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Dr K K Aggarwal

Padma Shri and Dr B C Roy National Awardee

Women are not diagnosed or treated as aggressively as men. Even though more women than men die of heart disease each year, women receive only 33% of all angioplasties, stents and bypass surgeries; 28% of implantable defibrillators and 36% of open–heart surgeries, according to the National Coalition for Women with Heart Disease.

Although the traditional risk factors for coronary artery disease — such as high cholesterol, high blood pressure and obesity — have a detrimental impact in men and women, certain factors play a bigger role in the development of heart disease in women.

• Metabolic syndrome — a combination of increased blood pressure, elevated blood glucose and triglycerides — has a greater impact on women than men. • Mental stress and depression affect women’s hearts more than they do men’s.

• Smoking is much worse for women than men.

• A low level of estrogen before menopause is a significant risk factor for developing microvascular disease.

• Though women will often have some chest pain or discomfort, it may not be the most prominent symptom. Diffuse plaques build–up and diseased smaller arteries are two reasons why symptoms can be different in women.

• In addition to chest pain, pressure or discomfort, signs and symptoms of heart attack in women include: Neck, shoulder, upper back or abdominal discomfort, shortness of breath, nausea or vomiting, sweating, light–headedness or dizziness and unusual fatigue.

• Endothelial dysfunction is more common in women. In this the lining of the artery does not expand (dilate) properly to boost blood flow during activity, which increases the risk of coronary artery spasm and sudden death.

• Results of the WISE study suggest that the commonly used treatments for coronary artery disease — angioplasty and stenting — are not the best options for women with more diffuse plaques.

• Typical tests for coronary artery disease — angiogram, treadmill testing and others — are not reliable in women.

• The WISE study showed that in some women, plaques accumulate as an evenly spread layer along artery walls, which is not visible using traditional testing methods.

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To be in a state of happiness, bliss and ananda is what the ultimate goal of life is. Everybody is born with certain inherent powers, which if cultivated in the right direction will lead to inner happiness.

The ancient Shiva Sutra text talks about the concept of Shiva and Shakti. Shiva is silence, Shakti is power; Shiva is creativity, Shakti is creation; Shiva is love, Shakti is loving.

In computer terminology, Shiva is the knowledge or the information and Shakti is the operational software. Shiva and Shakti together form the consciousness, in other words, the soul. The Shiva sutra – teaching about Shiva – describes five inherent powers of Shakti which everybody is born with. These are ”Chitta Shakti”, “Ananda Shakti”, “Gyan (Gnana) Shakti”, “Ichha Shakti” and “Kriya Shakti”. Kriya Shakti is the one which is most visible. Kriya is not same as karma. Karma is action born of cause and effect. Kriya Shakti is at the level of body and mind.

Ichha Shakti is the inherent desire, which controls the mind. Gyan Shakti is the inherent desire to learn and is at the level of intellect. Both Ananda and Chitta Shakti are at the level of consciousness and represent the desires or aim to be blissful.

These five powers also decide the needs of a person, which can be at the level of physical body, mind, intellect, ego or the soul. The needs activate the Shakti, which in turn leads to action. The purpose of life should be to direct the needs and the Shaktis towards the soul and not towards the ego. The power of Kriya Shakti should have all the actions directed towards the soul; Gyan Shakti should be directed towards the knowledge of the true self; Ichha Shakti towards the desire or intention to unite with the self; Anand Shakti and Chitta Shakti towards the awareness of God and to experience the bliss of God.

All thoughts, speech or actions in life should be directed on two basic goals: providing happiness to others and achieving self-happiness. Every action and relationship in life should involve these five powers to attain inner happiness. Most computers in the body require a key to get activated and the key in the case of Shakti is “intention or intent”. Intentions are something, which are under the control of a person, or one can practice control over them.

“Intention” always requires the association of its buddy “attention” with it. Attention is the focus of action on that particular intention. The combination of intention and attention can change perceptions of life and ultimately change the reality. It has been an old Upanishad saying that you are what your thoughts are. Right intention leads to the right thought; the right thought to right action; the right action to the right habit; the right habit to the right character and the right character leads you to what you are.

The punch-line, therefore, is to have right intention which should be directed towards one of the five Shaktis to acquire spiritual well-being. Health is not mere absence of disease but a state of physical, mental, social, environmental and spiritual well-being. Spiritual well–being now has been added as the fifth dimension of the health. It has been said that the body is the largest pharmaceutical armamentarium in the world and has the capacity to produce each and every drug available in the universe. This is based on the fact that no drug can go into the body without a receptor. The very fact the body has a receptor for every drug means it has the capacity to produce that drug.

All yogic paths to liberation are also directed towards these Shakti. One adopts the path of karma by activating Kriya Shakti, Gyan Marg by activating Gyan Shakti and Bhakti Marg by activating Ichha Shakti. Faulty lifestyle also involves distractions of three of these powers: Ichha, Gyan or Kriya Shakti.

Correct lifestyle involves the correct use of Kriya Shakti in doing actions, correct use of Gyan Shakti by acquiring knowledge about self and healthy behavior and correct use of Ichha Shakti by learning the dos and don’ts of life and controlling the mind towards various addictions of life, which can be addition of food, sex, drugs, alcohol, smoking, sleeping, not walking and or eating faulty Rajsik cum Tamsik high refined carbohydrate diet (Medscape)

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• Quit smoking: This is the first and foremost critical step that you can take in order to improve your health and combat age related health complications. Smoking kills by causing deadly diseases like cancer, strokes and heart failure. If you were a smoker in your younger years and still are, it is not too late to quit this fatal habit.

• Stay active: Make it a daily routine to undertake something that keep you fit and active. Let it be something that promotes strength, balance and flexibility and most importantly, something that you enjoy. Physical activity is critical for maintaining a healthy weight, controlling illness, promoting bone strength and reducing stress.

• Prevent accidental falls: Elderly people are especially vulnerable to accidental falls. They can be prevented by making small changes around your house like removing loose rugs and carpets, keeping walking paths free of cords and clutters and using night lights for hallways. Wearing good friction supporting shoes has been observed to significantly prevent falls.

• Stay updated with immunizations and screenings: Women over 50 should maintain regular mammography screening for breast cancer and Pap smear test for cervical cancer. Similarly, men should get screened for prostate cancer. Some preventive vaccinations against infections that can occur during old age are also available. Cholesterol, lipid profile and thyroid screenings are equally important. Consult your healthcare provider for these options.

• Maintain a heart healthy lifestyle: The chances of heart disease increase significantly as you grow older. To combat this deadly disease, maintain a healthy body mass index (BMI), keep your blood pressure in check and eat a healthy diet with less salt/sugar and cholesterol.

• Eat well: A well-balanced healthy diet when combined with moderate physical activity can be the key to healthy aging. Many illnesses like heart disease, hypertension, diabetes, obesity and osteoporosis are strongly linked to what you eat. Calcium and vitamin D supplements can help women.

• Stay mentally active: Maintain a good amount of mental activity in old age to counter dementia and cognitive impairment that come with aging. Any issues of mental lapse and memory problems should be addressed promptly.

• Sleep well: Many elderly people face problems with maintaining a healthy sleep cycle. Insomnia and daytime sleepiness in excess are common complaints, talk to your healthcare provider about such issues.

• Manage stress: Old age can be stressful, especially due to emotional trauma associated with loss of loved ones, major life transitions and loneliness. Try exercise and relaxation techniques like yoga or meditation. Old age can be a great time to renew your social circle. Practice the art of positive thinking, it may seem small but it can take your health a long way. Keep you sense of humor, those laughing exercises may look silly but are really helpful.

• Get regular checkups for dental, vision and hearing health: Your teeth, gums, vision and hearing have the potential to last a lifetime, if cared for properly. Get regular checkups with your healthcare provider to understand how old age affects these aspects and what changes you can incorporate to keep them healthy.

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There was a time when everybody in India, especially women, observed fast on a regular basis. In my childhood, I saw my mother not only observe fast herself but also insisting upon my sisters to observe fast once in a week, an extra fast once in a month and observe the two Navratras in a year of 9 days each. Together, this comes out to be around 80 fasts in a year.

When I go back to my childhood, I remember the fast used to be one day of avoiding cereals altogether. We were allowed to eat Roti made of Kuttu flour, singharha flour, samak rice and dal made of chaulai (all fruits).

In our childhood, we could never understand the meaning of fast. Today India is becoming a hub of diabetes, heart diseases and insulin resistance and all of them are linked with not observing fasts or eating high carb diets every day.

The culprit is eating carbohydrates, especially, refined carbohydrates. When we recall our mythology, only one king Raja Dashrath died of heart attack. This only signifies that our mythological lifestyle was preventing heart diseases in India. The western culture which is now spreading rapidly in India involves eating carbohydrates, especially, refined carbohydrates (white sugar, white rice white maida) every day.

I recently did a survey and found that women who do weekly vrats had a lower incidence of metabolic syndrome.

Today’s girls and women do not want to listen to the word ‘vrata’ or ‘spiritual vrata’.

Therefore, they must be made to understand the same in the language of a ‘medical vrata’. The simpler version of ‘vrata’ can be – not eating carbohydrates at all once in a week and replacing them with fruits and vegetables.

I normally suggest that once in a week, one should eat only fruits and vegetables and at the most can have milk, curd. If still someone has desires, they can have besan ka chila.

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• Exercise routinely to maintain the flexibility of the bones

• Don’t smoke as it can lead to rheumatic arthritis

• Eat a low-fat diet; increase the consumption of whole grains, fruits and vegetables. People who eat such foods are on a low risk of developing arthritis

• Consume more of vitamin C if you are an arthritis patient. The best sources of vitamin C are strawberries, kiwi, pineapple, kidney beans, cabbage and cauliflower.

• People who consume Omega 3 have fewer chances of developing swelling and stiffness in the joints. The best sources for the daily dose of Omega 3 are salmon, trout, sardines, mackerel and anchovies. And if you are a vegetarian, then walnuts, fish oil supplements and flaxseed are some of the options

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1. Know your strengths.

2. According to a British study, only about one-third of people have a useful understanding of their strengths.

3. If something comes easily, you may take it for granted and not identify it as a strength.

4. If you are not sure, ask someone you respect who knows you well, by noticing what people compliment you on, and by thinking about what comes most easily to you.

5. Strengths which most closely linked to happiness are gratitude, hope, vitality, curiosity, and love.

6. Strengths are so important that they’re worth cultivating and applying in your daily life, even if they don’t come naturally to you.

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Type 2 diabetes mellitus is strongly associated with obesity. More than 80 percent of cases of type 2 diabetes can be attributed to obesity.

• There is a curvilinear relationship between BMI and the risk of type 2 diabetes.

• Lowest risk is associated with a BMI below 22 kg/m2

• At a BMI greater than 35 kg/m2, the relative risk for diabetes adjusted for age increases to 61. The risk may further increase by a sedentary lifestyle or decrease by exercise.

• Weight gain after age 18 years in women and after age 20 years in men increases the risk of type 2 diabetes.

• The Nurses’ Health Study compared women with stable weight (those who gained or lost <5 kg) after the age of 18 years to women who gained weight. Those who had gained 5.0 to 7.9 kg had a relative risk of diabetes of 1.9; this risk increased to 2.7 for women who gained 8.0 to 10.9 kg.

• Similar findings were noted in men in the Health Professionals Study. The excess risk for diabetes with even modest weight gain is substantial.

• Weight gain precedes the onset of diabetes. Among Pima Indians (a group with a particularly high incidence of type 2 diabetes), body weight gradually increased 30 kg (from 60 kg to 90 kg) in the years preceding the diagnosis of diabetes. Conversely, weight loss is associated with a decreased risk of type 2 diabetes.

• Insulin resistance with high insulin levels is characteristic of obesity and is present before the onset of high blood sugar levels.

• Obesity leads to impairment in glucose removal and increased insulin resistance, which result in hyperinsulinemia. Hyperinsulinemia contributes to high lipid levels and high blood pressure.

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• Don’t Criticize, always look for positive in a person or a situation. There is always something positive in every situation.

• Don’t Condemn a situation (and a person) howsoever small it may be.

• Don’t Complain, unless it is a must. You will refrain from these 3 Cs if you are laughing. By avoiding the 3Cs we avoid a lot of arguments that would usually naturally occur when you criticize, condemn or complain. If we criticize, condemn, complain, show resentment, or gossip about others, it comes back to “us.” If we praise, support, encourage and forgive others, this too comes back to us.

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