Thursday 15 February 2018

Can one cigarette a day cause a heart attack or stroke?

Moderation is the key to long-term success, is a line I often use with my patients (and try and apply to my life too). However, there is one area, where moderation does not work, and that's for smoking. Most smokers accept that they have a problem, but are so addicted to the habit that, when I counsel them to quit, they will try and rationalize with me (and themselves) how a cigarette once in a while won’t hurt them. They also try to convince me that since they were smoking 15 cigarettes a day earlier, wouldn’t it be okay if they cut it down to five cigarettes a day. My answer to them is a well-rehearsed one, since I have said it a hundred times. I tell them, it’s like asking me whether it’s better to jump off the fifteenth floor of a building, or jump off the fifth floor! They usually get the message.

Last month, a study was published in the BMJ (British Medical Journal) which underscored this point. (Click here for study abstract). Researchers looked at studies from 1946 to 2015, and found that smoking one cigarette a day was associated with a 48% to 74%  increase in the risk of coronary heart disease (CHD) in men, a 57% to 119% increase in CHD risk for women, and a roughly 30% increase in the risk of stroke for both men and women.

The conclusions of the study, were:


Smoking only about one cigarette per day carries a risk of developing coronary heart disease and stroke much greater than expected: around half that for people who smoke 20 per day. No safe level of smoking exists for cardiovascular disease. Smokers should aim to quit instead of cutting down to significantly reduce their risk of these two common major disorders.
Benefits of quitting:
It’s never too late to quit smoking. It does not matter how long you’ve been smoking, the moment you quit your risk starts dropping. In fact, the benefits start from the minute you extinguish your last cigarette. Within the first hour your heart rate and blood pressure drop and the carbon monoxide level in your blood returns to normal. Over time your risk for heart attack, stroke and cancer starts dropping steadily towards that of a non-smoker. Of course, this information should not be used by you as a license to continue smoking with the thought that you will give it up one day in the future and recover all of your lost health. Remember, once there is build-up of plaque in your arteries, it can lead to a heart attack any time it ruptures. Smoking is one of the key factors that can precipitate plaque rupture, which is why even one cigarette can be harmful in the setting of blockages. It’s similar to standing on the edge of a cliff. Even a slight push may be enough to topple you over; in the same way, one cigarette may be the final straw that broke the camel’s back (no, not the cigarette brand, Camel).

Last para excerpted from my book, The Heart Truth 

Thursday 25 January 2018

HOW TO RUN A MARATHON IN LESS THAN 3 HOURS AND 40 MIN (3:40)

Let me begin with two disclaimers: I ran the 2018 Tata Mumbai Marathon on Jan 21, in 3:40:01, which is 2 seconds above the sub 3:40, in the title. Secondly, the title is worded in this manner, since it’s a ‘search term’, often typed into Google, and allows people to find articles, such as this. By no means, do I purport to be a guru of guiding people below specific timing goals, after having done it only once in my life (thus far…).

In January 2017, I completed the Mumbai Marathon in 3:54 hours, clocking the exact same time as I had done the previous year, and was quite disappointed. By itself the time was respectable, but I wasn’t elated, since my training was in tune with a better run, and I was injury-free. After the ritual download of my Garmin data, I noticed a strange pattern in both runs (2016 and 2017)- there was a dramatic drop in pace, post 32 km (20 miles). It didn’t need me to look at data to figure that out, since I had clearly suffered for the last 10 k on both runs, but what surprised me was the extent of the drop. In both instances, I was cruising along at an average pace of 5:15 min/km, till 32 km and then wham- the pace dropped by more than a minute per km after that. I’m embarrassed to say, that the obvious, didn’t strike me, which is that I’d hit the proverbial wall. It needed my friend Daniel Vaz, who’s an experienced running coach, to point it out to me.

After the 2017 run, I decided to take an off-season from running (which sounds unnecessarily grand, considering I didn’t have too much of a season to begin with), which extended till the end of August. I knew I had 4.5 months before the next marathon, and decided to go in with a better plan than the previous years, which would mostly centre around not bonking (a more colourful term for ‘hitting the wall’), in the last 10 km. I’m not going to bore you with the weekly mileage details, but want to highlight the key points, which I felt worked for me.



Finish line picture- at the 2017 Mumbai Marathon - with my daughter

1.       Make a plan and stick to it


I know that this is stating the obvious, but it shocks me as to how many runners train for the marathon, without a plan. All marathon training plans, should be based on gradual progression of running volume, and should include the following 3 components.

a.       The long run-This is the foundation of the training program, and refers to distances ranging from 12-35 km, in gradual progression and is done at a comfortable pace, which is usually 30-60 seconds slower than race pace. I ran my long runs at 5:45 min/km, since my goal was to complete the marathon sub 3:45, a pace of 5:15 min/km.

b.      Interval training-running distances between 400-1600 m, at close to all-out pace helps increase your VO2 max (your aerobic power), and gets you used to sustaining a fast pace at the end of your long runs, even when the muscles and spirit are flagging. My goal was to run 400 m in 1 min 40 secs, and the longer intervals, at multiples of that.

c.       Easy runs- as the name implies, these are done at a relaxed pace, a couple of times a week, to build mileage in your legs.

In addition to these, there are tempo runs, race pace runs, and fartleks, but the idea is not to get into the nitty-gritty of the plan, but just to outline it.

2.       Nutrition matters


As described above, I have had two experiences, of what I consider ‘hitting the wall’, and they weren’t pleasant. The feeling I had at that time was one where my legs seemed fine, breathing seemed fine, but I just felt that there wasn’t any ‘energy’ in the body to move it forward. That made me go back to the drawing board and look at how much carbohydrate I needed to supplement during the run. Yes, I still use old fashioned carbs, since they are the primary source of energy during running. Over the past few years, theories abound on getting to teach your body to be a better fat oxidizer, since theoretically fat in the form of stored triglycerides is a limitless source of energy. On the other hand, stored glycogen is good for about 2,000 cal worth of exercise, roughly translating to 20 miles or 32 km. The bulk of the data at present, still supports the use of carbs as a ‘performance fuel’, and I’m sticking to it, till there is different evidence.
My strategy consisted of getting in about 45 gm of carbs per hour of running, divided between a sports drink and supplemental carbs in the form of ‘gummy sweets’, since I find the taste of gels hard to handle after the first two. As I approached the 32 km mark, I was psychologically getting prepared to get slammed, but luckily it didn’t happen, and I do believe that the nutrition and fuelling strategy worked.

3.       Think less about your ‘self’….to improve yourself


This is a quote I’ve taken from the book, Peak Performance, by Brad Stulberg and Steve Magness. I read the book after my last marathon and found it full of insight, not only to improve running performance, but also to lead a better life. I highly recommend it to everyone.  Let me explain what this headline meant in relation to my race. My long time running partner, Cyrus Mehta, was on song this year. He needed to run 3:40 to qualify for the Boston marathon, in his age category. Now, for those of you who are running nerds, you’ll know what a big deal a BQ (Boston qualifying) is. For the past few months, I’ve been convinced and trying to convince Cyrus, that this would be a cinch for him this year, given his level of preparation. I was as keen on him getting that time, as I was in getting a 3:45. As usual, Cy took off like a rocket and I didn’t see him till just before the sea link. On the link, I kept looking at my Garmin (well, unfortunately I keep looking at it all the time), and wanted to finish the first half in 1:48, so that Cy had a great springboard to achieve the BQ. The time I had set for myself, was actually 1:50. Cyrus is a much stronger runner than me, so when he overtook me at the 26 km mark, I didn’t make an attempt to keep up. Well, to cut a long story short, thanks to pacing him, I had enough time in the bank to complete it in 3:40, even though my goal was a full five minutes longer.



Post-script: runners tend to be obsessive about their ‘timing’ and I’m no different. I tried to behave myself this year and promised to look down less at my Garmin. And what was the result- I didn’t look at it for the last km, and finished two seconds over a sub-3:40 time. Yes, I know it sounds ridiculous, to even talk about it, considering I bettered my previous best by more than 14 mins, but hey, if you’ve read the whole article thus far, you’re probably in the same category. On that note, I’m signing off. Have a great running year, and wave if we cross paths on the road. 


Last km of this year's run



From L to R - Deepankar,Deepa (podium finisher), myself, Cyrus, Rox the Boss, and Ali