What I'm Reading

Caldwell Esseltsyn Jr. is a cardiovascular surgeon at the Cleveland Clinic who asked twenty-four patients with severe coronary disease to make radical changes to their diets and follow a low-fat plant-based vegan diet.

The results are incredible.  Through diet alone, these patients were able to halt the progression of their heart disease and save their lives.  It also includes several very simple recipes for low-fat heart-healthy meals and snacks.

As this book demonstrates, diet is so important in heart disease.  This is why I discuss food at just about every patient encounter.

If you're not sure whether you can change your diet to improve your heart health and change your life, read this book!!!

New Adventures

On my first day of exercising for fun, I ran.

On my second day of exercising for fun, I biked.

Sound like a broken record of a triathle's life?

But, when I went running, I didn't have my GPS or my heart rate monitor.  I just went out and ran up and down a few hills for fun.

And, for my bike ride, someone asked me, "How far are you going?"  Normally, I know exactly how far I need to ride that day.  My answer was, "I don't know, I'm just going up."  It ended up being a fun 15 mile round-trip ride from the LA Zoo up to the Griffith Park Observatory.

Yesterday I tried  a boxing boot camp class.  I hadn't been to a boxing class in a couple of years, so I was a bit rusty with the punches.  However, given my running and triathlon background, I had no trouble keeping up with the class physically. 

Unfortunately, since boxing uses muscles that we don't use to swim/bike/run, I am still pretty sore. Even taking a deep breath strains a few muscles!
I am enjoying my new exercise program, in spite of the soreness.
Image from blog.mtviggy.com

I Am Burned Out

I haven't been enjoying running lately.  While I love to run, as of late I absolutely dread getting on the treadmill.

Today I came to a realization:  I have been training for something for over two years.  A half marathon.  A marathon.  A half ironman.  Another triathlon.

I need a break.

I exercise and train beause I enjoy it.  I do it for me.  So, when it ceases to be a fun challenge, I think that means I need to take a break.

I am dropping out of the CIM Marathon that I signed up for on December 6.  For the next two months, I will be exercising for fun.  Though I may do a few short 5k or 10k races, there will be no big events to train for.  I'm going to do things that I haven't done in a while -- kickboxing, rollerblading, and spinning.  I may even try some new things, like pilates or yoga.

I hope to come back refreshed in two months and ready to start base training for Ironman Lake Placid in July 2010.

Fuze Tropical Punch

I love pop / soda, and not the diet variety -- the full-calorie drinks, and I love fruit juice.  However, they're empty calories, so it is best to drink as little of these beverages as possible.

Recently, I discovered Fuze. One bottle has ten calories. It's flavorful and has vitamin C. It doesn't even taste low-calorie!

Atkins

A patient once described to me his diet which included healthy meals, such as "good foods like steak."  He experienced initial success with the Atkins Diet in rapidly losing fifteen pounds, and then, unfortunately gained back all of the weight within months.

The Atkins Diet was popular early in this decade as an easy way to rapidly drop weight.  True, the diet will allow you to lose a large amount of weight at first, most of it in water.  But, in the long-term, it isn't successful.  How many people do you know who have lost weight, kept it off for several years, and attribute their success to the Atkins Diet?  I don't know a single one.

Ingesting a diet high in saturated animal fat and protein is not good for the body.  Diets high in saturated and animal fat have been shown time and time again to increase the risk of heart disease and cancer. 

The European Prospective Investigation into Cancer and Nutrition, a multi-national study of thousands of people, demostrated that high-protein, low-carb diets increase mortality risk.

A low-fat, vegetarian diet, with lots of fruits, vegetables, and whole grains, with lean protein, really is the best option for health and permanent weight loss.

New Moon Century -- 100 mile bike ride

Physically, I'm always looking for something tougher, something bigger to accomplish.  Yesterday I rode 100 miles, including 9000 feet of climbing.  This is the most I have ever ridden in one day.

As of late, my training has been focused on running.  Cycling has been reserved for recovery days.  My last 40+ mile ride was over a month and a half ago!  So, needless to say, I was a bit worried.

However, this event supported a good cause, the Jewish Federation's Fed Up With Hunger campaign to feed hungry people in Los Angeles.  It was also an all-vegan ride!

The ride started in the West Valley community of Oak Park, headed south to Agoura Hills, west toward Thousand Oaks, south to Pacific Coast Highway, PCH into Malibu, then up Mulholland and when I say up I mean up up up with some serious climbing.  We stopped for lunch at mile 56.  The last 44 miles were full of climbing -- on Mulholland and up Topanga, and then back to the start.

I felt okay at the start.  I went out with a group that seemed at my level.  A couple riders were a bit faster.  I ended up riding much of the way with one person, who was on a commuter bike, and when it started getting windy on Las Posas Road and at the westernmost edge of PCH near Poing Mugu, I drafted off of him.  I'm not sure he realized I was drafting him, but when I gained enough energy, I rode in front to give him the chance to draft off me, but I'm not sure he took advantage because I'd turn around and see him behind and to the left of me.  Is there shame in a man drafting off a woman cyclist?  I'm not sure.

Once we reached Mulholland, around mile 39, the ride really began -- in other words, the climbing!  I really surprised myself that I had it in me to climb those mountains given my lack of recent cycling, but I passed a few riders in our group.

I was so thrilled to get to mile 56 and enjoy some lunch.  Since all the food was vegan, it was easy -- I fixed myself a whole wheat Tofurky sandwich with avocado, tomato, and Vegenaise.  Yum!

The last 44 miles were rough.  I found a couple of men who were about my pace to ride the last 35 miles with.  When struggling to achieve a goal, it's great to be around others -- that's why I do my long training runs or track workouts with a group -- I get energy from being with other people with the same goal.  I'd say I "hit the wall" at mile 85, climbing on Mulholland heading west back to Las Virgines Road.  My legs were tired, my knees ached, and my energy was sapped.  One of my riding companions flatted at mile 90, which made for a good excuse to stop and wait for him to change his tire.

When we finally finished, it felt so good to be done!  I slept so well last night.  Yesterday's ride helped me gain the confidence that I need going into training for Ironman Lake Placid, knowing that I can complete a long hilly course.  Also, I got to practice staying fueled while training, with both electrolyte solution and food.

No more endurance races for me for a while... not until the California International Marathon on December 6.

Three Runners Die in Detroit Half Marathon

Sadly, three runners died at the Detroit Half Marathon today, as reported in The Detroit News.

Two runners collapsed and died around mile twelve, and the third shortly after finishing.  All three were men, ages 26, 36, and 65.  All received prompt medical attention and had defibrillators applied to them, all unsuccessfully.

In addition, a 23 year-old man died at the Baltimore Marathon last week, and two runners died at the San Jose Rock N Roll Half Marathon just a few weeks ago.

Why are apparently healthy athletes dying, and why is this a more common phenomenon recently?

A person can feel well, train for a race, but unknowingly may have heart disease.  In younger athletes, those under age 40, the most common cause of sudden death during a race is a structural abnormality of the heart, such as hypertrophic cardiomyopathy, dilated cardiomyopathy, or arrhythmogenic right ventricular dysplasia.  The presence of those structural abnormalities of the heart, combined with the stress of a competitive athletic event, can trigger a deadly arrhythmia.  Amongst older participants, unknown coronary artery disease may be present, and could lead to a heart attack or arrhythmia that could then lead to death.

Statistically, the odds of dying while competing in a marathon range from 1 in 50,000 to 1 in 150,000.

What should an athlete do?  How can we find these things before someone dies?

This is a controversial question amongst the cardiology community.  I believe that everyone who wishes to compete in any type of endurance sports needs a full physical before participation.  This includes a physical examination, blood pressure check, full panel of blood work including fasting cholesterol levels, and an EKG.  A physician should also inquire as to whether there is family history of heart disease in any first-degree relatives.

In Italy, guidelines are even stricter.  All young competitive athletes have a complete echocardiogram, or ultrasound of the heart.  As you can imagine, the vast majority of these echocardiograms are normal, and thus this recommendation is quite controversial.

Despite the risk in participating in competitive athletics, I hope that these recent events will not scare people away from being active, because an active lifestyle, in spite of these risks, is far better than a sedentary lifestyle.

Dr. Oz -- Cowboy Goes Vegan to Save His Life

Rocco is a cowboy.  He's overweight, diabetic, and has a large amount of plaque in the arteries of his heart as demonstrated by a CT scan.  Dr. Oz challenges him to go vegan for 28 days with the goal of reversing his coronary disease and prolonging his life.

Watch the video here

Now, Rocco is similar to so many of my patients whom I see every day.  If he can become a vegan, then I'd say just about anyone with the right motivation can make important dietary changes to improve their health.

Long Beach Marathon

Today I ran the Long Beach Marathon.

I wasn't sure whether to run with the 4 hour pace group or go it alone.  As the gun went off and the 4 hour pace group dashed ahead, my choice was made for me and I started on my own.  I easily settled into a pace of 9:15-9:20 per mile.

I was nervous about being able to keep that pace, but for the first 13 miles it felt comfortable.  Then my legs felt heavier, and I slowed down, averaging 9:59/mile for the second half of the race.

Highlights of the race were running through Cal State Long Beach during miles 17-18 and all the enthusiasm of the students cheering us on, and the nursing home that brought their residents outside -- I've never seen a row of twenty elderly people in wheelchairs bundled up cheering at a marathon, it was awesome!

At mile 25, one of the stomach cramps that I have been plagued with came upon me.  I ended up slowing to a walk for about two minutes until it passed, and then I ran the rest.  The last mile felt so long, and it felt so good to finish!

My finishing time was 4 hours, 12 minutes, 55 seconds.  It's my personal best by almost six minutes over my San Diego Marathon.  But, I'm not that pleased.  I feel like I missed my goal, and could have gone faster.  Maybe I needed more longer runs.  Nonetheless, a personal best is a personal best, and I'll take it.

I think that before I race California International Marathon in Sacramento on December 6 that I will do a few things differently:  I hope to do more long runs, and I will take two Immodiums instead of my usual one.

Vegetarian Diets Reverse Diabetes

Improving control of your diabetes can be as simple as changing your diet.

In this interview from the Huffington Post, Kathy Freston talks to Dr. Neal Barnard, whose research has demonstrated that diabetes can be controlled and even reversed with a vegan diet.
Image from api.ning.com

Cooking Less... Eating Vegin' Out!!

Today I ran the Race for the Rescues 5K in 24:29, a new personal best for me, 1st in my age group and 6th woman overall.  I definitely have increased confidence going into next weekend's marathon.

With work, running, triathlon, and time with family and friends, it's tough to prepare healthy meals.  I don't feel like cooking when I get home.  And, living alone, fresh produce has a habit of going bad.

Veginout.com is a vegan home food delivery service.  They bring three different main dishes, four entrees, a soup, and five cookies.  It's enough food for eight or nine full meals, all for $110/week.

The food is healthy stuff, relatively low in oil and fat, and delicious.  I would love to see them provide calorie and nutrient information, but perhaps that's something they can provide in the future.

Check them out at http://www.veginout.com/.  And, if you sign up, tell them I referred you!

Taper

A Taper is a period of time during which we back down the amount of exercise that we are doing in preparation for an upcoming race.

I've never truly embraced the concept of a taper.  When I decrease the amount of exercise that I am doing, I feel sluggish.  Invariably, I gain a pound or two because I'm not as active.  But, when I stick with the taper plan and am rested before a race, I do well.

Last weekend's 18 miler went much better than the one before it.  I had some good runs this week.  This morning, I ran a total of 8 miles, six of those miles with the LA Leggers 9-minute per mile pace group, which is the first time that I have run with this faster group.  It was a challenge  running 8:20 per mile for eight minutes and then walking a minute, and keeping that pace while running up a couple of steep hills, but I was able to do it.

Tomorrow I'm doing a 5K race, just to get an idea of how much I've improved since July, when I had a personal best of 24:55.  I would love to break 24 minutes.  Then I'm going to go for an easy hour-long bike ride.

My strategy for Race Day at the Long Beach Marathon next Sunday:  Coach Jamie wants me to start at a 9:15/mile pace.  I think that's a little aggressive, but if I'm rested up enough, maybe I can keep that pace up for the race.  If around mile 7-8 I feel like that's a little too fast, I'll back it down.  My goal is to run in under 4 hours and 5 minutes.

Why I Do What I Do

This weekend, while rounding in the ICU, I looked up and saw a picture of one of my patients, smiling with his wife, standing next to two nurses who cared for him.

He was a previously healthy man in his early 30's.  A few days earlier, he had a fever, and then developed shortness of breath.  I had come in to the ER to see him at 1 am, saw that he had congestive heart failure and a weak left ventricle.  We stabilized him temporarily, but the next day, he was intubated, his blood pressure was dropping and he was requiring multiple medications to support his blood pressure.  This previously healthy man's life was in danger.  I cancelled half of my morning's patients to emergently place a central line to sort out what was going on.

In the days to come, he gradually improved, his heart function strengthened, and a week later he was discharged.

I see him in my office, and he's sitting on my exam table, smiling, and you'd think he'd never been ill.  He feels great.  He's back to work and back to playing basketball

And, I swear, when I saw that picture of him, smiling with the team who helped save his life, I smiled.

Got my Mojo Back

I was very disappointed after my long run this weekend.  Read below -- it was awful.  But I'm better now.

My coach was right.  I needed a few days off.  Monday was an hour of weights, Tuesday was a 30 minute run with a few accelerations, and today was a track workout.  We did 800's, and mine were all consistently between 3:34-3:37.

I think I'm back.

Burnout?

I'm trying to figure this out.....

I've been running 40 miles per week for several weeks.  Most of my runs have been on the treadmill because of the heat and because of my work schedule.  And, most of those runs have been great -- I had a personal best last Tuesday, where I was able to run 8 miles in 1 hr 11 minutes and 50 seconds on the treadmill, just under 9 minutes per mile.  I was thrilled!

And, I set the treadmill at a 1% incline, to best emulate running outdoors.  So, I felt like I was ready for my 18 miler on Sunday.

My goal was to run the 18 miles at 9:10 per mile.  The first three miles were at 9:30/mile.  I wasn't feeling fabulous, but I was chugging along.  At mile 5, I had an awful stomach cramp.  I stopped for a few minutes, rehydrated and slugged down a Hammer gel and kept going.  But, as the run progressed, I kept getting slower.  My legs felt heavy and I felt a bit tired.  By mile 14, I was just forcing myself to keep going, and my pace was down to 10:30 per mile.  I pushed to 16 miles and called it quits early.  There was no point in torturing myself to get the extra two miles out.

I've been agonizing over this not-so-stellar performance.  What went wrong?  Am I doing too much treadmill running?  Does this mean that the Long Beach Marathon is going to be a miserable experience too?  And my little Boston Marathon dream -- forget it!

I was so glad to talk to Coach Jamie today.  It was quite reassuring.  He thinks I'm overtrained, and has more confidence in me than I probably have in myself right now.

I'll have a day of easy running tomorrow, some track work on Wednesday, a 10K time trial on Friday, and an 18 mile run Sunday.  Coach Jamie thinks that if I can nail this 18 miler then I will be okay.  I've also vowed to do all of my running this week on the roads, not on a treadmill.  Maybe that will help.  I hope.....

Malibu Pictures

Pre-Race, in the transition area.

Running out of the ocean after the swim.  I may be smiling, but I am absolutely sucking wind!

On the podium at the Awards Ceremony --

Fourth Place Athena (since the first place girl started in the wrong wave, she was dq'ed)!!!!

Malibu Triathlon

Today I celebrated my 34th birthday by racing the Malibu Triathlon!!!

Me and April, a teammate, in the transition area before the race.

Half mile swim, 18 mile bike, 4 mile run.  Lots of celebrities.  I saw David Hasselhoff (looks far older in person), Mario Lopez (looks gorgeous even in a wetsuit and swimcap), and Jeremy Piven.

I did something different -- instead of racing as an age group athlete, I raced as an Athena, the category for women 150 pounds and higher.  My weight hovers between 148-150, and on the morning before the race, I was 150 so I decided to go for it.  Coach Jamie didn't agree with my decision -- he says I'm "competitive" and should "be fair", while another coach suggested I should use my size to my advantage and race in the Athena category.  While I admit that I am a normal weight for my height, being tall (5' 9 1/2") presents a definite disadvantage in triathlon, since long legs biomechanically are horrible levers on the bike and serve as somewhat of a disadvantage for running.

The swim was a bit choppy.  Some of the waves got some big swells, while ours didn't seem so bad.  I felt my swim was good, though I must admit I crashed into the third buoy before I went around it.  Yes, clutzy, but only cost me a couple seconds.  Even getting out of the water, it was a bit choppy.

I was pretty breathless getting out of the water, probably because of all the chop, and was having a heck of a time running through the sand to the transition area.  My bike ride was good, for me.  One benefit of being in a late wave is that I get to pass people on the bike, which isn't a common occurrence since the bike is my weakest leg of the race.  One girl on an archaic bike with no pedal clips kept passing me, and then I would pass her.  Every time she pulled up next to me, I laughed to myself, "I have a Cervelo!  Your bike isn't supposed to pass mine!"  But in the end, pride took over -- I wasn't going to let THAT bike beat me :) and I passed her for good.

I enjoyed the run.  Coach Jamie wanted me to run it in 8 minute splits.  I didn't quite hit that goal, but did run about 8:30/mile, and saw great friends and teammates on the course.  Best of all, my 4 year-old niece had just run the Tot Trot, and I saw my family near the finish line -- with about 200 feet to go, my brother yells, "Good job -- 2 more miles!"  I laughed, and dashed for the finish.

In the end, I finished in 2 hours and 3 minutes, five minutes faster than last year.  I placed fourth in the Athena category, which means I got to stand on the podium, which I have never had the chance to do at a large race.

I couldn't have had a more thrilling birthday!

No Soup For You! -- Watching out for Salt

There seems to be a common theme this week:  My patients love soup.

Unfortunately, soup is full of sodium.  Sodium causes fluid retention, which can lead to edema (swelling), increased blood pressure, and in those susceptible patients, congestive heart failure.

Some may believe that if the soup is homemade then it must be healthy and low in sodium -- not true.  A homemade chicken soup is made from the drippings of a chicken or another animal, which naturally are full of sodium.

Unless the broth is made with just water and vegetables, or is specifically labeled with a low sodium content, the soup is high in sodium, and if you have hypertension or congestive heart failure, then it is best to just stay away.
Image from static.howstuffworks.com

Spinach Dip

I love this spinach dip and will be bringing it with me to a Labor Day party this afternoon.  It's easy to make, healthier than a standard spinach dip, and tasty.

Here's the recipe:
3 pounds chopped frozen spinach, thawed and drained of extra water
1 small can of chopped water chestnuts
1/2 cup Vegenaise
2 tablespoons of imitation Chicken soup mix

Mix all ingredients in a bowl.  Refrigerate overnight.  Serve with chips.

Saturated Fats and Cholesterol

A common conversation that I have with my patients is how they've altered their diet once they have learned that they have elevated cholesterol.  Most will tell me that they've cut back on beef, but are eating more fish and chicken, and unfortunately, their cholesterol levels have not improved.

All animal foods contain cholesterol, because like us humans, their livers produce cholesterol.  In fact, beef and chicken and fish all have just as much cholesterol in them, so by switching to fish and chicken, dietary cholesterol consumption will not decrease.

More importantly, though, is saturated fat, which raises our bodies' cholesterol levels.  Interestingly, animal foods tend to be higher in saturated fat than plant foods.  These values are taken from the USDA National Nutrient Database:

Small Hamburger               3.56 grams saturated fat
Lean beef (1/8" fat trim)    1.38 grams
Large egg                          1.63 grams
Salmon, 3 oz                      1.63 grams
Roasted chicken breast       1.76 grams

However, here are the quantities of saturated fat for several vegetarian sources of protein:

Kidney beans, 1 cup            0.13 grams
Tofu, 1/4 pound                 0.69 grams
Veggie burger                     0.11 grams

Animal products tend to be high in both saturated fat and cholesterol.  So, if you have elevated cholesterol, it is especially important to limit your consumption of animal products.

Santa Barbara Triathlon -- In Action

A friend snapped this picture at the beginning of the bike course. I'm out of focus, which is ok, because you can see that the scenery along the bike course was really beautiful.

Santa Barbara Long Course Triathlon

My season was essentially over, with two small races to go. And then the e-mail two weeks ago from Jessica, with whom I travel to most of my races, which began...

"Feeling impulsive?"

Next thing I knew I was signed up for the Santa Barbara Long Course Triathlon. With less than two weeks until the race -- 1 mile swim, 34 mile hilly bike, and 10 mile run -- I knew I had the fitness base to do it, but also realized that this would not be an "A" race.

It is also late in the season. I find it harder and harder to get to the pool and go swim. So I haven't been to the pool lately, and my swim training has consisted of an ocean swim each week of no longer than one mile. Biking is always fun, and I've continued to ride hills. But as the fall approaches, I've focused more on my running to prepare for fall marathons. So my training for race day wasn't exactly ideal.

The swim was in ice-cold water. Halfway through, my hands and feet feeling like icicles, I just wanted to quit. I trudged through it and could not have been more glad to be running on the sand pulling my wetsuit off and heading to pick up my bike.

The bike was fairly hilly, but certainly not nearly as challenging as the hills of Wildflower earlier in the season. I dropped my bike chain about a mile into the ride. After what happened last year, there were a lot of people on the course cautioning us on the descents to be careful. My ride wasn't fabulous -- I got passed all over the place.

Lastly was the run. It was an out and back. The first two miles were flat, then miles 2-4 were all uphill. I love the run. For me it's the opposite of the bike. I get to pass people. On the entire run, I passed dozens of people, but only two passed me, and one was a man who I'll bet had a flat tire. My run time was pretty good -- 1 hr 31 min 30 seconds -- about 9:10 per mile.

My finishing time was 4 hours 31 min 31 seconds. 33 out of 47 in my age group.

One more triathlon, or maybe two, I may be racing with a friend who is doing his first triathlon.

Meat and Cancer

Consumption of meat increases the risk of cancer and heart disease.
This was reported on Good Morning America this morning. The suggestion is that parents should not be packing their kids' lunchboxes with slices of deli meat, since deli meat is high in sodium and saturated fat.

Alternatives suggested: Peanut butter and jelly on whole wheat. Or how about a sandwich with hummus and avocado? Or perhaps Tofurky?

Want more lunchbox ideas?
Vegan Lunch Box or Vegcooking are great resources.
Photo from abc.com.

Health Care Reform

I don't want to get political here. However, my experiences as a physician have shaped my opinion on this topic.

There are too many uninsured and underinsured in this country. They do not get the care they need for preventing diseases, and they present when it is too late, when their condition is out of control and the cost to treat it is far higher than what it would have cost to prevent the disease in the first place.

The rumors and scare tactics are absurd. One of my patients told me today that he, as an otherwise healthy elderly man in his 80's, with health care reform may not be treated for his hypertension, but instead would get "death counselling". Simply untrue.

The current health care system will bankrupt our country. There needs to be change. The melodrama and scare tactics need to stop and there needs to be intelligent discussion on this topic.

21-Day Kickstart to a Healthier Diet

Want to eat healthier but don't know where to start?

Have you thought about trying a vegan diet?

If so, then check out the PCRM 21-Day Vegan Kickstart. This looks like a great program!

Motivation to Exercise

I tell my patients to go exercise most days for at least 30 minutes. But what's to keep you going?

As I practice what I preach to my patients, I exercise just about every day. And there are days when my motivation is lacking. Sometimes when the alarm goes off at 4:30 am, I just want to roll over and go back to sleep. And, were I to be completely honest, every so often that's what I do. But, 99% of the time, I get up and go.

My goals keep me on track. In the next two months, I have two triathlons, and I want to perform my best. If I miss a workout, I fear that may impact how ready I am for my races.

Yesterday morning, on the treadmill at the gym, five miles into an eight mile tempo run, with my heart racing and sweat dripping on the treadmill, I was tired out. I thought, I can end this at six miles.

What kept me going was thinking of my long-term goals -- I want to qualify for the Boston Marathon for 2010. To do that, I need to get faster, and hard workouts like this have made me a faster runner and a better athlete.

Somehow I got a second wind and finished off my 8 miles with a sense of true accomplishment.

Goals are important for keeping us on track. If I didn't have goals for myself, I don't think I'd be able to wake up early and exercise.

A goal can be as simple as wanting to finish a 5K race. Another great goal is having the stamina to keep up with active grandchildren.

Whatever it is, find a reason to get out the door and exercise.
Image from media.photobucket.com

My Interview

This past Thursday, July 30, I was interviewed on the Simon Gowen Show on LA Talk Radio. I discussed the heart and exercise and my own triathlon experiences.
Listen here.

I'm going to be an IronWoman!

I decided to take the plunge..... I just registered for Ironman Lake Placid 2010, on July 25, 2010.

I had signed up for an ironman-distance race last year, but I wasn't feeling ready to put in the training. With my heart not being in it, I decided to drop out and wait until my heart was really in it.

In this sport, and really in anything in life, there's always bigger and better. When I started this sport and was doing sprint races, I thought one day I might do an olympic distance race. Now having completed four half-ironman distance races, I'm ready and excited to take the next big step.

Another Trip to the Farmers Market

All of the above items were found at the farmers market in Sherman Oaks on my trip this evening. Clockwise from left: fresh pita bread, dark green lettuce, barbeque tofu, tempeh, and fermented shitaake mushrooms.

Vineman 70.3 Race Report

On Sunday, I raced Vineman 70.3 in Sonoma County, California. For those of you not in the know, that's a 1.2 mile swim, 56 mile bike, and 13.1 mile run.

I knew it could be a hot day, so I was prepared. I had done a few key runs and bike rides in the heat, intentionally, so that I would be acclimated to 90+ degree temperatures. And, I had been drinking Gatorade, about two liters, daily for the two days preceding the race.

I had a really good race. Though, with all my hydration, I had five port-o-potty stops. I suppose that being well hydrated beats the alternative in this weather.

With the weather projected to be hot, I was glad to be one of the earlier waves to start. The gun went off for our swim at 7:18 am. The Russian River is a shallow river and it is possible to stand up in waist-deep water at many parts. Though I got clobbered by aggressive swimmers a few times as usual, it went okay, and as expected, my swim was about the same as my pace last year.

I quickly pulled off my wet suit and grabbed my bike out of transition. There's a short, very steep hill, as we leave transition. Rather than grind up the hill on my bike and kill my legs at the beginning of a long ride, I ran up the hill with my bike, actually passing people riding up the hill, and then mounted the bike.

Being an early wave, I was getting passed not only by women in my age group, but also by the waves of men (and women) who started after me. It is a little demoralizing getting passed by so many people. Nonetheless, I kept a steady pace of 16.5 miles per hour on the rolling hills of the course.

Speaking of hydration, though, I was very well hydrated. So hydrated, in fact, that I stopped three times while on the 56 mile bike ride to use the restroom, or should I say port-o-potty. But it worked out well because I never seemed to encounter a wait, and while I was in the bathroom I managed to talk a volunteer each time into filling up my front water bottle with Gatorade. So by the time I did my business, I was tanked up with Gatorade and ready to go.

On the positive, toward the end of the ride I started passing some people. Maybe some of them started too fast. But, by the end of my bike ride, it was approaching noon and the temperature was well over 90 degrees.

My bike to run transition was pretty good -- 3 minutes and 16 seconds.

As I started the run, I definitely noticed the heat. By now it was approaching 95 degrees. I was still feeling okay. I remembered that the run was hilly, and with this heat I knew that I was going to have to be especially conservative.

While I was apprehensive about the run, I know my strengths: I can run hills, having practiced running them in my Hollywood Hills neighborhood for months, and I know I can run in hot weather. A lot of people were succumbing to the heat and a lot were walking. I was able to run the entire course, with the exception of two port-o-potty stops, and walking for a few seconds at each aid station. There, I'd slug down one cup of Gatorade, toss one cup of water over my head, grab a piece of fruit and keep on going.

The last three miles were especially tough, and I had a little bit of stomach upset, but nothing that slowed me to a halt. My previous ten minute per mile pace slowed to closer to 11 or 12 minutes per mile, but I was still running, which was better than many people around me. I think a lot during those last miles about why I push myself to do these things -- because I love the challenge, and quite simply, because I can.

My half marathon split was 2:19. Far from my best half marathon, but considering that I had just swam 1.2 miles and biked 56, and it was 95 degrees outside, I was very pleased.

My finishing time: six hours and 35 minutes. That's thirteen minutes faster than last year.

Wednesday Morning Ocean Swim

This is from my Wednesday morning workout at Ocean Park in Santa Monica, before coming to work.

Juicy Ladies

I've been driving by the Juicy Ladies storefront for months, eagerly awaiting a smoothie place with maybe a couple of healthy offerings.

I was pleasantly surprised when I finally came in -- they have a delicious salad bar, part of which is shown above, delicious sounding sandwiches, and absolutely amazing smoothies! And on top of that.... IT'S ALL VEGAN!!!!!!

I piled up a plate with their kale salad, sesame tofu sticks, beet salad, and couscous, and when I was done had a peachy keen shake, which was creamy and delicious, sweetened not with fruit juice but with agave and almond milk. An omnivorous friend joined me today, and he too had salads and the vanilla almond shake, which also was amazing.

I think I have a new favorite lunch stop!

Can You Trust Vegan Restaurants?

It's always a leap of faith dining at restaurants to trust that the food being served is vegan. In a vegan restaurant, I tend to trust that the servers and owners share my values and are serving me a vegan item.

This blog posting has made me think twice about being so trusting.

Seventeen vegan restaurant items were tested for egg, casein (a dairy derivative), and shellfish. Ten of the seventeen, including some of my favorite places like Real Food Daily, Vinh Loi Tofu, M Cafe de Chaya, and Vegan Glory, did well.

However, seven of the seventeen restaurants, most of them vegan Thai restaurants, had food that tested positive for non-vegan ingredients. For example, some of the vegan "cheeses" actually contained dairy ingredients, and many of the mock meats were found to have egg and shellfish in them.

My concern over this lack of honesty is not mostly for dietary purity. There are many people with shellfish and milk allergies, and they could easily consume a product that could harm them.

My take home message: When in doubt, order an item with tofu or seitan (see two posts below), instead of the "fake meat".

Hungry Duck 5K

I visited my family in Michigan this weekend. On a trip, might as well do a race, right?

I ran the Hungry Duck 5K in Brighton, Michigan. It was a nice, residential area course, with some hills, including a not-so-nicely positioned hill in the last half of a mile. Nonetheless, I had a great day -- I finished in 24:55, which is my best 5K time ever, which won me third place in my age group and this hat. The duck necklace next to it was a finisher's "medal". There was even a "duck" standing at the finish line high-fiving us as we crossed. Loved it!

I was even quoted in the local paper.

Otherwise, a relaxing weekend by the lake. Caught up on some of my cardiology journals. Refreshed and ready to go back to work tomorrow.

Could it be... Seitan?

Forgive the lame joke. If you watched Saturday Night Live in the early 90's you'll get the reference.This is Seitan, which is wheat gluten. Basically, it's the protein part of wheat. The texture is meaty and it's loaded with protein and very low in fat. I stir fried strips of seitan with broccoli in a little bit of oil, soy sauce, and sesame seeds.

Breath of Life Triathlon Race Report

I've come a long way from the days when I rode an oversized road bike, my transition bag was a Home Depot orange bucket, and I was happy with 11 minute/mile run splits.

I now have a beautiful Cervelo P2C triathlon bike that fits me, a real transition bag, and the ability to run six miles with sub-9-minute splits. I'm still no superstar, but I've come a long way.

Today's Breath of Life Triathlon is a race that I participated in last year, with a time of 3 hours and 9 minutes. My goal was to beat three hours.

This is an olympic distance race: 0.9 mile swim, 24.9 mile bike, 6.2 mile run.

The swim: Cold water, lots of seaweed. Did my usual hyperventilating in the first two minutes, got clocked in the head by another swimmer, found my groove and finished the swim portion in 29 minutes. That's four minutes faster than last year's split, and I have not been working that hard on my swimming. As it so happens, it was a low tide so the swim was shorter.

I ran up to the beach. In front of me were a cluster of men from the previous wave who were walking up to the beach. I dashed between them, running through sand, and in the midst of my dashing and rushing dropped my goggles and swim cap. Whoops!

Transition has gotten faster. Find bike, catch breath, pull off wetsuit, drop helmet and suglasses on ground, put Luna Bar in mouth, pick up sunglasses and put on face, put on helmet, put on bike shoes, double check to make sure I have everything with me, grab bike and run out of transition area.

The bike was nice and flat. With my new (since last season) Cervelo P2C bike, I move faster. I haven't been riding too much since I've been focusing on running. But, I think my average speed was about 17.5 mph, a good mile per hour faster than last year. I still get passed on the bike a lot, but that's ok because I'll pass several of those folks on the run. Not the most beautiful bike course, but mostly flat and fast. Other than losing my water botttle straw from the bottle at the front of the bike (dropping things seems to be a theme today), I felt good about the bike.

After riding into the transition area, I quickly racked the bike, threw on socks then shoes, grabbed 2 Gu gels, my Garmin GPS (to tell me my pace... yeah I'm a geek), visor, and ran out to the run course. The first mile was in 8:15, the second and third in about 8:45, the fourth and fifth more like 9:00-9:15, and the last mile in about 8:15 to finish strong. My calves cramped up and my stomach cramped, but I could keep up my pace. I loved the out-back-out-back run course with the chance to see and cheer on other friends and club members who were racing.

Finish time: 2 hours, 55 minutes, 4 seconds. Almost fifteen minutes faster than last year. Far from first place, but definitely not last place. For me, a good race.

Heart Rate Monitors

You don't need one. But, I've found that wearing one helps me to see just how hard I'm working when I'm training.

This is my heart rate monitor that I wear on my wrist:
from DicksSportingGoods.com

And this is the strap that is worn around the chest:
from www.smoothfitness.com

For an aerobic workout, to build fitness, you want to aim for 60 to 80% of your predicted maximal heart rate (PMHR). Your PMHR is approximately 220-age.

So, for a 50 year-old person, PMHR is 170 beats per minute. The target range for a workout should be 102-136 beats per minute. You can allow your heart rate to go higher, which would put you into the anaerobic phase, using more glycogen for fuel than fat.

Exercise

Exercise is such an important part of health of the mind and body. I mention exercise in just about every office visit. In fact, when I worked in Glendale with a predominantly Armenian patient population, most of whom didn't speak much English (or exercise), I learned the Armenian word for exercise, marzank, to help me get across how important exercise is.

Most guidelines suggest that we should get thirty minutes of exercise most days of the week. However, newer findings suggest that an hour a day is even better. In studies of people who have lost weight and kept it off, most of them exercise for at least an hour most days.

Exercise does not mean that you have to go to a gym. Do something that gets your heart rate up like going for a brisk walk, bicycling, or hiking. Find others, like a spouse or friends, to exercise with to make you more likely to do it.

"I'm too busy" isn't an option. Your body doesn't care that you're an important CEO who doesn't "have time". If I have to wake up at 4:30 am to get in my workout, that's what I do. Even President Obama works out every day, and he's the leader of the free world! If time is an issue, go for a brisk walk for 15 minutes after lunch, then another 15 minutes when you get home.

"But I'm active at my job, I walk all day" -- That's better than having a desk job, but walking at work is not exercise. Cardiovascular exercise involves doing something where you get your heart rate up over an extended period of time.

Now, lace up your shoes, and go for a walk!

Welcoming New Patients!

This ad recently appeared in the LA Times and Daily News.

Grain Meat

Soy is all too common a source of protein for vegetarians. So, when I saw this at the Locali store, I had to try it out:
In these Field Roast Smoked Tomato deli slices, the main ingredient is wheat gluten, not soy. Three slices have 110 calories, 13 grams of protein, and only 3 grams of fat, none of which is trans or saturated fat.
After my long Sunday morning run, I made an open-face sandwich with three slices of Field Roast deli slices, avocado, lettuce, and tomato slices. 280 calories and very filling!

Shojin -- Organic Macrobiotic Japanese Cuisine

I love trying new restaurants. While there are plenty of vegetarian restaurants in the Los Angeles area, other than Madeleine Bistro, there aren't many that offer fine dining.

Shojin was a new adventure for a friend and I this evening in Little Tokyo. The restaurant offers vegan, macrobiotic, organic Japanese cuisine. We ordered the special menu, a five course menu of pre-selected items. It came with ponzu seitan (pictured below), a tempura avocado hand roll with soy paper, sea vegetable salad, spaghetti with vegetables, and a fruit tart for dessert.

The food was absolutely delicious and healthy.

Click here to visit Shojin.

Hemp Milk

For a change of pace from my usual cereal and soy milk, I just tried hemp milk. One cup of unsweetened hemp milk has 70 calories, 4 grams of protein, and plenty of vitamins and nutrients. It's also a balanced source of omega-3 and omega-6 fatty acids. I purchased this from Whole Foods.

San Diego Rock' 'N' Roll Marathon

Today's San Diego Rock 'N' Roll Marathon was my fifth marathon, and now I can finally say that I've run a marathon like it's supposed to be run. In every marathon that I've done up to this point, I've started too fast and found myself miserable from mile 20 onward. Not today.

One key to my success today was that I rested this week. I learned from my Wildflower race a few weeks ago just how important it is to not overexert in the days before the race.

My friend Ray, an ultramarathoner, who was doing the marathon as a "training run", agreed to pace me to a 4:20 finish. That was my goal for the day. We started at a 10 minute mile pace. I stayed consistent at that pace for several miles. I felt great.

Around mile 19, I still felt good. I gradually picked up the pace. For miles 22-24, I was hitting a 9:30-9:40 pace. I was passing just about everyone; it felt great!!! At mile 25, Ray turns to me and says, "Here's where you're going to give it everything you've got." I picked up the pace to 8:30/mile, and for the last two tenths of a mile, I hauled it in to the finish line.
My finishing time: 4:18:32. A minute and a half faster than my goal. And, I did it in negative splits, meaning that the second half of the race was faster than the first. Overall, a great day!

Change

I spend a lot of time talking to my patients about lifestyle change. I truly believe that a patient is not treated by pills alone. If a person commits to a healthful lifestyle, he or she will live longer. And I believe that people can change.

But change does not come easy. It comes a few small steps at a time.

I don't expect a patient with out of control blood pressure and lipids, who does not exercise, and who eats no fruits or vegetables, to come back to me a month later having become a vegan who exercises five days a week and with normal blood pressure and cholesterol. If he or she returns to me a month later with an improved blood pressure, perhaps a pound or two lighter, and is now eating a salad every now and then and walking two days a week, I consider that success, and we can improve even further from there.

Diet change is especially tough. Someone who consumes a lot of meat and not many fruits and vegetables cannot overnight adopt a plant-based diet. A great way to start is to give up beef and aim for two vegetarian meals a week. Then give up dairy, and try new things like soy milk and rice milk and hemp milk. And then another change towards eating healthfully, and another....

I can recall a time back in college when a grilled cheese sandwich, a large order of fries, a 24-ounce Coke, and a large ice cream sundae was a normal dinner. At that time, I thought that by putting on my Rollerblades a couple of days a week for a few minutes to get to my classes that I was exercising enough. I was overweight and had so little energy. It took years and many small steps along the way to become a healthier person.

Small steps can be the key to long-term success. Celebrate small successes, and keep moving forward.
Image from www.35unger.com

"It's in my chart"

Be an active part of your health care. Know your medical history. Carry a list of your major health problems and medications and their doses with you at all times. Consider getting a medical alert bracelet.

Just because something is "in the chart" doesn't mean that I have it in my records, especially if I'm meeting you for the first time. I do not rely on "the chart" for what doses of medications you take -- you are the keeper of the pill bottles and you are the one who puts the pills in your mouth, so you are the one who knows exactly what and how much you take. Further, all of your records may not have come to me yet if I am meeting you for the first time.

And, finally, imagine this scenario: You end up sick in an emergency room where none of your doctors practice. Your medical information is absolutely crucial to your treatment in the next few minutes and hours.

My New Favorite Workout

Exercise is a habit. If we enjoy exercising, it's easier to stick with it.

My favorite workout right now is the Ocean Speed Circuit. At 6:30 am, nearly 100 people from my triathlon club gather in Santa Monica to swim in the ocean. We swim out to a buoy, swim back to land, run a few hundred feed on land from one cone to another, and then get back in the ocean and do it all over again.


It's a great workout -- getting into the ocean, diving under waves, and running on the sand definitely gets the heart rate up. Swimming in the ocean always reminds me that I'm from the Midwest -- I am not entirely confident swimming under and over waves, and with the quick entrances and exits from the water, my ocean swimming has improved.

And really, what better way to start the day than a dip in the ocean?

Here's what it looks like from a traffic helicopter.

Wildflower Triathlon Pictures

Getting out of the water after the swim


Climbing that first big hill out of the transition area



Cruising along on the course... with a smile

Running the course... trails and hills... very challenging

Dashing to the finish line

And the big finish!

Farmers Market

I love a trip to the farmers market. The produce is locally grown, less expensive than at the grocery stores, and absolutely delicious! On top of that, supporting your local farmers market is kinder to the environment, because your produce was transported from somewhere nearby, like San Luis Obispo, California, as opposed to, say, Chile.

This sandwich is created from my farmers market trip today. Fresh whole-wheat pita bread with avocado hummus, cucumber slices, and a chopped tomato. Don't mind the few bites taken of the sandwich -- it's the best way to show you what's inside. Paired with a salad and some strawberries also purchased at the market, a very filling lunch after my long run this morning.

Big Lunch Salad

This is my typical lunch: A big salad.

The base of the salad is dark lettuce with carrots. Sometimes I'll add some beets, celery, cucumbers, or sunflower seeds. I always include some form of protein, such as kidney beans, chik peas, lentils, or tofu. Here, I've added Follow Your Heart's Chicken Free Chicken. The salad is topped with two tablespoons of Follow Your Heart's Thousand Island dressing.

I pair the salad occasionally with a slice of bread or a side of pasta and always include fresh fruit for dessert.

Follow Your Heart is a favorite stop of mine. They are a vegetarian grocery store in Canoga Park, just a mile and a half from my office. In addition, there is a fantastic cafe in the back of the store with delicious healthy vegetarian items.

Follow Your Heart is located at 21825 Sherman Way in Canoga Park.

Pictures from Wildflower

This is me climbing the hill called Nasty Grade. I'm almost at the top.


On the run, near the end. Fighting a stomach cramp and finding some adrenaline knowing that the finish line is less than a mile away.

Wildflower Race Report

It' s been a crazy year in my athletic life. I started by DNF'ing a marathon, coming back two weeks later to race a marathon where I achieved a personal record, and then being derailed from racing by an arrhythmia known as supraventricular tachycardia.

Eight days after my arrhythmia ablation, I raced Wildflower Long Course, one of the world's toughest half ironman distance races. I am pleased to say I had a great time and a great day as an athlete.

Wildflower is the only reason that I own a tent. It is known as the Woodstock of Triathlons. The only feasible way to race is to camp there the night before, and then of course celebrate the night after with my team at the campground.

My goal time for the race was 7 hours and 15 minutes. I thought that was a pretty ambitious goal and wasn't sure I could make it.

We started with the swim, which I estimated would take me 43 minutes. After accidentally following a swimmer into an embankment, I straightened myself out and had a good consistent swim. There were a lot of us out there in the water and I managed to avoid being elbowed or kicked too much. I followed a sea of different colored caps. But, toward the end, as I was getting out of the water to run to the transition area, I suddenly noticed a sea of men in pink caps that I had not seen before! I thought I was in the wrong place, until I realized that they were all the frontrunners in the shorter mountain bike triathlon race that was taking place that day.

Time for swim portion: 44 minutes. Close to my goal.

I pulled off my wetsuit, put on my bike shoes, helmet, and sunglasses, and hopped on my bike. I heard several friends and club members cheer me on as I rode out of the park. One person who knew about my arrhythmia issues yelled, "Surgery one week ago, racing today, no big deal!" Well actually it wasn't a surgery, it was a percutaneous procedure through the vein in my leg... ummm never mind. It's the thought that counts.

I had a tough time on the bike course when I tried it out a month ago. My goal was to finish in 4 hours and 15 minutes, or maybe 4 hours if I was doing really well. Since then, I put a new rear cassette on my bike that would make hills easier. What a difference!! I glided up the hill known as Nasty Grade with more ease than last time, passing several riders. As it turned out, I finished the bike ride in 3 hours and 50 minutes, taking forty minutes off my previous time!

On to the run. This is my favorite of the three sports. I had hoped I could finish in 2 hours 24 minutes, an 11 min/mile pace. This run course is TOUGH!! It is really hilly and mostly on trails. I passed a lot of the athletes who had passed me on the bike. Many people were walking. Other than a few very brief steep portions, I ran the entire course, though at many points my run was more of an uphill shuffle. I ran past Blaine from NBC's The Biggest Loser, who was competing with his cousin and fellow Biggest Loser contestand Dane, and this time around no one drove them to the finish line.

I had a sudden stomach cramp at mile 12. It hurt so badly that I started walking, until a member from my club yelled behind me to stop walking and to run. So I picked up the run again, and before I knew it, I saw the finish line, and the adrenaline kicked in and I had no more side pain. I heard "Dr. Heather Shenkman is coming across the finish line!"

Finish time: 7 hours, 11 minutes. Four minutes faster than my goal.

My run time was 2:29, a little slower than my goal, but actually faster than a lot of athletes in my age group.

I have to say, I just had a great race. For the most part, I felt great, even to the end. I had fun and achieved my goal time.

Ironically, I think some of my success was due to the rest that I had to take because of my heart procedure. I came into the race feeling well rested, which I think really helped. That's a lesson that I will take with me to my upcoming races.

Ablated!

I had my SVT ablation today (for more on that, read the post below this).

It was a long procedure -- about three and a half hours, since I had an atypical electrical pathway. I now understand why adenosine is so uncomfortable and how isoproterenol makes the heart pound. I recall lying on the cath lab table, in a fog of versed and fentanyl (sedation medications), as my heart would intermittently pound. But in the end, it was a success.

The staff in the cath lab and the nurses on the floor were great.

I definitely have a new appreciation for what my patients go through.
Image from heartrhythmguide.com

Seeing the Other Side

As of late, I find myself in the role of the patient.

About six weeks ago, I noticed some short bursts of palpitations and lightheadedness. Then during a weight training workout, I felt my pulse racing for about a minute before it would stop. I had only four hours of sleep the night before, it was 5 am at the gym, and I figured it was just due to fatigue.

A week and a half later, it occurred again while lifting. I looked down at my Polar heart rate monitor -- 180 beats per minute. That can't be right. My first instinct was to keep on exercising and hope it would stop, but trying to do squats with a racing heart doesn't work so well. I tried carotid sinus massage, pressing on the neck to try to stop the racing heart rhythm. Then I laid down, and by bearing down I was able to break the endless loop, watching my heart rate monitor flash from 180 suddenly to 73 beats per minute.

Being a cardiologist, I knew that this was likely a supraventricular tachycardia -- in other words, an abnormal circuit in the heart that can cause the heart to race. I obtained a portable heart rate monitor that I could carry with me wherever I went -- on long runs and bike rides, or in my lab coat pocket. If the palpitations recurred, I could capture the electrical impulses so that the rhythm could be diagnosed and appropriately treated.



Two and a half weeks went by without any palpitations. I hoped that meant that I was cured, but that was quite unlikely. Then, after a challenging bike climb, it occurred again. I pulled out my trusty event monitor to record the rhythm and sent in the recording.

My suspicions were correct. I have supraventricular tachycardia, also known as SVT. And the episodes are becoming more frequent, and at times are lasting longer, up to 25 minutes at a time!

There are two ways to treat this. The first option is medication. That would decrease the frequency of the attacks. However, it would cause my heart to be slower all the time and would limit my capacity to swim, bike, or run, and in all likelihood would not cure me. The second option is an invasive procedure called an ablation, which involves feeding a catheter from the large vein in the upper leg up to the heart, localizing the abnormal rhythm, and burning through that abnormal electrical circuit. The cure rate with the latter option is 90-95%.

I'm opting for the latter, more invasive procedure. I need a cure. If I had SVT while running or bicycling, it would be disruptive, and I'd have to stop. Worse yet, if I had SVT while swimming in open water, that could be downright dangerous.

Until my ablation procedure is done, I cannot race. Which absolutely kills me, because I was looking forward to my first race of the season this weekend.

I am nervous -- even though the complication risk is very low, normally I'm the one performing the procedure, and now I will be the patient on the table. I think this will give me a different appreciation for my patients' experiences.
Image from http://kirstyne.files.wordpress.com

More Passover Dishes

The recipe is called Mrs. Feinberg's Kugel. I have no idea who Mrs. Feinberg is, but her kugel is fabulous! The recipe includes 1 cup grated apple, 1 cup grated sweet potato, and 1 cup of grated carrots, and one cup of matzah meal. Then add 1 tsp salt, 1 tsp cinnamon, 1 tsp of baking soda. The recipe also calls for 1/2 cup of margarine -- I only used 1/4 cup, but probably could have gotten away with even less than that. There is also an optional addition of nutmeg and sugar, but honestly, the dish is sweet enough that it doesn't need added sugar. Bake for 45 minutes at 325 degrees.

Mushroom and potato casserole. Boil redskin potatoes, mash, and put them at the bottom of the dish. Then saute sliced mushrooms and onion, just until the mushrooms give up their juice. Pour the mushroom and onion mixture on top of the potato layer. Top with almond slivers and raisins. The dish calls for 2 tablespoons of margarine, which I omitted.

Matza Farfel Pasta

Tonight is the first night of Passover. Passover is a Jewish holiday on which we do not eat leavened bread, nor do we eat items that may resemble leavened bread. This includes soy, lentils, and peanuts, all of which are normally staples of my diet as a vegan.

I enjoy the holiday because it challenges me to prepare food that I would not normally make.
This is whole wheat matzah farfel with baby bella mushrooms, pasta sauce, and carrots. I sauteed the sliced mushrooms in 1/2 cup of pasta sauce, then added sliced carrots, and last 1/2 cup of matzah farfel. 320 calories.

Triathlon and Risk of Sudden Death

Research presented at the American College of Cardiology 2009 Scientific Sessions demonstrates that the risk of sudden death is higher during a triathlon than during a marathon. Most deaths occur during the swim portion of the race and the average age of those who died was 42 years old.

I think that the take-home message here is that athletes, particularly those who do not compete regularly in races or those who have cardiovascular risk factors, should be screened by their physicians before racing.

They're Not Mashed Potatoes....

but they're healthier and still really tasty!
I made mashed cauliflower. I boiled 12 oz of cauliflower for about 20 minutes, poured it through a drainer, and then mashed it. I added just one teaspoon of Earth Balance margarine, salt, and pepper.