Maintaining a healthy circulation is the key to enjoying a long and active life. Following the discovery of beta blockers, ACE inhibitors and diuretics and the understanding of the importance of aspirin and other anticoagulants there has been a revolution in the treatment of circulatory disorders over the last thirty years.

However, as in all branches of medicine, it is better to avoid the troubles by revelling in a healthy lifestyle than it is to rely upon the pharmaceutical industry once damage has been done. There is no better way to keep the arteries clear and the blood flowing than to take a reasonable amount of brisk but not violent exercise daily and to learn to enjoy a well balanced diet.

If one dietary measure needs to be taken, it is to ensure an adequate amount of fruit and vegetables daily. The official advice is to have five helpings of these every day, I am afraid that neither potatoes nor wine are included in the tally. Not all different types of fruit and vegetables are of equal value, because the glycaemic index, the speed at which the carbohydrate in the portion is absorbed and metabolised, varies. A rough and ready guide is that European vegetables and fruit tend to have a lower glycaemic index, that is to say they are metabolised more slowly than those of tropical origin. A high vegetable and fruit diet contains plenty of fibre as well as such trace elements as potassium, magnesium and calcium. Furthermore the highly coloured vegetables and fruit - although some of them may have a high glycaemic index and have been grown in tropical countries - are rich in antioxidant vitamins and flavonoids.

Taking appropriate antioxidants, whether vitamins or trace elements, including vitamin supplements is an important part of a good lifestyle regime that can lead to keeping arteries patent and maintaining a good blood flow. In the hustle and bustle of 21st century life, without a good multi-vitamin and trace element supplement, achieving a balanced diet may be near impossible. There are some herbal preparations that have a beneficial effect on the circulation. The advantages of soya may not be as great as statins but it is a natural artery preserver. In many parts of the world both garlic and gingko biloba have been used for their beneficial effects on the circulation for centuries.

Cardiologists are keen that a diet should be rich in potassium. Such rich fruits include oranges and bananas as well as the more mundane skins of baked potatoes, baked beans and bran-rich cereals. Just as doctors recommend a potassium-rich diet, they favour one with a low sodium (ie salt) content. They are especially keen that people shouldn’t add salt whether at the table or during cooking. There is enough natural salt in the food we eat to render any additional superfluous unless the weather is very hot so that people are sweating profusely. Until 5,000 years ago, humans didn’t add it to their diet. Even a thousand years ago the overall salt intake was only five grams a day but now the current average is twelve. Even if we could reduce this by only three grams there would be 20,500 fewer deaths from stroke and 31,400 from heart disease every year. The present objective is to bring our overall salt intake down to six grams a day so that we are almost back to the level of that achieved by our Norman conquerors; even then we wouldn’t match that of ancient cavemen.
The good news about diet is that circulation is improved by two or three drinks a day. For many reasons alcohol, and most people think red wine in particular, reduces the likelihood of having a stroke or heart attack. Unfortunately this is one preventive measure that can be overdone. Too much alcohol and some forms of circulatory and heart disease become more likely.

Whatever the diet, it must ensure that any excessive weight is lost. Men need to keep their waist measurement under forty inches and are recommended to keep it below 38. Women should have a waist of less than 35 inches and should strive to achieve one of under 32. These figures apply whether someone is a giant or very short, old or young. The reason for this apparent paradox has always escaped me but it is confirmed by numerous surveys and it is an easy rule to follow.

Brisk regular exercise should be taken daily, or at a minimum of five times a week. Walking is fine: there is no need to jog in lycra shorts, or to visit the gym, but the walk should last for at least thirty to forty minutes daily. It should be twice as long if the patient already has any risk factors for cardiovascular disease including diabetes, or a pre-diabetic state. The walking should be fast enough to make it difficult, but not impossible, to sustain conversation.

For those who know that their coronary arteries are in good order, swimming is the other exercise that is recommended. Swimmers shouldn’t dive into cold water, especially if they have recently had a large meal which directs the circulation away from their heart to their gastro-intestinal system. Research shows that swimming has advantages other than those of exercising the muscles. It seems that the regular steady exercise which doesn’t involve either strain or great concentration has a near hypnotic effect; this is often enough to dispel tensions of the day, or even week. It goes without saying that smoking, in particular cigarettes, is bad for every aspect of the cardiovascular system.

Tension and stress inevitably put a strain on the cardiovascular system. There are various relaxation techniques that range from having a bath, flicking through a newspaper or magazine or reading an interesting but intellectually undemanding book to the more organised relaxation techniques provided by suchdisciplines as yoga.

Once someone begins to feel cold because of circulatory failure, it is important to distinguish between troubles that have resulted from vaso constriction as opposed to the gradual furring up of an artery. In either event, the person needs to keep their legs and feet warm and dry. Older people should be aware that their temperature sense is blunted by their years. Warm socks and thick trousers made of woollen cloth are recommended. Jeans are neither waterproof, nor are a good insulator. Once they become waterlogged, or even damp, they chill rather than warm the body. The fashion for short as opposed to knee-length coats doesn’t only result in chilling but also increases the layer of subcutaneous fat so that women develop thick thighs.

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