Fructose Intolerance

Fructose intolerance is the intolerance of fructose in food. Here you will find information on the causes, symptoms, and nutrition of fructose intolerance. Fructose intolerance is one of the food intolerances. In principle, it is a metabolic disorder. People with fructose intolerance cannot digest or break down fruit sugar (fructose) or only to a very limited extent. According to the cause, doctors differentiate between intestinal fructose intolerance and hereditary fructose intolerance.

Intestinal and hereditary fructose intolerance

Intestinal fructose intolerance is by far the most common form. It arises from a previously unknown cause. A high-sugar diet and continued consumption of sugar substitutes may play a role.

Normally, fructose from food is absorbed into the body through the small intestine. The so-called glucose transporters (GLUT) play a central role in this. In the case of intestinal fructose intolerance, the function of GLUT-5 is restricted or there are too few transport proteins. Another cause is damaged mucous membrane in the small intestine, for example during/after acute gastrointestinal inflammation, Crohn’s disease, celiac disease, or taking medication. As a result, the fructose can only be insufficiently absorbed from the food in the small intestine – it is therefore not available to the body – and reaches the large intestine unused. If this happens without symptoms, doctors speak of fructose malabsorption (FM). However, if symptoms such as diarrhea, nausea, abdominal pain, or flatulence are added, the diagnosis is called intestinal fructose intolerance (IFI). Both clinical pictures are diagnosed using a fructose stress test, the so-called fructose hydrogen breath test.

Fructose Intolerance

The very rare hereditary fructose intolerance (HFI) is innate and significantly more dangerous than hereditary fructose intolerance. It must absolutely be excluded before a fructose stress test, otherwise, there is a risk to life for the patient. Because of a genetic change, those affected lack the enzyme aldolase B, which is involved in the breakdown of fructose. As a result, the ingested fructose is not broken down and competes in different ways with the glucose in the blood, the so-called blood sugar. This then results in dangerously low blood sugar levels (hypoglycemia) up to life-threatening shock. Other indicative symptoms of hereditary fructose intolerance are vomiting and bleeding disorders with rapid and frequent bruising.


Even healthy people can only tolerate around 50 grams of fructose per meal. With acquired fructose intolerance, this amount continues to decrease. In this way, more and more undigested fructose reaches the large intestine. There the fructose is an ideal breeding ground for bacteria. The gases and fatty acids produced during bacterial fructose digestion cause the typical symptoms of intestinal fructose intolerance. These are above all abdominal pain, gas, diarrhea, or constipation as well as irregular, often mushy stool.

Treatment By Renouncing Fructose

The therapeutic focus is on the elimination of small intestine weakness or small intestine colonization and the restriction/avoidance of fructose. Often other carbohydrates must also be avoided, for example, oligofructose (especially in fruits or prebiotic products), stachyose and raffinose (for example in legumes, leeks, and onions), lactulose (laxative), or sugar alcohols such as sorbitol, mannitol, maltitol, and palatinitol ( in diet products).

The only way to treat hereditary fructose intolerance is to avoid fructose completely. In the first twelve months of life, you should consistently refrain from eating fruit and vegetables; substitution with vitamins is recommended to compensate for this.

Itching (Pruritus)

It can be tormenting, whether after sunburn, insect bites, or allergies: itching (pruritus) is often harmless, but almost always annoying. The itch in itself is less of a disease than a symptom that indicates other diseases or problems. Learn more about the causes and treatment of itching.

Itching (pruritus) is a symptom of many diseases, including above all skin diseases with rashes such as psoriasis, neurodermatitis, or eczema. And scratching often doesn’t make it any better. Severe itching or discoloration of the skin should be examined because itching can indicate various serious diseases such as diabetes or cancer.


Primarily, itching is itself a symptom, and therefore a sign of underlying medical conditions. At first, the skin itches uncomfortably, which leads to scratching. Redness, crusts, and inflammation are the result. Persistent itching often leads to coarsening and thickening of the skin.


Itching has many different causes. In addition to insect bites, itching of the skin can be due to skin diseases such as psoriasis, neurodermatitis, or allergies, but also to diabetes, cancer, fungal infections, poor liver and kidney function, hypothyroidism, or phlebitis. Itching on the head could be caused by lice. However, itching also occurs without organic causes. In this case, doctors speak of psychogenic pruritus.


How the itching itself arises has not been scientifically clarified. Essentially, it is assumed that itching is caused by so-called histamines. Histamines are messenger substances that are released in the event of inflammation or allergies.


Treating itching requires an accurate diagnosis. Since itching can be a symptom of numerous diseases, you should always have a doctor examine the causes of persistent itching. This is especially true when skin changes (e.g. flea-like or star-shaped bleeding) and discoloration of the skin (e.g. yellowing of the skin and mucous membranes) occur.


Your doctor will first try to find out what is causing the itchiness and then initiate appropriate treatment. If a fungal infection is the cause of the itching, antimycotics (drugs against fungal infections) can help. Itching caused by lice, fleas, or itch mites is treated with so-called antiparasitic drugs. In the case of a viral infection such as cold sores, virus-inhibiting agents such as acyclovir or virus blockers such as docosanol help.

To relieve the itching in inflammatory and allergic diseases, the doctor can prescribe antihistamines (known as anti-allergic agents) or glucocorticoids (drugs containing cortisone), among other things.

Self-Help Against Itching

Some drugs against itching, for example, allergies, athlete’s foot, herpes, sunburn, or vaginal thrush, are available over the counter in pharmacies. Your pharmacist will advise you on the right choice. Cooling compresses also provide relief. Baths, creams, and ointments with tar, urea, or tannins also have an itch-soothing effect. Itchy insect bites can be treated with tripelennamine or bamipin lactate.

You should definitely refrain from scratching because it worsens the itching and can damage the surface of the skin. Then pathogens can penetrate more easily and trigger new inflammations with new itching. Measures that distract from the itching, such as exercise, tricky brain teasers, or relaxation exercises, are better.

Non-Hodgkin Lymphoma

Non-Hodgkin lymphomas can develop inside and outside of lymph nodes. Why the cells in this type of lymph gland cancer change in a malignant manner, however, cannot yet be clearly answered. You can find more information about the symptoms, causes, and treatment of non-Hodgkin lymphoma here.

The generic term non-Hodgkin’s lymphoma includes malignant diseases of the lymphatic tissue that are not Hodgkin’s lymphomas. In the case of non-Hodgkin lymphoma, a distinction is made between three main forms. The differentiation in this type of lymph gland cancer is based on how the corresponding tissue is composed, how quickly the lymphomas grow, and how quickly they spread. The division is made into:

    • highly malignant non-Hodgkin lymphomas
    • low-grade non-Hodgkin lymphomas
    • Burkitt lymphoma.

Highly malignant non-Hodgkin lymphomas

Highly malignant non-Hodgkin lymphomas are diffuse, large-cell B-cell lymphomas. They often develop in the gastrointestinal tract, bones, skin, or brain. Due to their strong malignancy and aggressiveness, they spread quickly and diffusely in all organs.

Low-Malignant Non-Hodgkin Lymphomas

The low-malignant non-Hodgkin lymphomas include various diseases, for example:

    • Chronic lymphocytic leukemia (CLL): It usually occurs in old age and often begins in the blood, and it often affects the bone marrow, liver and spleen.
    • The plasmacytoma: The plasmacytoma occurs around the age of 40. Enlarged lymph nodes and tumors in the bone and bone marrow are typical. This often leads to bone pain and fractures.
    • follicular lymphoma: This lymphoma tends to affect older people. It spreads to the lymph nodes and bone marrow. Although this lymphoma belongs to the group of low-grade non-Hodgkin lymphomas, it often turns into a very malignant form later on.
    • Rare low-grade non-Hodgkin lymphomas are hairy cell leukemia, extranodal lymphoma of the lymph tissue in the wall of the stomach and intestines, and mycosis fungoides.

Burkitt Lymphoma

Most people in West Africa develop Burkitt’s lymphoma. In Europe it occurs very rarely, if it does – it often accompanies AIDS.

The Lymphatic System

The lymphatic system is part of the body’s own defense system. It consists of pathways that run through the whole body and the lymphatic organs (lymph nodes, spleen, tissues in the gastrointestinal tract, thymus gland, and tonsils). The cells in the lymphatic system are called lymphocytes. They belong to the group of white blood cells (leukocytes). A distinction is made between two forms, the B and T lymphocytes. Both types of lymphocytes have different functions in the defense against pathogens.

80 percent of non-Hodgkin lymphomas develop from B lymphocytes, and only about 20 percent of all cases develop from T lymphocytes. Non-Hodgkin lymphomas can basically occur anywhere in the body and also in any organ. Most often, however, they develop in lymph nodes.

The incidence of non-Hodgkin lymphoma has been increasing for many years. The reasons for this are not known. According to the Malignant Lymphoma Competence Network, the annual incidence (frequency of new cases per year) is estimated at 10 to 15 cases per 100,000 people. According to the Robert Koch Institute, around 19,200 men and women contracted non-Hodgkin lymphoma in 2017. With 10,649 new cases, men were more frequently affected than women (8,550). In men, the average diagnosis is made at the age of 70, in women the mean age of onset is 72 years. Non-Hodgkin lymphomas can occur at any age.


The symptoms of non-Hodgkin lymphoma are variable. They depend on where the lymphoma is located. Non-Hodgkin lymphomas also attract attention at different rates:

  • Low-malignant non-Hodgkin lymphomas develop slowly and cause symptoms late.
  • Highly malignant non-Hodgkin lymphomas are quickly noticeable.

A typical symptom of non-Hodgkin lymphoma is in any case a painless enlargement of the lymph nodes, which occur most frequently on the head and neck. In addition, there are often general symptoms such as:

    • fever
    • night sweats
    • Fatigue, tiredness and weakness
    • declining efficiency
    • unwanted weight loss
    • Nausea/loss of appetite
    • Bloating
    • heartburn
    • Anemia
    • Skin changes (e.g. redness, paleness)
    • itching
    • depressed mood
    • increased susceptibility to infections
    • Headache or bone pain.

Depending on where the non-Hodgkin lymphoma develops, other symptoms such as abdominal pain, shortness of breath or nerve failure are possible.

The exact causes of non-Hodgkin lymphoma are still unknown. But there are factors that increase the risk of developing non-Hodgkin lymphoma. Risk factors for non-Hodgkin lymphoma are:

    • Chromosome changes that occur in the course of life (e.g. due to radioactive radiation)
    • Immunodeficiency, e.g. advanced HIV infection. The risk of the disease is particularly increased in the case of highly malignant lymphomas, which also affect the central nervous system.
    • Infections with the human T-cell leukemia virus HTLV-I specifically increase the risk of T-cell lymphomas.
    • Viral infections with the Epstein-Barr virus: The Epstein-Barr virus is one of the herpes viruses and triggers Pfeiffer’s glandular fever in younger people. The infection is primarily responsible for the development of the highly malignant Burkitt’s lymphoma, which occurs mainly in Africa.
    • Colonization with Helicobacter pylori: In many people, the gastric mucosa is colonized with the bacterium Helicobacter pylori, which can lead to chronic gastric mucosal inflammation. Then there is an increased risk of gastric mucosal lymphoma (MALT lymphoma).
    • Chemical substances such as benzene or certain insect or pesticides generally favor non-Hodgkin lymphomas.
    • Smoking: Smokers are more likely to develop non-Hodgkin lymphoma.
    • Older age: As you get older, the risk of developing non-Hodgkin lymphoma increases.


Your doctor will first examine your body for possible enlarged lymph nodes and other changes (such as enlarged spleen or liver). With a blood sample, various blood cell and organ values ​​can be determined. With an extended blood count (differential blood count) the distribution of the leukocytes – including the lymphocytes – can be determined. Sometimes malignant lymphocytes can also be directly detected in the blood.

To confirm the diagnosis of non-Hodgkin lymphoma, tissue from an affected lymph node or other affected lymphatic tissue is usually removed and examined. Using special methods, it is then possible in the laboratory to precisely analyze the cells and thus identify the type of lymphoma.

Non-Hodgkin Lymphoma

Further Investigations

Once a diagnosis of non-Hodgkin lymphoma has been made, further tests will need to be done to determine if the disease has spread. This includes ultrasound (sonography) of all visible lymph nodes, x-rays of the lungs as well as computer and magnetic resonance tomographies of various body regions. It may also be necessary to have a mirror image of the chest or abdomen and, if there is suspicion of bone or bone marrow involvement, a detailed examination of the skeleton or bone marrow may be necessary. The doctor also checks the cranial nerves and examines the testicles in men.

Positron emission tomography is a very sensitive method for discovering the exact distribution of malignant cells. The patient is injected with a radioactive substance that is distributed throughout the body and takes part in the metabolism. These processes can be made visible with a special camera. Since tumor cells have a different metabolism than other cells, they can be recognized by the changed image pattern.


How non-Hodgkin lymphomas are treated depends on the aggressiveness of the tumor. Therapy is also based on the age of the patient, the spread of the cancer cells, the chances of a cure for the respective lymphoma and the concomitant diseases.

Small, localized lymphomas can possibly be surgically removed. In the case of very slow growing tumors, it may be justifiable to wait and see and regularly check the disease. Doctors call this form of therapy watch and wait.

Chemotherapy for non-Hodgkin lymphoma

In the case of highly malignant lymphomas – even in more advanced stages – good results can be achieved with chemotherapy. Chemotherapy usually combines several substances in order to achieve the greatest possible effect. The cell-killing drugs are injected into the vein in several cycles, each lasting around 2 to 4 weeks. In the case of lymphomas in the brain, it is possible to administer the chemotherapeutic agents directly into the nerve water (liquor) so that they can work directly on the spot. The duration of therapy depends on the type and extent of the disease.

Possible side effects are hair loss, nausea, vomiting, tiredness, increased susceptibility to infections and anemia as well as permanently damaged fertility in men and women.

Irradiation For Non-Hodgkin Lymphoma

If the tumor is limited to a certain region of the body, local irradiation can also take place. Radiation is also an option if previous chemotherapy has failed. Low-malignant non-Hodgkin lymphomas generally respond better to radiation.

Radiation treatments also have side effects. As with chemotherapy, these include nausea and vomiting as well as hair loss. In addition – depending on the location of the irradiation – inflammation of the skin and mucous membranes, dry mouth or changes in taste can occur.

Antibody Therapy

Some non-Hodgkin lymphomas have cells with specific features on their surface. For some of them there are antibodies. These antibodies then attach themselves to the cells and mark them as malignant for the body’s own defense system. This stimulates the body’s own defense system to destroy the cancer cells. In some cases, the antibody can also be loaded with a radioactive substance, which then destroys the tumor cell itself (so-called radioimmunotherapy).


In some cases, therapy with interferon can be useful. Interferon supports the body’s defenses in the fight against cancer cells.

High-dose chemotherapy with bone marrow / stem cell transplantation

Sometimes it is not possible to completely destroy the malignant cells in non-Hodgkin’s lymphoma or there is a relapse. Then high-dose chemotherapy with subsequent transfer of bone marrow and the precursor cells of all blood cells (stem cells) contained therein can be tried. To do this, healthy stem cells are first taken from the patient’s blood or bone marrow in order to freeze them. Those affected then receive another high-dose chemotherapy – sometimes combined with whole-body radiation – to destroy all of the malignant cells in the bone marrow. During this time, those affected are at high risk of infection because their immune system is practically switched off by the medication.

After chemotherapy, patients then get their healthy, stored cells back into the bloodstream via an infusion. From there, the cells migrate to the bone marrow and start producing new blood. In rare cases, foreign material is used for the transfer (i.e. cells from strangers). Then, after the transplant, drugs must be taken for a long time to prevent these cells from being rejected.

The previous aggressive chemotherapy leads in most cases to permanent infertility. The risk of developing another form of cancer later on also increases. If irradiation was carried out at the same time, the risk of clouding of the lens in the eye (so-called radiation cataract) increases.


Life expectancy and the chance of recovery depend on the type of non-Hodgkin lymphoma. The later the treatment starts, the worse the chances of recovery. If left untreated, highly malignant non-Hodgkin lymphomas can, in the worst case, be fatal after just a few months. In addition, highly malignant lymphomas tend to recur despite aggressive therapy.

Low-grade non-Hodgkin lymphomas are cured by radiation, especially in the early stages. In more advanced stages, however, a cure is hardly possible.


Non-Hodgkin lymphoma cannot be prevented with certainty. In any case, it is beneficial not to smoke and to avoid exposure to radiation. HPV vaccination significantly reduces the risk of human papilloma virus infections – and thus combats one of the risk factors for non-Hodgkin’s lymphoma.

Inflammation Of The Pericardium (Pericarditis)

An inflammation of the pericardium – known in medicine as pericarditis – usually causes sharp pain in the chest. Find out more about the symptoms, causes, and treatment of pericardial inflammation here.

Doctors refer to pericarditis as pericarditis. The pericardium (pericardium) encloses the heart and on the one hand, delimits it to a certain extent from the free chest cavity. On the other hand, the pericardium is filled with fluid that forms a sliding layer for the movements of the underlying heart muscle (myocardium).

Pure pericardial inflammation is rather rare. Most of the time, the heart muscle itself is also affected. Cardiologists refer to this as perimyocarditis if only the upper layers of the heart are affected. Deeper-reaching inflammations involving the inner lining of the heart (endocardium) are called pancarditis.


Pericarditis often begins as a dry form. Doctors speak of pericarditis sicca. This is usually shown by stabbing pain behind the breastbone, which is particularly pronounced when the patient is exerted (coughing, deep breathing), but also when lying down.

Often – but not necessarily – a so-called pericardial effusion then follows. This swelling occurs when the volume of fluid in the pericardium increases due to inflammation. Doctors then speak of damp pericardial inflammation or exudative pericarditis.

The pain subsides and the heartbeat becomes quieter. Fever, panting due to shortness of breath, and severe inefficiency are further characteristic symptoms of pericarditis.

Inflammation Of The Pericardium

Cause Of Pericardial Inflammation

The cause of pericardial inflammation cannot always be identified. In up to 80 percent of cases, they are likely to be a long-term consequence of not completely cured viral infections, colds, or the flu. However, there are also non-infectious causes, for example as a result of heart attack, autoimmune diseases, radiation, or allergic reactions.


In most cases, pericarditis is treated with medication. The focus is on anti-inflammatory drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin and ibuprofen, high-dose acetylsalicylic acid (ASA), and the autumn crocus alkaloid colchicine. Glucocorticoids such as prednisone and prednisolone or triamcinolone are used if the inflammation persists.

To relieve the heart, dehydrating drugs (diuretics such as furosemide and torasemide) and the ACE inhibitors ramipril and captopril are used.

If bacteria are responsible for pericarditis, antibiotics such as tetracycline, erythromycin, and ampicillin help. In the case of non-infectious causes, the triggering disease must be treated specifically.

High Blood Pressure

The increased pressure in the arterial blood vessels is called high blood pressure (hypertension). Doctors refer to the disease as “arterial hypertension” or hypertension. The opposite of this is mostly harmless low blood pressure (hypotension).

This is how blood pressure is created

The blood is expelled from the heart through the aortic valve into the arteries. The pressure of the flowing blood on the walls of the blood vessels (arterial walls) is called blood pressure. The level of blood pressure depends on the pumping capacity of the heart and the diameter of the vessels.

With physical exertion or excitement, blood pressure rises, while at rest it falls again. Within certain limits, this is completely normal and also desirable. Permanently high blood pressure, that is, even at rest, is unhealthy. The definition of when blood pressure is too high is set by the World Health Organization (WHO).

Measure blood pressure: systolic value and diastolic value

The blood pressure is given in numbers, for example, 120/80 mm Hg (millimeters of mercury), speaking 120 to 80.

    • The systolic value (the first, higher, value, m example 120) results when the heart contracts and the blood presses into the arteries, i.e. during the pumping phase.
    • Diastolic pressure (the second, lower value) occurs when the heart relaxes and the heart chambers refill with blood. Doctors speak of the recovery phase.

When is blood pressure too high?

Hypertension according to WHO values ​​The specification for the definition of hypertension comes from the WHO, the World Health Organization. Currently (as of 2021), according to the WHO, a systolic value of at least 140 mm Hg and a diastolic blood pressure value equal to or more than 90 mm Hg are considered hypertonic – blood pressure above 140/90 mm Hg is therefore elevated. According to this definition, however, the increase in blood pressure must be permanent and not just temporary.

Experts: Limits for blood pressure values ​​are arbitrary

Some scientists point out that the WHO hypertension values ​​are set arbitrarily. Whether a blood pressure is too high or not can only be determined by taking an overall view of the patient’s state of health. Essentially, however, the WHO perspective has prevailed in conventional medicine.


Increased blood pressure is often not noticeable at first. The people affected often feel particularly fit and alert. Only very high blood pressure sometimes causes symptoms. Typical symptoms of hypertension are headache (often in the morning), dizziness, nausea, flushing of the face, nosebleeds, insomnia, fatigue, and ringing in the ears (tinnitus).

High Blood Pressure Crisis (hypertensive crisis)

Extremely high blood pressure values ​​(over 230/130 mmHg) lead to a high blood pressure crisis. Then it becomes critical. High blood pressure crises cause shortness of breath and seizures, consciousness is clouded, in the worst case the affected people fall into a coma. There is also the risk of organ damage (such as acute heart failure, myocardial infarction or pulmonary edema) or brain damage (e.g. stroke and high-pressure encephalopathy), and rarely even the main artery tears (aortic dissection).

High Blood Pressure As A Risk Factor For Numerous Diseases

Longstanding hypertension can have serious consequences or complications. For example, high blood pressure is a recognized risk factor for atherosclerosis. High blood pressure in connection with being very overweight, diabetes or lipid metabolism disorders also significantly increases the risk of developing cardiovascular diseases. These diseases include:

Every second German now dies prematurely from cardiovascular disease.


In the majority of hypertensive patients, no clear cause of the increased blood pressure can be determined. Doctors call this high blood pressure “essential hypertension”. If another disease causes high blood pressure, it is called “secondary hypertension”. Increased blood pressure is also common during pregnancy (for example in pregnancy poisoning).

Risk Factors For Essential Hypertension

Essential hypertension can be triggered by a variety of factors. In addition to a genetic component, lifestyle also plays a major role. The following factors increase the risk of essential hypertension:

    • Obesity
    • Sedentary lifestyle
    • high salt consumption
    • smoking
    • excessive alcohol consumption
    • stress
    • Lipid metabolism disorders (e.g. increased cholesterol level)
    • hereditary predisposition.

The diagnosis “essential hypertension” can only be made if other causes for the increased blood pressure have been ruled out.

High Blood Pressure

Causes of Secondary Hypertension

Conditions that commonly cause high blood pressure include:

    • Kidney disease (such as glomerulonephritis, cyst kidney, diabetic nephropathies, or narrowing of the renal arteries)
    • Vascular diseases (such as arteriosclerosis or congenital malformations of the main artery)
    • Hormonal disorders (such as Cushing’s syndrome, adrenal cortex disorders, pheochromocytoma, or diabetes)
    • Sleep apnea syndrome.

Medicines such as hormonal contraceptives (birth control pills) or cortisone can also cause high blood pressure.


To avoid consequential damage and complications from high blood pressure, therapy for hypertension should begin as early as possible. High blood pressure is easily detected with a first and second blood pressure reading. If hypertension is suspected, blood pressure is measured 24 hours a day. In the further course blood tests, eye and urine tests, an electrocardiogram (EKG), and an ultrasound examination of the heart, as well as the neck and leg vessels, should be arranged.

In order to rule out other diseases as the cause of hypertension, imaging methods such as CT or MRI also help. Of course, the full spectrum of these examination methods is not always necessary for the diagnosis of high blood pressure.


So-called antihypertensive drugs are given for drug therapy of hypertension. There are a number of antihypertensive drugs that work differently. In Germany, more than 15 million men and women take medication for high blood pressure every day.

Medicines Containing Contaminated Valsartan

In 2018, one of these active ingredients made headlines in particular. Many drugs containing the active ingredient valsartan have been withdrawn from the market because they are contaminated with the substance N-nitrosodimethylamine (NDMA). Manufacturers who obtain their valsartan from the production of the Chinese supplier Zhejiang Tianyu are affected. Here is the list of affected valsartan preparations. Later, even the smallest amounts of NDMA were detected in another active ingredient from the group of sartans. Losartan from the Indian supplier Hetero Labs is affected. The drugs with this active ingredient were immediately withdrawn from the market.

In the meantime, the European Medicines Agency completed a risk assessment process for the sartans candesartan, irbesartan, losartan, olmesartan, and valsartan in summer 2019. The impurities can form during the production of sartans with a certain ring structure (tetrazole ring) under certain conditions and when certain solvents, reagents, and other starting materials are used. Additionally, it is possible that contaminants were present in some sartans because the manufacturers accidentally used contaminated equipment or reagents in the manufacturing process.

Do sartan users have to expect an increased risk of cancer?

NDMA is classified as likely to cause cancer in humans by the International Agency for Research on Cancer of the WHO and the EU. About 900,000 people in Germany take valsartan. Whether the long-term intake of valsartan contaminated with NDMA actually increases the risk of cancer cannot yet be reliably answered. Danish researchers published a study in September 2018 [1]. It looked at data from more than 5,000 people who took valsartan between 2012 and 2017. These were men and women who had received either contaminated valsartan (approx. 11,900 patient-years) or uncontaminated valsartan (7,300 patient-years).

After analyzing the data, the scientists came to the conclusion that Valsartan contaminated with NDMA may not increase the general risk of cancer. But it is still too early for a reliable result. They also point out that in the group with NDMA contamination, a slightly higher rate of cases of colon cancer and uterine cancer was registered.

Sartans: What Should Patients Do Now?

Important for patients taking candesartan, irbesartan, losartan, olmesartan, and valsartan:

    • Not all candesartan, irbesartan, losartan, olmesartan, and valsartan medicines are affected.
    • Please do not interrupt the intake on your own.
    • If you have any questions about your treatment, talk to your pharmacist, who can tell you whether your medicine is being recalled.
    • If the medicine you are taking is affected, your doctor may prescribe a different medicine with an active ingredient that is not affected by the contamination.
    • If you are in a clinical study with valsartan and have any questions, speak to the doctor in charge of the study.
    • The sartans azilsartan, eprosartan, and telmisartan are not affected by the impurities due to their chemical structure.

Active ingredients against high blood pressure

The selection of the appropriate medication depends, among other things, on age, previous and concomitant illnesses as well as the response of blood pressure to the medication. The following antihypertensive drugs are given individually or in combination:

Dehydrating agents

So-called diuretics such as thiazide diuretics, loop diuretics, potassium-sparing diuretics and aldosterone antagonists remove water from the body. This reduces the blood volume. When less blood flows through the veins, the pressure in the blood vessels decreases, and the blood pressure automatically drops. In addition, the heart is relieved and fluid accumulations in the tissue (edema) are flushed out.

Beta-blockers such as metoprolol, propranolol, or pindolol

These drugs block so-called beta-adrenaline receptors and thus reduce the effects of the stress hormone adrenaline and the neurotransmitter noradrenaline. As a result, blood pressure drops and the heart rate drops at rest.

Calcium channel blockers

Active ingredients of the dihydropyridine type such as amlodipine, lercanidipine, or nifedipine prevent the influx of calcium into heart muscle cells, cells of the stimulus-conduction system, and muscle cells of the blood vessels. Calcium is required for the tension of the muscle walls. If there is less calcium available, the muscle walls can constrict less, and muscle contraction decreases. The blood vessels in the heart and in the body widen and the blood pressure drops accordingly.

ACE inhibitors

The antihypertensive ACE inhibitors such as captopril, enalapril, lisinopril, and ramipril act on the blood pressure regulation system (RAAS for short). They inhibit an enzyme (angiotensin-converting enzyme, ACE for short) that is required for the formation of angiotensin II from angiotensin I. Angiotensin II is the most powerful substance produced by the body. It directly increases blood pressure and indirectly inhibits the excretion of water. Without this conversion enzyme ACE, less angiotensin II is formed and the blood pressure increases less sharply.

AT-1 receptor antagonists and renin antagonists

AT-1 receptor antagonists are, for example, the sartans such as valsartan, losartan, and irbesartan: These drugs neutralize the blood pressure-increasing effect of angiotensin II (see above).

Renin antagonists such as aliskiren intervene in the blood pressure regulation system RAAS. You start at the very beginning of this cascade. This is how the hormone-like enzyme renin is bound. Renin is required for the conversion of angiotensinogen into angiotensin I. Less angiotensin I also means less angiotensin II. And the lower the angiotensin II concentration, the lower the increase in blood pressure.

2nd choice antihypertensive drugs

In addition to the drugs described, there are also second-choice active ingredients. This includes:

    • Alpha-blockers (like prazosin and tamsulosin): These drugs affect the autonomic nervous system. In this nervous system – which we cannot deliberately influence – two nerve cords act: the sympathetic and the parasympathetic. The sympathetic nervous system is active when aroused and in dangerous situations, the parasympathetic nervous system in the resting state and the recovery phase. The sympathetic nervous system is stimulated via different receptors called alpha or beta receptors. Alpha-blockers block the alpha receptors. This reduces the stimulation of the sympathetic nervous system and lowers blood pressure.
    • Potassium channel openers (such as minoxidil and diazoxide): Medicines in this group are used when other antihypertensive drugs are no longer working properly. They open the potassium channel and thus reduce the influx of potassium ions into the cells. As a result, the excitation of vascular muscle cells is reduced. The blood vessels relax and widen, and blood pressure drops.
    • Alpha-2 agonists (such as clonidine): Alpha-2 agonists or alpha-2 sympathomimetics only attack alpha-2 receptors. In this way, they dampen the activity of the sympathetic nervous system and the blood pressure drops.
    • NO donors (such as nitroglycerin and molsidomine): These organic nitrates reduce the tension in the vascular muscles. As a result, the larger arteries widen and blood pressure decreases.

Handle high blood pressure medication properly

If you have very high blood pressure, in particular, it is very helpful if you regularly check your blood pressure yourself. If you do not want to or cannot do this yourself, your pharmacist will be happy to assist you, for example. Of course, nursing services also take on this task. Ideally, you should keep a blood pressure diary in which you record the measured values ​​for systolic and diastolic blood pressure on a daily basis. In the pharmacy, you can also get blood pressure monitors that automatically record the course of the blood pressure values.

Strictly observe the dosage regulations: In order for antihypertensive drugs to work reliably, it is necessary that you strictly adhere to the intake instructions. This applies to both the dosage and the time of day. Even if your blood pressure is normal, you may not change the dosage yourself or even discontinue your antihypertensive drug. Without the medication, blood pressure could rapidly rise again and sometimes cause life-threatening cardiac arrhythmias.

Disclose complete medication: It is not uncommon for drug interactions to lead to health-endangering complications. Antihypertensive drugs are often involved, if only because they are prescribed in such large numbers. It is imperative that you disclose to your doctor or physicians if you are taking any other medication.

Medicines do not eliminate the cause

As a rule, drugs do not eliminate the cause of hypertension, but only help to keep high blood pressure within healthy limits. In addition, antihypertensive drugs have a number of side effects and interactions. It is therefore recommended that the dose of the medication be kept as small as possible.


The best of all is not to let high blood pressure develop in the first place. You can contribute to this with simple rules of conduct, namely:

    • Do not start or stop smoking in the first place.
    • You should only drink alcohol in moderation.
    • Watch your weight and lose weight if you are overweight.
    • Make sure you have a balanced lifestyle with enough exercise and a fresh, healthy, and balanced diet.
    • Limit your salt consumption.
    • Treat or avoid lipid metabolism disorders.
    • Avoid stress and high tension and learn relaxation techniques such as autogenic training, progressive muscle relaxation, yoga or tai chi.
    • As a diabetic, you should ensure that your blood sugar level is well controlled.

Blood Poisoning (Sepsis)

Sepsis is the technical term for blood poisoning. Sepsis must be treated quickly so that it does not prove fatal. Find out more about the signs, symptoms, and treatment of blood poisoning.

Sepsis is the technical term for blood poisoning. Without rapid emergency therapy, blood poisoning is almost always fatal. Therefore, an emergency doctor should be called immediately if there is the slightest suspicion of sepsis.

Sepsis is a very dangerous, sometimes life-threatening condition. In the course of blood poisoning, more and more vital organs fail. Such multi-organ failure is often fatal if left untreated. Even with maximum intensive care medicine, about 30 percent of those affected do not survive sepsis. According to the Sepsis Competence Network, 154 people die of sepsis every day in Germany. According to this, blood poisoning is the third most common cause of death after diseases of the cardiovascular system and cancer. An early start of treatment in an intensive care unit can significantly improve the prognosis.

Doctors differentiate between four degrees of severity of sepsis:

    • Systemic Inflammatory Response Syndrome (SIRS)
    • Sepsis (SIRS with proven infection)
    • severe sepsis
    • septic shock


The frequency of fatal blood poisoning cannot be determined precisely because sepsis itself is sometimes not recorded as the cause of death, but rather as a consequence of blood poisoning. According to the Sepsis Competence Network, there are at least 154,000 cases of blood poisoning in Germany. More than a third of them (36.4 percent) are fatal. This means that 154 people die of sepsis every day in Germany. Even if the study on which this frequency is based was published in 2007, experts continue to assume this size of deaths from blood poisoning.

Blood Poisoning


In sepsis, the functionality of several organs is always life-threatening impaired. That is why the symptoms are diverse. First of all, however, the following symptoms indicate sepsis:

    • Body temperature rise or fall (fever above 38 degrees Celsius or low body temperature below 36 degrees Celsius)
    • Racing heart
    • increased breathing rate
    • falling blood pressure
    • Restlessness, disorientation
    • Impaired consciousness
    • increased drowsiness
    • Bleeding in the skin and mucous membrane
    • lack of urine production.


Doctors understand sepsis as an inflammation that usually proceeds very quickly and is caused by bacteria and bacterial toxins, fungi, parasites, or viruses.


The emergency doctor should be alerted immediately if there is the slightest suspicion of sepsis. Because: The earlier treatment is started, the greater the chances of recovery.

Red streaks on the skin do not indicate blood poisoning

Many people have had a clear picture of the thought of blood poisoning since childhood. A fine red stripe that extends from a wound, often following the course of a blood vessel. And the fear becomes great when the streak spreads towards the heart. The fear is unfounded: the red stripe does not indicate blood poisoning. Rather, a lymphatic system has become inflamed there. It is true that this inflammation should be examined by a doctor. The family doctor can do this in peace. The rescue service does not have to be alerted.


The chance of survival in sepsis depends primarily on rapid treatment and the general condition. Blood poisoning often occurs in weakened patients. Then the forecast is below average. The average survival rate in Germany is a good 64 percent. According to the Sepsis Competence Network, Germany is well below the sepsis prognosis for Europe (73.5 percent).

Diet Cannot Cure Cancer

There are many rumors and false reports about healthy nutrition in cancer. Medical research is certain: nutrition is not a miracle cure for cancer. There is no form of nutrition that can cure or prevent cancer. But one thing is also certain: diet can have a positive effect on the course of cancer treatment and help prevent relapses.

This Is What Nutrition Can Do For Cancer

Depending on the type and stage of cancer, tumor diseases have a different impact on eating habits. Breast cancer, for example, is usually associated with fewer nutritional problems than esophageal cancer or colon cancer. The form and stage of cancer therapy also play an important role: targeted irradiation of a small tumor or a tumor precursor, for example, usually causes fewer symptoms than drug chemotherapy.

The following information on the right nutrition for cancer, therefore, provides a general overview for cancer patients and those interested. This information cannot and does not replace the urgently needed advice from the treating physician.

Appropriate Diet Improves The Chances Of Recovery

Cancer treatments often cause discomfort. This ranges from loss of appetite and severe gastrointestinal problems to pain when chewing, swallowing or purging. For many cancer sufferers, eating becomes torture. The result: Cancer sufferers often lose weight quickly. This weight loss, in turn, makes the cancer treatment less effective – and causes even more side effects. An adapted diet can help break out of this self-reinforcing cycle – or not even get into the cycle in the first place. This improves the chances of recovery. In addition, a healthy diet can help reduce the risk of relapse after cancer therapy has been overcome.

There is no one right form of nutrition for cancer patients. Rather, it is important to tailor diets to individual needs. The focus is primarily on 2 aspects:

    1. Avoid weight loss
    2. Prevent deficiency symptoms.

5 Simple Rules For Diet For Cancer

When you have cancer, it is less important which foods you eat. Of course, fresh food is usually better than industrially processed products such as fast food or ready-made meals. When in doubt, however, the motto applies: It’s better to eat something than not to eat. The German Nutrition Society (DGE) summarizes the basic recommendations in 5 simple rules for nutrition in cancer:

    1. Eat what you can handle.
    2. Then eat when you feel right.
    3. Create a relaxed atmosphere while eating.
    4. Let us help you avoid time pressure.
    5. If you have persistent complaints, ask for professional help.

What To Do About Cancer-Related Poor Appetite

A lack of appetite is one of the most common side effects of cancer and cancer treatments. The causes are manifold. Among other things, there are mucous membrane problems. Often, however, the tumor cells also make a contribution: They sometimes release messenger substances that inhibit appetite and cause nausea or vomiting. These symptoms are also typical side effects of cancer drugs.


Diet Cannot Cure Cancer

Unfortunately, the lack of appetite cannot be treated reliably. Experts, therefore, advise: Eat whenever you feel like it – even at night. Use every opportunity to strengthen yourself. Even the smallest portions are a step in the right direction. Try what stimulates your appetite. That can be a little stroll. If you can and are allowed to do sports, take advantage of that too.

Bitter substances stimulate digestion and thus also the appetite. Foods such as chicory, Brussels sprouts, broccoli, endive or rocket contain a particularly large number of bitter substances and many valuable vitamins, minerals, and trace elements. Herbs such as mugwort, tarragon, lovage, bay leaves, chervil or marjoram, and rosemary also contain bitter substances and are well tolerated by many cancer patients.

Eating If You Have Cancer-Related Chewing And Swallowing Problems

Chemotherapy and radiation therapy put a heavy strain on the body as a whole. They are designed to attack fast-growing cells such as tumor cells in particular. The rapidly growing cells also include, for example, the mucous membrane cells that line the mouth, esophagus, and intestines. If the mucous membranes are attacked or destroyed, this leads to chewing and swallowing difficulties, which can make eating very painful.

If the mucous membranes in the mouth, throat, and esophagus are attacked, you should avoid foods that further irritate the tissue. These include, for example, sour, spicy, salty, or hard foods. Food and drinks are lukewarm or cold (but not ice cold) better tolerated than hot.

In practice, soft and creamy dishes have proven their worth. It is not uncommon for cancer sufferers to use baby food in a jar. These mixtures are easy to swallow – and also contain many important vitamins, minerals, and trace elements.

Prevent Deficiency Diseases In Cancer

In order to prevent nutrition-related deficiency diseases in cancer, close medical monitoring is essential. Even a comparatively regular, fresh, and varied diet is sometimes not enough to meet the individual needs for nutrients. However, you should not resort to supplementary medication or food supplements without consulting a doctor. Vitamin and mineral products are – contrary to what the advertising promises – not always healthy. Rather, they also harbor risks. This even applies to healthy people.

If there is a pronounced nutritional deficiency, there is always the option of compensating for the need with a prescription-only balanced diet. Nutrition via infusions (parenteral nutrition) or tubes (enteral nutrition) ensures the supply when normal food intake is no longer possible or a deficiency has to be quickly compensated for.

No Evidence For Supposed Miracle Diets Against Cancer

Again and again one can read about forms of nutrition with which cancer is to be cured. These are often recommendations for low-carbohydrate or so-called ketogenic diets. On the Internet, in bookstores, with self-help groups and alternative practitioners – but also with some doctors – these diets are ascribed real miracles. The vast majority of experts, however, are certain: There is no form of nutrition that can cure cancer or even slow it down significantly.

The working group of the Prevention and Integrative Oncology Working Group (PRIO) of the German Cancer Society writes (see also studies/sources): “At the moment, there are no human studies (editor’s note: scientific studies on humans) that prove that a low-carbohydrate or ketogenic diet

    • can prevent or suppress the growth or metastasis of a tumor in humans
    • improves the effectiveness of chemotherapy and/or radiation therapy. “

Other experts agree: “Promises that cancer can be cured with the right diet are extremely dubious,” said Hans Hauner, head of the “Nutrition and Cancer” working group at the Munich Tumor Center in the news magazine Der Spiegel Fraud.

Human Studies Show Risks For Cancer Patients

The German Cancer Society has evaluated 15 studies that deal with the effects of a low-carbohydrate diet on cancer patients. The result: ketogenic diets are out of the question for cancer patients because they carry the risk of weight loss. Because weight loss has been proven to worsen the chances of recovery.

In addition, low-carbohydrate and ketogenic diets sometimes have significant side effects such as loss of appetite, nausea or constipation or arteriosclerosis, kidney stones, inflammation of the pancreas (pancreatitis), and dehydration.

What are the reports of the effects of ketogenic cancer diets based on?

The reports of the beneficial effects of the ketogenic diet in cancer are based on the interpretation of results from animal studies. It was observed that a low-carbohydrate diet can slow the growth of cancer cells in mice. However, a number of findings are withheld in most of the positive publications on the ketogenic cancer diet:

    1. After slowing down at the beginning, cancer cell growth even accelerated later in many animal experiments during the low-carbohydrate diet.
    2. In addition, tumor growth in the mice only slowed down if the animals also lost weight during the diet. Therefore, reputable researchers believe that weight loss is the cause of stunted growth.
    3. But the most important thing: results from animal experiments on mice cannot simply be transferred to humans.

Acute Kidney Failure

Acute kidney failure is a life-threatening emergency that requires the fastest possible therapy. Read about the vital functions our kidneys perform and the symptoms that indicate kidney failure. You will also learn everything you need to know about diagnosis, therapy, and prevention of acute kidney failure.

When the kidneys do their job no longer or only very incompletely, doctors speak of kidney failure. A distinction is made between two forms of progression: acute kidney failure (ANV) and chronic kidney failure (CRF). Acute kidney failure develops within hours to days and usually heals without consequences once the cause has been eliminated. In chronic kidney failure, the disease progresses slowly over months to years and, if left untreated, leads to death.

Function Of The Kidneys

Healthy people have two kidneys, one on the left and one on the right. Both kidneys perform important tasks in the body:

    • Excretion of metabolic end products (so-called urinary substances) and drugs
    • Keeping the water balance constant
    • Regulation of the electrolyte balance
    • Maintaining the acid-base balance
    • Production of hormones (such as erythropoietin and renin)
    • Conversion of inactive to active vitamin D.
    • Blood pressure regulation.

The kidneys as an excretory organ

Around 1500 liters of blood flow through the kidneys every day. Every day they excrete about one and a half liters of urine, which is filtered out of the blood. The blood flows through special filter systems (nephrons). A healthy kidney contains about 1 million such nephrons. In these filters, substances that the body no longer needs are, so to speak, sifted out of the blood (so-called urinary substances). If the urinary substances remain in the blood, they will poison the body. On the other hand, the nephrons also hold back important substances in the body. Above all, this includes proteins and electrolytes.


The symptoms of acute kidney failure are different. In any case, the main symptom is the significantly reduced amount of urine that is excreted. Sometimes no water can be left at all. In the course of decreasing urine production, the overhydration of the body increases. The consequences are, for example, water retention in the legs (edema) and in the lungs (pulmonary edema). Furthermore, life-threatening electrolyte disturbances (e.g. increased blood potassium concentrations) and life-threatening acidosis (acidosis) can occur. These make z. B. in the form of cardiac arrhythmias, nausea, and vomiting as well as rapid fatigue noticeable. If fluid builds up in the brain, the patient’s behavior can change. Psychological abnormalities such as excessive tiredness, indifference to impaired consciousness are indicative.


Doctors classify the causes of acute kidney failure as follows:

    • Prerenal ANV: In a maximum of 60 percent of cases, the cause of the kidney failure lies before the kidney (i.e. prernally). Often this is a suddenly greatly reduced blood flow to the kidneys, for example, due to circulatory shock in accidents or operations, due to blood clots in the kidney arteries, or due to drug side effects.
    • Intrarenal or renal ANV: Here the cause lies in the kidney itself (i.e. intra-renal). Triggers are damaged kidney tubules due to long-term lack of oxygen, damage from drugs or contrast media, and, rarely, severe inflammation of the kidney function bodies (so-called glomerulonephritis).
    • Postrenal ANV: The cause is an obstruction of the flow of urine behind the kidney (i.e. post-renal). The main obstacles to the outflow of urine are enlarged prostates, kidney, bladder, or urinary tract stones, inflammations, or tumors.


To diagnose acute kidney failure, the doctor must first clarify whether it is acute kidney failure or chronic kidney failure. The ANV is easier to recognize: The lack of urine production quickly gives the decisive clue.

Further diagnostic methods are anamnesis (i.e. questioning the patient), physical examination with listening to the heart and lungs, and laboratory tests. In particular, urinary substances such as creatinine and urea are determined in the blood. Test strips help with the urine examination. They record proteins, red and white blood cells, nitrite as an indication of a urinary tract infection, the urine pH value, glucose, ketone bodies, and bile pigments. This is followed by an examination of the urine in the laboratory.

The imaging methods used are ultrasound (sonography) and color Doppler sonography of the kidneys as well as X-rays of the chest with the heart and lungs. If the cause is inflammatory, a kidney biopsy may be performed. In this examination, a tissue sample is taken from the kidney during an endoscopic procedure.



The therapy of acute kidney failure depends primarily on the cause. This includes the following steps in particular:

    • Compensate for lack of fluids (if necessary with infusions)
    • raise low blood pressure (with medication if necessary)
    • Stop or switch drugs (such as antibiotics, pain relievers, and X-ray contrast agents) that have caused acute kidney failure
    • Surgically remove obstructions to the flow of urine (e.g. bladder or urethral stones, enlarged prostate, tumors).

Medical therapy

In acute kidney failure, your doctor can try to stimulate the excretory function with medication. For this purpose, so-called loop diuretics such as furosemide, piretanide, and torasemide are primarily administered. Alternatively, dehydrating agents of the thiazide-type such as hydrochlorothiazide and xipamide or potassium-sparing agents such as spironolactone can also be used.


If it is not possible to stimulate the kidney function again with medication, the phase until the kidneys produce urine independently must be bridged with a kidney replacement procedure (dialysis).


Sometimes drug therapy and dialysis are not enough to restore or replace kidney function to a sufficient extent. In these rare cases, a kidney transplant may be necessary.


The chances of recovery are very good if the cause of the acute kidney failure does not lie in the kidney itself. This is the case with prerenal and postrenal kidney failure.

Acute intrarenal kidney insufficiency is much less treatable, as more or less kidney tissue has been lost to varying degrees and irretrievably in this form. Acute intrarenal forms often lead to chronic renal failure. In addition, the complication rate (dialysis requirement) is significantly higher.

In many cases, serious illnesses, accidents or poisoning (also due to medication) are the cause of acute kidney failure. In these cases, up to 50 percent of those affected do not survive. The main cause of this is not kidney failure, but the circumstance that caused this failure.


Many over-the-counter drugs can damage the kidneys and cause acute kidney failure. Examples of this are popular over-the-counter drugs such as the pain relievers diclofenac, ibuprofen, and paracetamol or gastric acid inhibitors from the group of proton pump inhibitors. Therefore, you should not take pain relievers in particular for longer than recommended. In principle, it is advisable to discuss any prolonged use of medication with a doctor.

Stomach Acid Blockers Involve Risks

Proton pump inhibitors such as esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole are among the best-selling drugs in Germany. According to the drug report of the Barmer health insurance company, almost 12 million German proton pump inhibitors were prescribed in 2018. In addition, the active ingredients omeprazole, pantoprazole, or esomeprazole are also available over the counter. In public perception, gastric acid blockers from the active ingredient group of proton pump inhibitors are considered to be simple and safe drugs. However, two aspects are left out: the side effects and the fact that proton pump inhibitors can be addictive.

Kidney Damage as a Side Effect

The most common side effects of proton pump inhibitors include bone loss (osteoporosis) and magnesium deficiency with an increased risk of cardiac arrhythmias and seizures. These side effects have now been proven by a number of studies. It is even more serious that the medication permanently disrupts the natural regulatory cycle of gastric acid production. After prolonged use, between 14 and 64 percent of patients remain permanently dependent on the medication.

The connection between proton pump inhibitors and allergies is possible

Proton pump inhibitors may increase the risk of allergic diseases. Scientists from the University of Vienna published a study in the specialist magazine “Nature Communications” (August 2019) (see sources) that at least produced a striking statistical connection between the long-term use of proton pump inhibitors and allergic diseases. The scientists had evaluated data from Austrian health insurance companies. They found that the likelihood of prescribing antiallergic drugs increases by up to 300 percent if gastric acid blockers were previously prescribed. This does not necessarily mean that proton pump inhibitors actually trigger or promote allergies. In the opinion of the study authors, however, the connection cannot be dismissed out of hand and suggests that gastric acid blockers should only be used in very dosed quantities.

The German Society for Gastroenterology, Digestive and Metabolic Diseases assessed the study results differently. According to the press release, the specialist society does not see an “obvious connection between gastric acid blockers and allergies”. The design of the Austrian study does not give a corresponding assessment.

Intermittent Claudication

The medical term for intermittent claudication is intermittent claudication – translated: intermittent limping. Just like the colloquial term intermittent claudication, this term indicates the typical symptoms of this condition. Those affected can only run or walk short distances painlessly. After a few meters, the pain forces patients with intermittent claudication to stand. So that this is not so noticeable, those affected like to stand in front of shop windows and look apparently interested in the displays. Actually, they are just waiting for the pain to pass and for them to continue on their way.

Intermittent claudication as stage II of PAVK

Intermittent claudication is stage II of PAVK. Information on stages I, III, and IV can be found in the paVK clinical picture.

Stage II is divided again into II a and II b. The subdivision is based on the walking distance that those affected can walk without pain. In stage II a it is more than 200 meters, in stage II b the legs already hurt at a distance of less than 200 meters.


In addition to the typical calf pain when walking, some patients with intermittent claudication also experience pain in the thighs and buttocks. Often there is also a feeling of weakness in the legs (tired legs). As a result of the lack of blood circulation, the skin on the lower leg sometimes appears pale and cool. Dark spots, wounds, and inflammation on the lower leg are also possible symptoms of intermittent claudication.

Intermittent Claudication


As with paVK, atherosclerosis and the resulting insufficient blood flow are the main causes of the disease in intermittent claudication. Risk factors such as smoking, diabetes, elevated blood lipid levels, and high blood pressure or metabolic syndrome increase the risk of intermittent claudication.


Therapy for intermittent claudication consists in the treatment of peripheral arterial circulatory disorder. You can find out more about the different therapy options in the paVK guide.


Atherosclerosis is a pathological narrowing of the arteries that can lead to circulatory disorders and heart disease. Find out more about the causes, symptoms, and treatment of atherosclerosis here.

Medical professionals describe pathological (degenerative) narrowing of the arteries as arteriosclerosis. A similar term is or atherosclerosis. He basically means the same thing. But there is a small difference: medical professionals refer to the deposits of plaques in the blood vessels as or atherosclerosis. In colloquial language, arteriosclerosis and/or atherosclerosis are often referred to as hardening of the arteries or hardening of the arteries.

Atherosclerosis: plaques in the inner wall of the blood vessels

Healthy arteries are elastic and muscular and can adapt to different blood pressure situations. The arteries (excluding the pulmonary arteries) carry fresh, oxygen-rich blood from the heart throughout the body. In arteriosclerosis, substances dissolved in the blood (initially cholesterol, for example) are deposited in the inner wall of the blood vessels. In the further course, other substances such as calcium also accumulate at these points – so-called plaques are formed. These deposits change the inner wall of the vessel. It becomes rigid and swells. This narrows the vascular opening. The result is circulatory disorders in the areas that are supplied by the affected artery. A particular danger of atherosclerosis is that narrowed vessels can more easily be closed by a blood clot. The consequences of this are, for example, heart attacks or strokes. Men suffer from circulatory disorders more often than women.


Atherosclerosis is a so-called widespread disease because it is particularly common. With increasing age, almost everyone is affected by a pathological narrowing of the arteries. The number of deaths caused by atherosclerosis in Germany is around 360,000 per year. At the same time, the hardening of the arteries is the most common cause of serious secondary diseases such as heart attacks or strokes.


The symptoms of atherosclerosis, once they become noticeable, are usually severe. The symptoms depend on where the arteries are narrowed.

Circulatory disorders in the legs

Circulatory disorders in the legs lead to so-called peripheral arterial occlusive disease (PAOD), the 2nd stage of which is known as intermittent claudication. The legs hurt at first when walking, later also when resting. The disease got its name because patients repeatedly take breaks while walking and look in shop windows, for example.

Another circulatory disorder in the legs is the so-called smoker’s leg. In the smoker’s leg, the tissue on the toes, ankles, and legs slowly dies off because the narrowed arteries do not provide enough oxygen. Amputation may be necessary under certain circumstances.

Angina and heart attack

A narrowing of the coronary arteries leads to angina pectoris, and if one of the arteries is completely blocked, it leads to a heart attack. These heart problems are among the most feared complications of arteriosclerosis. This also applies to strokes, which are often caused by a vascular blockage in the brain.


Stroke due to atherosclerosis

Circulatory disorders in the brain lead to declining brain functions such as memory disorders, dizziness, or confusion. Depending on which brain region is affected, other failure symptoms can also occur in other parts of the body. Examples of this are numbness in the arms or legs or impaired vision. If the vascular narrowing is very severe or if a brain vessel bursts, a stroke occurs.


Unfortunately, it cannot be glossed over: the majority of the causes of arteriosclerosis are our own responsibility. Because the risk is primarily shaped by individual behavior. The following risk factors promote the development of arterial constrictions:

    • Blood fat levels (cholesterol and other fats) are too high because fats are deposited in the blood vessels, and high LDL concentrations in particular increase plaque formation
    • High blood pressure, because the blood vessels are exposed to greater pressure and wear out faster
    • Obesity because is often linked to high blood pressure or high cholesterol
    • Smoking, as nicotine narrows blood vessels and reduces blood flow
    • Stress (which in turn can cause high blood pressure)
    • Diabetes, as blood lipids are increasingly “saccharified” and are more heavily deposited in the blood vessel walls
    • Age, because the risk of arteriosclerosis increases significantly with age
    • Lack of exercise because it promotes obesity and does not train the vascular system
    • Genetic predisposition: Genes seem to play a role as a disease risk in arteriosclerosis.


For a more precise diagnosis of a narrowing of the arteries, your doctor will first use special examination methods to determine the location and extent of the narrowing of the arteries. This diagnosis of arteriosclerosis can turn out to be quite complex if, for example, the condition of arteries has to be assessed by a catheter examination.


For the drug therapy of arteriosclerosis, your doctor can use a whole range of active substances that relieve the blood circulation and the arteries in different ways. These are, for example, drugs that stimulate blood circulation, lower blood pressure, or thin the blood. Medicines are also available to treat high cholesterol or high levels of blood lipids. In addition, doctors usually recommend changing your diet and getting more exercise.

Surgical Therapy Of Atherosclerosis

Surgical treatment of atherosclerosis comes into play when medication and behavior change no longer help.

Stent Stabilizes Arteries

In the not-too-advanced stages of arteriosclerosis, the doctor has the option of making the affected vessels more accessible again. For this purpose, the affected artery is stabilized with a stiffener, the so-called stent, in an operation. In order to be able to place a stent, however, the artery still has to be narrowed enough so that the surgeon can reach the narrowing with an endoscope. If this is not possible, bypass surgery usually occurs.

Bypass Surgery

In particularly severe cases of atherosclerosis, there is no choice but to have surgery to detour around the narrowed or blocked artery or to replace the narrowed artery. This is called a bypass operation.

Self Help

Self-help for atherosclerosis is particularly effective if it reduces the risk factors. Eating a low-fat diet, losing excess weight, getting more exercise, and not smoking will support treatment and reduce the severity of the course of atherosclerosis.

Over-The-Counter Drugs For Atherosclerosis

    • Taking ginkgo preparations has a positive effect on blood circulation.
    • Taking garlic supplements in sufficient doses improves the flow properties of the blood and is also said to lower the cholesterol level.
    • Preparations with omega-3 fatty acids e.g. obtained from cold-water fish, reduce the risk of deposits in the arteries. They are also said to improve the flow properties of the blood and lower cholesterol levels and blood pressure.
    • Regular intake of acetylsalicylic acid (ASA) in low doses improves blood flow. Discuss this with your doctor.


There are a number of ways you can help prevent atherosclerosis. In any case, you should do everything possible to minimize the risk factors mentioned under arteriosclerosis. In a nutshell, the best way to help yourself is to eat a low-fat, varied, and fresh diet, exercise regularly in the fresh air (as early as 20 minutes a day), consume luxury foods such as alcohol and coffee in moderation, and refrain from smoking (For tips, see quitting smoking). The following tips will also help prevent atherosclerosis:

    • Regular monitoring of blood pressure, cholesterol, and blood lipid levels.
    • If the cholesterol level is high, pay attention to a low-cholesterol diet, i.e. reduce butter, eggs and the amount of meat, especially avoid saturated fats (e.g. high-fat sausage) and trans fats (especially in fried products such as french fries or potato chips), for the diet guide with high cholesterol levels
    • Diabetics should always make sure that their sugar levels are set correctly.
    • Obese people should definitely lose weight.
    • Avoid stress and learn relaxation techniques such as autogenic training, yoga, or Jacobsen’s progressive muscle relaxation.