[0:00] Welcome, my name is Dr. Warrick Bishop. I'm a cardiologist, an author and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people [0:12] Live as well as possible, for as long as possible. [0:15] heart disease is huge in Australia. [0:18] 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, cholesterol and weight. [0:32] for better health. [0:33] If you enjoy this podcast, I would be honored for a five-star review. [0:37] you can share it with your family and friends. It may well save [0:41] someone you love. [0:42] G'day and welcome to my podcast and videocast sessions, Dr Warrick. [0:48] Thank you so much for tuning in. I've got... [0:53] A couple of things I'd like to cover today. For those who are on pod... [0:59] then you just get to listen for those who are checking this out on video. [1:04] or YouTube, you get to see a few slides. So I'm going to share my screen and you can have a look at what we're going to be talking about today. [1:14] Um... [1:16] There's a couple of things I want to cover. All pretty straightforward, but a couple of important things that do crop up. [1:24] We're going to be covering... [1:26] Sugar? [1:27] fish and fasting, and what some of the latest research is showing us. [1:34] So let's start. [1:36] with sugar. [1:38] Um, [1:39] sugar-free drinks. [1:41] generally thought to be better than sugary drinks. We all know that. We think more fish is better than less for optimum health. And you will have heard me talk about intermittent fasting, improving metabolism, and even helping with weight control. So we're going to start with a couple of [2:03] common beliefs, sugar-free drinks are better, more, more, [2:09] Fish is better than less and intermittent fasting has got to be a good thing. So let's look at some data that's come across my desk. [2:17] just recently. [2:20] Well, sugar-sweetened beverages are a significant component of the sugar that's consumed in the population. [2:30] really is widely consumed. And not only are we looking at the sort of sweetened beverages, the soft drinks, the kids, [2:40] may consume, but there's a lot of sugar in alcoholic beverages that adults will consume as well. And particularly when adults go to mixes, there's a lot of sugar in mixes. Something like tonic water, for example, is really high in sugar. You'll be surprised. Check the label. So sugary drinks are broadly consumed. They're very low in providing satiety and they have a very high metabolic load. [3:10] But there is something that's particularly problematic about them, and that's when they [3:14] add fructose as the sweetener because fructose is predominantly processed in the liver and fructose gets if you like almost trapped in the liver and drives bad production so glucose doesn't do this as much [3:32] But fructose. [3:33] the [3:35] Sugar from fruit and high fructose corn syrup, which is almost a waste product, [3:42] drives fat production. Sugar doesn't. [3:45] what happens with that fat production is the fructose gets caught in the hepatocyte. [3:51] And... [3:53] kicks off a mechanism to generate... [3:56] fat production and then fat accumulation. That results actually in tiny little globules of fat accumulating within the liver cell. [4:08] And as more and more of that accumulates, your liver can become fatty. Now you will have heard of fat. [4:16] fatty liver. This is a really big problem. As it gets higher and higher, it gets called [4:22] metabolic associated steatose, steatatic liver disease, M-A-S-L-D, or we used to call it fatty liver disease. And this has complications of its own. [4:35] Several decades ago, at least, one of the main complications of [4:41] Um, [4:43] One of the main drivers for liver cirrhosis was alcoholic liver disease. And then we saw hepatitis infection, chronic hepatitis infection, hep B, as a driver for [4:56] CIRROSIS within the liver. [4:58] currently these days. [5:00] The biggest driver tends to be fatty liver becoming a metabolic associated steatotic liver disease, progressing to cirrhosis. [5:11] And that's driven, really to a large degree, by too much fructose. The liver doesn't cope with it and converts it into fat. [5:21] It turns out that if you try and get around this by completely sugar-free drinks, that sugar-free drinks are not metabolically neutral either. They do appear to affect the microbiome and do appear to have an effect on metabolic risk of their own, separate to a direct sugar effect. [5:44] Well, what's the takeaway? Well, you really do want to reduce the amount of sugar that you consume per se. You certainly want to remove fructose, which is added to a lot of the confectionary type fizzy drinks and mixes that adults might consume. [6:14] best is to stay away from these sweet sugary drinks as best you can and maybe try just water. [6:20] Maybe even Nuke. [6:23] Let's move on to fish. We all know that fish is good for you. It's got lots of omega-3 oils, protein, and it's got real cardiovascular benefits. But we also know that it's not without risk these days. And it turns out the large fish are accumulating more mercury. And this is to do with exposure to... [6:44] toxins within the oceans. And the risks of mercury toxicity actually rise with consumption of these fish. [6:56] Currently, and this paper that has come across my desk to trigger this, the Europeans are recommending no more than two to three times per week for the large fish that could be accumulators of mercury. Tend to choose smaller pieces and balance off risk versus benefit. I'll add in there for those who are in Hobart or those who are interested and living in a place or location where [7:23] an IV clinic, an IV therapy clinic that many IV therapy clinics exist. [7:30] will offer chelation therapy. [7:33] Gelation therapy is using a particular compound that can be infused into the bloodstream [7:40] and literally draw heavy metals and toxins out of the body and help those heavy metals and toxins be flushed out through the kidneys. You may want to explore that if you think you're someone who could have been exposed to mercury through blood. [7:57] uh, [7:59] fish consumption, but also things like lead with petrol exposure or paint exposure, or even arsenic with old pipes. So maybe think about that. But sticking with the fishy advice, not too many times, be aware of those bigger fish being the accumulators of mercury because they're at the top of the chain. [8:22] Let's talk about intermittent fasting. I've covered this many times and it is an area of interest for me. It's one that I think is really valuable. And I'm an intermittent or time-restricted eater myself. But someone said, let's check time-restricted eating, but control calories. Now, what that means is they took a group of people. [8:44] who were eating a certain amount through the day, figured out what calories they were having through the day, and then... [8:53] bundled all those calories together into one meal. Now if I recall I gave these people that meal [9:00] Last thing at night. [9:02] Well, was it good, bad or indifferent? What turned out was that when the calories were unchanged, there was no major metabolic improvement whatsoever and [9:14] I guess [9:16] If you stop to think about that, it's probably not surprising. [9:21] If you're eating the same amount of calories, you're basically having three full meals. [9:26] And what my observation is... [9:30] when I've been time restricted eating is that I'll have a big meal [9:35] But it won't be as big as three meals through the day. So, [9:40] I think... [9:42] Okay. [9:43] One of the things that comes with time-restricted eating is actually a slight... [9:48] natural reduction [9:50] in the amount that you would eat, and therefore you might see benefit there. In this study situation, where they forced people to have the same number of calories through the study protocol, that benefit wasn't seen. Also, loading it at night means that their activity subsequent to the meal was reduced. Again, [10:12] less opportunity for benefit. [10:16] There were some small weight changes, but not as significant as you might expect. It hasn't really changed my opinion about time-restricted eating, and I still participate. [10:26] Thank you. [10:28] It may be that there's a component of the calorie reduction being most significant when it comes to time restriction eating. I'm not sure, but it falls out that way anyway, because you just don't tend to eat three, four meal equivalents at that nighttime or evening meal. [10:45] So... [10:49] probably when it comes to sugary drinks, when it comes to [10:56] Um, [10:57] fatty liver sugary drinks when it comes to [11:02] Um, [11:04] Ow. [11:06] choices around that when it comes to time-restricted eating and when it comes to fish with mercury it's worth having a bit of a think about some of these things as we look to incorporate the beneficial aspects of these particular interventions into our life. [11:21] I'm going to wrap up there. It's a pleasure to share. I hope you got some benefit out of that. I always enjoy sharing. I always value your time and thank you so much for joining me. I'd love you to share. [11:32] and follow and like. That's what everyone says on the internet these days, but I really would be grateful. Do it next time, of course, and I wish you the very best, and I hope you live as well as possible for as long as possible. Take care and bye for now. [11:45] 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. [11:57] If you're interested in finding out more about how to evaluate that risk, [12:01] Check out [12:02] www.virtualheartcheck.com.au. It will give you information about risk, [12:10] And what else can be done to be even more precise?