Cardiovascular disease is the number one killer of human beings as of now. Number one. We cant escape that fact. Both in men and women. It includes coronary artery disease and ischemic stroke.
We cannot have old age as acause of death. Old people also die of something, and it turns out that Cardiovascular disease comes out at the top.
Diabetes and complications of Diabetes can be considered the next, but it is complicated, as Cardio Vascular diseases can be considered as complications of Diabetes also.
Let me digress a bit. Recently, there is a meme going around that the ‘low fat’ concept was all cooked up, while carbohydrates are the real problem. All of us have been fooled.
Well, like all types of sensationalism the truth is much more prosaic.
Let us start with basics, including the Framingham heart study and re-iterate some basics. I consider the following facts as firmly established: (If you don’t agree please stop reading. There can be no common ground between us. Read My whole book, then)
The main modifiable risk factors for cardio vascular disease and hence- of death- all over the world now (Cancers come second, if we exclude the many effects of Diabetes) are:
Hypertension- Increased arterial pressure causes small endothelial injuries or degrades the endothelium, making it more prone to the process.
Cigarette Smoking- Chemicals are thought to damage endothelium. Nicotine constricts blood vessels. It is one of the most damaging things you can do to yourself.
Diabetes- Increase in the blood sugar causes chemical changes to happen in the accumulated fat. The sugar attaches to the various chemicals, called glycation. Glycated particles cause much more inflammation than otherwise. Diabetes also complicates fat metabolism, making it more abnormal, and atherogenic.
Dyslipidemia- An abnormality in the fat components in the blood. Increased cholesterol and triglycerides promotes disease. LDL is a lipoprotein complex that transports fat from the intestine and liver to the tissues through blood. The increase causes deposition of fat under the endothelium. HDL is a lipoprotein that transports fat from the periphery to the liver for storage and utilization. Increased HDL protects against Atherosclerosis. Increased Triglycerides are also bad.
Obesity- Increase in body weight due to increase in fat content of the body is a bad thing. It increases hypertension and is a causative factor for diabetes. Fat metabolism abnormalities are common in obese people.
Decreased exercise- Moderate exercise is shown to have a beneficial effect in decreasing the process. Exercise works in complex ways. It decreases other risk factors like Diabetes and Obesity. It also has many direct benefits, like increasing HDL.
Coronary artery disease and stroke reached epidemic proportions in the west in the 1940s and 50s. This prompted for the search for the risk factors, and later, aggressive public health campaigns.
Since fat components seemed to have such an effect, and following further studies, ingested saturated fats and cholesterol was deemed one of the main culprits. Hence the low fat diet was introduced. Refined sugar and starch were also found problematic. But more emphasis was given to fats. Hence the low fat diet and the traditional food pyramid were introduced.
The traditional food pyramid that has been recommended by nutritionists for long have emphasised carbohydrates. Take grains at every meal, they said. They knew, decades ago, that sugar and refines starch were not good, and hence emphasized whole grains.They did recommend lots of vegetables and fruits. Avoid oils at all costs- they said. It was a kind of low-fat diet that was followed by people who came to know of this.
It worked.
In the USA, the proportion of people dying from coronary artery disease decreased by 50 percent by 2000, as compared to 1950. This is a country for which detailed statistics are available. It is a HUGE difference.
This means that the advice weren’t Bullshit. Not sensational enough, I know.
This reduction was the result of primary, secondary and tertiary prevention .So, prevention is possible, to an extent. It also means that there are a lot of things that are correct about the advices that are being given.
In India, we are at the upswing of the epidemic. It is yet to show its true frightening proportions.
But even in the west two other closely related scourges are gaining ground. And they show no signs of abating. They are Obesity and Type 2 Diabetes Mellitus. We in India are really beginning to see its effects too.
This is where we see something worrying. The incidence of obesity and excess weight has continued to grow. Diabetes reached epidemic proportions and shows no signs of abating.
It is not very hard to see what has happened. The public did not consume fewer Calories. The amount of cheap food in the world has gone up (!! Miraculously). The amount of calories eaten by an average human has gone up. Most of the increase has been of carbohydrates. Sweetened carbonated drinks, sugared fruit juices, polished white breads, biscuits, cookies, cakes, potato chips, French fries and other starch laden alternatives were offered by the food industry and embraced whole heartedly by the people.
What was needed was reduction of both carbohydrates and fats ( L ). This meant eating mainly fruits, vegetables and some protein. And starving to an extent, while avoiding essential food factor deficiencies. Let me tell you- this is not practical.
That is how the enough fat, protein and low carbohydrate diet came up. It is easier to follow, and since it provides easier satiety with less calories, obesity also could be tackled in a better way.
This is the key. It is easier to eat less, when what you eat have more protein and fat.
This would epidemiologically handle Obesity, Diabetes and Cardiovascular diseases provided one is careful with the types of fat eaten. Avoid saturated fats (red meats, milk products and certain oils) and trans-fats whenever possible. Eat fish and chicken to an extent. Some oil laden nuts are allowed.
Ingested cholesterol has found not to be the chief factor raising blood cholesterol. So, a few eggs a week is ok. This is probably the only conceptual change that has occurred scientifically. The food pyramid was slightly modified to include more good fats and proteins, so that carbohydrates can also be cut down. The Mediterranean Diet is an easy-to-follow diet of this type.
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