[0:00] Welcome, my name is Dr. Warrick Bishop, I'm a cardiologist, an author and a keynote speaker. [0:06] I'm CEO of the Healthy Heart Network. I'm all about trying to help people [0:12] Live as well as possible. [0:13] 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. [0:26] This podcast is all about helping you understand blood pressure, weight, cholesterol and [0:32] for better health. [0:33] If you enjoy this podcast, I would be honoured 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] Hi, if you're interested in looking after your best cardiovascular health, if you're 40, 50, or even beyond, and trying to figure out where cholesterol fits in, what you should be eating, how to reduce your risk of heart attack, then you're in the right place. My name's Dr. Warrick Bishop, and I'm a cardiologist with a podcast and videocast station. And today, I have a special guest, Steve Fenton, who's a cardiologist as well, a preventative cardiologist, [1:12] spirit. He's also an author and today we're talking about his book, I believe it's his first book, [1:22] The 5CH lifestyle. Steve, thanks so much for joining us today. [1:27] My pleasure. Great to be with you. [1:30] So for those listening, this is part two. If you missed part one, go back and listen. We really talked about the gap between... [1:40] Appropriate care for cardiovascular disease, identifying people who are at risk, being proactive about [1:48] The way we define risk [1:50] rather than using [1:52] the standard risk calculator approach and accepting that people can have heart attacks and events. One of the things that we shared is a couple of stories. But why don't we start off... [2:03] this particular podcast with another story. And Steve, within your... [2:10] book here, you've got a chapter where Brad features a 47-year-old male. Would you like to just share that story before we kick into the rest of the book? [2:22] Sure. Well, Brad is a young man who died of a heart attack. [2:30] These cases, you know, are tragically common, but he... [2:35] did have a family history of coronary artery disease and he had a number of other risk factors, some of which were traditional, high cholesterol, [2:45] Um... [2:47] But some were non-traditional and things like being sedentary, not exercising, too much sitting, being overweight, [2:58] He had, I think, some inflammatory diseases. He had obstructive sleep apnea. He had quite a lot of risk factors. [3:05] And... [3:07] They weren't really recognized. This is a bit of a problem. So as I spoke in the previous episode, these would have been picked up with an awareness of... [3:19] the non-traditional risk factors so that's one of the things i have discovered in in my many years of experience that a lot of other things matter [3:28] in addition to traditional risk factors. And I've put these into what I have developed and published called a personal risk profile score. So it's a personal, that means it applies to only us. It's a risk profile score. I'm not predicting risk. I'm not saying this person's at risk. It's just trying to spread a blanket far and wide so that we don't miss people who could be at risk. And if they get three points on my calculator, then there's a recommendation to have a calcium score. [3:58] Okay. [3:59] And if they have 10 points, that's a very strong recommendation. I think this profile is a really important step forward in trying to think about risk, Steve, and I really applaud... [4:09] you bringing it together. And for those listening, trying to understand this in a little bit more granularity, if I could try and help and I'll get your help to explain it as well, Steve, we often think about risk. [4:21] with the obvious things, the [4:25] traditional risk factors, the obvious things. And Steve's talking about looking at the less obvious things or the non-traditional risk factors. So obvious things as you get older, your risk is greater. If you're a smoker, your risk is greater. If you're male, your risk is greater than a female until females get older. If your cholesterol is elevated, if your blood pressure is elevated, I think everyone listening is a little bit better. [4:47] And every man on the street knows that. But then there are things that are not quite as obvious that can increase your risk. [4:55] You may have heard of a particle that can float around in your bloodstream, carrying cholesterol called lipoprotein libel A. This is... [5:03] non-traditional [5:05] But it's significant. So there's a number of other things in there. Women who maybe have high blood pressure during pregnancy. [5:14] people of Torres Strait Island or Aboriginal extraction, for example, people with an ankle break or reflex. I'll invite you to speak about a couple of those, just so people know what they are, but the importance... [5:27] for those listening, is that just because you tick the boxes on the obvious or the traditional risk factors, [5:35] you've really got to look a little bit more [5:38] and make sure that those non-traditional [5:41] or those less obvious risk factors are not playing into the game. And things like saturated fat diets over a period of time, family history, all these things can have a significant impact. Do you want to just fill that in a little bit more, Steve? [5:54] Yeah, look, I'd love to. Look, I've always thought that the diet that you grew up with, [6:01] and the diet you had for the first 20 or 30 years of your life and beyond that is very important as a risk factor. That's not in any of the traditional risk factors. So you can have had a terrible life for 30 years, then you get married to a healthy partner, and suddenly your life changes and you're eating well and your cholesterol is normal, but it doesn't account for those first 30 years of damage. So a lifelong exposure to a high saturated fat diet I think is absolutely included. [6:31] in that personal risk profile score. What you were talking about with old P little a, that's really important. So that's a kind of... [6:41] concerning molecule that definitely increases the risk. We know that. Up to now, there hasn't been a treatment for it. So it's kind of been a little bit in the background. But [6:52] all we could do up to this point is lower bad LDL cholesterol but there are new treatments coming probably by next year so it's really important if people have a bad family history that they ask their GP to do an LP and see if they're in that group. You mentioned absolutely that the factors that impact on women specifically so gestational diabetes, preeclampsia, [7:22] increasing the risk of atherosclerosis, but you won't find those in any traditional risk calculator. Depression, social isolation, [7:32] being driven [7:35] believe it or not marathon runners there's a number of other things that increase the risk of atherosclerosis we're still learning a lot more about it but what i might do is at least reassure your listeners that that's not necessarily all bad news what we're trying to do is get them to be checked now if we check any population between the age of about 45 and 75 or 80 [7:58] In every study, there will be about 50% who have an abnormality, and 50% will be normal. And I find that really useful for two reasons. One is those who we've identified as having plaque are quite motivated. There's been studies on this. [8:14] quite motivated to make some changes with diet, lifestyle, and in certain cases where required medication. The other good news is if you've got a zero calcium score in your normal, [8:25] In my practice, I find that's very motivating to actually maintain or improve a healthy lifestyle and diet, to keep it zero when it's repeated because these things have to be monitored through life. They're just not a one-off and they should be repeated in my practice anyway every three to five years depending on the risk. High risk, I would do it at three years. I've had my fingers burnt waiting for five years. So I think if you're poorly controlled, five years is too long. But if you're healthy, four to five years. [8:54] there should be a repeat, assuming it's a low number. If it's a high number, then there may be other strategies required. But I would encourage your patients, your listeners, I'm sorry, to have a look at this on the 5chlifestyle.com webpage, and it's a free interactive tool, and they can get a feel for how many points they have. They might want to work with their GP to get the blood test and blood pressure check, perhaps. Yeah. Look, I think, like I said, [9:24] opportunity to bring those [9:27] less obvious so-called non-traditional risk factors into the equation of calculating risk is really important. So for those listening, that is the risk profile score on the 5CH website. So go and check it out. But while... [9:46] While we're on that roll, once we've now got some identification of who might be at risk, we've done some calcium scores. Let's get on to what the 5CHs are all about, Steve. [9:59] yeah well look absolutely um the five ch's are chops cheese chips chicken skin and chocolate and they are icons for food groups that are best avoided or minimized to try to lower your intake of saturated fat trans fats sugars and thereby lower your cholesterol so i've measured these things [10:19] For many years, and I've got people to stop, [10:23] all of them or for a while um or some of them and in every case there is a reduction in ldl when somebody targets one of those groups or subgroups um so [10:37] So they're the five CHs. I've got to ask on behalf of those listening who love chocolate, are you really down on chocolate? Is it really such a bad thing? [10:48] Because we see, I think, from time to time, articles that tell us chocolate's good for us. [10:54] Yeah, well, look, not all 5CHs were created equally. [11:00] Probably chocolate's not quite as bad as the chops icon, which is red meat and processed meat especially. So I would say if I was grading the 5CHs, the worst thing you can eat is processed meat. That's full of fat and other bad things. And I think there's general agreement on that despite controversy with diets. Red meat... [11:19] bad but to specifically answer chocolate unfortunately there's no palatable chocolate that doesn't contain some saturated fat or sugar [11:27] Yeah, okay. And so the best if you're going to have some is dark chocolate and small amounts and not too frequently. But there is some evidence that chocolate can be good for you. So I'm not telling people not to have chocolate or anything for that matter. But I'd make a couple of points. [11:45] When I recommend people starting the 5CHs, [11:49] I tell them, and this is the secret recipe, so it's just between you and me. The secret recipe is I ask them to do it for a miserable month. I say, this is going to be a miserable month, and I want you to largely be pesco-vegetarian and all fresh stuff, lots of vegetables, [12:06] whole plant food stuff, nuts, oats, but don't have the 5CHs to the extent possible for that month. And then we'll repeat your cholesterol level and we'll see how you feel. [12:17] Now, I would say well over 90% of people feel so good, they come back happy and they say they never felt better. Not in all cases, but the vast majority. [12:28] But they might say something like, but I really miss cheese or I really miss chocolate. And so we have to make allowances. This has to be sustainable. And I don't want anybody to be miserable. But the other key thing is, Morik, I don't... [12:43] Even in my high-risk patients, suggest they are 100% on this. So you dial up your percentage according to a risk. If you've got a very low risk, zero calcium, so you can be pretty relaxed about it. If you do it in that case, maybe try to do this 70%, 80% of the time. It gives you plenty of leeway. If you're at high risk, you've already had a heart attack, bypass, stents, [13:05] I'd recommend you try to do this about 90% of the time, but if you do that, that's 10% of the time you can break out. That's about 36 days of the year. It's not too bad. It covers birthdays, anniversaries, special occasions, holidays. [13:19] It's just a guide. My patients come back saying, I've just been to France and Italy, and I didn't do the CHs very well, and their cholesterol is high, and that's pretty normal when people come back from a holiday or a cruise or a holiday period. So it's just a balance. I think... [13:37] it's okay to branch out for people at moderate risk. Um, [13:43] But I think then you get back on track. It's the mundane Monday to Friday that you need. You know, instead of the ham and cheese sandwich for lunch, you go for a salad sandwich or you might go for sushi or something that's consistent with the CHs. And then there are some things in my book sort of that are a checklist. Now, checklist starts with CH, so I'm being consistent. But certain peanut butters will put up the cholesterol massively. [14:13] but most peanut butter you buy at the supermarket will put up cholesterol a lot and that's something that [14:18] you know, most people don't know coconut products, which are positively recommended on the internet a lot, um, are very bad for cholesterol. Coconut oil is a real problem. Um, um, [14:31] Thank you. [14:32] I was going to say, Steve, as I look through those CHs, and I'll just add this for those people who did get that moment of chocolate apprehension, Steve breaks that down really smartly a little bit later in the book where he talks about chocolate, not just as chocolate, but representative of a food group of these sort of snacks that might be high energy or high sugar. [15:02] lollies [15:03] cakes, pastries, sweet drinks. These are really quite disastrous, isn't it? As I look through those 5CHs, Steve, I really get the sense that your efforts and your selection of those particular products, including sort of processed meats, is to drive down saturated fat and sugar across the board where you can. And that just makes perfect sense. It ties in with everything [15:33] approach to eating as well. No, that's a great point. Chocolate is an icon and it really does focus probably even more so on the things you mentioned. Simple sugars, lollies, cakes, biscuits, banana bread, donuts. What I'm really concerned about, Steve, and this is the one that I always get angst about, is you've got alcohol in there. [15:54] So you've got champagne and chardonnay and I read this chapter with trepidation. Just share with us where your thoughts are about alcohol these days. Well, no, I certainly had you in mind when I read this chapter. [16:13] We've had dinner a number of times, Stephen. I enjoy a glass of wine with my meal, no doubt. Well, yeah, and I don't... [16:21] not enjoy it. But look, I think we just have to put it in a little perspective. There have been [16:27] There was a favourable study some years ago that showed that one glass of wine was... [16:32] positive, two were neutral and three was harmful. And there have been some other studies that maybe don't cast alcohol in quite the same [16:42] positive light as that one but it's a tricky business alcohol clearly does have a lot of pleasurable aspects for some people it's uh important socially and it's part of religious activities um you know it's a nice icebreaker and you know we have to put this in balance i just i guess the point is that most studies would say that three drinks or more than three [17:12] people have to decide themselves I guess you know about what a what a level is that's appropriate but it's healthy to have one or two alcohol free days a week I think that's probably good for the liver to have a little bit of a rest [17:27] One drink, you know, probably four or five nights a week is okay. One to two. It really depends who you are. But I think it's just something we have to be mindful of, that excessive alcohol does seem to have some evidence of not being so positive. But look, admittedly, it's up for some debate. [17:46] There certainly is more and more of this research comes through. The time that micellar will last is definitely getting longer and longer. So yeah, I'm trying to cut down and follow those sort of guidelines. I think it makes perfect sense. So we've talked about the 5CHs, but what's the 5CH lifestyle? Because it must be more than just food alone. Can you speak to that for a sec? Because that's a whole chapter in the book as well. [18:16] Yeah, look, I cover that in detail, and most things that I recommend start with CH. So exercise is super important, just to start that list off, and so I think that's called chin-ups. But we ought to be exercising. I'm a great fan of moderate exercise. We don't have to do marathons. We don't have to be the world's gold medal weightlifters. But what's really good are three aspects of exercise. [18:46] where we're getting our heart rate up, whether it's walking, running, cycling, swimming, [18:50] skipping every everything where you're moving is good resistance work so light weights bands that's obviously good for the heart it's good for osteoporosis and so on and flexibility so we're doing some stretching you can go into that in a whole lot of different ways and get to the same end point you get a personal trainer you can join a group you do classes i think pilates is fantastic for people that want to try it yoga has its enthusiasts so exercise i would say [19:18] is really important. I try to get people to exercise when they're doing that miserable month. And it's very positive, as you know, for mental health. Yeah. And so that's probably number one. Number two, closely behind it is stress reduction. So, yeah, [19:35] You know, it's a stressful world, isn't it? And, you know, we all have stress. The important thing is to recognize it and to... [19:44] um, [19:45] develop a program that suits you, an individual, to minimise it and [19:52] that might [19:53] include regular breaks it might include me time every week or every day uh it's it's i think very useful for people to try meditation if that if they want to do that i think that's an excellent thing um yoga includes a bit of meditation for people who do that [20:12] A bit of quiet time. [20:14] And so there's different ways. But I think some people have huge stress and need to... [20:20] and probably get a counselor or a life coach or a psychologist and help them out of that particular you know thing that's causing it but stress reduction i think for the heart is very important we want to be if we can a lot of the time relaxed and content and maybe we shouldn't be watching the news every night you know it's it's it's a stressful business watching the news so whatever it takes um [20:43] more laughter and less stress are good for the heart. Yeah, 100%. Look, for those listening, I completely agree with Steve here. My own practice is I use a... [20:59] an app called NewCalm, so if anyone's part of my [21:04] Healthy Life Network community, you'll get my weekly emails, my newsletter. If you look on there, I've got New Calm featured as an app that my wife and I use, which regulates brainwaves and allows you the experience of meditation without even being a meditation expert. I think exercise is good for stress, and I think sleep ties in as well. [21:34] top of my list i literally set an alarm for when i go to bed not just when i wake up so um i agree steve all that stuff is super important yeah no sleep was the next one on my list too it's super important happy relationships um ideally you know um [21:55] Feeling a sense of contribution and involvement, engagement, all of these things come into the 5CH lifestyle. [22:03] Your last chapter is taking charge and we've got to the end of our second podcast, but this is your chance really to wrap it all up and really inspire people to take charge and how that would look. [22:21] for your ideal patient and for an individual listening to this. [22:26] Take charge, Steve, and tell people how to take charge of their cardiovascular risk. [22:31] Well, I would like, I'd love patients to work with their family doctor, ideally, with the awareness on both sides of the information in the book. And if they start with the personal risk profile calculator and get a feel for their risk, and if they're indicated to plaque testing with a calcium score, then they're the starting points. [22:52] and beyond that it has to be individualized if they [22:57] either have... [23:00] plaque on the calcium score, or even if they don't have plaque but they've got a lot of risk factors, it wouldn't hurt them to be referred to a preventative cardiologist for a check. This is a disease that will probably kill them. And so why not get a check? We would do that for airplanes. We would do it for cars. Why not do it for our hearts? [23:22] Each year our heart beats 36 million times. That's a very hard number to accept. So it's a very important organ. [23:30] But for many years, we should give it a bit of a check. So that's the message. And then if you are at risk or even if you're not, you want a healthier lifestyle, follow those 5CH tips with diet and lifestyle, and you'll be a lot healthier. [23:45] So, Steve, there'll be people listening who might want to explore the website or want to get hold of your book. [23:52] How would they do that? Look, I'd be delighted if they did either. The book is available through most... [24:02] good bookshops, I believe, certainly through Dimmicks. [24:05] There are many outlets through the web. It's also an e-book. And if they go to the 5CHLifestyle.com, [24:14] um web page they can see all the different options it's like on amazon and goodreads and [24:20] Things like that. So it's widely available. And I'd be delighted if they read it. And I'd be even more delighted if it made a difference to their lives. [24:30] That's what we're here for, Steve. Saving one life, making a real and meaningful difference in someone's life is an absolute privilege, as it has been a privilege to share with you, actually. I really value it, so thank you for your time. For those listening... [24:46] Yeah, I'm pretty sure you all have got something that you can take away from this. As a wise, I really do appreciate you tuning in, listening, and I do value your time. So thank you for sharing it with me and on this occasion with Steve. [25:01] um if you've got any queries or questions drop us a note at info at dr Warrickbishop.online i would love you to share and i'd love you to leave a positive review that all that stuff sort of helps in this modern world as you're probably aware but until next time i 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 [25:29] 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, [25:38] check out www.virtualheartcheck.com.au. It'll give you information about risk, [25:46] And what else can be done to be even more precise?