Balanced diet vs Crash diet for heart health

As a dietitian, I am disturbed by the fast pace at which crash diets are gaining popularity! And I strongly believe that people need to be aware of the potential health hazards of these currently trending diets. Nutrition is a basic prerequisite to sustain life. A balanced and nutritious diet is one which provides all the nutrients in required amounts and proper proportions. It can easily be achieved through a blend of four basic food groups namely:

  1. Cereals millets and pulses
  2. Vegetables and fruits
  3. Milk and milk products, eggs, meat and fish
  4. Nuts and oil seeds

The quantity of nutrient requirement varies with age, gender, physiological status and physical activity. A balanced diet should offer around 60-70% of total calories from carbohydrates, 10 – 12 % from proteins and 20 – 25% from healthy fat and should also other provide sufficient dietary fiber, antioxidants (Vitamin A, C, E, Beta – carotene, selenium etc.) which protect the human body from free radical damage.

Crash diets are modified diets undertaken on an urgent short-term basis with an aim of achieving rapid weights loss, improving blood sugar control etc. There are multiple crash diets that have sprung up recently and the most popular ones are low carbohydrate diets (Atkins, Zone diet), high fat diets (Ketogenic diet), low glycemic index diet, high protein diet (Paleo diet) and liquid diet. A crash diet is similar to a crash course wherein one cuts off either the fat and/or the carbohydrate intake and thus the calorie amount is drastically decreased (600 – 800 kcals/day instead of 1500-2000 kcals/day).

Crash diets often appear to be working in the immediate term. The diet sends signals to our body to get into starvation mode, where we will experience rapid onset of weight loss, which is mostly due to decrease in muscle mass and not the fat mass.

It is important to note that crash diets carry both short term and long term health risks. The most common short term risk is nutritional deficiency. Carbohydrates are the body’s main source of energy and restricting them completely can cause hypoglycaemia. Food devoid of carbohydrates is going to be low in fibre as well, leading to constipation and infection in the digestive tract.

Long-term risks of crash diets include damage to the brain, kidney, heart and other vital organs. Some established complications are:

  1. Eating disorder
  2. Metabolic disorder
  3. Anxiety
  4. Depression
  5. Muscle loss
  6. Compromised immunity
  7. Impaired brain function
  8. Weak bones
  9. Poor attention span
  10. Hair loss
  11. Skin problems
  12. Dehydration
  13. Cardiac failure
  14. Renal failure

False claims made by crash diet proponents:

Rapid weight loss – In reality, you won’t lose fat but rather lose muscle, bone and water

Restricting or over – Consuming of foods groups–It is better to avoid diets that severely restrict food groups or allow you to eat unlimited quantities of certain foods

Combining foods – There is no evidence that combining certain foods enhances weight loss; eg; Cinnamon powder drink and other preparations

Exercise not necessary –The truth is without adequate exercise the weight you lose will come right back

Crash diet leads to heart diseases:

Crash diet is harmful for our heart health too. In my experience at Cardiac Wellness Institute, I have cared for individuals who were diagnosed with severe coronary blocks after following high-fat diets for a few months and for others who have had several attempts at crash diets for weight loss and had multiple nutritional deficiencies.

Research has shown that individuals on a very low calorie diet suffered heart failure. Low calorie diet can causes abnormal heart rhythms that can be fatal when body levels of magnesium or potassium dropped in susceptible individuals. Excessive dieting can cause cardiac stress, potentially leading to heart attack. Every individual should consume a nutrient dense diet that includes vitamins, minerals, proteins and whole grains in order to control weight, cholesterol, blood pressure and blood sugar.

I would like to conclude that crash diets are not scientifically backed and are almost always harmful in the long run. Medical research clearly indicates that eating the right kind of food in a balanced fashion helps to prevent many health problems like heart disease and cancers, the two leading causes of death worldwide.

Losing weight is best achieved by following a calorie deficit balanced diet, where calories are lost by burning more calories than is consumed. Choosing whole foods and fibre-rich foods and exercising adequately with a positive mental attitude will help to improve fitness and achieve ideal body weight. Again, losing weight should not be the goal; instead, weight loss should be the side effect of following a healthy lifestyle.

Health Information in Tamil to Prevent Coronavirus

உலகம் முழுவதும் பரவிக்கொண்டிருக்கும் கொரோனாவைரஸின் தாக்கத்தைப்பற்றியும் அதை எப்படி தடுத்துக்கொள்ளலாம் என்பதைப்பற்றியும் சில ஆதாரபூர்வமான உண்மைகளை இங்கே பகிர்ந்துகொள்கிறேன்.

  1. பதட்டம் பயம் பீதி வேண்டாம்

பதட்டம் பயம் பீதி ஆகியவை ஏற்பட்டால் நம் நோய் எதிர்ப்புசக்தி குறைந்து நாமே நோயும் அதைச்சார்ந்த வதந்திகளும் பரவுவதற்கு காரணமாகிவிடுவோம்.

2. தடுப்பு முறைகளை கையாளவேண்டும்

தமிழ்நாட்டு அரசும் மத்திய அரசும் வெளியிடும் அனைத்து தடுப்பு முறைகளையும் நாம் அனைவரும் கையாளவேண்டும். கொரோனாவைரஸ் இருமல் தும்மல் மூலம் பரவுவதால் இந்த அறிகுறிகள் இருப்பவர்களடிமிருந்து தள்ளி இருக்கவேண்டும். சோப்பும் தண்ணீரும் அல்லது சானிடைசர் உபயோகித்து அடிக்கடி கைகளை நன்றாக சுத்தம் செய்யவேண்டும். மேலும் முகத்தை கையால் தேவையின்றி தொடக்கூடாது. நம்மை நாமே வீட்டுக்குள் தனிமைப்படுத்தி வெளியில் செல்வதை தவிர்த்துவிட்டால் நோய் பரவுவதை தடுத்துவிடலாம்.

3. ஏற்கனவே பிறநோய்கள் உள்ளவர்கள் மிகவும் எச்சரிக்கையாக இருக்கவேண்டும்

இதயம், நுரையீரல் மற்றும் சிறுநீரக நோய், சர்க்கரை வியாதி, ரத்தக்கொதிப்பு, கான்செர் போன்ற நோய் உள்ளவர்கள் மேற்கண்ட தடுப்புமுறைகளை தீவிரமாக கடைப்பிடிக்கவேண்டும். உங்கள் மருத்துவரின் ஆலோசனையின்றி எந்த மருந்தையும் நிறுத்தாதீர்கள். காய்ச்சல், இருமல், மூச்சுத்திணறல் ஏற்பட்டால் உடனடியாக மருத்துவமனையை அணுகுங்கள்.

4. வீட்டில் பின்பற்றவேண்டிய ஆரோக்கிய வழிமுறைகள்

நோய் எதிர்ப்புசக்தியைக்கூட்டும் உணவுகள் அதாவது வைடமின் ஏ, சி, இ உள்ள காரட், கீரைகள், பப்பாளி, நெல்லிக்காய், ஆரஞ்சு, பருப்புகள் மற்றும் கொட்டைகள் இவற்றை உணவில் சேர்த்துக்கொள்ளுங்கள். தினமும் அரை மணி நேரத்திலிருந்து ஒரு மணி நேரம் வரை மொட்டைமாடியில் நடத்தல், படி ஏறி இறங்குதல், யோகா, நடனம், மூச்சுப்பயிச்சி போன்ற உடற்பயிச்சிகளை செய்யுங்கள். மனதை அமைதியாக வைத்துக்கொள்ள நீங்கள் விரும்பிய பொழுதுபோக்கு அம்சங்களை வீட்டிலிருந்தபடியே பின்பற்றுங்கள்.

5. வதந்திகளை நம்பாதீர்கள், பரப்பாதீர்கள்

சமூக வலைத்தளங்களில் வெளியாகும் வதந்திகளை நம்பவும் கூடாது, அவற்றை மற்றோருக்கு ஷேர் செய்யவும் கூடாது. உங்களுக்கு கேள்விகளோ சந்தேகங்களோ ஏற்பட்டால் எங்கள் மருத்துவ குழுவை தொலைபேசி அல்லது மின்னஞ்சல் மூலம் தொடர்புகொள்ளலாம்; +91 44 43192828; +91 99404 08828; info@cardiacwellnessinstitute.com

Metabolic Syndrome is a threat to heart health

At our centre, we regularly come across individuals with multiple health problems, particularly those related to heart disease. Very often, they need robust prevention and rehabilitation programs to help improve their physical, physiological and psychosocial wellbeing.

One such condition which we encounter commonly these days is “Metabolic Syndrome”. As the name suggests it is a combination of multiple risk factors of heart disease such as abdominal obesity, high blood pressure, increased blood sugar level and abnormal cholesterol level. This condition is growing in number day by day in India and expected to grow exponentially across the globe. The fact that several risk factors are present in the same individuals puts them at a very high risk of heart attack and stroke.

Based on multiple research findings, the rise in the incidence of obesity and diabetes was found to be the main reason behind the increase in metabolic syndrome. Also, the younger population, that is individuals between 25 and 35 years of age, are most affected suggesting that it is high time the youngsters take note of it!

The criteria for diagnosing Metabolic Syndrome as per the International Diabetes Federation guidelines in 2006 are:

  • Higher waist circumference – more than 102cm for men; more than 88 cm for women & higher BMI
  • Increased blood sugar level – more than 100 mg/dL
  • Abnormal cholesterol levels – increased triglycerides and decreased High-Density Lipoprotein
  • Increased blood pressure – more than 130/85 mmHg
Obesity
Diabetes
Unhealthy Diet

The unhealthy lifestyle choices of our people such as

  • Physical inactivity
  • Unhealthy diet
  • Chronic stress
  • Disturbed sleep pattern
  • Increase in tobacco and alcohol consumption

are the culprits causing this sudden surge in metabolic syndrome.

One important fact to be highlighted here is that all the above risk factors are interrelated which means that the occurrence of any one of the risk factors could pave way for the others as well.

If an individual has been diagnosed with metabolic syndrome, the following management should be initiated at the earliest:

1. Intensive lifestyle modification

An intensive lifestyle modification program is the first and only step in fighting metabolic syndrome, especially in individuals who are young, whose blood pressure, blood sugar and cholesterol levels are borderline elevated and who are free of organ damage. The program typically consists of health education about the condition and its effect on the body, tailor-made exercise training which focuses on controlling blood pressure, lowering blood sugar and cholesterol levels and education about the importance of exercise, along with personalized dietary guidance. Psychosocial counselling to help individuals cope better with their mental stress and emotional problems is also included in the program.

Importance of Exercise Training in Metabolic Syndrome

Exercise training is the cornerstone in the lifestyle program because of its multiple benefits:

Aerobic Training

  • Helps to improve endurance and stamina
  • Results in fat and carbs being used up as calories
  • Lowers blood sugar, normalises cholesterol level and also controls blood pressure
  • Aids in weight loss

If you are wondering how much aerobic exercise is adequate, here is my recommendation:

Frequency Intensity Duration Type
5-7 days/week Mild to moderate Intensity 30-60 minutes/day walking, jogging, cycling, swimming, hiking, treadmill,
EFX

Strength Training

  • Helps to improve muscle strength and power
  • Aids in calorie expenditure and weight loss
  • Increases muscle mass and reduces fat mass
  • Can be done with the help of equipment or use of bodyweight too

Guidelines for strength training:

Frequency Intensity Duration   Type
2-3 days/week Mild to moderate Intensity 20-30 minutes/day Bodyweight (push-ups, pull-ups, squats), dumbbells, barbells,
machine-based

Other types of exercise training such as flexibility training, interval training and circuit training can be incorporated in the exercise program as per the individuals’ needs and health goals.

2. Medications

In individuals with advanced metabolic syndrome, that is high levels of blood sugar, abnormal cholesterol and uncontrolled blood pressure, medications such as anti-diabetic drugs, anti-hypertensive drugs and cholesterol-lowering drugs should be initiated along with the lifestyle intervention.

3. Surgery

Fat-reduction surgery or bariatric surgery is sometimes needed to address severe obesity especially if it does not respond to lifestyle changes and medications.

As metabolic syndrome is on the rise and so is the incidence of heart attack and stroke, we need to adopt a healthy lifestyle that includes regular exercise, balanced diet, well-managed stress and adequate sleep, along with regular medical checks. It is never too early and never too late to make a change that will improve your health and your overall wellbeing.

Sitting is the new smoking

If you are someone who sits for long hours, either for work or for leisure, this is a must read for you. Recent studies have shown that sitting at a desk, in front of a television, on the couch etc. for extended periods of time is associated with increased risk of hypertension, diabetes, obesity, cancer and heart disease.

But why is sitting compared with smoking? We all know that smoking is extremely harmful, to the extent that each cigarette is considered as lethal as a bullet. Is sitting also that sinister? Let’s look at some recent trends to better understand sitting and it’s harmful effects and changes we can adopt to minimize the harm.

Work trends

A majority of the youngsters today are working in environments that require long hours of sitting. Computer professionals, bank employees, public service cadres, teachers, medical professionals, call-centre agents, drivers, the list goes on. Number of hours of sitting ranges from 4-8 hours per day for most of them which adds up to almost 30-40 hours of sitting a week. And in their non-working hours, they choose to sit some more to watch television, surf the Internet and socialize over drinks and dinner.

In fact, the risk of heart attack and stroke is much higher in Indians in their 20s and 30s as compared to the western population where it is still a disease of the older age group. A combination of unhealthy lifestyle choices and genetic predisposition underlies this health hazard and prolonged sitting or physical inactivity or less movement is definitely a contributor.

One of the popular solutions has been standing workstations where you stand and work instead of sitting and working. However, standing for long periods of time also has its disadvantages and can lead to varicose veins, foot pain etc. Hence a combination of sit/stand work environment with adequate movement every 30 minutes is what we should aim for. Walking meetings are a welcome trend for small group meetings, phone discussions and conference calls.

Workstation exercises are a set of exercises that individuals do in their work spots every few hours for a duration of 10-15 minutes to relieve the stress of working and to refresh the body and mind. We, at Cardiac Wellness Institute, take pride in providing tailored workplace health and wellness interventions for organizations.

Fitness focus

You would agree with me in my observation that Indians tend to associate movement, activity, exercise, sports and fitness with their growing-up years and then put a full stop to it. As we enter into adulthood, into work routines and start a family of our own, we become less interested in and less motivated to pursue our passion for sports or active hobbies and blame it on the lack of time.

While it is challenging to juggle responsibilities like kids, work, social demands and personal wants, it is not impossible to be active throughout the day. All seated activities should be limited to short bouts of 30 minutes or so and interspersed with stretches, minor exercises and walking breaks as permitted by the work you are engaged in.

A sustainable way to incorporate fitness in the workplace is to form activity groups or clubs and work together as a unit. Running clubs, bicycling events and swim teams are some examples of likeminded individuals pursuing active hobbies in the workplace and this is a welcome change in organizations these days.

Healthy Ageing

As we age, we need to be more active both physically and mentally to counter the slowing metabolism, weakening of bones, the psychological setback of old-age and the neurodegenerative conditions like dementia and memory loss. Sitting should not be the default posture in our retired days, instead it should be a few minutes of sitting in between household chores, outdoor activities and active hobbies.

In case you are forced to sit for long hours due to mobility issues or joint pain, it is advisable to keep moving the neck, torso, upper limbs and lower limbs at frequent intervals to improve circulation, prevent muscle wasting and strengthen muscles.

In conclusion, smoking has devastating effects on our health and is to be completely and totally avoided. Sitting however is not so dangerous for us but the associated lack of exercise leading to heart attack and other chronic ailments is the bigger health concern facing humanity today. As a strong proponent of mindfulness, I would recommend mindful sitting which simply means being aware of our seated posture and sitting straight, doing some exercises while sitting and grabbing any opportunity to break that long sit.

Sit less, move more and live a healthy life!

Healthy eating resolutions for 2020

A new year often signifies a fresh start for many people. For some, this means starting an exercise routine, losing weight or following a healthier diet. It is important to remember that our diet pattern has the power to reduce the risk of chronic diseases over our lifetime and together with a healthy lifestyle it is extremely important to prevent illness.

Very often, within a few weeks of setting our new year health and wellness resolutions, we realise that they are unsustainable due to multiple reasons like work and family commitments, inability to take time off our busy schedules, failure to prioritise our health etc. and we end up breaking our resolutions. Thus we find ourselves making the same resolutions year after year. To break that cycle, we need to make resolutions that can not only improve health but also be followed in our day to day lives. The secret is to set simple and easy goals that are easy to follow and are also sustainable.

Here are some examples of attainable and sustainable healthy eating resolutions:

Goal No 1: Eat out less often

During peak working days and holidays, people eat out a lot at restaurants or other roadside shops due to work demands and lack of time to cook meals. When you eat out, you have less control over what you are actually eating. Moreover, a kind of addiction develops to the outside food, ultimately leading to consuming extra fat, salt, and sugar on a daily basis. Try to avoid or minimise the consumption of outside foods.

Goal No 2: Reduce your added sugar intake, little by little

Added sugars are sugars added during the making of processed (packaged) food and drinks and the sugar we add to our home-made beverages and dishes. Added sugar should be cut down gradually as it causes serious health issues, including diabetes, obesity, heart disease, high triglyceride levels and low HDL (good) cholesterol levels.

Goal No 3: Add veggies to your breakfast

One health-protective habit is to fill half of every plate or bowl with non-starchy veggies. For most people that is easier to do for lunch and dinner than for breakfast. So try to incorporate one serving (that is 80 grams) of vegetables in your breakfast meal.

Goal No 4: Eat two cups of fruits

Fruits are loaded with antioxidants, vitamins and nutrients. High fibre in fruits helps to regulate body metabolism. It is advisable to consume at least 2 cups of fruits (that is 150 – 200 grams) daily.

Goal No 5: Incorporate more probiotics and prebiotics into your diet

Prebiotics are natural, non-digestible food components that are linked to promoting the growth of beneficial bacteria in your gut. The best choices are bananas, onions, garlic, leeks, asparagus, artichokes, soybeans, and whole-wheat bread. Probiotics are active cultures that help change or repopulate intestinal bacteria to balance gut flora. Consuming probiotics may boost immunity and improve overall gut health and the best sources are yoghurt, kefir, kimchi and sauerkraut. Having a combination of prebiotics and probiotics in our diet can be a very powerful step to improving our overall health.

Simple tips for a healthier diet and lifestyle

  • Drink at least 1.5 litres to 2 litres of water per day
  • Follow mindful eating, that is chew food properly, eat slowly and avoid watching any screen/gadgets while eating
  • Aim to eat five servings of fruits and vegetables every day; add more colour in your meals with plant-based foods
  • Include whole grains instead of refined ones
  • Say no to junk foods, processed and preserved foods which are high in trans fat, preservatives, salt and sugar
  • Read the food labels and choose foods that are low fat, fat-free, no added sugar, zero trans fat and no preservatives
  • Try to include small, healthy meals; do not skip meals especially your breakfast
  • Aim for good quality sleep of around 7-8 hours per day

Setting small, sustainable, realistic goals is really the key to success in making habit changes. Any simple diet change is easier if we take slow and small steps. Resolve to make a few small resolutions this year and then just watch how far you go. If you or your loved ones have been diagnosed with heart disease, we recommend that you consult your dietician or your healthcare team to get guidance on the most relevant diet goals for your health condition.

Healthy diet, adequate exercise, sufficient sleep and well-managed stress levels together help to enhance our health and the quality of life. So go ahead and set some simple and achievable goals for a healthy body and mind. Be in the present, avoid distractions, savour every bite and enjoy every meal!

Pursuing your fitness goals after a cardiac diagnosis

Everyone of us wants to lead a healthy and happy life. We like to be fit and active and avoid being sick or afflicted with disease. There is no doubt that any chronic health problem brings with it physical and mental strain due to the need for multiple drug therapy, surgical treatment and other invasive procedures. In fact, very often our fitness goals and competitive attitude take a back seat when diagnosed with cardiovascular or cardiometabolic diseases like heart attack, hypertension or diabetes.

Everyday, we at Cardiac Wellness Institute meet clients of different fitness levels with a recent cardiac diagnosis, angioplasty or bypass surgery. Some of them are depressed and disheartened that they will be unable to run the marathon they had signed up for or continue their passion for sports like swimming or cycling. It is during their personalised cardiac rehabilitation with our team that they begin to believe in themselves and that they can actually achieve their goals.

Let me share some real-life examples with you.

A 45-year old entrepreneur based in Delhi suffered a massive heart attack and immediately underwent an angioplasty where a stent was placed to restore blood supply to the heart. He was married and had a young child. He was worried and anxious about returning to work, leading a normal life and the impact this disease would have on his future wellbeing. He enrolled in our Home-based Cardiac Rehabilitation program right after his procedure and we initiated him on smoking cessation, dietary modification and graded exercise training. He was counselled about getting back to work gradually, about coping with the stress of a cardiac condition, about resuming normal sexual activities and about the actions and side effects of medications.

He had been a physically fit person aiming to participate in marathons when the heart attack had struck suddenly. After about 20 months of cardiac rehab, he is a very confident man who understands that his medical condition is not a barrier for his dream of participating in marathons. He trains regularly covering all aspects of fitness namely aerobic exercise, overall strength and core fitness. He eats a heart-healthy diet, manages his stress levels well and leads a normal work life and social life. His motto has been “try, try, try until you succeed”.

A 58-year old advocate, social activist, organic farmer and a badminton enthusiast suffered a heart attack for which he underwent bypass surgery. He had a poorly functioning heart as a result of the heart attack and that caused him great anxiety. His dream was very simple – to get back to his active life at the earliest. He enrolled in our Cardiac rehabilitation program after a month of bypass surgery and has been extremely consistent in following our exercise training, dietary advice, education sessions and psychological counselling. He was very glad that his physical stamina, exercise capacity, blood pressure control and cardiac function all showed improvement within 3 months.

After completing his intensive rehab program, he signed up for the monthly maintenance program with us and goes to a fitness centre near his residence regularly. He is back in action with more energy and confidence in his daily routine and says, “I believe in things that help me to do better. Regular exercise, appropriate diet and keeping the mind healthy are among them”.

It is clear from the above stories that cardiac rehabilitation can help individuals with heart problems achieve their fitness goals. Some things to be kept in mind are:

  • An expert rehab team has to assess your fitness level, medical history and presence of signs and symptoms prior to enrolling you in a rehab program and giving you an exercise prescription
  • You have to start with mild to moderate intensity exercise with adequate intervals between each exercise and then increase the intensity gradually
  • If you are passionate about running, cycling, swimming, hiking etc. guidance of a fitness instructor or physiotherapist with adequate knowledge about cardiovascular physiology will help
  • Taking care of your emotional wellbeing through psychosocial counselling is very important to help you overcome your fears and chase your dreams

In conclusion, performing exercises the right way, eating the right type of food, keeping your mindset positive and avoiding tobacco and alcohol are keys to overcoming your cardiac ailments and leading a healthy life. Dreams are meant to come true and goals are meant to be fulfilled irrespective of your health barriers; the right guidance is all you need.

The 9 cardiovascular risk factors we should watch out for

As a Preventive Cardiologist, the question I get asked most often is this:

“I (or someone I know) have no bad habits and have not had any health problems in the past, but ended up with a heart attack. How come doctor?”

My immediate response is that there are 9 risk factors for serious heart and blood vessel disorders like heart attack and stroke. In fact, each of these 9 are independent risk factors which can cause disease by itself and when present in combination poses a very high risk of fatal heart disease.

The 9 cardiovascular risk factors: The Framingham (1) and the INTERHEART (2) studies are both landmark research works that have clearly identified the cardiovascular risk factors in all populations. The image below depicts the 9 risk factors that we should all be aware of and should watch out for.

A questionnaire-based survey was conducted this World Heart Day by Cardiac Wellness Institute to study the presence of behavioural risk factors for heart disease among college-going women in Chennai. Of the 554 students aged 15-30 years who responded to this survey, almost 40% reported to be chronically stressed. We have also noted a similar trend of staggeringly high rates of chronic mental stress among young corporate employees. Intensive lifestyle modification supervised by medical professionals has proven effective in changing dietary, exercise, sleep and stress-related risk factors in all age groups including young adults.

Hypertension, Diabetes and Dyslipidemia are the three silent killers which can only be identified by routine health check up. All 3 conditions often co-exist in the same individual but do not cause any symptoms leading to a very high risk of sudden death. Simple tests like blood pressure measurement and blood sugar and lipid level analysis will throw light on your risk profile. Mild variations from normal and early stage of disease can be managed with lifestyle changes alone but more severe abnormalities will require medications in addition to lifestyle changes.

Unhealthy diet, Inadequate exercise, Obesity, Mental stress along with tobacco use and alcohol abuse are the risk factors that are soaring high in our population. Spreading awareness about the ill-effects of these lifestyle choices is the first step in curbing them. The second and most crucial step is providing the right tools to help people modify their risky behaviour. Exercise training, meal planning guidelines, stress management techniques, goal-setting to become fit, and professional help to quit smoking and drinking are some ways we help individuals succeed in making these difficult but salient changes that impact their health in a very positive way.

If you have a family history of cardiovascular disease, that is your parents or siblings have had a heart attack, stroke or other cardiac problems, you need to be even more vigilant about the 9 risk factors and take all steps to lead a heart-healthy lifestyle.

Action Point 1 If you are over 40 years old and have not had a medical check yet, it is time you saw your doctor for a cardiovascular risk assessment. If you have had a doctor check up more than 2 years ago, you need to repeat one now.

Action Point 2 If you are over 20 years old and think you have 1 or more of the above risk factors, you should get a doctor’s opinion and blood examination every 5 years.

Action Point 3 If you have been taking medicines for any of the above risk factors, you need to revisit the problem along with your doctor to understand the response to medications and the need for lifestyle modification to reduce and eventually even stop medicines if all parameters are well controlled.

The truth behind Ketogenic diet

Obesity is a major health issue worldwide and increases the risk of several chronic conditions, including cardiovascular disease, hypertension, diabetes, and cancer. In recent times two types of diets have been for weight loss – Ketogenic diet and Paleo diet. Ketogenic (or keto) diets are characterized by a marked reduction in carbohydrates (usually to <50 g/day) and a relative increase in the proportions of protein and fat. The Ketogenic diet comprises of 70-80% fat, 5-10% carbohydrate and 10-20% protein, while the Paleo diet has 30% protein, 40% fat (from mostly monounsaturated and polyunsaturated fats) and 30% carbohydrates. This varies from a normal diet that comprises of 20-35% fat, 45-65% carbohydrate and 10-35% protein.

How the body handles a ketogenic diet

In our body glucose is the main source of energy for all cells and is obtained by consuming carbohydrates rich foods. The hormone Insulin is responsible for the proper use of glucose as a source of energy by the body. When carbohydrate consumption is low initially glucose in the muscles gets utilized and later stored glucose from the liver is used up for energy. If this scenario continues for 3 to 4 days and once stored glucose is fully depleted, blood levels of insulin hormone decreases and the body begins to use fat as its primary fuel. The liver produces ketone bodies from fat, which are used in the absence of glucose. When ketone bodies accumulate in the blood, this is called ketosis. Healthy individuals naturally experience mild ketosis during fasting and very hard exercise.

What to eat and what to avoid in a Ketogenic diet?

Healthy vegetables and fruits that are rich in natural sugars and carbohydrates are limited in this diet.

Foods included in the keto diet are:

  • Chicken, turkey, beef, pork, lamb,
  • Fish and seafood, especially fatty fish like salmon, sardines, tuna and mackerel
  • Eggs and whole milk
  • Nuts and oil seeds
  • Whole milk cheese, butter, paneer, yogurt
  • Avocados

Foods to be avoided in a keto diet are:

  • Cereals and Grains (e.g. rice, oatmeal)
  • Starchy vegetables, including corn, potatoes, and peas
  • Low-fat dairy products
  • Most fruits, except for lemons, tomatoes and berries
  • Pulses and legumes (Beans, peas, lentils)
  • Sugary (Juice and soda) and alcoholic beverages (wine, beer, and sweetened cocktails)
  • Snack foods, such as potato chips, pretzels, and crackers

Benefits versus Harms

Some immediate benefits of a Ketogenic diet are weight loss, reduced blood glucose level and increase in muscle mass. However, an increase in LDL or bad cholesterol, blocks in the coronary arteries due to excessive fat consumption, renal failure and liver dysfunction due to fat accumulation in the liver have been identified as the harmful effects of this diet.

Prolonged Ketogenic diet causes the following side effects in the body

  1. Constipation
  2. Dehydration and loss of electrolytes
  3. Kidney stones
  4. Hypoglycemia
  5. Bad breath
  6. Nutritional deficiencies
  7. High Cholesterol and an Increased Risk for Heart Disease
  8. Several vitamin and mineral deficiencies, decreased bone mineral density, and gastrointestinal distress
  9. People with kidney disease or a history of disordered eating should avoid the diet, and people with type 1 diabetes may want to avoid it

Ketogenic diet may be associated with some improvements in obesity, type 2 diabetes and HDL cholesterol levels, but these effects are usually short lived. Insulin resistance is also a potential negative effect.

If you’re at risk for heart disease, one overarching factor to consider is that the keto diet is restrictive, and it’s tough to stick to a restrictive diet. People go on keto and in the short term lose a lot of weight, but it’s not sustainable. So when they go off from keto, they regain the weight back. This yo-yoing or up and down effect of body weight is also not healthy in the long run.

In summary, the ketogenic diet is not free of side effects. Eating a well-balanced diet which includes all the food groups, that is moderate carbohydrate with high fiber foods such as fruits, vegetables and whole grains, healthy fats and proteins along with adequate water intake helps to achieve health goals without any complications. One should always talk to their doctor before beginning any new diet and also consult a dietitian to ensure they are getting enough nutrients through diet to keep them healthy and free from disease.

An introduction to HIIT

In spite of the strong medical evidence for the positive role of exercise in preventing and reversing obesity, diabetes, hypertension, dyslipidemia, heart diseases and stroke, not many are able to incorporate regular exercise into their busy lifestyles.

Due to time constraints and workplace issues, interval training might be the answer for the younger generation. Interval training is a type of exercise training, which involves periods of intense exercise and recovery. High Intensity Interval Training (HIIT) is a type of interval training that has been investigated a lot in the recent past and has shown promise both in heart disease prevention as well as in cardiac rehabilitation programs.

HIIT involves short bouts of high intensity exercises, with recovery periods that involve mild intensity exercises. There are different types of HIIT regimes, but the basic algorithm is to have a good warm up, short bouts of the combination of high and low intensity exercises for a time period and cool down.

Sample HIIT regime

5-minute warm up + [(4-minute high intensity exercise& 1-minute low intensity exercise) x 4 times = 20 minutes HIIT] + 5-minute cool down

This is different from Moderate Intensity Continuous Training (MICT) which has been followed for a very long time with well established evidence, in the following ways:

  • HIIT duration is relatively shorter than MICT (20 minutes vs 30 minutes)
  • Calorie expenditure is higher in HIIT than MICT
  • HIIT aids in weight loss and increasing muscle mass at a faster rate than MICT
  • HIIT is applicable for both aerobic training as well as resistance training

However, prior to enrolling in a HIIT program, there are some things to be considered:

  • An individual should be following at-least a mild to moderate intensity exercise regime for 2 months before starting HIIT, so it’s not for those of you who are beginners to exercise
  • It is advisable to have a fitness instructor or a physiotherapist initiate the HIIT and monitor you in the early stages
  • If you are a healthcare professional, remember to assess the physical activity level and exercise capacity of your client prior to initiating HIIT

Every exercise regime has some limitations, some of the disadvantages in HIIT are:

  • It is not advisable for high risk individuals (uncontrolled hypertension, angina, arrhythmias, valve stenosis, pulmonary complications, recent heart attack, exercise intolerance) and senior citizens
  • Chances for injury are higher in HIIT if adequate warm up and cool down aren’t done
  • The recovery period for a HIIT program is comparatively longer than other training, which might affect one’s adherence

With this introduction to HIIT, my aim as a cardiac physiotherapist is to help each and every one of you out there find the exercise regimen that best suits your health, work and lifestyle requirements. The secret to success is being regular with your exercise over continuing periods of time and enjoying every bit of it!

The role of plant-based diet in cardiac care

A healthy vegetarian or plant-based diet is a way of eating that emphasizes on a higher intake of fruits and vegetables, whole grains, pulses and nuts and a lower or zero intakes of animal-based foods (lamb, pork, chicken etc). The important message here is a plant-based diet can also be unhealthy if rich in refined grains (like white rice, white bread and maida products) and deficient in fruits and veggies.

Multiple studies have shown that eating more plant-based healthy foods reduces the risk of incidence and severity of cardiac disorders and protects the heart mainly because they contain zero dietary cholesterol, low saturated fat and more fibre. However, overconsumption of vegetable oils (more than 5 teaspoons per day), seeds and nuts and refined sugars can lead to abnormal blood cholesterol and triglyceride levels.

On the other hand, red meats and organ meats are rich in saturated fat and cholesterol so should be avoided or kept to a minimum. Fish, especially oily fish, are rich in healthy fats and can be included in your diet provided they are not deep-fried.

There are different types of plant-based diets such as the Mediterranean diet, the vegan diet, the DASH diet (Dietary Approaches to Stop Hypertension) and the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay). These diets emphasize on certain foods that are associated with heart disease eg. Whole grains, fruits and vegetables, nuts, seeds, oils, legumes, and beans and a minimal amount of low-fat dairy and non-vegetarian products (fish, egg, lean meat, chicken).

Health benefits of plant-based diet:

  • Plant-based fruits and vegetables are loaded with vitamins and minerals
  • Fruits and vegetables consist of antioxidants, which helps to control cell damage and the inflammation in arteries
  • Proteins from non-vegetarian foods consist of increased saturated fat whereas from plant sources (nuts, pulses, legumes) has only a minimal amount of saturated fat
  • A plant-based diet is also beneficial for individuals with high blood pressure and high cholesterol as it offers all the essential nutrients such as carbohydrates, protein, fats, vitamins and minerals for optimal health, and are higher in phytonutrients (Carotenoids, ‎Flavonoids).
  • Healthy and balanced plant-based plate are essential to control many disorders like diabetes, hypertension, obesity, heart disease and cancers.

Remember, a plant-based diet is not always healthy, particularly as

  • Deep-fried and preserved foods
  • Excessive saturated fat, sugar and salt from any source
  • Plant-based fast foods and snacks like veggie burgers, pizza and fries and chips.

If you have been eating non-vegetarian food regularly and a plant-based diet is difficult to follow for you, then begin small. A moderate change in your diet, such as lowering your meat intake by one to two servings per day and replacing it with legumes or nuts as your protein source, can have a lasting positive impact on your health.

Thus a vegetarian diet is healthy, nutritionally adequate and may provide health benefits for the prevention and treatment of certain diseases. Like any diet, a vegetarian diet should be part of an overall healthy lifestyle, which includes adequate exercise and excludes smoking and drinking excess alcohol. It is not necessary to go full vegetarian or vegan to get the best heart health benefits. The focus should be on eating the right foods, avoiding the wrong kind and moderating the intake of healthier animal products (egg, country chicken and fish). As a purely vegetarian diet is low in iron, vitamin D, B12and calcium, the inclusion of 1-2 servings of animal sources or plant-based foods fortified with these essential nutrients helps to overcome these deficiencies.

The chest pain checklist

The aim of this blog post is to provide you, our dear reader, some important facts and points about chest pain and thereby empower you to take the right decision when you or your loved one encounters it.

Chest pain is probably the most feared of all pains, mainly due to its association with heart problems. In fact, it is the second most common reason for presenting to the hospital emergency department across the globe (injury being the leading cause). Here are 5 common causes of chest pain and some tips to differentiate one from the other:

  1. Gastric acidity or heartburn
  2. Heart attack or angina
  3. Lung related causes
  4. Musculoskeletal problems
  5. Neurological pain

Gastric acidity or heartburn

Gastric acidity is also referred to as heartburn because it causes a burning sensation in the middle portion of the chest, typically behind the chest bone. The rising up of gastric juices from the stomach to the tube connecting the mouth and stomach (esophagus) and irritation of the inner lining of the tube is the cause for this burning sensation.

A few indicators of heartburn are:

  • Timing of the pain – the pain might occur before a meal if you often have untimely meals or skip meals
  • Association with food types – heavy meals or food with excessive oil and spice might trigger the discomfort
  • Response to antacids – if the pain or burning sensation subsides with over-the-counter liquids or tablets for acidity, it is likely a heartburn

Heart attack or angina

Chest pain due to cardiac causes can be very severe and sinister. It is important to know that the following causes may lead to cardiac related chest pain:

  • Sudden unbearable pain in the chest or upper part of the body due to a complete block of the blood vessel supplying the heart (myocardial infarction or heart attack)
  • A gradually building up chest pain which worsens during exercise or emotional bursts and gets relieved with rest or relaxation is called angina and is due to poor blood supply to the heart
  • A stabbing or piercing pain of the chest may be due to a tear of the major blood vessel leaving the heart or disease of the covering of the heart

Note: As heartburn and heart attack pain can mimic each other, it is best to see a doctor and get an electrocardiogram or ECG test at the earliest. Also, a healthy lifestyle which includes a balanced healthy diet in a timely manner, regular exercise and stress relieving techniques such as yoga, meditation and deep breathing, is extremely effective in keeping both heart related and gastric acidity related problems at bay.

Lung related causes

A few conditions like infection of the lungs, inflammation of the covering layer of the lungs, block in the artery supplying blood to the lungs and high blood pressure in the blood vessels carrying blood to the lungs can cause chest pain. The clues here are pain that worsens with deep breathing or coughing and at times associated with shortness of breath. As some of the causes are potentially lethal, it is imperative to consult a physician if the pain is severe or associated with difficulty breathing.

Musculoskeletal problems

Injuries to the muscles in the chest region or the ribs and the surrounding cartilages can cause chest pain. Pain on pressing a particular spot, also called tenderness, is an indicator of an underlying soft tissue or bony problem. The pain usually gets better with application of cold or hot fomentation or with anti-inflammatory drugs if it is soft tissue related.

Neurological pain

Any radiating pain in the neck, upper chest, upper back and arm can be due to nerve compression. The severity of pain may be more with upper body and arm movements and may be associated with other symptoms like tingling sensation, numbness etc.

Panic attack is another well-known cause of chest pain. You might not have any of the problems mentioned above but may experience a severe chest pain together with intense fear, rapid heartbeat, rapid breathing, profuse sweating, nausea and dizziness.

Shingles or herpes zoster infection of the chest region can cause a severe chest pain along with a band of blisters from the back to the front of the chest.

While chest pain may be due a variety of causes, cardiac and certain lung causes may be life threatening and should be addressed immediately without any time delay. So, here is the checklist for someone experiencing chest pain:

  • Is this a new-onset pain?
  • Is the pain severe or unbearable?
  • Is the pain radiating (spreading from one point to other areas)?
  • Is the pain associated with exercise or emotions?
  • Is the pain associated with meals, cough, deep breathing etc?
  • Is the pain getting better with over-the-counter drugs?
  • Is the pain lasting for days to weeks?
  • Is the pain getting better with local application of muscle relaxants or cold/hot fomentation?

While this post may come in handy when someone you know has chest pain, we strongly recommend consulting your physician to rule out serious medical conditions.

Are Fitness Apps and Devices safe for everyone?

The world today is more digital than it has ever been before! Smart phones and the associated apps have become an integral part of our work lives, family lives and social lives. People often use fitness apps for exercising these days. Let us take a look at some of the benefits and harms of this trend.

Fitness apps help us exercise better in the following ways:

  • Provide multiple exercise options and range of exercises for individuals who exercise on a regular basis (abdominal exercises, core strengthening, etc)
  • Provide reminders to help us stick to our exercise routine
  • Monitor key parameters like heart rate, steps per day and calorie intake and calorie expenditure and helps keep track of these numbers over time.
  • Help us work on different aspects such as aerobic exercises, strength training, interval training, circuit training and on particular areas like core muscles, upper limbs etc. if necessary

Even though fitness apps and devices help us exercise ourselves without the need for someone to supervise us, there are a few things that we should be aware of before starting to use one of these.

  • Anyone new to exercise should have a medical evaluation for underlying conditions like diabetes, hypertension and obesity as the fitness app or device will not scan for these conditions
  • When beginners indulge in strength training or vigorous intensity exercises without assessing their muscle strength and endurance, it may lead to injury of muscles, ligaments and joints if not done the right way.
  • App-based dietary advice to lose weight or burn more calories are not individualised and safe; hence they can cause excess fatigue, dehydration, fluid imbalance, giddiness and loss of conscious
  • Even though apps may provide illustrations or short videos on how an exercise is to be done, it is always advisable to have a fitness trainer or a physiotherapist to correct you in the early stages

Special advice for heart patients:

While all the benefits and limitations discussed above apply to cardiac patients also, it is important to note that fitness apps, devices and even physical trainers in most commercial gyms are unable to provide a personalized exercise prescription that is effective and safe for your medical condition. They are not trained to assess your heart rate, blood pressure and other symptoms like sweating, breathlessness and chest pain during exercise and this might lead to complications like abnormal heart beat, very high or very low blood pressure, sudden collapse etc. It is mandatory to consult your cardiologist or your cardiac rehab team to understand how to exercise safely and follow their guidance. Initiating the exercise regime under medical supervision and then gradually using relevant apps and devices as an adjunct is advisable.

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.