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M. P. Ravindra Nathan

Are you at risk for developing coronary heart disease, including heart attacks (CHD) in future?

For many, the wakeup call comes too late - like when they get a sudden heart attack or experience a bout of heart failure, which was least expected. Sometimes, the first sign of CHD may be 'sudden cardiac arrest' often resulting in death unless the person gets successfully resuscitated! Which means CHD can creep up without any warning. Hence, the question you should be asking is, "Am I a possible candidate for future heart problems? And what can I do to prevent or at least postpone this dreadful disease?"

CHD has become a global scourge. And South Asians often seem to have more severe form when compared to other ethnic groups. Identification and evidence based management of the well-recognized risk factors that lead to CHD and its complications such as heart failure or sudden death should be paramount among the approaches to protect your heart.

Physicians currently assess a person's risk for heart attacks, strokes, etc. on the basis of individual risk factors. For example, if you have high blood pressure (BP), it would be considered as a significant risk factor. Add high cholesterol level and cigarette smoking to that, the risk becomes higher. But a new assessment tool could gauge the risk of a range of future cardiovascular diseases at one time, according to several recent clinical studies. This global risk assessment based on "Framingham Risk Score" can estimate better a 10-year CHD risk in men and women.

Here is how it works. A certain number of points are allotted for each of these health conditions according to its importance in an individual and the final count is tabulated. The conditions incorporated into this scoring system are: age, levels of total cholesterol, high-density (good) and low density ((bad) cholesterol, systolic BP, treatment for high BP, smoking, family history, presence of obesity/ overweight and diabetes mellitus.

Among the top risk scorers, 60 percent of women and 49 percent of men developed CHD, suggesting that this risk scoring system has high predictive accuracy, as attested by several clinical studies. This simplified system also allows your doctor to estimate a quantitative prognosis in the examination room with a simple general prediction for future events.

Good health is the cornerstone for progress. Are you eating at least three servings of fruits and vegetables and doing the regular workouts as you are supposed to? And quit smoking? Otherwise, the consequences can be costly. Trying to protect your heart while going through the 'dos and don'ts' in daily life can be quite daunting. But a little effort will go a long way to give you a healthy life. Florida Medical Association wants you to know that "coverage of cardiovascular screening blood tests is provided as a Medicare Part B benefit. The beneficiary will pay nothing for the screening blood tests."

"Beat Heart Attack" was the theme of a new campaign launched by the American College of Cardiology during the recently concluded annual convention in Chicago, which I attended. "We have the research, we have the expertise and now is the time to step into the ring and take action against heart attack" said the campaign message. And as physicians we are bringing this message to the public - "Fight heart attack at every stage - prevention, intervention, discharge and secondary prevention."

So, please consult your doctor and find out your own risk for future cardiac problems. As Arthur Agatston, the famous preventive cardiologist and author of the popular book, "The South Beach Diet," says, "Many high risk patients can achieve astonishing turnarounds."

* Part of this article was recently published in Hernando Times (St. Petersburg Times)

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville, lives in Brooksville.



The average child gets approximately 43 minutes of total physical activity a day.

The average child spends about 5 percent of his/her time for walking in additional to school or daily activities.

The average child consumes at least 20 ounces of soda pop a day.

Only 27 percent of average children spend a good amount of time to develop their motor skills.

As children get older each year they become lazier about their health. Boys' physical activities decrease by 3-5 percent; and girls' physical activities does down by 7-8 percent.

Obesities are becoming common. Now, there is even a category of super obesity. There is a psychological research study about parents' behavior toward their kids' health. Nine out of 10 parents think that their kids are healthy. In fact, only three out of 10 kids are healthy.


There are plenty of steps children can take at home and in the neighborhood. They are more likely to perform physical activities better with their friends or similar age kids. Therefore, the following events would be good to create fun activities for summer break.

Pool party: Swimming, diving in pool, and playing ball in the pool is one of best type of exercise.

Especially in Florida, kids can have fun in the pool in the afternoon rather than watching TV or playing video game in an air-conditioned room. By swimming, kids will develop motor skills of breathing and natural floating. They also can develop rhythmic multiple movement of the entire body.

Swimming will give a good amount of stress to their muscle, which is important for kids in development of muscles. Be sure to keep the healthy snack around the pool for kids. No soda! Vitamin water is a good replacement for soda. Fresh frozen grapes are fun and nutritious. Pool party can be turn into beach day as well.

Evenings at the park: Take your kids and their friends to the park. Most of the time, all they can do at park is run around, play soccer, football and basketball, skating, and cycling. All these are opportunities for kids to find their own interest in sport. The play area for little kids in park is particularly designed to develop their motor skills of climbing, sliding, hanging, etc. Spending about 2-3 hours at the park for 2-3 days a week is good way to keep children on the move. Be sure to have plenty of water with you or in your car. Kids must not feel dehydrated at any point during play time.

Neighborhood field day: Create a field day in your neighborhood. Have competitions and give prizes for kids. Add running, rope jumping, bicycling, relay to the game list. Also, egg and spoon, slow bicycling work to test their motor skills.

An easy alternative is to incorporate some physical activity camps in between educational camps. You also can have fitness professional give a group lesson to your children. Kids are interactive. They learn faster in the company of others. It is important to create an interest of a healthy lifestyle in your children from the beginning.

Achut Mashruwala of Fitness Guru Inc. can be reached at (813) 857-5103 or e-mail

Payal Patel

In the last part of my article, I would like to be more specific in my food choices as to better the choices for the whole family. After all, being healthy should be a family goal, as I had stressed in my prior article. Since food choices are extensive, here are some examples of the right food choices.

Starting with the morning, never skip breakfast. It is true that breakfast is the most important meal of the day; so start off with a healthy breakfast such as low-sugar cereals such as Total, All Bran or Kashi. When choosing cereal in the grocery aisle, look up on the top shelf, where the healthy cereals are put away. More sugary and artificial cereals are on the lower aisles (that's where the kids can see it and can demand it).

Incorporate oatmeal or cream of wheat (not instant) in the idlis, upmas, etc. If drinking tea or coffee, use decaffeinated if possible, and limit it to one cup per day. For children older than 2 years of age as well as adults, 2 percent, 1 percent or skim milk should be used. The older we get, the lower the percentage of milk fat we need.

If eating eggs, a great source of protein, use the egg whites instead of the yolk. When choosing breads or bagels, stay away from the white breads, which is made of enriched white flour and is deficient of any nutritional value. Choose 100 percent wheat or whole grain breads, which are a better source of nutrition and more filling. Avoid chevdas (fast food snacks), fried foods, etc.

Try to snack in between breakfast and lunch as well as between lunch and dinner on a piece of fruit such as a banana, apple, an orange, a cup of strawberries, or the best, blueberries (high in antioxidants). Plain yogurt is a good choice with some fresh fruit added for taste. Avoid eating flavored yogurt, which taste great but are loaded with sugar, and artificial sweeteners, and flavors.

Try a protein bar, found at GNC or even your grocery stores, which are great to curb appetite, especially if you have a time where you tend to snack or overeat, especially after coming home from work. Grab a handful of almonds, walnuts, pecans, etc., which also are great as a snack and a source of nutrition (provides essential fatty acids such as Omega 3 and Omega 6).

At dinner time, get the kids involved in making a salad - incorporate spinach, beets, tomatoes, bell peppers, beans such as garbanzos, etc. Use low-fat dressing; otherwise, stick to extra virgin olive oil mixed with some salt and pepper. When making chappatis, use whole wheat flour from your American grocery store mixed in with the Indian atta (flour), half of each to give it more nutritional value.

One medium size roti has about 80 calories without ghee (butter) vs. 130 calories with ghee. Avoid puris that are deep fried or even high in fat parathas with paneer, and loads of oil. Use more fresh vegetables to make parathas such as spinach, cauliflower, onions, garlic, etc. and use half the oil to cook it to avoid extra fat and calories. Use canola oil or olive oil to cook vegetables, dals, etc. Incorporate beans such as rajma (kidney beans), cholay (chick peas, Moong, and best of all, small red beans found only in American grocery stores.

This is a good source of protein, especially for vegetarians as well as a wonderful source of fiber. It aids in constipation and weight loss. For meat eaters, grill or bake meats rather than fry. Also, eat less red meat, which tends to be high in fat as well as cholesterol. Incorporate more vegetables into your cooking and stay away from fattening sauces, curries such as the ones used in Punjabi food.

Limit sodas, caffeinated drinks, juices, sports drinks, etc., and drink at least 8-10 glasses of water. If you crave for dessert, have a fresh fruit instead of fatty desserts such as cakes, cookies, etc. Instead of ice-cream, eat real fruit sorbets, bars, or choose frozen yogurt.

If you make sweets, use non-calorie sweetener or the amount of sugar called for in a recipe and add the rest with non-calorie sweetener. Eat half the amount you would otherwise. Use low-fat or fat-free evaporated milk and unsweetened condensed milk in a recipe that calls for condensed milk.

In conclusion, eat wholesome foods and avoid foods that are a source of empty calories, which can lead to weight gain. Grill or bake instead of frying, such as samosas, egg rolls, vegetables meats. Replace chips, fried snacks with fresh vegetable snacks or baked chips, etc. Learn to read food labels and understand how to incorporate it into your diet.

I hope that this four-part series has led to a more educated decision when it comes to lifestyle as a family.

I would like to thank Bhavi Patel, a registered dietitian in assisting me with this series on obesity. We wish you a healthy and active lifestyle to better the future of not only you but your children as well.

Dr. Payal Patel is a board-certified pediatrician at Sunshine Pediatrics, 18928 N. Dale Mabry Highway, Suite 102, Lutz. For information, call (813) 948-2679.

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