Saturday, August 30, 2008  

Fasting Glucose 94
Weight 185
Blood Pressure, Resting Pulse 122/73, 66

I have never killed a man, but I have read many obituaries with great pleasure.   
        Clarence Darrow

Ah, cooler weather -- down to the 80s, anyway. I decided to risk a run today (not too long -- 4 miles), to see if my hip complained. It didn't, fortunately. I went to Spring Lake during the golden hour, just before sunset. I ran along the path around the lake, weaving around lots of other people who were there walking, running, cycling, pushing strollers, whatever. I love that time of day, particularly in the summer, when the heat of the afternoon suddenly vanishes, the wind dies, the hills around the lake turn dark blue on the west side and bright orange on the east, and the whole scene is reflected in the surface of the water.

Lots of Mexican families were making the circuit around the lake. Supposedly they arrive in this country healthier than the average American, and then develop big health problems when they adopt the American lifestyle (and abandon such sensible Mexican traditions as going for a walk after dinner). I guess the families I was seeing there tonight are the ones who aren't going to have their health ruined by the move to America. Anyway, it does me good to be wherever a lot of ordinary people are outdoors getting some exercise. The sedentary society we live in tends to make us feel as if exercise is a hobby, and a rather eccentric one. We need the reinforcement that comes with seeing that other people, normal people you might meet anywhere, are making it part of their lives -- even their family lives.

When people with Type 2 say "I can't exercise -- I have a family!", it makes me wonder what kind of lives their families are leading. Is the assumption that children, and adults who haven't been diagnosed with Type 2 so far, have no need to get out and move around in the fresh air? If so, the assumption is a bad one.

Friday, August 29, 2008  

Fasting Glucose 85
Weight 186
Blood Pressure, Resting Pulse 124/75, 58

We confess our little faults to persuade people that we have no large ones.   
        Francois de La Rochefoucauld

Because of my MHP (Mysterious Hip Problem) I decided not to run today; I went for a hike instead. My hip didn't bother me at all on that, and it was six miles or more.

It was hot, though not as hot as yesterday. About 95 degrees. I carried a Camelback water bag to make sure I didn't run out, and I pretty well emptied it, but I still ended up losing a lot of water weight. I'm just a sweaty guy, I guess.

I caught some pictures of the wildlife there -- deer and turkeys.

I could have got about a thousand pictures of lizards, too, if I had wanted to, but they like basking in the sun on hot rocks, and I was more interested in pushing on until I got to the creek trail, which is heavily shaded:

This picture makes it look a lot brighter than it actually is. It's a spooky, dark, Lord-of-the-Rings forest, but without the elves. About 20 degrees cooler than the rest of the park.

I've been thinking about the "anger" which a lot of people say they feel when they are first diagnosed with Type 2 diabetes. This puzzles me greatly, and not just because I didn't react that way to my own diagnosis. I can't make sense of it. Unless some wicked person found a way to make you diabetic, and deliberately did so, what does it even mean to say you're "angry"? Angry at whom? Angry about what? I don't see how anger enters into the picture at all.

I can understand how you can be angry over a problem such as a misleading highway sign, or a poorly-designed consumer product, or having your car stolen -- I mean, even though you don't know exactly who is responsible for things like that, you know that someone is, so your anger has at least a hypothetical target. But getting angry because you have diabetes? That I don't get. It's like getting angry because you have turned 40. Was somebody supposed to kill you when you were 39, so you wouldn't have to face this? For that matter, was somebody supposed to kill you before you became diabetic?

Well, the human brain is a mysterious thing. (I was going to say the human heart, but I think there's a consensus now that the brain is where our most absurd ideas and feelings are generated.) A lot of my own feeings are irrational, too; I just don't happen to share the particular kind of irrationality that makes people think the way to deal with health problems is to become furious at no one in particular.

Thursday, August 28, 2008  

Fasting Glucose 88
Weight 187
Blood Pressure, Resting Pulse 117/75, 65

Restore human legs as a means of travel. Pedestrians rely on food for fuel and need no special parking facilities.   
        Lewis Mumford

It was hot today (101 degrees in the early afternoon), which gave me some doubts about my plan to go for a trail run. I put it off until 4:30, by which point it had cooled to a mere 96 degrees. I swallowed as much water as I could stand to before I started, and hoped for the best. The trouble with trail-running, at least where I do it, is that once you start the run you're pretty much committed to it. That is, if you decide half-way through the run that you aren't feeling up to it, too bad. You still have to get back to your starting point under your own power. There aren't any taxis in the park, and there aren't any shortcuts either. Today, presumably because of the heat, the trails were almost deserted. At one point, about five miles in, I finally encountered another runner; as he passed he said "This wouldn't be a good day for a heart attack in here, there's nobody here to find you!". I said "I was just thinking the same thing about snake bite!".

I hadn't run since Monday. I was hoping that the problem with pain in my right hip, which started suddenly at the end of Monday's run, wouldn't recur. It did recur, in a milder form, quite early in the run, but I took a chance on continuing the run (on a long route, 8.3 miles) in the hope that it wouldn't get worse. It didn't get worse, it got gradually better. In the last mile I was feeling strong, and I wasn't hurting, so I sped up. Then, half a mile from the end, the pain came back, just as bad as it was on Monday. Damn! It always seems to be when I get cocky and start to speed up that problems like this bite me. It felt to me like muscle cramps around the hip rather than an actual joint problem. Whatever it is, I guess I'd better focus on cycling, swimming, or other non-percussive kinds of exercise, and give this myseterious problem some time to heal.

I was meditating on the subject of fatigue today. One of the things I had almost forgotten about my pre-exercise period (that is, pre-2001) is how tired I tended to be in those days. It is one of the great paradoxes of exercise: exercise consumes energy, yet it makes you more energetic. Generally speaking, people who work out end up having a lot more energy than people who don't.

I was never more fatigued in my life than when I wasn't working out at all. Now that I've been working out regularly for seven years (and some of my workouts are pretty heavy-duty affairs), I very seldom feel an urge to skip doing something because I'm too tired. In fact, the rise of "energy drinks" as a consumer product in recent years has puzzled me greatly, because I don't see lack of energy as a serious problem and I'm surprised that anyone does. In the days before I started working out, though, I might have seen the matter differently.

How do I feel right now, after having run 8.3 miles on rough, hilly trails in 96-degree weather? Not bad at all. Maybe a little tired, but it's a good tired -- it feels satisfying rather than exhausting. I guess that's an effect of the endorphins that hard exercise generates. And I'm sure that, in the morning, I'll feel perfectly capable of working out again -- although, because of the hip problem, it will have to be some kind of exercise other than running. Swimming, maybe, especially if it's not cooler tomorrow.  

Wednesday, August 27, 2008  

Fasting Glucose 93
Weight 187
Blood Pressure, Resting Pulse 125/76, 56

It's funny. All you have to do is say something nobody understands and they'll do practically anything you want them to.   
        J. D. Salinger

Despite the heat (it was 96 degrees this afternoon) I decided to go for a hike at Point Reyes. I figured today was a good opportunity to climb the big ridge with my camera and find that the view of the coast wasn't obscured by fog this time. I was right, there was no fog and the visibility was excellent:

For most of the hike, though, I was deep in the spooky woods, and mostly alone. It's Wednesday, after all, and not everyone is taking time off this week. I think I had a total of four encounters with other hikers during the entire loop. One of these was with a couple speaking French to their little girls. It's a silly reaction on my part, but it always makes me appreciate the attractions of the region I live in when I see foreign tourists here. If seeing this place is worth a long journey to them, I shouldn't take it for granted myself, should I? Encountering tourists can have an opposite and unpleasant effect -- sometimes the natural reaction of local residents is to smirk at anyone who is overly impressed by something which to them seems boringly familiar. I try not to let myself have that reaction. Better to envy, and try to recapture, the naive enthusiasm of someone who is seeing the sights for the first time.

Of course, to get to the ridge and gape at the Pacific coast, I had to climb a very long and steep trail through the woods:

Sometimes it seems as if you might as well get down on all fours, if the thing is going to be more vertical than horizontal. Because there was so much climbing, I counted this hike as my workout for the day (it wasn't really all that long, but it took a little over two hours to complete, and not just because of pauses to take pictures). I carried water with me, fortunately.

Somebody's figured out a way to make beta cells! Don't get too excited just yet, though, unless you are a mouse.

Beta cells are the cells in the pancreas that produce insulin. In Type 1 diabetes, an immune system reaction destroys these cells, and insulin production ceases. Type 2 diabetes is caused by loss of sensitivity to insulin rather than failure to produce it, but patients with Type 2 also tend to experienced a diminished capacity to generate insulin, either because overproduction of the stuff (to compensate for the loss of sensitivity) "wears out" the beta cells, or because high glucose levels in the blood have a toxic effect on the beta cells. So, whether you have Type 1 or Type 2, it might benefit you to be able to get some new beta cells into your pancreas.

The new technique involves infecting certain cells in the pancreas (cells which normally produce digestive enzymes rather than insulin) with a virus which transfers to the cells three genes which theoretically should cause them to start producing insulin, as if they were beta cells.

When this was tried in diabetic mice, it turned out that a little over 20% of the infected cells did, indeed, start producing insulin. They didn't produce enough insulin to cure the mice of diabetes, but the fact that it worked even partially is obviously promising.

An interesting detail: one of the researchers, Douglas Melton of the Harvard Stem Cell Institute, took up diabetes research when his infant son was diagnosed with Type 1 diabetes in 1993. He described himself as obsessed with finding a way to reverse the disease: "I wake up every day thinking about how to make beta cells". A practical advantage of the new technique is that it doesn't involve the use of stem cells (in other words, the research won't be hampered by politics).

A lot of potential problems would have to be worked out before this technique could be turned into a therapy approved for use on humans. And no doubt we will find, when the treatment finally becomes available, that it's really only available to the well-to-do. I guess that's where this becomes a political issue, after all...

Tuesday, August 26, 2008  

Fasting Glucose 88
Weight 187
Blood Pressure, Resting Pulse 119/75, 58

Refuse to be ill. Never tell people you are ill; never own it to yourself. Illness is one of those things which a man should resist on principle.   
        Edward Bulwer-Lytton

Today I was feeling no trace of the pain that hit me so hard toward the end of yesterday's long trail-run. Maybe the yoga session afterwards had a healing effect. It was odd how the pain was coming and going so abruptly -- more like a muscle cramp than joint pain, but the pain seemed to be very specifically located in the hip joint. It felt as if the joint was coming apart briefly, and then settling back into place. I don't get it. Whatever it was, it doesn't seem to be bothering me now, but I thought I best not to run today, in case some recovery time is needed. I went to the gym instead, and did a workout on a stair-climbing machine. Surely that puts some strain on the hip, but I didn't feel anything unusual -- not even a faint twinge. That seems like a pretty good sign. However, this hip thing has attacked me twice during long runs now. I'll be seeing my doctor in a few weeks, maybe he'll have some insight into it.

At least my blood pressure is staying down; that's good!

Researchers at the Mayo Clinic say that gastric bypass surgery (for weight loss) reverses Metabolic Syndrome, which is also known as Syndrome X (and is eventually known as Type 2 diabetes, once it gets that far). This was a study of extremely obese patients; some of them received the surgery, and the others got only counseling and supervision on lifestyle changes. In the non-surgical patients, the prevalence of Metabolic Syndrome declined only a little, from 85% to 75%; in the surgical patients it declined from 87% to 29%. The researchers concluded that weight loss was the factor that made the difference. The non-surgical patients didn't lose weight, and the surgical patients did; there weren't any other significant differences between the two groups.

In principle, it should be possible to lose weight without resorting to anything as extreme as stomach surgery, but as a practical matter, it seems that surgery is the only thing that works for a lot of people. I don't know what the long-term consequences of gastric bypass surgery are, but I guess that the risks involved in the procedure are not as serious as the risks involved in having Metabolic Syndrome and not doing something to get it under control.

Monday, August 25, 2008  

Fasting Glucose 94
Weight 187
Blood Pressure, Resting Pulse 119/80, 59

I don't believe in astrology; I'm a Sagittarius and we're skeptical.   
        Arthur C. Clarke

San Francisco is a fairly long drive from here, but I got my money's worth out of the trip; I got to play in two long music-sessions (one private and one at the pub). Playing music with good musicians is about as fulfilling a use of one's leisure time as it is possible to find in this world. Unfortunately, it doesn't count as exercise, so yesterday was a rest day. I hope I made up for it with the long trail-run I did today (9.3 miles).

During the last mile of today's run I suddenly developed a pain in my right hip -- the same sharp but intermittent pain that I felt in that same hip during that 10K race on the 4th of July. It slowed me down, but I kept running. When this happened in July, I recovered from it quickly; I hope that will be the case this time as well. I went to yoga class immediately after the run; maybe that will straighten out whatever was going on there.

I wasn't working today, so I went to do the trail-run a little early for a weekday -- at about 3:30 in the afternoon. If turned out that a high-school track-team was doing a practice run on the trails. They were on the same route as me, but going the opposite direction, so I saw a lot of teen-aged runners coming at me all through the route. None of them were carrying water, which struck me as odd, considering that the temperature was 87 degrees and the route was lengthy (and mostly remote from any water sources). I was carrying a water bottle, and drinking from it regularly. I wondered if the track coach, whoever he was, had a water station set up somewhere for these kids. Surely there had to be some kind of adult supervision involved here?

Eventually I found the coach, sitting at a picnic table in the coolest and shadiest part of the park (the only spot with a drinking fountain for more than 4 miles in any direction). One of his runners (who looked barely old enough to be in his first year of high school) was complaining to him that he had "run out of energy". The coach responded in the coldest and must inhuman voice this side of Dick Cheney, accusing the kid of staying up late every night and not getting enough sleep. Yeah, I guess that's the only reason why a kid might start to feel bad during a long trail-run on a hot day without a water bottle. Makes perfect sense.

I only had a brief exposure to this man, while I was refilling my water-bottle at the drinking fountain, but it was enough time for me to reach a pretty firm conclusion that he was scum. The sheer unpleasantness of the way he was talking to this kid would have led to bloodshed if it was between adults. There seems to be something inherently abusive (or at least abuse-friendy) about sports coaching. It's because of ding-a-lings like this guy that I think physical-education programs in the schools do more harm than good. They make athletic activity such a punishing experience for kids that many of them abandon exercise entirely as soon as nobody is in a position to force it on them any more. How exactly are these programs benefitting society? If their goal was to produce a sedentary adult population, they couldn't be doing a better job. But if that isn't their goal, I don't see that they have anything to be proud of.

A friend of mine recently taught me his method for making low-carb cookies (there's no wheat flour in them, and little actual sugar). I like them, and they certainly are lower in sugar and starch than other cookies; however, they aren't low in calories, because they aren't low in fat. I haven't yet done the nutritional analysis, but I've at least got the recipe together...

Mike Faircloth's Low-Carb Almond Cookies

Add to a mixing bowl:

Beat all these ingredients on low until well blended. While continuing to beat the mixture, gradually add:

Heat oven to 375. On an ungreased cookie sheet (preferably on a sheet of baking parchment) drop the dough in rounded tablespoonfuls, about 2 inches apart. Apply cooking-spray to a spatula and use it to flatten the balls of dough.

Bake at 375 until lightly browned (this could take anywhere from 10 to 16 minutes) 

From this recipe I got 40 cookies. They're highly seasoned cookies, and I can imagine some people wanting to back off on the nutmeg and cardomom, but I like that sort of thing. Use your own discretion.

Whether or not someone with Type 2 diabetes needs to be eating cookies, low-carb or not, is a question on which feelings might run high. I'm not advocating for cookies, here -- just saying that if you can't resist having some cookies in your life, these might be better for you than most others.

Saturday, August 23, 2008  

Fasting Glucose 92
Weight 187
Blood Pressure, Resting Pulse 117/71, 57

Anybody can sympathise with the sufferings of a friend, but it requires a very fine nature to sympathise with a friend's success.   
        Oscar Wilde

I think the recovery is beginning. I mean the recovery from the stress buildup of recent weeks. My blood pressure is down tonight. Perhaps more significantly, I went for an 8.3-mile trail run, and actually felt good during it.

I'd felt pretty lousy when I went running Thursday and Friday, and I was nervous about taking on such a challenging, hilly, lengthy run -- not knowing how I would feel once I was a few miles from my car and irrevocably committed to the route. To my surprise, I felt strong from the start. Even during the first five minutes (usually an interval of suffering for me, as my body reluctantly and painfully gets itself into exercise mode), I felt energetic. I warned myself not to get too complacent -- I hadn't hit the first climb yet. But the first climb didn't bother me. I warned myself that the second climb was much harder. That one didn't bother me either. And I knew everything after that would be easy. So I stopped worrying and enjoyed the experience.

It helped that I was there at Golden Time -- I didn't start till 5:50 PM, when the sun was getting low in the sky and the heat of the afternoon was coming to an end. It also helped that I ran into two separate herds (or flocks, or whatever the word is) of wild turkeys in the woods along Spring Creek. Just being in that canyon would be otherworldly enough, but to be sharing it with a bunch of silly-looking, feathery holdovers from the Jurassic era, marching in formation through the underbrush, was downright surreal. I loved it.

And when I finished the run, I wasn't tired. Not that I wanted to run farther than that, but I like to finish a run feeling as if I could  run farther if I needed to. Today I felt great. I hope I can keep that up.

Tomorrow I'll be driving down to San Francisco to play in an Irish music session at the Plough (an Irish pub). "Plough", I should mention, is the name that is given to the Big Dipper in Ireland, and is a popular name for Irish pubs. It's a long drive to San Francisco, but the quality of the music there is high enough to make it worth the trip.

Friday, August 22, 2008  

Fasting Glucose 85
Weight 187
Blood Pressure, Resting Pulse 122/75, 55

A person reveals his character by nothing so clearly as the joke he resents.   
        Georg Christoph Lichtenberg

Well, I'm done. The software release is as close to being ready as it's ever going to get with my help, and I'm taking next week off from work. I haven't got a plan for the week yet, other than to get rid of the tension that has been building up in me in recent weeks. Simply being away from the office helps with that sort of thing. I'll probably do a little hiking and camping, though not terribly far from home. Current fuel prices don't encourage long-distance travel. I don't think I'm going to be taking an impulsive jaunt to Ireland, as I did last September.

Today I had a hard time fitting in a workout; I finally managed to get out for a minimal run (about 3 miles). After work I went to the "Restorative" yoga workshop -- 2 hours of extreme relaxation. In some of the poses I was actually dozing off, and felt almost too tired and dopey to sit up and get into the next pose. I drove home slowly and carefully, like a drunk hoping not to be noticed.

My blood pressure is pretty good; not as good as yesterday, but pretty good. Let's see if I can make it better over the next week.

"Fasting plasma glucose levels within normal range independent risk factor for diabetes" reads the headline in Somone has done a study of people whose fasting glucose level is below the 100 mg/dl threshold of "normal', but only just barely. It turns out they're likelier to develop Type 2 diabetes than people who are in the lower part of the normal range. 

"Researchers from the Center for Health Research at Kaiser Permanente Northwest assessed 46,578 patients with fasting plasma glucose levels <100 mg/dL. Patients did not previously have diabetes or impaired fasting glucose, according to the study. Patients were divided into one of four groups based on their fasting plasma glucose levels: <85 mg/dL, 85 to 89 mg/dL, 90 to 94 mg/dL or 95 to 99 mg/dL."

The researchers followed up on the patients for a period of nearly seven years to see what happened to them. The result? The risk of developing diabetes increased by 6% for every increase of 1 mg/dl of fasting glucose. Patients who tested in the range of 95 to 99 were 2.3 times likelier to develop diabetes than patients who tested in the range of <85.

Apart from the first reaction which comes to mind ("well, duh!"), what can we say of this research? Well, maybe "duh" pretty much covers it. When a person develops insulin resistance, the body compensates for the problem, by releasing larger and larger doses of insulin. This not only compensates for the problem, it hides the problem. A glucose test can only tell you how much sugar is in your blood -- it can't tell you what chemical contortions the body had to put itself through in order to hold your blood sugar down to that level. It's only when this strategy fails completely, and your blood sugar rises significantly above the normal range, that we can say you have diabetes. But somewhere along the way, when the strategy is just about to fail, blood sugar starts rising a little. It's a lot likelier that you're in this state if your blood sugar is 99 than if it's 84.

That's not to say that everyone whose fasting level is 99 is going to shoot up to 199 a little later. However, everyone whose fasting level is going to rise to 199 is certainly going to have to pass through 99 along the way. Because everyone who is heading for diabetes is going to be at 99 before they're at 199, people who hit 99 are likelier to become diabetic later than people who haven't hit 99. In other words, duh! 

Thursday, August 21, 2008  

Fasting Glucose 89
Weight 187
Blood Pressure, Resting Pulse 115/67, 60

Not life, but good life, is to be chiefly valued.   

Well, this was the peak of the software-release crunch at work. All the things I fixed yesterday turned out to be working properly in this morning's software build. It doesn't look as if I have anything left to do on this release. I have to verify a few things tomorrow morning, but basically I'm done, and can go to work on bringing my stress level down. I'm planning to take some time off work next week; that should help. My blood-pressure reading tonight was down already.

After work I went to the state park and did a trail run, but it was a comparatively short one -- about 5 miles. I wasn't feeling good about running today, probably because I was so stressed-out about the work situation. Usually it takes me about 5 minutes to start feeling good on a run; today it took about half an hour, and even then I wasn't feeling like an athlete. My run tonight was just hard work, and therapy -- no fun to speak of. I couldn't relax and enjoy it. Well, I'll probably get better at that soon. Tomorrow night after work I'm going to another one of my yoga teacher's special Restorative Yoga workshops. It's basically just two hours of lying around and using various tricks to relax yourself. I really need it this time.

"Insurance gap leads some elderly to forgo medicine", reads the headline in Diabetes Today. It seems that about 15% of elderly people with chronic diseases are not buying the drugs that have been prescribed for them, simply because they can't afford them (an ugly feature of the Medicare drug-benefit program requires many people to spend $3850 out of pocket first, and apparently some elderly people don't have an extra $3850 burning a hole in their pockets). The percentage of patients who skip the medication varies with the disease being treated; if it's acid reflux, 20% of them go without medication; if it's Alzheimer's, only 8% of them do. For diabetes the rate is 10%. Apparently people are a little more scared of Alzheimer's than they are of diabetes. Whether they are right or wrong to see it that way, I don't know, but it's an interesting fact.

Anyway, a lot of people who need medication to manage their diabetes are doing without it for financial reasons. Maybe this is why I've been so resistant to the idea of treating my diabetes with medication: I don't want to become dependent on something which is expensive and which I might not be able to afford later.

It seems unlikely that I will never need medication, but if I can avoid becoming dependant on medication until very late in life, I will at least not be on a half-dozen costly medications at once by then. I don't want to be in a situation where I've been prescribed a long list of meds, and I have to make a decision about which of them it would be least dangerous to do without.

So, I guess I'd better keep running. And I'd also better keep doing yoga, so that I will be flexible enough to be able to continue running, and relaxed enough not to be pushing myself ever-closer to a heart attack.

It's a complicated thing, this healthy living, but in the long run unhealthy living is more complicated still. At least I'm not having to play medication-roulette.

Wednesday, August 20, 2008  

Fasting Glucose 93
Weight 187
Blood Pressure, Resting Pulse 126/74, 53

Almost all absurdity of conduct arises from the imitation of those whom we cannot resemble.   
        Samuel Johnson

A tough day at work -- we're closing in on the final software release deadline, which is tomorrow. As always happens in these situations, a lot of minor technical problems were discovered (and had to be solved somehow) at the last minute, under extreme time pressure. I was frantically correcting minor problems (mostly broken hyperlinks) all day, and trying not to let my blood pressure zoom out of control, as the number of problems to solve increased and the time available for solving them gradually disappeared.

Even so, I did manage to free up a block of time in the middle of the day to get out for a run -- and it was a substantial run, almost six miles and quite hilly. I knew I needed a hard workout today, if I was going to cope with everything that had to happen before I could go home. That my blood pressure was no worse than 126/74 in the evening tells me that I made the right choice there. Anyway, I did manage to solve the problems I needed to solve, and maybe the reason I was able to solve them (instead of sliding into ineffectual panic) was precisely that I did that hard workout, and was able to face the challenges of the afternoon in a comparatively relaxed state.

The big complaint everyone makes about exercise is that they can't find time for it in their busy schedules. When the going gets tough -- when they're dealing with a high-pressure day such as the one I had today -- they feel that they have no choice but to sacrifice their exercise program to the urgent demands of their schedule. Well, sometimes that can't be helped, but I think it's precisely when you're feeling both overscheduled and overwhelmed that exercise becomes most important. Going without exercise has a lot of harmful effects on people (and I don't just mean diabetic people); among other things, it increases tension, nervousness, fatigue, and frustration. When you aren't exercising, you're less able to function under pressure. A long workout can make you more effective the rest of the day, so in the final analysis it's a time-saver rather than a time-waster. Convincing your boss of that might be tricky, but simple observation will tell anyone who's paying attention that physically active people are generally better at getting things done. In any organization I've ever belonged to, the star players are also the most physically active people.

If you haven't yet tried daily exercise, it might seem to you that doing it would make you feel tired and listless, not lively and alert, but that is the great paradox of exercise: burning a lot of energy makes you more energetic rather than less. Even when I'm doing unusually heavy-duty endurance exercise, I feel less tired than I used to feel when my greatest exertion was getting into and out of chairs.

Of course, other forms of stress-relief are always welcome. Tonight I went to play in an Irish music session at a local pub. It was a good session, very satisfying musically. I was playing next to a woman who's a violinist with the local symphony orchestra, but has become interested in learning Irish music. It was funny how timid she was about starting tunes (usually telling me what tune she wanted to play, but asking me to lead it). I'm not remotely as good a player as her in terms of technique; she knows her way around the instrument better than I ever will. But she's now she's playing music in a style that is familiar to me but very unfamiliar to her, so she feels like a beginner, and is looking to me to show her the way. Even the most accomplished people can get into situations where they feel this way. The thing is, accomplished people are the ones who willingly  get into situations where they feel this way. That's how they become accomplished people. Playing it safe, doing what's familiar, doing what you already know you can do, is for losers if you ask me. What we call "talent" is often no more than an unusual willingness to work on difficult assignments, even at the risk of embarrassing yourself.

Tuesday, August 19, 2008  

Fasting Glucose 86
Weight 187
Blood Pressure, Resting Pulse 125/73, 57

He has no enemies, but is intensely disliked by his friends.   
        Oscar Wilde

Well, that's a little more like it. After my weekend of indulgence (with no workout at all on Sunday, and nothing more intense than walking on Saturday), my fasting glucose yesterday morning was 100; after a gym workout last night, followed by yoga, my fasting glucose today was all the way back down to 86, where it had been on Friday. And the weekend bloating is also in retreat, with my weight down to 187 already. Nobody's going to tell me exercise isn't important! Even my blood pressure is falling, though not as much as I wanted it to. As the software-release crisis at work winds down (and it's winding down fast now), I should get my blood pressure below the 120/80 target soon enough.

I did a run at lunchtime, but I only had time to fit in a 4-miler. I'm hoping to do a longer one tomorrow, maybe 6 miles.

I have my annual physical coming up. It's on September 11, but I'm hoping it won't be as fateful as that date suggests. At least it's not Friday the 13th.

More data is coming in on the obesity epidemic in America. Results from a study on obesity were released today by the Trust for America's Health and the Robert Wood Johnson Foundation. Some factoids:

What intrigues me about these statistics, and the statistics on heart disease I mentioned in yesterday's blog, is that in the face of all this there are still people claiming in print that (1) there's no evidence Americans are really getting fatter, and (2) there's no evidence that being fat is unhealthy.

I used to be about 65 pounds heavier than I am now, and I know perfectly well that carrying that weight did a great deal of harm to my health. Some of that harm I hope I've been able to repair, but I know I would have been a lot better off, then and now, if I'd never gained it in the first place. A lot of what I have to do now would be a lot easier.

I guess I've become like an ex-smoker railing against tobacco, but it makes me angry when people try to pretend that being fat is harmless, and try to make it into a civil-rights issue instead of a medical one. Face it, folks, it's a medical issue. A complicated and difficult medical issue, perhaps, but a medical issue nevertheless.

Monday, August 18, 2008  

Fasting Glucose 100
Weight 190
Blood Pressure, Resting Pulse 128/81, 50

Good advice is something a man gives when he is too old to set a bad example.   
        Francois de La Rochefoucauld

There's no mystery at all about the sudden jump in my fasting glucose and weight. It was a party weekend, pretty much from start to finish. I spent all of Saturday in San Francisco and Sausalito with visiting family, and most of what we did centered around food and drink. Very fine food and drink, to be sure, but much more of it than I'm used to, and more of it than is good for me. Sunday I spent with musician friends, and once again everything revolved around the dinner table.

I did a lot of walking over the weekend, but I didn't manage to fit in anything more strenuous. So, I'm feeling bloated and guilty today, but I'll recover. I did a gym workout today, and yoga in the evening, and I'm planning to do a run tomorrow -- if possible, a long trail run in the evening; if that can't be worked out, I'll have enough time for a 4-miler at lunch. I'm sure I can bring down my numbers pretty quickly. Well, my glucose numbers anyway; my weight is tougher to rein in. For whatever reason, my weight is capable of making sudden leaps upward, but it can only be dragged down an ounce at a time.

My blood pressure is up too, but I think the stress I'm going through over the software release I'm involved in at work is contributing to that. Well, I should be through the worst of that soon, so I'll get control of blood pressure soon as well.

I guess I wasn't being a very good role model this weekend, so I'll have to set a good example of actually doing something about the situation when the numbers start moving the wrong way. The whole point of collecting data on yourself is that it gives you a timely warning that you're drifting off course, and had better make a correction.

Researchers at the National Heart, Lung, and Blood Institute in Maryland have announced the results of a study of the lifetime risk of developing heart disease. Here's what they say are your chances of developing heart disease at some point in your life, if you're a woman:

And here are your chances if you're a man:

Apparently it doesn't pay to be a man. However, under most circumstances, you don't get to make a choice about that. Gender aside, what really pays is to control the factors that are controllable.   

Friday, August 15, 2008  

Fasting Glucose 86
Weight 186
Blood Pressure, Resting Pulse 120/66, 72

He was happily married - but his wife wasn't.   
        Victor Borge

My running partner had to cancel on the trail-run we planned for this evening, and she proposed running at lunchtime instead, but I didn't have time then, so I did the evening run alone. By then the temperature had dropped from 87 to 80, which was helpful. It was also helpful that I chose a shady route. But it was certainly a route with a lot of climbing in it, and it was 8.3 miles. Fortunately my stamina held up.

When I was near the end of the run, and cutting through a community park, I heard my name called, and saw a familiar couple approaching me from an adjacent walking path. It was another one of my running partners (he's the one who talked me into doing my first marathon, and more recently did a 70-mile triathlon), out walking the dogs with his wife. He said he was lucky to be able to go for a walk at all; apparently he was hit very hard by a virus earlier in the week, and when he tried to go for a walk yesterday he only made it across the yard before he had to sit down for a good long while. He said it was strange, less than a month after completing that triathlon, to find himself so weak that he couldn't walk a hundred feet. Well, viruses come to all of us, and sometimes they knock us completely flat, but some people recover from them a lot faster than others. He actually looked fine, and if he and his wife hadn't told me how sick he'd been earlier in the week I would not have known. If he didn't work out so much, I bet he wouldn't be able to recover so fast.

I managed to get through the 2007/2008 flu season without getting sick. Not to say that I didn't feel a virus coming on, more than once; the week before the marathon in March I thought I was about to succumb to a fever. But in each case I fought it off somehow, and never got sick enough that I needed to take to my bed, or take time off work. Before I started my exercise program, I was not nearly so good at avoiding illness. I would usually get one or two severe, prolonged fevers every winter, and these were extremely debilitating. My immune system just wasn't strong enough. Any virus could take me on and win. I'm not such an easy mark these days; it seems to be one of the many benefits of frequent exercise.

A new study has shown that treating Type 2 diabetes with mutliple drugs seems to increase the patient's risk of dying. This at a time when many doctors are pushing the idea of putting all Type 2 patients on multiple drugs right from the time of diagnosis. Unfortunately, a treatment for diabetes is generally regarded as "effective" if it reduces blood sugar, even if it shortens the patient's life in the process, so I don't think enthusiasm for the drugs-and-more-drugs approach to diabetes is going to be dampened by one more study showing that it's risky.

Thursday, August 14, 2008  

Fasting Glucose 92
Weight 186
Blood Pressure, Resting Pulse 127/76, 57

A hypocrite is a person who...   but who isn't?   
        Don Marquis

I did another shortish run (4.1 miles) at lunchtime today, but mainly because my work schedule was tight today. I felt better this time, and could have run farther. It was a little cooler, about 85 degrees.

I'm a bit stressed-out about the way the software release is going at work, hence the uptick in my blood pressure. 127/76 is not that bad, but I've been doing significantly better than that lately, and I wish I could continue it even during stressful times. Getting a software release finished is about like trying to get a big special-effects movie finished, but not quite that easy. At least, when you're trying to get a movie finished, your're probably not trying to coordinate your efforts with people located in California, Washington, China, and India -- I was exchanging frantic e-mails with people in all those places today.

Tomorrow, instead of running at lunchtime, I'm planning to go trail-running after work. (Memo to self: don't forget to bring the emergency sugar supply this time.) Sad to say, the prolonged sunlight of summer evenings is already receding. Sunset is at 8:05. Not that we can't get in a good long run and be finished by then, but not long ago, when the sun was setting at 8:40, you didn't worry about the timing at all. And, of course, you ideally want to do a run that you can finish well before sunset. The local park where we do this is so full of trees and steep hills that the trails can get pretty dark long before the sun has officially gone down. For the sake of safety and mental comfort, it's not a great idea to be out there on deserted trails when darkness is falling and everyone else has gone home. We have certainly done trail-runs in the springtime in which we carried head-lamps, and used them, and were glad we had them as we completed the final mile. I guess I have mixed feelings about this: there is something distinctly creepy about running through the woods when no one else is there and it's getting dark. There is also something distinctly appealing about it. A sense of adventure, I guess, achieved at a very small cost in increased risk.

My neighbor has advised me not to worry if I hear gunfire in the night. He and his wife have been engaged in a lengthy war with a huge rat which has been visiting their back porch lately. They've made repeated attempts to trap it, and to poison it, without success. Now he is keeping an evening vigil on the back porch with a gun. He tells me the gun will be pointed away from my house, and that the bullets are small. (Apparently there is ammunition designed specifically for rodents; in my world that's called niche marketing.) Well, I wish him success with the rat. If he ever bags it, I'm going to advise him mount its severed head on a pole, as a warning to other rats. I don't like those creatures, and "Ratatouille" didn't change my feelings one bit in that regard.

Wednesday, August 13, 2008  

Fasting Glucose 89
Weight 186
Blood Pressure, Resting Pulse 113/61, 56

People are more fun than anybody.   
        Dorothy Parker

The Angel Island trail run on Saturday had an official photographer, and he caught these pictures of me coming to the top of a steep hill and trying not to look winded. Behind me is Tiburon in the distance. Behind the photagrapher is a brilliant white wall of fog hiding San Francisco from view.

I ran again at lunchtime today, although the temperture (just under 90) made it a bit challenging. I only ran 4 miles, and I carried water with me, but I still had a hard time of it. The hills wore me out, and I felt exhausted at the end. I also had the usual problem of continuing to sweat profusely for about 45 minutes after the run was over. Unfortunately, it's forecast to be hotter tomorrow. In theory, the smart thing to do would be to get up early and run (or work out at the gym) before work, and before the temperature climbs. Getting up early is not one of my strong points, unfortunately.

In the dLife discussion forum, people have been chatting about glucose-testing, and disagreeing about how important it is. I had been assuming that the importance of testing was self-evident, and I was first startled and then depressed to learn otherwise.

There is a certain kind of diabetes hard-luck story, almost a literary genre unto itself, in which the patient stops testing his glucose (because he thinks he has it so well under control, there's no need to check). Then his glucose climbs heavenward, without his realizing it, and by the time he checks again, the situation has gotten so far out of control that there's no way to undo the harm he's done himself. It seems to me pretty obvious that this sad story could happen to any of us, if we stop taking in feedback on what's happening with our glucose levels. Certainly it could happen to me, even though I've been doing a pretty good job of controlling my glucose for over 7 years. Good habits and good intentions are important, but they're not enough -- you also need good data. People need feedback to stay on course. Knowing where you're driving is no substitute for headlights.

The list of factors that are known to affect glucose levels is very long, and many of these things are not directly observable. For example, both your insulin sensitivity and your insulin production can vary over time, but you can't perceive these changes. Therefore, your inuitive sense of what you can and can't get away with at the dinner table is not to be relied upon over the long term. It takes a surprising and disturbing glucose test result to jolt you out of your complacency, and make you reconsider your assumption that a stack of pancackes no longer presents a glucose-management challenge for you.

I've been told there is a research study proving that, if you have Type 2 rather than Type 1, and you're not taking insulin, it doesn't make any difference whether you test or not. Patients do about as well, or as badly, either way. This study is often mentioned by people who don't want to test, but I'm not absolutely sure which study they mean. It's probably this one, which turns out to be a cost-benefit study; it concludes that testing frequently is more expensive, has a negative impact on "quality of life", and produces so little reduction in the average patient's hemoglobin A1c results that testing simply isn't worth the money. This sort of study may serve the purposes of health insurance companies (which don't want to cover the cost of test strips), but I don't think patients are being especially well-served by it. As far as I'm concerned, the study only proves that a lot of diabetes patients test their blood sugar and, when the results are bad, do nothing about it. That mournful fact shold not be used against those of us who test our blood sugar and, when the trend is not favorable, figure out something we can do that will get the numbers moving in the right direction.

Everyone takes it for granted that a corporation is supposed to have an accounting department, that it is supposed to gather data on things such as income, expenses, and market share, and that it is supposed to take corrective action when the numbers are heading the wrong way. True, a lot of companies do all this and still fail, but that is never offered as a reason for companies to give up on accounting and try to get by on good intentions alone. Collecting financial data isn't a sure path to success, but not collecting it is way too dangerous, so companies continue to collect data, and adjust their business plans when the numbers change. Shouldn't this self-correcting approach apply just as much to the biological health of a person as it does to the financial health of a business? 

Tuesday, August 12, 2008  

Fasting Glucose 83
Weight 185
Blood Pressure, Resting Pulse 113/67, 59

Happiness is good health and a bad memory.    
        Ingrid Bergman

Another warm day, but a few degrees cooler this time -- in the low 80s. Yesterday at lunchtime I did a 5-mile run, and had a hard time cooling down afterwards. Today it was 4.3-mile run, and less hilly, so I recovered from it a bit better.

For dinner I made a miso-based vegetable stew, with brussels sprouts, broccoli, leeks, and tempeh (a traditional fermented soy food that's less bland than tofu -- more nutty in flavor). I tend to like brussels sprouts a lot better when they're small; I buy the smallest ones I can find, and cut them in half before cooking them. It worked for me this time; the stew made a satisfying dinner, perhaps all the more so for having a small number of ingredients. Vegetables can actually taste good if you let them; usually we cook as much flavor out of them as we can, and then hide whatever flavor is left with a bunch of added ingredients.

I have an annual physical exam coming up in a month. My doctor sent me the paperwork for the lab tests I'll take prior to the office visit, and I checked out the form to see which tests he ordered for me this time. He checked three boxes:

Notably unchecked was the box for "Hemoglobin A1c". I haven't had an A1c test since 2006, when I measured 5.4, which wasn't a personal best but nevertheless fell within the normal, non-diabetic range. Based on that, my doctor didn't think I needed the test in 2007. Now he has apparently decided that I don't need it in 2008, either.

His confidence pleases me, of course, but it also worries me a little that I'm not going to get an A1c this year. Most diabetes patients get the test twice a year or more. According to my doctor I'm not really diabetic anymore, so I don't need the test, but there's no guarantee that I won't become diabetic again, and the problem might very well sneak up on me when I'm not looking. I still do a daily fasting test, but (apart from an experimental period early this year) I'm not doing post-prandial tests now, and even if I were, it's possible that I could develop a problem with my blood sugar going high in the middle of the night, and never know it without an A1c test result to warn me that something was going wrong.

Certainly there are Type 2 patients who continue to get good results on their fasting tests (as I do), while shooting up to very high levels at other times. I have never exhibited a tendency to do that, but I suppose I might start heading in that direction, somewhere along the way, and an A1c test would be my opportunity to find out that it was happening.

Well, I'm not going to fret about it too much right now, but I suppose I might do a little bit of random testing at unusual times, to make sure that nothing strange is going on while I'm not looking. It may be that my doctor thinks I'm doing that already, and that's why he thinks he doesn't need to give me an A1c. He didn't always have such high confidence in me (and for good reason), but now that he does I suppose I should try to live up to it.

Monday, August 11, 2008  

Fasting Glucose 92
Weight 185
Blood Pressure, Resting Pulse 122/71, 54

Not to be absolutely certain is, I think, one of the essential things in rationality.   
        Bertrand Russell

Well, I did the Angel Island trail run -- but not exactly as planned. Most of the runners signed up for the 12K run (one loop around the island); a smaller number signed up for the 25K run (two loops). My running partner and I signed up for two loops, but weren't exactly sure we were ready to run both. Especially after we got off the ferry and looked at the extremely vertical hills we would shortly be climbing...

As you can more or less tell from this picture, it was clear on this side of the island and foggy on the other (notice the fog spilling over the ridge line at the upper left). This meant that, after we climbed to the top, we didn't get the usual views of the Golden Gate Bridge, Alcatraz, and San Francisco. On the other hand, there was clear air around Tiburon and Sausalito, so the harbors there were brilliant oases of sunlight and color in a sea of pale gray. I wish I had been able to photograph that scene on the run, but I didn't want to have my camera with me while I was running. If there's one thing you don't want to have on a long run, it's a heavy dense object to bounce against you all the way.

Because the ferry was late, and the run started 40 minutes later than planned, my running partner was worried about the schedule. She was attending an afternoon party that day and didn't want to be late for it. She was very tentative about the second loop. After climbing all those hills, I was pretty tentative myself. I thought that I should be a good sport, and run the second loop if she was going to, but I sure didn't feel like it. She finally decided, as we were finishing the first loop, that one loop was as much as she had time for. I can't tell you how relieved I was.

I hadn't done any run longer than 9 miles in five months, but the 15-mile distance wasn't what daunted me; it was the prolonged climbing. I had found the climbs exhausting during the first loop, and I wasn't sure I had enough gas in the tank to face doing them all again. So, with great relief, I called it a day after the first loop.

Given that the course we ran was 7.5 miles and extremely hilly, it wasn't exactly a wimpy workout, but it wasn't the challenge I had planned to take on, either. Well, sometimes it doesn't pay to take on a challenge you're not feeling ready for. I had signed up for the run on a last-minute impulse, and hadn't done any special training or psychological preparation for it. I'll just have to be more prepared the next time I sign up for something like this.

Friday, August 8, 2008  

Fasting Glucose 91
Weight 186
Blood Pressure, Resting Pulse 110/66, 58

No one can have a higher opinion of him than I have, and I think he's a dirty little beast.   
        W. S. Gilbert

I was wondering what sort of weather we're likely to have for the Angel Island trail run tomorrow morning (it's been sunny here, but is it fogged in there?), when my running partner pointed out that there's a web-cam on the island and we could check. So here's how things looked this afternoon:

Doesn't look too fogged-in today. With luck, it won't be tomorrow either. If this picture suggests that the island is flat, let me assure you that it isn't. From the ferry landing, the roads and trails climb over some very steep hills:

Once we make the climb, we'll get to the scenic southwestern side of the island, with great views of the Golden Gate bridge...

...and the San Francisco skyline:

I bought some new trail-running shoes today, but I'd have to be crazy to try them out on a 25-kilometer course. You need to break them in a bit before you can use them on such a long run. I'll have to use my old ones, even though they look pretty ratty.

I'm going to carry a water bottle, and also some sugar in case I start to feel like I need it -- which is pretty likely, as the distance is about 15 miles and it's on a rough, hilly trail.

It's an organized run, and the organizers provide food after the run -- including some very good banana-bread that the race director always makes. One of the upsides of doing endurance sports, if you're a Type 2 diabetic, is that it gives you a much better excuse than you'd ever have otherwise to spend some time grazing at the snack table. After you've run 15 miles, nobody can tell you you're not entitled to your cookies.

Thursday, August 7, 2008  

Fasting Glucose 85
Weight 185
Blood Pressure, Resting Pulse 123/72, 62

I didn't attend the funeral, but I sent a nice letter saying I approved of it.   
        Mark Twain

A beautiful day -- sunny, clear, calm, and only 70 degrees. I got out for a run at lunchtime; a slightly longer one than yesterday (4.5 miles).

Now that I'm signed up for that 15-mile trail run on Angel Island on Saturday, it suddenly occurs to me that that's a pretty long distance to run, and that I haven't done anything that long in a good while. In fact, I don't think I've run anything longer than 9 miles since the Napa Marathon in March. I still feel pretty sure I can do it, but I'm glad that it's a two-loop run. If I'm not feeling strong when I finish the first loop, I can call it quits right there -- I will already be at the finish line.

Which reminds me of what happened last time I ran in this event, three years ago. The picture I posted on Tuesday of myself in that race was taken early in the race. The picture below was taken near the end of it, and close examination will show that something must have happened to me along the way...

I was just about to finish the first loop when I finally got to a part of the trail where the ground was very smooth, and I didn't have to worry about tripping and falling. So I relaxed, and put on a burst of speed. And that, of course, was when I tripped on a rock and went flying. I landed on my right side, which is fairly obvious from the picture above if you note the dirt caked heavily on one side of my arm and one side of my head. (My right ear scooped up enough dirt to plant a petunia in.) When I picked myself up off the ground, I found that I had a bleeding scrape on one knee, and that I was hurting and feeling stiff everywhere. And the toe that hit the rock in the first place was throbbing. The obvious thing to do was to hobble to the end of the first loop, call it a day, clean my wounds, and wait for the ferry back to Tiburon.

But when I got to the finish of the first loop, I became convinced that I would feel better if I continued the run than if I gave up on it half-way through. Sometimes, if you get a minor injury during a run, it's therapeutic to keep going, and very untherapeutic to give up. I don't know whether the problem with quitting is simply that it makes you feel like a loser, and this is bad for your health, or whether the continued exertion does something that promotes healing, but over time I have developed a strong prejudice against quitting just because I've hurt myself a little. The one time that I hurt myself more than a little, I did give up on the run, but since then I've become pretty good at not falling down while trail-running, and I hope I can continue that trend on Saturday.

I suppose you might wonder why I would want to run the Angel Island race again, considering that the last time I did it I took a bad fall and ended the day bleeding and filthy. Well, here are my reasons:

And so, to be honest, my biggest concern now is that I won't get up early enough on Saturday morning to make the ferry on time. If I can manage that, the rest of the day will take care of itself.

Wednesday, August 6, 2008  

Fasting Glucose 79
Weight 185
Blood Pressure, Resting Pulse 116/66, 63

Before we set our hearts too much upon anything, let us examine how happy those are who already possess it.   
        Francois de La Rochefoucauld

I got out for a run at lunchtime today. Not too long a run (4.1 miles), but there was a long steady hill-climb in the middle of it that made it tough. It seemed hot to me; imagine my surprise when I checked and found that it was only 73 degrees. Funny how hot the weather seems to get whenever I run uphill.

My weekend camping trip, during which my calorie intake shot up but my weight and blood sugar didn't, has set me thinking about how active I really am most of the time (not very!), and how much of a difference it makes just being on your feet a lot instead of sitting down.

I work out pretty hard, so I like to think of myself as active, but the reality is otherwise. I'm not active at all between workouts. I spend many hours a day sitting in front of computers, both at work and at home. During the camping trip, I was hardly sitting at all. I was on my feet most of the day and much of the night. As we were a large group, scattered across multiple campsites, I found myself wandering around the vicinity constantly, often fetching something from my tent or my car. Even a brief visit to the bathroom meant going for a walk. Even conversation mostly took place standing, not seated. So, even though I was only working out during a small part of the weekend, I was up and around for almost all of it.

And wouldn't you know it, someone has done a scientific study of this. An article on Science Daily website entitled Fidgeting, Moving Around Key to Why Some Don't Gain Weight reports on some research done by the Mayo Clinic in 1999. They closely observed and measured a group of volunteers who overate for 2 months, taking in 1000 extra calories a day, to see how different people were affected by the surplus calories. Not surprisingly, they all gained weight. A bit surprisingly, some gained far less than others -- as little as 2 pounds, when the average was 10 pounds and some people gained as much as 16. So what happened? It turns out that the Mayo Clinic wasn't just monitoring weight and body fat and other physiologic phenomena. They also monitored behavior, and they found that some people responded to the increased calorie intake by increasing their physical movement during ordinary daily activities; they fidgeted, they paced, they wandered. And in the process, they burned off most of the surplus calories they were taking in. Those were the people who gained very little weight. Those who showed no increase in physical movement were the ones who gained a great deal of weight.

The Mayo Clinic researchers invented a term for this restless, fidgety behavior: they called it NEAT, for Non-Exercise Activity Thermogenesis. (Thermogenesis refers to the heat produced by any kind of calorie-burning process within the body.) In studying what happened to the extra 1000 calories the subjects took in, the researchers found that, on average, it broke down as follows:

Again, 33% was the average for NEAT. For those who fidgeted and wandered around the most, NEAT accounted for 69% of the surplus calories, not 33%. As the digestive process and basal metabolic rate weren't significantly affected, that didn't leave a lot of surplus calories to be turned into fat, so the fidgety test subjects gained little weight.

It seemed that there was a kind of "switch" that was thrown in some people when their calorie intake increased; they became restless, and their body motions burned off most of the extra calories. In other people, the switch was never thrown, their behavior remained unchanged, and they started gaining weight.

I don't know that the message we need to take away from this is that we should all start fidgeting to increase our NEAT percentage. Maybe the message is simply that we need to form a more accurate perception of how active we are, and take in calories that aren't out of line with our activity level. Instead of moaning about how unfair it is that some restless person we know eats more than we do and stays skinny, we should learn to make our comparisons more fairly. Stillness isn't necessarily a vice, but if you're not a restless person, you can't eat like one.

Tuesday, August 5, 2008  

Fasting Glucose 87
Weight 185
Blood Pressure, Resting Pulse 123/73, 64

The only way to discover the limits of the possible is to go beyond them into the impossible.   
        Arthur C. Clarke

I managed to get to the state park after work, with enough daylight left to do a pretty long run (a little under 8 miles). Normally, when I go trail-running I carry a water bottle which has a pouch on it for holding a glucose gel package. For distance running, I like to make sure I have some sugar on me, in case I start to feel hypoglycemic along the way. I normally don't have that problem on a run shorter than ten miles, but better safe than sorry, especially when you're going to be on remote trails far from help and darkness is going to fall soon.

Well, tonight I had the wrong water bottle with me, and there was no glucose gel attached to it. I thought it wouldn't matter, but on the other hand I felt bad about breaking a sensible rule. Anyway, my running buddy showed up, and she was carrying a package of little gummy candies (shaped like miniature sharks, for some reason), so I figured it was safe to proceed.

So, the run was going fine, and I felt more energetic than I usually do -- I was keeping up. Then, about six and half miles into the run, I suddenly felt like I had no gas in the tank. Even the shallowest rise was hard to climb. Then I started to feel that unmistakable hollowness and shakiness of a hypoglycemic episode coming on. Rather than try to tough it out, I called a halt and asked my partner to stop and break open her bag of gummy sharks so I could consume a few of them before we continued the run. She had some too, and in minute or two we ended our shark-break and continuted on our way. I started feeling better almost immediately; amazing how fast a little sugar intake can hit your system, especially when you're running.

I don't know why I had this episode tonight; it wasn't because I hadn't had enough to eat earlier in the day. But it was a somewhat stressful day at work, and that might have contributed somehow. I'm not going to worry about it too much. These things can happen to anyone occasionally, especially anyone who does a lot of distance running.

I am planning take part in an organized trail run on Saturday, on Angel Island (in San Francisco Bay); the distance is 25 kilometers, which is about 15 miles. I will definitely make sure I'm carrying glucose for that. I've done that run before, in 2005; it's a nice event. You take a ferry from Tiburon to the island, and run a couple of loops on trails around the island (if you decide you're not feeling up to running 15 miles that day, you can make it one loop, and cut the distance in half). Assuming it's not too foggy, you get to see some great views of Marin, San Francisco, Alcatraz, the Golden Gate Bridge, and the entire bay. This photo from the 2005 race shows me with Tiburon in the background. One of the reasons I like to take part in events of that sort, apart from the chance to do my workout for the day in a beautiful setting, is that I like to be surrounded by a few hundred other people doing the same thing; it makes me feel as if I belong. Exercise can be a lonely thing; you need to make it a social thing from time to time.

Monday, August 4, 2008  

Fasting Glucose 89
Weight 186
Blood Pressure, Resting Pulse 119/76, 52

Never believe anything until it has been officially denied.   
        Claud Cockburn

Just back from camping at Van Damme State Park, which is on the California coast, a few miles south of Mendocino. It's a lovely place, with tall trees, steep canyons, and ocean breezes to keep summer temperatures under control. Here's a view of the trees towering over our campsite, catching the last rays of the setting sun:

I was there with a big group, many of them coworkers or former coworkers. Most of them were there to go abalone-diving, an extremely demanding sport which I can't do to save my life. I know, because when I tried to do it years ago, saving my life quickly became the entire focus of the activity.

The northern coast of California has the coldest seawater for its latitude anywhere in the world, and it only gets colder as you get deeper, so if you're going to dive you have to wear a thick wetsuit, and it's pretty cold even then. Also, you can't use scuba gear to dive for abalone (it's a Fish and Game regulation, because that would make it too easy). So, you have to hold your breath while you plunge down to the rocks that the abalone are clinging to, pry one off, and swim back to the surface with it. Unfortunately, holding your breath while you're in cold water is not easy, even if you're holding still rather than kicking your way down or up. When I tried abalone diving in the past, I kept finding that, by the time I had kicked down deep enough to be able to even see any abalone, I was already desperate for air, and I would have to swim back to the surface without even making a grab for one of the creatures. Also, the abalone are always found in the kelp forest, and kelp is easy to get tangled in (it's like a loose bundle of rubber hoses); I was scared if getting snared by the kelp and drowning down there.

So, I stuck to terra firma over the weekend, and left the abalone-diving to those who could do it. (Fortunately, there were plenty of people there who could; and some were good at spear-fishing too, so there was an abundance of seafood for dinner.) I tried to contribute to the camp experience in other ways, such as food-preparation and fiddle-playing. As far as exercise went, I contented myself with trail-running while the others were in the water. Fortunately there was a really beautiful trail for that purpose, maybe the nicest trail I've ever run on; it followed a creek up from the ocean to the hills inland. Not only were there beautiful tall trees everywhere, I actually got to look at them, because the trail was so smooth. Usually, when I'm trail-running, I'm staring at the ground most of the way because of there are so many rocks and exposed roots to trip over. On this trail I felt safe looking around as I ran.

Our camping group was pretty diverse ethnically, so our big collective seafood dinners offered an extraordinary variety of ways to prepare abalone and fish. We had our seafood fried, steamed with vegetables, cooked in banana leaves with Malaysian pepper sauce, wrapped into sushi, made into ceviche, and served up in a Mexican seafood cocktail. It was all great. I eat vegetarian foods most of the time, so while I was there I think I was getting about ten times more protein than I'm used to. Looking on the bright side, the foods we were eating were mostly not carb-heavy, but I seemed to be eating all weekend and I was afraid I'd come home ten pounds heavier. I didn't; I think part of the reason was that, while I was at camp, I up and active more than usual. Not just the trail-running -- I was on my feet most of the day and most of the evening. That alone can make a pretty big difference. I exercise regularly and my workouts are hard, but the rest of the time I'm very often sitting in front of a computer. Maybe I need to schedule more walking-around breaks for myself.

There are always going to be occasions when I disregard my usual diabetes-related practices in order to get into the spirit of a group event. (Thanksgiving and Christmas are notable examples of this.) It's a slightly dangerous game, because once you start making exceptions on special occasions, there's a danger of treating almost every occasion as special, and living essentially without rules. However, by this point I feel I have enough "headroom" to get away with this sort of thing. I have built up my insulin senstivity to the point that I can handle eating a big festive meal. If I did it every day, obviously things would get out of control before long, so I'm trying to watch myself.

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