Journey to Health

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!!!

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

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

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

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!

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!

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

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

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?

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

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

New Creations in My Kitchen

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

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

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?

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!

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!

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!!!!

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

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

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?