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Lifestyle versus Genes in the causation of heart attack

Are you anxious and concerned that more and more people who appear healthy and normal are suffering a heart attack? Are you puzzled about how some individuals seem to have an unfair health advantage over others?

Lifestyle risk factors

We have discussed the modifiable and non-modifiable risk factors for heart attack or myocardial infarction in an earlier thread: http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/heart-disease-whats-all-the-hue-and-cry-about/

The INTERHEART study published in the year 2004 provided a major breakthrough in our understanding of the causation of heart attack. The researchers included 15152 individuals with heart attack and 14820 persons without a history of heart disease, from 52 countries, in this study. They identified that the 9 risk factors shown in the picture below are collectively responsible for 90-95% of the heart attacks we see today. Each one of these is an independent risk factor and presence of more than 1 risk factor multiplies the risk alarmingly.

Genetic risk factors

If you have been to a doctor by yourself or with someone, with a chest pain, your doctor would have asked the question “does anybody in your immediate family have a heart disease?” as part of the medical history taking.

Genes, as we all know, are the building blocks of our cells. We derive our genetic imprint from our parents and ancestors, share many of our genes with our siblings and relatives and even pass them on to our children. So, what is the chance that you will suffer a heart attack if your father or mother has had one? It is definitely higher than for your friend who does not have a family history of heart attack. However, research from the recent past provides some interesting insights into the role of lifestyle and genes in causing myocardial infarction.

Over 3000 Costa Ricans, equal numbers with and without myocardial infarction, participated in a medical research study published in 2016. An in-depth analysis of the lifestyle and genetic markers of heart attack in this population revealed that lifestyle risk factors were more strongly associated with heart attack than genetic susceptibility.

Take-home message

Leading a healthy lifestyle has by far the best chance of protecting you from heart attack even though you might have a family history. You might want to start by scoring yourself based on your lifestyle using the SLAM score http://www.cardiacwellnessinstitute.com/heart-disease-treatment-prevention/uncategorized/the-race-against-ourselves/

 

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Food and Mood

Did you know that your mood can affect your food choices? Yes, it is a proven fact. And of course, your food choices can also affect your mood. Nowadays, people are often experiencing symptoms of depression and anxiety like bad mood, irritability, lack of motivation and low energy levels that it becomes difficult to garner the attitude and motivation to make healthy food choices. Instead of opting for the time-tested local produce, we tend to choose convenience and comfort foods at times of stress, depression and anxiety.

Always remember that a healthy diet is important for your mental and emotional well-being and to prevent chronic ailments like depression and anxiety. When you are feeling well, you may find it easier to stick to a healthy diet, which will in turn help you to continue to feel well. On the other hand, bad mood leads to rash and unhealthy food choices which in turn worsen your mental stability.

How food can lift your mood 

Enjoying a wide variety of vegetables, fruits, nuts, seeds, wholegrain cereals, legumes, low-fat dairy, lean meat and oily fish are the best way to prevent and improve psychological problems. If you’re eating a healthy well-balanced diet of whole foods that contain a variety of nutrients, you’re more likely to feel calm, be in a better mood and think through workable solutions for your problems.

Some components of these diets that may be important for mental health include:

  • Increasing the intake of omega-3 fatty acids, found in fish, flaxseed, chia seeds and walnuts, to help fight off feelings of depression
  • Loading your plate with mood-supporting food by eating a rainbow of fruits and vegetable every day
  • Sprinkling in magnesium-rich foods such as almonds, spinach, pumpkin seeds and sunflower seeds which support sound sleep
  • Including whole grain products such as brown bread, brown rice, oatmeal, millets etc…which are fibre-rich foods and can promote the growth of good gut bacteria known to have a positive effect on mental health
  • Adding fermented foods like idli, dosa, kanji, dhokla, curd and cheese in the daily diet can also help the mood component through probiotics
  • Eating plenty of dopamine-building foods such as fish, poultry, eggs, leafy greens and legumes will increase your energy level, motivation and prevent depression, forgetfulness, insomnia etc
  • Limiting sugars in your diet as much as possible can help prevent abnormal body weight, depression and metabolic syndrome. Including natural sugars daily through whole fruits and root vegetables is an excellent health-promoting behaviour
  • Getting enough vitamin D rich foods in your diet is associated with low risk of depression and mood disorders. Vitamin D can be found in fatty fish, dairy products, egg yolks, orange, soy milk and sunshine
  • Keeping up your daily water intake is vital to maintain hydration and help you to feel more alert and productive.

How food can lower your mood 

Studies show that today’s diet is higher in processed foods with plenty of added salt, sugar and unhealthy fat and can increase the risk of depression and anxiety. If people feel a lack of motivation and energy they find foods such as chips, soft drinks, junk foods, preserved and processed foods. Unfortunately, a diet focused on these types of foods is more likely to aggravate symptoms of depression and anxiety.

  • If you aren’t eating at regular intervals and not getting enough calories, you may end up feeling foggy, tired and low in energy
  • Skipping meals, particularly breakfast, saps your energy and leaves you in a foul mood throughout the day
  • A diet lacking essential vitamins and minerals can cause depression, inability to concentrate and chronic fatigue. Moreover, it disrupts the brain cells and alters mood and behaviour
  • Chronic imbalance between the healthy unsaturated fatty acids (MUFA, PUFA) and unhealthy saturated fatty acids, particularly a lack of omega 3 fatty acids in the diet, has been linked to mental health problems
  • Habitual consumption of processed foods contribute to a larger waistline, feeling of sluggishness and quite often to insulin resistance and inflammation

Insulin levels: Some processed foods especially those with large amounts of added sugars can cause insulin levels to spike and drop rapidly, causing hunger to occur again fairly quickly.

Inflammation: Chronic inflammation can be a result of a diet that includes a large amount of processed and manufactured foods. This leads to elevated levels of C-reactive protein, which is associated with increased risk of psychological distress and depression.

As a nutritionist, my biggest challenge is to help my clients achieve their cardiovascular and overall health goals by altering their nutritional behaviour slowly but steadily. It is the integrated teamwork of the physician, physiotherapist, counselling psychologist and myself that helps achieve the desired physical and mental wellbeing in all our clients. We help our clients understand that just as heart rate and blood pressure are clear indicators of heart function, mental health, physical activity and dietary patterns are equally important parameters of cardiovascular health.

The take-home message:

  • Choosing healthy foods may help you to feel well and happy
  • A balanced wholesome diet may help to prevent and improve symptoms of depression and anxiety
  • Keeping a regular stock of healthy foods at home and work can help, eg. nuts, raisins, dried fruits etc.
  • Consume foods high in fibre to provide a sense of fullness
  • Drink fresh water throughout the day
  • Watch your alcohol intake

 

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SLAM score for heart health

We all love a competition now and then! A running race, a sack race, a bicycle race, a swimming race, a painting competition, a cooking competition, the list is endless. But we all like winning, no matter who or what is up against us.

So dear friends, let me introduce a new kind of competition to you! One in which you have to compete not against humans or gadgets, but against some of your own health-related behaviours. Yes, you are up against your own lifestyle risk factors (as shown in the left column) caused by your everyday behaviours (listed in the right column) in the table below.

Risky Lifestyle 

Negative behaviours that put your health at risk
1. Sedentary life 1.       Jobs that require long sitting hours

2.       Long commute in a bus/car/motorised vehicle

3.       Television/computer/mobile phone for entertainment

4.       Lack of awareness and interest in active lifestyle

5.       Inability to exercise due to poor time management

6.       Not establishing an exercise schedule that is sustainable
2. Unhealthy diet 7.       Consuming things without knowing their benefits/harms

8.       Not maintaining proper meal times

9.       Failure to make meal times an enjoyable family time at home

10.    Rewarding children/self with unhealthy treats

11.    Binge eating or force-feeding yourself/kids

12.    Ignorance about food labels and shelf life of foods/beverages

13.    Lack of interest in locally available natural ingredients
3. Addiction to tobacco/alcohol 14.    Giving in to peer pressure

15.    False belief that consuming tobacco/alcohol is trendy

16.    Associating abuse of substances with better quality of life

17.    Seeking relaxation in substance abuse

18.    Unaware of the poisonous chemicals they contain

19.    Reluctance to seek professional help to quit
4. Chronic mental stress 20.    Taking on more responsibility than you can handle

21.    Failure to recognize the stress triggers and your reactions

22.    Trying to conceal your emotions and feelings

23.    Not practicing any stress management technique

24.    Considering mental health problems a stigma

25.    Self-blame and not giving yourself a chance to feel better
5. Poor sleep habits 26.    Not knowing that sleep is as essential as water and food for us

27.    Spending too much time on the screen/monitor/gadget

28.    Not maintaining proper sleep hours while working/studying

29.    Consuming a lot of stimulants and energy drinks

30.    Taking sleeping pills on a regular basis

 

   

 

Self-Lifestyle Analysis and Monitoring score (SLAM score)

Using the 30 health behaviours and the 5 lifestyle risk factors listed in the table, each one of you can score yourself:

For each health-related behaviour you have, you get -1 point.

For each lifestyle risk factor you have, you get -4 points.

The worst SLAM score (if you have all the behaviours and risk factors) is -50 [that is, (-1×30 = -30) + (-4×5 = -20)=-50].

For example, if you are a bank employee who sits at the counter all day, commutes 45 minutes up and down to work by train, has a busy work schedule and a tight routine at home without much time for yourself, eats at odd hours and has a lot of ongoing stress due to work pressure and expectations at home, and gets less than 6 hours of sleep on average per day, it is highly likely that your SLAM score is in the unhealthy range (-20 to -40).

The ideal SLAM score

If you have identified your unhealthy behaviours and lifestyle risk factors and are ready to change for the better, your SLAM score is 0. Yes, for the first time getting a zero feels good! However, the ideal SLAM score is not 0, but +50. If you have a negative score, converting the negative score to a positive score will drastically change your health for the better. If you have a -20, the success is in gradually modifying your lifestyle to reach +20 within 3-6 months and aim for +50 in a year’s time.

Slow and steady changes to the unhealthy behaviours in a manner that is enjoyable and sustainable is the only way to reverse a negative SLAM score. The impact of these changes on your energy levels, fitness, confidence, cardiovascular health and overall health will be enormous.

The table below will help you make a plan on what behaviors to work on and how to achieve a healthy lifestyle. Each healthy behavior gets +1 point and each healthy lifestyle +4 points. My suggestion is to take one at a time, work on it till you’re sure you’ve got it right and then take up the next one. Be kind to yourself, don’t rush everything, and most importantly enjoy the transformation!

Healthy Lifestyle Positive behaviours that nurture good health
1. Regular exercise 1.      You take active breaks in between your long sitting hours

2.      You walk/cycle for at least a part of your long commute

3.      You prefer the outdoors than gadgets for entertainment

4.      You exercise on most days of the week for at least 30-40 minutes

5.      You manage your time well at work and home

6.      You establish an exercise schedule that you enjoy and adhere to
2. Healthy diet 7.      You understand the benefits and harms of what you eat/drink

8.      You stick to proper meal times

9.      You and your family enjoys the meal times at home

10.   You do not use unhealthy treats as rewards

11.   You do not binge eat or force-feed

12.   You read food labels and know the shelf life of foods/beverages

13.   You consume fresh locally available fruits, veggies and whole grains
3. No tobacco/alcohol use 14.   You resist peer pressure

15.   You know that consuming tobacco/alcohol is not trendy

16.   You know that abuse of substances is harmful for your health

17.   You have healthy relaxation strategies in place

18.   You understand that each cigarette has several poisonous chemicals

19.   You seek professional help to quit
4. Well managed stress 20.   You only take as much responsibility as you can handle

21.   You know your stress triggers and your reactions to them

22.   You do not mask your emotions and feelings

23.   You manage your stress with exercise/yoga/meditation etc.

24.   You recognize that mental health problems are not a stigma

25.   You seek help and give yourself a chance to feel better
5. Good sleep habits 26.   You understand that sleep is as essential for us as water and food

27.   You avoid viewing bright digital screens late into the evening

28.   You get 6-8 hours of sleep on most nights

29.   You avoid energy/stimulant drinks and go for fresh homemade ones

30.   You only take sleeping pills when prescribed and for short periods

 

 

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10 Golden rules to incorporate exercise while at work

Nowadays, we are so busy with work that exercise is completely missing from our daily routine. Especially, the younger generation is glued to the chair for long hours, working on computers, watching television and studying for exams. This causes many unwanted reactions in the body, often leading to chronic health issues. Lack of exercise is a major reason for the growing rate of obesity, diabetes, high blood pressure and heart disease. In this blog post, let me guide you through 10 golden rules that can be incorporated in your busy work day to change your lifestyle from sedentary to active.

      

  1. Avoid taking the lift; instead, you can use the stairs for climbing up and down. This is a great way to improve your cardiac and lung function and tone up your legs.
  2. Park your vehicle at a distance from your office and walk a while; or use the public transport system so that you compulsorily move those lower limbs.
  3. Go for a walk to the pantry and have your (healthy) snack or beverage instead of having it in your cabin.
  4. Drink water at regular intervals so that you will get up more often to walk to the loo.
  5. Walking meetings can be organised instead of sitting in a cold conference room. It not only adds up to your day’s exercise but also improves your brain function and your work performance.
  6. Avoid using the intercom facility and move around the office to communicate with your colleagues.
  7. Use your lunch break for a short walk.
  8. Do at least 5 minutes of stretching exercises at the end of every hour of desk job.
  9. If you travel frequently on work, use the opportunity to walk in the train station or airport before boarding.
  10. Form interest-based groups amongst your colleagues so that you can plan group activities during after-work hours and on your off days.

Hope you enjoy implementing these simple but effective measures to pep up your activity levels and preserve your heart health.

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The Healthfulness of Spices

Spices not only just excite your taste buds but are also composed of an impressive list of phytonutrients, essential oils, antioxidants, minerals and vitamins that are essential for overall wellness. Spices come from a variety of tropical plant and tree parts, such as seeds, fruits, roots, buds, stems and barks. Spices have been an integral part of our food for centuries, and today, become even more relevant in preserving good health as their popularity has widened and usage reached almost all the households on the planet!

Classification of Spices

Spices can be categorized botanically according to their source as follows:

  • Leaves of aromatic plants: Examples include bay leaf, rosemary, thyme, etc.
  • Fruits or seeds: Examples include fennel, nutmeg, coriander, fenugreek, mustard, and black pepper, etc.
  • Roots or bulbs: Examples include garlic, turmeric, ginger, etc.
  • Bark: Cinnamon, Cassia, etc.

In this post, you will learn about the various healthy spices along with their nutrition facts and health benefits:

  Cardamom – ஏலக்காய்

Cardamom is a seed pod, known for centuries for its culinary and medicinal properties. There are two kinds of cardamom used in Indian cooking: green and black. Green is the more common variety, used for everything from spice mixes to lassies to Indian desserts. Green cardamom can be blended whole when making spice mixes, like garam masala, however, when using them in sweets or desserts, you would pop the pod open and lightly crush the fragrant black seeds before using.

Black cardamom, on the other hand, is very powerful and smoky and needs to be used with a lot of caution. Normally only the seeds would be used, and if using the whole pod, it’s best to pull it out before serving the dish, as it can be very spicy to bite into.

  Nutrition facts

  • Cardamom is rich in various vitamins and micronutrients as well. These include niacin, pyridoxine, riboflavin, thiamine, vitamin A & C, sodium, potassium, calcium, copper, iron, manganese, phosphorus and zinc.

 Benefits of cardamom

  • Helps improve cardiovascular health
  • Aids in improving blood circulation
  • Treats nausea, sore throat, vomiting and hiccups
  • Reduces risk of colorectal cancer
  • Helps to cure stomach disorders

 Clove – கிராம்பு

Clove is a common spice in Indian cooking and it’s easily recognizable in many Indian preparations. The strong, almost medicinal flavour of clove comes from the concentration of essential oils. Cloves are technically flowers, and a lot of their oils are pressed out before they are dried and used in cooking. Cloves can be used whole or blended into spice mixes.

 Nutrition facts

  • Minerals in cloves include calcium, iron, magnesium, phosphorous, potassium, sodium and zinc
  • The vitamins found in them include vitamin C, thiamine, riboflavin, niacin, folate, vitamin B6, vitamin B12, vitamin A, vitamin E, vitamin D, and vitamin K

  Benefits of clove

  • Helps to control blood sugar levels
  • Protects liver against infections
  • Prevents bone erosions
  • Gives relief from inflammation & pain
  • Helps to cure oral diseases like gingivitis & periodontitis

  Cinnamon – இலவங்கப்பட்டை

Cinnamon is one of the highly prized items that have been in use since ancient times for its fragrance, medicinal and culinary properties. This delightfully exotic, sweet-flavoured spice is traditionally obtained from the inner brown bark of Cinnamomum trees. Cinnamon is used mainly as an aromatic condiment and flavouring

  Nutrition facts

  • Cinnamon contains vitamins and minerals that help to maintain good health. They contain nutrients which include water, protein, fibre, sugar, vitamins, and minerals. It also contains a very low level of fat
  • Minerals such as calcium, iron, sodium, potassium, magnesium, phosphorous and zinc are found in cinnamon. In terms of vitamins, they contain vitamin C, vitamin B6, folate, niacin, and riboflavin. It also contains vitamin A, D, E and K

   Benefits of cinnamon

  • Prevents coronary artery disease and high blood pressure
  • Removes blood impurities and improves blood circulation
  • Controls blood sugar in diabetics
  • Relief from menstrual discomfort and cramping
  • Provides relief from the stiffness of muscles and joints

  Black pepper – கருமிளகு

Black pepper is the fruit of the black pepper plant from the Piperaceae family and is used as both a spice and medicine. It is regarded as the “king of spice,” black pepper is an incredibly popular spice since ancient times. It is not a seasonal plant and is, therefore, available throughout the year. When dried, this plant-derived spice is referred to as a peppercorn. Because of its antibacterial properties, pepper is used to preserve food. Black pepper is also a very good anti-inflammatory agent.

   Nutrition facts

  • Black pepper is a rich source of minerals like manganese, copper, magnesium, calcium, phosphorus, iron, potassium, and vitamins like riboflavin, vitamin C, K and B6.
  • It has a high content of dietary fibre and has a moderate amount of protein and carbohydrates too.

   Benefits of Black pepper

  • It aids in weight loss and cures vitiligo
  • Provides respiratory relief
  • It prevents earaches and gangrene
  • Reduces risk of cancer, cardiovascular and liver ailments
  • Improves cognitive function

    Cumin –  சீரகம்

Cumin (Cuminum cyminum) is a flowering plant which belongs to the family Apiaceae. Cumin seeds are extensively used as a condiment or a spice in culinary practices of the Indian Subcontinent and some other Asian, African and Latin American countries. Both whole and ground cumin is used as a staple in various dishes due to its distinct warm and earthy flavour. Because of its strong aroma, only a small amount of cumin essential oil is used in recipes to provide them with a powerful punch. Both cumin and cumin essential oil boasts a number of important nutrients that can help keep you healthy.

     Nutrition facts

  • Cumin is an excellent source of iron, manganese, magnesium, calcium, phosphorus, thiamine, riboflavin, niacin and vitamin A, C, E, K, B1and B6
  • It contains minerals such as copper, zinc, and potassium
  • It is also rich in protein, amino acids, carbohydrates and dietary fibre
  • It is very low in saturated fats, sodium, and cholesterol.

        Benefits of Cumin

  • Regulates digestion
  • Beneficial for lactating mothers
  • Cures piles
  • Improves memory

Coriander Seeds – கொத்தமல்லி விதைகள்

Coriander is probably the most universal of spices in the Indian spice rack. It is one of the oldest-known spices in the world, and it’s characterised by its golden-yellow colour and gently ridged texture. The seeds are very aromatic with citrus notes. Whole coriander is used as a base for many spice mixes, and ground coriander is one of the most commonly used ground spices in Indian cuisine. It is a very popular ingredient in Asian dishes and curries, but they are also used in the making of sausage, stew, soup, bread, and in pickling vegetable. Some people even use coriander seed in the process of brewing beer.

        Nutrition facts

  • Coriander seeds are packed with nutrients, including high levels of dietary fibre, antioxidants, B vitamins, vitamin C, potassium, manganese magnesium, iron, zinc and calcium
  • These seeds also provide a moderate amount of protein and fat and the smell of coriander comes from its antioxidants and volatile oils, which include linoleic acid, oleic acid, Linalool, alpha-pinene, and terpene, among others.
  • Reduces cholesterol levels & high blood pressure.

      Benefits of coriander

  • Reduces cholesterol levels & high blood pressure
  • Promotes healthy bones
  • Beneficial for diabetics
  • Prevents conjunctivitis and macular degeneration
  • Gives relief from anaemia

Fenugreek seeds – வெந்தய விதைகள்

  • Fenugreek is an annual plant that is also known as methi in many parts of the world. The seeds are yellowish and look like tiny wheat kernels. It can be used for three distinct purposes: The leaves can be dried and used as herbs, the seeds can be ground into a spice, and the plant matter itself can be used as a vegetable, like sprouts and micro greens.

         Nutrition facts

  • It contains a variety of beneficial nutrients, including iron, magnesium, manganese, and copper, as well as vitamin B6, protein, and dietary fibre
  • Fenugreek also contains a number of powerful phytonutrients, including choline, trigonelline, yamogenin, gitogenin, diosgenin, tigogenin, and neostigogenins.

         Benefits of fenugreek

  • Lowers risk of heart ailments, dyslipidemia & kidney problems
  • Relieves constipation
  • Controls diabetes
  • Good for lactating mothers
  • Minimizes symptoms of menopause

Nutmeg and Mace –  ஜாதிக்காய் மற்றும் ஜாதிக்காய் தோல்

  • These spices nutmeg and mace are used a lot in Indian cooking. Mace is the dark-red outer covering of the nutmeg. Fresh nutmeg is processed by removing the pulpy outside and sliding off the mace. It has a tough outer covering that needs to be cracked off before grating. When dried, mace turns golden-orange and gives stronger in flavour than nutmeg. In our diet, they can usually be interchanged when preparing sweet dishes.

         Nutrition facts

  • The nutritional profile of this spices contains vitamin A & C, iron, calcium, copper, iron, manganese, dietary fibre, B vitamins
  • The spice has a small amount of fat, and a high concentration of volatile acids and antioxidants, such as myristicin, carotenoids, Linalool, pinene, cineole, and eugenol etc.

         Benefits of nutmeg & mace

  • Boosts digestive and bone health
  • Helps to dissolve kidney stone
  • Reduces skin inflammation & irritation
  • Provides relief from insomnia

Mustard – கடுகு

Mustard is a versatile cruciferous vegetable which belongs to the Brassica family just like broccoli and cabbage. Mustard seeds can be yellow, black, or brown and are used interchangeably in Indian cooking. The flavour of mustard seeds is released when they are crushed or cooked in oil. Their smoky, nutty flavour is a staple in curries and curry powders, and mustard oil is commonly used in the North of India.

         Nutrition facts

  • Seeds of its plant are a rich source of minerals such as calcium, magnesium, phosphorous and potassium
  • Along with this, it is a good source of dietary folate and vitamin A as well. Mustard greens or leaves of mustard plants are an excellent source of essential minerals including potassium, calcium and phosphorous and vitamin A, K and C
  • It is also a good source of magnesium and dietary fibre

         Benefits of mustard

  • Reduces risk of cancer and cardiovascular diseases
  • Aids in managing diabetes and cholesterol levels
  • Relief from respiratory disorders
  • Helps in curing pains and spasms
  • Effective in treating psoriasis and chronic bronchitis

Turmeric – மஞ்சள்

Turmeric is another common Indian spice and it’s closely related to the other members of the ginger family. This also makes it a popular ingredient in soups, sauces, curries, meat dishes, biscuits, rice preparations and as general spice flavouring for dozens of other cultural dishes and specialities. The flavour of fresh turmeric is slightly stronger than dried, and it stains very easily, so make sure you are careful with your clothes and utensils while using it.

         Nutrition facts

  • Turmeric is one of the most nutritionally rich herbs. It contains good amounts of protein, vitamin C, calcium, iron, dietary fibre and sodium
  • It also provides a rich supply of antioxidants, vitamin B6, potassium, magnesium, and manganese

         Benefits of turmeric

  • Helps in reducing stress and depression and maintaining heart health
  • Useful for treating gastrointestinal disorders
  • Helps to detoxify the body
  • It helps to prevent cystic fibrosis and cancer
  • It reduces menstrual pain and gives relief from nausea, fatigue, pelvic pain and cramps.
  •  
  • To summarise, the above-discussed spices provide innumerable benefits to our health and should be used in our daily cooking. Besides adding flavour and taste to dishes, they help prevent and alleviate various health problems. Instead of salt, you can choose one or more of these spices to replace it with various dishes like stew and soups, fruit and vegetable smoothies, salads, meat and seafood.
  • “Adding flavour with spices makes food taste better and adding spices to foods makes it easier to reduce added sugars, excess salt and saturated fats without reducing appeal”.

    Live Life With A Little Spice!

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5 Tips to travel the heart-friendly way

It is that time of the year when many of us are making plans to travel. Whether it is a short weekend trip or a long journey to a faraway place, there are some things to take into account before you go on a holiday, especially if you or your loved ones have been diagnosed with a cardiac condition.

Rule no.1: Get your doctor’s green signal

It is very important to discuss with your doctor prior to finalizing your holiday; a thorough check-up is warranted to ensure that you are medically stable and fit for travel. The location that you are planning to visit, the weather conditions there, the activities that you intend to engage in and the accessibility to healthcare are some of the key points that your doctor will expect you to know about, based on which you will be allowed or advised against the proposed trip.

For instance, if you have high blood pressure and coronary heart disease, travel to a high altitude location and engaging in activities like hiking at high altitude needs extra preparation and care. On the other hand, if you would like to do voluntary work in a remote village, identifying a hospital nearby will be key to ensuring a safe trip.

With device therapy for the heart (like pacemakers and ICDs)becoming commonplace, it is important to keep a device-card to show to the airport security check personnel (as metal detectors can beep due to the metal parts in a cardiac device).

Rule no. 2: Stock up on your medicines

The last thing you want to be doing on your holiday is search desperately for a medical shop that has a supply of your prescription drugs! Purchase your medications before leaving as per the number of days of travel (keep some extra stock for those unplanned extensions) and make a note of the expiry date of all meds. Keep a copy of your prescription handy in your hand baggage as you tuck away some pills for use during the commute. Be aware of the ideal storage requirements of your drugs (as you neither want your insulin frozen nor your capsules melted).

If your doctor is adjusting your BP or sugar medicines based on weekly readings, try not to leave on a vacation until the dosing and the BP has stabilized. I recently had to provide emergency medical care for an elderly lady on an international flight. She was being treated for hypertension and had left on a long flight journey within 2 days of a major adjustment to her medication. Her BP shot up to dangerous levels during the flight and she was almost in a hypertensive crisis but we were able to bring things under control.

Rule no. 3: Opt for a good travel Insurance scheme

There is nothing like good travel insurance coverage to take care of your unexpected illnesses while away from home. Many factors such as length of holiday, nature of disease and requirements of your destination country should be considered prior to buying travel insurance. It is a good idea to read the fine print to understand what is covered and what is not.

Rule no. 4: Read about any health warnings or vaccine requirements

While travelling is a pleasant experience and holds a special place in our hearts, it is mandatory to check for any health risks such as viral infections or endemic illnesses that could be a cause for concern for you. Likewise, if any vaccines have to be taken prior to arriving at a particular destination, you have to comply with that requirement to prevent any travel-related infections.

Rule no.5: Make time for health-promoting activities

Once you’re off on your vacation, do not forget to eat healthily, to get your daily dose of exercise and to immerse yourself in the new environment. While eating healthy can be more challenging outside than at home, focusing on natural and less processed foods and keeping some healthy snacks like nuts and fruits for your hunger pangs are tips to follow.

While you may be walking around monuments and natural spectacles, keep a track of how much activity you are getting and top it up with simple exercises like warm-ups, cool-down stretches and strength training while on the move. A practical suggestion is to keep a health diary (on a phone or any other device or on paper) wherein you record any changes in your health status and any new medicines or therapy you follow while travelling.

In conclusion, the most important rule is to have a lot of fun with the confidence that you have planned well in advance and taken all the necessary precautions.

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Control high blood pressure by eating right

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

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

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

There are two versions of the DASH diet:

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

Foods to be included more in your daily diet

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

Foods to be kept to a minimum

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Examples: Milk, yogurt, cheese etc

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

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

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

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

Examples: Chicken, fish, egg etc

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

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

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

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

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

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

1 serving = 1 tablespoon vegetable oil

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

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

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

Health Benefits of the DASH diet

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

More DASH Tips

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

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

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

The two steps to be followed in this technique are:

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

Who should do it?

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

Before starting…

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

Steps

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

Note

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

Benefits

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

Contract-Relax and Feel Relaxed

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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.

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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.

cardiacwellnessinstitute.com/images/issaltavillain.pdf

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.

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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.

 

 

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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.

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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.
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Cool tips for a hot workout

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

 

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

Symptoms: Heavy sweating and muscle pain or spasm.

Treatment: Stop your exercise and drink water.

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

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

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

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

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

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

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

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

Plan your workout

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

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

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

 

Tips for a cool and refreshing outdoor summer workout

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

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

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

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Medications for your heart, in a nutshell

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

Antithrombotic or blood thinning drugs

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

Commonly used blood thinners are:

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

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

Antihypertensive drugs

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

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

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

Antidiabetic drugs

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

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

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

Cholesterol-lowering drugs

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

Antifailure drugs

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

Antiarrhythmic drugs

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

Nutritional Supplements

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

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

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

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

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Staying Cool by the Pool

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

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

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

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

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

Watermelons

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

Lemons

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

Pineapples

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

Muskmelons

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

Sweet Limes

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

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

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

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Psychosocial counseling can reverse heart disease

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

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

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

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

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

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

 

 

 

 

 

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Exercise and Ageing – Made for each other

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

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

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

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

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

The benefits of regular exercise are:

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

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

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

Exercise tips

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

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

THIS IS THE DAY TO START DOING EXERCISE

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The sweet danger of sugar

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

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

Simple Sugars

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

Complex Sugars

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

Natural sugar

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

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

Added sugar

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

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

How much sugar can be consumed on a daily basis?

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

How many calories does one teaspoon of sugar contain?

Amount         –  1tsp (4.2g)

Calories          – 16 kcals

Carbohydrate  – 4.2 g

Health risks of eating too much sugar

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

Artificial sweeteners

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

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

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

“ Eat less SUGAR;

You’re SWEET enough already”

 

 

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Understanding the difference between heart attack and cardiac arrest

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

Heart attack: sequence of events

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

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

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

So what is a cardiac arrest?

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

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

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

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

Important points to note:

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

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