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Marathon Running Done Over Many Years Bad For Heart

May 21, 2015 - 74 comments
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Marathon Running Harmful



Marathons: In the Long Run Not Heart Healthy
John C. Hagan III, MD & James H. O’Keefe, MD

As the June7, 2014 Hospital Hill Half-Marathon “run up” commences, disturbing research is accumulating about potential cardiovascular dangers of exercising at maximal levels for durations over an hour, especially after age 40.  While this type of ‘excessive endurance exercise’ can occur with cross-country skiing, long distance swimming, triathlons, and 100+ mile bike races, the prototype activity is marathon running.
The first marathon occurred about 2500 years ago by the messenger Pheidippides who ran the 26.2 miles from the plains of Marathon to Sparta there proclaiming the Greek victory over the Persians. History records his first words were, “Joy to you, we’ve won.” Less certain are his last words, perhaps “My feet are killing me” before dropping dead.
Incredibly many physicians and the public have misinterpreted Pheidippides’ fatal run as healthful. In 2014 there are 739 marathons scheduled in the United States and Canada. It is estimated that over a half million people will complete a marathon this year. 100 mile ultra-marathons are common and worldwide months long extreme-endurance races of over 3000 miles exist.

Research published in the April 2014 Missouri Medicine: The Journal of the Missouri State Medical Association, a peer-reviewed medical journal, found that long-distance running over decades of life may cause a greater than normal buildup of calcified “hard” plaque and the more dangerous fatty “soft” plaques in the vital coronary arteries that supply the heart muscle. Lead authors Robert S. Schwartz, MD, of the Minneapolis Heart Institute, and James H. O'Keefe, MD, Saint Luke's Mid America Heart Institute, Kansas City found that long-term participation in marathon training and racing is paradoxically associated with increased coronary plaque volume. Since most marathon runners believe their long hours exercising, sometimes logging over a hundred miles per week for years on end, creates a strong healthy heart, or at least does not damage this vital organ, this new information is perplexing and shocking. Nevertheless, daily and less strenuous exercise remains one of the most important facets of getting and staying healthy.
Regular exercise and high levels of physical fitness are linked to lower risks for cardiovascular diseases and improved life expectancy. Four decades ago Thomas Bassler, MD, an American physician, reasoned that if some exercise was good more had to be better, and famously hypothesized that marathon running confers immunity against coronary plaque buildup and heart attacks. In the current study, Bassler’s theory—long term marathon running protects against coronary atherosclerosis—was tested by quantitatively assessing coronary artery plaque using high resolution coronary computed tomographic angiography (CCTA) in veteran male marathon runners.
To qualify for the study the long distance runners had to have completed at least one marathon each year for 25 consecutive years. The control subjects were a group of apparently healthy men who had never been regular vigorous exercisers but who were similar to the marathoners in age and other general cardiovascular risk factors. The 50 male marathon runners, as compared to the 23 inactive male controls, had increased total heart artery plaque volume, calcified plaque volume and non-calcified plaque volume. Although other medical studies had indicated that marathon running can cause accumulation of the less dangerous “hard” plaque this was the first time “soft” plaque was also found to be elevated. Soft plaque rupture and clot formation is felt to be the most common cause of heart attacks and sudden cardiac death.
Additionally, a Missouri Medicine editorial overview of excessive endurance exercise by prominent cardiologists Peter McCullough, MD, of the Baylor Medical Center, and Carl Lavie, MD, of the John Ochsner Heart and Vascular Institute, conclude that in marathon runners the chronic stress of endurance training for long periods of time may stiffen the heart arteries predisposing them to hardening and becoming partially blocked. Unlike other sports because the heart is pumping 5-8 times as much blood as during rest, marathon runners while training and racing hold this heavy strain on the heart for a very long time without rest breaks.  When this happens, it may stretch the heart chambers and lead to scar formation in the cardiac muscle.  Scar tissue in the heart is the cause of lethal heart arrhythmias and cardiac arrest in some of the highly publicized cases of seemingly healthy marathoners who die during training or long-distance running events. These deaths include 57 year old ultra-marathoner Micah True, also known as Caballo Blanco featured in the best-selling book Born to Run and 52 year old Jim Fixx author of The Complete Book of Running. Both died while running. Boston Marathon winner Alberto Salazar at age 47 was luckier and was successfully resuscitated after sustaining a heart attack while running, collapsing unconscious and without a pulse for 14 minutes.  

Future research is needed to find who is susceptible to having this happen, why, and how can we best train and exercise and enjoy the benefits without taking on life-threatening risks. One such test is a Heart CT Scan.  This relatively quick and painless examination can measure calcium deposits in the heart arteries. These calcium deposits are indicative of plaques in the coronary arteries. A normal value is zero but numbers over a 100 are associated with increasing risks of heart disease including angina, heart attacks and cardiac death. St. Luke’s Hospital offers Heart CT tests for $50 which is usually not covered by insurance. Tests can be scheduled by calling XXXXXX. No physician referral is required.
Exercise might be best understood as a drug with powerful benefits, especially for cardiovascular health. As with any potent drug, establishing the safe and effective dose range is critically important—an inadequately low dose may not confer full benefits, whereas an excessive dose might produce harmful effects that outweigh its benefits. Running marathons for decades is an excessive amount of exercise, predisposing to an increased coronary artery plaque buildup despite favorably altering many risk factors such as weight, blood pressure and risk of diabetes. A more moderate dose of exercise is a better strategy for promoting long-term cardiovascular health and durability.
An example of a sensible and time efficient ‘exercise prescription’ is shown in figure 1. Before starting or increasing exercise programs have a physical examination and discuss your exercise prescription with your personal physician.
Nothing in this new research invalidates that the most important and under-utilized “wonder drugs” for health maintenance are regular moderate exercise, a good diet, body weight vigilance, avoidance of all nicotine use, for those that drink alcohol no more than 2 drinks per day-ideally red wine, drive carefully and always fasten the seatbelt, get plenty of sleep, develop a social network of friends, have a pet─preferably a dog to walk─ and a satisfying spiritual-religious belief system.
####

LINK TO SCIENTIFIC PAPERS:

http://www.omagdigital.com/publication/?i=204134  

About the authors:
John C. Hagan III, MD is the Editor of Missouri Medicine and a Discover Vision Centers-Northland ophthalmologist. He is a former marathon runner and current daily walker-swimmer.

James H. O’Keefe, MD is a nationally known preventive cardiologist with the Mid-America Heart Institute at St. Luke’s Hospital, Kansas City. He is a daily moderate exercising runner. He and his dietician wife Joan authored “Let Me Tell You a Story: Inspirational Stories for Health, Happiness and a Sexy Waist” (McNeel Publishing, 2013)


Comments
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Avatar universal
by nahidul123, May 23, 2015
hey i m nahid.   i have done lasic operation in 2009 in both eyes. from then no problem in my eyes.but 3 days ago 16 may afternoon while i was playing footbal as usal in ground , suddenly football kicked by others hited my right eye. from i my vision become totally blurred . and i sar just like rainbow around the light. after got up in the morning i sar my pupil dilated and it ir very very slow responding in light, i visited doctor he has found , eye pressure is normal,( 18.6), there is no clogging of blood,retina and cornea is ok. but vgision is almost ok but sme times very little blurred vision BUT PUPIL STILL DILATED, he adviced to use DICLOFENAC SODIUM DROP,  DEXAMITHASON PHOSPHATE EYE DROP, AND LUBRICANT EYE DROP. AND ALSO prednisilone TABLET 2+0+2 DAILY, AND  B COMPLEX VITAMIN, NEURO VITAMIN. I m using all properly last  8 days. also using sunglass in sun also in room. but still there is no significant improvement of dilated pupil to become normal. i m depressed. when pupil become normal. please advice me if dilate not recover what may the other problem i may face.

I'm assuming that your doctor did not instill a drop to keep your pupil dilated and at rest (cycloplegic) as you are being treated for traumatic iritis.  Assuming the doctor did not put in a dilating drop you have traumatic iridoplegia (dilated pupil from damage to the constricting muscles of the iris)  It can be temporary or it can be permanent. Only time will tell. Discuss this with your ophthalmologist.  It would not be called permanent until it persists 4-6 months.

JCH MD

Avatar universal
by Coach007, Jun 08, 2015
Some (many?) runners are under the impression that they can eat whatever they want since they are running so many miles in training and racing.  Wrong.  Also, a family history of heart problems cannot be erased with long distance training and racing.  Additionally, your heart is a muscle too, of course, and lactic acid affects every muscle in extreme exercise.

You are absolutely right. Running is not a magic elixir that negates bad diets, smoking, obesity and other unhealthy habits. And since this initial post there have been 4-5 other major medical research papers that show that over-exercise (marathon type running done for years on end) is bad for the heart.  In fact in many studies that extreme over exercisers had heart disease at almost the same rate at non-exercisers.  All things in moderation. 55 minutes or less of all out activity for those that must "red line" it. For others that want to do as little exercise as possible 30 minutes of walking done 5-6 days/week will get most of the advantages of exercise and none of the downside.

JCH MD

14471876 tn?1434694755
by baoduobao, Jun 19, 2015
My father at the age of 80, has been in good health, no anything wrong. Four years ago had high blood pressure, a month ago due to cold caused shortness of breath, asthma, pulmonary infection and heart failure in the hospital, were discharged after treatment, has been weak, now the amount of exercise a giddy. Excuse me, what is the reason

There is not enough information there to offer any useful insights or information.   Not sure what "exercise a giddy" means.
JCH MD

Avatar universal
by BlaineB, Jul 15, 2015
My concern with this study is correlation doesn't mean causality! Not until someone commented on diet was it mentioned. New studies show that a low fat diet devoid of cholesterol is the main cause of cellular "stiffening. Diets high in added sugar are the real culprit when it come s to LDL being out of balance to HDL. I am also worried about the the number of runners compared to "healthy " adults. Why would it not be a one to one comparison. Sounds like a budget issue. High carbohydrate diet devoid of fat is gospel amongst runners. I would have more respect for this study if it included diet.

I do not have the time to add references to the many papers that have been published since the one we published in Missouri Medicine on the independent role of "excess endurance exercise" in causing adverse cardio-vascular events that make the risk of cardio-vascular disease almost as high in excess endurance exercisers (such as chronic marathon runners) as in sedentary non-exercisers. This is both US and European medical journals.  This adverse effect was studied independent of diet.   These papers can be found using the PUBMED search engine and even Google.

I have been a runner and among runners for almost half a century; high carbs in not gospel among runners and there is the usual diversity of diets found in the general population

JCH MD

Avatar universal
by BlaineB, Jul 18, 2015
Obviously I have insulted you. This is the wrong medium to have an intelligent conversation. Any different point of view seems to come off as an insult, I just wanted to make the point that heart disease is a complicated issue. It's wonderful and useful information to know what happens to your heart when you over train. I'm 100% behind this type of research. With that said I do believe this was an opportunity missed. You had a twenty five year widow to look back at and it seemed to include only one metric. I'm not blaming you for the lack of comprehension. I understand that headlines equals funding, but as concerned citizen I want it known that I'm aware of how our tax dollars are allocated for research.(another complicated issue).

I don't know how to properly respond to your statement about diet. I'm truly not trying to insult you. I should have not made a blanket statement. I too am a runner for about 35 years years now. As far as the "general population " , one only needs to read labels at the local grocery store to see the amount of carbohydrates vs fat and protein the general population consumes. As for myself and my experience, I consume gel shots and Gatorade for my fuel while I'm training and racing. Also the occasional banana. At the end of a marathone some is usually waiting with a pretzel and a banana... Sense all the perfect exercise in the world can be undone with a bad diet I feel it would be an important metric to include in a truly comprehensive study of this type.

Thank you for your consideration...

Avatar universal
by ear_ring, Aug 31, 2015
A good friend of mind is an ultra marathoner. He use to compete in 50+ mile events and he is in his late 50's. He has destroyed the joint in his left knee from the constant pounding and he needs a knee replacement. His hip sockets are shot as well. Personally I walk 7-8 miles a day. Anything carried out to extremes can't be healthy for you. Use common sense.

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by JohnHaganMD, Aug 31, 2015
Yes moderation in all things has played out well and proved out well over the years. Since we published our articles several more large studies have shown that all-out, maximum level exercise done for over an hour, especially for those over 40 is not healthy and the people that carry it to extremes such as the ultra-marathoners have cardiac disease levels that are similar to those that do not exercise at all.

JCH MD

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by hefner33, Sep 03, 2015
What about high intensity sports that go from extreme exertion to moderate exertion in over a span of a couple hours? So instead of having your heart rate at a constant high rate, your more up and down and allowed to rest for a little

177275 tn?1438375244
by JohnHaganMD, Sep 03, 2015
My internet is down and I'm working off an iPhone.  There are extensive studies published here and in Europe by multiple authors over several years. So this is not just a finding peculiar to our medical Journal Missouri Medicine.   The ability of go flat out for hours on end without damage to the heart declines with age especially after 40.  Allowing "recovery" like when you run intervals would be better than no rest at all.  So the worse damage occurs in marathoners, ultra-marathoners, long distance bicyclists, long distance cross country skiing and long distance swimming all done without breaks.

I was just contacted by a 53 year old endurance cyclist who thought he was in perfect health. No risk factors (except his 4-8 hour bike rides). He had a heart calcium artery calcium score done, normal is zero his was 1300+  (mine was 1606).

How much recovery would reduce the potential for damage I don't know as I've never seen a study on it and one would be very difficult to devise.

You look young.  Do your marathon, or your 100 mile bike ride or your Half Iron Man Triathlong.  Say "Been there, done that, its off the list) then do 10Ks.  You can't imagine how addicted I was to 4-6 hours runs.  I would have been so grateful to know of this research at your age.

JCH MD

5851092 tn?1404137064
by hefner33, Sep 04, 2015
If your speaking to me I'm Def no marathon runner. I'm more into sports that involve interval sprinting like full court basketball or recreational American football. If I ever do long distances it's usually only 2 miles and no longer than 20 mins. I'm 33

177275 tn?1438375244
by JohnHaganMD, Sep 04, 2015
Okay most replies like your first post are asking about themselves as being deep into extended maximum endurance exercise. Your sports are not the problem.

Most deaths on the BB court in young people are due to congenital heart disease that is undetected

JCH MD

Avatar universal
by RSW88, Sep 08, 2015
I need your advise, I am 56 years old with high myopic eyes. My hobby is jogging long distance. 7 years ago I had retinal detachment on my left eye and went through operation using gas technique , three months ago I experienced retina tear on my right eye and was fixed using laser. My eye doctor ( who handled both my left and right eye ) said my both retinas are now OK and I can resume my activities including running. I am a marathoner and jog 5 times /week. My eye doctor forbid me to run full marathon at the moment although he said it is OK for me to run again. He did not specify when I can run Full marathon again or if I can ever run marathon again. Is running marathon considered a strenuous exercise ? I am a leisure marathoner , jogging at slow pace, covering marathon distance around 6.5 hours.
Can I do slow pace marathon distance without jeopardize my retina ? Thanks  

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by JohnHaganMD, Sep 08, 2015
Advise that is specific for you can only come from your treating physicians and assuming by your "eye doctor" you mean your retina surgeon has said no to full marathon that is what you need to heed. If your "eye doctor" is an optometrist then you should communicate directly with your retina surgeon.

"Leisure marathoner" is a oxymoron.  Covering 26 miles even in 6-7 hours puts a strain on all your body systems.  Dial it back to 10Ks your heart, joints will be the better for it.

Follow this link to the Missouri Medicine issue we did on the dangers to the heart of marathon running (and remember I've spent 40+ years doing marathons and ultra-endurance things like 100 mile bike rides and Half Iron Mans

http://www.msma.org/docs/communications/MoMed/Hearts_Breaking_Over_Marathon_Running_MarApr2014_Missouri_Medicine_Vol_111.pdf

JCH MD

Avatar universal
by Gb2015, Oct 01, 2015
I am a regular half marathoner clocking around 25 miles /week during 5-6 months and arnd 40-45 miles for remaining part of year. I normally run 5-10 half marathons a year and am 30 years old. Also along with running i do weight training at moderate levels. Your article points at developing plaque deposits due to endurance running. Do i need to cut down on my running to avoid cardio problems later in life. Need your advice.

Avatar universal
by maryjar, Oct 10, 2015
My friend lives in nh and came down with a rash a few months a go...not sex..related..going thru a lot..was put on meds but not helping used cream but not helping...rash itches alot and spread thru whole body..please help

177275 tn?1438375244
by JohnHaganMD, Oct 10, 2015
If you keep your training runs to an hour or less and run at 60-75% you will be okay.  Going all out for more than an hour seems to be the threshold for damage.
JCHMD

Avatar universal
by elNW, Oct 18, 2015
Race walking gives you all the cardio advantages without tearing up your joints. Get coaching at the start if you are going to compete. You can be disqualified for improper form, and need to learn stretching techniques. .

177275 tn?1438375244
by JohnHaganMD, Oct 18, 2015
Sounds like good advice. JCH MD

Avatar universal
by TheRoc, Nov 11, 2015
I am 56.  I do jogging for 40 minutes every other day, three times a week.  Before the jog I do brisk walking as a warm up for 20 minutes.  After the jog, I also do a 20 minute slow pace walk around the room as a cool down.  The total time is 80 minutes.  Is that an over exercise?

Junnel, from the Philippines

177275 tn?1438375244
by JohnHaganMD, Nov 11, 2015
No not at all. Excess is running as hard as you can for over an hour 5-7 times week.  Keep it up. JCH MD

Avatar universal
by concerned_heart, Nov 30, 2015
dr Hagan:
37 year old with chronic chest pain.  during diagnostic work up (which included a cardiac cath) i was found to have moderate disease in small vessels. two stents placed with no relief. have since been release back to activity (despite unchanged pain).  running seems to help to some degree. i have set a goal of completing a half marathon. i run 30 minutes a day 3 days per week at a pace that i can still hold conversation then on the weekend due a long walk run of 5-13 miles (varied pace--from maximal (short distance) to leisure.  is this too much?

177275 tn?1438375244
by JohnHaganMD, Nov 30, 2015
Well best of luck. You have a pathological heart condition not like healthy hearts that have high coronary artery calcium scores but normal function testing (Like mine). So you will need to get your exercise directions from your cardiologist.

JCH MD

Avatar universal
by visansi, Dec 02, 2015
Dr. Hagen, thanks for highlighting the risks of long distance running at a stretch. I am a male, 5'9", 155lb, 46y with hypertension ~145/95, vegetarian from India. I have run 3 marathons and 6 half-marathons over the last 6 years.

My motivations for running are to manage my BP without meds and also to reduce belly fat as I have read that the body metabolism changes and learns to burn fat only after 2 hours of continuous exercise. Over a 3 month training period I reach a peak of 36 miles per week or around 7 hours of running per week. I run 5 or 6 of the long runs lasting 2 to 3 hours in the last one month that significantly reduces my belly fat and knocks off 3-4 kgs to 145-150lb.

Also these running events give a short term goal for my exercise routines and helps carve out time regularly for running and stick to it. Otherwise my work just expands to take up all my time - though that sounds lame.

Coming to this post from you, though my weekly hours does not seem like much, I can see your point is that the long runs lasting 2-3 hours can do more damage to the heart muscles negating other benefits. And your quote of "Leisure marathoner" is a oxymoron has stuck well with me :)

Now at the risk of sounding argumentative, I have the following
1) how bad is that one month of frequent long run marathon training phase for the overall health?
2) Is it reasonable to expect the damage to reverse in the next few months?
3) Is it wise to continue training and running half-marathon events?
4) Is that "fat burning after 2 hours" a valid explanation for the weight loss? If not, how else can I get into my slimmer trousers?

If the above questions are too generic and cannot be answered specifically, I will appreciate your general perspective and advice for my fitness style described above.

-visa

177275 tn?1438375244
by JohnHaganMD, Dec 02, 2015
If running marathons is important to you then you should be able to lower the risks by taking several actions. This is presumptive and derivative and not based on controlled studies which I'm sure will never by done.

1. Realize you can't diet by running.  Exercise is max 10-20% of dieting the rest is reducing caloric intake.
2. Take a walking break of 5-10 minutes every 30-45 minutes of running. Don't go "flat out" run at 50-60% of race day pace.
3. Marathons are better than double marathons and 100 mile and 100 metric miles; half marathon better than marathon; 10K better than marathon.
5. Consider getting a coronary artery calcium score (Normal is zero; less than 100 okay; mine was 1606)  

JCH MD

Avatar universal
by visansi, Dec 08, 2015
Thanks for the quick response Dr. Hagen. I appreciate your response online. I understand they can only be presumptive and derivative.

After my earlier post here, I went and got my BP checked expecting it to be trending down - but to my shock it came back as 150/100 ( 145-150/100 over 48 hrs). Then the doctor ordered blood work came back bad too. hdl 30, ldl 156, total cholesterol 220, triglecirides - 190. Creatinine 1.1 (all mg/dl).

Marathon training is off untill we get the BP and blood work under control. I have cut down on my running to 30-40 mins sessions, 3-4 times a week as per the doctors advice.
Since I felt quite good during my training (completed 15mi) and with no symptomps we have decided to try out 1 months of response to reduced running and dietary changes to assess the BP and blood work before starting medications.

History/profile over 15 years.
BP between 130-85 145-95 , mom has BP since 50, 75 years old now.
hdl between 38-43, total cholesterol 170-190, ldl, triglecyrides I cant remember.
Alcohol : 10-20 cans of beer per week till august 2015. None since then.
Diet - vegeratian + diary products. Eat out once a month.
Liestyle : tech startup career fr past 2 years. In-between startups for a year. Sedentary - hence the running.
Physically activity field sports till 2007.
Had ACL repaired in 2008 and running since 2009 (only non-contact sports since then).

I will report back with more test redults in 3 weeks time.

Just to keep Dr Hagen's perspective and context of this thread clear, neither my doctor nor I believe my running has caused any of these.

Again I appreciate all the feedback and support here.

-visa

177275 tn?1438375244
by JohnHaganMD, Dec 08, 2015
Well do work hard on them. Those are major cardiovascular risk factors that need to be controlled. Best of luck JCH MD

Avatar universal
by BigPine, Dec 20, 2015
Is there a limit on intensity? I run 6-7 days a week and do each run at close to maximal effort, but my total training time is less than 45 minutes per day. Is this a problem?

177275 tn?1438375244
by JohnHaganMD, Dec 20, 2015
No not at all.  Longer than 1 hours all out for those over 40 seems to be the threshold.  JCH MD

177275 tn?1438375244
by JohnHaganMD, Dec 20, 2015
No not at all.  Longer than 1 hours all out for those over 40 seems to be the threshold.  JCH MD

Avatar universal
by YoonECycle, Dec 25, 2015
One  of the reasons that calcium is deposited on the artery walls is because there is a deficiency of vitamin K2 in the diet. The diet today is very deficient because animals do not consume grass throughout their lives. Vitamin K2 producing bacteria in the stomach require grass. But vigorous exercise can increase levels of the transport protein glut4 by as much as 40%. This in turn improves insulin sensitivity. Exercise also boosts a signaling pathway that is driven by the transient rise in the superoxide radical. This pathway can triple levels of several antioxidant enzymes. Exercise also promotes auto phagy. It also promotes mitochondrial function by stimulating expression of mitochondrial genes. When cells switch over to anaerobic metabolism because of declining mitochondrial function, growth signaling is amplified. This in turn promotes tumor progression. I agree that extremely vigorous exercise  in the context of our modern diet and lifestyle has some detrimental aspects.

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by JohnHaganMD, Dec 25, 2015
The hypothesis is interesting but not proven by any controlled studies nor is it cited by the world's leading cardiologists in their analysis of why this occurs. However K2 is very important and every physician and dietician believes good health starts with a good diet of fish, fiber, fruits, vegetables, berries, nuts.

Thanks for the information.

JCH MD

Avatar universal
by YoonECycle, Dec 25, 2015
The Rotterdam Study:
proteins via carboxylation depends on the availability of vitamin K. We examined whether dietary intake of phylloquinone (vitamin K-1) and menaquinone (vitamin K-2) were related to aortic calcification and coronary heart disease (CHD) in the population-based Rotterdam Study. The analysis included 4807 subjects with dietary data and no history of myocardial infarction at baseline (1990–1993) who were followed until January 1, 2000. The risk of incident CHD, all-cause mortality, and aortic atherosclerosis was studied in tertiles of energy-adjusted vitamin K intake after adjustment for age, gender, BMI, smoking, diabetes, education, and dietary factors. The relative risk (RR) of CHD mortality was reduced in the mid and upper tertiles of dietary menaquinone compared to the lower tertile [RR = 0.73 (95% CI: 0.45, 1.17) and 0.43 (0.24, 0.77), respectively]. Intake of menaquinone was also inversely related to all-cause mortality [RR = 0.91 (0.75, 1.09) and 0.74 (0.59, 0.92), respectively] and severe aortic calcification [odds ratio of 0.71 (0.50, 1.00) and 0.48 (0.32, 0.71), respectively]. Phylloquinone intake was not related to any of the outcomes. These findings suggest that an adequate intake of menaquinone could be important for CHD prevention.
The problem is that the medical establishment has been preaching for decades that foods such as cheese meat and eggs which are good sources of K2 are to be avoided in order to achieve cardiovascular health.  100% grass fed red meat and pastured eggs and especially Gouda cheese are very good sources of K2. Key opinion leaders in the field would be unlikely to change their tune without a prolonged battle. Who took the USDA or FTA till about 2006 to finally admit that trans fat was a major factor in cardiovascular disease.proteins via carboxylation depends on the availability of vitamin K. We examined whether dietary intake of phylloquinone (vitamin K-1) and menaquinone (vitamin K-2) were related to aortic calcification and coronary heart disease (CHD) in the population-based Rotterdam Study. The analysis included 4807 subjects with dietary data and no history of myocardial infarction at baseline (1990–1993) who were followed until January 1, 2000. The risk of incident CHD, all-cause mortality, and aortic atherosclerosis was studied in tertiles of energy-adjusted vitamin K intake after adjustment for age, gender, BMI, smoking, diabetes, education, and dietary factors. The relative risk (RR) of CHD mortality was reduced in the mid and upper tertiles of dietary menaquinone compared to the lower tertile [RR = 0.73 (95% CI: 0.45, 1.17) and 0.43 (0.24, 0.77), respectively]. Intake of menaquinone was also inversely related to all-cause mortality [RR = 0.91 (0.75, 1.09) and 0.74 (0.59, 0.92), respectively] and severe aortic calcification [odds ratio of 0.71 (0.50, 1.00) and 0.48 (0.32, 0.71), respectively]. Phylloquinone intake was not related to any of the outcomes. These findings suggest that an adequate intake of menaquinone could be important for CHD prevention.
The medical establishment has been preaching for decades that foods that are high in vitamin K2 such as Gouda cheese, 100% grass fed meat and pastured eggs are dangerous and unhealthy. I doubt that the key opinion leaders of the medical establishment would change their tunes on this subject overnight.  It could very well be the case that zealous runners that you've been studying are also zealous about following the (incorrect) teachings of the medical establishment on this subject. And were therefore highly deficient in the vital vitamin K2.
I recently passed the 32,000 mile mark of my running career of some 40 years. My running has always been rather laid back with frequent rests. To build speed I usually race about once every two months and do interval training. I have also been lifting weights for 21 years.

Avatar universal
by YoonECycle, Dec 25, 2015
That last post could use some editing.

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by JohnHaganMD, Dec 25, 2015
Again thanks for the information. I don't think diet has anything to do with our studies and its the prolonged mechanical stress to the heart vessels and they microdamage they elicit that causes the calcium accumulation. Of course subsequent studies are showing that we marathon runners and other ultra long distance athletes may have firm, high density calcium deposits that do not carry the same risk of cardiovascular events has the low calcium density, fatty atheroma that are characteristic of other high risk non-exercisers (e.g. smokers, diabetics, hypertensives, high LDL, obesity, etc.)

Past that i can't speak with any authority to K2 other than my cardiologist thinks its important.

Thanks
JHaganMD

Avatar universal
by YoonECycle, Dec 26, 2015
This is one of the studies that I have been referring to. It is interesting that changes in cytosolic calcium is a major factor in signaling. The rise in sera calcium levels that follows more vigorous exercise has numerous effects but I have no idea whether it actually changes cytosolic calcium levels in non-muscular tissue. The authors explained that their measurement of insulin sensitivity of older subjects may have been deficient because they made the measurements several days after the last bout of exercise.

Impact of Aerobic Exercise Training on Age-Related

Changes in Insulin Sensitivity and Muscle Oxidative

Capacity

Kevin R. Short,1 Janet L. Vittone,2 Maureen L. Bigelow,1 David N. Proctor,3 Robert A. Rizza,1 Jill M. Coenen-Schimke,1 and K. Sreekumaran Nair1


Insulin resistance increases and muscle oxidative ca- pacity decreases during aging, but lifestyle changes— especially physical activity—may reverse these trends. Here we report the effect of a 16-week aerobic exercise program (n 65) or control activity (n 37) performed by men and women aged 21–87 years on insulin sensi- tivity and muscle mitochondria. Insulin sensitivity, mea- sured by intravenous glucose tolerance test, decreased with age (r 0.32) and was related to abdominal fat content (r 0.65). Exercise increased peak oxygen uptake (VO2peak; 10%), activity of muscle mitochondrial enzymes (citrate synthase and cytochrome c oxidase, 45–76%) and mRNA levels of mitochondrial genes (COX4, ND4, both 66%) and genes involved in mito- chondrial biogenesis (PGC-1 , 55%; NRF-1, 15%; TFAM, 85%). Exercise also increased muscle GLUT4 mRNA and protein (30–52%) and reduced abdominal fat (5%) and plasma triglycerides (25%). None of these changes were affected by age. In contrast, insulin sensitivity improved in younger people but not in middle-aged or older groups. Thus, the muscle mitochondrial response to 4 months of aerobic exercise training was similar in all age-groups, although the older people did not have an improvement in insulin sensitivity. Diabetes 52: 1888–1896, 2003



Fourth, recent work has shown that genes for mitochondrial proteins and the primary glucose trans- porter in muscle, GLUT4, are regulated by common sig- nals, including elevations in cytosolic calcium (29,30) and the transcriptional coactivator PGC-1 (peroxisome pro- liferator–activated receptor [PPAR]- coactivator 1 ) (31). Muscle mitochondrial function and gene expression are reduced in aging muscle, but the underlying cause and the relationship to insulin action are not yet understood (32–34). The second purpose of this study, therefore, was to measure the effect of age and exercise training on the gene expression of PGC-1 , GLUT4, and mitochondrial genes and nuclear transcription factors that regulate mi- tochondrial genes, including PGC-1 , nuclear respiratory factor (NRF)-1, and mitochondrial transcription factor A (TFAM). We tested the hypothesis that a moderate exer- cise program results in equivalent improvements in insulin sensitivity, GLUT4 expression, and mitochondrial genes and function in individuals whose age ranged between 22 and 87 years.




Avatar universal
by YoonECycle, Dec 26, 2015
Your comment is interesting. Dr Mercola and Marc Sisson (Mark's Daily Apple)have been preaching a gospel of moderate aerobic training and weight training as the road to health salvation.Both are former active long-distance runners.Sisson has been saying that our Paleolithic ancestors walked 7 miles a day but ran and sprinted substantially less. Hunting was a group activity that involved multiple players not a long sustained chases by one individual. It does appear that you are on to something. On the other hand this iPad is a bit not on to something.  It's not very good at taking dictation.

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by JohnHaganMD, Dec 26, 2015
For Yoon and others interested in this topic. My cardiologist and friend who discovered my Coronary Artery Calcium Score of 1606 (normal is zero) and subsequent cardiac work up only found my primary risk factor was 42 years of marathon type running 5-6 days/week is James O'Keefe MD.  This is his 18 minute TED talk for those interested. He does mention my case study in the talk (as "my friend John").

https://www.youtube.com/watch?v=Y6U728AZnV0

JCH MD

Avatar universal
by etaon, Jan 05, 2016
I have been an avid exerciser for most of my life but rarely for long periods of time.
Various activities, biking, swimming, moderate running/jogging, skiing, etc.
I have read studies that have found that exercising for more than 45 minutes has almost no extra fitness benefit.
Therefore it is pointless to engage in an exercise for more than 45 minutes anyway.
These studies found that the minimum for a good fitness level is 15 minutes.
30 minutes gives an excellent fitness level and there is a modest gain of fitness in 45 minutes compared to 30 minutes.
This jibes nicely with your advice to limit running to 10k

Dan

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by JohnHaganMD, Jan 05, 2016
Ken Cooper, MD father of "Aerobics" was the first to say that anyone running over 30 minutes is doing it for something other than fitness. Also one of the first to recognize that extreme endurance exercise depresses the immune system and might even predispose to some forms of cancer.

Your programs sounds very beneficial and well though out

JCH MD

Avatar universal
by JagatarPaul, Jan 26, 2016
Sir I am 24 year old I was accident 7 year before and  my knee is total damage it's possible my knee change this age ?

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by JohnHaganMD, Jan 26, 2016
I'm an ophthalmologist that was a marathoner for many years. You need to ask your question on an orthopedic forum. Better yet see an orthopedic surgeon interested in sports medicine in person to see what might be done.
JCH MD

Avatar universal
by SIHungary, Feb 25, 2016
Im 59, my heart ct showed above 75% occlusion in 3 main coronaries, later I got one stent, no more stent or bypass are reasonable. On a bicycle ergometer I feel chest discomfort at 85 watts. I should do some exercise, but how strenuous?  Is it safe or recommended to reach slight angina, or shoud I do it at lower level? If marathon is not good for a healthy heart, I suppose I should not reach even slight chest pain during excercise. Sometimes my pulse rate it at 120 and I do not feel angina, sometimes it comes at 90. Thanks.

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by JohnHaganMD, Feb 25, 2016
Your exercise prescription can only be written by your cardiology team.

Avatar universal
by TahNewellTutu, Mar 08, 2016
Hi Doctor,

I got hit in the eye about 18 days ago, something that didnt seem to hard to me. Right after that I had a black floater at night that went away but now am having flashes for about two weeks now. The optamologist told me that he sees swelling in my eye around the vitreous. Can this cause that or is this my vitreous detaching from my retina?

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by JohnHaganMD, Mar 08, 2016
If you saw the ophthalmologist right after the injury and the floaters and flashes started since then you need to return for a repeat examination. Yes it is likely the trauma caused the vitreous detachment and the floaters.

Avatar universal
by Jj532, Mar 17, 2016
Sorry to interrupt and asking but do you answer std questions?

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by JohnHaganMD, Mar 17, 2016
Not sure what you're asking. If you have an eye question go to the eye forum and post it there and I'll answer.

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by JohnHaganMD, Mar 17, 2016
Unless by STD you mean sexually transmitted disease questions then the answer is no and you need to go to that forum. If its an abbreviation for "standard" and its eye related yes go to the eye forum.

Avatar universal
by Osiasya, Mar 20, 2016
Dr. Hagan have you heard of the Galloway method? It is wear you run Marathons (or any distance really) not all out but in chunks/intervals. Like for myself I will do 1 minute walking then 30 seconds running for an entire race. I noticed in all the comments and discussion here you were talking about the negative effects for people "running their hardest" for more than an hour but about about these intervals where you are not running at top speed the entire time?

Basically what I am asking is; Do you think people who run using the Galloway method are also at a higher risk of damage if they do more than 10k's? Thanks in advance for your time!

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by JohnHaganMD, Mar 20, 2016
Yes I am familiar with the Galloway method and used it to run my first marathon. It allows recovery and should theoretically be better than running without any rest. However there are no studies to quote and no scientific literature on the subject. So if you're going to run longer than an hour, especially after age 40, taking these frequent walking breaks is a good idea.

JCH MD

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by healthcoachMarina, Apr 11, 2016
Hi, Dr. Hagan

I accidentaly found your blog and read everything posted. First of all, thank you very much for all the information and suggestions. I am 56 years old, a health coach, a long distance runner and a personal trainer. Exercise has been instrumental in my life. 17 years ago I was overweight and had high blood pressure. Thanks to exercise, I lost weight and forgot about my high blood pressure. I run 7 half marathons and spend at least 2,5 hours in the gym daily.Your article made me think that maybe I am overdoing it. I like your comparison of the exercise to the powerful drug.Consequently, it can hurt if taken in large doses.

Thank you again for your insights.

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by JohnHaganMD, Apr 11, 2016
You are welcome. Most of the new research on ultra-exercise is not good. Moderate exercise however is fantastic.

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by Prospero73, May 07, 2016
As an older (80) ultramarathoner, I have to question the association of sheer distance with physical damage.  In general, the shorter the race, the more intense, so that a mile is harder than a 5k and so on.  There is a break between the people who run races of a marathon or shorter, and those who run ultras.  In my case, I prefer the longer events, such as 50-milers and 100ks, because they allow you to move at a much more relaxed pace and still finish before the cutoffs.  With a resting heart rate of about 50 and a maximum of about 175, I normally run at around 4 MPH or slightly slower at a HR of about 115, breathing around 20 cycles per minute.  I have taken several treadmill tests during my 25 year career, with no indication of abnormalities.  I should add that I have also removed myself without hesitation from races when I didn't feel physically up to continuing.  Running is as natural a gait as walking, and endurance running is an activity where we excel over all other mammals.

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by JohnHaganMD, May 07, 2016
When you're 80 you can basically say anything you want.  So the 80 year old that smokes says cigs are good for them, or the 3 shots of whisky or the pancakes and hash browns.  

The evidence against ultra-endurance exercises is substantial, based on study of thousands of individuals and collaborated by different researchers in US, Europe and Asia.

But like I said at 80 you can say anything you want and claim its why you've made it that far.

Avatar universal
by Paxiled, May 08, 2016
I've been following this thread with interest.  I've never personally run or wanted to run a marathon, but as I understand it from those who do, the whole point of running one is that it isn't good for you.  People are all insecure, and believe this will prove something to themselves.  I doubt it does, because any time you have to resort to proving yourself to yourself, you'll probably just have to keep doing it again as time will erase any emotional gain that isn't achieved through some true emotional breakthrough.  But that being said, climbing mountains, racing on anything, whether it be skis or autos, hiking on sheer trails, working too many hours, flying too much across too many time zones, hang gliding, martial arts -- well, you get the point, people often very much enjoy doing things that really aren't safe.  We're all going to die, and we're all going to die because our hearts stop beating.  The only question is how long we live, and the better question is how much we enjoy life before we die.  So if running marathons, for whatever reason, is the thing a person most enjoys in life, including preparing to run them, so what if they die a little sooner?  I think this is an important issue.  Modern medicine judges everything by how long a person lives, even if those last few years are spent suffering.  Wouldn't it be much better to die younger but suddenly while doing the thing you enjoy the most?  Just some food for thought, because even just breathing our polluted air and drinking our polluted water is going to kill some of us early.

Avatar universal
by achillea, May 19, 2016
Ah, heck, why even bother with medical school?  Any person on the street knows as much as any doc.

Avatar universal
by Prasanth72, Jul 05, 2016
Hi sir,

I am prasanth. I recently got eyesight with astigmatism.
The measures are :
Right: 0 spherical  -1.0 cylndiral 180 degrees
left : 0 spherical  -0.5 cylndiral 170 degrees

I am having rays reflected in my eyes especially in nights like starbursts.
This problem recently started to my eyes. I consulted doctor and he told I have dryness in my eyes. But I didnt feel any irritation in my eyes.
I have rays reflected towards only left side while I am seeing with my left eye and only right side while im seeing with the right eye.
what to do to avoid that problem. Is my condition serious?
should I have to change my eye glasses?
Plz help me.

Thanks,
Prasanth.



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by JohnHaganMD, Jul 05, 2016
This conversation thread is not about glasses. You can post the above question on the eye forum and I will answer it there. JCH MD

Avatar universal
by Jvoce1, Oct 12, 2016
Hi Doc,

My question is this, I am following a blend of two methodologies of running, first is aerobic HR (Maffetone Method), so when I run I stay at or under 130 BPM, I am 50 but I occasionally sprint at the end of a run for a few minutes.  The second is the Galloway method of run/walk.  I am at a 4min run/1 min walk for the duration of my training which is about 3x a week for 45 min and a long run on the weekend.  I am also training for a half marathon and half ironman in 2017.  I expect to keep my HR training, even on the bike, at the 130 BPM limit for most of the training.  The theory is that over time, I will go faster at the same HR.  I can see improvements.  I also strength train 3x a week.  my current plan has me going up to 2.5 hours of running and probably 4 hrs on the bike.  Where does this fall in your opinion, if my HR is kept in the aerobic zone?  To add, I also try to keep a good HR during races, but will sometimes (well, mostly) exceed my training HR due to hills, pretty girls, etc.  Thanks,  Jim

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by JohnHaganMD, Oct 12, 2016
If you have to do that, realizing its more than you need to stay fit and has the potential to damage your heart and its arteries then the walk/run is best and bicycling at an easy pace.  This week is the KC Marathon and the KC Star is doing an article on this research. I did a video for them that should be one line tomorrow (Thursday) at www.kansascity.com and in the Kansas City Star paper on Friday you can read it at the same address.

JCH MD

Avatar universal
by Saydream, Nov 23, 2016
Hi Doc,
The night before I pulled out my agnail of Fingernail(the agnail growing on the hand--- forefinger), a little bleeding, A few moments later the wound(forefinger) stopped bleeding, Second day i have a football game in the afternoon, and i shake hands with other players and the referee, I remember they didn't touched my wound. Intense competition of the game, I do not know Whether the wound has been touched? for fear of wounds. At half-time, bought a Band-aid, after washing hands, with clean paper around the fingers(Fingernail wound) wrapped around a circle, then paste the Band-aid, finally, the end of the game, i found on the paper, there are two small traces of blood, very worried about whether the wound still is an open wound, Can it prevent virus?( HIV), worry that the wound was touched by someone else.
I'm too scared and now cannot be confirmed that the blood mark(the two small traces of blood) is mine or someone else, So I am very worried!

1.Please help me analysis, I will be infected with HIV? Traces of blood is mine or someone else's?
2.The wound(need to use external pressure will blood) is also an open wound? Can it prevent virus( HIV)?
3.Need someone else's blood entry another body the will be infected(Such as blood transfusion,Traffic accident injury) ?But a small wound, a little bit of bleeding will not be infected?
4. Can you  tell me how long can HIV virus survive after leave the host? and virus leaves the body fluid and blood (survive time)?
Thank you very much!

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by JohnHaganMD, Nov 23, 2016
This is an inappropriate forum for your question. Wander over to a HIV or infectious disease clinic.

Avatar universal
by Karismatico, Nov 28, 2016
Hi Doctor.
I am a 33 years old male.
Since 2012 i walk 30 minutes 4/5 times per week. I always had that idea that extreme exercise would be bad and surprisingy evidence is confirming that.
In 2012 i did a coronary CT scan and my calcium score was 3. Then i started walking on a regular basis.
What do you think of my calcium score?

I have done several treadmill strees tests, echo, heart MRI, holters (all normal, exept for PVC's (max 7 a day) in some holters).
My total colesherol is 165. but HDL only 48.
No diabetes. Dont smoke. No heart attack history, nor sudden death in my family, before 78 years old.


Avatar universal
by Karismatico, Nov 28, 2016
On my Coronary CT there were no significant stenoses. (all <10-15 %)
Before 2012 i used to play soccer on a regular basis.

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by JohnHaganMD, Nov 28, 2016
Those are excellent numbers keep it up. Moderation in all things.

JHaganMD

Avatar universal
by Karismatico, Nov 28, 2016
i suppose that calcium score would not raise significantly in 4 years...
maybe now i have 8-10?
thank you for your answer.

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by JohnHaganMD, Nov 28, 2016
No way to predict how it will change in the future. no likely any good to repeat for another 10-15 years

Avatar universal
by Snafu50, Mar 08, 2017
There have been some reports in the media about calcium supplements possibly causing calcium buildup on arteries? Is this a fact? Could you comment on this please? I'm 50 yo have not much dairy products, but a lot of fruit and vegetables, is this enough or could you recomend a 'safe' calcuim supplement?.

Thanks

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by JohnHaganMD, Mar 08, 2017
This is an excellent article that discusses the subject at length:  http://www.hopkinsmedicine.org/news/media/releases/calcium_supplements_may_damage_the_heart

You would need to discuss with your personal physician. There is a calcium supplement made by Cardiotabs that may have some advantages for people that have to take calcium supplements. Their website is easy to find. www.cardiotabs.com

Avatar universal
by Snafu50, Mar 08, 2017
Thank you for amazing informative response, I'll check the link soon.



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