Friday, March 23, 2012

March 23, 2012

PART 2 Not Being Single Single...



... because even if you stay out late and guzzle questionable quantities of tequila, procreation does mess you up The Problem with Single Parenting ­ A three-part series What kind of mother stuffs her face with Death by Chocolate while her hungry, angelic kindergartener watches on?
IF I COULD pick two questions that no one would ever be allowed to ask me again, they would be ­ What's Up and What's New. I mean, I'm a stay-at-home mom of a hyperactive five year old and I write between interruptions and things flying over my head ­ what do you think is up (the decapitated doll or a precious gadget)? As for the What's New question (both questions, actually) ­ I find that it's the single people who keep asking me that. I ask them what could have possibly changed in a couple of days or a week ­ since we spoke ­ and they go `Oh well, you'd have to be single and out on the town to know' or some such thing. I defensively retort `But I am single' and they go `Right, but you're not single single.' Oh.
Just when I thought getting left out of the cool circles ended with high school. What am I supposed to do now? Join the flashmobbers? It seems to be all the rage these days.
Maybe I should get out there (some place where the paparazzi is) and randomly dance (solo) till the cops drive me out with a lathi. I'd b popular in no time. Also, people would fanatically circulate my Youtube clip adding such things as `Crazzzzyyyy chick' and `Heheheeeeee' and I'd be sorted.
And like everybody else on Facebook, I'd finally be able to add `Living life to the fullest' on my bio.
That should teach the single single people for not granting me admission into their seemingly exclusive club.
Turns out, I'm wrong. That's not what they're saying at all. What they mean is ­ You can hang out with us but you have to forget all parental responsibilities while so doing or it could get in the way of all the fun. I get it ­ parents (well, mothers mostly) as a group, have earned notoriety for being obsessive-compulsive worriers who can't enjoy even the extremely rare night-out with friends without making panic calls home to check on what the children are eating, if they've been tucked in bed and even sneaking in an I-miss-you call or two when no one's looking. I know, it can be a bit much.
I make it a point not to do it when I'm out with friends ­ after all, my parents do a splendid job with the offspring so it's not like I'm abandoning her with the babysitter from hell. So I even manage to have a great time staying out late, guzzling questionable quantities of tequila ­ all the while taking care not to bring up the child, home or parenting in conversation. And suddenly ­ when it's respectably late (a bit after one in the night) ­ it feels like I've even convinced them, you know? I've stayed out late without doing the annoying mom thing. It's a special moment for me because I'm now about to be anointed single single.
And just as I begin hearing the coronation music in my head, someone decides it would be a good idea to have dessert. One look at that piece of Death by Chocolate and the music (in my head) comes to an abrupt halt. I have a vision of the five-year-old hungry for chocolate cake. And as all people in visions, she's dressed like an angel and standing on a cloud. I immediately feel a tangible pang of guilt ­ what kind of mother stuffs her face with Death by Chocolate while her hungry, angelic kindergartener watches on? Oh, I'm no mom. I'm more like the evil step-mother.
It's only a piece of chocolate cake and there's nothing rational about how I'm feeling but procreation (and The Brothers Grimm) does mess you up ­ it's like you're no longer allowed to enjoy chocolate, animated movies, dipping your feet in a pool or toratora rides unless you are accompanied by the child in question. Sigh. I can't keep up ­ being a parent and being single single are both full time occupations ­ it seems. I give up ­ I'm done living two separate lives. What I need is The One ­ except, I have no idea how to find him given that I'm mostly stuck indoors. Maybe the next time some single type calls and asks me `What's uuuuuup' and `What's new', I'll just put on my scary spinster voice and say `I'm looking for The One'.
That should shut him up.
Judy Balan is the best-selling author of Two Fates --The Story Of My Divorce
March 23, 2012

HOW TO HOOK YOUR GUY TO COOK

 HOW TO HOOK YOUR GUY TO COOK
 
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  1. Lure him into the kitchen with interesting promises and make him watch all the food shows that show men cooking. He is bound to get inspired and start cooking.
  2. Tell him your friends say that couples cooking together is a great bonding exercise (it really is). That should get him into the kitchen. Make it fun for him by looking for recipes that he likes.
  3. Get him into the ‘masculine’ spirit of things, with recipes that have beer, vodka, brandy and wine as ingredients. And gift him cookbooks written by men.
  4. Whatever you do, don’t criticise his food. Shower him with so many compliments, he wouldn’t have a reason to stop trying. Drop hints later on about how he could improve.
  5. Turn the kitchen into his den. Have things that he loves around him – the iPod with his favourite music and a mini bar.
  6. Select recipes that take minimal time. He won’t be able to excuse himself saying that they are complicated.
  7. Make sure you praise him in front of everyone. Especially in front of his mother. It will get tough for him to back out then.
  8. If nothing else gets him into the mood, do what British chef Jamie Oliver suggests: withhold sex until he starts cooking.
March 23, 2012

Where No Man Has Gone Before...



...And done what women did before, that is, ventured into the kitchen to cook and serve food `I realised my wife wasn't interested in learning newer cuisines, so I started cooking'

A FEW WEEKS ago, on a nippy winter night at a friend's place, around 10 of my buddies and I were indulging in the happy mix of great alcohol, good appetisers and enjoyable conversation that is a staple of fun weekends ­ when the tenor of the evening abruptly changed. The host brought out the star of the party ­ a pahari mutton dish he had cooked himself ­ and a few minutes later, I noticed two very different reactions to the food. While the women all served themselves and moved back to resume their interrupted conversations, the men stood around congratulating the cook, trying to dig into the dish to guess the ingredients, suggesting modifications and requesting for the recipe. And I thought to myself, what's happening here? When did men start to love to cook? And when did women lose interest?

THE INCREASING TRIBE 
Look around you. Chances are, you'll find this happens more often than you think. While men from previous generations prided themselves for not being able to even boil water, today their urban counterparts are not just turning on the gas, but cutting, dicing and slicing their way to culinary heaven ­ from making quick staples for dinner to elaborate meals, to exotic dishes from the last foreign country they visited. Vicky Ratnani, head chef of fine dining restaurant Aurus in Mumbai, who also hosts Gourmet Central on NDTV Good Times, agrees. “At a recent cooking workshop that I hosted, nine out of 25 participants were men ­ guys who had busy lives and high-pressure careers ­ but were taking time off to learn the skill,“ reveals Ratnani. And what about the women?
Well, most seem to enjoy spending time away from the kitchen. Quite a few of them, especially between the ages of 20 to 30, don't know how to cook at all. And even if they do, chances are that they have too much on their plates and hence little or no desire to slave away in the kitchen. “Given a choice, I would not cook, I'd rather use my time to manage the house well, juggle the demands of my career, look after the overall needs of my husband and maintain a social life,“ says Indra Desai, a 35year-old corporate lawyer.
Most urban career-minded women are increasingly delegating daily cooking chores to the domestic help. And most of their partners are okay with the arrangement.
Abhishek Singh, a 20-something business consultant, loves trying out new recipes. He picked up the nuances of cooking while in college when he stayed as a paying guest. Now married, he has no issues with the fact that his wife doesn't know how to cook. Says Singh, “She will learn. Cooking together will be a great bonding exercise.“
This is a departure from the days when prospective grooms could never imagine a homemaker who didn't know how to rustle up a delicious, hot meal.
So now, the old proverb `the way to a man's heart is through his stomach' should actually read: the way to a woman's heart is through her stomach.
The tables have turned, and how.

WOMEN DESERT THE KITCHEN
When it comes to cooking, chances are your family fits into one of these three categories: 1. The woman is still the only one who is cooking.
2. The woman knows how to cook but doesn't; the domestic help does.
3. The woman, the domestic help and the man cook in turns.
Now, a new category appears to have emerged: The woman cannot/does not want to cook, but the man does, often with the domestic help as a back-up.
The reasons for this change are a shift in attitudes. As we all know by now, women are now working long hours in offices. They have a space beyond the kitchen to feel `acknowledged.' According to lifestyle management expert Rachna K Singh, chauvinism is giving way to sensitivity. “Our society is evolving and that means an equal division of chores





Men who cook are hot.
Any man in sync with his feminine side is attractive, like a man with a baby
between the genders, one of which is cooking. This happened in the West a long time ago,“ explains Singh. We are living in the age of cooking democracy, she adds. “Some women were never taught to cook by their mothers ­ no family recipes handed down ­ so they don't know where to begin. Others don't trust their cooking abilities enough to feed their spouse, and some others want their men to cook for them.“
And why is it that women are not enjoying the process of cooking as much as before? To begin with, did they really enjoy it? “Ask your mothers. A lot of them wouldn't really have enjoyed cooking but were forced to. Now that women have all the freedom, they'll cook only if required,“ says Dr Syed Mubin Zehra, social analyst and author of Sexual and Gender Representations In Mughal India.

THE MEN ARE LOVING IT 
 The men who like to cook also love talking about it, says Sunil Tickoo, CEO, WG Hospitality, (who was helpful for our shoot at Q'BA Restaurant and Bar in Delhi as always), who loves putting together burgers and other dishes for his children.
Back in office, a usually aloof colleague unleashes a long monologue about his fascination with baking, which began at the age of 14 by watching his aunt churn out brownies by the kilo.
Now, he gets up at the crack of dawn to bake if he has someone coming over, and has specific knives, pans and other cooking equipment that no one, except him, is allowed to use.
Model Aman Singh goes a step further saying he is a kitchen Nazi who has to be in control.
So yes, men can not only boil water now; they can do much more!

IT TAKES all kinds of men to make their maiden forays into virgin territory: the kitchen.
Here's how to recognise one species from the other:

THOSE WHO LOVE TO COOK. PERIOD
Like model-turned actor and now TV host (Chakh Le India) Aditya Bal who got into the kitchen and began to cook out of boredom and frustration (his film career wasn't taking off). Bal cooks every day.
Though he admits it can get monotonous, experimentation keeps him going. He can easily cook for 25 to 30 people (maybe with just one helper) and has had 80 people over for an `only biryani' meal.

THOSE WHO PLAN IN ADVANCE AND EXECUTE
Unlike a majority of women, for whom making food is a chore that needs to be done in the minimum possible time, for these men it is all about the fanfare and planning.
“After carefully drafting out a menu, I start getting the ingredients from the vendor. A day before, I keep most basic things ready so that on the night of the party, I just have to throw everything in,“ says Bal. He doesn't go by the book and aims to keep getting better at the art of cooking.

THOSE WHO COOK TO IMPRESS THEIR WOMEN
Men who cook are hot. Nobody's contesting that. A man who cooks for you on a date has already won you over halfway through. That's why even in Bollywood movies, a lot of male characters now don aprons and are seen cooking vigorously to hook the ladies. Hrithik Roshan did it for Katrina Kaif in Zindagi Na Milegi Dobara, and Imran Khan served a plateful to Deepika Padukone in Break Ke Baad. And that's how actor and now TV host Aly Khan (who hosts Foodistan on NDTV Good Times) started to cook.
“I was in England for my studies and my mother would get masalas when she would visit. I used the ingredients to make food to impress women. They would often flip. Food is a sensory thing. And it is very romantic ­ laying the table, putting together a dish and then tasting it together. Also, the first bite (exploring the flavours) is like having an orgasm.“ Khan's love of cooking has continued. Whenever he's in India, he whips up special rice or gosht and loves to contrast textures.
What is it that makes a man who cooks so attractive? Any man in sync with his feminine side is attractive, like a man with a baby, explains Rachna K Singh. “A man who cooks seems like someone who is sensitive and compassionate. He has evolved.“
Advertising professional Rita Jha, 28, agrees. “Men can fix a car and build a campfire. Shouldn't they know how to feed you without ordering in food? That says a lot about their life skills. We think `this guy is going to ease our burden when we are together'.“
Also, most women find the idea of a man understanding spices, playing with them, and then finally sampling the mix (yes, the same way Aaron Eckhart dips his finger and tastes food straight from the pan in the movie No Reservations) sensual.
“He seems like he'll be good in bed.
Most times, it is true,“ winks Jha. Is he a glutton or a gourmet?
For many men, cooking is therapeutic and is done when they have spare time

THOSE WHO SAVOUR THE FLAVOUR AND CREATE IT
A lot of men learn cooking because of sheer necessity. They live away from home on their own and start cooking for practical reasons.
Consultant Abhishek Singh, for instance, began to cook when his sister and he were staying away from their parents. “I wanted to have good food. Eating out costs money. So I started to learn Continental and Chinese (that I love). I started to mix and match flavours and seasonings and come up with newer dishes. As a result, my cooking has become spontaneous and experimental“.
Unlike Singh, other men begin wielding knife and skillet because they feel they can beat their female partners at their own game.
Engineer Ajay Malhotra, 34, for instance, began to cook, when he got bored of the staple dal-chawal and the `special' butter chicken his wife fed him. “My wife also works and I realised she isn't that interested in experimenting or learning newer cuisines, so I started cooking and realised I was good at it.“

THOSE WHO COOK ON SPECIAL OCCASIONS 
 Some men only like cooking for parties. Or Sunday breakfast.
Others cook fancy stuff ­ meat or crab or whatever's the flavour of the season. Cooking is therapeutic and is done when they have spare time.
With beer in hand, friends or family for company, and a special occasion to celebrate.
Chef Vicky Ratnani says, “Lots of my friends are holiday cooks. They end up taking one to two day workshops on local cuisine when they are abroad.“ Actor Aly Khan, too, has a lot of holiday cooks as friends.
“When we meet in London or Dubai, we hang out in the kitchen and bond over cooking,“ he says.
Disclaimer: If the article seems a little skewed, it could be because the writer is a woman who doesn't want to ever cook.

WHY DO MEN LOVE COOKING?
  • Cooking has become a `hobby' for most men. Because they do not have to cook, they choose to cook.
  • Men find it relaxing and gentle.
  • A kitchen is not a place they are expected to be in and hence it becomes their comfort zone. There are no expectations and they are not being judged (women/wives are only too happy to see them in the kitchen).
  • It may sound clichéd but men need results. Cooking is productive. Someone eventually ends up eating and that is satisfying.
  • Cooking is all-involving. It invokes all the senses of a person.
  • The person cooking has total control. To see something from inception to conclusion is more satisfying than a lot of work in office. It is also creative. Men can steer things their way and that's why they want to chop, cook and garnish everything themselves. A lot of them don't like the wife to interfere too much.
  • Cooking has immediate benefits: All the men interviewed for the story said that the part they loved most about the process was when people enjoyed eating the food they had cooked. There is nothing more satisfying than that.
  • With male chefs on TV channels, cooking has become macho.
  • Men love to experiment and they can be adventurous in the kitchen.

Not many cook by the book.

To get some action. Celeb cooking confessions V J-ACTOR Gaurav Kapoor and composer-guitarist Ehsaan Noorani are from the `I love to be in the kitchen' tribe. Gaurav says he's a `spatula wielding jedi' in the kitchen. And Ehsaan `makes the meanest porridge and lays the most impeccable table.' They got chatting at Thai and Chinese restaurant Dragonfly and Vong Wong, Mumbai.

When did you start to cook?
Gaurav: I started pottering around in the kitchen as soon I could reach up to the gas stove.
Ehsaan: If making tea counts, then in America as a student! Later I managed instant noodles and the odd edible omelette.
Your first kitchen memory...
Gaurav: Put water on boil to check evaporation and went out to play.
Mum went in after an hour and began to shriek.
Ehsaan: I used to help my aunt Parvana wash dishes. She said the woman in my life will thank her.
You favourite part about cooking?
Gaurav: The confluence of flavours and ingredients.
Ehsaan: That the most basic ingredients in the right combination can create such complex and incredible dishes as well as huge disasters! Exactly like making music.
Your favourite cooking instrument?
Gaurav: A sharp knife. Also works well if people don't like your food. Ehsaan: I'd have to say the ladle.
Cooking is...
Gaurav: Peaceful.
Ehsaan: Cathartic.
The most and least time you've taken?
Gaurav: 90 minutes for a chicken recipe my mum gave me.
Ehsaan: I take ages to make tea. But I cook porridge quickly and am fast at pouring milk into cornflakes.
Do you dominate in the kitchen?
Gaurav: I'm like Genghis Khan, my knife is my sword.
Ehsaan: I'm just glad I'm not burning and breaking things! Does a man cooking attract women?
Gaurav: Sure does (winks).
Ehsaan: My cooking hasn't attracted any woman! Even if it did, the moment she probably tasted the dish, that attraction vanished! What if your woman can't cook?
Gaurav: It's absolutely fine.
Ehsaan: Doesn't make her less attractive.
Would you rather be in the bedroom or the kitchen...
Gaurav: Anywhere, as long as it's steaming.
Ehsaan: Multi-tasking.
A word on vegetarian cooking.
Gaurav: I was dating a beautiful girl, who was also a chef and a vegetarian. It was heaven on a plate.
Ehsaan: It's tough. There's a fine line between raw and cooked vegetables though mine are always raw.
March 23, 2012

How To Break a Weight Loss Plateau



 

How To Break a Weight Loss Plateau

No matter how efficient your diet workout plan, you are bound to face a weight-loss plateau at one point or another. But this does not mean your weight-loss trend has ended, it just means that you need to revise your tactics and fitness routine to overcome the plateau and march ahead! Plateaus are common to anybody who's been on the same diet and exercise plan for a while, which is the reason why you don't see the same results you saw at the beginning. But its not as scary or difficult to break a weight-loss plateau. I've done it myself, and I hope my ideas help you achieve similar results too!

If you've been eating right and exercising often, you've probably been losing weight at a rate of one or two pounds a week. However, as you get closer to your optimum weight, it usually gets harder to lose those last few pounds. You know you've hit a weight-loss plateau when more than two weeks have gone by without any further change in your weight, while you still follow the same regimen! So the first thing you do is review your exercise and diet program, find out what's wrong and make amendments. Here are a few helpful tips to get you started!

Calorie Intake Diet Plan

As you probably know by now, weight loss is all about burning more calories than you consume. A healthy diet plan is the key, so take a quick look at your food diary, or calorie intake.

Are you still keeping track of your portion sizes, even when you are dining out?

Are you spacing your meals 5 times a day, dividing daily calories between them?

have you recently sneaked in a few desserts or carbs thinking a piece won't hurt much?

Did you switch to sodas instead of smoothies and juices?

Are you drinking enough water?

It's easy to increase your calorie intake accidentally, without realizing how its hurting your diet plan. Remember, a baked potato is not the same as a baked potato with gravy and butter! So evaluate your calorie consumption; maintain a diet hhournal if you like; if you are well above the 1200(for women) or 1500 (for men) daily intake level, you can try cutting down a couple hundred calories to break the plateau. However, if you are consuming less than 1,200 calories a day (1,500 for a man), your body may react by slowing down as a self-preservation measure. This means your metabolism rate falls, and you actually store fat even if you're working out consistently.

Eat 5-6 Times a Day

Eating frequently stabilizes your blood sugar, controls appetite, and keeps your energy up. Ideally, you shouldn't go more than three or four hours without eating something. Doing so slows down your metabolism and makes your body burn fat at a slower rate. Its also very important to eat as soon as you feel hungry - a feeling of hunger indicates your blood sugar is going down, which makes you prone to craving simple sugars. If you're eating three times a day, eat five. If you're already eating five times, upgrade to six or seven. This doesn't necessarily mean you'll be eating more food; just divide your calories into 6 meals per day.

Change Your Workout Routine

"Variety is the spice of life" - and this phrase has never been so fitting to a scenario! It takes your body only four weeks to get used to a workout. Once something becomes a routine for your metabolism, plateaus are likely. The most efficient way to break a plateau is to shake up your fitness routine. Join an online weight loss program to find tips and ideas. If you are used to 30 mins on the treadmill, switch to cycling or kick-boxing instead. Instead of the stationary bike, switch to a Stepper or a StairMaster. Instead of running in the morning, try playing tennis or do some swimming. Use Interval Training to your advantage; short bursts (30-60 sec)of higher-intensity movement, such as sprint, followed by 2-3 mins of less intense exercise like walking. Adding variety to your routine brings revs up your metabolism as the body has to start adapting again.

Add More Strength Training

If you are not doing so already, start lifting weights now to boost your metabolism and burn fat! When you lift weights, your muscle fibers suffer tiny tears which causes you to experience soreness for a couple days; but that's normal. Changing the intensity of the workout helps a lot. Try to increase the amount of weights you lift, or try changing the number of repetitions. Whenever you change a workout routine your body responds by burning fat. Do not under-estimate the power of strength-training; in fact, lifting weights is the best way to conquer that plateau! Challenge your muscles with harder exercises or heavier weights (every 6 to 8 weeks), adding a set of risers during your step class, increasing the incline on the treadmill, the duration of your run/walk, etc… It might seem tough at first as your newly challenged muscles will have to work harder but you will burn more calories and build more lean muscle mass in the process. its always a good idea to do a combination of resistance machines and free-weights, as the latter can increase metabolic rate as high as 10% in one session!

Avoid Alcohol Drink Water

Thirst is often mistaken for hunger. Every time you feel the urge to snack, drink a glass of water first and see if the urge goes away. Coffee, tea or any other juices count as liquids, but add an extra glass of pure water for each cup of coffee you drink, as caffeine tends to dehydrate the body. Research has shown that BMR increase by 30%, not to mention flushing out all toxins from your body, thereby contributing to a healthy weight-loss. As for Alcohol, it is a known fact that it contains a large amount of calories, but hardly any other nutrients, and some of these are also high in sugars and fat. Alc0hol consumption slows down the fat burning capabilities of the body, as the body focuses on using the alcohol (a toxin) as fuel, rather than burning fat for energy. Alc0hol also dehydrates, which in turn, makes you hungry. So avoid Alc0hol, and start drinking more Water instead!

Losing weight requires exercise or controlled caloric intake . While its important to maintain a healthy weight, do not get obsessed by it! And plateaus in weight loss are very common; it only means you've successfully lost a lot of weight, and now you need to re-evaluate your regimen to overcome the weight-loss plateaus. Just follow the simple steps above, and you'll be ready to drop a couple more sizes the next time you buy yourself a new dress!


Tuesday, March 20, 2012

March 20, 2012

Aaradhya Amitabh Bachchan Granddaughter

Saturday, March 17, 2012

March 17, 2012

These five habits can save your heart — here’s how

 

These five habits can save your heart — here's how


According to hard data, five harmful habits herald the coming of heart disease. These five are smoking, being inactive, carrying too many pounds, eating poorly, and drinking too much alcohol.

Alone and together, they set the stage for artery-damaging atherosclerosis and spur it onward. They do this by deranging metabolism and changing how cells and tissues work. They also disturb the markers of health we worry about so much: blood pressure, cholesterol, and blood sugar. All too often, the end result of these five habits is a heart attack, stroke, peripheral artery disease, valve problem, aortic aneurysm, or heart failure. And the damage they cause isn't limited to the cardiovascular system, but extends to the kidneys, bones, and brain.

What can making better choices do for health and longevity? Consider this provocative finding from the Nurses' Health Study. Nonsmoking women with a healthy weight who exercised regularly, consumed a healthy diet, and had an alcoholic drink every other day were 83% less likely to have had a heart attack or to have died of heart disease over a 14-year period, compared with all the other women in the study. The results were almost identical in a similar study in men. In these two studies, more than two-thirds of all cardiovascular events could be chalked up to smoking, excess weight, poor diet, and drinking too much.

Five strategies for change

Count on these five white knights to protect your heart, your arteries, and the rest of you. They will make you look better and feel better. And it's never too late to start.
  1. Avoid tobacco. Smoke from cigarettes, cigars, and pipes is as bad for the heart and arteries as it is for the lungs. If you smoke, quitting is the biggest gift of health you can give yourself. Secondhand smoke is also toxic, so avoid it whenever possible.
  2. Be active. Exercise and physical activity are about the closest things you have to magic bullets against heart disease and other chronic conditions. Any amount of activity is better than none; at least 30 minutes a day is best.
  3. Aim for a healthy weight. Carrying extra pounds, especially around the belly, strains the heart and tips you toward diabetes. If you are overweight, losing just 5% to 10% of your starting weight can make a big difference in your blood pressure and blood sugar.
  4. Enliven your diet. Add fruits and vegetables, whole grains, unsaturated fat, good protein (from beans, nuts, fish, and poultry), and herbs and spices. Subtract processed foods, salt, rapidly digested carbohydrates (from white bread, white rice, potatoes, and the like), red meat, and soda or other sugar-sweetened beverages.
  5. Drink alcohol in moderation (if at all). If you drink alcohol, limit your intake — one to two drinks a day for men, no more than one a day for women.

Making change

If you have one or more habits that are working against you, now is as good a time as any to set a course for better health. How? The American Heart Association recommends "cognitive behavioral strategies for promoting behavior change." They aim to help you think more positively about yourself as you make healthy changes. Here are some of those strategies:

Set goals. Having specific, achievable goals is a key strategy for successful change. Goals that involve behaviors ("I will eat three servings of whole grains a day") tend to work better than physiological goals ("I will lower my cholesterol").

Track your progress. With all the things you have to remember each day, it's hard to know whether you are meeting your daily goals. Data from dozens of studies show that self-monitoring is an important attribute of successful changers. You can track your exercise or pounds lost with a notebook, a computer, a smartphone, or an invention of your own.

Motivation. Changing a habit or behavior is easier if you have a good reason for doing it. Motivation can be something big, like getting in shape for a walking trip with a grandchild, or small, like fitting into a slimmer suit for a wedding. The more personal the motivator, the better.

Get support. Starting a change isn't nearly as challenging as sticking with it. Support from family, friends, a doctor, or someone else — even from an online community — can provide feedback and encouragement, especially when you are feeling low.

You don't need to aim for a complete transformation all at once. Small changes in diet, exercise, or weight can make a big difference in your health. Setting goals you can realistically achieve, and then meeting them, can snowball into even bigger improvements.


March 17, 2012

10 things you should know about heart disease


 

10 things you should know about heart disease


Women and men share most risk factors for heart disease — including high cholesterol, inactivity, obesity, high blood pressure, and smoking — but there are some gender differences in its development, symptoms, and prognosis. Compared with men, women have a greater chance of dying from heart disease; they're twice as likely to have a second heart attack within six years of the first; and they don't fare as well after bypass surgery or angioplasty. On the other hand, women tend to develop heart disease about 10 years later than men.

What explains these disparities? The later onset of heart disease is probably due in part to the protective effects of ovarian estrogens, which are not lost until menopause. But because women develop heart disease later, they're more likely to have coexisting conditions, like diabetes, which can complicate treatment and recovery. Women also have smaller hearts and coronary vessels, which can make surgery more difficult. And some standard diagnostic techniques, such as coronary angiography, may be less effective for women.

Angiograms are good at finding cholesterol-laden plaques that bulge inward from vessel walls, forming blockages inside the arteries. That's how plaque typically forms in men. In women, it tends to grow more uniformly throughout the vessel walls and therefore may be undetectable by an ordinary angiogram. Heart attacks in men are usually caused by plaque rupture, which produces a clot that shuts down blood flow in an artery. Women are more likely to suffer from plaque erosion — they shed smaller pieces of plaque that generate a host of smaller blood clots. Moreover, women are more likely than men to have microvascular disease — narrowing or stiffening of the microscopic tributaries of the coronary arteries. These microvessels, too small to be seen on an angiogram, nourish the heart muscle and keep it healthy. Even when the main coronary arteries remain clear, microvascular disease can restrict the heart's oxygen supply, producing angina and other symptoms.

There's a lot more to learn about how women's hearts differ from men's, how they age, and how they respond to diet, exercise, stress, and other influences. Research is ongoing — so stay tuned. In the meantime, here are 10 things you should know about women's heart risks and how best to manage them.

1. Unfavorable cholesterol

. The cholesterol (blood lipid) risk factors for heart disease are somewhat different in women than in men. A low level of "good" HDL cholesterol (below 50 milligrams per deciliter, or mg/dL) is a greater risk for women than elevated "bad" LDL cholesterol (the biggest lipid-related risk factor for men). High triglycerides (over 150 mg/dL) are also a greater risk factor for women, especially women with a waist measurement of 35 inches or more. Total cholesterol is less important than another number — the total-cholesterol-to-HDL-cholesterol ratio (total cholesterol divided by HDL cholesterol). The optimal ratio for women is less than 3.2. Risk in women is also associated with non-HDL cholesterol (total cholesterol minus HDL), which should be less than 130 mg/dL. What to do. Have a fasting lipid profile every five years. If your cholesterol levels need improvement, lifestyle changes come first — exercise, not smoking, weight control, and a nutritious diet that includes plenty of fruits, vegetables, and whole grains. Depending on your level of risk, your clinician may also recommend a medication (see "Medications you may or may not need").

2. The role of inflammation.

Cholesterol is not the only indicator of heart disease risk. Evidence that inflammation plays a role in the formation of artery-clogging atherosclerosis has put a spotlight on C-reactive protein (CRP), a substance the body produces in response to infection and inflammation. Now there's a test for blood vessel inflammation called high-sensitivity CRP, or hsCRP. The Women's Health Study found that women with high hsCRP were about twice as likely as those with high LDL cholesterol to die from a heart attack or stroke. And women with normal LDL cholesterol but high hsCRP were at greater risk than those with elevated LDL and low hsCRP. As a result of such findings, the hsCRP test is now often used to estimate the likelihood of a heart attack. What to do. Healthy women with no known risk factors for heart disease don't need an hsCRP test. Nor do women at high risk who are already being treated. However, if you have normal cholesterol but other risk factors such as high blood pressure or a family history of heart disease, an hsCRP test might serve as a "tiebreaker" to help you decide whether to take a medication. Insurance usually covers the cost.

3. Blood pressure control.

In both sexes, high blood pressure, or hypertension, damages the cells lining the coronary vessels and sets the stage for inflammation and plaque development. An optimal level is less than 120/80 millimeters of mercury (mm Hg). Up to age 55 or so, women are less likely to have high blood pressure than men. After that, their blood pressure typically rises more sharply than men's, and by age 70, about 80% of women have hypertension. What to do. If your blood pressure has crept above the optimal level, try lowering it with lifestyle approaches such as weight loss, increased exercise, moderate alcohol (no more than one drink per day), cutting back on salt, and following a healthy diet. If your blood pressure is 140/90 mm Hg or higher, your clinician may recommend a medication, usually a thiazide diuretic. (For more information, visit www.health.harvard.edu/womenextra.)

Heart disease prevention targets for women*
Risk factors Targets
Lipids, lipoproteins
Total cholesterol Below 200 mg/dL
HDL cholesterol Above 50 mg/dL
LDL cholesterol Below 100 mg/dL
Triglycerides Below 150 mg/dL
Non-HDL-C (total cholesterol minus HDL) Below 130 mg/dL
Blood pressure Below 120/80 mm Hg
Body mass index (BMI) 18.5-24.9
Waist circumference (measured at navel level) 35 inches or less
Alcohol intake 1 drink or less/day
Exercise (moderate intensity, such as brisk walking) 30 minutes/day**
Sodium intake Less than 2.3 g/day (about 1 tsp. salt)
*If you already have or are at high risk for heart disease, your target numbers may be different.
**Women who need to lose weight or sustain weight loss should aim for 60-90 minutes per day.


4. The need for exercise.

More than 50 years of research has shown that the more physically active you are, the lower your risk of heart disease. In one study of postmenopausal women at risk for cardiovascular disease, those who were fit (able to jog at a rate of 5 mph or perform the equivalent) had a lower rate of heart attacks, strokes, and death — regardless of body weight — than those who were not fit. Exercise promotes many beneficial changes in the heart and the coronary arteries, including increased antioxidant activity and improved function of the endothelium (the cells lining the coronary arteries). It can raise HDL levels and lower triglycerides, changes that are especially important for women. It also helps ease mental stress — a risk factor for high blood pressure and thus heart problems. What to do. Apart from not smoking, exercise is probably the single most important thing you can do to reduce your risk for heart disease. For a list of resources on increasing activity and improving fitness, go to www.health.harvard.edu/womenextra.

5. Differences in symptoms.

Both women and men may experience angina, the classic sign of heart disease, which causes chest pain, a cold sweat, nausea, and other symptoms. But women are more likely to report several less dramatic symptoms as well, including general discomfort, exhaustion, or shortness of breath under stress or during daily routines. Women are also more likely to experience Prinzmetal's angina, which occurs at rest (usually at night) and is caused by a spasm in a coronary artery. In both men and women, chest pain or pressure is often the first sign of a heart attack; arm pain, shoulder pain, and sweating are also common and unisex. But women are more likely to also complain of fatigue, nausea, back pain, dizziness, and palpitations. One study found that 84% of women (and 76% of men) experienced prodromal symptoms — early, heart-related warning symptoms (chest pain, arm and shoulder pain, shortness of breath, and fatigue) in the year before a first heart attack. What to do. The lesson here is, if you feel unusually tired, achy, or short of breath, check with your clinician to make sure it isn't heart disease.

6. Depression and the heart.

The links between the mind and heart health are hard to quantify, but most health experts agree that psychological factors can contribute to cardiac risk. One of the most significant for women is depression. In the Nurses' Health study, depression was associated with an increased risk of fatal heart disease, including sudden cardiac death, even after correcting for other risk factors (including high blood pressure, high cholesterol, smoking, obesity, and inadequate exercise). It's not only that depression promotes heart disease; a heart attack can cause depression, which in turn raises the risk of a second heart attack. One way depression is harmful is that it can discourage a woman from taking care of herself — from exercising, avoiding cigarettes, eating well, and taking medications. Direct biological mechanisms may also be involved, including increases in inflammatory responses and blood clotting. What to do. If you're having a difficult time emotionally, your heart health is among the many reasons to consider seeing a mental health professional. Get a referral from your primary care clinician, or find a therapist through the National Alliance on Mental Illness, www.nami.org, 800-950-6264 (toll-free), or Mental Health America, www.nmha.org. For a list of mental health providers who accept Medicare, go to www.health.harvard.edu/providers.

7. Sleep and the heart.

Poor sleep is associated with high blood pressure, atherosclerosis, heart failure, heart attack, stroke, diabetes, and obesity. In one study, middle-aged women who got no more than five hours of sleep per night over a 10-year period had a 30% greater risk for heart disease than women who averaged eight hours. Inadequate sleep has also been linked to coronary calcium, a component of atherosclerotic plaque. Another cardiovascular risk is a sleep-disrupting breathing problem called sleep apnea. And blood levels of several inflammatory markers (CRP, interleukin-6, tumor necrosis factor–alpha, and others) increase with poor sleep. What to do. Try to get seven to eight hours of sleep a night. If your sleep is chronically disturbed or inadequate or you often feel sleepy during the day, talk to your primary care clinician. Or, you can start here: www.nlm.nih.gov/medlineplus/sleepdisorders.html.

8. Assessing risk.

For many years, experts have relied on a risk-assessment tool based on data from the Framingham Heart Study that estimates the risk of having a heart attack in the next 10 years by taking into account age, gender, smoking, cholesterol levels, and blood pressure. A measure known as the Reynolds risk score also takes into account hsCRP and family history and has improved predictive ability, especially for heart attacks in women. In one study, the Reynolds model reclassified into higher or lower risk categories nearly half of the women judged to be at intermediate risk by the Framingham model. What to do. To calculate your Framingham risk score, go to www.health.harvard.edu/heartrisk. If your risk is moderate — 5% to 20% — consider getting the hsCRP test, then reassessing your situation with the newer Reynolds model, which you can find at www.reynoldsriskscore.org.

9. Medications you may or may not need

. Statins have become the treatment of choice for improving cholesterol levels. These drugs lower LDL, slightly boost HDL, and slightly lower triglycerides, by amounts that vary depending on the statin. Statins are an option if your cholesterol remains high despite lifestyle changes. But they're not for everyone. They may cause troubling side effects — especially muscle aches and, rarely, liver problems. And although they've been shown to reduce the risk of cardiovascular events (including fatal heart attacks) in women who already have heart disease, it's not clear whether women with high cholesterol but no symptoms of heart disease can also benefit. Other medications that target cholesterol levels are available and may be more appropriate in some circumstances. What to do. Talk to your clinician. If you have high triglycerides and high LDL, a class of drugs known as fibric acid derivatives may help. If you have low HDL cholesterol, one option is niacin, which both increases HDL and decreases LDL and triglycerides. Niacin usually must be given at a relatively high dose and monitored by a clinician.

Aspirin is a question mark for women. A daily aspirin has been shown to reduce the risk of a first heart attack in men, but the Women's Health Study found more equivocal results for women. Daily aspirin helped prevent ischemic stroke (the most common type), and it was somewhat effective in preventing heart attacks among women ages 65 and over. But for women under age 65, regular aspirin use was no better at preventing heart attacks than taking a placebo. Clearly, aspirin isn't a miracle worker, and it's not entirely benign either. Gastrointestinal bleeding and hemorrhagic stroke are risks of regular aspirin use. What to do. Talk to your clinician about the risks and benefits of aspirin for you. And keep in mind that a healthy lifestyle can be far more effective than aspirin in preventing heart attacks and strokes.

10. Improved diagnosis.

The standard approach for assessing cardiac symptoms starts with electrocardiography (ECG) — at rest and on a treadmill (stress testing) — and may progress to coronary angiography, an x-ray that outlines any blockages in the coronary arteries. But ECG can miss heart disease in women, and angiograms can fall short, as noted earlier. What to do. Nuclear stress testing and stress echocardiography are more reliable than ECG and are available in many centers. Also, some women may need two other tests: intravascular ultrasound, which captures cross-sectional images of the artery walls, and coronary flow reserve studies, which measure blood flow in response to increased demand, often revealing whether the microscopic vessels in the heart wall are supplying it with enough blood. Both tests can be performed during angiography.


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