Avoiding Injury

In my 20's and early 30's, I ran, and sporadically I would strength train.  I had a tendinitis in my foot that kept me from running for nearly a year and a half.  Then I was plagued by plantar fasciitis that burned with every step I took.  And once that healed, iliotibial band pain kept me from running for another three months.  Ultimately, I realized that I needed to make some changes as an athlete to avoid more injuries.

In the past 9 years, I have remained injury-free, even as I train harder.  Here's how:

1)  Foam roller -- I spend a couple of minutes on my foam roller a few times a week.  I pay particular attention the the lateral aspects of the thigh, which is overlying the iliotibial band which can easily get inflamed.  If I find a spot that hurts, I concentrate on rolling out that particular spot.

2) Massage -- Get a massage every so often.  It will keep you limber and loosen up any problem areas.  I recommend either David Wachtel of LA Body Mechanics or Efren Jimenez at Joseph Lamar Salon.  Both of these guys are athletes and do great work.

3) Yoga -- Great for flexibility, stretching, and relaxing.  I incorporate restorative yoga into my training, and particularly love Melissa's Sunday evening restorative yoga class at Black Dog Yoga.

4) Get a coach -- I have a coach not necessarily to push me, but rather to rein me in.  I could be perfectly happy running and doing boot camp strength classes day in and day out, but that would be a quick recipe for injury.  Coach Gerardo Barrios of Fortius Racing knows my goals and gives me a schedule of training to follow so that I am strong on race day and stay healthy getting there.

5) Strength training -- A strong core and strong body make for a stronger runner. I strength train two to three times a week, once a week privately with Corey Enman of Burbank Fit Body Bootcamp and another couple times a week at Tru Fit Bootcamp in Van Nuys.  In the off-season, I also love Barry's Bootcamp, an hour workout consisting of 30 minutes of running and 30 minutes of strength training.

6) Swimming/cycling/cross-training-- It's important to use other muscles that you don't necessarily use for running.  I swim and ride my bike a couple times a week, even during running training and the triathlon off-season.  Cycling strengthens the glutes and hamstrings, and swimming is great for core stability and strenght.  Both are great for flushing out the legs after hard running.

And this is how I keep on training and keep from falling apart!!!

Phoning it in

Do you get annoyed when you come to a workout, ready to give it all your effort, and you are surrounded by people who seem to not care?

I found myself in that position at a recent boot camp class.  Two women in front of me, probably in their mid 20's, spent much of the class giggling to one another and generally not doing the workout.

START -- 100 jumping jacks.  I get to work.  One-and-two-and-three-and-four-and.....  And I'm starting to break a sweat.  Our two cutesy crop-pants-wearing friends do a few lacksadaisical slow jumping jacks.  When I'm counting fifty jumping jacks to myself, I see them stop and move on to the next exercise, which is supposed to be 50 sit-ups.

I bang out my situps.  One, roll up, two, roll, three, and so forth.  These two chicks slowly roll up, tousle their hair, one stops for like two minutes to fix the perfect pony tail.  They did, maybe, 20 of the 50 situps.  Followed by 40 mountain climbers, of which they each did about 10.  Then 30 squats by which each of these girls might have lowered her rear end about six inches toward the ground, possibly a total of six times. Then 20 push-ups, and I think each of them did 5-10 exercises that involved a slight bend in the elbows, before doing two or three of the ten thrusters that they were supposed to do, and finally followed by about 15 seconds of what should have been a minute long plank,in which one of the "planks" involved an ass way up in the air and resembled nothing of a plank.

It is nearing the twenty minute mark, I am sweating and finishing off a final 100 jumping jacks.  These two girls have been standing around for 5 minutes, I think they may have done a yoga pose or two to stretch and then walked over to check their cell phones for the remainder of the time.

Should I care what these two lazy twenty-something girls in front of me are doing?

The problem is, I do care.  And it annoys me, that I am working my ass off to get results, and they're barely making an effort.

Now, my point is not to mock people who aren't in shape.  I am mocking the people who don't care to try, who don't push themselves.  My point is that if you come to a fitness class, you should put in the effort.

So why does this bother me?  After all, I'm here at bootcamp for myself.  I'm not here to facilitate anyone else's workout.  Perhaps it's because I come to a class to have others push me, and watching others not put in the effort does not inspire in the least.

I look in the mirror at myself.  I'm fit.  I get results because I WORK HARD.  When I come to work out, I give everything I have.  Your body gains little if anything by half-assing a workout.

For me, I have to remember, I'm here for my workout.  I have to find the people who inspire ME and stick with them.  I find those types of people on Fortius Racing.  I find them at master swim workouts.  And sometimes I find them at my bootcamp classes, and when I see them, I stick with them.  I watch what they do.  I try to keep up, do more.  Because they push me, and hopefully I push them too.

Eating Healthy for the Holidays

The holidays are a tough time for those of us trying to stay healthy and stick to our fitness goals.

I knew I'd be heading to a couple social events in the evening, so lunch had to be healthy.

This is blended cauliflower, spinach, cabbage, and green onion sautéed in vegetable broth, with Trader Joes teriyaki baked tofu. When you blend cauliflower into tiny bits in a Vitamix, somehow it has so much more flavor.

In the evening, I was going to my friend Suzanne's "White Trash Christmas" party. It's a funny theme, and the food all fits the theme. Funny, and perhaps delicious to some, but definitely not healthy. Fried cheese sticks. Oreos. Pizza. Spam rolls. Chicken nuggets. In other words, stuff I don't eat.

I informed Suzanne that in spite of the theme that I was bringing a large salad to share. Yes, that's me, the healthy buzzkill.

I love a good salad! My strategy was to bring a salad that could serve as a complete dinner for me, or as an appetizer for others. Dark leafy lettuce, lentils, carrots, blended cauliflower (I'm on a bit of a kick with this blended cauliflower as you can tell), apple slices, organic cherry tomatoes, almonds, dried cranberries, and a Bragg's pomegranate dressing on the side.

And, even at a party where the theme is unhealthy food, my salad was essentially polished off.

Happy Holidays! And stay healthy!!!

Going for the BQ -- Boston Qualifier

I had an awesome triathlon season -- three Ironman 70.3 events, moving from top 27%, to top 23%, to top 20% in my age group.

After my nearly ten years as a multisport athlete, I have one goal on my bucket list -- the BQ.  Boston Qualifier.  And, as I turn 40 next year, there's no time like the present, since the qualifying standard becomes a slightly less challenging time of 3:45 as I age up.

I talked to my coach, Gerardo of Fortius Racing, and he thinks I can do it.  Actually, he has given me the goal of 3:39.  A 3:39 would give me adequate cushion to my time to make sure I can get a spot in the 2016 Boston Marathon.

I plan to qualify for the Boston Marathon at the Napa Marathon on March 1, 2015.

That's an 8:21 per mile pace.  I stutter a bit as I type that, because that's pretty darn fast.

Santa Monica Run Fest 10k, October 19, 2014 -- 51:14

I am currently in my base training, which is the early training for the marathon.  So far, I've been doing a lot of trail running.  But recently, the training has picked up, and I have to admit, it's a little scary.

On Friday morning, I had a workout goal to run 4 x one mile in 7:45-7:55 per mile, with 200 yards as a break in between each.  I hit my goal for the first two miles, but on the third mile I ran 8:05, and for the fourth, I had nothing left so I cut the mile down to a half mile and finished that in 3:59, an 8:00/mile pace.

My coach sounds confident that I can achieve a qualifying time if I do the workout plan that he gives me.  I am nervous, but I'm going to trust him, because he knows what he's talking about.

It's going to be a tough four months.  But, I'm ready for the challenge.

Nuts and Avocados

Last week, I attended the annual meeting of the American College of Lifestyle Medicine.  Not only was it an opportunity to hear some of my favorite speakers, but I had the chance to meet plenty of like-minded medical professionals, who like me feel that medicine is more than just a handful of pills.

One of my plant-based heroes, Dr. Caldwell Esselstyn, author of Prevent and Reverse Heart Disease, presented at the first morning of the conference.  His work has demonstrated that not only can people adhere to a whole-food plant-based diet, but that when they do amazing things can happen.  He has demonstrated that changes in diet can lead to a decrease in angina, fewer cardiac events, and even reversal of plaque build-up in the arteries as seen on an angiogram.

Dr. Caldwell Esselstyn

The diet that Dr. Esselstyn advocates is free of meat, fish, dairy, egg, oil, nuts, seeds, and avocados.  In other words, it's more intensive than just a vegan diet, and inherently quite low in fat.

I have a number of patients who have successfully followed Dr. Esselstyn's program, and not a single one of then has has a recurrent cardiac event or needed another stent.  But, the question that I have been asked, and I have wondered, why no nuts or avocados?  I can understand avoiding animal products and oils since these are inflammatory to the body, but why go so far to restrict the diet?

So, I approached the microphone at the end of Dr. Esselstyn's talk, and I asked.  His answer was that because they are high in fat, they are not helpful to most cardiac patients.  But what about those cardiac patients who are normal body weight, can they enjoy nuts and avocados?  His succinct answer?  "No."  So I pressed him on the question and asked, "Why?".

Dr. Esselstyn answered that this is how his studies were designed, the diet has worked so well, and as a result he hasn't wanted so change up a successful formula.  Some participants who I spoke with found this to be an unsatisfying and unscientific answer.

from www.goodhousekeeping.com

And, yet, at the same time, minutia like nuts and avocados, does it matter?  Does it really matter when, to paraphrase President of the American College of Lifestyle Medicine, Dr. David Katz, "most people are eating glow-in-the-dark junk"?

My take on all of this -- I would love to see all of my coronary disease patients on Esselstyn's diet.  That said, I eat avocados and nuts, and I don't believe most people should avoid these foods since they have plenty of important nutrients.  But, for those patients with coronary disease who are so motivated, I encourage them to follow the program espoused by Esselstyn.

But, the majority of my patients, while they are willing to make positive diet and lifestyle changes, may not feel ready to go quite this far.

And some of my patients have far less than ideal diets, those who may eat the majority of their meals at fast food outlets, or when asked about fruits and vegetables will tell me that they eat "eggs and potatoes."  In these cases, it might be a victory just to get this patient to eat one fruit and one vegetable per day.

We can all agree that more fruits and vegetables, less processed food, less refined sugar, less sodium are all good choices.  So let's start there, at the very least, when encouraging lifestyle change.

Normal

It's interesting what our sense of "normal" is.

When I first meet a patient, I ask her about her diet.  A typical response is, "I eat normal."

What does "normal" mean?  Upon further questioning, "normal" is the Standard American Diet.  In other words, a diet high in processed meat, red meat, sugary desserts, high-fat dairy, processed foods, refined grains, and sugary drinks.  It's a diet that has few fruits and vegetables, if any.

A "normal" diet is one that increases the risk of heart attack, stroke, diabetes, obesity, arthritis, and many forms of cancer.

from www.newhealthguide.org

How normal is that????

Why can a person sit and eat a burger, fries, and large soda and no one think anything of it, and if I sit down with a big salad for lunch, it's viewed as alien, atypical, or even.... "healthy".  But not normal.

So, how is that we as a society have come to view foods and habits that kill us as "normal"???

Our paradigms need to change.  And that's going to take a big shift in how we as a society view food and exercise.

My New License Plate

I had to share... :)

Silverman 70.3 -- Ending the Season Right

I certainly didn't pick easy races this year.  St George 70.3 was a hilly course with a high of 73 degrees, Vineman 70.3 was pretty damn hot too, and Silverman, with an elevation gain of over 4000 feet on the bike course and three loop hilly run, it just ended up being a long challenging day.

Swim
We had heard rumors of Lake Mead being as warm as 80 degrees.  When the water is warmer than 76 degrees, wetsuits are not legal.  I brought mine anyway, and when I heard the water was about 75 degrees, I was glad that I could wear my wetsuit to give me more buoyancy and therefore a bit more speed.

My wave, women 35-39, was one of the first to start.  I started in about the second or third row of women.  About halfway through, in my full-length wetsuit, I felt really warm.  My mouth was dry.  And I was worried -- did I just overheat on the swim and blow my entire day? Fortunately, I didn't.  I drank quite a bit in the first few minutes of the bike and in transition and I was fine.

I'm going to digress for a minute -- I had a side bet with one of my teammates Kosha.  He is an amazing athlete, former college football player, blazing fast runner, and awesome cyclist.  But on the swim, he and I are pretty close.  At Vineman, he was 23 seconds faster on the swim, and at Malibu he was a couple seconds faster also.  We made a bet over a shot of tequila over which one of us would be faster.  In this race, finally, I outswam him -- by 7 seconds, with a time of 38:33.  But, a win is a win, and he had to do a tequila shot.  And I joined him in doing the shot, because truthfully, it was an amazing swim for both of us.

My swim:  17/70 women finishers in my age group

Bike
This was a hilly bike.  Not just hilly, but basically no flats.  We were either going up or down, but mostly up because the point-to-point course ended us at a higher elevation.  And no shade from the elements.  It got hot fast, like over 90 degrees.

There's an interesting psychology to where one starts in a race.  In Malibu, when I'm in one of the last waves, I get to pass a lot of people in front of me.  But, at Silverman, when I'm one of the first waves, I get passed by a lot of people.  I have to not get demoralized, remind myself that most of the people passing me are men, that I'm not getting passed by (many) women, so I'm staying ahead of my competition.

The wind was a factor also.  I have a disc wheel in the back, which makes me even more susceptible to wind.  On some of the downhills, I felt pretty unsteady and found myself gripping the brakes.

The biggest challenge for me on the bike was mechanical issues with my chain.  Whenever I would try to shift to my smaller gears, the chain would fall off.  It fell off four times, necessitating me to get off my bike and put the chain back on.  That wouldn't take me more than 20-30 seconds and a little lost momentum each time, but it did give me a brief chance to stop pedaling and stretch.

My legs were tired.  I'd say about 20 miles in, I thought to myself, how am I going to do this?  It's hot.  My legs hurt.  And I have 36 miles to go.  In my head, I broke it down.  Let's get to the turnaround.  Then, let's get to the gate at the exit of the park.  Then, let's get onto that next turn, let's get over that big hill, and let's get to T2 and start running.  Yes I'm getting passed, but those are mostly men.

I stayed well hydrated, which is important on a hot and windy day.  After finishing off my two bottles of coconut water, I relied on one bottle of Ironman Perform (yuck) and then some water.  I had a couple of mini-Bonk Breakers also.  I don't love gels when I'm on the bike; solid food just makes me happier.  And the aid stations are just fun.  I yell out what I need, put out my hand, fly by on the bike, and grab the bottle or the Bonk Breaker or banana or whatever it is.

I arrived at T2, the second transition area, to find very few bikes, which was reassuring, and indicated that most of the other women in my age group were behind me.

My Bike:  3 hours and 24 minutes.  14/70 women finishers in my age group.

Run
Three loops.  Well over 90 degree weather.  More hills.  My run was more of a shuffle.  I felt like I was barely moving.  But, my strategy is always to run everything except the aid stations.  Because, no matter what speed I'm running, it's faster than any walk.  And if I stop to walk, I won't want to run again.

Again, awesome volunteers with lots of goodies at the aid stations.  At each station, I took a cup of water and drank it.  I took another cup and poured it over my head.  Then I'd swig a cup of Ironman Perform (double yuck) or some Coke.  And then I'd grab another cup of water to douse my head.

To keep cool, some women were handing out zip lock bags of ice.  I grabbed one and stuffed in the top of my tri-top.  When the ice melted, I'd refill it with more ice.

Running with bag of ice stuffed in my top

I can't say I felt great.  The heat took a lot out of me.  I stopped looking at my watch because I just didn't want to know how slow I was running.  But yes, I was running.  Not walking.  It was a slow run.  How was I not getting passed by everyone?  My coach Gerardo who was running as part of a relay team, breezed past me,  He reminded me to run tall and take smaller steps going uphill.

Is this over yet?

Sometimes I put a mantra into my head.  I saw people walking, and slowing to a walk was all too tempting.  I kept saying to myself, "What are they doing?  They are walking.  What am I doing?  I'm running.  So I'm going to keep on running."  Kind of silly mantra, but it kept me going.

What made this event nice was that there were so many familiar faces on the course.  About twenty of us from Fortius Racing were there, and a bunch of others from LA Tri Club who I knew.  It always helps to cheer people on or to get some words of encouragement, and on a day like this, a few "Go Heather!" 's can make a huge difference.

My Run:  2:23.  17/70.

Overall Finish time:  6:33.  17 out of 84 women finishers in my age group.

My slowest 70.3 all season, BUT my best finish.  12 women in my age group didn't finish the race.

I'm so grateful for the success of this race.  I stuck around toward the end for the rolldown for Ironman 70.3 Worlds, with a chance of a rolldown slot to compete at the world championships.  I didn't get a spot, but to think I even had a chance, was just a cool feeling!

I'm happy to finish the season well .  I'm taking a few weeks off and then will start marathon training. More about that soon.

Be critical of what you hear...

We hear all sorts of messages about our health, and many of them are conflicting.  However, it is important to see who and where those messages are coming from and what context they are in.

I am going to give a couple examples.

1) "People with lower cholesterol die earlier."

This is true -- sort of.

I was recently told this by a patient with coronary artery disease who cut the dose of his statin on his own, for fear of increasing his risk of death because his cholesterol numbers were too low.

Several groups of people have low cholesterol -- people with advanced cancer, liver disease, or anyone with severe calorie malnutrition.  And yes, these people are more likely to die sooner.  But, I think it's obvious to say that they aren't dying because their cholesterol is too low, they are dying of their underlying disease.

And it is that underlying disease that is causing the low cholesterol numbers.

However, on the converse, among the majority of people, those people who don't have terrible life-threatening diseases like those described above, lower total cholesterol numbers are not associated with increased mortality.

In fact, in those patients who have coronary or vascular disease, we use statin medications to drive the cholesterol numbers down.  But, as we are learning, more important than making the numbers look nice, statins perform an important role to stabilize and potentially reverse the plaque that is in the arteries, improve endothelial function which is the functioning of the lining of the arteries, and reduce risk of heart attack and stroke.

And, in this patient population, problems with cholesterol numbers being driven "too low" have not been identified in the large randomized controlled trials.  Further, there is a population of people with a genetic PCSK9 mutation which leads to extremely low cholesterol numbers, and these people have very low risk of cardiovascular events.

2) "Are Himalayan salts good for my health"?

Interesting question.  I've done a little research on this question.  When you enter "Himalayan salt" into a search engine, the vast majority of sources of information come from places that want to sell you Himalayan salt.  So, anything you read on those pages you need to take with a grain of salt, so to speak.

What I can tell you about Himalayan salt is that it is not processed like standard table salt, and naturally contains many minerals including iodine.  Himalayan salt is also lower in sodium than table salt.

I do not know that there are specific health benefits to using Himalayan salt.  Specifically, I do not know of any type of clinical trial that supports any health benefit of Himalayan salt over any other type of salt.  But, if you can cite a study that would say otherwise, please leave it in the comments, as I am eager to learn.

That said, regardless of the source of the salt, it contains sodium.  Sodium does not need to be supplemented in our diet, and in fact diets higher in sodium are associated with higher blood pressure and higher risk of cardiovascular disease.  

Bottom line is this -- do not believe everything you hear about health.  Question everything.  And if I'm your doctor, question me too!!!  When a patient asks questions, I know he is processing what I have told him, and a knowledgeable patient is a powerful patient who has the tools to make good choices for his health.

Malibu Classic Triathlon -- Race Report

I do this race every year; this was my 7th year in a row.  I love the Nautica Malibu Classic Tri because it's well-organized, a race where lots of people get exposed to the sport and some for the first time, and it's just a big fun race with a few celebrities.

This is actually my shortest triathlon of the year, amongst the three half-Iron distance 70.3 races and Santa Barbara Long Course which I raced a few weeks ago.

Swim
The women start after the men, and start from youngest to oldest, so the women 35-39 was probably the third to last wave.  When you start after a lot of people, there are lots of people to pass, which can be fun.

Photo courtesy of my Shiggy Ichinomiya, aka GoShiggyGo.

I started the swim in the second row, and fairly close to the left since there was a current that would be pulling us to the right, or west.  As we ran in to the water, there were a few significant waves that I managed to dive under.  The current was definitely pulling us west, and I had to redirect myself to get to the first buoy.  Once around the buoy, there was a fair amount of chop, but I felt okay.

However, getting out of the water was a different story. I'm a hesitant ocean swimmer, particularly when it comes to exiting the water.  The westward current persisted, and I saw several swimmers who were way too far west.  I was able to sight the flags for the swim exit chute, so I didn't go off course.  In addition, there were a few waves, and I almost felt like I was being sucked back in.  As I looked behind me, I saw a wave coming, and I panicked briefly, but turned around and dove under it.  And then another wave that I dove under. I looked behind me, and the water looked flat and I went for it, put my head in the water and probably swam at least ten strokes without breathing in a panic to get out.

Bike
In the transition area, everything went seamlessly, wetsuit came off without any crazy dramatics of arms or legs getting stuck.  Helmet on, wrestle bike off the rack, and go... but WAIT!  No sunglasses!  So I turn around and grab my sunglasses and off I go.

18 miles of biking and I passed a ton of people, but no one passed me.  I stayed on my aero bars most of the time.  I did a lot of yelling "On your left!" but I think that's a courtesy so that no one is freaked out by my suddenly approaching.  My chain dropped at Leo Carillo, the turnaround point, but we were moving slowly to get through a narrow space, so I jumped off the bike, put the chain back on, and wasted no more than 20 seconds.

Other than a little drop of the chain, a good ride.  Time was 55:56, so somewhere between 19-20 mph on the bike.

Run
I saw only a couple of bikes on our rack, indicating just a couple women in my age group ahead of me.  Maybe I took too long typing my shoes, but my 2:26 T2 time was too long.  Maybe I need to re-take that part of kindergarten, or perhaps as I'm breathing heavy I need to be a little more speedy in getting my shoes on as I catch my breath.

Off onto the run.  4 miles, supposedly, but it ended up being 4.2 miles.  I passed a lot of people, but most importantly, one of my age group competitors Abby, who I know from having run track with her before, sped past me.  She said "good job", and I said "good job" to her too.  She was blazing fast, so I knew I wouldn't even have a chance of keeping with her, so I let her go.  As it turns out, she finished fifth in our age group, and I finished sixth (with only five spots on the podium).

My overall time was 1:56:25.  Sixth place out of 107 women in our age group.  Good enough to qualify me for USA Triathlon Age Group Nationals for the fourth year in a row, but just one place away from a position on the podium.

Great race, fun day.  Next year I'll race as a 40-44 year-old woman, which will give me a better chance of hitting the podium -- my time would have been 4th place in women 40-44.

One more race left this season, and that is Silverman 70.3 on October 5.  And then a few months off.  And when I say "months off" that doesn't mean the couch and bon-bons.  That means I exercise, on my own terms.  Not sure exactly what that exactly will be yet.  I'm thinking it will be a lot of boot camp classes and some swimming and maybe a bit of running, and a fun bike ride here and there.  For me that's relaxing. :)

Comfort Foods

Nearly 10 years ago when I contemplated becoming a vegan, I found myself in a dilemma.  Or at least at the time what felt like a dilemma.

Veganism felt so final.  As in, I could never again eat some of my favorite comfort foods.  Chocolate chip cookies.  Brownies.  French toast.  Macaroni and cheese.  Not that these were major staples of my diet, but they were things I enjoyed from time to time (more so then than now, as I've considerably improved my diet in the meantime, thanks to triathlon and my desire to be healthier).

As I explored, I found vegan versions of all of the above.  Except macaroni and cheese.

And it wasn't just the run-of-the-mill macaroni and cheese that I craved.  It was the blue box.  Kraft.  With the orangey powdery cheese with all sorts of artificial coloring and flavoring.  It was a comfort food growing up, and even as a young adult a treat that I enjoyed every now and then.

I realized, though, that my craving for the blue box would not superimpose itself on my commitment to health, the animals, and the environment.

And then there was this:

Source: kblog.lunchboxbunch.com

Earth Balance's version of macaroni and cheese!

I whipped this up the other evening.  It has the powdery vegan cheese and instructions to add a non-dairy milk and Earth Balance Buttery Spread margarine.  I used almond milk, but I found that my Earth Balance margarine was moldy from sitting in my refrigerator and not being used (proof that I don't eat unhealthy food all that often), so I left it out.

It was delicious.  I only ate half a box worth and made a salad to enjoy with it.  At 640 calories in a box (one "serving" has 260 calories and there are 2 1/2 servings in a box, but let's be real, who eats just one serving?) with about 1300 mg of sodium, it's not the healthiest choice.

My point is this:  Look hard enough, and I think there's a vegan version of just about everything.  And when you find those decadent foods in a vegan version, don't imagine that they are magically healthy.  When your diet is clean, a small rare splurge can be reasonable.

One last note-- this is not a paid endorsement!  If only I was important enough to get paid to promote stuff...

Challenge Me!!

Over the past three months, I've participated in challenges.  In June, I completed a push-up challenge by doing 100 push-ups daily for 30 days.  In July, it was a plank challenge, to hold a plank position for progressively longer periods of time, with a goal of a five minute plank.  I got to 4 minutes and 30 seconds.  While I didn't fully complete the challenge, 4:30 is longer than my previously longest plank by a minute.

That's me.  In a plank position.  It's a tough one to hold once you get beyond a minute and a half.

This month, I've taken on a challenge of my own, chosen by me to suit my personality.  I am meditating for ten minutes each day.  I must admit, I don't feel like I am good at meditating, but I think it will make me a better, calmer, more balanced person.

I'll challenge myself next month too.  I'm not sure what it will be yet.  Maybe a challenge not to eat after 7 pm?  For October, my tentative challenge is to do yoga every day, since my season will be done after my October 5 race at Silverman 70.3.

Challenge yourself.  Can you be stronger?  Fitter?  Eat better?  Pick a challenge, recruit a few friends, and get to it!

Nine and a half years a vegan!

Hard to believe it's been that long since March 2005, when I paced the Strong Memorial Hospital cafeteria my first night as a vegan looking for what vegan thing I could eat for dinner and settled for a peanut butter and jelly sandwich.

From my own trials and mistakes, here's what I've learned:

1) It's not just about eliminating animal products.  It's about including new foods.

It is hard to stick with something when the approach is "these are the things I cannot eat."  But rather, it should be a journey of finding what you CAN eat!  Try new foods.  Have you ever had quinoa?  Baked tofu?  Seitan (not pronounced like the devil, but rather say-TAN)?

2) Screw-ups happen

In spite of your best efforts, you are going to eat something that isn't strictly vegan.  It happens.  I was at an event a few months ago and was noshing on some delicious crackers, and after the fact I found out that one of the top ingredients, to my dismay, was milk.  Whoops.  I didn't drop dead from eating the dairy-laced crackers.  But now I know, if I see those crackers, I won't eat them again.

3) Don't sweat the small stuff

If a food has meat, dairy, or eggs in it, clearly it's out of the question.  What about "natural flavor"?  Or sugar, which is usually processed with bone char?  Or most varieties of wine, which are clarified with fish gills, unless you get organic or kosher wine?  Is that lecithin from animal or plant sources?  Was that veggie burger cooked next to a meat burger?

I'm getting a headache thinking about all these minutia.  When you drove your car today, you probably ran over a few ants and a few mosquitoes splattered on your windshield.  Get over the details or you'll drive yourself crazy.

4) It's vegan.  It's not gluten-free, oil-free, paleo, grain-free, additive-free, completely unprocessed, salt-free, strictly organic, nut-free, and so forth.

There have been a few prominent vegan bloggers who got so bogged down in eating so perfectly that their health became compromised and they decided they could no longer follow a vegan diet.  I can understand why a person with heart disease might choose Esselstyn's oil-free, nut-free diet, because it does reverse heart disease, but for most of us who don't have coronary disease we don't need to be so restrictive.

In my own diet choices, I aim for a whole-food plant-based diet.  I do eat some processed foods every so often.  Today I didn't have long for lunch, so I heated up a Tofurky Turk'y Broccoli Cheddar Pocket.  The "Cheddar" is non-dairy, of course, and the "Turk'y" wasn't made of turkeys, as you might imagine.  And every so often, for a special occasion, I may have a vegan cupcake (I love animals too much to eat a non-vegan cupcake).  Or if I'm driving through Las Vegas I will have an apple fritter from Ronald's Donuts.  I eat well most of the time, but I'm not perfect.

If my diet were perfect, I don't think I'd be very happy.

5) Don't push!!!

If you want to know why I'm vegan, I'll tell you why as simply as I can -- because I see the consequences of animal foods on peoples' health on a daily basis, and because I love animals and am horrified by how animals become food.  I will leave it at that, and if you want to know more, I"ll tell you more.  I think that if most people were aware of the details of how their slice of cheese or their chicken sandwich came to be, they would be horrified and disgusted.

I've been an influence for several people who chose veganism, and they come to that conclusion on their own, not because they were shamed or prodded.

6) Have a sense of humor

An animal rights activist once asked me, "What are your thoughts on the relationship of humans and dogs?"  I thought it was a bizarre question, and my response was that they taste delicious with ketchup and mustard.  Clearly I don't eat dog meat, as I am the proud owner of two adorable greyhounds, but the person who asked the question didn't think that was too funny.  Oh well.

Or, people make silly comments that aren't meant to be a serious dig at veganism.  And their response should be equally silly.  "You know plants have feelings?"  "Yes, I hate plants.  I'm going to murder a bunch of plants for dinner and have salad."

7) Sure!  I'll come to your birthday dinner at Morton's.

But you better come to my birthday dinner at Vinh Loi Tofu.

Any reasonable restaurant will make you a vegan meal.  It may not be the most scrumptious thing you've ever eaten, but they'll come up with something.  A chef at Morton's once made me a delicious tower of pasta and vegetables with a marinara sauce.  Another steak house brought me a plate of plain steamed vegetables and I begged for some soy sauce on the side to give them some flavor.

7) I'm vegan and proud!

There's the joke, "How do you know who the vegan in the room is?  Don't worry, she'll tell you!"  That's me. I feel great, I'm healthy, I'm a triathlete.  And I feel amazing, thanks much in part to how I eat.

Vineman 70.3 Race Report

I raced Vineman 70.3 this past Sunday, 3 days ago.

I came into the race with high expectations.  At St George 70.3 in May, I had the race of my life.  In spite of a run fitness that was sub-par due to a foot fracture just 5 months before the race, I finished my fastest 70.3 by 18 minutes on a hot 90+ degree day and a very hilly course.

While St. George proved I am quite good at riding hills, my speed on the flats needed improvement.  So, in the 2 months leading up to Vineman, my coach gave me bike workouts that were on flats with 10-20 minute bursts of zone 3-4 riding, pushing the pace for those intervals to make me a faster cyclist.  And I was fairly consistent in doing weekly track workouts to bring my run back up to where it had been before I broke my foot in December.

On race day, I gave myself a goal time of 5:40.  That would be by far my fastest 70.3 if I could do it.  Breaking it down, that's a 38 ninute swim, 2:55 bike, and 2:00 run, with about 4-5 minutes for each transition.

Swim
I had a side bet with one of my teammates that involved a shot of tequila, so I had extra incentive to swim fast.  It wasn't a very crowded swim, and I eased into the out-and-back without difficulty.  The Russian River was quite shallow, more so than usual in the current drought in California, but even in two feet of water, I continued to swim, and not stand up.  Standing up would have slowed me down.  It was an odd feeling as my hand would hit the bottom of the lake on several strokes. That said, a couple people who were dolphin-diving, in other words, standing up, diving, standing up again, and so forth, passed me.

Swim time:  38:31.  My fastest swim time ever.  My teammate with whom I made a bet: 38:04.  For both of us, a personal best, so I will gladly do a shot of tequila to celebrate both of our successes.

I had a heck of a time pulling my arms out of my wetsuit.  Next time I swim in open water, I think I'm going to put BodyGlide on my wrists and see if that helps to pull the wetsuit off.

Bike
The bike portion of my race fell apart at a few places.  Coming out of the first transition, my bike front wheel didn't seem to be moving very well.  Instead of immediately mounting my bike, I pulled off to the side to take a quick look and make sure nothing serious mechanically was wrong with it.  Fortunately, it was just some mud, and in the first several hundred feet the mud came off my front tire.  Then between miles 8 and 12, my bike tool kit, which contains spare tubes, tire levers CO2, etc, fell off my bike not once but TWICE, requiring me to pull off the course, dismount my bike, get the components that had flown onto the road, and pack in back up.  Ultimately, I threw the loose components into my pockets, and fortunately without the CO2 cartridges jostling around the kit stayed in place.  Then my chain came off around mile 24 and I dismounted the bike again and quickly put the chain back on.

My hydration was a bottle of half coconut water and half water (the other bottle fell off the bike), and about half of another water bottle.  So, over 56 miles, I only drank about 30 ounces, probably not enough.  The rest of my nutrition consisted of medjool dates that I packed from home and the Bonk Breaker bars on the course.

In spite of these various nuisances, and two bathroom breaks, I averaged 18.3 miles per hour over the 56 miles, for a time of 3:03, a little slower than my goal of 2:55, but still okay.

Run
I felt amazing starting the run!  Temperatures were still moderate, and the first two miles were each run in about 8:20 apiece.  My strategy, which I stuck to, was to walk through the aid stations, drinking at each station, and run everything else, including hills.  I knew that I hadn't drank enough on the bike, so I had to be sure to drink the electrolyte solution, which was Ironman Perform.  It's not my favorite tasting drink, but it's effective.

Then the heat hit, and my pace slowed.  By mile 10, my legs felt heavy and it took everything in me just to keep running.  Around mile 11, I decided to stop looking at my watch because I was so fed up.  What was wrong -- not enough hydration?  Was yesterday's delicious vegan scone a bad idea?  Was I on my feet too much yesterday?  While I felt like I had come to a crawl, my run averaged out at 9:21 per mile, with a time of 2:02, only two minutes off from my goal.

The grand finish
I finished in 5:54.  That was a bit off from my goal, but three years ago I did this race in cooler conditions and finished in 6:27.  So, I had my personal best on this course by 33 minutes, and my personal best at the 70.3 distance by 15 minutes.  At 35 out of 137 women in my age group, I placed in the top quartile.

My amazing teammates and friends.

Lessons Learned
--Secure the flat kit.  Really really secure it tightly.
--Hydrate better on the bike
--Get the wetsuit off faster!!!  BodyGlide on wrists before the swim?
I think that's it.  For the most part, a well-executed race on a hot day.

Why Steady-State Cardio is NOT Where It's At!

The other day, a young woman I know was lamenting that she has lost weight, but can't seem to get her abs to look more toned.

She's made great changes to her life, has lost 30 pounds in a year, and exercises regularly.

What's her exercise routine?  30 minutes on an elliptical trainer, followed by lifting weights.

My first thought -- how boring!  I'm not a big fan of cardio machines.  But, worse yet, 30 minutes of moderate intensity cardiovascular exercise isn't going to help you bust through a plateau.

This is what is referred to as "steady state cardio".  Getting on a machine, doing some low-to-moderate intensity exercise for a set period of time, without breaking much of a sweat.  True, it's exercise, but it's completely ineffective at reshaping your body or helping you to lose weight, especially if you're at a plateau.

To make change, you need bursts of intensity.  Moving from exercise to exercise.  Challenging yourself.  For example, running, then doing some burpees, then push-ups, then frog-jumps, then star-jacks, then some dips, then squats...... I'm tired out just writing these exercises, let alone doing them.

For me, I have two of these types of workouts in my weekly regimen, in addition to challenging track, cycling, and swim workouts.  While you can do something like this on your own, I always find it more fun, and more challenging, to do a challenging workout like this with a group.

My favorites:

Fitamorphosis -- www.fitamorphosis.com -- Corey Enman's fat-burning inferno, voted the best bootcamp in Burbank

Barry's Boot Camp -- www.barrysbootcamp.com

Push-Up Challenge

Do you challenge yourself?  If you want to get fitter or stronger, you definitely should.  Several of my teammates from Fortius Racing Team and I have taken on a 100 push-up challenge per day each day for the month of June.

It's been an interesting experience.  On the first day, I struggled to get the 100 pushups done, 14 here, 10 there, then 5, then 5, then 5, and finally they were done and my arms and chest hurt!!!

A week into it, and I've gotten stronger and a bit more creative.  Here I am stopped on my bike ride yesterday doing some push-ups.

And on Friday, I did a few after my swim in the ocean:

Even after a week, I feel stronger.  Today as I got out of the pool in the deep end, I was able to do a full "deck-up", whereby I use both hands on the pool ledge to pull myself straight out of the pool.  No leaning on a forearm, no ladder, no lurching my belly onto the pool deck.  I pushed myself straight out of the pool.

By the end of the month, I will have done 3,000 push-ups.

Stuff Vegans Ask Me, Part Two

I've got some really motivated patients who have survived heart attacks or have had angioplasties.  They listen when I encourage them toward a plant-based diet, they read Esselstyn's book Prevent and Reverse Heart Disease, they read Ornish's books, Mcdougall, Fuhrman, and so on.  And then they make changes -- go plant-based, cut out the oil and the animal products, and learn to love things like kale and quinoa.

And then they ask -- I'm eating perfectly.  Do I need a statin?

Great question.  I'm a big advocate of less being more when it comes to medications, cutting down medication to the bare minimum.

Studies have been done on secondary prevention, that demonstrate that statins reduce risk of recurrent heart attack and can decrease plaque burden in the arteries.  That said, so do whole-food plant-based vegan diets.  So if you're on a vegan diet, do you need a statin too?

There will never be a study randomizing vegans to a statin or no statin -- it would simply be unethical.  My recommendation is, statins are pretty benign medications.  Most people tolerate them.  I recommend that all patients with coronary artery disease and peripheral vascular disease, regardless of diet, take a statin.  A statin has very little chance of causing harm, almost no chance of causing permanent harm, and yet may have benefit.

Motivation

It's hard to start an exercise habit.  Some people assume that regular exercisers wake up every morning eager to take on their workouts.

But that's not true.  More times than I can count, I wake up grumpy, wanting to roll over and go back to bed.  However, I still complete my planned workout, most of the time.  Why?

1) I know where I started.

That's me in 2005.  There have been many early mornings and long workouts between then and now that have gotten me to where I am today.

2) I know what I've accomplished.

Were it not for those 5 am wake-ups, or the cold evenings in the pool, I would not have accomplished what I have done.  I would not have earned a bronze medal at the Maccabiah Games in Israel last summer.  I would not have been able to complete Malibu 7 Canyons or Mulholland Challenge without the spin classes and long training rides.  Nor would I have had an awesome performance at Ironman St. George 70.3 a few weeks ago.

3) This guy will be pissed.

That's my coach, Gerardo Barrios of Fortius Racing.  He gives me a training schedule and helps me set goals.  If I don't do what's asked of me, I won't achieve those goals.

4) I won't see these guys.

These are my teammates, and my friends.  It's fun to see them.  If I sleep through a pool workout, they'll be asking me later where I was.

5) I feel awesome later.  My morning workout gives me energy for my day.  Without it, I just don't feel as good.

What's your motivation?  It's not always easy to go out and get in that workout.  But find what motivates you.

St George 70.3. Maybe I was ready after all?

I knew I had been doing lots of cycling since my foot fracture.  But I hadn't done much running.  I had about a half dozen runs longer than an hour over the past couple months, nothing longer than 9 miles.

My expectation for this race:  Normal swim, something in the 39-40 minute range, a good bike since that's what I've been doing so much of, and a lackluster at best run.  Also, I know there's going to be a high of 95 degrees, with no shade on the course.  So it's going to be a tough day.

 Some of my teammates before the start of the race.

Swim -- Was THAT The Gun?
With three minutes until the start, we amble into the lake and start to swim toward the start line, which is several hundred feet away.  It's cold by my standards, at 60 degrees, but with a steady supply of nervousness, that coldness isn't noticeable.  We're a few hundred feet from the start line when we hear a gun go off.  The woman next to me and I look at each other puzzled, and then we hear, "The 35-39 year-old women are off!", and we frantically realize we missed our start gun and start swimming.
I was hoping to finish in 38 minutes, but with the late start, it turned out to be more like 41 minutes.

Bike -- let's do this!!!
Now here's my strength at this point.  I've done three insanely hilly rides, the Malibu 7 Canyons Century, L'Etaupe with four loops of the Rock Store climb, and the Mulholland Challenge 120.  So I knew that this would be my strongest leg, and my running isn't up to where it was before my fracture, so I knew to go hard on the bike.  But, I knew not to go too hard, because I needed to have some gas left in me for the run portion of the race.  I passed people while climbing hills, maybe about 60 or so people going up Snow Canyon, the long climb of the bike course, but on flats and downhills plenty of people passed me.  I projected that  I would finish the 56-mile bike ride in 3 hours 30 minutes.  My actual time:  3:09.  Disbelief.  Wow.

Run
So there in the picture above, at the start of the run, I'm yelling to my coach, I can't believe how fast I just did that bike?!  Given my lack of recent run training, and the 90+ degree heat and lack of shade, I started conservatively.  I knew I would run the course, walking the length of the aid stations, and if truly necessary on an uphill, I would walk.  But, I didn't need to walk.  I reminded myself, what I lacked in running over the past few months, I had in my years of endurance training.  I am an endurance mule.  Drink, stay hydrated, keep jogging.

The out-and-back nature of the course was pretty awesome for seeing teammates and cheering them on.

A funny thing happened on the run -- I felt good.  I was keeping pace, felt no need to walk other than the aid stations.  And at no point did I feel that awful exhausted when will this horrible thing end feeling?  Did I not push hard enough?

That run that I projected would take me 2 hours and 30 minutes?  2:08.

Overall time -- 6:09.  Oddly, my fastest 70.3 time ever, on the toughest course and the hottest day.  I'm elated.

That means that Vineman 70.3 and Silverman 70.3 will hopefully be under 6 hours.  That's going to be my goal.

Pass the Fried Chicken, I'm on Lipitor!

It is true that statins have been shown in randomized controlled trials to reduce the risk of a first cardiovascular event.  The number of patients needed to treat to prevent one event is relatively high, as I have previously discussed, but it is true that there can be a role for statins in primary prevention.

The problem is that the real world doesn't function like a clinical trial.  People who are on a statin know that they are taking a medication with the purpose of lowering their cholesterol.  An important question that I've wondered is, how much does knowing that one is taking a statin affect behavior?

Anecdotally, I can tell you I've had conversations with patients in which they have rationalized less than ideal diet choices by stating that they are taking a cholesterol-lowering statin.  Or more blatantly, the person who goes out for a decadent dinner and then doubles up on his statin dose.

Source:  kevinmd.com

There is a study that was published in JAMA Internal Medicine this week on that subject.  This was a retrospective study looking at the caloric intake of statin users and statin non-users.  The study found that statin users increased their caloric intake by 9.6% and fat intake by 14.4% over the course of the ten year period studied, while non-users had no significant change in caloric or fat intake over that time.  Further, the statin users' body mass index (BMI) increased by 1.2 kg/m2 during that time, while the non-users BMI increased by only 0.4.

So, the increased calorie and fat intake and weight gain of a statin user may negate much of the beneficial effect of the statin medication.

What's a clinician to do?  I think it's important that we make sure our patients realize that a statin medication is not a carte blanche to eat whatever and however much they want.  But I think we also need to be judicious in choosing who we put on a statin as well, and make sure that their risk is appropriate to justify the statin prescription.

Passover Seder 2014

I hosted my fourth annual seder at my home with nearly 30 guests, including my four nieces.  This is why I open my home to family and friends for the holiday.

This year I used a different hagaddah, 30 Minute Seder -- The Hagaddah that Blends Brevity with Tradition.  The author of this hagaddah is a genius -- everything you need in a seder, including some songs, and a minimal amount of Hebrew, is included.  The story of Passover is told in a clear manner, unlike those archaic Manischewitz hagaddahs that many of us grew up with.

We ate well.  Hors d'oeuvres consisted of mock chopped liver and a Sabra eggplant spread and a beet salad with cut-up veggies for dipping.

I served a matzo ball soup from Nava Atlas.  The matzo balls were kitniyot-free, made from matzo meal and quinoa flakes, and were baked instead of boiled in water.  I would love to find nice fluffy matzo ball recipe that is kitniyot-free.  These were smaller, perhaps a bit more solid than a traditional matzo ball, but nonetheless good.

My newest dish for the holiday was a spinach, leek, and potato matzo gratin from Nava Atlas.  I added in some kale in addition to the spinach, and I did not add the Daiya vegan cheese since I thought the dish was already creamy enough.

From previous years, I also served a quinoa with pine nuts and dried cranberries, eggplant casserole, and a carrot apple sweet potato kugel. 

We had a chocolate matzo loaf and some delicious fruit and an apple-date mousse for dessert.

Here's an index of previous years of Passover seders and recipes.

Adventures in Cycling - A DOUBLE Race Report

When I fractured my foot back in December, I knew I wouldn't be able to do the marathons I had been training for.  So my goals had to change. 

I always looked in awe upon my teammates, particularly my female teammates, who were participating in challenging bike rides, things like the Mulholland Challenge and Furnace Creek 508.  And, I've always been a slightly weaker cyclist compared to my abilities in swimming and running, with the excuse that I have long legs and they're just not very good levers.

So, in those six weeks in an orthopedic boot, I'd go to spin classes 3-4 times a week, and sometimes two spin classes back-to-back.  I'd put my good foot in a stirrup and the booted foot on top of the other pedal.  I got some interesting reactions, a few double takes, a few spin instructors who thought I was "badass", and one who thought I was simply out of my mind and threw me out of her class out of fear that my spinning in an orthopedic boot was unsafe.

As I spun, and swam, I decided on a new goal -- complete some of those challenging rides that my fearless teammates had accomplished.  I signed up for Malibu 7 Canyons Century on March 15 and Mulholland Challenge 120 on April 12.

When the orthopedic boot came off, and I was riding with my teammates, I realized that I've become a stronger climber on the bike.  And I continued training, but now outdoors, with up to six hour training rides scheduled.  Some of the long rides were done while on call, hours of loops around Griffith Park, or up and down Laurel Canyon and Rinaldi Street by Holy Cross Hospital.  But the training rides got done, for the most part.

Malibu 7 Canyons
Imagine this -- come up with a hundred mile ride with the steepest climbs in the Santa Monica Mountains -- Decker Canyon, Deer Creek, Latigo, Portrero, Westlake Blvd.  Then add in the gnarliest descent with the worst condition roads (Yerba Buena), and have riders come down that descent TWICE.  Add in unstocked and unprepared aid stations on an 80+ degree day, no refreshments at the end, and no t-shirts as promised with entry.  That was the Malibu 7 Canyons Century.

That was the hardest ride of my life.  I was barely turning my legs toward the top of Deer Creek, and on parts of Portrero (mile 70) and Westlake Blvd (mile 85), I got off my bike and walked some of the 17-21% grade climbs.  Highlights of the ride included meeting other local cyclists around mile 55 and joining a pace line of about ten strangers on flat roads as we headed down PCH and Las Posas to our next climb.  Nine hours and forty-nine minutes later, I finished, sore, exhausted, and tired out.

L'Etape du California
I hadn't planned on doing this ride, as it falls a week before the Mulholland Challenge 120 ride.  But, as part of my weekend training before the race, I had done four trips up the Rock Store climb, and seeing several of my teammates sign up, I thought I'd give in to peer pressure and give this race a try.

L'Etape is the eighth stage of the Tour Of California cycling race.  The pro cyclists will be doing this same course in May, so this was an awesome opportunity to ride what the pros will ride.  The race consists of four loops, starting at the Hyatt in Westlake Village, heading east on Agoura Road, south on Cornell, then west on Mulholland, including the Rock Store climb, and then north on Westlake Blvd.

The Rock Store climb is a famous climb for cyclists.  It's about 2.5 miles with an average incline of about 7%, with plenty of twists and turns and beautiful views.  The climb gets its name from the Rock Store restaurant and bar which is at the base of the climb, a joint frequented by motorcyclists.

Results for the ride were based on combined times on all four Rock Store climbs.  I had no plan to win, just to see how fast I could get up that hill.

That's my team -- Fortius Racing!

Climb #1 up Rock Store felt pretty good.  I pushed a little harder on the second climb.  On the third climb, I felt a little bit more challenged.  And somewhere halfway through the fourth climb up Rock Store, I just wanted it to be over, my legs were tired.

That's me at the beginning of the second loop, having only been up Rock Store once.  My fuel for this ride consisted of coconut water mixed with equal parts tap water, bananas, orange slices, dates, a baked sweet potato, and peanut butter and jelly.  I've noticed I feel better fueling with real food as opposed to the more artificial gels, bars, blocks, and the like.

I enjoyed seeing my teammates on this ride, including my boyfriend Joel, who I did much of this ride with, though he sped away from me on the flats and I caught him on the climbs.

Obligatory selfie at the top of the Rock Store climb.

This was a challenging ride, certainly not as painful as M7C.  While my fingers were frozen and numb in the first eight miles of the ride, by the third loop I needed ice in my water bottles to keep from overheating.  The last half of this ride was easily 80+ degrees, and I was mindful to keep drinking water and consuming fruit for electrolytes once my coconut water was done (the H3O drink on the course simply wasn't palatable to me). 

Eighty-two miles later, it felt good to be done.

And the shocker -- I won my age group, women 30-39, for the fastest combined time for climbing Rock Store!

I couldn't be happier.  It's good to see my efforts on the bike over the past few months pay off.  And I feel confident heading into Mulholland Challenge 120.