Air Pollution and Heart Disease

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

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

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

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

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

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

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

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


Knowledge-sharing: the essence of effective Cardiac Rehabilitation

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

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

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


Pranayama and its cardioprotective effect

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

How deep breathing impacts us?

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

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

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

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

Benefits of Pranayama

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

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

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




Getting to grips with heart failure

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

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

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

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

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

How does exercise help heart failure?

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

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

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

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

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


Going Nuts Every Day

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

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

Nutrition Facts

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

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

Health Benefits of Nuts

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

Protection against Cancer

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

Prevention of Gut Problems

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

Better weight management

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

Improved Heart Health

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

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

Recommended Portion

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

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

Tips for Adding Nuts to Your Daily Food Plan

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

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