Podcast Episode #60: Why Do Healthy People Have Heart Attacks?

In this podcast episode, everything you need to know about reducing your heart attack risk, water intake during exercise, protein carb ratios for fat loss, detox and rashes, thyroid medications, testosterone, doping, drafting and Is too much produce a bad thing.

Welcome to the BenGreenfieldFitness.com podcast. We provide you with free exercise, nutrition, weight loss, triathlon and wellness advice from the top fitness experts in the nation. So whether you're an Ironman triathlete or you're just trying to shed a few pounds, get ready for non run of the mill cutting edge content from BenGreenfieldFitness.com.

So after last week's massive listener Q and A, this is Ben Greenfield back with a somewhat more normal podcast episode where we will have our special announcements, we'll have our listener Q and A and we have a featured interview today with a guy named Dr. William Davis and he's a pioneer when it comes to assessing your cardiovascular risk. He's written a book called Track youk Plaque and we're going to talk to him today about heart attack considerations for both athletes and the general population. Some of the important things that you need to know, some of the reasons why the tests that they're giving these days are outdated and it'll be an interesting discussion with Dr. Davis. Also got a lot of listener Q and A this week as well as a few special announcements and you're going to want to tune in to those. So let's go ahead and move on to this week's episode number 60 from BenGreenfieldFitness.com.

Special Announcements.

For those of you who may not subscribe to the newsletter or who may not have visited the blog at Ben Greenfield Fitness lately, I recently posted on something called Miracle Noodles and I'm not going to get into too much details on this podcast, but these were recommended to me by a physician. As a matter of fact a physician that we've had on this show, Dr. Roby Mitchell. And there's something that he had been using with his patients to help the people who really needed to decrease their starch and sugar intake but wanted to do things like still have pasta or noodle based meals. What these are are they're carb free, gluten free, fat free and calorie free noodle. You may have had these before. They're almost like a rice noodle, a little bit chewy and they are made from a japane and so in a similar way that stevia is made from a root and is kind of a calorie free alternative to sugar, you could consider miracle Noodles your calorie free alternative to pasta. I haven't been able to find them in a lot of grocery stores, but I was able to find a good source to get them online. And I also found out that ABC News did a story on these miracle noodles and how some people were using them. So what I did was I took that video from ABC News and I put it in the show notes to this podcast. And I also wrote an article article on the blog that I'll link to in the show notes of this podcast about miracle noodles, what they're all about, how you would use them, where you would get them. So check that out if you are really wanting to have your pasta but not take in the starches and the sugars. So the next thing is that we have completed the order for the Ben Greenfield Fitness and Pacific Elite Fitness Cycling jerseys and shorts. But for those of you out there who are not cyclists or not triathletes, who maybe want to get some threads with the Ben Greenfield Fitness logo on them, I have created a hoodie, a men's active singlet, a women's active singlet, something that you can use for weightlifting or running or jogging, cycling, and then also a kind of a trucker style hat. You can check out the pictures of those and also see where you can get them for an incredibly affordable price. Over at the show notes of this podcast, there's a black hoodie, there's a white men's active top, a white women's active top, and then kind of a black and white hat and it says BenGreenfieldFitness.com Fat loss, nutrition and human performance. So check those out. And there's a link to that in the show notes as well. And then the final announcement is that we are still trying to get people into the Pacific Elite Fitness Official 2010 Triathlon Training Camp where I'm going to be the head coach. And this camp is open to all levels. It's a really unique, completely all inclusive experience. It's going to be down in Austin, Texas and in January. The actual date is January 18 through January 25. If you're a triathlete, head over to the show notes and click on the link that's going to bring you over to all the details for that camp. In order to take advantage of the special pricing that we're offering on that, you have to sign up by October 31st. And it's incredibly all inclusive, includes all lodging, your meals, your coaching, your training, everything is all planned out and that can be Split actually into three payments of $439 to cover you for the entire camp. And that is an incredibly good deal because most camps of this level you'd get that, but it wouldn't be all inclusive. It would include your meals. You would have to be paying for that yourself. And considering that you can get into Austin for about 89 to 99 bucks one way from about any US city, this will be a pretty good deal for you. So those are this week's special announcements and we're going to move on to a jam packed Listener Q and A starting with a call in question.

Listener Q and A hi Ben, my name is Todd. I had a question about protein or I guess recovery supplements after a workout and I was confused. I see that some articles I've read indicate that a protein, a carbohydrate to protein ratio is best for Recovery, like a 4 to 1 type of ratio after a workout and other types of protein powders that are available that are more of a source of protein in general. I was just curious, with respect to fat loss, are any of those two options after a workout better than one versus the other as far as retaining muscle as you're losing weight or burning fat and as well as just general muscle recovery if you are training for endurance sports a five or six day a week type of training regimen? So I was just confused on which product or types of products might be best for someone in that situation. Thanks again. Enjoy listening to your podcast. Have a great day.

All right, Todd, that's a really good question, and this is one that I've gotten from many of the athletes who I work with who have read about the fact that research has shown it is ideal for recovery from any type of endurance activity as well as most types of sport conditioning activities, to take in a 3 to 1 up to a 4 to 1 carbohydrate to protein ratio after exercise. And so there's a bunch of different formulations on the market that are in a good way based on this research. You can take something like Hammer Nutrition's Recoverite or you could take Endurox R4. Those are two examples of that 3 to 1 or 4 to 1 ratio. Now the flip side to this is that when you do take in carbohydrates that can inhibit the amount of fat that you actually burn. And we walk a very fine line when it comes to accessing the body's fat stores, but also giving the body enough recovery fuel after exercise to where you don't get a cortisol release A drop in lean muscle mass, an attack on your immune system. And so the general rule that I follow with the athletes that I work with or with the clients who are exercising but still want to lose fat is we will take the most important and the most difficult workout sessions, the ones that are really considered to be structured workouts, typically of an hour or longer in duration. And those are the workouts that we really focus on refueling extensively for and using something like that 3 to 1 or 4 to 1 ratio. Now for some of the shorter, what I would call fat burning efforts, you can actually get away with not fueling either before or after the workout. So you can do something like a morning nice easy fat burning session that's at your fat burning heart rate, that's typically about 50 to 60% of your maximum heart rate. You cannot eat before that session. And you can even delay eating for one to two hours after that session and actually tap into fat stores without doing a lot of damage to your body because the type of fat burning exercise that you engaged in was not tearing up muscle or not necessitating a, a very aggressive recovery measure. Now you contrast and this is the other part of your question. Those 3 to 1 and 4 to 1 ratio carbohydrate to protein mixes with the stuff that's just pure protein. And there's a few different ways that you can use something like a pure protein that doesn't have a carbohydrate with it. One thing that I'll use that for is an evening snack when you don't want a lot of carbohydrate, you don't want to spike the insulin levels, but you do want to take advantage of the fact that protein can actually cause a nice little growth hormone release which causes fat burning and helps with forming and recovery for your lean muscle mass. You can actually take whey protein a couple scoops of that, put it in a little bit of water, stir it up, or a little bit of fat free yogurt, stir it up and take that in before bed and have a nice primarily protein based snack. The other thing that comes in handy for is if you don't have access to one of these three to one or four to one carb to protein mixes. You can take something like a scoop of protein powder and consume that along with a, for example banana and a handful of whole grain cereal after workout and get that 3 to 1 or 4 to 1 carbohydrate to protein ratio. The other thing that I'll use the whey protein for is to actually substitute for carbohydrate in some of the meals that I would normally cook. Typically for breakfast meals I will substitute pancake mix or waffle mix with about a one to one ratio of protein powder to the pancake mix or the waffle mix. I substitute for about a half cup of the oatmeal oatmeal that I eat in the morning. Now about a scoop and a half of the Mount Capra double bonded whey protein powder and that works really well. So the whey protein can be used as a source for cooking as well. Now if you're somebody who can't tolerate whey protein, a lot of different forms of protein out there. Pea protein, hemp protein, soy protein. You gotta be a little bit more careful with rice protein is also out there. So there's a lot of different sources in addition to the whey protein. But Great question, Todd. And remember, if you have a question you want to do the call in thing like Todd did, you can call the 800 number at 877-209-9439 and listen for your option to leave a question for the BenGreenfieldFitness.com podcast. I will put that toll free number in the show notes so you can surf over there. Write it down. Say you're driving along in your car and you realize you wanted to ask me a question. Whip out that 800 number, call it up and ask. The other thing that you could do is you could Skype Pacific Fit, which is my online Skype name. So let's go ahead and move on to the next question for this week. And this question is from listener Jason, who says a little bit of a long question here. Morning, Mr. Greenfield. Parenthesis. You said you liked that. I do like that. I do like it. When you call me Mr. Greenfield again, it makes me feel old and responsible. Been doing some flying lately and become a fan of listening to your podcast. I was hoping you could give me some feedback on an issue I had in my first try I competed in a week or so ago. Basically the issue is that on my run I got severe stomach cramps and suffered from ab muscle pain for a few days after the event. A little bit of background and history is that I am in good shape, probably about 15% body fat. I trained for the event for seven weeks and felt good going into it. I had some cereal and a slice of toast for breakfast. Okay, good, good breakfast. That's what you want to do. Avoid fats and proteins. Have that carbohydrate. Jason, I don't know if you had it two hours before the race, but that's about what you would want to do. And he goes on about 16 ounces of water. Then after getting to the course, had a cliff bar. That was probably a mistake. Jason, you don't need to take in any more food after breakfast. That's just going to sit in your stomach. Just before the race, I had a goof. Jeez, dude. This was a sprint triathlon. You could have rolled out of bed and done this with no fuel, but you ate a lot. Did the 300 meter swim in 5:47, then did 15 mile bike in 47 minutes. I had two bottles of water while doing the bike portion. Regular bike water bottles. In my transition to the run, I had half a small bottle of Gatorade. That's where the problem started. Got out of the T2 area and started getting stomach cramps, which hung around for the entire run, which slowed me down to about 28 minutes instead of the 25 I was hoping for. I did the race in 1:24, which was six minutes faster than what I was going for. But I'm very competitive and want to improve. Any help you could give me would be appreciated. Someone said it was because I drank too much liquid. Okay, Jason? Yeah, I would agree with that. Someone who said that you drank too much liquid. Look at it this way. About the amount of liquid that your body's going to be able to tolerate during activity is right around 17 to 24 ounces and up to about 30 ounces per hour during exercise. Looking over what you took in, we have that 16 ounces of water that you had for breakfast. And I'm not sure if breakfast was two hours before, like I said, but let's just say that it was. And then I'm not sure if you took in any water between breakfast and the race. You may have been sipping on water, but then you had two bottles of water during the bike portion, which you said took you 47 minutes. So you had twice as much water as you needed during the bike. You got off the bike and you had half a small bottle of Gatorade, so there's more liquid. And at that point your stomach was cramping not only from all the liquid that you took in, but also from the fact that you ate a ton. And this is one of my pet peeves. Here's my little rant. A lot of the fueling that people do for triathlon, it's based off of advice. That's trickle down advice from Ironman Triathlon, where You eat or you die. In a sprint triathlon or even in an Olympic distance triathlon, you can get up and do that event just fine with zero fuel. Your body has enough fuel stores on board to be able to get through about two hours of exercise. Now, granted, you don't want to do that because sugar in your system can make you feel like you're not working quite as hard, and it can keep you a little bit more motivated mentally. There have been a couple of research studies that were done on that, but you took in way too much. What I would have done is stuck with the breakfast that you had. I would have skipped that clif bar that you had just before getting to the course. You didn't need that right before the race. The goo. Yeah, you could do that. I often encourage people to have, like, a gel with a little bit of caffeine in it to give them a bump about five minutes before the race. And then for a sprint distance triathlon, at that point, clear water. That's all you need. Unless you plan on being out there for a very long time. You know, two and a half hours and you're going super slow. You might be able to take in a little bit extra, but literally just pure water, the equivalent of one water bottle per hour. And really for a sprint triathlon. Now I'm going to turn to your speed because you're saying you're very competitive, you want to improve. Little insider secret that most of the people who cross the finish line first are dehydrated when they cross the finish line. The speed that you have to race at in order to get to a podium finish does not allow for you to drink as much as you ideally should. So best case scenario, you might get a chance to take a couple of sips of water during that bike. But we are looking at a race where you are only out there if you are really going as fast as you want. Maybe an hour and 15 minutes. For any of you who have gone to the gym without a water bottle and exercise for an hour and 15 minutes, it's doable, you can make it. And you just think about how much time you save not taking the water breaks and how much more of an aerodynamic position you can hold. And it makes sense. So, Jason, taper off that fueling a little bit and taper off that hydration a little bit. Unless you're going out and doing an Ironman triathlon. And then moving on to listener Malia. And just a little background on this question. Malia was one of our competitors in the Shape 21 Lean Body Challenge. As a matter of fact, Malalia came in second in that challenge. If you want to see a picture of Malia and it was pretty amazing what she did, you can go check out shape21.com and actually see Malia's progress. Not her progress, but her final results, her impressive before and after photos and what Malia says is doing the shape 21 thing made me start researching raw food diets since it is very similar. I don't think I told you, but in the second week of Shape 21, I had a very bad cold. I took it particularly hard because I had not had a cold in about four years. I was afraid I was doing something wrong with your diet and exercise plan. But in learning about raw foods, this is a normal occurrence due to detoxification. I don't remember that being in your book. If I missed it, I guess that is par for the course because I missed several other things the first time through. But if you did not include it, may I recommend adding it? And Malia, I think that's a wonderful suggestion because that happens with almost everybody that I work with that comes to me. That is not eating an incredibly clean diet or that has fat cells that they need to burn through. Because as we talked about in last week's podcast, when your body is in a toxic state, toxins can hide and embed themselves in your body fat. And the fatter you are, the more toxins that you store. So this can cause your body to actually not function properly, become sluggish, lose efficiency. But when you actually start to lose weight, the fat that you're using as energy is basically broken up and burnt as energy. But the toxins that were stored in and around that adipose tissue is released. And this can cause a variety of kind of annoying symptoms. You know, headaches, mucus production, rashes, flu like symptoms, joint pain. And this can stay with you for a few days as you are burning through a lot of fat, as you're cleaning up your diet. And those are typical symptoms of detoxing. It's kind of like when I try to get people to give up some of the sugar that they're eating at night or to kind of back off their starch intake. What happens is they feel very sluggish and very slow for a few days as their body begins to utilize fat as a fuel. And if they're eating a clean diet and not living in a a polluted area, not exposed to a lot of cleaners, not taking in a lot of toxins from Preservative foods, preservative laden foods and processed foods, then that's about all they get. But if they were actually eating a fairly unclean diet, then they, along with that sluggishness, will get a rash. A lot of times it's on the arm, sometimes in the midsection of the waist. I've had some people that I get down to about 10% body fat. And as we take off the last few pounds of body fat, this is usually with the guys who we're trying to get really flat abs with, we'll see a little bit of a rash appear in the midsection as we eliminate that last little bit of fat. So absolutely that is a fairly normal occurrence. We're going to move on to a question from listener Drew. Listener Drew says on a somewhat related note to the pollution question, I have a question that also relates to the harmful chemicals of our modern day world. Let's suppose that an athlete is on a tight budget and honestly cannot afford to buy organic produce. Let's suppose that he or she can only afford non organic produce. Do you think it might be better in this case to forego produce altogether and consume the necessary vitamins and minerals from other sources? In other words, does ingesting huge amounts of harmful pesticides or genetically modified produce outweigh the benefits the produce may provide? Well, Drew, it is true that there are a lot of herbicides, a lot of pesticides, and more of the herbicides and the pesticides on the produce that's non organic. That's kind of one of the definitions of organic produce is that they haven't sprayed it with a lot of that stuff. But foregoing produce altogether, it does not take into account the fact that there is an option you haven't considered and that would be actually removing as many herbicides and pesticides, pesticides as possible from the non organic food that you purchase. And you can do this very easily by taking that produce home. And this is just an extra step that you'll need to make a part of your lifestyle. And you take that produce, you put it in the sink, you fill the sink with water until the produce is submerged, and then you dump about a half cup of vinegar into the water, kind of stir the vinegar in, let your produce sit for about 10 minutes, and then take it, it rinse it and put it in the vegetable crisper in your refrigerator. And that will remove a lot of those herbicides and pesticides. Yes. If they weren't farmed using organic methods, you may notice that there's not quite as many minerals, quite as many nutrients in that produce, but you're still going to remove some of the herbicides and the pesticides. So that's what I would do. And as a matter of fact, to take that even one step further, if you go and look at the archives@bengreefulfitness.com and you go back and listen to the interview with Dr. Ann Louise Gittleman, she actually does that same thing. But she uses Clorox, which blew my mind when I heard about this. And I personally haven't switched to using the Clorox. But she had a very logical rationale for why she used it and why she has a lot of her patients use it. And so you could go and listen to that as well and get some tips on it. She called it a Clorox bath. Or you could probably just Google Clorox bath and read more about that way to actually soak your produce to remove some of the harmful chemicals. I in no way think that you should try to replace all your produce with vitamins and minerals because there is a synergistic effect of what you get from say a whole piece of fruit that you're not going to get from the isolated vitamin C and the isolated phytonutrients and the isolated antioxidants from that fruit. It's one of the mysteries of nature that scientists still haven't quite figured out. But you actually get more benefit from eating the fruit itself rather than all the extracted ingredients from the fruit or from the vegetable. So good question. Listener Pete says. Hi Ben, Got a more general question in regards to the Ironman and half Ironman bike leg. Whenever I listen to the pros talking via podcast, they always mention riding with or being dropped from the group. Are they talking about riding together with a three bike lane gap or are they just straight out drafting? Also, I noticed the wtc, which for those of you listening stands for World Triathlon Corporation, have introduced anti doping laws across the board for pro and age group qualifiers. I'd like to know your thoughts on what percent of people are actually cheating both pro and age grouper. Do we have a big problem in our sport? Well, Pete, let's address the first part of your question. And that's about when the pros say that they're riding with or being dropped from the group. What happens is that up near the, especially up near the front where everyone's riding fairly competitively is people are for the most part not drafting in terms of breaking that bike length rule that they have set. Three bike Lengths. In some triathlons, it's up to four. In others that you see, it's about seven meters. But if you have ever tried sitting on the wheel of another cyclist that's seven meters ahead of you, it really is quasi draft legal. And it does help you out quite a bit. I've heard people say that you can get a draft as far back as 50 meters, and when a car passes you on the road, you can definitely feel that draft for quite some time after a car passes you on your bike. But the idea is that the pros have to learn how to use their competition effectively, but also ethically in the triathlon, when they're drafting or when they're talking about being with the group, they're not drafting in a way that breaks the rules of the sport, but they are catching a draft that's within a legal draft zone. And you can easily experiment for yourself and see how much energy you save by keeping those seven meters between you and the bike in front of you. You also realize that they give you a certain number of seconds. I believe it's 20 seconds now, it might even be 15 in WTC to pass a cyclist. And that's another area where you do get a little bit of a draft. And there is some passing that goes on back and forth among the pros near the front of the pack. That gives them a little bit more of a slingshot, if you will, past the competition. Now, they will actually get a draft penalty if they are seen slingshotting quite frequently, meaning passing, dropping back 15 seconds and then and doing it again and basically leapfrogging each other. But as long as it's done here and there, a little bit adds up, especially over 112 miles. And yeah, they are, in a way drafting, but it's legal drafting done quite strategically. So the second part of your question with regard to the WTC enforcing the anti doping rules. So I think that there are a lot of supplement companies out there that a lot of age group athletes are using in their training and in their racing that may not be 100% clean. So if you want complete peace of mind that you're not doping or that if you do qualify for the World Championships and get tested, that you're not going to test positive. What you want to look for is that whatever supplements that you're using are approved by the wada, that they are actually what's called WADA certified, and they're tested for WADA prohibited substances. And WADA is the World Anti Doping Agency. The other thing that you can look for is that the product is produced in what's called a CGMP facility, which is a current good manufacturing practices facility. Probably the one supplement or the one supplement company that I use that would most toe the line when it comes to, well, gosh, is that just an ergogenic aid or is it illegal? Would be Millennium Sports because I use their Cortagen product, I use their electrolyte product, I use their creatine product, their nitric oxide product. I use a lot of stuff from that company. That company is 100% WADA approved, it is C GMP certified and it's something that I can actually use with peace of mind. Every year I qualify for either the Half Ironman or the Ironman World Championships since I started doing those distances. And I'm not concerned at all about testing positive because the only other supplements that I take are just vegetable supplements and omega 3 fatty acid supplements. So in terms of the number of people that are cheating, I don't think there's that many people cheating. In terms of the number of people who are cheating without knowing it, yeah, there probably are quite a few people because there's a lot of supplement companies that are out there. And if you take someone that was just into general fitness and then got into triathlon and they were used to ordering all their supplements from say something like bodybuilding.com, yeah, I can't guarantee that some of those supplements are 100% clean. So you just have to be careful. I really think that most triathletes are fairly ethical, but that sometimes they might be taking things into their body without even knowing about it. Finally, we have a question from Listener Jim. Listener Jim had a little bit difficult question. He says, I take Armour Thyroid. Should I consider specific times that I dose in the morning on race days? I currently dose once a day in the a.m. when I wake up. Also I take Androderm testosterone patches. I also have some gels. I take three per day and usually replace them when I go to bed. They are 5mg for a total of 15mg per day. I understand you are not a doctor, but I would like to know if the levels of both of these prescriptions affect performance. Now, for those of you listening in, Armour Thyroid is a natural alternative to something like Levothyrox, which is primarily what's called a T4 based supplement. Whereas Armour Thyroid is what's called a desiccated thyroid supplement, which means that it comes from essentially the ground up thyroid of like a sheep or a pig. And it's higher in what's called T3. And what a lot of natural physicians and a lot of now allopathic physicians are realizing is that when you take something like levothyroxine it just replaces the body's T4 levels. And you can often get a better response in someone who has hypothyroidism or someone who has a low thyroid and is experiencing weight gain when you give them just a little bit of T3 along with that T4. And that's what the armour thyroid is. It's something that I actually recommended to someone back in my podcast on 8 Ways to Improve your metabolism, because this person was on a synthetic thyroid and I was recommending that they actually switch to an armor if their physician was willing to speak with them about that. I think that in that case they ended up just going and ordering it themselves from a Canadian pharmacy. But, but I don't really recommend doing self dosing. I definitely recommend going hand in hand with a physician who knows what they're doing anyways though he says about that armor thyroid, should I consider specific times that I dose in the morning on race days? T3, which is what's in that armor, that's pretty short lived. It usually spikes and then declines pretty quickly. And so a lot of people will split their armor thyroid doses up throughout the day like into two to three portions throughout the day. Either way though, that's going to be best absorbed and utilized by your system if you take it on an empty stomach. And so that means if you're getting up in the morning and you're eating your race morning breakfast two hours before the race, then you're going to want to get up and take Your armor Thyroid 2 1/2 hours before the race for optimal absorption. Now here's the quandary is that because it spikes then declines very quickly, it might be out of your system. The actual T3 effect might be out of your system by the time you tow the starting line. If you are hypothyroid then that might leave you a little blah, a little sluggish right about the time that you're supposed to be starting the race. So the other option would be you could eat your breakfast, wait a couple hours, let some gastric emptying occur and then take your arm or thyroid dose about a half hour before the race. And what a thyroid medication does is it will increase body temperature, it will speed up metabolism, and technically this could be conducive to enhanced exercise performance. There are some physicians that argue that not only that no patient needs to use T3, but also that T3 could be dangerous, that it could actually negatively affect exercise. And when I went through and looked for research to show that T3 could actually cause you to not have as effective an exercise session or could experience adverse health effects during exercise, I could find no research that showed that at all. I do know that based off of just the fact that pharmaceutical companies have a huge amount of sway in the education of physicians these days, that they're not big fans of using Armour Thyroid as an alternative to levothyroxine or synthroxin. And that may be the reason that there is a little bit of jadedness against armour thyroid and T3. And then the other reason that I know that people wonder about it is that Muhammad Ali took a bunch of his thyroid supplement that included T3 prior to the match that he actually lost. He took an overdosage of T3 and that excessively high dosage left him weak, fatigued, and a pretty poor match when he fought Joe Frazier. And so I know that there was kind of like an urban legend out there that T3 would impair exercise. The one thing that I did find in terms of T3 and muscle mass was a study that investigated the mechanism of reduced exercise tolerance in hypothyroidism. And essentially all this study found was that long term use of a hypothyroid medication caused more protein catabolism and lean muscle mass loss when compared with a control group that was not on the T3. And so the fact that you're taking a testosterone supplement is probably good. The other thing that I would bear in mind is that you would want to make sure that you are taking in a complete amino acid profile and you are actually doing things like lifting weights. Because that study did show that T3 could cause a little bit of protein catabolism. But that wasn't immediate, that wasn't short term, that was long term. Let me just see if I can find how long that study actually went for. It doesn't actually say the number of days. Okay, two weeks. Yeah. So what that means if you're taking it right before a race, obviously you're not going to undergo two weeks of protein catabolism right before the race. So of course it would be ideal if you didn't have to take a hypothyroid medication at all. But that's not the scenario. And so we're just trying to figure out what would be practical versus what would be ideal. And then your Other question about the Androderm testosterone patches, for those of you who are listening in. Androderm is something that a lot of older males will take to prevent what's called andropause, which is the natural decline in testosterone as you age. Big, big difference between the amount of testosterone that's in Androderm and the amount of testosterone that is in, say, what you would see someone in the Tour de France wants taking as an illegal substance. So the deal with testosterone is that it is a proven performance enhancer and that if the Androderm cause you to test high for free testosterone in a situation like we were talking about above with Pete's question, then you could be DQ'd. Androderm is classified under the Anabolic Steroids Control act as Schedule 3 controlled supplement. And that puts in the same category something like Andro, which you saw a lot of baseball players using. So again, you'd be banned from the sport if high enough levels of testosterone were found in your system and you were using this stuff. And what high enough levels would be considered under WADA rules would be any ratio of testosterone to epitestosterone that is greater than 4 to 1. Now, how much testosterone are people taking that are testing at these levels? 100 plus per day, and in some cases well above 150 milligrams per day. Jim is taking 15 milligrams per day, and it's not even an orally administered testosterone that he's taking. It's a time release patch. And so there's very, very, very small chance that you would test positive if you're using this stuff. And I would not encourage those of you who are healthy young males who aren't testosterone deficient to rush out and get your hands on Androderm to bring your testosterone levels back up and legally enhance your performance in triathlon. You do have to be careful with artificially replacing your testosterone levels. But in Jim's case, I do happen to know from another contact with Jim that he is taking this for medical reasons. And so I think it would be fine for him to continue as a physician has advised him to take testosterone. Now, the one final caution is that oral Androderm has been associated with fluid and electrolyte disturbances, meaning that it's caused people to retain sodium chloride, water, potassium, calcium and phosphates. And once you're getting up to the longer distances, like half Ironman or Ironman distance, that would be something that it could be prudent to avoid. So you may just want to back that off a few days before a race of that distance. So great questions this week. Remember, if you have a question you can email me BenGreenfieldFitness.com you can call 877-209-9439 and leave me a voicemail. I love to get your questions and I will try to answer them to the best of my ability. But remember that nothing that I say on this podcast is meant to be medical advice. It's not meant to replace the advice that would be given to you by your physician. I do recommend that for any medications or any medical conditions that you do, go speak with your physician and not use this podcast as your sole means of getting advice. So with that being said, let's go ahead and move on to this week's interview with Dr. William Davis on tracking your plaque and reducing your cardiovascular risk.

Featured topic.

Hey podcast listeners, this is Ben Greenfield and on the other line I have Dr. William Davis and Dr. Davis is the author of Track your Plaque Plaque, which is described as the only heart disease prevention program that shows how new CT heart scans can be used to detect, track and control coronary plaque. Dr. Davis is a cardiologist and the medical director of Milwaukee Heart Scan, a member of the Nutritional Magnesium association, and he basically created the Track youk Plaque program to help apply cutting edge technology in heart disease prevention. So thanks for coming on the show, Dr. Davis.

Well, thank you Ben. Good to be here.

I'd like to hear a little bit.

More about your background in cardiology and how you actually progressed to create this Track youk Plaque program.

Well, my background starts as many of my colleagues did, and that is about 15 years ago. I was young and full of testosterone. All I wanted to do were high tech cardiac procedures. So I had trained to do that and that's what I did for the first several years of my career. Back then I did the angioplasties, atherectomies, laser atherectomy, all those fancy devices you heard about in the past. And that's what I did from 7am till 9pm at night. And I think I did it fairly well. My mother died. My mother died at age 62 and this was about three months after she had her own angioplasty at a very high quality facility in New Jersey where I'm from. And it took me a while to sink in, but I realized that what I was doing really was a fruitless exercise that is stenting, atherectomy, ballooning, all that stuff was nothing more than a fancy band Aid for disease that continued, all you buy at best is a little bit of time. And so I began to think a lot and explore about this notion of can we track the progression of this disease? And even better, can we identify its causes and put a stop to it? And that was the genesis of this notion of what I call track your plaque. Plaque meaning atherosclerotic plaque. And tracking it. Bennett gives you a whole new perspective on this disease when you think of it as something you can follow, measure, track, and even manipulate. And in the years I've been doing this, if you set your sights on achieving a goal, I can tell you that in the first few years, we did not achieve it. But as time has gone on, I've gotten better and better at it. And through this online process called Track youk Plaque, as well as what I do in practice, this and the concepts I articulate, we're getting a lot better at it. Our current record, by the way, for reversal of plaque is 64% reduction.

Now, it's my understanding, I guess, that couldn't you already test for plaque? Isn't that something people have always been able to do?

No, it's only something that's been possible in the last decade or so. Before then, you'd have to have a heart catheterization or have something obvious happen like a heart attack or a bypass in order to have heart disease detected. Stress testing is a kind of a mainstream means of detecting coronary disease, but only detects coronary disease in its advanced stages. In other words, has to be a blockage sufficient to block flow in one of the coronary arteries for an abnormality to be detected in a stress test. And so the vast majority of people, people walking around have plaque yet have no knowledge of it. So what you and I really need is a real easy, low risk test that we can use to identify plaque. Now, additionally, cholesterol testing has been the means to tell people whether or not they have plaque. Unfortunately, cholesterol fails more often than not, and too often it leads to nothing more than cholesterol drugs, as you probably know. And so we need a test of the disease itself, and the disease is plaque. Cholesterol is only one small item band on a long list of causes that leads to plaque. And so one of the ideas I try to pass on is that there are many, many things that cause you and me to have plaque. Cholesterol is one little item on the list. There are many others. There's no doubt that cholesterol is the most profitable cause of of plaque. It's not necessarily the most important cause. And if you and I set our sights on achieving control over plaque, perhaps even tipping the scales in our favor to reduce plaque, then we need to identify all the causes and correct all of them. And that may or may not involve cholesterol.

I see. So if you could paint a picture for me and for the audience. If someone in the past was concerned that they might have cardiovascular cardiovascular disease or wanted to screen themselves prior to, say, preparing for a triathlon, then contrast for me what they would have done in the past to discover heart disease versus how they would actually look at heart disease risk Using this track your plaque method.

A triathlete might be a special situation in that this person is going to push themselves to very high levels of effort. That person may still need a conventional stress test because the question may not just be the presence of plaque, but maybe the safety of exercise. And that question still is answered by this traditional standard test called the stress test. If the stress test is abnormal, it means there's plenty of plaque and that person does indeed have coronary disease. Now, let's assume we have a triathlete who is fit, obviously, and has no symptoms and maybe has a very bland cholesterol pattern. And that person just wants to know if they have plaque or risk for long term risk for heart disease. Then a plaque measurement, that is a heart scan, will tell that person whether or not they have plaque or not. It's a very easy test. We're talking about a 30 second, literally a 30 second test that does involve a small quantity of radiation and some expense because the insurers don't like, like to pay for this test, just as they balked at paying for mammograms for the first 30 years of its history. Likewise with scans. But it's money well invested because it tells that person if they have plaque or not. So if a triathlete feels well, he can do his ironman, no problem, but he has, let's say, a heart scan score. That's how the result was reported, let's say, of 300 at age 52. We know that person has long term potential over the next several years for having heart attack, development of symptoms and those kinds of things.

Interesting. Can you explain just to the people, because this is something that I discovered recently. I wasn't aware of the concept of silent plaque.

Well, virtually all plaque, I should say most plaque is silent. That is for all the people who are going to have a heart attack or have bypass or three stabilization or something like that at some point for many years, will have silent plaque. So if John Smith has a heart attack at age 55, he had silent plaque for the preceding 30 years. So it's those years or decades of this disease of atherosclerosis that accumulates and risk accumulates with it. So most plaque is silent plaque until it finally expresses itself as chest pain or angina or heart attack or something other, some other catastrophe.

Okay, so let's say that I want to know if I actually have plaque buildup going on in my arteries, whether it be. I personally am a pretty healthy guy, but I'm interested in finding out from just a genetic standpoint if perhaps it's something that I'm at risk for. Can you walk me through the process of what's involved with actually getting one of these heart CT scans from the point where do I find out how to get one, and what process do I go through once I show up at the scanning center?

Well, it's a little bit different in every state, more or less. You'll see ads for heart scans. You can call your local hospital and see if they can perform a heart scan for you. Up to a few years ago, there were only a handful of scanning centers nationwide, about 200 of them. Now there's many of them because.

The.

Newest scanners, called multidetector or 64 slice scanners, have been adopted by hospitals. So hospitals, oddly, have become the centers of heart disease prevention for heart scan purposes. And so it really just boils down to calling your hospital or watching the ads or calling the scan centers in your area. There are listings for these places on our website, trackyourpluff.com Regrettably, we haven't been very good about keeping that up to date. There's another website called, I believe it's.

Called.

Scancenter.Com, something like that, that lists nationwide scanners. The scan centers have changed so rapidly that all of us have had a difficult time keeping track nationwide. All the scan centers but those websites or just some phone calls in your area should uncover Bose centers that are capable of doing a scan. Now, the best scanners are the electron beam scanner and 64 slice Connecticut scanners or better. Those two are the most accurate, least radiation scanners. And by the way, I should mention that there's a lot of confusion about the fuss about radiation exposure made by the media. What the media has been fussing about that is the test that introduces a radiation exposure of several hundred chest X rays is not a hard scan. That's another test called ct, coronary angiogram. And those tests, while they do generate wonderful images, do require a lot of radiation. And that is not a heart scan, though some newspapers and magazines and TV shows have called them heart scans. The simple heart scan you and I want, that is this means of measuring plaque is a low radiation test.

Okay, gotcha.

So you can schedule your heart scan. It's a process. Paperwork takes 10, 15 minutes. The scan itself is literally just a minute or so, and then you're done. And then you get your results, usually in a few days after the physician overreads the scan, and you get a score. And the score is nothing more than the quantity of calcium in the arteries. It's the tripping point. Most people have a hard time understanding, but it's very simple. You're given a score, for example, 250, and that's a calcium score. And the reason why we measure calcium is because it's easy to see and it's very easy to precisely quantify. Now, a lot of critics say, but calcium is not the disease. The curious thing IS calcium occupies 20% of the volume of all 20% of total plaque volume. In other words, if, for instance, I have 2 cubic millimeters of calcium, I've got 10 cubic millimeters of total plaque. So using that relationship, which, by the way, holds true in men and women and older people and younger people, I can know how much plaque I have in my heart's artery. Arteries. So the calcium score you get from a heart scan is nothing more than an indirect gauge of the total amount of plaque you have in your arteries. If I know how much plaque I have today, I can track that over time. And we make it our goal to stop it from growing or to reduce it. Interestingly, Ben, in the studies that have examined what happens to these heart scan scores, in other words, if you have a heart scan today and you have it again year or two, the average rate of growth of these scores is 30% per year.

Wow.

When I saw those data several years ago, that was an eye opener. In other words, if we know that the score is going to increase 30% per year, if we do nothing, we should do something and we should try to manipulate that score. I can tell you, having seen this in people who have not made the effort to stop plaque growth, it does indeed grow at that rate. It's a very frightening phenomena if you don't stop to it.

Interesting. So when I go in to get this scan done, they're simply going to do an injection run the scan, and then do I get Instant feedback or do you actually get feedback later on after the test?

It varies from scan center to scan center, but by the way, there's no iv, there's no injection, you wear your own clothes, you lie down, hold your breath once, and the scan time varies between 12 seconds and about 40 seconds, depending on the variety of scanner used. So it's very, very easy. There might be some confusion with the CT coronary angiogram, where there is indeed an iv, an X ray dye and all that stuff, but for a simple heart scan, this little kind of mammogram of the heart, you and I don't need an iv, don't even have have to change our clothes. Now, some scan centers have a very nice policy of having the CT technologist sit down with you and go over the scanner because the physician is usually not there. Some occasional centers do indeed do that, where the cardiologist or the radiologist is sitting right there. But most centers, it'll just be a technologist who then points out some of the features of your heart scan, and then you generally get the results several days later after the interpretation by the cardiologist or the radiologist.

So with as many triathletes, athletes and active individuals who are listening to our show, should they care about this? I mean, are there certain individuals that should be worried about the early detection or the prevention of heart disease? Or is this something that's pretty much limited to the people who are eating hamburgers and living sedentary lives?

No. You know, there's a very interesting conversation in your question, and that is elite athletes have an unusual propensity. Contrary to popular opinion, there is a subgroup of people who are elite athletes who are in fact at high risk for heart disease. You've probably heard these stories. You'll hear about the marathon runner, for instance, who has a very high heart scan score, or the guy who finished 25 marathons, yet ends up with a bypass surge operation. So unfortunately, the media often says, puts it like, does marathon running cause heart disease? Which unfortunately, that's simply not true. The question here is there's something hidden in this person genetically that drives the risk for heart disease. And that risk can be easily uncovered by a simple heart scan. So if a marathon runner finished a 26.2 mile run last Tuesday, but has a heart scan score of 400 today, we know that person has long term risk. It doesn't mean they should stop their marathon efforts. It means a very serious effort to control the risk needs to be undertaken.

Sorry to interrupt, but in your experience, do Those type of people have any symptoms prior to having something like a cardiovascular episode during an event or a training session.

Many do not. And that's the dilemma that people who, our elite athletes tend to be fearless and often simply don't want to accept that there really is risk. But I've seen it happen. In fact, I take care of several marathon runners and athletes. Now, interestingly, this is a little bit complicated, but there's a subset of causes of heart disease. It's a genetic cause called lipoprotein A. This is peculiar to people who have high aerobic capacity. It's a very unique and very fascinating, by the way, genetic pattern. And it's passed on very cleanly from mother to father. I'm sorry, from parents to children. So if your father, for instance, had a heart attack at 42 and you're 43, it's a very good time to think about being screened for heart disease. And this lipoprotein A genetic pattern is very passed on. And it seems to be passed on mostly in people who have high aerobic capacity. So I tell my patients with lipoprotein A, if you want to see a whole bunch of other people with a similar pattern, go to a marathon or a triathlon, and you'll see a whole bunch of people who share your pattern. Now, the wonderful thing about, like, is that while it's a high risk for heart disease, it is something that can be corrected. It's a little bit more difficult than, say, giving a person a drug for high cholesterol. It takes a little bit more effort, a little more insight, but it is something that can be controlled in the majority of people. You just have to know whether you have it or not. But the first issue to settle is whether or not there's plaques. If you're a marathoner and you have a heart Scan score of 0, your risk for heart attack and those kinds of catastrophic things in the next five to 10 years is close to zero.

So if you actually worry that you have plaque or find out that you have plaque via one of these scans.

What type of things can you do.

Aside from, I guess, surgery to actually reduce your risk or increase the chance that you're going to survive even with the plaque?

There's plenty, Ben. And one thing I would like to stress is heart scans have sometimes been used by some of my colleagues as a means to get people to go through procedures. I'd like to make clear that is a misuse of this test. In other words, if the only aim of a heart scan is, is to find out who needs a stent or a bypass. That is a misuse of a test. In other words, there are no doubt some people who are so far along the process of heart disease that they have their disease uncovered by a heart scan. But the vast majority of people, in other words, people who are, well, who feel fine just want to know if they have long term risk and they happen to have a score. These people do not need a procedure. They might need a stress test, test at most. But the vast majority of people who feel fine just want to know if they have long term risk and have a positive score do not need procedures. Unfortunately, I still see these stories of so and so has a heart scan, his life was saved and he had a bypass surgery. A great many of those procedures never need to be done. So I don't want to give anybody the impression that a heart scan is a means to identify need procedures. Heart scan is a wonderful tool for prevention. What can you do to put a stop to the risk posed by plaque? Well, first order business identified the causes. And so everybody's cause may be unique. So if it's a marathon runner whose dad had a heart attack in his 50s, one of the things to think about is lipoprotein A. And so someone needs to take the effort to identify the causes. Vitamin D deficiency. A big, big cause. Ben, if there's one nutrient that your audience pays attention to, it's vitamin D.

Yeah, we've heard that from so many physicians on this show, we'll chalk another one up to vitamin D based off what you just said.

Fish oil. Omega 3 fatty acids is a widespread deficiency in correction of omega 3 fatty acids is a wonderful tool. That alone reduces risk for cardiovascular events substantially. One of the things we pay attention to is thyroid health. We're seeing, I'm in Wisconsin and we're in the part of the country often called the goiter belt, that is enlarged thyroids from lack of iodine. Men, we're seeing it come back, the goiters that are coming back. And the iodine deficiency is not as bad as it was in 1923, but it's coming back. And one of the consequences is thyroid dysfunction, which can then express itself as accelerated plaque. And so one of the things we pay attention to is normalization of thyroid measures. So those are the basic things. Identify the cause, correct some of the common deficiencies. And that simple formula achieves stopping of the increase in heart scan scores or even a reduction in score in great people.

Should people be thinking about magnesium based off of the relationship between plaque formation and calcium.

Magnesium is yet another supplement that we use to address the deficiencies of modern life. So magnesium, as you know, has been taken out of most municipal drinking water and it's actually most bottled water. And so magnesium deficiency is becoming almost an epidemic nationwide. And that has implications because if your magnesium is low, your blood pressure is a little bit higher, blood sugar's a little bit higher, insulin responses are distorted, and you have more potential for heart rhythm disorders. So magnesium, you're absolutely right. Magnesium is becoming a larger issue as time passes.

Interesting. So the impression that I'm getting from you is that not only do you have the general population who could be walking around with plaque, not knowing it, and maybe even getting stress tests that aren't necessarily going to identify their risk, but we've also got this subset of athletes, marathoners and triathletes who would also be considered at high risk based off of their levels of lipoprotein A, their genetic predisposition to a heart attack during exercise. Is that correct?

Absolutely. I think the easiest way to sift through the uncertainty is what I've been preaching all along is for everyone, a male over 40, females over 50, to get a heart scan. And you'll know with great confidence if there's risk long term for heart disease.

Is there a certain age at which one should begin to track their plaque?

Yeah, I think the age cutoffs we generally use is a male 40 and over, females 50 and over. Unless there's something in your past or in your family's history that suggests that heart disease starts sooner. For instance, if my dad had a heart attack at age 38, I should probably think about it five to 10 years earlier than 40. So I might get my heart scan as early as 30 or 30, 35 because of my family history. But speaking 40 from males and 50 females, and that's worked out pretty well. That's based on, by the way, the data that shows that asks the question, at what point do men and women begin to show positive scores?

Right, right. Well, interesting. This has been really good information and I'm looking forward to getting this out to our audience. Did you have any other resources to which you'd like to direct the audience? Actually, I'm going to put a link to trackyourplaque.com I'll put a link to your book as well about the heart disease prevention program there on the website. Anything else that you would like to mention?

Of all things I do, Ben, ironically, my blog seems to draw the most fire and the most traffic.

Okay.

And your blog address is the easiest way to find it without having to give you a lengthy URL is just to put the phrase heart scan into the Google search. I usually come up in the first.

Few choices Google search. I'll find it and link to it in the show notes as well. All right, well, thank you for coming on the show and sharing this information today, Dr. Davis.

Oh, thank you, Ben. It was a pleasure.

All right.

So if you want to go check out Dr. Davis website, it's trackyourplaque.com I'm going to put put a link to his book in the show notes and I'm also going to put a link to his website in the show notes so that you can find out more about that in future interviews that we have coming up. We're going to be talking about organic farming methods and remineralization of soil. We're going to be talking about women's hormone issues and man. Some very interesting topics on that for both guys and girls, especially guys out there. Wives, girlfriends, moms, daughters, you're going to want to listen to this stuff. I've got a follow up discussion on my blood, saliva and urine testing that I did with bioetics and Dr. Richard Cohen that's going to be incredibly interesting. It's going to blow you guys away once you find out the type of things that my body was actually deficient in just because it'll give you a way to find out a little bit more about your body. And then we're going to be doing upcoming part podcast from Kona. I'll be down there at Ironman from October 4th through October 11th. I will be hopefully getting a few interviews in during that race. I'll be attending the Hawaii Ironman medical conference. And so if you're going to be down there in Kona, make sure that you say hello or drop me a line. So until next week, this is Ben Greenfield. Make sure that you check out the new T shirts, hoodies and singlets over over at the show notes of this podcast. Check out that video on Miracle Noodles. I'm serious. Quick clip from ABC News. And then also of course tune in to the brand new Pacific Elite Fitness triathlon training camp for you multi sport athletes out there. Have a great and healthy week. Sa.