health right now

FROM THE HEART DOC

health right now

Demand Change
The road to good health requires us to be vigilant and make a collective effort.
DR VIKAS SAINI is a clinical cardiologist and researcher at Harvard Medical School and Harvard School of Public Health. He is president of the Lown Cardiovascular Research Foundation in Boston. Write to him at vikas.s@preventionindia. com.

TOP: PHOTOGRAPH BY: RITESH SHARMA; BOTTOM: SHUTTERSTOCK/INDIAPICTURE

y biggest worries about heart health in India are: unregulated trans fats and high sodium content in processed foods, the high glycaemic index of many meals particularly the heavy use of white rice, uncontrolled air pollution, and the increasing lack of physical activity in the cities. Each of these items increases the risk of a coronary event, and together, I suspect they contribute enormously to the rising disease burden. Can they be avoided? Yes, but not without an intense effort on the part of indi-

viduals and the collective. There has been talk about banning trans fats for years. The science is clear. These fats are the worst offenders in dietary elements causing heart disease. Yet this seems to remain just talk. One can speculate about ways in which powerful economic interests may be preventing corrective legislation. But the fact that these poisons continue to be used in foods is a shame. Similarly, sodium content in many processed foods can be insanely high. I was shocked to see 1000 mg of sodium listed on a reputed brand. While the food is hygienic and the company is striving to maintain a social conscience, the issue of taste is so critical that an otherwise responsible company has missed an important opportunity. And what of the others? We clearly have a long road ahead to make progress in sodium reduction.

White rice is an absolute no from the point of view of heart health in the Indian subcontinent. Maybe not if you are working on the farm for six or 10 hours every day. But millions of rice eaters are not. Nothing beats the aroma of basmati to announce a hearty meal. But these lovely grains are practically poison. I have switched to brown rice as much as possible. Im told by Dr Viswanathan Mohan of Chennai that people may consider switching to brown rice if they can be convinced it is better for them. This augurs well for the future, but change needs to come fast. My colleagues in the Department of Nutrition at the Harvard School of Public Health are collaborating with Mohan on a pilot project to assess the feasibility of this switch. Air pollution causes heart attacks. There are several biological pathways that promote this risk. One is an apparent change in autonomic balance. Another is through triggering inflammation. A third is by constricting blood vessels. Attempts to protect oneself

using air conditioners at home and in the car may filter out some of the particulate matter. But when the very air is polluted, how can one avoid it completely? Theres very little an individual can do to address this problem, it demands collective action. The air we breathe, the food we eat, and the monitoring systems we create in our society represent a way to make the commons healthier. This is the major task facing India and the entire world: we all must move beyond our individual bubbles into the common space that we all share. This is the only possible path forward, but to pursue it, people will need to link up with each other and demand change.

Air pollution causes heart attacks.There are several biological pathways that promote this risk.

SHUTTERSTOCK/INDIAPICTURE

PREVENTION APRIL 2012