Brown Heart FAQs

HOT OFF THE PRESS ON MARCH 13th! The American College of Cardiology and American Heart Association along with 9 other organizations just came out with new guidelines on cardiac prevention and cholesterol. A BROWN HEART SUMMARY IS OUTLINED BELOW. Almost all of them STRONGLY REINFORCE the Brown Heart principles we have been advocating Top 10 summary points are noted below, especially for BROWN HEARTS 1. South Asians ancestry is formally recognized as a RISK ENHANCING FACTOR. Our cardiovascular risk may be underestimated by traditional calculators, so LDL lowering should be taken seriously even at younger ages. 2. Specific LDL targets are back in the guidelines. The new recommendations again emphasize treating to clear LDL goals based on risk. 3. LDL goals now depend on cardiovascular risk. For Brown Hearts we have already been STRONGLY recommending. The numbers 100, 70 and 55 are what we have been advocating and are reflected in the guidelines. DO YOU KNOW YOUR LDL NUMBER? In general, aim for LDL below 100 mg/dL; If diabetes, go below 70, and if heart disease go below 55 4. The guidelines now emphasize 30-year risk, not just 10-year risk. This is especially important for younger adults, whose short-term risk may appear low despite high lifetime exposure to LDL. 5. Supplements do not meaningfully lower LDL. Fish oil, cinnamon, turmeric, plant sterols, and red yeast rice were no better than placebo in trials, and garlic pills may even raise LDL. 6. Lp(a) should be checked at least once in life. Elevated Lp(a) is an independent risk factor and may justify more aggressive LDL lowering. 7. Cholesterol prevention should start early. At-risk adults should begin trying to lower LDL by around age 30 and continue throughout life. 8. Screening should begin early in life. LDL testing is recommended in childhood around age 10 to detect familial hypercholesterolemia, and again around ages 18–20. 9. Repeat cholesterol screening regularly. Most adults should be rechecked at least every 5 years, and more often if they have high LDL or other risk factors such as diabetes. 10. Lifestyle comes first, but many patients will also need medication. Diet and exercise are the foundation, but statins and other LDL-lowering therapies are often needed to reach modern targets

Short answer: A2 milk isn’t a magic upgrade over regular milk for health, in India or the US. The main difference is the beta‑casein type (A2 vs A1). Some people with “milk discomfort” (bloating, gas) report fewer GI symptoms with A2, but strong randomized data are limited and effects are modest. It doesn’t lower cholesterol, diabetes risk, or weight in a meaningful way. Practical tips: choose based on tolerance, taste, and budget. If regular milk bothers your stomach, a 2–4 week trial of A2 (or lactose‑free) is reasonable. For heart/metabolic health, focus on overall pattern and portions: prefer low‑fat/toned milk, keep total dairy to about 2–3 servings/day, and watch added sugar in flavored milks. Nutritionally, A2 and regular milk have similar protein, calcium, and vitamins.

A2 milk is not a magic upgrade over regular milk for health, whether it is sold in India or the United States. The primary distinction is the type of beta‑casein protein: A2 versus A1. In India, A2 milk often comes from traditional Desi cows and may be minimally processed or unpasteurized, whereas in the U.S. it is produced from cows that are genetically tested and selectively bred for the A2 protein. Some individuals who experience milk‑related gastrointestinal discomfort such as bloating or gas report fewer symptoms when they switch to A2 milk, but randomized trial data are limited and any benefit is modest. A2 milk does not meaningfully lower cholesterol, reduce diabetes risk, or affect weight. Nutritionally, A2 and regular milk contain similar amounts of protein, calcium, and vitamins. Practical advice is to choose the type of milk based on personal tolerance, taste, and budget; a 2–4‑week trial of A2 (or lactose‑free) milk can help determine if it improves symptoms. For overall heart and metabolic health, focus on the total dietary pattern: prefer low‑fat or toned milk, keep total dairy intake to about 2–3 servings per day, and limit added sugars in flavored milks.

Thanks for asking—there’s a lot of hype here. Short answer: for most people, A2 milk is not clearly “healthier” than regular milk. Both have similar nutrition (protein, calcium, vitamins). The difference is the beta‑casein type: A2 lacks the A1 variant that can break down into a peptide (BCM‑7). Some people with milk discomfort (bloating, gas) report fewer symptoms with A2 vs regular milk in small studies; this doesn’t apply to lactose intolerance (that’s about lactose, not A1/A2). No strong evidence shows A2 improves long‑term health, heart risk, diabetes, or weight. Practical take: if regular milk feels fine, no need to switch. If you get GI discomfort with regular milk, a trial of A2 (or lactose‑free) is reasonable. Focus on overall diet quality and modest portions (about 1–2 cups/day depending on your protein/calcium needs).

Great Q Ravi! With Lp(a) 106 and CAC 296, the strategy we’ve been advocating is to drive atherogenic particles even lower. Your LDL 60 and ApoB 58 are good, but given high Lp(a) and plaque burden, many experts aim LDL/ApoB into the <55 range. Adding ezetimibe is a reasonable next step: it’s well‑tolerated, generic, and typically lowers LDL/ApoB another ~15–20%, helping you clear that <55 target (especially helpful when Lp[a] is high). If you don’t reach goal or have events/symptoms, a PCSK9 inhibitor is the next escalation.

With Lp(a) 106 and CAC 296, the strategy we’ve been advocating is to drive atherogenic particles even lower. Your LDL 60 and ApoB 58 are good, but given high Lp(a) and plaque burden, many experts aim LDL/ApoB into the <55 range. Adding ezetimibe is a reasonable next step: it’s well‑tolerated, generic, and typically lowers LDL/ApoB another ~15–20%, helping you clear that <55 target (especially helpful when Lp[a] is high). If you don’t reach goal or have events/symptoms, a PCSK9 inhibitor is the next escalation.

Statin therapy — in this case, Rosuvastatin 5 mg daily — was started to bring LDL down to target, especially important given the added risk from a very high Lp(a) level.

Here you go—direct links to each guideline/statement: - 2018/2019 AHA/ACC/Multisociety Cholesterol Guideline (JACC 2019;73:e285–e350): https://www.jacc.org/doi/10.1016/j.jacc.2018.11.003 - 2019 ACC/AHA Primary Prevention Guideline (Circulation 2019;140:e596–e646): https://www.ahajournals.org/doi/10.1161/CIR.0000000000000678 - 2022 ACC Expert Consensus Decision Pathway on Nonstatin Therapies (JACC 2022;80:1366–1418): https://www.jacc.org/doi/10.1016/j.jacc.2022.07.006 - 2023 AHA Scientific Statement on Lipoprotein(a) (Circulation 2023;148:e282–e294): https://www.ahajournals.org/doi/10.1161/CIR.0000000000001196 - 2023 AHA/ACC/Multisociety Guideline for Chronic Coronary Disease (has Lp(a)/ApoB context): https://www.jacc.org/doi/10.1016/j.jacc.2023.07.002 - 2021 ESC/EAS Dyslipidaemia Guidelines (latest European; supports ApoB/Lp(a)/CAC; supersedes 2019/2022 drafts): https://academic.oup.com/eurheartj/article/42/34/3227/6359190 - ESC/EAS Pocket Guideline PDF: https://www.escardio.org/static-file/Escardio/Guidelines/Publications/DYSLIPguidelines-dyslipidemias-FT.pdf Note: The “2022 European” update you mentioned is encompassed by the 2021 ESC/EAS full guideline and subsequent focused updates/position papers. This is educational information only.

I hear the confusion Vishal...and great question—headlines about “full‑fat dairy and red meat in abundance” don’t reflect where the evidence or major guidelines (AHA/ACC, 2019–2023; ADA; ESC) actually sit. Current cardiometabolic guidance still prioritizes: more minimally processed plants, fish, legumes, nuts, and oils rich in unsaturated fat; limit saturated fat (roughly <7–10% of calories); keep sodium modest; and manage LDL/ApoB aggressively. For South Asians, I’d be even more cautious as we have been advocating

Hi great question this is the direct medical evidence. Current evidence suggests that polytetrafluoroethylene (PTFE) coating and aluminum in air fryers do not make air frying inherently harmful when used below 250°C and for recommended durations, but overheating, prolonged use, and degradation of coatings can increase the risk of exposure to potentially hazardous substances.[1] Further research is needed to clarify long-term health effects of chronic low-dose exposure to PTFE microplastics and PFAS.

Early observational studies, including the INTERHEART trial, suggested that moderate alcohol consumption lowered heart disease risk, but newer, higher‑quality research has shown that this apparent benefit was largely due to residual confounding and bias (healthier lifestyle, higher socioeconomic status, and the “sick‑quitter” effect). Mendelian randomization studies and large prospective cohorts that separate lifelong abstainers from former drinkers do not demonstrate a true cardioprotective effect. At the same time, evidence of harm even at low levels is stronger: increased risk of atrial fibrillation, hypertension, hemorrhagic stroke, several cancers (especially breast), injuries, dependence, and adverse effects on sleep and weight. Consequently, major guidelines (AHA/ACC, WHO, U.S. Dietary Guidelines, India’s FSSAI) now recommend not starting to drink for heart health; if alcohol is consumed, it should be light and infrequent—generally ≤1 standard drink per day with several alcohol‑free days—and less is better.

THE PERFECTION TRAP Article Reference: The New York Times May 13th. There is this wonderful article in the New York Times last week that reinforces what we at THE BROWN HEART has been emphasizing: Instead of “All or Nothing”, go on the principle of “All or Something” when it comes to any habit, in this case exercise SUMMARY POINTS The article warns against the “perfect workout trap”: when people cannot do their ideal workout, they often skip exercise completely. Experts recommend shifting from an “all-or-nothing” mindset to an “all-or-something” mindset: even a short walk, stretching, dancing, or one set of squats counts. Small amounts of activity can still improve health, including heart health, blood sugar control, mental health, and muscle strength. Rigid fitness messaging like “no excuses” or challenges where missing one workout means starting over can discourage people, especially when 150 minutes/week feels unreachable. The article suggests making a backup plan: if you cannot run, walk; if you cannot go to the gym, do body-weight exercises at home; if you are late to class, still go. A useful strategy is to create a “menu” of workouts of different lengths and intensities, so you always have a flexible option. The long-term goal is consistency over years, not perfection every day. Missing a few days or weeks should not make you quit. Main takeaway: Do something, even if it is small. Focus on what you can do today, not on the workout you missed

Reported benefits are minor and objectively small. So Is it harmful? No. Just be mindful of calories…. All that being said, here’s my issue with the BROAD question: “are there benefits?” related to any food item in a BROAD SENSE: you can take just about ANY reasonable food item and find some theoretical benefit that is individually modest and small: almonds, specific fruits, specific vegetables, lean chicken, fish, kiwi fruit, cucumber, karela…..the list can go on indefinitely….. Studies on REAL OUTCOMES are more along the lines of interventions like “increasing overall intake of fruits and vegetables” instead of a common notion that if I increase ONE thing (almonds, or anything else”) somehow it will have dramatic benefits. So have almonds if you enjoy them in moderation!!!!! But don’t expect a dramatic improvement in memory, eyesight or anything else for that matter (maybe a 5 point drop in LDL!!)

Just be mindful of calories. Maybe switch to lower fat milk to accommodate a few almonds. That will keep total calories reasonable. The almond milk from here has only 30 calories and you can take it

IMPORTANT TAKE-HOME MESSAGES FROM THE LATEST BLOOD PRESSURE GUIDELINES FROM THE AMERICAN HEART ASSOCIATION 1. The overall treatment goal is now simpler: aim for BP <130/80 mm Hg for most adults. 2. Medication should start earlier in many people. Drug therapy is recommended for adults with average BP ≥140/90, and also for selected adults with BP ≥130/80 if they have heart disease, prior stroke, diabetes, chronic kidney disease, or a higher heart disease risk (in my opinion MOST INDIANS FALL HERE!) 3. Home BP monitoring matters more than ever. The guideline emphasizes home blood pressure monitoring plus frequent follow-up and standardized treatment protocols. It also cautions against relying on cuffless devices such as smartwatches for accurate BP measurement until they are more reliable. 4. High BP is now framed not just as a heart and kidney issue, but also a brain issue. The guideline highlights stronger evidence linking hypertension to cognitive decline and dementia, and recommends early treatment with a systolic target <130 mm Hg to help reduce that risk. This last point is very valuable. I have historically been somewhat reluctant to be overly aggressive in elderly patients when it comes to BP control but the evidence linking better BP control and dementia prevention will change that!!!

Angioplasty (stent) is usually preferred when disease is focal and suitable for a catheter fix, and when a quicker recovery is important. Bypass is favored when disease is complex, widespread, or involves key branches. General guide (discussed in Heart Team conferences): - Angioplasty: 1–2 vessels; discrete blockages; right coronary or circumflex lesions; acute heart attack to quickly open the artery; high surgical risk or frailty; prior bypass with a new focal blockage; when symptoms persist despite medicines and anatomy is stent‑friendly. - Bypass surgery: Left main disease (especially complex), 3‑vessel disease—particularly with diabetes, reduced heart function, or extensive calcification; diffuse/long lesions, multiple tight blockages, or poor stent landing zones; when durable long‑term relief is prioritized; failed prior stents with restenosis; associated valve/aortic disease needing surgery. Key points: both improve symptoms; survival advantage is clearer with bypass in left main or multivessel disease with diabetes. Before any stent for stable symptoms, ensure objective ischemia (stress imaging) or invasive physiology (FFR/iFR), and optimize medical therapy. In an emergency heart attack, angioplasty is the immediate treatment to save heart muscle. This is educational information, not medical advice.

The Ankle Brachial Index (Ratio of BP in leg vs arm) is a simple test, typically used in people over 50 (or those with risks such as diabetes, smoking etc.) to screen for PERIPHERAL VASCULAR DISEASE (arterial disease involving arteries of the legs). However, It can also predict heart disease in these same populations. The problem with using it for heart disease screening is that in MANY instances it is normal and yet the person has heart disease (this is often called a “Low sensitivity” for the test). However, if you get the test for other reasons like above, AND it is ABNORMAL, your risk of heart disease is high and must be investigated further.

Thanks for asking—important to get this right. Occasional antacids (like calcium carbonate) are generally safe if used as labeled. Problems can arise with frequent or long-term use: calcium antacids may cause constipation and, in high doses, raise calcium and strain kidneys; sodium bicarbonate adds sodium (can raise BP); magnesium/aluminum antacids can affect kidneys if kidney function is reduced. Omez-D (omeprazole + domperidone) more frequently or long term isn’t ideal without a clear diagnosis. Omeprazole (a PPI) is effective short term, but prolonged use has links to low magnesium/B12/iron, gut infections (C. difficile), kidney issues (rare interstitial nephritis), and rebound acidity when stopped. Domperidone can affect heart rhythm (QT prolongation), especially with higher doses, in older adults, or with interacting drugs; liver injury is uncommon but reported with many meds. Key point: short courses are usually fine; frequent or chronic symptoms need evaluation and a tailored plan (dose, duration, H. pylori check, lifestyle triggers). If you have kidney disease, heart rhythm issues, or take other QT‑affecting drugs/antibiotics, avoid self-escalating Omez-D.

For Indian adults, lower ApoB is better. Practical targets are <80 mg/dL if you have diabetes, hypertension, or a strong family history; <70 mg/dL if you have documented plaque or a coronary artery calcium (CAC) score >100 or are otherwise very high risk; consider <55 mg/dL in known atherosclerotic cardiovascular disease (ASCVD) or very high CAC. For lower‑risk adults, a starting goal of ≤90 mg/dL is reasonable. Lp(a) should be viewed as a risk amplifier. Levels ≥50 mg/dL (≈125 nmol/L) raise lifetime ASCVD risk; levels ≥180 mg/dL (≈430 nmol/L) are very high. Because there is no reliable way to lower Lp(a) directly, use an elevated value to set stricter LDL/ApoB goals and to intensify overall risk management. If Lp(a) is high, aim for LDL <70 mg/dL (or <55 mg/dL in very high risk), keep blood pressure <130/80 mmHg, manage diabetes per guideline A1c targets, avoid tobacco, and consider earlier or more intensive therapy with statin + ezetimibe or a PCSK9 inhibitor. A CAC scan can be useful to refine risk when uncertainty remains. Steps to lower ApoB: 1. Medications – statins are first‑line; add ezetimibe if needed; PCSK9 inhibitors (e.g., evolocumab, alirocumab) or REpatha for persistent high risk; bempedoic acid for statin‑intolerant patients. Niacin is not recommended for outcomes. 2. Diet – adopt an Indian‑adapted Mediterranean pattern: abundant vegetables, pulses (chana, rajma), soy/tofu, nuts; use primarily unsaturated oils such as canola, rice‑bran, sunflower, groundnut, and extra‑virgin olive oil for low‑heat cooking or salads; limit ghee, butter, red and processed meats; keep saturated fat <7‑10 % of calories. 3. Weight and activity – aim for a waist‑to‑height ratio ≤0.5 (men ≤90 cm waist, women ≤80 cm); exercise 150‑300 min/week, including 2‑3 days of resistance training and occasional vigorous intervals if tolerated. 4. Fiber and plant sterols – consume 25‑30 g of fiber daily from oats, barley, psyllium/ispaghol, etc.; consider plant‑sterol‑fortified foods, which can lower LDL/ApoB by ~5‑10 %. 5. Monitoring – recheck lipids and ApoB 6‑12 weeks after any therapeutic change, then every 6‑12 months; check Lp(a) at least once in a lifetime.

Hi VP, - Apple cider vinegar (ACV): It can slightly blunt post‑meal glucose spikes and may modestly reduce appetite/weight in some small studies, but there are no strong randomized trials showing meaningful long‑term cardiometabolic benefit. It can irritate the throat/stomach, worsen reflux, and erode teeth. If you enjoy it, use 1–2 teaspoons diluted in a big glass of water with meals, sip through a straw, and avoid if you have reflux, ulcers, low potassium, or take insulin/sulfonylureas (risk of lows). Flax seeds have better data. They add soluble fiber, plant omega‑3 (ALA). meta‑analyses show small drops in LDL and improved regularity. Use 1–2 tablespoons ground (not whole) daily in dahi, dal, salads, or atta (10–15% mix).

here is the data on Apple cider vinegar : It can slightly blunt post‑meal glucose rises and may modestly curb appetite in small studies, but strong long‑term RCT evidence for weight, diabetes, or cholesterol isn’t there. Safety caveats: can worsen reflux, irritate stomach/throat, erode teeth, and interact with insulin/sulfonylureas ( If you like it, limit to 1–2 teaspoons diluted in a big glass of water with meals, use a straw, and skip if you have reflux/ulcers. Flax seeds have better data. Ground flax (not whole) adds soluble fiber and ALA omega‑3; meta‑analyses show small LDL reductions and improved regularity. Use 1–2 tablespoons ground daily in dahi, salads, smoothies, or mix 10–15% into atta.

Hi there—quick take: - Apple cider vinegar (ACV): It can slightly blunt post‑meal glucose rises and may modestly curb appetite in small studies, but strong long‑term RCT evidence for weight, diabetes, or cholesterol isn’t there. Safety caveats: can worsen reflux, irritate stomach/throat, erode teeth, and interact with insulin/sulfonylureas (hypoglycemia) or diuretics (potassium). If you like it, limit to 1–2 teaspoons diluted in a big glass of water with meals, use a straw, and skip if you have reflux/ulcers. - Flax seeds have better data. Ground flax (not whole) adds soluble fiber and ALA omega‑3; meta‑analyses show small LDL reductions and improved regularity. Use 1–2 tablespoons ground daily in dahi, salads, smoothies, or mix 10–15% into atta.

I did research and it does look like that in a meta analysis( which means they combine multiple studies to get an aggregate report) the apple cider vinegar was associated with the weight loss and some improvement in blood glucose. A lot of the studies are from Iran on an average 15 to 20 ML of apple cider vinegar was used. Unfortunately, because of the acid nature, there’s no major study on gut health. There are some linked reports to hepatitis and pancreatitis in small population. Interestingly, in the same meta analysis cinnamon in 500 mg to 2 g daily , fenugreek seeds in the dose of 10 to 30 mg daily has somewhat similar report . But most of the data are small from four weeks to six months. Meta analysis is usually done when the individual studies are small.

The original data did show that Indians have narrower arteries, but that data has not been proven in the recent studies specially Masala study. . Having said that, Indians do have more Plaques and blockages in their arteries so the overall lumen of the artery is narrower than their counterparts

Thanks for sharing that—and good to hear you don’t have any heart issues. If you don’t have cardiovascular disease, you usually don’t need a “blood thinner” for prevention. Current guidelines advise against routine aspirin for primary prevention (especially after 60) because bleeding risk often outweighs benefit. Being allergic to aspirin doesn’t create a need for an alternative. If, in the future, you ever do need antiplatelet therapy (for example after a stent or heart attack), non‑aspirin options exist (e.g., clopidogrel, prasugrel, ticagrelor). Choice depends on the situation, other meds, and bleeding risk, and would be prescribed by your cardiology team. Desensitization to aspirin is sometimes done when aspirin is clearly indicated, but not if you’ve had severe reactions like anaphylaxis. Most protective step now: control risk factors—LDL or ApoB to low targets, BP <130/80, HbA1c healthy, waist-to-height ratio ≤0.5, exercise 150+ min/week, avoid smoking. This is general education, not medical advice.

Quick take: Call emergency services immediately. Chew aspirin only if you’ve been told you don’t have an aspirin allergy/bleeding risk. Use sublingual nitroglycerin (Sorbitrate) only if previously prescribed for you and you’re not having low blood pressure or taking sildenafil/tadalafil. Neither drug “stops” a heart attack; they are supportive while you get urgent care. Why: A heart attack is a blocked coronary artery. The life‑saving step is rapid reperfusion (angioplasty/stent). Evidence: early aspirin modestly lowers death/re‑infarction by reducing clot growth; benefit is real but not huge. Nitroglycerin relieves chest pain and reduces heart workload; it doesn’t open the artery and hasn’t shown mortality benefit. Both can drop blood pressure; nitro can be dangerous with erectile‑dysfunction meds. What to do if chest pain is suspicious: 1) call EMS, 2) rest, avoid driving yourself, 3) chew 162–325 mg aspirin if no allergy/bleeding, 4) take your prescribed nitro as directed (usually 1 tab/spray under tongue, up to 3 doses 5 minutes apart while waiting), stop if dizzy or faint. This information is educational; seek personalized guidance from your clinician.

Renu and I are often asked is whether or not to take Aspirin routinely after a certain age for prevention. It depends which category you are in: A. If you have had a heart attack, stent/bypass, ischemic stroke/mini stroke, or peripheral arterial disease or have known narrowing of heart arteries aspirin is often used in LOW dose 81 mg daily in the US and 75 mg daily in India. —This is called *Secondary prevention B. If you have NOT had any of these but are trying to prevent the first episode from happening this is called Primary Prevention. This is where most recommendations do NOT call for Aspirin routinely today, because the bleeding risk can overpower the benefit, particularly in those over 60. However each person is different and you must discuss all the potential benefits and risks with your doctor.

Autophagy in layman's terms, it is like the cell's internal ""clean-up crew,"" where unwanted or damaged parts are packaged into small sacs and then sent to a recycling center (the lysosome) to be broken down and reused for energy or building new cell parts. This process helps cells stay healthy, adapt to stress, and remove potentially harmful material, such as damaged organelles or invading microbes. Autophagy happens with fasting for 12 hours or exercising There are several papers that say autophagy in moderation is important for cardiac disease. but when done excessive can damage cardiac cells so giving a gap for 12 hrs is not a bad thing. Prolonged fasting or prolonged Exercise may not be as good.

any kind of vegetable oil is good for dry and curried vegetables I use canola but you can also use sunflower. As we had spoken mustard oil does have one component which has bad rats data for cardiac disease and that’s why it has been banned in both Europe as well as USA. However, occasional use of mustard oil is not a problem. Everything should be in moderation

Both are “heart-friendly” oils and a bit of a preference. Olive oil is hard to do “high heat” cooking in (because of low smoke point), but is great for salad dressings and low heat cooking. (Regardless we need to be doing less high heat cooking!!) We have historically used the cheap and time tested “work horse” for Indian cooking: Canola Oil. For our other Western style cooking, including Italian cooking and salads, we use Olive Oil

While there are a lot of tests that calculate Biologic age ( functional age) vs real age ,their use in modern day assessment has not been proven and they are not clinically indicated.

All good points. 1. Point about am circadian rhythm is valid- cortisol levels somewhat higher between 8-10 am 2. ⁠the Mexican meal was high in protein ( 2 types of meat) and had salad as well . There was practically no walk prior. So it was a balanced meal with relatively lower carbs And that was the point really.

Check your blood pressure twice daily (morning and evening) for the first 1–2 weeks while you are adjusting medication. Sit quietly for 5 minutes, back supported, feet flat, arm at heart level, and avoid caffeine, exercise, or smoking for 30 minutes. Take two readings 1–2 minutes apart and record the average. Once your readings are stable, you can reduce monitoring to 2–3 days per week (or once/twice weekly). Aim for a home average below 130/80 mmHg; tighter control is reasonable after coronary stent placement. Morning readings taken before carvedilol may be higher, so also consider an occasional check about 2 hours after the dose to see the medication’s effect. Carvedilol should be taken with food to improve absorption and reduce dizziness. When you practice time‑restricted eating, anchor each carvedilol dose to a meal or a small snack within your eating window (e.g., a handful of nuts, yogurt, milk, or a slice of toast). If you plan a true 24‑hour fast, discuss with your cardiology team whether to shift the dosing time, use a minimal‑calorie food vehicle for the dose, or switch to a beta‑blocker that does not require food. Do not stop carvedilol abruptly. Stay well‑hydrated, and if you feel light‑headed, weak, or record a systolic pressure below 100 mmHg during fasting, pause the fast and re‑evaluate with your clinician. A 12–14‑hour fasting window is generally safer and still effective for weight loss while maintaining cardiovascular health after stent placement.

Several (small) nutrition studies have shown that cooking, cooling (refrigerated for 24 hours) followed by re-heating rice can indeed increase the RESISTANT STARCH content which can LOWER blood sugar spikes somewhat. Two small studies in diabetics ALSO demonstrated lower sugar spikes. However at least ONE study showed no effect. Bottom Line: We do not see any downside of cooking, refrigerating and reheating to lower white rice’s glycemic index somewhat. Evidence does seem to support this to some extent Another technique is to make sure you do not SIMMER with large amounts of water for a long time. Continue to MODERATE rice intake overall, but the trick does have reasonable data to support

Great Q. Detailed convo around this will be beyond the scope of this forum, but VERY thought provoking counter-arguments (and true scientific criticism) about the data from Blue Zones research is worth mentioning. Ig Nobel Prize-winning research: Longevity claims may reflect “lousy birth-and-death recordkeeping” more than accurate human lifespans [https://jheor.org/post/2682-ig-nobel-prize-winning-research-longevity-claims-may-reflect-lousy-birth-and-death-recordkeeping-more-than-accurate-human-lifespans] Related NY Times article Do People in 'Blue Zone' Actually Live Longer ?' [www.nytimes.com/2024/10/24/well/live/blue-zones-longevity-aging.html?unlocked_article_code=1.bE8.WDxs.r8MD23XXktSG&smid=url-share]

this is a complex question because obesity confers heart attack risk in multiple ways that include visceral fat, diabetes, high BP and other risks. So although there is a direct relationship between obesity and heart attack rates, detailed causation is more complex

Is BRI the New BMI? A new metric for assessing body weight is gaining traction, giving doctors a clearer picture of how body size may impact chronic disease and overall health risks.[https://share.google/Yqs6pSnA0fuZ8Ze3U] Very appropriate and research-based article. Makes a lot of sense and along the lines of emphasizing “roundness” including waist circumference as a surrogate marker for visceral fat and poor health outcomes.

the thermal receipt per se in our research does not show to release micro plastics, but rather releases the BPA and specially if you touch the receipt after using hand sanitizer. But even today it’s not a huge source for BPA release.

BPA-free plastic containers are generally acceptable for storing cold or room-temperature food, provided they are food-grade and not scratched, cloudy, cracked, or worn. However, “BPA-free” does not mean completely chemical-free or risk-free. Some products replace BPA with related chemicals such as BPS or BPF, which may also harmful effects

When you’re looking for butter, substitutes always look at three things . Saturated fat , trans fat and mono unsaturated fat. As we have talked many times, the saturated fat should be less than 10%. Trans fat should be 0%. And Mono un saturated can make the rest of it.

unsalted or salted butter in 1 tablespoon has 11 g of fat out of which 67% is saturated fat. Most of the vegetable oils on the other hand in the same amount have only 10% saturated fat so there is a clear difference .We always talk about doing things in moderation so if you use butter, use a teaspoon in a day and use the rest as oils.

Thanks for asking—there’s confusion here. A coronary artery calcium (CAC) scan is still useful if you’re on statins. Statins can increase the density of existing plaque and sometimes slightly raise the calcium score over time, but that doesn’t invalidate the test.

Thanks for asking—here’s the straight take. A CAC scan (non‑contrast CT that scores plaque calcium) is most useful to refine risk when you’re unsure about starting or intensifying prevention. If CAC=0, short‑term risk is low and you can often defer statins unless there’s diabetes, smoking, strong family history, or very high Lp(a). If CAC is >0, risk rises with score: 1–99 suggests benefit from statins if age >40; ≥100 (or ≥75th percentile) strongly supports statins and tighter LDL targets; very high scores (≥300–400) imply high plaque burden and warrant aggressive risk‑factor control. It doesn’t replace lifestyle, LDL/ApoB lowering, or symptom evaluation; it’s radiation‑light (~1 mSv) and not for people with known CAD or during unstable symptoms.

Some studies hae shown an association between higher Calcium intake and higher CAC scores but the evidence is mixed and it is very important to have some context. The increase in CAC score in these settings may NOT reflect an increase in heart attack risk because this may reflect more STABLE plaque that is LESS prone to rupture and cause heart attacks. This is the same reason that CAC scores may increase with aging and this increase does not necessarily reflect an increase in risk. Which is why we typically do not like to repeat CAC scores after an initial assessment. IN short it is not recommended to stop Calcium supplementation that is otherwise indicated for bone health etc. Hope this perspective helps. This is absolutely correct about the CAC score, however it is recommended that we try to do the calcium by diet first before we do supplementation. The typical calcium requirement in postmenopausal females or males is 1500 mg per day . one cup of milk, one cup of yogurt and one and a half slice of any cheese fat-free or usual gives you 300 mg of calcium each. So if you have 3 to 4 helpings of these every day, you do not need supplementation, . Green leafy vegetables also give you 300 mg of calcium roughly. So if your daily food contains all and you’re just taking a 500 mg of calcium supplementation that is fine . We do not recommend very high dosages of supplemental calcium in post menopausal women.

Observational Data Most observational data suggests that increase in DIETARY Calcium is not associated with higher CAC, and some cohorts even show lower odds/risk of calcification with higher dietary intake. Regarding CALCIUM SUPPLEMENTS: Some cohort data (including analyses from the MESA cohort) suggest supplement users may have higher odds of incident CAC compared with getting calcium mainly from food. However, other analyses in MESA did not find a substantial association between calcium supplements and actual heart attacks/CVD events, which is the REAL outcome that matters Randomized Trial Data (Higher Quality) In a Women’s Health Initiative substudy looking at coronary calcium, calcium + vitamin D supplementation showed no difference in CAC scores after years of follow-up. Recent trial meta-analyses overall find no clear significant increase in CHD or stroke risk (and if there is any risk, it appears small). BOTTOM LINE 1. Food-first calcium is the safest default (Milk, Dahi etc) 2. Don’t take calcium supplements “just because” for heart health or CAC prevention—there’s no proven CAC benefit. 3. If a supplement is truly needed (osteoporosis, low intake, certain high-risk groups), aim for modest doses unless advised otherwise by physician 4. Be extra cautious and individualize if there’s kidney disease, recurrent kidney stones, hypercalcemia, hyperparathyroidism, or heavy use of calcium-based antacids. Always discuss with your doctor before following advice.

Dr. Ashwini Wagle from California has written a whole book on it and has measured everything in her lab. MyFitnessPal also gives a lot of Indian dishes calories Available on Amazon. (Carbohydrate Counting Traditional South Asians Food Lists) INDIAN DIETS-DRS NIRMAL AND RENU JOSHI [https://youtube.com/live/XgFZ0EOIhQ0?feature=share]

Yes, canola oil is perfectly health and is in top 3 oils to use. canola or vegetable oil, olive oil, avocado oil

Chest Pain, “Indigestion” like discomfort in upper abdominal/chest area or shortness of breath are common symptoms. Best approach is to call an ambulance or try to get to a hospital quick and NOT ignore. Discuss with your doctor “ahead of time” (electively during a regular appointment) if it is appropriate for you to take sublingual (under tongue) nitroglycerin and chew -1-2 baby aspirin tablets. If so, keep those two things handy as first aid if you get chest pain. Renu and I during our hike in Uttarakhand, had kept aspirin and Nitroglycerin with us.

Thanks for the question—there’s a wording gap here. There aren’t clinical outcome trials on “Brown Hearts” as a defined intervention or program in cardiovascular prevention. If by “Brown” you mean South Asian hearts (i.e., cardiometabolic prevention in South Asian populations), there are important data, but not many large, South-Asian–only randomized outcome trials. What we do have: strong outcome evidence for LDL lowering (statins, ezetimibe, PCSK9), BP control, smoking cessation, and diabetes management that applies across ethnicities, plus cohort studies showing South Asians develop ASCVD younger with higher plaque burden at lower BMI/waist. If you meant a specific product or initiative named “Brown Hearts,” share details and I’ll assess the evidence.

A PCP can prescribe all medications including statins. Do remember that the threshold for starting among PCP’s as well as cardiologists (particularly in South Asians at high risk) can vary which is why you need to be empowered with high quality evidence as it relates to you and ask probing questions so you can advocate for yourself. From a cardiac prevention standpoint, I would love to see an LDL level as a bare minimum. If this is unequivocally high the big goal is to lower it to target (less than 100 in all South Asians and lower numbers-less than 70 or 55 in higher and highest risk groups respectively) I like to see a Lp(a), ApoB , hs-CRP and CAC score for reasons we have shared before, MORE so if you are poorly motivated to start medication or need additional incentive to start lifestyle modification and/or meds. Even if insurance does NOT cover some or all of these, they can be obtained for less than roughly $200 (all included) here in the US and a few thousand rupees in India.

this person is HIGH RISK for cardiovascular disease and needs his/her LDL aggressively controlled to as low as possible below 70 (personally would like to see closer to 50’s). Would also consider Coronary CT (although hard evidence for this is somewhat lacking). There is no “mildly deranged” lipid panel—only specific LDL goals….This is where many South Asians err in management —the doctor tells them the lipid panel is “OK” or “mildly abnormal” but it is NOT OK. Additionally aggressive weight reduction and lifestyle change is critical—if BMI is particularly high—also consideration for Semaglutide like medication.

Researched this extensively during our documentary , including detailed conversations with Dr. Prabhakaran Dorairaj (head of CCDC in India)……Overall the following conclusion: There was a definite increase in cardiac mortality from the direct inflammatory effects of Covid 19. However, the high risk of cardiac pathology in South Asians has a much more complex and nuanced origin (with multiple genetic and environmental life style contributions).

There are no high‑quality randomized clinical trials showing that cayenne pepper (capsaicin) water clears blocked arteries, reverses arterial plaque, or meaningfully reduces cardiovascular inflammation. Laboratory and animal studies suggest capsaicin may have modest effects on metabolism and vasodilation, but these findings have not translated into proven plaque regression or reduced cardiac events in humans. If you enjoy a pinch of cayenne in food and it does not upset your stomach, it is safe to use, but it should not be relied upon for heart‑disease treatment. To lower cardiovascular risk and slow plaque progression, follow evidence‑based strategies: control LDL/ApoB (often with statins when indicated), keep blood pressure below 130/80 mm Hg, avoid smoking, maintain a healthy weight, engage in regular physical activity, follow a high‑fiber, minimally processed, plant‑forward diet, and manage diabetes if present.

Cheese is not a “heart food,” but small amounts can fit into a heart‑healthy pattern. It is high in saturated fat and sodium, which can raise LDL cholesterol and blood pressure, so guidelines still advise limiting it. Observational studies on fermented dairy are mixed and generally suggest a neutral effect on cardiovascular events, making moderation especially important for people with South Asian risk patterns. A practical approach is to keep portions modest—about 20–30 g (a match‑box size) a few times per week—and choose lower‑sodium, lower‑fat varieties such as part‑skim mozzarella, paneer made with toned milk, ricotta or cottage cheese, and small crumbled amounts of feta. Limit very salty or aged cheeses (e.g., cheddar, parmesan) and processed cheese slices. Stay within a saturated‑fat budget of less than 10 % of total calories (roughly ≤15–20 g/day) and keep total sodium under 2 g/day (≈5 g salt). If LDL or blood pressure is elevated, be stricter; if levels are well controlled, occasional cheese for taste is acceptable within an overall Mediterranean‑style, high‑fiber diet.

This is a very true and insightful observation Anil! A lot of hard data also exists on this from work done by Ranjan Yajnik (Pune) and Dr. Usha Sriram (Chennai) , which is why preventive efforts in cardiac prevention are never too early to start—In fact ideal time is in childhood! This is the time the foundation is being laid for either good health behaviors and preventive methods , or conversely in development of childhood obesity and associated risks.. On the other hand, there is a lot of good information (MASALA study) on the positive effects of ADULT CHILDREN on the health habits of their PARENTS. In other words, children are encouraging and influencing positive health behaviors in their South Asian parents

Hi, the coconut still is high in saturated fat, but it is associated with fiber so it improves gut health and it also has less absorption so it can be used in moderation but not for every day cooking. The same thing for nuts. It is advisable to have a total of 10 nuts every day whichever form you can take them in so if you’re putting more than that, then it’s not advisable.

We always say that nothing is good or bad. Yes, you can clearly use Goat meat once a week and you can also use coconut oil for certain special cooking. Maybe once a week. What we recommend against is continuous daily use of these on daily basis. Even with Goat ,beef and pork there are lean cuts which are fat free and they are heathier .

Low‑dose colchicine (0.5 mg once daily) is now an evidence‑based option to lower recurrent cardiovascular events in patients with stable coronary artery disease (CAD) or after a recent myocardial infarction (MI), provided it is tolerated. The ACC 2025 guideline, together with ESC 2024 and CCS recommendations, endorse its use in selected high‑risk patients as an add‑on for residual inflammatory risk (elevated hs‑CRP, recurrent angina or PCI) after optimal statin, antiplatelet, blood‑pressure and lipid therapy. The benefit is derived from two large randomized trials—COLCOT (post‑MI) and LoDoCo2 (chronic CAD)—which showed a 23‑31 % relative risk reduction in a composite of MI, stroke and ischemia‑driven revascularization, with an absolute benefit modest enough to give a number‑needed‑to‑treat of roughly 35‑70 over 2‑3 years. No clear mortality reduction was observed, and LoDoCo2 noted a small, uncertain increase in non‑cardiovascular death. Common adverse effects are gastrointestinal upset; rare myotoxicity can occur, especially when combined with high‑dose statins or in chronic kidney disease. Colchicine should be avoided in significant renal or hepatic failure and with strong CYP3A4/P‑gp inhibitors such as clarithromycin, certain azoles, or cyclosporine. Routine laboratory monitoring beyond standard CAD care is not required, but patients should be counseled to report persistent diarrhea, muscle pain, or weakness, at which point the drug should be stopped.

Cold‑pressed mustard oil has a pungent flavor many of us love, and it’s rich in mono‑ and poly‑unsaturated fats. However, it also contains erucic acid; animal data raised heart concerns, so edible mustard oil is restricted/banned in the US/EU. Human evidence is limited and mixed. My take: it’s fine as an occasional flavoring, but I wouldn’t make it the primary everyday oil. Practical plan: use a neutral, heart‑friendly oil (canola, sunflower/safflower high‑oleic, or rice bran) for most tadka/saute; use extra‑virgin olive oil for salads/low heat; use mustard oil sparingly for jhal muri, fish marinades, or a light finish after cooking. Keep total oil modest (about 1–2 teaspoons per person per meal).

Theoretical benefits have been reported but published data on better clinical outcomes in large trials is not available. Additionally you rightly point out practical barriers such as shelf life and smoke point as issues. Not quite enough data to recommend in favor of refined oils currently available

We strongly endorse screening colonoscopy for colon cancer screening (in most average risk people starting at 45)…..Effects on gut bacteria are transient and NOT a reason not to get it.

Re constipation, some strategies: a) Increase fiber : beans, lentils, lettuce, chia, flax seeds etc.) b) increase fluids c) increase some complex carbs that also help with constipation such as prunes, berries, oats etc) d) some less processed types of proteins such as greek yogurt, tofu, eggs and chicken… Re: on how much protein, you just have to learn to measure to begin with—eventually you have a pretty good idea and then do not have to measure exactly…..More coming up in a reel soon!

What a great question : an extraordinarily common problem and very debilitating.!! I get asked this question all the time. I have put together a simple list of things, including my own personal patient experience to help you. PLEASE SEE BELOW FOR CONSTIPATION PREVENTION 1. Diet changes Increase fiber gradually: vegetables, fruits, beans, lentils and whole grains Aim for 20–30 g fiber/day. I always recommend this first step to start with Drink adequate fluids, especially when increasing fiber In our home, we use supplemental SALAD with every meal (you can do cool things like an olive oil tadka etc to make it more palatable!)—but definitely: lettuce, raw cabbage etc. 2. Natural remedies and habits Psyllium husk daily with plenty of water, Prunes or prune juice (beware of sugar content with the juice! WHOLE PRUNES ARE GOOD, Two kiwifruits daily Psyllium Husk products: METAMUCIL OR ISABGOL (Indian Store!) Regular walking or exercise, Use the toilet after breakfast etc. I have not included medications for treatment that I use if above fails

Extra-virgin olive oil is primarily for non-high heat, cooking or salad dressings, etc. For higher heat, Indian cooking or as an all-purpose oil we like canola oil for that reason. The refined version is safer for high heat if you want to use and that can be used for Tadka as well

CoQ10 (ubiquinone) is a vitamin-like compound your cells use to make energy. Evidence is mixed: it can modestly help statin‑associated muscle aches in some people, slightly lower blood pressure (about 2–4 mmHg), and may improve symptoms in heart failure when added to standard therapy. It is not a treatment for blockages, stroke prevention, or cholesterol. On double blood thinners (for example, an anticoagulant like apixaban/warfarin plus an antiplatelet like aspirin/clopidogrel), caution is important. CoQ10 is structurally similar to vitamin K and can reduce warfarin’s effect (raising INR variability), and case reports note additive bleeding risk with antiplatelets/anticoagulants. If used, keep the dose modest (e.g., 100–200 mg/day with food), avoid starting around surgeries, and monitor closely for bruising/bleeding and, with warfarin, INR changes. If bleeding risk is high, it’s safer to avoid it.

CoQ 10 can indeed lower the effectiveness of Warfarin (blood thinner) and you must make your doctor aware that you care using it.

Yes in the US. Costs around $100 (most insurances do not cover), In India costs around 3-4 thousand rupees

CAC scan is a non‑contrast CT that quantifies coronary artery calcium. It is primarily used to refine cardiovascular risk when the decision to start or intensify preventive therapy is uncertain. A CAC score of 0 indicates very low short‑term risk; statin therapy can often be deferred unless the patient has diabetes, smokes, has a strong family history of premature CAD, or markedly elevated Lp(a). A score >0 signals increasing risk: scores 1–99 suggest considering statins in individuals older than 40; scores ≥100 (or ≥75th percentile for age/sex) strongly support statin use and tighter LDL/ApoB targets; very high scores (≥300–400) indicate substantial plaque burden and warrant aggressive risk‑factor control, including lifestyle modification and LDL lowering. In Indian populations, a baseline CAC scan is recommended after age 30–35 for those not already on preventive statins, using Indian age‑specific reference values; a high score for age prompts aggressive LDL lowering and lifestyle measures. The test delivers low radiation (~1 mSv), is not indicated for patients with known CAD or during unstable symptoms, and does not replace clinical evaluation.

Yes , there is some genetic difference in developing collaterals but there is no clinical testing for that. DM and Female sex is associated with poor development of collaterals and calcium channel blockers drugs like Verapamil and statins are associated with better collateral circulation. the development of collateral circulation in the coronary arteries can be promoted by physical exercise. One paper showed > 10 hrs of exercise per week ( not intensity related) can develop more collaterals . The other pharmacological stimulation (e.g., G-CSF), mechanical interventions (e.g., external counter pulsation) are very tedious and can be only done in patients with EXTREME angina only.

Guide To Make Informed Decisions Last night, during a very insightful meeting of Renu and I with community members in Kolkata, several raised concerns that they are often unsure whether s STENT is being recommended for a solid, life saving reason or simply to drive the economic engine of hospitals and health systems? I reviewed the data from published literature and also from across India and am providing a summary below: There is a good research study (Patil et al. Indian Health Journal) that looked carefully at appropriateness of stenting procedures. Overall, stents done for documented , acute heart attacks were appropriate. However, when there is NOT an acute heart attack, almost 4 out of 5 times, indications for stenting were considered “uncertain”, with a lot of missing information to ensure that it was necessary. Overall when considering a stent, The single most important question: “Is this an emergency or not?” A) When a stent is often truly needed (usually urgent/lifesaving) If you are having a heart attack or an unstable situation—for example: * severe ongoing chest pain, * ECG changes suggesting a heart attack, * rising cardiac enzymes (troponin), * unstable blood pressure, breathlessness, dangerous rhythm, …then opening the blocked artery quickly can be lifesaving. In India’s registry data, a major indication for PCI is post-myocardial infarction, meaning many procedures are related to heart attacks. In these emergency situations, a stent is often the right call. B) When a stent may be optional (usually not urgent) If this is stable chest discomfort (for weeks/months), or a blockage found during testing, or you are currently stable in the hospital—then we slow down and decide carefully. Here’s the key message: In stable coronary disease, large studies showed that adding angioplasty/stenting to best medical therapy does not reduce long-term risk of death or heart attack as an initial strategy for most patients—though it can help symptoms in some people. So, in stable cases, a stent is mainly for: * symptom relief when medicines aren’t enough, and/or * high-risk anatomy or high-risk testing that suggests a dangerous situation. 3) Why do families feel confused? Because an angiogram can show a “blockage,” but a blockage that looks tight is not always the blockage that is truly limiting blood flow. That’s why in many stable cases, good cardiology practice is to confirm whether the narrowing is truly causing reduced blood flow—often using: * a stress test or imaging, and/or * “pressure wire” tests like FFR/iFR in the cath lab (your doctor may use different terms). 4) The “3-question checklist” I recommend before an elective (non-emergency) stent If this is not a heart attack emergency, you can politely ask: Question 1: “What problem are we solving—saving life, preventing heart attack, or mainly reducing symptoms?” In stable disease, the main benefit is often symptom improvement, not guaranteed prevention of future heart attacks. Question 2: “How do we know this blockage is the one causing ischemia?” Ask whether the decision is based on: * stress test evidence, or * FFR/iFR, or * other objective evidence—not only “it looks 80–90%.” Question 3: “Have we tried strong medical therapy first, unless there is a high-risk reason not to?” Many stable patients do very well with: * antiplatelet therapy if indicated, * cholesterol lowering (statin/other), * BP and diabetes control, * anti-anginal medicines, * lifestyle and cardiac rehab. 5) India-specific “cost and transparency” tip In India, the government introduced price ceilings for coronary stents to reduce overcharging. Parliamentary/government documents also discussed concerns about very high margins in the past. So it is reasonable to request: * an itemized estimate/bill, * the stent name/brand and MRPs/allowed price, and * documentation of the indication This is not about accusing anyone—it’s about informed consent and transparency. 6) When I strongly encourage a second opinion (if stable) If the situation is stable and you feel rushed, it’s okay to say: * “We respect your recommendation. Since this is not an emergency, we’d like a second opinion today/tomorrow.” That’s especially wise if: * you have no or minimal symptoms, or * no clear ischemia testing was done, or * multiple stents are proposed immediately without explaining the “why.” The Bottom Line If it’s a heart attack or unstable situation—stents often save lives If it’s stable disease—stents can help symptoms, but many people can be treated safely first with excellent medicines, and the decision should be guided by objective evidence and clear goals

There is no evidence and data that creatine lowers Cholesterol or help cardiac disease. One old paper show a decrease of 5 % but recent data does not show improvement.

Thanks for asking—there’s a lot of confusion here. Creatine monohydrate is a well-studied supplement that helps muscles recycle energy (ATP), which can modestly improve high‑intensity performance and lean mass when paired with training. The standard adult dose is 3–5 g/day. For a healthy, athletic 15‑year‑old, limited studies suggest creatine can be safe short‑term with proper dosing and hydration, but pediatric data are smaller than in adults. Major sports medicine groups don’t ban it, yet advise using it only if: 1) the teen has a solid training/sleep/nutrition base, 2) no kidney disease, dehydration, or recurrent cramps, and 3) a clinician and coach are aware. Side effects are usually mild (water weight, bloating); ensure good fluid intake and choose third‑party tested products. If the goal is general fitness or school sports, the key is consistent training, protein (about 1.2–1.6 g/kg/day), carbs around workouts, sleep, and coaching; creatine is optional, not essential.

Creatine is extremely well studied to prevent sarcopenia above the age of 50. There is strong evidence that it helps as a daily supplement, particularly when it is combined with adequate protein intake (daily) and regular resistance training exercise.However, before you start, you MUST check with your physician, to make sure your kidney function is normal and other safeguards such as adequate fluid intake etc. are in place in your specific instance and accounting for your specific issues. Whether or not you start creatine, if you are above 50 (and indeed younger folks as well) please do ensure regular resistance training exercise along with protein intake that is at least 1-1.2 gm/kg daily—South Asians often struggle in accomplishing both of these goals.

Are you looking for a quick overview of dabigatran? Here’s the gist. Dabigatran is an oral anticoagulant (“blood thinner”) used to prevent/treat clots—commonly for atrial fibrillation (to lower stroke risk) and for DVT/PE treatment or prevention after some surgeries. It directly blocks thrombin (clotting factor IIa). Typical US/India doses are 150 mg twice daily; dose may be reduced (e.g., 110 mg or 75 mg) with older age, kidney impairment, or higher bleeding risk. It starts working within hours and doesn’t need routine INR tests, but kidney function should be checked at baseline and at least yearly. Key safety points: higher risk of bleeding (gums, urine, stools, bruising); seek urgent care for severe headache, weakness, black/tarry stools, or vomiting blood. Stomach upset or dyspepsia is common—taking with food and plenty of water helps. Avoid NSAIDs (ibuprofen, diclofenac), high-dose aspirin, and certain supplements that increase bleeding (fish oil >1–2 g/day, ginkgo, garlic, nattokinase). Strong P-gp interactions matter: for example, amiodarone, verapamil, ketoconazole can raise levels; rifampin can lower effect. Unlike some others, dabigatran has a specific reversal agent (idarucizumab) for emergencies. Practical tips: take it twice daily, don’t skip doses, don’t crush/open capsules (it increases absorption and bleeding risk), store in original bottle/blister to protect from moisture, and use caution with fasting/dehydration. If a dose is missed, you can take it up to 6 hours before the next dose; otherwise skip—don’t double up. Avoid concurrent proton pump inhibitor only if not needed, as it may reduce levels slightly, though many still use it for reflux. In India/US, cost and availability vary; generics exist in some markets. This is general education. If you share the reason you’re considering it, kidney function, and other meds, I can tailor the risks/benefits and alternatives (e.g., apixaban, rivaroxaban, warfarin) in plain language.

Dabigatran is an oral anticoagulant (“blood thinner”) and is used to prevent/treat clots—commonly for atrial fibrillation (to lower stroke risk) and for preventing clots after some surgeries. Has same bleeding risk (like gums, urine, stools, bruising) and do not take it with ASA

Yes , caloric requirement changes with age for a variety of reasons (lower muscle mass being one of them), but if you calculate the TDEE (Total Daily Energy Expenditure) it already accounts for age…. Learn How Many Calories You Burn Every Day Use the TDEE calculator to learn your Total Daily Energy Expenditure, a measure of how many calories you burn per day. This calorie calculator will also display your BMI, BMR, Macros & many other useful statistics! [https://tdeecalculator.net]

A total of 10 to 12 nuts a day overall is reasonable. Again, just do the math on the calories to keep an eye on that important element.

There is no magic amount that is “healthy”. Just go back to the basics of calculating for yourself, the amount of proteins, carbohydrates, and fat. Apps or Google searches will indicate to you whether they’re referring to cook or uncooked. When it comes to calories or macro nutrients. Also remember, this is not an exact science. Rough ideas are absolutely fine.

For ALL saturated fat keep it less than 10% of total calories (ideally less than 7% in South Asians) So simple answer to your question: If you are consuming 1600 cals in a day that is about 11 gram saturated fat in a day. Just 1 tablespoon of ghee will get you close to that amount NOT counting ANY other saturated fat

Short answer: walking most days can meaningfully lower cardiovascular risk—especially if you hit enough volume and pace. What helps most is total steps and brisk intensity. Data from large cohorts and AHA guidance show: - Steps: ~6,000–8,000 steps/day is linked to lower death and heart-event risk; benefit continues up to ~10,000–12,000. - Intensity: brisk pace (≥100 steps/min; you can talk but not sing) adds extra benefit versus slow strolling. - Time: aim ≥150 minutes/week moderate activity (brisk walking), or ≥75 minutes vigorous, plus 2 days of strength training for best protection. Walking improves blood pressure, insulin sensitivity, LDL/ApoB slightly (bigger effects with more intensity/weight loss), and reduces inflammation. For South Asians—who carry higher central obesity risk—pair walking with waist goals (waist-to-height ratio ≤0.5; men <90 cm, women <80 cm) and LDL targets (<70 mg/dL if high risk). Take-home: Daily brisk walking is a powerful start and can be “enough” for many, but adding some hills/intervals and brief strength work gives added protection. This is educational information, not medical advice; tailor to your health status and build up gradually if you’ve been inactive.

YES.

Thanks for sharing—good topic. A1c is useful, but it has blind spots. Two points I agree with: 1) HbA1c can mislead in anemia, kidney disease, iron/B12 issues, hemoglobin variants (common in South Asians), pregnancy, and with rapid glucose swings; 2) earlier detection and tracking beyond A1c helps. What’s better “than” A1c depends on the question: - To diagnose earlier: fasting glucose (≥126 mg/dL), 2‑hour OGTT after 75 g load (≥200), and/or fasting insulin/HOMA‑IR for insulin resistance in select cases. OGTT is the most sensitive for early dysglycemia. - To monitor day‑to‑day control: Time‑in‑Range (TIR) from a CGM adds real‑world detail (target TIR ≥70%, lows <4%). A1c ~7% ≈ average glucose ~150 mg/dL, but two people with the same A1c can differ wildly (125–175 vs 50–225 mg/dL). - When A1c is unreliable: use fructosamine or glycated albumin (shorter window ~2–3 weeks) plus SMBG/CGM. Bottom line: don’t throw A1c out—it predicts complications and guides therapy—but pair it with fasting/OGTT for diagnosis and CGM/TIR (or structured fingersticks) for management, especially in South Asians prone to post‑meal spikes and central insulin resistance.

Targets are the SAME. What is adjusted for South Asians is mainly the screening threshold, not the A1C threshold. ADA recommends considering diabetes/prediabetes testing in adults with overweight or obesity at BMI ≥25 kg/m², but at BMI ≥23 kg/m² for people of Asian ancestry/

South Asians experience a more rapid decline in insulin sensitivity and faster increases in fasting glucose compared to white individuals, This accelerated metabolic deterioration suggests that earlier and more intensive screening may be warranted in this population. Some experts propose extending the HbA1c range for high diabetes risk from 6.0-6.4% to 5.7-6.4% in South Asians, or repeating glycemic testing at 6-month rather than 12-month intervals.There are 3 other ways to find early insulin resistance 1. The 2-hour oral glucose tolerance test (OGTT) is the most sensitive test for detecting early pancreatic failure and insulin resistance in South Asians before HbA1c becomes abnormal . But it is tedious to do 2. The triglyceride-glucose (Tg/Glu) ratio at cut off of > 1.19 ( which means if your ratio is > 1.19) demonstrates high sensitivity (80%) and specificity (79%) for detecting insulin resistance in normoglycemic South Asian males. It can be used before A1C to predict Insulin resistance 3. The TG/HDL ratio demonstrates moderate sensitivity (52-86%) and specificity (61-98%) for detecting insulin resistance, but shows significant ethnic and sex-specific limitations in South Asians, particularly in South Asian women where it performs poorly. SO we would not recommend that

Healthy food can still pick up plastic chemicals from the way we store, cook and serve it. Microplastics and chemicals such as BPA, phthalates and PFAS can enter food from plastic containers, cookware, cutting boards, bottled water and can linings. Complete avoidance is unrealistic, but a few practical kitchen swaps may reduce exposure: * Use wooden or metal utensils instead of plastic * Choose wood or bamboo cutting boards * Cook with stainless steel or cast iron instead of damaged nonstick pans * Store and reheat food in glass—never microwave plastic * Use glass or stainless-steel blender containers * Carry a stainless-steel water bottle or coffee tumbler * Choose dried beans and chickpeas more often instead of canned versions The goal is not to become fearful of every plastic product. Focus especially on reducing plastic contact with hot food, hot drinks and high-friction appliances, where shedding may be greater. Small, realistic changes can reduce exposure without making healthy eating complicated.

When a radioactive iodine uptake (RAIU) scan is unavailable, differentiate Graves disease from thyroiditis by combining clinical clues, laboratory tests, and thyroid ultrasound with color Doppler. A positive TSH‑receptor antibody (TRAb/TSI) strongly supports Graves disease; a negative result makes Graves less likely but does not completely rule it out. Ultrasound findings are also discriminative: Graves typically shows a diffusely enlarged gland with marked hypervascularity (“thyroid inferno”), whereas thyroiditis (subacute, painless, or postpartum) shows normal or reduced flow, and subacute thyroiditis may have focal hypoechoic, tender areas. Laboratory patterns help further: both conditions have elevated FT4/FT3 and suppressed TSH, but Graves often has a higher FT3:FT4 ratio and a sustained course, while thyroiditis shows a transient thyrotoxic phase with a low/absent uptake physiology, followed by hypothyroidism and recovery. Inflammatory markers (elevated ESR/CRP) and neck pain point toward subacute thyroiditis; lack of pain, presence of ophthalmopathy or dermopathy favor Graves. Clinical exam findings such as a bruit over a non‑tender goiter support Graves, whereas tenderness supports thyroiditis. Practical algorithm: if TRAb is positive and Doppler shows hypervascularity, treat as Graves (antithyroid drugs, beta‑blocker, consider definitive therapy). If TRAb is negative, the gland is tender, ESR/CRP are elevated, and Doppler flow is low, manage as thyroiditis (NSAIDs or steroids for pain, beta‑blocker for symptoms, no antithyroid drugs). A short trial of beta‑blocker alone with repeat labs in 4–6 weeks can also clarify the diagnosis, as thyroiditis will improve spontaneously while Graves persists. Trab (thionamide therapy) is used for Graves disease but has no role in treating thyroiditis.

No amount of eggs are bad for a vegetarian person going to Gym but only egg whites. Egg yolk has a lot of fat and cholesterol so that needs to be consumed sparingly. For example, you can eat eight eggs with six or seven whites and one yolk. Egg white only gives you protein, which is great for a person going to Gym.

For most people 1 whole egg a day is healthy. Beyond that egg whites are fine but not yellow (yolk). And overall keep total daily saturated fat intake to less than 7% So if you do the math: daily total sat fat should not exceed 12 grams counting everything ( adds up quickly!) Each egg yolk is about 1.5 gms alone!!!

People taking antihypertensive drugs do not have to avoid egg yolk completely. If your LDL/ApoB is well‑controlled, whether naturally or on a statin, a moderate amount of whole eggs can be part of a heart‑healthy diet. Aim for overall saturated fat intake below about 12 g per day and choose lower‑saturated‑fat oils (canola, light olive, sunflower). For most individuals, up to 6–7 whole eggs per week (roughly one yolk per day) is acceptable. If you have diabetes, very high LDL/ApoB, established heart disease, or are at higher risk (e.g., South Asian, hypertension), limit yolks to 2–3 per week and rely more on egg whites for protein. South Asians typically need 60–70 g of protein daily, and eggs are an easy source. Keep other numbers in view: LDL <70 mg/dL for high‑risk, waist‑to‑height ratio <0.5, and blood pressure <130/80 mmHg. For a visual guide see my Instagram reel: [https://www.instagram.com/reel/DSfIEMojElf/?igsh=MWczYXVoeHF0eXN3]

COVID-19 acute infection is clearly associated with the endothelial dysfunction, leading to arterial stiffness and inc risk of clots etc but the long-term sequelae only happens in people who have long Covid and symptoms persisting more than six months. This is a very active area of research and if people have persistent endothelial dysfunction months and years after Covid, which is clinically seen as decreased exercise capability, cognitive dysfunction, and extreme fatigue they will need to be evaluated by a physician . There are a lot of medications being tested and I probably would not discuss details here but can separately answer your question . Covid vaccine on the other hand, actually lower the endothelial dysfunction caused by COVID-19. A transient endothelial dysfunction can occur which last only 48 hours to a month and vaccination does not lead to long-standing endothelial dysfunction. Having said that cardiac disease has been happening for last 40 years and will continue to happen in SA and it’s more a lifestyle issue than Covid itself

Enteric coated Aspirin (In US) or Gastric resistant aspirin (India) “supposedly” lowers risk of gastric irritation from aspirin, compared to aspirin without such coating. More recent trials show that BOTH have relatively similar side effect profiles and also probably work equally well! So either one is fine!

In follow up to the excellent presentations by members of the South Asian Heart Center, I did an independent data/ evidence review on scientific effective ness of coaching programs. Here are a few summary points: 1. Ashish’s group themselves have presented data that “event free survival” (period without getting a heart attack) is higher in the intervention group (those who got coaching) 2. ⁠A study led by Ruth Wolever, PhD, professor of Physical Medicine and Rehabilitation and director of Vanderbilt Health Coaching at the Osher Center for Integrative Medicine, found that 10 sessions of health coaching for people at risk for coronary heart disease (CHD), type 2 diabetes (T2D) or both led to increased physical activity which was sustained six months after the intervention ended. 3. ⁠Another study by Krishnamurthy and colleagues (Neurology: Clinical Practice 2024) found that in people at high risk for heart attacks, using a structured coaching program 5-year risk of heart attacks went down (interestingly, in this study, those with moderate or lower risk were not impacted) 4. ⁠Other research has shown that individuals who engage in coaching programs have shown clinically significant improvements in blood pressure, cholesterol levels, blood glucose/A1C levels, BMI, cardiorespiratory fitness and overall heart health. By fostering high-quality motivation and self-efficacy, health and well-being coaches help patients become more internally motivated and confident in their ability to make meaningful health changes and maintain them over time.

At 53, seeing 170–186 bpm during hard runs isn’t automatically dangerous if you’re asymptomatic and well-trained, but it’s higher than typical zone-2 First, Wrist sensors can overshoot during sweat/cold/impact—try a chest strap, Also there is a more specific formula for calculating MPHR which is 208-0.7 xage rather than 220–age; so for 53 age that would come up to 183. However, get a basic screen (blood pressure, fasting lipids, HbA1c, thyroid), a 12‑lead ECG, and consider an exercise treadmill test with ECG to rule out silent ischemia/arrhythmia before pushing intensity.iF basic tests are good then you should continue to build endurance. Hope that helps.

Thanks for the Q—both statements have a kernel of truth but need context. - “Low intensity uses more fat than high intensity”: At easier, steady efforts (zone 2), a higher fraction of energy comes from fat. As intensity rises, the body shifts toward carbohydrates. However, total calories burned per minute are higher at high intensity, so absolute fat burned over a shorter, harder session can still be substantial. The key is weekly consistency: mix zone 2 for metabolic health and some higher-intensity work for fitness and glucose control. - “High intensity causes a high glucose spike”: During hard efforts, stress hormones (adrenaline) raise glucose to fuel muscles, so a temporary rise on CGM is common. Post-exercise, insulin sensitivity improves and average glucose typically trends lower, which is beneficial overall (especially relevant to what you’re describing).

EXERCISE: SUMMARY OF SOME NEW SCIENTIFIC ARTICLES To spark conversation, I am summarizing a few recent scientific studies on EXERCISE published in the last year or so 1. Exercise variety may matter: A 2026 BMJ Medicine study looked at long-term cohorts and found that people doing a greater variety of physical activities had lower mortality risk, even after accounting for total physical activity volume. In plain English: walking is good, but walking + strength training + cycling/swimming/sports may be better than doing only one thing (reference:BMJ Med. 2026 Jan 20;5(1):e001513. doi: 10.1136/bmjmed-2025-001513) Physical activity types, variety, and mortality: results from two prospective cohort studies [https://bmjmedicine.bmj.com/content/bmjmed/5/1/e001513.full.pdf?__cf_chl_tk=Gb8Okh0JqkGXrI9KghuOUVLTfZ7VxNjUfm7bUYVWyrs-1769896844-1.0.1.1-X7kr8pPQpv2CnfFdHezKvoXbXtBa.Vn1NYLbR7ubNTg&utm_campaign=61-como-estao-os-outros-90-do-seu-dia&utm_medium=longevidade_news&utm_source=alphaorigin] Reminder for Brown Hearts: Yoga alone is great, but NOT enough on it’s own PLEASE make sure you have a portfolio of exercise: Aerobic, Strength training and flexibility 1. Leisure-time and transport activity help; occupational activity may not A 2025 Scientific Reports NHANES analysis found that meeting guidelines through leisure-time physical activity or transport-related activity was associated with lower CVD odds. Meeting ≥150 min/week through leisure activity was linked with about 22% lower odds of CVD, and transport activity with about 40% lower odds. But occupational physical activity did not show the same protective association (Reference: Scientific Reports volume 15, Article number: 35341 (2025) This supports the idea that hard physical labor is not the same as structured exercise with recovery Reminder for Brown Hearts: Working hard at work is good, but does not count as exercise that helps cardiac health 3. HIIT continues to show strong cardiometabolic benefits A 2025 meta-analysis in sedentary populations reported that HIIT can improve cardiorespiratory fitness, metabolic health, vascular health, blood pressure, resting heart rate, arterial stiffness, and endothelial function. It also notes that HIIT is time-efficient, which matters for sedentary people who “don’t have time.” Important caveat: HIIT should be introduced gradually, especially in people with risk factors or symptoms. 4. Yoga-based cardiac rehabilitation from India A 2025 Scientific Reports legacy follow-up from Bengaluru examined yoga-based cardiac rehabilitation after CABG. It followed an original randomized trial and reported that yoga-based cardiac rehab showed better long-term survival/MACE signals than conventional exercise-based rehab, though the authors note limitations including single-center design and male-only participants. (Reference: Scientific Reports volume 15, Article number: 20068 (2025) This is interesting for India because yoga may be culturally acceptable, low-cost, and scalable—but it should be framed as adjunctive cardiac rehab, not a replacement for medicines or standard care 5. Indian older adults: physical activity linked to lower heart disease A study using LASI data from India found that among adults ≥60, adequate physical activity was associated with 28% lower odds of CVD (heart disease) . It estimated that about 9.3% of CVD cases in this older Indian population could be prevented by increasing physical activity from inactive to adequate levels. (Reference: Exploring the link between physical activity and cardiovascular disease among Indian elderly: Evidence from the Longitudinal Aging Study in India(LASI) [https://doi.org/10.1016/j.cpcardiol.2024.102778]) Bottom Line: Continued SUPERB evidence that COMBINATION OF DIFFERENT TYPES OF EXERCISE is the best for heat disease prevention!!!

Thanks for asking. The clearest exercise win for lowering blood pressure is consistent aerobic activity, with some strength work added. - Aim for 150–300 minutes/week of moderate cardio (brisk walking, cycling, swimming, dancing) or 75–150 minutes/week of vigorous cardio (jogging, uphill walking, aerobics). Spread over at least 4–5 days; even 10–15 minute bouts count. Expect about 5–8 mmHg systolic drop over 8–12 weeks. - Add 2–3 days/week of resistance training (bodyweight, bands, light weights): 1–3 sets of 8–12 reps for major muscle groups. This lowers BP further. - Do daily short “movement snacks”: 5–10 minutes after meals and hourly sit‑breaks. - Limit very heavy straining (max lifts) if BP is uncontrolled; keep breathing—no breath‑holding. - Track home BP (AM/PM, seated, 5 days/week) to see your trend while you continue meds.

Factor five Laden does actually just the opposite . In young females and smokers with positive factor V laden , there’s actually slightly increased risk of coronary artery disease and stroke, but in general population in good studies, it has not shown any worse effects. This was shown in a recent meta-analysis . Clearly no beneficial effects.

Great questions—and no need to apologize. - Testing at age ~9–11: Yes. Universal lipid screening at 9–11 years is recommended, and earlier targeted testing (as early as 2 years) if there’s a parent/sibling with familial hypercholesterolemia (FH) or very high LDL. If FH is known in the family, test the child sooner rather than waiting to 10, and consider genetic cascade testing if a pathogenic variant is identified in a parent. - Food/fats for kids with FH: Children need fats for brain and growth, so we don’t go “low‑fat.” The goal is smart fats and portion control: limit saturated fat (ghee, butter, coconut oil, high‑fat dairy, fatty red meats) and favor unsaturated fats (oils like canola/olive/peanut, nuts, seeds, avocado, oily fish). Practical balance: use minimal ghee (occasional 1/4–1/2 tsp on dal/roti for flavor, not daily), keep total saturated fat roughly ≤7–10% of calories, and include nuts/seeds/avocado in kid‑sized portions (e.g., 5–10 almonds or 1–2 tsp nut butter, 2–3 slices avocado). Emphasize high‑fiber foods (millets/rolled oats, chana/rajma, vegetables, fruit), low‑fat milk/curd, and active play. If LDL remains high, options like plant sterols/stanols and bile‑acid sequestrants or statins (age‑appropriate, guideline‑based) are considered by the pediatrician. Know your numbers: fasting lipid panel by age 2–8 if FH is suspected, then at 9–11; LDL thresholds for FH in kids are typically ≥160–190 mg/dL (lower if a parent has FH). Early, heart‑healthy patterns plus appropriate therapy give kids with FH an excellent outlook.

Here’s a quick roadmap to explore applied science and market trends on “foods for health,” weight management, and nutrigenomics using IFT (Institute of Food Technologists) resources: - Start hub: ift.org → search “weight management,” “personalized nutrition,” “nutrigenomics,” “functional foods,” “microbiome,” and “metabolic health.” Filter by News, Journal Articles, and Emerging Trends/IFT FIRST. - Science deep-dives: Journal of Food Science and Comprehensive Reviews in Food Science and Food Safety publish R&D on protein quality, satiety fibers (beta‑glucan, inulin), resistant starch, sugar/fat reduction tech, alternative sweeteners, emulsions, and bioavailability (encapsulation, lipid carriers). - Market/innovation: IFT Newsletter, Food Technology magazine, and IFT FIRST session summaries cover: GLP‑1 era meal solutions (higher protein/fiber, smaller portions), microbiome‑targeted prebiotics/postbiotics, plant-based reformulation, clean labels, precision fermentation, upcycled ingredients, and personalized nutrition platforms. - Personalized nutrition/nutrigenomics: look for pieces on genotype-informed advice (e.g., caffeine, lactose, folate), polygenic risk scores, wearable/CGM-driven foods, and regulatory/ethical notes; evidence remains mixed—most benefits come from broad patterns (higher protein, fiber, unsaturated fats). - Practical health angle: for weight, aim protein 1.2–1.6 g/kg/day, fiber 25–35 g/day, minimally processed foods, and time-in-range if using CGM. Educational only; use these resources to track both validated science and hype before acting on products.

It is entirely safe as a skin lotion

very informative article in the New York Times today on March 19th Ozempic Is About to Go Generic for Billions of People In India, China and several other nations, Novo Nordisk is on the verge of losing patent protection for its blockbuster weight loss drug, opening the door for cheaper competing versions. [https://www.nytimes.com/2026/03/19/health/ozempic-wegovy-generic-india-china-canada.html?unlocked_article_code=1.WFA.Iyto.Y7nOr_CItsTt&smid=url-share] SUMMARY FOR BROWN HEARTS 1. Novo Nordisk is losing patent protection for semaglutide in several major countries, opening the door to generic Ozempic/Wegovy in places that together represent about 40% of the world’s population. 2. The first generics are expected in India immediately, with China, Canada, Brazil, Turkey, and South Africa likely to follow in the coming months. 3. This could dramatically improve access, since semaglutide has been too expensive for most patients outside wealthy groups and high-income countries. 4. India and China alone represent a massive potential market, with more than 800 million adults who are overweight or obese and over 360 million adults with diabetes. 5. Analysts expect generic prices could eventually fall to around $15 per month, far below current branded prices such as about $349 per month for higher-dose Wegovy in the U.S. without insurance. 6. Wider availability could expand use not only for diabetes and obesity treatment, but also for cardiovascular prevention, since semaglutide has been shown to reduce heart attacks and strokes. 7. The drugs are helpful but not perfect: some patients stop because of side effects like nausea, vomiting, and constipation, though severe reactions are uncommon. 8. Public health advocates hope cheaper generics will push national insurance systems to start covering these drugs, especially where cost has been the main barrier. 9. Patent expiry adds pressure on Novo Nordisk, which is already facing competition from Eli Lilly and from copycat compounded versions in the U.S.; Novo has tried legal action and price cuts to defend its market. 10. Generics may also spread to poorer countries where Novo never sought patents, and researchers estimate semaglutide could potentially be mass-produced for as little as $3 per month per patient.

Reflux-related cough is common and very treatable. The goal is to reduce acid reaching the throat and calm airway sensitivity, which most people achieve with lifestyle changes and, if needed, short‑term medication. Helpful habits include: finish dinner 3–4 hours before bedtime; raise the head of the bed 10–15 cm (placing blocks under the legs rather than using extra pillows); eat smaller, lower‑fat meals and avoid trigger items such as mint, chocolate, alcohol, coffee/tea, tomatoes, citrus, and spicy or fried foods; stop smoking or vaping; aim for a leaner waist with about 5–10 % weight loss; and avoid tight belts or corsets. If symptoms persist, an 8‑week trial of a proton pump inhibitor (e.g., omeprazole) taken 30–60 minutes before breakfast is the usual next step, and adding an alginate after meals or at bedtime can help with breakthrough reflux. Because a chronic cough can also be caused by asthma, post‑nasal drip, or ACE‑inhibitor medications, and because red‑flag signs such as cough lasting more than 8 weeks, nocturnal coughing, difficulty swallowing, unexplained weight loss, vomiting blood, or recurrent pneumonia warrant further evaluation, you should seek medical assessment if any of these occur.

This is the clinical guidelines from American societies In summary, while ghee is traditionally used for ""cleansing"" in some cultures like Morocco and India , there is no evidence-based clinical guideline or consensus in modern medicine supporting the use of ghee to cleanse the body. This is such a controversial topic that is hard to give answers. It does have more saturated fat than the other oils. There are small studies on Ghee from Ayurveda literature that say that Ghee may not be the wrong kind of saturated fat, but there’s no long-term data available so I would still stay with the American health association guideline at keeping the daily Ghee in moderate amount at less than half a tablespoon per day so that your saturated fat is less than 7%.

Would strongly advice a full-throttle effort at weight reduction by diet and exercise FIRST for at least 4-6 months (The South asian Heart Center Coaching program may be a perfect “hand holder” for you to get help). Such lifestyle change will serve you well long term, regardless. I would LATER (after 6 months) consider medication use (based on more clinical details in close consultation with your primary care doctor). I would definitely NOT use any medications from compounding companies (without an ongoing relationship with a primary care physician) Medications in this class, while having great weight loss and cardio-protective data, also have other issues and side effect profiles that are troubling and need careful supervision. Keep us posted of your weight loss journey and do consider joining the next Podcast from the South Asian Heart Center and /or contacting them for help

large study of about 98,000 people with type 2 diabetes in the U.S. Veterans health system found that people did best when they combined GLP-1 diabetes medicines (a class that includes drugs like semaglutide) with multiple healthy lifestyle habits. Researchers tracked major cardiovascular outcomes—heart attack, stroke, or cardiovascular death—and counted eight “low-risk” habits (better diet, physical activity, not smoking, good sleep, avoiding heavy alcohol, managing stress, social connection, and no opioid use disorder). On average, GLP-1 use was linked to a modest reduction in risk, but those who had 6–8 healthy habits plus GLP-1 use had a much lower risk than people who had fewer healthy habits and weren’t on a GLP-1 drug. Because this was an observational study (not a randomized trial), it can’t prove cause-and-effect—but it strongly supports a practical message: medications can help, but the biggest benefits come when you “stack” them with lifestyle (Nguyen X-MT et al., The Lancet Diabetes & Endocrinology, Feb 25, 2026. ) 2. REDUCING TV TIME TO LESS THAN AN HOUR A DAY LOWERS RISK OF HEART ATTACK: Less TV time may be a simple “heart-protective” target A UK Biobank analysis found that people who watched 2+ hours/day of TV had a higher risk of atherosclerotic heart and vessel disease than those who watched ≤1 hour/day. Notably, keeping TV time low appeared helpful even for people with higher genetic risk for type 2 diabetes 3. AVOCADO AND MANGOES REDUCED RISK IN PRE-DIABETES: Prediabetes, a risk factor for cardiovascular disease, is common and underdiagnosed in the US.Adding an avocado and 1 cup of mango daily improved heart health in adults with prediabetes. Even without a full diet overhaul, small, achievable adjustments can support heart health.

GLP 1 are good to reduce weight for obesity although they are typically used for a BMI above 29. I have done a full podcast on GLP1 recently with an influencer in London along with a holistic nutritionist and Plastic surgeon , which I can post here. They should be used with caution and unfortunately, when you stop the GLP 1 if you have not changed the lifestyle completely the weight will come back. Also 20-30% of wt loss is Muscle because it is lost rapidly.

My recent podcast on weight loss drugs which I did with a nutritionist from CA , and Plastic surgeon from London VIDEO PODCAST Weight Loss Drugs: What No One Tells You About Ozempic, Wegovy, Mounjaro, and More Are weight loss drugs like Ozempic, Wegovy, and Mounjaro the miracle breakthrough for obesity and metabolic health—or a dangerous quick fix with hidden risks? In this powerful episode of The Wellness Algorithm with Anshu Bahanda (Wellness Curated), we cut through the hype, celebrity buzz, and TikTok trends to uncover the real science and long-term effects of GLP-1 medications. [https://youtu.be/ZVvA2tezp2Q?si=HZjOfbtDVenTE0KK] Podcast Episode Weight Loss Drugs: What No One Tells You About Ozempic, Wegovy, Mounjaro, and More Wellness Curated [https://open.spotify.com/episode/3xgLzSRQo1vwg225Sorvwn?si=Q0Ta-PPGQSSAb3w397opPg]

Short answer: gur/desi shakkar (jaggery) is not a low‑GI/GL substitute for sugar. It’s essentially sugar with a bit of minerals. - Glycemic impact: Jaggry’s GI is typically high (around 70±), similar to white sugar; GL per serving is also similar because the carb load is comparable. So blood glucose and insulin responses are not meaningfully better. - Calories/carbs: Nearly the same calories and grams of sugar as table sugar/honey. - “Mineral” bonus: Trace iron/potassium exist but in tiny amounts at dessert‑size portions—nutritionally negligible. For baking: if you like the flavor, use it sparingly and cut total sugar by 25–30%, add fiber/protein (e.g., whole‑wheat or oat flour blends, nuts, yogurt/paneer), or try partial swaps with allulose/erythritol blends (e.g., allulose:monk fruit 2/3:1/3) to lower sugars while keeping taste and texture reasonable.

Yes there is similar data on bread like rice that the GI index is lower as compared to fresh bread but studies in human are small with 15-30 people and BG drop is modest : the BG rise decreases from 132-120 so not a huge change. Also there is confusion whether it happens in store bought bread where there are more chemicals . Home made bread has more chances . So in summary there is a small decrease but I would recommend eating healthier version of fresh bread like seeded bread. , 647 bread which has more fiber and less carb. Hope that helps.

What we do Not recommend is in excess . You can have normal amount of eggs without worries. No food really help hyperthyroidism except if you have a hot nodule and you have excess of iodine .

It is being increasingly understood that gut bacteria have a significant role to play in multiple diseases. However, the problem has been that the POTENTIAL benefits and DETAILS around it are only currently being worked on and not available yet for general public use in a safe and effective manner. Several complementary health providers are doing these tests and making numerous recommendations around the results, that are not fully based on rigorously tested scientifically data. Three of the most reputed health centers in the country continue to NOT recommend such testing for routing use. Summary below: HOPKINS: Johns Hopkins researchers have NOT endorsed specific direct-to-consumer (DTC) gut microbiome tests and instead have called for greater regulation of the industry due to significant concerns about validity, reliability, and misleading claims CLEVELAND CLINIC: Cleveland Clinic does NOT currently recommend or use consumer gut microbiome tests for routine health maintenance, citing a lack of evidence for their utility due to the absence of a benchmark for a "normal" gut microbiome. MAYO CLINIC: primary applications are in research to understand the microbiome's role in disease and treatment response, NOT yet as a routine clinical diagnostic tool for everyone My own take: The path of gut microbiome testing and related recommendations is currently being defined, and is not recommended for regular use. If you do decide to pursue, it can be EXPENSIVE and result in multiple recommendations on supplementation, not backed by high quality scientific evidence Likely to change as more data evolves! Stay tuned!!! Exciting area

The answer is if you have not followed diet and exercise , the very first step is to follow a low carb, low fat and high protein diet. . You can listen to the diet seminar if you have not heard . Also at least incorporate 150 minutes of exercise per week. Do it for three months and not only you will lose weight, but you will also improve your A1c. If at that time if the A1c does not improve the very first drug we start is metformin, which is very safe, lowers the appetite, and also improve A1c.

there is no correlation between decreased HDL and diabetes, other than a loose statistical association because both can be part of metabolic syndrome. Raising HDL by meds (some have a small positive effect) is no longer considered a benefit for cardiovascular prevention. The biggest emphasis backed by trials is LOWERING LDL

Home made butter has roughly same saturated fat as that in commercial butter. Both high in saturated fat. So be moderate

Good morning! For tea/coffee biscuits, think “high-fiber, lower sugar, lower saturated fat.” Practical picks: oat- or multigrain “digestive” styles with ≤4–5 g sugar and ≥3–4 g fiber per 100 g, ) Also threptin biscuits have higher protein and less cholesterol if you buy "Lite" . Use simple RUSK with peanut butter. control portions For halwa: use coarse Sooji, Even better swaps: 1) 50:50 sooji:oats (powdered), 2) 50:50 sooji:besan (adds protein), 3) cracked wheat (dalia) or coarse “lapsi,” 4) foxtail/barnyard millet rava.or Quinoa . Add nuts, cardamom, saffron; finish sweeter with adding Dates or raisin so you can use less sweetener.Allulose causes some bitterness so pl add it with pure monk fruit in 2/3-1/3 proportion . Keep helping small.

Classic heart attack symptoms: 1) pressure/squeezing/heaviness in the center/left chest lasting >5–10 minutes or coming in waves, 2) pain that can spread to left or right arm, jaw, back, or upper stomach, 3) shortness of breath, 4) cold sweat, nausea, or lightheadedness. In women and people with diabetes, symptoms can be subtler—unusual breathlessness, fatigue, or upper back/jaw pressure with or without chest pain. When in doubt, the key is: NOT to wait but immediately get to an ER to get help. “Time is muscle” as they say and can be life saving to to to the hospital early

Treatment of heart disease includes emergency care for acute events, long‑term medication, procedures when indicated, and lifestyle modification. **Emergency care** – For a heart attack or unstable symptoms call emergency services. Initial measures may include oxygen, pain control, blood‑thinning agents and rapid opening of the blocked artery with percutaneous coronary intervention (angioplasty and stent) or coronary artery bypass grafting if needed. **Long‑term medical therapy** – Goals are to lower LDL/ApoB (statin first‑line, add ezetimibe or a PCSK9 inhibitor if needed), control blood pressure (ACE‑inhibitor, ARB, calcium‑channel blocker, etc.), use antiplatelet agents such as aspirin after a stent or myocardial infarction, beta‑blockers after MI or for angina/heart failure, and heart‑failure specific drugs (ARNI, SGLT2 inhibitor, mineralocorticoid‑receptor antagonist, diuretics). Additional agents are used for specific problems: nitrates for angina, anticoagulants for atrial fibrillation with stroke risk, and other drugs as appropriate. **Procedures** – Percutaneous coronary intervention (stent) or coronary artery bypass surgery are performed based on coronary anatomy and ischemia testing. Valve disease may require repair or replacement, rhythm disorders may need pacemakers, implantable cardioverter‑defibrillators or catheter ablation, and advanced heart‑failure may require left‑ventricular assist device or heart transplantation. **Lifestyle and risk‑factor control** – Cardiac rehabilitation, regular aerobic activity (150 – 300 min/week) plus strength training 2–3 days, a heart‑healthy diet (Mediterranean‑style, plant‑based, beans, nuts, fish, limit refined carbs, saturated fat, and ghee; use unsaturated oils), smoking cessation, adequate sleep, stress management, and maintaining a waist‑to‑height ratio < 0.5. Target numbers are LDL < 70 mg/dL (consider < 55 mg/dL for very high risk), blood pressure < 130/80 mmHg, and optimal diabetes control (A1c as appropriate). These measures reduce symptoms, prevent future heart attacks, heart failure, stroke and death. This information is general education and not a personalized treatment plan.

thx for the Q. Diet advice has actually become MORE consistent now. Here’s the steady ground: the best‑evidence pattern is mostly plants, high fiber, adequate protein, and limited saturated fat—without needing to be zero‑oil or fully vegan. Whole‑food vegan can work well, but “carbs aren’t a problem” is only true for intact, high‑fiber carbs (beans, lentils, millets, oats, vegetables, fruit). Refined carbs (white rice/maida snacks, sweets, juices) do drive glucose, triglycerides, and belly fat—especially in South Asians.

American Heart Association Statement Below: The AHA (2021 and 2026), the 2025–2030 Dietary Guidelines for Americans, and other authoritative bodies consistently recommend using nontropical liquid plant oils (including seed oils) in place of animal fats and tropical oils as part of heart-healthy dietary patterns. A 2025 narrative review in Nutrition Reviews concluded that the "demonization" of seed oils is not supported by available human research evidence and that contrarian claims risk shifting public dietary behavior away from evidence-based recommendations Key Caveats The evidence is strongest for replacing saturated fat with PUFA-rich oils rather than simply adding seed oils to an existing diet. High-temperature deep frying may generate lipid peroxidation products such as hydroxynonenal, which has been hypothesized to contribute to cell damage through lysosomal destabilization, though this remains largely based on mechanistic and animal data rather than human clinical outcomes. OUR “WORK HORSE” OIL for Indian cooking remains Canola Oil. As a reminder MINIMIZE OIL USE OVERALL REGARDLESS OF TYPE

Heart palpitation is when your heart rate starts to rise . There are many reasons for it starting from anxiety, thyroid, heart, disease, and other things so if you have continuous / frequent palpitations, you should be evaluated by the doctor to find out the reason before you do treatment.

This question illustrates issues with using natural remedies for well defined syndromes (in this case Parkinsons disease). Here’ s the evidence: 1. A few natural herbs/supplements have been studied in Parkinson’s disease (PD), but the honest bottom line is: none are proven to slow or reverse PD, and evidence for symptom benefit is limited and inconsistent. The most important issue is safety and drug interactions 2. ⁠Some herbs have been studied that naturally contain L-DOPA, the active treatment ingredient commonly used to treat PD. Results have been mixed and it is impossible to figure out what doses are effective. Instead, L-dopa alone or in combination has been well tested as a MEDICATION in scientific studies for DECADES with well established dosage guidelines. I would much rather use a standardized medication (under physician guidance) instead of herbs for PD

HERBS THAT CAN ALTER DISEASE STATES AND DRUG EFFECTS Many Indians use natural remedies and natural supplements. If you do, please make sure you let your doctor know since several can interfere OR enhance effect of medications for specific conditions. Some key examples are the following: A. Herbs that can increase bleeding risk in those taking blood thinners Garlic and ginger Supplements High dose turmeric (Haldi) supplements B. Herbs that can lower blood sugar more than expected in patients with diabetes on medications Fenugreek (Methi) Karela C. Herbs that can Raise BP Multethi (Licorice) D. Herbs that can alter Thyroid treatment Ashwagandha Guggul Holy Basil (Tulsi)

Thanks for asking. I’m assuming “LBB” means left bundle branch block (LBBB). Many people with LBBB travel safely, but the key is why the LBBB is present and how the heart functions. High altitude (15,000 ft/4,500 m) has low oxygen and can strain the heart and lungs; risks rise if there’s underlying coronary disease, cardiomyopathy, valve disease, pulmonary hypertension, or reduced ejection fraction. Best approach if the trip is important: get a pre‑travel cardiac review to confirm stability (exam, recent ECG, echo; stress testing only if symptoms/risk). If cleared, use these precautions: ascend gradually (2–3 days acclimatization at 8–10k ft first), go slow the first 48–72 hours, avoid heavy exertion and alcohol/sedatives, stay warm and well hydrated, know altitude sickness signs (headache, nausea, unusual breathlessness at rest, chest pain, confusion) and descend if they appear. Carry regular medicines, a copy of ECG, a pulse oximeter, and have a plan to reach lower altitude quickly. If she develops chest pain, severe shortness of breath, or fainting, treat as an emergency and descend immediately.

Yes . We definitely recommend the blood test and CAC score if you are around 35 yrs of age or family history .

Medication use is all about BALANCING risks and benefits and never a binary “good” or “bad”…so here is the low down: BENEFIT: Remarkable heart attack prevention benefit: 30-50 people need treated to prevent one heart attack—so HIGHLY BENEFICIAL POTENTIAL diabetes risk: about 300 people need treated before 1 new episode of diabetes happens Add to that , that the potential risk above is in people already pre-disposed and are therefore at higher risk of heart attacks We strongly urge people to stay on statins (if indicated) to reduce heart attack risk and not to be overly concerned about the SMALL increased risk of pre-diabetes.

Yes. Being natural doesn't mean a supplement is safe. High doses of fat-soluble vitamins (A, D, E, K) can cause toxicity syndromes. In one case, high-dose Vitamin D contributed to worsening sleep issues, and low-dose hydrocortisone (taken as a supplement) contributed to fluid retention.

Hi Pragati, Short answer: high HDL (80) does not cancel out high LDL (135). LDL (and ApoB, the particles carrying LDL) drives plaque formation; HDL is harder to modify and high levels don’t reliably protect against heart attacks. Current best approach is to treat LDL as the main risk lever.

These are recommendations from AHA. The American Heart Association emphasizes that while vigorous physical activity confers superior cardiovascular adaptations and outcomes compared to moderate-intensity exercise, the relative risk of acute cardiovascular events is transiently increased during vigorous activity, especially in habitually sedentary individuals or those with known or occult cardiovascular disease.[1] Overall, the consensus is that the benefits of regular exercise outweigh the risks for most individuals, but high-volume, high-intensity endurance exercise may create a substrate for adverse cardiovascular adaptations in susceptible populations.

Yes. This patient's main reason for consultation was abnormal heart tests, not obvious cardiac symptoms — cardiovascular risk from elevated LDL and Lp(a) can be silent until it's evaluated with proper testing. Knowing your Lp(a) status (which many people are never told) is important for assessing true heart disease risk.

My assessment: 1. Fluid retention was happening from a combination of things including low dose hydrocortisone 2. ⁠Sleep issues were being made worse by high dose Vitamin D (vitamin D levels were high) 3. ⁠He did not know about the high cardiac risk from Lp(a)——risk rises to very high levels at this level of Lp(a) along with an elevated LDL My intervention 1. Stopped Hydrocortisone 2. ⁠Stopped Vitamin D 3. ⁠Started Rosuvastatin 5 mg daily, and emphasized importance of lowering LDL very aggressively (down to less than 70) Learnings for all 1. Natural is not necessarily safe (Vitamins ADEK can cause syndromes of toxicity in higher doses) 2. ⁠Please carefully evaluate your supplement list and make sure your doctor knows what you are taking 3. ⁠Learn about your heart disease risk and use appropriate medication to GET TO TARGET on your LDL (less than 100 for most Indians, less than 70 with Diabetes and Known heart disease or very high risk)

typically the parathyroid levels are high when there is a low vitamin D, which can also cause a high alkaline phosphate. It is a very common cause in Indians . Typically hyperpara thyroid is not associated with diabetes. If the vitamin D is low, correcting the deficiency will reduce the parathyroid levels. If you can DM me personally with your numbers I can help you. There is one condition where the high parathyroid is associated with high calcium. In that condition, if the calcium is high for a long time, it can affect the heart vessels. Also autoimmune conditions is a very broad word . There are many autoimmune conditions that cause different problems . There is specific autoimmune condition that causes type 1 DM . I can help you if you have a specific autoimmune condition and want some answers

Addressing the HDL question first: Evidence has moved away from trying to increase HDL with meds. Benefits of med induced increases in HDL are just not well documented . I would be much more interested in lowering LDL (well documented benefits). Niacin has too many issues of side effects and not worthwhile In high risk individuals with TG between 150-500 treatment with Vascepa may be indicated in higher risk individuals (as an adjunct to statin therapy)……if. you tell me a bit more about the risk profile of this person, I can be more specific

HIIT routines can be tricky at this age and have too many “ifs and buts” including making sure that you have clearance from your physician. On the other hand if you are fit and have previously engaged in moderate to more aggressive exercise, a modified version may be OK, but would dhave to be tailored after speaking to your physician. Happy to provide inputs on this via DM. All this being said, in people above 75, it is critically important to maintain MOBILITY and STRENGTH So definitely plan to do muscle strengthening exercises and Japanese Interval Walking if you can. I will post something on Strength training soon. HEALTH OF INDIAN PHYSICIANS I recd a wonderful and thought provoking article on the health of Indian physicians (In India), that was just published. The primary research was conducted by a physician (now in the UK and part of this group). Key points: The study surveyed 265 practicing doctors in India across different specialties. Nearly 1 in 2 doctors had high blood pressure, and about 1 in 4 had diabetes Among doctors with high blood pressure, only about 6 in 10 had it under good control. Thyroid problems affected about 1 in 5 doctors. About 1 in 9 doctors never exercised, and around 3 in 10 drank alcohol occasionally. Despite medical knowledge, less than half had checked their long-term blood sugar (HbA1c) in the last 3 months. Overall, doctors often delay or skip preventive health checks, just like the general population. To me, the key take home message is that knowledge alone does not inspire change…….MUST ACT!

Thanks for asking—home BP is one of the best habits for heart health. The reliable way is “7‑day, twice‑daily, two‑readings” using proper technique. - Setup: Use an automated, validated upper‑arm cuff that fits your arm. No caffeine/exercise/smoking 30 minutes prior; empty bladder; sit quietly 5 minutes, back supported, feet flat, arm at heart level. Avoid talking. - Schedule: Take 2 readings morning and 2 readings evening, 1 minute apart, for 7 days (skip day 1 if you want the most accurate average). Log all values; average the rest. - Targets at home: aim <135/85 mmHg average (clinic targets are usually <130/80 if tolerated). - Ongoing: If stable, repeat a 3–7 day check once a month, or any time meds/symptoms change. Keep the cuff calibrated every 1–2 years.

thanks for your Q about HRV (Heart Rate Variability) and it's predictive value in assessing cardiac health. High HRV is generally considered better than low when it comes to overall health. However, because there are many things that can affect it, it is hard to “hang your hat” on it a sole and independent indicator. I think more data will come out over time before it establishes its approrpiate place

1. In primary prevention (those who have NOT had a heart attack) , persistently elevated hsCRP should prompt consideration of statin initiation or intensification, irrespective of LDL-C 2. In secondary prevention (those known to have heart disease) , hsCRP is at least as powerful a predictor of recurrent events as LDL-C 3. Low-dose colchicine should be considered for patients with chronic stable ischemic heart disease, particularly those with hsCRP >2 mg/L despite aggressive lipid-lowering therapy IMPORTANT CAVEAT No direct anti-inflammatory trial has yet been completed in a purely primary prevention heart disease-free population, though trials of IL-6 inhibitors (ziltivekimab) are anticipated to report in late 2026–

2 drugs have been found to be useful in clinical trials: COLCHICINE and STATINS.

Answer is an unequivocal YES. The landmark CANTOS trial (2017) demonstrated direct proof that lowering HS-CRP to less than 2 in patients who had had a heart attack, lowered the incidence of another one regardless of lowering LDL cholesterol

Here’s a clear, up‑to‑date snapshot. Diagnosis thresholds - ACC/AHA (USA, 2017, reaffirmed): Normal <120/80; Elevated 120–129/<80; Hypertension ≥130/80 (Stage 1: 130–139 or 80–89; Stage 2: ≥140 or ≥90). Confirm with out‑of‑office BP when possible. - ESC/ESH (Europe, 2023): Office hypertension ≥140/90. Home average ≥135/85; 24‑h ambulatory ≥130/80 (daytime ≥135/85; night ≥120/70). - NICE (UK, 2023): Clinic ≥140/90 → confirm with ambulatory (daytime average ≥135/85) or home (≥135/85). Why differences? US emphasizes earlier risk reduction at ≥130/80; Europe/UK keep office cut‑off at 140/90 but rely on home/ambulatory confirmation. How to measure (office and home) - Sit quietly 5 minutes; no caffeine/exercise/smoking 30 minutes prior; empty bladder. - Use validated upper‑arm cuff, correct size; arm supported at heart level; back supported; feet flat; no talking. - Take 2 readings 1–2 minutes apart; average them. New device/visit: measure both arms, use higher arm thereafter. - Home BP: morning and evening, 2 readings each time for 7 days; discard day 1, average remaining (diagnostic threshold ≥135/85). - Ambulatory monitoring is best to exclude “white‑coat” and detect “masked” hypertension. This is educational information; your clinician will tailor targets based on age, diabetes, CKD, or ASCVD risk.

Here’s the punchline: HPS2‑THRIVE (niacin/laropiprant) and ILLUMINATE (torcetrapib, a CETP inhibitor) showed that changing surrogate markers (raising HDL, lowering LDL or CRP) is not enough—only randomized outcomes trials that measure heart attacks, strokes, and deaths can tell us if a therapy truly helps. Why it matters: Torcetrapib impressively raised HDL and lowered LDL, yet ILLUMINATE was stopped early because deaths and cardiovascular events increased—off‑target harm (e.g., blood‑pressure rise) outweighed lipid changes. In HPS2‑THRIVE, adding niacin to statins improved HDL/TG but did not reduce major vascular events and increased serious adverse effects (infection, bleeding, new‑onset diabetes, liver/skin issues). So, we need large, well‑designed outcome trials before adopting therapies; prioritize therapies with proven event reduction (e.g., statins, ezetimibe add‑on, PCSK9 inhibitors) rather than chasing surrogate improvements.

I am tracking a lot of excellent new published literature on the many benefits of an Indian Adaptation of the Mediterranean Diet. A whole lot of data has accumulated over the last 25 years on this. Current thinking supports an Indian-adapted Mediterranean approach—keeping the science-backed principles (plant-forward, high fiber, minimally processed foods, healthy fats) while using Indian staples and flavors. Early Indian studies show this pattern is feasible, culturally acceptable, and heart-friendly, especially when built around everyday foods we already know and enjoy. What this looks like on your plate: more dals, chana, rajma, vegetables, fruits, nuts, seeds, whole grains and millets; protein mainly from plants, with eggs, fish, or dairy in modest amounts if you choose; and a shift toward unsaturated oils (extra-virgin olive oil where feasible, or commonly used non-tropical oils used wisely), while cutting back on ghee/butter, refined carbs, sugary foods, and deep-fried snacks. This isn’t about abandoning Indian food—it’s about making Indian food work harder for your heart, reducing inflammation, and supporting long-term metabolic health. Small, consistent swaps matter more than perfection. And don’t forget: repeatedly shown has been the fact that most Indian spices have excellent anti-inflammatory effect and are “Mediterranean Diet Friendly”!

From our research on Ayurveda and allopathic medicine, they obviously can be combined. Ayurvedic ways of living are wonderful to prevent diseases, which is a simple life with exercise, healthy, steamed vegetables, etc. etc. many of the supplements are good for prevention like for the early stages of diabetes and other diseases, but once you develop the disease, unfortunately Ayurveda alone will not be able to improve it by itself as there are very limited clinical studies. So at that time, you will need to add medications, but still practice some of the Ayurvedic principles. We are actually planning to do a talk on Aurveda and Allopathy in the future. Hope that answers your question.

Current research does not provide solid evidence that intermittent fasting alone can reduce existing arterial plaque. However, intermittent fasting can promote weight loss, lower triglyceride levels, improve insulin resistance, and sometimes lower blood pressure. These metabolic improvements lower overall cardiovascular risk, which may indirectly influence plaque progression, but direct plaque regression has not been clearly demonstrated.

My overall take: Intermittent fasting remains a good way to lose weight and works for many. Long term effects remain a topic of scientific study and more meaningful scientific info will come out. For those pursuing this method, I have no reason to tell them to stop. One important thing : if you like to intermittent fast, make sure your protein intake remains adequate over time. This simply worded article in the New York Times nicely summarizes the issues involved. Is Intermittent Fasting Bad for Your Heart? Here's What We Know [https://www.nytimes.com/2024/03/20/well/eat/intermittent-fasting-study.html?unlocked_article_code=1.iE8.0OHK.O9oq5cyscvq1&smid=url-share]

The study had significant limitations ( including recall bias). If people do follow IF for weight loss, we suggest they ensure adequate protein intake . We continue to recommend the time tested method of overall caloric restriction for long term weight loss

Absolutely! that’s exactly why it works well and is practical

Intermittent Fasting is an effective way to reduce weight, and multiple clinical research studies have documented its effectiveness. Of the different ways, the most moderate and the most likely to be followed longer term is the 16/8 method (16 hours of fasting and 8 hours of food intake). ONE VERY IMPORTANT CAVEAT and potential issue: You can get behind on protein intake pretty quickly (even more so if you are vegetarian) and this has many negative health consequences that we have previously indicated. So make sure you are INTENTIONAL about ensuring adequate daily protein intake. At least 1-1.5 gm/kg. So if you are 70 kg. ensure AT LEAST 70-100 gram protein daily.

Several folks over 60 tell Renu and I that they are a bit hesitant to pursue High Intensity Interval training (HIIT) for a variety of physical limitation reasons. There is an evidence-based technique called Interval Walking Technique (IWT) that you can consider. Here’s the routine: Warm Up: Easy walking for 10 minutes Walk Briskly for 3 minutes (you should be short of breath!) Walk at normal pace for 3 minutes Repeat this cycle for a total of 30 minutes IWT is proven to help weight loss, lower visceral fat, improve insulin sensitivity and reduce the risk of Type 2 diabetes. Reference: Karstoft et al. Diabetes Care 2013, Vol 36 (2) 228-236 Japanese interval walking: the viral exercise trend that could put a spring in your step This article is more than 9 months old Alternating between fast and slow walking is particularly suited to people who do not do much regular exercise [www.theguardian.com/lifeandstyle/2025/aug/09/japanese-interval-walking-the-viral-exercise-trend-that-could-put-a-spring-in-your-step?utm_source=chatgpt.com]

The pink salt does not have enough iodine in fact, most of the natural salts, including sea salt, do not have enough iodine because the normal salt is fortified with extra iodine. So the pink salt does not meet your iodine requirement unless you are eating other things fortified with iodine

A good source is iodized table salt. Only a quarter teaspoon gets almost 50% of daily requirement met. Needless to say, total salt intake has to be moderate (I have previously posted our video on Salt). Dairy products such as milk and yogurt also provide iodine.

Hi, there are a few studies evaluating the iron glycinate comparing with fumarate. Many of them are observational studies so class two evidence but there is at least a couple of studies with good evidence that they’re better absorbed and the stomach side effect may be a little less so that over all absorption is a little bit better. However, at the end of six months, the results were the same in the levels of iron and hemoglobin. So yes, if your stomach gives you your problem and you have difficulty tolerating definitely worth a try

Khapli wheat can be a sensible swap if you enjoy rotis but want a gentler glucose rise. It’s an ancient wheat with more fiber and protein than many refined atta blends, and small Indian studies suggest a lower glycemic impact versus regular wheat flour.

Khapli (emmer) wheat can be a sensible swap if you enjoy rotis but want a gentler glucose rise. It’s an ancient wheat with more fiber and protein than many refined atta blends, and small Indian studies suggest a lower glycemic impact versus regular wheat flour. That said, “low GI” doesn’t mean free pass—portion size and what you eat with it still drive glucose. Practical tips: choose 100% khapli or mix with chana/besan or soy flour (20–30%) to boost protein/fiber; keep rotis thin; pair with dal/vegetables and some curd; watch total carbs. If you use a CGM/glucose meter, check 1–2 hours post‑meal (aim <140–160 mg/dL). Taste, tolerance, and consistency matter most.

Lactase tablets work only for lactose intolerance they break down the milk sugar (lactose) that can cause gastrointestinal symptoms such as gas, bloating, or diarrhea. They do not reduce the amount of carbohydrate (including lactose) that is absorbed as glucose, so they will not prevent a rise in blood‑sugar levels after dairy intake. If your glucose rises, the cause is the carbohydrate load from the dairy product. Strategies include: • choosing dairy with lower lactose or total carbohydrate (plain Greek yogurt, strained curd, paneer, cheese); • using smaller portions and pairing with protein, fiber, or healthy fat to blunt the glycemic response; • selecting lactose‑free milk, which still contains similar carbohydrate content but may be easier on the gut; • monitoring your glucose 12 hours after the dairy serving with a meter or CGM to see the actual impact and adjust portion size or product choice. In short, lactase tablets will not control the blood‑sugar spike; manage the carbohydrate content and timing instead.

Yes. Over‑the‑counter (OTC) fast‑acting lactase tablets or drops are available without a prescription and can help many people with lactose intolerance reduce symptoms when they consume dairy products such as milk, ice cream, paneer, or kheer. The product provides the lactase enzyme that the small intestine lacks; it should be taken immediately before the first bite or sip of lactose‑containing food or drink. The dose may need to be increased for larger lactose loads. These enzymes work best with low to moderate amounts of lactose; very large quantities may still cause gas or bloating. Most individuals tolerate low‑lactose foods (e.g., dahi/curd, hard cheeses, lactose‑free milk) even without supplements. Safety is generally good, but if symptoms persist despite proper use, consider lactose‑free products or seek medical evaluation for other possible gastrointestinal causes.

Lactose intolerance means the small intestine lacks enough lactase to digest lactose. Over‑the‑counter (OTC) options are generally safe and do not require a prescription. Common OTC measures include: - Lactase enzyme tablets or drops taken just before consuming lactose‑containing foods (milk, ice cream, paneer, etc.). - Lactose‑free dairy products (lactose‑free milk, hard/aged cheeses such as cheddar or parmesan, butter/ghee) and plant‑based milks (soy, almond, oat) which contain little or no lactose. - Yogurt with live cultures can be tolerated in small amounts because the cultures help break down lactose. If symptoms persist despite proper use of lactase supplements or lactose‑free products, a healthcare professional should be consulted to rule out other gastrointestinal conditions. Specific product recommendations require knowing the exact item in question.

Arginine is currently not recommended to use as a supplement for lowering cardiovascular risk. While the older study showed very good data, the current literature showed conflicting results so large studies needs to be done."

Thanks for the Q—LDL 135 and A1c 6.3% both need attention. The key is to lower LDL/ApoB and improve insulin sensitivity while keeping things practical. - Food pattern: Mostly plants and pulses, plenty of veggies (aim 8–10 fistfuls/day across meals), higher fiber (30–40 g/day) from dal/chana/rajma, oats, millets, veg, fruit. Keep protein ~1.0–1.2 g/kg/day using dal+egg/fish/chicken/curd/soy; make paneer an occasional small-portion item. Swap ghee/cream with unsaturated oils (canola/peanut/sunflower for Indian cooking; extra-virgin olive oil for salads/low heat). Limit fried foods, sweets, refined atta/white rice; choose chapati with multigrain/atta+chana/besan mix, or brown rice/millets. Nuts (a small handful/day) help lipids. - Cooking habits: Smaller oil quantities (about 1–2 tsp per person per meal), more steaming/pressure-cooking/stews; less deep-frying/high-heat tadka. - Weight and waist: Target waist-to-height ratio ≤0.5 (men <90 cm, women <80 cm); even 5–7% weight loss improves A1c. - Activity: 150–300 minutes/week aerobic plus 2–3 strength sessions; add brisk walks after meals (10–15 minutes) to blunt glucose spikes; aim ≥7,000–8,000 steps/day. - Sleep/stress: 7–8 hours, reduce late-night eating; manage stress (yoga, breathing). - “Know your numbers”: Recheck lipids after 6–12 weeks of changes; track fasting and post-meal glucose (or CGM briefly) to raise time-in-range. We advocate for all of the above because tightening diet quality, portions, and activity reliably lowers LDL and brings A1c toward <5.7–6.0 over months without extremes.

Thanks for the question—here’s the straight take. With your numbers (LDL 111 mg/dL, non‑HDL 138, triglycerides 153) and a strong family history of stents, the key is tightening LDL/non‑HDL and addressing triglycerides, sleep, and thyroid—all of which interact in perimenopause. What to change now: - Know your risk baseline: get ApoB (preferred), Lp(a) once, and consider a coronary calcium (CAC) scan to decide how aggressive to be. Targets if risk is elevated: LDL <70 and non‑HDL <100 (South Asians often benefit from tighter control). - Food tweaks (keep your tennis/walking): shift white rice to smaller portions or swap 50–100% with higher‑fiber options (steamed brown rice, hand‑pounded rice, millets like little/kodo/foxtail, or quinoa), add 1–2 cups/day of pulses (chana, moong, rajma), 25–35 g fiber/day, and 80–100 g protein/day (eggs, fish, curd/paneer, soy, dal + dairy). Use unsaturated oils (canola/groundnut for tadka, olive oil for low heat), limit ghee/butter/coconut to “occasionally.” Trim sweets, refined snacks, and alcohol (all push triglycerides). - Body composition: aim waist-to-height ratio ≤0.5 (South Asian cutoffs: women <80 cm). Even 3–5 cm off the waist can drop triglycerides and LDL. - Thyroid and sleep: keep TSH in a tight range (about 1–2.5) as undertreatment can raise lipids; tackle hot flashes/sleep (CBT‑I, cooling, magnesium glycinate at night; menopausal hormone therapy can be discussed if appropriate and low ASCVD risk). - If CAC is >0 or ApoB/Lp(a) are high, medication becomes reasonable; if CAC is 0 and ApoB low, push lifestyle first. Statins are safe long‑term; if muscle aches occur, vitamin D repletion or CoQ10 can help, or switch agents. The key is lowering LDL/ApoB; HDL is hard to change, and triglycerides usually fall with the above pattern. If you’d like, share ApoB/Lp(a)/waist/CAC when available and we can calibrate targets further.

- Testing at age ~9–11: Yes. Universal lipid screening at 9–11 years is recommended, and earlier targeted testing (as early as 2 years) if there’s a parent/sibling with familial hypercholesterolemia (FH) or very high LDL. If FH is known in the family, test the child sooner rather than waiting to 10, and consider genetic cascade testing if a pathogenic variant is identified in a parent. - Food/fats for kids with FH: Children need fats for brain and growth, so we don’t go “low‑fat.” The goal is smart fats and portion control: limit saturated fat (ghee, butter, coconut oil, high‑fat dairy, fatty red meats) and favor unsaturated fats (oils like canola/olive/peanut, nuts, seeds, avocado, oily fish). Practical balance: use minimal ghee (occasional 1/4–1/2 tsp on dal/roti for flavor, not daily), keep total saturated fat roughly ≤7–10% of calories, and include nuts/seeds/avocado in kid‑sized portions (e.g., 5–10 almonds or 1–2 tsp nut butter, 2–3 slices avocado). Emphasize high‑fiber foods (millets/rolled oats, chana/rajma, vegetables, fruit), low‑fat milk/curd, and active play. Know your numbers: fasting lipid panel by age 2–8 if FH is suspected, then at 9–11 Renu and I are NOT Pediatricians so do consult your child's pediatrician if more specific questions, or a special lipid clinic....

LDL targets remain the exact same as we have always educated on this forum: Less than 100 for all Indians Less than 70 if you have diabetes or known heart disease Probably even lower if further higher risk…. If control is not possible with statins or unable to control despite statins…..this is a wonderful option

Your target LDL is less than 70 based on all current guidelines . This is simply because you have diabetes. Please discuss starting meds w your doctor to lower LDL to less than 70

Less than 100 mg/dL for most Indians. For those with diabetes, known heart disease, or very high cardiovascular risk (such as very high Lp(a)), the target is more aggressive: less than 70 mg/dL.

Thanks for asking—this is exactly the right time to “know your numbers” for your sons. Given a first‑degree relative with coronary disease, the prudent goal for them is LDL <70 mg/dL, ideally with ApoB <80 mg/dL if measured. If either has additional risk (South Asian ancestry, central obesity/waist >90 cm men, hypertension, prediabetes/diabetes, smoker, high Lp[a], or CAC >0), aim even lower—LDL closer to <55 mg/dL. They should also check Lp(a) once in their lifetime; if elevated, we push LDL lower as the actionable lever. Quick add: start with a fasting lipid panel in their 30s, track non‑HDL too, and recheck every 1–2 years to stay on course.

Great question—yes, you can shift toward pattern A with the same habits that lower atherogenic particles. Practical playbook: cut refined carbs and sugary snacks/drinks (they drive small, dense LDL), keep saturated fat modest (ghee, butter, coconut, fatty red meats → limit to small amounts, not daily), and favor unsaturated fats (mustard/canola/peanut for Indian cooking; extra‑virgin olive for salads/low heat). Build meals around high‑fiber carbs and protein: dal/chana/rajma, soy/paneer/tofu, fish/eggs/chicken, vegetables, millets/oats; aim ≥25–30 g fiber/day and ~1–1.2 g protein/kg/day. Lose visceral fat (waist/height ≤0.5), exercise most days (mix cardio + 2–3 days resistance). If LDL remains high, prioritize lowering LDL/ApoB—pattern usually improves as numbers drop.

With a first‑degree relative who has coronary artery disease, tighter LDL control is recommended for their children even in their 30s. A prudent goal is LDL < 70 mg/dL when lifetime risk is elevated; if additional risk factors such as high Lp(a), elevated coronary artery calcium, diabetes, or multiple risk factors are present, aim for LDL < 55 mg/dL. Check a fasting lipid panel and ApoB (goal <65–70 mg/dL, <55 mg/dL if very high risk), measure Lp(a) at least once, monitor blood pressure, and assess waist‑to‑height ratio (<0.5). Begin with lifestyle modification and add lipid‑lowering medication if needed to achieve the targets.

Thanks for asking—family history matters. With a first‑degree relative who has coronary artery disease, the current best approach is tighter LDL control in their children, even in the 30s. - Target: LDL <70 mg/dL is a prudent goal when lifetime risk is elevated (as we’ve been advocating for South Asians and those with family history). If additional risk is present—high Lp(a), elevated CAC, diabetes, or multiple risk factors—aim closer to <55 mg/dL. - “Know your numbers”: check a fasting lipid panel, ApoB (goal <65–70 mg/dL; <55 if very high risk), Lp(a) once in a lifetime, blood pressure, and waist-to-height ratio (<0.5). Use lifestyle first; add medications if needed to reach targets.

Out of the two big culprits LDL is the better one to focus on because you can easily improve it with medications and diet .Even with aggressive diet control you can improve the LDL by 20 to 30% .HDL is usually low in south Asians and is very hard to increase and only aggressive exercise can increase HDL. Some medications may increase a bit (such as Niacin) but have side effects. Walnuts may increase slightly as well

Great Q. Our take is as follows: 1. When possible use natural FOOD sources of protein to increase protein intake to the desired level typically 1-1.2 Gm/Kg per day 2. ⁠If you HAVE to use artificial commercially available protein supplements, try to limit use to minimum reqd to supplement to reach above levels 3. ⁠There have been a bunch of published reports of LEAD in protein powders. We are carefully tracking those 4. ⁠When it comes to comparing protein powders (or comparing other commercial products in the US) Renu and I often look toward the non-biased CONSUMER REPORTS publication 5. ⁠I am attaching a wonderful article published last year by CR that addresses the LEAD concern in detail and compares various protein powders and shakes. Please take the time to review. Protein Powders and Shakes Contain High Levels of Lead [https://www.consumerreports.org/lead/protein-powders-and-shakes-contain-high-levels-of-lead-a4206364640/] Also, a related CR article on the best ones within the supplements: Best Chocolate and Vanilla Protein Powders and Shakes, Based on CR’s Lead Testing [https://www.consumerreports.org/health/supplements/best-chocolate-vanilla-protein-powders-shakes-a7432164344/]

The goal is to keep your TSH around 1.5 to 2 so whatever thyroid medication is needed keep that TSH to improve the LDL

I’m glad he got help and is home. Yes—life can be good and active with stents. The goal of stents is symptom relief and to restore blood flow; long‑term outlook depends more on controlling risk factors and meds than on the number of stents. Key points to expect: 1) medicines are essential (dual antiplatelet therapy for 6–12 months to keep stents open, plus statin, beta‑blocker, ACEi/ARB if indicated), 2) cardiac rehab improves fitness and confidence, 3) lifestyle matters a lot even without prior “BP”—aim BP <130/80, LDL <70 mg/dL (consider <55 if high risk), HbA1c in target, waist-to-height ≤0.5, 150–300 minutes/week activity with some strength work, 4) avoid smoking and keep total salt ~1 tsp/day. Ask his team to clarify: which arteries were treated, whether this was a heart attack vs “silent ischemia,” evidence of residual ischemia (stress imaging, FFR/iFR), and the plan/timing for the remaining lesions. With adherence and rehab, many people return to normal routines, travel, and work, often feeling better than before.

Lp(a) (lipoprotein(a)) is a genetic cardiovascular risk marker. A normal level is under 30; a level near 140 is considered very high. Elevated Lp(a) combined with elevated LDL significantly raises cardiac risk, and many patients are unaware they have high Lp(a) since it's not part of routine testing.

Great question—Lp(a) is an important, inherited risk marker, and it’s good you’re thinking critically about causes and fixes. Straight answer: Lp(a) levels are determined mostly by genes (the LPA gene); they’re not known to rise because of “leaky gut” or gut bacteria. Lp(a) is made in the liver and circulates in blood; it doesn’t “leak in” from the intestine. Gut health matters for many reasons, but current evidence doesn’t show that treating dysbiosis or intestinal permeability lowers Lp(a) or its risk. What to do instead: 1) know your number (once in a lifetime test; high is typically >50 mg/dL or >125 nmol/L), 2) lower overall atherosclerotic risk aggressively—keep LDL/ApoB low (often LDL <70 mg/dL, consider <55 if risk is high), control BP (<130/80), don’t smoke, keep waist-to-height ≤0.5, exercise 150–300 min/week with some vigorous work if safe, and optimize diabetes/insulin resistance, 3) consider tools when indicated: statins for LDL reduction (they don’t lower Lp[a] but cut events), ezetimibe or PCSK9 inhibitors if needed (PCSK9s can reduce Lp[a] ~20–30% and events), 4) emerging Lp(a)-specific drugs (antisense/siRNA) are in late-stage trials but not yet approved, 5) niacin can lower Lp(a) but hasn’t reduced events and has side effects—generally not recommended by guidelines. On the gut: a fiber-rich pattern (vegetables, dal/chana/rajma, nuts, seeds, whole grains/millets, curd/dahi if tolerated) supports a healthier microbiome and lowers LDL/ApoB a bit—good for heart risk even if it doesn’t change Lp(a). Limit ultra-processed foods and excess alcohol. If you have true GI symptoms, celiac/IBD, or frequent antibiotic use, treat those on their own merits. Take-home: 1) no proven “gut fix” cures high Lp(a), 2) focus on driving LDL/ApoB and other risks down, 3) consider PCSK9s if overall risk is high, and 4) keep an eye on forthcoming Lp(a)-targeted therapies.

You’re asking about lipoprotein(a), or Lp(a). It’s a genetically set cholesterol-related particle that raises lifetime risk of heart attack, stroke, and aortic valve disease—often with no symptoms. Key points: - Test once: a blood test (reported in mg/dL or nmol/L); levels are stable from childhood. - High: ≥50 mg/dL (≈125 nmol/L). - Why it matters: adds risk on top of LDL/ApoB, with particular concern in South Asians. - What helps: there’s no reliable lifestyle reducer. Focus on what’s controllable—lower LDL/ApoB (often target <70 mg/dL; consider <55 if very high risk), manage BP, diabetes, weight, and avoid smoking. Statins don’t lower Lp(a) but reduce events; PCSK9 inhibitors lower Lp(a) ~20–30% and cut events. Dedicated Lp(a) drugs are in trials. This is educational, not medical advice.

Great Q…Lp(a) is a risk factor we discuss quite a bit in the docu. It is a risk factor for ischemic heart disease, and over 25% of Indians may have high levels (over 50). Current meds however, have little impact (maybe with exception of some PCKS9 inhibitors)..but a lot of research is under way in this area. I find it very helpful in South Asians in following way: If high: it is a yet another tremendous motivator to change lifestyle (or start statins if LDL is already high Current recs only suggest a SINGLE determination (NO need to repeat) “Extended” Lipid profiles include it, but if done separately can cost around USD 25-50 depending on the lab. In INdia, extended lipid panles inlcude Lp(a) and Apo B There’s another risk to your heart that’s getting new attention [https://wapo.st/4mxWFWE] (more about Lipoprotein(A))

To both of you LPa is a very good test for all South agents to be done at the age of 30 to 40 to find out if you have a higher risk of heart disease. While it does look different in different labs any level above 50 is high and that should motivate you to keep your LDL less than 70 if you are a diabetic and you’re on a statin and your LDL is less than 70 then you do not need to check LPa. We currently have no drugs to lower LPa.

Not really, unless you begin to develop known side effects such as muscle aches. If so few things can be considered: a) Use of Coenzyme Q (Co Q 10) b) supplementing with Vitamin D if levels are low Above two strategies work for some. If side effects remain bothersome, consider switching to a different statin

Thanks for the kind words—great question. Short answer: diet and most standard lifestyle changes do not lower Lp(a) meaningfully. Lp(a) is largely genetic and fairly stable over life. Current best approach is : If Lp(a) is higher lower LDL to less than 55 using statins/ lifestyle. Certain current drugs like PCKS9 inhibitors (Repatha) may help--physician consultation would be very important Several new drugs in pipeline though and likely to come out in the next 12 months!! Stay tuned!

diet and most standard lifestyle changes do not lower Lp(a) meaningfully. Lp(a) is largely genetic and fairly stable over life. Current best approach is : If Lp(a) is higher lower LDL to less than 55 using statins/ lifestyle. Certain current drugs like PCKS9 inhibitors (Repatha) may help--physician consultation would be very important Several new drugs in pipeline though and likely to come out in the next 12 months!! Stay tuned!

Risk prediction using ASCVD risk score is fraught with problems in South Asians because in the original studies not enough of us were represented. The person you describe is EXACTLY the kind of person we advise being aggressive from the preventive standpoint. The high Lp(a), LDL over 100, and pre-diabetes status all strongly predispose to cardiovascular disease. Personally, in addition to overall risk factor modification (wt, diet, exercise etc) I would start statin therapy with an aggressive goal to lower LDL to less than 70 at a minimum.

Yes, magnesium place a significant role in improving cramps. Especially diabetics have low magnesium all the time. taking magnesium 400 to 800 mg can help with cramps. You have to remember that it can cause diarrhea so you have to start slowly magnesium oxide or magnesium glycinate both can work . Magnesium glycinate can also help with sleep specially in postmenopausal woman. It does not do any harm . .

Thanks for asking—here’s the bottom line: a high CAC percentile means you have a higher plaque burden than peers, but being asymptomatic with LDL 48 on statin therapy is exactly the right path. You do not need a stent unless there are symptoms (exertional chest pressure, breathlessness, jaw/arm pain) or objective evidence of significant ischemia on testing. Stents are for symptom relief or clearly high-risk blockages, not for silent calcium scores. The key is aggressive prevention: keep LDL very low (you’re there), control BP, don’t smoke, exercise, and optimize weight/sleep. If there’s any doubt about silent ischemia, a stress test with imaging can clarify, but routine stenting is not indicated in your situation.

With high calcium score and low LDL, it is exactly important to know what actual LDL is and I would like to keep it as low as possible like less than 55

I look at MCT oils ( concentrated derivatives of high saturated fats ) similar to their “parent” oils such as coconut oil. Although short term data exists on mixed lipid results, I continue to worry about long term use of high saturated fat amounts. So our recommendation continues to follow AHA guidelines of restricting saturated fats to less than 7% of caloric intake..

Digging more into this. Unfortunately, no easily available resources are available, but our “Brown Heart” expert Professor of Nutrition is sending me a good resource soon. I will post it when available

Meat can be part of a heart‑healthy diet when the type, portion, and cooking method are chosen wisely. The main upsides are high‑quality protein, iron, vitamin B12, zinc and strong satiety, which can help with weight management and meeting protein needs, especially in diets that rely on legumes. To keep the downsides low, select lean cuts, trim visible fat, and keep portions modest (about 75–100 g cooked) and infrequent (roughly once a week). Prioritize fish and skinless poultry; limit red meat (beef, goat, pork) and avoid processed meats such as bacon, sausages, and deli slices, which are high in sodium and saturated fat. Use moderate‑heat cooking methods—stewing, pressure‑cooking, baking, or low‑heat sautéing—and avoid charring, deep‑frying, or prolonged high‑heat grilling that generate reactive aldehydes, oxidized cholesterol, and other by‑products. Marinating with acid and herbs, using unsaturated oils, and pairing meat with plenty of fiber‑rich vegetables and legumes further reduces risk and supports a healthier gut microbiome. Concerns about TMAO, hormones, and pesticide residues are minimized by choosing reputable sources and proper cooking. Overall cardiovascular risk is driven more by total diet quality, LDL/ApoB levels, central obesity, and fitness than by meat alone, so when these factors are controlled the nutritional benefits of meat can outweigh its potential harms.

6 MEDICATIONS THAT INCIDENTALLY LOWER THE INCIDENCE OF DEMENTIA (from the New York Times yesterday) There is a wonderful article in the New York Times from yesterday that I am summarizing . The article suggests that several common vaccines and medications may be linked with a lower risk of dementia, but the strength of evidence varies. A key caution is that many findings are observational, so researchers are still trying to separate true biological protection from “healthy user bias,” where people who get vaccines or take medications may also have better overall health habits. 1. Flu vaccine: Annual flu vaccination has been associated with lower dementia risk in older adults, with one study showing up to a 40% lower risk. A newer study found that the high-dose flu vaccine for adults 65+ was linked with even lower Alzheimer’s risk than the standard-dose shot. 2. Shingles vaccine: This has some of the strongest evidence. Studies from several countries show about a 15–20% lower dementia risk, and the newer Shingrix vaccine may offer even greater benefit, possibly especially in women. 3. Cholesterol medications / statins: Statins are associated with about a 10–15% lower dementia risk, likely because controlling cholesterol may protect blood vessels and brain health. However, trial results have been mixed, so they are not currently used solely for dementia prevention. 4. Blood pressure medications: Hypertension drugs are also linked with about a 10–15% lower dementia risk. This makes biological sense because high blood pressure is a known dementia risk factor, but researchers are still studying how much benefit comes directly from the medication. 5. Anti-inflammatory drugs: Because inflammation contributes to Alzheimer’s disease, these drugs are biologically plausible, but the evidence is inconsistent. Some studies suggest benefit with ibuprofen, while others show no benefit or possible harm; a Cochrane review found no evidence to support aspirin or NSAIDs for dementia prevention. 6. Diabetes drugs: Metformin and SGLT2 inhibitors may modestly lower dementia risk, likely through better blood sugar and insulin control. GLP-1 drugs initially looked promising in observational studies, but recent trials of oral semaglutide did not slow cognitive decline in Alzheimer’s patients, so more research is needed.

Low‑dose melatonin (0.5–1 mg, up to 3 mg if needed) is generally safe, non‑addictive, and can be used to shift your circadian phase. Possible side effects include morning grogginess, vivid dreams, headache, or nausea, and it may interact with blood thinners, diabetes or seizure medications. For a sleep‑maintenance problem like waking at 3–4 am, take melatonin 30–60 minutes before your desired bedtime, or try a very low dose (≈0.5 mg) 6–8 hours before the usual 3:30 am awakening to advance your sleep window. In addition to melatonin, follow these sleep‑hygiene steps: * Keep a consistent wake‑time each day, even after a poor night, and aim for 7 hours of consolidated sleep. * Expose yourself to bright natural light for 20–30 minutes soon after waking; avoid bright screens after 9 pm. * Restrict bedtime to match your true sleep need (e.g., if you currently sleep 10:30 pm–3:30 am and 6:00–6:30 am, consider moving bedtime to about 11:00 pm and maintaining a 6:00–6:30 am wake‑time). * If you are awake for more than 15–20 minutes, get out of bed, dim the lights, and engage in a quiet activity until sleepy. * Limit caffeine (no later than noon or, at the latest, 2 pm) and avoid alcohol at night. * Finish dinner at least 3 hours before bedtime. * Use a brief relaxation technique at the time of the awakening (e.g., 4‑7‑8 breathing, body‑scan, or a short “brain‑dump” journal) and avoid looking at the clock or screens. * Consider an evening dose of magnesium glycinate 200–400 mg if tolerated. If awakenings persist beyond 4–6 weeks despite these measures, consider a structured CBT‑I program (e.g., Sleepio or CBT‑I Coach). Seek medical evaluation if you have snoring, reflux, pain, nocturia, untreated sleep apnea, thyroid problems, depression, anxiety, or are taking medications such as beta‑blockers that can affect sleep.

Hi Vini , thank you for a great question. This is the story of my life and has been very well addressed in the documentary. There’s clear evidence from multiple studies ( SWAN and others that there is an increase in LDL and apo Lipo protein B right around peri menopause, and after menopause. This is attributed to a decrease in estrogen which improves the LDL clearance from the liver. It is also attributed to an average of 10 to 15 pound weight gain primarily visceral around the abdomen, which is associated with high LDL.

The first thing you need to see is how high your cholesterol and the blood pressures. You need to improve them in normal Range whether it is taking medication for short term for controlling both problems. At the same time you should start your lifestyle and diet again, but in moderation, the extremes for wt loss is usually not successful because the rebound happens quickly. The first thing to start is you calculate your total daily energy expenditure and decrease the calories by 300 to 500 and start exercise program 150 minutes a week in zone two. You should aim for a slow and study weight loss and make the lifestyle changes which you will adhere to in long-term . Some diet part we will cover in the webinar as well. Hope that will help. one more thing. We learnt and talked about SAHC in the documentary. This is a virtual program where they work on diet, exercise, meditation and sleep with a coach for 1 yr. Their goal is to prevent cardiac disease in SA population. You might want to connect with them . Anyone who is interested can check them out . South Asian Heart Center .

There is no reliable scientific evidence that putting pieces of iron, silver, or gold in water or cooking vessels provides health benefits, and doing so can carry risks. Iron: Traditional "iron fish" or similar iron objects can increase iron content in boiling water or acidic soups, but the amount of iron released is unpredictable and may lead to excess iron intake or contamination. Iron deficiency should be treated with proven methods such as iron‑rich foods or prescribed supplements, guided by laboratory testing. Silver: Silver is not an essential nutrient. Colloidal or ionic silver can accumulate in the body, interfere with medications, and is discouraged by health agencies (e.g., FDA, WHO). Silver vessels may leach minute amounts of silver, but this offers no proven health advantage. Gold: Gold is not a human nutrient. Edible gold is inert and provides no therapeutic effect. Overall, safer alternatives for cooking and drinking include food‑grade stainless steel, cast iron (which can modestly add iron during acidic cooking), or glass. Meet micronutrient needs through a balanced diet and medically indicated supplements rather than by adding metals to water or cookware.

The Brita is supposed to remove the heavy metals and improves taste , but it actually does not decrease the micro plastics. In fact, both the filter and the plastic container can release micro plastics. There are better alternatives for filtration like the one which you can use under the sink or over the sink. There are also Life straw glass filters .And the filters available by Culligan . They remove not only the metal but also do not release the micro plastics. Hope that helps.

Currently no established method to do…..Best approach is to reduce exposure by reasonable means but not “go crazy” about it. Other methods known to reduce exposure that seem reaonable: Do not microwave food in plastic, including containers labeled microwave-safe. Avoid pouring boiling liquids or very hot food into plastic. Store and reheat food in glass, ceramic or stainless steel. Replace scratched, cloudy or worn plastic containers and cutting boards. Avoid repeatedly reusing disposable plastic water bottles. Use safe tap water when available; bottled water can contain more particles than tap water.

coffee filters do release some micro plastics as well because they’re not completely paper and they have some plastic like polyethylene. But they are much less of a magnitude than the plastic teabags.

They definitely release more micro plastics than the water coming out from the glass jug. Plastic bags also release, micro plastics, but if you don’t store food in them for a long time or definitely don’t heat food then the micro plastics are much lower One other interesting thing is that if you use the thin containers which are disposable, they release more micro plastics then the reusable thick containers. They release much lower dose of micro plastics so if you have to store food, use the thick ones and not thin ones.

yes the teabags do release micro plastic in a significant amount. The studies however, are inconsistent as to how much release. Also different type of teabags which releases less micro plastics. In fact, the premium brand teabags which have the pyramid kind of teabags release the most. Lipton and tetley come into a second category., Where the company says It is cellulose pack , but they still have some micro plastics. A truly paper teabags will not release any, but those are hard to find. So maybe lose leaf tea is a better way to go.

Avoid microwaving food or adding very hot food or drinks to plastic containers. Use glass, ceramic, or stainless steel for hot items; replace scratched plastic containers and cutting boards; reduce unnecessary single-use plastics; ventilate and wet-dust your home; and use safe tap water when local water quality is reliable, since bottled water is not automatically safer.

The strongest human observational evidence concerns cardiovascular disease: microplastics identified in arterial plaques have been associated with higher rates of heart attack, stroke, and death. This association does not prove that microplastics directly caused those outcomes.

Microplastics are plastic particles smaller than 5 mm; even smaller particles are called nanoplastics. They are present in food, drinking water, household dust, and air.

No. Microplastics are a genuine emerging concern, but the evidence is still developing. Focus on practical exposure reduction without panic, expensive testing, supplements, or “detox” treatments.

This is the category of high to low release of micro plastics in plastic containers. 1. Highest release of micro plastics is with microwaving 2. putting hot food in the plastic containers. 3. Storing on room temperature for long duration of time 4. Storing the refrigerated food but again if it is stored for long amount of time it releases, micro plastics. 5. ⁠putting in freezer releases, less micro plastics, but then if you warm it and thaw, then it releases a lot more. Hope that helps.

storing rice, and Dal in containers actually has the least risk of releasing micro plastics because of the lack of acidity , fat, and moisture. Also washing the grains and the Dal significantly takes the micro plastics away, so you’re safe by storing them into containers

Many studies are small and observational, methods for measuring microplastics are not standardized, sample contamination can occur, and researchers have not established a safe exposure level.

Early studies suggest possible associations with poorer sperm quality, intestinal inflammation, and adverse pregnancy outcomes. More rigorous research is needed before drawing firm conclusions.

Laboratory studies suggest these particles can promote inflammation, oxidative stress, and cell injury. These findings raise concern, but laboratory results do not by themselves show the size of health effects in everyday human exposure.

There is currently no convincing proof that microplastics directly cause these conditions. Claims that they have been definitively shown to do so go beyond the available evidence.

Yes. Researchers have detected them in human blood, lungs, arteries, placenta, reproductive tissues, and brain. Detection alone does not establish that they cause disease.

Microwaving frozen phulkas/rotis tightly wrapped in cling film is not the best practice—especially when the plastic is touching the food. USDA guidance says microwave-safe plastic wrap may be used as a loose cover, but it should not touch the food during microwaving. It should also be vented so steam can escape. “Microwave-safe” means the product is suitable for that intended use; it does not mean that absolutely no chemicals or microscopic particles can migrate during heating. With frozen rotis, the cling wrap is tightly pressed against the surface. As the roti heats, steam and hot spots develop directly against the plastic. Heating plastics can increase migration of plastic components, and experimental studies of plastic food packaging have found greater migration during microwave heating. The long-term clinical significance of this exposure is uncertain, but it is easily avoidable.

There isn’t a single “brain health check” doctors do at a set age. The key is to assess and treat the risk factors that drive cognitive decline (especially in South Asians): vascular risks (blood pressure, LDL/ApoB, diabetes risk), sleep, depression, thyroid, hearing, and physical inactivity. At 52 with prediabetes, BMI 30, hypothyroidism, central fat, and a family history of dementia, it’s very reasonable to ask for a focused midlife brain-risk review, that includes a basic mini-mental status exam and a careful assessment of the risk facors noted above --most of whichyou may already have had (A1c, lipids, Lp(a) , thyroid, sleep assessment etc.) and make sure treat what can be treated.

Thanks for asking—there’s a lot of confusion here. Short answer: there’s no scientific evidence that milk + fruit is a harmful “incompatible” combination. Smoothies with milk or dahi/curd and fruit are generally safe and nutritious. The key is how your gut handles lactose, fiber, and acidity. A few practical points: ripe acidic fruits (citrus, pineapple) can curdle milk—this looks unappetizing but isn’t dangerous; if it bothers your stomach, use yogurt/curd or kefir instead (the cultures help digestion). If you’re lactose intolerant, choose lactose‑free milk, yogurt, or soy/almond milk. For better blood sugar control (important in South Asians), add protein (Greek yogurt, milk, tofu) and fiber (chia, flax, nuts) and keep portions modest. Avoid adding sugar, honey, or syrups.

Millets are higher in fiber (and protein) and therefore raise blood sugar more gradually than white rice. They therefore have a lower glycemic index and are known to have a beneficial effect on blood sugar control compared to rice.

Thanks for asking—clear answer: mixing dals is healthy and safe for most people. There’s no scientific evidence that combining different lentils “confuses” digestion or creates toxins. In fact, mixed dals can improve protein quality (more complete amino acid profile), add fiber and minerals, and taste great. Indian households have long used mixed dal, khichdi, sambar, and chana–moong blends without harm. That said, some folks do get gas/bloating from legumes (such as what you’re describing). The key is how you cook and portion: soak well (6–8 hours), rinse, cook until soft (pressure cooker helps), use hing/jeera/ginger, start with smaller servings, and increase gradually. If one dal troubles you, use gentler ones (moong, masoor) or try sprouted.

Research data on mushroom coffee is limited. Most of the studies in humans are of small size. It definitely has less caffeine, almost half of regular coffee and it does have some antioxidant properties and may lower CRP in some patients. No Major impact on Cholesterol and heart disease. It has no major effect on bloating, but some coffee ingredients have probiotics which might help digestion. However in other papers, It has actually shown to increase bloating. Also for menopause there is a very minimal amount of phyto estrogens which may improve some menopausal symptoms. So overall less caffeine then regular coffee, so it may help sleep. Data on bloating is equivocal.

An evidence-based summary Bottom line: Mustard oil is not all bad, neither is it a magic heart-protective oil. It has some real advantages: low saturated fat, high monounsaturated fat, and a meaningful amount of plant omega-3 called alpha-linolenic acid, or ALA. But traditional mustard oil can also be high in erucic acid, which is the reason it remains controversial internationally. The good Mustard oil has a favorable fat profile compared with ghee, butter, coconut oil, and palm oil. It is relatively low in saturated fat and contains more unsaturated fats, including MUFA and ALA omega-3. That matters because replacing saturated fat with unsaturated fats generally improves LDL-related heart risk. There is also Indian observational evidence suggesting benefit. A major case-control study in India found that people using mustard oil for cooking had a lower risk of ischemic heart disease compared with sunflower oil users; the reported relative risk was about 0.49 for cooking use. But this was observational, so it shows association, not proof. A randomized Indian trial in patients with suspected acute myocardial infarction reported that mustard oil and fish oil groups had fewer cardiac events, possibly related to omega-3 fatty acids and reduced oxidative stress. This is interesting, but it should not be treated as definitive modern evidence that mustard oil prevents heart attacks. The bad The controversy is erucic acid. Traditional Indian mustard oil can contain high erucic acid, and animal studies link high erucic acid exposure to myocardial lipidosis, a fat accumulation in heart muscle. EFSA notes this effect in animals and established a tolerable daily intake; it also says the effect appears temporary and reversible in animal models. A 2022 review summarized the controversy well: limited evidence shows high-erucic-acid mustard oil causes cardiac lipidosis in rats, but the human cardiovascular effects remain unclear; the authors called for better prospective studies and randomized trials. The U.S. FDA does not allow expressed mustard oil to be sold as edible cooking oil because of erucic acid concerns, which is why many bottles in the U.S. are labeled “for external use only.” However, other jurisdictions allow limited erucic acid exposure, and India permits mustard oil under its own food standards. Everything in between Mustard oil’s sharp flavor comes partly from compounds such as allyl isothiocyanate, which may have antimicrobial and biologic effects. But many “anti-cancer,” “detox,” or “miracle heart oil” claims go far beyond human evidence. Also remember: all oils are calorie-dense. One tablespoon of oil is roughly 120 calories, whether it is mustard, olive, avocado, sesame, or groundnut oil So the biggest problem in many Indian diets is not just which oil — it is how much oil, repeated frying, pakoras, pooris, namkeen, restaurant food, and ultra-processed snacks. PRACTICAL RECOMMENDATIONS REGARDING MUSTARD OIL If you DO use it (In the US it is not available for oral use, but Indian stores do make it available-typically labeled for external use) use mustard oil as one of several oils, not as your only oil and not in unlimited quantity. For Indian cooking, a reasonable approach is to rotate or combine with oils like canola or olive oil, depending on dish and cooking method. Avoid reusing oil for deep frying. Overall, most things mentioned in the article are true. That being said, for the vast majority of the population it remains an excellent test to assess blood sugar control over a 3 month period. Almost no test is perfect, and A1c is no exception

If you look at our seminar, the mustard oil properties are listed there. Unfortunately, it has a specific compound more than 80%, which is banned across all USA and UK because there is some animal data that is causes Hardening of arteries . If you want to use it occasionally that’s fine but I would not recommend on a daily basis.

There is some data on this from SMALL studies demonstrating improved lipid profiles, and also other benefits such as mild BP reductions and also antithrombotic activity. However, well done, large randomized controlled trials demonstrating clear efficacy are lacking. A few take home messages: 1) Data is not clear enough to recommend regular use 2) It may have effects on the coagulation pathways resulting in increased bleeding risk 3) It may interact with medications, particularly blood thinners, with potential resulting side effects. Overall: wait for more data On the second part of the question: STATINS AND SOUTH ASIANS: 1. Statins, particularly Rosuvastatin, may actually work somewhat MORE in South Asians. So it is recommended to start LOW in South asians (recommended starting dose for Rosu is 5 mg in South Asians) 2. ⁠ STATINS SOMEWHAT LESS LIKELY TO CAUSE NUISANCE SIDE EFFECTS SUCH AS MUSCLE ACHES: Rosuvastatin (Most effective and potent in lowering LDL cholesterol) and Pravastatin (less effective but also less chances of muscle side effects)

Hi Kumu, NO massaging your neck (or any area) with sesame oil or other oils does not loosen arterial plaque or make it “travel.” Atherosclerotic plaque sits inside the artery wall, under a fibrous cap, and is not affected by rubbing the skin or muscles above it. Massage works on skin, fascia, and muscle—not inside blood vessels—so it won’t trigger a stroke. However, avoid deep, vigorous pressure directly over the carotid artery if you’re older or have known vascular disease, because pressing hard can briefly drop heart rate/blood pressure or rarely dislodge an existing clot after a procedure; gentle massage is fine.

Remember the injectable form of this same drug has been used and available for many years (I have myself been on for over 8 years now)—very favorable side effect profile. so it is now just come as oral medication so the safety profile is no different so there’s no reason to wait one year either way depending on individual detail…. REMINDER: Statins have known ANTI-INFLAMMATORY effects (we recently put out reel on that)….that this class is now known to have…. I know….class is same…So far what is known: mild side effects—about 9% risk of some dizziness (compared to 4% for placebo) and 7% risk of some diarrhea (compared to 2% with placebo) Of importance, at least for now, the muscle side effects so bothersome with statins have not been reported

Learnings: 1. Salad and Fiber is an amazing “immunizer” against blood sugar spikes 2. ⁠Stress causes rapid sugar spikes 3. ⁠Even small amount of carbs (white bread) will cause sugar spikes that are worse than even a full balanced meal Disclaimer/ Caveat: Rapid sugar spikes in blood are only ONE lens to look through. Total calories are obviously also very important

Non‑statin agents can lower LDL cholesterol substantially and, for several of them, reduce cardiovascular events, but statins remain first‑line because they have the most robust, long‑term outcome data and are inexpensive. The main non‑statin classes are: 1. Ezetimibe oral tablet that blocks intestinal cholesterol absorption; adds about a 15‑25% LDL reduction and has proven event‑reduction benefit when added to a statin or used alone in statin‑intolerant patients. 2. PCSK9 inhibitors (alirocumab, evolocumab) subcutaneous injections every 24 weeks; produce large LDL drops (≈50‑60%) and have strong outcome data; used when LDL goals are not met with statins or when statin intolerance exists; cost is higher. 3. Inclisiran small interfering RNA (siRNA) therapy given on day 0, at 3 months, then every 6 months; yields LDL reductions similar to PCSK9 antibodies; outcomes trial results are pending. 4. Bempedoic acid oral pro‑drug activated in the liver; useful in statin‑intolerant patients; modest LDL lowering (≈15‑20%) and recent trials show cardiovascular benefit. 5. Icosapent ethyl omega‑3 fatty‑acid formulation that lowers triglycerides and addresses residual risk but does not significantly lower LDL. In practice, clinicians tailor therapy to achieve a low LDL/ApoB target, balancing efficacy, side‑effect profile, cost, and patient preference. Non‑statin options are effective alternatives, especially for those who cannot tolerate statins or need additional LDL lowering beyond what statins provide.

Final word on nonstick is to try to minimize the use and replace as soon as there is any sign of wear and tear, use with low heat, cooking only and avoid high heat to minimize the release of toxic gases from the nonstick coating. Best to use glass in the microwave and avoid heating in plastic containers.

Both homemade paneer and plain packaged paneer fall into the same NOVA category (Group 3: processed foods), because paneer is made by adding an acid to milk to curdle it, then pressing—an intentional processing step that changes the original food. Exceptions: if a packaged paneer has added flavors, preservatives, colors, or lots of added fats/starches, it could edge toward Group 4 (ultra‑processed). If it’s just milk + acid (and maybe salt), homemade vs packaged is the same NOVA group; differences then come down to freshness, texture, sodium, and hygiene rather than processing category.

Thanks for asking—totally reasonable to be curious here. Obicetrapib is a CETP inhibitor (same drug class as anacetrapib/evacetrapib), aimed at lowering LDL and ApoB. It’s still investigational in the US and not available for routine prescribing. Phase 2/early phase 3 studies showed substantial LDL and ApoB reductions on top of statins, and a large cardiovascular outcomes trial (BROOKLYN/ROSE/TRIAD programs; key one is PREVAIL) is ongoing. Prior CETP drugs had mixed or negative outcome results despite lipid changes, so regulators will wait for clear event‑reduction data. For now, proven options to drive risk down remain statins, ezetimibe, PCSK9 inhibitors, and lifestyle, especially if LDL/ApoB targets aren’t met.

1.⁠ ⁠Does OSA contribute to heart disease? Absolutely yes. It is an important risk factor (although associated with several confounders such as high BMI and other co-morbidities)….However direct mechanisms contribute to a high risk of ischemic heart disease among people with OSA: a) Each episode of apnea leads to adrenergic hormone release which increases BP and has direct adverse effects on blood vessels (inflammation similar to that caused by inflammatory foods etc) b) OSA can cause direct disruption in cardiac function by changing normal fluctuations in HR and BP 2.⁠ ⁠Does OSA happen more often in South Asians (unrelated to confounders) is a more open question with conflicting studies from the US and UK, some showing an increased incidence and others refuting such an increased incidence.

1. Oil intake has NO direct effect on joint health 2. ⁠If anything, overuse can increase caloric intake and increase weight—which would indirectly worsen joint health

EPA/DHA (fish‑derived) have the strongest evidence. High‑dose pure EPA (icosapent ethyl 4 g/day) lowered events in high‑risk patients with elevated triglycerides despite statins. However, mixed EPA+DHA capsules haven’t consistently reduced events, and over‑the‑counter doses (1 g/day) are unlikely to help the heart. If triglycerides are ≥150–200 mg/dL after lifestyle and statin, discuss prescription‑grade EPA (icosapent ethyl) rather than OTC . If you prefer vegan, a higher‑dose algal EPA/DHA (around 1–2 g/day combined) is reasonable for triglyceride lowering, recognizing outcomes evidence is weaker. If triglycerides are normal, focus on diet quality: daily ALA foods, fiber (chana/rajma, millets/atta blends), and keep LDL targets tight (often <55–70 mg/dL in established ASCVD).

Thanks for asking. Bottom line: organic and regular (conventional) milk have similar nutrients (protein, calcium, vitamin D if fortified). The key differences are farming practices, not core nutrition. - What “organic” means: cows are fed organic feed, no routine antibiotics or synthetic growth hormones, and more pasture access. Residual antibiotic/hormone levels in regular milk are already regulated to be negligible; both are tested for safety. - Fat profile: small studies show slightly more omega‑3s in organic whole milk, but the difference is modest and shrinks if you drink low‑fat/skim. - Taste/cost/shelf life: organic may taste different and often costs more; both are pasteurized and safe. Health-wise, choose the type you’ll drink consistently; prioritize low‑fat (1%/toned) to limit saturated fat, especially for heart risk.

Panchamrit (a mixture of milk, curd, honey, ghee, and sugar) is a traditional prasadam, not a medicinal product. Common myths include the belief that it detoxifies the body, boosts immunity, or cures disease. Scientific evidence does not support these claims; the mixture provides basic nutrition—protein, calcium, probiotics, antioxidants, fat‑soluble vitamins, and quick energy—but no proven therapeutic effect beyond that. It is safe in small portions for most people, but individuals with diabetes, high triglycerides, lactose intolerance, or cholesterol concerns should limit intake. Raw honey should not be given to infants under one year due to the risk of botulism, and clean preparation is essential to avoid contamination. Enjoy Panchamrit as a cultural offering, not as a health tonic.

there are no large, peer‑reviewed human outcome trials yet, and real‑world questions remain (delivery to the liver, durability, off‑target effects, immune reactions, cost). So, this is promising but experimental. Current best approach for high LDL—especially in South Asians—is proven therapy: lifestyle + statins as foundation, adding ezetimibe or approved PCSK9 inhibitors if needed to reach targets.

Here’s the quick, practical view. Indications (when to consider adding a PCSK9 inhibitor like evolocumab or alirocumab): - Established ASCVD (prior MI, stroke, PAD) on maximally tolerated statin ± ezetimibe but LDL-C still above goal (generally ≥70 mg/dL; some clinicians use ≥55 mg/dL for very‑high risk per ESC). - Familial hypercholesterolemia (HeFH or HoFH) with high LDL-C despite statin ± ezetimibe, or true statin intolerance with persistently high LDL-C. - Statin intolerance with high ASCVD risk and LDL-C not at goal despite ezetimibe. - Post–acute coronary syndrome needing rapid LDL lowering (add to statin per guideline pathways). - Lp(a) is not an approved indication alone, though PCSK9 inhibitors lower Lp(a) ~20–30%; may sway decisions in very‑high risk patients with high Lp(a) when LDL also needs lowering. Contraindications and key cautions: - Absolute: prior serious hypersensitivity to the drug or its excipients. - Relative/precautions: pregnancy/breastfeeding (limited data—generally avoid), severe hepatic impairment (limited data), children except specialist‑guided FH use, and injection‑site reactions or eosinophilia history with biologics. - Drug interactions: none significant (monoclonal antibodies). However, monitor if used with other potent LDL‑lowering agents for very low LDL; current data show very low LDL is generally safe. - Practical: high cost and need for prior authorization; adherence to injection schedule (every 2 or 4 weeks). Effect sizes and targets: - LDL-C reduction ~50–60% on top of statin; ASCVD event reduction in high‑risk patients (FOURIER, ODYSSEY OUTCOMES). - Typical goals: LDL-C <70 mg/dL for ASCVD; <55 mg/dL for very‑high risk; non‑HDL <100 or <85 mg/dL respectively.

Hi currently there are no plant based medicines for thyroid. The only natural supplement some people use is Ashwagandha. There is very marginal data in very small studies about its efficacy. My full video thyroid is available on YouTube.

There are several studies now available comparing the different plant based milk like almond ,oat ,rice and Soy milk comparing with cow milk. I did not find a whole lot of data with buffalo milk. The interesting findings are that cow milk and soya milk are the only one that contain > 3% protein and all the other milk had < 1% protein despite fortification. Also the other nutrient like vitamin B12 vitamin B six and some other micro nutrients were much lower. The calories are much lower in all plant base milk. So if you clearly have dairy allergy these are good substitutes, but we really do not have long-term data on what kind of nutritional deficiencies might occur by using plant-based milks overall . Hope that helps .

Unfortunately, no!

Another Pandora box. Yes there is some micro plastic release from the dishwasher as well as the dishwasher / laundry soap packets because they’re plastic so you potentially can use liquid soap. But that micro plastics release increase significantly if you wash plastic containers in the dishwasher. Also using a smaller cycle and low heat cycles both for dishwasher and laundry can help.