Ask the Experts: Feeling Faint; Pulmonary Rehabilitation; Flexitarian Diet
Q: I’ve been experiencing feelings of faintness just recently, though I haven’t actually fainted. They seem to occur in the afternoon, when I’m getting up after my nap. Any thoughts on what might be causing the problem? I have high blood pressure, for which I take medication, but no other serious health issues that I know of.
A: Feeling faint isn’t normal, so you should mention your symptoms to your doctor if you haven’t done so already. Not addressing the problem puts you at risk of injury if you do actually faint during one of these spells—they also may be caused by an undiagnosed health problem that needs to be treated.
You mention that you take blood pressure medication. It is possible for these drugs to contribute to a phenomenon called orthostatic hypotension: a sudden drop in blood pressure when you stand up suddenly after being seated or prone. As you rise, blood rushes to your lower limbs and the supply of blood and oxygen to your brain drops, which may cause you to faint. If your doctor suspects this is the reason for your feelings of faintness, he or she may adjust your medication dose.
In some cases, feeling faint can signal an underlying heart condition. If your doctor suspects you may have one, you may be referred for diagnostic tests.
—Rosanne M. Leipzig, MD, PhD, Geriatric Medicine
Q: My wife has chronic obstructive pulmonary disorder, and has been advised to take part in a pulmonary rehabilitation program. Is this worthwhile, given that her condition is incurable?
A: You are right that chronic obstructive pulmonary disorder (COPD) has no cure, but it is a treatable illness. We now have numerous medications and other therapies that reduce symptoms and improve a person’s ability to participate in the activities of everyday living. Pulmonary rehabilitation is one of these.
Staying as physically active as possible is vital if you have COPD, but many people with the condition reduce their physical activity because they feel short of breath. Less physical activity can start a vicious cycle of progressive deconditioning that ends up worsening breathlessness. Pulmonary rehabilitation is aimed at breaking that cycle, and people who participate in a program have less shortness of breath and an increased ability to exercise. Furthermore it has been shown that participating in a pulmonary rehabilitation program reduces the number of exacerbations (episodes of worsening of the condition) that people with COPD experience.
Exercise is the most important aspect of pulmonary rehabilitation, but your wife also will be shown breathing techniques that help her make the best of her remaining lung capacity, and strategies that help prevent and manage COPD exacerbations. She also will likely benefit from the educational component of the program, which will teach her how to properly use an inhaler to ensure that she gets a sufficient dose of medication when necessary. Studies suggest that pulmonary rehabilitation benefits are generally sustained for up to six months after the program ends, especially if the exercise training is maintained.
—Neil Schachter, MD, Pulmonary Medicine
Q: My sister follows a “flexitarian” diet. I’ve never heard of this—what does it involve?
A: A flexitarian diet is essentially a semi-vegetarian diet: you’re cutting back on meat without forgoing it completely, while boosting your intake of plant-derived antioxidants, and other nutrients. A fully vegetarian diet has been linked to a lower risk of cardiovascular disease, diabetes, stroke, and cancer, but for those who like the occasional steak or burger, going semi-vegetarian means you get at least some of the benefits vegetarians enjoy. You also may find that a flexitarian diet helps you better manage any weight gain as you age, since plant-based foods are high in the fiber that helps you feel full for longer after meals.
If you’re interested in following a flexitarian diet but you’re used to basing all of your main meals on meat, ease into your new eating pattern slowly. Try scheduling “meat-free Mondays,” on which mushrooms, beans, chickpeas, lentils, or tofu (a soy product) are your protein source, and substitute fish for meat on a couple of other days.
—Fran C. Grossman, RD, MS, CDE, CDN, Nutrition
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