Monday, June 30, 2008  

Fasting Glucose 85
Weight 188
Blood Pressure, Resting Pulse 125/79, 52

Never take the advice of someone who has not had your kind of trouble.   
        Sidney J. Harris

Another nice day, no smoke in the air at all. Sunny, clear, a pretty sky, and temperatures in the low 70s. Plus, I was able to take advantage of it, and get outdoors for a 4.3 mile run at lunch. While I was climbing the steeper hills, of course, the temperature seemed to shoot up to the 90s; funny how that happens. The real advantage of the mild weather was that I wasn't overheated afterwards. On hot days I take a cool shower after a run, get dried and dressed, and still return to my desk looking so sweaty that they must think I did the run in my office clothes. That wasn't a problem today, at least. I hope tomorrow's weather is similar. But tomorrow I'll probably be exercising after work anyway, because my meeting schedule doesn't leave me a big enough slot at mid-day to fit a run in. I'll improvise something.

Oh, good: more scary headlines about diabetes and aging! A new study from the Harvard Medical School finds that "older adults with type 2 diabetes may have a steeper mental decline as they age", confirms earlier reports that link diabetes to "speedier mental decline and dementia", and suggests that "the longer a person has had diabetes, the more substantial the cognitive decline over time".

Well, let's put that in perspective. An awful lot of health problems associated with aging are apparently consequences of glycation (proteins becoming encrusted with sugar). Excessive glucose in the bloodstream certainly accelerates glycation. Therefore, it isn't surprisping if any age-related problem (including mental decline) is found to be linked with diabetes. (I mean, how many health problems aren't found to be linked with diabetes?)

So what lesson do we take away from this new study? The lesson we should take away is "Okay, I guess that's one more reason for me to keep working hard at controlling my glucose -- but I knew that already." However, the lesson we are tempted to take away is "I'm doomed! I'm going to be senile before I'm 60! Thre's nothing I can do about it! It's hopeless!" The headline-writers are out too scare us, and they're pretty good at it. It's hard not to rise to the bait sometimes, but we need to fight that impulse.

Following diabetes research news is a delicate business. You want to stay informed, of course, so you can't simply ignore what researchers are saying. On the other hand, you can't afford to have a panic attack every time someone spends a bunch of grant money proving once again that out-of-control diabetes isn't good for you. I recommend following the research news, but following it with a bit of skeptical detachment, and with an irreverent readiness to read between the lines. Everyone who announces research results is going to try to make the results sound dramatic and important, but often it is fairly easy to see that something obvious, trivial, or questionable is being dressed up as a new and terrifying revelation. 

The trouble with this kind of bad news ("diabetes makes you senile!") is that it sets our minds racing so fast, we forget about certain basic issues, such as what we mean by the word "diabetes". Strictly speaking, diabetes is chronically elevated blood glucose, so if you can get yourself out of the elevated range and down into the normal range, you will no longer be "diabetic" and the bad news won't apply to you. But the vernacular definition of diabetes (which even doctors and public-health officials use so often and so thoughtlessly) is simply a label; it is applied to certain people based on something in their medical history, and it applies forever -- they are not permitted to stop wearing that scarlet letter "D", no matter what improvements they make in their health or their lab results. Presumably the people wearing that label are all alike,and presumably the same thing happens to all of them.

Because those of us who have been diagnosed with diabetes tend to accept this permanent status label without question, every single bit of bad news that anyone ever digs up about diabetes seems to apply to us personally. If we were to read a headline tomorrow claiming that diabetes causes vampirism, we would think "Oh great, now I have to give up garlic, too!". We always race ahead to some conclusion about what we think is sure to happen to us because, like most other things that can go wrong with a human body, it has been linked with diabetes.

Most of us don't have enough time or mental energy lying around unused to be squandering any of it on research results which essentially restate bad news we've heard before (without telling us anything we can do about that we're not already doing). Maybe we'll just have to go on strike, and refuse to panic any more until researchers come with something more interesting to tell us.

Saturday, June 28, 2008  

Fasting Glucose 94
Weight 188
Blood Pressure, Resting Pulse 121/71, 64

Please give me some good advice in your next letter. I promise not to follow it.   
        Edna St. Vincent Millay

Free at last! The air didn't smell of smoke today, and I could see the hills in every direction. There still must have been a lot of smoke in the upper atmosphere, because the sun still looked pink even at noon, and it didn't seem to be radiating any heat. In the lower atmosphere, however (which is where I do almost all my breathing), the air was reasonably clean for the first time in a week. So I figured it was my chance to exercise outdoors for a change.

First, though, I had to get myself out of the house, and before I could do that I had to get myself out of bed. That was a tough assignment today; I think that long yoga-relaxation session last night did something odd to me. I slept deep, and I slept long. I'm sure my BG test would have been lower if I'd got up a few hours earlier; sleeping late always raises it a bit. Anyway, my day got off to a very slow start, and I had to spent several hours working myself into a fully active state.

When I finally reached that point, however, I was unusually energetic. In the evening I did a trail-run with a distance of 8.1 miles, and I found it far easier than I usually do. The time flew by, and my pace was better than usual, particularly in the second half of the run, when you would think I'd be getting tired. Maybe that was because I was so relieved to be running outdoors again, and not on a treadmill at the gym. The thing is, I wasn't feeling great at first. I started out with some soreness in one shoulder and one hip, and I was worrying about that. Would it get worse as the run went on? No, actually, it got better. After maybe 3 miles nothing was hurting, running fast seemed easy, and all the world was beautiful. The sunset over the lake, during the last mile, helped confirm that feeling (the ground-level atmosphere may be clearer now, but the smoky sunsets are as dramatic as ever.) 

Friday, June 27, 2008  

Fasting Glucose 84
Weight 189
Blood Pressure, Resting Pulse 119/74, 52

Advice is what we ask for when we already know the answer but wish we didn't.   
        Erica Jong

Okay, that's enough: this wildfire crisis must stop. I'm tired of exercising indoors. It was a little less smoky today, but the air wasn't so clear that it seemed advisable to go for an outdoor run. So, I was back on the treadmill again, and I hate doing that two days in a row, let alone five.

After work I went to a special "restorative poses" workshop at the yoga center where I take a class on Mondays. For two hours I was lying around on the floor in various positions designed to relax me, usually with a bolster or a folded blanket artfully placed under me somewhere to elevate my spine, spread my ribs, or whatever. It was silent in the room, except for occasional instructions from my yoga teacher, guiding us through the process of releasing tension from the body, one muscle at a time. To say that it was relaxing understates the case considerably. It was more like general anesthesia. I kept falling asleep, though never for long (I'm pretty sure I didn't sleep through any transitions to the next pose; I wish I were also sure that I didn't snore.) 

It seemed a shame to have to drive home after that, and in fact I wondered if I could handle it. It turned out to be okay, but I was glad I was only driving on low-traffic suburban streets, not freeways. I think I'll have to do a little more of that kind of thing at home in the future.

If the air is even a little bit less smoky tomorrow than it was today, I'm going to hit the trails and go for a long run or bike ride. I don't want to see the inside of the gym again for a day or two.

Thursday, June 26, 2008  

Fasting Glucose 86
Weight 188
Blood Pressure, Resting Pulse 121/74, 52

For an idea ever to be fashionable is ominous, since it must afterwards be always old-fashioned.   
        George Santayana

No progress on clearing the air around here; the number of wildfires now burning in California is apparently over a thousand. Anyway, the air is still thick with smoke, the sunlight struggles to get through it, and rather than inhale too much of it I'm still exercising in the gym rather than the great outdoors. Every time I go outside I find that the world looks artificial, as stylized as a Japanese print (especially in the evening).

Because my indoor workouts are never as good as my outdoor ones, my blood pressure is creeping back up. 121/74 is obviously not a bad reading, but it's not as stellar as the ones I've been getting lately. I'll be glad when I can go back to trail-running, which helps me more than any other kind of exercise I do (probably because I enjoy it more than any other kind of exercise I do.)

The government (or rather the U.S. Centers for Disease Control and Prevention) has released some more figures on the prevalence of diabetes in the United States. About 24 million of us have diabetes (mostly Type 2), which is an increase of more than 3 million over the past two years. In other words, 8% of the population as a whole has diabetes. (However, the rate is a lot higher in some groups; for example, 25% of people aged 60 or older have the disease.)

The more startling figure presented by the CDC, at least in my opinion, is that 57 million Americans have "pre-diabetes", that euphemism invented recently to describe people who have Type 2 diabetes but haven't yet reached the arbitrary threshold of 126 mg/dl on their fasting tests. (It's a little like describing women who are still in the first trimester as "pre-pregnant".) Even if we accept that the distinction between diabetes and pre-diabetes is for real, there is little reason to doubt that most of the people we call "pre-diabetic" today are going to be called "diabetic" later. It appears that, before very long, there will be more than 80 million Americans with diabetes.

I'm not sure American can handle a problem of that size, at least if it continues to deal with Type 2 diabetes the way it does now. Giving people expensive drugs that don't work very well is a going to seem more and more like an unsatisfactory solution when we're applying it to 80 million people. Considering how many of those people won't be able to afford the drugs, we might end up with a revolution in diabetes treatment purely by accident. At least some of the people who aren't able to afford the drugs will be forced, in desperation, to try something better. 

Wednesday, June 25, 2008  

Fasting Glucose 88
Weight 188
Blood Pressure, Resting Pulse 119/69, 55

There is time enough for everything in the course of the day, if you do but one thing at once, but there is not time enough in the year, if you will do two things at a time.   
        Lord Chesterfield

I hoped (with no rational basis) that the smoke from the wildfires wouldn't be as bad today. Instead it was worse.

Unfortunately I left a window open overnight, so I woke up smelling smoke this morning, which is generally not a good sign. Certainly it didn't get the day off to an encouraging start, and things did not improve from there.

I'm resigned to exercising only in the gym this week. One problem with indoor exercise, for me, is that it bores me silly and I can never persuade myself to make it a long workout. Out on the street, it's often pretty easy for me to talk myself into converting a 4-mile run to a 5-miler, and on the trail I can even talk myself into converting a 6-miler to a 9-miler, just because it's a beautiful day or I'm in a beautiful setting. In the gym, I will do a 30-minute workout and call it done. Part of the reason my glucose control tends to be better in the summer is that I end up exercising more; in the winter and early spring (the only rainy parts of the year in northern California), when I'm hitting the gym a lot to escape the cold rain outside, my workouts are never as intense. Because I'm forced to be in bad-weather, gym-workout mode right now, I'm expecting (and so far getting) a slight increase in glucose, weight, and blood pressure.

However, in the gym this evening I did persuade myself to do a strength-training workout on their weight machines before I started my cardio workout. As I haven't done strength training lately, I made it a fairly light workout, a beginner's workout. It wasn't easy exactly, but I didn't want to start out by overstraining myself and getting injured. My big problem with strength training is that I don't enjoy it, but I guess that just means I'll have to find a way to enjoy it. My belief is that the people who succeed at any difficult task are the ones who identify whatever it is that they will have to do even if they don't like doing it, and then learn to like doing it.

I hope that soon the wildfires will die down and we'll get some cleaner air; for now, though, smoke is king around here.

Tuesday, June 24, 2008  

Fasting Glucose 88
Weight 187
Blood Pressure, Resting Pulse 108/70, 50

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With more than 800 wildfires currently active in California, the air quality is taking a bit of a beating. The amount of smoke varies from hour to hour, but the air is never really clean. This evening the view westward across the valley was extremely murky:

And the evening sun could be stared at without discomfort:

The air will probably remain smoky for the rest of the week. Which, I guess, means I'd better continue to get my exercise in the gym rather than outside. It's too bad, because I vastly prefer outdoor exercise. I think of the gym as that place I go when it's raining. Well, I'll just have to pretend it's raining, then.

Today I followed up on last week's presentation at work on stress management, and made an appointment to talk to someone who runs the employee health program. She told me about a class she's put together that meets on Wednesday afternoons and practices breathing and relaxation techniques very similar to what the cardiologist described. I told her it was ironic that I was coming to see her about this subject now, because right now my blood pressure is lower than it's ever been and I'm not stressed out.  However, I think this is partly because of a temporary lull at work; next month we'll have a software release happening, which inevitably means a big pileup of work, and problems, and long hours. I'm not stressed right now because nothing very stressful is happening, but I want to be able to stay relaxed when things are no longer so easy. She advised me to start going to that relaxation class, which I plan to do starting next week.

She also told me that, although it's great that I'm doing so much cardio exercise, my exercise program is a little unbalanced because it currently includes no strength-training exercise. She advised me to try working that back into my program, even if I have time for only a little of it. She says strength-training has a lot of benefits and I shouldn't leave it out. This is true, I'm sure; strength training is recommended for people with Type 2 (because your muscles are your glucose sponges, and it pays to keep them in a robust condition). I used to work out on weight-machines, but I got out of the habit when I reached the point of being able to maintain good glucose levels on cardio exercise alone. BG control isn't the whole issue, though; strength training also prevents other problems, such as osteoporosis, and it probably helps with blood pressure too. I've been meaning to get back into it, or at least feeling as if I ought to, and maybe the nudge from her will be enough to get me started again.

Monday, June 23, 2008  

Fasting Glucose 84
Weight 187
Blood Pressure, Resting Pulse 105/68, 53

There are two kinds of people in the world, those who believe there are two kinds of people in the world and those who don't.   
        Robert Benchley

Now I know what caused the sudden cooling yesterday, which continued today: the wildfires raging all over California have been disrupting wind patterns, and sending so much smoke into the upper atmosphere that it's filtering the sunlight. I noticed a little of this yesterday (it was hazy and you could detect a hint of smoke in the air), but today the haze was much thicker, the sunlight looked pink at noon, even the nearest hills were almost invisible, and the air smelled and tasted of smoke to such a degree that nobody wanted to exercise outside. (In fact, there was an air-quality warning issued today, declaring the air "unhealthy" and advising against prolonged exertion.) I decided to skip running at lunch, and work out at the gym after work instead (and it was crowded there, because a lot of other people had made the same decision). I had come to work by bike (not fully appreciating, first thing in the morning, just how bad the state of the atmosphere was becoming), so I had to climb the big hill on the way home under "unhealthy" conditions. Fortunately the air had cleared a bit (without heating up) by the time I had to do that, so it wasn't as hard as I thought it might be. I think I'll drive the car to work tomorrow, unless the air seems dramatically better in the morning. It's too bad that, at a time when we seemingly ought to be making a special effort to minimize air pollution, I'm planning to switch from cycling to driving. Well, life is full of ironies, isn't it?

Another irony is the way I sometimes have to struggle to fit into my schedule the things which I do at least partly in hopes of reducing my stress level. Thus, today, I rode my bike home from work as fast as I could, hurriedly ate dinner (a re-heat of the vegetable soup I made yesterday), and rushed to the gym to get my treadmill workout done, so that I could get back in the car and rush to my yoga class, so that I could relax. Is there something wrong with this picture?

Maybe not too wrong, since I came home and measured my lowest blood pressure ever.

The epidemic of Type 2 diabetes continues unabated. In The U.S., new cases of diabetes are currently being diagnosed at a rate of 1.5 million per year. According to the Centers for Disease Control and Prevention, one in three Americans born in 2000 will develop diabetes.

I know how I'm supposed to feel about this (appalled and horrified), but knowing how I'm supposed to feel about something usually makes me want to react in the opposite way. (For example, nothing could be less upsetting to me than reports claiming that today's young people are hopelessly ignorant; young people are not just our future, they are also our competitors in the struggle to make a living, and when I have to compete, I prefer to compete with dopes.) Anyway, although I'm not usually the first person to spot the silver lining in any gloomy situation, in this case I'm tempted to take comfort in the knowledge that I'm going to have so much company in the coming years. When a third of the population are diabetic, there will certainly be a lot of people to discuss the subject with, and maybe the subject will be a lot better understood. It's even possible that someone like me, who has had a good success record at controlling the condition without medication, will be seen as having something valuable to contribute to the discussion.

Sunday, June 22, 2008  

Fasting Glucose 87
Weight 186
Blood Pressure, Resting Pulse 112/68, 60

I have come to the conclusion that my subjective account of my motivation is largely mythical on almost all occasions. I don't know why I do things.   
        J. B. S. Haldane

What a difference a day makes. It was about 20 degrees cooler today. I don't know the reason for the dramatic drop in temperature (it was sunnier today), but I certainly liked it, and tried to make the most of it.

During yesterday's heat I made a plan for an easier workout today, probably with swimming included, but when the temperature turned out to be so comfortable I switched plans and went for a bike ride. It was partly a trail-ride, but more than half the distance was spent on city streets getting to and from the park. Both parts of the ride were hilly. I don't know what the distance was, but the whole adventure took 2 hours and 40 minutes, so it was a substantial ride. The climbing was the hard part, though. I had to take rest breaks on a couple of hills that I know I've climbed in one try before. All that means, I think, is that I haven't done much cycling lately (apart from my work commute, which is very short), and I'm out of training for that particular sport. Part of the problem was that I didn't do a good job of pacing myself; I would try to pedal too fast on the climbs, and become exhausted. Funny how, after I rested a minute to get my heart rate down, on resuming the climb (slowly) I would find that it wasn't that hard. When you're climbing a hill on a bike, persistence is more important than speed, so you have to find a speed (however slow) that you can sustain. Being out of practice, I tended to bungle that crucial aspect of the problem.

Trail-riding is something I've done very little of, so I still lack the confidence to do it right. In particular, I lack the confidence to go fast downhill, and I brake a lot to keep myself from building up speed. I have a great fear of loss of control. Mountain-bikers say that speed is your friend, speed makes you safe. It's when you lack forward momentum that you're most in danger of taking a fall. Maybe so, but I can't help feeling that an untalented mountain-biker like me could easily take a fall at any speed, and the consequences would be a lot more serious if I was going fast when it happened. (Realistically, the part of the ride when I was most in danger was the part where I was mixing with motor vehicles getting to and from the park, but it's hard for me to see it that way.)

The other thing I could do today that seemed out of the question during yesterday's heat was cook. I have a bunch of local organic vegetables in the refrigerator and I need to use them before they spoil, but yesterday the thought of using the oven or the stove was more than I could handle. After the bike-ride today I made a very successful vegetable soup. The Serrano chile I threw into it made it pretty fiery, but I like spicy foods, and oddly enough they make me feel cooler in the summer. Also, eating hot chiles releases endorphins, and they made a nice mix with the endorphins I was already enjoying from the ride. The high that follows an intense workout (from the body's self-generated morphine) is one of the reasons active people stay active, to the puzzlement of sedentary people who have never experienced that high and can't believe it's for real. Well, it is for real; we're not making it up. 

Saturday, June 21, 2008  

Fasting Glucose 82
Weight 187
Blood Pressure, Resting Pulse 114/66, 57

Always listen to experts. They'll tell you what can't be done and why. Then do it.   
        Robert Heinlein

June 21, the summer solstice, the longest day of the year. Local sunset is at 8:38 PM. Not surprisingly, it was another hot day, around 100 degrees in the afternoon. Not many people were outside exercising today, strangely enough. Here's a view looking up to the trail atop the dam at Spring Lake. Notice the unusual absence of joggers, cyclists, and dog-walkers up there... 


Where was everyone? Were people afraid it would be too hard to exercise on such a hot day? Were they worried that they might collapse from dehydration or heat stroke if they attempted it? Sensible objections, these, come to think of it. However, I'm way beyond thinking about sensible objections to exercise. By this point, it just doesn't feel right not to work out, so I did a trail run, with a distance of 7.4 miles.

Surprisingly, it wasn't that hard. Before I started the run I went for a walk at Spring Lake (where I took the photo above), just to get myself used to moving around in the heat. And I carried water with me on the run. I chose a route that had a lot of shady sections where I could cool down (and I knew it would take to me to a place where I could refill my water bottle).

I was practically alone on the trails, which is pretty unusual for a Saturday. And yet, the run really wasn't terribly difficult, and after the run was over it was easier for me to cope with the heat the rest of the day than it ordinarily would have been. After running in the heat, sitting around in the heat doesn't seem like anything to whine about.

Friday, June 20, 2008  

Fasting Glucose 91
Weight 187
Blood Pressure, Resting Pulse 112/69, 54

Estimated amount of glucose used by an adult human brain each day, expressed in M&Ms:  250.   
        Harper's Index, October 1989

A hot day -- 100 degrees, but by doing my lunchtime run a little early I had the advantage of running when it was a mere 95. At least I had two running buddies to do the run with; that helps. You can see that they're not fainting, so maybe that means you won't.

I bike-commuted today, however, so the full heat of the late afternoon was waiting for me when I had to make the big hill-climb to get home. It's such a short ride in terms of distance (about a mile and a quarter), but when you're gaining 500 feet of elevation in the process, and it's blazing hot, it becomes quite a challenge. I think I'm getting just a little bit better at it, but so far "better" means "faster", not "less miserable". Well, another improvement is that the voice in my head that says "you can't do this" is fading away. I can do this, that's clear. Whether I can learn to like it is a question which time will have to answer.

The American Diabetes Association has been pushing to replace the Hemoglobin A1c test (or at least the test result, as we know it today) with another kind of number which they think will be better understood. I'm not sure I'm entirely behind them on this.

If patients don't understand the A1c test today, is it because patients are too stupid to grasp what's involved? I doubt that; I think the problem is that no one makes an effort to tell them what's involved, in plain English.

When experts decide to "dumb down" a subject for popular consumption, they usually succeed only in making it seem less interesting, not clearer.  I think understanding of the A1c test among diabetes patients would be improved if the information were presented to them in a more, not less, scientific way.

For example, the A1c test result is usually reported as a unitless number. "6.8", or whatever. My old high school physics teacher would have roared, "6.8 what? Bottles of beer, for crying out loud?". He had no patience with students who used numbers in this meaningless way. Well, I think the medical establishment could rise to meet high-school standards of clear communication, if it really tried.

The A1c result is a percentage, and should be stated as such. If your A1c result is 6.8%, it means that 6.8% of the hemoglobin in your red blood cells is encrusted with sugar. I suspect that most adult diabetes patients would be able to understand a direct statement of that sort. Of coure, the statement would also raise several other questions in their minds:

  1. Is 6.8% a lot?
  2. How much of an average person's hemoglobin is encrusted with sugar?
  3. If my percentage is higher, why is that?
  4. Why is hemoglobin such a crucial thing to measure?
  5. Why does it matter how much of my hemoglobin is encrusted with sugar?
  6. How will this affect me?
  7. Is there anything I can do about it?

And not one of those questions is terribly hard to answer!

  1. 6.8% is above normal (only someone with diabetes would get a result that high), but it could be worse. We usually tell diabetes patients to keep it under 7%, but that doesn't mean 6.8% is great. The lower you can get it, the better.
  2. The normal range is 4 to 6%.
  3. Your blood sugar level has been elevated, on average, over the last few months. The more sugary your blood gets, the more sugar attaches itself to proteins all over your body.
  4. Hemoglobin (or a particular form of it called hemoglobin A1c) is just one of thousands of proteins in your body; it's not more important than the others. It's just an easy one to measure for the purposes of this test, and the results tell us what's happening to your proteins in general.
  5. Sugar tends to gum up the works; when proteins in your tissues and organs become encrusted with sugar, they can't do their jobs properly; this causes degenerative health problems. The A1c test detects that process of sugar-encrustation (usually called "glycation") at work, before it's had time to harm you.
  6. If more and more of your proteins become encrusted with sugar ("glycated"), this will gradually damage everything in your body; almost any medical problem you can imagine might result from this.
  7. You can bring down your A1c result by bringing down the average sugar level in your blood, and there's plenty you can do to make that happen.

But the ADA thinks diabetes patients don't understand any of this, and couldn't hope to understand it -- even if someone took the revolutionary approach of telling them. So, they would like to report the A1c result not as the percentage of hemoglobin that has become glycated (which is, after all, what the test actually measures), but rather as "eAG" (estimated Average Glucose, in mg/dl).

Obviously, the more sugary your blood has been lately, the larger the share of your hemoglobin that is glycated, so we can work backwards from the result to figure out what your average BG must have been in the past few months. (Because red blood cells have a lifespan of 3 months before they're recycled, the test can't tell us anything about what was going on more than 3 months back.) However, it's not a simple matter to turn this general principle into hard numbers.

A rough-and-ready formula was developed years ago for calculating the average BG based on an A1c result; according to this formula, an A1c result of 6% was equivalent to an average BG of 135 mg/dl. More recent research, using modern diagnostic tools and a more continous measurement process, has concluded that the old formula over-estimated average BG. The ADA has published a new formula based on this research:

(A1c X 28.7) - 46.7 = eAG in mg/dl

By this formula, an A1c of 6% equals an eAG of 126 mg/dl (not 135). The ADA wants doctors to report the A1c result to patients not as 6% but as "126 mg/dl", on the grounds that this will be more meaningful to patients who already measure their BG in mg/dl on a daily basis.

I'm not so sure about that.

First of all, the A1c test doesn't really measure average BG. There is obviously a relationship between A1c results and average BG, but the exact nature of that relationship is not absolutely clear; the formula for converting from one to the other has just changed, and might change again. Isn't it better to report what you really measured, not the estimates it leads you to make, based on a currently favored method of interpreting the results?

Second, the A1c result, properly considered, is a more interesting and more important result than average BG. The only reason we care about BG in the first place is because of what we suspect it might be doing to us; the A1c test measures what it is doing to us. If elevated BG didn't cause proteins to become glycated, it wouldn't be a problem. Glycation is what actually harms us. When you can actually measure the effect that you're worried about, isn't that more to the point than measuring something which merely leads to that effect?

Third, I'm not so sure that "average BG" is going to mean as much to diabetes patients as the ADA imagines. BG fluctuates so much from test to test, and especially from one time of day to another, that averaging out all that noise and reducing the thing to a single number does not necessarily bring much clarity to the situation. I have a pretty good idea of what my fasting BG average is, but if you asked me to estimate what my BG would be like if I measured it a thousand times a day and averaged it all out, I couldn't begin to guess. And if you told me the number, I might not even have a sense of whether that was good or bad.

Look at it this way: you've probably been a driver for many years, and your car's speedometer is in front of you every day. You probably have a pretty good idea of how fast you usually go on the highway, and how fast you usually go in residential neighborhoods. But if you had to guess what your average speed had been on a recent trip that involved a combination of backroads, residential roads, freeways, and a traffic jam on a bridge, could you do it? Could you even guess? If a GPS device reported to you afterwards what your average speed had been, would the figure mean anything to you? Probably not. But you might have a pretty clear idea of how much gasoline you burned up getting there; that at least would be meaningful information.

These days my average fasting BG is 86 mg/dl, and trending downward. No doubt my continuous average is higher, as it would have to include the glucose spikes following meals. The last time I had an A1c test the result was 5.4%, which (according to the new formula, anyway) translates to an eAG of 108 mg/dl. I'm not sure that "108" means much to me. The 5.4% means more. I know where it puts me in terms of health risks: 5.4% is within the range expected in healthy, non-diabetic people. It's not quite as low in that range as I had been in earlier tests (and hope to be in future tests). I suspect my next A1c test will be lower than 5.4. If it's higher, I'll have to look at what more I could be doing to drive it down, but I honestly think it will be lower. Anway, I know how to think about it! I can't say the same thing for "eAG", at least so far.

Anyway, I'm getting a little tired of the assumption that diabetes patients need to be spoken to as if they were very young children (and by no means the brightest in their class). The health-care industry has been operating on that assumption for years, and if it was going to produce good results we would have seen it by now.

Why not, as a daring experiment, try talking to diabetes patients as if they were literate adults? People have a way of living up to expectations -- low or high, as the case may be. Maybe the reason diabetes patients aren't doing a very good job of managing their condition is that nobody expects them to, and they can see that.  

Thursday, June 19, 2008  

Fasting Glucose 79
Weight 187
Blood Pressure, Resting Pulse 119/73, 57

When one admits that nothing is certain one must, I think, also admit that some things are much more nearly certain than others.    
        Bertrand Russell

I've been thinking a lot about feedback lately. That is, the engineering concept of feedback, where the output of a system somehow gets back into the input of the system. Sometimes that's a good thing, and it's all part of the design. Often, though, feedback is an accidental effect, and it causes serious trouble. That's what happens when a public-address system starts "hearing itself". A sound-wave from the loudspeaker is picked up by the microphone and routed back through the system again (only louder this time, because of the amplifier gain) -- and this loop keeps repeating itself, several hundred times per second, until a painfully loud squeal erupts from the loudspeakers, and everyone in the vicinity winces and howls and plugs their ears. That awful noise continues until someone breaks the feedback loop, either by turning off the microphone, or moving the microphone farther from the loudspeakers, or turning down the amplifier gain.

Note that, when this happens, no single part of the system is to blame. The problem is not just the fault of the microphone, or the loudspeakers, or the position of the microphone relative to the loudspeakers, or the amplifier gain setting. It's the combination of all these elements that's causing the trouble. You could solve the problem in various ways, by changing one or more of these elements. What you can't do is to sit around doing nothing and waiting for the problem to solve itself, because it won't. You've got to do something, make some change to the way the system is set up, because things can't be allowed to continue like this.

Human physiology involves a lot of feedback loops, and unfortunately most of them are neither as simple nor as well-understood as a public address system. The body has a seemingly endless supply of "systems" that influence one another, and reinforce one another. (That's why medications tend to have surprising and undesirable "side effects"; introducing any new element into a complex system is likelier to break something than to make everything work better.)

A consequence of the body's abundance of systems that feed into one another is that a lot of seemingly unrelated health problems are closely linked. They travel together, so to speak. If you have health problem A, you're likely to get stuck with health problem B (or C, or D, or all of them). These health problems tend to feed into each other, and reinforce one another. They gang up on you. Like the microphone, the amplifier, and the loudspeakers in my example of audio feedback, they each make their own contribution to the problem, and they work together to worsen it.
There's also a hopeful aspect to this situation, however. If you can find a way to "break the loop", by making some improvement in the system so that problems are no longer reinforcing one another, the benefits can be enormous. Solving one health problem often solves another one, or even several of them.

A fair amount of new health information has come my way over the last few months (new to me, at least), and it all seems to have a bearing on this issue of feedback, of systems in the body interacting and feeding into one another, of health problems making each other worse:

This combination of destructive processes sounds grim and hopeless, if you look at it from the point of view of a helpless bystander who can't do anything but watch the disaster unfold. However, there's some very good news buried in all this: you aren't helpless to cope with these problems. There are things you can do about them, mostly without professional assistance, and once you start, all those feedback loops begin to work for you rather than against you. Instead of everything getting worse, everything starts to get better. Losing weight reduces insulin resistance, hypertension, and inflammation. So does exercising -- and exercising also reduces stress.

Making better lifestyle choices has an amazing effect, as one problem after another is alleviated, and each improvement seemingly triggers another one. It's not a miracle, though; it just means that you finally started living the way you were supposed to be living from the start.

Wednesday, June 18, 2008  

Fasting Glucose 77
Weight 188
Blood Pressure, Resting Pulse 116/70, 62

When we were children, we used to think that when we were grown-up we would no longer be vulnerable. But to grow up is to accept vulnerability... To be alive is to be vulnerable.    
        Madeleine L'Engle

I went to the dentist today, with the recent findings about the link between periodontal inflammation and diabetes fresh in my mind (see my June 11 posting below). However, my BG has been good lately (my fasting average was 86 for the past month, and 85 for the past 2 weeks), so I wondered if that might be a sign that my mouth is healthier than it was, so I might get a better report from the hygienist than I usually do.

I did! She said my gums looked good. Also, the placque-removal procedure was almost entirely painless this time, which it usually isn't, and that alone was enought to tell me that there couldn't be much inflammation in there.

So how did I achieve that? I flossed regularly, but I've done that before without such good results. The only explanation I can think of is that I bought some cinnamon-flavored toothpicks recently, and I've got myself into the habit of using them to clean and stimulate my gums after lunch. Aparently this did the trick. So, if you are having a hard time getting your BG down, see if there's something more you could be doing to keep your gums healthy. Apparently this can benefit you in more ways than one.

It was a warmer day today -- about 90 degrees -- but I did a hard run anyway. It was 6.5 miles and extremely hilly, even by local standards. I felt pretty wrung out after that. I did carry a water bottle, and I even refilled it when a drinking-fountain turned up along the route, but a hard run in hot weather is never going to be easy, no matter how fit you are. It's funny how, when I'm running in the winter (and trying to figure out how to dress for it without overdressing for it), the idea of running under a hot sun begins to seem like something to look forward to. Well, when you get your chance to run under a hot sun, the idea of running in the rain suddenly becomes very appealing. I can't wait for winter!

Tuesday, June 17, 2008  

Fasting Glucose 81
Weight 188
Blood Pressure, Resting Pulse 107/66, 56

Events in the past may be roughly divided into those which probably never happened and those which do not matter.   
        William Ralph Inge

Today at work, as part of a company program to promote employee health, we had a lecture from a cardiologist, John M. Kennedy. His subject was the effect of stress on the heart. Apparently he's written a book on the subject, but it hasn't come out yet and he wasn't plugging it directly.

Unfortunately he only had an hour to speak, and he devoted too much of that hour to convincing us of two things we already believed: that stress increases the risk of coronary heart disease, and that coronary heart disease is a big problem. 

He said that doctors don't need to be convinced of these things either, but they're not sure what to do about the stress issue. He said he once addressed an audience of cardiologists, and asked them how many of them believed that stress was a major contributor to cardiovascular disease; everyone there agreed that it was. He then asked them how they were helping their patients reduce stress, and the room fell silent.

He said that this was a very unfortunate situation, because the high-tech tools that are now available to cardiologists have made surprisingly little difference in terms of saving patients' lives. Prevention, not treatment, is still the only thing that does make a big difference, and if we want to keep patients alive we will have to find a way reduce all the factors that promote cardiovascular disease -- not just elevated cholesterol, but elevated stress as well.

Sress is a physical response to fear or time-pressure. The latter is the dominant element in job stress. Put anybody in a racing-against-the-clock situation, and stress is the result. Stress causes the adrenal glands (a pair of olive-sized structures planted atop the kidneys) to release the two "stress hormones", adrenaline and cortisol. These hormones trigger the classic fight-or-flight stress response, which elevates your heart and respiration rate, and has many other effects. Unfortunately, those other effects include harmful ones, such as inflammation.

Anything that triggers an inflamatory response ends up being bad for the heart, because it makes the coronary arteries (which supply blood to the heart muscle) vulnerable to injury. A lot depends on keeping the three coronary arteries in good working order, but the combination of cholesterol buildup (due to a poor diet or lack of exercise) and chronic inflammation (from stress, high blood pressure, and excess insulin in the bloodstream) has a very destructive effect on these arteries.

I asked him if there was some reason why the coronary arteries had more of these problems than other arteries -- he said they don't really have more placque or injuries or blood clots than other arteries, it's just that the consequences of such problems there are a lot more serious than equivalent problems elsewhere would be (apparently there aren't a lot of people who die suddenly from a leg-attack). Also, the coronary arteries are surprisingly narrow to start with, so there's not much margin for error.

He showed us pictures of a coronary artery in an actual heart-attack patient; the artery was narrowed down like the waist of an hourglass at one point, owing to a thick cholesterol placque there, but just past that point the artery was wider than normal, and in that wide area the arterial wall was torn, resulting in a blood clot. Inflammation of the artery from chronic exposure to stress hormones had very likely laid the groundwork for this injury.

By the time he got to the what-can-we-do-about-this discussion, unfortunately, time was running out, and he rushed through his recommended program for stress-reduction in a way which left me rather confused. I guess I'll have to wait for his book to come out to get a firm grasp of what he's recommending. He uses the acronym BREATHE to summarize it -- it stands for Begin, Relax, Envision, Action, Treatment, Heal, End. It amounts to a brief meditation break which you start your work-day with, and repeat during the day when things don't go right. The basis of it is the finding that, in addition to a natural stress response, we humans also have a natural relaxation response, which has the opposite effects and can be triggered by such techniques as slow, deep breathing and positive mental imagery. He said that sophisticated medical testing has demonstrated that ancient, traditional practices such as yoga and tai chi are getting at something true and measurable -- the relaxation response is for real, and it works. He said it had been shown not only to reduce stress and cardiovascular problems but even such problems as tumor growth.

Unfortunately, I didn't get a very complete grasp of the details of the BREATHE program. I guess I'll have to wait for his book to come out. Or, since I'm already taking a yoga class, I may just need to apply yoga breathing and techniques to life in the office. I don't think I'm going to do any yoga poses in my cubicle, except maybe Mountain Pose, which amounts to standing up straighter than you ever have before, and holding it for six or more slow breaths.

Even without fully understanding what a BREATHE break involves, I just tried doing one, to the best of my ability, and then measured my blood pressure. 107/66! Not the absolute lowest I've ever measured, but pretty close. And the other really low ones have usually followed a long evening trail-run. Today I did an evening run, but it was a shorter, easier run on pavement (4 miles) and I didn't test until about 3 hours later.

Tomorrow I have a dental appointment. Now that I know about the connection between periodontal disease and insulin resistance, I'll pay more attention than usual to what they tell me about the state of my gums. 

Monday, June 16, 2008  

Fasting Glucose 84
Weight 188
Blood Pressure, Resting Pulse 119/73, 52

Those who flee temptation generally leave a forwarding address.    
        Lane Olinghouse

Once again, a fine day for exercising outdoors: sunny but only about 70 degrees. I did a 5.3 mile run at lunchtime. Also, it was another bicycle-commute day. And I went to yoga class in the evening. So, I spent rather a lot of time today doing good things for my body; I certainly hope my body appreciates everything I do for it. (But if my body could speak for itself here, it would probably point out that I'm just trying to make up for the many years I spent neglecting it, and that we're still a long way from being "even".)

A recent study of diabetes and race (conducted by researchers in Boston) found that doctors are largely to blame for the poorer health outcomes of black patients with the disease. At least, that's what the Reuters summary of the report says, but I hope that Reuters has garbled the thing somehow, because the research as they describe it sounds amateurish and dopey. For example, the report says that patient income and insurance explained 38% of the difference in health outcomes between black and white patients, while the conduct of their doctors accounted for 75%. Leaving aside (for a moment) the question of what justifies this accusation, I can't help noticing that the arithmetic doesn't work. When one factor accounts for 38% of something, that leaves only 62%, not 75%, to be accounted for by other factors. The researchers in this case don't sound as if they were sticklers for precision.

So what dictates the conclusion that doctors are to blame if their black diabetic patients don't do as well? It's hard to tell from the details that have been released. The study found that the doctors gave their black patients tests for lipids and Hemoglobin A1c just as often as they gave these tests to their white patients, so apparently the doctors were making some effort to do the right thing. "However, white patients were more likely than black patients to reach commonly accepted benchmarks for controlled levels of blood sugar (47 percent vs. 39 percent), LDL cholesterol (57 percent vs. 45 percent) and blood pressure (30 percent vs. 24 percent)."

Huh? The outcomes were different, and therefore we know the doctors did something wrong? The researchers seem to have decided that, because they couldn't (or anyway didn't) think of anything else to explain these disparites, the doctors must be to blame in some way. In a debate, this is what is known as "begging the question" -- that is, claiming that the question under discussion (in this case, "why do black diabetes patients do poorly compared to white diabetes patients?") can be cited as if it were evidence for one's preferred answer to the question. We think the reason black patients don't do as well is that doctors are racists, and here's the proof: black patients don't do as well!

The only actual difference in patient care cited was that black patients were prescribed statin drugs (for high cholesterol) less often than white patients were. How much less often was not mentioned, and the possibility that black patients were less often able to afford statin drugs was not mentioned either. Anyway, it seems odd that, if doctors are such racists, they treat patients equally in most things, then suddenly draw the line at statins. It also seems odd that prescribing cholesterol medications less often would have any effect on blood sugar or blood pressure. As a conspiracy theory, it doesn't seem to add up. However, it does have the same thing going for it that most conspiracy theories do: it beats facing reality.

Here's the reality: when it comes to diabetes, what the doctor does is not nearly as important as what the patient does. We are not talking about appendicitis here; diabetes isn't the sort of problem that can be solved by a doctor's intervention. If doctors were supervising their diabetes patients all day and all night, telling them what to do and what to eat and what to drink, we might be justified in assuming doctors are to blame for any difference in patient outcomes. But doctors aren't in a position to do that. All they can do is give good advice and hope that, for once, it is followed.

Face it, folks: diabetes goes well or badly depending on what the patient does, and that's all there is to it. The longer we refuse to confront this seemingly obvious reality, the worse America's diabetes crisis will become. Blaming the doctors, with or without incendiary charges of racism thrown into the mix, seems like an especially stupid way to address a problem which is essentially about getting patients to take more responsibility for their health.

Sunday, June 15, 2008  

Fasting Glucose 88
Weight 188
Blood Pressure, Resting Pulse 116/71, 68

Brain: an apparatus with which we think we think.   
        Ambrose Bierce

It was another perfect day, sunny and mild, and I not only didn't feel like resting, I didn't feel like making today's workout an easy one, either. I ended up doing an 8.3-mile trail run. And, believe it or not, at the end of it I didn't even feel especially tired. I wasn't hurting, either. Over the years since I started working out in 2001, my body has gradually adapted itself to exercise (and perhaps I have also learned to do it better), so it doesn't take the same toll on me that it once did. 

I remember the first few times I ran the same trail route I did today, and how exhausted and sore I would feel at the end of it. I especially remember that my hips and abdominal muscles would be so overstrained after the run that it would be painful to climb back into my car to drive home from the park. These days, I don't seem to feel that way after a run. My yoga teacher (who sees me Monday nights, often just after I've done some big exercise event on the weekend) recently commented that I seem to be recovering better from such events than I used to. As I've now passed the 50-year mark, you would think such problems would be getting worse for me instead of better. I'm glad they're not.


Saturday, June 14, 2008  

Fasting Glucose 87
Weight 187
Blood Pressure, Resting Pulse 123/71, 49

To my embarrassment I was born in bed with a lady.   
        Wilson Mizner

Today was planned to be a rest day, but I really didn't feel like resting. A sunny, clear Saturday, with mild temperatures and no wind -- how could I not go outside and do something?

There are good reasons for taking the occasional rest day. It gives your body a chance to heal from whatever trauma your workouts have inflicted recently. Also, it helps you avoid getting so sick of exercise that dying young begins to sound like a good deal. However, I'm pretty sure that when my body really needs a rest it tells me so in no uncertain terms, so if a rest day comes up and I don't feel like resting, I might as well go outside and do something, provided it's nothing too heavy-duty. Today I decided it would be okay if I went for a walk in the evening on one of the trails that I usually run on.

The route was about four miles, with lots of climbing. If I wanted to count it as a workout I suppose I could, but I'm not going to. I'm still going to file today under the "rest" category. So I'll work out tomorrow (though it may be a lighter workout than usual).

For me, merely being out in the woods and fields (especially at sunset) is at least as therapeutic as stretching out in a hammock, so I'm glad I did it. 

Friday, June 13, 2008  

Fasting Glucose 94
Weight 187
Blood Pressure, Resting Pulse 106/64, 60

To me, old age is always 15 years older than I am.   
        Bernard M. Baruch

Still sunny, but cooler -- about 85 degrees. I decided to do a more difficult run today -- 5.5 miles, with about 700 feet of climbing. Also, I bike-commuted again, so once again I had that difficult climb to do in the evening. (The fact that I just called it "difficult" instead of "nightmarish" is probably a sign of progress on my part.) Anyway, after working out so hard today, my blood pressure is almost stunningly low this evening.

106/64! I never thought I'd see a blood pressure reading that low. I have even started to wonder if I've overcorrected, and pushed myself into the territory of low blood pressure. I looked that one up: it turns out that low blood pressure is anything below 90/60. I'm not there; I'm in the normal range.

Of course, if you dragged me into my doctor's office this evening and put the cuff on my arm, I might read 135/90 instead of 106/64. White-coat syndrome is mighty hard to defeat. But if I can at least get a lower reading there than I usually do, even that will be progress.

Some doctors think white-coat syndrome (the increase in blood pressure which occurs simply because the patient is in a medical setting) should not be viewed as a source of error, because it tells us how the patient reacts to stress, and therefore is the best indicator of what goes on with the patient's blood pressure during the stresses and strains of daily life. Doctors who think this are being awfully naive, I would say. For many of us, submitting to a medical examination is perhaps the most stressful thing we do all year long. It's an extreme situation; our fate hangs in the balance. If we're going to get tragic news about our health prospects, this is where and when the news will be broken to us. A defendant waiting for a verdict could not be under any more strain (and the defendant at least has the comfort of knowing that the judge isn't going to put on a rubber glove at any stage of the court proceedings). Not everyone gets this nervous in the doctor's office, but a great many people do. And I am no exception!

I once hoped that, if I turned my health situation around and started getting greatly improved lab results, this would remove the stress from my visits to the doctor's office. I would glide in there with a confident smile and maintain an air of unruffled calm thoughout the entire process, modestly accepting my doctor's congratulations on all that I had achieved. To my disappointment, this has not happened. I still go in there worried. What I'm worried about is that, even though I think I'm doing great, and my last several medical exams went fine, this time some unpleasant surprise awaits me -- the lab results or the doctor's examination will reveal some scary issue that I don't know about yet. The suspense is, if anything, worse than it used to be, because in effect I have more to lose. Once upon a time I used to go to the doctor's office without much hope, and therefore without much risk of disappointment. Now I go there with high hopes, and also with a lot of fear that my hope will turn out to be founded on an illusion.

I guess there's just no solution to white-coat syndrome, in my case at least. I guess my solution will have to be to aim for getting superb results at home, and hope that these translate into results that are good, or at least mediocre, in the examining room.

Thursday, June 12, 2008  

Fasting Glucose 84
Weight 187
Blood Pressure, Resting Pulse Multiple -- see below

Actions lie louder than words.   
        Carolyn Wells

It was 90 degrees today; I did a four-mile run at lunch, at a pretty decent pace I thought. I had a water bottle with me and drained it completely. Even more than yesterday, I was embarrassingly sweaty for much of the early afternoon -- it's just hard to cool down after a run in the heat.

As long as I was thinking about it, I figured I should repeat that blood-pressure experiment from 2003. I rode home from work on my bike, up a very steep hill (about 500 feet of climbing), took a blood-pressure reading as soon as I got in the house, and repeated the mesurement at 15-minute intervals. Here are the results, compared to the 2003 results (unfortunately I didn't record the pulse reading in 2003, so it's an incomplete comparison). As I hoped, the results were better this time:

Time after
BP, Pulse
1 min 179/85, 92 190/80 
15 min 124/74, 66 133/81 
30 min 121/75, 62 130/73
45 min 117/69 58 121/71
60 min 111/72 59 118/70

This time my blood pressure was significantly less elevated immediately after the climb, and it dropped farther and faster.

It seems that exercises raises my systolic pressure (the first number) a lot more than it raises the diastolic pressure (the second). I guess that makes sense: the systolic pressure is the pressure in the middle of a pulse, and if your heart is pumping harder the systolic pressure is bound to shoot up even if the pressure between pulses doesn't. 

A systolic reading of 179 sounds dangerously high, but that's only if you judge it by the standards that are defined for resting blood pressure.  If you're just lounging around the house and your systolic pressure is 179, obviously you've got a serious problem. But during strenuous exercise (and that ride up the hill was harder on me than the run at lunchtime, even though the run included a substantial portion of that same hill-climb), the rules are different. I think even the healthiest athletes can expect to have a very high systolic pressure during a challenging workout. It's hard to find out much about this, though, as almost everything written about blood pressure refers specifically to resting blood pressure, not blood pressure during exercise.

Anyway, my doctor didn't seem to see anything wrong with the numbers I obtained in 2003, and the new numbers are better. I'm making progress.

Which raises the interesting question of how I'm making progress. The superficial explanation is that I've been getting a lot of exercise during the 7+ years since I was diagnosed with Type 2 diabetes, and in recent years I've increased the intensity, doing more long-distance runs. But to me that's not a specific-enough explanation. How exactly does strenuous exercise over a long period cause blood pressure to go down? Apparently by causing changes in the body which are physical, measurable, and even visible.

Athletic men tend to have large blood vessels standing out in relief under the skin of their arms and legs -- I was never like that, but over my years of exercise I have started to see those branching structures appear on me as well. They are only conspicuous on the back of my hands and feet, but they are starting to be faintly visible on my arms and legs as well. What this means is that my body is expanding its circulatory system, making its existing blood vessels larger, and even adding new ones. Also, my heart muscle is stronger than it was. As a result of these changes, my heart is able to do more without working harder -- that is, it can move a greater volume of blood per contraction without exerting greater pressure. That is why my resting pulse is a lot lower than it used to be, and presumably why my resting blood pressure is also lower than it used to be.

Other factors affect blood pressure, however, including stress. I happen not to be experiencing a lot of that right now, but that's likely to change. (We have a software release coming up next month; the process of completing a software release amounts to 8 weeks' worth of crises crammed into the last 5 days, and as long as human beings are involved it will always be like that.) Still, if I can keep making slow but steady progress on my fitness level, the unavoidable stresses of life will affect me a lot less than they otherwise would have. 

Wednesday, June 11, 2008  

Fasting Glucose 87
Weight 187
Blood Pressure, Resting Pulse 108/64, 58

You can pretend to be serious; you can't pretend to be witty.   
        Sacha Guitry

I ran at lunch -- it was a little cooler today, about 89 degrees, but without the breeze we had yesterday. The distance was four and a half miles; I didn't want to do any more than that because I also rode my bike to work, and I wanted to keep a little energy in my gas tank for the climb up the hill after work. The climb seemed just a little easier this time. If I keep doing it regularly it will probably get a lot easier. You'd think that, with all the running I do (and it's usually on hilly terrain), my legs would be in perfectly good shape for climbing hills on a bike. However, getting in shape for one form of exercise usually doesn't get you in shape for another form of exercise; each activity uses different muscles, or uses the same muscles in a different way, so that you really can't use one sport to get in shape for another.

Anyway, ending my work day with a tough hill-climb on the bike certainly seems to have been good for my blood pressure. The 108/64 measurement quoted above was taken about three hours after the ride home.

Once, as an experiment, I made that same bike ride up that same hill and started taking a series of blood pressure measurements immediately after I got home. The results were:

After 01 minutes: 190/80
After 15 minutes: 133/81
After 30 minutes: 130/73
After 45 minutes: 121/71
After 60 minutes: 118/70

I shared those results with my doctor; he said that the very high reading immediately after very strenuous exercise was acceptable to him, because the pressure dropped so far and so fast afterward. (If the pressure had lingered at an elevated level for a long time, he would have been more concerned.) That experiment was almost 5 years ago now; I bet I'd get better results today. Maybe I'll try that again soon.

It seems like researchers are constantly discovering associations between Type 2 diabetes and other conditions. If you have Type 2, you are much more likely than non-diabetic people to have this problem, that problem, and a score of other problems. The trouble is, how are we to interpret an association of this kind?

If someone discovers next week that people with Type 2 sneeze a lot more than the rest of the population, will it mean that Type 2 causes sneezing, or that sneezing causes Type 2? Or will it mean that both Type 2 and sneezing are caused by some third factor yet to be identified? Sorting out such issues can be mighty tricky. A disorder associated with Type 2 might be a consequence of Type 2, but it might also be a cause of it. The only way to tell the difference is to see what happens after you make a change to one of the two.

Maria E. Ryan and  George W. Taylor, researchers on dental diseases, reported to the diabetes conference in San Francisco last week that periodontal disease (that is, gum disease) is strongly associated with Type 2 diabetes -- and the indications are that it's the gum disease that's causing the diabetes, and not the other way around.

Chronic inflammation of the gums seems to precede, and promote, insulin resistance. According to Taylor, "We think periodontitis may adversely affect glycemic control because the pro-inflammatory chemicals produced by the infection -- such as IL-1-beta, IL-6, and TNF-alpha -- could transfer from the gum tissue into the bloodstream and stimulate cells to become resistant to insulin." The researchers found that gum infections tend to drive blood glucose upward, and that getting gum infections under control tends to bring BG back down.

Therefore, if you have Type 2, you need to take care of your gums, and if you have periodontal disease you need to get it treated. Many of us tend to see dental care as somehow more optional, or at least less important, than other kinds of health care. It sounds as if it's time for us to get rid of that attitude. If your mouth isn't a in healthy state, the rest of you is not likely to be in a healthy state. Chronic inflammation anywhere in the body seems to have this sort of harmful effect (promoting not only insulin resistance but cardiovascular disease as well), but gum tissue is an especially common hot-spot for chronic inflammation, and it's important not to overlook the problem -- especially as the problem is so easily overlooked! Inflammation of the gums often does not produce enough irritation for the patient to be aware of it; you need to see a dentist to find out what's going on in there, and do something about it if there's a problem.


Tuesday, June 10, 2008  

Fasting Glucose 82
Weight 188
Blood Pressure, Resting Pulse 106/69, 61

Some cause happiness wherever they go; others, whenever they go.   
        Oscar Wilde

I didn't have time for a run at lunch, so I did a trail-run in the evening. It was warm, but so windy that the wind more or less canceled out the heat. The distance was 8.1 miles. Even more than usual, I started out the run thinking "I feel awful! I can't do this! I'm going to collapse in another minute!". Then I started feeling better, and I kept on feeling better and better as the run progressed. There weren't very many other people on the trails (although every time I thought I was alone enough to take a leak in safety, a little group of women cyclists or joggers would magically appear around the nearest bend). There was a lot of wildlife, though. Mostly deer, rabbits, lizards, and wild turkeys. At one point I looked down into a deeply shaded gully and saw a group of about 20 turkeys walking along in that peculiar stalking-Tyranosaur way they have.

I came out of the park just before sunset. I love to be outside at that time of day, when the sun is so low that you can't see it from where you are, but you know it must still be above the horizon because the hills and treetops are glowing orange, while everything around you is already in blue shadow.  I stopped at a store that had a salad bar on the way home, and packaged up a nice salad with a lot of greens and vegetables and beans. I was hungry, but that's what I was hungry for. I guess my body knew it needed some vitamins and fiber. Then I got home and experienced the magic of a hot shower after a long workout; there is nothing like it. Then dinner and a nice glass of red wine. I am at peace, and my blood pressure reading reflects it. 106/69! For me that's incredibly low. I hope I can make this winning streak last.

A week from today we're going to have a cardiologist give a presentation at the office on job stress and how not to let it kill you. I'm going to prepare a list of questions to ask him. Maybe he can help me keep these numbers low when the stress-factors start piling up later this summer, as I'm sure they will.

Monday, June 9, 2008  

Fasting Glucose 90
Weight 188
Blood Pressure, Resting Pulse 113/69, 57

Any American who is prepared to run for President should automatically, by definition, be disqualified from ever doing so. 
        Gore Vidal

It was a wee bit warmer today. When I went running at lunch it was 90 degrees. It could be worse (and will be). 90 isn't that bad when the humidity is low (which, thankfully, it nearly always is in these parts). Still, a hilly run in warm weather, especially when the weather has been cooler lately and you're not adjusted to the heat, can feel a little alarming. You become afraid of overdoing it, and unconsciously back off on the pace. I took a water bottle with me, though -- on a hot day I think that's a good idea even for a relatively short run (and today's run was only 4.1 miles).

The biggest effect of hot weather on my lunchtime runs is that, even after I get out of the shower after the run, I keep sweating for 30 minutes or more, so I get dressed and report back to the office looking looking as if I skipped the shower. Oh well; it's embarrassing, but so is life in general. The only escape from embarrassment is by way of the graveyard, and I'm not ready to go there yet.

I received an e-mail from the community college where I was taking a computer class recently. The subject line of the e-mail says "THOMAS, take a class this summer and measurably improve your life". Hmmmm. I thought I had already noticed a measurable improvement in my life (that is, the recent decline in my blood pressure), which began almost as soon as I was through with the class I took in the spring semester. Not taking a class has been very good for me so far. I was planning to devote my summer to it, and I don't think they can talk me out of doing so. If I'm going to try to do more of anything this summer, I think it will be hiking. And music-making. Taking a class is not part of the plan. Sorry, SRJC, you're too late. My life is measurably improved already.

More news has emerged from the big diabetes conference in San Francisco. A long-term (7+ years) study of Type 2 diabetes patients in pretty poor health found that "intense" control of blood glucose was not enough, by itself, to significantly reduce the risk of cardiovascular disease in these patients. Another major non-surprise, in other words. I understood that there was already abundant evidence to show that BG control was not enough by itself to reduce the elevated risk of cardiovascular disease which is associated with Type 2 diabetes. Well, apparently there's a lot more evidence of this now. The study found that the patients who actually reduced their risk of cardiovascular disease were those who, in addition to controlling BG, also achieved good control of blood pressure and lipids, and who adopted a healthy dietary and exercise habits.

To be sure, controlling BG is enough, by itself, to reduce the risk of other kinds of diabetes complications. That's good and important, of course, but preventing retinopathy isn't going to be much consolation if you can't enjoy your excellent eyesight because you had a heart attack and died. Therefore, regardless of what you're doing to control your BG, you also have to work on preventing cardiovascular disease. That being the case, why not kill two birds with one stone, and use a treatment to control your BG which also happens to have the effect of preventing cardiovascular disease? In other words, even if you're going to go to the pharmacy, you'll still have to go to the gym, too (at least if you want to stay alive), so why not go to the gym first? If you do well enough at that, the trip to the pharmacy might not be necessary.

Sunday, June 8, 2008  

Fasting Glucose 83
Weight 188
Blood Pressure, Resting Pulse 120/73, 68

Expecting the world to treat you fairly because you are good is like expecting the bull not to charge because you are a vegetarian.   
        Dennis Wholey

I did manage to get up early enough to get to Healdsburg and run in the Fitch Mountain Footrace, a 10-kilometer (6.2 mile) race. It's a difficult race, as the route features one big climb and a lot of smaller ones. For once I managed to finish it in less than an hour. My time was 59:20, so my pace was 9:33/mile. Not fast by the standards of real athletes, but fast for me, especially on a hilly course. Anyway, the story I came home with had to do with another runner, not me.

While I was waiting for the race to start, I noticed a young man who was walking around the plaza in an odd manner which led me to guess that he had cerebral palsy. His movements were all exagerrated, as if his limbs were abnormally long and the only way for him to get any use out of them was to execute broad swooping motions, like a stilt-walker. He wasn't just hanging around the park, though. He had a race number pinned to his shirt. I wondered how on earth he was going to complete the race. Was he going to walk it? Would he have to drag himself across the finish line long after everyone else was done and the race judges wanted to be home? It was hard to imagine him running with any speed. Was it even safe for him to attempt this? Should someone be talking him out of it?

But he seemed to know a lot of the runners, and he greated them loudly and enthusiastically (even his speech had the same swooping quality, as if he had to get through each syllable by hurling himself through it). He seemed to be the happiest person there. He couldn't have been more excited. Maybe he was in his element, and I just didn't know it yet. Maybe he had somehow managed to become a runner despite his disability.

When the race started, I noticed two things about him. The first was that as he ran, his feet swung in wide arcs to the left and right -- they never seemed to be directly under him. The second thing I noticed was that, despite this odd and seemingly inefficient gait, he was running at a very respectable pace. Certainly more respectable than mine; for a while I tried to keep up with him, but it was hopeless. Not only could he run, he could run fast. He lost me long before we got to the first hill, and I didn't see him again until I crossed the finish line and saw him hanging around there -- it was obvious that he had been done with the race for a good while, and was beaming with pride as his friends congratulated him on his performance.

There's a lesson here, obviously. Two lessons, as a matter of fact. One is that, when we make pessimistic assumptions about what others can or can't do, we invite them to make fools of us, and often they turn out to be fully prepared to take us up on it.

The other lesson, and probably the more important one, is that it's wrong to think of exercise as something which can only be done by the fittest people, the most perfect physical specimens. Even people with serious physical disabilities work out (or don't work out) as a matter of choice, just like everyone else. The critical issue is nearly always willingness, not ability. A lot of sedentary people think that, although in theory it would be a good idea if they exercised, it's not possible in their case. They know themselves well enough to realize that they're just not capable of it. Which means, of course, that they don't know themselves at all.

Saturday, June 7, 2008  

Fasting Glucose 83
Weight 189
Blood Pressure, Resting Pulse 120/69, 54

If two things don't fit, but you believe both of them, thinking that somewhere, hidden, there must be a third thing that connects them, that's credulity.
        Umberto Eco

Today was a rest day for me. I did a little bit of walking in the morning, but as my walking companion is 81 years old, you can easily believe that I didn't go terribly far or fast. It was definitely a day without exertion.

I believe (but cannot prove) that it's necessary for me to take a rest day each week, to allow my body tissues to heal, and also to prevent myself from burning out on exercise and refusing to do any more of it. All week, while I was struggling to fit exercise into my schedule, I was looking forward to this rest day, and yet I spent the day feeling as if I ought to be exercising. I've been restless instead of relaxed. I even planned a hike in the hills for the evening, but then decided that it was silly (and probably counter-productive) not to take a rest day when I had one coming.

Anyway, I'm probably going to do a 10K race tomorrow morning (the Fitch Mountain Footrace in Healdsburg) and it's a good idea to rest the day before a race. The reason I say I'm "probably" going to do it is that I haven't registered for it, and if I want to register on race-day I'll have to get up very early to get there in time to register. Getting up early is not one of my strong suits, especially on a weekend. If can manage to get myself to Healdsburg in time for it, I'll do the race. If not, I'll do a trail run or a bike ride.

I've done the Fitch Mountain Footrace before, and I've always found it difficult because of the climbing involved. I've had a lot of trouble making a time of less than an hour in it. I have hopes of doing better this time. Certainly I did better when I ran in The Relay in April; if I can manage to run like that this time, maybe I'll achieve a personal best.

Tonight I made a soup from local organic vegetables, and it was really good. I have a spotty record where cooking is concerned (especially soups), but I got it right this time. I hope I can reproduce it in the future. Part of the reason I have a spotty record is that I tend to throw in spices and ingredients impulsively, without following a recipe or creating a written record of what I've done. As a result, some of my cooking works and some of it doesn't. Oh well, at least that adds the excitement of suspense to the process.

Friday, June 6, 2008  

Fasting Glucose 83
Weight 188
Blood Pressure, Resting Pulse 123/72, 56

Money is the most envied, but the least enjoyed. Health is the most enjoyed, but the least envied.   
        Charles Caleb Colton

I had a good run at lunchtime. It was 5.6 miles, and involved about 500 feet of climbing in the first part of it. That was pretty hard, I admit. But when I got to the top of the hill, there was long stretch of relatively flat road along a ridge line, with a great view of the valley to the west, towards Sebastopol and Occidental. It was sunny and very clear. The temperature was in the high 70s, but there was a breeze to keep me cool. Tomorrow will probably be a rest day for me, so I figured I ought to take the opportunity to do a pretty solid workout today.

Today some disturbing news (or disturbing headlines, at any rate) came out of a medical conference in San Francisco today. It seems that a program called ACCORD (Action to Control Cardiovascular Risk in Diabetes), which aimed to reduce cardiac risk in Type 2 diabetes patients through a strategy of "intensive glucose lowering", was terminated when a safety review found that, instead of reducing the patients' risk of death, the program was apparently increasing it by 22%, over a period of less than four years.

As soon as I read this I began to wonder what "intensive glucose lowering" meant, and how it was being achieved. It turns out that the goal was a Hemoglobin A1c level below 6%, and although the average patient in the study only got it down to 6.4%, the patients in the control group (who died less often) were in the range of 7 to 8%. And how was the reduction in glucose achieved? By administering "a menu of medications"; participating doctors made their own decisions about which drugs to give and how much of each, but patients in the study were a lot more heavily medicated (typically with insulin plus three oral diabetes drugs) than those in the control group. And they died more. Looking on the bright side, they had fewer non-fatal heart attacks than patients in the control group. An irreverant person might note that the most reliable way to avoid having a non-fatal heart-attack is to have a fatal one, but not all the deaths were from heart attacks; the patients died from many causes, which makes it difficult to draw specific conclusions from the results.

Except for me, of course! I'm perfectly ready to draw what seems to me the screamingly obvious conclusion: giving people a lot of drugs is not the best way to treat Type 2 diabetes, because even when it "works" (in the sense that some number on a lab report goes down), the patient's health often gets worse instead of better. Admittedly, defining "better" and "worse" health can be tricky, but I don't think it's unreasonable to assert that, if you have made a patient 22% likelier to die within four years, you have probably not made the patient healthier. This outcome tells us (as if we had no other way to know) that drugs have unintended consequences, and that taking many of them at once is a dangerous business.

Let me note in passing that, in the rather long article describing the study, the words "diet", "exercise", and "lifestyle" do not appear. There is much talk of drugs, and no talk of anything safer or more effective. I'm sure the doctors involved in the study would say that the high-risk diabetes patients in this study would not have tried any therapy less convenient than taking drugs, and perhaps that is true. It's sad, though. And it's a little irresponsible to be talking about the second-best therapy for Type 2 diabetes (and a distant second, at that) as if it were the only game in town.

Thursday, June 5, 2008  

Fasting Glucose 87
Weight 189
Blood Pressure, Resting Pulse 119/71, 57

Most people would sooner die than think; in fact, they do so.   
        Bertrand Russell

In recent years we've been hearing a lot about the "glycemic index", a simple number which is supposed to tell us how big an impact a particular food will have on BG. You'd think we should be able to tell that just from the amount of carbohydrate in the food; however, there are some complicating factors (such as the amount of fiber and fat also present in the food) which determine how fast the carbohydrate is digested, and even how much of it is digested. If two foods have the same amount of carbohydrate, the one with the higher glycemic index is the one that will give you a bigger glucose spike. Therefore, goes the theory, we should pay attention to the glycemic index of a food rather than its carb content, because glycemic index is what really matters.

The glycemic index has a range of something like 0 to 100. I say "something like 100" because the scale works by comparing the tested foods against a standard food (usually white bread), so that 100 is the maximum unless you use a different standard food (or you manage to test something that's an even worse glucose-bomb than white bread). Anyway, an index value below 56 is considered "low", and a value above 69 is considered "high". So, you're supposed to avoid foods in the high range, and try to get into your diet a lot of foods in the low range.

Personally, I've never been able to get very excited about the glycemic index. I'm not sure that it really adds all that much to what we already knew. As nutrition labels don't include the glycemic index (and produce doesn't come with food labels anyway), anyone who wants to make use of the glycemic index is going to have to spend a lot of time reading (and presumably memorizing) data tables. And if you can't memorize the index values, but you want to reduce them to some basic rules of thumb, they turn out to be exactly the same rules of thumb you would be using anyway: foods with a lot of starch or sugar in them have high index values, but if those foods are also high in fiber, their index values are more moderate. (Wow, who saw that coming?)

So far, I haven't found a single example of a food which has a glycemic index which was much higher or much lower than I would have expected for other reasons. So what does this index bring to the party?

Another problem I have with the glycemic index is that there doesn't seem to be a solid consensus on what the index values are for specific foods. The values vary, depending on who's doing the testing. I'm not surprised, given the testing method: you give 10 healthy volunteers the same amount of the same food, and then measure the impact on their BG. You compare the result of this test to the result of a similar test using white bread (or whatever the standard test food is). Much is made of the standardization procedures which supposedly make these results reliable, but for heaven's sake! No wonder different authorities quote different index values for the same food. Sometimes the same authority will quote different values from the same food.

I just looked up "potatoes" on, and their table has three separate listing for Russet Burbank potatoes weighing 150 grams and baked without fat. The three glycemic index values for this food are given as 56, 78, and 111. The only explanation offered for the difference is that the first two numbers were measured in Canada and the third was measured in the USA (where "healthy" volunteers might possibly be harder to come by). The American result probably involves a typo (not so much the result itself -- I suspect that a larger serving size was used, and recorded incorrectly). But even if we disregard the American result, the 22-point difference between 56 and 78 is notably larger than the 15-point between the "low" and "high" ranges of the index as a whole! Sorry, but I can't regard this as a high-precision measurement process.

What brought this issue to my mind today was reading a research summary from the European Journal of Clinical Nutrition. The research was done in Switzerland in 2006, and it was apparently the first study that ever compared glycemic index results for one food (a breakfast cereal) in different kinds of people, as opposed to the usual procedure of trying to test various foods on a population of similar people. In this study, the test subjects were all young males of normal weight, but they were sorted into categories according to their level of physical fitness. One group was sedentary, another group was "moderately trained", and the third group was "endurance trained".  

Surprise, surprise: the glycemic index of the cereal turned out to vary widely with fitness level. The index values were highest for the sedentary group and lowest for the endurance-trained group (the moderately-trained group were in the middle). The average difference between the sedentary and endurance-trained groups was 23 points (and remember that the difference between a "low" index and a "high" one is only 15 points!).

So, what I conclude from this is that it probably isn't worth my time to agonize over whether kidney beans have a lower glycemic index than chickpeas, but it's definitely worth my time to go on long trail-runs, such as the ones I did yesterday and Sunday.  

Wednesday, June 4, 2008  

Fasting Glucose 87
Weight 189
Blood Pressure, Resting Pulse 116/72, 63

A man's health can be judged by which he takes two at a time -- pills or stairs.     
        Joan Welsh

Once again I exercised after work rather than at lunchtime, but this time it was a more serious workout -- a trail run with a distance of 7.2 miles. The weather was perfect for it: sunny and clear, 70 degrees, and a little breezy. I didn't get started until nearly 7 PM, so the landscape had that golden glow which movie directors want us to think lasts all day. The park was unusually empty; even the dam at Lake Ilsanjo (all trails lead there, so everyone ends up there) was deserted. Not much wildlife, either, although I did startle one deer, and I heard a few noises here and there that made me wonder briefly if a mountain lion was behind me and getting ready to pounce. (Mountain lions do live in that park, but I haven't seen one yet and hope not to in the future.) It seemed so lonely in there that I wasn't inclined to waste any time. I finished before sunset.

I needed to pick up some groceries on the way home, and by the time I got to the store my sweaty running clothes were feeling pretty chilly in the evening breeze, but putting on a wind-breaker was all I needed to warm me up and cover me adequately. Still, I did have that silly feeling that it must be terribly obvious I had just been trail-running, and someone might even ask me about it. I still take a certain childish pride in doing these things, and I suppose I'm waiting for some stranger to congratulate me on it. (This expectation is not realistic.)

Humanity is divided into the kingdom of the active and the kingdom of the sedentary, and people who work out in any kind of serious way are likely cross that frontier pretty often. In the middle of a long bike ride, you stop at a store or deli to pick up lunch, and you wait in line in your damp cycling clothes surrounded by people whose biggest physical effort of the day so far was getting into and out of the pickup truck, and you have a powerful feeling that you are at the intersection of two entirely separate worlds.

Once again, my blood pressure is looking good. The reason for this might be nothing more significant than that I have been exercising in the evening rather than at midday this week, so the beneficial impact of the exercise is still lingering by the time I make a measurement at night. Whenever I can get back to exercising at lunchtime the improvement may be lost, but we'll see.


Tuesday, June 3, 2008  

Fasting Glucose 83
Weight 189
Blood Pressure, Resting Pulse 113/69, 56

Regret for wasted time is more wasted time.  
        Mason Cooley

Once again I couldn't run at lunchtime and elected to go to the gym in the evening instead, but at least I didn't dither about it this time. Rather than do another easy workout on an elliptical trainer, I ran fairly fast on a treadmill. I dislike treadmill running, partly because it forces me to maintain a constant pace (my instinctive habit is to speed up and slow down from moment to moment), but mainly because I have a fear of falling down and being wedged and abraded by the contraption. Nothing like that has happened to me, but it always seems to be a possibility. Anyway, I put aside that fear today and ran hard on it. Tomorrow I plan to do a real run in the real world, if at all possible.

Some researchers in Switzerland, studying the effect of a large intake of fructose (a simple sugar found in honey, in some fruit juices, and in "high-fructose corn syrup", an industrial sweetener which is injected generously into soft drinks and processed foods), have reported a surprising result. The result is that men process fructose very differently than women do. In men, large doses of fructose cause several indicators of health risk to go up -- including insulin resistance, BG, and especially triglycerides. Women seem to process fructose much better, with much less indication of harmful impact. (For example, triglycerides increased only 16% in women, but 83% in men.) Nobody has any idea why women tolerate fructose better than men, but apparently they do.

Biochemical differences between men and women have long been a troublesome medical issue, because medical facts which apply to men don't always apply to women, yet standard medical practices for both sexes are often based on studies of male subjects alone. For example, the "standard" symptoms of a heart attack are only standard for male patients; when a woman has a heart attack, her symptoms are often different -- and for that reason doctors may not recognize what's happening to her.

I don't want to make too much of the fructose study, which I assume will have to be replicated by other researchers before it is taken entirely seriously, but the indications are that taking in a large amount of fructose is not such a great thing for anyone, that it's worse if you have diabetes, and that it's worst of all if you're a man and you have diabetes. So, it sounds as if I should avoid taking in very much of the stuff. Another nail in the coffin of my old idea that honey is healthier than other kinds of sugar.

Once again, I have uncharacteristically low blood pressure today. I don't know of a reason for it, except for the obvious ones: I had a hard workout late in the day, and I'm not very stressed-out right now. Those don't seem like adequate explanations to me, but I can't think of anything else. 

Meanwhile, here's our future:

Monday, June 2, 2008  

Fasting Glucose 88
Weight 189
Blood Pressure, Resting Pulse 118/71, 50

The goal of life is living in agreement with nature.  

I don't want to give the impression that sticking to my exercise plan is never a struggle for me. Some days I really, really don't feel like it. Today, as it happens was one of those days. After yesterday's trail run (which was, after all, 8 miles long, and over hilly terrain), I just wasn't feeling like running today. It wasn't just a mood -- my hips didn't feel like it, and my ankles weren't too sure either. Moreover, my usual running partners at lunchtime weren't around today. So, I told myself I would choose plan B, and go to the gym after work. I would have to fit it in before went to my yoga class, but there would be time. (I didn't even try to persuade myself that yoga would count as a workout -- I knew better than that.)

But when I got home, I didn't feel like going to the gym, either. I was very, very tempted to skip it. Then, when I finally drove to the gym, I found the parking lot unusually full, and once again I was tempted to leave, on the grounds that there was some kind of special event going on and there wasn't room for me. However, I did find a space in the parking lot, and the special event (whatever it was exactly) turned out to be happening on the adjacent golf course -- the gym had room for me, and there were cardio machines free. So I did my minimal workout (30 minutes on an elliptical trainer), showered, and got to yoga on time.

At least I have something to show for all that spiritual struggle -- when I got home from yoga and measured my blood pressure, it was another good reading.

I used to go through this kind of struggle with myself every single time I worked out -- now I only go through it occasionally. It's strange that I've made so much more progress on the physical front than on the psycological one. At this point I've done several 100-mile bike rides, and three marathon races -- either of which is a mighty big step up from the 15-minute episodes on the stationary bicycle which were my original workouts. But in terms of staying motivated, and being willing to do what's required whether I feel like it or not, I still occasionally revert to my earlier state. Oh well -- at least I don't give in to the temptation, and in the end that's what matters most.

In other news, I see that some researchers at the University of Navarra in Spain have found that the "Mediterranean" diet (dominated by vegetables, fish, fruits, and olive oil, with only a small contribution from red meat and dairy foods) results not only in a reduction of heart disease but in a dramatic reduction in the rate of Type 2 diabetes. The study followed a group of adults for four years and found that those who adhered to the Mediterranean diet were 83 percent less likely to develop type 2 diabetes than those who did not. The better the adherence to the diet, the lower the risk.

Surprisingly, the diet had a protective influence even on high-risk groups, including smokers, the elderly, and people with a family history of diabetes.

Sunday, June 1, 2008  

Fasting Glucose 97
Weight 189
Blood Pressure, Resting Pulse 126/78, 56

Half of the modern drugs could well be thrown out of the window, except that the birds might eat them.  
        Dr. Martin Henry Fischer

I overslept a little (which may explain why my BG was higher than usual today), but I was able to get together with my friend for the trail run today. As he was complaining of being out of shape, I chose the only route through the park I could think of which didn't begin with an immediate hill-climb. It was certainly a hilly route, but it began with a two-mile stretch that was almost flat, so at least we had the opportunity to warm up before we got to the really hard part. The weather was mild -- it seemed hot when we were climbing the biggest hills, but it was only 70 degrees. 

He said he was being pushed into bad health habits by his work schedule, or rather his work travel schedule (here it is June 1st, and so far this year he's been to India once, China once, and Korea four times). Travel -- particularly business travel -- sure does have a way of derailing your exercise program and undermining your diet. I've never had to do a very large amount of business travel, but I've done enough to know how hard it is to work on your health while doing it. Six trips to Asia in six months! I know I could never handle that. I'm glad no one is asking me to. Anyway, I'm going to encourage him to do more trail-runs with me on the weekends in the future.