I really feel the need to share my story. I started heavy duty aerobic exercise at about 28 years old I am currently 62. Since I was never good at sports it was the only thing I was so good at that I just did it constantly. I ended up becoming a group exercise/aerobic instructor and was certified in many different modalities such a spinning, kickboxing, body pump… all of which are very high intensity in their own right. I could easily walk 4 miles to the gym for my shift and teach two back to back one hour high intensity classes like spinning and then kickboxing. Plus, I was personal training several clients a day and would do every single repetition with them. I am pretty much a research in science geek and found out about 1998 of the dangers of doing too much cardio but at that point I was already 48 years old. I started having extremely low resting heart rates in the vicinity of 32 or 33 bpm which I just passed off as coming with that level of athleticism. A good part of my day was spent at about 170 beats a minute!!! in 2000 I went to see about my symptoms of low heart rate only to find out I had sick sinus syndrome. I am now on my second pacemaker and about to be next year on my third. I have had numerous arrhythmias and I have a fib and VTach. I tried to tell my clients who were running marathons to stop running literally… For their life. Trying to convince a runner to stop running- even when all their joints are taped up, is like trying to pull a molar out of a whale.. The moral of the story is if you are still running distance or doing high performance cardio you might want to slow it down. On the bright side, I did become a Pilates and yoga instructor and still was able to fulfill my desire to teach and even got a better more balanced body out of the deal
Dr Sean OMara tells his patients to quit LD running, and to sprint. Some of his fascinating findings are in this video. th-cam.com/video/QTFFYF4btfk/w-d-xo.html
Thanks sir for bringing this to people who is ignorant and don't know what to do to prevent chronic disease....this will prevent disease progression and save lives
Beautiful multidisciplinary talk! So much to process. I was one of those people over exercising and kind of got to the conclusions described by Dr O’Keefe through the psychological pathway rather than the empirical. Asking why am I doing this and what are the gains and opportunity costs. This has been immensely reassuring that I am on the right path of moderation, reasonable control and balance. Thank you both for this super informative compendium on cardiovascular health balance and long term prevention ideas.
Experienced frequent PVC’s with high volume high intensity exercising. Have since reduced pvc with more zone 2 training and weights thanks to these type of podcasts.
Glad you mentioned that about the magnesium/ potassium intake. I’ve been aware of higher dose magnesium for a while, but the potassium was only recently brought to my attention by Stan efferding. I don’t have the toss and turns at night and my mood and energy are much better and the headache severity/ frequency are lower to non existent since taking in 1-2g/3-4g respectively. The use of stimulants certainly necessitates higher doses, and I know some medications do too, but I’m not certain why we seem to be so lacking. Diet and maybe we are drinking so much more filtered water.
I liked the analogy of engine exhaust that the body can pump out antioxidants to cope with for about 45 mins. I wonder if San Migel's Zone 2 definition stokes this. I also watched Jame's presentation at TED, he cited the elevated progression of atherosclerosis of endurance athletes. How much of that is poor diet and not replenishing the antioxidants in the body? There's already studies that simple things like blueberries can preserve immune function and anti-oxidant content of marathon runners blood. This did hit me at a good time though - I was falling in love with endurance sports and kept skipping out on weights. I want to re-align for health not performance
it would be a fascinating conversation on DHA and the brain if you have an interview with Dr. Jack Kruse- A neurosurgeon. His information is on such a high-level it will melt your brain
Regarding how oxidized cholesterol/trigs are like zits that draw in the immune system's monocytes, thru the endothelium and become macrophages.. which generates inflammatory markers and ultimately drains or attracts thrombi/smooth muscle/collagen and becomes a scar... According to Vladimir Subbotin, arterial damage starts deep, and not at the surface or endothelium layer. "The intima is the only layer that is avascular (no blood vessels). And even though its multiple layers thick its still thin enough to use diffusion for nutrients/oxygen. .Inflammatory compounds in the blood cause damage to the intima (the layer in contact with blood). Damage to any tissue causes its cells to divide to repair. If this goes on constantly then the cells will continue to divide and the layer will thicken. If the layer gets thick enough, the deeper parts furthest away from the lumen (where the blood is) wont get enough oxygen through diffusion. Aka hypoxia. This causes the cells to send signals for blood vessel growth which extend in from the vaso vasorum.supplying the media.Blood vessels causes the deeper intima cells come in contact with molecules (LDL) that they otherwise would not. This causes reactions resting in artherosclerotic plaque." Would love to get James O'Keepfe and Dr. William Li take on that theory! Finally Manolis Kellis suggests similar processes lead to similar disease across the body... for example, a hallmark of dementia is when microglial cells (the resident immune macrophage cells in the brain) start to proliferate.
Everything good for the heart relaxes vessels, like nitric oxide release and usually through that mechanism. Insulin does the opposite so it is clear it is the real villain in heart disease.
One problem with this discussion is that there seem to be six types of exercise: 1. Resistance training/weight lifting 2, Zone 1 - fat burning/10,000 steps 3. Zone 2 4. HIIT - i.e. bouncing between Zone 1 and Zone 4 5. Stretching/yoga 6. Core training Seems to me that we should be incorporating ALL of them into a weekly exercise routine. As Peter says, the opportunity cost of running 50 k per week - probably in Zone 3 - is that you don't get these other, equally important, forms of exercise.
i don't quite understand the value of the Mediterranean diet study. the term "Mediterranean diet" is so loose that it hardly even means anything quantifiable, and even if it did, there are dozens of difference between the diet groups. so unless someone adopts the exact protocol of the study, i am not sure what generalization can be made here
They mentioned the affect of alcohol on resting heart rate. I know that's been known for sometime but I didn't know about it until I stumbled across it on my own this year. Most of the time these days I have no alcohol. Sometimes I'll buy a bottle of wine and drink a single glass a day for 4-5 days until it's gone. But in a social setting I'll sometimes drink more. Me and a buddy went car camping and we split a bottle of wine every night. Went to a friend's memorial service which involved a 3 day long sort of party. A high school reunion at which I had 4-5 glasses of wine one day spread out over maybe 6 hours. Normally my average overnight heart rate recorded by my fitness watch hovers around 52. Two drinks and it is reliably 62. During all the events described above my overnight HR was 60-80. I've not kept careful enough track of my consumption to tell whether a single glass of wine elevates it or not, but two drinks usually elevates it by 10 beats per minute. More alcohol elevates it more. At a 4th of July party I think I had 3-4 glasses of wine over about that many hours and my overnight HR was 80. I've done several difficult hikes with 4-5,000' of elevation gain and loss and those might raise it 5-10 beats per minute. So I was pretty shocked to see it rise nearly 30 beats from having a couple too many drinks at a party.
You ever read “the heart and circulation” by Branko Furst? Very interesting read by a anesthesiologist, points out many areas of circulation that aren’t very well understood- it would be so cool to hear your opinion on the book if you’ve read it!
Highly recommend this video who want to spend all their money and time continuously needing disease management. Pills pills pills...sprinkled with a little exercise and diet advice. Big pharma lovers here
I am coming to the conclusion that one of the first pieces of information I want a host to ask a cardiologist, something that is not asked here, is what percentage of your patients smoke, and what percentage are overweight. One of the hardest things for us to except is that a great number of people are not going to care, what the best diet is or whether they should stop smoking or whether they should lose weight. A doctor can’t even count on a patient taking pills, never mind, cutting out all the low nutrient, high dopamine inducing foods that they’re used to. I saying this because I imagine a lot of people want to think that there is going to be a way to counteract all these things without having to use drugs. I certainly was in that camp for a long time. we probably could make progress if medical school was designed to look at prevention first, but even then, with the forces in play that there are, are you still going to have people who are willing to die, rather than give up their food high. And I’ve been trying to get my A1c down for a year and a half by eliminating almost all the unprocessed, starches and fruits that used to be my main stays because my A1c was going up, even though I had cut out sugar for the most part and pretty much all processed foods. but the average glucose has not come down that much and I honestly don’t feel that much better. And any case, I’m really tired of this having kind of almost taken over a lot of my life for more than a year and a half with actually so little result because I keep wanting to avoid any kind of meds. I think of it as me being smarter and I realize there’s an awful lot of ego involved, that may be misplaced. I had already done a lot of things, right, having lost weight, kept it off, cured myself of compulsive over eating of sweets and crap, but it just seems like the precision that would have to be involved for me at this point is turning me into almost a kind of freak. I guess if the culture is crazy, there’s some value in being a freak, but it has its costs.
I’m not disputing that the low fat diet may have been a problem, but to imply that the recommendation of it actually lead to problems is questionable because who the heck actually did it?
Re the best exercise; I would go more into the demographics of who plays tennis/badminton for longevity as it is usually associated with wealthy people...who tend to live longer for so many reasons outside of the sport they’re playing.
I have learned one thing helping me usually as studies are mentioned: correlation instead of causation. Of course here also. The story with the number of steps must be also a correlation. With what correlates the daily number of steps... Your imagination can play with that... I stumble on something like the level the attitude in life, the mind set, being outside, having contacts...
So is 30 min of aerobic with about half that time in HIIT good for longevity? In anaerobic, trying to keep cortisol low and Hgf high is 10 mins of Kettlebell with exercise to muscle fatigue good? Thanks if you do answer and if you can’t answer, Thanks anyway for just presenting new and interesting info!
1:16:46 - What about the high omega-6 content of nuts and seeds, especially for those with the APOE4 gene? Should we skip the nuts and just focus on EVOO, avocados, and oily fish?
SO informative to a regular guy with high blood pressure !! Why hasn't my doc suggested a calcium score... Well I'm gettin one. Oh hmmm, this guy is anti saturated fat, eh? Paul Saladino et al beg to differ about that...
James seems to espouse the standard heart-health hypothesis & cardiology dogmas, not what I was expecting from someone Peter typically interviews. Will listen but not hearing any challenges from Peter to ask James to comment on his contemporaries who are critical of the past epidemiological blue-zone studies. Since Peter is still a proponent of statins, would love to hear him converse with David Diamond who’s most notably a critic of the data and advertising behind statin manufacturers and resulting advertising.
Interesting observation, I noticed that myself. There’s definitely seems to be these conflicting perspectives on that topic, which makes it very hard to judge as a civilian
@@tonyz4292 you mean, because his studies don’t reflect your personal view on exercise he must be spouting out outdated ancient medical literature? Nice try though. If you disagree please list the source materials which you construe as dogma
I liked the first half of the podcast, the other half I didn't, Dr Keefe said that he didn't normally saw a reversed CAC, but Patrick Theut reversed his CAC with supplements; they are talking about Omega 3 and EPA, why Dr Keefe says nothing about EPA interfering with arachidonic acid? Why they expend a lot of time promoting statins and not telling anything that statins depletes Q10 instead of talking about K2 for example? They don't tell you how the LDL values should normally be, too low (less than 100) your probabilities to get cancer growths, to high they could become ox-LDL, etc. They don't talk about the APOE type and CVD, etc... Why they recommend fish when I personally got huge quantities of mercury in blood only eating 150g a day, now that I completely removed fish from my diet, mercury is going down to normal levels, if you eat fish today, you get plastics and mercury, very unhealthy food. About magnesium, Attia said 2gr, 2gr of what kind? between gluconate, citrate, malate, etc you get different elemental mineral content... and they said nothing about the ratio between magnesium and calcium, nor they say anything about the ratio between potassium and sodium. They talk about nuts because of their fat, but lot of people can not manage very well exogenous histamines where nuts are good triggers...
@@erastvandoren but there is plenty of información that says the opposite, for example: www.ncbi.nlm.nih.gov/pmc/articles/PMC1934492/ "Patients with low concentrations of low density lipoprotein (LDL) cholesterol, lowered as a result of taking statins, are at significantly more risk of being diagnosed as having cancer compared with patients with higher concentrations of the cholesterol..." LOW LDL CHOLESTEROL IS RELATED TO CANCER RISK www.acc.org/about-acc/press-releases/2012/03/25/15/15/ldl_cancer Search papers and you will find much more info.
@@erastvandoren we are talking about low LDL and cancer risk, for the statins shows me an study where statins are helping to prevent CAC because I didn't found any, statins are only business for the labs and the doctors desperate to make money with people, most of the doctors today became the new mercenaries.
Great podcast. I have integrated Peter’s approach regarding exercise for longevity already and it feels good! Being a whole food vegan for 5 years, not „militant“ but looking for nutritional excellence as I am not protected by youth anymore I can not help it but find it annoying to still hear in 2020 about the lack of nutrients on a vegan diet like B12 or „incomplete“ protein or the lack of selenium. Geeze, get a bit of a grip of nutrition values of plants. You do not have to eat 50 cups of beans to get enough protein but a bit of tofu or soy yogurt completed by some lentils or beans. Through a handful of kidney beans onto your mega salads , Peter and add some, include a Brazil nut per day and you get enough selenium even if do not eat ANY whole grains). 2 tbsps of hempseeds every day get you 50% of your daily RDA of magnesium, iron and zink (content can vary of course so eat a rainbow of plants). Omega 3‘s? Get an algae oil capsula to be on the safe side if you assume you are a bad converter otherwise some walnuts, & flax seeds, chia seeds, again hempseeds in your porridge/oatmeal/overnight oats or in your tofu scramble (scrambled „eggs“) on rye bread or and you are well served. We only have so many calories in our food bank to spend per day and you need to know what you are doing, with any kind of nutrition but it is no rocket science.
If you can't convert nutrients in plant food as well as from animal foods, it would seem your desire to eat plants is religious, not physiology based. That's fine. But it is true we can't eat endless amounts of food. Some of us would rather eat what converta more efficiently. That seems better for the planet too.
I was wrong in that there is a lot on chatter but also a lot of information that I will take to my Cardiologist! Will try and get him to listen to this, but he so damn busy takes 3 months to get an appointment!
I would love to hear doctors talk about exercise and what be good for people in different ages and condition rather than the technicals that as Lyman like me just get lost! The long winded conversations just make it torture!
For food there is Michael Pollan's In Defense of Food. For exercise the US guidelines - 150 minutes moderate exercise a week or 75 minutes more intense (which I'd avoid if I was moving from sedentary). This kind of exercise is what makes the biggest difference. After you get into the diet or exercise then there is heaps of further information. The intensity of exercise is related to heart rate, so takes account of varying health levels.
As you talk about troponin levels after a marathon would they not be elevated due to the fractionation levels (mm) from the quad muscles? Or do you look at overall troponin levels??
This was awkward to listen to as I gear up for a 20-30 mile zone 2 trail run. I guess I'd rather have my heart explode doing something I love rather than sit at home. I did that for 35 years and it was not pretty.
I was thinking the same thing. I'm close to 60 and ride hills and long rides. I run marathons and one ultra. I suppose they key is the zone 2 exertion, but when I hit hills on a bike or on a run, it's impossible to stay in zone 2. I just started 7 years ago, so less years. Maybe that makes a difference. Not planning on stopping.
@@puetzranch There's a study that came out in 2019 that disproves the notion that there is a line where sports becomes unhealthy. "However, despite speculation that these abnormalities confer an increased risk of future adverse events, elite endurance athletes have an increased life expectancy compared with the general population." This is a quote.
Prevention begins with our own personal responsibilities of course. But just as much with government. We spend 10 billion/year in just the CDC and FDA, and really what's the return on investment? So, perfect example is we've done pretty well with reducing smoking over the last 50 years. And that's a pretty easy one, meaning, it's not like the debate of saturated fat and red meat in that there really is no safe level of smoking. So, why are we so fat? A whopping 70% of Americans are overweight, and of that, 40% obese. We've learned the hard way that obesity is the number one risk factor of all cause premature mortality, the least of which from covid. Where's the government push to trim the fat, not off our plates, but off our bodies? Isn't policy what these mega multi billion dollar bureaucracies get paid to do? If we don't tackle our overweight problems, we'll get a handle on obesity, heart disease, and probably cancer, our biggest killers.
That was one of my big take always as well. Kind of crazy docs have this knowledge and are treating themselves with it as a result. Not really accessible to people are aren’t presenting typical conditions the drug is used to treat.
Yes, our ancestors ate a lot of fiber. Primitive folks still eat 100-150g of fiber daily. Transition to fiber-depleted foods is a 20th century phenomenon.
@@haseebtubing remember if u r on a crap diet, statins slow the progession. He has to go with the studies and standard preventative cardiologists only have statins in their toolbox.
@@iss8504 statins are the worst thing you can put in your body. Anyone defending it deserves zero respect, especially if they are scientists and doctors.
I like to run but often get dizzy and chest discomfort (dont worry, im unvaxxed), I think im not knowledgeable enough to do this safely on my own yet. Hopefully this pod helps.
Freaking Peter says how most EV Olive Oil is actually canola oil... ten seconds later I find out my "Premium Extra Virgin Olive Oil" is 94% soybean oil 🤬
Wow that is criminal indeed! I share Peter’s absolute shock and disdain for these practices, we are lucky in Europe to get the real Greek or Italian goodness ❤️👌
why does insulin make things worse? it fucks your lymph system, which is the only way out of cells for reverse cholesterol transport. huge number of insulin receptors in the very ends of lymph vessels. also why pcsk9 inhibitors work so well - loaded with lxr's like the liver.
Is anyone listening to this knowledgeable about recurrent pericarditis? I used to exercise intensely and it’s something I struggle with. It seems that a lot of people struggle with this and doctors can’t seem to find the cause. There are potentially many causes such a viruses, bacteria, autoimmune diseases and physical trauma for myself and others have been tested for/ have ruled out. For a while I have been convinced that it has been a malfunction with the stress system. But listening to this I’m interested if there are any doctors or med students listening to this may have some insights regarding too much exercise and pericarditis?
Your heart is meant to burn on free fatty acids, which is how it gets almost all its energy normally (not glucose or ketones), but if the heart is not getting enough oxygen it has to switch to glucose which is bad news. Whatever the root cause is it is probably making it difficult for the heart to get maximum oxygen and pushing beyond that point is a bad idea. Some fasting should help with the symptoms and probably the root cause too.
"ezetimide doesn't have side affects", I lost all deference to this doctor after that statement, Personally, I could hardly get out of bed after trying that drug! GO figure.?
Well dr Ken Berry I believe eats higher amounts of saturated fats cause he's a carnivore that eats lots of red meats and organ meats and Reddmans real salt
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I really feel the need to share my story. I started heavy duty aerobic exercise at about 28 years old I am currently 62.
Since I was never good at sports it was the only thing I was so good at that I just did it constantly. I ended up becoming a group exercise/aerobic instructor and was certified in many different modalities such a spinning, kickboxing, body pump… all of which are very high intensity in their own right.
I could easily walk 4 miles to the gym for my shift and teach two back to back one hour high intensity classes like spinning and then kickboxing. Plus, I was personal training several clients a day and would do every single repetition with them. I am pretty much a research in science geek and found out about 1998 of the dangers of doing too much cardio but at that point I was already 48 years old.
I started having extremely low resting heart rates in the vicinity of 32 or 33 bpm which I just passed off as coming with that level of athleticism.
A good part of my day was spent at about 170 beats a minute!!!
in 2000 I went to see about my symptoms of low heart rate only to find out I had sick sinus syndrome. I am now on my second pacemaker and about to be next year on my third.
I have had numerous arrhythmias and I have a fib and VTach.
I tried to tell my clients who were running marathons to stop running literally… For their life.
Trying to convince a runner to stop running- even when all their joints are taped up, is like trying to pull a molar out of a whale..
The moral of the story is if you are still running distance or doing high performance cardio you might want to slow it down.
On the bright side, I did become a Pilates and yoga instructor and still was able to fulfill my desire to teach and even got a better more balanced body out of the deal
Dr Sean OMara tells his patients to quit LD running, and to sprint.
Some of his fascinating findings are in this video.
th-cam.com/video/QTFFYF4btfk/w-d-xo.html
This is just terrible advice and while you were symptomatic for something doesn't mean that was caused by the exercise.
Pilates is great but expect hip replacement unless you're doing healthy yoga.
Btw, my husband also gets arrhymias when he is extremely fit so he has to be careful. When his resting bpm sinks below 45, he starts to have problems.
@@TheSubieFan Yes it was all caused by exercise. Have you ever heard the term “overuse”.
Thanks Dr. Attia. This is probably the best podcast on health even among the great ones. Keep up the great work.
Thank you, the history of cardiology is like a walk through my father's medical history.
I'm so glad we are talking about prevention now.
What does not kill me makes me stronger. Until it kills me.
Thanks sir for bringing this to people who is ignorant and don't know what to do to prevent chronic disease....this will prevent disease progression and save lives
Beautiful multidisciplinary talk! So much to process. I was one of those people over exercising and kind of got to the conclusions described by Dr O’Keefe through the psychological pathway rather than the empirical. Asking why am I doing this and what are the gains and opportunity costs. This has been immensely reassuring that I am on the right path of moderation, reasonable control and balance. Thank you both for this super informative compendium on cardiovascular health balance and long term prevention ideas.
Experienced frequent PVC’s with high volume high intensity exercising. Have since reduced pvc with more zone 2 training and weights thanks to these type of podcasts.
Just started listening to this because of an MD I work with told me about it. Very informative!
Glad you mentioned that about the magnesium/ potassium intake.
I’ve been aware of higher dose magnesium for a while, but the potassium was only recently brought to my attention by Stan efferding.
I don’t have the toss and turns at night and my mood and energy are much better and the headache severity/ frequency are lower to non existent since taking in 1-2g/3-4g respectively.
The use of stimulants certainly necessitates higher doses, and I know some medications do too, but I’m not certain why we seem to be so lacking. Diet and maybe we are drinking so much more filtered water.
I liked the analogy of engine exhaust that the body can pump out antioxidants to cope with for about 45 mins. I wonder if San Migel's Zone 2 definition stokes this. I also watched Jame's presentation at TED, he cited the elevated progression of atherosclerosis of endurance athletes. How much of that is poor diet and not replenishing the antioxidants in the body? There's already studies that simple things like blueberries can preserve immune function and anti-oxidant content of marathon runners blood.
This did hit me at a good time though - I was falling in love with endurance sports and kept skipping out on weights. I want to re-align for health not performance
it would be a fascinating conversation on DHA and the brain if you have an interview with Dr. Jack Kruse- A neurosurgeon.
His information is on such a high-level it will melt your brain
Great podcast, thank you both
Dr O. We just bought badminton sets for Covid distancing and family fitness. Thanks. Playing with friends.
Regarding how oxidized cholesterol/trigs are like zits that draw in the immune system's monocytes, thru the endothelium and become macrophages.. which generates inflammatory markers and ultimately drains or attracts thrombi/smooth muscle/collagen and becomes a scar...
According to Vladimir Subbotin, arterial damage starts deep, and not at the surface or endothelium layer. "The intima is the only layer that is avascular (no blood vessels). And even though its multiple layers thick its still thin enough to use diffusion for nutrients/oxygen. .Inflammatory compounds in the blood cause damage to the intima (the layer in contact with blood). Damage to any tissue causes its cells to divide to repair. If this goes on constantly then the cells will continue to divide and the layer will thicken. If the layer gets thick enough, the deeper parts furthest away from the lumen (where the blood is) wont get enough oxygen through diffusion. Aka hypoxia. This causes the cells to send signals for blood vessel growth which extend in from the vaso vasorum.supplying the media.Blood vessels causes the deeper intima cells come in contact with molecules (LDL) that they otherwise would not. This causes reactions resting in artherosclerotic plaque."
Would love to get James O'Keepfe and Dr. William Li take on that theory!
Finally Manolis Kellis suggests similar processes lead to similar disease across the body... for example, a hallmark of dementia is when microglial cells (the resident immune macrophage cells in the brain) start to proliferate.
Everything good for the heart relaxes vessels, like nitric oxide release and usually through that mechanism. Insulin does the opposite so it is clear it is the real villain in heart disease.
One problem with this discussion is that there seem to be six types of exercise:
1. Resistance training/weight lifting
2, Zone 1 - fat burning/10,000 steps
3. Zone 2
4. HIIT - i.e. bouncing between Zone 1 and Zone 4
5. Stretching/yoga
6. Core training
Seems to me that we should be incorporating ALL of them into a weekly exercise routine. As Peter says, the opportunity cost of running 50 k per week - probably in Zone 3 - is that you don't get these other, equally important, forms of exercise.
Sorry your really good radiologists missed the calcium. If you put the calcium study in movie mode you will find just how much the score can change.
i don't quite understand the value of the Mediterranean diet study. the term "Mediterranean diet" is so loose that it hardly even means anything quantifiable, and even if it did, there are dozens of difference between the diet groups. so unless someone adopts the exact protocol of the study, i am not sure what generalization can be made here
They mentioned the affect of alcohol on resting heart rate. I know that's been known for sometime but I didn't know about it until I stumbled across it on my own this year. Most of the time these days I have no alcohol. Sometimes I'll buy a bottle of wine and drink a single glass a day for 4-5 days until it's gone. But in a social setting I'll sometimes drink more. Me and a buddy went car camping and we split a bottle of wine every night. Went to a friend's memorial service which involved a 3 day long sort of party. A high school reunion at which I had 4-5 glasses of wine one day spread out over maybe 6 hours. Normally my average overnight heart rate recorded by my fitness watch hovers around 52. Two drinks and it is reliably 62. During all the events described above my overnight HR was 60-80. I've not kept careful enough track of my consumption to tell whether a single glass of wine elevates it or not, but two drinks usually elevates it by 10 beats per minute. More alcohol elevates it more. At a 4th of July party I think I had 3-4 glasses of wine over about that many hours and my overnight HR was 80. I've done several difficult hikes with 4-5,000' of elevation gain and loss and those might raise it 5-10 beats per minute. So I was pretty shocked to see it rise nearly 30 beats from having a couple too many drinks at a party.
THANKS FOR THE INDEPTH INFORMATION ON CARDIO EXERCISES. I AM GOING TO LIMIT CARDIO TO 1 HOUR AND 30 MINUTES.
Per week?
So what exercise schedule is recommended?
You ever read “the heart and circulation” by Branko Furst? Very interesting read by a anesthesiologist, points out many areas of circulation that aren’t very well understood- it would be so cool to hear your opinion on the book if you’ve read it!
Highly recommend this video who want to spend all their money and time continuously needing disease management. Pills pills pills...sprinkled with a little exercise and diet advice. Big pharma lovers here
Happily, I'm in no danger or over-exercising.
What are your thoughts on the findings of the China Study? They seem to contradict much of what is shared here.
very technical but very good as usual.
I am coming to the conclusion that one of the first pieces of information I want a host to ask a cardiologist, something that is not asked here, is what percentage of your patients smoke, and what percentage are overweight. One of the hardest things for us to except is that a great number of people are not going to care, what the best diet is or whether they should stop smoking or whether they should lose weight. A doctor can’t even count on a patient taking pills, never mind, cutting out all the low nutrient, high dopamine inducing foods that they’re used to. I saying this because I imagine a lot of people want to think that there is going to be a way to counteract all these things without having to use drugs. I certainly was in that camp for a long time. we probably could make progress if medical school was designed to look at prevention first, but even then, with the forces in play that there are, are you still going to have people who are willing to die, rather than give up their food high. And I’ve been trying to get my A1c down for a year and a half by eliminating almost all the unprocessed, starches and fruits that used to be my main stays because my A1c was going up, even though I had cut out sugar for the most part and pretty much all processed foods. but the average glucose has not come down that much and I honestly don’t feel that much better. And any case, I’m really tired of this having kind of almost taken over a lot of my life for more than a year and a half with actually so little result because I keep wanting to avoid any kind of meds. I think of it as me being smarter and I realize there’s an awful lot of ego involved, that may be misplaced. I had already done a lot of things, right, having lost weight, kept it off, cured myself of compulsive over eating of sweets and crap, but it just seems like the precision that would have to be involved for me at this point is turning me into almost a kind of freak. I guess if the culture is crazy, there’s some value in being a freak, but it has its costs.
I’m not disputing that the low fat diet may have been a problem, but to imply that the recommendation of it actually lead to problems is questionable because who the heck actually did it?
Peter Attia is just a very brilliant man born to be a medical doctor.
Re the best exercise; I would go more into the demographics of who plays tennis/badminton for longevity as it is usually associated with wealthy people...who tend to live longer for so many reasons outside of the sport they’re playing.
They eat expensive foods like beef and seafood and very little junk food.
I have learned one thing helping me usually as studies are mentioned: correlation instead of causation. Of course here also. The story with the number of steps must be also a correlation. With what correlates the daily number of steps... Your imagination can play with that... I stumble on something like the level the attitude in life, the mind set, being outside, having contacts...
Holy cow...I totally missed it, for sure, glad you mentioned it.
So is 30 min of aerobic with about half that time in HIIT good for longevity? In anaerobic, trying to keep cortisol low and Hgf high is 10 mins of Kettlebell with exercise to muscle fatigue good? Thanks if you do answer and if you can’t answer, Thanks anyway for just presenting new and interesting info!
"excessive saturated fat is not a good idea"- yeah that's a tautology. the question is what constitutes excessive
Fantastic information! Thanks guys👍🏻👏🏻
I skipped all the over exercise parts. Don't think its a problem for me.
1:16:46 - What about the high omega-6 content of nuts and seeds, especially for those with the APOE4 gene?
Should we skip the nuts and just focus on EVOO, avocados, and oily fish?
yes and eat plenty of Cheetos to get yellow vitamin in ur diet
SO informative to a regular guy with high blood pressure !! Why hasn't my doc suggested a calcium score... Well I'm gettin one. Oh hmmm, this guy is anti saturated fat, eh? Paul Saladino et al beg to differ about that...
Paul Saldino is an anomaly among cardio docs.
Saw the name and I was REALLY confused for a second
Check out “Nitric Oxide Dump” workout. Could be a groundbreaker
Lol...same.
James seems to espouse the standard heart-health hypothesis & cardiology dogmas, not what I was expecting from someone Peter typically interviews. Will listen but not hearing any challenges from Peter to ask James to comment on his contemporaries who are critical of the past epidemiological blue-zone studies.
Since Peter is still a proponent of statins, would love to hear him converse with David Diamond who’s most notably a critic of the data and advertising behind statin manufacturers and resulting advertising.
Interesting observation, I noticed that myself. There’s definitely seems to be these conflicting perspectives on that topic, which makes it very hard to judge as a civilian
Nothing dogma about his argument.
@@tonyz4292 you mean, because his studies don’t reflect your personal view on exercise he must be spouting out outdated ancient medical literature? Nice try though. If you disagree please list the source materials which you construe as dogma
I liked the first half of the podcast, the other half I didn't, Dr Keefe said that he didn't normally saw a reversed CAC, but Patrick Theut reversed his CAC with supplements; they are talking about Omega 3 and EPA, why Dr Keefe says nothing about EPA interfering with arachidonic acid? Why they expend a lot of time promoting statins and not telling anything that statins depletes Q10 instead of talking about K2 for example? They don't tell you how the LDL values should normally be, too low (less than 100) your probabilities to get cancer growths, to high they could become ox-LDL, etc. They don't talk about the APOE type and CVD, etc...
Why they recommend fish when I personally got huge quantities of mercury in blood only eating 150g a day, now that I completely removed fish from my diet, mercury is going down to normal levels, if you eat fish today, you get plastics and mercury, very unhealthy food.
About magnesium, Attia said 2gr, 2gr of what kind? between gluconate, citrate, malate, etc you get different elemental mineral content... and they said nothing about the ratio between magnesium and calcium, nor they say anything about the ratio between potassium and sodium.
They talk about nuts because of their fat, but lot of people can not manage very well exogenous histamines where nuts are good triggers...
There is no connection between low LDL-C and cancer.
@@erastvandoren but there is plenty of información that says the opposite, for example:
www.ncbi.nlm.nih.gov/pmc/articles/PMC1934492/
"Patients with low concentrations of low density lipoprotein (LDL) cholesterol, lowered as a result of taking statins, are at significantly more risk of being diagnosed as having cancer compared with patients with higher concentrations of the cholesterol..."
LOW LDL CHOLESTEROL IS RELATED TO CANCER RISK
www.acc.org/about-acc/press-releases/2012/03/25/15/15/ldl_cancer
Search papers and you will find much more info.
@@CarlosLemans Did you upvote yourself? LOL
@@CarlosLemans How do you know it's not the effect of statins? Show me a mendelian randomization study with the same effect.
@@erastvandoren we are talking about low LDL and cancer risk, for the statins shows me an study where statins are helping to prevent CAC because I didn't found any, statins are only business for the labs and the doctors desperate to make money with people, most of the doctors today became the new mercenaries.
Great podcast. I have integrated Peter’s approach regarding exercise for longevity already and it feels good! Being a whole food vegan for 5 years, not „militant“ but looking for nutritional excellence as I am not protected by youth anymore I can not help it but find it annoying to still hear in 2020 about the lack of nutrients on a vegan diet like B12 or „incomplete“ protein or the lack of selenium. Geeze, get a bit of a grip of nutrition values of plants. You do not have to eat 50 cups of beans to get enough protein but a bit of tofu or soy yogurt completed by some lentils or beans. Through a handful of kidney beans onto your mega salads , Peter and add some, include a Brazil nut per day and you get enough selenium even if do not eat ANY whole grains). 2 tbsps of hempseeds every day get you 50% of your daily RDA of magnesium, iron and zink (content can vary of course so eat a rainbow of plants). Omega 3‘s? Get an algae oil capsula to be on the safe side if you assume you are a bad converter otherwise some walnuts, & flax seeds, chia seeds, again hempseeds in your porridge/oatmeal/overnight oats or in your tofu scramble (scrambled „eggs“) on rye bread or and you are well served. We only have so many calories in our food bank to spend per day and you need to know what you are doing, with any kind of nutrition but it is no rocket science.
If you can't convert nutrients in plant food as well as from animal foods, it would seem your desire to eat plants is religious, not physiology based. That's fine. But it is true we can't eat endless amounts of food. Some of us would rather eat what converta more efficiently. That seems better for the planet too.
I was wrong in that there is a lot on chatter but also a lot of information that I will take to my Cardiologist! Will try and get him to listen to this, but he so damn busy takes 3 months to get an appointment!
Really good info. Thank you!
I would love to hear doctors talk about exercise and what be good for people in different ages and condition rather than the technicals that as Lyman like me just get lost! The long winded conversations just make it torture!
For food there is Michael Pollan's In Defense of Food. For exercise the US guidelines - 150 minutes moderate exercise a week or 75 minutes more intense (which I'd avoid if I was moving from sedentary). This kind of exercise is what makes the biggest difference. After you get into the diet or exercise then there is heaps of further information. The intensity of exercise is related to heart rate, so takes account of varying health levels.
As you talk about troponin levels after a marathon would they not be elevated due to the fractionation levels (mm) from the quad muscles? Or do you look at overall troponin levels??
This was awkward to listen to as I gear up for a 20-30 mile zone 2 trail run. I guess I'd rather have my heart explode doing something I love rather than sit at home. I did that for 35 years and it was not pretty.
I was thinking the same thing. I'm close to 60 and ride hills and long rides. I run marathons and one ultra. I suppose they key is the zone 2 exertion, but when I hit hills on a bike or on a run, it's impossible to stay in zone 2. I just started 7 years ago, so less years. Maybe that makes a difference. Not planning on stopping.
@@puetzranch There's a study that came out in 2019 that disproves the notion that there is a line where sports becomes unhealthy. "However, despite speculation that these abnormalities confer an increased risk of future adverse events, elite endurance athletes have an increased life expectancy compared with the general population." This is a quote.
Zone 2 is likely fine if you are in a true zone 2 heart rate.
Yea this guy skirted the zone 2 question. Very unsatisfying. But I suppose that research hasn't been done yet
@@puetzranchplenty people do more than 5 mile a week and live long and healthy - I think it’s click bate bullshit
Prevention begins with our own personal responsibilities of course. But just as much with government. We spend 10 billion/year in just the CDC and FDA, and really what's the return on investment? So, perfect example is we've done pretty well with reducing smoking over the last 50 years. And that's a pretty easy one, meaning, it's not like the debate of saturated fat and red meat in that there really is no safe level of smoking. So, why are we so fat? A whopping 70% of Americans are overweight, and of that, 40% obese. We've learned the hard way that obesity is the number one risk factor of all cause premature mortality, the least of which from covid. Where's the government push to trim the fat, not off our plates, but off our bodies? Isn't policy what these mega multi billion dollar bureaucracies get paid to do? If we don't tackle our overweight problems, we'll get a handle on obesity, heart disease, and probably cancer, our biggest killers.
What if i played soccer, tennis AND golf?
So how would a non-diabetic go about obtaining an SGLT-2 inhibitor? Would my primary care prescribe this?
That was one of my big take always as well. Kind of crazy docs have this knowledge and are treating themselves with it as a result. Not really accessible to people are aren’t presenting typical conditions the drug is used to treat.
s.flavescens ethanol extract
Our ancestors ate a lot of fibre??? That’s crazy, he hasn’t really let go of the food pyramid with a comment like that
And he's also defending statins lol
Nobody gets everything right.
Yes, our ancestors ate a lot of fiber. Primitive folks still eat 100-150g of fiber daily. Transition to fiber-depleted foods is a 20th century phenomenon.
@@haseebtubing remember if u r on a crap diet, statins slow the progession. He has to go with the studies and standard preventative cardiologists only have statins in their toolbox.
@@iss8504 statins are the worst thing you can put in your body. Anyone defending it deserves zero respect, especially if they are scientists and doctors.
I like to run but often get dizzy and chest discomfort (dont worry, im unvaxxed), I think im not knowledgeable enough to do this safely on my own yet. Hopefully this pod helps.
Dr Adir or Adar a cardiologist says no to statins
Your suggestions of a good brand of olive oil?????
Good olive oil should slightly burn the back of your throat when you place a tablespoon of it in your mouth.
PREDIMED impressive??? The different diets there were hardly different. Very bad study.
Red meat and saturated fats are "essential nutrients?" I'd _LOVE_ to see the data/study/source of that!
Freaking Peter says how most EV Olive Oil is actually canola oil... ten seconds later I find out my "Premium Extra Virgin Olive Oil" is 94% soybean oil 🤬
Always read the labels. Companies cheat. That’s happened to me before now I read every label.
@@Artzimer1958 I've never seen a label that said that a particular bottle of evol was a blend. You have to look for certified tested brands.
Buy EVOO from Chile or Australia
Wow that is criminal indeed! I share Peter’s absolute shock and disdain for these practices, we are lucky in Europe to get the real Greek or Italian goodness ❤️👌
Real evoo is peppery and fruity tasting. If it's bland that's a sign it was doctored or highly refined
why does insulin make things worse? it fucks your lymph system, which is the only way out of cells for reverse cholesterol transport. huge number of insulin receptors in the very ends of lymph vessels. also why pcsk9 inhibitors work so well - loaded with lxr's like the liver.
Everything good for your heart opens the blood vessels and insulin narrows them.
BS
Is anyone listening to this knowledgeable about recurrent pericarditis? I used to exercise intensely and it’s something I struggle with. It seems that a lot of people struggle with this and doctors can’t seem to find the cause. There are potentially many causes such a viruses, bacteria, autoimmune diseases and physical trauma for myself and others have been tested for/ have ruled out. For a while I have been convinced that it has been a malfunction with the stress system. But listening to this I’m interested if there are any doctors or med students listening to this may have some insights regarding too much exercise and pericarditis?
Your heart is meant to burn on free fatty acids, which is how it gets almost all its energy normally (not glucose or ketones), but if the heart is not getting enough oxygen it has to switch to glucose which is bad news. Whatever the root cause is it is probably making it difficult for the heart to get maximum oxygen and pushing beyond that point is a bad idea. Some fasting should help with the symptoms and probably the root cause too.
"ezetimide doesn't have side affects", I lost all deference to this doctor after that statement, Personally, I could hardly get out of bed after trying that drug! GO figure.?
Ask dr David Diamond about statins . He will explain the statistics behind the whole con.
All Peter. Hardly any okeefe.
His ego is too big
Brand name of a legit EVOO?
Name /url of certification for legit EVOO?
Doing low cardio and intense short HIT is bad advice
👏
Great vid. “Biological plausibility” = Bro science 😂
Dr Gundrys olive oil might be the real deal
Well dr Ken Berry I believe eats higher amounts of saturated fats cause he's a carnivore that eats lots of red meats and organ meats and Reddmans real salt
I just got trolled lol
“There are two kinds of cardiologists: vegans and those who haven't read the data.” Cardiologist Dr. Kim Williams.
The third type of cardiologist: Those who are wrong.
Stop this nonsense about endothelial injury!That's not how it works!
You are clueless