Public Health measures have merit variously for different diseases. In my book, Stone Agers in the Wrong Lane, the origin, evolution of CHD and other degenerative diseases I used the acronym, NERSH to represent nutrition, energy, exercise, respiration, reproduction, sanitation, shelter and water as basics for animal survival, and reproduction, including us. We, homosapiens have devised systems to effect this, that require education and work, NERSHEW. To say other species don’t I believe is a fallacy. Most animal species teach their young to identify and collect nutrition, survive?Others innately do so as if programmed!
In my series of blogs on Coronary Heart Disease, I have tried to make the case that CHD and a stall of other diseases, are self served food born diseases, that have arisen because of our faulty decision making. We have progressively replaced nutrition with energy alone via processed CHO, which includes sugar. We have added toxins alcohol and tabacco and a constellation of others in everyday life. Public health measures have historically been aimed at tabacco, alcohol, and now overweight-obesity (OWOB). The other was saturated fat, animal fat, cholesterol, the largest, longest lasting, faulty, unproven nutrition ‘CON’ ever.The latter’CON’, has ‘cost’ our species in morbidity and mortality staggeringly over seven decades. The medical interpretation of different fractions of cholesterol lipids in blood, their relation to diet, was a shambles and there was too much ‘rank pulling’ and what appeared to be ‘fraud’ in some academic quarters.My impression was perfectly good studies and evidence were, dismissed or ignored.The story of saturated fat and cholesterol is a century old and as dramatic, complicated, full of intrigue, ego’s as a pre-Lenin Russian novel. Interesting that a member of the late Tsar’s medical team published the presence of atheroma like lesions, in chickens(herbivores) fed animal fat and cholesterol. Its a shame he did not do the same to rats he had in his laboratory(carnivores), as subsequent studies have shown, the rat does not produce atheroma lesions in this nutrition context!!
Medical practitioners had the task of advising their patients, that all these items of oral-gustatory pleasure were verboten and try and make biological sense of the tsunamis of advise about serum lipids after each new study was published.Medical practitioners and patients became confused and sceptical. Within areas of medicine there was increasing intolerance of past dogma and weak recent, at times un-interpretable data.
I have made the case that the template for our degenerative diseases with CHD, commenced with the conversion to Neolithic type nutrition, where seed CHO was increasingly consumed, removed from the husk. The change, the loss, extent of the variety and number of micronutrients was marked, believed to have plummeted from 2-500 species to a handful.Protein consumption fell, contrary to theory. Atomic, biochemical analysis of Neolithic homosapiens skeletons, confirmed the nutritional changes and deficiencies. Apart from skeletal shortening, the cranium and brain size shrank too! This was a major metabolic change and demand on all organ systems.This pattern of nutrition continued through the last century and has had sucrose sugar added in increasing quantities.In the last 30-40 years high fructose corn syrup has been included in processed foods and beverages.
As the consumption of CHO grew in its various forms through the century, CHD and its risk factors accompanied it. Animal fat and saturated fat consumption has remained near flat in the US for the entire century. OWOB, DM, hypertension, and metabolic syndrome thrived in this Capitalist society where ‘greed’ and ‘growth’ was supposed to be good for you. Sorry, got that very wrong. If it is any compensation the Communist Countries of the Soviet Union and Eastern Europe had disgraceful morbidity and mortality figures for all the Degenerative diseases, over the same period. In the 1970’s-80’s the average male life expectancy in Russia was 46 years. Did Russia recognise it was losing the ‘cold war’ by attrition, malnutrition and if it continued as such, would have depleted its male population of essential services. Women were not afflicted to the same extent.
Politicians, commerce, finance, law and the various ‘autocracies’that determine largely what you can do in our society have no concept of the vagaries and unpredictability of biological systems in medicine.I have watched them, been on the receiving end for 50 years, its frightening.Here is some simple figures for the US. 31-32% of adults die of CHD annually. 67-75% adults are OWOB.30% of OWOBS are ‘prediabetic’. 9-11% adults are Diabetic. 85-90% of adult diabetics die of CHD. Currently 37% of US adults smoke tabacco. Tabacco contributes to CVD, and chronic pulmonary disease as well as one common lung cancer. 30% US adults have pre-hypertension and 33% have treated hypertension.
Imagine the management by the primary physician, general practitioner of these patients.These pathologies tend to be treated from middle age on, as patients who smoke, drink too much alcohol, have little activity, are OWOB’s, pre-diabetic, diabetic, have CVD, hypertension, CORD, perhaps mild renal failure and a high percentage the metabolic syndrome, which includes a lipid abnormality. These are the people you see on your Main St., who believe they are ‘healthy’, who are told they are and will live longer.This is a punch bowl of pathology to handle for the doctor, in a continuous dynamic state, all self inflicted.Well today the doctor has several new aids that can be measured in blood. Most if not all of these patients will have evidence of CHO Dyslipidemia, with insulin resistance and Microalbumin in their urine. These three pathologies can be monitored, they have strong associations with CVD,CHD and premature death,while the treatment program is progressed.CHO Dyslipidemia is the source of small dense LDL that is found in vascular atheroma, the basis of CVD and CHD.Microalbumin in the urine is associated with CHD and we speculate that damage of the endothelium with inflammation and raised insulin levels may be responsible.
A quick glance at this tangle of risk for CHD, it is apparent individual risk factors as they collect other risk factors, worsen the prognosis for the individual and the incidence of CVD and CHD.The metabolic syndrome is an example. There is no linear progression of these risk factors, as any clinician will be aware of. In my professional experience if you have a risk factor, your doctor needs to be given the opportunity to find other risk factors now or in the near future. A risk factor lays the template for your premature demise. You are not ‘healthy’ with risk factors and risk factors do not make you live longer!
Public health measures to reduce or eliminate the consumption of tabacco, alcohol, in different societies, cultures has had patchy success. The ‘deadly’diseases, the planets leading cause of death, CHD with CVD are rarely driven by a single risk factor. But I have tried to make the case that processed CHO with sugar and its myriad of processed manufactured products, lumped together physico-chemically as processed CHO, is our most potent and extensive consumed risk factor.
Dr.Lindsay.A.Green. FRACP. FCSANZ.