Cardiac protein as an early predictor of heart attack

Very late last night just as I was already retiring to bed at nearly 3 am, I received a WhatsApp message from Professor Dr Andrew Charles Gomez, a very prominent and famous ENT Specialist asking my opinion of a claim by a speaker at a conference on nutrition and aging he attended who said that a heart protein called cardiac myosin can be used as early detector of heart attack?

I instantly got up from my bed to type my personal opinion on this to Prof Gomez


Dear Prof Dr Andrew Gomez,


I am surprised you heard from one of the conference speakers on nutrition and anti-aging you attended that cardiac myosin is used as an early detection of heart attack?


Since I was not at the conference, I do not have the details of that claim. This is the first time I heard of using cardiac myosin as an early predictor of AMI (acute myocardial infraction).


As you are a reputable medical specialist yourself, let us argue this logically.


First of all, myosin is not something new to scientists. Even during my student days in the early 1960’s we already learn about this protein both in our physiology, and later in our nutrition lectures, that this protein (myosin) is present in all muscles for their contractile functions.


There are essentially two types of myosin expressed by three different types of genes; two for skeletal muscles – namely, one for slow skeletal muscles, and the other for fast muscles; both of which are actually responsible for the conversion of energy-rich phosphate bonds ATP (adenosine triphosphate) into ADP (adenosine diphosphate) with the release of energy like muscle contraction. We all know that even in biochemistry.


The remaining 3rd type of gene (MYBPC3) exclusively expresses cardiac myosin that is responsible for the continuous non-stop contraction of the heart.


This protein (cardiac myosin) remains in the cardiac muscles at stable and low levels. But they may increase by drugs such as cardiac myosin activators in the event of a heart failure.


But I have never heard of a heightened expression of this cardiac protein even BEFORE an acute cardiac event such as AMI. This does not seem scientifically logical to me. How do you expect a gene able to know or predict that an acute event is going to happen that requires it to increase its (protein) expression? This is like fortune-telling and putting a cart before a horse.


In medicine, doctors ought to know (unfortunate a lot don’t) that in most diseases, biochemical lesions starts to appear in the blood before the clinical presentations become apparent. But this can only happen if the pathology is already present without the clinical features manifesting themselves in the early stages of the disease.


Just to give you one or two examples will do - hydroxyproline and hydroxylysine for collagen formation is low before gingival lesions become apparent in scurvy.


Another example is erythrocyte transketolase activity in the RBC is affected even BEFORE a thiamine deficiency and beri-beri clinically manifest itself.


Yet another simple example is blood sugar levels is elevated for months or years before polyuria, polydipsia, polyphagia, weight loss, retinopathy, nephropathy and other complications are presented as complications in diabetic patients.


Another example is the elevation of various liver enzymes - alanine transaminase, aspartate aminotransferase (SGOT)… etc., even before signs and symptoms of liver diseases are apparent.


There are hundreds more such examples of biochemical and protein expressions appearing BEFORE a clinical presentation following the existence of already an active pathophysiology


However there are also a number of examples where the biochemical expressions are not sensitive enough for them to appear first before the clinical lesions manifest themselves.


One example are the tumor markers for cancer detection. These markers are neither specific nor sensitive enough to detect a lurking cancer already in existence in the body until the neoplasm are already very massive and in an advanced stage.


The reason is probably an existing malignant tumour requires billion of cancer cells to collectively express sufficient amounts of abnormal malignant proteins to be sensitive enough for chemical detection.


In the event of tiny amounts of cellular cancers lurking in the body all the time which we all have, but dealt with by the immune system, these small amounts of malignant cells cannot express sufficient amounts of abnormal proteins for chemical detection.


The only exception I can think of are the prostate-specific antigen (PSA) where its blood elevation is common for both prostate cancer and benign prostatic hyperplasia (BPH). The only choice for diagnostic differentiation between PSA in prostate cancer and BPH is to look at the velocity of the PSA increase over time, and also the free and combined PSA ratios.


In a total PSA level, there will be more free PSA in BPH than in the case prostate cancer. That ratio expressed should be taken into consideration short of performing a TRUS biopsy (transrectal ultrasound biopsy) for differential diagnosis.



PSA detection expressed by the prostate gland is quite specific for prostate anomaly. The rest of the other tumor markers are neither sensitive nor specific. This is the only example I can think of at the moment as I type this sentence.



In short, in most cases biochemical changes precede a clinical presentation. It is the presence of an asymptomatic pathophysiology preceding that causes protein expressions as changes in the blood chemistry.


This is because the pathology is already actively present as a trigger factor for the genes to express the specific proteins. This is so logical to understand.


However, there is only one exception I can think of at the moment in which an acute event comes first; after which then there is an expression of a protein (enzyme).

In this exceptional example, there is an increase in cardiac enzymes creatine kinase (CK-MB), and also the troponin levels which are released by the heart muscle within 3-12 hours of onset of chest pain, reach peak values within 24 hours, and return to baseline after 48-72 hours.


These cardiac enzymes are released only after an AMI. This is because the heart muscles already suffered a damage, and the enzymes expressed are only an after effect. But there is no way the heart knows when it is going to suffer a sudden coronary insufficiency for it to express the enzymes beforehand?


So the genes responsible for such enzyme (protein) release can express themselves only after a sudden acute event. AMI happens when the coronary vessels suffers a sudden ischemic episode, unlike chronic diseases. In an AMI there is no way of predicting this instant event. This is logical.


So, how can cardiac myosin be expressed beforehand and detected as an early predictor before the heart even knows of an imminent sudden cardiac event? This beats my all my basic understanding in medical sciences


As we can clearly see from the example of CK-MB and troponin being released ONLY after the cardiac event has happened, I see no way can the gene MYBPC3 ability to express the myosin-binding protein C (cardiac myosin) before the event?


In lighter vein, genes are not fortune-tellers or harbingers that can foretell a medical catastrophe yet to come for person to take the necessary precaution.


What you heard from the conference presenter on nutrition and aging does not make scientific sense to me to the best of my understanding.

Maybe I need to get hold of his published paper (if any) to read the study, the methodology, data and inference.


Thank you for asking


Lim ju boo

Peeling An Apple. Is It Wise?

Recently someone sent me a WhatsApp showing a mechanical apple peeler, and how it can peel many apples rapidly, efficiently and very cleanly.


I replied to tell him that the skin of an apple or any fruit especially highly coloured ones contain the core of their nutritive and even medicinal value, and such a device is doing injustice to Nature, the apple and the most of all, the consumer himself.


The Skin is Wholesome and The Best:


In fact a consumer of a cleanly peeled apple is throwing away the best part of the fruit.
The skin with its tens of dozens of phytochemicals, antioxidants, and phytonutrients of various molecular weights, many of which with low molecular weights below 400 are bioavailable through the human intestinal gut as Nature intended. They are meant for human consumption, but are lost through ignorance and fear of toxicity.


WhatsApp Ignorance:


Following that, a few in my WhatsApp group replied, the reason why they normally remove the skin of an apple is because of the wax. One said he tried to use hot water (I suppose he meant “blanching”), rub it with cloth and tissue paper, but the wax is still there.

Some even wrote using a combination of baking powder and vinegar and all sorts of de-waxing methods. But the wax is still there.


Unfortunately those with no knowledge of even simple inorganic chemistry do not realize that using a combination of baking powder (which is sodium bicarbonate), and vinegar (which is acetic acid) only result in production of carbon dioxide, sodium acetate and water in the reaction.


None of these resultant compounds can remove waxes, whether mineral wax or natural ones. But they believe in such “knowledge” taken from the Internet!!


Finally they found the best way is to skin off the apple, and consume only the white flesh beneath.
This prompts me to write a small explanation in this blog.


Perhaps most people who try to remove waxes on the surface of apples or from the skin of most fruits and vegetables do not know even simple food science, nutrition or chemistry.


I think they do not understand what wax is on the skin of an apple? I think most people think wax is toxic, and is harmful to health.


Simple Household Science:


Let me explain using with just a little organic chemistry, and a bit of physiology.
The wax on the skin of an apple is a natural fruit wax secreted by the apple itself for its own protection.


Most plants, fruits and vegetables such as apples, oranges, lemon, tomatoes, pumpkins, water melon…etc., etc , do secrete waxes and oils on their skin to protect themselves against water from outside, and internally against moisture loss and subsequently dehydration.


Even animals like ducks, birds, chicken do the same when they peen their features to keep them waterproofs and stay dry and warm.


Even the human skin secrete sebum with its sebaceous glands, and the body oils on our skin is about 26 % wax esters and about 12 % squalene, but mainly triglycerides and less of other free fatty acids.


Wax esters and squalene are unique chemical composition of the sebum on our skin, and are produced as a protective layer to keep the skin moist, and this secretion is not found anywhere else in the body.

So we may say these waxes are natural substances and are mainly made of esters. But then, what are esters?


Esters:


Now in order to explain what esters are, we need to understand just a little bit of organic chemistry.
Let me explain this in simple language.


Esters are organic compounds formed by the reaction between alcohols and organic acids.
For instance, esters derived from carboxylic acids have the general formula RCOOR’ A simple example will do, such as ethyl ethanoate CH2COOC2H5, and methyl propanoate, C2H5COOCH3.


Esters containing simple hydrocarbon groups are volatile fragrant substances found in most fruits such as in apples, citrus fruits, mangoes, peaches…etc.


Esters as the Fragrance Fruits:


Because of their fragrance, food scientists and food technologists used them as flavouring agents in the food industry.

Similarly, like oils and sebaceous secretion on human skin or the oils from the uropygial gland (preen gland) in birds to preen their features, they are called triesters, meaning they are waxes or natural oil and fats molecules containing three ester groups.

Wax can be solid or semisolid substances. There are classified into two main types. The first type is mineral wax which is a mixture of hydrocarbons with higher molecular weights.
finitely not found naturally in apples or in any fruit or vegetable or rubbed into apples by the fruit producers.

The waxes found in apples and plants and in all animals, are actually esters of fatty acids to protect them from moisture, and these are edible and not toxic.


Do Not Peel an Apple:


So there is no need to scrape off the skin of an apple. Sometimes, apple and other fruit producers do rub in just a drop or two of natural waxes to the apples to preserve and to store their produce for a longer time and for better keeping qualities during handling, transport, and storage, but these are same wax esters they use as the apples themselves, and they are of food grade, not industrial or mineral waxes.
So there is no reason why health conscious consumers should peel away the skin of an apple.


A Holistic Natural Apple:


It is “An (whole and holistic) Apple a Day that Keeps the Doctor Away”
And that’s what Nature intents, not an un-holistic one with its best parts removed. What Nature puts in, let no man put asunder.


I hope I have explained clearly in reachable non-technical language to the ill-informed consumers, including the so-called “nutritionist”, “food toxicologist” and “health and food experts”


“Let the Whole Food be Thy Medicine” (my own quote)