Prachi Jaiswal

What do we understand by the term Abdominal bloating?

Abdominal bloating is a common clinical condition that is rarely dangerous but it causes discomfort. It is common in both men and women and is not age-centric. Anyone can report this condition irrespective of gender or age. Abdominal bloating generally associates with abdominal distention. Abdominal distention is a condition where you can see and feel an increase in abdominal girth. 

Do you ever feel your abdomen swelling up and you all of a sudden start feeling heavy? The distention of the abdomen is so visible that you start feeling uncomfortable. Generally people report such discomfort after having meals or maybe by the end of the day. This swelling up of your abdomen and a visible distention is known as bloating. Now you must wonder why it happens? Well, bloating is one of the major symptoms reported by the people suffering from gut disorders, and the most common of all these disorders is IBS (irritable bowel syndrome).

What is IBS? Irritable bowel syndrome is a common disorder that affects the large intestine. 

IBS is a condition characterized by unexplained abdominal discomfort or pain which associates with changes in bowel habits. Other common symptoms include gas, bloating, diarrhoea and constipation, and increased GI distress associated with psychosocial distress.

Learn more about what IBS is and how to manage it.

Abdominal bloating

Bloating can be defined as a sense of gassiness or a sense of being distended where measurable distention does not have to occur. You may or may not be able to measure the distention and therefore, the term abdominal distention should be used for those people who show a visible increase in abdominal girth. 

Let us try to understand  the diagnostic criteria for bloating.

Rome III for functional bloating:

• Recurrent feeling of bloating or visible distention for at least 3 days per month
• Onset of symptoms at least 6 months prior to diagnosis
• Presence of symptoms for at least 3 months
• Insufficient criteria to establish a diagnosis of irritable bowel syndrome, functional dyspepsia, or any other functional gastrointestinal disorder

Many people also suffer from other symptoms such as burping, well this should not be gel up with bloating and it should be monitored to rule out the actual condition. 

Why is bloating bad? 

Well, on top of all the reasons, bloating creates distress. Let’s just assume that you start your day with energy and a positive feeling. You have your meal, work on your usual stuff and by evening you start feeling abdominal discomfort with a visible distention. In such a situation, you will start feeling stressed. Not only does the person feel distress, but the quality of life also suffers. 

The diagnosis and treatment of bloating is not completely understandable by researchers. But in the past decade, there has been intensive research on bloating, IBS, flatulence and other gut disorders to understand these conditions more properly. 

Pathophysiology of bloating

Pathophysiology is very important to understand the cause of the condition. It relates pathology with physiology so that we can get a better understanding of what goes on inside our body and what results in the disease condition. 

The pathophysiology of gas and bloating is quite complicated. We need to relate and understand the gut microflora, intestinal transit, gas production, etc. 

Gut microflora:

Gut microflora or gut microbiome are the bacteria that reside in our intestinal tract. They have an impact on not only gut health but on the whole body. This microflora varies from one person to another and it is more than the total number of cells in the human body. As the colonic microflora varied from one person to antoher, less research is available for the same. Do you know that these bacterias play an important role in maintaining immune health of the gut, production of short-chain fatty acids and even these can control the obesogenic factors. They also have an impact on gas production. If there is a minor disturbance in the gut microflora, it can lead to gut malfunctioning which also includes gas production. 

Intestinal gas:

At any point of time, the average individual has around 100-200 cc of gas within the gastrointestinal tract. Volume and composition of human intestinal gas determined by …. The volume of gas increases after consuming meals. Let’s try to understand this mechanism. We just learned that 100-200 cc of gas is present in the GI tract at any time. When we consume meals, digestion takes place and post-prandial this volume of gas increases. It depends on the individual how much postprandial gas will be there. Also, the colonic gas production depends on the gut microflora. These bacteria metabolize different components and as a result gas is produced. Now, during digestion and metabolism, the gastric distention and the movement of small intestines make sure to accelerate the process of gas transit. When there are some disturbing or delaying factors present for such movements, gas retention may take place leading to discomfort. 

The 5 most common gases present within the GI tract are nitrogen, oxygen, carbon dioxide, hydrogen and methane. Most of the carbon dioxide is absorbed by the small intestine. 

One cannot define how much gas production is normal and how much is abnormal for human beings. It is individualised and therefore what seems abnormal for one person might feel normal for another. Bloating is more of a sensory phenomenon and therefore we cannot measure it exactly. 

What can we do to treat bloating?

The best way to treat bloating and abdominal distention is to understand the underlying cause of the problem. When you try to understand the chief symptoms and the cause behind them, then you can easily manage bloating and abdominal distention. 

A person suffering from bloating should know the pathophysiology of the same, so that a clear picture is formed in the mind of the patient and how to handle the condition seems easy.

Diet:

Food is something that we all cherish irrespective of any other factors. Diet is an integral part of our daily routine and therefore, understanding your diet is one of the crucial steps in managing bloating. Ideally the dietician should take a thorough look at the dietary history and habits of the individual and should focus more on the foods which are fermented in the colon ( dairy, fructose, fructans, fibre and sorbitol). To better understand what these foods mean and how a low FODMAP diet works, read through FODMAP diet. 

Now, you must wonder how to manage a diet to improve bloating? 

Well, the answer to this question is quite simple. All you have to do is to eliminate a food group at one time and see if the symptoms improve. Such diets are generally called elimination diets or hit and trial methods. One food group is eliminated at one time, let’s say dairy is eliminated from your diet, then your dietician will see if the symptoms improve or they’re still the same. In the similar manner other food groups are eliminated and re-introduced depending upon the status of the symptoms. 

What works for one person may not work in case of another and therefore, such elimination diets are on individual basis.

Exercise and posture:

You might have noticed that when you’re in a supine position, the symptoms of bloating worsens as compared to an upright position. Well, posture plays a great role in managing bloating symptoms. Individuals suffering from bloating should know that exercise and posture can help reduce the frequent episodes of bloating in a day. 

A light exercise or maybe a walk can help you ease out the gas produced in the body. Make sure to not lay in a supine position after having meals.

Probiotics:

You must be aware of the term probiotics. Well, probiotics are the live microorganisms that intend to give health benefits to the host when consumed in adequate amounts. In many randomize trials, researchers observe that an adequate amount of probiotics can significantly improve bloating and flatulence in IBS patients. Probiotics promote the health of gut microbiota, which in return make sure to improve gut health. It is more of a domino effect, probiotics work on your gut microbiome health and as a consequence the bacteria make work on the normal functioning of the colon which reduces bloating and abdominal distention. 

Lactose intolerance and gluten sensitivity:

Apart from identifying the cause of bloating and trying elimination diets, you should also check for some common conditions such as lactose intolerance and gluten sensitivity. Many people are unaware of the fact that they are lactose intolerant or have gluten sensitivity. Our food practices are such that milk and wheat are most commonly consumed foods in every household. 

Lactose intolerance is a condition in which the body is not able to fully digest lactose in dairy products. It is due to the deficiency of an enzyme called lactase. Consumption of milk causes symptoms like abdominal cramps, discomfort, diarrhoea, and bloating. Fermented forms of milk such as curd and paneer are better tolerated in place of milk. During childhood, the production of the enzyme lactase is maximum. As we age, most people are not able to produce enough lactase to digest lactose. Therefore, it is important to understand whether your bloating is a result of lactose intolerance.

On the other hand, gluten intolerance or sensitivity is an immune response that takes place on consumption of gluten (a protein found in wheat, barley and rye). Symptoms generally include diarrhoea, abdominal discomfort, fatigue and bloating. The treatment includes following a strict gluten-free diet for the rest of the life. 

Apart from these treatments, over the counter medications are also available to treat bloating. But such medications shall only be follow on doctor’s prescription.

Bottom line:

Bloating and abdominal distention are very common symptoms and affect the quality of life of an individual. It is very important to understand the underlying cause of bloating to treat and manage it effectively. Diet along with exercise and correct posture can help you manage it. 

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What is obesity? 

Obesity is a complex disorder related to lifestyle, environment and genes. It is a condition where there is excessive fat storage in the body which increases the risk of health problems. The World Health Organisation (WHO) has declared obesity as the largest global chronic problem, including in India. Almost 30-65% of Indians are either overweight or obese, directly correlating with the increasing prevalence of obesity-related comorbidities: hypertension, metabolic syndrome, dyslipidemia, type 2 diabetes, cardiovascular disease, stroke, osteoarthritis, sleep apnoea, respiratory problems, certain cancers, polycsytic ovary syndrome (PCOS), infertility and gestational diabetes in women. 

A proper body weight is most conducive to good health. Increase or decrease from this normal body weight beyond certain limits are not only detrimental to health but also predispose a person to many other disorders. There should be a balance between energy intake and expenditure. 

What happens when there is an imbalance in energy intake and expenditure?

 Several neural, hormonal and chemical mechanisms help maintain the body weight by keeping a balance between energy intake and energy expenditure. If there is more energy consumed than expended, then the remaining energy is stored in the body in form of either glycogen or fat (depending upon the periods), such an imbalance is called a positive imbalance. You consume more energy and expend less, the excess energy then gets stored in the body. Now, if you consume less energy and expend more, such an imbalance is called negative energy imbalance. 

Both of these imbalances show symptoms over a period of time. If there is a chronic positive imbalance, then you might start seeing fat deposits and gain in your weight over a period of time. Therefore, it is very important to create a balance between energy intake and expenditure.

Let’s try to understand what are the risk factors of chronic obesity?

Etiology

Genetics

Genetic inheritance influences a person’s chances of becoming obese. Many hormonal and neural factors involved in weight regulation are determined by genetic factors. The number and size of fat cells, regional distribution of body fat and resting metabolic rate are also influenced by genes. Nutritional or lifestyle choices can activate or deactivate these obesity-triggering genes. Various genes are involved in weight regulation, but these following caught much attention, the Ob gene, adiponectin (ADIPOQ) gene, the “fat mass and obesity related gene”, FTO gene and the beta 3-adrenoreceptor gene. It is also seen that the FTO gene predisposes the individuals to diabetes by its effect on body mass.

Physical inactivity

Lack of exercise and a sedentary lifestyle, accompanied by chronic overeating are also one of the most pressing causes of chronic obesity. The increase in screen-time and decrease in exercise routine is increasing sedentary lifestyle. 

Sleep and stress

Shortened sleep alters the endocrine regulation of hunger and appetite. Hormones that affect appetite take over and may promote excessive energy intake. Thus recurrent sleep deprivation can modify the amount, composition, and distribution of food intake and may contribute to the obesity epidemic.

Stress is another factor. The cortisol hormone is released when an individual is under stress, and stimulates insulin release to maintain blood glucose levels in the “fight-or-flight” response. Thus an increase in appetite occurs. Chronic stress with constantly elevated cortisol levels can also lead to appetite changes. Cortisol levels are typically high in the early morning and low around midnight.

Taste, satiety and portion sizes

Just imagine that you are in a buffet and there are numerous delicious options of food in front of you. What will you do? Will you try to resist or will you just put the amount of food on your plate for which you are actually hungry? Or would you rather like to try each and every option available and increase the amount of food? 

Well, food gives us satisfaction, we all crave for something or other. When provided with numerous options, an individual ends up eating more, totally ignoring his/her hunger. We think that just adding half a piece of cake or a muffin will not do too much! But all these extra calories add up. 

Therefore, there is a direct correlation between taste and portion sizes. Once you keep on eating extra portions, you’ll form a habit and then going back to eating according to your hunger feels difficult. 

Gut microflora and diet

You must be wondering what can be the relationship between gut microbes and the diet you consume? Well, researchers have identified a complex relationship between the both, i.e., microflora gut population and food absorption. There are two microbes present in the gut- firmicutes and bacteroidetes. These two live in a symbiotic relationship, one acting as slimming and the other acts as fattening microbe. Firmicutes bacteria tend to be much more efficient at nutrient breakdown and calorie absorption than bacteroidetes, and therefore contribute to calorie absorption and the development and maintenance of chronic obesity in individuals. A higher number of bacteroidetes, on the other hand, may help to make or keep people lean. Weight loss, then, it appears would require a higher number of bacteroidetes and a lower number of firmicutes. (Reference: Krause’s food and nutrition care process, 14th ed).

Now let’s briefly understand how you diagnose chronic obesity?

Diagnosis:

Anthropometric assessment-

Body weight and height are measures of body size and based on these, BMI (body mass index) is the most researched measure of generalised obesity. It helps in assessing the nutritional status, identifying individuals at risk, and monitoring the efficacy of a nutrition intervention. It also provides information about the body’s stores of fat and muscle. 

In anthropometric measurements, one can measure weight, height, waist circumference (for abdominal obesity), and waist to hip ratio (WHR). 

Classification of obesity based on Body Mass Index (BMI) (kg/m2):

Category	Grade	WHO	Indian consensus
Underweight		<18.5
Normal		18.5-24.9	18-22.9
Overweight		25.0-29.9	23-24.9
Obesity	III	30.0-34.935.0-39.9	25-29.930-34.9
Extreme obesity	III	>40.0	>35

Waist circumference cut offs for Asian Indians:

Gender	Action level 1	Action level 2
	Should avoid gaining weight	Seek medical help
Women	>72 cm	>80 cm
Men	>78 cm	>90 cm

Assessment of physical activity:

Physical activity tells a lot about the lifestyle of an individual. It is very important to assess how active a person is. It can be measured by questionnaire, direct observation and using electronic monitoring devices such as pedometers (to measure step counts) and heart rate monitors. 

Dietary assessment:

It is crucial to know the diet of a person. What is she/he eating and how much. Food choices and food portions make a huge difference and therefore should be assessed properly. Generally a 24 hour dietary recall is done by a nutritionist to understand all about diet. It can be done through a questionnaire or by asking one to one or by asking the person to maintain a food diary.

After discussing what obesity is, what are the risk factors and how can you assess is a person is obese or not, now is the time to understand why is chronic obesity harmful? You must know that obesity is a reversible disorder. With proper diet, exercise and lifestyle modification, you can bring your weight down in the normal ranges. Of Course there are a few factors such as genetics which are not in your control. But such factors can be easily managed by taking care of modifiable factors, such as diet, physical activity, sleep and stress. 

Why reaching a higher BMI can be dangerous to your health?

Chronic obesity leads to psychological problems, mechanical disabilities, predisposition to renal, metabolic and cardiovascular diseases and overall reduces life expectancy. 

Obesity is a disorder which is metabolically unhealthy. It can predispose you to many complications. Chronic heart disease, diabetes, hypertension, gall-bladder disorder, stroke, cataract, PCOS, sleep apnea, hormonal cancers, gout and osteoarthritis are just a few complications which tend to worsen if you are obese. 

Being obese always doesn’t mean that you can get these complications. There are people who are obese and still living a healthy life. But the risk of development of such complications is always a concerning factor. 

If we talk in terms of BMI, then many studies suggest that a normal BMI increases longevity but any deviation from the normal range, i.e, 18-22.9 kg/m2 can reduce the longevity and quality of life. 

Furthermore, if you look at the consequences of obesity, you’ll see how much chronic obesity really costs. 

Mechanical disabilities:

The extra weight load of the body may cause flat feet and arthritis leading to pain in hips, knees and spine. Moreover, adipose tissue deposition in the chest region and under the diaphragm interferes with normal respiration and predisposes to bronchitis. This further makes breathing difficult and the person feels sleepy and drowsy throughout the day. 

What is the relationship between obstructive sleep apnea and obesity?

Obstructive sleep apnea (OSA) is characterized by episodes of complete collapse of the airway or partial collapse leading to deprivation of breathing and oxygen temporarily. OSA is linearly related to obesity because in chronic obesity fat gets deposited in the chest area making the airways narrow. The muscle activity in this region also decreases and there are frequent episodes of hypoxia (having low oxygen level in tissues). Furthermore, such episodes can alter heart rate, drop in oxygen saturation and loud breathing sounds. It impacts cardiovascular health as well. 

Obesity is one of the major risk factors for OSA which further leads to other comorbidities such as hypertension, CAD, depression, insulin resistant diabetes and sleep related accidents.

Other comorbidities:

Obesity is one of the major leading risk factors for non-alcoholic fatty liver disease which can further develop end-stage liver disease. Fat deposits on the liver causes various other problems and further causes alterations in metabolism of macronutrients. 

Obesity is also related to increased risk of gallbladder disease. Moreover, the production of cholesterol and the amount of serum cholesterol is reported to correlate with body weight and the number of fat cells. 

Obesity and heart disease:

With the increased fatty deposits in the body, there is an increased risk of atherosclerosis, stroke and heart attack. The fatty built-up in the arteries make them narrow leading to atherosclerosis. Furthermore, it becomes difficult for blood to pass through the narrow arteries leading to hypoxia and cell death. This makes the heart work more and more to pump blood with more efficacy. Moreover, myocardial infarction, congestive heart failure are few conditions which can develop over time if the heart keeps on working in such stressful conditions. 

Understand more about heart disease by reading How to prevent heart disease? A step by step detailed guide for you.

Do you know the relationship between obesity and type 2 diabetes mellitus?

Obesity can worsen diabetes and it is also one the major risk factors of developing diabetes. In obesity there is hyperinsulinemia and insulin resistance or impaired insulin uptake by receptors in target tissues. Insulin resistance is common in obesity and can be reversed. Furthermore, the fat deposition in abdomen and central obesity is one of the major reasons for insulin resistance. Moreover, in these conditions the cells resist the insulin present in the body leading to elevated blood glucose levels. Chronically such conditions develop into pre-diabetes and then to diabetes. 

To understand more about pre-diabetes and insulin resistance, give a read to Understanding Pre-diabetes and insulin resistance!

PCOS and obesity

Due to hormonal disbalance, obesity is one of the risk factors for PCOS. in fact, menarche is found to occur generally at a younger age in overweight or obese girls. Irregular menstrual cycle and increased menstrual abnormalities are also experienced by females. 

To know how to manage PCOS, give a read to A comprehensive guide- PCOS and Dietary Habits

Stress

Obesity leads to psychological problems such as anxiety, stress and depression. Furthermore, fatigue, drowsiness and irregular sleep cycles cause such psychological conditions. An obese person may also suffer from personality complexes and may disassociate him/her self from the society. 

Bottom line:

Obesity associates with many comorbidities such as coronary artery disease, diabetes, hypertension, stroke, obstructive sleep apnea, PCOS, psychological conditions, etc. Above all, obesity can reduce life expectancy and may also tarnish quality of life. Obesity is a reversible condition and therefore, one should work towards reversing it for a sustainable life. Moreover, with a proper diet, physical activity and lifestyle and behavioral modification, one can easily win over obesity and lead a happy and healthy life!

If you are struggling shedding weight. You can talk to us by taking this assessment: Click here

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Heart disease or cardiovascular disease, is often a preventable disease. In India, non-communicable diseases (NCD’s) account for the majority of deaths (59.1%), with most loss taking place during the productive years of life. And in India, cardiovascular disease accounts for about 53.7% of NCD mortality. Cardiovascular disease remains to be one of the leading causes of death worldwide. And therefore, to understand how to prevent and manage cardiovascular disease is very important and should be a priority in relation to public health. 

According to the World Health Organisation (WHO), CVDs are the number 1 cause of death globally, taking an estimated 17.9 million lives each year. CVDs are a group of disorders of the heart and blood vessels and include coronary heart disease, cerebrovascular disease, rheumatic heart disease and other conditions.

Coronary heart disease – disease of the blood vessels supplying the heart muscle;

Cerebrovascular disease – disease of the blood vessels supplying the brain;

Peripheral arterial disease – disease of blood vessels supplying the arms and legs;

Rheumatic heart disease – damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria;

Congenital heart disease – malformations of heart structure existing at birth;

Deep vein thrombosis and pulmonary embolism – blood clots in the leg veins, which can dislodge and move to the heart and lungs.

Coronary Artery disease

Do you know what coronary artery disease is? Well, CAD or coronary artery disease causes dangerous thickening and narrowing of coronary arteries. You must wonder why it is dangerous. We all know that blood travels through blood vessels in our body. Now imagine those blood vessels becoming narrower day after day. A time will come when the arteries will become completely blocked by thickening and narrowing. In such cases, the blood will not be able to pass through that segment of the artery. This will lead to oxygen deprivation to the part of the body to which blood is not able to reach. In such conditions, the heart has to work more to pump blood with much more force. The artery may become completely blocked or it may become prone to clotting.

This disrupts the flow of blood carrying oxygen and nutrients to the heart, causing serious problems such as angina (chest pain), myocardial infarction, arrhythmias (irregular heartbeat) and possible heart failure. The symptoms depend on the stage of illness. The commonly noticed first indication is shortness of breath or chest pain or exertion.

You must wonder how to prevent such conditions? So, such conditions develop over a long period of time, slowly and usually over decades. Looking at the time frame, you might have understood that there is a great possibility to prevent heart disease. The best way to prevent heart disease is through eating habits and lifestyle modifications.

Risk factors

 Let’s briefly discuss the risk factors to prevent heart disease

Major risk factors	Additional risk factors	Non-traditional risk-factors
Advanced age	Obesity, abdominal obesity	High Lipoprotein (a)
High total cholesterol	Family history of hyperlipidaemia	High clotting factors
High non-HDL-C	PCOS	High inflammatory markers
High LDL-C	Metabolic syndrome	High uric acid
Low HDL-C	High Apolipoprotein B	High homocysteine
Diabetes mellitus
Hypertension
Chronic kidney disease
Cigarette smoking
Family history of CVD

As we can see in the table, few of the risk factors are modifiable and few are non-modifiable. For example, you cannot modify advancing age or your genetics. But you can surely modify your lipid profile, manage your diabetes or obesity or kidney disease. It is very important to understand the risk factors as they tell us a lot about the condition. 

If we talk about the diagnosis of heart disease to prevent heart disease, then the markers such as blood pressure, lipid profile, blood glucose as well as family history of the disease are commonly used. One can also go for tests such as electrocardiogram (ECG), inflammatory marker tests such as high sensitivity C-reactive protein, or chest angiography or thallium test, depending on the symptoms suffered by the individual. 

What is lipid profile? And Why is it so important in reference to heart health?

Lipids are bound to protein as lipoprotein for transportation in blood. Lipids consist of total cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL).

We all are aware of HDL being the good cholesterol and LDL being the bad cholesterol. To understand cholesterol better give a read to A comprehensive guide on different types of cholesterol.

Importance of lipid profile in relation to heart disease is that it is one of the most basic factors leading to the development of heart disease. You cannot see or feel it, and therefore, it is important to get it checked. Once checked, you get to know your numbers which becomes easy to prevent heart disease. You must be aware of the fact that LDL contributes to the fatty build-ups in arteries which causes atherosclerosis. This raises the risk of heart attack, stroke and other heart-related conditions. On the other hand, HDL acts as a scavenger, carrying LDL away from the arteries and back to the liver for disposal. 

Triglycerides

Apart from cholesterol, triglycerides are of utmost importance. Triglycerides are the most common type of fat in the body which stores excess energy. A high triglyceride level with low HDL and high LDL level is linked with fatty build-ups in artery walls. It is observed that many people with heart disease or diabetes have high triglyceride levels. It can also elevate as a result of obesity, physical inactivity, smoking, excess alcohol consumption, or a diet which is very high in carbohydrates. Well, to make it easier to understand, all these conditions can easily be monitored with a better diet and good lifestyle habits. 

By reading this you must have got an idea of how diabetes or obesity is related to heat diseases. A high level of triglycerides in both of these conditions may cause the development of heart related conditions. You must also be aware of the fact that heart diseases are one of the manifestations or complications of diabetes and obesity in the long term. 

Can we really prevent heart diseases?

Yes, we can prevent heart disease for sure. All you need is extra care and attention towards your lifestyle habits and what goes into your body. If you are able to make mindful eating choices and modify your lifestyle in such a way that you are physically active, practising meditation, and losing excess weight, then the chances of developing heart disease becomes significantly low. In fact, a person suffering from any heart condition should also try to follow a lifestyle which promotes heart health. 

For example, if you’re taking care of your diet, eating healthy and in moderation. Along with diet, you’re able to follow a physical activity routine, then the levels of your deranged lipid profile will surely start becoming normal and you’ll see the levels coming in optimal ranges. All it takes is a little bit of motivation and focus!

How can we prevent heart diseases?

The following should be the goals of prevention:

• Eating a heart healthy diet
• Being physically active
• Shedding extra weight (if overweight or obese)
• Smoking cessation
• Moderate alcohol consumption
• Focusing on electrolyte balance
• Practicing mindful eating and focusing on portion control.

Diet:

Diet is one of the most important parts of our lives. We always look forward to having our meals of the day. And therefore, one can never keep diet aside. It is very important to plan your diet according to your health status. All of the food and beverages choices that you make in your daily life matter. The amount of calories consumed, what kind of fat goes into your body, are there adequate nutrients in the diet. Each and every choice matters. If a person is overweight, the amount of calories to lose and maintain weight will matter.

Diet patterns to follow:

Mediterranean diet pattern: this diet pattern focuses on the consumption of whole foods as compared to refined foods. A diet rich in fruits and vegetables with low fat milk and milk products and lean meats. It focuses on healthy fats such as oil, nuts and seeds. This diet pattern is considered to be healthy because it includes around 5-6 servings of fruits and vegetables with whole grains, nuts, beans and seeds. The Mediterranean diet is also rich in fibre.  

DASH diet pattern: DASH diet stands for Dietary Approaches to Stop Hypertension. This diet pattern focuses on vegetables, fruits, low fat dairy, whole grains, and fish. It is low in saturated fats and trans fats and rich in minerals and vitamins such as potassium, calcium, magnesium, protein and fibre. 

To know more about the DASH diet and how it helps in hypertension management, you can give a read to the DASH diet and its role in hypertension.

The healthy vegetarian eating pattern: this diet pattern majorly focuses on the vegetarian choices available in the diet such as pulses, legumes, soy products, nuts and seeds. This pattern also includes dairy and whole grains. People may or may not include eggs in their diet in such a pattern. 

What does a heart healthy eating pattern include?

1 cup= 250 ml

• Fruit- 1-2 no.
• Vegetables: 2.5 cups/day (include green, red, orange and other colours)
• Grains: 3+ servings of whole grains and <3 of refined grains
• Dairy low fat: 2-3 cups/day (milk, curd, buttermilk, paneer)
• Protein rich food options:

– Meat, poultry, eggs- 100g/day

– Dals, pulses, legumes

– Nuts, seeds: 8-12g/day

• Oil: 20-25g/day

Dietary fats and heart disease:

The association between LDL cholesterol and saturated fatty acids (SFA) to heart disease is not only very strong but also important to understand. Do you know that 1% increase in SFA consumption equals 2.7 mg increase in serum cholesterol. Furthermore, low intake of SFA replaced with polyunsaturated fat (PUFA) which contains vegetable oils, may prevent heart disease risk by 30%. So therefore, it is a wise choice to reduce SFA and trans fat from your daily diet and replace them with PUFA or MUFA (monounsaturated fats).

Both MUFA and PUFA may be used to replace SFA, with PUFA having a greater cholesterol-lowering effect. Examples of PUFA include sunflower and corn oil and oils high in MUFA are olive oil, canola oil, peanut oil and gingelly oil. 

Dietary cholesterol <200 mg/day. dietary cholesterol is present only in animal foods and the richest sources are organ meats and egg yolk.

Exercise and physical activity

In addition to the dietary recommendations, adults and children of all ages should meet the physical activity guidelines for health promotion. Achieving a healthy body weight by appropriate control of the diet and level of physical activity holds the key to a healthy lifestyle.

For adults, it is generally advised to do a least 150 minutes of moderate-intensity aerobic physical activity per week or around 75 minutes of vigorous physical activity per week. If all days of the week are not possible, then you should at least aim for 5 days/week. Both aerobic and non-aerobic exercises are beneficial. 

You can carry out a simple activity to keep your heart healthy, and that is going for a brisk walk. Make sure to get your heart moving!

Shedding extra weight:

Weight gain and heart disease are related to each other. Obesity is associated with an increased risk of CVD. Furthermore, high levels of triglycerides along with changes in body composition are one of the most critical reasons. Weight loss is also associated with an increase in HDL cholesterol and decrease in LDL cholesterol.

Therefore, it is important to reduce those extra kilos! Achieve your healthy weight goal and try to maintain it with the help of a diet and physical activity regime.

Alcohol consumption

Consumption of alcohol in high amounts can cause cardiomyopathy and high blood pressure in some people. Furthermore, moderate consumption has few adverse effects. Moreover, alcohol should not exceed 30-60 ml of ethanol per day. 

Bottom line:

Heart diseases are preventable with not only the help of right diet but also with good lifestyle habits. The prevalence of heart disease is increasing in India and even worldwide. Moreover, it is very important to follow a heart-healthy lifestyle to keep the disease conditions at bay.

Make sure to keep your heart healthy and beating by making a few changes in your lifestyle slowly and steadily. For example, it is better to take stairs than elevators, better to avoid fried and oily food and have whole foods, better to have alcohol in moderation than over-consumption. These small choices everyday can really make a difference.  

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To understand different types of cholesterol, it is very important to first understand what cholesterol is and what its role is in our body.

What is cholesterol?

Cholesterol is universally present in all eukaryotic cells, in their plasma membrane. It is a fat-like substance which is present in the bloodstream and is also present in body organs. There are various types of cholesterol, but generally it is mentioned as total serum cholesterol, which signifies the total amount of cholesterol present in the serum. 

Cholesterol is present in tissues and in plasma, either as free cholesterol or as combined with a long chain fatty acid, this form is a storage form. If we talk about transportation of cholesterol in the body, it is transported via plasma. It enters the bloodstream, and as mentioned is present in 2 forms in the plasma. Both of these forms, i.e Free or combined, are transported in lipoprotein. Lipoproteins are the substances which are made up of fat and proteins, that carry cholesterol through the bloodstream. There are two main types of lipoproteins- high-density lipoprotein (HDL), also known as ‘good cholesterol’ and low-density lipoprotein (LDL), also known as ‘bad cholesterol’. We will discuss these further, later in the article. 

Facts about Cholesterol:

Do you know that cholesterol is an amphiphilic lipid? Well, it contains both hydrophilic and hydrophobic parts in it. Furthermore, this nature of cholesterol makes it an essential structural element of cell membranes. It also forms the outer layer of plasma lipoproteins. 

Now, you think that how exactly is cholesterol synthesised in our body? Well, it is synthesised in many tissues present in our body, from acetyl Co-A. Acetyl Co-A is the precursor of not only cholesterol but also many other steroids in our body. 

Sources of different types of cholesterol:

We just got to know that cholesterol can be synthesised in our body, and the process is the same for animals as well. Cholesterol is present in all eukaryotic cells and therefore, it is the result of animal metabolism. It occurs in food sources of animal origin such as egg yolk, meat and liver. 

Before discussing different types of cholesterol, let’s first try to understand what role does cholesterol play in our body:

Functions of different types of cholesterol:

• The main function of cholesterol is to maintain the integrity of the cell membrane.
• It also serves as the precursor for the synthesis of many substances that are important for human survival such as vitamin D, steroid hormones.
• One of the most important roles of cholesterol is that it helps in the production of bile salts in the liver. 

Different types of cholesterol:

Lipids are bound to proteins as lipoproteins for transportation in the blood. The lipids consist of total cholesterol, LDL and HDL cholesterol levels, and triglycerides. 

Cholesterol

Total blood (or serum) cholesterol

Two main types of lipoproteins carry cholesterol to and from cells. One is low-density lipoprotein or LDL and the other is high-density lipoprotein or HDL. 

HDL cholesterol

HDL, also known as good cholesterol, acts as scavenger or a hunter or a collector, carrying LDL cholesterol away from the arteries and back to the liver for disposal. This is one of the main reasons why high density lipoprotein cholesterol is k/as good cholesterol. Moreover, a healthy HDL cholesterol level may protect against heart disease and stroke. 

Why is HDL cholesterol considered to be heart healthy?

You must have come across many statements claiming that HDL cholesterol is good cholesterol and is also heart healthy. It is actually true. The mechanism behind this is that LDL tends to flow to arteries and it tends to collect over there, forming a clog. Through the time, debris, fat cells, platelets along with LDL cholesterol accumulate in the arteries. This accumulation makes arteries narrow and it becomes difficult for the blood to flow through the artery. Over time, this accumulation may completely block the passage, making it impossible for the blood to flow. This whole condition is known as atherosclerosis.

If the artery is blocked, the blood won’t be able to reach the part of the body, which that particular artery is catering to. In such conditions, the cells, or the part of the body to which blood is not able to reach, becomes deprived of oxygen and stops functioning, resulting in the death of the cell or the part of the body. 

Now, to make it easier to understand, HDL helps in preventing the accumulation of the LDL, debris, platelets etc in the arteries. By doing so, HDL prevents atherosclerosis and promotes heart health. 

According to a cohort study, it is estimated that the annual number of deaths from CVDs (Cardiovascular diseases) in India is projected to rise from 2.26 million (1990) to 4.77 million (2020). This shows just double numbers. Heart disease is escalating in India and it is the need of the hour to focus on how to prevent and treat heart diseases.

Talking about HDL, low levels of HDL cholesterol increases the risk of heart disease. People with high blood triglycerides usually also have lower HDL cholesterol. 

Factors that can affect HDL cholesterol are: genetics, type 2 diabetes, smoking, being overweight and being sedentary negatively affects HDL cholesterol levels in serum.

It is observed that women tend to have higher levels of HDL cholesterol than men.

LDL cholesterol

LDL cholesterol is also k/as bad cholesterol, as it contributes to fatty build-ups in arteries causing atherosclerosis. As discussed above, this raises the risk for heart attack, stroke and peripheral artery disease. A low LDL level is considered to be good for heart health. 

What can cause high levels of LDL cholesterol in the body?

Well, firstly, a diet rich in saturated fats and trans fat is unhealthy because it tends to raise LDL cholesterol. A low level of HDL cholesterol also raises LDL cholesterol in our body. 

Classification of LDL, HDL, Total cholesterol (mg/dl), according to ATP III (Adult Treatment Panel) Classification

LDL Cholesterol
<100	Optimal
100-129	Above optimal
130-159	Borderline high
160-189	High
More than equal to 190	Very high
Total Cholesterol
<200	Desirable
200-239	Borderline high
More than equal to 240	High
HDL Cholesterol
<40	Low
More than equal to 60	High

How we can really increase good cholesterol and reduce bad cholesterol in our body.

The most efficient way to increase good cholesterol and reduce bad cholesterol is through diet. Your food choices say a lot about your body. If you learn to choose what is best for you, then you can govern your health to a certain level.

But diet alone may not provide you with the results that you aim for, you need to get moving, start staying active, and boost your physical fitness. Diet and exercise can really help you to reduce your bad cholesterol and even it reduces your risk of CVDs. 

Understand better about how to prevent heart disease with a detailed step guide!

Lifestyle modification is the key to lead a healthy life. But how can you really modify your lifestyle? 

Well, 1) try to be more fit

2) Practice mindful eating

3) Stop smoking 

4) Drink alcohol in moderation

5) Practice meditation

6) Lose excess weight

Let’s now further understand how can we really increase good cholesterol and reduce bad cholesterol

Diet:

Many studies have shown that a Mediterranean diet with high servings of fruits and vegetables and consumption of low fat milk and milk products, can really aid in reducing bad cholesterol in your body. 

What changes do you need to make in your diet?

• Consume around 5-6 servings of fruits and vegetables daily
• Consume low fat milk and milk products, such as buttermilk, fat-free milk etc.
• Make sure to reduce the intake of saturated fats and completely avoid trans fat.
• Include sources of healthy fats in your diet such as MUFA (mono-unsaturated fatty acids) and PUFA (poly-unsaturated fatty acids). Examples of MUFA and PUFA include rice bran oil, olive oil, sunflower oil, safflower oil, soybean oil, etc. 
• Include a serving of nuts in your diet such as 4 almonds, 1 walnut, etc.
• Consume whole grains as compared to refined grains.
• In the similar manner, make sure to consume whole cereals such as wheat, millets, rice, as compared to refined cereals such as refined wheat flour. 

There is generally a controversy about whether to consume eggs if you have high cholesterol.

So, are eggs good or bad for your cholesterol?

Many studies have shown that the cholesterol in eggs does not tend to increase or raise the serum cholesterol. In Fact eggs can be eaten as a part of a healthy diet that is rich in fibre and low in saturated fats. Eggs do not increase the risk of dyslipidemia. 

The fats that you should focus on are saturated fats. Furthermore, the sources of saturated fats include ghee, butter, coconut oil, etc. Moreover, if you have a deranged lipid profile, make sure to limit your intake of saturated fats and avoid trans fats.

Therefore, it is very important to focus on what kind of fats you are consuming in your daily life. 

Some tips to choose good fats:

• Use more and more PUFA and MUFA sources in your diet.
• Avoid processed foods and foods high in fats, sugar and salt, such as biscuits, cookies, chips, pickles etc.
• Always read the food labels for the amount of saturated fat and for trans fat. If you make reading labels a habit, you’ll always be able to make a wise food choice while doing grocery shopping.
• Use a non-stick pan and utensils to prepare food, so that the amount of oil/fat used to prepare a meal is minimum.
• Use combinations of oils while cooking.

Exercise:

It is very important to get moving. Exercise can not only reduce bad cholesterol, also may aid in raising HDL cholesterol. A moderate intensity of physical activity for about 30-40 minutes for 5-6 days a week can really help you reduce your LDL cholesterol. 

What kind of exercises can you opt for?

• Go for a brisk walk
• Opt for running, jogging, or cycling.
• You can do aerobic or cardiovascular exercises. 
• If suited, you can do resistance training as well. 

Make sure to give your body a recovery period after workout. 

Quit smoking

It is observed that by quitting smoking you can reduce the bad cholesterol in your bloodstream and improve HDL cholesterol.

Studies show that smoking can make LDL or as you say bad cholesterol, a bit stickier. Which makes LDL stick to the artery wall and make the build-up known as plaque. This plaque further leads to atherosclerosis. 

On the other hand, quitting smoking can increase HDL cholesterol which further reduces LDL cholesterol. 

So, take a wise step, and quit smoking for good heart health.

Losing extra weight

You might wonder what is the relationship between cholesterol and weight? Well, weight does have a significant effect on cholesterol. Losing weight can help you reduce cholesterol. According to the American Heart Association, high cholesterol can affect people with any weight. But being overweight or obese adds extra burden, as it further increases the LDL cholesterol and decreases HDL cholesterol.

Do you know that, Every 5 kgs you are overweight, causes your body to produce as much as an additional of 10 milligrams of cholesterol per day. 

Source: https://www.webmd.com/cholesterol-management/cholesterol-and-weight#:~:text=Every%2010%20pounds%20you’re,of%20heart%20disease%20and%20diabetes.

Apart from these lifestyle changes, if you suffer from hypercholesterolemia, medications can help you as well. But these medications must be taken under the consultation of your doctor. 

Bottom line:

Though we need cholesterol to perform certain important functions in our body, excess of cholesterol is harmful for our heart health. LDL cholesterol causes build-up of plaque in our arteries leading to atherosclerosis. Moreover, the effect of high cholesterol is not limited to this, you may suffer from other cardiovascular diseases and manifestations of CVDs. 

Make sure to keep a balance between HDL and LDL cholesterol to promote heart health. 

Also, if you have a deranged lipid profile, you should always consult a doctor before following any kind of diet or before taking any kind of drugs and supplementation. 

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