Dr Zareen Morgan: I'll never forget a morning I went into the coronary care unit. It was a Sunday morning and I looked around at the male bay and I thought, gosh, they're quite young today. And I talked to them and they didn't really have many risk factors, but the key thing that they spoke about was having this period of stress that then led to this central crushing chest pain that brought them in. And it's so important now for us as a society really to think about how we can how we can tackle this.
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. Today, I'm speaking with Dr Zareen Morgan, who is a consultant cardiologist, a specialist in cardiac imaging, specifically advanced echocardiography and cardiac MRI, following her PhD in sleep at Imperial College London and the Royal Brompton Hospital. We'll be talking about her exciting new project called Fresh Hearts, where she's committed to tackling the root causes of cardiac disease, which aims to empower people to lead longer, healthier, happier lives. We'll be talking about her personal experience of lifestyle medicine, the cardiologist from America who inspired her journey, and a particular focus on things like atrial fibrillation and preventative cardiology, what that actually means. Make sure you listen to the end of the podcast where I'll be summarising what we talked about and how you can get involved with her new project, the Fresh Hearts project. I honestly think it's going to be game-changing for the NHS and I cannot wait to send people her way who want to look after their hearts more effectively using lifestyle alongside medicine. Like I always say, there is a lot of evidence-based, safe, dietary and lifestyle change that we as practitioners can be confidently discussing with our patients. And that's what we're going to be chatting about today. So make sure you listen right to the end. Check out Dr Zareen Morgan and her website. I'm going to put all her socials on my podcast show notes. In the first part of this podcast with Dr Zareen, I made her some chai-spiced overnight oats with dried pears, some berries and some quality fats. If you want to see the recipe, then check it out on YouTube at thedoctorskitchen.com. You can also see it on my podcast show notes at thedoctorskitchen.com too. On to the podcast.
Dr Rupy: So, Dr Zaran. I'm going to call you Zaran.
Dr Zareen Morgan: Call me Zareen.
Dr Rupy: Zareen, okay, Zareen. I just, it's just the way I always pronounce people's names. I do it very phonetically.
Dr Zareen Morgan: Yeah, it's it's it's the way I blame my parents.
Dr Rupy: I've got a friend called Zareen and it's Z O R E E N.
Dr Zareen Morgan: It should really have a double E in it.
Dr Rupy: Okay, fine. Okay, fine.
Dr Zareen Morgan: I almost changed it by deed poll once. People kept calling me Zarin.
Dr Rupy: That's like me.
Dr Zareen Morgan: It sounds like a baddy in a Bond movie.
Dr Rupy: You just sat there with your with your white cat. Yeah, exactly. Exactly.
Dr Zareen Morgan: Exactly.
Dr Rupy: Okay, Zareen. We're going to be cooking, we're not going to be cooking actually, we're going to be prepping something very, very simple. It's overnight oats with a chia spice mix, some chia seeds, some chai, sorry, chai spice mix, some chia seeds. I've already got one prepped from last night, so don't worry, you're not going to have to wait 12 hours for it. And it's going to be chocolate and dried pears. These are kind of unusual. I don't know if you've seen these before, but these are basically half dried pears, really, really, really good sources of sort of fibre, but they're very, very sweet as well. So it gives that nice sweetness without having to use coconut sugar or honey or whatever. And I just thought as you're a working cardiologist and you know what it's like to be as a training cardiologist as well, you're busy and you need to have breakfast sorted. So yeah, I thought I'd do that for you.
Dr Zareen Morgan: Perfect. Sounds very exciting.
Dr Rupy: Great. Okay. And I've got this trusty scales as well because like we were saying, I'm really bad at like, you know, measuring things out. So I'm going to put everything there. Zareen, tell us about, tell us about yourself because I mean, the first time we met was after a talk I was or a panel I was on or something and you came up to me afterwards and you were like, you know, I'm a consultant cardiologist and I've had a couple of patients that have read your books and it's been pivotal for them and stuff. And I thought that was so touching for me to hear, but particularly as you're a consultant cardiologist as well, which I massively respect obviously. So tell me, tell us a little bit about yourself and what you're up to now and and how you got here as well.
Dr Zareen Morgan: Yeah, so I I've had quite an interesting journey, I guess. I qualified in 2001, long, long time ago.
Dr Rupy: Not that long, come on.
Dr Zareen Morgan: And you know, I had a really varied career in medicine. I did loads of things, travelled to loads of different hospitals around the UK and I think I had a really good foundation in general medicine. And then in about 2005, I decided actually I really like cardiology. This is what I want to do. And then got into cardiology training. Loved it for a very long time. And then had the opportunity to go to the Royal Brompton Hospital and do a PhD which involved sleep. So that is where, round the corner from here. That's where my interest in sleep and the role of sleep in cardiac health first came to came to be. And then after that, I got a training program up in the Mersey Deanery. So I went up north and completed my cardiology training in Liverpool. And qualified in 2017 I qualified.
Dr Rupy: Oh wow, okay, yeah.
Dr Zareen Morgan: Yeah. And I mean, I guess my journey's been quite varied and I've had lots of different experiences. And really what I've come to the conclusion of is that over the years, I've seen so many patients and what I'm noticing now is that they're really getting younger and they're getting sicker. And there are lots of different reasons, there are lots of different causes, but I honestly believe that one of the main factors is that we have a busy, stressful life that our modern life lends itself to poor eating habits, poor sleeping habits, stress, not as much physical activity as we should. And then that translates into cardiovascular disease and sadly what I'm just, you know, seeing them in the wards at a younger and younger age. And so I started really reflecting on how I practice medicine and my training is in imaging. I do a lot of cardiac imaging, mainly ultrasound and cardiac MRI, but now I'm putting a real focus on prevention because I think that's where I can really have a bigger impact.
Dr Rupy: Yeah, yeah. Tell us a bit more about your training. So you talked about imaging and what you're you're generally doing, but ultrasonography is sort of the mainstay of what you were doing or was it?
Dr Zareen Morgan: Both ultrasonography, which is echocardiography. So for people who don't know what that is, that's effectively ultrasound scanning. So it's what what we use in pregnant ladies to look at babies. But instead, we use the same sort of probe and look through the chest wall at the heart and we can look at the structure, the function, valves. We can do various things. We can give medications to speed the heart rate up and we can see what happens when periods of stress. We can also do ultrasound scans when people swallow the probe, so take a slightly different approach. So that, yes, all of those ultrasound modalities I do and cardiac MRI as well. And I've had a bit of training in cardiac CT, although I don't currently practice that at the moment.
Dr Rupy: Okay, fine, yeah. So cardiac MRI, I had a cardiac MRI as well because as you know, I had paroxysmal atrial fibrillation and that's sort of, you were saying that's how you found out about me, right?
Dr Zareen Morgan: I did. I did. They did because I mean, we'll probably talk a little bit about my journey, but I then I I was introduced to lifestyle medicine, did a bit of Googling, and I came up against your podcast came up on my iTunes podcast suggestions. And I thought, I'll have a listen to this. And I listened to the introduction where you talk about your journey and the atrial fibrillation. So all of a sudden, all these things kind of really resonated with me as a cardiologist with seeing, you know, hearing about a young person with atrial fibrillation of which I see a lot. And the fact that, you know, you went down a very traditional route, which is obviously the route that we all go down and you kind of have to explore. And that you managed to reverse it and keep it at bay with lifestyle measures. I found it amazing. I found it phenomenal. So that is actually, yes, how I first found out about you.
Dr Rupy: Yeah, yeah. And it's it's a really interesting story because I think, you know, and I've chatted to a whole bunch of lifestyle medicine advocates, if you like, or not that I think you need to be particularly novel or cavalier these days for one of a better term to practice and and be a promoter of lifestyle medicine. But everyone seems to have their own personal story when going into here. And you know, the personal stories can can be either yourselves or a family member or someone very close to you or even patients themselves or anecdotes and that kind of stuff. Do you have a personal story? Do you have something that like changed in your life?
Dr Zareen Morgan: Yeah, I mean, I I do have a personal story and it's interesting that you you mentioned that because I I've noticed that too. I've noticed that whenever I speak to lifestyle medicine practitioners, often they do share their story. And they share their story of, you know, going down a very conventional route, which obviously does work, but for them it hasn't and they've explored different options and and it's really given them a new lease of life almost. And then that's inspired them. And that's a very similar story to me actually.
Dr Rupy: And you know, sorry, just to say one thing, I don't think it's almost because of the fact that you've shunned conventional medicine or you you've chosen a pure alternative path. I think it's more so that you experience what it's like to be a patient. And that changes your practice forever. You have this new sense of empathy, this new understanding of how embarrassing and powerless it can be to be a patient.
Dr Zareen Morgan: And lonely.
Dr Rupy: And lonely. Absolutely. Yeah. Sorry, you're about to say.
Dr Zareen Morgan: No, that's absolutely fine. And I do want to emphasize that point. I think it's a really important point that we're not shunning conventional medicine. Conventional medicine is amazing. We've made so much progress with procedures, with medications, and that's not what we're saying or promoting. But lifestyle changes always make a difference. And it can be small or it can be large, but it it's always worth exploring.
Dr Rupy: Absolutely. Yeah. Yeah.
Dr Zareen Morgan: So I guess my story, gosh, I've I think it started probably after I went back to work after having my son, who's now five years old. Prior to that, I was a cardiology registrar and as you know, it's very busy. We do a lot of shift work. There are a lot of exams. And it really wasn't a problem. You know, I had loads of energy and I was dedicating a lot of that to my work and that was fine. However, when I went back after maternity leave, I found that I struggled. And I don't think I realized that I was struggling. I think there's a real mentality that you just get on with it and you cope.
Dr Rupy: Oh, totally. Yeah, it's that sort of alpha medic mentality of like, you know, you're not weak, you can get on with things and yeah.
Dr Zareen Morgan: Yeah. And I had before, you know, I've been a medical reg for five years. I've, you know, I've done a lot of things and I thought, you know what, just cope, Zareen, this is fine. But I was struggling. I was struggling really because the demands of the job are so high, plus, you know, I'm a mum, I want to spend time with my my son, I want to be a good wife, I want to there's so much expectation that you place on yourself. So I slowly started to get what in retrospect now I'm I realize was symptoms of burnout. And I mean, it started with, you know, poor sleep. It started with just, you know, stress. I was really stressed a lot of the time and quite unhappy. And then I think it was sort of the middle of 2016 when I was nearing the end of my training that I started getting symptoms, so physical symptoms. And the physical symptoms are actually really interesting. I haven't really talked about because but I do think it's important that I do mention them because as you mentioned, it's quite a lonely place. And I think that a lot of people, a lot of women go through the symptoms that I went through and think that they're alone and and that's certainly how I felt as well. So I started getting bleeding, a PV bleeding mid-cycle. So obviously, you know, you you you think what's what's wrong? And I went to my GP and then I got ultrasounds and I got, you know, they they said, oh, you know, there's a polyp, it might be that. And I it didn't stop. So I just kept bleeding. And it started off as a little bit and then it progressed to a bit more. And then I thought, right, okay, I'm bleeding now a lot for the majority of the month, I am now bleeding. So I think actually I should take up the offer of having this polyp removed and take it out. And they took it out and I think for about four or five days I didn't bleed and then it started again. And then it got really bad and I I still I didn't talk about it. I was so ashamed. I was quite embarrassed, which is sounds really stupid to me now. And it got really bad to the point where I was, I had like this one what was probably a hemorrhage whilst trying to put a TOE probe down someone's, you know, into someone's. So a transesophageal echo is what I talked about earlier is is effectively an endoscopy. So it's like putting a probe into someone's mouth. And you know, I was quite good at this procedure. So my consultant was standing back looking at me going, why is she struggling? And I at the same time as trying to put a probe down into someone's mouth was like, oh my god, I'm having clots. I can feel the clots going down my leg. So I just excused myself and ended up going into hospital. And really, nothing much changed. I was put on medication. They thought, maybe it's an infection, maybe it's, you know, they couldn't find anything pathological per se. And then I just kept on bleeding and I kept on bleeding. And it wasn't, I didn't put two and two together. I didn't think maybe it's because, you know, I've been I'm burnt out, maybe it's because I just thought there was something physical.
Dr Rupy: Of course, yeah. I mean, who would at that point, right? As a conventionally trained medic. That's not something you consider.
Dr Zareen Morgan: Yeah. And then I thought, okay, I'm finishing my training in in early 2017. I'm going to take a break. I don't think I'm ready to start a consultant job and you know, I thought about finances, I thought about various bits and pieces, but I thought, no, I'm going to take a I'm going to take a month off and then I'll reassess and I'll see what I want to do. And I kept bleeding. At some point, I thought, right, I'm going to come off all my medications because it it wasn't helping. I was still bleeding. I wasn't sleeping. And then, and I did still keep on bleeding, but the really interesting thing for me was that the day I stopped bleeding, and no joke, the day I stopped bleeding was the day I finished my training and the day I was going to have a month off.
Dr Rupy: Wow.
Dr Zareen Morgan: Yeah. And it really highlighted and I haven't bled like that again.
Dr Rupy: And was that the light bulb moment for you?
Dr Zareen Morgan: And that was a Eureka moment for me that I was really stressed. It was stress. I don't know what it was doing to my hormones. It was a combination of that and the lack of sleep. I had a really poor diet, although we had started making some changes. And so that month off really allowed me to reflect on what was going on and do a bit of research, figure out how we were going to progress forward, sort of radically changed what we ate, changed how I coped with stress. I started doing mindfulness, yoga. I really did a lot of work on myself. And you know, there's still a lot to do. And I but I really feel like it was a warning sign for me and a wake-up call to realize that yeah, I was I could I and I felt really empowered that yes, I had this, but I was I was in control. I could change it. I could manage it. And that's not always the case.
Dr Rupy: Yeah, absolutely.
Dr Zareen Morgan: And but yeah, it's funny. I've never I've never really spoken about the bleeding, but I do I did think it's important to speak about it because yeah, it's a lonely place. And if anyone else is going through it, then you're not alone and it it do find do seek help. But there are things that you can do as well.
Dr Rupy: Yeah, I mean, first of all, I think it's super brave of you to talk about these things openly because as I know, as a medic, you have this shield and you don't want to let anyone know about chinks in your armor.
Dr Zareen Morgan: No.
Dr Rupy: And you don't ever want to demonstrate vulnerability. I think we're getting better at it right now as a as a sort of profession. And it's because of people like yourself speaking up and saying these sorts of things about and admitting to the fact that yes, I am stressed and yes, I am a patient. That we will get better eventually. But that honestly, I I commend you so much for for being open and honest about it because it is something that we see time and time again. It's something that I see as a general practitioner. I see it all the time. And that's not to suggest that, you know, we should be taking people off medication because they clearly have a role as they did for you. You know, I still prescribe all these different medications. I still prescribe iron tablets. We still prescribe progestogen tablets when when needed. But you know what, trying to get to the root cause of of issues and trying to tentatively figure out what it might be for that person. In your case, it sounds like it was a like a a catalyst of of different features like poor sleep and stress and perhaps what you were eating as well. And for different people, it might be different things. And it's just about trying to and that that's it's hard to do in medicine, isn't it? Because we're clear we're thought this sort of like biological model of medicine where it's just we have one symptom or one condition and we have a treatment algorithm for that. And we have to think a little bit wider about it. But that that's such a powerful story and I think a lot of people will be resonating with that.
Dr Zareen Morgan: I hope so. I hope so. And I hope it makes people appreciate that they're not alone and that they can they can get help and that it is something that we do need to talk about and be more open about.
Dr Rupy: Totally. Yeah. I'm so I'm I'm actually I'm doubly glad that you're talking about this because I'm also an ambassador for the Eve Appeal, which is a charity that aims to raise awareness of the five gynaecological cancers. And so getting things like bleeding checked, changes in menses, all that kind of stuff, pain and pain having sex and, you know, so I think it's a taboo subject, but we're trying to smash the shame around talking about it because a good friend of mine, Anita Mitra, she's another ambassador for the Eve Appeal. She opens up her book talking about a patient who had been consistently bleeding for years before she even saw anyone. And it was because of the embarrassment and the fact that, you know, we as medics also have the same embarrassment around the subject. It speaks volumes, right? It really does. I'm going to get back to this recipe real quick before we get. So all I've done here is I've put in the chia, the chai spice mix, the oats, the almond milk, actually, no, this is coconut milk here. And a bit of cacao powder as well. Sounds very fancy. Chia is probably the most expensive mix, but really it's just a bit of cacao powder, a bit of nut milk or whatever milk you want to use and some oats. You can really, really strip it back to that. Oh, and the dried pears to give the sweetness. So, through the magic of what I've made earlier, this is one that's been essentially soaking overnight for about 12 hours now. So that's got the same ingredients and we're just going to top it with whatever you want. So I know you like some nuts. So we've got some sliced almonds. We've got some some berries here and then smooth almond butter as well. We're not in school so we can use nut butters and all the other stuff that we want here. So yeah. So what what is your sort of like eating habits now? You said that you changed your eating habits quite a bit and yeah, what what's it what do you what do you tend to eat for breakfast and stuff?
Dr Zareen Morgan: Yeah, we and no shame here by the way. Breakfast is often a difficult one, but I I my both my husband and myself, we we make a smoothie.
Dr Rupy: Uh-huh.
Dr Zareen Morgan: Yeah, and just put loads of chia seeds, flax seeds, kale, and then a whole load of fruit. We put some nut butter. I think maybe we put a bit too much in.
Dr Rupy: I mean, I I I am known to eat this from the jar to be honest. Like when I'm at work, yeah, people often find me just like with a jar of nut butter and like some fruit.
Dr Zareen Morgan: Yeah.
Dr Rupy: So I probably have too much as well. But yeah.
Dr Zareen Morgan: But yeah, it sets us up for the day. And then what I realized was if I find it hard to eat healthily when I'm on the go. And so for lunch, we generally when we're organized. We make a vat, a big vat of salad with quinoa, parsley, nuts, grated carrots, grated beetroot, chili, garlic, loads of olive oil, loads of lemon, walnuts, pumpkin seeds, anything I've got in my cupboard that can keep and it keeps. So we make a big vat of that, shove it in the fridge and then have that for lunch. And it fills us up, yeah. And I found that that post-lunch dip has gone.
Dr Rupy: Yeah, absolutely. Yeah, I mean, I used to be like relying on the canteen sort of sandwiches and that kind of stuff in hospital, which they we really need to address that. But um, yeah, I used to have that slump and stuff and yeah, and when I started eating a lot more fresh and a lot more sort of quality fats and that kind of stuff, I found immeasurable differences in my energy levels. So try this. Give it a try. Be honest. So that's spiced pear with overnight oats and chia, some berries and some nuts on top. Super simple. Something I have pretty much all the time. In fact, I've got one waiting in the fridge for me.
Dr Zareen Morgan: I want to get some of the pear.
Dr Rupy: Yeah, yeah, yeah, definitely need some of the pear because otherwise without there's no other sweetness in it at all. So you need to get some of that dried pear in it. So it kind of goes with the the spiciness and stuff. So nice.
Dr Zareen Morgan: You do a very fake mmm there. Very good mmm but.
Dr Rupy: Good. Well, hopefully you'll be making this and and maybe maybe your five-year-old will will appreciate it too.
Dr Zareen Morgan: Not sure he will. He likes anything with chocolate in it.
Dr Rupy: Yeah. We'll take a break real quick. But if you want to listen to the rest of our conversation, go over to iTunes or whatever your favorite podcast player is. And then we're going to be chatting about preventative cardiology, your new fresh project, and some other stuff about lifestyle medicine. It's going to be great.
Dr Rupy: So how was your overnight oats?
Dr Zareen Morgan: It was great. I loved it.
Dr Rupy: Good, good. I'm glad.
Dr Zareen Morgan: I will be I will be experimenting with that at home.
Dr Rupy: Good. And you can experiment because you know, there's turmeric spice latte mixtures you can use, you can use ginger, cinnamon, cardamom, clove. Just as long as you've got that sweetness balance and the recipe is on the website and stuff. It it yeah, it really makes a difference.
Dr Zareen Morgan: Thank you.
Dr Rupy: No worries, anytime. I'm excited to see some of your pictures on social media after having that one now you know the recipe. So let's talk about preventative cardiology and you know, I I've personally got a lot more medics asking me where to start and how I started. So we know your personal story, we know sort of what led you to the sort of light bulb moment, the realization that, you know, all these other factors that are holistic certainly have a demonstrable impact, a huge impact on your well-being. So where did you start?
Dr Zareen Morgan: So I started, obviously I was a practicing doctor at the time. I'd gone through this big lifestyle issue and sort of come out the other end and reflected a lot on my own health and how I did things. And then started to look at my patients and how I treated my patients, what I told them, what messages I gave to them. And I was so shocked. I don't think until this point in time I'd really realized how little attention I was paying to prevention over and above, you know, all the usual medications that we give and the prescriptions that we write. And I also realized that a lot of the time when I was seeing patients in clinic, I was putting a bandage on the problem. So they'd come in, their blood pressure would be high. I'd say that's, you know, it's high, let's give you a tablet. And then I'd see them three months later and then their blood pressure would be still high and I'd be thinking, okay, right, let's give you another tablet. And what I what I realized was that when in cardiology, what we've done over the years is phenomenal. We've achieved so much. We've the mortality from heart disease has dropped year on year. And yet the prevalence hasn't really dropped. So the number of people with cardiovascular disease hasn't really dropped. And what I was seeing was that my patients were getting younger and they were getting sicker. And whereas, you know, they weren't dying because we've really improved not only our techniques for preventing, you know, cardiovascular disease with statins and those sorts of things. We've also increased the treatment options for people having heart attacks. So initially we used to just pop people on aspirin and beta blocker and watch them have their heart attack and then there were clot busting drugs and now there are techniques where we take people into catheter labs and open up their their blocked blood vessels. So these techniques have really made a big difference and stopped people from dying, but we haven't really improved the morbidity aspect. We're excellent at treating acute disease, but what we what we lack is really focusing on what happens when it's no longer acute, the moment it becomes chronic. And so not only did I reflect on how I was treating patients in clinic, but I was looking at what I was doing on my coronary care rounds. Patients were having, you know, having just had their heart attack, having just had their stent put in, would be on the coronary care unit and in would walk and I'd be prescribing the aspirin, the statin, and in would walk the voluntary service trolley. And honestly, I I I would look at it and I there's not one healthy thing on that trolley. There's chocolate, cordial, crisps, you know, newspapers, which probably cause a lot more stress as well. But at the same time, I didn't think about the newspapers. That's a new angle actually. It's it's but I really thought there's nothing here that is health promoting. And so it made me really rethink how I was practicing medicine. And then I started to give a lot more advice focused on lifestyle. I started to do that in clinic. That's when I came up against with your podcast. And interestingly enough, I was getting phenomenal results. So people were coming off their blood pressure tablets and it wasn't big, big changes. It was often just adding a little bit of exercise into their daily routine or changing the times that they ate. It wasn't big changes. And one woman, I remember very clearly, had atrial fibrillation and I said, what about listening to this podcast? It's a doctor called Rupy Aujla. And why don't you, why don't you have a, why don't you have a read of his book? So she did and then came back three months later. Honestly, she was like a changed woman. She had tears in her eyes. She said, you were like an angel sent from above. And obviously I took all the credit. I said, yes, obviously. Thank you. But the credit was due to what you the advice that you'd given in your book. And I at that point really started feeling so good about what I was doing. I wasn't necessarily prescribing medication. I would when it's necessary, but I was giving a lot of lifestyle advice. And so I then realized that I love prevention, I love lifestyle, talking about lifestyle measures, and I started reflecting on what I thought were the key elements of a good lifestyle preventative strategy in patients with cardiac disease and came up with the fresh heart project where all the letters of fresh stand for one element or pillar. And that's now what I'm focusing on. I still do cardiac imaging, I still see patients, but I'm really now moving towards prevention and lifestyle.
Dr Rupy: That's brilliant. And we're going to talk about the fresh program that you've started in a second. But what I find quite interesting is that even today in conventional cardiology for one of a better term, I can't really think of something to separate what we mean by lifestyle and how we treat people with just drugs essentially. But there are more and more investigations and more and more research trials geared towards pharmaceutical options as a as a preventative cardiology in itself. So, you know, PCSK9 inhibitors, better and better statin medications, drugs. We really need to reframe what we mean by preventative cardiology, I think in this country and beyond because as you said, a typical patient journey is just that. You see a cardiologist or a GP, you put on some drugs, you you let them go on their merry way for a few months and then you come back, you realize that they're at the next step of the treatment algorithm. And we don't even get a chance to talk about diet and lifestyle stuff because we haven't really had that in our mind. So when you think about preventative medication cardiology, and we'll talk about the fresh heart project in a second, what does that what do you think of from a pharmaceutical point of view, from an interventional point of view and from a lifestyle point of view?
Dr Zareen Morgan: Yeah. So I think that we have to take an approach which uses all of those because we've made so much progress with pharmaceuticals actually. So I'm definitely not against pharmaceuticals in primary prevention.
Dr Rupy: And I think that's a really good point because a lot of people think of statins in particular as the devil or, you know, no one should be on a statin, which I think is very, it's quite a dangerous play to make because and I'm not just talking about the people with familial hypercholesterolemia who have a genetic condition that renders them more likely to have higher levels of these lipoproteins in their blood. It it's they genuinely are fantastic clinical tools to use alongside all the other tools we have in our toolbox.
Dr Zareen Morgan: And that is exactly it. It's like having a toolbox. And part of your toolkit is medication. Part of your toolkit is, you know, intervention if necessary in certain cases. Yeah, yeah. But not always. We could talk about the courage trial. We could, we could talk about the courage trial. And then part of it is lifestyle. And so should we talk about the courage trial?
Dr Rupy: Yeah, what do we talk about that? Yeah, yeah.
Dr Zareen Morgan: So yeah, the courage trial was very interesting actually. So I think was it 2007? 2007. It was quite a long time ago. And they looked at lots of patients. So two about 2,300 patients. And they randomized them. So either to and they these were patients with documented coronary artery disease and they had to have ischemic symptoms. So what we mean by that is that there are three main blood vessels that supply the muscle of the heart and in those blood vessels, there are significant narrowing which when tested are significant, okay? So these are patients with coronary artery disease that is significant. There are a couple of exceptions. So one is if they'd had, I think bypass grafts and one is if they had very, very severe, very proximal, very high up disease in the left main which which is excluded. And that is something that supplies a massive territory and should be treated interventionally. Very uncommon. So the majority of patients with stable angina and coronary artery disease, they randomized them either to intervention. So if you and and you know, it makes sense. If you've got a blockage in the artery of your heart, opening up that blockage just from a, you know, from an academic perspective makes sense. If you open up that blockage, you're supplying more blood to that bit of the muscle and you think, you know, that's going to be beneficial. So in half of the patients, they underwent intervention to open up the blockages. In the other half, they just gave them tablets. So they just gave them medications and said, right, we're going to test this and they followed them up. And what they found was that actually the end point of major, you know, cardiovascular events and mortality was the same. So the outcomes were the same in both arms. So it didn't matter if you if the blood vessel was opened up, which really you'd think would help mortality, but it didn't. Tablets worked just as well. And what it might have done was help with anginal symptoms a little bit, but actually when you look at the the tablet group, anginal symptoms were helped as well. So really, intervention and stents in the majority of people with stable angina is not a heart attack, not not something where you'd go into, you know, hospital acutely with, works just as well, you know, tablets work just as well. It does not save lives, it may help symptoms. And that the there was the orbiter trial as well very recently. I haven't come across that. Don't know if you've come across that. So this was a group in London, Daryl Francis did. And he said, well, that's all very well. Courage is very well, but people who are undergoing intervention, they have had a procedure. So is there a placebo effect with that? We haven't really tested. So so they did, they took a smaller group, but about just over 230 patients and they randomized them to medications, optimal medical therapy or stents in people who had a blockage in one of their blood vessels. And that was very interesting. And they they they actually found again, so the group that had just medication actually underwent a procedure. So they genuinely did not know if they had a stent or not because they had a procedure. They had an angiogram where we look at the arteries of the heart and they had a little pressure wire or a little wire put down that artery with the blockage. So they had had but they didn't have the stent. So they just had a sham procedure. And then the other group did have the stent. Again, their exercise time was identical. Yeah. Oh my god. And people genuinely did not know which group they were in.
Dr Rupy: Yeah, I mean, the first the first reaction is like, how on earth did you get that through ethics? First of all, like the sham procedure versus the.
Dr Zareen Morgan: It's a good point and that was really raised at a lot of meetings, but it's a question, it's a genuine clinical question that we have.
Dr Rupy: Yeah, yeah. I can understand because if you can demonstrate the courage in the courage trial that medication versus intervention in stable patients, so not acute patients, stable patients, have similar outcomes, then it stands to reason, you could potentially argue, well, if we try sham versus the intervention, then maybe we're not putting them at greater harm as long as they're on medications as well, I'm assuming.
Dr Zareen Morgan: The what what the the question from the courage trial was that, you know, it helps with anginal symptoms. And the only way in which you can test that it helps with anginal symptoms is to do a randomized control trial where they genuinely don't know if they've had a stent or if they haven't had a stent. And, you know, it was there were lots of criticisms, there weren't very many patients, it wasn't followed up for a very long time, but it's very interesting findings. So watch this space. But intervention in people who are stable generally works just as well as tablets. And it does not reduce death. It does not reduce events. And that is the message.
Dr Rupy: And that's really interesting because I think back then, the because of the rationale of essentially putting something in that's going to physically widen your vessels, stands to reason that, you know, it's it's going to be good for you. And back then it was kind of like the wild wild west, right? It was just like people doing stents all the time, like, you know, you got any cardiac issues or whatever, we'll just put you through a stent and and and that's how it was. But that was really revolutionary at the time, right?
Dr Zareen Morgan: Yeah, yeah. Yeah. And so when we talk about prevention, medications are one element of it. And we do that very well. But what I I realized very, you know, recently was that we don't do the lifestyle very well. And Rupy, it's not about blame, which I think is a really important thing to mention. Because often when we talk about diet and lifestyle and exercise, particularly when patients have had a heart attack and they're in a vulnerable position, it feels like a bit of an attack and it feels like we're saying part of this may be your fault. And that promotes a psychology where they may not be as receptive to what you're trying to say and they're in a very vulnerable position. And I genuinely don't think that we can blame patients because as a society, I think we are more health conscious than before. I mean, how many of us have had a gym membership that we can't go to? How many of us have said we we're on a diet or we're being good today? And just not been able to keep that up. And so it I don't think it's to want of trying. I think it's actually because the environment that we're in, the society that we're in sets us up for bad, you know, health behaviors. I mean, if you look at the blue zones where people live to 100 really well, they didn't think, oh, I've got to be good today. I've got to go to a gym. It's just that their environment was set up for health and longevity. And why is it now that at every street corner there's a fast food restaurant or in particularly in deprived areas there are fast food restaurants. Why is it that, you know, you go to a hospital canteen and to get a, you know, bowl of chips is cheaper than a salad or even a banana sometimes. And why is it that, you know, when patients are on the coronary care unit, they're having chocolate and cordial and crisps wheeled to you. It's just that society has evolved for convenience. We're always on the go and we're sleep deprived.
Dr Rupy: Absolutely. I I mean, I feel very strongly about this because I think the default option should always be the one that is in line with our evolutionary design and how we are meant to function. And currently it's one geared more towards consumerism and convenience, which unfortunately don't go hand in hand with health. And the more we see the fact that morbidity is increasing and we have greater prevalence of cardiovascular problems in particular amongst a whole bunch of other things that we can talk about. It's going to at some point come to a head where we're going to have to actually design new societies and new cities with this in mind, which I'm actually very much looking forward to because I think we can make these changes quite effectively if we plan with the right mindset. But that in itself is going to be quite controversial, I guess and it it's going to take a new way of of thinking about how we work with industry in particular. Industry has a bad name. But I think there may be some genuine attempts from moral standing people within industry that could could change the way health is intertwined with design and and how we sell products essentially. I know that you've taken a lot of inspiration from some cardiologists in particular from America who have done lifestyle medicine projects, who have gone through the same sort of training as you. What sort of teachings have you sort of gleaned from them and the research that came out of that?
Dr Zareen Morgan: Yeah, absolutely. I mean, I think there are some very inspirational cardiologists in the states. In particular, a couple that I've learned a lot from are Esselstyn. I don't think he was a cardiologist, was he a vascular surgeon? He was I don't know, to be honest. I thought I I assumed he was a cardiologist because I remember coming across that paper that everyone talked about in the past about improving luminal narrowing for for people with established cardiovascular disease.
Dr Zareen Morgan: And he sort of revolutionized, he paved the way really, I think. And what he showed was that through just the power of diet, you can reverse coronary artery lesions, established coronary artery lesions can be reversed through the power of diet. And he used a very plant-based, vegan, very low-fat approach. And his patients complied. So he saw phenomenal results. And then there are others, there's Joel Fuhrman who has also used, he uses a very plant-based approach as well. And he calls it, I think, nutritarian where, you know, you look at the nutrient content. I think there's something really to be said for that because if you look at the nutrient, if you maximize on nutrients rather than empty calories, then automatically your diet improves. And he's seen phenomenal results. And then there's also a cardiologist called Dean Ornish who uses, you know, I mean, he's seen phenomenal results. He's taken people who have established coronary disease and reversed it. He's taken people on heart transplant lists and reversed it. And what he's done is he's used a program of lots of things. So it's not just diet, although that's an integral part. He's he uses lots of coaching, he uses yoga, meditation, he uses a bit of exercise as well. But then one of the key things that he gives his his his patients is love and belonging and a safe space in which they can explore the lifestyle changes that they can sustainably make and, you know, to promote their health. And he's so he's been quite an inspiration, I have to say, and the way he goes about it.
Dr Rupy: Yeah. And I think, you know, one thing that's important to mention is that a lot of the studies have been alongside conventional therapy, right? So some of the studies that showed reversal of cardiovascular disease of which there are plenty, even though the studies might promote the fact that it was a dietary intervention, it was alongside statin therapy and anti-blood pressure medication. The important thing to know, and this is something that I feel quite strongly about is I've put plenty of people on statin medications. I've put plenty of people on blood pressure and cardiovascular preventative medications. I have not seen reversal. If anything, it's the other way around. So there is something magical, again, like something really to be taken advantage of and and and given more attention about the interplay of diet and clinical medication and, you know, all the other interventions that we have as well. There is something quite special about that relationship and that's not something to be scoffed at.
Dr Zareen Morgan: Yeah. And Rupy made a very important point in that it is done in conjunction with medical therapy. So if anyone is thinking, oh, I'm going to do this, it's brilliant. Please do and explore it for yourself and do what works for you. However, do it in conjunction with your doctor. So if you are on statins, if you are on medication, there is a reason you are. And do it in conjunction with your GP or your cardiologist or or your medical practitioner.
Dr Rupy: Yeah, even myself, like, you know, I I didn't shun medical therapy. You know, I still had my electrophysiology studies. I still had my cardiac MRI that incidentally found a gallstone. Yeah, yeah, which I've had I mean, I've ultrasound myself plenty of times because I yeah, and I don't have a gallstone anymore. Yeah, yeah, which is quite odd. But uh, yeah, no, I had a whole bunch of that and it was with the blessing of my cardiologist because they knew that I could still be on my anti-arrhythmic medication or beta blockers whenever I needed them, that I could try lifestyle measures. You know, if this was something that was significantly worried about, then I probably wouldn't have gone down that way because at that point, I was a very conventionally minded medic and you know, the thought of lifestyle, which was introduced by my mother, was just so foreign to me. I was like, I just thought my mum was off her rocker. And now it's kind of like, I told you so. It comes with its own issues. But um, but yeah, yeah. No, I think it's a really important point as well. And you know, that's why I love the fact that you are a consultant cardiologist and you're a big advocate for this. And I see the work that you're doing with the the fresh project is going to be revolutionary in this country because sorry, there's one thing I do want to mention about Dean Ornish because I'm a massive fan. Is that it's currently covered by American medical insurers, right? His program. And that I think speaks wonders because if you can convince a profit maximizing organization that your program alongside conventional therapy is beneficial and there is data to support that, it's nothing to be scoffed at. That's a huge, huge success for for Dean and for lifestyle medicine in general.
Dr Zareen Morgan: Oh, yeah. And it took him a long time, didn't it? But it makes sense. Prevention is cost-saving.
Dr Rupy: Yeah, absolutely. So let's talk about fresh. Yes. I've been I've been dying to talk about fresh this whole time. So tell us what fresh is, how you came up with it and and what it stands for and how you're going to put it into practice.
Dr Zareen Morgan: Yeah. So the Fresh Heart project came about because I wanted to simplify the lifestyle measures that I think are additional to whatever conventional therapy you're on, just to maximize primary prevention and secondary prevention and the prevention and and it's not just about heart disease. It is really about getting the most out of life and living your best life because if you if you if you live by all these pillars and take small steps, then you will feel better. And that's the key. If you feel better, everything else tends to fall into place. And so I came up with fresh because yes, it is a nice punchy acronym, but it really does incorporate all I all the things that I believe lead to a healthy lifestyle. So the F stands for food, the R stands for relaxation and stress management, and the E stands for exercise, the S stands for sleep, and then the H stands for happiness. Very important part, I think. Very important. Very important. Yeah. Yeah. And if by addressing all these aspects, not all at once, in small steps, you can make real headway in feeling better. And once you start to feel better, you can start to do a little more and then a little more. And then very slowly you'll realize that things are falling into place, symptoms are disappearing, blood pressure is getting better. And it's a real motivation to carry on. So the way I want people to take the fresh heart project is to take little bits, try it and use it as a kind of resource for figuring out what's right for them. So I really want it to be a an educational experience. B, I want to I want it to be a very personal experience. So I'm running day programs at the moment and talking about all these different aspects. And you know, Rupy, it's been amazing. I've had such really overwhelming response to what I'm talking about. And, you know, I've had a group of teachers, I've had a group of, you know, retired individuals. I've had I've had lots of different groups. It doesn't matter what age, there are things that I talk about that resonate with everyone. So it doesn't matter what age. And I think what I've now want to do going forward is which I am going to do hopefully starting in September is pilot more of a coaching program where we take people and coach them through a sort of a six-week program with a 10-week a 10-week sort of intervention arm where we we we'll see them for six weeks very intensively. For the next four weeks, we won't see them as intensively, but we'll still touch base and then we can still touch base for a further few months after that just to coach them through different lifestyle changes because behavior is difficult to change.
Dr Rupy: Huge, hugely difficult. And I'll also say all the details for that will be on the podcast show notes. So make sure you go to thedoctorskitchen.com and then check out this episode and all the links to that will be there. So if you do want to go onto this program, it will be there for you. But what I find interesting is that there's so many different factors that you need to try and and put together. How do you even go about trying to address which one is the most appropriate first mover for the patient in front of you? Because I have to do that in an eight-minute consultation. So it's very different. I sort of like have to rely on my sort of clinical skills, acumen, getting a report with the patient and then diving into, okay, what is the one thing, what is the best next step for this person in front of me, rather than putting my own internal biases, which is clearly food. But, you know, it might be for that person in front of them relaxation. It might be sleep. It might be, you know, what's the easiest and the most impactful factor. So how do you go about that in your program?
Dr Zareen Morgan: So I will go through them all and people know.
Dr Rupy: Okay.
Dr Zareen Morgan: People just know what's missing. People then can reflect on themselves, reflect on their lives, reflect on what's missing, reflect on what what is the most important for them.
Dr Rupy: What what is it for you?
Dr Zareen Morgan: Sleep. Sleep is the big one. As you were saying, I was like, yeah, I got that, got that. Yeah, sleep is the big one. It's always the yeah, yeah.
Dr Zareen Morgan: Yeah. Mine as well. Yeah. Sleep is difficult.
Dr Rupy: Yeah.
Dr Zareen Morgan: Yeah. And it's the first to go. Whenever I'm stressed, whenever I'm anxious, I don't sleep very well.
Dr Rupy: You used to be a sleep researcher.
Dr Zareen Morgan: I did. I did. I used to, so I my PhD looked at people patients with obstructive sleep apnoea.
Dr Rupy: You want to just explain what obstructive sleep apnoea is for the listeners?
Dr Zareen Morgan: Yes. So obstructive sleep apnoea is a condition where when you go to sleep at night, your airway maintains patency, it's open, okay? And when you go to sleep, the muscles of your body relax. And in a condition called obstructive sleep apnoea, the muscles of the airway also relax as well. So you can actually get an obstruction to air going in and out of the lungs, okay? So what happens is that you the patients with obstructive sleep apnoea fall asleep, they they start getting more relaxed, the muscles relax, their airway collapses, and the they get changes in their bloodstream. So the oxygen goes down, the carbon dioxide goes up, but they don't really wake up. Their brain registers that this is happening so that so they then have a big kind of snort where they kind of open their airway and they have a little wakening, but again, it's a little wakening, they don't wake up. And they go back into sleep. And then they obstruct again and they have a little wakening. So what happens is that they're having these little wakenings throughout the night and they don't get to deep sleep. So they are missing out on this massive proportion of restorative deep sleep, plus they're having these obstructive episodes or apneas, which is changing their physiology and causing all sorts of issues, not only cardiac, but, you know, metabolic. And they have an increased risk of cardiovascular disease, in particular hypertension. And actually coming back to atrial fibrillation, which is what you had, which I don't know if all listeners are aware of what atrial fibrillation is. It's a condition where the top of your heart essentially the top of your heart beats, the bottom of the heart follows. But in atrial fibrillation, what happens is the top of the heart wobbles and then so the bottom of the heart follows, but it it doesn't have a clear signal. So it follows quite erratically and quite irregularly. And sometimes that can be fast, sometimes that can be slow. Sometimes people don't really realize it, but often it's very symptomatic, especially if it's fast. And patients with obstructive sleep apnoea have a higher risk of developing atrial fibrillation.
Dr Rupy: Interesting. And I think like, you know, there's so many issues with poor sleep that extend beyond cardiovascular, but just to think about cardiovascular, and I'm so glad it's obviously part of your lifestyle pillar because it's just such a huge part. You know, increases or disruption, I should say, to your satiety hormones. So ghrelin and leptin, when that goes out of whack, you're more likely to crave the salty sugar foods. You have disruption to your roaming cytokine levels, so your inflammatory markers are elevated. You have an increased risk of stiffening of your arteries themselves and luminal narrowing that is part of the atherosclerotic picture. Blood pressure, like you said, catecholamines, so the actual hormones that drive your your blood pressure up. And cortisol, I think, which is a related to stress, which if you're going to have poor sleep, that's going to be an issue anyway because you're going to be ratty the next day and everyone's had that. But if you've had that persistently over a long period of time, you know, it it's one of these really interesting hormones, cortisol, because it's anabolic to fat cells. So it increases your fat cells, but it's also catabolic, so reducing to your muscle cells. So you get this like it's a really bad picture when you have that in excess. Cortisol is one of the most important hormones. It's not something that we need to get rid of. But it's that balance that's completely out of whack with poor sleep. And that's why you just see this like fantastic interplay of all these different things. And using a pharmaceutical model in my head, you might like, oh, okay, so cortisol is bad, so let's get a drug for that. And, you know, blood pressure is bad, so we'll get a blood pressure medication. And, you know, sleep's sleep's an issue, so we'll give them a sedative to increase. Do you know what I mean? That's a very sort of naive, very reductionist way of doing it. Whereas if you can just try and improve their lifestyle, you're naturally going to be improving all these different things at the same time. So, you know, this whole notion of lifestyle as medicine is true. It's literally medicine in its most truest form.
Dr Zareen Morgan: Yeah. Yeah. And you've hit on so many important things with sleep. I mean, I was looking at patients with obstructive sleep apnoea who have other risks. So they are generally a little bit more overweight. So that comes with its own risks. You know, some of them are there's a higher prevalence of diabetes, which obviously has more risks. But if you look at just simple sleep deprivation, so if you don't have any sleep disorder, if you if you sleep for less than six hours of a night, then you are also at increased risk. And it's through all the mechanisms that you talked about. So the sympathetic nervous system predominates. And when we talk about that, we talk about stress, you know, that's when we typically talk about it. Our sympathetic nervous system is evolved so that we can deal with an acute stressor. So, you know, we can run away from that saber-toothed tiger. We can we can it's a fight or flight response. And our blood pressure goes up, our heart rate goes up, and, you know, our levels of adrenaline go up. And if you aren't getting enough sleep, then you have that sympathetic nervous system predominance. And nowadays, lots of people are wearing monitors and rings and they can measure things a thing called heart rate variability. And we find that actually, if you are relaxed and you don't have and you're not stressed and your sympathetic nervous system is is on is not on overdrive, then you have a variability in the in your heart in your heart the the time interval between your heartbeats. So if you take a breath in, your heart rate tends to speed, and if you take a breath out, your heart rate tends to slow. And that is normal and that is good. But if you have lots of adrenaline circulating, lots of sympathetic nervous system activity, then that goes and you find that in a lower heart rate variability. And so you do have a sympathetic.
Dr Rupy: So which is kind of unintuitive, right? Because I'm obsessed with HRV. I think yeah, so I I have a an aura ring that I not an advert by the way, I just I genuinely like this as a tracker because I genuinely don't like I don't wear a watch, I don't wear anything, but I I'm fascinated with the quality of my sleep. So when I first came across HRV, I remember thinking, oh, okay, so like, you know, surely the shorter the HRV, the smaller, the less stress. No, it's the other way around because you want interbeat variability for which is actually a marker of, you know, improved resilience and less stress.
Dr Zareen Morgan: Absolutely. So yeah, the sympathetic nervous system is on overdrive. You mentioned hormones, in particular leptin and ghrelin. So if you your your hormones essentially, if you have a higher level of leptin, you feel fuller. Okay, it's a very, very basic way of looking at it. But your level of of leptin is also if you're sleep deprived and you don't feel full, you feel and and that's that makes sense because if you wake up in the morning and you're tired and you're knackered, then you want you crave that, you crave food. And you don't crave a bit of broccoli or some kale. What you crave is like that simple carb hit that's going to get your blood sugar up and get your energy levels going. So you crave that donut, you crave that muffin. And so that's another way in which you can just if you're not if you're not getting enough sleep and you know, you're perfectly healthy and normal, you can then lead it leads to adverse behaviors. And then your insulin, you know, you you you become insulin resistant and insulin is obviously the hormone that mops up glucose. And if you're resistant to this, your blood sugar level can go up and then you can have a risk of type two diabetes. And all of this, all of this, as you've mentioned, creates inflammation in the body. And inflammation is the hallmark of so many diseases. It's the hallmark of a lot of cardiovascular disease. It's the hallmark of what I see a lot. It's the hallmark of, you know, many, many conditions that are not cardiac, that are inflammatory or autoimmune. So it it getting enough sleep is very important. And our modern life doesn't set us up for that. You know, we're always on the go. We're always we're always there's something to do, isn't there? That can compromise sleep.
Dr Rupy: Yeah. And that's I'm so glad you brought that up because I think not to trivialize it and you can't just sit in front of a patient like, you need to be happier. And I don't care whether you know, you come from a family where you've been emotionally abused or you're living on the bread line and you're struggling to figure out where you're going to be sleeping in the next couple of weeks. You know, but there are mechanisms that can improve our resilience to the modern day stresses, psychological stresses, whether that be through meditation, whether it be through breathing, whether it be through, you know, reframing your mindset on a day-to-day basis to think about things, whether it's performing a gratitude exercise. I mean, it was one of the things that I found like, you know, it put a positive spin on a day. What have otherwise been a stressy day.
Dr Zareen Morgan: Not listening to negative news in the morning. Three minutes of negative news in the morning makes you more likely to have and report a negative day.
Dr Rupy: You know what one of the best things I did was take BBC news off my home screen. Honestly, I I used to literally used to be every time you open up a new tab, BBC news straight away. And my word, if it was on now, like hearing about America and all the rest of it, I just wouldn't be able to do it because it does that. It really reframes your mindset to think of something that is clearly going to be sensational on the news. And there's a lot of negativity around at the moment. But I I'm really glad you brought that up because I think it has a huge, huge impact.
Dr Zareen Morgan: And social isolation as well. I mean, that creates a huge degree of unhappiness. And nowadays, well, you know, we're neurobiologically hardwired to feed off the energy of other people. That's how we've evolved. That's how we've, you know, we've lived in tribes and we've evolved in tribes. And nowadays we're in our tiny little houses and looking at our screens and and not being as interactive. And I think that's having a big impact on our own health and well-being.
Dr Rupy: This is a bit of a segue, but I I recently came across this case study looking at a patient who had a mutation in the far gene, the FAH, and that gene basically made her perceive pain much, much lower. So she she she was I don't know if there's that movie where they cut themselves and they hurt themselves and they can't feel pain. That was her, that was her issue. It was a genuine concern because she, you know, she'd burn herself and she wouldn't realize. You know, pain is a very protective mechanism that we have. She'd lost that. But one of the other things that they found out about her was that her perception of happiness was elevated, was much higher. So her psychological resilience was a lot higher. And this kind of kind of speaks into the anecdotes we have about, you know, positive thinking when you go and have your blood taken or positive breathing when, you know, you're going through a stressful event. You know, there we are intertwined in so many physiological ways to our psychology. It's nothing to be sneered at.
Dr Zareen Morgan: Again, another very pragmatic inclusion in your fresh project and I think it's going to be super, super impactful. Honestly, really can't wait.
Dr Rupy: I've got to say it again, I really do commend Dr Zareen's pragmatic approach to lifestyle medicine and her openness to the different strategies we have to preventing ill health across our NHS healthcare system and beyond. To summarize some of the points that I think are really important, something that she she actually brought my attention to, it's looking at the news in the morning and being aware of what impact that has on your stress levels. The connection between happiness and cardiovascular disease and going to link to the study that she mentioned regarding the Framingham cohort on the podcast notes at thedoctorskitchen.com, so go check them out. The nutrition principles that she really stands by are very similar to the ones that I was advocate. Whole grains, quality fats, largely whole and lots of plant-based foods. And we also talked about how lifestyle is an adjunct to therapy. So something that we use alongside the current tools we have and to use lifestyle as a clinical tool, food as a clinical tool, and everything else is really the way forward. You know, we we could have talked a lot about decreasing central adiposity and fat cells, improving endothelial function, reducing lipoprotein atherogenicity, postprandial hyperinsulinemia, but really it comes down to the principles that we were talking about. If we can identify people that are at higher risk, perhaps using stratification stores like metabolic syndrome, we can truly reduce the number of heart attacks that we see coming through emergency medicine doors and something that I see all the time working in emergency medicine. Please do go check out the website for Dr Zareen. It is lifestylecardiology.com. You can find her on Instagram at Fresh Heart Doc, under the same name on Twitter. I really encourage you to go check out her website, sign up for the fresh project if you're appropriate as a patient, and you can find all of this information and more at thedoctorskitchen.com. Subscribe to the newsletter for weekly science-based recipes, content, and much more to help you live the healthiest, happiest life. And please give us a five-star rating if you like this podcast. It really does help spread the message. Tweet us at doctors_kitchen, check out the Instagram and YouTube, and of course, don't forget to order a copy of my latest book, Eat to Beat Illness. I will see you next time on the podcast.
