Author: noorali

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Heart Disease and Your Enemy #3

Yesterday was Valentine’s Day. It must have been an evening of love and chocolates for you. That is good. Love and happiness are good for your heart. As they say, “Make love, not funeral plans.” And there is science behind that. It keeps your life active. People who have more sex live longer than those you don’t. Married people and people in healthy relationships live longer than lonely people.

Chocolates are good for your heart. But they are high in calories so if you are going to eat chocolates then you have to make adjustments to your calorie intake for that day. Evidence based recipe for a perfect meal (called polymeal) include wine, fish, dark chocolate, fruits, vegetables, garlic and almonds. Dark chocolates daily (100 grams) reduce blood pressure and cardiovascular diseases by 21 per cent.

Let us go back to our enemy No. 3 – inactivity.

Being a couch potato is hazardous to your health. Being active is good for your health. That is obvious, right? Am I insulting your intelligence by writing such simple and obvious facts?

We have couch potatoes in all age groups. They watch too much TV or spend too much time on the Internet. While they do that they eat junk food. Inactivity plus junk food equals bad news for your heart as you get older. Regular physical activity makes your heart strong.

In sedentary people or couch potatoes, the risk of heart attack was seven times higher in a German study and more than 100 times greater in a U.S. study during vigorous exertion than during lighter activity or no activity. If you compare this to among people who exercised regularly, there was almost no increased risk. Another beneficial effect of regular exercise is that it increases the blood level of HDL (good cholesterol). HDL is another line of defense against heart attack.

The type and amount of exercise required to be fit and healthy depends on your age, your health and your current state of physical fitness. There are three types of exercises: aerobic, weight lifting (resistance training) and stretching. A good exercise program should benefit all three aspects of fitness: stamina, flexibility and strength.

A study found that 150 minutes a week (two and a half hours) of a moderate exercise such as walking and 75 minutes per week (an hour and 15 minutes) of activity like easy jogging provides good health benefits.

It has been estimated that people who are physically active for approximately seven hours a week have a 40 percent lower risk of dying early than those who are active for less than 30 minutes a week.

Be active, do whatever you can and have fun. If it is not fun then don’t do it. Find a partner, join a group, get a dog and just go for a walk. You can celebrate Valentine’s Day every day. Who cares, as long as you are having fun…right?

Ok, get moving now.

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Heart Disease and Your Enemy’s Best Friend – Triglycerides

In the last column, we discussed about the harmful effects of bad cholesterol (LDL) on your cardiovascular system. I call LDL enemy number one. Today, we move on to our enemy number two – triglycerides.

Triglyceride is another type of lipoprotein which carries harmful fat-carrying particles. That means it is a bad one. It is the main constituent of vegetable oil and animal fats. It is a major component of chylomicrons and very-low-density lipoprotein (VLDL).

Chylomicron is one of the microscopic particles of fat occurring in a ‘milky’ fluid composed of fat and lymph formed in the intestine during digestion. Next, VLDL is produced in the liver and later becomes the bad LDL.

Triglycerides are the most common form of fat in the body. In fact, almost all the excess calories you consume, whether from fats or carbohydrates, are converted to triglycerides and stored in your fat cells. Once at capacity these cells divide. If you ‘lose weight’ these cells decrease in fat content but never in number. This makes it easier to get fat again.

High levels of triglycerides in the bloodstream have been linked to atherosclerosis (hardening of the arteries), and the risk of heart disease and stroke. High triglyceride levels can
cause pancreatitis, a painful and potentially dangerous inflammation of the pancreas.

What causes elevated triglycerides?

Elevated triglyceride levels can be related to your diet (high in bad fats, carbohydrates and alcohol) and your genetic makeup. In addition, high triglyceride levels can be produced by several medical conditions including: obesity, diabetes, metabolic syndrome and hypothyroidism (low thyroid).

How can we manage high triglyceride levels and reduce the risk of CAD, stroke and death?

It starts with lifestyle modification. Your diet has to change. The key is to replace bad fats with good fats in your diet.

Bad fats are: saturated fats (found in meat and dairy products, some plant foods such as coconut oil, palm oil and palm kernel oil) and trans fats (found in commercially packaged foods and fried foods).

Good fats are: monounsaturated fats (found in nuts, almonds, pistachios, avocado, canola and olive oil) and polyunsaturated fats (found in seafood, fish oil, omega-3, corn, soy, safflower and sunflower oils). Monounsaturated fats have also been found to help in weight loss, particularly in reducing body fat.

Eat plenty of fruits and vegetables. Avoid alcohol, lose weight, exercise, do not smoke, and control your blood sugar and blood pressure. Wow, sounds easy! Well, sort of. There is plenty of help around to achieve your goals. You and your doctor should work together. But you have to have the motivation to start the ball rolling.

This plan will help reduce LDL bad cholesterol, the bad triglycerides (friend of enemy number one) and increase HDL good cholesterol. Next week, look for more fodder for your healthy heart besides love and chocolates on Valentine’s Day. Who is your enemy number three?

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Is Dietary Cholesterol Really Bad for You?

February is Heart Month. This month brings back memories of my father. It was twenty years ago, on February 4, my father passed away from a massive heart attack due to coronary artery disease.

Heart disease kills people. How can we stop this killer?

Healthy diet and healthy lifestyle are two weapons we can use.

When we talk about healthy diet, we mean diet low in saturated fats and trans-fats. Saturated fat is present in full fat dairy products, animal fats and several types of oil. Trans-fat is most often encountered in margarine and hydrogenated vegetable fat, many fast foods, snack foods and fried or baked goods.

Over the years, studies in humans have not provided convincing evidence for an impact of cholesterol intake on coronary artery disease (CAD). Rather, these studies have consistently established a close association between a certain eating pattern and the risk of CAD.

This eating pattern has usually been characterized by a high intake of total fat, low intake of fiber and polyunsaturated fatty acids found mainly in fish (omega-3), corn, soybean and safflower oil (rich in omega-3).

So, is dietary cholesterol really bad for your heart?

The body produces enough cholesterol for our needs. Cholesterol is essential for all animal life. It’s an important part of a healthy body because it’s used to form cell membranes, some hormones and is needed for other functions. It has to travel to different cells to meet its cholesterol demand. In order to travel in the blood, cholesterol is carried by two kinds of lipoproteins – low-density lipoprotein (LDL) and high-density lipoprotein (HDL).

LDL cholesterol is referred to as “bad cholesterol,” because it contributes to atherosclerosis, which is a build-up of cholesterol in the arteries and it leads to heart disease. If too much LDL cholesterol circulates in the blood, it can slowly build up in the walls of the arteries feeding the heart and brain. Together with other substances it can form plaque, a thick, hard deposit that can clog those arteries. This condition is known as atherosclerosis.

HDL cholesterol is often called “good cholesterol,” because it carries cholesterol from other parts of the body back to the liver to be removed from the body.

When you get a fasting blood test for cholesterol profile, which parameter is the most important? As the pundits say, “In politics, it is the economy, stupid.” When it comes to heart disease it is the blood level of LDL which is important……stupid. Did I just say that?

Ok, I said that. Because we worry too much about eating low cholesterol diet but forget that our real enemy is LDL. Experts have proved that total fat intake; especially saturated fat and trans-fats are the major players in the LDL synthesis in blood. Data indicate that dietary cholesterol has little effect on the blood LDL.

Eat right and exercise regularly and get control of your real enemy: LDL. In the next few articles we will continue our discussion on how to defend our blood vessels against this killer.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

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Patients with Celiac Disease Should Have Regular Follow-up

Celiac disease (CD) is a lifelong autoimmune intestinal disorder and runs in families. First degree relatives of individuals with CD may or may not manifest symptoms of the disease. It affects people to varying degrees, from being critically ill to being completely well.

Gluten is the common name for the offending proteins in specific cereal grains that are harmful to persons with CD. When gluten is ingested, it causes immunologically toxic reaction in the lining of the small intestine. The small intestine is lined by villi which help absorb the nutrients from the food we eat. The toxic reaction damages these villi thus interfering with the absorption of nutrients and leading to diarrhea and malnutrition.

Symptoms of celiac sprue in children appear when cereal is introduced in their diet, anywhere between the ages of four to 24 months. They present with diarrhea, impaired growth and abdominal distension. Vomiting, anemia and swelling of the body tissues with fluid occur due to malnutrition.

Celiac sprue can develop in adults as new cases. About 20 per cent of the patients may be diagnosed after the age of 60. Otherwise, most adults with celiac disease will have history of the disease going back to childhood.

What is the long term effect of celiac disease if it remains untreated?

Chronic diarrhea will result in fluid and electrolyte imbalance. Development of cancer of the small bowel is a possibility. Poor absorption of food nutrients will result in malnutrition and poor immune system. Iron-deficiency anemia is now the most common clinical presentation in adults with celiac sprue. Osteoporosis is another likely complication of celiac disease.

Approximately, 50 per cent of adult patients do not have clinically significant diarrhea. So, making a diagnosis and provide follow-up is not always easy.

Why regular follow-up is important?

An article in the Canadian Journal of Gastroenterology (August 8, 2010) says that long term follow-up of patients with celiac disease is important for monitoring three things: their clinical status, dietary compliance and complications.

Most guidelines recommended a scheduled annual review and regular measurements of body mass index, dietary review with a nutritionist and serial tissue transglutaminase antibody testing. Some recommend annual hemoglobin, ferritin and folate checks. One guideline recommended annual hemoglobin, electrolyte, calcium, albumin, ferritin, folate, fat-soluble vitamin, liver function test, parathyroid hormone and bone density measurements (approximately $400 per patient).

What is the science behind these guidelines?

Unfortunately, there are no evidence based guidelines to suggest exactly what needs to be done in follow-up to change the outcome of the disease or prevent complications from the disease itself.

The survey done by the authors of the article say that most gastroenterologists in Canada provide routine long-term follow-up to their patients with celiac disease. Those who do not, delegate this role to the patient’s family doctor.

The follow-up is most often provided on an annual basis, and includes reinforcement of the need to adhere to a gluten-free diet, dietary review, physical examination, laboratory tests and a recommendation to join a patient support and advocacy group, says the article.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!