone.” Your triglycerides are high enough to cause a reasonable concern but not too high to unequivocally recommend starting triglyceride lowering medication right away.

The most important thing you need to do at this level is to work with your doctor to try to find out what may be causing your triglycerides to go up. You need to make sure you do not have any thyroid problems. You need to make sure you do not have undiagnosed diabetes. You need to make sure you are not taking any medication that could raise your triglyceride levels. You need to make sure you do not have any undiagnosed kidney problem.

After you do those things, you need to look at your bad cholesterol level and your overall risk for heart attack. If your bad cholesterol (LDL) is high, take statin. If you have high risks for heart attack, take statin regardless of your LDL level. The next step is to do the 7 things on the list I recommended for people with triglyceride level between 150 and 500mg/dl. After you have done all these things and your triglyceride is still high, you may need to take specific medication to lower triglycerides.

This is a decision you need to take after discussing the pros and cons with your doctor, as there are no unequivocal guidelines.

What are triglycerides: levels higher than 1000mg/dl

If your triglyceride levels are higher than 1000mg/dl, that is definitely not healthy. To give you an idea of what that is like, lets go back and redo our triglyceride level calculations. If your triglyceride level is 1000mg/dl, it means that you have about 1 whole ounce (10 times 1/10 of an ounce) of fat running in your blood. Imagine melting an ounce of butter and pouring it in a bottle containing 4/5 gallon of water. Now imagine shaking that bottle trying to dissolve it in that much water. You can imagine that your water would look milky if you were somehow able to get it dissolved.

high triglyceride milky blood

high triglyceride milky blood

That is exactly how your blood would look if your triglyceride levels were higher than 1000mg/dl. You can look at the color of your blood in the vial when they take it and you may actually see the milky color. That level of fat in your blood is not healthy. If your triglyceride level is that high, you still need to do everything I suggested to people with triglyceride levels between 501 and 1000mg/dl. In addition to that, you may need specific medications to lower your triglyceride level.

What are triglycerides: conclusion

It took me a lot of time and dedication to put together this detailed article about triglycerides. “What are triglycerides?” is a common question I get from my patients. There are a lot of different articles about this subject on the internet but most of them only present a certain opinion or point of view. My goal was to present the whole story about what triglycerides are and what role they play in our body. If this article answered your questions, please share it with your friends and family. If you still have further question, you can ask them in the comment section. I cannot give you specific medical advice about your case but I can answer your general questions about triglycerides and cholesterol.

Water intoxication

water intoxication overview

water intoxication overview

We need water to survive. “Drink plenty of water” is a common health advice you have heard all your life. You have probably heard stories of people dying from lack of water. It is, therefore, hard to imagine that there is such a thing as water intoxication or water poisoning.

Can drinking too much water be harmful? Definitely.

Can you die from drinking too much water? Yes you can, but death by drinking water is very rare.

However, it is relatively common to see people admitted to the hospital after drinking too much water. In my 10 years of treating hospitalized patients, I have personally treated at least 10 patients with water intoxication symptoms. To understand how water intoxication happens and how much water is too much, you need to understand how your body regulates water.

Water intoxication: How your kidneys adapt to fluctuations in water intake

Water intoxication prevented by kidneys

Water intoxication prevented by kidneys

Your water intake fluctuates from day to day. You may drink a gallon of water a day when you are out on a hot sunny day. You many only drink a few cups of water on other days. Your body has a very sophisticated mechanism to adapt to varying amounts of daily water intake.

Your kidneys are the most important organs that maintain water balance. The amount of water in your blood (we will call the water component of the blood “blood water” in this article for convenience) determines its concentration of salt. The concentration of salt (more specifically Sodium; we will use the term salt and sodium interchangeably for this discussion) in blood water is extremely important for the normal functioning of your body organs.

Even a slight change (less than 2%) in blood water salt concentration can make you very sick. When the salt concentration in blood water goes down, water goes inside your organ cells and they swell up. The swelling of your brain can be dangerous and can cause many worrisome symptoms. Similarly, when the salt concentration in blood water goes up, it draws water out of your organ cells and they shrink. The rapid shrinking of your brain can be very dangerous too.


Water intoxication body water

Water intoxication body water

After drinking too much water, that water gets absorbed into your blood. Without the rapid adjustment by your kidneys, that water would make your blood dilute. The average volume of blood water is about 3 liters (about 4/5 of a gallon). If you rapidly drink a gallon of water, that water gets absorbed into your blood. However, all of that water does not stay in your blood vessels. Water and salt can freely go in and out of your blood vessels into a space called extracellular space. This is the space between your blood vessels and your organ cells. This space contains about 11 liters (2.9 gallons) of water. The concentration of salt in blood water and this extracellular water is same because both salt and water can flow freely between these spaces.

However, your organ cells have a membrane that does not allow salt to go in or out freely. The movement of water between these two spaces is determined by the salt concentration of blood water (which is same as the salt concentration of extracellular space).

Water poisoning: how much is too much? Is a gallon of water a day too much?

When you drink a gallon of water, that water goes into your blood and then to your extracellular space. Before you drank that gallon of water, the volume of blood water and extracellular water was 3.7 gallons (2.9 extracellular plus 4/5 blood water). After rapidly drinking that gallon of water, this volume would expand to 4.7 gallons (3.7 plus 1). Without intervention from your kidneys, this would cause a significant change in the concentration of salt in your blood water. To be precise, the concentration would change by 21%( 1 divided by 4.7). Such a large change in blood water salt concentration might kill you instantly from too much brain swelling secondary to water intoxication. Luckily, your kidneys will intervene and save your life.

Your kidneys have the ability to separate salt and water from your blood water. When the salt concentration of blood water goes up, kidneys take out the salt and make highly concentrated urine with the extra salt. When the salt concentration of blood water goes down, kidneys make very dilute urine with extra water. The ability of kidneys to make very dilute and very concentrated urine varies in different species of animals. The kidneys of animals that are adapted to desert can concentrate the urine many more times than we humans can.

There is a limit to how much and how fast your kidneys can make very dilute urine. If you are an average build young healthy person, your kidneys can filter about 90-120 milliliters (3 to 4 oz.) of blood water per minute. Most of this filtered water is reabsorbed and goes back into your blood. Within a certain limit, your kidneys can control the amount that gets reabsorbed. When more water is reabsorbed, your urine becomes concentrated. When less water is reabsorbed, your urine becomes dilute. In theory, normal human kidneys can dilute the salt content of the urine to about 1/6 the concentration of salt in blood water. At this dilution the maximum theoretical amount of urine you can produce in 24 hours is about 20 liters (about 5 and a quarter gallons). It appears that it would take your kidneys at least 4.6 (24 divided by 5,25) hours to get rid of that gallon of water. Assuming you have perfect kidneys, you can prevent water intoxication if you take your time and spend at least 4.6 hours to slowly finish that water.

So, can you drink a gallon of water a day? Yes you can. Drinking a gallon of water a day does not cause water intoxication as long as you do not drink it very fast. You can even get by drinking 5.25 gallons of water if you do it slowly and uniformly over a 24-hour period. However, this calculation assumes that you have a pair of perfectly working kidneys with good capability to produce maximally dilute urine. Your kidneys may not be fully capable of pushing its ability to the limits. In practice, I would recommend finishing a gallon of water over at least eight hours to avoid any chance of water intoxication. If you have known kidney problems, you may need to adjust even further.

What happens when you keep gulping water faster than that? You start to have water intoxication symptoms. The water goes down to your stomach and starts getting absorbed into your blood. Your blood starts to get a little dilute; your body gives a signal to your kidneys and they start working right away to produce maximum amount of dilute urine as fast as they can. As you keep drinking too much water, the kidneys can no longer excrete all the excess water. When you continue water intake at that rate, dilution of blood water begins. Your brain starts to swell up.

How much water should i drink? How many ounces of water should i drink a day?

How much water should you drink depends on how you spend your day. If you are working out in the sun, you need more water. If you are staying inside in a climate controlled room, you need less water. If you are eating salty snacks, you need more water to go with that. If you are on a low sodium diet, you need less water.

How much water is too much in a day? At least 20 liters(5.3 Gallons) for someone with average kidneys function.

How much water can you drink in a day safely? This depends on your diet and your kidney function, but for most healthy people up to10 liters (2.6 gallons) a day should be safe.

How much water is too much in one hour? A gallon in less than 4 hours.

Water intoxication symptoms

Symptoms of drinking too much water start as soon as salt concentration of blood water drops down by about 3%. The first symptom is usually nausea. It may be your body’s way of telling you to stop drinking more. If you keep drinking past that, you will get other symptoms of drinking too much water. You will feel weak and lethargic. Your may start to have headaches. As your blood water gets more dilute, your brain function gets compromised and you will become confused. Life threatening water intoxication symptoms appear when the salt concentration dips below 14-15% of normal. At that stage, even your heart and lungs stop working and you may die from symptoms of water intoxication.

To summarize, here is the list of water intoxication symptoms from mild to severe:

  1. Nausea
  2. Weakness
  3. Lethargy
  4. Headaches
  5. Confusion
  6. Coma and death

Water intoxication: What is the lethal dose of water?

The median lethal dose or LD50 of water has been calculated at 6 liters, which is about 1.6 gallons. The lethal dose calculation assumes that all of it is taken right away. LD50 is defined as the amount required to kill half of all test subjects. This dose calculation is not based on actual observation in humans and may not be very accurate.

As you can see, water intoxication and death from drinking too much water depends on the speed with which you drink it. You can drink the 1.6 gallons of water slowly over 24 hours without getting any water intoxication symptoms. However, if you drink it within an hour, you can die from water intoxication. Death by drinking water is not common but it happens. Death from too much water is occasionally reported in the news. There was a news article with a headline, “Lady dies from drinking too much water.” It was about a female contestant in a water drinking competition in Sacramento, California. It is never a good idea to participate in a water drinking contest because we know that drinking too much water can kill you. The fact is, water drinking contest kills!

How do you treat water intoxication?

If you have concerns about someone having possible water intoxication symptoms, you need to get that person to the nearest ER right away. As I stated in the beginning of the article, I have treated a few of such patients. They need to be admitted to ICU for close monitoring.

If the sodium concentration in the blood is only reduced by less than 3%, they can be just observed closely without access to any drinking water. We then check their sodium (salt) concentration every one or two hours to make sure they are trending in the right direction. We also check their urine sodium level to confirm the diagnosis.

If the sodium concentration were reduced more than 10%, the patient’s condition would be critical. We monitor those patients very closely and start treatment with IV infusion. We give salt solution that has a concentration of about 3.8 times the normal blood water salt concentration. When this highly concentrated salt mixes with the blood, blood salt levels start to rise up. We watch the patient very closely during this stage because correcting the salt level too fast can be dangerous. We do not want to shrink the swollen brain too fast. That can cause permanent damage to a part of the brain. We check the blood salt level every hour while closely monitoring the patient’s vital signs. We adjust the salt-water infusion rate to make sure we are slowly raising the salt level at an acceptable rate. Patients slowly improve with the treatment and become more awake and alert.

Water intoxication: Why would anyone drink too much water in the first place?

This is a good question. I sure hope you do not drink that much water after reading the dangers of water intoxication. However, it happens because some people do not know that even water can be dangerous. People think drinking water is good for health and push the limits. Sometimes people start drinking too much water because of some psychological problems. They may be anxious and depressed and somehow feel that drinking water would help them cleanse their problems. At other times, people may drink too much water when they are going through withdrawal from alcohol or drugs. They may be trying to detoxify themselves by flushing their bodies with water.

Once recent trend that may cause water intoxication in otherwise normal people is excessive water drinking to lose weight. There are many websites that advocate drinking water to lose weight without any warning about the risks of too much water consumption. In today’s society, it is very hard to lose weight and people are always looking for quick and easy ways to lose weight. Drinking water to lose weight can be very dangerous if you drink more water than your kidneys can handle. Also, drinking water to lose weight as a part of “water fasting” can be more dangerous if you do not eat enough sodium while drinking excess water.

I hope you would share this article with your friends and family to raise awareness about potential dangers of water intoxication. Yes, water is good for you but too much of a good thing can sometimes be bad.


Smokers cough

Narrowly speaking, smokers cough is defined as persistent cough in smokers as a result of the irritation and damage of the lining of lungs from smoking cigarettes. In practice, smokers cough represents a spectrum of lung disease from mild irritation to advanced COPD. It is hard to separate pure smokers cough from beginning of more advanced lung diseases. For practical purposes, smokers cough can be seen as the first step towards development of COPD. As a practicing internist, I have evaluated and treated patients at different stages of their lung damage from smoking. I will give you a detail account of what happens at each stage and how smokers cough progresses into advanced lung disease.

Smokers cough: a basic review of lung anatomy

Smokers cough: lung structure

Smokers cough: lung structure

A basic review of what is inside your lungs will help you better understand smokers cough. Do not worry; you do not need to know any technical terms to understand basic mechanism of lungs. As you can see in the pictures, there are air pipes that go inside your lungs and divide into smaller branches. Eventually they become very small and finally each small branch ends up in a small balloon like sack.

This small sac is where the actual exchange of oxygen and carbon dioxide takes place.

Smokers cough: inside air sacs

Smokers cough: inside air sacs

To ensure smooth breathing, air needs to be able to go down all these air pipes and reach the air sacs while breathing in.

Smoker cough: air tubes and air scas

Smoker cough: air tubes and air scas

Similarly, air should be able to flow smoothly out from the air sack all the way out to the nose when you breathe out. With this basic knowledge, you can see how smoking related lung damage impedes smooth airflow. Although, I have explained smokers cough and ongoing lung damage in terms of discrete stages, please bear in mind that it is a continuous process where changes in one stage lead to the next. The end point of these changes always lead to COPD as you will see shortly.

Smokers cough: First stage of lung damage from smoking

Smokers cough lung cilia

Smokers cough lung cilia

Cigarette smoke is made up of many different particles and gases. When you inhale this mixture inside your lungs, your lungs try to protect themselves using several lines of defenses. Tightly packed cells called the epithelial cells of the air pipes guard the inner lining of your lung. They are the first line of defense against external irritants. They produce liquid mucous to help clean the inside of the lungs and clear the debris. They also have small hair like projection called cilia that literally sweep the mucus along with the dirty particles. The inner lining of the lungs also have immune cells that help to capture and kill invading organisms. Your immune system has the ability to recruit additional immune cells and inflammatory mediators to your lungs when needed to fight any invasion.

When the particles and gases in the cigarette smoke reach the inner linings of your lungs, the epithelial cells sense those irritants and produce more mucous. They try to clear the debris by sweeping with the cilia. They also initiate the cough response and help expel the dirt out of your lungs. When you start smoking, initial cough is part of the defense mechanism. As you keep smoking, this defense mechanism gets weaker. The epithelial cells start to lose their cilia and become less effective in clearing the particles. They produce more mucous but their ability to clear the mucous and irritants decrease. At this stage, the irritation and surface damage leads to persistent cough as your lungs try to free themselves of the irritants. When you have mostly dry cough everyday for at least three months, it could be smokers cough from the beginning stage of lung damage.

Smokers cough: continued damage beyond the initial stage

As you continue to smoke cigarettes, you will have further and more extensive damage in your lungs. The production of mucus keeps going up. Normally mucus is only produced in relatively bigger air tubes so that they can be cleared easily. When the irritation and damage of the epithelial cells continue, even smaller air tubes start forming cells capable of producing more mucus. When the amount of mucus in small air tubes reaches a certain level, it starts to get trapped. With mucus trapping, your cough gets worse and you begin to transition from dry cough to wet productive cough. Due to decreased debris clearance and accumulation of mucus, you may be susceptible to more frequent upper respiratory infections. Your immune system gets activated to build up a better defense system because of the increased susceptibility to infection. In the short term, this may be helpful to fight infection. However, the over-activation of immune system can cause long-term lung damage.

Smokers cough: chronic bronchitis and air tubes remodeling

When you start to have daily cough with copious amount of sputum production for at least 3 months, you meet the criteria to be formally diagnosed with chronic bronchitis. Other than significantly increased mucus production, there is significant inflammation from over-activation of the immune system when you have chronic bronchitis. The inflammatory immune cells infiltrate the epithelium. The inflammation results in enlargement of the mucous producing glands. The toxic gas and particles present in cigarette smoke continue to damage the surface of the air tubes repeatedly. The cells of the air tubes try to repair themselves back to normal. However, the surfaces of the air pipes lose their original structure because of the repeated damage and repair. This is called remodeling. It can lead to narrower air tubes.

Smokers cough: Airway obstruction

When the narrowing of air tubes becomes widespread, it can cause significant slowing down of the airflow inside your lungs. The airflow obstruction gets particularly worse when the tube narrowing involves small branches of the air tubes. When you get to this stage, you start to have wheezing sounds in your chest. Some of the wheezing may be loud enough for you to hear it yourself. At other times, you may not hear it but your doctor can listen to it with the help of a stethoscope. At this stage, you will have chronic productive cough associated with wheezing.

Smokers cough: Chronic obstructive pulmonary disease (COPD)

When the airway obstruction is permanent and associated with some degree of respiratory compromise, you have chronic obstructive pulmonary disease. It is the ultimate end game of smokers cough in most smokers. It is said that anyone who keeps smoking will get COPD at some point in his/her life if he/she lives long enough. It is a question of “when”, not “if”. However, there is a significant variation in the amount of cigarette smoking required to get COPD. Some people may get COPD with just 15 years of smoking while it may take 30 or even 40 years for others. It is true even if they smoked the exact same numbers of cigarette a day. Some people are born with a gene that makes them highly susceptible to getting COPD even from relatively small amount of cigarette exposure. When you have COPD, you will have some degree of shortness of breath along with smokers cough and wheezing.

At first, the shortness of breath may only be apparent with exertion. If you live a sedentary life and do not walk, run or climb stairs, you may not notice any shortness of breath. In those cases, the only symptom you have could be a feeling of low energy or being tired. You may attribute that to getting old or being overweight and not pay much attention.

If you feel tired and meet the following three criteria, you most likely have COPD:

  1. Have smoked for many years
  2. Have chronic smokers cough with sputum production
  3. Have wheezing

Although airway obstruction is one of the main problems in COPD, it is not the only one. Smoking can also damage your air sacs in addition to your air tubes. In some people, air pipe damage predominates while air sac damage predominates in others. In addition to that, smoking can also reduce the overall elasticity of your lungs and make them somewhat stiff.

Smokers cough: Air trapping or emphysema:

Emphysema is a component of COPD. Air trapping and airway obstruction are two main parts of COPD. In an individual patient, one of the two may predominate. In patients with emphysema predominant COPD, the air sacs get enlarged and saggy. As a result, air is trapped inside the air sacs and effective movement of air in and out of the air sacs is reduced. This results in inadequate gas exchange and can lead to respiratory distress. In these patients shortness of breath is usually more common that smokers cough or wheezing.

Smokers cough: Is it reversible if you stop smoking?

In the initial stage, the lung damage from smoking is completely reversible if you stop smoking. When your lung damage has reached the level of COPD, the damage is irreversible. It is hard to pinpoint the exact point in the progression of disease where it changes from being reversible to being permanent. There have been several studies trying to answer this question and they have a general idea but it is not very precise. In general it is thought that the changes can be reversed slowly if you stop smoking before there is any remodeling of the airways. However, individual response varies. In some people the inflammation from immune over-activation may be self-sustaining and may continue the damage for a long time. To be safe, it is best to stop smoking before you develop the symptoms of chronic bronchitis.

Smokers’ cough: Does quitting help when you already have COPD?

The changes of COPD are irreversible but that does not mean that quitting cigarettes is not important. In fact, quitting cigarettes is the only treatment that can help to halt the progression of disease. It is important to understand that lung damage from smoking is a continuous process. Just because you already have COPD does not mean that there is no further damage from smoking. COPD at any stage gets worse if you keep smoking. If you have bad air tubes, they get worse with smoking. If you have bad air sacs, they get worse with smoking. If you have bad productive cough with wheezing, it gets worse if you keep smoking. If you have bad shortness of breath, your breathing will only get worse if you keep smoking.

I hope that this article on smokers cough will encourage you to quit smoking early enough to avoid irreversible lung damage. Please share this article with your loved ones if you think it may help them. If you have any questions, please leave them in the comment below. I cannot give you any specific medical advice but I will be happy to answer your general questions about smokers cough.

Gas pains in chest

Gas pains in chest

Gas pains in chest

I have personally treated may patients who sought medical attention because they felt like they had gas pains in chest. However, when you feel you have gas pain in the chest, it not always caused by the actual presence of gas in your chest. It is important to rule out other more serious problems when you feel like you have gas pains in your chest. However, if you are certain that your gas pain in chest is actually caused by gas, you can skip the rest of the article and proceed directly to that section.

Gas pains in chest: Could it be your heart?

Pain originating from your heart can be very non-specific. Your heart does not have direct pain sensors like the ones present in your skin or your muscles. When there is a lack of oxygen in your heart muscles, the resulting distress signal reaches your brain in a highly complex manner. You cannot pin point the source of the discomfort. Out of the many ways a heart attack can present, feeling of “gas” or “indigestion” in the chest is a relatively common one. In the right setting, a heart attack can feel like gas pains in chest. The nerves coming out of your heart and your digestive tract share a common pathway when they travel to your brain. The feeling of heaviness and pressure caused by the lack of oxygen in heart muscles can feel like gas and bloating inside your chest. If you feel like you have gas pains in chest, you need to think about the possibility of a heart attack. If you have risk factors for a heart attack, you need to seek medical attention right away. Here are some specific situations where a gas pain in chest could represent heart attack.

1. Gas pain in chest with previous history of heart attack:

Many people with history of heart attacks, present with similar symptoms when they have another heart attack. If your first heart attack felt like gas pains in chest, you need to take it seriously. When you have the exact same feeling, you need to go to the nearest ER right away to get it checked.

2. New abrupt onset gas pain in chest:

The onset of a symptom can be very valuable in trying to figure out its cause. If the gas pains in chest appeared suddenly out of nowhere, you need to be concerned about the possibility of a heart attack. It is especially true if you do not normally get gas pains in the chest or if this particular gas pain in your chest feel different than your usual pain.

3. Gas pains in chest associated with sweating, palpitation or shortness of breath:

When you have lack of oxygen in your heart muscles, you may have symptoms other than pain or discomfort. Those symptoms could be a signal of bodily distress. Our body has an inherent ability to sense danger and respond accordingly. This danger may be intrinsic or extrinsic. Our body responds to danger or stress with a “fight or flight” response. When you encounter a danger on the outside, your heart rate goes up, your pupils get larger, and you breathe faster. This is how your body prepares you to face the danger. When the danger is inside your body, it also activates a similar response. You may sweat a lot, feel your heart beating faster, and start breathing faster. If you sense this type of stress signal while you have gas pains in your chest, you need to get help right away. 4. Gas pain in chest with walking: When you get gas pain in your chest every time you walk a certain distance, you need to be thinking about possible angina. Stable angina is pain originating from your heart as a result of lack of oxygen. With stable angina, your heart gets enough oxygen to function normally at rest. When you start walking or exerting yourself, it reaches a point when your coronary arteries cannot supply your heart with enough oxygen to match the increasing demand. As a result, you start to get pain or discomfort in your chest if you keep moving any farther. The pain usually goes away in less than five minutes if you take a rest. With stable angina, the distance you can walk before you get the chest discomfort is predictable and this is a very specific characteristic of stable angina. If you have gas pain in chest every time you walk a certain distance and it goes away with rest, it is likely that you may be having a form of stable angina. You need to call your doctor and get it checked out as soon as possible.

Gas pains in chest: Diseases of the food pipe

There are several conditions of your food pipe that can give you a sensation of having gas pain in chest. Many of them are not actually caused by excess gas. The gas pain in chest caused by problems of the food pipe can be very similar to gas pain caused by heart problems. In many cases, it is important to exclude heart related causes before looking for problems in the food-pipe.

Oversensitive food-pipe is a common cause of gas pain in chest. Oversensitive food-pipe may make you feel very uncomfortable form even mild acid reflux. It can also make you feel distended with passage of food. It may also be sensitive to temperature. Hot or cold food may lead to a sensation of irritation and bloating that can last for quite a while. It can certainly make you feel like you have excess gas in your chest.

Acid reflux from stomach is another important cause of gas pain in chest. Hydrochloric acid is produced in the stomach to help digest the food you eat. This acid can flow backwards and climb up your food-pipe. It can irritate and burn the inner lining of your food-pipe. That burning and irritation can feel like pressure and bloating from gas.

The nerve supply of our digestive tract is very complex. Unlike the sensation from our skin, the sensation from our internal organs is not always what it feels like. If we could feel everything exactly as it happened in our inner organs, that would not be very pleasant. This is why acid burning (very unpleasant) may feel like gas distention (less unpleasant).

Treatment with a strong dose of acid reducing medication for at least 4-6 weeks is used to confirm the diagnosis of gas pain in chest from acid reflux. If your symptoms improve with the treatment, it is the likely diagnosis. If your symptoms do not improve, you will need additional testing and specialist referral to investigate further.

For gas pain in chest due to oversensitive food-pipe, acid-reducing medication is still the most helpful treatment. The major irritating factor that causes gas pain in chest of patients with sensitive food-pipe is acid from the stomach. Even small amounts of otherwise normal reflux of acid from the stomach can cause severe distress in people with sensitive food-pipe. Other than taking acid reducing medication, they can avoid eating food that is too hot or too cold. They can keep a journal of what food makes them feel like they have gas pain in chest and try to avoid those.

Gas pain in chest: Actual retention of gas in the digestive tract

Some of you do have gas pain in chest due to over-retention of gas in your digestive tract. You may not feel it but all of us swallow some air when we eat. It is normal to have about 200 ml of gas in the digestive tract. Most of that is nitrogen from the air we swallow. Rest of the gas is produced in the intestine during digestion of food. There are certain foods that can produce more gas than others.

Bloating and gas pain in the chest can be from retention of gas in the food pipe or stomach. This type of gas pain in chest is usually, but not always, associated with belching. If your gas pain in chest gets better after you belch, it is likely that your gas pain was actually caused by gas in your food pipe. Certain foods help relax the lower portion of food pipe and facilitate the flow of gases from stomach back to the food pipe where it can build pressure and cause gas pain in chest. Examples of such food include chocolate, fat and mint. If you are fairly certain that your gas pain in chest is actually caused by gas retention, you can apply three basic home remedies to treat your gas pain.

  1.  Swallow less gas
  2.  Avoid foods that produce too much gas
  3.  Prevent gas from coming back to food-pipe from stomach

When you gulp your food or drink, you swallow more air. Eat more slowly and sip your drinks to avoid too much air swallowing. At times, you may be involuntarily swallowing air even when you are not eating. This behavior can occur, with or without your notice, while you are anxious or under stress. If you have frequent belching associated with gas pain in chest, pay close attention to your mouth and your throat to make sure you are not swallowing air when nervous. You may be doing it while swallowing saliva or just swallowing air. You may also be swallowing air while you are chewing gum, drinking with a straw or drinking from a water fountain. Pay close attention during those activities to make sure you are not swallowing too much air. In some cases, you may need treatment for your anxiety if you are unable to stop swallowing too much air.

Carbonated beverages are one of the most common sources of food that contain air. Normally, that air comes out when you belch but if it gets trapped in your stomach or food pipe, it can cause gas pain. It is true that carbonated beverages induce belching in some people and that helps them get rid of the excess gas. However, it is better not to have too much gas in the stomach in the first place. Other foods that produce too much gas can vary with individual. Some people have decreased ability to digest certain carbohydrates. Some may have trouble digesting carbohydrate from milk while others may have problem with certain legumes. If certain food causes too much gas in your digestive tract, you can avoid gas pain in chest by avoiding those foods.

As I said earlier, it is better to avoid getting too much gas in the stomach in the first place. However, you can prevent gas symptoms in your chest by preventing too much gas from coming up to your food-pipe from your stomach. You can avoid such foods as chocolate, fat and mint to accomplish that.

Sometimes, your gas pain in chest from too much gas can be worsened if you have too much acid in your stomach. You can try some antacids or acid reducing medications to see if that might help you. You can also try over the counter gas reducing medications such as Gas X or Beano to help reduce your gas. Gas X has a compound called simethicone and it is supposed to break gas bubbles but its practical efficacy is unclear. Beano has an enzyme that might help breakdown some undigested food. They may or may not help you but you can try them, as they do not have any major side effects.

Where is the heart located?

When you understand where heart is located in your chest, it will help you learn more about heart diseases and how they affect you. I will be explaining the details of location and structure of the human heart in plain English without using any technical jargon. In my medical practice, I come across many patients with different types of heart disease and many of them have questions about human heart. I am writing this article to explain the basic facts about your heart and how it relates to your heart symptoms. However, knowing the location of heart is not enough if you are worried about a heart attack. Please read this article about symptoms of heart attack in general or this article about mini heart attack symptoms or this article about silent heart attacks if you are worried about those things.

Where is the heart located in relation to your chest wall?

When you talk about the location of any organ in your body, you need to define some landmarks first. Heart is located inside your chest wall. It is important to look at your chest wall and pinpoint some specific areas that we will use as reference point when we talk about the exact location of your heart.

location of the heart sternal notch

location of the heart sternal notch

When you look in a mirror, look slightly below your neck. You will see a small dip where your neck meets your chest. This is an important landmark. It is called the sternal notch. It is the point where your 2 collarbones meet your central breastbone. You can feel your two collarbones going towards your shoulders from this point. If you feel slightly below this notch along your breastbone, you will feel a ridge in the midline. This ridge is called the sternal angle. It is another important chest landmark that will help you find out the exact location of your heart.

Where is the heart located from sternal angle

Where is the heart located from sternal angle

Your heart in protected inside your chest by your rib cage. Your ribs form the rib cage by connecting with your spine in the back and breast bone in the front. To understand where different parts of your heart are located inside your heart, you need to be able to locate and count your front ribs. You cannot see or feel your first ribs because they hide deep behind your collarbones. However, you can easily feel your second ribs and use them to count and locate other ribs. When you locate the ridge in the breastbone( the sternal angle), you can simply move your finger to the left or the right and you will be directly touching your second rib. From this point on you can feel and count the rest of your ribs as you move your finger downwards.

To understand the detailed location of your heart, you need to count downward as far as the 6th rib.

Where is your heart located in relation to your ribs, breastbone and collarbones?

Where is the heart located in rib case

Where is the heart located in rib case

Now that you know what makes the front of your chest wall, you can ask more specific question about the exact location of your heart. If you look at the picture, you can identify the four borders and one pointed tip or apex of the projection of your heart inside your chest. The upper border starts at the level of the 2nd rib about ½ inch to the left of the edge of the breastbone. The upper boarder is slanted downwards towards the right. The upper border and the right border of the heart meet at a point on the third rib ½ inch to the right of the right breastbone edge. The lower border of the heart meets the right border at a point on the sixth rib ½ inch to the right of the right edge of the breastbone. The left border of the heart is angled towards the left as it goes downwards. The point where the left border of the heart meets the lower border of the heart is the leftmost point of the heart. It called the apex of the heart. The apex of the heart is located at a point in between the fifth and the sixth left ribs. It is at a distance of about 3 and a ½ inch from the center of the heart. You may be able feel the beating at the apex of your heart if you have relatively thin chest wall. First, you can try to feel the pulsation by putting the flat of your hand in that area. Once you feel it, you can narrow its location by using two fingers and moving them where the impulse is greatest. Where are the different chambers of the heart located? Now that you know where the borders of your heart lie inside your chest, lets try and look at the locations of the different chambers of the heart.

location of the heart chambers

location of the heart chambers

The heart is made up of 4 chambers. The upper chambers are called atria (singular atrium) and the lower chambers are called ventricles. There are right and left atria, and right and left ventricles. The left side is bigger and more muscular than the left side. The shape of the heart in not symmetrical and, therefore, the right and the left sides are not located along the right and left borders. You need to take into account the 3 dimensional nature of the heart to understand how the different chambers project when looking through the front of the chest. When looking at the heart from the front, the right border of the heart is formed entirely by the right atrium. Right and left ventricles form the lower border of the heart. The left ventricle forms the apex of the heart. The left atrium forms the small upper portion of the left heart border. The left ventricle forms the rest of the left heart border. The majority of the left atrium lies on the back of the heart.


The location of the heart chambers and its relation to blood flow

Location of the heart chambers and its relation to blood flow

Location of the heart chambers and its relation to blood flow

Knowledge about the location of the heart chambers will hell you understand how blood flows in and out of the heart. First, the used blood from the body returns to the right upper chamber (called right atrium). It then flows to the right lower chamber (called the right ventricle). The right ventricle pumps the blood to the lungs. The lungs freshen up the blood with oxygen and send it back to the left upper chamber (called the left atrium). The blood then flows down to the left lower chamber (called the left ventricle). The left ventricle has the most powerful pump and it pumps out the fresh blood to the rest of the body.

Nerve supply of the heart:

To understand your heart symptoms, you need to answer 2 questions: “Where is heart located?” and “What is the nerve supply of the heart?”. Knowing the location of the heart and its different chambers are important but it is not enough to understand how you feel pain or discomfort coming from the heart. It is important to note that the heart does not have the kind of pain sensing nerve that are present on your chest wall. The nerve supply of the heart is a part of the autonomic nervous system and it normally bypasses the conscious part of your brain. That is why you do not normally feel your heart beating. You do not feel direct pain from your heart. The pains you feel from abnormalities in your heart do not match the location of your heart in your chest. Pain resulting from a lack of blood supply in your heart originates from a complex process and such pain is poorly localizing. The pain may even be not be felt in your chest at all.

Why does the location of the heart matter if you cannot relate the pain to the location?

If you can pinpoint the exact location of your chest pain, that pain is likely coming from somewhere other than your heart. The knowledge about the exact location of your heart inside your chest helps your doctor listen to your heart and analyze normal and abnormal heart sounds coming from different parts of your heart. Detailed knowledge of the exact location of your heart is absolutely necessary to interpret x-rays of your chest. The normal location and size of your heart chambers serve as a reference when part of your heart changes in shape or size from certain medical conditions. You may also feel your heart beat at the apex of your heart when your heart is beating too fast or too forcefully. If your heart is enlarged, the apex of your heart may be felt farther to the left instead of the normal location. An abnormal apical beat may be the first sign that the shape, size and location of your heart is not normal. An ultrasound of your heart can enable your heart doctor to see how your heart chambers look. The knowledge of normal location and size of your heart is essential to interpret any abnormal findings.

I encourage you to share this article with anyone who is curious about the location of the heart. It is my hope that this article will help you understand some basic facts about your heart. If you have any more questions about the heart or heart diseases, please ask them in the comments below. I cannot give you any specific medical advice but I can help you understand basic facts about the human heart and heart diseases.

Pain in left lower abdomen

Pain in lower left abdomen: A review of internal organs

As a practicing physician, I have evaluated and treated many patients with pain in left lower abdomen. I think it will be helpful for you to review what internal organs you have inside your body that can cause pain in lower left abdomen. I will be explaining everything in plain English so that you can understand and use this information without any prior medical knowledge. I believe that everyone can learn medicine if taught in a language they understand.


pain in left lower abdomen digestive

pain in left lower abdomen digestive

Here is a picture that shows you what lies under your skin in your lower abdomen. Among organs in the abdomen, colon and rectum occupy a significant part of the lower left abdomen. Colon is a part of the digestive tract. Food from your stomach goes to small intestine where most of the nutrients is absorbed. The small intestine is about 20 feet long and lies curled up in your lower abdomen. It connects to the large intestine. Colon is the major part of the large intestine and it helps mostly with reabsorption of water and some remaining nutrients in the digestive tract. The part of the colon that runs horizontal in the picture is called the transverse colon and the part that goes downward on the left side is the descending colon. Similarly, the part that goes upwards on the right side is the ascending colon. Appendix is a small pouch located near the junction of the small and large intestine. The descending colon leads to rectum and opens outside to anus.

pain in left lower abdomen kidneys

pain in left lower abdomen kidneys

Kidneys and blood vessels are also important in evaluating pain in lower left side of abdomen. They lie behind the digestive tract and can be seen in the next picture. The major artery than runs along the back of the lower abdomen is called abdominal aorta and it eventually divides to supply blood to the legs.

Pain in lower left abdomen from diverticulitis

Diverticula are sac like protrusions that develop in the colon wall. They are more commonly formed on the left side of the colon than on the right. These sacs can get inflamed and cause significant pain in lower left side of abdomen. This type of pain is usually described as cramping, irritation but could also be sharp and relenting. The severity of pain may depend on the severity of inflammation. The pain in left side of abdomen from diverticulitis is usually constant for a few days, which may help to distinguish it from other conditions that deteriorate rapidly. In addition to left lower abdominal pain, patients may have occasional diarrhea. Presence of blood in stool can happen but is very rare. As in most digestive tract disease, you may have nausea and vomiting with diverticulitis.

When untreated, diverticulitis can get worse and may cause complications. It can form collection of pus called abscess and patient may have pain in upper left abdomen in addition to the pain in lower left side of abdomen.

One of the most feared complications is a rupture of colon wall at the protrusion. When it ruptures, the dirty fecal material may enter the sterile interior of the abdominal cavity and cause widespread inflammation and infection that can be life threatening. When this happens, the whole abdomen becomes painful and tender.

Pain in lower left abdomen from colitis

Colitis simply means inflammation of the colon. It is not a single disease but describes a condition that can result from a number of different disease processes. From the first picture, you can see that colon is present on the left, right and middle of the lower abdomen. Abdominal pain from colitis can occur in any of these places depending on the part of the colon that is involved. A mild inflammation of the right sided colon may cause dull pain lower right side while severe inflammation of the lower left colon may cause significant pain in lower left abdomen. Pain originating from the inflammation of colon can cause some feeling of irritation and constant need to evacuate your bowels. Diarrhea is common but not always present. The severity of pain may or may not correlate with the severity of inflammation because different patients have different levels of pain tolerance.

Pain gets worse if you develop complications from colitis. Just like diverticulitis, any form of colitis may end up with rupture of the colon wall. The resulting symptoms of widespread infection and inflammation can be identical to the rupture caused from diverticulitis.

Pain in lower abdomen: peritonitis

Peritonitis simply describes what I explained earlier: it is the widespread inflammation and infection of the internal lining of the abdominal cavity. Abdominal cavity is the space inside your abdomen where your internal organs live. This cavity is usually clean and sterile. The dirty part containing fecal material and undigested food is contained inside the digestive tract by the wall of the intestines. Whenever the contents of the bowel leak outside to this sterile area, it can cause catastrophic inflammation. You can feel the resulting pain almost all over your abdomen. This type of pain can be very sharp. When you have peritonitis, your abdomen is very tender. It hurts more when you touch or poke it.

If you have pain like this in any part of your abdomen, it is a medical emergency. Peritonitis can kill you within a few hours if not treated right away. If you are having abdominal pain of this nature, please stop reading this article and call 911 right away.

Pain in lower left abdomen from colon cancer

The pain and discomfort from colon cancer may be similar to that caused by colitis. Like colitis, it can happen on the left or right lower abdomen. You may only have dull pain in right side or left side of your abdomen. All the symptoms I described for colitis can happen with colon cancer. That is why it is important to screen for colon cancer after you recover from an episode of colitis. The only way to be sure about colon cancer is to get colonoscopy with biopsies.

Pain in lower left abdomen from acute appendicitis

As you can see in the first picture, appendix is normally located on the right lower side of your abdomen. Pain from acute inflammation of the appendix, called acute appendicitis, is also normally located on the right lower abdomen. However, it is important to know that acute appendicitis can occasionally cause pain in left side of abdomen. In the right setting, you cannot rule out acute appendicitis just because the pain is located on the wrong side of your abdomen.

Acute appendicitis can cause pain in lower left abdomen because of the individual variation in human anatomy. In a small percentage of people, the colon anatomy is reversed and organs switch sides. In those people, appendix can be found on the left side. In other people, the appendix can be very long; so long that the tip of the appendix actually crosses the midline and lies on the left. When the inflammation of appendicitis affects those people, the pain can be felt on the left side. Some people may even have pain in upper right abdomen.

Left lower abdominal pain from acute appendicitis shows how each individual is different and how there are exceptions to the rules in medical symptoms.

Pain in lower left abdomen from left kidney stones:

Kidney stones may cause pain in lower abdomen and back. Pain originating from the left kidney can be felt in the left lower abdomen. Because of the difference in the type of nerve that supplies kidneys and intestine, the nature of the pain is usually different. Pains originating in the kidneys are more localized and sharper. They also tend to occur more towards the sides of the abdomen. Some patient may also feel pain in upper left abdomen. These types of pain usually occur in waves with fluctuating intensity. As the stones move, the location of pain may move with it. Sharp pain in lower left side of abdomen that slowly moves downwards, could be the result of kidney stone passing downwards from the left kidney traveling towards the urinary bladder.

Pain in lower left abdomen from ruptured abdominal aortic aneurysm

As you can see in the second picture, a major artery runs down the middle behind the digestive tract. It carries blood that eventually goes to your legs. This part of the artery is called abdominal aorta and it can sometimes balloon up. When that happens, it is called an aneurysm. The aneurysms can develop slowly over many years without causing any symptom. However, they can suddenly rupture causing severe sharp pain in lower abdomen. The resulting pain is usually in the middle with radiation to the back but can also be felt in the left lower abdomen if the blood moves towards the left side.

A massive bleeding from the rupture can result in shock and death within a few hours. However, the bleeding may temporarily halt because of sequestering of the blood around tight places behind the abdominal membrane. This may allow enough time for surgical repair that can save the patient’s life.

Women specific left lower abdominal pain:

left lower abdominal pain in women

left lower abdominal pain in women

Diseases of the internal female reproductive organs can cause left lower abdominal pain specific to female patients. As you can see in the picture, female reproductive organs include two ovaries and fallopian tubes on two sides. The uterus or womb lies in the middle and connects to the cervix. The cervix opens into the vagina. The location of the women specific abdominal pain depends on which organ is affected. Women specific left lower abdominal pain can occur when the left ovary or the left fallopian tube is involved. It can also occur when the left side of the ureter has problems. The most feared women specific pain in left side of abdomen is caused by ectopic pregnancy in the left fallopian tube. It is called ectopic pregnancy because it happens outside the womb. Besides severe sharp pain in lower left side of abdomen, ectopic pregnancy can cause vaginal bleeding, dizziness, lightheadedness and occasionally fevers or chills.

Different kinds of cysts and tumors can form in the left ovary and left fallopian tubes. These normal or abnormal growths can cause different patterns of pain in lower left abdomen of female patient. Lower abdominal pain in women over 50 along with vaginal bleeding raises concern for gynecological cancers.

I hope this article about left lower abdominal pain will help answer some of your questions about this particular symptom. Please share this article with your friends and family and do not hesitate to post your questions and comments below. I cannot give you any specific medical advice but I can answer your general questions about what causes pain in the left lower abdomen.


Shortness of breath after eating

Note: This article only talks about shortness of breath after eating. You may want to read this article first to understand what is considered shortness of breath, and look at all the possible causes of shortness of breath in general.

Shortness of breath after eating: Decreased lung expansion

shortness of breath after eating

shortness of breath after eating

Decreased lung expansion could be the simple explanation of why you are short of breath after eating. This comes from the basic mechanism of how your lungs work when you breathe. As you can see in the picture, your lungs need space to expand when you take your breath. As you breathe in, your lungs push down on your diaphragm. Diaphragm is what separates your chest from your abdomen.

Your abdomen is filled with your stomach, intestines and other vital organs such as liver, pancreas and spleen. When you take a deep breath, you push your lung downwards. The diaphragm goes down and makes room for the expanding lungs. The diaphragm then pushes down on your abdominal organs. After you eat a large meal, your stomach can get distended. A distended stomach makes it hard for the diaphragm to push on it. As a result, your lungs do not get to expand fully. The lower part of your lungs may not get enough air. When it happens, you may have trouble breathing after eating a full meal.

It may seem like a very simple explanation of why someone may have shortness of breath after eating but I have personally seen patients who had serious problems with this. Shortness of breath after eating from decreased lung expansion can happen to anyone but people with obesity are very prone to it. In obese patients, the abdominal cavity is always distended because of excessive amount of adipose tissue stored in the abdominal cavity. They have decreased lung expansion all the time but they have more trouble breathing after eating.

In people with severe obesity, the decreased lung expansion not just causes shortness of breath after eating, but also leads to life threatening diseases. This condition is sometimes called pickwikian syndrome or obesity hypoventilation syndrome. When the lungs do not get space to expand for a long time, they continue to collapse more and more. At some point, the lungs become incapable of meeting the oxygen requirement of the body. The remaining normal part of the lung tries to squeeze more oxygen out of whatever air they get. In this process, the blood vessels of the lungs get damaged and lose their elasticity. That can put pressure on the heart and can lead to life threatening heart and lung damage. If you are overweight and have shortness of breath after eating a full meal, which could be a warning sigh that your lungs may not have enough space to expand properly with breathing. You need to see your doctor and get a formal lung capacity test where you breathe into a machine that measures how much air you are moving. If your lung capacity has reduced significantly, you need medical attention.

Trouble breathing after eating: patients with COPD

I have seen many people with COPD experience more shortness of breath after eating. There may be several different reasons why COPD patients have trouble breathing after eating but diaphragm pushing back against the lung can be an important consideration. . Many people with COPD have hyperextended lung, which means that they have lungs that are stretched out all the time because of loss of elasticity or recoil. As a result, they occupy more space in the chest cavity. The lung may already be pushing tightly against the diaphragm when the stomach is still empty. After a meal, the stomach takes up more space in the abdominal cavity and as a result, the diaphragm gets pushed back upwards. This can further impede the movement on already weak lungs in patients with COPD. As a result, they get more short of breath after eating.

The second reason why people with COPD get more shortness of breath after eating is slightly more complex. This particular mechanism causes trouble breathing after eating in patients with advanced COPD. These patients are very weak and frail. They may have shortness of breath at rest without oxygen. These people usually get short of breath with minimal activity at baseline. They are usually oxygen dependent. These people may get short of breath after eating because post-eating state represents a kind of stress on their bodies.

When you eat your meal, your body has to do some work to digest and metabolize that food. Your stomach has to physically churn that food down. Your digestive glands have to produce enzymes to digest the food. Your intestine has to squeeze the food downwards. The lining of your intestine has to absorb the nutrition and send them to the liver by blood. Your liver has to perform chemical processing of the nutrition based on the needs of your body. All these processes require expenditure of energy. Anything that requires more energy requires more oxygen consumption. More carbon dioxide is released from burning fuel when the energy expenditure goes up.

Patients with advanced COPD have very little reserve capacity of how much more oxygen their lungs can absorb and how much carbon dioxide they can get rid of. This increased need for oxygen after food consumption can be a significant stress on their lungs and they can have more shortness of breath after eating

Shortness of breath after eating: acid reflux

Acid reflux can be another reason why you have shortness of breath after eating. When you eat something, your stomach produces hydrochloric acid. This acid helps digest your food in the stomach. Sometimes, overproduction of acid causes it to come out of the stomach and climb up the food pipe. Occasional acid reflux can be normal but frequent acid reflux can cause problems.

Acid reflux has been known to cause shortness of breath after eating by irritating your air pipe. The acid can climb up and irritate your throat. It may make you cough or aspirate small food particles. That can lead to irritation and spasm of the air pipes that go inside your lungs. That can interfere with the smooth in and out movement of air from your lungs and you have shortness of breath after eating or even while eating. In patients who already have shortness of breath from asthma, acid reflux can make it worse. Some asthmatics may not notice the actual reflux of acid if it is mild. However, they may note that they have more trouble breathing after eating. That could be clue that they may have undiagnosed acid reflux. Acid reflux is also thought be a possible cause of worsening shortness of breath in patients with COPD. People with bad acid reflux tend to have more exacerbation of their COPD symptoms.

I hope this article about the symptom of shortness of breath after eating will helped answer some of the questions your questions about trouble breathing after eating. Please share this article with your friends and family and do not hesitate to post your questions and comments below. I cannot give you any specific medical advice but I can answer your general questions about what causes shortness of breath after eating.


How to raise blood pressure and when you should do it

Many patients suffer from hypertension or high blood pressure but there are times when people present with low blood pressure. There are a lot of resources out there to help people with high blood pressure but very few articles that provide information to people with low blood pressure that are trying to find out how to raise their blood pressures. I will attempt to provide a comprehensive and detailed explanation of what low blood pressure signifies and how to raise blood pressure when necessary. I am writing this article for patients and people with no medical background. I will not be using any medical terminology without explaining it in plain English. How to raise blood pressure depends on your specific situation. First, I will explain what causes your blood pressure to rise and fall.

What causes blood pressure to rise and fall?

How to raise blood pressure

How to raise blood pressure

There are 3 major things in your body that control your blood pressure. You need to understand how they work together to maintain your blood pressure. This will help you properly understand how to raise your blood pressure when it needs to be raised.

  1.  Heart
  2.  Blood vessels
  3.  Blood volume

As you probably know, heart is basically a pump that pumps out blood to your blood vessels. The force with which the heart pumps out your blood directly cause pressure on your blood vessels and that pressure is your blood pressure. When your heart pumps blood with more force than needed, it causes your blood pressure to rise. When your heart muscle is weak and does not pump with enough force, it causes your blood pressure to fall.

Your blood vessels have to withstand the force of the blood being pumped out of your heart. If your blood vessels are relaxed and elastic, they make your blood pressure lower. If your blood vessels are constricted and stiff, they can raise your blood pressure.

Finally, the volume of blood circulating in your body also affects your blood pressure. If you have too much blood circulating in your system, that could be the reason of your elevated blood pressure. If you do not have enough blood circulating in your system, you may have low blood pressure.

When we talk about treatment for low blood pressure, we need to remember that anything that affects blood pressure does so by changing one of the three things.

What to do for low blood pressure when you have no symptom from it

Low blood pressure symptoms arise when your brain or any other vital organ does not get enough fresh blood. When you have absolutely no symptom from your low blood pressure, you probably do not need to know how to raise your blood pressure. Blood pressure of the general population varies greatly. What is generally considered low blood pressure may be normal for you. In fact, some researchers have shown that a lower than normal blood pressure may be beneficial to you if your body is well adjusted to it. However, for you to go without treatment for low blood pressure, you must meet certain physical requirements. You need to be otherwise healthy and well. You need to be physically active and able to perform cardio exercise without any dizziness, lightheadedness, chest pain or shortness of breath. You need to be able to run or climb stairs without difficulty. If you are physically fit and active and still do not have any symptom, you may not need to think about how to raise your blood pressure.

How to raise blood pressure when you have bad infection

Severe infection can cause a sudden drop in blood pressure when your body gets overwhelmed. Infection can affect all three things that cause blood pressure to rise and fall.

When disease-causing organisms invade your body, it tries to fight the infection by activating your immune system. If your immune system kills those bugs before they proliferate, you may not develop any serious infection. If the bugs continue to multiply despite your immune defense, the infection can worsen quickly. When it happens, it triggers your body to activate more and more immune defense mechanisms. That can ultimately reach to a state of widespread immune over activation. While that is more ammunition to kill those invaders, the war also takes its toll on your body. Your blood vessels relax to circulate blood more to expedite the fight against invading organisms.

As you recall, your blood vessels play an important role in raising or lowering your blood pressure. When blood vessels relax, blood pressure goes down.

At first, your heart tries to raise blood pressure by pumping harder and faster. That is why your heart beat go up when you have infection. When your heart muscle gets tired from the overwork, it can no longer compensate and you may have a sudden drop in blood pressure.

Your body also tries to raise blood pressure by increasing blood volume. When you have a bad infection, your body releases various substances in your body. Some of these substances control your kidneys and tell them to decrease urine production. When you make less urine, you have more water in your blood. That is how your body tries to raise blood pressure by increasing blood volume. Ultimately, other things play out to lower your blood volume and your blood pressure drops. When you are infected, your appetite goes down. When you do not eat or drink much, you get dehydrated and your blood volume goes down. When you have fever, you sweat a lot and lose water decreasing your blood volume.

When you understand what makes your blood pressure fall, you can learn how to raise blood pressure in that particular situation.

You can start with the easy things you can do to raise your blood pressure at home or avoid having low blood pressure in the first place. You can drink plenty of water and eat properly. When you have enough salt and water in your body, it helps to raise blood pressure by increasing blood volume. You will learn the details of how salt and blood pressure are related in the next scenario. For now, just learn that keeping yourself hydrated is important. You can also take medications to lower your fever. When your fever goes down, you lose less water by evaporation. Drinking fluids and keeping cool are easy things you can do early on to help raise your blood pressure.

When things worsen and your blood pressure starts to fall, you need specialized treatment to raise your blood pressure. At this stage, your body is going into a state of shock. This is a medical emergency. You need to call 911 or go to the nearest emergency department and let the experts figure out how to raise blood pressure. I will briefly describe what they will do to help raise your blood pressure. First, they will infuse saline water into your veins to get your blood volume up quickly. They will also start antibiotics to fight the root cause of your problems. If that does not work, they will start some medications to help constrict your blood vessels. Remember how constricting your blood vessels raise your blood pressure. If that is not enough, they may start other medications to force your heart muscles to pump harder. That is how the experts raise blood pressure in situations of dire medical emergency.

How to raise blood pressure when you are tired all the time

Treatment of low blood pressure may be required if you have symptoms from it. When your blood pressure is low all the time and your body is unable to adjust to it, you have symptoms of low blood pressure. You may feel tired all the time or you may have dizziness or lightheadedness. You may even faint on a hot day. You may feel tired climbing up stairs or you may feel like passing out. If you have these symptoms and your blood pressure is low, you may need to find the cause of your low blood pressure before figuring out how to raise blood pressure.

Unlike the sudden drop in blood pressure with bad infection, the low blood pressure that makes you tired is of slow onset. There are several different diseases that eventually affect your blood volume or your blood vessels that result in low blood pressure. Hormonal imbalance is a frequently encountered problem that can cause slow onset long-term low blood pressure. The most important hormone that helps raise blood pressure is the adrenal hormone. It is made in the glands called adrenal glands. You have a pair of adrenal glands inside your body and they are located on top of each kidney. Adrenal hormone helps regulate the salt and water in your body and help raise your blood pressure when needed. It also directly and indirectly affects your blood vessels and help control blood pressure. The exact mechanism of how adrenal glands raise your blood pressure is complex and hard to explain in just a few paragraphs.

When you have low blood pressure all the time and have symptoms with it, you need to schedule a visit with your doctor to start a thorough investigation. Your doctor may have to refer you to see specialists before finding the exact cause of your low blood pressure. In some cases, everything comes back normal and they never find out why your blood pressure is low. In such situations, there are several things you can do to raise your blood pressure. Your doctor can prescribe certain medication that help retain salt and water in your body. You can also increase your salt and water intake to raise blood pressure.

How to raise blood pressure by eating more salt and drinking more water

This method is only recommended in certain specific situation such as the one described above. The balance of salt and water in our body is very crucial to our survival. When salt is dissolves in water, the resulting solution have certain physical and chemical properties that are critical for bodily functions. Salt water in our blood has a property called osmotic pressure. It is the force created on membranes that only allow certain molecules to pass through. Certain sections of our blood vessels are made of such membranes at the microscopic level. It allows water molecule to pass but does not allow the salt molecule. Salt draws water. When you eat more salt, you get thirstier and you drink more water. The water goes inside the blood vessels and increase blood volume but salt remains inside. This increases the pressure on your blood vessels and this is how you are able to raise your blood pressure by eating more salt. At the same time, eating too much salt can cause high blood pressure by the same mechanism.

I hope you have learned how to raise blood pressure in certain different situations. This is a very important medical topic and I am sure you have may questions. Please share this article with your friends and family and do not hesitate to post your questions and comments below. I cannot give you any specific medical advice but I can answer your general questions about how to raise blood pressure in different situations.