Smokers often say and probably believe they know all about the effects of smoking. But when you quiz them, they have big gaps and mistakes in their knowledge. This isn’t surprising, because smokers are human. Humans feel uncomfortable when their behavior is out of step with their attitudes or knowledge, a situation psychologist call ‘cognitive dissonance’. Never mind the jargon, it just means we mostly like to feel we are doing the right thing and not doing the wrong thing. When we come across some information that is out of step with our behavior, we are inclined to disbelieve or ignore that information. To avoid feeling uncomfortable about their smoking, smokers tend to avoid or disbelieve information about its harmful effects.

[ad]

A 1984 survey for the Victorian Anti-Cancer Council found that a quarter of smokers, meaning about one million in Australia, believed that no illnesses were caused by smoking. While nearly 60 per cent knew that smoking could caused lung cancer, less than 25 per cent knew that it caused heart disease, bronchitism emphysema and stroke, even though these illnesses are more likely and occur more quickly than lung cancer. Only 3 per cent knew that smoking could cause complications in pregnancy. While there is no doubt that the propaganda of the tobacco industry contributes to this alarming degree of ignorance in those people most at risk to tobacco related disease, it is also true that it reflects the fact that smokers tend to avoid correct information about the health effects of smoking.

If you are a smoker and wants to quit smoking, you are going to need all the help you can give yourself, especially to stay quit. That means building up your motivation. You can do this by knowing accurately all of the harmful effects of smoking that you will be saving yourself from and by identifying the benefits you will gain from not smoking. That means learning about smoking. If you would like to know about aspects of quitting smoking, the Anti Cancer Councils and the National Heatr Foundation and possibly your state health department publish pamphlets and booklets on the topic which they will happily give you. You can find them through your state capital telephone book.

Sevenfold more operations in one year. If we look carefully at these figures, the fact that stares us in the face is the personal monetary gain for the operating team in the USA compared to hardly any fiscal benefit to the team in the UK.

[ad]

Be that as it may, let us look at the development process of the coronary artery disease — a relentless disease which has no cure as yet. Our only hope is prevention.

While it is true that fixed blocks in the large surface coronary arteries in man might result in exceptional chest pain, such’ blocks have not been shown to kill anybody. The fatal heart attacks (myocardial infarction), in which a portion of the heart muscle dies, are usually caused by near-normal looking surface arteries being blocked suddenly by a large clot. To date the mystery of how this clot gets formed has not been solved.

The critical narrowing of the aforementioned large arteries serves as a good provocation for collateral blood flow keeping the muscle viable. Prospective studies have shown even extensive blockage of all the three large vessels to be innocuous as far as death is concerned. The fears expressed by certain medical quarters that these blocked arteries can eventually cause damage to the good muscles of heart has not been borne out by facts. Nevertheless, significant damage tithe total heart has not been borne out by facts. Curiously, even disease of the left main artery (labeled ‘widow-maker’) which is supposed to kill the victim in a short time, has been shown to be absolutely safe (without operation) in a large cohort of men having these blocks who refused surgery (lucky blokes !!).

What then are the real indications for bypass surgery? There are two absolutely certain indications. The first is intractable chest pain which cannot be relieved by any medical method. Fortunately, the latter situation is exceptionally rare. The second indication is Avery poorly functioning heart (left ventricle) with a large dilation of its wall (aneurysm) whose capacity to pump blood has been severely curtailed. Whereas such patients gain good functional benefit through bypass surgery coupled with resection of the bulge,

The mortality rate of these patients with respect to the operative procedure (peril-operative mortality) is prohibitively high consequences; many surgical teams (whose prime goal is to make money) do not like operating on these patients.

Another myth created by the doctors is the hope that bypass surgery prolongs life. There are no studies available to date which have shown improved survival rates after bypass surgery, although minor benefits in longevity were shown by two small groups but only in young patients, who, in the first place, did not need surgery. Two of the milestone studies in this regard suffered from a flawed study design. In fact, bypass surgery has consistently been shown to progressively accelerate blocking of the native circulation (the patient’s own arteries).

The story of angioplasty is still worse. There has not been single large- scale, well-conducted study which has indicated this procedure to be useful at all. Even the recent RITA study did not show this procedure in a good light. The angioplasties arteries of nearly half the patients get blocked off in virtually no time atoll; in the remaining patients, these arteries get blocked off progressively. All attempts to keep these opened vessels functioning for a long time through methods such as using drugs of all kinds and resorting to various diets have come to naught. Nevertheless, there are two more ongoing studies. One of them pertaining to the use of drugs such as harden, an extract of leeches, and the other to self-administered, low-dose heparin(which ought to be ready in the near future). The hope of using the latest monoclonal antibodies against platelet-aggregating globulin, though theoretically sound, does not seem to be promising; as its cousin did not do well in heart transplant patients. Nature keeps its secrets close to its chest. A new process called fibro cellular intimae hypertrophy (FCIH) blocks these angioplasties vessels, which we have yet not understood fully. Curious are the ways of the human body!

[ad]

Why then are these procedures being carried out even in thecae of innocent people who have no chest pain or any other disability related to the heart’s pumping capacity? The only one reason could be a good business proposition; the scenario is alto common and transparent.

Let us consider a typical situation. A middle aged man, coming up in life, goes for a total medical check-up. Some test shows something abnormal. He is thus goaded to get an X-rayon the heart vessels, lest potentially dangerous, but quiet, blocks in these arteries should result. Such blocks are sometimes seen even in children, as shown by the Vietnam and Korean war victims and also by the recent Los Angeles riot victims. As has-been stressed earlier, such blocks rarely kill a person. But the doctor invariably informs the innocent victim, by showing him the blocks in his heart vessels that he is sitting on a volcano which can erupt at any time and finish him off. Which person under these circumstances can refuse the ruse of total cure by bypass surgery or angioplasty? The advocate, the jury and the judge are all rolled into one person; the cardiologist. Depending on whether the cardiologist is an intervention list or not, his advice would be to go in for angioplasty or surgery. The judgment thus delivered, the hapless victim is gripped by intense fear ofsuddendeath and is relentlessly pushed on to the operating table. The relatives also join in the plea for ‘correcting the plumbing’. The diagnosing doctor and the intervention team must adopt totally different ideals and values if the situation has to change for the better.

How can we save the day? We must convince all doctors to treat on a priority basis those human beings suffering from intractable chest pain or consequent heart failure and not the so-called ‘menacing coronary angiograms’.

Angiograms should be done only after the decision to interfere has been made, depending on the patient’s actual condition and not for diagnosing coronary artery disease as a gold standard. Infect, the largest coronary artery surgical study has shown that angiograms are only needed to plan the operation and not as an algorithm of the indications for surgery. Health education of patients should take on paramount importance in order to counter the menace of proliferating bypass centers!

There is strong evidence linking a high fat intake with high blood cholesterol And triglyceride levels, which in turn increases the risk of at hero-sclerosis and coronary heart disease. On the one hand, fat is a normal part of our bodies, providing insulation against cold and physical knocks and being an efficient way to store surplus Energy for future use. It can taste good and prevent hunger, since it takes Time to digest. On the other hand, having too much fat in our bodies, which is? Easily achieved by eating too much fat in our food, is convincingly associated with a large number of health risks. Meanwhile, establishing sensible eating as a part of your lifestyle is an essential foundation for sustained weight loss. Cholesterol is a substance you have almost certainly heard offend possibly Worried about’. It is often not really understood by most people and it is still the subject of on-going research afar as health is concerned. On the One hand, cholesterol is normally a part of the wall (or membrane) around each of our body cells and in the protective covering on nerve cells. It is also used to make some hormones (including sex hormones) and bile acids which are used to? Digest fats. You would be in trouble without any cholesterol.
[ad]

Your liver makes about one gram of it each day and, on a typical Australian diet, you would eat About another 0.6 grams of it each day. After the age of six months, your body Is able to make all the cholesterol it needs. Your body can try to cut back its Cholesterol production if your diet includes a lot of cholesterol, but only to A limited extent. On the other hand, although the exact role of high cholesterol in heart and Blood vessel disease is still debated by experts, it seems reasonably clear That it is associated with increased health risks. For example, a ten-year Research study by the US National Heart, Lung and Blood Institute on some4, 000 Men found that reducing your cholesterol level by 25per cent reduces your risk Of a heart attack by 50 per cent. To meet criticisms of previous research on this question, this study was designed to rule out the possibility that the Health gains were due to other factors, such as differences in blood pres-sure, Smoking, drinking or exercise. To try to settle some of the controversy about cholesterol and health, in 1984 The US National Institutes of Health assembled a panel of fourteen experts, Chosen for their solid professional standing but apparent lack of prejudice on This issue, to review the available evidence. The panel concluded there is a direct link between high cholesterol levels and premature death from heart Disease. They also decided that the average cholesterol levels amongst Americans were too high, and that recommended levels should be set lower than they were previously. In sum, they told the whole American population they should be eating less fat and reducing their blood cholesterol levels, rather Than just focusing on the minority with obviously high levels. This general advice has recently been criticized as possibly being based on too narrow as ample of people and for over-emphasizing the importance of cholesterol levels Compared with other lifestyle factors such as the need to exercise. Part of the confusion is that there are two kinds of cholesterol, ‘good’ and ‘Bad’. ‘Bad’ cholesterol is called low density lipoprotein (LDL).

It is the Cholesterol that tends to stick to the walls of your arteries, contributing to Disease. ‘Good’ cholesterol is high density lipoprotein (HDL) which seems to remove excess cholesterol from your blood. The proportions of these two may be as important to your health as your total cholesterol level. We don’t expect to settle an issue still being argued by experts and still being researched but, on the basis of present knowledge, it seems a good idea to keep your Blood cholesterol down to the recommended level, while increasing the proportion Of HDL to LDL. It is worth noting that are liable way of boosting the ‘good’ Portion of your cholesterols regular exercise. Dr Paul Nestle, the Deputy Director of the Baker Institute admonish University, has claimed that Australian average cholesterol levels tend to be 5 per cent higher than those in the USA.A CSIRO report in 1988 said that 70 Per cent of Victorians were still eating too much fat. Although women were more likely than men to use non-fat cooking methods and to eat low- Fat foods, these efforts were being cancelled out by their eating more cream, Salad dressings, full-fat cheeses, cakes, biscuits, chocolate and snacks. The Researchers found that 37 to 38 percent of the daily energy intake of Victorians was fat, compared with our recommended goal of 30 per cent. The main Sources of fat in Victorians’ diets were dairy foods. There is no reason to expect the situation would be any better in any other state. Healthy eating guideline: Reduce your intake of fats. Fats include the visible fat on meats and the less obvious fats in butter, Margarine, edible oils and processed foods.

You can achieve this goal in a Number of ways.

*Eat less high fat meat such as beef, pork and lamb. Replace them with lower Fat meat such as fish. *Grill or dry roast meat and fish, rather than frying or roasting in fat or Oil, and rather than stewing. Fish can also be poached, steamed or microwave.

*Trim the fat off meat before cooking. Preferably remove the skin and its Attached fat from poultry. *Use less butter and margarine. Put your spread straight onto the toast Instead, or use low fat substitutes like cottage or ricotta cheese.

*Replace whole milk (full cream or homogenized) with skim milk. Cows’ milk is a High fat food designed for baby cows. Humans are the only species that regularly consumes milk, in its various forms, after infancy. It has recently been suggested that women should drink milk for its calcium content, to prevent unnecessary loss of bone with increasing age. You can get all the calcium you need from skim milk. In choosing your skim Milk, do read the labels. Our local supplier sells a so-called ‘high-protein, Low-fat’ milk. In comparison with their own plain skim milk, it offers only 18 percent more proteins but ten times as much fat and 46 per cent more Kilojoules. Flavored milk is loaded with refined sugar, not to mention artificial colors and flavors. Make your own with some pureed fresh fruit for Flavoring. From corn, soy, or sunflower seeds, chooses one that has not been hydrogenated (Look for the term ‘cold-pressed’ on the label). Margarines vary a lot in how much hydrogenation they have suffered but the Manufacturers don’t tell you this on their labels. Until they give us the Information we need to make uninformed choice, use moderately on margerine. At least some of the time, a little butter may be better (but cottage or ricotta cheese would be better still). Good news for us seafood lovers!

First, the fear that some seafoods were high in cholesterol and so should be eaten sparingly, turns out not to be true (they Contain a different kind of sterol).

Second, cold-water fish contain Unsaturated oiling their flesh (presumably it stops them from freezing solid in icy waters) and this oil has been found to reduce the stickiness of blood Cells. This oil was discovered by researchers trying to understand why Eskimos, Who ate a high fat diet, did not have high incidence of heart disease. They found that the Eskimos also ate a lot of fish containing this oil and some of the fat they ate from marine mammals like seals and whales also contained unsaturated fats.

Some people have jumped at this news with the Suggestion that we should all guzzle huge amounts of cod-liver oil. Quite Apart from the risk of dangerously over-dosing on Vitamin A, this suggestion is Tasteless and boring. A more interesting way of making the health gains offered by this discovery is to eat some cold-water fish, like mackerel, cod or tuna regularly. Note that the unsaturated oil is in the fish, not the oil that is put into cans by fish processors. Go for fresh fisher fish packed in water. The other common concern about cholesterol is eggs. It is true that egg yolks contain a lot of cholesterol but research on the effects of eating them has produced contradictory results. Eggs are potentially a good food source, easily prepared in variety of ways, easily digested and the cheapest form of animal Protein.

[ad]

Medical researchers in Adelaide reported in1988 that eating egg yolks Increased blood cholesterol levels only in people who are already susceptible to high cholesterol levels. Normal people who ate two eggs a day showed newly- Gable increases in blood cholesterol. If you have a serious cholesterol Problem, you should probably avoid eggs. If you aren’t sure, see your doctor (a Cholesterol level check is a good idea, anyway). If you don’t have a problem with cholesterol, eating eggs isn’t going to give you one. He eating guideline: Eat a moderate number of Eggs, cooked at low temperatures or raw. Eggs immoderation (like everything Else) can be a tasty, low cost part of your healthy eating plan. You can reduce any risk to your health further by not over-cooking them. High temperature cooking, like frying and hard-boiling, changes the cholesterol into cholesterol oxides. These seem to be more of a problem than the original Cholesterol. So soft boil or lightly scramble or poach them. Or have an egg Flip (using skim milk flavored with fresh fruit, of course). Consumer Association tests have found no significant difference between ‘free range’ and other eggs. They were critical of the delays in getting eggs to the consumer and the widespread use of artificial coloring to make yolks more yellow. Unless you can keep your own chooks or buy from someone who does the practical answer is again more pressure on the politicians for a more efficient and honest egg industry.

`Your good health!’ It’s one of our most common toasts. If it does not always accompany the healthiest of drinks, that doesn’t deny the fact that good health is something we often wish for each other and for ourselves. Later we will explain how you can enjoy some very good drinking, if that’s to your taste, as a part of a healthy lifestyle. That’s a point we would like to make early and will repeat often: living a healthy lifestyle does not mean going without all the things you like and putting up with things that no one in his right mind could ever like. It does mean enjoying the good things in life and coping with a few healthy demands in moderation.

[ad]

In recent years there has been a growing interest in health and the factors that affect it. The clearest evidence of this is the massive growth of the ‘health’ industry — ‘health food’ shops,’ health and fitness’ centers, ‘health’ magazines, `health’-giving gadgets, potions, and pills. If you’ll forgive the pun, we think this interest is healthy because, as we will explain, you are the single most important influence over your health. Unfortunately, your interest may sometimes be attracted to a part of the ‘health’ industry that seems to offer magical solution for good health. No need to make much change to how you live or what you eat or drink. Certainly no need for all that unpleasant and sweaty exercise. Just swallow one of these vitamin pills a day or let our machine do the exercise for you or eat lots of oat bran. As you will learn, these magical solutions for good health are magical only in their capacity to earn money for their marketers.

For most of us, enjoying good health will involve making some moderate changes to several aspects of our lifestyles. Although they will cost a bit more effort from you than the magical solutions require, those changes need not cost you anymore money than you already spend on daily living.

The ‘health’ services in our community are one of our biggest costs. Doctors, nurses, paramedical and support staff, hospitals, health centers, equipment and drugs, all cost us amino. Each year they gobble up a major share of the budget at national, state and local government levels, not to mention affair slice of most family budgets. Even if you rarely need to consult a doctor, you probably pay a compulsory ‘health’ insurance levy to Medicare and may well pay an additional `health’ insurance premium to a private ‘health’ fund.

With all of this interest, activity and expenditure, you might assume we would all know about and enjoy good health. The truth is sadly otherwise. It is true that fewer babies or children die and people live longer than they used to. Some diseases that often killed or crippled have largely disappeared. But many of these health gains are due more to improved public health measures such as sewerage, drains, clean water supplies and better food handling than to advances in medical science.

The ‘wonder drugs’ of the 20th century have in fact been admixed blessing. They certainly saved many lives, but that has sometimes prompted an over-use which has spawned the growing threat of drug-resistant strains of diseases. The widely

Reported advances in medical technology, such as transplants, artificial body parts and in-vitro fertilization, are welcomed by their successful recipients but these are comparatively few and the costs are comparatively high.

Many people have misunderstood the promise of medical science to be: ‘No matter what goes wrong with your body –or why it went wrong — we will fix it for you’ although medical scientists would be the first to say they have never made such sweeping promises. They are, like most scientists, cautious in their public statements. But the way in which their activities are reported in the popular media when another ‘breakthrough’s announced carries such a message. Medical scientists are usually enthusiastic about their work and understandably wanton have it reported favorably, especially in times of dwindling financial support for research.

Although the public image of medical practitioners has taken a battering lately, there are still vestiges of the old attitude that the family doctor will have an answer for every-thing. This attitude, coupled with the unduly optimistic expectations of what medical science can deliver, has led many people to an irresponsible approach to personal health that has served them ill indeed.

For all the gains in public health, we are not a very healthy lot. We may like to think of ourselves as a sun-bronzed, outdoorsy, sporty bunch, but the only truth in that stereotypes our high incidence of skin cancer from excessive exposure tithe sun. Our most popular recreation is watching television; our most popular outdoor recreations would be eating and drinking (usually unwisely); and our usual involvement in sport is watching it. A survey released in 1984 by the Australian Bureau of States-tics found that 70 per cent of the population had taken some

Sort of health-related action in the two weeks before the survey. Of that group, 94 per cent had taken some sort of medicine, 25 per cent had consulted a doctor or specialist, 9 per cent had consulted some other sort of health professional, and 8 per cent had taken off one or more days from work. And that was just in a typical fortnight! Not exactly a national picture of glowing health.

Not only do we seem to have a high rate of health problems, but the situation may be getting worse. A report from the Australian Medical Association in 1984 concluded that teenagers today are far less healthy than those of thirty years ago. Dr David Bennett, said it was myth that teenagers today led fit, healthy lives. Instead they had higher rates of suicide, accidents, alcohol and drug abuse, sexually transmitted disease and psychological problems than any previous generation. One survey found that 9 per cent of teenage boys and 18 per cent of teenage girls were moderately obese (10 per cent overweight), while 4 per cent of boys and9 per cent of girls were seriously obese (20 per cent over-weight). Although parents were understandably worried about their teenage children using illegal drugs, the drugs most used by teenagers were alcohol, painkillers and tobacco. Dr Bennett said that two thirds of secondary school students used alcohol and painkillers, and a half were smoking tobacco, although these of other drugs was comparatively rare.

Atherosclerosis is a build-up of fatty deposits on artery walls, and it is a major underlying cause of heart disease.

R Fred Epstein, Professor of Epidemiology at the University of North Carolina, addressing the Seventh International Sym-podium on Atherosclerosis in 1985, said: ‘Atherosclerosis is basically a childhood disease, both because undesirable habits are formed in childhood and because the disease itself starts in

Youth.’ Those undesirable habits were smoking, lack of exercise, and eating habits that led to high levels of blood cholesterol and excess weight. There is a message there, if you are apparent or a teacher. But the message applies as well to all of us: our health reflects our lifestyle.

In a 1985 report by Mrs. Ruth English, principal nutritionist with the Commonwealth Department of Health, diet-related diseases were claimed to be responsible for 60 per cent of our deaths. She said that heart disease, hypertension (high blood pressure), stroke, some cancers, diabetes, and liver and gallbladder ailments were associated with excessive eating and drinking, especially of too much fat, refined sugar, alcohol and salt.

Further, her report said Australians are getting fatter. In1980, 41.3 per cent of men and 31.5 per cent of women were overweight. By 1983, 42.6 per cent of men (an increase of 1.3per cent in only three years) and 35.1 per cent of women (an increase of 3.6 per cent in the same period!) were overweight.

She had some other bad health news for us. One in six men and one in eight women had high blood pressure. Of men and women, 20 per cent had dangerously high levels of cholesterol and triglycerides in their blood. Thirty-two per cent of men and 25 per cent of women smoked regularly, the men averaging 21 and the women 16 cigarettes a day. Other health workers have reported that, although growing numbers of adults are quitting smoking, the public health benefit of thesis being canceled out by the growing number of younger people, particularly girls and women, who are taking it up. Airport to the Victorian government in 1985 predicted that the incidence of cancer in that state would rise by 20 per cent over the next ten years. Although some of that increase would reflect the aging population, the major contributor would be raising rates of lung cancer in women.

Finally, Mrs. English reported that only one in ten men and only one in twenty women were exercising at least three times week, the number of workouts recommended by the National Heart Foundation.

Part of the explanation for our not being as healthy as we could be is that many of us don’t know the facts about good health. In the past much health education has been conducted in over-simple or over-negative ways which fail to reach or impress many people.

The frauds, quacks and gimmick-merchants loudly push very simple and often wrong ideas about health to try to get your consumer dollar. The defensive tobacco and junk food industries try to cloud the issues for their selfish benefit. The sugar industry is currently running a very dishonest series of television commercials all pushing the claim that white refined sugar is a ‘natural’ food. The very Australian character in these ads, standing in a sugar cane field, proclaims: ‘You won’t find any NutraSweet trees out here.’ What he doesn’t add is that you also won’t find any crystals of white refined sugar growing anywhere other than in the very artificial sugar refineries. It’s no wonder that many people are misinformed about health.

In late 1989 the Saul wick Age Poll conducted a telephone survey of Australians’ health knowledge and found some alarming gaps. Sizable numbers of people had the wrong idea about suntan protecting you from sunburn (12 per cent wrongly believed it did); about food eaten during childhood contributing to heart disease in middle age (20 per cent wrongly believed it didn’t); about successful friendships con-attributing to good health (13 per cent wrongly believed they don’t); and about the accuracy with which people can judge how much their drinking will interfere with their driving safely (33 per cent wrongly believed drinkers could judge this accurately). The majority of people surveyed had the wrong idea about the desirable frequency of exercise (71 per cent wrongly believed that twice a week was enough), and about the possibility that moderate alcohol use may reduce your risk of heart disease (59 per cent wrongly believed that it wouldn’t).

A 1990 report in the Medical Journal of Australia also con-clouded that too few Australians understand how to reduce

Their risk of heart disease. This survey, for the University of Sydney’s Department of Public Health and the Prince of Wales Hospital, found that few people knew they should reduce the amount of fat in their diet or that they could reduce their risky doing exercise or learning to manage stress better. Al-though most had had their blood pressure tested, less than half had ever had their cholesterol levels measured and only5 per cent knew they had high cholesterol levels. Since other surveys suggest that 20 per cent of Australians have high cholesterol levels, the researchers concluded that three out of four people with high cholesterol did not even know it.

`But I’m going to die of something, sooner or later, so why not enjoy myself now?’ How often have you heard that justification for an unhealthy lifestyle? Maybe you have used it yourself, like the peasant in the Wizard of Id cartoon. The idea was expressed a little more technically, if just as misleadingly, by leading cardiologist. At a European Society of Cardiology con-grass in 1985: ‘What is the use of preventing death from coronary disease if you die from cancer two years later?’ We will refrain from predicting that cardiologist’s answer if, when about to die of a heart attack, he were offered a two- year extension to his life.

[ad]

Healthy life styling is not about preventing death, because no one can do that. Although the average life span has tripled since Roman times, the maximum life span has not increased much, if at all. Some researchers in aging speculate that in the future it may be possible to extend the maximum life span. Butte research focus today is on how to reduce age-related disease and decline, so that more people achieve their maxi-mum life span, and enjoy doing so because of their good health. That is, healthy life styling is about preventing preamp- true, unnecessary death, with the bonuses of also preventing other, non-fatal illnesses and enhancing our participation inland enjoyment of life. Let us emphasize that point again: healthy life styling is about enjoying life to the maximum.

According to the 1989 figures from the Australian Bureau of Statistics, heart disease was still our number one killer, but it was declining as a cause of death while cancer was increasing. In 1988 heart disease, caused by blockages in the arteries, accounted for 27.3 per cent of all male deaths (down from 28.3 per cent in 1987) and 25.3 per cent of female deaths(down from 26.3 per cent in 1987). Other forms of heart disease had also fallen slightly. Heart disease is very much lifestyle illness and, as such, a postponement of a cause of death.

Cancer was our second major killer, accounting for 23.2 percent of female deaths (up from 22.7 per cent) and 25.9 percent of male deaths (up from 25.3 per cent). Dr Oliver Alabaster, Director of Cancer Research at the George Washington University, has concluded that 60 per cent of cancer in women and 40 per cent of cancer in men is caused by our eating and drinking habits. Cancer in the lungs and airways was the biggest group of fatal cancers and continues to increase, especially in women, reflecting their increasing smoking habits. The incidence of skin cancer (including melanoma), reflecting unwise exposure to the sun, showed a small decrease in this survey but is still much higher than five years before. Even though the incidence of our third major killer, stroke has fallen in recent years it still accounts for 14.4 per cent of female deaths and 8.1 per cent of male deaths. It, too, reflects lifestyle factors like diet. To varying extents, all of our major causes of death today can be postponed by moderate changes in our lifestyles.

Healthy life styling is not only about living longer by avoid-in premature death. It is also about enjoying your life more. A popular joke that is a variation on the Wizard of Id cartoon has a doctor advising her patient to give up all of the things he enjoys. The patient then asks if he will live longer, and the doctor replies, ‘No, it will only seem longer.’ It’s a moderately funny joke but, like many jokes, it’s simply wrong. Leading healthy lifestyle is just not about going without all of the enjoyable things in life, while forcing you to eat dry lettuce leaves arid suffer endless exercise, because few of us would be dedicated or silly enough to do that. Sensible healthy lifestyles enjoyable in itself, places no unreasonable demands or- restrictions on you, and increase your ability to enjoy life. Have you ever imagined how an obese person feels in summer, wearing a 10 or 20 kilogram overcoat of fat that he can’t takeoff? Have you ever listened to a smoker coughing up half her lungs in the morning? Have you ever watched a hung- over person, a delicate shade of grey, twitch as the family cat stamps down the hall? Have you ever found yourself too short of wind to play with your kids or friends? Who is really enjoying life?

If the bad news is that our self-inflicted attack on health begins in childhood, the good news is that it’s not too late to turn that

Into an attack on illness in adulthood. Recent research 11, shown that, even when begun in middle age, gradual reductions in calories consumed and in body weight can prolong healthy life. In studies with non-human animals, these moderate changes delayed age-related declines in immunity, held cancer, kidney and auto-immune diseases at bay and led to prolonged vigor. Evidence from humans goes in the same direction. In 1984 Dr Raymond Harris, President of the Center for the Study of Aging in Albany, USA, reported that exercise can retard some of the functional declines that accompany aging, such as the loss of muscle tissue, flexibility, endurance, bone strength, capacity for physical effort and efficiency of the heart and lungs. Not only that, but he also suggested exercise may help to normalize blood pressure and blood levels of sugar and cholesterol, and to ward off depression and dependency.

Similarly encouraging results have been obtained in Australia, showing that it is possible to improve your health by changing some of your health-related behavior. In 1987 Dragnets Dodson, a Newcastle medical researcher reported that death rates from heart disease fell by more than 40 percent between 1966 and 1983. She estimated that changes in smoking and other health- related behavior accounted for more than half of this reduction. She also found reductions in average blood pressure and blood cholesterol levels, consistent-with changing eating habits in the community.

So what’s gone wrong? Despite the advances of medical science this century and despite the proven possibility of improving our health even if we start late in life, nationally our health is poor and even declining amongst young Australians. We suggest the problem is that most people have been missing-formed about health. We find that many people are unaware of what health really is, of how much they can personally do to improve their health, and of the benefits to be enjoyed as result of that effort.

It was heartening to note in a recent study published in the prestigious scientific journal, Nature, which demonstrated the presence of an abnormal gene in people who get heart attacks without having any of the known risk factors (Nature, 1992, 359:641-44).

[ad]

Such a study does not belittle the role played by environmental factors such as tobacco smoke. Abnormal genes can penetrate and produce a disease only in the company of environmental factors. If an individual inherits the abnormal gene predisposing him to a heart attack, his smoking will advance the time of onset of the disease. If he abstains from smoking, he will probably get a heart attack in his eighth or ninth decade when salient heart attack is the best way to meet one’s maker.

Most modern scientific data seem to corroborate the good old Indian wisdom that a person has to die at the predator-mined time but lead certain codes of conduct in food habits and also in his social behavior. Nature cannot be that foolish as not to know how to keep an organism going in spite of minor changes within or without the organism.

The high-tech medical world seems to have forgotten the foregoing golden rule. Writing about the latest interventional techniques in heart disease victims, the leading British heart journal had this editorial advice to offer (B.H. Jr., October 1992, p. 423): “It seems that the greater the relative gain achieved ban intracoronary intervention, the greater the subsequent loss. This is certainly food for thought for interventional cardiologists, those considering arming themselves with latest devices, and indeed patients (and doctors) with obstructive coronaryarterydisease contemplating their option.” The editorial goes on to suggest “as the search for a solution continues, we pro pose the matching technique as a temporary surrogate for randomisedstudies; and the use of relative gain, relative loss, and net gain index as a unifying quantitative approach to the comparison of all interventions –assessment and even laser surgery. How good the ways of nature!

The most important cause of heart attack is something which cannot be changed by anyone, that is, our inheritance of the genes from our parents who might either be suffering from the disease or might have a family history of the disease. Since we do not know the exact cause of a heart attack, epidemiologists have suggested various precipitating or triggering factors which are called ‘risk factors’.

The ideal food habit to prevent a heart attack would be to eat only half of what you would like to eat normally. Popular misconceptions about avoiding certain types of food items might also harm the heart. The best advice would be to eat what you, would like to eat, but in moderation. It is also better to remember that the food supplied by nature is the best for the body and it should not be spoilt very much just to suit the palate.

[ad]

Alcohol, even in moderation, is not good for the heart. A large dose of alcohol will directly affect the heart muscle, producing irreversible damage. It would be premature to advise people to drink in moderation for the good of the heart, since many other harmful metabolic and pharmacologic effects of alcohol on the heart are now coming to light. Sudden death is more common in alcoholics. Smoking is yet another risk factor which one can overlook only at one’s own peril.

A common belief is that heart attacks occur more commonly in sedentary workers as compared to heavy manual laborers. The scientific data in this regard are less than satisfactory. Our survey conducted in Mangalore has shown that even hard working fishermen suffer an equal number of heart attacks compared to businessmen sitting in their offices. The only difference is that the fishermen had their heart attacks at a later age compared tithe sedentary workers. Heavy competitive sports and unusually heavy exertion are not good for the heart. Day-to-day work done properly should give one enough exercise to keep the heart goings long as one does not overeat and become overweight.

Life is full of stress. For instance, a mother who is about to give birth to a child, a boy during his first day at school, a young

Man going for an interview, a student appearing for an examination and young people getting married, are all under stress. In other words, stress is an integral part of life is

Normal very difficult to ask someone to avoid stress in life. Inez itself. Itthecourse of events, stress does not adversely affect the heart. However, distress, unusual stress or abnormal stress reaction to ordinary stress is the ‘agent’ which kills a man. If you love your day.

Work, you develop no stress even if you work for 24 hours in asleep five to seven hours of restful sleep should be quite suffice an average man for leading a healthy life. Interestingly, than more tent foresight hours of sleep per day is quite detrimental to worrying about sleeplessness is worse than sleeplessness health.

Sexual activity is very good for the heart as itprovidesan easy way of spending about 150 calories of one food intake one and also relaxes the system. I must hasten to add that the guilt associated with extra-marital sex is not good for heart. The heart. A good sexual ability in men is a sign of a healthy.

Studies on risk factors have shown that human beings can be grouped into various personality types. At one extremity of the scale is the overambitious, usually successful, dynamic, one-up, middle-aged man who has a more than aver due to underlying human traits of pride, ego dynamic, drive, basically. These people belong to type ‘An’ in sharp to those not so contrastousy and hatred. Successful, lazy, ‘could-not-care-less’ type e odes individuals groupe as type 13′. In between, there are variousdes of classified under type ‘X’. Various human beings,

Reports reveal that type ‘A’ persons have the highest incidence of heart attacks. The type B’ persons. Type ‘X’ persons has an incidenpared to cue in between the two. Such data are now being questioned as many new studies have failed to confirm this kind of relationship. There are many other studies which have already disproved this hypothesis. Such conclusions should not be interpreted by our youngsters as an excuse to be lazy and not to do anything in life. The higher incidence of heart attacks in type A’ persons could possibly bedew to negative traits such as hatred and anger.

[ad]

Perhaps the greatest human tragedy occurs when a human being gets frustrated and feels totally rejected by his or her own people and society. The ‘voodoo’ deaths among African tribals are examples of such a situation. History is replete with examples omen that have had heart attacks shortly after they had been rejected by their own people or their policies had been castigated or condemned! Woodrow Wilson, a former President of USA, had a heart attack about four hours after his bill for integration of North with the South was rejected by the Congress against his wishes. Winston Churchill had a heart attack not long after he was rejected by the British electorate following the Second World War. Charles de Gaulle died after a heart attack in his village soon after he was rejected by the French people. Richard Nixon managed to go to China in spite of being afflicted by major heart problem when he was still at the height of his glory but had a near-fatal attack within a couple of months of having been thrown out of the presidency because of the Watergate scandal. Of course, there are exceptions. In fact, exceptions do prove the rule. Never ever get frustrated in life. If you follow the old saying of the Bhagavad Gita, i.e., “do your labor and donor worry about the reward”, you can probably avoid many situations in life which make people frustrated. Trying to harm someone behind his or her back is also one of the important causes for triggering off a heart attack. Forgiveness is a great preventive measure against heart attacks.

When a person’s blood pressure is consistently higher than that of his peers in the same age group, it is called high blood pressure.

The higher the pressure, the quicker the death. There is no disease called ‘low blood pressure’. If one’s blood pressure remains high, it produces damaging effects on organs such as the heart, the brain, the kidney and the eyes. Vascular diseases resulting from high blood pressure are the greatest killers known to mankind.

When an individual’s blood pressure is high, he or she does not exhibit any symptoms and usually feels fit. Fatal vascular accidents or failure of the heart, or the brain, or the kidney or the eyes may provide the first sign of disease.

The pressure inside the artery during the contracting phase of the heart and that during the relaxation phase of the heart are called systolic pressure and diastolic pressure, respectively. The former is usually higher than the latter.

[ad]

Blood pressure should be checked regularly. One can easily detect a tendency for the blood pressure, long before any serious damage can be done to the body. You can prevent high blood pressure and its ravages by simply changing your lifestyle or by means of minimal drug therapy.

In the initial stages, there are certain methods to effectively control elevated blood pressure and also to make the victims of this unfortunate malady perfectly fit so that they can again become useful to their families and also to society.

Even at a late stage, when high blood pressure has already caused some damage to the aforementioned target organs, medical science has now progressed tremendously and can help such unfortunate victims. However, the process may prove socially and economically detrimental, and may not make the victim normal again.

Checking the blood pressure involves a very simple technique which can be mastered by any intelligent person within a very short time. The basic idea should be to train five to ten enthusiastic volunteers in every locality to check the residents’ blood pressure. In case the recorded pressure is higher than expected, it has to be rechecked several times before a doctor need intervene. One casual reading of high blood pressure may not be significant.

The advantages are as follows:

You can easily keep it under control.

You can prevent serious or fatal diseases affecting the heart, the kidney, the brain and the eyes.

You can save yourself from premature death.

You can save a few thousand deaths in your own community.

[ad]

Since the ravages of high blood pressure usually kill men in the prime of their life, the aforementioned measures will help prevent many women from becoming widows and many a child from becoming a destitute. We would do well to remember Benjamin Franklin’s immortal words: “Be sober and temperate and you will be healthy.”

Some of you may be shocked to know that there was a time when doctors had advised diabetic patients to eat plenty of sugaring order to replenish its loss through their urine. Such advice must have killed quite a few diabetics! The notion was then changed

And patients were told to avoid sugar and carbohydrates totally in order to prevent blood sugar levels going up. Instead, patients were asked to go in for very high protein and diets. The latter course resulted in more misery and premature vascular deaths amongst diabetics. Now medical science is slowly getting back to its senses and asking patients with diabetes to adopt a more rational diet containing moderate carbohydrates of the non-refined variety such as rice and to take smaller helpings of proteins and fats.

[ad]

Many a diabetic and his or her spouse even now carry the impression that if one becomes a diabetic, one must give up one’s staple rice diet and go on to eat wheat in its various forms. This factor upsets many household routines. Scientifically, rice proves to be a better diet for a diabetic compared to wheat for more reasons than one. By weight, wheat contains marginally more protein than rice. A split-up of the proteins into the four varieties, which are albumin, globulin, glutamine and proclaim clearly shows rice to be much superior (protein-wise) as proclaim (the best protein for humans) makes up 55 per cent of the protein content in rice, while it accounts for a mere 5 per cent in wheat. Also, the dietary fibers in rice (not same as plant fiber) is better than that in wheat.

Vegetarianism is the latest of the food fads in the West. While it is true that most vegetarian foods are safer than meat and poultry, the latter are not totally bad. Vegetarian food results in a better internal environment for fats and leads to tranquility of the mind. Such food also results in a lesser intake of protein compared to a meat diet, which proves beneficial in the long run. A mixed vegetarian diet is full of dietary fibers which has its own advantages, the most palpable of which is the good bowel motion that one gets daily. Fiber also helps in reducing the absorption of extra fats from the intestines.

Presently, a great deal of fuss has been created about the inclusion of fiber in one’s diet. It has been claimed that fiber

Reduces the incidence of cancer in the gut, so much so that many Americans have restricted their intake to only bran! However, it should be pointed out that scientific data in this regard are not conclusive or final; the supposition is purely hypothetical.

One should consume generous quantities of whole grain foods, legumes, vegetables and fruits, which contain protective elements such as fiber, carotene (pro-vitamin A) vitamins C and E and selenium.

You should moderate your intake of fat. Your total fat intake should not exceed 30 per cent of your total calorie intake. All fats are equally bad and there is nothing to choose among them. Please remember to avoid fried food because, when fat boils at L.1600C, it incorporates within itself the atmospheric oxygen to produce 25-hydroxycholesterol which damages the walls of blood vessels.

There are various kinds of fat; for instance, good, indifferent and indeterminate (fish) fats. So, any advice to drastically reduce fat may not be good. If one seriously believes in cutting down fat rapidly and promptly, such a situation would amount to very serious deficiency in essential fatty acids which sustain life. The safe course would be to cut down fat intake gradually.

You should avoid overeating. It should be noted that very high energy diet may even lead to cancer. One should avoid highly salted and smoked food. The latter is especially bad for stomach cancers. Alcohol should be totally avoided. The diet of a modern-day human being can be divided into three types:

[ad]

(1)Killer diet: Food with excessive fat plus tobacco and Alcohol.

(2)Questionable killer diet: Excess fat, sugar, Carbohydrate protein and salt. Healer diet: Plenty of micronutrients for healthy life. Plenty of fruits and vegetables.

Presently, we have been following the principle of ‘disjointedincrementalism’ in our diet approach. Instead of viewing the problem as a whole, we have merely been trying to nibble at theedges, dealing only with a part of it which has high public visibility (for example, cholesterol). This approach is counterproductive. Pure food, in the form in which it is available in nature, is the best form of food. We should not adulterate it, as we normally do in order to suit our palates.

The risk of heart attacks rises with the intensity of smoking. This risk is particularly higher in the case of smokers below the age of 50. The death rates of such persons due to heart attacks are ten times greater than those of non- smokers of the same age.

You are more prone to a heart attack if you are a smoker in addition to other risks. Cigarette smokers switching over to pipes or cigars do not reduce the risk of heart attack. Carbon monoxide and nicotine are the two toxic substances which reduce the oxygen supply and also enhance blood clotting. Cigarette smoking causes crucial blocks in leg blood vessels and might lead to the loss of a leg. These occurrences very rare in non-smokers. Filter cigarettes are no less dangerous than non-filter cigarettes. Passive smoking can be harmful to people with a known history of heart disease. Three million deaths occur due to smoking worldwide, annually. Ten per cent of British children in the age group 11-15 years smoke despite a ban on cigarette sales to them.

[ad]

The world’s top brand of cigarette brings in $ 23 billion sales revenue per yearned-smokers are much less likely to fall victim to heart attacks than those who continue to smoke. You stand to save nearly Rs. 10,000 a year if you have been smoking 10 to 20 cigarettes a day. If you have been smoking more than 20 cigarettes a day for 30 years, you would have smoked more than two hundred thousand cigarettes! As already mentioned the risk of heart attack increases with the numbers of cigarettes smoked. It should be borne in mind that those who start smoking at 15 years of age run a greater risk of having a heart attack than those who start after 20.

If you are still healthy, it is important to stop smoking before you develop an illness. If you have just suffered a heart attack, one of the most important decisions you should make is never to smoke again. A heart attack provides you a very strong motive for stopping smoking.

[ad]

Two out of three persons who have stopped smoking have asserted that they found it surprisingly easy. Keep a record of your smoking pattern, begin cutting down on the number of cigarettes on a daily basis till you reach the zero level. Find a friend to support and encourage you in your endeavor. Also ask your doctor to help you.

Be prepared for a radical change in your lifestyle. Go in for plenty of exercise, which will help you in relieving tension. Drink plenty of fruit juices. Find a new hobby or listen to soothing music. The craving for cigarette will automatically cease in a few weeks or months.

If you have suffered a setback and you begin smoking again, analyze carefully the reasons for your failure. If at first you don’t succeed, quit, quit, quit and quit again.

Nearly 90 per cent of the total body cholesterol is synthesis din the liver and only 10 per cent (a rather small portion) is obtained from food intake. In spite of all these facts, high-profile propaganda has been launched against cholesterol in human diet, so much so that many people are afraid even to look at foodstuffs containing cholesterol, leave alone eating them! If one were to totally shun cholesterol, one would age very fast as cell replacement would get impeded. The skin would become loose and wrinkles would appear prematurely.

[ad]

Another falsehood that has been propagated pertains to vegetable oils. A majority of laypersons are under the impression that coconut oil is rich in cholesterol, while sunflower oil is freeform it. Nothing can be farther from the truth. In fact, no vegetable oil contains cholesterol. Cholesterol comes only from animal food (non-vegetarian). However, certain oils do contain other fatty acids and fats, whose level of content depends on the nature of the oil (mainly viscosity). I must hasten to add here that all types of fat are equally good or equally bad, depending on how they are consumed. While saturated fats may be bad for the blood vessels, unsaturated fats are related to human cancer. So it is futile to choose between one fat and another. The safest is to exercise moderation in fat intake; only about 30-34 per cent the total food intake must be fat. It is also important to remember not to deep-fry food articles because when oil burn sat a high temperature (160″C), the oxygen in the air gets incorporated into the fat in the food being fried so as to produce very toxic chemical which damages the blood vessel walls directly.

Michael Brown got a Nobel Prize in 1989 for discovering the cell wall receptors for cholesterol. Having experienced the futility of trying to reduce human cholesterol levels, he decided to treat his children to ice-cream for the first time in their life and could not resist the temptation to eat some himself. He even wrote an article in Reader’s Digest entitled “Daddy Also Likes Ice-cream”.

[ad]

Over the years, every scientific effort to reduce human cholesterol through drugs has resulted in higher death rates among the treated groups compared to the controls. There have been several drug trials to lower serum cholesterol since the original study in 1969 (Edinburgh-New Castle Study) to the recent Helsinki study, using a new drug Gemfitrozil. All of them had more total deaths in the drug group compared to placebo group. It remains a mystery as to why people still want their body cholesterol levels reduced by resorting to drugs. Our cholesterol levels are what they are because of the genes we have inherited from our parents and, as such, the only beneficial way of changing the cholesterol level for good is to change our parents! Advances in genetics have shown the presence of a gene for vessel wall thickening called the (anthrax gene). There is no use barking up the wrong tree trying to lower blood cholesterol!