Hi guys, my name is Sanjay Gupta, I'm a consultant cardiologist in York and today again I have great pleasure introducing Dr Simon Smail who's a consultant gastroenterologist. Me and Simon we work very closely with each other and One of the questions a lot of people write to me about on my videos is this connection between the stomach and the heart and I'm very fortunate that I have Simon and Simon is very well-read gastroenterologist and I was keen to explore this connection between the stomach and the heart and if you could also Simon Just talk to us a little bit about the vagus nerve because a lot of people have mentioned the vagus nerve So what do you think is there a connection between the stomach of the heart or are they two separate systems because a lot of guys say to me when they go to see their doctor they say oh, it's your stomach nothing to do with your heart Okay, or it's your heart nothing to do with your stomach So I think there's no doubt that that first of all the heart and the suffragous are quite close when you go down the Suffragous endoscoping you can see the atrium Butting them you can see that's only about two millimeters away. It's not far And could you ever find that when you're going down you can actually irritate the back of the heart? Okay, so I think there's a that that for me I think that's more likely to be a nervous response So as we mentioned the vagus nerve innovates so no it supplies Both the heart and the gullet and there are some common pathways that go up from both those organs up to a Collection of nerves just below the What base of the skull and there are common pathways from? That collection of nerves up into the brain which may be why it's difficult to tell heart pain from Gullet pain sometimes because they're actually very similar and they're following the same path So if they have the same nerve supply Affectation of one system could affect the other yeah, certainly and that's true for nerve for messages going up But it's also true for messages coming down. I guess potentially too So we recognize that people having endoscopy for example often have A change in heart rhythm. I get it's commonly gets faster or slow but also You can have change in rhythm in terms of some people going to atrial fibrillation So when you're actually putting down the food bagel stimulation when you put this chew down the food pipe to look at the food pipe You can actually alter the rate of the heart. Yeah, and the rhythm and can actually push people into your population How interesting? Okay, not commonly not come Okay, any other connections between the stomach and the heart. So I think that it's also true that Emotional context has a huge influence on how We respond in terms of what how we perceive what's going on in our viscera. So Chapp called Kazimaziz has done an almost amount of work around looking at how emotional context affects visceral sensations so how we perceive what's going on in our guide So what you're saying is it could just be that they're both Responding to an emotional stress We call it a gut feeling. Yeah, because you know the gut has more nerves in it than than than the brain So if you get anxious for example that would not only affect that feeling and that's why maybe there's that way people complain of butterflies And the stomach So that's really so butterflies is is an emotional response In your gut and and you know people also complain of a fullness of bloating when they're stressed And that's because Naturally When you eat a meal the stomach relaxes at the top end in the funnels And becomes more motile in the bottom end to empty But when you're stressed it relaxes less well so kind of tightens up and it empties less well and circles you feel fuller Sooner, which is why you can't eat so much when you're feeling anxious. That's interesting and I guess the fourth Four thing is probably inflammation and if you're being pain from your stomach because reflex is so common that may cause inflammation within the body and that could cause How to take it so if people have Reflux they can get a softy or spasm and as we talked about previously the They if you get a softy or spasm which is a pain from your gut as a result of increased pressure You can get as a consequence Changes in your heart tracing In response to that. So whether it's actually the inflammation or whether it's the Neurohomonal response. I think is Up for discussion and further research, but it's really interesting. Well, so this is great. Thank you so much I think it's quite nice for those people out there who are finding it difficult to convince their doctors that there may be a stomach Heart connection to listen to you and your expertise and I guess it's quite nice that there's a cardiologist We talked to each other and we actually agree with each other which is a new job So excellent so Simon could you quickly tell us a little bit about the more than just medicine initiative that you've launched which was So so it's a A group of us dietician Sanjay Tom exercise professional myself See lots of people for whom their disease is either exacerbated or brought on by their lifestyle choices I think we're all on that journey where you know, we all know things that we could do better in terms of making healthy choices I certainly have that and In terms of the whole Healthcare community. I think we spend in the UK about 40 billion pounds a year on lifestyle related disease or disease that's Exasperated by lifestyle and yet somehow our current and Provision doesn't doesn't seem able particularly well in certain areas to help people with that change certainly not in my gastroenterological practice is difficult and so what we wanted to do is provide a A platform whereby we're going to try and empower and educate people through videos like this But also provide some written material We're working on providing a free web portal that people will be able to access on things like sleep and stress and Smoking and alcohol just to give them help with where to go and and how they might prepare for all making better choices And then we're also running lifestyle and behavior change programs to help people with an at risk of chronic disease They're paid for at the moment, but we're seeking Forget it funding NHS commissioning And we're in that process. So we really want to You know, we want to make a difference. So I guess the strength of something like this is for example if someone is overweight And they're diabetic and they have high blood pressure They could come and develop an a program and they will see a consultant like me or you and they will see a Dietitian and and we'll be sitting together with the patient and and with them We'll work out what they want You know what the choices might be that they could make better on what we can do to try and help them make those choices If their exercise is good, but their diet is bad then they get more Look at reducing this so or you know Eating less saturated fat and we can have all of that and the idea that the patient is setting goals Yeah, the patient is a partner with all these people and patients the most important bit That's really interesting. Thank you so much if you get a chance Please visit the more than just medicine website www.morethanjustmedicine.go.uk If you have any comments please don't hesitate to drop us a comment After this video and we'll do another video as soon as you've got our free portal up and running We'll do another video And maybe what Simon at some point you we could do a video on Any tips or tricks you may have to try and help people with their vagal Their vagal nervousious. Thank you so much. Great. Thank you