How strong is your heart?

   Mental stress decreases the blood supply to the heart.(ischemia) Anger has a greater effect on blood supply to the heart. Anger and hostility are strongly related to heart attack

There are three tests which can assess the effect of the mental stress and anger on the blood supply to the heart.

• Mental arithmetic test 
• A speech task
• Anger recall test

These are psychological stress tests

Mental arithmetic test:

person is asked to subtract serially 7 from 3505 for 6 minutes. Subjects were rated on the basis of speed and accuracy

This test induces significant changes in ECG in patients with heart disease. and also in otherwise healthy individuals.

 

A speech task:

A potent psychological stressor, which reliably increases the blood pressure and heart rate. The person

speaks on a hypothetical situation in a department store where he is accused of stealing the belt he is wearing. The subject was given 3 minutes to prepare the speech and 3 minutes to give a speech defending himself and prove that he bought the belt he is wearing.









Anger recall test:

He is asked to recall an incident during the last 6 months, that still made him frustrated,angry and upset.Then he is asked to describe and recreate the incident





After each test, the subjects are rated how anxious and angry the task made them and how angry they were during the anger task compared to the anger during the recall test.




, It could also reveal the coronary heart disease in persons with a normal ECG both at rest and during exercise. 

Anger can damage your heart

    

Anger and hostility are strongly related to coronary heart disease. It affects pumping strength of heart

Angry outburst could trigger heart attack within hours.
It is not an ordinary anger, but an intense anger with hostile and destructive behavior

Events that trigger heart attack:

• Arguments with family members and others, 
• Work conflicts,
• Road rage.

What is the mechanism?

• Increased heart rate (palpitations)

• Spasm of blood vessels and rise in blood pressure

• Decrease blood supply to the heart (ischemia)

• Increased clotting of blood

• Fight or flight reaction:

      This involves release of stress hormones like adrenaline  
      and cortisol and there is a burst of energy.
      Now you are ready to fight an enemy or run away

• If this happens repeatedly, it causes wear and tear of artery walls

P.S.

We know physical risk factors for heart attack, but not aware of emotional risk factors.

Anger is the strong risk factor for heart attack.

We take care of diet, exercise, cholesterol, high B.P.

There is a need to control the anger and hostility. But the patient may not be convinced. On the other hand,he may justify his anger. 

There is a gym for exercise, there is statin for cholesterol, medicines for high B.P. and diabetes.
But there are no clinics which can tackle the anger in a professional manner. 

But if we can control the anger, it will help to a large extent to prevent a heart attack

It is not an easy task

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Heart attack : The Facts

     


 Sri Jayadeva Institute of Cardiovascular Sciences and Research in Bengaluru is India’s largest heart hospital with 1,200 beds and 75 full-time cardiologists. Over the past few years, the number of heart-attacks are increasing in young people between the age 30 -40 years 
.
They studied about 2,000 such cases in the last two years.




“ 40% of them did not have any conventional risk factors. 


It is known that 

• 60% of heart patients in the world are Indians.

• Indians are 4 times more vulnerable

• They are younger, and poorer than in the West

It has been shown that lower education increases the risk of hear attacks. Also the people in the low income group are more susceptible.

Who suffers?

• 'Low' control over life

• 'Low' in social hierarchy 

Social gradient plays a role in life and death

Heart attack: Risk decreases with education

i

Increasing number of years spent in education likely to lead to health benefits


This study published in JAMA tracked the health of nearly 14,000 adults from 1987 through 2013. 

The participants had varying levels of education, 

Dropping out of high school and lower levels of education were linked to increased number of heart attacks

 Education reduces this risk.

How this can happen?

The effect is mediated through the other risk factors for heart attack

Those who spend longer time in education: 

• Less likely to smoke,
• have lower BMI 
• healthy blood cholesterol profile

 Those with lower education levels:

• have poor income, 
• less access to medical care, 
• low physical activity, 
• higher levels of smoking, 
• poor diets, 
• high blood pressure,and diabetes,
  
  
   

P.S.

How simple is this? 

Educate everybody and get health benefits.

But how difficult it is.

This will need big social and political reforms 

  

"Bad" cholesterol is not that "bad"

Now a days, every one knows about cholesterol and heart attack. People eat only white of egg and give the yellow part to maid servant (good for her health).

Then came the entry of 'zero' cholesterol cooking oils and people were impressed. They abandoned the traditional cooking oils in favor of these 'zero' cholesterol oils. 
  . 
In fact, every cooking oil is 'zero' in cholesterol.
Cooking oil comes from plants and plants do not know how to synthesize cholesterol.

Animals synthesize cholesterol and all the animal products have ready made cholesterol (milk,cream, egg,cheese, meat)




Every one knows about 'statins". Many adult males are taking statins for many years and never stop it.

We know that bad cholesterol should be less than 100 mg for protection from heart attack. After taking statins for many years, the 'bad' cholesterol level falls to around 45 -50 mg.which is very low. 

At this stage, it is wise to stop statin for 2- 3 months, and start it only if the cholesterol goes above 100. If it is still below 100, no need to start it again. You should be happy. But the patients are not ready for this. Once on a statin, you cannot stop it and nobody tells them to stop. 

A patient aged 90 years came to me for some minor illness. He is taking a statin for the last 25 years and does not want to stop it. He is still worried about a heart attack (at the age of 90) I said jokingly "look, now you will need some reason to die. Isn't it.  So stop the statin now"  He was not impressed. 

Bottom line:

Cholesterol is a risk factor, but it is not the only one..

There are many other risk factors like diet, lack of exercise, high BP, diabetes, and depression, We ignore them and
focus only on cholesterol.

Role of cholesterol in heart attack is still controversial

How early can you get diabetes?

I had a patient coming from U.S. He is there since last 20 years.He came with his wife and two boys,14 and 12 year old. These children were born in America and so they are American children (of Indian origin)

While treating my patient I asked for the blood test of the boys for hemoglobin,vitamin B12 and D3. But my patient took the package for a number of tests, which included HbA 1c
and average blood sugar.

Both the boys were border line diabetics. I was shocked.
I had never asked for this test ( I never thought on those lines)   

Obviously, the diet they were having there was the cause.
Breakfast was cereals which have high sugar content.The lunch is in cafeteria at school which is fast food(only)

These boys did not carry lunch box from home. (their mother was also not insisting) They used to have snacks the whole day,like candy, biscuits, chips, rice crisps, coke and other sugary drinks.

The dinner was home cooked, which was just rice, dhal and a vegetable some times.

High GI foods are fast foods, breakfast cereals
Low GI foods are wheat, rice, chole,, rajmah, mung, mutter,curds, fruits

The blood glucose levels in these two boys are high due to the fast food. They are on the border line but the average blood sugar was still normal (less than 140)

This is due to high secretion of insulin in response to high blood glucose. But how long? Pancreas will get exhausted one day and insulin secretion will start falling.

There is chaos inside at present.

It is like driving the car in the first gear. How far it will go?  

I talked to the whole family and asked to change the dietary pattern as shown in these pictures.

P.S.

The family has gone back to U.S. 
Will they follow my advise? I do not have high hopes.

Eating is a behavior and behaviors do not change overnight. It needs a conscious efforts for a long time.

If they do not change, I am really afraid that these two boys will become diabetic in a few years. 

Do you know ultra processed foods?

Processed foods are those whereingredients such as oil,sugar or salt are added and they are packaged

Ultra- processed food takes this process one step further by incorporating preservatives, artificial flavors and colors. These foods go through multiple processes (extrusion, molding, milling)and contain many added ingredients and are highly manipulated

The NOVA classification

(NOVA is a name and not an acronym)

It’s a classification system that was developed by an international panel of food scientists and researchers. It splits foods into four categories according to the extent and purpose of food processing, 

It specifies which foods belong in which group, and provides precise definitions of the types of processing underlying each group.

Minimally processed

processed culinary ingredients

Processed foods

Ultra processed foods and drinks

Minimally processed foods:

vegetables, grains, legumes, fruits,nuts, meats, seafood, spices,eggs and milk

Processed foods:

These foods have been altered, but not in a way that’s detrimental to health. They are convenient and help you build nutritious meals.: These are Simple bread, cheese, tofu, canned vegetables, canned fish, yogurt, smoked meat

Ultra-processed foods:

Formulation of food substances modified by chemical processes and then assembled into "ready to consume" hyper palatable food and drink products using flavors, colors, emulsifiers and other cosmetic additives 

• Industrial processes include hydrogenation, hydrolysis, extrusion, moulding, reshaping, and pre-processing by frying. Flavoring agents, colors, emulsifiers, humectants, non-sugar sweeteners,  

• These foods are microbiologically safe, convenient, and highly palatable.

  The aim is to create durable, convenient and palatable ready-to-eat or ready-to-heat food products suitable to be consumed as snacks 

 Ultra-processed foods 

• Higher content of total fat, saturated fat, added sugar, 
• High calories
• High salt, 
• Lower fibre and vitamin density,   
•  
• Which foods are ultra processed?

• Mass produced packaged breads and buns,
• Sweet or savory packaged snacks, 
• confectionery and desserts,
• Soft drinks
• Sweetened beverages,
• Chocolates
• Meatballs, poultry and fish nuggets,
• Sweetened breakfast cereals
• Packaged soups
• Chicken nuggets
• Hot dogs
• Reconstituted meat products transformed with the addition of preservatives other than salt (eg, nitrites),
• Chips
• Instant noodles and soups, 
• frozen or shelf stable ready meals, 

Health risks

Increased cardiovascular risk:
Elevated cholesterol, 
Hypertension
Obesity

• These foods might affect satiety control  
•  food processing affects nutrient availability in the small intestine by altering the properties of the plant and animal cells in food. 
• several compounds are neo formed and unhealthy during the process . 

Soybean is good for your heart

The Food and Drug Administration(US FDA) has granted the following health claim for soy and can be printed on the pack of soy product.

 "25 grams of soy protein a day, as part of a diet (which is  low in saturated fat and cholesterol), may reduce the risk of heart disease" 

An American Heart Association(AHA) review says: 
"many soy products should be beneficial to cardiovascular and overall health because of their high content of polyunsaturated fats, fiber, vitamins, and minerals and low content of saturated fat"

Anti cancer potential:

Soybeans have high levels of antioxidants. This makes them good for preventing the onset of various cancers. Antioxidants neutralize free radicals, which are harmful byproducts of cellular metabolism. 

 American Institute of Cancer Research, concludes that soybeans are rich in fiber content which is linked to a lower risk of colon cancer 

Soy products:

Soybeans have become popular in recent decades.  

The high levels of protein make these soy products an ideal protein source for vegetarians and the variety of soy products has created a massive new market altogether.

Tofu
It is a soybean product, made from the curds of soya milk (so it's similar to cheese, just using soy milk as a base rather than milk). Those curds are pressed into blocks and can be made into different textures — soft, firm and extra-firm.

Soybeans are important source of protein for those with a vegetarian or vegan lifestyle. It is an excellent alternative for animal proteins.

The biological value of soy protein is superior to other vegetable proteins:

Soybean                          80
Rice                                 78

Wheat                              66

Bengal gram(chole)         74

Groundnut                        55

Maize                               50

Soybeans are processed for their oil. Soybean oil is a  polyunsaturated oil which also contains omega-3 fats, which are heart-healthy. 

Ideal cooking oils are those with high omega-3 contents. 
Mustard oil has the highest omega- 3 contents followed by coconut oil, pure ghee and soybean oil.

You can use any of these 4 oils as per your choice.