Sunday, December 22, 2013

No More Pain In The……….

Happy Holidays everyone!  As much as I love the holidays for the festivities, fellowship, food, and celebrating the birth of our savior, another reason the holidays are fun is the fact that our annual trip to Disney World for the Disney World Marathon weekend is just a couple weeks away!
While May and I do a very good job with eating a healthy diet most of the year, for us the Holidays are a time to indulge in some of those guilty treats that are set to the side the rest of the year.  In my mind I justify our “celebration of the not so good, good stuff” by the fact that we are usually running high mile weeks (60+ for me) through the first of the year while adding in strength training and some swimming. Add in the fact at Disney we will be on our feet all week and end the vacation with a multi-day romp through Walt’s world all makes for a somewhat guilt free indulgence.
This year has been a bit different and I have been a “scrooge” thus far. Don’t get me wrong, we have decorated the house and tree, have had fun shopping and have loved watching Elli take in all the excitement. Today is set aside to make marshmallows, caramels and mocos (a cake treat from my childhood) and several batches of peanut butter while Jazz Holidays plays on Pandora and the NFL is on mute in the back ground!  The Vokaty’s are blessed and this has been a great Christmas so far!
So you may ask “how can you be a scrooge with all of that?”  Good question!  As you may know I have been suffering from a left knee and left IT band issue since IRONMAN Augusta 70.3 in late September that has dramatically decreased my mileage and increased my frustration.  Not sure how the injury happened but it did so nothing to do but deal with it.
The IT band can be a “fickle” friend or foe, nowhere to be found one day and the next day it shows up unexpectedly the first minute of your run.  Having some lower left knee pain as well and having no signs of healing over two months, I made an appointment to see Dr. Scott with Moore Clinic in Columbia this past Tuesday.  (as with most good doctors, it took a while to get in so the apt was booked well in advance)
Highly recommended by Jen Coleman, Dr. Scott is a runner and an Orthopedic Doctor specializing in sports injuries.  Somewhat apprehensive to make the appointment as I wasn’t sure I was going to like what he told me due to having the Dopey Challenge coming up in two weeks (5K, 10K, Half Marathon and Marathon on consecutive days) I somewhat reluctantly went to my appointment on December, 17.
Doctor Scott and staff and AWESOME!  He took x-rays of my knee and put me through a series of tests to check the integrity of my tendons, ligaments and cartilage.  Being more nervous than a teenage boy about to go on his first date I anxiously awaited Dr. Scott’s verdict. 
Being human our minds always go to the worst possible place and I just knew he was going to tell me my knee was trashed and that I was going need surgery and be out of commission for six months. I kept thinking of ways I could still run the Disney Dopey Challenge. After all it was only 60 miles (add in warm up for good measure) over four days I told myself….that wasn’t so bad. Maybe I could run on crutches or just drag my left leg behind me. 
The verdict was in and my knee was fine. No structural damage, no arthritis and no tendon, ligament or cartilage damage!  Praise God! That was an early Christmas present and I nearly hugged him!  Trying to stay calm he confirmed the pain was from my IT band and that is what we needed to treat.
He explained as a “high mileage” triathlete, I run linear, bike linear and swim linear.  This linear, forward motion has built up my quads, hamstrings and calves but has not done anything to strengthen my IT bands.  That makes perfect sense. So what do I do now?
ICE, rest and my foam roller has been the course of action, I am happy to say that I have been able to get back to running on a regular basis last week.  I started slow and short with a knee brace, then no brace running easy and then finally added on some miles with no issue.
While the above has helped, I also got off my statins (check with your doctor before you do this) for a couple weeks as one of the side effects is blocking the body’s natural ability to heal injuries.  I also added back some animal protein to my diet to aid in recovery.  With high mileage and high intensity workouts, and having an injury that needs to heal, my protein intake needs to be no less than 125 grams a day. Unfortunately in my all vegan diet I was only getting about half that and was also missing some key amino acids only found in animal protein that aids injury repair. So when your Ox is in the ditch, you do what you need to do.
With adding back some dairy, eggs and meat, we have been very selective in choosing only organic (steroid, antibiotic and hormone free) foods that have also been grass fed. (May has prepared us some organic, grass fed beef from a farm in NC and it is the most lean, amazing tasting meat I may have ever eaten!)  In addition I have taken (OK the holidays are the exception) a great deal of sugar and other refined carbs such as white rice (less sushi as I just can’t let that go), white breads, white pasta, etc. out of my diet.  I feel great!
It has been an interesting experience as this combination of no statins and higher protein and lower carbs (basically the Paleo diet for athletes) has done wonders to get my knee in running shape in three weeks where the I did not make any progress over two months on a strictly vegan diet.
Being able to run relatively pain free, Dr. Scott is helping me not only help with temporary relief; he has prescribed the following to help me strengthen my IT bands.  First he prescribed abductor and adductor exercises that will strengthen the insides and outsides of my upper legs. While I do most of my weight training at home, the YMCA and Gold’s has the machines and I need to work on these areas. Being a personal trainer I know what to do and that weight training starts tomorrow.
Next is six weeks of physical therapy where I will work with a PT on other strengthening exercises and trust me I will be a good patient as I never want to go through this again.  Finally the last course of treatment is, ready for this, soccer.  Yep, good old soccer or football if you can believe it.  What soccer does is helps me run laterally in a way that does not bore me to tears. 
I have asked Santa for a soccer ball and some small orange cones so I can work on my lateral running skills (and ball handling skills) in the field next to the tennis courts twice a week.  Hey, the world cup is coming next year so I might as well get into the spirit of the games now!  I am also looking to join a recreational soccer league at Plex Indoor Sports in January.  I will continue with stretching and my foam roller and even have a topical anti-Inflammatory cream that was specially made for me by ABC Plus pharmacy.  More on this very unique non-NSAID topical treatment in a future post.
With Christmas three days away, I received an early present in the form of good news from Doctor Scott that my knee was OK and more importantly the Lord answered my prayers that my knee would heal and I could run the Dopey Challenge at Disney.  I realize I won’t be able to run the race at the pace I want, but I don’t take for granted the ability TO run and will enjoy the journey. The real prize is arriving at Coeur ‘D Alene for my first IRONMAN 140.6 race in June.
So today is all about making peanut butter, caramels, mocos and marshmallows with my family, getting a little shopping in  and thanking God for all the gifts he has already given me.  This is today for tomorrow morning at 4:30 I have a date with my Saucony’s and the road for 10 miles and another date at the Y for some strength training for my legs. 
Happy Holidays!

Monday, December 16, 2013

Restricted Breathging for Enhanced Endurance

Restricted breathing has become a new technique many endurance athletes are adopting to try and improve lung and breathing performance. So what is restricted breathing?  Have you ever tried to breathe through a small hose?  That is restricted breathing.  Go for a swim and take 6-8 strokes without taking a breath. That is another example of restricted breathing. Anything that limits the normal intake of air during rest or during training is restricted breathing.
Then there is hypoxic breathing which is much different than restricted breathing.  While restricted breathing limits the about of air and oxygen that enters your lungs, hypoxic training is where you actually pull in less oxygen into your body. Climbing to the top of a mountain where there is less air and oxygen available is an example of hypoxic breathing.
According to Ben Greenfield, restricted breathing enhances your endurance by strengthening your inspiratory and expiratory muscles, which increases your maximal ability to move gas in and out of your lungs.  Restricted breathing partially limits the amount of oxygen available to working muscles, while also slightly strengthening your respiratory muscles-making a hybrid of resisted breathing and hypoxic training.
One point of clarity: many restricted breathing devices are marketed as hypoxic training devices, but don’t stimulate altitude at all and do not result in any hypoxic adaptations.  Altitude training masks cannot change the atmospheric pressure you are training in.  For these masks to accomplish this effect, they would need to be equipped with a hypoxic air generator that regulates the O2 to simulate altitude.



Eestricted breathing masks, while they don’t provide hypoxic training via emulating higher elevations, they are effective for improving ventilator capacity though restricted breathing.  If a 14,000 foot mount peak is not in your back yard, congratulations, you are in the majority of people. Since altitude training is not an option for the majority of us endurance junkies, we are limited to resisted or restricted breathing techniques.  Restricted breathing can have substantial benefits on your training without the stress or expense of altitude training.
Here are some examples of restricted breathing techniques you can use in your daily training.
Swimming
Instead of breathing every one or two strokes, try breathing every 6-8 strokes. As your endurance improves, you can extend your time between breaths until you are able to swim a 25 or 50 yard set without breathing. This oxygen debt will help improve your breathing technique.
Another tool is to get a front-mounted FINIS Swim Snorkel and add a FINIS Cardio Cap to restrict the amount of air you get through the snorkel.

Restricted Breathing Masks
You can wear a restricted breathing mask (remember they may be marketed as altitude masks but ONLY offer restricted breathing unless it is connected to a hypoxic air generator) during a run or cycling session.


PowerLung
Keep a PowerLung restricted breathing device handy and use it frequently throughout the week.

Good Old Fashioned Breathing
If you normally breathe through your mouth when running or cycling, try breathing only through your nose, breathing deep from your abdomen. This provides a natural restricted breathing opportunity and helps train your inspiratory and expiratory muscles.
HERE’S TO BEING FIT FOR LIFE!
Chris is a Certified Personal Trainer and exercise and endurance enthusiast.  He competes yearly in numerous running races, marathons, ultra marathons, triathlons and other endurance events.

Monday, December 9, 2013

Cholesterol – Is it Bad or Good?

Cholesterol – Is it Bad or Good?
That is the question that is being raised by many.  Cholesterol, is it good or bad?  The short answer is, yes.  However, the answer is buried in the details of a rather complex formula that I will attempt to discuss.  While current mainstream medical thought states that high cholesterol is bad and causes heart disease, further research and thinking may reveal that low fat, high carb diets designed to lower cholesterol with the help of statins may actually be causing increase levels of heart disease and causing a plethora of health issues in America today.
While I am not a doctor and do NOT recommend that anyone make any dietary or medical changes without conducting their own research and consulting with their doctor,  information I have learned through a vast self-study and inquiry over the past few weeks has me questioning my approach to improving my heart and general health.
Last week I took a stress test to  learn if there were any outwardly signs of heart disease and not only was the test clean, I had managed to put up one of the best tests the exercise physiologists had seen.  Feeling good about these test results and that I do not have outward signs of the onset of heart disease, I wanted to further study the effects cholesterol, exercise, diet and most importantly statins (atorvastatin) have on “preventing” heart disease and on health in general.
As most know, I have mostly abandoned dairy and meat in favor of a plant based diet. While I do not follow a strict plant based diet 100% of the time, I do stick to this form of eating 90-95% of the time.  I also exercise 15-25 hours a week, depending on where I am in the training cycle for major triathlons or marathons. So far so good.
While on a recent business trip I picked up a copy of the book “Sugar, Salt and Fat, How the Food Giants Got Us Hooked” by Michael Moss and I was intrigued and shocked at what Moss brings to light in his book.  In summary he showcases just how much sugar, salt and fat the food giants include in processed food.  While May and I do not eat a lot of processed foods, I discovered that I had much more sugar in my diet than I realized and was consuming more bad carbs such as white rice, pasta and white potatoes than I realized. These are killers of HDL (good cholesterol) and raise the ever dangerous triglycerides.

During a recent health screening benefit at work, I was able to have a cholesterol work up done and at the time I felt good about the results.  While not perfect, most indicators were favorable. Having had time to further study cholesterol and heart disease I became concerned about my results and if they truly were indications of health or early warnings that further changes may need to be made in my diet.  My total Cholesterol was 160, HDL 36, LDL 92, Triglycerides 202 and blood glucose 88. While my HLD (good cholesterol) was a bit low and my triglycerides a bit high, the overall test results were “good” and based on mainstream medical thinking they are in line with heart health. A non-smoker, avid exerciser and a “heart healthy” diet, all is well, or is it?  Let’s take a closer look at cholesterol, statins and diet as they relate to heart disease. Bear with me as this is a rather in-depth analysis and will take a while to explain.
I love to study and learn new things, in particular things that are exercise, endurance sports, diet and health related.  I have recently discovered Dr. Steve Gangemi, better known to many as the “Sock Doc.”  He resides and practices in Chapel Hill, NC and practices holistic health, with an aim for preventing health issues while also identifying and fixing the causes of medical issues rather than treating the symptoms.  With many IRONMAN triathlon finishes to his credit, he understands sports and endurance fitness and concentrates on endurance athletes and athletes in general but works with the general public as well.  His web sites are Sock-doc.com and drgangemi.com.
Wanting to understand the “why” behind training, health, processes, etc., I am attracted to Dr. Gangemi’ s thinking and processes for preventing and healing injuries and improving health.  Preventing issues before they happen resonates with me so I was intrigued when I read his article titled “Elevate Your Cholesterol Profile, Elevate Your Health.”
While mainstream medical thought is that lower cholesterol at all costs is better, Dr. Gangemi challenges this reasoning and the role cholesterol plays in the development and proliferation of heart disease. Cardiovascular disease is caused by a wide range of nutritional, lifestyle and environmental factors (diet, exercise and processed foods) that result in inflammation that gets out of control. According to Gangemi, genetics most likely play some factor, but minimal compared to the rest. The genetic link is typically a cop-out when someone doesn’t take control of their own health. Toxins, infections, excessive stress, lack of proper exercise and diet are far more damaging to the heart than high total cholesterol.

Gangemi does not profess that high cholesterol is okay, but he does stress that lower cholesterol is not necessarily better. Cholesterol just doesn’t shift to a dangerous level without other contributing factors. A poor diet and overall health lead to unhealthy cholesterol levels whether that’s low, high, or imbalanced.
Gangemi explains that low cholesterol is often much more dangerous than high cholesterol even though we’re led to believe that cholesterol is evil. A cholesterol level below 160 mg/dl is said to increase one’s risk of many cancers, stroke, neurological problems such as memory loss and dementia, and many other health problems ranging from digestive to hormonal. He points out the components that make up cholesterol.
Some notable cholesterol functions:
It acts as a precursor to vitamin D – low cholesterol means it will be more difficult to absorb this vitamin necessary for a healthy immune system, bones, and DNA.
It is the precursor to all steroid hormones such as glucocorticoids which control blood sugar, mineralocorticoids which regulate electrolyte balance and blood pressure, and sex hormones such as progesterone, estrogen, and testosterone.
It is used to synthesize bile acids in the liver, which are important for the digestion of fats. These bile salts are then stored in the gallbladder.
Cholesterol is found in every cell of your body and is a necessary component of a healthy brain that needs to store and recall memory, process ideas, and function at its highest level.
Cholesterol is made up of HDL, LDL and VIDL which are basically triglycerides.  HLD, or better known as “good” cholesterol remove cholesterol from tissue where LDL or commonly known as “bad” cholesterol tend to deposit cholesterol in to tissues, thus their rap for being bad cholesterol.
Triglycerides, in my opinion, are the catalyst for the damage bad cholesterol can do to the cardiovascular system. Triglycerides are the main transporters of dietary fat in the bloodstream.  This includes excess fat that that results from excess carbohydrates in one’s diet.  Research has shown that a diet consisting of 60% carbohydrates (considered a heart healthy diet) can increase triglyceride levels as much as heavy alcohol consumption (two drinks per day) can.  Simple sugars are major culprits in elevating triglyceride levels.
Your body produces cholesterol and is a necessary component for a healthy body.  Cholesterol plays a role in fighting inflammation and also is a major lien of defense when your immune system comes under attack. Lowering your cholesterol can thus weaken your immune system and delay repair of injuries and muscle damage.
 Gangemi explains that all cholesterol particles can be either large or small. Ideally you’d like to have more large, buoyant HDLs and LDLs than small, and more small VLDLs/triglycerides than large. These can be measured through a more thorough lipid analysis that specifically measures the size and volume of HDL, LDL and VIDL particles.
One sign that your LDLs are most likely large (good) rather than small (bad) is your HDL to triglyceride ratio. If your HDLs are at least one-half of your triglycerides, then you most likely have large LDLs. So for example, if your HDLs are 40 and your triglycerides are over 80 that would be concerning where and HDL of 120 and triglycerides of 60 would indicate large HDL particles and small VIDL particles which is what you are striving for.
Gangemi also provides insights on other cholesterol ratios.  In his opinion, one should shoot for total cholesterol to HDL ratio of 3:1 or lower.  If your total cholesterol is 180 and your HDL is 60 that would be considered good.
Now on to LDL which is known as the bad boy of cholesterol. Gangemi explains that the LDL upper limit was dropped several years ago by most labs from 138 to 100. So now a LDL of say 125 is considered high, regardless of whether they are the small or large LDLs.
Interestingly, around the same time this happened, the pharmaceutical industry was trying to get the upper limit of total cholesterol lowered from 200 to 190. That way, if your cholesterol level was 195, your doctor would recommend a statin medication “for your health.” This never happened, but the LDL was soon lowered – a whopping 38 points. Now a lipid panel of 190 total cholesterol, 65 HDL, 105 LDL, and 100 triglycerides, (a triglyceride makes up 1/5 of the total cholesterol, so 100 = 20 of the total points), which is excellent, is flagged as having a high LDL.
While LDL is considered the bad cholesterol as it in the cholesterol that attaches to tissues (heart and artery tissue), Gangemi explains what it is about LDL cholesterol that makes it harmful.  It is the oxidized LDLs rather than LDLs per se that contributes to atherosclerosis and “cholesterol problems.” Free radicals, unhealthy fats, and a high carbohydrate diet cause the oxidation of the LDL particles.
Paul Jaminet, Ph.D. further explains LDL (low-density lipoproteins).  LDL particles serve as your body’s scouts or sentinels, detecting foreign threats like germs.  The LDL particle protein is very fragile and very easily oxidized.  When it comes in contact with bacterial cell wall components, it quickly becomes oxidized LDL, which doesn’t get taken up by cells that are looking to take in fats.  Instead, oxidized LDL gets take up by the white blood cells, and an appropriate immune response is mounted against the microbe that oxidized the LDL lipoprotein.  That’s the reason oxidized LDL are associated with a lot of health problems.  Its means you have a lot of “foreign” things that should not be inside you stimulating your immune system.
Gangemi goes on to explain more about oxidation of LDL particles. Free radical damage is often the result of lack of antioxidants in the body, such as vitamins A, C, and E but perhaps more importantly are all the healthy antioxidants found in fruits, vegetables, and herbs. Vitamin D is also a very important antioxidant – and one that won’t be well utilized by a low cholesterol body. Coenzyme Q10 is a very an important antioxidant needed by the heart and for the body to make energy. Statins (cholesterol meds) block CoQ10 from being made naturally in the body, therefore increasing free radical damage and further oxidizing LDLs. This is dangerous. The more stress one is under – physical, nutritional, and emotional – the more free radical damage your body will succumb to.  (Exercising and statin use may be more harmful than helpful).The more oxidized the LDL particles become (and the smaller the LDL particles) the more damage they do and smaller, denser LDL particles oxidize more easily than large particles.
Unhealthy fats mean partially hydrogenated “trans” fats as well as all polyunsaturated vegetable oils – corn, soy, sunflower, safflower, peanut, cottonseed, and yes definitely canola. The main reason for these oils being considered unsafe is the highly processed nature that provides long shelf life and high smoke points.
Statins – Magic, Mystery or Meddling
There are many different views on statins and their validity for “reducing chances of heart disease and death” in healthy people and in those that have already had cardiac issues. Dr. Gangemi explains what statins are and how they function.
Statins are known as HMG-CoA reductase inhibitors – they stop the synthesis of a compound called mevalonate from being formed. Mevalonate is the precursor of cholesterol, but also the precursor of squalene and coenzyme Q10 (ubiquinone), as previously mentioned.
Statins, other than blocking how cholesterol and other compounds are made, are touted as beneficial as some studies show they greatly increase the amount of nitric oxide made by the blood vessel lining which results in stroke reduction and its residual neurological effects. Some also say that statins protect against stroke by increasing the body’s ability to dissolve blood clots independently of both nitric oxide and cholesterol. Of course, as mentioned previously, you can significantly lower your risk of stroke by limiting your number of oxidized LDLs. Additionally, nitric oxide is made naturally in high amounts in healthy individuals with adequate protein intake (via the amino acid arginine) and proper cofactors (primarily manganese and vitamin B6).
According to Gangemi, high cholesterol is not the primary cause of heart disease and statins don’t decrease this risk for most people. Statins do however impair vitamin D metabolism and CoQ10 production (needed for energy production) as previously mentioned, as well as squalene production.


Squalene accumulates at the greatest concentrations in the skin, where it has a vital role as a free radical scavenger, preventing the harmful effects of the degeneration of fats. Adequate concentrations of squalene in the skin prevent oxidative damage from ultraviolet light. Squalene is also a substance that protects people from cancer. You may have heard of claims that “sharks don’t get cancer.” This is because squalene is super high in shark liver oil so you should naturally keep your squalene levels high.
That is a LOT of information to digest but in summary it appears that diets high in saturated fats and cholesterol don’t necessarily lead to heart disease. Remember triglycerides that are transporters of LDL and fats in the blood?  The higher your triglyceride number the more LDL fats will likely be elevated and if the LDL particles are small and dense the more easily they oxidize. So what drives up cholesterol?  According to Dr. Gangemi it’s the high carbohydrate diets (white flour, white rice, pasta, sugar, high fructose corn syrup and an overabundance of any grains) and so-called “heart healthy” vegetable oils (corn, soy, canola, safflower, peanut, etc.) that are linked to heart disease, cancer and most all diseases. A diet high in carbohydrates and inflammatory oils increase LDLs and oxidize them – and that can cause atherosclerosis.
Now that we know what bad cholesterol is, how it affects the body and what produces oxidized LDL particles and drives up triglyceride levels let’s look at some ways to establish and regulate a healthy cholesterol level for you.
According to Dr. Gangemi, most doctors don’t exercise or eat well and they sure don’t how to prescribe it so they fall back on the “diet and exercise alone aren’t enough” motto and recommend a statin. Proper exercise and a healthy diet can do wonders for your health and your cholesterol. That doesn’t mean you cut out all the fat from your diet and get up from your desk a few times a day to walk to the water cooler.

Dr. Gangemi offers some recommendations with the concept that maintaining heart health is about keeping inflammation at bay.
Supporting Dr. Gangemi’ s view on inflammation, Gary Taubes, science author with degrees from Harvard, Stanford and Columbia Universities, concurs that a major culprit in heart disease is inflammation.  He states that inflammation is caused when we expose our bodies to toxins or foods the human body wasn’t designed to process. These foods, however, are not the saturated fats in butter, meat and cheese-the things we have been taught to avoid.  They are in the foods marketed as heart healthy such as processed oils and processed foods.

(Authors note – While many will say our ancestors ate meat and dairy and survived, it’s important to note that the meat and dairy they consumed was MUCH different than what is found on the supermarket shelves today.  They meat and dairy they consumed was free of hormones, antibiotics and was grass fed and extremely lean. If you are going to consume meat and dairy, look for organic, grass feed meat and dairy that is free from hormones and antibiotics)
Remove all refined sugar (that includes juice) and grains from your diet. Triglyceride levels quickly drop with a low carb diet. Alcohol can also drive up triglycerides.
Exercise! Aerobic exercise is a great way to start especially if you’re already on a statin (or any medication for that matter). Strength training may be beneficial for you too.  It may be advised for you to have a stress test before engaging in any physical activity.
Eat a lot of organic vegetables – the more the better. Sorry, corn and potatoes are not veggies and due to the high starch level act more like carbohydrates and drive up triglycerides.
Keep the fruit to 1-2 servings a day; more only if you exercise intensely or for a long duration.
Eggs don’t raise cholesterol. Actually, they most likely will lower it. Make sure they’re pasture raised. Avocados, coconut milk & coconut oil are also healthy fats.  (Gangemi also recommends butter and milk but that is an individual preference and will depend on each person’s individual cholesterol profile and composition. Look for organic milk that is free of hormones and antibiotics and grass fed if possible)
Rid your diet of all the trans fats and polyunsaturated vegetable oils. In addition to exercise this may be the biggest, quick hit improvement you can make.
Consider a fish oil supplements
If currently taking a statin, take a CoQ10 supplement.  CoQ10 prevents atherosclerosis by reducing the accumulation of oxidized fats (remember the oxidization of small, dense LDL particles) in blood vessels. It also can lower high blood pressure, regulate the rhythm of your heart, and improve chest pain and exercise toleration if you have angina. (Some research shows that statins negatively impact aerobic gains from exercise, can cause muscle pain, delay the injury recovery process and negatively impact memory and cognitive function)  You can get CoQ10 naturally from red meat (grass fed), but it’s tough to eat enough. You’ll lose more CoQ10 over the age of 40 and with exercise too so if you take a statin then you’ll quickly become depleted. Dr. Gangemi says a general recommendation is 200mg a day but you need to consult with your doctor before stopping, changing or adding any new medications or supplements.
Other resources to check out that support Dr. Gangemi’ s views on healthy cholesterol levels, statins and the real causes of heart disease included:
The Statin Damage Crisis
Dr. Duane Graveline M.D., Dr. Malcolm Kendrick M., Malcolm

Ignore the awkward! How the cholesterol myths are kept alive
Uffe Ravnskov

Cholesterol Clarity: What The HDL Is Wrong With My Numbers?
Jimmy Moore, Eric C. Westman

Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar--Your Brain's Silent Killers
David Perlmutter, Kristin Loberg

If you are still with me that is a LOT of information to digest but information that makes a lot of sense and with new science, it’s worth talking about and studying.  When Pfizer created Lipitor it generated over $11 billion in revenue from this one drug and still brings in $4 billion a year on Lipitor now that it has lost its patent. This pays for a lot of research that can tell the story they want told and can go a long way to persuading the medical community that “all is well.”  I not saying you should stop taking your statin but you should arm yourself with as much information as possible and use this information with talking with your doctor about what is best for your health.
The Vokaty Chronicles
If you recall, Dr. Gangemi says one should strive for HDL to be twice your Triglyceride level and your total cholesterol to HDL should be 3:1. Based on the values of my most recent cholesterol screening at work, my HD is 17% of my triglycerides which is not good and my total cholesterol to HDL is 4.6 to 1 which is also outside the recommended level.
While I had a cursory understanding of diet, cholesterol and the effect of statins on the body before this research, my desire to research further has stemmed from a few issues concerning fatigue, a nagging knee sprain and lack of aerobic improvement during workouts.
Some of this fatigue and slow healing from injuries may be from lower than necessary protein levels.  As an endurance athlete you need between .8 and 1 gram of protein per pound of body weight. For me that is between 100 and 125 grams of protein per day, possibly more with an injury.  With my current plant based diet, I have been lax in calculating my protein intake and have likely been well below the necessary levels.  I will begin to track protein levels daily.
Armed with new information and a quest to be healthy I am going to experiment with some changes in diet and medication to see if I can improve my overall cholesterol levels, my heart and general health and my athletic performance.  I will provide updates weekly updates beginning Monday, December 2 on my progress here at “How Bad Do You Want It.” 
DISCLAIMER: I am not a doctor and you should NOT make any changes to your medication, diet or activity level without first consulting your doctor.  I do recommend conducting research yourself and prepare for the visit with your doctor with questions and information you deem important.  If you want to or are into endurance sports, strength training, etc. be sure your doctor is familiar with your sport and understands the demands, requirements, etc.
Plan of Action:
Visit my doctor and get a new blood panel taken during a fasting state (the results above were not taken in a fasting state and likely lead to elevated triglyceride levels.
Blood Work Request:
Lipid Pane - Total Cholesterol, HDL, LDL (total number and particle size) VIDL (triglycerides and particle size)
Glucose
Thyroid (TSH, free T3, free T4, TPO antibody, TG antibody)
Testosterone (free and PSA)
Vitamin D (25 OH D)
Vitamin B6, A, E and C levels
Inflammation markers (hs-CRP = high sensitivity C-reactive Protein)
I stated on 40 mg of Lipitor when I was NOT exercising or eating a “better” diet and once my panel results come back, will ask to go off Lipitor for 90-120 days to see what effects diet and exercise have on my cholesterol. With that information I will then determine if I want to continue statin use.
Target 100-125 grams of protein per day
Discontinue use of any oils with the exception of Extra Virgin Olive Oil and Coconut Oil or grass fed, organic butter in moderation.
Add more healthy fats (EVOO, Coconut Oil, Coconut Milk, Low Fat Cottage Cheese, avocados, nuts, seeds) to my diet. I will still limit dairy intake due to the health and cancer concerns of the protein casein found in daily.
Add back organic, farm raised eggs to my diet – no more than one a day
Add back organic, lean protein on occasion in the form of white chicken or turkey meat, grass fed organic beef and pork along with cold water fish that is wild caught so it will have consumed its natural diet and not grain fed.
Coconut and Almond milk– Unsweetened
Eliminate refined sugar and high fructose corn syrup
Cut back dramatically on carbs, especially refined carbs and add in more vegetables with a focus on dark, green vegetables
Limit alcohol consumption to weekends
Add in more dark chocolate – 85%+ cacao – YUM (dipped in Mays homemade, sugar free cayenne peanut butter is hard to resist)
Lower salt consumption
Add 20 mg of CoQ10 supplement daily
Consume more homemade peanut butter (May’s peanut butter is totally awesome) free of sugar and limited addition of EVOO as needed.
Add more Quinoa to our diet
Continue strenuous exercise in my training for IRONMAN Coeur D’ Alene and IRONMAN 70.3 in Raleigh in June and REV3 Knoxville in May.
Desired Outcomes and Goals:
Triglyceride level half that of HDL
Total cholesterol to HDL ratio of 3:1 or lower
LDL 130 or lower with large particle size and large particle size for HDL
Reduce inflammation
Increase energy
Reduce injuries and increase recovery time
Thanks for letting me share my thoughts, concerns, ideas and plans with you. Although I feel good, your health is nothing you should ever take for granted and the best medicine is preventative, not treating symptoms after an issue arises.  I am always looking for continuous improvement and I am excited to begin this journey and have you join me. 

Friday, December 6, 2013

Food To Be Fit For Life

Sports Nutritionist Tips
For many individuals, creating and committing to a healthy diet can be extremely difficult. While working out or training can be tough enough, the power of food and the pervasive nature of marketing and advertising process food can be overwhelming.  Couple all that powerful marketing with the role food plays in social and work functions, it’s easy to see why maintaining a healthy diet that is conducive to exercise and endurance performance can be a challenge.
Nancy Clark, RD and sports nutritionist breaks down some misconceptions most people have about food and provides some practical and easy to follow fundamentals.
It’s All About The Meal
For the active athlete, especially the endurance athlete, meals should be about good, healthy carbs with protein as an accompaniment. In today’s maze of diet trends, many times protein becomes the lead with carbs being seen as completely bad.  Simple carbs should be limited but complex carbs from fruits, vegetables and whole grains are not only good but necessary for strenuous training and racing.
“Every meal should consist of at least three different kinds of fruits and vegetables, lean protein, grains and calcium-rich foods,” Says Clark.  Examples include:
                Oatmeal (steel cut), nuts, raisins
                Wholegrain pita, humus and veggies
Burning Fat, Not Muscle
While an active person may be hungry for large amounts of protein, Clark says that little portions of protein feed, build and repair muscles.  Many people receive far more protein than is required, even for active adults.  Excess protein will be turned into fat unless you stay active.  Burning fat is good but if your goal is to lose weight, you must still place your body into a calorie deficit.  For endurance athletes, your body will perform better and recover more quickly when fueled with complex carbohydrates and not excess protein.
Food For Training
Whatever your sport, Clark says an integral part of any training program is a two-part system of complex carbs and lean protein.  The body needs carbs for fuel and protein to help build and repair muscles.  Choosing quality calories is the key to performance enhancement.
 Additionally, protein can come from not only lean cuts of meat and fish, but vegetables are a viable source of protein that also provide rich, complex carbohydrates and are much easier to digest.  I find my performance improves and my recovery times are much quicker when I get my protein from plants versus animal sources.
When shopping for food, here are a couple of recommendations.  First, never shop when you are hungry as you are likely to make unhealthy impulse purchases. Second, with a few exceptions like oatmeal and dried beans, the majority of your shopping should be done on the outer areas of the grocer story, staying away from the middle isles where the highly processed food is located. Finally, create a daily meal plan and stick to the plan. Eating clean is very rewarding and you will also be rewarded with a healthier body that performs at a higher level.
HERE’S TO BEING FIT FOR LIFE!
Chris is a Certified Personal Trainer and exercise and endurance enthusiast.  He competes yearly in numerous running races, marathons, ultra marathons, triathlons and other endurance events. 

Friday, November 29, 2013

Where to Run

Fall is here and you are excited to run in the cooler temperatures.  Summer can get hot and temperatures more conducive to baking a cake than running make it difficult to run outdoors.  Excited to begin your running journey outside, you wake up to find the temperature in the 40’s a gusty wind and enough rain to make you consider building an ark. You have a decision to make. Run outdoors and brave the elements, hit the treadmill or enjoy another cup of coffee, curl up in a warm blanket and catch up on The Walking Dead.

Treadmills can ignite serious debate among runners questioning if they are a legitimate training tool for those that are or want to become serious about running. According to Jenny Hadfield, co-author of “Running for Mortals” and columnist for Runner’s World Blog Ask Coach Jenney, “you can still get a great workout on the treadmill,” she says.  Although you can get a good cardio workout on the treadmill, there are some differences to running outdoors.

When running outdoors, you utilize different muscle groups than you do on the treadmill. Outdoors you must utilize your quads, hamstrings and calves to continually propel yourself forward.  Add wind, hills and the constant resistance of the road you have to work harder to propel yourself than you do on a treadmill. The natural mechanics of a treadmill are to propel you forward. Thus, you are able to run faster but you are working more on your balance than on propulsion.

To compensate for this lack of resistance, many people set the treadmill on an aggressive incline which can be problematic.  This is unrealistic as unless you are running up Mt. Evans in Colorado, you won’t encounter this when running outdoors. An aggressive incline will alter your stride and over strain you muscles, in particular your quads and hamstrings which can lead to injury. If you are looking for more resistance, set your incline to 2-5% range and if possible have the incline change during your run to more closely simulate outdoor running.

One of the benefits of running outdoors is you can lose yourself in thought and let the miles pass by without having to focus on what you are doing. Running on a treadmill can be extremely boring and requires continual concentration so you don’t misstep and be launched off the back of the machine like a jet fighter off an aircraft carrier.  Trust me this happens and ALWAYS at the gym in front of your fellow exercisers.

Running indoors also requires proper ventilation and fluid replacement. Proper ventilation and fluid intake are critical. Consuming fluids on a treadmill is an art and takes practice so you don’t have a one person accident (see above).

While running outdoors in the elements can be tough, indoor running requires either a trip to the gym or a substantial investment on a quality treadmill for home. Additionally, if you shell out the bucks for a treadmill, it will take up valuable space in your home.

So what’s the verdict?  While treadmill running can provide a good workout, my personal preference is to run outdoors whenever possible. If you are looking for fitness only, then treadmill running may be your ticket. If you are more serious or want to do some races and improve your speed, my preference is running outdoors.  Having done both I find running outdoors provides an overall better workout and gives me experience in the same conditions I will face on race day. 

                                                                                                                                                                                                            
Here is to being fit for a lifetime!

Chris is a Certified Personal Trainer, exercise and endurance enthusiast.  He competes yearly in numerous running races, marathons, ultra marathons, triathlons and other endurance events. 

Sunday, November 24, 2013

At The Heart of it All – Crushing the Mechanical Bull of Medicine

“Chris, you are going to die…….if you don’t make some serious changes to your life immediately!”  Those were the words that my doctor said to me four years ago with conviction, confidence and the assurance a grade school teach has when proudly proclaiming there will be a test tomorrow.  He looked me straight in the eye and putting his arm on my shoulder also said, “I don’t want that to happen on my watch and you can avoid this but it is up to you!”
Well what do you say to that?  What can you say to that? “Oh he is just getting paid to say that” or “it’s not really that bad, after all I am only 43, how can that be?” For those that know me, I lost my dad to a massive and sudden heart attack when I was 16 and he was 47.  One minute we were laughing and talking and the next minute my life was changed forever.
I had been thinking about my journey in life and that significant mile marker “47” was fast approaching and I could not help but wonder what it had in store for me. Would I out live my father? Would we have an unceremonious tie or would I fall short? Two of the three options were not attractive and the pressure was mounting.
While many may think that this was an easy decision to make, it was and it was not.  I had heard these words before but had safely secured them to a place in the back of my mind for processing for a later date – translation – put them on the shelf and forget about them but this time was different.
I had a wonderful wife whom I loved very much and were trying to get pregnant and I could not help but think why God would give us a precious life to take care of when I was blatantly not taking care of my own?  Ouch!  Sometimes God nudges me; sometimes he gives me a gentle pat on the back then other times he hits me over the head with a Louisville Slugger to get my attention.  This time he used the bat and it worked.
I won’t bore you with the details here on my getting into shape as I have shared that already (you can read that story here in my post “Sometimes Life Has a Strange Way of Getting Your Attention”) but I do want to share with you a rewarding experience that has come out of this process.  I share this with you because if I can do this, you can to. It boils down to How Bad Do You Want It and trusting God to guide you in the process.

Having made the decision to reclaim my health, the first order of business was to do a stress test to see what type of shape I was in and to see if there were any issues with blood flow or oxygen getting to my heart.  If you are not familiar with this process, they hook you up to an EKG and put you on a treadmill that starts at a 4% incline and increases in speed and incline every four minutes to put stress on your heart. Sounds easy enough, right? Ha!

That first test was horrible. I lasted just short of six minutes as was gasping and standing in a puddle of my own sweat. Ouch, what a horrible experience. That “wild bull” (Ok it was a treadmill but it felt like a wild animal) had bucked me off no sooner than I had gotten on it. We both came to the rodeo, one left a champion and I left defeated and realizing how much work I had ahead of me. “Well Chris” I thought, “You got yourself into this mess, what are you going to do about it?  Looks like you have some work to do.” I did not relish a second date with that contraption but first things first, I wanted those test results.

Sitting in the lobby area collecting myself, it was time to see my doctor.  It’s funny how people are. If you know someone well enough you can read their facial and body expressions and know the entire story or at least the Cliff Notes version without them saying a word. Before Dr. Jani said a word I knew what he was going to say.
“Chris, you have a couple abnormalities that are concerning. I am ordering a Nuclear Stress Test to get a better look at your heart!”  Not surprised but not what I wanted to hear, I asked “Will I have to get on that treadmill again?”  Really, I was just told I could have issues with my heart, self-imposed issues no less and all I could ask was if I had to get on the treadmill again?”  No points awarded for good questioning and the answer was “Yes.”  Just great!  Not only did I get my butt kicked by that “wild bull” just moments ago, I had to get ready to saddle up and do it again in a week. I could almost see it grinning at me in attack mode, like a lion getting ready to devour a helpless rodent.  “So a nuclear stress test” I managed to mutter, “what does that entail?”  Congratulations Chris at least you managed to ask a question with some substance.  He went on to explain…….
A nuclear stress test measures blood flow to your heart muscle both at rest and during stress on the heart. It's performed similarly to a routine exercise stress test, but provides images that can show areas of low blood flow through the heart and areas of damaged heart muscle.
A nuclear stress test usually involves taking two sets of images of your heart — one set during an exercise stress test while you're exercising on a treadmill or stationary bike and another set while you're at rest. A nuclear stress test is used to gather information about how well your heart works during physical activity and at rest.
You may be given a nuclear stress test if your doctor suspects you have coronary artery disease or another heart problem, or if an exercise stress test alone wasn't enough to pinpoint the cause of symptoms such as chest pain or shortness of breath. A nuclear stress test may also be recommended in order to guide your treatment if you've already been diagnosed with a heart condition.
Well there you have it. One week later and I was back on the “wild bull” and this time I was also getting nuclear medicine shot into my veins so they could see the images of my heart.  I looked like a Borg from Star Trek and the medicine felt like freezing lava entering my system. No need for Christmas lights this year, I could just stand in the window with a star on top of my head and May could hang the decorations from my body as I was sure to glow from this injection.
The treadmill still won in convincing fashion but I managed to eke out a couple more seconds so as not to be an utter failure and to preserve some self-esteem. I liken it to scoring a touchdown with two minutes to go in the game when you are behind 70-0. The score does absolutely nothing but keep you from getting shut out. Oh well, I had to take what I could get and at least a few seconds was progress in the right direction.
I was blessed that the nuclear test results were normal and there was no MAJOR issues but I needed a course correction quickly.  “You are fortunate” my doctor said.  “But it’s up to you what you will do going forward.”  Enter the formulation of the title for my blog….”How Bad Do You Want It?”
Those two tests did the trick and with the Lord’s help, I set my life on a course to improve my health.  I lost nearly 40 pounds, took up running, biking and swimming and improved my eating with a more recent improvement by adopting a mostly plan based diet.  I had completed three marathons, countless other races and two half IRONMAN triathlons this past year. I felt great and all was well, or was it?
I turned 47 on March 8 and I couldn’t help but wonder if the Grim Reaper was on my tail.  He can be sneaky and I had done all I could to prevent him from making an early appearance.  My father passed away on November 15 and the closer that date came, the more anxious I got. I know that is ridiculous but it was my reality and I had to live with it.
So what is the purpose of this post? Well I’m glad you asked.  A strange chain of events began that would get my attention. In September a good friend of mine checked himself into the ER with severe chest pain.  Not yet 50, this scared both of us.  Thankfully it did not appear to be anything other than stress but this got me looking ever more closely for the Grimm Reaper. 
Fast forward to October and another good friend of mine in his early 50’s who is active, lean, eats well and an is good physical shape was not feeling well for a couple of weeks as he had been tired and lacked energy. But things got worse. As were talked on day he was complaining of a tingling in his chest and left arm that was radiating up his neck. DANGER WILL ROBINSON.  After much pleading he went to the ER and they discovered he had one artery with 80% blockage!  How can this be?  By God’s grace he is fine and on the road to recovery. Once again I turned my sights on the Grim Reaper, peeking around every corner more carefully than ever before.
Now it’s November 13th and I am on my way to New York City for a business meeting and I brought along the most recent issue of Marathon and Beyond to read on the plane.  Hal Higdon had written an article on the life of Jim Fixx. For those that don’t know Jim Fixx is credited with starting or at a minimum, helping launch the running boom in the 70’s. Having been a smoker and overweight, Fixx took up running and became somewhat of a celebrity.  He wrote the classic book “The Complete Book of Running” and by all accounts was in excellent shaping, having run several sub three hour marathons.  He died of a heart attack at age 52 while on a run. (Fixx had several symptoms of cardiac distress that he ignored and did not have a diet conducive to heart health and he never did a stress test)

How can that be?  Now my concern for my own state of being was escalating. Two friends of mine had cardiac issues, I just read an article about a talented runner in Fixx that died of a heart attack at age 52 and it was only two days to the anniversary of my dad’s passing from the same affliction. Add in I was recovering from a bad virus and still didn’t feel well and had all the makings for one big helping of “Freak out Stew!” Sitting in my hotel room I was scared to answer the door as it may be the Grimm Reaper posing as a house keeper and I was not ready to meet him just yet.
That’s it. I had to do another stress test for my own piece of mind. I called my doctor’s office and asked for an appointment for a stress test.  The young lady put me on hold and next thing I know I have my doctor on the phone.  That is one of many reasons I LOVE Dr. Jani. He is always there to talk when I need him. 
“Chris, he said, you don’t need a stress test. You run, you take your meds, your blood work is good and you eat right.”  “I know that Dr. Jani” I said, “But dad died at 47 and that anniversary is in two days, I have two good friends that are healthy that had cardiac issues and Jim Fixx just scared me to no end.  I need this test to make sure I am OK and for peace of mind.  I have a beautiful wife and a precious two year old, please do this for me. “Ok, you got it.” He said. We will see you at 8:00 am on Wednesday in my office.” Ok, test is on the books, I just needed to avoid the old Reaper until then.

This time I was excited for the rematch with the treadmill.  When David, the Exercise Physiologist who was going to administer the test called me back to the lab, he looked at me and asked “What are you doing here?”  I had to chuckle and proceeded to tell him the story outlined above and he just smiled and said “OK, let’s get started.”
David is an awesome exercise physiologist and was a pleasure to work with. He truly cares about his patients, has a great attitude, is very informative and was a lot of fun to talk with.   Never shy to carry on a conversation about exercise, I learned that David and I had a lot in common with our beliefs on exercise, health, diet and life in general. He is a graduate of the University of South Carolina and had done his graduate work in Texas.
All hooked up to the EKG, it was time to get on the treadmill.  Although the room was not much larger than a small office, I pictured in my mind Rocky entering the Ring for the first time against Apollo Creed. There was music, screaming fans and the adrenaline was pumping.  This was my shot at redemption and I was ready to give this treadmill a beating.
Dave explained the test and that my MAX heart rate for a man my age was 173 and we wanted, if we could, to get my heart rate to 85% of max or in the range of 145. “No sweat” I said, “this may take a while.”  He explained the test would start on a 4% incline and would increase in speed and incline every three minutes. “Let’s get after it” I said.  In my mind I could hear the bell ring and just like that the rematch was on, Treadmill vs. Vokaty, round three! 
David was very encouraging during my test. He kept asking how I was doing and that my test results were amazingly good.  He said I was making his day as he usually doesn’t get to see many healthy people take these tests….and the timer kept running. Four years ago I was not able to make six minutes, this day I was had not even broken a sweat at six minutes and my heart rate was barely above 90. Take that treadmill. I could hear the machine groan as we moved on to level 3, territory it didn’t see very often. “Now who is getting tired” I muttered to my nemesis. “I hope you brought your “A” game today because you are going to need it!”
The longer I went the more encouraging David got and the more excited we both became.  Level 3, level 4, level 5, level 6…..17% inclined and running 7:00 minute miles.  “Are you up for level  7?” David asked.  “Bring it” I said, “let’s do this.”  I could hear the treadmill groan as we moved to a 20% gradient and sub 7:00 minute miles.  I was sweating profusely and pounding out the minutes.  The test was clean and I kept on pushing, 173, 174, 175, my heart rate kept climbing and maxed out at 178.
“What is the next level like?” I managed to ask David. “There isn’t a next level, this is it!”  WOW I had put a beat down on the champion.   How about that!  Yes I was tired, but it was my arms that were the most tired as I had to hang on to keep from being launched off the back of this beast while running up hill at a 20% incline.  I came, I ran, I conquered the test! Ladies and gentlemen there is a new world champion!

As David slowed the machine and I cooled down I think he was as excited as I was. He raved about my test results, my VO2 max and that this made his day actually administering a test to a healthy person. It’s what he said next that made me grin from ear to hear.  “Chris” he said, “while doing my graduate work in Texas one of my professors referred to this test (treadmill) as the “Mechanical Bull” of medicine.”  “You my friend have just CRUSHED the mechanical bull of medicine.  Congratulations.”  “There is absolutely NOTHING preventing blood or oxygen from getting to your hear. Whatever you are doing, keep it up!”
 At that point I thanked God silently for these results and I also thanked him for the “country club” hill.  So adequately named, the country club hill is a steep hill that starts at the country club and has three gradients and is ALWAYS the last mile of all my runs, short or long. I have a love hate relationship with that hill. I HATE it during training but LOVE it when in competition and today I LOVED it as it plays a big role in improving my health. It’s like a mean drill instructor that you can’t stand but admire at the same time. 
At that moment I knew that the Grimm Reaper was nowhere to be found. While I know that there are no guarantees in life, I had some peace of mind that I was on the right track. My test results had improved from the last time; I felt great and was controlling the things that I could control. It goes to show that with the Lord’s help, proper diet and exercise you can reverse your health.  It all boils down to commitment and How Bad Do You Want It. Is it easy? Of course not but nothing good in this world comes easy. If there is no price to pay, then there is no worth. Our salvation is the only free gift but the rest we have to work for. 
Before I could leave David needed to share the test results with Dr. Jani.  We walked to a reception area and he went over to talk to my doctor. I could see them both and hear them so being naturally curious, I just had to eavesdrop, after all it was my test so I felt inclined to listen in.
“You didn’t find anything wrong with him, did you David” doctor Jani stated.  “No, Chris in incredible shape” David said. “Let me look at the test” Dr. Jain asked.  As he looked at the test results, Dr. Jani asked David “He stayed on the treadmill how long?  “20 minutes “David said. “I have never seen anyone do that in all my years of medicine.”  David said “I know, this was a lot of fun. In fact, I have worked with many of the athletes at USC and this is one of the top five tests I have ever seen!”
Dr. Jani walked over to me and gave me a big hug and told me he was proud of me. I am sure it is rewarding for doctors and technicians to see their patients succeed and turn their health around. He told me to keep running, keep eating plants and to enjoy life.
I was ecstatic and relieved.  In four years I went from being in horrible shape and on the road to cardiac ruin to having reversed my health and giving a great big TKO to the Electronic Bull of medicine.  I am not na├»ve enough to think that countless others have had much better results and are in much better shape than me, but for me this was huge. 
I will never compete for a podium spot in a marathon or a 70.3 or 140.6 triathlon but there will be more people behind me than ahead of me when I finish. The sheer fact that I can compete, compete against myself and finish is what is important. I decided to reclaim my life and health and to enjoy the process.



As I left my Dr. Jani’s office I was relieved, happy, thankful and proud. I was experiencing a similar feeling to what I had felt when completing my first half IRONMAN. I set goals for major changes and with God’s help I had done it.  I share it with you because if I can do it, anyone can.  Give it to God and think about How Bad Do You Want It.  The commitment is the hardest part; enjoy the journey and the rewards that follow.