DrMirkin's eZine: Heart attack during exercise, low-fiber for constipation, more . . .
Published: Thu, 03/31/22
April 3, 2022
On March 20, 2022, a 44-year-old woman died of a heart attack after finishing the Los Angeles Charity Challenge Half Marathon of a little over 13 miles in just under four hours. However, this event does not mean that vigorous exercise causes heart attacks; in a fit person, vigorous exercise helps to prevent heart attacks.
Heart attacks are not caused by narrowed arteries. They are caused by a plaque suddenly breaking off from the inner lining of an artery leading to the heart, followed by bleeding, and then a clot forms to block completely all blood flow to a part of the heart muscle. That part of the heart muscle then suddenly is completely deprived of all oxygen and dies. Vigorous exercise in susceptible people with unstable plaques in their arteries can increase circulation enough to break off a plaque from an artery to cause a heart attack.
The American Heart Association has cautioned that, “Exercise, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people” (Circulation, Feb 26, 2020). The authors cite more than 300 scientific articles showing that exercising excessively long and intensely may be associated with heart damage, increased plaque formation in arteries, scarring in the heart itself, markers of heart damage in the bloodstream, or irregular heartbeats called atrial fibrillation.
Vigorous Exercise in Fit People Helps to Prevent Heart Attacks
Another review of 48 research articles found no reduction in lifespan, no matter how much a person exercises (Br J Sports Med, Aug 12, 2019). The authors said, “There was no threshold beyond which lifespan was compromised.” Exercise was associated with a 30 to 50 percent drop in deaths related to heart disease (Circ Cardiovasc Qual Outcomes, 2014;7:597-602), and with reduced need for medications to treat high blood pressure, high cholesterol, or diabetes (Med Sci Sports
Exerc, 2007;39:1933-1941).
Some people do have heart attacks and die while exercising, but fewer than five percent of sudden deaths due to heart problems in men 35 to 65 occurred during sports activities (Circulation, Apr 21, 2015;131(16):1384-91). Furthermore, people who have already had a heart attack can markedly reduce their chances of having another heart attack by starting an exercise program, and those who exercise intensely are protected the most from suffering another heart attack (Mayo Clin Proc, Sept 2014;89(9):1187-94).
Who is at Risk for Suffering a Heart Attack during Exercise?
The highest number of sudden heart attack deaths in highly-competitive sports occurs in athletes under the age of 35 (Circulation, 2018;137:1561-1570), and the estimated incidence of heart attack deaths during any exercise is highest in older people, at about 21 deaths per one million participants per year (Circulation, Apr 21, 2015;131(16):1384-91). Those at highest risk for suffering a heart attack or sudden death during exercise are people over 35 who already have
significant heart attack risk factors (N Engl J Med, 2012 Jan 12;366(2):130-40). Athletes who die during exercise often had warning symptoms long before they died, such as an unexplained drop in athletic performance, chest pain, shortness of breath, heart palpitations or fainting. These people possibly could have been diagnosed and saved by getting a stress exercise electrocardiogram when they started to develop symptoms of heart disease (Eur J Cardiovasc Prev Rehabil, Dec
2006;13(6):859-75).
Warning signs of increased risk for an impending heart attack (Lancet, 2011;378:1244-1253) include:
• Pain or discomfort in the chest, neck, jaw or arms, at rest or with physical exertion
• Unusual shortness of breath
• Light-headedness
• Ankle swelling
• Rapid or irregular heartbeat
• Burning or cramping sensations in the lower extremities when walking
• Heart disease indicators such as high blood pressure, blood sugar, or LDL cholesterol
• Kidney disease
• Diabetes
People are most likely to suffer a heart attack during exercise when they suddenly increase the length and intensity of their training. This includes people who are starting a new exercise program, or regular exercisers who decide to enter an endurance event such as a marathon or triathlon and suddenly increase the intensity and duration of their exercise program (Circulation, Feb 26, 2020). The American Heart Association is concerned that some of the millions of people doing endurance exercises and competing in endurance sports may have pre-existing conditions such as heart arteries blocked by plaques or heart or blood vessel abnormalities. Long and intense exercise may harm them. Those who have any questions about their health or a family history of heart or blood vessel disease should check with their doctors before they start or increase their exercise programs. Remember, even well-trained endurance athletes can suffer from heart disease or structural abnormalities.
How to Start a New Exercise Program or Increase Your Intensity
When you have been checked by your doctor and are ready for your new exercise program, you should start very slowly. Gradually build up your effort until you are able to exercise for at least 30 minutes a day, five days a week. For example, if you are just starting a walking program, start walking at a comfortable pace and stop that session when you feel any local discomfort, pain or tightness in your body, particularly in your leg muscles. Try to walk every day and never try to exercise through
discomfort or pain. After a few months of this background training and when you are able to exercise comfortably for 30 minutes a day at a slow pace, you can check with an experienced participant in your chosen sport to help you start more intense training. See How to Start an Exercise Program and All Exercisers Can Gain
Health Benefits from Elite Training Methods
My Recommendations
I believe that with few exceptions, virtually everyone should try to exercise every day. Older athletes can and should continue to compete into their later years, but they need to remember that preventing heart problems involves more than just exercising. You can help to prevent heart attacks, cancers, dementia and premature death by following an anti-inflammatory lifestyle:
• Eat lots of fruits, vegetables, whole grains, nuts, beans and other seeds
• Avoid or restrict sugared drinks, sugar-added foods, red meat, processed meats and fried foods
• Lose excess weight if overweight
• Keep hydroxy vitamin D levels above 30 ng/mL (Current Atherosclerosis Reports, Jan 23, 2017)
• And of course, exercise regularly
Exercise to Help Prevent a Heart Attack
Vigorous Exercise Won’t Hurt a Healthy Heart
The standard treatment for chronic constipation is to eat a high fiber, plant-based diet. In 1969, Denis Burkitt showed that lack of fiber in the diet was associated with increased risk for diverticulosis, hemorrhoids and colorectal cancer (Lancet, 1969;294:1229–31), and today it is accepted that eating lots of dietary fiber in plant foods is healthful and helps to prevent heart attacks, strokes, certain cancers and premature death (Nutr Rev, 2009;67:188–205), as well as constipation.
However, other studies have shown that taking in large amounts of fiber can actually cause constipation in some people. In one study, constipated people on a high-fiber diet solved most of their constipation problems by going on a very low fiber diet (World J Gastroenterol, Sept 7, 2012;18(33):4593–4596). Doctors followed 63 people with an average age 47. They were all severely constipated, their doctors could not find a cause, they had normal colonoscopies to rule out disease, and
had not had colon surgery. The participants ate no fiber for two weeks and then went on the diet of their choice: no-fiber, reduced-fiber, or high-fiber. Six months later, the 41 patients who stayed on a no-fiber diet and the 16 on a reduced-fiber diet had significant improvement in their symptoms:
• bowel frequency increased from one movement every 4.19 days to one movement per 1.9 days
(compared to the high fiber dieters who had one movement every 6.43 days
• reduced symptoms of bloating
• reduced straining to pass stools
The six participants who had returned to a high-fiber diet had no change in their constipation.
Try Prunes First
Before you try a low-fiber diet to see if it will affect your constipation, at least give prunes a trial. Prunes contain soluble fiber and sorbitol, which produce gas that helps to push stool along (Pediatr Gastroenterol Hepatol Nutr, Dec 2014;17(4):203-208). They also contain a compound called chlorogenic acid that stimulates the muscles that line your intestines and colon to contract. To avoid excessive amounts of gas, take only two or three prunes at a time, and work up to five or
more servings a day or as many as you need. A study of 120 healthy adults assigned them to groups that were given either 0, 10 or 15 prunes per day for four weeks (Clinical Nutrition, Feb 2019;38(1):165-173). Adding prunes to their diets increased:
• number of bowel movements to almost every day
• stool weight
• stool content of Bifidobacteria, healthful colon bacteria that reduce inflammation because they do not try to invade cells lining the colon
My Recommendations
If you are chronically constipated and the standard treatments have not helped, you may want to try a low-fiber diet to see if this corrects your problem. Unfortunately, a low-fiber diet misses a lot of important nutrients that are found in vegetables, fruits and seeds (including legumes and whole grains), so I would not recommend it as a long-term diet. However, a trial could help you find out whether too much fiber is part of your constipation problem. You could then gradually re-introduce
the healthful high-fiber foods and see what is the ideal balance for you.
Chronic Constipation
William Hurt was a stage, screen and television actor who won an Academy Award for best actor in Kiss of The Spider Woman, was nominated three other times for Academy Awards and starred in many popular films including Children of a Lesser God, Body Heat, The Big Chill, and Broadcast News.
On March 13, 2022, at age 71, he died from an aggressive prostate cancer that was first diagnosed ten years earlier in 2012, when it had already spread to his bones. He suffered terribly since he did not want to take pain killers because of his previous history of addiction to drugs and alcohol.
His Progression Through the Years
Hurt was born in 1950 in Washington, D.C., the son of a career diplomat and an employee of Time, Inc. When he was six years old, his parents divorced and his mother married Henry Luce III, the son of the founder of Time magazine. Hurt went to Middlesex School in Concord, Massachusetts, where he joined the Dramatics Club and was featured in many school productions. At Tufts University he studied theology, but then switched to acting at the Juilliard School. Read more
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