← The Peter Attia Drive

#134 - James O'Keefe, M.D.: Preventing cardiovascular disease and the risk of too much exercise.

Oct 26, 2020 2h 9m 25 insights
<p>James O'Keefe is a preventative cardiologist and bestselling author of The Forever Young Diet and Lifestyle. In this episode, James discusses cardiac physiology and what makes the human heart susceptible to disease. He provides evidence for what supports his approach to exercise--elucidating both positive and negative kinds of exercise for heart health. He also discusses the role of nutrition, specific nutrients, and pharmacological interventions to support heart and brain longevity.</p> <div> </div> <div>We discuss:</div> <div> <ul> <li>James' background and why he favors a preventative approach to cardiology [3:15];</li> <li>Understanding atherosclerosis and the misconception that it's a "plumbing problem" [10:15];</li> <li>The danger in excessive exercise—a reverse J-shaped mortality curve [21:15];</li> <li>The story of Micah True—A case study of excessive exercise [49:15];</li> <li>The best kinds of exercise for longevity—The Copenhagen City Heart Study [53:00];</li> <li>Being a more balanced athlete and finding the right exercise intensity [58:45];</li> <li>Heart rate during exercise, resting heart rate, and other important metrics [1:04:00];</li> <li>Nutrition for cardiovascular health [1:09:45];</li> <li>Important nutrients: Magnesium, potassium, calcium, sodium, and collagen [1:19:30];</li> <li>SGLT2 inhibition for diabetes, cardio-protection, and general longevity [1:24:15];</li> <li>GLP-1 agonists for weight loss and reducing cardiovascular risk [1:34:15];</li> <li>Statins—Mechanism of action, safety, and useful alternatives [1:37:25];</li> <li>A 40-year view on cardiovascular risk, and the possibility of reversing arterial calcification [1:45:45];</li> <li>Evidence for high dose EPA and DHA for the reduction of cardiovascular disease risk [1:53:30];</li> <li>The impact of omega-3, curcumin, and other compounds on mental health and dementia [1:59:00];</li> <li>James' focus beyond cardiology [2:02:15]; and</li> <li>More.</li> </ul> <p>Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> <br /> Show notes page for this episode: <a href="https://peterattiamd.com/JamesOKeefe">https://peterattiamd.com/JamesOKeefe</a> <br /> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> <br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> <br /> Connect with Peter on <a href="http://Facebook.com/PeterAttiaMD"><u>Faceboo</u></a><u>k</u> | <a href="http://Twitter.com/PeterAttiaMD"><u>Twitter</u></a> | <a href="http://Instagram.com/PeterAttiaMD"><u>Instagram</u></a>.</p> </div>
Actionable Insights

1. Adopt Pesco-Mediterranean Diet & Fasting

Follow a pesco-Mediterranean diet that is moderately high in fat (from nuts, extra virgin olive oil, fish), very low in refined carbohydrates and added sugar, high in vegetables, and low in processed foods. Incorporate daily intermittent fasting for at least 12 hours, preferably 14-16 hours, to improve cardiovascular health and prevent chronic diseases.

2. Eliminate Sugar, Refined Carbs

Prioritize eliminating sugar and refined carbohydrates from your diet, as they are identified as the absolute worst dietary villains contributing to obesity, high triglycerides, and diabetes.

3. Start with 15 Minutes Daily Walk

Begin exercising with a brisk walk for at least 15 minutes a day, aiming for 150 minutes per week, as this small amount of activity can lead to a significant 30% reduction in serious cardiovascular disease.

4. Adopt a Balanced Exercise Portfolio

Incorporate a diverse range of physical activities beyond just aerobic exercise, such as yoga, strength training, and activities that improve balance and flexibility, to support overall health and longevity. Avoid over-specializing in one type of intense exercise.

5. Prioritize Social Exercise Activities

Engage in sports that foster social interaction and reduce stress, such as tennis, badminton, or soccer, as strong social support is a significant predictor of longevity, potentially more so than intense solitary exercise.

6. Train for Longevity, Not Peak

Distinguish between training for peak athletic performance and training for longevity, as the former often involves volumes and intensities that can be detrimental to long-term heart health, especially after middle age.

7. Moderate Exercise for Longevity

Avoid extreme or protracted high-intensity exercise, especially after age 40-45, as it can cause micro-damage to the heart, overstretching chambers, and leading to conditions like atrial fibrillation. Focus on moderate, consistent activity rather than superhuman volumes for long-term health.

8. Aim for 8,000-12,000 Steps Daily

Strive to achieve 8,000 to 12,000 steps daily, mostly through walking, as this level of activity is associated with a significant reduction in mortality.

9. Monitor Resting Heart Rate

Track your resting heart rate as a key feedback mechanism for tuning your lifestyle, aiming for a lower rate by optimizing exercise, sleep, alcohol intake, and stress management, which indicates a cardioprotective zone.

10. Get a Heart Calcium Scan

Men over 40 and women over 60 should consider getting a cardio scan (calcium score) to assess their risk of heart disease, as a zero score may indicate less need for certain interventions, while a positive score signals a need for action. This test helps determine the presence of arterial plaque, which is a strong indicator of past inflammation and future risk.

11. Lower Insulin Levels Naturally

Aim to keep insulin levels low by exercising regularly, minimizing belly fat, and adhering to a diet free of sugar and easily digestible refined carbohydrates, as high insulin levels can accelerate atherosclerosis.

12. Use High Polyphenol Olive Oil

Choose extra virgin olive oil that is high in polyphenols, identifiable by a black pepper-like stinging sensation at the back of the palate 10-20 seconds after swallowing, as these antioxidants are crucial for long-term health.

13. Salt Whole Foods to Taste

When consuming a diet rich in whole, natural foods that are naturally low in sodium, feel free to salt them to taste, as this can enhance palatability and encourage greater consumption of healthy options.

14. Increase Potassium and Fiber Intake

Increase your intake of potassium and fiber, as modern diets often provide significantly less of these essential nutrients compared to our ancestors’ diets.

15. Supplement Daily Magnesium

Consider supplementing with approximately two grams of magnesium daily, as many people are deficient, and it serves as an important cofactor for essential bodily reactions.

16. Supplement Collagen and Bone Meal

Consider supplementing with collagen (pills or powder) and organic bone meal (for calcium hydroxyapatite, around 1 gram/day) to support hair, skin, nails, bones, and muscle health, reflecting a ’nose-to-tail’ ancestral diet.

17. Supplement High-Dose Omega-3

Consider supplementing with 2-4 grams per day of high-quality EPA and DHA omega-3, as many people are deficient, and higher doses have shown remarkable reductions in cardiovascular events, especially for those with triglycerides above 150.

18. Omega-3 for Mental Well-being

Take a high dose of omega-3 daily to significantly improve mental health, as deficiency is common and correlates with depression, ADHD, and cognitive issues.

19. Use Highly Absorbable Curcumin

Incorporate a highly absorbable curcumin (like theracurmin) into your regimen, especially if at risk for Alzheimer’s disease, as it can significantly reduce inflammation (TNF-alpha) and improve brain function.

20. Consider SGLT2 Inhibitors

Discuss with your doctor the potential benefits of SGLT2 inhibitors, even if you don’t have diabetes, as these drugs have shown to reduce heart failure, renal failure, and cardiovascular death by burning belly fat and raising ketones.

21. Practice SGLT2 Inhibitor Hygiene

If taking an SGLT2 inhibitor, pay special attention to hygiene by using a wet wipe after urination, especially for females, to prevent topical yeast infections due to increased glucose in warm, moist areas.

22. Explore GLP-1 Agonists for Weight/CVD

Consult with your doctor about GLP-1 agonists like semaglutide for safe and effective weight loss (up to 10% body weight) and cardiovascular risk reduction, even if you are not diabetic.

23. Consider Statins for High Risk

If you have existing heart disease or have experienced a cardiovascular event, discuss statin therapy with your doctor, as these medications are thoroughly tested and proven to improve prognosis by reducing MI, stroke, and cardiovascular death in high-risk individuals.

24. Explore Statin Alternatives

If statin intolerant, discuss alternative cholesterol-lowering medications like ezetimibe or PCSK9 inhibitors with your doctor, as they offer effective ways to reduce cholesterol without the common side effects of statins.

25. Adopt Long-Term Health View

Shift your perspective from short-term (e.g., 10-year risk calculators) to a 30-40 year view of health, especially for cardiovascular mortality, to proactively implement preventative strategies for long-term well-being.