Candy Crush


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“Y. Kawakami, H. Yamanaka-Okumura, Y. Naniwa-Kuroki and M. Sakuma, “Flaxseed oil intake reduces serum small dense low-density lipoprotein concentrations in Japanese men: a randomized, double blind, crossover study,” Nutrition Journal, vol. 14, no. 36, 2015. (…”

Never lived,
Merely survived.
A scripted life full of 
sighs, and sugar coated lies,
Read the epitaph
of the young old man,
Who died.

An unusual question

DS1 asked an unexpected question, “AC, which of the two sayings is more true in your opinion? The meek shall inherit the earth or Veer bhogya vasundhara?”

I looked at him. The question was bizarre. He was not known for asking philosophical questions.

The first saying was a quotation from the Holy Bible “Blessed are the meek: for they shall inherit the earth“.2 The second was from Shrimad Bhagwat Gita, which meant “only the brave will enjoy this earth.”3

DS was my classmate who had left India to settle in the USA. He is a cardiologist by profession and was visiting his ailing parents in India. During this visit, he himself suffered from a Myocardial Infarction.  Fortunately, he had reached a private hospital in time to have primary PTCA.4 He was currently recuperating in the hospital.

I had gone to look him up and to wish him a quick recovery. It was early morning and his hospital was on my way to work. When I entered his room, I found him busy devouring breakfast. On his tray were two fried eggs with sunny side up, a single buttered toast and black coffee.

A long lost friend

We had met after nearly 40 years. I decided to remain quiet about all that bright yellow yolk in the spoon moving towards his mouth. In college, we used to have long and frank discussions about what was right and what was wrong. 

His decision to leave India was also the subject of one of our discussions. He was very clear that it was the only way he could improve the financial state of his family.

During his breakfast we caught up on the lost time. Overall, he appeared very disconsolate that day.

“AC, I have not lived for myself even a single day.” There was a regret in his voice, “And everyone I have tried to help has exploited me.” 

I asked him, “Why do you say that?”  

He said, “I guess, I have never talked about it to anyone in my life so far. It started very innocently when I was very young. We were a very poor family. My parents were busy making ends meet and I studied in a ‘Sun & Sand’ school.”

Turning point

I smiled at his use of a fancy term for a village open air school where there is ‘sun above and sand below.’ He added, “For the secondary level, I was placed in a Government school, where the fee was merely 81 paise per month and none of the boys were interested in studies.”

I was aware that many brilliant students come out of such schools because of strong motivation. He carried on, “One day, our class-teacher Tripathi sir, called me and said – DS, if you do your maths well, I will let you pluck mangoes from the school tree!”

“What happened then?” I asked.

“Forbidden fruit was a big temptation for the young me. I worked hard and topped in maths. Tripathi sir, as promised, allowed me to pluck five mangoes every day during the season. Of the five, he used to keep four and give me one. And I would proudly take that mango home as a trophy to share with everyone.”

“Everyone?” I asked

“My parents and my two younger sisters. And the look of pleasure on their faces was addicting too.” He reminisced. “It changed my attitude to work. It led me into the habit of trying to remain in the good books of my teachers/parents.” 

“So that is why you were so committed?” I observed.

“I used to get depressed if I did badly in any subject or if I could not do any chore at home as asked.” He replied.

“Good for you! No wonder you did so well.” I tried to cheer him up.

“Yes, it did work well for me till I reached the USA.” he sighed.

“As far as I know, you have done extremely well there too!” And that was the truth.


“In a way that is right. However, the guilt of leaving them was there. I used to feel compelled to share a major part of my scholarship money with my parents. Later it was from my pay. My sisters started taking their new found affluence for granted.” He said.

“Ohh.” there was nothing for me to say.

“With time, the demands from home kept increasing. My parents also now wanted to buy a flat and I felt obliged to help them as much as I could by staying away from all conveniences or luxuries for myself.”

I could sense that he was regretting it at some level now. He continued after a brief pause.

“You see, I never tried to have a good time as all my colleagues did. Never drank, never bought anything expensive for myself. I pushed myself to remain busy with my work. There was always something to be done for the family. Sisters’ education, marriage and then post marriage rituals; problems with brothers-in-law and so on. My focus on my parents and sisters was one of the reasons that my wife left with our kids. I was left alone with my work.”

I tried to console him, “Your work is formidable. Your research has made you a legend. Everyone admires you.”

I saw his eyes tearing up. He said,”That is the main problem!”

“Why?’ I was astonished.

“It’s a long story.” He was reluctant to go any further.

“I have time. And It will be better for you to take it out.” I tried to be helpful.

He thought for some time and then said, “You see, when I finished my cardiology, my mentor was working on coronary heart disease (CHD) due to atherosclerosis. My thesis was also on the same subject.”

“Naturally! That’s the subject dominating research the world over.” I interjected.

Cholesterol at the centerstage

He stated further, “Our team had done a lot of work on the risk factors for CHD, which included obesity, physical inactivity, raised blood glucose, raised blood pressure, raised total cholesterol, and high salt intake.5 I was asked to focus mainly on the cholesterol.”

I could understand that,”Yes it has been in the centerstage!”

“In 1950s, it was thought that saturated fat in diet is the principal cause of elevated serum cholesterol and CHD. American Heart Association (AHA) by 1960s, had accepted that Americans should lower their intake of saturated fat.”6

He was giving me the background of his research work. “I continued work in this area and some of our work led to the U.S. federal government formulating a document ‘new dietary goals’ and recommended reducing fat intake in diet (1977).7 My mentor was a part of that national document largely because of my research.”

I was impressed, “That shows the caliber of your work!.”

“At that time, we were aware of an alternative theory by a British physiologist, John Yudkin, who said that sugar was closely related to CHD incidence and mortality.8 My mentor saw his work as a competition and we debunked it. We proposed that cholesterol was the main thing.”

He was talking of a time when we had just discovered that cholesterol was carried in the blood with some proteins as tiny vesicles called lipoproteins. Some classes of these lipoproteins, for example, low-density lipoproteins (LDL) were linked to higher risk of CHD. That’s why we called it bad cholesterol. This was in contrast to high density lipoproteins (HDL) which was known as good cholesterol.

Several papers had suggested that different components of diet could raise LDL.9,10 I saw no harm in DS’ suggestion that one should reduce intake of dietary fat.

Figure-1: Relationship of cholesterol and heart disease. Over years, our understanding has evolved that it is not the total cholesterol that is related to heart attacks. Only a small specific component known as ‘small dense oxidised particles’ that are mainly responsible for atherosclerosis and heart attacks. The remaining portions of cholesterol may be even protect from heart disease or may be neutral. (The periods shown on the top of cartoon are approximate)

Good and bad cholesterol

He elaborated further, “Our research later showed that it was incorrect to blame total cholesterol or LDL for heart disease. CHD risk depended on a special component of LDL called ‘small dense LDL’ which was more readily oxidized.11,12 The remaining large, buoyant or fluffy LDL could even be anti-atherogenic.”13,14

“You mean the remaining large, fluffy LDL behaved like good cholesterol?” I asked.

“There were some indications that it does. The research also showed that eating saturated fat led to reduction in small-dense LDL and increased large buoyant LDL.15,16 It meant that saturated fats protect against CHD, although we called these conclusions controversial.17,18

“You mean eating saturated fat protects one against heart disease?” I repeated what he had said.

He took no notice of my remark and went on, “Something more came to light around the same time. Some saturated fatty acids increased LDL and HDL levels while others did not.19 For example, saturated fatty acids – streate and laureate, seemed to reduce heart disease risk.”

I recalled one report which had generated a lot of discussion among lay people, “Would that explain the normal cholesterol levels in an 88 years old man, so called ‘Cool Hand Luke,’ who ate 25 eggs a day for the last 15 years?”20

He replied nonchalantly, “I am not sure. That was a freak case. There must have been some genetic protection there.”

Why cut down fat?

I looked at him sideways and remarked, “But the hospitals are now allowing eggs to patients with heart disease!”

He understood that I was referring to his breakfast and said defensively, “Yes, thanks to the efforts of the egg-industry, the restrictions on eggs have now been eased.”21

“Tell me in simple term, what should one eat?” I asked

He was ready with the answer, “If one wants to reduce really bad cholesterol, one may be advised to eat low carbohydrate diet with reasonable amount of fat/saturated fat (including nuts, avocados, flax seed oil and fish oils).22,[ref]V. Guay, L. B. A. Charest, A. Tremblay and C. P. , “Effect of short-term low- and high-fat diets on low-density lipoprotein particle size in normolipidemic subjects.,” Metabolism, vol. 61, no. 1, pp. 76-83, 2012. ([/ref],23,[ref]Y. Kawakami, H. Yamanaka-Okumura, Y. Naniwa-Kuroki and M. Sakuma, “Flaxseed oil intake reduces serum small dense low-density lipoprotein concentrations in Japanese men: a randomized, double blind, crossover study,” Nutrition Journal, vol. 14, no. 36, 2015. (],24,25,[ref]M. Pedersen, C. Mølgaard, L. Hellgren and L. Lauritzen, “Effects of fish oil supplementation on markers of the metabolic syndrome.,” J Pediatr, vol. 157, no. 3, pp. 395-400, 2010.([/ref] One should exercise more and avoid sugars particularly fructose.”26,[ref]S. Rizkalla, “Health implications of fructose consumption: A review of recent data,” Nutrition & Metabolism, vol. 82, no., p. 7, 2010.([/ref]

“Is that what current guidelines say?” I wanted to be sure.

“Current guidelines suggest that saturated fats as well as sugars, each should not form more than 10% of total calories.27 He continued his narrative, “When we first recommended that fat intake should be reduced, we had not realised that it will be replaced by carbohydrates!”

What does one eat in low fat diet?

“And what was the impact?” I asked.

“Clearly unfavourable! If carbohydrate intake was increased, total cholesterol automatically rose,28 In addition, HDL levels fell with increased risk for CHD!”29 He said. “Consuming even moderate amounts of sugar led  to an increase in CHD risk significantly.30,31,32,33 Most of the evidence was coming from our competitors.”

“So your recommendations went to prove your competitors right?” I could not hide my smile.

Look at carbohydrates

He sighed. “In a way, yes. High sugar in diet led to increased risk for CHD, insulin resistance and other vascular diseases.34,[ref]Szanto S, Yudkin J. Dietary sucrose and platelet behaviour. Nature 1970;225:467-8.[/ref],35 Among the sugars too, fructose, and sucrose, seemed to be more harmful than others.”36 

I asked, “Common cane sugar is sucrose. Isn’t fructose the sugar that is present in fruit juices, honey, corn syrup and mayonnaise?” 

“Yes! Fructose induces leptin resistance. 37 Leptin resistance causes obesity and therefore is a risk factor for CHD.”38

Sugar, honey and fruits?

I remmembered, “Fructose is also the main cause of non-alcoholic fatty liver disease (NAFLD), which in itself is a risk factor for CHD.”39,40

“Yes, fructose has many additional harmful effects.”41,42

“I asked, “So, is carbohydrate worse than fat?”

“More and more studies are finding that dietary fat has no significant impact on risk of CHD.43,44,45 Thus, there was no scientific evidence to support our recommendations of 1977. But the same theme was copied in many subsequent guidelines in the USA and also 1983 Dietary Fat Guidelines of the UK.46,47

“What happened when people followed your older guidelines and reduced saturated fat in the diet? Was it not beneficial?” I asked.

Sugar is the poison!

“I give you bitter pills, in a sugar coating. The pills are harmless - the poison's in the sugar”

― James St. James, Party Monster: A Fabulous But True Tale of Murder in Clubland

He answered, “Results depended on what the ‘saturated fat‘ calories were replaced with! Many replacements such as trans-fats or omega-6 polyunsaturated oil were worse and lead to higher deaths.48,49,50 If we replaced it with refined carbohydrates or sugars, the risk of CHD is increased.51,52,53 Replacing saturated fats with whole grains could be beneficial for CHD though.”54

“You are equating carbohydrates and sugar.” I interjected.

“Refined carbohydrates are rapidly converted to sugar and lead to increased risk of diabetes as well as CHD.”55,56,57,58,59,60

I tried to console him, “Lets forget all research for a moment. Even if your competitors were proven right, science was richer. You should be happy!” 

“AC, you have missed the real point!” He appeared alarmed.

“Which point?” I asked.

Shocking revelation

“In 2016, JAMA61 published a report based on internal sugar industry documents to describe how the industry influenced the scientific debate over the dietary causes of CHD over five decades.”62

“What did that paper say?” I asked.

“It was devastating. It started with Sugar Research Foundation (SRF or the research front of sugar industry) president Henry Hass’s 1954 speech, on What’s New in Sugar Research.”63 

“What did he say?” I was puzzled.

“In his speech, he quoted from one of my mentor’s papers that reducing 20% calories from fat can reduce blood cholesterol. And asked his men to try to fill that 20% gap with energy giving sugars. The sugar industry then went on to spend $600,000 (Around $ 6 billion in today’s value) to orchestrate a disinformation campaign. It taught lay people that sugar keeps us alive and gives us energy to face daily problems.”64 

“Ooh,” I saw his point.

A learned fool is more a fool than an ignorant fool

DS further said, “When Yudkin’s research started getting attention, SRF (Sugar Reseach Foundation) financed a program to change society’s negative attitude towards sugar.65 Project 226 was born,66 which resulted in the famous 2-part review in NEJM on Dietary Fats, Carbohydrates and Atherosclerotic Disease.67,68

I added, “NEJM is one of the most reputable medical journals in the US.”

“This paper did not disclosed funding and participation of SRF. It concluded that there was ‘no doubt’ that the only dietary intervention required to prevent CHD was to reduce dietary cholesterol and substitute polyunsaturated fat for saturated fat in the American diet.”

“That’s a biased conclusion, ignoring contemporary knowledge.” I exclaimed.

He quietly said, “I am surprised that you are unaware of this. It had made quite a media splash then.”69,70,71,72 But that was not the end of the story.”

I asked, “Is there more?”

“The sugar industry also commissioned yet another review, “Sugar in the Diet of Man,” and several other papers aimed at favourably influencing the 1976 US Food and Drug Administration evaluation of the safety of sugar.73,74,75 It appears that the industry has a long history of influencing scientific minds and federal policy using its financial muscle.”

Doctors are gullible

I asked, “I guess, the pharmaceutical industry is not the only one doctoring medical science.76 Are you depressed because you were unknowingly manipulated to mislead people?”

“More than depressed. I learnt later that my mentor had received major funding from SRF. My own scholarship was sponsored by SRF money. My mentor in the USA, just like Tripathy sir, allowed me to keep one mango, while he took home four! All my initial research was not only funded by SRF money, but was also analysed by SRF paid statistician. My lifetime of hard work appears a deception to me now, because it was used to mislead the world!”

I stared at his stern face and said nothing

After a pregnant pause, DS asked an unexpected question, “AC, which of the two sayings is more true in your opinion? The meek shall inherit the earth! or Veer Bhogya Vasundhara?”

The meek may be disinherited!

I did not answer his question. Obviously he identified with the meek. One who followed all the rules and tried to please everyone. He regretted that he could not be a ‘veer’ or a brave one who lives by one’s own rules.

I said, “DS, you can not blame yourself. The credit or discredit belongs entirely to your mentor, who orchestrated everything!”

DS spoke in a low voice, “I was the proverbial good boy. Very conscientious, obedient and well meaning. I did all I could for everyone in my life. Two days back, when I was having an MI, I thought, my end had come. My whole life scrolled past in front of my eyes. I felt cheated and exploited! Maybe self centered people are better off.”

I tried to console him. “You are a good man DS. You did everything an ideal son, brother or student should have done. Let the world live by the values it has.” 

After some time I wished him a quick recovery, and came out. I was wondering how can one escape being exploited by the big businesses? The word ‘business ethics’ is an oxymoron and goes way beyond the contradiction in terms.77 

In the Treta yug, assiduous and dutiful Ram, who had followed every rule in the moral book, was worshipped as God because his conduct was exemplary for his time. In Dwapar yug, ingenious Krishan had to bend every other rule to succeed!

For Kaliyug, what kind of conduct would be appropriate for Kalki?

Just ponder over this question. Happy Deepawali.

Figure-2: Indians are known to smother Gods with sweets, which are ultimately eaten by them in His name (Prasada). Despite all sweet offerings, Gods not only manage to survive, but still come to our help in need.



1 Names of the characters in this conversation are imaginary, though every fact stated is real
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61 Journal of American Medical Association
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  1. Abinash Paul said:

    This is brilliant, Sir.

    It will still probably be a while before mainstream medicine focuses on eliminating sugar and other carbs like has been done with saturated fat in the last two decades.

    Insulin resistance is central to the pathology of all these life style diseases and obesity. The sooner our advice to patients is based on this fact, the better.

    7 November 2020
  2. Mihir K Mohapatra said:

    “ pondering over the definition of TRUTH”

    8 November 2020
  3. thank you for your question sir. lust for gold is not a new thing. it was there at time of ram and krishna too. so there is no reason that why in times of kalki this lust should not be there. the problem gere is that group of influential scientist are twisting facts and figures and chaneellising research in one particular way. this needs to be checked and onus is on ram and krishna to incarcnate once more.

    8 November 2020
  4. Rajan Kapoor said:

    Brilliant and thought provoking as always. There is an adage in Hindi “िजसकी लाठी उसकी भैंस”. This is like ‘laws of physics ’which never fails. For Kalki to restore dharma, restore justice in the world, his proverbial sword has to function like लाठी in kaliyug too. He has to wrest control of लाठी, to end darkest, degenerating and chaotic stage of the Kaliyug, which we are in now and usher in the Satyug.

    8 November 2020
  5. Sankar prasad Gorthi said:

    Your ability to knit up a story and discuss scientific information is phenominal sir. Few years ago reports of incidence of Intracerebral hemorrhage in patients with low cholesterol started appearing. Then the cholesterol industry scam was reported. We have successfully robbed many people of their happiness by recommending diets low in saturated diets. Only JATS ftom haryana region firmly believed that ghee is best. The present era is of “Ketogenic diet”. In my opinion exercise moderation and enjoy everything life offers. People who excessively restricted salt intake landed with poor quality of life due to hyponatremia. In kaliyug the only saving option for us is to learn evidence based medicine and do critical appraisal of medical literature. We should corrrectly observe the effect size of an intervention and then adopt. Once again thank you very much for an excellent blog sir.

    8 November 2020
  6. ganesh k said:

    In SatYuga or DwaparaYuga the Actor used Agency as appropriate. Rama hid and slew Vali, he used Vibeeshana to get Ravana.He suspected his brother and shadow Laxman as well as his soul mate Sita. Krishna is celebrated for his schemes and his resort of Maya to press his advantage. One would expect Kalki too to be an Adept using agency appropriate. Meek is used in Bible to refer to patience, that to wait for the fruits that harvest offers us, patience is virtue. The Gita quote has a context, that one must be adventurous and bravely fight as Arjuna was expected to, having assembled on Kurukshetra’s hallowed grounds. Just as a farmer must be patient to beget a good crop, the warrior must be brave to enjoin the war! In India the use of sugar is not the only flavour of offerings, though sweetmeat vendors make it easily so. Traditional worship is with flowers, Tamil பூ+சை which is Sanskritised as Puja. It involves some bitter, some sweet, some sour, some tangy and other flavours. Ghee and sesame oil is part of such offering too! Neem, raw mango and some bland forest fruits are mandatory for auspicious new year in tribal and Dharmic almanacs. Dr DS as a cardiac disease researcher acquits himself well, save for his error of making his spouse think he was partisan. Even now convalescing he is aware of how his research was hijacked or misguided by his mentor and the sugar lobby. I am sure he will no longer offer four mangoes to them! So no taint affects him, his Karma is Yogic, his focus is always of his efforts not rewards! Naishkarmi! In one medical lesson of Cholesterol versus sugar, Anand sir has seeded so much of Vedanta! The very Gita can be played out in the simple after 40 years meeting of two friends! Kudos sir for sparking such thought and provoking peers and juniors into ethical science!

    8 November 2020
  7. Vivek Hande said:

    Food For Thought. However , when it comes to diet and life in general, I think our grandmothers knew it all .. everything in moderation is just fine.

    8 November 2020
  8. Abhishek Sharma said:

    Beautifully crafted sir , very enlightening . Though regarding kalki avatar i think he ll also go by the rules of kaliyuga that is No Rules .

    8 November 2020
  9. Maj Gen Ajay K Dutta said:

    Pick ur own endpoint which might or might not be conventional in true sense and devise ur own rules to fallow and achieve that endpoint is Kali yug mantra . I do feel sugar content in diet is more important then saturated fat both for healthy body and living.

    8 November 2020
  10. Varanasi Subrahmanyam said:

    Excellent. Well sculptured. We expect more from AC!

    8 November 2020
  11. Dr Vijay Mohan Kohli said:

    Dear Anil,

    Thanks for this wonderful and subtle expose’. You have very beautifully laid bare the vested interests of various industries. What surprises me most is that main stream Cardiology and Medicine still chooses to ignore Inflammation as the cause of heart disease ( and Insulin Resistance for that matter, which in turn fuels the metabolic syndrome ) and still goes after reducing cholesterol despite compelling scientific evidence to the contrary.

    It all started when Ancel Keys proposed his now infamous ‘diet heart hypothesis’ in 1953, which changed everything and is responsible for the revolution of refined, packed, and preserved foods and the focus on carbohydrates while at the same time, vilification of healthy fats. Sugar became a necessary ingredient of food the world over to which we are paying the price for Insulin resistance with its attendant complications of Diabetes, Heart disease, Obesity, Hypertension, fatty liver, strokes, erectile dysfunction, PCOS etcetera.

    The time has now come for us to go ‘back to the future’ and for us doctors to recommend the lifestyle our ancestors followed about ten thousand years back and to follow a diet which is natural in its quality as well as timings for those suffering from Inulin resistance.

    At this point of time, blood tests like a regular lipid profile has become redundant since testing for the dense LDL is now possible (though I must admit that it is an expensive test), and test for inflammation by doing an Hs CRP and Homocystein. Certain other tests like PLA2 and Lipoprotein (a) are now gaining more relevance.

    It is now time to add healthy fats in our diets, like ghee (from grass fed cows), cold pressed coco nut and mustard oil, along with extra virgin olive oil, home made butter coco nut ‘malai’, all of which help raise HDL, and reduce triglycerides (though there will also be an increase in LDL but the raised HDL is likely to balance it out). As a practicing cardiac surgeon, this is what I have been prescribing my patients.

    The time has also come for us to seriously reconsider prescribing statins as they have so many side effects.

    I take this opportunity for recommending readers to browse through ‘Put your heart in your mouth’ by Dr Natasha Campbell-McBride. She has beautifully highlighted the evils of sugar (from its action on destruction of the healthy gut bacteria) to what actually causes atherosclerosis and what can we do about it.

    Anil, regarding my response to your question, is that avatars (like Ram and Krishna) come into this world to correct things when this world gets steeped in evil, but unfortunately do little to show us or take us on the path of ‘moksha’. This job is is left for fully realized gurus to carry out , who are always present at any point of time, but available only to handful of really true seekers. We can discuss this some other time.

    Thank you once again for your truly great blog. I am so very happy that you have taken it upon yourself to bring it out e very so beautifully. May He bless!

    8 November 2020
  12. Veteran Air Commodore Dr HSR ARORA said:

    Excellent article. Culprits are sugars & not the cholesterols. Pharmaceuticals published papers to make medico believe cholesterol is the cause of vascular disease Sugar is like petrol/ diesel fill the tank & do not drive for 2-3 month all the pipes carrying petrol will become bad , car will not move. Fundamental is 100 gm carbohydrates will give 400 calories which can be almost nullify if you do 10 km brisk walk . Otherwise you are inviting scores of diseases.

    9 November 2020

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