The pioneer of heart transplant surgery , Christian Bernard said “ I have saved the lives of 150 people by heart transplants.If I had focussed on preventive medicine earlier, I might have saved 150 million”
Heart disease is the Leading cause of death worldwide.Although it was almost unknown a century ago it has become so rampant now that the general public is fussing about Cholesterol.
According to the latest NHANES data (2020), an average man is pre-diabetic !!! and possesses a risk factor for developing heart attacks and strokes !!! According to Dr.Kraft , "those with Cardiovascular disease not identified with diabetes are simply undiagnosed” and mostly in the stages of prediabetes ( OGTT ) and pre-prediabetes ( Diabetes in situ - Krafts curve ).There has been a drastic shift in the occurrence of heart disease in the old age to the middle aged and even younger age groups in the last 2 decades because of the increased prevalence of Insulin resistance worldwide which is indicated by the shift towards the left in the Insulin level.
"Epidemics persist only as long as the genuine cause of the disease is not understood and hence preventive and therapeutic measures could not be developed ".
It holds true with respect to Heart disease.
Cholesterol is not well understood even to this day by conventional science. Just because cholesterol numbers are altered and high in heart disease , it is often viewed as the Causation that Cholesterol gets deposited leading to atheroma and thence heart attacks.Correlation is not causation.It could be the greatest error of the century !!!
" Knowledge moves forward not by repeating the known facts but by refuting the false dogmas "
Insulin Resistance is independently associated with two variables which goes hand in hand with each other. 1.Dyslipidemia - characterisation ( increased Triglycerides and small dense LDL , decreased HDL-C ) & 2.Prothrombotic state - its effect .Scientific communities linked LDL-Cholesterol as the causative factor of Heart disease ( Correlation vs Causation confusion).
The discovery of nitric oxide , a Nobel Prize winning science, is a landmark discovery in the field of medicine. The Superman molecule, Nitric oxide is produced by the endothelial cells which causes relaxation of blood vessels , protects against Platelet aggregation, smooth muscle proliferation , monotype adhesion & superoxide radical elaboration preventing oxidative damage of vascular walls. Insulin Resistance causes less Nitric oxide production , thereby losing the protective effect is now prone for the development of Hypertension , Heart disease and Stroke.
Another problem in the understanding of Heart disease is the atherosclerotic plaque vs Thrombosis.
Whereas most of the heart attacks ( 70 % ) arise from soft plaques - vulnerable plaques , Angioplasty and Bypass are more and more focused towards stabilized hard plaques ( could be the reason for stable angina ).
Lp(a) rather than LDL-C is consistently associated with atherosclerotic plaque. Lp(a) has more of a reparative role as a bandaid. Cholesterol lowering drugs like Statins and PCSK9 inhibitors are widely used for Hypercholesterolemia.
Heart attack is literally the infarction of the particular area of the heart that developed over a period of minutes by thrombosis ( which inturn is caused by plaque rupture ) . Angina is all about supply-demand concepts particularly during exertion ( incapacitating because of poor circulation ) .
The true indication of angioplasty is within 3-6 hours of onset of symptoms in heart attacks ( which can account for < 5 % of all the angioplasty done nowadays ) and in the relief of intractable chest pain resistant to medications. Although angioplasty looks fascinating, we are not treating the root cause but rather disturbing the stabilized atherosclerotic plaques.
Atherosclerotic plaque in Coronaries develop over a period of years that the insufficient oxygen demand is compensated by angiogenesis ( formation of new blood vessels bypassing the stenotic plaques ).The very reason why most patients are still normal without incapacitating chestpain even with 90 % or 95 blockage % is collateral circulation. It's the natural bypass which the heart has done for itself without a scalpel !!!! Atherosclerotic plaques are compensated by Collateral circulation for effective functionality of the heart by keeping up the perfusion.
A mystery to be revealed to solve the misery of the present and future.
Heart attacks occur only in humans !! animals don’t. Why ?
Atherosclerotic plaques form in arteries but not in veins.. Why ?
Infarctions occur in the heart but are rare in other organs.. Why ?
A fascinating molecule leads the way to the puzzle of human cardiovascular diseases.
It may not be necessarily so. Lipoprotein (a) links arteriosclerosis and blood clot clot formation. Lp(a) not LDL binds to fibrin , collagen and endothelial cells and is the primary contributor to the arteriosclerotic plaque. Earlier researchers had missed looking for apo(a) and therefore came to the wrong conclusion that the LDL causes arteriosclerosis. Lipoprotein(a) accumulation parallels the size of the arteriosclerotic plaque.
The atherosclerotic plaque is an initially life saving repair process of the artery wall when it is weakened by long term deficiency in micronutrients. It develops when this repair process goes too far and overcompensates.Lipoprotein (a) is a mobile repair molecule that reaches the sites of tissue repair. The adhesive apoprotein (a) is a substitute for collagen in the vascular wall whenever it is injured or structurally impaired. Lipoprotein (A) is a repair molecule for the vitamin-deficient artery wall.
Conventionally LDL-C has been demonized as bad cholesterol and most of the therapeutic and preventive measures are based on reducing the LDL-C to minimize the cardiovascular risk
The current understanding of cardiovascular diseases
Fat transporting molecules enter the artery wall and deposit their fat content inside this wall ; it occurs at random ; no biological purpose . arteriosclerosis is a fatalistic process and it is essentially irreversible
Lipid molecules are deposited inside the artery walls mainly as intact lipoprotein particles, predominantly lipoprotein (a).It has an important biological purpose of protecting against scorbutic blood loss. Arteriosclerosis is a regulatory process. The formation of arteriosclerosis is reversible by an optimum intake of micronutrients which inturn causes progressive plaque cap thickening and plaque shrinkage.
Understanding the past is the way to the future
Understanding scurvy as the biggest threat to the survival of the human race in the past is the key to the eradication of cardiovascular disease of the future.human lipoprotein(a) is a surrogate for vitamin C in the artery wall.
We cannot redo the delete button in evolution ( lost the ability to synthesis vit C ) !!!
Stable plaques are Fibrous , slowly occlusive & stenotic which can cause stable angina or silent occlusion ; this is compensated by collateral circulation.
Vulnerable plaques are thin capped fibroatheroma or eroded ; typically non-stenotic prior to the event producing unstable angina , acute myocardial infarction and sudden cardiac deaths.
Plaque rupture causes thrombosis
A crack develops in the surface of a tiny plaque and the inner contents come spurting out, acting as a catalyst to cause the blood to clot, forming an occluding thrombus
“The sales pitch” taught to students- an angiogram showing shadows of old plaques. The critical view point which is often missed is that the severity of heart disease is closely related to the absence of flow in the blood vessel supplying the heart and not the degree of stenosis.
Calcium in arteries is the end of inflammation. Calcification is a result of chronic inflammation and is laid down in old scars. The vulnerable plaque is often small and unseen even with an Angiogram or CT-heart scan( CAC).
Both of them are palliative procedures with no survival benefits with the exception of relief of angina.surgically treated blocks are hard like a rock ; bypassed are large stable lesions ( non-lethal). The culprit lesions ( volatile plaques) are left untouched. Surgery treats the hard, fibrous plaques( scars ) which never kill : rupture of tiny volatile plaques kills the heart muscle.Doctors can see and treat large scars. Tiny pustules are unseen with no treatment ( other than diet ). Placement of a bare metal stent to prop open the artery causes cells to proliferate : 40 % of arteries are closed down within a year. Drug eluting stents (DES) dissolve out of the device -medications over the first 4 months , to become bare metal stents,.DES are associated with a reduced risk of closure, but an increased risk of blood clots. Angioplasty breaks up the blockages and dilates the artery.
Unfortunately , products of injury released by fracturing the plaque cause further blood clotting. Half of arteries so treated are completely closed down within 5 months.
12 Randomized , Clinical Trials Enrolling 7182 Participants
Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Stable Coronary Artery Disease
A Systematic Review and Meta-Analysis of Randomized Clinical Trials Conclusion: In this most rigorous and comprehensive analysis in patients with stable CAD, PCI, as compared with OMT, did not reduce the risk of mortality, cardiovascular death, nonfatal myocardial infarction, or revascularization.
Circulation: Cardiovascular Interventions. 2012 August 1 ; 5:476–490
Study Report | 5 Year Survival Rate Surgical | 5 Year Survival Rate Medical |
| Veteran’s Study | 82 % | 80 % |
| European Study | 93 % | 85 % |
| CASS Study | 95 % | 92% |
Angioplasty with sudden closure of vessel benefits when treated within 90 minutes. Treatment benefits seen when from the first contact to reperfusion therapy is less than 90-120 minutes. The sooner the better.
Cholesterol is the greatest scam of the century based on Diet heart hypothesis.two correlation factors were linked together. Lipid hypothesis that saturated fats causes rise in cholesterol & cholesterol causes heart attacks. Therefore saturated fats cause heart attacks is just a prediction rather than science.
Cholesterol is carried by the lipoproteins which contain triglycerides ( for energy delivery to all the cells of the body ) and cholesterol along with antioxidants like tocopherol, lycopenes, carotenes for cellular repair. The excess cholesterol and the junks are removed by HDL back to the liver which inturn is eliminated by the bile.
We can change the cholesterol numbers within days, simply by changing the major source of fuel i.e carbohydrates or fats. If one's diet is carbohydrate rich , then LDL-C will be low ; if diet is rich in fats , then LDL-C will be high. It is based on the lipid energy model.
Liver meets up to 80 % of cholesterol production, our body needs.is our body so stupid enough to make the demonized molecule , cholesterol just to kill itself ? If the diet is high in cholesterol , then the liver senses it makes less cholesterol and if you don’t take cholesterol in your diet , liver makes more of it. LDLl is essential for host defense, modulation of inflammation, prevention of vascular calcification , receptor functioning and processing , cellular signaling , neurotransmitter signaling, cell repair , muscle function , membrane integrity and Energy delivery.
The answer is yes !!! Only, If you stop the repetitive injury from your fork & spoon and smoking
Since angioplasty nor bypass prolong life, the indication is relief of incapacitating chest pains ( angina ) unrelieved by good medical therapy ( medications and lifestyle changes )
The Big Pharma & Food industry , near 100% of cardiologists ( AMA, AHA, ACC ) would like us to use processed vegan diet and Use cholesterol lowering medications like Statins and PCSK9 inhibitors to keep the LDL to near zero ( greater the reduction , higher the benefit ) giving a false sense of security against cardiovascular diseases.It is worthwhile to note that the cholesterol lowering drugs has no role in primary prevention. In fact, the effect of statins on extending lifespan, even in secondary prevention is merely the difference of only 3-5 days.
THE GREATEST DECEPTION OF ALL TIMES
| All Cause Mortality (ACM) timeline in LDL clinical trials with statins and PCSK9 inhibitors | |||||||
| Outcome | 4S | IDEL | CARDSATOR | ASPENATOR | JUPITER | IMPROVEIT | FOURIER |
| No.of Patients randomised | 4444 | 8888 | 2838 | 2410 | 17802 | 18144 | 27564 |
| LDL % reduction | 25.0% | 23.0% | 33.0% | 30.0% | 50.0% | 24.3% | 59.0% |
| Mortality - Treated | 8.2% | 8.2% | 4.3% | 5.7% | 2.8% | 5.8% | 3.2% |
| Mortality - Placebo | 11.5 | 8.4% | 5.8% | 5.7% | 2.2% | 5.7% | 3.1% |
| Mortality Benefit | 3.3 | 0.2% | 1.5% | 0% | 0.55% | 0.10% | 0.1% (+) |
| Year of Publication | 1994 | 2005 | 2004 | 2006 | 2008 | 2015 | 2017 |
What causes atherosclerosis ?
If not LDL-cholesterol , what else can cause heart disease. It is often an inflammatory disease produced by two major factors (i) Ectopic fat deposition (ii) Direct injury by the oxidizing molecules from processed foods - excess Sugars , Acidic drinks , Refined oils (PUFA) ,Trans-Fats , Smoking & Air pollution.. To repair this damage, the cholesterol kicks in and acts as a bandaid stabilizing the vessel wall.The plaque becomes unresolved & progressive if there is poor collagen formation which is largely due to poor micronutrients( vit C & minerals ).
The old concept : higher the LDL cholesterol = more invasion from lumen, crossing the endothelium and promoting atherogenesis ( Inside Out ).
The emerging concept : Ectopic fat deposition in the heart ( epicardial / intramyocardial ) elicits inflammatory response.The unresolved inflammatory process calls for the cholesterol rescue !!!! Finally Lp(a) is deposited by the blood vessels supplying the blood vessel - vasa vasorum ( Outside In ).
Statins have multiple side effects Cognitive decline and memory loss , accelerated aging , Myopathy and muscle soreness , cardiomyopathy , increase in the incidence of Diabetes. Yet , Statins are one of the most commonly prescribed drugs !!!!
If heart disease is an inflammatory disease ( fire ) , LDL- Cholesterol in particular Lp(a) is a firefighter which uses up antioxidants it carries,& supplies cholesterol for cellular repair ( band aid ).We have wrongly arrested the firefighters just because of their presence whenever there is any injury to blood vessels.
Insulin resistance is associated with chronic inflammation , Procoagulant state and Dyslipidemia ( Triglyceride/ HDL ratio > 1.3 and VLDL-C > 15. Here, Insulin resistance is the causative factor and all others are associated factors. Because of some association of increased LDL-C with Heart disease , it is mistakenly tagged as Causation or risk factors, and most of the measures are addressed to reduce LDL-Cholesterol !!! Wonder why we are not able to tackle the crisis of cardiovascular diseases.
Total LDL - Cholesterol is not a good indicator of Insulin resistance and hence cardiovascular health. But unfortunately, it is the most celebrated cardiovascular risk factor !!!Large dense LDL-C is neutral ( usually increases with low carb diet & lean mass ) with respect to cardiovascular diseases whereas small dense LDL-C( which increases with Insulin resistance and intake of excessive sugars and refined carbohydrates )is associated with increased cardiovascular risk. It is very important to understand that, LDL-C is only a surrogate marker of heart disease.
A unique but highly underrated entity in which the ECG and CT angiogram would be normal but still the patient continues to suffer from chest pain because of poor microvascular circulation ( multiple capillaries perpetrating the Myocardium of the heart).Coronary MVD is heart disease that affects the heart’s smallest coronary artery blood vessels.
Spasms within the walls of these very small arterial blood vessels cause reduced blood flow to the heart muscle. It could be relieved by augmenting the nitric oxide production by reversing Insulin resistance
Patients who go for master health check ups run through the stress test in a treadmill with constant monitoring of ECG or ECHO. The basic idea is whether the patient develops chest pain on exertion, accompanied by changes in the pattern of ECG or ECHO which likely happens when there is > 50-70% blockage in the coronaries. Around ⅔ of heart attacks occur due to soft plaques which cannot be detected by Treadmill stress. Treadmill or even CT angiogram cannot detect those vulnerable plaques !!!! People who are tested positive are advised for Angiogram warranting unnecessary therapeutic interventions in which the hard, fibrous plaques are treated, instead of treating the vulnerable plaques which typically cause plaque rupture and thrombosis.
CIMT ( Carotid Intima media Thickness ) by Ultrasound is a good surrogate indicator of cardiovascular health. The increased IMT reflects early stages of atherosclerosis and cardiovascular risk. It is cheap and non-invasive. Negative stress echo and stress MPI tests only imply a lack of flow limiting disease; they do not indicate lack of atherosclerotic disease. It is important to remember that when these tests are "negative," the implication is favorable short-term prognosis rather than any implication regarding lack of disease. In contrast, carotid intima-media thickness (CIMT) scanning protocols can detect atherosclerotic disease in early and asymptomatic stages. CIMT may be a more optimal screening and risk-stratifying technology. The CAFES-CAVE study showed that Ultrasound screening of B/L Carotid & Femoral bifurcations may the practical, reliable & cost-effective assessment of progression/regression of subclinical atheromas.
Stents , Statins & Surgical bypass are palliative measures not addressing the roots of cardiovascular health.
The key to cardiac wellness is Reversing Insulin Resistance ,
1.Augmenting nitric oxide production - leafy greens and exercise; . 2. Eliminating Ultra Processed foods - excess sugars , trans fats , PUFA (refined oils) & acidic drinks.
3. Avoidance of smoking and Alcoholism , Psychological Stress and Sedentarism.
Dr. Thangadurai
Liposuction is the most performed aesthetic surgery in the world. It is also the well-known and popular procedure that sculpts areas of the body with excess fat, streamlining, slimming and contouring the body. A tummy tuck, also known as abdominoplasty, is a plastic surgery procedure that aims to firm, flatten, and smooth the abdomen. During this surgery, a plastic surgeon removes excess fat and skin and tightens the abdominal muscles. The tummy tuck is not like liposuction. The two are often combined because the primary objective of abdominoplasty is to tighten muscle tissue, not remove fat. In combination, liposuction and a tummy tuck can significantly improve abdominal contours.
A tummy tuck can be ruined. Patients should not count on their tummy tuck to last indefinitely if they do not maintain healthy lifestyle habits after their procedure. Weight gain can still occur and stretch the abdominal muscles. Pregnancy may also diminish the contouring achieved with a tummy tuck; hence it is highly recommended to postpone this procedure until after one’s family is complete.
Although, these procedures are appealing and appears more aesthetic, there are hidden disadvantages, when it comes to metabolic health.
Body composition differs significantly according to the sex. Men tend to carry less fat composition (10-20%) whereas women have a greater fat composition (18-30%) because of the female sex hormones which promote fat storage. Estrogen promotes hyperplasia (increase in number) of fat cells and its deposition mainly in the gluteo-femoral (hips & butts) region in the subcutaneous space. Thus, women of reproductive age groups can expand the subcutaneous adipose fat depot without becoming metabolically sick. It is evident that the Subcutaneous Fat threshold (beyond which it gets deposited in the visceral space) is much higher in women compared to men. Women tend to suffer from metabolic conditions at least 400 % less compared to men because of the same reason. But once they attain menopause, the protective effect of estrogen to store more subcutaneous fat is lost and they start depositing fat in the visceral space and tend to become metabolically unhealthy, particularly if they are following a poor dietary lifestyle and sedentarism as well as having a poor muscle mass (sarcopenia).
Subcutaneous Fat is a metabolic advantage. Evolutionarily, our human race survived droughts and famines because we are able to store the excess energy in the form of fat for future use (during periods of adversity). We are no longer facing the times of food scarcity or famine in the last 4 to 5 decades and we are living in a world of surplus- simply like “cactus in the rainforest”. Unfortunately, in the last 5 decades the human race is suffering from surplus nutrition developing overweight and obesity.
The fats that are getting stored in the subcutaneous space from head to toe are good fats because they secrete anti-inflammatory adipokines that modulate metabolism favorably. But once the capacity to store fat becomes saturated, they become hypoxic and secrete proinflammatory cytokines for angiogenesis (establishing new blood vessels) for the hypertrophied fat cells as a compensatory mechanism for their survival. The hypertrophied fat cells become insulin resistant, now promoting lipolysis increasing the free fatty acids in the circulation. Now the whole body tend to suffer from insulin resistance because of proinflammatory cytokines and excess free fatty acids in the circulation. Now, the fat storage occurs in the visceral space and also throughout the body including vital organs like liver, pancreas, heart, kidneys and blood vessels supplying them.
Generally, Subcutaneous fat expands by hyperplasia (increasing number of fat cells) whereas visceral fat undergoes hypertrophy (increase in size). It is not the fat that you see (pinchable fats or external obesity) but the invisible fat (internal obesity) that you cannot see, kills you slowly. The external (subcutaneous) obesity is a metabolic buffer of positive energy balance which protects against insulin resistance until the personal fat threshold is overwhelmed. The internal obesity in the visceral space particularly in the liver promotes insulin resistance and affects cardio-metabolic health adversely over a period of time.
The subcutaneous fat in the abdominal region is called the stubborn fat. The first fat to get mobilized under fasting or low insulin dietary protocol is the visceral fat which is metabolically active and also being resistant to the anti-lipolytic action of insulin. Hence the visceral fat in the abdominal area gets mobilized easily but the subcutaneous fat in the abdominal area which is actually benign is the last to get mobilized. Therefore, it is usually called as the stubborn fat. The ectopic fat (including the visceral fat) is preferentially mobilized compared to the subcutaneous fat and hence mobilization of subcutaneous fat takes a longer time for it to be used as a source of energy whether by fasting or dieting or regular physical activities. It is not a stubborn fat anymore and we can achieve aesthetic look even without any surgical intervention or liposuction.
Generally Fat cell Numbers in Teen years linger for a lifetime. A normal person has between 25-35 billion fat cells, but this number can increase (hyperplasia, more so in women under the influence of estrogen) in times of excessive weight gain, to as many as 100-150 billion cells. The number of fat cells in the body remains constant after their formation; the cells just expand (hypertrophy, more so in males) and shrink in size during weight gain and weight loss respectively. Fat cells have an excellent capacity to shrink and expand in accordance with the energy balance. The radius of the fat cells can increase up to 20 times which then translates into 8000 times increase in its volume.
Personalized dietary protocols to change the body composition (for example, increasing the protein intake and reducing the energy in the form of both carbs and fats along with micronutrient rich and fiber rich diet) along with Fasting and regular workouts, helps in melting down the so-called stubborn fat in the context of low insulin levels. Low insulin level causes lipolysis (breakdown of fats) and hence the subcutaneous fat stores are used up as a source of energy. It is quite possible to achieve aesthetic appearance naturally with a healthy lifestyle. The fat cells are better shrunken by this holistic approach rather than to remove them by liposuction or tummy tucks.
The safe limit for fat removal through liposuction is typically around 6-8 pounds (equivalent to 3-4 liters). Going beyond this limit increases the potential risks of complications. Liposuction cannot be considered a weight loss surgery as it does not reduce your overall weight considerably. Instead, this surgical procedure targets excess fat stores in precise areas of the body and improves an individual’s shape or appearance. Only the fat under the skin can be removed during liposuction, not the internal fat that surrounds our organs which is related to Insulin resistance -related medical problems. The main goal of liposuction is to shape the body by removing inches. Many patients can lose 1-3 inches depending on the treatment area and the amount of fat removed.
In abdominoplasty (tummy tuck), the typical recipient loses between 4-15 pounds depending on how much excess abdominal skin there is, how much fat in the abdominal region and the type of abdominoplasty selected. Again, tummy tucks are not a weight loss solution. To qualify for the procedure, you must be at or close to your ideal weight. Although the fat percentage of fat mass can go substantially from 30% to 20% following the procedure, the cardiometabolic risk stays the same; perhaps they have increased risk of developing cardiometabolic conditions over a period of time since they have lost a significant fat depo in the subcutaneous space.
These procedures are mainly done in younger and middle-aged women, mainly the reproductive age groups. Most of the fat cells throughout the body under normal conditions are smaller and expand by hyperplasia (increasing their number) and not by hypertrophy (which causes insulin resistance when it reaches the upper threshold limit). The hyperplastic baby fat cells in the subcutaneous region throughout the body are a metabolic advantage to the premenopausal women which act like a shield protecting against the development of insulin resistance and metabolic disorders.
When the fat cells are considerably removed most of them being in the small & hyperplastic stage, the total number of healthy fat cells which acts as a depot for energy storage decreases. In other words, the Personal Fat Threshold of the person decreases after these procedures. Now when there is positive energy balance, the left-out fat cells have limited capacity to expand by hyperplasia and over a period of time, it expands by hypertrophy and hence they have increased risk of developing insulin resistance. Whenever the personal fat threshold gets reduced, the fat deposition eventually happens in the visceral space leading to metabolic related disorders.
Shrinking the fat cells by comprehensive holistic metabolic approach of eating healthy, staying in fat-burning mode for most part of the day, fasting and regular physical activities actually help in keeping the fat cell intact and healthy whereas removing or sucking out fat cells in the subcutaneous space by these procedures could lead to reduced number of fat cells, overall. To summarize, the good subcutaneous fat gets removed leaving behind the dangerous and bad visceral fat untouched. It is very important to maintain ideal body weight after the procedures by eating right and involving themselves in regular physical activities to prevent any such metabolic complications.
“Nothing makes a woman more beautiful than the belief that she is beautiful.”
Dr.R.R.Thangadurai M.S,
It's not infrequent that we hear from our friends and family members saying "I literally got a heart attack watching that match" particularly a thriller or a high profile game with a lot of expectations and a nail biter.
Is it a fact or fiction ? Let's explore scientifically
Normally , our body functions in a well coordinated manner controlled primarily by nervous system and endocrine system
Heart is innervated by autonomic nervous system both sympathetics and parasympathetics.Sympathetics is more and more concerned with Flight/Fight response in periods of acute stress,which is necessary for survival. Parasympathetics calms down the body, for rest, digestion and repair which is a basal state to keep the body in harmony.
Sympathetics increase heart rate and cardiac output and are augmented by adrenal hormones secreted in times of stress.
Emotional stress is a well-known trigger of acute coronary syndromes.The increased sympathetic drive is generally considered a dangerous chronic condition in patients with occult or known coronary artery disease.
Emotional stress is driven to our brain by the peripheral sensitive apparatus eliciting a complex reflex including central and autonomic nervous systems with sympathovagal recruitment and adrenal stimulation with increasing catecholamine plasmatic concentration. The final effect of rising blood pressure, tachycardia , sweating , and peripheral vasoconstriction.
When one is emotionally attached to cricket match, in terms of nationality, he gets deeply connected that the sympathetic system is several times more and more activated to increase the heart rate and cardiac output that for few minutes he may feel the pounding heart in the close context.He may experience the same level of stress which the player experiences in the field just by watching the broadcast.The basic difference is the player is fit physically to endure the amount of stress involved in a game because of increased cardiovascular reserve and collateral circulation which come into play to tackle the inadvertent situations whereas the normal ordinary men in the middle age & old age , most of them being metabolically unhealthy with poor cardiovascular reserve and poor collateral circulation.
If the coronary circulation is blocked by atherosclerotic plaque , it is manifested by symptoms of chest pain during physical exertion which is otherwise unrevealing during normal day to day activities.This is what we call stable angina.Our Indian sub-population is having poor cardiovascular health because of poor nutrition and sedentarism, even our former Indian Skippers like Kapil Dev & Savrou Ganguly are not exemption who suffered from heart attacks and underwent angioplasty.
We always have heard in the news about tens of heart attacks and unprecedented deaths while watching cricket matches particularly between India & Pakistan. When it is a close contest between the two sides, the nervousness is increased several fold.In India cricket is a sensation and not just a game of bat & ball. For people with normal cardiovascular reserve, it is not much of a problem tackling the sympathetic overdrive. But for people with compromised cardiovascular reserve , particularly the old aged and middle aged-increased sympathetic stimulation during excitement increases heart rate by 2-3 times that of normal, with heart pounding fast. It can cause discrepancy i.e., increased demand in cardiac work vs poor increase in blood supply demand.It can cause myocardial ischemia when sustained for a considerable time can finally trigger heart attacks with poor outcome.Coronary spasms occur most commonly in smokers , insulin resistance & emotional stress.
Heartbreak and broken heart are popular definitions of sudden cardiac death related to grief.
In patients with chronic coronary artery disease, the so-called “vulnerable patients” with multiple risk factors such as metabolic syndrome, active smoke, hypertension and diabetes the emotional stress can elicit a catecholamine direct toxic effect on a vulnerable plaque in the coronary artery tree leading to vessel occlusion.
Also, short-term severe stressful situations often can cause severe but usually temporary heart failure. This condition is called broken heart syndrome, also known as takotsubo cardiomyopathy, apical ballooning syndrome or stress cardiomyopathy
Cricket is a game to be enjoyed in a sportive manner just like any other sport.
High Emotional attachment is unnecessary and unwanted ones : love cricket ; play cricket & watch cricket but you should be grounded to reality. It is never a matter of life and death. Know your purpose in your life.Media hypes it for their commercial purpose !!!
There are a lot of things going on in Cricket in terms of politics, Corporates and entertainment sectors which become more and more evident during IPL matches being played every year.
“ Give them bread and circuses and they will never Revolt”. The modern day circuses are the IPL cricket and T20s.
Roman’s Colosseum: The era of Gladiators
Cricket stadium : The Modern day Colosseum
The evil was not in bread and circuses per se, but the willingness of the people to sell their rights as free men for full bellies and the excitement of the games which the other human hungers which bread and circuses can never appease.
In a political context, the phrase means to generate public approval , not by excellence in public service or public policy, but by diversion, distraction , or by satisfying the immediate or base requirements of a populace, by offering them a palliative : for example food ( bread ) or entertainment ( circuses ). It is particularly relevant to the current Indian Political system.
It’s possible that stress reduction exercises might calm down the mechanism that converts stress to heart attacks and strokes.
In fact, stress reduction tactics—like increasing your physical activity, practicing mindfulness, deep breathing, even seeing a funny movie— reduce both the size and activity of the amygdala, while having beneficial impacts on other brain tissue, too. So do your heart a solid by calming your racing mind.
Increase physical exercise.
Find an exercise regimen that works for you. This can include daily walks or riding a bicycle. Start slow and gradually lengthen these regimens over time.
Practice relaxation exercises.
Incorporate muscle relaxation techniques, such as breathing exercises, to deal with anxiety and stress into your daily routine.
Make a connection to your spirituality.
Spirituality helps to give your life a clearer purpose and a greater connection to the world and others. It's not necessarily connected to a specific belief system or even religious worship. Try prayer, meditation or keep a journal to express your feelings and focus your attention.
Seek professional help.
Get an annual physical and talk to your health care provider about your health, including psychosocial stress.
* Eat a healthy diet
* Avoid added sugars, refined oils , trans fats, and highly refined carbs
* Limit alcohol- it acts a toxin and hence no safer upper limit
* Stop smoking.
* If you smoke, plan to quit.
* Monitor your heart health.
* Know your numbers for blood pressure, blood glucose and cholesterol.
Dr. Thangadurai
In the last 50 years, we have been suffering from a lot of chronic ailments, particularly NCDs ( Non Communicable Disease) like diabetes, hypertension, fatty liver, obesity, PCOS, high cholesterol, heart disease and strokes. These disorders are generally considered as chronic and progressive, for which a lot of drugs are given lifelong, by the healthcare professionals to keep the parameters in check. Such symptomatic reductionism cannot stop the progression of the disease nor the complications associated with those disorders. This is what we call 'learned helplessness'.
The first step in finding a solution to any problem is to define the problem ; without a complete understanding of pathophysiology we cannot prevent or reverse the condition even with newer drugs, genetic or stem cell research or high-tech medical equipment.
There has been a silent twin epidemics of obesity and TOFI ( thin outside fat inside ) which is largely overlooked and mistreated by the healthcare system. This is largely due to westernization & the changes in the food system – ultra processing of foods , use of artificial fertilizer and pesticides ; big food industry also impacts the health of the population by the introduction of high energy foods, excess sugars and refined oils.
According to the NHANES study an average adult over 20 years of age is pre diabetic, so it is at most imperative to find the solution to this silent epidemic of NCDs for improving the quality of life and to prevent these metabolic disorders from occurring in the future generations.
Our body has innate intelligence and memory to thrive in the environment which has developed over millions of years. Several adaptations have evolved in the living beings mainly for the survival and the perpetuation of species. One such mechanism for survival is by storing the energy whenever is possible so that the surplus of energy could be used in the time of food scarcity or famine. Insulin is a hormone produced in the pancreas for appropriate energy utilization.
We are no longer facing the times of food scarcity or famine in the last 4 to 5 decades and we are living in a world of surplus – simply like “ cactus in the rainforest ". Even one third of the children are suffering from metabolic disorders.
The modern man is a completely modified species compared to ancestors, both hormonally and metabolically. Ultra processing of food produces biological mismatch that produces a higher amount of insulin ( 2 to 4 times) than what is required . This hyperinsulinemia drives excess fat deposits ( lipotoxicity) in the liver, muscle, pancreas and viscera along with subcutaneous ( external) obesity and hence drives the development of all the metabolic disorders over a period of time, through Insulin resistance.
The most common disorder which the entire population suffers is hyperinsulinemia but majority of the scientific communities and healthcare professionals are unaware of it. The sad part is that most of the consequences of these disorders are symptomatically managed with drugs lifelong.
Nearly half of the adult population & even ⅓ of pediatric age groups are suffering from the silent epidemic of overweight & obesity.
We had prevalence rate of obesity of only 1% before 100 years now it has become rampant particularly in the last 5 decades.Now the prevalence of Obesity in India is 40 % ( at least abdominal ) that poses the metabolic risks as well.Many of us still believe that the Overweight & Obesity is mainly genetic !!! But contrary to the belief , it is mostly epigenetic ( bad food & poor lifestyle ) because the prevalence of Obesity due to genetics cannot change from its constant rate of 1 % even after several hundreds of generations whereas the Obesity due to epigenetics ( Hormonal imbalance because of ultra processed foods) can greatly vary ( now 39% ) in accordance with the environment.
Conventionally , Obesity is defined by weight or BMI ( Body Mass Index ) for quantification of Obesity. Obesity simply means Overfatness and not necessarily overweight.Another fact is we need to demarcate between the benign subcutaneous obesity ( pinchable fat ) and the dangerous invisible visceral fat which drives the metabolic disorders.
“ Insulin - The Game Changer "The primary function of insulin is not only anabolic ( storage of excess energy in the form of glycogen in the muscles and liver & fat in the subcutaneous adipose tissues) but also anticatabolic ( prevents the breakdown of stored form of energy , particularly lipolysis). The problem with current day societies is 'we are swimming in high insulin levels and yet unaware of it'. The hyperinsulinemia due to ultra processed foods had essentially signaled our biology to store more and more fat all the time ( high fat storage) and decreased utilization of fats for energy ( low fat burning) . This energy toxicity intoxicates our entire body that most of the metabolic disorders are simply the manifestations of the common denominator called insulin resistance.
Energy Trap & Toxicity under high insulin levels
Not only the energy is stored but it's getting trapped under persistent high insulin levels. In a normal insulin sensitive person, there is ease in switching over from carb burning to fat burning particularly in the fasting period. This is called Metabolic Flexibility. But in insulin resistant persons, the insulin is persistently elevated hence the lipolysis is often suppressed which means you are having plenty of energy, but it is underutilized due to the abnormal high insulin levels. This is called Metabolic Inflexibility. The most interesting fact about the energy toxicity is that it predominantly occurs in the visceral space making each & every organ to be metabolically unhealthy over a period of time. High Insulin levels causes Functional leptin resistance & slows down body metabolism.
“What could be the potential solution?"
High insulin drives metabolic disorders and hence the only effective and sustainable solution could be to decrease the inappropriate insulin secretion due to the ultra-processed foods. So we have developed a scientific solution called WINSULIN protocol ( loW INSULIN diet and lifestyle) by introducing minimally processed foods back to the food system.
Is the current solution more problematic ?
We are currently focusing too much on the calories - eating less and moving more; it can produce some short term results but ultimately it slows down the metabolism & in the long run , weight gain comes back in vengeance.
Is there anything better than the Calorie model ?
Now we have understood that the calorie model is outdated and no longer valid. The Hormonal theory could explain obesity and the metabolic disorders thereby providing clues to reverse those conditions as well !!
*HME - Hormonal-Metabolic-Energy
*satiety hormones - Ghrelin , GLP-1 & PYY
| Calorie model | Hormonal model | |
| Concept | Eating less & moving more | Eating real food with fasting |
| Quality of food | not taken into account ; mostly Ultra Processed | Only Whole foods |
| Energy expenditure | Conscious effort | Autopilot mode |
| Metabolism | Slows down | Increased |
| Rebound weight gain | occurs | not so |
| weight loss | short-term | long-term |
| Sustainability | poor | excellent |
| Quantity of energy burnt | Low | High |
| Eating | conscious restriction | No need to control calories or portion size |
“ Lowering the energy toxicity could be the appropriate solution”
WINSULIN protocol ( low insulin diet and lifestyle) including minimally processed or unprocessed traditional grains and pulses, organic farmed foods, intermittent fasting , optimal cooking methods such as rice drain method, appropriate macronutrient ratio in a given meal, elimination of excess sugars ultra processed carbs and refined oils, avoidance of unnatural combination of carbohydrates and fat at the same time in a given meal could be the universal solution to all the metabolic disorders.
Low insulin state causes accelerated lipolysis that the body runs in a state of nutritional ketosis during which our body runs predominantly on ketones ( acetone, acetoacetate & beta- hydroxybutyrate) . The body which had been a miser in spending energy under high insulin levels has become a king lavishly spending the stored form of energy !!! The best part is not much of any effort is made to burn the excess calories except for “eating real food with fasting”
The excess released energy from the fat stored ( increased lipolysis) is not only utilized for meeting daily requirements but it is wasted or expelled out from our body in the form of acetone during breathing ( sweet smell of acetone in breath ) and elimination of acetoacetate and beta hydroxybutyrate also occurs, in the urine.The first to go fat is from the viscera ( particularly liver fat ) in preference to the subcutaneous fat since the visceral fat is metabolically active and readily undergoes lipolysis.
When you drop refined carb intake and extend your fasting window, your ketone levels increase.
There are three different types of ketone bodies that can be measured – these are called acetone, acetoacetate and beta-hydroxybutyrate.
One way to measure ketones is to test your urine. You’re not measuring fat per se but you are measuring the increase in ketones – a sign of potential fat metabolism increase.
Testing your urine using specialized (and often expensive) ketone strips helps to give you a rough idea of how far into ketosis you are.
By holding the strip in your urine you’ll note a color change if the number of ketones in your body has increased excessively – specifically acetoacetate because it is expelled from the body via urine, as opposed to acetone which is expelled via breathing (one of the reasons why those in ketosis often report having sweet smelling breath).
This nutritional ketosis is different from starvation ketosis which is accompanied by acidosis. In conventional medicine, whenever there is detection of ketones in the urine or its increased levels in the blood, a red alert is made that something is very serious. We need to understand the demarcation between the nutritional ketosis ( in which insulin levels are low physiologically during fasting window and the body essentially runs on ketones and fatty acids except the tissues like nerves, red blood cells, part of the kidney which runs only on glucose ) vs ketoacidosis ( in which there is pathologically low insulin levels causing ketones to go high beyond the physiological limits and accompanied by acidosis).We have to remember that we are all natural fat burners except during the periods of eating and few hours of postprandial period.
In a world in which the healthcare community is primarily focused on the calorie model of producing a illusory calorie deficit and hence weight loss by 'eating less and moving more' and encouraging zero calories' foods, both of which have failed again and again in the last 40 years , Low insulin could be the ultimate bio hack in preventing , treating and reversing all the metabolic disorders of the modern era.
If We want to burn calories without much effort, then choose low insulin protocol or if you want to burn calories with great effort but in vain choose calorie counting. Any sensible person, if they understand the real science, may not choose the calorie model of eating less and moving more because it's tiring and against their will. Who wants to consciously stretch themselves toiling in physical exertion when there is an autopilot subconscious mode of burning the excess fat without even being aware of it by just making the changes in the hormonal levels, particularly insulin.
Another myth propagated by the big food industry is that Zero calorie foods ( e.g diet soda) are better alternatives and are safe. But the reality is that adding artificial sweeteners disrupts the microbiome , some are neurotoxic and impacts the metabolism in an indirect way although it does not contain glucose in the first place. How many people do you know, who feel fantastic and lose weight after switching over to diet soda ?
"You cannot outrun your bad food habits out of exercise" meaning you cannot burn the excess fat produced by high insulin levels due to ultra-processed foods by increasing physical activity. Most of the wellness programs are unfortunately based on this failure model and the history repeats. It's time to shift our paradigm from Calorie Centric theory to the Hormonal theory of Obesity for better metabolism and reversal of Metabolic disorders with ease.
Dr.R.R.Thangadurai M.S,
The modern world is rife with stresses, distractions and physical challenges that people encounter on an everyday basis. The rapid advances in technology over the last 200 years have made our lives more comfortable in many ways but have also taken away from us the physical activity that our ancestors used to experience on a daily basis.
Add to this the pressures of day-to-day existence in the 21st century, we find that the comfort that modern life has lured us into comes at a cost: a plethora of mental and physical disorders ranging from anxiety and stress to hypertension, diabetes and cardiac issues. In this context, the relevance of Yoga has become even more pronounced.
Yoga is an ancient Indian practice that has been around for over 5000 years. It is a holistic approach to physical, mental and spiritual wellness that focuses on the integration of the body, mind, and soul. In the modern world, Yoga has gained immense popularity as a way to manage these stresses, while helping to improve physical fitness and improve overall health.
Yoga teaches us to lead a healthy life. It improves creativity, concentration and sharpens our memory. In the hustle and bustle of modern life, it is natural for our emotional stability to decline. Yoga is a great way to prevent this while also improving our stamina, muscle strength and mental stability.
The modern world has made everyone seek instant gratification. Moreover our body and mind are hacked by the Big Corporates by hijacking the Dopaminergic overdrive mainly by confusing the pleasure with happiness like happy meals, happy hours etc. making us addictive, unhappy and sick. In the pursuit of pleasure, we lose happiness. Most of us are either in aggression or depression but not grounded to reality. Corporates and the westernization of our society are creating an illusion and our perception is altered and we are far off from real values and ethics."The World has got enough for everyone's needs but not for someone's greed !!" Instant weight reduction, instant relaxation and instant energization are sought by many. While this is a bane of modern life, Yoga can be beautifully blended into this fast-paced world to help us achieve our goals. There are many types of Pranayamas (Heating Pranayama and balancing Pranayama) and Asanas (twists , arm balances) that can actually help us rejuvenate ourselves quickly once we learn the right technique! Let us explore the various benefits of yoga, and how it can help individuals control their mind and body in today's fast-paced world.
The practice of yoga has been shown to have a positive impact on mental health and well-being. It can help to reduce stress, anxiety, depression, help a person relax, and improve overall mood.
Stress is one of the biggest mental health challenges faced by people in the modern world. The fast-paced lifestyle and constant demands of daily life can take a toll on an individual's mental well-being, leading to chronic stress and anxiety. Yoga provides a powerful tool for managing through the practice of mindlessness ( living to the moment and the ultimate emptiness ) and meditation. The combination of controlled breathing, mindlessness and physical movement can help to reduce the levels of the stress hormone cortisol, leading to a reduction in stress levels. Amygdala, the emotional sentinel in our brain hijacks the prefrontal cortex during times of stress. 'Low on emotions' state keeps us in a calm and composed state even at adversity enabling us to handle stress properly. High on emotions literally hijacks the thinking capacity of the cortex and reflexive decisions are made from the hindbrain which often go wrong making us distressed. It is worthwhile to note that we should never make decisions when you feel distressed. It is wise to have high Emotional IQ
Additionally, yoga includes a variety of postures or “asanas” that have been specifically designed to promote relaxation and reduce stress. For example, the downward-facing dog pose, known as Adho Mukha Svanasana, is an excellent yoga pose for reducing stress and anxiety. By stretching and contracting the body in specific ways, yoga helps to release pent up tension and promote a sense of relaxation.
Through the practice of yoga, individuals learn to focus their awareness on one particular thought in the mind and be present in the moment, which can help reduce stress and anxiety. In yoga, individuals use controlled breathing techniques and body movements to bring the mind into a state of calm and relaxation. By doing this, they can shift their focus away from the stressors of daily life and find inner peace.
Awareness is a mental concept that allows us to be more present in the world around us and is a very important part of Yoga. Awareness is a glow of light illuminating the part of the mind which we wanted to focus. Where is mind ? Never mind !! It's not definitely in the brain but rather the universal consciousness. Brain is like an antenna for perceiving the broadcast. There should be awareness in the postures, in the feeling of the stretches and observation of the breath. This is when the practice becomes more beneficial. Each time we practice experiencing a posture with awareness, the gift of the posture keeps on getting enriched and we experience growth in our practice.
Awareness is not about only doing an asana. It is a very good ego boost. Each session of pranayama practiced with awareness increases our experience of sensitivity and expands our awareness. Awareness is the essence of Yoga. Being aware of our current emotion, without being judgmental about it is the same as Yoga.
One of the primary benefits of yoga is the ability to bring about a deep sense of relaxation. Basically, Vagal tone is strengthened in many different ways through breathing techniques thereby one continues to stay in parasympathetic dominant mode (the natural state) except for acute emergencies (flight or fight response - Sympathetic dominance for protection) helps people to stay grounded to reality. Through the practice of yoga, individuals can release tension in both their mind and body, reducing feelings of stress and anxiety. In addition to the physical movements and breathing techniques, the focus on mindfulness and being present in the moment can help individuals achieve a deeper level of relaxation.
Anxiety is a common mental health concern in the modern world. We are living in a world of Sympathetic dominance; the very reason for many of the diseases of modern-day civilization. Interestingly, such derangement is often emotional rather than physical causes. The practice of yoga can help to reduce anxiety by promoting relaxation and reducing the levels of stress hormones in the body. By focusing on the present moment and controlling the breath, individuals can learn to calm their minds and reduce feelings of anxiety.
Every time life takes you on a roller coaster ride, just ‘Pause’ for a moment! Be a witness to the situation without any attachment or aversion, instead of clinging to it. This gives a clear perspective of the situation, and this is what mediation teaches us.
Depression is a serious mental health condition that affects millions of people worldwide. While yoga is not a cure for depression, it can help to manage symptoms and improve overall mood. The combination of physical activity and mindfulness can help to increase the production of feel-good hormones, such as serotonin and dopamine, leading to improved mood and reduced symptoms of depression.
Yoga is often seen as a form of physical exercise that combines controlled breathing, postures (asanas), and meditation. The physical aspect of yoga is aimed at improving flexibility, strength, balance, and overall health.
The practice of yoga involves a range of movements and postures that help to stretch and strengthen the muscles, tendons and ligaments, thereby improving flexibility and range of motion. Over time, a regular yoga practice can increase flexibility and reduce the risk of injury, especially for individuals who spend a lot of time sitting or have sedentary lifestyles.
Many yoga postures require individuals to hold their own body weight, which can help to build strength in the muscles, especially in the arms, legs, and core. This can be particularly beneficial for individuals who are looking to improve their overall fitness level. For example, the warrior pose, or Virabhadrasana, is an excellent yoga pose for building strength in the legs, arms, and core. Yoga is not only for flexibility or aerobics, but it could improve muscle building and strength through anaerobic or weight bearing strength training.
By practicing yoga regularly, individuals can also improve their overall body tone. The combination of stretching, holding poses, and controlled breathing can help to tone and sculpt the muscles, leading to a more toned and defined physique. In a world moving towards sedentarism with high prevalence of Sarcopenia ( muscle loss ) Osteopenia ( bone loss ) mainly attributed to the disuse atrophy, hence preserving them is so vital for preventing chronic ailments.
In yoga, balance is not just physical but also mental and spiritual. Through the practice of yoga, individuals can improve their balance both on and off the mat. This can help to reduce the risk of falls, especially among the elderly, and improve overall posture and alignment.It is worth to remember that the most common reason for morbidity and mortality among elderly is falls & fractures.
Yoga is not just a physical practice but also a spiritual one. The word ‘yoga’ means ‘union’ and is meant to bring about a sense of unity between the individual and the universe. The spiritual aspect of yoga is focused on the development of awareness and consciousness, leading to a deeper sense of connection and purpose.
Through the practice of yoga, individuals can develop a greater sense of self-awareness. This involves being mindful of the thoughts, emotions, and physical sensations that are experienced in the present moment. By developing self-awareness, individuals can gain a better understanding of their own needs and desires, leading to a deeper sense of purpose and fulfillment.
We always tell our kids to concentrate particularly on their studies. But we ourselves have no idea what concentration is ? and the methods to concentrate !! Concentration is the ability to keep your focus on a particular thought.The ability to stay concentrated for a longer time is the willpower.Willpower is like mental biceps !! Yoga helps you to focus , to concentrate and increase your willpower when practiced regularly on a daily basis.
" Wherever attention goes, your energy flows " & ultimately power manifestation happens turning them into reality. The problem is we never where to focus ? In order to find where to focus, we should know the purpose in your life. Each & every human is gifted a specific ability to perform a single task at the very best of human possibility !!! This would definitely give us the path to find the purpose in our life. Boredom will never occur if you synchronize yourself with the purpose in your life.
The practice of yoga can also help to develop a deeper sense of connection to the universe. This involves a sense of interconnectedness with all living things and a deeper understanding of the interdependence of all things. By developing this sense of connection, the practice at Yoga helps to realise the ultimate truth and to be at peace with oneself.
The ancient practice of Yoga continues to be more relevant than ever in the modern world. By combining physical movements, breathing techniques, and mindfulness, Yoga offers individuals a powerful tool for controlling their mind and body. Whether you are looking to reduce stress and anxiety, increase flexibility, muscle strength, and body tone, or simply find inner peace, Yoga has something to offer for everyone.
The modern world is filled with noise, distractions and multiple forms of stimuli. Noise, whether external or internal, is a part of our daily existence, and practising Yoga amidst it brings us back to the present moment and helps us stay focused. Embrace Yoga amidst all the noise and find your inner peace regardless of where you are!
Suvasini, Yoga expert
