Only Exercise On The Days You Eat w/ Dr. Joseph Alpert

Episode Information

July 9, 2020

Dr. Joseph Alpert (Cardiologist, Editor-In-Chief of the American Journal of Medicine) discusses his path to cardiology, how he established the universal definition of a heart attack, exciting developments in heart health, and more.

Topics Include:

• His journey from Harvard to becoming Chief of Cardiology at UMass and then Chief of Medicine at the University of Arizona in Tucson
• His mentor (world renowned cardiologist Dr. Lewis Dexter) and how he was influenced by his style and warmth
• His love of writing and publishing and how that led to him becoming the Editor-In-Chief of the American Journal of Medicine
• The importance of exercise on heart health and how he and his wife exercise
• How he established the universal definition of myocardial infarction (a heart attack) that is been declared by the FDA to be the official definition used to get drug studies approved
• The latest technological developments in cardiology including pacemakers, implantable defibrillators, artificial intelligence, and STEM cells
• The future of transplants, the animals that most closely resemble human bodies and organs, and how far animal testing has come to ensure animal safety
• Why he signed on to Doctorpedia as Chief Clinical Advisor immediately when Jeremy Wosner approached him because he thought it was such a good and important idea
• Diet and lifestyle changes that can help prevent heart disease and complications
• His tips for how to stay healthy, which include exercise, eating fruits and vegetables, and taking vacations and enjoying life

Highlights

• “In medical school, when we did the clinical rotation, I ran into one of the pioneer cardiologists of the 20th century, Lewis Dexter. A wonderful man who was also a wonderful human being and so that really pushed me in that direction. I’d also done some research on circulatory physiology, so I already had a little background and that sort of got me going. I eventually trained with Dr. Lewis Dexter and still try and emulate his style and his intellectual ability – a wonderful kind man. A super human being.”
• “In terms of the hours, there’s a couple of things. First of all, you have to be efficient. You can’t sit around and daydream and play computer games. You have to use your time efficiently. And the other thing is you put in long days. Then sometimes you’ve got to work weekends or evenings. “
• “I used to run in marathons and do other competitive stuff when I was younger, but now what I’m doing is just trying to maintain my health and both my cardiovascular, my lung, bone, and muscle health.”
• “It’s been shown that some people who do this more than several hours a day at high intensity exercise, that actually it’s not good for the circulatory system. These folks develop the arrhythmia, the atrial fibrillation at an earlier age, their arteries get calcified in earlier age. So exercise is terrific, but just like everything else: you can do too much. You can drink too much water. Everything in moderation, as the Ancient Greeks said.”
• “The universal definition is now over 20 years old and it’s in its fifth iteration. It’s been declared by the FDA to be the official definition that should be used for all the studies to get drugs approved in the United States. This has fostered a huge research industry, in helping to define this whole thing. I think at this time in my career, that’s one of the things that I was part of that I’m most proud of.”
• “Another interesting area is this whole artificial intelligence. We now use computers to put our whole medical information. We don’t write, we don’t use paper. My joke that I always say is the only paper in our hospital is toilet paper. We don’t write charts anymore. It’s all on the computer and with programs that are in development now, the computer is going to be making suggestions to us.”
• “This STEM cell thing works. Maybe eventually we’ll be able to do something in the heart. But right now the STEM cells haven’t worked, but there’s a lot of research going on and we’ll see. Maybe people will figure out a way to implant cells in the heart so we can grow some new heart muscle.”
• “Right now, for example, we take pig valves and plant them in the heart. The hope is that eventually we’ll be able to take these specially biochemically changed pigs and grow them to take their hearts and put them in humans.”
• “We can correct your blood pressure, we can correct your high cholesterol level, and markedly decrease your chance for having a heart attack or a stroke.”
• “For a long time people were saying that you’ve got to eat much less red meat. Well, there just were a number of studies where they pulled together all of the studies that have been done on meat and it turns out there’s a very small risk of eating meat. It’s not as evil as it had been thought.”
• “I think this is going to be a really useful service to patients, where they can spend a half an hour that they’re not going to get in their doctor’s office hearing in language that they can understand exactly what’s going on that’s not right with them and what we can do to help them.”

Relevant Links

• Doctorpedia Spotlight Interview
• Videos on Diabetespedia
• Healio Article About Defining MI
• American Journal of Medicine

Daniel Lobell: (00:00)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice. Since every person is unique, please consult your healthcare professional for any personal or specific needs. This is Daniel Lobell with The Doctorpedia Podcast. I have Dr. Joseph Alpert on the line. How are you today?

Dr. Joseph Alpert: (00:31)
I’m good. It’s a beautiful cool day here in Tucson.

Daniel Lobell: (00:35)
Wow. Tucson. And you’ve been there for quite a while, right?

Dr. Joseph Alpert: (00:38)
Yeah. Well, I’m into my 28th year. Originally from New England, but I don’t think I could go back to the snow and ice.

Daniel Lobell: (00:46)
What brought you to Tucson in the first place?

Dr. Joseph Alpert: (00:49)
Usual story. My mentor who I’d followed from Harvard to UMass, where I was Chief of Cardiology and he became the Dean here at the University of Arizona and he pulled me down to be his Chief of Medicine.

Daniel Lobell: (01:03)
Wow. And Tucson is beautiful. If you’re going to get pulled anywhere, that’s the place to go. I used to go there in the summers.

Dr. Joseph Alpert: (01:10)
Yeah. It’s just gorgeous. I can look out the window and see a big blue sky, mountains all around. It’s a convenient size of a little over a million people in greater Tucson. And because of the university and the number of big industries and the retirement community, there’s a lot to do here. A lot of cultural things and good restaurants, tourist attractions, and so forth. It’s a nice place to live.

Daniel Lobell: (01:36)
And to my memory, they have one of the great telescopes in the country at that university, if I’m correct?

Dr. Joseph Alpert: (01:43)
Yeah, absolutely. Well, the planetary science and astronomy departments are probably if not the first in the world, first or second or third. Of course we’re surrounded by mountains with telescopes and I think the Mars Lander was built here – the one that’s roaming around.

Daniel Lobell: (02:05)
Wow. Pretty cool.

Dr. Joseph Alpert: (02:06)
Yeah. Big astronomy, a lot of NASA work, lots of big government contracts. And of course also a lot of defense work. [Laughs]

Daniel Lobell: (02:17)
Right. I like to talk to the doctors about where it all began for you. When you were a kid, did you want to go into cardiology?

Dr. Joseph Alpert: (02:25)
I grew up in New Haven, Connecticut and my dad had a very large and successful dental practice. He had hoped, of course, that I was going to go to dental school and take over his big practice, but already from childhood, I grew up in a home with a strong clinical presence. And I was a good student, so my parents encouraged me: “do whatever you want. Be a doctor, be a scientist, whatever.” And then when I went off to college, I had a wonderful experience one summer with a marine biologist. And then I started to think, “well, maybe I’ll do a PhD in marine biology.” And he had come from Scripps to Yale. I was a Yale undergrad and actually did a whole year’s graduate study at the University of Copenhagen where he had a good friend, but there wasn’t enough people contact for me. And so I had applied also to med school, so then I came back to med school. And in medical school, when we did the clinical rotation, I ran into one of the pioneer cardiologists of the 20th century, Lewis Dexter. A wonderful man who was also a wonderful human being and so that really pushed me in that direction. I’d also done some research on circulatory physiology, so I already had a little background and that sort of got me going. I eventually trained with Dr. Lewis Dexter and still try and emulate his style and his intellectual ability – a wonderful kind man. A super human being.

Daniel Lobell: (04:04)
What made his style unique?

Dr. Joseph Alpert: (04:06)
Yeah. Well, I’ll tell you an anecdote that’ll give you a Dexter style, because this was Harvard and there’s a fair amount of arrogance among some of the faculty there. So it was the first day of doing intern – we do free bunch of internal medicine during the third year, it’s called a clerkship. There’s a faculty member who sort of supervises the residents – the interns and the higher level residents. The higher level resident had told us, “work up the patients, write the history and physical and the chart, but you won’t have to sort of present the case to the attending, to the professor for a couple of days until you see how the intern and the residents do it, until you get your feet under.” So I was on the first night and I worked up the patient and Dexter comes in and he was the attending and he said, “alright, who’s the student who is going to present to me today?” So of course everybody looks at me and the senior residents said, “well, Dr. Dexter, we had told the students they could have a couple of days to watch us do it and so forth.” So he comes over to me, puts his arm around me. He says, “come on, present to me. I don’t bite.” And I went home that night and I said to my wife, “I’m going to be a cardiologist, just like Lewis Dexter, if I possibly can.

Daniel Lobell: (05:24)
[Laughs] We could say–

Dr. Joseph Alpert: (05:27)
He was such a warm human being and he was one of the pioneer cardiologists of the 20th century. He really got the field off of its feet.

Daniel Lobell: (05:36)
We could say he’s the man who got your “heart” in it. [Laughs]

Dr. Joseph Alpert: (05:40)
[Laughs] Yeah, absolutely. Absolutely. He had a wonderful heart and students loved him. He was one of the most beloved faculty members at the Brigham Hospital where I did my training.

Daniel Lobell: (05:55)
Well, that’s a, that’s a pretty cool anecdote that you shared. I appreciate that. It sounds like he was quite a guy.

Dr. Joseph Alpert: (06:04)
Yeah. I think that’s what influences a lot of people into deciding on a career choice. They see somebody that they want to emulate. They see somebody who they respect and just say, “I’d love to be able to be as good as so-and-so.” And then of course you need some intrinsic interest in the subject.

Daniel Lobell: (06:24)
Right. Or some kind of a skill to begin with, some kind of inclination towards it that is, I think, natural. Right? Or innate to a person.

Dr. Joseph Alpert: (06:37)
Yeah. During my year in Denmark, a number of good things happened. I learned the language. I met the woman who became eventually my first wife and we had two terrific kids together. But during that time I also became friendly with a med student who was living in this dormitory that I was living in and when he heard I was going to go back to med school, he said, “well, I have an uncle who’s a researcher at one of the hospitals here and if you can get funding, you could come back and spend the summer working for him. Those days, the NIH was giving out a lot of money to students to encourage people to do academics, so I was able to get some money and I went back then after my second year in medical school and actually spent a summer and then a whole year working in what in Scandinavia is known as a clinical physiology lab and the projects that I was assigned were circulatory. So already, I had some research experience in circulation. The fellow who ran the lab in Denmark was also one of the world’s leading doctors in physiology – clinical physiologists who studied blood flow. I got involved with that. That fit nicely into meeting Dexter, that I’ve had some background in research of circulatory physiology in humans.

Daniel Lobell: (08:07)
Yeah. You know, I have a little background in circulation too.

Dr. Joseph Alpert: (08:11)
Oh, really? What did you, what did you do?

Daniel Lobell: (08:14)
I used to have a paper route.

Dr. Joseph Alpert: (08:17)
[Laughs] That’s a slightly different kind of circulation.

Daniel Lobell: (08:19)
Oh, okay. [Laughs].

Dr. Joseph Alpert: (08:19)
Like you probably went in a big circle, right? The blood goes in a big circle, too. So of course there’s a connection.

Daniel Lobell: (08:34)
Right. [Laughs] We know that you’re also the Editor-in-Chief of the American Journal of Medicine. How do you find enough time to fit that into your schedule and what do you love about that that drives you to do that?

Dr. Joseph Alpert: (08:46)
I’ve always liked writing and I loved publishing right from the very beginning. Part of it was that my mother was a journalism major in college and worked for a number of years in Pittsburgh. That’s where my parents met, at the University of Pittsburgh. She eventually became a high school English teacher and so forth. So there was always a strong emphasis in our home, in terms of writing clearly and speaking clearly. I’d always published a lot and in college I was always helping people rewrite their term papers and stuff like that. So when I saw the advertisement that the Elsevier was looking for a new editor in chief for the Green Journal – one of the oldest and most respected internal medicine journals. And of course I was a chief of medicine, so not just a cardiologist. I thought “oh, let me apply and see what it was like.” And I went for an interview in New York with the Elsevier people and just loved them. They were professional, they were fun to talk to, obviously very smart. The journal had sort of sunk in terms of its readership and so it needed a sort of remake. It just seemed like a fun challenge.

Daniel Lobell: (10:09)
Right.

Dr. Joseph Alpert: (10:09)
In terms of the hours, there’s a couple of things. First of all, you have to be efficient. You can’t sit around and daydream and play computer games. You have to use your time efficiently. And the other thing is you put in long days. Then sometimes you’ve got to work weekends or evenings. And right now it’s easy because I’m married for the second time and my wife is a basic scientist – a professor also here at the U of A. And so she has to put in long hours writing grants and going over laboratory data and so forth. So we do fine. It means we get to dinner a little late in the evenings, but it still works.

Daniel Lobell: (10:57)
That’s good. A basic scientist almost sounds like an insult. Like “oh, that’s just a basic scientist, not one of the advanced ones.” [Laughs]

Dr. Joseph Alpert: (11:04)
[Laughs] No, but actually we met because she’s doing research in the same area – heart attacks or myocardial infarcts is the medical term. She’s interested in ways to improve the care of these patients by decreasing the amount of heart muscle that gets damaged with a heart attack.

Daniel Lobell: (11:26)
Fascinating.

Dr. Joseph Alpert: (11:26)
We actually met talking about what she does and how it might apply in the clinical situation. And then we discovered we were exercising together at the hospital fitness center and we’d have lunch together and A leads to B and B leads to C.

Daniel Lobell: (11:43)
That sounds like a romantic comedy, but not your typical one. [Laughs].

Dr. Joseph Alpert: (11:50)
[Laughs] That’s right. Maybe they’ll make a movie of us.

Daniel Lobell: (11:50)
Yeah, maybe. I have a quote here from you. You say, “my motto is that you only have to exercise on the days that you eat.” So my question to you, is there such a thing as too much exercise and what kind of exercise do you recommend?

Dr. Joseph Alpert: (12:06)
Yeah. And you’re absolutely right. You can do too much exercise. And we’re starting to recognize that there are people, for example, who do marathons every weekend and you can do too much. I generally do between one and two hours a day. I don’t kill myself. I do it for health. I used to run in marathons and do other competitive stuff when I was younger, but now what I’m doing is just trying to maintain my health and both my cardiovascular, my lung, bone, and muscle health. My routine is in the morning, I’ll get up and I have in our garage, I’ve got an exercise bike and I have a little elliptical machine. And you know, I’ll do 20 to 30 minutes on each one. And then my wife likes to do Zumba. We belong to LA Fitness. In the evening I’ll go and maybe do another half hour of elliptical and some weights. And I don’t kill myself – I’m not trying to compete in some sort of a master’s event and so forth. But I do want to maintain my health as much as possible. I think it is possible to exercise every day. Although a lot of the sports medicine colleges and so forth recommend to just take a day or two off during the week. If I have a time when I’m traveling or whatever and I miss a day, it’s not a problem.

Daniel Lobell: (13:41)
But too much exercise could also be a strain on the heart. Is that correct?

Dr. Joseph Alpert: (13:46)
Well, it isn’t so much a strain on the heart, but when you do a lot of any exercise, you’re doing some little bit of damage to your skeletal muscles, so that’s why the next day you wake up and you’re a little stiff. It’s the muscle telling you you’ve done a little injury. Well, what happens is when you do that little injury, you stimulate the muscle to grow, right? To reproduce it and get stronger.

Daniel Lobell: (14:10)
Right.

Dr. Joseph Alpert: (14:11)
What happens if you do too much exercise is you’re likely to do some – first of all, musculoskeletal injury number one. And number two, if you do a lot of muscle injury, there’s a lot of inflammation, right? And inflammation is one of the beginning factors to damage to blood vessels that leads to hardening of the arteries, atherosclerosis, heart attacks, and strokes. And so it’s been shown that some people who do this more than several hours a day at high intensity exercise, that actually it’s not good for the circulatory system. These folks develop the arrhythmia, the atrial fibrillation at an earlier age, their arteries get calcified in earlier age. So exercise is terrific, but just like everything else: you can do too much. You can drink too much water. Everything in moderation, as the Ancient Greeks said.

Daniel Lobell: (15:16)
Right. I want to shift gears for a second here. I know that you created a universal definition of myocardial infarction. Is that correct? Did I say it right?

Dr. Joseph Alpert: (15:27)
Yes. You said it correct.

Daniel Lobell: (15:29)
Now, I don’t know what that is. Can you please explain it?

Dr. Joseph Alpert: (15:34)
That’s a heart attack. Myocardial: ‘Myo’ means muscle. ‘Cardio’ means heart, right? Most medical terms are derived from Greek and Latin. Myocardial means heart muscle, and infarction means death of heart muscle tissue, secondary to lack of blood flow. So what happens in a myocardial infarct is one of the arteries – usually with a lot of this hardening of the arteries, atherosclerosis, one of the arteries closes down a blood clot forms in it – and so the heart muscle that’s supplied by that artery suddenly gets no blood, no oxygen, and no feeding – no nutrients, and it starts to die. There’s a number of drugs and things that you can do, but the best thing you can do is to get the person down to a cardiac catheterization laboratory and open up the artery again, suck out the clot or break up the clot. Often we put a little stent in that area that was, that was closed to help hold it open. In other words, restore the blood flow. I always jokingly say that I’m a general cardiologist, but we have specialist cardiologists: we have cardiac electricians – people who deal with pacemakers and all of the electrical activity of the heart. And we have plumbers.

Daniel Lobell: (16:55)
[Laughs] Yeah.

Dr. Joseph Alpert: (16:55)
The plumbers are the guys that open the pipes and restore the blood flow in a heart attack. The universal definition thing is something – I do a lot of work… because of my time in Denmark, I have a lot of Danish cardiology friends since I speak the language and I know the culture and I lived there a total of almost three years. My very good friend there, a fellow named Kristian Thygesen from the University of Aarhus and I were talking about the fact that when you see research – clinical research – often the studies used to sort of conflict with each other. They wouldn’t agree on their results. And we discovered that it was because people were defining who they took into the study differently, like apples and oranges. One group was doing apples and one group was doing oranges. They were defining myocardial infarction differently – the criteria for taking them into the study. So we got a couple of the big international cardiology organizations – American College of Cardiology and the American Heart Association and the European Society of Cardiology – to get together and put together conferences where we would bring in heart attack experts from all over the world and we came up with what we called a universal definition that we hoped everybody would use, not just for research but also in clinical studies. For example, if you studied how many people were having heart attacks in Tokyo and so forth, if they used the universal definition, you could compare to how many people were having heart attacks here in Tucson and the different kinds of heart attacks. The universal definition is now over 20 years old and it’s in its fifth iteration. It’s been declared by the FDA to be the official definition that should be used for all the studies to get drugs approved in the United States. This has fostered a huge research industry, in helping to define this whole thing. I think at this time in my career, that’s one of the things that I was part of that I’m most proud of.

Daniel Lobell: (19:16)
Wow. It’s pretty cool. And I can see why, I’ve never come up with any universal definitions yet, but I’ve got hopefully my whole life ahead of me to do that, or what’s left of it.

Dr. Joseph Alpert: (19:29)
You and you could see also, I mean it has to do with science. If there’s one group studying, let’s say they’re studying earthworms but they define the earthworm differently in the two groups. They may end up selecting different earthworms and then suddenly different types of earthworms and they can’t compare their results. Science is always about comparing what you’re doing to somebody else’s doing and then both groups work in a direction where you understand earthworms or heart attacks better than you did before.

Daniel Lobell: (20:03)
I think I’m going to redefine earthworms. I’m just going to call them worms. If they’re in the earth anyway, I’ve never heard of an air worm, you know?

Dr. Joseph Alpert: (20:15)
[Laughs] That’s probably right.

Daniel Lobell: (20:15)
[Laughs] Seems like too wordy.

Dr. Joseph Alpert: (20:18)
Yeah, this is true. I don’t know about that. Well, there are some worms that live in trees. You know, there are tree worms. [Laughs]

Daniel Lobell: (20:27)
What are some of the latest developments or technology that are on the horizon for cardiology at this point that excite you?

Dr. Joseph Alpert: (20:36)
Sure, well there’s a couple of things. Or more than a couple of things. Each area – as I was jokingly referring to before, the cardiac electricians, the cardiac plumbers – they do a lot of high tech stuff, with the pacemakers and these implantable defibrillators that if you have a bad arrhythmia, it can actually shock the heart, like a special kind of pacemaker. All those things are constantly improving. They’re very good now and they’re getting better. And the same thing about opening up the arteries by the plumbers – that gets better all the time. The equipment, the little wire stents that help hold the arteries open – all of that keeps getting better. A couple of things that are happening, though, for the general cardiologist is we’re coming up ways to monitor the electrical activity of the heart with patches or with devices put in your smartphone or on your watch. So that when people say, “I feel my heart racing and bouncing and so forth” and then we listen to it and it’s perfectly regular. Of course they don’t have the arrhythmia all the time, it’s intermittent. These devices help us identify what’s going on. And it’s an example of personalized medicine, where the patient is actually involved in helping to figure out what’s going on. And there’s going to be more and more of these devices, either patches that will be applied to the skin that will be relaying radio signals and telling us all kinds of information about blood pressure, heart rate, and maybe a whole bunch of other examples of what’s going on in the body. So that’s a very, very interesting area. Another interesting area is this whole artificial intelligence. We now use computers to put our whole medical information. We don’t write, we don’t use paper. My joke that I always say is the only paper in our hospital is toilet paper.

Daniel Lobell: (22:42)
[Laughs]

Dr. Joseph Alpert: (22:42)
We don’t write charts anymore. It’s all on the computer and with programs that are in development now, the computer is going to be making suggestions to us. I’ll give you an example. Let’s say I’m seeing a patient for the first time who has very difficult to treat high blood pressure and the computer can look into its vast store of information and compare my patient to a million other patients throughout the world who have had a hard time with this and see certain similarities to some of those patients and actually make suggestions. “I think the best drug you should try is such and such for this patient.” That’s coming probably in the next 20 years. Some people are afraid of it. “Oh it’s going to replace the doctors.” I don’t think it’s going to replace us. I think it’s going to be a big help to us. It’s going to help us also in reading the x-rays and scans and so forth. So that’s another big area. The other thing that’s happening is we’re understanding the biochemistry, the chemical machinery of the cells better and better. That’s one of the things my wife is working on. After a heart attack, even though you open the artery again, there’s still damage to the heart muscle. And it’s ongoing, the inflammation and everything that occurs after the heart attack continues to damage some of the heart cells. And there are going to be ways I think to stop that, to decrease the amount of continuing low grade injury that goes on for a number of weeks after a heart attack. And that’s because we’re going to understand better and better how the chemistry, the biochemistry, in the cells works and we’re going to be able to manipulate that. And then there’s a lot of hope for this STEM cell thing to be able to create new heart cells. So far, it’s been a bust. There have been a bunch of experiments and they haven’t worked. But it works in a number of areas like sickle cell anemia. This STEM cell thing works. Maybe eventually we’ll be able to do something in the heart. But right now the STEM cells haven’t worked, but there’s a lot of research going on and we’ll see. Maybe people will figure out a way to implant cells in the heart so we can grow some new heart muscle. Right now, we can’t grow new heart muscles. When the heart muscle has been damaged – the heart’s not like liver. If you damage the liver, it makes new liver cells to replace the dead ones. The heart doesn’t do that. So that’s this whole STEM cell thing. But those are some of the exciting things that are happening.

Daniel Lobell: (25:32)
What about heart transplants?

Dr. Joseph Alpert: (25:36)
The transplant area – this is a little bit science fiction. You probably know, I think there’s worldwide something like 5,000 transplants a year, but the need is much, much greater. So many patients can’t be transplanted. We have an artificial heart that pumps, but it really only is good for temporary needs – to keep people alive until they can get a heart transplant. It’s not a final solution. Blood clots form in it and of course it can have mechanical failure and so forth. So it’s a temporary thing. What we would like to do is be able to transplant hearts. You say, “well, okay, why can’t we take a heart from a pig, for example, and put it in a human?” Well, the problem is the body would reject the pig heart. But there are a lot of experiments being done now where they’re changing the surface markers on the surface of the pig heart cells, so it looks like a human. Right now, for example, we take pig valves and plant them in the heart. The hope is that eventually we’ll be able to take these specially biochemically changed pigs and grow them to take their hearts and put them in humans.

Daniel Lobell: (26:53)
Mutant pigs.

Dr. Joseph Alpert: (26:55)
That would give us a supply as big as we need.

Daniel Lobell: (26:58)
Yes, this does sound like science fiction – mutating the pigs into half pig, half human, walking around.

Dr. Joseph Alpert: (27:06)
Yeah! There are places that are doing it. You know what I mean? It’s still – I would say it’s not in its infancy, but it’s in his childhood. They’re getting some interesting results. We’re still a long way from taking one of those hearts and putting it into human beings. But again, just like with STEM cells, science is highly sophisticated and technologically advanced. It wouldn’t surprise me if in 10-15 years we were doing that.

Daniel Lobell: (27:35)
We’re going to start losing our women to these pigs. They’re going to walk around and they’re going to say, “yes, he’s got a pig body, but he’s got a human heart and I fell for it.”

Dr. Joseph Alpert: (27:46)
[Laughs] Well, as you know, there’s a lot of similarities between humans and pigs.

Daniel Lobell: (27:51)
[Laughs] Too many!

Dr. Joseph Alpert: (27:51)
[Laughs] Some people are probably already more pig than human. Interestingly, there are a lot of similarities. Pigs eat everything just like we eat everything. Their teeth resemble ours. Their heart looks very much like a human heart and they’re used for a lot of animal experiments for new devices and so on because their circulation is very much like the human circulation. So when you say somebody is a pig, you may be right.

Daniel Lobell: (28:22)
It’s fascinating. Do pigs clean more closely resemble us in these ways than monkeys? Or is it just illegal to–

Dr. Joseph Alpert: (28:31)
–No, monkeys are the closest.

Daniel Lobell: (28:31)
Yeah, so I guess it’s just illegal to take from a monkey.

Dr. Joseph Alpert: (28:38)
Yeah. Even monkeys, we’d have to change the surface markers on their cells before we could transplant their hearts. Lots of us, including myself, are a little uneasy about doing experiments on monkeys. They’re sort of our cousins. Whereas nobody feels bad about pigs cause we’ve been killing pigs for–

Daniel Lobell: (29:00)
[Laughs] Screw the pigs! Down with the pigs!

Dr. Joseph Alpert: (29:05)
[Laughs] We’ve been killing and eating for forever. So I think a pig is a safer model to do this, than to do it to monkeys.

Daniel Lobell: (29:16)
You know, the pigs have to start a PR campaign–

Dr. Joseph Alpert: (29:18)
There’s a lot of uneasiness about monkey research.

Daniel Lobell: (29:21)
Yeah. But it seems like it could be lifesaving for a lot of people. Right?

Dr. Joseph Alpert: (29:29)
Yeah. Absolutely.

Daniel Lobell: (29:31)
So why are we trading human lives for monkey lives? Is that the question?

Dr. Joseph Alpert: (29:35)
Right. We do a lot of monkey experiments because they are very close to us. Particularly experiments on how does atherosclerosis, the hardening of the arteries, get started? Recovery from strokes. And so there are colonies of monkeys in the U S and around the world that are used for a number of experimental models. But people are a little uneasy about it. And I’m always a little uneasy too about torturing monkeys.

Daniel Lobell: (30:06)
I’m not on board with it. I don’t like torturing any animals.

Dr. Joseph Alpert: (30:10)
I agree with you.

Daniel Lobell: (30:10)
I just wonder if we’re being too hard on pigs and too soft on monkeys, if the monkeys are the ones that could really save us. Right? I don’t know. I don’t know the answer.

Dr. Joseph Alpert: (30:25)
Yeah. I can tell you things have gotten much better since the days when I was a med student and we were doing animal experiments. There was a lot less concerned about the welfare of the animals and there’s a lot more concern about the welfare of the animals now.

Daniel Lobell: (30:39)
They have nice hospital beds and cable television now when they’re being experimented on?

Dr. Joseph Alpert: (30:45)
The places where they’re kept are kept beautifully and clean. There’s always now a vet full time, taking care of the animals. But the truth is most of the experiments these days done by basic scientists are done on mice and rats. In my day we did a lot on dogs. There’s much less on dogs. I would say mice and rats and of course also pigs. And then there’s also isolated cells, so you don’t have to feel so bad that you’re doing stuff to animals.

Daniel Lobell: (31:14)
Right. It is fascinating to me, though, that we have so much in common with pigs and yet we have so much disdain for pigs.

Dr. Joseph Alpert: (31:22)
Yeah, it’s true and pigs are smart. You know, it turns out that pigs are very intelligent.

Daniel Lobell: (31:28)
Yeah. I used to have one do my homework for me.

Dr. Joseph Alpert: (31:33)
[Laughs] Sounds good.

Daniel Lobell: (31:41)
[Laughs] Okay. So let’s talk a little bit about the online health space. What’s your view on the online space and do you encourage or discourage your patients to look to the internet for information?

Dr. Joseph Alpert: (31:53)
Yeah. Here’s the problem. Because the electronic medical record now takes much more time than the handwritten notes used to take. So doctors are constantly stressed to get the patients in and get them out, because there’s a lot of patients waiting to be seen. Now we’re spending extra time with the computer, there’s less time to spend with the patient. So a lot of times patients don’t get good explanations of what’s what’s going on and many patients are not very sophisticated. Maybe they never took high school biology, so they don’t understand when we talk about, “well, there’s a problem here in the liver” and they think, “what’s my liver doing? Why do I have a liver?” And so forth. So, really you need to be able to have a vehicle to explain in simple, straightforward language that anybody can understand without a lot of medical terms in it exactly what’s going on and what the plan is to try and help this person get better. Because of that, when Jeremy Wosner first came to me with the idea of helping and participating in Doctorpedia, I thought it was a terrific idea. And I still think it’s a terrific idea that you have on the web excellent docs who speak layman’s language, explaining illnesses that the patients can understand clearly. It’s just like the advertisement, “an informed consumer is our best customer.” It’s the same thing with a patient. When the patient understands what we’re trying to do and why we’re trying to do it and why it’s important to do this or that medicine and why this operation would help, and so forth – that patient’s gonna do better than if they say, “Oh, I don’t know if I even understand it, I’m not sure I’m going to take the pills and so forth.” Of course there’s a lot of fake news out there about, “Oh, this pill was dangerous or that operation doesn’t work” and so forth. It’s good to put absolute realistic and truthful news on the web so that patients can get that information and I think a lot of patients want that information and they don’t ever get the time to get it from their doctor. Their doctor’s too harassed and running around trying to see everybody as quickly as possible.

Daniel Lobell: (34:12)
Yeah, absolutely. I try to keep the doctor for a few minutes just to ask some questions. They’re always rushing out and they stick you with a nurse or just somebody who’s less qualified, so I think it’s great. You’ve been the Chief Clinical Advisor to Doctorpedia. How have you seen Doctorpedia grow over the years?

Dr. Joseph Alpert: (34:33)
Yeah, the moment Jeremy explained to me – this is now probably five, six years ago – when the whole thing started of what his plan was and what the idea was to recruit docs who had skills in communicating with patients to make these recordings that patients could see and understand better what was going on. I thought it was a great idea from the moment he told me and I knew it was needed because I have patients come to me all the time for a second opinion who told me, “I was told this – now I honestly don’t understand what the doctor said to me. He or she used a lot of medical terms and didn’t have much time to answer my questions.” I end up spending a lot of time with patients trying to make things clear, but there’s only so many patients I can see in a day. And so that the internet offers a gigantic chance to put all of that information available to as many patients as want it.

Daniel Lobell: (35:34)
Absolutely. Let’s talk for a second about preventative heart health. What can patients do to make sure that they never have to see you?

Dr. Joseph Alpert: (35:48)
You bet. I always joke with people that I would love to stamp out heart disease, but it’s not likely to happen. Because a lot of things in our lifestyle – the rich diet, getting fat, not exercising, smoking cigarettes, not paying attention to getting our high blood pressure or high blood cholesterol levels treated and so forth. All of those things can prevent heart attacks and strokes. We know there have been excellent studies that show when people follow the lifestyle recommendations – when they’re putting an inch of butter on their bread toast every morning, and eating tons of ice cream and getting fat and not exercising and smoking cigarettes and not paying attention to their health – we know that those folks don’t do well. And we know that the people who pay attention to the lifestyle issues and eat intelligently and exercise regularly and don’t get fat and don’t smoke cigarettes and don’t take drugs off the streets – they live a long and happy life. And the people that do the opposite usually have a short and miserable life and end up in the hospital a lot, with lots and lots and lots of problems. So there’s no question that lifestyle – taking care of yourself and visiting the doctor, checking your blood pressure because you might feel fine but your blood pressure might be high, you might feel fine but your cholesterol might be very high – these things now can be taken care of medically. We can correct your blood pressure, we can correct your high cholesterol level, and markedly decrease your chance for having a heart attack or a stroke.

Daniel Lobell: (37:41)
What about dietarily? What do you recommend people not to eat?

Dr. Joseph Alpert: (37:44)
Well, of course, Daniel, that’s a huge area of controversy. It turns out there’s a thousand different diets on our planet. For a long time, the Heart Association was always saying that red meat is a problem because it has a lot of bad kinds of fat in it that raises blood cholesterol – raising the bad kind of blood cholesterol. And so for a long time people were saying that you’ve got to eat much less red meat. Well, there just were a number of studies where they pulled together all of the studies that have been done on meat and it turns out there’s a very small risk of eating meat. It’s not as evil as it had been thought. It’s also, it’s almost impossible to do a long term study, a 25 year study, in which you insist people only eat this, you can’t eat that, and have comparison groups. It’s almost impossible to get people controlled that that way. So what we do in terms of nutrition is we end up looking at big surveys. 10,000 people in the United States, what did you eat today? And so forth. Is this what you normally eat, and so on. And then you follow those people looking for development of disease. It’s called epidemiology. It’s population study. And there’ve been a few interventional studies where they try to keep people on a diet for a year and so forth, see what happens to their blood cholesterol. But you can imagine how difficult it is to control what people are eating. So what they get from the epidemiology studies, the population studies is that you get correlations, that people who eat a certain diet tend to do better than the people who don’t. And what comes out is the following advice: lots of fruits and vegetables (which is no surprise because that’s what our cousins, the chimps and the gorillas and so forth, eat), lots of fruits and vegetables, not a lot of sugar, not a lot of heavy fat things like tons of butter, moderate amounts of meat, seafood preferred over beef and lamb and pork, and nuts and whole grain breads rather than the plain white bread that we often eat, and then olive oil rather than butter to cook with. Those recommendations, it’s called, as you probably have heard, it’s a Mediterranean diet. It resembles a diet eaten by people in Greece and Southern Italy and Southern Spain. That’s probably the healthiest diet. And then of course, don’t be a pig. [Laughs] As we’ve talked about just a few minutes ago.

Daniel Lobell: (40:31)
Lean more towards monkey.

Dr. Joseph Alpert: (40:31)
Don’t become fat and sloppy.

Daniel Lobell: (40:33)
One thing I didn’t hear, you mention there is salt. Do you advocate for any kind of use of salt? I know it’s a controversial thing these days.

Dr. Joseph Alpert: (40:49)
Yeah. It turns out some people are very sensitive to salt and get high blood pressure and other people, it doesn’t make any difference at all. On the other hand, I always tell my patients “no snow storms.” But of course, if they have heart failure, if their heart’s not pumping well, we try and have people cut back on their salt because when you take a lot of salt, you also hold onto a lot of water and that make the symptoms of heart failure worse. But for the average person, I would say that if your blood pressure is normal, you can eat whatever salt you want but I wouldn’t say “no snow storms on your food”. Don’t be excessive in your use of salt.

Daniel Lobell: (41:34)
[Laughs] Yeah. Well that sounds pretty reasonable

Dr. Joseph Alpert: (41:41)
Daniel, the thing is most things in diet is just be reasonable. Don’t eat a pint of ice cream every day. Don’t put tons of butter on your bread. Don’t eat junk food all the time. Try to eat salads and have fruit and whole grain breads when you’re going to eat bread. Modulate the amount of sugar that comes into your diet – not too many sugar drinks and all that sort of thing. We have a big problem with childhood obesity in this country and also in other countries as well. And a lot of it relates to sugar drinks.

Daniel Lobell: (42:27)
Yeah.

Dr. Joseph Alpert: (42:28)
It’s a lot of empty calories in sugar drinks.

Daniel Lobell: (42:32)
It’s incredible how much they pack into a drink. You’re drinking a cake, essentially.

Dr. Joseph Alpert: (42:38)
Yeah, absolutely. And of course, when you drink sugar, sugar actually fuels your appetite. For a second your blood sugar goes way up and then it comes skyrocketing down and that triggers your hunger again. A lot of these sugar drinks actually encourage you to eat more than you should.

Daniel Lobell: (42:57)
It’s a spike in your insulin levels, which I was going to ask you about meat. Doesn’t that also spike your insulin levels and affect appetite?

Dr. Joseph Alpert: (43:07)
I’m sorry, what spikes your insulin levels?

Daniel Lobell: (43:09)
Eating meat – doesn’t that affect your satiety levels.

Dr. Joseph Alpert: (43:14)
Nope. Protein is not so bad. It’s carbohydrates that spike the insulin level. So that’s cookies and breads and cereal and particularly sugar. Because what the body does is it converts carbohydrates into sugar. So if you need a piece of white bread, it ends up as sugar in your bloodstream spikes it. Meat and fish and poultry are mostly protein. Of course the high protein diet is another controversial diet. Very controversial. One time I looked on Amazon to see how many books there were on diets and there were 5,000 entries. You could just imagine. It’s a difficult area because people eat so differently all over the world. But in general, what has come out is that if you don’t make yourself fat and you don’t eat constantly sweet, sugary, and very fatty things like ice cream and beef, moderate the amount of that you take in and have lots of roughage – lots of salads, lots of vegetables and fruits in your diet, nuts and whole grain things. That’s a reasonable diet. And then exercise and keep your weight at a reasonable level. There’s a very good chance that you’re going to live a very, very long time. And visit your doctor periodically. Make sure your blood pressure is okay, that your cholesterol is okay. The chances of you developing terrible heart disease are much less if you do that than if you’re fat and sloppy and not exercising and eating all the wrong things

Daniel Lobell: (45:05)
Right. I know you have some videos up that people I’m sure are going to want to see more from you after listening to this interview. You have some on the diabetes site for Doctorpedia.

Dr. Joseph Alpert: (45:17)
Sure. We did diabetes and of course we did a bunch of other things talking about high blood pressure and high cholesterol. Many of my colleagues have made some wonderful videos covering not only diabetes but other areas and many more planned. I think this is going to be a real useful service to patients, where they can spend a half an hour that they’re not going to get in their doctor’s office hearing in language that they can understand exactly what’s going on that’s not right with them and what we can do to help them.

Daniel Lobell: (45:56)
I agree. And I’m excited to be a part of it. I ask every doctor to round off the interview with the same question, what do you do to stay healthy? And I know you do some running and tell me about how that helps or hurts the heart please.

Dr. Joseph Alpert: (46:11)
Sure. I take doses of my own medicine. I ran for many years, did marathons and so forth, but my joints talk to me now. So what I now do is I have an exercise bike, I have an elliptical machine, and I belong to a health club. First thing when I get up in the morning, I eat a little breakfast and then I exercise for 40 minutes to an hour, go to work, do work. And then often in the evening I’ll go with my wife to the health club and do maybe another half an hour, particularly weights, because I have a weight system here, but it’s not as sophisticated as what’s in the health club. I try not to eat too much sweets and try not to eat too much heavy fat foods, heavily fried foods. And so I eat lots of fruits and vegetables. And I try and keep my weight at the right level. I have a family history of high blood pressure, so I take medicines and my blood pressure is well controlled. I have a wonderful wife. We have a wonderful relationship. As you know, that’s important. Human beings are pack animals. We don’t do well as hermits, so it’s important to have wonderful friends and love relationships. That’s a very important part of health.

Daniel Lobell: (47:37)
Absolutely.

Dr. Joseph Alpert: (47:37)
Try and enjoy life. Take time for yourself. Don’t hesitate to take vacations. I know people that say “Oh, I never have time for vacations.” That’s a very bad idea. You need to take some time off and enjoy yourself and have some pleasurable experiences.

Daniel Lobell: (48:01)
I’ll take that advice to heart. I’m going to book a trip to Hawaii right now – doctor recommended. [Laughs] I’ve got a good excuse now.

Dr. Joseph Alpert: (48:14)
Yeah, you want to have more in your life than just work.

Daniel Lobell: (48:20)
[Laughs] That’s fantastic.

Dr. Joseph Alpert: (48:22)
Work is important but you also want to have times when you’re not working.

Daniel Lobell: (48:25)
Yes, I agree and fantastic advice and it was really a pleasure getting to talk to you here on the show, Dr. Alpert. Thank you.

Dr. Joseph Alpert: (48:33)
Great. I’m happy to talk to you again anytime.

Daniel Lobell: (48:36)
Much appreciated. Have a wonderful day.

Dr. Joseph Alpert: (48:40)
You too, thanks a lot, Daniel. Bye.

Daniel Lobell: (48:41)
This podcast or any written material derived from its transcripts represents the opinions of the medical professional being interviewed. The content here is for informational purposes only and should not be taken as medical advice.