By Dr. Rajiv Bajaj, Cardiology
Prevention of heart disease is quite simple. All your present confusion is due to poor understanding of simple biology. You can keep our heart and body healthy quite easily. The single rule of healthy long life can be stated in one short sentence, and you will find it in this blog. The blog is longer, because you should understand the science behind it, and reach the truth yourself. The extra reading will give you the confidence to follow the correct method. So, spend a little time to understand blockages, cholesterol, lipid profile, and diet.
The heart pumps blood into pipes called arteries. If these pipes develop a block, blood and oxygen supply to an area stops, leading to damage. Blockage of heart arteries, (called coronary arteries) damages heart muscle, causes heart attacks.
Arteries have high pressure, they require continuous maintenance and repairs. Damage and injury to arteries is more with tobacco smoke, high blood pressure, when blood contains toxins, or when high glucose levels damage our body’s proteins (glycosylation). Food cholesterol has virtually nothing to do with blockages.
Food provides us energy, and raw materials for body’s maintenance.
Calories come mostly from fats and sugars, but there are many other possible sources. Alcohol, organic acids, proteins, etc. Modern crops like wheat, rice, potatoes, maize, barley, oats, etc. contain mostly glucose. Conversely, oils, and animal foods are ‘zero-glucose’ foods. Sugars promote growth. Milk contains sugar. Pigmies ate uncooked, low sugar foods, and were very small. Forest tribal who cook with fire grow to over 4 feet. Our modern, sugar rich diet helps us grow six feet tall. For similar reasons, farmed pigs and chickens are huge too.
Body’s proteins are built from about 20 different amino acids. About 50 grams of high quality protein daily is sufficient. We cannot store excess protein. Excess is degraded by liver and excreted by kidneys. High protein diets are therefore wasteful and unhelpful.
There are about 20 essential micronutrients, like salt, calcium, iron, iodine, vitamins. Animal-foods or mixed plant diets can supply all, though vitamin B-12 and iron can fall short in vegetarians.
Diet related misinformation:
We are constantly misguided about diet and health. Unhelpful clichés like ‘anti-oxidants’, ‘junk foods’, ‘empty calories’ constantly add to our confusion.
Think of food by its chemistry. It does not matter whether almonds/cashew are advertised as healthy or unhealthy, whether they are imported from California or are local produce, whether they are brown, skinned or eye shaped. What matters mostly is what enters our blood stream after nuts are digested. Similarly, it does not matter whether glucose is from potato, wheat, jaggery, or apple; or whether the bread is white, brown, or multigrain. All glucose is always just glucose.
All fats too, are nutritionally similar. All have the same glycerol, calories, and similar fatty acids. Our body burns all fatty acids the same way. The situation is similar to the burning of different oils in a Dipawali lamp, or different woods in a log fire.
Apples, almonds, honey, red wine, olive oil, aloe vera, quinuo, etc. are ascribed magical benefits. Unlike Hindus, the Chinese are meat eaters; they believe that rhinoceros’ horn, snakes’ bile, tiger bones, dog’s genitalia have magical health benefits!
There is scaremongering about fats, animal foods and salt. There is constant repetition that ghee and butter are always adulterated, that eggs, chicken or pigs are spreading epidemics.
There is no mention of glucose and table sugar as the basis of modern diseases, but continuous noise that salt is deadly. Our kidneys filter about one and half kilos of salt every day, and reabsorb over 99.5% in the kidney tubules. The amount filtered and reabsorbed is easily adjusted very exquisitely by very strong regulatory mechanisms. Despite this simple biology, 5 grams of salt daily is proclaimed healthy, 3 grams extra per day is painted a deadly killer.
Indigestible and unwanted substances are called fibre. Fibre is now promoted as healthy! Much of modern dietary advice is clearly nonsense.
The biggest contributor to artery injury and blockages is modern lifestyle. In science, modern lifestyle means only one thing: moving from forest foods to agricultural foods. Agriculture gives us a high glucose diet, forest foods are very low in glucose. Glucose is an instant, explosive fuel, required during emergencies. Glucose is very reactive and tends to damage every protein it touches.
Glucose damages artery lining, it damages HDL and converts healthy LDL to unhealthy, small dense LDL. The cholesterol inside blockages comes from small dense LDL which is formed when diet contains too much sugar, glucose, or alcohol.
Thankfully, our liver does not allow too much glucose to enter the circulation, otherwise, our blood glucose would shoot up to over one thousand after every meal! The liver converts food sugars into the non toxic fuel, triglycerides. Very little glucose can be stored in our bodies, excess is converted to fat, it contributes to obesity. The amount of glucose consumed must therefore be matched to our activity level. Physically active people, like labourers and sportsmen can tolerate more glucose, but sedentary people must exercise to spend it if they prefer a high glucose diet.
Sedentary life plus glucose rich diets raise blood insulin level and predispose to Diseases of Modern Lifestyle, also called Diseases of Civilization. Despite popular belief, cholesterol, genes, stress, over-eating, pollution, pesticides, etc. are not so important.
Triglycerides (and also cholesterol) do not dissolve in water. They are called lipids or fats. Oil, ghee and meat-fat are mostly triglycerides. The body uses them as fuel.
All triglycerides are nutritionally similar. Triglycerides from food enter blood directly as chylomicrons, but sugar from diet is first converted into triglycerides by the liver before it enters the blood stream. Since modern diets are full of glucose, we keep the liver busy manufacturing triglycerides from glucose; this predisposes us to fatty liver. Fasting triglycerides should be less than 150. Higher values suggest that the diet contains too much glucose or alcohol.
There is confusion whether fats are healthy or unhealthy, whether some are good, and others bad. All natural fats in use are equally nutritious, except vanaspati ghee and margarine from factories. Factories convert cheaper vegetable oils into artificial butter and ghee. This factory process uses very high temperatures, and leads to formation of chemicals called trans fats. Trans fats do not burn as fuel in our cells, they block our enzymes. They are chemicals, contaminants. They are preferred by bakers, manufacturers and some eateries as they are cheap, and do not become rancid.
Cholesterol is a building block of animals. Plants have cellulose, animals have cholesterol. Cellulose creates rigid structures, and plants are therefore immobile. Cholesterol gives animal cells flexibility. We can walk, talk, swim etc. because our cells have cholesterol. Everything of every animal, including hair, nails, bone, blood, eggs, meat, skin, wing, milk, etc. always contains. cholesterol; and everything obtained from plants is always ‘zero cholesterol’.
There is only one type of cholesterol in all animals. Most of it is manufactured by our cells. We can get some from food. Our livers can easily excrete excess in bile. Food cholesterol does not raise the blood levels. Most of the cholesterol in blood comes from the liver, very little from food. Rains cannot increase the sea level. Fresh LDL and HDL are continuously put into blood, and old are continuously removed by liver. This process is vital for our survival.
LDL and HDL:
Since lipids are insoluble in blood, they circulate in blood in packets called ‘lipo-proteins’. We have LDL, HDL, and chylomicrons. All these three contain a mixture of various proteins, fats, and other insoluble substances.
LDL and most of HDL are made in liver. Fresh LDL and HDL keep entering the blood, and old lipoproteins are continuously removed by liver. One of their many jobs is to keep our arteries and blood clean. Lipoproteins trap all insoluble dirt, including broken cells and bacterial toxins whenever and wherever they enter our blood stream. LDL and HDL work together, like mop and bucket. The liver has macrophage cells for safely disposing the toxins they collect and bring (macrophage means giants that swallow enemies).
Our blood has more toxins during illnesses, and LDL and HDL get busy. Instead of idling in blood, they carry loads of toxins to liver. Blood levels of LDL and HDL therefore drop in every illness. High levels generally reflect good health, and low levels some illness, but there are exceptions to this rule. Sometimes, there is accumulation of old toxin-filled lipoproteins in blood. Egs: In familial hypercholesterolemia clearance of old LDL by liver is slow. Similarly, alcohol slows removal of old HDL. In such uncommon situations, high levels of LDL or HDL are not healthy.
Statin medicines help by clearing old LDL from blood, but most lipid medicines just change the blood report without improving health. Torcetrapib was tested as a medicine because it increases blood HDL. It does so by blocking transfer of rubbish from HDL to LDL, forcing HDL to go on circulating with all the rubbish it collects. Predictably, torcetrapib causes harm, not benefit.
Lipid Profiles ‘tests’ are quite popular, but not very helpful. Lipid Profiles tell us very little about who will get a heart attack.
The lipids we measure are mostly from liver, not food. Total cholesterol, triglycerides and HDL are measured. All the other numbers are often arithmetic. E.g.: VLDL is triglycerides divided by 5. Additional measurements like apo A, B, Lp(a) etc. are promoted, but do not help much.
Cholesterol levels below 300 are normal. Levels persistently above 300 (or LDL levels above 220) suggest familial hypercholesterolemia. Much lower levels of cholesterol and LDL are presently advocated. The dangerous cholesterol levels have been changed from 350 to 270, 250, 220, 200, 170, 150 etc.; and safe level of LDL too, is being continuously reduced. These recommendations are motivated. In 1945, a heart disease scare was started in USA. Large research programs were rolled out to ‘find the cause’ of the ‘number 1 killer’, and they imposed the cholesterol theory everyone learns.
High Triglycerides and low HDL are common in people prone to blockages. This is called atherogenic dyslipidemia (lipid profile abnormality that predicts development of blockages). Triglycerides increase when our diet has too much glucose or alcohol. HDL and artery wall are continuously damaged by glucose, and require renewal. Focus on triglycerides and HDL levels to protect health. Except in rare genetic disorders, triglycerides and HDL stay perfect with a traditional healthy diet; a diet low in sugars and alcohol.
Diseases of Modern Lifestyle are caused by abundance of glucose in modern crops. These diseases do not occur in wild populations till they clear the land and start agriculture. If we reduce sugar, jaggery, and alcohol, and increase oils and animal products, we can avoid most diseases and sail into our 80s.
If we follow this rule, we can avoid the problems caused by glucose and insulin to our liver, arteries, heart, and every other part of the body, including brain, nerves, teeth, gums, stomach, gall bladder, colon, appendix, kidneys, uterus, prostate, joints, muscles, immune system, every nook and corner of our entire body.
Check out the diet of those who stayed healthy till 90, or discuss food with knowledgeable biochemistry graduates to understand the truth. Relying on medical establishments is not enough. They are forced to toe the line about cholesterol, food, and health; to promote agricultural foods and physical activity as the science of health. It is not science, it is not the best way at all.