Reverse your Heart Disease

This article is written by Mr. Shakur Tisekar. The article is dedicated to his late brother, “GAUS TISEKAR” who suffered from Heart Disease and left for heavenly abode on 26^th December 2011.

“Mili hai bahut sazaa unse Dil lagane ki

Nazar lag gai mere pyar ko Zamane ki

Markar bhi  KABR se Nikle hai dono hath, is ummeed se ki,

Kahi wo na aa jai, Arzoo jo rah gai unhe gale lagane ki...”

The above Shayari on Dil (heart) linked with Pyar (love) made me think, how many countless shayaris have been written on heart as a symbol of love? We all believe that love is felt in the heart. It has been a topic of many Shayars (poets) for many centuries.  If that is so then what is the answer for following question?

Tension happens in brain and love is felt in heart.
Then why do people get heart attack when they are tensed?
and why people get mad when Love fails?

My article revolves around this question. Second question that perplexes me is, if heart is symbol of love then why heart disease is number one killer in India? What you can expect in this article is how India has become a capital of heart disease. Based on national data, you will find the projection of how many Kokan are affected by heart disease? I have extrapolated data to estimate, how many Kokani  die each day because of heart attack. What will be the financial impact of surgeries? (How many accredited hospitals are in Mumbai.)

Can we reverse the heart disease? The answer is yes and I have then explained my own experience in this. What causes heart disease? What are the risk factors? What are the preventive measures to delay onset of heart disease? We will discuss on all above points therefore stay tuned.

Heart attack is number one killer in India:

Heart attack causes 19% of total deaths in India. The mean (average) age of Indian people getting heart attack is 48. This reminds me the old famous Marathi Lawani song,”SOLAWA WARIS DHOKYACHA GA, SOLAWA WARIS DHOKYACHA.” After, India has become capital of heart disease; I think this song should be modified as,” 48 WA WARIS DHOKYACHA GA, 48 WA WARIS DHOKYACHA”

Jokes apart but the worst part is, one third of people are unaware of their heart disease until they have a heart attack. This is a scary bit. My calculations indicate that on an average, 14 Kokani people die every day due to heart attack. The below is the statistics I have collected. At the bottom, in the Reference section, I have mentioned all the resources from where I have collected data for this article.

Kokan area - Square KM	30,728	Kokan population Density	931.7/Sq. KM
Kokan population (2011)	2,86,29,512	Kokani Muslim population	13.4%
Kokani Muslim population	38,36,355	Kokani per capita income	66000/ Annum
Kokani  total yearly income	1889.5 million Rs.
Death rate ( 2010) per year	7.2/1000	Kokani  death per year	206134
Death rate due to heart attack	19%	Kokani  death due to heart attack	39166 per year ( 107 deaths/ day)
Yearly heart surgeries required for whole India	2.5 Million	Yearly heart surgeries  required for Kokani	59552 per year
Average Cost of surgery (Miraj & Bangalore)	2,00,000 Rs	Total yearly surgery cost of Kokani	11.91 Million Rs.

55% of people getting heart attack are below 50 years. Recently a young lawyer under 45, and my distant relative, died due to heart attack. I had no clue that he had heart disease. He had Rs. 4-5 lakh savings from his practice with him so he could have done heart surgery but he thought that if operation fails then his family will not only lose him but also all his life’s entire savings. Therefore, he simply chose to die. No one can say that he did the right thing but this is a heart-wrenching story. I have seen a 20 year old boy dying because of his Mitral valve damage since childhood as a result of undiagnosed and untreated rheumatic fever. His parents simply could not afford his surgery & therefore they had to let him go.

If young men are dying because of heart disease, then who is going to care for people over 50? Again, same story, everyone in the family let them suffer painful death simply because they are helpless. I am sure you must have come across at least one such sad story if not many in your life. The sole searching question we all have is,” Shall we simply do nothing and let people die or we as a community do something about it?”

Cardiac surgery success rate in India and healthcare Hospital standard in India:

Coronary artery bypass graft surgery (CABG) was first performed in India in 1975 about 13 years after its advent in 1962. In the mid 1990 some 10,000 CABG surgeries were performed annually in India. Presently the annual number is about 1, 00,000. The surgery success rates in India were not as high as developed countries until 1990. The lower success rates were attributed to technical challenges, which cardiac surgeons in India have to face. These are chiefly related to small coronary vessels, arterial conduits, diffuse disease and late presentation. Kinare & Kulkarni in a smaller series from Mumbai reported that heart weight in Indians varied from 148 to 249 g while in the West the average weight of the heart, in males is 300 g and that in females is 250 g. (I personally think we Indians have big heart, so what if not in dimensions) Such smaller sized vessels pose difficulty during anastomosis and may result in early graft closure leading to higher mortality. Come year 2000, a cardiac surgery success rate in India was even better than developed countries. That proved Kinare & Kulkarni report irrelevant. For example, Dr. Naresh Trehan who is cardiac surgeon at Medanta hospital in Gurgaon, Haryana has performed more than 60,000 cardiac surgeries with 99.5% success rate. Dr. Shetty who did cardiac surgery on Mother Teresa at Narayana Hrudayalaya, Bangalore has carried out thousands of surgeries with 98.6% success rates. Success rates of cardiac surgery in US is 98.2%

As a result, an estimated 150,000 foreigners travel to India for low-priced healthcare procedures every year which is expected to grow 2 billion $ healthcare industry by 2015. To improve the standard of healthcare in hospitals, Government of India, in 2006, introduced National Accreditation Board for Hospitals (NABH) accreditation as International accreditation was perceived to be too difficult to achieve by hospitals in India which is not true because Asian Heart Institute in Bandra, Narayana Hrudayalaya (Bangalore), KIMS Kerala, Apollo hospital chains, Fortis hospital chains have successfully acquired accreditation from JCI (Joint Commission International).

Healthcare Hospital Standard in Mumbai:

Mumbai’s hospitals and doctors were top rated before 30-40 years but unfortunately Mumbai’s healthcare standard has deteriorated in recent years. No one would have considered going to Bangalore for treatment in 1975 but today 12 hospitals in Bangalore & 25 hospitals in Delhi acquired India’s NABH accreditation (out of total 125 accredited hospitals nationally) as against Mumbai’s meagre 6 hospitals. Medanta hospital in Haryana performed thousands of cardiac surgeries using highly sophisticated Da vinci robot whereas in Mumbai, it is recently started in Asian Heart Institute Bandra. Skill of Mumbai doctors can’t be questioned. As an example, Dr. Panda from Asian Heart Institute, Bandra did heart surgery on Prime Minister Manmohan Singh. Narayana Hrudayalaya hospital has both National plus international accreditation and their cardiac surgery cost is lot less than what we spend in Mumbai.  I don’t have first-hand experience of Narayana Hospital but it may be worth exploring.

Accredited hospitals in Mumbai

NABH ( National Accreditation Board for Hospital )Accredited hospitals in Mumbai:

Lilavati Hospital Bandra, Holy spirit Hospital Bandra, Hinduja Hospital  Mahim, Nanavati Hospital Santacruz, Hiranandani Hospital, Powai, Godrej Hospital, Vikhroli

Joint Commission of International (JCI) accredited hospitals in Mumbai:

Asian Heart Institute, Bandra, Fortis (previously called Wockhardt) Hospital, Mulund, Shroff Eye Clinic.

Heart attack symptoms:

The warning signs of heart attack can be varied and may not always be sudden or severe. You may have just one of these symptoms, or a combination of them. They can come suddenly or develop over minutes and get progressively worse. Symptoms usually last for atleast 10 minutes.

Warning signs could include:

• Discomfort or pain in the centre of your chest—

This can often feel like a heaviness, tightness or pressure. People who have had a heart attack have commonly described it as like an “elephant sitting on my chest”, “a belt that’s been tightened around my chest” or ”bad indigestion”. The discomfort may spread to different parts of your upper body.

• Discomfort in these parts of your upper body:

You may have a choking feeling in your throat. Your arms may feel heavy or useless.

• You may also experience other signs and symptoms:

– feel short of breath

– feel nauseous

– have a cold sweat

– feel dizzy or light-headed.

Diagnosis of heart disease:

The physical exam:

The doctor will look at your skin for good color, which shows that your body is getting a good supply of oxygen-rich blood. Your doctor will also feel your skin for warmth and feel your pulse to check your heart's rate, rhythm and regularity. Each pulse matches up with a heartbeat that pumps blood into the arteries. The force of the pulse also helps evaluate the amount (strength) of blood flow to different areas of your body and problems with circulation. Your doctor will check for swelling, which is a sign that your heart is not pumping efficiently.

Your doctor will use a stethoscope to listen closely to the sounds the heart makes with each heartbeat. The doctor can evaluate your heart and valve function and hear your heart’s rate and rhythm by listening to your heart sounds.

Abnormal sounds include:

●     Murmur: An abnormal whooshing sound made by blood flowing abnormally through the heart. This may indicate a leaky heart valve.

●     Click: An abnormal sound made by a valve that is stiff or stenotic (narrowed).

Blood Pressure

The doctor will measure your blood pressure. High blood pressure (hypertension) is a common problem that often leads to heart disease.

Blood pressure is the force (pressure) exerted in the arteries by the blood as it is pumped around the body by the heart.

Blood pressure is a measurement of two types of pressure that are recorded as mm Hg (millimeters of mercury):

●     Systolic pressure: This is the amount of pressure in the arteries when the heart contracts. This is the higher of the two numbers.

●     Diastolic pressure: This is the amount of pressure in the arteries when the heart is relaxed between heartbeats. This is the lower of the two numbers.

The normal blood pressure for an adult who is relaxed at rest is less than 140/90 mm Hg.

Blood pressure may go up or down, depending on your age, heart condition, emotions, activity and the medications you take.

One high blood pressure reading does not mean you have high blood pressure. You may have to have your blood pressure measured at different times to find out what your typical reading is.

ECG Test:

An electrocardiogram (ECG) is a medical test that detects cardiac (heart) abnormalities by measuring the electrical activity generated by the heart as it contracts. The ECG can help diagnose a range of conditions including heart arrhythmias, heart enlargement, heart inflammation (pericarditis or myocarditis) and coronary heart disease.

Stress Test:

Exercise stress testing is a procedure used by doctors to measure the performance and capacity of the heart, lungs and blood vessels during exercise.

A common type of exercise stress test involves using an electrocardiogram (ECG) to record electrical signals from your heart during exercise. Alternatively, an echocardiogram may be used instead of an ECG. An echocardiogram uses sound waves (ultrasound) to produce images of your heart. A third type of exercise stress test involves injecting a radioactive material and following its progress through the heart’s blood vessels. This is often called a 'nuclear stress test' or a 'myocardial stress test'.

In some people, exercise stress testing is not suitable. In such cases, medicines may need to be used instead of exercise to stimulate the heart. This is called 'pharmacological stress testing'.

Echocardiogram:

An echocardiogram is a test in which ultrasound is used to examine the heart. In addition to providing single-dimension images, known as M-mode echo that allows accurate measurement of the heart chambers, the echocardiogram also offers far more sophisticated and advanced imaging. This is known as two- dimensional (2-D) Echo and is capable of displaying a cross-sectional "slice" of the beating heart, including the chambers, valves and the major blood vessels that exit from the left and right ventricle

Sticky patches or electrodes are attached to the chest and shoulders and connected to electrodes or wires. These help to record the electrocardiogram (EKG or ECG) during the echocardiography test. The EKG helps in the timing of various cardiac events (filling and emptying of chambers). A colorless gel is then applied to the chest and the echo transducer is placed on top of it. The echo technologist then makes recordings from different parts of the chest to obtain several views of the heart. You may be asked to move from your back and to the side. Instructions may also be given for you to breathe slowly or to hold your breath. This helps in obtaining higher quality pictures. The images are constantly viewed on the monitor. It is also recorded on photographic paper and on videotape. The tape offers a permanent record of the examination and is reviewed by the physician prior to completion of the final report.

Cardiac CT Scan:

Cardiac computed tomography, or cardiac CT, is a painless test that uses an x-ray machine to take clear, detailed pictures of the heart. Doctors use this test to look for heart problems.

During a cardiac CT scan, an x-ray machine will move around your body in a circle. The machine will take a picture of each part of your heart. A computer will put the pictures together to make a three-dimensional (3D) picture of the whole heart.

Sometimes an iodine-based dye (contrast dye) is injected into one of your veins during the scan. The contrast dye highlights your coronary (heart) arteries on the x-ray pictures. This type of CT scan is called a coronary CT angiography , or CTA.

Coronary angiogram:

A coronary angiogram is a special x-ray of your heart using an injected contrast dye. The angiogram looks for heart muscle or heart valve abnormalities. It can also see if the coronary arteries are narrowed or blocked. An angiogram can also diagnose heart problems including aneurysm (abnormal ballooning of the heart wall), heart arrhythmias (irregular heart beat) or birth defects, such as a hole in the heart.

The test is done in a special laboratory called a cardiac catheterisation laboratory (Cath Lab), which is similar to an operating theatre. A slender catheter (a thin, hollow plastic tube) is threaded through the largest artery in your body (the aorta) until it reaches the coronary arteries of the heart. A special contrast dye is injected and x-rays are taken of the blood vessels as the dye moves through them. Another term for coronary angiogram is cardiac catheterisation.

Risk:

This is an invasive test. Therefore, it carries a very small risk.

Although very rare but possible complications of an angiogram:

Some of the possible complications of a coronary angiogram include:

●     Allergic reaction to the contrast dye, including hives and itchy skin

●     Bleeding from the wound

●     Heart arrhythmia

●     Heart attack

●     Stroke.

Cardiac PET Scan:

Although many cardiologists still consider coronary angiography to be gold standard for measuring heart disease, Cardiac PET scan is becoming a new Gold standard for assessing whether or not heart disease is getting better or worse.  Angiograms measure only blockages in the artery whereas Cardiac PET scan measure how much blood flow the heart is receiving. Also, Angiogram is invasive hence it carries some risk where as Cardiac PET Scan is non-invasive test.

There were 22 Cardiac PET Scan machines installed in India in 2010 which would have been doubled by this time. All accredited hospitals in Mumbai as well as big private hospital In Mumbai have this machine. Also, KEM hospital in Parel has this machine. The cost of cardiac PET SCAN test in private hospitals in India varies from Rs. 15000 to Rs. 27000 depending on the protocols used.

An interventional procedure:

An interventional procedure is a non-surgical treatment used to open narrowed coronary arteries to improve blood flow to the heart. An interventional procedure can be performed during a diagnostic cardiac catheterization when a blockage is identified, or it may be scheduled after a catheterization has confirmed the presence of coronary artery disease.

An interventional procedure starts out the same way as a cardiac catheterization. Once the catheter is in place, one of these interventional procedures is performed to open the artery: balloon angioplasty, stent placement, rotablation or cutting balloon.

Balloon angioplasty: A procedure in which a small balloon at the tip of the catheter is inserted near the blocked or narrowed area of the coronary artery. The technical name for balloon angioplasty is percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI). When the balloon is inflated, the fatty plaque or blockage is compressed against the artery walls and the diameter of the blood vessel is widened (dilated) to increase blood flow to the heart. This procedure is sometimes complicated by vessel recoil and restenosis.

Balloon angioplasty with stenting: In most cases, balloon angioplasty is performed in combination with the stenting procedure. A stent is a small, metal mesh tube that acts as a scaffold to provide support inside the coronary artery. A balloon catheter, placed over a guide wire, is used to insert the stent into the narrowed artery. Once in place, the balloon is inflated and the stent expands to the size of the artery and holds it open. The balloon is deflated and removed, and the stent stays in place permanently. During a period of several weeks, the artery heals around the stent. In this way, restenosis is somewhat diminished.

Angioplasty with stenting is most commonly recommended for patients who have a blockage in one or two coronary arteries. If there are blockages in more than two coronary arteries, coronary artery bypass graft surgery may be recommended.

Drug-eluting stents (DES): Drug-eluting stents contain a medication that is actively released at the stent implantation site. Drug-eluting stents have a thin surface of medication to reduce the risk of restenosis.

Concern was raised in 2006 regarding the safety of drug-eluting stents due to the risk of blood clots forming on the stent, causing a heart attack. The Food and Drug Administration (FDA) continues to feel that DES, when used according to approved indications, are safe and effective. 

Source: Update to FDA Statement on Coronary Drug-Eluting Stents (January 4, 2007).

If you receive a drug-eluting stent, your doctor will prescribe certain medications for several months after your procedure to prevent the risk of clotting in the stent. It is extremely important to keep taking the medications as prescribed until your doctor tells you otherwise.

Rotablation (Percutaneous Transluminal Rotational Atherectomy or PTRA): A special catheter, with an acorn-shaped, diamond-coated tip, is guided to the point of narrowing in the coronary artery. The tip spins around at a high speed and grinds away the plaque on the arterial walls. This process is repeated as needed to treat the blockage and improve blood flow. The microscopic particles are washed safely away in your blood stream and filtered out by your liver and spleen.

Cutting balloon: The cutting balloon catheter has a balloon tip with small blades. When the balloon is inflated, the blades are activated. The small blades score the plaque, then, the balloon compresses the fatty matter into the arterial wall. This type of balloon may be used to treat the build up of plaque within a previously placed stent (restenosis) or other types of blockages.

Bypass Surgery:

A heart bypass operation is performed to 'bypass' a narrowed segment of coronary artery. This is usually done by inserting a section of the patient's saphenous vein, taken from the thigh or lower leg. This is also called coronary artery bypass graft surgery (CABG)  

Heart bypass surgery is performed under general anaesthetic. The saphenous vein (from your leg) the internal mammary artery (from your chest wall) or the radial artery (from your wrist) can be used as grafts. Commonly, between two and four coronary arteries are grafted, depending on the location and severity of the blockages.

The surgeon accesses your heart using one of two possible incisions: either cutting down the length of your breastbone (median sternotomy) or cutting beneath the left nipple (thoracotomy). A heart-lung machine maintains your blood circulation while your heart is deliberately stopped. The vein or artery is then grafted onto the narrowed segment of coronary artery, which allows the blood flow to bypass the blockage.

Sometimes, the operation is performed while the heart is still beating (this is called 'beating heart' or 'off-pump' surgery).

Cardiopulmonary Resuscitation - CPR

Cardiopulmonary resuscitation, or CPR, is a lifesaving rescue method that anybody can and should learn. It is a combination of both rescue breathing and chest compressions to provide blood flow to the brain and heart.

Lab test to conform heart attack:

When the heart is deprived of oxygen, the muscle fibers are damaged, and their components like troponin, Creatine kinase (CK), Myoglobin (Mb) leak in to the bloodstream. Measuring these enzymes in lab, heart attack is confirmed.

What are heart diseases?

There are two extreme views in medical fraternity. One extreme view advocates that cholesterol is everything in heart disease where as another extreme believes that cholesterol has little to do with heart disease. The reality lies in between these two extremes. Although Cholesterol is just one of the several risk factors, it is indeed a big contributing factor in Coronary artery disease related deaths.

There is some time congenital (birth) heart defects like hole in heart chambers, many times mitral valve is damaged if rheumatic fever is not treated, few people suffer from aortic valve leakage, few are born with genetic muscle disease that affects muscle of the heart, and some people have severe irregular heartbeats that become fatal. These all diseases have very fancy and sexy names. If you want to know it, please see website address mentioned in the reference.

Coronary artery disease:

As explained above, there are many heart diseases however this article is focussed on coronary artery disease.

What causes coronary blockages to form?

Blockages form when the lining of a coronary artery is damaged. The body attempts to repair this by putting the physiological equivalent of a Band-Aid over the damaged area. This Band-Aid is made of cholesterol, collagen and other materials. If the injury to the lining is chronic, then the Band-Aid begins to pile up, one on top of another. Over time-in few decades theses begin to build up and form coronary artery blockages. The body’s attempt to heal itself becomes destructive & deadly when the injury is chronic and repetitive.

How much artery blockage is safe?

Blockages up to 50% are considered as moderate risk. Anything above 50% needs immediate intervention by life style changes. Blockages of 70% and above are considered as extremely dangerous and surgery is preferred because any small blood clot or small heart spasm is enough to cause massive heart attack if arteries are blocked over70%.

What are the risk factors of Coronary artery disease?

●      Genetic: If there is history of heart attack in the family, the risk of acquiring heart disease is high

●      High cholesterol level:   As explained above

●      High blood pressure: When blood pressure is elevated, the blood hits the side of the arterial wall with increased force thereby causing injury to the lining of the coronary arteries. To repair it, cholesterol is deposited. This reduces inner diameter of blood vessels that again increases the blood pressure further & it becomes the vicious circle.

●      Diabetes: Insulin produced by pancreas regulates sugar level in blood. This insulin besides regulating blood sugar level, stimulates the secretion of Lipoprotein Lipase, an enzyme that increases the uptake of fat from bloodstream in to fat in body’s cells. As a result, when body produces more insulin, it is more likely to convert dietary calories in to body fat. When body becomes insulin resistant, pancreas produces more insulin to compensate insulin resistance which increases the conversion of those calories in to body fat. Excess insulin may enhance the growth of arterial smooth muscle cells which in turn starts clogging up arteries. That is why people with diabetes have higher rates of heart attacks.

●      Nicotine: Most people know that cigarettes are major cause of lung cancer but relatively don’t know that smoking causes many more deaths from heart disease than from lung cancer. The nicotine and other toxic substances in tobacco are absorbed in to the blood and injure the lining of the coronary arteries. Nicotine also causes coronary arteries to constrict and blood clots to form and lodge the coronary arteries.

●      Spasm: Coronary arteries are not rigid like lead pipe; the arteries are flexible which can constrict, thus reducing coronary blood flow. When a coronary artery goes in to spasm, it can injure the lining of the artery, leading to cholesterol deposition and plaque build-up leading to clogging the arteries. Depending on spasm intensity, severe spasm can cause bleeding in to the walls of the vessels, causing the wall of the artery to bulge in to the artery. Severe anxiety or shocking news may also cause spasm. Stimulants: Cocaine especially Crack and amphetamines are perhaps the most potent stimulants of arterial constriction, blood clot formation and plaque haemorrhage (bleeding). Other stimulants such as caffeine, may do this but to a much lesser degree.

●      Blood clot: Heart attack usually occurs when a small blood clot lodges in an artery that is already significantly blocked with cholesterol and other deposits.

●      Age: As we age, our arteries slowly get clogged. In India mean age of getting heart attack is 48, therefore anyone above 40 years age  have a high risk than person below 25.  

●      Emotional Stress: Based on research findings, importance of emotional stress as a cause of heart disease is now achieving widespread acceptance. Studies have indicated that emotional stress increases blood pressure and cholesterol level no matter what diet you are eating. Type of stress is not important. It is noticed that Tax consultants have increased cholesterol  levels at the end of financial year, Medical students (I believe this will be true for all students but study was done only on medical students) have high cholesterol levels during their exam period. A brutal study from Dr. Boris and Dr. Genja published in Soviet scientific journal demonstrated very clearly as to how emotional stress can cause coronary artery blockages to form. In their very cruel experiment, male baboons were taken from their female mates and placed in separate cages. Then the males were forced to watch their mates copulate with a rival monkey. After four months of this, the isolated male monkeys had significant increases in coronary artery blockages.

How does emotional stress lead to coronary heart disease?

Emotional stress comes in two basic categories: Acute and Chronic. Acute stress means nasty flare up of stress that last for a short time only. 'Chronic' stress means there is a long standing persistent stress. Our body is designed to cope up with acute stress well and not chronic stress. Our body responds to acute stress by trigger mechanism known as flight or fight response which prepares us either to fight or run away. The body does this in two ways. First, there are direct connections between heart and brain. This is the answer of first question I raised in the beginning of this article. These nerves called sympathetic nervous system stimulate receptors in the heart that makes it beat faster, harder and can cause the coronary arteries to constrict. Second, the brain causes adrenal glands to secret stress hormones such as adrenaline and steroids such as Cortisol, which circulate in the blood until they reach heart. It causes a series of body responses. One of them is arteries in our arms and legs begin to constrict, so that less blood will be lost if we become wounded. Our blood clots more quickly to avoid blood loss. This is short time measure to overcome danger however with emotional stress, it is chronic in nature. We often don’t have time to recover from one stressful situation before we get hit with another. Faster Heart beats for prolonged period causes blood pressure to go up which injures the lining of coronary arteries. Also, stress related spasm injures lining of the coronary arteries too. This leads to piling up cholesterol that clogs the arteries leading to heart disease.

Can we prevent heart disease ?

Why do blood clot where it is not supposed to clot in the first place? Why arteries go in to spasm & what mechanism activates the mechanism that causes coronary artery blockages to form? The answer lies in our life style we choose each day, what we eat, how we respond to stress, how much we exercise and whether we abuse our body with nicotine, drugs etc.

Diet: Strict changes in diet and life style can not only prevent heart attacks but can actually reverse the clogging of the arteries. A diet high in saturated fat and cholesterol provides the building blocks for coronary atherosclerosis (forming plague in arteries). Diet can affects the heart very quickly, not just over a period of years as is commonly believed until now. Even a single meal high in fat and cholesterol may cause body to release hormone called thromboxane which causes the arteries to constrict and blood to clot faster- One reason why heart patients often get chest pain after eating a very fatty meal and why so many of them end up in emergency room after a rich holiday feast or rich Kokani wedding reception party.

National Cholesterol Education Programme guidelines advise patients with high Cholesterol level to reduce fat intake to 30% of total calories and to reduce cholesterol consumption from 500 Milligram to 300 milligram per day.  Unfortunately, this guideline does not work for most of the people and Cholesterol level will still be too high. Even reducing fat intake to 20% does not make huge difference. We all, including our doctors then believe that high cholesterol level is genetic and can’t be controlled by diet changes at all. Doctor tells us, “Well, you will have to start taking cholesterol lowering drug for the rest of your life.”

There is a genetic variability in how efficiently or inefficiently a person metabolizes dietary saturated fat and cholesterol. Some people can eat almost anything yet their blood cholesterol levels do not increase very much. Others find that even a small amount of dietary fat or cholesterol makes their cholesterol level increase. Most of us are somewhere in between on this spectrum. It all depends on how many LDL- Cholesterol receptors you have in your liver cells as their primary role is to bind & remove cholesterol from blood stream. The more Cholesterol receptors you have, the more efficiently you can metabolize. The number of cholesterol receptors you have is, in part, genetically determined.

Only 5% of people have genetically high Cholesterol levels that remain elevated regardless of life style.

75% of our fat is produced by body so we don’t need too much dietary fat externally. To reverse heart disease, all the foods we eat needs to be cholesterol free. The daily fat intake needs to be below 35 gram with less than 14 gram Saturated fat.

Fat does taste good but if we decrease the amount of fat in diet, our palate will readjust. After a while, we will find that diet with less fat taste delicious and food used to taste so good will begin to seem too rich or oily. Diet should be balanced with less fat, high proportion of complex carbohydrate and adequate proteins.

Complex carbohydrates include fruits, vegetables, grains, and legumes (beans) in their natural forms. Sugar in complex carbohydrates are absorbed slowly, thereby helping to keep blood sugar level constant and so they don’t stimulate our body to produce excessive amounts of insulin. Fasting in Ramadan is best with diet full of complex carbohydrate (Sehri) in the morning as you feel full of stomach nearly whole day.

 However, complex carbohydrates behave like simple carbohydrates when they are refined. That is what we all Kokanis do. We remove bran and fibre part from our rice and wheat flour and refine in to white flour which is the most unwise thing to do. Since bran and dietary fibre is removed from our Kokani roti, chappati and rice, sugar in rice, chappati, roti, gets absorbed very quickly in our body and provokes insulin response.

Simple carbohydrate-sugar and sweeteners like high fructose corn syrup; alcohols etc. which our body converts to sugar are absorbed rapidly causing blood sugar to rapidly increase.

Can we reverse heart disease?

Yes certainly. One of my uncles has done this successfully. I have reversed my heart disease as well. Let me tell you my story.

In March 2005, I felt congestion in my chest.  I went to my General Practitioner, who took my ECG.  The ECG graph looked beautiful & artistic to me but for some reason my GP did not like it so he referred me for Stress Test. My GP did not like my stress test report either. He referred me to Cardiologist. He confirmed me that I have heart disease. He booked me for angiography and I was told that if blockages are more than 70% then they will go for angioplasty. The word angioplasty gave me impression that doctor is doing some alterations in my heart by plastic surgery to make it as a designer heart which will be more presentable to whoever I share my heart with. Doctor found all my three arteries blocked by 58%. Since one artery is blocked at the junction point, doctor told me that I need bypass surgery and angioplasty is not suitable for me. He said we will wait for two years so that blockages would reach 70% level. He gave me 100mg of Aspirin to take every day to avoid blood clot.

Doctor advised me against going to gym and to do exercise. He said people with coronary artery blockages; exercise actually increases the tendency of blood to clot and arteries to constrict which may lead to heart attack. I was explained that normal coronary arteries produces a substance called endothelium derived relaxation factor or EDRF, that dilates the coronary arteries, allowing more blood to flow to the heart.  Due to clogging of the coronary arteries, much less EDRF is produced so arteries tend to constrict due to exercise, reduce blood flow that may lead to heart attack.

When I came to India and met Alli mamu (Dr. Allimiya Parkar, Cardiologist), I asked him whether blockages can be reversed? He said yes and asked me to read, Dr. Ornish’s book reverse your heart disease. He told me how Sayeed mamu (Alli mamu’s brother) reversed his heart disease after first heart attack purely by diet. I followed the advice in the book. I don’t smoke and I don’t drink alcohol but I was having dilemma about exercise. I followed the safe exercise formula given in Dr. Ornish book that worked well. My cardiologist realised that I have improved drastically so he keep postponing my heart surgery. After 5 years, he checked my blockages again. The blockages were reduced from 58% to 42%.

Slight reduction in blockages results in great improvement in blood flow. If half inch pipe line is replaced with one inch pipe line in water supply, the flow is increased by four times. Same principle applies in arteries as well.

Safe exercise level:

Half an hour walk daily is good enough exercise. There are two formulae used for safe exercise. The safe heartbeats are calculated as 

0.80 (220- your age)

The other method is called Karvonen Equation, which takes in to account resting heart rate;

Safe heartbeats= [(maximum heart rate – resting heart rate) x (0.80) + resting heart rate]. First formula is my favourite as it is just easy.

Reducing stress level:

Getting connected with people & getting connected with God by praying or meditation are the best way to keep stress under control.

The other thing to control stress level is to apply 90/10 rule in our entire life situation. You may already know about 90/10 rule and its story but it is worthwhile to mention here to reinforce it again.

90/10 rule: 10% of life is made up of what happens to you. 90% of life is decided by how you react.

What does this mean? We really have no control over 10% of what happens to us. We cannot stop the car from breaking down. The plane may be late arriving, which throws our whole schedule off. A driver may cut us off in traffic. We have no control over this 10%. The other 90% is different. You determine the other 90%!

How? By your reaction. You cannot control a red light, but you can control your reaction. Let's use an example. You're eating breakfast with your family. Your daughter knocks over a cup of coffee onto your business shirt. You have no control over what just happened. What happens next will be determined by how you react. You curse. You harshly scold your daughter for knocking the coffee cup over. She breaks down in tears. After scolding her, you turn to your wife and criticize her for placing the cup to close to the edge of the table. An exchange of verbal abuse follows. You storm upstairs and angrily change your shirt. Back downstairs you find your daughter has been too busy crying in hurt to finish breakfast and get ready for school. She misses the bus. Your wife leaves immediately for work, upset and angry.

You rush to the car and drive your daughter to school. Because you are late, you furiously drive 40 miles an hour in a 30 mph speed limit. After a 15 minute delay and throwing $60 (traffic fine) away, you arrive at school. Your daughter runs to the building without saying good-bye.

After arriving at the office 20 minutes late, you find you forgot your briefcase. Your day has started terrible. As it continues, it seems to get worse and worse. You look forward to going home. When you arrive home you find damage and hurt in your relationship. You can only expect, “Not tonight…” answer from your spouse and no smile from your daughter.

Why? All because of how you chose to react in the morning.

Here is what could have and should have happened. Coffee splashes over you. Your daughter is feeling apologetic and sorry. You gently say with a smile, "It's OK honey, I know you didn't mean it."

Grabbing a towel you rush upstairs. After grabbing a new shirt and your briefcase. You come back down in time look through the window and see your child getting on the bus. She turns and waves. You and your spouse kiss before you both go to work. You arrive 5 minutes early and cheerfully greet the staff. Your boss comments on how good of day you are having.

Notice the difference? Two different scenarios. Both started the same. Both ended different. Why? Because of how you CHOOSE to react. You really do not have any control over 10% of what happens. The other 90% is determined by your own free will.

Body Mass Index and heart disease:

My weight was 70 Kg when I got heart disease. Sayeed mamu had 60 Kg weight when he suffered his first heart attack. Both weights were ideals in terms of body mass index. Obesity  is considered a risk factor for heart disease but we were not obese so I asked question to Alli mamu,” I am not obese person then why I got heart disease?” He asked me,” What was your weight at the age of 25?” I said,” 50” He said,” Heart growth stops at the age of 25. Heart is designed to take care of body weight at the age of 25. Arteries also are designed to take care of body weight at the age 25. In fact everything in our body is designed to take care of weight at the age of 25. There is 10% inbuilt overload capacity. Your weight has increased by 40% which means you are obese as far as heart is concerned. If some one’s weight is 100 Kg at the age of 25, and his weight is increased to 110Kg then he is not obese from hearts perspective. When I read Kulkarni report about how Indian men’s heart size is small & diameter of coronary arteries are less compared to westerners, it made sense to me. I can visualise, Andrew Simond’s heart, arteries and organs will be bigger than Rahul Dravid now. I think many Indian people are not obese but they increase their weight considerably compared to their weight at 25 making them vulnerable to heart disease.

Religion and heart disease:

Fasting in Islam is good for the heart. Also, Zakat system in Islam can take care of all health problems of Muslim community. Prayers are good for reducing stress. Going for Umra & Hajj is like great stress busters too as you forgets all the worldly things and get connected to Allah. It is like recharging the battery, recharging our soul.

This is equally true for all the other religions as well. Going in temple, meditation, performing religious rites has similar effects like prayers in Islam.

Meditation & Yoga: Ancient monks Swamis, Sufis, have demonstrated how inner peace and happiness can be achieved with the help of meditation & self realisation. In mid seventies, studies in in Boston, New York, California, England and other parts of the world were proving that meditation can lower blood pressure, reduce cholesterol level, and decrease the frequency of irregular heart rhythm & so on. Yet, almost all of these techniques ultimately derive from Yoga. Herbert Benson, M.D.; a well known cardiologist at the Harward Medical school, spent two decades conducting pioneering research on beneficial effects on meditation. He found that meditation can lower BP, decrease premature  heartbeats, inhibit gastric acid secretion, & produce other beneficial effects. Jon KabatZinn, Ph.D., director of stress Reduction Clinic at the University of Massachusetts medical school, has found similar results using yoga techniques with his patients.

The system of yoga was first compiled by Patanjali somewhere between 5000B.C. & A.D. 3000. In his book, Yoga Sutras, Patanjali outlined general principles showing step by step how a person can find inner peace & knowledge through Yoga. Patanjali did not limit his instructions to any particular technique or religion, for Yoga is not religion. Exercise does not conflict with any religion. Same thing is true about Yoga. It is a system that can help broaden a person’s present experience of his/ her own philosophy, religion & daily life. Yoga complements rather than replaces western approaches and medical care.

Other side effects of Cholesterol:

We all talk about clogging coronary arteries because it leads to heart attack & death however all our arteries in our body starts clogging as we age. If arteries leading to brain are clogged, it causes stroke. However, partial Clogging of brain arteries may not be life threatening but it can affect quality of life. Blood supply to brain gets reduced so 45 year old person’s brain will not be as sharp as 20 year old students. People at 45 age, have difficulty with memory. They can’t do university degree at this age. This is because of partial clogging of arteries. When clogging of arteries reduces blood flow to digestion system, you will find that you are not able to eat anything and everything you like and get away with it as you used to, when you were 25 year old. And God forbid, Penis thrombosis can make married person’s life upside down. Even partial clogging of penile arteries can affect quality of person’s sexual abilities. Therefore, if nothing else motivates Kokani men to eat less fatty stuff then at least this side effect should motivate our married Kokani men. Everything we are talking about is not to enhance our life but to improve quality of life.

In summary, Prevention is always better than cure. To prevent heart disease, we should give utmost importance to diet, exercise and reducing our stress level. We should not abuse our body with smoking, drinking alcohol & drugs.  Heart disease can be reversed with life style changes. We don’t need to change drastically. We just need to give up on our current sedentary life style. We need to get connected with our people and God.

About Author :

Authors introduction in his own words:

My name is Shakur Tisekar living in Sydney, Australia, with wife and two sons. Having done my schooling till SSC from Siraj ul Islam, High school, Furus, I completed Diploma in Electrical Engineering from Saboo Siddik college. I  started my career with Bombay Electric Supply Trandport-BEST, as we know today, for a few months and later joined Brihan Mumbai Corporation-BMC. In the meantime I also got married. A few years later I did Bachelor of Engineering from Sardar Patel College, followed by MBA (Finance) from Newport University. I also did a research project from United states Agency for International development through National Productivity Council, Chennai, and bagged a few certificate courses including Personality Development and Post Graduate Diploma in Teaching in Curtin University, Perth. After passing Technology Architect, Proven Specialist Exam, I now work as a Technology Consultant Analyst in an American IT company. Well, I am not only boring nerd, but I enjoy all good things of life, this includes Bollywood movies, Music, Sports like Cricket, Chess,  and sometimes reading novels too.  

Background of article:

About six month back, I read Cancer awareness post by Dr. Wasim Phoplunkar on Facebook. Dr. Manzer Sahibole also wrote an article on women related issues in iKokni. I realised that similar awareness is required for Heart disease as heart attack is a number 1 killer in India. While playing Chess and simultaneously chatting with my late brother, I suggested him that he should request Dr. Wasim to create awareness about heart disease as well. What he replied to me was totally unexpected,” Shakur, Why can’t you write awareness article, yourself? I said, “Bhaijan, are you kidding? How can you expect an Engineer writing medical article and that too on serious topic like heart disease? We have plenty of highly qualified Doctors. They will grill me literally.” My brother replied,” If you do with good intention, no one will grill you. Just start creating awareness and Doctors will correct you if you have erred in your article and will add their input.”

I did not take his advice seriously. As many of you may be aware that my brother is no more with us now. Four weeks before, I happened to read that same chatting again and I decided that I will write an article as per my brother’s will. That is why you are reading this article.

This article is written for common man or layman like me. Therefore, I have tried to avoid medical jargons as much as is practically possible. Those who know little about Latin language, would easily understand Jargons, like, Hyper means high, hypo means low, tension means pressure, Pancreatitis means inflammation of pancreas, infarction means tissue death due to lack of oxygen, myopathy means muscle disease, so on and so forth. But again I am assuming that majority would not be conversant with Latin language, therefore, instead of using cardiac infarction term I have used heart attack. However, I have not gone overboard and translated medical term such as Lipase enzyme as,” PACHAN DRAVVYA” etc.

Lastly, I request every reader to feel free to correct me wherever you believe that I have given unauthentic information or made mistakes. I will be more than happy to be corrected because reaching correct information to our people is more important than my own little ego.

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DR. DEAN ORNISH’S PROGRAM FOR REVERSING HEART DISEASE… DR. ORNISH

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