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with higher blood pressure, higher measures of inflammation and worsening cholesterol profiles, all of which contribute to heart disease.65 Findings from multiple studies demonstrate that a lack of sleep causes raised stress hormone levels and activation of your ‘fight or flight’ system which leads to changes in your mental ability as well as causing strain on your heart. In addition to the direct impact, after a poor night’s kip your brain sends signals to make you hungrier, making you more likely to crave that sugary croissant or salty fried snack, which will compound the detrimental impact.66 As with most things in medicine it’s not about quantity but quality. Seven to nine hours a night is a general rule of thumb, but try measuring how long you sleep at the weekend without an alarm waking you the next day and being aware of how refreshed you feel. This will give you a personal indication of generally how much sleep you should be aiming for during the working week, too.

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      + Stress-relieving techniques As an adjunct to improving stress hormone levels and reducing inflammation, stress-relieving techniques and mind–body interventions including deep breathing exercises, meditation and yoga can have positive effects on heart health. It may seem slightly leftfield for a conventionally trained doctor to be recommending this, but actually mental stress has been shown in many studies to be a significant contributing factor to heart disease.67, 68 Stress activates the immune system to create an inflammatory environment as it perceives the body is ‘under attack’ and this can lead to oxidative stress that damages and weakens blood vessels. These same stress hormones can increase sugars in your bloodstream, which can impact fat production by the liver as well as cholesterol ratios. There are robust clinical reasons behind why one of the most effective lifestyle programmes for heart disease, the Dr. Ornish Program for Reversing Heart Disease, has an intense focus on stress-relieving techniques. We would all benefit from one of these in our daily routine and you can check the website www.thedoctorskitchen.com.

      + When we eat The timing of when we eat has been shown to have a significant impact on our blood sugar, cholesterol ratios and the overall impact on our heart health.69 It is an unfortunate and well-recognised fact that shift workers who experience regular disruption to their circadian rhythm (the rough 24-hour cycle that all our cells are aligned to) have a greater risk of heart disease, obesity, dementia and generally live shorter lives.70 However, there are certain practices that even shift workers can employ to mitigate the effect of cycle interference. Studying this population of workers has led to some interesting recommendations that even those who are lucky enough not to have to do odd working patterns can employ. As a guide, it has been suggested that night-shift workers should eat at the start of their shift (dinner) and at the end (breakfast) to minimise the negative impact of eating when their bodies should be asleep. This practice of ‘defining periods of eating’ to a rough 10–12-hour window (during hours that you are awake) has also been shown to have favourable effects on markers of disease risk.71–73 As a general rule of thumb, this practice allows cells of your liver, pancreas and gut to better tolerate the food you ingest so that it is less likely to cause blood sugar spikes and cholesterol imbalances which can affect your heart. It’s a simple guide that not only gives your gut a rest (allowing it to perform the numerous other functions it needs to do) and minimises disturbance to your important rhythms, but also it also discourages mindless snacking in the late evenings that most of us do out of boredom.

      These simple diet and lifestyle practices are incredibly powerful and accessible to the entire population. Combining these with the other chapters that demonstrate how to improve your immune system, balance inflammation and relieve stress produces a collective medicinal package that is so powerful in the fight against the biggest killer in the UK today. Our food and lifestyle are powerful tools that I encourage you to use, whatever your age for the optimal functioning of this principal organ.

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       Inflammation

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      It’s amazing how many times I see ‘inflammation’ as a concept coming up in different medical specialities as one of the potential causes of disease. It has almost become a unifying theory that links conditions of the modern world to our lifestyles. You might think I’m just talking just about the swollen ankle that happens after an injury, or the redness that surrounds a cut on the skin, but high blood pressure, heart disease, dementia, diabetes and mental health problems all have links to an imbalance of inflammation in the body at a cellular level.75

       WHAT IS IT?

      I see many products being labelled as ‘anti-inflammatory’ and I think there is a lot of misunderstanding about what inflammation really is. This chapter will give you more of a tangible idea about the role of inflammation in our health as well as how to tackle the problems related to an imbalance of this essential system.

      Inflammation is your body’s normal response to events that cause damage to cells, like an injury or infection. The process involves proteins being released in response to the damage and these proteins send signals to the cells of the immune system to come and help. This is usually a short-lived, adaptive response that involves coordination of many complex signals and organs.74

      The inflammation process is very important: without it our cells would not be aware of bacteria causing something like a simple skin infection, and leaving the bacteria undetected in our body could lead to an uncontrolled severe infection with significant consequences. Inflammation is critical for infection prevention and to keep the body alert. We have, in essence, evolved to be able to fight infections, and a host of other stressors to the human body, effectively and swiftly using inflammation as an important tool.76

      However, inflammation is meant to be a temporary, protective response. Whether that’s a reaction to a knee injury or an infection in your digestive tract, inflammation is essentially a big nudge to your body, letting it know something is not quite right and needs to be addressed swiftly. Inflammation is meant to be a short-lived process that resolves over hours, days or, at worst, weeks. However, what we are witnessing in modern society is persistent, low-grade inflammation over longer periods of time, also referred to as ‘meta-inflammation’.77 Today we have a number of seemingly small and insignificant stressors that create subtle inflammation over long periods of time and can manifest in a multitude of symptoms. These range from the subtle and vague, such as fatigue, lack of mental clarity and skin irritation, to the more pronounced, including pain, mood disorders and heart disease.78, 79 These symptoms will obviously overlap with other causes, but we are becoming more aware of the damaging effects of inflammation imbalance that is at least in part to be related to these and many other conditions.

      Examples of stressors potentially causing low-grade inflammation include excess sugar consumption, psychological stress, sedentary behaviour, accumulation of fat tissue and nutrient deficiencies (including vitamin D, Omega-3 and different micronutrients). Depending on our ability to tolerate these factors, the result can be low-grade meta-inflammation. This culmination of seemingly insignificant stressors can potentially tip us into a pro-inflammatory state, putting us at risk of the wide spectrum of conditions that inflammation is related to. This pro-inflammatory imbalance is what I will refer to as ‘inflammation’ for the rest of this chapter and what can be rebalanced with delicious foods and an enjoyable, healthy lifestyle.

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