Coronary Artery Disease in South Asians | The risk factors and how to reduce risk

This lecture I discuss the risk factors of Coronary Artery Disease in South Asian populations and what can be done to reduce the risk of severe disease.

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My previous lectures I mention during the video that discuss the topics of diet and fasting in more detail:
”Fasting for Survival” –
”The Fat Lies” –
”The Bittersweet Truth” –

The Blood Test I mentioned:
What is a Kraft Test? –

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My other Videos:
Holiday food shopping playlist:
Why your Cardiac Examination is Incomplete-
Treat High Blood Pressure’s Root Cause –
What is a Coronary Calcium Score? –
What is a CT Angiogram (CTA) of the Heart? –
What is Cardioversion? –
What is a Leadless Pacemaker? –
What is Right Heart Catheterization? –
What is a Heart Attack? –
Heart Attack Treatment –
What is an Echocardiogram? –
Monitoring Heart Failure with CardioMEMS –
Introduction to Cardiac Catheterizations –
What is a Loop Recorder? –
External Counterpulsation (ECP) for Chest Pain and Coronary Calcium –

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About Dr. Pradip Jamnadas, MD, MBBS, FACC, FSCAI, FCCP, FACP

The founder and Chief Medical Officer of Cardiovascular Interventions, P.A. in Orlando Florida where, since 1990, he has been repeatedly recognized in local publications as a Top Doctor performing thousands of interventional procedures in hospital and out patient settings. As a consultant cardiologist with a large diversified inpatient and outpatient practice he is noted for his passions for teaching and illuminating prevention for cardiovascular disease . He is also a clinical assistant professor of medicine at The Florida State University and University of Central Florida.

Disclaimer: The information provided is for general knowledge and is not a substitute for individual medical advice. All viewers should consult their physician before starting any medical program or treatment. Any action you take upon the information that you find within this content is strictly at your own risk. Neither Dr. Pradip Jamnadas nor Cardiovascular Interventions will be liable for any damages or losses in connection with the content on this YouTube Channel.

Well hello everybody i’m dr gymnatis I’m a interventional cardiologist here In orlando florida with cardiovascular Interventions and today’s presentation Is on coronary artery disease in south Asians And this is a very important subject Because it there’s not much literature On this so i really wanted to expand on This so i hope you’ll enjoy this Presentation if you Like the presentation i would like you To subscribe to my channel and give us a Thumbs up and We’ll go right into the presentation So Coronary artery disease in south asians Is a huge huge problem And we’ve recognized this for a very Long time Why is it that south asians who are from India pakistan or bangladesh But also south asians who are living Abroad from any of these places have the Highest incidence of coronary artery Disease in the world And this has been a real point of Interest And of concern here we go the prevalence Of the heart disease is so high That in non-asians okay in the united States there’s a 2.5 coronary artery Disease risk but if you look at south Asians who are living here or living in

India it’s 7.5 percent so it’s almost a Three times higher risk of having heart Disease and this has been documented Over and over again it’s a huge problem And if you look at coronary artery Disease in india in non-diabetic Patients is 11 Coronary artery disease risk and in Diabetics is 21 Folks this is so high that this is of Extreme concern to us this 11 In my opinion is actually an Underestimation because that just means That they haven’t diagnosed diabetes in The other patients so what is diabetes Diabetes is when your blood sugar is Really high your hemoglobin a1c is high Your blood sugars are greater than 126. But non-diabetics They contain a lot of pre-diabetics And one of the things you’re going to Learn in this slide presentation is the Pre-diabetics who have the very high Incidence of coronary artery disease It’s the hyperinsulinemia which is so Prevalent in the south asians that Actually causes this problem so it’s not Just diabetes it’s also pre-diabetes So i made a note down here which clearly States that non-diabetic risk is 11 Percent in india because many of those Actually have pre-diabetes not just Diabetes So moving on indians in the united

States have the same rate of coronary Artery disease as indians living in India as well so this was a study that Was done in the uk singapore mauritius South africa fiji and in trinidad And in the united states Compared to the caucasian populations They have four times more Hospitalizations for coronary artery Disease they have up to four times more Complications of the same disease as Well And they have up to 10 times more Disease than those who are under the age Of 40. you know i’ve seen this in my Practice all along that when they get Hospitalized the outcomes are much Poorer and people say that oh yeah yeah Because the arteries are smaller they’re Not smaller you’re born with the same Size arteries it’s just that you have More diffuse disease more disease so They look smaller why more complications Because they have an underlying Metabolic problem as well so you can Have coronary arteries but if you have a Metabolism problem in your body then You’re going to have a lot of Complications as well so such as Non-wound healing is poor high blood Pressure is also present and just having High blood sugars and high insulin Levels Changes your risk of having all the

Complications under the age of 40. So When a young agent comes into my office And is complaining of symptoms that Suggest of coronary artery disease Almost invariably my studies are Positive i will find that they indeed Have calcification in the arteries they Have coronary arteries you don’t take This lightly do not take this lightly so I’m very aggressive in young young Asians so these studies are well Documented and If you look at urban indians Have the same rate of coronary artery Disease as overseas patients So Rural indians have 50 less coronary Artery disease and the question is why Why is that what is so different about Indians that are not Living in the cities but living in the Rural areas and there are lots of Reasons for this predominantly to do a Diet lifestyle exercise and stress What we also find is that indians who Are living in the cities have a 25 Heart attack rates in those who are Under the age of 40. So they present with heart attacks they Don’t just present with angina they Actually present with a heart attack So now let me tell you the difference Between a heart attack and sudden death

You’ve all heard of south asians who Suddenly just dropped dead at a young Age under the age of 40 under the age of 55. we all know these people What happened to them Well the mode of death is twofold either They can have sudden cardiac death Or they can have a heart attack Sudden cardiac death is an arrhythmia Where they suddenly go into a arrhythmia Called ventricular tachycardia and Suddenly they have no blood pressure They kill over and unless the paramedics Come and give you a shock You’re basically gone that is sudden Cardiac death Heart attack is caused by a blockage in One of the arteries that suddenly Cracked open and a blood clot formed the Artery is now shut down and now there’s No blood supply getting to the heart Muscle the patients usually feel chest Pain pressure heaviness shortness of Breath sweating they’ll usually have Some sort of pro prodrome not just Suddenly keel over they’ll actually have Some symptoms And then if that persists they can also Go into an arrhythmia and then suddenly Pass away or make it to the hospital but They’ve got a lot of pump damage their Heart muscle is damaged and then they Die of low blood pressure and what we Call pump failure

So arrhythmias can occur in a heart Attack can also occur with sudden Cardiac death sudden cardiac death is Caused when you have all the blood Vessels being narrowed So now the whole heart doesn’t see Enough blood supply and they go into That terminal arrhythmia that’s why we Open up blocked arteries we open them up To prevent sudden cardiac death prevent Arrhythmias so this disease so far you Can see in asians is very malignant Presents a sudden cardiac death or Myocardial infarctions in a large number Of patients and Many times they’re under the age of 50. So all the more reason we need to be Very very vigilant And what are the risk factors the Biggest risk factor is this one here Called metabolic syndrome And i’m going to talk more about that in A few seconds but you’ve all been heard About high blood pressure well high Blood pressure is also caused by Metabolic syndrome you don’t just get High blood pressure there’s always a Reason for it and the third cause is Smoking then diabetes well diabetes is a Metabolic disease so as i said in the Beginning if you have pre-diabetes or You have diabetes the risk is the same That is a key thing that i’ve said today Whether you have pre-diabetes or frank

Diabetes It’s the high insulin levels in these Patients that cause the disease you only Define diabetes because the sugar level Is now over a certain arbitrary 126 Fasting But the underlying pathology is still The same The high insulin levels cannot control Your sugar levels anymore so the sugar Levels start increasing and when they Reach a certain point say oh you’re a Diabetic now but actually It’s the high insulin levels that you’ve Had for years and years and years that Causes all the damage to the arteries And i’ve covered this all in my video on The bittersweet truth which is linked Below you all can please look at that Because that will give you a great idea On the difference between pre-diabetes And diabetes and how malignant it is Then i’ve listed hyperlipidemia as a as A cause as well but only certain types Of hyperlipidemia when you have a high Triglyceride low hdl which is also Related to your sugars so It’s important that we look at your Lipid panel connective tissue disease Which you know of like let’s say you Have lupus Then you have a tendency to have blood Clots at any site where the artery is Ruptured so connective tissue disease

Causes the arteries to become smaller And if they rupture you’re more likely To get a blood clot in it Obesity obesity is listed separately but Obesity is related to metabolic syndrome Because what makes you obese in these Patients is the high insulin levels Because the incidence job is to take all Your calories and put them into storage So that’s going to cause fat gain and That causes obesity so if you look at These obese patients again i’ve covered That in my talks before obesity is Created by a hormonal change in your Body So that even if you only consume 2 000 Calories if your insulin levels are Running high you’re going to gain weight Because everything that you’re eating a Large percentage of it is going to go Into storage so it’s important to Understand that they all linked to this Metabolic condition obesities And then increased abdominal hip ratio Of 0.85 Now this is very important for south Asians What’s important to understand is if you Look at the south asian they’re usually Not that overweight So if you look at them from the back They look pretty slim but the moment They turn sideways you’ll notice that Their stomach is sticking out

Look around you Look at the south asian patients They have abdominal obesity it’s all in The belly Now where did this come from It comes from excessive carbohydrates Excessive sugar which under the Influence of insulin Has to be put away into storage you see You can’t have glucose floating around In the blood so we have insulin that Immediately takes it out of the Bloodstream And in the liver the insulin converts The sugar particularly fructose and Glucose Into fat and in the liver it becomes fat So that’s why you get a fatty liver it Stores it and when the fat stores are Saturated in the liver It moves into the pancreas From the pancreas it moves into all the Fat around the inner organs that’s why You have a belly so you look at somebody And they have a belly but the rest of Them is not fat the arms are nice and Thin the legs are nice and thin the neck Is nice but they have a belly They’ve got insulin resistance they Probably are pre-diabetic or there may Already be a diabetes a diabetic they Probably have a fatty liver and their Insulin levels are probably high Yet if you go to the standard charts and

Look at the body mass index you say oh Is he overweight no he only weighs 145 Pounds for example But he’s got a belly then he’s got a Problem so therefore the belly sticks Out The hips are nice and narrow That’s trouble Now the obese patient who has fat all Over He is in trouble too but not as much as This this is very malignant because the Type of fat that is generated in the Liver from excessive carbohydrates is Very inflammatory so if you do a biopsy Of the fat that’s in the belly That Biopsy Will show a lot of inflammatory Molecules in it and inflammatory markers In the blood will be very high versus The ones who are very obese but then you Do inflammatory markers on them or if You do a biopsy of the fat you don’t see Much inflammatory cells in them so those Are what we call metabolically healthy Obese patients So It’s not just obesity it’s where the fat Is and south asians look around you’ll See it’s all in the belly you’re in Trouble That is a major red flag So

We’ll find that in general Asians have fluid of the few of the Traditional risk factors And the paradox is that A blood pressure That is well tolerated in a caucasian Let’s say 140 over 90 Is not well tolerated in south asia so The risk to your vascular system starts At a much lower blood pressure South asian you need not good blood Pressures you need perfect blood Pressures 130 over 85. the body mass Index for caucasian Ideal 25 south asian 23 Go to the charts check your body mass Index make sure it’s down to 23. That’s your metabolism that’s where you Need to be we are in in a in a crisis Right now among south asians So if you look at the rural population In india versus the urban population You’ll see that the urban population’s Body mass index is much higher 24 to 25 And you’ll see well that’s not more than 25 yeah but that’s by caucasian Standards But for for standards in india for Example that’s still too much and if you Look at these patients they all have Abdominal obesity They all have that bad fat generated From excess of carbs and sugars and Insulin resistance and the hip to waste

Ratio is 0.99 and they have a sedentary Lifestyle in the cities versus in the Rural population the body mass index is Only 20 Hence they have better health their Abdominal obesity is much lower the hip To waist ratio is usually less than 0.95 And they are they are non-sedentary They’re very active they walk a lot you Know they were walking three four miles Minimum twice a day and they’re doing a Lot of physical activities so that Explains a lot of the difference between The urban Population the rural population and what They’re eating as well and how much Sugar they’re consuming Diabetes is so much more prevalent in The urban population for the same Reasons it’s to do with the diet eating Too much sugar too much carbohydrates So let’s look at diabetes then In the united states the prevalence is Only 5.3 percent well i shouldn’t say Only it’s still too much But in india it’s 12 to 14 percent Now just understand that 80 percent of The indian Hindus for example are vegetarian They’re vegetarian and yet they have Such a high incidence of coronary artery Disease So this is a misconception that if You’re vegetarian you immune no you it’s

The carbohydrates and the sugars and It’s the diabetes so diabetes and Pre-diabetes stand out as the major risk Factors for coronary arteries in south Asians If you can sum this up in one sentence Then why do south asians have such a High instance of coronary artery disease It’s because of diabetes and Pre-diabetes Abdominal obesity metabolic syndrome Hence you have all these problems so It’s diabetes pre pre-diabetes happiness Anemia metabolic syndrome And this causes them to have high blood Pressure High triglycerides Low hdl And they have a normal Or just slightly elevated ldl the Traditional risk factors that you all Know about the bad cholesterol ldl And look it’s all over at the bottom it Has very little If any effect in south asians So the high triglycerides are caused by High sugars High insulin levels the low hdl are Caused by the same thing hypertension is Called behind insulin levels which Blocks nitric oxide so it makes your Arteries Not vasodilate and hence you develop Hypertension so you can see that the

Root cause Get to the root cause of the problem Root cause is diabetes and pre-diabetes Now diabetes you can pretty much check It out you go to the doctor’s office They’re going to check your blood sugar And say it’s high or hemoglobin a1c is Over 6.5 but how do you diagnose Pre-diabetes so we’re going to talk About that in a second about how we Diagnose pre-diabetes So insulin insulin is your problem What causes insulin secretion Sugar bottom line is the sugar sugar Drives insulin to go up number one Why do you become resistant to to Insulin because you’re eating too much Sugar too much carbs Carbs also causes The blood sugar to rise and your insulin To rise up as well Okay so it’s too much carbs Especially carbs without Fiber That means processed carbohydrates which We’ll talk about in a little bit more Processed carbohydrates made into flour Anything made from a flour Is poison until proven otherwise So These things that drive the insulin have To have to have to be addressed in the Diet And if you look at

As i mentioned before 50 of south asians Overall are vegetarians Okay And Non-vegetarians have the same rate of Coronary artery disease not the means If you have fats That come with the meat And if that meat Is Not Not from a farm that fed the animals With grains then the omega-6 levels are Going to be okay in that fat that fat is Probably okay and not that detrimental To you But we’ve blamed saturated fats Please look at my Video on the fat lies The fat lies covers all the Misconceptions about fat what type of Fats are really bad for you and what Types of fats are actually innocent But if you look at saturated fats in Vegetarians in south India they say that oh yeah there’s too Much coconut oil it’s not entirely Correct you see Even coconut oil in india has changed From virgin to refined Coconut oil anything that’s refined Anything that’s processed anything That’s centrifuged anything that’s Heated up anything

That that has been heated and cooled Again will have trans fats in it and Worst of all and this is the take of Home take home point for you the worst Oil is vegetable seed oils So these are all refined vegetable seed Oils extremely high in omega-6 which is Pro-inflammatory and of course it’s part Of our essential fatty acids we do need Omega-6 we do need omega-9 because we Don’t make them but we don’t need so Much of it And our diets have completely been Transformed because now we consume way Too much vegetable seed oils so what are Vegetable cereals they’re made from Seeds now why are they so bad for you or Multiple reasons because those seeds Have a lot of chemicals in them to Protect themselves from predators Because they want those those those Seeds to actually Grow and perpetuate the species so they Contain in them substances that the Consumer will not like and actually will Hopefully not come back and take more Seeds away But in india there’s there’s vegetable Ghee so that’s a total misnomer Ghee is ghee it’s saturated fats that’s Manufactured from milk products okay so That’s that’s the butter as they call it Vegetable ghee is purely made from Vegetable oils whether it’s made from

Soybean oil or peanut oil or sunflower Seed oil or canola oil they’re all Processed they call them vegetable Cereals well there’s not one of those Things are vegetables they’re all seeds So eating an oil that’s made from those Seeds cotton seed oil for example soy Soy oil it’s a waste product Cotton cedar was a waste product i can i Cover that in my talk on fat lies as Well as Other lectures these are all waste Products that somebody decided let’s Make a profit on it let’s use it and Let’s feed people with these vegetable Seed oils which you’re not supposed Look until the turn of the century we Did not consume vegetable seed oils Because we don’t have processing Ability If you look at the solvents the heating Process and you go to one of these Plants where they make vegetable seed Oils i tell you you will not consume any Vegetable seed oils at all this is Extremely important so your cotton seed Oil your palm oil your mesola corn oil Is stated your your soybean oil your Sunflower seed oil All of these look at the consumption and As the consumption of these is rising Rising so why are we using so much Well all processed foods have these oils Because it makes for dryness of the

Product and a very long shelf life Because of the long shelf life Processed foods use these oils The processed foods are processed in and Of themselves They’ve been stripped of all the fiber And they’ve been powderized And then they add the final poison which Is the vegetable seed oils to give it Longevity so you can see that it’s a Perfect creation It’s the perfect creation of a food That’s not going to go down it’s a Healthy meal So carbohydrates and sugars okay Are very high in both populations Vegetarian and not non-vegetarians right But The vegetarians will consume far more Wheat flour chickpea flour of course the Vegetable seed oils sugars sweets and All these refined products if the Product doesn’t look like that in nature And it’s been transformed into something Else Don’t touch it That’s what’s driving the metabolic Process that’s what’s driving the Premature coronary artery disease in the South asian Continent so asians in the united states They eat united states foods they eat U.s foods also And they go to exercise and they go to

The gym as well But they also consume these other Products So long as you’re consuming the other Products and then the rest of the time You’re eating some salads as well and You’re adopting a reasonably healthy Diet The fact is you still got all the bad Stuff inside you as well It’s like having the perfect diet but You’re still smoking so the perfect diet Doesn’t undo what smoking does similarly Having a Mixed diet where you eat some Asian foods but you’re also eating American foods the american food’s not Going to protect you especially the Healthy american foods now of course a Lot of us also consume some of the Processed foods of the western society Which is also Just as bad as all these things that i’m Talking about today so in order to Reduce the risk You need to first and foremost know that Do you actually have the disease already Or not so that’s called detection and Then we treat it And we reverse the metabolic disease That you got so how do you What’s early detection so these patients Come to me they’re in their 40s and they Want to know am i at risk well i say

Well you may already have the disease It starts i told you 10 to 15 years Before you get your diabetes diagnosis Or coronary artery disease you’re Already Working at metabolic syndrome So that when you get your heart attack You’ve actually earned it It’s terrible it’s terrible so the first Thing i do is i do a coronary calcium Score and a coronary calcium score is a Low-grade ct scan of the coronary Arteries if there’s calcium buildup in Those arteries you know you already have The disease Calcium equals hardening of the arteries Calcium equals atherosclerosis So that’s the first thing that i do i’ll Show you some pictures of that And then i do a blood test and the blood Test i do is called the craft test And that monitors your insulin level and Your glucose level so basically you just Like your glucose trans test you take Some sugar water but instead of just Measuring your sugar over the next one Hour and two hours and back down again i Actually measure your insulin levels as Well so sugars may be good But at the expense of very high insulin Levels once i have that i say okay You’re not a diabetic because the sugars Are within range so i cannot call you a Diabetic but look at your insulin

Response It’s way off the mark and therefore you Need to sensitize your body to insulin Now you need to go on my diet and other Measures including fasting very Important to restore the insulin Sensitivity and of course i’ve done a Video on this one as well which is Tagged at the bottom so please watch That one on fasting and fasting for Survival and for south asians this has Been part of our culture we’ll talk more About that in a few minutes as well but This is extremely important And then We have a crp level which tells me how Much inflammation is going on in your Body We have the homocysteine level very Important because it is linked to Atherosclerosis your a1 is related to Sugar and look i didn’t put 6.5 6.5 is For diabetes but if you want to see Whether you have insulin resistance You’re going to be between 5.7 and 6.5 And then i look at your triglyceride hdl Ratio so often times even if i don’t Have the insulin levels if i look at the A1c which is an easy test everyone Should be able to get that i look at the Triglyceride hdl ratio greater than two Then i already know that you probably Have insulin resistance sometimes i Don’t even have to do the craft test on

Those patients i look at the body i see That the belly is the problem and I’ve made my diagnosis you need to make Lifestyle changes you want more proof Then i’ll do the craft test on you as Well so this is a coronary calcium score Scoring site it’s a ct scan so as you Can see over here this is ct scan it’s a Cross section of the heart and this is The aorta right here and coming off the Order is the left main coronary artery And this is this is the left anterior Descending artery arching forward and This is the circumflex artery going at The back over there and here in this Particular picture you see all these White spots here and this is the calcium Because remember x-rays don’t go through Calcium they’re like bone right right so You see all these big white spots on the Ct scan the scan takes literally five Minutes to do no iv injection just come In just lie down as long as your heart Rate is nice and steady and less than 65 We can do this sometimes we have to give You a better blockage just to slow your Heart rate down a little bit give you a Little tablet because you want a nice Scan because after all this is a moving Object so you want to get a nice slow Hard heart rate but these are further Scans demonstrating the calcium and here This one here the left entry is sitting Out so much and you can score this

Calcium so the higher the score the more Dangerous uh it is for the patient so The ideal score is zero and between a uh Zero and a hundred is mild although i Don’t think it’s mild i think that’s Moderate between 100 and 400 is Considered moderately severe and over 400 it’s very severe so i’ve had so many Patients that come here they’re Completely asymptomatic and their scores Are 2 000 2 500 is oh my goodness this has been Going on for years and years and years And we don’t know when you put on this Calcium and therefore one it establishes The diagnosis but number two i repeat This study in two years what does that Tell me in two years so if your score Was let’s say a hundred and two years Later it’s jumped to 400 then i know That there are still some factors in you Yet you’re building up more plaque You’re making more atherosclerosis You’re making more hardening of the Arteries so you dig deeper find out why Are you doing this do you have a leaky Gut do you have Do you have sensitivities to certain Medications but we can certainly do more Investigations here this is very very Important now moving on The next picture here is Demonstrating on the ct scan what your Arteries are going to look like

So here’s an artery that comes in the Front over here And you can see that the plaque of Calcium here there’s a calcium here look How lumpy bumpy this artery is And you can see that’s very thin it’s Becoming thin here so the calcium is in The walls of the arteries and the actual Lumen is thin because there’s diffuse Disease diffuse disease look how thin This This one is more dramatic this is Demonstrating all the white spots of the Calcium and this is what the arteries Look like so this is a ct angiogram so For this test we inject some contrast Into your irregular iv and as we’re Injecting it we do the ct scan at the Same time when we do that scan we can Actually see the contrast filling the Arteries and we can see the calcium Buildup also at the same time we have Very very dramatic pictures that we get And here’s another one where we can Subtract out the rest of the heart Beautiful techniques and you can see the Arteries what they look like where they Are uh whether they’re completely Blocked or not this is the left hand Traditional artery this is the right Cornea but this is an anomalous right Coronary artery by the way this is the Right coronary artery it’s coming off Near the left main coronary artery so

You can see congenital disease as well So you can see that the arteries are Coming off in the normal place or not it Should be coming off the right cusp Which is usually around here but this One it’s not it should be like this one You see that this one’s coming off the Right and here’s the artery but look at All the calcium buildup in the walls of This arteries and you can imagine now in Your mind’s eye how one of these plaques Is going to rupture and the day it Ruptures A blood clot forms inside and seals off The artery So once you have calcium the higher the Calcium score Okay the higher the calcium score the More plaque the more plaque you have the More likely that it’s going to crack Somewhere along here it’ll crack and When it cracks the blood clot forms Seals off the artery and now all of a Sudden you’re having a heart attack so One day you’re feeling good the next day You’re having a heart attack why are you Feeling good the day before because the Blockage doesn’t have to be a 90 Blockage that cracks and then seals off The artery it could be a minor plaque it Could be a little area of calcium such As this one here There’s no predictability as to which One of these calcium plaques is going to

Close off and cause the heart attack the Severity of the stenosis does not Predict the sight Of the occlusion i’m going to say that Again the severity Of the Narrowing does not predict the sight of The future occlusion that means a minor Blockage of less than 50 in an artery Can suddenly crack the next day and Become a hundred percent just as well as A 90 Blockage that can also crack the next Day and close it off now of course the Tighter the block is more likely you’re Going to have chest pains and you’re Going to get some warnings but in Majority of the patients there’s no Warning there’s no warning that i’m Going to have a heart attack tomorrow You wake up in the morning and bingo it Cracks and you’re getting a heart attack Now when you have a narrowing And this narrowing is causing you lack Of circulation and therefore you’re Getting angina angela means chest pain You are Lucky You are now Lucky So if you’re lucky that you got this Warning system That you had some chest pain That means you’ve got a tight blockage

Somewhere that’s restricting the blood Flow Now you can go to your doctor and say Hey doc i’ve got i’ve got some Some chest pain and the doctor will do a Stress test on you and see that there’s A problem order a ct scan or some other Diagnostic modality and we’ll be able to Tell and move you forward but many of These patients unfortunately have no Warning whatsoever they have absolutely Zero warning so here’s some more Angiograms you can see in this one the Artery here there should be an artery Right along here this is called the pda And it’s missing so we know that he’s Already had a heart attack it’s already Closed off the artery And when we do three-dimensional Reconstructions you can see these Arteries quite nicely and quite Beautifully Beautiful imaging here’s another set of Arteries but I want you to appreciate The disease Meaning See it don’t just assume well i’m okay Just because i passed my stress test Because i just told you that you could Still have a lot of calcium you could Have minor blockages have a stress test Pass the stress test because none of the Blockages are more than 70 or 80 percent

So you only fail your stress test when The blockage is more than 70 or 80 Percent Now that should scare you i hope it’s Scaring you Because if you have a minor blockage of All all over here let’s say a 50 50 60 70 70 50 60 70 You may pass the stress test because You’re still getting plenty of blood Flowing you’re not getting any chest Pain whatsoever and therefore you think You just hunky dory because you did your Stress test and you passed it and worse Still you did your sugar test and you’re Not diabetic and you go home and then a Few years later you get a heart attack And you say whoa how where did those Blockages come from all of a sudden And i hope you’re getting a better Picture of why you why that happens So to reduce this risk I also do a liver ultrasound because if You have a fatty liver it’s part of this Metabolic process where does this fat Come from i told you it’s the sugar and The carbohydrates and processed foods Sometimes it also comes because you have A gut problem Intestinal dysbiosis as i call it which Is the wrong bacteria in your gut Or it can come from food sensitivities Which cause what you know what is known As a leaky gut where

Certain Ingredients in your food should not be Crossing over into your bloodstream but They do and and they create a immune Response in your body which cross reacts With other Parts of your body and cause Inflammation and that of course Causes coronary artery disease so when These things happen you get a liver Ultrasound and you see it’s a fatty Liver why would you have all that fat in Your liver well there you go that means You have insulin resistance you need to Get rid of the fatty liver first thing You need to do is get rid of the sugar And then you need to also gradually do The fasting program That i encourage all of you to do Because that’s going to reset your Microbiome in your gut and give you Sensitivity again to insulin so you got To do the fasting program watch my video On that and you got to watch what you’re Eating so the newer blood tests that are Emerging which are not always covered by Insurance uh the insulin like growth Factor binding protein which is very low Increased leptin levels decreased Attention levels increased sept levels Increased lipoprotein little a and Increased Pi1 Levels but

Those are just tests that that can be Done if people want to do that it’s not Often covered by insurance but the Bottom line is Eat whole foods only if it doesn’t look Like the like it appears like that in Nature don’t touch it Don’t touch it Don’t eat it it’s gonna look like like It does in nature otherwise don’t need It If it’s going to stay like that for days Or weeks on end Don’t eat it it’s probably processed So non-processed foods whole foods high Fiber why do you need high fiber some People say oh fiber fiber is good for me It’s not just for your bowels and your Bms and all that stuff you need fiber For your bacteria in your gut Number one because the bacteria is What’s going to consume the fiber and These bacteria liberate Good nutrients into your body and they Improve your your gut health as well as Your immune system But also you need high fiber because When you eat foods in the intact state With with all that fiber you produce Less insulin because the food is not Processed it’s because still all the Fiber in it you’re not going to evoke That huge insulin response when you eat It because when something is processed

It goes into your stomach and then goes To the duodenum it goes to a dotnam all As as processed food rate it’s already Semi-digested the body thinks that oh my God i got to deal with all this Nutrients all at once that’s coming in I’m going to produce a lot of insulin Because i’ve got to get rid of all the Stuff that’s coming so the k cells and The duodenum start producing a ton of Signals to the pancreas to say i’m going To need lots and lots of insulin for This because there’s all this processed Food that’s come down Foods that are still in their natural State will also evoke an insulin Response but because of all that fiber The the response is is much smaller so It’s much much attenuated So that’s why you want for the high Fiber foods fermented foods are very Good for you because for the good for The bacteria in your gut because that’s Good for your immune system so i Encourage a lot of yogurt some kefir Sauerkraut kimchi And That improves the the diversity of your Microbiome and there’s a lot of research Going on about the microbiome your Microbiome changed when you came here to The united states as well so you got to Keep that unless when we go back uh to Our homeland sometimes we get gi upset

It’s all to do with the bacteria even if You’re eating the right stuff you’ll Still notice changes in your stools Because of the the microbiome changes That are occurring Measure your blood pressures make sure That there it’s always less than 130 Over 85 Because that’s a sign of underlying Metabolic disease Lose weight bring your body mass index Down to 23 people say oh yeah you look Terrible no no you look great get it Down to 23. And do intermittent fasting because that Restores insulin sensitivity it allows The gut microbiome to get better it Improves leaky gut gives your gut a Chance to rest what are we doing these Days We eat every two to three hours We’re not supposed to do that Teleologically our great-grandparents in India Were lucky if they ate once a day Sometimes they would even pass that Because they fasted a lot And they didn’t fast because they didn’t Have food it was just the lifestyle it Was just the lifestyle Some patients i advise them to do time Restricted feeding that means They eat in a six hour window which is Still better than eating every few hours

Where you’re constantly stimulating your Pancreas to make lots and lots of Insulin eating multiple meals a day Bad idea Okay eat Infrequently and fast more frequently So omad is once a day meal this is what I i would love to do most of the time so Even if i’m doing once one meal a day Five days a week And then saturdays and sundays i can Enjoy a little bit more It’s still better Eating once a day allows your body to Heal restore insulin sensitivity you’ll Notice your blood pressure will get Better your energy levels will go higher Your mental functions are better and That’s a whole new talk that i’ve given Please As i said before watch my my lecture on Fasting okay so fasting for survival Very important lecture okay one thing That is addiction i got to mention Something about addiction because many People want to do this and they start Feeling terrible when they start fasting Or changing their diets it’s because You’re addicted to the processed foods And don’t take this lightly it’s serious And it happens to a lot of people and The symptoms that they get when they’re Not eating oh my sugar level went very Low it’s not the sugar level went low

It’s because you’re a junkie basically You withdrawing from carbohydrates and Sugars because those sugars go to the Same part of the brain Which is related to dopamine processing So it goes to the same part of the brain As drugs would go as well so you’re Basically going through the same Withdrawal process and you’ll have the Same problems with cues that make you Want to go and eat and you get urges That you want to go and eat that sweet Thing and then a lot of the the foods That are processed also have in them Certain chemicals that make you addicted Addiction molecules in all of these such As in in in dairy products as well as in Wheat products there are chemicals in Them they’re similar to opioids um And they can also cause an addiction So watch for addiction if you do start This diet and you notice that this is Happening to you it’ll wear off in a Couple of days just like the drug addict We just put him in a room in the Hospital after three days he’s detoxed He’s fine he’s gone over it and it Doesn’t continue forever so the first Few days are the toughest but you got to Make this change and you’ve got to make Them now Exercising daily prefer the resistance Exercises That’s my preferred mode of exercise

I’ve got a separate video on exercises And if your coronary calcium score is Very high i do add aspirin to your your Medical arrangement because i think that If the if that calcium cracks and a Blood clot forms at least that clot will Not be a big one it’ll just be a small Little one and hopefully you won’t even Know that a plaque ruptured in your Artery and then i also give my patients With a lot of coronary calcium vitamin K2 because most of us are vitamin k2 Deficient and we know that vitamin k2 Deficiency causes coronary calcification Uh omega-3 supplements extremely Important as part of my test i do the Omega-3 panel and i usually supplement Them with omega-3 vegetarian and Non-vegetarian vitamin d3 this is huge Vitamin d people poo-poo it but it’s so Important it controls over 300 metabolic Processes in the body and most of us Today are vitamin d deficient because we Are indoors all the time we don’t get Enough sunshine that our forefathers had Plus the foods themselves these days Have less vitamin d content I sometimes give them a herb called Berberine which is a little bit related To metformin and has the same kind of Effects and does sensitize it to insulin Gives you a little bit of weight loss as Well and it’s pretty innocuous so i like Berberine as a supplement uh in patients

Who are pre-diabetics and they don’t Want to take metformin But metformin of course has been shown To reduce the progression from Pre-diabetes to diabetes so sometimes I’ll give it to you not because you’re Diabetic but you’re pre-diabetic it also Now latest data is showing that Metformin Also affects your microbiome so it’s a Very important one and i give it Particularly if you have a positive Coronary calcium score sometimes i give Them angiotensin receptor blockers Especially the blood pressures are high But remember when your insulin levels Come down your blood pressure also gets Better i sometimes give them a glp-1 Receptor agonist as well and these are The names of the drugs but remember that If i give you a drug of this kind it’s Only because i want to change your Physiology for now but ultimately you Can do it yourself through diet Look this is one of the diseases That can be turned around through diet Question is are you willing to do it Do you have the gumption do you have the Willpower Self-control to do this or i are you a Junkie now for food and you just can’t Change oh that’s just the way i’ve been Brought up and that’s the way i am Because history will repeat itself it’ll

Keep happening you will still get Diabetes you’ll be pre-diabetic and the Worst part is that once you get diabetes Then it’s not just heart disease Dementia huge one look around you There’s people with dementia and you Wonder why did they get dementia it’s Vascular it’s small vessel disease it’s It’s inappropriate the vasodilation in The brain now they’re calling this type 3 diabetes insulin resistance at the Level of the brain Blindness small vessel disease in the Brain peripheral vascular disease Atherosclerosis in the legs chronic Renal failure all related to diabetes as Well This is so important folks i i cannot Overemphasize this it reduces total Mortality as well or cause mortality Also goes down If you’re going to use drugs I use it initially but the goal really Is your diet you really have to change The diet You got to eat whole foods and we in the South asian Stores have such a variety of vegetables All vegetables are amazing amazingly Healthy for you now of course cut down On the potatoes if you have over Diabetes or insulin resistance because These simple carbohydrates such as Potatoes are just simply glucose

Molecules stuck together They do come with some fiber so it’s not All that bad but eat whole foods these Are further new drugs other drugs that i Advise some people to try You know this new category sglt2 Inhibitors i use that for my cardiac Patients with coronary artery disease Because they do reduce cardiovascular Risk by 38 hospitalization by 35 and Death rates by 32 So This is very very powerful so what does This drug do it basically gets rid of The sugar in your urine so the question Is what’s that got to do with such a Beautiful reduction in your risk What it has to do is your total body’s Glucose load goes down you’re unloading The body of that excess glucose that’s Why it really works so well and remember Besides glucose glucose is not that Toxic it’s fructose so i got to say Something about juices No Juice is processed there were no juices 10 000 years ago there were no juices Out there there were no steel mills Until the late part of the 18th century So no juicing no processed foods No milling products And i’m going to give you now My 13 most important points in summary Lose weight

Avoid all sugar high fructose corn syrup Simple starch or ties and desserts and Sweet dishes snacks all juices processed Foods refined products products made From flour especially wheat stay away From wheat Barley you can try some barley or Sorghum Those are alternatives that you can use Avoid all vegetable seed oils prefer Ghee extra virgin coconut oil omega 3m Butter Frequent fasting You must do some sort of fasting program Stop eating all the time and on the go Avoid antibiotics as much as possible Consume fermented foods because you want To take care of the bacteria in your gut Eat a variety of fiber from a variety of Plants don’t eat too much fruit because They’re high in fructor in fructose so Eat lots of little little of different Types of fibers And then consume organic meats if you’re Going to eat meat chicken fish turkey Eggs all that should be organic so that You don’t Catch some of the chemicals in them as Well as the omega-6s which i’ve Mentioned before Make sure you’re sleeping at least seven Hours a day your gut needs a break your Brain needs a break you need a break and Your brain is what’s going to heal your

Body during delta sleep no blue lights At night after 8 o’clock Start planning the evening there were no Lights in the caves before There were no electric outlets in caves Before And that’s when you were manufactured That’s when you were made your body’s Blueprint is from those days Resistance exercises High-intensity interval training is what I recommend for most patients they feel So much better when they do that because That’s what you’re supposed to even Teleologically you’re not supposed to Run two three kilometers every day Because if you run two three kilometers The tiger the saber tooth tiger would Have caught you up already you can’t Outrun them but you can have short Bursts of intense activity so you just Quickly sprint and get out of the way or Quickly swim across the lake or you Quickly climb up a tree and those are What i call high intensity exercises Short bursts of activities stress Management very important okay you must Find at least one pleasurable activity On a daily basis something that gives You intense pleasure everyone’s Different but whatever it is Find it find that one and then have a Stress management program and we are Very fortunate we have yoga we have we

Have our spirituality that we can Engross ourselves into and no more than One alcoholic drink a day 10 minutes of direct sunshine every day Because of the vitamin d and behavioral Therapy means Be on the lookout you may be an addict Look for the cue enablers and avoid Addiction foods So be aware how do i feel when i eat This why am i eating this am i am i Fully aware of what’s going on or am i Eating involuntarily and just as a Reflex both mental and physical just Grabbing the stuff and just eating it am I addicted to it And if we honestly look at these things You will find that that you can make the Changes um So i hope you all enjoyed this but It scares me that the incidence of Coronary arteries in south asians is so High and climbing And there’s not a week that goes by when I hear that Somebody lost their son At a young age Parents are still alive And they may be in the 80s And the sun is in their 50s and lost the Sun it’s a tragedy what’s going on And you know throughout school nobody Really gave us an adequate explanation As to why this is happening

But i hope that i have shed some light As to why we are particularly prone to So much premature coronary artery Disease as young age and don’t buy this Theory that it’s always so genetic That’s it it’s not Um if it runs in families it’s because They probably eat the same thing and Behave the same way and they and they Metabolize their life in the same Psychosocial ways So i hope this is helpful to you if you Like this please don’t forget to Subscribe to my channel And look for some more videos And Press the thumbs up button Thank you Good health You

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