World Nutrition, Health & Disease Conference 2009

World Nutrition, Health & Disease Conference 2009
Held in conjunction with Asia Food Technology, @ Singapore Biopolis. 20 July 2009:
Excerpts from the Keynote address.

Dr. V.P. Nair, PBM: MBBS, MRCP (UK), MRCP (Ireland), FRCGP (UK), FRCP (Edinburgh) FRCP (Ireland) FAMS (Cardiology, S`pore) FICA (USA) FACC (USA) FESC (Europe) FRCP (London)
Senior Consultant Interventional Cardiologist,
Mount Elizabeth Medical Centre, # 16-08, Singapore

Singapore is a melting-pot of cultures and therefore also a melting-pot of numerous eating delights, often with a fusion of food philosophies. At the same time we give importance to good eating habits and nutrition.

About 250 years ago, Ben Franklin, coined the phrase “An apple a day keeps the doctor away”. He did not know then that apples contain vitamins, minerals, fiber and antioxidants such as flavanoids and polyphenols with some beneficial effects on heart disease and cancer. Some of the components found in apples are known to be anti-allergenic; some are anti-carcinogenic, anti-inflammatory and anti-viral. The apple story is only an anecdote to the wider concept of basic food, nutrition and caloric requirements of our body. Recently Soursoup also has been found to be as good if not better than apple.

The issue of nutrition, health and disease has been for a long time the focus of scientific research and development. Even though this has led to major advances in nutritional values, preservation and storage capabilities are much more needed in the development, dissemination and application of food technology. We have to overcome growing health challenges faced by humanity, as we enter the second decade of the 21 century. As of July 2009, the Earth's population as estimated by the United States Census Bureau is 6.78 billion. By 2050, the population may reach 9 billion. By then world food shortage will become critical due to water shortage, climate changes , deforestation , global warming as well as increase in population, unless consistent corrective measures are made by the governments and the people.

Today, two-thirds of all deaths in America, Europe and Singapore are due to heart disease and cancer. However in Africa, most of Asia and Latin America, infectious diseases are still the commonest cause of mortality and morbidity. With the worldwide increase in life span due to better health care, housing, immunization, hygiene and sanitation; disorders specific to the ageing population will become more common. 50 years ago, majority of the world’s population died before the age of 50. In 1996, the average global life expectancy reached 65, while the average life expectancy in industrialised countries was 80. Life expectancy in Singapore is the 5th best in the world being above 80. The paradigm has therefore shifted significantly in the last 5 decades.

I mentioned the previous facts as a prelude to my presentation. As a Cardiologist, my primary focus is on the medical treatment of health-related issues. It is important not only to treat diseases after they manifest, but also to prevent their occurrence as well. Apart from medical therapy, a large part of patient care is also dependent on the adherence to a healthy lifestyle and good nutrition. The two are complementary and synergistic. You will no doubt hear more about this from our distinguished panel in the ensuing lectures and scientific papers. I will therefore deal predominantly with the medical aspect of this topic.

In the medical fraternity, we often treat diseases with overt symptoms. But there are many conditions that exist, without symptoms. High blood pressure is one of them. It may not have any symptoms and it may be detected only by a chance blood pressure reading at a routine physical examination. If untreated, it can cause damage to the heart, brain, eyes and the kidneys. Almost one third of American adults and 1 in 7 Singaporean adults have hypertension. Hypertension and diabetes are one of the leading causes for kidney failure, heart disease, stroke and blindness world-wide. The biggest culprit within this spectrum is Coronary heart disease, or disease of the heart arteries, where lipid plaques block the epicardial arteries of the heart.


The recognized risk factors for coronary heart disease are, tobacco smoking, high blood pressure, dyslipidemia manifested as high levels of bad cholesterol (LDL or low density lipoprotein - the lousy cholesterol) and low levels of good cholesterol (HDL or high density lipoprotein - the healthy cholesterol), diabetes, advancing age, male gender, obesity, family history of heart disease, sedentary life style, chronic stress and in some cases elevated blood homocystine levels. These risk factors need to be identified promptly and treated appropriately.

Assessment for the detection of coronary artery disease include history, physical examination and certain basic investigations such as Electrocardiography (ECG), blood tests and special tests such as a Treadmill exercise stress test, numerous imaging modalities such as Echocardiography, Multi-slice CT scan of the heart and the gold standard Coronary Angiogram.

Once this has been done, the blocked arteries can be treated with medications, ballooning (angioplasty), stenting or bypass surgery. New medications, off pump Coronary Artery Bypass Grafts, and Drug Eluting Stents have revolutionized treatment of coronary artery disease and improved quality of life significantly. As mentioned earlier, nutrition and a healthy lifestyle have a major part to play in the treatment of heart disease in addition to the interventions mentioned.

Almost 2 decades ago, in the Straits Times interview I coined the phrase “the longer the belt line, the shorter the life line” as a means to remind the public about the importance of abdominal obesity and its connection to one’s longevity. This adage has now been proven true worldwide in the subsequent years. Most notable, was a study by a group of cardiologists led by Dr. James de Lemos at the University of Texas and reported in the American College of Cardiology on 14 August 2007. Using MRI and other tests after a long-term study of 2744 people, a direct relationship was found between waist size and early indications of heart disease, regardless of patient’s overall weight and some other risk factors.

Obesity is an undesirable outcome of overeating and lack of exercise. It is postulated that one’s waistline circumference should be less than 80 cm for women and 90 cm for men. A person’s waist-to-hip ratio, sometimes described as “Gut to Butt ratio”, should be less than 1 for men and below 0.8 for women. Similarly one’s Body Mass Index (BMI) should be kept below 25kg/m2, as proposed by the WHO. However, for people of Asian origin, a BMI of below 23kg/m2 is desirable.

Science has proven that a heart healthy diet is one with relatively unprocessed foods with veggies, fruits, grains such as rice or wheat that retain some of their original kernel. Rice bran is the outer brown layer of the rice kernel. Such 'whole' foods became scarce in Western diets. Some eggs, liver or fish are also vital for most of us indeed in limited amounts. But excess intake of red meat high in animal fat including cholesterol and saturated fats and consumption of pure sugars leads to coronary heart disease, diabetes, certain cancers and dental caries.
During food processing, such as mass production of flour or noodles, we lose 60-90% of most healthy vitamins. We degrade proteins by deep-frying and our factories hydrogenate oil which first zaps all omega-3 by trans-forming it into toxic trans-fat. Most single nutrient diseases like scurvy, beriberi and goiter were wiped out by food fortification, our 'weapon of mass nutrition' in the last few decades. Processed foods low in many nutrients such as vitamins B6, B12, folic acid and vitamin D, may lead to “Long-Latency Deficiency Diseases”, such as heart disease, cancer, bone loss and Alzheimer's dementia.

We should therefore be more careful with our sources of food and how they have been processed. Good nutrients that have been removed also need to be replaced. So exercise regularly, eat healthy food, relax and remember my punch line “the longer the belt line, the shorter the life line”.

Thank You

OPEN UP? Periodontal Disease-A Growing Cardiovascular Concern

OPEN UP? Periodontal Disease-A Growing Cardiovascular Concern
Posted Jun 04, 2009 at 10:56 PM, EDT by Melissa Walton-Shirley

Maybe it’s time for a little cross marketing……….between the dentist’s office and the cardiology exam room that is.

When earlier studies linked gingivitis to cardiovascular disease, we as cardiologists began to agree over small talk in doctors’ lounges or medical meetings that the finding was remotely “interesting”. I’ve even gone so far as to tell a modest number of patients staring at me from behind toothless grins that poor dental habits could be associated with heart disease. Now with the recent publication from the University of Kiel, Germany suggesting a genetic link between periodontal ills and atherosclerosis, it’s apparent that I should do more than just mention it in casual conversation.

There is one huge obstacle however. I don’t think cardiologists know much about the oropharynx. About the only time I ever look in someone’s mouth is when I’m forced to fill out that ridiculous ASA criteria prior to a cath (I know just enough to be able to check the box if I can see the Uvula). Occasionally, I inspect the soft palate for petechia in a patient with a FUO. Other than that, I’m content to listen to the carotids, check for facial asymmetry or JVD, note the thyroid and call it an HEENT exam. So, I’ve taken a little time to ask folks who are “in the know” about periodontal disease and what exactly we as cardiologists should look for. As for the cross marketing approach mentioned above, maybe dentists should place information packets on their waiting room tables informing their patients of the risk factors for coronary disease. Maybe we should approach our respective national associations about taking a more aggressive stance on campaigns for better periodontal health. It seems imperative that we join together to drive a change in our culture that would cause us to view poor dentition as not something shameful but potentially deadly. No doubt, our current economic downturn in America and the lack of universal coverage for dental insurance will continue to take its toll. Universal coverage for dental health would be another lofty goal.

From the cardiologist’s perspective, it’s time we tuck something more than just Viagra (or Lipitor) into those much coveted give-away-bags that sometimes takes so much courage to obtain. Maybe we should surprise our patients with something really practical……….. like a toothbrush, dental floss and toothpaste as well.

Comments

"Beautiful Smile brings beauty to the Beating Heart" had been my motto in recent years. It is clear now that gum infection and root canal abscess of teeth including gingivitis and pyorrhoea; apart from causing discomfort to the sufferrer, has detrimental effects on the heart. As such let us the cardiologists and our dental doctor collaegues, have a common strategy to combat Heart & Tooth Disease.
Dr. V. P. Nair, MD, FRCP, FACC. Cardiologist, Singapore,
dr.vpnair@gmail.com lordsiva@starhub.net.sg

Posted by Dr. V. P. Nair, Jun 09, 2009
Reply to this comment

For my daughter's 21st birthday, I gave her two braclets, a yoga block, a yoga tape and two packs of dental floss. She laughed. I had her to read my blogg. I hope it will be the birthday gift that will keep on giving!!
thanks for your post Dr. V.P.

Melissa Posted by Melissa, Jun 12, 2009

good and bad cholesterol