The Naked Heart

Before birth, the foramen ovale is a vital foetal opening between the right and left atria, allowing oxygen-rich placental blood to bypass the inactive lungs. After the first breath, pressure in the left atrium increases, closing the flap naturally. In around 25% of adults, the flap does not seal fully — this persistent communication is called a Patent Foramen Ovale (PFO) which is an important cause of cryptogenic stroke. All standard tests including an echocardiogram can be normal- it can be only be diagnosed using a bubble contrast study and once diagnosed, treatment with clam shell closure is high effective.

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If you have ever found yourself feeling breathless climbing stairs or walking uphill — even though your lung and heart tests are “normal” — you are not alone. Many people attribute it to age or fitness. But recent research has uncovered a powerful hidden cause of breathlessness: visceral fat — the fat stored deep inside your abdomen, around your organs. In this blog, we will explore what visceral fat is, how it affects your breathing, and — most importantly — what you can do about it. 

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“For every threat that rises against us, humanity answers with a greater invention. Show us the enemy, and we will forge the remedy.”

For much of modern cardiology, in its battle against coronary artery disease—one of mankind’s greatest threats—the “enemy” seemed clear. When I trained, the diagnostic armoury was focused on accurately identifying flow-limiting narrowing of one or more coronary arteries: the 3–4 mm vessels supplying the heart with oxygenated blood. Prognosis was measured by the number of occluded arteries, the degree of stenosis, left ventricular ejection fraction, blood pressure, and cholesterol profile.

Diabetes mellitus was acknowledged as a risk factor, but it was largely regarded as a separate, niche condition—managed primarily by GPs and endocrinologists. Invasive coronary angiography was the gold standard, the reference point against which all non-invasive tests—such as the stress ECG or nuclear cardiology scans—were judged. A patient’s future could be read from the arteries illuminated on that cath lab screen: a narrowing meant risk; an occlusion demanded action.

Yet in the last decade, a profound paradigm shift has unsettled these foundations—and in some respects, turned them on their head.

An ILR is a matchstick-sized device implanted under the skin of the chest, usually under local anaesthetic in a brief outpatient procedure. Once in place, it continuously monitors the heart’s electrical activity, storing recordings of any abnormal events it detects automatically or when triggered by the patient using a handheld activator.

Modern ILRs have:

An ILR may be recommended if you:

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In the evolving world of preventative healthcare, one size no longer fits all. We are learning that each person has a unique biological blueprint – shaped by their DNA, lifestyle, and environment – which determines how they respond to food, exercise, and medications. Today, sophisticated tools allow us to uncover this blueprint and personalise health advice in a way never before possible. The goal? Not just to avoid disease, but to extend your healthspan – the number of years you live in good health.

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Dietary fats have been wrongly maligned for much of modern nutritional history. But as the science evolves, it's clear that fat – far from being harmful – is a vital macronutrient that supports energy metabolism, hormonal health, brain and heart function, and even weight control.

Rather than fearing fat, we should focus on:

Avoiding refined carbohydrates and ultra-processed foods.

The time has come to move beyond fat-phobia and embrace a more nuanced, evidence-based approach to eating. In a balanced, whole-food diet, fat is not the problem — it’s part of the solution.

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As we age — particularly if we have inherited genes that predispose us to metabolic disarray that accompanies modern diet and lifestyles, we start to gain weight as visceral fat increases, and muscle mass declines. This double effect worsens blood pressure, cholesterol triglycerides, and blood sugar — contributing to what is known as the metabolic syndrome. Fat cells that have reached their capacity to store extra energy as a healthy reserve start to cause havoc by releasing free fatty acids and in turn worsens insulin resistance, that steepens the decline in health.

However in many cases if we can reduce visceral fat, rebuild muscle, and reach a caloric deficit, we can reverse many of these effects.

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In the UK, the recommended minimum daily protein intake is 0.75g per kilogram of body weight. However, mounting evidence suggests that this baseline is not enough, especially for older adults, those managing chronic conditions, or anyone engaging in weight loss strategies.

In practice, most people are falling short of even this modest target. In this article and podcast, strategies to maintain skeletal muscle mass to improve metabolic health and reduce the risk of sarcopenia are aired. Could equipping our patients attending our holistic GLP-1 mimetic clinic with a food analysis app called Dr Shape and other items in our metabolic toolbox really be the answer?

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Emerging evidence shows that lifetime exposure to LDL cholesterol and high glucose variability are some of the strongest predictors of cardiovascular risk. Just as lung cancer risk is tied to pack-years of smoking, heart disease risk correlates with cumulative LDL levels and impaired glucose metrics  over time.

This is why some people in their 20s with risk factors (like diabetes or a family history of heart disease) are starting statin therapy preventatively. However, many are understandably hesitant to start medication so early. Lifestyle changes remain the cornerstone of early prevention.

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It may seem unusual to talk about heart disease in teenagers and children, but the groundwork for heart health is laid early in life. Habits formed in youth often carry into adulthood, and many cardiovascular risk factors—like high cholesterol, high blood pressure, or obesity—can be silent, slowly progressing without symptoms.

In families where heart disease runs deep, understanding risk and prevention from a young age can be life-changing.

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