In this article, we will look at how to lower heart disease risk and Alzheimer's risk using diet. Here, the teachings of Ayurveda intersect with cutting edge biomedicine in fascinating ways.
From the Ayurvedic standpoint, we are all quite familiar with risk factors and dietary guidance for heart disease. We know that kapha individuals will have a greater risk of atheroma leading to coronary heart disease, while vata individuals are stress-prone and so can develop vata hridrog (heart disease). Now, the latest discoveries in biomedical science and genetics have led researchers to an interesting conclusion: there are three types of people with different lipid profiles and disease risks. To understand this we will have to take a brief look at plasma lipids.
When a patient brings their blood test results, they will often be concerned about their total cholesterol. However, a typical blood test will also show the break-out of HDL 'good' to LDL 'bad' cholesterol. HDL or high-density lipoproteins are the smallest lipoprotein molecules in the blood and also the most dense because of their higher ratio of protein to cholesterol. They act as physiological vacuum cleaners, picking up cholesterol from blood vessel walls and transporting it to the liver, adrenals and gonads. Higher proportions of HDL protect against heart disease (1, 2). LDL or low-density lipoprotein, is implicated in the creation of plaque in the arteries and hence is thought to play an important role in heart disease (3).
If your patient has had a more sophisticated test, their specific apolipoprotein levels will have been determined. Apolipoproteins A, C, E, J, L and M are contained in HDL, while apolipoproteins B and E are components of LDL (4 ,5, 6, 7). Apolipoprotein E (ApoE) is of particular interest to us as Ayurvedic practitioners. ApoE is involved with triglyceride, phospholipid, cholesteryl ester and cholesterol transport in and out of cells and is a ligand for LDL receptors. ApoE has been implicated in autoimmune conditions such as multiple sclerosis (8) and in neurodegenerative diseases such as Alzheimer's (9) as well as in coronary heart disease (10). It has been found to suppress lymphocyte proliferation (11).
So now we get to the really interesting part: genetic polymorphism of apoE. In humans, there are three main types of apoE, epsilon 2, 3 and 4, giving different disease susceptibilities. And since one gene is inherited from each parent, there are six apoE types in all: 2/2, 2/3, 3/3, 2/4, 3 /4. This of course cannot help but remind us of the various prakruti types in Ayurveda. ApoE types epsilon4, including 4/4 and 3/4, have been found to have a higher risk of heart attacks, coronary heart disease and Alzheimers (12,13) They also tend to have higher fasting blood sugar and hence propensity to diabetes (14). ApoE epsilon3 types have a neutral risk of heart disease and apoE epsilon 2 types have a lowered risk of strokes (15) but, according to some studies, do have a higher risk of heart disease as compared to the 3/3 type (10).
So far, few of my thousands of patients have had their ApoE genotype determined. Speculatively though, we can see apoE epsilon4 types as having many characteristics of kapha syndrome, with an increased tendency to diabetes, atherosclerosis, and heart disease. We could perhaps imagine that the 'neutral' 3/3 type, who will get heart disease in response to dietary and lifestyle risk factors, as similar in some respects to pitta types and the 2/2 types as vata types, who do have an increased risk of heart disease, as Madhava Nidhanam states, because they are susceptible to stress and worry (16). This topic needs and merits further research.
In the meantime, many patients do come to see us because they are worried about their cholesterol and yet reluctant to take statin drugs. For the kapha type, suspecting that they may well be apoE epsilon 4, we need to take steps lower their array of risks. Smoking is a typical kapha addiction that is extremely dangerous for cardiac health. Sedentary lifestyle is of course another risk factor lethal to kapha. Fried foods, refined sugars and refined starches are similarly important to address. Inflammation plays a key role in atherosclerosis and heart disease (3) and is related to a Standard American Diet (SAD) high in meats and low in vegetables. The kapha/suspected apoE 4 type must be guided towards a diet high in omega 3 fatty acids. As one of my patients characterized her Ayurvedic diet: "I'm following an Indo-Mediterranean diet." Emphasizing plant-based food rather than meats, both the Ayurvedic and the Mediterranean diets lower cardiovascular risk and increase the anti-inflammatory omega three fatty acids in the diet. Although fatty fish such as salmon has been emphasized as a key to heart health, fruits and vegetables are alternative sources of omega threes. Indeed, the mass consumption of fish oil is likely to have a devastating effect on fish species. Instead, emphasize flax oil, olive oil (here's where the Mediterranean gets into the picture), legumes--an Ayurvedic mainstay--along with nuts, berries, cruciferous vegetables, basil, garlic and leafy greens.
Turmeric is a super-food that distinguishes the Indian diet. Not only will turmeric help reduce inflammation (17) and have blood-thinning effects (18), it will also help prevent the other great risk apoE epsilon4 presents--Alzheimer's (19).
For the pitta type, supposed apoE epsilon 3, susceptibility to heart disease is a result of inflammation. As well as stressing an anti-inflammatory diet rich in omega three fatty acids, consider all the other ways to reduce pitta's tendency to inflammation. Health begins in the mouth, an important site of inflammation that can lead to heart disease (20). Use of herbs such as neem and triphala in dental care, using a tongue scraper and regular 'oil pulling', rinsing the mouth with sesame, sunflower or coconut oil can help reduce pitta's susceptibility to heart disease. Again, use turmeric as a spice and herbal supplement to reduce inflammation and give anti-inflammatory teas such as tulsi tea (21).
And for the vata suspected apoE epsilon2, stress management is key, along with a basic vata-soothing Ayurvedic diet. Vata's tendency to worry predisposes to heart disease, since anxiety generates pro-inflammatory cytokines, which lead to arterial plaque formation. A good yoga routine emphasizing shivasana and pranayama, a daily meditation practice and soothing teas such as a mix of brahami and tulsi will help shift vata out of the high-risk group without use of medications.
Hopefully further research will illumine the relationship between prakruti and apolipoproteinE genotypes. iN the meantime, as we have shown, it is interesting to note modern biomedicine pointing to three main types in terms of cardiac risks. As Ayurvedic practitioners, we can tailor primary prevention to the individual constitution.
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