It a word, yes. Many of you may have noticed that there are a number of what are described as heart-healthy spreads on the market. Most of these contain monounsaturated fat, which is not particularly heart healthy, or omega-3 fatty acids (most of which are Alpha Linoleic Acid, which may be heart healthy, but the jury is still out on- see the previous discussion on fish oil). If you really look, a few claim to actually lower cholesterol. Most of these contain either plant sterols or stanols, which turn out to be reasonably cool little chemicals.
Plants synthesize a number of very cholesterol like molecules that we usually refer to as plant sterols as a group, though the do have individual names (the poster boy is a compound called sitosterol, more on that later). When we eat these, they actually are absorbed into the cells that line the intestine by the same protein that helps us to absorb animal based cholesterols - a transporter with the fancy name of the Niemann-Pick C1 like 1 receptor (which is actually where the drug Zetia works). When cholesterol is absorbed into these cells, it gets packed into dense balls of fat called chylomicrons, which then ultimately find their way into your blood stream, and the cholesterol subsequently finds its way into the walls of your blood vessels causing atherosclerosis - this is bad.
In most people, however, if one little molecule of a plant sterol finds its way into that ball of fat, your body kicks it and all the animal based cholesterol stuck in the fat globule back out into your intestine where it simply goes the way of all the other waste products that find there way into the intestine. The fancy name for the molecules that do this is are sterolin 1 and sterolin 2, which are almost always mentioned in conjuction with the genes that code for them ABCG5/ABCG8. In other words, for almost everybody, eating plant sterols keeps you from absorbing cholesterol. If it isn't in your blood stream, it isn't in your artery walls, which is what we are aiming for.
At this point you may have noticed that I keep throwing in qualifiers (almost everybody, most people, etc). That's because some very rare individuals have a condition called sitosterolemia (it also goes by a new name phytosterolemia). These individuals lack the mechanism (due to gene mutations in ABCG5and ABCG8) for kicking the the plant sterols out, meaning that they make it in to the body and wreak havoc on blood vessel walls causing heart disease, heart attacks, etc.
So this brings us to the plant stanols I mentioned earlier. There does not seem to be a disease equivalent to sitosterolemia for plant stanols, so the butter substitutes made with stanols rather than sterols should be safe and effective for everybody. Again, the plant sterol based products are really good for the vast, vast majority of people, but not quite everybody, and unfortunately, there's no quick, easy way to tell if someone has phytosterolemia. The stanols keep your body from absorbing cholesterol the same way the sterols do, but at least theoretically work for everybody.
One other thing I get asked a lot is if you have to eat a lot of cholesterol for sterols and stanols to work. The answer to this is unequivocally no. Most of the cholesterol ( a good 80 percent in most people) circulating in our gut is not from what we eat at all, but actually excreted by our liver and then reabsorbed by the body further down in the intestine (a process called entero-hepatic circulation). Whether you are getting rid of the cholesterol that you just ate or cholesterol that was once in your blood makes little difference, it will all make you LDL come down.
Saturday, November 28, 2009
Friday, November 27, 2009
Why I Run - or does a runner have a mu nature?
Increasingly, I am asked why I run. Not infrequently, it is a non-runner who asks - most runners have their own reasons and don’t question your decision. It’s easy to say why I started running: my wife loves doing it. I was initially support staff for her through a few races, and then she talked me in to doing it myself. Why I continue doing it is another matter. Throughout my non-storied career, I have to admit, “why do I run?” has become something I ask myself more frequently. I’d love to say it was thoughtful introspection was the reason, but I’m not that deep (I lack a goatee and don’t drink coffee). In reality, it usually happens on a long training run or dead-tired, late in a race. Really more “why am I running right now?” A why-am-I –putting-myself-through-this thing that I pose internally, but I think the conclusion I have come to works both in that situation and on a more philosophical level.
I usually tell people that I really don’t like to run. In fact, I hate it. I explain that I run so I won’t embarrass myself in races, and that I race because I like getting T-shirts and shiny medals. From non-runners, I frequently get the “do you win a lot?’ question which is answered with laughter on my part. Amusingly enough, a few times, this has been taken as an arrogant, “yes, I always win” statement, which is actually funnier than the initial question. Other people usually will buy this “it’s for the swag” line of reasoning, and being perfectly frank, I probably wouldn’t be as likely to go out and run if I didn’t have a goal (some organized race coming up). It’s not the kind of thing that I can use to motivate myself at mile 20 on a training run, however (though I am figuring out that tweeting or posting how far I intend to run that day is a motivating factor – somehow it feels like I have etched the workout in stone). I’ve seen other folks write about why they run. My reaction is usually more of a “good for them” than a “Precisely, that’s why I do it too”. In truth, most of the reasons others cite for the answer to the question don’t work for me. I don’t get a runner’s high, I don’t clear my mind by racing long distances, and I think that I’m actually able to control my weight better by working out with weights than by running. I do understand the PR idea and subscribe to it, but if it isn’t a standalone concept. Why would I care about setting a personal record in a hobby that I didn’t care about for other reasons?
So why do I get up at 4AM and go stand in the freezing rain with a bunch of other idiots also waiting for a race to start? Why do I actually enjoy aching for a few days after. Why do I have an entire wall of my house with my wife’s and my race bibs stapled to it? The answer may inhently lie within the question.
Running is not a religious or spiritual experience of any sort for me, though I recognize and applaud the fact that for lots of people it is. I do think I can best explain my affinity for it with (at least my understanding of ) a Zen concept. The Koan “Does a dog have a Buddhist nature?” is apparently answered correctly with the single word “Mu”. To my understanding, the word effectively means “unask the question”. In other words, there is something inherently wrong with the query posed. It’s not quite the same thing as George Mallory's famous “because it’s there” answer as to why he wanted to climb Everest, but it’s in the same spectrum. Why do I run? Mu. And shiny medals and T-shirts.
I usually tell people that I really don’t like to run. In fact, I hate it. I explain that I run so I won’t embarrass myself in races, and that I race because I like getting T-shirts and shiny medals. From non-runners, I frequently get the “do you win a lot?’ question which is answered with laughter on my part. Amusingly enough, a few times, this has been taken as an arrogant, “yes, I always win” statement, which is actually funnier than the initial question. Other people usually will buy this “it’s for the swag” line of reasoning, and being perfectly frank, I probably wouldn’t be as likely to go out and run if I didn’t have a goal (some organized race coming up). It’s not the kind of thing that I can use to motivate myself at mile 20 on a training run, however (though I am figuring out that tweeting or posting how far I intend to run that day is a motivating factor – somehow it feels like I have etched the workout in stone). I’ve seen other folks write about why they run. My reaction is usually more of a “good for them” than a “Precisely, that’s why I do it too”. In truth, most of the reasons others cite for the answer to the question don’t work for me. I don’t get a runner’s high, I don’t clear my mind by racing long distances, and I think that I’m actually able to control my weight better by working out with weights than by running. I do understand the PR idea and subscribe to it, but if it isn’t a standalone concept. Why would I care about setting a personal record in a hobby that I didn’t care about for other reasons?
So why do I get up at 4AM and go stand in the freezing rain with a bunch of other idiots also waiting for a race to start? Why do I actually enjoy aching for a few days after. Why do I have an entire wall of my house with my wife’s and my race bibs stapled to it? The answer may inhently lie within the question.
Running is not a religious or spiritual experience of any sort for me, though I recognize and applaud the fact that for lots of people it is. I do think I can best explain my affinity for it with (at least my understanding of ) a Zen concept. The Koan “Does a dog have a Buddhist nature?” is apparently answered correctly with the single word “Mu”. To my understanding, the word effectively means “unask the question”. In other words, there is something inherently wrong with the query posed. It’s not quite the same thing as George Mallory's famous “because it’s there” answer as to why he wanted to climb Everest, but it’s in the same spectrum. Why do I run? Mu. And shiny medals and T-shirts.
Monday, November 23, 2009
Spira Striker Review
Let me first say two things before I get into the details about this shoe. First, I like quirky shoes - I've been running in a combination of Mizuno Wave Nirvanas and Wave Creations for about as long as Mizuno has been making them. Second, I wanted to like this shoe. The concept (mechanical spring in lieu of foam or plastic or gel in the sole) seemed to make good sense. As I am never really in danger of slipping up and winning a race, I didn't really think that the USATF's ban on spring loaded devices would really have much of an impact on me. I'd seen the Spira's at few different races, most notably the Disney Endurance series, and thought I'd give them a try.
I bought a pair of the Spira SRS 111 Striker Performance Runners with the hopes that they might become my new shoe. I have no complaints with the quality of the shoe. The sole is well made, and I believe Spira's claim that the spring will outlast the shoe. The upper is fairly detailed and seems well tailored. It did not, however, work very well for my particular foot. For whatever reason, the sides seem to come up too far around my ankle. I also found the toe box a bit cramped. The shoes were a little hard to get in to as well.
I used them on several training runs, and, frankly, they just didn't work for me. I have heard folks complain that the springs hurt their feet, which wasn't at all the case for me on a 12 mile run. What did happen, however, was that my hamstrings and glutes got tired very quickly compared to normal, and were also sore the next day.
I'm not sure what to make of the purported energy return. They felt pretty much like regular shoes most of the time. I think they were actually working, but my hamstrings and glutes were somehow cancelling them out - hence the fatigue and soreness. Every once in a while though, particularly on a downhill, it did seem like their was a little something extra in my step. I found myself altering my running style quite a bit while I was wearing them to try to get the spring back. Every once in a while I'd be successful, but I think there is a fairly steep learning curve associated with these shoes. My experiemce reminded me of the articles I've read about people in the early stages of learning how to run barefoot.
In a nutshell, I have a feeling that this is the type of shoe that one has to run in for a while, maybe even altering their stride, in order reap benefits from. The energy return felt really good when I hit it just right, but it was an infrequent thing for my running style. At this point, I'm not willing to change my stride (to be totally frank, largely because of the uncomfortable uppers rather than the weird soles). I'm going to stick with my Mizunos, but I'll probably try them again later in the spring.
I bought a pair of the Spira SRS 111 Striker Performance Runners with the hopes that they might become my new shoe. I have no complaints with the quality of the shoe. The sole is well made, and I believe Spira's claim that the spring will outlast the shoe. The upper is fairly detailed and seems well tailored. It did not, however, work very well for my particular foot. For whatever reason, the sides seem to come up too far around my ankle. I also found the toe box a bit cramped. The shoes were a little hard to get in to as well.
I used them on several training runs, and, frankly, they just didn't work for me. I have heard folks complain that the springs hurt their feet, which wasn't at all the case for me on a 12 mile run. What did happen, however, was that my hamstrings and glutes got tired very quickly compared to normal, and were also sore the next day.
I'm not sure what to make of the purported energy return. They felt pretty much like regular shoes most of the time. I think they were actually working, but my hamstrings and glutes were somehow cancelling them out - hence the fatigue and soreness. Every once in a while though, particularly on a downhill, it did seem like their was a little something extra in my step. I found myself altering my running style quite a bit while I was wearing them to try to get the spring back. Every once in a while I'd be successful, but I think there is a fairly steep learning curve associated with these shoes. My experiemce reminded me of the articles I've read about people in the early stages of learning how to run barefoot.
In a nutshell, I have a feeling that this is the type of shoe that one has to run in for a while, maybe even altering their stride, in order reap benefits from. The energy return felt really good when I hit it just right, but it was an infrequent thing for my running style. At this point, I'm not willing to change my stride (to be totally frank, largely because of the uncomfortable uppers rather than the weird soles). I'm going to stick with my Mizunos, but I'll probably try them again later in the spring.
And it's shaping up to bad night...
A colleague volunteered to take my usual Thursday call night this week, so I'm on Monday. It's always fun being on call at the first of the week. I was just informed that I have four admissions waiting on me, and I'm not even technically on for another 6 minutes. The upside is that it means I'm home on Thanksgiving and can even probably get in a rare mid-week day time run. My wife convinced me that none of the local Turkey Trot like phenomenons were long enough to really be a good training run, so I think we are foregoing them this year.
Sunday, November 22, 2009
Saturday, November 21, 2009
Two New Half Marathons in Columbia SC
I just found out about two new half marathons in Columbia, SC yesterday - Columbia has had a single half marathon (The Governor's Cup) for a long time, but has been lacking in other events. New this year are the Columbia Half Marathon (http://www.columbiahalfmarathon.com/) on Feb 27, 2010 and the Palmetto Half Marathon (http://www.palmettohalfmarathon.com/) on April 10, 2010. The Columbia Half Marathon is the kick-off event for a new series of races sponsored by USRA that will focus on half marathons mid-size cities. Columbia in mid-February is usually about perfect for distance running from a weather standpoint. The US women's Olympic marathon trials were held in Columbia a few years ago, and they intend to utilize much of that course. It will likely be a hilly course, but probably a great run. The Palmetto Marathon appears to be more of a locally run event that will largely be a fund raiser for local charities. April can be kind of warm in South Carolina, but it will probably be a flatter course as well. Of the two events, the Palmetto Half also seems to have the cooler logo. I'll likely run both, though the Mercedes Half Marathon is only two weeks before the Columbia Half Marathon. They're both halves (or when one is referring to two half marathons, is its "halfs"?), though, so two weeks should be more than enough recovery time.
Tuesday, November 17, 2009
Pre-race peanut butter sandwiches
As I mentioned before, I usually don't like to try something new for the first time on race day, but in addition to my use of the Sugoi Ready T, I also decided to try a new pre-race food. For years, I have eaten power bars pre-race, and for years I have had some GI issues prior to the race. I finally decided that the bars might have something to do with it, and figured I would try something new - an old fashioned, plain, uninteresting, peanut butter sandwich. Having just read that there was probably some benefit to eating four to five hours before a race, I also tried a new schedule.
As odd as this sounds, I made a peanut butter sandwich prior to going to bed the night before the marathon, encased it in couple of plates, and stashed it under my pillow (it was the only place I could think of in the room that the dogs would not be able to get to, and I had no desire to get up and find my midnight snack in the bowels of one of my collies). I woke up around 1am, devoured the sandwich, and went right back to bed. I woke up race morning and promptly ate another peanut butter sandwich.
The result of my 2 phase plan: I not only felt like I had more energy than I usually have race morning, but I had no Gi distress. I'm definitely going to continue doing it. About mile 15, I started waxing poetic about a peanut butter and Roctane sandwich for my next race, but I don't know it that will come in to fruition.
As odd as this sounds, I made a peanut butter sandwich prior to going to bed the night before the marathon, encased it in couple of plates, and stashed it under my pillow (it was the only place I could think of in the room that the dogs would not be able to get to, and I had no desire to get up and find my midnight snack in the bowels of one of my collies). I woke up around 1am, devoured the sandwich, and went right back to bed. I woke up race morning and promptly ate another peanut butter sandwich.
The result of my 2 phase plan: I not only felt like I had more energy than I usually have race morning, but I had no Gi distress. I'm definitely going to continue doing it. About mile 15, I started waxing poetic about a peanut butter and Roctane sandwich for my next race, but I don't know it that will come in to fruition.
Sunday, November 15, 2009
Post Marathon Run
Took a short 7 mile run today for the first time since the marathon last Sunday. I was planning on taking it easy anyway, but I forgot to recharge the battery and my Garmin died about 30 feet into the run. I was forced to plod along at whatever speed I felt like going with no hope of having any way to determine how fast I was going. It made for an extremely relaxing and enjoyable run.
Fish Oil for Runners - and everybody else for that matter
A lot has been made of omega 3 fatty acids/fish oil and their health benefits - both for folks who are active and folks who aren't. What I can tell you is that there truly are some pretty good research behind taking fish oil on a daily basis. From a cardiovascular standpoint, Omega 3 fatty acids has been shown in fairly large doses (about 4000 mg)to decrease triglycerides (part of the "bad" non-HDL cholesterol) and minimally increase HDL. In fairly small doses ( about 1000mg per day), it has been shown to help prevent electrical problems with the heart (arrhythmia) and also to act as a decent anti-inflammatory agent. The side effects seem to be fairly minimal - there is some increased risk for bleeding and more commonly there is the phenomenon known as the "fish oil burp". People who are taking fish oil may not be getting the expected benefits, however, because in order to do so, you have to learn to label read.
What most people don't realize about fish oil is that it is not all Omega 3 fatty acid - it's a fairly heterogeneous mixture of a lot of different fats. In order to reap the benefits of taking it, you have to make sure you get adequate quantities of the omega 3 components. In most fish oil, the Omega 3 part is delineated on the label as DHA and EPA, both of which are acronyms for long scientific names not worth committing to memory. In order to determine how much Omega 3 fatty acid a given fish oil pill has in it, add up the amount of DHA and EPA it contains. This may be anywhere from about 250mg to up around 900mg for a 1000mg to 1500mg fish oil capsule. Divide the the total amount of omega 3 fatty acid you need daily by the amount of DHA + EPA contained in each pill and round up to the next whole number. That is the number of pills that need to be taken on a daily basis in order to achieve that amount of Omega 3. As you can tell, this is not necessarily a big deal if you are trying to get to the 1gram dose necessary to prevent arrhythmia and work as an anti-inflammatory (what most runners want), but if you are only getting 250 mg a capsule and you are trying to get up to 4grams a day, then you are popping 16 fish oil capsules a day! Hard for anybody to swallow.
Also, a quick word about the "plant based" Omega 3 fatty acid Alpha Linoleic Acid (ALA). This is an inexpensive omega 3 that's being pumped in to everything from cooking oil to yogurt these days. It's even somehow managing to get into fish oil capsules. Mechanistically, it would seem to make sense that this shorter fatty acid would have the same effects as its longer chain big brothers EPA and DHA, but the not nearly as many studies have been done on it. If you are a vegetarian or can't stand the fish oil burp, it may be worth trying, but know that it doesn't have the body of evidence behind it that DHA and EPA have.
What most people don't realize about fish oil is that it is not all Omega 3 fatty acid - it's a fairly heterogeneous mixture of a lot of different fats. In order to reap the benefits of taking it, you have to make sure you get adequate quantities of the omega 3 components. In most fish oil, the Omega 3 part is delineated on the label as DHA and EPA, both of which are acronyms for long scientific names not worth committing to memory. In order to determine how much Omega 3 fatty acid a given fish oil pill has in it, add up the amount of DHA and EPA it contains. This may be anywhere from about 250mg to up around 900mg for a 1000mg to 1500mg fish oil capsule. Divide the the total amount of omega 3 fatty acid you need daily by the amount of DHA + EPA contained in each pill and round up to the next whole number. That is the number of pills that need to be taken on a daily basis in order to achieve that amount of Omega 3. As you can tell, this is not necessarily a big deal if you are trying to get to the 1gram dose necessary to prevent arrhythmia and work as an anti-inflammatory (what most runners want), but if you are only getting 250 mg a capsule and you are trying to get up to 4grams a day, then you are popping 16 fish oil capsules a day! Hard for anybody to swallow.
Also, a quick word about the "plant based" Omega 3 fatty acid Alpha Linoleic Acid (ALA). This is an inexpensive omega 3 that's being pumped in to everything from cooking oil to yogurt these days. It's even somehow managing to get into fish oil capsules. Mechanistically, it would seem to make sense that this shorter fatty acid would have the same effects as its longer chain big brothers EPA and DHA, but the not nearly as many studies have been done on it. If you are a vegetarian or can't stand the fish oil burp, it may be worth trying, but know that it doesn't have the body of evidence behind it that DHA and EPA have.
Saturday, November 14, 2009
And now moving on...
With the Outerbanks Marathon in the books, my next task is the Goofy Race and a Half at Disney World. I've done both the half and the full there before, but never on consecutive days. I have to say, this one is more just about getting through it than making any sort of time goal. This particular group of races is actually the first one that I'm actually worried about finishing rather than trying to finish it in a certain time. My wife has done it twice, and doesn't seem to think its a big deal, but she's also a much stronger runner than I am.
After that, we're off to a couple of more half in the spring - the Mercedes half marathon in Alabama and the Shamrock Half marathon in Virginia Beach. Never run in Birmingham before, but I'm looking forward to it. I ran the Shamrock Marathon last year, and its a well run event. Looking foreword to it again this year.
After that, we're off to a couple of more half in the spring - the Mercedes half marathon in Alabama and the Shamrock Half marathon in Virginia Beach. Never run in Birmingham before, but I'm looking forward to it. I ran the Shamrock Marathon last year, and its a well run event. Looking foreword to it again this year.
ARBITER 6 - HALTS - my 2 cents
Shifting gears from running to lipids for a few minutes, I want to throw my 2 cents in about the ARBITER 6 trial that appears to be one of the most anticipated studies revealed at AHA this year. It's a trial that compared the ultrasoncially measured carotid intima media thickness (CIMT) of patients taking a statin with niacin and a statin with zetia (ezetimibe) over time. CIMT is considered to be a surrogate marker for coronary artery disease, which is considered to be a surrogate marker for cardiovascular injury or death. In other words, it's comparing the thicknesses of plaques in artery walls in the neck of groups of patients on two different groups of medicines, with the speculation that the greater decrease in the size of that plaque (or the lesser increase in size) will translate into fewer heart attacks, less heart disease, fewer deaths, etc.
It's interesting to me that a trial based on surrogate endpoints and that deals with two risk factors that both have an effect on cardiovascular health is garnering so much attention. There has been much speculation that the trial was stopped early because the niacin arm proved to be superior to the ezetimibe arm- if so does this come as any big surprise? From what I can tell, there is no mechanistic reason for zetia not to work, but when used in combination with a statin, it will only cause a added 15 to 20% decrease in LDL-C and will have minimal effects on other parameters. In contrast, niacin will potentially decrease LDL by about 10%, but will also raise HDL substantially. It also has an effect on HDL and LDL particle number as well as triglycerides. I don't think that it would be too surprising if it turned out that manipulation of these multiple parameters (all of which seem to have a positive effect when it comes to coronary artery disease) turn out to be more effective than basically just lowering ldl? Would anybody be surprised to find niacin to be the superior drug with this in mind?
On the other hand, I do not think that a negative result for ezetimibe in this trial would necessarily be a "death nail" for that drug either. First, this study is an imaging study, not an outcome trial, so results have to be taken with a grain of salt - we'll have to await Improve It in 2012 for mortality data with ezetimibe (a negative or equivocal trial in that situation may be a signal to start the funeral dirge). Second, ezetimibe seems to be a relatively safe drug, so, I don't see any good reason not to use it in combination with niacin and/or a statin. Third, though niacin appears to be the perfect complementary drug to a statin, unfortunately in clinical practice, its side effect profile does seem to be a limiting factor in its use - if zetia works, but not as well as niacin, it still may be a viable alternative to niaspan in those who can't tolerate the later.
I'll also be interested to see what the mean LDLs are for each group - if the entire group is at or near goal (because of their baseline statin use), then perhaps lowering the ldl further (with zetia) is not nearly as effective as manipulating other cardiovascular risk factors (niacin).
In short, I use a lot of use a lot of niacin in practice - and pretty much regardless of the results of this trial, I still will. I use zetia largely as an adjunct to statin therapy in LDL lowering in patients who are on a maximally tolerated dose of a statin, but who are not at goal (or with those who seem to have "statin tachyphylaxis"). I never liked the idea of using zetia as a substitute for a higher dose of a statin if the individual could tolerate the statin, and I still don't . I have always thought that niacin was underutilized, and this trial may lend some credence to this this idea, but otherwise, unless there is a truely surprising outcome, I'm not sure how much it will alter my practice patterns.
It's interesting to me that a trial based on surrogate endpoints and that deals with two risk factors that both have an effect on cardiovascular health is garnering so much attention. There has been much speculation that the trial was stopped early because the niacin arm proved to be superior to the ezetimibe arm- if so does this come as any big surprise? From what I can tell, there is no mechanistic reason for zetia not to work, but when used in combination with a statin, it will only cause a added 15 to 20% decrease in LDL-C and will have minimal effects on other parameters. In contrast, niacin will potentially decrease LDL by about 10%, but will also raise HDL substantially. It also has an effect on HDL and LDL particle number as well as triglycerides. I don't think that it would be too surprising if it turned out that manipulation of these multiple parameters (all of which seem to have a positive effect when it comes to coronary artery disease) turn out to be more effective than basically just lowering ldl? Would anybody be surprised to find niacin to be the superior drug with this in mind?
On the other hand, I do not think that a negative result for ezetimibe in this trial would necessarily be a "death nail" for that drug either. First, this study is an imaging study, not an outcome trial, so results have to be taken with a grain of salt - we'll have to await Improve It in 2012 for mortality data with ezetimibe (a negative or equivocal trial in that situation may be a signal to start the funeral dirge). Second, ezetimibe seems to be a relatively safe drug, so, I don't see any good reason not to use it in combination with niacin and/or a statin. Third, though niacin appears to be the perfect complementary drug to a statin, unfortunately in clinical practice, its side effect profile does seem to be a limiting factor in its use - if zetia works, but not as well as niacin, it still may be a viable alternative to niaspan in those who can't tolerate the later.
I'll also be interested to see what the mean LDLs are for each group - if the entire group is at or near goal (because of their baseline statin use), then perhaps lowering the ldl further (with zetia) is not nearly as effective as manipulating other cardiovascular risk factors (niacin).
In short, I use a lot of use a lot of niacin in practice - and pretty much regardless of the results of this trial, I still will. I use zetia largely as an adjunct to statin therapy in LDL lowering in patients who are on a maximally tolerated dose of a statin, but who are not at goal (or with those who seem to have "statin tachyphylaxis"). I never liked the idea of using zetia as a substitute for a higher dose of a statin if the individual could tolerate the statin, and I still don't . I have always thought that niacin was underutilized, and this trial may lend some credence to this this idea, but otherwise, unless there is a truely surprising outcome, I'm not sure how much it will alter my practice patterns.
Wednesday, November 11, 2009
Product Review: Sugoi BC Ready T
The Gist: The best tech shirt I have ever used.
The Good: Excellent wicking ability, very light, great fit
The Bad: nothing really - non stretch fabric odd to put on at first
The Review
I decided to put my Sugoi BC Ready T to its first extended long run use at the Outer banks Marathon last weekend. I normally like to try out new clothing on a training run prior to using it in a race just in case something doesn't work out, but I had a good experience with this particular shirt in a 5k last weekend, so I decided to chance it.
To the best of my understanding, the BC Ready T is the same shirt as the Ready S/S with Sugoi's proprietary brand champion graphics applied. It's made of Sugoi's finotech fabric, and comes in 9 different colors. The finotech is impressive, but is notably different than most tech fabrics out there. It feels pleasant, but lighter and perhaps a bit thinner than similar fabrics.
The strange part is actually comes when putting the shirt on - their isn't much, if any, give to the fabric. It isn't a negative, but I think most of us are used to deforming our shirts a bit when we pull them on, and its a bit strange to meet resistance. This lack of stretch doesn't inhibit movement at all, in fact you hardly notice the shirt is there. You don't notice it at all once the shirt is on, its just different.
What I did notice with the shirt on was the fact that it wicked better than any other shirt I have ever worn. Keep in mind that I'm a slower runner who spends a fair amount of time out on the course, and that I'm also a good size guy (6'2" and 190lbs). I sweat a lot during a race and it kept me dry and chafe free throughout. I wore it in a rather humid environment, and it still never felt heavy or water logged. The flat sewn seams blend in with the rest of the shirt and aren't noticeable. Hands down, this has become my favorite race shirt overnight.
The BC graphics, are also, it my opinion, very cool and make it easy for family and friends to pick you out during a race. Its red, black, and white thunderbird logo is a nod towards the location of Sugoi's headquarters in Vancouver and was designed by David Franklin, a respected aboriginal artist from Washington State. While graphics of this ilk have been common to cycling for a long time, they are relatively new in running clothing, and really make you stand out in a crowd in a good way.
All in all, this is a great shirt and I highly recommend it. I fully intend to get a few more.
The Good: Excellent wicking ability, very light, great fit
The Bad: nothing really - non stretch fabric odd to put on at first
The Review
I decided to put my Sugoi BC Ready T to its first extended long run use at the Outer banks Marathon last weekend. I normally like to try out new clothing on a training run prior to using it in a race just in case something doesn't work out, but I had a good experience with this particular shirt in a 5k last weekend, so I decided to chance it.
To the best of my understanding, the BC Ready T is the same shirt as the Ready S/S with Sugoi's proprietary brand champion graphics applied. It's made of Sugoi's finotech fabric, and comes in 9 different colors. The finotech is impressive, but is notably different than most tech fabrics out there. It feels pleasant, but lighter and perhaps a bit thinner than similar fabrics.
The strange part is actually comes when putting the shirt on - their isn't much, if any, give to the fabric. It isn't a negative, but I think most of us are used to deforming our shirts a bit when we pull them on, and its a bit strange to meet resistance. This lack of stretch doesn't inhibit movement at all, in fact you hardly notice the shirt is there. You don't notice it at all once the shirt is on, its just different.
What I did notice with the shirt on was the fact that it wicked better than any other shirt I have ever worn. Keep in mind that I'm a slower runner who spends a fair amount of time out on the course, and that I'm also a good size guy (6'2" and 190lbs). I sweat a lot during a race and it kept me dry and chafe free throughout. I wore it in a rather humid environment, and it still never felt heavy or water logged. The flat sewn seams blend in with the rest of the shirt and aren't noticeable. Hands down, this has become my favorite race shirt overnight.
The BC graphics, are also, it my opinion, very cool and make it easy for family and friends to pick you out during a race. Its red, black, and white thunderbird logo is a nod towards the location of Sugoi's headquarters in Vancouver and was designed by David Franklin, a respected aboriginal artist from Washington State. While graphics of this ilk have been common to cycling for a long time, they are relatively new in running clothing, and really make you stand out in a crowd in a good way.
All in all, this is a great shirt and I highly recommend it. I fully intend to get a few more.
Outer Banks Marathon Review
Stats:
2009 Finishers - 1815 (full) 3392 (half)
RunningDoc Three Point Course Assessment:
Scenery Rating (1 - 10 scale with 10 being best): 9
Crowd Support/Amenities (1-10 with 10 being best): 10
Ease of Course (1(easy) through 10 (really hard): 7
Swag:
Shirt - Short sleeve (half marathon) or long sleeve tech shirt (marathon), understated, sophisticated, graphics
Medal - Good size and heft, pirate themed, cool skull and cross bones on back
Other - Outer banks Swag Bag (a reusable shopping bag this year, a gear bag last year, much preferred last year's bag), Outer banks Marathon Visor at finish, Free Beer at Finish
Race:
I have to say that I really enjoyed this race. While relatively small, it is well organized, well supported by volunteers, and has very decent swag. The race had very good transportation provided from the finish site to the start and had ample port-a-potties at the start and finish and throughout the race, which is rare for a community race like this one.
The course itself is very nice, but substantially more challenging than one would expect for a coastal race. I usually equate a beach race with flat and fast, but this course had a fair amount of elevation change. You start off in Kitty Hawk, NC and run through several very pretty neighborhoods on or near the sound side of the island, and then on to the town of Kill Devil Hills, the home of the Wright Brothers Monument and the site of the first manned flight in history. You circle around that monument (at it's base, which is a very good thing, because it is on a very high sand dune) at about mile 8 (which I have to admit, in practice is one of the cooler things I have done during a race). At some point between mile 10 and the half way mark, you start running on a dirt path with gently rolling hills. The going is tougher, but not too bad. It is, however, very definitely not flat at this point. It is, however, well compacted dirt with good footing.
This changes about mile 12 when you enter what appears to be a maritime forest. You begin running on a bed of pine needles that seem to absorb any sort of impact - you get no return of energy from your stride. You also seem to run straight up hill at astounding slopes at some point (parts of it reminded me of running "the bear" at Grandfather Mountain, a race in which one climbs over 1500 feet in five miles). This mile or so of the race is pretty and actually really fun, but it sapped my energy for what seemed like the rest of the race. You pop out of the pine needle strewn trail about mile 13 and the rest of the race is on standard roadway.
The second half of the course has its high points, but in my opinion is less interesting than the first half. You run past Jockey's Ridge which is the highest sand dune in the US. It is impressive when you drive by it or stand on it, but running past it the time I remember thinking it made me feel like I was running through a desert with no end in sight. You then wind trough some very nice communities and end up again on the sound. The view is quite pretty, but less varied than the first half of the race. After the neighborhoods, you run some fairly empty stretches of highway surrounded by strip malls and pancake houses through Nags Head. It's a straight and boring, but necessary, stretch of road that takes you to the Washington-Baum Bridge, which is a steep killer between mile 22 and 23. The view from the bridge is probably spectacular, but it came at a time in the race when it took most of my concentration to put one foot in front of the other. The run into Manteo at the end is great, flat, and pleasant. The finish line was well organized, though there seemed to be two different electronic finishing points fairly far apart - I kept pushing hard through the second one, but I would have liked to have known if I actually need to do it or not.
Two things really stood out about this marathon - the volunteers and organization and the communities involved. This was an extremely well organized and formally supported race. The water and Gatorade stops were well placed and staffed, they had hammer gel available at more stops than any other race in which I have ever participated. The volunteers at the finish line put a medal around my neck, handed me an ice water drenched wash cloth, threw a mylar sheet around me, plopped a Gatorade in my hand and a finisher's visor on my head and shunted me off to have my picture taken with Blackbeard (a tradition at the end of this race) before I really realized that I had finished the race. Five minutes later, I had retrieved my 2 free Coors Lights and was on the way back to the car. The post race party was clearly great and very family friendly, but we had a long trip in front of us, so elected to forgo it this year.
Despite all the great organization, I think the most impressive thing about this race was the "unofficial" volunteers all along the race course. There were ample official water stops, but also dozens of unofficial water, candy, sports drink, and even beer stops along the course. The good people of Nags Head, Kill Devil Hills, Kitty Hawk, and Manteo come out in droves and really make this a great experience. Even the dry stretches of beach highway late in the race are lined with cheering spectators who go the extra mile to help you out along the way. The crowd support was superb.
All in all, this is a great race. It is, for the most part, an interesting course, with excellent crowd support and impressive organization. I highly recommend it.
2009 Finishers - 1815 (full) 3392 (half)
RunningDoc Three Point Course Assessment:
Scenery Rating (1 - 10 scale with 10 being best): 9
Crowd Support/Amenities (1-10 with 10 being best): 10
Ease of Course (1(easy) through 10 (really hard): 7
Swag:
Shirt - Short sleeve (half marathon) or long sleeve tech shirt (marathon), understated, sophisticated, graphics
Medal - Good size and heft, pirate themed, cool skull and cross bones on back
Other - Outer banks Swag Bag (a reusable shopping bag this year, a gear bag last year, much preferred last year's bag), Outer banks Marathon Visor at finish, Free Beer at Finish
Race:
I have to say that I really enjoyed this race. While relatively small, it is well organized, well supported by volunteers, and has very decent swag. The race had very good transportation provided from the finish site to the start and had ample port-a-potties at the start and finish and throughout the race, which is rare for a community race like this one.
The course itself is very nice, but substantially more challenging than one would expect for a coastal race. I usually equate a beach race with flat and fast, but this course had a fair amount of elevation change. You start off in Kitty Hawk, NC and run through several very pretty neighborhoods on or near the sound side of the island, and then on to the town of Kill Devil Hills, the home of the Wright Brothers Monument and the site of the first manned flight in history. You circle around that monument (at it's base, which is a very good thing, because it is on a very high sand dune) at about mile 8 (which I have to admit, in practice is one of the cooler things I have done during a race). At some point between mile 10 and the half way mark, you start running on a dirt path with gently rolling hills. The going is tougher, but not too bad. It is, however, very definitely not flat at this point. It is, however, well compacted dirt with good footing.
This changes about mile 12 when you enter what appears to be a maritime forest. You begin running on a bed of pine needles that seem to absorb any sort of impact - you get no return of energy from your stride. You also seem to run straight up hill at astounding slopes at some point (parts of it reminded me of running "the bear" at Grandfather Mountain, a race in which one climbs over 1500 feet in five miles). This mile or so of the race is pretty and actually really fun, but it sapped my energy for what seemed like the rest of the race. You pop out of the pine needle strewn trail about mile 13 and the rest of the race is on standard roadway.
The second half of the course has its high points, but in my opinion is less interesting than the first half. You run past Jockey's Ridge which is the highest sand dune in the US. It is impressive when you drive by it or stand on it, but running past it the time I remember thinking it made me feel like I was running through a desert with no end in sight. You then wind trough some very nice communities and end up again on the sound. The view is quite pretty, but less varied than the first half of the race. After the neighborhoods, you run some fairly empty stretches of highway surrounded by strip malls and pancake houses through Nags Head. It's a straight and boring, but necessary, stretch of road that takes you to the Washington-Baum Bridge, which is a steep killer between mile 22 and 23. The view from the bridge is probably spectacular, but it came at a time in the race when it took most of my concentration to put one foot in front of the other. The run into Manteo at the end is great, flat, and pleasant. The finish line was well organized, though there seemed to be two different electronic finishing points fairly far apart - I kept pushing hard through the second one, but I would have liked to have known if I actually need to do it or not.
Two things really stood out about this marathon - the volunteers and organization and the communities involved. This was an extremely well organized and formally supported race. The water and Gatorade stops were well placed and staffed, they had hammer gel available at more stops than any other race in which I have ever participated. The volunteers at the finish line put a medal around my neck, handed me an ice water drenched wash cloth, threw a mylar sheet around me, plopped a Gatorade in my hand and a finisher's visor on my head and shunted me off to have my picture taken with Blackbeard (a tradition at the end of this race) before I really realized that I had finished the race. Five minutes later, I had retrieved my 2 free Coors Lights and was on the way back to the car. The post race party was clearly great and very family friendly, but we had a long trip in front of us, so elected to forgo it this year.
Despite all the great organization, I think the most impressive thing about this race was the "unofficial" volunteers all along the race course. There were ample official water stops, but also dozens of unofficial water, candy, sports drink, and even beer stops along the course. The good people of Nags Head, Kill Devil Hills, Kitty Hawk, and Manteo come out in droves and really make this a great experience. Even the dry stretches of beach highway late in the race are lined with cheering spectators who go the extra mile to help you out along the way. The crowd support was superb.
All in all, this is a great race. It is, for the most part, an interesting course, with excellent crowd support and impressive organization. I highly recommend it.
Tuesday, November 10, 2009
Sunday, November 8, 2009
Friday, November 6, 2009
Outerbanks Marathon
Heading to Nags Head for the Outer Banks Marathon later today. It's supposed to be sunny and in the 50s to 60s, so it sounds like ideal weather. I ran the half last year and my wife ran the full. We're reversing that this year. Towards the end you have to run over a bridge over the intracoastal waterway - which I have to admit I'm not looking forward to doing.
Wednesday, November 4, 2009
Red Rice Yeast
I've been asked three times in the last two days now if one can take red rice yeast in combination with a statin. The answer is basically no. The Red Rice Yeast functions chemically just like a weak statin, so it would be similar scenario to taking two statins at the same time. You won't see much of an improvement in your lipid panel, and you could increase the risk of rhabdo, transaminitis, etc.
Tuesday, November 3, 2009
Product Review - Sugoi BC Rocket Cap
I have to admit that I'm a bit picky when it comes to running caps - I've largely used the same cap for a few years now, occasionally buying a new one only to revert to my old favorite (usually after only a single use of the other). That said, since I purchased the Sugoi BC Rocket Cap, I haven't worn anything else. The cap looks good, and it works. It's a black, tech fabric hat with Sugoi's Brand Champion Thunderbird Logo on the bill. I was a little concerned about the shape of the hat from the pictures - the bill seemed too short for the cap portion in the pictures, but when it arrived it was proportioned correctly - really a good looking hat. I think that the picture may look distorted a bit because of the band of very functional scotchlite-type material across the front of the bill. It also has the same reflective material on the back of the cap so you can be seen coming and going. The cap portion does a great job of wicking sweat away from your head, and also breathes quite well. From a fit standpoint, I have a middle of the road hat size, and it could be let out substantially or taken up substantially, so I think they did a nice job on adjustability. All in all quite a good product.
Monday, November 2, 2009
PaceTats
Pace Tats are not only an excellent product, but have a phenomenally fast shipping turn around time. I ordered some Friday at 9PM and the showed up today in the mail.
Odd Resistance Pattern
So I just saw a culture from an outside facility that supposedly showed a gram negative rod that was susceptible to ampicillin, but not unasyn. I'm not quite sure I understand that one.
Sunday, November 1, 2009
My Weekend
My latest predicament is the old trying to fit appropriate training in to the call schedule issue. I was on for 32 hours straight from Thursday morning to Friday evening, and then my wife and I started back going to the gym with a new personal trainer Friday night, post call. We haven't been in about four months. I got up the next morning and ran a little local 5K (which was fun). I woke up Sunday morning extremely sore, I think from the Friday evening workout. The only problem is that I'm slated to run the Outerbanks Marathon next weekend. We'll have to see how that goes.
My Initial Post
Welcome to the initial installment of "The Running Doc". At this point, I envision this blog as a mix of the odd combination of tasks I undertake on a weekly basis. A strange combination of hospital medicine, lipidology, running, weightlifting, and the difficulties of being a professional with responsibilities both in and out of work while still trying to trying to train for half and full marathons and just generally trying to stay fit. I also intend to give my admittedly biased reviews of the races I attend, the products I try, and generally anything else I feel like writing about. I fully expect this blog to evolve as I go, but this is the idea for now.
Subscribe to:
Posts (Atom)
Posts
