Part Two

Exercise 

The only bad work out is the one that did not happen.

Unknown

Exercise should be regarded as a tribute to the heart.

• Unknown

Chapter -2

EXERCISE 

Reading is to the mind what exercise is to the body

• Joseph Addison

There is an old saying that exercise won’t necessarily help you live longer but it will help you to live younger longer.  In some cases it will help you even to live longer.  Research has shown that increased level of fitness can boost longevity and reduce mortality rates from all causes of deaths.

Any form of physical activity can improve health, including daily activities that would not necessarily be called exercise.  Adding a regular exercise program to the mix would benefit your health even more.  Put simply, leading an active life enables you to keep on being active, putting off (or avoiding altogether) the time when you have to depend on other people to perform your daily tasks.

How exercise keeps you healthy

If exercise could be packed into a pill, it would be the most commonly prescribed medicine in the world.  Physical activity provides health benefits for every part of the body.  Regular physical activity improves your health in the following ways:

• Reduces the risk of developing heart disease – and the risk of dying from it.
• Cuts your risk for stroke
• Lessons your risk of developing high-blood pressure
• Lowers your risk for type-2 diabetes and if you have diabetes if helps to control your blood sugar better
• Reduces the risk of Colon Cancer
• Helps you achieve and maintain a healthy body weight
• Reduces the feelings of depression and anxiety
• Reduces stress
• Improves your sleep
• Reduces the risk of falling and breaking bones in older people
• Delays the development of age-related dementia and Alzheimer disease
• Relieves arthritis pain
• Results in fewer doctor visits, fewer hospitalization and medications

Types of exercise

There are 3 main types of exercises – Aerobic – Activity, Muscle – Strengthening and Bone-Strengthening.

Aerobic – Activity (Exercise)

Aerobic exercise is only type of activity that uses the large muscles of the arms and legs in a continuous fashion. Aerobic fitness is also called cardiovascular fitness because it improves the ability of the heart, blood vessels, and lungs to supply oxygen and fuel to the body.

Aerobic activities make your cardiovascular system stronger, lowering your risk of heart disease and high blood pressure.  Regular aerobic exercise also increases your endurance – hence also called endurance activity.  The following exercises provide Aerobic Activity:

• Walking
• Running
• Jogging
• Swimming
• Bicycling
• Stair Climbing
• Dancing
• Skipping rope
• Rowing
• Cross Country Skiing.

Muscle – Strengthening 

Exercises that build muscles go by a variety of names, including strength training, resistance training, weight training or weight lifting.  Strengthening exercises are safe and effective ways of building muscle mass for people of all ages, including those who are not in perfect health.  In fact, people with health conditions – including heart disease, arthritis – often benefit the most from weight lifting.

Benefits of Muscle Strengthening Exercises Are:

• Increases muscle strength, flexibility and balance and lowers the chances of falling and breaking bones.
• Increases bone density and reduce the risk for fractures, especially in older people.
• It helps in weight control, because people with more muscle mass have a higher metabolic rate. An increased metabolic rate is helpful for both weight loss and long-term weight control.
• Strength training is also beneficial for prevention and control of type-2 diabetes.
• Strength training is vital for heart health because heart disease risk is lower when your body is leaner.

Getting Started With Weights

When you are starting out on muscle strengthening exercise, use a low-weight dumbbell or machine weight to determine what weight you can handle comfortably and safely.  You can also use tubing and elastic bands for strength training.  You can also work against your body to build muscle mass by doing pull-ups and push-ups.  It is recommended that you warm-up for 5-10 minutes of aerobic exercise before starting strengthening exercises.

Beginner State:

• Select one exercise from each of the following body areas: hips and legs, chest, back, shoulders, low back and abdomen.
• Do 1-2 sets of 8-10 repetition with enough weight to be comfortable.
• Try to breaths out as you lift or press against resistance, and breathe in as you lower the weight.

Intermediate to Established Stage:

• Do total of 10 exercises. Select one from each of the following body areas: hips and legs, quadriceps, hamstrings, chest, back shoulders, biceps, triceps, low back, and abdominal.
• Do 2 sets of 8-12 repetitions.
• Breathe out as you lift and breathe in as you lower the weight.

Warm-up Rest Periods and Cool-Down

It is recommended that your warm-up for resistance training should include 5 to 10 minutes of aerobic activities.  The length of rest period (1-2 minutes) between sets will depend upon the weight used.  Heavier the weight, longer the in between rest period.  The cool-down phase brings the body to resting levels.

Bone-Strengthening

Bone-strengthening activities produce a force on the bones that promote bone growth and strength.  The force is commonly produced by impact with the ground.  The good news: bone strengthening activities can also be aerobic and muscle-strengthening like running, jumping rope, tennis, basketball, football and hopscotch.

The Benefits of Cross-Training

Cross-training is a technique that enables you to fight boredom while gaining extra benefits from your fitness program.  Cross-training is performing two or more different types of exercise – either with one workout or alternately in consecutive sessions.  If you walk or jog, for example, you could lift weights twice a week or take a yoga class.  You can engage in more than one type of aerobic exercise – bicycling, walking or swimming or playing sport, for example to vary your workouts even more.  Bringing variety to your exercise sessions can help keep you motivated.

No single type of physical activity can provide all the health benefits gained from exercise.  For example, aerobic exercise enhances heart health because of sustained used of large – muscle group.  But aerobic activity does not necessarily help developing muscle mass, especially in upper body.  On the other hand weight – training builds muscle mass, but does not necessarily improve joint flexibility.  Only a combination of the different types of exercise can give you the optimal, all – round fitness your body needs.

Cross-training helps make your entire body stronger and lowers your risk of injury.  It also wards off the monotony of everyday exercise.

When to stop exercising

• If you develop dizziness or faintness
• Chest pain or pressure
• Irregular, rapid heart beat
• Develop injury

Physical Activity Guidelines (President’s Council for Physical Fitness, USA)

Children and Adolescents (6-17 years old) 

Children and adolescents should get 60 minutes or more of physical activity daily.  That includes:

• Aerobic Activity: Most of the 60 or more minutes a day should be either moderate – or Vigorous – intensity physical activity (such as running, biking, dancing) at least 3 days a week.
  

• Muscle – Strengthening: As a part of 60 or more minutes of daily physical activity, include muscle – strengthening – physical activity (such as using playground equipment, climbing trees, or lifting weight) on at least 3 days a week.
  

• Bone-Strengthening: As a part of the 60 or more minutes of daily physical activity, include bone-strengthening physical activity (such as running or jumping rope) on at least 3 days a week.
  

It is important that young people try a variety of physical activity and do something they enjoy.  The activity should be appropriate for their age. 

Adults (18-64 years old) 

Aerobic Activities:

For substantial health benefit, adults should do one of the following:

• 150 minutes (2 ½ hours) each week of moderate-intensity aerobic physical activity (such as brisk walking, or tennis).
• 75 minutes each week of vigorous – intensity aerobic physical activity (such as jugging or swimming laps, Soccer, basket balls.)
• An equivalent combination of moderate – and vigorous – intensity aerobic physical activity.

Do aerobic physical activities in episodes of at least 10 minutes if possible, spread it out through the week.

For even greater health benefits, do one of the following:

• Increase moderate – intensity aerobic physical activity to 300 minutes (5 hours) each week.
• Increase vigorous – intensity aerobic physical activity for 150 minutes (2 ½ hours) each week.

Doing more physical activity will lead to even greater health benefits.  Not sure whether you are at a moderate or vigorous activity level? Try the talk test.  If you can talk while you are active, then you are participating at a moderate level.  If you can say only few words without stopping to catch your breath, then you are engaging in vigorous activity.

Muscle-Strengthening Activities:

• Do muscle – strengthening activities (such as lifting weight, using resistance bands, push-ups, sit ups, using machines) that are moderate to high intensity and involve all major muscle groups (-legs, hips, back, chest stomach, shoulders, and arms) on 2 or more days a week.
  

Bone-Strengthening Activities

Bone-strengthening activities can be both aerobic and muscle-strengthening like running, jumping rope, basketball, tennis, soccer.

Older Adults (Age 65 and Older)

Regular physical activity is essential for healthy aging.  Adults over 65 gain substantial health benefits from regular physical activity.  These benefits continue to occur throughout their lives.

• For older adults who are fit and have no limiting chronic conditions, the guidelines are the same as those for all adults (18-64 ages).

Guidelines Just for Older Adults

• Be as active as possible.
• Do some activities to improve your balance – Good balance is important to help prevent falls. Some balance activities are:
• Climb stairs.
• Do tai-chi
• Walk on uneven side walk.
• Walk on heels and toes.
• Walk forward and backward.
• Lean your body forward, backward.
• Lean your body forward, backward or to the side.
  

Improve Your Flexibility

• Make the bed
• Bend over to tie your shoes
• Pull a sweater over your head
• Reach for a food item on a kitchen self.

Exercise and physical activity can have a positive effect on your everyday life.  Even if you think you are too old or too out of shape to exercise, start now.  It is never too late to start. Being inactive can be risky. 

How long, how often, and how hard?

Once you take the exercise challenge, consider three factors that make up the backbone of any god exercise program: frequency, duration, and intensity.  The bottom line is: If you are doing nothing, do something.  If you are already exercising, do more – exercise for a longer period and at greater intensity.

If you have been inactive or if you are overweight, start out slowly. The best approach is to start with light or moderate activity – such as walking, biking or swimming.  Gradually increase the duration of the activity first.  Once you are exercising more than 30 minutes a day, gradually increase the intensity of the activity.  Mixing in some light weights add value once your heart and lungs are fit.  The key is to get moving and be more physically active than you already are.

Part one
Nutrition

Every human being is the author of his own health or disease
– Buddha
He who cures a disease may be skill fullest, but he that prevents it is the safest physician.
– Thomas Fuller, (1608-61)

Don’t eat less. Eat right.
– Unknown

Anyone can work out for an hour, but to control
What goes on your plate the other 23 hours …….
That is hard work.
– Unknown

Chapter -1
Nutrition

Eat food. Not too much. Mostly plants.
– Michael Pallin

Of all the steps you can take to stay healthy and prevent disease, eating a nutritious diet and physical activity is most important. Healthy eating and exercise can help you maintain proper weight and lower the risk of many diseases like – heart disease, high blood pressure, stroke, type-2 diabetes, cancers, dementia and depression. Healthy eating during pregnancy leads to healthier babies.

Poor nutrition and under nourishment is major problem in developing countries. They contribute too much to disease, disability and death especially among mothers and children. Obesity is a major problem in developed countries and becoming one in developing countries.

Building a healthy diet
The food we eat is made up of three main nutrients: Carbohydrates, protein, and fat.
Carbohydrates 1 Gram = 4 Kcal

Carbohydrates or carbs come in two types: simple and complex. Simple carbs are sugars, including the sugar found in fruits (fructose), the milk sugar (lactose), and the white sugar in your sugar bowl (sucrose). Simple carbs taste sweet and are easy to digest. They can cause a sudden rise in blood sugar (glucose) levels – which a person with pre-diabetes and diabetes has to avoid.

Foods containing complex carbs – such as brown rice, whole-grain breads, cooked dried beans (dals of all kinds), and sweet potatoes – take longer to digest and raise the blood sugar slowly. Complex carbs also contain a lot more vitamins, minerals, and other nutrients than simple carbs. Each gram of Carb – simple or complex has 4 calories.

Fiber
Fiber is a type of carbohydrate that is found in the cell walls of plants. Fiber is not digested by the body. Dietary fiber has been found to help reduce the risk for type 2 diabetes. Fiber – rich food can also help reduce the absorption of cholesterol into the blood stream. Fiber also helps keep the intestinal tract functioning well and reduce constipation. It also reduces the risk for diverticulitis (a condition in which small pouches develop in the walls of large intestine).
Fiber comes in two forms: soluble and insoluble. Soluble fiber can help control blood sugar levels and improve blood cholesterol. Insoluble fiber softens and adds bulk to the stool, and reduces constipation. Good sources of soluble fiber are cereal grains (such as barely, oat meal, and oat bran), fruit (including citrus fruits, prunes, pears, apple, and bananas), legumes (lima beans, kidney beans and navy beans), peas (such as chickpeas and black-eyed peas) and vegetables (such as carrots, broccoli and Brussels sprouts). Good sources of insoluble fiber include whole grains (brown rice, barely, whole wheat) flaxseed, carrots, cucumbers, zucchini, celery, tomatoes, and the edible skins of many fruits (guava, apple etc.).

How much fiber do we need?
A good rule of thumb is to eat about 28 grams of fiber a day for a 2,000 – caloric diet. Drink plenty of water to avoid bloating and gas.

Protein 1 Gram = 4 Calories

The protein food is made up of a chain of compounds called amino acids. The human body needs roughly 20 amino acids to make all of its protein, which are the main components of muscles. Our body can manufacture 10 of the 20 amino acids it needs. These are called the non-essential amino acids because we do not have to get it from our food. There are 10 other amino acids – the essential amino acids – which we can get only from our diet.

Food derived from animals – including meat, poultry, fish, shellfish, eggs and dairy products – supply all the essential amino acids. Plant foods – including grains, fruits, and vegetables – do not provide all the essential amino acids.

The quantity of protein an adult needs per day is 0.8 grams per kilogram of body weight. Children and adolescents need more – close to 1.5 grams/kilogram of body weight per day to provide for their growth and development.

Eating too much protein can lead to gout (a form of rich man’s arthritis). A high-protein diet can also place a heavy burden on the kidneys, which excrete in the urine excess waste from protein.

Fats I Gram -9 Calories

Fat is an essential nutrients – meaning our body needs certain amount of fat to make various things. Fat helps our body to absorb Vitamin A, D, E, and K (fat soluble vitamins). We also need fat for proper growth, development, and general good health. Fat also gives taste to the food we eat. It is the type of fat and the amount you consume that is important.

There are two main types of fat that are found in our food – saturated and unsaturated.

Healthy Fats
Healthy fat – including monounsaturated and polyunsaturated and plant sterols – are beneficial when consumed in moderation. These healthy fats can improve our blood cholesterol and reduce the risk for heart disease. Monosaturated fats, found mostly in olive, canola and peanut oils are the healthiest fats you can eat. They decrease the level of harmful cholesterol (LDL) and increase the level of beneficial cholesterol (HDL) in the blood. Mono saturated fats are usually liquid at room temperature

Polyunsaturated fats

Polyunsaturated fats are found in corn, sunflower, flaxseed, and soya bean oils, and in the oils of fatty fish such as salmon mackerel, and tuna. Rich in Omega – 3 fatty acids and Omega – 6 fatty acids, poly unsaturated fats lower total cholesterol in the blood (both – bad kind LDL and good kind HDL). They are usually liquid at room temperature.

Plant sterols and stanols

Substances called plant sterols or stanols are fat found in nuts, seeds, and many other plant foods. When eaten regularly plant sterols and stanols can slow the absorption of dietary cholesterol and lower the level of harmful cholesterol in the blood. Some studies have found that regularly eating 4-6 nuts a day can reduce the risk of heart disease by about 25 percent. Nuts are also rich in protein, fiber and minerals. Just avoid the salted nuts.

Unhealthy Fats
Fats we need to watch out for include saturated fats,trans fats, and dietary cholesterol. These fats can raise the total and the bad cholesterol (LDL) in the blood.

Saturated fats
Saturated fats is found mostly in food that come from animals, including fatty cuts of meat, poultry with skin, whole and 2-per cent milk, butter, ghee, cheese and lard (Pig fat). But high amount of saturated fat can also be found in some foods that come from plants, such as palm kernel oil, palm oil, coconut oil and cocoa butter. Eating saturated fat increases the risk of heart disease and high blood pressure. There is some evidence that eating large amount of animal fat and saturated fat may raise the risk of prostate cancer in men and cancer of the uterus (endometrial) in women.

Trans fats
Unlike other fats, most trans fats are formed when food manufacturers turn liquid oils into solid fats. To do this, manufacturers add hydrogen to vegetable oils in a process called hydrogenation. Hydrogenation increases the self-life and stabilizes the flavor of many popular foods.Trans fats are the reason French fries and deep fried chickens and fish taste so good. Trans fats are found in many dry snack foods like crackers, cookies, pies. They are in vegetable shortening and margarine.

Trans fats elevate total and bad cholesterol (LDL) and lower the level of good cholesterol (HDL). In addition, trans fats seem to trigger the immune system to increase inflammation in the body. Inflammation has been linked to an increased risk for heart disease.

What can you do to avoid trans fats? Read the food nutrition label. When eating out avoid deep – fried foods or do not cook at home with hydrogenated oil.

Dietary Cholesterol

Cholesterol is a fat that the body needs in small amount. Blood cholesterol is a substance made by our liver to help the body manufacture hormones, vitamin D and bile acids that help the body digest fat and repair cells. Problems arise when the liver makes too much bad LDL Cholesterol. HDL Cholesterol is beneficial because it removes cholesterol from the arteries.

Dietary cholesterol refers to the cholesterol that is present in some food of animal origin.
Plant based food do not have cholesterol.

. Common food sources of cholesterol include egg yolk, shrimp, lobster, red meat, full-fat dairy products and organ meats (liver, kidney and brains). Dietary cholesterol does not raise blood cholesterol as much as saturated fats and trans fats do. But limit your intake of cholesterol to less than 300 mg a day. For example – the yolk of one large egg contains 214 mg of cholesterol. It is recommended that healthy people should not consume more than 4 eggs a week. People with heart disease should limit to one or none.

Using Fats Wisely

You can help lower your blood cholesterol by replacing saturated fats with unsaturated fats. But also keep in mind that limiting the total amount of fat and oils helps keep your calorie intake moderate, which in turn helps you control your weight. Choose liquid vegetables oils like – canola, peanut, olive, sesame, soy bean and sun-flowers. Avoid saturated and trans fats like – butter, ghee and solid shortenings (hydrogenated oils).

Vitamins

Vitamins and minerals are considered micro nutrients. Even though they do not provide energy like macro nutrients – carbohydrate, protein and fat, they have other functions to keep us healthy. Vitamin D makes our bones and teeth stronger. Vitamin Ahelps us in our vision. Vitamin E boosts our immune system. Vitamin K helps to clot our blood. Vitamins B1 helps to convert food into energy. Vitamin B12 helps in blood formation. Vitamin C prevents a disease called scurvy.

Minerals

Minerals are inorganic chemical compounds, not made by plant or animals. Minerals work in the body to regulate hormones and support the activities of enzymes. Some of the major minerals needed by the body are calcium, iron, fluoride, magnesium, phosphorus, chromium, iodine and copper.

Antioxidants

Oxidation is an essential activity of all life system, but in excess it can damage cells and can contribute to disease like arthritis, heart disease and Alzheimer. Antioxidants – such as Vitamins A, C, and E, and beta carotene – may be antidote to excessive oxidation protecting cells against damage. The minerals selenium, magnesium, copper and zinc also have antioxidant properties.

Phytochemicals

Phytochemicals are naturally occurring substances in plant foods that can help us keep healthy. Fruits, vegetables, and legumes (dried beans and peas) contain hundreds of phytochemicals. Phytochemicals work together with vitamins and minerals to protect us against cancer, heart disease, and other disorders. Eating a variety of fruits, vegetables and legumes gives us all of these nutrients together.

Water

Water is a required nutrient for all living beings. Water is required for digestion of foods and hydration of the body. Researchers have found a relationship between water intake and reduction of gallstone and kidney stones.

With respect tophysical activity, water is important to prevent dehydration. Besides plain water, other sources of water are food, tea, coffee, milk, juice and other beverages.

To supplement or not to supplement?

While vitamin and mineral supplements are heavily advertised and widely used, their overall benefits are questionable. Some supplements can have unwanted side-effects. Some of them can have adverse reactions when taken with some prescription medicines. While our body needs essential nutrients, taking mega dose of some nutrients can be harmful.

In developing countries Vita A and iron-deficiencies especially among children are common. Vitamin-A deficiency leads to poor vision. Iron deficiency leads to anemia (low hemoglobin). Children in developing countries should receive supplemental Vitamin-A, iron and Vitamin-D. Pregnant mothers everywhere should take supplemental folic acid (to reduce birth defects) and iron. Older adults should take extra Vitamin-D and Calcium to prevent thinning of the bones.

Bottom-line: try to get most of your micronutrients from a well-balanced diet. Pregnant mothers, children and older people need some supplement as mentioned above. But avoid mega dose of anything.

Vegetarian diet

There are three main types of vegetarians. Ovolacto vegetarians arethose,who shun meat and fish but consume eggs and dairy products. Lacto vegetarianswho consume dairy products but not eggs.Vegans –who consume only plant food.

Generally a vegetarian diet can be very healthy. Vegetarians tend to have lower risk of developing heart disease, high blood pressure, and certain types of cancer. They are also less likely tobe overweight. But pure vegetarians (Vegans)can develop iron deficiency anemia and vitamin B deficiencies if they are not careful about what they eat. Some of them compensate by eating too much fatty foods.

Even if you are not a vegetarian, it is good idea to eat vegetarian foods few times a week.

Food Safety

Food-borne illnesses are common in developing countries but also occur in developed countries. The most common food-borne illnesses are caused by bacteria and few viruses. The most common bacteria are – Campylobacter, Salmonella and E. coli. The viruses are Rota virus, Norwalk and Norwalk – like viruses.

The foods most likely to be contaminated with bacterium or virus are raw food of animal origin, including raw meat and poultry, raw eggs, unpasteurized milk (raw milk), and raw shellfish (shrimps, crabs, lobsters). Eating raw fruits and vegetable can also be chancy. Washing produce can lower the risk of contamination but won’t eliminate it. The following precautions can help reduce the risk of food poisoning:
• Wash your hands.
• Wash all produce. Remove the outermost leaves of lettuce or cabbage.
• Cook meat, poultry and eggs thoroughly.
• Don’t drink raw milk.
• Don’t contaminate one food with another. To avoid cross-contaminating foods, always wash your hands, utensils, and cutting boards in warm soapy after.
• Refrigerate leftovers right away at 340 F to 400 F.

2015, USDA Guidelines (United States Dept. of Agriculture Expert Committee)
• Follow a healthy eating pattern across the lifespan.
• Focus on variety, nutrient density and amount.
• Limit calories from added sugar and saturated fats and reduce sodium intake.

Key Recommendations

A healthy eating pattern includes:
• A variety of vegetables – dark green, red, orange, legumes (beans and peas), starchy and other.
• Fruits especially whole fruits.
• Grains, at least half of which are whole grains (brown rice, whole wheat etc.)
• Fat-free or low-fat dairy, including milk, yogurt, cheese, and / or fortified soy drinks.
• A variety of protein foods including sea food, lean meats and poultry, eggs, legumes (beans and peas) and nuts, seeds and soy products.
• Oils (Olive, Canola, Peanut, Sunflower, Soybean, Corn)

Limit
• Saturated fats, trans fats, added sugar, and salt, alcohol and sugar – sweetened drinks.
Bottom line – Eat in moderation. Eat a variety of foods, mostly fruits and vegetables, legumes, whole grains, low fat dairy products, sea foods (fish and shrimp), lean meat, some nuts and soy products. Stay active. If you are gaining weight, it means you are eating too much! Reduce your portion size.

Introduction

Health, disease and disability are dynamic processes which begin before an individual realizes that she/he is sick.  Each year millions of people die of preventable diseases like – diarrhea, malaria, tuberculosis, HIV/AIDS, heart disease, stroke, cancer and diabetes.  Many of these deaths can be prevented or greatly reduced by public health measures like provision of safe-drinking water and food, immunization, safe child-birth and lifestyle changes.  Lifestyle changes include-proper nutrition, physical activity and exercise, not smoking or drinking and watching one’s body weight.

There are multiple sources for health information.  Many of them are sponsored by food or drug or marketing companies.  Many of their information are biased.

This is a book about preventive health – that is how to keep you healthy.  This is not a book about disease and treatment.  It is a book meant for non-medical people.  The guidelines provided in this book are not mine.  They are from non-biased, reputable sources like World Health Organization (Geneva), Center for Disease Control and Prevention (CDC-USA) and American Medical Association.

Medical research is constantly advancing and recommendations are also changing.  All the information presented here was collected in January-February 2017.  Some of them may be outdated by the time you read them, but the basic ideas presented in the book will still be relevant. The best way to get the latest information on any topic is for you to visit the web-sites listed at the end of the book under “sources”.

It has been said that – information is not Knowledge and knowledge is not wisdom.  To get wisdom, you have to act on your Knowledge.  Changing one’s lifestyle is not easy but it can be done.  Many people are doing it every day.  Be the one who changed.

Dr Saheb Sahu, M.D., F.A.A.P., MPH.