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Microcirculation in Hypertension, A New Target for Treatment?

The number of effective agents available for the treatment of hypertension is now substantial. However, in spite of this, most would agree that there is still considerable scope for improvement in the way hypertension is managed. In many countries, the great majority of hypertensive subjects still show imperfect blood pressure control.1 Furthermore, the reductions or improvements in end-organ damage seen during antihypertensive therapy do not always correlate well with the reduction in arterial blood pressure achieved. Thus, there seems to be a need for new therapeutic perspectives in the treatment of hypertension. One important new perspective might be provided by an enhanced appreciation of the importance of the microcirculation in the pathophysiology and treatment of hypertension.

 

The Microcirculation in Hypertension

In hypertension, the structure and function of the microcirculation may be altered in at least 3 ways. First, the mechanisms regulating vasomotor tone may be abnormal, leading to enhanced vasoconstriction or reduced vasodilator responses. Second, there may be anatomic alterations to the structure of individual precapillary resistance vessels, such as an increase in their wall-to-lumen ratio. Finally, there may be changes at the level of the microvascular network, perhaps involving a reduction in the density (rarefaction) of arterioles or capillaries within a given vascular bed. It is likely that the relative contributions of these factors will be different in different vascular beds and may vary between different forms and models of hypertension. Nevertheless, it is possible to discern a historical shift in the focus of antihypertensive therapy between these different mechanisms. Initially, antihypertensive therapy was directed mainly toward altering vasomotor tone and promoting vasodilation. More recently, attention was directed toward reducing or reversing changes in resistance vessel structure, and in the last few years, there has been a further evolution toward reducing or reversing microvascular network rarefaction. Interestingly, several antihypertensive agents that act acutely to reduce vasomotor tone are now known to have additional chronic actions on vessel and network structure, which may be more important in the long-term treatment of hypertension.

In this article, we review the animal and human evidence available for the role of the microcirculation during hypertension and the effects of therapy, focusing on those aspects that are likely to be common to most forms of hypertension and most organ systems.

Microcirculatory Abnormalities in Hypertension: Both Cause and Effect?

It has been known for many years that the diameter and structure of small resistance arteries can alter in response to changes in blood pressure and flow. There have been numerous reports of decreases in arteriolar diameters in experimental secondary hypertension.4 Increases in the media-to-lumen ratio of small arteries have also been widely documented in several forms of hypertension,4 consistent with the classic view that vessels maintain constant wall stress in the face of changing pressure. However, it is not clear whether similar changes occur in arterioles in primary hypertension. In SHR, arterioles have not been reported to show consistently reduced luminal diameter or wall thickening (reviewed by Struijker Boudier et al).4

A more consistent observation has been microvessel rarefaction. A reduction in the number or density of microvessels has been reported for many years in most forms of clinical and experimental hypertension. Several studies have documented microvessel rarefaction in SHR and after the experimental induction of secondary hypertension.4

It has been suggested that rarefaction may occur in 2 phases.9 The first phase of functional rarefaction involves microvessel constriction to the point of nonperfusion, possibly as a result of increased sensitivity to vasoconstrictor stimuli. The nonperfused vessels may then disappear, leading to the second phase of structural or anatomic rarefaction, which cannot be reversed by maximal vasodilation. In patients with primary hypertension, the reduction in density of capillaries in the skin of the dorsum of the fingers has recently been shown to be mainly a result of anatomic rather than functional rarefaction.10

It is therefore possible to view microvessel abnormality and rarefaction as responses to increased vascular pressure. However, this is clearly not always the case, because microvascular changes similar to those observed in hypertension can be found in conditions such as scleroderma, syndrome X, and hypertrophic cardiomyopathy in the absence of any elevation in arterial blood pressure. Furthermore, there is evidence that abnormalities in the microcirculation may cause or contribute to the elevation of blood pressure.

Targeting the Microcirculation to Prevent End-Organ Damage: Beyond Blood Pressure Reduction?

Numerous trials have demonstrated that antihypertensive therapy is effective in reducing major vascular events, including stroke and coronary heart disease. However, several forms of specific end-organ damage that primarily involve the microcirculation are thought to be secondary to hypertension, including nephropathy, retinopathy, lacunar infarction, and microvascular angina. Thus, it is to be expected that there will be additional benefits from targeting the microcirculation during antihypertensive therapy in terms of the prevention of or reduction in end-organ damage.

One of the most intensively studied forms of end-organ damage with microvascular involvement is microalbuminuria or increased urinary albumin excretion. Microalbuminuria is known to be a risk factor for cardiovascular disease and mortality in nondiabetic and diabetic individuals. In the Framingham study, proteinuria was 3 times more common in hypertensive than in normotensive individuals and was associated with a 3-fold increase in mortality.18 Importantly, hypertensive patients with microalbuminuria have an increased cardiovascular risk compared with normoalbuminuric patients with similar blood pressure.19

Although microalbuminuria may be an early marker of renal dysfunction, it is now clear that it can be reversible. A recent large-scale study of 6000 nondiabetic hypertensive patients showed that microalbuminuria can be reversed in many cases by antihypertensive therapy.20 In SHR, different antihypertensive agents have different effects on renal afferent arteriolar structure. ACE inhibition produced a greater increase in the diameters of distal afferent arterioles than a calcium antagonist of equivalent hypotensive effect.21

The heart is another organ that may suffer end-organ damage, and numerous studies have reported changes in myocardial microvessel structure and density in hypertension. During normal development, myocardial microvascular density increases during the first few postnatal weeks but then decreases, probably because angiogenesis fails to match the growth in myocyte volume.22 During the pressure-overload hypertrophy that often accompanies hypertension, the picture that emerges from studies in both animals and human patients is that microvessel growth is insufficient to prevent dilution because of the greater increase in other myocardial components; hence, microvascular density decreases.22 It has been argued that microvascular changes may make a substantial contribution to the development of cardiac failure in hypertensive patients.23

The risk of stroke is greatly increased by hypertension. Although there are multiple causes of stroke, the form that is perhaps most closely associated with small-vessel abnormality is lacunar infarction, the occurrence of small, deep infarcts thought to be caused by the occlusion or rupture of small vessels, largely as a result of hypertensive changes.

Hypertensive changes in cerebral arteriolar structure have been documented in animal models. In SHR, reductions in the external diameter and increases in the media-to-lumen ratio of cerebral arterioles have been reported.24 However, most reports conclude that neither cerebral arterioles nor capillaries undergo rarefaction in SHR or in other experimental models of hypertension. At least some forms of antihypertensive therapy can reverse structural changes in cerebral microvessels25 and can dramatically increase the lifespan of stroke-prone SHR.26,27

Conclusions

Abnormalities of microvessel structure and microvascular network density often accompany, and may be an important cause of, primary hypertension. Microcirculatory abnormalities are also likely to be central to many forms of hypertensive end-organ damage, including those involving the kidneys, heart, and brain. Optimal antihypertensive therapy should therefore be targeted at both large and small vessels. Available evidence suggests that the 2 longest-established classes of antihypertensive agents, diuretics and β-blockers, have no specific beneficial actions on the microcirculation. However, the results of numerous animal studies and a much smaller number of clinical studies indicate that the newer classes of antihypertensive agents and some combinations of agents offer considerable potential for improving microvessel structure and network density. It would therefore be predicted that more widespread use of these agents and combinations would enable substantial reductions in end-organ damage to be achieved, with consequent reductions in morbidity and mortality. Much further clinical research is needed to assess the extent to which this potential can be realized in clinical practice.

This article was written on behalf of the European Working Group for Microcirculation and Cardiovascular Disease. Other members are E. Agabiti-Rosei, University of Brescia, Italy; T.F. Lüscher, University Hospital, Zurich, Switzerland; G.A. MacGregor, St George’s Hospital Medical School, London, UK; and E. Vicaut, Hôpital Fernand Widal, Paris, France.

HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

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Did you know when used in a regimen, D`OXYVA users have reported a number of health and beauty benefits?

doxyva benefits

OPTIMIZE BLOOD CIRCULATION FOR A WIDE VARIETY OF SIGNIFICANT OUTCOMES

D’OXYVA® (deoxyhemoglobin vasodilator) in various clinical trials has validated leading independent research results and demonstrated above-average results in improving a host of physiological functions at the same time.

People using D’OXYVA® have recorded significant improvements in cardiovascular activity leading to much improved physical activity. As part of a healthy lifestyle, D’OXYVA may help significantly reduce the risk of high blood pressure, hypertension, cholesterol, and diabetes in just two or three months, with an average use of 5 minutes a day and 5 times a week.

Poor circulation is a gateway for a litany of ailments: slow healing, depression, poor complexion, sores, slow metabolism, and more.

D’OXYVA significantly improves sustained oxygen-rich microcirculatory blood flow locally and throughout the body. Its patented method of fully non-invasive, painless, and harmless transdermal delivery is unique only to D’OXYVA.

When used daily, D’OXYVA users have reported a number of health and beauty benefits, including but not limited to:

  • Relief from symptoms of microvascular complications
  • Significantly increased cardiac function, physical fitness, endurance and strength, muscle size, body tone, faster recovery from sports injuries and surgical trauma
  • Improved self-esteem via promoting healthy and radiant skin, complexion, dry skin relief, and acne reduction
  • Significant reduction in downtime from other skin treatments and cosmetic procedures when used in combination, reduction in the appearance of scars, cellulite, fat, spider veins and stretch marks
  • Promoting and maintaining a healthy weight, improving general mobility, deeper, more restful sleep
  • Significant improvement of mental acuity; concentration, problem solving, multitasking, eye-hand coordination, heightened stamina, energy, and focus while managing stress
  • Improved vitals across the board during checkups with zero adverse event reports after years of regular use by people with various health, demographic, and ethnic backgrounds

HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

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4 things you should know about erectile dysfunction

Erectile dysfunction (ED), once shrouded in secrecy, is now in the spotlight, thanks to high-profile advertisements for drugs like Cialis, Viagra, Levitra, and Stendra. But despite this greater awareness of ED, many men — and women — don’t really know much about this condition. Here are four things to know about ED.

ED is often the result of diseases or conditions that become more common with age. It can also be a side effect of the medications used to treat them. Other possible causes of ED include prostate surgery, stress, relationship problems, and depression.
Other age-related factors besides disease can also affect a man’s ability to have an erection — for example, with age, tissues become less elastic and nerve communication slows. But even these factors don’t explain many cases of ED.

Cardiovascular disease is a common cause of ED. Clogged arteries (atherosclerosis) affect not only the blood vessels of the heart, but those throughout the body as well. In fact, in up to 30% of men who see their doctors about ED, the condition is the first hint that they have cardiovascular disease.

Intriguing findings from the Massachusetts Male Aging Study suggest there may be a natural ebb and flow to ED — that is, for some men, trouble with erections may occur, last for a significant amount of time, and then partly or fully disappear without treatment.
Regardless of the cause, ED often can be effectively addressed. For some men, simply losing weight and exercising more may help.

Others may need medications, and there are other options available as well. Given the variety of therapies available, the possibility of finding the right solution is greater than ever.

 

Reference: https://www.health.harvard.edu/mens-health/4-things-you-should-know-about-erectile-dysfunction

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Are Veiny Arms Really a Sign You’re Super Fit?

You’ve seen the crazy photo of cyclist Pawel Poljanski’s insane leg veins after his 70-hour Tour de France pump. And the Rock boasts a pretty impressive bicep vein, too. Plus, go to any bodybuilding competition, and you’ll see a whole slew of guys with impressive vascularity as well.

What all these veiny guys have in common is that they are in tremendous shape. But is vascularity really a sign of superb fitness?First, let’s take a look at the reason your veins pop in the first place.

Your arteries carry blood away from your heart to the tissues throughout your body, like your muscles. Your veins—which have thin walls and dilate easily—pump the blood back toward your heart.

“The venous outflow is slower than arterial inflow, causing a back-up of venous blood causing higher pressure in the veins,” says Doug McGuff, M.D., author of Body By Science. That increases pressure causes the veins to “pop” out. That’s the pump you get.

But what you’re doing also plays a role in the pop, too.

“Swelling in the muscles pushes the veins out to the surface,” says Spencer Nadolsky, D.O., author of The Fat Loss Prescription. “Your muscles swell when working out and push the veins closer to the surface of your skin, which makes them more pronounced.”

You probably notice your veins popping more during weight lifting than when you’re simply taking a walk or doing other kinds of light cardio.

In general, higher-rep weight lifting with fast concentric movements—say, the part of a biceps curl when you bring the weight up toward your arm—would trigger the biggest pump, says Dr. Nadolsky.

“High intensity interval work can produce this effect as well,” says Dr. McGuff. “Muscular loading and fatigue drive arterial inflow into the muscle, so exercise that triggers this will produce venous engorgement.”

Okay, so your veins tend to pop when you’re working out, but does how veiny you get actually depend on how fit you are? Well, sort of.

The leaner you are—meaning, the less subcutaneous fat you have covering your muscles—the more pronounced your veins will look, says Dr. Nadolsy.

But it’s not just about being lean: Having low body fat along with upped muscle mass is the magic combination for veins that pop, even when you’re at rest. So in some ways, pronounced veins are an indirect sign of fitness.

 

 

Reference: https://www.menshealth.com/fitness/vascularity-and-fitness-level

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Diet, Exercise Combined Can Improve Blood Circulation in The Brain

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New research suggests that losing weight through diet and exercise could help improve blood circulation in the brains of older adults with type 2 diabetes, which can also help improve cognitive functioning.

Type 2 diabetes can affect blood circulation by stiffening blood vessels and reducing the amount of oxygen that circulates throughout the body, including the brain, which can affect the way we think and make decisions.

Cognitive problems have also been linked to being overweight and obese, conditions that are common for those with type 2 diabetes.

Although lowering calorie intake and increasing physical activity are already known to reduce the negative effects of type 2 diabetes on the body, the effect on the brain has so far been unclear.

To research a possible connection, the team behind the new study looked at information from a 10-year-long study called Action for Health in Diabetes (Look AHEAD).

As the study teaches participants to implement healthy, long-term lifestyle changes, the researchers were able to focus in on whether participants with type 2 diabetes — who made their lifestyles healthier by eating fewer calories and increasing their physical activity — had better blood flow to the brain.

They looked at 310 overweight or obese participants taking part in the study, aged 45 to 76 and with type 2 diabetes, and assigned the participants to two groups.

In the first group, participants were given a daily goal of eating between 1200 to 1800 calories in order to lose weight, based on their initial weight.

They also had a goal of partaking in 175 minutes of physical activity throughout the week through activities such as brisk walking.

The second group acted as a control group, who instead of following a diet and exercise plan attended Diabetes Support and Education classes.

During the study, the participants all had their mental functions tested, including their verbal learning, memory, decision-making ability, and other cognitive functions, and around ten years after the start of the study completed an MRI brain scan.

The team found that those who made the healthy lifestyle changes of eating fewer calories and increasing their physical activity had greater blood flow in the brain.

The results also suggested that the lifestyle changes were more effective in increasing or maintaining blood flow in the brain for individuals who were overweight but not obese.

However, the team still concluded that for all participants, whether overweight or obese, long-term weight loss through diet and exercise is beneficial in increasing brain flow in those with type 2 diabetes.

The researchers published their findings in the Journal of the American Geriatrics Society.



Reference: https://lifestyle.inquirer.net/277528/diet-exercise-combined-can-improve-blood-circulation-in-the-brain-of-type-2-diabetes-patients/#ixzz5lDytsUP3 

HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

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Did you know that poor circulation in the lower extremities occurs when plaque builds up in the arteries that supply blood to the legs?

Did you know that poor circulation in the lower extremities occurs when plaque builds up in the arteries that supply blood to the legs?

Poor Circulation in Legs

Poor circulation in the lower extremities occurs when plaque builds up in the arteries that supply blood to the legs. Symptoms such as pain, numbness, or tingling sensation in legs are likely to be experienced in the event of reduced blood flow to the legs or feet. The following write-up provides information on the contributing factors for this circulatory problem.

Blood is a specialized body fluid that performs the vital function of transporting oxygen and nutrients to various parts of the body. While the oxygenated, nutrient-rich blood that is pumped by the heart is carried by the arteries to the cells, tissues, or the organs of the body, the veins deliver deoxygenated blood from various parts of the body to the heart. The pulmonary veins are an exception, as they carry oxygenated blood from the lungs to the heart.

If the arteries supplying blood to a particular part of the body become partially or completely blocked, a host of distressing symptoms could arise due to the reduced blood flow. Circulatory problems could also arise if the valves present in the veins are not working properly. Under such circumstances, the deoxygenated blood is prevented from returning to the heart. This causes the blood to collect in the veins.

Peripheral Vascular Disease (PVD) is an umbrella term that is used for the medical conditions associated with the blockage of the large arteries that are not located within the heart or the brain. Peripheral vascular disorders are often characterized by reduced blood flow to the legs and feet.

People who make poor lifestyle choices are more likely to be affected by circulatory problems. Poor blood circulation is often observed in the elderly, or people who are affected by certain medical conditions.

HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

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D’OXYVA on cellulite and fat reduction

Cellulite is a symptom of abnormal fat cell growth and an inflammatory response under the skin’s dermis layer. The skin’s dermis layer is known as the living skin, and it is composed of nerves, elastin, fats, blood vessels, and collagen fibers, which provide elasticity. With age, our skin produces less collagen, causing the skin to look wrinkled and saggy. Also, fat cell growth or expansion within the well-delimited hypodermis skin layers compromise effective O2 supply from the vasculature (microcirculation) and push the outer skin layers up while the fibrous septa pull it down. This physical action, which is due to fat cell overgrowth, causes the skin to have an orange-peel and cottage-cheese appearance.

Our body’s physiological response to hypoxia is well known. Hypoxia provokes an inflammatory response associated with the overproduction of adipokines, interleukins, macrophages recruitment, and increased glucose sensitivity (GLUT-1 expression). In other words, when cellulite appears in our skin, we have two major problems: disruption of the dermis skin layer architecture due to abnormal fat cell growth and an inflammation response caused by hypoxia. Substantial evidence suggests that hypoxia (low SpO2 ) is a protagonist in adipose physiology and in adverse bodily responses associated with obesity.

D’OXYVA gentle, super-saturated CO2 vapor causes instant artery microcirculation and venule dilation, thereby improving blood flow. By improving the skin layer’s blood flow, it allows our body to stimulate circulation, detoxify, balance, and increase O2 delivery. D’OXYVA® allows our body to self-heal, particularly by adjusting the fat cell microenvironment. As a result, fat cells decrease their growth rates through a reduction in glucose sensitivity and the promotion of catabolism. After D’OXYVA® administration, the inflammatory response decreases due to the elimination of the hypoxia state.

After adhering to a D’OXYVA® treatment plan, cellulite patients will find significant improvement in their skin’s appearance and feeling.

HOW D’OXYVA CAN HELP?

D’OXYVA is the only fully noninvasive, completely painless transdermal (over-the-skin) microcirculatory solution that has been clinically tested to significantly improve microcirculation.

The improvement of microcirculation, i.e., blood flow to the smallest blood vessels, benefits one’s health, immune system and overall sense of well-being in a variety of ways.

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D’OXYVA as endorsed by Dr. Stephen Pfeifer

I was introduced several years ago to the transdermal COD’OXYVA® delivery system and had the chance to utilize this modality in my practice as well as see the benefits noted by other clinicians who have started implementing the protocols. I was initially skeptical that such an affordable and simple system could have such profound health benefits. But after witnessing improvements in blood pressure, chronic venous insufficiency, diabetic wound healing, mood, and athletic performance enhancement, I realized that this treatment has the potential to help millions of patients with chronic health conditions. So, like most scientists, I began to investigate the reasons why this technology could be so effective.

Could it be possible that one of the main causes of most of our patients’ health problems is rooted in physiologic imbalances in the autonomic nervous system and microcirculation? Have we clinicians been chasing imperfect treatment options with medications and interventions that may certainly ameliorate symptoms initially, but which fail to address critical root causes of physiologic dysfunction and dysregulation?

There is an increasing consensus that microcirculation is critical in many ways. Our vascular system works in such a way that the great arteries have little impact on blood pressure, but small ones control almost 70% of the blood-flow resistance. Each adult organ can have more that 2 miles of capillaries inside it. Each capillary bed is in charge of exchanging small molecules between organ cells and the blood to maintain a healthy cell microenvironment or a state of homeostasis. The vascular system reacts to the concentration of metabolism’s by-products by deciding where to allocate resources and remove waste. However, with time and the accumulation of microcirculation damage due to bad health care habits, poor diet, and sickness, our bodies lose their ability to maintain homeostasis, resulting in poor wound healing, pain, infections, and so on. In other words, the microcirculation system helps our bodies maintain uninterrupted blood flow where it is needed the most.

Another overlooked system is the autonomic nervous system. Many books have been written in the functional medicine arena regarding the concept of adrenal exhaustion, as holistic doctors are realizing that this fundamental imbalance contributes to so many health conditions today. Today, we are bombarded with bad news on TV, we have work and financial challenges, and we have constant interruptions from our cell phones and emails. This constant attack on our survival cortisol hormones can be overwhelming. In functional medicine, we can even document this phenomenon with salivary cortisol hormone levels measured 4­–6 times per day. Typically, we see three progressive levels at play. The adrenal system starts as stressed and wired, then progresses to stressed and tired, followed by burned out and exhausted. At each level, this autonomic imbalance takes its toll on our health. Mother nature provided us with a wonderful adaptive capability to mount a stress response when, in the caveman days, we were running from a pack of wolves. It diverts all energy away from the parasympathetic system (rest and digestion) to a sympathetic response (fright and flight) so we can respond physically, using muscle strength, increased heart rate, and increased cardiac output to respond to a physical challenge. After the challenge is gone, the body should return to homeostasis and a calming parasympathetic mode for rest and digestion. Well, that is just not happening in today’s world, as we are in constant overdrive trying to escape the pack of wolves. So, we primary care doctors are always recommending stress-reduction strategies like yoga, better sleep hygiene, blood sugar stabilization diet strategies, and vitamin supplements that support adrenal balance.

It is refreshing to see a new technologic advancement that can help the many health problems exacerbated by autonomic imbalances. A simple and safe 5-minute transdermal COdelivery device has been shown to work immediately, and there is scientific proof that the physiologic effects continue for many hours. Scientific evidence is available that transdermal COdelivered by the D’OXYVA® device works through several mechanisms:

Reduces inflammation by reducing free radical plasma levels

Raises antioxidant levels and induces vasodilation (microcirculation) through humoral pathway communication

Decreased R-R heart rate interval variation

Activation of the PNS parasympathetic system, causing a vasodilation response

D’OXYVA® is a class 1 low-risk medical device using the natural properties of CO(a FDA-cleared drug) to activate our body’s chemoreceptors and increase organ blood flow through microcirculation while promoting oxygen delivery in capillary beds and organ tissue.

My name is Dr. Steve Pfeifer, and I am a consultant for Circularity and a retired functional medicine doctor. I am proud to be part of the Circularity scientific team that is partnering with clinicians to continue independent research regarding these benefits. More than two dozen research projects have been performed to test D’OXYVA® ‘s potential and safety, and much more are ongoing throughout the world. In fact, at the D’OXYVA® University here in Indianapolis, our doctors are studying the athletic enhancement potential in elite Indy Car race drivers and general athletes to document objective benefits with recovery and pulse oximeter readings reflecting perfusion indexes.

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Have you Heard of Dylan’s Story?

As 180 entrants prepared to run the Camo Run 2017 supporting Veterans and their families at Fort Benjamin Harrison, Indianapolis, Indiana, 14-year-old Dylan Letendre stopped by the booth of Pasadena-based Circularity Healthcare, one of 12 vendors sponsoring the event. Circularity is the company that pioneered the D’OXYVA® medical device (Class 1, low risk) that delivers a gentle, highly concentrated, vaporized CO2 to the body through the skin, improving microcirculation important to sports’ performance. He got into line, and when his turn came, he asked the booth representative how D’OXYVA® could help him win the race. Dylan’s father was the soldier in whose name the Camo Race was founded. This year, the event honored the 10-year anniversary of Brian Letendre’s (Dylan’s father’s) death in Ramadi, Iraq, where he served as a Marine captain. The race raises money for The Golden Star USA Foundation, which

Dylan’s mother, Autumn founded in 2011 to help other families of Veterans. Because D’OXYVA® is a non-toxic, Non-invasive Transdermal Delivery (NTD) system utilizing FDA-cleared Medical CO, a steady group of runners requested infusions prior to the event. Dylan was among them. Circularity gave the youngster a cardiovascular snapshot prior to his D’OXYVA® application, then ran a Masimo® test that measures perfusion index (microcirculation), pulse rate, and oxygen in the system on him and the other recipients. After getting his second Masimo® reading after a single five-minute application of D’OXYVA® , he expressed concern that his perfusion index level (PI) wasn’t higher, testifying to his knowledge of the subject. He was encouraged to Dylan Letendre Page 2 2 stay with the group at the booth until he was satisfied that his PI had, in fact, had almost quadrupled. http://www.geistcurrent.com/a-heart-for-heroes-bo… Dylan’s pride in his performance during the race was impressive and a big highlight of the event. Both he and his mother’s friend Becky, provided testimonials as to how they felt after coming in from the race. Circularity Healthcare’s D’OXYVA®and continues to engage in strong public outreach in support of community events and other important causes. -0- David Jackson, senior sales associates at Circularity Healthcare re-capped the foregoing Camo Run 2017. He can be contacted for more information at crm@doxyva.com

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Why Big Pharma Is Struggling to Profit From the Obesity Epidemic

In a decades-long struggle to control her weight, Carolyn Mills joined the YMCA many times, signed up for the Jenny Craig diet program and tried fen-phen, the drug combination later found to damage heart valves. As her size yo-yoed down and back up, her health deteriorated.

She finally found the answer in a new class of medicines. Now, those drugs and changes to her diet have helped Mills cut her weight to 250 pounds (113 kilograms) from 300 pounds over the last six months. The drawback: her out-of-pocket expenses are almost $300 a month and may head higher. She says it’s worth the cost.

 

Carolyn MillsSOURCE: CAROLYN MILLS

“Obesity haunts me,” said Mills, 62.

Mills highlights the difficulties big pharma faces as it seeks to profit from an epidemic that afflicts more than 600 million adults worldwide. Medicines like Novo Nordisk A/S’s Saxenda, the latest one used by the Boston resident, are safer and more effective than past treatments. Yet employers and insurers are reluctant to cover the drugs, meaning the cost often falls on patients’ shoulders, limiting the potential market.

Drugmakers such as Novartis AG, Novo and Sanofi are pushing ahead, testing even more advanced medicines they hope will deliver greater weight loss than the drugs available today. Once seen as a problem only in wealthier countries, obesity is on the rise in lower-income regions too, increasing the risks of diabetes, heart disease and cancer. That raises health costs and contributes to millions of deaths each year. More than a third of U.S. adults fall into that category.

“Given the public-health crisis around the world with obesity, if we can find a medicine that has strong efficacy and reasonable tolerability there’s no question there’s a very large market here and it would potentially have a big impact on health care,” said Vas Narasimhan, global head of drug development at Basel, Switzerland-based Novartis.

The industry faces hurdles over and above the lack of coverage. Modest weight-loss results and criticism of medicine as a way to treat obesity mean just 2 percent of excessively overweight people rely on drugs. The history in the field is also littered with failures, making some manufacturers leery.

In 2008, a Sanofi weight-loss drug was taken off the market in Europe amid concerns it could lead to depression and suicidal thoughts, while Pfizer Inc. and Merck & Co. ended obesity programs the same year. Those drugs were designed to suppress appetite by blocking the same brain receptor that makes marijuana smokers hungry.

“There’s a gold mine available,” said Ralph Abraham, a doctor at London Medical, a clinic in the U.K. capital that started a weight-management program incorporating Saxenda. “But it’s also been a graveyard in the past.”

Scientists are drawing lessons from treating a related disease: diabetes. Saxenda, which has a list price of more than $1,000 a month and has been sold in the U.S. for two years, has the same key ingredient as Novo’s diabetes medicine Victoza and works like a hormone the body produces naturally that regulates appetite.

Some doctors said they’re comfortable with Saxenda because they’ve been prescribing Victoza for years.
While Saxenda is relatively small today, its sales are forecast to climb to more than $1 billion within five years from about $240 million last year, according to estimates compiled by Bloomberg. Four other obesity drugs tracked by Datamonitor Healthcare—Contrave, Qsymia, Belviq and Xenical—accounted for just $280 million in sales in 2016. The global market for such drugs is projected to climb to about $24 billion in a decade from about $1 billion last year, London-based consulting firm Visiongain estimates.

The average weight loss of 5 percent to 10 percent that patients see with the existing drugs doesn’t “knock your socks off,” said Robert Eckel, a doctor and professor who focuses on obesity and diabetes at the University of Colorado. He said he’s only prescribed Saxenda “a couple of times because there are few people who are willing to pay that much for it.”

The next generation of medicines could work better.

Novartis has a treatment in mid-stage tests that could potentially help patients lose 10 percent to 15 percent of their weight, or even more, if trends seen in early studies continue, Narasimhan said. The company will decide how to proceed based on data due next year.

In the past “we could never thread the needle,” he said. “Now we have more mechanisms that we can take forward.”

An experimental drug Novo is developing showed in early studies it can achieve weight loss of as much as 14 percent, the company said last month. Combining it with other medicines could ultimately make it even more potent, leading to a possible reduction of more than 20 percent, Chief Science Officer Mads Krogsgaard Thomsen said in an interview.

Obese patients sometimes stop taking the drugs and regain weight when they see results plateau, and new and improved medicines may encourage people to stick with them, Thomsen said. Weight loss approaching 15 percent or 20 percent “would be a major breakthrough,” said Eric Ravussin, a specialist at Pennington Biomedical Research Center in Louisiana.

Sanofi is evaluating a drug in obese patients with diabetes that has potential to move closer to the results of surgery, said Stefan Oelrich, head of its diabetes unit. People who opt for bariatric surgery can lose more than 30 percent of excess body weight within six months. AstraZeneca Plc at the same time said it’s developing a diabetes treatment that may have potential in obesity and other metabolic diseases.

Louis Aronne, a doctor at Weill-Cornell Medicine in New York, compared obesity to hypertension, which was once regarded as a lifestyle issue and is now a field with scores of drugs. He predicted that every major medical institution would have a program focused on the disease within a decade.

Read more on the obesity epidemic: QuickTake

Several insurers in Canada have picked up Saxenda, and health authorities in the United Arab Emirates have agreed to pay for some patients in public hospitals, according to Novo. In the U.S., legislation was re-introduced in April aimed partly at improving access to weight-loss medicines for Medicare beneficiaries. It’s hard to predict how policies will play out as Republicans seek to overhaul the Affordable Care Act, but the Obesity Society, a research group, called the proposal a key step in tackling a disease that contributes to $200 billion a year in health costs.

Doctors are gaining a better understanding of the biology of the condition, increasingly seeing obesity as a disease, while there are signs that more insurers are covering medication, said Caroline Apovian, the Boston Medical Center specialist who treated Mills.

“We’ve learned a lot,” she said. “The treatment of obesity will prevent many other serious disorders that in the long term will save us money.”

Mills, an operations manager at a dental practice, said she’s swimming and trying to be more active to build on the progress she’s made with drugs.

“We’re reaching the tipping point with the percentage of people who are so overweight,” she said. “It’s my hope that the tide is changing and people are understanding it’s not just a matter of pushing yourself away from the table.”

 

Reference: https://www.bloomberg.com/news/articles/2017-07-04/why-big-pharma-is-struggling-to-profit-from-the-obesity-epidemic