How to prevent heart disease, according to science | Prof. Eric Rimm

the number one killer is heart disease and what we found is that just simple things like uh healthy body weight exercise not smoking and a healthy diet 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 welcome to Zoe science and nutrition where World leading scientists explain how their research can improve your health today we learn about heart disease and how to prevent it in the US One in every five deaths is caused by heart disease How likely you are to develop it depends on a lot of things some of these like your genes you can't do anything about but many other risk factors are under your control I'm excited to have Eric Rim on the show to tell us more Eric is a professor of epidemiology at the Harvard Chan School of Public Health he's also one of the world's top 100 most cited scientists he conducts huge studies to understand the impact of food and Lifestyle on your risk of chronic conditions like heart [Music] disease Eric thank you very much for joining me today thanks for having me Jonathan great to see you it's a real pleasure and fun to be able to do this in person in Boston so we have a tradition here um which we always start with a round of quickfire questions can I tell you the rules sure so the rules are that you can say yes or no or if you absolutely have to you can give us a one- sentence answer this is very hard for professors but they do normally manage it are you willing to give it a go yes fantastic well that's a good that's a good start okay if I don't sleep enough does this increase my risk of heart disease yes see that wasn't too bad if my parent parents had heart disease am I at higher risk yes I'm approaching 50 have I left it too late to significantly reduce my chance of having a stroke or heart attack no very good news for me and for many listeners I know are the symptoms of heart disease exactly the same in women as in men no we'll definitely come back to that is it possible to reduce high cholesterol without drugs yes okay last one and you don't just have to say yes or no what's the biggest myth that you often hear about heart disease the biggest myth um one of them maybe what you said is that people think oh I'm already 50 years old there's nothing I can do about it now yeah I think the other one is that I'm on drugs now there's nothing I don't have to worry about it anymore and that you know there's drugs are just something you can take to help you but there's a lot that can still be done after you're taking medication so just taking drugs is not enough uh well taking drugs helps a lot but there's so much more you can do yourself after that to further reduce your Ben your risk sounds exactly like the conversation I have with my dad I have a favor to ask 63% of people that watch this podcast haven't hit the Subscribe button we want this podcast to reach as many people as possible as we continue our mission to improve the health of Millions so if you've ever enjoyed this podcast please hit the Subscribe button doing us a small favor really makes a big difference thank you so actually as as like um you know some of our listeners will know um my father was diagnosed with high cholesterol in his 20s so when he was um very young and as a consequence really just you know actually even before I was born so my whole childhood was very much influenced by the advice that doctors gave then um to my father about what do you do if you have um High cholesterol and so that impacted the food we had and um all of that was with the aim of reducing his risks of of heart disease uh so this is something that has definitely been sort of present in my life I also think sadly that pretty much all the advice he was given has actually made uh would have made matters worse rather than better maybe we just start at the beginning just really simply what is heart disease that's that is it's an intriguing question because when people think of heart disease they think heart attack is the the only form of heart disease but there's a lot of different forms of heart disease it can be a valve problem it can be where your heart just gets worn out from pumping and it can be the classic Heart Disease which is when you get atherosclerosis built up on the inside of your arteries and then a blood clot happens it clogs your arteries and doesn't allow oxygen to get to your your muscle which causes a heart attack so there's a lot of other things that we call heart disease but I think probably the main one that your listeners are worried about is am I at risk for a heart attack um the pump failure one which is called congestive heart failure is something that more and more people are worrying about um people that are overweight for decades and have high blood pressure for decades when they get to be 80 years old the heart gives up and it's not because there's a blood clot that stopped blood flow it's congestive heart failure your pump your heart is just not as good and efficient as pumping and so the essence of the heart attack is sort of like these blood these tubes of the blood is going through getting sort of more and more restricted until one day it gets blocked is that I always try to think of analogies of like and some of it is like you buy a new house and the drain in the shower works really well because the pipes are brand new and the water flows down and after years of stuff in your shower whether it be hair or dirt you know eventually it starts to clog up the outside of the pipe and that's kind of what happens with your arteries is that even you know heart attacks take a long time to happen so you can start in your 20s and your heart attack doesn't happen until you're 50 or 60 and and I think just to make sure I've understood this is not a quick process you're saying amazingly that even you know you can look in people in their 20s and already see the start of these pipes getting like blocked so it's a multi- deade experience yeah it is it's a multi- deade experience and most chronic diseases are of that nature but heart disease is one that I think that has been the best mapped out that you can see this over many decades and you can see it go faster among people who smoke a lot and you know sometimes people get signals you get a little bit of chest pain you feel a little pain down your arm you think oh I have angena maybe I'm having a heart attack and you can go in and see oh that person is 70% uded and included means 70% blocked yeah 70% blocked yeah sorry thanks no that's and so you know the the question is what do you do with someone like that you can put them on drugs you can go in and try to you know balloon them out or you can hey say you know you it's time for for you to change your lifestyle you need to stop smoking you need to lose weight you need to change your diet let's talk about things that we can do to help you and your your father probably had that whatever 40 years ago and some of the advice back then was not what we know now and we probably would give your father very different advice if that happened today and I definitely want to get into that just before I do you know there's a few other terms that I think I often hear um people use um one is cardiovascular disease and I guess I'm interest is that the same as heart disease and the other thing is people often mention stroke at the same time as heart attack could you just unpack that for me yeah sure I mean cardiovascular disease is everything in your vasculature and that includes stroke and so we talk about stroke or a heart attack or sometimes people get intermittent claudication where you kind of get that oclusion in your arteries in your legs and you start feeling leg pain and so and vascul is just like any tube that is carrying my blood is that there you go yes that's a good way to think about it and in most Western countries the US Canada um UK Australia the number one and the number three or the number one and number four cause of death is heart attacks and strokes so when we say cardiovascular disease we are talking about what most people die of in Western countries yes we know cancer is usually number two or number three in that group but cardiovascular disease really represents when you look at mortality you know pre-co and what people were dying of was what is heart disease and strokes and could you explain the stroke because I think you had this very nice explanation for sort of ultimately how get the heart how does a stroke fit in I think about that is like feels like it's something completely different and also feels like something that people worry about maybe more now than when I was a child while at the same time it feels like they worry maybe a little less about heart attack is there yeah and some of that is just our understanding of the causes of that and and so you mean they might have thought it was a heart attack and now they have a better understanding that maybe treated a little bit better and we're doing a better job of bringing heart disease rates down and a stroke is complicated because a stroke is not one thing a stroke can be you know a a a blood vessel in your brain bursting or a blood vessel in your BL brain getting clogged and those are both called stroke they're Different Stroke types but the causes of those two different types of stroke are quite different in Western countries most of The Strokes are where an artery gets clogged uh like a heart attack and it's like essentially a heart attack in the brain and you can't get blood through to the brain and parts of the brain die and that's why people lose function they loose they can't control the side of their face or other things happen when you have a occlusion we call an es schic stroke essentially means a blocked artery to the brain um at the other kind of stroke where the blood vessel bursts you know then you have essentially blood breeding bleeding in your brain which also can cause you know tremendous complications so for the stroke that you're describing you're saying where sort of most common if you're listening to this in Western Country it's it's again a blocked blood vessel this is the same process that you're describing it's just that ultimately instead of the um the vessel being by your heart it's in your it's in your brain something quite different it's it's how the cause of it is different um a lot of the es schic Strokes or blockage Strokes are where you have a clot somewhere else in your body and it travels up to your brain and and blocks because the arteries in your brain are a bit smaller than the big ones that take blood to your heart so it is a little bit harder to understand there's many different causes of stroke and some are short-term and probably some are 10 or 20 30 years of having high blood pressure and not treating your blood pressure or not changing what you do to reduce your blood pressure got it well I think as we talk about this be interesting to understand what can affect um you know just the heart attacks you're talking about and what can also be beneficial as we're talking about this broader cardiovascular disease and some of them are you know some of them are the same some of the same RIS risk factors you may have for strokes as you have for for heart attacks and some of them are different before we start to talk about those risk factors I actually just wanted to come back to this answer that you gave um right at the beginning about how symptoms for men and women were not exactly um the same and I know you've written a lot of papers actually looking specifically at Women's risks from um heart disease and it's a topic we we talk about on the podcast quite a lot about how in general um Women's Health has been really understudied in science um and in fact often historically maybe women weren't weren't even participating in studies could you tell us a bit about what those difference in symptoms are you know it's it's it is true you know angena which is sort of the early pain that you may feel is different in women and men and when you talk to cardiologists and um historically what they would say is you know they would downplay a woman symptoms to say oh I have a little chest pain oh it must be something else and the chest pain in men would be stronger or or just how they report it to the doctor you know some of it was like you it's a a female response to a clinician versus a male response to the clinician and the clinician's response to hearing those symptoms so some of it may be that they were actually closer than we thought and perhaps maybe the clinician was not taking it seriously because they've been told well you're not likely to have a heart attack because you're a woman based upon faulty data so that right and whether it was faulty yeah some of it was faulty data and some of was just Perceptions in in historical so now that I think that has changed a lot and there's a Much More Much Greater recognition by national organizations of heart disease and women and heart disease is still the number one killer of women so that's pretty shocking actually isn't it I'm not saying that everybody intentionally did that necessarily but yeah it's pretty shocking that if it's like the number one killer of women it could have been missed in this way um how much of that is from um I don't know if you know about how much of that is from like the lack of the studies and how much of it comes from maybe uh you know a lot of sexism and things that we would have had 60 years ago which hopefully is is a lot better today yeah historically a lot of it was we just didn't study women and you know some of the first studies really in the 50s and 60s were almost exclusively among men and so we studied men this is what happened and you treat men is because there were men studies it wasn't until the 70s and 80s and some of our work and some other work around the around the globe where people said oh we really need to look in a female population and you needed a really big population if you're studying 40y olds there's not a lot of women that have heart attacks when in their 40s so you really needed large populations so that was the other problem is that oh we have the Framingham heart study it has whatever 3,000 men and 2,000 women that just wasn't enough to see heart attacks you could see changes in cholesterol you could see these other things but it was you really needed to have studies that were 50,000 or 100,000 and now over time we have many of those studies in men and women and we can explain a lot of heart attacks just by seeing what people choose to do in their life and you know I don't want to shock the audience saying oh my gosh you know number one killer I mean there's 10 times more women that die of heart disease than die of breast cancer so 10 times more women die of heart disease than breast cancer so I'm shocked and I imagine that a lot of listeners well no one wants breast cancer or heart disease and part of it is that there's a lot of women that are diagnosed with breast cancer and we know how to treat it and the long-term survival among women that are you know treated with breast cancer is very good and what they die of is heart disease you know sometimes they get breast cancer again 10 or 20 years ago later or get some other cancer but a lot of what they die of is heart disease you asked me the question you know if your parents had a heart attack or had heart disease is that put you at risk for heart disease it does but do we know why well some of it is probably genetics but probably it if you're parents had bad lifestyle choices and it led to a heart attack they probably trained you how to do the same thing because you are probably ate poorly as a child and you probably didn't exercise much and you know you probably had all those other Lifestyles factors that your parents had that led to their risk of heart disease well that that makes sense and I think there's a a great transition to talk actually about the studies that you've been involved with and um I know that some of these studies are huge right like more than 100,000 people and as um again I think our listeners have sort of uh sort of discovered that's incredibly rare in science right most particularly things that are trying to understand things like nutrition you know they might be on 20 40 50 people rather than these enormous numbers so it's very exciting and I think allows you to do things that otherwise are really hard can you tell us a little bit about what you've been trying to figure out about heart disease and um and maybe we go from there sure yeah it's um again it's been exciting to be part of this research team for for so long with so many great people that have expertise in different areas but the true uh you know underlying reason to start um three of these studies was the nurse's health study one the nurse's health study 2 and the health professionals follow-up study the reason we started these studies was to capture information about Free Living individuals they were all in the US for these studies Free Living makes them sound a bit like chicken what no no no no no what what is a free living individual means they're not coming into a clinic they're not sick these were doesn't mean they're not in jail just want to clarify it okay general population they were they worked as professionals so there were nurses and dentists and osteopaths and people that worked in uh professional um uh careers but we were ask every two years we send them a very detailed questionnaire saying tell us about yourself and we have very careful ways of asking them about their diet and we've spent a lot of time figuring out the best way to ask someone about their diet but the strength of these studies is one is that people who are in these studies want to stay in them they want to re they respond every two years to a questionnaire which is amazing I mean a lot of studies that are done like this have a a questionnaire at the beginning and they just follow people just like tell us about yourself and then we just follow you for 20 years and you and we go back and look at what you said 20 years ago to see if we can predict who has a heart attack in our studies every two years we send them a questionnaire saying hey how's it going and we you know it's it takes them about a half hour to fill out and at you know in the middle of that is hey have you had any any Di nosis of any diseases over the last two years and that can be from you know benign breast disease to heart disease to stroke to you know I fell down and fractured my hip so it gives us the opportunity to then go back and look at all of the questioners that led up to that time to say could we statistically try to predict who had a heart attack who who fell down and broke their hips and do we have enough information to kind of draw statistical models to say ah these are the things that we can best predict in our in my case who's going to have a heart attack and we don't just trust them when they say oh I had a heart attack you want to go back and get their medical records and have you know we have a cardiologist that review them and go oh okay this is a standard definition this person clearly had a heart attack it's interesting 25% of the people report a heart attack and they really didn't have a heart attack we get the medical record I'm really surprised I would have thought that I could understand that some things are hard to tell but a heart attack in my mind you're like walking along and then suddenly you collapse on the ground and you know the ambulance is there feels like you'd know if you had a heart attack I mean well some of it is that like the details of how they worked it up wasn't enough for us to say it's a heart attack we say oh it's probably a heart attack but 5 or 10% of the people really probably just had too much onions for dinner they have had some chest pain and they want to tell us they had something so they write it down it's a heart attack we go back and get their medical records they say it's not a heart attack so it so there is you know we do if someone says they had bypass surgery everybody reports that properly because you don't accidentally have bypass surgery and not know what it is I have I agree that that I would you know things like colon cancer and breast cancer and some of it is we go back and get the medical record so we can figure out what type of breast cancer and all the other details from the pathology report but heart attacks really are are the enzymes elevated you know do we have these two or three other clinical things and we say okay it's a heart attack but the okay so you're able to really guarantee that it meets a particularly sort of tight clinical definition so this gives you a really accurate data to to look at and then the beauty of it is we can go back and look not just at what they told us 30 years ago when they started the study but also did they change anything over their life and most adults think about yourself whoever's if you're listening to this have you been doing the same thing since you were 21 years old or since you were 16 years old and most people have not you know some people maybe smoked for 10 years and then stopped some people used to exercise and then stopped some people didn't exercise had kids and then figured out how to exercise with their kids so all those things change your risk of having a future heart attack so yeah I'm thinking that drink a lot less than when I was 20 but I also have children so I sleep a lot less than when I was 20 so you know it's so we'd want to put those things into statistical model and I'd like to compare you to someone else who has done a lot of other those things similar but you know maybe didn't change their diet or maybe didn't exercise or maybe you know did sleep as well so it's not a clinical trial where we truly randomize people but since the studies are so large we have 240,000 women that we've been following statistically and medically for 30 or 40 years so there's a tremendous amount of information you know some of the women are now over 100 years old so it's I mean it is a lifespan and there are really important things you can do in your 30s and 40s that are important for I think it's a great example we talk about this quite often about like some of the challenges of really trying to understand human health is that um you're trying to measure people who live the same length of time as we do right so it's not like you sometimes meet scientists who are doing things on mice or something right and they can get these results really fast cuz mice don't live very long but you know ultimately you're interested in things that um happen you know towards the end of your life that really affect your your quality of life and that takes a long time so I think what's amazing is you know this study has been started such a long time ago so it's almost like you have this time machine right to look back on what happened and it's similar to um you know Tim's twin study in uh in the UK where again you know because it's 30 years old you get this amazing ability to look look back and this is what makes I think um sort of Science of human health much harder than lots of people realize who come from elsewhere because it's there's no shortcut to the time and nutrition is is one of the most challenging things to study some of is like what was available to buy in the 70s and 80s in terms of food supply is different so we have to take some of that into consideration there are times in just in the even Humanity that you know this was available back in the 70s ' 80s and it's no longer available or science has changed and now we have different types of food so we to the best of our ability we try to take that into consideration and nutrition is even harder than something like physical activity because physical activity you can do it or you cannot do it and there's obviously different kinds of way doing physical activity but eating we kind of all need to do that so if you suddenly stop eating something that means you're going to replace it with something else and that's the true challenge of studying nutrition and dietary patterns hi I want to take a quick break and share something new back in March last year we created this podcast to uncover how the latest science can help us live longer and healthier lives we' spoken to many leading scientists who are doing amazing research and over hundreds of hours of conversation we've uncovered key insights that have the potential to help improve your health if you don't have hundreds of hours to spare not to worry at the request of many of our listeners our team has created an amazing guide summarizing 10 of the most impactful discoveries you could apply to your life and as your for free simply go to zoe.com sfree guu or click the link in the show notes and please let me know what you think of it okay back to the show s right we've teased our listeners a long time so I think 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 you know about the risks for for heart disease so um there's been several studies that we've done in our pop in our groups of men and women and what we what we tried to do is suppose you just look at someone's choices in life like you know pretend someone even doesn't even go to the doctor doesn't give their blood doesn't whatever and 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 you know a healthy body weight um exercise not smoking and a healthy diet and in the healthy diet we put in a little bit of alcohol um 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 on women and 60 to 70% of heart attacks on men and that's you know the number one killer is you know heart disease so 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 Mak maybe taking medication for high blood pressure or high cholesterol even th those populations that make healthy choices can get rid of 60% of their risk of heart attack so just I just want to make sure go that 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 if you make a real change to your lifestyle you can really dramatically reduce your chance of having a heart attack that's amazing it's a you know three or fourfold drop in risk of heart disease and you know it's 50 to 70% of the heart disease that happens among people who are taking medicine you could get rid of if people exercised you know had had a healthy weight had a good diet and didn't smoke so just make sure understand let's say somebody's listening to this right now who's in their mid-50s um 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 the way we looked at it it was to just give people a simple score you know zero through five how many how many of these things do you do that are healthy okay and the cut off 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 you know two and a half to three and a half hours a week of 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 you know a zero if you didn't smoke you got a one so you can see it's in a in a healthy a healthy weight is if you have a BMI under 25 so these are just relatively simple cut offs and we were just counting people zero Z1 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 so it's and it's a beautiful very nice linear scale the more healthy things you have the lower your risk of heart disease and can you change that so so just to make sure I've got it you're saying you had this way because there's a lot of complicated data to make quite simple you gave everybody like a score between one or five basic was quite simple criteria it sounds like your diet it's like a one or a zero right and we know that over simplifi way simpli it's quite simple and you saw this enorm you say like a three to four time difference in likelihood of getting a heart attack from you know people with like Zero versus five um 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 change so maybe they were only scoring one or two and they went to four or five in their 50s and was that able to make a big change or now you're like uh okay it's a bit better but it doesn't really matter yeah no that's that is the most important question is like what can I do about it and 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 stated a one and people that went to a one from a one to a five like have the risk of heart disease they have the risk of heart dise so like don't ever it's never too late is really the message which is amazing message saying even in your 50 because I think many of us have sort of felt like it's all too late right you'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 half your risk of heart disease at that point if you are to make a um a set of changes yeah I mean that's and that's we have to generalize over everybody there I'm sure some people do better than other people because of what 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 having 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 the study if you follow people for 40 years you can watch them go through life and you know we don't know why they choose chose to go from a one to a five what is it that someone was LE 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 okay 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 leave live healthier and they could have the risk of having I think that makes sense it's funny I'm meeting someone tomorrow and he was explaining like he's going to the gym for like 2 hours tomorrow morning and I was like that's just the definition of not having any children in the house anymore isn't I was like just thinking I could imagine doing that in my 20s and uh I could see that once your kids are maybe like late teenagers on you can imag but otherwise it's obviously totally impossible right you can you know some people get exercise equipment at home some people saying you can't do any exercise but I I am saying you can see how there's a lot more opportun you know get a lot more opportunity potentially um particularly you know if you've had something like children and family responsibilities can make this very hard Tak 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 so there's a lot of reasons some of it's probably behavioral and stress and some of it is just the choices that they can sad actually to um to hear I mean we see saying we have an expert who studies trauma and PTSD and it's the same thing people who have early life trauma because they witnessed a violent event or other causes of trauma who then go on to have PTSD also have a you know 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 so I guess you you're able to pick up a lot of complexity um in this I think just before we talk about like what can you do and maybe dig into that in a bit more detail um one of the things you've mentioned is around um weight and I think um 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 um heart disease and um you know I think that for many of us this sort of affects the way they think about um things is that true um yeah there's there's no question that people of all sizes and shapes have heart attacks um and strokes and you know there there are a lot of other biological things going on among normal way people there's more adverse things going on on overweight and obese people obviously they're much higher risk of diabetes which put you at risk for heart attacks but you can get a heart attack while appearing to be you mentioned this sort of I know slightly arbitrary scale the BMI with a lot of questions about whether there 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 yeah I saw 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 and 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 their what we call healthy weight and they don't do anything else and they still have a you know elevated risk of of heart attack so so there's a lot of other things inflammation and lipids and high blood pressure that can go on among someone who's a you know healthy weight I um I ended up doing one of these body scans when I took part in one of our first um Zoe studies that sort of gave the the um the First Data that we used so this was about um five or six years ago and I remember the nurse was really shocked as she looked at the scan because um you know for those of you on AUD like I'm I'm not a particular big um would say you are quite yes um 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 uh in my belly and not everywhere else and um you know the nurse was really surprised because it was 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 um I was I was told I was well actually that's really bad like actually um it's not really like your overall weight which is so um important it's actually more where it's located and so in my case like 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 actually that's um that is a real risk factor that's some of what I described of men versus women is that women there would be 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 fatter on the liver or on the kidneys so um you know I think that does put you at modestly increased risk but there's probably lots of other things that you do that you know would help uh uh prevent that risk I you know it's I've changed my diet quite a lot since then so I'm I'm looking forward to rescanning I'm hoping that I will have managed to uh make some uh 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 it's good to have muscle you know throughout the body that helps with insulin sensitivity and and helps with a lot of other biological factors plus people have lower cholesterol so you know ER okay it's a br transition it's a brilliant transition to okay people have listened 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 um reduce that risk and I'd love to just talk through like what are the top things that um 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 you everybody who does smoke should try to find programs and so that may be that may be very obvious um and is vaping a really 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 longterm 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 fig the data but you're pretty negative we haven't been a to put so if yeah we we actually have a new study that my my colleague Hari travar is studying younger people that are in their teens and 20s and I 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 but that you know try to work offing vaping is not as bad as smoking but it's definitely not a sort of harm-free activity in your mind and so then 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 weightbearing 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 so your it's you know some of it's aerobic but some of it is truly impacting you know weightbearing exercise and some people as you said go to the gym and lift weights or you know you can just be at home and doing push-ups there can be we talk about weight bearing in quite a lot of different context why and a lot of that is ALS we often talk about um 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 um your risk of these sort of heart attacks and strokes what how does the link between exercise um and and those yeah I mean we see a a lot of that with age that as women become post-menopausal 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 get on a scale and weigh the same but it's it's all it's more adapost and less muscle is the muscle helping with the heart I'm just trying to understand is is the muscle actually is it the muscle that's helping reduce the heart disease or is it something actually was it separate from that to do with the ex yeah um it's probably it's probably a lot of it's just the muscle because muscle pulls glucose out of the bloodstream the muscle is very biologically active in beneficial ways obviously muscle can help for lifting and not falling and you know other things like that but but it's not just that like the muscle is actively it's really interesting say active organs they're active they're I think that's a surprise for most people as opposed toting weight the muscle feels like a very inactive organ until you're I'm moving my arms back and down but like I think most of us think about muscles very much as as like a tool to move something but you're saying you can actively help to sort of counteract these these things that are affecting give us very 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 to 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 you know I have to go for a run or I have to go to the gym and get on a treadmill or whatever and we why you're at the gym you know lift weights for 20 minutes I think that counts and is there some shift it does that mean that we're now like science in general has got like more convinced or more interested about the importance of muscle rather than just like doing exercise is that part of because I do feel that what you're saying is going to be a surprise for a lot of people you and I think you're like prob it's sort of obvious everyone in 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 IM men Lee is one of the leaders in the world in physical activ ity and there is there are clear physical activity guidelines that say aerobic and resist 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 you know pounding weights like a 21-year-old because they want to have physical appeal what you're trying to do is keep you from losing muscle M 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 you know keep your risk down so so you talked about smoking and and exercise what what else can you do so then 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 coid how a lot of people gained weight you know here was this time everybody was stressed and locked in their houses and probably eating poorly and doing other things and a lot of people gained weight prestent company included and so I think that you can see how it can happen pretty fast most of the time it's not 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 we measure things in pounds here but in our large studies you know men were ging 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 you know that's that's the thing that it has changed a lot the science is so much better now than it was 30 or 40 years ago and your father was diagnosed with high cholesterol at age 22 and he probably was said you know 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 lowfat 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 and that there's not a lot of people nobody wants to put their 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 the science you know I think to be fair right there were um um science was nowhere near as good then and you know I think even now there are still some people that would say no no no you should have a lowfat diet and you can there are some people that do okay on lowfat 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 a few friends who are vegetarians and don't add vegetable oil to their foods and eat 15% of calories from fat and and there's good science if you e the rest of the diet is healthy and you have lowfat 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 um I don't know is that something that you see at all in in in your data um because obviously you're looking a lot of these averages but you know is it like one do you feel like there's one answer for for everybody or actually that there's likely to be more person you know I think you are you know leading the way in in understanding personalized nutrition and I think there is something to that in our large cohorts we've collected uh 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 and you can say the same for coffee some people have coffee had tremendous benefit and some people had less benefit but in our larger studies when we have their diet questioner and we don't have the poop of everybody and we don't have the genin 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 you know lower risk of of dying from anything by being in these healthy dietary patterns I I think that you know we obviously believe 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 so it feels like you know there's um uh there's a range or that I've yet to meet anyone who who says oh I think some people be fine on a diet of ultr processed food all day long right so this is always about I don't know anybody like that I I haven't yet to meet a scientist gentics won't help you with that your microbes I'm really interested now one thing that um you haven't mentioned so far is sleep is there any evidence of sleep impacting heart disease yeah I mean the the sleep studies um 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 and if youd 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 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 700 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 sleeping sleep is still important it's I think it's important more for things like um we're just finishing a paper that's going to be published on high blood pressure and diabetes so I think some of the impacts of sleep are on more shortterm factors um that are risk factors for heart disease but are measured more short term and 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 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 sleep intensity than we do of their diet or their physical activity patterns and so where does that because it was quite complicated 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 7 to8 hours you know is that a risk factor for heart disease or not yeah I mean we do see that it's a a modest risk factor heart disease for people that sleep a lot less than 7 hours and a lot more than 8 hours there's all sort of like to yeah and some of that just you know may be 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 so 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 like has some but it's definitely like quite a bit lower for you um than some of the other it's study the intensity of of studying sleep is much less than what we've studied for obesity physical activity and diet and smoking over the last 40 years got it so then we may not have the level of data that understands it in as uh in as in as close um a way and I mean maybe just to sort of wrap that up together imagine somebody's um listening to this and I think sometimes you know it's easy to say all these things but um it can be hard in um in our busy lives and I think it also be hard if you have all these patterns of um behavior and and where you are to say like you can um really make a change do you see evidence that um like do people have to like solve all of this to change this um and I think you already mentioned weight for example I think all the um evidence talking to lots of of people is that um you know reducing your weight is extremely hard and we we also see this some of with our um with our own participant some lose enormous amounts of weight other not so much for a lot of complex reasons so I think that's when I think for a lot of people is like well I know that's really difficult I know 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 uh 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 if you can say I'm I'm going to decide to exercise tomorrow I'm going to start on a half hour day I'm G to walk every day blah blah so that's an easy easier switch to flip than say tomorrow I'm G 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 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 you know staying on the the diet and to losing keeping the weight off because most of the studies that were short-term people gain the weight back and that's another way say is what really matters is sustainability of what you do don't be frustrated don't nothing doesn't make sense to do anything which is shortterm it only makes sense to do something which is going to be a longterm change in your lifestyle right you have to buy into it saying okay I realized 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 SP spend an extra half hour preparing food at home that's healthier dark green leafy vegetables that's fruit that's healthier protein so I you know I think you have to consciously make that decision because it's not going to be magical for losing weight amazing Eric can ask one final question I think it's very exciting going through all of this and I'm just curious since we have you um 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 you know in the next couple of years yeah I think you know we as I said we know in general the healthy diet is beneficial and a healthy diet is you know no 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 all 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 the work that you're doing is trying to dig a little deeper and know about their genetics know about their the microbes that are in their body that's processing that so 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 would 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 microb that I knew that you could take and that microb would take up residence and say ah it's now going to do all the beneficial things for your coffee so I think it's really both areas it'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 this magic pill and then coffee will 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 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 you know health no I think that's um well obviously when you're talking about personalization and starting to understand also how this interacts with our micros and things like that is is very exciting to me and um I'm hopeful that that is sort of the next stage of of our Discovery we're working on it it's 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 and I think it's amazing what you've been able to do with these studies from 40 years ago and I think you know the big shift of what's what's possible now right is these amazing way you can use digital devices to collect all sorts of things that just weren't possible obviously um in the past and the ability to start to do a lot of tests um on people as you said free living right like actually in their um in their homes organic free living in as not as as we are those of us who are only going to be participants you mean at home all right okay um you know can suddenly get these results which previously were only possible if you went into some like you know super duper Lab at you know Harvard or um then you only can do 20 people CU they had to come into a lab and two days so I think that's very exciting about the Next Room Eric thank you so much I would like to do a quick summary um which always doing just please let me know if I get uh any of this wrong so I think we started off by talking about what is heart disease and you have This brilliant analogy of like you move into your house in your 20s 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 um a stroke and this is affected by things slowly over a great period of time that um it's a complete myth that women don't die from heart disease it's actually the number one cause um of death for women which I was really shocked to to hear about and it feels like that comes from a lot of like lack of study and assumptions which we now know are are wrong and this is something that you look at um uh a lot and to be aware there might be some difference in the way that um um uh women might report symptoms and that might also be part of why it's been under studied you said amazingly that even if you're in your 50s you can still have your risk of heart disease if maybe you haven't been um making all the best possible lifestyle choices for yourself and you were to make a change which is I think a fantastic um story that it's like it's not too late which yes which really cheers me up when I look at my son who like everything seems effortless he's like getting bigger every minute and like everything seems a lot harder you know at this point and then you talked about what are the things that you um you can really focus on and the first thing you said was like stopping smoking if you are smoking and interestingly you know if you have transitioned to vaping as a way to get out of this that's probably better than smoking but it's I mean you said the data is 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 definitely um talked about exercise and I think the thing that I was particularly struck by is how interested you are not just in um sort of cardio exercise but stuff that actually ensures that you um 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 they're playing this really big role in supporting your health so stuff that therefore involves um in some way lifting um some weight some resistance um so I think that was really I think a surprise for me for a lot of people the your body weight affects um uh your risk so we know that it's really hard to uh reduce it but certainly thinking about like what's your what what's your diet and how do you make sure that it isn't on that sort of steadying increase that you described year after year that puts you um at risk diet and clearly this is all the the healthy things that we talk about often and then I think we talked a little bit about sleep and your I think my takeaway was your sleep can have an impact it's a bit lower probably than these other factors but it's also a bit less studied um than in the past so it's possible that you may come back uh 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 the healthy diet part and you know so many people want to go on a fad crazy diet because they heard someone talk about something and someone lost a you know 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 shortterm and I think that uh obviously as Zoe we believe in this passionately and I think one of the things we talk a lot about is um you know the the only good diet is one that you can sick with for a long period of time um and it's got to be one where you know it can't be so ex cream that you can never eat things you want and it's it's got to be sustainable uh and I think best of all if it can be personalized to you that also means if it's good for you it's going to be much more supportive of you like it's easier because I think a lot of this is about you know can you 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 uh in the future to talk about the new research you're working on all right great thanks for the conversation it's a pleasure thank you all right thanks thank you Eric for joining me on Zoe 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 podcast as always I'm your host Jonathan wolf Zoe science and nutrition is produced by yellow hings Martin Richard will and Tilly fford see you next [Music] time

Channel: ZOE

Views: 163,355

Keywords: zoe, zoe podcast, gut health, ultra processed foods, tim spector, jessie inchauspe, gut health diet, ultra processed foods documentary, ultra processed food, heart disease, eric rimm, heart attacks, heart attack

Id: pAhaZlkXatM

Length: 58min 17sec (3497 seconds)

Published: Thu Nov 09 2023