**EP388: Red Wine, AI, Aspirin, and Time Restricted Eating**
**Dr. Auric Bishop:** Welcome, my name's Dr. Auric Bishop. I'm a cardiologist, an author, and a keynote speaker. I'm the CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes, someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, and cholesterol for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love.
G'day and welcome to my podcast and videocast station. I really appreciate you tuning in. Well, today I'm going to try something different. I had feedback from one of the people who regularly listen to my podcast that what I need to do is let you guys know what I'm going to be talking about, then talk about it, and then remind you again. In that process, I need to make sure I don't use doctor words and that I keep it simple.
So, with that feedback on board, today I'm looking to talk about red wine and its impact on cancer. I want to talk about the field of artificial intelligence and its role in particularly looking at coronary artery calcium and coronary CT angiography, helping in reporting that and its accuracy, and where it may be utilised in the future. I also want to talk about low-dose aspirin for colorectal cancer because it's come up for a number of years in respect of colorectal cancer, so I'd like to share some information with you about that. And last but not least, I'd like to speak with you about time-restricted eating, and that's where you create a small window in a 24-hour period, perhaps an eight-hour window, where you eat in that window and basically fast outside of that window. So an eight-hour window where you eat would be called an 8:16 because that's the eating period, and 16 is the fasting period, adding up to 24. If you fasted for 20 hours and ate only in a four-hour window, that would be a 20:4 restricted time eating regime.
So that's what we're going to talk about. As I said, we'll kick off with red wine and cancer, and I have a genuine deep discomfort talking about this because I really do enjoy a couple of glasses of wine most nights. I particularly enjoy one glass of wine with my meal, and if you're a bit like me, then when new research comes out telling us that there is no upside to drinking alcohol, it probably leaves you disappointed, a bit like it does for me.
Well, unfortunately, the science and the research is suggesting that alcohol is probably the third leading preventable cause of cancer. So it is a real deal. Moderate drinking, which in the past we used to think maybe had some health benefits, has probably lost that status. We now start to believe that there is no positive impact for any amount of alcohol. Although we do accept that red wine, for example, contains antioxidants like resveratrol, the problem is ethanol is a known carcinogen. The studies, and a good number have come out over the last couple of years, are showing us that even modest consumption of alcohol— and we're talking several glasses a day— are linked with increases in cancer rates.
Now, I don't have any extra granularity on that. I can't tell you what else is going on for those individuals. Are they people who drink an increased amount of alcohol in a lower socioeconomic group and combine that with poor food choices? I don't know. Is that people in a higher socioeconomic group with good food choices and still having the same problem? I guess at this stage, what I need to convey is that from the literature, there is no safe level of alcohol when it comes to cancer prevention or cancer risk. And I guess that means that you just need to be informed to make the decision for yourself that is most appropriate.
Well, I said the next thing that I would talk about is artificial intelligence and coronary CT angiography analysis. I'm not sure if any of you can visualize what a cardiac or CT coronary angiography picture looks like or a cardiac CT picture looks like. But you can probably imagine an x-ray of some sort, and you can probably appreciate that as you look at an x-ray, there really are distinct features which can be quantified, compared, and analyzed.
CT coronary angiography is the way that we inject contrast to outline the arteries and get these beautiful 3D reconstructions and fine slices of exactly what's going on with the heart and the arteries. Well, it turns out that if you train and give an AI program the resources it needs to interpret and read CT scans, it actually can do it. There was a trial relatively recently performed called the PACIFIC-1 trial, where they looked at comparing AI interpretation versus expert radiologists. It turned out that the AI actually had a higher diagnostic accuracy compared to humans, and it was particularly effective in high plug volume cases.
Now, I wasn't entirely sure how they got a gold standard for this and what they compared it to, but the conclusions of this particular study were that AI could enhance CT coronary angiography and certainly improve interpretation, particularly giving nice evaluations around the degree of narrowing. The importance of this is that I think we're going to see more and more of it. Indeed, it's quite time-consuming for a reporter like myself to do and report a full CT coronary angiogram. It actually takes a fair bit of time. The nice thing about AI is that with a powerful computer, it can be faster.
What's also really important is that an AI program for dealing with this sort of reading doesn't need to take a coffee break, a lunch break, or a toilet break. In fact, it doesn't even have to go home at night. So I can see that this technology will make its way into radiology and be incredibly impactful, particularly in terms of improving the sort of workflows and the ability to get films reported.
Now, I think what will happen is that these scans may well come to conclusions. They may say something is normal, and if it is, I suspect it's going to be very accurate that it is normal. But I think the flip side is that AI interpretations may then flag areas of concern, and this will be where an expert reader will provide an opinion based on what's being flagged by the AI program. Whether we like it or not, I'm pretty sure this technology will be implemented broadly very, very soon. It has an enormous impact on workflows, it will be incredibly cost-effective, and as far as we can tell from this PACIFIC-1 trial, also incredibly accurate. So keep an eye out for it.
Well, the next thing I said that I would talk about is low-dose aspirin and colorectal cancer. I'm speaking specifically about Phase 3 of a particular trial called the ALASCCA trial, which is an aspirin in colorectal cancer trial. In the ALASCCA trial, it turns out that aspirin actually reduced recurrence by 50-odd percent in individuals who had a particular mutation as part of their colorectal cancer. That mutation was a phosphoinositide 3-kinase mutation. You don't need to remember that, but it's good if you know someone in this space and could be impacted by this that they at least ask what sort of mutation is going on.
The recurrence is just staggering. So if you were someone who had this particular mutation, you would be, well, inappropriately treated if you weren't on aspirin. It seemed to improve disease-free survival in some other subgroups, but that particular group with that mutation really benefited amazingly well. This is really speaking to how we're going to be starting to incorporate our understanding of genes and gene manipulation more and more as we progress with our understanding of medicine.
This particular study was quite robust. They looked at over 600 patients across Europe in multiple centres and really demonstrated this significant response to aspirin, which is really a very low-cost intervention with quite a dramatic impact on recurrence. Now, there is a little bit of data about primary prevention, trying to stop colorectal cancer in the first place. This data is not anywhere near as clear, and in this situation, we're talking about people who've already got the cancer, they've had the cancer removed, and the mutation associated with that cancer has been evaluated and identified.
So it's slightly different in a very specific group, but really, what an amazing opportunity to think about what the future may hold as we become wiser and wiser about the particular mutations that may be involved with specific cancers and what we can do about it.
Look, the last thing I was going to talk about is time-restricted eating. I'm a little bit of a fan of that because I embrace time-restricted eating myself. I tend to eat maybe in a two or three-hour window. I probably eat from somewhere around 5:30 or 6:00 at night and stop eating by about 8:00, probably 8:30. So what's that? 5:30 to 8:30? We're talking three hours. So I probably do something in the order of a 3:21 or 4:20 time-restricted eating pattern.
This particular paper on time-restricted eating and belly fat therefore caught my attention. The study looked at about a 12-week period where people embraced time-restricted eating, and what they were looking at was the impact on belly fat, or what belly fat represents is visceral fat. Visceral fat is the term used to describe the fat that wraps around our important organs.
So what this particular study did was look at time-restricted eating versus not in a control group when it came to belly fat and visceral fat. It turns out that the time-restricted eating group actually showed quite good weight loss compared to usual interventions for weight loss strategies. Certainly, time-restricted eating seemed to show better glucose control and reduced subcutaneous fat.
What's really interesting, though, is that although that subcutaneous fat around the belly seemed to reduce, that didn't correlate with the time-restricted eating being better than standard weight loss therapies for reduction of visceral fat or visceral adipose tissue. Now, I didn't know how to interpret that because it struck me that if you're losing tummy fat and your belt is coming in, then there's a very good chance that you're changing the metabolic profile, improving insulin sensitivity, I should say.
Because that weight around the tummy, normally that central adiposity, the belt going out is normally associated with the sort of pre-diabetic metabolic processes which drive and are associated with visceral adipose tissue or visceral fat. So it intrigued me that this study showed improved weight loss and better glucose control but didn't show a reduction in visceral adipose tissue. And partly, I think that may be related to this study actually only running for 12 weeks. That wasn't long enough.
I'm not 100% sure. I think if you were looking to reduce visceral adipose tissue or fat around your organs, you would probably consider time-restricted eating, but you'd combine it with exercise and good food choices.
So that's going to do me for today's podcast. As I have had the feedback, I'll just remind you that we talked about red wine, and it doesn't protect you against cancer. In fact, even moderate alcohol intake can increase the risk of cancer, and there is no level of alcohol consumption that we believe is good for you. Almost certainly, we're going to see AI come into play for more and more diagnostic roles.
We have shown already, and I talked about today, that cardiac coronary angiography can be undertaken effectively and with even better accuracy than skilled readers. We talked about low-dose aspirin and how exciting it could be that for certain individuals with a specific mutation, aspirin has an incredible role at reducing the recurrence of colorectal cancer. Really fantastic information and such an exciting future to look toward.
And lastly, we talked about time-restricted eating. It's good to help you lose weight and good for your sugar control. There is a question about whether it helps with visceral adiposity or fat around your organs. So combine that with sensible food choices, exercise, and connecting with those you love, and you will live a long and happy life.
For now, I'm going to wrap up. I hope you enjoyed that. I've probably gone a little bit longer than usual—about 17 odd minutes. I hope I haven't worn you out. If you have enjoyed it, drop us a note at info@drwarwickbishop.online and perhaps suggest some other topics I could cover. If you do like this podcast, please share it, and please subscribe. I'd be super grateful for you to do that.
Till now, I am going to jump. I am going to wish you the very best. I do hope you live as well as possible for as long as possible. Take care and bye for now.
Did you know that coronary artery disease kills one in four people? So most of us are likely to carry some risk or know someone who does. If you're interested in finding out more about how to evaluate that risk, check out www.virtualheartcheck.com.au. It will give you information about risk and what else can be done to be even more precise.
