The concept of the value and benefit of gluten-free food has been gaining momentum for the last 10 years. Discussion related to gluten-free diets goes back to the mid-1950s, but those peer-reviewed articles were primarily focused on the treatment of celiac disease and related gastrointestinal disorders. Today gluten-free diets are being adopted as an overall health-promoting measure by broad segments of the population. Is this trend merely a fad or are there actual advantages for the average person in cutting down on gluten intake?
Gluten is a structural protein found in wheat that provides a glue-like property and helps dough stick together. Gluten-containing wheat works best for bread making, and a few thousand years ago gluten-containing wheat became the standard wheat crop. Similarly, the protein in barley and rye is predominantly gluten. Researchers posit that tens of thousands of years ago our digestive systems were optimized genetically to process a diverse diet of grains. But a modern diet is mostly composed of uniform, gluten-containing grains. Our digestive systems were not designed to process such a heavy load of gluten, and the result is the development of a range of gluten-sensitivity disorders and autoimmune diseases.1
Gluten sensitivity has been proposed as a culprit in numerous conditions, including autism, attention deficit hyperactivity disorder, schizophrenia, rheumatoid arthritis, fibromyalgia, and infertility.2,3 The link to such conditions is not clearly understood, but case reports identifying gluten sensitivity as a causal factor have appeared in numerous professional journals for more than 10 years.
For children, adolescents, and adults with such disorders, it may be appropriate to adopt a gluten-free diet to eliminate a potential source of tissue inflammation. Other persons with various nonspecific digestive complaints may also benefit from a gluten-free nutrition plan. For example, if you experience frequent, or even periodic, upset stomachs or other gastrointestinal problems, consumption of gluten may be part of the clinical scenario. Two months on a gluten-free food plan should be sufficient to determine whether gluten protein is a contributing factor to such complaints.
Going gluten-free takes a lot of dedication, time, and effort. The first step is to learn which foods in your diet contain gluten. As noted, wheat, barley, and rye are primary sources of gluten protein. Quinoa, teff, buckwheat, millet, and amaranth are gluten-free replacements for gluten-containing grains. It's important to bear in mind that many foods contain wheat and represent hidden sources of gluten, including beer, potato chips, brown rice sugar, soy sauce, and processed food such as deli meats, frozen burgers, and bread crumbs. Being gluten-free requires diligence, but the payoff may be substantial in terms of overall health and well-being.
1Sapone A, et al: Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Med. 2012 Feb 7;10:13. doi: 10.1186/1741-7015-10-13
2Isasi C, et al: Fibromyalgia and non-celiac gluten sensitivity: a description with remission of fibromyalgia. Rheumatol Int 2014 Apr 12. [Epub ahead of print]
3Herfarth HH, et al: Prevalence of a gluten-free diet and improvement of clinical symptoms in patients with inflammatory bowel diseases. Inflamm Bowel Dis 20(7):1194-7, 2014
Efficiency. It is something we all look for in home appliances or cars. How much energy will this thing take to run? Does the system have any weaknesses? If it's a used car, we want to know if the car had its oil changed regularly and if the parts have been properly cared for. We know that when one thing is imbalanced, the whole system becomes less effective. The truth is, regular maintenance (getting that tune-up, having that spine adjusted) can play a significant role in overall "fitness." When all systems are fully supported and functioning properly, we run, work, and play better.
Though it can be difficult to define, physical fitness refers to a state of overall health that includes the ability to perform a range of activities, from a hard workout to working comfortably at a desk, with ease and efficiency. According to the American College of Sports Medicine, there are four interrelated types of fitness that contribute to complete health: muscular fitness, which includes muscle strength and endurance; flexibility, which includes muscle/tendon elasticity and range of motion; cardio-respiratory fitness, which includes the heart, lungs, and blood vessels; and body composition, or the percentage of body fat to nonfat tissues (bones, organs, etc.). Because no one system functions independently, the fitness of each affects all the others.
While it's important to get adequate exercise, eat right, and treat our bodies kindly to maximize health in all of the above categories, regular alignment or "maintenance" through chiropractic adjustments can be a big step to improving overall fitness. Because chiropractic works toward balancing the body's systems-bones, muscles, nerves, and organs-through proper posture and alignment, regular chiropractic care allows the whole body to perform at its best, increasing energy reserves as it decreases the stress and fatigue that can result from improper alignment.
In fact, icons of fitness such as Decathlon Gold Medalist Dan O'Brien and Superbowl MVP Joe Montana use chiropractic care to maintain peak physical performance; and the trend is catching on among a number of professional athletes and sports teams. The U.S. teams for the 2002 Winter Olympics were the first to employ an official Doctor of Chiropractic, Dr. Robin Hunter, and they had one of the best showings ever. Coincidence? Hunter has stated the chiropractic care is all about "correcting bio-mechanical faults and misalignments, and treating injuries with hands-on work, so that the athletes can return to play faster and better." John Stockton, a pro basketball player that has turned to chiropractic to better his game says, "It's not just the adjustments, it's balancing muscles and overall health." After a recent skiing accident, Schwarzenegger remarked, "I had one of those miracle moments when you call a chiropractor, they care for you and then days later you ski again like a champion on moguls."
Though it may feel like a miracle, the principle of chiropractic is simple. When the body is well aligned, muscles, joints, and ligaments function together with greater ease. Internal organs aren't hindered-the lungs and heart are better able to do their jobs. Perhaps even more importantly, chiropractic care helps prevent injuries that can result from overtaxing a particular part of the body that may be compensating for those that aren't functioning as well. Through chiropractic the body gets a tune-up. We're ready to roll-more efficiently and with a greater sense of well-being.
How would you rate your physical fitness? Would you like to learn how chiropractic care can help you with your goals?
Kids don't have that strong a relationship to vegetables. Kids will go through the motions, pushing broccoli spears and lima beans around their plate a few times, but few veggies actually reach the inside of a kid's mouth.
And yet, we want our kids to eat vegetables on a regular basis. The best way to do this is to serve fresh veggies daily, and make sure WE eat all the vegetables on our plates!
Why bother? It turns out that vegetables - all kinds of vegetables - contain super-powerful ingredients that help keep us healthy and help us ward off a wide range of serious illnesses.1,2 These magical substances - phytochemicals - give fruits and vegetables their big nutritional kick!
"Phyto" is Greek for "plant". Brightly colored fruits and vegetables contain the most nutrients and the most phytochemicals.
Well-known phytochemicals include lycopene, found in tomatoes; isoflavones, found in soy; and flavonoids, found in fruits such as blueberries and cranberries.3 Phytochemicals have wide-ranging effects - some are antioxidants, others stimulate enzyme activity, and others have hormonal action. All phytochemicals act to enhance health and well-being and human performance.
Antioxidants provide significant protection for your body's cells against the destructive oxidation potential of free radicals. Free radicals are produced by normal metabolic activities, and they are neutralized by antioxidants which we obtain in a well-balanced diet.
But if we're not consuming our daily requirement of fruits and vegetables, our reserves of antioxidants are decreased, and free radicals can destroy cells and create disease. For example, certain types of cancer are linked to free radical damage.
Bottom line - broccoli spears are much more than flowery green things your Mom used to make you eat. Broccoli is a superfood, rich in antioxidants and rich in cancer-fighting ability.
Carrots - another superfood- are rich in beta-carotene, an important antioxidant. Your body converts a portion of beta-carotene into Vitamin A, which helps strengthen the immune system and protects the digestive tract.
Tomatoes round out the list of the top three super-veggies. Tomatoes are rich in lycopene - a potent antioxidant. Lycopenes give tomatoes their rich, red color. These phytochemicals have proven health benefits in the areas of cardiovascular disease, cancer, diabetes, and osteoporosis.
Eating vegetables daily provides so much benefit for people of all ages. Five to nine portions of fruits and vegetables are recommended in a balanced nutritional program.
Your chiropractor is an expert on nutrition and will be glad to help you construct food plans that work for you and your family.
1Hayes JD, et al: The cancer chemopreventive actions of phytochemicals derived from glucosinolates. Eur J Nutr 47(Suppl 2):73-88, 2008
2Nair S, et al: Natural dietary anti-cancer chemopreventive compounds: redox-mediated differential signaling mechanisms in cytoprotection of normal cells versus cytotoxicity in tumor cells. Acta Pharmacol Sin 28(4):459-472, 2007
3Vinson JA, et al: Cranberries and cranberry products: Powerful in vitro, ex vivo, and in vivo sources of antioxidants. J Agric Food Chem June 2008 (in press)
The mystery writer Raymond Chandler, author of "The Big Sleep" and "The Long Goodbye", famously extolled a "California breakfast" of orange juice and a cigarette. Of course, this was back in the bad old days when lighting up was part of most people's morning ritual. Today, although the orange juice might remain, a healthy breakfast consists of various nutritious replacements for the non-nourishing cigarette.
The importance of eating a good breakfast has been widely promoted in countless public health campaigns, yet many people persist in rushing past this critical meal, jumping right in to their daily work activities while bolting down an oat bran muffin or, worse, a toaster pastry. Such behavior does not support a healthy lifestyle and is especially deleterious for children and teenagers.
From the adult perspective, a lack of sufficient nutritional energy resources will negatively impact a person's work performance. In the absence of appropriate blood glucose levels, your body will seek out other energy sources such as stored fat. The metabolic demands of utilizing fat for energy are much greater than those of processes that use glucose. Over the course of a morning, such inefficient metabolism leads to tiredness, fatigue, and even a headache. Other body systems suffer, especially the digestive system and the nerve system.1,2 For example, the primary source of energy for your brain is glucose. If you've had a less-than-nutritious breakfast, the supply of glucose reaching your brain is substantially reduced. As a result, your thinking gets muddled. Creativity and decision-making processes degrade. Your overall effectiveness as a human being becomes markedly reduced.3 The negative consequences can only be imagined.
It may be fairly considered that young people depend even more on their brains than do adults. Their brains are responsible, in addition to everything else, for coordinating the growth and development of their entire bodies. The nerve system is the body's master system and the brain is the command and control center of the nerve system. Proper nutrition, critical for long-term health and well-being of all persons, is even more important for children and teenagers. Habitual lack of a healthy, nutritious breakfast leads to an unending list of problems for young people as they get older and become adults.
It is a truism that breakfast is the most important meal of the day. Every meal is necessary and valuable, but a complete breakfast sets the tone for how things will go for the next 12 to 18 hours. Taking the time for breakfast is well worth the effort. When your energy stores have been replenished, you're ready for action. You might need to get out of bed 15 minutes earlier, but this change in routine will soon become a useful new habit. All of your family members will benefit by taking this time to take care of themselves.
As all real estate brokers know, a fresh coat of paint will make any property look good. Whether your home is a row house in Baltimore, a Paris atelier, or even a Winnebago, a new coat of paint will bring a shine to the interior and put a smile on the faces of both residents and guests. You may find that a similar smile will appear on your face and the faces of your friends and family members when you engage in activities that provide you with a metaphorical fresh coat of paint. Specifically, you'll obtain your "new look" by incorporating a healthy diet and regular, vigorous exercise in your daily routine.1,2
But what exactly is "a healthy diet," and what is really meant by "regular, vigorous exercise"? A healthy diet consists in a daily practice of consuming food from all five food groups: fruits, vegetables, grains, proteins, and dairy. Importantly, a healthy diet includes at least five daily servings of fresh fruits and vegetables. Overall, the more colors on your plate, the better. If you're consistently eating yellow, green, red, blue, orange, and purple foods such as squash, corn, grapefruit, kale, broccoli, apples, peppers, blueberries, carrots, oranges, potatoes, and eggplant, you're well on your way toward a lifelong healthy diet.
The grains food group contains whole grains such as whole wheat, brown rice, bulgur, and barley. For those who require gluten-free whole grains, the numerous choices include amaranth, buckwheat, quinoa, brown rice, and teff. The protein food group includes beef, lamb, chicken, eggs, fish, beans and peas, and nuts and seeds. There are plenty of protein sources for vegetarians and others who don't eat meat or other foods derived from animals such as eggs and milk. The dairy group is included to provide sources of calcium.3 These foods include low-fat and fat-free choices such as milk, yoghurt, and cheese. If you're a vegetarian or have allergies to dairy products, other sources of calcium include kale, collard greens, spinach, salmon, sardines, blackstrap molasses, and beans. For men and women aged 19 to 50, the recommended daily requirement for calcium is 1000mg. For women over age 50 and men over age 70, the recommended daily requirement for calcium is 1200mg.
Regular, vigorous exercise means doing at least 30 minutes of exercise five days a week. Walking, running, bike riding, swimming, using an elliptical machine or treadmill, and weight training are all good choices. Lifting weights three times a week and doing some form of aerobic exercise two times a week is one example of such a program of vigorous daily exercise. For some people, walking five days a week for at least 30 minutes each day represents an optimal program. Find out what works best for you and do that consistently. Change your program every few months to keep both your mind and body challenged. Again, the specific form of exercise is not critical. What works for one person will not work for another. The key is consistency. Five days a week, at least 30 minutes a day.
Your fresh coat of paint is not merely metaphorical. Once your new lifestyle changes take effect, probably within three to six weeks, you'll begin to develop an inner glow and an outer glow that will be visible for all to see.
1King DE, et al: Impact of healthy lifestyle on mortality in people with normal blood pressure, LDL cholesterol, and C-reactive protein. Eur J Prev Cardiol 20(1):73-79, 2013
2Lopresti AL, et al: A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. J Affect Disord 148(1):12-27, 2013
3Nachtigall MJ, et al: Osteoporosis risk factors and early life-style modifications to decrease disease burden in women. Clin Obstet Gynecol 56(4):650-653, 2013
Wouldn't it be great if your body came with an owner's manual? You'd probably begin reading it around the age of seven or eight, and right away you would be able to start taking better care of your precious body. You would learn how you can use your body efficiently and effectively. By learning how to use your body correctly, you'd be ensuring a lifetime of good health and peak performance. You wouldn't have to play catch up when, after years and decades of uninformed abuse, your once-perfect physical machinery began to systematically break down. In fact, by taking the time to learn sound practices, habits, and techniques now, you could avoid what, for many, turns out to be years or even decades of unnecessary physical pain and mental or emotional suffering. Fortunately, it's never too late to start improving your life and maximizing your health, and the sooner you get started, the sooner you will start experiencing the benefits.
So, what topics would such an owner's manual cover? The manual would discuss and describe the usual suspects - good posture1, exercise2, nutrition3, and proper rest - that everyone knows about but almost no one puts into regular, or even irregular, practice. The single greatest benefit of having your own personal instruction guide is that you would be able to learn about these processes without trial and error. The metaphorical horse of good health would not yet have left the barn. Rather than shutting the stable doors after the stalls had emptied - the way most of us pay attention to our health - you would be empowered as to how to actually take care of yourself.
So what can you do? Without the benefit of such an owner's manual or the lucky acquisition of teachers and coaches who really know what they're doing, most of us struggle along. Our posture gets worse and worse, our muscles and joints get tighter and tighter, and sooner or later (usually sooner) we develop pain that quickly becomes chronic. Fortunately our bodies are resilient and reparable. Once we find the right person (such as a chiropractor) who can teach us about good posture and healthful exercise, it's possible to start feeling better. A chiropractor is intimately familiar with the spine and can help you figure out the secrets to your own body, so that you get all the benefits of having an owner's manual without having to do all the legwork yourself.
Using posture as an example, a chiropractor can teach you the secrets that many mentors and coaches impart to dancers, gymnasts, and all other highly trained competitive athletes. You can learn how to balance your weight over the balls of your feet. You can learn how to stand erect and straight, but not rigid. You can learn how to open your chest without straining your chest muscles, allowing your lungs to take in all the air you need to function at your peak. You can learn how to let your shoulder girdles relax, resting them on your rib cage, sitting or standing straight and tall without tightening and fatiguing your neck and upper back muscles. You can learn how to activate and properly use your core abdominal musculature, providing a firm and secure foundation for all your body's activities. A chiropractor is an expert of the human spine, and has an intimate understanding of how your spine and posture affects how you feel, as well as what you need to do to take care of this precious part of the human anatomy.
High serum glucose. High cholesterol. High blood pressure. This is a trifecta you definitely don't want to have. This combination of laboratory findings is known as metabolic syndrome, a new medical term that has been in existence for less than ten years. It's well-known that there is an epidemic of obesity in America. Two-thirds of Americans are overweight or obese. Thirty percent of American children are overweight or obese. The numbers continue to increase. The United States is also in the midst of an epidemic in diabetes. Eight percent of Americans over age 20 have diabetes - one in twelve people. Again, the numbers are increasing.
Recently, public health researchers discovered that people who were overweight and had diabetes also had high blood pressure - the combination of findings was termed metabolic syndrome. The implication is that if a person has one or more of these abnormal findings, he is at risk for the others.1,2,3 If a person has high blood glucose she is at risk for high blood pressure and elevated cholesterol. Being overweight increases the risk of developing diabetes and developing cardiovascular disease - heart attack and stroke.
The statistics and medical conclusions are sobering, and yet there is good news. Each of these serious disorders - diabetes, obesity, and high blood pressure - is a lifestyle disease. Lifestyle contributes significantly to developing any and all of these conditions. Making long-lasting changes in the way we live has long-lasting effects on our health and well-being. Lifestyle recommendations are not breaking news. Everyone knows about the benefits of healthy nutrition and regular vigorous exercise. Research has consistently shown that diet, exercise, and proper rest significantly improve one's health. The great challenge is to cause people to engage in these activities which are in their own interest.
An additional important lifestyle change is to engage in regular chiropractic care. Chiropractic care ensures optimal functioning of the nerve system which ensures optimal functioning of all other body systems. If the nerve system is over- or understimulated, physiology will break down in various ways and disease will result. Chiropractic care balances nerve system activity via gentle manipulation of spinal joints. Proper function of the spine results, with normalization of nerve activity. Chiropractic care enhances all other lifestyle activities. Healthy nutrition and regular exercise can have maximum benefit when your spine and nerve system are functioning properly.
1McNaughton SA, et al: Dietary patterns, insulin resistance, and incidence of type 2 diabetes in the Whitehall II Study. Diabetes Care 31(7):1343-1348, 2008
2Brunner EJ, et al: Dietary patterns and 15-y risks of major coronary events, diabetes, and mortality. Am J Clin Nutr 87(5):1414-1421, 2008
3Roman B, et al: Effectiveness of the Mediterranean diet in the elderly. Clin Interv Aging 3(1):97-109, 2008
Everyone wants to grow their bank account. We know our financial health is usually estimated by the level of our resources. The more money in the bank, figuratively speaking, the more secure we feel. If our resources include stocks, bonds, and property, we are even more secure.
We can use such fiscal accounting as a metaphor for our physical health and well-being. The more resources we can accumulate in our "health account" the healthier we'll be. And if we're able to diversify the "holdings" in our health accounts, as we'd like to be doing with our financial accounts, we'll enjoy more and better long-term health from many points of view.
Whether we're paying attention or not, our physical resources fluctuate as regularly as do our financial resources. And as in financial accounting, health accounting involves income and expenses. If income exceeds expenses, you enjoy higher levels of relative health. The converse is also true - when expenses exceed income, health deteriorates.
What kinds of things can go into our health accounts? We can easily list the most crucial of these - food,1 exercise 2 and rest.3 But we're not interested in quantity. We're much more interested in quality. We're interested in maximizing value. For example, focusing on quantity with respect to food causes a person to become overweight. Focusing on quality - high-quality protein and high-quality complex carbohydrates, with plenty of fresh fruits and vegetables - causes a person to become leaner and fitter. We don't want to fill our health accounts with coins made of lead and copper. We want to fill them with coins made of gold.
As far as rest is concerned, it's important to get, on average, the rest we need. Most people require 7 to 8 hours of sleep each night. There are exceptions, of course. For the average person, getting 6 or less hours of sleep on a long-term basis will deplete their health account. But getting too much sleep also has a negative impact. Again, quality is more important than quantity.
There are many additional sources of "income" that enrich our health accounts. Loving relationships with our family, fulfilling relationships with our friends, stimulating and challenging activities and interests, learning new skills, and exploring new environments all grow our health accounts and enhance our long-term health and well-being.
Chiropractic care is another source of "income" for our health accounts. Regular chiropractic care helps a person maximize the value - on a physiological basis - of the food, exercise, and rest she is getting. Chiropractic care helps people get the most out of their health resources, becoming more efficient and effective in terms of physiology, health, and well-being.
1Greenwald P, Dunn BK: Do we make optimal use of the potential of cancer prevention? Recent Results Cancer Res 181:3-17, 2009
2Jackson AS, et al: Role of lifestyle and aging on the longitudinal change in cardiorespiratory fitness. Arch Intern Med 169(19):1781-1787, 2009
3Smaldone A, et al: Sleepless in America: inadequate sleep and relationships to health and well-being of our nation's children. Pediatrics 119(Suppl 1):S29-S37, 2007
What does the future hold in store? None of us can know with certainty, although some predictions are possible. Stock market indexes will rise. Then they'll fall. Then everyone will hope that the indexes will rise again. Hemlines will fall. Then they'll rise. Then in two or three years they'll fall again.
The French have a saying for all this - plus ça change, plus c'est la même chose. The more things change, the more they stay the same. In fact, things have changed a lot in 10 years. The Internet exploded. Cell phones are everywhere. In the United States an African-American man was elected president. Longstanding dictatorships were toppled in the Middle East.
The next ten years have the possibility of being even more gloriously impactful.1,2,3 Things do not necessarily remain the same. The actress Betty White has reinvigorated her career at age 89. Jeff Bridges won a Best Actor Academy Award at age 61, highlighting a 40-year career. The 2010 Best Original Screenplay Academy Award went to the 73-year-old first-time winner David Seidler. Leon Russell, the beloved musician/songwriter, was recently inducted into the Rock and Roll Hall of Fame. Well into his 60s, Russell observed that he had been "lying in a ditch on the side of the highway of life" when he his career was suddenly, unexpectedly resurrected by Elton John.
In the next ten years, for us, anything is possible. But in order to move beyond the "same old, same old" we are required to make a choice. Another old saying, "if it's going to be, it's up to me", remains true today. We need to make choices on our own behalf, choices that will further our growth and development and the growth and development of our loved ones. We can create a spectacular next ten years.
In general most people pay close attention to auto maintenance. Whether the concern is tires, brakes, transmission, or windshield status, people make sure that their cars do what they need them to do. People count on their cars to perform effectively. No one wants a surprise, especially in a critical situation. But in stark contrast, people often give much less consideration to their own physical functioning and capacity than they do to several critical performance factors related to their own automobiles.
The metaphor of machine upkeep standing in for health maintenance is commonplace but apt. To prove the point, most of us allow our physical conditioning to deteriorate far beyond that which we would ever tolerate relative to our cars or even our power lawnmowers. The immediate consequences of such neglect are the developed world epidemic in diabetes, the United States–based epidemic in obesity, and the ongoing high levels of cardiovascular disease worldwide.
What redress is required with respect to our physical health and welfare? As with our cars, the long view is needed. If we lease a new car every year, upkeep is not an issue beyond an oil and filter change or two. But if we want our car to continue to perform reliably for three, five, or ten years, regularly scheduled service is necessary. Our cars need check-ups every 12 months or so. As flesh-and-blood organisms, we require a similar schedule of maintenance.
Importantly, feeling fine is not necessarily a good guide to how we're doing from a health perspective. High blood pressure, for example, is known as the "silent killer." There are no fully recognizable signs and symptoms of hypertension, until it's too late.1 By the time a person has had a debilitating heart attack or stroke, high blood pressure has probably been in place for years. Similarly, the early symptoms and signs of diabetes are subtle and seemingly harmless. Fatigue and an inability to focus may be ignored or interpreted as mere symptoms of an overly stressed lifestyle. Frequent thirst and frequent urination might be conveniently explained away as side effects of poor eating habits. Again, serious damage may be done, possibly involving one's kidneys and one's vision, as a result of undiagnosed and untreated diabetes.2
The solution to helping prevent such potentially serious health problems is to make sure you have regular check-ups. Operating on the long view, rather than operating as the proverbial ostrich (with his head buried in the sand) or the proverbial grasshopper (who fiddled all day), we will have annual or biannual blood pressure readings and blood tests. Appropriate scheduling for such check-ups will be specific to the individual, based upon age, past medical history, and family history. The critical takeaway is to practice preventive health care based on the long view.3 Perform personal maintenance and service checks as needed.
1Kumar N, et al: Management of patients with resistant hypertension: current treatment options. Integr Blood Press Control 6:139-151, 20132
2Adebayo O, Willis GC: Changing Face of Diabetes in America. Emerg Med Clin North Am 32(2):319-327, 2014
3Lynch EB, et al: A self-management intervention for african americans with comorbid diabetes and hypertension: a pilot randomized controlled trial. Prev Chronic Dis 2014 May 29;11:E90. doi: 10.5888/pcd11.130349
