Fiber intake for better heart health

If you are wondering what the connection is between fiber intake and heart health, read on! In this blog post, I hope to convince you that including sufficient amounts of fiber in your diet is not only important for a healthy gut but also for a healthy heart.

When someone has difficulty in passing stools, the common advice given is “eat bananas”. The reason is that banana contains soluble fiber which helps to regulate bowel movements and thereby addresses the problem of constipation.

So what is dietary fiber? It is a non-digestible form of carbohydrates present in plant based foods like fruits, whole grains and vegetables. It can neither be digested nor broken down like other foods.

There are two kinds of dietary fiber namely soluble and insoluble fiber.

  • Soluble fibers are easily dissolved in water and change into a gummy gel like substance that is partially digested in the large intestine. Some examples of soluble fibers are legumes, lentils, brown rice, oats, barley, whole or cut fruits (with skin and pulp and not in juice form), potato, and dried beans. Apart from helping in blood pressure reduction, the low glycaemic index of high fiber foods helps to control blood sugar level.
  • Insoluble fiber absorbs water, which adds bulk to the digestive tract and helps to regulate bowel movements. Whole grain products, cabbage, green beans, green leafy vegetables, nuts and whole bran are some foods rich in insoluble fibre. Fiber can have various beneficial effects on our body when taken in good quantities every day.

Evidence from medical research

Greater dietary fiber intake is associated with a lower risk of many cardiovascular diseases including coronary heart disease. Dietary fiber intake specifically from grains is inversely associated with total mortality rates, particularly cardiovascular, infectious, and respiratory deaths in both men and women (a National Institute of Health Survey done in USA has shown that dietary fiber intake actually lowered risk of death from cardiovascular, infectious, and respiratory diseases by 24%–56% in men and 34%–59% in women).

In fact, constipation can be a serious threat to heart health as it increases the strain on the heart and can lead to sudden death in individuals with heart ailments. So consuming adequate fiber in your diet not only prevents heart problems but also helps avoid some dreaded complications in heart patients.

What other benefits does fiber provide?

* Fiber can soak up water in the stomach slowing the absorption and increasing the feeling of fullness

* It can cause weight loss by reducing your intake of high calorie foods

* Fiber can promote the growth of good bacteria in your gut, thereby establishing a healthy gut microbiome

* Consuming adequate amounts of fibre prevents gastrointestinal disease, piles and haemorrhoids

 * Fiber is known to protect against colon cancer

How much fiber should I eat?

The Indian Dietetic Association recommends that adult men and women should consume about 25-35 grams of fiber per day, with 10-15 grams from soluble fiber. This can be accomplished by choosing 6 servings of grains (of which 3 are from whole grains), 3 servings of vegetables, and 2 servings of fruits.

Choose high fiber varieties of grain-based foods like whole-wheat chappathis, multigrain bread, millet dishes and unpolished rice like brown rice instead of refined grains like maida products, white rice and white bread. Include a variety of wholegrain, such as brown rice, oats, millets and barley and 2-3 servings of fruits and 3-4 servings of vegetables every day.

Can too much fiber be harmful?

High-fiber foods are good for your health. But too much fiber can produce excessive intestinal gas and abdominal bloating. My suggestion is that you increase fiber in your diet gradually over a period of time. This allows the natural bacteria in your digestive system to adjust to the change. Drinking adequate water will help you to avoid the gas, bloating, cramping and constipation that can occur when you increase your consumption of fruits, vegetables, legumes and whole grains suddenly. If you are advised to be on fluid restriction due to heart problems, you should consult your dietician to find out more about how much fiber is good for you.

I hope I have convinced you to incorporate fiber-rich foods into your daily life! It is really that simple. When you think of all the health benefits plus the added bonus that you may lose excess body weight and become fit, why shouldn’t you start focusing on fiber for a healthy you?

What is Home-Based Cardiac Rehabilitation?

Before explaining about home-based cardiac rehabilitation, let me recall a few important things about cardiac rehabilitation. Cardiac rehabilitation is a medically supervised program for individuals with chest pain, heart attack, heart failure etc. and for those who have undergone any cardiac procedures or surgeries. It is a proven risk-reduction therapy and includes education, exercise training, nutritional guidance and psycho-social counselling. Fewer complications, freedom from repeated hospitalization, ability to do more things and improved health related quality of life are some of the key benefits of cardiac rehabilitation.

Conventional cardiac rehabilitation consists of 4 phases namely:

Phase 1 – Counselling and expert advice during the period of hospitalisation with heart ailments

Phase 2 – Recovery phase lasting a few days to a few weeks after hospitalisation, surgery or any other procedure

Phase 3 – Supervised exercise cum education phase lasting 3-6 months

Phase 4 – Maintenance phase for regular follow-up and guidance after the intensive supervised rehab program

Currently, cardiac rehab programs are offered by a team of healthcare professionals based in multi-speciality hospitals or in dedicated rehab centres like ours. Please go through our earlier blog post about cardiac rehabilitation for more on this topic (http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/10-things-you-must-know-about-cardiac-rehab-2/) .

How did Home-Based Cardiac Rehabilitation come about?

“Home Based” cardiac rehabilitation has been in vogue for a while now in developed countries. As the distance from the rehab facility and the logistics of commute back and forth are the main bottlenecks preventing maximum utilization of cardiac rehab services, home-based cardiac rehab became popular. It typically replaces phase 3 of the conventional cardiac rehabilitation program. Instead of attending 2-3 rehab sessions per week at the cardiac rehab centre, the individuals exercise in and around their home as advised by the rehab team. They also get dietary and psychosocial counselling through phone and/or video calls.

The rehab team at Cardiac Wellness Institute has been providing conventional as well as home-based cardiac rehabilitation for the past 5 years. Please read on for some Patient Stories:

Gentleman based in Singapore: Ram (name changed), a 45 year old gentleman from Tamil Nadu working in Singapore, suffered a heart attack and underwent a stent procedure. He and his wife were in a state of denial and disbelief that he had suffered a heart attack at such a young age. They had a daughter in kindergarten and were worried for her future. Moreover, there was a strong family history of young sudden deaths due to cardiac cause on Ram’s side and the recent demise of his brother had come as a major shock to them.

Ram enrolled in a home-based cardiac rehab program with us as he felt that the cardiac rehab program in Singapore was inadequate in addressing his dietary concerns (pertaining to South Indian diet) and his psychosocial problems (working in a foreign country, lack of support of extended family etc.). Once our rehab team had reviewed all his reports and was convinced that he was clinically stable and ready for home-based rehab, we went all out to provide him the moral support, exercise training, evidence based guidance on what to eat and what to avoid, and stress management advice, all through phone calls, video demonstrations and sharing of study material through internet. Ram successfully completed his 3-month rehab program and has been on a maintenance program for the past 6 months.

We have faced some challenges like for instance when Ram and his wife would get anxious and call us to check about a new-onset pain in the left shoulder during stressful situations or a bout of gastrointestinal symptoms with some food changes. We had to explain to them that long-distance rehab programs are not conducive for emergency health advice as we cannot see and examine the individual.

Gentleman from closer to home: Rathnam (name changed) is a 68 year old gentleman from Namakkal, Tamil Nadu, India, running his own business. He suffered a heart attack recently and was treated with a stent procedure. His risk factors were diabetes, hypertension and obesity in addition to sedentary lifestyle, lack of balanced diet and work-related stress. He and his wife were able to come in person for the initial evaluation and initiation of cardiac rehab program (3 day stay in Chennai near our rehab centre) following which they have had weekly communication with the rehab team on a home-based program. In the past 3 months, Rathnam has had days when work-related travel would come in the way of exercise but he keeps a log of his physical activities and his dietary intake and reports to us systematically. He is scheduled for a repeat in-person evaluation to quantify his progress and to discuss the next steps.

Advantages of Home-Based Rehab

  • Simple, feasible and convenient; avoids the hassle of commute and can be done in home surroundings
  • Sessions are administered through phone or video chat
  • Working individuals have the flexibility of doing the exercise at their convenient time
  • Individuals living in other cities or towns in India or residing abroad can also enroll in a home-based program
  • Participants do not get over dependent on the rehab team or the rehab facility.

Disadvantages of Home-Based Rehab

  • Cannot be administered for individuals with high risk of complications
  • Chance of miscommunication or misinterpretation is higher
  • Lack of a fixed exercise schedule may hamper their adherence to our   guidelines
  • Due to long distance communication, the rehab team is unable to provide any emergency medical advice
  • Participants might not take the home-based program seriously and may not derive maximum benefit

Hence, home based cardiac rehabilitation is an alternative to conventional cardiac rehabilitation and can be offered to most individuals who aim for a complication-free recovery and enhanced health-related quality of life.

We are what we eat

If there is one thing that all of us would agree upon, it is that we are a sum total of what we eat, drink and chew! That is probably how this saying ‘we are what we eat’ came to be and is gaining popularity. In a day and age where food has transcended geographic, sociocultural and religious boundaries, it is up to us to choose a healthy diet and consume wisely on a daily basis.

Right from our hunter-gatherer days, the human race has had to fight for food, but in different ways. We fought against wild animals and natural disasters to procure food in those days and are fighting against commercialisation of food and the associated health hazards in the present times. As advocates of healthy eating practices across peoples of diverse origins and backgrounds, we believe that if our relationship with food is healthy we can be healthy humans and if it is unhealthy we will lose our health and wellness quickly. Not just heart health, but the health of our blood vessels, skin, bones, muscles, nerves, hormones, sensory organs like eyes and ears, liver, lungs, kidneys and brain, and most importantly the health of our digestive system which hosts millions of microorganisms depends to a great extent on what we eat.

A healthy relationship with food can go a long way in preserving health and preventing disease. Here are 5 things to ponder about and 5 habits to inculcate to ensure that we have a lasting healthy relationship with food.

  • How we feel about our food

A love and longing for water and food have kept us alive for millennia. The challenge today is to restore that unadulterated love and longing. Not just for water but for clean drinking water. And not just for food but for naturally available and minimally processed food. Once we re-establish that strong bonding with our food, we would better appreciate healthy food and stay away from the myriad unhealthy options available out there.

  • What we know about our food

We take great pains to research and find out as much details as possible about a new gadget or device before buying it, but we tend to take our food for granted. We assume that everything that is packaged and sold to us in the grocery store or supermarket is hygienic and healthy. We trust that the food that is prepared in hotels and restaurants and served to us is safe to eat and of high standards. Unfortunately, we are failing in our responsibility to ensure food hygiene and safety standards for our family members and ourselves by not reading food labels, not enquiring about the ingredients while eating out and by heeding to marketing strategies like media advertisements and price-cuts. Being aware of what we consume is fundamental to a balanced healthy diet.

  • How involved are we in the farm-to-table process of our food

This is an area of “growing interest” in today’s world. People are realizing that they can not only procure minimally processed ingredients and prepare their own meals but can also grow their own fruits and veggies for use in their household. This is the kind of involvement that is going to help us and our future generations eat healthy. If we cannot grow our own ingredients, we can at least choose what ends up in our kitchens as raw material. If we have to eat out often due to work commitments or social pressure, we can definitely choose healthy options while eating out and engage in preparing meals at home whenever time permits. 

  • How open are we to making dietary changes

Having an open mind is key to moving ahead and staying healthy. When it comes to food, we especially see that people are reluctant to change. While we are not recommending that you forego your dietary culture and tradition, we would like to emphasize that our nutritional requirements have changed as we have shifted to more desk-based jobs and sedentary lives. Our exposure to outdoors and to sunlight has drastically come down compared to before. Changing environmental factors have given rise to several allergic reactions to food, chemicals etc. We need to listen to our bodies and make changes to what we eat and drink so that we reduce the impact of external factors on our health. We also need to be open to take professional help, as there are experts in the field of nutrition and dietetics to help us maintain a balanced healthy diet no matter what our medical condition.

  • Who determines what we eat

If you are a young adult or a grown-up, you should be the one who determines your daily diet. Toddlers and school-going children rely on their parents, caregivers and sometimes their educational institutions for food so we have an added responsibility to ensure that our young ones are also eating healthy. It is not acceptable to blame the canteen at office, the food delivery app or the greasy food at the nearby restaurant for our unhealthy diet. It is we who should take full responsibility for our food choices and make modifications to what we eat, how much we eat and when we eat in order to meet our health and wellness goals.

To conclude, we should relish every bite or sip we take, keeping in mind that naturally available, minimally processed and home-prepared foods and beverages are always the best for our health.

Summer, Fitness & Heart Health

As the summer is here, very few will dare to get under the scorching sun and exercise. People literally sweat doing nothing and exercising outdoors will make you sweat more. Dehydration, heat stroke and even death can occur if exposed to too much heat.

In this post, we would like to share answers to some common questions we get asked during our routine work as a cardiac rehab team:

Is it advisable to exercise during summer? – Yes, you can exercise during summer, but it is advisable to do the exercises either early in the morning or just before or during sunrise (Source of Vitamin D) (or) post sunset in the evening.

What are the common precautions to be taken while exercising in hot weather? –Wear appropriate clothing and footwear; take sips of water or electrolyte mixed beverage for hydration; ensure the temperature is regulated (if indoors) or not more than 36 deg Cel (if outdoors); do adequate warm up and cool down exercises.

Can we exercise indoors during the summer? – Yes, you can exercise indoors. There are many exercises that can be done inside your house without any fancy equipment. Use of body weight and space will be helpful.

How to avoid dehydration or stay hydrated during summer? –Increase your intake of fluids. Instead of drinking plain water, add a pinch of salt and sugar to improve water retention. Use of electrolyte mixed beverages that are available in the market may be helpful for individuals who indulge in athletic activities and sports. Others can stick to water mixed with a pinch of salt and sugar, fruit juice (with pulp and without added sugar) or tender coconut water.

What types of exercises are advisable? –Combination of aerobic exercise and strength training can be done at home. Aerobic exercises should be done at least for 30 minutes on 5 days a week and strength training for 2 days a week. Free exercises using one’s own body weight or simple equipment like dumbbells weight cuffs and resistance bands are the main options for building muscle strength. The major muscle groups for strength training are shoulders, biceps, triceps, forearm, quadriceps, hamstrings and calf muscles.

I have been diagnosed with a heart ailment and am taking medicines. Is it safe to exercise in very hot conditions? –As you are under treatment for a heart problem, it is best to take the advice of your Cardiologist or your Cardiac Rehab Team. In general, people with heart conditions should avoid exercising in extremes of weather as it can add to the workload of the heart. However, if you take the above precautions, your exercise regime will be fruitful.

From the above questions and answers, it is evident that exercise can be done indoors and also it is simple, effective and also cost-effective (sometimes zero cost too).

Some of the indoor exercises are:

  • Push ups or modified push ups
  • Forward lunges – with or without dumbbells
  • Half squats
  • Normal planks
  • Steppers – with or without dumbbells
  • Abdomen sit ups
  • Quick sprints
  • Stair climbing – brisk walk or jog 2 to 3 floors in a single repetition

These can be done while traveling too. Adequate warm-up should be done prior to exercise and slow and relaxed stretching should be done as a cool down to avoid muscle cramps or soreness. Not to forget that overtraining can also affect the body.

Thus it is important to exercise with adequate precautions during the hot summers. If you exercise the right way with proper guidance and techniques, it is easier to achieve the desired goal. And remember exercise can be done anywhere and all it needs is dedication, determination and commitment.

Yes it is proven: Blocks can disappear

One or more blocks in the blood vessels supplying the heart muscle is known as coronary artery disease. Severe coronary artery disease is the culprit in the majority of heart attacks. It is a combination of cholesterol deposits and blood clots in the inner lining of the blood vessels that usually prevents blood flow and causes heart muscle damage. As soon as someone is diagnosed with a heart attack, the emergency medical team rushes to give intravenous medications to stop the blood clot from growing and takes immediate steps to restore the blood flow through a stent procedure or surgery. While this often saves heart muscle as well as lives, a long-term approach to disease management is equally important. Let us see why.

The most common question that our patients ask us is “will the blocks inside my coronaries go away or are they permanent?” The answer to that is “yes it’s proven that blocks inside coronaries can disappear with time but here is what you need to know…”

  • Coronary blocks get formed over a period of months to years, so it takes time to regress and disappear
  • The younger the person the more likely that the blocks will regress
  • Hardened blocks due to calcium deposits are less likely to regress
  • Most importantly, intensive lifestyle modification in combination with cardio-protective drugs has been proven to cause regression and disappearance of blocks

Smoking cessation, regular exercise, a heart-healthy diet, stress management, health education and counseling are all part of the disease reversal strategy in a cardiac rehabilitation program. While strong evidence is available to support this phenomenon of coronary artery disease regression from developed countries, we are the first to have published our experience on Indian patients recently (https://www.ncbi.nlm.nih.gov/pubmed/27133332).

How a coronary block develops. (1) normal blood flow (2) reduced blood flow due to fatty deposits (3) complete block due to rupture of fatty deposit combined with a blood clot

Take home message 1: Never too old

If you are a senior citizen reading this post, you are probably wondering if disease regression is possible in your age group. While younger men and women have a higher likelihood of disease reversal, it has been proven beyond doubt that intensive lifestyle modification has benefits in all age groups. It can halt the growth of the coronary blocks and aid in the development of newer blood vessels or ‘natural by-passes’ to compensate for the reduced blood flow.

Take home message 2: Never too young

The latest guidelines for the prevention of cardiovascular disease conclude that a healthy lifestyle should be adopted as early as from the age of 5 years. So if you have young children or are a young adult thinking of starting a family, it is important to keep in mind that healthy lifestyle behaviors have to be incorporated in your everyday living rather than on an occasional basis.

Move ahead with Heart Failure

Heart failure, a growing medical threat across the globe, not only affects the heart but also the functioning of all the body parts. Individuals with heart failure often face various challenges in their day-to-day life like tiredness and exhaustion, shortness of breath, physical weakness, water logging in the body, frequent infections and mental depression. While it may be very frustrating for the affected person and the caregivers to try to overcome the disease, some simple lifestyle measures actually go a long way in improving the quality of life.

In this post, we would like to share with you the heart-warming story of Mr.S, an 84-year old gentleman, who is currently undergoing cardiac rehabilitation with us.

Mr. S is a retired LIC employee . He has had a medical history of diabetes, hypertension, heart attack, chronic kidney disease and heart failure (ejection fraction 40%). He was taking several medicines to keep his illnesses under control. He lived with his family which included his wife, son, daughter-in-law and grandchildren.

Right after our first interaction with Mr. S, we understood that he had multiple health issues and needed individual attention from the rehab team. His main complaints were breathlessness during physical activity, generalized weakness and inability to lead a normal life. He used a walking stick for support and was unable to climb even a few steps. His ambition was to be able to walk at least a kilometer without any hindrance and difficulties.

After ascertaining that Mr. S’s condition was stable, we started him on a personalized cardiac rehab program comprising of supervised exercise, health education, counseling and dietary advice. He visited our rehab centre two times a week and followed our advice for home exercising on the other days. The exercise sessions were very short to begin with. It consisted of a prolonged warm-up period followed by simple exercises like on-the-spot marching with support, and stepping up and down a step a few times, and some cool-down stretches. He needed frequent rests which we allowed.

Breathing exercises were taught to ensure proper breathing technique to help with his breathing difficulty. Education about his current health problems, red-flag signs to watch out for, exercise and its effects, healthy eating and ways to meet his nutritional requirements, role of medications and their importance and adherence to exercise on a long term basis was an integral part of his program.

The rehab team helped Mr. S set weekly health goals that were small but achievable. In spite of a few inter-current illnesses, Mr. S has made progress and is able to do more. He is now cycling continuously for 15 minutes and working with low-weight dumbbells to improve his strength, after a month of continued efforts.

Sometimes, it does take a longer time to see improvement but close monitoring, baby steps and constant encouragement are the keys to success. Mr. S feels that he still has a long way to go before being able to walk a kilometer but we know for sure that he is much nearer to achieving his goal than he was a month ago.

If you or your loved ones are suffering from heart failure, talk to your Cardiologist about cardiac rehabilitation as it is an approved and mandatory aspect of management in the current era.

Exercise after Heart transplantation

We all know that exercise has multiple positive effects on our body and helps to improve our physical, mental and social well-being. There is ample evidence to show that exercise helps to decrease all risk factors for heart and blood vessel diseases, thereby preventing major diseases like heart attack and stroke in healthy individuals and also controlling and reversing the disease in previously diagnosed persons.

In recent years, organ transplantation techniques and outcomes have advanced commendably and one of the major solid organs transplanted today is the heart. In an earlier post, we had discussed about organ donation in general and heart transplantation in particular: http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/the-most-precious-gift-ever/

Let us look at some interesting facts about heart transplantation and the need for cardiac rehabilitation post transplantation.

As heart transplantation is a major surgery it does take a few weeks of intensive medical care for a full recovery. The immediate post transplant period is challenging as the anti-rejection medications lower the defense mechanism of the body which in turn increases the chances of serious infections. So, adequate rest, regular intake of medications and proper infection control steps are of high priority during this time.

Comprehensive cardiac rehabilitation which includes supervised exercise, appropriate nutrition, psycho-social counselling and alternative therapies like yoga and meditation plays a major role in the long term survival of the transplant recipient. Overall body weakness, reduced muscle strength due to prolonged illness prior to surgery, low level of exercise capacity, decreased chest wall movements due to surgical site pain, and restrictions in daily activities to prevent infections are some of the practical problems faced by the rehab team when dealing with a post transplant individual.

While patients and their family members may be worried about exercise making them more tired, aggravating their pain and even putting them at risk for complications, several research studies have shown that cardiac rehabilitation and exercise in particular not only helps individuals recover faster but also greatly improves their quality of life and long term survival.

Here are some exercise guidelines for heart transplant recipients:

  • Enroll in a cardiac rehab program at the earliest; start exercising 3-5 days/week, at mild to moderate intensity, for 30-40 minutes each day.
  • Aerobic exercises such as brisk walking, stationary cycling, treadmill in comfortable speed and cross trainer can be done. Those who cannot visit the rehab centre on a weekly basis due to distance and other limitations can follow home-based rehab programs as prescribed by their rehab team.
  • Once the surgical wound has healed well, strength training can be initiated with moderate intensity twice per week.
  • Regular follow up with the transplant team and the rehab team is important; any pain, discomfort, giddiness or palpitation during exercise should be reported immediately.
  • All medications should be taken as prescribed and blood levels of specific drugs should be monitored periodically.
  • All dietary advice should be followed closely.
  • Remember to note down your BP and heart rate prior to, during and post exercise for those following a home-rehab program.
  • Try to work out in a healthy environment to avoid infections. Wear face-masks while travelling and avoid crowded places.
  • Adequate warm-up and cool-down should be done to avoid exercise related complications.

In conclusion, exercise is an important aspect of the post transplant cardiac rehab program. If performed properly and with adequate education and supervision, it is the best tool to protect, preserve and promote the functioning of the new heart!

Dietary Diversity for Better Health!

As we all know, good nutrition is an important aspect of a healthy lifestyle and disease prevention. Eating a variety of foods, or “dietary diversity”, is a widely accepted concept to ensure a healthy and nutritious diet. It is a key component of health, fitness and overall wellness and helps to reduce the risk of major diseases like heart diseases, diabetes mellitus, metabolic syndrome, hypertension, stroke and cancer. In this blog post, I would like to elaborate the importance of dietary diversity and its scoring methods, with an aim to enable you to measure your own nutrition situation and also to assess and improve the nutritional status of all your family members.

Several studies have shown that dietary diversity may be beneficial to a healthy weight, as it is appropriate to promote a healthy eating pattern, emphasizing on adequate intake of plant foods, protein sources, low-fat dairy products, vegetable oils, and nuts and limits consumption of sweets, sugar-sweetened beverages, unhealthy fats and red meats.

Dietary Diversity Score (DDS) – Dietary diversity is a qualitative measure of food consumption that reflects household access to a variety of foods, and is also a proxy for nutrient adequacy of the diet of individuals. The diverse diet (DD) which has all the food groups (vegetables, fruits, grains, meat, and dairy products) is necessary for achieving nutrient adequacy and optimal growth and development. Too much of unhealthy dietary factors and too little of required nutrients are both associated with increased risk of chronic diseases and malnutrition. Thus, dietary guidelines are recommended in improving the diversity of the diet. Nowadays, we are at a greater risk of macro and micro-nutritional deficiencies due to physiological changes, acute and chronic diseases, ageing factor and at times differences in financial and social status. Being aware of the dietary diversity component will improve the nutritional status of children and adults across age groups. Several studies have shown that the overall nutritional quality of the diet improves with a diverse diet. Therefore, diversity in the diet is important to meet the daily requirements for energy and other essential vitamins and minerals not only for those who are at risk of nutritional deficiencies but also for the general population keen on preventing health problems.

Food Group Examples
Cereals Corn/maize, rice, wheat, sorghum, millet,
oat
White roots and Tubers White potato, yam, cassava, sweet potato
Vitamin A rich vegetables &
Fruits
Pumpkin, carrot, sweet potato, bell pepper,
mango, apricot, papaya, grapes
Dark green leafy
vegetables
Amaranth, kale, spinach
Vegetables & Fruits Tomato, onion, cabbage, broccoli,
citrus fruits, pear, apple
Poultry & Fish Chicken, fish, lean meat, egg
Legumes, Nuts & Seeds Lentils, beans, peas, nuts and flax seeds,
pumpkin seeds
Milk and Milk products Milk, yogurt, cheese
OilsSunflower oil, rice bran oil, gingelly oil,
groundnut oil 
Spices, Beverages Spices(black pepper, salt), coffee, tea

Benefits of Eating a Diverse Diet:

Ensures optimal macronutrient intake: Proteins, carbohydrates and fats are the macronutrients that your body needs to maintain and regulate the body functions. Most people with average activity should get approximately 50 per cent of their total daily calories from carbohydrate to 20 per cent from protein and 30 per cent from a fat source.

Sources: whole grains, beans, legumes, eggs, dairy products, nuts, healthy plant-based oil.

Helps meet your micronutrient requirements: Micronutrients are needed in small quantities, but they are critical for the perfect execution of the myriad reactions going on inside our bodies. Eating a varied diet increases your chance of acquiring all your essential micronutrients (vitamins and minerals) and reduces the risk of acute infections and chronic ailments.

Sources: coloured fruits and vegetables, green leafy vegetables, nuts and seeds

Facilitates hydration: Your body contains about 60-75 percent of water. Water is required for several key functions like regulation of temperature, transport and absorption of nutrients and elimination of waste products from the body. Feeling thirsty, dry mouth, tiredness, headache and dizziness indicate that you need more fluids. If your fluid intake is not adequate it may lead to dehydration. Your intake of fluids should be liberal to prevent dehydration (eg: six to eight glasses of fluids every day).Water has no calories and is in fact known to keep your heart, kidneys, joints and skin healthy.

Induces peaceful sleep: Some unhealthy foods like artificial sugar, sweetened beverages, packed and processed foods may lead to several problems like indigestion, bloating, abnormal cholesterol level and high BP. Include a healthy balanced diet rich in variety and promote good sleep and better health.

Leads to a better and happier you: As you start eating a balanced and diverse diet, you begin to have more energy, feel less stressed and start accomplishing more in lesser time compared with when you consume an inappropriate diet. Diet is the foundation of one’s well-being.

In conclusion, eating a well-balanced diverse diet everyday is more fun, more interesting and of course the best way of meeting your daily requirement of essential nutrients. If you have been advised by your doctor or dietician to avoid certain food groups or types of vegetables due to a medical condition, you should request for a periodic re-evaluation and get an updated dietary advice every 3 months.

The most precious gift ever

We all love to receive gifts, be it simple or expensive, or practical or exotic. We value the gifts and hold them very dear to our hearts for a long time. They bring back fond memories whenever we see them. Many of us give our time, money or material possessions for a charitable cause. We might not know the name or the identity of the people benefitting from the good deed but we nevertheless donate when the cause appeals to us. Have you ever wondered what the most precious gift or donation is? 

I believe it is donating an organ to a person in need! It is nothing but literally gifting the opportunity to live a disease-free healthy life to someone who has been deprived of that. I recently registered myself as an organ donor at the Tamil Nadu Organ Sharing Registry portal https://tnos.org and am very happy to have done so. I will not be alive to see the person(s) whose lives and whose health improves after receiving my organs, but I will rest in peace knowing that a part of me will continue to live on meaningfully. 

While blood and eye donation are things many of us have heard of, solid organs like heart, lungs, kidneys, liver and pancreas are successfully being transplanted from a deceased individual to a diseased individual with good outcomes these days. Medical advances are so commendable that within a couple of hours of (brain) death of an individual, multiple organs are harvested and transplanted into different needy individuals if the individual was and/or the family members are willing to donate. There is a government registry that connects the transplant team in hospitals with the family of the deceased individual and the families of sick people in need of organs. As there is always a greater demand than there is availability of organs, priority is given to patients based on certain criteria like date of registration, severity of illness, age and other associated illnesses. 

A heart transplant is advised to individuals with severe heart failure resulting from various underlying heart problems and not responding to medical, surgical or device treatment. Chennai has become one of the leading heart transplant hubs in India today. Individuals from various parts of the country are being referred to hospitals in Chennai for the procedure, as the experience and expertise of the transplant doctors here are superior. 

The cardiopulmonary rehabilitation team at Cardiac Wellness Institute provides pre and post transplantation rehab for heart and lung transplant patients. It is not only important to take care of the new organs and the new lives by adopting a healthy lifestyle but also equally important to prevent diabetes, hypertension, dyslipidemia and coronary heart disease which are much more common in people who have been transplanted with a new heart and other solid organs.   

While the transplantation team continues to be the core team involved in the care of transplant patients, especially their medication schedule and monitoring for organ rejection, infections etc., the rehab team supports the lifestyle needs of the patient such as nutritional requirements, exercise needs, mental wellbeing and psychosocial aspects. A strong relationship is established between the patient, family and the professionals in the rehab team during the weeks to months of the rehab program and this helps in addressing any anxiety or worries the the patients and their family members may have. In fact, the disease burden as well as the surgical procedure and the post-surgical recovery have such huge impacts on the psyche of the affected individual and the immediate family members that the comprehensive support of a wellness physician, a psychosocial counselor, a physical therapist, a yoga instructor and a nutritionist become very valuable.

The new lease of life that individuals get is something they are thankful for the rest of their days. So if you’re convinced that the most precious gift is donating your organ(s), why not register yourself as an organ donor?

Exercise & Fittness for Women

Women’s day is around the corner and what can be more helpful than reliable and specific information on women’s fitness. Physical exercise, as you may know, is a planned repetition of bodily movements, done on a regular basis. Now let us look at some exercise principles for women.

The FITT principle is often used to describe an exercise session:

F – Frequency of exercise

I – Intensity of exercise

T – Time or duration of exercise

T – Type of exercise

Frequency refers to the number of times per day or week an exercise is done (eg. 2 times/day, 5 times/week). Intensity refers to the amount of effort that is required to perform the particular activity, which is expressed as a percentage of maximal oxygen consumption or maximal heart rate or in easy terms how breathless we become. Time/duration refers to the total time allotted for the exercise regime. Type of exercise refers to the different components of exercise namely – aerobic, resistance or strength, flexibility, balance etc.

Exercise guidelines for women do not differ much from the recommendations for the general population. Thus, the current global exercise recommendations are as follows:

As per the American Heart Association guidelines, every individual should exercise at least 5 days a week that is a minimum of 150 mins of moderate intensity aerobic exercise per week, or 75 mins of vigorous aerobic exercise per week. In addition to this, they should do strength training exercises twice a week.

 

For women new to exercising 

  • Ideal start to exercise regime would be basic aerobic exercise like brisk walking, cycling, hiking or use of equipment’s such as stationery cycle or cross trainer for 30-45  mins on 3-5 days/week.
  • Adequate warm up of 10-15 mins prior to exercise and cool down of 5-10 mins post exercise is a must.
  • Strength training can be started after 4 weeks of regular aerobic exercise.

For women already exercising (following an exercise regime for more than 3-6 months)

  • Increase the exercise intensity and also try other training such as high intensity interval training, recreational sport activities and regular participation in sports events like marathon, hiking, cycling tour etc.
  • Adequate combination of strength and aerobic training can enhance your overall fitness.

 

 

 

    

Here are some exercise recommendations for some special populations of women:

Diabetes

  • Individuals on anti-diabetic treatment can do aerobic exercise of moderate intensity for 30-60 mins for 5-7 days/week and always keep some healthy snack like a fruit or water with electrolytes for use in case of low sugar levels (hypoglycemia).
  • Resistance training helps you to shed more calories and when combined with aerobic exercise is the best way to lose weight and normalize blood sugar.

Hypertension

  • For hypertensive individuals, aerobic exercise such as swimming, cycling and brisk walking is ideal. Resistance training can be added for better results at a later stage.
  • If your resting BP is above 200/100 mm-Hg do not exercise; consult your physician.
  • Avoid breath holding while exercising.
  • If you have nausea, giddiness or palpitations, stop the exercise session and consult your doctor; a low salt diet high fibre diet can help control BP.

Obesity & Overweight

  • Here the focus should be on exercise and proper diet. Calorie expenditure should be more than calorie intake (refer to calorie blog post).
  • The exercise session should be at-least 60 mins, 5-7 days a week with aerobic and strength training combined.
  • Increase the hours of physical activity per day to avoid weight regain.
  • Keep a positive health goal such as improved fitness or a better balanced diet rather than a negative goal like losing weight.

Dyslipidemia (Abnormal cholesterol level)

  • A combination of aerobic exercise, resistance training and flexibility training along with relaxation techniques like meditation will help improve your cholesterol.
  • A high fiber diet rich in fruits, veggies and whole grains is equally important.
  • Long term use of lipid lowering medications can cause muscle weakness and soreness. Kindly consult physician if so

Osteoporosis (Weak bones)

  • Here the main aim is work on weight bearing activities that enhance bone density and also help in strengthening your bones and muscles.
  • Exercising 5 days/week, 30-60 min per session on weight bearing aerobic activities such as walking, cycling, cross trainer and strength training helps to improve bone density and muscle mass
  • While working on strength training, avoid lifting heavy weights and handle the equipment’s with precautions

Post-menopausal women are at a higher risk of obesity, osteoporosis, heart attack, stroke and some cancers. It is important that they indulge in regular aerobic and strengthening exercises to keep these diseases at bay.

Breast cancer is a common malignancy affecting women of all ages these days. If you have a family history of breast cancer, periodic screening tests like mammogram can help to identify the disease early. Maintaining a healthy lifestyle with regular exercise, balanced diet and a relaxed mindset is the key to preventing many cancers including breast and uterine cancers.

Hope the exercise and lifestyle recommendations are helpful for you and your loved ones in keeping good health!

Food delivery apps – a boon or a bane?

Nowadays, with a fast-paced life, it has become difficult to find time to cook at home! In today’s digitally connected world, food delivery at home is one of the most convenient services you can take advantage of. Food delivery apps are a new rage as they connect restaurants, cafes, sweet shops or any producer of ready-to-eat foods to the app owners to deliver food at their doorstep in a short time. In short, these apps act as a collaboration platform between the food hubs and the customers. As a dietician, I would like to share with you the pros and cons of ordering outside food so that you can make wise decisions.

ADVANTAGES:

Convenience

At present, a food delivery app is one of the most convenient services for everyone. Due to technology, with just a few clicks away on your phone, you can have a delicious hot meal delivered right at your house or office in an hour. Ordering food is great for busy people who may not have time to prepare a fully home-cooked meal. You don’t need to worry about what you’re going to eat next or if you have time to cook it and ensures that you won’t go hungry and will enjoy what you eat.

Saves Time

You don’t want to spend time shopping at the grocery store and buying the ingredients for your favourite meal, and then preparing and cooking at home. Instead, you can just call up your favourite restaurant and have your delicious food at home.

Choices are Endless

With endless varieties on the menu, you have a wide spectrum of food to choose from. This is especially true if you live in a city because the options are infinite. It also gives you a chance to try foods from different cultures. When cooking at home, we tend to stick to the local cuisine or the dishes we are comfortable making. When ordering food, you just have to order a dish that you like and satisfy your taste buds!!!

Coupons

Some restaurants and also certain apps offer rewards for ordering frequently, so they provide coupons for further upcoming orders. You don’t have to pay full price and can use these coupons and offers in future orders. This will save you some money while ordering your favourite food.

DISADVANTAGES:

On the contrary, the habit of ordering outside food can be addictive and dangerous to your health. Food poisoning, indigestion, acidity and food-borne infections in the short term and obesity, cholesterol problems, diabetes, hypertension, heart problems and other chronic disorders in the long term are the health hazards of this habit. Cancer is also known to occur due to the use of artificial flavouring and unhygienic cooking.

Expensive:

It’s undeniable that eating at home is much less expensive than ordering food or eating out. When you eat at home the labour cost is comparatively less to make your meal, you save on sales taxes and tips but if you order the food, you have to pay for everything. Just think of how much money you could save by making your own meal!

Consuming More Calories

When you order pizza, cheese loaded burgers or pastas, briyani or Indian sweets on a regular basis; you are consuming a diet high in calories and unhealthy fat. Even an order of salad or sandwich may be packed with hundreds of calories. When you order food, you probably have an idea of ingredients that are used to make your meal, but you can never be 100% sure. For instance, Chefs often use butter when frying something in a pan. But you might be unaware that 1 tablespoon of butter contains around 100calories. That’s a lot indeed! If you are looking to eat a healthy diet, then ordering food is definitely not an option.

Unaware of Restaurant’s Cleanliness

Another disadvantage is that you have no idea about the restaurant’s hygiene, cleanliness, and food processing and preparation conditions. Consuming unhygienic ally prepared food is sure to land you in illness. It’s always better to go with homemade food rather than eating food from a substandard place.

Cooking for Yourself

If you depend on outside food, then you will never successfully learn how to cook. Cooking is a skill that will benefit you throughout your life, so it doesn’t hurt to start early! When you grow older and have a family, you’ll like to cook at home as it is cheaper and also safe to administer, since you know the dark side. During holidays and celebrations, you’ll love to cook food for your guests too, rather than ordering it which may not impress them. When you stop ordering food and start to cook those recipes, and teach yourself how to cook some of your favourite meals, it will result in healthier eating habits and an improvement in overall health. Dedicating some time to cooking for yourself, you will definitely see a great change in your health and also in your bank account!

THE FINAL VERDICT:

Is It Worth It?

We know that ordering food is extremely convenient and will save you a lot of time especially if you are a bachelor, working out of town or new to the place. However, the money you spend on these can really add up to much higher than just cooking them at home. There is no clarity on what you’re eating and you might probably be consuming more calories than recommended or required. Additionally, the health hazards of eating outside food are numerous.

When you cook for yourself, you’ll save money and learn an essential lifelong skill. Taking a couple of  hours at the beginning of the week to prepare your food or making easy recipes on a daily basis are some tips to eat healthy home cooked food, save money and live a happy life without disease.

So the final verdict is it might be alright to have these apps on your phone and use them occasionally when home cooking is out of the question but making a habit out of this is definitely a NO-NO!

 

Stressors stressors all around!

Stress is nothing but our own body’s response to an external trigger or ‘stressor’. We have looked at how stress can lead to heart problems with a real patient example in an earlier post

(http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/beware-stress-can-kill/).

In fact, we are aware that almost all the parts of the body including blood vessels, skin, nerves, muscles, joints and all internal organs can start to dysfunction as a result of too much stress. So, let us take an in-depth look at stress and what causes it in this post.

The word ‘stress’ has been used for centuries to explain the concept of elasticity in Physics. It was only in the middle of the 20th century that the term stress got associated with biological stress by the Hungarian endocrinologist Hans Selye. And the term ‘stressor’ was also born at around the same time to refer to any external stimulus or environmental condition that causes stress in an organism.

In today’s modern world, stressors are all around us. Mounting stress in the system is more the norm than the exception. Stress has become the most difficult piece to solve the puzzle of skyrocketing lifestyle disorders.

There are only 2 ways to deal with this health crisis called stress:

  1. To prevent our body’s response to stressors
  2. To counter our body’s stress response effectively

If and only if the mind does not perceive the stressor as a stressor is it possible to prevent the body’s stress response. With a basic instinct to preserve and propagate our species, and with our inherent stress response as the most reliable resource to meeting that end from our cave-dwelling days, stress has become a double-edged sword in the modern world.

We know that every time our ancestors faced a threat to their lives in the past, stress hormones like adrenaline, noradrenaline and cortisol have helped them mount a “fight, fright and flight response” and survive the acute crisis. However, today, humans have gained such supreme powers on this planet that there is no threat to life on a daily basis but a myriad of stressors all around us that are perceived as serious threats instead. The acronym ‘NUTS’ is often used to describe the stressors faced by humankind today.

N – Novelty (eg. Any new situation like a change in a job or a new baby)

U – Unpredictability (eg. Inability to predict boss’s response or the weather)

T – Threat to ego (eg. When someone makes us feel incompetent or unreliable)

S – Sense of low control (eg. Lacking the power to change a difficult situation like job dissatisfaction)

Coming back to the 2 ways to deal with stress, we can either train our minds to not perceive everyday situations as serious threats, or build a capability to effectively overcome the mounting stress response, or both. The proven path to acquiring one or both of these defence mechanisms is to take the help of professionals who have expertise in dealing with psychological problems. Just like physicians diagnosing your physical health problems and giving you treatment, psychologists will be able to assess the seriousness of the emotional problem and suggest appropriate coping strategies.

Let us take the example of a young woman diagnosed with diabetes. She is 36 years old, has a full-time job and a family with 2 kids aged 10 and 7 years. This is a new and a definitely unpleasant situation for her to be in when things were going smoothly. She is unsure of how she is going to cope with the disease, the medications and the doctor visits and is especially concerned about the complications that it can lead to. She also feels she has no control over her health condition and is grappling with thoughts like “how did I get diabetes?”, “should I have taken better care of myself?” etc.

In our experience providing holistic healthcare solutions for individuals with chronic cardiorespiratory and metabolic diseases, psychosocial counselling is as important as anti-diabetic medications in this young person. This approach has not only helped people deal with the stress of their disease better but has also aided in reversing and completely curing the disease in many instances.

 

 

 

Calories – Inside Out

We all know that there is a close link between body weight and heart health. In fact, obesity or excessive body weight in relation to height, is an independent risk factor for cardiovascular disease.

Regular exercise along with a healthy diet can help maintain physical, physiological and mental health. Many of us want to reduce weight; some of us wish to gain weight. An important thing to understand before making any weight management plan is the concept of calorie intake and calorie expenditure.

Calorie intake per day refers to the amount of calories that is being taken in the form of foods or supplements by an individual in a 24-hour period. Calorie expenditure refers to the amount of calories that is being burned out by an individual in the same time period. The overall working of our body relies on these two things, in short, on our body metabolism.

Now let us see what Positive calorie intake and Negative calorie intake are. Positive calorie intake refers to calorie intake being higher than calorie expenditure and negative refers to intake being lesser than expenditure.

Positive calorie intake = calorie intake > calorie expenditure = Weight Gain

Negative calorie intake = calorie intake < calorie expenditure = Weight Loss

In India, an average working individual consumes around 2100 – 2500 kcal in a normal day (weekday) and goes upto 3000 kcal during the weekends (outside food consumption). Our body at a resting state expends around 1200 – 1400 kcal for carrying out our basic functioning. Overall an individual has around 600 to 700 calories being left unused post consumption. This results in calorie overload, leading to weight gain.

Incorporation of physical activity and exercises can help in depleting the additional calories. Moreover, a minimal modification in the calorie intake with the help of a dietitian can help you shift from a positive calorie intake to a negative calorie intake resulting in weight loss.

Use of indoor equipments like treadmill, cycle ergometer, and cross trainer with adequate speed, inclination and resistance, burns around 300 – 400 kcal/hr. Outdoor activities such as jogging, swimming, brisk walking, hiking and cycling burns up-to 400 – 500 kcal/hr. Individuals involved in sports such as badminton, tennis, cricket, basketball, volleyball, football etc expend about 450 – 600 kcal/hr. Other activities like Zumba, Pilates, Yoga and Gymnasium can also help you loose your extra calories and attain an ideal body weight. If you are underweight and are planning to gain weight, it should be a healthy weight gain resulting from the intake of a healthy balanced diet and engaging in appropriate exercises rather than taking nutritional supplements, eating junk food and performing excessive exercises and succumbing to injuries.

Some important points to keep in mind with calories…

  1. 3,500 kcal = 0.45 kg of fat
  2. Adequate calorie expenditure = 200 – 400 kcal/day (or) 1000 – 1500 kcal/week
  3. Exercise 3-5 days/week for aerobic training, 2-3 days/week for resistance training and daily 15-20 minutes/day for abs and core training for more calorie expenditure
  4. Healthy weight loss = 1-2 kg/month
  5. Adequate calorie intake for weight loss =1600 – 1800 kcal/day
  6. Spend more time in outdoor activities and sports that you enjoy; it will help relieve your stress and expend those extra calories
  7. Incorporate a combination of workouts (rather than the same routine everyday) for better calorie expenditure
  8. High intensity interval training and resistance training burns calories even after the workout session.

Regular exercise and a good diet are sure to help you reach your health goals. Additionally, having an idea of your calorie intake and expenditure is important to maintain fitness and body weight. This is especially true for those of us who are diabetic, hypertensive, obese and diagnosed with heart problems. Better weight management is a sure-shot strategy to improved health metrics. Eat right, stay fit and always believe that you can!

Overcoming Barriers to Healthy Eating

Eating a healthy diet is very important for a healthy life. But lack of awareness about the basics of nutrition and lack of proper guidance are the two major roadblocks in achieving this. Even those health-seekers who are aware of what kind of food promotes good health and which are the culprits that worsen health, quite often struggle to overcome barriers to healthy eating.

For example, the usual reasons that are given for not following a proper diet are– lack of time to prepare healthy meals, peer pressure or temptation, busy with office work, the high cost of buying healthy food… Do you believe that healthy eating habits are not always as easy as they sound? What has stopped you from changing your eating habits in the past? What do you think might stop you in the future?

Well, we need to identify our barriers first and try to overcome them one by one. As a dietician, I would like to share some tips on how to overcome some common barriers to healthy eating.

Barrier: “I don’t have the time to prepare meals every day”.

Solution: If you don’t have enough time to prepare elaborate dishes, then try preparing easy and healthy foods such as sandwiches, vegetable and fruit salads, chapatti and chickpeas curry, soups that take less time etc; all of these come with enough amounts of nutrients when prepared correctly. Share your meal-making tips with friends, family and colleagues, so you can trade off days that you prepare food.

Barrier: “I can’t afford to eat healthy foods all the time”.

Solution: Eating healthy fresh foods isn’t always more expensive. Buying fresh foods like fruits and vegetables in season, green leafy veggies, whole–grains and eggs can all save your money on food, compared to those that are unhealthy such as pre-packaged junk foods and fast foods that are available for the same price. Appropriate planning of your budget on healthy foods, smart shopping and easy cooking can save money in the long run.

Barrier: “I don’t have time to make changes”.

Solution: The most common excuse I hear from my clients is “My life is too busy” or “I have more important things to do”. First, work on time-management techniques that fit you; next, ask your family and friends how they manage to fit good nutrition into their lives. Don’t try to make too many changes at once, take every step slowly. Planning in advance for the next day’s meals, following simple but healthy recipes and allotting time for relaxed eating on a busy day will all help you achieve your goal.

Barrier: “I don’t like healthy foods”.

Solution: Some clients give reasons such as “I don’t like vegetables,” “I don’t like low-fat foods,” or “I really crave sweets and high-fat foods”. The main reason for this is developing a liking for high-fat, sweet and greasy foods from a young age. A gradual change in eating behaviour is being achieved by almost all our clients when they are given the right awareness and guidance. Fruits topped with seeds, use of herbs and spices in a dish, whole grain recipes with nuts, and creative salads and smoothies are sure winners when it comes to healthy eating and feeling full at the same time.

Barrier: “I don’t know what kinds of foods are healthy”.

Solution: It is believed that healthy foods are natural food that helps to sustain good health as well as containing vital nutrients that are grown without artificial substances or processes. While choosing healthy foods focus on whole grains, fruits, vegetables, lean protein like chicken and fish and low-fat dairy products. Limit the intake of added sugar, salt and oil. Avoid unhealthy foods that are preserved, packed and processed and also packaged drinks. These steps will help to promote good health and also protect against chronic diseases.

Eating is an important part of your journey and the incorporation of healthy eating habits is one of the best ways to help you reach your ultimate health goal. Start incorporating healthy foods into your daily diet to prevent heart diseases, diabetes, hypertension, weight gain and other chronic health issues. Hope this barrier-solution format motivates and encourages you to take the right steps to a balanced healthy diet. If you require answers to more specific problems or challenges, you may contact the healthcare team at the Cardiac Wellness Institute for a detailed dietary assessment and guidance.

 

Pulmonary rehabilitation: in a nutshell

I am glad that pulmonary rehabilitation is starting to get it’s much deserved attention. We had elaborated on the basics of pulmonary rehab in an earlier post…

Breathe, Believe & Receive

Let me explain why pulmonary rehab is the need of the hour. More and more people today are suffering from chronic diseases of the airways and the lungs like chronic bronchitis, emphysema and asthma. While breathlessness, airway tightness, cough, wheeze, expectoration, tiredness and fatigue are noted  early in the disease phase, many of them go on to become oxygen dependent in due course of time as they are unable to meet their own body’s oxygen requirements. In other words, their breathing efficiency drops so much that the oxygen content in room air is no longer enough for them; supplemental oxygen in a concentrated gas form is prescribed to these individuals and they breathe in this extra oxygen either intermittently or throughout the day. While it is not a taboo or a stigma to be on ambulatory oxygen (i.e. extra oxygen supply that you carry with you while you continue to do your routine activities like going to work, exercising, socialising etc.), it is a clear indication that the respiratory system is choking under threats like smoking, air pollution, lack of exercise and unhealthy diet.

Medical management of chronic lung problems includes medications, lifestyle changes,  pulmonary rehab and oxygen supplementation. Surgical management is limited to lung transplantation.

Can pulmonary rehab help prevent this stage of supplemental oxygen requirement? Yes, pulmonary rehab is proven to improve the breathing efficiency of the diseased airways and lungs and prevent the stage of oxygen dependency. However, it should be initiated early for maximum benefits. As soon as you or your loved one is diagnosed with a chronic lung disease, it is imperative to seek out the nearest pulmonary rehab service and enrol in a rehab program.

Will pulmonary rehab help improve my breathlessness and other symptoms? The components of pulmonary rehab, namely health education, breathing exercise, aerobic exercise, strength training, dietary modification and group counselling, together help to reduce your symptoms and increase your ability to do daily activities. At least 4 weeks of pulmonary rehab with 2-3 sessions per week are warranted in all chronic lung patients.

How should one go about finding out if pulmonary rehab is likely to benefit him/her? Talk to your pulmonologist. An increasing medication dose and number of drugs, an inability to do things that you could do with ease earlier, a falling body weight and muscle weakness are some indicators of resistance to medical management. Pulmonary rehab, if it was not started at the time of diagnosis, should at least be initiated when drugs are not helping anymore. Pulmonologists and general physicians managing such patients should stress the importance of a comprehensive pulmonary rehab program and refer their patients to avail such services.

A recent publication in the journal Lung India addresses some pertinent issues of chronic lung patients and stresses the need for comprehensive pulmonary rehab services across the country (doi:  10.4103/0970-2113.116248).

Spreading awareness about chronic lung disorders is our prime concern.

Cardiac Wellness Institute is conducting a health awareness program that aims to help people with cardiac and pulmonary ailments manage their health better and also to enable disease prevention in high-risk individuals.

The program is scheduled for 9.15 am – 12.45 pm on Saturday, 26th January 2019. Registration fee is Rs. 500 per person. Please call 044-43192828 or 9940408828, or email cardiacwellnessinstitute@gmail.com to register for the program.

Agenda:

09.15-09.30: Registration

09.30-10.30: Heart Lung Mechanics by Dr. Priya

10.30-11.15: Group exercise by Physiotherapist

11.15-11.30: Refreshments

11.30-12.15: Nutrition tips & recipes by Dietician

12.15-12.30: Details of upcoming rehab programs

12.30-12.45: Q&A

The 4 components of exercise to counter high BP

High blood pressure (BP) or hypertension is a major threat to your health and your quality of life. It can lead to life-threatening conditions like heart attack and stroke. The youth in India is more and more affected by this medical hazard. In fact, 1 in 5 young adults in our country is suffering from hypertension, according to a recent press release (1). So it is time to shift our focus to preventive rehabilitation in the younger generation.

Preventive rehabilitation is designed to reduce risk factors and prevent diseases. It is teamwork of physicians, exercise therapists, nutritionists and psychologists. In this blog post, I would like to share some exercise tips for the prevention and cure of hypertension.

Are you aware that exercise can reduce blood pressure? Indeed, regular physical activity not only reduces the stiffness in your blood vessels but also makes your heart more efficient hereby lowering your blood pressure to a desirable level.

Aerobic exercise, strength training and flexibility exercise are the three components of exercise that work hand in hand to bring down your elevated BP to normal levels. And together with breathing exercises, you definitely have the upper hand against high BP!

Aerobic Exercise

Any activity that you do use a large muscle group for a long duration which increases your heart rate and breathing rate is known as aerobic exercise. The best examples are walking, cycling and swimming.

Strength training or Resistance Exercise

I am often faced with the question “Is resistance exercise safe?” The answer is YES. It has long-term health benefits on all muscles including the cardiac muscle and also reduces the overall resistance in the arteries which is the underlying culprit causing high BP(2).

The American heart association recommends 2 days per week of resistance exercise for cardiac and hypertensive patients.

Flexibility Exercise

It improves flexibility and blood flow in the muscles. Regular flexibility exercise improves muscle endurance. Yoga is the best example of this group of exercise. It is not only a mind-body aligning tool but also a great stress buster.

Breathing Exercise

Find a comfortable spot at home or at work and start breathing deeply and slowly in a relaxed way for 10-15 minutes. This is known as deep breathing or regulated breathing or pranayama and it helps to relax your mind and your body. Special breathing techniques need to be learnt from experts and practised the right way for maximum health benefits.

The above-mentioned exercises are ideal for hypertensive patients. In addition to exercise, dietary changes and stress management training for all and BP lowering medication for a few are the best tools to reduce blood pressure. Most importantly, consult your physician before beginning your exercise program. We provide personalised preventive rehabilitation programs for individuals with high blood pressure, diabetes, cholesterol problems, body weight issues and psychosocial problems including chronic stress and addictions. The outcomes of our programs are excellent and our results have been published in international medical journals.

Reference

  1. https://www.escardio.org/The-ESC/Press-Office/Press-releases/One-in-five-young-adults-in-India-has-high-blood-pressure
  2. https://www.ahajournals.org/doi/pdf/10.1161/JAHA.112.004473

Let the flu not hamper your cardiac wellbeing

If you have heart problems, it is important to do all you can to avoid getting the flu. Flu and pneumonia create special problems for heart patients. You’ll have a harder time fighting off viruses that cause the illness. In fact, people with heart trouble are more likely to get the flu than people with any other long-term (chronic) illness. Pneumonia is a lung infection that prevents your lungs from getting enough oxygen into the blood, creating a strain on the heart. Viral infections like the flu also put added stress on your body, which can affect your blood pressure, heart rate, and overall heart function. In this blog post, I would like to outline some easy dietary trips to prevent flu and to hasten recovery from it.

Symptoms of the flu:

The flu usually comes on quickly. You might have one or more of the following symptoms…

  • Fever (usually high)
  • Severe aches and pains in the joints and muscles
  • Generalised weakness
  • Warm, flushed skin and red, watery eyes
  • A headache
  • A dry cough
  • A sore throat and watery discharge from the nose

Though your appetite may be down during the flu it is important to eat a variety of foods (at least in small portions) from all food groups. In this way, you can ensure you get the vitamins, minerals, antioxidant-rich foods and macronutrients needed to support your immune system, to reduce the risk of chronic lung disease and to keep other prolonged illnesses at bay.

Let us see some superfoods to include in your daily diet in the flu season.

Brightly coloured vegetables:

Try to eat a rainbow of brightly coloured vegetables that are proven to protect your health. These are packed with nutrient-rich plant compounds called phytochemicals that help the body neutralise free radicals. Free radicals cause damage to your cells and tissues and may lead to chronic illness. According to the American Institute for Cancer Research, the following vegetables contain the much-needed phytochemicals:

  • Cabbage
  • Carrots
  • Tomatoes
  • Greens
  • Sweet potatoes
  • Beetroot
  • Carrot
  • Bell peppers
  • Turnip

Brightly coloured fruits:

Fruits are particularly high in antioxidants, vitamins A, C, E and phytochemicals and have a protective effect on the lungs. They have been linked to a lower risk of dying from chronic lung disease. In fact, consuming as little as 100 grams a day (approximately one serving) of fruits is associated with a 24% lower risk of death due to lung ailments. The brightly coloured fruits that I would like to recommend are:

  • Apples
  • Pears
  • Citrus fruits (orange, sweet lime)
  • Berries
  • Cherries
  • Watermelon
  • Grapes
  • Pomegranates
  • Lemons
  • Pineapples
  • Bananas

Add Garlic and Onion to dishes

Garlic and onion are called “natural antibiotics” due to their healing powers, especially against infectious diseases like cold and flu. They help treat the common cold and may decrease the chances of a cold by 64 %. For example, onions are one of the richest sources of dietary flavonoids, which may decrease your risk of cancer, lung and cardiac diseases. Onions are also a great source of vitamin C, a vitamin that plays an important role in immune function. Research has shown that regular consumption of the organosulfur compounds found in onions and garlic may also prevent the development of cardiovascular diseases.

Black tea:

Black tea contains xanthine alkaloids from which the stimulant theophylline is derived. Theophylline is a bronchodilator and it is used in the treatment of lung diseases as it helps open up the airways and decrease breathlessness. These are rich in antioxidants, such as flavonoids. Regular consumption of black tea may help lower the risk of heart attack and cardiovascular diseases, diabetes and cholesterol abnormalities.

Try to add ginger to your diet

Ginger not only has anti-inflammatory properties but it is also a powerful natural painkiller which will help us fight a cold. It reduces fevers, soothes sore throats and encourages coughing to remove mucus from the chest. It also helps break down mucous to help clear your respiratory tract and alleviate symptoms of congestion. The two chemical compounds shogaols and gingerols are present in ginger that stimulate blood circulation and open our sinuses. The improved blood circulation means more oxygen entry into our tissues, which in turn will help to remove toxins and viruses. Fresh ginger is best had in teas and cooked with foods.

Get enough vitamin D through sunlight or food

Vitamin D, also known as“sunshine vitamin” is an important nutrient for overall health and also reduces the risk of respiratory infections, including colds, bronchitis, pneumonia and flu.  Nowadays, we see a high prevalence of vitamin D deficiency in our people especially in the winter months; when our exposure to sunlight is low we need to maximise the absorption of vitamin D from our diets. Try to eat vitamin D rich foods including fatty fish such as tuna, salmon, mackerel, eggs, legumes (beans and peas), nuts, seeds, soy products and mushrooms. Including a selection of these foods regularly throughout the winter months is a good way to improve your vitamin D levels and also to keep acute and chronic lung infections at bay.

Omega -3 fatty acids:

A diet rich in omega-3 fatty acids is well known to protect the lungs against chronic inflammation and also reduce the risk of heart attack, diabetes, obesity, abnormal cholesterol level and hypertension. Omega-3 fatty acids may also help improve symptoms of flu. These are some foods loaded with omega-3 fatty acids, to be added to your daily diet:

  • Fatty fish (salmon, herring, tuna, mackerel, sardines)
  • Cooking oils (rice bran, canola, flaxseed, and soybean)
  • Mixed nuts
  • Flaxseed, sunflower seed, pumpkin seed, chia seed
  • Soybeans

Here is a low fat immune boosting flu-fighting garlic soup recipe especially for you:

Ingredients:

  • 3 tablespoons olive oil
  • 1 big onion, chopped
  • 5 cloves garlic, minced (optional)
  • 1 big carrot, finely chopped
  • 5 mushroom caps, finely chopped (white button mushroom)
  • 1/4 cup coriander, finely chopped
  • 1/2 cup spinach, rinsed
  • 1/8 teaspoon turmeric powder
  • 6 cups water
  • salt, pepper and crushed red chilli flakes to taste

PROCEDURE:

  1. In a medium-sized pan heat oil and sauté the onions, turmeric powder, red chilli flakes and garlic.
  2. Now add the carrots, mushrooms and coriander and fry for a couple of minutes.
  3. Stir in the rinsed spinach and water. Add salt and pepper and cook for about 15-20 minutes until the spinach is cooked.
  4. Switch off the stove.
  5. Stir in the chopped coriander leaves and minced garlic if using. Now, hot soup is ready to serve.

Workstation Exercises for a Healthy Heart

Most of us use a computer and its accessories in our work today and this creates many ergonomic risk factors such as repetitive movements, awkward postures and staying in the same position for a considerable period of time, all of which can trigger muscle pain and strain. The neck, shoulders, wrists and hands are the most affected parts of the body.

It is time we start moving our body at regular intervals in our workplaces as prevention against work-related aches and pains. In fact, the branch of medicine that addresses such work-related health issues is called Occupational Health.

In this post, I would like to share with you some “Workstation Exercises”. Did you know how important it is to do exercises in your workplace? Yes, it is extremely important and gaining a lot of attention globally! It is proven to reduce the stress in your joints and improve flexibility, thereby indirectly helping you perform better in your work and achieve superior results. Also, cardiovascular diseases like heart attack and stroke that are claiming so many of our young peoples’ lives can be completely avoided by being fit both in and out of the office!

Now, let’s begin the desktop exercises. Here are 10 easy and quick movements that you can do at your workstations…

1. Eye exercise

Keeping the back and neck straight and the head still, look as high as possible, look up and down and rotate your eyes. Repeat this sequence 10 times without moving the head, as shown in the picture here.

2. Head turns

Turn your head to the left side to look over the left shoulder and hold for 10 seconds and again move to the other side and repeat both 10 times.

3. Chin tucks

Raise the head to straighten the neck. Tuck the chin in and upwards creating a double chin. Hold for 10 seconds if possible. Repeat 10 times.4. Shoulder rolls

Stand straight with your arms by your sides and keep your legs shoulder-width apart. Circle the shoulders forward and backwards. Repeat this 10 times.

5. Wrist stretch

Interlace your fingers, face your palms outward, and straighten arms in front. Hold for 10 seconds and relax. Repeat 10 times.

6. Chest stretch ;

Place your hands behind your head, and squeeze your shoulder blades together and repeat these steps 10 times.7. Back arching

Stand straight and support your lower back with your hands, gently arch back and hold for 5 to 10 seconds and relax. Repeat as often as possible.

8. Side stretch

Interlace fingers, face your palms outward and straighten your arms above your head. To stretch your sides, slowly lean to the left and then to the right. Hold for 10 seconds and relax. Repeat 10 times.

9. Leg lift

Hold one foot off the floor with your leg straight for 5-10 seconds and relax. Repeat with the other leg and do the cycle for 10 times in each leg.

10. Foot movement 

Hold both feet off the floor and move your feet up and down. Repeat 10 times.

SOME POINTS TO REMEMBER:

·         Take 5 minutes of break at the end of every hour in your workplace

·         Every hour, try to do a few exercises from the above list

·         Avoid sitting for a long time

·         Change your position of work as often as possible

·         Get ergonomic advice from an expert if you have chronic pains

All the above exercises are extremely easy to do in your workplace; it only takes a little bit of motivation and probably some team effort to get this going regularly in your office. Once you start, you will immediately notice the change in your wellbeing and you can also prevent long-term disability by being consistent. Combined with a healthy diet and a positive attitude you can stay healthy and be productive at work for a very long time. If you need personal assistance please feel free to contact our team at Cardiac Wellness Institute (www.cardiacwellnessinstitute.com).

 

The power of Mind-Heart connection

As a practitioner of evidence-based medicine, I am impressed by all the research that looks at the effects of regular exercise, good nutrition, quitting tobacco and adequate sleep on the heart, but am disappointed that very few doctors are looking into how much matters of the mind can affect the heart.

 

 

 

 

 

 

 

 

 

 

The reason is straightforward: it is easy to measure the number of hours of exercise and sleep, the amount and type of food intake and even the number of times someone smokes or chews tobacco in a day; but it is rather difficult to quantify and qualify peoples’ feelings and emotions. Leave alone a healthcare professional, even you yourself may not be able to accurately say what makes you happy or sad or angry or afraid.

Nevertheless, we know for sure that the mind and the heart work in unison. One cannot be separated from the other. Both are mutually interdependent on each other. In other words, there is a strong connection between the mind and the heart and they have to be equally well cared for to prevent diseases as well as to cure them. So come, let’s embark on a mindful journey to feel the power of the mind-heart connection, which in turn has the power to heal all our diseases.

  1. Understand that all feelings are natural

You would agree with me if I said there is no night without day and no autumn without spring. These are natural phenomena that keep the earth going. You don’t compare one with the other or pray for one over the other. So, why would you think that happiness and contentment are superior to sadness or fear or disappointment? Each of these feelings is natural and genuine. There is no need to hide or mask any emotion. As long as there is a reason or a situation for your particular emotion, you should just feel the emotion and let it pass.

For example, we often tell our kids “don’t cry like a baby”; and we even tell ourselves “I should feel happy all the time”. The former does not help kids realise what makes them happy or sad and the latter is an impractical and unrealistic goal to achieve. A positive attitude is something we should all aim for but that only means that we should not brood over spilt milk for too long; it doesn’t mean brooding is wrong.

  1. Look inwards and reflect, the answer is often within

With a fast-paced life and several roles to fulfil in a day, many of us forget to look inwards and reflect. There is such an overload of tastes, smells, sights, textures and sounds in today’s world that a few minutes of calm and quite without any external stimuli is hard to find. And to top it all, we have our smart phones that give us all of these stimuli at one shot even when we are alone.

In my humble opinion, today, a few minutes of self-refection every day is the need of the hour. It is the only way one can understand his/her emotions, likes and dislikes and priorities in life. And if you’re constantly stressed out due to various happenings around you, looking within and modifying your responses to stressors or external triggers is the only way out.

  1. Work on your coping skills

While it’s true that a crisis doesn’t strike too often, nobody is immune to unexpected turns in life like an estranged marriage, a bad investment or the death of a loved one. What we don’t want to do is feel so downhearted and blue that we end up with depression, suicidal tendencies or a heart attack.

Coping skills are nothing but ways in which we can bounce back to normal after a blow in life. That is why we often say invest time in building your friends, family and faith (religious or non-religious) in the days that you don’t need them so much. The investment will pay off when a crisis strikes; your friends, family and faith will serve as shock absorbers and help you get on track again.

  1. Identify your passion and fuel it

Not many of us know what our passion is. We do our work, we care for our family, we take a vacation once in a way and we grow old. That’s fine, but if there are some aspects of your daily routine that give you immense pleasure and make you loose track of time, that is the thing that you are passionate about! It might be singing, dancing, reading, writing, cooking, being creative, solving puzzles, gardening, stitching, playing with kids, cleaning the house, helping someone in need, praying, playing a sport, being one with nature, etc. The list goes on and on. Basically, it can be anything in which your mind and body is actively engaged (there are only a few things that do not qualify: television watching, spreading false news and hatred, and destructive thinking and actions). You just need to create time or free up more time from your daily tasks to spend at least half an hour everyday to grow your passion.

There is scientific evidence to prove that when you are passionate about something and have a meaningful life, your longevity goes up significantly.

  1. Challenge yourself more often

Yes, this is where most of us are lagging behind. We are afraid of challenging ourselves for fear of failing. We don’t want to push our limits as we are currently comfortable and feel no need for any challenges. We often blame our age for this attitude. But that’s exactly when you need to challenge yourself to something new like learning a new language, scaling new heights at the work/home front or developing a completely new skill. Have we not come across men and women who run marathons in their 70s and 80s, people who get PhDs after retirement and individuals who become a sensation overnight for overcoming serious obstacles to health and life?

Research shows that the best ways to avoid dementia, depression and other chronic ailments are a healthy lifestyle combined with a thirst for new knowledge and skills.

In short, caring for our minds, nurturing our souls and taking some time out for ourselves on a daily basis will go a long way in keeping us healthy and happy as long as we live!

If you are interested in attending a workshop on mind-heart connection and would like to learn from experts in the field of psychology and yoga, please see the event details on: https://www.facebook.com/events/253339935338681/

Fruits & Diabetes: Friends or Foes?

Diabetes Mellitus (DM) commonly referred to as diabetes is one of the most rampant chronic conditions affecting humans today. It occurs when the pancreas does not secrete enough insulin or when the cells of the body become resistant to insulin. It is a lifestyle disorder in which the body struggles to control the levels of blood sugar but is unable to do so due to unhealthy eating, exercising and stress management habits.

We all know that eating fruit is a delicious way to satisfy hunger and maintain a healthy lifestyle. Although we know fruits and vegetables are good for us, people with diabetes are often told they should avoid fruits because they are too sweet or contain sugar. All fruits contain natural sugars along with a good mix of vitamins, minerals and fibres. As a nutritionist, the question that I get asked most often is “I am diabetic, can I eat fruits?” So, are fruits really advisable for you if you have diabetes?

 

In this blog post, I hope to shed some light on the important issue of fruit intake for people with diabetes. First, let me explain two key concepts related to diet and diabetes: Glycemic Index and Glycemic Load.

Glycemic Index (GI)

GI is a number that gives you an idea about how fast your body converts the carbohydrates in a specific food into glucose. Two foods with the same amount of carbohydrates can have different glycaemic indices based on whether they contain more of simple sugars or complex sugars.

The smaller the number, the more time the body takes to convert it into glucose and so the more desirable for diabetic individuals.

55 or less = Low (most desirable in diabetics)

56 to 69 = Medium (less desirable in diabetics)

70 or higher = High (least desirable in diabetics)

The purpose of knowing the GI is to eat foods that are less likely to cause sudden steep increases in blood glucose levels. If you have diabetes, you must choose low GI foods in your daily diet. Research has proven that a low GI diet not only helps keep your blood glucose and blood cholesterol under control but also reduces insulin resistance and thereby the risk of complications likes heart attack and stroke. A recent research article explains how a low GI diet can help people with diabetes manage their blood sugar better https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006296.pub2/full.

Glycemic index of some fruits:

 

Glycemic Load (GL)

The GL of a food item is a number that indicates how much that food will raise a person’s blood glucose level after eating it and it is mostly based on the glycemic index (GI). Large research trials have shown that people who consumed lower glycemic load diets were at a lower risk of developing diabetes and heart disease https://www.ncbi.nlm.nih.gov/pubmed/23364021

The formula for calculating the GL of a particular food or meal is:

Glycemic Load = GI x Carbohydrate (g) content per portion ÷ 100.

Foods with a GL below 10 are regarded as “low” and those with a GL above 20 as “high”. Examples are:

Low GL foods: Apples, Pears, Oranges, Grapes, Peaches, Strawberries, Tomatoes and Watermelon

High GL foods: Dates, Raisins, Dried fruits.

Here’s a look at some common myths about fruit intake and diabetes:

Myth – Fruits are not suitable for diabetic patients

Fact – If you want to manage your blood glucose, cholesterol level, blood pressure and body weight you must include fruits in your daily diet. In fact, most fruits have low to medium glycemic index. (Refer glycemic index above)

Myth – Diabetic patients can have added sugar in the form of brown sugar, sugar substitutes etc.

Fact – All added sugars should be avoided. Alternatively, you can opt for a sugar-free balanced healthy diet. Natural sugars are present in fruits, vegetables and milk so you can go with natural sugars instead of adding sugar to your diet.

Myth – Diabetic patients can eat special ‘diabetic’ foods available in the market

Fact – ‘Diabetic-friendly’ labelling tends to be used on sweets, biscuits and similar foods that are generally high in fat and sugar. As a dietician, I wouldn’t recommend eating sugar-free diabetic foods like diabetic sweets, biscuits and beverages. They have been found to worsen your diabetes and also lead to complications of liver, kidneys etc. Opting for natural foods is the best.

Myth – Fruit juices are safe for diabetic individuals

Fact–Fruit juices are to be avoided mainly because juices lack the goodness of fibre present in the whole fruit and quite often extra sugar and preservatives are added. Fresh home-squeezed juices without any added sugar and with the pulp are preferred to readymade juices. However, nothing to beat the fruit eaten as a whole.

Myth – You should stay away from chikoos, mangoes and bananas

Fact – These fruits are by themselves a treasure trove of nutrition and there is no need to consider them a taboo. But portion size is very important while taking these fruits to manage your blood glucose levels. In fact, grapes and bananas are very beneficial because they are high in fibre, low in fat and full of vitamins and minerals. Mangoes too are rich in nutritive content. And all these fruits protect against heart disease, cancer and certain digestive problems.

The longstanding concern amongst our people is that fruits contain high levels of natural sugars which will inevitably increase blood glucose level. Due to the low glycemic index of most fruits they do not lead to a sharp rise in blood glucose levels. In contrast, processed foods like white bread, packaged sugary drinks, chocolate, biscuits, cakes etc. have a very high GI and are definitely to be avoided.

As a dietician, my advice would be to keep a food diary to help track your fruit and vegetable consumption, as well as the other foods that you eat in a day. In this way, you can get professional help to ensure the intake of a well-balanced diet that helps nourish your body and keep your diabetes under control.

Dietary Tips to Control Blood Glucose:

  • Try to eat whole fruits as much as possible, as some nutrients are lost in fruit juices
  • Add a wide variety of fruits – rainbow colours – in your daily diet to prevent chronic diseases like high blood pressure, heart diseases, stroke, obesity, constipation and certain cancers
  • Avoid excessive intake of dried fruit because it has high GI value
  • Avoid health drinks, aerated drinks and packed drinks.

Incorporating fruits into your diet is the best way to lower the risk of various health problems. Whether you have diabetes or not, you need to consume a healthy portion, that is at least 5 portions of fruits and vegetables, every day.