Sunday, November 27, 2016

What's the Best Weight Loss Program?

Devoured by Sophie Egan on the term low fat. "But when looking so carefully at the removed fat, we overlook what replaces it.  When fat is taken out, sugar and salt are added to keep the product from tasting like garbage.  Or, at best, tasting like nothing at all.  In addition, a product might get packed with extra carbs and weird thickeners and additives.  All of these replacement ingredients are often worse for us than the apparent offender." 
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From Racing Weight to South Beach to Betty Crocker


We're probably alike in many of the ways we approach food.  Triathletes are taught to think on many planes about that which is put in their mouths as fuel, nutrition, contributing to our power to weight ratio - oftentimes more to weight part of that phrase - to name just a couple. When do taste or satisfaction enter the equation?  Not often enough is likely your immediate answer. One wouldn't suggest you take your paycheck down to Krispy Kreme and buy a gross of


these mouth watering treasures but once in a while is fine. We're bombarded from all sides on what constitutes the best nutritional plan for us to keep the weight off and have the energy needed at training and racing time.  Your kitchen library probably looks like the photo above, maybe worse, and trying to separate fact from fiction, what's the take home message here? can be a challenge.  So let's turn to a level head in the nutrition world, one who publishes mostly science backed data without a lot of opinion added in.  If you haven't read Sports Nutrition by Asker Jeukendrup, it would be a good addition to your Christmas list along with the 4th edition of the The Triathletes Training Bible by Joe Friel which came out last month. I own the former and plan to purchase the latter.  Jerukendrup tried to clear the smoke in the diet world and published the info below.  Yes, I know that it's four, no wait, five full paragraphs, not the CliffsNotes version, but it's really well written and I believe you'll learn something valuable.

What’s the ‘best’ weight loss diet? Tough question right? I’ve been thinking a lot about this recently especially in light of some things I’ve read on twitter, blogs, Facebook, Tumblr… there are certainly a lot of opinions out there and everyone is convinced they’re right and that their diet is best/better/bestest! Trials have been conducted (lots), but personal anecdotes seem so compelling, some have even established foundations to ‘prove’ that their theories as to causes of all [sic] obesity and diabetes - http://www.nusci.org/http://nusi.org/ (note the subtle difference between these two websites and foundations, but with completely different dietary philosophies), http://thenoakesfoundation.org/ - there’s some big money (and big interest) behind this! There are also institutions who have their entire reputations at stake advocating for certain dietary approaches - http://www.health.harvard.edu/special_health_reports/healthy-eating-a-guide-to-the-new-nutrition - What is so interesting is that few of these approaches seem to resemble the Food Guides, My Plates, Food Guide Pyramids from the respective countries in which these foundations, approaches, advice, etc say is THE way to eat. I mean if the experts disagree then what chance do the ‘mere mortals’ have?

Ockham's (Occam) razor is basically an axiom that in a sea of competing ‘theories’ (in this case dietary approaches to good health) the one with the fewest assumptions should be selected. The case may be that all of the approaches make assumptions? There appears to be enough evidence, from basic mechanisms, clinical trials, to support high fat/high protein, low fat/high fibre, high plant/high fibre or a multitude of other assumptions. But what’s missing, why are there so many ways to advocate for weight loss and good health? Could it be that multiple approaches work? Or are we just seeing crafted stories – Dr. David Katz (and his unnamed colleague) think so, at least in some cases: https://www.linkedin.com/pulse/article/20141119173130-23027997-want-health-try-the-truth. It seems, however, after conducting an in-depth survey (OK, it was a pretty shallow twitter question), that everyone (yes there are still some doubters) agrees that to lose weight – be it fat or lean – requires (yes I said requires) a negative energy balance. I know, hold on, it’s crazy but it’s true.

Many will talk about the ‘type’ of weight that is lost and I can certainly agree that fat loss should most often be emphasized over lean loss and it appears pretty clear that high(er) protein and exercise (particularly resistance exercise) are effective in this regard: http://www.ncbi.nlm.nih.gov/pubmed/21775530 (apologies for a gratuitous citation of our own work, there are many fine pieces of work in this area). But the fundamental truism is that E balance has to be negative and when you do that, and can sustain your new weight (likely by following the same approach you used to lose it) then you achieve success! But as we know the success rate of weight loss is not good (yes that’s an understatement) and yet every dietary best seller and concept that comes out has a new theory as to what it is that causes weight/fat gain and how to reverse it “Forever” and to “Forget everything you’ve ever been told” or that “What you’ve heard is all wrong.” I don’t doubt that there’s a shred of truth in everyone’s approach, but Ockham’s razor would suggest that there’s a really simple truth behind all weight loss programs and it really has to be whether you can stick to staying in negative energy balance to lose the weight and then stick to your new energy intake, eating less, forever… which as we know is a long time! So stick to it is what wins? Well I think that’s a big part of it.

It is said that those who do not study history are doomed to repeat it. What then of the Paleo, the LCHF, the high fibre vegetarian, the Real Food, Wheat Belly… well here’s a (brief) list of their predecessors and well know their fates: Scarsdale, Ornish, Weight Watchers, Dr. Bernstein, Herbal Magic, Cabbage soup, Atkins, Zone, South Beach, Raw Food, Mediterranean Diet, DASH, Jenny Craig, Sugar Busters, Flexitarian, TLC, Fruitarian, Cookie diet, Kangatarian, Hacker’s diet, Stillman Diet, Nutrisystems diet… you get the point. All of the aforementioned were called breakthroughs, revolutionary, and THE answer to losing weight and… yup keeping it off. And people still follow, swear by, adhere to, and ‘know’ these diets work. And for the people who stick to them they undoubtedly do. We also know, from the National Weight Control Registry http://www.nwcr.ws/research/ that there isn’t one specific formula that promotes lasting weight loss. The one thing that does appear to be true is that whatever the folks who lost weight did to lose it then they have to keep doing it! A point recently made by Dr. Mike Joyner (http://www.drmichaeljoyner.com/wheat-belly-low-carb-diets/) is that in his opinion “… the key to successful long term weight loss appears to be related to developing the skills and behavioral strategies needed to effect long term changes in diet, exercise and overall physical activity.”

I couldn’t agree more frankly and we’ve perhaps forgotten the lesson of how important cardiorespiratory fitness is (http://www.drmichaeljoyner.com/wheat-belly-low-carb-diets/). And thus, when considering the answer to the question of what diet works and works best, you have to take a step back and recall your history. All of the diets have a history of ‘success’ on an individual level and yet the number of people who are obese continues to rise. So, is your diet on this list and is it the best? If it works for you of course it is, but there’s not been any magic in any diet to date and I’m betting it’s going to stay that way. I do wish all of the folks who have started foundations to prove their diet is best, the best of luck (I actually hope they succeed). But I think they’re being a little na├»ve when they think they’re going to ‘cure’ obesity or type 2 diabetes with THE best diet, unless of course they’ve found that magic ‘stick to it’ juice? For the record, there’s no such thing as ‘stick to it’ juice!

Sunday, November 20, 2016

"You're Going to Need an Operation." What do You do Next?


                                           “He who will not risk will not win.”

                                                        John Paul Jones


To some, bamboo would be a frightening choice for bike construction. To others, it's a chance to be a little different. Pretty cool, though!

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Gluten Sensitivity. Really?

A recently published study in the journal Digestion found that 86 percent of individuals who believed they were gluten sensitive could tolerate it. Individuals with celiac disease, a hereditary autoimmune condition that affects about 3 million Americans, or roughly 1 percent of the population, must avoid gluten. Those with extremely rare wheat allergies must also remove gluten from their diet. In addition, those with gluten sensitivity, a condition that affects 6 percent of the population (18 million individuals), should also avoid gluten.
That doesn't explain why an estimated 30 percent of shoppers are choosing "gluten-free" options, and 41 percent of U.S. adults believe "gluten-free" foods are beneficial for everyone, especially when many of those foods are often lower in nutrients and higher in sugars, sodium and fat than their gluten-free counterparts. And much of the growth in the category is coming from cookies, crackers, snack bars and chips.


Thanks in part to a lot of hype from gluten-free evangelists and celebrity wheat-bashing, many Americans are convinced they're "gluten-sensitive" and better off avoiding foods that contain it. "People want to believe that they are gluten intolerant because it's a way for them to avoid carbs, because they also think carbs make them fat," explains registered dietitian Vandana Sheth, a spokesperson for the Academy of Nutrition and Dietetics.


Volunteers registering Ironman athletes on the Big Island
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You’re going to need an operation.  Now what?

    “And then he walked out of the room.”  If you’ve never had surgery, being told that the next step in your care involves a trip to the operating room can be a tad upsetting.  What’s going to happen to me? How long will it take to get over it?  Can I pay for it?  Are you sure there isn’t another way to get better?

These and a 1000 other questions run through the mind of the new patient as he/she’s been told, for example, that their shoulder will continue to dislocate unless something is done surgically to prevent it.  Although it seems difficult, maintaining control is important and having some idea of what questions you need the answers to helps.  In this setting, our shoulder dislocator will probably have a discussion with the surgeon about the procedure, basics of the reconstruction including risks, location of the incision, time in hospital if any, post op therapy and finally return to sport.

There will also be a discussion with the nurse/assistant covering the nitty gritty details like agreeing on a date for the operation, where and time, diet, what to wear, pre-op blood or lab work if needed, and all the little details that are so important to the patient.  In our office this often includes a video about the surgicenter, parking, and an example of someone else going through the same basic surgery to try to put them at ease.  Also at this stage is the first of several permits that you’ll be asked to sign, the permit for surgery.  In our exceptionally litigious society this is the first document that you’ll see explaining the basic nature of what will happen to you and the basic risks.  You’re giving the surgeon permission to do the operation understanding that positive results, while implied and hoped for, are not guaranteed.  If you have any doubts, want a second or even third opinion, now’s the time to do so!  You’re the one having the operation and need to feel not only is it right for you but this surgeon and medical team are also right for you.  It doesn’t bother the surgeon at all if you say you need to delay the procedure, ask around, and in fact some docs actually encourage it.  There are some operations that get better results early, however.

You’ll also probably talk with the insurance office.  On the day of surgery you’ll arrive at the hospital/surgicenter an hour or two early, change into one of funny gowns that opens in the back, meet the anesthesiologist  - another permit – and discuss the options for anesthesia, picking what’s right for you.  There may be an IV involved also.  And when your turn comes, off you go into a whole new world.

Good luck!




And remember, SUPPORT THE SPONSORS THAT SUPPORT YOUR RACE.   It wouldn’t be bad taste to also wear their logo.

Sunday, November 13, 2016

You Can Always Win the Transitions



“I always win the transitions!” says a patient of mine. And she does.  I think she feels that more important than the race results some times.  Positive feedback for effort expended. 


Sensors being placed on legs of local athlete who sets the pace.




Here’s how.  She makes things very simple. 1) only bring into the transition area what you absolutely need, 2) Practice, practice, it’s all in the set up, and 3) Keep it simple.

The day before the race, know the course cold.  It’s so easy to memorize. On race morning when you rack your bike and drop your stuff do a nice slow walk through from your bike to the mount line and from the swim exit to your bike.  Do it a couple times (not talking to your friends but to memorize it.)  it will also help you relax some.

Anyone can have a lightning quick wetsuit exit.  If you ever have the pleasure of volunteering at the transition area of a sprint tri, watching the comedies of wetsuit removal appearing not unlike Harry Houdini and his 1920 straight jacket act or the wrestling of an invisible opponent.  First, Training Bible Coach Jim Vance will tell you to cut off the bottom hands breadth of the legs of the suit. I guarantee you it will make no difference in your swim, you’ll just get your feet out faster. And PAM sprayed around the ankles will make this remarkably easier. (Just make sure you use regular PAM as the flavored types seem to attract hornets, as one triathlete found out the hard way.)  At water’s edge you’ve unzipped the suit – while moving, you’re always moving – and a shrug or two aids in getting the top down to your waist giving you the appearance of the so-called “headless monkey.” At your bike, a quick pull gets the suit to your knees and Coach Eric Sorenson of the Annapolis Striders would tell you to simply step on the suit and pull your foot out.  All this in under 10 seconds. Remember that pre-race practice stuff?  Your race number is on a belt under your wetsuit so it’s helmet, sunglasses and go!  Forget that toweling off and foot bath stuff – unless it’s part of a pedicure.  Really, you won’t blister in a sprint race.




Your bike shoes are already clicked in and fixed with rubber bands, left pedal forward assuming you mount from the left, is a given.  This has been shown time and again to be the quickest.  If, during your home transition practice before the race, you ride barefoot with your feet atop the shoes for 5 or 10 minutes you’ll see how easy it is giving you one more learned skill that may be important one day.  In the race, you’ll have a quick mount well away from the start line and other riders.*  The mount line has the highest potential for collisions and that might ruin your day.  When you return to T2, slip on those lace locked running shoes, grab your hat and you’re off.  Some cannot do this standing up and will duct tape a towel to the outside bottom of a plastic milk crate, place it right next to one’s front wheel, and use it as a quick seat to apply running shoes.  It also makes for a handy way to transport your gear in/out of the transition area.

Compare your transition times to those in your age group, and to your performance last year and YOU WILL BE THE QUICKEST!!

*A good number of triathletes are just not comfortable with this technique regardless of practice.  That's fine.  Donning one's bike shoes in T1 can be done quickly if you have a good place to sit. Unless the transition is packed super tight, put all your stuff in an old plastic milk crate to which you have padded the bottom. There's usually just enough space between your bike and your neighbor for said crate. Once your wetsuit is off, put it out of the way, sit on the crate putting on the bike shoes, and off you go. Just remember, running on cleats can prove a little slippery.  Be careful. 


Padded milk crate

Saturday, November 5, 2016

What Ironman Says About the Chip on Your Ankle to Athletes



"I've got too much time on my hands
It's hard to believe such a calamity
I've got too much time on my hands
And it's ticking away, ticking away from me."

                                                                            Styx


Time.  Chip time.  Elapsed time.  Transition time.  Ultimately it's what this sport boils down to.  The technology to measure it has gone rapidly from hand held stop watches depending on the users attention level for accuracy to chip timing of various sorts today.  In some running events the chip can part of your disposable paper race number or intertwined in the laces of your shoe but we triathletes use the ankle strap for most events.  Uniformly reliable, accurate, and virtually invisible to the user.

There are isolated instances where competitors have "lost" their chip, either accidentally or intentionally. When the latter occurs, almost without exception, the system is smarter than the user and this form of rule breaking is ferreted out quickly.

Two quick reported examples from Hawaii would be an athlete a couple years ago who cut the run course short by 4 miles bypassing the NELH (Natural Energy Lab of Hawaii, an out and back loop late in the event) or a decade ago when one athlete took another athletes chip with him/her to the far reaches of the bike course in the small village of Hawi.  Both episodes were discovered.

The following is copied from the Ironman Athlete's Handbook and is an excellent starting place to understand the thinking from the top on triathlon chip use. 

TIMING 
The 2016 IRONMAN® World Championship is timed with Mylaps Pro Chip technology by Sportstats. Your responsibilities as an athlete include: 
1) As soon as you pick up your race packet and Mylaps Pro Chip, please go to the Chip Verification table during registration. Be sure that your correct name shows up on the computer screen. 

2) You must wear your Mylaps Pro Chip at all times during the race. Fasten it to your right ankle with the velcro strap before the swim and leave it on until after you finish the entire 140.6 mile course. You may apply Vaseline around your ankle; it will not affect the chip or timing. We recommend securing the Velcro strap using a safety pin since this is a non-wetsuit swim. Volunteers will help you remove the chip at the finish line. 


3) If you do not start the race on Saturday, October 8, you are still responsible for returning the chip to race management. Chips should be returned to the Drops Clerk.  Rest stops, transitions, etc. will be included in your total elapsed time. Splits will also be recorded for each segment of the race. 


4) In addition to the 17 hour overall cutoff time, there are cutoff times for each segment of the race.  Start time may vary based on water conditions. 


5) If you drop out of the race at any time, you must notify and return your timing chip.  Failure to do so may disqualify you from participating in future IRONMAN events. It is essential that we know where you are on the course at all times for your safety and our peace of mind. If you are transported to any IRONMAN medical station, the medical staff will take responsibility for your chip. 


6) By picking up your race number and chip, you are guaranteeing that you will return your loaned chip to race management, or you will be fined $75 for it's replacement.


7) If you lose your timing chip during the event, you are responsible for obtaining a replacement. Volunteers will have extra timing chips at the following locations: swim exit, bike exit and run exit. If you lose your timing chip on the run course, you must notify a timing official immediately after crossing the finish line. 


8) Do not intentionally cross the finish line as part of a group. Your finish placement may be jeopardized potentially resulting in loss of prizes or awards. Remember: NO CHIP = NO TIME Failure to wear your chip on race day, return your chip after the event or pay the chip replacement cost will disqualify you from future IRONMAN events. PRE-RACE INFORMATION






And, what Ironman says about cutoffs.

RACE TIMING AND CUT-OFFS The race will officially end 17 hours after your designated start time. Aid station stops, transitions, etc., will be included in your total elapsed time. Splits will be recorded for each segment of the race. The following cut-off times apply for each segment of the race: Swim Cut-Off 2 hours and 20 minutes after your designated start time. Bike Cut-Off 10 hours and 30 minutes after your designated start time. Run Cut-Off 17 hours after your designated start time. MyLaps Pro Chips will capture your splits (swim, T1, bike, T2, run) and overall finish time. IRONMAN reserves the right to remove an athlete from the course and DNF the athlete if our course staff determines there is no possibility of an athlete finishing the given discipline (swim, bike, run) before the posted cut-off times based on an athlete’s location, time and average speed up to that point.


This is the entire Athlete's Handbook from Kona and if you had a couple spare minutes it makes for interesting reading.