Sports Nutrition

Just because I'm the VeganHeartDoc doesn't mean I have it all figured out when it comes to my own nutrition.

I'm not perfect in my own eating habits, but I think I do better than most.  I get my fruits and veggies. I eat whole grains instead of refined grains.  I don't eat a lot of junk, and though that big chocolate chip cookie from Follow Your Heart after lunch was delicious, it certainly wasn't necessary.  I'm also not perfect with portion control either, and I do love to snack throughout the day.

I've been thinking hard about my own nutrition and what changes I need to make.  Perhaps part of it is the extra five pounds of padding that I've acquired in the off-season.  But, more importantly, I'm about to take on the most daunting physical challenge that I've ever encountered:  The Ironman.  2.4 miles of swimming, 112 miles of bicycling, and 26.2 miles of running, all in the same day.  My training weeks will consist of anywhere between 10 and 18 hours of cardiovascular exercise in a week.

I've recently talked to a nutritionist, and I've discussed nutrition with my new personal trainer.  The consensus is that I need more protein in my diet.  Now, the average person needs no more than ten percent of their calories from protein, and when left to my own devices, that's about how much protein I consume.  But, as an endurance athlete, my requirements are higher so that I don't catabolize too much muscle.  From what I've read, I need about 1.3 to 1.5 grams per kilogram body weight of protein per day, which for me is about 90-100 grams of protein per day.

I've been thinking of ways to get that protein -- veggie chili, soy yogurt, Chicken-Free Chicken, Luna bars, tofu, Kashi Go Lean (which is my favorite cereal already), and protein smoothies.

My personal trainer did bring up a good point -- I would benefit from a rapidly digestable protein.  Whey protein is digested rapidly, but as a vegan, I do not consume dairy.  I am looking into a good source of rapidly digestable vegan protein.  So far, I have come up empty.  If anyone has thoughts on this, feel free to share!

Back to Training

I like having a goal.  And I like structure.  And competition.

That's why I'm a triathlete.

I've enjoyed the past three months of working out for the sake of working out, with no schedule and no coach to report to.  But, I'm ready to start training again.  I'm even ready to start swimming again.

Ironman Lake Placid training starts February 1.

Southern California Half Marathon

It is still my off-season, but I've been keeping up with my running, staying at 20-30 miles per week, much of it hills because I'm really beginning to love running in my neighborhood.

A friend wanted to do a half marathon this weekend, and I agreed to join her.

The weather today was perfect for a race -- at the 8 am start time, it was in the low 60's, and warmed up slightly during the race.

As I haven't been specifically training for a half marathon, I hadn't thought too much about pacing myself.  I have wanted to run a half marathon in under two hours.  Toward that goal, I decided that I should aim for 9:00-9:15 per mile, and if I felt good at the halfway mark to pick up the pace.

The start was crowded.  With thousands of us lined up, and no indication of where walkers, slower runners, and faster runners should start within the crowd, the first mile was crowded.  I probably spent too much time and energy dashing between people.  My first mile was 9:09. 

I had a little bit of an ache in my left ankle, which I've ignored this week thinking it was a big nothing, but during the race, it did nothing more than just ache.  I was more bothered by a blister in my left arch.  After the race, that was a different story, as I sit here typing with a bag of frozen corn on my right ankle.

Back to the race:  The course was on major roads and along canal paths, and it was mostly flat.  I had consistent mile splits, averaging about 9:10 per mile, so by mile seven, as I high-fived a guy announcing the race and wandering the course with a microphone, I decided to pick up the pace a bit, and the last half was done at an average pace of 9:00 per mile.

There were lots of enthusiastic volunteers on the course directing us, which I loved!  But, the fluid stations were horribly understaffed.  I couldn't get anything to drink at several stations because there weren't enough volunteers, the volunteers were not spread out and were too clustered together, leading to too much crowding to effectively grab fluids.  One station had only one volunteer with Powerade and about a dozen other volunteers holding water.  Another station ran out of Powerade by the time I got there; that shouldn't have been the case -- I was definitely in the faster half of runners so there was no reason to run out.  I think that the race could have done well with fewer volunteers with direction signs and more volunteers at the aid stations.

I wasn't sure that going sub-2 hours for the race was doable, since my training has been pretty free-form -- I run when I want and as far as I want.  But, when I hit the ten-mile marker and saw that my time was 1:30, I realized I could do it.  As long as I kept sub-10 minute miles, I knew I could do it.

So, I pushed the last few miles, and coming around the corner to the finish line, I knew I had it.  My finishing time was 1:58:58, my best half marathon time by four minutes.  24 out of 126 women in my age group.  202 out of over 1700 women.  896 out of over 3800 runners.

Cravings

Think about the foods you crave.  What are they?  Pizza?  Nachos?  Candy?  Or maybe fruit?  Salad?

Fruit?!?!?!?

I was thinking about this while talking to one of my patients today.  She is someone who has made some major changes -- she now follows a low-fat, mostly vegetarian diet.  She also now exercises regularly.  Her cholesterol numbers, as a result, look fabulous -- her total cholesterol dropped from 239 to 139, and her LDL (the so-called bad cholesterol) plummeted from 168 to 71.

She tells me that she feels better eating lighter, and she doesn't crave a lot of the heavier foods that she used to eat.  She was surprised to find herself craving healthier items.

I can understand that from my own experience.  While I once craved fast food, I now crave things like apples, strawberries, carrots with hummus, oatmeal, and even salad.  Granted, I still enjoy a little bit of chocolate or ice cream occasionally.  But those aren't regular staples of my diet.

If you are thinking about making changes to your diet, keep this in mind:  As you make positive changes to your diet, you will feel good, and your body will crave the healthy foods that make you feel good.

Pumpkin Pudding

So I'll be honest -- the only reason I have a can of pumpkin in my kitchen cabinet is because I was afraid I might mess up the pumpkin pie that I made for Thanksgiving.  I came up with this recipe, and I'm proud of the results.

Ingredients:
One can of pumpkin, 15 oz
Silken tofu, seven ounces
Agaven nectar, three tablespoons
One half teaspoon of nutmeg
One half teaspoon of allspice

Put all ingredients in a blender and puree until well mixed and smooth.  Refrigerate in individual dishes.

Makes four servings.

Nutritional information per serving:
120 calories
1.5 grams of fat
5 grams of protein

Dinner for my parents

In honor of my parents' visit to Southern California, I cooked for them:

Squash, carrots, and sweet onion stir-fried in a tiny amount of oil and teriyaki sauce.

Whole wheat pasta spirals

Mashed cauliflower, mixed with a little soy milk and pepper.

Field Roast -- a great source of protein, but high in sodium.  If you want a low-sodium option, grill some tofu steaks.

Staying Fit on Vacation

I just returned from a relaxing trip to the Bahamas.

A lot of people see vacation as a time to throw caution to the wind, become sedentary, and eat obscene quantities of food.  I see things differently.

To me, vacation is a time to unwind.  But, because exercise makes me feel good, I keep it up.  I tone down my routine, but I still exercise in some way on most days of a vacation. 

I do a lot of running on a vacation.  I find that running is a great way to explore the local sights.  Another favorite workout is running barefoot on wet sand.  I go barefoot, and I run along the beach just where the waves touch the sand.  It's a little more challenging than running on trails and works different muscles.

I found another triathlete physician, and he put me through the paces of his own workout.  It was fun for me, because I always love a challenge.  We did intervals of ten minutes alternating on the bike and on the treadmill, and did a total of six intervals, followed by a brief swim (yes, me, voluntarily swimming in the off-season) in the ocean.

On vacation, the bottom line to exercising is to keep it fun.

Happy New Year!

2009 was a good year.

Professionally, I joined Valley Cardiovascular Specialists and moved into my office in West Hills.  I've been fortunate to work with wonderful people, including Ashley, my receptionist, and Keely, my medical assistant.  I have had the opportunity to get to know and take care of some terrific patients.

Athletically, it was a challenging year, and yet one of great accomplishments.  I DNF'ed a marathon and came back to complete a marathon two weeks later to prove I could do it.  I learned what it was like to be a cardiac patient with my arrhythmia and ablation.  I completed two half Ironman-distance triathlons, one of which was a personal record for me, and the other is considred the second-hardest triathlon course in North America.  I even learned to not take myself so seriously by running a marathon in costume.

My most proud athletic accomplishment of this year: taking forty-five minutes off of my marathon time from 2008, getting down to 4 hours and 12 minutes for a marathon.

I'm looking forward to the upcoming year of challenges, of meeting and caring for new patients.  I'm excited to finally be able to call myself an Ironman (or Ironwoman, which is it?) once I complete Ironman Lake Placid in July.

Happy New Year... and may your 2010 be filled with health and accomplishment!

Losing a Patient

I take care of patients with complicated medical illnesses.  Unfortunately, that means that occasionally my patients pass away.

One of my patients died a few mornings ago.

I met him in February.  He was an engineer and inventor, one of the brightest people I've ever met.  He had right heart failure, and was one of the few patients who knew why I look so closely at a patient's neck.

"How's my angle of Louis?" he would often ask as I looked at his neck veins to assess his right heart pressure.

He was one of my more talkative patients.  He would talk about science, research, often things that were a bit over my head.  He was dutifully compliant with his medications and kept meticulous records, though he occasionally indulged in foods higher in salt, which led to occasional decompensation of his heart failure.

He read my blog, because he'd ask me about my races and comment on my posts.  In particular, I remember him being very curious about my experience with supraventricular tachycardia and my ablation earlier this year.  I think he even posted an anonymous comment about my "ablative cardioversion".

I was also fortunate to have the connection of my medical school advisor being one of his closest friends.  He invited me to his home for lunch, which gave me the opportunity to reunite with my former advisor.  Seeing his home gave me more insight into who he was as a person and as an inventor.

But, it was ultimately other health issues that took their toll.  A compression fracture caused terrible back pain.  Cognitively, I could see him declining as he became less intellectual and less talkative at his more recent visits.  Most recently, swallowing became difficult for him and he was hospitalized due to aspiration into his lungs.

He was discharged home and passed away two days later.

He's a unique man who definitely left an impression.

Athlete Cookies

My friend Gail competed as part of a relay team for the San Diego Triathlon, to benefit the Challenged Athletes Foundation. She offered to make cookies for anyone who sponsored her $100. I took her up on the offer, and challenged her to make vegan cookies. Here they are, and they are very funny!!

From left to right, these are in honor of my best 5K race, my best marathon, and my most recent marathon which I ran in costume.

Clockwise from the top, these commemorate Santa Barbara Long Course triathlon with its chilly ocean swim, California International Marathon, and the New Moon Century ride.

These cookies are for Wildflower Long Course triathlon and Vineman 70.3, the two half-ironman distance races that I completed this year.

Running as Supergirl

I thought seriously about whether to post my marathon pictures on the blog. As a cardiologist, I have a certain image to maintain.

But, the more I thought about it, the more I thought that being Supergirl for a race was something I wanted to share. Fitness has to be fun, and I think that this experience reflects that. If exercise was always serious and always hard-core, we would burn out, a lesson that I've learned over the past few months of training.

So here are a few pictures from my race. Through the wind and cold, I had much more fun running as a superhero than I would have otherwise.

CIM Marathon

Today was the CIM Marathon in Sacramento.  I've been doing more cross training and a lot less running, and I wasn't sure what to expect from my legs or how long it would take me to finish.

I chose to run with the 4 hour and 15 minute goal time group.  My last marathon seven weeks ago, that I was far better trained for, was a 4:12 finishing time.

But, for the first time ever, I ran the marathon in costume, as Supergirl.  Complete with a cape.  The day was cold and windy, so the long sleeves of the costume and the cape worked well to keep me warm.

Self-portrait with my camera.  Better picture coming soon, hopefully.

At the start of the race, it was 29 degrees and maybe by the end the temperature was in the mid-40's. I started with the 4:15 pace group. Our leaders, Lisa and Mike, definitely made the running eperience unique. They had us shaking out our arms and fingers every couple of miles. It seemed silly, but they kept saying, "You'll thank us at mile 20", and yes they were right, it kept our upper body loose. They instructed us to take the tight turns on the course so that we limited the distance that we were running.

I felt good at mile 4, so I broke away from the group and went ahead. A few miles later, I stopped to use the restroom and the group caught up with me around mile 8.

The winds were strong and made running far more challenging. Our pace leaders told us to "tuck in" and run closer together to try to shield the wind. It helped a bit, but the cold and the wind definitely took their toll. With wind, there is more fluid loss, so I was mindful to drink as much as possible.

I pulled ahead of the pace group again at mile 12, and they caught me at mile 14. Lisa, one of the pace leaders said, "We caught up with Supergirl!" Part of me thought she was taunting me for thinking I could pull ahead.

I stayed with the group through mile 21 I needed that group support, positive energy, and shielding from the wind. It took everything in my being to keep up with them and not drop off.

At the water stop at mile 21, I choked on my cup of water, and as I choked, the group ran by. I tried to keep them in sight, but they kept getting farther and farther away.

Dressing as Supergirl definitely has its advantage in crowd support. Lots of people yelled, "Go Superwoman!" "Go Supergirl!" It really helped push me forward. But, my mile splits dropped below ten minutes. I felt tired. But I kept going. Three miles left. Two miles left. One mile. And then a strong finish. Even the announcer yelled for Supergirl!

My finish time:  4 hours, 16 minutes, thirty seconds.  That's about three and a half minutes slower than my time seven weeks ago at Long Beach, when I was training harder.  I'm proud of my time, and I had fun along the way.

Does work count as exercise?

I ask all my patients if they exercise.  It's an important question since exercise is so important for cardiovascular health.

A common answer:  "I exercise at work."

Unless you are a bicycle delivery person who covers large distances or a valet car attendant who spends most of your shift running to retrieve cars, it doesn't count.  Construction and manual labor don't really count either, since those jobs involve short bursts of lifting or exertion as opposed to a sustained effort.

Granted, a job that has you moving on your feet is far better than a desk job in terms of promoting heart health.  However, for true cardiovascular benefit, you should be doing something outside of your daily work that involves a sustained effort, preferably for at least thirty minutes on most days of the week.

Tofu Pumpkin Pie

I baked this from a recipe from Vegweb.  It's a whole wheat crust, which I bought from the store, and a filling made from pumpkin puree, maple syrup, cornstarch, silken tofu, nutmeg, and cinnamon.  I'll be serving it up with Soyatoo whipped cream.

Happy Thanksgiving!!!

Teriyaki Bake

This is a similar, easy recipe to the one from a week earlier.

Chop up some veggies and extra-firm tofu.  The veggies in here are eggplant, carrots, squash, sweet potato, and onions.  Add teriyaki sauce.  Mix it up, cover with foil, and bake for 40 minutes at 400 degrees.

Cranberry Sauce

A less sugary, lower-calorie, easy version of a Thanksgiving favorite.  I concocted this on my own to make sure it tasted good before subjecting my family to my cooking.

1 bag of cranberries, 1/2 cup of orange juice, 1 large sliced apple, and 1 1/2 tablespoons of agave nectar.  Heat it in a saucepan for about thirty minutes, until the cranberries all burst.

Where I'm At

I've been coach-less for three weeks and doing mostly what I want for exercise.

Needless to say, I didn't qualify for Boston.  However, I am proud to say that in the course of eighteen months that I cut my marathon time down from 4:57 to 4:12.  I'm proud to say that through much effort and good coaching that I'm a better runner.  One day I'll qualify for Boston, it just won't be this year, or likely next year since I'll be shifting my focus to Ironman training.

However, I decided to run the CIM Marathon after all.  I'm already signed up and I love doing long training runs, so I'm going to just do it.

I have only been running three days a week.  Last week, I ran 4 miles on Monday, six miles of hills on Friday morning, then twenty miles on Saturday morning.  Perhaps the six miles of hills on Friday made Saturday's run more painful than it needed to be.  Nonetheless, I finished the long run.

Another thing I've noticed with less exercise is that I can't get away with eating quite as much.  In peak training for my 70.3 (half-Ironman distance) races, I could easily maintain my weight on 2700-2800 calories per day.  Now, doing only about an hour of cardio 5-6 days per week and two days of weights, it's more like 2400 calories per day.

I feel great.  Relaxed.  Eager to start Ironman base training in January.

Dr. Shenkman Goes to Washington

I spent a few days in Washington DC last week.  As you can see, it was quite rainy and cold, not at all resembling the weather that we are accustomed to here in Los Angeles.

I traveled with a Young Leadership group from the Jewish Federation of Los Angeles.  We went to the White House, Capitol, Supreme Court, State Department, Holocaust Museum, and US Treasury Department.

We also had the opportunity to meet with representatives of our members of Congress to discuss a couple of important issues:  hunger in Los Angeles and Iran.

In Los Angeles, one in eight people face hunger every day.  That's a very sad statistic for a wealthy country like ours.  As I discussed in an earlier post, this is the role of the Jewish Federation's Fed Up With Hunger campaign -- to bring attention to hunger locally and to raise funds to combat it.

As a cardiologist, I had the opportunity to give my perspective on hunger:  Those who face hunger are poor and as a result eat unhealthy foods that are high in calories, fat, and sugar, and hence obesity is becoming more and more prevalent, especially amongst the poor.  Obesity leads to high blood pressure, diabetes, abnormal cholesterol, and as a result to heart disease.

Diseases like hypertension and dyslipidemia that once were thought to occur in middle age are being seen in younger and younger people.  I took care of a 25 year-old man with a heart attack and have a handful of patients who are younger than me who have suffered heart attacks.  I see teenagers with high blood pressure, diabetes, and dyslipidemia.

To help to combat obesity, we need to fight hunger by providing healthy options to cheap junk food.

Veggie and Tempeh Bake

I chopped up some yellow squash, sweet potatoes, a green pepper, red onion, and coconut-flavored tempeh mixed it with some Liquid Bragg's and a little agave nectar and sprinkled with pepper.  I baked this at 400 degrees for about 35 minutes and served it over whole wheat pasta.

Low Carb Diets Won't Make You Happy

A study in this week's Archives in Internal Medicine (Nov 9, 2009, Vol 169, No 20) looked at the effect on mood and cognition of a low-fat versus a low-carb diet.  Patients on both diets lost the same amount of weight, 14 kilograms.  However, those on the low-fat diet had greater improvements in mood compared to those following a low-carb high-fat diet.

Interestingly, the "low fat" group got 30% of its calories from fat.  I'd call that more of a moderate fat diet, but clearly that diet has less protein and fat than the "low carb" diet.

Why the difference in mood?  Serotonin may be suppressed by a low carbohydrate diet, while it may be upregulated by a lower fat diet.

Thee bottom line:  It doesn't matter what you eat to lose weight.  But, what you do eat in your weight loss obviously has an impact on how you feel.