18663 Ventura Blvd, Suite 202, Tarzana CA 91356

Monday, October 27, 2014

Nuts and Avocados

Last week, I attended the annual meeting of the American College of Lifestyle Medicine.  Not only was it an opportunity to hear some of my favorite speakers, but I had the chance to meet plenty of like-minded medical professionals, who like me feel that medicine is more than just a handful of pills.

One of my plant-based heroes, Dr. Caldwell Esselstyn, author of Prevent and Reverse Heart Disease, presented at the first morning of the conference.  His work has demonstrated that not only can people adhere to a whole-food plant-based diet, but that when they do amazing things can happen.  He has demonstrated that changes in diet can lead to a decrease in angina, fewer cardiac events, and even reversal of plaque build-up in the arteries as seen on an angiogram.
Dr. Caldwell Esselstyn

The diet that Dr. Esselstyn advocates is free of meat, fish, dairy, egg, oil, nuts, seeds, and avocados.  In other words, it's more intensive than just a vegan diet, and inherently quite low in fat.

I have a number of patients who have successfully followed Dr. Esselstyn's program, and not a single one of then has has a recurrent cardiac event or needed another stent.  But, the question that I have been asked, and I have wondered, why no nuts or avocados?  I can understand avoiding animal products and oils since these are inflammatory to the body, but why go so far to restrict the diet?

So, I approached the microphone at the end of Dr. Esselstyn's talk, and I asked.  His answer was that because they are high in fat, they are not helpful to most cardiac patients.  But what about those cardiac patients who are normal body weight, can they enjoy nuts and avocados?  His succinct answer?  "No."  So I pressed him on the question and asked, "Why?".

Dr. Esselstyn answered that this is how his studies were designed, the diet has worked so well, and as a result he hasn't wanted so change up a successful formula.  Some participants who I spoke with found this to be an unsatisfying and unscientific answer.

And, yet, at the same time, minutia like nuts and avocados, does it matter?  Does it really matter when, to paraphrase President of the American College of Lifestyle Medicine, Dr. David Katz, "most people are eating glow-in-the-dark junk"?

My take on all of this -- I would love to see all of my coronary disease patients on Esselstyn's diet.  That said, I eat avocados and nuts, and I don't believe most people should avoid these foods since they have plenty of important nutrients.  But, for those patients with coronary disease who are so motivated, I encourage them to follow the program espoused by Esselstyn.

But, the majority of my patients, while they are willing to make positive diet and lifestyle changes, may not feel ready to go quite this far.

And some of my patients have far less than ideal diets, those who may eat the majority of their meals at fast food outlets, or when asked about fruits and vegetables will tell me that they eat "eggs and potatoes."  In these cases, it might be a victory just to get this patient to eat one fruit and one vegetable per day.

We can all agree that more fruits and vegetables, less processed food, less refined sugar, less sodium are all good choices.  So let's start there, at the very least, when encouraging lifestyle change.

Saturday, October 18, 2014


It's interesting what our sense of "normal" is.

When I first meet a patient, I ask her about her diet.  A typical response is, "I eat normal."

What does "normal" mean?  Upon further questioning, "normal" is the Standard American Diet.  In other words, a diet high in processed meat, red meat, sugary desserts, high-fat dairy, processed foods, refined grains, and sugary drinks.  It's a diet that has few fruits and vegetables, if any.

A "normal" diet is one that increases the risk of heart attack, stroke, diabetes, obesity, arthritis, and many forms of cancer.
How normal is that????

Why can a person sit and eat a burger, fries, and large soda and no one think anything of it, and if I sit down with a big salad for lunch, it's viewed as alien, atypical, or even.... "healthy".  But not normal.

So, how is that we as a society have come to view foods and habits that kill us as "normal"???

Our paradigms need to change.  And that's going to take a big shift in how we as a society view food and exercise.

Saturday, October 11, 2014

Thursday, October 09, 2014

Silverman 70.3 -- Ending the Season Right

I certainly didn't pick easy races this year.  St George 70.3 was a hilly course with a high of 73 degrees, Vineman 70.3 was pretty damn hot too, and Silverman, with an elevation gain of over 4000 feet on the bike course and three loop hilly run, it just ended up being a long challenging day.

We had heard rumors of Lake Mead being as warm as 80 degrees.  When the water is warmer than 76 degrees, wetsuits are not legal.  I brought mine anyway, and when I heard the water was about 75 degrees, I was glad that I could wear my wetsuit to give me more buoyancy and therefore a bit more speed.

My wave, women 35-39, was one of the first to start.  I started in about the second or third row of women.  About halfway through, in my full-length wetsuit, I felt really warm.  My mouth was dry.  And I was worried -- did I just overheat on the swim and blow my entire day? Fortunately, I didn't.  I drank quite a bit in the first few minutes of the bike and in transition and I was fine.

I'm going to digress for a minute -- I had a side bet with one of my teammates Kosha.  He is an amazing athlete, former college football player, blazing fast runner, and awesome cyclist.  But on the swim, he and I are pretty close.  At Vineman, he was 23 seconds faster on the swim, and at Malibu he was a couple seconds faster also.  We made a bet over a shot of tequila over which one of us would be faster.  In this race, finally, I outswam him -- by 7 seconds, with a time of 38:33.  But, a win is a win, and he had to do a tequila shot.  And I joined him in doing the shot, because truthfully, it was an amazing swim for both of us.

My swim:  17/70 women finishers in my age group

This was a hilly bike.  Not just hilly, but basically no flats.  We were either going up or down, but mostly up because the point-to-point course ended us at a higher elevation.  And no shade from the elements.  It got hot fast, like over 90 degrees.

There's an interesting psychology to where one starts in a race.  In Malibu, when I'm in one of the last waves, I get to pass a lot of people in front of me.  But, at Silverman, when I'm one of the first waves, I get passed by a lot of people.  I have to not get demoralized, remind myself that most of the people passing me are men, that I'm not getting passed by (many) women, so I'm staying ahead of my competition.

The wind was a factor also.  I have a disc wheel in the back, which makes me even more susceptible to wind.  On some of the downhills, I felt pretty unsteady and found myself gripping the brakes.

The biggest challenge for me on the bike was mechanical issues with my chain.  Whenever I would try to shift to my smaller gears, the chain would fall off.  It fell off four times, necessitating me to get off my bike and put the chain back on.  That wouldn't take me more than 20-30 seconds and a little lost momentum each time, but it did give me a brief chance to stop pedaling and stretch.

My legs were tired.  I'd say about 20 miles in, I thought to myself, how am I going to do this?  It's hot.  My legs hurt.  And I have 36 miles to go.  In my head, I broke it down.  Let's get to the turnaround.  Then, let's get to the gate at the exit of the park.  Then, let's get onto that next turn, let's get over that big hill, and let's get to T2 and start running.  Yes I'm getting passed, but those are mostly men.

I stayed well hydrated, which is important on a hot and windy day.  After finishing off my two bottles of coconut water, I relied on one bottle of Ironman Perform (yuck) and then some water.  I had a couple of mini-Bonk Breakers also.  I don't love gels when I'm on the bike; solid food just makes me happier.  And the aid stations are just fun.  I yell out what I need, put out my hand, fly by on the bike, and grab the bottle or the Bonk Breaker or banana or whatever it is.

I arrived at T2, the second transition area, to find very few bikes, which was reassuring, and indicated that most of the other women in my age group were behind me.

My Bike:  3 hours and 24 minutes.  14/70 women finishers in my age group.

Three loops.  Well over 90 degree weather.  More hills.  My run was more of a shuffle.  I felt like I was barely moving.  But, my strategy is always to run everything except the aid stations.  Because, no matter what speed I'm running, it's faster than any walk.  And if I stop to walk, I won't want to run again.

Again, awesome volunteers with lots of goodies at the aid stations.  At each station, I took a cup of water and drank it.  I took another cup and poured it over my head.  Then I'd swig a cup of Ironman Perform (double yuck) or some Coke.  And then I'd grab another cup of water to douse my head.

To keep cool, some women were handing out zip lock bags of ice.  I grabbed one and stuffed in the top of my tri-top.  When the ice melted, I'd refill it with more ice.

Running with bag of ice stuffed in my top

I can't say I felt great.  The heat took a lot out of me.  I stopped looking at my watch because I just didn't want to know how slow I was running.  But yes, I was running.  Not walking.  It was a slow run.  How was I not getting passed by everyone?  My coach Gerardo who was running as part of a relay team, breezed past me,  He reminded me to run tall and take smaller steps going uphill.
Is this over yet?

Sometimes I put a mantra into my head.  I saw people walking, and slowing to a walk was all too tempting.  I kept saying to myself, "What are they doing?  They are walking.  What am I doing?  I'm running.  So I'm going to keep on running."  Kind of silly mantra, but it kept me going.

What made this event nice was that there were so many familiar faces on the course.  About twenty of us from Fortius Racing were there, and a bunch of others from LA Tri Club who I knew.  It always helps to cheer people on or to get some words of encouragement, and on a day like this, a few "Go Heather!" 's can make a huge difference.

My Run:  2:23.  17/70.

Overall Finish time:  6:33.  17 out of 84 women finishers in my age group.

My slowest 70.3 all season, BUT my best finish.  12 women in my age group didn't finish the race.

I'm so grateful for the success of this race.  I stuck around toward the end for the rolldown for Ironman 70.3 Worlds, with a chance of a rolldown slot to compete at the world championships.  I didn't get a spot, but to think I even had a chance, was just a cool feeling!

I'm happy to finish the season well .  I'm taking a few weeks off and then will start marathon training. More about that soon.