Monday, June 27, 2011

Come Take My Class!!!

I will be teaching a three-session class, along with Jeri Gertzman, a Registered Dietitian, on "Plant-Based Nutrition for a Healthy Heart".
It is a three-session class where you will learn why a plant-based diet is optimal for health, and how this diet can prevent and even reverse heart disease. We will even feed you with delicious food!!!

There are two three-session classes scheduled: July 18, 25, and August 1, and September 12, 19, and 26.
The cost is $15 per session or $40 for all three sessions.
Classes will take place at my office from 6:30-8:00 pm -- 7325 Medical Center Drive, Suite 300, West Hills 91307.

Call (805) 210-7411 or email nhayes@regalmed.com to register.
Image from www.tcolincampbell.org

Sunday, June 26, 2011

Breath of Life Triathlon -- Race Report

Today I raced the Breath of Life Triathlon, an olympic distance race -- 0.9 mile swim, 24.8 mile bike, and 6.2 mile run.

The race took place in Ventura Harbor and along nearby roads.  Previously, the race was held at San Buenaventura Beach, which meant the swim could be choppy, but the run was scenic along the boardwalk.  This time, the swim was calm and the run had unexciting views.

I had my goals -- 28 minute swim, 1:25 bike, and 53 minute run.  I met them all -- 26:48 swim, 1:23:38 bike, and 52:50 run.

The swim start wasn't too crowded, which is always nice, to avoid getting kicked and elbowed.  But there were some very aggressive women in my group, so it was a tough start.  We swam two loops, jumping out of the water and running across a timing mat on the sand between the loops.  I sprinted out of the water after the first loop, perhaps showing off, and dove right back in.  This expenditure of energy ended up being counterproductive because after landing in the water again, I ended up pretty winded for the next minute or so, and spent about 15 seconds doing breaststroke catching my breath.  That said, none of the 3 or 4 people who I passed on land passed me in the water.

The bike was flat and dull.  One woman coming out of the transition area at the same time remarked that she didn't have a gel with her.  I gave her one of mine.  She then proceeded to draft off of me for the first four miles of the race.  When I passed her, she acknowledged she was drafting me and suggested we draft off each other for the remainder of the race.  While drafting was a tempting proposition, drafting is not legal in this race, so I pulled ahead and stayed away from her. 

We rode three loops around a few farms on a mostly flat course.  I have definitely become a faster cyclist, as I was able to maintain an average speed of 18.2 mph on my bike.  I was passed by lots of men with fancy wheels and helmets, but not by too many women.  If I'm riding 18-20 mph, I think I can get over someone flying by me on their bike.

The run was an out-and-back, through the harbor and then along a really boring road with not much to see other than the strawberries across the street and runners and cyclists.  But, on an out-and-back, it is easy to know who is in front of you and who is behind you, in case you feel competitive.  Which, sometimes I do :) Though I know I'm not going to win the race, I like to see how I'm doing relative to others.  And I like giving the occasional high-five to my friends who are racing.  I dropped my pace a bit toward the end of the run, but stayed between 8:15-8:43 per mile.

Total finishing time: 2 hours and 48 minutes and 39 seconds.  This was my best time on an olympic distance course, so I am very happy.

Thursday, June 23, 2011

Do Patients Really Listen?

Am I wasting my breath when I suggest eating better, exercising, and losing weight?

A lot of doctors think so.

I was discussing this with another physician this evening.  Often, our solutions are pills -- you have high blood pressure, you get a prescription for amlodipine.  You have high cholesterol, you get a script for simvastatin.  You have palpitations, you get atenolol scribbled on a prescription pad.

But, what about diet and lifestyle?  If, to lower your blood pressure to a normal range, you could cut back on the sodium in your diet, eat less fast food and more fruits and vegetables, would you do it?  Or what if cutting back on (or better yet, eliminating) animal foods would slash your LDL cholesterol drastically without the need of a pill?  Or, if cutting out your morning latte would eliminate your palpitations, would you do it?

True, many patients are set in their ways, or have emotional barriers that keep them from living a healthy lifestyle.  But, I think patients are more motivated than we give them credit for.  If the option is lifestyle change or a pill, I don't believe that most people will chose the pill.

Friday, June 17, 2011

Track

Running track is one of my favorite workouts.  It's full of adrenaline and pure speed, and yet also of learning to pace oneself.

I had not run track in over a year and a half.  I was busy training last year for an Ironman, and there has also been the barrier of my office being far from the track.

But, the track is what has helped me go from being a 4:57 marathoner to a 4:12 marathoner, and hopefully even faster than that in the near future.  I am grateful for all of my gains in running over the past couple of years, but I still want to one day run a marathon fast enough to qualify for the Boston Marathon.

Recently, I made a decision:  I love the track, and as I need to get faster, I need to get back to the track.  Unfortunately, my workplace is in West Hills, and the Los Feliz Flyers track workout is at Caltech in Pasadena.  And I have two dogs at home eager to go outside.  It's a tight commute, but I make it to track by 7 pm.

There are two groups at the track:  The fast group, and the TOG's (aka The Other Group), the slower group.  My pace makes me one of the faster TOG's, or it makes me the caboose of the fast group.  When I last ran track, I was running with the faster group.  And upon returning, I thought that's where I would start again.

The first track workout in a year and a half was a bit of a disaster.  The workout was 400 repeats, or one lap around the track.  I nailed the first one in 1:36, and smiled at our coach Don, like "hey look at me, I haven't gotten slower, I still have it!".  Then the next lap was 1:39.  Then 1:42.  Then 1:44.  I kept falling farther and farther behind on each lap.  My heart rate was approaching 190 on each lap and barely came down with the short rests between laps.  I was beat!  I knew I'd blown up, and ended up quitting mid-workout.

Over the past several weeks, I've been running with the TOG's.  I'm still one of their faster runners, but running with that group has helped me to not go out all guns ablaze, so to speak.  And, even in six weeks of track, I'm faster than I was before I started this little stint.  I ran a track mile in 7:09, my fastest ever, and my brick runs (running after getting off the bike) lately have been consistently faster.

My short-term goal is to get a bit faster and join the fast group.  Long-term, my goal is to qualify for the holy grail of marathons -- Boston. 

Boston 2013, look out, here I come!

Tuesday, June 07, 2011

AIM-HIGH? Not so high apparently.

Some things in medicine seem like common sense, but they are not.

Since heart disease and osteoporosis increase after menopause, when estrogen levels drop, it was thought that supplementing estrogen would help.  Then the WISE study demonstrated that there may actually be harm in taking estrogen.

Diets high in fruits and vegetables, which in turn are high in vitamins, nutrients, and phytochemicals, lead to decreased risk of heart disease.  So, it would make sense that vitamin supplements would help, right?  Many studies and meta-analyses have looked at whether supplementing B vitamins, vitamin E, folate, or coenzyme Q10 would reduce the risk of heart disease.  Not a single study has shown that vitamin or mineral supplementation reduces heart disease.  In fact, vitamin E supplementation may increase the risk of stroke.

But niacin was thought to be different.  Niacin raises HDL ("good cholesterol") levels and lowers triglycerides and LDL levels.  Several small studies showed that niacin alone might reduce risk of cardiovascular events.  Therefore, it was thought that if some is good, then more is better.

The AIM-HIGH trial of more than 12,000 patients already on statins with controlled LDL cholesterol sought to determine whether addition of long-acting niacin would further reduce cardiovascular events.  However, the trial was recently stopped early because patients showed no decrease in cardiovascular events, but did experience an increase in risk for stroke.  This increase in stroke was somewhat surprising, and there is no obvious explanation for the small but significant increased risk of stroke.

Another drug, torcetrapib, a CETP-inhibitor, which raises HDL, was studied a few years ago as a hope for patients with heart disease.  However, studies showed increased all-cause mortality amongst patients on a combination of a statin and torcetrapib.

Dr. Neal Barnard of PCRM, the Physicians Committee for Responsible Medicine, has an interesting take on the subject. Artificially raising the HDL with medicine like niacin may not be what helps people live healthier and longer. The key may be healthy diet and exercise, which in turn raise HDL levels.

Better living doesn't necessarily come from better pharmacology.  Healthy diet and lifestyle are still the cornerstone of reducing heart disease risk.

Saturday, June 04, 2011

Go See Forks Over Knives!

I finally saw Forks Over Knives this week.  It's a movie about how eating the right foods can reverse disease and save your life.

The message is simple:  You are not doomed to a life of disease, even if it runs in your family.  You have the power over what you put into your body.  And, if you choose the right foods, particularly by following a plant-based (or as firefighter Rip Esselstyn puts it, "plant-strong") diet, you can avoid and reverse many diseases.

As a physician, the part I found interesting was observing Dr. Matt Lederman of the Exsalus Wellness Center conselling patients.  The Exsalus Wellness Center, based in Los Angeles, is run by Dr. Lederman and his wife Dr. Alona Pulde.  Their approach to health includes a plant-based diet.  I think the concept of a wellness center is pretty cool.  From hearing Dr. Lederman speak, I understand that he spends two hours of time with a patient for a new consultation.  And, the patients who come to Exsalus are in many ways self-motivated -- as Exsalus does not directly accept insurance, the patients who are there have directly sought out Drs. Pulde and Lederman.

I'm a bit envious of them -- I'd love to have two hours to spend with each new patient.  And I'd love to have a patient population eager to soak up knowledge about a plant-based diet.  But, perhaps that's part of the challenge of what I do.  While many patients seek me out knowing my approach to patient care, many see me by default because they are sent to me by their primary care physician.

Nonetheless, I think that the message of self-determination can ring true in just about any patient.  When given the option, "I can give you a pill for this, or we can try to reverse this with diet and exercise," most patients will choose the latter option.  And, this is an opportunity to get across to patients that they CAN change their lives just by what they choose to eat.

Forks Over Knives is one powerful movie -- it can change your life.  No joke.