|
|
 |
 |
| Sunday, 15 August 2004 |
 |
|
 |
Features |  |
| News Business Features Editorial
|
Maintaining a healthy heart Over the last four decades there has been a steadily increasing mortality and morbidity from degenerative diseases of the heart and blood vessels among people of progressively younger age groups. Dr. D.P. Atukorale, consultant cardiologist, gives readers advice on how to maintain a healthy heart.
If there are no abnormal physical signs, your G.P. will refer you to a reliable laboratory (lab) to do certain lab tests such as urine full report, ECG, Lipid profile, fasting blood sugar, (FBS) and a full blood count (FBC). For those of you who are over the age of 40, or those with a family history of hypertension, diabetes mellitus, heart attacks or strokes, a check up at least once a year is a must. High Blood Pressure (Hypertension) It is common knowledge that hypertension if not diagnosed and treated causes heart attacks, strokes, heart failure and kidney failure. One of the commonest causes of sudden death is hypertension. Irrespective of your age, majority of physicians maintain the systolic B.P. below 150 mm Hg (ideally between 120 and 140) and diastolic BP below 90 mm Hg (ideally between 70 and 85 mm Hg). If your B.P. is elevated your G.P. will advise you to get the BP checked again in a few days. If the B.P. is still high your G.P. will advise you to: (a) get on to a low salt diet; (b) give up smoking if you are a smoker; (c) cut down your weight if you are obese or overweight; (d) stop or cut down the consumption of alcohol; (e) take regular exercises If the B.P. does not come down to normal with above measures, your G.P. will start you on anti-hypertension drug therapy. Of course, all anti-hypertension drugs have side-effects. Smoking Smoking is the commonest cause of heart attacks. Cigarette smoke contains about 4000 chemicals that are injurious to your health. Of these nicotine is the most important poison and this brings down your good cholesterol (HDL), increases the serum level of bad cholesterol (LDL), increases the clotting tendency of your blood, causes elevation of your blood pressure, causes tachycardia (rise in heart rate), and cardiac rhythm disturbances (palpitation). Cigarette smoke contains a poison gas called carbon monoxide which causes hypoxia (lack of oxygen) to vital organs such as the brain and the heart. When a smoker gives up smoking, the HDL returns to normal level and the high LDL level comes down in a few months. Hypercholesterolemia If your lipid profile report shows that your LDL (bad cholesterol) is too high (over 100 mg percent) your G.P. will advise you to take a low saturated fat, low cholesterol diet and to avoid consumption of beef, mutton, pork, and other animal products such as sausages, burghers, snacks such as cutlets and pastries. Your G.P. will advise you to take a non-fat milk powder and for frying purposes, he will advise you to take a polyunsaturated vegetable oil. But these vegetable oils have to be taken in moderation as excessive consumption of these can cause lowering of HDL. one word of warning about these polyunsaturated oils. If these are used for repeated frying dangerous, ketones, aldehydes, free radicals and transfats are formed an these transfats are carcinogenic and causes elevation of your LDL. The safest oil for frying purposes is unadulterated coconut oil and repeated frying does not result in production of dangerous aldehydes, ketones, free radicals and transfats. Coconut oil does not raise your serum cholesterol level or level of your LDL (bad cholesterol). HDL Cholesterol HDL is your good cholesterol and higher the HDL level better. Serum HDL level should be above 40 mg percent. People with low HDL are prone to heart attacks and the causes of low HDL are smoking, lack of exercise, obesity and consumption of too much of vegetable oils and so-called polyunsaturated margarine (which contain transfats). Alcohol in moderation raises your HDL. Consumption of avocado and cashew nuts in moderation is known to raise your HDL. In the same way, stopping smoking, cutting down your weight if you are obese and taking regular exercises results in elevation of your HDL cholesterol. Consumption of olive oil too, raises your HDL. If your LDL does not come down with dietary restriction mentioned earlier, your G.P. will prescribe anti cholesterol drugs such as Statins. Diabetes Mellitus Diabetes is one of the diseases your G.P. can diagnose long before you get full blown symptoms of diabetes such as increased thirst, frequency of nutrition and loss of weight by arranging for a blood sugar estimation. A significant number of patients with mild and moderate diabetes don't have glycosuria (sugar in urine). Once your G.P. confirms the diagnosis of diabetes he will advise you to take a diabetic diet and only in cases which cannot be controlled with diet, he will start you on hypoglyealmic agents and if necessary refer you to a physician. Diabetics are more prone to hypercholesterolemia and hypertriglyceridaemia (high serum levels of triglycerides) and they have high levels of serum LDL cholesterol (bad cholesterol) and are more prone to heart attacks, strokes and kidney failure. About 25 percent of diabetic patients get silent heart attacks, i.e., they don't get the typical angina pain when they develop myocardial infarction (heart attacks). Obesity Obese or overweight people are more prone to heart attacks, hypertension, hyperlipidaemia (high serum levels of cholesterol and triglycerides). Obese people are more prone to cancer. Your G.P. will advise you regarding a low fat, low calorie diet and regular exercise if you are obese or he may refer you to a dietician. When you take regular exercises your serum HDL cholesterol goes up and LDL cholesterol level comes down and collateral circulation of heart muscle improves, making you less prone to heart attacks. Both soluble and insoluble fibre which is present only in vegetarian diet are very important for your health. The soluble fibre which is present in fruits such as papaw and apples and vegetables such as carrots bring down your level of LDL (bad) cholesterol. Animal products do not contain fibre and fibre is abundant in whole grains, nuts, fruits and vegetables. People who don't consume fibre are more prone to cancer of colon (large bowel) so to maintain a healthy heart, consume plenty of fruits and vegetables. Consumption of tea, coffee and dark chocolate in moderation helps to prevent heart attacks as these contain polyphenols which have antioxidant action. Vegetarian Diet Vegetarian diet prevents heart attacks by 50 percent. Vegetarians are less prone to diabetes, obesity, hypertension and hypercholesterolemia. Serum LDL level of vegetarians is lower than that of non-vegetarians as they consume more polyunsaturated fats and monounsaturated fats. **** To maintain a healthy heart, (a) Get a check-up by your G.P. (b) Eat less salt (c) Eat less fat especially saturated fat (d) Eat few calories if you are overweight (e) Take regular exercises (f) Give up smoking (g) Eat more fibre and (h) Take more fruits and vegetables. Diabetes and exercise A considerable number of people, young and old in Sri Lanka suffer from diabetes. Regular exercise is one way of effectively controlling this disease. The following article discusses exercises that are specially recommended for diabetic patients. People with diabetes have to make changes in their life style such as giving up smoking, eating a healthy diet, and doing more exercises. Exercises are highly beneficial to people with diabetes. With regular exercises general health is improved, heart problems are reduced, high sugar levels are better controlled. Exercises stimulates the body to use glucose and greatly increases the body's insulin sensitivity. It is found that the effect is produced for about 12 hours or more by a single bout of exercises. Blood glucose level varies from person to person. So it is important to determine their own response to exercises. The intake of food (carbohydrate) the dosage of insulin or anti diabetic drugs taken has to be adjusted accordingly on medical advice before starting an exercise program. There are two types of exercises. Aerobic exercises - are quite beneficial to diabetic persons as it improves insulin sensitivity, blood glucose levels, blood pressure and lipid levels. Aerobics refer to any exercise that helps you use oxygen more efficiently. So activities like swimming, jogging, tennis, badminton, bicycling, rowing, aerobic dancing - old time and modern, using aerobic equipments - treadmill, stationary bike which are associated with movements over a reasonable period and the body uses a substantial amount of oxygen are good exercises. The best activity for those who do not like above exercises is brisk walking. Mild to moderate aerobic activities are a short walk around the block or garden, play actively with kids, rake leaves, mow the lawn or other garden work. All people have a maximum pulse or heart rate per minute. Your maximum pulse is approximately 220 minus your age. If you are 40 years old your maximum pulse is above 180. A sufficient pulse level during exercise for an ordinary person is approximately 60 per cent of the maximum pulse. Anaerobic exercises - are not generally recommended for people with diabetes as these physical activities are too sudden, rapid and stressful. These exercises produce fewer benefits and may be associated with a rise in blood pressure. So activities like motor racing, standard mountain climbing, long distance running and weight lifting are not recommended. Sometimes some of these exercises can cause hypoglycaemic reactions. Exercise session should begin with a gently 5-10 minutes warm up and stretching of the muscles to be exercised and concluded with 5-10 minutes cool down period. Twenty to forty minutes of moderate exercises, 3-4 times a week is very useful in getting favourable effects on blood pressure, blood fat, and heart functions. Moderate exercises means that it makes you puff a bit but be able to carry out a conversation during exercise taking a few puffs between sentences. For very elderly people who stay at home, active mobility exercises to maintain full range of movements in both arms, legs, neck, back and some exercises to maintain strength and balance are important. Some simple exercises are given below. * Stand in front of a wall facing it, reach up gradually crawling with fingers and bring hands down making a big circle as possible, follow your hands with eyes once to left and then to right. Repeat 8-10 times. * Take a towel and rub your back by holding the two ends of the towel, one arm behind the neck, the other arm behind the back and move hands up and down. Change hands and repeat the exercise. This can be done on standing or sitting on a low stool with feet on the floor. * Touch your shoulder with same hand and draw a big circle with the elbow. Do with both arms together. Repeat the exercise 8-10 times in sitting or standing. * Draw an imaginary circle with your nose. * Hold hands behind your neck, bring your elbows together in front and then backwards, repeat 6-8 times in sitting or standing. * Sit on a low stool and stand up. If you need support place your hands on a table or on a flat surface at the level of your waist. * Stand with one leg and change to the other leg. Support your hands if necessary. * Climb up a few steps regularly. It is better to do exercises 1-2 hours after meal. Morning is the best. Exercises present risks for some patients, so careful planning of the timing duration and type of activity and attention to diet around the time of exercises are important for diabetic people. Foot Injuries - To prevent blisters and other injuries, due to reduced sensation should wear well fitting shoes when exercising. Socks also should fit well. Those who have Retinopathy (a disease of the retina of the eye) should avoid strenuous exercises, which makes sudden increase in blood pressure, as it can cause bleeding from the blood vessels in the back of the eye. If symptoms like dizziness, weakness, shortness of breath are present, exercises should not be continued. Regular check-up of blood sugar level blood pressure and foot care are very important if you want to enjoy the exercise program and get the benefits. When you need further instructions about exercises it is better to meet your physiotherapist. by Mrs. P. J. S. Herath, Senior Physiotherapist |
|
News | Business | Features
| Editorial | Security Produced by Lake House |
The first step one has to take to maintain a healthy heart is to
undergo a medical check-up by a general practitioner (GP) or any other
government or private medical practitioner. Your G.P. after taking a
clinical history, will do a general examination which includes checking
your weight and height, checking the blood pressure (B.P) and auscultation
of your heart for abnormal heart sounds and murmurs.
