Keeping Nutrition and Fitness at the Heart of Vascular Health

As the world moves to an endemic stage, recent studies have pointed out the rising risks of new heart problems due to the pandemic. With growing uncertainty around heart health data, what can the general public practice to minimise further risks to their vascular wellness? Against this backdrop, healthcare practitioners must play a more active role in ensuring the public is aware of the importance of nutrition and diet management.

Alex Teo, Director, Research & Development and Scientific Affairs, Asia Pacific, Herbalife Nutrition

As the world turns a page on the pandemic, much is still unknown on the full implications of the Covid-19 virus and its health impacts in the long term. For example, “long Covid1” is an emerging phenomenon

1 https://www.bbc.com/news/health-57833394 that has brought about anxieties over the pandemic’s largely undiscovered long-term effects. Recent studies show that this virus could increase the risks2 of cardiovascular diseases (CVDs), particularly among people with pre-existing cardiovascular conditions or lifestyles that are not conducive to good vascular health.

In Asia, this is a concerning development given that CVDs were already the leading cause of 10.8 million deaths3 in 2019, or approximately 354 per cent of the total deaths in the region.

Amidst this landscape, how can consumers maintain or boost their vascular wellness? The shift in focus towards preventive care such as choosing a healthy lifestyle with balanced nutrition that promotes heart health, regular check-ups and maintaining a good relationship with a healthcare

2 https://www.nature.com/articles/s41591-022-01689-3 3 https://www.jacc.org/ doi/10.1016/j.jacasi.2021.04.007?_ ga=2.51021292.412519287.1648615111697237784.1648615111#bib2 4 http://ghdx.healthdata.org/gbd-results-tool. professional (HCP) are some of the primary measures that can help.

According to the Herbalife Nutrition Myth Survey5, consumers also want and rely on credible and accurate information from HCPs and nutrition companies when it comes to differentiating between nutrition myths and facts. Hence, HCPs can play an influential role in raising awareness on nutrition and lifestyle options for health risk prevention.

Here are some aspects for consumers and HCPs to look into when it comes to maintaining a healthy heart:

General nutrition philosophy

When it comes to nutrition for heart health, the ideal calorie consumption should comprise 40 per cent carbohydrates, 30 per cent protein, and 30 per cent healthy fats, coupled with 25 grams of fibre and adequate hydration – around eight glasses of water per day.

While a dietary pattern of fresh fruits, vegetables, lean protein and whole grains

5 https://www.herbalife.com.sg/apacnews/press-release/ nutrition-myth-hcp/

provide a good daily dose of vitamins and minerals, other natural molecules such as omega-3 fatty acids, nitric oxides, and flavanols have beneficial effects on vascular health.

Nitric Oxide

Although still largely unfamiliar among the general public, the importance of the molecule nitric oxide is critical in supporting good heart health. Nitric oxide is a molecule that helps all the cells in our body to communicate with each other. Despite being a simple molecule, nitric oxide is an important biological regulator and therefore a fundamental component in many fields of physiology and medicine.

A component of our arteries and other organs, the natural molecule restores arterial elasticity and promotes vasodilation, which means the widening of blood vessels resulting from relaxation of the muscular walls of the vessels. With an intake of 3 grams or more of arginine, which can be found in protein-rich foods such as nuts, fish, meats, dairy, and multigrain, we can increase the amino acid, which gets directly converted into nitric oxide.

Flavanols

Flavanols, which are naturally occurring compounds found in plants, can support cardiovascular health by lowering blood pressure, and improve nitric oxide production and arterial function.

Flavanols are found in foods like berries, cocoa (dark chocolate), kale, and tea to name a few sources of high concentration.

To profit from flavanols found in cocoa, it is recommended6 that cocoa flavanols be consumed daily from sources such as cocoa powder (2.5 g),

6 https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j. efsa.2010.1792 dark chocolate (10 g), and/or cocoa extract (200 mg). For health-conscious individuals, selecting chocolate products with less sugar and fat would allow them to reap maximum benefits from cocoa flavanols.

Similarly, studies have shown that drinking green or black tea may have beneficial effects on blood pressure7 in people with pre-and hypertensive ranges. Furthermore, tea consumption can benefit people with type 2 diabetes8 , which contributes to a higher risk of heart disease and stroke.

Get your heart active

Identifying people with existing or potential vascular risks should be followed by sharing with them tips on the importance of exercise and

7 https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6567086/ 8 https://www.medicalnewstoday.com/articles/tea-anddiabetes#summary

Omega-3

Omega-3 is helpful in maintaining healthy vascular performance due to its ability to reduce inflammation throughout the body. Inflammation is often responsible for the occurrence of heart diseases and strokes as it tends to restrict blood flow through the vascular system.

Foods like fatty fish (salmon, mackerel, and tuna), flaxseeds, walnuts, pumpkin seeds, and soybeans are high in omega-3 fatty acids. Not only is fish a great substitute for foods like beef, which is high in saturated fat, the omega-3s also help to support a healthy cardiovascular system by helping to lower triglyceride levels.

The consumption of plant-based omega-3 fatty acids supplements is useful for vegetarians, as these are primarily found in fish.

suggesting the right kind of exercises and duration. For instance, the American Heart Association9 recommends 150 minutes or more of moderate-intensity aerobic workouts or 75 minutes of intense aerobic exercises per week. Depending on the person, one can also choose a combination of both. The World Health Organization10 (WHO) also recommends aerobic exercise as the ideal form of physical exercise.

The aerobic exercises focus on repetitive and patterned movement of muscle groups such as legs, shoulders, and arms. The most popular aerobic activities11 include swimming, jogging, walking and dancing etc. HCPs can educate patients on the benefits of exercise such as lowering blood pressure, strengthening of muscles leading to superior oxygenation, weight management, lowering of stress and

9 https://www.heart.org/en/health-topics/high-blood-pressure/changes-you-can-make-to-manage-high-blood-pressure/ managing-blood-pressure-with-a-heart-healthy-diet 10 https://www.who.int/dietphysicalactivity/global-PArecs-2010.pdf 11 https://www.who.int/dietphysicalactivity/global-PArecs-2010.pdf increase in presence of HDL cholesterol. Complementing these exercises with adequate nutrition and food intake is also crucial to enable one to keep up with one’s heart health endeavours, by providing the necessary dietary support needed to fuel an active lifestyle.

Role of healthcare professionals

With the added threat of Covid19 related cardiovascular risks, the importance of an active lifestyle becomes even more important. By advocating a lifestyle that is active and focused on the right nutrition, HCPs can bring about a transformation in the way people approach their vascular health. Medical facts and health resources need to be conveyed to the general public in an easyto-understand manner. Caregivers can also identify people who are at a higher risk by looking at their parameters such as lifestyle, food habits, existence of heart problems, diabetes and the individual as well as family health history.

Multi-sector collaborations can also go hand in hand with ongoing efforts to raise public education. For example, Herbalife Nutrition has formed collaborations with various government bodies and nutrition organisations in the region. In Indonesia, the company’s partnership with GERMAS, a government organisation under the Ministry of Health, has aided the dissemination of information from GERMAS’ many public health campaigns to local consumers, with the help of Herbalife Nutrition’s extensive distributor networks.

Steps forward for vascular wellness

The identification of Covid-19 as a contributor to vascular diseases has raised a new area of concern. However, this risk can be managed and prevented by more meaningful collaborations between HCPs, nutrition companies and other stakeholders. Most often, it starts with enabling wider access to accurate and proper information about the causes of vascular diseases, and encouraging more prevention measures through balanced nutrition and an active lifestyle.

AUTHOR BIO

Alex Teo has some 30 years of experience in food and nutritional sciences, having led the research and innovation of new products and processes at several multi-national corporations in the region. Dr. Teo's research works have been extensively cited in peerreviewed journals and he has received numerous patents for these works. He has a doctoral degree in Food Science and Nutrition. He has spoken at major conference proceedings across the US & Asia.

An Agile Response to Pandemic Management

Oracle

Throughout the pandemic, Oracle worked closely with the with the US Department of Health and Human Services and Centres for Disease Control on several solutions to help support the COVID-19 recovery efforts. The vaccine management capabilities developed were made available to numerous countries worldwide, including locations in Africa and Australia. As part of a ten-year philanthropic gift from Oracle, the Tasmanian Government has implemented this solution supporting their community through the phases of the vaccine rollout.

Peter Williams, Executive Director, Healthcare Industry, Oracle Japan and Asia Pacific

1) What are the key benefits of the vaccine management system?

The prime purpose of the vaccine management system is to make it as easy as possible for citizens to access and receive the vaccination so we can drive up the level of community uptake.

Through the Oracle Health Management System, individuals can book a vaccination appointment online or through the hotline. They then receive a digital Quick Response (QR) code to confirm their identity, which speeds check-in at their vaccination appointment. From there, healthcare workers use the system to record the type of vaccination administered and create or update a unique electronic health record for every person vaccinated. The system also reminds consumers to schedule a subsequent dose vaccination, if required.

With all data held securely in the Oracle Cloud running in Australia data centers, authorised government personnel can easily see the percentage of the population that has been fully or partially vaccinated and the types administered to help manage inventory and demand. Individuals also have their record of vaccination included in the Australian Immunisation Register as required under national legislation.

Doing all this requires technology that is simple to use and intuitive, and can be readily accessed through your phone, but also work for the digitally disadvantaged. The technology also needs to be able to quickly adapt when things change and operate at scale while maintaining the specified integrity, security and privacy of the information.

2) How would the state and local governments manage their state-wide COVID-19 vaccination program with this system?

Oracle has been working with governments around the world, in the US, in Africa and in Australia, implementing the Oracle Health Management System in support of vaccination programs for both COVID-19 and other diseases, such as Yellow Fever.

For Tasmania, it was essential that any IT solution could support several requirements, including operating a call centre hotline, dealing with some particular cohorts (such as schools), managing “walk-ins” at clinics, as well as enabling all citizens to be able to book appointments online and clinic staff to manage the administration of the vaccine.

Another important aspect for Tasmania was also integrating seamlessly with the national immunisation register so citizens vaccination status is captured and is also included in their ‘My Health Record’, which also uses Oracle technology and helps over 20 million Australians access their key health data.

3) Can you shed some more light on how the Tasmanian Government executed the vaccination program smoothly?

When Tasmania started to work with us in early 2020, there was an urgency for action. We knew from experience elsewhere that we could very quickly stand up the system. From our initial engagement, it took less than six weeks

Peter Williams is Oracle’s Executive Director, Healthcare Industry for Asia-Pacific, helping healthcare organisations gain insights to drive business transformation and digital evolution. Peter has previously held senior health ICT roles for National and State governments in Australia. He currently co-leads the ISO Task Force on Artificial Intelligence in Health Informatics. to get to production and go-live with the cloud solution from our secure data centre in Australia. Tasmania worked with us to help achieve that timeline.

Oracle Health Management System is built using Oracle Cloud Infrastructure (OCI) and our low code application development platform, Application Express (APEX). The system is highly configurable and lends itself to supporting agile processes. With the proven successes of the Health Management System in other regions, Tasmania wanted to take the system “out-of-the box” as much as possible in the first instance to avoid delay. But some features unique to Australia needed to be accommodated. That is where the agility and responsiveness of APEX stood out. After discussing requirements with users, it was literally configured overnight by our US team and the changes walked through with the Tasmanian team on the following day. This agility is particularly important as policy changes in the way vaccines are to be administered requires system parameters to be quickly reset.

4) How do you think this system would enable governments to scale quickly and support high-demand vaccine programs without any disruptions or failures?

The capability of APEX is just one part of the solution. Some of the most critical features of the system are ‘under the hood’. As noted, the system is deployed on Oracle Cloud Infrastructure (OCI), which is Oracle’s next generation cloud platform, and provides massively scalable performance with stringent, built-in data security which is essential for government.

For individual citizens, the system is designed to help them throughout the entire process – covering right from booking their appointment, to receiving a QR code to streamline processing when they arrive for their vaccination, to sending reminder notifications and confirmation of their vaccination status.

Service providers want people to have the most seamless possible process to check-in, receive their vaccine, and have their treatment recorded. To get that outcome, the workflow of the system must align with the administra-

When Tasmania started to work with us in early 2020, there was an urgency for action. We knew from experience elsewhere that we could very quickly stand up the system. From our initial engagement, it took less than six weeks to get to production and go-live with the cloud solution from our secure data centre in Australia.

tive and clinical processes. The Oracle Health Management System is deliberately set up to allow changes to workflow to be configured at the local level without necessarily requiring any change to the core system.

It also provides clinics with operational reporting in real time on how many people have been processed, failures to attend, waiting times, etc. These data can be rolled up to provide a view of regional performance. The system also comes with access to Oracle Analytics Cloud. Its capabilities assist management and policy makers to undertake analysis of data in the system to help plan for the future.

5) Although the challenges were unprecedented, what approach do you have for the pandemic management?

As a cloud service provider, it is not our role or remit to manage pandemics and other large-scale disasters, but there is a critical role for technology and data to play, now and in the longer term. We have responded to that need. For example, throughout the pandemic, Oracle provided cloud technology and services to the U.S. government to ensure our public health officials have access to up-to-the-minute data to better understand and combat the virus.

In addition, the University of Oxford and Oracle have collaborat to build the Global Pathogen Analysis System (GPAS), which is now being used by research organisations on nearly every continent to discover and act on potentially harmful new coronavirus mutations.

Researchers are using the system to upload pathogen data and receive comprehensive results within minutes. With user permission, the results may be shared with participating laboratories around the globe in a secure environment. Making this data comprehensible and shareable can help public health authorities evaluate and plan their response by giving them invaluable insight into emerging variants even before they are officially designated as Variants of Concern.

Institutions using the platform include: the University of Montreal Hospital Centre Research Centre, the Institute of Public Health Research of Chile, the Oxford University Clinical Research Unit in Vietnam, the Institute of Clinical Pathology and Medical Research – New South Wales Pathology, and Oxford Nanopore Technologies. GPAS is also now part of the Public Health England New Variant Assessment Platform.

6) How will your organisation ensure your employee wellbeing and safety of productive assets in the aftermath of the crisis?

Our employees’ well-being and success are of paramount importance at Oracle. True to these priorities, we continue to invest in our people through ongoing career development, diversity and inclusion initiatives, and health and wellness programs designed to support them throughout the pandemic and beyond.

7) How would this platform enable health officials and providers to manage vaccine distribution, expedite vaccine administration, citizen registrations, inventory management, and simplify monitoring?

Unlike many systems out in the marketplace, the Oracle system is not built to just manage the current global pandemic. It is a full function system designed to be adaptable for use with any vaccine protocol, not just COVID19, and to be a sustainable system for the future. Already, it has been used for HPV and Yellow Fever vaccinations in Africa and influenza in Tasmania. Further, while the Oracle Health Management System is built on an agile and flexible base, it is managed exactly like any of our other global Software as a Service products with regular new releases incorporating innovation and learnings from successful implementations provided as and when available.

8) Any other areas you would like to comment on

Oracle is a global organisation with a large number of employees and their families impacted by the global pandemic, including thousands here in Asia. Oracle saw an opportunity to help be part of the solution and didn’t hesitate to lend its people and technology to the fight. The important lessons we learned, such as the critical importance of being able to obtain fast, real-world data, will continue to impact how we help the healthcare market and the communities where we work and live for years to come.