Daily Times

Recently, there have been quite a few columns on these pages about matters pertaining to health and healthcare, and even about heart disease. When I first started writing for this newspaper I made a deal with the then editor of the op-ed pages that I would avoid writing about medicine, especially about medicine from a patient-doctor perspective. That said, one of the problems for me is to read ‘half-baked’ opinions about medicine in general but more particularly about heart disease bandied about by people who derive much of their information from Wikipedia. Before I go any further I must, in the interest of full disclosure, admit that for more than 30 years I have practiced heart surgery so perhaps I know a little bit about diseases of the heart. But, dear readers, worry not. This is definitely my last article on this issue for quite some time.

So, the first important thing to be put to rest is the idea that heart disease, especially the sort that produces heart attacks, is heavily related to the consumption of trotters (siree paye). Trotters of the pig are established as ‘soul food’ in the US and if there was any association between trotters and heart disease many learned articles would have appeared by now in peer reviewed journals about such an association. Since that has not happened we can assume that trotters are probably not too dangerous and, as long as one does not live on trotters alone, a normal and relatively long life can be expected. The important point is that what we eat is important for our body in many ways but excluding one type of food completely is not too effective in keeping us healthy. Yes, I would also add that by what we eat I mean things that are commonly eaten and not some exotic stuff like fugu (puffer) fish or wild mushrooms that might be poisonous.

Four things influence heart disease the most. First, of course, are our genes. Those of us who have parents that had heart attacks at an early age (men before 55 and women before 65) have a higher risk of developing blockages in heart arteries leading to heart disease themselves. Second, those with diabetes (high blood sugar) have a high risk of developing heart attacks also. Third are people who have too much ‘bad’ cholesterol and not enough ‘good’ cholesterol in their blood. Fourth are secondary factors like high blood pressure and ‘lifestyle’ factors like smoking, putting on too much weight, not being active enough and eating processed food. These are some but not all things that have been found to increase the risk for heart attacks. And contrary to popular belief, unrequited love is not a cause of heart attacks.

Of risks other than inherited tendencies, many can be prevented, treated or changed. First is the problem with diabetes. Today, we are seeing a worldwide epidemic of diabetes. And as more people get diabetes, more people get heart attacks. The modern epidemic of diabetes might actually be related to dietary warnings issued a couple of decades ago. Many scientists dealing with heart disease managed to convince each other, and people in general, that eating fatty foods was bad for the heart. As a result, people started avoiding fatty foods like the above-mentioned trotters and started eating a lot more carbohydrates (starches) to fill their stomachs. The one good thing about fatty foods is that they fill you up sooner than foods with less fat. So, we saw people eating more bread, rice and pasta, and more of them in terms of quantity. And, yes, the cola industry kept pushing its sweet and extremely calorific drinks. Soon people started getting fat. And fatter they became, the more diabetic they became and eventually had greater chances of having heart attacks. The first step to control this diabetes epidemic is to decrease the number of calories we consume every day, and adding some fatty foods to our diets will help us do that. Losing weight is about the best thing people who are overweight can do to improve their overall health. Also, diabetes and high blood sugars must be properly treated.

The next thing that is important is the amount of good and bad cholesterol in our body. Most people should get a cholesterol blood test when they arrive in the middle years of their lives, especially if many in their families have had heart attacks at a young age. Today, we have medicines that can decrease the level of bad cholesterol in the body, called statins. Some of the more enthusiastic heart doctors are of the opinion that everybody in this world should take statins somewhere along the line. Personally, I am a little suspicious of medical recommendations that apply to almost everybody. That said, people with some of the major risk factors for developing heart artery blockages mentioned above should take statins if they have ‘high’ levels of bad cholesterol. As far as increasing the amount of good cholesterol is concerned, soon there should be a reliable pill to do that also.

Of course, there are many common sense things that can decrease the risk of heart attacks. First is to stop smoking cigarettes. This is not only good for the heart but is also good for the lungs. As far as high blood pressure is concerned, this is eminently treatable and should be treated properly. The one thing I have not mentioned yet is exercise. Exercise has so many health benefits that all of us should exercise every day if possible. A brisk 15 to 20-minute walk every day is a good way to start and, if maintained, at that level offers most of the benefits associated with exercise. However, one warning: before starting a programme of strenuous exercise in your ‘middle years’ please do get a medical check up.

The author is a former editor of the Journal of Association of Pakistani descent Physicians of North America (APPNA)