Added sugar and its impact on our health

As a nutritionist managing the diet and lifestyle of individuals with heart ailments and comorbidites like diabetes, hypertension, obesity and chronic renal failure, I am hugely concerned about the alarming surge in people’s sugar intake! If you are wondering about what sugar is and what the difference is between natural and added sugar, I recommend you go through our earlier article

Now that you understand some basics about sugar, let us see how added sugar is detrimental to our overall health and our heart health in particular. The below image outlines all the detrimental effects of excess sugar in our diet. It is important to realise that making simple lifestyle changes like cutting down on sugar intake can reduce the risk of all of these and even other ailments like cancer and multi-organ damage.

The link between excessive sugar consumption and heart disease is worth elaborating upon. High levels of sugar in the blood can damage the inner walls of the blood vessels leading to coronary artery disease, heart attack and heart failure. This is one of the key reasons for heart problems and sudden death in youngsters today.

The vicious cycle

Habitual intake of sugary foods leads to several nutritional deficiencies which in turn are notorious triggers of sugar cravings. This vicious cycle has to be broken.

There are three steps in the fight against excess sugar consumption. When we explain to our clients these tips and tricks, they are often empowered to start taking the initial steps to overcoming the sugar addiction.

  1. Know the villains

Excessive sugar in the diet is the number 1 villain. And the main reason we consume so much added sugar is the addiction for sugar! Just like tobacco and alcohol, sweet dishes and treats are addictive. It is a ‘just a habit’ or ‘a harmless act’ as many would call it. But reaching out for chocolates, biscuits, candies and cookies after a meal or indulging in sweet snacks more than occasionally are truly harmful habits. Quite often, it is these small habits that add up to a critical health hazard.

You should be aware by now that added sugars are the secret ingredient in many packaged foods. Some common aliases for this villain are:

  • High-fructose corn syrup
  • Cane sugar or sucrose
  • Brown sugar
  • Honey
  • Agave syrup
  • Maple syrup
  • Fruit juice concentrate
  • Molasses

Huge amounts of sugar are added to soft juices, energy drinks, alcoholic drinks, soda, fruit drinks, pasta sauce, iced coffee and teas, bakery products like brownies, cookies and doughnuts, ice cream, salad dressing and even packaged yogurt. Reading food labels is one easy way to identify the level of added sugars in packaged foods, but be aware that most bakery items do not come with food labels and are nevertheless loaded with sugars!

2. Replace the villains with heroes

You want to cut down on added sugars but are there any foods to make up for that? Yes, there are some sugar-rich natural foods, the real heroes that are full of natural sugars like fructose, maltose and lactose, as detailed below.

  • Fruits (all fruits contain fructose which is a healthy form of sugar)
  • Vegetables (root vegetables like carrot and beetroot have more natural sugars than other vegetables)
  • Dairy products (lactose is the natural sugar present in dairy products)
  • Whole grains (the natural sugar maltose is present in several grains like wheat, barley and corn)

So go ahead and include at least 4-5 portions of fruits and vegetables, 2-3 portions of whole grain dishes and adequate dairy products in your daily diet and notice the difference! Your body will stop craving for sweet dishes simply because you are fuelling it with sufficient healthy and natural sugars! We should also be clear that sugar is an essential dietary component as long as it is consumed as natural foods and not in the form of added sugar.

3. Use hidden heroes to break the addiction

The hidden heroes are nothing but non-dietary measures that will help you to stay active physically and mentally and beat that boredom or depression, both of which are prime reasons for giving in to that sweet temptation.

Some hidden heroes that our clients have found useful in breaking their sugar addictions are:

  • Regular exercise
  • Adequate sleep
  • Sufficient hydration
  • Emotional balance / psychological support
  • Peer groups / Social circles with similar interests
  • Pursuing hobbies
  • Volunteering / social work
  • Creative arts / music / dance

In summary, sugar is not always a foe. It is definitely a friend and a key component of a healthy balanced diet provided we know how to stay away from those added sugars that are actually nothing but sweet-looking (and tasting) devils!


Post COVID Syndrome and ways to Overcome it

While you may be aware of the symptoms of COVID-19 by now, it is equally important to know that around 20% of those who recover from the acute phase of the infection may continue to have health issues in the weeks and months that follow, this is known as post-COVID syndrome. With a high rate of recovery in India, several individuals are struggling to cope with the aftermath of the infection. There is strong scientific evidence to show that a medically supervised rehabilitation program helps in the complete recovery from this post-COVID syndrome.

Individuals affected with COVID-19 may be left with physical and mental impairments such as:

  • Impaired lung functions
  • Severe muscle weakness
  • Joint stiffness
  • Fatigue
  • Limited mobility and ability to do daily tasks
  • Delirium and other cognitive impairments
  • Difficulty in swallowing and communicating
  • Mental health disorders and psychosocial support needs

It has been found that not only does the presence of diabetes pose a threat when it comes to recovery from COVID-19, but non-diabetic persons may also develop diabetes as a complication of the COVID-19 infection. Both the direct effect of the virus on sugar metabolism as well as the indirect effect of steroid medications on blood sugar levels have been implicated in this. The impact of the coronavirus on the heart has also been recognised. Acute inflammation of the cardiac cells known as myocarditis, blocks in the coronary arteries leading to heart attack and abnormal heart beat known as arrhythmias are some established cardiac complications of the COVID-19 illness.

Post COVID rehabilitation is the need of the hour to improve the overall wellbeing of individuals by  improving their lung function, functional capacity and exercise tolerance, by enabling early return to work and daily routine and by enhancing psychosocial wellbeing.

The main focus areas in post COVID rehab as outlined by the World Health Organization, European Respiratory Society and American Respiratory Society are:

  1. Improve lung functions
  2. Decrease fatigue at rest
  3. Improve mobility and joint functions
  4. Prevent further muscle weakness
  5. Provide customised exercise training
  6. Provide appropriate dietary advice
  7. Provide adequate psychological counselling
Benefits of Post COVID rehabilitation

Individuals recovering from COVID-19 are advised to focus on some self management techniques as follows:

  • Improving lung functions and breathlessness

Breathing exercises such as diaphragmatic breathing exercise and thoracic expansion exercise will help to improve lung expansion and avoid further deterioration. Forced expiratory technique such as coughing and huffing will improve the bronchial hygiene and also assist in expectorating the mucus. Breathing exercises are proven to decrease the severity of breathlessness and paves the way for being more active.

  • Improving fatigue and exercise intolerance

Fatigue and exercise intolerance are the most common symptoms of post-COVID syndrome and can be managed by appropriate exercise training. Exercise capacity testing is a must to identify the level of functioning and to administer appropriate exercise training. A combination of aerobic exercises, resistance exercises that improves muscle strength and endurance and breathing and flexibility exercises is a must for rapid recovery. Activity pacing and energy conservation techniques should be advised such that it avoids the onset of fatigue and also aids exercise performance.

  • Improving psychological health and mental wellbeing

Survivors of COVID-19 face several psychosocial challenges such as stigma in the living community, at work, at social gatherings and public places. This in turn can result in insomnia, isolation, anxiety, depression and other psychological disorders. It is important that the rehab program provides counselling, reassurance, coping skills, and emotional support to overcome this stressful period.

  • Improving dietary intake

A healthy balanced diet is key to full recovery from any illness. Consumption of fruits & vegetables, protein rich foods and whole grain products with appropriate vitamins and minerals and staying away from unhealthy foods like fast food, packaged food, fatty food and artificially sweetened dishes will aid in the speedy recovery from the coronavirus.

We at Cardiac Wellness Institute are providing Post COVID Rehabilitation through a completely online service. You may contact us at +919902155772 for further information.


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
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,

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,

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.


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.


Foot care tips for diabetic individuals

I am glad to share one more interesting post here. We all know about diabetes mellitus but to our surprise and shock, around 425 million people are affected by diabetes in India. By the end of 2045, this is expected to rise up to 151 million people (ref 1 below).

Diabetes is a condition where the body is unable to properly utilise the sugars and starch in our diet. Although medical management of the disease is advancing rapidly, there is unfortunately no magical cure for diabetes. Intensive lifestyle modification is the only way to reverse and potentially completely cure diabetes.

Treatment of diabetes aims to minimise complications and help people to manage the disease better. Regular exercise and a balanced healthy diet are the two major components of disease control apart from medication.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, neuropathy or dysfunctional nerve endings occurs in about 70% of people with diabetes, leading to pain, numbness, lack of sensations and also to harmful infections (ref 2 below).

In fact, neuropathy is one of the reasons for silent heart attacks in diabetic individuals. A holistic approach to diabetes is extremely important to prevent end-organ damage shown in the picture above.

Diabetes puts your feet at higher risk for calluses, corns, bunions, blisters, and ulcers which may become gateways to potentially disabling infections. That’s why the diabetic foot is an important complication you should know about. So in this thread, I’ll discuss some key points on how to take care of your feet if you are diabetic.

Foot Care Routine

Inspect your foot – Look at your feet for red spots, cuts, swelling and blisters. If you cannot see the soles of your feet, use a mirror or ask someone for help.

Wash your feet everyday– Wash your feet in lukewarm water (neither too hot nor too cold) and dry your feet with a towel, especially between the toes.

Moisturise – Apply skin lotion over the tops and bottoms of your feet, but not between your toes.

Trim toenails regularly – Trim your toenails straight across and file the edges with an emery board or nail file. 

Avoid walking barefoot – As sensations in your feet can be dampened, you may be unable to feel cuts and blisters which can become dangerously infected.

Take care of your diabetes – Work with your healthcare team to keep your blood glucose in your target range.

Wear diabetic friendly footwear – Support your feet with personalised footwear that is well-fitting, well-cushioned and protects your feet.

Quit smoking – As tobacco can also reduce circulation in the small blood vessels of your hands and feet and worsen the ability to feel pain, temperature differences etc, it is best to stay away from active as well as passive smoking.

Examination – Consult a podiatrist or foot specialist on a regular basis.

Burger’s Exercise:

This is an exercise that helps to improve circulation in your legs and prevent foot-related complications.


  • Lie down in head-up position and lift your leg up to 45 degrees upward (if necessary keep something to support your legs as in the picture)
  • Hold the position for 2-3 min
  • Then sit with knees hanging down for 2-3 min
  • Then lie down in head-up position for 5 min
  • Repeat for 4-5 times /session
  • Plan for 3 sessions daily


It improves peripheral circulation in your legs (ref 3 & 4 below).


Assistance and medical supervision may be required.

The three stages of exercise should be done continuously.





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”




Heart disease – what’s all the hue and cry about?

Blog 4, 1 old couple

Have you ever wondered, “Why is there such a hue and cry about heart diseases and more so, why is it much more now than a decade or two ago?”

The disease burden

Diseases of the heart and blood vessels such as heart attack, stroke and hypertension, known as cardiovascular diseases, are not only claiming more and more lives across the globe but are also posing an acute threat to the economic development of our subcontinent. While the statistics can make you dizzy, all you need to know is cardiovascular disease is the Number 1 killer disease amongst men and women today. The rising incidence of health problems like diabetes, high cholesterol and obesity, combined with harmful behaviors like smoking, alcoholism, unhealthy diet, inadequate physical activity and high stress levels are contributing equally if not more to this health crisis.

Cardiovascular diseases are multifactorial in origin, meaning there are several environmental and biological factors causing them. Though you might not be exactly sure what caused you or your loved one(s) to acquire the disease, you can be very sure of one thing: The lifestyle choices you make on a daily basis play a major role in causing as well as controlling the disease. There is therefore an urgent need to spread awareness about the risk factors and empower people with ways and means to better manage their health.

The risk factors can be broadly classified into modifiable (those that can be modified by us) and non-modifiable (those that our beyond our control) factors.

Blog 4, 2 family

Modifiable risk factors

  • Hypercholesterolemia (high blood cholesterol levels)
  • Hypertension (high blood pressure)
  • Diabetes (elevated blood sugar levels)
  • Overweight and Obesity
  • Physical inactivity
  • Unhealthy eating habits
  • Smoking
  • Excessive alcohol consumption
  • Psychosocial factors (such as chronic stress, anxiety, depression etc.)

Non-modifiable risk factors

  • Hereditary factors (genetic predisposition that runs in families)
  • Ethnicity (racial factors)
  • Age
  • Sex

I personally believe that the non-modifiable risk factors can also be modified but let’s save that for another day.


Healthy Lifestyle Choices

You would be surprised if I told you that your diabetes, hypertension and heart condition could be reversed. A healthy lifestyle characterized by regular physical exercise, balanced nutrition, and positive and healthy mindset is the building block for prevention and reversal of all cardiovascular diseases. While medical and surgical interventions are critical, addressing the risk factors by making the necessary changes to your lifestyle will go a long way in improving quality of life and keeping complications at bay.


A cardiac rehabilitation program is something you (and your family) should consider if you have had a heart attack, angioplasty or stent procedure, bypass surgery or other heart surgeries. Keep reading my blog entries for more useful info.