#134 - James O’Keefe, M.D.: Preventing cardiovascular disease and the risk of too much exercise.

The Peter Attia Drive

James O’Keefe is a preventative cardiologist and bestselling author of The Forever Young Diet and Lifestyle. In this episode, James discusses cardiac physiology and what makes the human heart susceptible to disease. He provides evidence for what supports his approach to exercise--elucidating both positive and negative kinds of exercise for heart health. He also discusses the role of nutrition, specific nutrients, and pharmacological interventions to support heart and brain longevity.

We discuss:

• James’ background and why he favors a preventative approach to cardiology [3:15];
• Understanding atherosclerosis and the misconception that it’s a “plumbing problem” [10:15];
• The danger in excessive exercise—a reverse J-shaped mortality curve [21:15];
• The story of Micah True—A case study of excessive exercise [49:15];
• The best kinds of exercise for longevity—The Copenhagen City Heart Study [53:00];
• Being a more balanced athlete and finding the right exercise intensity [58:45];
• Heart rate during exercise, resting heart rate, and other important metrics [1:04:00];
• Nutrition for cardiovascular health [1:09:45];
• Important nutrients: Magnesium, potassium, calcium, sodium, and collagen [1:19:30];
• SGLT2 inhibition for diabetes, cardio-protection, and general longevity [1:24:15];
• GLP-1 agonists for weight loss and reducing cardiovascular risk [1:34:15];
• Statins—Mechanism of action, safety, and useful alternatives [1:37:25];
• A 40-year view on cardiovascular risk, and the possibility of reversing arterial calcification [1:45:45];
• Evidence for high dose EPA and DHA for the reduction of cardiovascular disease risk [1:53:30];
• The impact of omega-3, curcumin, and other compounds on mental health and dementia [1:59:00];
• James’ focus beyond cardiology [2:02:15]; and
• More.

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