Welcome to Freshly Forever, a podcast that gives you fascinating insights week after week. Here's your host, vaikumar. Dr Akhil Tahir is an experienced physician who, until 2009, in his words, believed that heart disease won't happen to me. To quote him, he is now a resurgent physician. Further to a bypass surgery at the age of 61, and he recovered from it remarkably is now a septuagenarian athlete, a heart-healthy speaker, holistic health and wellness consumer and a big proponent of whole food, plant-based diet. We had the pleasure of talking to Dr Tahir in season two of this podcast in a two-part episode on heart health. Here are some nuggets from that conversation on the cultural impact of heart disease. Let's take a listen. Is heart health compromised more in certain cultures than others? You think?

Absolutely. You hit the nail on the head. We South Asians when I say South Asians, we mean people mainly from India, pakistan, nepal, sri Lanka, as far as Bhutan and Maldives we are all South Asians. We are 25% of the world's population. Roughly, we carry 60% of the world's heart disease. Oh, no, yes, in India, from 2000 to 2019, our disease increased double for heart disease.

Now what has happened? Even in the United States, we are four times more likely to get heart disease than other ethnic groups like the Japanese, koreans or Chinese. We are getting our heart disease at a younger age 25% are getting it before they reach the age of 40, and 50% are getting it before they reach the age of 40 and 50% are getting it before they reach the age of 55. Therefore, the American Heart Association says that being of South Asian descent is an independent risk factor for heart disease.

Now, when we go a little bit more into depth, why and what is being done? We are a small community compared to the whites and the blacks, so what happens is we do not have too much of research facilities. We don't have the money for that, but there is a study which is called the Masala Study, that is, the mediators of South Asians living in America and what they found was, when they did a study with 40, between the ages about 1,100 people I don't know why they took this number, 1,100, between the ages of 40 and 84,. What they found was that people of South Asian descent do not appear obese according to the Western terminology, but they carry fat. They carry fat in their abdomen.

So it is called visceral obesity. This visceral obesity is where fat is deposited into your muscles, in your liver and around the heart. The subcutaneous fat just below the skin is perfectly okay, but this fat which is there? So if we go by body mass index according to the Western term, we will have a problem. We will not be able to. We will be slipping through the cracks, mm-hmm. So my point first is that according to the body mass index, it's 25. Up to 25 is normal. We should keep it as 23. Our obesity as South Asians should be 28, not 30 and above. Do an abdominal girth and you will find that 35 is supposed to be normal in males and 30 is normal in females. 35 is supposed to be normal in males and 30 is normal in females. I would go lower for South Asians 32 for 33 for males and 28 for females. But we do carry fat. My body mass index when I had my heart disease was only 22. And I was carrying a pouch. So that is the first thing.

What are the other things that we South Asians have? We're insulin resistant. When people hear this thing insulin resistant I tell them very simply a lay person is that when you get sugar in your blood. The insulin carries the sugar to the cells and it is used as energy. But if your cell is deposited with fat, then it comes back into the blood and you get your blood sugar rise and therefore you get pre-diabetic and diabetic. Third thing we, for some reason and we are studying on this calcium is very much more deposited in our coronaries. Number four our coronaries are very small compared to others and we have got larger lesions in our coronaries are very small compared to others and we have got larger lesions in our coronaries. We've got multiple vessel disease and we've got tight stenosis. When we have that blockage, and then independent risk factors are like spilling protein in the urine, which is more so in our women. Our women, they are more likely to get gestational diabetes as opposed to other women. And finally, your age group is different. But my age group, the first generation of Indians of my age group, we did not know how to spell exercise and so we were all sedentary slobs or couch potatoes, including myself.

So, oh, and then our food habits. Think about our food habits. We have mostly saturated fats, oils, processed food, sugars, refined foods. All this is that you know something, why they've got a connection with oil. You've got a cultural connection with oil. You've got a cultural connection with oil. If, in my family or otherwise, if we don't use oil means that you're doing, you're showing generosity to a person in our culture, which is wrong. It's a sign of warmth. If you have a pot of curry on your dining table and if you want floating of oil oil like the Valdi slick that means you're not being just as to your yes, and this oil is absolutely new to the new Newton, you know. So the idea is that this cultural connection to oil is so deeply ingrained into it that I have seen people use the oil again and again. The same oil back in India I've seen this is that oil again and again. At very high temperatures it becomes those meat products or things like this, secret chemicals that become cancerous, carcinogenic do you think this happens only to South Asians?

or what about the standard American diet? And what about other Western cultures? And what about people, say, in the Mediterranean region? So how do the other cultural folks succumb to heart disease, even when that happens in those cultures?

The standard American diet is very aptly called the SAD diet Meat, eggs, dairy sugar. Now this is the worst diet. But my point is this why is it that 80% of Indians are vegetarians 75 to 80%. Why are we the heart disease capital of the world? It's because of our dairy saturated fat and cholesterol isn't there? Because of our overuse of oil and butter and ghee. Do you know that ghee has now? Just two weeks back I was doing some studies and it said that ghee has got where you have oxidized cholesterol, which is terrible, worse than the regular cholesterol. Tenfold increase in oxidized cholesterol if you use ghee. But then comes the question is so many talks have gone around and people have asked me that, look, is ghee helpful and can we use a teaspoonful this and that? No, if you want, medically speaking. No, if you are talking about certain, because all I'm saying is questions that have been put forward to me. The Sri Krishna Bhagwan used to drink dahi and ghee and all that. So I turn around and say, look, I am not a religious expert at all, I'm only talking about from the viewpoint of what it is medically wrong.

Now, in those days, do you have the means to put a cow in your shed and feed the grass? Totally no, you don't. Dairy in this country is liquid meat, saturated fat and cholesterol. Rip Esselstyn said it very aptly One ounce of meat is equivalent to 2% of regular milk. A cup of 2% milk, and look at the milk. How do you get milk on the shelves of your grocery stores? You have to impregnate the cow continuously. So you push estrogens like crazy and this estrogen in the milk that comes in is one of the leading causes of prostate cancer in men. So that estrogen that you are having, you're getting saturated fat, you're getting cholesterol, you're getting a load on your kidneys, so you get renal functions which are going down. You get osteoporosis faster with your meats. Why in the world would anybody want to have meat and dairy, or meat for that matter?

Then you have the question of lactose intolerant. Do you know? Some of the people in the world are lactose intolerant, but we say that because we have the belching and distension. Oh, we have enjoyed the meal. No, that is wrong. You have not enjoyed the meal, you are lactose intolerant. And one final thing when my patients, when I tell them to give up milk, dairy, they come back to me in six months and say. I ask them have you given up dairy? And they say yes. I say what about cheese? They say no, no, we have the cheese. Why? Because it takes a large quantity of milk to make a small quantity of cheese and cheese. We've got casein, a protein which is found in cow's milk, and that protein turns into casomorphine, so that casomorphine becomes an addictive quality like morphine. So the last thing people want to give up is cheese. They say I can give up everything, but I can't give up cheese.

Yeah, it's interesting, you pointed that out. It's interesting, you pointed that out B-A-I-P-K-U-M-A-R and our website, ypkumarcom. Until next time, with yet another interesting guest and yet another interesting topic. It's me Y saying so long.