Coney Dogs and Detroit Lions

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

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

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

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

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

P.S. The Lions won tonight!!! 5-0!!!

Malibu Triathlon 2011

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

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

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

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

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

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

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

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

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

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

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

Photo courtesy of Paul Hekimian of LA Tri Club

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

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Crossing the finish line.  Photo courtesy of Marvin Suntonvipart.

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

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

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

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

Vegans are the ONLY Normal Weight Population!

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

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

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

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

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

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

Coronary Calcium Screening -- Does Everyone Need One?

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

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

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

I would disagree strongly.

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

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

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

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

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

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

Heart-Attack Proof Diet??

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



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

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

Hansen Dam Triathlon

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

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

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

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

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

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

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

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

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

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

Awards Ceremony -- "Podium"!!!!

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

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

Unprocessed

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

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

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

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

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

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

Vineman 70.3 Race Report

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

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

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

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

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

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

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

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

I'm No Chicken of the Sea

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Diet Myths

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

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

from askfreud.com

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

from walldesk.net

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

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

Come Take My Class!!!

I will be teaching a three-session class, along with Jeri Gertzman, a Registered Dietitian, on "Plant-Based Nutrition for a Healthy Heart".

It is a three-session class where you will learn why a plant-based diet is optimal for health, and how this diet can prevent and even reverse heart disease. We will even feed you with delicious food!!!

There are two three-session classes scheduled: July 18, 25, and August 1, and September 12, 19, and 26.
The cost is $15 per session or $40 for all three sessions.
Classes will take place at my office from 6:30-8:00 pm -- 7325 Medical Center Drive, Suite 300, West Hills 91307.

Call (805) 210-7411 or email nhayes@regalmed.com to register.
Image from www.tcolincampbell.org

Breath of Life Triathlon -- Race Report

Today I raced the Breath of Life Triathlon, an olympic distance race -- 0.9 mile swim, 24.8 mile bike, and 6.2 mile run.

The race took place in Ventura Harbor and along nearby roads.  Previously, the race was held at San Buenaventura Beach, which meant the swim could be choppy, but the run was scenic along the boardwalk.  This time, the swim was calm and the run had unexciting views.

I had my goals -- 28 minute swim, 1:25 bike, and 53 minute run.  I met them all -- 26:48 swim, 1:23:38 bike, and 52:50 run.

The swim start wasn't too crowded, which is always nice, to avoid getting kicked and elbowed.  But there were some very aggressive women in my group, so it was a tough start.  We swam two loops, jumping out of the water and running across a timing mat on the sand between the loops.  I sprinted out of the water after the first loop, perhaps showing off, and dove right back in.  This expenditure of energy ended up being counterproductive because after landing in the water again, I ended up pretty winded for the next minute or so, and spent about 15 seconds doing breaststroke catching my breath.  That said, none of the 3 or 4 people who I passed on land passed me in the water.

The bike was flat and dull.  One woman coming out of the transition area at the same time remarked that she didn't have a gel with her.  I gave her one of mine.  She then proceeded to draft off of me for the first four miles of the race.  When I passed her, she acknowledged she was drafting me and suggested we draft off each other for the remainder of the race.  While drafting was a tempting proposition, drafting is not legal in this race, so I pulled ahead and stayed away from her. 

We rode three loops around a few farms on a mostly flat course.  I have definitely become a faster cyclist, as I was able to maintain an average speed of 18.2 mph on my bike.  I was passed by lots of men with fancy wheels and helmets, but not by too many women.  If I'm riding 18-20 mph, I think I can get over someone flying by me on their bike.

The run was an out-and-back, through the harbor and then along a really boring road with not much to see other than the strawberries across the street and runners and cyclists.  But, on an out-and-back, it is easy to know who is in front of you and who is behind you, in case you feel competitive.  Which, sometimes I do :) Though I know I'm not going to win the race, I like to see how I'm doing relative to others.  And I like giving the occasional high-five to my friends who are racing.  I dropped my pace a bit toward the end of the run, but stayed between 8:15-8:43 per mile.

Total finishing time: 2 hours and 48 minutes and 39 seconds.  This was my best time on an olympic distance course, so I am very happy.

Do Patients Really Listen?

Am I wasting my breath when I suggest eating better, exercising, and losing weight?

A lot of doctors think so.

I was discussing this with another physician this evening.  Often, our solutions are pills -- you have high blood pressure, you get a prescription for amlodipine.  You have high cholesterol, you get a script for simvastatin.  You have palpitations, you get atenolol scribbled on a prescription pad.

But, what about diet and lifestyle?  If, to lower your blood pressure to a normal range, you could cut back on the sodium in your diet, eat less fast food and more fruits and vegetables, would you do it?  Or what if cutting back on (or better yet, eliminating) animal foods would slash your LDL cholesterol drastically without the need of a pill?  Or, if cutting out your morning latte would eliminate your palpitations, would you do it?

True, many patients are set in their ways, or have emotional barriers that keep them from living a healthy lifestyle.  But, I think patients are more motivated than we give them credit for.  If the option is lifestyle change or a pill, I don't believe that most people will chose the pill.

Track

Running track is one of my favorite workouts.  It's full of adrenaline and pure speed, and yet also of learning to pace oneself.

I had not run track in over a year and a half.  I was busy training last year for an Ironman, and there has also been the barrier of my office being far from the track.

But, the track is what has helped me go from being a 4:57 marathoner to a 4:12 marathoner, and hopefully even faster than that in the near future.  I am grateful for all of my gains in running over the past couple of years, but I still want to one day run a marathon fast enough to qualify for the Boston Marathon.

Recently, I made a decision:  I love the track, and as I need to get faster, I need to get back to the track.  Unfortunately, my workplace is in West Hills, and the Los Feliz Flyers track workout is at Caltech in Pasadena.  And I have two dogs at home eager to go outside.  It's a tight commute, but I make it to track by 7 pm.

There are two groups at the track:  The fast group, and the TOG's (aka The Other Group), the slower group.  My pace makes me one of the faster TOG's, or it makes me the caboose of the fast group.  When I last ran track, I was running with the faster group.  And upon returning, I thought that's where I would start again.

The first track workout in a year and a half was a bit of a disaster.  The workout was 400 repeats, or one lap around the track.  I nailed the first one in 1:36, and smiled at our coach Don, like "hey look at me, I haven't gotten slower, I still have it!".  Then the next lap was 1:39.  Then 1:42.  Then 1:44.  I kept falling farther and farther behind on each lap.  My heart rate was approaching 190 on each lap and barely came down with the short rests between laps.  I was beat!  I knew I'd blown up, and ended up quitting mid-workout.

Over the past several weeks, I've been running with the TOG's.  I'm still one of their faster runners, but running with that group has helped me to not go out all guns ablaze, so to speak.  And, even in six weeks of track, I'm faster than I was before I started this little stint.  I ran a track mile in 7:09, my fastest ever, and my brick runs (running after getting off the bike) lately have been consistently faster.

My short-term goal is to get a bit faster and join the fast group.  Long-term, my goal is to qualify for the holy grail of marathons -- Boston. 

Boston 2013, look out, here I come!

AIM-HIGH? Not so high apparently.

Some things in medicine seem like common sense, but they are not.

Since heart disease and osteoporosis increase after menopause, when estrogen levels drop, it was thought that supplementing estrogen would help.  Then the WISE study demonstrated that there may actually be harm in taking estrogen.

Diets high in fruits and vegetables, which in turn are high in vitamins, nutrients, and phytochemicals, lead to decreased risk of heart disease.  So, it would make sense that vitamin supplements would help, right?  Many studies and meta-analyses have looked at whether supplementing B vitamins, vitamin E, folate, or coenzyme Q10 would reduce the risk of heart disease.  Not a single study has shown that vitamin or mineral supplementation reduces heart disease.  In fact, vitamin E supplementation may increase the risk of stroke.

But niacin was thought to be different.  Niacin raises HDL ("good cholesterol") levels and lowers triglycerides and LDL levels.  Several small studies showed that niacin alone might reduce risk of cardiovascular events.  Therefore, it was thought that if some is good, then more is better.

The AIM-HIGH trial of more than 12,000 patients already on statins with controlled LDL cholesterol sought to determine whether addition of long-acting niacin would further reduce cardiovascular events.  However, the trial was recently stopped early because patients showed no decrease in cardiovascular events, but did experience an increase in risk for stroke.  This increase in stroke was somewhat surprising, and there is no obvious explanation for the small but significant increased risk of stroke.

Another drug, torcetrapib, a CETP-inhibitor, which raises HDL, was studied a few years ago as a hope for patients with heart disease.  However, studies showed increased all-cause mortality amongst patients on a combination of a statin and torcetrapib.

Dr. Neal Barnard of PCRM, the Physicians Committee for Responsible Medicine, has an interesting take on the subject. Artificially raising the HDL with medicine like niacin may not be what helps people live healthier and longer. The key may be healthy diet and exercise, which in turn raise HDL levels.

Better living doesn't necessarily come from better pharmacology.  Healthy diet and lifestyle are still the cornerstone of reducing heart disease risk.

Go See Forks Over Knives!

I finally saw Forks Over Knives this week.  It's a movie about how eating the right foods can reverse disease and save your life.

The message is simple:  You are not doomed to a life of disease, even if it runs in your family.  You have the power over what you put into your body.  And, if you choose the right foods, particularly by following a plant-based (or as firefighter Rip Esselstyn puts it, "plant-strong") diet, you can avoid and reverse many diseases.

As a physician, the part I found interesting was observing Dr. Matt Lederman of the Exsalus Wellness Center conselling patients.  The Exsalus Wellness Center, based in Los Angeles, is run by Dr. Lederman and his wife Dr. Alona Pulde.  Their approach to health includes a plant-based diet.  I think the concept of a wellness center is pretty cool.  From hearing Dr. Lederman speak, I understand that he spends two hours of time with a patient for a new consultation.  And, the patients who come to Exsalus are in many ways self-motivated -- as Exsalus does not directly accept insurance, the patients who are there have directly sought out Drs. Pulde and Lederman.

I'm a bit envious of them -- I'd love to have two hours to spend with each new patient.  And I'd love to have a patient population eager to soak up knowledge about a plant-based diet.  But, perhaps that's part of the challenge of what I do.  While many patients seek me out knowing my approach to patient care, many see me by default because they are sent to me by their primary care physician.

Nonetheless, I think that the message of self-determination can ring true in just about any patient.  When given the option, "I can give you a pill for this, or we can try to reverse this with diet and exercise," most patients will choose the latter option.  And, this is an opportunity to get across to patients that they CAN change their lives just by what they choose to eat.

Forks Over Knives is one powerful movie -- it can change your life.  No joke.

BBQ -- Vegan Style

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

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

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

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

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

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

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

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

Chest Pain

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

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

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

Tofu Scramble

This is so easy, and so healthy!

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

Steak House Dinner

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

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

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

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

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

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