Harmful Aliments

Lipids are fats that are found throughout the body. Cholesterol, a type of lipid, is found in foods from animal sources. This means that eggs, meats, and whole-fat dairy products (including milk, cheese, and ice cream) are loaded with cholesterol - and vegetables, fruits, and grains contain none. The liver produces about 1,000 milligrams of cholesterol a day, and you probably consume about 150 to 250 milligrams in the foods you eat.

Because cholesterol can't travel alone through the bloodstream, it has to combine with certain proteins. These proteins act like trucks, picking up the cholesterol and transporting it to different parts of the body. When this happens, the cholesterol and protein form a lipoprotein together.

The two most important types of lipoproteins are high-density lipoproteins (or HDL) and low-density lipoproteins (or LDL). You've probably heard people call LDL cholesterol "bad cholesterol" and HDL cholesterol "good cholesterol" because of their very different effects on the body. Most cholesterol is LDL cholesterol, and this is the kind that's most likely clogs the blood

vessels, keeping blood from flowing through the body the way it should. About one third to one fourth of the total amount of cholesterol is HDL cholesterol. HDL cholesterol carries cholesterol back to the liver, where it can be processed and sent out of the body.

• UNDERSTANDING THE CHOLESTEROL CYCLE
Most of the cholesterol in the body is made by the liver. Some comes from dietary intake. When you eat fatty foods, the fat goes to the liver after being absorbed in the intestine.
There it is combined with protein and packaged into two types of lipoprotein packets:
• LDL (low density lipoprotein)
• HDL (High density lipoprotein)
It is in these forms that cholesterol circulates in the blood. Usually this transport system works well. However, if you eat too much fat, your liver makes extra LDL. This extra LDL is released into your blood stream, where it can wreak havoc.

• IS ALL CHOLESTEROL BAD?
No. Some cholesterol is required for the natural functioning of the body. Simplistically one may look at cholesterol as 'good' cholesterol and 'bad' cholesterol. LDL cholesterol is the 'bad cholesterol', since this can be thought of as the form of cholesterol which 'sticks' to the blood vessels walls. HDL is the 'good cholesterol'. It functions to transport the stuck LDL cholesterol back to the liver for removal from the body, thereby helping to keep the blood vessels clean. Our aim should therefore be to reduce the LDL cholesterol and increase the HDL cholesterol in our body. Every 1 mg/dl increase in HDL cholesterol reduces the risk of heart attack by 2 %.

• HIGH BLOOD CHOLESTEROL: A SILENT DISEASE
High blood cholesterol is detrimental. Anyone can develop high blood cholesterol regardless of age or sex. It causes no warning symptoms and can quietly sneak up on you, so diagnosis of high blood cholesterol comes as a surprise to most. In fact, a heart attack or stroke may be the first clue that your cholesterol is raised. Like high blood pressure or diabetes, most people are unaware that their blood cholesterol is high until they see their blood test report. And like these diseases, it is a potential threat to your health and therefore needs intervention. The good news is that it can be easily managed, once we are alerted to its presence. Don't be alarmed, but do take it seriously.

• HOW DOES HIGH BLOOD CHOLESTEROL AFFECT ME?
High blood cholesterol is one of the three major risk factors for coronary artery disease. High blood cholesterol can significantly increase the risk of you having a heart attack. Fortunately, all these risk factors are modifiable. You can take steps to lower your cholesterol levels and thereby lower your risk for coronary heart disease.

• WHAT LEVEL IS "HIGH"?
• Total cholesterol levels can be classified as :
• Desirable: less than 200 mg/dl
• Borderline: 200-239 mg/dl
• High: 240 mg/dl or higher

• LDL cholesterol can also be classified similarly.
• Optimal: less than 100 mg/dl
• Near optimal: 100-129 mg/dl
• Borderline: 130-159 mg/dl
• High: 160 mg/dl or higher

• One should aim to keep :
• Total cholesterol level below 200 mg/dl
• LDL level below 130 mg/dl (below 100 mg/dl in the presence of heart disease)
• HDL levels above 40 mg/dl
• Triglyceride (another form of fat) level less than 200 mg/dl.

If your blood cholesterol is 240 mg/dl, you have more than twice the risk of developing heart disease as someone with blood cholesterol of 200 mg/dl. A cholesterol level of 300 mg/dl increases the risk 6 times. If your high blood cholesterol is combined with another major risk factor (high blood pressure, smoking, diabetes, etc.) it increases the risk of coronary heart disease still further. So with blood cholesterol of 300 mg/dl a smoker has a risk almost 20 times as high as a non-smoker with normal cholesterol!

• WHO SHOULD HAVE BLOOD CHOLESTEROL MEASURED AND WHEN?
Everyone should have their blood cholesterol checked at least once after the age of 30. If your cholesterol is 'desirable' it can be checked every 5 years. If it borderlines it should be checked every 2-3 years. But if your cholesterol is high, or you have some other risk factors for heart disease, you will need to have it checked more frequently.

• HOW DOES HIGH BLOOD CHOLESTEROL CAUSE HEART DISEASE?
Coronary Heart Disease is caused by atherosclerosis i.e., building up of cholesterol in the walls of the arteries of the heart, somewhat like the deposition of rust within a water pipe. This leads to a slowing of the blood flow within these arteries, which can ultimately get blocked. The basic cause of atherosclerosis is deposition of cholesterol in the blood vessels. Hence if one can control the level of cholesterol, one can retard the process of atherosclerosis. The obstruction to blood flow can cause chest pain (angina pectoris), heart attack (myocardial infraction) and ultimately a weakening of the heart muscle (congestive cardiac failure).

• HOW DOES LOWERING THE BLOOD CHOLESTEROL HELP?
Lowering your blood cholesterol will reduce the rate of build-up of fatty substances in your Coronary arteries. This in turn will reduce your risk of a heart attack and death. As a rule of thumb, if your total blood cholesterol is high, reducing it by 1 % will reduce your risk of having a heart attack by 2 %. This means that if you have successfully reduced your total blood cholesterol by 25% from 250 mg/dl to 190 mg/dl, you have succeeded in reducing your risk of heart attack by 50 %!

• WHAT ARE LIPOPROTEIN A, HOMOCYSTEINE AND FIBRINOGEN?
These are also known as 'incremental risk factors', since they increase the impact of higher levels of cholesterol in contributing towards heart attacks. These factors are genetic in origin and although they cannot be changed to any large extent, their impact can be lowered by diet, exercise vitamin B, statins and niacin.

• HOW CAN I REDUCE MY BLOOD CHOLESTEROL?
There are three ways to lower blood cholesterol:
1. Diet
2. Exercise and weight loss
3. Drugs
The most important treatment for high blood cholesterol is a diet that is low in saturated fats and cholesterol. This diet has to be continued for life and you will discover that such a diet will soon become your regular routine. To break the monotony of such a diet allows you a treat every month. On this day allow yourself to eat anything you want without bothering about its fat content or feeling guilty. Such treats facilitate long-term compliance with a diet.

Exercise (e.g., walking, running swimming, etc.), and maintaining ideal weight are equally important for reducing high blood cholesterol levels. Read the section below on how you should go about this. Medicines are the final step to reduce high blood cholesterol. If your cholesterol levels are very high to start with, or if they are not adequately reduced after a few months of diets and exercise, then drugs may become necessary, Remember, medication is an addendum to your diet and exercise plan and does not replace it. If your cardiologist prescribes medication, you must still continue your low fat diet and exercise schedule, since this forms the mainstay of therapy for high blood cholesterol. These are the safest methods of treatment and reduce the requirement of medication to lower your cholesterol levels.

• FOODS TO AVOID AND WHAT IS PERMISSIBLE
Avoid : Fat and cholesterol – rich foods like :
• Organ meats: kidney, brain, liver
• Beef, veal, pork
• Oyster, clams, lobster, shrimp
• Sausages, salami, corned beef, chicken skin
• Whole milk, condensed milk, Bengali sweets
• Cream, butter, lard, cheese
• 'Khoya'
• Egg yolk
• Mayonnaise, salad dressing
• Hydrogenated oils, ghee (contains 96% saturated fat ), coconut oil (76% saturated fat ), or palm oil(55% saturated fat)
• Cream filled biscuits, croissants
• Coconut or other nuts (except almonds or walnuts)
• Pastries, puddings
• Chocolates, toffees
• Ice cream
• French fries.

Do eat:
• Fruits, vegetables, salads
• Cereals, pulses
• Egg white
• Skim milk
• Cottage cheese
• Curd (made from skim milk)
• Chutneys, pickles (no oils)
• Tea, coffee, fruit juice
• Potatoes, rice
• Almonds, walnuts (but unfrosted and un salted)
• Occasionally: chicken (without skin) or fish (not fried).



Diabetes is a disorder that affects the way your body uses food for energy. Normally, the sugar you take in is digested and broken down to a simple sugar, known as glucose. The glucose then circulates in your blood where it waits to enter cells to be used as fuel. Insulin, a hormone produced by the pancreas, helps move the glucose into cells. Healthy pancreases adjust the amount of insulin based on the level of glucose. But, if you have diabetes, this process breaks down, and blood sugar levels become too high. There are two main types of full-blown diabetes. People with Type 1 diabetes are completely unable to produce insulin. People with Type 2 diabetes can produce insulin, but their cells don't respond to it. In either case, the glucose can't move into the cells and blood glucose levels can become high. Over time, these high glucose levels can cause serious complications.

• Pre-Diabetes:
Pre-diabetes means that the cells in your body are becoming resistant to insulin or your pancreas are not producing as much insulin as required. Your blood glucose levels are higher than normal, but not high enough to be called diabetes. This is also known as "impaired fasting glucose" or "impaired glucose tolerance". A diagnosis of pre-diabetes is a warning sign that diabetes will develop later. The good news: You can prevent the development of Type 2 diabetes by losing weight, making changes in your diet and exercising.

• What is Pre-Diabetes?
Type 1 Diabetes : A person with Type 1 diabetes can't make any insulin. Type 1 most often occurs before age 30, but may strike at any age. Type 1 can be caused by a genetic disorder. The origins of Type 1 are not fully understood, and there are several theories. But all of the possible causes still have the same end result: The pancreas produces very little or no insulin. Frequent insulin injections are needed for Type 1.

- Type 1 Diabetes : Insulin and Diabetes

• Type 2 Diabetes :
A person with Type 2 diabetes has adequate insulin, but the cells have become resistant to it. Type 2 usually occurs in adults over 35 years of age, but can affect anyone, including children. The National Institutes of Health states that 95 percent of all diabetes cases are Type 2 diabetes. Why? It's a lifestyle disease, triggered by obesity, a lack of exercise, increased age and to some degree, genetic predisposition.

- Type 2 Diabetes : Top 6 Risk Factors For Type 2 Diabetes
• Gestational Diabetes:
Gestational diabetes (GD) affects about 4 percent of all pregnant women. It usually appears during the second trimester and disappears after the birth of the baby. Like Type 1 and Type 2, your body can't use glucose effectively and blood glucose levels get too high. When GD is not controlled, complications can affect both you and your baby. Your doctor will help you work out a diet and exercise plan, and possible medication. Having GD increases your risk for developing it again during future pregnancies and also raises your risk of Type 2 diabetes later in life.

HOW TO CONTROL DIABETES
Doctors have now proven that exercise and weight loss can greatly reduce the chances of millions of Americans contracting diabetes - and it doesn't take a starvation diet or running a marathon.
The NIH (National Institute of Health) study studied 3,234 Americans who not only had the risk factors of diabetes but also had an exam - the oral glucose tolerance test - which showed their bodies already were not properly processing blood sugar. Almost half of the subjects belonged to minority races.

Fifty-eight percent of the subjects who did moderate exercise for 150 minutes a week and lost 5 to 7 percent of their initial body weight stayed off diabetes for at least the three years of the study. The benefit was seen for every race and ethnicity. The oldest people, over the age of 60, reduced their risk most, by 71 percent.

Most of the subjects walked. They ate 1,200 to 1,800 calories a day, which cut fat consumption to 25 percent of daily calories. This was helped by such dietitians' tips as to choose meals such as baked chicken over fried and seasonal vegetables with lemon.

Walking and dropping, on average, 15 pounds helped people with a very high risk of getting the most common form of diabetes cut those odds by 58 percent, concluded the study by the National Institutes of Health.

Some 10 million Americans are at a very high risk of contracting Type 2 or adult-onset diabetes and could benefit from the findings - if only they knew they were at risk. Type 2 diabetes - where people gradually lose the ability to use insulin, a hormone crucial to converting glucose into energy - accounts for most cases. It's increasing at epidemic proportions, as Americans get older, fatter, and less active.

Risk factors include being over the age of 40; being overweight; being black, Hispanic or American Indian; and having diabetic relatives. Now the question is how does one find all those people who need help. Unfortunately, diabetes screening is not routine.

For people who can't do that, a daily pill called metformin may be an option, the study found. Metformin reduced the diabetes risk by 31 percent - not nearly as effective as changing ones lifestyle and an option that carries the risk of side effects. Still, it's the first medication ever with proven protective against diabetes.

Metformin reduced risk by 31 percent and so is a second option, which could help people who physically can't exercise, said lead researcher Dr. David Nathan of Massachusetts General Hospital. No one knows if taking the daily pill plus diet and exercise would work better, because that wasn't studied. Also, people cannot consume metformin with kidney disease because of a rare but life-threatening side effect.

According to the National Institutes of Health (August 2001), the Food and Drug Administration has approved metformin only as a diabetes treatment. Bristol-Myers Squibb, which sells it under the brand name Glucophage, is considering whether to seek FDA approval to market the drug as a way to prevent diabetes, too.

Information provided is courtesy of and compiled by the Academy of Anti-Aging Research.

Q. What is the connection between diabetes, heart disease, and stroke?

Ans. If you have diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her childbearing years.
People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious & more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging & hardening of blood vessels (atherosclerosis).

Q. What are the risk factors for heart disease and stroke in people with diabetes?
A. Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.

You can't change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here :

• Having central obesity. Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.

• Having abnormal blood fat (cholesterol) levels.

- LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries - the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of - LDL cholesterol raise your risk of getting heart disease.

- Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.

- HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.

- Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

- Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.

Q. What is metabolic syndrome and how is it linked to heart disease?

A. Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and type 2 diabetes. The National Cholesterol Education Program as having any three of the following five traits and medical Conditions, define it :

- Traits and Medical Conditions
- Definition
- Elevated waist circumference
- Waist measurement of
• 40 inches or more in men
• 35 inches or more in women
- Elevated levels of triglycerides
• 150 mg/dL or higher or • Taking medication for elevated triglyceride levels
- Low levels of HDL (good) cholesterol
• Below 40 mg/dL in men
• Below 50 mg/dL in women or
• Taking medication for low HDL cholesterol levels
- Elevated blood pressure levels
• 130 mm Hg or higher for systolic blood pressure or
• 85 mm Hg or higher for diastolic blood pressure or
• Taking medication for elevated blood pressure levels
- Elevated fasting blood glucose levels
• 100 mg/dL or higher or
• Taking medication for elevated blood glucose levels

Source : Grundy SM, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112:2735–2752.

Note : The American Association of Clinical Endocrinologists, the International Diabetes Federation, and the World Health Organization have developed other definitions of similar conditions.

Q. What can I do to prevent or delay heart disease and stroke?
A. Even if you are at high risk for heart disease and stroke, you can help keep your heart and blood vessels healthy. You can do so by taking the following steps:

Make sure that your diet is "heart-healthy." Meet with a registered dietitian to plan a diet that meets these goals:

- Include at least 14 grams of fiber daily for every 1,000 calories consumed. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber. Increase the amount of fiber in your diet gradually to avoid digestive problems.

- Cut down on saturated fat. It raises your blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm and coconut oil. Your dietitian can figure out how many grams of saturated fat should be your daily maximum amount.

- Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs.

- Keep the amount of trans fat in your diet to a minimum. It's a type of fat in foods that raises blood cholesterol. Limit your intake of crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods, salad dressings, and other foods made with partially hydrogenated oil. In addition, some kind of vegetable shortening and margarines have trans fat. Check for trans fat in the Nutrition Facts section on the food package.

• Make physical activity part of your routine. Aim for at least 30 minutes of exercise most days of the week. Think of ways to increase physical activity, such as taking the stairs instead of the elevator. If you haven't been physically active recently, see your doctor for a checkup before you start an exercise program.

• Reach and maintain a healthy body weight. If you are overweight, try to be physically active for at least 30 minutes a day, most days of the week. Consult a registered dietitian for help in planning meals and lowering the fat and calorie content of your diet to reach and maintain a healthy weight. Aim for a loss of no more than 1 to 2 pounds a week.

• If you smoke, quit. Your doctor can help you find ways to quit smoking.

• Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke. However, aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.

• Get prompt treatment for transient ischemic attacks (TIAs). Early treatment for TIAs, sometimes called mini-strokes, may help prevent or delay a future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, and blindness in one or both eyes, double vision, difficulty in speaking, or a severe headache.

Q. How will I know whether my diabetes treatment is working?
A. You can keep track of the ABCs of diabetes to make sure your treatment is working. Talk with your health care provider about the best targets for you. A stands for A1C (a test that measures blood glucose control). Have an A1C test at least twice a year. It shows your average blood glucose level over the past 3 months. Talk with your doctor about whether you should check your blood glucose at home and how to do it.

A1C target
Below 7 percent
Blood glucose targets
Before meals
90 to 130 mg/dL
1 to 2 hours after the start of a meal
Less than 180 mg/dL
B is for blood pressure. Have it checked at every office visit.
Blood pressure target
Below 130/80 mm Hg
C is for cholesterol. Have it checked at least once a year.
Blood fat (cholesterol) targets
LDL (bad) cholesterol
Under 100 mg/dL
Triglycerides
Under 150 mg/dL
HDL (good) cholesterol

For men: above 40 mg/dL
For women: above 50 mg/dL


Control of the ABCs of diabetes can reduce your risk for heart disease and stroke. If your blood glucose, blood pressure, and cholesterol levels aren't on target, ask your doctor what changes in diet, activity, and medications can help you reach these goals.

Q. What types of heart and blood vessel disease occur in people with diabetes?
Two major types of heart and blood vessel disease, also called cardiovascular disease, are common in people with diabetes: coronary artery disease (CAD) and cerebral vascular disease. People with diabetes are also at risk for heart failure. Narrowing or blockage of the blood vessels in the legs, a condition called peripheral arterial disease, can also occur in people with diabetes.

Coronary artery disease, also called ischemic heart disease, is caused by a hardening or thickening of the walls of the blood vessels that go to your heart. Your blood supplies oxygen and other materials your heart needs for normal functioning. If the blood vessels to your heart become narrowed or blocked by fatty deposits, the blood supply is reduced or cut off, resulting in a heart attack.

Peripheral Arterial Disease
Another condition related to heart disease and common in people with diabetes is peripheral arterial disease (PAD). With this condition, the blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet. PAD increases the chances of a heart attack or stroke occurring. Poor circulation in the legs and feet also raises the risk of amputation. Sometimes people with PAD develop pain in the calf or other parts of the leg when walking, which is relieved by resting for a few minutes.

SMOKING
Quitting smoking is easy. I've quit umpteen times. "The unfortunate thing about this world is that good habits are so much easier to give up than bad ones."

FACTS ABOUT TOBACCO SMOKE :
Tobacco smoke contains over 4,000 poisons and chemicals including :
• Nicotine: a powerful stimulant, which is harmful to the heart. It is also the substance that causes the dependence on cigarettes.
• Carbon monoxide:a poisonous gas which decreases the efficiency of the heart and lungs to deliver oxygen to the tissues.
• Tar:This is full of cancer causing chemicals.

WHAT ABOUT TOBACCO SMOKE :
The reasons for these are several. Try to find out which of these apply to you since it will give you valuable insight into how you can overcome these triggers :
• Nicotine craving: this is due to withdrawal symptoms when the nicotine levels in the body fall. This is evident if you need to have a cigarette within 30 minutes of awakening in the morning, or feel irritable and have a headache after a movie or a long meeting in which you could not smoke.
• Habit smoking: if you smoke at the same time and at the same place every day e.g. in the toilet, driving to work etc.
• Mood smoking: if you smoke when you are depressed, bored, relaxing, etc.
• Social smoking: if you smoke because others in your group are smoking.

WHAT CONNECTION DOES SMOKING HAVE WITH MY BODY?
The fact is that smoking is dangerous to your heart. When you smoke your heart rate increases and the heart rhythm may become irregular. Your heart beats harder and blood pressure rises. The walls of the blood vessels get thickened and are more likely to develop a spasm. Blood becomes more 'sticky' and likely to clot in the arteries of the heart which may lead to a heart attack. Smoking also has many other serious side effects: lips, palate, gums and teeth are irritated and stained. The throat is irritated leading to cough and throat infection. Lungs are affected too: the tiny sacs in the lungs that permit oxygenation of the blood are damaged. There is also of risk of bronchitis, emphysema and chances of getting cancer increases. Additionally, the irritants in cigarette smoke are harmful to your eyes, digestive tract, nervous system and kidneys.

You know it's bad for you: You have heard the ads on the TV and radio. You have read the fine print on the cigarette packs warning you about the danger of smoking. Your children tell you that their teacher has taught them that smoking is bad. The cancer society has said it over and over again. But it's even worse than you think! Consider these facts before you light up.

WHAT ARE THE RISKS OF SMOKING?
Smoking is suicide in slow motion. In 1979, the U.S. Surgeon General published a book entitled 'Smoking and Health'. Just the summary of the ill effects of smoking covered over a thousand pages! So there are many good reasons to stop smoking. Let us review a few of these reasons:
• Smoking dramatically increases the chances of a heart attack. Smokers have twice the risk of having a heart attack as non-smokers. The risk is 4 times in heavy smokers, 8 times if you have high blood pressure or high cholesterol and 10 times if you are a woman on the 'pill'. Moreover, heart attacks occur at a younger age in smokers (approximately 10 years earlier) and are more severe than in non-smokers.
• Stroke is at least 2-3 times more common in smokers.
• High blood pressure is aggravated by smoking.
• Circulation of blood in the limbs may be affected in smokers. This can lead to pain in the legs on walking (claudication), and can culminate in gangrene and the need for amputation of the limbs. The risk of gangrene is increased by 5 times in smokers.
• Lung ailments including chronic ('smoker's') cough, colds, bronchitis and emphysema are caused by smoking.
• Lung cancer is linked to smoking in 85 % of all cases. Heavy smokers are 20-25 times more likely to die of lung cancer than non-smokers.
• Stomach ulcers are commoner in smokers. Moreover, such ulcers heal more slowly than in non-smokers. Tobacco contains substances that interfere with proper digestion.
• Children of smokers run higher risks of colds and respiratory problems. Moreover, they are more likely to start smoking themselves at a younger age.
• Pregnant women who smoke or live in households where someone smokes have a higher risk of still-births and more often deliver low-weight and high-risk babies. This is caused by decreased oxygen supply to the foetus of these mothers.
• Smoking also affects your general well-being. Studies have shown that smokers visit physicians oftener than non-smokers for minor ailments of all types.
• Smoking is a social evil. The dangers of 'passive smoking' are well established. Your non-smoking friends and colleagues suffer due to your smoking. Smoking is increasingly being frowned upon all over the world, and more and more institutions are banning smoking on their premises.
• Bad breath and stained teeth are common in smokers.

GOOD NEWS : WHAT IS IN IT FOR YOU IF YOU QUIT?
• You will feel better.
• You will lose your irritating smoker's cough
• Your food will taste better
• Your breath will smell better
• Your children will not start smoking
• You will save cigarette money
• You will cut down your health risks
• You stand to live a longer and healthier life.

IF SMOKING IS BAD AND THE BENEFITS OF QUITTING SO MANY, THEN WHY DOESN'T EVERYONE QUIT?

If you are a smoker you could probably answer this question yourself. People give many excuses for not quitting. Ask yourself if these apply to you:
• "Smoking helps me concentrate": Untrue. Cutting down on cigarettes will results in more oxygen supply to your brain and actually increase concentration. However, this occurs after a few days once your nicotine addiction is controlled.
• "I enjoy smoking": This enjoyment is short lived, and the price one has to ultimately pay for this is unacceptably high.
• "Smoking relaxes me": On the contrary: nicotine makes the heart beat faster and raises the blood pressure. You may think you are getting relaxed, but ask your heart!
• "I don't have the will power to quit": Oh yes you do! You are tougher than you think. You only think you do not have the will power since you are making this an excuse to avoid trying to quit.
• "I quit once in the past for 6 months. I can stop whenever I want, but I want to enjoy it for some more time". This is probably the all-time favourite excuse. But it's just that: an excuse to continue smoking.
• "I felt terrible the last time I quit": Maybe. But even the worst withdrawal symptoms last only a few days. After this, the good feeling starts. Did you stay off smoking long enough the last time to experience the pleasures of a smoke-free life?
• "I've smoked for so long, I'm sure the damage is already done": Untrue. The damage is ongoing. Moreover, recovery from this damage starts immediately after quitting.
• "I can stop later, there's no hurry": This is plain and simple procrastination – a common trap and a favourite excuse not to stop.
• "All my friends smoke": Good. You can all give up together. Or at least you can be the source of inspiration to them.
• "Why worry? Everybody's going to die when their time comes: True. But why have painful lingering death from heart disease, stroke, cancer or a lung disease. Continuing to smoke almost guarantees a death from these causes.

SOME TIPS ON HOW TO QUIT SMOKING:
• Firstly, decide positively that you want to quit.
• Be confident in your ability to stop. You have more will power than your think!
• List all the reasons why you want to quit. Keep the list where you will see if often, e.g., on your mirror or the dashboard of your car. Every night before going to bed, remind yourself of all these reasons.
• Find a partner whom you can talk to during the time you are trying to quit. It is often helpful to ask a friend who has successfully quit in guiding your efforts. It is best you can find a friend whom you can convince to quit with you.
• Set a target date for quitting – this date should be 1- 2 weeks from today, perhaps a special day like your birthday, your anniversary or a holiday. If you smoke heavily at work, quit during your vacation. Make the date sacred and don't let anything change it. Bet a friend that you can quit on your target date.

BEFORE THE TARGET DATE:
• Stop carrying cigarettes with you.
• Limit the places and circumstances where you smoke: e.g., smoke only in one chair in one room.
• Change the situations in which you smoke: e.g., if you normally smoke while driving to work, stop doing so. Smoke either before or after your journey, if you must.
• Change the way you smoke: e.g., use a cigarette holder.
• Change brands after every pack. This reduces your dependence on the flavour of your favourite brand.
• Concentrate on each cigarette you smoke: Give it all your attention. This means no tea, coffee or TV when you smoke. This will cut down on 'automatic' smoking.
• Keep a smoking diary. Write down the occasion of every cigarette you smoke and review the information daily. Set a reasonable limit on your consumption.
• Advertise to friends and family about your decision to quit on the target date.
• Decide on how to reward yourself for quitting. Plan a suitable reward for the end of the first day, first week, first month and first year.

ON YOUR TARGET DATE :
• On the day you quit, throw away all cigarette and matches. Hide lighters and ashtrays.
• Think of quitting in terms of one day at a time. Tell yourself you won't smoke today, and don't.
• Visit the dentist and have your teeth cleaned to get rid of tobacco stains.
• Keep yourself busy. Go to the movies, exercise, take long walks, go bike riding.
• Buy yourself a treat. Do something special to celebrate the day.
• IF you miss the sensation of having a cigarette in your mouth, play with something else – a pencil, a paper clip, an empty cigarette holder or try chewing gum.
• Reach for a glass of juice instead of a cigarette for a midday lift.
• Get plenty of rest and avoid getting into situations where you need a cigarette (e.g., a card party with your smoker friends).
• Absorb yourself with activities that are most meaningful and satisfying to you.
• When you get withdrawal pangs or feel irritable practice deep breathing, exercise, go for a walk or take a shower.
• Start thinking of yourself as a non-smoker.

AFTER QUITTING :
• During the first few days after you quit, drink large quantities of water and fruit juices. Try to avoid alcohol, coffee and other beverages with which you normally associate your cigarette smoking.
• Do something else with your hands. If you use to smoke while driving to work, do exercises with your hands when waiting for the traffic lights to change. If you used to smoke while watching TV, keep a soft drink to sip next to you or munch popcorn or peanuts instead of smoking.
• Try to keep away from your smoking friends for a few days.
• Don't sit in your favourite smoking chair.
• Change your daily routine: e. g. if you were habituated to a cigarette as soon as you got up, go for a walk instead or have a shower.
• Don't allow you to trick yourself. A few favourite tricks are: "one cigarette won't hurt", or "I'll just have one to prove that I have really been able to quit". Recognize these symptoms and remember that these are just a momentary weakening of your resolve. Such thoughts should be stamped out as soon as they arise.
• Think positive. Keep reminding yourself that you are a non-smoker now.
• Keep reinforcing the benefits you stand to reap by staying away from cigarettes.

WHAT IF I SLIP UP?
If you do succumb to a cigarette in the first few days of being a non-smoker do not get discouraged. You are not a failure by slipping up once. It is the easy way out to accept this lapse as a failure of your entire program and revert to your smoking habit. To avoid this:
• Accept this as a temporary set-back and remind yourself that you have made a promise to yourself to quit.
• Invoice others: discuss the problem with your family, your support person or quitting partner.
• Learn from your set-back. Try to recognize the circumstances that led to the lapse. Maybe it was a situation; friend or surrounding that set it off. Try to avoid these triggers in futur

In any case you should not allow a few lapses to abort your entire program.

WHAT IS THE ROLE OF NICOTINE SUPPLEMENTS WHEN QUITTING?
If withdrawal symptoms are severe, it might be useful to consider nicotine chewing gum or nicotine patches. However, these are useful only if they are part of a strategy to quit altogether, rather than to merely reduce the number of cigarettes smoked. It is much better to quit without these props.

WHAT ABOUT 'ANTI SMOKING' DRUGS?
These drugs help reduce the dependence on nicotine and make the sensation of smoking less pleasurable. Again, although these may be helpful, it would be better to just stop without their help.

IS IT NOT TRUE THAT I MIGHT GAIN WEIGHT ONCE I STOP SMOKING?
Some ex – smokers do gain weight at first after quitting smoking. However, most return to the original weight soon, by simple exercises or effortless diets. Moreover, the weight gain is no problem for the heart: to equal the cardiac risk of a 20- cigarette-a-day smoking habit you'd have to gain 50 kg in weight!

WHAT CHANGE CAN I EXPECT AFTER I STOP SMOKING?
Within 12 hours of your last cigarette your body will heal itself. As the levels of carbon monoxide and nicotine in your blood stream decline, your heart and lungs start to recover from the long abuse. You will breathe easier. Within a few days your sense of smell and taste will return and your smokers cough will subside. Your appearance will improve and your stamina will return. In the initial stages you might experience some withdrawal symptoms, making you feel irritable and edgy. But these effects are temporary. Within 12 months of your last cigarette, your risk of having a heart attack or cardiac death is reduced by 50 %. Ten years after quitting you risk is exactly the same as that of a non-smoker.

More important, you will begin to experience a feeling of well-being that you will find exhilarating. You will feel really alive: clear headed and full of energy. Most of all, you will feel a sense of heightened self esteem and accomplishment: that you have finally freed yourself of the smell, expense, dependence and dangers of smoking.
Someone has rightly said : ' A cigarette is a white stick with a fire at one end and a fool at the other'.
If you don't smoke - never start.
If you are a smoker : promise yourself NOW to kick the habit.

" The only way to stop smoking is to just stop - no ifs, ands or butts".

" very affection of the mind that is attended with pain or pleasure, hope or fear, is the cause of an agitation whose influence extends to the heart. "

WHAT IS STRESS?
Walter Cannon drew attention in the 1920's to the 'fight or flight' responses to stress. In the past few years stress has grown to unimaginable levels, and has deservedly been labeled as the 'modern epidemic'. Stress is an unavoidable fact of life. More than 80% of responders to most 'stress polls' feel stressed. Some stress is a part of daily life: it affects everyone. A small amount of stress is actually helpful: it helps to keep us going. But too much stress on your mind and body can make you sad or ill. If you allow it to build up, stress can often produce tension, which can reduce your work efficiency and interfere with your normal daily activities.

Hippocrates taught that the state of the mind influences health. Today stress and the symptoms it produces are common problems. Many people visit doctors for stress-related complaints including physical problems which can be attributed directly to stress. Heart problems can also often be attributed to stress. Stress has been known to give rise to or worsen high blood pressure or angina pectoris and may actually precipitate a heart attack. According to some experts stress may be the single greatest contributor to illness in the modern 'industrialized' nations. An old proverb cautions us that "the brain may hold a conversation with the heart that can result in death". Stress and its associated physical complaints can be helped. Knowing about stress and recognizing its dangerous nature is the first big step.

WHAT CAUSES STRESS?
Probably the single common thread amongst all causes of stress is change. Sudden change, especially if it is disagreeable or untimely, precipitates stress. This could be:
• Personal loss: death of a loved one or a friend, separation, divorce, etc.
• Change of job: especially if it results from trouble at work, getting fired or change of a boss.
• Monetary problems: debts, loss of steady income, budget problems, etc.
• Illness/injury: this may result in stress, or be the effect of stress.
• Change in the family structure: e.g., pregnancy, childbirth, migration of children, disruption of a joint-family, etc.
• Retirement: this is a common, but often unrecognized cause of stress.
• Happy events: e.g., sudden lottery, a big promotion, or a daughter's marriage are happy events, but can induce stress.

ARE SOME PEOPLE MORE PRONE TO STRESS?
Yes. Some people are less proficient with coping. As an example, children who are overprotected may be poorer at coping with stress in adulthood. The ability to cope with stress is inborn to some extent. But like any good behaviour it can be learnt later in life.

WHAT IS ANXIETY?
Anxiety may be described as the vague fear that something bad is going to happen, even if there is no real threat. Anxiety may result from suppressed feelings that we cannot cope with. Or it may arise as a result of a conflict between our desires and reality. Excess stress can also lead to anxiety.

A certain amount of anxiety is good: it is a natural helpful response to a stressful situation and may actually help us perform better in these circumstances. For e.g., if you are appearing for a job interview, it is natural to be a little anxious. However, if that 'keyed up' feeling and tension is too severe, it may affect your performance during the interview. Also persists after the interview, you may be on the way to a full fledged 'Anxiety State'. Prolonged anxiety can lead to serious health problems such as ulcers, high blood pressure, angina, heart attacks, etc.

WHAT IS DEPRESSION?
This is a feeling of sadness or disappointment that leads to apathy and withdrawal from social interaction. Depression may result from prolonged stress, anxiety, frustrations, inability to live up to one's expectations or disappointments in life. The symptoms of depression include chronic fatigue, sleeplessness or undue sleepiness, inability to concentrate, boredom, feelings of worthlessness or hopelessness, restlessness and lack of interest in food, friends, food, sex, etc. Prolonged depression may lead to high blood pressure, weight loss, substance abuse, etc. Occasionally depression is expected and probably normal (e.g., failing in exams causes depression). But if this depression is prolonged or severe, it may become a serious problem. It can make you miserable, as also the people you interact with. This can seriously damage your physical, mental and social well-being.

WHAT ARE THE EARLY WARNINGS SIGNS OF STRESS?
Knowing that there may be some way to recognize that we are stressed may help us take preventive steps before we have a major breakdown. These signs include:
Physical symptoms:
• Constant feeling of exhaustion.
• Frequent illnesses: including headaches, insomnia, indigestion, nausea, diarrhea, constipation, sexual problems, etc.
• Excessive worrying about real or imagined problems.

Emotional symptoms:
• Mental fatigue: difficulty in concentrating.
• Apathy: lassitude, avoiding work or pleasure.
• Irritability: overtly aggressive, defensive or argumentative feelings.
• Anxiety: about work, family and possessions along with continuous feelings of restlessness or insecurity.
• Sense of worthlessness.
• Suspicious or insecure thoughts.

Behavioral symptoms:
• Extremism: at work, in spending, gambling, alcohol.
• Avoidance: of work, responsibility, family and friends.
• Personal neglect: poor hygienic, slovenly appearance, accident proneness.

COMBATING THESE PROBLEMS:
Having recoginsed that these problems can occur has to try to avoid them. This can be done by: • Exercising regularly: walking, running, cycling, swimming anything you like. These activities will help you to let off steam and reduce stress.
Learning to relax : relaxation is a technique which has to be learned. Just a few minutes a day of peace and quiet can make a great difference. Try it!
Taking a break : from your hectic routine. A change of pace, no matter how brief, will help reduce stress.
Taking it over: with relatives or friends. The simple act of sharing a problem any work miracles.
Planning your work: stress and tension build up when you have bitten off more than you can chew. Planning work in advance will allow you to direct your energies more effectively and limit stress-including conditions.
Being realistic : people who expect too much of themselves can get stressed if things don't work out according to their expectations. So set realistic goals.

If however, stress hits you and cannot control it, it is always a good idea to seek professional help. Seeking help is not a sign of weakness. On the contrary it's smart. Your cardiologist can help diagnose the problem, and if basic counseling does not help, he would be able to direct you to a professional more trained in such problems.

Don't let stress keep you down. Stress is an integral part of life. Everybody has ups and down. In fact life would surely be dull without them. A positive attitude goes a long way towards helping you over the rough spots in life.

Remember that life is 10% what happens to you and 90% how you react to it. Be optimistic. It helps.

HYPERTENSION (HIGH BLOOD PRESSURE) THE SILENT KILLER!

WHAT IS BLOOD PRESSURE?
Blood pressure is the force of the blood pushing against the walls of your vessels. Everyone has blood pressure. This is the pressure generated by the pumping action of the heart, which is responsible for providing blood to the various parts of the body. When your heart beats, it squeezes blood into your arteries. The blood pushes against the insides of your arteries with every heartbeat and the force it exerts against the arterial wall is called blood pressure. However, if your blood pressure is high then this is detrimental to you. It has been estimated that almost 10% of the adult healthy population has high blood pressure. Knowing your blood pressure and whether you have hypertension can save your life!

WHY BE CONCERNED ABOUT HIGH BLOOD PRESSURE?
While it is normal to have blood pressure, high blood pressure can increase your risk of heart attack, stroke and cause serious damage to various other organs, chiefly the kidneys and eyes. Extensive medical studies done on tens of thousands of patients have shown that people with high blood pressure die age younger age than those whose blood pressure is normal. In one large study, men between 30 to 39 years of age with a blood pressure of 140/95 (which previously had not been considered to be high enough to generate concern or be dangerous) had two and a half times the death rate of men of the same age group who had normal blood pressure. At a blood pressure of 150/100 the death rate was five times as great! In women and in older men, the increase in the death rates from these relatively minor elevations in blood pressure was not as high as in the young men, but the risk was still substantial.

BUT DOCTOR, I FEEL JUST FINE. WHY SHOULD I THINK ABOUT HIGH BLOOD PRESSURE?
It is not for nothing that hypertension has been called the 'silent killer'. While some patients may experience headaches, fatigue, dizziness or shortness of breath, most people having high blood pressure know nothing about it unless told by their doctors or until some complication occurs. It's victims go around their daily lives with no reason to suspect that anything is amiss until symptoms appear after years of uncontrolled hypertension have resulted in damage to an organ. People who rarely go to a doctor may never detect that their blood pressure is elevated and may there by miss out the chance of preventing damage to their organs.

IF LEFT UNTREATED, WHAT CAN HYPERTENSION DO?
Hypertension can affect your:
Heart: leading to angina, heart attack, or lead to a thickened and enlarged heart which cannot work efficiently and may ultimately end up as congestive heart failure with water accumulation in the lungs.
Brain: continuous high pressure on the arteries of the brain may lead to a blood clot or ruptured artery in the brain. Loss of memory, blindness, speech difficulty or paralysis may follow.
Kidneys: persistently high blood pressure will damage the delicate filtering units of the kidney. This can result in uremia, swelling of the body and kidney failure, necessitating dialysis or kidney transplantation.
Eyes: as a result of the high pressure, walls of the blood vessels in the eyes thicken. This leads to deterioration of vision, possibility of bleeding into the eyes and ultimately blindness.
Yet millions of patients don't even know that they have hypertension- and many who are aware do not follow a proper treatment plan.

WHAT CAUSES HYPERTENSION?
In most cases the causes of hypertension remains unknown. However, certain risk factors may predispose some people to have high blood pressure:
Heredity : high blood pressure runs in families. Family members are at a higher risk of developing high blood pressure.
Age: older people are more likely to have high blood pressure than younger ones. This risk rises after 35 years of age.
Stress : anxiety, competitiveness and hostility (i.e. 'type A' behaviour) may increase the predisposition to high blood pressure and may aggravate existing hypertension.
Excess sodium : too much salt causes blood volume to increases and blood vessels to constrict. The heart must now pump harder leading to high blood pressure. Furthermore, extra sold can aggravate existing hypertension, necessitating more drugs to control the high blood pressure.
Overweight : hypertension is twice as common in overweight people.
Drugs : birth control pills, weight loss drugs, nasal decongestants, thyroid hormones, etc. can temporarily cause high blood pressure.
However, even if you are not in these groups, you may still have high blood pressure. So we all need to have our blood pressure checked every year after the age of 35 years.

WHAT IS SECONDARY HYPERTENSION?
In most patients the cause of hypertension is not known. However, in a small percentage (1-5%, depending on age) of patients, hypertension occurs as a result of some other disorder such as kidney disease, thyroid problems, hormonal problems affecting the adrenal glands, drug intake, etc. high hlood pressure occurring due to these causes is termed secondary hypertension. Secondary hypertension is commoner in young hypertensive. It is to exclude secondary hypertension that your doctor may perform various laboratory tests to detect if you may possibly have a correctable cause for your high blood pressure.

HOW CAN HIGH BLOOD PRESSURE BE DETECTED?
The 'sphygmomanometer' is the instrument used to measure blood pressure. The one your doctor uses has a cuff wrapped around your arm and inflated until circulation in that limb is temporarily stopped. A stethoscope is placed at the elbow and by releasing the air slowly, the cuff is deflated. The doctor can hear the swishing sounds made by the blood once the cuff is deflated sufficiently to restore blood flow in the arm. This marks the upper blood pressure reading or the 'systolic blood pressure'. As the pressure in the cuff falls further, these sounds disappear marking the abolition of all obstruction to the blood flow. This marks the lower blood pressure reading or the 'diastolic blood pressure'.

Electronic blood pressure instruments are available which use the same principle to measure blood pressure at the elbow, wrist or finger. However, these instruments are never as precise as the manual sphygmomanometer that your doctor uses and their accuracy should be periodically verified by your doctor.

BUT WHY ME?
One of the myths about high blood pressure is that it is a disease of high-strung nervous people, or aggressive big-city executives with 'bad habits'. Unfortunately this is not true. Hypertension can occur in housewives or labourers and farmers or business executives. It afflicts the poor and the rich, the ambitious and the lazy, the extrovert as well as the introvert. Unfortunately, an easygoing relaxed personality and a healthy life style is no guarantee against hypertension.

WHAT GOODS DOES TREATMENT DO?
The good thing about high blood pressure is that once it has been discovered it can be controlled and lowered. These result in a dramatic lowering of the risks associated with the disease.

When the doctor finds a patient's blood pressure to be high, the first step is to determine whether it is an isolated high reading or if the patient really has persistently high blood pressure. To determine this the patient may need to have his blood pressure recorded at different times and after elimination of stress, recent exertion, cigarette smoking, etc. moreover, even in normal people, blood pressure goes up and down and may reach quite high levels with exercise and stress. These occasional high readings are quite and do not require treatment.

It is important to realize that treatment for high blood pressure must continue for life. Sometimes drugs can be stopped, especially if the patient loses weight, exercises and reduces salt intake. But these 'non-drug therapies' must be continued even if drugs can be stopped. In most people, high blood pressure can be controlled but not cured. It is thus vitally important for the patient to understand and accept the need for long-term treatment and to follow his doctor's advice over the years. If the patient, lulled by a false sense of security discontinues his treatment on his own, his blood pressure is likely to rise again without his knowledge and the risks of serious complications begin to rise as well.

WHAT LEADS PEOPLE TO DEFAULT ON THEIR TREATMENT?

The biggest obstacle to treatment is the patient's attitude. High blood pressure does not usually make the patient feel sick. Moreover, since most people are unaware of it's serious hidden dangers, those with hypertension often do not co-operate fully with their cardiologist. This problem is compounded by the cost and discomfort of regular medical treatment and the occasional minor side effects that some medicines produce.

Often, patients who felt perfect before their hypertension was detected feel slightly unwell for a few days after starting medicine, further making it difficult to convince them that the medicines are actually doing them good. For all these reasons some patients fail to come back to the doctor for additional blood pressure readings or diagnostic tests, once they are told that their blood pressure is high. Worse, they may fail to follow the doctor's instructions regarding treatment. These obstacles to treatment occur in all medical disorders, but can be especially severe and dangerous in treatment of high blood pressure. A sufferer of high blood pressure must remember that he is taking treatment not for his present complaints but to prevent damage to his organs 5, 10 or 20 years down the line.

WHAT IS 'WHITE-COAT HYPERTENSION'?
This is a well documented medical phenomenon. Often a person may have blood pressure readings when he goes to cardiologist. However, when he records the blood pressure himself or has it recorded by someone with whom he is more familiar, his blood pressure reading is invariably normal. This 'white-coat hypertension' is an anxiety-related phenomenon due to the patient's anxiety as to what his doctor will find, whether he will pass 'BP test' and the fear that if he fails it he may be put on drugs. White-coat hypertension needs no treatment except reassurance.

HOW CAN I HELP TO CONTROL MY BLOOD PRESSURE?

Your physician will choose the safest and most effective medication for you. Additionally, you can also help by :
• Taking medication as directed: Even if you are feeling well and think that your hypertension is now 'cured' NEVER discontinue, decrease or substitute medication without consulting your physician. This can result in dangerous changes in blood pressure. If the medicines make you feel bad, tell your doctor: he will change it to one that suits you better. But do not stop your medicines on your own.
• Establish a daily routine: Make taking the daily medication a part of your daily routine, such as with breakfast or after dinner. Put your drugs where you can see them and ensure a system to remind you if you miss a dose.
• Report side effects: Inform your cardiologist if you feel faint, develop a cough or swelling of the ankles. Side effects are occasionally seen with some types of antihypertensive drugs and are easy to remedy if only you inform your doctor.
• Maintain a blood pressure chart: This will ensure that you monitor your pressure at regular intervals and will enable good blood pressure control.
• Keep all appointments with your cardiologist: Once or twice a year is generally adequate once your blood pressure is well controlled.

IN WHAT OTHER WAYS CAN I LOWER MY BLOOD PRESSURE?
Lose weight : Weight loss may lower blood pressure levels of people who are hypertensive. Choose a diet that is right for you, and stick to it.
Exercise : Having high blood pressure does not mean that you have to slow down. On the contrary, exercise is good for you. Exercise alone may not reduce your blood pressure, but it will help reduce tension, promote relaxation and augment weight loss. An exercise schedule that suits you should be performed at least 3 times a week.
Reduce salt intake : Most people eat far more salt than needed. Eat less than one teaspoon of salt per day. That means cutting out preserved foods, papads, pickles and extra salt on the table.
• Reduce alcohol intake, or do not drink at all.
Reduce stress : Try meditation, yoga, breathing exercises, stretching or anything else that works for you to reduce your stress. Get enough sleep, but avoid dependence on sleeping pills.
Stop smoking : Smoking raises your blood pressure. Stop smoking totally!

HOW CAN MY FAMILY AND FRIENDS HELP ME CONTROL MY HYPERTENSION?
Friends and family members can indeed play an extremely important supportive role by :
• Understanding the patient's illness, its potential seriousness and the importance of controlling it.
• Participating in the patient's dietary and exercise schedules. This includes joining him in his morning walk (spouse, children, and friends), regulating diet and switching to a low salt low fat style of cooking (spouse) and supporting his decision to reduce alcohol and quit smoking (friends).
• Reminding the patient to take his medication, exercise, maintain his diet and stay away from alcohol and tobacco.
• Enabling the patient to get adequate sleep and stay from stressful circumstances.
• Providing encouragement, moral support and family sympathy.

DOES BLOOD PRESSURE INCREASE WITH AGE?
Yes. Blood pressure does rise slightly with age. This is because blood vessels become harder with age, resulting in a rise in the systolic (upper) blood pressure reading. However, if this rise is more than beyond acceptable parameters, then it needs to be treated. High blood pressure readings in older people cannot be ignored or labeled as 'normal'.

CAN CHILDRENHAVE HIGH BLOOD PRESSURE?
Yes. However, in most children this is due to 'secondary hypertension' (see above) and other causes for hypertension have to be very vigorously sought in children. Moreover, in children with secondary hypertension, blood pressure can be cured and not merely controlled. Blood pressure check-ups should also be done occasionally in children.
DOCTOR, I DON'T WANT TO START MEDICATION BECAUSE I WILL HAVE TO TAKE IT ALL LIFE LONG.
All cardiologists experience such statement regularly. Although illogical, the patient's underlying fear is genuine. Remember that you have to take medication to prevent serious complications that will appear many years later. By not taking drugs initially and continuing to feel well nevertheless, you may feel that you have outsmarted the cardiologist and defeated the disease. However, this is always a short-lived victory for which thousand have paid dearly by strokes, heart attacks and kidney failures. It is sure that if you are hypertensive you may need to take medication for the rest of your life, but this is truly a small inconvenience in exchange for continued good health.

CAN HYPERTENSION INTERFERE WITH MY SEX LIFE?
No. having high blood pressure does NOT impede with enjoyment of full sexual activity. However, if you feel that some medication is interfering with your sexual functioning you must consult your physician, who can easily change it to another which is better tolerated.

REMEMBER :
• High blood pressure can be controlled and not cured (just like diabetes).
• Have your blood pressure checked regularly and follow your physician's advice.
• Your blood pressure will remain normal just as long as you take your medicines.
• In general, medicines will need to be taken life-long.
• Some minor inconveniences of taking medicines will greatly improve your ultimate quantity and quality of life.
If you do all these things, you can feel better and live longer. So do them now. You deserve to be healthy for as long as you live.

Cerebral vascular disease affects blood flow to the brain, leading to strokes and TIAs. Narrowing, blocking, or hardening of the blood vessels that go to the brain or by high blood pressure causes it.

Stroke
A stroke results when the blood supply to the brain is suddenly cut off, which can occur when a blood vessel in the brain or neck is blocked or bursts. Brain cells are then deprived of oxygen and die. A stroke can result in problems with speech or vision or can cause weakness or paralysis. Fatty deposits or blood clots—jelly-like clumps of blood cells—that narrow or block one of the blood vessels in the brain or neck cause most strokes. A blood clot may stay where it formed or can travel within the body. People with diabetes are at increased risk for strokes caused by blood clots. A stroke may also be caused by a bleeding blood vessel in the brain. Called an aneurysm, a break in a blood vessel can occur as a result of high blood pressure or a weak spot in a blood vessel wall.

TIAs
TIAs are caused by a temporary blockage of a blood vessel to the brain. This blockage leads to a brief, sudden change in brain function, such as temporary numbness or weakness on one side of the body. Sudden changes in brain function also can lead to loss of balance, confusion, and blindness in one or both eyes, double vision, difficulty in speaking, or a severe headache. However, most symptoms disappear quickly and permanent damage is unlikely. If symptoms do not resolve in a few minutes, rather than a TIA, the event could be a stroke. The occurrence of a TIA means that a person is at risk for a stroke sometime in the future.

Heart Failure
Heart failure is a chronic condition in which the heart cannot pump blood properly -it does not mean that the heart suddenly stops working. Heart failure develops over a period of years, and symptoms can get worse over time. People with diabetes have at least twice the risk of heart failure as other people. One type of heart failure is congestive heart failure, in which fluid builds up inside body tissues. If the buildup is in the lungs, breathing becomes difficult.

Blockage of the blood vessels and high blood glucose levels also can damage heart muscle and cause irregular heart beats. People with damage to heart muscle, a condition called cardiomyopathy, may have no symptoms in the early stages, but later they may experience weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet. Diabetes can also interfere with pain signals normally carried by the nerves, explaining why a person with diabetes may not experience the typical warning signs of a heart attack.