Vegan Heart Doc

Really, Paula Deen?

2012-01-22T14:19:00.000-08:00

One of the most decadent chefs of the Food Network has recently announced that she's had diabetes for three years.

If you go to her web site, she talks about how she'd like to help her fans see "Diabetes in a new light." Click on that link and it takes you to an advertisement for Victoza, the new diabetes drug that she is endorsing.

It's like me putting a cigarette vending machine and a hamburger stand in my waiting room, and then subsequently doing angioplasties on those patients. But then again, unlike Paula Deen, I took the Hippocratic Oath to "Do No Harm".

When interviewed by Al Roker last week, she claimed, “Here’s the thing, you know, I’ve always encouraged moderation,” But seriously, since when is a hamburger inside of a glazed donut moderation? And does someone who proclaims that she can't live without butter or a deep fryer have the right to say she encourages moderation?

This is moderation?

from http://todayhealth.today.msnbc.msn.com/_news/2012/01/16/10170320-did-paula-deens-diet-cause-her-diabetes

"Moderation" is about the biggest cop-out there is. Who can't legitimately claim they eat "in moderation"? Compared to a stick of butter or a tub of lard at each meal, anything is moderation.

What do you do if you're a chef who has earned her reputation as providing recipes for decadent food, and you yourself end up succumbing to one of the diseases that results from eating that food? I don't know, but signing an endorsement deal with a medicine to treat type 2 diabetes is not the ethical answer to that question.

Devil in a Black Can

2012-01-15T16:30:00.000-08:00

In my daily living, my habits are good. I eat my veggies. I exercise. I don't smoke. I manage my stress.

And yet, I was polishing off 4 or more cans of diet soda every day. I wrote about my Coke Zero Habit a year ago, a habit that I've only had for a few years.

After my morning workout, I would crave soda. Then midway through my morning clinic. Then midway through afternoon clinic. And then with dinner. And then if I went out at night, another Coke Zero or Diet Coke.

It was all getting to be a bit much.

There are many reasons to stay away from it. Diet soda may increase cardiovascular risk, it is acidic which is not good for the body or for an athlete who is training, it has no nutritional benefits, it can leech the bones of calcium, it deceives the body into thinking that it wants to eat more calories than it should, and as someone who has an annoying condition called interstitial cystitis it irritates the bladder and increases frequency of urination.

I thought back to seven years ago when I went vegan. My last holdout was my love of chocolate brownies. Once I realized how silly that was, I ditched dairy and eggs and never went back. (In the meantime, I have perfected my own decadent vegan chocolate brownie recipe.)

On New Years Day, I decided to do it, to give up diet soda.

That first day was tough! I came home from a morning bike ride, and I wanted that black can!!! I loved the fizz, the taste, the way it gave me energy. All I could do to keep craving that can was to leave the house and go to yoga class.

And somehow, after yoga, I felt calm. I didn't need the soda.

The next few days were tough. I went back to work on January 3, and instead of my soda can, I brought a small thermos of mango tea. That actually got me through my morning fine.

And on January 4th, there was one can left in my refrigerator. I posted this picture on my Facebook page, with the caption, "Honey I miss you xoxoxo".

And here we are, on January 15. No diet sodas for me since the new year. And I feel good. No more ups and downs in my energy level. I don't have to use the restroom as often since I'm drinking less caffeine.

I think I've kicked the habit for good. And I think I can stick with my no-soda lifestyle.

Boney Mountain Half Marathon

2012-01-08T16:34:00.000-08:00

Today, I ran my first trail race, the Boney Mountain Half Marathon

I chose this event at the suggestion of Coach Gerardo. I wouldn't have decided on my own to do a trail race. My goal is to be a faster runner and eventually qualify for the Boston Marathon. When planning my season of races, Coach G told me that by doing trail running that I will become a faster road runner. So, while I feel a bit like Ralph Macchio's character in "The Karate Kid" blindly doing his wax-on wax-off drills at the behest of Mr. Miyagi to become a karate champ, here I am stumbling along trails to become a faster marathoner.

And sadly, stumbling is not an exaggeration. I am not terribly coordinated., which has led to a number of spills while running trails. This is why, in spite of my height at 5 feet 10 inches, I am not a skilled volleyball or basketball player. In fact, were it not for the coordination that I acquired during my four years as a high-school cheerleader, I likely would not be able to walk and chew gum to this day.

On Wednesday morning, I took not one, but two, spills on Dirt Mulholland and the single track trails nearby., leading to a bruised chin, scraped up palms, a chunk of skin sliced off the tip of my right pinky finger, skinned knees, and a scraped up and bruised left thigh.

So, I approached today's race at Boney Mountain with some trepidation and yet with the advice of many trail-running teammates about how much I will love running trails, how much easier it is on the knees and joints, and all the beautiful scenery.

As I told people that this was my first trail race ever, I got a lot of reactions of, "You picked this one???" If I'm going to tackle trails, I might as well do one of the toughest trail half marathons out there. Go big or go home, right?

The gun went off shortly after 8 am. Dressed in a tank top, hat, trail shoes, and most importantly, running pants to protect my knees, I took off with the crowd. The first mile was on pavement, and was mostly downhill. The second mile had a few rollers, and about that time we had some single track trails. This means that you can't pass. You're as fast as the person in front of you, unless he or she lets you pass.

Then at mile 3, we had our first real climb, which was about a mile long. I held back -- I could have gone faster, but for a first trail race, and more importantly so that I didn't trip and fall, I didn't go too fast. So, for much of that climb I was walking. And then there was a nice downhill from there. A lot of people passed me. I was cool with that.

What I liked about this race is that people are friendly. They aren't competitive. It's like we're all out there to conquer the mountain as one big happy family of trail runners.

I would say that the race really began at mile 6, with four miles of a steady incline, over 1300 feet of climbing. To those of you who don't run trails, the best analogy I can think of is Masada in Israel. While on vacation, I'm the one who went ahead of my group, ran to the top of the mountain, turned around and ran halfway down, then ran back up, while others in my tour group struggled to just get to the top. Imagine three Masadas stacked back to back to back. That is what miles 6-10 of this course was.

Again, I walked much of this, trying to be conservative. A few people passed me, and toward the top, I passed a couple of them. Those four miles of climbing were tough. But, I felt okay. I felt like I was exerting myself, but didn't feel like I was suffering. Maybe that means I could have pushed harder, sure, but it means I didn't push too hard.

At mile 10, we started to descend. Now, I'm not that confident about my footing on trails, so I let plenty of people run by me. My right iliotibial band, just above my knee, started to ache, but I was able to run through that. Around mile 11.5, I tripped, landed on my hands and knees, and without missing a beat pushed myself up from the ground and kept on running. I knew I likely scraped up my right knee, but I ignored it and pressed onward.

At mile 12, there was a little hill. I ran about half of it. And then the last 3/4 mile was flat to downhill. As we made the last turn toward the finish with about 1/2 of a mile to go, I was hit with a headwind that must have been 40 mph. Whoa! But, I pushed through it, running for the finish line, where my friends and teammates greeted me.

That's me slapping a high-five to teammate Chris Fisher, who had finished so much before me that he had time to change clothes and come back to cheer us on. Bodie Olmos and Mark Shainman were also waiting at the finish line.

Finish time: 2:42. Well ahead of my goal of 3 hours.

Me and teammate Alison Chavez, who is far more experienced in trail running, and had run 11 miles of trails the day before the race.

I stopped at first aid and had the cut on my right knee irrigated. It should heal okay, it's not too bad. A teammate decided to take a picture of my booboo, but I will spare you and won't post it here.

Overall, a good experience. I need to gain more confidence on trails, which may lead to me taking fewer falls.

Happy New Year!

2011-12-31T17:42:00.000-08:00

I hang my head in shame.... it's been a month since my last post!

I'm on a little break from work, and will be back on January 3. In the meantime, I'm relaxing, spending time with family, and doing some fun workouts.

With my extra time, I had the chance to try out Barry's Bootcamp. It's a challenging aerobic workout that mixes in bursts of cardiovascular exercise with weight training. Try it!

Happy new year!!!!

Not a Great Day at the Santa Barbara Marathon

2011-11-28T20:50:00.000-08:00

My first question to the organizers of the Santa Barbara Marathon: Where's my shirt??? You ran out of shirts, and your volunteers asked me for my name, bib number, and t-shirt size, and said it would be coming in the mail. It hasn't. Size medium in women's, please. Thank you.

I was ready. Or, better yet, I was ready to run the Santa Clarita Marathon the week earlier, but I ended up sick and missed it. So I was still sort-of ready.

I signed up for the Santa Barbara Marathon three days before the event, knowing that I wanted to do a race with the fitness I had accumulated from months of marathon training. Hence the high bib number of 1348, not otherwise accounted for by my name being at the end of the alphabet, and no name on my bib either.

Luckily, my friend Lenny was going to be running the half marathon, so I had a travel companion.

I stayed at a chain hotel in Carpinteria, the closest hotel that I could get to the race parking area, about 20 miles away. The hotels were all booked up with race participants and the two hundred or so weddings taking place in the greater Santa Barbara area that weekend. So I was stuck at said unfancy chain motel. Cars on the freeway kept waking me throughout the night. So, I wasn't terribly well rested.

On race morning, I parked at UCSB, then took a shuttle to Dos Pueblos High School, which is where the marathon started. Unfortunately, the buses dropped us off a half of a mile away, which is a minor annoyance when you are running, oh, another 26.2 miles later that day.

Someone must have been reading the comments about the race because contrary to previous complaints of lack of facilities, there were more than enough port-o-potties, an important matter for someone like me who likes to empty her bladder three or four times before the start of the race.

With only eight hundred or so of us running the race, it felt a little silly to line up under a "Start" banner. Nonetheless, off we went, to run a 9-mile loop around Goleta. Boring. Completely boring. The first few miles were a slight downhill, then a slight uphill for the next few miles. At mile nine, we pass the high school again, and I'm thinking, have I really gone anywhere? I wasn't feeling terrific, perhaps a bit tired, and I was struggling to keep my mile splits at 9:30 per mile, which was my goal. I was worried because my heart rate was staying in the high 160's, which I knew for me was a bit high.

Around mile 8 was a photographer. I'm not sure what came over me, but I decided I needed an interesting race photo of me with my arms stretched out and my tongue sticking out.

In spite of not feeling awesome, I figured I'd stay the course. Miles 10-12 felt like I was moving downhill, and after downing a Gu gel or two I felt a second wind. I enjoyed all the locals standing out on the roads cheering us on. I smiled and thanked them of course. I was annoyed by the guy on a mountain bike who passed me within just a few inches, to then ride next to his girlfriend (presumably) for the next three miles, passing her food and water. Granted, this girl wasn't going to win anything, and neither was I, but seriously, if we want food or water when we want it, we have to carry it with us, and I didn't want any near misses with this guy's stupid mountain bike crashing into me.

So perhaps my annoyance with Mountain Bike Guy was a bit over the top. I may have been getting cranky because I was feeling tired and lousy.

The "wall" came around mile 16. My mile splits had dropped off and I decided from then on that any time goal was out the window and I was going to ignore my Garmin. The goal at this point was to put one foot in front of the other and run the rest of this race, avoiding the temptation to walk, and just get this 26.2 miles done.

The next 7 miles were no fun. The scenery continued to be uninteresting for the most part. And I maintained my fatigued shuffle of a jog, walking only through aid stations. Then at mile 23 was a huge hill, which I managed to run up, or more accurately shuffle up at a whopping pace of 15 minutes per mile. But the reward at the top of the hill was what a marathon based in Santa Barbara should be -- a nice view!!!! The ocean!!!! Finally!!!

I think the next couple miles were downhill, and were kind of pretty since we could see the ocean. I slugged through, and finished as strong as I could. One benefit of doing all these races is that I know a couple of the local race announcers through the LA Tri Club. Tim Bomba was announcing finishers, and typically he'll give me a shout out, which is kind of cool, "Here comes Heather Shenkman, of LA Tri Club, cardiologist, so if you want your heart checked...." or something like that. It's good to hear when you feel like crap, completely spent, and need an extra push to get across the finish line.

My finish time: 4:27 and a few seconds that actually put me closer to 4:28. But let's round down and call it 4:27. I feel better about that.

I believe that under better circumstances, I could have pulled a 4:05. So what happened? I have learned to never take a trans-continental trip within the weeks before a marathon. I think that led to me getting sick And I can't say I was completely recovered, even if it was a week later. There was an extra week of taper and being sedentary, which may have helped an extra pound or two creep onto my frame. The peak of my training was too far in advance of this race. And then there was the noisy freeway in front of my motel.

I've learned my lessons, and I will continue on in my quest to become a faster marathon runner. My next full marathon is the LA Marathon in March. I have two half marathons in the meantime.

My suggestions to the people who run the Santa Barbara Marathon:
-Please make the course more interesting. Goleta is beyond dull to run through. Last I checked you have an ocean nearby. Can we maybe run near that instead?
-Your volunteers are enthusiastic, along with the locals. They couldn't have been nicer.
-Thanks for ample port-o-potties. Really.
-More aid stations with Gu and food. And how about some banana or orange slices at aid stations?
-More food at the finish line. No, I don't mean places where we can spend money and buy lunch. I mean, more than just orange and banana slices. How about granola bars, fruit salad, something a bit more filling so we don't have to binge on food from the vendors giving out free samples? Note to Pure Bar people -- thank you for letting me take 4 bars. They were awesome. I'm sold on them.
-Please send me my t-shirt, women's medium. And that's how I'll start and end.

IronDoc Reporting for Duty!

2011-11-25T19:32:00.000-08:00

I went to another Ironman race. But, this time, unlike in July 2010, I came as a volunteer, not as a participant.

Several members of my Fortius team were racing at Ironman Arizona this weekend. Twenty-five of us (!) came along to support. It's a cheap, quick flight from Los Angeles, I was excited to support my team, and it's always been my dream to work in the medical tent for an event like this.

From 10 am - 3 pm, my team worked at the Bike Special Needs station. Because the race consists of a 112-mile bike ride, many participants might want to have their own special items available, like a specific bottle of sports drink, a sandwich, a spare bike tube, and so forth. Our whole Fortius volunteer crew -- all 25 or so of us, stood out on Beeline Highway, yelling out race numbers and handing off bags. Overall, people were grateful (except for one athlete who chose to yell at us for not having his bag available immediately as he whizzed by at 20+ miles per hour).

That's me and my teammate Nikki holding an athlete's bag while he finds exactly what he needs. It's a great feeling to help an athlete during a tough race like this.

For more about the Bike Special Needs volunteer experience, I refer you to my teammate Ryan "the Ironmadman" Schneider's terrific blog.

Following our five hours at Bike Special Needs, I spent a couple hours sitting and relaxing by Tempe Town Lake catching up with an old friend who lives in Arizona while cheering for athletes running by. Some looked strong, some looked a bit tired, and others appeared completely ragged. I yelled as loud as I could for my friends who were racing, and yelled for many strangers. I think they all appreciated the encouragement; I know that I did when I raced Ironman Lake Placid last summer.

Later in the day, I volunteered in the medical tent. This was a very different experience from what I ever imagined.

The tent was basic -- multiple folding chaiselounges covered in white sheets, with IV poles nearby. In the middle of the tent was a table covered with basic medical equipment -- IV fluid bags, band aids, stethoscopes, blood pressure cuffs, ibuprofen, acetaminophen, and aspirin. There was no cardiac monitoring equipment, no anti-nausea medications, no I-Stat machine to check electrolytes. Just the basics.

Our volunteer team consisted of all sorts. There was a crew of nurses from one of the local ER's, a paramedic instructor who loved putting in IV's, a smattering of other medical professionals, a very eager aspiring medical student, and a couple of physicians. I worked alongside a pediatrician, a family practice doc, and a physicians assistant.

I saw a lot of dehydrated athletes. He or she would come in, propped up by 1 or 2 volunteers, eyes glazed over, pale. We would obtain vital signs. Then I'd wander over and introduce myself, "I'm Heather, I'm one of the doctors" (no need for formalities in this setting). I'd see if they could drink -- broth, Ironman Perform electrolyte drink (which they had been drinking all day long during the race and most laughed if I suggested it), or water. If they couldn't drink, they'd get an IV. We'd give up to a liter of normal saline. If, after that, they were vomiting, or unable to tolerate oral liquids, or if they had been in the tent for over 20 minutes, they were sent via ambulance to the hospital. In my six hours in the medical tent, I sent three athletes to the hospital.

There are some tough people who race the Ironman. I think some are too tough for their own good. One woman, in her late 40's, raced with a stress fracture and some sort of gastrointestinal issue that was requiring an endoscopy the following week. She was badly dehydrated, and teammates who saw her cross the finish line hunched over looking like she was in terrible pain. She was racing against the instructions of all of her physicians, and I think she got her Kona slot, but at what cost of tearing apart her body.

Another man, a physician in his 60's, with multiple medical issues including a recent prolonged hospitalization, also raced. He finished spectacularly, I believe in under 12 hours based on his arrival time in the medical tent. After a liter of IV fluid, he was doing fine, but should he really have raced that day?

One woman received a liter of fluids and still couldn't keep any liquid down. I gave her an hour to perk up and then told her we needed to send her to the hospital. At her request, I went outside to update her husband, who told me that she ended up in the ER dehydrated after last year's Ironman. What???? If you do something once and you end up in a hospital, should you do it again???

The Ironman is a grueling race, based on the distance covered in one day. I finished my race last year with a severe tendinitis that kept me from running for two months. That was nothing compared to some of the stuff I saw during my day in Arizona. This is an event where one third of all participants require medical attention in one way or another, only 95% finish, and about 100 athletes end up in the hospital.

Is the human body meant to do this? In addition to the oxidative stress placed on the body from the hours of training and the long race day, there is such a huge potential for injury and illness.

I've sworn in the past that I would never do another Ironman. However, a part of me has always wondered, if I'm more fit now, could I blow away my finishing time of 14 hours and 45 minutes? I could. But, I don't want to destroy my body to do it. Watching the race has definitely changed my perception.

It's a Messed-Up, Unhealthy World

2011-11-11T15:48:00.000-08:00

Americans are fatter than ever. Nearly a third are obese, and two thirds are overweight. Michelle Obama leads a campaign against obesity. And yet, the same US government has funded Domino's Pizza to produce a pizza with 40% more cheese, of which one slice has two-thirds of the limit of artery-clogging saturated fat as a person should consume in an entire day. And you can bet that slice of pizza is loaded with sodium, leading to elevated blood pressure and increased risk of heart attack and stroke.

You'd think we would feed our kids healthy meals in school? And yet, the National School Lunch Program meals are laden with animal fat and fried foods. A third of kids are overweight and obese, and half of all children between the ages of 2 and 15 have fatty streaks in their arteries. Often, the meals that a child gets in school are the only meals that he or she eats in an entire day.

And, being busier than ever, Americans are eating more food outside the home than ever. In one fast food meal, there may be more than a day's worth of blood-pressure raising sodium and a huge quantity of artery-clogging trans and saturated fats.

There's a big lack of physical activity, which leads to health problems. Only half of Americans exercise regularly, and the definition of "regular exercise" is a pathetic three sessions per week of thirty minutes of exercise.

And then, as a result of being heavy and eating all this junk and not exercising, our patients come in and they're obese, and their blood pressure is high, and their cholesterol is too high. What do most doctors do? Do we ask what our patients are eating? Do we ask if they're exercising?

No, usually we don't. We look at the unfit, overweight specimen in front of us and we assume, often incorrectly, that this person is set in his ways, that he doesn't have the capacity to change. We as doctors might even have the same physique as our unfit patient.

We reach for that magic cholesterol-lowering pill that we can give "when diet and exercise aren't enough," a medicine that might very well give our patient debilitating muscle cramps. And, your doctor probably won't tell you this, but if you have never had coronary artery disease, that magic pill likely won't prevent an event.

In low-risk patients with elevated cholesterol levels and no prior heart problems, you would need to treat 250 of them with a cholesterol-lowering statin pill every day for five years to prevent a single cardiac event! In the most optimistic of studies, you would need to give a statin drug to 40 people every day over the next five years to prevent just one event. This pill won't prolong your life and probably won't improve your quality of life either. This is why I rarely prescribe statins for primary prevention of heart disease.

And then rather than counsel our patients on the benefits of fruits and vegetables and decreasing dietary sodium intake, we hand over a prescription for atenolol, the most commonly prescribed blood pressure medicine. Atenolol lowers blood pressure in the arms and legs but not the pressure seen by the heart and brain, increases risk of diabetes and stroke, and does nothing to reduce risk of cardiovascular events. Or, the second most prescribed blood pressure medicine, hydrochlorothiazide, also known as HCTZ, which when given at "appropriate doses" raises glucose levels and increases risk of diabetes, has limited evidence to demonstrate prevention of cardiovascular disease.

Or maybe your doctor does tell you to eat healthy, exercise and lose weight. But what's the drug rep bringing the doctor and his or her staff for lunch today? Pizza? Barbecued ribs? A tray full of cookies and brownies? Take a peek in the break room. You may be surprised by what you see.

We seem to have become a pill-pushing profession. We give our patients a band-aid in the form of atorvastatin or atenolol, and we refuse to address the poor lifestyle habits that make our patients sick in the first place. And as a whole, we're pretty lousy role models too.

I believe we have clout. I believe our patients aren't stupid, and I believe they're receptive to us. If we with our MD or DO or NP or PA initials after our names talk to our patients, I think they'll listen. And, if more of us do this, then I think we have the power to heal.

Eating (Sometimes) Healthy in the Holy Land

2011-11-10T21:31:00.000-08:00

I just got back from a weeklong trip to Israel. Beside all the great historical things to see, the food was amazing.

One thing to observe in Israel is that the people there are thinner than they are here. Part of it may be how much they smoke, but I think much of it has to do with diet. They seem to eat a lot of salad.

Breakfast was our biggest meal of the day. The hotel had an abundant array of cheeses and yogurt, and an omelette bar, which I didn't touch. But, there was also a huge salad bar, with fresh lettuce and vegetables, and also with prepared salads that had nuts and seeds and fruit. Another thing I loved at breakfast was a date and sesame spread to put on bread, which was absolutely delicious. I also enjoyed a couple slices of halvah, which I won't even suggest is a health food, but it is a mixture of sesame and sugar.

Here's a typical lunch. We had fresh hummus, baba ghanoush, pita bread, salad, chik peas, and I indulged and had a little bit of falafel.

Another treat for lunch was a Sabich sandwich. Inside the pita, we had grilled eggplant, tahini, mango chutney, cabbage, and some other veggies. Normally it comes with egg, but I had mine without.

I enjoyed some street falafel in Jerusalem. I wasn't a big fan of the greasy french fries on top, so I didn't eat them. Inside the pita was some of the best falafel I've ever eaten, along with hummus, tahini, and veggies.

Another bonus of eating in Israel, where most of our meals were kosher, is that if it's a "fleshig" meal, also known as a meat meal, there will be no dairy. So, any ice cream served with a fleshig meal is by default dairy-free and vegan!

There was only one meal where I had no options, a bag lunch with "American-style" cheese or tuna sandwiches. Luckily, we stopped at a gas station (!), and this is what they had to offer:

A gas station with a whole bunch of salads, hummus, and baba ghanoush. I asked for hummus with some tomato and cucumber slices.

Needless to say, I ate well on my trip.

Plan B

2011-11-05T17:07:00.000-07:00

I signed up to run the Santa Clarita Marathon tomorrow.

My training was spot-on. I ran 20.5 miles in 3 hours and 20 minutes, including a jaunt up Temescal and up and down the hills of the Pacific Palisades. I've been doing my track workouts, strength training, cross training, listening to my coach, staying on my program. If it's 5:15 am on a weekday, odds are I'm up and getting ready to workout before a long day at work.

Then, I spent 8 days in Israel during my two-week "taper" before the Santa Clarita Marathon. In spite of a few evening indulgences of alcohol, I had some amazing runs -- 6.25 miles, and 8 miles, as morning runs along the Mediterranean coast in Tel Aviv just after sunrise. I ran ten miles one morning in Jerusalem, where even in warm weather and on a hilly course I was able to keep a 9:30 per mile pace. I even "ran" Masada -- up to the top, turned around and came halfway down, then back to the top, in 80-90 degree heat.

At the top of Masada

My taper running in Israel couldn't have been better.

Then, I flew back home on Monday night. The flight was about 15 hours, and I sat next to an older man who kept sniffling. Maybe he got me sick, I don't know. I had a heck of a time adjusting to the time change -- the first few nights home, I found myself falling asleep by 8 pm and waking up at 3 am. Then I developed a cold.

I thought this cold would pass, but it hasn't, and I feel lousy. I don't get sick very often, but during the last race I ran, the Long Beach Half Marathon on October 9, I was getting over a viral gastroenteritis. I finished with what most would consider a good finishing time (2:09), but it wasn't up to what I should have done. After the race, I landed in the med tent for half an hour, unable to stand up for fear of vomiting or passing out, and it took an hour to walk the mile from the finish line to my car. Long story short, I should not have run that race.

And I'm taking that lesson to heart -- Santa Clarita is an important race for me, and I want to have my best marathon finisher time yet. If I try to run tomorrow, I will feel lousy and be disappointed with my performance.

So, I'm completely bummed out, but I am skipping tomorrow's marathon.

However, I will not let my base training go to waste. I am contemplating three different options:
--Santa Barbara Marathon -- Saturday, November 12, next weekend. Rolling hills, similar to Santa Clarita, a point-to-point race that isn't all too scenic until the end.
--Malibu Marathon -- Sunday, November 13, next weekend. Very hilly, especially over the last 8 miles. Not a race where I will post a very fast time, but at least it's local and I might be able to talk my family into cheering me on at the end.
--California International Marathon -- December 4, a month from now. It's relatively fast, with great crowd support, and a few rolling hills. But it's in Sacramento, it's cold (28 degrees at the start line when I did the race 2 years ago!) and would require flying to the race. And I don't feel like waiting another month to run.

I am leaning toward doing Santa Barbara. In the meantime, I'll be resting (which I'm not very good at) and hoping this cold passes.

Coney Dogs and Detroit Lions

2011-10-10T21:55:00.000-07:00

When I heard that Coney Dog, a Detroit-style hot dog joint, was opening up on Sunset Boulevard, I had mixed feelings. It's always good to see my hometown represented in Los Angeles, but not as a restaurant that typically offers nothing for a vegan.

But.... when I heard that the place serves vegan hot dogs and vegan chili, I knew I had to try it out. Tonight was the Detroit Lions' first appearance on Monday Night Football in ten years and seemed like an appropriate time to visit.

I had a California Jack. Actually, I had two. It's a vegan hot dog on a bun, topped with vegan chili, grilled onions, and mustard. It's got a bit of a spicy kick to it, and it's good!!! As the owners and their daughter worked the huge crowd filling the restaurant on this momentuous evening, one of the owners explained that they have a relative named Jack who moved to California and became a vegan, and hence the name of the hot dog.

You can also get several Detroit standards like Faygo cola (by the way, it's POP not soda), Vernors, and Stroh's beer.

Now, I'm not about to suggest that this is the healthiest food option around, but compared to a cholesterol-laden chunk of saturated fat that is a beef and pork hot dog, I'd say this is a pretty tasty choice.

P.S. The Lions won tonight!!! 5-0!!!

Malibu Triathlon 2011

2011-09-18T15:59:00.000-07:00

This was my last triathlon of the season... and while it's been a great season, I couldn't have asked for a better race to end things with.

I decided to race as an Athena (women 150lbs+) -- Malibu Classic Triathlon is a competitive race, and here is a place where I could have a chance of placing high.

Conditions were perfect, with the day starting a bit overcast, air temperatures in the mid-60's, and a water temperature of 65 degrees.

Swim
One of the down sides of racing Athena is that I start the race in the absolute last wave group. As the gun went off, I ran into the ocean. This is my first ocean race since my mishap south of Venice Pier a couple of months ago where I nearly drowned. My once fearless approach to ocean swimming is now tempered with a significant amount of trepidation. As we ran into the ocean, I dove under one wave. Then a larger wave came, and I said, out loud, "oh my g-d", dove under it, came up hyperventilating. It was quite a crowd of us swimming, so until I got around the first buoy, I stuck with breaststroke. Once that turn was made, my breathing calmed down, and I swam toward the last buoy, sighting every four strokes. After making the last turn and heading to shore, I was grateful to the lifeguards who yelled to us that there were big waves behind us. I turned around, panicked for a second, dove under the wave, then turned around and came to shore.

Picture taken by Paul Hekimian of LA Tri Club, as I'm trying unsuccessfully to yank myself out of my wetsuit and run at the same time.

Coming out of the water, I was a bit disoriented, and I started running in the wrong direction. I couldn't get my wetsuit zipper open, and once I finally did, I couldn't free up my left arm. So, running into transition with my left arm pinned inside my wetsuit, I looked like a woman in a straitjacket. It was an awesome look. After that, to complete the whole klutz act, I couldn't get my bike off the rack, and then in moving my items one of the snaps came loose off my race belt and went flying off (I found it when I returned after the bike ride).

Swim time -- 16:09. Last year's time was 18:55.

Bike
As I ran in from the swim, I saw one of the Athena racers running off with her bike. As the bike has always been my limiter sport of the three, I considered her to be gone in all likelihood, with the possibility of maybe catching her on the run.

I guess I've gotten stronger on the bike, because I passed just about everyone on the course. Over the entire 18 miles, only three passed me. And, at mile 7, I passed the Athena woman who I knew was ahead of me.

And a point of bike etiquette: When you pass, say "On your left". Or "Hi." Or "I'm passing you." I spent many years being the slow girl on the bike (and amongst some groups I still am) and having people whizz by me within inches and not say a word to warn me. I said "On your left" maybe a hundred times. Clilmbing PCH out of Leo Carillo, gasping for air, it was shortened to "Left." But, out of courtesy, I still warned those that I passed.
Bike time -- 58:49. Last year's time was 1:03:37.

Run
I love the run course -- along Zuma Beach and back. The fact that it's out and back means I get to see many of my friends and teammates who are both slower and faster than me, which is always fun. My first miile was 8:13, and I got slower from there, which wasn't good, but I still averaged 8:34 per mile over 4 miles.

Photo courtesy of Paul Hekimian of LA Tri Club

Run time -- 34:16. Last year's time was 36:45.

Crossing the finish line. Photo courtesy of Marvin Suntonvipart.

Overall time: 1:55:11. Last year's time was 2:05.

I won first place out of 32 women in the Athena category! But it gets better -- had I raced in my age group, I would have taken 8th place out of 83, which is the top 10% of the age group, which means that I have qualified for USA Triathlon Age Group Nationals 2012!! The race takes place in Burlington, Vermont, and I've always vowed to myself that if I ever qualify for an event that I will go there and do it, so it looks like I have a little summer vacation for next year!

Some fabulous friends who raced, and even more awesome friends who cheered us on today.

I could not have asked for a better ending to my triathlon season. Thanks Coach Gerardo for your coaching wisdom, thanks Team Fortius for being awesome training partners, thanks Kiki my personal trainer for pushing me to be stronger, and thanks to all the plants that I eat that give me the fuel to be an athlete. :)

Vegans are the ONLY Normal Weight Population!

2011-09-15T17:11:00.000-07:00

When classified by diet, a recent study found that people who are omnivores, who follow the Standard American Diet, are the heaviest, with an average body mass index of 28.8.

Flexitarians, who eat meat infrequently, weigh less, but are still overweight.

Vegetarians, who do not eat meat, but may eat dairy or eggs, weigh even less, but even they are on average within the category of being overweight.

Vegans, who do not eat any animal products, are the only one of these four groups who are on average a NORMAL weight!

Watch a video discussing the findings from this study from the Journal of the American Diabetes Association here:

And while you're there, explore Dr. Michael Greger's web site, http://www.nutritionfacts.org/. There's some great information there, and Dr. Greger delivers the facts with his unique sense of humor.

Coronary Calcium Screening -- Does Everyone Need One?

2011-08-29T14:48:00.000-07:00

I watched Sanjay Gupta's special "The Last Heart Attack" yesterday. I had eagerly awaited it because I knew he would be talking to Bill Clinton, Dr. Dean Ornish, and Dr. Caldwell Esselstyn about plant-based diets and heart disease.

We heard from one woman with a prior heart attack who turned down bypass surgery and is doing well by taking her medications and following a plant-based diet. And, Bill Clinton discussed how he's changed his diet to improve his health as well.

An interesting aspect of the show was the discussion of coronary calcium scans. Sanjay Gupta interviewed Dr. Agatston, the physician who came up with the concept of the scan, and ironically is the author of The South Beach Diet. Dr. Agatston states that coronary calcium scans are "the standard of care."

I would disagree strongly.

A coronary calcium scan looks for calcium in the arteries of the heart. If the scan finds zero calcium, that would indicate that a person's likelihood of a cardiac event in the next four years is essentially zero. However, if you have a score greater than zero, you do have some risk. The higher the score, the greater the risk.

But, it's not a harmless test. It comes with a significant dose of radiation -- 2 to 3 milliSieverts, or the equivalent of 8 to 12 months of environmental exposure. Further, the test doesn't tell us how tight narrowings are, and can't accurately state that a patient needs angioplasty or bypass surgery. For these reasons, your HMO insurance likely won't cover it either.

Stress testing is still the standard of care because stress tests identify functional abnormalities -- in other words, they identify portions of the heart that may not get enough blood with stress, and these areas when revascularized (with bypass surgery or angioplasty) will provide symptomatic relief.

I had a patient recently come to me with just about every risk factor imaginable -- he's diabetic, high blood pressure, high cholesterol, strong family history of heart disease, and a history of smoking. He wanted a calcium scan. He didn't need a calcium scan to tell me that he's high risk.

I think a coronary calcium score might be reasonable to better risk-stratify someone at intermediate risk, or to help motivate someone who otherwise would not make lifestyle changes.

But, the bottom line (as it often is): If you don't want a heart attack, live clean -- eat healthy, exercise, maintain a healthy weight, and don't smoke.

Heart-Attack Proof Diet??

2011-08-22T14:09:00.000-07:00

Bill Clinton has been a vegan for one year. As a result, he's lost weight and feels well and has had no further need for invasive interventions to his heart.

Tune in to CNN on Saturday, August 27. Sanjay Gupta is hosting a special called "The Last Heart Attack". He talks to President Bill Clinton about his new diet, and to Dr. Caldwell Esselstyn, author of the book Prevent and Reverse Heart Disease.

See a clip from the special here. I'll defnitely be tuning in.

Hansen Dam Triathlon

2011-08-21T19:34:00.000-07:00

I've done an Ironman and several half-Ironman distance races. But I still love small races too. It's a chance to just go full-steam and give it what I've got.

Today's Hansen Dam Triathlon was a 500 yard swim, 11 mile bike, and 5k run.

This is me and my friend Kenny, who was doing his first triathlon today!!

Swim
I decided to take a slightly different strategy on the swim -- start at the front of the wave, go all out on the start, and push myself all the way through. When the gun went off, there were about a dozen or so women who powered in front of me, but shortly thereafter I think I passed a couple of them as we rounded the first buoy. On this rectangular course on a man-made lake, sighting the buoys for the turns was not a problem. Swim time: 10:55 -- a minute and a half faster than the last time I did this race. I was the fifth woman (out of 33) in my age group out of the water. I credit my coach Gerardo Barrios with leading an awesome swim workout on Tuesdays and Thursdays and scheduling me to (begrudgingly sometimes) swim 3-4 times per week.

Bike
Not my strength. Long legs=crappy levers. That's my excuse. One woman who finished the swim at the same time that I did went flying away on the bike. I tried to keep her in sight but she was gone! The bike had a couple of hills, but most of it was flat, along the roads around the park and over the Hansen Dam. Two women passed me on the bike. I was surprised there weren't more people who passed me. Bike time: 33:22. Over 3 minutes faster than my 36:43 of two years ago.

Run
There's an important rule in triathlon -- Never try anything new on race day. Which would suggest that maybe I shouldn't have decided to try running without socks. I figured it would take some time off of my second transition. And it did. But now I have a couple of blisters in my arches.

In short races, the run is my strength of the three sports. I managed to catch the woman who flew ahead of me on the bike course. The run took us through some trails of the Hansen Dam Recreation Center. Now, the run is supposed to be a 5k, but I measured 3.21 miles on my Garmin. At water stops, I'd grab a glass of water, take a sip and dump the rest on my head. There were a few inopportune hills, like the one that is a quarter mile from the finish line. I powered through that last hill, joked with the guy who I had run the last half of the trail with by yelling, "Don't let yourself get chicked at the finish!" as he, as a result, sprinted to the finish line just ahead of me.

(the definition of the word "chicked" is allowing oneself to be beaten in a race by a woman)

Run time: 27:47. Two years ago was 24:49, but I really believe they made the run longer this year.

Overall time: 1:14:45. Two years ago: 1:17:37.

Awards Ceremony -- "Podium"!!!!

Second place (out of 33) in my age group!!! This would be my first time racing in LA in which I have podiumed in a triathlon in my age group.

So, getting older, getting faster -- a great day at Hansen Dam!!!

Unprocessed

2011-07-31T21:29:00.000-07:00

Chef AJ is one of the most interesting people you'll meet. At the beginning of her classes, you will hear "I Will Survive," with her own singing and lyrics, dancing, and even a handstand in front of her food processor as she sings (yes sings!) about the benefits of whole, plant-based foods.

While her teaching methods are certainly unorthodox, her message is clear: Processed foods are unhealthy, and following a whole-food, plant-based diet is not that hard. And, if you can't get to one of her classes, you can read her book, Unprocessed.

Chef AJ talks about the many challenges she has faced in her life -- eating disorders, a miscarriage, and a health scare -- that led her to the way of eating that she so passionately preaches. As she says it, on page 2:

My simple rule of thumb is this: If I can make it in my kitchen, using whole ingredients, it's unprocessed. I can cook lentils and add carrots and and onions and spinach to make a soup, so that's unprocessed. I can blend fruits together to make a smoothie, so that's unprocessed..... But I can't make a Fruit Loop. I can't slaughter a cow. I can't make vegetable oil, so any recipe calling for oil involves a processed ingredient.

It's simple, but it makes sense. Not only does she tell you how to become "unprocessed", but she includes several of her simple yet delicious recipes. An invitation for dinner at AJ's house is one I'll never turn down, because I know I'll get healthy food that tastes incredible. Her recipes are straightforward, and I've made several of them, including a couple that I've blogged about. My favorites are her Hail to the Kale Salad (page 122) and Chef AJ's Disappearing Lasagna (page 100).

If you're looking to improve your diet and get healthy, this book is for you.

Vineman 70.3 Race Report

2011-07-18T22:07:00.000-07:00

I've raced this three times, and this was my best performance. But I could have done better.

If something could go wrong during the week leading up to the race, it did. You can read below about my misadeventures in the ocean from last Sunday. That managed to truly screw up my left shoulder, and on the following day while swimming with my niece I felt pain with every single stroke in the water. Then shortly thereafter I got sick with a cold. Coach Gerardo basically had me stop working out, which of course was the right thing to do, but when I go from my usual daily exercise to zero exercise, my mood changes and I feel like a sloth.

On Sunday, my shoulder still felt a little funny. I joked that the worst case scenario would be that I would do a 1.2-mile one-armed drill. Or, since the Russian River, where the Vineman swim takes place, is so shallow, I could walk the whole thing. And, though I felt better from my cold, I was still bringing up some funky-colored mucus.

Swim
My goal was 40 minutes. The swim start was a mess as usual. The shoulder felt a little funny at first, but any discomfort was gone within ten minutes. I finished the swim in 39 minutes.

Bike
My weakness. I was consistent, but I got passed all over the place. One woman in my age group decided to pass me on the right. When I suggested that was unsafe, she yelled "Bitch!" at me. I love our sport most of the time, but such unsportsmanlike conduct is just unnecessary. I have never had so much snot come out my nose during one bike ride.

Run
I'm a decent runner, and in a sprint or olympic race I can fly by dozens of people on the run. But, my runs during my last few long races have been less than stellar. Coming out of T2, I felt great. I ran the first mile at what felt like a comfortable pace, which ended up being 8:50. Mile 2 was completed in 9:30. Mile 3 was 10:00. And my mile splits got worse from there. I didn't feel tired, but my pace fell. The balls of my feet hurt like hell, especially running the trails around the vineyard. Gradually, as we got back onto solid pavement and downhill running, the feet hurt less. Then my stomach began to grumble. For those of you who don't know, distance running increases gastrointestinal motility. My stomach grumbled more. Then, around mile 11, I made a rather urgent port-o-potty stop. Thereafter, my stomach felt so much better, and the last two miles flew by.

I was grateful to see Fortius teammates Mike, Karen, Joe, and Ray just around the corner from the finish line. Their encouragement really pushed me, though I had to ask Joe and Ray to stop running with me so I didn't get disqualified for outside help.

My Finish Time: 6:27:08.
That's eight minutes faster than my previous attempt at Vineman 70.3, and my best half Ironman time ever, all in spite of still being sick and injuring my shoulder. I wanted to go 6:15, and under better conditions, I could have done it. But I also want to troubleshoot my run, why I'm so much relatively faster running a shorter course than I am on a longer course. That will come next season -- I'm done with long course triathlons for the year. I have two shorter races, Hansen Dam and Malibu, and plan on running a fall marathon.

I'm No Chicken of the Sea

2011-07-10T16:30:00.000-07:00

The ocean is a funny place. Some days it's quiet, and then without warning it's not.

I have a race one week from today, Vineman 70.3, which is a half-ironman distance race. At this point, as my coach likes to remind us, you can't do anything to make your race better, so now is the time to taper and be ready for race day. To that goal, I had a 45 minute open water swim on my schedule for today.

The "Chicken of the Sea" swim with the LA Tri Club takes place at 8:30 am on Sunday mornings. It is called "Chicken of the Sea" because the location is sheltered by the Marina, and is considered ideal for those who are nervous about waves in the ocean. We swim north toward the Venice Pier, about a mile away.

Now, I'm no "Chicken". I've lived in Los Angeles for four years and during that time have done numerous ocean swims. I join the Tower 26 group every Wednesday morning during the summer, where we practice entering and exiting over and over again. I was on call until 9 am, so I entered the ocean a bit later than everyone else, so I was swimming alone. But, I did see a member of my team there and said hello to him at the start, so that someone knew I was there.

I entered alone and swam alone, though there were several swimmers in the area. The water was a bit wavier than usual. I did my swim on my own. I kept it at a leisurely pace since I have a race coming up next week. It was uneventful.

About forty minutes later, just a few hundred yards from the Venice pier, I prepared to exit. Initially, the water was pretty flat. And as I headed to shore, I swam looking behind me periodically so I would not be surprised by any major waves.

A few hundred feet from shore, a rather tall wave approached. I'd say it was about six feet high. I prepared to dive under it. As I dove under, I got caught in the wave and was dragged forward. My left arm twisted and I felt it pull hard. I think I was dragged to the floor and it felt like eternity before I came up again.

But as soon as I could stand up, another big wave came. Barely having caught my breath from the previous wave, I tried to dive under, but similarly, I was dragged with it. And I stood up again coughing, not sure which direction I was facing. Another wave was coming. I thought I was in front of a lifeguard tower, but might have been dragged in one direction or another, because I didn't see the tower any more. I could barely speak but I put my hands overhead hoping to get attention from someone on the shore. But I didn't get a chance as another huge wave pounded me. As I was dragged underwater this time, I lost my swim cap and goggles.

I was absolutely wiped out, gasping for my breath. Again I put my hands overhead and yelled "Help!" I have no idea how loud I yelled. Probably not very loud. Unfortunately, I didn't get anyone's attention. Fortunately, the waves calmed down and I was able to get to shore.

I sat down on the sand, heart still pounding, still gasping. As I sat there, another club member came by, and asked if I was ok. I was calm by then, and I walked with him back to where we had started our swim.

In the end, I have a strained left shoulder and right groin muscle, which seem to be calming down after I iced them. I had a throat full of sand, my ears were packed with sand, and even hours after this adventure, whenever I lean foward salt water and sand drain out of my nose.

The ocean and I need to spend some time apart for now.

My lesson from today is that even if I know people at a swim, I can't be swimming alone, even if I am experienced. Another swimmer with me might have been able to pull me in when I tired out, or could have been more effective at getting the attention of a lifeguard.

The other lesson is that no matter how calm the reputation of the water where I'm swimming, conditions can change, and I need to be ready.

Diet Myths

2011-07-05T20:15:00.000-07:00

There are a few statements when it comes to food that I have issues with:

"Don't eat carrots. They have too much sugar."
How many people are too heavy due to eating too many carrots? If carrots are the true culprit of your diet, then you eat far better than I or anyone else does.

from askfreud.com

"I avoid pasta and bread."
There's no need to avoid bread and pasta. Stick to whole grains. And remember what a portion size is -- 3/4 of a cup of dry pasta, or 56 grams, is 210 calories. Measure it out. You'd be surprised how small it is compared to a standard restaurant serving size of pasta. And, when you go out to dinner, stay away from the bread basket, especially if you are getting a pasta dish or meal with bread in it.

from walldesk.net

"I don't eat red meat. I eat lots of chicken and fish."

I wrote a whole post on this subject. An animal is an animal is an animal. Why should an animal of one species be so "good" for you an another be "bad"? Beef, chicken, and fish have the same quantities of cholesterol. And, lean beef and chicken have similar quantities of artery-clogging saturated fat. So, if you really want to do yourself a favor, cut back on or get rid of the animals from your diet.

Come Take My Class!!!

2011-06-27T14:20:00.000-07:00

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

Breath of Life Triathlon -- Race Report

2011-06-26T14:38:00.000-07:00

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.

Do Patients Really Listen?

2011-06-23T22:39:00.000-07:00

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.

Track

2011-06-17T00:06:00.000-07:00

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!

AIM-HIGH? Not so high apparently.

2011-06-07T16:56:00.000-07:00

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.

Go See Forks Over Knives!

2011-06-04T21:04:00.000-07:00

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.

BBQ -- Vegan Style

2011-05-30T21:33:00.000-07:00

I could talk your ear off about how tasty a healthy vegan meal can be. Or I can just feed you fabulous food. Yesterday, I threw a backyard BBQ. Here's what I served up:

Kebabs with peppers, tofu, baby bella mushrooms, grape tomatoes, and pineapple, marinated in Soy Vay sauce.

A big salad full of organic lettuce, grated carrots, peppers, cucumbers, pear, mango, cinnamon almonds, cilantro, and dried cranberries.

Hors d'oeuvres -- cut up veggies, jicama, hummus, salsa, and (in the upper right corner) Texas Caviar, which consists of peppers, black and pinto beans, cilantro, jalapeno, vinegar, and date syrup.

More hors d'oeuvres -- to the left is a bean dip with vegetarian refried beans, guacamole, Tofutti sour cream, and Daiya vegan cheese.

"Crab cakes" made by Lisa K., from tempeh and some other ingredients, baked not fried. Yum!

Mom's chili -- made from a mix by Fantastic Foods, but with a few variations, including canellini beans and Muir Glen fire-roasted tomatoes.

And, you can't forget dessert!!! Chocolate brownies with chocolate frosting, and carrot cake.

Chest Pain

2011-05-22T07:21:00.000-07:00

If you have new chest pain, see your doctor. That's the most important thing I'm going to write today. Plain and simple.

Some people are embarrassed that they're making a big deal out of nothing. And to be honest, less than half of the new patients that I see with chest pain actually have pain due to heart disease. But, I have encountered a man in his mid 30's who attributed the pain in his chest that he got whenever he exercised to "gerd", or reflux. At 37 years old, he had a heart attack and underwent emergent bypass surgery.

Many things cause chest pain, other than heart disease -- a pulled muscle, inflammation of the cartilage of the ribs, esophageal reflux, esophageal spasm, anxiety, depression, injury, amongst other possible causes. But do not wait -- get it checked out. See your primary care doctor, and if needed, come see me or another cardiologist for an evaulation.

Tofu Scramble

2011-05-15T21:48:00.000-07:00

This is so easy, and so healthy!

Microwave a sweet potato until soft, allow to cool, remove the skin, and cut into cubes. Combine in a wok: Cubes of extra firm tofu, sweet potato, spinach leaves, salsa, turmeric, garlic, and either a splash of soy sauce or Bragg's liquid amino acids. Cook for about ten minutes and serve.

Steak House Dinner

2011-05-05T10:18:00.000-07:00

I eat healthy, and so do a lot of people. Not everyone else in this world does. But I realize I need to be able to roll with the punches in life, so to speak.

Last week, I attended a cardiology educational meeting at Arnie Morton's steak house. Now, I won't even start on the irony of learning to treat coronary disease in the setting of a steak house. I do realize, though, that every so often we end up by social necessity eating at a restaurant that we would not typically choose on our own.

As you might imagine, Morton's doesn't have a tofu stir-fry or lentil loaf on the menu. However, I spoke with our server Heather (fabulous first name, no?) and asked her what the chef could prepare. I ended up with the chopped salad with no bacon, eggs, or cheese, and with a mustard dressing, and for my entree a plate of steamed vegetables, a baked potato, and a side of soy sauce:

I must say, the steamed veggies were quite delicous. It was a huge plate and I didn't finish everything, but I did polish off all the spinach, broccoli, tomatoes, mushrooms, and about half of the asparagus and brussel sprouts.

Would I have enjoyed a more interesting dinner, perhaps with a protein, just like my colleagues enjoying their steak or fish? Sure. But, I think that as a vegan, it's important to go to restaurants that don't solely cater to non-meat-eaters. If they have enough of us as customers, perhaps one day they'll put something on the menu for us.

The most important point: You can get a good healthy meal at just about any nice restaurant. You are the customer. Just ask.

Wildflower 2011 -- A Tough Day for a Personal Best

2011-05-03T16:46:00.000-07:00

Wildflower is a favorite race of mine -- the second toughest half-Ironman distance course in North America (1.2 mile swim, 56 mile bike, 13.1 mile run). The course is infamous for its hilly bike and challenging trail run. Wildflower is also known for its camping experience.

I've raced Wildflower previous years, and I've camped out in my tent, shivering and miserable, barely getting any sleep. That has made racing even more challenging, and particularly led to a less than stellar race for me last year. I vowed that if I ever came back to race that I would not be camping.

When a couple of friends invited me to join them in renting a house, I decided that I wanted to give Wildflower Long Course another shot. And, with eight hours of good sleep and weeks of hard training, I was ready on race morning.

Swim
The beginning of the swim was more crowded than I had remembered. Perhaps it felt crowded because I haven't been in open water since September.... oops :) But, after rounding the first buoy, the crowd dispersed and I settled into my stroke. Halfway through the swim, I felt waves. I could see a Sheriff's boat circling, and a couple boats next to them. I have enough open water experience that even though I was expending some extra energy, I had no trouble getting through them. I could see a couple of women around me who had started the race before I did and I could tell they were having a tough time with the choppiness of the water.

As I swam, I noticed one of my old bad habits -- I use the swim caps in front of me to determine which way to swim, as opposed to sighting off of a landmark like a buoy. If I ever become a swimming frontrunner in a race, I will be in big trouble. But that likely won't ever happen.

My goal was to swim in 40 minutes. I finished in 40 minutes and change.

Bike
The Wildflower bike course presents challenges of its own. Coming straight out of the transition area, riders head straight up Beach Hill. That's me beginning the climb:

Beach Hill is steep and it's nearly 2 miles long. It would be easy to stand on the bike, grind out the hill, and trash my legs, but then again there are 54 more miles to ride. After that are some rollers. Lots of people pass me. I'm used to that -- the bike is my weakness. Then the road flattens out. And then we picked up a really strong headwind. I'm pedaling hard and I feel like I'm barely moving, but my bike computer tells me I'm only moving at 10 miles per hour! So of course I'm thinking, what's wrong with me, but as I think about it more, no one is passing me, so it must be the wind.

After 8 or so miles of miserable headwind, we turn right onto Jolon Road, where the headwind becomes a side wind (is that the term for it? I don't know, but I think you understand what I'm saying). The wind is blowing me to the right, and at times I have trouble staying upright on my bike. And finally, the wind seems to settle down just as we reach the infamous Nasty Grade hill at mile 42. I felt okay, and after weeks of hill riding, I sailed up the hill, passing at least 20 riders, and not a single one passing me.

My goal was 3:40. This took me 3:53. I blame the wind.

Run
After that grueling ride, we now get to run 13.1 miles of trails. The first six miles are the toughest, with plenty of steep hills. A lot of people walk at this point, but I ran up all of them except for three particularly steep hills that I power-walked. The balls of my feet were absolutely burning -- if I stepped on a rock, they would hurt even more. But, as I kept running, the pain got to be bearable.

After the trails, we run through the campground, with plenty of cheering. And that's about where this picture was taken:

Next was an out-and back uphill and down, and then back up and down again, and a small hill and then a long descent of about half a mile into the finish.

I finished the run in 2:22, which was around my goal of 2:20.

My time: 7:04:11, beating my personal best by seven minutes. A tough day, but a good race for me.

Forks Over Knives -- The Movie

2011-04-23T16:31:00.000-07:00

If you are concerned about heart disease, you need to see this movie:

"If the truth be known, coronary artery disease is a toothless paper tiger that need never, ever exist and if it does exist it need never, ever progress." -Caldwell Esselstyn, M.D.

My Big Fat Vegan Passover Seder

2011-04-21T18:20:00.000-07:00

"What do you mean, you don't eat no meat?.... That's ok, I make lamb!"

Quote from My Big Fat Greek Wedding

For my first seder that I prepared on my own, I thought I'd have my family and a couple of friends, and it would be a small festival. But, as I put the word out, many people were looking for a seder, some had never attended one and wanted to know more about Passover, and others were just curious what a vegan seder would be like. Next thing I knew, I had twenty guests in my home!!!

Seder Table -- Seder plate, matzah, and small glass of wine for Elijah the Prophet

My 5 1/2 year-old niece painted the seder plate. She painted all the spots on the plate except for the spot for the shankbone, "Because we don't eat meat." Cute. In place of the bone, I placed a few beets on the plate, and a vegetarian friend brought his very own "tofu shankbone." Traditionally there is an egg on the plate to represent the spring; instead we had a flower.

Passover has become a holiday of excessive processed foods, cottonseed oil, fat, and too many eggs. Clearly, this is not the case in my home. This is a Vegetable and Matzah Casserole from The Vegetarian Pesach Cookbook by Roberta Kalechofsky:

Matzah farfel, layered with sauteed eggplant, tomatoes, mushrooms, and peppers, covered with more whole wheat matzah farfel and tomato sauce.

Russian Potato and Mushroom Croquettes from Debra Wasserman's The Lowfat Jewish Vegetarian Cookbook:

I also served matzah ball soup based on the Post Punk Kitchen recipe, using tofu instead of egg to hold the balls together (I observe a sephardic Pesach, so I do eat soy and other kitniyot). Mrs. Feinberg's Kugel, one of my favorites, made from sweet potato, apple, and carrots also made an appearance and was polished off quickly!

And you cannot ever ever ever forget dessert!!!! One friend brought one of the infamous box mixes of brownies, but she used flax seed instead of eggs. It came out quite good! This is the No Bake Chocolate Matzoh Roll from The Vegetarian Pesach Cookbook.

And, what kind of holiday is it if the pets don't get to participate? Here, my dog Curves eagerly finds the afikoman, or hidden matzah! :)

It should be the youngest child who finds the afikoman, not the youngest dog, right? My mischevious dog Curves.

Have a joyous Pesach, and please, go easy on the eggs!

Training for Wildflower Long Course

2011-04-17T10:50:00.000-07:00

It's been a bit too long since I've posted.... so I will update you on my training. Coming soon, you'll get to read about my first Passover seder that I've hosted. I will be having about 18 people at my home and the seder will all be vegan (and cardiologist-approved!)

51 mile bike ride yesterday -- climbed both Latigo and Mulholland!

I am again doing Wildflower Long Course -- a half Ironman-distance race (1.2 mile swim, 56 mile bike, 13.1 mile run) which is one of the toughest in North America. The bike course is hilly, as is the run which more than half of it is on trails.

This year, I've switched coaches to Gerardo from Fortius Coaching. He's definitely having me train harder than I ever have for a half-ironman distance race. Rather than the 12-hours per week that I've become accustomed to when getting ready for one of these races, I'm doing 16-17 hours per week of training. He also has me doing far more hill work on the bike and running. I can't remember the last training run that was completely flat!

Two years ago, I finished in 7 hours 11 minutes. Last year was a disaster due to a busy few days at work beforehand, and my inability to get any sleep at the campground before the race. This time around, I'm not camping -- after all, I hate camping. A group of us is renting a house. So, I plan on being well-rested with the chance of finishing in under 7 hours.

Time to Start Exercising!!!

2011-04-02T16:07:00.000-07:00

What's your excuse?

I've heard them all. But, it's time to see the excuse for what it is, realize that exercise is crucial to good health, and start or get back to making it a habit.

A good goal for everyone is to get at least thirty minutes of cardiovascular exercise most days of the week -- this is exercise that is sustained and keeps the heart rate elevated. This means a heart rate of 60-85% of your predicted maximal heart rate, though an easier gauge of exertion is that you should be able to carry on a conversation, but talking should be just a little challenging.

Here are some of the excuses I hear every day:

"I'm too tired"
Exercise gives you energy. The more you move, the more energy you have. If you don't move, you have less energy.

"I have no time"
Your body and your arteries could care less how much "time" you have. Make the time, it's important. Do you have ten minutes during your lunch break to get outside and walk? Do you have a couple minutes before dinner, or after dinner? I'm sure you do. I fit it in by getting up early in the morning, often 5:00 am, to get my workout in before I see patients.

"I have arthritis -- my knees/hips/back hurts"
Again, your arteries don't care about your aches and pains. And, in fact, for some of those pains will benefit from exercise and range of motion. If walking hurts, then get on a bicycle, or swim or walk in a pool.

"I have an active job"
Occasional lifting of heavy items or intermittent walking are not the sustained cardiovascular exercise that your heart benefits from. Unless you are a valet who is literally running for hours to fetch cars, a bike courier, or you're doing some sort of continuous exercise for thirty or so minutes of a time, your job doesn't count as exercise.

"I stretch" "I lift weights"
Great, I'm sure you're very limber or strong. But that's not the sustained cardiovascular exercise that will keep your heart healthy.

"I'm lazy"
Really? Don't be.

That's me, at about 25 1/2 miles into the LA Marathon, setting a good example for my patients and exercising :)

LA Marathon 2011 -- Cold and Rainy

2011-03-20T19:38:00.000-07:00

Today was far from an ideal day. In a race where hundreds dropped out due to hypothermia, I'm grateful to have finished as well as I did.

My Marathon Bib -- Keeping it Unique!!!

My morning started at 3:20 am. By 4:20, I parked my car at my friend's condo in Santa Monica and walked to the shuttle buses. I arrived at Dodger Stadium by 5:15 am, with over two hours to kill until the race. In avoiding the morning chill, I intermittently sat, laid down and napped, ate bananas and soy yogurt, and used the port-o-potties about five times (yes, really).

Around 7 am, I checked my gear bag and fought through the crowd to get to my seeded corral, for runners who had previously completed sub-5-hour marathons. The crowd of us was told that the corral closed at 7 am, which of course we had never been told, and created chaos and anxiety, and finally we were permitted to enter the seeded corral area.

Unlike last year, in which we waited forty-five minutes for shuttle buses to get off the jammed up freeway and drop off the rest of the runners, we started on time. It was kind of funny because I think the gun went off earlier than it was supposed to -- the announcer gave a "Runners......" like he was going to say "get set" or something like that, but then *BOOM*! And, the "We Love LA" song that plays at the beginning of every marathon started late and was skipping all over the place. It was definitely an awkward start.

With the help of my coach Gerardo of Fortius Racing, I had decided that my strategy for a goal race time of 4:05 would be to run 9:20 per mile splits. The first three miles were downhill, and I probably did each one in 9:10. People were passing me all over the place. But, as a seasoned marathoner, I know to let them go. To paraphrase my first triathlon and running coach Mary Eggers, "There are two kinds of people who will pass you at the beginning of a marathon -- people who are faster than you, and people who will be walking at mile 22."

Less than a mile into the race, it began to rain. This would be the theme of the day -- rain and cold. At mile one, I ditched my waterproof jacket and was running in a tank top singlet and shorts. I kept my gloves on, but by mile five, I tucked those into my shorts and ultimately disposed of them mid-race. While it may have been fifty degrees and pouring rain, I didn't feel cold.

Mile four presents the biggest hill of the course -- a short, steep hill up to Disney Concert Hall. I practice hills regularly, so this was no big deal to me. With another uphill at mile five, and a port-o-potty stop, the next few splits were a bit slower. Around the seventh mile, I ran into an LA Tri Club member who I know who was out on the course doing a training run. He paced me for the next four miles into Hollywood and gave me someone to talk to, which made the run a bit easier.

The rain poured harder, and at times felt absolutely torrential. While I felt okay, I found out after the race that hundreds of runners dropped out, and several runners were taken to local hospitals with hypothermia.

I love running through Hollywood. We ran along the Walk of Fame on Hollywood Boulevard, and then down the Sunset Strip. This was about midway through the race. Though my socks and shoes were soaked and the rain was pouring, I felt good and strong. My time was a bit off at 2:04:00 at the half marathon point, so I thought that since I felt well I might still be able to hit my goal if I got back on my 9:20 pace.

And, I continued to feel pretty good. The bottoms of my feet were sore, I had a mild ache in my right hip, but compared to other marathons I've done, I felt great. But my splits were off -- they were more like 9:45 than the 9:20 that I was aiming for.

I continued to feel good running down Santa Monica Boulevard in West Hollywood, and then down Burton and Rodeo Drive in Beverly Hills. Once I reached mile 18 in Century City, I had a brief pep talk to myself: Look, you feel good, now is the time to pick up the pace and try to hit your goal. If nothing else, let's at least try to get a PR (personal record -- my best prior marathon was Long Beach 2009 which I ran in 4:12:55).

About now, I started passing people. A seasoned marathoner, and as this was my tenth marathon I think I can call myself "seasoned", knows how to pace herself. Though I was passing more than I was being passed, and I still felt good, I just couldn't get much faster.

The toughest part of the race is about mile 20, through the VA Hospital grounds. There's a significant uphill, and the scenery is blah at best. The rain was absolutely pouring, I had given up on trying to run around puddles and landed right in them without caring as my feet were already drenched, and my legs were starting to ache.

Next is the turn onto San Vicente Boulevard. The Hirshberg Foundation had an enthusiastic group with loud upbeat music and I would consider them the highlight of the entertainment on the course -- it's impossible to pass them and not feel energized. They're also an organization that I support since the father of one of my closest friends died of pancreatic cancer. So, from here, most of the course was downhill on San Vicente Boulevard. In spite of my legs feeling heavy and tired, I was moving along at a good pace. I passed far more runners than passed me. There were lots of spectators and a number of people that I knew, and their encouragement pushed me toward the finish line.

Turning the corner from San Vicente onto Ocean Blvd, the end was in sight with about a mile left to go. Fortius Coaching had an enthusiastic group cheering us on, and from there on out, I just pushed to the finish line.

My finish time: 4:12:59. Just four seconds slower than my best marathon, Long Beach 2009, which was run in much sunnier conditions.

It felt so good to be done!!! I must not have looked so good because one of the medical staff approached me, and I smiled, said I'm a doctor, and I'm okay, and he let me be. However, hundreds who crossed the finish line, mostly those who finished after me and likely weren't running the whole thing and thus didn't keep their core temperature up, were treated for hypothermia shortly after finishing.

I walked the long three-quarters of a mile or so to the marathon finisher's festival area. It was pretty empty since not many people wanted to make the trek in the cold and rain. I was shivering. The music was horrible, the gear check was horribly disorganized so I decided not to wait for my bag for fear of becoming hypothermic. However, since there were so few people at the finisher's festival, I received about ten bags of potato chips and a dozen Clif bars because so few people came to take them.

All in all, it was a tough day with pouring rain and cold temperatures. I didn't hit my goal, but I think I did well given the extremes in the weather. I feel like if this was a warmer day without rain that I could have done better. But, as I know others fared worse than I did with respect to their goals and the weather, I am grateful.

Salad Du Jour

2011-03-17T21:18:00.000-07:00

Today's salad: tofu, lentils, korean veggies - lotus and burdock, mango, bell peppers, flax seeds, and avocado

One Week Until the LA Marathon

2011-03-13T20:23:00.000-07:00

I don't typically get nervous about races. But I am getting antsy about the LA marathon on March 20, just one week away.

I've been training hard. I've put in at least eight runs of 15 miles or longer. I've done them on about a ten minute per mile pace, and I've managed to run the last few miles of those runs on about a 9:00-9:15/mile pace.

I had a personal best half marathon time in January at the Los Angeles 13.1 -- 1:57:00.

Yesterday, my "taper" workout was a three mile warm-up, six miles at "marathon pace", and a one mile cooldown. I decided that for the sake of this run that 9:15 per mile is my marathon pace, and I managed to do that while keeping my heart rate in a respectable range of 155-165 per minute.

So what kind of time will that get me in a marathon? My personal best is 4:12 at Long Beach in 2009. I can beat that. One online pace calculator says that based on my half marathon that I can hit 4:08. My coach thinks I can hit 4 hours. I think 4:05 is a reasonable goal. I'm not sure.

I care so much about this because I want to qualify for the Boston Marathon. It's a far away dream, but I think that with the right training that I can do it. The qualification standards just got tougher, but that just means that I have to get tougher.

This week is a taper week. A few short runs, and some yoga and stretching. And hopefully plenty of sleep so that I am well rested and ready on Sunday.

Sunday Brunch

2011-02-20T20:25:00.000-08:00

Mom and I whipped up this brunch in about 30 minutes:

On the left is a tofu scramble with spinach and sweet potato. I sauteed this in a wok, with no oil added, just some pepper, turmeric, and garlic. On the right are pancakes made from the Aunt Jemima box mix -- instead of adding eggs, we used Ener-G Egg Replacer, a tapioca and potato starch egg substitue.

A big salad with lettuce, carrots, red peppers, cucumber, pear, ground flax seeds, and dried cranberries.

My plate -- loaded up with (clockwise from the top) salad with low-calorie mango vinaigrette dressing, Yves vegan sausage, tofu scramble, strawberries, grapes, blueberries, and pancakes topped with baked apple and Soyatoo whipped topping.

My Coke (Zero) Habit

2011-02-11T11:01:00.000-08:00

Growing up, and through college, med school, and internship, I drank plenty of regular pop/soda -- and I say pop because as a product of the Midwest, that's what it is -- pop, not soda. As an intern on call, I carried a 20-ounce bottle of Coke in my pocket.

Sometime around the end of internship, as I thought about all the empty calories that I was getting from soda, I decided to give it up. Since then, it's been a rare treat at a social event, limited to about four ounces, which is enough to fulfill my craving.

Then I started training for the Ironman. Life became work, sleep, train, eat, work, sleep... you get the idea. I was tired. A cup of green tea was my pre-workout fuel, but then the Coke Zero can became a fixture on my desk at work during morning clinic. I loved it -- the taste, the fizz, the caffeine, everything about it. Next thing I knew, I was drinking nearly a liter a day of Coke Zero.

Now, I've read Skinny Bitch, and I know there's concern about aspartame. And I know that putting processed crap into the body just isn't a good idea. But I love this stuff. I've cut back to one can, maybe two, per day.

A can a day can't be bad, right? Not according to the most recent data on the subject.

A recent abstract presented at the International Stroke Conference this week suggests that heavy consumption of both diet and regular soda in patients over age 65 is associated with a 61% increased risk of vascular events, including stroke and heart attack. The risk remained even after adjusting for other risk factors.

The study is not perfect -- it was a small observational study of 2500 patients at one site and looked only at older patients. While diet soda consumption has been linked to diabetes and the metabolic syndrome, this is the first study to link soda to vascular events.

So what about a 35 year-old vegan triathlete cardiologist with a one-can-a-day habit?

As I look across my desk at the empty soda can, I think it's time to give it up. I may continue to drink diet soda at social gatherings, but as a daily habit, it's just not necessary.

Sodium

2011-01-16T19:02:00.000-08:00

Sodium. Salt. It's the bane of my existence as a cardiologist.

In medical school, we learn that 85% of diagnosis is history. This is very true, especially when it comes to uncontrolled hypertension or congestive heart failure.

Why does sodium matter? Sodium consumption leads to retention of fluid. This can raise the blood pressure, and in someone with a weak or stiff heart, can lead to congestive heart failure.

When I encounter a patient with an extremely elevated blood pressure or new onset heart failure, the first thing I ask about is diet.

Me: Do you watch your salt intake?
Patient: Yes, I never add salt to my food.

And there is the first fallacy: Just because you are not salting your food does not mean you are consuming a low-sodium diet. There is often plenty of sodium in the food you are eating.

Me: What did you eat yesterday?

The answers to this question are always interesting. Here are some of the recent high-sodium items consumed by patients of mine:
Soup "but it was homemade soup, not from a can"
Pad Thai "with just a quarter of a cup of fish sauce"
Hot dogs
In 'N Out Burger
Pizza
Various foods on a cruise ship
Las Vegas buffet

If you are eating at a restaurant, you can assume you're getting a ton of sodium. Any soups, or entrees labled au jus, in broth, marinated, in soy sauce, these will all be highest in sodium. Or, if it comes from a box or a can at the grocery store, be cautious and read the label. And finally, any homemade broth from an animal is loaded with sodium -- the drippings of the animal are very concentrated in sodium.

Read here for more on diet and hypertension and heart failure.
Image from legacy.co.mohave.az.us

Resolutions

2011-01-07T21:11:00.000-08:00

My resolution is to do more yoga and to stretch.

Me and my nieces doing yoga on the Wii Fit

In the past, I've been of the mindset that you train hard to get better. Which to some extent is true. But, it's important to take care of your body too. Yoga helps to strengthen and stretch. Massage is good too. I think that a combination of massage and yoga has helped improve and nearly resolve a hip flexor strain that I had been dealing with over the past few months.

Journey to Health

2010-12-29T09:53:00.000-08:00

We all start somewhere.

This is where I started at age 18, an overweight college freshman who ate way too much pizza and ice cream, drank too much soda, and barely exercised.

If you scroll down to any post on this blog, you'll see pictures of me now. It's a big difference, not only in how I look, but also how I feel.

I share this because I talk about lifestyle change all the time with my patients. Diet and exercise are such important parts of heart health. Patients have said in various manners, and others have silently thought, how can a slender cardiologist who eats healthy and exercises regularly relate to me?

I can relate because, as you can see above, I've been where you are. I made my own journey from overweight unhealthy college student to fit and healthy cardiologist.

Just before starting medical school, I began exercising. And over the course of medical school, my eating habits improved. I ditched regular soda during my first year of residency. During my second year of residency, I ran my first marathon -- slowly -- in just under six hours.

Then, I started incorporating more vegetables into my diet. During the second year of my cardiology fellowship, I went vegan. And, over the past five years, through triathlon training and working with excellent coaches and personal trainers, I've become a better athlete, far exceeding my running times from when I was ten years younger.

In the meantime, I've struggled with my eating habits, particularly at night, when I have had tendencies to overeat. A couple of years ago, I worked with a nutritionist to help get some of my eating habits in check.

I'm certainly not perfect in how I eat, but I've come a long way. And I understand from my own experience that lifestyle change comes in baby steps. It doesn't happen overnight. But with time and with effort, we can all adopt healthier lifestyles.

Vegan Doesn't Necessarily Mean Healthy!!!

2010-12-19T17:17:00.000-08:00

I was reminded of this recently. A patient with high triglycerides told me of her intent to become a vegan. She ate two meals and usually one smoothie every day from a local vegan restaurant. While she was completely vegan at this point, her repeat blood work looked no better -- her triglycerides were still very high.

Why is this???

Not everything that is vegan is healthy. Salt and oil are vegan. So are avocadoes. And coconut milk. And white bread. So, even on a diet that is vegan, we can still be unhealthy.

And, it's important to remember that when you eat at a restaurant, you don't know what has been added to your food for flavor. Vegan or not, the chef usually does not care about your long-term health; he or she just wants you to love the food so you come back and buy more.

While I love a good restaurant meal, most of my meals are prepared at home. I usually pack a salad loaded with veggies and tofu slices or lentils and a piece of fruit for dessert.

Remember: A healthful vegan diet consists of plant-based foods that are unprocessed (or minimally processed), with lots of fruits and vegetables, with minimal (if any) oil, and low in salt.

My Team

2010-12-12T15:01:00.000-08:00

To provide excellent care, it takes more than one person. These are some of the people whom I am fortunate to work with every day.

From left: Ashley our office manager, me, Lizzy our receptionist, and Keely my medical assistant.

They're a great team who care about our patients. Lizzy is the friendly face that greets you when you enter the office and when you are leaving. Keely is the person who brings you to the exam room and takes your vital signs. And, Ashley works behind the scenes to schedule tests and keep the office running smoothly.

Going to a cardiologist can be and intimidating experience, and my wonderful staff helps to make our office a welcoming environment. Without them, I could not do everything that I do every day, and I am so grateful to have them.

Off-Season Training

2010-12-05T13:42:00.000-08:00

It's been a long off-season, or at least that's what I consider it, as I've been without a coach or a specific training plan since Ironman Lake Placid in July.

I still exercise most days, with three days of weights, three runs, and the occasional bike ride.

I was about to blog about "excuses" and the reason why we might stop exercising, with the premise of suggesting that we all get off our collective tuchus, stop coming up with reasons why we shouldn't break a sweat, and just get it done. But then Tuesday morning came -- I woke up, ate breakfast, drank my pre-workout green tea, watched the news to hear that it was 38 degrees outside, and then went upstairs and crawled back into bed for another hour and a half. I guess we all have our moments of inertia, and that was mine.

My running has consisted of three runs per week. Tuesday is a tempo run, Thursday is a hill run either on my own or by doing hill repeats with my triathlon girl friends, and Saturday is a long run. Yesterday's run was twelve miles.

Today I ran the Walk of Ages 5K. At the start, a man in front of me tripped, and I in turn tripped over him scraping up my left knee. But, we both got up and ran the race. In spite of the rough beginning, I finished third place woman overall (first and second place were teenagers!) and first place woman ages 30-39. My friend Miriam took first place in her age group 25-29.

Miriam and I and our gold medals!!!

Right now, I'm enjoying myself. While I am training for a half marathon in January, I am maintaining my fitness and not pushing myself too hard.

Vegan Thanksgiving

2010-11-21T19:24:00.000-08:00

My family celebrated Thanksgiving a week early. So, if you're looking for a few ideas of what to serve at your celebration, here's what we had:

Broccoli recipe from vegancoach.com -- broccoli sauteed with shallots, walnut pieces, and a tiny amount of olive oil and soy sauce.

Stuffing made by my sister-in-law's mother -- yummy with cranberries!

Field Roast celebration roast. We also had a Tofurky, but that had been polished off before I took a picture of it.

Sweet potatoes! My sister-in-law Mary Ruth made these. They are far healthier than you would think from their amazing taste! She mixed sweet potatoes, applesauce, and a little bit of Earth Balance spread, and cooked it in a crock pot.

Homemade cranberry sauce recipe courtesy of Chef AJ -- cranberries, oranges, and date paste whirred in my Vitamix blender. Don't mind my brother's maturity in the picture below.

Mashed potatoes and Tofurky gravy. I mix the potatoes with unsweetened soy milk, just a little bit of Earth Balance, a pinch of salt, and lots of pepper.

Happy Thanksgiving!!!

Get Healthy Challenge!

2010-11-16T19:54:00.000-08:00

The staff at my office has talked about how they want to get healthier, and if you read down a couple of posts, you can hear a bit of my own frustration of maintaining my weight when not training for a major event.

As a result, I started the West Hills Multispecialty Office Get Healthy Challenge! It is a five week challenge to eat better, adopt positive healthy habits, and lose weight. The challenge started yesterday with a weigh-in. I've offered up a $100 prize to the person who loses the most weight. I've also given everyone a copy of the book Skinny Bitch for inspiration, since no one quite says it like Rory and Kim.

Each day, I am providing a health tip. Today's tip: Pack a lunch so you're not tempted by unhealthy choices around you. Yesterday: Soda has 100 calories per eight ounces -- cut it out! I think I'm also going to have a "Skinny Bitch Potluck Lunch in a couple of weeks.

Nine people in my office are participating, and so far there's a lot of buzz.. I'm really excited!!!!

Cookin' With Chef AJ!

2010-11-10T20:55:00.000-08:00

Chef AJ is a plant-based chef who prepares unprocessed foods with no sugar, oil, or salt. I've taken some of her classes and have loved her food, but have never prepared any recipes, until now.

This is my Vitamix, and in it I am making her "Dream of Tomato" soup. It includes tomatoes, red peppers, lemon, and some spices. I love the "Hot Soup" function because it blends everything and at the end of a few minutes, you have.... guess what? Hot soup!

To make it my own, I added flax seeds and a cup of soy milk.

And, here's her Cranberry Relish. At Thanksgiving, I make cranberry sauce every year. It has orange juice, which is very sugary, and then even MORE sugar added. AJ's version is simple: Cranberries, oranges, and dates. And psyllium husk, which I didn't have, so I didn't use, but it doesn't need it.

I love this stuff. I'm going to make this for my family for Thanksgiving, but for them I'll probably add a few extra dates to make it sweeter.

Learn more about Chef AJ's classes: http://www.chefajshealthykitchen.com/

Success and Relapse

2010-10-30T16:58:00.000-07:00

We're doing great. We've lost weight. Look awesome. Ran our first 5k. Completed a marathon. Or an Ironman.

And then, perhaps complacency sets in...

We aren't quite as careful... the exercise drops off, the good eating habits slip. And there's a bit of denial... I still look good, my clothes still fit, I've only gained two pounds. Four pounds. Then ten pounds.

But the reality is, often we relapse from the good habits we've adopted.

That's a position I find myself in. After Ironman, my exercise has decreased dramatically, as it should -- 20 hours of exercise per week is way too much. I'm still working out six or seven days a week, but the intensity of those workouts has decreased, or they're shorter. I walk/run with the dogs and call that cardiovascular exercise, when that is nothing compared to what I used to do.

And I'll have to admit, my eating habits haven't adapted entirely to that change. And here I am, seven pounds heavier than when I finished Ironman Lake Placid.

It's time to get back on the wagon..

I'm writing down everything that I eat. I'm being more mindful of my portions. And, I'm making sure that I get an hour of cardiovascular exercise every day.

I will do better. We all can. Tomorrow is a new day, and going forward, I will get back to where I was.

Dog Companionship Can Make You Healthier

2010-10-12T21:06:00.000-07:00

I've had my pooches for six weeks now. It's been an adjustment for all three of us. I've learned that it takes dogs time to build up stamina for long walks when they've lived in a kennel environment all of their lives. And they've learned that my dining room floor is not a toilet.

Curves and Gold, my rescued greyhounds, have been so wonderful to have. As I've mentioned before, they make me a happier person. They always greet me with wagging tails.

There's great benefits to owning dogs. Dog companionship has been demonstrated to lower blood pressure and cholesterol. Dog owners have less depression. They get over acute illnesses much quicker. And dog owners live longer.

Of course, if you're looking to get your own dogs, rescue. NEVER buy from a breeder. So many dogs need loving homes.

If I eat healthy, can I avoid statins?

2010-10-10T17:39:00.000-07:00

Recently, I gave a talk to a group of participants who are following an unprocessed, plant-based diet for thirty days. I spoke about what heart disease is, the risk factors for heart disease, and how to prevent it.

Interestingly, the most popular topic was statin medications. Several of the participants wanted to know why statins, which are cholesterol-lowering medications, could be needed if an ideal healthy plant-based diet is followed.

Yes, diet is very potent at lowering cholesterol. In fact, a plant-based diet can be as potent as the highest dose of statin medication in lowering cholesterol levels. However, in spite of a "perfect" diet, they may still be recommended.

Diet is powerful, but there are certain circumstances where statins are indicated:

- When diet and exercise are not enough to lower the LDL cholesterol to goal, which may be the case even in people who are following a pristine diet

- Coronary artery disease, history of heart attack, diabetes, peripheral arterial disease, and stroke -- even if the LDL cholesterol is low, statins have pleiotrophic effects, which means that they do more than just lower the LDL level. They reduce progression of arterial disease, improve the lining of the arteries, and reduce occurrence of heart attacks and strokes.

There are randomized controlled studies of hundreds of thousands of patients that definitely support the use of statins to prevent arterial disease in patients who have risk factors but do not yet have arterial disease and also in patients who already have disease.

I wholeheartedly support a plant-based diet and exercise to get cholesterol to goal, especially since I am a vegan and avid exerciser. But some people simply cannot get to that goal, and others have risk factors that indicate a strong benefit from a statin medication.

Newsletter Feature Article About Me

2010-10-07T23:00:00.000-07:00

It's great to be recognized by my employer for my triathlon endeavors:

New Creations in My Kitchen

2010-10-03T11:29:00.000-07:00

Two creatons made with my new Vitamix blender:

Truffles!!!

Now, I can't quite give away all of the ingredients just yet because they will be entered into a competition this evening and I think these truffles just might be able to win. The concept is easy, though: Mix a nut with dried fruit and dates to sweeten them. Or add cacao to make something chocolatey. Put them in the freezer. Then serve. Yum.

Green Smoothie

Mix one cup of almond milk, one banana, seven strawberries, and two handfuls of kale. Since I had just worked out, I added one scoop of chocolate Sun Warrior protein. On the Vitamix, choose the "smoothie" operation and the machine does all the work. Or you can make this with your own blender. Amazingly nutritions and tastes very good, even though it's green :)

Bill Clinton Adopts a Plant-Based Diet

2010-09-25T20:50:00.000-07:00

Former President Bill Clinton, once known for his trips to McDonald's while in the Oval Office, has gone nearly vegan.

He underwent coronary artery bypass grafting surgery in 2004. He then had an angioplasty of one of his vein grafts in February 2010. Here, he talks about why he changed his diet:

I wish him the best -- it sounds like so far he feels great and has lost some of the excess weight that he was carrying. I also hope that the publicity of someone as prominent as him switching to a plant-based diet inspires others to be healthy.

End of a Season

2010-09-19T21:43:00.000-07:00

Best to end the season on a high note..... my 2010 races:

Los Alamitos Race on the Base -- 4th in age group, my first reverse triathlon (run - bike - swim)

Wildflower Long Course -- 7:39:25, not a good race, 28 minutes slower than last year, much due to lack of sleep in the days leading up to the race

Redondo Beach Sprint -- 2nd place Athena -- on the day after riding 125 miles

Ironman Lake Placid -- 14:45, hitting my goal of finishing my first Ironman in under 15 hours, and screwing up my right knee in the process

Malibu Classic -- 2nd place Athena, on a screwed up knee and basically no running for seven weeks

Long Beach Tri -- today -- ending the season -- FIRST PLACE ATHENA!!!! Had I raced as an age group athlete, I would have taken fourth place. But, I'll use my size advantage while I have it :)

Was I Supposed to Train for this Race?

2010-09-16T21:30:00.000-07:00

It's been a crazy five years. Five years ago, I spent an entire summer training for a sprint distance triathlon. On Sunday, I raced the Malibu Classic triathlon seven weeks after completing an Ironman, and on no particular training schedule.

I didn't think about it until a friend talked about his "taper" for the race. And it came to me -- Was I really supposed to train for this?

Life since Ironman has been more mellow. I've been focused more on weight training, lifting five days a week, which I've never done before. I've been swimming twice a week with the Fortius coached swims, cycling when I feel like it, and running hardly at all due to a slow-to-recover tendinitis in my right knee.

Actually, let me be more honest about the knee issue: I'm stubborn. I was told not to run for two weeks after the Ironman. I ran in one week. Bad idea. Then I ran five miles on concrete a week later. That was a worse idea that led to me limping for the next three days. Gradually it's gotten a bit better but I've tried a few times to increase the running and it has not worked.

In total, I've run less than fifteen miles in the seven weeks since Ironman. So why not go out and run four miles at the Malibu Classic? Sure!

The knee was bad all week before Malibu. But I had already paid big $$$ for the entry and the race is more like a social hour than an actual competition. Or at least that's how I treat it.

I raced in the Athena category, as a woman over 150 lbs. Don't get me started on this one, but I'm a tall girl at 5'10", and my current 156 pounds makes me a normal-sized person, not an "Athena". But the long legs... huge bike disadvantage. Huge. Really.

The water was ice cold -- 58 degrees. While warming up, or shall I say freezing in the water, I contemplated skipping the whole thing. I hate cold water. And with my knee not behaving, I had no idea if I could even complete a four mile run without excruciating pain.

You really want me to swim in this ice cold water???

My swim was strong. I knew I was doing well since I was surrounded by swim caps from the previous wave of athletes. Running on the sand out of the water led to excruciating knee pain.

There was only person at the Athena bike rack, and the rest of the bikes were still there, so I figured I was in second place. Number one took off, and I was about a minute behind. Putting on a knee brace took another twenty seconds in transition.

I decided that my bike strategy would be to haul ass -- my run is usually my strength, and with my knee in the condition it is in, I had no idea how slowed I would be by the pain, or if I could even *finish* a four mile run. Dropping out was a definite possibility, so I might as well just kill it on the bike. A couple miles into the bike ride, I saw another rival with the "ATH" on her calf. She passed me, leaving me at #3. I then passed her on a climb. And she passed me again. We chatted -- I told her that I thought she and I were #2 and #3 and that I'd see her on the podium.

She and I leapfrogged positions on the bike. Shortly after the turnaround, I passed #1 who was struggling on the climb out of Leo Carillo beach. But, the other girl was ahead of me, so at this point I thought I might be #2. At the time I didn't know it, but there was another Athena out there ahead of all of us.

My bike-to-run transition is a little longer because I don't ride a bike in socks, but I have to put on socks to run. I was surprised to find another Athena at the rack putting her shoes on to run. And, the girl who led initially passed me in transition, and I passed her about 30 seconds into the run.

Surprisingly the knee wasn't all that bad. It hurt, but it was a consistent, moderate ache that didn't seem to get worse. I came upon another "ATH" on the run who I didn't even realize was out there. I passed her. I passed a lot of runners, and as it turned out, my pace was about 9:10 per mile, where a year ago it was 8:30.

My finishing time was about 2:05.

I found my new friend from the bike ride. I figured we had podiumed, and my guess was that I was third place. I was wrong...

... I was second place!!!!!!!!!! Out of 23 athletes in my category!!!

Second place on the podium, rockin' my stylish knee brace.

It feels great to be on the podium, and a great birthday present to me :)

New Housemates!

2010-08-31T21:51:00.000-07:00

Introducing my new friends:

Curves

Gold

Curves and Gold are rescued greyhounds. Bred for racing, they spent a year and a half as canine blood donors, and then another six months in a kennel waiting to be adopted.

They're beautiful and sweet dogs. They are long time friends, and yet have completely different personalities. Gold, a 6 1/2 year-old male, had a two year racing career in West Virginia, with several first and second place finishes. Curves, a 4 1/2 year-old little girl, never raced -- at 51 pounds, she's tiny for a greyhound, and she'd rather play with toys, particularly those that squeak, than focus on racing.

Dogs are great to get us out the door. They love to walk and run and play. As for running, greyhounds are sprinters. Kind of the opposite of me, the Ironman :) At most they'll jog 3-4 miles, and the rest of the time they are couch potatoes. Curves and Gold will jog about a third of a mile with me, and after that, they're done. I'd love to build them up to a couple of miles, but for now, I just love throwing tennis balls to Curves in the backyard while Gold chases after his little doggie friend Curves.

And there's just something so wonderful about coming home to two friends eager to see you. I feel like there's something about me that's just happier having them around.

I'm in the Sports Section!

2010-08-28T20:08:00.000-07:00

From this week's edition of my hometown paper, the Detroit Jewish News.

Not bad for someone who was in "special gym" in elementary school for being unable to stand on her right foot, or the girl who gained twenty-five pounds during freshman year of college from being sedentary and eating too much junk. I am proud to say that I've come a long way.

Try Vegan -- For Cheap!!!!

2010-08-27T16:26:00.000-07:00

There's a great deal from Gobble Green. For those of you in the Los Angeles area, they'll deliver a week's worth of food -- that's seven days worth of food, three meals a day -- for $99! An amazing deal. And the food looks delicious.

The deal is only good for two more days. Get your Gobble Green food delivery today!!

Low-Carb Versus Low-Fat

2010-08-18T22:00:00.000-07:00

Every so often, one of the journals will publish a study trying to compare a low-carbohydrate diet such as Atkins to a low-fat diet.

Last week's Annals of Internal Medicine had a comparison of patients following either diet for two years. Weight loss at two years was about the same, but on a few parameters, such as change in HDL, the low-carb diet was superior.

There are a few problems with the study. First off, low-fat was defined as 30% or fewer calories from fat. 30%? Really?! I would hardly call that low-fat. Also, there's nothing stating what people actually ate. When people in previous studies have been told to consume 30% fat, their fat intake actually hovers around 36%. That's definitely not low-fat.

If you look at Dean Ornish's studies on low-fat diets in patients with coronary disease, the fat content prescribed is 10%, and those patients had overall regression of their coronary disease and improvement in their lipids, even in the absence of statin medication. Perhaps 10% fat is challenging for most to obtain, but I think 30% is way too high to be called low-fat.

Look closely at the patient populations of the low-fat versus low-carb studies such as this one. They're overweight but remarkably healthy. They don't have diabetes and aren't on statin medications for cholesterol. Their blood pressure is under pristine control. And of course they don't have coronary artery disease. These are characteristics vastly different from the general American public, and a huge departure from the typical patient whom I see in my office.

Here's my problem with the concept of the Atkins low carbohydrate diet: We weren't designed to eat that way. Think back to our predecessors who dwelled in caves. They didn't eat huge quantities of meat. And admittedly, they weren't vegans either. They ate the little meat that they could hunt down, catch, and kill. There was no McDonald's drive thru or a supermarket meat counter to buy a prepared slab of meat.

I strongly believe that a plant-based diet is the best option for health. Plant-based diets reduce risk of coronary disease, lower blood pressure and cholesterol, help to manage and reduce the risk of diabetes, lower body mass, and reduce the risk of many cancers.

Worldfest

2010-08-18T21:50:00.000-07:00

I just found this, and thought I had published it. Perhaps not. Better late than never -- it was written back in May.

Worldfest, a celebration of all things vegan, took place today in Encino.

There were lots of food vendors and yummy things to try. I enjoyed Olade, a low-calorie drink (20 calories per 8-oz bottle), and in particular their Tropical flavor. I promptly went to Whole Foods afterward and picked up several bottles. Rawsheed had great raw pizza samples, and this was an amazing introduction to his very creative line of raw cuisine.

For dinner, I needed something unique. So I hit up Strictly Vegan, a Jamaican catering company out of Rancho Cucamonga:

This was a spicy treat! Gardein vegetarian chicken with peas and carrots, squash, rice and plantains.

And of course there were the speakers. Rip Esselstyn was speaking as I came in. He's the firefighter behind the book The Engine Two Diet, and the son of famed cardiothoracic surgeon Caldwell Esselstyn. His talk basically can be summarized as: It's not about curing heart disease -- it's about eating the right things and taking care of your body so you don't need a cure. Amen to that -- the message that I try to get across to my patients on a daily basis.

And finally, after Ironman Lake Placid when I have more time, I want to adopt a dog. I spent a lot of time talking to the folks at CalGAP, California Greyhound Adoption Promotion, who promote adoption of ex-racing greyhounds. I asked them important questions like, with a doggy door can I leave a Greyhound when I'm at work? Will the dog go jogging, and how far?

About that knee... and what CAN I do??

2010-08-12T22:08:00.000-07:00

The knee felt great. On Sunday, I ran a half mile warmup before lifting some weights. So, on Monday, it made sense to run five miles. On concrete.

Wrong answer.

I then proceeded to limp for the next two days. But I listened to the advice I give my patients: If you can't walk, then get in the pool. So I got in the pool and I stretched and I swam.

The knee still aches, but it's better. I know I need to not run for at least two weeks. And this bums me out, and I could sit and stew on it and be mad.

Or I can look at it in a more positive way: Here are all these days when I would have run, and now I have the opportunity to do something else.

Yesterday, I climbed up and down Sepulveda Boulevard for an hour on my bike. That was fun. Tomorrow morning I'm swimming in the open water. On Sunday, a friend and I are doing a dance class.

It's all in how you look at things. Were it not for an injured foot six years ago, I would have never dusted off my old mountain bike and I certainly never would have jumped into the pool to brush up on my freestyle stroke, and I never would have done my first triathlon, let alone the Ironman that I completed less than three weeks ago.

I can't run. But there's so much else that I CAN do.

Sun Warrior

2010-08-11T22:26:00.000-07:00

I tried a new protein powder -- Sun Warrior Raw Vegan Protein, in vanilla. It has 70 calories per serving with 16 grams of protein. The number one ingredient, interestingly, is raw sprouted whole grain brown rice, and according to the label it is one of the most easily digested proteins.

And yet, it tastes terrific! I've mixed with soy yogurt, and this evening I made a smoothie with one scoop of vanilla Sun Warrior, one cup of strawberries, half a cup of blueberries, and a cup of ice.

At 200 calories, this smoothie is very filling.

Ironman -- The Day in Pictures

2010-08-08T09:33:00.000-07:00

Out of the water after two miles, pulling my wetsuit off.

Beginning the bike ride

Beautiful scenery on the ride....

Leading the pack! Okay not really, but the picture sure makes it look like I am.

Running the marathon. Having fun. :)

The finisher shot!!!!!!!!!!!

Limping on an excruciatingly painful knee, and somehow couldn't get the grin off my face. I'm an Ironman!!!!!

After the Ironman...

2010-08-04T22:26:00.000-07:00

It's been ten days since Ironman Lake Placid.

To answer the question I've heard the most: How's the knee? -- It is still sore.

I took off the two days following the race from exercising. I was traveling, but my knee still hurt, and it's hard to exercise while limping.

I was back in the pool last Wednesday and swam 1000 meters in about 28 minutes. I was slow. I was tired. But it felt good to get back in the pool.

I've worked out every day since. I have taken it easy though. I've swam a few times, went to a spin class, got on an elliptical, and even took a choreographed dance class. It's been really interesting being without a coach and a schedule.

On Sunday, I tried to run. I had been pain-free in my knee for two days and thought I could do it. Nope. About three quarters of a mile in, it hurt. It hurt worse at a mile so I turned around. A mile and a half into the run, I had to walk.

While nothing would make me happier right now than going for a run, I know that I can't. I've learned from past experiences that ignoring minor injuries turns them into more major injuries that will keep me out of running for even longer.

I've changed the focus of my training. Rather than focusing on endurance, I'm focusing on bodybuilding. I'll be weight training five days a week. I've never done this before, but I look forward to the challenge.

Food as Medicine

2010-08-01T11:43:00.000-07:00

One of my new favorite shows is "Losing It with Jillian Michaels," and one of the points that she makes is that your food can be the poison that kills you, or it can be your medicine that makes you healthy.

I love to eat. Over time, my diet has evolved from grilled cheese, fries and coke, to far healthier choices. Needless to say, salad was not always part of my repertoire.

Above is one of my favorite salads. It's healthy too. On a bed of organic lettuce, I add some of my favorite veggies, like carrots and peppers, slices of fruit like mangoes and apples, tomatoes, avocado, and 150-200 calories worth of protein like lentils, marinated tofu, Field Roast, or Chick'n-free Chicken from Follow Your Heart.

I don't add salad dressing. Rather, I let the salad marinate in the tomatoes and fruit, and no calorie-laden dressing is needed.

I get my organic lettuce and bulk veggies and fruit at Costco. Or I buy from local farmer's markets. Trader Joe's has marinated tofu or lentils in their refrigerator section, and Follow Your Heart in Canoga Park (if you live in LA) has lots of "fake meat" options, including my favorite, Chick'n-free Chicken. Field Roast, a soy-free "grain meat" sold at Whole Foods, has a meaty texture and tastes great sliced in sandwiches, cubed in salads, or cooked with veggies and mashed potatoes.

Ironman Lake Placid -- The Race Report

2010-07-27T21:40:00.000-07:00

This may be my longest blog post ever, but it was an amazing day that I will never forget, and there are so many things that I want to share.

My goals for the day: Finish in under 15 hours, preferably without a glow-stick – racers who are out well after dark are forced to run with a glow stick so that they are visible.

Pre-Race

We arrived at 5 am to be body-marked with our race numbers written on our arms and legs with permanent markers, inflate the tires of our bikes, drop off our “special needs” bags, and pee about three or four times (luckily the port-o-potty lines moved fast). I then handed off my morning clothes to my parents, who were so fabulous to drive all the way to Michigan to watch me race.

Swim – 2.4 miles

The swim was a two loop course in Mirror Lake. I entered the water and the nerves kicked in. Though there was an underwater cable which could be used to sight the direction of the swim easily, that area was incredibly crowded so I elected to position myself in an area a bit less crowded to the side. My swim distance would be a bit longer, but it would be less stressful and hopefully with fewer kicks, elbows, and scratches. I treaded water as we waited for the start gun at 7 am.

There were over 2,600 of us starting the swim, and triathletes can be aggressive. Within thirty seconds, someone kicked me in the chin. I tried to find clear space, which was challenging amongst this cluster of people. My ankles got scratched numerous times by other swimmers’ watches. By about five minutes in, I finally had some clear space in front of me, though throughout the swim people constantly were knocking into me.

I completed my first lap in just over forty minutes. This was definitely on track to my goal of finishing in less than an hour and thirty minutes. For some reason, the cluster of men in front of me were taking their time getting out of the water. I dashed around them and back into the water for my second loop, rejoicing in my excellent first loop time. This time I managed to find my way onto the cable, at least for about five minutes. But, even though we had spread out a bit, the cable was still crowded and I again drifted to the outside.

Total swim time: 1:23:09. Well under my goal of 1:30.

First Transition

Again, people were way too slow getting out of the water. I dashed around various stragglers, pulled my wetsuit down to my waist, and found a wetsuit stripper. It’s a cool process – the athlete lies down and two people pull the wetsuit off of you. It’s much faster than taking it off yourself. I threw the wetsuit over my shoulder and ran, and again, most people were not running or were barely shuffling, so it was a process of darting around people again to get to the transition area, which was a block away and across the street.

Transition at an Ironman is entirely a different process from at any other triathlon. I grabbed my bag of bike transition items and dashed into the women’s changing tent. Forget modesty – clothes are coming off quickly and there are volunteers in the tent to help us with whatever we may need. I tore off the swimsuit, which took a bit of effort, and put on my shorts and tri-top. As I put on my bike shoes, took a few bites of my Purefit bar, put on my hemlet, stashed my sunglasses for the time being (it was very dark in the tent), and stuffed my swim gear into my bag, I asked a volunteer to put sunscreen on me. I handed the bag off to a volunteer and ran out of the tent holding my banana, trying to figure out where to stash it because I wasn’t ready to eat it quite yet. As it was too big for my pockets, I stuffed it under my sports bra strap, which held it in place.

Transition #1 time: 12 minutes (could have been a little faster, but with a long bike ride ahead I prefer to be prepared and comfortable)

Bike (112 miles)

I ran out of the transition area with my bike and saw LA Tri Club friends Gerardo, Ray, and Karen. I waved, pumped my fist in the air, and nearly fell off my bike in all of the excitement.

Start of the bike course. Banana stashed at top of shirt. Fist in air and almost falling off my bike.

The bike course at Ironman Lake Placid is known as one of the toughest. It consists of two loops of the course. While the first thirty miles includes a nice long downhill and some rollers, the last twenty-six includes a long steady climb followed by some flats and then yet another set of climbs. Living in Los Angeles, we have the Santa Monica Mountains nearby. Early in the season I did a lot of long steady climbing, and my training has consistently included hilly portions of PCH (Pacific Coast Highway), so I was ready for this course.

The biggest mistake that one can make on the Ironman Lake Placid course is to ride it too hard, especially in the first loop. 112 miles is a long way to travel, and killing one’s legs on the bike leaves little reserve to run a marathon. Therefore, I made a consistent effort to not push all-out on the bike.

A lot of the bikes had fancy wheels, and many riders had the sophisticated aero helmets. I was amused that with my Cervelo P2C, standard wheels, and normal helmet, I was able to ride faster than some of those with the fancy equipment. That said, the bike is still my weakness, and with that in mind, I knew that I would be passed frequently. One very important rule: Two kinds of people will pass by on the bike – those who are faster, and those who will be walking the marathon course.

The first few miles had some gentle climbs. Then there was a nice, several mile long descent into the town of Keene. My speeds were up to 45 miles per hour, which was a little scary with the rain coming down, but I held onto the handlebars as opposed to my aero bars. Then there was a fairly flat ride north, an out-and-back on a slight hill. Then the race really began as we turned out of the town of Jay and headed uphill into Wilmington. While not a very steep hill, it was a long and challenging hill. Once into Wilmington, the course flattens for a while, and as we head back to Lake Placid, there are several climbs followed by flats.

The loop back through Lake Placid is exciting – spectators are screaming and cheering. I stopped to get my “special needs” bag, with a Tofurky sandwich in it, and I eagerly explained to the volunteer who gave me my bag exactly what Tofurky is. I saw my parents and I saw my friends again. Then I did the bike loop all over again, just a bit slower, but still feeling strong.

I have to give huge props to the volunteers at the aid stations. They were kind, encouraging, and upbeat. I would get off the bike to use the port-o-potty, and a volunteer would hold my bike and ask if I needed anything, like another bottle of water or sports drink. When I came out, I would have that bottle and be ready to go. I thanked the volunteers every chance that I could; they made my day.

Bike time: 7 hours, 38 minutes. The second loop was only a bit slower than the first. Surpassed my goal time of 8 hours.

Transition #2

I passed my bike off to a volunteer with the bike shoes still clipped in, and ran barefoot to grab my transition bag. This time, I did not need to change clothes, though I did have a spare shirt in case I felt the need. I chose not to go into the dark and smelly changing tent and instead sat down on the grass to put on my shoes, socks, and visor and stuff my pockets with my snacks. I had a peanut butter and jelly sandwich which definitely hit the spot, took a few bites, then ran into the changing tent for more sunscreen and to drop off my bike equipment, and out for the run.

Run – 26.2 miles

Starting the run -- PBJ sandwich in left hand, high-fiving someone with the right

Up to this point, I felt great. My energy level was high. I ran the first half mile stuffing my face with PBJ. Yum. I knew to keep my pace conservative at the beginning in order to conserve energy for the end, but with the downhills it was hard to hold back. I wanted to run eleven-minute miles, and considering that in my best marathons my pace has been about 9:40 per mile, I thought this would be no big deal. Little did I realize just how much a long swim and bike would take out of me.

The first six miles went well, and I averaged 10:55 per mile. Then I slowed down. My knees were aching, and my pace gradually became 12-13 miles per hour. I felt like I was running faster, but I definitely was not.

The aid stations were fully loaded – sports drink, water, pretzels, bananas, orange slices, Powerbars (not vegan, so I had my own Clif bars in my pockets), energy gels, cola, and chicken broth (another non-vegan item, but no big deal since I didn’t feel like I needed more salt). At each aid station, I would drink a few ounces of sports drink and a few ounces of water. I walked those few steps as I drank, because with this long of a day, it wasn’t worth the few seconds I could save as I choke on my drink while trying to run with it. I ate well while on the bike so I had enough energy and didn’t need to worry too much about eating while running. And, I definitely was hydrated enough since I was peeing quite frequently, perhaps a bit too frequently, but that is better than the alternative -- dehydration.

The run was an out-and-back twice. Again, running back into Lake Placid, the crowds were amazing and encouraging. There’s a hill heading back toward the Olympic Oval, and while most other people were walking, I was running up that hill with the biggest grin I could muster, which helped me find more crowd encouragement. I run hills – I love them!

I saw my parents as I started the second loop and handed them a few extra items from my pockets and gave them a high-five. “Go have dinner – I’ll see you at 9:30!” I yelled.

My right knee gradually ached more and more on that second loop. I ran into Mark, an athlete of my former coach Mary Eggers, who I had met just a few evenings earlier. I talked to him through miles 14-15, which took my mind off the pain. He walked, and I kept running. The second loop felt longer than the first as my knee ached.

Around mile 19, the pain was getting severe and occasionally sharp. But, I kept running. My run pace hovered around a miserable 13 minutes per mile. At mile 22, I realized that continuing to run in excruciating pain was not a sustainable strategy, so I started to power-walk. I’m sure I looked ridiculous, swinging my arms and taking big steps. My pace was not that much slower than my jog/shuffle, and my knee was not nearly as painful.

There were a lot of ambulances – over the last half of the run I saw over a half dozen of them. I reminded myself that I was lucky that I was still on two feet and not on my way to a hospital.

As we got into town, around mile 23, Mark from Rochester caught up with me – he said, “Run this with me” or something like that. I said, “I don’t know if I can, but I know I should.” I started to run again. The knee hurt, and I winced with every step. Luckly, we were heading back to town with all the crowds, and their energy carried me. Again, I put on my biggest grin, a smile hiding me gritting my teeth with pain. I saw the hill back into town and I kept on running it. I saw my roommate Liz, who qualified for Kona that day, who in spite of already having finished and having spent time puking in the medical tent still mustered the energy to wait to cheer me on. “You’re the only one running up this hill!” she yelled. And on I went. At mile 25, I started to walk again. Mark caught up with me, and I looked at him and said, “I need to run now,” and off I ran.

The crowd was great – “You’re almost there!” That last mile was the longest of my life. As I headed into the Olympic Oval to finish, I saw Gerardo, Ray, and Karen, and they took this picture. Looking at it, you have absolutely no idea how much pain I was in, but from that point, endorphins carried me forward.

On my way into the Olympic Oval -- Can you tell that my knee is killing me?

The crowd was amazing and loud as I ran into the Olympic oval. One runner passed me, and I let him go ahead of me so that he would have his few seconds to himself as he finished. As I approached, I heard the voice of the infamous Mike Reilly, who announces all of the Ironman races, “Heather Shenkman, of Sherman Oaks, California…. YOU ARE AN IRONMAN!”

I remembered to smile and keep my arms high in the air so that I’d look good for my finisher picture. The finisher picture looks awesome, and I'm carrying it around in my white coat pocket to share with everyone. Once I have a digital version, I'll post it.

A volunteer held onto me as I nearly passed out at the finish line. I posed for my finisher picture, received my finisher’s hat and shirt, and limped over to meet my parents. I had just completed 140.6 miles and now I could barely walk. Mom and Dad carried my stuff (and luckily they did not need to carry me!) and helped me get my bike to the area to be transported back to Los Angeles, and then drove me back to my hotel. If they were not there, the end of that race would have been grueling – I have no idea how I would have hobbled with my belongings and my bike and how I would have gotten back to my hotel.

Overall time: 14:45:25. Better than my goal of 15 hours. And without a glow-stick. My splits were pretty consistent, and even with my knee issues my run time didn’t drop off at all.

The day after the race....

It was an amazing day. But I will never do another Ironman. Why? I’ve done one and I am now and Ironman. I have nothing more to prove. I value my free time, and I look forward to spending that time with my family, my two nieces, and my friends, and fulfilling one other dream: getting a dog.

Two days later, and my right knee still aches and I am still limping. With ice and ibuprofen, it should feel better soon, and I will slowly get back to a scaled-down workout routine.

I Am An Ironman!!!!

2010-07-26T15:26:00.000-07:00

I did it!!!

It was an amazing and challenging day. My finishing time was 14:45, which was within my goal of finishing in under fifteen hours. I feel great, though my right knee is a bit sore.

The full race report in all its glory is coming soon.

Tomorrow is the Big Day!!!

2010-07-24T11:01:00.000-07:00

Tomorrow is the Ironman.

I did a short swim in Mirror Lake this morning, dropped off my bike, and then a short run. Now I'm relaxing. Drinking water. Trying not to be nervous.

My goal is fifteen hours. If I have a good day I might be able to pull this off in under fourteen hours.

You can track my progress at IronmanLive.com. My bib number is 2553.

I've put in the training and I'm ready. Here goes nothing.

Live from Lake Placid!

2010-07-23T13:34:00.000-07:00

Sunday is the big day.

We arrived on Wednesday night, after two flights cross-country and a 2 1/2 hour drive from Albany.

Race Check-In at the Lake Placid High School gym

On Thursday, we checked in for the race. The details are mind-boggling. We were ID'ed at least twice, weighed in (so that if we end up in a medical tent that the personnel will know our healthy weight), and received our race numbers and bags.

The product expo

LA Tri Club friends

We bought schwag with the race logo on it, including t-shirts, workout clothing, water bottles, and the obligatory M-dot sticker that will go on the back of my car to commemorate this event.

Then we went swimming in Mirror Lake. It's a beautiful lake, very clear, and on Sunday will be very crowded.

Bike course -- sketchy roads, beautiful scenery

On Friday morning, we went for a 45 minute bike ride followed by a 20 minute run, all at relatively easy paces. The bike ride was over one of the more challenging parts of the course, which I had no trouble on, and gave me a little bit more much-needed confidence.

Tonight (Friday) is the welcome dinner, followed by the mandatory pre-race "talk".

More to come....

It all started in Upstate New York...

2010-07-20T21:05:00.000-07:00

Five years ago, I was a cardiology fellow-in-training and a repeatedly injured recreational runner. To stay in shape, I dusted off my clumsy mountain bike that I bought in 1992 at Toys R Us before heading to college. I also did spin classes and I swam.

My spin class instructor, Mary Eggers, was a triathlon coach. One day, once I could finally start to run again, I asked her if she thought I could do a triathlon.

I spent the entire summer of 2005 training under Coach Mary's guidance for a sprint triathlon. Then in September 2005, I completed my first triathlon, the Finger Lakes Triathlon. I had a blast that day. And, from there on out, I was hooked.

In the past five years, I moved to Boston and then to Los Angeles. My world has changed more than I could have ever imagined -- new jobs, new people, new homes. But, triathlon training has stayed constant. It has been my link to meeting some amazing friends. It has been my stress relief. And it has been my source of strength when I have had tough days, to go pound the pavement for a run or jump in the water for a few laps to sort out my thoughts or to escape.

This week, I will be returning to upstate New York, to Lake Placid, for my first Ironman distance triathlon. That's a 2.4 mile swim, 112 mile bike, and 26.2 mile run. 140.6 miles in one day. I'll get to see Coach Mary who hooked me on this sport. And, I'll have the chance to complete my biggest physicial challenge yet: The Ironman.

Taco Dip

2010-07-19T21:04:00.000-07:00

I love entertaining, and now that I have my own home I have an opportunity to do it. It's an opportunity to share delicious vegan food. Here's one of my favorite recipes: Taco Dip.

There are four layers, from bottom to top:
Refried beans

Guacamole

Tofutti brand sour cream

Daiya "cheddar" cheese

This dip goes fast, and guests are left wondering if this comfort party food really is vegan.

The Ironman Blues

2010-07-10T20:32:00.000-07:00

After all of this training, who would do an Ironman again?

I did my long workout today, on call. 64 miles on the bike, along the same nine mile loop, so that I'm close enough to my hospital in case I need to tend to a sick patient. I was exhausted the minute I got on the bike. Four and a half hours later, I was wiped out, my eyes dry from riding, perhaps a bit woozy from the heat. Then I put on a pair of running shoes and ran six miles.

Don't get me wrong -- I want to be an Ironman more than anything else. I love exercise and the way it makes me feel. But, this is more than I ever care to put my body through again.

One more long workout tomorrow. Then I taper.

Sixteen more days to Ironman Lake Placid.

The Secrets of Thin People

2010-07-08T21:22:00.000-07:00

There is no such thing as naturally thin.

If you are looking to lose weight, watch thinner people -- they have different habits. Watch at a party what they are eating. How often do you see them hitting up the buffet table?

A few other secrets of thinner people:

They eat breakfast.

They eat several times a day.

They exercise regularly.

You'll often find them taking the stairs instead of the elevator.

There's no need to obsess over diet and weight, but if you watch closely, you'll see that thinner people have different habits that keep them at a healthy weight.

With a Little Help From My Friends

2010-06-29T21:39:00.000-07:00

Finding others to exercise with makes a workout more fun and sometimes challenges us to do more than we might do on our own.

If I tried to do all twenty or so hours a week of Ironman training all by myself, I don't know if I would get through it.

While I do a long run alone at the crack of dawn , and a 1-2 hour bike ride alone one evening per week, I have a number of workouts with others. I join a coached pool swim, a group ocean drill swim, and I usually find people for my long bike ride.

My weekly e-mail to several women in my tri club who cycle at about my pace goes something like this:

"I'm doing 112 miles, starting at PCH and Temescal at 7:00 am, meeting up with the PCH 101 ride at 8:30, heading out past the Oxnard fruit stand to Ventura, and then turning around and coming back.

I'd be eager to have someone start with me at Temescal, or start at Zuma and ride out past Oxnard with me, or ride with me at the end, or join me for any amount of time on the ride. Let me know if you're in :)"

There's no one on my exact schedule, but usually I can find people to ride pieces of the ride with me. Thank goodness for my friend Lee who accompanied me for at least two thirds of my 125-mile ride a few weeks back. It was fun talking to her as we rode up toward Ventura. While her strength is riding on flat roads, mine is on hills, and she really pushed me on the flats of the ride. And, as we got tired out we took turns drafting off one another to give each other a break.

Similarly, though even if you're not training for an Ironman: Use the buddy system. It makes exercise a whole lot more fun.

One Month until Ironman Lake Placid

2010-06-28T13:50:00.000-07:00

I look forward to becoming an Ironman. But, I don't think I need to do another one.

It wasn't until yesterday that I truly got excited about this adventure. Several of my friends raced Iroman Coeur D'Alene yesterday. I tracked their progress online and watched the live feed at the finish line. It is quite fascinating -- the live camera captures everyone after they cross the finish line. The announcer states the names of the finishers, so that when I cross the finish line (and I will!), he will say, "Heather Shenkman, You are an Ironman!" People looked tired, but they definitely looked elated to finish.

This weekend, I rode 75 miles on my bike on Saturday. On Sunday, I swam a total of 2250 yards and ran 16 miles. Next weekend, I get to ride 112 miles then run 6 miles on Saturday, and on Sunday swim 2 miles and then run 15 miles.

It is interesting how my skills have evolved with my training. Surprisingly, I've become a faster swimmer. Through coached swimming and a few pointers, my swim stroke has improved and I am faster than I was at the beginning of the season. On the other hand, I'm a slower runner. I haven't done any speed work at the track for months, but then again, that's not necessary when training for an endurance event like an Ironman. While my long run pace earlier this year may have been 9:30-9:45/mile, I find myself chugging along at 10 minutes per mile or slower, and after a long swim or bike, my pace for 15-16 miles may be closer to 11 minutes per mile.

I've been contemplating my nutrition during the race. I've found that a Tofurky sandwich on whole wheat with lettuce, tomato, and avocado fuels me well. I have also found that I can wrap this sandwich in foil and duct tape it to my seat post for consumption later on in my ride.

The event is sponsored by PowerBar, which is a bit of a dilemma for me as a vegan. Their Ironman Perform electrolyte beverage, which they've sent samples of to all of us since it's not available in stores yet, fuels me well for my long workouts. But, the PowerBars contain dairy, as do several of the energy gels. That means I'll have to carry more food on my bike, which shouldn't be a problem. I'll have one Tofurky sandwich, one PBJ, a PureFit bar, and some Clif Blocks. I'll also take a banana, which I usually consume in the first hour on the bike. On the run, I usually go with less solid nutrition, like the blocks and gels.

I've figured out my goal times: 1 hr 30 minutes for the swim, 7 hrs 30 minutes for the bike, and 5 hours for the run. That should put me well toward my goal of finishing in under 15 hours.

Turmoil in the Water

2010-06-20T19:15:00.000-07:00

I like to think that after three years of living as a triathlete in Southern California, having swam in the ocean dozens of times, that I'm an adept ocean swimmer.

Then again, sometimes in multisport training, we have experiences that humble us. Today was one of those days.

Today was scheduled to be my first two mile open water swim before Ironman Lake Placid. Now, granted, I've swam nearly two miles in a pool, but an open water swim is a bigger challenge without the walls of a pool to push off of.

I ran into my coach and started chatting with him as the group ambled down the beach to start swimming. He cut me off, "Not to be rude, but you need to catch up to those people, so start running." Or something like that. And I realized, the superstars who planned on swimming two miles were far ahead of me, jogging down the beach. I took off after them.

I arrived, catching my breath as the two mile group was suiting up. The group was mostly men, and those who I recognized were definitely what I would consider to be elite athletes. My friend Gail, who I would say is part fish, was getting ready to do the two miles. Knowing my relative speed was quite a bit slower than the rest, I asked her to tell me if anyone there might be around my pace, and she introduced me to someone named John, who I asked to keep an eye out for me, though I knew that Gail would look out for me at the end even though she is considerably faster. For ocean swims, we use the buddy system -- given the possible dangers of the ocean.

The group headed in. The waves were bigger than usual. Some of the elite types dove on in and headed out like it was nothing. Being from the Midwest (or at least that's what I use as my excuse), I tend to get into the ocean a bit slower. John dashed off. Gail was quick behind him. The rest were well ahead. And there I was -- me and the waves. Big waves. One after another.

One thing I've learned is that if you see a big wave coming, go with it. Put your arms straight out in front, tuck your head, and dive under it. Do not turn to the side. Do not cower. Those are surefire ways to get knocked over, lose goggles, get tossed under, etc.

The waves kept coming. One after the next. And they were big. I'd barely swim one stroke when another wave faced me and I prepared to dive under. There was absolutely no break. After five minutes of this, I turned to the shore and realized I'd barely moved forward. In the distance I saw that several members of the group had taken off.

I was alone, floundering in the ocean, trying to get out past the waves, and I just couldn't do it. I was tiring out. After about eight minutes of no progress, hyperventilating, and fatigue, I turned around and swam back to the beach. I was really upset. Like as in crying, tears, that kind of upset. The last time I cried was a year and a half ago when I was unable to finish the Surf City Marathon due to gastrointestinal upset that led to me dehydrating like a raisin.

As I got out of the water, the thoughts in my head were of course disappointment in my abilities to swim through the waves when everyone else in my group seemed to have no problem. I must have looked quite distressed because one of the lifeguards approached me. I don't recall exactly what I said, something to the extent of, "I've done this before, I'm not a newbie, I don't know what happened." He could tell I was pretty shaken up, suggested walking down the beach, catching my breath and getting in at a lifeguard stand closer in.

I walked back toward the start. I wistfully saw the others who managed to get past the waves, their tiny swim caps bobbing in the ocean as they swam toward the Manhattan Beach pier. As I came up to the one mile mark, I saw another woman standing in a wetsuit and swim cap, looking shaken up as well. As it turned out, she was another member of my club who similarly had issues of getting past the waves.

I stood and chatted with her for a few moments. I felt better. I suggested that she and I try again, and we could stick together and get a mile swim done. We saw a few others trying to get into the ocean, and we saw that with the size of the waves that it took them longer than usual. The waves, while choppy, looked calmer here than they did down at the Hermosa Beach pier, so I felt ready to give it another shot. My new friend said she would stand by while I tried to swim out.

I was ready. I swam a few strokes, dove under a few waves, and it felt like deja vu. But then there was a break in the waves, enough time for me to get out far enough from the shore to a point where the water was calm. I swam forward, prepared to travel the one mile to the Manhattan Beach Pier. I did take one break, where I rolled onto my back, looked up at the sky, and as I thought about that day started to hyperventilate again. From there, I decided I needed to finish, and I could do it. I would count a hundred strokes and see how much closer I was to the pier. And then another hundred. And gradually, I made progress. At the pier, conditions became choppy and I felt like I was swimming in a washing machine, but with a bit of extra effort I managed to get around, and while almost being hit by some idiot on a wakeboard I did finish the mile swim.

I did see Gail at the end, and she and John had waited for me after getting past the chop -- I just couldn't see them beyond the barrage of waves at Hermosa Pier.

I'm afraid to try the two mile swim from Hermosa Beach to Manhattan Beach again. But then again, I feel like I won't be complete until I do it. Next time, I will start early so I don't have to run down the beach. And, Gail has offered to accompany me next time, and I think I'll take her up on that.

Racing and Training... the beat goes on

2010-06-13T17:36:00.000-07:00

My legs hate me.

They're tired. They're wiped out from yesterday's training ride of 125 miles on PCH from Santa Monica to Ventura and back. And they were mad that I made them work again today at the Redondo Beach Triathlon.

I wanted to do a race before Ironman Lake Placid. So, I chose the Redondo Beach Triathlon and I raced it as an Athena, which is the category for women over 150 lbs. While I'm a normal weight for my height, I'm a tall girl, and just a hair over that weight. These long legs are no advantage on a bike, so I feel justified in racing that category.

The race was a half mile swim, 6 mile bike, and 2 mile run. That relatively long swim compared to the bike and run put me at a disadvantage since I'm not a great swimmer.

As we started, I saw one Athena girl take off into the water and I never saw her again. While she finished the swim five minutes faster than me, overall her time was only 50 seconds faster. My swim was definitely more tired than usual after yesterday's 125-mile bike adventure.

The bike portion was an out-and-back two loop course. My legs were absolutely screaming at me with soreness. But, I pushed on through. The mostly flat course of two three-mile loops was crowded initially but then thinned out.

Then there was the run, always my favorite part in a race, because it's where I'm strongest. And, surprisingly, my legs felt good to run. Since we Athenas started in the last wave, there were plenty of people ahead. I passed at least thirty people over the course of two miles and not a single person passed me.

I landed on the podium -- second place Athena! Had I raced my age group, I would have done well too at seventh out of seventeen.

Horrible picture. Nonetheless, it's me on the podium, which is pretty cool.

Tomorrow will be a well deserved rest day. But after this, I have two more Build weeks, a recovery week, and then a Peak week prior to my taper for IM Lake Placid on July 25.

The Doctor's Cholesterol

2010-06-01T14:44:00.000-07:00

I just got my own cholesterol numbers back:
Total cholesterol - 160
Triglycerides - 86
HDL - 71
LDL - 72

Thought I'd share what a healthy vegan diet and exercise have done for me. :)

The Paradox of the Hospital Cafeteria

2010-05-31T10:41:00.000-07:00

Have you seen the offerings of your local hospital cafeteria?

The hospital is a place of healing. Many people who are hospitalized have illnesses that are at least partially due to poor diet choices.

So, then, why is it that the cafeteria serves up unhealthy fare? Fried chicken. Hamburgers. Bacon and sausage and biscuits with gravy. A delicious vegan noodle dish, but with 2200 mg of sodium per serving. Sure, there is a salad bar and plenty of fruit, but why do we need to serve the junk too?

Why not make the cafeteria a place where the loved ones of patients can learn about healthy food choices?

Eat. Train. Work. Sleep.

2010-05-24T21:28:00.000-07:00

That's life training for an Ironman.

Ironman Lake Placid is on July 25. Two months from now.

I'm in my "build" phase. That's coach lingo for "arse-whupping". Last weekend was an 80 mile bike on Saturday, and then on Sunday a 1.5 mile swim followed by a 15 mile run.

Next weekend's training: Saturday 100 mile bike followed by a 3-4 mile run. Sunday is a 1.5 mile swim followed by a 16 mile run.

So far, I'm keeping up....

NiceCream Vegan Ice Cream

2010-05-20T22:11:00.000-07:00

This is an incredible concept: A Vegan Ice Cream Parlor!

I met a friend for dinner at Sunpower Natural Foods, then walked over to NiceCream, which opened just over a week ago. They have soft serve, hard-packed ice cream, milkshakes, truffles, and other amazing treats. All are raw.

I tried a scoop of chocolate and a scoop of pistachio. My friend got some soft serve and I helped myself to some of that too. Yum!

Nicecream -- 3701 Cahuenga Blvd, Studio City, CA

Appetizers

2010-05-14T23:56:00.000-07:00

Healthy appetizers: Hummus and Spinach Dip with carrots, pita chips, pepper slices, and broccoli.

Cheese for Vegans!!!

2010-05-04T22:24:00.000-07:00

No I have not fallen off the Vegan Wagon and gone to the dark side of dairy.

This is a grilled cheese sandwich that I made for dinner with Daiya cheese.

Daiya is the first vegan cheese that I've ever had that melts like dairy cheese. I've had it on vegan pizza from Whole Foods, on nachos, and in macaroni in cheese. The texture and the taste are amazing!

Daiya cheese has 90 calories per 1/4 cup serving, with six grams of fat, 2 grams of it being saturated fat, 1 gram fiber, and 1gram protein, with 15% of the daily requirement for calcium. Interstingly, it is not soy-based like most other vegan cheeses, but its main ingredients are tapioca or arrowroot flours, canola oil, safflower oill, coconut oil, and pea protein.

I enjoyed my grilled cheese sandwich with a spinach salad topped with Follow Your Heart Chick'n Free Chick'n and ground flax seeds. Yum!

Wildflower Race Report

2010-05-03T20:47:00.000-07:00

We have good races and bad races, and while it's no fun to not attain our goals, a bad race is something we can learn from.

Two nights before the race, I was busy on call seeing patients in the hospital. On the day before the race, I had to work, and thanks to Ventura County traffic, I didn't arrive at the campground until well after 10 pm, and was chugging Coke Zero wtih caffeine to stay awake for the drive. Thank goodness for terrific friends who brought my tent up with them and pitched it during the day so that I didn't have to wrangle with it at night. But, as I'm not one who enjoys camping, even though I was tired, I didn't sleep very well on the night before the race.

My day just started out bizarre. Just before our wave of women 35-39 started (I'm 34, but because I turn 35 this year, my "triathlon age" is 35. Depressing), we had the chance to get in the water to warm up. I jumped in, swam a few strokes, and noticed that my timing chip felt loose around my ankle. So, I tightened the velcro. Apparently, adjusting wet velcro is a bad idea, because as the gun fired at the start of the swim portion, I felt the chip come loose again. I had to stop in front of a bunch of women running into the water to readjust it. Then as I swam through a crowd of bodies, getting kicked once in the face, the chip was lost and gone!

Now, athletes do not get to finish a race without a timing chip. I panicked as I thought of what I would do. I'd try to find a race official upon getting out of the water. Or maybe I'd borrow my friend Jessica's chip, since she was registered but wasn't racing and might have it with her. Nonetheless, I was quite distracted as I swam, trying to figure out what to do without a timing chip.

Meanwhile, as I swam in the lake, overhead on the microphone to the thousands of spectators and athletes: "Heather Shenkman, we have your timing chip. Please come and get it." That did me no good since obviously I couldn't hear.

I got out of the water, panicked. My time was 44 minutes. Same as last year. I looked for a race official to tell that I didn't have my timing chip. I couldn't find one.

When I got back to my transition area, I looked down and right on top of my bike shoes, there was my timing chip!!! What a relief. I fastened it tightly around my ankle and took off with my bike.

That's me taking my bike out of the transition area to start the 56 mile bike portion of the race.

As always, Lynch Hill is the first hill we encounter as we ride out of the transition area. It's steep. It's tough. Then came some rolling hills, and about 25 miles of mostly flat road. Then there was Nasty Grade, this monster of a hill that's a couple miles long, around mile 42. And I got up it. The ball of my left foot was burning, along with my toes, but around mile 53, the pain was pretty bad. To try to ease it, I stopped pedaling with my left and pedaled strictly with my right foot for about a minute. The brief rest helped somewhat.

I felt a little slow on the bike. And, as it turns out, I was slow on the bike. Over four hours. Last year, the 56 mile ride took me 3 hours and 50 minutes.

As I transitioned from bike to run, I knew I wasn't moving very fast. I knew my goal of breaking 7 hours was gone. Maybe I could break last year's time of 7:11?

The first mile of the run was 11 minutes. The second was about 12. My left foot was in excruciating pain, especially trying to run any hills. I walked about half of mile 3, as I winced and thought, can I really finish this? Will this pain ever go away. Luckily it did. I ran/walk through mile 5, through more tough hills that I should have been able to run. Those five miles took me over an hour! I couldn't believe how slow I was!

Negative thoughts kept creeping into my mind. If this race is going this poorly, can you really do IM Lake Placid? Are you really as good an athlete as you think you are? I am tough on myself, no question. To quash those thoughts, I tried to remember what I had said to other athletes who were disappointed after a disappointing race -- "You're a good athlete who is having a bad day." Right? I wasn't sure.

Then, even on the flats, my run pace was 11-12 minutes per mile though I felt like I was moving faster. Clearly I was not. But, unlike many athletes out there, I was still running. Just one foot in front of the other. I was going to finish.

The half marathon run took me two hours and 40 minutes. My most recent half marathon before this was 1:58. Yikes.

My finish time: 7 hours 39 minutes. That's 28 minutes slower than last year.
That evening, LA Tri Club had an amazing dinner, and it was just a lot of fun to hang out at camp and relax after the race.

I put in the training for this event. I just wasn't rested, and that darn plantar fasciitis (I think that's what was going on with my left foot) flared up. I know I shouldn't beat myself up over this. It wasn't my "A" race -- Ironman Lake Placid is, and I have just under three months to get ready.

I'm staying positive. I've learned from Wildflower, and I will be as rested as can be when it's time to race Ironman Lake Placid.

I Hate Exercise

2010-04-30T00:14:00.000-07:00

This is exactly what one patient said to me this week. He had exercised in the past, but it became such a chore that he absolutely abhorred it.

I probably have several other patients who clandestinely feel the same way. Some grit their teeth, do everything they can to get out the door and do their walk, the same walk every day, because they know they need to do it for their health. Others with those feelings may choose not to exercise at all.

I can understand that. If I did the same workout every day, day in day out, month after month, I'd get bored. I'd probably quit.

My mother gets on the treadmill for an hour five days a week. She walks at 3.5 miles per hour, or a little faster, with maybe a 2% incline while watching TV. That's her workout. She rarely walks outdoors. Somehow she sticks with it, but I think that after nearly two years it's getting a little monotonous for her.

I think exercise needs to be interesting in some way. Whether it be choosing from a few different treadmill workouts, perhaps one with an incline or another with intervals, or doing different exercises, like golf one day, bicycling another, dancing the next, and so forth, mix it up!

That's what I love about triathlon. There are three different sports to master -- swimming, bicycling, and running. No two days in the row have the same exercise.

What I told my exercise loathing patient: Just get up a couple times a day and go for a short walk, even if just for a few minutes -- it'll make you feel better. I didn't use the word "exercise", because if I did he would likely tune me out completely. And he even agreed, he could use the stress relief of a brief walk in the middle of the day.

Exercise needs not be a chore -- make it interesting and fun and it will be easier to keep the habit.

Sugar and Cholesterol Levels

2010-04-25T12:31:00.000-07:00

We know that our cholesterol levels are impacted adversely by consuming cholesterol, saturated fats, and trans fats.

An article from JAMA (Journal of the American Medical Association) on April 21 2010 finds that the higher the intake of added sugar, the lower the HDL "good" cholesterol, and the higher the LDL cholesterol and triglycerides.

It is likely that this is due to fructose, which leads to increased production of lipids by the liver and decreasing removal of lipids from the blood stream.

So, as part of a healthy diet, here is yet another reason to stay away from foods with added sugar.

Found My Nemesis

2010-04-24T13:56:00.000-07:00

It's a bike climb in Brentwood called "The Three Bitches". Three successive hills. Relatively short, but extremely steep.

On this morning's ride, a group of us split off to climb "The Three Bitches". I climbed the first, standing on my bike the entire time, huffing and puffing. At the top, I looked to my right to see an even steeper hill, the second of the three "Bitches".

I'm always up for a challenge. However, I'm racing Wildflower Long Course next weekend and am supposed to be tapering, or cutting back on my exercise so that I am well-rested for the race. Now is not the time to do insane things.

But, I do promise: I will be back. (as I say that, ironically, I do believe that the Guvernator, Arnold Schwarzneggar, did drive by us during our ride. No joke.)

Two Weeks to Wildflower

2010-04-18T20:37:00.000-07:00

I am racing Wildflower Long Course again this year. It is one of the toughest half-Ironman-distance races -- 1.2 mile swim, a very hilly 56 mile bike, and a similarly challenging 13.1 mile hilly run.

For the most part, my training has been going well. Today's workout was a 3000 yard swim in the pool, my longest swim workout yet, followed by a 5 mile run at just under a 9:00/mile pace. I did have a lousy workout yesterday -- I was supposed to ride for two hours and then run for 45 minutes. I was not in the mood to ride, though my legs felt okay. I just wasn't feeling it, and with the lack of mind to override the body, so to speak, I ended up with a side stitch and quit at an hour and twenty minutes of riding.

We all have good days, and we all have bad days. Yesterday was a lousy day, and today was pretty great.

I've been riding and running lots of hills lately. I have found some killer hills in my new neighborhood -- for those of you familiar with the San Fernando Valley, I run a route that includes a nearly two mile climb from Ventura Boulevard due south to Mulholland. It's tough, but it's helped make me a strong hill runner. My bike rides have taken me up several of the canyons from PCH up through the Santa Monica Mountains.

Last year's Wildflower was a pretty good race for me. But this year I want to do better. Last year I finished in 7:11; this year I want to break seven hours. I am more experienced and I think I'm more fit. Coach Jamie of Triathlon Training Series, my coach for over two years, who has really helped me to grow as an athlete, continues to put together my workouts. There have been changes, though. Since January, I have a new personal trainer who pushes me very hard. Also, I also think my nutrition is better, incorporating more protein and less sugar and processed foods.

I have two more weeks to train. This week will be challenging, and the following week will be a taper so that I am well rested for the race.

Plavix Controversies

2010-04-16T22:21:00.000-07:00

Several patients have had questions about Plavix (clopidogrel) lately.

Before you read on, if you are on Plavix, DO NOT STOP TAKING IT! You are likely on it for good reason, and depending on your clinical situation, stopping it may be extremely dangerous. Talk to your doctor if you have any concerns.

I am not going to get into the scientific nitty-gritty here, just simply an overview.

Combination with a proton pump inhibitor (PPI), such as omeprazole, Protonix, Nexium:
There has been concern that taking Plavix and a PPI together reduces the effectiveness of Plavix. Small studies on healthy volunteers demonstrated decreased platelet inhibition when Plavix was taken with a PPI. However, a larger randomized trial, the COGENT trial, which enrolled thousands of patients showed that outcomes were no worse when Plavix and a PPI were combined, and in fact the combination of the two medications reduced risk of gastrointestinal bleeding complications.
Bottom line: If you are on both Plavix and a PPI, it is likely safe to continue to take both medications.

Resistance to Plavix:
Recently, the FDA published a warning that people with certain genetic mutations may have resistance to Plavix, and these patients tend to have worse outcomes. This statement certainly sent a flurry of phone calls and questions to cardiologists nationwide. The problem with this warning is that it is true that these patients do less well, but there is no evidence at this point of exactly what we should do for patients who are resistant to Plavix -- should they receive a double dose of Plavix, or be switched to a different medication such as Effient (prasugrel)?
Bottom line: Don't stop your Plavix. Talk to your doctor.

So You Want to Tri?

2010-04-03T21:49:00.000-07:00

I am really excited to hear that a few people close to me want to do their first triathlon. As I love this sport, I encourage them wholeheartedly!!!

This is me finishing my first triathlon nearly five years ago, the Finger Lakes Triathlon, in September 2005.

I had a blast and after that race, I got hooked by the sport.

Why I still "Tri": To stay healthy, feel good, stay in shape, handle the stress of life, and to set a good example for my patients.

Triathlon is a great sport to get into. If you can swim, bike, and run, you can do a triathlon! Pick a sprint (short) distance race, and start training! Of course, see your doctor first to make sure that you are healthy enough to train.

If you are in Los Angeles, look into joining the LA Tri Club. They have lots of great workouts for beginners all the way to seasoned athletes. And, find a race to set as your goal -- I love the Hansen Dam Triathlon, which is a friendly sprint-distance triathlon in August, and you can read my race report from the 2008 race.

LA Marathon 2010

2010-03-22T21:43:00.000-07:00

My training has been disjointed -- for various reasons, my runs have been broken up. Iliotibial band pain caused a 20-mile run to be run as a 9 mile run one day and an 11 mile run the following day. Another 12-mile run was interrupted by a patient emergency. So I can't say I had done a complete run longer than 15 miles before the marathon.

I was so excited to run the LA Marathon with the new Stadium to the Sea course, starting at Dodger Stadium and ending in Santa Monica.

Organization was definitely lacking, and in particular, traffic. We were lucky that we arrived two hours early, and even then, we were in a long line or cars to get in. I hear that people were jumping out of the shuttle buses on the 110 freeway because they thought they'd miss the start. Nonetheless, the start was delayed by 25 minutes and we were stuck crammed in the start corral.

Shortly before 8 am, we were on our way. The route began with a loop around Dodger Stadium, then into downtown LA. There were a few small hills. It was crowded. Someone tripped me and I nearly landed on my face at mile 3. Then at mile 4, we hit a big hill, the hill heading up to Disney Concert Hall. I saw a guy taking a picture of himself, so I told him to pass me his camera and I took a pic of him. He shot one of me also and gave me his email address. So here's the pic of me that he took climbing that hill. You can tell that it was early on because I was still smiling.

Why run a race if it's not going to be fun? And this was just a friendly course. There were people cheering us on along the entire course. So many fans set up their own hydration stations or handed out cut up fruit and candies and Red Vines. It's like a buffet, but we definitely have to work for it! The enthusiasm of the spectators is what pushed me through the second half and to the finish line.

I started too fast. I thought I could go at a 9:45 pace. But, I may have been a little faster for the first few miles, thinking I felt really good. But, around mile 11, my legs began to feel way too heavy. My mile times were getting slower. The bottoms of my feet hurt. In Beverly Hills at mile 16, when I saw one of my mile splits was 10:30, I decided I was done watching my pace and I just wanted to be done. By mile 20, running through the VA, I wasn't sure I would make it.

I love beer during a long run. At mile 22, there were a couple spectators passing out beer. I eagerly swigged down the small cup of beer -- it tasted so good! I have drank beer during three of my eight marathons, including my personal best time in Long Beach in October.

San Vicente is a downhill through Brentwood and then into Santa Monica. I sure didn't feel like it was downhill! But, I was so happy to see people I knew, friends, tri-club members, and friends from the track, on the sidelines cheering me on. On the last mile, I saw Coach Jamie, and I think I stuck my tongue out at him to let him know I felt like crap. Not very nice of me.

My final time: 4:28. Not my best (Long Beach 2009 -- 4:12). Not my worst (Chicago 2000 -- 5:37). But decent for the training that I had. And fun in spite of the pain.

Success!

2010-03-17T10:10:00.000-07:00

I'm thrilled to hear when people I know are able to improve their health through lifestyle change. Here's a few recent success stories:

* A young physician with high cholesterol adopts a vegan diet. As a result, her LDL cholesterol drops by more than half, down to a normal level, while her HDL (good cholesterol) remains stable.

* A woman in her early 50's with high blood pressure and a history of other complications after surgery a few years ago initially comes in with chest pain. She was an avid swimmer, having recently joined a master swim group. I put her through a stress test, during which she was able to walk and run on the treadmill and the test was negative for ischemia (in other words, no evidence of significant coronary disease). She is free of chest pain, has her blood pressure under control, and now swims competitively and has completed two triathlons and is training for her third.

* A man in his early 40's who is significantly overweight and with elevated triglycerides starts working out with a personal trainer and adopts a vegan diet. His personal trainer tells me that so far he has lost more than 5 percent of his body fat and is getting fit. While I have not seen his repeat lipid panel since his lifestyle changes, I am sure that he will have great improvements.

My Fuel

2010-03-13T19:56:00.000-08:00

We all have those products that we rely on for performance. Here are mine:

PureFit Bars

These bars are amazing! They have anywhere from 200-240 calories, 18 grams of protein, and less than two grams of saturated fat per bar. They are perfect fuel in the middle of my afternoon. Today I ate one to refuel as I was losing steam on a tough hill climb on my bike -- it worked!!! PureFit bars are vegan, kosher certified, and gluten-free. I just ordered six boxes online -- http://www.purefit.com/

Vega Sport Performance Protein

This stuff is fabulous for refueling after a tough workout. One scoop has 110 calories and 20 grams of protein, including branch chain amino acids. The instructions on the package say to mix one scoop with a cup of water. I prefer to mix it with water and a splash of orange juice, or better yet with a soy yogurt.

Clif Shot Bloks

On a long run or bike ride, it's critical to take in fuel and electrolytes. Clif Bloks are easy to ingest. Three blocks contains 100 calories, 70 mg sodium, 20 mg potassium, and 24 grams of carbohydrates. I love the fact that the blocks are not messy like gels. And, they're tasty, kind of like gummi bears!

Firecracker 10k

2010-02-28T16:52:00.001-08:00

Up until this weekend, I hadn't raced in about six weeks. But, there were two great races this weekend, the Race on the Base triathlon (see post below), and the Firecracker 10k today.

The Firecracker 10k was held in Chinatown. It's the hilliest race I've ever run. The first 3/4 of a mile is a gradual incline. Then until mile 3 it's a climb, and some of it is quite steep. The scenery in Elysian Park was beautiful, followed by the course winding along Dodger Stadium, and ending downtown.

I finished in 54:52, a time that I'm quite proud of given the hills on the course. The last standalone 10k (as in not part of a triathlon) that I ran was eight years ago back in Detroit, and my time was twelve minutes slower on a flat course. It's good to know that even though I am getting older I'm still faster :)

Race on the Base

2010-02-27T19:32:00.000-08:00

Today was my first triathlon of the season. It was also my first reverse tri -- run-bike-swim, instead of the traditional swim-bike-run.

I had a rude awakening -- even though I am 34, I am no longer a 30-34 year old, I'm now a 35-39 year old!! Since I turn 35 this year, I aged up to the older group.

I realized this was not a hard-core race. I saw a lot of mountain bikes and even a beach cruiser! I like these kinds of races, where many participants get their first taste of what a triathlon is like.

The weather was not the most agreeable. We started our run in rain, and as the race progressed, the rain only poured down harder and the wind blew hard. I put my head down and ran as hard as I could.

My run was good -- I kept a pace of about 7:50 per mile for the three mile run. That's about my usual 5k pace. I was worried that I might not have the steam for the bike and swim.

Coming into transition at the end of the run, I saw a full rack of bikes -- this is a good sign, meaning that I'm ahead of most of my age group. I pulled off my wet shoes and socks, which took a few extra seconds of transition time, put on my bike shoes, grabbed my bike and headed out. The flat bike course, which consisted of three loops of the runway, had plenty of puddles, so my bike and I got soaked.

Since I knew I had a good run, I didn't want to give up my lead, which I knew was quite possible since running is my best event and I am not a strong cyclist. Only two women passed me on the bike, and neither was in my age group.

Running to the pool was interesting. As I ran, I tried to put on my swim cap, which was quite awkward. The swim consisted of four lengths of a 50-meter pool. The pool was crowded, and swimming after a run and bike is more challenging than swimming at the beginning of the race. At the end of the swim, there were lifeguards to help lift us out of the water and the finish mat was just a couple feet away.

The medal was pretty cool -- a dog tag:

For me, it was a great race. I was fourth place in my age group out of 56 women. That was less than a minute and a half behind the third place winner, in other words thirty seconds off my first transition time and a minute off my bike. But I'm still really happy with my performance. It's a great start for my season!

Is Soy Dangerous?

2010-02-25T15:09:00.000-08:00

Many myths exist about soy not being safe -- that it can increase risk of breast cancer, cause hypothyroidism, and increase sterility in men.

Neal Barnard, M.D. wrote an editorial for The Huffington Post that dispels these myths.

Image from gobblegreen.com

There are many benefits of soy, including reducing risk of cancer, decreasing LDL cholesterol, reducing the risk of uterine fibroids, and lessening the risk of fractures.

Read on here.

Recovery Hike

2010-02-22T11:57:00.000-08:00

The view from my morning recovery hike to the Hollywood Reservoir, taken by my cell phone camera.
After running 20 miles this weekend, today is a rest day.

Forks Over Knives

2010-02-20T20:46:00.000-08:00

Many diseases, including coronary artery disease, hypertension, diabetes, and obesity can be treated and prevented by a plant-based diet. This is a belief that I am passionate about and have seen in my daily work as a cardiologist.

The movie Forks Over Knives, which is coming out this summer, is based on the premise of diet as a treatment for disease. It traces the lives of two important pioneers, T. Colin Campbell PhD of Cornell University and Caldwell Esselstyn MD of The Cleveland Clinic. Both come from animal farming backgrounds, and yet both are strong proponents of plant-based diets.

View the trailer here

For Foodies

2010-02-19T23:17:00.000-08:00

I love eating, and I loooove trying new restaurants!

One of my favorite blogs is quarrygirl.com. When I think I've tried out just about every veg-friendly restaurant in LA, I go to her site and see all the neat places that I have yet to check out.

This is a great site if you want to eat vegetarian but aren't sure where to go.

I love LA -- it's a great place to be a vegan!!!