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Reassurance cure for Palpitations

Dr. D. P. Atukorale (Consultant Cardiologist) claims to have cured a number of patients who were affected with some mild palpitations of the heart merely by reassuring them, after ECG and a few other investigations that they need no medications.

Dr. Atukorale states this in a reply to a patient from Jaffna, Mrs. R. Rajakulendram who wants to know, what kind of medications are best for palpitation.

Dr. Atukorale in his reply states "In the thirty five years of my practice, out of the thousands of patients referred to me for palpitations not even one per cent were due to organic heart conditions, and they were fully cured and forgot about the conditions once I assured them after ECG and other tests that they really were not having any kind of serious palpitation condition needing medication.

Reply:

Palpitations are pounding or fluttering sensation in the heart region and are due to consciousness of the heart's action. Normally people are unaware of their heart beat. However normal people can experience palpitations at certain times, for example, after intense exercise, or sexual intercourse or heightened emotion when the heart rate goes up (above 100). But the neurotic individual may experience the symptoms at near normal rates of less than 100.

One particularly common form of palpitation is that described as an extrasystole (extra beat) or a missed beat and when you have an extrabeat which occurs in the cardiac cycle, this leads to a prolonged pause before the next beat. The long pause leads to overfilling of the heart and this beat is particularly strong and one may be aware of the pause or the strong beat.

These extrasystoles are very common in the majority of the normal population if you examine them very carefully or monitor them, but only a minority of the individuals especially those with stress are aware of these palpitations and are entirely benign and are associated with normal life expectancy unless there is clear-cut evidence of heart disease such as rheumatic heart disease or coronary artery disease. The above mentioned innocent extrasystoles do not require any drug treatment and majority are cured if you do an ECG and reassure them.

Palpitations can be experienced when the rhythm of the heart is disturbed as in atrial fibrillation e.g. due to rheumatic heart disease or when the rate is too rapid and in certain heart diseases the speed of the heart can be as high as 150 to 200 when the person has to be treated for the rapid rhythm and the underlying heart disease.

There are some people who get this rapid type of palpitations without any known cause and this could rarely occur after excessive consumption of coffee (more than five cups) or tea (more than ten cups of tea) or after excessive consumption of alcohol. Sometimes palpitations can be due to very slow heart beat (below 50 per minute) as in heart block or sick sinus syndrome. Your palpitations can be due to the drugs prescribed for your bronchial asthma and your physician has quite correctly prescribed verapamil for your palpitations.

As you appear to be very anxious about your palpitations and chest pain, please see your family physician or a cardiologist who will arrange for an E.C.G. and reassure you if your ECG is normal. In rare instances doctors have to arrange for other investigations such as 2D-Echogram, Holter monitoring and other tests, if they suspect that there is an organic basis for the palpitations.

In the 35 years of my cardiology experience out of thousands of patients referred to me for palpitations, not even one per cent were due to organic heart disease and they forget about the palpitations once they are reassured that their ECG and other investigations are normal.

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ADA endorses vegetarian diets again

by Prof. Mahinda Palihawadana, Sri Lanka Vegetarian Society

In these days when people are likely to be confused by varying opinions on the advantages and disadvantages of vegetarian diets, it would be enlightening to hear the official opinion on the society subject expressed by the premier nutritional authority in the modern world.

This professional body is the American Dietic Association (ADA). Every five years since 1987, it has been issuing a 'Position Paper' on vegetarian diets. The fourth of such papers appeared in the latest issue of the journal of the Association (JADA, Vol. 103, No. 6, June 2003). A novel feature about this latest paper is that it has been issued as a joint statement of ADA and another North American professional body, the Dietitians of Canada (DC).

The first position paper issued in 1987 stated: "It is the position of the American Dietetic Association that appropriately planned vegetarian diets are healthful, nutritionally adequate, and provide health benefits in the prevention and treatment of certain diseases." It reaffirmed this position in 1992 and 1997. The latest version gives the same conclusion as the position held by both ADA and DC.

This authoritative report runs into 43 pages, of which fully 19 are taken up by 256 references to papers pertaining to the subject that have appeared in reputed professional publications up to the time of compilation.

Let us consider a few salient aspects of this important document.

According to professionally conducted survey reports, 4.8 million people in USA in the year 2000 and 900,000 people in Canada in 2002 "consistently followed a vegetarian diet and affirmed that they never ate meat, fish or poultry". (The latest conservative survey conducted in 2003 shows that the number of vegetarians in USA has gone up by 900,000 and now stands at 5.7 million. It must be mentioned that there are also other surveys, based on less rigid questionnaires, which show that between 14 to 18 million Americans "regarded themselves as vegetarians".)

Evidence for the increased interest in vegetarianism includes "the emergence of animal rights/ethics courses on college and university campuses; the proliferation of Web sites, magazines and newsletters, and cookbooks with a vegetarian theme; and the public's attitude toward ordering a vegetarian meal when eating away from home. More than 5 per cent of those surveyed in 1999 said they always order a vegetarian meal when they eat out; close to 60 per cent "sometimes, often or always" order a vegetarian item at a restaurant."

"Restaurants have responded to this interest in vegetarianism. The National Restaurant Association reports that 8 out of 10 restaurants in the United States with table service offer vegetarian entrees. Fast-food restaurants are beginning to offer salads, veggie burgers, and other vegetarian options. Many college students consider themselves vegetarians. In response to this, most university food services offer vegetarian options."

"There has also been a growth in professional interest in vegetarian nutrition; the number of articles in the scientific literature related to vegetarianism has increased from less than ten articles per year in the late 1960s to 76 articles per year in the 1990s. In addition, the main focus of the articles is changing. Twenty-five or more years ago, articles primarily had themes questioning the nutritional adequacy of vegetarian diets. More recently, the theme has been the use of vegetarian diets in the prevention and treatment of disease. More articles feature epidemiological studies, and fewer reports are case studies and letters to the editor."

"There is a growing appreciation for the benefits of plant-based diets, defined as diets that include generous amounts of plant foods and limited amounts of animal foods.

The American Institute for Cancer Research and the World Cancer Research Fund call for choosing predominantly plant-based diets rich in a variety of vegetables and fruits, legumes, and minimally processed starchy staple foods and limiting red meat consumption, if red meat is eaten at all. The American Cancer Society recommends choosing most food from plant sources.

The American Heart Association recommends choosing a balanced diet with an emphasis on vegetables, grains, fruits, and the Heart and Stroke Foundation of Canada recommends using grains and vegetables instead of meat as the centre piece of meals.

The Unified Dietary Guidelines developed by the American Cancer Society, the American Heart Association, the National Institutes of Health, and the American Academy of Paediatrics call for a diet based on a variety of plant foods, including grain products, vegetables, and fruits to reduce risk of major chronic diseases." "The US market for vegetarian foods (foods like meat analogs, nondairy milks, and vegetarian entrees that directly replace meat or other animal products) was estimated to be $ 1.5 billion in 2002, up from $310 million in 1996. This market is expected to nearly double by 2006 to $2.8 billion. Canadian sales of meat analogs more than tripled between 1997 and 2001."

"The ready availability of new products, including fortified foods and convenience foods would be expected to have a marked impact on nutrient intake of vegetarians. Fortified foods such as soymilks, meat analogs, juices, and breakfast cereals can add substantially to vegetarians' intakes of calcium, iron, zinc, vitamin B-12, vitamin D, and riboflavin. Vegetarian convenience foods including veggie burgers and veggie dogs, frozen entrees, meals in a cup, and soymilk can make it much simpler to be a vegetarian today than in the past."

The paper also refer to official policy statements that have recently been made with regard to vegetarian diets. The United States Dietary Guidelines state, "Vegetarian diets can be consistent with the Dietary Guidelines for Americans, and meet Recommended Dietary Allowances for nutrients." They give recommendations on meeting nutrient requirements for those who choose to avoid all or most animal products. Some have said that implementation of the Dietary Guidelines can best be achieved by use of vegetarian and plant-rich diets.

National food guides include some vegetarian options. Foods commonly eaten by vegetarians such as legumes, tofu, soy burgers, and soymilk with added calcium are included in a table accompanying the USDA's Food Guide Pyramid. Canada's Food Guide to Healthy Eating can be used by lacto- and lacto-ovo-vegetarians. Health Canada has stated that well-planned vegetarian diets are supportive of good nutritional status and health."

The paper also mentions in brief the reasons that Americans give for choosing a vegetarian diet. These include health considerations, concern for the environment, and animal welfare factors. "Vegetarians also cite economic reasons, ethical considerations, world hunger issues, and religious beliefs as their reasons for following their chosen eating pattern".

After making the "position statement" and supplying a picture of modern vegetarianism in perspective, the paper summarizes the health implications of vegetarianism and examines in considerable detail the various "nutrition considerations for vegetarians". In this process, it discusses the latest scientific evidence with regard to protein, iron, zinc, calcium, the whole range of vitamins including vitamins D, B-12 riboflavin, A/beta carotene, omega - 3 and - 6 fatty acids and iodine.

A section on "vegetarianism throughout the life cycle" follows, which focuses on the adequacy of veggie diets for infants, children, adolescents, pregnant and lactating women, older adults and athletes. Then come as fairly long section on vegetarian diets and chronic diseases, which basically shows the proven as well as the probable usefulness of these diets in the prevention and treatment of obesity, cardiovascular disease, hypertension, diabetes, cancer, osteoporosis, renal disease, dementia, diverticular disease, gallstones and rheumatoid arthritis.

Very interesting to read is the section on the role of dietetics professionals. "Vegetarian clients may seek nutrition counselling services for a specific clinical condition or for assistance in planning healthful vegetarian diets.

Dietetics professionals have an important role in supporting clients who express an interest in adopting vegetarian diets or who already eat a vegetarian diet. It is important for dietetics professionals to support any client who chooses this style of eating and to be able to give current accurate information about vegetarian nutrition." How stark is the contrast between this position and the one adopted by health professionals in Sri Lanka, who, with the exception of a distinguished few, generally discourage the clients who are interested in adopting a vegetarian diet.

The ADA/CD position paper ends with the following significant statement: "Vegetarian diets are appropriate for all stages of the life cycle. There are many reasons for the rising interest in vegetarianism. The number of vegetarians in the United States and Canada is expected to increase over the next decade. Dietetics professionals can assist vegetarian clients by providing current, accurate information about vegetarian nutrition, foods, and resources".

Vegetarians in Sri Lanka, who constitute a significant segment of the population, have every right to expect that official and unofficial health professionals and hospital authorities in our country will take appropriate notice of the modern developments reflected in this paper and take a progressive and enlightened stand on food choices made by people based on ethical, health and environmental considerations.

The June 2003 issue of the ADA Journal which carries this position paper is available on the internet.

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Blood pressure and temper

At present the main killer in our country is "Heart Attack". An uncontrolled blood pressure may cause heart attack. If a person continuously loses his temper there is a possibility of increasing the blood pressure beyond a certain limit, which causes Heart Attack.

It is our duty to keep our minds in a good condition for a healthy life. Some persons think that losing temper is a qualification for the post they hold without realising that it shows their mental weakness. According to my point of view any person who loses his temper frequently is having a mental weakness. He does not have adequate will power and has to take corrective action.

The disadvantages of having a bad temperament are as follows:

1. Losing your control - If you are driving a car you may meet with an accident.
2. You insult others unnecessarily.
3. You fail to understand matters of importance.
4. Become unfriendly - for your employees, friends and family.
5. You place yourself in an embarrassing situation after shouting sometimes in bad language as well.
6. It results in arguments. May be with your superiors and you may lose your promotion or even the job.
7. Damages property (break tables, glasses etc.)
8. Creates family problems (Divorce is possible).
9. Results in violence, injuries and even murder.

On realising these disadvantages a person should take the following steps to rectify the situation.

1. Never have an intention of insulting others in public.
2. Plan your work, so that disturbances are reduced.
3. Create positive thinking and determine to have a happy life.
4. Take regular exercises and have adequate rest in both body and mind.
5. Have adequate sleep and do not break rest.
6. Stop liquor, narcotics and cigarettes.
7. Have your meals on time.

Practise some relaxing techniques, such as regular meditation ("Metta Bhavana" or "Ana PanaSati").

I hope our people consider these matters seriously and will have a pleasant life.

S.R. Balachandran, Council Member, The National Chamber of Commerce of Sri Lanka

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