Eating out

Indian eating patterns are undergoing revolutionary changes with the spectacular growth of restaurants. Here are some suggestions to eat healthily away from home without missing out the fun.

Eat something healthy (Fruits, a vegetable sandwich made without butter, salads) to take the edge off your apetite before you leave home

At a south Indian restaurant select steamed preparations such as Idlies, Idiappam and rice and avoid dishes such as vadas and bajjis

Limit or avoid dishes with coconut or cream

At a north Indian restaurant order plain tandoori breads instead of puris, parathas or baturas etc

For beverages select an unsweetened juice such as vegetable, fruit or tomato juices. Alcoholic beverages = Extra calories

Choose lean meat, fish or chicken without skin

Cooking methods – Choose foods which are boiled, grilled, broiled, steamed, poached, roasted or baked. Avoid foods which are fired au gratin or made with a gravy

Avoid breaded fried foods

Order fruit for dessert instead of a high calorie item such as icecream, pie or an Indian sweet

Changing a diet that you have been eating for years is not so easy. The first thing in putting a new diet plan in to action is to take a look at your eating habits and try to replace negative habits with positive ones

FATTY ACIDS IN THE DIET:

Fats are an essential part of the diet but too much of the wrong kind can be bad for your health. Fats may be saturated or unsaturated. Unsaturated fats may be ‘mono unsaturated’ (MUFA) or ‘poly unsaturated’ (PUFA)

Saturated Fatty Acid (SFA) increases both the total as well as the bad cholesterol in the blood (Eg Butter, ghee, coconut oil, palm oil, dalda)

Poly Unsaturated Fatty Acid (PUFA) – Lowers LDL – C (Low density) and HDL – C (High Density) level. (Eg. Sunflower oil, corn oil)

Mono Unsaturated Fatty Acid (MUFA) is a healthy fatty acid which lowers the levels of LDL – Cholesterol and triglycerides without lowering the HDL level cholesterol (Eg: Canola oil, peanut oil, gingely oil, rice bran oil)

Trans fatty acids are formed during the process of hydrogenation. These increase the total cholesterol, LDL cholesterol and lowers the HDL cholesterol (Eg Margarine, Dalda)

• Eating to reduce blood cholesterol:
• Substantially reduce saturated fat in your diet – trim all visible fat from meats
• Limit dietary cholesterol – reduce intake of animal products to not more than 120g/day
• Use low fat dairy products and limit milk consumption to 500ml/day
• Avoid high fat dietary products such as butter and cream
• Limit egg yolks to a maximum of 2/3 per week
• Commercially baked goods (cakes, biscuits, pastries and puffs) are often made with egg yolk, saturated fats and trans fats such as shortening (Shortening is any fat that is solid at room temperature) and lard. Consume such foods only rarely
• It would be best to limit fired foods and snacks
• Use only 4-5 teaspoons of the recommended cooking oil per day (not more than 25% of your calories should come from the fats in your diet)
• Regular exercise program may further help in lowering blood cholesterol

NUTS AND THEIR BENEFITS:

Almonds, peanuts and walnuts contain healthy oils, vitamin E and MUFA. They are good sources of protein and fibre. These will help to keep the cholesterol levels in check. One ounce (30g) of the above per day is recommended

ALCOHOL:

Alcohol is sources of empty calories (it includes no vitamins, minerals or proteins) and can be turned in to fat, adding weight to the body. It increases the level of trigylcerides in your blood if in excess. Moderate drinking (1-2 standard drinks per day) may be beneficial. Check with the doctor if it is allowed for you.

CAFFEINE:

Caffeine is a stimulant that gives a boost of borrowed energy. Stimulants containing caffeine are found in tea, coffee, cocoa, chocolates and cola. They may increase the frequency and severity of irregular heartbeats and can increase blood pressure.

A maximum of two cups of coffee may be consumed per day

You may be advised by your doctor to reduce your sodium intake if you have high blood pressure, congestive heart disease or kidney disease. When you think of sodium, the salt you sprinkle on food probably comes to mind. Salt is in fact made up of sodium and chloride. Sodium is an essential mineral for the body. All the cells in the body are bathed in fluids that contain sodium, which helps to maintain the body’s fluid balance

Some of the sodium in your diet occurs naturally in foods. The rest comes from the salt added to foods when cooking or processing. Indian consumes as much as 10g of added salt.

How much salt can you use?

The amount will depend on your specific needs and may vary from ¼ to 1 teaspoon per day (2-5g/day)

Simple steps to cut down salt:

Since the taste for the salt is an acquired habit it is possible to reduce its intake gradually without much difficulty. Here are some general rules to keep the sodium intake within the recommended guideline.

• Avoid foods preserved in salt such as dry fish and meat
• Limit the use of salt in cooking
• Do not keep a salt shaker on your dining table
• Cut down on convenience food – cakes, biscuits, cheese, canned foods, fast food, some are high in sodium even when they do not salty
• Ask for unsalted dishes when eating out
• Use herbs and spices to enhance flavor of foods in place of salt.

-          A dash of lime

-          Onion and Vinegar

-          Nutmeg, Bayleaf, Cinnamon

-          Dry chillies, mustard seeds, pepper

-          Coriander, mint

-          Ginger and garlic

Foods to avoid or limit: (which contain high amount of sodium):

• Pickles
• Baked foods
• Canned foods
• Dry fish and meat
• Papad
• Cheese
• Processed meats such as bacon & ham
• Bottled sauces such as ketchup & soy sauce
• Powdered and canned soups
• MSG (Monosodium Glutamate – Ajinomoto. Apart from the sodium content, Ajinomoto is not recommended for consumption)
• Salted snacks such as chips, nuts and mixture

A word of caution about salt substitutes:

Salts substitutes may contain potassium salts which are contra-indicated for persons with kidney problems. Take the salt substitute container to your dietitian for his/her advice before using the product.

HEART HEALTHY COOKING:

Make your favorite recipes heart healthy by following these simple steps

•  Substitute a lower fat ingredient for a higher fat one . (Try skim milk instead of full cream milk)
• Choose Unsaturated fats. Use oil instead of butter, shortening (Shortening is any fat that is solid at room temperature) or ghee
• Use less of the high fat ingredients. Use less meat, eggs or cheese than what the recipe states. Use only part of the fat or oil called for
• Remove the fat. Trim visible fat and skin. Refrigerate curries, gravy, soup or stew until the fat rises to the top of the bowl and skim it off
• Change the cooking method. Steam boil, roast or microwave without adding fat. Saute with water, juice or broth instead of oil

Cultivate the habit of reading the food label on commercial food packages, to get information on the amount and type of fat and sodium in contents

Dear Sir,

It is with great humility that i type this message to you. You may not know me…for it was in my 11 th standard that i first met you when you had operated on my dad… CABG for Mr.Srimurugan at MMM… Just one look at you that day was all it took for me to decide that I want to become a cardiac surgeon and help people like my dad who were suffering from heart ailments.

Your philosophy of ever reaching out to the needy as a service to God reached me really deep sir, right then. And after 11 years, here i am sir…Doing my MCh Cardiothoracic Surgery at Sri Jayadeva govt. institute of Cardiology at Bangalore.

I was doing my MS at Chengalpat Medical College, when you had given that wonderful interview for our college magazine. I always keep telling everyone around me that you are my role model sir..because you always are and will be. I always keep those words of mother Theresa which you have framed in the hospital very close to my heart.

Thank You for everything sir.

You really are a mountain of inspiration.

Yours sincerely
Balaji

Fibre is made up of a number of complex carbohydrates. There are two types of fibre: Soluble and Insoluble

Soluble Fibre:

• Promotes normal functioning of the digestive tract
• Helps lower LDL (Bad) cholesterol, while maintaining the HDL (good) cholesterol
• Soluble fibre is reduced by bacteria to short chain fatty acids that appear to eventually block cholesterol synthesis in the Liver
• Pectins, gums and mucilages are some types of Soluble Fibre
• Good sources of soluble fibre include oat bran, dhals, grams, channa, fruits and vegetables

Insoluble Fibre:

• In addition to reducing the discomfort of constipation and other digestive disorder s, it protects against cancers of colon and the rectum
• Cellulose and hemicelluloses are some of the Insoluble fibres
• Good sources are chewy outer skin and fibres of seeds, fruits, vegetables and legumes

How does fibre help us?

• It increases the bulk in our diet and gives us a feeling of fullness. It delays the absorption of carbohydrates and fats
• Foods high in fibre tend to be low in fat and calories. Therefore eating more fibre-rich foods may help to keep your weight in control
• High fibre foods are also likely to be high in antioxidants such as Vitamins E, C and beta carotene
• Eating a diet consisting of high-fibre foods can also reduce the risk of diverticulosis, hiatus hernia, heart disease and obesity
• How much fibre do we need?
• About 30 grams of fibre a day is recommended. Remember to drink plenty of water (8-10 glasses a day) to help move the fibre with the food along the intestines

Tips to increase fibre intake:

• Incorporate more whole grains, cereals and millets such as whole wheat flour (atta), ragi, oats, corn etc
• Eat some lentils, legumes and dhals such as toor dhal, urad dhal, channa and green gram every day
• Consume adequate amounts of fruits and vegetables. This means atleast three helpings of vegetables and two fruits a day
• Eat fruits and vegetables with their skin as far as possible. Include salads and sprouts in your diet

Diets high in processed foods are low in fibre.  The traditional Indian diet which contains whole grains, pulses, dhals, vegetables and fruits can provide the good amount of fibre.

Does stress cause your blood pressure to rise? Can stress cause you to have a heart attack? While differing opinions exist about these and other issues, research has shown that stress does play a role in many cardiovascular disorders.

Most of the medical literature on stress and heart disease refers to physical stress. But most people are referring to the emotional variety when they talk about stress.

Exercise or other forms of physical exertion places measurable and reproducible demands on the heart. This physical stress is generally acknowledged to be good. In fact, the lack of physical stress (i.e., a sedentary lifestyle) constitutes a major risk factor for coronary artery disease. So this kind of “stress” is usually considered to be good for the heart – as long as the heart is normal.

If there is underlying heart disease, however, too much physical stress can be dangerous. In a person who has coronary artery disease, for instance, exercise can place demands on the heart muscle that the diseased coronary arteries cannot meet, and the heart becomes ischemic (i.e., starved for oxygen.) The ischemic heart muscle can cause either angina (chest pain), or a heart attack (actual death of cardiac muscle).

In summary, physical stress is generally good for you, and is to be encouraged, as long as you have a normal heart. On the other hand, with certain kinds of heart disease, too much or the wrong kind of physical exertion may be harmful.

But either way, physical stress does not cause heart disease.

Emotional stress is generally the kind of stress people are talking about when they refer to stress causing heart disease. We would have heard of people saying “No wonder she suffered an attack, she was going through a lot”.

Everyone – even doctors – have the notion that emotional stress, if it is severe enough or chronic enough, is bad for you. Most even believe that this kind of stress can cause heart disease. But scientific evidence that it actually does so has been hard to come by.

Emotional stress and heart disease

There is a fair amount of circumstantial evidence that chronic emotional stress can be associated with heart disease and early death.

Several studies have documented that people without spouses die earlier than married people. (While some might claim this constitutes evidence that emotional stress is actually good for you, most authorities agree that having a spouse actually provides a significant degree of emotional support and stability.) Other studies have shown fairly conclusively that people who have had recent major life changes (loss of a spouse or other close relative, loss of a job, moving to a new location) have a higher incidence of death. People who are quick to anger or who display frequent hostility have an increased risk of heart disease.

So emotional stress is bad, right? It didn’t start out bad. Evolutionarily speaking, emotional stress is a protective mechanism. When our ancestors walked over a rise and suddenly saw a saber-tooth tiger 40 yards away, a surge of adrenaline prepared them for either fight or flight as they considered their options.

But in modern times, now that saber-tooth tigers are few and far between, most often neither fight nor flight is the appropriate reaction to a stressful situation. (Neither fleeing from nor punching your annoying boss, for instance, is generally considered proper.) So today, the adrenaline surge that accompanies a stressful situation is not channeled to its rightful conclusion. Instead of being released in a burst of physical exertion, it is internalized into a clenched-teeth smile and a “Sure, Mr. X, I’ll be happy to fly to Delhi tomorrow and see about the new project.”

It appears that the unrequited fight-or-flight reaction, if it occurs often enough and chronically enough, may be harmful.

While our knowledge about stress and cardiovascular diseases is incomplete, most experts agree on the following points:

• Stress does contribute to heart disease in certain individuals.
• Stress also contributes to high blood pressure, high cholesterol, and other cardiac risk factors (e.g. smoking, overweight, etc.) in many individuals.
• Whether or not stress caused your illness to occur, suffering a heart attack or other cardiac condition is itself quite stressful for most individuals and their families.

Thus, if you’ve recently had a heart attack, stroke, or other cardiovascular condition, it is reasonable to assume that stress may have played a role in causing your illness to occur.

But when do you know that stress has actually taken a toll on you. When you are exposed to long periods of stress, your body gives warning signals that something is wrong. These physical, cognitive, emotional and behavioral warning signs should not be ignored. They tell you that you need to slow down. If you continue to be stressed and you don’t give your body a break, you are likely to develop health problems like heart disease. There are at least hundreds of physical, mental, emotional and behavioral warning signs and signals.

Recommendations

Stress management techniques may be quite helpful in reducing the risk of coronary events, and have the added benefit of being risk-free. Thus, there seems to be little reason not to recommend some form of stress management in people with heart disease, or with risk factors for heart disease. And finally, it should be pointed out that exercise is a great way of reducing chronic stress, and in addition has the advantage of directly lessening the risk of coronary artery disease, and helping to control obesity.

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.

Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

Stroke

Additional studies have pointed to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared to those in the control group.

Heart transplant is a simple three step procedure. This is a rather simple procedure for a cardiac surgeon compared to other complicated surgeries.

First Step:

Harvesting organ from the donor:

The donor is usually a brain dead person on life support. When the family of such a person is willing to donate the organ, the organ is removed and protected in ice to prevent any damage. A heart once removed from the body stays stable for about 6 hours. Due to time constraints the Heart is usually flown down if the transplant has to be conducted interstate. The Tamil Nadu police offer support in such cases if the Heart has to be taken from one part of the city to the other. The areas are cordoned off immediately on request. Procuring a heart itself is a very structured and transparent process with the help of the government. The heart usually goes to such a recipient who needs it most.

Removing the recipient’s damaged heart:

The second step is removing the damaged heart. This is a very simple procedure if the recipient has not undergone any previous surgeries. In case the recipient has undergone a Bypass or a catheter implant then cutting through the scar tissue may prolong or complicate this step.

Implantation of the donor heart: The third step is probably the easiest; the implantation of the donor heart. Today, this operation basically involves the creation of only five lines of stitches, or “anastomoses”. These suture lines connect the large blood vessels entering and leaving the heart. Remarkably, if there are no complications, most patients who have had a heart transplant are home about one week after the surgery. The generosity of donors and their families makes organ transplant possible.

Who needs a Heart transplant?

Most patients require a transplant because their hearts can no longer pump well enough to supply blood with oxygen and nutrients to the organs of the body. A smaller number of patients have a good pump, but a bad “electrical conduction system” of the heart. This electrical system determines the rate, rhythm and sequence of contraction of the heart muscle. There are all kinds of problems that can occur with the conduction system, including complete interruption of cardiac function causing sudden cardiac death.

While there are many people with “end-stage” heart disease with inadequate function of the heart, not all qualify for a heart transplant. All the other important organs in the body must be in pretty good shape. Transplants cannot be performed in patients with active infection, cancer, or bad diabetes mellitus; patients who smoke or abuse alcohol are also not good candidates. It’s not easy to be a transplant recipient. These patients need to change their lifestyle and take numerous medications (commonly more than 30 different medications). Hence, all potential transplants patients must undergo psychological testing to identify social and behavioral factors that could interfere with recovery, compliance with medications, and lifestyle changes required after transplantation.

Moreover, needing a heart and being a suitable candidate are not enough. The potential donor heart must be compatible with the recipient’s immune system to decrease the chance of problems with rejection. Finally, this precious resource, the donor organ, must be distributed fairly. The Multi Organ Harvesting Aid Network makes sure that the sickest recipient is given the first preference. As mentioned earlier, this organization makes sure the entire process is fair, structured and transparent.

Results of a Heart Transplant:

In patients with severe heart failure that requires transplantation, the mortality rate within one year is 80%. Five year survival in patients with any form of complex heart disease and heart failure is 50%.

After heart transplant, the one year survival rate averages 90% and five year transplant averages 60%.

Complications of a heart transplant:

The immune system of the body fights against the implanted organ as it sees it as a foreign body. Rejection can be controlled with powerful immunosuppressive medications that greatly reduce the chances of complete organ rejection. Even while there is no active rejection, there is a possibility of acute chronic rejection which causes the growth of tissues in heart vessels. This eventually leads to blockage and finally the organ fails to pump. This is the main factor why heart transplant does not have good long term results.

Immunosuppressive drugs greatly reduce the chances of rejection but also increase the chances of infection in the recipient. The recipient is prone to the most common infections and some may eventually die of developing cancer.

How does a heart transplant patient know if he or she is rejecting the donor organ or developing an infection?

Symptoms

• Weakness,
• Fatigue
• malaise (feeling lousy),
• fever, and
• “flu-like symptoms”, such as chills, headaches, dizziness, diarrhea, nausea and/or vomiting.

In such cases, the recipient has to immediately seek medical attention and perform all required tests so that it can be treated appropriately.

How is rejection of the organ diagnosed and monitored?

The standard for monitoring rejection is the endomyocardial biopsy. This is a simple operation for the experienced cardiologist and can be done as an outpatient procedure. First, a catheter is put into the jugular vein in the neck. From there, the catheter is advanced into the right side of the heart (right ventricle) using an x-ray method called fluoroscopy for guidance. The catheter has a bioptome at its end, a set of two small cups which can be closed to pinch off and remove small samples of heart muscle. The tissue is processed and placed on glass slides to be reviewed under the microscope by a pathologist. Based on the findings, the pathologist can determine whether or not there is rejection.

Immunosuppressive therapy is then adjusted, for example, increased if rejection is present. Investigators have tried to develop less invasive methods to monitor for rejection. There is a new high-tech analysis that can be done in a sample of blood that is very promising and much easier for the patient than the endomyocardial biopsy. This test looks at the expression of specific genes in cells in the blood. The amount of expression of key genes indicates whether or not rejection is occurring. Nevertheless, so far, no method has replaced the endomyocardial biopsy.