Dr Mohsin Wali, MD –FACCC, Senior Consultant in Sir Ganga Ram Hospital, Former physician to the Former Hon’ble Presidents of India Sh. Shankar Dayal Sharma, Sh. R. Venkataraman and Sh. Pranab Mukherjee and Former Hon’ble Prime Minister. Sh. VP Singh, speaks to News 360 about Healthy lifestyle one must adopt.
Q. COVID-19 virus attacked people with co-morbidities like heart conditions etc. Are people with heart conditions at major risk?
A. Even without a heart Condition, COVID-19 virus has manifested in a big way. Initially, the COVID-19 virus was believed to be a viral infection. Let me clear out that it is not a viral infection, it’s an inflammatory disease and it involves all organs of the body. Not only lungs but rather it goes to the muscles, heart even to the nose. You must have heard that people have lost their sense of smell, The virus goes to the tongue and its nerves and people have lost sense of taste. This virus also causes headache because it goes to the brain and most importantly it goes to the heart membranes. It does reach the arteries and causes two types of manifestations; one is procoagulant and the other one is anticoagulant. Procoagulant means promotion of coagulation which means clotting. Anticoagulant means bleeding so it is like a double-edged sword which manifests with bleeding, clotting, gangrene etc. Doctors have taken out blood clots from the lungs; patients have vomited out blood clots and in the heart, the involvement of the heart muscle, which is a very serious condition, is called Myocarditis. Myocarditis is a very serious affliction. I would not call it an infection but an affliction of the cardiac muscle, which can lead to even sudden cardiac death. So people who are otherwise healthy, even they can have sudden death with post- COVID-19 complications. During the first two waves of COVID-19 a lot of young people have lost their lives who had no heart disease and not only people have died, they have developed fluid in their heart, fluid in their lungs, fluid in the abdominal membrane, because of the involvement of the peritoneal membrane. So COVID-19 has an appropriate word I’m using, which has not been used much by WHO, that is protean manifestations all over the body. It can involve any organ and people have died in great numbers, the cause of which the world doesn’t know actually.
Q. What should be a healthy lifestyle? What should we do to avoid such things?
A. First, let me talk about COVID-19. A few people who have suffered from COVID-19 have lost their lung functions completely.
They are not able to show the full saturation. Most of them are having low saturation, like 94, 95 (O2 Levels). They’re not able to walk. They’re not able to breathe properly. They’re not able to exercise. During the exercise regime, people shouldn’t have to exert much. They have to walk; they have to do respiratory exercises, most importantly, deep breathing. So this is one side of the story. When you say cardio exercise, you don’t run on the treadmill. If you do so, you can faint, you can pass off, you can have arrhythmia, or you can have sudden death. So what we are advising now is to do very graded exercises. Let me also talk about another aspect which is called Autophagy, it means when the body eats its own muscles. The body has a mechanism to eat its muscle and make oxygen from that Metabolism. And suddenly a person overnight can lose one kg, two Kg and in five- six days, he can lose 10 kg weight. So this is also called auto cannibalism. Where your body is eating its own flesh, muscle fiber. You are losing your muscle mass and this has led to worse consequences like recurrent infection, vertigo, balancing problem, and loss of energy, loss of power, loss of joints power, and many other muscular complications. So if you lose 10% of the muscle, the risk of infection rises upto 70% & one very important thing that has come up, which was used by athletes that is called H M B beta hydroxy, beta methyl butyrate, which is a, an active metabolite convert of Leucine.
Non-vegetarian people can have Fish, Mutton, Chicken, even vegetarian people can have Cheese (Paneer) and Mushrooms have also been found to boost up the immunity. Here I’m telling brain exercises that are advisable; you should concentrate, meditate, because there are a lot of people who are having brain fog as a symptom of post COVID-19., Confusion, lack of sleep, unexplained headaches, and loss of memory are also some of the post –COVID-19 implications.
Q. How one should differentiate between a Gastric pain and Cardiac condition since they are commonly misunderstood and interchangeable symptoms for common masses.
A. This is a very important question. Even we doctors get confused at times. When the lower part of the heart, that is the bottom of the heart, in a common man’s language gets involved, this is the same nerve which supplies to the stomach. So the manifestations like abdominal pain, upper abdominal pain, vomiting, feeling of bloating, discomfort & symptoms are very well mistaken for gastric upset. And patients are even treated in emergency and given injections for acidity attack and sent home and then the following night or probably the same night, the patient comes back to the hospital either with sudden death or with a frank heart attack.
When you say there is stomach illness, pointers like abdominal pain, vomiting, bloating, upper abdominal pain discomfort etc. are there, How to differentiate this , depends if a person is young, Non-smoker, non-diabetic, healthy person and there is a history of eating out or abnormal diet, abnormal meals, and, no previous heart disease, no family history of heart disease, so this puts more weight on the abdominal issue, but I would say in each and every such patient who has presented in emergency with abdominal pain, we must rule out a heart condition by doing an ECG and if you have a test which can rule out cardiac muscle involvement like ECHO, Troponin, TMT then we must perform them as well. Once we have seen ECG is normal and the pain is relieved by giving Antacids then, patients can be sent home, otherwise observe the patient for at least eight to twelve hours. There is no harm in keeping the patient in the hospital because you are saving a life.
Q. If a patient goes to the hospital/clinic at night and there is no facility at the hospital of an ECG or an ECHO, what should be done?
A. Treat him as a heart patient, unless proved otherwise. You must know if there is a heart condition, simple blood pressure will fall. If you observe patterned and gradual fall in the blood pressure within few hours, if it is 120/70, 110 /60 later it goes to 90 /50. After one hour, it is 80/50. You are diagnosing a heart attack. In addition, the patient may be sweating and may be restless. Patient may be having a feeling that he’s collapsing, the patient may feel dizzy and weak. Then you don’t think of gastric condition. You think of a cardiac condition. If you don’t have even an ECG, then treat the patient like in our old days, we used to treat patients with morphine injection, oxygen etc and patients used to survive. Now we have everything. All the hospitals and good clinics have a ECG machine, so we can do serial ECGs and once two serial ECGs are normal, the patient can then be treated as a non-cardiac patient.
Q. Is the age group of Heart patients falling down drastically?
A. Yes, we have spoiled ourselves. My father at an age of 90 had a normal coronary angiogram. He was cycling; He was walking till the last day of his life. He was climbing the stairs, not using elevators, as old people had a much more disciplined life. They were mostly non-smokers. They were having a simple diet. They were doing walking exercises. They were not dependent, not used to having any junk food. So now what we have done is that we have spoiled our lifestyle. Now-a-days, a new entity has been described which is called Juvenile Coronary Artery Disease also known as coronary disease of young people, especially in developing countries like India. Youngsters are consuming a lot of junk food, late & irregular sleeping hours. They have no sleep rhythm regulation. They take a lot of sweets, ice creams, carbonated drinks and are overweight.
A few of them have become pre-diabetic now and already we have become the diabetic capital of the world. With this diabetes, pre-diabetes, impaired glucose tolerance, smoking, increased weight obesity, and with metabolic syndrome fatty liver, lack of sleep hygiene and erratic food, this has led to irreversible damage to the coronary arteries and the age limit is no longer aligned. It is a very grey zone. Anybody at any age can have a heart attack, but when we talk of heart diseases, they can be by birth also. This used to have an age range usually after 45 years but now that range gap is getting narrowed and one can have a heart condition as early as 20, 25 or even at 30 years. And, I have seen the youngest patient having a heart attack at the age of 18 years.
Q. What are healthy food habits according to you and we all must adopt to prevent unnatural cardiac conditions?
A. A Lot of people talk about healthy food habits. So the best is the food which does not fill your stomach much and keeps your stomach one-third empty. That is also a very important thing prescribed by erstwhile religious people. One should eat more leafy vegetables. Dieticians give an example of a rainbow diet where you should have these colors in your platter. If you have red tomato, violet grapes. You can have Blueberries, and other fruits which look light colored like melons. You can have watermelon and you can have Apple, Guava. All fiber rich foods, and less of spices, and less of oily food, less of Carbs, mean eat less of roti. One Very fault of vegetarian diet is that people who are supposed to eat more vegetables, they eat very little vegetables and they have more Rotis in India. So the whole purpose of taking fiber and vegetables gets lost. Those people who take non-vegetarian, they take a lot of Meat and a lot of Roti and get themselves loaded. I get many calls in the night around 11 o’clock to 2 AM where a patient has Angina like symptoms. Many people have attacks at that time because when the food goes in, it causes less circulation to the heart and more circulation in the stomach. So you have to keep your diet low in volume and low in carbohydrates and take plenty of water. And you must have good amount of protein and then sugar intake has to be curtailed because excessive sugar is a bad thing for body and metabolism. It increases your weight. The most important sources of sugar are ice cream, chocolate (except dark ones), and these bottled drinks, which contain the highest amount of unhealthy sugar. Old people used to eat Jaggery, which is raw, not processed.
When we talk of healthy food, first is the quantity. Second is the quality. So both quantity and quality should be looked into. You should have consumption in the proportion of 40-40-20, like 40% protein, 40% carbohydrate (maximum), and 20% oil and fat. And in oils when we talk, there are so many fancy concepts about oils. Some people don’t like Desi Ghee, which actually is a good thing. It doesn’t cause much harm. On the contrary, all these refined oils have problems because super saturated oil, marketed as healthy oil in the market, has more damaging stuff. Either oil should be sunflower oil, or if you can afford olive oil and best could be groundnut oil for daily use. So be careful when you are choosing your medium for cooking, don’t go for Vansapati, or dont go for oils which are rich in saturated fats. The classical Kadwa Oil (Mustard oil) used to be the best, but we don’t find genuine mustard oil these days.
In the end, let me tell you that a lot of people talk about the harmful effects of milk. I don’t think milk in moderate quality consumed daily is harmful for the heart. At the most, you can have toned milk if you are fussy about it, but I think milk has good protein, For instance in Japan, there is a tribe which is called Maasai, whose diet is a 100 percent milk and they have 0% heart attack. So it is wrong to say milk causes heart attack or milk can cause heart attack!