A Conversation on Cardiac Rehab with Dr. Abeel Mangi | Starting Strength Radio #12
RIP,
Maybe I am partial because I live in CT right down the street from where Dr. Mangi works, or maybe its because I have had my own butt saved by my own cardiologist at Bridgeport hospital (a Yale affiliate) years ago, I am not sure. But what I am sure of however is this is my favorite podcast by far put out by Starting Strength. There is so much that personally resonated with me from this podcast and I think it will for many others too. There are so many people out there like me who have had some sort of disease, ailment etc. . . that want to change their lives for the better.
Personally, I have been trying to figure out how to get my wife involved with strength training. She sees how I feel now and loves the fact that I am not out running 100's of miles a week as a skinny fat marathoner anymore. Rather she sees how much energy I have, how productive I am and how I have more time to spend enjoying life and am much harder to kill. That said however, every time I have mentioned certain things about strength training to her, she would give me a crazy look.
I think this podcast may be the avenue I need as I will just happen to be watching this when we are hanging out after dinner tonight and nothing else is on TV. If she hears this info from a local CT. MD who knows???
Anyway, this was an awesome informative podcast and this along with my own personal body transformation reaffirms my belief in strength training. Keep up the great work you and the team do!
Thanks!
Sparky
P.S. and yes you are both correct as mentioned in the podcast, when someone like a cardiologist or oncologist (both in my case) saves your life, you tend to ignore everyone else and go to them only. Only a little over a year ago did I finally get a PCP as I asked my oncologist and my cardiologist every question known to man for the last decade. Its a relationship bond that never gets broken. Get a few of these wonderful people on board with strength training and I think we will see amazing changes to peoples lives for the better.
Excellent stuff. I hope it will represent a way to "get the word out".
I thought your summary at 43:36 "What we have here is the answer... to the conditions that predispose for heart disease" was particularly compelling and should be the core of a message that might penetrate some of the fog.
Something you said in that context surprised me a bit, though: at 43:48: "We know what dietary interventions to make..."
Really? Is there an article I have missed on exactly this subject? I have always found dietary claims in this regard extremely confusing... I would really appreciate a few more words on that subject -- even though I know the more important claims, in terms of health impact, are related to the results of hard physical activity -- I, at least, am already convinced on that front. Where can I find more clarity on the diet component of it all?
Loved this one. More like this please.
Coincidentally, I listened to the podcast on my last day of "Cardiac Rehab." I am one of their "stars" because my "mets" are so high on the treadmill, elliptical etc. Interestingly, I really never did cardio before, because I was primarily lifting and one or two HIIT workouts a week. With much trepidation, I returned to lifting a month out from my heart attack and stent. I had been told by my cardiologist not to lift more than 55 pounds, and to never ever, ever valsalva.
After posting a couple of questions here, talking to a doctor who lifts, and doing some reading and research, I started back on a NLP and some 90 days later my lifts are back where they were before the MI, and the numbers are still moving up. I spoke to the staff at the Cardiac Rehab and they were interested in the podcast, and I know at least two of them will listen to it. They expressed frustration that they weren’t able to do more, but are limited because of the equipment available to them and the fact that there aren’t enough of them to really coach the participants. I'm going to encourage them to include an educational lecture on barbell training if nothing else. At least the participants could be exposed to these ideas.
You seem to have hit on something here. I am not sure if it was the interesting, well-spoken guest, the highly relatable nature of the topic, the emotion-evoking personal stories or the presentation of unconventional wisdom in a logical, highly credible way, but people love it!
Only saw one "How am I supposed to beat off to this?" comment on Youtube vs. up to 50 on some of your other videos. It looks like it wasn't such a big issue for this one.
The amazing thing is that there are only 2421 views on YouTube right now. The sillyass Q&A video last time was at 15,000 by this same time, and this one is, in the opinion of many people, the best one we've done.
Maybe we should change the tittle to, “What heart doctors REALLY THINK about lifting weights,” and then a close up shot of you, mouth agape, as if you’ve just heard something shocking.Quote:
Originally Posted by Mark Rippetoe
Oh 2019. As our friend Jay Livsey says, what a time to be alive.
From this discussion, two questions/points of a completely serious nature:
1. What is an appropriate definition of what constitutes a “processed” food? This has increasingly become a pop-culture bullshit term, at least to me. All substances that are appropriate for human consumption require some level of human intervention in order to make their nutrients readily available, either mechanically, thermally, biologically, and/or chemically. What’s the criteria? Beyond the obvious distinction of Kraft Mac and Cheese versus Grandma’s Sunday macaroni.
2. Rip and Dr. Mangi, how do your opinions on “high carb” diets square with the recommendations given by Santana, et al., regarding nutrition for trainees? Are you referring to general population? Does the relatively high protein content that we advocate and recommend mitigate any deleterious effects? (I think I may have answered my own question here; if you are eating 200g of protein as a male, it’s pretty hard to get to the USDA’s recommended percentage of carbohydrates intake per day.)
1. Dr. Mangi stated that any food that comes out of a box is a processed food, and this is a good approximation.
2. High-carb diets without sugar are necessary for heavy training. I'll ask Robert to comment.
You jest, but this might actually be part of the solution. It’s worth a shot, in my opinion. This is important stuff.Quote:
Originally Posted by Ray Gillenwater
YT watchers and podcast listeners are not the same audience. The short excerpts are what get things in front of the former. 3% for the 3%!Quote:
Originally Posted by Mark Rippetoe
A high complex carbohydrate diet that is high in fiber is necessary to maximize performance. My position on fat is that you don't have to worry about it in the sense that you will accidentally get enough of it in your diet without even trying. On the same token I do not think that any professional on either side of the spectrum will argue against a diet high in fruits, vegetables, and whole grains in favor of pizza, beer, donuts, and Cheetos. People forget these foods are high in carbohydrates and fat. To answer your question regarding protein, yes eating a high protein diet is known to improve glycemic control. Eating a meal that has both carbohydrate and protein is going to have a lower glycemic response than one with carbohydrate alone. The same effect has been observed with fiber. Carbohydrate quality is the key here. Lastly, when protein needs are met and fat is held moderate then it is difficult to meet the USDA standards (~45-65% of calories from carbohydrate), which is why eating properly to drive progress under the bar is Not Easy.Quote:
Originally Posted by Satch12879
Excellent. It should have more views. Pearls before swine.
This is a terrific series of posts. I am certainly a believer in terms of "getting the word out," and believe that physical activity is an incredibly important tool that we should all use in order to ward off disease, and to prepare us to fight off disease (and recover from it) should it befall us - because it will befall all of us at some point. Getting sick does not mean that one cannot re-discover, or find for the first time, the inner reserves to re-invent oneself and to do something new and exciting, to improve oneself in at least one dimension. As my trainer John Kenney has often told me: "There is no better feeling as an adult, than being able to surprise oneself!" Having said that, if you are recovering from a disease, you want to start training under supervision. You want to be sure that you develop the capacity to train hard over time. Its hard to accomplish anything meaningful overnight.
I personally tremendously strength training and believe in its benefits, but also advocate high intensity interval training, endurance training - or whatever gets us off the couches and motivates us to move. I do some or all of these 5-8 times a week depending on how I feel. Having specific goals to train towards can be a powerful motivator for certain people.
I am not "anti-carb." I think that discovering and using complex cardohydrates with low glycemic index to support physiology and training goals is important. I am not sure that one needs to eat a lot more protein than most of us Americans already do. I just believe that if we start to pay attention to what makes up one's food - one may be surprised. If its more chemicals than things you recognize as food - its probably not food. If its sweet potatoes, vegetables, fresh meats, fruits - then its safe to say that that is probably food.
My only point is that we need to move, we need to challenge ourselves - physically, mentally, emotionally, spiritually, intellectually, etc., to stretch ourselves past the point where we are comfortable. The human body is a wondrous machine and if challenged, if stressed, it can generate adaptation that is truly remarkable. We may even surprise ourselves.
This was amazing, thank you!
I will use this video.
Why are “complex carbs” that keep blood sugar and insulin elevated for hours and hours considered superior to “simple carbs” that get quickly shuttled into liver and skeletal muscle, which then allows blood sugar and insulin levels to fall to normal/baseline/low levels again?
Dr. Mangi, great video. As has been said, one of the best I've seen put out. You mentioned the concept of a partnership in the video.I know it's a challenge, but how would you recommend we go about forming a partnership with cardiologists (or any other doctors for that matter)? I've thought about this myself, possibly reaching out to show them what we do to reduce the stigma of barbell training. Any thoughts on how best to form such a partnership would be greatly aprpeciated!
Quote:
Originally Posted by FatButWeak
1) Complex Carbohydrates typically contain fiber
2) Glycemic response is greater when carbohydrates are consumed alone
3) Glycemic response is blunted when carbohydrates are mixed with protein, fiber, and fat
4) Simple carbohydrates are useful around workout times when need is higher
Also "hours and hours" of hyperinsulinemia and hyperglycemia is unlikely a healthy individual.
I have no background as a health expert. I have just been reading a lot of non-academic literature on the subject so allow me to test how well I understand the answer.Quote:
Originally Posted by FatButWeak
The simplest of carbs is glucose and fructose, which combine to make sucrose. Indigested sucrose quickly separates into its component parts.
Glucose triggers an insulin response signally “make fat of unburnt glucose. I include ready stores of glucose in the brain and muscles as burnt. Fructose creates no insulin response and cannot be used in muscles or brain (I will skip repeating “brain” from here on due to the main focus of this website.) Fructose has to be processed with alcohol in the liver before the body can use fructose byproducts. The liver creates triglycerides of those byproducts that it spews into the blood stream. Those triglycerides are easily made into fat tissue. Glucose triggered insulin acts as an accelerant to building fatty tissue.
Without the presence of fiber, protein, or fat to slow the decomposition of sucrose, these fatty depositing processes go into high gear. Complex carbs then keep adding fuel to the fatty depositing process when the fructose byproducts are nearly spent, making it last even longer.
In the absence of sucrose, complex carbs must be more slowly decomposed by the body. The glucose does not set off nearly the insulin surge. The fructose has more time to move from triglycerides to conversion to glucose in the muscles as a workout or protein build occurs.
Without the insulin screaming for fat deposits to be built out of fructose byproducts, the body has more chance to “make good choices,” to quote the neighbors’ 4-year old, about how to use the nutrient components in the blood stream.
In other words introduction of sucrose makes insulin run around like Chicken Little screaming the sky is falling or the end is nigh and that you should stock your bomb shelters now.
Complex carbs without Chicken Little are like a fine meal overlooking the countryside with no worry in the world. The body has time to reflect and leisurely build the best body it can.
That’s all I got. How did I do?
You made a couple of mistakes.Quote:
Originally Posted by Hekktor
Fair enough. Good to know. I guess back to the books to study more. Any places to focus my attention?Quote:
Originally Posted by Mark Rippetoe
Thanks for the discussion. I suppose I should clarify my particular circumstances: if one is living on a very low carbohydrate diet generally (either the pursuit of a keto diet or just a very low carbohydrate diet) AND seeks to control bodyfat through close monitoring of daily caloric intake AND frequently depletes his muscle glycogen stores via hard, regular, consistent, barbell training, AND knows this by seeing a steady drop in scale weight, which scale weight readily comes back when carbohydrates (and water) refill muscle glycogen stores, THEN wouldn't simpler carbs - always excluding artificial sources of fructose - like rice, white bread, waxy maize, glucose powder added to whey shakes be a superior choice? Theres no point in slowing down the process, is there?
I ask becasue I am - self diagnosed - not very insulin sensitive and complex carbohydrates and the resultant elevated levels of insulin over a longer period of time seem to trigger bingeing behavior, possibly thru the effects of insulin on my ghrelin and lepin. I do NOT experince these bingeing problems with smaller amounts of the faster acting carbs. And yes, I know white rice and white bread are considered complex carbs, but...are they really? Theyre pretty fucking processed.
Thanks
Long grain riceQuote:
Originally Posted by FatButWeak
Ingredients:
100% long grain rice.
That does not compute.
Bread is 6 basic ingredients: flour, water, yeast, sugar, salt, fat. Nowadays, making your own bread is child's play. Don't buy bread in plastic wrapping, go to a bakery or buy a bread machine.
The simplicity of ingredients in white rice in no way reflects the amount of processing its been through: from wikipedia: "White rice is milled rice that has had its husk, bran, and germ removed. This alters the flavor, texture and appearance of the rice and helps prevent spoilage and extend its storage life. After milling, the rice is polished, resulting in a seed with a bright, white, shiny appearance...The milling and polishing processes both remove nutrients...White rice is often enriched with some of the nutrients stripped from it during its processing."Quote:
Originally Posted by Scaldrew
This processing makes it very, very easily and quickly digested. White bread, regardless of where its made, is similarly aggressively proicessed, which makes it quickly and readily digested.
Four basic ingredients--flour, water, yeast, and salt--and even the salt is optional if you're from Tuscany (though saltless bread tastes pretty flat, to be honest). I like a pan dulce as much as the next person, but the fat and sugar are 100% optional for making basic yet delicious bread.Quote:
Originally Posted by Scaldrew
You are referring to denovo lipogenesis are ignoring the fact that this is not metabolically efficient. It requires extreme overfeeding of carbohydrate and/or fructose for this to happen (>100% of Total Daily Energy Expenditure exclusively from carbohydrate) and even then it has been reported that fractions of a lb were gained under those conditions. This is because carbohydrates also stimulate their own oxidation and blunt dietary fat oxidation. As you eat more carbohydrates you burn more carbohydrates and burn less dietary fat. In energy surplus conditions, you'd burn off the extra carbohydrates and store the dietary fat as body fat.Quote:
Originally Posted by Hekktor
Mr. Santana: Thanks for your learned contribution. I guess Im wondering if the slower digesting complex carbs, precisely because they are slower digesting, result in a longer more protracted insulin response. For example, if 200 calories of waxy maize or a similar fast acting carb is dissolved, acted upon by insulin and stored in (lets just say) 60 minutes, which then allows insulin levels to return to baseline, wouldnt 200 calories of slow digesting carbohydrates (ltes say something really complex, like 100 calories of black beans spread onto 100 calories of whole wheat bread) take a lot longer to breakdown, be digested acted upon by ilin and sotered? lets say the black bean sanich takes 180 minutes - wouldn't that cause a longer time of elevated insulin before insulin returns to baseline?Quote:
Originally Posted by Robert Santana
In other words, If x units of insulin get pumped out to dispose of 200g of carbs - regardless of whether they are complex or simple - wouldnt it be better from an endocrineological persepctive to just pump out x units get it over and done with in a short burst of time? As opposed to slowly releasing X units over many more hours as the complex fibers, fats etc. get broken down slowly and released into the blood. Its my understanding that even slightly elvated levels of insulin cause downstream signaling to other hormones (namely ghrelin and leptin, but probably others) that can make things difficult for former fat boys who are always struggling with excess adiposity, such as myself.
Thanks again.
