The other fat, besides Cholesterol, that had gained importance in the latest series of research studies is Triglycerides - being a major cause of heart disease. Almost all the fats that we eat in our food are nothing but Triglycerides. This is probably the other name for OILS. Triglycerides also form a part of the blockage.Tri means three and Glycerides come from Glycerol. Triglycerides is a combination of one Glycerol molecule with three fats (or fatty acids). In other words, three chains of fat molecules (units) when attached to one Glycerol can constitute Triglycerides.

These three chains of fatty acids, depending on the number of Hydrogen atoms that they contain, can be saturated, mono unsaturated or poly-unsaturated in hydrogen. The understanding is pretty simple; if there are thirty slots for hydrogen in a fatty acid and all of them are filled up, it will be called saturated (with hydrogen) fatty acid. Most of the hydrogenated fats, like vanaspati, push hydrogen in high pressure in the fatty acid molecules - to make the fat saturated. They take poly-unsaturated fat and before selling converting them into saturated fat by adding hydrogen.On the other hand, if one hydrogen is missing in the fatty acid chain it ceases to be saturated. Now it will be called unsaturated by one hydrogen only.

This fat is the mono-unsaturated fat. It is something like 29 hydrogen atoms instead of 30(as in saturated fat). Really meaning, it makes very little difference.Thirdly, if more than one hydrogen is missing in the fatty acid chain (like 28 out of 30) - this fat becomes poly-unsaturated. Literally and structurally there is hardly any difference between these three types of fats. They look alike as well. Even from the heart disease formation angle all of them contribute almost equally to the blockage formation.

It is like one does 90% harm, the other two will do 88 and 86% harm.Almost all kinds of oil are 100% fat - any combination of these three kinds of fat. It is through the bad and unethical advertisements, for promoting their products that the oil-companies have created an impression that Triglycerides are good for the heart disease (which is interpreted as “helping to cure heart disease by the patients”). This is never a fact. I have given a chart of average contents of the oils for the patients' use. Choose if you can. The normal level of Triglycerides in the blood is 60 to 160mg/100ml.

SAAOL recommends less than 120 mg/100ml. More than 160 mg is associated with increased incidence of heart disease.Small amounts of Triglycerides are also manufactured in the liver. All the foods contain some invisible oils also. These two combined can make up for the minimum amount of oil requirement of the body and SAAOL recommends no additional oil intake by the heart patients.

2. Intake of Alcohol

Alcohol intake is also a known risk factor of Coronary Heart Disease - directly or indirectly. Alcohol has become associated with heart disease in many ways. Alcohol leads to increase Triglycerides, owing to its similarity of structure with Glycerol, a known component of Triglycerides.

Many good laboratories do not take blood samples for lipid profile test (which includes Triglycerides) if the patients have a history of intake of alcohol in the last 12 hours. Alcohol also is contributing to huge calories to the patients. Many people eat a lot of fried items, while drinking. This also contributes/adds to fat, cholesterol and calories. Alcohol is often associated with increased stress and bad interpersonal relationships in the family. Alcohol also is one of the major reasons of liver disease and failure, besides gastritis, neurological damages. There has been some confusion about the recommending of alcohol in some newspapers and medical journals.

It has been shown that Alcohol can increase the HDL levels in the blood, but it also increases the Triglycerides - it does more harms than benefit to the patients. When you take alcohol you have to see all the effects rather than one isolated parameter. More over, many of these research studies are carried out in countries where the temperature is very low and alcohol is used in quantities much more than what is consumed in India with its temperate climate. The extrapolations are not justified with regard to alcohol. Many studies also have shown that alcohol also leads to an increased incidence of heart disease.

3.  Low HDL Cholesterol

HD L cholesterol is the so-called “good” cholesterol and can be measured from a fasting blood sample. It has a very high affinity to bind cholesterol and can remove cholesterol from the blockages. HDL cholesterol level in the blood should be maintained above 40 mg per 100 ml of blood to prevent heart disease. Indians are known to have low HDL cholesterol and it is often seen that the average HDL cholesterol in Indians is below 40 mg per 100 ml of blood.

4. Obesity or Overweight

If the weight of a person is more than the upper limit of weight for that age and sex, he is called obese or a fat person. People who eat too much fat and do not do exercise put on weight. There are standard charts available from which one can find out whether one is overweight or obese. Obese individuals have greater chances of getting heart diseases. They have increased chances of getting high blood pressure and diabetes and thereby blockages. Eating low caloric food, avoiding fats, avoiding too much sugar, and undertaking regular physical exercise can prevent obesity.

Fat people remain inactive and are also made fun at sometimes. Therefore, they tend to develop excessive mental tensions resulting in hypertension and heart attacks. The chances of getting heart attacks increase by 15 times for obese people as compared to lean and thin individuals. SAAOL recommends a slow but sustained reduction of weight in obese patients. A reduction of 2-3 kg per month is ideal.

5. Sedentary Life Style/ Lack of Physical Activity

Sedentary life or lack of exercise in our daily life has become the most important reason of heart disease in the modern life where you can manage everything without much effort. With the modern technology, help from the wives, drivers, servants, peons, and staff most of the executives have stopped doing any physical activity. Research studies have shown that low physical activity is often associated with high incidence of Coronary Heart Disease. Regular exercise can break the fat that we consume, decrease the cholesterol, reduce the blood sugar, control the blood pressure, reduce overweight by consuming stored fat in the body and makes the heart more healthy, habituated to respond well to unexpected physical activity needs.

The absence of the same will have the opposite action. Without exercise more and more people will have Heart Disease, Diabetes, High Blood Pressure, Obesity and very low fitness. Besides, lack of physical activity will lead to less flexibility, joint diseases, and so many other ailments. Think of a normal person in the modern society. His life is literally sedentary. He gets up at 6 AM, has bed tea, reads newspapers. These two sedentary activities will consume about two hours alongwith watching of Television. He will probably talk on phone for sometime, in the morning hours. Then a bath and a good breakfast follows. He goes to the office or shop not by walking or cycling but by a car, scooter or public transport doing very low physical activity. Even if he plans to walk everyday, mostly he misses.In the office, he does a lot of writing, talking and computing - all requiring him to sit on the chair - the whole day. No exercise till now. Late in the evening he comes home in the car or by any other mechanical vehicle. He then watches Television, gossips, have good dinner and sleeps. No exercise in the whole day. Heart disease is bound to come one day, may be after 5 years. If one does not exert physically, he must cut down the fat intake in diet or otherwise face consequences.

It is seen daily labourers, porters, farmers, athletes or people who go to offices by cycles  hardly have a heart disease. On the other hand - clerks, officers, executives, sedentary businessmen, lawyers, doctors, bankers are more prone to heart disease, because of lack of their physical activities. In the past people did not have these vehicles. They used to work more physically - walking to the office, visiting other villages on foot, working in the fields, carrying the luggage themselves, grinding their grains, cleaning the homes themselves. So they were not having heart disease as they would break all the fats and meats they were eating. Now things have changed, therefore the heart disease is coming closer.

6. Smoking or Tobacco Consumption

People who smoke (cigarettes or bidis in India) are four times (400% more) more prone to develop heart disease, compared to the non-smokers. The Framingham heart study carried out in a small town of Framingham, USA, studied more than 5000 people and their families for more than three decades, confirmed that smoking substantially increases the risk of heart attacks.
It was also shown in the follow-up studies of the same group, even after cessation of smoking, people are still prone to have heart attacks. The researchers found that cigarette smokers, who quit smoking, are still more susceptible to heart disease even after five years. Smoking induced risk for heart disease can be related to the degree of smoking and with more duration of smoking the risk increases.

A person who smokes 10 cigarettes per day is almost double at risk than those smoking 5 per day. Tobacco that is inhaled during smoking is the major cause of erosion of the inner lining of the coronary arteries. Out of the thousands of chemicals in tobacco - nicotine, tar, alkaloids etc. lead to this damage and make the layer more susceptible to Cholesterol and Fat deposits.

It is something like painting the inner lining with glue which would catch the Cholesterol and stick them on the wall. One must also remember that smoking is equally bad as having tobacco in any form. Zarda, tambaku, gutka, khaini, snuffing, tobacco used to clean the teeth- popular in many parts of India- have equally bad results. These also lead to blockages. Smoking is also bad to the health, as it leads to damage to the lungs, causing bronchitis and Asthma. It also causes lung cancer. Smoking can also aggravate peptic ulcer and chewing tobacco leads to gastritis. Staying in a big city has an effect of smoking 5-6 cigarettes.

Those who live with smokers or work with them are now also known to have bad effects of smoking. They are also prone to develop heart disease. These people are also called passive Smokers. Psychological stress and tension is also a known factor to lead to increased smoking, besides its addiction. Many people keep on shifting from one type of smoking to another, but this does no help. In many parts of India, like West Bengal, smoking is also considered a habit of affluent people and educated people. People smoke as if it will make them smart. Tobacco or smoking prevention has to be taken on war footing all over the world. It is astonishing that whereas the tobacco smoking is reducing in the developed countries, in the developing countries the incidence is going up. The World Health Organisation (WHO) has now put-up smoking prevention on its priority list also.

7. Stress and Mental Tension

Psychological Stress or Tension is now recognized as the most important risk factor of coronary heart disease. With more and more scientific research results pouring in over the last 2 decades we have come to know that excessive stress can lead to the following:
1. Increase in Blood Pressure.
2. Increase in the Heart Rate.
3. Increased concentration of fat in blood.
4. Increased Blood Sugar.
5. Increased Cholesterol in Blood.
6. Spasm of Coronary and other arteries.
7. Increased Blood Clotting.
8. Increased deposition of Fat and Cholesterol in the arteries.

This means that stress is such an influential risk factor that even in the absence of other risk factors it can itself become responsible for coronary heart disease. I have seen many people without high cholesterol, overweight and family history, having normal blood pressure developing angina only because of excessive stress. The problem with stress is that there are no means of measuring it even with the latest scientific gadgets. There is no unit, such as ml, mm, kg, etc., to define it. Because of this reason the modern science and cardiologists have specifically abstained talking about stresses in heart diseases.

It is now known that city dwellers have 3 times more chances of heart disease than those in small villages, the major reason being excessive stress in city life. Research has also revealed that a particular type of people (Type-A behaviour) who are aggressive, always short of time, short tempered and stressful are much more prone to develop heart disease. Most of the young heart patients of modern day have Type-A behaviour. It is obvious that without controlling the stresses we cannot stop the advancement of heart disease. Sudden stress or anger leads to the spasm of coronary arteries, which precipitates sudden angina and heart attacks. This is the reason or mechanism why many people develop heart attacks when they are excessively strained or hear a bad news.

8. Diabetes Mellitus The normal levels of blood sugar in a fasting person are between 80-120 mg%. If the fasting level of blood sugar is more than 110 mg%, or after meals more than 160 mg%, it is called diabetes or high blood sugar. In diabetic patients, sugar can be detected in the urine also. Patients with diabetes have higher chances of development of coronary blockages. They also get several other diseases like kidney-damage, as well as damage to the nerves and eyes.

Patients with diabetes are usually obese, have high blood pressure and high blood cholesterol levels, all responsible for blockages. Heart attack occurs at a younger age in severe diabetics. The symptoms of diabetes are increased thirst, increased urination and weight loss, but in some there may be no symptoms at all. Control of diabetes is must for heart patients. India has a very high number of diabetic patients.

9. High Blood Cholesterol

High Blood Cholesterol is one of the most known risk factors of Coronary Heart Disease. Previously Cholesterol was supposed to be the most important cause of Heart Artery Blockages but with more and more research data coming in, it has become one of the first three risk factors. Cholesterol is a type of fat particle present in the blood in small quantities. This waxy particle is made up of a single chain of fatty acid with 27 carbon atoms.

The structure is so complex that this fatty acid is rotated in four rings - in combination called Cyclo- pentano-perhydro-phenantherene ring. It is one of the most decorated molecules - known to the medical science. Cholesterol has very important functions in the body - as it forms a part of the cell wall, nerve coverings and the brain cells. We cannot imagine life without this molecule. So important is the requirement of Cholesterol in the body that the liver has a manufacturing capacity of the minimum amount of Cholesterol required by the body.

But if this molecule is present in more than adequate quantity in the body or blood, the excess can be deposited to create coronary blockages. Not only heart is affected, high cholesterol can also get deposited inside the brain arteries, leg arteries and also in the skin below the eyes. Cholesterol is carried in the blood is in free form, which is very dangerous and it can be also carried in combination of proteins (known as lipo-proteins).

There is a strong relationship of blood level of free Cholesterol and rate of deposition of blockages in the heart arteries.Previously it was presumed that a Cholesterol level of 250mg/100ml of blood is normal and safe. This was about 20 years back. After a lot of further research, it was found that a level less than 220mg/100ml was okay in the next ten years. But the latest scientific research has now proved that any level more than 200 mg/100ml is definitely not good.

The normal range of this fat is now considered between 130 and 200 mg/100ml of blood. SAAOL Heart Program recommends a level of Cholesterol lower than 160mg/100ml of blood to achieve optimum results. It is quite a common sense that we should try for the lowest of the normal range if the option is given. The blood levels of Cholesterol are high in those people whose diet is rich in Cholesterol. The foods that contain high Cholesterol are Egg Yolk, meat of any kind (mutton, beef, chicken, pork- both red meat and white meat, fish). Another rich source is Milk and its products like Ghee, Cream, Butter, Ice Cream, Chocolates, Paneer, and Curd etc.

This becomes the culprit in vegetarians, who depend heavily on milk. Any other fat, especially the saturated fatty acids are used in the liver to manufacture Cholesterol.Cholesterol is mostly deposited in the heart arteries, after it is converted into LDL. Cholesterol, the so-called Bad “Low density Lipo-protein Cholesterol”SAAOL recommends very low Cholesterol (130-160mg/100ml) in the blood. The total intake of Cholesterol in the diet of a person should be as low as 10mg/day. A chart containing the contents of Cholesterol in most common foods is given in the diet section of the book. A usual vegetarian on milk diet consumes as high as 200-500mg Cholesterol in a day and for the non-vegetarian it goes as high as 1000mg per day.

In most of the developed countries it is compulsory to put a display on the food levels - the exact content of Cholesterol in every food that contains it. But unfortunately in India this is not done, and this makes it difficult for the general public to know what food to eat and what to avoid.Regular physical exercise, stress management, stopping of smoking can also lead to lowering of the Cholesterol in the blood, besides control of diet.

10. High Blood Pressure

The normal blood pressure in adults is between 100/60 to 140/90 mm Hg. If the blood pressure is consistently more than 140/90 on two or more separate occasions, it is called High Blood Pressure or Hypertension. It is a very common disease and about 20% to 30% of adults suffer from hypertension all over the world, but a majority of people is not even aware that they have this disease because it does not produce any symptoms in a vast number of them.

This is why this disease has been correctly called the “silent killer”. High blood pressure puts an extra strain on the heart and the arteries supplying blood to the other organs of the body. Many diseases are caused by high blood pressure such as heart attacks, heart failure, kidney-failure, stroke (damage to the brain), and damage to the eyes. Higher the blood pressures, greater are the chances of getting the above diseases, mainly heart attacks.High blood pressure can be classified as Mild, Moderate and Severe. It is also one of the major causes of deposition of cholesterol and fat in the coronary arteries. It damages the endothelial lining of arteries, making them more prone to fat deposition. Besides a high intake of salt, psychological stresses are also implied as important causes of high blood pressure.