BBEEYYOONNDD TTRRAAIINNIINNGG Mastering Endurance, Health and Life

BBeenn GGrreeeennffiieelldd

I experienced my first "PVC" when I was in the middle of an 18 mile training

run for Ironman Hawaii.

To prepare my body and mind for the rigors of the Kona lava fields, I had chosen to go

pound the pavement at 4pm in the afternoon on a blistering 97 degree day in my hometown

of Spokane, Washington. At about mile 15, with my throat parched and my body

overheating, I paused for a quick sip of water from the drinking station beside the trail. But

as I bent down to take a drink, something suddenly felt very wrong in my chest.

My heart skipped a beat.

Several times.

Here I was exposed in the scorching heat, 3 miles from home, and my body's primary

internal engine - the organ that literally decides whether I live or I die - seemed to be

seriously malfunctioning.

If I had been lost in the tunes of .mp3 player, my labored breathing or the beat of my feet on

the ground, I probably wouldn't have even noticed this cardiovascular electrical short-

circuit. But I was lucky enough to have not been moving when my heart decided to flip-flop.

And I definitely noticed.

So I walked home. Slowly.

-----------------------------------------------

Let's back up for a second.

After all, a PVC may sound like something out of a science fiction novel or a do-it-yourself

household plumbing guide.

But PVC actually stands for "Premature Ventricular Contraction", and you're about to learn

how it happens.

Every time your heart squeezes blood out to the rest of your body, it requires an electrical

impulse. In a normal electrical conduction, impulses originate from an area in the top right

corner of the heart known as the "sinus node" (see picture below). The electricity then

spreads across the upper two chambers of the heart (the atria), and is then transmitted to

the lower two chambers (the ventricles) through the "atrioventricular node".

During a normal heartbeat, your heart's ventricles contract blood out to your entire body

after your heart's atria have helped to fill them. In this way, the ventricles can pump the

maximum amount of blood both to the lungs and to the rest of the body.

So how can this electrical misfiring happen?

Every piece of tissue in your heart is electrically active. This means that all heart tissue can

conduct electricity. However, all heart tissue can not only conduct electricity, but can also

generate electricity. Normally, your heart tissue is conducting electricity generated by the

sinus node. However, occasionally it will generate electricity on it's own as well - and when

this happens a premature contraction results.

So when a PVC happens, your heartbeat is not initiated by your sinoatrial node (your body's

normal heartbeat initiator), but rather by special fibers in your ventricles that are triggered

by the atrioventricular node, bypassing the normal method of electrical stimulation. This

means your ventricles contract first - before your atria have optimally filled the ventricles

with blood.

And this not only means that blood circulation of oxygen and nutrients is way less efficient,

but it also means that you can feel things like palpitations, skipped beats, extra heart

contraction, irregular heart rhythm, slight chest pain, a feeling of faintness and fatigue, or

shortness of breath.

Now before you have a PVC panic attack, please allow me to make something

very clear: the occasional PVC is actually common.

That's right - nearly everybody has a skipped or extra heartbeat every now and then. As a

matter of fact, cardiac electrophysiologist and cyclist Dr. John Mandrola, in a very good

blog post on PVC's, says that PVC's are the second most common rhythm problem he sees

(he points out that a related electrical abnormality called an atrial arrhythmia, also known

as a "heart flutter" is the most common).

In that same post, Dr. Mandrola also points out a few other interesting facts, including:

1. In an overwhelming majority of people, especially those with normal heart structure,

PVCs are benign - which means that the extra beats do not actually indicate heart

disease or any other serious and immediately threatening issue...

2. The normal person has about 100,000 heartbeats per day (athletes with slow

heartbeats would have fewer heartbeats than this), and only people with more than

20,000 PVCs per day are actually at risk for developing cardiomyopathy (weak heart).

That means about 20% of the time, you'd be experiencing PVC's - and trust me - you'd

probably know it if this were the case.

3. PVC's might indicate training excess. Here's exactly what Dr. Mandrola says about

this:

"I see this often in athletes. It might happen during a big training block or

immediately afterwards. Of course, my theory is that PVCs associate with excess

inflammation. The reason I see inflammation as the link is because PVCs often occur

in patients who are exposed to stress. The middle-aged person going through a

divorce, the doctor embroiled in a lawsuit, the minister who takes care of everyone

but himself, the grad student during exams. The theme here is that PVCs tend to

cluster at times of high inflammation–be it physical, mental or emotional..."

"Recently, a cycling friend told me his PVCs had resolved almost as soon as he

stopped training for races. He still rides, fast at times, but doesn‟t „train.‟ (I‟m not

advocating not racing; it‟s just an anecdote.)"

4. PVC's could potentially be aggravated by dietary deficiencies. For example, Dr.

Mandrola says that he has had some patients report benefit from magnesium

supplementation, and Dr. Mark Sircus said the same thing when I interviewed him on

the podcast episode "The Shocking Information About A Compound That

Pharmaceutical Companies Really Don’t Want You to Know About." I referenced that

episode again in a follow-up audio recording I did entitled "How To Avoid Sudden

Heart Attacks While Running". While electrolytes may matter less than Gatorade

would have you to believe, they're certainly important for heart health and electrical

conductivity in hard charging athletes, and in an era of mineral-depleted diets and

excessive stress and over-exercise, I suspect deficiencies such as magnesium are a

much bigger contributor to the problem than many people might think (yet another

reason why I slather my body with magnesium oil after every hard workout).

In a nutshell, you can think of PVC's as a canary in the mine. As a matter of fact,

in this helpful forum discussion on MedHelp, it's pointed out that two conditions are known

to cause PVCs during exercise - one is coronary artery disease and the other is myocarditis

(heart "inflammation"), and both are often aggravated by excess adrenaline (e.g. stress

and/or overtraining) and poor exercise conditions. But in the absence of these two factors,

PVC's may actually be no big deal at all.

--------------------------------------------

Now of course, there are other potential cardiovascular concerns that go above and beyond

palpitations or PVC's. From leaky valves to an enlarged heart wall, I discuss many of these

other heart issues in the chapter "Are Endurance Sports Unhealthy".

In that chapter, I also address potentially disturbing findings by researchers like Dr. James

O' Keefe (famous for his TED Talk video "Run for your life! At a comfortable pace, and not

too far."), and point out the balanced evidence on the other side of the fence produced by

Armi Legge in his articles "Does Cardio Cause Heart Disease" and "10 Reasons Why a Large

Athlete’s Heart is Usually Not Dangerous".

Ultimately, if you don't have time to read the links above, the take-away message is this:

Even though exercise is generally good for your health and your

heart, there's some evidence that high amounts of exercise - especially long

bouts of endurance exercise - could potentially be bad for your heart,

especially when combined with lifestyle stress, difficult exercise conditions

such as extreme heat, nutrient and electrolyte depletion, and genetic risk

factors for heart disease.

And with my combination of PVC's, my history of intense and often excessive exercise, and

my very high cortisol levels from a fast-paced lifestyle, I didn't want to take any chances.

So what action did I personally take?

It was this sage advice from the Dr. Mandrola article on PVC's that led me to take the next

step:

"A basic medical evaluation can exclude significant structural heart disease."

In other words, there must be some kind of a test or medical evaluation of my heart that

could tell me whether or not I was at risk of dropping dead during my next Ironman and

leaving behind a lonely wife and two fatherless boys - or whether my PVC's were simply

normal and harmless occurrences.

It was this line of thinking that got me on the phone with the Spokane Heart Institute to

schedule an appointment with local cyclist and cardiologist named Dr. Timothy Bishop.

--------------------------------------------

Dr. Bishop is a slim, fit, bespectacled man, and I could tell as soon as he walked into the

room that he was a seasoned cyclist and health enthusiast. In other words, this wasn't some

out-of-shape doc who didn't know a running shoe from a loafer.

I inwardly pumped my fist that I got hooked up with a doc who knew exercise, and then I

proceeded to spill the beans on my heart palpitations, my concerns, the James O' Keefe

findings, and the recent Wall Street Journal article "The Exercise Equivalent of a

Cheeseburger". I also filled Dr. Bishop in on the fact that I am an author writing a book on

endurance sports, and specifically interested in the potentially deleterious effect of exercise

on the heart, including the potential for increased risk of arrhythmias and coronary artery

disease in athletes who participate in extreme endurance events.

Dr. Bishop was very careful to lay out both sides of the "exercise is bad for your heart"

argument.

And he really knew his stuff.

He explained all the recent findings and recently published data on potential for heart risks

in endurance athletes, laid out both sides of the argument in a balanced way, and ended by

emphasizing that in most cases, in a relatively sedentary society, we're probably doing more

harm than good by warning people away from exercising.

In other words, the last thing a couch potato needs to hear is that if they go for a long walk

they're going to have a heart attack.

Point well taken.

"But Dr. Bishop," I explained, "Let's just say, hypothetically, that a guy like me who has

been beating up his body for 10 years wanted to get some peace of mind? Can't I just get

some tests to find out if there are any issues with my heart?"

The doctor pushed up his glasses, "Ben - if you were showing serious signs of heart

problems, I'd be happy to test you. But if I ran a battery of expensive medical tests on every

person who waltzed in wanting to get their heart evaluated out of sheer curiosity, I would

technically be practicing medicine irresponsibly and potentially misusing the medical

system and simply racking up unnecessary expenses."

Once again, point well taken.

But I kept pressing, "But doctor, let's just say, hypothetically, that I were going to get tested

to get some peace of mind. What would you do?"

Dr. Bishop then took a deep dive into the rabbit hole, explaining the huge battery of

available heart testing options, including:

1. A CT scan of the heart, in which you get injected with an intravenous dye

(iodine) and then your heart is scanned using a high speed CT scanner, allowing

the assessment of blood flow to their heart muscle, and visualization of the heart

anatomy, coronary circulation, calcium buildup in the arteries, and detailed

information about vessels surrounding and coming in and out of the heart

(which includes the aorta, pulmonary veins, and arteries).

2. An exercise electrocardiogram, also known as a stress ECG, which provides

information about how the heart responds to exertion. It usually involves

walking on a treadmill or pedaling a stationary bike at increasing levels of

difficulty, while your heart's electrical activity, heart rate, and blood pressure

are monitored - and is especially good at detecting PVC's or other arrhythmias.

3. A transthoracic echocardiogram, which is a heart test similar to X-ray, but

without the radiation. The procedure uses the same technology used to evaluate

a baby's health before birth (AKA an ultrasound). A hand-held device called a

transducer is placed on the chest and transmits high frequency sound waves

which bounce off the heart structures, producing images and sounds that can be

used by the doctor to detect heart damage, wall thickness, heart size, valve

function or significant scarring (admittedly, this test won't pick up some of the

less significant scarring raised in some of the concerning articles about mild

heart scarring from endurance exercise, but will at least show areas of serious

damage).

4. Cardiac catheterization (also called cardiac cath or coronary angiogram),

which is a relatively invasive imaging procedure in which a long, narrow tube

called a catheter is inserted into a blood vessel in your arm or leg and guided to

your heart with the aid of a special X-ray machine. Contrast dye is injected

through the catheter so that X-ray videos of your valves, coronary arteries, and

heart chambers can be created.

5. MRI (magnetic resonance imaging). An MRI uses large magnets and radio-

frequency waves to produce pictures of the body's internal structures. This

technique obtains information about the heart as it is beating, creating images

of the heart throughout its pumping cycle. Although expensive and a bit more

difficult to get, an MRI can evaluate the anatomy and function of the structures

of the chest, including the heart, lungs, major vessels, and pericardium (the

outside lining of the heart). It is also used to determine the presence of diseases

such as coronary artery disease, pericardial disease, cardiac tumors, heart

valve disease, heart muscle disease (cardiomyopathy), and congenital heart

disease. A sample of an image from an MRI is below:

At this point, my head was spinning with the options. I had originally figured we

could just do something as simple as throw me on a treadmill, have me run for a little while

with a few cables attached to my chest, and call it good.

I leaned forward in the office chair, "OK, doc, so let's say I want to find out if I've actually

done any damage to my heart over the past few years, and discover if I maybe, just might

happen to be one of these walking statistics who has a perfect storm going on in my chest

that could lead to me dropping dead during Ironman Hawaii in 4 weeks? What could I do?"

Turns out the options were:

A) fly to some extremely expensive concierge medical facility, like the Princeton Longevity

Center, and pay some booka bucks for whatever test I'd care to throw money at (I wasn't

extremely keen to explain that expense to my wife)...

B) call around to a variety of medical research institutes or academic institutions such as

University of Washington and try to get into a heart study in which they use an MRI or

one of the other fancier tests...

C) stay in my own backyard and get tested by Dr. Bishop at the Spokane Heart Institute

using their standard heart preventive testing equipment - namely a stress ECG and an

echocardiogram...

Option C was sounding like a reality, and like something I may be able to actually pull off in

a timely fashion before Ironman, so I pressed on...

"So Dr. Bishop, if we just take into consideration those heart palpitations I had during my

long run, we could technically justify doing some like an ECG and ultrasound, right?"

Having filled me in on all the options, the reality of the situation, the fact that I was

probably just fine, and potential expenses associated with the test, Dr. Bishop finally gave

in. He nodded yes.

And just like that, within 5 minutes I was outside in the hallway scheduling with the

receptionist to show up at the downtown hospital that Friday at the ungodly hour of

7:00am for a heart ultrasound and a treadmill stress test.

-----------------------------------------

That Friday, my alarm blared at 5:30am. I rolled out of bed, and opted for a cup of

decaffeinated coffee, just to avoid any potential effects of caffeine on my heart rhythm, then

hopped in my pickup truck and headed downtown.

The ultrasound came first, and it was actually a bit surreal to both feel my heart in my chest,

but also see it up there on the computer screen. Up to this point, my only experience with

the stereotypical black and white ultrasound monitor was having watched my twin baby

boys wriggle around in mom's tummy. And now it was my heart up there on the screen

instead, wriggling, churning, pumping, sucking, pushing, pulling and pumping in my chest

as the ultrasound technician darted his magic wand around my chest - measuring valve size,

wall thickness, and the size of my four primary heart chambers -the right and left atria and

right and left ventricle.

The ultrasound (AKA transthoracic echocardiogram) looks like this:

Within 30 minutes, the technician was finished and my heart was all measured up.

Next, came the treadmill stress test, which was a bit more involved than simply lying on a

table while a technician gave me a free chest massage.

For this test, I stripped down to my running shorts, threw on my running shoes, shocked

the nurses with my resting heart rate of 29 beats per minute, and then had 8 "leads"

attached to my chest and abdomen to measure electrical activity in my heart while I ran on

the treadmill - beginning at an easy pace and progressing in speed and incline to gradually

harder intensities until I reached close to maximum capacity.

I suspected I was perhaps not the stereotypical test subject for the Spokane Heart Institute

when the nurses began discussing whether or not the treadmill was actually going to go any

faster or higher.

In other words, they'd never seen anyone take this test to the red-hot intensity I took it.

But I really wanted to push to the limits and ensure my heart was truly "stressed" during

this test. After all, I didn't want useless, walk-in-the-park data. So I stared at the cold wall

and pounded away for 21 and half minutes - up to an 18% incline on the treadmill.

That's not my focused mugshot in the photo below, but it's a pretty good picture of what a

treadmill stress test actually looks like once you're all hooked up to the cables (albeit in the

early stages, before the real torture begins).

And that was it.

Within 2 hours, I was all wrapped up, and headed over to my follow-up meeting with Dr.

Bishop, who was waiting with all my results in hand.

-----------------------------------------

So what did we actually find out?

Dr. Bishop summed things up pretty quickly in his post-test meeting with me. It went like

this:

1. The ultrasound showed that my heart was structurally sound with zero concerning

defects. The technician actually described my heart as a "textbook image" (I kept my

fingers crossed that he wasn't talking about the bad part of the textbook).

2. The ultrasound did indeed show that I have a mildly enlarged right and left atrium (the

upper heart chambers), but the size is still completely typical and well within range of a

normal "athlete's heart"*. My left and right ventricle and heart wall thickness were within

normal limits, with no evidence of significant scarring.

3. During the exercise stress test, I achieved 19.2 METS which according to the report,

represents a "new Spokane Cardiology record for exercise tolerance". Although there were

occasional PVC's during the test, they were completely benign, normal and within limits,

and there were no exercise-induced arrhythmias or heart rhythm changes concerning for

myocardial ischemia (e.g. I wasn't going to drop dead of a heart attack from the type of

rhythms I experience at high exercise intensities).

4. One of my heart valves - the pulmonic valve - show trace "regurgitation", or just a bit of

backflow, which Dr. Bishop explained was completely normal and quite common, with no

cause for concern.

And then, we shook hands, he told me to swing by anytime if I had more

questions, and I was happily driving home for breakfast.

*As you can read in the well-researched post on athlete's heart at Impruvism.com, there is

no evidence showing that an enlarged athlete‟s heart leads to long-term disease

progression, cardiovascular disability, or sudden cardiac death - as is backed up in a

paper by Dr. Barry Maron, the author of this excellent review on athlete‟s heart. The idea

that extreme athlete‟s heart could be harmful in some cases “is perhaps unlikely but at this

time cannot be excluded with certainty.” There‟s also little evidence that having an

enlarged heart is going to make you much healthier. It‟s unlikely that a marathon runner

is going to have a healthier heart than someone who lifts weights a few times a week and

stays active with other light activity. So ultimately, there‟s not much evidence having a

large, athlete‟s heart is bad or good for you.

Finally, you might be wondering about the actual cost of all this testing. At the time of this

writing, I haven't received the final bill, nor do I know how much of the damage my

catastrophic health insurance will pick up vs. what I'll end up needing to personally shell

out of my Health Savings Account, but I have to admit...

...the peace of mind from testing my heart was well worth it, no matter what

the cost. When I'm charging down the lava fields during Ironman Hawaii next

week, it will be nice to know that my ticker is going to keep on ticking.

-----------------------------------------

So when it comes to whether or not endurance exercise is bad for your heart, what's the

final take-away message for you and me?

A) Ultimately, it doesn't look like ten years of extreme endurance exercise, including

oodles of bodybuilding, hardcore, marathon-esque workouts, marathons, long distance

cycling, high intensity interval training and Ironman triathlon has done much damage at

all to my heart. I've got arteries like firehoses, actually - and extremely low resting heart

rate, low blood pressure and a normal heart structure.

B) If you're experiencing heart palpitations or you're worried about other heart issues, the

most important steps you can take are to minimize lifestyle stress, take care to recover

properly after your exercise sessions, avoid overtraining and underrecovery,

consume adequate water, nutrients, vitamins, antioxidants, and

electrolytes (especially magnesium) and accept the fact that you may be taking risks by

putting your body into stressed-out "running from a lion" mode when you're in

excessively hot conditions.

C) If you really want true peace of mind, go get a test like I did. You may need to press a

little to actually get your doctor to order one. Heck, you may even need to make things

sound just slightly worse than they actually are if it helps you get the preventive test

you're looking for. If money isn't an issue and you want the gold standard heart test, find

a longevity institute or concierge medical facility and opt for a full body CT Scan or gated

MRI. But if you need something quick, convenient and not quite as costly, you can get a

heck of a lot of information from a stress EKG and echocardiogram like I did.

Finally, if you want the nitty-gritty details and to download the full .pdf results and official

medical report from my visit with Dr. Bishop - as well as see my follow-up heart scan and

treadmill stress test results - then here's how you can do it:

I just published the entire medical report on BenGreenfieldFitness Premium

channel, and you can click here to go Premium and to check it out

now. Premium is just ten bucks *a year* and includes a secret vault with

dozens of other hidden articles, videos and podcasts that you can access from

your phone, your tablet and your computer. If you want to dig into the nitty-

gritty medical report, see what the results of a hard stress EKG looks like, get

more details on the structure of the heart of a guy who's been beating himself

up with endurance sports for the past decade, are still curious about the

results of the whole heart testing process, or just want more insider content,

I'd highly recommend you click here to go Premium.

And thanks for reading!

To Your Health,

Ben Greenfield

-----------------------------------------