Today’s episode is a random musing inspired by Theodoric of York, Medieval Barber. In past posts, we have discussed the importance of looking at new and evolving data to frame our metabolic health rather than clinging to outdated dogma. Consider new perspectives!
Theodoric of York ALMOST got it. ALMOST. You can find this classic Steve Martin bit on YouTube or read below:
…unfortunately, we barbers are not Gods. You know, medicine is not an exact science, but we’re learning all the time. Why just 50 years ago we would’ve thought your daughter’s illness was caused by demonic possession or witchcraft. But now a days, we know that Isabelle is suffering from an imbalance of bodily humors. Perhaps caused by a toad or a small dwarf living in her stomach…
…Perhaps I’ve been wrong to blindly follow the traditions and superstitions of the past centuries. Maybe we barbers should test those assumptions analytically. To experimentation and scientific method. Perhaps this scientific method could be extended to other fields of learning. Like natural sciences, art, architecture, navigation, perhaps I could lead the way to a new age. An age of rebirth. A Renaissance!
Nah!
ALMOST!
In the last post, we talked about “Stepping away from the Seed Oils!”
In past posts, we posited that “Butter could Build a Better Brain.”
In past posts, PrimalRD encouraged us to be CURIOUS. What is in our food? What is banned? What was sprayed on our kale? What did that cow eat?
Stay Curious!
That’s the secret sauce! Stay curious! Crazy curious. I recently traded emails with an acquaintance who decided to pursue a degree in Architecture after years in the design field. Her motto she said, was “Stay Curious!”
Damn right! Be a lifetime learner! (Of course, I invited her to subscribe to Your PrimalMed Prescription and spread the word.)
Back to medicine and changing narratives.
Remember an older post when I talked about Coronary Artery Calcium Scores on CT, The Canary in the Coalmine? How does that translate to our thoughts on exercise and more importantly, excessive exercise? Stay curious!
How much exercise is too much? Does EXCESSIVE endurance exercise create increased rates of atherosclerosis? Is there a “sweet spot” of just the right amount of exercise?
Our current thoughts that long-term endurance exercise may lead to a paradoxical increase in coronary atherosclerosis was raised again by a new study. This study was presented at the American College of Cardiology (ACC) Scientific Session/World Congress of Cardiology (WCC) 2023 on March 6.
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehad152/7069916?login=false
The Master@Heart study looked at the presence of coronary plaques in lifetime endurance athletes vs healthy non-athletes and late stage (starting after age 30) athletes. The study looked at the presence of not just stable calcified hard plaques, but utilized CT angiography (a CT scan of the heart that uses an injected contrast or dye) to look at non-calcified soft plaques. Soft plaques are more likely to rupture and cause a cardiac event.
This study showed that lifelong endurance athletes (over 10-11 hours/week of at least moderate exercise) had more coronary plaques, including more non-calcified plaques, than fit and healthy individuals with a similarly low cardiovascular risk profile who were not long time “endurance athletes.”
"We consistently see higher plaque burden in lifelong endurance athletes. This is regardless of the plaque type, whether it is calcified, mixed, noncalcified, in the proximal segment or causing more than 50% stenosis," concluded Ruben De Bosscher, MD, Catholic University of Leuven, Belgium, during his presentation.
De Bosscher adds that "the worst thing you can do is nothing at all. As soon as you do a little bit of exercise ― just brisk walking or jogging up to 3 hours a week ― it seems that's where you get the most benefit. And after that, we tend to see an increase in coronary plaque burden."
The sweet spot, the study suggested, is mild-moderate exercise. Movement and exercise are CRUCIAL components of metabolic health. This study does not say that exercise is bad. Not at all. Like most things in life, there is a sweet spot and excess in anything may have deleterious downstream effects. The law of diminishing returns holds true.
So now what? Endurance athletes still have overall better health outcomes than couch potatoes. The study doesn’t look at mortality outcomes, just the presence of hard, mixed and soft plaques in vulnerable coronary arteries. What advice do we give to the population?
The most recent physical activity guidelines in the US recommend between 150 to 300 minutes of moderate exercise, such as brisk walking or 75 to 150 minutes a week of vigorous activity, such as running.
I agree. But how you exercise and HOW you fuel is probably going to be a most crucial factor.
The author of the study concluded, “Lifelong endurance sport participation is not associated with a more favorable coronary plaque composition compared to a healthy lifestyle. Lifelong endurance athletes had more coronary plaques, including more non-calcified plaques in proximal segments, than fit and healthy individuals with a similarly low cardiovascular risk profile.”
As a former marathoner, I am curious. The question I have is: “What did the lifelong athletes in this study eat? Were they carb-fueled Gatorade-guzzling GU gel chomping beasts, constantly fueling with sugar, and enduring insulin spikes and troughs? Could that be the cause of underlying inflammation?”
I think so.
More studies are needed of course, since this was observational and looked at only a few hundred subjects. At the end of the day, diet and lifestyle changes bests over-exercising. The old adage of “You can’t outrun a bad diet” holds true.
I would love to see a study looking at the cardiovascular risk factors and coronary plaque burden in the low carb/ketogenic athlete community. Should runners run? Of course! Should it be excessive? That depends on the person and their goals and underlying health. I would say in most middle-aged folks, proceed with caution and stick to moderate endurance exercise and focus on strength and resistance incorporating your PrimalMed push-ups planks and squats.
Bottom line: Scientific thought is not set-in-stone dogma. It is always evolving. Stay curious and read. At least read Your PrimalMed Prescription!
AND for you curious readers, future musings will include:
- Obesity! Is it to be thought of as a disease? Treatable by the new injectable drugs such as Wegovy and Ozempic? Is Obesity really a genetic disorder?
At what point do we choose to consider chronic disease as “Foodable” rather than “Druggable?” (Credit to Dr. Robert Lustig, a pediatric endocrinologist who coined this term and spoke at last years Metabolic Health Summit. His most recent book, “Metabolical” is a most worthy read).
Can we think of the root cause of most chronic diseases as treatable with diet and lifestyle (Foodable) as our default state BEFORE just looking for the next drug?
- More on Seed Oils! Can our current pandemic of “Overfed, Overfat and Obese” be explained by daily overconsumption of ultra-processed and oxidized seed oils rather than an issue of “Ya gotta eat less and move more, you gluttonous sloth!!!”
As an allopathic Physician, my training was rooted in the tenets to “Diagnose and Treat.” As a Radiologist, I diagnose. At PrimalMed, we are curious. Look upstream. Ask the why? Sometimes, the answer is not “I need a new drug.”
PrimalMed stays CURIOUS.
PrimalRD stays SUPER-CURIOUS.
I invite to you do the same.
TL;DR: Unleash your own Theodoric of York. Be curious and ask questions. Go one step further than Theodoric did. Don’t give up on your quest for knowledge!
Consider new approaches to the current wisdom and dogma. Read and share Your PrimalMed Prescription to friends and family so they can enjoy the musings on Metabolic Health as seen through the eyes of a curious radiologist!
Oh…and think “Foodable” rather than “Druggable.”