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Dr K K Aggarwal

Predicting sudden cardiac death

By Dr K K Aggarwal
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  • Normally people can walk a distance of 400-700 meters in 6 minutes.
  • A 6-minute walking distance of less than 300 meter is a simple and useful predictor of sudden cardiac death in a patient with mild to moderate heart failure.
  • Patients with interstitial lung disease who can cover less than 200 meters during 6 minute walk test are 4 times more likely to die than those who can walk greater distance.
  • People who can cover a distance of 200-300 meters need further evaluation.
  • A fall of SpO2 of more than 4% ending below 93% suggests significant desaturation.
  • An improvement of more than 70 meters or 10% in distance walked can make all the difference.
  • An improvement of 30 meters in any distance walked is the minimally important difference in any treatment.
  • Sudden cardiac death is linked to 15% of total urban mortality.
  • Risk factors for sudden cardiac death include abnormal lipid level, high blood pressure, cigarette smoking, physical inactivity, diabetes, obesity and family history of premature heart disease or heart attack.
  • Binge alcoholism can cause sudden cardiac death (6 or more drinks per day or five drinks in one session).
  • Risk of sudden cardiac arrest is transiently increased for up to 30 minutes after strenuous exercise.
  • If you are at low risk for having a heart problem, you do not need a regular treadmill test.

Nine modifiable risk factors for heart attack

By Dr K K Aggarwal
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The majority of known risk factors for heart attack are modifiable by specific preventive measures.

The nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, daily consumption of fruits and vegetables and regular physical activity. These account for over 90% of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10-year risk of a first heart attack event is 6% or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years, begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

Nine modifiable risk factors for heart attack

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , | | Comments Off on Nine modifiable risk factors for heart attack

The majority of known risk factors for heart attack are modifiable by specific preventive measures.

The nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, daily consumption of fruits and vegetables and regular physical activity. These account for over 90% of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10-year risk of a first heart attack event is 6% or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years, begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

Eating refined sugar can cause diabetes

By Dr K K Aggarwal
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  • Eating too much refined white sugar can cause insulin resistance and future diabetes.
  • If one has diabetes, it does not mean that he/she cannot have desserts forever. While eating too many sugary foods should be avoided, one can have an occasional dessert, especially if one exercises and otherwise eats healthy. It’s better to substitute brown sugar or Jaggery in that case. Artificial sweeteners including stevia are the other options.
  • Fruits are healthy for diabetics but cannot be consumed in huge amounts, as they contain carbohydrates.
  • As per Ayurveda, diabetes is a Kapha disorder and diabetics should limit the intake of sweet, salt and sour taste in the diet. Bitter and dark green fruits and vegetables have anti-diabetic properties.
  • One should combine a bitter taste with a sweet taste when choosing a vegetable or a fruit. For example, one should not combine peas with potatoes but one can combine potatoes with fenugreek (methi) leaves or spinach (palak).
  • Diabetics are not more susceptible to colds and other illnesses but may have more complications of flu.
  • Taking insulin does not cause hardening of the arteries or high blood pressure.
  • Diabetes is not contagious and one cannot catch diabetes from someone else.

Eating refined sugar can cause diabetes

By Dr K K Aggarwal
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Eating too much refined white sugar can cause insulin resistance and future diabetes.

Diabetes does not mean that one cannot have desserts forever. While eating too many sugary foods should be avoided, one can have an occasional dessert, especially if one exercises and otherwise eats healthy. It’s better to substitute brown sugar or Jaggery in that case. Artificial sweeteners including stevia are the other options.

Fruits are healthy for diabetics but cannot be consumed in huge amounts, as they contain carbohydrates.

As per Ayurveda, diabetes is a Kapha disorder and diabetics should limit the intake of sweet, salt and sour taste in the diet. Any fruit or vegetable, which is bitter and dark green, has anti-diabetic properties.

One should combine a bitter taste with a sweet taste when choosing a vegetable or a fruit. For example, one should not combine peas with potatoes but one can combine potatoes with fenugreek (methi) leaves or spinach (palak).

Diabetics are not more susceptible to colds and other illnesses but may have more complications of flu.

Taking insulin does not cause hardening of the arteries or high blood pressure.

Diabetes is not contagious and one cannot catch diabetes from someone else.

Cinnamon in diabetes

By Dr K K Aggarwal
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In a meta-analysis of 10 studies in patients with type 2 diabetes, consumption of cinnamon supplements improved fasting blood glucose and cholesterol levels, but not HbA1c levels. The report is published in the Annals of Family Medicine.

Small doses of cinnamon supplement could be used in association with traditional diabetes medication.

Cinnamomum cassia was the most common form of cinnamon studied in the trials.

The effect of cinnamon could be attributed to its active component cinnamaldehyde.

The advantages of cinnamon include its cost, tolerability and safety profile.

Long-term administration of high-dose cinnamon may be unsafe since its coumarin content has been tied to liver damage in animal studies.

Spiritual Prescriptions: Prefer Meditation and Not Medication

By Dr K K Aggarwal
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Meditation, and not medication, should be the first-line of treatment for most lifestyle disorders. The very fact that our body has a receptor for each and every drug means it has the capacity to produce that drug. God did not make these receptors for pharmacological agents or drugs. The key lies in achieving the undisturbed state of consciousness, which can be obtained by either controlling the disturbed state of mind or bypassing it by using the mantra.

The subject of spiritual medicine should be included in schools, colleges and medical sciences.

Confession and communication are two easy modules of controlling the disturbed state of mind. As darkness is absence of light, negative thoughts are absence of positive thoughts. To reduce negative thoughts, one should inculcate positive thoughts, actions and behaviors. One cannot hate a stranger. One can only hate a person whom he or she has loved. Hatred is therefore withdrawal of love, and it can only be removed by bringing the love back.

It has been shown that diseases like diabetes, high blood pressure, heart disease, paralysis, asthma and acid-peptic disease can be kept under control with meditation without or with minimal medicines.

(Disclaimer: The views expressed in this write up are my own).

Top 10 Ways to Keep the Kidney’s Healthy

By Dr K K Aggarwal
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We all want our kidneys to last for a lifetime. We should all show our love for kidneys by adopting 10-step program for protecting kidney health. Start with monitoring blood pressure and controlling weight and then move on to the rest of the kidney-healthy tips.

  • Monitor blood pressure and cholesterol.
  • Control weight.
  • Dont overuse over-the-counter painkillers.
  • Monitor blood glucose.
  • Get an annual physical exam.
  • Know if chronic kidney disease (CKD), diabetes or heart disease runs in your family. If so, you may be at risk.
  • Dont smoke.
  • Exercise regularly.
  • Follow a healthy diet.
  • Get tested for chronic kidney disease if youre at risk.

Nine modifiable risk factors for heart attack

By Dr K K Aggarwal
Filed Under Wellness | Tagged With: , , , , , | | Comments Off on Nine modifiable risk factors for heart attack

The majority of known risk factors for heart attack are modifiable by specific preventive measures.

The nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, daily consumption of fruits and vegetables and regular physical activity. These account for over 90 percent of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10-year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

A slight move is all that matters

By Dr K K Aggarwal
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Middle-aged women who move around more in their daily life have lower levels of intra-abdominal fat, a risk factor for heart disease. A minor modification in daily routine – reducing the time watching TV or increasing the walk time to work – can make a difference in the long-term health.

Visceral fat is a hot topic because of metabolic syndrome, which predisposes people to diseases.

Intra-abdominal fat, or the fat that wraps around the organs in the abdomen and chest, tends to accumulate at midlife and can contribute to developing diabetes, hypertension and heart disease. The fat around the organs is known to be more related to heart disease and diabetes. A woman does not need to appear outwardly heavy to have a potentially troublesome extra “tire” around her organs.

Exercise for long has been known to reduce the amount of intra-abdominal fat.

All about Diabetes

By Dr K K Aggarwal
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  • India is the diabetes capital of the world.
  • People with diabetes are nearly two times more likely than people without diabetes to die from heart disease, and are also at greater risk for kidney, eye and nerve diseases, among other painful and costly complications.
  • Type 2 diabetes can be delayed or prevented, and both types 1 and 2 diabetes can be managed to prevent complications.
  • In type 1 diabetes, the body does not make insulin. In type 2 diabetes, the body makes insufficient insulin or does not use insulin well.
  • Gestational diabetes occurs in some women during pregnancy. Though it usually goes away after the birth, these women and their children have a greater chance of getting type 2 diabetes later in life.
  • Type 2 diabetes has begun to affect young people.
  • Losing a modest amount of weight — about 15 pounds — through diet and exercise can actually reduce your risk of getting type 2 diabetes by as much as 58 percent in people at high risk.
  • In type 1 diabetes, tight control of blood sugar can prevent diabetes complications.
  • Choose healthy foods.
  • Take a brisk walk every day.
  • Talk with your family about your health and your family’s risk of diabetes and heart disease.
  • If you smoke, seek help to quit.
  • Make changes to reduce your risk for diabetes and its complications — for yourself, your families and for future generations.

What type of a vegetarian are you?

By Dr K K Aggarwal
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There are 4 main types of vegetarian diets:

  • Lacto–ovo–vegetarian consumes dairy products and eggs but no meat, poultry, or seafood
  • Lacto–vegetarian eats dairy products but not eggs, meat, poultry, or seafood
  • Ovo–vegetarian eats eggs but no dairy products, meat, poultry, or seafood
  • Vegan does not eat any animal products, including meat, fish, poultry, eggs, and dairy products; many vegans will also avoid honey.

Vegetarian and plant–based diets are associated with a reduced risk of obesity, diabetes, heart disease, and some types of cancer as well as increased longevity. Vegetarian diets are typically lower in fat, particularly saturated fat, and higher in dietary fiber. They are also likely to include more whole grains, legumes, nuts, and soy protein, and together with the absence of red meat, this type of eating plan may provide many benefits for the prevention and treatment of obesity and chronic health problems, including diabetes and cardiovascular disease.

Diabetes mainly linked to obesity

By Dr K K Aggarwal
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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.

Kidney patients more at risk for future heart attacks

By Dr K K Aggarwal
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Chronic kidney disease patients with kidney function less than 60% are included in the list of criteria for defining people at highest risk for future heart attacks.

In a large cohort Canadian study published in The Lancet led by Dr Marcello Tonelli at University of Alberta, patients with only chronic kidney disease had a significantly higher rate of heart attacks than those who only had diabetes. Those who had already had a heart attack had the highest overall rate of heart attacks.

Chronic kidney disease should be regarded as a coronary heart disease risk equivalent, similar to diabetes, as patients with the condition have high rates of cardiovascular events, particularly when they also have proteinuria. When chronic kidney disease was defined more stringently with kidney function less than 45% and increased proteinuria, the rate of first heart attack was higher in those with both chronic kidney disease and diabetes than in those with either disorder alone.

Top 10 ways to keep the kidneys healthy

By Dr K K Aggarwal
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  1. Monitor blood pressure and cholesterol.
  2. Control weight.
  3. Dont overuse over-the-counter painkillers.
  4. Monitor blood glucose.
  5. Get an annual physical exam.
  6. Know if chronic kidney disease (CKD), diabetes or heart disease runs in your family. If so, you may be at risk.
  7. Dont smoke.
  8. Exercise regularly.
  9. Follow a healthy diet.
  10. Get tested for chronic kidney disease if youre at risk.