CLINICAL INNOVATORS
Interview by
KATLYN NEMANI, MD
Promoting Hunter-Gatherer
Fitness in the 21st Century
James H. O’Keefe, MD
J
ames H O’Keefe, MD, is a cardiologist and
Medical Director of the Charles and Barbara
Duboc Cardio Health & Wellness Center at
Saint Luke’s Mid America Heart Institute. He is a
Professor of Medicine at the University of Missouri-Kansas City. He has been listed among USA
Today’s Most Influential Doctors. In addition to
contributing to more than 300 articles of medical
literature and authoring best-selling cardiovascular books for health professionals, including The
Complete Guide to ECGs, which has become the
ECG study guide of choice for American cardiology training programs. Dr. O’Keefe has also coauthored, with his wife Joan O’Keefe, consumer
health books including The Forever Young Diet and
Lifestyle and Let Me Tell You a Story.
How did you become interested in preventive
cardiology? What was your path like to
becoming a leader in the field?
By age 15, I had become fascinated with the heart
and wanted to be a cardiologist. After completing
Internal Medicine and Cardiology at Mayo Clinic,
I did a 4th year of CV training as an Interventional
Fellow under Dr. Geoffrey Hartzler, the visionary genius who invented primary percutaneous
coronary intervention (PCI) for acute coronary
syndrome (ACS) and who also pioneered multivessel PCI. During my 4th year, Dr. Greg Stone (the
other interventional fellow at the Mid America
Heart Institute from1988-89) and I scrubbed in
with Dr. Hartzler as he labored through diffuse
multivessel coronary artery disease (CAD) with
nothing but balloon catheters and wires. It was
emotionally and physically exhausting work even
for our energetic, irrepressible, and controversial
mentor.
Patients with stable but extensive CAD flew
into Kansas City from all over the world for elective multivessel PCI, and usually developed diffuse
restenosis in the ensuing months. It became clear
34
CardioSource WorldNews
Nothing makes an
organism flourish
like placing it back in
the environment for
which it’s adapted.
Through the marvels
of epigenetics, the
right types of physical
activities can drastically
alter gene expression
and improve health and
wellness.
to me that atherosclerosis is a systemic inflammatory disease, and thus its definitive cure would
be a proactive preventive strategy not a reactive,
invasive, and focal approach. After one long and
especially grueling case, Dr. Hartzler looked at me
and asked, “Are you sure you want to do this for a
living?”
I have the utmost respect for my interventional
colleagues and their field is light years beyond
where it was 27 years ago. Still, my heart wasn’t
in the cath lab; cardiac prevention is my passion. I
think we may be entering a new era in cardiology
where CAD, except for ACS, is going to be largely
managed with conservative noninvasive measures,
including the potentially revolutionary PCSK9
inhibitors. The dawning age of U.S. cardiology will
be increasingly focused on the rising epidemics
of atrial fibrillation, structural heart disease, and
heart failure—and prevention will evolve to be
important in these arenas as well.
You have promoted exercising “like a huntergatherer” to optimize health. What does this
pattern of activity look like, and how does it
affect gene expression?
Nothing makes an organism flourish like placing
it back in the environment for which it’s adapted.
Through the marvels of epigenetics, the right
types of physical activities can drastically alter
gene expression and improve health and wellness.
We humans, via natural selection, are the ultimate
cross-trainers. I encourage people to mix it up:
run, walk, swim, climb, yoga, tai-chi, weight lifting, high-intensity intervals, etc.
Outdoor exercise is particularly exhilarating
and relaxing, and it’s great to have an alwayseager exercise pal. Humans and canine genes
have co-evolved together for tens of thousands of
years. We are descendants of dog-lovers, and dogs
are designed to be our perfect outdoor exercise
companions. Take note, the dog owners and their
canine best friends are generally outside exercising regardless of the weather. I often write out a
prescription: one dog, taken once or twice daily for
a walk or run. Substitution permitted.
Gardening is another ideal exercise for CV
health and longevity. An ancient Chinese proverb
goes something like this: “If you want to be happy
for an hour, have a drink or two. If you want to
be happy for a weekend, get married. If you want
to be happy for a week, butcher your pig. But if
you want to be happy for a lifetime, become a
gardener.” Sunshine and fresh air, forager-gatherer
style exercise, probiotics from the dirt, and the
satisfaction of nurturing life (that doesn’t talk
back) is therapeutic. The food and flowers that you
grow yourself will improve your health and happiness long before the plants ever, or even if they
never, make it to your table. Finally, I also remind
people that sexual activity, at the very least, is
July 2015