This year was supposed to be a big year of racing for me. I had planned on doing the Boston marathon in April, Ironman St. George in May, and add on possibly another Ironman in hopes of a Kona qualification. Plus, I had the 70.3 World Championships in New Zealand which I was super excited about.

But of course, Covid had other ideas. Before I knew it all of my races were cancelled and there looked to be no hope of any triathlons being able to go on at all. I deferred the 70.3 Worlds to next year in St. George, and Boston was completely cancelled. My Ironman in St. George was also cancelled, however we were given options to defer to races later in the year. 

Luckily, I chose to defer to Ironman Florida, the only race on the list that still made it to the start line. 

It was tough trying to train for a race that I was doubtful would ever even happen. I also came down with Covid in June and was sidelined from any meaningful training for about 4-6 weeks. The relentless fever that lasted a week and chest burning cough that lingered for months made running, biking, and swimming a tough prospect.

Fortunately, I slowly recovered and got back into the training mindset, always remaining hopeful that I would be able to compete in some sort of race before the year was over. As summer turned to fall and Ironman Florida still hadn’t been officially cancelled, that hope tuned to excitement. 

Finally, around September or October, I started receiving emails about the race and things got real. Panama City Beach was actually going to host both the full and half Ironman! With Covid protocols in place it was definitely going to be a different race, but I was just grateful to have the opportunity to actually compete this year. 


I arrived at Panama City Beach on Thursday, two days before the race. Ironman had us pick an hour time window to come register and pick up our packets to limit the crowds. Even though registration was outside, everything was set up with flags and markers on the ground to ensure social distancing. 

Volunteers were seated behind plexiglass and everything was pretty much done without any actual contact. Temperature checks were done when you entered different areas, everyone wore masks, and there were hand sanitizer stations set up all over the place. Everyone involved was super helpful and they really pulled out all the stops to make this as safe of an environment as they could during this strange Covid time.

After checking in  I dropped off my bike at the Playtri tent to have some mechanical issues worked on. The guys did an excellent job to get my bike race ready and I will definitely be using them again at future races. I wandered around the Ironman Store as I waited, then picked up my bike and headed to my hotel to get some rest.

I woke up Friday to get in a quick swim, bike, and run. I drove down to the pier only to find that I had forgot my goggles at the hotel. Perfect start to the day! Not wanting to have to deal with parking again I decided to do a quick 30 minute bike, and then run to my hotel to grab my goggles and run back to my car. The 4 mile jog worked out perfectly!

I walked down to the pier and did a quick 10 minute swim in the ocean. The waters weren’t too choppy, but I knew that could quickly change. After my short pre-race day workouts I headed back to the hotel and got my bike and race bags ready for check-in. 

Like registration, everyone had a preset time to check in their bikes to avoid congestion. I racked my bike around 5, dropped off my bike and run bags, and headed home for some rest and carbs.

Race Morning

As usual, I had prerace jitters and woke up at 4 before my alarm even went off. I put on my trisuit, grabbed my First Endurance hydration bottles I had mixed up the night before along with my wetsuit and goggle, and headed out to transition. 

Transition was pretty similar to past races, other than the fact that everyone was wearing masks. I had my tires topped off with air, filled up my aero bottle, and made sure my bike and run bags had all the essential.

Due to Covid, there would be no changing tents with chairs in transition. We had to leave our bags by our bike and did everything on our own during transition. This was actually fine by me. As much as I love how much the volunteers help us out, sometimes it’s easier for me to grab what I need on my own. 

The 2.4 Mile Swim

We waited by our bikes until they called out our projected swim times so that we could start walking down to the swim start. I am a horribly slow swimmer with my best time being around 1:11. I was a bit ambitious and walked down with the one hour to 1:10 group in hopes that I could draft off some faster swimmers. 

We were ushered into the water three swimmers or so at a time every five seconds. About 10 minutes after the official start time I was finally in the water. And boy was it rough! There was about a 10-12 mile per hour wind coming from the northeast and it made the water pretty choppy. Not the worst I have swam in, but definitely made me motion sick and had me swallowing a decent amount of salt water. I was just happy to make it through, even with a slow 1:15:30 time.

It was a long run back up to transition. With no wetsuit strippers I peeled off my suit myself, found my helmet and shoes in my bike bag, and started out on the longest part of the day. 

112 Miles of Biking

The course at Panama City Beach is flat, but the wind can still make it a challenging ride. The first 40 miles or so of the bike was mentally tough as we pedaled into a headwind most of the way. The rest of the ride was a mix of tailwind, headwinds, and crosswinds. 

I felt like I was doing decent with my power and staying well hydrated. However, the big issue I have with a flat course is that I forget to take posture breaks. Obviously you want to stay aero as much as possible, but I had to remind myself to sit up once in a while to stretch out my back and give my gut some space to digest the carbs I was gulping down. 

The last part of the bike was into a headwind, and I was so happy to finally clip out and be done with a bike split of 5:14:20.

Unlike the typical Ironman, there was no one to grab my bike for me and I had to run it back to the rack myself. Kind of a bigger bummer than I thought. Sometimes it’s the little things you take for granted! 

Marathon Time

Once I racked my bike I bent down to grab my run bag and that’s when the first big stomach cramp hit me. All of my abdominal muscles seized up at once and I had to stand up and arch back to try to stretch them out as I massaged my abs. Not good. The pain eased up and I slipped on my socks and shoes, grabbed my visor and sunglasses, and clipped on my race belt. Last leg, here we go!

The beginning of the run I felt great! After training in the humidity of the Florida Keys, the weather actually felt nice. But around mile 2 the stomach cramp hit again. “No, don’t do this!” I actually said out loud to myself as I took some deep breaths and started massaging my abs while I kept running. Again the pain lessened, and I kept going. 

I made it to the 13.1 mark and still felt pretty good when the cramping came on full force again. I tried running through it but had to eventually stop completely to try to stretch out my abs again. This time, I couldn’t get the pain to stop so I tried just running (or rather shuffling) through it. 

Usually, the run will have aid stations every mile. However, because of Covid, they were now every 2-2.5 miles apart. At first, this wasn’t a big deal, but as the race stretched on this was a game changer. Quitting a race has never been an option for me, but with about nine miles left I didn’t know if I could make it. Aerobically, I felt fine. But my stomach cramping was killing me, and my legs were finally starting to feel the impact of 137 miles of racing. 

I had just about used up a flask of First Endurance Gel so I emptied the rest and filled it with Gatorade at the next aid station to carry along with me between aid stops. I just told myself I had to keep moving my legs. I knew my time was suffering, but I just had to make it to the finish line. Ignoring the pace on my watch I just tried to keep my legs going. Finally, after what seemed like forever with a shuffling snails pace of running, I made it to the red Ironman carpet. 

It was great to be done, but sad not to see the usual crowd lining the finish line, giving high fives. Thanks Covid….

But at least there was Mike Reilly, and when I heard him announce my name as an Ironman it was the best feeling I had all day!

My final time was 10:28:54, a couple of minutes faster than my time at Florida in 2019. When I got back to my car I finally looked up my results and realized I had finished first in my age group!! WHAT!?!! I couldn’t believe it! That guaranteed me a Kona spot for next year.

So after a crazy year of Covid and cancelled races, there was a happy race ending at least. And I am so glad I pushed myself to finish the race. I am super pumped to be going to Hawaii next year and will be putting in some serious training in 2021. 

Race Report from Muncie 70.3 July 13, 2019

So, I have been slacking in the race reports. After Ironman Texas back in April I made a last minute decision to run Ironman Gulf Shore 70.3 two weeks later. I surprised even myself with a third place age group finish and a trip to the 70.3 World Championships in Nice in September!

After racing in Panama City Beach in May I didn’t really have any concrete goals other than the race in Nice. But after some changes in my personal life I decided to make July a month of racing and travel. And the first stop was the half Ironman in Muncie.

Road Trip!

I made the ten hour drive up from South Carolina with my new Felt IA2 and my dog Frankie on the Friday before the race. This was my third time racing Muncie, so I was already familiar with the course. Although the swim did race in a different direction, everything else was the same. 

Packet Pick Up and Pre-Race Nutrition

After dropping off Frankie at the hotel, I picked up my race packet and headed to the store for some pre-race snacks. It has taken me awhile to figure out what works best for me before a race, but recently I have figured out that a glazed donut is pretty awesome the morning of the race. It has quick carbs and is easily digested, at least for me. 

Anyways, I’m in the store, unashamedly about to grab my single glazed donut from the pastry rack. I look down at my phone for a second and look up and some random dude is right next to me and is laughing, saying how funny it is that the day before a race I’m standing in the dessert aisle. 

I honestly didn’t know what to say. Was he food shaming me? Yeah, I run Ironmans and occasionally eat a donut. Get over it. I didn’t say anything and just stared him down until he walked away. So yeah, that guy still pisses me off.

Race Prep

Anyways, I eventually got back to the hotel and arranged everything for the morning. Hydration, nutrition, bike, helmet, swimskin, goggles, running shoes, belt, etc. Checked and double checked. Then did the usual lay in bed nervous for a few hours before falling asleep, only to wake up every hour thinking I had overslept.

Finally, my actual alarm went off. I headed out to the Prairie View Resevoir to begin the day. After racking my bike and scoping out the path from transition, I headed over to test out the water. It was warm. I can’t remember the exact temperature, but definitely not wetsuit legal, which is always a bummer for a slow swimmer like me. But I would make due.

The Swim

The race started at 7, but due to the rolling start I didn’t get into the water until about 7:20. As usual there was the obligatory kicking and elbowing the first few hundred meters until everyone spread out.

The water was calm, but for some reason I could just never get into a rhythm. My time coming out of the swim was a few minutes slower than I had hoped and I knew I would need to make up some ground on the bike.

The Bike

The bike course at Muncie takes you out for the first 8-10  miles before you get to the double loop. I started passing people pretty quickly and was feeling good about myself until I hit a huge bump. My hydration bottle on the front nearly popped off. The ring around the straw acutally did, which meant my straw was flopping all over the place for the rest of the race. Plus, all my Medjool dates that I like using for nutrition popped out onto the ground. Luckily I still had some gels, but I was a sad little biker for a minute.

The rest of the first loop went pretty well, but things got really congested on the second loop as I tried to make my way around some cyclers coming on for their first loop. After a little over two and a half hours I made my way back to transition and it was on to the run.

The Run

I had a little hold up in transistion after I forgot a gel and had to run back. I probably only lost a few seconds but it always feels longer in the moment. I got onto the run course and honestly felt like my heart was going to explode. It was pretty hot and it was hard to get my heart rate down.

My Garmin 935 watch beeped showing my Performance Condition. For anyone that has used this watch, this basically shows what performance level you are at compared to baseline and ranges from -20 to +20. I was at a -7. Let me tell you, if that was -7, -20 must be death.

The first half mile was relatively downhill and luckily this helped me slow my breathing. The rest of the run was rolling hills, with a big part in the blazing sun. I managed to keep a decent pace once my heart rate settled down and overall felt pretty good given the conditions.

So Close to Breaking 5 hours…

I crossed the finish line in 5:00:57. It was a pretty strong race, but I was still bummed about not getting under five. All the “if onlys” start popping into my head. A little faster swim, quicker in the transition, a few less water stops…but in the end it was still a great race.

After getting back to my car to grab my phone, I checked the results to see that I had finished third in my age group! Depending on what the girls in front of me decided, that meant I could possibly get a spot for the 2020 World Championships in New Zealand.

New Zealand 2020!

I grabbed some food from the athlete tent and took a quick nap under a tree while I waited for the awards. I got my third place plaque, took some pictures, then waited around for the roll down. When it got to females 35-39, it was revealed that we would get 2 slots. The first name was called and no one responded. Then the second-no one. Finally “Holly Smith” was called. 

New Zealand is far, but how do you turn down that opportunity? So I’m pretty pumped about heading there in November of 2020. But first I am going to try to conquer my second full Ironman of the year in Lake Placid on July 28th. Then there’s the 70.3 World Championships in Nice in September. So never a dull moment! And yes, I will be eating a donut before each of those races!

After a few warm up races (Ellerbe Marathon in February and The Intimidator 70.3 in March), it was time for the first big race of the season…Ironman Texas! I’ve now made it my new goal to do at least one Ironman a year, and by picking an early one this allows me the option of still being fresh for a late season 140.6 if I so choose. I arrived in Houston on Thursday to pick up my packet and bike which I had shipped by TriBike Transport. I know that I could get my own bike box and schlep it with me to the airport…but I just don’t trust airlines. When I traveled to Santa Rosa last year they lost my luggage that had all of my race gear. Sure, it showed up the same night, but still…not worth the risk.

Anyways, after landing and standing in line for an eternity at the rental car line, I made my way from Houston to The Woodlands. I had never heard of the place before signing up for this race, but I’m sure I glad I was introduced. The Woodlands is beautiful and a perfect venue for a race. I made it over to the expo, grabbed my race goodies and bike, then headed back to the hotel to relax for the night. Which, for anyone that has been tapering knows, is easier said than done. But I wanted to get some rest and do a quick bike and run in the morning just to make sure everything was in working order.

Friday morning I did just that then headed over to the transition to drop off my bike and bags and get a quick glimpse of the swim course. Seeing the narrow waterway made me a bit nervous for the mass open water swim the next day but I tried to put this out of my head as I headed back to the expo for a visit with my AltRed teammates and a quick photo op. My nerves were starting to set in a bit as I realized how close race time was getting. After getting back to the hotel I preoccupied myself with making sure I had all the essentials for the morning before another restless pre-race night of sleep.

The narrow waterway near the swim finish


I popped out of bed Saturday morning, threw on my race clothes and timing chip, grabbed my Tailwind water mixes, Medjool dates, and Maurten gels for my bike, and headed over to transition. As always, it was packed with racers and their families. I weaved through the pack to my bike and waited in line to have my tires pumped up. Then after filling up my water bottles and strapping my nutrition to my bike I headed out to the swim start. It was actually nice to have the quarter mile walk over to the start to take a breath and mentally prepare for the long day ahead. The pros went off first, about 20 minutes before the age groupers. I was pretty excited that Daniela Ryf, the reigning Kona champion, was going to be out on the course today-and likely beating me by several hours!

Awaiting the swim start

It was a rolling start and I was hoping to finish the swim under 1:20, which is right around my typical 2.4 mile swim time. After shimmying into my wetsuit I joined the sea of humanity between the 1:10-1:20 sign. As it is before any race of this distance, the anxiety in the air was palpable. The gun went off and our group slowly made our way down the chute. Finally I was sent off with a group of three others into the water. I’m not gonna lie, the water was pretty gross and I couldn’t see anything in front of me. Now I’ve raced in quite a few triathlons, but this swim was probably the most stressful. It seemed that no matter how hard I tried to move to the outside or away from a group I was constantly being pushed, pulled, kicked, and elbowed. But I knew if I started panicking the race would be over for me before it even started. I mentally blocked out my surroundings and imagined myself back in the pool doing an interval workout. The rest of the swim I just concentrated on maintaining my form and racing my own race. Before I knew it I was coming around the turn and heading towards transition. Finally I made it to the steps and was graciously dragged up by a couple of volunteers (seriously whoever those guys were they were awesome-as were all the volunteers that day). I looked down at my Garmin watch and realized that for some reason it must have stopped and restarted because it only recorded about three-quarters of the swim. I had no idea what my time was, but gauging by the real time of day I figured it must have been around 1:15.  With a little help from the wetsuit strippers I was soon making my way to my bike bag and into the changing tent. I slapped on my helmet, sunglasses, and bike shoes, grabbed my bike, and was off onto the bike course.

Looking at the map and elevation of the bike course, one would think this was an easy 112 miles. Really it probably had the least amount of elevation of any course I had done to date, right along with Ironman Florida. But just like Florida, wind was the story of the day. Once we hit the toll road around mile 20 or so, the headwind was there to greet us. Since my legs were still fresh at this point I made it through the next 20-25 miles before the turn around relatively fine. The tailwind on the way back was amazing and I figured if I could just make up my time with the wind at my back, the second loop into the headwind wouldn’t be so bad. Once we made the turn the U-turn around mile 60 I realized this was not going to be the case. The wind had picked up, and for the next 25 miles I felt like I was pedaling as hard as I could and not going anywhere. Add that to the fact that now the sun was blazing down with about 80 degree heat, and the doubts about making it through this race started to pour in. I made it to the last turn around and at least had the tailwind again. However my legs were so fatigued at this point it was hard to take advantage of the push. I was so happy to finally see the transition area coming back into view after that brutal ride that took about 5:45. Only 26.2 miles to go!!!

Running after a 112 mile bike ride is always an experience when you first start. The legs are still Jello, and you aren’t really quite certain how you’re supposed to run a marathon now. But, you do…because damn it you paid a lot of money to finish this race! I grabbed my gels and Base Salt, downed some Gatorade, and headed out for the final leg of the day. It was now at least 85 degrees with no cloud cover in sight. Luckily, the course was flat and the crowd support was amazing. The run was three loops around The Woodlands trails. It was gorgeous and if I didn’t feel like I was dying I definitely would have enjoyed it more. But really, the support from the volunteers, families, and friends was second to none. My highlight of the race came as I was finishing my first lap. There was an announcer by the aid tables announcing names of runners going by. I heard “Holly Smith from Columbia, SC” as I slowed down to grab some water. Then, about five seconds later heard “We have a new race leader…Daniela Ryf looking strong!” I turned around and there was the Kona champ, running like a six minute mile as she was finishing the race, looking like she was out for a jog. It was AWESOME! I scrambled to the side to stay out of her way as she went on to win the race. I, on the other hand, still had about 18 miles to go!

As always, the signs along the route were great. Some of my favorites included:

“Don’t you wish you still had your bike?” (I actually did not-I never wanted to see that bike again after what it just put me through)

“Run like Hillary just found out you’re going to testify” (who doesn’t like some political humor)

One with a picture of Lori Loughlin that said “I can get you into Kona” (If she could I would take it!)

And the one that actually did keep me going-”When you feel like stopping, think about why you started.” I actually kept repeating this one to myself because there were too many times I just wanted to throw in the towel. But pain is only temporary-online race results are forever!

Ironman #6…Done and Done!

After a little over four hours I finally crossed the finish line, sunburnt, sweaty, dehydrated, and happy as hell! I was an Ironman for the sixth time! I ended up finishing sixth in my age group, not quite good enough for Kona, but still my best age group finish yet. After a hectic swim course and a grueling day in the sun I couldn’t have been prouder of my finish. Now time to get ready for the next one!

It’s time for the 2019 race season! Anyone who knows me knows how much I love endurance running and triathlons. It’s hard to believe that my first marathon was 14 years ago!  Over that time I have done 11 marathons, numerous half marathons , 5ks and 10ks, 11 half ironman triathlons, 5 full ironman triathlons, and just last year my first 50K at the Barkley Fall Classic. Suffice it to say, all those races and training takes its toll on the body. For that reason I am always looking for ways to not only improve my performance, but also my recovery. However, I also want to make sure any type of supplement I use is both safe and effective. While doing research on recovery and performance I stumbled across AltRed.

AltRed is a fairly new supplement that is comprised of the phytonutrient betalain. Betalain is a component of beetroot that, in its separated and concentrated form patented to AltRed, has been found in clinical studies to improve oxygen delivery, decrease lactic acid production, and decrease markers of muscle damage. This means higher power on the bike, faster times on the run, stronger swims, and enhanced recovery. Based on my personal experience, I can attest to the fact that it works. I have already seen my FTP on the bike go up by 10 watts, my 100 meter swim time decrease by 15 seconds, and increased VO2 max on my runs. And because of this I have become a brand ambassador for AltRed for the 2019 race season. I will be sporting the AltRed logo and touting its benefits at races because it is truly a brand that I believe in and support.

Check out the studies here and here. I’m not one that likes to shell out money for a placebo, which many miracle supplements out there turn out to be. That is why I was impressed by the research that was undertaken to show the benefits of AltRed. Plus, it is plant based and all natural. It is NSF Certified for Sport™. This ensures that AltRed meets NSF’s stringent independent certification process guidelines for dietary supplements and supplements intended for use by athletes. If you’re interested in learning more check out the website or send me a message. If you’re interested in trying it yourself you can get 15% off using my referral code hsmith-altred which can be used as often as you want. This is not just a supplement for triathletes. Any type of endurance athlete can benefit from AltRed to aid in their training and recovery. Trust me, I’m a doctor 😀

   Essential oils-proven benefits or expensive placebo?

For the last several years I have seen ads and posts inundating my Facebook feeds and google searches praising the amazing benefits of essential oils. Migraine relief, anxiety calming, muscle soothing, and even antimicrobial activity-seemingly there is nothing these magical oils cannot do. I do not doubt that people have found benefits from these compounds, but are anecdotal reports enough to support the price tag on these essential oils? What does the research really show?

antimicrobial activity

With flu season upon us, many will look to any natural remedy to fight this and any other contagious pathogens floating around. There have been literally thousands of publications looking at the bioactivity of essential oils as antimicrobial, antiinflammatory, antioxidant, and immunomodulating agents. However, does in vitro bioactivity translate into in vivo human benefits?

I have had many people ask me about OnGuard, a Doterra essential oil that is known to enhance immunity. It contains five essential oils-wild orange peel, clove bud, cinnamon bark, eucalyptus leaf, and rosemary leaf. A 2010 study showed influenza virus was suppressed by this essential oil treatment (1). Great right? Well the problem with this study was that it was in vitro, meaning it was done in a test tube. Additionally, it was done in canine kidney cells. So while the study is promising in that the essential oil could reduce infectivity, it is not possible to say if this actually translates in vivo in humans.

Another more recent in vitro study looked at two unique blends of Cinnamomum zeylanicum, Daucus carota, Eucalyptus globulus and Rosmarinus officinali and the activity against fungal, viral, and bacterial strains. It was found that these blends were active against the fourteen Gram‐positive and gram‐negative bacteria strains, including some antibiotic‐resistant strain. Additionally, one of the blends was active against H1N1 influenza strains and the pneumonia causing bacterial strains  S. aureus and S. pneumoniae. This is a potentially promising finding in those suffering both from influenza and post influenza pneumonia. In an era of antibiotic overuse and emerging resistance to both wide and narrow spectrum antibiotics this is a very promising finding that definitely deserves further research.

Tea tree oil is another essential oil that has been found to have activity against MRSA, an extremely pathogenic bacteria responsible for skin infections and respiratory infections. One study found that while not as effective as mupirocin cream for clearance of nasal carriage, tea tree oil was more active against MRSA skin lesions than chlorhexidine and silver sulfadiazene (3). This study was done in humans which was in contrast to the previous studies.

As noted above, there are hundreds of other bioactivity studies out there and I have only highlighted the above to show that there is promise in using essential oils as antimicrobial agents. Tea tree oil has been examined in human studies against MRSA skin infections, however the other research is mainly in laboratory testing. Will it hurt to use essential oils to help decrease possible viral or bacterial spread? No, unless you have an allergic reaction to the oil itself and it is used as recommended it is unlikely to cause any issues. If you forgo medical care because you believe an essential oil will cure you from a major illness that can also be an issue, so I do not recommend relying solely on these agents. Could essential oils theoretically reduce viral  or bacterial replication in humans? Maybe. More studies would need to be done in humans in  controlled studies to say conclusively. This is easier said than done as essential oils can be very unique in their chemistry depending on the plants that they are derived from, but I am hopeful that standardized studies may be able to be performed in the near future.

If you don’t mind spending the money, essential oils, especially those containing cinnamon, eucalyptus, clove, tea tree oil, and rosemary may have increased benefits in decreasing viral and bacterial spread of certain respiratory pathogens. And lets face it, we shell out money for many other unproven treatments or over the counter medications that probably don’t really do much in halting the spread of viruses or shortening the duration of illness. Also, we must remember that antibiotics do nothing to treat viral infections, which is the major cause of “colds” that people suffer from this time of year. From sinusitis to bronchitis, antibiotics typically are not needed despite the fact that I have patients requesting these on a daily basis. I would much rather be able to suggest something like essential oils to help combat these infections, rather than increasing the risk of antibiotic resistance and subjecting individuals to the many adverse side effects of inappropriate antibiotic use.


I have many patients that deal with migraines, and anyone that suffers from these headaches understands how debilitating they can be. There are many over the counter medications that are utilized-acetaminophen, aspirin, ibuprofen, naprosyn, and combinations with caffeine. Unfortunately, these are often unsuccessful in aborting migraines and often people have to turn to prescription triptans. Even then, those who frequently experience migraine headaches will find that no medications work, and even prophylactic treatment with beta blockers or Topamax does not stave off the episodes. (We will soon see how the new CGRP antibody-Aimovig-fares.) Time and again I have anecdotally heard about success stories with essential oils. So naturally I had to investigate.

The research out there is scarce, although I did find a couple of studies. One from 2012 investigated the benefits of inhaled lavender essential oil in migraine sufferers. This was a placebo controlled trial with 47 participants where the case patients inhaled lavender essential oil for 15 min, and the placebo group inhaled liquid paraffin. The response to lavender in reducing headache severity and even aborting migraines was significantly greater in the lavender group (4). However, a 2017 study using topical rose oil did not show benefit over placebo (5).

Mechanistically, peppermint oil also has the potential to alleviate headaches.  Research has shown that local application of peppermint oil generates a long-lasting cooling effect on the skin, caused by alteration of the cold receptors. It has also been shown that peppermint oil inhibits serotonin and substance P induced smooth muscle contraction in animal models, and it is also induces a significant increase in blood flow to the skin (6). However, there are no random controlled trials in humans looking at peppermint oil specifically for migraine relief.

As there is minimal research out there, a clear conclusion cannot be drawn. Lavender may be beneficial in reducing migraine headaches, and who I am to argue with a long suffering migraine patient who tells me it works for them? The one thing to consider is that certain scents and perfumes can actually worsen or precipitate migraines in some, and in these people inhaled essential oils may actually worsen the symptoms. Other than that, its not something that is likely to cause any adverse reactions  so at this point there seems to be no harm in using essential oils for migraine relief. This is actually a product that would be much safer than chronic NSAID or acetaminophen use. For those with heart, kidney, and liver disease, using ibuprofen on a chronic basis is contraindicated. And of course those with a history of gastric ulcers or reflux cannot take NSAIDS on a consistent basis either. Individuals with hypertension and coronary artery disease are often advised to stay away from triptans as well. So if essential oils work and help to alleviate the symptoms of migraines, I think they are a great option for many people.

Anxiety and stress

One of the biggest touted benefits I see out there for essential oils is that it helps calm anxiety and reduce stress. In this fast paced and demanding world we live in, anxiety disorders are becoming more and more prevalent, and this can severely impair day to day functions. The vast majority of medications used to treat anxiety can be habit forming and have adverse effects, so having a more natural option for treatment would be extremely valuable. I have to admit, when I can relax and breathe in something aromatic it does help release some tension. However, is there any science behind this?

A 2013 study actually looked at EEG patterns to discern if essential oils can have relaxation effects on the brain. It compared inhaled lavender, rose, sandalwood, and peppermint. It found that rose had the best effect on stress relief in females, while peppermint provided better calming effects in males (7). Another study examined participants solving difficult math problems  (considered the stressed state). EEG recordings were taken prior to solving the math problem, during the stressed state, and then while receiving aromatherapy with essential oils. Lavender, rose, sandalwood, and lemongrass  were used and EEG patterns were measured. There did appear to be a significant reduction in stress with all four essential oils, and this occurred within about ten minutes of exposure (8). Another study showed that lavender, when compared to almond oil, had a more relaxing effect based on self reporting. In addition, blood pressure, heart rate, and skin temperature were reduced in the lavender group indicating decreased autonomic arousal. This was a small study that involved twenty healthy patients between the ages of 18-35 (9).

Other studies have looked at an orally administered lavender containing capsule marketed as Silexan. A 2010 trial showed that the lavender oil preparation significantly improved the quality and duration of sleep and improved mental and physical health without major adverse side effects(10). Another larger study compared this oral lavender preparation not just to placebo but also to the antidepressant paroxetine in participants with generalized anxiety disorder. The end-point looked at the reduction in the Hamilton Anxiety scale score. The lavender preparation decreased this score significantly compared to placebo. There was only a trend toward significance when compared to paroxetine, however there were fewer adverse effects in those receiving the lavender supplement compared to paroxetine (11). A different study compared Silexan to lorazepam, or better known to many as Ativan. This was a six week study that again used the Hamilton Anxiety rating scale as an end point to measure improvement in the subjects anxiety. The lavender preparation was comparable to the lorazepam in this study in ameliorating anxiety, with the advantage of not having sedating properties like those seen with lorazepam (12).

These are just a few of the many studies that have shown promise for the use of essential oils to reduce the symptoms of anxiety. It should be noted that it is difficult to do blinded studies with aromatherapy due to-you guessed it-the aroma. So in some cases it is hard to say if it is more of an expectation bias that leads to subjective reporting of improved mood. The lavender oil capsule preparation, marketed as Silexan, has also shown to decrease symptoms of stress and anxiety not only when compared to placebo, but also had similar effects when compared to lorazepam and paroxetine. For some, this may mean being able to avoid habit forming medications for symptom relief. For others, essential oils, notably lavender, could be a great add on for individuals with anxiety that may not be fully resolved with pharmacologic therapy.


We all need it, and the majority of us don’t get enough of our favorite “S” word-Sleep. Seriously, when was the last time you got the full recommended eight hours of sleep? Getting enough shut eye at night allows our bodies to recover and is crucial in maintaining our health and wellness. Sleep affects our mood, cognitive function, and stress levels. It allows our bodies to recover after a hard workout, and it helps maintain our immune systems to fight off all those nasty microbes that surround us. However, a great deal of people suffer from sleep deprivation for numerous reasons. I’ve found the number of patients I have had requesting sleep aids has grown substantially in the past few years. Most of this seems to stem from stress and anxiety, which was addressed above. Many just cannot seem to unwind from the day and end up caught in a vicious cycle of poor sleep and increased stress, which then circles back to poor sleep the following night. There have been a number of pharmacologic agents developed over the years to combat insomnia, however these can be habit forming and have numerous side effects. I have found myself trying to find more natural ways to help individuals with their sleep issues despite the fact that many are requesting Ambien by name. There are plenty of anecdotal tales about the benefits of aromatherapy and sleep, and it turns out some controlled trials as well.

A study from 2010 investigated the effects of a lavender, roman chamomile, and neroli oil blend aromatherapy on anxiety, sleep, and blood pressure in patients who were admitted to the ICU after stent placement for coronary artery disease. It was found that those in the aromatherapy group experienced reduced anxiety, increased sleep, and stabilized blood pressure compared to the control group who received standard nursing care without aromatherapy (13). Another study looked at inhalation of lavender by healthy male and female subjects prior to sleep. There was an increase in deep wave sleep in both sexes as well as increased energy the subsequent morning (14). These are just examples of some of the studies out there looking at essential oils and sleep, but again does show promise that there is more than just a placebo effect from aromatherapy and essential oil use.


Everyday we hear about the opiate crisis and the addictive nature of prescription pain medications. I have not stumbled across research directly comparing essential oils to narcotic pain medications, although there are studies that do examine the the role of essential oils and pain relief. One review and meta-analysis showed that aromatherapy decreased pain  among subjects based on a visual analog scale. This meta-analysis looked at a variety of studies, ranging from chronic back and knee pain to post-operative and cancer pain. Studies looking at neck and knee pain showed improvement in range of motion when essential oils and massage were combined with conventional treatment. In a randomized trial following total knee replacement surgery, those treated with eucalyptus aromatherapy, along with standard pain medication treatment, had lower pain levels and blood pressure levels. Studies looking at postpartum pain, cancer pain, and pain related to dialysis also showed benefits using essential oils (15). In these studies, essential oils were mainly used as a complementary treatment in addition to pain medications or other usual care. However, it is promising in that this could help decrease the reliance on addictive narcotic pain medications.

in summary

This is not an all inclusive list of studies done on essential oils, but serves to highlight the fact that their is more than just anecdotal tales that support the benefits of essential oils. These are overall safe as well, although individuals using essential oils need to make sure they are using the oils as directed. There is the potential for skin irritation if directly applying the oils to the skin. Theoretically there is the potential for exacerbating respiratory symptoms when diffusing the oils, however there are also studies showing benefits of essential oils in patients with asthma. So use needs to be individualized and monitored.

Essential oils can be used in a diffuser as aromatherapy, and some can be applied to the skin. If being used on the skin (even if you’re just adding the essential oils to a bath), you’ll need a carrier oil—a neutral, plant-based oil that can act as a base. Common carrier oils include sweet almond, jojoba, olive, sunflower seed, avocado, and grapeseed. This really serves two purposes. Mainly it protects against skin irritation and skin reactions. But dilution also extends how long your essential oils will last as well.

The next question is: What is the best essential oil brand to buy? The market is saturated with so many options, it is difficult to know exactly what you are getting. This is not an article comparing brands, but during my research I did find a great review site that looks at some of the most popular brands: Essential Oil Haven. There is an overview of each brand, and individual reviews that follow. There is great information here about how these oils are labeled and what to look for when comparing brands. Obviously, purity and testing are of utmost importance, and this breaks it down nicely. Essential oils are not FDA approved or monitored.  Labels like “100% therapeutic grade”, “100% pure”, and others are just marketing tools that companies use. Some companies have even stopped using these terms as they find the labels misleading. I am only trying to point out that there is a lot of marketing jargon and ploys that companies use to try to say that their products are superior to others, and it is important to do your own research when deciding what brands to use.

Young Living and Doterra seem to be two of the more popular brands and I have heard great things about these companies. I personally have been using NOW, Thrive Market, and Aura Caucia essential oils. Full disclaimer, my main reason for this is that I have a subscription to Thrive Market (which I highly recommend not just for essential oils but for their whole marketplace), and all of these brands are sold on this online marketplace at incredible prices. You can get 25% off your first purchase using the link below.

Overall I think essential oils are a great tool in combating different health issues as noted above. I am not saying they are a substitute for good medical evaluation and care. But they can be used as an add on to the treatments we are currently using in the medical field and should not be completely written off. I am hoping to see more research in the future on these products, especially in the area of antiviral/antimicrobial activity and pain relief.  Having another option other than misused antibiotics and prescription opiates could be a game changer in healthcare.

Thrive Market

    1. Wu S, Patel KB, Booth LJ, Metcalf JP, Lin HK, Wu W. Protective essential oil attenuates influenza virus infection: an in vitro study in MDCK cells. BMC Complement Altern Med. 2010;10:69. Published 2010 Nov 15. doi:10.1186/1472-6882-10-69
    2. Brochot A, Guilbot A, Haddioui L, Roques C. Antibacterial, antifungal, and antiviral effects of three essential oil blends. Microbiologyopen. 2017;6(4):e00459.
    3. Dryden, MS et al. A randomized, controlled trial of tea tree topical preparations versus a standard topical regimen for the clearance of MRSA colonization. Journal of Hospital Infection. 2004. 56:4.
    4. Sasannejad P, Saeedi M, Shoeibi A, Gorji A, Abbasi M, Foroughipour M: Lavender Essential Oil in the Treatment of Migraine Headache: A Placebo-Controlled Clinical Trial. Eur Neurol 2012;67:288-291. doi: 10.1159/000335249
    5.  Maria, N, Mohammad HH,  Mohsen T, Mojtaba H,  Abdolhamid S. Efficacy of topical Rose (Rosa damascena Mill.) oil for migraine headache: A randomized double-blinded placebo-controlled cross-over trial. Complement Ther Med.  2017 Oct;34:35-41. doi: 10.1016/j.ctim.2017.07.009. Epub 2017 Jul 25.
    6.  Göbel H, Schmidt G, Dworschak M, Stolze HHeuss D. Essential Plant Oils and Headache Mechanisms. Phytomedicine. 1995 Oct; 93-102.
    7. Liu, CW et al., Electroencephalographic Study of Essential Oils for Stress Relief. Applied Mechanics and Materials. 2013;1085-1088
    8. Hema, CR, Revathi, S. A Preliminary Study on Aromatherapy as a Stress Buster Using EEG Signal Analysis. Emerging Trends in Engineering Research. 2012; 211-219.
    9. Sayorwan, W., Siripornpanich, V., Piriyapunyaporn, T., Hongratanaworakit, T., Kotchabhakdi, N., & Ruangrungsi, N. The effects of lavender oil inhalation on emotional states, autonomic nervous system, and brain electrical activity. Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2012 95 4, 598-606.
    10. Kasper S, Gastpar M, Müller WE, Volz HP, Möller HJ, Dienel A, Schläfke S. Silexan, an orally administered Lavandula oil preparation, is effective in the treatment of ‘subsyndromal’ anxiety disorder: a randomized, double-blind, placebo controlled trial. International Clinical Psychopharmacology. 2010 Sep;25(5):277-287.
    11. Kasper S, Gastpar M, Müller WE, Volz HP, Möller, Sandra HJ, Schläfke S, Dienel A.  Lavender oil preparation Silexan is effective in generalized anxiety disorder – a randomized, double-blind comparison to placebo and paroxetine, International Journal of Neuropsychopharmacology, 2014 June;17:859–869.
    12. Woelk HSchläfke S. 2010A multi-center, double-blind, randomized study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 17:9499
    13. Cho MY, Min ES, Hur MH, Lee MS. Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention patients in intensive care units. Evid Based Complement Alternat Med. 2013;2013:381381.
    14. Namni Goel PhD, Hyungsoo Kim & Raymund P. Lao (2005) An Olfactory Stimulus Modifies Nighttime Sleep in Young Men and Women, Chronobiology International, 22:5, 889-904.
    15. Lakhan, S. E., Sheafer, H., & Tepper, D. (2016). The Effectiveness of Aromatherapy in Reducing Pain: A Systematic Review and Meta-Analysis. Pain research and treatment2016, 8158693.

flu is no joke

Prevention is the best treatment.

No matter how much real evidence is out there, many refuse to believe the benefit of vaccinations. Some will claim that doctors “push” vaccines because we receive kickbacks. Well, if you consider not having a bunch of people with a horrible, life threatening virus breathing on me, then yes I guess that is a kickback. But no, I will receive no monetary compensation by trying to protect your life. It just happens to be my job. I still remember several years ago when we had the Ebola scare and people were pleading for a vaccine for this extremely rare disease. Yet these were the same people that would refuse a flu vaccine. Blows my mind. Last year, over 80,000 people died from complications related to influenza. 80,000!! I know that there are a lot of questions out there about the flu vaccine and a lot of myths have been perpetuated. While there is a small group of people for whom this vaccine may not be appropriate, for the majority of people this is not something that should be skipped. Let’s break it down based on the most common reasons patients give for wanting to forgo the flu vaccine. 

“The flu vaccine gave me the flu”

This is probably the most frequent reason I hear when someone tells me they do not want the flu vaccination. No, you will not get the flu from the flu shot. The vaccine contains weakened or inactivated virus that stimulates your body to make antibodies to fight the real influenza virus. Now there are a couple caveats to this. One is that it takes about two weeks to build up these antibodies, so if you are exposed to the flu in this time period you can still develop symptoms. In addition, the flu vaccine is developed every year based on what strains are believed to be most prevalent in the upcoming year. It is not 100% effective every year and there may be strains out there that were not included in the vaccine. Luckily, though, by receiving the flu shot your body will still respond to a slightly different strain which usually will minimize the symptoms and shorten the duration of the illness if you do contract influenza. And for anyone that has suffered with influenza this can be critical. Also, many people will get a common cold or another infection that is not actually due to the influenza virus but people will assume that it is the flu. Every illness during the winter is not, in fact, influenza, and you can still contract a number of different bacterial and viral infections that unfortunately not all vaccines can protect against. 



“i don’t like vaccines in general. they are dangerous and cause health issues.”

That Lancet article by Dr. Andrew Wakefield will just not go away. The 1998 article linked the MMR vaccine with autism and has had people worried ever since.  However the children that Wakefield studied were carefully selected and some of Wakefield’s research was actually funded by lawyers that were involved in lawsuits against vaccine manufacturers. The paper was retracted 12 years after it was originally published due to these inconsistencies and the finding that there really was no consistent link between the MMR vaccine and autism. This has not stopped many from skipping vaccines altogether, and unfortunately this has lead to an increase in childhood diseases that had all but been eliminated. Measles, whooping cough, and mumps are just a few that have been trying to make a comeback, along with influenza in the winter. Now that does not mean that you may not experience some mild side effects from the flu vaccine. You may have a sore arm at the inoculation site for a day or so after receiving the shot. Others may develop a low grade fever and mild muscle aches which is typically just the body’s physiologic response as it is building up antibodies. The majority of individuals do not experience these side effects, but even if you do, isn’t a day of mild discomfort worth not having a week or more of misery with the flu? Or the possibility of even ending up in the hospital?

Very rarely a vaccine can cause a hypersensitivity or allergic reaction. If you have ever experienced severe anaphylaxis (difficulty breathing or airway swelling) after receiving a vaccine this would be a contraindication. Guillain-Barre Syndrome is another very rare occurrence that has been reported following administration of the flu vaccine, although the CDC reports that safety monitoring over the years has not detected a clear link between Guillain-Barre and the influenza vaccine. Studies suggest that the risk of developing GBS after actual influenza is higher than the potential risk of GBS following vaccination. Every year 1-2 people per 100,000 develop GBS regardless of flu vaccination status. (1)

“i’m healthy, I don’t need a flu shot”

There are clearly individuals that are more susceptible to the flu and who will suffer more serious health consequences if they contract this deadly virus. However, anyone can get the flu, even young healthy people. Everyone over 6 months is advised to receive the flu vaccine, including pregnant women. And trust me, if you’ve ever had the real honest to goodness influenza virus, you do not want it again. Dealing with fevers, body aches, debilitating cough, and just overall weakness and malaise is no way to spend your days, especially for the health conscious person that wants to keep up with their fitness and training regimen. The flu will set you back a couple weeks. Also, you can prevent the spread of the virus to those that are more susceptible by getting vaccinated. 

“the flu is just a really bad cold”

According to the CDC, 80,000 people died from complications from influenza last winter

Nope, influenza is a very serious virus. Young children, those over 65 years of age, and individuals with medical comorbidities such as COPD, diabetes, and immunosuppressed states are especially susceptible. The flu can predispose the body to developing concomitant bacterial pneumonia and can even progress to septicemia (infection in the bloodstream). The infection can progress rapidly and the signs and symptoms need to be recognized and addressed by a medical professional immediately. PEOPLE DIE EVERY YEAR FROM THE FLU. It is not an illness to take lightly.

surviving flu season

There are a number of ways to be proactive in preventing the flu. This of course includes the flu vaccine as noted above, but there are other easy preventive measures you can take. Wash your hands with soap and water on a regular basis especially after making contact with others that are sick or after coughing or sneezing. Avoid sharing utensils and glasses and wipe down surfaces at home with an antibacterial cleaner. Despite your best efforts, unfortunately you may still develop symptoms consistent with influenza. Fevers, chills, muscle aches, fatigue,  and persistent cough are possible indicators that you have the flu. Your doctor can perform a flu swab to determine if you do indeed have the flu. If you catch the symptoms early you can be started on an antiviral medication. However, this is only beneficial within the first 48 hours of symptoms, which is why it is important to be proactive. Let’s be safe this flu season. Remember, prevention is the best treatment.



  1. Vellozzi, C, Igbal S, Broder K.  “Guillian-Barre syndrome, influenza, and influenza vaccination: the epidemiologic evidence. Clin Infect Dis. 2014 Apr; 58 (8):1149-55.

 Low carb vs low fat diets

       main findings

  • In the short term, weight loss is higher at 3-6 months in the low carb groups, but after 12 months there is no significant difference
  • Triglycerides were lower and HDL higher in low carb group in these short term studies, LDL trends towards higher
  • No significant differences in blood pressure, glycemic control, insulin sensitivity















what the research tells us

low carb vs low fat

There are a lot of books, products, and posts on social media telling us what to eat, when to eat it, and what to avoid to obtain the best health. But what are the facts? There are a multitude of well designed studies that have been conducted to determine what, and even if, there is an ideal eating pattern. This is always going to depend on underlying medical issues and individual goals, but here is a breakdown of some of the trials with links to the full studies provided in the references section. The number preceding the synopsis corresponds to the study in the references. Just remember, when you read something and they say  “fill in the blank diet” is linked with “fill in the blank benefit” you really should evaluate the study yourself. I’m not saying become an expert at reading scientific papers, but if you just check out the abstract you will find that sure, the benefit was there but it may have been either: A) an insignificant change; B) over a short period of time; C) only tested in a small group of people. Also it is important to know what they were comparing the diet to and if the subjects had any underlying medical issues. So without further ado, a breakdown of some of the studies out there today on low carb vs low fat diets. There is a lot of research out there on other eating patterns, such as the Mediterranean Diet, and I will break down some of those studies in a future post.



1. The first trial I will discuss came out of the New England Journal of Medicine in 2003. This study was done around the time that the Atkins Diet was hitting a real surge in the late 90’s an early 2000’s. This study randomized 63 obese male and female subjects to either a low carbohydrate diet or low fat diet for the span of 12 months. Participants were excluded if they had Type 2 diabetes, were taking lipid lowering medications, were pregnant or lactating, or were taking weight loss medications. For the 33 subjects who were assigned to the low-carbohydrate, high-protein, high-fat diet carbohydrate intake was to be limited to 20 g per day  for the first two weeks and then gradually increased until a stable and desired weight achieved. Each subject was given a copy of Dr. Atkins’ New Diet Revolution,  which details the Atkins diet program. Subjects were instructed to read the book and follow the diet as described. The 30 subjects who were assigned to the conventional diet were instructed to follow diets that included about 60% of calories from carbs, 25% from fat, and 15% from protein, with 1200 to 1500 calories per day for women and 1500 to 1800 calories per day for men.

In regards to weight loss, those in the low carb group lost significantly more weight than the group on the conventional diet at 3 months and 6 months, but the difference in weight loss was not statistically significant at 12 months.

Health biomarkers were also measured. The low carb group did see a statistical improvement in triglycerides and HDL cholesterol, however there were no significant differences in blood pressure, total cholesterol, LDL cholesterol, insulin sensitivity.

In conclusion, there was more weight loss in the low-carb group, significant at 3 and 6 months, but not at 12 months.  The low-carb group had greater improvements in blood triglycerides and HDL, but other biomarkers were similar between groups, and actually a trend toward higher LDL in the low carb group.


2. Another study from the New England Journal in 2003 compared low carb vs low fat diets, however this time in severely obese individuals with a BMI above 43. 132 individuals with severe obesity (mean BMI of 43) were randomized to either a low-fat or a low-carb diet, and many of the subjects had metabolic syndrome or type II diabetes. The subjects assigned to the low-carbohydrate diet were instructed to restrict carbohydrate intake to 30 g per day or less. No instruction on restricting total fat intake was provided. Vegetables and fruits with high ratios of fiber to carbohydrate were recommended.The subjects assigned to the low-fat diet received instructions on diet including caloric restriction sufficient to create a deficit of 500 calories per day, with 30 percent or less of total calories derived from fat.

When caloric intake was compared after 6 months, it was found that those on the low carb diet had an overall lower intake of calories compared to the low fat group. There was thought that perhaps this was due to greater satiety. Again, triglycerides were lower in the low carb group, with no change in total, HDL, or LDL cholesterol. 

In regards to weight loss, the low-carb group lost an average of 12.8 lbs while the low-fat group lost only 4.2 lbs. The difference was statistically significant. However, this trial was stopped at 6 months. As we saw in the previous study, at 3 and 6 months weight loss was greater in the low carb group as well, however at 12 months no significant difference was found. Is 6 months really enough time to call this a study in favor of low carbs? Also, was the difference more due to decreased caloric intake or due to ratio of macronutrient intake? There also seemed to be a trend towards better glycemic control (in diabetics only) in the low carb group. However, when broken down this again appeared to be more linked to decreased caloric intake. 

3. A very small study was done in adolescents comparing a low fat to low carb diet. This study only included 30 adolescents, all who were overweight. They were not instructed to decrease calorie intake. Those in the low carb group did lose a larger amount of weight than those in the low fat group, 21.8 pounds compared to 9 pounds. The low carb group again had decreases in triglycerides, but total cholesterol and LDL only decreased in the low fat group. Not only was this study small in size, it was also only conducted over a 12 week period.

4. A study in obese women without other medical comorbidities compared a very low carb diet that was also low in calories to a low fat diet. This trial only lasted 6 months and included 53 participants with moderate obesity, which was a BMI between 30-35. It excluded patients with medical issues such as hypertension, diabetes, and cardiovascular disease. Subjects were randomized to 6 months of either a very low carbohydrate diet or a calorie-restricted diet with 30% of the calories as fat.  The women in the very low carbohydrate group lost an average of 7.6 ± 0.7 kg after 3 months and 8.5 ± 1.0 kg after 6 months of diet. Women following the low fat diet lost 4.2 ± 0.8 and 3.9 ± 1.0 kg at 3 and 6 months, respectively. There were no differences in blood pressure, lipids, glycemic control, or insulin levels between groups. 

5. Another 6 months trial again compared low carb to low fat diets in treating patients with obesity and high cholesterol. It was conducted on 120 overweight subjects with a BMI between 30-60 and high cholesterol, however subjects had no other medical issues. The results did find a higher weight loss in the low carb group at 20.7 pounds on average compared to 10.6 pounds on average in the low fat group.  However, the percentage of total weight loss that was fat mass was similar in the 2 groups (78% in the low-carbohydrate diet group and 74% in the low-fat diet group). As would be expected, the low-carbohydrate diet group lost a greater amount of total body water in the first 2 weeks of the study than did the low-fat diet group (−1.1 kg versus −0.5 kg).  As in the above studies, the low carb group had lower levels of triglycerides and higher HDL cholesterol but no difference in LDL or total cholesterol. Symptomatic adverse effects occurred more frequently in the low-carbohydrate diet group than in the low-fat diet group, including constipation, headache, halitosis,  muscle cramps, diarrhea, general weakness. While not statistically significant, LDL did increase 10% from baseline in the low carb group which was consistent with increasing LDL levels in other studies.

6. A trial that looked at a few different diets randomized 311 overweight/obese premenopausal, nondiabetic women to 4 diets: A low-carb Atkins diet, a low-fat vegetarian Ornish diet, the Zone diet and the LEARN diet. The Atkins diet was the very low carb diet starting with 20 g of carbs a day and working up to about 50 g of carbs a day. The Zone diet was moderately low carb (about 40% of calories from carbs). The LEARN diet (Lifestyle, Exercise, Attitudes, Relationships, and Nutrition) was low in fat, high in carbohydrate (55-60% calories from carbs). The Ornish diet was very high in carbohydrates, with the emphasis being no more than 10% of calories from fat. Again, the very low carb Atkins group lost the most weight at 12 months (10.3 lbs) compared to Ornish (5.7 lbs),  LEARN (4.9 lbs), and Zone diets (3.5 lbs). The weight change at 2 and 6 months was statistically significant. However, (and again), the difference was not statistically significant at 12 months except for when the low carb diet was compared to the Zone diet. 

7. A longer study lasting 2 years was done in 61 individuals with type 2 diabetes. They again were randomized to low carb or low fat diets, along with calorie restriction for both groups. Patients on the low fat diet aimed for 55–60% of calories from carbohydrates and those on low carb diet aimed for 20% calories from carbohydrates. Over the 24 month period there was no difference in weight loss or common risk factors. At 6 months there was improved glycemic control in the low carb group, but this was not seen long term at 2 years due to noncompliance in the low carb group.



overall conclusions

The above studies compared low carbohydrate to low fat diets. This is by no means all of the studies out there, but there is a similar trend in all of them. As you can see, the main finding was that more weight loss was seen in the low carb diets compared to the low fat diets, however this was only in the first 3-6 months. Many studies were stopped after 3-6 months which would lead many to believe that low carb diets were indeed better if they simply looked at the results and ignored the time frame. However, studies extending out to >6 months showed that there was no long-term advantage in weight loss. In addition, there was really no benefit in other health parameters. The main health benefit was in decreased triglyceride levels and improved HDL. However, total cholesterol, LDL cholesterol, blood pressure, and insulin sensitivity were not statistically different between groups. In fact, there tended to be a trend toward increased LDL in the low carb groups which makes sense as the fat intake is much higher in these diets. Compliance in the low carbohydrate group was also low.  Unfortunately, these trials all compared low carb to low fat diets, and there are so many different diets and eating patterns out there which are not just simply “low fat.” Also, I am not saying that this shows low fat diets are by any means better than low carb, but there really does not seem to be a major benefit from low carbohydrate diets in regards to long term weight loss or health parameters.If you’re only looking for weight loss for 6 months, and then regaining it back, then I suppose low carb is for you.

Also, since the studies really don’t go out to more than 12 months (other than the one that was 24 months) we don’t really know the long term safety of low carb diets. Most people do not adhere to low carb diets in the long term, but if they could would there be any long term metabolic effects due to reliance on ketones for energy? Would this even be something sustainable over several years? The decreased triglyceride and increased HDL levels are important, but this can be achieved through other dietary and fitness interventions. Also, as a low carb diet essentially leads to higher fat intake, LDL and total cholesterol levels showed higher trends in the low carb group. Could this have significant impacts in the long run? Since these trials did not look at cardiovascular outcomes and only on biomarkers this is also something that is unknown. 

The above studies were all randomized controlled trials. I do want to bring up a recent prospective study that was presented at the European Society of Cardiology this year that looked at he relationship between low carbohydrate diets, all-cause death, and deaths from coronary heart disease, cerebrovascular disease (including stroke), and cancer in a nationally representative sample of 24,825 participants of the US National Health and Nutrition Examination Survey (NHANES) during 1999 to 2010. Compared to individuals with the highest carbohydrate consumption, those with the lowest intake of carbs had a 32% higher risk of all-cause death over an average 6.4-year follow-up. The risks of death from coronary heart disease, cerebrovascular disease, and cancer were increased by 51%, 50%, and 35%, respectively (8). This was a prospective study and there are many variables that are not accounted for between participants. Additionally, these studies can only find associations, not causation, and rely heavily on participants food journals. While prospective studies are not ideal, a six year randomized controlled study would not be feasible, so this may at least shed some light onto the long term effects of low carb diets. Another meta-analysis of eight prospective studies showed a U-shaped trend of mortality based on carb intake. Those in the lowest (<40% of calories) and highest (>70% of calories) ranges of carb intake had the highest mortality, with intakes of 55-60% being the most ideal range (9). (Disclaimer: This does not mean I think that everyone should have this percentage of intake).


What should we be eating then?

I think the overall thinking shouldn’t be “low carb” or “low fat” because you need to look at how all the macro-nutrients are altered in these diets. For low carb diets are the carbs being replaced more with fat or protein? And vice versa in the low fat diet-are these people increasing protein or increasing carbs to make up the difference in energy consumption? It doesn’t need to be an all or nothing approach to eating, which is why I think breaking down your nutrition into a ratio of protein, carbs, and fats seems to be the most beneficial way to approach nutrition. You have heard this as “Counting Macros”. This is not just something for elite athletes and body builders. I believe that anyone looking to live a healthy lifestyle can benefit from approaching nutrition in this way instead of arbitrarily cutting out food groups. It’s basically just eating a balanced diet that is customized to your fitness goals, activity level, and also to the types of sports or training in which you are involved, and will change on a daily basis. I will discuss this in future posts


  1. Foster GD, et al. A randomized trial of a low-carbohydrate diet for obesity. New England Journal of Medicine, 2003.
  2. Samaha FF, et al. A low-carbohydrate as compared with a low-fat diet in severe obesity.New England Journal of Medicine, 2003.
  3. Sondike SB, et al. Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents. The Journal of Pediatrics, 2003.
  4. Brehm BJ, et al. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. The Journal of Clinical Endocrinology & Metabolism, 2003.
  5. Yancy WS Jr, et al. A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia. Annals of Internal Medicine, 2004.
  6. Gardner CD, et al. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study. The Journal of The American Medical Association, 2007.
  7. Guldbrand, et al. In type 2 diabetes, randomization to advice to follow a low-carbohydrate diet transiently improves glycaemic control compared with advice to follow a low-fat diet producing a similar weight loss. Diabetologia, 2012.
  8. M Mazidi, N Katsiki, D P Mikhailidis, M Banach, International Lipid Expert Panel (ILEP); P5409
    Low-carbohydrate diets and all-cause and cause-specific mortality: a population-based cohort study and pooling prospective studiesEuropean Heart Journal, Volume 39, Issue suppl_1, 1 August 2018.
  9. Siedelmann SB, et al “Dietary carbohydrate intake and mortality: A prospective cohort study and meta-analysis”The Lancet Public Health 2018; 

my first bike-run ironman

Oh what a day it was at Ironman Chattanooga. I was already a bit nervous about how I was going to make it through this only being two weeks out from the grueling Barkley Fall Classic. Here’s a quick race recap-from the revamped start due to the swim cancellation, to some first mile bike issues, all the way to my brain’s non-stop commentary throughout the run trying to will myself to the finish line. Let me tell you, just because there was no swim does not mean this was a walk in the park.


The day started with my alarm going off at 7 am. This was the latest I had ever been able to sleep in for a race. Normally, I would be getting in the water right now, but unfortunately the swim was cancelled due to flooding, high water levels, and elevated E.coli readings (gross).  Without this leg, the race wouldn’t start until 8 AM with the pros, then the age group athletes beginning at 8:25. So I got my gear together, parked my car near the finish line, and walked over to the bike start area. As there were close to 2000 athletes, you can imagine they just can’t start everyone off on their bikes at once, so the plan was to send off athletes two at a time every five seconds. We would start based on our bib number. I was 755 so wouldn’t start until closer to 9 AM. 

I stopped by the body marking area and had a stranger draw my number and age on me with a black marker then found my bike and filled up my water bottles. I had my trusty new favorite endurance drink Tailwind in two bottles and would get Gatorade from aid stations when I ran out. I also had my zip lock bag of Medjool dates which I now love so much more than those goopy gels for quick sugar and potassium. I topped off the air in my tires, checked my chain and wheels, then stood with the others awaiting our time to head off. 

We slowly made our way by twos down the chute to the start. I was actually pretty nervous. For some reason, no matter how many races I do I still have issues with clipping in and mounting my bike around people. Its so stupid but I feel like I need my own space and I was afraid I would tumble into the person next to me. Before I knew it though I was up. I heard a beep and was off! I had my right foot clipped in and pushed off effortlessly, swinging my left foot around and into the other pedal. Ha! Take that bike start! I owned you. Or so I thought. 


early bike issues

I made my way up a short incline and then into a gradual downhill. We crossed some railroad tracks that bumped around my bike and water bottles, but luckily nothing flew off the frame. After a few minutes, though, I noticed something felt off. I was pedaling hard and my heart rate was shooting up, but I felt like I wasn’t moving. People were flying past me. Every few second I would here “On your left,” “On your left,” as the riders were letting me know they were going to pass. “What the hell is wrong with me?” I thought. I felt like my legs were pedaling through quicksand. I couldn’t get going at all, and all these negative thoughts started racing through my mind. “I ruined my legs with that 50K two weeks ago” and “I just can’t bike anymore” were a few. Less than ten miles in I was thinking I was going to have to drop out. My Garmin showed my heart rate was in the 170’s, and I was going nowhere. I was already debating what new sport I was going to have to take up, because clearly I was not cut out for triathlons anymore. But then I came to a hill and I knew it wasn’t me. I was in literally the smallest possible gear on my bike and could not get to the top of this tiny incline. Then it hit me.  This had happened to me a year ago, on this same course in Chattanooga when I raced the 70.3 World Championships. I had hit the railroad tracks and my tire had jammed up against my frame. I pulled over and sure enough, my tire was hot from all the friction of rubbing against the frame. I released the back skewer, pulled the wheel back, and secured it into place. I walked my bike up to the top of the hill and hopped back on. The feeling when I started pedaling again was glorious! My legs were churning freely and I felt like I was flying. I was a new person as I started flying by the racers that had passed me. What a relief. I was upset about the time and energy I had wasted for the first ten miles, but I was so happy that it was something that was easily fixed early in the race. I still had 132 miles to make this my race. 

the bike course

The rest of the bike course at Chattanooga overall was pretty nice. Once I fixed my bike issues I was able to start enjoying the ride…as much as anyone can enjoy a 116 mile trek. We went south of town into northern Georgia and had some pretty awesome views around Lookout Mountain. Before I knew it we were turning around to head back for our second loop! I had been rehashing the beginning of the ride in my mind and wasn’t even paying attention to the distance. This was actually pretty awesome. So much of these long endurance races is psychological, and knowing I was close to mile 60 and over halfway done helped push me a little harder. No matter what, its always going to be physically challenging, but being able to overcome the mental aspect is what really keeps me moving in these races. I grabbed a few dates, sipped some Tailwind, and continued on the second loop. By this time I was running low on fluids so I threw one of my water bottles out at an aid station and grabbed a fresh Gatorade. A few miles out from that I hit a major bump and my dates went flying out behind me. I was pretty bummed but wasn’t about to stop and run back for them so I just hoped I could maintain enough calories with the Tailwind and Gatorade.

The rest of the ride was pretty uneventful. We hit mile 112, the normal end to an Ironman bike, and I was ready to be done. Four bonus miles never seemed so long. Finally we were back to the transition area. I dismounted, handed my bike off, grabbed my run gear bag, and headed to the changing tent. The volunteers at these events are so great. They grabbed me some water and helped me with my run belt and shoes. I took a couple of naproxen for some foot pain I had been dealing with since my 50K at the Barkley Fall Classic two weeks before,  laced up my shoes, and headed out. 



thoughts during a marathon after a 116 mile bike

Starting to run after the bike leg of an Ironman is an odd thing. Your legs are kinda like jelly, but your body is used to moving fast on the bike. Due to this, my first few miles I always go out faster than I should. Also, the bike ride is much more technical  and it requires more focus as you have to watch for other riders, holes, turns, hills, and bumps. You have to be careful of drafting and for people coming up behind you so the time seems to pass more quickly. For me, the run is different. My mind is all over the place during the 26.2 miles to pay dirt. I think the best way to describe my race experience here is to break it down by mile. 


Mile 1: Ahh…my legs are Jell-O. Here we go! Seriously…we’re starting uphill? Okay, slowly but surely. What, my first mile was 8:06…that’s too fast! I need to stay around a 9 minute mile to keep a steady pace the whole way.

Mile 2: Alright, nice downhill. Heart rate coming down a bit. Ok cool, aid station up ahead. Water, gatorade, Base salt, check. Ahh…7:46 mile pace..nooooo I’m gonna die. SLOW DOWN!

Mile 3: There’s a guy at an aid station announcing “Mile 3 or Mile 16 aid station.” Man, wish I was at mile 16. Ugh…this sun is unbearable.

Mile 4: Ok, making a turn towards the park. Finally some shade! Pace is down to 8:30-9:15 minute miles counting my walk through the aid stations. I got this.

Mile 5-6: Nice shaded areas on Tennessee Riverwalk. Just an easy training run, right?

Mile 7is or so: Starting to get a little delirious at this point. We’re back on the main highway and I see someone wrote “shut up legs!” in chalk about halfway up a hill. For some reason all I can think of is “Shut up Drew Brees!” from that memorable Marshawn Lynch YouTube video. (Parental discretion advised.) “Ok, I gotta put the team on my back!” I think as I head up the hill.

Mile 8: Starting to get to the hills in the neighborhoods. Lots of people walking but I know if I stop I won’t be able to get started again. I take a couple licks of Base Salt and drink some water at an aid station and start my way up. 

Picture from The Sports Daily: 


Mile 9-10: Someone is playing “Chariots of Fire” from a truck. Instead of thinking of some monumental run finish I think of this 20 second video of Detroit Lions coach Matt Patricia throwing a challenge flag against the Patriots. Man, wonder how the Lions are doing against the Cowboys today? (Spoiler alert: They lost.)

Mile 11: A little downhill, more uphills, some scenic views. I don’t know, I’m tired..

Mile 12: More uphill as we make our way back to the neighborhood hills we had just descended. Now, I understand people want to walk up the hills, I don’t have a problem with that. But when they walk 2 wide and don’t let anyone pass its pretty annoying. I weave through the groups of people walking uphill, head back downhill and hear someone playing “The Final Countdown”. All I can think of is the Detroit Pistons and John Mason introducing Chauncey B-B-Billups.

Mile 13.1: Okay, now we’re at the boardwalk. Almost halfway. I come to the division for a right turn for lap 2 or a left turn towards the finish. Begrudgingly I make my right turn. 13.1 miles to go.

Mile 14: Alright…starting the whole course over again. Just keep this pace for a couple more hours…no big deal. 

Mile 15-16: I don’t know what happened these last two miles…did I black out? Are we done yet?  Gross..10 more miles still.

Mile 17-18: Back to the Riverwalk and some much needed shade. At least I’m not cramping. And my whole body is on fire so I don’t even notice if my foot hurts. Yay!

Mile 19-20: Out on the highway again and up the hill with the “shut up legs” drawn on the cement. Hills are stupid.

Mile 21-23: Second time around up the hills on Barton Avenue and Hixson Pike. Thanks race coordinators for putting a bunch of hills at the end of the course! 

Mile 24: Okay, 2 miles to go. Are my legs still moving? I can’t tell, everything hurts but I seem to be moving forward. Oh crap, the hill on Barton is back. I think of Rat Jaw at the Barkley Fall Classic and I realize this is nothing. It took me an hour and a half to go up that monster. This will only take me a few minutes. 

Mile 25-26: I’m gonna make it!!! Over the bridge/boardwalk  and back towards the finish line. Legs don’t fail me now!

Mile 26.2: This is the longest 0.2 miles in the history of running. They must have measured this wrong. Ugh…it’s downhill and my legs are on fire. I hear cheers and see the carpet and Ironman logos. “Holly Smith, you are an Ironman!” Wow, that was awful….which one should I sign up for next year?


I ended up finishing 7th in my age group, 30th female, and 193rd overall in my fifth Ironman, minus the swim.  Still 142.2 miles is no joke.  And seriously, which one should I sign up for next year?




my first ironman duathlon

“Dear Ironman Chattanooga Athletes-

 Due to significant flooding and record-breaking rains that Chattanooga and the surrounding areas in Tennessee have recently experienced, IRONMAN and local city officials have determined that in the interest of athlete safety, it is necessary to cancel the swim portion of the 2018 Little Debbie IRONMAN Chattanooga triathlon presented by McKee A Family Bakery.”


This was the opening paragraph of the “Important Race Announcement” email that broke my heart.  My mind immediately went into angry, “poor me” mode. The race was in two days and I didn’t even realize this was going to be an issue. I had been spending more time at the pool and had really been looking forward to this fast down current swim, as this leg is my weakest of the three disciplines. And now, it was just over. I wasn’t going to be able to officially have a fifth full Ironman under my belt. Even though the race is still going to be over 140.6 miles due to the bike being 116 miles compared to the normal 112 mile bike distance, it still wasn’t going to be a triathlon. Just a stupid, 142.2 mile duathlon. My immediate reaction was to just not do it anymore, and the excuses started flooding my brain. I mean, I was still not fully recovered from the Barkley Fall Classic just two weeks ago and I was battling with foot pain that was affecting my running. I would have to make a five hour drive to Chattanooga, and miss the Lions play on Sunday (ok maybe that’s a bonus…). Plus, I have already done four other Ironman races, why should I waste my time on something that would have an asterisk by its name? But then I thought of all the training I had done up to this point, and how I wouldn’t be able to stand thinking about everyone out on the course Sunday while I was sitting at home feeling sorry for myself. And even though I am not an overly religious person, I also thought about a prayer. I remember when I was maybe 12 or 13 my dad gave me and my siblings a medallion with the beginning of the Serenity Prayer engraved on the back. He told us it was his dad’s, our Grandpa Smith’s, favorite prayer. It’s a simple prayer, but extremely meaningful. The first three lines read: “God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.” I have included the full prayer at the end of this post, but those beginning words have always stuck with me, and it seemed appropriate that they popped back into my mind at this time. There are so many things that we cannot control in life, and a lot of times we let those moments overwhelm us to the point that we don’t see all of the things that we can control. We let one set-back or disappointment define us, but if we just change our perspective a bit we should see that while many things are beyond our control, these circumstances can open up new opportunities. 


“God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.”


There are many things I cannot control about this, or any, race. Weather, flooding, other racers, the outline of the course-these are all aspects that I cannot change. But there is so much that I can influence, and really it starts with my attitude about tomorrow. Sure, to put it simply, it sucks that the swim is cancelled. But hey, I have never done an Ironman Duathlon before, so that’s pretty cool. I won’t have to worry about swallowing E.coli (no one likes drinking poop water), or getting kicked in the face during the swim. I get to sleep in a couple extra hours and my body will be fresh at the start of the bike leg and, even though its four miles longer, I could potentially get a great split! And it could really help my hydration and nutrition during the run without having that extra hour plus from the swim early in the day. I realize that it’s okay to be disappointed, but that shouldn’t prevent me from going out and enjoying this race and all it has to offer. Anyone that crosses that finish line tomorrow after 142.2 miles should be pretty darn proud of themselves. That is a distance few can cover, and while it won’t technically be a “triathlon”, I think everyone should still consider themselves an Ironman. Plus, it means that I just have an excuse to sign up for another one soon. And while my legs may still be a bit tired and heavy from the Barkley Fall Classic, I will do everything I can to prepare myself for Sunday. As I sit here in my Tennessee hotel room I am wearing my new favorite recovery tool, my Air Relax compression boots, and finalizing my nutrition and hydration plan for tonight and tomorrow to at least maximize what I can bring to the course tomorrow. I’m controlling what I can control.





FYI: These compression boots are amazing!

This goes far beyond just this race. No matter what your goals are, it’s important not to worry or dwell on the circumstances that you cannot control. You will never be able to control the weather, getting older, or what other people think, do or say. I may not have the endurance that I had ten years ago, and my body doesn’t recover the way it used to, but instead of wishing I was younger I am just going to work harder to push myself to MY limits, and no one else’s. There are always going to be people that are in better shape and much faster than me. Instead of thinking that I can never compete with or be them, I will continue strive to be the best athlete that I can be. I cannot control how other people view me or if they agree or disagree with my beliefs or opinions and that’s okay too.  I will focus on what I can control, because why waste your energy on what you can’t?




the serenity prayer

God grant me the serenity to accept the things I cannot change; 
courage to change the things I can; and wisdom to know the difference. 
Living one day at a time;
Enjoying one moment at a time; 
Accepting hardships as the pathway to peace; 
Taking, as He did, this sinful world as it is, not as I would have it; 
Trusting that He will make all things right if I surrender to His Will; 
That I may be reasonably happy in this life and supremely happy with Him
Forever in the next. Amen.











Disclosure: I have included links on this page to products I have used and mention in the post. If you click on these links and choose to buy these products I will receive a small commission. I only place products that I have used, trust, and recommend to give you a quick link, however I always recommend to shop around and compare retailers.







breaking down the trend “diets”

I find nutrition so intriguing. While pursuing my Bachelor’s degree in dietetics, I loved learning about the interaction of macro and micronutrients with the physiology of the human body. It was incredible how these little molecules could fuel so many reactions to allow us to perform day to day functions. That is why I find all of these new diets out on the market so interesting to research. I often hear people say “I’m Paleo” or “I’m Keto”, like it’s a defining characteristic. While everyone has their own reasons why they choose certain eating regimens (I hate the word diet), whether it be weight loss, performance, building muscle, or even just cultural beliefs, I think it is important to understand how you are affecting the bodies physiology. Let me briefly break down some of the new “diets” on the market today. This is not an in depth science course, but a simplistic way to better understand what these diets entail and my opinion on them based on my experience as a physician with a strong background in nutrition. There have been trials looking at how these diets may impact health and certain conditions such as cancer, heart disease, hypertension, and diabetes. I am not going to review these here but will discuss those in later posts. 


atkins diet

Let’s start out with the one that started it all out. The Atkins Diet is focused on low carbohydrate intake in phases. The goal is to deplete your bodies glucose and glycogen stores so that your body will turn to fat to fuel the body. I describe this in more detail below when I talk about the ketogenic diet, which is similar to Atkins but a little more intense. The Atkins diet is set up in phases. Phase 1 is the induction phase where carbohydrate consumption is limited to under 20 grams a day. In contrast, the average American consumes about 300 grams of carbohydrates a day. The foods recommended therefore are high in fat and protein. Phase 2 is the balancing phase where some low carb vegetables, and small amounts of fruit and nuts are added back into the diet as additional carbohydrate sources. In phase 2,  5 grams of carbohydrates a day are added each week until the dieter stops losing weight. At that point the individual is supposed to reduce the daily carb intake back down by 5 g until they start to lose weight again, thus “balancing” one’s carbohydrate intake. This does allow for more nutrient and fiber sources, but is still restricting many healthy food options. The average amount of carbohydrates in this phase is around 25-50 grams of carbs a day, still very low.  In phase 3, also called the fine-tuning or pre-maintenance phase, the dieter once again increases their carb intake by 10 grams a week until their weight loss again slows. Carb intake typically ranges from 50-80 grams a day here.  Phase 4, the lifetime maintenance phase allows the person to add a wider range of carbohydrate sources while monitoring their weight to ensure that they are not gaining weight. Carbohydrate intake is still low, usually no more than 100 grams a day. Whole grains and starchy vegetables are allowed, however still only in small amounts.

Just reading what I typed out above bothers me so much. This diet is basically saying to trick your body into thinking it is starving and then slowly add back more carbs…but not too much. Give me a break. First off, people cannot stick to this diet. Studies have shown that most dieters that start the Atkins Diet are no longer following it a year or so out and most stop a lot sooner than this do to low energy levels. I know there are people that will argue and say it works great and they have lost a ton of weight on it and that’s fine. I am happy this has worked for them. For most people, it is just not sustainable. In the induction period, yes, you will see the numbers on the scale drop. A gram of carbs holds four grams of water, (carbo-HYDRATE-get it?) so you will lose water weight for sure. But isn’t the goal to increase lean body mass, decrease body fat percentage,  and improve overall health?  Once you start adding carbs back into the diet, this water weight will come back, and that is why I suppose the diet incorporates that balancing phase. Also, yes your body will use fat for energy, but at the expense of your own energy levels, fluctuating hormone levels, and poor sleep. People often complain of constipation, headaches, fatigue and dizziness. I will discuss controlled trials on these diets in a separate post, but suffice it to say that while studies have shown increased weight loss in the first 3-6 months, there are no controlled studies showing long term benefits of this diet. 

ketogenic diet

The Ketogenic Diet was originally utilized to treat patients with epilepsy and seizures. Once the low carb craze started becoming widespread, the ketogenic diet, or keto, moved in as a sort of “low carb on steroids” diet. It involves eating an extremely low amount of carbohydrates and high proportion of fats. The breakdown of calories for most keto diets is 70% fats, 25% protein, and 5% from carbohydrates. As you can see, this is not even close to what the average human would eat with a normal balanced diet. If you are following this way of eating, you are basically taking the calories you would get from carbohydrates and swapping those out for fat, similar to the first phase of the Atkins Diet. 

So what kinds of foods are on the keto diet? The same recommendations as the Atkins diet, without the reintroduction of higher carbohydrate foods.  That includes plenty of high fat foods like red meat, eggs, dairy products, avocados, nuts, and oils. You are told to avoid carbohydrates like pasta, rice, oats, beans, root vegetables, and starchy vegetables. 

The reasoning for this is to put your body into ketosis, hence the name. This is basically a starvation state for the body. This is what is happening in the first phase of the Atkins Diet, however since you are not adding back some higher carbohydrate foods to this diet, the body is continuously in a starvation state. The preferred fuel for the body and brain is glucose, however when there are not enough glycogen stores around due to lack of carb intake, one is forced to use ketones, the by-product of fat breakdown, for energy instead. You may think “Great! I want to burn fat! This is perfect!” Except it’s not. The brain needs glucose to function, which is why you may have also heard people on keto diets talk about “brain fog” or “keto flu”. It’s not a fun thing and along with brain fog includes headache, chills, sore throat, digestive issues, dizziness, insomnia, irritability, and more. Also, in my medical career I have seen too many people in the hospital suffering from diabetic or starvation ketoacidosis to know that you cannot really maintain living off only ketones for energy for a sustained period of time without causing other metabolic issues. Additionally, there are no controlled studies showing long term benefit. In the short term, sure you may lose some weight. If you read my blog post title “Foods to Avoid to Lose Weight” you will note that I even dabbled in this diet for a short period of time. But I do not recommend this pattern of eating.  Don’t get me wrong, I think that the foods included in the keto diet- eggs, dairy, avocados, nuts, are all great foods. However I recommend them as part of a balanced diet along with fruits, vegetables and whole grains. 


paleo diet

The Paleo Diet comes from the word paleolithic, or the caveman era, and looks at what our ancestors ate before processed foods. Basically, anything a person would have been able to hunt or gather. The breakdown for a Paleo diet is about 30% of calories from protein, 35% from fats, and 35% from carbohydrates, so you can see the carbohydrate ratio is much more liberal than the above diets. Carbs are allowed, but really only in the form of fruits and vegetables. 

The Paleo diet includes fresh fruits and veggies, lean meats, fish, nuts, seeds, eggs, and healthy oils. There are also “foods to avoid” or “off limits foods” that include anything processed along with dairy, grains, vegetable oils, refined sugar, and legumes. While I do agree that processed foods and refined sugars should be limited in a healthy lifestyle, I do not feel that there should ever be “banned” foods. Also, this diet restricts you from extremely healthy options. The thought is that humans need to go back to the basics and what our ancestors ate is how our body was meant to process foods. In theory this sounds legitimate and I do feel there are some good components of this diet. I don’t think that this is something that has to be followed strictly however. There are plenty of healthy dairy products out there and by completely cutting this out of your diet you are limiting high calcium and vitamin D sources. Sure you can supplement or eat a truck load of leafy greens to try to compensate, but unless you have a real health condition such as lactose intolerance or Celiac disease, I do not see a reason to completely cut out dairy or whole grains. Banning whole grains and legumes also removes key fiber sources from the diet. It is just really hard for me to get on board with something that actually cuts out complete food groups.


The vegan diet is both a lifestyle and a prescribed diet, and I know a lot of people that follow this not just for the claimed dietary benefits but also because of other social, ethical, and environmental reasons. The vegan diet excludes all meat and animal products. This includes dairy, eggs, fish, and seafood. The diet allows fruits, vegetables, whole grains, legumes, nuts and seeds. There are different variations on the vegan diet however I am not going to go into detail on each of these here. Obviously the biggest things to worry about following a strictly vegan diet are nutrient deficiencies. Iron and B12 deficiencies are prevalent due to the lack of meat intake. By restricting dairy there are also issues with calcium and vitamin D sources.  This diet is another one that restricts whole groups of foods, and for that reason I don’t recommend to strictly follow a vegan diet as I do think there is a role for incorporating lean meats, fish, and dairy into healthy eating habits. However, if a vegan diet is being followed for ethical beliefs there are ways to supplement and combine protein sources to avoid dietary deficiencies. Another issue I have with the vegan label is that  I sometimes think people fall into the trap of seeing something labeled as vegan and assume that means it is healthy. I often see recipes posted online for things like “vegan” cookies or stores selling “vegan” chips. If you look at the ingredient list and nutrition facts for many of these foods they are not what you would consider healthy. Many contain high amounts of sugar and saturated fats, so it is important to always look at what products contain and not assume that if you are shopping at Whole Foods everything is automatically good for you. 

whole 30

 Whole30 is not a sustainable way of eating but rather  a 30-day program to determine which foods or food groups are causing intolerances in your body. Whole30 is complicated and comes with a lot of rules and off limits foods. Sugar, alcohol, grains, legumes, dairy, MSG, sulfites, pastries, or snacks are all on the “banned” list. You eat a lot of meat, fruits, and vegetables, but that’s pretty much it. I guess maybe you do it to see if you have food intolerances such as to gluten or dairy. However, I see no reason to go a month of your life being absolutely miserable to do this. I have seen people post about following Whole30 and feeling better than they have ever felt before. I will take their word for it, but I see no reason to follow this diet. If you think you may have a dietary intolerance you can slowly start cutting out foods that seem to cause your GI distress until you pinpoint the culprit. I see no reason to do it all at once since then you don’t know what was really causing your issues. You just cut everything out, how do you know what food was causing the problem?! Do I think its good to limit refined grains, sugars, and alcohol in one’s diet? Of course, but I don’t think it is healthy to feel guilty for having a glass of wine or a piece of bread. There again you’re losing that connection with emotional and mental well being as well. It is also a 30 day program and not a long term plan. But I guess this diet sells books and products so I’m sure we will continue to see it advertised. 


Bottom line

If you haven’t noticed already, I am not a fan of trend or fad diets. I do not believe that banning or restricting foods is going to allow anyone to lead a well balanced, healthy lifestyle. It seems that many have become caught up in the notion that less is more, and that the answer to weight loss and fitness is to completely cut out “bad foods.” But health is not just about food. It is about physical activity, fitness and performance, along with emotional and mental well being. If your diet is so restrictive that it is causing increased stress, limiting social interactions, or impairing your sleep and recovery, is this “diet” really benefiting you?

When patients ask me about what they should be eating, I always tell them that its not about dieting, but about a lifestyle change. That being said, I do feel that Mediterranean Diet is a good guideline to start with, more so because it outlines more of a lifestyle change than a restrictive way of eating. This includes whole grains, fruits, vegetables, legumes, along with healthy oils and fats. Fish and seafood are recommended a few times a week, and dairy, like cheese, are eaten in moderate portions. Red meats and sweets are also allowed just at lower portions. This eating pattern does not have foods that are “off-limits” or “banned.” It allows for discretion and enjoying food, but also being smart in dietary choices. Of course, these choices still need to be tailored to each individual based on one’s goals, and that is where meal planning comes into play. In addition, for elite athletes and those looking to improve performance, meal planning is going to be much different than those that are just starting on the path to fitness. There are tons of books out there with great recipes and cooking ideas to incorporate these eating habits into your life, such as The Complete Mediterranean Cookbook: 500 Vibrant, Kitchen-Tested Recipes for Living and Eating Well Every Day. 

So no matter where you are on the path to better health, don’t feel like you have to restrict yourself to achieve your goals. There are plenty of ways to incorporate great tasting foods without feeling guilty. I realize that we are living in the era of instant gratification, but if you are truly looking to improve your health, quick weight loss is not the answer. If you look at a diet and see that it is going to be a struggle to follow, chances are that you won’t be able to stick with it for the long term. Maybe you will see some weight loss in the short time you are able to adhere to it, but is that the goal? Health and fitness is something that is achieved and maintained over a lifetime, not a month.



30% protein, 35% carbs, 35% fat

 Okay: fresh fruits and veggies, lean meats, fish, nuts, seeds, eggs, and healthy oils.

 Off-Limits:dairy, grains, vegetable oils, refined sugar, and legumes



 70%fats, 25%protein, 5% fats

 Okay: high fat foods like red meat, eggs, dairy products, avocados, nuts, and oil

 Off-Limits:  carbohydrates like pasta, rice, oats, beans, root vegetables, and starchy vegetables


Atkins diet

 Similar to ketogenic diet, but in phases. 20 grams carbohydrate in phase 1 up to 100 grams a day in maintenance phase

 Okay: High fat foods such as red meat, eggs, dairy in phase 1

 Off-Limits: Carbohydrates like pasta, rice, oats, beans, root vegetables, and starchy vegetables. Gradually added back in later phases but at low levels



 No specific breakdown of calories into macronutrients

Okay: fruits, vegetables, whole grains, legumes, nuts and seeds

Off-Limits: meat and animal products. This includes dairy, eggs, fish, and seafood.