A few weeks ago, somebody close to a family member of mine suffered a massive heart attack. He was Indian, in his fifties, was extremely health conscious, exercised regularly, and for all intents and purposes, appeared absolutely healthy prior to the incident.
Why are some populations so very prone to diabetes and heart disease, while others are not?
How do the chips fall, ethnicity-wise? Off the bat, If you asked me who the healthiest people in the world were today, the answer that would spring to mind would be the Scandinavians. Is that really so? Where do different ethnic groups feature on the health spectrum? More importantly, what is the best yardstick to measure “health?”
While it would be difficult to find any single parameter that would be truly representative of the overall health status, cardiovascular disease seems like one of the better choices, because this is often the end-of-the-road problem in people with many conditions: obesity/overweight, diabetes, and even inflammatory disorders such as rheumatoid arthritis and lupus. It also seems to be the top killer: for example, the highest death rate per 100,000 individuals for all cancers is 261.5, while that for coronary heart disease is 405.1. Here is a fascinating infographic on death due to coronary artery disease, and you can go here to get the actual numbers and ranking: Now, what this shows is that heart disease is a BIG problem in Russia and adjoining countries, as well as the middle-east. Given that I am Indian, I paid attention to where this country, with its skyrocketing incidence of the metabolic syndrome lies: India features a bit lower on the list, towards the tail end of the “high” category, but still cannot at all be counted as one of the healthier nations based on this criterion.
While genetics definitely plays a role in predisposing or protecting, the environment also plays a huge role in increasing or decreasing risk.
To this end, the diets of the Japanese, Scandinavians, and the Mediterranean populations, who of whom fall in the lowest risk category, should be scrutinized.
Additionally, here we will scrutinize two factors that are commonly seen in some of the high-risk category nations.
Vitamin B-12 deficiency and high homocysteine:
Why does Vitamin-B-12 deficiency arise? Well, one risk factor is vegetarianism, where the only dietary source is now cow milk and its products. An even stronger one is veganism, where you have no vitamin B-12 in your diet.Then, there is Vitamin-B-12 malabsorption, where is is not absorbed if taken orally: here, your diet matters not at all. While B-12 deficiency is rare among say, whites, it is extremely prevalent among Indians, especially Indian males: Nearly 70% of a population of Indian men were Vitamin-B12 deficient! As a note, I have seen firsthand that many Indians, despite being total carnivores, are still B-12 deficient because of malabsorption, which is probably genetic.
What is the connection between this and heart disease? Turns out, Vitamin B-12, folic acid, and maybe Vitamin B6 have important, and possibly non-overlapping roles in making sure your levels of homocysteine are low. Elevated homocysteine has been implicated in both heart disease and stroke (reviewed here). And, not surprisingly, but very worryingly, homocysteine elevation is ridiculously common: 25% of Indian men in America and 58% of Indian men in India.
Why is this one implicated? Well, for one thing, maternal vitamin D deficiency during pregnancy may increase LIFELONG risk for insulin resistance (which leads to Type 2 diabetes) and type I Diabetes (multiple studies) in the child.
Next, let me first introduce you to this concept: most disease conditions (including heart disease, autoimmune disease, stroke and cancer) have their root in something called “inflammation.” This process is required to fight infections, but it is truly a double-edged deadly sword: it needs to be a laser strike to be protective, but it is not always so: inflammation can persist, but it does so silently, stealthily, over decades, without you being aware of it.
To guard against this, nature has evolved many mechanisms to curb inflammation, one of the most important, possibly, is Vitamin D.
Indians (also people of African origin) have a big problem with vitamin D deficiency: nearly 90% of “healthy” Indians were Vitamin D-deficient (reviewed here). Compare and contrast this to the finding that only around 11% of a “healthy” white population comes up as deficient. Clearly, despite ample sunlight, Indians have a problem making vitamin D. And, I have made myself blue in the face repeating this, diet is a very poor source of Vitamin D.
Russia, where heart disease is such a big killer, may also have a vitamin D deficiency problem given lack of sun exposure in the long and brutal winters. This however, is poorly studied.
To summarize RISK:
If you are Indian (or are of African origin), or are of another ethnicity but lack/avoid sun exposure or constantly wear sunblock, you are almost certain to be vitamin D-deficient.
If you are Indian, vegetarian, or vegan, you are possibly or certainly Vitamin B-12-deficient, and are at high risk for having elevated homocysteine levels.
These risk factors will likely increase your risk for heart disease and stroke, and your risk is further increased if you have either hypertension or diabetes in your family.
I am writing this blog post to increase awareness because both these fixes are so darned easy. However, both these risk factors should be addressed as early as possible in life (i.e., start with your kids, or even better, fix this while you are pregnant with your children). In addition to screening for Vitamin D and Vitamin B-12, older people are ideally best off testing their homocysteine levels as well, in addition to their lipid profile and all the other traditional tests.
Easily doable things to cut your risk:
1) As discussed above, screening for and correcting Vitamin D/B-12 deficiencies if you are an at-risk population
2) The Scandinavian/Japanese fix: Include plenty of Omega-3 fatty acids in your diet: this has been shown to protect against CVD and strokes.
3) The Mediterranean fix: Include olive oil very regularly in your diet, but without subjecting it to high heat, given its low smoke point.
4) Get plenty of folic acid: supplementing with it is controversial,so I recommend getting it via vegetables and greens; that has been shown to protect against heart attacks. Note that cooking destroys much of the folic acid, so salads are a great idea.