The Food Medic - S3 E5 - Can you die of a broken heart?

Episode Date: August 6, 2019

Our guest today is ​Dr Nikki Stamp - an Australian trained cardiothoracic surgeon.Nikki is 1 of 11 female heart surgeons in Australia and is a sought after speaker for women in surgery and a participant of social media campaign #ILookLikeASurgeon. Her research includes mentoring and gender in surgery, improving the patient journey and outcomes after cardiac surgery and the way plaque forms in our arteries. She is also author of the book “Can You Die of a Broken Heart?” And is due to release her second book “Pretty Unhealthy” later on this year.On this episode we chat about women in medicine and surgery, the gender bias in cardiac medicine, how our lifestyle can impact our heart and what we can do to try offset that risk, and if you can actually die of a broken heart.This weeks listener question is “What foods can I eat to lower my cholesterol?” So if you’re interested to find out the answer stay tuned to the very end of the episode and if you want to submit your own question to the show all you got to do is ​tweet, facebook message or instagram DM your questions with #thefoodmedicpodcast. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Hello and a very big welcome back to the Food Medic podcast. I'm your host, as always, Dr. Hazel Wallace. I'm an NHS medical doctor and founder of the Food Medic, which is an educational platform discussing nutrition and other aspects of lifestyle in the context of health. Today, I'm not joined by anyone in the studio as our guest is based in Australia, but we will be Skyping her. So if the sound quality is a little bit different today, that's why. So our guest is Dr. Nikki Stamp, an Australian trained cardiothoracic surgeon. Now, Nikki is one of 11 female heart surgeons in Australia and is a sought after speaker for women in surgery and a participant of the social media campaign I Look Like a Surgeon. Her research includes mentoring and gender in surgery, improving the

patient journey and outcomes after cardiac surgery and the way plaque or atherosclerosis forms in our arteries. Her first book Can You Die of a Broken Heart has been released and translated into a number of languages. And her second book, Pretty and Healthy, will be released later on this year. I think you're really going to enjoy this conversation. But before we get into that, it's time to share this week's listener question, which is, what foods can I eat to lower my cholesterol? So if you're interested in finding out the answer, stay tuned to the very end of the podcast. And if you want to submit your own questions to the show, all you got to do is tweet, Facebook message or Instagram DM me your questions with the hashtag thefoodmedicpodcast.

Nikki, welcome to the show. Thank you so much for having me by the power of technology. It's very exciting. I know you are like my first international guest from afar. I've had people in the studio with me, but not physically in a different country. So this is very cool. No way. I feel very special. How cool. Okay.

So, well, I know a little bit about you, but I'd love if you could share with our listeners, like, who you are and what your background is. I'm Australian, as you can probably tell from my horrific accent, and I'm a heart and lung surgeon in Australia. And it's interesting because I'm one of 11 female heart surgeons in this country, which is about 5%, so very similar to the UK and the US. It's a lonely field for a woman. But aside from my day job, I spend a lot of time doing a lot of health advocacy, particularly in the realm of heart disease, because obviously it's something I'm very interested in. I do a lot of work for women in surgery, trying to, I suppose, iron out some of

the gender biases that we see in my workplace, but also in a lot of workplaces. So I guess that's me in a nutshell. Amazing. And the fact that you are one of 11 female heart surgeons in Australia is incredible. And like you said, I can imagine it can be quite lonely, but also very cool. So what made you decide to go into cardiothoracic surgery? Was it always the dream or was it something that you just like stumbled upon one day and decided this is for me? So I have a bit of a convoluted story to get to medicine and started when I was eight. I used to see a surgeon on TV, an Australian surgeon called Victor Chang, and he was working on a durable mechanical heart here in Sydney.

And I was just so taken with what he wanted to do that I told my mum at eight years old, very precocious, that when I grow up, I want to be a heart surgeon and finish the work of Victor Chang. But then I got waylaid as a teenager, which is, you know, standard teenage behavior. And when I left school, I really wasn't sure what I was going to do. I was going to become an accountant. But at the last minute, I was like, no, that is definitely not for me. I sort of had this revelation that I wanted to be a doctor. I went to medical school and I was always going to be a surgeon.

But I was actually going to be an orthopedic surgeon. And then I got given a rotation as a junior doctor in cardiac and basically I never left after that I just I really really love what I do and I pretty much have done since the first moment I sort of set foot into a heart surgery theater just I just love it yeah it's very very cool it's interesting that you were going to do accountancy because I was in the same boat when I was a teenager and then changed my mind very last minute. It's such a common thing. I sort of laugh, you know, it's quite funny that we're asked to make decisions about the rest of our lives when we're, you know, what, 14, 15. It's really cool

that, you know, we live in a time where it is a little bit easier, I think, to go through that motion of changing your mind. And, you know, for me, you know, it was a bit of a roundabout pathway, but I'm very sure I've wound up where I belong. Yeah, absolutely. I think I'm definitely on a roundabout pathway and still going around the pathway, figuring out what I want to do. So for most doctors and surgeons, like I actually don't really like this question because I'm asked it all the time and I'm sure you do as well, but I think it'd be really interesting for listeners.

But what I imagine one day to the next is never the same for you. But if you could kind of put a typical day-ish for you, could you share one of those? Like how you'd kind of start your day in the hospital, what else you'd do, and the types of things that you actually do in hospital will be really interesting for people. Yeah, you're absolutely right. I think in medicine, one of the cool things

is that there is no normal day. But I suppose a typical day for me, I try and exercise before work because by the end of the day, it is uh pretty much off the table i'm usually too tired or i'm too late and my day sort of starts somewhere between seven or eight o'clock um i do a ward round sometimes i have to go to meetings um and then i start operating on days i operate and normal in a normal day, I do two heart surgeries in a day because they

take quite a while. They take about four-ish hours minimum each. So in the course of the day, that's pretty much all we can get done. And then I do on-call. So I'm on-call about one in every four, every five days. And that's when things can kind of get pretty crazy. And I work in a transplant unit as well. So that's another thing that can just pop up out of the blue. But you know, I actually, I really like that. And I think with regards to my team, I think that we're all really geared up for those emergency moments. And that's a time when we can really shine and really step up to the plate and hopefully make a big difference in someone's life. I can imagine. That's incredible. And I mean, we spoke about

the fact that you are one of very few female cardiac surgeons, but also surgeons in general. And I think a stereotype still exists in surgery, and that is that surgeons are men. And in Australia, the US and the UK, only 12% of surgeons are female, despite the fact that now over half of medical graduates are actually women. Do you think this dated stereotype acts as a barrier for women pursuing careers in both medicine and surgery? I think that's absolutely the case, know and it is a really strong stereotype and it's held by our colleagues it's held by the public and you know it's really common that I'll spend you know say 40 minutes with a patient explaining to them what I'm going to do for them in surgery and and they'll say sorry when are we going to meet the surgeon and you go oh my goodness

it's not a slight on them it's what we've all been conditioned to believe. That's just the picture that pops into our mind. But, you know, that lack of role models, that lack of visible women in that role is important because you can't be what you can't see. And if you feel that no one has been able to pave that way before you, has gone through the trials and tribulations that might affect you more so than perhaps some of your male colleagues, then it's really off-putting. And there are lots and lots of different reasons why women don't pursue careers in some medical specialties, in medicine, in surgery, sexual harassment, bullying, work hours, inflexible work hours. I mean, not being able to access part-time training, all these kinds of things that are really huge barriers. And in a

modern time, they're also barriers for men. Society's changing and we all want to have a career. We all also want to have a life that may involve a family and it's really important that we start changing the places that we work in that are encompassing so many more people because that is the way we are going to attract the best and brightest and that is really the most important thing particularly for our patients yeah absolutely and there was a recent study actually that came out to say that female surgeons have better outcomes with their patients. Is that correct?

Just trying to think of it from the top of my head. Yeah, so there's a few studies that are really interesting with women surgeons, women doctors. There are some saying that women have better outcomes. Women have less complaints, patient complaints. There was a really interesting study from Florida, I believe, where they showed that women patients who had a heart attack, if they were treated by a female physician, that they actually had better survival. Likewise, readmission rates. There's a lot of data. And I don't think it's necessarily saying that one gender is better than the other. I think there's some interesting roles with regards to having a doctor who looks like

you is probably important, who can perhaps empathise with you and your situation. There's a lot more to say that women spend a bit more time with their patients and have communicate in a different way. So that's really important for our patients to be able to have someone who listens to them and is there for them. So there's a lot of interesting things to dissect there. But you're absolutely right. There is some really interesting data about the differences between men and women surgeons.

And your first book explores the differences between men and women who present with heart attacks and heart disease. And I think we often think of heart disease as a man's disease. And yet coronary heart disease remains the single biggest killer of women worldwide. And women are more likely than men to receive the wrong initial diagnosis. So why does this happen? Is it biology? Is it bias in healthcare? Is it a combo of both? And what are we doing to try to bridge that gap? You're right. There is a lot of stuff going on.

The Australian statistics is women are three times as likely to die of heart disease than they are of breast cancer. And I think it's twice as likely in the UK. We do think of heart disease, heart attacks as something that affects our dads, our brothers, even the men in TV shows, they're the ones having heart attacks, not the women. So the reasons are a bit complex. There's a lack of awareness. A lot of women don't know that heart disease is something they need to be concerned about.

There's a lack of awareness amongst healthcare workers. I don't know what it was like for you, but when I was in med school, we were never taught these gender differences in diseases. It was heart disease and it was for men and women, but the reality is that there's heart disease for men and there's heart disease for women. There's a lot of stuff around different biology, so heart disease that affects women can be a little bit different to men plus there are a few illnesses that we see pretty much exclusively in women

and some of them we see exclusively in young women we see different treatments and the treatments are not only that the treatments work a little bit differently in women sometimes they don't work as well women have more side effects to the medications that we give them. But we also know that women are less likely to be given evidence-based treatments if they have a heart attack. So if you go to a hospital and have a heart attack, if you're a man, you're discharged on all of the tablets that we know save lives. If you're a woman, that's pretty hit and miss, which is really concerning. And then finally, there's a real sort of delay in referral

to expert care so for my in my field you know like i say i work in a transplant center we don't get referrals for women for advanced therapy like heart transplant until it's really really late and that really affects their outcome so it's a bit of a i I always call it a perfect storm. There's so much going on there and it's really hard to kind of muddle our way through that. One of the most important things I think, though, is raising awareness because women need to know what to ask for and we need to demand good, appropriate, gender-specific healthcare.

And I think if we're empowered, we're empowered with knowledge, particularly to turn up to our doctors and say, listen, this is what I'm worried about, and this is what I need. I think that's a really important way of influencing all of those other things. Yeah. And not being afraid to speak up. I think anecdotally, not even that long ago, I had a patient come through with chest pain and she almost convinced me it was nothing because she was like, I'm just under a lot of stress or I'm just a worrywart and it's, you know, it's just anxiety. And I was like, I'm sure it's just anxiety.

And yes, she did have like full-blown MI happening and I didn't expect it because she was so relaxed about it and she was more concerned about what she had to do to get home to make sure she cooked the dinner in time and I think that also has a play like our roles and we almost feel like we're too busy to have a heart attack or ever be sick. It's so true there's a fantastic video that's made by the American Heart Association with Elizabeth Banks who I love I think she's so funny but she's you know having a heart attack and she calls the ambulance and they're like you know we'll be there in two minutes and she sits up and looks at her house which is the mess from

the kids and she's like no no can you wait a little bit and you know it's so true I don't have time to be sick you know if someone says to me you know said to me I had something serious wrong with me I'd be like no no no I've got things to do oh it's so so true and I'm sure that applies to men as well but it was just anecdotally I was like I need to share this um so I actually lost my dad to a stroke when I was 14. And while a stroke affects the brain and not the heart, the risk factors for stroke and heart disease are pretty much the same. And I wanted to chat to you a little bit about that and what people can do from a lifestyle point of view

to help protect the heart and their brain and their blood vessels as much as they can from these conditions. Yeah, you know, I just, I can't imagine, you know, that must have been just so, so difficult. And when you're 14, you don't, you don't have that rationalising mind that you have now. So, I mean, that just feel really, really heartbroken for you. They are linked conditions and we like to think of cardiovascular diseases as sort of a big umbrella thing because what we sort of tend to find is that someone who has disease in their vessel, say in their heart, it's not uncommon to have it elsewhere and that could be in their brain

which could lead to a stroke or in their legs which can lead to peripheral vascular disease. So they are really interlinked and there is a degree of preventability about a lot of these illnesses. And I think as you allude to, there also isn't. But even for people who have, say, a huge genetic risk, and I'm one of those people, I have a lot of heart disease in my family, you can decrease your risk very significantly by the lifestyle that you lead. And one of the things that I try to talk to people about is doing something that's manageable, because I find the information and the expectation that you're going to live this perfectly healthy lifestyle to be quite overwhelming. So one of the things that I'm really, really strict about is quitting smoking.

That is probably the single most important thing that you can do for your health. Exercise. And you don't have to be doing a marathon. You don't have to be doing the latest trend in exercise. Anything you can do, whether it's walking or dancing or anything, anything that gets you moving basically is good for you and even as little as a few minutes a day can be really beneficial to your health and of course you know diet is very important i think that's probably the one where people find the information most

overwhelming and most challenging but you know a diet that's, you know, lots of fruit and veg, lots of whole grains, you know, oily fish and nuts, those kind of healthy fats are things that we would like to see people take up and that's probably the way that we can all sort of reduce our risk. Then you have a lot of other stuff like, you know, managing depression. You know, depression and anxiety have effects on our cardiovascular health and managing our sleep

because poor sleep is also a problem. So there's a whole bunch of other things that we can do. But like I said, I think people need to look at a manageable way that they can live a healthy lifestyle rather than shooting for the stars straight away. Yeah, absolutely. But I think those few nuggets of information are really useful for people. And it's useful to hear that from someone who is very qualified to give that advice. Because like you said, there's so many different like snippets of information when it comes to various conditions online. And you often hear like slogans like heart healthy food and things like that. But it's not really individual foods that are going to future proof you from a heart attack.

It's really overall lifestyle. Absolutely. Absolutely. And like I say, you know, even if you live a perfect lifestyle, you can totally reduce your risk. You're never going to reduce that risk to zero. That's why I think, you know, having a manageable, achievable approach is actually more likely to get people to make some positive changes. Yeah. And I think at the moment, people, especially younger people, and I'm generalising here, but they are keen to tackle things through their lifestyle and they're almost like turning their backs on conventional medicine. But sometimes lifestyle measures are just not sufficient on their own when it comes to reducing risk or when it comes to treatment.

And medications such as blood pressure medications or statins are essential. They're necessary to help reduce that risk and help get people better. But there's so much scaremongering, especially around statins. And I wanted to ask you as a heart surgeon, is this something you experience? Is this something that your patients are concerned about? And what advice do you give them? I do hear this a little bit. I'm hearing it probably more often, particularly with statins, which have a lot of bad press.

And basically, statins, medications that lower your cholesterol, they've been very well established to reduce the risk of heart disease particularly people who've already had a heart attack or who have have high risk but they also have additional effects in addition to reducing your cholesterol they just basically make your blood vessels a lot more healthy i actually had this argument with my dad like my dad's an educated guy he's really smart but he got put on statins and he's been on blood pressure medication for ages and he started googling statins and all of a sudden he's like oh this don't feel right and feel sick it hurts does this and he was just being so just so wrapped up in google about it. So I actually just yelled at him.

I don't do that to my patients. I don't yell at my patients like I yelled at my dad. But, you know, I think it's really important the way we communicate with people to try and communicate that risk and trying to empower people to make those decisions for themselves. Now, I spend quite a bit of time with my patients to try and answer their questions, ask them what they're afraid of, what they're worried about. And for those people

who go on any medication, not just statins, and have side effects or have concerns, very often there are alternatives that they can tolerate a bit better. There are other things that they can do. We can start with lifestyle changes if that's what they want, as long as they're monitored. Lifestyle changes should be treated just like a medicine. They need to be monitored. They need to be done under the supervision of someone who knows what they're talking about.

I can't force anyone to do anything. And for me, it's really important to respect that patient's autonomy. But I also say it's my job to try and give them the correct information and listen to their concerns and try and help them work through that. But nine times out of 10, people will then say, okay, no, that's fine. You've answered my questions or you've told me enough benefit that I'll give it a try. And I think that's really the way we've got to start approaching this rather than being sort of adversarial about it and try and work with people to try and work out what exactly they're concerned about and work out how we can empower them, not dictate to them, unless it's my dad, dictate to them what actually was going to work best for them and their beliefs. Yeah, absolutely. And like you said, that goes for all types of medication as well. And it's our role as health professionals to be able to offer those risks and benefits and

allow the patient to make a decision. But I guess one thing that we're tackling that is a bit more new age is that we have like these little groups popping up here and there who are very passionate about anti this and anti that and it's not always grounded in science if at all no uh and it is really it is really hard and you know it seems like a benign thing to do sometimes to be into i don't know the first uh example that pops to mind it's unfortunately celery juice um because it's everywhere um but you know but it's unfortunately celery juice because it's everywhere. But, you know, but it's fine to be in that, but it can be a slippery slope from there. And if you start with something that seems really benign and then you kind of buy into that, it can result in you, you know, refusing or declining or whatever, you know, really important medical treatment. And I don't see that often,

touch wood. I don't see really blatant ignoring or not taking medication too often, but it is becoming a bit more common. And I find it really concerning and it's really sad. I don't want people to ever miss the boat to effective medical treatment. I think that would be a really, really sad event for that person, that family. And it certainly hurts us as health professionals as well. We don't want to see people suffer unnecessarily. No, that's very true. Now, your first book is titled, Can You Die of a Broken Heart? Which I've read and I loved, by the way. So for anyone who has experienced a bad breakup or lost someone close to them, I'm sure they can relate to that feeling

where you physically feel like your heart is broken. It's physically in pain. But can you actually die from a broken heart? Yes, but we're not going to, really, the short answer. Most of us will be fine. It was a really interesting question. It's a question I get asked quite commonly and uh you can i mean there's really really rare circumstances we do see it sometimes in more elderly patients and it's not because their heart stops because they're just so

devastated it is usually the emotional upset in conjunction with a lot of underlying, quite serious medical problems. So in that case, and that is actually a real genuine risk. And for people, particularly elderly people who lose someone, lose their, say, a lifelong partner, the risk of them dying themselves is really quite high for the first month after that. But then we have another sort of group, which is really uncommon, which is called broken heart syndrome or Takotsubo cardiomyopathy, which is a mouthful. But it is basically where you get some massive emotional event. And that can be, you know, the death of a loved one, it can be a natural disaster. I heard of a woman who was a lawyer who lost a really important presentation and the emotional shock of that causes this massive release of hormones, particularly adrenaline, that directly damages the heart muscle. And even though that's a very dramatic thing to happen,

it's very uncommon. But when it does happen, people generally recover from it quite fine. But for the rest of us you know that sort of horrible physical feeling when you've lost someone whether it be the breakup of a relationship you know pretty much we've all been there you know some of us more than others but when that happens you do still get this sort of hormone response where you release adrenaline and cortisol which are two really important stress hormones and they they do affect your heart, they affect your blood pressure, they affect your sleep, they affect your immune system. There's a lot of sort of negative physical effects that can happen. And then on the other side, you know, from your emotional upset, but also from some of these

physical things, you don't take care of yourself like you might normally do. You know, you might turn to things like drugs and alcohols, you might cut yourself off from other people. And those things then add to that physical side of heartbreak or grief or loss. When you have a difficult time, actually, the most important thing is to keep up those self-care things. And that's eating well, exercising, doing your best with sleep, which can be really hard. You connected to other people, being connected to other people releases a hormone called oxytocin, which I think a lot of people might know as the hug or the love hormone. And oxytocin almost directly opposes the actions of adrenaline and cortisol. It's good for your blood vessels. It's good for your heart. It's good for your sleep. So when we do feel bad, it does actually affect our bodies. And for me, exploring this phenomenon a lot more was a really interesting sort of deep

dive into how linked our emotional state and our physical well-being can be and why they're both incredibly important to take care of. Yeah, absolutely. It's so interesting. But I can't let you go without chatting to you about your new book, which is called Pretty Unhealthy. And this comes out September 2019, I think, if I'm correct. But can you tell us the concept behind this book and what inspired you to write it? So we're jumping the gun in Australia. We're getting it before, we're getting it in September. The UK and the rest of the world is going to have to wait till January. So I'm sorry. But it's basically a look at our sort of obsession with health and what I'll admit, which, you know, it's literally everywhere. We're so into exercising you know we run errands in our active way for

goodness sakes um so we're so obsessed with with being healthy or at least looking like we're healthy but we're actually not healthy we are sicker than ever we are subjecting ourselves to problems with this you know relentless pursuit of looking like we're living a healthy lifestyle and so this was a actually I got this idea when I was sitting in the lounge of Heathrow airport waiting to fly home from London I think last year or the year before and it just sort of struck me how how misguided our ideas about health were so this was a really, really interesting thing to write. It took me to some really weird places. It took me to some dreadful social media accounts. It took me to diets and exercise programs and psychology and eating disorders and a whole host of things that

I never thought I would be writing about as a heart surgeon. I got to talk to some incredible people who are really, I suppose, leading the charge for discovering what health actually is and how we can actually be healthy rather than just look like we're being healthy. And so I think it's going to be a conversation starter. I don't think everybody will like what I have to say, particularly if you're perhaps an influencer who maybe says the exact opposite of what I have to say. But I want it to be a conversation starter. I want people to actually be healthy, you know, mind and body. And I think that some of the things that I got stuck in really, you know,

are really important conversations. You know, what is health? What is health to me? What is it to somebody else? How can we navigate all this information overload that we've got? There's a lot of really interesting things that I learned and I hope that people really stop to think about their own health and prioritise taking care of ourselves. Yeah, absolutely. And one of the things that I always say to people, especially when it's online, is that appearance is not an indicator of health. And that does cause a lot of confusion. It brings up a lot of feelings because people will instantly go to kind of BMI or weight circumference and things like that. Like although those measurements do add into a picture when we

are putting the puzzle together, how someone looks in isolation means nothing to us. Absolutely right. And we're in a really visual climate at the moment. You know, Instagram, for example, is an incredibly visual medium and that's all we have to go off. So it's sort of no wonder that our judgments, particularly in a modern time, are really coloured by what we look like. The snippet, the tiny snapshot we see of somebody's life

that we make a judgment on. And we really want to step back from that. Yeah, absolutely. I mean, it's awesome seeing more and more credible and qualified health professionals using social media for sharing advice and it's how I met you and how I've connected with lots of other health professionals which is wonderful but sometimes it's hard to spot the fake doctors and experts amongst the actual ones I mean the medical medium is just one huge example but what's your advice for navigating the world of wellness?

It's hard. And it's hard because even people who are qualified, there are plenty of doctors who perhaps, you know, step outside their lane or give bad advice online, but, you know, all we have to go on is their qualifications so i suppose if i were to distill this down to really simple advice look at people's qualification it does matter if they are qualified to talk about what they're talking about then that's fine and that should be their area so you know a personal trainer you know perhaps should be giving nutrition information like i shouldn't be telling you how to run a workout. Who's telling you? Do they have a vested interest? Do they have a monetary arrangement with the information that

they're giving you? Is it out of left field? You know, if it's really in contrast to accepted thinking, you need to sort of raise that as a bit of a red flag. And I think the way they respond to questions, to being, I suppose, challenged on some of their information or ask for clarification is another thing for me, because people who have the goods to back up what they're saying, I think will be willing to engage in conversation or are able to say, no, here's where my information comes from. And I think if you're unsure, then you can seek out extra professional advice. And that's not always easy to do. Seeing a dietitian, for example, is not something that

everybody has access to. But there are a lot of really good online resources, particularly ones that come from good bodies like a dietitian association, a medical association, from government resources, for example, and nutritional guidelines. If they're sort of in keeping with that, then it's probably okay. If they're way out of left field, then you need to be really asking questions.

Yeah, I think that's good advice. And finally, I would love to know what practices you have in your routine to just look after your own health and how you balance it all because you seem to be doing an incredible amount while saving lives I honestly don't know I don't know how it all happens I really just it just happens some of the time I just I don't know I turn up and happen and I just turn up to the next thing um I am I am stupidly

busy though you're absolutely right. That's actually the thing that I would like to do better at the most. And one of the most important things for taking care of myself is actually learning to say no and really prioritizing. Sometimes it's prioritizing sitting on the couch and watching Netflix because that's important for my well-being. I think the thing that grounds me the most and makes the most difference to my health and well-being is exercise. I run. I'm not a great runner, but I like the challenge and I swim a lot and I'm a much better swimmer than I am a runner. And when I have those things regularly in my routine, everything else falls into place. I sleep better. I'm much more mindful. I eat a lot better. I'm much less stressed. But any exercise I can do, I really enjoy and I love. And on that note,

I'm going to head out early in the morning, tomorrow morning before work and try and get to at least half an hour or something in to make my day just a little bit better. Yeah, absolutely. And I mean, oh, I know what you mean when you have to drag yourself out of bed, even now it's summer in the UK and this morning I just sat at the edge of my bed and try to convince myself of all these other things that I could do instead of going to the gym. But once you get there, even if it's like 15 minutes, even if it's not the gym and you're just going for a walk, you absolutely do feel great after. Oh, totally.

And, you know, I've sort of, as I've matured and become a little bit wiser, if I go for a swim and it's the worst swim I've ever had, you know, even if I swim half of what I had planned to, I did something. And I'm getting a lot better at saying, well done you for turning up. Even if it wasn't perfect, you did it. And that's the most important thing. Yeah. Okay. So, I mean, this conversation has been incredible. It's been so nice to actually physically speak to you as well. Before you go, please do let the listeners know where they can find more about you because you have some really incredible posts on social media that I think will help a lot of people. So you can find me on all socials, on Twitter, Facebook, Instagram, at DrNikkiStamp. And my website is DrNikkiStamp or oneword.com. Amazing. Thank you for joining me today. And I'll speak to you soon.

Thank you so much, Hazel. So everyone, that was Nikki. I hope you found the episode informative. It was such a pleasure to be able to speak to Nikki. I've been following her for a long time on social media. I also have her book and I'm really excited for her next book. Now, before I let you go, it's time to answer this week's listener question.

So the question was, what foods can I eat to lower my cholesterol? Which in hindsight is actually really appropriate for the context of this episode topic. Now, as you would have heard from the episode, medication plays a pivotal role in reducing cholesterol. However, diet and lifestyle is also very important. So first of all, let's just bring it back to basics what is cholesterol? Essentially it's a waxy substance which is mainly made in the body but you can also get it through your diet. Now cholesterol is not all that bad and it actually

plays a vital role in the healthy functioning of the body including the production of sex hormones and fat soluble vitamins. However having too much cholesterol in the blood can increase your risk of heart and circulatory disease. The risk is particularly high if you have a high level of LDL cholesterol, which you've probably heard called as the bad cholesterol, and a lower level of HDL cholesterol, which you may have heard referred to as good cholesterol. So overall, it's in our interest to keep our LDL cholesterol which you may have heard referred to as good cholesterol. So overall it's in our interest to keep our LDL cholesterol relatively low and a healthy diet can help support that. Now there's some nutrients and foods which have been shown to support heart health

so I'm going to run them through with you now but it's important for me to say that an overall healthy diet is the best approach to have in general. So things like unsaturated fats which are often called healthy fats there's strong evidence suggesting swapping saturated fat for unsaturated fats can help reduce the risk of heart disease so foods that are rich in unsaturated fats would be things like oily fish, nuts and seeds and plant oils. Having a diet which is rich in whole grains so whole grains are grains which have not been stripped of their edder bran and original parts of the grain are still intact. So things like brown rice, wheat, rye, oats, barley, they can help reduce your risk. Dietary

fibre is also really important which you can find in all plant foods and this has the power to reduce your cholesterol. There's a particular fibre actually in oats called beta-gl plant foods and this has the power to reduce your cholesterol. There's a particular fiber actually in oats called beta-glucan and this appears to be particularly effective at reducing cholesterol. So having your porridge in the morning is a great way to get that in and obviously fruits and vegetables are also important for lots of reasons. Not only do they have fiber that we just spoke about but they also have things called polyphenols which are plant chemicals and they have antioxidant properties so they can help support your health there so i guess in summary lots of fruits of veg unsaturated fats whole grains and pulses lots of fiber some dairy and oily fish and less saturated fats and refined

sugars where possible but please remember no one food will cure or cause heart disease and an overall diet is what matters most. Okay guys hopefully that's cleared up some confusion and don't forget if you do have a question to please send it in and just use the hashtag thefoodmedicpodcast. That's all from me and I'll see you again next time.