I got a team.
It's Harps, it's the You Project, it's the new doc. We've got a new dock, a brand new doc. We've had lots of docks. We've got a new one. I'll introduce him in a moment. I hope you're doing great. I hope you Victorians survived the heat yesterday yesterday being what is today? Tuesday? It's today Wednesday, Doc, how's my brainer? I think it's Wednesday. It's Wednesday all day. So yesterday was the twenty seventh, of course. I hope you survived.
Hope you're okay. Today is a much more reasonable twenty seven or something like that, and the thriving metropolis of Melbourne. Bottom line. I hope you're doing all right. Thanks for joining us again, Doctor David O'Donnell, Hi, welcome.
To the You Project.
Thanks good to be here.
How often did do one of these things?
Like?
How often?
Now we love Kate save we both know Kate Saban love her, but she was you were intimating that she might be and I'm fully backing you a little bit bossy and she bosses has boss bostht of us around and she bossed you on to hear how often do you do something like this.
I'm speaking three or four times a week, but most of that is in person to groups, community groups, sporting groups, things like that. So podcasts probably once a month, you know, and if you listen to the radio, you hear me on the radio from time to time trying to get the message out how important heart health is. Anywhere I can get that message out, i'll talk. Give you up but a cup.
Before we dive into the specifics and the stories and the revelations around heart health, tell us your medical kind of genesis, like did you go grant where you ten going? I want to be a doctor, or did you go I want to be a race car driver. But if that doesn't work, I'm going to look at hearts.
So yeah, it's an interesting question. I was talking to someone on the weekend as a PA teacher, and I actually wanted to be a pe teacher growing up. Couldn't think of anything better when you're a twelve year old boy, the peach just the coolest guy in school. So I was I shouldn't call myself a failed athlete, but I wanted to be an athlete. Wanted to be a swimmer. Got to the point that swimmers weren't making any money
and doctors were making money. So I made a decision to quit swimming and become a become a doctor.
Has that never has that never been the It's always been the case. I guess a few swimmers have made though. How old were you at that stage when you went ah doctoring?
So this was just after year twelve, So seventeen eighteen. I was the honest Entrews. I was probably not going to make it. I spent a bit of time with the Institute of Sport and I said I should have been a rower, but I didn't like growing. I like swimming. Yeah, but anyway, so I was probably not going to make it, but I used that as an excuse for why I didn't make it. So got in a medicine and if you're doing medicine, there's nothing better than the heart. I'm
feel sorry for every other doctor in the world. You know, I get to deal with you know, you get to deal with something that's active, it's beating. It's fun. You get to do procedures, you get to operate, you get to save lives, you get to come into three in the morning and be the hero. But you also get to spend hours with patients trying to get them through real difficult times. So I have no doubt that cardiology
is the best specialty in medicine. But you'll have other doctors on here will disagree with me.
Well, I mean, the beauty is that we don't want everybody being in love with cardiology, then we don't have all the other areas covered, right, So I'm glad that you're like, if I'm going to see a cardiologist moving forward, which is every chance you're my guy, because I want someone who's skilled and good and knowledgeable and blah blah blah blah blah, but also actually gives a shit about what he does, and not just for the dough but
rather because you're passionate about that science and that work and that skill and that I guess do you? I mean, I think doctors obviously this is a dumb and obvious thing to say. But because you're under so much pressure, which so much demand, and you don't have limitless energy or limitless time, and I feel a little bit like
that at the moment. So I do generally five to seven podcasts a week and finishing my PhD in corporate speaking one hundred plus times a year and a bunch of other shit, right, And I'm like, I get to the point where I go, what's the best use of my time and energy today?
So how do you Because.
You could probably work twenty eight hours a day and still have more stuff to do, So how do you decide where your attention and energy should be?
Yeah, look, I probably ought to disclose that I'm only a doctor one day a week. Now I'm actually really I'm an executive. I'm CEO of Atvara Hartcare, which is Australia's biggest cardiology group. So I actually stepped back from full time clinical work, and I stepped back for a little bit of what you're describing. My practice was full. I had ten thousand patients on my books, couldn't see any more, absolutely jam packed full morning tonight. And yeah, I've got a nego. I thought I was doing a
pretty good job for those ten thousand patients. Each patient I saw, I thought I was doing a good job. Yes, hundreds of thousands of people in Australia who weren't getting care. So what I've really shifted my priority is how do we get care to more people? How do we get more people to look after their hearts. So rather than looking after one patient at a time, I'm trying to get a message out to hundreds and thousands of patients.
You know. And the mantra that I live with is improving Australia's heart health, not improving your heart health, Craig, that's part of improving Australia's heart health. But I would have improve the heart health of all Australians and that takes a different perspective. And you know, that's some of the stuff I'm doing there is working with Kate, saving bee Fitfood's, working with a Heartbeat of Sport, working with SISU, working with these groups to actually promote healthy heart behaviors.
Because at the end of the day, that's going to make more of an impact than I could make as an individual doctor. My mum was pretty upset with me. She thought that I should have stayed a doctor and kept operating and saving lives one by one. But yeah, I made the decision because I think there is something more we can do. I think it can have a greater impact. Sometimes by what you're doing, by you doing this podcast, you can have more of an impact than
you good Bye. Seeing four or five patients in the day. Yeah, yeah, I think.
For me, I like the fact that every time I chat someone like you, but we go into ninety countries and where you know, the audience varies, but it's many thousands a day, right, And I like the fact that I can, you know, with my guests, people like you who graciously give us your time and knowledge and experience, but share messages with thousands of people versus one obviously, And it's like, even with my stuff around human behavior and psychology and the mind and stuff, I love the
fact that I can teach people. I can teach five, ten, twenty thousand people one idea and now they all whether or not they do anything with it, operationalize it or not. Now they've heard about this thing called the false consensus effect, which is the fact that we think that other people think like us, which is problematic, right, And then they know, oh, and I go, by the way, you know, the only person who thinks like you is you. That's not bad
or broken, that's human. But when you go through life assuming other people think like you, there's going to be there's going to be some issues, but just that one thing, and people go, oh, I never even thought that. I never even think about how other people think theory of mind, right, and then you go, yeah, so you're just introducing them to like you're almost opening a new door in their brain for them to think about stuff which is relevant
for everyone, just like heart health health. It's not like, oh, this is only applies to twenty percent of the population.
No, this is one hundred percent.
So yeah, platforms like this, and you know, I'm a small fish, but you know I love the fact that.
We get to do that.
Yeah.
No, that's what makes a difference one hundred percent. What do you think the disconnect is between people hearing what we're going to talk about today, what they should do or potentially think about doing, why they should do it, you know what might happen if they do, what might happen if they don't, and them actually taking action or just gone great chat boys, Thanks see you later.
But then here I am being interviewed by a psychologist. You know, I should probably throw the question back at you, but you know, I've got a strong belief that patient engagement or client engagement is key to success. You cannot expect someone to follow your advice if they're not engaged in the way you're giving it. I often ask young medical students what's the number one skill of a cardiologist? And let's say, oh, you know, he has to be really good with his hand. You have to be able
to put a stent in. He has to be able to concentrate for twelve hours, he has to be able to interpret complex things. I'll tell you I think the number one skill of a cardiologist who is engage your patient. Yes, listen to the advice you're giving them. And if you can engage your patient and give them solid, convincing advice, then that's step one. Step two is make looking sure. I don't want to sound like alcoholics anonymous here, but step two is actually the patient accepting that they have
a problem. And we live in a world where you can go on YouTube, you can go on chat GPT, and you can find out that there's nothing wrong with you. You can find out that you're helping Your body age is anywhere from twenty to eighty, depending on which one you want to look at. So you can always get information that's incorrect or fuzzy or noisy, Whereas if you've got real information given to you by someone you trust and a series of strategies, then that's a huge step forward.
And again I don't want to go too much into psychology, but you know, we know a lot of doctors and I'm sure you've thought this or your willpower is not a strategy. Just telling someone you need to lose weight is allte of time. Everyone knows ne to lose weight. You look in the mirror. You don't need an anthropom more fixed, you don't need a dexascan. You know you're overweight. But what you need is a strategy on how you're going to do that. Not will power now will be vital.
You've got great willpower. I know that because you wouldn't do five to seven podcasts a week if you didn't, you wouldn't do a PhD. I've got great willpower, but my willpowers tested. Your willpower is tested. Now there's people who have a lot lower baseline of willpower. You've got a given strategy. So it's not about telling someone to lose weight. It's like, let's work through the five or six ways we can do strategies to do this one hundred percent.
And I would even add to that strategies, you know, timeline accountability, like having a plans. Great A lot of people chuck a plan in having a strategy good. But then, like my question to my clients and the people I work with, is can my action outlast my motivation and inspiration or discipline or willpower, because all that shit's temporary. Like, I'm pretty fucking disciplined, but I'm not always disciplined.
I have my moments, I have my weeks, right, But the.
Fact that I have created for me an operating system which is just interwoven with who I am and how I am, Like it's my default. So I don't need to you know, like I've never smoked a cigarette, I've never drunk alcohol in my life, I've never been high, all those things. I don't say that as a brag.
It's just my story, right.
But so because that's my natural, normal, day to day operating system, I don't need to find discipline, will power, strength, courage, fucking resilience to not eat shit and to not drink
booze and to not smoke cigarettes. And I think it's that how do we take it from I want to change my behavior and obviously my health outcomes and discipline and willpower and motivation and strategy is good, But what's better is when Eventually that just becomes my day to day process without having to think in inverted commerce.
Yeah, and I think you know you've you've touched on something I think is really important. That is, you've also got to be able to forgive yourself when something goes wrong. You don't one good one hundred percent of the time, because no one will be. I work on the strategy be eighty to ninety percent good all of the time is far better than being fifty percent good. You know, it's a New Year's resolution time. You see the number of people who are doing the hard reset on YouTube
or on Instagram. Don't do the hard reset, guys. The hard reset look It might work for some people, but generally it's about figuring out what are the five or ten things you can do that are going to impact you for the year. And one of the things I talk about is layering layer your habits, so you know, if you're trying to do exercise, yes, line up to go to the gym each morning, but also take the stairs at work and also go to the second closest coffee shop, not the closest coffee shop, go to the
second closest toilet in the office. Park a stop away and catch a walk in the last kilometer to work. So lay your habit so one thing doesn't happen in the day. You haven't ruined the day, you haven't set yourself back. You've got other things that you've done in the day. Because, like you, I've learned now I've been a doctor for thirty years. Your willpower just doesn't work. It does work for the first two weeks of January,
and it stops. It works when you make your resolution when you're sitting down at the beach, but as soon as you get back to the busy office, it disappears. So make sure you're putting the strategies that you can.
Finow yeah, one hundred percent, one hundred percent, and that you know when you think about I've spoken about this too many times, so forgive me audience, But when you think about.
You know, the ritual and the tradition of.
New Year's resolutions, and how like if we actually did some and then there's been kind of research done on it. But the people who actually achieve what they want to achieve, set out to achieve, maintain those results, and potentially improve on those results over any significant length of time is close to zero like, it's definitely less than ten percent. Now, if that was a medication, it will never get approved,
do you know what I mean? It's like, well, this is the idea of it's good, and it's kind of sexy and traditional, and it's cultural, and we're all familiar with it, and we all get a bit, like you said, a bit momentarily inspired, which is good inspiration, discipline or good starters. But that's the thing, is like, what can
you do when you can't be bothered? Because, as you said, you get back from the beach, Now you at work, different environment, different context, different headspace, different routine, and then all that shit that you did while you were staying on the peninsula with your feet in the water and it was beautiful, you're not there anymore.
Now you're back here.
So that's that trying to maintain that psychological, behavioral and emotional momentum that you started.
You know.
So what about this is a very simple question, but just for our.
Listeners who don't know the answer to this, what is a heart attack? What is a cardiac arrest?
Yeah? Look, it's a really great question and it's one that cardiologists have been trying to fall down the public's view for many years. My view is it's heart disease. But let me explain the difference between the two. A heart attack is when you block an artery supplying blood to your heart. Yeah, And if we get a chance, we're going to a bit more deferent because heart attacks don't happen gradually. There's a gradual build up, but heart
attacks suddenly. So you block an artery, you block an artery in your heart, no blood's getting through the area that that artery is supplying. That tissue starts to die. And when that tissue starts to die, that's a heart attack. It's death of heart muscle. Yeah. Yeah. A cardiac arrest is a situation where the rhythm of the heart becomes noncompatible with life. I pause there for a second, because
the rhythm doesn't actually stop. It can stop. There's a condition called a sisterly where the heart just stops, but there's a condition called ventricular fibrillation where the heart goes so quick that there's no cardiac output. So cardiac arrest is when your heart, due to a n trial issues, is no longer pumping blood around the body. And if that's not fixed, it's fatal. You cannot survive a cardiac arrest unless it stops either spontaneously or because someone's defibrillated.
You yes.
Now, where this gets complicated is that in Australia and most developed countries, the number one cause of cardiac arrest is having a heart attack. So you have a heart attack, the muscle dies and that leads to the electrical disarray which causes the cardiac arrest. But whereas is really important is there are conditions which predisposed to cardiac arrest which are not heart attack. So people are born with congenital abnormalities in their heart and they have completely normal arteries.
And this is where you hear of young people having cardiac arrest. There are genetic conditions long QT syndrome regard to syndrome the predisposed young people to having cardiac arrests, completely normal arteries and purely an electrical problem. So they are different issues. But in Australia, when a fifty year old man arrests at the MCG has a cardec arrest at the MCG, he gets successfully defibrillated. Chances are I he was having a heart attack.
Yeah right, Okay, Now I want to ask you a very specific question, and the reason for the question will become apparent post question, your honor. Great, So if a dude who was otherwise healthy and fit, not me, by the way, but it could be a bloke named to Mark who was who is my training partner, and let's say he was fifty three, lean, doesn't drink, doesn't smoke,
eats great, in good shape. Let's say hypothetically, one Friday he had a cardiac arrest at the gym one foot from me, which I'll say is very annoying, completely interrupted my training, very selfish, look at me, right, So seventeen oh five until seventeen No, yeah, seventeen oh five till seventeen twenty two, offline, right, So Daddie mcdead'ster seventeen minutes.
So my theory, they didn't. So he had a.
Cardiac arrest, right, he did a set of chins. He did a whole bunch of chins, like twenty. He came down, held his breath because he's an idiot. So blood pressure went to a million over fucking six million, right, so for sure, hold your breath the whole time. Great was out working all day in the heat. I think he was dehydrated and when he does drink, he drinks on this day energy drinks, which great, you know, caffeine stimulants
terrific for the heart and the nervous system. And then came to the gym and had another pre workout and then trained with me and then dropped dead at five past five. But that combination of heat, dehydration stimulants, could that produce a cardiac arrest?
Yeah? Absolutely, you know, we've got to put in perspective that most people get hot dehydrated do not have a cardiac arrest. But in the right situations, it does happen. And yes, you know, again, I would say that a fifty three year old male, it's most likely that he's actually ruptured a current reartery. So he's torn a current reartery due to a combination of stress dehydration, and that's what's led to a block of an artery and a
cardiac arrest. And a lot of those things can be known in advance, and it leads to what would we have done if we knew a fifty three year old We've been telling him exercises, vital exercise is critical, you know, doing hard exercise anaerobic it was great for you but do it in a controlled fashion. You know, I jump in. Don't deplete all your buckets at once. So yeah, you know, deplete a bucket. You can. You can train like crazy, but if it's a forty degree day, don't get dehydrated,
or don't try and quite as hard. Don't deplete all of energy levels at once, because that's when you're most at risk. We actually know that these these plaques or these cholesterol build up in your heart. They rupture because of information and that rupture is triggered by a high blood pressure, but it's triggered by illnesses. People have the flu are more likely to have a heart attack. People that had COVID were more likely to have heart attack.
So lots of things can actually trigger you. And if you're not well, if you're feeling average, that's not the day to overdo it at the gym. Overdo it at the gym. You're feeling great. The day you're feeling great, not the day you're feeling average.
Did I mention he's not that clever?
Look again, I'm going to leave that comment on.
But here's the thing with him.
He had no heart damage or not significant heart damage, and his arteries were fine.
So he literally had an arrest.
And obviously it turned out after such a seventeen minutes off line amazingly well because you know, I started working on him twenty seconds after you hit the deck. But and then the ambos were brilliant. Do you know what's the funny thing about the ambos You probably know this, right, But they come in and they got their relative from where they were quick, but it was still it's still about eleven minutes, and eleven minutes when you're doing what I was doing, feels like eleven hours.
Anyway, they got.
There and I'm like, oh, thank god, thank god, and they walk in the paramedics, the MICA dudes and doets and they're like, oh, good job, keep going, and then they just leisurely set up Oh my quick.
But yeah, he had very little.
You know, he had the memory of a goldfish for a while, but made a full recovery within kind of a month or so, which I guess that's the exception, not the rule.
Right. Look, there's two things to say here. One is congratulations, you've done a cracking job of CPR. Most people cannot keep someone alone for eleven minutes, so you've done a cracking job. I'm involved at NIPPERS over summer and all the kids. Wow, we learning CPR. We're learning CPR for the one time it happens. And yeah, one time it happens, you know you've saved this guy's life because you know CPR.
It's it's actually been shown. The two things that matter is how good your CPR is and how quickly you get a defibrillator on. So one of the things you want to do is next time, make sure your gym's got a defibrillator. And we should be having because if you can get good quality CPR, really you keep the blood flowing till someone can defibrillate them back to normal or the heart goes back to normal. It's on a court, but it's been shown in out of hospital arrests less
than five percent of people survive. Wow, So now that goes up. The best place in the world this US, but I'll translated to Australia. You know, the MCG is a pretty good place to avocadiac arrest. Melbourne Airport's a pretty
good place to avocadiac arrest. You have thirty forty thousand feet above the air is a pretty good place AVOCADEC arrests because there's structures and processes in place to get early CPR early different relation, and there's always doctors and nurses hanging around, so they're really good places to actually have an arrest. So your mate's very lucky you were there.
Yeah, well I feel I was lucky because it's you know, it's a privilege.
But thank you, just quickly.
I'm not I think I'm sure about this, but atherosclerosis build up of I'm being super sciensy here, build up of gunk in the artery blood vessels. Areteriosclerosis hardening right now?
Both is are they both lifestyle related? Or is one more genetic or the I don't know, so.
Again you're using scientific terms. I love the gunk, I think hardly.
Yeah, exactly, the gunk. So what we call try and stay with me if you can. I don't want you to get lost. I know I'm you know, medically brilliant, but I'm just trying hold on.
I'm checking the textbook behind me to keep up. So what we call it these days is athosclerotic cardiovascular diase as CVD.
And now who's showing up? Now he's showing.
Up that covers any form of build up of cholesterol or gunk in your heart, and you know it's worth spending a couple of minutes. When you're born, your arter is a nice and pristine they're clean. But all of your arteries, all of your pipes, they have a lining, and that line is called endothelium. That's not important, but if you get disruptions in that lining, that's when cholesterol can actually get inside the lining and start building up
in the lining of the heart. And it's that cholesterol build up that is cardiovascular disease or FASCVD, and it's a cholesterol build up that happens over years. And I would be fairly certain that you've got some cholesterol in your heart right now. It might be a very low level, but you've probably got some in your heart. We know this from Vietnam War when they did all topsies on American soldiers who were shot. They found cholesterol and a
lot of teenagers. So there is cholesterol in the arteries of our heart. A low amount of that is okay, but as that builds up, it forms a plank and then you get inflammation and your body reacts to that and it's that reactive plark. That is the problem. A plant that's been there for forty years is much less of a problem that a plant that's formed over the last couple of years, particularly as it's got inflammation, because
it's that plant can then tear. You know, there's lots of lots of analogies that people use, but the one that I like is to know to tell people, you know, you get a plumber over and he says, you've got a leaking water pipe in your roof. Yeah, you'd say to him, fix it. But when we tell people you've got cholesterol in your heart, let's how and I don't worry about it. Not worrying about it is waiting until the roof collapses. Now, if you don't get your water
pipe fixed, your roof is going to collapse. It might not be in the next six months, it might not be in the next five years, but your roof is going to collapse. Yes, And we've also got to remember that sometimes when we fix the pipe, the damage has been done. The roof is going to collapse anyway, And occasionally it's leaking not enough, so it's not going to collapse. So we're all playing the odds here. It's not about saying if you've got cholesterol in your heart, you're going
to have a heart attack in twelve months. That's not what we're saying. We're saying, if you've got cholesterol in your heart, your risk of having a heart attack goes up, and we need to take that seriously and be more definitive about whether you are going to have a heart attack or not. Yes, you notice I'm actually talking about cholesterol in your heart. I'm not talking to here about
a cholesterol blood test. Yes, that's a fallacy that a cholesterol blood test or a basic cholesterol blood test is all you need. A basic cholesterol blood test is very much a starting point. And you know, if we want to diagnose artery disease, we need to be looking at the arteries. And that's a big push of ours at the moment, is to get people of the right age, of the right risk to get their outeries looked at.
If your outer is a clean, fantastic. If your uter is are not clean, let's talk about what we can do about it.
I'm going to throw you under the bus here just because I can ye well, I'm going to say what I think and then you can agree or disagree.
So I'll throw me under the bus.
I feel like generally everyone noticed I said feel so not a not statement. I feel like and generally I feel like dudes are not as good as women at being proactive about their health and maybe these things. I know that's very broad and sweeping and it varies greatly, But do you think generally that's true or untrue?
So this is really fascinating in an area that I'm really intrigued by. What you've said is absolutely correct that males are less likely to be proactive about their health. Yes, but doctors are far more likely to be proactive with males than females. Sorr. I shouldn't say doctors. The health system when it comes to pio vascular disease is very
heavily skewed towards investigating males. And you know, I always worry about quoting stats on podcasts, But a fifty year old woman is seven times more likely to die of a heart attack the breast cancer. No, I mean a woman who has a woman who has survived breast cancer is more likely to die of a heart attack than recurrent breat cancer. So we've got to understand that heart disease is the number one cause of death of women
in Australia. And it's a medical thing as much as a social thing that if you go to your GP tomorrow, if you have a GP you haven't been for a year, he's going to send off a cholesterol test, he's probably going to do an ECG. He's certainly going to check it for diabetes. He's going to check your prostate. If you're a woman, you'll get a PAP smear, you'll get your breast examination, you might get some ultrasounds. So we've got to change the men mentality that women are just
as high risk of men of heart disease. It lags in women because hormones are protective and anyone looking at the time you can see they've got a significant interest Viya my wife in hormones. But hormones are protective, so pre menopause or women have a degree of protection that disappears postmenopause. So postmenopause are women pretty quickly catch up to men in terms of cardiovascular risk. So what you've
said is spot on. Men are less proactive, but the medical system is more focused on males, which leads to women actually being underrepresented in investigations for heart disease.
That old kind of.
Psychological chestnut that people are scared to go to the doctor. Is that as true or one? Is it true? Is it as true as it he used to be?
What do you think?
I'm blown away by people's fear of doing it. So there's a test I do a lot called a CT current reintrogram. It's a test people, Do you have cholesterol build up in your heart?
Yes?
And I would not go a week without a sensible, well educated person saying to me, I'm not sure if I want to know. Yeah, I'm like, what do you mean? You know, I'm not sure. You know, it's a terrible analogy. But with the bushfires at the moment, I've got a place down on the Great Ocean Road. I was looking every ten minutes to see where the fire was and decided to leave. Now the analogy is, well, I won't look at the app I'll just see it, and if I don't get burnt, I want and if I do get burned,
I lost. You know, it's a crazy way of living to not want information. Again, this is a little bit biased by doctors. Again, I'm not down on doctors here, but as doctors, we're not there to prescribe everything for every patient. We're there to give patient information and with that information give them the right treatment. And I would guarantee. I shouldn't guarantee someone like you comes to me and I say, oh, you got high cholesterol, go on this
cholesterol tablet. All be If I show you a picture of your arteries that shows you've got cholesterol in your arteries, that makes the job of me getting you on a cholesterol tablet a whole lot easier because you can physically see what's going on in your heart. You can see the leaking pipe, and if you can see the leaking pipe, you want to do something about it.
I used to My previous career was so my first degree was exercise science, So I owned a bunch of gym's pet studios blah blah blah. Not unlike our friend Kate and I used to. You know, when I would meet someone and they're coming on board, they're going to work with me or one of my team. I had five hundred trainers over twenty five years work for me, So like quite a big business in that space, blah
blah blah. But we would be as methodical and kind of systematic and scientific as we could without being without overreaching. And so one of the things I would do with people is, you know, we do a kind of a sub vo two max test. We do some strength testing, a few you know, flexibility, range, movement, all the normal stuff, all the boring. Tell me how you eat, how much booze?
Do you have coffee, tea, sugar? But but all that, and then more often than not, I would do a body composition test, take some girth measurements, put them on the scales, like not make a big deal of just what it is, what it is, and we go, look, this is day one.
I just want some baseline data. This is you on day one.
You can do three pushups, you can run three hundred meters, and you can hold your body weight on a chin bath for fifteen seconds. Cool, it doesn't matter because that's meaningless until we get a second measurement.
Right.
And the amount of people who would say to me, tell me everything, but don't tell me my body composition, weight or girth measurements like they would want to the other stuff. They were happy to know, But I don't want to know what my weight is. I don't want to know my measurements. And I do not want to know, because I'd explain to them what body composition means. They're like, I don't want to know that, and I would I would respect that, but I would say, whatever.
It is, it is.
So because you don't know, it doesn't mean it's not true. It just means you don't have all the information, so you're not fully informed. And I can't make all the decisions for you. I can support you, guide you, educate you, but ultimately you're the only one who can execute. You're the only one who can make the decisions, eat the food, change of behaviors, think differently. You know, It's like I
your job is actually to create the change. I'm a glorified cheer squad with a bit of information thrown in and yeah, that used to blow me away, but it would probably be thirty percent of the people, so I'm not surprised.
And you know, the ones that the ones that see positive results. That's one of the best ways to improve in the future. You know, you see your I mon't use the word BMI because someone will throw something at the podcast that you know it can be and my drops by one or two. That does actually make you live longer. And if it dots by one or two, then that motivates you to move it again, and that
motivates you to move it again. If you do a whole lot of stuff and nothing changes, it's very hard to motivate yourself over and over again to keep doing it. So if you don't have the measure up front, it's really hard to see progress.
And also we're trying to figure out apart from the broad kind of application of various ideas and treatments and methodologies, we're trying to see, Like I say to my clients, I'm trying to see what works for you. Because your best diet ain't the best diet. It's your best diet. Your best excise program is not my best excise program.
How much sleep you need, I don't need. You know, I might need more or less, and not only you might need more today because you walk twenty five thousand steps today and you worked all day unloading trucks, and so you might need you know, these these numbers around food and exercise instead and volume and even you know whatever caffeine and boo like. These are not constants. They're variables based on how your physiology is working at that moment or in that. You know, so thinking that there's
a standard, Oh, how much water should I drink? Well, how much do you weigh? How much water is in? What's the water content of your diet? How much you're sweating? How what's the temperature? Do you work in an air condition environment? It's like, dude, there are fifty seven factors that and even then when we factor it all in, we're guessing.
It's an educated guesses.
Spot on it. Yeah, this gets back to some of the stuff that I hear you and David Gillespie talking about. You know, FAD medicine has a lot of randomized controlled trials, but they are talking about population science. Yes, what you're talking about is individual science and the individual or what I call personalized care, other people call personalized care. You cannot generalize, well, you can generalize, but generalizations don't always work.
You know. Again, Kate will tell you that a very low calorie diet is really good for you, and if that works for you, then that is really good for you. And there's science that show it's really good for you. But other people will say, well, iron, you can do this if I do my fasting for eighteen hours. Now, there's no evidence that one is better or the other. There's evidence that if it works for you, it's better. And that's what we've got to remember in healthcare that
there's personalized treatments based on generalized results. And this is where you know. Having it's something that's bugged me for many years. In cardiologies, we keep telling people risk. We kept saying, oh, you've got a four percent risk of this or a seven percent risk of that. Yes, And it's very different in the oncology world. You don't say to someone, oh, you've got a four percent risk of breast can so you actually do a mammogram and a biops.
You just see if they've got it or not. And that's where we need to get do in cardiac disease. And that's where actually looking at your arteries and saying do you have something in your arteries that we can manage? That's really important because we're personalizing. We're not saying I take one hundred people, I'm going to save three lives by putting one hundred people on this drug. We're saying, this is your risk, and this is what I can do to your risk based on what I've seen in your heart.
Yeah, yeah, I'm always talking to people about listening to their body. I go, what's your body's saying? Because your body's telling you stuff all the time. Right, maybe you've got your fingers in your ears and maybe you've tuned out. But there's a thing called biofeedback, and basically it's your body communicating with you and it's smarter than you, so you should probably tune in right and that whole without trying to be too cliche about this, but you know,
like reconnecting with your body. It's a cliche thing, but it's actually a true thing. Like we're so quick to reach for a pel of powder, a potion, a needle, a fucking whatever that removes the symptom but doesn't treat the problem, and there's a need for that, but also just that will you know.
Like one of my mates lives on Voltare.
And I'm like, do you know how fucking bad that is for you? I go, do you His hips?
Fucked?
Right?
So he has Voltaire and sandwiches for lunch. I'm like, bro, you got to like, firstly, your hip's getting worse. Secondly, you're just metaphorically putting your fingers in your ears.
Going la la la doana No do wanta know?
But that shit is going to catch up with you soon, if not now. So that just feel what you feel, and let's explore that again.
There's a couple of things I tell people, one who's listen to your body. The other's look in the mirror. You don't need tests to tell you what you need to do where you need to be healthy. By listening to your body and looking in the mirror, you can get those answers. But for the people that can't, there's some really cool work being done around heart rate variability. And you probably know heart variability. It's a really good market of where your body is now. Unfortunately, most of
your watches don't do very accurately. But as we learn more about this, elite athletes are using heart rate variability to actually guide their training, and I think we should. It's a sign. You know, this came to me during COVID. We have a lot of people with implantable devices, pacemakers and defibrillators, and we would be ringing people on a Tuesday and saying we've seen some spikes on your defibrillator. How are you doing? And that's how I'm fine. I'm fine.
The call back on Thursday and say I've just been diagnosed with COVID. How did you know two days before I felt on well? And that's because the body starts to go off before you feel it. So if we can get these markers and really work with that, And that's what we say with your mate with the carategorist about going to specifics, you know, he might have had a really low heart rate veriability on that day and we'd have said, Okay, today is not the day to
overdo it in the gym. Your body's fatigued, your bodies run down. Don't do it now. If you can listen to your body, but that takes a lot of practice. But if you can listen to your body, great. If you can't, let's figure out what else we can do to look at this. And I think that's ten years from our heart rate variability would be a really important factor. Yeah, yeah, well.
It probably is now, but it's just not accepted and recognized.
But all right, so.
It's just your watches aren't accurate enough. It's noise from a watch. If you can actually use an implantable device to measure heart rate variability, it is game changing. Ye, But I'm not going to stick something in you just to measure heart right, veriability just yet.
I'd let you, I'd let you, all right. So here's what I'm going to do. I'm going to give you some prompts, some words or terms, and I want you to just riff on it. In relation to heart health, you know, all the stuff that we're talking about, whatever comes to mind.
One minute or so, if you can, because.
I've got I've got about eights.
So the first one is genetics.
I just got to tell you there's a rule of my work that if you want DoD's my nickname at work, if you want Dot to speak for ten minutes, telling them he's got three seconds. So you've told me, I've got a minute, So you've got a minute. So heart health, you know long jeury. Genetics go absolutely fundamental in predicting your risk of a lot of things, in particular heart disease. There are multiple factors we can identify. In some of
those we can actually treat. The thing with genetics is we know that people with a bad genetic profile good lifestyle do far better than people with a bad genetic profile and a bad lifestyle. So genetics are one component, but it reinforces the importance of good lifestyle. Cholesterol is predominantly genetic. There are certain subtypes absolutely genetic. Let's get you treated early and get onto it. Family history of
art disease. Anyone under anyone in your family under sixty five years of age that are heart attack, You ought to be getting.
Checked you fifty eight seconds. I made that up, all right, Next one.
So what I'm talking about here is not exercise per se, but daily movement. So incidental occupational activity.
Statement. I'm pretty sure it was Steve Jobs sitting kills, moving heels. I love that statement. Or sitting is the new cancer. That might have been his statement. That might have been the book after that was sitting kills.
Moving, Sitting is the new smoking has got a fair bit of airplay.
Absolutely, and you know it's absolutely true that incidental activity. And this is what I say. Never go to the closest coffee machine, go to the second closest, Never go to the closest toilet. If you can get our standing desk and use it. You know, I was in the AFI. Yes, they're talking about my habit, which is I do one meeting every day walking so I'm based in at Melbourne. I do a lap of the g every day siloa to warning Saalea to Kevin Bartlett, or at least as
I walk around, So absolutely don't sit still. We know that fidget has actually lived longer than non figures and part of this is just that motion of activity that we do during our day. So yes, yes, yes, do as much as you can.
Genetics Sorry I interrupted your glass so all this stuff and I was not genetics. Sorry, Diet diet, I know this is I know we could do an hour on this, so I understand. I understand the demands I'm putting on you.
So a healthy heart diet will make you live longer. Yeah, defining a healthy heart diet is incredibly difficult. Yes, what's key in ninety percent of people in Australia is we need less calories. Now, how we get less calories is the difficult question. Through a low calorie diet, through fasting, through the macro nutrients. There's not a lot of evidence
that one's better than the other. But what's clear is if eighty percent of Australians lost ten percent of their way, I'd be a lot less busy and I'd love it.
Yes, yes, that's that's I have a backup question that if we get time, I might which.
Is very specific.
Anyway, stress stress distress, not you stress distress.
I think stress has been underappreciated for many years, and I love the fact you're bringing it up. A lot of this heart rate variability stuff that we measure as a sign of stress, which can be psychological or physical. There is a syndrome known as broken heart syndrome. It's real. If your partner passes away, your risk of having a heart attack goes up dramatically in the months after that, and a lot of that is due to profound stress.
Chronic stress absolutely causes all sorts of problems. The rupture of your arteries, the inflammation your arteries is triggered by stress. So managing your stress, what I call the autonomic nervous system, is critical, and you know the best way of doing it. It's exercise. The second best way is routine. If you don't have to think about stuff, if you're doing it regularly, that's going to de stress you. So absolutely a well underappreciated cause of heart possess. Well, you touched on the
next one. So structured exercise or an exercise a plan that's implemented into your operating system. So for optimal heart health, there's been a lot of work on this, and I don't mind what you're doing, but you should be doing some aerobic exercise most days. And again, you can define aerobic a lot better than me, But I define aerobic because you're puffed, you're sweaty, you can talk, but just you get home and you're tired, you don't get home
and you're collapsing on the couch. That's aerobic. Now, if you have a base of thirty minutes most days, or fifteen minutes every day, or forty five minutes three times a week, that's great. But now we know on top of that, put in some weight training, put in some high intensity and if you get that combination together, that really gives you the amplified effect on heart health. So put the structure in, but base it around aerobic. Then
throw other stuff in as you enjoy. But again, you know, no point me saying you've got to do forty five minutes of walking. If you've got a bad hip, you've got to find the exercise that works for you.
Yeah, so true. This one's a little bit lucy, goosey and broad. So I'll let you go wherever you want with it. Lifestyle, which I know encompasses a lot of shit, but doubt.
Lifestyle has more impact on heart disease than anything else we know. So lifestyle has impact on longevity, but it has more impact on health span, which is how long you're actually healthy for, and that to me is critical. Lifestyle is underappreciated, and if anyone wants to criticize doctors, it's we don't spend enough time on lifestyle. I know I've got seven seconds Peter Attia from longevity. You know, I heard the other day he's got seventy five patients.
I had ten thousand, he's got seventy five, so he can afford to spend all the time on lifestyle. I spent all my summers talking to the people at the beach about lifestyle, because lifestyle is key. You get your lifestyle right, you might still need a few medications, but you'll need a whole lot less than if you get your lifestyle wrong. So it is the number one thing that we should be doing. And exercise, stress, alcohol, nutrition, sleep, They form the basis of lifestyle as far as I'm concerned.
Yeah, I probably should have ended with that, but just back to two more which you just kind of covered briefly, but so specifically.
Booze.
I don't drink, so it's not a big I don't even really get it. But booze and heart health.
There is no benefit for alcohol in heart health. That is a fallacy. There was a belief once upon a time a glass of red wine was good for your heart. That has been disproven. There is evidence that alcohol is bad for your heart, even in very low quantities. Yes, we need to balance that with lifestyle factors, social factors. And I'm quite happy to tell you that I will always have a beer, and the Boxing day test matches on.
I'll love a champagne on New Year's Eve. I'll have a glass of wine with some friends over dinner once once or twice a month. So I don't drink. But don't. Don't anyone out there think that alcohol is good for you, because it's not. Alcohol at any level is bad for the heart. Now where that level lies is somewhere between one and two standard drinks a week. But I would tell people if you want to drink, because it is helping you in other ways. And social, you know, we
talk about social. You haven't mentioned that yet. Social interactions are critical for good heart health. And if your social interaction is having a glass of wine with some friends over dinner, then keep that up. If you can't go to soda water, so alcohol is bad for you, no question about that. But I don't want to be too rigid with people that they're having this prescriptive way of
living that doesn't fit with their lifestyle. I'm okay with people enjoying themselves from time to time, as long as it's not in excess.
I'm glad you raised that about socializing. Sociology, relationships, human connection, love, giving love, getting love, feeling valued. It's something that I forgot for this list, but I talk about corporately with It's quite a almost like a red herring in a corporate environment when you talk about, you know, being loved and feeling valued and seen and connected, and what a physiological impact that has, and not just on hard health,
but a bunch of things. It's funny now we talk about the impact of whatever diet, lifestyle, exercise on your health, and now we talk about the importance of that that social connection as been possibly more important than sometimes exercise or movement, depending on sorry, exercise or food at times.
And let's remember we're in a state where working from homes just become mandated. I'm not sure that we're fully appreciating the social impacts of that, yes, but anyway, that's a separate topic. But yeah, look, there's a great book, Lost Connections by Hari. I'm not promoting anyone that I've got a relationship with there, but it really talks about the science behind connections and you know the importance of having relationships with family, relationships at work and how that
impacts your health, and it's really fascinating. He's more on the depression side, but it's absolutely the same part disease as well.
Quite like that, dude, he's got an interesting mind. My last one, which is for me, the toughest one, although it's not a big struggle, but periodically it is. I feel like all of those like lifestyle, booze, daily movement, you know, exercise, like they're pretty much within our control. We can make a decision and just do it. But we can't make a decision and go I'm going to sleep great tonight. You know, it's like, yeah, your body's
like no, you're not, fuck off. So that to me, because everything else is pretty in line For me, that's that move the need all the most. If I sleep great, I'm nine out of ten. If I sleep shit, I'm a four.
Yeah, And that's been shown repeatedly in data that your performance as an athlete, your stress levels are all impacted by your sleep. You know, we were associated with the sleep business once upon a time, and the sleep doctors will tell you you can manage your own sleep, not every night, but you can put in strategies to get better sleep. But the fundamental thing from me is sleep is profoundly impacting heart health, and these people. The other thing we've got to remember is that we are all
slightly different. I do not need nine hours sleep a night. I'm quite comfortable with six and a half to seven and that has no impact on my metabolic features. As soon as I dropped to five hours, it impacts it. So this sort of belief. When I was a young doctor, we used to work forty eight at seventy two hours straight. Your mind was fried. You couldn't possibly do it. So sleep is critical. I think people have real problems with sleep.
Should say sleep specialist, not for medications, but for strategies. It's around blue light, around strategies, around what the bedroom's for around, what you have with your cup of tea before bed, all of these things that you can do. And I think it's about habit forming. It's the same that you've got a great habit of exercise and health, maybe your habit around sleep's not great and maybe that's something you should ask yourself about. Yeah.
Yeah, I've got a lot of bad habits. You're great. Can we do another one?
Absolutely? What's we talk about next time? Athletic performance shark attacks in Sydney. I'm an expert.
Yeah, we can get You're a chatty Kathy and I like it. Hey, Doc, promote whatever you want to promote. Point my listeners any direction you'd like them to go.
Look, as I said right at the start, my mission is to improve Australia's heart health. If you're over forty five, if you've got a family history of heart disease, if you've got risk factors for heart disease, please go and get your heart checked. You're not going to get shoved on treat and you're going to work out what is
your risk and what can you do about that? And if no one else is looking after your at Varahatkerell, look after you, but by all means go to your normal GP and get them to do this test for you.
Amazing. Thanks so much for debuting on the EU project. I think they're going to like you a lot, and I think they're going.
To want you back.
We'll say goodbye affair, but for the minute. Thanks David. Really appreciate you.
Awesome. Thanks for the time.