How can he die from a heart attack at 40? “He was so fit and regular at the gym.” “Looking at him, I am sure he didn’t have an unhealthy diet”
Mid-2021, my social media accounts flooded with direct messages and tags right after popular Indian actor Sidharth Shukla succumbed to sudden heart failure.
Heart diseases are wrongly perceived as diseases of old age. Young adults do not worry about the risk of dying from a heart attack. It is rare for my young clients to express concern over critical heart conditions. While young people are more concerned with losing weight quickly, they often opt for a trendy, crash diet that lacks essential nutrients. The word ‘diet’ has become a synonym for exclusion rather than inclusion.
Awareness is scarce
What surprises me is the fact that many Indians are unaware of the prevalence of heart failures in young adults, and significantly high—killing lakhs of young people every year. The incidence rate is only rising. The World Health Organization (WHO) revealed that India accounts for one-fifth of all non-communicable diseases (NCD)-related deaths worldwide and most of these deaths are from the younger population. The Global Burden of Disease study stated that the cardiovascular disease (CVD) death rate in India is 272 per 1,00,000, which is significantly higher than the global average of 235. Around 2.63 million Indians died from CVD in 2017, which was the leading cause of death in the country as well. But how many Indians are familiar with these statistics? Nutrition policies intended to reduce the prevalence of NCDs lack systematic awareness programmes to inform the public on the prevalence and the outcome of such diseases.
Most Indians lack basic nutrition education
A combination of risk factors—age, gender, ethnicity, genetics, smoking habits, diet, lack of physical activity, cholesterol level, high blood pressure, diabetes, and depression—are responsible for cardiovascular diseases. Some of these risk factors are not in our control, but what we eat, how much we exercise, how our mental health is are modifiable risk factors with the right choice of lifestyle.
The Indian diet is cereal-based, includes more carbohydrates, has less protein, and lacks essential micronutrients. The intake of ‘white’ foods—refined flour, white sugar, salt, and potato—has increased manifold in recent years, making Indians more vulnerable to serious metabolic syndromes such as type 2 diabetes, CVDs, obesity, and hypertension. As a result of the global nutrition transition, young Indians are now hooked to ultra-processed foods—instant noodles, chips, pizza, burgers, fried chicken, pastry, cake, chocolate. Junk foods are cheap across the globe, but the ‘real cost’ of eating junk foods is not communicated to the general population. Food labels do not provide nutritional information or warnings. A nutritional score for packaged Indian foods has not yet been developed.
Can we blame the youth for not eating healthy? From my practice, I confer that 50 per cent of young Indians are not aware of basic nutrition education. Consequently, the importance of eating optimum protein, dietary fibre, and green vegetables is highly overlooked. Moreover, healthy foods are lost behind the dazzling advertisement of soft drinks, billboards promoting fast foods, and celebrity endorsements.
Personalised diet and nutrition policies are key
There is a huge knowledge gap when it comes to the association between diets and cardiovascular diseases. The Indian food system and nutrition policies need a significant revamp of nutrition communication strategy to prevent and manage CVDs and other NCDs. However, policy modification isn’t enough. Educating the public about the benefits of lifestyle modifications and nutrition is crucial.
Apart from policy modification and effective implementation, personalised nutrition is the key to preventing mortality and morbidity. Eat whole foods, avoid packaged and processed foods as much as possible—one mantra to ensure healthy eating. Make your plate balanced with a variety of whole foods, such as lean protein (present in chicken, whole eggs, fish, paneer, soy chunk, tofu, chickpea, beans, and legumes), vegetables (all green, leafy, and colourful ones), low-sugar fruits (guava, pear, berries, peaches), yoghurt or curd, and high-fibre whole grains (oats, millets, quinoa, barley, whole-wheat). Dietary habits aligned to the Mediterranean style of eating is best to prevent metabolic syndromes by reducing inflammation and oxidative damage.
The nutrients that are highly overlooked in the Indian diet are proteins, vitamin D, and essential fatty acids such as omega 3 and omega 6. Researcher J. Ranganathan and colleagues reported that an average Indian consumes just 47 gm of protein per day—the lowest in the world. The Mediterranean and Dietary Approach to Stop Hypertension (DASH) diets focus on eating more fruits, vegetables, whole grains, low-fat dairy, lean protein, nuts, and seeds that are found to be effective in lowering high blood pressure, high cholesterol level, and elevated risk of CVDs.
The role of Vitamin D in reducing overall mortality risk from CVDs is well-documented. A 2021 study including 6,329 adults concluded that a higher serum vitamin D3 level was associated with a significant lowering of all-cause and CVD mortality. Sadly, Vitamin D knowledge among Indians is limited. What’s more? Despite getting enough sunshine, more than 70 per cent of Indians are vitamin D-deficient and diet alone can’t address that. As India began producing more vitamin D-fortified foods, the question is—how many of us actually know about them? Furthermore, do we have access to such foods at all?
A variety of nutritious foods are produced in India that promote overall health, including heart health. Lack of nutrition education regarding healthy dietary practices among young Indians, however, cannot be ignored as a potential factor for the increased incidences of metabolic syndromes, including heart attacks. The development of a comprehensive national nutrition strategy including personalised nutrition and nutrition education is vital to tackling NCDs.
Dr Subhasree Ray is Doctoral Scholar (Ketogenic Diet), a certified diabetes educator, and a clinical and public health nutritionist. She tweets @DrSubhasree. Views are personal.
(Edited by Humra Laeeq)