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Newsletter. Issue 2003-9. May.3, 2003
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Health Tips

1. Health Watch - Heart Attack in Indians
2. Health Tips: Fitness Over Fifty (Link)

Health Watch - Heart Attack in Indians
by Avinash Patwardhan, M.D.

Several studies conducted among Indians have revealed an extremely high rate and early occurrence of heart attacks. Established risk factors such as diabetes, smoking, high blood pressure, elevated blood cholesterol, diet high in saturated fat, lack of exercise and stress are common to all ethnic groups. But Indians whether in India or abroad have a 4-5 times higher rate of heart attacks and that too at a much younger age. Every Indian unless proven otherwise is at high risk for coronary artery disease. It is important to note that both men and women are at equal risk.

Studies have now shown that there is a large group of Indians who have a genetic predisposition for coronary artery disease. A significant number are vegetarians, and many have made maximum modification to their lifestyle to reduce their risk of heart attacks, yet they still have a very high incidence of coronary artery disease. This genetic problem with coronary artery disease in Indians is complex and multifactorial.

Early intervention at younger age with appropriate drug therapy has shown significant reduction in cardiac events. The abnormalities identified in lipids and genetic profile are
1. Elevated levels of lipoprotein (a), (Malignant CAD)
2. High levels of low-density lipoproteins, (LDL)
3. Low levels of high-density lipoprotein, (HDL)
4. Diabetes associated with insulin resistance.
5. Elevated Homocysteine levels.
6. High levels of triglycerides.
7. Smaller diameter of coronary vessels with right-sided dominance.
8. Elevated levels of Cardio CRP (C-Reactive Protein)
9. Clamydia Infection of chronic nature.

An Indian with or without a bad family history of Coronary Artery Disease (CAD), must have a thorough evaluation of the following.
There is no excuse for not getting these done early in your life.

Total Cholesterol
< 150 mg
< 100 mg
> 40 mg
< 150 mg
Lipoprotein (a), Lp (a)
< 30 mg
< 15 um
Fasting blood sugar
< 126 mg
Cardio CRP
< 1.0 mg/L (> 3.0mg = high risk)

Lifestyle changes alone are not enough to correct the abnormalities.
Drug therapy is a must to bring the levels to target values. One cannot achieve them by diet.

To prevent a coronary event, attaining target values is absolutely essential.!!
"Statin" group of drugs are the most effective and should be taken with no hesitation

Treatment schedule has to be very aggressive to include: -
1. Aggressive correction of lipid abnormalities with statins, (Zocor, Lipitor, Pravachol) and Niacin to be monitored by your MD.
2. Enteric Coated Aspirin: 81 mg daily.
3. Fish Oil capsules 1000mg / day ( should have EPA and DHA > 200mg)
4. Folic Acid 1000 ug per day
5. Vitamin B-12 500 ug per day
6. Vitamin B-6 50 mg per day
7. Rigorous control of diabetes.
8. Multi vitamin one daily.
9. Olive oil is the preferred oil for cooking.
10. Total fat intake of no more than 30 to 40gms per day.
11. Treadmill exercise 20 to 30min. at 3.00 to 3.5 mph daily.
12. Life style changes, stress reduction, meditation, yoga, etc.,

This is a simplified outline of Coronary Artery Disease, and the associated genetic and lipid abnormalities that are frequently encountered in Indians. Most of these abnormal factors can be corrected with appropriate therapy and intervention.
The earlier in your life you get your lipids and metabolic status evaluated the better are your chances of avoiding a serious cardiac event.

Health Tips: Fitness Over Fifty (Link)
From: CanIndia News Weekly, April 18, 2003

Old age can be fun and happier if it is healthy, full of enthusiasm and fit. It is said that " He who has health has hope and he who has hope has everything". Therefore it is necessary that as you enter your mid-lives you learn to take extra care for your body to avoid chances of physical incapacity and take proper diet and exercise to lengthen your life and make your lives fuller, minds happier and bodies more younger.
As you start ageing you will lose:
- 20 percent of your body's water content.
- 60 percent of your ability to taste.
- 35 percent of your ability to pump blood from the heart.
About 3 inch in height.
As far as your health is concerned you become:
More susceptible to cold and heat.
Suffer from osteoporosis, kidney, bladder problems and constipation.
Lose some mental functioning due to loss of brain neurons and thus become more
Thus in order to reverse or slow the effects of ageing all you need to do is have a well-
balanced life. You have to exercise effectively, adopt good eating habits, quit smoking and drinking and live a happy and healthy life.
Nutritious food for a healthy life:
For a proper diet food should include protein, vitamins, minerals and fibre.
Protein: Protein is essential for building nearly every part of the body-the brain, bones, heart, muscles and even the blood.
It is made up of 22 amino acids, otherwise known as the 'building blocks of life'.
Adults require 0.75 g of protein per kg of body weight per day. Protein is found in foods like fish, eggs, beef, whole wheat, milk, liver, soya beans, beans, peanuts, brown rice and peas,
Vitamins: Vitamins are organic compounds that are essential in small amounts for the growth and development of our body. They act as enzymes (catalyst) which facilitate many of the body processes.
Minerals: Our body uses many minerals such as phosphorus, calcium, and magnesium for strong teeth and bone; zinc for growth; chromium for carbohydrate metabolism; and copper and iron for haemoglobin production.
Fibre: Fibre is the part of the food which we consume, that is not digestible. It helps to move the food through the intestine by increasing their peristaltic action. Foods containing fibre are whole grain cereals, fibrous vegetables, and root vegetables like carrot, beet, turnips and other leaf) vegetables.
Thus your diet should have the combination of all the nutrients listed above and it ,should also come in proper quantity. In your daily diet you should have the following:
Fruits: Have fruits whichever you like 2-4 servings per day.
Vegetables should be consumed at lunch and at dinner not more than 3-5 servings per day.
Grain products like bread, chapati, rice 6-11 servings per day.
Meat, source of protein should be consumed 2-3 servings per day.
Milk one glass per day.
Physical fitness for energy:
Physical fitness is essential for a healthy and happy life. Exercise helps you in this age in many ways. A person who has been exercising regularly will look and feel younger than a person who has not been exercising. But that doesn't mean you cant exercise and look young. You can start
exercising and can slow or reverse ageing and look and feel much younger. Therefore make it a point to exercise 30 minutes every day for a better and healthy life. You can swim, jog, do brisk-walking, play your favourite sport, and go to a gym, cycle or go in for yoga.
Following are a few exercises, which you can include in your fitness program: For strengthening chest muscles and triceps do press-ups. If you are unable to do regular press-ups then you can do it by keeping your knees on the floor or by pushing away from the wall.
For biceps-lie on the floor. Then bend your legs and keep your feet flat on the floor. Lock your hands behind your thighs and pull your head and shoulder upto your knees.
For upper leg muscles-hold on to a table and do a one-legged half-knee bend or do the exercise with both legs.
For lower leg muscles-hold on to a table and then rise up on your toes. Do this exercise one leg at a time.
Relax and massage your muscles after you finish exercising.

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