The Big Three: Forgotten Disciplines of Endurance Training

Over years of coaching/training (endurance) athletes of all types, I have seen a few common denominators consistently decrease performance amongst age group athletes of all abilities.

The mindset that “more is always better” can be the undoing of an athlete of any ability level. It has cut more than one season short for many athletes. Certainly, there has to be an emphasis on volume during the right time of the season, in the correct context of an overall training plan, and in a manner that fits into the athlete’s life. However, a consistent emphasis on more volume or higher intensity, can easily be the undoing of what could have been a fantastic season before it even gets started. In its truest form, successful training is about the right dose, at the right time, for the right person.

Keeping this in mind, the value of properly timed recovery enters the conversation. Exercise is stress to the body—trauma, if you will. Therefore, in order to maximize the benefit from any exercise, the body needs an adequate and properly prescribed recovery period following exercise-induced stress. Recovery takes many forms and meanings, and rarely includes sitting on a couch eating Bon Bons. However, there may be a time and a place for such a thing, believe it or not. Well, maybe not the Bon Bons… One thing is certain: without allowing adequate timing for adaptation (the body’s response to training load) to take hold, the body will eventually rebel in a manner that may present itself in one of a thousand different ways including: injury, acute and/or chronic fatigue, metabolic syndrome, or other symptoms that are detrimental.

Second on this list brings us strength training. This is a proposition at which many endurance athletes will balk. However, considering the dialog from above regarding recovery, training/exercise is stress/trauma to the body. If the body’s skeleture, musculature, and energy systems are not strong, something will give. Rarely, does a seasoned tri-athlete or ultra-distance runner need to swim, bike, and/or run more. Instead, a regular, strategically placed 20-40 minute strength session will prevent injury, increase mobility, muscle function and help maximize endurance focused training sessions. Speed is built on strength, not the other way around. Again: Successful training is about the right dose, at the right time, for the right person.

Third on my list is the “N” word. Yup, nutrition. Clearly, there is not enough room on this page to adequately address this one. However, a few of the common mistakes amongst age groupers, elites, professionals, experienced, and those coming off the couch embarking on their maiden voyage alike, commonly include: Not eating enough. Yup. You read that correctly. More than one athlete got started in the craziness of our sport as a means to lose weight therefore believing they should exercise more and eat less. Sorry folks, it doesn’t work that way. Actually, you should be eating more. However, more probably does not include the “Bon Bons” referenced above. It does, however, include eating more of the right foods at the right time to support the work you are doing and adequately fuel the energy system. And that brings me to the next nutritional error: Fueling the wrong energy system. I see this day in and day out with athletes of all abilities. This goes hand in hand with destabilizing blood sugar or creating a metabolically inefficient environment that plays a major role in limiting athletic performance.  If you’re performing poorly or even performing well and guessing at your nutrition, ask yourself how well you could perform if you were fueling your body correctly?

Who will the Future Doctors Be?

I worry about the future of medicine, of doctors in particular, as the healthcare laws, mandates and reforms continue to change and evolve. It seems to me that outside of clinical and bench research and resultant treatment advances, few of the healthcare changes are occurring for patient benefit and certainly none are for the benefit of the doctor.

The outcry for “Healthcare Initiatives” by government and lawmakers because of the continued escalation of dollars spent on individuals’ use of medications, hospital services and insurance coverage, is never ending. Unfortunately, government’s answer to the problem never focuses on the root issue and therefore their proposals for fixing the situation will never be successful. A patient recently asked me, “How will Trump’s election and health care changes affect you?” My answer is that regardless of what Trump does or doesn’t do, most assuredly the changes won’t benefit me or other doctors in any way. We doctors can only brace ourselves for the impact and hope it doesn’t hurt too much.

For decades, the answer to rising healthcare costs has been to reduce doctors’ reimbursement rates. Doctors who have had a large percentage of their patients come from poor communities or who depend largely on government subsidized reimbursement (Medicare/Medical/etc.) have had to close their practices or work for someone else, such as Kaiser Health System, in order to have a guaranteed income. Not only are reimbursement rates reduced yearly, which is analogous to being demoted or taking a pay cut every year, doctors are actually being PENALIZED for not participating in more paperwork that does not improve patients’ health and adds even more uncompensated time to our days and increases our overhead. For example, Medicare devised the PQRS initiative, which stands for “Physician’s Quality Reporting System” that supposedly improves patient care by having doctors fill out various questionnaires regarding aspects of patients’ care and medical screening whether they are related to an individual doctors’ treatment of the patient or not. Doctors are being penalized by an additional 6% or more back to 2013 if they have not submitted the required paperwork. Unless something changes, future penalties are already scheduled up to 2018 for paperwork not submitted this year. The PQRS does not improve patient health outcomes; it gives the government a reason to do more of what they’re going to do anyway—make doctors pay.

It is ironic to me that the Medical Doctor, as a career, could be careening down such a treacherous road. I was eleven when I decided to become a doctor. I was told that it was a very noble profession but that I would have to sacrifice much in order to accomplish that goal. I would have to study hard, spend many years in school, and delay gratification for at least twelve years longer than most anyone else who wasn’t trying to do the same. I was warned that I would have to work very hard once I became a doctor and that my nights and weekends would not be my own. I was assured, however, that the reward would be worth it. The reward would be prestige, respect, financial comfort and independence, to name a few. Disappointingly, the promised reward is becoming ever more elusive.

I enjoy being a doctor, despite the undercut reward because I am gratified by working hard, taking care of people and “doing good.”  Doctors are smart, kind people, who make decisions every day about how to best care for someone else. However, every person deserves to make decisions for their best benefit, especially if it concerns survival. I worry about what kind of people will become doctors in the future.The carrot should always be bigger than the stick and right now the carrot is shrinking at an alarming rate. The way it stands now, physicians are often the scapegoats and worker bees that businessmen and corporations oftentimes profit from unfairly. Government decisions are squeezing the very people who have sacrificed years of blood, sweat, and tears for their careers. Although I won’t quit, I for one would not make the same choice knowing what a doctor’s work and life would be like at this time. I am fearful about whether there will be any kind, compassionate, capable physicians when I need one in my old age. Despite all, I will remain hopeful that someday, smarter, wiser and gutsier politicians will step up and start looking out for the future of this country and its people.


Quality Sleep: A Must for Good Health


Infants 12-17 hours

Toddlers (1-2) 11 – 14 hours

Preschoolers (3-5) 10 – 13 hours

School Age (6-13) 9-11 hours

Teens (14-17) 8-10 hours

Adults (18-64) 7-9 hours

Older Adult (65+) 7-8 hours

The above recommendations assume that the quality of sleep is good, but in many cases it is not. Lack of sleep, or poor quality of sleep, can be dangerous, causing car accidents or job related injuries due to the slowing of your reaction time; relationship problems; poor job performance; memory loss; health issues and mood disorders. Lack of quality sleep contributes to heart disease, obesity, diabetes, Alzheimer’s, cancer and many more ailments.


  • Bad habits: Do you have irregular bedtimes? Do you drink caffeine drinks late in the afternoon or evening? Do you smoke or consume alcohol in the evening? Do you fall asleep with the TV on?  Do you allow time for digestion after dinner?
  • Mental Health: Depression, anxiety and post-traumatic stress disorder and the drugs used to treat these problems can all take away your ZZZZs.
  • Health problems: Chronic pain, arthritis, GERD, heart failure, thyroid problems, neurological disorders, hormonal imbalances and many medications can all interfere with sleep. Malnutrition can also play a role such as magnesium deficiency which can cause depression, mood changes and stress- like symptoms.
  • Sleep apnea and Restless Leg Syndrome: Not only seriously effects quantity and quality of sleep for the victim, but can also affect others.


  • Turn off the Tube. Additionally, video games and surfing the net late in the evening promote the “stay awake” mechanisms of the body.
  • Employ Bedtime Rituals. A warm bath and a book, a regular bedtime, peaceful music, learn relaxation techniques and meditation.
  • Exercise regularly, preferably not just before bedtime.
  • See your doctor. A sleep diary can help by keeping track of your bedtimes and waking hours, how long and well you slept, amount of waking times and how long you stayed awake, your emotions and stress level and a list of medications you take. 
  • There are several types of therapy available such as Relaxation Training, biofeedback to help control breathing, heart rate, muscle control and mood and cognitive-behavioral therapy to ease worries.
  • Ask your doctor for a sleep test. Sleep apnea is treatable by applying a CPAP or dental sleep appliance.  The change experienced, from the return of youthful energy and the return of memory, to better health and more, can all be as a result of correcting sleep problems.

At my office, the Advanced Oral Diagnosis and Treatment Center in Danville, we have delivered hundreds of dental sleep appliances with an amazing rate of success. Most medical insurances cover dental appliances for obstructive sleep apnea.  Contact us today to learn more: and 925-837-8048.

Healing Arthritis – From the Inside Out

Joint pain, known as arthritis, comes in many forms. The most common type is osteoarthritis, known as “wear and tear arthritis.”

Joint pain can flare up for a number of reasons—some of which may be overlooked by conventional practitioners. Many of my patients ask me if their pain is caused by arthritis. Sadly, it is estimated that one in five Americans has been diagnosed with some form or arthritis. There are over a hundred different arthritic conditions, rheumatoid arthritis and osteoarthritis being the most well known.

Rheumatoid arthritis is an autoimmune disease causing inflammation in the synovial fluid of the joint. Rheumatoid arthritis is most common in the hands and feet and is frequently accompanied by a hot or warm feeling in the joint, stiffness for over 30 minutes in the morning, the same joint affected on both sides of the body, polyarthritis (more than one joint affected at a time), and pain that can last through the night. With this form of arthritis, most of my patients notice the pain eases the more they use the joint.

Osteoarthritis, on the other hand, feels worse the more we exercise and as the day wears on. Also linked to inflammation, this type of arthritis can be traced back to a breakdown in the joint cartilage. It generally affects the hips, knees, spine, hands and feet and develops as more of a wear-and-tear situation, whereas rheumatoid arthritis is closely tied with genetic factors that lead to an autoimmunity problem.

What you need to know if you suffer from arthritis

 All forms of arthritis involve some kind of inflammation, either local or systemic. When injured, a chain of events in your immune system known as the inflammatory cascade is triggered.  This is what causes the redness, swelling and pain we often see with an acute injury.  When this process, known as local or acute inflammation, turns on and then off in response to injury it’s a sign of a healthy immune system. Yet when the symptoms of inflammation don’t disappear, it tells us that your immune system is unable to turn itself off when it should and therefore leads to a state of chronic inflammation.

How do I begin to heal my arthritis pain naturally?

Adopt a healthy diet rich in natural anti-inflammatories. Eat small meals often and choose a diet of richly colored fruits and vegetables, lean proteins, and pure omega-3 fatty acids. Remove foods that contribute to inflammation such as refined sugar, white flour/baked goods, canned or packaged foods.

Correct vitamin and mineral deficiencies. Vitamin, mineral and antioxidant deficiencies have been shown to suppress immune function and contribute to chronic degenerative processes such as chronic inflammation, arthritis, cancer, Alzheimer’s, cardiovascular disease and diabetes. Special blood testing can reveal what your body has absorbed from your food and/or supplements over the past six months and zero in on what is deficient. Micro-Nutrient Testing allows a person to know exactly what to eat and/or supplement in order to support their healing process. By correcting nutritional imbalances the body is given the building blocks it needs to naturally create its own anti-inflammatories and heal from the inside out.

Class IV Laser Therapy.  Ending the pain caused by arthritis requires stopping the cycle of inflammation. Class IV laser therapy is an excellent method for this, because it is presently the only modality that can both reduce inflammation and heal tissue simultaneously. Laser therapy creates an optimal healing environment that reduces inflammation, swelling, muscle spasms, stiffness and pain. As the injured area returns to normal, function is restored and pain is quickly relieved.

We have great success helping people solve the causes of their joint pain.  If you suffer from arthritis it is worth your while to spend some time figuring out which of any number of factors are contributing to your pain—and which combination of therapies will help heal it. The good news is,  you can do it without drugs, and you don’t have to give up any of the activities you love!

For more information or to set up a consult with Dr. Niele Maimone call 925.362.8283 or visit



Give Your Presence as Your Present

Regardless of your religious background or which family traditions flank your household during the Holiday Season, there is a ton of gift giving this time of year. First you agonize over which perfect gift to buy in the hope it will be loved, used and valued. Then there’s the mad rush of crazed, last minute shopping, dealing with long lines of generally frustrated cashiers and customers, over-crowded department stores blaring holiday music, and of course, spending too much money.

So, we give the present, most often in the midst of a hectic family get together, with way too much food, where wrapping paper is flying, and the actual gift that was exchanged has been overlooked. “Thank yous” are muttered, and then it’s on to the next gift. The entire process has flown by without so much of a pause, a moment of gratitude, or an intentional acknowledgment. Now, I know this scenario may not be true for all of you, and if it’s not, that’s fantastic! But for many of us, this accurately describes the days of get-togethers with family and friends during the holidays.

While I know this ubiquitous experience comes with both its positives and negatives, the universal sentiment is that it is often stressful, not relaxing, and sometimes not even enjoyable. The clean-up always seems to have underpinnings of “how can next year not stress me out so much?”

Well, one possible solution is to practice slowing down. Practicing mindfulness is about being present; being intentional and giving pause to the moments in our lives. All too often our daily life parallels those moments of wrapping paper flying and indulging in too much food; it all happens so fast that we aren’t present enough to even remember it. And the next thing you know the day is over and you were so stressed leading up to it, and so distracted during it, that you can’t recall the details to know if you even enjoyed it. The tools of mindfulness allow an antidote to this craziness. It’s about cultivating presence, starting with slowing down, breathing and acknowledging your current moment experience, allowing you to find joy and peace amidst the chaos of daily life.

The pace of our society does not support slowing down and being present. We are so accustomed to moving at an accelerated speed that we are often mentally onto our next task before even completing what we are currently doing. This even shows up in how we communicate – we are anticipating a response, and our response to that response, before the other person is even done talking, taking us completely out of what is actually being said! This failure to be present is not your fault; it’s unfortunately how we’ve been conditioned, and it isn’t benefitting anything or anyone. In fact, it does not help your productivity or your ability to focus. Studies show that multitasking in fact decreases our optimal brain functioning. And I truly believe the biggest consequence is to that of our relationships. When we are so crazed, busy, distracted and multitasking, our ability to connect diminishes greatly, which negatively affects ourselves, as well as the other people and relationships in our lives.

So, if you want to become more mindful and more present, then follow these tips:

–Slow down. Take a minute and just breathe.

–Be present. Be here now; look around, take it in, and breathe into the present moment.

–Communicate with intention. Make eye contact and listen with an open heart, non-judgmentally.

–Increase your awareness. Notice what is going on around you as well as what is going on inside of you (thoughts, emotions, sensations).

–Stop multitasking. Practice giving your attention to what is in front of you, especially when it is close family and friends.

–Put away your digital device. That email, text or status update will still be there, even if you don’t check it every two minutes.

If you could incorporate these tools into your daily life, coupled with utilizing your breath as an anchor to the present moment, your life will begin to feel more centered and fulfilled. And especially during the hectic holiday season—there are so many moments you can use as an opportunity to be here now. And that, quite possibly, may be the best gift you could give someone.

So forget about stressing about that perfect tie, sweater or picture frame. Allow your presence to be your present. Your friends and family will thank you for it.

If any of the above resonated with you, and it’s a pattern you’d like to change, I can help. The time is NOW to be more present and live your optimal life. (Though remember, it is a practice, and will not happen overnight – it takes time for your brain to learn new habits and patterns, and ways of being.)

Enjoy your holiday season!!

Joree Rosenblatt, MA, LMFT