A 21st century water cure

Acute effects of Zamzam water on blood pressure and heart rate variability

Objective:

There is a lack of studies exploring the effects of Zamzam water on human physiology. The present study determined the effects of Zamzam water on blood pressure and heart rate variability (HRV).

Methods:

This comparative interventional study was conducted at the Department of Physiology, of our university in March 2018. A total number of 97 female subjects drank 500 ml of either Zamzam water or mineral water in one minute. Finometer Pro and PowerLab (ADInstruments^R) with ECG electrodes through bioamplifier and attached finger pulse transducer were used to collect data at the baseline (for five minutes), during (for one minute) and after the drink (for five minutes). Paired and uunpaired student’s t-test, one-way ANCOVA and one-way repeated measure ANOVA were used for analysis. Blood pressure parameters were followed minute by minute and HRV parameters were compared as a 5-minute of baseline segment to 5-minute post drink segment.

Results:

Within-the-group comparison exhibited significant increases in blood pressure parameters (systolic, diastolic, pulse and mean arterial pressure), over a 5-minute post-drinking period in both groups. Zamzam water caused a significant increase in SDRR (an indication of overall HRV) and RMSSD (an indication of vagal activity) as compared to baseline.

Conclusion:

Both drinks cause a significant increase in systolic, diastolic, pulse and mean arterial pressure within five minutes post-drinking period. Zamzam water produce a significant increase in cardiac vagal tone but has no effect on cardiac sympathetic activity. Mineral water has no significant effect on both, cardiac vagal and sympathetic activity.

[Autonomic dysfunction in patients with multiple sclerosis]

AIM

To optimize the early diagnosis of the autonomic dysfunction in patients with MS.

MATERIAL AND METHODS

The main group consisted of 46 patients: 15 men and 31 women with MS (McDonald, 2005), the average age was 33.35±9.9 years, the average score of the Expanded disability scale (EDSS) was 2.8±1.17 points. The control group consisted of 24 healthy subjects matched by age and sex with the main group. A study of the autonomic nervous system was carried out using the Scheme for detection of signs of autonomic disorders (A.M. Vein, 1998) and analysis of heart rate variability (HRV) at rest and after active orthostatic test (AOT).

RESULTS

Autonomic dysfunction was found in 73% of the patients. The overall score of the Scheme was significantly higher in MS patients (31.32±9.43 points) compared to the comparison group (2.36±4.39 points, p<0.05). According to HRV, the contribution of brainstem autonomic centers in the regulation of stress-response during AOP was significantly reduced (p<0.05) and was characterized by the lack of activation of the sympathetic division of the ANS. In patients with MS, cerebral influences were dominating on HRV baseline records, evaluated by the domination of the VLF component in the spectrum. During AOP, VLF was almost leveled in both groups, and the VLF changes in patients before and after the AOP reached statistical significance (p<0.05).

CONCLUSION

The use of the Scheme is preferable in outpatient clinics to screen the large numbers of patients with MS, and then selected patients could be referred to the instrumental methods of investigation.

The Treatment of Primary Orthostatic Hypotension

OBJECTIVE

To review the efficacy and safety of pharmacological and nonpharmacological strategies used to treat primary orthostatic hypotension (OH).

DATA SOURCES

A literature review using PubMed and MEDLINE databases searching hypotension, non-pharmacological therapy, midodrine, droxidopa, pyridostigmine, fludrocortisone, atomoxetine, pseudoephedrine, and octreotide was performed.

STUDY SELECTION AND DATA EXTRACTION

Randomized or observational studies, cohorts, case series, or case reports written in English between January 1970 and November 2016 that assessed primary OH treatment in adult patients were evaluated.

DATA SYNTHESIS

Based on the chosen criteria, it was found that OH patients make up approximately 15% of all syncope patients, predominantly as a result of cardiovascular or neurological insults, or offending medication. Nonpharmacological strategies are the primary treatment, such as discontinuing offending medications, switching medication administration to bedtime, avoiding large carbohydrate-rich meals, limiting alcohol, maintaining adequate hydration, adding salt to diet, and so on. If these fail, pharmacotherapy can help ameliorate symptoms, including midodrine, droxidopa, fludrocortisone, pyridostigmine, atomoxetine, sympathomimetic agents, and octreotide.

CONCLUSIONS

Midodrine and droxidopa possess the most evidence with respect to increasing blood pressure and alleviating symptoms. Pyridostigmine and fludrocortisone can be used in patients who fail to respond to these agents. Emerging evidence with low-dose atomoxetine is promising, especially in those with central autonomic failure, and may prove to be a viable alternative treatment option. Data surrounding other therapies such as sympathomimetic agents or octreotide are minimal. Medication management of primary OH should be guided by patient-specific factors, such as tolerability, adverse effects, and drug-drug and drug-disease interactions.

Autonomic Dysregulation in Multiple Sclerosis

Multiple sclerosis (MS) is a chronic, progressive central neurological disease characterized by inflammation and demyelination. In patients with MS, dysregulation of the autonomic nervous system may present with various clinical symptoms including sweating abnormalities, urinary dysfunction, orthostatic dysregulation, gastrointestinal symptoms, and sexual dysfunction. These autonomic disturbances reduce the quality of life of affected patients and constitute a clinical challenge to the physician due to variability of clinical presentation and inconsistent data on diagnosis and treatment. Early diagnosis and initiation of individualized interdisciplinary and multimodal strategies is beneficial in the management of autonomic dysfunction in MS. This review summarizes the current literature on the most prevalent aspects of autonomic dysfunction in MS and provides reference to underlying pathophysiological mechanisms as well as means of diagnosis and treatment.

Non-pharmacological management of orthostatic hypotension in the older patient

Orthostatic hypotension (OH) occurs in up to 30% of community-dwelling older people. Its presence confers a greater risk of incident co-morbid disease and all-cause mortality. As per guidelines, first-line treatment should consist of non-pharmacological therapies. Effective lifestyle modification advice includes the avoidance of rapid postural changes and large meals. Physical counter-manoeuvres, when comprehensively described, effectively abate symptom progression. Patients should drink 1.5 to 2 litres of water daily, though reports suggest only half of older people comply with this regime. Moderate salt consumption is advised, though with caution as supine hypertension often co-exists. Compression hosiery benefits older people and, contrary to popular opinion, is well tolerated. Potential, future therapies include impedance threshold devices. Older patients with OH frequently have co-morbid disease such that a pharmacological approach is ill-advised. They respond well to non-pharmacological therapies and these should form the primary therapeutic approach.

Cardiovascular responses to water drinking: does osmolality play a role?

Water drinking activates the autonomic nervous system and induces acute hemodynamic changes. The actual stimulus for these effects is undetermined but might be related to either gastric distension or to osmotic factors. In the present study, we tested whether the cardiovascular responses to water drinking are related to water's relative hypoosmolality. Therefore, we compared the cardiovascular effects of a water drink (7.5 ml/kg body wt) with an identical volume of a physiological (0.9%) saline solution in nine healthy subjects (6 male, 3 female, aged 26 +/- 2 years), while continuously monitoring beat-to-beat blood pressure (finger plethysmography), cardiac intervals (electrocardiography), and cardiac output (thoracic impedance). Total peripheral resistance was calculated as mean blood pressure/cardiac output. Cardiac interval variability (high-frequency power) was assessed by spectral analysis as an index of cardiac vagal tone. Baroreceptor sensitivity was evaluated using the sequence technique. Drinking water, but not saline, decreased heart rate (P = 0.01) and increased total peripheral resistance (P < 0.01), high-frequency cardiac interval variability (P = 0.03), and baroreceptor sensitivity (P = 0.01). Neither water nor saline substantially increased blood pressure. These responses suggest that water drinking simultaneously increases sympathetic vasoconstrictor activity and cardiac vagal tone. That these effects were absent after drinking physiological saline indicate that the cardiovascular responses to water drinking are influenced by its hypoosmotic properties.

Effect of water drinking on sympathetic nervous activity and blood pressure

Recent studies suggest that water drinking elicits acute changes in human physiology. Water drinking profoundly increases blood pressure in patients with autonomic failure. Water drinking also increases blood pressure in quadriplegic patients, cardiac transplant recipients, and older healthy subjects, but to a lesser extent. Blood pressure does not change in healthy young subjects. More recently, water drinking was shown to increase energy expenditure. The acute changes in cardiovascular regulation and in energy expenditure with water drinking appear to be mediated through activation of the sympathetic nervous system. The sympathetic activation may involve a spinal reflex-like mechanism. The stimulus that causes the sympathetic activation is not known. The acute water pressor response can be exploited in the treatment of patients with impaired orthostatic tolerance caused by autonomic failure, postural tachycardia syndrome, or, perhaps, neurocardiogenic (vasovagal) syncope. The increase in energy expenditure with water drinking should be recognized as an important confounding variable in metabolic studies and may hold some promise as an adjunctive measure in the prevention or treatment of obesity.

The rationale for sitting elderly patients in hospital out of bed for long periods is medically unsubstantiated and detrimental to their recovery

The notorious statement by Asher about the dangers of bed rest [Brit Med J 1947; ii: 967-8] which continues to be quoted out of context in leading medical journals today is inapplicable to modern short stay elderly hospital patients and has little medical foundation. 'Blood clotting in the veins' is more likely to result from venous stasis during sitting than from lying down. 'Lime draining from the bones' refers to subjects' spending weeks, not hours, in the horizontal position and similar losses have been shown to occur in healthy people immobilised in chairs for long periods during the day. Constipation is common in sick old people and there is no evidence that 'scybala stacking up the colon' is more likely to occur in bed than in a chair. The 'flesh rotting from the seat', or pressure sores, occur as frequently or more frequently, in sick patients nursed in chairs as in bed. 'Urine leaking from the distended bladder' may be reduced in very debilitated old people sitting in chairs, but at the expense of impaired renal function associated with reduced perfusion in the upright posture and exacerbated incontinence due to a compensatory diuresis at night. The 'spirit evaporating from the soul' today is more likely to afflict old patients who are exhausted by prolonged chair nursing and orthostatic hypotension due to age or illness. Recent studies in intensive care patients have highlighted the hypotension due to vasodilatation which can occur in infection and trauma. There is no evidence that nosocomial pneumonia is reduced by sitting patients out of bed, and lack of sleep is likely to exacerbate infection and delay recovery. Preventing patients from lying down when they feel the need is a violation of their rights and has been shown to be probably as injurious as the Victorian practice of preventing healthy patients from getting up. Physiotherapy is obviously important but patients should be allowed to decide for themselves how long they spend in or out of bed.

Water drinking in the management of orthostatic intolerance due to orthostatic hypotension, vasovagal syncope and the postural tachycardia syndrome

Water drinking recently has been shown to raise blood pressure in normal subjects and in patients with autonomic failure who have orthostatic hypotension. However, in normal young subjects, ingestion of approximately 500 ml has no pressor effect; but in older subjects there is an increase in blood pressure. An even greater rise in blood pressure occurs in cases with autonomic failure. The possible mechanisms responsible for the pressor response to water include neural and humoral factors; fluid redistribution also needs to be considered. This review will concentrate on the water pressor response in normal subjects and different groups of patients with autonomic diseases who have orthostatic intolerance, on the mechanisms that could be involved, and on whether this pressor response may be used in the management of orthostatic hypotension, vasovagal syncope and the postural tachycardia syndrome.