first_imgThen God spoke. Through thunder and lightning, trumpet and smoke, he gave two tablets of stone, inscribed by his own finger: the Ten Commandments.In an age when thunder and lightning in our cells and tissues overwhelm us, doctors are the new gods. And right now they are dishing out the,Then God spoke. Through thunder and lightning, trumpet and smoke, he gave two tablets of stone, inscribed by his own finger: the Ten Commandments.In an age when thunder and lightning in our cells and tissues overwhelm us, doctors are the new gods. And right now they are dishing out the new ten commandments for optimising your health. The oldest umbrella organisation of cardiologists in India, the Cardiological Society of India (CSI), is asking us to embrace 10 everyday tips to live better. With ‘My heart, Your heart’ as the theme for this year’s World Heart Day on September 29, cardiologists have put together a slim document, ‘Ten Commandments for Creating Heart-Healthy Homes’ (see graphic), in 11 languages, and sent it out to schools and movie halls. “It is our gift to the nation, not just to keep the heart-health conversation on but also to take it a step further- a call for action,” says Dr Soumitra Kumar, general secretary of CSI. “Keep the ten commandments in mind, follow it yourself and teach your children,” he says.According to the World Health Organization, of the 54.7 million deaths across the world per year, 36 million are due to noncommunicable diseases or NCDs like heart attacks, stroke, cancers, chronic respiratory diseases, hypertension and diabetes. A large proportion of these are due to the risks related to urban built environment: from physical inactivity and obesity, cardiovascular and pulmonary diseases from transport-generated air pollution, ischaemic heart disease and cancers from household biomass energy use (coal, dung, wood, low-cost fuel), asthma from indoor air pollution and smoking, heat-related strokes and illnesses. Outdoor air pollution alone is responsible for 3.7 million deaths annually, mainly due to NCDs, while physical inactivity is responsible for 3.2 million deaths.advertisementUrbanisation is one of the leading global trends of the 21st century. While cities can bring in opportunities, they also have a significant impact on health. By 2050, over 68 per cent of the world’s population will live in cities. According to census reports, India is shifting toward city life- from 11 per cent in 1901 to 25.7 per cent in 1991 and 32 per cent now; it is slated to rise to 41 per cent by 2050. And NCDs have turned into the top 10 killers in the country. A just-released study by the researchers of the India State-Level Disease Burden Initiative (published in Lancet, September 2018), shows that the leading risk factors are: dietary (56.4 per cent), high systolic blood pressure (54.6 per cent), air pollution (31.1 per cent), high total cholesterol (29.4 per cent), tobacco use (18.9 per cent), high fasting plasma glucose (16.7 per cent) and high body-mass index (14.7 per cent).So how bad is urban living and how can you protect yourself? Cut out the 10 everyday tips from CSI and hang it on your wall, to begin with. And read on to see what experts suggest about managing the health hazards of urban living. JUST WHAT THE DOCTOR ORDERED:Look out for those little signs and flip the red flags.Knowing your body, how it works, and the environment you live in are the key to being proactive about your health. There are three things one has to work out. First, know your genes. They will tell you about your chances of getting the three most common and devastating diseases. If there is coronary heart disease in either your mother or father, you have double the chance of getting heart disease: 20 per cent. If both parents have it, then there is 30 per cent chance.Then there is diabetes. If one parent has it, children have 25 per cent chance of getting it. If both parents do, chances go up to 50 per cent. Cancer is the third risk. Some people inherit gene faults that enhance their risk of developing particular types of cancers. BRCA genes carry risks of breast and ovarian cancers to the next generation, something Hollywood actor Angelina Jolie has. Other inherited genes are linked to other cancers; some gene faults can increase the risk of more than one type of cancer. However, some people with a predisposing genetic variation never get the disease while others do, within the same family. Second, understand your own body structure and how you treat it. There is a mismatch today between the quality and quantity of food we eat, our energy intake and output, especially because of sedentary lifestyles. We need to balance that. You need to do three things for that: reduce oil-based products, sugar and carbohydrate and eat more fruits and vegetables, keeping in mind the ultimate calories these foods give your body. On an average, an adult needs about 1,600 calories a day. To match that consumption, you need 40 minutes of cardiovascular exercise- gym, walk, jog, swim- to keep your circulation in good shape.Third is the environment and how it can create a huge amount of stress, leading to high blood pressure and the thickening of arteries. The best way to neutralise stress is through yoga and pranayam. Asanas neutralise the effect of sitting for long, stooping over computers, waiting in traffic for hours, keep your body flexible, your bones healthy. Pranayam gives higher quantity of oxygen to your brain because you are taking a deep breath and holding it, allowing 200 per cent oxygen to your brain, which refreshes serotonin and dopamine levels. A stress buster, you must do that every 24 hours. It also cleans your lungs. Along with it, avoid tobacco and alcohol in excess: no more than 60 cc in 24 hours, no more than four times a week.advertisementHow well do you know yourself? And what does ‘know yourself’ have to do with your health? A lot.- Dr Naresh Trehan, Cardiovascular surgeon, CMD, Medanta: The Medicity, GurgaonIndia has the dubious distinction of being the country with the highest number of deaths due to air pollution, according to the World Health Organization. Yet, most Indians are unaware of the enormity of the problem. Such is the level of air pollution in our country that everyone in India can be called a smoker now. Think about it: we have 52 newborn smokers every minute. And every Delhiite has smoked 10 cigarettes every day in the past year.What can people do to save themselves? We breathe 25,000 times a day, inhaling 10,000 litres of air on average every day, and inhaling thousands of kilograms of toxins in each breath. About 99.99 per cent of those toxins come out, but a minuscule portion does not. As we keep breathing, 25,000 times a day, that tiny portion becomes a chunk, gets deposited in our lungs, absorbed by body and damages brain, heart, kidneys, reproductive system and every organ of the body.In children, it can lead to neuroinflammation which, it has been proved, leads to cognitive underdevelopment, or low IQ. In adults, air pollution leads to five to 10 times higher brain attacks (paralytic); hypertension in people in their 20s and 30s; five to 10 times higher heart attacks in people living in polluted cities. Numerous studies show rise in hospitalisation from heart attacks following spikes in particulate matter. Similar correlation has been shown with asthma, COPD and pneumonia. Such is the level of air pollution in India that neonates develop bronchial problems. The number of lung cancer patients is zooming. The past 20 years belonged to heart disease, the next 20 will see a lung disease epidemic.Try to contain dhul and dhuan (dust and smoke), the two contributors to air pollution, at home, in your neighbourhood or outside. That’s the only way to save yourself.- Dr Arvind Kumar, Pulmonologist and thoracic surgeon, Chairman, Centre for Chest Surgery & Lung Transplantation & Director, Institute of Robotic Surgery, Sir Ganga Ram Hospital, New DelhiEffectively, there is no remedy. Air is a continuous flow, it goes across boundaries. So when it is highly polluted outside, don’t go out. Normally, we breathe 12-14 times a minute. But when we do outdoor activities- running, jogging, exercising- we breathe about 45 times a minute. You will inhale more toxins every minute. That is why we have been opposing marathons, which are supposed to be good for your health but actually kill by poisoning your body. Medically, it’s suicide. Masks do not help: those sold in pharmacies can’t keep out particulate matter and the N95 or N99 masks are effective if worn tight across the nose. Even these can only prevent large particles from getting into the lungs. Finer particles like P2.5 or harmful sulphates and nitrates can pass right through.advertisementIndoor air pollution is also a big issue in India. Air purifiers do no good, because they are effective over limited space. You can do yoga, but it only helps enhance your lung capacity, it can’t remove the particulate deposits that line your lungs. The real remedy is taking small individual efforts to contain two things, dhul and dhuan (dust and smoke)- the two contributors to air pollution- at home, in your neighbourhood or outside. You as a citizen need to take the initiative, to curb pollution, to improve the air you breath. That’s the only way. People don’t eat on time and eat very late. They work all day, come home late and with just enough energy to have dinner and crash. The best meal time at night would be around 7 pm, but if that is difficult, try and eat by 8 pm and then give a gap of two-three hours before going to bed, that would be ideal. Irregular meals may set you up for obesity, high blood pressure and Type 2 diabetes. The practice of eating and then falling asleep is not a good thing for your health: your body and digestive system should rest while you sleep, not digest food.People are often in a rush and don’t do justice to their breakfast. That’s a big problem. Breakfast should be heavy, lunch should be moderate, and dinner should be light and early. That’s very hard to implement, but needs to be done.Lack of sleep and quality sleep is another challenge. Many times people come to me complaining that they are always fatigued, can’t get up on time, sleep during the day, can’t concentrate. And then you find out that their sleep hours are about five hours. There are all these stories about famous people sleeping four-five hours, but, let’s say, they are superhumans. For ordinary mortals you need seven hours of sleep. Most people complaining of day-time tiredness are not getting their full sleep.The main challenge in urban individuals is their inability to stick to meal timings.- Dr Ambrish Mithal, Chairman and Head of Endocrinology and Diabetes, Medanta: the Medicity, GurgaonThird is physical activity. I come across people with very long home-to-work commutes every day. Long commutes take away any time for you to do things you like. You also spend less time participating in moderate to vigorous exercise- be it a social experience like aerobics, playing sports, doing yoga or taking solitary walks. But that doesn’t happen. And after dinner there should be a little bit of activity. Prolonged sitting is a risk factor for diseases of the heart, diabetes and stroke.Finally, food at the workplace. Many companies and organisations now offer food, but usually it’s not healthy. Healthy food means more of fruits and vegetables, less of roti and maida-based stuff. But everything is simple carbs in our life. If you have a lot of high-fibre veggies and multigrain bread, that should be good enough. However, in large-scale or community cooking, the dangers of infection with vegetables and salads is very high. The reason why deep-fried food is popular in India is because germs get killed. However, then you are damaging your arteries in the long run. So you have to hit a midway between the risk of infection and the risk of chronic disease to work out a properly-cooked clean food that avoids simple carbohydrates. Polluted air from traffic, factories, power generation or smoking on a daily basis, along with the daily pressure of living in crowded and fast-paced cities, loud noise, serpentine queues and long hours of commuting from one place to another turn on our stress system and over time, wear down our body and mind. Exposure to environmental stressors can lead to multiple problems, from higher cholesterol, blood sugar and triglycerides levels, increased heart rate, lower immunity, decreased muscle and bone density to increased rates of depression and anxiety. Pollution is believed to have inflammatory effects on the heart, causing chronic cardiovascular problems. Studies have shown increases in the number of deaths and hospitalisations during high concentrations of smog.Urban health is really deteriorating. A major reason is the deteriorating environment due to air pollution.- Dr Ashok Seth, Chairman, Fortis Escorts Heart Institute, New Delhi; and Head, Cardiology Council of Fortis Group of HospitalsAir pollution tends to strike especially the elderly or those already struggling with heart disease. But it’s not just heart disease, pollution is linked directly to multiple problems, including depression.What are the solutions? Apart from understanding that we have a responsibility towards our environment- for instance, create green spaces to breathe, walk, play and exercise- we have to find time for ourselves. This year, the World Heart Federation’s global campaign for World Heart Day on September 29, ‘My Heart, Your Heart’, is all about making a promise: what can I do to look after my heart right now and everybody we care about. It’s about making a few small changes in our lives, so that we can live longer, better and more heart-healthy lives. As an individual, make a promise to yourself to be more active, say no to smoking, eat healthier, and do things that you enjoy. As a healthcare professional, that means save more lives. At the level of policymakers, it means implementing an action plan for chronic, noncommunicable diseases.Most people spend at least 40 per cent of their waking hours at their workplaces. A lot of companies already have environment-friendly green offices, but not many have comprehensive cardiovascular wellness programmes for employees. So, this year, we could start thinking about moving from green offices to heart offices, where employers will have to accurately track the heart health of their employees and provide clear, evidence-based solutions to improve their cardiovascular health. These could include standing desks, treadmill desks, outdoor meetings; banning smoking at the workplace, including the building itself; food in the canteen incorporating healthy snacks and fruits. Offices should aim for heart-healthy certification, apart from green certification. Three things to keep in mind to take care of your heart and health:1) Prevent heart disease: be more active, play, walk, do housework, dance, say no to smoking;2) Be aware of what you are eating: have water or unsweetened juices, swap sweet for fresh fruit, eat five portions of fruit and vegetables a day, limit processed foods that are high in salt, sugar and fat; and3) Take time out for yourself and your family: your health is the state of your body and mind. And research shows that positive attitude is linked to better heart health.As told to Damayanti Dattalast_img

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