The Paradox of the Hospital Cafeteria

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.

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

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

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

Cheese for Vegans!!!

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

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

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

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

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

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

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?

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

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!

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

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

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

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?

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

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

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