Regenerative Health with Max Gulhane, MD
I speak with world leaders on circadian & quantum biology, metabolic medicine & regenerative farming in search of the most effective ways of optimising health and reversing chronic disease.
Regenerative Health with Max Gulhane, MD
94. Dr Ankur Vemur: Emergency Physician on Key Metabolic Risk Factors for Heart Disease (Not Cholesterol)
Dr Ankur Vermur sees heart attack patients daily in his emergency room in New Delhi, India, almost all of them with normal cholesterol levels. We discuss the key, underappreciated metabolic risk factors for aetherosclerosis (ASCVD) and how you can avoid them with lifestyle changes.
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TIMESTAMPS
02:38 Understanding Heart Attack Symptoms
05:31 The Changing Landscape of Heart Attack Risk Factors
08:34 The Role of Diet in Heart Health
11:23 Metabolic Dysfunction and Its Impact
14:22 B12 Deficiency and Cardiovascular Health
17:16 The Importance of Lifestyle and Occupation
19:54 Challenging Traditional Medical Guidelines
22:48 The Role of Vitamin D and Sun Exposure
33:53 The Importance of Sleep and Nutrition
36:10 Addressing Nutritional Deficiencies in India
40:58 The Role of Doctors in Questioning Practices
47:32 Cultural Perspectives on Diet and Health
53:35 Challenging Dietary Guidelines and Hypotheses
59:13 Research and Future Directions in Metabolic Health
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Okay, welcome back to the Regenerative Health Podcast. Today I'm speaking with Dr Ankur Verma. Now he is an emergency physician in New Delhi, india, who is doing some very interesting research and observation about certain groups of patients coming in to his emergency department. So, ankur, thank you for joining me.
Speaker 2:Hey, thanks for having me, Max. I'm looking forward to this.
Speaker 1:So your work kind of stood out to me when you published or you've popularized or discussed some very interesting findings with respect to heart attack patients who are coming into your emergency department. So in this discussion I want to get deep into the characteristics of people who are having heart attacks, because in India, in Australia, around the world, this is a major cause, if not the most important cause, of death and disability in the world. But maybe before we kind of get into the nuts and bolts of what we think and what you've observed is happening and who's at risk, maybe talk a little bit about the presentation of someone who's coming in with a heart attack, because that might make it a bit more real for people.
Speaker 2:Yeah, you know, it's quite common for people to think that a left-sided chest pain leading to the left arm is the most common symptom. But you know, whatever we've read in our textbooks as the textbook presentation is actually one of the rarest presentations of those diseases, aren't they? But you know, a patient with a heart attack does not need to have just chest pain. You know, there could be profuse sweating which is, you know, uncharacteristic of the patient. You know, if they feel that you know that I'm just sweating profusely too much today, it's not normal for me they could be having shortness of breath, they could be having pain which is going into the neck and jaw. I've actually had patients who've come in with diarrhea and they were actually having a heart attack. So those are some of the presentations, but obviously the most common is actually retrosternal chest pain or tightness, you know, where you feel as if an elephant is sitting on your chest, you know. And then just squeezing your chest out. That's the most common presentation. And then obviously, you have radiation to the different arms, and you know it's been seen that. You know, if it's's radiating to both the arms, that's more ominous than radiating to the right arm, more ominous than radiating to the left arm. So, uh, you know and by ominous I mean you know the patients are going to crash really really quickly if you don't do anything. Uh, so these are.
Speaker 2:These are some of the really typical ones. But then one needs to understand that if you have certain comorbidities, like like diabetes, which is the most common comorbid condition, especially in india, probably across the world, right, you don't come with typical symptoms. You probably won't even come with sweating or shortness of breath. A lot of these people come with, you know, just upper abdominal pain, which they usually tend to pass as acidity or probably heartburn or something, and they don't have these typical symptoms. Even their ECGs will not be completely characteristic of an MI. You need to do your TROPS, you need to do some ECHOs and then diagnose the patient with an MI. But I've had these silent ones come in just feeling uneasy and they come in and they have an STL-evited MI on the ECG and then we do the STEMI code.
Speaker 1:But yeah, these are some of the symptoms which are more common for patients who are coming in with a heart attack and talk about India specifically with respect to this problem of atherosclerotic cardiovascular disease, Because in Australia and New Zealand, America, US, Canada, obviously it's a problem. We have certain characteristics I mean age of onset, obviously, comorbidities but it seems to me that what's happening in India is particularly bad and particularly severe.
Speaker 2:Yeah, I mean, age is no bar anymore for having a heart attack. I mean, we published a case where we had a 17-year-old come into the heart attack and this was way before the pandemic, so it's not like it's not been happening over the years. A lot of people don't actually survive up to the hospital, right, and you know they don't even get an autopsy, so you don't even know if they were having a heart attack. But today's uh date, we get a lot of patients actually uh, who survive till the hospital and we're able to diagnose them and uh, and we're seeing people from the ages of 20 all the way to about 80, 90 years old. I mean, yeah, 80, 90 years old used to be the ones that we read about. You know that that's when you're going to have a heart attack.
Speaker 2:But I still feel a lot of the people in India were having heart attacks even at younger age groups. Most of them, or most of them, were not even diagnosed with heart attacks. Most of them, or most of them, were not even diagnosed with heart attacks. But we're seeing this and and uh, most a lot of people think that smoking is one of the risk factors. I mean, we know that is. I mean, you don't have to think, we know that, but most of my patients don't smoke like I think. If, if I remember correctly the study that we're doing right now, about 75 to 80 percent don't even smoke, right? So we're looking into why exactly are they having a heart attack, right?
Speaker 1:and and that's something interesting that we're digging into, and we've I've had some conversations with some cardiologists, just just, you know, raising some prickly questions no, I love it, and that's what that's what this podcast and and yours as well is about is asking prickly inconvenient questions that that challenge uh challenge the status quo. So talk about these traditional risk factors, because there's lots of papers essentially showing that we can no longer necessarily rely on these traditional risk factors per se to help predict heart attacks. So give us the background on what those traditional risk factors are, and then we can talk about what we think is also going on.
Speaker 2:Yeah, if you remember, in our MBBS or our graduate textbooks, we read about modifiable and non-modifiable risk factors, right? So your modifiable ones were basically smoking and your lifestyle the food that you're eating Hypertension, diabetes, could be modified through medications. And your non-modifiable ones were basically your age and sex. Males had a higher propensity of having a heart attack and, you know, higher the age, more chances of a heart attack. But it's surprising how we didn't focus too much on the modifiable ones and the most important one, the most famous modifiable risk factor, was always cholesterol, right, and LDL, before the concept of metabolic syndrome actually came about. I think these were some other ones and so, and smoking was obviously something that that was really focused upon, uh, and rightly so. But uh, people didn't focus on the pathophysiology behind hypertension and diabetes, you know? Uh, or cholesterol, first of all, cholesterol was not rightly so, but wrongly described to be a cause of atherosclerotic cardiovascular diseases or heart attacks. Hypertension and diabetes, yes, but what was the mechanism behind getting the hypertension and diabetes, you know, behind getting the hypertension and diabetes? You know, that was something that was never looked into or never taught. We were all taught to give medications to try and pacify the hypertension and diabetes. Right, but it never worked. It never works, right.
Speaker 2:So all the patients and they come in with heart attacks and you're like, oh fine, you're a diabetic, you're bound to have a heart attack someday. Then what's modifiable about it? Then right, yeah, I mean, if you're going to do that, if that's what our attitude is going to be, all right, this guy had diabetes and you know this is one of the complications. Then what are we doing about it? We're just putting them on medications and just adding it on and on and on increasing the doses and putting on more medication and waiting for the complications to happen, and then you can't do much about it. You're just going to give more medications for each complication. It doesn't work.
Speaker 1:And that's you as an emergency physician is that you're at the bottom of the waterfall. People have people could have been like floating down the river for 20, 30 years, collecting metabolic dysfunction and and and cardiovascular risk, and then they fall down the waterfall and you're there to kind of patch them up and and, uh, try and prevent them from dying. But there was so much that could have been done in the intervening preceding years to address the problem, but it wasn't done. And it's a comment about the state of our profession which is, it's almost this nihilistic, waiting for, as you say, something to happen. Oh, he's a diabetic. We're waiting for him to have his stroke or have his heart attack. We're waiting for his kidneys to pack in and get plugged into the dialysis machine. But it's so good that you're actually kind of doing some of this research to try and understand why.
Speaker 2:Yeah, I mean, once I got into my metabolic journey and down the rabbit hole and I saw the Matrix and I was like what a second man. Are we actually saving lives? We're not. I mean, we're saving that patient in that moment of time. I mean they might come in and crash and go into a dysrhythmia or a VT or a VF and all of that. And you know we do our CPRs and advanced techniques or whatever and save the guy. And then they put a stent after that. But then what happens?
Speaker 2:Once he's discharged, right, he's put on medications, rightly so. Again, the guidelines say so. So you know you have to put them on medications, uh, especially in the acute stages. Yes, I understand, uh, and then they're given, uh, the wrong dietary advice, and it's it's the advice that the patient was usually having anyways, especially in india. And and they're discharged and uh, and they continue with the metabolic syndrome, uh, it just gets worse. And we know, once you have a heart attack, you can always have it, but should you, or do you actually have to have another heart attack? Can it be prevented? And not by medications, because that's not doing it right. I mean, I, all of us have seen so many patients coming in with the second heart attack. Uh, they're eating apparently right and clean and green and they're non-smokers, but they still have a second heart attack and that's blamed on the first heart attack, right and they're on statin therapy exactly yeah.
Speaker 2:so yeah, we'll get into that if you want yeah absolutely so.
Speaker 1:Talk about these people Like. What are the characteristics of these people there? Obviously, and to give a bit of a background, india has a very vast and extensive culture of vegetarianism. So people aren't eating animal products. People are probably not eating a lot of fish either. They're not eating seafoods, they're just eating wheat, wheat-based products. They're eating, um, you know, wheat-based bread. They're eating rice rice what else? What's this typical diet that people are eating?
Speaker 2:yeah, uh, people do eat some seafood, but then again, you know, uh, what I like to call people in india plant omnivores the one who you know probably say that, oh, we're non vegetarians. You know, if I ask them, how frequently do you eat your meat or your eggs, or your seafood? It's like, probably once or twice a week, right, and that's accompanied with rice or rotis, which is wheat based, or naans, which is, you know, like refined flour. So those are the plant-based omnivores, because the rest of the meals, so I give them an average, like you know, if you're eating three meals a day, that's 21 meals a week. How many times would you eat meat? It'll be twice. Two out of 21, right, uh, that's just like five percent, something I don't know, uh, or 10%, yeah, so, and that's that's about 30% of the population. The rest, 65 to 70% of the population, are pure vegetarians. And you know, if you, if you look at breakfast all throughout India, it's majorly carbohydrate based and carbohydrate loaded. You know, if you go to south of India, it's gonna be. You know, I don't know, if you go to south of india, uh, it's going to be. Uh, you know, I don't know if you've heard of these dishes, but you know idli and dosa and vadas and you know these are all cereal and grain based and and have a lot of potatoes in them, so it's all carbohydrates, a lot of oxalates.
Speaker 2:Now you get you go to the west of india and you have these rice-based uh uh breakfast which is likeha, and I've had my share, for sure, because I did my medical from the west of India and that was a staple. You know we would play, you know something like poker in the night with just coins and just to time pass and whoever won for like 100, 150 rupees. You know we would bike it down to one of those railway stations where you get really nice poha at four in the morning and just hog. So, yeah, so that's, that's like the staple breakfast of west of india. You come to the north of india, you might you must have heard of chole bhature and parathas and all of that. That's all again carb based and the same with east of india. So, and and if you go to the metropolitan cities, uh, it's like english breakfast. So you have baked beans and breads and croissants and stuff and, uh, people like to do that fruits and juices and all right, so people do that. Uh, that's the most common. This is the breakfast, right, so you can imagine what the lunch and dinner is going to be, right. So started, not a good start. Exactly exactly. So that's how the breakfast starts in most of Hindead and we're doing a lot of research.
Speaker 2:So we're an academic department and the last couple of batches, I've named them the metabolic emergency group or the emergency metabolic group. So their research and thesis is all based on emergency medicine and the metabolic health of our patients. Because I realized, uh, 90, 95 percent of my patients who are coming in have metabolic dysfunctions or complications of that. Right. So they're coming in with heart attacks or strokes or diabetic, keto acidosis, hypoglycemia, kidney, chronic kidney disease and their complications, cancers and their complications, severe infections or severe sepsis, right. So those are the ones who are immunocompromised and they think that they're absolutely fine, but they've never got tested, right? All of these are coming in. You know hypothyroid complications, asthma, autoimmune disorders, aaa, pcos dissections, all of these right. And then 5% of the traumas that are coming in. You can't do much about that, so you deal with them, but these are the ones that are coming in.
Speaker 2:You know kidney stones, gallbladder stones. You know high oxalate diets, don't know. I mean, as a doctor, you know, uh, and I accept, I accept my fault of telling people drink more water because you've got kidney stones or have some more beer or, you know, avoid tomatoes or you're dehydrated, that's why you're getting these stones. And and because we, we weren't told about oxalates or calcium oxalate or where you get that from, right. So so diet's a problem.
Speaker 2:You know all my gallbladder stone patients, they're all vegetarians, right, and you know we forget our biochemistry as to as to what the function of bile is and what's going to happen when, when it's not released, when you don't have the right food, right. So so all of these are coming in. So we're doing a lot of research and we're seeing a lot of things, we're observing a lot of things, which is obviously you can't do rcts. Nobody can do rcts. It's, it's not that easy, uh, especially related to emergency medicine and their diets, right, because it's like a cross-sectional study in that particular moment of time. And so, yeah, these are all epidemiological association studies, observational but massive observations. I mean, if you link that with the biochemistry and the physiologies, we'll understand what's happening, right.
Speaker 1:So these are non-smoking patients with metabolic dysfunction. So they've got signs of insulin resistance, pre-diabetes diabetes and these are the people coming in with their heart attack and again it's flying in the face of these traditional risk factors. The question I also want to ask is what are the occupation of these people who are coming in with heart attack?
Speaker 2:Yeah, so for smoking, most of them are non-smokers, like 75% to 80%, just to be clear. They have different occupations. We've got government officials, we've got a lot of the labor class coming in. We've got a lot of business people coming in, the service class people, all walks of life, you know. I mean from the rich to the poor. It's not sparing anyone, right in different religions.
Speaker 1:Indoor or outdoor workers, are they mostly indoor office?
Speaker 2:workers, both, both, but mostly indoor ones, mostly indoor ones, probably the outdoor. So we're a private hospital, right, so not everybody can afford us, but a lot of them actually do come in and you know they get the free treatment for the heart attacks.
Speaker 1:Yeah, okay. So yeah, tell us what you're finding, because obviously, b12 deficiency, hyperhobocystinemia Explain these concepts, so people can understand what they mean.
Speaker 2:Yeah, absolutely. I mean, we all know how important B12 is for us. That's the most important water-soluble vitamin, right? And you get that only from animal products, and there are actually a lot of cereals and grains and vegetables that block the uptake of vitamin B12 from the meat that you eat. So if you're combining your, your, your chicken gravy or your tandoori chicken with with uh, your carbohydrates and your anti-nutrients, your b12 is not going to go up, it's going to get blocked. And it's so apparent because a lot of my trolls tell me, you know, I'm a non-vegetarian, my b12 is low, you know. So you're talking crap. I'm like you're eating it the wrong way, right? I mean, when I started with my carnivore journey, my b12 was like 300 something. Now it's 1060, something like that. Uh, because I stopped having things said that were blocking my b12. So india, like I said, is mostly a plant-based country. No matter what people want to say, it's mostly a plant-based country and it's rampant. B12 deficiency is in everybody, everybody, I think so, in our. My patients, in a heart attack patients.
Speaker 2:We're looking at a few of the things. We're looking at their lipid profiles. We're looking at the diabetes data with hba1c. We're looking at the b12 levels. We're looking at their homocysteine levels. Uh, obviously, the other demographic and epidemiological characteristics like age and sex and smoking and alcohol and what they eat right and and not not what they eat. It's not a it's not a food frequency thing that we're doing, but the dietary preference. But if they're an om, if they say that they're omnivore or a pescatarian, we just ask them how frequently they eat that right and the rest of the times it's obviously uh, plant-based and uh. And we're taking out the triglyceride to hdl ratios and it's massive. I mean every one of them.
Speaker 2:I think we've collected about 120 patients till now. Every one of them has a high tg2 hdl ratio which is more than two. Uh, I think three or four or maybe you know benefit of doubt, I don't remember the numbers off the top of my head, but probably you know. You know, if I take them the upper limit, probably eight to 10 patients have normal B12 levels because of supplementation that they're doing. They're vegetarians but they're taking supplements which is cyanocobalamin, so they're like 1500s and 2000s. Some of them have normal homocysteine levels. Most of them have still have high homocysteine levels. Most of them still have high homocysteine levels. The rest, everybody has B12 deficiencies, and by B12 deficiency I mean less than 400, you know which is not even optimum, because the reference range goes from like 190 to 900. And you know you get neurological symptoms when you go below 400, right, so you need your optimum levels to be above 400 or 500.
Speaker 1:So yeah, b12 deficiency, pick a moles per liter. I believe is the unit.
Speaker 2:Yeah, yeah, yeah, yeah, absolutely. And you know I've seen B12 levels as low as 30. Wow. And homocysteine levels as high as 223. Wow, and homocysteine levels as high as 223. Wow, in these heart attack patients.
Speaker 2:So, for your listeners, homocysteine is a protein which actually balances out your clotting. It's supposed to help you heal when you get hurt and all and it clots your blood. And methionine is an essential amino acid which is converted into homocysteine. That's just one of its function and it does its job. And B12 remethylates homocysteine. That's just one of its function and it does its job. And B12 remethylates homocysteine back into cysteine, so it keeps it under check, you know. So our bodies like that, where you know it has checks and balances. But then if you don't eat B12 in the right way, your homocysteine goes out of control.
Speaker 2:And all of these patients have high homocysteine. So homocysteine is actually an independent risk factor for cardio, the cardioembolic disorders, and by that I mean you can clot in your lungs, you can clot in your brain, you can clot in your heart, you can clot in your legs, anywhere in your body, right, uh? So that happens, and high homocysteine actually destroys your glycocalyx also. So I have this really interesting conversation with uh now the doctors nader, ali and malcolm kendrick right. And homocysteine actually destroys your glycocalyx also. So when your glycocalyx is getting destroyed, your nitrous oxide is falling down right. So your blood pressure is going to spike up. It's not going to be in control and then it causes injuries and those injuries can lead to blood clot.
Speaker 2:So you have an injury, blood clot, and then you have the homocyte which is causing a blood clot, and then you have the body's defense mechanism coming on as band-aids, you know, and, and that, I feel, is what is going to cause an atherosclerotic block later on, when it keeps happening again and again, and again and again, and and more so. These I've had actually patients come in with the second heart attacks and we had done the b12. At the first time it was low. We did it again, it was still low. Means what?
Speaker 1:that they weren't given the right direction for dietary interventions yeah, and I guess, from my point of view and looking at this problem of atherosclerotic cardiovascular disease, I absolutely agree with a lot of what Dr Malcolm Kendrick says about endothelial damage and damage to the blood vessel wall and this glycocalyx as being this kind of primary insult that therefore then drives this pro-clotting, pro-thrombotic environment which leads to, over time, a micro-injury which gets plugged by a platelet plug and then occasionally a macro-injury where you get a massive endothelial damage and then a huge blood clot that actually occludes the lumen of the coronary artery, leading to massive AMI.
Speaker 1:The point about nitric oxide is a fascinating one and the one that I'm particularly passionate about, because it's known quite well by now that ultraviolet, a light, uh induces or um, essentially liberates nitric oxide from, from the stores in and around the endothelial layer, meaning that people who are not getting out in natural sunlight that's why I asked you about the uh occupation of these heart attack patients people who aren't getting out in ultraviolet light are therefore not getting a vasodilating force which is then going to push their blood pressure up. And actually also there's a link to an inverse relationship between vitamin D and homocysteine, meaning that maybe it's the UV light that can potentially offset some degree of this hyperhobosystenemia that was um originated from a b12 deficient diet.
Speaker 2:Yeah, yeah, absolutely, and you know a lot of my clients and my patients who who are consulting me for, you know, reversing disorders. You know they're actually considering me for diabetes or, you know, fat loss or weight loss and maybe hypertension, loss of the periods and stuff, different, different things. And when I get these, get them all tested they're all vitro deficient with high homocysteines. We need to understand. I mean, homocysteine has also been linked with a lot of dysrhythmias like supraventricular tachycardias, atrial fibrillation all been documented, all been published. I've actually sent out a paper for review which is linking. I mean I've been seeing my pure vegetarian patients coming in with no known comorbid conditions, young ones between 20 to 30 having absolutely tanked b12 and really high homocysteine levels, right, and I'm actually trying to collaborate with some cardiologists who might, you know, uh, do like a ct coronary angio on them and then we can see and and the lipid profile and see what's happening. You know, and and that's you know I forgot to mention in the study of my heart attack patients, most of them have a cholesterol level less than 200. Most of them have LDL levels less than 100. Maybe the average is about 105 because of the omnivores who eat some meat, so they spike it up a little bit and that's what we want. We want a little higher ones there. So that's also really, really interesting.
Speaker 2:We've also got a lot of them who are already on statins, right, the first heart attack, or they have diabetes and they've been put on statins as per guidelines and their levels are absolutely okay. You know, and these are the ones the you know. Another interesting part is that the guidelines don't ask you to do your lipid profiles when you have a heart attack. They don't. They don't. The guidelines don't say that. You know you're supposed to start them on statins, right, it's a blanket rule that you give them the loading dose, which is obviously for the you know, because you know pleiotropic effect. It has an anti-inflammatory effect at that moment, right, and later on you're supposed to continue them on the statins.
Speaker 2:And I asked my cardiologist when we were doing all of these tests you know, like, like, the cholesterol levels are normal, the lipids are normal. Why do you want to keep them on statins for forever? Because that doesn't seem to be the cause of the heart attack, especially not the ones with the normal ones, right. But they can't help it because the guidelines say so when you have vultures sitting outside anywhere who can always instigate the patient or, you know, like you want, started on statins, you know, is the doctor trying to kill you, it happens. I've spoken to neurologists and they're like. At least a couple of them said we don't want to start our stroke patients on high-dose statins which can be harmful, especially with the patients who have diabetes.
Speaker 1:It's a very interesting situation where it's almost like the patient isn't statining hard enough. Why aren't you?
Speaker 2:statining hard enough, you've come in with your second heart attack.
Speaker 1:You know, and they are, they're taking this medication. But it really speaks to the fact that the paradigm is misunderstanding the true root cause of these patients' illness, Otherwise they wouldn't come in with another AMI. And I'm reminded of a study, I think it was 2015. I'll add it to the show notes, but I talked about it in a talk I did at Regenerate in 23, sorry, 24, no 23.
Speaker 1:And it was an analysis of about 120,000 emergency and hospital presentations with coronary artery disease either ami or um or coronary artery disease and they measured the serum lipids and the serum lipid levels. Uh, over half of them were in the normal range like in inverted commas meaning again like we're we're. Are we missing something or we're simply not looking at the problem in the correct way?
Speaker 2:yeah, I think, I think that was the epic study or something right 120, 130 000 uh patients it was an observational.
Speaker 1:Yeah, it was an observational cohort.
Speaker 2:Yeah, yeah, most of them were between 70 to 100 ldl levels, and, and, and the conclusion was you need to bring the LDL to less than 70.
Speaker 1:Yes exactly.
Speaker 2:I was like why is I mean you can't be chasing zero, right?
Speaker 1:Well, that's what they want. They want the apopoeia level and the total cholesterol LDL to be driven to zero in order to prevent this condition, so they want the liver to stop working.
Speaker 2:basically.
Speaker 1:Yeah, and really I think both you and I what we're saying is that this APOB-focused, ldl-focused paradigm of heart attack prevention is failing patients and it's kind of missing the point here, and I really love it how you were investigating a nutritional aspect of it, and I previously have talked about the way that the light and the light environment is affecting it and is affecting the degree to which the blood or the blood products are liable to coagulate and therefore clot over. So have you ever measured vitamin D? Are you able to measure serum vitamin d? Are you able to measure serum vitamin d when you do these patients um initial?
Speaker 2:blood tests. So not on these mi ones, because it's not in the research protocol. So, uh, we're not doing uh vitamin d in this, but, yeah, I mean a lot of other physicians do get them done. We're doing another really interesting one, which is uh on young adults with uh, no history of diabetes, right? So, uh, anybody coming from the age of 20 to 45 with the sugar level a random sugar of 140 or above, we're testing them for their a1c's but what's that?
Speaker 1:in nano nanomoles? A millimoles per liter, because my audience all right let me just more of the metric. And to clarify Ankur is referring to the US unit of lipids which is, I believe, deciliter, milligram per deciliter. Milligrams per deciliter. In Australia and the UK we talk in millimoles per liter. So, it's a different unit, all right. Let me just uh 7.8 okay, yeah, so sorry, a random. A random blood glucose above 7.8? Yeah, yeah.
Speaker 2:Yeah, yeah, and 45% of them turn out to be diabetic and they didn't even know that.
Speaker 1:So it seems to me that there's this massive iceberg of undiagnosed type 2 diabetes and B12 deficiency, hyperhobosy, cyst anemia, probably vitamin D deficiency as well 100%, yeah, yeah, yeah, yeah 100%. Talk about, because when I visited India, I noticed that people were wearing long sleeves. People wear long sleeves, long trousers, people are avoiding the sun. Can you speak to people's sun exposure habits?
Speaker 2:It's really hot here. You, you know when it gets hot, so people do want to cover up, uh, you know, and we are near the equator, so uh, yeah, I mean during during the summers, uh, or even during the winters, uh, but uh, it depends on where you are actually. I mean, if you're way up north in the hills and all you do want to cover up, I mean if you go to the beach sides and all people are actually wearing short sleeves and stuff, but I mean that's when they're on a holiday, right. Or if you're living in Goa or Kerala, people do get out a little bit. The metropolitan cities, I mean, you have your cars, you have your houses, you have your offices uh, you don't want to actually come out. And you know, unless and until the weather is nice, you know, when it's a little breezy and stuff, people do actually try and go out, but it's not, it's not like a daily habit.
Speaker 2:Uh, even for me it's really difficult because, you know, I wake up at 7, leave at 7 30 for work. I don't wear sunglasses anymore, uh, to work. And I've realized the difference because you know, uh, when I used to wear sunglasses to work, I would be yawning all the way, uh, and then I realized, you know, the brain doesn't know, or the brain is confused, that you know. I just woke up and then it's dark again. Yeah, you know, uh, but since I stopped bedding into work, uh, I feel energized. You know, I wear the blue light blockers in the evening so I get my melatonin in time, so, so I, I do all of that and and that's and it's really helping me.
Speaker 2:100 because I can, I can see my sleep, uh is, it's such a beautiful sleep, right, because you just passed out. You have no idea what happened, even though you if, if you know, if you're not that tired during the day, uh, if you don't have major catabolism during the day, uh, the nights are like, absolutely so serene, so peaceful. I mean, you know you get knocked out and you wake up on time and and you're full of energy and you can do whatever work you want to do uh in the morning. So, yeah, I mean, uh, some of these habits actually do need to get in uh to a lot of people in india yeah, I, I strongly suspect that.
Speaker 1:Um, and from from measuring my, in my clinical practice, measuring people's vitamin d level, uh, again from from michael professor michael hollick's work on on-ranging people in Africa, an ideal blood range is above 100 nanomoles per liter.
Speaker 1:125, which is, I believe that's 40 nanograms per deciliter. So most people aren't getting near that. If they're just doing incidental exposure, meaning if they're just taking off, rolling their sleeves up or wearing a sword sheath shirt, no one's getting close to that ideal vitamin d level. So if people, unless you're essentially taking your shirt off and intentionally exposing yourself to the sun. So I guess the reason why I'm bringing this up? Because because from my point of view I think this is an intimate related aspect to this atherosclerotic cardiovascular disease, because if we're unplugging from the sun and patients aren't getting these critical light signals to vasodilate, to regulate their circadian function of their cardiovascular system, then that's, that's just adding, adding onto the problem. And if, if we're adding cultural sun avoidance onto cultural vegetarianism, it's like it's like the ticking time bomb yeah, yeah, absolutely man, yeah, you're absolutely correct talk a little bit now about, um, like what can be done, because you've obviously, you're obviously uh identifying kind of this problem.
Speaker 1:Like what, what next? What can you, what advice can you give? What, what are you doing?
Speaker 2:yeah. So I mean, I have my own, uh side metabolic health practice, right. So, uh, getting a lot of patients through that and even uh, on flow, uh, with my real-time patients, we do give them, uh, you know, a sort of a rundown into nutrition or a nutrition 101, and a lot of my teammates have actually started to understand what what I've been talking about, because they're seeing it themselves and they're all doing the research, right, uh, it's, it's their thesis. So, uh, they're seeing that we're trying to get as many case reports and case series because I think that's really important. A lot of people, you know, uh, you know just, uh, uh, don't don't give importance to case reports and cases. I think it's really important because that's where the seed is planted, that's where an idea is planted and that's where you start. That just opens the door into uh, what, what, what you're looking at, you know, and and then you see more of that pattern happening, right, it's like seeing the matrix, right. So you know, a case report will lead to a case series. A case series will lead to an observational study. That can lead to an interventional study. So people need to understand that.
Speaker 2:So we're doing so many different studies. We're doing sarcopenia and diet. We're doing urethra and renal calculi and diet. We're doing all the metabolic syndromes coming. That's, I think, my biggest one. We're about to hit 11,000 patients for that and then we're going to sit down and analyze that study. So 11,000 patients have come in with different diagnosis but they all have comorbid conditions like diabetes, hypertension, heart disease, strokes, alzheimer's cancers, all of that. You know their dietary preferences. That is like a 32-question dietary questionnaire which has everything sugars and alcohol and smoking and exercise and all of that.
Speaker 1:Is that on presentation, like they come into the department and they fill out the form?
Speaker 2:Yeah, yeah, yeah, yeah, absolutely. So we're doing that and so we get to talk to them. You know, I mean heart attack patients. You know why do you think you've had the heart attack? Because nobody asks them this question question and the patients have stopped asking this question. Right, if they hit 40, 45, why did I have a heart attack? Uh, maybe a 20 or 30 year old might ask why did I have a heart attack? But they don't get the right answer. Maybe it was cholesterol, you know. Maybe it was something that you ate, but most of them eat what doctors and and the dietary guidelines want them to eat. Right, and that's what the advice is when they're giving I. I remember I had this 25 year old who came in with a stroke. He had had two heart attacks previously, age 25 incredible age 25.
Speaker 2:Yeah, he was on all the medications. He was taking all his medications on time, all of it, right. His lipid profile was clean, absolutely clean, right. But his b12 was pathetic.
Speaker 1:His homocysteines were really high, pure vegetarian and and maybe it's a really good point to mention that we can't blame uh, familial hypercholesterolemia on these really young ages of of uh ami, because that's uh, you know, that's what, what can be a reason, but this guy's lipid profile is, as you said, it's completely in the normal range, so we can't even the cardiologist can't even blame that absolutely yeah and uh, and I mean the thing is that people are not asking at least my team.
Speaker 2:I'm proud of my team because they've started asking these questions. I mean, they've started to have these discussions with their colleagues, their peers, you know, junior residents or academic residents and the other consultants. And we need more doctors actually questioning our own practice, right, and we need more doctors actually questioning our own practice, right. We need to understand and there's something really nice that I think Tom Cowan I had heard him on a podcast who said doctors have a thought disorder. You know, once you've read something, we don't want to relearn and unlearn, or unlearn and relearn things, right, and we have this uh that that whatever we're saying is absolutely right, it could be right. I'm not saying that we're always wrong, but uh, to question ourselves and and think about the pathophysiology, uh, and and and relating that to uh, the way we live, I think is is important for doctors to address and uh, you know, uh, get sorted.
Speaker 1:I've said this before, but I think the more subspecialty training one does, the more convinced they are of their correctness and their position and the more resistant they are to changing. And it's frustrating, but I think that seems to be the case. Talk about your journey, because I guess you probably wouldn't be doing this research if you hadn't gone down this path yourself.
Speaker 2:Yeah, absolutely. I mean, everybody has a trigger point and because of that, I actually feel that, you know, I'm trying to raise as much awareness as possible so people don't wait for that trigger point, because that trigger point just could be a cardiac arrest and the family is like you know, this guy was healthy and you didn't even know that he was unhealthy, right? Like I said, we're getting so many undiagnosed diabetic patients who are young adults, right, and it's lucky for them that they're coming into my department and we're doing the study and we're diagnosing them with diabetes, so that something is done about that. Maybe they put on medications, you know, I mean, we do have a discussion with them regarding the diet, but then if they did not come in and they were living with that undiagnosed diabetes, they could have ended up with a heart attack and may not have been able to be brought into my emergency on time, right? So I don't want that. I don't want people to have those triggers.
Speaker 2:My trigger was when I did my test. I just did my random routine test in 2021. I saw my triglycerides was 600. And I knew something was wrong and I knew it was because of my diet, but the thing was I thought I was having the right diet, which is a standard Indian diet. But I was always an omnivore, and a better omnivore than the rest of India because I used to love meat from the age of two. I've heard stories of myself from my family, of you know how they would cook a separate full chicken for me and a separate full chicken for the rest of the family. You know that's how much I loved it it. But then obviously carbohydrates happen to all of us and you know, and I call exogenous carbohydrates an anti-nutrient along with the rest of the list, right. So all of that was there and obviously junk food and everything happened during college and post-college and you know, I mean I still remember we used to have blue pepsis and stuff and I'm like why anyways? So we've done all of that, right. And my triglycerol was 600. So I cut down on my sugars. It was an instant trigger for me. I cut down my processed sugars, I cut down my intake of rice, I brought it down, so it became sort of like a low carb. And then I read Robert Lustig's Metabolical and that took me down the rabbit hole, you know. So I said triglyceride, why I didn't even know about triglyceride to htl ratio at that time, because we were never taught and none of the labs actually report that, right. So then I realized my triglyceride to htl ratio at that time was 16. Wow, right, yeah, eight times more than what it should be. So probably taking time bomb, I don't know, uh. But uh, and so I went low carb.
Speaker 2:I had been exercising for many years but obviously I used to eat a lot, because my trainers tell me eat as much as you can, eat as much as you want, because you want to get the calories back in, and you know. And then exercise and you want to burn it off and all of that, you know, kiko brothers, uh. And then I lost about 22, 23 kgs, uh, but I still had inflammation, because I've seen my photographs from that time because I'm still having a little bit of carbs. And then, uh, somebody sent me paul saladino's, uh, carnivore time reels. I saw that I'm like this makes sense to me and I had also cut off red meat for the first five or six months because, you know, I didn't know better. Uh, but I was put on statins. I was put on amlodipine for, for essential hypertension.
Speaker 2:Yeah, essential yeah and uh, but. But I stopped both of them at six months and uh, once I went down the whole rabbit hole, I, I researched, you know, uh, everything out of it. You know it's not like I believe salarino at the first go. Or you know everything out of it. You know it's not like I believe Saladino at the first go. Or you know, when I saw Sean Baker's podcast, I did my own research. I went and read all the books, all the papers that they were citing. I downloaded as many papers as I could got into it.
Speaker 2:I actually asked my first year PG residents to bring me their biochemistry books, because, you know, I don't know where mine is. And I started reading it again. I, I'm like this makes so much of sense, you know and it. Well, why was first year of medical school not translated into the final year of school? You know, and uh and so, and then I understood right and I saw changes in my own health and my family's health. My uncle I reversed his 25 years, 20 years of diabetes in two months on carnival. Uh, yeah, I mean, and I'm doing, I'm actually writing a case report on that I reversed his 20 years of diabetes in two months on Carnivore. Yeah, I mean, I'm actually writing a case report on that. He's no more, unfortunately, because of the renal cell carcinoma that he suffered from, because of uncontrolled diabetes and the chronic kidney disease that it leads to. Right, so that's the most important, or the major causes of RCC, and this is something really interesting that I really have to tell you.
Speaker 2:So I was having a conversation with artificial intelligence, you know, and I asked it what is the most common cause of renal cell carcinoma? It said smoking, hypertension and chronic kidney disease. I said what if somebody doesn't smoke? So it's hypertension and chronic kidney disease. I'm like, what about diabetes in the like? You know, textbooks don't mention diabetes. I said, yeah, but then what is the most common cause of chronic kidney disease? And it said I see where you're going. Of course it's. It's diabetes, you know, and that's, that's a critical pathophysiology.
Speaker 2:I said what about a diabetic diet which is actually prescribed? And it actually said, yeah, diabetic diet has a lot of carbohydrates which can actually worsen your diabetes. And you know, it went the way that. I don't know, I wanted it to go, but you know, the conversation was so interesting and finally it gave me a whole flow chart of diabetes, insulin resistance and diabetic diet, 230 grams of carbs, worsening insulin resistance, hypertension, chronic kidney disease and finally, renal cell carcinoma. But that was nice. So, yeah, I saw that he was on multiple medications, changed so many times over the past 20 years. I went through all his records. He was always given the diabetic diet and once he was told that you know, he needs to go into insulin and dialysis, which he did not want, I put him on carnivore and two months his doctor actually wrote down recovered from diabetes and hypertension, does not require any more medications. Wow, this took 20 years to do.
Speaker 1:Incredible. It's stark, this contrast of standard Australian living or standard Indian living, standard American living, compared to when you put patients back in an environment, and back into a food environment that is ancestrally appropriate. What does a carnivore diet look like in India? Is it something that's accessible to most people? Is it? Something that's accessible to most people? Is it something that people can eat or is it expensive? Like talk about that.
Speaker 2:Yeah, I've had. See, it's accessible. We get mutton everywhere, which is good, right. We get beef in some of the states in the south of India, above Maharashtra and above. You get a lot of buffalo meat which is equally nutrient-dense as beef. You get a lot of mutton, which is really, really nutrient-dense and has a lot of other amino acids. You get seafood. You get chicken. There are a lot of pasture-raised chicken and goats, especially the goats. The mutton is pasture-raised. You get a lot of eggs, right, so it's it's not difficult to source.
Speaker 2:The only thing is that india eats very less. We eat like five kgs per person per year. That's the average, which is insane. It used to be 3.5, so, yeah, it's increased a little bit in the past couple of years and it's very easily accessible, right, so you can do easily do eggs, pork, uh, chicken, mutton, seafood five of them different combinations.
Speaker 2:Uh, we do use some spices, uh, for indian cooking, that's okay, I think, for the for the palate. Yes, some of them have oxalate, so I I tell my clients to avoid those, like you know, uh, turmeric or cinnamon or cloves or black pepper and stuff. But you know, just completely go into. You know the continental style, you know, just the steak and or grilling gets a little difficult for the Indian palate. But you know, as long as you can do mix and match, it's absolutely fine.
Speaker 2:I mean, you know, you, you, you have so many options for eggs. There's so many options for goat, you know, you can grill it, roast it, cook it in ghee or something. So many options for eggs. There's so many options for goat, you know, you can grill it, roast it, cook it in ghee or something. So many options for pork you know we've got pigry farms like 110 year old, 110 years old over here and they have fantastic pork. So we do that and, and it's not expensive, because I tried this with one of my ward boys, you know he came in with an HBA1CF11 to me and I put him on Carnivore and you know he was doing fish, mutton and eggs and brought it down to about 5, 5.5 in about one and a half months or something like that, and he's sustaining it. Yeah, doesn't earn as much as I do.
Speaker 1:What's the access to? To like dairy and and like dairy products. What oils are people using like mostly, and what can they use?
Speaker 2:yes, a lot of people use ghee clarified butter clarified butter, yeah, uh, but again, uh, refined oils has actually come in and, uh, a lot of people use refined oils. But another one that's really rampantly used in India, which I don't mind, is mustard oil, cold pressed mustard oil that doesn't have omega-6, it has omega-9 aerosol. Very little research on that, right. I think they've done some research on rats, where they give them, like you know, massive doses and obviously things happen to the rat. So you know they've banned it in, which doesn't make sense, because in india we've we've used mustard oil for generations and generations. You know, I don't see it causing much damage and I basically use butter, lard, tallow, ghee, virgin coconut and virgin mustard there you Can you speak to the cultural practices with respect to the consumption of beef?
Speaker 2:Yeah, I mean that's a controversial topic in India, but yeah, a lot of South India, a lot of South India actually eats a lot of beef, and I've read a few historical books where it's mentioned that a lot of the religion uh, the religious priests and and brahmins used to eat a lot of beef, and this has been documented by swami vivekananda and br mbedkar in their books. And you know, we have a very strong caste system in india from ages, right. So you have the topmost and then you have the brahmins, and then you have the untouchables, right? So apparently everybody used to eat beef and once the Brahmins got to know that the untouchables also eat beef, they made it a sin to eat it. So, yeah, I mean, people have their own beliefs and to each his or her own. I'm not advocating it for anybody.
Speaker 1:That's what I was getting at, because my understanding is that obviously Hinduism, the consumption of beef is not common. But if you dig back into the Vedic texts and the old a couple of thousand years back, it was a thing that was done meat consumption. So somewhere along the line it's been a social taboo to eat, to consume beef. But but historically, uh, it wasn't necessarily the case.
Speaker 2:Yeah, yeah, I've been reading that. Uh, I think one of the I think it was a rig veda. I'm not a scholar, but I mean I've read the translations and stuff and uh it says that uh, the beef is so sacred that you should feed it to the sacred guests.
Speaker 1:Well, I mean everyone's sacred, everyone deserves to eat beef. But understandable, it sounds like, even if I mean it's a big jump to go to say consume it if you haven't for your whole life and your parents didn't. But it sounds like there's lots of other options for people. Yeah, yeah, yeah absolutely so.
Speaker 2:I mean, I think mutton is really. It's great and you know you get minced ones. There's a really nice recipe that we do, where it's just a mutton curry and we put minced meat and boiled eggs inside and just put in the slow cooker and it turns out absolutely fantastic. You should try that out with beef, if you want.
Speaker 1:Yeah, you're making me hungry just talking about it, but let's so. It sounds like these changes that you've made individually. Now you're doing the research in your emergency department. You're educating some of your colleagues and your juniors how do they feel when you essentially take the data and you shove it in front of their face about these characteristics of people having heart attack. And it's nothing like this diet, heart hypothesis or the lipid hypothesis that you know you and I were taught in medical school.
Speaker 2:I think that is a diet heart hypothesis that needs to be rewritten. Right, yeah, you eat the right foods and get your B12 up and reduce your homocysteine levels, get your cholesterols up, get your LDL levels up, you know you'll have good immunity. Another thing that people don't realize we missed on that cholesterol is an important precursor for the insulin receptors, right? So the lipid rafts and all of that and I mean mean, if you're bringing down your cholesterol levels and you already have diabetes, it's only going to worsen your insulin resistance. So I think there is a diet-heart hypothesis, but the only thing is that they've got it the other way around.
Speaker 1:That can be looked into right. Yeah, and seafood too, and the omega-3 fatty acids from marine-derived foods is enormously beneficial for reduction in cardiovascular risk and it makes sense because of its effect on clotting and coagulation. Absolutely so people are changing things, I guess. At least you're raising the message. I think you're showing people what's possible. So how is your message going down with your private clients? Are a lot of people adopting some of these techniques?
Speaker 2:Yeah. So first my team Not all of them are adopting these techniques. My HOD did and he's reversed his hypertension and prediabetes, so he's doing really well. Some of my juniors they're waiting for the right time. Probably they're waiting for their trigger. I've shown them their MRIs and the visceral fat that they have and the sarcopenia that they have around their abdomen, so maybe that triggers some of them. But most of them have started eating more animal-based and they're doing the same. I mean, they're preaching the same to their patients. A lot of my other colleagues, you know the senior consultants, were there neurologists, cardiologists, pulmonologists. They've seen the difference because you know, I've been working with them for the past 10 years and they've seen me change right and, uh, they know what I'm doing is right. They can't say what I'm doing is wrong because you know I I look fitter than them.
Speaker 2:Uh, you know yeah yeah, so, yeah, I mean, uh, and and if, if I raise a question, it's going to be a valid question, right, so, uh, nobody can come after me for that, uh, because, because they're not raising the questions themselves, right, so, yeah, uh, that that's, that's something that's really interesting. And my clients yeah, I mean a lot of them are actually doing this really really well. Uh, some of them see the magic with the weight loss that happens in the first 10 days. Right, that's way, what a way that goes. And you know, there's just more. I think it's it's a good thing that that that happens because of the insulin sensitivity creeping back in, because it gives them more motivation. Uh, if they see that right, and, and you know, I've reversed, they've reversed their diabetes or high uric acid levels, vitriol deficiencies, infertility, pcos you know I had a patient who was advised IVF at the age of 29. And you know, in two months of carnivore, she actually conceived and is now a mother of a seven-month-old baby. So you know, things like that Non-alcoholic, fatty liver, hypothyroid, hashimoto's, rheumatoid psoriasis all of these are doing fantastic right now.
Speaker 2:I know I've had a few vegetarians actually convert into carnivore, yeah, so, again, I mean they needed triggers. So both of them actually ended up with autoimmune rheumatoid arthritis. And ended up with autoimmune rheumatoid arthritis. And you know, one of them was on methotrexate and was bearing all the side effects and she had a baby and you know she wanted to hold a baby for the rest of her life, properly, you know, uh, so she's turned carnivore. And another friend of mine who was a vegetarian, uh, she's been diagnosed with rheumatoid arthritis. So, yeah, she's done, she's, she's transitioning right. So she's doing two meals animal and one meal, uh, still a little bit of carbs and veggies. So I'm going to wean her off that slowly because, uh, she's she's eaten vegetarian all her life for the last 40 years. So, yeah, it's gonna take some time, but yeah, I mean, at least at least they got motivated enough. Everybody wants that trigger.
Speaker 2:So, yeah, my patients are doing quite well. There are some who are still waiting for the right time to actually start off, uh, and they've understood everything. Yeah, and we have this fasting group going on. Uh, my carnivore consult, thursday fast, so we do like a 24 hour fast together. Uh, it's a smaller community, so you know anybody who does carnivore consistently with with us for like four or five or six months and the same results. I add them onto my uh fasting group. Uh, so you know there's that bonding and uh community development over there, so so, yeah, it's a start. Uh, let's see where it goes.
Speaker 1:My website's coming up soon, hopefully, so working on that, so a few things going on here the thing we didn't talk about was this role of epicardial fat in terms of the pathophysiology of atherosclerosis and atherosclerotic cardiovascular disease, and what I mean by that is, if we take a scan of the heart usually the best modality is MRI you can see that there's this ectopic fat, this fat that shouldn't be there, you know around the artery and it's sitting right next to the coronary arteries and it's releasing all this inflammatory cytokines which are going to be provoking endothelial dysfunction and right there next to them and also, you know, atrial fibrillation and other kinds of cardiac dysfunction.
Speaker 1:So are you, are you able to measure that?
Speaker 2:or I guess not necessarily on the patients that come in um and with it no, not all of them I'll show you something that's a ct oh yeah of a trauma patient that came in. So so you can see the amount of visceral fat here, right.
Speaker 2:Yeah the abdomen's just packed with it. Yeah, yeah, so we do this and then you know, when we do this and apparently the patient does not have any comorbid conditions yet. But I think having this is a major comorbid condition and maybe over the next few years he'll end up with maybe diabetes or heart disease or fatty liver or whatever you know, maybe an MI, we don't know diabetes or heart disease or fatty liver or whatever you know, maybe an mi, we don't know, uh. So yeah, and, and when we see this, we go and talk to our patients.
Speaker 2:You know, there's a lot of fat inside you, you see, and if you see the whole city, he doesn't have too much of subcutaneous fat. Uh, he's, he's like a basic toffee, uh, but but you can still make out that he's going to have some visceral fat inside and then the scan proves that he doesn't have epicardial fat right now. But yeah, I mean, if he continues the way, he's an auto driver, he eats mostly vegetarian, a lot of carbohydrates, so we try and counsel as many people as possible, you know, and showing them fat. He's not educated, so it's going to be very difficult for him to actually understand, but then a lot of people who are educated also refuse to understand.
Speaker 1:Yeah exactly Ankur? What research projects do you have coming up? Because, yeah, I want to know what topics are you specifically looking into or how are you looking into? Into this more?
Speaker 2:yeah, so we're doing a lot uh, like I mentioned before, uh, you know, we're doing uh geriatric falls with fractures and sarcopenia and diet right. Uh, we're doing uh erythritic alkali with diet. We're doing, uh we're going to start uh cholelithiasis, which is is gallbladder stones and their association with what people are eating. We're doing this big metabolic syndrome and nutritional association of about 11,000 patients. That's going on. We're doing our heart attack patients. That's going on.
Speaker 2:We're doing diabetes undiagnosed diabetes in young adults and got a few more. We're doing non-alcoholic fatty liver and association with the dietary preferences and what else. Yeah, I think we're doing that and we're going to start probably when the new batch comes in. I'm going to do something with dysrhythmias, atrial fibrillation and B12 and stuff. Why? Because, or maybe try and get scans done, if the ethics committee actually allows us, so that you know a lot of people with atrial fibrillations have epicardial adipose tissue, right, and that's the fact which is the trigger for the different pathways.
Speaker 2:And you know we go and do a radio ablation and burn that fat off to stop it, right. I mean, what if you just reduce the epicardial fat with the right diet and the exercise and all the protocols and patients don't have AF again? Because you know they put on medication, they put on calcium channel blockers and stuff. You know all of that. So, but they still keep having recurrent episodes, right, they're coming into the emergency and then you go to anticoagulate them and they end up bleeding in the brain or upper GI bleeds and so many complications Keep checking their INRs to see if they're in theropuses or not, and you know it's so painful even for the patient, right?
Speaker 1:It's so painfully preventable. As you say, they just repeat customers of their cardiologist. They come in, they get another ablation which attempts to remove this pathological tract of cardiac wiring. If they made these lifestyle changes then they could potentially reduce that fat and be less likely to go into this malignant or pathological rhythm. Absolutely.
Speaker 1:I guess, my interest, like I said earlier, is that I would really love to see a vitamin D level on all these patients. I'd like to, because that test is a really good proxy for essentially total sun exposure. It can be done on blood spots, so I don't know, maybe if that might be a cheaper way of doing it, but to collect information about sun exposure habits as well. Like I don't know if you know about the Pellylinquist Melanoma in Southern Sweden cohort study. That was like a 20-year study looking at all-cause mortality and they just asked I mean, it was a more in-depth question, but they just had four questions about sun-seeking behavior, like sunbathing, and they were able to show a dose response between all-cause mortality and actual clotting, blood clotting and I believe it kind of asks for mortality too, with respect to the most to the least sun exposure. So I have a personal thought that those of your patients who are office workers, it workers and the more vitamin deficient, more sun avoidant I think, the more likely they are to have these problems.
Speaker 2:I'm sure they are. I mean, we've got some profiles that we run on some patients who go into the IPDs right, and that profile has vitamin Ds and 100% of them are deficient unless and until they're supplementing.
Speaker 1:Yes, yeah, yeah, yeah. Well, it's a massive tsunami of disease that you're fighting. It sounds like initially with one hand, but now you've got some team members on board. So, yeah, I want to congratulate you for all the work you're doing and, yeah, I mean, I don't think it's more important work that could be done right now for the health of the people in India. So, yeah, well done.
Speaker 2:Yeah, thanks a lot, man Max. It's important to raise awareness regarding this and we need to understand that. You know, we became doctors to actually cure people, not to make them sick. It's not our intention to make them sick, but then it's important for us to realize that we're not doing what we actually went out to do and this is the way to do it. You've got to get them right through the right interventions, and medicine is not one of them.
Speaker 1:Absolutely. It's this sad state that, you know, our colleagues, have we become, uh, you know, just observers of managed decline? It's a managed decline of of health and chronic disease, and and that's definitely not what you or I signed up for. So, yeah, um, fantastic work. Where can people find you, follow you, you contact you?
Speaker 2:Yeah, I mean, I'm on Instagram and I go by the name of thecarnivoreep. Ep stands for emergency physician, so I'm there. My podcast is on Spotify and Apple. It's called the Desi EM Project and the same website is going to be launched soon. So yeah, fingers crossed, that happens quick. I am on X, not very active, but I'm on X. That's A-N-K-S-V-2-5. That's AnxV25 on X, I think. Yeah, I mean, if people are professional and get onto LinkedIn, so you'll find me there.
Speaker 1:Amazing and Facebook. Everybody has Facebook yeah, great, great Well, thanks very much An much, anchor. Thank you for your time. I really appreciate the chat right.
Speaker 2:Thanks a lot, man max. It was a pleasure having uh coming onto your show.
