M. P. Ravindra Nathan

In the cover story of a recent issue of Time magazine, one of the 10 ideas that are changing the current day world was reported as: "Mandatory Health" (not Health Insurance). Corporate bosses are trying to force their employees to live better and crack down on unhealthy habits. It's clearly because of absenteeism, heavy medical expenses and a host of other woes, which goes along with chronic illnesses. This essentially means "don't fall sick" if you don't want to be terminated from your job.

And how are you going to maintain good health day in and day out? To begin with, you need to know your own vulnerability, your own risk, for major diseases such as heart attacks, strokes, diabetes, cancer, etc. Then take steps to prevent them or at least manage them effectively. Maybe, this is a good time to take a look at the health of the most vital organ in your body - the heart. Is it working well? Are you at risk for future problems and how can we prevent them?

First, a story from my personal experience.

Ralph, only 65, was referred to my office for consultation, because of an abnormal electrocardiogram (EKG). He had three short episodes of mild chest discomfort in the past month, which he discounted as indigestion. Yes, the EKG showed some changes; so, I advised him to get admitted to the hospital and have some tests. He wasn't convinced but finally relented. It turned out that he had a severe blockage of one of the main coronary arteries. With an angioplasty and a stent, he went home in three days, fully recovered. Lucky for Ralph, but it could have been worse.

In 2004, at the age of 58, former President Bill Clinton suddenly developed tightness in the chest while he was coming back from an extended tour promoting his autobiography, 'My Life.' He had experienced similar symptoms before, especially on exertion, which he attributed to exhaustion. He consulted his cardiologist and soon had an angiogram which showed 90 percent blockages in two arteries. "I was heart attack waiting to happen," he confessed. The story of Clinton's operation, although a media event, was a "learning moment" for the entire nation.

In spite of all the advances in preventive care, the epidemic of heart disease continues unabated. An estimated 79.4 million Americans have some form of cardiovascular disease (CVD) - heart attacks, strokes, angina, heart failure, etc. Many suffer from more than one type. Coronary Heart Disease (CHD), which affects more than 15 million Americans, is still the single leading cause of death in the United States and certainly results in frequent hospitalizations and permanent disability. In 2008, the direct and indirect costs associated with CHD could surpass $150 billion.

CHD has become more prevalent in India and amid Indians residing all over the world. Interestingly, while the CHD rates seem to be coming down in the western world, it has skyrocketed into epidemic proportions in India with no downturn any time soon. Finally India is waking up to meet this challenge, none too sooner. The average age of first heart attack or Myocardial Infarction (MI) is significantly lower in Indians, nearly half of all MIs occurring before the age of 50 and a quarter before even 40!

The underlying cause of CVD is a process called 'atherosclerosis' - simply, a hardening of the arteries. This means 'plaques' are accumulating within the lining of your coronary arteries that supply blood to the heart muscle. These plaques consist of several blood constituents, notably cholesterol, platelets and calcium. Some of them, so-called 'vulnerable' plaques, are prone to rupture, leading to sudden heart attacks and deaths.

To be continued.

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

The Indian American community is packed with smart, highly-educated, successful career-oriented adults and kids. However, they are not at the healthiest or active at their optimal potential and physical capacity. The early stage of chronic diseases in adults, children and teen obesity, improper growth in teens and adolescents are commonplace in our community.

It is essential to understand what fitness is and the reason it is important. In the old days, fitness was defined as the capacity to carry out the day's activities without undue fatigue. Fitness is about well-health and well-being. The definition of fitness has changed along with our lifestyle.

Now, physical fitness is defined as the body's ability to function efficiently and effectively in work and leisure activities, as well as to be healthy. The core concept is the same. Fitness is not about being thin, having a small waist or bulging muscles. It is a combination of qualities that enables us to be at our full potential in performing vigorous physical activities.

Fitness can be performance-related or health-related. Performance-related fitness is a measure of an athlete's agility, balance, power and speed. Health-related fitness, which is essential for everyone, can be achieved through regular physical activity. The physical activities are:

Flexibility is the ability to move joints and use muscles through a full range of motion. Stretching is a flexibility exercise.

Children are flexible. They can lose their flexibility as they grow if they don't routinely do stretching exercises. In adults, it is a good way to warm up the body to perform hardcore exercises. Stretching exercise should be no longer than 20 minutes and cause no pain. The proper stretching routine should relax the body as well as energize the body. The best time to perform stretching exercise is morning. Many times, evening can be good as well take away the stress from work and reenergize the body for after-work chores.

Aerobic fitness is the body's ability to use oxygen efficiently and depends upon the condition of your heart, lungs and muscles. This type of fitness increases the amount of oxygen that is delivered to your muscles, which allows them to work longer.

Children can achieve aerobic fitness by playing sports that require running, jumping, kicking and quick movements. It is the best way for kids to achieve aerobic fitness while having fun. An aerobic exercise also is essential for adults. It can help fight chronic diseases and maintain physical and mental activity. Aerobic exercise should always start with regular walking.

Then, it should progress to longer duration and speed. Aerobic fitness requires regularity and discipline. It cannot be achieved in a short period of time but keep in mind that regular exercise and constant progression will lead to a healthier body and mind. Indeed, aerobic fitness is necessary to enjoy retire life.

Muscular fitness includes building stronger muscles and increasing how long you can use them. Resistance training through weightlifting and body movements, such as push-ups, can improve muscular fitness.

Muscular fitness is a huge attraction among teens and adolescents. It is necessary to create muscular fitness in young boys and girls to become strong and healthy adults. It is a little easier to adopt exercise and healthy lifestyles at young age than in the mid 30s or 40s.

It also is a perfect time to tone up the body to last a long time. My personal experience shows that the muscles strength and flexibility developed at a young age (between 15 to 20) will give you a proper fit look and strength for the remaining working life. Muscular fitness requires hardcore exercises as well as professional guidance because there are many chances of hurting your muscles and other parts of the body if the exercise isn't done appropriately. The youth should make a workout session as part of social life.

Group training is a good way to achieve muscular fitness.

Regular exercise and balance diet is the key to physical fitness and a healthy you. However, it is important to understand the type of exercise, duration of exercise, and the combination of exercise that specifically meets your body needs. I also believe that everyone can improve physical fitness and health, yet my personal experience shows that professional guidance makes it much easier, fun and effective.

Consulting a professional trainer increases the motivation level far more than personal decision of getting up in the morning for a workout. Just as we need teachers to inculcate discipline and keep us focused, a fitness trainer helps to create the same discipline to improve your fitness and lead to a healthy life.

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

	Payal Patel

In this month�s article, I would like to stress the importance of food groups and serving sizes as well as talk about eating a balanced meal. It is important that a child eat the serving size recommended for his/her age as well as choose healthy foods.

A child aged 1-10 years of age should have three servings per day of milk products such as milk, cottage cheese, yogurt, cheese, etc. Children in this age group should have four or more servings of bread and cereal per day such as wholegrain bread, unsweetened cereal, cooked rice, pasta, grains. For Indians, a roti is a better choice than naan, bhakri or puri, which either is made with enriched white flour-with little nutritional value or contains more oil. For South Indian cooking, idli is a better choice than medu vada, dosas, uttapamas, which require more oil.

Adding vegetables such as peas, carrots-grated or blended spinach to idlis also fortifies them. Four or more servings of fruits and vegetables are ideal for kids of this age. Examples of yellow/green group are spinach, squash, carrots, peach, cantaloupe, etc., as well as citrus such as oranges, tomatoes, tangerines and strawberries. You can incorporate these as snacks such as carrot sticks, baby tomatoes or even salad before dinner. Frozen or canned vegetables also can be utilized in cooking.

Fruits such as strawberries, bananas, etc. can be used to create smoothies or be eaten as snacks or as a healthy alternative to dessert.

Since a lot of Indians don�t eat meat, beans such as chickpeas (cholay), kidney beans (rajma), moong (mag), black-eyed peas, etc. are a good source of necessary protein in our diet. For those who are lactoovo-vegetarians, eggs are a good source of protein.

Serving size is important because it determines the amount of calories consumed by a child. Discussing these choices with your child can help them understand nutrition as they grow up. A serving for a 1-3-year-old is half the serving of a 3-10 year old. For example, a half a cup of milk one serving for a 1-3 year old, whereas one cup is a serving for a 3-10 year old. A 1/4th cup of strawberries equal a serving for a 1-3 year old, whereas a � a cup of strawberries is a serving for a 3-10 year old.

Choosing nutritional foods such as for iron beans, lentils, cereals, dried fruit and green leafy vegetables as well as using cream of wheat (not instant) as a substitute for rava is important. Vitamin B12 can be obtained from dairy products, eggs and cereal. Folic acid rich foods are beans, berries, etc. Vitamin C can be obtained from fresh or frozen fruits and vegetables and fruit juices. A good source of Vitamin D is dairy products, eggs and cereals. Calcium can be obtained from dairy products and green vegetables.

Some of the ways to maintain healthy eating habits is eating at regular times, discouraging snacks, eating only at the table, eating slowly, grocery shopping together and teaching children about foods that are healthy choices. Other good options are packing lunch for school, instead of buying lunch from school. If your child does buy from school, reviewing the school lunch menu with him/her is a great way to ensure health eating habits.

In my next and final article on obesity, I will talk about a more generalized diet concentrating on particular foods, especially Indian meal choices that will benefit the children as well as the parents change their eating habits to better the lifestyle of the whole family.

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.