I am bit busy today… so you will have to wait a day for me to post referenced stuff about ‘alcohol consumption’ and the link to increased ‘adiponectin levels’ and decreased ‘C-reactive protein levels’… but you know what I will be writing about in the next post.. If you are curious - google the stuff I have put in ”. So you can combine ‘alcohol consumption’ +’adiponectin levels’ and ‘alcohol consumption’ + ‘c-reactive protein’ levels.. you can also try a search in pubmed.. In any case do google and find more about ‘adiponectin’ and ‘c-reactive protein’ and their association with the risk of myocardial infarction (heart attack) rates.

On the other side I will put a link (at the end of this post) to a recent and very good (free to access)paper by an indian author on the role of epigenetic factors and the interaction of environment on the current increase in the rate of Type II diabetes (and insulin resistance) seen in the urbanized and NRI population. He has done a very good of summarizing what I would have said on this subject and the paper is well written.

In a nutshell, he is saying that bad maternal nutrition causes low birth weight and insulin resistance (through epigenetic mechanisms), in babies. The babies then get lots of carbohydrate rich food that helps them gain weight quickly and creates a muscle thin/ fat rich phenotype.. and that the very quick rise in living standards in urban india and NRIs.. provides fuel to the fire.. and makes them more centrally obese and insulin resistant.

My take - This insulin resistance leads to type II diabetes and increased C-reactive protein and decreased adiponectin levels. Thus you get an increase in the rate and aggressiveness of heart attacks in the affluent indian population. Now given that this seems to epigenetic (temporary changes in gene transcription that die off after 3-4 generations).. it will very probably not be big issue for 3rd and 4th generations NRIs or even urban india in say 40 years. You see the west also went through a similar stage (chronic undernourishment to plenty) .. however it is likely that because this change occurred more gradually in the west (about 60-80 years - 1840-1920) and they used to drink alcohol (reduce chronic inflammation) and eat meat (lower risk of maternal under-nutrition and more fat in diet)they were spared the worst effects of that change (remember they had high CVD rates in fairly young affluent people at the begining of last century all the way in the 1940s)..

Indians because of their twin obsessions with vegetarianism and abstinence from alcohol will likely be the worst hit in this change.. and the fact that the change occurred in less than 2 generations..

Again

vegetarianism is very often = low maternal body weight, low birthweight
and neonatal insulin resistance (probably a combination of intrauterine conditions and epigenetic imprinting) and once you born high carbohydrate foods do not help either..

moderate alchohol = increased adiponectin, decreased c-reactive protein levels and a consistent association with lower CVD risk..

And here is the link

http://jn.nutrition.org/cgi/content/full/134/1/205

Early Life Origins of Insulin Resistance and Type 2 Diabetes in India and Other Asian Countries

C. S. Yajnik

J. Nutr. 134:205-210, January 2004

http://money.cnn.com/news/newsfeeds/articles/prnewswire/DCTU04210072007-1.htm

Summary excerpt:
A new study suggests that U.S. employers may be significantly underestimating the overall costs of poor employee health, while failing to fully assess the diseases and health conditions that drive these costs.

The study, which appears in the July issue of the Journal of Occupational and Environmental Medicine quantifies the link between employee health and productivity more dramatically than any other study to date and shows that the relationship between the two is much more significant than previously thought.

Thanks.

In the last para, you bring up an important point - the clustering of unhealthy behaviours. I would however also like to know if you have any data on the change in alcohol consumption trends in India. On a minor scale, I have noticed a marked change between the early 1990s and now, with women being the key contributors to the trend. On the relationship between alcohol consumption and women’s health, the jury is still out. It is possible to argue a point by choosing selective studies but I am keeping an open mind.

I am sure you will separate the studies about incidence and those about mortality when you share the references. Many here are not regular readers of Health related journals so they will probably also appreciate the granularity of the data.

Thanks again.

I will soon (a day or two) give you a basic list of pubmed searchable references for point 1]. It will be a longish list.. you will have to see the general slant of these articles.. somewhat like a meta-analysis.

About point 2]- again a a longish list soon (couple days). I should say that C-reactive protein levels (and other markers of chronic inflammation)are higher in every ethnic group that has higher CVD risks and they are well correlated to your risk of getting CVD. People with serious autoimmune diseases like lupus and rheumatoid arthritis have a significantly increased risk of CVD. Moreover high C-reactive protein levels are linked to your risk of getting IGT and Type-2 diabetes. Why? I don’t know.. no one really understands it… Is reduced insulin sensitivity the cause of elevated C-reactive protein levels or vice-versa.. who knows?

I will also devote one post to the reasons why the cholesterol hypothesis (later refined to high LDL and low HDL) for CVD came to be dominant and why it may be wrong.. in that it is correlation (or maybe amplification), not causation..

Maybe I will also devote one post to why CVD was a problem when the west first industrialized (lots of men did die around 50-60 at the turn of the last century and into the early decades of the last century and not from infections).. and why it was not well noticed at that time (technology and low value of human life) and possible reasons for it’s decline including epigenetic influences on tissue insulin sensitivity and exposure to some infectious diseases.

About point 3] - once again you will get a long list. You should however keep in mind that research about alcohol consumption and CVD risk from japan (and other asian countries) could be affected by their sensitivity to alcohol (dehyrogenase deficiency), ‘cultural leanings’ and the fact that unlike in western countries moderate regular alcohol consumption is associated with lower socioeconomic classes, a group that always has had higher CVD mortality in developed countries.

The reason that the alcohol - CVD connection strikes me as important is because many alcoholics have rather bad food habits, weight problems, hypertension, liver damage but their arteries are amazingly clean and plaque free- Yes you will get references for that too.. What I am saying here is that even if moderate regular alcohol caused a modest 30-50% reduction in CVD (extrapolated from results in white populations), it would still be worthwhile for indians, especially since we do not have the dehydrogenase deficiency that east-asians have. Moreover indians are somewhat less prone to severe hypertension and intracerebral bleeds, the major vascular effect of excessive chronic alcohol use.

As for 2. I cannot disagree but for the rest of the readership, again how about some references? Thanks.

You say: “Maybe that is why gujratis have a higher risk of CVD?MI than punjabis.. which is higher than white britons, which is higher than french.. You get the point.”

Actually that UK study found that Gujaratis have a LOWER risk than Punjabis and that Hindus have a lower risk than Muslims. So I am afraid much as your reasoning may sound lyrical it is not accurate.

A few counter-points to ponder:

Japanese alcohol consumption is lower than their western counterparts and so is their risk of heart disease. Recent studies in Japan however indicate a strong relationship between hypercholesterolaemia and heart disease.

On the other hand, black and Indian/ Asian (in UK speak) populations drink less alcohol than the white population in the UK but has a higher risk of heart disease.

The incidence of heart disease in France is not much lower than say in the UK, but their mortality from heart disease is lower. Even within France there are differences in mortality across regions and some US states have mortality rates from heart disease similar to France’s. Wine - the main French tipple - is being consumed less and less in France and many adults do not drink any alcohol at all.

Unless your point about alcohol was made in jest, I am not sure I would support the alcohol suggestion.

I do not drink and I would much rather prefer to keep the great chance at amusement I have when people around me get progressively drunker and drunker. You may think they have healthier hearts than I do, but the positive effect of unbounded laughter on heart health is probably even bigger than the alcohol effect :-)

The reason why I mentioned the point of whites feeling racial superiority regarding their risk of CVD and MI because of a few rather obvious factors..

1] Most scientific articles always point out that whites have lower risk of CVD than any other racial group except some east-asian countries.. so indian,hispanic, black etc are supposed to be high risk groups..

The most common explanation given is natural selection of individuals who were more good at accumulating fat.. and in times of plenty that works against you..

This is curious as there is no logical reason why it would work out that way.. as for most of human history (save the last 150 odd years), the degree of hunger, poverty and deprivation of the average white was not that different from countries. Evolution and selection of that order takes longer… like thousands of years.. inbred natives in south-west US (historically arid) such as ‘pima indians’ are an example of that adaptation.. however almost all other nonwhites are not!

2] There is a serious lack of understanding about the nature of the arterial plaque that causes a heart attack.. Plaques start out as an inflammation in the arterial wall attracting immune cells that then take up cholesterol (LDL) from the surrounding blood and create more inflammation.. the result of this inflammation is a form of scar tissue on the arterial walls. These are known as unstable plaques.. When for some reason the ‘cap’ of one of these unstable plaque comes off, a localized clot forming event occurs.. and it is this clot that blocks your coronary arteries giving you a heart attack..

In time.. if the unstable plaques does not come off ,and give you a heart attack, they become stable hardened plaques.. these are the ones you can see on arteriograms..they however mainly cause exertion angina.. and can increase your risk of getting MI by allowing a smaller clot to cut of blood supply.. SO when people see these in arteriograms, they should be seen as what they are.. proxy measurements for he dangerous little buggers (small unstable plaques).

3] I think Indians should drink more alcohol regularly as alcohol does reduce the risk of CVD, MI and ischaemic stroke (majority of stokes).. Of course if you drink over 4-5 drinks a day it does increase your risk of haemorrhagic stroke (minority of strokes). Aim for 2-4 drinks/day (depends on your weight and CVD risk) The interesting link between alcohol consumption and CVD/MI was first discovered in the early years of the 20th century, when autopsies were first done on a large scale. They realized that drunks usually has perfect plaqueless arteries compared to others of their age.. This link has been shown time and again in large studies (thousands of people for years). Maybe that is why gujratis have a higher risk of CVD?MI than punjabis.. which is higher than white britons, which is higher than french.. You get the point.

And alcohol also lowers reactive protein C levels (maybe that is how it works- by lowering chronic inflammation).. a proxy indicator of chronic inflammation and considered to be very good predictor of CVD/MI risk.. and indians do have significantly higher average levels of this than the white population..

Curiously on the flip side indians have significantly lower levels of mortality/ morbidity from cancer than whites (coincidence or correlation?)

More next time… off to get some wine.. you should too *S*