Wonder why at least one in each of our family members of the entire population is affected by one or a combination of metabolic disorders like Diabetes , Hypertension, Obesity , Fatty liver , Cholesterol, Heart disease , PCOS and Infertility , collectively called " the Plagues of Prosperity ". It has been widely rampant several times in the last 50 years after the introduction of the Green revolution, Industrial farming and globalization of foods.
Fast foods are literally defined as easy and ready to make in minutes.
Fast foods can be cooked Fast , raise blood sugar very Fast and we end up living Fast to meet the maker in heaven soon !!!!
" Most of the foods are inherently healthy but what we have done to the food has made it toxic "
Ultra Processing of foods - removal of fibers and addition of excessive sugars made them ultra palatable and addictive. Our system is not designed to sense and assimilate the UFP ( High sugar & Low fiber ) properly because the liver is flooded with a lot of glucose within a short span of time that the pancreas makes a lot of Insulin to keep the blood glucose within normal limits in such situations. High insulin levels & Insulin resistance are the primary drivers of Metabolic disorders.
Almost all of us believe " all home cooked foods are healthy " ; an absolute myth that needs to be debunked. Maybe this could have been relevant prior to Industrial farming and the green revolution but certainly not in this present era !!! Hard to believe ? Bitter truth and the ground reality. Almost 75 % of our population is suffering from chronic Non-communicable diseases ( NCDs ) due to poor lifestyle choices. All these metabolic disorders which were largely unknown & mainly affecting the affluent society ( Kings & Queens of the past ), a century ago have become so rampant that it affects even the poorest of the poor sparing no families !!!
White polished rice is easy to cook in 10 min whereas the traditional organic rice varieties need 30 - 45 min for proper cooking !!!
Grains contain three layers viz epicarp full of husk and multilayered bran ; endosperm contains only the carbohydrate and germ contains healthy fats and micronutrients.Traditionally we use to hand pound the rice , removing only the husk and few layers of bran. Consuming it in wholesome form with minimal processing supplies low glycemic Load and necessary nutrients like B-vitamins and minerals ( acting as cofactors of metabolism) packed in them for proper Metabolism.
Removing the fiber from the grains, particularly rice and wheat, increases the shelf life for years whereas the fiber rich unpolished grains cannot be stored for months. The problem arose when "Food became Commodities". Moreover, it is highly incompatible in restaurants to use unpolished rice which cannot be stored for months whereas polished rice and white flours can easily be stored for years !!!! Another problem is deficiency of B-complex vitamins which acts as cofactors in many of the reactions related to Energy Metabolism & Methylation pathways. The intake of pulses has gone down drastically after the green revolution because of the monopolization of crops viz , Rice , Wheat , Corn & Soy along with cash crops. We are actually depriving the gut microbiome with a low fiber diet.
Our soil is deprived of nutrients particularly minerals with 5 decades of industrial farming and hence our food supply has micronutrient deficiencies particularly minerals and vitamins & we are treating micronutrient deficiencies with pills !!!
NUTRIENTS |
CHEMICAL FARMING |
ORGANIC FARMING |
| Organic Matter | -14% | +29-99% |
| Total Nitrogen (N2) | -7-22% | +21-100% |
| Available Phosphorous (P) | 0% | +63% |
| Available Potassium (K) | -22 % | +14-84% |
| Zinc (Z) | -15.9-37.8%
| +1.3-14.3% |
| Copper (Cu) | -4.2-21.3% | +9.4% |
| Manganese (Mn) | -4.2-17.6% | +14.5% |
| Iron (Fe) | -4.3-12% | +1 % |
The problem with Wheat is that hybrids were introduced in the green revolution which are responsive to artificial fertilizers and sprayed with pesticides, Insecticides, herbicides and weedicides. Gluten content in wheat from chemical farming is at least three times higher compared to organic traditional wild variety. It affects mitochondria slowing down the metabolism, adversely affects gut microbiome and produces gastrointestinal disorders including leaky gut , which predisposes to autoimmune disorders & Metabolic disorders.
Most of the home cooked foods nowadays are mostly ultra processed and high Insulin diets ( a combination of high refined carbs and refined oils ). The glycemic index, glycemic load and the insulin response of home cooked foods are as comparable to that of foods served in fast food restaurants.It is not only the fast foods in restaurants that impact our health but the effect of home cooked ultra processed foods is far more higher in producing the metabolic disorders because most of us , use to dine out mostly during the weekends and not on a regular basis in day to day life.
Food industry and Big pharma have fabricated scientific research to their economic advantage, demonizing the saturated fats that humans have been using for thousands of years. In the 1960s , Heart disease was rampant in the general population and the government funded a lot of research studies to decode the science and reason behind it. Ancel keys conducted a large scale study in 22 countries and found no correlation between the expected dietary fat and heart disease. He tricked the world by eliminating the countries which didn't show a positive correlation. Out of the 22 countries where studies were conducted, only 6 countries showed a positive correlation between dietary fat and heart disease whereas the rest of the countries showed no correlation at all.He published in the research paper that dietary fat is the cause of Heart disease. Following that recommendations and guidelines were given for populations who were scaremongered about saturated fat and Cholesterol. This scaremongering is still prevalent in the public !!! People switched over to eating a lot of refined carbs and excessive sugars and decades passed away.Now Heart disease is the leading cause of mortality worldwide.Largely influenced by the food industry Saturated fats that increase cholesterol and hence they are bad according to the Diet- Heart hypothesis. Even the heart associations are advocating PUFA ( PolyUnsaturated Fatty Acids) as Heart healthy not knowing about the Oxidative damage they bring to our system. The altered cholesterol numbers are just a reflection of metabolic health status and Insulin Resistance and have nothing to do with intake of saturated fats or cholesterol in diet per se !!!
Liver makes cholesterol 2-3 g/day which is absolutely essential for cellular homeostasis- repair and regeneration , synthesis of steroids and sex hormones , membrane fluidity and receptor functions , neuronal health and Quorum sensing for Immunity. LDL-Cholesterol has been wrongly demonized as bad fat and scientific communities are using statins & PCSK9 inhibitors to keep it near zero for reducing the risk of cardiovascular diseases like heart attacks and strokes. The entire population is affected by the scaremongering about the Cholesterol & cholesterol phobia is very prevalent around the world.
Refined oils are mostly made from Soybean, cottonseed , corn , canola and tagged as heart healthy vegetable oils !!! It is high in PUFA ( PolyUnsaturated Fatty Acids) which are more prone for Oxidation.In Fact these oils increase the chances of heart attacks and strokes !!! It is widely used not only in restaurants and commercials but also in most homes as it is much cheaper and looks clearer. Most of us are still unaware of the effects of refined oils in our biological system one is that they are mostly PolyUnsaturated Fatty Acids ( PUFA ) prone to oxidation and produce oxidative damage and free radicals inside our system.To neutralize this excess free radicals, we need more and more antioxidants like Glutathione ( the most important free radical scavenger) primarily in Liver. It is reflected by elevated liver enzymes ( GGT- Gamma Glutamyl Transferase ) & AST ( Alanine aminotransferase ). Moreover , the Oxidative damage inside the liver causes inflammation ( Steatohepatitis ) and one runs the risk of easily developing Insulin resistance syndrome since the metabolic buffer of PFT ( Personal Fat Threshold ) is bypassed. The so-called " Bucket handle " hypothesis that when subcutaneous fat storage is saturated and overwhelmed, fat spillover occurs and causes Fatty liver and systemic insulin resistance is not very valid to a major portion of the population in this modern era. The metabolic syndrome is most often explained by Main lining Hypothesis that Liver plays a central role in energy homeostasis and Fatty liver is a harbinger of Systemic Insulin Resistance. Liver fat is driven by excess Fructose ( sugars ) consumption and hyperinsulinemia causing De novo Lipogenesis (DNL) ie., conversion of sugars into fat. One become fat and sick in the past to suffer from metabolic disorders ( before 4-5 decades ) BUT In the present day modern era, one may not have to become obese and overweight since most of the ultraprocessed foods are directly hitting the liver and produce Fatty liver and hepatic insulin resistance and thence systemic insulin resistance.
Another important aspect in the food chain is the Hybridization of Fruits in the last 100 years to make it taste like honey & its abundance throughout the year. The natural taste of fruits is Tart !! as most wild fruits. Fruits towards the end of summer give the animals a survival advantage to eat more and more & store it as fat so as to survive the periods of adversity ( Food scarcity in the winter months ).This is particularly seen in hibernating animals. We are living in a world of surplus and unlikely to suffer droughts or food scarcity. Now we are "Cactus in the Rainforest". The survival advantage has become a Curse !!! Although fruits are natural energy bars loaded with micronutrients and electrolytes it is worthwhile to take locally available seasonal fruits.Hybridized high sugary fruits in large quantities are not fine for someone with metabolic disorders.
Low sugary fruits are fine when consumed in wholesome form. It is often mistaken that fruit juices are fine ; Absolute myth !! The fruits when consumed in wholesome form have both soluble and insoluble fibers with low Glycemic Load and Low Insulin response whereas the juices contain only the soluble fibers with high Glycemic Load and high insulin response. Insoluble fibers form a lattice network in the inner lining of the small intestine whereas soluble fibers form hydrogel over the lattice network preventing rapid absorption of glucose and fructose into the blood circulation. Since most of the insoluble fibers are removed during Juicing , Sugars flood the liver pretty quickly driving DNL producing Fatty liver. Fruit juices are no different from soda !!
Most of the ingredients ( grains , vegetables, spices and fruits) used for cooking at home are loaded with pesticides, herbicides, weedicides , Insecticides all of which are Biocides that have its impact on our biological system particularly gut microbiome and mitochondria.Our Mitochondria is derived from bacterial genes by maternal inheritance ( mother's side ) & Our gut microbiome is an integral part of human biology. Biocides inhibit the 'Shikimate' pathway of the microbiome and act as mitochondrial toxins slowing down the metabolism and ultimately produce Insulin Resistance and Metabolic disorders. It affects the integrity of the inner lining of the gut wall producing Leaky gut and potentially many of the gastrointestinal disorders and Autoimmune disorders.
Basically the differences that we see between fast food restaurants and home cooked foods is the use of Flavor enhancers ( MSG - Monosodium Glutamate or Ajinomoto which is excitotoxin to the neurons producing neuronal damage) the very reason why we are hooked towards fast foods in restaurants , food additives and preservatives and high fructose corn syrup (HFCS ) and corn flours.
Hydrogenated fats ( Trans Fats ) are nothing but vegetable oils bombarded with hydrogen to make it solid at room temperature and preferred in most restaurants as they are cheap and easy to handle. But it contains a lot of trans fat in it. It is very new to our body that it cannot metabolize , resulting in Fatty liver and adverse cardiovascular consequences like Heart attacks and Strokes.Although it is banned in most of the developed countries like the European Union and USA , the ban is still waiting to happen in India.Most of the restaurants use this kind of cheap oils for their routine use. The sad story is it is also widely used in cooking at home merely because of its cheap price in the name of vegetable ghee !!!
Home cooked foods of the modern era are at least 75% as bad as fast foods !!! Little do we know this very basic information and still we are in great delusion that home cooked foods are healthy and continue to suffer from chronic diseases lifelong.
"Your eyes cannot see what you mind does not know "
What we need the most in alleviating the chronic metabolic disorders like Diabetes , Hypertension, Obesity and Heart disease is Education , enrich your knowledge & empower yourself to lead a disease free drug free life. We need to shift our focus towards Organic foods , reduce our sugar consumption , routine use of unpolished or slightly polished traditional rice and millets by organic farming , and avoid vegetable oils. This could be the only sustainable and scientific solution to prevent, treat and reverse metabolic disorders from its roots rather than treating them with drugs , lifelong !!!
We are living in a digital world of misinformation ; fabricated scientific researches and false propaganda of mass media, wondering why we are stuck with false knowledge ?
Finally , choose your food plate wisely !!!
because ,
" Good food is Medicine &
Bad food needs medicine "
Dr. Thangadurai
Erectile Dysfunction (Impotence) is the inability to get or maintain the erection, firm enough for the sexual act. It is no more a disease of only the old age, which itself may not be necessarily so, in good health. It is often encountered by the middle-aged men and even in the younger men in their 30’s nowadays. Males with ED may feel the penis to return to a flaccid state before the ejaculation or complete intercourse with the partner. It has become a nightmare for most of the middle-aged sexually active men. It can be isolating, emasculating and distressing. Psychologically it can make a person to feel ashamed, embarrassed and frustrated. It may lead to anxiety, depression and self-esteem problems if it goes untreated. It strains relationships and Impotence stays as strong grounds for legal divorce than the other reasons for male infertility. In India, it is still considered a taboo to talk about erectile dysfunction, a discussion with the right person and the healthcare professionals to seek out for their advice. Most often than not, the common advice given by their peers is just to pop up a pill, before a sexual act to stimulate and maintain erection for a considerable amount of time.
More than 95% of men can be treated for ED, according to the CDC. Sometimes, ED could be due to the underlying disorders like type 2 diabetes, chronic kidney disease, multiple sclerosis, Peyronie's disease, injury to penis, bladder, prostate, pelvis or spinal cord. Smoking, Drinking and medications (propranolol, methyl dopa, SSRIs) could also lead to erectile dysfunction. There are a variety of treatments available. These include medications that increase the blood flow to the penis, testosterone to help erections in those with low testosterone, a vacuum device that fits over the penis and creates an erection firm enough for sex, injections or suppositories to stimulate an erection before sex and penile implants. Many of us may not even aware of the underlying problem behind erectile dysfunction and the ways to cure it. The only way to know the best treatment is to speak with a doctor and discover whether the source of ED is due to physical or psychological. Early morning erections rule out physical cause of ED.
Although Psychology & Stress play an important role in erectile dysfunction, the most important reason which is often ignored is our failure to understand is that it's not about a problem confined to the sexual organs. Perhaps, it is a symptom of Insulin resistance affecting the entire vascular system. A man is as old as his arteries; so, if the vitality of cardiovascular system is preserved, he can stay younger and agile lifelong. The secret to "Youngevity-Healthspan" is to stay insulin sensitive with diet rich in micronutrients to keep all of your organs in harmony.
The discovery of Nitric oxide (NO) as a signaling molecule in cardiovascular system for which Nobel prize was awarded, led to the billion-dollar business of the little blue pills and eventually the Blue Pill became a Pop Culture Phenomenon. Erection happens only when there is pooling of blood in the penis, mediated by Nitric oxide. What happens in Insulin resistance? The endothelial cells are not producing nitric oxide good enough to maintain erection. Taking pills for ED is just like taking pills for diabetes and hypertension lifelong. Although symptomatically you may feel better momentarily, the disease stays lifelong. Unless the roots of the disease are addressed, the cure for any disease is always remote; ED is not an exception to that.
Nitric oxide in the form of nitrates is used for vasodilation in patients suffering from angina pectoris (ischemic heart disease), which is a disease of inadequate blood supply. Even many vacuum assisted devices are used as effective measures for ED. Aren’t we really ignoring the basic problem which needs to be addressed in the first place?
ED could be a canary in the coalmine. It could be the first symptom of the impending heart attack. In more than 80% of the heart attacks, there is a prior history of erectile dysfunction in the last 5 years. The blood vessels supplying the arteries are affected first considering the caliber of the arteries, smaller being affected first followed by the larger ones. So, if someone suffer from ED, it should be treated as a serious condition after ruling out other causes, because the vascular system is universally affected by endothelial insulin resistance and the atherosclerotic plaques formation.The inability to maintain erection can possibly be the first symptom of vascular insulin resistance. The symptom of heart disease may appear a little late because of the difference in the caliber of the vessels involved.
Erectile Dysfunction should be considered as a comorbidity. Healthcare professional should have a detailed discussion with the patients with ED about the risk of Cardiovascular diseases and possibly evaluate if needed. Hence the focus should be not only to treat the ED but also in the prevention of Cardiovascular diseases.
How can we improve nitric oxide production naturally? There are two sources of nitric oxide namely (i) endogenous – produced by the endothelial cells of the vascular system throughout the body thereby relaxing the smooth muscles, causing vasodilation. (ii) exogenous – from the food supply. The nitrates are enriched in beetroot and green leafy vegetables. The oral nitrates in the food supply are converted into nitrites by the action of facultative anaerobic bacteria in the oral cavity and hence it is essential to chew the food adequately (ideally 25-32 times) with lips closed for facilitating this action. The nitrites are converted into nitric oxide, by the action of hydrochloric acid in the stomach.
The endogenous production of nitric oxide is severely compromised when the body suffers from insulin resistance. It is absolutely essential to reverse insulin resistance completely to cure erectile dysfunction. The exogenous supply of nitrates from natural sources are better choices without any side-effects unlike other prescriptions or procedures.
The best way to prevent erectile dysfunction is to make healthy lifestyle choices and to manage any existing health conditions. For example
1. Seek healthcare professionals who follow evidence-based clinical practice for the reversal of diabetes, heart disease or other chronic conditions.
2. Regular checkups and medical screening tests to look for insulin resistance periodically for prevention.
3. Switch over to organic foods because endothelial nitric oxide synthase is vulnerable to glyphosate (pesticides) and other environmental toxins like aluminium and mercury.
4. Stay away from ultra-processed foods that cause insulin resistance (a trifecta of excess sugars, refined carbs and refined oils).
5. Stop smoking, limit or avoid alcohol and don't use illegal drugs. “Stop Smoking & Keep Walking” is the mantra for your Vascular Wellness.
6. Exercise regularly as it potentiates nitric oxide production by several folds. Nitric Oxide Dump is a new version of high-intensity interval training (HIIT) that is designed to stimulate the release of nitric oxide, which can catalyse and promote health. This training uses simple movements done in quick succession, providing benefits similar to longer workouts, but accomplished in just a very small fraction of time.
7.Kegel exercises, or pelvic exercises, have proven to be effective in addressing erectile dysfunction, and it should be used as the first-line of treatment. The ischiocavernosus and bulbocavernosus muscles in the pelvic area surround the penis and are active during an erection.
8. Take steps to reduce stress that help in performance anxiety.
9. Get help for anxiety, depression or other mental health concerns.
10. Yoga
11. Herbs and supplements like Shatavari, Ginseng, L-arginine, L-carnitine etc.,
12. Fasting improves insulin sensitivity so as regular physical activities. Fasting induces autophagy which could help in the reversal of the atherosclerotic plaques.
Finally, it's not all about the potency of one organ, but the preservation of functionality of the entire vital organ systems which reflect the state of sexual health.
Dr.R.R.Thangadurai M.S,
Knee replacement surgery is one of the major surgeries done in most of the tertiary care centers. Osteoarthritis is classically referred to as the degenerative changes because of wear & tear. But is it really so? OA knee seen in the elderly is increasingly affecting even the middle aged nowadays, tells you a different story. Obesity, together with aging and injury, is among the main risk factors for osteoarthritis. Obesity-related osteoarthritis can affect not only the weight-bearing joints, but also the hands, suggesting a role for circulating mediators released by the adipose tissue and known as adipokines. Thus, osteoarthritis may have a systemic metabolic component. Evidence from both epidemiological and biological studies support the concept of metabolic osteoarthritis, defined as a broad clinical phenotype that includes obesity-related osteoarthritis. Thus, osteoarthritis can be related to metabolic syndrome or to an accumulation of metabolic abnormalities. In addition, studies have demonstrated associations linking osteoarthritis to several components of the metabolic syndrome, such as hypertension and type 2 diabetes, independently from obesity or any of the other known risk factors for osteoarthritis. Both in vitro and in vitro findings indicate a deleterious effect of lipid and glucose abnormalities on cartilage homeostasis. Chronic low-grade inflammation is a feature shared by osteoarthritis and metabolic disorders and may contribute to the genesis of both. Thus, osteoarthritis is emerging as a disease that has a variety of phenotypes including a metabolic phenotype as the predominant variety, in addition to the age-related and injury-related phenotypes.
In OA, the joint space is decreased due to damaged cartilage and bone spurs. The evolution of the Osteoarthritis disease process is characterized by cartilage degradation at least in part by proteolytic breakdown of macromolecules, in which MMPs play an important role. Further, fibrillation and erosion of the cartilage surface result in the release of molecular breakdown products into the synovial fluid. The phagocytosis of cartilage matrix breakdown products and other materials induces an inflammatory reaction in the synovial membrane, thereby resulting in local synthesis of proteases and proinflammatory cytokines.
We all know that the modern diseases of civilization have been rampant in the last 40-50 years; so is the prevalence of OA. Can there be any correlation between these two? Interestingly the answer is a huge yes when we know the roots of the disease !! Most of the cardiometabolic disorders are rooted in Insulin Resistance. Careful evaluation of OA roots in insulin resistance!!! But it is hard to believe…
Let's dive deeper into the science of understanding the pathogenesis of OA. In the past, OA was viewed as a degenerative condition occurring in old age because of the wear and tear phenomenon. Recent scientific researches challenge this hypothesis and favour the inflammation associated with insulin resistance as the major causative factor in OA. Some proponents favour that it is a combination of mechanistic and inflammatory disorder associated with insulin resistance. Increased joint loading, adipose tissue inflammation and atherogenic dyslipidemia act synergistically to induce tissue damage in OA. Synovial Macrophage activation and the resulting inflammation links the Obesity with OA. In diabetes, synovial insulin resistance causes reduced anti-inflammatory and anti-catabolic effects of insulin.
Hepatic Insulin resistance is associated with increased production of MMPs ( Matrix Metalloproteinases) ie., dissolve the extracellular matrix laid down by the bone forming cells called osteoblasts. Although normally MMPs are secreted constitutively from the liver in smaller amounts for homeostasis, their secretion is increased several times when someone suffers from insulin resistance. Other mediators in insulin resistance impacting joints are chronic low grade inflammation, proinflammatory cytokines like IL-6 and TNF-alpha. Now comes the question; are we treating it right ?
The various treatments which are widely available are NSAIDS to relieve pain ( actually it can destroy the joints on long term use). Calcium supplements and vit D normally considered to increase bone strength actually may increase the atherosclerotic burden !!!
1.Protein forms the backbone or the matrix, in which deposition of minerals like magnesium, calcium occurs. Hence protein rich foods are very much needed for healthier bones.
2. Vit D increases the absorption of calcium by several folds and hence calcium supplementation is usually not necessary for bone health.
3. Without Vit K2, the calcium absorbed is largely misdirected towards soft tissues and even arteries throughout the body increasing the atherosclerotic burden. Hence it is utmost essential to prescribe vit K2 whenever vit D3 is suggested to guide the absorbed calcium towards the bones. Vit K2 deposits calcium in the bones and takes away the calcium deposition from the arteries.
4. Magnesium supplementation mitigates chondrocyte apoptosis and facilitates chondrocyte proliferation and differentiation. Synergistic effect of Magnesium and probiotics in modulating the inflammatory milieu could help in the prevention and treatment of OA.
5. Vit C acts a cofactor in the hydroxylases which converts proline to hydroxy proline; Proline, hydroxyproline and Glycine form the basic structural components of collagen and its long-term deficiency causes impaired collagen synthesis and scurvy. Hence it is essential to supplement vit C for optimizing collagen synthesis.
An artificial knee joint has metal caps for the thigh bone and shine bone, and high-density plastic to replace damaged cartilage. Each of these artificial parts is called a prosthesis. Knee replacements surgery replaces parts of injured or worn-out knee joints. The surgery can help ease pain and make the knee work better. Recent research studies found that about a third of total knee replacements in the United States are inappropriate. The numbers could be considerably far higher in our country.
If a person is severely affected by osteoarthritis with poor quality of life impacting everyday activities, causing them patient to stay in the house more and avoiding outdoor activities. People who need knee replacement surgery usually have problems walking, climbing stairs and getting up out of chairs.However, the most common reason for knee replacement surgery is to ease pain caused by arthritis. Fortunately, in our holistic approach pain gets settled in a few weeks in most of the patients with OA by reversing insulin resistance with a micronutrient rich, anti-inflammatory diet and protocols. As a general rule, it avoids unnecessary surgical intervention.
knee replacement surgeries can be considered only if it is resistant to optimal conservative management.
Although Knee replacements are common and relatively safer procedures nowadays, the risk of having complications depends on your age and general health.
1. Blood clots or DVT (Deep Vein Thrombosis) and sometimes serious complications like pulmonary embolism.
2. Wound infections are less common, and they are treated with antibiotics but sometimes may require further surgeries.
3. Damage to nerves or tissues.
4. Problems with your new knee may be in bending the knee, ongoing pain and stiffness and instability which improve with physiotherapy and certain exercises.
5. Per-operative and postoperative anesthetic and drug adverse reactions.
Pain relief, improved joint function and joint stability are the main goals of treatment. The muscle weakness and muscle atrophy contribute to the disease process. So, rehabilitation and physiotherapy were often prescribed with the intention to alleviate pain and increase mobility. However, as exercise has to be performed on a regular basis in order to counteract muscle atrophy, continuous exercise programs are recommended in people with degenerative joint disease. Therapeutic exercise regimes either focus on muscle strengthening and stretching exercises or on aerobic activity which can be water based. Surgery should be reserved for those that have not responded appropriately to less invasive methods.
1.Maintaining Insulin sensitivity throughout your life.
2.Ensure your diet contains quality proteins in adequate amounts. Unfortunately, Indian subpopulation tend to have a deficit of 30-40% in their daily intake of proteins. People over 60 years actually require 1.5 times the normal protein requirement which is not met in most of the cases.
3.Micronutrient rich diet (vitamins, mineral, antioxidants, polyphenols)
4.Regular physical activity & exercise."Use it or else you lose it" (Bone is a dynamic structure - improving muscle mass and strength improve bone density and quality).
5.Ensure the TDS of drinking water in the optimal range of 200-300 (RO water with TDS less than 50 in most cases have the potential to leach out the minerals in the bones over a period of time).
"Preserve your joints before it is too late".
Dr.R.R.Thangadurai M.S,
Heart disease which is largely unheard of a century ago, has now become the leading cause of deaths worldwide. Drastic change in the food system in the last 60 years contributed much to most of the diseases of modern era. Insulin resistance is the common denominator in heart disease as well.
Lipid profile actually reflects the current metabolic status. Although, atherogenic dyslipidemia tells you the current metabolic status and predicts the future risk of poor metabolic health, it fails to reflect the atherosclerotic burden. The correction of dyslipidemia by reversing insulin resistance recently by following healthy food and lifestyle cannot guarantee you that you may not suffer from cardiac events.
Humans do not produce Vitamin C due to a mutation in the GULO (gulonolactone oxidase) gene that occurred 40 million years ago. Normal GULO is an enzyme that catalyses the reaction of D-glucuronolactone with oxygen to L-xylo-hex-3-gulonolactone. This then spontaneously forms Ascorbic Acid (Vitamin C). However, without the GULO enzyme, no vitamin C is produced. This has not been selected against in natural selection as we are able to consume more than enough vitamin C from our diet. It is also suggested that organisms without a functional GULO gene have a method of "recycling" the vitamin C that they obtain from their diets using red blood cells. Arteriosclerotic plaques develop as a result of long-term vitamin C deficiency. Lipoprotein (a) became a surrogate for vitamin C in our ancestors. Arteriosclerosis is an early form of the sailor’s disease, scurvy.
The atherosclerotic plague once formed almost never heals completely, although it can be stabilized. Hence it is utmost important to realize that the past events in the blood vessels predicts the future risk. It is easier to reverse insulin resistance completely with proper diet and lifestyle within few months. But it is really possible for the plaques in the arteries of the heart to disappear completely?
For example, a person who suffered from insulin resistance (accompanied by atherogenic dyslipidemia) for the past 15-20 years could have a plaque buildup in the form of the old hard stenotic plaques and soft non-stenotic plaques. Reversing insulin resistance can drastically reduce the risk of heart attacks or stroke but may not be possible to eliminate the risks completely.
Another difficulty in predicting the atherosclerotic burden is that most of the imaging techniques from stress ECG to ECHO or even angiogram to CAT, mainly identifies hard plaques and mostly the soft plaques go undetected. But doctors have now found that most heart attacks are caused by soft or vulnerable plaques. A Vulnerable plaque is an inflamed part of an artery that can burst. Hard plaques are partially healed lesions with calcium deposition in which the inflammation has settled down and hence the chances of rupture are very less. Having hard plaques are not without risks but comparatively very less compared to soft plaques in producing heart attacks.
Any significant blockage of coronary vessels (beyond a threshold) helps in the formation of collaterals from the vessels nearby. A person who is insulin sensitive has good nitric oxide (NO) production which regulates arteriogenesis along with angiogenic factors and shear stress. NO significantly impacts vasomotor tone to enhance conductance of the newly recruited collateral arteries, and this effect is augmented by exercise training prior to arterial occlusion.NO plays a central role in arteriogenic signaling events. Maintenance or improvement of NO production and signaling, such as with regular exercise, may improve endothelial cell function and thus may help preserve the arteriogenic potential of pre-existing collateral networks. In patients with CAD, a well-developed coronary collateral circulation contributes to reduction of infarct size, LV dysfunction & mortality. Hard plaques actually can contribute to most of the stenotic lesions in producing anginal pain in which the heart muscle suffer from ischemia due to the stenotic lesion perse as well as from the poor collateral circulation. Angina is not usually life threatening, but it’s a warning sign that you could be at risk of heart attack or stroke. However, your angina may turn into a heart attack if the cells in your heart do not get enough oxygen for too long and they start to die, which is often precipitated by physical exertion like moderate to heavy exercise, trekking, unacclimatised work or strenuous physical activity or even emotional stress. In these cases, the heart attack occurs without coronary artery thrombosis. Angina symptoms are usually relieved within a few minutes by rest, relaxation, and taking medications used to treat angina.
The only way in having a bullet proof heart, devoid of risk of heart attacks is “not developing any atherosclerotic lesion throughout the life”. Is it really possible? Atherosclerosis develops only when someone suffer from insulin resistance for a substantial period of time, in which the ectopic deposition of the fat in the heart incites inflammation. Inflammation of the coronaries causes deposition of cholesterol (Cholesterol carries antioxidant molecules and it acts a band aid repairing the blood vessels) results in the formation of plaques. The antioxidants in LDL - Tocopherol, Carotenes are used before there is damage to the phospholipid bilayer or Apo B100 – When these are oxidised it’s considered oxidized LDL. When viewed from this standpoint, LDL is a friend to be cultivated rather than annihilated by Statins or PCSK9 inhibitors.
Lp (a) – Not LDL - binds To Fibrin, Collagen & Endothelial Cells.
Atherosclerosis develops over a period of “decades” but most of the heart attacks happens within “minutes” due to the rupture of those plaques producing coronary artery thrombosis.
Though there is no cure for coronary heart disease or way to remove the atheroma completely that has built up in the arteries, treatments and changes to your lifestyle can help to prevent your condition and your symptoms from getting worse. Progressive plaque cap thickening and plaque shrinkage could be accomplished with micronutrient rich diet and staying insulin sensitive, with consumption of leafy greens & beets. All these factors augment the production of nitric oxide.
Unfortunately, the development of atherosclerosis starts early in life, in their teens and progresses as one gets older. It is worthwhile to remember, that one-third of the paediatric population is suffering from insulin resistance with one or more components of metabolic syndrome. Hence, primordial prevention of heart disease should be started from the childhood itself.
1.Pycnogenol-150 mg
2.Gotu Kola - 450 mg
3.Vitamin K2 - mega doses ( 2 mg for 3 months followed by 200 mcg till normalization of biomarkers)
4.Nattokinase
5.Niacin
Tocotrienols, berberine, aged garlic, magnesium, potassium and Vit D also help to clean out plaque naturally.
Dr.R.R.Thangadurai M.S,
Gestational Diabetes is a type of glucose intolerance or diabetes that develops in pregnancy.GD usually appears in the middle of pregnancy between 24-28 weeks.
The prevalence of GD is 10 % worldwide and it is around 15 % in India. This could be attributed to the poor nutritional status overall.
Physiological insulin resistance occurs both in puberty as well as pregnancy. In Nature, Nothing really happens without a reason. Both the stages are associated with growth spurt. We all know that insulin is an anabolic hormone and the compensatory increase in insulin levels (compensatory hyperinsulinemia) help the foetus to grow at a rapid pace which is actually required during pregnancy.
Your healthcare provider will test your blood sugar during pregnancy. The test may have two parts viz., 1. Glucose Challenge test – using a sweet liquid. After an hour, you will have a blood test to check your blood sugar level. 2.Glucose Tolerance Test if your challenge test results are unusual. GD screening is routinely done between 24-28 weeks of gestation. At this stage, hormones start getting produced by the placenta. This organ forms in the uterus and supplies the fetus with oxygen and nutrients. The hormones it makes can interfere with insulin. However, the screening is done early for at-risk pregnancy in which there is prior history of GD/PCOS/ Obesity/ Known glucose Intolerance/ BMI>25 to prevent the complications associated with hyperglycemia to both mother and the fetus.
GD usually don’t produce any symptoms and that’s the tricky part. But some people experience frequent urination, nausea, thirst and tiredness. There are usually no warning signs of gestational diabetes. Symptoms are mild and often goes unnoticed until you are tested for diabetes in the second trimester of pregnancy.
If uncontrolled , it may lead to complications such as macrosomia in baby, premature delivery, respiratory distress syndrome in infants, hypoglycemia in the baby, risk of future diabetes in the baby as well as the mother, high blood pressure and Pre-eclampsia in mother.
If you are diagnosed with gestational diabetes, nutritional recommendations based on calorie model is done. Avoiding junk foods, processed foods and sugary drinks. Eating smaller meals more often. Exercise often plays an important role in glycemic control. You can talk to your healthcare provider about creating a safe exercise plan, tailored to your unique needs in terms of age, fitness level before pregnancy, overall health and weight. People with diabetes typically have more prenatal visits to check fetal growth (via ultrasound), monitoring of weight gain and discussion with the healthcare provider.
Compensatory hyperinsulinemia due to physiological insulin resistance occurs in pregnancy. It is partially mediated by HTR2B receptors (serotonin receptors) for beta cell proliferation. Serotonin synthesis is dependent on vitamin B6. Low B6 causes failure of beta cell proliferation that contributes to the development of GD.
Interestingly around 40% of women are B6 deficient during pregnancy.
There is a knowledge gap between the scientific researches and the current clinical practices. Much of the scientific researches often go in vain even it contributed some valuable information to the scientific communities. The scientific researches (most of them being funded by the tax payers money) are not actually translated into clinical practice at a desirable pace for the welfare of the population. It is influenced by the Big Pharma and Food industry in the regulation of guidelines and protocols. One such example is the neglect of the importance of vit B6 with relevance to Gestational Diabetes.
Nearly 50 years back, the relevance of vit B6 in GD was published in a world’s renowned scientific journal, BMJ under the title – Improvement of Oral Glucose Tolerance In Gestational Diabetes by Pyridoxine (July, 1975).
During gestation, there is an imbalance in the Trytophan-Nicotinic acid metabolism and needs more of the rate-limiting coenzyme Pyridoxal 5’ Phosphate. Consequently, nearly every pregnant woman will develop a relative pyridoxine deficiency as shown by an increased urinary excretion of tryptophan metabolites, particularly xanthurenic acid, after oral administration of L-tryptophan.
Relative Pyridoxine deficiency leads to the production of Xanthurenic acid (a tryptophan metabolite). Xanthurenic acid is an insulin antagonist thereby inhibiting its functions. Hence increased Xanthurenic acid in relative vitamin B6 deficiency leads to impaired glucose tolerance. Supplementation of vitamin B6, 100 mg daily for 2 weeks reduces the xanthurenic acid to normal levels and it significantly improved glucose tolerance, curing GD in most of the cases. In this particular study, patients responded very well to another course of vit B6 supplementation if they were poor responders initially.
It's totally disheartening to see so many of the pregnant women developing gestational diabetes. Adding more fuel to the fire is the total lack of concern in the last 50 years for overlooking such valuable research and not being translated into clinical guidelines and protocols. Our centers’ experience with the supplementation of vitamin B6 in GD is extremely encouraging, eliminating the need for insulin and avoiding the complications associated with gestational diabetes. Every woman with gestational diabetes or even with the risk of GD should be supplemented with Vitamin B6 100 mg once daily or 40 mg thrice daily for 2 weeks. I hope this implementation comes into clinical practice of every obstetrician and gestational diabetes should no longer be a nightmare anymore !!!
Dr.R.R.Thangadurai M.S,
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
