There has been increasing evidence for high intensity training in terms of changing and improving your metabolism in terms of insulin resistance. This may have benefits in terms of improving you metabolic profile over the long term.

How does it work?

20 secs of maximal effort in between normal steady paced exercise for three interval that's it.... three times a week.

This may be of benefit but has to be taken in context. Weight reduction is aided by exercise. The mental and physical benefits of exercise are well documented. This is not an alternative but may be incorporated into an exercise program. Remember before starting a high intensity exercise program have a chat with your doctor if you are not used to exercise.

Also weight reduction in overweight patient's is an important part of improving overall health, but remember diet is far more important than exercise.

The effect of emotion on our ability to do things is so important. Get the emotion right get the thought right get the action right. Applying this to healthy living to get the thought right we need to rationalise to attain the correct emotion first. Visualisation is a well established technique. Image the feeling of good health and a trimmer figure. Hold the emotion. Then think of the action plan. Then act on it.

The type of exercise or diet plan is not crucial to be honest, sticking to the plan is.

I recently spoke with a patient and having discussed their lifestyle modifications we came up with simple strategy for weight loss. 

1. weigh yourself everyday to act as a motivational tool

2. your carbohydrate intake and increase your protein content... educate yourself about what you eat

3. try to exercise more often

The patient came to see me; he had lost 8 kg since his last appointment.

keep it simple 

The Psychological impact of heart disease

This a large subject that is not often talked about. I was discussing this with a colleague today. Patients who in particular suffer heart attacks (where the blood supply to the heart it stopped and they commonly present with chest pain) can be greatly impacted. It is not only the body that needs healing it is also the mind. 

Questions like is it going to happen again?  Am I going to die? Will I lead a normal life? These can weigh heavily on people and cause them to go over it again and again. 

Counselling can help and sometimes exposes wider lifestyle changes that need to be made. It is something that should be discussed more openly and in a non-judgemental way.

four rules to lose weight

1. Weigh yourself everyday. Although people don't always agree with the regularity of weighing yourself it does give you a motivational tool to watch your weight so do it everyday at the same time.

2. Reduce the carbohydrate and increase the protein. Carbohydrate can be stored as fat, protein generally does not and it keeps you fuller for longer

3. Use my fitness pal app to calorie count. It keeps you focussed and it educates you about food and portion size.

4. Write down the calorie content of the ten foods you eat the most this helps educate you about your food.

Statins are a class of medicine that lower cholesterol. Drugs such as simvastatin, rosuvastatin or atorvastatin may be familiar to some. Cholesterol is a key component in causing furring up of the arteries that can lead to heart pains and even heart attacks.

There has been some recent news about who should need a statin, indeed should more of the population take them? What about the side effects?

The answer is to look at the individual patient and assess their individual risk profile. Then decide together if a statin is necessary. There are other measures that reduce your cholesterol risk, such as exercise (increasing the good cholesterol: HDL). Diet may help to a certain extent. Also looking at the whole patient to see if the other risk factors for heart disease can be reduced is very important, such as blood pressure, smoking and weight reduction. See your doctor to find out your risk. Remember prevention is better than cure.

Smoking is one of the single biggest risk factors for heart disease and stroke. The numbers of smokers is reducing thankfully. This does mean that the remainder of smokers are the more 'hardcore' smokers who are less likely to quite. The fact remains that qutting at any point in your life is of benefit.

There are a number aids to stopping, counselling, patches, gum and even electronic cigarettes. There has been some controversy about the use of these are the amount of nicotine may be unregulated. There is however some good evidence that they increase quitting rates.

Whatever you do, whatever it takes,  just do it just stop.

Coronary artery blockages can cause the blood supply to the heart to stop. Conventionally we have used metal stent mounted on a balloon to open up blocked arteries and to keep them open.

In the last few years there is a new type of stent available that is made of a biodegradable material that dissolves away completely after 18 months to 2 years. This means that there no longer any stent left within the artery for the rest of the patients life. This may have implications for younger patients and those requiring a long segment of artery that needs to be stented.

There has been a recent trial looking at the presumed benefit of polyunsaturated fat versus saturated fats (like butter). The trial suggests that there is no benefit from polyunsaturated fats like olive oil. Don't panic. I think the basic message is still the same. Portion discipline and regular exercise still apply. Moderation is the key. Simply follow the same old advice such as fruit and veg regularly, If you do decide to go back to butter as opposed to margarine with polyunsaturated fat, just remember moderation is the key.

Supplements and heart health.

Health supplements are promoted to help cardiovascular health. There has been a recent large analysis looking at the benefit of health supplements and cardiovascular health. The results seem to suggest that there is no benefit from these over the counter health supplements. Multivitamins do not seems to prevent cardiovascular events such as heart attacks. (USPSTF Annals of internal medicine Feb 2014).

Having a healthy diet and taking regular exercise are the key to reducing your risk of heart disease.

A further recent study has shown that having a vegetarian diet cuts your blood pressure. This is an association and the other aspects of being vegetarian such as lower body weight and cholesterol may play a part in the mechanism. Nevertheless being vegetarian does lower you blood pressure which is a major factor in development of heart disease (JAMA Internal Medicine Feb 24 2014).

So try just eating a healthy diet, get rid of the supplements and if you can cut out the amount of meat in your diet.