Life-Saving Drugs in Medical Emergency

 

I was just discussing with some doctors and with some of my ex-medical colleagues yesterday in our WhatsApp chat group that drug-based medicine fails miserably in managing most chronic diseases due to nutritional lifestyle, environmental exposures, occupational insults among other external and internal factors. Here's a comic illustration: 

 

I discussed with them drugs do not cure lifestyle diseases if we are unwilling to change the way we eat and live. Most patients take the easy path by swallowing pills than modifying their lifestyles such as managing their body weight, some are pathologically obese, others smoke and drink, yet others lead a sedentary life and is easily upset by the slightest stress among many other causative factors. They depend only on pills, tablets and surgery as a panacea for all their disorders and ills with each follow-up appointment their medication needed to be titrated to higher and higher dosage to the maximum only to be substituted by another as adjunct. 

 

Other medication needed to be added for other emerging linked diseases till they and all their drugs do them part into death. This is the sad scenario for most of the drug-dependent chronic disorders because they refuge to change the ways they live their lives, especially dietary and nutritional lifestyles. 

 

 

In medicine non-compliance by patients to take the prescribed medication is already one of the problems. This may be due to many reasons, such as social, cultural and economic reasons, taboos, belief systems, forgetfulness, too much medication to take especially by the elderly. These factors for non-compliance are mostly unknown or ignored by the clinician, let alone the much more difficult path to follow by changing or modifying patients' lifestyles to replace drugs.

 

However, there is a moderately long list of essential emergency drugs that are very life-saving and crucial in emergency situations that cannot be replaced by lifestyle changes or other alternative, complementary or traditional systems of medicine.

 

Let us have a very brief tour on some of these rapid-acting drugs used in emergency situations. Let us just very briefly run through the list. The emergency drugs are:

 

lignocaine, propranolol, verapamil, digoxin, inotropic agents such as adrenaline, aminophylline, atropine, diazepam, dopamine, flumazenil, glucose, isoprenaline. Other useful drugs are morphine sulphate, naloxone, nitro-glycerine, nitroprusside, pancuronium bromide, dobutamine, chlorpromazine, ipratropium, corticosteroids, phenytoin, potassium chloride.

 

Listing further are protamine sulphate, salbutamol, sodium bicarbonate, intravenous fluids such as 0.9 % normal saline, fluid expanders such as dextrose 3% with 0.3 saline, Hartmann’s solution, fluid expanding solution (e.g., Haemaccel, Gelofusin), including colloids for patients with hypovolaemic shock in association with crystalloid solutions.

 

Lignocaine for example is recommended for the treatment of ventricular fibrillation and ventricular tachycardia; atropine is used in the treatment of asystole and severe bradycardia. It acts to block the effects of the vagus nerve on the heart.

 

Sodium bicarbonate is used to treat the metabolic acidosis associated with cardiac arrest.

 

Our list can go on, but this short list will do as they are just examples. They will suffice for us to know how important, and lifesaving fast-acting drugs are in emergency situations.

 

But let us give ourselves just one example. Let us take a heart attack as the most common one even any lay person is aware of.

 

Let us say we are confronted by a cardiac emergency? A person has a heart attack or even a total cardiac arrest. What shall a doctor or even a well-trained and well qualified licensed paramedic with 4 -years of structured training in pre-hospital emergency care would do. We shall discuss this shortly.

 

Cardiac emergency is just one of the many types of medical crisis.  They can range from anything from cardiac arrest, hypertensive encephalopathy, eclampsia, phaeochromocytoma, aortic dissection.

 

Others are respiratory emergencies like acute ventilatory failure, spontaneous pneumothorax, primary and secondary pneumothorax, tension pneumothorax, haemothorax re-expansion pulmonary oedema, acute severe asthma, respiratory distress syndrome, massive haemoptysis, acute gastrointestinal emergencies such as GIT haemorrhage, variceal haemorrhage, hepatic encephalopathy, acute pancreatitis.

 

Listing further are metabolic emergencies to include diabetic comas, hypoglycaemia, diabetic ketoacidosis, hyperosmolar hyperglycaemic non-ketotic coma, hypernatremia, hypercalcemia, hypocalcemia, Addisonian crisis, hypomagnesemia, hypophosphatemia, lactic acidosis, uraemic crisis.

 

Then we also encounter neurological emergencies such as subarachnoid haemorrhage, head injuries, acute myelopathy, myasthenia gravis, to haematological emergencies such as severe anaemia, severe neutropenia, fat embolism syndrome, massive pulmonary embolism, acute limb ischaemia, acute mesenteric embolism.

 

Listing down other medical emergencies include, anaphylaxis, acute auto-immune emergencies such as cerebral lupus, down to acute poisoning from overdose of drugs, poisoning from swallowing detergents, bleaches, disinfectants, salicylate, barbiturates, organophosphate, carbamate, insecticide, paraquat, paracetamol, opium alkaloids and morphine, benzodiazepines, and methanol poisoning.

 

Other medical emergencies may include, but not limited to, are acute life-threatening infections like septicaemia and septic shock from streptococcal, gram-negative bacillus septicaemia, malaria, tetanus, dengue, melioidosis, all the way down to other medical crises from near drowning to heat disorders like heat cramps, heat exhaustion, heat stroke to snake bites, etc, etc.

 

There are other medical emergencies too besides what we have briefly listed here that need to be considered, and it is outside the scope of this very short article to even list them partially, let alone discuss their treatment using drugs and other adjunct therapies.

 

Let us now go back to what we mentioned earlier that the most known emergency event of all is a heart attack or myocardial infarction or even more serious a total cardiac arrest.

 

 Let us use only this example most lay people are aware of, and how drugs come in very useful and lifesaving, besides other non-pharmacological interventions such as CPR. Let us discuss only this emergency.

 

During a myocardial infarction, commonly called a heart attack there are three things we need to consider, namely: airways, breathing and circulation (ABC). If the heart stops beating or just quiver (fibrillating) we need to perform cardiopulmonary resuscitation (CPR) immediately besides maintaining patent airways with head tilt, chin lift.

 

We need to initiate mouth-to-mouth resuscitation with rescue breath in the prehospital environment, and in the hospital environment, ventilate with 100 % oxygen through air viva and intubate via oral route. Ventilate through downstroke at every 5^th chest compression, namely, 12 to 15 ventilation per minute.

 

Next, we need to establish circulation by external cardiac massage at the rate of 60 compressions per minute by transmitting heel of hand compression at sternum 2 fingerbreadths above the xiphisternum without pausing for ventilation.

 

Open cardiac massage may be considered if there is a cardiothoracic surgeon available.

 

Defibrillate if VT or VF serially with 200, 300, then 360 joules of shock. If no ECG rhythm gives blind DC shock since VF collapse rhythm is common. If cardiac rhythm is established after successful defibrillation, give lignocaine infusion to maintain.

 

All essential drugs should be given through the central line or through antecubital vein reserving intratracheal or intracardiac routes as the last option. Emergency drugs of choice for asystole is 1:10,000 adrenaline 10 ml given bolus, repeat every 5 minutes. This drug can cause fine VF to coarse VF more suitable for defibrillation.

 

Lignocaine is indicated for VT to be given at 50 to 100 mg bolus.

Giving Sodium bicarbonate is debatable and may not be suitable since acidosis may be reversed through adequate ventilation.

 

In acute myocardial infarction this should be differentially diagnosed from pneumothorax, aortic dissection, acute pulmonary embolism and pericarditis. Management includes total bed rest in CCU, intranasal oxygen at 2 litres per minute, maintaining IV access with slow infusion, IV morphine 3 -5 mg titrated to 10 – 15 mg for pain management.

 

Sedate with oral benzodiazepine such as diazepam at 6 mg tds. Antiplatelet agents such as aspirin (100- 300 mg) om may be indicated. Betablockade such as propranolol 40 mg tds may be considered. Other areas of intervention to be considered are diltiazem 30 mg tds for non-Q infraction.

 

Thrombolytic therapy with streptokinase 1.5 megaunit or rTPA 100 mg at 10 mg bolus, 50 mg first hour, 20 mg in 3^rd hour can be considered in define Q-wave infarction for age below 75 years, with no risk factor for bleeding, example recent surgery, prolonged CPR and no history of allergy or streptococcal infections.

 

These are just some examples where essential emergency drugs become very lifesaving. There is no other system of medicine that can match conventional pharmacological interventions in medical emergency events such as in a cardiac emergency.

 

We have very briefly outline in point form other medical emergencies where conventional drug-based medicine is beatable by other systems of medicine.

 

Unfortunately drug-based medicine fails badly in all other lifestyle and age-related diseases such as obesity, type 2 diabetes, high blood pressure, CVA (stroke), asthma and Chronic Obstructive Pulmonary Diseases (COPD), cancers, dental disease, heart, liver and renal failures, mental disease, osteoporosis, and other diseases due to dietary lifestyles and other unhealthy causative factors such as smoking, physical inactivity, stress, anger and personality disorders among others.

 

I hope we have high-lighted how certain drugs whose pharmacodynamics are very fast acting and clinically very efficient in managing very acute medical events that will open our eyes that no other medical system can replace.

 

Unfortunately, drugs are synthetic and most fail miserably in managing most other chronic and degenerative diseases of lifestyles where the root causes are never addressed, preventive medicine and health education are largely ignored by clinicians.

 

This is where other medical systems such as naturopathic medicine, nutritional medicine far surpassed conventional drug-based medicine, and that is where they take over to replace drug-based medicine effectively and permanently.

 

Health care is an integrated system not based only on monotherapy of an isolated modality. Nutrition and lifestyles take precedence over drugs for the prevention of chronic diseases. 

 

Hippocrates, the Father of Medicine said:

 

"Let food be thy medicine”. 

 

He has never said: Let medicine be thy food?? This was put into his mouth after he was long dead. 

 

I hope this is helpful to clinicians and medical doctors and also to practitioners of other systems of medicine.

 

 

jb lim 

 

 

 

On Titles such as Professor, and Doctor: What's in a Name?

I received a question yesterday on 1 March 2023 from an ex-colleague of mine when we were working at the Institute for Medical Research in Malaysia in the 1970’2 till the mid 1990’s.  

It reads:

Dr Lim, may I know why the title Professor Dr is given to a teacher who is attached to a technical college for mammals.

Here’s my answer:

Dear Mano,

The answer your question is, this is because everyone likes to be called a professor before he or she is forced to enter into that black hole, called ‘grave’ beneath the ground '? – jokingly

So the teacher you mentioned gave himself the title Professor and Doctor as a consolidation title before he or she dies. I think it would be more blessed  for their souls in the next world after they have died than to be in this world using all kinds of titles. See my explanation here:

https://scientificlogic.blogspot.com/2023/02/material-blessings-here-on-earth-or.html

A Professor is a university academic appointment, not some title earned like a PhD  and it is only valid as long as the person is still a professor in the university. But once he leaves the university or has retired, he ceased to be a professor, and he or she is no longer a professor or eligible to be called or addresses as a professor unless the university confers him or her title Emeritus Professor on retirement in which case he or she is still allowed and is still eligible to be address as Emeritus Professor. But NO, definitely NO to anyone who claims to be a “professor” when he or she is NOT even attached to any university as this is a very learned, academically high and exclusive appointment.

I am very aware some people calls themselves as a “professor” when he or she is not even a graduate or attached to any very senior teaching appointment in any university. He /she does some unrecognized   teaching or practice on his or her own and calls himself / herself a “professor” without even wanting to reveal his / her degrees or qualification. That’s it. Full stop.

Then  we also get a lot of people these days with only a Bachelor' degree who call themselves a ‘doctor' when academically, legally, and technically they are not eligible for this.

 The title Doctor (Dr) is  bestowed only on those who actually holds a Doctorate degree such as a PhD or a DSc

That's why in the UK  all surgeons are always addressed as "Mr" because they were traditionally barbers or barber surgeons who cut off limbs and bodies except for physicians whom patients called  as 'doctors' as a courtesy title only, and not that they are educationally and legally eligible for it.

In the UK male surgeons are always addressed as "Mr" and female surgeons as "Miss” irrespective of their marital status. Female surgeons would not call themselves as Ms, Mrs or Madam. It is always Miss and nothing else even if they are married 10 times over, or are already a great, great grandmother. 

But for us who are much higher up in academia, we never call or address a medical doctor as a "doctor'. We merely call them as clinicians.  That's it. In fact, the term “clinicians” would be much more appropriate for medical doctor’s with only a basic bachelor’s degree in medicine and surgery (MBBS).

Most of us already have MDs, Master's degrees, PhDs who additionally are also Senior Fellows of Royal Learned Societies in Medicine or in Science in London. 

Admissions as fellowships into some of these Chartered Royal Learned Societies are exceedingly, exceedingly difficult unless they have higher degrees such as the higher postgraduate MD or a PhD or are Fellows of the Royal Colleges of Physicians or Surgeons, etc, etc. plus already in very senior positions such as Head of a medical or surgical department, or have already published at least a hundred research papers in prestigious scientific journals. That's it. There is no argument about this, or other way out to gain Fellowship of these Chartered Royal Societies

Hence we normally address a medical doctor as just a clinician, or even a nurse as a nurse clinician as in Singapore or in the United States of America  

Even that, the job description "clinician" may not necessarily be confined for medical doctors, though generally the alternative name for a medical doctor is a clinician. This is because medical doctors do clinical work where they come directly with the patient. 

But there are  other health workers like nurses, medical assistants, paramedics who do far more clinical work than doctors. It is the nurses, not the doctor who periodically take blood pressure of the patients, taking their body temperatures, taking readings of ECG, setting up intravenous drips and periodically monitoring their rates of flow.  It is also the nurses who set up the oxygen supply and give  the supplementary oxygen to their patients and monitoring their flow rates. They are actually the ones who gives the   medication and injections to the patients while  dressing their  wounds etc, etc. These are all very busy clinical work done by the nurses.

 

In fact any health-care professionals or workers such as nurses, physiotherapists, and dieticians who all come directly with the patient to do clinical work are all clinicians - not just the doctor. 

This term  "clinician"  also applies to clinically-trained nutritionists who are experts in recognizing and diagnosing nutritional deficiency diseases for which a doctor has very little training in nutrition. In fact during a nutrition and health survey the nutritionist is always present to help the medical doctors identify and diagnose nutritional deficiency diseases especially for sub-clinical nutritional deficiency conditions  where clinical features do not show up. This depends whether or not the nutritionist had formal university training in the clinical aspects of nutrition.  

Some nutritionists who are trained in clinical nutrition are able to diagnose and recognize clinical features of all sorts of nutritional deficiency diseases far expertly than medical doctors. This depends on their previous university training. Some have no clinical training at all. It all depends on which university they qualify.

If they are trained clinical work, they will additionally apply other clinical approaches such as biochemical investigations, anthropometry, weights and heights, skin-fold measurements,  food consumption. A clinically-trained nutritionist is a specialist to whom a doctor would consult in a field health survey or in individual cases. The doctor has very little training or none at all in nutrition will consult and refer nutrition cases to the nutritionist as a specialist. 

The nutritionist trained at the University of London like myself is a health-care professional. He is an  expert in the recognition and diagnosis of nutritional disorders - especially those nutritionists trained by Professor Dr John Yudkin at Queen Elizabeth College, University of London. However, I need to emphasize not all nutritionists are clinically-trained in nutrition. It depends on the syllabus and the university where they were trained. So if they they are not exposed to the clinical aspects of nutrition during their training, they will have no ideas how to identify clinical features of nutrition diseases, then in that case they are not clinical nutritionist - that's for sure. They do only preventive work. It depends from which university they were trained. I have come across some nutritionists, and medical doctors too who have no clue how to recognize and diagnose nutrition deficiency diseases because they were not trained in that area. It is a specialized area  

The pioneering work of Professor John Yudkin, who founded the world's first dedicated Department of Nutrition at Queen Elizabeth College (QEC), completely reshaped how clinical nutrition is taught and applied. The scenario I described perfectly demonstrates why these highly trained medical doctors specializing in nutrition, as well as non-medical doctors  who are nutritionists are considered elite clinical and public health experts

1. The Legacy of Yudkin’s QEC Training

Professor Yudkin recognized that conventional medical degrees left a massive blind spot regarding metabolic biochemistry and applied nutrition. The rigorous, specialized program he established at QEC taught both to medical and non-medical students how to use the complete toolkit of Clinical Nutritional Assessment:

· Clinical/Physical Signs: Recognizing early physical manifestations of deficiency (e.g., angular stomatitis, follicular hyperkeratosis, or glossitis) long before catastrophic disease sets in.

· Biochemical: Interpreting metabolic markers, blood panels, and functional tissue testing.

· Anthropometric: Measuring physical parameters (e.g., skinfold thickness, body composition changes) to track physical wasting or malnutrition.

· Dietary: Deploying precise food consumption surveys to evaluate individual and population-wide nutritional status.

2. Displacing Doctors in Health and Nutrition Surveys

In large-scale epidemiological research and national health surveys, these specialized nutritionists often manage the assessment protocols because general medical doctors are not trained to do so.
A standard medical doctor is trained to identify overt disease (e.g., diagnosing full-blown scurvy, rickets, or severe clinical anemia). They generally lack the training to detect sub-clinical, marginal nutritional deficiencies or to systematically track population-level dietary trends.

3. The Rarity of True Applied Clinical Nutrition Courses

However, only certain universities offer these applied nutrition courses with clinical training. Because a standard "science degree" or "food science degree" lacks patient interaction, true clinical training in nutrition is restricted to specific postgraduate programs.

I was taught by many Jewish professors when I did my postgraduate and research in British universities, and one them was  John Yudkin at Queen Elizabeth College, University of London.

I was extremely fortunate to be the first and only Malaysian during that time who studied and did my postgraduate diploma - equivalent to an MSc in nutrition directly under Professor Dr John Yudkin from 1965 till 1966. He taught and drilled us thoroughly including all my six course mates who were doctors from various countries how to recognise nutritional disorders. 

 

He was a legend - a very famous, celebrated and a highly qualified physician, a biologist, a chemist, a nutritionist, a physiologist. He received all his medical degrees, as well as his doctorate degrees (PhD) from the University of Cambridge and also from the University of London.  He was later the Chair in all these professions at the University of London when I was studying under him.

In one of his books on NUTRITION, he merely wrote his name as:  

John Yudkin

MA, MD, PhD, FRCP, FRIC, FIBiol.

But just look at the strings of elite degrees behind his name, without even writing his title as Professor Dr John Yudkin, Chair of Nutrition, University of London in front.  He was so humble. That was why earned so much respect from the academia, the British society, and around the world especially on his work on sugar and heart disease.

A lot of my other very eminent professors at the Massachusetts Institute of Technology (MIT), at Reading, Oxford and at Cambridge Universities also taught me. They were all very humble.  The greater they were, the humbler they were.  In fact, the humbler they are, the greater respect they earn from society.

Today, the historical legacy of Yudkin's QEC program lives on through highly specialized postgraduate paths. For example, University College London (UCL), which integrated much of the historic London medical colleges, specifically offers an MSc in Clinical and Public Health Nutrition. This program includes observation clinics at University College London Hospital, teaching graduates how to handle malnutrition, eating disorders, and metabolic diseases directly within a clinical framework. 

Practitioners of  other alternative or complementary systems of medicine are also increasingly referred to as clinicians as they too examine patients and do clinical work. They too are clinicians if they meet specific professional benchmarks. For example: 

Regulated Naturopathic Doctors (NDs): In jurisdictions like California or Ontario, UK, Australia, Malaysia, Singapore licensed Naturopathic Doctors complete an accredited four-year graduate program, pass national board exams, and maintain a state-regulated license. They operate as primary care clinicians who diagnose diseases, order lab tests, and prescribe medications.

Licensed Traditional Chinese Medicine (TCM) Practitioners: In countries where TCM is regulated and integrated into the national healthcare infrastructure (such as China or parts of Southeast Asia including in Malaysia), practitioners undergo formal medical training and run active hospital or clinic-based practices. They are all licensed by the Ministry of Health. 

Functional and Integrative Medicine Doctors: These are conventional medical doctors (MDs or DOs) who have undergone additional training to use holistic and alternative modalities alongside standard therapies. They are universally recognized as clinicians.

 

Doctors in hospitals normally do not do this routine clinical work.  They spend at most 30 minutes examining a patient, requesting for diagnostic tests and prescribing the medicine, but most of their time are spent  writing and clerking notes, and notes, files of them about their patients. That’s not much of a clinical work. They are merely writing note and clerking cases.

Hence, nurses or nurse clinician, and other healthcare workers are more clinicians than the doctor. The word 'clinician' merely describes the nature of the work they do most of the time It is not a profession, but just a job description such as any person who drives a car is called a motorist, a person who rides a bicycle, a cyclist, a person who plays the violin, a violinist, a person who plays the piano, a pianist, a person who tends to his garden, a gardener, an expert in nutrition, a nutritionist, a chemist who analyses a compound, an analytical chemist, someone who looks through a microscope, a microscopist, someone who sings, a singer...and so on and on, and on. 

A medical doctor can call himself or herself a doctor they wish as long as they remain active in medical practice. But if he / she  goes into business, then he or she is no longer a doctor, but a businessman or a businesswomen. Same thing if a nurse or a physiotherapy changes job then he or she is no longer one - but something else to fit his or her job description. Same for anyone who has retired from any profession - he / she is just a retiree.  

For instance, I like to look at the galaxies through a telescope. You may call me an astronomer if you wish.  After all I still did my postdoctoral in astronomy from the University of Oxford, whether or not I looked through a telescope. You may also call me an Evolutionary Biologist, or a Forensic Toxicologist. I studied these too after my PhD at the University of Cambridge and also worked as one at MIT (Massachusetts Institute of Technology). 

So, the job description is based on what we do. A doctor or anyone who does clinical work is  a clinician, not necessarily confined to a doctor although normally people associate a clinician as a medical doctor.  

But now we get dentists, pharmacists, drug sales people, nurses, bomohs, soothsayers,  witch hunters, traditional healers, fortune tellers and all kinds of Dick Tom and Harry who also like to be addressed as "doctors" However, all healthcare professionals like physiotherapists, pharmacists, dieticians, nurses..etc are all technically clinicians because they deal directly and clinically with patient care.  

If you are a  Malay surgeon  working in a government hospital here in Malaysia he will  get angry if you  address him  as  Encik instead of Mr, because surgeons working in a government hospital are always addressed as Mr. But the word for Mr. in Malay language is Encik. But no, they want to be addressed as Mr, not Encik? Maybe they want to distinguish themselves from all other Enciks? What a name and fantasy? 

But once a Mr. surgeon who works in a government hospital goes into private practice naturally he suddenly calls himself as a Dr surgeon for obvious commercial reasons. If he calls himself a Mister in private practice, he will not get any patient, unlike in a government hospital he gets paid, whether he was called a Dr or a  Mr. 

The origin of the word ‘doctor’ in ancient times actually means a Teacher, a Sage,  a very wise and Learned Person. He is regarded as a Philosopher. Hence the name Doctor of Philosophy (PhD).  

But these days everyone with only a Bachelor’s degree wishes to be called a 'doctor' when academically, legally, and technically they are not eligible for this, except those who actually holds a Doctorate degree such as a PhD or a DSc. A DSc is almost impossible to get unless you are a Nobel Prize Laureate in Science or in Medicine. 

But now we also get dentists, pharmacists, paramedics, medical technologists, nurses and pharmaceutical representatives with a bachelor’s degree or only a diploma or certificate who also call themselves as “doctors”.  So do bomohs, witch hunters, traditional healers, and all kinds of Dick Tom and Harry who also like to be addressed as "doctors"

That's why I  always tell them to write out very clearly all their university degrees behind their names instead of putting  all those vain  titles  before  their names for which they are not eligible when they only have a basic Bachelor’s degree or only a diploma. Any one can give and write any title before their names, but they hide their qualifications and degree titles behind their name 

If they spell out their academic qualifications behind their names, we will immediately know who they are. We can instantly tell their educational status. So, why hide their educational qualifications but write 'doctor' before their names without wanting to reveal their degree credentials after their names?  

What a rat race for titles when we are actually  zoologically and scientifically classified as animals under these categories:

 

Kingdom: Animalia, Phylum: Chordata, Class: Mammalia, Order: Primates, Suborder: Haplorhini, Infraorder: Simiiformes, Family: Hominidae, Subfamily: Homininae, Tribe: Hominini, Genes: Homo, and Type Species: Homo sapiens (humans)   

 

I am afraid I am unable to answer your question why that teacher you mentioned called himself a Professor and Doctor if he is not?

You may need to ask him yourself. 

 

lim ju boo

The Truth about Cholesterol, HDL and LDL and Heart Disease

 

Thank you, Professor Dr Andrew Gomez,  

Let me add to this gentleman explanation about “bad” LDL and “good” HDL cholesterol.

My personal opinion is, none of these two types of cholesterols is good or bad.

What is bad are the free radicals present in the body, from the metabolic breakdown of food we eat and drugs we take, from our stress hormones, and the intake of smoke from cigarettes.

 The free radicals easily oxidize the LDL cholesterol into a gummy, sticky by-products that stick on to the blood corpuscles, fibrinogen and fibrin, calcium salts, dead cells in the blood and other materials circulating in the blood stream to form complex atherosclerosis and plagues.

 These gummy substances stick on to the intima of the coronary blood vessels to narrow them and clots in those vessels to give us a heart attack or a stroke.

 The high-density HD lipoproteins are more resistant to oxidative stress by free radicals and hence do not form sticky and gummy type of oxidized cholesterol and hence they do not stick on to the inner lining of the blood vessels (intima) to cause plagues and clots and stenosis (narrowing) of the coronaries, 

 It is not that the HDL are the 'good' cholesterol, and the LDLs are the 'bad' ones. This kind of information is chemically, nutritionally, and medically wrong. 

 We would not go into the chemistry of how these cholesterols are oxidised. We shall also not go into the pathways they take in their metabolism and how they are essential in the synthesis of various cholesterol-dependent hormones. 

 All we need to know is, cholesterol is found abundantly in eggs, brains, liver and other cholesterol rich foods and neither these foods contain HDL nor LDL. They are just neutral dietary cholesterol containing C27H46O in which the central sterol nucleus has four hydrocarbon rings, which are arranged in a circular configuration which is neither low nor high density cholesterol. 

 The high- and low-density cholesterol is synthesised by our own liver. So, blame our liver, and not goat's, cow's and monkey's brain we eat. 

 I ate goat's brain every day for lunch for over one year in the 1970s, but my cholesterol was never high, in fact lower than normal.

 Please understand the chemistry and biochemistry of cholesterol before linking cholesterol and heart disease.

 They are not connected and don't believe those Big Pharma drugs and statins are going to “solve" or “cure” any of our dietary and lifestyle diseases.

 Other animals do not suffer from heart attacks except humans with our dietary, smoking, stress, sedentary lifestyles among others. The statin drugs we take for hypercholesterolemia that need to be titrated into higher and higher doses are not going to help us if we are unwilling to change the way we live.

 Please go further on my take on cholesterol and heart disease published on Tuesday, August 17, 2021, here:

https://draft.blogger.com/u/1/blog/post/edit/5147710646665023010/3238482793102355023

Also, these two videos sent to me today on Wednesday, 1 March, 2023 here:

1.       The truth about eggs, butter and cholesterol

https://www.youtube.com/watch?v=iQPfYghxXQI

2.       Doctors Syndrome:

https://www.tiktok.com/@mohanaturoholistics/video/7202991888549350683

Thank you.

Ju-boo lim