Why Fit Does Not Equal Healthy

Ever hear about the long distance runner who died of a heart attack? The risk of this happening is extremely small. According to a study published in the New England Journal of Medicine in January 2012, out of 11 million long-distance runners, 59 people suffered cardiac arrest, 51 of them men. Being fit did not make them healthy!

Are you one of those people who believe that if you exercise your health will automatically be good? Should you worry about over-exercising? Is too much of a good thing (like exercise) bad for you?

While exercise has widespread effects on the body, I am going to focus here specifically on heart disease. In a recent article on Bloomberg TV, reporters Natasha Khan and Shannon Pettypiece reviewed how fit men between ages 40-60 are dying from cardiac arrests related to their training for triathlons or Iron Man races. The 40-to-60-year age bracket, often referred to as middle-aged men in Lycra, or Mamils, are often extremely fitness conscious. They frequently find themselves at a time in their lives when they can afford to exercise more regularly, and are still buoyed to some degree by testosterone levels that have not yet waned. So – why are these fit men dying? Should their exercise not protect them from this?

Unfortunately for these men, having a normal treadmill stress test is not good enough. While data shows that exercise does offer protection for heart disease when studying large populations, each person should be approached individually.

Let’s look at some underlying concepts:

Exercise as a rule is a good thing. Even after heart attacks, exercise can help with new vessel formation around the heart. Exercise in general helps stop plaque buildup in the artery wall. These cholesterol-laden or atheromatous plaques may line the artery wall – blocking the blood flow. Plaques may be calcified or “hard” plaques, or more brittle “soft” plaques. In general it is the soft plaques that break off, clog the artery and result in sudden death or heart attacks.
These plaques don’t simply arise spontaneously. They depend on having underlying high blood pressure, abnormal cholesterol levels, high blood sugar levels, high homocysteine levels, high inflammation, tobacco smoke exposure, genetic risk and more. Men are more inclined to have these problems than women. A myriad of other factors including diet, psychological stress and toxins in the environment play a role in the formation of these plaques.
So, while exercise helps, especially in moderation, there may be other genetic or environmental factors that tip the balance in favor of making more plaque. Very strenuous exercise may be associated with increased oxidative stress (or “rusting”) of the artery walls, high blood pressure surges, less sleep and increased stress on the body. Coupled with other risk factors, intense exercise can aggravate underlying heart disease.

Hopefully, this will make you think a little differently about your heart. If you understand that heart disease is multifactorial in its origin, you can understand that while exercise is a good thing, there is more to the story than just exercise. What does this mean?

Moderate exercise is good.

Running appears to lower the risk of dying from heart disease when an athlete doesn’t exceed more than 20 miles a week, log more than five to seven miles per hour, or run more than two to five times a week, researchers at the Ochsner Health System of New Orleans and the University of South Carolina found in a study last year.

Don’t stop there – address other risk factors:

Eat a nutrient-dense anti-inflammatory Modified Mediterranean Diet filled with lots of fresh vegetables, fruit, whole grains, nuts and olive oil. For more information on this read out book, Get Well and Stay Well – Optimal Health Though Transformation Medicine. (Steve and Sandi Amoils MD’s. Integrative Medicine Foundation, 2012.)
See your doctor. Address blood pressure, cholesterol, inflammation, blood sugar and other issues that may lead to heart disease.

What should you do if you are over 40 and thinking about entering a triathlon or participating in intense exercise?

Ask your doctor to check your blood pressure, cholesterol (LDL and HDL, triglycerides), inflammation (hs-crp) and homocysteine as a baseline.
If you have a family history of heart disease, consider a baseline stress test. However, this may miss underlying problems in your coronary arteries.
Consider doing a Coronary Artery CT (CAT scan). This can pick up coronary artery calcification which may be a silent precursor to developing plaque in your coronary arteries.
Find out if your doctor can do newer blood tests to evaluate for precursors to heart disease.

These tests include genetic predispositions or polymorphisms such as ApoE, KIF6, 9p21 genotype, LPA Intron Genotype and more. Besides looking at standard tests as described above, you can also have tests such as lipid sub fractionation, which subdivides the good (HDL) and bad (LDL) cholesterol subtypes further into good and bad subtypes.

At our center, we look also look at:

Lp(a) levels which looks at particles that can clog up arteries
LP PLA2 or PLAC testing, reflecting your tendency to calcify your artery walls
Fibrinogen levels which show us your tendency to make blood clots
Vitamin D and Omega 3 (Good fat) levels in your blood
And more.

Don’t think you are immune to heart disease even if you are fit or ultrafit. If you develop any unusual chest, neck, jaw or arm pain or tightness while you are working out, go see a cardiolologist. Also, if you find you are more short of breath than you think you should be, this may be another reason to seek help.