THE GROWING CHALLENGES OF HEALTH MANAGEMENT

BASIC FUNDAMENTALS

THE FUNDAMENTALS

• In Health Management it is much more important to go for prevention of problems rather than trying to get the best and high tech treatment. Prevention is better than cure.

• The cost of medication is going up by geometric proportion. It is therefore all the more necessary to go for better health management to avoid the diseases.

• By proper Health Management, one can possibly avoid many debilitating diseases, slow down the ageing process and can remain active throughout the life.

• It is therefore of prime importance for every one.

• In this presentation, a few known fundamentals for Health Management are given, so that, we can benefit by observing these.

THE HEART DISEASE

• This is one of diseases, where the Management and Prevention is most effective.

• The main reasons for heart problems are blockages in the arteries and the generic factors responsible for it are discussed below:

1. If any of the arteries supplying blood to the heart gets blocked, the heart cannot perform the function of pumping the blood satisfactorily. This can result in condition which we call heart disease.

2. Though heart is pumping blood for the whole body, it can utilize only the blood it receives from the arteries supplying blood to it. Like a cashier in bank, who is counting money all the time, but uses money only thru salary.

3. It can result in major problem, and may require going for ‘Open Heart Surgery’ or going for ‘Angioplasty’, both are quite expensive.

4. It needs to be understood that, the blockages in arteries are not caused overnight. People have belief that, all of sudden someone can get heart disease. This is not true. It takes decades to create the blockages.

5. Nature has provided us with substantial over-capacity in the arteries. One can live normal life with up to 70% blockages.

THE HEART DISEASE

• Though there are genetic tendencies for occurrences of heart problems, these tendencies can be kept in check by proper management of the lifestyle.

• Besides the genetic aspects, the other factors contributing to heart blockages are the intake of animal fats (Milk, Ghee and butter for vegetarians), more intake of tri-glycerides & trans-fats (thru oil in the food) and poor life style with no physical exercise.

• One needs to shift towards, food with less of animal fats and oils, and cut down completely the trans-fats to reduce the chances of cholesterol deposition in the arteries.

• One needs to evolve a diet which is low on fats, but high on satisfaction value, so that one can continue with this diet all the time. This diet would require, major filling to be done by vegetables and fruits, with reduced intake of carbohydrates and fats.

• Maintain a good value for HDL in the lipid profile, so that bodies natural capacity to remove the blockages becomes effective. If HDL count is low, temporarily one can take high dose of thymine (Vitamin B3).

LIFE STYLE CHANGES

• The life style changes are also necessary to avoid the chances of occurrence of heart disease. These changes are :

1. Cultivating and following the practice of walking around 2-3 kms every day. This can be quite enjoyable specially in the morning and evening with friends.

2. One needs to learn to ‘let go’ things. In real life most of the times the things would not go through as we desired. Many times just the opposite may happen. Learning to ‘let go’ would reduce chances of hypertension.

3. We however, need to draw a line beyond which we would not ‘let go’, else people may take us for granted.

4. It is also necessary to cut down on smoking and control high blood pressure to reduce the chances of heart disease.

5. The life-style and dietary changes discussed above would also reduce the chances of diabetes.

CAUSES OF DIABETES AND PREVENTIVE MEASURES

• DIATETES IS ESSENTIALLY CAUSED BY SEDENTARY LIFE STYLE. SEDENTARY LIFE STYLE AND FOOD RICH IN SUGAR AND FATS IS A DEADLY COMBINATION RESULTING IN INCREASE IN THE CHANCES OF GETTING DIABETES.

• HIGH PRESSURE JOB, REQUIRING CONTINUOUS TENSION IN THE MIND IS ANOTHER IMPORTANT FACTOR CONTRIBUTING TO THE DIABETES.

• TENDENCY TO GET DIABETES IS ALSO TRANSFERRED GENETICALLY. IF FATHER OR MOTHER HAS DIABETES, THE CHANCES OF CHILDREN GETTING DIABETES IN THEIR LIFE TIME ARE HIGH.

• HOWEVER, WE CANNOT ALTER THE GENES WE HAVE INHERITED. ONLY THING WE CAN DO IS TO TAKE PREVENTIVE MEASURES, SO THAT THE GENETIC TENDENCY IS NOT MATERIALSED INTO ACTUAL DIABETES.

• WHAT ONE NEEDS TO DO IS TO ADDRESS THE ROOT CAUSES MENTIONED ABOVE TO REDUCE THE CHANCES OF GETTING DIABETES.

SLOWING THE AGEING PROCESS

• Our body is pre-programmed to live for a definite period. However, in the recent past, tremendous advancements have taken place to study the ageing processs and finding the root causes and to find if the Ageing can be controlled or slowed down.

• Many theories have evolved in the last few decades promising to slowing down the ageing process and extend the life span.

• It has been observed that, slowing the ageing process is also associated with ability to maintain fitness till last.

• This means that, if we can add 5 years to the life span by slowing the ageing process, we would be adding 10 years to the active life.

• Our dependence on others in the sunset years of the life would be much reduced.

• The major theories on ageing process are shown in the next few slides.

THE CELL METABOLISM THEORY

• As per this theory, every cell in our body has a life span. The body continues much longer than the life span of individual cells by the process of renewal of cells by reduction division process.

• Research has shown that reduced calorie intake reduces the metabolism rate, resulting in increased life span of individual cells, while it has no detrimental effect on number of times a cell can divide and continue. Caloric restriction thus, has been shown to significantly increase life span. Research has also shown that, the activity level that one can be maintain with age, improves substantially with reduction in calorie intake.

• This is today, the best known method to science, to slow down the ageing process. This has been proven in animal studies beyond any reasonable doubt. This has also been now proven to be true for human beings as well.

THE CELL METABOLISM THEORY

• With this theory, the earlier concepts of providing minimum 2500 calories to maintain good health are now gone.

• A person would need to evolve a diet pattern for him, which is ‘low on calories and good on vitamins and minerals content. The diet pattern should also be high on ‘satisfaction value’, so that, one can continue with the diet pattern for long time. A diet which depends largely on varieties of fruits and vegetables for major filling with less dependence on carbohydrates and fats, is best for this purpose.

• Thus with reduced caloric intake the ageing process slows down and the life span can get enhanced and many more years to active life gets added. This results in improved capability to live life usefully till the end.

THE TELOMERASE THEORY

• Cells in the body will normally divide approximately 60-80 times before they simply stop dividing, and eventually die.

• A possible explanation for this pre-programmed cell death is due to a cap – a ‘Telomere’ – at the end of each of the 23 pairs of chromosomes that make up the human genome. (Chromosomes are the thread-like structures of DNA found in the nucleus of all cells in the body, carrying genetic information, in the form of genes).

• Telomere can be equated to the plastic cap at the end of a shoelace. Each time the cell divides; the telomeres shortens. After a specific number of cell divisions, the telomere is whittled away, and the end of the chromosome becomes frayed (just like a shoelace) and then it stops dividing, leading to cellular dysfunction and cell death. In due course, this cumulative cell senescence (death) contributes to the ageing process.

THE TELOMERASE THEORY

• Recently, an enzyme has been discovered which could prevent/restore the shortening of the telomeres. This enzyme has been called Telomerase. Telomerase acts to repair the damage to telomere and helps in maintaining the telomeres length and stability, prolonging the ability of the cell to continue dividing & renew. Telomerase could hold the key to unlocking the mystery of ageing by its ability to prolong cell division and consequently, slow down the ageing process.

• Telomerase is found in stem cells. This could be one of reasons contributing to the anti-ageing effect of the embryonic stem cells used in the stem cell therapy today.

• This is one of most important discoveries on the ageing process. In fact this year’s Nobel Prize for Medicine has gone for work in this areas only. This has a potential to enhance the life span substantially.

THE NOBEL PRIZE FOR MEDICINE FOR 2009

IN THE PRESS RELEASE FOR ANNOUNCING THE NOBEL PRIZE FOR MEDICINE THIS YEAR, FOLLOWING WAS ANNOUNCED BY THE NOBEL COMMITTEE:

• 5 October 2009

• The Nobel Assembly at Karolinska Institutet has today decided to awardThe Nobel Prize in Physiology or Medicine 2009 jointly to

• Elizabeth H. Blackburn, Carol W. Greider and Jack W. Szostak

• for the discovery of

• "how chromosomes are protected by telomeres and the enzyme telomerase“

• THE SUMMARY OF THE RESEARCH WORK ANNOUNCED IN THE PRESS RELEASE IS SHOWN IN NEXT SLIDES.

THE SUMMARY OF THE RESEARCH

• “This year's Nobel Prize in Physiology or Medicine is awarded to three scientists who have solved a major problem in biology: how the chromosomes can be copied in a complete way during cell divisions and how they are protected against degradation. The Nobel Laureates have shown that the solution is to be found in the ends of the chromosomes –the telomeres – and in an enzyme that forms them – telomerase.

• The long, thread-like DNA molecules that carry our genes are packed into chromosomes, the telomeres being the caps on their ends. Elizabeth Blackburn and Jack Szostak discovered that a unique DNA sequence in the telomeres protects the chromosomes from degradation. Carol Greider and Elizabeth Blackburn identified telomerase, the enzyme that makes telomere DNA. These discoveries explained how the ends of the chromosomes are protected by the telomeres and that they are built by telomerase.

THE SUMMARY OF THE RESEARCH

• If the telomeres are shortened, cells age faster. Conversely, if telomerase activity is high, telomere length is maintained, and cellular senescence is delayed. This is the case in cancer cells, which can be considered to have eternal life. Certain inherited diseases, in contrast, are characterized by a defective telomerase, resulting in damaged cells. The award of the Nobel Prize recognizes the discovery of a fundamental mechanism in the cell, a discovery that has stimulated the development of new therapeutic strategies.”

• THUS THE TELOMERE THEORY HAS NOW UNLOCKED ONE OF THE SECRETS OF THE AGEING PROCESS.

• THIS WOULD EVENTUALLY RESULT IN TREATMENT TO INCREASE TELOMERASE ACTIVITY, WHICH WOULD DELAY THE CELL SENESCENCE, PROLONGING THE LIFE SPAN OF THE CELLS. THIS WOULD SLOW DOWN THE AGEING PROCESS.

THE STEM CELL THEORY

• As we age, there is loss of stem cells. The stem cell reserves we are born with diminish, along with this loss, our ability to repair and regenerate tissues also goes down. So, as we age, our bodies accumulate more and more dysfunctional cells, and age-related changes occur in the skin, organs, sex glands, immune system, blood-forming system, muscles and other systems.

• Stem Cell therapy can re-furbish the reserve of the stem cells. With this, body’s capacity to repair the cell damage can improve. This would result in slowing down of the ageing process substantially.

• One of distinct possibility is to collect the stem cells from the ‘Umbilical cord’ at the time of birth, which is normally just discarded and thrown away after the birth. ‘Cord blood’ is a good and potent source for the stem cells and this can be collected and preserved in frozen condition (at -40 degree centigrade) for future use. It is like insurance, for the individual. If one can afford this expense, the stem cells in cord blood should be preserved as this can provide long-term benefit to the child.

VITAMIN & MINERAL INTAKE

• It has been proven that, sufficient intake of important minerals and vitamins helps in improved body function and thwarts chances of debilitating diseases.

• A research study has proved that, ensuring enough in-take of Vitamin A, Vitamin C, Vitamin E and Vitamin B-complex and regular intake of sufficient Calcium helps in increasing the life expectancy by 4 years. Ensuring sufficient Calcium intake helps reduce the chances of de-calcification of bones and helps maintain good mobility even at advanced age.

• One glass of non-fat milk a day can also provide sufficient calcium to the body to ward off the danger de-calcification of bones. Sufficient intake of fruits and green vegetables can easily ensure necessary inputs of vitamins A, C, E & B-complex.

• Another most important thing to follow is to totally avoid intake of trans-fats. The intake of trans-fats results in increased LDL and reduced HDL in lipid profile. Thus it results in double damage to our body system.

NURTURING THE ABILITY TO ‘LET GO’

• It is very important to nurture our ability to let go things. In our life many times things do not go through as we want. Many times just the reverse happens.

• Many times losses happen and we need to learn to take these losses.

• John D Rockefeller - the founder of Standard Vacuum & Oil Company, had already made a million by the age of 23. However, he was extremely pushing to his staff, and used to get extremely worked up if things did not happen as he wanted. He was unable to take even the minor losses. Due to this, by 27 his health condition deteriorated and was physically and psychologically wrecked.

• Luckily, he met a good doctor, who told him in no uncertain terms that, if he wants to live longer, he needs to change his attitude towards life. He was told to learn to ‘let go’ things. He learnt the lesson and regained his quietness and internal peace and lived on to form the Stanvac empire and the Rockfeller Foundation (the biggest philanthropic organization).

MAINTENANCE OF FAMILY HARMONY

• A good harmonious family environment helps in improved feeling of well-being and fosters sense of being wanted, in each of family member. This single factor can improve the expected life span by as much 5-10 years for an individuals.

• Members in the family need to nurture life stance ‘I am O.K. you are O.K.’. This is fundamental to maintain smooth relations. The life stance like ‘I am O.K. you are not O.K.’ is the starting point of rift and should be understood and got rid off. Simple method to implement this is to stop passing judgments on people around us. Instead of criticizing individuals, the process or the method used should be criticized, so that the process improves and next time things happen in correct way.

RETIREMENT PLANNING

• After retirement, many people start getting feeling of acute loss, due to being not wanted by the society. With the loss of job, the power is gone, the money inflow stops, there are no subordinates to do tasks for you. You feel helpless. Unless one is able to fill this gap and structure his time creatively, there would be acute sense of loss after retirement. This requires careful planning and professional advice. This is key to continue to live active life after retirement.

• If this planning is not done satisfactorily, ageing gets accelerated and a person gets into health and psychological problems. In this age group, more than 50% diseases are psychosomatic diseases, which can be averted by careful planning of the retirement.

YOGA & MEDITATION

• Not enough solid research has been carried out on the impact of Yoga and Meditation on the ageing process. However, our ancient texts like ‘Patanjali Yoga Sutra’ give considerable importance to Yoga and meditation to contain the effects of ageing process.

• Scientifically it has been now proven that, meditation helps increase the ‘alpha waves’ pattern in the brain’s EEG (ElectroEncephaloGraphy), which is an indicator of improved feeling of wellbeing and happiness. More evidence is getting build up which indicates that the yoga and meditation helps reduce the anxiety syndrome and reduces the internal ticking speed of body clock. Combined effects of all these is to reduce the ageing process. Moreover, the body performance is also improved significantly with this. Thus more useful years to life are added by Yoga and Meditation.

FREE RADICAL THEORY

• Every cell in the body requires cellular respiration for the sustenance of life. However, this process also produces bye-products. Environmental toxins, air pollution and ultraviolet radiation, as well as diet, tobacco, and alcohol all result in the production of highly reactive cell by-products referred to as free radicals. These free radicals attack the structures of the cell, resulting in the accumulation of toxic metabolites interfering with cell membrane function, and DNA/RNA and protein synthesis, thus decreasing cell energy production, and potentially accelerating the aging process.

• Recently, it has been found that the fruits and vegetables having strong FLAVOR have very beneficial effect on removing the toxic metabolites and the free radicals. In fact a new science called flavonics is evolving now to study the beneficial effects of the foods having strong flavor.

FREE RADICAL THEORY

• Fruits like Jamun, apples, grapes, etc which have strong flavors, have a very beneficial effect on the body. Further even drinks like tea & Coffee, which have a strong flavor have a similar beneficial effect. Due to this factor, both of these have now been upgraded in food value.

• Fasting on water or fruit juices is also one of the best known way to cleanse the body of these free radicals and thus slow down the ageing process.

• Indian practice of keeping fast at certain intervals on specific lunar dates, with only fruits being permitted, helps reduce the free radicals and is a very sound practice.

THE DNA/ GENETIC DAMAGE THEORY

• Our DNA is a genetic blueprint inherited from our parents. We are therefore born with a unique genetic code, which determines the tendency by which certain factors affect the rate at which we age. Also with time, there is damage to the DNA itself, resulting in loss of efficiency of various functions and organs. The DNA damage can be thought of as a cumulative phenomenon based on our lifestyle, diet, and exposure to certain toxins, pollutants, UV radiation or other environmental influences. In addition, as we age, the mechanisms responsible for the repair of genetic damage become less effective. This genetic damage can result in the production of abnormal proteins, and sugar-protein complexes which can lead to defective functioning of the cells.

• Though one has to live by the DNA he has inherited, some damage control exercise can be done to reduce the environmental damage to the DNA. Life styles protecting one from the UV radiations and pollutants can somewhat help contain the effects of these and should be pursued to the extent feasible.

THE DNA/ GENETIC DAMAGE THEORY

• One can give to the next generation only three things In inheritance. The first thing is property and monetary assets, the second thing is life stance which gets formed during first five years of live of child (Sanskars as we call in hindi) and the DNA structure.

• The DNA is not static entity. There is a linkage between the life style and the RNA, and RNA communicates with DNA (RNA is a messenger to DNA). Thus with inferior life style the DNA gets deteriorated and then this passes on to the next generation. By healthy life style one can pass on the improved DNA to the next generation.

• It is therefore our moral obligation to pass on improved DNA to the next generation. To enable this happen we must follow a healthy life style right form our childhood, so that during our reproductive years, the DNA is an improved version of what we inherited.

• It is said that major changes in our DNA can happen with the cumulative effects in seven generations. Tendency for diabetes or heart disease can be built or can be eliminated by superior life style.

CONCLUSIONS

• Though, the ageing is a complex process and there is not one specific theory or the cause, still there are common factors amongst various theories. These common factors are easy to understand and implement. With these, one can reduce the ill effects of the ageing process.

• The common factors are reduced calorie intake, ensuring intake of adequate vitamins and minerals (calcium as well), and maintaining of adequate physical activity level by walking 3 kms every day.

• Reduced animal fats, and reduced intake of oils and trans-fats is necessary to reduce the LDLs which helps in reducing the chances of blockages in arteries.

• It is much easier and cheaper to maintain good health. Corrective treatments are very costly, and are in-adequate.

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