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Monday, February 14, 2011

Fruits and vegetables for your heart

Heart2Heart - Fruits and vegetables for your heart

Wednesday, February 9th, 2011 13:17:00

Dr Haizal Haron Kamar
I used to hate eating vegetables. Well, I still do, but please don't tell my mum. I've always wondered as a kid why I had to be force-fed with a mountain of veges on the plate each time because they were apparently good for me. I didn't mind fruits though, especially the local ones.

So what is so special about these two groups of plant species and their supposed good effect on health?

Fruits and vegetables have long been known to be good at preventing certain can­cers but did you know that they have a ben­eficial effect on reducing heart disease too?

In the European Prospective Investigation into Cancer and Nutrition (EPIC)-Heart study, it was found that people who consumed at least eight portions of fruit and vegetables a day had a 22 per cent less risk of dying from heart disease compared to those who ate fewer than three portions a day. A portion weighed 80g or the equivalent to a small banana, a medium apple or a small carrot.

The study which was published online on January 19, 2011 in the European Heart Journal followed over 300,000 men and women without any history of heart attack or stroke from eight European countries. The results suggested that every one portion increment in fruit and vegeta­ble intake was associated with a 4 per cent lower risk of fatal heart disease.

The authors, however, were not able to give a definite reason for this observation. The exact biological mechanism is still unclear.

It has been postulated in the past that various antioxidant micronutrients present in fruits and vegetables reduce atherosclerosis - process of cholesterol plaque formation and buildup in the walls of the arteries - caused by oxidative damage. However, findings from large-scale studies looking at effects of these antioxidant micronutrients on the heart have not supported this hypothesis.

Proponents of antioxidants have argued that taking supplements such as those used in these studies are not the same as having the whole fruit or vegetable because there are many other components in fruits and vegetables that may confer protective effect on the heart.

So what shall we do now? Rush to the near­est supermarket and fill the cart to the brim with fruits and vegetables? Before you start having eight bananas today and get everyone wonder­ing what on earth has happened to you, consider the following recommendations by the American Heart Association.

Have eight or more fruit and vegetable serv­ings every day. An average adult consuming 2,000 calories daily should aim for 4.5 cups of fruits and vegetables a day.

Look out for added sugar and salt in canned or frozen vegetables. Fresh is still best. Keep it colourful to make it tasty as well as interesting. Challenge yourself to try fruits and vegetables of different colours.

Add fruits and vegetables to the foods you love. Put extra veges on top of your pizza or slices of fruit on top of low-fat frozen yogurt.

Enjoy fruit-based desserts. Canned fruit in natural juice is a good choice for dessert.

Use healthy cooking methods. Roasting, steaming, baking and microwaving veg­etables are ideal preparation methods. If you have to fry, use oil that is low in saturated fats. Avoid trans fats altogether.

Learn new recipes featuring fruits and veg­etables.

So what fruits should you go for? Most fruits are good for the heart but just be care­ful on the sweet ones if you have diabetes as there is natural sugar in fruits. Plenty of sweet grapes, for instance, can bring the blood sug­ar level through the roof.

The ones that are generally good for your ticker are the ones highest in antioxidants. These include pomegranate, red grapefruit, blueberries, kiwi fruit and red and purple grapes.

I certainly had plenty of vitamin C and other antioxidants in the shape of oranges and mandarins over the new year break. But veges? That is still going to be a bit hard to swallow.

If you have any questions or comments, please write to me at haizal@tropicanamedi­calcentre.com. Have a fruitful week ahead and see you next Wednesday.

Pain returning after angioplasty

Question: I had an angioplasty with two stents placed in my arteries eight months ago. I was fine for about six months but the pain returned thereafter. I am surprised at how fast the pain came back. Is it usual for this to happen after an angio­plasty?

Answer: There are a few reasons why you are having pain after your angioplasty. I am in no position to tell you exactly why as your doctor is the best person to do this. Symptoms of angina can return after a successful angioplasty and it could be due to any of the fol­lowing:

1. Re-narrowing (restenosis) of the stent. There may be overgrowth of tissue within the stent which, with time, may be bad enough to block the pas­sage of blood bringing you back to square one. The risk of this happening used to be around one in five within a year of stent implantation with bare-metal stents but with the advent of drug-eluting stents (stents coated with anti-cancer drugs to prevent re-narrowing) a decade ago saw the re-narrowing rate reduced to between 5 to 10 per cent.

2. Worsening of plaques not treat­ed by angioplasty earlier. There are usually mild cholesterol plaques in other arteries too. These might not be bad enough at the time of angio­plasty to have anything done to them but with time, these plaques could have grown and started blocking flow of blood causing angina symptoms.

3. Pain is not due to the heart. It could just be possible that the pain you are having is because of other causes such as acid reflux or muscle pain. However, this may not be likely as I am sure you have not forgotten your angina pain from before the an­gioplasty 8 months ago and, there­fore, you are able to compare.

For the first two reasons above, non-compliance to medications and failure to change lifestyle for the bet­ter such as continuing to smoke are some important factors contributing to the progression of the disease. I am not implying this might be so in your case but as a benefit to the readers.

Your doctor will most likely ask for some tests such as an exercise stress test on the treadmill to determine the cause of your symptoms. Your medi­cines may be changed or added to improve your condition, failing which a repeat coronary angiogram may need to be performed.

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