Interesting Conversation with my Cardiologist

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tonkadtx
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Interesting Conversation with my Cardiologist

Post by tonkadtx » Sat Nov 26, 2016 6:44 pm

So I had my semi annual Cardio visit and I had an interesting conversation with the cardiologist. This guy is 60, but looks 40, great shape obvious player (nothing but hot women working in the office). We talk about training, judo, etc. His new kick for everyone is lifting (relatively) heavy, sprints/hiit/burst cardio (based on your health and ability), and paleo/atkins/low carb as well as fixing other issues like sleep problems. I was somewhat surprised. The two books he recommended were "Strong Medicine", which I have read, and "Eat Meat and Stop Jogging", which I just bought the kindle version of.

I thought his was interesting in lieu of the general discussions we've been having about training, health, and ageing.

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Shafpocalypse Now
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Re: Interesting Conversation with my Cardiologist

Post by Shafpocalypse Now » Sat Nov 26, 2016 7:24 pm

IDK, seems like he's just slightly behind the time. I can't seem to get through Strong Medicine. Haven't read "Eat Meat and Stop Jogging"...I did read Grant Peterson's "Eat Bacon and Stop Jogging" which is a simple read with a similar message.

The carb thing is funny.

Extremely low fat, high carb diets have a similar effect to low carb, high fat diets.

Look up Walter Kempner and his high carb diet, which he used as a dietary intervention for 'malignant hypertension with kidney failure'.

From Wikipedia

"Kempner's implementation was very strict, but also careful - patients were hospitalized for several weeks at the beginning of treatment. The initial treatment was stopping all medication and putting the patient on a diet consisting of "white rice, sugar, fruit, fruit juices, vitamins and iron, and provided about 2000 calories, 20 grams of protein, and 700–1000 ml of liquid as fruit and fruit juices. Sodium content was extremely low, about 250 milligrams per day, and chloride content about 100 milligrams per day."[1] If results were good, after several months small amounts of lean meat and vegetables were added to the diet.

Kempner obtained remarkable results, and he was invited to present them at a meeting of the New York Academy of Medicine in 1946. His presentation survives and "presents clear and unambiguous evidence, including blood pressure charts, retinal photographs, chest radiographs, electrocardiograms and laboratory results, documenting the benefits of his diet."[1][A]

Kempner described his diet as "a monotonous and tasteless diet which would never become popular.... Kempner's only defense of its use was the fact that “it works,” and that the diet was preferable to the alternative of certain death"[1]"

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odin
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Re: Interesting Conversation with my Cardiologist

Post by odin » Sat Nov 26, 2016 7:42 pm

Hmmm, jogging ain't so bad for some either. Different adaptations to hiit. Either/or seems a bit like saying don't eat fruit, eat vegetables.
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tonkadtx
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Re: Interesting Conversation with my Cardiologist

Post by tonkadtx » Sat Nov 26, 2016 7:56 pm

Hmmm, jogging ain't so bad for some either. Different adaptations to hiit. Either/or seems a bit like saying don't eat fruit, eat vegetables.
Yeah, I'm starting to think Mark's Daily Apple has it right, Lift a couple of times a week, Sprint once, and move a lot but not very fast.

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Re: Interesting Conversation with my Cardiologist

Post by Shafpocalypse Now » Sat Nov 26, 2016 8:15 pm

Do cardio to help internally, do resistance to help externally...the rest is details

However, don't neglect the long duration steady state stuff in favor of intervals only.

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Re: Interesting Conversation with my Cardiologist

Post by Koko, Beware » Sat Nov 26, 2016 8:25 pm

Shafpocalypse Now wrote:IDK, seems like he's just slightly behind the time. I can't seem to get through Strong Medicine. Haven't read "Eat Meat and Stop Jogging"...I did read Grant Peterson's "Eat Bacon and Stop Jogging" which is a simple read with a similar message.
I must've walked by this book fifty times in our local bookstore before finally picking it up to see if it was what I thought it would be, which it was. Easy to digest, a good airplane book etc.

The paleos are funny...the more evangelical ones I know also seem to get 3-4 hours of sleep a night because they are too busy arguing with people online and getting upset about GMOs. That's sort of a joke but kind of not one either. There's a lot of bad shit that can go on even if you think you've got your diet dialed in. (And if you are eating paleo, lifting weights, and taking in about .25g protein/lb bodyweight...that is not dialed in.)

The jogging stuff, I feel like a lot of the folks who rail against LSD are imagining really overweight people pounding their joints into dust doing 3 suuuuuuuper slow miles (so yeah, going for a walk and pushing a prowler is probably better in that case) or folks hopping on treadmills going at much higher heart rates than true LSD would have you hit. Anyhow, just my impression and not meant to dismiss the MD in question above.
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Re: Interesting Conversation with my Cardiologist

Post by Thud » Sat Nov 26, 2016 10:11 pm

Shafpocalypse Now wrote:patients were hospitalized for several weeks at the beginning of treatment.The initial treatment was stopping all medication and putting the patient on a diet consisting of "white rice, sugar, fruit, fruit juices, vitamins and iron, and provided about 2000 calories, 20 grams of protein, and 700–1000 ml of liquid as fruit and fruit juices.

This was for hypertension. So he removed them from their stress and probably reduced their caloric intake.

Diet, lifestyle and exercise, how complicated does it need to be?
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Re: Interesting Conversation with my Cardiologist

Post by Sangoma » Sun Nov 27, 2016 10:56 pm

In kidney disease with reduced renal function it makes perfect sense to reduce the intake of protein and sodium, simply because in that situation kidneys cannot handle nitrogen load - and sodium. There is no reason to promote it to healthy population. Similar to very low carb/ketogenic diets for diabetics - good for them, but not of particular benefit to the rest of us and with a few side-effects.
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Re: Interesting Conversation with my Cardiologist

Post by Sangoma » Sun Nov 27, 2016 11:10 pm

Health recommendations seem to swing the other way, from cardio only to lifting and HIIT. Once again, the answer is in the middle: the mix of lifting, heavy and light, long runs, HIIT is what will give the most benefit.

Diet wise - there have been numerous fights about low carb here. At the end of the day it's whole foods and lower calories that will do the trick. As every grandmother would tell you.
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Re: Interesting Conversation with my Cardiologist

Post by Tirofijo » Mon Nov 28, 2016 1:35 am

I'm 45 with a family history of heart disease. My bloodwork is one the wrong side of borderline, at best.

It amazes me that science can't come to a consensus about preventing heart disease.

Take statins --- Statins don't work and the side effects are hell.

Eat a plant-based diet --- No, the China Study was fatally flawed.

Pay attention to your LDL/HDL ratio --- No, platelet size is the true predictor.

Do long steady state cardio -- Are you crazy? The oxidative damage will send you to an early grave.

-----------

What I'd like to know is if the vast majority of cardiologists/pathologists/researchers still believe in the AHA's recommendations, and all the naysayers (the people saying the things on the right of my little blurb above) are just a very vocal small minority (sort of like the 3% of scientists that think global warming doesn't exist.)

Maybe we do have a consensus but the new thinking is just getting all the press?


--------

Tonkadtx,

Your cardiologist sounds progressive. What's his take on traditional cholesterol numbers as a predictor of heart disease?

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Re: Interesting Conversation with my Cardiologist

Post by Shafpocalypse Now » Mon Nov 28, 2016 3:29 am

Tirofijo..I fucking feel for you. Why can't we have a straightforward recommendation that is true to help reduce CVD risk? Or even consolidate several differing opinions into assorted 'paths' to better CV health?

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Re: Interesting Conversation with my Cardiologist

Post by Sangoma » Mon Nov 28, 2016 6:13 am

Shafpocalypse Now wrote:Tirofijo..I fucking feel for you. Why can't we have a straightforward recommendation that is true to help reduce CVD risk? Or even consolidate several differing opinions into assorted 'paths' to better CV health?
Humanity managed to survive without official recommendations for centuries before various medical bodies were established. Besides infection (which has been taken care of by medicine fairly well) there only two ways a human can die naturally: consequences of atherosclerosis - majority of which is a heart attack - or cancer. If you live in the First World and don't do something extraordinarily stupid the chances of dying before old age is not high.

In this respect I would recommend books by Nortin Hadler. Puts medical media hype into proper perspective.
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Re: Interesting Conversation with my Cardiologist

Post by johno » Mon Nov 28, 2016 3:49 pm

Shafpocalypse Now wrote:Tirofijo..I fucking feel for you. Why can't we have a straightforward recommendation that is true to help reduce CVD risk? Or even consolidate several differing opinions into assorted 'paths' to better CV health?
Agree. The greatest killer of adults and medical "science" has no consensus solution. Not even a reliable predictor of heart disease, AFAIK.

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Beyond eating "well" and doing moderate cardio (brisk walks), I am working toward four 30 min. saunas per week. I probably wouldn't sauna if I didn't enjoy it.
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Re: Interesting Conversation with my Cardiologist

Post by Grandpa's Spells » Mon Nov 28, 2016 4:42 pm

Shafpocalypse Now wrote:Tirofijo..I fucking feel for you. Why can't we have a straightforward recommendation that is true to help reduce CVD risk? Or even consolidate several differing opinions into assorted 'paths' to better CV health?
Exactly. A sane version would have five models shown to work well, rather than nitpicking over sub-components.
One of the downsides of the Internet is that it allows like-minded people to form communities, and sometimes those communities are stupid.

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Re: Interesting Conversation with my Cardiologist

Post by Shafpocalypse Now » Mon Nov 28, 2016 4:52 pm

Saunas...I might have to join a shitty gym just to get access to one.

I love saunas, but usually in Texas I can just sit in my fucking attic for 8 months of the year and sweat.

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Re: Interesting Conversation with my Cardiologist

Post by Thud » Mon Nov 28, 2016 5:11 pm

I like my cardiologist, he's reasonable and honest. He looks at the controversial studies (like that ~75% of the people who have heart attacks have normal markers for cholesterol) and admits he doesn't know what to make if it. He says there are probably a dozen risk factors for CV disease (genetics, stress, weight, smoking, activity, etc) and cholesterol is one of the few that can be measured, thus, that is where the current emphasis is placed.

He also admits, re statins, that since the AMA and the like have guidelines most Drs have to cover their asses. If he doesn't follow guidelines and a patient dies he's subject to get sued and/or lose his license.

Putting all that aside, I asked him what he really thinks. He said his cholesterol is a little high and he takes nothing for it. He said that mine is very high and that the risk/benefit of a statin suggests I should probably err on the side of taking one, so I do so at a very low dose. My son has seen a renowned "complementary physician" (well versed in traditional as well as alternative medicine) and while there I bounced the controversy off him and he concurred with the Dr's rec and reasoning.

It's guesswork and hedging bets. They just don't know. Do what makes sense to you and live with it. It's cliche but the truth probably lies somewhere around: moderation.
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Re: Interesting Conversation with my Cardiologist

Post by TomFurman » Mon Nov 28, 2016 7:58 pm

LSD cardio. Like Cooper said, anything past 15 miles of running is for something other than fitness.
Optimal bodyweight.
Varied diet.
Check ups.
3 grams of combined EPA/DHA. If you are NOT involved in getting hit in the head with a stick or fist,.. 1/4 baby aspirin. [Try that in your pill splitter]
HRT when appropriate
Fiber
Sleep. Manage apnea with fat loss or one of those Bane masks.
Manage stress.
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Re: Interesting Conversation with my Cardiologist

Post by TomFurman » Mon Nov 28, 2016 7:59 pm

A note. I reviewed, "Strong Medicine" with an advance copy from John Ducane. Nicely made book but I feel it is weakly supported by evidence. Just my take. YMMV.
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Re: Interesting Conversation with my Cardiologist

Post by climber511 » Mon Nov 28, 2016 8:16 pm

TomFurman wrote:LSD cardio. Like Cooper said, anything past 15 miles of running is for something other than fitness.
Optimal bodyweight.
Varied diet.
Check ups.
3 grams of combined EPA/DHA. If you are NOT involved in getting hit in the head with a stick or fist,.. 1/4 baby aspirin. [Try that in your pill splitter]
HRT when appropriate
Fiber
Sleep. Manage apnea with fat loss or one of those Bane masks.
Manage stress.
Pretty nice list that most people should be able to do.

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Re: Interesting Conversation with my Cardiologist

Post by Blaidd Drwg » Mon Nov 28, 2016 8:29 pm

climber511 wrote:
TomFurman wrote:LSD cardio. Like Cooper said, anything past 15 miles of running is for something other than fitness.
Optimal bodyweight.
Varied diet.
Check ups.
3 grams of combined EPA/DHA. If you are NOT involved in getting hit in the head with a stick or fist,.. 1/4 baby aspirin. [Try that in your pill splitter]
HRT when appropriate
Fiber
Sleep. Manage apnea with fat loss or one of those Bane masks.
Manage stress.
Pretty nice list that most people should be able to do.

One thing I'm leaning towards (someday the evidence may catch up) is that if you are playing fast and loose with one of those...lets say Masters PL and you can't run optimal BW (I'm in the 220's now, the charts would have be in the 160's and in the best of all possible worlds I'd probably be 200-12) you'd better be prepared to UP the dose of the other good shit. (except the fish oli...We are gonna look back on that stuff in shame I think)

More Yoga.
More cardio
Tighter diet.

Sux to say it as I'm pretty far from that but I think that's where this movie goes.
"He who knows only his own side of the case knows little of that." JS Mill

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Re: Interesting Conversation with my Cardiologist

Post by dead man walking » Mon Nov 28, 2016 8:59 pm

why yoga?

i can think of a couple reasons, but i'm curious what prompts you to suggest it.
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Re: Interesting Conversation with my Cardiologist

Post by Shafpocalypse Now » Mon Nov 28, 2016 9:10 pm

IMO, yoga is convenient if you just pop in a disk or go to a class. Actually thinking up your own flexibility routine can be a bit of a pain in the ass. Yoga also tends to focus on breathing and mindfulness...which you can do with your own routine or practice, but it's not built in unless you build it in.

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Re: Interesting Conversation with my Cardiologist

Post by odin » Mon Nov 28, 2016 9:29 pm

Yeah I think with yoga - like Tai chi - you can probably get all of the benefits by doing other stuff. Eg you could practice some deep breathing for 10 minutes, then run a joint mobility session then relax for 10 minutes and either meditate or space out or whatever.... But chances are you wont, so just do the pre-packaged version. It's an easy win for a lot of shit we need as we age that you wouldn't otherwise do.

My off the shelf anti-aging list would be yoga, maffetone cardio (Tom's 15 miles recommendation is good) and machine or bw based strength stuff to battle atrophying muscles. 3 meals a day and a healthy amount of drinking with friends and family at the weekend.
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Re: Interesting Conversation with my Cardiologist

Post by climber511 » Mon Nov 28, 2016 9:35 pm

Blaidd Drwg wrote:
climber511 wrote:
TomFurman wrote:LSD cardio. Like Cooper said, anything past 15 miles of running is for something other than fitness.
Optimal bodyweight.
Varied diet.
Check ups.
3 grams of combined EPA/DHA. If you are NOT involved in getting hit in the head with a stick or fist,.. 1/4 baby aspirin. [Try that in your pill splitter]
HRT when appropriate
Fiber
Sleep. Manage apnea with fat loss or one of those Bane masks.
Manage stress.
Pretty nice list that most people should be able to do.


One thing I'm leaning towards (someday the evidence may catch up) is that if you are playing fast and loose with one of those...lets say Masters PL and you can't run optimal BW (I'm in the 220's now, the charts would have be in the 160's and in the best of all possible worlds I'd probably be 200-12) you'd better be prepared to UP the dose of the other good shit. (except the fish oli...We are gonna look back on that stuff in shame I think)

More Yoga.
More cardio
Tighter diet.

Sux to say it as I'm pretty far from that but I think that's where this movie goes.
Jury is still out on the fish oil. I think additional oils (different kinds) can have benefit but like most things - not to excess. I've been taking a tablespoon of olive oil (or flax, cod liver etc) with a tablespoon of apple cider vinegar in a glass of hot water with a teaspoon of honey for maybe 40 years now. My grandfather did it and it's a habit for me now - not sure if it does anything but doesn't hurt anything either I guess.

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Re: Interesting Conversation with my Cardiologist

Post by Blaidd Drwg » Mon Nov 28, 2016 9:51 pm

dead man walking wrote:why yoga?

i can think of a couple reasons, but i'm curious what prompts you to suggest it.
For me I say yoga because it forces me to do all the things I'm bad at doing. I've no reason to question the other folks above here countering with general flexibility or breathing exercises...it's just that when I've done yoga on the regular, everything else got better. I can think of a dozen or so reasons why that might be the case but I suspect...it's a stand alone event I can't get out of, it's directed by someone else so I'm actively learning and three it forces me out of my comfort zone in a lot of ways (setting/people/etc)
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