How to prevent heart disease, according to science

22:34That's zoe.com with the code FEEDYOURGUT at checkout. You could be one of the first in the US to try the gut supplement that's changed my day, and I know it'll change yours too. Sorry, we've teased our listeners a long time. So I think we, no, no, don't apologize. No, no, not at all. But I think they're like, okay, so what have you found out? So what has this told you about the risks for heart disease? So there's been several studies that we've done in our groups of men and women. And what we tried to do is suppose you would just look at someone's choices in life, like pretend someone even doesn't even go to the doctor, doesn't give their blood, doesn't whatever.

23:14And really what you, you know, can you make choices at home? And if you made the right choices, what percent of heart attacks could we get rid of? And what we found is that just simple things like a healthy body weight, exercise, not smoking, and a healthy diet. And in the healthy diet, we put in a little bit of alcohol for people that drink, but you can explain 60 to 80 % of heart attacks. So if everybody just did those four choices and did them in a healthy way, you could get rid of probably 70 to 80 % of heart attacks in women and 60 to 70 % of heart attacks in men. And the number one killer is, you know, heart disease.

23:56So if you can get rid of something which 60 to 80 % of it just by making healthier lifestyle choices, and we even in our studies in men and women, we see even people, as you mentioned earlier, who are in their 40s and 50s and be making, maybe taking medication for high blood pressure or high cholesterol, even those populations that make healthy choices can get rid of 60 % of their risk of heart attack. So, I just want to make sure you're saying that even if you are in your 40s or 50s, and maybe you've got all of those risk factors or many of those, if you make a real change to your lifestyle, you can really dramatically reduce your chance of having a heart attack?

24:35That's amazing. It's a three or four-fold drop in risk of heart disease. And it's 50 to 70 % of the heart disease that happens among people who are taking medicine And you could get rid of if people exercised, had a healthy weight, had a good diet and didn't smoke. So just to make sure I understand, let's say somebody's listening to this right now who's in their mid-50s. How much can they reduce their risk of heart attack if, let's say, they're maybe not at the healthiest thing and they were to really make a big change? Yeah. So the way we looked at it, it was to just give people a simple score, zero through five.

25:07How many of these things do you do that are healthy? And the cutoff for exercise is like a half hour a day. And you don't have to do it a half hour every day. if you just have two and a half to three and a half hours a week of moderate to vigorous activity. If you had that, then you get a one. If you don't, you get a zero. And then we kind of classified people based on a healthy diet, and we gave people in the top 40 % of a diet, we gave them a one if they had a healthy diet and zero if not. And if you smoked, you got a zero. If you didn't smoke, you got a one. So you can see it's in a healthy weight as if you have a BMI under 25.

25:42So these are just relatively simple cutoffs. And we were just counting people zero, zero one. So you could have a zero all the way up to a five. And if you had a five, which means you were healthy in all of those, and therefore your risk of heart disease was three to four times lower than people who are zeros. And it was still two to three times lower than people who are one. And it's a beautiful, very nice linear scale. The more healthy things you have, the lower your risk of heart disease. So just to make sure I've got it, you're saying you had this way, because there's a lot of complicated data, it's made quite simple.

26:16You gave everybody like a score between one or five, basically, it was quite simple criteria it sounds like. It's like a one or a zero, right? And we know that - Right, let's just oversimplify, way simplified. So it's quite simple. And you saw this enormous, you said like a three to four time difference in likelihood of getting a heart attack from people with like zero versus five. Coming back, I guess, to this question about, okay, but I can see that if I've done that since I'm 20, I'm great. But do you have people in your sample who like really changed and maybe they were only scoring one or two and they went to four or five in their fifties?

26:50And was that able to make a big change? Or now you're like, oh, okay, it's a bit better, but it doesn't really matter. Yeah, no, that is the most important question. It's like, what can I do about it? And our populations were large enough that we had some people that did change that went from a one to a five. And some people stayed at a one. And people that went from a one to a five, like, halve their risk of heart disease. They halve their risk of heart disease. So, like, don't ever, it's never too late is really the message. Which is an amazing message. You're saying even in your 50s, I think many of us have sort of felt like it's all too late, right?

27:21You're sort of stuck with all the choices you made. You're saying even if you haven't made any of those right choices until your 50s, you can halve your risk of heart disease at that point if you are to make a set of changes. Yeah, I mean, we have to generalize over everybody there. I'm sure some people do better than other people because of all the differences that we know from genetics to microbiome and all the other things that your guests have talked about. So that means, on average, it's about a halving of risk for people that really, truly have made change. And that is in your 40s, 50s, and 60s, which I think is the richness and the uniqueness of this study.

27:55If you follow people for 40 years, you can watch them go through life. And, you know, we don't know why they chose to go from a one to a five. What is it that someone was living unhealthy or living in a way maybe they had young kids that just couldn't do anything because they had three kids and they were just trying to deal with their kids. Their kids got a little older. Finally, they said, OK, I now have time to exercise. I can now lose a little bit of weight and I can now think about eating healthy. So they suddenly had a point in their life where they could live healthier and they could have the risk of having.

28:25I think that makes sense to me. It's funny. I'm meeting someone tomorrow and he was explaining like he's going to the gym for like two hours tomorrow morning. I was like, that's just the definition of not having any children in the house anymore. And I was like, just thinking, well, I can imagine doing that in my twenties. I could see that once your kids are maybe like late teenagers on, you can imagine, but otherwise it's like obviously totally impossible. Yeah. Right. You can, you know, some people get exercise equipment at home. Some people walk their dog. I'm not saying you can't do any exercise, but I am saying you can see how there's a lot more opportunity, you know, you get a lot more opportunity potentially, particularly, you know, if you've had something like children and family responsibilities can make this very hard.

29:03We have people taking care of sick parents that we've studied and we try to look, what is the impact of having to take care of a sick parent on your risk of heart disease? And it actually increases your risk of heart disease. Why is it? Because one, there's probably added stress, but probably two is just for the reason you said, I have to be there. I have to be the nurse for my mother, she's ill, she had a stroke. And so if I'm taking care of my mother, then I can't exercise, and sometimes I have to eat quickly. And so I eat fast food and have fish and chips instead of making something that's healthier.

29:32So there's a lot of reasons. Some of it's probably behavioral and stress, and some of it's just the choices that they can make. It's quite sad, actually, to hear. I mean, we have an expert who studies trauma and PTSD, and it's the same thing. People who have early life trauma because they've witnessed a violent event or other causes of trauma, who then go on to have PTSD, also have a one and a half to two times fold risk of having a heart attack, probably because of the stress involved, but probably because it leads them to bad choices, bad lifestyle choices because of the mental health anguish they're going through.

30:05So I guess you're able to pick up a lot of complexity in this. I think just before we talk about what can you do and maybe dig into that in a bit more detail, one of the things you've mentioned is around weight. And I think for a lot of people historically, I think the view has been, well, if you're not overweight, then you don't need to worry about heart disease. And I think that for many of us, this sort of affects the way they think about things. Is that true? Yeah. There's no question that people of all sizes and shapes have heart attacks and strokes. And there are a lot of other biological things going on among normal weight people.

30:47There's more adverse things going on among overweight and obese people. Obviously, they're much higher risk of diabetes, which puts you at risk for heart attacks. But you can get a heart attack while appearing to be, you mentioned this sort of, I know it's slightly arbitrary scale, the BMI, with a lot of questions about whether they could be something better. But you're saying, you know, with these people who are in your below 25, they can still have heart attacks? Yeah. In our scale, BMI was only one of those five points. So if the only thing that you have is a BMI and you have a point, you have a one point, but you don't exercise, you have a bad diet and you smoke.

31:19And actually a lot of the reason that people are normal weight or underweight, healthy weight is because they smoke and smoking people who smoke weigh three or four kilograms less on average. I digress. Nonetheless, we do have people that have a point only because they're what we call healthy weight and they don't do anything else and they still have an elevated risk of heart attack. So there's a lot of other things, inflammation and lipids and high blood pressure that can go on among someone who's a healthy weight. I ended up doing one of these body scans when I took part in one of our first Zoe studies that sort of gave the first data that we use.

31:54So this was about five or six years ago. And I remember the nurse was really shocked as she looked at the scan because, you know, for those of you on audio, like I'm not a particularly big person. I would say you are quite healthy weight, yes. But what was interesting was that it turned out that I do have fat on my body. It's just all nicely nestled sort of around the organs in my belly and not everywhere else. And the nurse was really surprised because it sort of wasn't obvious and she did these all the time. So it goes to show that, you know, it wasn't totally obvious. And I was told afterwards, well, actually, that's really bad.

32:29actually, it's not really your overall weight, which is so important. It's actually more where it's located. And so in my case, sadly, it was all stuck right in the middle where it shouldn't be. So even though actually like on a BMI scale, people would have said that I was fine. Actually, once you do this more detailed analysis, that is a real risk factor. And that's some of what I described of men versus women is that women, they would be less likely to have that in the, between the ages of 18 and 55 or something like that, that they carry their fat in different places. What you described was visceral fat, which is around the organs, which, you know, there are many people now who are doing studies of the types of fat around each of the organs and how it impacts it if there's fat around the liver or on the kidneys.

33:15So, you know, I think that does put you at modestly increased risk, but there's probably lots of other things that you do that would help prevent that risk. I've changed my diet quite a lot since then, so I'm looking forward to rescanning. I'm hoping that I will have managed to make some improvement. I mean, that's why when we talk about exercise, we talk about not just aerobic exercise, but resistance training, so that people, when they do gain weight, it's muscle mass and not fat mass. So it's good to have muscle throughout the body. That helps with insulin sensitivity and helps with a lot of other biological factors, plus people have lower cholesterol.

33:52So, you know, Eric, it's a big transition. It's a brilliant transition. Okay. People listen to all of this. You terrified them like number one and number four cause of death. I think most people are thinking I'd like to not die. And in fact, also I'd like to have this quality of life for a long time. So given all of this amazing study, I think you also have some good insight into what people can do to reduce that risk. And I'd love to just talk through, like, what are the top things that anyone listening can do that could actually reduce their risk here? Yeah, I mean, some of the things are clear, you know, smoking versus not smoking.

34:29Everybody who does smoke should try to find programs. And so that may be very obvious. And is vaping much safer or? You know, some of the short-term studies would suggest that vaping is as detrimental as smoking. It's just that, you know, something is not burning. So you probably won't have some of the impacts long-term that you get from a cigarette, but some of the exposures you get from vaping. Yeah, I would strongly recommend people not to vape as well. We just haven't figured it out. Yeah, pretty negative. You haven't got all the data, but you're pretty negative on vaping. Yeah, I mean, we haven't been able to put it in our models.

35:01So if you're... Yeah, we actually have a new study that my colleague, Horry Trevorrow, is studying younger people that are in their teens and 20s, and we do have a fair bit of vaping there. So we'll be able to look at the impact on diabetes and weight gain and things like that that happen over time. We don't have that yet. So we're working on it. But you're, you know. Yeah, I'm anti-vaping and anti-smoking. And I think that's, I think any most public health professional would say that. And, you know, yeah, I'm not going to get to the details of, you know, transitioning off of smoking. If going to vaping helps, that's good.

35:31But, you know, try to work off everything. Vaping is not as bad as smoking, but it's definitely not a sort of harm-free activity in your mind. And so after that, it's physical activity. And that also is a choice. And I think, you know, physical activity, you know, it's best if it's moderate to vigorous so that you're sweating. So if you go for a light walk with a dog, it's nice if you pick up the speed a bit. And I do think resistance training is important. Something where you are doing weight-bearing exercise. And some of that can be as simple as, you know, being in your own TV room, you know, standing up, sitting down, standing up, sitting down.

36:06So you're, you know, some of it's aerobic, but some of it is truly impacting, you know, weight-bearing exercise. And some people, as you said, go to the gym and lift weights, you can just be at home and doing push-ups. There can be things that - We talk about weight-bearing in quite a lot of different contexts. Why, and a lot of that is also, we often talk about with people talking about just sort of your quality of life, for example, that if you lose this strength, but why do you think it impacts your risk of these sort of heart attacks and strokes? How does the link between exercise and those.

36:36Yeah. I mean, we see a lot of that with age that as women become postmenopausal and men get older, you just naturally lose muscle mass. And so a 70 year old man can weigh less than they did when they were 55, but they're at higher risk because they've lost muscle and they've gained fat and, you know, they may look to get on a scale and weigh the same, but it's, it's all, it's more adipose and less muscle. And is the muscle helping with the heart? I'm just trying to understand, is it the muscle that's helping reduce the heart disease or is it something? Yeah, it's probably a lot of it's just the muscle because muscle pulls glucose out of the bloodstream.

37:15The muscle is very biologically active in beneficial ways. Obviously, muscle can help for lifting and not falling and other things like that. But it's not just that. The muscle is actively, it's really interesting you're saying. It's really active organs. They're active. I think that's a surprise for most people. Yeah, as opposed to just lifting weights. The muscle feels like a very inactive organ until you're, I'm moving my arms back and down. But I think most of us think about muscles very much as like a tool to move something. But you're saying you can actively help to sort of counteract these things that are affecting, forgive us.

37:47Very, very biologically active resistance training reduces your risk of diabetes and heart disease. And you're right, there's the group of 17 to 25 year olds or whatever that are doing it for whatever, physical appeal. But it's really when you get to your 30s, 40s, and 50s that people stop. They think about exercises. I got to go out and I have to go for a run or I have to go to the gym and get on a treadmill or whatever. And while you're at the gym, lift weights for 20 minutes. And I think that counts. And is there some shift? Does that mean that we're now, like science in general has got more convinced or more interested about the importance of muscle rather than just like doing exercise?

38:25Is that part of it? Because I do feel that what you're saying is going to be a surprise for a lot of people. And I think you're like, oh, it's sort of obvious. Everyone in science has known this for like the last decade or two, but often that's a bit the - Yeah, I think it's in the last decade. And my colleague, Imen Lee, is one of the leaders in the world in physical activity. And there are clear physical activity guidelines that say aerobic and resistance training and resist as you age that resistance training, that muscle building, or it's really just muscle saving in some cases. You don't think of a 70-year-old pounding weights like a 21-year-old because they want to have physical appeal.

38:58What you're trying to do is keep you from losing muscle mass because biologically, that's what happens. Your hormones shift as you age, and your body loses muscle mass. So you have to retain that to keep your risk down. So you talked about smoking and exercise. What else can you do? So then we talk about body weight. And body weight, I wish there was a switch that you could flip and say, oh, I'd like to lose 10 kilograms. And we saw over COVID how a lot of people gained weight. You know, here was this time where everybody was stressed and locked in their houses and probably eating poorly and doing other things.

39:30And a lot of people gained weight, present company included. And so I think that you can see how it can happen pretty fast. Most of the time, it's not the case. People gain a half a kilogram or a kilogram a year on average in their adult life. If you look at people in our cohorts, you know, we measure things in pounds here. But in our large studies, men were gaining a half a pound to a pound and women were gaining a pound to a pound and a half per year for 30 or 40 years. And that can lead to long-term risk. So the last thing I haven't talked about is diet. And that's the thing that has changed a lot.

40:05The science is so much better now than it was 30 or 40 years ago when your father was diagnosed with high cholesterol at age 22. too. And he probably told him to stop eating butter and eat margarine, which was partially hydrogenated vegetable oil, which probably did him much worse by doing that. And then he went on low-fat diets, as you said. And that was a terrible thing that this country did in the 70s and 80s and probably was spread out throughout the world, is people were pulling fat out of food, healthy fat out of food, and putting in highly processed carbohydrates, which I'm sure you have talked to many people about.

40:40And that - There's not a lot of people, nobody wants to put their finger on supporting that anymore. It's interesting. It's definitely one of those things where no one was ever in favor. But I know that the science, I think to be fair, right? Science was nowhere near as good then. And I think even now there are still some people that would say, no, no, no, you should have a low-fat diet. There are some people that do okay on low-fat diets. Low-fat diets don't taste good. And so most people can't stay on them for a long time. but you know i have a few friends who are vegetarians and don't add vegetable oil to their foods and eat 15 percent of calories from fat and and there's good science if you eat it the rest of your diet is healthy and you have low fat you can do it most people can't stay on it for more than three months or six months and i think we haven't talked a lot about personalization but that's something that zoe believes a lot in so i don't know is that something that you see at all in in your data um because obviously you're looking at a lot of these averages but you know do you feel like there's one answer for everybody or actually that there's likely to be more personalized?

41:36Yeah, I think you are leading the way in understanding personalized nutrition. And I think there is something to that. In our large cohorts, we've collected 100 ,000 bloods from women and 20 ,000 bloods from men. And we've collected stool samples from 20 ,000 women to get their microbiome. So I think we will be able to tease out that. And some of our early studies in the microbiome clearly show that, that some people who eat dietary fiber do have much lower levels of inflammation, but not everybody. And you can say the same for coffee. Some people have coffee had tremendous benefit and some people had less benefit.

42:13But in our larger studies, when we have the diet questionnaire and we don't have the poop of everybody and we don't have the genus of everybody, what we can look is at the average. And there are just dietary patterns that show up that people live longer. Clearly, they're at lower risk of heart disease, of cancer, of respiratory diseases, lower risk of dying from anything by being in these healthy dietary patterns. I think that we obviously believe it. I think the personalization is fascinating as you go to the next level equally well. I've yet to meet anyone who says, oh, some people don't need to do any exercise.

42:48So it feels like there's a range. I've yet to meet anyone who says, oh, I think some people would be fine on a diet of ultra-processed food all day long, right? So this is always about - I don't know anybody like that. I haven't yet to meet a scientist. Genetics won't help you with that. Know where your microbes, yes. But I'm really interested. Now, one thing that you haven't mentioned so far is sleep. Is there any evidence of sleep impacting heart disease? Yeah. I mean, the sleep studies that we have done is, some of it is like, if you take someone's body weight, you take someone's diet, you take someone's physical activity and they're smoking, that explains a lot of it.

43:23And if you plug sleep into it, there may be a small additional benefits. But I think some of the reasons that people sleep better or not is because they exercise during the day. They're actually tired. You know, they ate a certain diet that doesn't keep them up at night. So there's all these things we talk about are a little correlated. You know, if you have a lot of coffee at 7 p.m. at night and, you know, you drink five glasses of wine, that's going to impact your sleep. So you can see there's correlations that we try to tease out. And when we do tease that out, sleep is still important. I think it's important more for things like, we're just finishing a paper that's just going to be published on high blood pressure and diabetes.

44:04So I think some of the impacts of sleep are on more short-term factors that are risk factors for heart disease, but are measured more short-term. And some of it is that sleep differs every night that some people fluctuate in their sleep. And some people say, oh, you know, five, you know, a week ago I had one really bad night's sleep, but the rest of the time I was doing okay. So some of it is variability in sleep itself. And so I think, you know, we try to capture it, but I don't think we do as good a job of measuring people's overall sleep intensity than we do of their diet or their physical activity patterns.

44:35And so where does that, where does that leave you? Somebody's listening to this and they're sleeping very badly and they're having, you know, way less than seven to eight hours. Is that a risk factor for heart disease or not? Yeah. I mean, we do see that it's a modest risk factor of heart disease for people that sleep a lot less than seven hours and a lot more than eight hours. There's all sort of like excess sleeping. Yeah. And some of that just, you know, maybe the underlying reasons like why is someone sleeping 11 hours a day? And they may have other conditions that are leading to that. But yeah.

45:07So I think the question is, can you change that? You know, oh, I only sleep five hours a night. I feel fine. You know, should those people be taking something to help them sleep longer? I don't think we know the answer to that. There haven't been large trials where you give someone a sleeping medication and they sleep three hours longer. I don't know if that changes their heart disease risk. Okay. So I'm getting the message that it has some impact, but it's definitely like quite a bit lower for you than some of the other groups. And some of it is less studied. The intensity of studying sleep is much less than what we've studied for obesity, physical activity, and diet and smoking over the last 40 years.

45:41Got it. So then we may not have the level of data that understands it in as close a way. And I mean, maybe just to sort of wrap that up together, imagine somebody is listening to this. And I think sometimes, you know, it's easy to say all these things, but it can be hard in our busy lives. And I think it can also be hard if you have all of these patterns of behavior and where you are to say like you can really make a change. change. Do people have to solve all of this to change this? And I think you already mentioned weight, for example. I think all the evidence talking to lots of people is that reducing your weight is extremely hard.

46:19And we also see this with our own participants. Some lose enormous amounts of weight, other not so much for a lot of complex reasons. So I think that's one I think for a lot of people is like, well, I know that's really difficult. And are you saying, well, if you can't really make a difference to that, it doesn't really matter? Or actually, you know, if you can shift even one of these things, is that going to make a difference? Yeah, it definitely makes a difference. I mean, I think trying to shift any one of these things makes a difference. And for some things, you can flip a switch and you're changing it the next day.

46:49If you can say, I'm going to decide to exercise, tomorrow I'm going to start on a half hour day, I'm going to walk every day, blah, blah. So that's an easier switch to flip than say, tomorrow I'm going to lose 10 kilograms. Losing weight takes a while. And if you're losing it very fast because you're going on some radical diet usually means you're going to gain it back. Almost everybody who loses it very quickly can't keep it off because your body just takes six months or a year to metabolically adjust. In the field, most people now don't look at a study unless it's gone for a year or two to look at compliance, to look at long-term staying on the diet and to losing, keeping the weight off because most of the studies that were short-term people gain the weight back.

47:30And that's another way to say what really matters is sustainability. Yeah, so don't be frustrated. Nothing doesn't make sense to do anything which is short term and only makes sense to do something which is going to be a long term change in your lifestyle. Right. You have to buy into it saying, okay, I realize I'm going to make a change. I'm not going to get order out food three times a week that's highly processed and chips and whatever. I'm going to make a change that this is important to me. So I may spend an extra half hour preparing food at home that's healthier, dark green leafy vegetables, that's fruit, that's healthier protein.

48:03So I think you have to consciously make that decision because it's not going to be magical for losing weight. Amazing. Eric, can I ask one final question? I think it's very exciting going through all of this. And I'm just curious, since we have you here right now, what are you most excited about in terms of sort of the research that you're working on now that you might maybe be coming back and talking to us about in the next couple of years? Yeah, I think, as I said, we know in general the healthy diet is beneficial. And the healthy diet is no processed meats, actually as little as possible of red meats and having sufficient amounts of whole grains and having plenty of healthy fat, vegetable fats and legumes, you know, beans and plant protein and, you know, coffee, maybe a little alcohol, polyphenols from berries.

48:48All those things are good. And, you know, reducing sugar-sweetened beverages, those things seem to be beneficial across all of our populations. But as you know, that is an average. That means if I take 300 ,000 people and look at those that have a lot of sugar-sweetened beverages and bacon and processed meats, they are at higher risk of diabetes and at higher risk of heart disease. Maybe there's some people that are a little less high and some people that are very high risk. And so how do we figure that out? And some of that is, you know, obviously the work that you're doing is trying to dig a little deeper, know about their genetics, know about the microbes that are in their body that's processing that.

49:27So I am excited about that because we are starting to see signals where we know people are slightly different and how do they respond, what I would really love is not only to see how people will respond, but can I give you something that can change? So if you really like coffee and 40 % of the people maybe don't respond and don't get the great benefits of coffee, you can tell those 40 % not to drink. But what would happen if I had a microbe that I knew that you could take and that microbe would take up residence and say, ah, it's now gonna do all the beneficial things for your coffee. So I think it's really both areas.

50:01It's understanding the science of who responds to who and then saying, what can I do about it? And I would love it if it's not a drug. You know, I would love it not to be like, oh, take this magic pill and then coffee would be beneficial for it. I would love it if we said, oh, that coffee will be really beneficial for you if you ate more whole grains and fed those bugs. So those bugs grew more and then you would get the benefits from coffee. So that's the passion for me is that I would like to take you, Jonathan, to say, here's what you need, here's what you're going to eat, and this is how it's going to change your overall health.

50:32No, I think that's, well, obviously, when you're talking about personalization and starting to understand also how this interacts with our micros and things like that is very exciting to me. I'm hopeful that that is sort of the next stage of our discovery. We're working on it. It's an expensive process and there's a lot of data to collect, but we have 40 years of data before this. So we actually have a lot of information we can use to help us understand. And I think it's amazing what you've been able to do with these studies from 40 years ago. And I think the big shift of what's possible now is this amazing way you can use digital devices to collect all sorts of things that just weren't possible, obviously, in the past and the ability to start to do a lot of tests on people.

51:10As you said, free living, right? Like actually in their homes. Yeah, it's not like organic free living chicken. In their homes, as we are those of us who are only going to be participants. You mean at home? All right. Okay. You know, because suddenly you get these results, which previously were only possible if you went into some like, you know, super duper lab at, you know, Harvard or - Then you only could do it in 20 people because you had to come into a lab and spend two days there. Too expensive. So I think that's very exciting about the next year. Eric, thank you so much. I would like to do a quick summary, which we're always doing.

51:37Just please let me know if I get any of this wrong. So I think we started off by talking about what is heart disease. And you had this brilliant analogy of like you move into your house in your twenties and it's brand new and the pipes are all fine and slowly over time it gets blocked and blocked and blocked. And if that completely blocks, you can have a heart attack and the same process can end up being one of the reasons that you have a stroke. And this is affected by things slowly over a great period of time, that it's a complete myth that women don't die from heart disease. It's actually the number one cause of death for women, which I was really shocked to hear about.

52:12And it feels like that comes from a lot of lack of study and assumptions, which we now know are wrong. And this is something that you look at a lot. And to be aware, there might be some difference in the way that women might report symptoms. And that might also be part of why it's been understudied. You said amazingly that even if you're in your 50s, you can still halve your risk of heart disease if maybe you haven't been making all the best possible lifestyle choices for yourself when you were to make a change, which is I think a fantastic story that it's not too late. There's hope. Yes. Which really cheers me up when I look at my son who like, everything seems effortless.

52:48He's like getting bigger every minute. Everything seems a lot harder at this point. And then you talked about what are the things that you can really focus on. And the first thing you said was like stopping smoking if you are smoking. And interestingly, if you have transitioned to vaping as a way to get out of this, that's probably better than smoking. But I mean, you said the data's not there, but I think you were pretty strong. You felt like this is probably not good. You should be really trying to figure out how you can get off that as well. Talked about exercise. And I think the thing that I was particularly struck by is how interested you are not just in sort of cardio exercise, but stuff that actually ensures that you either are growing your muscles or as you're getting older, maintaining them because it's been this big shift in science saying like these muscles are like active.

53:30They're playing this really big role in supporting your health. So stuff that therefore involves in some way lifting some weight, some resistance. So I think that was really, I think a surprise for me for a lot of people. your body weight affects your risk. So we know that it's really hard to reduce it personally thinking about like, what's your diet and how do you make sure that it isn't on that sort of steady increase that you described year after year that puts you at risk. Diet, and clearly this is all the healthy things that we talk about often. And then I think we talked a little bit about sleep and I think my takeaway was your sleep can have an impact.

54:06It's a bit lower probably than these other factors, but it's also a bit less studied than in the past. So it's possible that you may come back in a few years' time and revise this a little bit. Yeah. Did I get it okay? You did. I mean, I think the challenge is the healthy diet part. And so many people want to go on a fad, crazy diet because they heard someone talk about something and someone lost three kilograms in a month. And I think we should try to avoid that. We know so much about a healthy diet that the extremes usually only work short term. No. And I think that, uh, obviously as Zoe, we believe in this passionately.

54:42And I think one of the things we talk a lot about is the only good diet is one that you can stick with for a long period of time. And it's got to be one where, you know, it can't be so extreme that you can never eat things you want and it's, it's got to be sustainable. And I think best of all, if it can be personalized to you, that also means it's good for you. It's going to be much more supportive of you. Like it's easy. Cause I think a lot of this is about, can you stick with things? So we are sold there, Eric. Great. Thank you so much. I thought that was absolutely fascinating. And I hope we can get you back in the future to talk about the new research you're working on.

55:15All right. Great. Thanks for the conversation. It's a pleasure. Thank you. All right. Thanks. Thank you, Eric, for joining me on Zoe's Science and Nutrition today. We've learned that good nutrition is a powerful way to reduce our risk of heart disease. If you want to understand how to support your body with the best foods for you, so you can have many more healthy years to come, then you may want to try Zoe's Personalized Nutrition Program. You can learn more and get 10 % off by going to zoe.com slash podcast. As always, I'm your host, Jonathan Wolfe. Zoe's Science and Nutrition is produced by Yellow Hewins Martin, Richard Willen, and Tilly Fulford.

55:52See you next time.

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