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25/10/2024

Wake-up call on how lack of sleep affects health, productivity

Not getting the right amount of shut-eye increases our risk of developing a host of physical and mental health disorders, not to mention the impact it has on our daily life and productivity.

Abdurahmaan Kenny, neuroscience product manager for Pharma Dynamics, says sleep deprivation is a growing problem.

“Insufficient sleep has been linked to seven of the 15 leading causes of death in America, including cardiovascular disease, cerebrovascular disease, accidents, diabetes, and hypertension.

“Those who sleep less than six hours a night also tend to struggle with weight issues, having a body-mass index (BMI) of 12% greater than those who sleep between seven and nine hours.”
Abdurahmaan Kenny
He points out that over time, chronic sleep deprivation may also lead to insomnia. When an individual consistently experiences insufficient sleep over a prolonged period, it can disrupt the body’s natural sleep-wake cycle and the regulation of sleep hormones such as melatonin.

This disruption can result in difficulties falling asleep, staying asleep or getting restorative sleep, which are characteristics of insomnia.

“Long-term sleep deprivation can affect various bodily functions, impacting cognitive abilities, mood and overall health. It can lead to increased stress, irritability, difficulty concentrating, memory issues, depression and anxiety, as well as a weakened immune system.”

Other critical factors that contribute to insomnia, include stressors like grief, chronic pain, substance abuse, medical comorbidities, impaired social relationships, lower socio-economic status, old age, and being female.

Insomnia is more common in women because of hormonal fluctuations, a predisposition to depression, anxiety, and stress, as well as circadian rhythm disorders, and coexisting medical problems.

If you think you have insomnia, treating it typically involves a combination of lifestyle changes, behavioural strategies, and, in some cases, medical intervention.

Kenny suggests the following approaches to manage and treat the condition:
Establish a consistent sleep schedule: Maintain a regular sleep routine by going to bed and waking up at the same time every day, even on weekends. This helps regulate your body’s internal clock.

Create a relaxing bedtime routine: Develop pre-sleep rituals that signal to your body that it is time to wind down. This might include drinking a cup of soothing herbal tea, like Rooibos, reading a book, taking a warm bath, and practicing relaxation techniques like deep breathing, meditation, or listening to calming music.

Optimise your sleep environment: Ensure your bedroom is conducive to sleep. Keep the room cool, dark, and quiet. Invest in a comfortable mattress and pillows. Minimise electronic devices and screen time before bedtime as the blue light can disrupt your sleep.

Limit stimulants and alcohol: Reduce or eliminate caffeine and ni****ne, especially in the hours leading up to bedtime. While alcohol might make you feel drowsy initially, it can disrupt your sleep later in the night.

Regular exercise: Engage in regular physical activity, but try to avoid vigorous exercise close to bedtime as it can be stimulating. Exercise during the day can promote better sleep.

Cognitive behavioural therapy: It is a structured programme that targets behaviours and thoughts affecting sleep. It helps identify and replace negative thoughts and behaviours with positive ones to improve sleep.

Mindfulness and relaxation techniques: Practices like mindfulness meditation, progressive muscle relaxation or guided imagery can calm the mind and body, making it easier to fall asleep.

Limit daytime naps: If you must nap during the day, keep it short (20 to 30 minutes) and avoid late afternoon naps, as they can interfere with nighttime sleep.

“Consistency and patience are crucial, as changes in sleep habits and improvements may take time. Consulting with a general practitioner (GP) or sleep specialist can provide personalised guidance and treatment options suited to your specific needs.”

25/10/2024

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24/10/2024

BACK TO BASICS: Too much pressure!

What serious health condition do you know of that affects one in three South African adults? It is responsible for one in two strokes and two in every five heart attacks, according to the Heart and Stroke Foundation of South Africa.

Yes, you guessed right – high blood pressure.

How can our incredibly well-designed body go wrong in such a high percentage of people? Is this because of genetic changes over which we have no control, or is it related to environmental and personal behaviours that can be modified? What is high blood pressure? Every heartbeat creates pressure in our vascular system. This drives life-giving blood around our 100 000 km of blood vessels. This system is vastly more complex than the water reticulation system of a large city.

However, if all the blood vessels were fully open, the pressure would be too low to perfuse all our body cells. Muscles lining these blood vessels are controlled by nerves and hormones to open or restrict blood to certain areas through highly complex mechanisms. These blood vessels are lined by endothelial cells which provide a super smooth surface. Endothelial cells also produce nitric oxide, a powerful relaxant of blood-vessel muscles. One of the main precursors of nitric oxide comes from our diet, especially green leafy vegetables, carrots and beetroot.

The main contributing factors to high-blood pressure include being overweight, too much salt and too little potassium intake (mostly obtained from fruits and vegetables), lack of exercise, drinking too much alcohol and caffeine-based beverages, smoking, uncontrolled stress, family history of high blood pressure and belonging to certain ethnic groups. Certain diseases can bring on high blood pressure, kidney disease, diabetes, sleep apnoea, certain hormonal problems and auto-immune conditions and medications like contraceptive pills, steroids, anti-inflammatory pain killers, and liquorice-containing medicines.

Understanding these causes offers opportunities for patients to reduce modifiable risks. This is accomplished through lifestyle behaviour change. In many cases it may be possible to restore normal blood pressure, with sufficient commitment. But even adopting some changes can reduce risks. This is not to undermine the secondary role of medications.

The most researched lifestyle intervention is the DASH (Dietary Approaches to Stop Hypertension) eating plan. This promotes eating vegetables, fruits and whole grains; low-fat or fat-free dairy, fish, poultry, beans, nuts and vegetable oils, reducing saturated fats, found in meats and tropical oils, and limiting sugar-sweetened beverages. The DASH eating plan is also low in sodium, and high in potassium. Beneficial effects can already be measured within one week. And in the long term it reduces the risk of heart disease mortality.

Lifestyle-behaviour changes are recommended in the SA National Guidelines for Hypertension as the foundation of managing the disease. But work with your doctor and, if necessary, use medication.

V This health column is written by Dr Dave Glass, a retired obstetrician/gynaecologist living in Somerset West for just over a year. He is also chairperson of the South African Lifestyle Medicine Association (Salma).

V Glass, with an MBChB, FCOG(SA) and DipIBLM, has a passion for preventing and addressing the root causes of chronic diseases.

24/10/2024

Heart Awareness Month: SA still faces a crisis of cardiovascular-disease

The Heart and Stroke Foundation South Africa (HSFSA) is well- known locally, regionally and internationally for dedicating the entire month of September to heart awareness.

Given that Heart Awareness Month is one of the foundation’s key campaign events it aims to make a significant impact on heart disease awareness and, through the campaign strategy, also aims to reduce the burden of cardiovascular disease (CVD).

Sunday 29 September is World Heart Day (WHD), when the HSFSA’s Heart Awareness Month campaign will culminate. The foundation will align with the World Heart Federation on the day. By embracing this global theme, the HSFSA underscores the need for sustained collaboration and collective action to achieve lasting impact.

Taking a comprehensive look at the CVD statistics pertaining to the mortality and morbidity rates in the South African context, it is alarming that South Africa is still facing a crisis of CVD burden.

In 2020, Statistics South Africa highlighted mortality trends, indicating that Diabetes Mellitus, hypertensive disease, cerebrovascular disease and heart disease were marked in the top 10 leading natural causes of death in SA. These conditions added up to an estimated 17% of all reported deaths in 2020.

HSFSA CEO Professor Pamela Naidoo, together with key stakeholders, has realised that the South Africans do not fully understand the complexity of CVD. “There are many medical conditions that constitute the cluster of CVDs,” she explained.

As a starting point Naidoo conceptualised the focus on heart failure given the many misconceptions about what the condition is exactly. Consequently, this year’s awareness campaign’s primary theme is on heart failure and its key risk factors.

Over a four-week period each week will have an exclusive but related theme on heart failure. The themes are as follows: Week 1 – What is heart failure?; Week 2 – The causes of heart failure; Week 3 – Management of heart failure and living with heart failure; and Week 4 – Diabetes type 2 and other risk factors for heart failure.

This week, the HSFSA delves into the first theme . . .

What is heart failure?

Heart failure, or congestive heart failure, is a “serious condition, in which the quantity of the blood pumped by the heart each minute (cardiac output) is insufficient to meet the body’s normal requirement for oxygen and nutrients.”

However, this does not mean that the heart is about to fail or stop completely. During heart failure the organ is not capable of coping with its workload. When the heart does not pump efficiently the heart has to beat faster and gradually enlarge to cope with the workload causing the heart to weaken and the amount of blood pumped to the body to be restricted.

The circulation becomes sluggish causing excess fluid to be retained in the body. When this happens your blood cannot deliver enough oxygen and nutrients to the rest of your body to allow it to work normally.

Heart failure can damage your liver or kidneys and may lead to other conditions including pulmonary hypertension or other heart conditions, such as an irregular heartbeat, heart valve disease and sudden cardiac arrest.

Heart failure may happen suddenly with severe symptoms (known as acute heart failure) or symptoms may appear slowly and gradually worsen (known as chronic heart failure). If not treated heart failure (HF) can be life-threatening. If treated, however, many individuals live with HF for years.

Types of HF may be divided into two categories: Left-sided HF and right-sided HF.

Left-sided HF is when the power of the left heart chamber is reduced, causing the left chamber to work harder to pump the same amount of blood. The left chamber is responsible for pumping blood throughout the body. There are two types:

HF with reduced ejection fraction, also called systolic HF. The left heart chamber does not have enough force to push enough blood into circulation.
HF with preserved ejection fraction, also called diastolic HF. The left heart chamber does not relax normally because the muscle has become stiffer and thus the filling of the chamber with blood is impaired.
The term ejection fraction describes the heart chambers’ strength and ability to empty with each beat. Specific left sided HF symptoms may include fluid build up in the lungs, causing shortness of breath, bluish color of fingers and lips, sleepiness or trouble concentrating and an inability to sleep lying flat.

Right-sided HF affects the lower right heart chamber and is responsible for pumping blood to the lungs. Some particular symptoms may include fluid build up and swelling in the abdomen, legs and feet or a pain in the abdomen area.

Symptoms of HF may include:
shortness of breath with activity or when lying down;
wheezing;
a cough that doesn’t go away or a cough that brings up white or pink mucus with spots of blood;
swelling in the abdomen, legs, ankles and feet;
weight gain from fluid retention;
fatigue, weakness or dizziness;
rapid or irregular heartbeat;
nausea and loss of appetite;
increase need to urinate at night; and/or
palpitations.

24/10/2024

Putting the spotlight on heart health this month

Throughout the month of September the Heart and Stroke Foundation of South Africa (HSFSA) is placing the spotlight on heart health, creating awareness heart disease and its risks.

Heart Awareness Month is one of the foundation’s key campaign events. It aims to make a significant impact on heart disease awareness and, through the campaign strategy, also aims to reduce the burden of cardiovascular disease (CVD).

Sunday 29 September is World Heart Day (WHD), which the HSFSA’s Heart Awareness Month campaign culminates in. The foundation will align with the World Heart Federation on the day. By embracing this global theme the HSFSA underscores the need for sustained collaboration and collective action to achieve lasting impact.

Over a four-week period each week will have an exclusive but related theme on heart failure. The themes are as follows: Week 1 – What is heart failure?; Week 2 – The causes of heart failure; Week 3 – Management of heart failure and living with heart failure; and Week 4 – Diabetes type 2 and other risk factors for heart failure.

This week, the HSFSA delves into the second theme . . .

The causes of heart failure

When considering the different types of heart failure (HF) the foundation notes that HF may be caused by a weakened, damaged or stiffened heart.

If the heart is damaged or weakened the heart chambers may stretch and get bigger, which means that the heart can’t pump the blood out of the heart at the rate it is supposed to. If the main pumping chambers of the heart are stiff or rigid they can’t fill with enough blood between beats.

The heart is vulnerable to many factors that may lead to the heart muscle being damaged, weakened or rigid. These risk factors include advancing age, s*x, inherited cardiomyopathies, hypertension, diabetes mellitus, obesity, certain infections, consumption of alcohol, drugs or to***co products and selected chemotherapy medicines.

Conditions that may damage or weaken the heart, and lead to heart failure:
Coronary artery disease and heart attack: Coronary artery disease is the most common cause of heart failure due to atherosclerosis taking place in the arteries supplying the heart muscle. This reduces blood flow and can lead to heart attack, which in turn damages the heart tissue.
Hypertension/high blood pressure: Hypertension causes the heart to work harder to pump blood throughout the body. Over time, the extra work can make the heart muscle too rigid or too weak to properly pump blood.
Heart-valve disease: The valves of the heart ensure the blood flows in one direction. Heart-valve disease or damage may cause the heart to work harder to pump the blood. This may weaken the heart over time. Treating some heart-valve conditions may reverse heart failure or improve heart function.
Myocarditis: Myocarditis is most commonly caused by a virus, which is characterised by inflammation of the heart muscle, and can lead to left-sided heart failure.
Congenital heart disorders: The heart, chambers or valves that haven’t formed properly may cause other parts of the heart to work harder to pump blood.
Arrhythmias: Irregular heart rhythms may cause the heart to beat too fast, slow or inconsistently, creating extra work for the heart.
Other diseases or causes: Some long-term diseases like diabetes, thyroid disorders, or chemical imbalances may contribute to chronic heart failure.

Some acute conditions are: allergic reactions, any illness that affects the whole body, blood clots in the lungs, severe infections and use of certain medicines. It is also important to note that the causes of HF differ across countries. In tropical countries for example, parasites can lodge in the heart leading to HF.

24/10/2024

A month for fostering heart awareness

As we observe World Heart Day and Heart Awareness Month this month, it’s essential to recognise the profound impact our health decisions can have on future generations. Our actions will determine whether we can stem the tide of heart disease in South Africa, where heart disease, stroke and hypertension (high blood pressure) remain prevalent.

According to the Heart and Stroke Foundation SA (HSFSA), 215 people die every day from heart disease or strokes in South Africa. Hypertension, a major risk factor for heart disease, affects more than 45% of adults in the country and its prevalence continues to rise.

Ryan Snodgrass, CVD Product Manager for Pharma Dynamics, highlighted the urgent need for a shift from treatment to prevention.

“As the largest supplier of cardiovascular medicine in the country, Pharma Dynamics is acutely aware of the need to shift its focus from treatment to prevention,” he said. “The ESH (European Society of Hypertension) guidelines provide a clear framework for this, underscoring the critical role of lifestyle interventions.”

The recently-released guidelines from the ESH offer a blueprint for creating a healthier future, one that starts with us and extends to those who will follow in our footsteps.

The ESH guidelines provide the following practical steps to prevent, delay the onset and manage blood pressure:

1. Adopt a heart-healthy diet:

Eat more vegetables, fresh fruits, fish, nuts and low-fat dairy products.
Eat less red meat.
Reducing salt intake is crucial, as excessive sodium consumption is closely linked to hypertension. It’s recommended to have less than one teaspoon of salt per day.
Limit your sugar intake by eating less refined and processed foods.
Eat more foods rich in the mineral potassium, such as lentils, squash, prunes, raisins, potato with the skin, kidney beans and soya beans. Potassium is a core element of the DASH (Dietary Approaches to Stop Hypertension) diet, along with calcium, magnesium and fibre. An array of potassium-rich recipes can be found in our new DASH recipe collection, Hearty (www.heartyfood.co.za).
2. Engage in regular physical activity: A minimum of 150 minutes of moderate-intensity exercise per week, such as brisk walking, swimming or cycling, can lower your risk of heart disease. People with high blood pressure are also encouraged to do some sort of weight and resistance training.

3. Maintain a healthy weight: As your body mass index, waist circumference and waist-to-height ratio increases, so does your risk of developing hypertension. If you need to lose weight, a modest weight loss that can be maintained is recommended along with calorie-intake reduction and exercise.

4. Limit alcohol consumption and stop smoking: Both alcohol and to***co are major contributors to heart disease. Limiting alcohol intake and quitting smoking are essential steps to protect heart health.

5. Manage stress: Chronic stress is a known risk factor for hypertension. Incorporating stress-reducing practices such as mindfulness, meditation or yoga can significantly benefit heart health. Ensure that you’re getting enough sleep, so seven to nine hours a night is recommended.

6. Limit exposure to environmental noise and air pollution: Noise and air pollution are considered environmental stressers, and while admittedly difficult to control if you live in the city, those with high blood pressure can try changing the location, timing and type of outdoor activities to reduce their exposure.

Pharma Dynamics has been at the forefront of promoting cardiovascular health in SA. Through an extensive range of cardiovascular medicines and preventive health initiatives, such as the Cooking from the Heart resource, the company aims to empower individuals to take control of their heart health.

“Our commitment to heart health goes beyond medication,” said Snodgrass. “We believe in a holistic approach that includes educating the public about the importance of lifestyle changes. Heart Awareness Month provides the perfect platform to reinforce these messages.”

He highlights that the power to protect our hearts lies within our hands. “By following the hypertension guidelines and making small, but meaningful lifestyle changes, we can reduce the risk of heart disease and lead healthier, longer lives. We encourage all adults to assess their heart health by visiting their GPs annually for a check-up and to make the necessary lifestyle changes. Whether through adopting a healthier diet, increasing physical activity or managing stress, every step counts in the journey to a healthier heart.

“Most importantly, heart health is more than just a medical concern, it’s a legacy we pass on to future generations. The way we live our lives – what we eat, how much we exercise and whether we choose to smoke or drink, can significantly influence the health habits of our children.

“By role-modelling healthy behaviours today, we can help shape the health of our children and the generations that follow.”

Wellness and Vitality Research Centre

25/10/2024

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