HUNGER GAMES Malnutrition Affects 35% of Mankind Are You in Danger Too? 10

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NOW PLAYING: HUNGER GAMES Malnutrition affects 35% of mankind are you in danger too? 10

20 28 34 55 Risk Factor Chronic An active life at the Our Chef Recommends: Nature´s Medicine Inflammation: Defense amazing age of 102 Spring to Life with a Cabinet: Cayenne Pepper System Gone Rogue Fresh Start Captain Ward Bob Switzer invented Richard A. Amiello Invention of the invented neon colored paint for marked life-saving cork lifejackets safety vests K-15 Kevlar Vest sternum support vest 1865 1930 1975 2008

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For centuries man has been striving to increase security, reduce pain and improve the quality of life.

www.posthorax.com 4 CARDIAC BULLETIN

28 39 62

Pictures (Title and this side): © freshidea/stock.adobe.com © Alenavlad/stock.adobe.com © NOBU/stock.adobe.com © LIGHTFIELD STUDIOS/stock.adobe.com © Paweł Michałowski/stock.adobe.com © dbvirago/stock.adobe.com © Jan Regan CARDIAC BULLETIN 5

IN THIS ISSUE

Live better with Our Chef recommends: 06 34 Spring to Life with a (Grand) Children Fresh Start 7 simple ideas for more harmony in your family Recipes 48 For our recommended menue 10 Now playing: Hunger Games 35% of hospital patients are at risk Nature´s Medicine of dangerous complications due to 55 undetected malnutrition. Cabinett Chayenne Pepper

20 Defense System 62 A Fortunate Stroke gone Rogue of Serendipity Risk Factor The Story of The Posthorax® Chronic Inflammation Sternum Support Vest

28 The Chronicles 67 Subscribe! of Coppola How to get your Cardiac Bulletin An active life at the to your front door amazing age of 102 67 Imprint © LIGHTFIELD STUDIOS/stock.adobe.com

life’s necessities. The endeavor requires our continued goodwill their dependence on the adults in their lives. They need our

love, attention, assistance and guidance. There is no necessity language and acquirehelp the to skills gain to control handle over the equipmenttheir body, for learn testing our such lifestyle treatment. and Young persons are quite aware of

us be honest, you are likely to end up resenting or pro- 6

when someone underestimates your intelligence? Let baby language, haphazard commands or desperate attempts

whatsoever to address children with an incomprehensible

with undisguised annoyance? How do you feel,

to control. They are sentient beings, responsive to love, CARDIAC BULLETIN descending manner or to be ordered around

appreciation, respect and kindness. Stable affection, Would you like to be talked to in a con-

care and patience go a long way. As a result they WITH LIVE BETTER

with respect and dignity. will return our love and respect, rather

Treat your children than incidentally spilling their milk 7 simpleideasformoreharmonyinyourfamily

or interrupting our coffee

break. (GRAND) CHILDREN CARDIAC BULLETIN 7

LIVE BETTER WITH (GRAND) CHILDREN

Allow children2. to decide for themselves and give them choices, Make their environmentwhen possible. safe enough, so they do not get hurt exploring it. Store your breakable items and childproof your home, and you will not have to make them anxious about getting hurt. (When my three year old son insisted on using a knife to help me cook, I used to give him a butter knife and have him “chop” cucumbers for our salad. His feeling of pride and accomplishment was price- less – and today he is a fantastic hob- by chef!) Confidence is an important commodity in any area of life. 8 CARDIAC BULLETIN

3. Designate a certain time period of the day or week, when you allow your little one to decide your actions. Let your child invite you to a place of his/ her choice (their room, the park, the play- ground) and have him/her boss you around as they please for the agreed upon time span. In early years this practise might have you discover a hidden talent of building Legos or playing Crazy bones. Later on, my teenage son used to opt for giving him company watching late-night boxing fights. Now it is my turn for pride, as he taught me to appreciate and gain some knowledge about the sport. Nevertheless, next time you need some cooperation from your child, it might be much easier to obtain.

4. Give your children the freedom to own their - possessions without interference. How would you feel about your hus band/wife constantly telling you to be - careful of the ring or watch they gave you? Does it feel like an infringement on your free dom if someone else tries to tell you what to do - with your things? A child has similar experiences with us. He or she might even resent possessing things, if we cause them to associate posses sions with being controlled. So they destroy their doll or their toy car. Don’tOr they we cutthrow up a piece of their clothing. or give things away, when WE don’t like them anymore - not when we are told to? © blantiag/© mangpor2004/stock.adobe.com CARDIAC BULLETIN 9 5. Determine a stable code of conduct. Life requires understanding to feel secure. An invariable set of basic rules gives your child prediction of the consequences of his/her actions. Do not waver, unless reason requires to make adjustments. Let them know, that in order to do your job well, you need them to respect the things which are 6. important to you. If grown ups did not have privileges, children Give them would lack incentive to competence. grow up. Success in life requires thousands of skills. Observe your children and see what they are trying to do or have an interest in. Embrace their eagerness to learn. Help them to acquire the skill for what they are trying to accomplish. Instruct them, have them practise until they feel confident. Give them praise and let them be in charge of their newly acquired skill and ability. It keeps them active and focuses their interest on their own activities and the world around them, rather than touch screens and virtual realities.

7. Let them contribute to you, the family and others. A child has so much to give! Accept his/her attentions for you. It may start with a funny gesture to entertain you with, affection, the carefree spirit of youth, or a breakfast cooked for you on Sunday morning. (I still count a box full of cutest crafts-objects, a portfolio of precious drawings and paintings, as well as many memories of adorably prepared coffee andprized scrambled possessions!) eggs among my most

Let your children assume responsibilities and praise them (even for the attempt!). Explain how the family works and operates and what is needed from them. Allow them to be in charge of some family necessities. Confidence in one’s value is the only security in life. 10 CARDIAC BULLETIN

NOW PLAYING: HUNGER GAMES

35% of hospital patients are at risk of dangerous complications due to undetected malnutrition.

hen the subject of suffering from hunger comes up, our hearts immediately go out to the 2 billion of the world´s population, who are struggling with malnutrition and the 800 million people subjected toW suffering from actual hunger. We deem them exclusively in third world countries, war zones and cri- sis- or catastrophe-stricken areas. © freshidea/stock.adobe.com CARDIAC BULLETIN 11 © soupstock/stock.adobe.com 12 W from thebody´smuscle-and fattytissues. mode, wherethecellsare suppliedwithenergydirectly nutritional demands,metabolism goesintoadifferent the body. To meet the sudden, drastically increased dous amountofstressandphysiologicaltrauma for Operations andsurgicalprocedurescauseatremen - fer considerable weight loss during their hospital stay. ished whenadmittedtothehospital. About 25% of patients are already under- or malnour- mated, potentiallyleadingtoseriousconsequences. prevalent, thoughoftenundetectedorunderesti - area ofhospitalsand healthcare these problemsare and undesirablechanges in life circumstances.Inthe habits dietary ordisease-related age- means, financial with lack of basic nutritional knowledge, inadequate practice. Furtherinvestigationfoundthesehabitslinked fruit, legumesandwholegrains,havebecomecommon equate consumptionofvegetables,healthyproteins, intake ofsugarandwheatproducts,pairedwithinad- tifaceted. Studieshavedemonstrated,thatexcessive industrially developed countries are complex and mul- tion intermsofhealthandproductivity. ty ofhealthynutrientsareboundtoaffecttheirpopula- zones, asinadequatedietaryhabitsorlimitedavailabili- dition ofhiddenhungercanimpactentiregeographical stunted growth and increased risk of infection. A con- deficiency A can leadtoblindness,lackofzincmayultimatelycause vitamin cases, extreme In bigger. grows of the symptoms,while the coreproblem lingers and the traditional medicalapproachfocussesontreatment unduly prolonged. Unaware of the underlying causes, weakened andrecoverytimeforillnessinjurygets detected malnutrition,thebody´simmunesystemgets lifes usualtravails.Givenacontinuedconditionofun- drive, lackofconcentrationandweaknessjust part of ticed, asmostofustendtoconsidertiredness,lack health consequences. Initial symptoms may go unno- iodine, zincorvitaminA,canpromptahostofserious of essential nutrients,suchasomega3fattyacids,iron, Deficiencies hunger. chronic of form this for cause ous countriesnutritionalimbalancesareapredominant from socalledhiddenhunger. Ineconomicallyprosper- afflicted group. Germanyalonehas1.5millionadultssuffering the of majority the up making sick persons Europeans being at risk of malnutrition, assumption isfarfromthetruth! An additional75%ofclinicallytreatedpatientssuf The causesforundernourishmentandmalnutritionin The World Health Organisation estimates 33 million CARDIAC BULLETIN these types of problems do not exist. Alas, the structures, service social refined established, ithin wealthyindustrialnationsandtheirwell seniors and

CARDIAC BULLETIN 13

Especially in case of older persons under- and malnutrition occur as a consequence. To make matters worse, patients often feel a severe loss of appetite, when undergoing therapy and/or experiencing pain. Since 1974 numerous scientific studies have clearly documented negative consequences and medical complications caused by malnourishment after operations. The EU criticised the high numbers of malnourished patients in European hospitals as utterly unacceptable. One of the encountered difficulties was, that apparently there had never been any internationally standardised definitions for the terms under- and malnutrition. The German Association for Nutritional Medicine took on the project and developed valuable guidelines on the subject, definingunder-nutrition as insufficient bodily energy resources (body fat). In contrast, malnutrition is defined as deficit of specific essential nutrients. As persons suffering from malnutrition are not receiving adequate amounts of energy, proteins and other nutrients from their food intake, the resulting imbalance between nutrient intake and nutrient requirements triggers uncontrolled breakdown of body tissues. In case of quantitative malnutrition, insufficient calorie intake causes loss of fat and muscle mass, weakness and increased risk of infection. Though the manifestations of qualitative malnutrition are not as apparent, its consequences can be just as severe. Lack of specific nutrients may show up in form of pigmentation disorders, gingi- vitis, chapped lips, night blindness, etc.

Both forms of malnutrition have a negative impact on morbidity, therapy, recovery time and hospital stay, mortality and on the quality life for patients.

Scientific research has shown, that a condition of malnutrition triples the number of complications during the hospital stay and prolongs patient immobility. For patients in intensive care, malnutrition significantly increases the risk of mortality. In response to stress and physical trauma induced by surgical procedures and operations, the organism is faced with extraordinary, stren- uous demands on multiple levels. Bypassing the usual modus operandi of generating fuel and energy from food intake, the metabolic “emergency reaction” takes immediate recourse to muscle-tissues and fat reserves, causing weakness and muscle atrophy. Inadequate supply of specific macro-nutrients such as proteins, and mi- cronutrients (vitamins and minerals) slow down wound healing, as the condition interferes with the necessary physiological processes. Therefore nutritional measures, aimed at prevention of complications and enhancement of the healing process, continue to gain importance in terms of perioperative nutrition optimisation. (Perioper- ative means before and after operations.) 14 recovery. to meettheincreaseddemands greatlyenhance normal weight and adequate nutritional supplies molecules for construction of tissues. Therefore tabolism, where nutrients are utilised to build of anabolism. Thisisaconstructivetypeofme - sues, task ofrepairingandrebuildingavarietytis- the response. Yet inflammatory initial necessary the tissues itbuildsacutephaseproteinstopromote for stressfulperiods.Byaccessingmuscleandfat initial catabolicresponseisasurvivalmechanism The insufficiency. heart from suffering patients of proteinafterextendedperiodsbedrestin al causesforcatabolism.Thisexplainstheloss neural stimulationandinfectionsareaddition- tion, malabsorption of food, immobility, reduced loose up to 200g of body fat per day. Malnutri- may patient a bed, to confined when even Thus, to depletingfattytissuesforenergyresources. the bodydonotgoveryfar, theorganismresorts pounds ofmuscletissueperday. loss ofbloodcanlead to breakdownofup2 bolic conditions.Serioussurgicaltraumaor tion. Severeoperationscauseextremecata- pends ontheseverityofsurgicalinterven- tion ofbreakingdownmuscle-andfattissues. cytokines alsocontributetothecatabolicreac- Just liketheaforementionedstresshormones, response. inflammatory the of part as cytokines ject toinjuryordestruction,thebodygenerates tisol andglucagon.Whenbodytissuesaresub- secretion of the stress hormones adrenaline, cor- the sympatheticnervoussystemandaresulting condition getstriggeredthroughactivationof ing downofmoleculesforuseasenergy. The known as tissues andproteins.Thistypeofmetabolismis the energy of carbohydrates for later use), fatty glycogen (glycogenisthebody´swayofstoring of calorie-burningandexcessivebreakdown energy stores, due to an The organismrespondsbymobilizingthebody´s ries ofinevitablephysiologicalstressreactions. mental stressitcausesforthepatient,elicitase- As theminorreservesofactualcarbohydratesin The intensityofthemetabolicreactionde- The actualsurgicalintervention,aswellthe changes arelikelytotriggerserious the bodyandensuingmetabolic Postoperative stressreactionsof actual healingprocess, with its complex CARDIAC BULLETIN requires the bodytobeinacondition catabolism, as it deals with the break -

consequences. uncontrolled increase

Increased blood sugar levels and postoperative insulin resistance are another aspect of the problems induced by malnutrition.

Insulin resistance provides ideal conditions for infections and wound healing complications. It is another consequence of the endocrine stress response and sets in just minutes after the tissue injury occurred. In its usual anabolic (constructive) state of metabolism, the body uses insulin to “open the doors of the cells” and allow blood sugar to be pushed into the cells in order to generate energy. Upon the release of stress hormones due to the surgical impact and catabolic reaction, the insulin receptors of the cells get blocked. The “cell doors” get shut and the blood sugar cannot be pushed into the cells. As a result the sugar remains in the blood stream. The intensity of the insulin resistance depends on the severity of the operation.

After major operations insulin resistance can amount to 90%. Even after intermediate operative stress, the condition can last for more than a week. Scientif- ic studies proved insulin resistance to be the main cause for postoperative complications. Just like with Diabetes patients, postoperative insulin resistance promotes infections, kidney problems, heart insufficiency, muscle weakness, etc. In case of Diabetes, these consequences usually develop over the course of years, while postoperative insulin resistance prompts the same complications within a matter of days or weeks.

Consequently, insufficient food intake without customised nutritional supplementation can be at the root of a host of unwanted complications for all aspects of healing and recovery. These include poor wound healing and may manifest as dehiscence (= gaping of the wound after it had already started closing), delayed cal- lus formation, disturbed coagulation, reduced enzyme production, impaired metabolism of drugs by the liver, respiratory problems, circulatory problems, suppressed immune system, increased susceptibility to infection, severe mental apathy and physical exhaustion. For op- timum healing and recovery the organism needs a suf- ficient quantities of minerals, trace minerals, vitamins, amino acids and energy. Ideally these would be customised for the specific condition at hand and the situation to be remedied. The anabolic reconstruction phase can only com- mence, once all requisite building blocks for wound healing are present and the process has been successfully established. Ideally, this would occur after five to seven days after the surgical intervention. The fat and protein tissues of the body would then begin. If the catabolic phase is unduly prolonged for weeks or months by a condition of malnutrition, the anabolic phase will mirror the extended time period and take that much longer as well. © ChiccoDodiFC/stock.adobe.com 16 CARDIAC BULLETIN CARDIAC BULLETIN 17

Doctors and scientists have developed and clinically tested workable solutions in form of Enhanced Recovery After Surgery (ERAS) concepts.

Numerous studies documented the necessity of nutritional supplementation before and after operations. The fact holds true for all patients, even if they have not suffered from malnutrition before undergoing surgery. Patients who were capable of receiving extra supplies of oral nutrition in addition to the provided hospital diet, showed far better outcomes than patients without nutritional supplementation. The Enhanced Recovery After Surgery (ERAS) concepts have been developed based on the data of extensive studies and research. The pillars of these optimised recovery strategies are improved preoperative preparation, improved anaesthesia procedures, pain management, earliest possible mobilisation and most im- portantly optimised nutrition after surgery. The latter encompasses provision of carbohydrate enriched liquid foods, earliest possible resumption of oral food intake and adequate nutritional supplementation. Nu- merous studies in the field have demon- strated the use of customised liquid foods to lower the rate of postoperative complications by 35%, decrease the time of immobility by 2 days, and reduce mortality by 35%. These numbers also provide evidence for the significant budget relevance of addressing and remedying malnutrition. In addition to the documented health benefits, provision of liquid foods and nutritional supplementation for malnourished patients is also highly cost efficient. Early diagnosis and prevention of malnutrition are essential factors for lowering healthcare costs.

Diagnosis

Earliest possible detection and treatment of increased nutritional risk are essential for a swift recovery of postoperative patients. Doctors have a variety of parameters available to determine a person´s nutritional state: Weight, body mass index, circumfer- ence of the mid upper arm, thickness of the triceps skinfold, blood work, candida skin test, etc. © Sebastian Kaulitzki/stock.adobe.com trition. observable indicators for a condition of malnu- for thewarningsignalslistedbelow. Theyare 7. 6. 5. 4. Pallor 3. Weakness 2. 18 1. Obviouslossofweight.Observethefit If youarecaringforalovedone,watchout 7 Warning SignalsforMalnutrition of severaldays orweeks Dark coloured urineoverthecourse Constant lowbloodpressure Lack ofdrive and bonyhands. Sunken facewithcavernouscheeks a reliableindicatorformuscleatrophy. the mid-upperarmonaregularbasis.Thisis their weight.Measurethecircumferenceof of theperson´sclothingandkeeparecord CARDIAC BULLETIN 6. possible. 5. 4. 3. 2. 1.

ing backintobadhabits. of thegame,thusavoiding thepitfallsoffall- chance ofsuccess,asonealwaysstaysahead ning andshoppinghighlyincreasesthe nutrients. Settingasidetimeformealplan- al supplementsensuressufficientamountsof time. Theadditionofhighqualitynutrition- habits andculinaryenjoymentatthesame able mealplanandachievesensibleeating portion ofcreativity, onecancreateapleasur remedy ofmalnutritionaswellagenerous ons. With specificguidelinesaimingatthe as muchnutritionaldietaryrecommendati- Personal preferencesshouldbeincorporated important componentofpatientcare. underestimated! Thejoyofeatingisan The socialaspectofeatingshouldnotbe ingredients shouldbeofthehighestquality the conditiontheyareappliedtoand combination shouldbecustomisedtomatch the qualityoflifeforpatient.Their combating infectionsandgenerallyincrease function oftheorganism,areeffectivein nutritional balanceforrecoveryandproper specific deficiencies.Theycreatetherequired weight gainandaredesignedtotarget digest. Nutritionalliquidsfacilitateswift readily available,simpletotakeandeasy adequate suppliesofenergyandnutrients,are nutritional augmentation.Theyprovide Liquid foodsareanexcellentsourceof supplementation customisedforthesituation. should becompensatedwithnutritional Lack ofvitamins,mineralsandtrace meals. day aremoremanageablethanlargehearty Several smaller sets of dishes throughout the digestible meals,whichappealtotheirpalate. appetite. Theyshouldbeofferedeasily patients oftensufferfromconsiderablelackof After operationsandexhaustingtherapies adequate energysupplies. nutrient-rich, healthywholefoods,with Make suretoprovideawellbalanceddietof life. be neglected on thewaytoabetterquality of are highlydesirablefactors andshouldnot Good companyandapleasant environment 6 Ways toPreventMalnutrition

© llhedgehogll/stock.adobe.com CARDIAC BULLETIN 19 © NOBU/stock.adobe.com 20 CARDIAC BULLETIN O gerous impactsorinvaders. dan- of effects the off fight to mechanism sault range ofstimuli.Itsoriginalpurposeisanas- these vitalresponses,engineeredtohandlea ger certain mechanisms. Inflammation is one of trig- perceptions or situations physical Specific erarchy of(moreorless)synchronizedsystems. body are partofastimulusresponsedrivenhi- about? degenerative conditions.Whatisallthebuzz type 2 Diabetes, Altzheimer´s and various heart-disease, cancer, metabolic syndrome, most chronicWestern diseases.Thisincludes On aphysiologicallevel,allprocessesinthe DEFENSE SYSTEM DEFENSE SYSTEM inflammation as an underlying cause in cause underlying an as inflammation research hasrevealedlow-levelchronic scientific decades two last the ver GONE ROGUE Risk Factor ChronicInflammation style ithastoexistin. the challengesposedbyenvironmentandlife- tween evolutionary adjustment of the body and last 60yearshavevastlyincreasedthegapbe- gens likebacteria. organism the could easilybetakenoverandkilledbypatho- it, Without inflammation. the swelling and pain as immediate symptoms of heat, redness, cause can flow blood increased protect thetissuesinaffectedareas.The lease chemicalsintothebloodtodefendand bacterial infections,thewhitebloodcellsre- an injury or foreign invaders such as viruses or experiences body the When fire”. on set nite, Exponential technologicaladvancesoverthe ig- “to means “inflammare” term Latin The CARDIAC BULLETIN 21 © staras/stock.adobe.com 22 CARDIAC BULLETIN

©/stock.adobe.com CARDIAC BULLETIN 23

or lack of a better solution, these factors prompt the initial inflammation response into an enforced permanent state. This is when the biochemical Fprocesses connected with it become a major problem. For once it has become chronic, inflammation inap- propriately attacks the body´s own tissues and causes premature aging. It can be triggered by unwanted substances in the body, such as environmental pollutants, herbicides and pesticides, plastics, synthetic chemicals contained in cosmetics or beauty products, nutritional toxins like trans fats, toxins from cigarette smoke, toxins from medication, an excess of fat cells (especially in the belly area), systemic infections, sleep deprivation, lack of exercise and stress.

In some diseases like arthritis, the body´s immune system triggers an inflammatory response, when there are no foreign invaders to fight off. These so called au- toimmune diseases prompt assaults at normal tissues, treating them as if they were infected or abnormal. In other words one or more of the aforementioned harm- ful factors misdirect and lock inflammation into an area. So the initial “special ops unit for foreign impact and invaders” has gotten corrupted and trapped. In case of chronically inflamed joints, the result is arthritis. The increased number of cells and inflammatory substances within the joint cause irritation, swelling of the joint lining and, eventually, wearing down of cartilage (cushions at the end of bones). Chronically inflamed lungs develop asthma, a chronically inflamed brain gets Altzheimer´s. Chronically inflamed arteries are subject to accelerated growth of arterial plaque, leading to elevated blood pressure and heart disease. Thus high blood pressure is an indicator, that one´s arteries are not functioning properly. How does this happen?

Arteries are flexible, elastic tubes with muscular walls, that expand and contract to pump blood through the body. Depending on their location, they must have different capabilities. Elastic arteries are located in the vicinity of the heart. They have a high collagen and elastin content within their wall structure, which enables them to stretch in response to each pulse of the heart. This is how they transform the pulsing blood flow coming straight from the heart into a more or less continuous flow, which is necessary to protect organs and tissues in close vicinity to the heart from dangerous blood pressure highs or -lows. © buritora/stock.adobe.com 24 CARDIAC BULLETIN CARDIAC BULLETIN 25

MUSCULAR ARTERIES Diet, exercise, stress and environmental factors can influence arterial/endothelial health. Muscular arteries are located at a relative A diet high in refined carbohydrates and sug- distance from the heart. Their smooth muscu- ars causes proteins in the blood to become sug- lar structure serves the purpose of maintain- ar-coated. These sugar-coated proteins irritate ing even blood pressure throughout the body (inflame) the lining of the arteries. (resistance arteries). The inner lining of the If the body is deprived from minerals like arteries is called endothelium. Proper endo- calcium and magnesium, as well as nutrients, thelial function is vital to maintain all body such as those found in vegetables, beans, fruits tissues and organs in good working condition. and nuts, arteries loose the ability to dilate. As Endothelial muscle-tone and -action maintain a result they constrict, which leads to a rise in proper blood pressure through adequate dila- blood pressure. tion and constriction of the vascular diameter. Therefore a person´s blood pressure and how Without exercise, blood vessels are eventual- much work the heart has to do, to pump blood ly going to weaken and become stiff, just like throughout the body, depends to a large de- any other muscles. Having high blood pressure gree on the condition of this delicate lining. means, one´s lifestyle is not in tune with one´s It also protects the tissues from various toxic genetic needs. Therefore one must take action substances, regulates the blood clotting mech- to go after these “partisan- turned special ops anism and controls fluid, electrolytes and oth- guys” and implement actions, which enable er substances, which get interchanged between them to return to their original jobs. Fortu- blood and tissues. nately there is a number of simple changes one can make towards lowering one´s exposure to inflammatory agents. 26 CARDIAC BULLETIN

WHAT YOU CAN DO

Tobacco contains 300 toxic substances with a Eliminate tobacco use or exposure, alcohol and negative impact on the arteries, making them medical drugs as much as possible. Nature has sick, causing them to constrict and grow arteri- potent remedies for the majority of ailments. al plaque. These toxins also damage cholesterol and cause it to become abnormal, and thus more Eliminate sugars, diet sodas, gluten, corn, dairy likely to penetrate arterial lining and settle as products and trans fats. To reduce exposure to plaque. For smokers the single most important herbicides and pesticides, buy organic foods as step to take for overall health is to quit. much as your budget allows. “Grass-fed, pasture-raised and wild-caught” are definitely desir- Use natural, non toxic cleaning supplies. Most able attributes for meats, poultry and fish. supermarkets offer healthy alternatives made without chemicals, in case you feel more adven- Supplement your diet with lots of leafy greens, turous, you can find many recipes for effective healthy proteins, organic greens powders, colla- natural household cleaners on the Internet. gen, aloe vera juice, digestive enzymes and high Use air purifiers or air-filters in your home. quality probiotics. A healthy intestinal flora is key Avoid use of plastic for storing food or drinks. for an inflammation free body. Turmeric is a natu- Replace your plastic storage containers with glass ral anti-inflammatory food supplement available products, get stainless steel- or glass bottles for as fresh root, powder or capsules. Its benefits are your water or electrolyte drinks. so many, we dedicated an entire article to the “Golden Goddess from India”. Use water filters or filtration systems for your drinking water, as well as for personal hygiene, Maintain a healthy “sleep hygiene”. Insufficient as the skin is the body´s largest absorption organ. or poor quality of sleep stresses the body and causes production of the stress hormone cortisol. Replace personal hygiene products and cosmetics with natural products from health-shops or With intelligent choices we can build a bridge organic salons. to overcome overwhelming environmental challenges and lifestyle inadequacies. Informed, Seek holistic dental care and make sure you healthy changes can narrow the gap between have no amalgam in your mouth. physical evolution and technological pollution. © Jane/stock.adobe.com CARDIAC BULLETIN 27 © Alenavlad/stock.adobe.com 28 CARDIAC BULLETIN COPPOLA THE CHRONICLES OF THE CHRONICLESOF LIFE EXPECTANCY CARDIAC BULLETIN 29

LIFE EXPECTANCY THE CHRONICLES OF COPPOLA Is reaching the amazing age of 102 really worth the trouble?

In our inaugural Issue of Cardiac Bulletin we Given the determination, good genetics, pro- explored the concept of life expectancy. In- per diet and adequate exercise, we have a fair specting facts and figures, various areas of the chance to outwit (and out-discipline) the decay world, science, medicine and lifestyle aspects, of our physical bodies and negotiate more time we searched for answers on how to achieve a on this Earth. Yet there is still another catego- healthy and enjoyable extension of our life- ry of questions left unanswered. “Why try?” span. And yes, we did find some clues in terms “What for?” “Why on Earth would one want to of lifestyle changes and got some valuable be as old as the hills?” “ What is one to do at a pointers from studies regarding nonagenarians hundred?” and centenarians. “Can it really be worth the trouble?” 30 CARDIAC BULLETIN

o one seems to be exempt from occasionally pondering such thought. Today´s youth-fixated, anti ageing-focused cul- Nture tends to keep our minds locked into a “single story” view, as Chimamanda Ngozi Adichie called it her inspiring TED talk.

We are exposed to a constant stream of me- dia messages, portraying advanced age as un- desirable, associated with cutting back, weakness, illness, lack of fun and aesthetic. How is this a limited viewpoint? Well it inspects life, happiness and well-being merely from the viewpoint of physical youth, depriving us of a large spectrum our existence might otherwise encom- pass. To convey more of what I am referring to, let me introduce you to someone I have been remotely acquainted with for a quarter of a century. Meet Anton Coppola, classical conductor and composer, and yes, uncle of renow- ned film producer Francis Ford Coppola. (You might have gotten a glimpse of “Uncle Anton” in 102 Years old and still not about to retire: the film “The Godfather Part III“, where he was Conductor Anton Coppola featured conducting a scene of an opera.) I saw the charismatic centenarian recently, when his family, friends and fans from New York, as well as local opera lovers turned out to watch the world premiere of his latest composition, the opera “Lady Swan White”, at Straz Center for the Performing Arts in Tampa, Florida. It was as fa- scinating to observe the composer, watching from his box, beholding the body of musicians with unwavering intention, anticipating the shaping of every phrase, as it was to experience the thrill of hearing and seeing the very first rendition of his latest work unfold on the stage. Prompted by his famous nephew, who of course was in atten- dance that night, Anton Coppola had spent the better part of his 101st year writing an operatic score to one of Strindberg´s plays. In his 102nd, he was invited to bring the production to the stage at Straz Center in Tampa. Leading a well conducted life

You certainly have read the numbers correctly. Anton Coppola was born on March 21st 1917 in Brooklyn New York to an Italian immigrant family. In the heyday of silent film, 10 years before the inauguration of Radio City Music Hall, 30 years before television started broadcasting, one had to be quite self-reliant for entertain- ment. Coppola senior, a toolmaker, deemed his sons should all know how to play musical instru- ments. Anton took up studying the piano at age 6 and quickly discovered his passion for music. © peshkova/stock.adobe.com CARDIAC BULLETIN 31

On Sundays the family would gather to enjoy a big meal of pasta and meat, while listening to Arturo Toscanini´s popular symphony radio bro- adcasts. Traditionally they would have soup on Mondays, Tuesdays pasta, Wednesdays a surpri- se, Thursdays pasta, Fridays fish and some light fare on Saturdays. Meals were taken together at the family table.

When his mother took the boy to see an opera he was so taken by the “little man in front of the orchestra, waving his arms, producing this wonderful sound”, he announced that was how he was going to spend the rest of his life. And he has indeed been passionately following his calling to this day. Getting a memorable start by joi- ning the Metropolitan Opera´s children´s chorus at age 10, he entered just in time to participate in the American premiere of Puccini´s fairyta- le opera Turandot in 1927. Under the baton of none other than the revered Tullio Serafin, who would later become the musical mentor of Maria Callas, young Anton got to perform with a most distinguished cast of European singers. Several years later his remarkable dedication and musical talent came to the attention of the conductor Gennaro Papi, formerly Puccini´s favou- rite rehearsal pianist. The Maestro taught him the art of conducting and advised the young man to familiarise himself with playing an orchestral instru- ment. Anton opted for the oboe, “I prac- tised like an idiot”, and proceeded beco- ming the first oboist of the Radio City Music Hall orchestra. After conducting his first opera at age 18, Mr. Coppola went on to lead operas and musicals throughout Ame- rica, following his vocation, working with some of the grea- test singers of the 20th century, such as Mario del Monaco and Ebe Stignani. Con- currently advancing his musical education, he achieved a masters degree in composition. His work, including a symphony, several film scores and the opera Saccho and Vanzetti has touched and inspired audiences all over the world. 32 CARDIAC BULLETIN

During his extensive career, the master has tirelessly striven to nurture and groom younger generations of musicians for professional careers, as he headed the symphonic and opera departments at the Manhattan School of Music. For his distinguished achieve- ments he was awarded a lifetime achieve- ment award from the Puccini Foundation, and the Italian government bestowed him with the honour of Cavalliere Gran Ufficiale. In 1996 Maestro Coppola became one of the founders and musical director of Opera Tam- pa, where his opera Saccho and Vanzetti world premiered in 2001. Having held the post for 17 years, he turned it over in 2012. In a TV inter- view covering the event, the then 95 year old showed a glimpse of his competitive spirit, telling the audience, Toscanini had stopped conducting at 87, Stokowsky at 90, and he intended to beat these records...which he indeed had already accomplished at the time. Asked whether he considered himself a dictatorial conductor, he deadpanned “Is there any other kind?”. Sharp minded and alert, with a height of 5 feet, he commands attention and focus with charisma and keen interest. Having pursued his lifelong passion for music, he succeeded in the career he had always wanted. He has been married to his wife Almerinda Drago, a former ballet dancer, since 1950. They have been living in their apartment on Manhattan´s West Side since 1956. When asked about how they have maintained their loving marriage for more than six decades, Anton Coppola turns out being a realist and a romantic at the same time, offering “Patience - given that indispensable ingredient of fatal attraction of course!” as his recipe for success. A profound love for art and the desire to create and participate in the field of beauty keep the couple engaged with the world, gene- rously contributing to it on multiple levels.

To have a composer conduct his own music at 100 years old has never happened before.

In honour of his centenary birthday in 2017, Opera Tampa staged a two hour concert, featuring the Maestro himself conducting an orchestra and solo singers, performing for an illustri- ous audience, including Oscar winning family members Francis Ford Coppola, his daughter Sophia and Nicolas Cage. © RobertoM/stock.adobe.com CARDIAC BULLETIN 33

Turning the century mark is a rare milesto- ne. Having a composer conduct his own music at 100 years young certainly is a feat, no one has accomplished before. Nevertheless it is no reason for Anton Coppola to retire from his calling. Which brings us back to the premiere of Lady Swan White in February 2019. While the baton had been passed on to another conductor, our Main Man had revised the libretto, cast the show and arrived two weeks prior to the performance. He had attended all rehearsals and spent twelve hours per day in the theatre, just as the rest of the cast. The performance was emotional and magical with a message of love and confidence transcending all evil. At the end of the night, a deeply moved audience and cast emerged from a once in a lifetime experience.

Getting with the times

So, how does one spend one´s time at 101? Well, Mr. Coppola´s days start at 7 am and end at midnight. He works, stays fit walking in the park and has a Vodka Martini at 7 pm. Though we have already covered some of his activities, it is noteworthy that he still occasionally goes to watch operas. Unlike so many of us, the author not entirely excluded, Anton Coppola is not lamenting the loss of past vocal styles and finding the present never quite living up to these. He says he enjo- ys today´s operatic work and can see in which ways it has improved, due to TV and cinema raising people´s expectations in terms of sta- ging and acting. With current performers such as Jonas Kauf- mann and Elina Garancia, Diana Damreau and Kristine Opolais, Maestro Coppola considers opera in very good hands. He favours the gen- re of opera because it encompasses and unites all the arts – literature, music, voice, acting, set design, costume design and many more. Its creation and production require an enormous wealth of knowledge, experience, craft and ar- tistic sense of quality. Ultimately this cannot merely be obtained from books or gleaned from internet courses, or taught in college. Artists of newer generations are shaped by those, who have put in the time, blood sweat and tears and managed to walk the path before them. Traditions are han- ded down by masters. The treasures of wisdom and artistry are passionately sought by aspi- ring performers. The artist Anton Coppola is not about to retire. LIFESTYLE

Our chef recommends

Spring to life with a FRESH START Continuing our culinary trip around the Mediterranean, tracking down the region´s acclaimed dietary habits, we have garnered recipes and flavours from the French and Italian Riviera, where meal times are sacred pillars of social- and family life, and where the flavours of the seasons are celebrated even with the simplest of dishes. We adapted our selections with regard to heart-healthy preparation, making use of the abundant variety of fresh vegetables, herbs and fruit available in late spring. CARDIAC BULLETIN 35 36 CARDIAC BULLETIN

RAW VEGETABLE PLATTER WITH BLACK OLIVE-LAVENDER - TRUFFLE OIL-SPREAD AND TAPENADE

Having forgone breads does not mean one Indulge and explore different colours, flavours cannot enjoy the traditional little some- and textures. From wedges of romaine lettuce, thing served before a meal. On the contrary. endives, scallions, tomatoes, bell peppers, cau- Raw vegetables are so much more than just liflower, broccolini to radishes and carrots, the fit to replace crostini, baguette and all their palette is endless. blood-sugar spiking kin. The high fibre content Match your choices to complement the rest of of vegetables makes them a double D (Deli- your menu. We selected the mildly peppery, cious and Desirable ) carrier medium for fla- juicy stalks of baby bok choy in combination vourful savoury spreads and dips. In Provence with crunchy yellow and red peppers, Belgian they are often served as “Crudites”, neatly ar- endives and cherry tomatoes for scooping up ranged bite size sticks, to start off a summer the delicious spreads. Infused with truffle oil, meal. You can follow the whims of your palate our black olive-lavender paste offers subtle (or settle for what your refrigerator has to of- depth and contrast, while the tapenade bursts fer that day) and compose a different medley with intensity (tapeno is the Povencal term for of choices each time you prepare the dish. capers). © Jan Regan CARDIAC BULLETIN 37 38 CARDIAC BULLETIN

PASSION FOR PASTA? HARDLY ANYONE CAN ELUDE ITS UNIVERSAL APPEAL.

Delicious, comforting and even capable of creat- With adoption of a heart healthy lifestyle we ing a sense of bond or community amongst those largely eliminate simple carbohydrates (such who share it, I would say pasta transcends social as flour products) for the sake of maintaining barriers. Decades ago one of my friends, now healthy blood sugar- and triglyceride levels, as a museum featured cast glass artist, built her well as curbing inflammation. Luckily there are initial clientele of collectors at weekly Sunday a few exceptions to the rule. One of these is pas- pasta dinners in her bohemian apartment. She ta. Due to its very dense consistency, the intes- had learned to cook a simple authentic Marinara tinal tract does not absorb it as quickly as other sauce during an extended Italian art sojourn. carbohydrates. Hence, consumed in moderation, pasta does not tend to spike blood sugar levels Friends, neighbours, collectors and the occa- as much as baked goods or breads. Our chef rec- sional Hollywood celebrity would gather for a ommends using Ronzoni gluten free (made from plate of Marlene’s authentic Penne Marinara, white rice, brown rice, corn and quinoa), Barilla and glimpses of the newest cast glass sculptures. PLUS (made from chickpea, flaxseed, lentil and From a culinary perspective pasta is versatile oat flour), or any other brands of pasta products carrier of aromas and textures, capable of mar- rich in fibre. Given an active, healthy lifestyle, a rying unlikely combinations of flavours. In Italy moderate portion can be enjoyed once or twice it is actually served as an intermediate course a week. With the familiar heart-healthy food between the antipasto and the main protein groups in mind, we opted for spaghetti with dish. sardines, garlic and Cayenne pepper, featuring healthy fats, lean protein and potent herbs and spices in one recipe:

SPAGHETTI WITH SARDINES, GARLIC AND CAYENNE © Jan Regan CARDIAC BULLETIN 39 40 CARDIAC BULLETIN

GRILLED CHICKEN BREAST AND RADICCHIO

Aside from flavouring, there is a little know A cast iron grill pan is ideal for indoor prepa- how on getting grilled chicken breast just ration. The heat should be moderate, certainly right. For a deliciously moist and juicy result, not as hot as for red meat. Once they are done, it is best to use pasture raised (or at least free the breasts should rest a little, just like a roast. range) organic chicken breast. Flattening the This way the juices can settle before serving. meat between two sheets of waxed paper or Oven grilled radicchio with its slightly bitter plastic wrap and gently pounding it, will let it hue is a perfect complement. If you don’t want cook more evenly. It can be marinated in the to include a course of sardine pasta as a first refrigerator for several hours or at cool room plate in your menu, you can prepare ½ of the temperature for one hour. If refrigerated, the recipe without the sardines with just olive oil, breasts should definitely be brought to cool garlic, pepper and parsley as a side dish. room temperature before cooking. © Jan Regan CARDIAC BULLETIN 41 42 CARDIAC BULLETIN

FOUR SEASONS SALAD WITH GRILLED CHICKEN BREAST

As a prominent member of the food group lean proteins, chicken breast is naturally very close to your heart. To keep it interesting and simple at the same time, we suggest to vary the theme. Prepared as given in the recipe on the previous page, grilled chicken breast also tastes delicious when cut in strips and served over a hearty salad with the contrasting flavours of slightly bitter radicchio, walnuts and marigolds, sweet oranges and grapes, pungent shallots, celery and a Dijon vinaigrette. © Jan Regan CARDIAC BULLETIN 43 44 CARDIAC BULLETIN

STRAWBERRIES WITH RICOTTA YOGHURT CREAM

Strawberries are part of the pleasures of spring. Ricotta hails from Italy and is one of the worlds oldest cheeses. Its origins can be traced back to the Bronze age. Made from milk whey left behind after the production of Mozarella and Provolo- ne, it is a much healthier choice than most, as it contains less salt and less fat than other cheeses. Its slightly sweet, mild, nutty flavour and grainy moist texture is equally suited to sweet and savoury dishes. The strawberry mint ricotta dessert is a heart healthy adaption of an Italian classic. The creative alternative surprises the palate by marrying strawberries with fresh basil and turmeric to add a touch of culinary sophistica- tion. © Jan Regan CARDIAC BULLETIN 45 46 CARDIAC BULLETIN

STRAWBERRY COCONUT-MILK SMOOTHIE

Smoothies are a fun way to start the day or easy go to go snacks for those times, when one is crav- ing coffee and sweets in the afternoon. On the quest for a heart healthy diet, we skip most dairy products, so our recipe suggests unsweetened coconut milk for its rich taste and creamy texture. If you prefer, you can also try unsweetened almond milk instead. The added spices and flavours provide an interesting complexity for the palate. For added nutritional value, feel free to include some protein powder of your choice! © Jan Regan CARDIAC BULLETIN 47 48 CARDIAC BULLETIN

RAW VEGETABLE PLATTER TAPENADE

This combination of vegetables and dips has The origin of this type of paste is subject to potential to become a replacement for bread! contradictory claims. One was made by a It satisfies by providing plenty of fibres and Frenchman, others go back to the ancient tempts the senses with a multitude of flavours. Greeks. What matters for us is the enticing in- Bok choy is a rich source of dietary fibre, vita- tensity it adds to simple greens. mins C, A and K, calcium, magnesium, potas- Artichokes are rich in fibre, antioxidants and sium, and iron. Bell peppers are a great source boast strong anti-inflammatory properties. of antioxidants, Vitamin C, B Vitamins, potassium and fibres. Preparation time: 15 minutes

Preparation time: 10 min Ingredients: ½ cup (125 ml) red roasted peppers, drained Ingredients: and roughly chopped 2 stalks of baby bok choy ½ cup (125 ml) marinated artichoke hearts, 1 yellow bell pepper drained and roughly chopped 1 red bell pepper 8 rinsed and pitted Kalamata olives 2 Belgian endives about 12 fresh basil leaves 1 container cherry tomatoes ¼ cup (60 ml) extra virgin olive oil 1 tablespoon capers, rinsed Wash and dry the vegetables. Break the bok 1 clove garlic, chopped choy leaves off the stalk, separate the leaves 1 teaspoon freshly squeezed lemon juice of the Belgian endives, clean bell peppers from freshly ground pepper to taste seeds and cut them lengthwise into sticks. Ar- range all vegetables on a decorative platter Put all ingredients into a food processor or and serve with black olive-lavender-truffle oil- blender. Pulse in short intervals until the spread and Tapenade. mixture is finely chopped. Do not blend it! It should be chunky not smooth. Transfer to a serving dish. CARDIAC BULLETIN 49

BLACK OLIVE-LAVENDER- TRUFFLE OIL-SPREAD

Aside from their legendary culinary status, olives are high in Vitamin E, antioxidants and a source of healthy mono-unsaturated fatty acids. Lavender and thyme provide the charac- teristic French provincial touch and truffle oil a hint of luxury.

Preparation time: 5 minutes

Ingredients:

½ cup (125 ml) black olive paste ½ teaspoon dried Lavender flowers - purchase culinary (food grade) Lavender 3 sprigs fresh thyme 1 teaspoon truffle oil

Put the ingredients into a bowl and stir thor- oughly until the mixture has a homogeneous texture. Transfer into a serving dish. 50 CARDIAC BULLETIN

SPAGHETTI WITH SARDINES, GARLIC AND CAYENNE

Sardines are best when they are packed in olive Preparation time: 30 min oil. It locks in the flavour, keeps the fish moist and belongs to the group of beneficial fats. Ingredients: Spanish and Portuguese varieties tend to have (4 portions) a more intense flavour. They are also available as baby sardines, which have no bones at all. 1 package (12 oz, 340 g) gluten free Spaghetti While its popularity certainly does not match (we like Ronzoni 4 grain, or Barilla PLUS) that of salmon, halibut or sole, the relative- Salt ly unglamorous species boasts an astounding 1/3 cup (75 ml) extra virgin olive oil array of health benefits, warranting a regular 4 cloves garlic finely chopped place in our diet. Fresh or canned, they are 2 cans (300g) sardines (in olive oil) an excellent source of vitamin B12, vitamin 1 bunch Italian parsley finely chopped D, calcium (bone health) and selenium (acts 1 small crushed chilli pepper as an antioxidant); as well as fatty acids EPA Cayenne pepper and DHA, which aid the body in reducing in- 1 teaspoon freshly squeezed lemon juice, or to flammation and thus reduce risk of disease. your liking The high content of omega 3 fatty acids and protein helps to regulate blood sugar levels, Fill a large pot with water, add ½ teaspoon of as the absorption of sugar into the blood gets salt and bring to boil. Add spaghetti and boil slowed down; prevents blood clotting because al dente, as instructed on the package (usually they break down cholesterol and reduce blood about 8 minutes, depending on the grain com- pressure; and support brain function. Studies bination). Drain in a colander. have also shown that sardines promote an increase of immune cells in the body. Since they Meanwhile heat the olive oil in a skillet on me- are small mouthed, they do not contain as dium low heat. Add the minced garlic and stir many toxins as larger fish (such as Tuna). for just a few minutes. The garlic should not Garlic lowers total cholesterol and increases really change colour. Open sardine packages HDL; decreases clotting, lowers blood pressure and add their content to the pan. Use a kitch- and boosts the immune system. (For more de- en spoon or a spatula to separate the sardines tailed information regarding this potent me- into small pieces and stir. If the mixture seems dicinal plant please refer to the article “Unsung too dry, add some olive oil to give it a smooth Hero – Garlic” in Cardiac Bulletin Issue 0.) consistency. Add chopped parsley, crushed Parsley is an excellent source of vitamin C and chilli peppers and Cayenne to your liking, as folic acid (or folate, one of the B vitamins). It well as the lemon juice. Stir and then add the boosts immune function, acts anti-inflammato- pasta. Toss it well with two kitchen spoons or ry and assists in preventing thickening of the tongues, so it can absorb the oil and the fla- artery walls. Regular intake may also help to vours. Transfer portions to bowls and serve. lower blood pressure. Cayenne is beneficial for boosting the metabolism and lowering blood pressure. CARDIAC BULLETIN 51

GRILLED CHICKEN BREAST AND RADICCHIO

Meat from pasture raised organic chickens is For the grilled chicken breast: a clean protein and therefore the best choice. Trim any fat off the chicken breasts. Place If clean is not available, lean is the next best them between two sheets of waxed paper and alternative. Lean protein has less fat, which is pound gently with a mallet to even them out. where the hormones, pesticides and chemicals Transfer to a plate or baking sheet. are stored. So trimming off fat and skin helps Rub the chicken breast with smoked salt, pep- a great deal. per, garlic powder, chilli powder and fresh Radicchio is the perfect vegetable for thyme leaves. Strip the rosemary leaves off the people who have an aversion to greens! It is sprigs and chop them. Sprinkle them over the native to Italy and has burgundy coloured breasts. Drizzle with ½ of the lime juice and leaves with prominent white veins. It is a great a little olive oil. Cover and marinate at cool source of dietary fibre, as well as vitamins C room temperature for about an hour or in the and K. The pigment not only provides a vibrant refrigerator for several hours. Be sure to bring hue, but also powerful antioxidant properties. it to room temperature before cooking. Studies have shown radicchio to help with reg- Preheat a cast iron grill pan at medium heat ulating blood sugar levels, weight control and (chicken needs a lot less heat than steak). liver health. Place the chicken breasts on the grill pan and depending on the thickness, cook for about Preparation time: 30 min 2-4 minutes on one side then 2 minutes on the (+ 1 or more hours marinating time) other side. Pour the rest of the lime juice over the meat and let evaporate. Transfer to a serv- Ingredients ing platter and let it rest for at least 6 minutes (4 portions) before serving.

4 pieces of organic, pasture raised chicken For the radicchio: breast (skin and bones removed) Preheat the oven at 400ºF (200ºC). smoked sea salt Peel any wilted outer leaves off the radicchio freshly ground black pepper and cut it into thick wedges. Place them into a garlic powder ceramic- or glass baking dish and drizzle with fresh thyme olive oil. Sprinkle with smoked sea salt and fresh rosemary pepper and bake for 10-15 minutes until nice- olive oil ly browned. freshly squeezed juice from 2 limes chilli powder 2 heads radicchio 52 CARDIAC BULLETIN

FOUR SEASONS SALAD WITH GRILLED CHICKEN BREAST

This light fare combines lean protein, healthy Cut the radicchio in half and remove the white fibres and beneficial fats. Marigolds are avail- stalk. Break the leaves into bite size pieces. able in fine grocery stores as edible flowers. Remove romaine leaves from the stalk and You can also grow your own in a pot at a sunny break into bite size pieces. spot. Daily watering will not only make them Prepare four plates and start creating the salad grow in decorative abundance, but also pro- with a generous layer of romaine and radic- vide you with a flavourful addition to salads, chio leaves. Arrange the orange pieces on top fish and desserts. and sprinkle celery strips, shallot slices, grape halves and walnuts over the lettuce. Prepare Ingredients: the dressing and drizzle it over the salad. Now (4 portions) place the strips of grilled chicken breast on top and sprinkle with Marigold petals. 4 pieces of grilled chicken breast prepared as given in the previous recipe, cut into strips 1 head radicchio 1 head romaine lettuce 1 navel orange, peeled and cut into bite size pieces 2 celery stalks chopped into thin strips 1 handful green grapes, cut in halves 1 handful shelled walnuts, coarsely chopped 1 shallot thinly sliced Optional: petals from 8 Marigold flowers (if you cannot find these, replace them with sprouts of your choice)

For the dressing: salt pepper red wine vinegar olive oil ½ teaspoon Dijon mustard CARDIAC BULLETIN 53

TWO VERSIONS OF FRESH STRAWBERRIES WITH RICOTTA YOGHURT CREAM

The grocery lists of “The Clean Fifteen and If you choose a grainy, moist ricotta, the con- the Dirty Dozen” we published in the previ- sistency will be more liquid, if your ricotta is ous issue of Cardiac Bulletin leave no question firm, you can use a tablespoon to form scoops about the necessity to buy organically grown and place these atop of the strawberries. strawberries, unless you are growing your own. Part skim Ricotta and plain cow’s or goat Ingredients for the creative version: milk yoghurt are suitable partners. (4 portions)

Ingredients for the classic version: ½ pound (250g) fresh strawberries (4 portions) 1 cup yoghurt 4 tablespoons ricotta ½ pound (250g) fresh strawberries grated zest from one organic lemon 1 cup ricotta 2 tablespoons Xylitol (or to your liking) 2 tablespoons plain yoghurt 1 teaspoon turmeric 1 vanilla bean 1 handful fresh basil leaves grated zest from one organic lemon 2 tablespoons Xylitol (or to your liking) Wash and trim the strawberries and cut them 1 handful fresh mint leaves in quarters. Wash the basil leaves, pat them dry and chop them finely. Put yoghurt, ricotta, Wash and trim the strawberries and cut them Xylitol, turmeric and grated lemon zest into a in halves. Arrange them on 4 dessert plates. bowl. Cut the vanilla bean in half, scrape the Wash the mint leaves, pat them dry and break seeds out and add them to the other ingredi- into small flakes. Sprinkle these over the straw- ents. Stir well and spoon the mixture onto 4 berries. Put ricotta, yoghurt, Xylitol and grated dessert plates. Arrange the quartered straw- lemon zest into a bowl. Cut the vanilla bean in berries as rosettes and sprinkle with basil. half, scrape the seeds out and add them to the other ingredients. Mix well and serve over the strawberries. 54 CARDIAC BULLETIN

STRAWBERRY COCONUT-MILK SMOOTHIE

The nutrients contained in coconut-milk in Ingredients for 2 Portions: combination with our palette of flavours are ideal to satisfy mid afternoon cravings and 1 can coconut-milk hold you over until it is time for dinner. Though ½ pound (250g) strawberries coconut-milk contains saturated fats, 50 % 2 teaspoons bee pollen thereof come in form of lauric acid, which has ¼ teaspoon vanilla extract highly antiviral and antibacterial properties. 1 teaspoon turmeric powder According to recent research has not been grated zest of an organic lemon linked to any negative changes in cholesterol 2 tablespoons Xylitol levels and even seems to support heart health. 2 scoops protein powder of your choice You can experiment with different flavour combinations (cardamom, grated orange zest, Put all ingredients into a blender and mix to a a few drops of bitter almond oil) or add fresh smooth and creamy consistency. If you are us- herbs such as mint or basil for variety. ing full fat coconut milk and want your shake to be more liquid, you can add just a little water before blending. NATURE’S MEDICINE CABINET

Cayenne Pepper BOLD, BEAUTIFUL AND FIERY ALSO KNOWN AS Chili Pepper

ayenne peppers are the fruit of the herbaceous shrub capsicum an- num acuminatum. They are cous- ins to bell peppers and pimientos, jalapeños etc. and part of the nightshade Cfamily - but not related to black pepper (piper nigrum), which yields berries. © Paweł Michałowski/stock.adobe.com 56 CARDIAC BULLETIN CARDIAC BULLETIN 57

he slender, tapering cayenne peppers grow to Native Americans in Mexico and Peru have been a length of about 10 – 20 cm, with a slight using Cayenne as food and for medicinal purposes, curve at the tip and somewhat rippled skin. to aid with stomach aches, gas, cramps and circula- TThe plant originated in Central and South Ameri- tory disorders. In the 15th century, Spanish and Por- ca. Today it is cultivated in subtropical and tropi- tuguese ships, in search of India and the prized Mal- cal climates on every continent. The pods get dried, abar pepper berries, found the Caribbean with the sometimes smoked and then ground into flakes or chilli pepper plants instead. They took their bounty fine powder. The colour palette can vary from green back to Europe and from there brought the plant to to yellow, orange, deep fiery shades of red, reddish various tropical regions for cultivation. Initially the brown or purple. Unlike chilli powder cayenne does powder had become known as Indian pepper, until not contain any other spices, though it may be a Amerigo Vespucci’s discovery - that in fact Columbus blend of different chilli varieties. When the seeds had found a new continent - clarified the plant’s ori- are included in the process, the powders are hot- gin from the New World. Today’s leading cultivators ter. Commercially sold cayenne registers between and exporters are India, Indonesia, Thailand, China, 30.000 and 50.000 SHUs = Scoville Heat Units, Mexico, Nigeria and Tanzania. which is about 10 times more than jalapeños. The Scoville scale was developed by American chemist Herbal-medicinal use around the world Wilbur Scoville in 1912 to determine the degree of spiciness for peppers based on their percentage of In Indian Ayurvedic and traditional Chinese capsaicin content. Capsaicin is a phytochemical con- medicine cayenne’s healing properties are held in centrated in the pepper’s veins and seeds. A sweet high regard, as a remedy for circulatory problems, pepper contains no capsaicin and has a Scoville gas and digestive ailments. Japanese and Korean rating of zero. The hottest chilli peppers rank at healing arts use the potent spice in ointments for 300.000 SHUs. healing frostbite and muscle pains. Leading Amer- ican herbalists consider it to be the single most Cayenne is a popular culinary spice around the important medicinal plant. A well known Western world. Its musky aromatic bouquet and pungent, fi- cleansing and detoxification regimen successfully ery flavour add flamboyance and richness to soups, promotes cayenne in combination with fresh lemon fish, meat, pasta, rice dishes, desserts or drinks. In juice, maple syrup and water. Taken exclusively sev- medicine it is revered as a remedy for circulatory eral times throughout the day for about 10 days, the problems, digestive aliments, joint pain, headache potent mixture is held to assist with detoxification relief, skin irritations and many more. and a large variety of problems including weight loss. Modern evidence based research has con- History firmed the therapeutic value of cayenne pepper for a host of different conditions. The German commis- Capsicum is one of the earliest plants cultivated in sion E has approved cayenne to treat painful muscle the new world and considered the first spice used by spasms, arthritis, rheumatism, neuralgia and lumba- humans. Purportedly the name cayenne comes from go. “kynnha”, the word for pepper in Tupi Indian language. It is not certain whether the fiery chillies lent Health benefits their name to Cayenne, the capital of French Gui- ana, or the peppers were named after the location. Circulatory stimulant: Cayenne is one of the most Nevertheless, seeds and fossils found in ancient cave effective herbal circulatory stimulants. Lack of cir- dwellings bear witness, that chilli peppers (chilli is culation is a common denominator for all disease. the Aztec name for cayenne pepper) have been cul- Lack of fresh blood supply to the sick or injured area tivated in South America for about nine millennia. is equivalent with lack of oxygenation, lack of waste Scientists speculate the compound capsaicin was de- removal, lack of nutrients. Consequently, even with veloped as an evolutionary defence mechanism to a healthy diet, the healing properties of foods discourage animals from eating the pods. 58 remains intheblood. respond to the insulin hormone and therefore the glucose sion intoenergy. Insulin resistancemeansthecellsdonot drawing glucosetotheheart- andmusclecellsforconver- response arrives. case of suspected heart attack and stroke, until emergency in aid first effective an as water warm of glass a in cayenne dic medicine,valueadministeringaheapingteaspoon of useful remedyforpreventionofatherosclerosis. clearing awayartery-narrowinglipiddeposits,making ita tial ofloweringoxidizedfatandtriglyceridelevels the fibrousmeshwhichimpedesflowofblood. activity,fibrinolytic down break to enzymes using process a uid intoasemi-solidform.Intakeofcayenneencourages platelet aggregation, causing blood to change from its liq- powder canreducethepainofanginapectoris. regain theirelasticity. strengthen andcleanthewallsofveinshelpthem canactually pepper of cayenne contents bioflavonoid and C flow. Vitamin blood up freed a by lessened be can pain more prone to herniate, swell and collapse. The resulting Having thinner, less muscular walls thanarteries, veins are ies. Itmayalsoeasethepainofcongestedswollenveins. strength sel ves blood dicates thattheincreasedcirculationimproves hard, hencebloodpressurecanreduce.Research alsoin- ly throughthevesselsheartdoesnothavetoworkas free- more flowing blood With narrowing. from walls the ral vasodilator, itpreventsthemusclesfromtighteningand tiny musclesinthevesselwalls.Thusconsideredanatu- for healing.Itdilatesthebloodvesselsbyrelaxing tion, and thus facilitates the chemical processes necessary flow withinsecondsafteringes- blood the increases and cayenne, thepotentphytochemicalcapsaicin,stimulates where they are needed. One of the active compounds in or herbal remedies cannot easily reach the target areas, Insulin response: Insulin is the hormone in charge of First aid: Leading American herbalists, as well as Ayurve - Prevention ofatherosclerosis:Capsaicinhasthepoten- Prevention ofbloodclots: Blood clots are a result of fiery the muscle, heart the to blood more transporting By CARDIAC BULLETIN and reduces plaquebuildup in the arter- -

Consequently, blood sugar levels can become dangerously high. This is one of the major risk factors for heart disease. Intake of cayenne pepper has been found to increase insulin sensitivity and the required insulin response.

Digestion: Cayenne promotes the production of saliva which is important for digestion and essential for breaking down carbohydrates, as the enzyme responsible for initiating break down of starches into maltose is contained in saliva. The spicy powder also stimulates secretion and flow of enzymes and gastric juices, which aid the body to metabolize food; relieves constipation and reactivates a sluggish gastrointestinal tract.

Anti-irritant properties: Studies have found that intake of cayenne pepper stimulates alkali- and mucus secretions and particularly gastric mucosal blood flow which may assist the prevention and healing of ulcers.

Weight loss: Research documented that if eaten for breakfast, cayenne pepper creates less appetite, thus facilitating decrease of calorie intake. It burns fat because it has metabolism boosting properties and normalizes glucose levels.

Anti-inflammatory: Cayenne is one of the key anti-inflammatory foods, capable of soothing inflammation and bloating resulting from allergies, food sensitivities and infections.

Detox support: Capsaicin cleanses the body by triggering the production of a powerful substance called nitric oxide, which helps opening up the capillaries. This allows the cells to dispose of bacteria, waste and toxins and helps to eliminate acidity.

Cold and flu remedy: Cayenne is a great source of vitamin C. As the body cannot make or store this vitamin, it is essential to consume foods containing this nutrient on a regular basis. The spicy powder also contains beta carotene and antioxidants. It supports the immune system and helps with breaking up congestion and mucus.

Antifungal properties: Studies have provided evidence of cayenne being active against 15 fungal strains including Candida. (Candida is a type of fungus existing in the body for purposes of food absorption and digestion. A bad diet can cause excessive growth of Candida fungi, creating cravings, hormone imbalance, joint pains digestive problems, skin irritations and a weak immune system.) © dule964/stock.adobe.com 60 be veryinvigoratingstartofyourcaffeine-freeday. to a glass of warm water with some maple syrup can kick-start the body’s metabolism. A teaspoon added the body. peppers, as these induce perspiration and help to cool a remedyforgingivitis. tures tobeappliedthegumswithawaterpick,as and arthritis,whenappliedasanointment. legs fromdiabetes,lowerbackinjuries,rheumatism after surgery, painfromnervedamageinthefeetor have also documented cayenne pepper to relieve pain ishes, asitcannotbetransportedtothebrain.Studies pletes substancePandthesensationofpaindimin- location ofthepain.Thecompoundcapsaicinde- enne caneffectivelydistractsensorynervesfromthe brain fromanylocationthroughoutthebody. Cay- ical inchargeoftransmittingpainmessagestothe Substitute forcaffeine:Asastimulant,cayennecan Diaphoretic: People inhotclimatesconsume Oral health:Herbalistsrecommendcayennetinc- Joint andnervepainrelief: Substance P is a chem- CARDIAC BULLETIN genetically strongandnon-toxic. purchase originalnon-hybridseeds,becausetheyare would liketogrowyourownchilliplants,seek its healingproperties.Ifyouhaveagreenthumband ically grownproducts,asoverheatedcayennelooses treat skinirritations,soremusclesandtension. the stomach. Creams are available for topcial use to tinctures over capsules, as the former do not impact ternal use.Leadingherbalistspreferrecommending ex- and internal for available are herbs beneficial er variety ofcayennetincturesincombinationwithoth- hottest extracthasabout300.000heatunits.Agreat capsules or tincturesofvariousconcentrations.The crushed redpepper. Providers ofherbalremediessell called sometimes is it flakes into ground When time. small quantities,asittendstolooseitspungencyover der shouldbestoredinadarkcontainerandbought at supermarkets or health food stores. Cayenne pow- Whichever you choose, it is important to buy organ- Fresh, driedorpowderedchillipeppersareavailable Availability CARDIAC BULLETIN 61

Nutrition information Cayenne gives zest to soups, seafood, meats, rice, The main active ingredient capsaicin gives cayenne pasta, curries, stews and other spicy dishes. It features its spiciness and numerous medicinal properties. A prominently in many hot sauces, pickles, seasoning variety of bioflavonoids provide rich antioxidant qual- blends and the famed Spanish chorizo sausages. ities. The peppers contain about twice as much vita- Some chefs prefer to use whole cayenne peppers, as min C as citrus fruits, as well as vitamins A, E, C, B6, these do not have a dominant flavour of their own, K, manganese and potassium. and thus lend themselves to raising the heat of a dish People have different tolerance levels for cayenne, without altering, but subtly enhancing the existing so it is better to start on a low gradient and work to- flavours. wards a higher tolerance. Aztecs used to flavour bitter chocolate with cayenne Culinary use – how to add some spice to your life. and then coat thinly sliced vegetables and herbs with Bold, beautiful and fiery, cayenne pepper quickly the mixture. In Mexico it gets sprinkled over fresh conquered a special place in many popular cuisines fruit to add some Latin passion to the sweetness. On around the world. Its smoky bite continues to inspire cold winter days cayenne can provide extra warmth Indian, Thai, Chinese, Mexican, Peruvian, American, when added to hot chocolate. Middle Eastern, African, Spanish, Italian and South- For delicious, heart-healthy and easy recipes featur- ern European cooks to infuse our meals with a portion ing cayenne, please refer to the article “Our chef rec- of temperament. In fact, the pungent note of capsa- ommends” in this issue. icin has been found to induce increased production of endorphins (feel-good-hormones), literally making the world a happier place for those who choose to savour its bite. © dbvirago/stock.adobe.com A FORTUNATE STROKE 62 CARDIAC BULLETIN The storyofthePosthorax SternumSupportVest OF SERENDIPITY CARDIAC BULLETIN 63

What do one of the world’s foremost heart surgeons and a habitual entre- preneur / competitive extreme-sportsman have in common? And how might this affect you? Well – let’s just say for one, they must both be able to face and master life-and-death situations without flinching, and they must have a healthy appetite for challenge. As for the rest, please allow us to take you to the Caribbean island of St. Maarten, where our story begins. 64 CARDIAC BULLETIN

t started out with Dr. Lars Svenson, one of for assisting patients and doctors with conquering the world’s leading heart surgeons of the re- these problems. Mr. Epple brought that sketch back nowned Cleveland Clinic in the United States, to Europe and took on the challenge of develop- buying one of the most high profile racing ing the Posthorax Sternum Support Vest, based on yachts at the time from Jürgen Epple, habitual Dr. Svenson’s idea. A strong, innovative entrepre- Ientrepreneur and competitive extreme-sports- neurial spirit, honed by having built a successful man from Austria. Entering Heineken regatta, the brokerage firm in Austria, developed remunerative most prestigious sailing competition of the Amer- investment strategies and having engaged in ex- icas, with Paragon, a three hulled vessel capable treme sports, came in handy when engaging in the of pleasing even the most passionate maritime task at hand. thrill-seekers, the two adventurous spirits joined forces and, while conquering the elements at sea During the initial phase he was collaborating with together, became friends. Needless to say – they the Institute of Biomechanics at the University of won the trophy. Vienna. The first step was construction of a thorax model with sensors measuring the pressure exerted Mr. Epple at the time had been contemplating to from within the body when breathing or cough- leave the field of financial business, as he had a ing. Then a prototype vest was placed around the desire to engage in an activity focused to benefit thorax model, with sensors indicating the exact mankind in a more immediate way. A conversa- amount of counter-pressure to stabilize the wound tion of sharing professional experiences at a St. area. During this stage Mr. Hujber the “Austrian Maarten island bar provided the necessary spark. Astro-taylor” (today in charge of manufacturing Dr. Svenson happened to mention the problem the product) was brought onto the team. He had of sternum infections after open heart surgery. acquired valuable experiences some years earlier, Separation of the patient’s breastbone with a saw, when collaborating with a cardiologist in construc- for purposes of allowing the surgeon access to the tion of a vest measuring Astronauts’ heart rates heart, is part of the procedure and potentially pre- during Space Shuttle/Challenger flights to the Mir cipitates a host of complications bound to impede Space Station. Together they faced and overcame or unduly prolong proper healing of the sternum many challenges. Whether one observes his actions (breastbone). Osteoporosis, diabetes, other wound or engages in a conversation, the common denom- healing problems, as well as the mere necessity to inator and driving force with any of Mr. Epple’s breathe and cough can pose severe risks of lethal activities appears to be a thorough disagreement infections for patients. with the status quo paired with a strong ambition The seasoned surgeon drew a sketch on a nap- to use the laws of physics in favour of the cause he kin, jotting down what he thought was needed is applying himself to. CARDIAC BULLETIN 65

After building, testing, improving and fine-tuning applied and observed on actual patient groups in about thirty prototypes, the product reached its relevant leading medical centres. Overall Mr. Epple final version. and his team succeeded in achieving 13 non-indus- One of the crucial tasks at hand had been deter- try funded clinical trials at prestigious hospitals in mining just how much extension the vest had to al- 7 countries, proving the workability and demon- low, and where it had to stop. Flexible hyper-exten- strating the outstanding value of the Posthorax sion-stop-mechanisms were developed and placed Sternum Support Vest time and again. on the front of the vest. If fitted correctly, these allow a desirable flexibility of 1-1.5 cm. Exten- CITY OF VIENNA AWARD sions exceeding these measurements get stopped – the healing fracture is therefore guaranteed to The first trial was done at Hietzing Heart Center be stable. The support cushions change the angle in Vienna headed by Dr. Michael Gorlitzer and its of- and transfer the internally created pressures. great success was recognized by the City of Vienna, They prevent gaping of the two bone parts and fric- awarding the Innovation prize of the City of Vienna tion between the surfaces of the bone. (Even light for 2009 to the Posthorax Patient Care Model. friction creates heat, which promotes the growth of Today the product is distributed to and success- bacteria, hence leading to the dreaded infections.) fully used by leading hospitals in more than 30 Their ergonomic shape was developed to guaran- countries on 4 continents. Its application has saved tee maximum comfort and functionality. Women’s many lives by significantly reducing the number of cushions are shaped specifically to accommodate sternum infections, reducing patient recovery time, the anatomy of the breasts while redistributing avoiding re-operations and contributing to reduc- the pressures generated by respiratory activities, tion of hospital time, thus minimising risk and sudden motions etc. A special bra was created to saving financial resources for healthcare institu- be inserted into the vest, to avoid any pull from the tions and patients alike. Compassion and care are weight of the breasts on the healing thorax halves. some of the most essential qualities in any human endeavour. Posthorax is committed to improving With the final version at hand, the next step was the quality of life for postoperative patients and for getting heart surgeons’ attention and presenting anyone who wants to make a change towards high- the vest as a workable solution for increasing the er level of postoperative care for self or others. speed of the bone healing process, prevention of infections and decreasing the duration of patients’ P.S.: Aside from their impressive professional hospital stay. Clinical trials are essential in the field accomplishments, both Dr. Svenson and Mr. Epple of evidence based medicine, as they statistically have continued garnering regatta trophies and show the value of a product, not only in theory, but breaking maritime speed records! EMBRACE YOUR HEALING PROCESS Advertisement

POSTHORAX™ Sternum Support Vest The innovative device, created with a passion for excellence, clinically proven to reduce pain, protect your sternum, optimise recovery, prevent complications, minimise risks and decrease hospital time. CONFIDENCE CONQUERS

Posthorax 2 Peveril Court 6-8 Phone : +43.720.505345 International London Road, Crawley E-Mail : [email protected] United Kingdom RH10 8JE West Sussex Web: www. posthorax.com EMBRACE YOUR IMPRINT Cardiac Bulletin is published quarterly (4 times a year) by Posthorax International Ltd. HEALING PROCESS 2 Peveril Court 6-8 London Road Crawley RH10 8JE United Kingdom For more information visit www.posthorax.com or send an email to [email protected]

Texts & Contents: Susanne Epple

Graphic-Design: Andreas Balatka

Pictures: stock.adobe.com Jan Regan (S 34-47) Posthorax Archives (S 62-65) and posthorax.com

Printed in Austria by: Gutenberg Druck Druckhausstraße 1 2540 Bad Vöslau NEXT ISSUE RELEASE: Disclaimer: Any contents of SEPTEMBER 2019 this magazine, such as any text, graphics or images are for information purposes only Inspiring readers to create their own personalised and do not constitute medi- lifestyle for long-term heart health. cal advice. No content of this POSTHORAX™ magazine is intended to be a substitute for medical advice, Providing innovative, relevant information, Sternum Support Vest treatment or diagnosis. Always curated to orientate, educate and implement seek the advice of a physician game-changing ideas and steps with focus on what The innovative device, created with a passion for excellence, clinically proven to reduce pain, with any questions you have CAN be done to reshape life towards a healthier, regarding a medial condition. happier future. protect your sternum, optimise recovery, prevent complications, minimise risks and decrease hospital time. This magazine does not recom- mend or endorse any specific tests, physicians, products, CONFIDENCE CONQUERS procedures, opinions or other information mentioned in this magazine. Reliance on any SUBSCRIBE TO YOUR information provided in this magazine is solely at your own risk. You should consult CARDIAC BULLETIN a doctor/physician before be- ginning a program of exercise. Discontinue your exercise Simply subscribe at: www. cardiacbulletin.com session immediately if you or by e-mail: Posthorax 2 Peveril Court 6-8 Phone : +43.720.505345 experience any pain, dizziness [email protected] International London Road, Crawley E-Mail : [email protected] or discomfort. United Kingdom RH10 8JE West Sussex Web: www. posthorax.com 68 CARDIAC BULLETIN © LIGHTFIELD STUDIOS/stock.adobe.com