IN FIRST PERSON
Dr. GEORGE THOMAS reflects on the mass of easily available dietary advice that adds to his already-complicated life as a cardiologist.
THE last patient for the day was Mr. Menon. In 20 years, he survived two heart attacks, an angioplasty with stenting and a bypass surgery. But what was bugging me was his insatiable appetite for dietary advice. His endless list of dietary FAQs bogs me down. "Doctor, can I eat scrambled egg with onions? Can I take a small peg of whisky with warm water? Is this new brand of heart oil good?"
Sometimes I want to say "Look Menon, eat any thing ... Just don't eat my head!" Of course, such a choleric rejoinder would have been an expensive mistake.
To make matters worse, we have expert advice. The American Heart Association and the American College of Cardiology issue guidelines almost every year. Honourable physicians like Dean Ornish and the late Robert Atkins (may his soul rest in peace) have their versions of a good diet. Not to be left behind, experts in every country extol the virtues of native diets. The French paradox has become the recipe for a Mediterranean diet. The Coconut Board swears by coconut and coconut oil. Palm oil producers try to palm off palm oil. Beef producers are bullheaded in recommending beef and beefing up scientific evidences to prove their point. Milk producers claim dairy products to be the cream of healthy nutrition. The egg coordination committee has hatched a media blitz to market eggs. Noted physician Joseph Alpert summed up the prevailing dietary muddle in his editorial "Will the real heart-healthy diet please stand up!" in Current Cardiology Reports.
My reading into the innards of the subject has not helped either. Food is linked to a variety of biochemicals. Insulin released during food intake can be good or bad. Chemicals like leptin and ghrelin are involved in dietary regulation. There are good and bad cholesterols, good and bad carbohydrates, good fats and bad fats.
The trouble is, what is good today may be bad a few years later or vice versa.
Two years ago, I told Mr. Shenoy that nuts were bad for his heart. Then he brings me a copy of Time, which says that they are good. Now he is nuts about nuts. We have to follow food items like stocks on the bourses. My wife is ecstatic today chocolates are up. But I am dejected coffee is down. That's not all.
You thought you knew all about diets eh? Well hear this: All fats are not bad. It's the trans variety that does harm. Similarly, all bad cholesterol is not bad after all. There is this small dense particle, which has been found to be the worst offender. Coming to the good cholesterol, here comes the better `Milano' type.
Of course the best is yet to come. The mysteries of cholesterol unfold like various stages of undress in the metabolic striptease. Again, high levels of homocysteine could prove harmful. And throw away those multivitamin pills. The current recommendations are not to use them as a routine. As this is an acute deviation from recommendations two years ago, I have to eat prescriptions I had written earlier.
The other problem is the patients' obsession with cholesterol figures. A few numbers up has them pressing the panic button. Sandhya is a diet faddist. She checks her cholesterol every three months and keeps a record of the same. A few digits lower cheers her; if it's up it has her sulking.
To add to my woes, there are the greens. The environmentalists are contributing to the dietary mess. I used to recommend fish as a heart-friendly diet. Omega (not to be confused with the horologic brand) fatty acids, which are good for the heart, are found in cheap oily fish like sardine and mackerel.
Now the greens have issued a warning that it is precisely these fish that concentrate pollutants. That's not all. The vegetables that form the foundation of a heart-friendly diet are contaminated with pesticides. You can afford to do away with the contaminated colas. But to tell my patients to give up fish and vegetable would be unimaginable.
Amid all this confusion, I decided do some research on diet. A Google search of "diet" yielded 20600000 results in 0.24 seconds. That I am sure would add to the confusion in an already flummoxed patient in search of the will-o'-the-wisp of an ideal. A simple mantra for good health would be to eat right, work right and sleep right. By work I mean physical work and not `digital' work at the computer keyboard.
I tried to trace the history of dietary advisers, for basic human behaviour are a dime a dozen. We have experts advising on how to bring up children, how to breathe, how to make love and so on. The professional dietician is a recent phenomenon. The cup and spoon, gram and ounce quantification of the food we eat is a modern development. Similarly classification of foodstuff into carbohydrates, proteins, fats and vitamins has come very late in the history of mankind. In the past man just ate what he liked. The body has innate signals of craving so that we eat the foodstuff that is required most.
Going back in time was an eye-opener. The early man did not process the food. No elaborate cooking. No mass production. No refining. So the key would be to go back in time and eat natural food as far as possible. Two examples would amplify my point. Sugar is a cause for dental caries and a host of other problems while sugarcane is good for the teeth. Extracted oils are bad but whole nuts are good. Doesn't that make sense? So it would be better to eat an orange than drink its juice.
Dietary practices are as diverse as mankind itself. No food is to be condemned. But as the Hindu philosophers said, even amrut (heavenly nectar), if consumed in excess, is poison. So eating in moderation should be the motto. Similarly, variety is the spice of diet!
Coming back to my clinical woes, I had this patient Saramma, a pleasant old lady 75 years young. She was hypertensive with coronary artery disease. She had this weird dietary enquiry. Could she eat banana chips? As per the current medical guidelines, this would be taboo. But, I reasoned, she had survived beyond the Biblical three score and ten. What was the point in my restricting her? So I told her "Saramma, go ahead. What else do you like eating?" She came out with a dietary list, which would be medical anathema. Then, what was the secret of her long life?
I advise my patients on the various aspects of food. What to eat? What to eat in plenty? What not to eat? What to eat in moderation? Some adhere to my instructions religiously. But, for many, my instructions are valid only as far as the clinic door. Their next chance to eat a mutton biryani or aloo paneer with scoops of ice cream and jalebis will send my dietary advice to oblivion. But I have a method to handle these dietary desperados. If their bad cholesterol is up, I prescribe Aztor and if their good cholesterol is down I give Neasyn.
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