Saturday, November 28, 2015

Mimi Winsberg, M.D.

Self Tracking with the Basis Watch

One of the challenges a physician faces when evaluating a patient is making sense of a lot of information within a limited time. The same is true for a coach monitoring an athlete’s progress. Physicians and coaches are now leveraging the ability of patients and athletes to collect their own data. Self tracking has become an important trend for monitoring health and fitness, as people take charge of their own data collection and become mindful of their daily patterns and habits. A number of wearable devices have come on the market to aid in self tracking including the new Basis B1 watch.

Going Gluten-Free

Much attention has been given in the press lately to the gluten-free diet. Thousands of gluten free products have hit the market, and many athletes are asking themselves if going gluten-free could offer a performance edge. A number of professional triathletes have eschewed gluten, and some of the pro cycling teams eat gluten-free when racing.

Going Old School

Having just returned from a week of training and racing on the Big Island, I thought I’d share my experience of racing after a week of John Newsom’s Kona Epic Camp.

In fairness, the camp was titled Kona Epic Camp Lite, as it would not involve the insane volume that Epic Camp is known for, and we were not subject to a points system or any other internal competitions within the camp. The idea was to go old school: get some big training done in the famous Hawaii lava fields, and then tackle the Hawaii 70.3 on the last day of the camp. I had no idea whether it would work, but as I boarded the plane to Kona I found myself hoping the camp would be more “Lite” than “Epic.”

Breaking Through is Hard to Do

I’ve been reading quite a bit recently on the subject of creativity, as it seems to be vogue in the literature of business, education and even neuroscience. It’s a subject that has interested me for some time and our research group at Stanford was looking at measures of enhanced creativity in patients with bipolar (manic-depressive) disease 15 years ago.

There is no question that breakthrough solutions (that is to say bursts of creativity) develop from at least two separate strategies.

Coaching Styles

Years ago on a visit to Paris, desperate for some exercise, I accompanied my mother to her Parisian health club. The club was set in an old stone building, and a well-coiffed instructor led me into an exercise studio with exposed brick walls and rich wooden floors. Accustomed to American fitness classes that are sprinkled liberally with chirps of “good job” and “nice work,” I was taken aback when the French instructor’s first comment to the group was “Vous etes nules!” -- literally informing us that we were all zeros. The feedback just got more critical from there.

Depression and the Endurance Athlete

Last month’s column looked at some of the potentially common biologic pathways in depression and athletic underperformance syndrome. To follow up on this, many athletes expressed interest in understanding more about depression; specifically how to recognize it, and what can be done if you observe symptoms in yourself or a friend.

Depression and Underperformance Syndrome: Is There a Common Denominator?

In recent psychiatric news, a new blood test may accurately determine whether a person is depressed.

Interestingly, some of the diagnostic markers for depression come from the same domains that are affected with underperformance syndrome.

Everyone Has Their Limits

This month Endurance Corner is addressing limiters, with the idea that there may be a key skill or weakness that is holding back your best performance. We each vary in our specific physical limiters, but the most common limitation we all face in performance may be the ability to focus for extended periods of time. As Roy Baumeister and John Tierney discuss in their enlightening new book "Willpower: Discovering the Greatest Human Strength", the energy to exert self-control, one of the most valuable human traits, is easily exhausted.

Pulling Rabbits Out of a Hat

by Mimi Winsberg, M.D.

When I put together an ambitious fall racing schedule, I knew it would be met with some skepticism. I was careful not to share it all at once. Some things are better digested in bite size pieces.

In short I had decided to race the Vegas 70.3 world champs, then Kona, followed by ITU long course world championships and Ironman Arizona two weeks after that. “Why are you doing this?” my husband asked. He was the only one who had been given full access to the schedule. “Because I can,” I answered. He looked at me quizzically, shook his head and went back to his reading material. We have learned not to get in the way of each other’s goals.

He shouldn’t have been surprised, as he’s been my primary role model for pulling rabbits out of a hat. He has taught me not to listen to naysayers, and that if you keep your cool, things usually work out. “It might be an ugly little rabbit,” he will say under pressure, “but I’ll just have to pull a rabbit out of a hat.”

In trying to set goals or standards for ourselves, does it make sense to set them very high, thus risking failure and potential disappointment, or to set them lower, making them achievable, but not necessarily requiring us to perform to our potential?

According to Harvard Business School Professor Max Brazerman and his colleague Ann Tenbrunsel, a professor of business ethics at Notre Dame, the authors of “Blind Spots” : “The answer is yes, and yes. You need to set both a floor and a ceiling.”

Performance tends to oscillate around standards. By setting only low standards, you remove the motivation to do any better. By setting only high standards, too much internal tension is generated from the inability to achieve them. Setting both allows the mind to take advantage of both the minimum standard and the high expectations without succumbing to each of their negative effects.

Preoccupation and Passion

If a naive observer were to land in Kona during the Ironman world championships, he or she might get the impression of a hard bodied version of a Trekkie convention. There is something vaguely cult-like about the “ironman family”, and it’s no surprise that the IM corporation’s marketing department seems to take some not-so-subtle cues from the church.

I was recently discussing with a patient the distinction between preoccupation and passion. He raised concerns over what he feared was an obsessional focus on a particular pursuit. Are there any triathletes that can relate?


It’s world-championship season, and no matter what kind of volume we have put in over the summer, no matter how consistent our training has been, much of our success in the final big A race will depend on the execution of our endgame. How is your endgame?

The Power of Will

For our 25th reunion, my alma mater sent out a survey to members of the class, asking about various aspects of their lives, work, health and habits. One question was the following:

    I need more (pick one only):
  • love
  • money
  • recognition
  • sleep
  • responsibility
  • sex
  • time
  • will power

A good friend who is living the dream (or his dream, anyway) pointed out that all he really wanted more of was will power. Ah, the ever elusive sense of will power and self control... if only there were a way to summon up more mental discipline. This month EC focuses on what it takes to be a fast age grouper, and aside from hard work (which seems obvious), it appears that of the commodities listed above, will power trumps all.

Busyness and Mindfulness

People wear busyness as a badge of honor. Ask most Bay Area parents how they are, and they often reply “crazy busy.” Every profile I’ve ever read of top age groupers emphasizes the athlete’s time management skills: how they get up at 5 a.m. (or 4 a.m. or 3 a.m.) to train, how they are great at multi-tasking, and how they juggle a busy schedule of child rearing, work and training. It may well be true (though somehow everyone finds time to tweet). But, when it comes to going fast as an age-grouper, busy may not always be better.

Married with Triathlon

We all know marriage has it’s stress points. There is the dual career marriage, marriage with toddlers, and the more recently documented phenomena of divorce by triathlon, as exposed in the February 1, 2011, Wall Street Journal piece entitled, “A Workout Ate My Marriage.”

Gordo asked me to write a piece on managing oneself as an endurance athlete in a marriage to a non-training spouse. First, a disclaimer: This article intends to share some wisdom from a leading marriage expert, and should not be construed to imply that I have successfully minimized the impact of triathlon on my marriage. Any resemblance to persons, living or dead, is purely coincidental.

Competition and Sportsmanship

Sports and morality have an intertwined relationship. Many of us expose our children to organized sports at least in part to promote social behavior and good sportsmanship. Athletics are seen as a vehicle for moral development that encourages and rewards qualities such as courage, honesty, tenacity, self-control and respect.

Yet displays of unsportsmanlike behavior are apparent throughout competition, and there is ongoing debate about whether sports participation actually leads to increased social development. Even among adult age group athletes, where there is arguably little at stake, we still witness immature and destructive competitive behavior at times -- between social peers no less. So what gives? Why are some athletes able to be good sports? Why is winning (or losing) a bigger deal for others?

Gut Feelings

The term “gut feeling” originates from the notion that the enteric nervous system acts as a primitive brain and that our guts are closely tied to our brains. The neurotransmitters that regulate our brain function are also active in the gut. Given this physiological link, it’s no surprise that we often feel emotion in our gut.  

Many of us have gut reactions to racing. At least 50% of endurance athletes have experienced gastrointestinal (GI) distress during races. But, just as our muscles adapt to training, so can we train our guts.

The Psychology of the Injured Athlete

Injury is a subject most athletes would rather avoid. While it’s easy to take our health for granted, many of us have faced our own injuries, or those of a friend.

Physical pain is awful, but the psychological sense of loss associated with injury can be even worse. There is much to learn about the psychology of injury, both to help others through setbacks, and also to prepare in case the unthinkable happens.

Are Energy Drinks Energizing?

When the news of Alberto Contador’s doping scandal hit the media last fall, my 8 year-old daughter said with complete confidence and utter solemness: “I think he must have taken ‘5-Hour Energy’.” It was funny, but it also drove home advertising’s pervasive influence on our culture.

What about the notion of energy from a bottle? Energy drink producers advertise that their beverages “boost energy,” and they usually do not emphasize the energy in the form of the sugar they contain, but instead emphasize a variety of stimulants, vitamins and herbal supplements.

The Grey Zone

Much has been written about the dreaded grey zone of training. The “grey zone” is usually defined as the training zone that falls between aerobic endurance and intensity work. The zone is considered grey because it is a training intensity that is too hard for long endurance sessions or proper recovery, but not hard enough to trigger specific adaptions to higher intensity intervals.

There may, however, be a role for grey zone training this time of year.

Setting Up a Satisfying Season

In this month of New Year’s resolutions, conversations turn towards the question: “So, what’s in store for this season?” A new year is a clean slate, full of promise, ready to be inscribed with training blocks, events, and we hope, new personal records.

In considering how to mark up that slate so that it will deliver your most satisfying season, I’d like to explore some principles behind the psychology of satisfaction. I hope that reflecting on these ideas will help with the approach to your season plan.

Snow Blindness

by Mimi Winsberg, M.D.

Dealing with winter isn’t just about holing up in the basement with your two trusty foul-weather friends, the indoor trainer and the treadmill. In a quest for race specific fitness, triathletes can overlook the benefits of snow as a training venue. Snow blindness is such a common multisport illness, that I thought I would write a piece in praise of thin white lines -- that is to say, tracks in the snow.

Snow doesn’t tug at the hearts of most lava obsessed triathletes. Of all the weather systems, snow is the least celebrated and least likely to grace the pages of multisport magazines. But to me, triathlon is a jealous mistress, relentlessly demanding my time and efforts until winter brings a welcome respite and lets me reconnect with my first love, the snow.

I look forward to snow the way a small child anticipates Santa’s arrival. Having grown up in Canada, I probably learned to ski shortly before I could walk. Snowy winter mornings have always been a treat. With a new blanket of fresh snow, we like, as my son says, to “wake up early with the animals” and head out into the muted landscape. Fresh tracks in the white powder make you feel that the world is yours for the taking.

Over a decade ago I made the transition from downhill skiing to Telemark. With free-heel gear, you get the aerobic benefits of skinning up the mountain if you are in the backcountry, and descending becomes a series of lunges that bolster quad and glute strength, while using hip rotation and core strength for stability.

Lessons from a Season

Stepping back and taking the bird’s eye view of a season offers a perspective that is not always available mid-season. In the tunnel of a build, the worm’s eye view predominates as we plow through the workouts, buried in fatigue, with a myopic focus on the next key session or event.

It’s possible to accumulate a lot of experience without stepping back to learn from it. Here are a few lessons from other fields to help analyze the big picture of a season.

Female Athlete Triad

by Mimi Winsberg, M.D.

Since October is body composition month, I thought I would take the opportunity to discuss an important triad of disorders particular to female athletes. This triad is most often seen in sports that emphasize leanness, or where low body fat offers an advantage. Having just returned from Hawaii where the typical athlete looked to be about 5% body fat, I can safely say that triathlon falls in this camp.

Grace Under Pressure - Part II: Applications For Life

by Mimi Winsberg, M.D.

In part one, we looked at how engagement and focused attention fosters a graceful, confident and winning mindset in sport. How do these skills more broadly apply to success in life?

Controlling one’s attention and managing mental energy is not only a successful race strategy, but also fundamental to taking charge of one’s life and experience. The explorer Ernest Shackleton said “Life to me is the greatest of all games... And even to win the game is not the chief end. The chief end is to win it honorably and splendidly.” It’s how you play the game, and your approach that matter most.

Grace Under Pressure

by Mimi Winsberg, M.D.

When October gets underway, all eyes in elite triathlon circles turn to the big island as athletes make their annual pilgrimage to the Mecca. Hawaii’s lava fields will test an athlete’s physical limits, but also test their mettle. At a race where intense preparation and superior fitness are almost a given, performance differences may boil down to mental fortitude, courage and plain old guts.

Showing Your Work: The Power of Numbers

by Mimi Winsberg, M.D.

Showing your work was routine in high school and college math classes, and usually necessary for full credit. It always seemed like an extra requirement. In the real world isn’t getting the right answer all that matters?

If you think you have graduated from the days of showing your work then think again. Welcome to triathlon training: the world of workout logs, power files, training stress scores, intensity factors, calories consumed and kilojoules burned.

Baby's First Triathlon

by Mimi Winsberg, M.D.

Pumping milk in the front seat of her car is not Tina Pretre’s typical pre-race routine. But as the new mom prepared to dive into the 58-degree San Francisco Bay waters to race in an olympic distance triathlon, she found herself doing exactly that. To her surprise, she was not alone. A competitor next to her was also breastfeeding her baby.

Despite the unusual warm-up, Pretre went on to place fourth in her age group. Her daughter was among the spectators at the finish line. She was eight weeks old.

Pre-Race Rituals and Superstitions

by Mimi Winsberg, M.D.

I often joke that the endurance sports community is rife with obsessive-compulsive disorder (OCD). OCD is defined as an anxiety disorder characterized by recurrent intrusive thoughts and repetitive behaviors and rituals aimed at reducing anxiety.

Nowhere is this more manifest than in athletes' pre-race rituals and superstitions. As an important race looms, triathletes find themselves needing to eat specific foods, wear lucky clothes, look for significance in their race number, groom in particular ways (shave, paint nails, braid hair), listen to certain music, and do ritualized pre-race workouts and warm-ups. Some athletes need to carry a family photo or lucky charm on race day.

A Window of Perspective: Making Sense in the Post-Race Period

by Mimi Winsberg, M.D.

After spending months preparing for our A-races with laser-like focus, we toe the line and give it our best effort. A great outcome can make for a big rush of excitement, and a less than desired outcome can leave us with regret or disappointment.

With successful results the euphoria might last hours or even days. But, regardless of outcome, there is a point when the post-race buzz fades and we are left wondering, “OK, now what?” In considering how our minds work, this is probably a pretty typical response.