1. THE GROWING CHALLENGES OF
HEALTH MANAGEMENT
BASIC FUNDAMENTALS

2. 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.

3. 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.

4. 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).

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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 award
The 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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).

18. 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.

19. 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.

20. 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.

21. 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.

22. 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.

23. 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.

24. 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.

25. 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.

26. THANK YOU