Control high blood pressure by eating right

With high blood pressure or hypertension being the most widespread cause of heart disease and stroke, let us try to understand the ideal eating pattern to prevent and control hypertension.

DASH stands for Dietary Approaches to Stop Hypertension. It is a flexible and balanced diet plan that helps create a heart-healthy eating style for our life. This DASH diet is a lifelong approach to healthy eating that is designed to prevent and control high blood pressure.

The goal of DASH diet is to encourage people to reduce salt in their diet and eat a variety of foods rich in nutrients, such as potassium, calcium and magnesium, that help lower blood pressure.

There are two versions of the DASH diet:

  • Standard DASH diet.You can consume up to 2,300 mg (or) 1 teaspoon of salt a day. This is meant for anyone who wishes to adopt a healthy food pattern to prevent heart and blood vessel problems.
  • Lower sodium DASH diet.You can consume up to 1,500 mg (or) ¾ teaspoon of salt per day. If you have been diagnosed with high blood pressure, swelling or edema of feet or have heart failure this is the salt level that is ideal for you.

Foods to be included more in your daily diet

  • Vegetables
  • Fruits
  • Low-Fat or Fat-Free Dairy
  • Whole-Grains
  • Lean Meat, Fish, & Poultry
  • Nuts, seeds and legumes

Foods to be kept to a minimum

  • Sodium (salt)
  • Sugar / Sweets
  • Fatty meats
  • Saturated and Trans Fats

Now, let us see the recommended Daily Servings for the healthy food groups:

  1. Vegetables: 4-5 servings
    1 serving = 250 ml (1 cup) raw green leafy vegetables; 125 ml (½ cup) cooked vegetables

Examples: Broccoli, carrots, tomatoes, sweet potatoes, avocadoes, mushroom, brussels sprouts, spinach and other greens or veggies etc

Advantages: Vegetables are packed with potassium, magnesium as well as fibre and vitamins.

  1. Fruits : 4-5 servings
    1 serving = 1 medium piece of fruit; ½ cup fresh, frozen or canned fruit

Examples: Bananas, apples, grapes, berries, lemons, pineapple, apricots, tomato, oranges etc

Advantages: Fruits are great sources of fibre, potassium, and magnesium and low in fat. They can easily be enjoyed as a snack or a side dish with other main courses.

Note: If you go for canned fruit or juice, make sure no sugar is added.

  1. Grains (mainly whole grains): 6-8 servings

1 serving = 1 slice whole-wheat bread; 125 ml (½ cup) cooked rice, pasta or cereal

Examples: Bread, wheat, brown rice, pasta, oats, millets etc

Advantages: Always focus on whole grains instead of refined grains because it is low fat and nutrient-dense with many essential vitamins and minerals such as iron, B vitamins and zinc.

  1. Dairy Products (low fat): 2-3 servings

1 serving = 1 cup of skimmed milk (or) low fat yoghurt

Examples: Milk, yogurt, cheese etc

Advantages: Dairy provides plenty of calcium, protein, and vitamin D. However, aim for low fat or fat-free dairy, since dairy can otherwise be loaded with fat.

  1. Lean meat, Poultry and Fish: 2 servings or less

1 serving = 3 ounces of lean meat, poultry and fish

Note: The area of your palm covers 3 ounces of meat

Examples: Chicken, fish, egg etc

Advantages: Meat can be a rich source of protein, iron, B vitamins and zinc. Take heart- healthy fish such as tuna, salmon and herring which provides omega 3 fatty acids to reduce your bad cholesterol.

  1. Nuts, Seeds and Legumes: 4-5 servings per week

1 serving = 1/3 cup nuts; 2 tablespoons seeds;1/2 cup cooked beans or peas.

Examples: Almonds, walnuts, sunflower seeds, kidney beans, peas, lentils, peanuts etc

Advantages: Seeds and legumes are good sources of protein, magnesium, and potassium. They’re also protective against certain types of cancer and cardiovascular disease due to their phytochemicals content.

  1. Fats and Oils: 2-3 servings per day

1 serving = 1 tablespoon vegetable oil

Examples: Olive oil, canola oil, safflower, sunflower, soybean etc

Advantages: Fat helps your body’s immune system and allows you to absorb vitamins. However, too much of fat increases your risk of heart disease, diabetes and obesity. 

Keep away from trans fats, found commonly in processed and fried food.

Health Benefits of the DASH diet

  • Reduces blood pressure
  • Lowers bad cholesterol and increases good cholesterol
  • Helps in weight management

More DASH Tips

  • If you now eat one or two vegetables a day, add another serving at lunch and dinner.
  • If you don’t eat fruit now or have only juice at breakfast, add a serving of fruit to your meals or switch out your juice for the whole fruit.
  • Opt for low fat or skimmed dairy when you might normally do full fat or cream.
  • Snack on nuts, raisins, unsalted and unbuttered popcorn or frozen yogurt rather than salty chips and cookies.
  • Use low fat or fat free condiments, and try reducing your salad dressing amounts by half. Home-made salad dressing consisting of pepper powder, lime juice, jeera powder and olive oil is a good alternative to store-purchased dressings.
  • Beware of the hidden salt lurking in pre-processed foods like ready-to-eat noodles, papadums, canned foods, ketchup and cooking pastes/powders.

Relax, Refresh, Recharge

In the midst of our busy lifestyle, we very often forget to relax and rejuvenate our mind and body. Relaxation is nothing but a state of physical and mental calmness. Being relaxed automatically gives us the ability to manage psychological stress and anxiety in all situations. There are many techniques to help us attain a relaxed state, in this blog, I’m going to walk you through the popular stress-buster called “Progressive Muscle Relaxation Technique”.

As the name implies, this involves sequentially contracting and relaxing various muscle groups in our body.

The two steps to be followed in this technique are:

  1. Contract  (or) tighten
  2. Relax (or) release

Who should do it?

While anybody who desires a relaxed mind can follow this technique, anxious, stressed out and psychologically disturbed individuals should definitely practice this method for an improved state of mind.

Before starting…

  • Set a quiet place in your room
  • Wear loose, comfortable clothing
  • Free your time
  • Sit (or) lie down on a mat on the floor or on a firm bed
  • Initially take 5 deep breaths


  • Inhale and contract one muscle for 5 to 10 seconds
  • Then exhale and suddenly release the tension in that muscle
  • Give yourself 10 to 20 seconds to relax, and then move on to the next muscle
  • Try to focus on the changes when the muscle is relaxed
  • Gradually work your way up the body contracting and relaxing muscle groups


  • The muscle contraction must be gentle, not too strong and painful
  • The technique must be performed slowly and your mind should be focused on it
  • It takes some time (probably a week or two) to get the right technique
  • Each session would take about 10 minutes, you can start by doing it 2 times per day.
  • Stay relaxed for a bit, and then slowly returns to daily life.


  • Alleviates stress and anxiety
  • Reduces blood pressure
  • Relieves insomnia
  • Prevents heart ailments by keeping the risk factors under control
  • Improves symptoms of chronic pain
  • Improves memory and concentration as it is a form of meditation when done right

Contract-Relax and Feel Relaxed

Air Pollution and Heart Disease

Air Pollution as a leading cause of respiratory diseases has been known for long, but there is less awareness of its impact on heart diseases.

Historically, increased deaths due to heart diseases were noticed during the great smog of London in 1952. Many recent studies in US, Europe and China establish air pollution as an important cause of coronary heart disease.

Outdoor air pollution is a complex mixture of thousands of components. From a health perspective, important components of this mixture include airborne particulate matter (PM) and the gaseous pollutants ozone, nitrogen dioxide (NO2), volatile organic compounds (including benzene), carbon monoxide (CO), and sulphur dioxide (SO2).

Among particulate matter, fine particulate matter, also known as PM2.5, which is less than 2.5 micrometers (μm) in diameter is of greatest concern. Because PM2.5 is so small, when inhaled, it can reach deep inside the lungs, leading to a wide range of health problems. Re-suspension of dust by wind and moving vehicles, combustion of fossil fuel or wood for transport and other purposes, power plants, industrial activities all lead to increased air pollution. Indoor air pollution due to solid fuel burning remains an important cause in developing countries.

Developed countries have maintained strict air quality recommendations for particulate matters over time. But in developing countries like India, with poor infrastructure, large population, meagre resources and poor political will, air quality has worsened over time (image below shows air pollution in Delhi). In such a case individual protection from its harmful effects is a plausible solution.

Reduction in personal and communal exposure to airborne pollutants can be achieved through simple measures such as:

  • Avoid inefficient burning of biomass for domestic heating
  • Avoid walking and cycling in streets with high traffic intensity, particularly during rush hour traffic
  • Exercise in parks and gardens, and avoid major traffic roads.
  • Limit time spent outdoors during highly polluted times of the day, especially infants, elderly, and those with cardiorespiratory disorders.
  • Consider ventilation systems with filtration for homes in high pollution areas.
  • Travel by walking, cycling, and public transportation whenever possible to do your part to reduce this global problem.

In particular, individuals with or at high risk of cardiovascular disease should be advised of these measures to limit exposure to pollutants and also advised of the importance of compliance with primary or secondary prevention medication in order to combat the potential effects of air pollution exposure.

Knowledge-sharing: the essence of effective Cardiac Rehabilitation

Education or knowledge-sharing is the most important aspect of Cardiac Prevention and Rehabilitation Programs. For someone who has had a heart attack or myocardial infarction, having a reliable and knowledgeable professional to talk to and get answers to some pertinent questions makes a big difference. This is what health education is all about. The British Association of Cardiovascular Disease Prevention and Rehabilitation very aptly describes the 6 core components in this artwork:

Health behaviour change, which is the first and fundamental step in improving the cardiac and overall wellbeing, depends hugely on proper education. Let us take the common example of hypertension. We all know that high blood pressure is not good for our body and most of us are also aware that reducing salt intake can help reduce our blood pressure. However, only when an experienced dietician understands the food pattern of an individual and educates him/her about obvious and hidden salt in our daily diet, the simple ways by which salt can be cut-down in the household and what are the alternative ingredients that can be used to enhance taste in low-salt cooking, that person is actually able to make that particular health behaviour change of reducing salt in their diet and sustaining that change.

The healthcare team at Cardiac Wellness Institute is not only involved in educating patients and their families about the risk factor management, heart-healthy nutrition and exercise principles but is also actively engaged in training healthcare professionals from other parts of India so that more such comprehensive and high-quality cardiac rehab services become available to the people who need it, close to wherever they live.

Pranayama and its cardioprotective effect

Pranayama is a Sanskrit word. “PRANA” means energy of life and “AYAMA” means to control. So pranayama simply means controlling one’s own breath (inflow and outflow of air). Deep Breathing is the scientific word for pranayama. Taking a long deep breath to the bottom of the lungs, and holding it for a while and then slowly releasing it, is what is called as deep breathing.

How deep breathing impacts us?

  • Draws more oxygen into the body
  • Holding the breath allows more contact time between the blood and the oxygenated air for gaseous exchange, or simply better loading of blood with oxygen
  • Availability of more oxygen to all the organs including the heart to sustain their functions

Pranayama which only takes a few minutes to perform immediately lowers resting blood pressure and heart rate. Regular practise of pranayama results in permanent decrease in blood pressure and heart rate which means that the workload and the wear and tear for the heart are both reduced. The cool thing about this breathing technique is that it can be practiced anywhere, anytime and without any equipment.

Heart attacks are predominantly caused by an imbalance in the demand-supply ratio of oxygen to the continuously working heart muscles. Deep breathing can help uproot the cause of heart disease and even reverse the course of it.

Regular practice of pranayama also resets the autonomic nervous system to parasympathetic dominance, meaning it decreases arousals to external stimuli thus decreasing anger and hostility. Stressful triggers are an inevitable part of life but it is how we perceive these stressors that is the major determinant of our health.

Benefits of Pranayama

  • Reduction in blood pressure and heart rate
  • Relief from day to day stress and anxiety
  • Regulation of myocardial oxygen demand – supply ratio
  • Strengthens the muscles of respiration and provides relief from breathlessness
  • Improved sleep pattern and a permanent solution to sleeplessness
  • In short, all the benefits of meditation can be achieved by using deep breathing as a meditative technique, that is, by focusing on the breath as we breathe in and out.

When pursued in combination with regular exercise, healthy diet and a positive mindset, Pranayama is bound to make our hearts younger and our lives more enjoyable.

I would like to conclude with this quote from Dr. Russ Harris, a medical practitioner, psychotherapist and a bestselling author.



Getting to grips with heart failure

For someone who has suffered a heart attack, has gone through several tests and life-saving procedures and has a long list of medicines to consume, a diagnosis of heart failure can be depressing. It not only means more medicines and more investigations but also lesser ability to do the things they enjoy and a reduced quality of life. However, the outlook for individuals with heart failure is not so gloomy after all. In fact, if you read this post till the end, you will be convinced that there is so much one can do to manage heart failure better!

The term ‘heart failure refers’ to the inability of the heart to perform its work well. In other words, the heart is not pumping blood effectively leading to all the body parts getting lesser oxygen than they need. The causes of heart failure are:

  • Ischemic heart disease (coronary blocks/angina/infarction)
  • Hypertension
  • Valve problems of the heart
  • Cardiomyopathy (heart muscle weakness)

The complaints typically given by patients are excessive tiredness, breathlessness, reduced ability to do physical activities, swelling of feet, cough at nighttime and discomfort in lying down posture. The cough, swelling of feet etc are caused by accumulation of fluids in the lungs and extremities as a result of the poor pumping of the heart.

While an X-ray chest will often show an enlarged heart and an ECG will show electrical changes, the ejection fraction (EF, an important parameter measured during an echocardiogram) gives a clear indication to the doctor about the cardiac function. The EF in healthy adults is between 50-75%, which means that the normal heart pumps just over half the heart’s volume of blood with each beat. There are 2 types of heart failure based on whether the EF is preserved (50% or more) or reduced (less than 50%). Both types of heart failure can be managed with medicines, limiting fluid and salt intake, and a proper diet and exercise regimen.

How does exercise help heart failure?

This is a very important question and warrants a thorough explanation. When someone is newly diagnosed with heart failure, they will be prescribed specific drugs to help improve the cardiac function and to reduce the symptoms. The number and dosage of drugs will be adjusted in the ensuing days to weeks until the symptoms are under control and the vitals are stable. Simultaneously, there will be changes made to the dietary pattern and fluid intake to prevent the heart from getting overloaded. This is the right time to initiate cardiac rehabilitation and supervised exercise as it benefits the heart in the following ways:

  • Strengthens heart and cardiovascular system
  • Reduces your blood pressure
  • Helps manage your weight better
  • Improves your circulation and the way your body uses oxygen
  • Gives you more energy, which lets you be more active without getting tired or short of breath
  • Makes your muscles stronger and more toned
  • Prevents the heart failure from worsening
  • Graded exercise improves the conditioning of your heart and lungs and allows you to participate in social, physical and sexual activities like normal individuals

While aerobic exercises are a must, strengthening exercises and balance and flexibility exercises are ideal too. It is recommended that individuals with heart failure keep track of how they feel during the exercise session and even after the session. Any excess breathlessness, discomfort, sweating, palpitation, giddiness or disorientation has to be informed to the healthcare provider immediately. Proper warm-up and cool-down are mandatory before and after each exercise session to prevent complications.

The advantages of a cardiac rehab program are that in addition to an exercise expert, there is a dietician who helps plan the meals and fluid intake per day taking into account the various factors like cardiac, renal and metabolic function; and there is a counselor who takes care of the psychosocial aspects such as feeling depressed, unduly stressed or helpless.

So how often should the EF be measured in someone with stable heart failure? The echo test, ECG and blood investigations should be done yearly if there are no new complaints, and more frequently if the clinical condition demands it.

Going Nuts Every Day

Nuts are an incredibly delicious and versatile plant-based food that are rich in healthy fats, proteins and fibre. While the term ‘nut’ in the true botanical sense is limited to only a few nuts like chestnut and hazelnut, any large, oily kernels found within a shell and used in food are commonly called nuts. Some of the widely consumed nuts are almonds, walnuts, brazil nuts, cashew nuts, hazelnuts, peanuts and pistachio nuts.

So why are we so confused about nuts? What is there in nuts that makes them desirable? And why can’t we binge on nuts all day? If you take a look at the nutrition facts of nuts, the amount of fat might be the first thing that jumps out at you. It looks like a lot of fat! However, there is a big difference between the good fats and bad fats, and nuts are filled with the good type of fat!

Nutrition Facts

Nuts provide a range of nutrients, including large quantities of healthy monounsaturated and polyunsaturated fats (49–74% total fat), and moderate amounts of protein (9–20%). They are also a good source of dietary fibre and give a wide range of essential nutrients, including vitamin B, vitamin E and minerals such as calcium, iron, zinc, selenium, manganese, copper, potassium, magnesium and antioxidant compounds (flavonoids and resveratrol) and plant sterols. They are naturally low in sodium and sugars and have a low glycemic index. Each nut variety contains its own unique combination of nutrients, let’s take a peek inside some of them:

  • Almonds: Protein, calcium and vitamin E
  • Brazil nuts: Fibre and selenium
  • Cashew nuts: Iron, copper, vitamin E, K and B6
  • Hazelnuts: Fibre, potassium, folate, vitamin E
  • Peanuts: Protein, niacin, vitamin E
  • Pistachios: Protein, potassium, plant sterols and the antioxidant resveratrol
  • Walnuts: Folate, omega 3 fats and antioxidants

Health Benefits of Nuts

There are several health benefits of nuts, some of them are listed below:

Protection against Cancer

One of the best aspects of nuts is their high content of healthy polyunsaturated fatty acids or PUFA also called omega-3 fatty acids. These fatty acids have cardioprotective and anti-inflammatory properties and have been shown to reduce the chances of colon, prostate, and breast cancer.

Prevention of Gut Problems

Every variety of nut has a high content of fibre, making this family of foods more desirable. First of all, fibre is important in the digestive process because it adds bulk to the stool. This means that bowel contents move through the digestive tract smoothly because the fibre stimulates peristaltic motion in the smooth muscle of the intestine. When stool moves freely through the system, constipation is reduced and regular bowel movements can begin. This reduces the chances of developing haemorrhoids, polyps and certain types of gastrointestinal cancers.

Better weight management

Fibre present in nuts makes the body feel full and inhibits the release of ghrelin, the hunger hormone, which keeps obese people from overeating. There is a misconception that eating nuts leads to weight gain but it’s not true. A small handful of nuts (30–50g) each day is not associated with weight gain, and may also help reduce the risk of obesity. The healthy fats in nuts can help you feel fuller, which helps to control appetite. Moreover, some fat is trapped in the fibrous structure of the nut; it passes through the body rather than being digested. Eating a handful of nuts in your daily diet as a substitute for less healthy foods such as fried foods and baked items is a change we all can make.

Improved Heart Health

Studies suggest that consuming about 30g (a handful) of nuts per day may reduce the risk of developing heart disease. Nuts have a high proportion of healthy monounsaturated and polyunsaturated fats and are low in saturated fats. It contains a large amount of good cholesterol or HDL cholesterol that helps to keep the bad LDL cholesterol in check. Thus, nuts have a heart-protective effect in the following ways:

  • Good balance of monounsaturated and polyunsaturated fats that help regulate blood cholesterol
  • Fibre and plant sterols that help prevent cholesterol in the diet from entering the bloodstream
  • Arginine is an amino acid which helps keep blood vessels elastic thereby reducing the risk of atherosclerosis
  • Antioxidant vitamins and minerals, e.g. vitamin E, copper, manganese, selenium and zinc, and other antioxidant compounds such as flavonoids and resveratrol that reduce oxidation and inflammation known to cause coronary artery disease.

Recommended Portion

A healthy daily intake of nuts is 30 grams (a small handful) or approximately about 1/3 of a cup which is equal to:

  • 20 almonds
  • 10 Brazil nuts
  • 15 cashews
  • 20 hazelnuts
  • 10 whole walnuts
  • A small handful of mixed nuts

Tips for Adding Nuts to Your Daily Food Plan

You can incorporate more nuts by following some of these tips:

  • Sprinkle almonds on top of yoghurt
  • Sprinkle chopped nuts onto your cereal
  • Having a mix of raw nuts as a snack instead of other unhealthy options like chips or chocolate
  • Adding some nuts to salads, smoothies and gravies is sure to add taste and texture.

Cool tips for a hot workout

Summer is hot but it is also the perfect time of the year to go outside with family and friends for fun activities like swimming, cycling and exploring nature. While the long summer days are an additional boon and motivation for doing outdoor activities, we cannot ignore the fact that the heat and humidity give extra stress to our body. Our natural cooling systems may fail if we are exposed to high temperatures for a long time without taking sufficient precautions. In this blog post, we will discuss the ill-effects of overheating on our body during a workout and ways to prevent it. The heat-related illnesses that we should be aware of are:


  • Heat cramps: These are brief but painful muscle cramps that occur during or after exercise or work in a hot environment. Heat cramps are thought to be caused by a deficiency of electrolytes like sodium and potassium.

Symptoms: Heavy sweating and muscle pain or spasm.

Treatment: Stop your exercise and drink water.

  • Heat exhaustion: It is the body’s response to an excessive loss of water and electrolytes.

Symptoms: Heavy sweating, paleness, muscle cramps, tiredness, weakness, dizziness, headache, nausea or vomiting and fainting.

Treatment: Stop your exercise and move to a cool place.

Loosen your clothing, take a cool shower or splash yourself with cold water and drink water.

  • Heat stroke: It is the most serious form of heat injury and is considered a medical emergency.

Symptoms: Lack of sweating despite the heat, headache, dizziness, red hot and dry skin, muscle weakness or cramps, nausea and vomiting, rapid heartbeat which may be either strong or weak, rapid shallow breathing, seizures and unconsciousness. Behavioural changes such as confusion, disorientation, or staggering may also occur.

Treatment: Call for a doctor, and start the first aid until emergency personnel reach the spot. Move the victim to a cool place, loosen clothing, try to lower body heat by immersing in a tub of cold water, and place wet towels in the armpits, groin, neck, and back.

Any and all of these heat-related conditions can pose a threat to the heart function because the pumping of the heart depends on a delicate balance between the fluids and electrolytes in our body. To protect ourselves from these illnesses proper precautionary measures should be taken before starting the workout.

Plan your workout

Exercise up to your ability, don’t push too hard. Low to moderate intensity exercise is preferable. Break longer workout sessions into 2-3 short sessions (for example ½ hr in the morning and ½ hr in the evening).Choose a park with a lot of shade or the beachside to avoid the heat. Swimming and cycling are good options for aerobic workouts. Strength training and other forms of exercise can be done in the outdoors when the heat is less or in an air-conditioned room or gym.

Always start your session with warm-ups and finish with a cool-down. Some basic warm-up exercises are shown here:

And a few useful cool-down stretches are shown here:


Tips for a cool and refreshing outdoor summer workout

  • Get a health check done prior to starting any new exercise.
  • Time your workout for early mornings or late evenings to avoid the heat.
  • Before starting your workout have a cold shower to reduce body temperature.
  • Try to find a shaded area for your workout.
  • Wear light and loose clothing.
  • Apply sunscreen before going out for a workout.
  • Drink sufficient amounts of water; tender coconut water is a good electrolyte source after a workout.
  • Listen to your body, don’t overdo any exercise.

Cardiac Wellness Institutes celebrates World Health Day on 7 and 8 April 2018 with a goal to make “Health For All” a reality. There will be a medical camp which includes basic parameters like body mass index, blood pressure, important blood tests, and a consultation with the doctor, physiotherapist and dietician. We will be conducting group fitness sessions and education and counselling classes on healthy diet, stress management etc. Each participant also gets an opportunity to sponsor the camp for an underprivileged person.

So this summer stay tuned in to for some cool programs for a better health today and forever!

Medications for your heart, in a nutshell

A question I am often faced with while talking to my patients is “Do I really need to take so many medicines doctor?” and my answer to them is “Each one of these drugs has a specific action in your body, let’s first get you to understand them better and then see how we can reduce them.”

Antithrombotic or blood thinning drugs

These drugs work by reducing clot formation in the blood vessels (anticoagulants such as heparin or warfarin) or preventing the clumping of platelets in the arteries (antiplatelet drugs).They are usually referred to as ‘blood thinners’. You are prescribed this group of drugs if you have had a heart attack, stroke, transient ischemic attack, coronary artery disease, peripheral artery disease, an angioplasty, a bypass surgery, congenital heart disease or a valve replacement procedure.

Commonly used blood thinners are:

  •      Aspirin (eg. Ecosprin)
  •      Clopidogrel (eg. Deplatt, Clavix)
  •      Ticagrelor (eg. Brilinta, Axcer)
  •      Dual antiplatelet therapy is a combination of aspirin and clopidogrel  (eg.       Clopitab-A, Clavix-AS)
  •      Vitamin K antagonist (eg. Acitrom)

The main side effect of taking blood thinners is bleeding. You have to report to your doctor if you have any symptoms of bleeding like excessive tiredness, sudden weakness, blood in stools, dark coloured stools, blood in urine or excessive menstrual bleeding. Elective procedures (such as tooth extraction, cataract surgery, urological procedure etc) should be done with the advice of the treating cardiologist.

Antihypertensive drugs

There are several classes of drugs used to lower the blood pressure. The commonest are

  • Diuretics – that is ‘water pills’ that causes you to make more urine (eg. Lasix, Tide Plus, Dytor)
  • Drugs that act on the Renin-Angiotensin-Aldosterone system – they act on the hormones that raise blood pressure and block them and are particularly important in the treatment of diabetic patients with high blood pressure (eg. Pinom, Repace, Cardace, Zestril)
  • Calcium channel blockers – work by blocking the entry of calcium into the cells of heart and blood vessels and hence reduce blood pressure (eg. Amlong, Cilacar)
  • Beta-blockers – reduce blood pressure as well as the workload on the heart by blocking the beta-receptors in the heart and blood vessels (eg. Starcad, Cardivas, Nebicard)
  • Several drug combinations of the aforementioned drug groups are available in the market

The side effects of antihypertensive drugs include low blood pressure, slow heart rate, swelling of feet etc. and the symptoms may be giddiness, breathlessness, and fatigue (to mention a few).

Antidiabetic drugs

As diabetes and cardiac problems often coexist in the same individual, drugs to lower the blood sugar are a common feature of a cardiac prescription. The two main groups are oral antidiabetic drugs and Insulin injections. Some commonly used drugs are:

  • Biguanides like Metformin (eg. Obimet, Glycomet) – work by reducing glucose production in the liver and increasing the uptake of sugar by peripheral cells like skeletal muscle. It is the first drug to be prescribed in a newly diagnosed diabetic patient along with dietary modification and exercise regime.
  • Sulfonylureas like Gliclazide, Glimepiride (eg. Amaryl, Diamicron) – act as insulin secretagogues and increase the insulin production in the pancreas.
  • Glitazones, Voglibose, Vildagliptin, Empagliflozin etc. are some other oral drugs used to control blood sugar levels.
  • Insulin comes in various forms such as rapid-acting, short-acting, intermediate-acting, long-acting and pre-mixed forms.

The main side effect to watch out for is hypoglycemia or low blood sugar (<70mg/dl), which manifests as giddiness, shakiness, anxiety, hunger, irritability, sweating, palpitations, and if the hypoglycemia worsens as confusion, slurring of speech, blurred vision, seizures and loss of consciousness.

Cholesterol-lowering drugs

Statins are commonly prescribed drugs (eg. Atorvastatin, Rosuvastatin) that help to eliminate excess cholesterol from the body. Muscle weakness, body pain and altered liver function are some common side effects of statins.

Antifailure drugs

The heart’s function or ability to pump blood may be reduced as a result of coronary artery disease, heart muscle disorder, valve problems of the heart and some other causes too. Many drugs described in the antihypertensive section are used to treat heart failure; Digoxin (eg. Lanoxin) is also used in the intravenous or oral route.

Antiarrhythmic drugs

When the heart beats too fast or too slow, doctors recommend drugs to reduce the abnormal heartbeats (eg. Cordarone) or artificial pacemaker to increase the very slow heart rate. There are several drugs in this group.

Nutritional Supplements

Vitamin tablets, iron supplements, omega fatty acids, resveratrol etc. are prescribed to support the nutritional requirements of cardiac patients.

Device therapy (eg. ICD, CRT-d, LVAD) is recommended for individuals in addition to medical management when warranted. End-stage heart failure can be managed by heart transplantation procedure when a suitable donor becomes available.

With this overview of medications and management of heart disease, we hope you are better equipped to help yourself or your loved ones. This should prompt you to keep a medication diary wherein your current prescription drugs are listed out and any changes to them or any side effects are noted down. Also, remember that alcohol is best avoided while on heart meds as it interacts with many drugs and can cause harm by reducing the potency of the drug and/or increasing the unwanted side effects.

Better control of your risk factors through healthy lifestyle changes is a definite way to reduce the dosage and number of drugs. However, changes should only be made after consulting your physician.



Staying Cool by the Pool

Summer Fruits are one of the best ways to beat the heat. So, let’s have a look at some fruits to keep you cool this season.

Some fruits are extremely useful during summer because they refresh, rehydrate and rejuvenate us during the hot days. When the environment is hot and humid, our body has to work harder to maintain a normal temperature. This is automatically achieved by our body’s internal mechanism by altering the blood circulation and losing water through skin and sweat glands. Heat waves are extremely dangerous in cities due to pollutants that are trapped in the atmosphere. During a heat wave, it is recommended to reduce strenuous activities or reschedule them to a cooler time of the day. Moreover, you should avoid too much of sun exposure in the daytime. It is also recommended to drink a lot of fluids in the summer even if you don’t feel thirsty.

Extreme temperatures are not only demanding on the body’s metabolic mechanism, they can also be a threat to the normal functioning of the heart. It is because of this reason that we recommend individuals with heart ailments to take extra precaution in the summer and winter seasons.

While water is very important at such high temperatures, you can also resort to fruits in order to keep your body hydrated and healthy. Eating summer fruits is a healthy way to keep you cool and get all the goodness of nature. These are the fruits to cool you down:

  1. Watermelons
  2. Lemons
  3. Pineapples
  4. Muskmelons
  5. Sweet Limes


  • Watermelons are made of 92% water and electrolytes, and it has the highest water content out of all summer fruits. One cup (100g) of watermelon has only about 46 calories.
  • Melons are low in saturated fat and sodium and they are a good source of potassium, magnesium, vitamin A, C, B1 and B6.
  • It can have a positive effect on people suffering from asthma, arteriosclerosis, diabetes, colon cancer and arthritis. Melons have antioxidants that help neutralize free radicals to keep us youthful and energetic.


  • Lemons generally have 89% water and it is one of the most refreshing drinks in summer. One lemon fruit contains 17 – 24 calories, depending on the size.
  • They are a good source of vitamin B6, potassium, iron and an excellent source of dietary fibre and vitamin C.
  • Lemon water is very good for common summer weather problems like nausea, heartburn and dehydration.


  • Pineapples are a delicious summer fruit. It has approximately 86% of water content. A hundred grams of pineapple contains about 48 calories, mostly from sugars.
  • Pineapples are rich in vitamin C and bromelain, which help fight microbial infections and boosts immunity. It is rich in antioxidant which helps to reduce cholesterol level and prevent heart diseases.
  • Pineapple will help get rid of respiratory tract problems like frequent colds. This fruit contains high amounts of manganese that helps in strengthening bones and connective tissues.


  • Muskmelon is a popular summer seasonal fruit; it is another high water content fruit with 90% water. 100 grams of muskmelon contains about 34 calories.
  • It is rich in potassium, an important electrolyte that is helpful to regulate blood pressure. Other vital nutrients found in muskmelon are vitamins A, C and K, protein, fibre, folate, calcium and iron.
  • Regular intake of muskmelon reduces the risk of obesity, diabetes and heart disease while promoting healthy skin and hair. It also provides protection from common cold and some cancers.

Sweet Limes

  • Sweet lime or Mosambi is a versatile fruit with a sweet and sour taste. It has 80% water content and a medium- sized fruit provides 43 calories.
  • It is rich in vitamin C, copper, iron, fibre and calcium. The acids in sweet lime help to flush out toxins from the bowel and to prevent constipation.
  • This fruit is rich in antioxidants and flavonoids that have detoxifying and antibiotic properties and is also effective in healing peptic ulcers.
  • It will keep you hydrated and provide essential minerals and vitamins at the same time. Sweet lime juice is helpful in treating sunstroke.

Including summer fruits in your daily diet can be very beneficial for your overall health this season. The good thing about these summer fruits is that they not just keep you cool, but are loaded with vitamins, minerals, and a lot of other health benefits too.

Enjoy these healthy refreshing fruits in summer and beat the heat!!!

Psychosocial counseling can reverse heart disease

Psychosocial counseling simply means getting individual or group sessions with a healthcare professional experienced in ‘mind matters’. You might be taking your medicines regularly, getting your parameters checked and visiting your doctor periodically, but these measures will only help you monitor your health. It takes a little more effort to reverse heart disease!

You need to strike at the root cause of the problem if you would like to see the end of it. As psychosocial issues like chronic stress, depression and anxiety play a major role in causing coronary artery blocks and are often hidden or unnoticed, it takes an expert to address these issues of the mind. We have already seen in an earlier post that poorly managed stress can repeatedly attack the coronaries and ruin your heart as well as your overall health.

It is for this reason that a psychosocial counselor has become an integral part of the cardiac rehab team. A comprehensive cardiac rehab program like the one we provide at Cardiac Wellness Institute includes supervised exercise, dietary modification and psychosocial counseling in addition to health education and targeted behavior change. The counselor helps individuals understand the concepts of feelings, emotions and habits and paves the way for unraveling the stress triggers. Stress management techniques, non-pharmacologic treatment of depression, anger reduction methods, coping skills after a cardiac procedure,  ways to overcome anxiety, sleep problems and addiction are just a few things that a counselor can help you with. The image you see here is from one of the group counseling sessions at our centre where our counselor made participants do role-play (something like a mini-drama) to help them understand everyday stress triggers and coping strategies.

As counseling is defined as listening to someone and providing advice to overcome his/her problems, the counselor should not be the sole person providing counseling. Members of our team, for instance, take time to listen to what our patients have to say and work together with them in finding an effective solution to their physical and mental health problems. We are all counselors in our own little ways! But we know our limitations and acknowledge and appreciate the role of the psychosocial counselor in solving the deeply ingrained emotional problems faced by our patients.

With strong scientific evidence becoming available on the complete regression of coronary blocks with intensive lifestyle modification, there is no reason to ignore or neglect the psychological distress you are going through. It is not something to be ashamed or embarrassed about, we all have feelings and there are experts to help us feel better.

If you or your loved ones are going through a rough patch or if you would like to know how an experienced counselor can help you, please get in touch with us and we will guide you in the right direction.






Exercise and Ageing – Made for each other

In an earlier thread, we have discussed how older adults can maintain good nutrition. In this blog post, we will look at how exercise can enrich the lives of senior citizens. Ageing, as believed by many, should not stop you from doing activities; on the contrary, it should allow you to do all your favourite activities and lead a healthy life. Engaging in regular exercise is the best way to achieve this.

Most people think that walking is the only exercise suitable for elders. While walking is definitely suitable for all ages and health conditions, there are many types of exercises that you can do as you age. Exercise is an important part of everyone’s health and this is very true for elders too. “If you don’t move, you won’t move” is an old saying. That is quite right because as we age our physical and mental abilities change causing both deterioration in coordinated function and an increasing dependence on others. Hence, as a physiotherapist, my advice for all of you out there is: “start to move now and prevent ill health forever”.

You are all aware that high blood pressure, diabetes, arthritis, heart disease and stroke are common in the elderly. What you might not know is that all of these conditions can be controlled and reversed with exercise. In fact, frequent falls or fear of fall due to impaired balance and coordination is the worst enemy to a happy and enjoyable seniors’ life; even this can be solved by regular exercise. Additionally, muscle strengthening exercises help to improve your level of performance in daily activities. While these are all compelling arguments to start your exercise regimen right away, remember to get proper medical advice prior to starting any new exercise.

There are various types of exercises that you can do to improve muscle strength, balance and coordination

  • Aerobic and flexibility training– 5 days/week
  • Strength training – 2 days/week
  • Balance and coordination training – every day

The benefits of regular exercise are:

  • Improves your strength and helps you stay independent
  • Improves your balance and prevents falls
  • Gives you more energy
  • Prevents and reverses diseases, such as heart disease, diabetes, arthritis and osteoporosis
  • Improves your mood and fights off depression

Stop exercising and contact your doctor if you experience any of the following symptoms:

  • Muscle or joint pain
  • Chest pain or pressure
  • Excessive shortness of breath
  • Light-headedness, dizziness

Exercise tips

  • Always start your exercise session with warm-up and end with cool-down exercises
  • Drink more fluids to stay hydrated
  • Start slowly and set reachable goals
  • Exercise in a small group to stay motivated
  • Listen to your body and respond to its needs
  • Don’t overdo any exercise
  • Avoid doing exercise when you are sick

The definite way to attain all the health benefits of exercise in your old age is to start doing exercise in your younger years. It is never too early to start exercising, and it can never be too late whatever your age! The team at Cardiac Wellness Institute provides various programs to improve the health status of all individuals including senior citizens. If you are interested and eager to know more about the seniors’ program please feel free to contact us, we will help you improve your health and your quality of life in an enjoyable manner.


The sweet danger of sugar

Would you like to understand ‘sugar’ better? While you might know that sugar is really sweet and enhances taste did you know that it can be dangerous too? Let me take you through some basic facts about sugar before seeing the health hazards of this sweet ingredient…

Sugars are broadly grouped into simple and complex sugars, and natural and added sugars.

Simple Sugars

Simple sugars are carbohydrates that are quickly absorbed by the body to produce energy. These sugars are present in both natural and processed foods. Natural foods that contain simple sugars include fruits, vegetables and milk products. Processed foods often have simple or refined sugars added to improve flavour. Examples of refined-sugar foods include candy, cakes, syrups, fruit juices and carbonated beverages.

Complex Sugars

Complex sugars are complex carbohydrates that take a longer time to digest as they are packed with fibre, vitamins and minerals. Examples are cereals, legumes, whole wheat pasta and vegetables.

Natural sugar

Natural sugar is naturally occurring, which makes them healthy. There are two types of natural sugars.

  1. Fructose – it is found in fruits
  2. Lactose – it is found in dairy products. These nutrients help to stabilize your blood sugar levels, which prevents you from feeling hungry soon after eating.

Added sugar

Added sugars are sugar carbohydrates added to foods and beverages during their processing. This does not include naturally occurring sugars such as those in milk and fruits. It provides empty calories that are of no benefit  to your body. Examples are candy, cake, soft drinks, ice cream and other desserts. Consuming too much added sugar is a health hazard!

Sugar, honey and jaggery are the commonly used sweetening agents added to beverages and foods to increase palatability. The crystallised sugar we all keep in our kitchen shelves is made up of glucose and fructose. It’s a source of energy providing 4 kilocalories per gram. Jaggery is made from sugar cane juice after processing it and is a fair source of iron. Honey is the golden coloured syrup made by bees from the nectar of flowers. It also consists of glucose and fructose.

How much sugar can be consumed on a daily basis?

While theoretically, a normal healthy adult can consume 24 grams (or) 6 teaspoons per day, research reveals that minimal or zero added sugar is best for our health. Diabetic patients, however, have a reduced ability to metabolise sugar and should strictly avoid all forms of added sugar.

How many calories does one teaspoon of sugar contain?

Amount         –  1tsp (4.2g)

Calories          – 16 kcals

Carbohydrate  – 4.2 g

Health risks of eating too much sugar

Sugar, an instant source of energy, can lead to multiple health problems if consumed in large quantities: weight gain, fatty liver disease, diabetes, hypertension, heart attack, stroke and kidney failure are some of the common ailments caused by this sweet substance.

Artificial sweeteners

Artificial sweeteners, also referred to as sugar substitutes, are used to replace sugar in foods and beverages. Sucralose, aspartame and saccharin are the mostly purchased artificial sweeteners, especially by diabetic individuals. We will look at these agents in depth in a future blog post, but it is apt to say that their use should be minimised keeping in mind their harmful side effects.

So, here are some tips to cut down on sugar in your daily diet:

  • Instead of adding sugar to cereal or oatmeal, add fresh fruits (try bananas, pomegranate or berries) or dried fruit (raisins, cranberries or apricots).
  • If you consume tea, coffee or milk with added sugar, try alternatives like green tea, black coffee and unsweetened milk.
  • Instead of adding sugar in recipes, use extracts such as almond, vanilla, orange or lemon.
  • Enhance the taste of foods with spices instead of sugar; try ginger, allspice, cinnamon or nutmeg.
  • Compare the sugar content of different foods and choose the lower sugar and calorie option.

“ Eat less SUGAR;

You’re SWEET enough already”



Understanding the difference between heart attack and cardiac arrest

If you are under the impression that a heart attack and a cardiac arrest are the same, you are mistaken. Both these terms refer to different conditions of the heart; let us see how.

Heart attack: sequence of events

When someone has reduced or lack of blood flow in the blood vessels supplying the heart muscle, or in other words, one or more critical block(s) in the coronary arteries leading to deficient oxygen supply to the myocardium, the individual is said to have a heart attack.

This usually manifests as chest pain, chest tightness, lower jaw, neck or upper back discomfort or heartburn. Breathlessness, giddiness, excessive sweating, nausea and vomiting can accompany the pain or be lone symptoms. Silent attacks can occur too.

A heart attack (or myocardial infarction) can lead to a cardiac arrest.

So what is a cardiac arrest?

A cardiac arrest is when the heart suddenly stops pumping blood, mostly due to abnormal electrical signals or arrhythmias within the heart. There is a sudden lack of blood supply to all the body parts including the brain leading to a loss of consciousness and collapse.

Cardiac arrest is a deadly condition, which can lead to death within a few seconds to minutes. By providing immediate cardiopulmonary resuscitation (CPR) and defibrillation, a cardiac arrest can be reversed. An automated external defibrillator or AED is available in many public facilities these days for this purpose. However, only people trained in CPR and emergency healthcare should volunteer to resuscitate someone, as incorrect maneuvers can be dangerous.

There are several reasons for a cardiac arrest; the commonest is a heart attack.

Some other causes of cardiac arrest are cardiomyopathy (due to diabetes, hypertension or other causes), heart failure, valve abnormalities, abnormally formed coronary arteries, recreational drug use, certain medications, certain electrical abnormalities of the heart like Wolff-Parkinson-White Syndrome and inherited genetic abnormalities like Long QT Syndrome.

Important points to note:

  • Heart attack leads to death of heart muscle tissue which if untreated can lead to death of the individual; however, a massive heart attack can cause instant death. Whether sudden or not, the usual mechanism of death following a heart attack is cardiac arrest.
  • Cardiac arrest is a deadly condition that can cause death in a matter of seconds to minutes; immediate CPR can reverse the arrest.
  • Treatment for someone who has had a heart attack often includes lifestyle modification, medicines, angioplasty or bypass surgery and cardiac rehabilitation.
  • A cardiac arrest survivor is managed with lifestyle advice, medicines, cardiac device like pacemaker or implantable cardioverter defibrillator (ICD), surgical denervation if necessary and cardiac rehabilitation.
  • Sudden cardiac arrest or death in a healthy individual below 40 years of age may be due to a genetic cause; thorough evaluation by a cardio-genetic team often helps prevent future arrest/death.
  • Both heart attack and cardiac arrest are preventable by healthy lifestyle, regular health checks and adherence to medication.

The healthcare team at Cardiac Wellness Institute provides comprehensive services for individuals and families with heart attack and cardiac arrest; you may contact us for any further questions or clarifications.

Exercise is a must after heart surgery

As a Physiotherapist providing personalised cardiac rehabilitation programs for individuals of different ages and walks of life, it is part of my work to address their questions and concerns related to exercise. In this blog post, I hope to clarify some of the doubts pertaining to exercise in the minds of patients who have undergone or are planning to go through a cardiac surgery.

  1. Is it safe to exercise after a bypass surgery?                                                             Yes. It is not only safe to exercise after a bypass surgery but it is also a part of the treatment plan after someone is diagnosed with coronary blocks and undergoes stent procedure or bypass surgery. In fact, regular exercise has been proven to improve the outcomes after all types of cardiac procedures including valve replacement, device implantation and even heart transplantation. Be sure to talk to your doctor before you start your exercise routine as a comprehensive Cardiac Rehabilitation program that offers supervised exercise sessions along with nutritional advice and psychosocial counselling is ideal.

2. How will I benefit from exercise?                                                                    Regular exercise after a heart surgery has the following benefits:

  • Helps you get back to work early
  • Reduces the risk of future cardiac events
  • Restore your physical function to normal
  • Improves stamina and confidence
  • Reduces stress
  • Lowers the chance of depression
  • Helps reverse the coronary blocks

3. What kind of exercise can I do and when can I start?                                     You can do aerobic exercises like walking and cycling in the initial period after surgery but after some time strength and flexibility exercises and even high-intensity exercises can be done. However, the exercise training should only begin after the surgical wound heals completely and is best done under the medical supervision of a cardiac rehab team.

4. Is the exercise program common for all patients?
No, it will be a personalised program specifically designed for you by a medical practitioner following international guidelines.

5. How hard can I exercise?
The exercise should be started at low intensity and it can progress gradually according to your body’s response. We generally recommend a walking program for patients, to begin with.

6. Can you guide me on how to go about a walking program?
Start your program with shorter sessions, for example, 10-15 minutes of slow walking, and gradually progress to 30-40 minutes of brisk walking with 10 minutes of warm up and 10 minutes of cool down periods. Please consult your healthcare provider prior to starting any exercise plan.

7. Can I get back to playing sports and swimming after my heart surgery?   If you have been playing some sports and swimming prior to your heart surgery, you can safely resume these activities after your cardiac rehab program. During the rehab program, you will gradually increase your work-out intensity in a safe environment where your clinic parameters will be monitored. The rehab team will prepare you for playing the sport of your choice with due consideration to your heart function, risk factors and medications. Swimming is a great exercise but it can be an extra burden on the diseased heart; so please take medical advice before hitting the pool.                                                          

8. What are the warning signals to be noted during exercise?
If you experience any pain or discomfort in the chest, shortness of breath, dizziness, unusual sweating or palpitation (abnormal heartbeat), you should stop the exercise, take rest and report to your doctor at the earliest. Any upper body tightness, pain or discomfort can be a warning signal for cardiac problem.

9. How can I include more physical activity in my everyday life?
You can take the steps instead of the elevator if your home or office is on the first few floors of a high rise building. While going for shopping, park your vehicle as far away as you can to walk those extra steps. But be cautious not to carry heavy bags on your way back as lifting heavy objects can be harmful to the heart. If you are engaged in a desk job, get up from your seat every half an hour and do some stretches.

10. What happens after I complete the cardiac rehabilitation program?
After completion of the exercise program in cardiac rehabilitation, you will know the safe and effective method of exercise, the cardinal warning signs to be noted while you exercise and the various types of exercises (strength, flexibility, etc..) and how to mix and match them

Here are some general exercise tips:

  • Start slowly, progress gradually
  • Exercise in small groups to stay motivated
  • Exercising regularly is more beneficial than exercising in bouts
  • Don’t overdo any exercise; go by the response of your body
  • Stay hydrated; do not exercise in extremely cold or very hot weather conditions


Which type of milk is best for me?

Milk is a rich source of essential nutrients that are required for our body, especially optimal heart functions. It is rich in high-quality protein and is an excellent source of vitamins and minerals such as calcium, vitamin B12 and riboflavin.

Benefits of drinking milk:

  • Milk is one of the best sources of calcium for the body
  • Milk is rich in Vitamin D that helps the body absorb calcium
  • Proper calcium intake contributes to strong and healthy bones
  • Drinking milk provides other benefits such as healthy teeth and nerves

Now that you know milk brings a lot of goodness with it, let’s look at the types of milk  generally consumed.

Cow’s milk

Pros of cow’s milk:

  • Cow’s milk comes in various types and brands (Table 1)
  • Whole milk can provide essential proteins, extra calories from fats, as well as vitamins and minerals for infants and older adults
  • It is high in calcium, which is the key for healthy bones
  • It is less expensive and widely available in grocery stores and convenience stores

  Cons of cow’s milk:                   

  • Whole milk is high in saturated fat as well as cholesterol as it’s animal based
  • Milk is a common cause of food allergy (allergy to milk protein)
  • Many people lack the enzyme to digest lactose (milk sugar). This is called lactose intolerance, which causes bloating, gas, and diarrhoea.

Table 1. Locally available cow’s milk brands 

Brand Type of milk Colour of packet Fat ( %)
Aavin Toned

Double toned


Full cream












Double toned

Full cream


Golden Cow


Family toned




Blue (dark)



Blue (light)








Mother dairy Toned


Full cream










Double toned


Full cream

Blue (dark)

Blue (light)







Cavin’s Toned


Full cream







Arokya Toned

Double toned


Full cream















Double toned


Full cream









Goat’s milk  

Pros of goat’s milk:

  • This milk is easily digestible by humans
  • It is rich in calcium and tryptophan level which is an essential amino acid
  • Goat’s milk contains selenium, an essential trace mineral that supports the immune system

Cons of goat’s milk:     

  • Goat milk is deficient in folic acid and vitamin B6 and B12 which are all essential for growth and well-being
  • Hence exclusive goat milk diet in infants and young children can be dangerous
  • It is expensive compared to cow’s milk

Almond milk

Pros of almond milk:

  • It is low in calories and contains no saturated fat
  • It is a good source of vitamin A and can be fortified to be a good source of calcium and vitamin D
  • It is vegan and naturally lactose-free

Cons of almond milk:

  • It is not a good source of protein
  • It may contain carrageenan, which may cause digestive issues in some people
  • It affects thyroid hormone levels

Soy milk

Pros of soy milk:

  • It is a good source of protein, vitamin A, vitamin B12, potassium, and isoflavones, plus it can be fortified with calcium and vitamin D
  • The fat content in soy milk is good for the healthy heart
  • It contains very little saturated fat

Cons of soy milk:

  • Soy is a common allergen for both adults and children
  • Too much soy may be a problem for people with thyroid conditions
  • Too much soy of any kind in the male diet can cause infertility problems

Rice milk

Pros of rice milk:

  • It is the least allergenic of milk alternatives
  • It can be fortified to be a good source of calcium, vitamin A, and vitamin D.
  • Rice milk is naturally sweeter than other milk alternatives        

Cons of rice milk:

  • It is high in carbohydrates, so it’s the least desirable choice for people with diabetes
  • It is not a good source of protein
  • Eating too much of a rice product may pose a health risk for infants and children due to inorganic arsenic levels

Coconut milk

Pros of coconut milk:

  • It is highly nutritious and rich in fibre, vitamins C, E, B1, B3, B5 and B6 and minerals including iron, selenium, sodium, calcium, magnesium and phosphorous
  • It rarely causes allergies
  • Coconut milk is lactose-free so can be used as a milk substitute by those with lactose intolerance

  Cons of coconut milk:

  • High amounts of saturated fat in coconut may contribute to weight gain
  • It is not a good source of protein
  • Excessive intake of coconut milk can lead to cardiovascular diseases


While milk comes in various types and strengths, there is no one size fits all when it comes to ideal milk. The table below gives the nutritive value of some commonly used milk types.

Toned (also known as skimmed or low fat) milk is suitable for children and adults; it has many important health benefits including its ability to build strong bones and teeth, boost the immune system, protect the heart, prevent diabetes, eliminate inflammation, aid in weight loss and help stimulate growth. Pasteurised milk is superior to raw milk as it is microbe-free and ready to drink.

The recommended daily allowance of calcium varies by age and gender. From ages 19 to 70, men should get 1,000 milligrams of calcium, and 1,200 milligrams if they are 71 and older. Women between the ages of 19 and 50 should get 1,000 milligrams of calcium a day, and 1,200 if they are 51 and older.

Make milk a part of your every day diet and enjoy good health!

Is it okay to feel the way I feel?

If you are feeling anxiety, fear, guilt, confusion, anger, depression or just drained of energy after you have been diagnosed with a heart problem – you’re not alone. It is extremely common for individuals to experience emotional disturbances when their routine life gets shaken up by a cardiac problem.

Questions often arise in our minds when a sudden health calamity strikes. While some of them have straightforward answers, some questions can only be answered with passage of time and especially after tiding over the acute phase.

Worries are to be expected. It is only natural that you are worried about your health and the thought about what is in store for you.

Your needs will vary depending on your health condition, your age, your social support and other factors, but everyone has needs that must be addressed by the healthcare team.

Let us see what emotions two of our patients felt.

As seen in the picture above, Mr. Arun (name changed) was rushed to the emergency department directly from his office within 30 minutes of the start of acute chest pain. He was 44 years old, married and had 2 young children. He was working in a multinational IT company as a project lead. He had never had a health check before this episode and was paranoid about what the doctors are going to say. He was diagnosed with a heart attack due to a severe block in an important coronary artery and advised angioplasty immediately.

Why me? Is this the end of my career? Will I live to see my daughters grow up? Can my block be reversed? …. These are just a few questions running through his mind prior to angioplasty.

Another individual, Mrs. Neela (name changed) was in her 70s and taking treatment for diabetes and hypertension when one day she suddenly collapsed to the ground while climbing stairs at home. Her maid who was at home at that time did not know what to do, panicked and called the family doctor’s phone. He promptly alerted the ambulance and instructed the patient to be admitted to the emergency department. The first aid crew in the ambulance provided CPR and successfully revived the lady. She was diagnosed with severe heart failure (Ejection Fraction 22%) and was initiated on multiple medications. Mrs. Neela was better within a week but she had several questions, concerns and unaddressed needs.

How do I prevent a future collapse? What should my caretakers do if I collapse? How can I improve the function of my heart? How often should I see the doctor? Can I carry out my daily duties?

This is where a cardiac rehab team comes into the picture. By providing answers to health-related questions, alleviating worries and offering evidence-based guidance and advice, our team of healthcare professionals work side by side with the doctors and nurses in the hospital, to establish a rapport with the patients and their family members. They provide ongoing emotional support during the hospital stay, the recovery period and most importantly during the intensive rehabilitation period of 3-6 months after the disease sets in.


Postural changes to relieve breathlessness

Did you know breathlessness or difficulty in breathing may be an important indicator of various health issues? Any unusual breathlessness while climbing stairs or walking can be caused by anaemia, heart ailments and lung problems. So don’t neglect the signal your body is giving, consult your doctor at the earliest!

Once the doctor has checked you, you will be explained about the underlying medical condition and prescribed some medications. It is very important that you follow the doctor’s instructions. You should report back to the doctor if the breathlessness does not improve or if it worsens.

In this blog post, we are going to see some easy postural techniques to relieve breathlessness (dyspnoea).Breathlessness is an unpleasant sensation and its severity increases as the disease progresses, leading to significant disability and a negative effect on quality of life.


These positions will improve the use of breathing muscles with the assistance of gravity. It helps in the normal pattern of breathing and decreases your anxiety during breathlessness.


  • Lie on your side with 3-4 pillows
  • Keep your head & shoulder supported
  • Relax yourself
  • Breathe in & breathe out

STANDING (fig 1)

  • Stand near the chair/table
  • Bend forward
  • Rest your hands on the chair/table
  • Relax yourself
  • Breathe in & breathe out


  • Sit in chair with foot on the floor
  • Bend forward
  • Rest your elbows on your knees
  • Relax yourself
  • Breathe in & breathe out


  • Sit in chair with foot on the floor
  • Bend forward
  • Rest your head & forearm on the pillow
  • Relax yourself
  • Breathe in & breathe out


Easy steps to be followed in all the above positions to reduce and manage breathlessness

  1. Sit in relaxed position
  2. Breathe in slowly through your nose
  3. Breathe out even more slowly through your mouth
  4. Repeat the above steps 5-10 times

A to Z of a heart-healthy lifestyle


We introduce the English alphabets to our kids at a very young age hoping that their language skills and intellect will start developing as they master their A to Z. Likewise, let us try to understand the building blocks of a healthy heart through this set of lifestyle guidelines.

A Avoid tobacco products and alcoholic beverages
B Balance your diet by including fruits, veggies and whole grains
C Cheer up and be grateful for what you have
D Discover your hidden talents and use them
E Engage in some form of exercise everyday
F Fruits – everyday; fast foods & fried foods – very rarely
G Goal setting is a useful tool to improve health
H Help others as much as you can
I Invest time in building friendships and relationships
J Juices should ideally be fresh, homemade and sugar free
K Kill the sitting habit; get up and walk as much as possible
L Love unconditionally – Learn a new skill – Leave the past behind
M Make meditation a part of your life
N Nature is all around for us to enjoy, protect it and pass it on
O Open up your feelings to your loved ones
P Play games that bring back memories of childhood
Q Quitting smoking is the best gift you can give yourself
R Refresh your body and soul with active hobbies
S Smile as much as you can; sleep at least 6-7 hours per day
T Television/gadget time should be kept to a minimum
U Use your time wisely – don’t use lack of time as an excuse
V Visit your physician regularly to keep your health in check
W Water – drink a lot; Walking – brisk walk is the most effective
X Xpect less out of others and give more from yourself
Y Young at heart is a feeling, it is a state of mind that can beat aging
Z Zealously follow your dreams but don’t lose track of your health

If we can lead this lifestyle and set an example for our youngsters to follow, there is going to be a sea of change in how they care for themselves as they grow up.

When the going gets tough, the tough get going – Old Saying

Tough are those who are resilient to unhealthy habits – New Saying


How to optimise nutrition as we age

Health refers to physical, mental and social well being, as defined by the World Health Organization. Nutrition plays an important role in preserving health in all age groups, and more so in the elderly. If you are in your 60s, 70s and beyond or caring for someone who is 60 plus, you should read this post to understand the age-related barriers to healthful nutrition and the ways to overcome them.

Older people are at higher risk of insufficient diet and lack of nutrition. Planning and preparing nutritious meals becomes more difficult with advancing age. Even though it is of high priority to consume more calcium, iron, fibre, protein and other nutrients, it can be hard to meet the dietary requirements due to physical, mental, economic, and social and lifestyle changes.

Medical factors:                                                                                                                 

With increasing age, we often come across health issues like breathing difficulties, joint pains, stroke, mood problems and poor memory. These conditions may affect one’s appetite, mobility or ability to swallow, all leading to altered food intake and suboptimal nutritional status. Medications can add to this due to the side effects of loss of appetite, nausea, diarrhoea, vomiting, dry mouth, imperfect absorption of food and alterations in taste and smell. A heart-healthy diet is recommended for people of all ages, but it is especially important after midlife when the risk of heart disease is highest.

The ability to taste and smell food is an important part of feeling hungry and eating well. Foods may seem to lose their flavour as you age. Your favourite dishes might taste different. Older adults can experience diminished ability to taste and smell because of certain medications and conditions. Reduced ability to taste may also result from a decreased number of taste buds or receptors involved in the sensation of taste. The sense of smell also diminishes, particularly after age 70, perhaps due to loss of nerve endings in the nose. Loss of smell makes food less tasty and enjoyable.

Difficulty swallowing can result from a stroke or other conditions and lead to dietary deficiency if an appropriate alternative is not provided. The health of your teeth is an essential factor in your nutrition. Dental problems, poorly fitting artificial teeth or missing teeth make it difficult to chew. Improper chewing can lead to poor nutrition, reduced quality of life and diminished health in general.

Nutritional factors:                                                                                                         

Many people don’t feel like eating and eat less as they age; making it difficult to get all the nutrients they need for good health. Changes in your body’s regulatory mechanism, hormonal balance and nervous stimuli can affect how much you eat. Your desire for food can also be affected by medications and other factors. Older adults may not absorb nutrients well because of age-related changes in metabolism (a collection of chemical reactions that takes place in the body’s cells). Vitamin B12 deficiency is particularly common because the digestive tract of an older adult doesn’t absorb this vitamin well, leading to depression and memory disorders.

Socio-economical factors:                                                                                     

Seniors living on fixed incomes may not be able to afford the amount of nutritious food needed to maintain good health. Money budgeted for groceries may take a back seat to the costs of utilities, housing, medication and health care. Eating alone can have a negative effect on your nutrition, especially if you are depressed or have a poor appetite. Older adults who live by themselves may also be vulnerable to social isolation, particularly if many of their life-long friends are no more.

Physical factors:                                                                                                                         

The ability to buy the ingredients and cook healthy meals are important factors in an elderly person’s nutrition. Homebound or disabled people are unable to go out grocery shopping or prepare meals thereby leading to poor health.

Psychological factors:                                                                                                      

Very often, we fail to identify the emotional and psychological problems that can derail nutrition as we age. Depression is a common cause of weight loss and lack of proper nutrition in senior citizens. Stress and fearfulness can also cause you to eat less than you need. Alzheimer’s disease is the main cause of memory loss as we age. The onset of Alzheimer’s disease is insidious, and disease progression includes memory loss and loss of physical function and independence. Memory loss and confusion can affect an elderly person’s desire to eat and their ability to feed themselves.

If there is a problem there is a solution

Ways to approach the challenges of sub-optimal nutrition status:

Recognition of poor nutritional status is a key to reversing any effect. Prevention, early identification and treatment of weight loss are crucial to good health in the elderly.

The first step should always be to maximise an individual’s nutritional intake from regular food and drinks, often termed “Food First”. The Food First approach includes increasing the frequency of eating, maximising the nutrient and energy density of food and drinks and fortifying food with the much-needed nutritional elements.

Eating methods that ensure good nutrition:

  • Encourage “little and often” – that is, three small meals with regular in-between snacks of energy-rich, high protein foods. Encourage people to eat every two to three hours
  • Serve meals and snacks that are appealing in size and appearance – avoid large meals, use small plates and maximise the “eye appeal” of the food
  • Drinks can reduce hunger – keep drinks for after meals rather than before and during a meal
  • Choose nourishing fluids – milk-based drinks, soups or fresh fruit juice can replace soda or coffee
  • Consider meal settings – make mealtimes enjoyable and avoid interruptions or rushing during meals
  • Find ways to stimulate hunger – a short walk before meals can be helpful
  • Add flavour to your meals with herbs and spices
  • Encourage adequate dental and oral care
  • Modify the consistency and texture of foods as needed instead of leaving them out; try soft foods that require little chewing eg. tender cuts of meat cooked in gravies are often more easily managed
  • Consuming a variety of foods from the four food groups that include grains, grams, fruits and vegetables will ensure that energy, macronutrient and micronutrient requirements are met
  • Food is the best way to get the nutrients you need; dietary supplements like vitamin and mineral pills may be prescribed if you have deficiencies due to improper absorption of certain nutrients but not otherwise

Healthy ageing recommendations:                                                                                    If you follow a few tips on healthy eating as you age, your risk of disease can be largely minimized:

  • maintain a healthy weight and body composition
  • increase vegetable and fruit consumption
  • reduce total, saturated and trans fat consumption
  • increase dietary fibre
  • reduce dietary sodium (salt) and increase dietary potassium
  • obtain your vitamins and minerals from foods rather than supplements
  • maintain normal blood cholesterol, blood glucose and blood pressure
  • limit alcohol intake; stay away from tobacco in any form
  • increase physical activity
  • A heart-healthy diet that limits saturated fat and salt, while incorporating whole grains, plenty of fruits and veggies and walnuts, almonds, avocados, olive or canola oil and potassium-rich foods, such as bananas and low-fat milk is best suitable for senior citizens. Calories from fats should be limited to between 20 and 35 percent of an older adult’s diet and most of the fats should be unsaturated (namely nuts, vegetable oils and oily fish are rich in unsaturated fats).

Don’t hesitate to ask for support:

  • Use convenience foods: ready to make cereals like bread, cornflakes, oats, adai using organic millets etc
  • Enlist family and carer support; consider a service that delivers prepared meals to your home. It minimises your efforts and is usually affordable
  • Prepare snacks and meals to eat later if you’re unable to prepare each meal
  • Add extra nutrients to meals and snacks to boost energy intake, for example, add soya paneer to gravies and powdered peanuts to vegetable dishes
  • Ensure shopping and food preparation assistance is available
  • Consider assessment by a physiotherapist or occupational therapist

Make eating a social event:                                                                                         

Meals are more enjoyable when you eat with others. Find a meal program for seniors by contacting your local senior centre, attend an adult day-care centre or invite friends, family and neighbours to share meals with you. There are many ways to make mealtimes pleasing.

Nutrition education programs to improve mental health:                           

Nutrition education programs for the caregivers of people with poor mental health are the best way to prevent weight loss and improve their nutrition status. The most recent collective evidence suggests that the optimal approach for Alzheimer’s disease would seem to combine early nutritional approaches (multi-vitamin supplements), along with lifestyle modifications such as social activity and mental and physical exercise, with an addition of medicines if necessary.

Our Upcoming Program for Seniors:                                                                             

As part of our heart-health awareness campaign, Cardiac Wellness Institute is launching a program for senior citizens (men and women 60 years of age and older) to enlighten and equip them with skills for ageing healthily. The Healthy Aging program will commence with a free introductory session from 10.30 am -12.30 pm on Wednesday, 22nd November 2017. Thereafter, interested seniors can enrol for weekly sessions. The components included in the program are Doctor Consultation, Exercise Sessions, Nutrition Advice, Group Education and Counseling.

Registration is mandatory and free of cost.                                                          Please call +9144 43192828 or +91 9940408828 or send an email to for registration.

Active ageing benefits the individual, improves health, increases independence and assures a good quality of life.