Losing excess weight, reviewing your exercise programme, lowering your bad cholesterol, optimising your blood pressure and avoiding harmful supplements will certainly start you on the path towards a healthy new year.
1. Lose That Excess Weight
Successful weight loss programmes require a combination of dietary measures and exercise. There is no lack of dietary regimes that tout the effectiveness of their programmes to transform your body from a couch potato appearance into a finely chiselled athletic physique.
Alas, the truth is that most people who enrol in such dietary weight loss programmes put back most of the kilograms that have been shed by the end of the second year. Like it or not, exercise is an integral part and a necessary component for successful weight loss.
This class of sugar lowering medication belongs to the “glifozins”. When food is eaten and is digested and absorbed, blood sugar increases. The elevated levels of blood sugar “spill out” of the blood into the urine in the excretory channels within the kidney, and as the urine passes through the channels within the kidney tissue, the sugar is reabsorbed back into the blood stream.
The “glifozins” block the reabsorption of the sugar from the urine in the kidney channels and allow the sugar to be passed out of the body through the urine. The net effect is calorie loss from the body and hence over time, weight will gradually decrease.
By drinking lots of fluids, more urine is passed out and hence more calories will be lost, leading to increased weight loss. The average patient can lose 5kg over three months and a motivated person who controls diet and exercises can lose 10kg in three months.
2 Exercise In Moderation
Over the past few years, studies that have been done to determine the right amount of exercise have come to some conclusions. Firstly, more is not necessarily better.
Those who exercise daily are not better than those who exercise three times a week and may even be worse off.
Secondly, intense or strenuous exercise may not produce additional benefits. Those who engage in strenuous physical exercise are generally not better off than those who engage in moderate exercise.
Pre- and post-marathon ultrasound and electrocardiogram studies of the heart show that marathoners had abnormal heart rhythms and abnormal heart function upon assessment immediately after completion of the marathon but most of these changes reverted to normal baseline findings one week post-marathon.
Furthermore, studies on communities that have a large number of centenarians show that these centenarians have a history of engaging in mild to moderate activities such as gardening and walking to the market; they do not have a history of engaging in strenuous or intensive physical exercise.
If you have been sedentary and have risk factors for heart disease, including high blood pressure, diabetes mellitus, high cholesterol level, family history of heart disease, and smoking, you should seek your doctor’s advice before embarking on an exercise programme.
American Heart Association data shows that about half of the men and about two thirds of the women who die suddenly from a heart attack do not have prior symptoms. Hence, having no symptoms does not mean that you have no underlying heart disease.
3. Keep That Cholesterol Down
High bad cholesterol is the major culprit for occlusion of the heart arteries for most people. Reducing bad cholesterol is an important step towards reducing the likelihood of heart attacks.
For those who eat excessively and hope to use exercise to burn off the cholesterol, they will be disappointed to know that the effect of exercise on lowering cholesterol is very minimal.
While dietary control is an important measure, for many with underlying heart disease, it may not be sufficient and they have to turn towards the statin class of drugs, which is presently the most effective class of medication for lowering cholesterol available to the public.
Unfortunately, not everyone can tolerate the use of statins. While muscle aches and abnormalities in blood liver tests are the most common side effects, more serious side effects include memory loss, development of diabetes mellitus and abnormal kidney findings.
Fortunately, these more serious side effects are uncommon. For those heart patients who are unable to tolerate statins but yet need to lower bad cholesterol to reduce the likelihood of heart attacks, there is finally light at the end of the tunnel.
A new class of drugs that have effects comparable to statins have been approved and should be available to the public this year. This class of drugs, known as PCSK-9 inhibitors, acts via a completely different mechanism from statins.
While statins act by blocking the production of cholesterol, PCSK-9 inhibitors enhance the removal of bad cholesterol from the blood stream into the liver for degradation. Unlike statins which are taken orally daily, PCSK-9 inhibitors are given as fortnightly or monthly injections.
Combining statins and PCSK9 inhibitors in patients can bring the bad cholesterol down to extremely low levels and may potentially reverse blockage in heart arteries. In theory, combining both classes of medication over a period of time may result in “spring cleaning” of the arteries in the body.
4. Optimise Your Blood Pressure
Over the decades, while researchers have produced hundreds of research papers to determine what is “normal” blood pressure, there has been controversy over the degree to which low blood pressure should be decreased in those with high blood pressure to get maximal beneficial effects.
The release of the results of the SPRINT (Systolic Blood Pressure Intervention Trial) study in late 2015 confirms that lowering the upper or systolic blood pressure to under 120 mm Hg in higher-risk older patients reduces cardiovascular and mortality risk.
The SPRINT study provides data that in non-diabetic adults 50 years and older who are at increased risk of heart disease or with kidney disease, lowering the systolic blood pressure to 120 mm Hg or less will translate into lower rates of acute heart attacks, stroke, heart failure and death.
However, this needs to be balanced with the need for more drugs and potentially more side effects resulting from medications.
5. Watch That Calcium Supplement
The 2015 Dietary Guidelines from the US government include an advisory against the consumption of calcium supplements based on evidence that the consumption of calcium supplements is associated with increased incidence of heart disease.
The excess calcium is deposited in the walls of heart arteries and results in narrowing of the arteries. Despite this, mass media promotion of the consumption of calcium supplements remain unabated. For those who are concerned about ensuring bone health, Vitamin D consumption is a better and safer option.
As you plan your health roadmap for the coming year, these few pointers can help to get you off to a right start. If you have been sedentary and have risk factors for heart disease, do remember to seek your physician’s advice if you intend to start on an active physical exercise programme.
Dr Lim is medical director at the Singapore Heart, Stroke & Cancer Centre. He is a professor at Fudan University, Shanghai and vice-president of both the World Chinese Doctors Association and the World Federation of Chinese Cardiovascular Physicians. He is also founding editor of Heart Asia, a journal of the British Medical Journal Publishing Group.