Wednesday, April 26, 2017

Bike Crashes; If You Ride Long Enough....

The author with three elated 2016 finishers

"Twenty years from now you will be more disappointed by the things that you didn't do than by the ones you did do." 

                                                                               H. Jackson Brown, Jr.

Low back pain, pretty common in our group, is often treated with a non-steroidal anti-inflammatory drug, a skeletal muscle relaxant and a narcotic pain killer.  A recent study published in JAMA with 323 patients who suffered acute, non-traumatic (nonradicular) low back pain found that adding the muscle relaxant and/or oxycodone to the NSAID naproxen alone "did not improve functional outcomes or pain at 7 days' follow up."  


       "A high school runner in Whitely County, KY was set to compete in a regional cross country meet when she was assigned the bib number 666, "the number of the beast" according to the Bible.  Thacker and her coach appealed unsuccessfully for a new number, so she decided not to race.  "I didn't want to risk my relationship with God," she said.  Sports Illustrated

        In contrast, I was issued race number 666 for an early summer triathlon in Virginia Beach a couple years ago,  prominently displayed on both arms, legs and hands following body marking.  It was a beautiful day to race, hot and sunny, leading to a tad of sunburn in most competitors. I was even lucky enough to win my age group so I might have stayed outside at the post-race party a little longer than usual. Later that day, when showering at home, washing off my race numbers, I learned that heavy Sharpie use works as an excellent sunblock.  Quite tanned from the race, I had noticeably white 666's on both arms, legs and hands, a fact that was pointed out to me repeatedly over the next couple days at the pool!  I wonder if it played a role in my performance.


Have you ever had a bike crash that required medical attention?

This is a question we put to to the athletes who passed by our questioner following bike check in Kailua-Kona, HI for the 2015 event

Before sun up, a few last minute adjustments

I wondered what I'd find out if I polled the athletes at the top of our sport, mostly age groupers like you and me, about bike crashing.  I've written here before about it as the wider my circle grows the more this topic comes up.  It's hard these days to watch a single stage of a pro bike race or talk up tri at the local pool when somebody doesn't walk in with a swath of road rash running down their leg or shoulder.  Or how about your buddy with the femur fracture following a mountain bike accident?  In my Sunday bike group alone, over the course of several years we've had a hip fracture with surgery, facial fracture with broken jaw during an IM,  and a pelvic fracture mountain biking requiring hip replacement. Oh, and before I joined them, one guy tried to Evil Knievel his way up a ramp.  Bad news though, the bike just stopped and my friend broke his neck. Fortunately, no surgery was required and he's back riding.  

Of the 215 athletes in Hawaii who answered the poll, almost half admitted to serious bike crashes.  Of 149 men, 72 said yes.  And of 66 women, 28 had required a visit to the doctor or hospital.  Of these 72 men who were told to seek further medical treatment, not all did. Surprised?  No, probably not.  But, all 28 of 28 women in our survey who were advised further treatment did so.  One woman claimed 35 accidents.  That, to me, is long past time to find a new sport.

In short, approximately 48% of responders crashed hard enough that at least one care giver felt medical treatment was in order.  To me, this is pretty concerning. I believe we as a group need to be a little more attentive to the potential for injury when we ride becoming a little more selective about the riding surface, surroundings, fellow bikers bike handling skills, you name it to try and get this number to drop precipitously.

We all know someone seriously injured or killed on a bike. Sadly, some of us more than one! Make your Spring resolution one where you will assume further responsibility for your own personal bike safety.  If you need to stay home or ride indoors because of questionable riding surface conditions or it's just too dark with too many cars then so be it.  Better to alter your training...and still be able to train than the opposite.

Sunday, April 23, 2017

April is National Donate Life Month. Might You Have the Need One Day?

"I been up, I been down. Take my word, my way around.  I ain't askin' for much."         ZZ Top

Volunteers, the life blood of any race.

Organ, eye and tissue transplants offer patients a new chance at healthy, productive and normal lives and return them to their families, friends and communities.

Nearly 120,000 men, women and children currently await lifesaving organ transplants and hundreds of thousands more are in need of corneal and tissue transplants.  On average, 22 people die each day because the organs they need are not donated in time.  Fortunately, one donor can save or heal the lives of more than 75 people.

Registering as a donor is a gift to your family, giving them certainty of your decision to help others in need.  It is also a symbol of hope to those awaiting a lifesaving or healing transplant.

Facts About Organ, Eye and Tissue Donation

People of all ages and medical histories should consider themselves potential donors.  Your medical condition at the time of death will determine what organs and tissue can be donated.

All major religions support donation as a final act of compassion and generosity.

Donation should not delay or change funeral arrangements.  An open casket funeral is still possible.

There is no cost to the donor's family or estate for donation.

In the United States, it is illegal to buy or sell organs and tissue for transplantation.

Living donation is an opportunity to save a life while you are still living.  It is not covered by your donor registration.  Living donors can provide a kidney or a portion of their intestine, liver, lung or pancreas to a waiting patient.

Triathletes are giving people.  This is just one more way.

This information courtesy of   

Sunday, April 9, 2017

"Why is it That the One Who Snores Always Falls Asleep First?

The federal Centers for Disease Control and Prevention calls sleeplessness a public health concern. Good sleep helps brain plasticity, studies in mice have shown; poor sleep will make you fat and sad, and then will kill you.  Where we're concerned, it'll help make you the athlete you want to be.

One of the negatives of being a triathlete, or having the personality that gravitates toward triathlon, is that each of us wants to get six things done in the time allotted for four.  Something has to give; frequently that's time in the sack.  The old, "I know it's bedtime, I'm almost done with ______________"  When you have a couple minutes, this is a good read.  Sleep is the New Status Symbol

While on a Sunday bike ride recently, the topic of snoring came up. I ride with an older group, several of whom will have wine or beer with dinner most nights or maybe something 
later in the evening and that snoring was becoming more of problem.  Two agreed that it was considerably worse on weekend nights after a race.

I'd remembered a couple of things from med school that could contribute, one being alcohol that can overly relax the upper airway tissue.  The other was having a fat neck, not much of a concern in the bike group. But I was sure there were other contributing factors of which we should be aware. The piece from Harvard below covers the subject pretty thoroughly, isn't overly "med speak"  and could be a big help if one is interested.  My thanks to the folks at Harvard.

Snoring solutions

Simple changes can help to turn down the volume.
If your wife or sleep partner often seems bleary-eyed and resentful in the morning, you may be one of the millions of adults who snore habitually—a condition that affects twice as many men as women. Snoring occurs when your upper airways narrow too much, causing turbulent airflow. This, in turn, makes the surrounding tissues vibrate, producing noise.
Snoring is a sign that there is a really narrowed space,” says Dr. Sanjay Patel, a sleep disorder specialist at Harvard-affiliated Beth Israel Deaconess Medical Center. “That happens either in your nasal passages or in the back of your throat.” Some men are snorers because they have excess throat and nasal tissue. Others have floppy tissue that’s more likely to vibrate. The tongue can also get in the way of smooth breathing.
Once the source of the snoring is identified, you can take appropriate steps to dampen the nightly din. These include not drinking alcohol at night, changing sleep position, avoiding snore-inducing medications, and addressing causes of nasal congestion.

How to alleviate snoring

Here are some factors that contribute to snoring and what you can do to alleviate them.
Alcohol. Alcohol, a muscle relaxant, can slacken the tissues of your throat while you sleep. “We see this all the time,” Dr. Patel says. “Spouses say the snoring is tolerable except for the nights when their partner has had a couple of beers.”
Body weight. Extra fat tissue in the neck and throat can narrow the airways. Losing some weight could help to open the airways if the person is overweight or obese, although many people who are lean also snore.
Medications. Medications that relax muscles can make snoring worse. For example, tranquilizers such as lorazepam (Ativan) and diazepam (Valium) can have this effect. In contrast, antihistamines may actually alleviate snoring by reducing nasal congestion.
Nasal congestion. Mucus constricts the nasal airways. Before bed, rinse stuffy sinuses with saline. If you have allergies, reduce dust mites and pet dander in your bedroom or use an allergy medication. If swollen nasal tissues are the problem, a humidifier or medication may reduce swelling.
Sleep position. When you lie on your back, slack tissues in the upper airways may droop and constrict breathing. Sleeping on your side may alleviate this. You can also try raising your torso with an extra pillow or by propping up the head of the bed a few inches.
Smoking. Men who snore are often advised not to smoke, but the evidence this will help is weak. Needless to say, there are already plenty of other good reasons to quit smoking.

Anti-snoring products

Many products claim to help with snoring, but few of them are backed by solid research. One potentially effective option is wearing an anti-snoring mouth appliance, which pulls the jaw (along with the tongue) slightly forward to open the upper airway. An appliance made by a dentist can cost around $1,000. Do-it-yourself kits cost much less, but may not be as well tailored to your mouth.
Nasal-dilating strips are inexpensive and harmless, and some small studies suggest they may help reduce snoring. You apply these adhesive strips across your nose at bedtime to help to open up the nasal passages. Breathe Right is one well-known brand, but there are many others available at relatively low cost.
If you are unsure what to do about snoring, a physician can advise you and also make sure your snoring is not related to an underlying sleep disturbance, common in men, called obstructive sleep apnea. “The louder the snoring, the more likely it is to be related to sleep apnea,” Dr. Patel says. “Not all men who snore have sleep apnea, but if the snoring is frequent, loud, or bothersome, they should at least be evaluated.”

Sunday, April 2, 2017

MRI's Are Good, But Are They Good For You?

So, after putting your bike on the rack on the car after today's ride, you accidentally step back off the curb and roll your ankle. This is pain, big time pain, as you reflexively flop around on the pavement in agony. As the intensity slowly dissipates, and your bike buddies encourage you to get up if you can and get out of the traffic, you find that you can hardly walk on it and wonder now what? If this is serious, everything's going to change from your scheduled track work out tomorrow to the trip to Disney World next week (you hope not that one, the kids have been looking forward to this for weeks.)

When you get home, you visit you favorite tri forum, post the injury looking for direction from the knowledgeable, but often anonymous (and not so knowledgeable) audience.  The call for an MRI or two, the foot and the ankle, to "see what's going on in there" is heard more than once.

Some time later, rroof (a noted Sports Podiatrist from Cincinnati - and not anonymous) posts, "uh, well maybe you need an examination and a diagnosis first, perhaps an x-ray if indicated." Of course he's right.

This scenario plays out every day on tri forums, in athlete to coach communications, and simple every day life. Those of us in medicine get pushed every day to "take a look" with an MRI when a more appropriate course, and perhaps a less aggressive course, is correct. (MRI - nuclear magnetic resonance - produces images of the molecules that make up a substance, especially the soft tissues of the human body. Magnetic resonance imaging is used in medicine to diagnose disorders of body structures that do not show up well on x-rays.*) Noted researcher Jennifer Hodges has found that, "If they're not the ones paying for the examination, they'll be much more likely to request that it be performed."

Jack Wennberg of Dartmouth’s Center for the Evaluative Clinical Sciences is often quoted as having said: "…up to one-third of the over $2 trillion that we now spend annually on health care is squandered on unnecessary hospitalizations; unneeded and often redundant tests; unproven treatments; over-priced, cutting edge drugs; devices no better than the less expensive products they replaced; and end-of-life care that brings neither comfort, care, nor cure."

It's also interesting to note that this is not just a patient driven phenomenon. In a recent study in the Orthopedic literature, it was found that with physician owned MRI scanners, there was a higher likelihood that a study would be ordered than if the doctor had no financial interest in the unit. Makes you think doesn't it. And these are my peers.

The take home lesson here is that, with MRI examinations that are sometimes billed at over $3000 each (thus the consideration of an ankle MRI, and foot MRI as suggested above, could be billed in excess of $6,000,) some measure of restraint is needed. "Fiscal restraint on the part of both parties," says Hodges. If there's a diagnostic unknown between the doctor and the patient, ask the question, "Would my treatment be changed/enhanced with an MRI? Would we use the information from the scan, positive or negative, to make a decision in my care?" If the answer's no, or perhaps not right now, maybe another treatment entity is appropriate at this time.  Plus, the time you'd be using in the scanner may be used by someone who's really sick or injured and needs it badly.

Monday, March 27, 2017

Asphalt or Concrete, Which to Run On?

Here's one for which every running shoe shop employee thinks they know the best answer.
If you just apply a little common sense, and physics of course, you can figure out what's best for your training be you a 60 mile per week athlete or one with lesser aspirations.

Ready? They're equal.  Since both concrete and asphalt are easily 1,000 times harder than the sole of your new model running shoe, there's no significant hardness difference.  But having said that, blind fold an experienced runner, have him/her run on each surface, and even blindfolded they can tell you the difference.  Read on.

Kona concrete conveyor

There's this number called Young's modulus of elasticity. I'll reproduce it here in case you'd like to use it for your shopping list, to calculate the gas mileage in your Jeep, or perhaps the proper pH of the pool.

Young's Modulus

It's the measure of stiffness of a solid material. 

If you were to make a quick pit stop by Google you'd find a real range of answers like:

Livestrong  "The impact to your body's joints as you run is an important factor to consider. Although concrete and asphalt are each hard surfaces, concrete is harder and might result in more joint pain."

Runners World forum  "With all other factors being the same...the difference between the two surfaces is like the difference between a runner weighing 160 lbs or weighing 165 lbs." And I thought " a complete package...I probably gain 5 lbs from summer to winter just in extra clothing." Me, I don't avoid concrete surfaces."

Or the one that makes the most sense scientifically:

Slowtwitch  Johanthan Toker, Phd.  "The difference between concrete and asphalt is a bit like the difference between a standard HDTV and higher resolution TV, where the limiting factor becomes the eye's ability to observe the difference. The difference can be measured, but the difference is not significant in the greater context of the situation. In the case of running, both concrete and asphalt are very hard and deflect very little. The fact that one deflects a tiny bit more than the other scientifically does not translate to an observable difference in impact, especially when running is considered to include the impact absorbed by a running shoe and the sole of the foot."

So if we look at the quote that may best sum this up, from Paul Osepa*  

In running shoes, training on concrete is like adding one 
extra stride's worth of shock for every every thousand 
strides that you would take on asphalt, or about one stride per mile.
Since the cushioning difference between any two shoe models
is much more that 0.01%, I submit that shoe choice, and not
surface choice, is the only thing that matters for injury prevention
on hard surfaces.

It's worth noting that concrete is generally the most consistent surface material, while asphalt is typically cambered. 

But, can an experienced, blindfolded runner tell the difference between running on concrete versus asphalt?  Absolutely.  Maybe it's the friction difference between a porous surface and one that's less so.  Maybe it has to do with the fact that many asphalt roads are cambered, angled toward the curb for drainage.  Possibly the way a foot strikes a slightly porous substance is different.  I don't know.  But there's a difference in feel.  That said, a runner doesn't need to choose one over the other to have a successful workout without fear of increasing the potential for injury.  But if you have the option of grass, dirt or the track, I'd take it.


Paul Osepa, Cool Running

More J. Toker

The difference between concrete and asphalt is a bit like the difference between a standard HDTV and higher resolution TV, where the limiting factor becomes the eye's ability to observe the difference. The difference can be measured, but the difference is not significant in the greater context of the situation. In the case of running, both concrete and asphalt are very hard and deflect very little. The fact that one deflects a tiny bit more than the other scientifically does not translate to an observable difference in impact, especially when running is considered to include the impact absorbed by a running shoe and the sole of the foot.

The compressibility of rubber, EVA and a sock have considerably more contribution to the impact transmitted to the foot within the shoe than the difference between concrete and asphalt. Consider that the difference in hardness between concrete and asphalt is equivalent to adding less than 1mm of extra rubber to the sole of a shoe.

Beyond these hard surfaces, there are significant differences between road and track, trail, grass and sand. I would submit therefore that the goal of a runner trying to reduce the hardness of a surface explore these other options. 

For example, dirt trails have other benefits too, working the body's proprioception and dynamic lateral movements and stimulating the brain with changing conditions – reconnecting with nature, some might say. Barefoot running on grass or sand is another combination that is sure to reduce the force impact and trigger further changes in running form.

As studies have shown, our bodies adapt to running surfaces. Provided good biomechanical form is maintained, any running surface will work. It's also nearly impossible to change somebody's mind once they have made it up. You may disagree based on your personal experience – that's fine. As for me, I'll stick to the dirt trails and looking for mountain lions, or leaving footprints on the beach.

Thursday, March 23, 2017

How to Get Out The Door on Those Mornings You Don't Want To

Not everyone can be an Ironman. Not everyone wants to be an Ironman. And, some that want to be an Ironman are told they don't have what it takes. But once you're an Ironman, you're an Ironman for eternity. It was an Ironman who came up with, "Swim 2.4 miles, bike 112 miles, run 26.2 miles, and brag for the rest of your life."

                                   Navy SEAL Captain John Collins
                                   USNA 1959 

Navy SEAL David Goggins

If the above is the only thing you remember when you walk out the door on a lousy weather day, when you'd rather stay in bed, rather do almost anything else, let it be this! 

Everyone encounters days where it's easier not to get out of bed, not to think about working out, not see what your thermometer reads.  And some days you do go back to sleep.  Not often, but it does happen.  It's OK, not something to beat yourself up about or get too worked up over.  But keep it an only once in a while experience, OK?  On those other days, when you know it's cold, or windy, or both, just think about the transition area of a recent "A" race.  

Let's see, body marking was pretty smooth, oh, and look at the water, smooth as glass today.  I'll park my bike get the message.  Think about a carrot of some kind, the calorie expenditure of your five mile run and how close you are to your racing weight.  Just  a couple more miles and you'll have 40 for the week.  Play the mind game, get dressed from the "everything I'll need in the morning" pile of clothes you laid out last night and before long, when the first drop of sweat beads up on your forehead you'll think, "Whew and to think I almost slept in today.  I'm not going fast, but I'm going."  In the words of multiple national age group swim record holder Shirley Loftus-Charley, "A slow time is better than no time."*

You know she's right.

One of the athletes I profiled for Ironman Hawaii this year was Brett Kruse, a gent who works for Starbucks.

He has a very inspirational story involving breaking his foot five weeks before Kona but overcoming this for his 14th Ironman finish.  One of many take aways from his personal victory was, even though he was told by his doctor early on that he had no business going to Hawaii, he was going anyway.  His thought process?  "Well, I can stay home and watch the race on TV, bitter, or, I can go to Kona, do the swim, do the bike and see. See what happens.  If I can walk or run, fine.  If I can't then I won't be wondering for the rest of my life what if I'd tried."

He finished!

So for the rest of us, finishing, starting actually, is what we do.  "A slow time is better than no time."

Sunday, March 19, 2017

Drink to Thirst or By Plan? The Big Guns Weigh In

How do we reconcile the thoughts of two respected, and usually correct triathlon information sources in this important matter?

Last weeks blog, Drink to Thirst?  Hah!  It Doesn't Hold Water was not only fun to write but one able to bring out a more complete picture of hydration.  In short, what works for one athlete, or one subset of athletes, doesn't necessarily work for all.  In this case, it definitely doesn't work for all.

Triathlete Magazine, recently quoted a study of cyclists where some drank to thirst and others followed a regimented drinking plan. "What they found? Prescribed drinking mitigated the impact of dehydration better than drinking to thirst."  They took that a step further and had the athletes rehydrate "to match their sweat loses, what we call individualized hydration protocol, they performed better, they cycled faster and they had lower body temperatures.” This suggests that prescribed drinking to match fluid loss in the heat provides a performance advantage."

We need to keep in mind that the studied athletes were elite level and other factors or variables may be involved as well.

It's been suggested that drinking to thirst is a recommendation that works for the slower athlete.  If you are going a bit faster it may be better to at least consider a plan.  It is good to use early parts of a race when the GI tract is working fine to absorb both carbohydrate and fluid.  Later in the race, even though you may be thirsty, the gut may not absorb as much. Don't drink excessively and use common sense.

Joe Friel, of the Triathlete's Training Bible, in personal communication noted, "Drinking to a schedule is not supported by the research. And the downside is that people come up with a schedule that is unrealistic and then drink themselves into hyponatremia. There have been several such deaths in marathons by back of packers. Even among those who should know better, i.e., a physician who died over drinking G-ade at Boston a few years ago. It’s dangerous to suggest this to people."

I believe both of these rehydration philosophies right and here's why.

A couple years ago, at the Ironman Sports Med course they have at the Royal Kona Resort in Kona the week before the World Championship, having previously been on the faculty, I was encouraged to attend a cogent lecture on Death in Triathlon.  The hydration issue was presented more like a spectrum rather than a yes or no situation.  

The speaker went through those hyponatremic deaths addressed by Joe Friel and common factors seemed be slower runner, cool day, women slightly more at risk than men, fluid overload thru overhydration - drinking excessively.  A little later, the speaker challenged the audience with a question like this.  OK, you’re supposed to, in one sentence, write the hydration plan for Pete Jacobs and Frederik Van Lierde, both winners in Kona, a 12 hr IM finisher and a 17 hour lottery finisher.  (Oh, on an 80 degree day and a 30 degree day.)

 In my mind, since the energy expenditure/ambient conditions are wildly different for this foursome, so would be their race plans.   Maybe Kona athletes are a subset unto themselves.  Potentially more knowledgeable, better experienced with trial and error of what works for them as individuals, that kind of thing.

Pretty ride for Women for tri (on top tube)

The actual percentages of our Kona hydration survey were as we obtained them in the blog, 86% either using a plan or “both.”  (Their words.)  I plan to repeat this study in October by the way.

So, we can see both sides of our street here.  I suppose that leaning more toward the athlete you’d find on the Kona pier at 6:00 am race day planning a 10 hour or less race, having at least the skeleton of an idea of both nutritional and fluid needs wouldn't be surprising.  However, the "everyday competitor" maybe a little newer to the sport or somewhat slower, hydration guidance would be to let thirst rule the day.

Monday, March 13, 2017

Drink to Thirst? Hah! It Doesn't Hold Water.

While strolling through Youtube recently, listening to a little Juke Box Hero by Foreigner,,  I found this below:

“At my school in 5th grade, some IT guy was leaving the school, so my class wrote a parody of this song called ‘Macbook Hero’ since he fixed the Apple Macbooks my school used.  The entire 5th and 6th grade classes sang it to him.  It was truly epic.” 

Following that, another poster noted, “He was a juice box hero!”

A big vote for originality!


Need a long day 2000y challenging work out?  Try this.  After a good warm up, we'll swim 4 X500, each 500 broken into 125's. Now this can be swum two ways.  The first time you try it swim the first 125 in the first 500 fast, next three easy.  The second 125 in the second 500 fast, 1,3,4 easy.  In the third 500, the third 125 fast, etc.

Then, next time you try this set, and you're feeling frisky, swim buddy Colin says, "In the first 500, swim the first 125 fast, 2-4 easy.  In the second 500, the first and second 125's are fast, 3 an 4 easy.  In the third 500, swim 1, 2, 3 125's fast, etc.  

Easy and fast are relative terms.  You want to be able to finish each 500, as well as finish the 2000y set, so set your pace accordingly.  When you finish, there's a real sense of accomplishment.

Drink to thirst. It's all the rage you know. Maybe they first heard it on American Idol

I could dazzle you with statistics.  Suffice it to say that a single hydration strategy is ineffective in the world of triathlon.  The only way for you to know what works best for you is to try various methods in training.  Try different strategies in shorter races.  I know more than one person who brings a bathroom scale to races, gets an accurate weight before the start of the event and also before the post-race (beer) rehydration recording both. The overly simple drink to thirst may indeed work for many, but it absolutely does not work for all. Two Kona veterans, obviously experienced in the sport, come to mind.  

One athlete, his sixth time in the Hawaii race, got to mile 95 on the bike and it was "either sit down or fall down.  I was dizzy to say the least."  He got this far on the bike, stopped at the mini med tent where Nurse Alice sat him down with a big glass of cool water.  30 minutes later, after his 3rd glass, he felt great, thanked Alice profusely and finished race. The next year he took a bouquet of flowers to the Kona hospital operating room where she worked to say thanks again.

Our 2nd athlete, with only one Kona slot available and a faster runner behind him as he approached the finish of what could be his first ticket to Hawaii, notes "I was pushing hard."  He won the age group and Kona slot.  "You can see that guy in my finisher's photo. He was 11 seconds behind me."  Looking a little grey, then a little light headed, he made the med tent and was immediately hooked up to an IV.

If it's assumed that those that qualify for Kona might be the most experienced in our sport what do the Kona qualifiers do?  It's an either/or question right?  Leave it to triathletes to come up with a third option of course.  So, this past October, 14% said they drank by thirst and 70% use a pre-race designed plan.  This leaves 16% who told us "both."  Thus, despite the teaching and preaching of a number of authorities, this group, which might be the finest and fittest on the planet that particular day have learned - likely though screwing it up - that for them some type plan will give them the highest chance of doing well in the endurance triathlon environment. 

Susan Lacke of Triathlete Magazine wrote the following:

Drink to Thirst or Drink on a Schedule?


"Drink to thirst is a recommendation that works for the slower athlete.  If you are going a bit faster it is better to go with a plan.  It is good to use early parts of a race is working fine to absorb both carbohydrate and fluid.  Later in the race, even though you may be thirsty, the gut may not absorb as much.  Don't drink excessively and use common sense.  The goal should be to lose a little weight (2 to 4 pounds) at the finish line. You definitely want to avoid weight gain, which clearly would be a sign of drinking too much.  In hot environments dehydration can definitely be a very important factor. Don't forget that good hydration starts before the race, and hydrate well in the days leading to your race."

Enough said.

Sunday, March 5, 2017

Exercise More, Drink More Alcohol? They Talking About You?

 Whenever reassembling your bike, you'll get to a part that uses unique fasteners.  You will drop at least one. It will ping, tink and plunk off of 3 or 4 surfaces and then disappear from the space-time continuum!

Later, after you've had a new one FedExed in, at a cost near the value of your LBS entire inventory, the old one will turn up.  Often just after it has punctured your new fifty dollar bike tire.
                                                                                                    Thx, Mike McNessor


For some reason, it never occurred to me that after a swim workout I always put my gear back in my swim bag in the same order.  Seems that way.  Fins first, then snorkel, paddles, shampoo, etc. cause that's the only way all that stuff'll fit.  

BUT, it's become my 4X's/week transition practice.  Really, I hit my watch, stuff the bag and dress, while timing how long it takes me to get the locker room door.  I'm fast, but very orderly, because just like in a race, I've put everything in it's usual place and through practice, practice I know where that is.  It's fun.  Give it a try.  

You know you need the practice, we all do.

I read this last year after we did our no-alcohol January.  After thinking about it briefly, thought it was exactly correct.  Many of my best friend athletes also aren't shy about their relationship with bourbon or beer.  Read on.

People who exercise more also tend to drink more (alcohol)

Michael Bierer, MD

Michael Bierer, MD
I take care of adults in primary care and I treat addictions. So when I was sent a journal article titled “Daily Physical Activity and Alcohol Use Across the Adult Lifespan,” it piqued my interest. This paper describes the drinking and exercise habits of 150 largely white, low-risk, community-dwelling adults (meaning it didn’t include people who were in the hospital or a nursing home) in central Pennsylvania. In this study, volunteers used a smartphone to record their daily drinking and exercise habits in 3-week blocks. This smartphone technique made it possible to get good information and to analyze daily variations for each individual. What is clear from the analysis is that people tend to drink more alcohol on days when they exercise more. This is true whether they’re young, old, male, or female.
This is not a study of problem drinkers or risky drinkers, nor of people with alcohol use disorders (what we used to call alcohol abuse or alcohol dependence). This is also not a study of the effect of an intervention to change lifestyle behavior. That is to say, this study does not tell me what happens if I advise a patient to exercise more or to drink less. The study also does not suggest that if you decide to exercise more, it’s likely you will drink more. It is solely an observational study, not a study of change over time.
These are healthy people in general. The mode and median number of drinks per day was zero. That is to say, among this group, there was no drinking at all on half or more of the days recorded. So the results may have been different in a different population (for instance, a more economically challenged or urban population). The results of a similar study, I expect, would be different were it conducted among a high-risk group; for example, people working to drink less or exercise more might engage in a “virtuous cycle” whereby the enjoyment of a sense of more energy, less fatigue, or better physical strength would provide the power to make further healthy choices. Increased exercise might be linked to decreased drinking in this kind of population.

The challenge of making — and keeping — healthy lifestyle changes

What I’ve observed in my practice is that significant changes in health-related behaviors travel in packs: people who adopt healthier drinking habits (for instance, reducing their intake to one drink per day if female or two per day if male, on average) also get off the couch, walk more, lose a pound or two, and generally pay more attention to their health. The challenge for them — and me — is to sustain these healthy changes.
There is a lot of seriously unhealthy sedentariness among adults in this country. Many people do not move around this planet under their own steam other than to go to the car, fridge, or couch. No joke. Hours are spent every day sitting in front of a lit screen. We come home from work, having been typing and mousing, straining our neck and back and keyboarding muscles, only to collapse on the couch to click around on the remote. Maybe we’re tense, so we have a drink. When it’s time to go to bed, we’re not physically tired, so we’ll have a few more drinks. So we won’t sleep efficiently (because alcohol disrupts healthy sleep cycles). And then we’ll do it all again the next day.
Making even a small sustainable dent in this cycle can be challenging. The positive effects may not be evident quickly. Only patience and commitment are rewarded. But the rewards, accumulating bit by bit, can be great.

A few ways an “exercise prescription” can make a difference

Although this study wasn’t intended to look at addiction, I’d like to mention the role of exercise in the treatment of mood disorders and addiction. There is evidence that aerobic and muscle-building exercise have positive effects on depression; research is ongoing on their effects on addiction. The attractive aspects of a sensible “exercise prescription” include its relative “safety profile” (meaning lack of negative side effects), its known positive effects on brain health, and the ability to customize it to whatever a person’s favorite activity might be. Of course, pacing oneself is paramount so as not to over-train or sustain injury. Some of the changes in the central nervous system due to exercise — for instance, increases in some dopamine activity (similar to the effects of intoxicants) enhanced blood flow, and glial cell proliferation — may also be related to improvements in mood and cognitive function.
People who have substance use disorders often suffer from a lack of joy (other than the chemical high) and from isolation. Isolation both permits the use of drugs or alcohol without bothering others, and may drive the use of them as a salve for loneliness. So combatting isolation is part of addressing addiction. Exercise (in groups) is a pro-social activity: the sense of community, and the positive emotional impact of interpersonal contact (that is, the simple joy of being with others), may be essential ingredients of getting — or staying — on the road to recovery.