HIIT interrupts this cycle by dramatically improving insulin sensitivity and glucose uptake in skeletal muscle — particularly in the large lower-limb muscles of the thighs and glutes. A single 20-minute session of HIIT can activate GLUT-4 transporters in muscle cells for up to 24–48 hours, drawing glucose out of the bloodstream and away from storage in the liver and visceral fat depots.

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This is the last blog in Naked Heart Series for a year. Weekly blogs are to be released on Metabolic Health instead with a view to book launch in 2026 'The VAT Trap'.

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Mitochondria are the power stations inside every cell, converting food into energy. But in modern life, with constant carbohydrate intake and low energy demand, they become overwhelmed. Just like solar panels producing too much electricity for full batteries, mitochondria have nowhere to send surplus fuel. This triggers oxidative stress, inflammation, and early ageing. Insulin is meant to divert excess glucose to safe storage — but when that system fails, metabolic chaos follows. In this article, we explore how your mitochondria manage energy, what causes them to overload, and how lifestyle changes can help restore balance and protect long-term health

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Troponin-negative chest pain presentations are often sent home without a timely work up or prompt imaging tests like a CT angiogram. A delay can be critical. As clinicians, we must identify which patients need further testing urgently. Where clinical suspicion is high, irrespective of troponin rise doctors and health commissioners should prioritise resources, so that an accurate diagnosis can to be made. Lives literally depend on a prompt anatomic test being done in time. Until this has been made available nationally, patients experiencing unexplained chest symptoms who have not had clinical follow up and diagnosis confirmed are advised to 'vote with their feet'- either head back into hospital in event of further symptoms, or even consider arranging to fund their own urgent CT angiogram from an independent medical provider.

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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:

• Automatic arrhythmia detection algorithms
• Wireless home monitoring (transmitting daily summaries to the cardiology team)
• Battery life of 2–4 years
• MRI-compatibility in most cases

An ILR may be recommended if you:

• Have unexplained syncope with inconclusive standard tests
• Have had a cryptogenic stroke, TIA, or TGA, where AF is suspected but not proven
• Have infrequent but concerning palpitations that evade short-term monitoring
• Have suspected intermittent AV block or sinus pauses

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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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