Episode 45 | Dr. Aaron Baggish, M.D. | Exercise And The Heart

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Kathy Smith: Aaron, welcome to the show. 

Aaron Baggish: Kathy, it’s great to be with you. 

Kathy Smith: Well, now, we got to meet last year when you were in town for the Sports Medicine Conference here in Park City. One subject we touched upon briefly is the importance of exercise and that almost every single organ and body system benefits from regular movement. This is specifically true of the heart, so it’s interesting that heart disease is the leading cause of death in America. And, yet, it’s one of the most preventable through exercise. So, let’s just get very basic here. Why is exercise and movement so good for the heart? 

Aaron Baggish: Well, we could spend all day talking about that. There are a long list of reasons why physical activity – specifically exercise – is really the cornerstone of cardiovascular health. Probably the easiest way to start thinking about this is to start talking about the risk factors or the reasons why people develop heart disease. Those include a list of things that will be familiar to most of your audience including things like high blood pressure, high cholesterol, diabetes. It turns out that daily physical activity is the single best way to move all of those risk factors in the right direction. 

Kathy Smith: It’s interesting. You’re right. Everybody has heard those words. We’ve been bombarded with it for years and years. Yet, it’s been my big motivation for all these years, is getting people to do what they know they’re supposed to do. You know what’s interesting is that there’s been so much talk about healthcare in the country, and I’ve heard you say that treating a patient with heart disease costs more than 20,000 extra dollars per year per person. That means that we could save almost–according to you–40 billion–or something I’ve read that you’ve said–about $40 billion a year by just getting about 25% more Americans to exercise moderately. Now, those numbers seem staggering. Is that accurate what I just said? 

Aaron Baggish: Yes, I think in broad brush strokes, that’s very accurate. The dent that we as a society could make in terms of reducing and/or preventing cardiovascular disease simply by becoming more physically active is staggering. It overshadows essentially any other intervention that we as medical professionals or as exercise professionals could think about bringing to the health of Americans and, more importantly, people across the world. 

Kathy Smith: When you’re in your office and you’re–I’m making an assumption here. I’m not sure it’s accurate or not because I know you work with a lot of athletes. But if you’re sitting with somebody who is sedentary, who is not exercising and has gotten some diagnosis that you just said – high cholesterol, high blood pressure – and they’re not exercising, what do you say to that person to get them off the couch and get moving? 

Aaron Baggish: I start by discussing a topic that I think has become increasingly evident even over the past four or five years and that is it takes really very little physical activity, particularly if you’re starting with nothing, to make dramatic health strides in the right direction. So, people know all about physical activity recommendations are 150 minutes a week sort of thing. And I think that’s a great goal for most people. But for those that are starting on a sedentary background, simple things – as little as walking five or ten minutes a day or simple lifestyle steps like moving from a seated position to a standing desk – those actually really make a big difference over the long haul. Simple, small things, to start, go a long way. 

Kathy Smith: When you think about it, I go around the country preaching those techniques and some of the things you mentioned, but we have become a society with not even–forget the television–we have the iPhones, the iPads. And not the adults but the children are getting exposed at a very young age to things that they can be doing hour after hour after hour that don’t require any movement. Any thoughts about that? 

Aaron Baggish: I think, Kathy, you hit the nail on the head. The public health crisis that has emerged from lack of physical activity starts at an incredibly early age. This is a function of what happens within school systems but also what happens within the hours before and after school.  

We used to be a society in which people walked or rode their bike to school and were physically active most of the day and came home, dropped the book bag and ran out an played until the sun went down. That type of existence that I suspect you and I grew up with is no longer the norm. And that is that kids typically take public transportation and are driven to school. They spend increasing little time during the school day with physical activity in the context of recess or physical education programs. Then, they come home and plop themselves in front of the computer or the video game system. Although it used to be inconceivable that a young child would get less than 10,000 steps a day, we see that this is actually the norm, and this is really the root of the problem. 

Kathy Smith: It takes a group effort, it seems like, to solve this, because it’s hard to be that lone person telling your kids you can’t play with your video game after school–or with the school systems. I know that when I was in high school, this was kind of the beginning of starting to cut back on physical education, and they were putting more money, more resources toward academics and less toward P.E. I know that trend has continued. Is it starting to be reversed around the country? 

Aaron Baggish: Sadly, we’re not really seeing that. As a healthcare professional and perhaps more importantly as a parent, this makes me quite literally sick to my stomach. I think the way to make the needle move in this field, I truly do believe starts in the home and that’s with parents modeling physical activity as a part of daily life and also as an important part of play. I agree; there needs to be a systemic shift in the way schools and communities approach physical activity both to prioritize non-motorized transportation but also to really remind each and every one of us that physical activity needs to be part of the school day and, for that matter, the work place day. 

Kathy Smith: So true. We talked about people who aren’t moving.  

Now, your focus has been for people who like to move and like to move a lot and fast – athletes, people who like extreme sports, and it’s been interesting. I got hooked into you early on when I heard about your research, because obviously being an exerciser my entire life, loving to move my body, run marathons, do high-intensity training, when I heard this idea that intense training might be bad for your heart–I think it might have been a New York Times article that grabbed my attention. I thought, “Wow, that is something I want to check out.” Tell me a little bit about your research and what you found about high-intensity exercise and your heart. 

Aaron Baggish: I think it’s probably safe to start by acknowledging that I didn’t get into this business because I was concerned about too much exercise hurting people. The reason I got into this business and we started our program here in Boston was out of recognition of the fact that no matter how much exercise you do, if you have risk factors for heart disease or have a genetic, predisposition to heart disease that there’s no amount of exercise that will allow you to outrun those problems. No amount of exercise confers complete immunity from cardiovascular disease.  

So, the goal of what we do is to take physically fit and active people who go on to develop problems and work with them in ways that both provide the best healthcare possible but also really focus on keeping them as athletic and active as possible.  

You’re right. A few years back, there started to become a fair amount of interest in the concept of overdoing it, too much of a good thing. I will say the science there is still very shaky. We can discuss this in more detail, but it remains unclear whether you can really do too much exercise and actually move yourself back into an unfavorable health category. 

Kathy Smith: Two things that came out of that, that obviously for my own personal history, my father died when he was 42 years old of a massive heart attack. One lesson that I’ve learned since then is understanding this idea of genetics loud and clear, because as I go to my doctor, I have seen through the years whether it’s with cholesterol–mainly for me it’s my cholesterol profile.  

It’s not the type of thing that I can just say, “Oh, I exercise so I don’t have to pay attention to that.” That was, I think, the misconception we had early on was, “I exercise. I have a good profile when it comes to when you look at the outside of me.’ Yet, what I was finding is that I had to really start paying attention to – much more closely – diet specifically, which I do want to get into a little bit because there are so many things that are being thrown at us about diets as it relates to the heart. I do think this idea that genetics plays a big role and that we should know especially for our kids, again, we should start thinking about this early on if they’re playing sports. I know it’s something that you’ve talked about through the years. Could you just kind of elaborate a little bit?  

Aaron Baggish: I think there are two elements of genetics that you’re getting at. One is the genetic profile that matters later, we’ll say, in the second half of life around acquired disease – things like coronary artery disease which is presumably the disease your father died from with a massive heart attack. These are things that as people transition from childhood to adulthood, they need to understand. They need to understand them by asking their parents and relatives about problems that have occurred, things that run in the family. 

This is where knowing those risk factors and, then, working with a physician who understands how to address them but, also, how to address them in a way that doesn’t limit someone’s ability to exercise is really crucial.  

The second point I think you brought up at the end was the issue of genetics around sports participation, particularly in young people. It turns out that sports and exercise in the kind of pre-teen, high school, college years are the single most important way to develop good physical activity patterns, stay healthy, enjoy social connectivity. But if there are underlying genetic heart problems–these are rare, but they do occur–when they push themselves harder at a young age can get into trouble with things like sudden death. So, there and again, the starting point is a family discussion.  

If strange things happen within a family, people die at early ages without good causes – there are unexplained car accidents or drownings, this really should be a stimulus for people to talk about the potential for a genetic heart disease problem within a family. 

Kathy Smith: I know it’s rare, but you do find and you read the stories about athletes having problems, whether it’s a basketball player. I remember when I was in Los Angeles, there was a Loyola basketball player that had had a heart attack, so you do see these things. Are there recommendations you have for parents of athletes or the athletes themselves, saying, “If you’re going to play a sport, these are a couple of good tests you might think about besides just a regular physical in addition to your physical.” 

Aaron Baggish: Indeed, there are actually fairly well-developed recommendations that we spend a lot of our time working to reinforce and to think through. The first place to start is for young people and their parents to work on an annual basis with either a good pediatrician or a good sports medicine doctor or internist to get a physical examination that focuses on heart disease. The use of stethoscope, a discussion about heart symptoms potentially that come out during exercise is the place to start. That’s where the American Heart Association and the American College of Cardiology come down on their recommendations and that is an annual physical exam and medical history for each competitive athlete.  

There certainly are additional tests that can be done, each of which comes with their pros and cons. The most common additional test would be a simple electrocardiogram which has the ability to pick up more heart disease but also comes with the potential problem of false positives and some of the implications of generating a problem when one doesn’t really exist. So, I would say in simple terms a good history and physical by a competent doctor or nurse practitioner or physician’s assistant is the place to start every year. In local situations where the resources are appropriate, an electrocardiogram can be a great addition.  

Kathy Smith: How does that relate to an older athlete, and older means anything above 35. I’m not talking about a child or just someone in their 20s, but 35, 40, 45 and, then, on – especially the weekend warriors, the guys, the girls, the women, the men that want to get out and do their 10Ks, do their marathons, participate. What are your recommendations for that group? 

Aaron Baggish: I think for people that are already doing those things and are feeling well and have no established cardiac risk factors, there should be no cause for concern and they should continue to do what they’re doing. In older folks–and, again, you used 35 years quite appropriately because in our world that is the age time point at which the type of diseases that affect people switch.  

Before the age of 35 and people get into trouble, it’s typically because of some inherited heart muscle problem or heart valve problem, whereas older folks tend to develop things like coronary artery disease or arrhythmias like atrial fibrillation. 

And in older folks, again, if they’re feeling well, they’ve been active all their lives, there’s no cause for concern. If people are in their third, fourth, fifth, sixth, seventh decade and they want to start a vigorous physical activity program de novo, that should really be initiated after a conversation with their healthcare professional, which again focuses on risks and perhaps undiagnosed disease. 

Kathy Smith: Ok. This maybe sounds like a simplistic question, but it’s fascinating to me. That is, we talk about the heart and most of us understand where our heart is and it’s this organ and it pumps the blood through our body. But I talk to very well-educated people, and I don’t think that people quite understand the arterial system and the idea that we have these arteries that run through our body and they impact every single, as I said in the opening, organ and system in our bodies. So, there might be warning signs early on or there might be things that are happening throughout your body because of blocked arteries. Can you just give us a little bit of an education on arteries and how we should view our arteries? 

Aaron Baggish: Sure. Arteries are the pathways that connect the heart, which is the pump to virtually every piece of tissue in the body. Everything in our body that’s alive requires oxygen and nutrients, and it’s the arteries’ job to deliver those substrates.  

So, arterial health, meaning arteries that function well are able to dilate and constrict appropriately and transfer blood appropriately. Without that, you’re not alive and you’re not functioning well. Over time, if the risk factors we talked about are present and not dealt with – so, again, things like uncontrolled high blood pressure, poor lipid profiles, unmanaged diabetes, cigarette smoking – over time, those begin to affect the ability of the arteries to do their job. What really starts to happen is the arteries stiffen and become less responsive in terms of being able to dilate and constrict on demand. Eventually, they start plaquing and blocking up. When that happens, anything downstream is compromised. The best example are the coronary arteries which supply the heart.  

The heart’s like any other muscle. It needs blood flow to be able to do its job. When the arteries that supply it start to get clogged up, the heart no longer functions effectively and people can start to feel that in the context of a symptom called angina or chest pain. So, arteries all over the body are prone to that sort of blockage and disfunction paradigm. 

Kathy Smith: So, if the blockage is happening more towards your brain, it’ll be more stroke related. If it’s happening more towards your feet, you might have numbness. I know there’s all the commercials on TV about Viagra and things like that. Does that have a lot to do also with just blood flow and arteries? Is that part of what’s going on in the things that I’ve mentioned? 

Aaron Baggish: It does. Any tissue that’s supplied by blood flow needs to have the ability to augment blood flow when it’s being asked to work. It’s susceptible to problems with clogging.  

You mentioned the erectile disfunction situation and although there are many types of erectile disfunction, one certainly is vascular disease in which the penis is not getting enough blood flow and simply not able to do its job. As you know, there’s a multi-billion-dollar industry invested in not preventing that through things like exercise and physical activity but simply throwing medications at it after the problem has emerged. 

Kathy Smith: I know. I always love hearing where exercise can really be a cornerstone and should be a cornerstone of good health. It has to be complemented obviously with a good diet. With all the confusion out there of where to approach diet, we have everything from–I went to a workshop two weekends ago where it was all about being a vegan and really high-level doctors presenting their information on heart disease and reversing heart disease through a plant-based diet.  

Then, of course, we’ve had on the show doctors who talk about the blue zones and about the Mediterranean diet. Then, we have, of course, the keto movement. Research is being presented on if you go with cutting out refined carbohydrates and going for getting into this ketogenic phase and that helps with heart disease. I’m telling you, I know my stuff and I get confused now. Can you do anything to help clarify that? 

Aaron Baggish: I think the first place to start – and I’m fond of saying this – is that diet is the least scientifically understood part of health. And it’s probably the most important part, right there alongside with physical activity. When you look at how much we know about the way medications work, about the way surgical procedures work, even about how exercise works, I think we’ve got most of the story pretty well teased out. That’s not so with diet and that’s exactly why the long list of things that people feel very passionate about is being the single best way to do this exists. Because there is no scientifically rigorous consensus. I certainly have my own approach to diet, both personally and with my patients, and I can tell you it doesn’t fall in to any of the real popular categories that you just went through. 

Kathy Smith: Would you mind running it by us? 

Aaron Baggish: Sure, I’m happy to. It’s admittedly a very simplistic approach to eating and that is that the diet should be based on as much in the way of leafy green vegetables and fresh fruits as possible. Carbohydrates really should be a portion of the diet, probably not a majority but a significant minority. Carbohydrates should come from as much unrefined, unprocessed sources possible – anything that’s been whitened. So, white bread, white pasta, white rice should really be considered poison because of it’s ability to spike blood sugar, which inevitably is what causes high cholesterol. It’s not the cholesterol we eat that causes high cholesterol. It’s the excess of simple sugar we eat that gets converted into cholesterol.  

And, then, finally is the issue of protein source. I do not typically recommend that people follow vegan diets; although, I know many healthy people that do. My approach is really to focus on protein sources that either swim or fly and to try as hard as possible to remove all mammal meats from the diet –  things like beef, pork, lamb, sheep because of reasonably good basic science which has shown that they have a pro-inflammatory effect on the body which underlies many forms of disease. Not just heart disease, but also things like cancer and dementia and other things that really cripple people later in life.  

Kathy Smith: As you’re listing out the diet there, it seems like it’s a way that I’ve been eating for quite a while. I find that my diet vacillates a little bit depending on–or shifts back and forth–depending on the time of the year, how much exercise I’m getting. That’s the biggest thing that I’ve seen even with the carbohydrate load is that if I’m doing a lot more endurance training, I find that I’m just craving more of these good carbohydrates you’re talking about.  

I also know that as the weather changes and I want more warming foods that there’s a point that I’m just really drawn to the stews and the soups and with a lot of the protein coming, as you said, from fish and chicken. But the main thing that I found is that when you talk about whatever diet you go on, it’s getting your calories and cutting out the sugars and the refined carbohydrates. Because I find even for anybody that I’m talking to, if you haven’t taken that step and that inflammation that’s caused with all of those refined carbohydrates, it is so taxing on the body.  

I think that’s the approach that I have, but it is one of those things that as you said people get very passionate about their diet plan. The one last thing I’m going to say about this – I wrote a book about 10 years ago. It was based on different–not blood types or anything like that. But it was based on this idea that some people, because of genetics, because of your upbringing, because of many different factors work better with different diets.  

My co-writer at the time, she had a huge problem with metabolic syndrome. My breakfast was oatmeal with some walnuts, with some almond milk, with some blueberries. If she had that oatmeal and that same breakfast, her blood sugar would spike and she would have a foggy brain and she couldn’t work well, where I worked really well under that.  

Part of the reason is that I got up in the morning and I went for a run and it was my lifestyle that helped me to metabolize those carbohydrates better I guess. Have you noticed that a bit also with people that exercise and don’t exercise as far as diet? 

Aaron Baggish: Yes, I think that when it comes to the choices of food that we put into our body, it’s not unreasonable to listen to what our body’s telling us particularly as things like season or physical activity level change. Our bodies are–this is not a scientific way of explaining it, but I think our bodies are pretty smart and they know how to identify their needs. And, so, I think as things ebb and flow and as you figure out what works for you whether it’s to optimize athletic performance or in the case you were just talking about, cognitive performance, when you set down at the keyboard to write or to do something creative, I think when you find things that work, as long as they follow the basic health principles that I just ran through, there’s no reason to stick with them. 

Kathy Smith: Ok, well listen, I could ask you questions forever, but I know our time is up. So, I just want to tell you it was so great having you on the show. I admire everything you’re doing and look forward to the next 10, 20, 30, 40 years of how we are going to really solve this heart disease problem so it no longer will be the number one killer of people in the country. It’s a personal problem for me because it’s genetically in my family. So, I thank you for everything that you’ve done.  

Just a general reminder to everybody out there, remember moderate exercise is vital for developing this strong immune system, a healthy circulatory system. It’s good for your bones and it’s good for your brain. Almost every single organ benefits from regular exercise. So, for the sake of your body, if you’re not exercising, get out there and get active. Grab a friend. Get walking. If you like the podcast, share it with your friends.  

Aaron, thank you so much. I hope that you get out here skiing in the next few months with your family or with a group and we can get out skiing. 

Aaron Baggish: Kathy, thanks. The pleasure’s been all mine. I look forward to seeing you. 

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