Obesity has reached crisis levels in Australia, with 67% of Australians classified as being overweight or obese (2022 data). BMI measurements have been used in epidemiological studies to define overweight individuals with a measurement of 25 kilograms per metre squared and obese individuals with a BMI measurement of more than 30 kilograms per metre squared. It is now recognised, however, that BMI-based measures of obesity may both underestimate or overestimate adiposity and provide inadequate information about health at the individual level and subsequently undermine medically sound approaches to healthcare and policy. A recent Commission of 58 experts in this field reported a consensus in The Lancet defining obesity as "a condition characterised by excess adiposity, with or without abnormal distribution or function of adipose tissue and with causes that are multifactorial and still incompletely understood". They subsequently teased out the diagnosis of obesity to include preclinical and clinical definitions, where:

Pre-clinical obesity is defined by excess fat accumulation as measured by direct means with DEXA or indirect anthropometric measurements such as waist to height, waist circumference or waist to hip ratio measurement. This group of patients have no clinical disease or end-organ damage or symptoms as yet, but an increased risk of developing clinical obesity and conditions such as type 2 diabetes, cardiovascular disease and some neoplasms. The treatment focus in this group includes counselling and the introduction of measures to prevent progression to the next subgroup, which is clinical obesity.

Clinical Obesity is defined as a chronic, systemic illness characterised by alterations in the function of tissues, organs, the entire individual, or a combination thereof, due to excess adiposity. Clinical obesity can lead to severe end-organ damage, causing life-altering and potentially life-threatening complications. The main focus of management for this cohort is to improve end-organ dysfunction as a priority rather than to focus on weight loss alone. Treatment options include lifestyle modification through diet and counselling, and rely on established pharmacology such as GLP-1 receptor agonists, which are likely to be used as a long-term treatment strategy. For a select number of patients, however, these medications can induce nausea, vomiting, diarrhoea, constipation and reflux. In more serious cases gastro paresis and pancreatitis are described. Non-responsiveness and high cost may be a limiting factor amongst some patients. Consequently, surgery remains the cornerstone for safely and effectively managing obesity and includes both gastric sleeve and bypass operations.

To discuss this new definition of obesity and approach to thinking about obesity, as well as to review surgical options, I was curious to open a discussion with Dr Melissa Beitner. Melissa is a fellow of The Royal Australasian College of Surgeons; she is American Board of Surgery certified, a fellow of the American Society of Metabolic and Bariatric Surgery and is a diplomat of the American Board of Obesity Medicine. Melissa is incredibly well credentialed, having undertaken bariatric surgery fellowships at Mount Sinai Hospital in New York, Royal Brisbane and Women's Hospital and St. George Hospital, Sydney. She has special areas of interest in bariatric surgery and obesity medicine, and is also highly skilled in hiatus hernia and anti-reflux surgery, cholecystectomy and general surgical removal of lumps and bumps. Please welcome Meissa to the podcast.

References: 

Dr Beitner, Weight Loss Solutions: www.360surgery.com.au

Definition and Diagnostic Criteria of Clinical Obesity, F Rubino et al. The Lancet Diabetes and Endocrinology Commission. Vol 13, Issue 3, P221-262, March 2025

Molecular pathology combines molecular analysis with traditional morphology and immunohistochemistry to understand disease at its most fundamental level. The field continues to evolve as new discoveries enter clinical practice.

Through molecular pathology, our knowledge of genetic mutations and targeted therapies has expanded. It is now rare for a tumour report to omit genetic findings. This discipline, while distant from daily clinical work, underpins treatment algorithms and prognostic models.

The ten hallmarks of cancer include: genome instability and mutation, resistance to cell death, sustained proliferative signalling, evasion of growth suppressors, replicative immortality, angiogenesis, invasion and metastasis, altered metabolism, tumour-promoting inflammation, and immune evasion.

Normal DNA contains proto-oncogenes that promote growth and tumour suppressor genes that restrain it. When balanced, they regulate healthy proliferation. Mutations in either disturb this balance, driving uncontrolled growth.

Germline mutations are inherited and present in every cell, while somatic mutations are acquired, often influenced by smoking, ultraviolet exposure, or diet. When proto-oncogenes mutate, they become oncogenes.

The RAS and BRAF oncogenes are key in molecular pathology. RAS controls upstream signalling that triggers cell growth, differentiation, and survival. Mutated RAS genes cause constant activation, leading to excessive signalling. The three RAS genes, HRAS, KRAS, and NRAS, are found in 20 to 25 percent of all human tumours and in 90 percent of pancreatic cancers. The BRAF gene, on chromosome 7, regulates downstream signalling and cell growth. BRAF mutations occur in about 10 percent of colorectal cancers, up to 50 percent of papillary thyroid cancers, and 27 to 67 percent of melanomas.

Other oncogenes include MYC, EGFR, and HER2. HER2 amplification is seen in some breast and ovarian cancers. These findings are vital as targeted treatments, such as JAK inhibitors and monoclonal antibodies, act on these pathways. A single mutation can activate an oncogene.

Tumour suppressor genes perform repair functions including correcting DNA mismatches, regulating the cell cycle, and promoting apoptosis. As telomeres shorten with age, mismatch repair errors increase. Mutated genes lose this ability, causing abnormal protein synthesis. Reports often describe mismatch repair proficient (no mutation) or mismatch repair deficient (mutation present), particularly in colon cancer.

Key tumour suppressor genes include BRCA1, BRCA2, and the Lynch syndrome genes MLH1, MSH2, MSH6, and PMS2. When mutated, they increase the risk of breast, ovarian, prostate, colon, uterine, and pancreatic cancers. While often inherited, mutations can also arise spontaneously or through epigenetic silencing. Each gene has two copies; both must be affected before suppression is lost. This two-hit hypothesis, proposed by Knudson in 1971, explains tumour development with ageing.

Methylation, sometimes noted in reports, refers to chemical modification of CpG (cytosine-phosphate-guanine) sites within a gene, often influenced by epigenetic factors. Abnormal methylation disrupts DNA repair, leading to failed tumour suppression.

This is a brief overview of a complex and evolving field.

Joining me is Dr Pranav Dorwal, Molecular and Anatomical Pathologist at Monash Health, also working in Diagnostic Genomics. Dr Dorwal is an examiner for molecular pathology, researcher, and author of over 60 publications. He has held positions at MD Anderson Cancer Center (Houston, USA) and Memorial Sloan Kettering Cancer Center (New York, USA), completed a fellowship at ANU Canberra, and received the Chancellor’s Gold Medal for Clinical Pathology.

Please welcome Dr Pranav Dorwal to the podcast.

References:

Dr Pranav Dorwal – www.monashhealth.org | www.genomicdiagnostics.com.au
Oncology at a Glance, Graham Dark, Wiley-Blackwell
www.pmc.ncbi.nlm.nih.gov

Each year in Australia, there are about 1,800 new diagnoses of ovarian cancer and over 1,000 deaths, making ovarian cancer the fifth most common cause of death from cancer in women. The lifetime risk is about 1.6%, increasing to 5% if a first-degree relative is affected, and 45% and 25% respectively if the BRCA1 or BRCA2 mutation is present.

The median age of diagnosis is 63 years, with two-thirds of patients diagnosed at 55 years or older.

Histologically, tumour cells may arise from the outer epithelial lining cells of the ovary (60%), the germ cells (30%), or sex cord stromal cells (8%). Epithelial tumours of the high-grade serous type are now thought to spread to the ovarian surface after arising from secretory cells at the fimbria of the fallopian tubes, acquiring a TP53 mutation there before metastasising to the ovary as clinically evident ovarian cancer.

Serous carcinomas represent the vast majority of primary malignant ovarian tumours (75%–80%) and are composed of columnar cells with cilia. These tumours are subdivided into high-grade and low-grade serous carcinomas, which has particular relevance for BRCA-associated ovarian tumours.

As with many internal diseases, clinical presentation may be late, with vague pelvic discomfort giving way to pain and bloating, followed by more systemic symptoms as the disease advances.

The tumour marker CA 125 may only be elevated 50% of the time in early disease, rising to 80% in advanced cancer; however, false positives may occur with benign ovarian disease, leiomyomas, and endometriosis. As with tumour markers used in the follow-up of other cancers, its utility in screening and early diagnosis is limited.

The disease is advanced in 75% of cases at the time of diagnosis. Five-year survival is about 41% when local spread is detected, reducing to 30% or less with distant metastases, compared to 89% survival or above with early detection when the disease is localised.

Given the importance of this condition, I was curious to consult Professor Thomas Jobling once more on current practices of surveillance, approaches to detection and management, and how to manage risk in first-degree relatives. How should we approach an ovarian cyst found incidentally during abdominal imaging? What symptoms should we, as clinicians, be mindful of in triggering our suspicion to investigate further?

I know you will find this conversation with Professor Thomas Jobling interesting. Tom is a gynaecological oncologist, ex-AFL footballer, and medical researcher with a highly respected reputation in Melbourne and internationally. He has extensive experience with minimally invasive surgery, including robotic surgery, for gynaecologic cancer. His main research area is ovarian cancer, for which he received an Order of Australia Medal in 2017, and he is currently Head of Gynaecological Health and VMO at Peter MacCallum Hospital.

Please welcome Professor Jobling to the podcast.

References:

• Professor Tom Jobling: [email protected]

• Ovarian Cancer: Cancer Australia

• Pathobiology of Ovarian Carcinomas, Chinese Journal of Cancer, 2016 Jan; 34

• Ovarian Cancer Research Alliance: https://ocrahope.org/

Mobile anesthesia is a unique concept in Australia closely related to office-based surgery (OBS) a term used internationally for any surgical or invasive procedure performed outside hospitals with these procedures taking place in private practices or ambulatory surgery centers and often involves various levels of anesthesia, including general anesthesia, moderate sedation or deep sedation. In Australia mobile anesthesia has become particularly relevant in dental treatments and radiological procedures and allows hospital quality anaesthesia to be provided in non-hospital settings such as dental offices. This approach enables a broader range of procedures to be safely performed outside traditional hospital environments.

The growth of mobile anesthesia has been driven by convenience and efficiency, cost effectiveness, technological advancements and patient demand. An area of particular interest relates to the positive impact mobile anesthesia can offer special needs patients who often face challenges in accessing dental care. In Australia approximately 1 in six people live with disability, some with severe and profound disabilities and mobile anesthesia is helping to break down the barriers to treatment for such patients. 

The state of Victoria regulated mobile anesthesia services in 2018 and there are now 29 mobile anesthesia businesses operating in the state. Anesthesia related mortality rates in Victoria are low for mobile delivered anaesthetics at about 3.29 deaths per million people per year matching national averages. 

Given this evolving area of practice, I was curious to expand my knowledge concerning mobile anaesthesia by inviting anesthetist and Associate Professor David Canty to the podcast. David is the academic director of ultrasound simulation at the university of Melbourne and Adjunct Associate Professor in the Department of Medicine and Nursing at Monash University. He works as an anesthetist across multiple forms of complex surgeries and is the medical director of a mobile anesthesia company working with dentists in Victoria. His passion for mobile anesthesia is quite palpable, please welcome David to the podcast.

References :

Dr David Canty: www.sleepdentistry.com.au

Mobile Health Services: Department of Health ,Victoria. www.health.vic.gov.au

Mobile Anaesthesia: https://pmc.ncbi.nlm.nih.gov

On a recent vacation to Exmouth on Western Australia’s far North coast, home to the amazing Ningaloo National Park, I had the pleasure of meeting Anaesthetist and outdoor adventurer Dr Neil Banham.

I discovered that when Neil wasn’t kiteboarding, his daytime job was Director of Hyperbaric Medicine at Fiona Stanley Hospital in Perth.

Our conversation exposed my deep ignorance of the potential use of HBOT beyond the management of air and gas embolism and piqued my interest in the various conditions that ay assis

Hyperbaric Oxygen Treatment (HBOT) exposes an individual to near 100% oxygen inside a treatment chamber at pressures higher than sea level. For clinical purposes, the pressure must equal or exceed 1.4 atmospheres absolute (ATA). Most HBOT in Australasia is performed at 2 ATA.

HBOT was first used in the early 20th century and by the US Navy in the 1940s to treat decompression sickness (“the bends”). In the 1960s it was used for carbon monoxide poisoning, and its use has since expanded. There are currently 15 approved indications accepted by the Undersea and Hyperbaric Medical Society. These fall under urgent and non-urgent conditions, and the Medicare Benefits Schedule includes specific item numbers for many of them.

Urgent conditions include: air embolism, central retinal artery occlusion, carbon monoxide poisoning, clostridial myonecrosis (gas gangrene), compromised surgical grafts and flaps, crush injuries and compartment syndromes, acute arterial insufficiency, decompression sickness, intracranial abscess, necrotizing soft tissue infections, exceptional blood loss anaemia, specific acute thermal burns, and idiopathic sudden sensorineural hearing loss.

Non-urgent conditions include delayed radiation injuries (soft tissue or osteoradionecrosis). HBOT for radiation cystitis has proven effective in over 80% of cases in published literature. A typical course is 30 sessions (2.5 hours per day, five days a week for six weeks) – a significant commitment. HBOT is also indicated for radiation proctitis, chronic refractory osteomyelitis, and some problematic wounds such as grade 3–4 diabetic foot ulcers.

There is growing interest in its application in inflammatory bowel disease, including ulcerative colitis and Crohn’s disease. A recent systematic review and meta-analysis of 118 patients treated with HBOT for perianal fistulizing Crohn’s demonstrated clinical response and remission rates of 75% and 55% respectively, warranting further consideration. Several studies also show improvements using HBOT as adjunctive therapy for hospitalised ulcerative colitis flares, and its role here will be watched with interest.

Contraindications include untreated pneumothorax, uncontrolled hypertension, congestive cardiac failure with ejection fraction below 35%, claustrophobia, congenital spherocytosis, uncontrolled diabetes, chronic sinus conditions, and advanced emphysema (“blue bloater”). Other factors include avoiding disulfiram, which blocks superoxide dismutase, and doxorubicin.

As in every field of medicine, delving into specialty subjects highlights deep knowledge and expertise. With curiosity at a high, I was privileged to hold this conversation with Neil about practical issues of HBOT, how it works, and its value across many indications. There is much to learn and reflect on in relation to the clinical problems we face.

Please welcome Neil to the podcast.

References:
Dr Neil Banham: [email protected]
Role of hyperbaric oxygen therapy in patients with inflammatory bowel disease: Kaur et al. www.co-gastroenterology.com
Hyperbaric oxygen therapy for refractory perianal Crohn’s disease: Tome et al, Gastroenterology & Hepatology, Vol 20, Issue 4, April 2024
Hyperbaric Patient Selection: DuBose et al: StatPearls, July 31, 2023. www.ncbi.nlm.gov/books

Cancer is one of the biggest health challenges worldwide. In 2021, about 15% of all deaths were cancer-related. In Australia, there are approximately 624 cases of cancer per 100,000 people, an incidence which has increased by about 7 % over 20 years, with an estimated 43 % of people being diagnosed by the age of 85 years. On a positive note, improved oncological medicine and care have reduced mortality by about 25 % which is very reassuring. The top ten cancers diagnosed in Australia, starting with the most common, are Prostate Cancer, followed by Breast Cancer, Melanoma, Colorectal Cancer, Lung Cancer, Non-Hodgkin Lymphoma, Kidney Cancer, Pancreatic Cancer, Thyroid Cancer and Uterine Cancer. From this group, deaths are more common with Lung Cancer, followed by Colorectal cancer and then Pancreatic and Breast cancer.

Often, a primary practitioner will make the diagnosis or suspect changes in his/her patient that lead to a diagnosis being established. Whilst most treatment regimens are initiated by Oncologists, radiotherapists or Surgeons, the primary practitioner is very frequently saddled with managing many of the day-to-day issues arising from therapy and the emotional trauma associated with cancer treatment. I was interested to explore oncology in general practice more with my colleague, Oncologist Dr Michael Fernando, who generously joins us today on the podcast.  Michael is beginning his journey in medicine and brings a huge amount of compassion, maturity and enthusiasm with him. He also jointly runs a podcast called Oncology for the Inquisitive Mind, which has been very well received, and I strongly recommend it to you.

Please welcome Michael to the conversation.

References.

Dr Michael Fernando. Epping Specialist Group. www.eppingspecialistgroup.com

Oncology for the Inquisitive Mind: podcasts.apple.com

Uterine cancer is the fifth most common cancer in females and the most common cancer of the female genital tract in Australia, with about 3,300 cases annually and 660 deaths. The major prevalence is in women between 50 and 70 years, and the quoted major risk factors include: early onset menarche and late menopause, obesity, nulliparity, unopposed oestrogen treatments, polycystic ovaries with prolonged anovulation, extended use of tamoxifen for breast cancer treatment and Lynch syndrome, which confers a 30 % lifetime incidence. Presenting with abnormal PV bleeding or prolonged post-menopausal bleeding, other presentations may include dyspareunia, pelvic pressure, weight loss, anaemia and in later stages, possibly pelvic pain. Whilst a PAP smear will frequently be negative, pelvic imaging revealing a suspicious endometrium and subsequently hysteroscopy and biopsy guide the diagnosis. Patients with more than 50 % myometrial invasion have a six-to-seven-fold higher prevalence of pelvic lymph node metastases and advanced surgical stage compared with women with less than 50 % invasion. With current management the five-year survival has improved over the past 40 years to 83 %. 

In contrast to endometrial cancer, which has seen an increasing incidence since 1982 of about 0.9 % per year, Cervical cancer prevalence has reduced from 14 per 100,000 in 1982 to 7 per 100,000 in 2017, influenced by the introduction of the HPV vaccine Gardesil in 2007. Gardesil 9 is the HPV vaccine used in Australia’s National HPV Vaccination Program, providing 100 % protection against HPV strains 6,11,16,18,31,33,45,52 and 58, which are known to cause genital warts and cervical and other HPV -related cancers. Types 16 and 18 cause most of the HPV -associated cancers. This vaccine is recommended for all children aged 12 to 13 years and is free for all Australians aged 12 to 25 years. The vaccine is estimated to prevent up to 90% of cervical cancers and 96% of anal cancers.

I was fortunate in this podcast to have a conversation with Professor Thomas Jobling regarding the risks and management of endometrial and cervical cancer. Tom is a gynaecological oncologist, ex-AFL footballer and medical researcher with a very respected reputation in Melbourne and internationally. He has extensive experience with minimally invasive surgery, including robotic surgery, for gynaecologic cancer. His main research area is ovarian cancer for which he received an Order of Australia Medal in 2017, and he is currently Head of Gynaecological Health and VMO at Peter MacCallum Hospital.

Please welcome Professor Jobling to the podcast.

References :

Professor Tom Jobling: [email protected]

Endometrial Cancer Treatment-NCI 

Endometrial Cancer-Cancer Australia

The pace of modern life may not give many of us the time to stop, rest and recover with a good night’s sleep, yet sleep is as important for good health as diet and exercise. Regular healthy sleep improves brain performance, mood and health. Poor sleep hygiene is associated with increased risk of heart disease, stroke, obesity, impaired immune and cognitive function.

Sleep consists of two distinct states as shown by EEG: REM sleep (rapid eye movement sleep), where dreaming occurs, and non-REM sleep, which is divided into 4 stages. Sleep is cyclical, with four or five REM periods during the night, accounting for about 1/4 of total sleep. Initial REM periods are shorter than later ones. During REM sleep, information is believed to be cemented into memory.

Stage 4 sleep is the deepest, during which blood pressure, heart rate and breathing slow, muscles relax, and both growth and repair processes are believed to occur. Stage 4 usually occurs in the first several hours of sleep. Variations in sleep may be due to shift work, travel or individual patterns. Creativity and responsiveness to unfamiliar situations are impaired by sleep loss.

Alcohol, smoking and stimulants such as caffeine, cold remedies and cocaine can reduce sleep time. Benzodiazepines tend to increase total sleep time with variable effects on non-REM sleep. Antidepressants tend to decrease REM sleep, with rebound on withdrawal in the form of nightmares.

For most adults, 7–9 hours of uninterrupted sleep is recommended — a little less for older adults and more (8–11 hours) for teenagers, with even more needed for infants and toddlers. Sleep dysfunction is common and includes short sleep (less than 6 hours for under 65s, or 5 hours for older adults), long sleep (longer than recommended), poor sleep quality (frequent waking, difficulty falling asleep), and disorders such as sleep apnoea, restless leg syndrome and insomnia.

Doctor-diagnosed sleep disorders affect about 1 in 5 adults, and 48% of adult Australians report at least two sleep-related problems. Up to 19% report not getting enough sleep. Shift workers (around 16% of the Australian workforce) are at higher risk, with 1 in 3 experiencing sleep disorders, including falling asleep at work and having a 60% higher risk of accidents compared to non-shift workers.

An Australian survey of 1,050 adults revealed that sleeping pills were being used by 37%, 14% were using melatonin, and the majority were taking a range of hypnotics, including benzodiazepines and non-benzodiazepine products (e.g. Zopiclone from the cyclopyrrolone group or orexin receptor antagonists).

I wondered if this high level of prescribing indicates that our general approach to advising patients on sleep should change in favour of promoting more natural ways of achieving sleep hygiene. To satisfy my curiosity and gain insights into healthy sleep patterns and how to achieve this naturally, we are joined by senior research scientist Josh Leota from Monash University’s School of Psychological Sciences.

Josh is actively involved in sleep research, especially regarding the effects of sleep on athletic performance, and is currently studying a cohort of elite female athletes competing locally and after travelling through time zones interstate. I was very pleased to welcome Josh to share smart insights into understanding sleep cycles, how poor sleep may impact health, and advice on achieving sleep without pharmacological assistance.

References:

Josh Leota, Research Fellow. School of Psychological Sciences, Monash University, 270 Ferntree Gully Rd, Notting Hill, Vic 3168

Sleep problems as a risk factor for chronic conditions: www.aihw.gov.au

https://www.nature.com/articles/s41467-025-58271-x

Falls in the elderly are associated with significant morbidity and, after a serious fall, indeed predict the transition within a year of 10-15% of seniors to long-term care facilities. Additionally, the one-year and three-year mortality for seniors is 16.4 % and 40.5% following a report of more than one fall in the past 3 months (about double the average). When a hip fracture complicates the fall, the all-cause mortality is three times higher than for the average population and as high as 27% in one year in some studies. 

Many factors are at play in the deterioration of senior patients experiencing falls and mobility decline. Faltering stability may arise from inadvertent overmedicating with hypotensive agents and beta-blockers, or the consequences of previous cerebrovascular accidents, Parkinson's disease and myopathies. Excluding these more overt and obvious conditions, one of the greatest determinants of falls is toe strength. Toe strength affects stability, which is a problem in an estimated 1:4 people over the age of 65 years. 

The problem of falls relating to toe strength, foot proprioception and distal muscular control piqued my interest and led to a curiosity to explore this issue further with expert physiotherapist Allan Abbott. Allan is known for pushing the boundaries of knowledge and learning, and for providing a fresh perspective on many functional issues affecting us that one may not have considered previously in any detail. In an earlier podcast, Allan helped us explore breathing techniques designed to enhance physiologic function, and I would commend these episodes, including 139,140, as well as 153 and 154, to you. 

The concept of dying from the feet up warrants careful examination and thorough understanding. Hopefully, after listening to this podcast, you will believe, as I do, that we could all benefit from the ideas Allan explores. 

I was keen to learn more about the major factors contributing to foot problems, the exercises we should be considering and recommending as well as performing regularly ourselves to improve toe strength, balance and dexterity. The role of footwear and how one may select “good” foot support in terms of orthotics is also of significant importance and interest. 

If you are interested in improving foot function and limiting morbidity both for your patients and yourself, please join me with Allan as he navigates this fascinating topic.

References:

Mr Allan Abbott - Physiotherapists http://www.healthinnovations.net.com/

The prognosis of falls in elderly people living at home: Donald et al. Age and Ageing. Vol 28. March 1999.

Mortality and cause of death in hip fracture patients aged 65 or older - a population-based study

Panuka et al.BMC Muskuloskeletal Disorders. May 20, 2011

Older adults and balance problems. Sep 2022. www.nia.nih.gov

The Greek messenger Pheidippides famously ran 42 kilometres from Marathon to Athens delivering news of victory in battle before dropping dead, still a young man. Pheidippides was undoubtedly fit and an accomplished runner as he had been a Greek herald messenger his entire life. Was his untimely death due to excessive exercising or unforeseen preexisting cardiac risk factors? This stand-out story mirrors the sad death last year of champion athlete and Queensland iron man Dean Mercer, aged 47 years, from an acute cardiac event after an early morning swim session. Was his death a consequence of his extraordinary training schedule or preexisting cardiac disease?  The famous Australian Carney sisters were both forced to retire from world triathlon competition and their elite standing with life-threatening cardiac disease, similar to world champion triathlete Greg Welch. Notable athletes such as American marathon runner Ryan Shay succumbed from a fatal cardiac event at 28 years during Olympic Marathon trials and athlete authors Christopher McDougall known for his book ‘Born to Run’ died alone on a trail run in New Mexico aged 58 years similar to Jim Fixx who wrote ‘The Complete Book of Running’ and died in 1984 at the age of 52 from an acute cardiac event.  These notable cases raise questions about the insidious impact of elite endurance sport and volume exercise and raise concerns about cardiac rhythm disturbances and coronary arterial plaque rupture, as well as chronic inflammation in a condition some refer to as “Athletes’ Heart”. 

As compelling as this diagnosis may seem, the proposed condition “Athletes’ Heart”, however, is not widely accepted and indeed, quoting Andre La Gerche, who is an expert sports cardiologist at the Baker Heart and Diabetes Institute, there is no proven link between endurance sport and sudden death. To the contrary, Athletes live longer. Endurance athletes and gold medallists live the longest; however, endurance athletes are about 2-5 % more likely than the general population to develop heart problems, including rhythm disorders such as Atrial Fibrillation”.                     

Dr La Gerche urges us to remember the importance of separating public health from individual risk and reminds us that exercise in all forms reduces the risk of cardiovascular disease and diabetes and extends life. Any individual can have a heart attack; there are 20,000 deaths from heart disease per year in Australia -one every 10 minutes. Common things happen commonly, and about 1 per 100,000 people die of heart attacks during marathons; no conclusion can be drawn as a preexisting condition in such cases was likely.

The question remains whether moderate exercise should be the goal with caution for those entering elite high-volume endurance training regimes. As noted, studies are progressing, but to answer some of these questions, I was joined by cardiologist Dr Maria Brosnan. Maria is an elite athlete herself, having competed widely, and has a strong interest in arrhythmias as well as cardiac physiology in elite athletes. She works at St Vincent's Heart Centre and The Baker Institute as well as the National Centre for Sport Cardiology. She serves as a consultant for Tennis Australia, The AFL draft, Rowing Australia and several professional cycling teams. Please welcome her to the podcast.

References:

D Maria Brosnan: St Vincent’s Heart Centre, www.stvheart.com and nationalsportscardiology.com

Competitive Sports and the Heart: Benefit or Risk ?. https://pmc.ncbi.nih.gov

Athletes and Heart Disease: Why Does It Happen? www.mountelizabeth.com