Run for your life! At a comfortable pace, and not too far: James O’Keefe at TEDxUMKC

Run for your life! At a comfortable pace, and not too far: James O’Keefe at TEDxUMKC

August 16, 2019 100 By Bertrand Dibbert


Translator: Herald Park
Reviewer: Denise RQ Hello, great to be here. I’m a cardiologist, but before that,
I was an exercise enthusiast. I’ve exercised, I bet,
pretty much everyday of my life. I had two grandfathers
who were alcoholics. But for me, my way
of copping with life is exercise. When I’m nervous, anxious, tired,
happy, sad, or whatever, I exercise, if I have the time,
and sometimes even when I don’t. You might have seen me
in an airport, waiting for a flight, running up the down escalator
with my backpack on, to kill 20 minutes. But I always thought that exercise was
the best thing for my heart, and I think that’s how I decided,
at age 15, I wanted to be a cardiologist. But now that I am 56 years old,
and a lot of decades have gone by, I’ve started to have a few warning sings
from my heart; a couple years ago I noticed this, and I got on a mission. I’m a research cardiologist,
and I have a research fellow. We have been working on this
for a couple years, with the help of some of the brightest
cardiologists from around the country, we came to some startling new insights
that seem to emerging about exercise. This made me think twice
about my lifestyle, and I’m worried that I may have
made a lethal mistake. I hope it’s not too late,
but let me tell you the story. So, as I said, I have been
exercising for a long time. But if we go back 2,500 years,
there is a guy named Pheidippides who ran the 26 miles from a battle field near Marathon, Greece, into Athens to proclaim the news about
a momentous victory over the Persians. When he arrived at the emperor’s throne
and said, “Victory is ours,” he abruptly collapsed and died. Now, you may have heard that story before, but what you probably didn’t know is that
Pheidippides was an accomplished runner. He’d been a Greek herald
messenger his whole life. He ran a lot of miles everyday, I bet he was the fittest guy in Athens
the day he died. That’s strange. But now let’s go forward
two millennia or more. When the Baby Boomers came of age,
another boom happened: the running boom. If exercise was good for you
as anybody could know, then more had to be better, and the ultimate test of running
and endurance was a marathon. There was a physician who became famous
back in the mid-70s by boldly proclaiming that if you could complete a marathon,
you were immune to heart attack. This urban myth actually still
holds sway with a lot of physicians. One of my patients and friends is John. He is 68 now, but he’s been
running for 45 years. As he puts it, if he hasn’t run
twelve miles in a day, he felt like he was wimping out. When I saw him, he came
into see me, and I said, “John, let’s do a cardiac scan,
a CT scan, simple, little, non-invasive, quick, high tech scan of your heart. Your arteries, I’m sure, will be
soft and supple, clean and healthy. So that’s what a normal
cardiac scan should look like: no calcium whatsoever
in these arteries. His is over here; his score was 1,800. Anything above zero is abnormal, anything over 400 is severe; at 1,800,
his arteries are harder than his bones! That can’t be good, and he didn’t have
any other risk factors to speak of. So in fact, people do die
during marathons, but let’s be realistic. If you look at the latest data,
the risk is minuscule: 1 in 100,000 participants. I’ve gotten to be friends
with a guy named Amdy Burfoot. Amdy won the Boston Marathon in 1968. He is currently editor-in-chief and has been a long time editor at large
at Runner’s World Magazine. In conversations we’ve had
in recent months, he has challenged me. “If endurance extreme exercises
are so bad, show me the bodies.” He’s got a good point;
1 in 100,000 is a pretty low risk. But I’m not so worried about that; running is supposed to add years to your life,
and even life to your years. So, could it be shortening
your life expectancy? I’m not worried about
dropping into a risk, I am just trying to do
the right thing, I’m a cardiologist, I’m the business of finding out
the ideal diet and lifestyle. I’m coming to the conclusion
that running marathons and extreme endurance athletics
do not fit into that recipe. So, that being said,
let me be clear about this: there is no single step
you can take in your life to ensure robust health
and remarkable longevity than a habit of daily exercise. This is a study of over 400,000 Chinese
that was just published last year. We published an editorial
along with this afterwards, but they found vigorous exercise,
this is all cause mortality reduction, the more reduction the better,
and this is minutes of daily exercise, so 10, 20, 30 minutes of daily exercise. At 45 or 50, you get a point
of further plateau, so further efforts and time do not appear to convey further improvements
in life expectancy. Down here is light to moderate exercise:
walking, housework, day to day moving around; just get off
your seat and move around. More is better there; it’s not quite
as beneficial as vigorous exercise, but more is better. You can exercise all day it seems, without getting yourself in trouble
if you keep it down. So, one of my heroes, I love evolutionary medicine, I think if you look in the world
of nature and into our deep past, you can find the template for
ideal health, even in our modern world. Charles Darwin was wrong
about one thing though: it’s not the survival of the fittest. No, in fact it’s the survival
of the moderately fit, OK? If the best you can do
is walk one flight of stairs before you have to rest,
things are not looking good. It could be a bumpy ride
in the next few years. On the other hand, if you can dance, lightly swim, or even jog six miles
an hour, that’s a ten minute mile, that’s a pretty comfortable pace, right? Your mortality plummets, and if you,
after warming up on a treadmill, can achieve a speed of seven
to seven and a half miles an hour, you are pretty much bulletproof,
when you look at outcomes. In fact, further attainments
of peak fitness do not translate into further increases in life expectancy. It plateaus out. In fact there’s even a little trend
that it might even go up a little bit. So, the important concept is
that dose makes the poison. It’s true with a lot of things,
and if we could come up with a pill that gave all the benefits
that we get from exercise, I’d be looking for work. In fact, exercise not only cuts
your chance of premature death in half, but it reduces risk of heart disease,
Alzheimer, osteoporosis, depression. It is an amazing drug, but just like
any drug, there is an ideal dose range. If you don’t take enough of it,
you don’t get the benefit. If you take too much of it,
it could be harmful, maybe even fatal. When you’re sitting here, listening,
sitting around like most Americans do, doing nothing, your hearts pumping,
just idling along about a gallon a minute, about four, five liters a minute. If you went out, went for a run
right now, and you ran hard, that would go up
four, five or even sixfold. Five, or six gallons a minute! That is a workout,
your heart is working hard, but that’s what it’s meant
to do, intermittently. You know maybe 5,10, 30 minutes,
and maybe up to 60 minutes but by 60 minutes
something starts happening: the stretch in the chambers
starts overwhelming, the muscle’s ability to adapt, the catecholamine
and adrenaline levels rise, the free radicals blossom,
and it starts burning the heart. It starts searing and inflaming
the inside of your coronary arteries. We’re not really meant for
these sustained levels of exercise, for hours at a time. If you go to a marathon,
and this has been done several times, you take a troponin level
at the end of the marathon, over half of them will have
elevated troponins. What’s a troponin? Troponin is a sacred chemical
to us cardiologists. When we see that a troponin
goes up it means one thing: heart muscle has died. Normally, we hop into action
because that generally means there’s a heart attack going on,
we need to get a vessel open! In this case, these are little micro tears
from the stretching and the searing, and it’s not a big deal if you do it once. These are little micro tears, they heal; a few days later it’s gone,
the heart’s back down to normal size. But if you do this over and over again,
the chambers start dialing up, they get scarred, they get stiff,
they thicken. If you look closely you can see
these little white patches in these veteran
extreme endurance athletes accumulate and for people who have been doing this
for years and decades, their heart becomes older before its time. We’re asking too much of it,
it’s overwhelming the heart’s capacities. This is a fascinating study
done by a cardiologist that I know, and whose son is also a cardiologist. These two were both avid runners
up in Minnesota. They did a study looking at the CT scans,
like I’ve shown you of John’s, looked at a group of marathoners who
have been doing this for at least 25 years at least 25 marathons in that time
compared to secondary controls. You can see here that they had 62%
more plaque despite fewer risk factors. People say, “That can’t be true.” In fact, a German cardiologist
just replicated this study showing a 108 marathoners
with similar findings. Hard to dismiss. Veteran endurance athletes
also have a five fold increase risk of atrial fibrillation,
a dangerous irregular heart rhythm. There is sort of an epidemic
of this going on among runners because we’ve only been doing this
for a few decades and it takes a while for this to develop. Even more worse, when we see this,
as cardiologists, our pupils dilate, our heart rate goes up;
this is ventricular tachycardia, which is a potentially
life threatening rhythm, and we can see this from the scarring in the ventricle
in some endurance athletes. So “Born to Run” is a book
that was published, a non fiction book, published just in 2009. The hero of this story
is a guy named Micah True. He dropped out of American culture, went down to live
with the Tarahumara Indians in the northern part of Mexico
in the Copper canyons. He was an epic runner, legendary for his ability to run
long distances, hundred mile races. The Indians down there nicknamed him
“Caballo Blanco”, the White Horse, for his ability
and his remarkable endurance. So Micah True died, sadly,
at 58 years of age, on a routine 12-mile run, in the wilderness of New Mexico,
in March of this year. When they did the autopsy, they found an enlarged, thickened
heart with scar tissues. The coroner said,
“idiopathic cadiomyopathy.” But I’ve looked at that path report,
and it reads like a description of the pathology we might expect to see
in some extreme endurance athletes. My colleague who wrote
some of these papers with me, Peter McCullough, has coined the term
“pheidippides cardiomyopathy.” That’s what he had. There are a couple papers that are
coming out in the next two months, and we’re publishing
a couple papers as well. They are going to change
the thinking about exercise. This is one of them by Chip Lavie,
one of my colleagues, and maybe my best friend. He down in Oshner Clinic in New Orleans,
and this is a look at 50,000 runners. 52,000 people followed for decades,
on average 15 years but up to 30 years. They compared the non-runners,
about 38,000, to the runners, about 14,000 and what they found was that runners
did live longer, 19% longer, but if we look closer,
you’ll see that the runners, compared to the non-runners,
for the risk of death, the reference is one. If you ran more 25 miles per week,
your benefits went away. You only got 25-27% reduction
in mortality rate. If you ran between 5 and 20 miles
a week, ideally 10-15 miles a week. When we looked at the running speed,
sure enough if you ran too fast, over eight miles per hour,
which is a 7:30 pace, the benefits went away. Now they weren’t worse
than the non-runners, but heck if you’re running that much, you would think you’d get
some health benefits, but no, you have to back off
to a six or seven miles per hour pace, which is about a ten miles per hour jog. Interestingly, how many days a week? Seven days a week if you’re running,
the benefits go away. You need to run fewer days,
two to five ideally. So another study that’ll be published soon
is this one from across the pond. The Copenhagen City Heart Study
compared the non-runners to the runners and found the same thing; the relationship appears much
like that of alcohol. Mortality is lower in people
reporting moderate jogging than in non-joggers
or those undertaking extreme exercise. The moderate joggers got a 44% reduction
in mortality, they live six years longer, but it went away if you over did it. So the truth is that exercise does confer
powerful benefits, and the belief is “more is better”. But we’re learning that more
is not better in this case. One of my good friends Meghan Newcomer
is a triathlete from New York City. She grew up next door,
a dear family friend, she’s one of the top
triathletes in the country. She did ten races last year,
and she is 30. She won half of them. The other half she collapsed from heat exhaustion, dangerous
heat exhaustion near the end of the race. I told Meghan, “Meg, if you want
to be in the real Olympics, which you very well could be,
you just keep hammering away, maybe up your game a bit. But if you want to be alive and well for the 2052 Olympics, 40 years from now, you need to back and way off. Back your pace off and find
some healthier exercise pattern.” So there’s one last study
that I want to tell you about. This is a study from last year
that looked at mice. They hammered these mice,
they ran them to exhaustion, every day, for four months,
and you know what? This replicated those same findings
that we saw in Micah True, and the other findings
that I told you about. But what provides hope to me
is that when they took these guys off their iron mouse training regiments,
their hearts came back down to normal. The fibrosis even melted away,
and their ventricular irritability and atrial fibrillation
tendencies, all gone. Well, I’m a man not a mouse, but here’s hoping
that maybe that works in humans too. Anyway, we’re not meant to run.
We’re not born to run, I should say. We’re born to walk; we need
to be walking more today. We need to be strolling, we need to be moving
our body rather than sitting. Every chance you get, move, and do some high intensity
interval training from time to time. But personally, I’ve found that what I do
now is I’ve shorten my runs up. I go, when I run, I run a one and a half
to, at the most, three miles, but typically about two miles. I take the pace down, and I walk
with my wife, play with the kids, and stop in meadows
or parks, and do some yoga. When I’m swimming, rather
than churning away, I go on my back, and I do some nice gentle backstroke. I watch the clouds sail overhead,
and see the birds soaring in the sky, and I can feel my heart relaxing,
healing, and getting better. So all things in moderation
is not a new concept. This was something that one
of Phidippides’ contemporaries, the father of medicine said,
2,500 years ago, “The right amount
of nourishment and exercise, not too much, not too little,
is the safest way to health.” So I’ve never presented in my 30 years
as a cardiologist such controversial data. But the truth is,
this is a U-shaped curve. The couch potatoes are using this as an excuse to continue
their sedentary behaviour. Then there’s the whole
extreme exercisers, people like me, who don’t want to hear this mess; in fact,
they kind of want to kill the messenger. I’ve been getting a lot
of adverse comments about this research. But you know what I’ve decided? It is that you need to snuggle in to the safety of the middle of
the “U” curve when it comes to exercise. Or when it comes to anything else in life. To me, I’ve decided
that running too fast and too hard is only going to speed up my progress towards the finish line in my life. So I’ve decided to back it off, and hopefully, enjoy
more sunrises and sunsets. Thank you. (Applause)