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       Eat for your

       Heart

      If you’re tempted to skip over this chapter because you’re in your mid-twenties or early thirties and you believe heart disease is only something of concern in later life, think carefully about flicking past these pages. Heart disease isn’t something that suddenly becomes relevant as soon as we reach a certain age threshold. We build the foundations for a healthy or unhealthy heart in our childhood and we are starting to see the early signs of atherosclerosis (narrowed, inflamed arteries) in those as young as teenagers.³⁵ But rather than scaring you into booking a CT angiogram to determine the state of your vital organ, I want to show you how much control you have using your fork.

      Our heart is a complex machine that generates electrical energy to synchronously contract its muscles, pumping blood around our network of vessels. The blood contains vital oxygen molecules, as well as nutrients to feed every cell in our body, but the heart itself is desperately reliant on the same nutritional need. Micronutrients like potassium, magnesium and calcium are essential to ensure the contractility of this muscular organ that, hopefully, will never stop throughout our entire existence.

      If you hit the gym harder than usual and you’re dehydrated, or perhaps you haven’t had adequate nutrition prior to your workout, your muscles will feel stiff and generally fatigued. Feed yourself the right fuel, however, and you’re less likely to feel the negative effects of training. Our heart muscles are categorically different from the skeletal muscles in our limbs, but the general principles of feeding our muscle tissue still apply. It’s vital to ensure your heart is adequately nourished to perform its function throughout its lifetime and make lifestyle choices that nurture this beautiful, industrious machine. Thankfully, this isn’t hard, and the food you can enjoy is still incredibly delicious and exciting.

      It’s important to remember that the heart (like most organs) is incredibly resilient. As demonstrated by some impressive studies, reversal of atherosclerosis can be achieved with a lifestyle that encourages your body to look after itself.³⁶ A number of cardiologists have demonstrated, using both blood tests and imaging to look at the vasculature of the heart, that a healthy lifestyle can reduce blockages of the arteries.^{37, 38} This is absolutely groundbreaking and something not thought possible up until a few years ago. In fact, some lifestyle medicine programmes have become so effective at reversing cardiovascular disease that they’re now covered by American health insurers.^{39, 40}

      But rather than trying to just reverse heart disease, I want to focus on the habits that will prevent the life-changing event of a heart attack that happens to over 100,000 UK citizens each year. Yes, there is evidence to suggest that we can drastically improve post-heart attack symptoms with intense lifestyle changes, but the better and more effective aspiration is to prevent that stage in the first place.

       THE MEDITERRANEAN WAY

      The Mediterranean diet has been heralded as the most heart-healthy diet and evidence supports this. When we look at large population studies, it’s clear that a Mediterranean way of eating, that includes plenty of fruits, vegetables, good-quality oils and healthy fats, significantly reduces the likelihood of high blood pressure, strokes and heart disease.^{41, 42} A representative dish of how to eat with this focus in mind is my Roast Walnut and Squash Medley with Persillade (see here) or the Aubergine and Walnut Ragu (see here).

      We can analyse why this may be the case by examining the components of a Mediterranean way of eating. The focus is on colourful vegetables such as tomatoes, squash, lentils and dark leafy greens, which are fantastic sources of the micronutrients necessary for optimum cardiac muscle function.^{43, 44} The most extensively studied of these micronutrients include potassium, calcium, magnesium and co-enzyme Q10,⁴⁵ but there are a huge number of other plant chemicals found in the same foods that we still haven’t fully investigated the effects of.⁴⁶

      There are now over 30 years of data, including the results of the Lyon Heart Study, PREDIMED studies and other large research projects that all point towards Mediterranean-style diets and lifestyle modifications as being significantly more effective at prevention of cardiovascular disease than drugs combined.⁴¹ To put this another way, if you change your lifestyle and eating habits, it has a more powerful effect on your health than any number of medication combinations I can prescribe. This is simply not common knowledge among our population, nor medical professionals and, quite frankly, it should be printed on the front door of every cardiac unit and general practice surgery in the country. Considering the exorbitant cost of medications and interventions directed at preventing cardiovascular events that our healthcare system invests in,⁴⁷ there is simply no excuse for why diet education should not play a central role in healthcare. We do ourselves a disservice by not engaging in this conversation and it is where we need to direct our resources.

       NUTRIGENETICS

      If you happen to have a family history of heart disease, you may be thinking to yourself that your genes are your destiny and there isn’t much you can do about your ‘dirty DNA’. On the contrary: studies have shown that we are more in control of our heart disease risk than previously thought. Our genetic blueprint is inherited from our parents; this information is stored in every cell of your body and it is unchangeable. However, we can change the OUPUT of our genes by changing what we put IN to our system.⁴⁸ The ability to change the expression of our genes is a concept I introduced in my first book. Nutrigenetics, nutrigenomics and epigenetics are among a few novel science disciplines that focus their attention on the role of nutrients and bioactive food compounds in gene expression.⁴⁹ When I personally learnt more about this field, it revolutionised my perspective on just how important food and our lifestyle is.

      Once we begin to understand and believe in the power of environmental influences on the very foundations of our existence, it becomes clear why diet is one of the most technologically advanced treatments we have in our armoury against disease. When you consume food it ‘speaks’ to your DNA and this communication can either lead to an overall positive or negative outcome. By introducing colourful foods, nutrient-dense ingredients and good-quality fats (which all the recipes in this book contain) we not only provide micronutrients and proteins for heart function, but we are also changing the messages transmitted via our DNA.⁵⁰ Cardiologists are now warming to the idea that nutrigenomics has a role in their speciality and I see more specialists attending lectures in nutrition, engaging with me on social media and at talks, wanting to learn more. This area of research gives us further mechanistic information about why particular diets like the Mediterranean diet are so cardio protective⁵⁰ and I’m sure biomedical informatics will help tackle the complexity of this field.

      What we can be certain of is that the root cause of – and solution to – the clear majority of cardiovascular diseases that I see in the emergency department and primary care is manageable

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