Dr Ayan Panja: We've talked about inflammation a lot and I hear it, I hear that word a lot on your podcast because as we know, it drives so many disease conditions and cardiovascular disease is definitely partly inflammatory. We know that. And the thinking is is that this sort of reaction that your your vessel wall has to try and heal itself from this injury creates this inflammatory cascade and rather than just having local inflammation, triggers systemic inflammation in your whole cardiovascular system and that can put your blood pressure up and cause narrowing of arteries elsewhere in the body as well, in other arteries, not just the ones around your heart.
Dr Rupy: Welcome to the Doctor's Kitchen podcast with me, Dr Rupy, where we discuss the most important topics and concepts in the medicinal qualities of food and lifestyle. These are some of the things that I've written about in my new book, Eat to Beat Illness, which is out on the 21st of March. And you'll find in it the principles of healthy eating and how to apply these to protecting our brains, balancing inflammation and improving our heart, which is exactly what we're talking about today. I invite fellow doctor and friend, Dr Ayan Panja, who's a general practitioner, a super generalist and lifestyle medicine enthusiast. He's also co-founder of the Royal College of GPs accredited Prescribing Lifestyle Medicine course and we're talking about eating and lifestyle for our heart health. Now, eating for your heart as a concept is not about food like a pill, but diet is an important consideration for protecting and promoting our heart health. And it's why I ultimately believe that nutrition training is vital for all medics to grasp an understanding of as well as the public. Now, there is a lot of evidence-based, safe dietary and lifestyle change that we as practitioners can be confident in discussing with our patients. Listen up because it's not just people in their 50s and 60s that need to be listening to this. It's actually relevant for all generations, whether you're in your 20s, because looking after your heart is a lifelong process and atherosclerosis, which is what you'll find out about in the podcast, can start in as young as your childhood. If you like this podcast, give it a five-star review. The show notes will be on the doctorskitchen.com and make sure you subscribe to my YouTube channel where I'll be doing a lot more nutrition and cooking videos. Listen right to the end of the podcast and I'm going to summarise exactly what we talked about onto the pod. Ayan, welcome back to the show.
Dr Ayan Panja: Thank you very much, Rupy. It's so good to be here.
Dr Rupy: I told you this before, but honestly, the response from our previous episode on eating for your brain was so, so good. Honestly, the way you communicate and obviously the topic and how fascinating it was, it was just brilliant. So I knew I had to get you back on.
Dr Ayan Panja: Oh, thank you so much. I'll pay you that fiver later. But how are things going?
Dr Rupy: Yeah, good, busy but good, as always. Frontline general practice, harder than ever, but still enjoyable, working long hours. Lots of change going on in our practice, all positive, which is good. And yeah, just keeping myself busy and trying to look after myself. Yeah, it's all good fun.
Dr Ayan Panja: Because I refer to you as a super GP because you really are full-time, frontline, coalface, you see the ins and outs. You do so many other things as well, one of which is PLM, Prescribing Lifestyle Medicine, which is just going from strength to strength.
Dr Rupy: Yes, it is. Thank you very much for that. Yeah, Prescribing Lifestyle Medicine, really brilliant response and it now just has a life of its own. The next one is in May, which I'm looking forward to. And it's just getting GPs to think broader. You know, and that's what I mean by super generalism, just broader and broader about what causes non-communicable symptoms and what often seem like mystery illnesses can actually be helped by simple lifestyle measures.
Dr Rupy: Exactly. And I love the fact that it's a day course and you teach the foundations of lifestyle and actually, you know, you're not making it prescriptive for one particular thing. What happens when you get people to think about the root cause of their conditions and actually educate GPs and why we need to try and assess the root cause is a lot of things get better.
Dr Ayan Panja: Absolutely. It's what I call a multimodal approach. You're almost like tinkering with or tightening the screws, I like to sort of call it, on something where you tighten one screw and then another one tightens itself sometimes. And life's a bit like that. You know, we cover a lot of cases on the course and one of them, actually the chap had forgotten, you know, to enjoy himself. There was nothing in his life that gave him pleasure. And all he had to do was join a dad's football team and then that led to one of the dads talking to him about a particular type of diet and then that led to something else. And then before you knew it, he was feeling a lot better. So, you know, that is the magic of lifestyle medicine, but there's a lot of science to it. And I think trying to put them together and help the person who's sat in front of you is what we try and do on that day. And I think I think we've achieved it.
Dr Rupy: And I think I love that aspect of unravelling the science behind lifestyle because on the face of it, it sounds very complementary and alternative for want of a better term. However, when you do try and go upstream, you can affect so many downstream things that lead to better health outcomes.
Dr Ayan Panja: Absolutely right. You know, it's better to stop the ball rolling down the hill rather than sort of try and scoop it up once it's got to the bottom of the hill. And that's exactly what you're what you're saying in terms of getting to the root cause. And yeah, I mean, I hope that that becomes a conventional part of medical training. In medicine, we call it etiology, you know, which is the underlying cause of a disease. And I sadly think that in the last 100 years or so, that has been largely forgotten in medicine for lots of reasons, partly because of time pressures, partly because of a move towards a pharmaceutical approach. And there's nothing wrong with drugs. Drugs are here to stay and they're very important, but there's so much you can do before going down that route.
Dr Rupy: Yeah, absolutely. And as I always say, you know, it's nothing exceptionally wild. It's actually according to a lot of nice guidelines where diet and lifestyle is the first thing that we should be assessing, particularly for things like cardiovascular disease, which brings us nicely onto our topic today.
Dr Ayan Panja: Absolutely right. And and you make a really good point. The nice guidelines for ischemic heart disease actually do mention lifestyle interventions first. It's just that for some reason they get ignored. Even I didn't know they were there until I looked at them a couple of years ago. So, yeah, absolutely. Lifestyle first, food first.
Dr Rupy: According to the guidelines. Yeah, yeah, yeah, that's right. Um, so I think it's very appropriate for two frontline GPs in the face of increasing numbers of cardio-related diseases, lifestyle-related diseases to be talking about heart because it's something that we see day in, day out.
Dr Ayan Panja: It absolutely is. And and, you know, neither of us are heart specialists, we're not cardiologists. Why should we be talking about heart health? It's because, as I always say, in general practice, what we do is we save lives in slow motion. And this is heart disease is a really, really good example of this.
Dr Rupy: Can I just repeat that? Saving lives in slow motion. I love that concept. Honestly, it's absolutely spot on.
Dr Ayan Panja: Thank you very much. Yeah. And I and I think it's just, you know, it it's in comparison really to the kind of big heroic stories that you sometimes hear your hospital colleagues tell. And in general practice, we don't have that. It's all about nudging people and changing behaviours and hopefully preventing a bad outcome. I mean, heart disease is massive. 160,000 people die a year of it in this country. It tends to affect people more in deprived areas. And globally, it's a huge issue as well, causing about 30% of all deaths, so just under a third. So it it's a massive issue. And I think the bit that hits home for me mostly, although it's an issue for everyone, is that in the UK, around 23,000 people a year die prematurely. So, you know, young men and women dying of heart disease. And you hear this, I hear this week in, week out where someone at the age of 45 has just literally dropped dead because of a heart attack. And that is tragic. And if there's any way of preventing that, then we as GPs should be doing it.
Dr Rupy: Absolutely. Saving lives in slow motion. And I think, you know, what's what's more important, what's very important is for a lot of people, the first symptom of heart disease is a heart attack. And then they'll they will either present to myself in A&E or or or whatever with with chest pain or without chest pain as well. And that's why it's something that I think a lot of people when they start listening to this podcast might think, oh, well, you know, I'm in my 20s and 30s, I don't really have to think about this until I'm in my 50s. Actually, heart disease can start, well, you put the foundations for a healthy heart as early as your teens.
Dr Ayan Panja: Absolutely right. And it's, you know, that is the the reason it's often called the silent killer because you don't have any warning symptoms until it's too late. And of course, as we know, sometimes you start developing something called angina. And angina is where you get chest pain almost always on exertion when you're going upstairs or running or walking up a hill. And usually, but not always, it tends to affect people of a of a certain age, older people generally, because you would expect some kind of furring up of your arteries, which is what causes the heart disease in the first place, which we can certainly talk about. But you're quite right, you know, heart health is something that needs prioritizing. And like a lot of the topics on your podcast, it is linked in many ways to other systems and actually the underlying causes of what drives heart disease have a lot in common with other diseases.
Dr Rupy: Yeah, absolutely. And I think that's why again, going back to PLM and and stuff and things that you you teach other practitioners, when you hit the root cause, you're actually improving the outcomes of a plethora of different conditions, one of which is heart disease.
Dr Ayan Panja: Absolutely right. And in many ways, you mentioned the brain episode and your kind words, you know, which I I I really thank you for. I'm touched by that. But but actually we could almost play that podcast again and it would almost it would almost be relevant to heart disease. There are some subtle differences, obviously, because they're different conditions, but the principles are very similar.
Dr Rupy: Well, that I'm glad you said that because in my new book, Eat to Beat Illness, I basically take the I I the method or the thinking behind me writing the book was to zoom in on different conditions and look at the intersection of nutrition and lifestyle on that particular condition, trying to pull out all the different scientific articles, of which there are many on different subjects, so skin health, inflammation balance, supporting your immune system. And the final chapter is zooming out. And when you zoom out, everything is very, very intertwined. And there are so many ways in which we as GPs, because we see patients in and out, it's very easy for us to see the interconnectedness of our body and we can't treat things in silos. Actually, when you look at the body as a holistic system, you can actually improve a whole bunch of things by doing some simple principles that everyone can apply.
Dr Ayan Panja: That sounds amazing. And I love the concept of it. I can't wait to read it actually because I think you're right, you know, you do need organ specific elements, but ultimately that zooming out is is something that often we don't do in medicine and and that gives you the bigger picture, doesn't it? Where everything connects up. Amazing. I love it.
Dr Rupy: So atherosclerosis, which is essentially a narrow inflamed arteries, I suppose is a very succinct way of talking about it, is the commonest or one of the commonest causes behind heart disease. We're largely going to be talking about atherosclerosis and ischemic heart disease. Let's talk a little bit about the background. So your heart is encased in a crown of vessels called the coronaries. And this industrious machine that hopefully never stops throughout our whole lifetime will supply the muscles and the cells of your heart with oxygen and nutrients. And the furring up of those arteries is responsible for some of the symptoms that we've talked about, angina, chest pain and a heart attack.
Dr Ayan Panja: That's exactly right. You know, your heart beats 30 to 40 million times a year. And if if anyone out there wants to kind of feel what your heart does, if you just open and close your hand once a second for about 20 times, you'll realize that you get exhausted after about 20 or 30 seconds and you think we're all doing this in the studio now. And, you know, that's what your heart has to do for its for your lifetime. I think we we've looked talked about the bit about the scale of the problem, which is huge. Atherosclerosis, as you say, means furring up of those coronary arteries. So there are four main arteries that supply the heart itself with blood, which which seems strange because the heart supplies everything else with blood, but it it itself needs a supply of blood. And the way that atherosclerosis starts is with really an injury to the wall of the blood vessels within, you know, around the heart. So the inside wall, you know, imagine sort of a piece of tubing with sort of a rubber layer inside, like, you know, copper piping with some rubber inside. And that rubber layer on the inside is what's called your endothelium, the sort of the inner lining of your blood vessel. Now, why does that injury occur? Lots of reasons. High blood pressure will cause it, smoking will cause it, high levels of cholesterol and another type of fat called triglycerides can cause it. Pollutants can cause it. So we know, for example, if you live in a part of the world like Hong Kong where there's enormous amounts of particulate matter or pollution in the air, rates of heart disease and respiratory disease are much higher there. So so it starts with this endothelial injury. And what the body does, and this is something that's only been discovered really more in recent years because there are lots of theories on heart disease and and we'll talk a bit later about fats and the like. But your body responds by trying to repair that injury and it forms the second phase of that is that it forms something called a plaque, which is made up of fat, cholesterol and calcium and all sorts of other bits. And that plaque can just stay there or if you're very unlucky, it can become unstable and break off. And then you're in real trouble because either the blood vessel bursts or that plaque goes and dislodges itself and then blocks the artery completely. And that is what happens when you have a heart attack. When the plaque actually bursts the blood vessels, that is almost always fatal. It's a lot of cardiologists back in the day used to call it the widow maker, you know, this plaque that is just waiting there and often kills younger men. Obviously women die of it too, but but actually stereotypically men get heart disease more more often than women. So that's sort of the mechanism of atherosclerosis and how it develops. And then what drives that is, um, a number of factors really. So we've talked about inflammation a lot and I hear it, I hear that word a lot on your podcast because as we know, it drives so many disease conditions and cardiovascular disease is definitely partly inflammatory. We know that. And the thinking is is that this sort of reaction that your your vessel wall has to try and heal itself from this injury creates this inflammatory cascade and rather than just having local inflammation, triggers systemic inflammation in your whole cardiovascular system and that can put your blood pressure up and cause narrowing of arteries elsewhere in the body as well, in other arteries, not just the ones around your heart. So, so that's really how heart disease progresses.
Dr Rupy: Yeah. And I I from early understanding, I think we used to think it was simply a cholesterol problem that was largely related to plumbing. So essentially clogging up arteries with this waxy substance that limits blood flow distal to where the blockage is. And now we understand from your beautiful explanation about the cascade of inflammation, the introduction or the expression of pro-inflammatory proteins from oxidizing LDL particles that you find in cells, as well as macrophages, and it's caused this like this explosion of different inflammatory particulates and and that will cause this thrombosis and and a heart attack unfortunately in a lot of cases.
Dr Ayan Panja: Yeah, that's right. I mean, you're absolutely right. So you get the formation of foam cells and then you end up with something called a fatty streak. And what you were saying about LDL, so LDL is low density lipoprotein. It's effectively what is colloquially known as bad cholesterol. Why is it known as bad cholesterol? Because it sticks to the side walls of your blood vessels and can encourage that endothelial injury. I have to say at this point, not all LDL cholesterol is bad, but most of it is. And and you're quite right, when that process happens, you probably didn't actually, but free radicals and oxidative stress. So so these are basically, you know, molecules that steal electrons from others and that oxidizing effect of the cholesterol causes inflammation. So this process called oxidative stress leads to inflammation and that fuels that cascade and it becomes systemic.
Dr Rupy: Yeah, I think that's a really important point about LDL being very important actually. So LDL essentially is a lipoprotein, so it carries cholesterol around the body. And one of the things that we don't actually realize, I think, and in a lot of cases is LDL is involved in reverse cholesterol transport. So it actually brings cholesterol away from the body back into the liver where it can be repackaged. And we thought that was primarily the HDL. So LDL does definitely have an important role in cholesterol homeostasis. It's when it becomes oxidized, it's when you have this picture of inflammation and because LDL can impact the cell walls, particularly the endothelium as well, causing this cascade of inflammation and and ultimately a blockage, it gets a bad rap. So it's important that, you know, we look at both merits of of LDL and HDL.
Dr Ayan Panja: Yeah, absolutely right. And I think, and that's part of the the issue just going off on a tangent, you know, people listening who may have had their cholesterol checked at the doctor's surgery, nowadays we tend to give people a split, don't we? In terms of, oh, you've got your LDLs have gone up and your HDLs have gone down. And is that valid? Yes, I think it is because it gives you sort of a as good a measure as we can get, you know, unless you've actually sort of, you know, tunnel into your blood vessels with a microscope and have a look, you're not going to get a much better measure than that. And and sometimes you see, as you know, when people improve their dietary habits or they sleep better, those parameters move and I've definitely noticed that in my patients where their triglycerides drop and actually their LDL HDL profile improves. So, so, um, so cholesterol is is important. I think you're quite right, it used to just all be about cholesterol and I think the thinking has changed there. It's a factor, but it's certainly not the be all and end all.
Dr Rupy: I think as NHS GPs in particular, we're sort of bound by having quite a very basic cholesterol profile as well. And we have to do the best that we can with the biomarkers available to us in the healthcare system. There's a lot of talk around LP little A, other markers of inflammation as well, things like HOMA and insulin resistance. I mean, we'll probably get on to talk about cardiometabolic disease in its entirety. But from what we have, yeah, I think I tend to look at triglycerides and ratios a lot more.
Dr Ayan Panja: Yeah, absolutely. And and it's um, it you're right, you've got to really, again, it goes back to looking at the whole person and whether they've got any other kind of inflammatory conditions, what their family history is like, what their habits are like, and and trying to risk assess really. What's difficult here is that, um, you're trying to look for underlying causes for something that hasn't happened if you're trying to prevent something. And that that is difficult because all you've got are, you know, like you say, blood results, NHS blood results. And sometimes you can measure other things like we mentioned something called high sensitivity CRP, which is a general marker of inflammation, particularly associated with cardiovascular health. Homocysteine, that's a type of protein that sometimes builds up in the blood and makes the blood thicker. But again, not routinely available in NHS tests. And also, you know, I would I would say a fasting insulin is something that's worth looking at, you know, partly because it picks up people who are pre-diabetic much quicker and more effectively than an HBA1C. And and, you know, blood sugar control is is key in this. Why is that? Because it's a risk factor for diabetes, but it also, you know, if your blood sugar's haywire because of your insulin response, that will drive inflammation. So, you know, the guy that eats your tasty croissant all the time, you know, every day, three or four times a day is in big trouble, you know, because they're going to get that yo-yoing and that will lay down the kind of fat that causes heart disease with those insulin spikes. So, um, so I think, yeah, you know, there are other biomarkers, you know, there's um, there's something called apoB, which is also a type of fat particle. And again, in some specialized tests, they look at the numbers of that to be more of a, you know, an indicator of risk. But these are these are difficult things to to measure conventionally and and I think you just do what you can.
Dr Rupy: Absolutely. I think, you know, your point about fasting insulin is really important because our body is incredible at keeping that sugar level in a tight window. And it will increase and pump out insulin to respond to those increases in glucose that we ingest. And so it will essentially hide from being detected by an HBA1C or a simple glucose measurement for a long time before it actually results in something like pre or diabetes type two in its entirety. So, yeah.
Dr Ayan Panja: I think also there's, you know, I think it would be, you know, disingenuous not to mention drugs at this point as well, because statins come up a lot, don't they? It's one of the most common topics, I think, in health, if you look at any of the newspapers. And, um, and there's there's again, it's a polarizing kind of argument about, you know, there's the anti-statin camp, isn't there? And, you know, I prescribe statins routinely on repeat prescription because a lot of my patients are on them. And is, you know, am I pro or against statins? Well, you know, actually, if you if you look at the studies on statins and physically what they do to atherosclerotic deposits, they do reverse them to some degree. But balancing against that is the side effects that they give you. And also, how many people do you have to treat with a statin to actually save one person from a heart attack? And those numbers, which are called numbers needed to treat, are not so good. So the numbers needed to treat for a Mediterranean diet in terms of keeping people healthy is very low. It's actually seven. So if you get if you make seven people eat a Mediterranean diet, you will save one person from having a heart attack. But actually for statins, it's much, much higher. It's anything between 60 and 100. So, you know, it it it's not so clear cut. And it's difficult to sort of get that risk across to the patient when they're in front of you in terms of, you know, should I take a statin or not? And once you've had an event, obviously, and you go into hospital, you come out on a very high dose of a statin because, you know, quite rightly, a cardiologist or a a doctor in the hospital will do everything they can to prevent you from having another one. So I think it it's, you know, I'm not in that camp that says no one should ever have a statin because I think that's short-sighted, but, um, but if possible, and if you can do it through lifestyle, then then you should.
Dr Rupy: Absolutely. And I I'm glad you raised that point because I think a lot of people like to, again, make it a very clear-cut decision and make it a black and white between using statins and not using or or, you know, are statins good or are statins bad? And as you've rightly painted the picture, it depends on that person in front of you. It depends on their motivation to want to even consider other ways in which they can control their cholesterol and cardiovascular risk. And also whether they've had an event as well, or whether they've got a family risk of of high propensity of of heart disease. And I think, um, those are sort of important considerations. And that's why the question of whether statins are good or bad or whether we should be having them is, um, it's not the correct question to ask. The question to ask is, is it right for my patient or is it right for me?
Dr Ayan Panja: Exactly. Exactly right.
Dr Rupy: And that brings us, I suppose, to we've talked about sugar, but sugar is a really, you know, uh, it's a very popular at the moment, probably more so than fat, I would say.
Dr Ayan Panja: Yeah, there's always one or the other, isn't there? Yeah, or sugar, yeah. I think we've gone up and down, haven't we, over the last few years about whether sugar is important. I mean, it's as as important. And one of the things that I think I learned about over the last few years is these AGEs or advanced glycemic end products that have a role in a whole plethora of different diseases, you know, obviously diabetes, but also as a mechanism for causing the issues that surround diabetes, issues affecting your kidneys, issues affecting your eyes and stuff. But particularly with heart disease, these AGEs are quite important.
Dr Ayan Panja: Yeah, I mean, I think I think when it comes to sugar, um, it's very simple in the way that I see it. So, apart from when you're having your treats, um, if you have natural sugars like from blueberries or from oranges or bananas and, you know, the two latter fruits, bananas and oranges can be quite high in sugar, but, um, you know, fruits also contain fiber and fiber actually helps you manage your sugars a lot better in terms of your blood sugar. So, you know, a Mars bar and a banana have probably about the same amount of sugar in terms of the number of grams, but which one is going to, you know, all things being equal with your gut microbiome, but, you know, which one's going to spike your sugar more? The Mars bar because it doesn't have the fiber that the banana does. So as a very, very dull kind of rule of thumb, you know, natural sugars sort of not so bad, you know, artificial sugars in processed foods probably quite bad, you know, and, um, and and, you know, I I don't always follow that myself. I I like a bit of dark chocolate. I might even have some milk chocolate now and again, you know, but but it's, um, and that's a treat, it's okay, but it shouldn't just be a regular part of what you do, you know, um, because that would be bad. So it's sort of it's thinking about the source of sugar really. Again, it's that, you know, food first type thing, thinking about, you know, what's natural and and what comes, you know, out of the earth, if you like, you know, those things are much less likely to be harmful.
Dr Rupy: I love looking into the science behind the structure of what you find in natural foods. So apple, for example, um, you know, it is technically a high sugar food if you look just at the sugar content, the fructose that you find there. However, when you look at the fibers in it, it causes, it creates this almost like matrix effect on the inner lining of your gut. And that actually limits the sugar response that you have in your blood. Obviously, patient to patient that can be quite different. And actually, I'm really excited about continuous glucose monitoring now because you can actually give personalized information on the basis of what the sugar responses to certain foods to that patient. But basically what happens with, you know, natural high fiber foods that are also high in sugars is that you it blunts that sugar response because of this matrix effect. It's almost like, you know, giving an extra barrier for your for your gut. And as well as obviously the benefits of having a varied amounts of of different fibers. And what I'm noticing actually in, um, healthy bars in quote unquote, um, is that they're adding fiber to the bars themselves and they can, you know, make a claim, it's got added fiber, it's got 10 grams of fiber. What they usually add is just one type of fiber and that doesn't have the same blunting effect and it doesn't have the same benefits to the microbiota either. So I think that's a good rule of thumb, you know, just having natural sources of of sugars which already have those fibers in them.
Dr Ayan Panja: Yeah, yeah, absolutely. And and you know, it it's it's a case of, um, you know, it's it's it's really difficult, I think, isn't it? Because if you're constantly going around worrying about what what you're eating. And and my my my sort of hack for myself is just having, um, things to hand that are going to nourish you. So, as long as you're not allergic to any of these things, my ones are nuts and berries and olives. Those three things are all heart-healthy foods. And they're quite satisfying, you know. Okay, now and again, I just I fancy some chocolate, which is, you know, but but most of the time, if you're grazing on those things, you will feel full and actually they're doing your body some good, you know, and they've got the right kind of oils, the right kind of fats. And, you know, berries, for example, as we talked, I think on the brain podcast, they they work in several ways. They're full of antioxidants, which in theory, although the evidence on antioxidants isn't fantastic, to be honest, but in theory, they stop that free radical activity and that oxidative stress. They also work directly on the gut in terms of the gut microbiome. And and they're fibrous. So, you know, you're you're getting a a whole load of benefits. And they're quite sweet, you know. Yeah, yeah.
Dr Rupy: This is what I love about the science behind food because it's never black and white. It's never one thing or the other. It's just a continuous shade of gray. And like, you know, you look at like just one thing like berries, for example, or a type of high fiber food. You get the polyphenols, let's say from dark green leafy, uh, dark leafy greens. You get the polyphenols, you get the anti-inflammatory phytochemicals, things like sulforane, indole-3-carbinol. You get the fiber. And you look at what the fiber does, and the fiber will increase short chain fatty acid production in your gut. And what does that do? Well, it nourishes your colonocyte. And what does that do? Well, it increases anti-inflammatory effects and it dampens your immune system. What does that have an effect on? Well, that has a downstream effect on the impact of endothelial damage and thus lowering your risk of cardiovascular disease. It's incredible. I mean, that's just one pathway, you know. You look at the direct antioxidants, for example, the antioxidants that you find in berries will have that dampening effect on reactive oxygen species. Again, lowering your risk of inflammation, lowering your risk of cardiovascular disease. And it's it's a really important that you point you made about antioxidants in general because I think when they're supplemented in high amounts synthetically, they tend to have the opposite effect. And I find this absolutely fascinating because antioxidants themselves or oxidation itself is very important for cell signaling. It's very important to have this almost adaptive response that is ingrained in how your body functions. And when we try and disrupt that by, you know, giving too much of a good thing, it can have the opposite effect.
Dr Ayan Panja: Yeah, yeah, absolutely. And it is bizarre because I I've looked at these studies as well. Um, in fact, I've got one here with me, which I printed off. It's called oxidative stress and inflammation in heart disease. Do antioxidants have a role in treatment and or prevention? And it's from, um, where is it from? It's from Hawaii, actually, from 2011. But it's a review article. So it looks at, um, previous studies. And actually it's not not great. And as you say, it's synthetic ones don't seem to confer that benefit. So again, it's that it's food first, isn't it? Yeah, yeah. It's like the same ones like, um, so as part of my one of my modules on phytonutrients, we were looking at supplementation of resveratrol. And resveratrol is a phytochemical that you find in things like, um, grape skins, uh, red wine. Yeah. You have to drink 60 liters of it. Yeah, 60 liters. Exactly. Yeah. Sounds good to me. But when you look at when people take it from whole foods, you see a suggestive, um, cardioprotective effect. When you see you take higher amounts of the same chemical in a supplement form, you don't see the same effect. And then it further, I mean, it's very perplexing, but then you you examine it and what happens when you have it from red wine, for example, or dried grape skins, is that there are multiple different metabolites that are created as a result of digestion from your, um, colonic, uh, microbiota. And that leads to a whole bunch of other effects that you can measure in your urinary metabolites of resveratrol. So it might not be the resveratrol that you find in one singular form, it might be the 20 or 30 other forms that you find. And that is why it comes down to a whole food first approach for me all the time. And that's why I think, you know, supplements for certain people, they might be beneficial. Nutraceuticals may be beneficial for certain people. I'm very interested in sulforaphane. I don't know if you've come across those in China, they've been using them to sort of increase the, um, excretion of environmental pollutants, uh, in the urine, actually, things like benzene and stuff like that. I think there are uses, but food first approach wins every time.
Dr Rupy: Yeah, absolutely.
Dr Ayan Panja: I think, uh, when it comes to our toolkit, you know, we've talked a bit about, um, improving lifestyle practices, uh, the fact that, uh, quality fats are very important from the perspective of heart health. Um, and I think stress as well, something that we don't really talk about too much. And and actually, you know, at the end of the chapter I've written on, uh, eating for your heart, I've done a whole section on the evidence base behind mindfulness, uh, movement, obviously, for cardiovascular disease, um, and sleep optimization. And I think, you know, um, what you're doing in PLM and and what you're trying to do to educate more GPs to have these sort of gentle nudges, fantastic.
Dr Rupy: Yeah, no, thank you very much. And it's, you know, we haven't really talked much about exercise because I think we take it as a given, don't we? But that's obviously very, very important for cardiovascular health. Um, but no, it's it's, um, you know, we're we're all trying to do the same thing really. We're trying to kind of, you know, live a good quality, you know, high functioning life for as long as possible without making it a chore. And I think, I think, you know, no one wants to die before their time. They don't. And and unfortunately that is happening as we speak. You know, someone has a heart attack every seven minutes, I think in the UK. And wouldn't it be great if we could just reduce that number just by, you know, making one or two little changes in our in our lifestyles, you know, you know, eating more nuts, eating more fish, um, exercising a bit more, relaxing a bit more, reducing stress levels. You know, is it really that difficult? And will it lengthen your life? Well, as Dean has shown through his work, yes, it will. If you can reverse an actual narrowing within an artery within a year, if he can do it, you can do it.
Dr Rupy: I love getting Dr Ayan Panja onto the podcast. He is so good at communicating quite difficult concepts and very, very good at explaining exactly what the benefits of lifestyle are. To summarise essentially what we talked about, we first defined narrow inflamed arteries and why inflammation is a very important part of the process and how we need to understand what balances inflammation. And just as a side note, there is another podcast on inflammation as a concept with Dr Jenna Macciochi, which you should definitely check that out as well. Mediterranean diets that focus on lots of different coloured vegetables, plant focused, dark leafy greens and quality fats that we get from whole sources such as extra virgin olive oils, nuts and seeds are fantastic additions to the diet. They also contain micronutrient rich foods that have magnesium, calcium, coenzyme Q10, as well as a whole bunch of other phytochemicals that we know are important for protecting your heart. The concept of nutrigenetics is changing the expression of your genes using lifestyle, food and your environment. And this gives us some explanation as to why people who lead Mediterranean style lifestyles with low stress and lots of different coloured foods have benefits to heart health. Sleep, stress and movement are key features of lifestyle that are heart healthy. And in particular, the Ornish lifestyle program that both me and Dr Ayan are big fans of, I'll put in the show notes so you can check those out on the doctorskitchen.com. I didn't want to go too hard into the evidence behind sugar and its effects, but essentially excess sugar in the diet that we don't just get from the granulated white stuff, but we also get from processed foods, sugary drinks, refined juices and refined carbohydrates are things that we need to minimize in the diet. And on balance, a Western diet has high amounts of sugar. In our toolkit, alongside pharmaceuticals like statins and blood pressure medication, we have diets that are low in sugar and refined carbohydrates, lifestyle practices, nutrigenomics, so changing the expression of your genes using colourful food, as well as stress relieving techniques. These are all things that we have in the locus of our control that can improve the functioning of this vital organ. I really hope you enjoyed listening to this podcast. If you'd like to, please do give us a five-star review and subscribe to the podcast. You can find Dr Ayan at doctorayan.co.uk on his website and on socials, it's doctor_ayan on Twitter and Dr Ayan Panja all one word on Instagram. Make sure you go check him out. You can check out the show notes on the doctorskitchen.com and do not forget to pick up a copy of my new book, Eat to Beat Illness, which is out on the 21st of March 2019. If it's already out, make sure you go onto Amazon or all good book stores and get yourself a copy. There's lots more information about heart health, brain health, inflammation balance and tons of recipes to help you on your journey toward better living. See you next time.
