What I'm Reading

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

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

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

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

New Adventures

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

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

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

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

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

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

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

I Am Burned Out

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

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

I need a break.

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

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

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

Fuze Tropical Punch

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

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

Atkins

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

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

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

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

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

New Moon Century -- 100 mile bike ride

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

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

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

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

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

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

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

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

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

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

Three Runners Die in Detroit Half Marathon

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

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

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

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

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

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

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

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

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

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

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

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

Watch the video here

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

Long Beach Marathon

Today I ran the Long Beach Marathon.

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

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

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

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

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

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

Vegetarian Diets Reverse Diabetes

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

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

Cooking Less... Eating Vegin' Out!!

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

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

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

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

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

Taper

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

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

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

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

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

Why I Do What I Do

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

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

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

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

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

Got my Mojo Back

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

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

I think I'm back.

Burnout?

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

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

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

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

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

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

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

Malibu Pictures

Pre-Race, in the transition area.

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

On the podium at the Awards Ceremony --

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

Malibu Triathlon

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

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

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

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

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

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

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

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

I couldn't have had a more thrilling birthday!

No Soup For You! -- Watching out for Salt

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

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

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

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

Spinach Dip

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

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

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

Saturated Fats and Cholesterol

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

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

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

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

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

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

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