Monday, December 28, 2009  

There are two big holiday problems I must deal with each year. One of them is over with, or mostly over with (I'm thinking of the party-food tsunami that crashes ashore on Thanksgiving and doesn't begin to recede until the day after Christmas). I coped with that one pretty well in terms of glucose control, though not so well in terms of weight control (I am 5 pounds heavier than I was when I left for Scotland in October).

The second problem, which only begins on Christmas, is the problem of what to do between December 25 and January 1. For many people this isn't a problem -- they go back to work during the interval between the two holidays. But my workplace shuts down during that time, so I'm obliged to burn up some vacation time. And I almost always end up feeling that I wasted these days off.

I'm not the sort of person who hops a plane for Hawaii the day after Christmas. It's not just that travel doesn't appeal to me at this time of year; the sad truth is that I don't feel like doing anything at all, even locally, at that time of year, and I usually just fritter the time away doing nothing in particular. Which would be okay, if I felt comfortable doing nothing in particular -- but I'm not that sort of person, either! So I'm really stuck: apathetic about doing anything, and unhappy about doing nothing.

This might seem to be a less diabetes-relevant issue than the onslaught of Christmas-party foods, but I think that it has a health impact. The combination of doing nothing and feeling depressed about it cannot possibly be good for me. It would clearly be better for my health to find something interesting to do during the interval between the holidays. I usually tell myself, during the fall, that this year I'll find a solution to the problem -- and then I usually fail to come up with anything.

But this year, I found a solution! Whether it's a good solution or not remains to be seen, but I have high hopes. The solution is Camp Harmony -- a gathering of musicians that begins tomorrow night and continues through the upcoming weekend. Friends of mine have attended this annual retreat for years. I've never been to it myself, because I was discouraged by the long drive (almost 200 miles, partly on mountain roads that are sometimes shut down during winter storms) and also by what I'd heard about the inadequate facilities. However, Camp Harmony has now been relocated to a much nicer facility which is only a short distance outside of the town where I live -- it's as if the people running the thing had mounted a campaign to overcome my objections and get me to attend. So how could I say no under the circumstances?

I don't really know how I'll use my time at the place. It's pretty unstructured, from what I hear. Some people teach workshops there on various styles of music, but I think the main activity is finding people you can play with, and hanging around with them making music till the wee hours. Five days of that might not be your idea of nirvana, I realize, but it happens to be mine. That kind of day-and-night music making probably does just as much to improve my sense of well-being, and reduce my blood pressure, as my exercise program does -- and that's saying a lot. As Joseph Campbell said, follow your bliss.

I get the impression from reading comments on the dLife forum that a lot of people with diabetes are experiencing great difficulty in the bliss-finding department.  "Everyone else is having fun and I'm getting screwed" is how they would summarize their lives after diagnosis. Well, achieving happiness is a tough assignment for most of us, and having diabetes doesn't make it any easier, but we've got to do our best. I doubt that happiness is often achieved by people whose pursuit of happiness consists of wishing that they had a different life. The odds are better for people who try to figure out how to have fun within the limitations of the life they've actually got. The narrower those limitations are, the more imagination you have to apply to the problem, so it's too bad that Type 2 diabetes tends to strike people at a point in life where their imaginations, like their muscles, have begun to atrophy from insufficient use. But if you can learn to start using your muscles again (and my experience says you can), maybe you can learn to start using your imagination again, too. 

I'll need to keep exercising, of course, while I'm at Camp Harmony, and that might mean a lot of running in the rain, given the forecast:

The marathon training schedule calls for a 7-miler on Wednesday and a 10-miler on Saturday. I may jiggle the dates a bit, doing the 7-miler tomorrow morning (before I get packed and head for camp) and doing the 10-miler on Sunday (after I get home from camp). That way my workouts at camp can be relatively brief, and easy to work into the schedule there, whatever that schedule turns out to be.

I don't know what the food will be like at camp, but I suspect that there will be enough healthy choices that it won't be a problem.

Blogging will be a problem, however, so I'll have to report on how the week went after I get back on Sunday.

Saturday, December 26, 2009  

Christmas day was clear and sunny, and far from cold (it was about 60 degrees most of the afternoon). This was the view from my father's front door:

It would have been good running weather, but for practical reasons I had decided to take it as a rest day (and make up for it with a long run today -- which I did). Not only was Christmas a rest day, it was also a day that revolved around eating rich foods, so I was pleasantly surprised by my comparatively low fasting test result this morning. I suppose the reason for it was that the high-calorie foods I was eating yesterday were mainly high-fat foods rather than high-carb foods.

Currently I am not restricting carbs the way most a lot of people with Type 2 diabetes do, for the simple reason that I don't have to. After doing so much intense exercise for so long, I am now able to get away with eating more carbs than most people with Type 2 can. But my resistance to the arguments of the low-carb crowd is slowly crumbling, and I might decide to make it my New Year's resolution for 2010 to try cutting back a lot on carbs, to see what kind of difference it makes for me.

The weather was a little less encouraging today (cloudy and threatening rain), but it was the day I had set aside for a long trail run, so I put on multiple layers and headed for the woods (the same woods I went running in last weekend). Although I haven't definitely decided to do the Napa Marathon this year, for now I'm following the training schedule for it, and this weekend the schedule called for a 13-miler. I threw in an extra tenth of a mile to make it exactly equal to half a marathon.

I did get rained on a little bit, during the last few miles, but it was a light rain and it really didn't get me any wetter than I already was, so it didn't bother me.

I was relieved to find that the run wasn't hard for me to do, even though it happened after a day of overeating. I felt less sore than I did after the 12-miler a week ago. So, I'm tentatively optimistic that I can handle the training program. We'll see how the rest of it goes (I'm still in the easy phase, after all.) 

The thing is, I've already run 4 marathons, so I no longer feel the need to run one just to prove that I'm capable of surviving the ordeal. At this point I only want to do it again if I can feel good about the experience. I don't mean I want the experience to be easy (running a marathon is never easy), but I want to be feeling some fun and satisfaction from the experience, and I also want to be pretty sure that it's strengthening me instead of injuring me. I'm quite ready to drop out of the training program if it's making me miserable, or if it starts to feel as if it's doing me more harm than good.

I know that a lot of people who do distance running eventually have to give it up, because they've hurt their knees or hips too much to continue. You could conclude from this that long-distance running is harmful and I ought to quit while I'm ahead. I think it's possible to draw another conclusion: that people who do distance running need to be keeping a close eye on how their joints and muscles are doing, and take some kind of corrective action immediately if problems develop. I'm guessing that most of the people who did themselves permanent harm with their running probably did it by ignoring pain and forcing themselves to run hard in an injured condition. I may be wrong in my guess, but I think it's at least a plausible guess. Anyway, I seem to be better today at running without hurting than I was 5 years ago, which is not what you'd expect if running was slowly but surely destroying my joints. So, I'll keep on running for now, but pay a lot of attention to how it's affecting me.

The Christmas music at work went well enough, but I wish we'd had more coworkers to play to. The effect of the layoffs this summer was sadly evident in the thinned-down crowds of employees around us. As if holiday depression weren't enough of a problem already!

But there was also a lighter side to Christmas this year! My home town of Concord, California continued its long-established habit of embarrassing itself with poorly-conceived public art projects. One such venture, the "Spirit Poles" installation of 1989, was voted the ugliest public art project in the United States:

However, the Spirit Poles were torn down in 2001 and the city fathers apparently decided this year that it was about time to make Concord a laughing-stock all over again. They wanted to have an official community Christmas tree in a downtown park, but this year they didn't want to spend money on a temporary tree set up for that purpose. So, instead, they decided to decorate an evergreen tree that was already present in the park. Somehow they failed to notice, as they were decorating it, that this particular evergreen was rather conspicuously dead:

Local television news crews have visited the park numerous times to take pathetic footage of this gray, skeletal evergreen. No news story on the subject has failed to compare it to the sad-sack tree in the old Charlie Brown Christmas TV special.

It wouldn't have been my choice of tree if they had asked for my input, but I can't claim that I'm sorry they chose as they did; I've greatly enjoyed watching them prove that they haven't lost their touch.

Wednesday, December 23, 2009  

Today our little group of strolling musicians at work finally managed to have a Christmas-music rehearsal with everyone present, including two who had never attended any of the earlier rehearsals. It was a good thing we finally managed to do that. Our performance is tomorrow morning, after all, and if I'm going to wander around the company site playing Christmas tunes in front of everybody I work with, I'd prefer that it not be a musical train-wreck. And it doesn't take much to make that kind of derailment happen. Until you actually run through the music together, you don't discover that different musicians are making different assumptions, and setting themselves up for disaster.

We certainly made a discovery of that type today. One of the musicians who hadn't been to a rehearsal yet is a clarinettist. Music for his instrument is usually written in a "transposed" format. Our sheet music is not transposed in that way (when it says C-sharp, it means C-sharp), but for some reason he assumed otherwise. Where our music said C-sharp, he played B-natural. When he played the first tune with us, every note he played was a wrong note. The effect was ugly beyond belief -- a kind of punk carol, which we might as well have retitled as "Fart The Herald Angels Sing". Eventually it dawned on him what was wrong. I'm hoping he can make the necessary adjustments by tomorrow. He says he can -- that he'll write out the music in transposed format by hand. He'll be up late if he's doing all that tonight, I can tell you! But I'm glad we discovered the problem today, and not while playing at the office tomorrow morning.

You might well ask why we do this at all, considering how difficult it is to make it happen, and how little time we have free to work on getting it right, and how great the risk is that we will all embarrass ourselves in front of our coworkers and bosses at the office. Why do it?

"Tradition" is part of the answer. This will be our 14th year in a row of playing Christmas music at the office on the last work day before the holiday break. We've done it in good years, in bad years, and in unspeakable years (2001 and 2009 being the most unspeakable of all, with coworkers been layed off in horrifying numbers). During unspeakable years it is hard to work up the proper spirit for this kind of thing; there is no doubt about that. I guess it just seems to us that it would be bad luck to quit now. It would feel like a surrender.

For me, there is also another issue at stake: the importance of getting out of one's comfort zone. There is probably nothing worse for you than to keep doing whatever you feel comfortable doing, and to avoid doing whatever challenges or scares you. Whether it's playing Christmas tunes in the office or running marathons, I try to keep doing things, at least once in a while, which I find hard to do and which I very well might fail at. It's a little hard to express why I think this is a valuable thing, but I guess the best way I can say it is that successful diabetes management is not about doing what you feel comfortable doing. It's about doing what you don't feel comfortable doing, because you know it's good for you. If you have diabetes, you need to cultivate the habit of occasionally doing what doesn't come naturally. If we all did exactly what we felt like doing, we might not be around to do it for very long.

Tuesday, December 22, 2009  

It was cold but sunny today -- good running weather. I was able to get outside for a run at lunchtime. A lonely run (my running buddies are not at work this week), but a pretty good run. Once again, my leg muscles felt better while I was running than they did before I started.

If you have been diagnosed with Type 2 diabetes, there are two facts above all which you would like to know about yourself: (1) how much insulin productivity have you lost, and (2) how much insulin sensitivity have you lost? These two factors will determine how difficult your task is going to be, so it's hard to keep plowing forward not knowing the answers to these questions. Unfortunately, most of us are probably never going to find out the answers to these questions.

Some would argue that it doesn't matter whether you have these answers or not, because you can't do anything about it anyway, so what's the point? I disagree: there are things you can do, and you'd have a clearer idea of what's needed if you knew where you stand in regard to these issues. (By the way, not everyone with Type 2 has lost insulin productivity -- a lot of them make more than the normal amount of insulin, to compensate for their loss of sensitivity to it, and surely it would be useful to know if you're in that situation.) Unfortunately, finding out where you stand in regard to these issues is very difficult, because neither insulin productivity nor insulin sensitivity is easily measured.

Let's consider insulin productivity first. Even in someone who produces a lot of insulin (comparatively speaking), the concentration of insulin in the bloodstream is extraordinarily low -- there's just a tiny trace of the stuff in circulation. Also, the amount of it is constantly fluctuating, and it's unevenly distributed (there can be ten times as much of it in the portal vein as in the peripheral circulation!) -- so when and where do you sample it? For these and other reasons, your insulin level is going to be hard to measure. Outside of a research setting, it generally won't be measured at all.

It is possible, without actually measuring insulin, to perform a test which gives an indication of how much insulin you're probably producing. This is the C-peptide test. C-peptide is a waste product which is left behind by the insulin-making process. The more insulin you're making, the more C-peptide will be hanging around in your bloodstream (at least until it's broken down by the kidneys). And C-peptide is easier to measure than insulin is.

So, some people are given a C-peptide test, which generally gives a good idea of the rate of insulin production. However, the results of the C-peptide test have to be interpreted with some caution. Because the test only measures a waste-product of insulin production, not insulin itself, the result can be misleading. For example, if C-peptide is not being broken down by the kidneys at the normal rate, it builds up in the bloodstream, and in that case the test result gives an exaggerated idea of how much insulin you are making.

Anyway, even the C-peptide test is not given all that often. It is mostly used as a diagnostic tool in cases where it's not obvious whether someone has Type 1 or Type 2. It is generally not used on someone who is established as having Type 2, to figure out how much insulin they're still making. However curious you might be about that, it isn't considered clinically useful information -- because knowing the answer doesn't empower you to do anything about it. My opinion is that knowing the answer would help you comprehend your situation, and comprehending your situation is nearly always useful; however, my opinion on this point is not widely shared by clinicians.

Measuring sensitivity to insulin is even more problematic. It's easy to come up with a rough, qualitative definition of insulin resistance: the cells that make up your various body tissues are not as sensitive to insulin as they ought to be. But when you try to define the problem quantitatively, and measure it, things get more complicated. How sensitive to insulin should your cells be? And how do we determine whether or not they make the grade?

For most of us, loss of insulin sensitivity is not measured -- it is assumed. If you developed diabetes as an adult, and it doesn't appear that you have Type 1, then it is taken for granted that you have lost some of your sensitivity to insulin, but usually no effort is made to determine exactly how insulin-sensitive you are. There is a way to test this, but it's not a simple or inexpensive test, and most patients never get it.

Insulin sensitivity is measured using a procedure which is known as the "hyperisnsulinemic euglycemic clamp". All three of those words are puzzling, but they can all be explained. "Hyperinsulinemic" refers to an abnormally high level of insulin, "euglycemic" refers to a normal level of blood sugar, and "clamp" refers to a process which, like a thermostat, constantly adjusts a fluctuating quantity so as to keep it confined within a certain range. In short, the test tries to answer the question "how much glucose does it take to keep your blood sugar level normal during an insulin overdose?".

The way the clamp process works is that you spend a few hours in the clinic with two IVs running -- one which pours insulin into you and one which pours glucose into you. If the insulin IV were running and the glucose IV weren't, you'd be driven into hypoglycemia; the glucose IV prevents that from happening. During the test, your blood glucose level is monitored, and the flow rate of the glucose IV is fine-tuned until you're getting just enough glucose to keep the insulin IV from pushing you into a low. (Because the test pushes you toward hypoglycemia for a long period, it would be a pretty dangerous procedure if you weren't being closely watched.)

The rate of glucose influx that is needed to keep you from going low indicates how insulin-sensitive you are. With normal sensitivity, it would take a lot of glucose to keep you from going low; with impaired sensitivity, it would take very little.

The glucose flow rate during the last 30 minutes of the test (by which point things should have stabilized) is the "result" of the test. In a person with normal insulin sensitivity, the flow rate would be 7.5 milligrams of glucose per minute or higher. If the rate is any lower than that, the patients is considered to have "impaired glucose tolerance" (that is, diminished insulin sensitivity). If the rate is lower than 4.0 mg/min, the patient is considered to have "insulin resistance" (that is, severely diminished insulin sensitivity) -- and the lower the rate, the more insulin sensitivity you have lost.

Obviously this is a complicated test to administer -- and that's the simple version of it! In some cases, the glucose in the IV is labeled with a detectable isotope such as Carbon 13, making it possible to distinguish injected glucose from glucose released by the liver, and monitor the situation much more thoroughly. Because this test requires 2 hours or more of intense medical supervision, it is bound to be an expensive procedure (in terms of price range, think "surgery" rather than "lab work"). Once again, it is usually done only as a diagnostic tool in cases where it's not clear whether the patient has Type 2 or not. Most of us will never have this test done. Simpler testing methods (including the oral glucose tolerance test) can give a rough indication of insulin sensitivity, but they don't really measure insulin sensitivity, and the estimates they lead us to make can be wrong.

Even if there were easier and more affordable ways to get your insulin productivity and insulin sensitivity tested, the results would only be valid for the time at which you took the test, because these things can change a lot over time (in the case of insulin productivity, any change is pretty sure to be in the undesirable direction, but insulin sensitivity can go either way). So even if you had hard numbers, you wouldn't know how long they were going to remain valid. The bottom line: you probably won't ever be able to do better than make an educated guess about how much insulin productivity and insulin sensitivity you have lost.

So what is a Type 2 patient with a healthy intellectual curiosity to do in this situation? When you have been handed the task of regulating your own blood sugar (because your endocrine system is no longer doing it for you), but the two main factors affecting your blood sugar are destined to remain hidden from you, how do you learn to accept being kept in the dark? Well, the simplest approach, and the most popular, is to throw up your hands, saying that it's all a mystery and there's no point in thinking about it. The trouble with this approach is that it's far too easy to make the transition from "there's no point in thinking about it" to "there's no point in doing anything about it".

There needs to be some middle ground between knowing and controlling every aspect of the situation on the one hand, and letting nature take its course on the other. If you can't have certainty, you can at least figure out what is probably the right thing to do. You don't want to be like a smoker who decides that, since there's no certainty that he will get lung cancer if he smokes, or that he won't get it if he quits, he might as well keep smoking and let fate decide the outcome.

Because we can't know and control every aspect of our diabetes, we need get as comfortable as we can with the unknowns, and do what we can about them. In the case of insulin sensitivity, there are a lot of things we can do to improve it, even if we can't measure how well it's working:

In the cases of insulin productivity, you mostly have to be content with holding your ground rather than gaining it, but still there are things you can do to avoid losing more insulin productivity than you have lost already. The main thing is to reduce your glucose level (high blood sugar degrades insulin productivity over time) in any way you can:

In addition, some oral diabetes drugs can increase insulin productivity by stimulating the pancreas; whether this does or doesn't "wear out" the pancreas is controversial, but it's certainly one way of making more insulin. Then there's the direct approach: take insulin shots. Most people with Type 2 don't want to do this until they are forced to, but it might be easier on your system than the oral drugs. The question is: are you taking the shots to give yourself a normal level of insulin (which you would have if your pancreas were working better), or are you taking the shots to give yourself enough of an insulin overdose to compensate for your lost insulin sensitivity? Overdosing on insulin appears to be very bad for your arteries, and is considered a cardiac risk factor, so rather than doing that I would prefer to improve my insulin sensitivity to the point where an insulin overdose is not needed -- assuming, of course, that that approach can be made to work! So far it's working for me. It probably won't work forever, but it's been working for almost nine years now, and that's a pretty good test.

It does frustrate me that I can't directly monitor my insulin productivity or insulin sensitivity, and that I can do nothing more than guess at what's going on based on blood sugar results. But at least I have something to go on. 

Monday, December 21, 2009  

I'm clawing my way back to connectivity -- my new PC and new version of Windows are largely incompatible with the old tools I had been using to work on this site, and the old ways I had been doing things, so it has taken me a while to become capable of posting anything here. Windows 7, like just about any other Microsoft product, offers many inconvenient conveniences -- that is, it thinks it knows what I should be doing instead of what I am in fact trying to do, and it tries mighty hard to coral me into substituting its goal for mine. It takes a lot of experimentation to find a way around these obstacles to complete a task. But if you're reading this at all, I must have won at least a partial victory.

Without quite making up my mind that I really am going to run the Napa Marathon in March, I did decide that I would at least begin the training for it, and see how it goes. So I did the 12-mile run on Saturday. And a demanding 12-miler it was, because it was a trail-run over very steep and muddy terrain.

I have to admit that my legs were sore after the run, and were still sore today -- I felt it every time I got out of my chair at work. It made me wonder if my body doesn't really want to start marathon training, or isn't ready to handle it. I didn't run at lunchtime -- it was raining, and that was my stated excuse, but what really held me back was that I thought my legs were too sore for me to attempt running. I was going to go to the gym after work, and do an easier workout.

But by sundown it wasn't raining any more, and I thought maybe I was babying myself too much. So, I put on my lights and went outside for a hilly 5.6-mile run. Well, what do you know -- almost as soon as I started running, my legs started feeling better. Then I went to yoga class and continued the leg-rehab.

When my muscles are sore, resting usually doesn't help them, but using them usually does. Peculiar things, those muscles.

On Saturday I didn't just go trail-running -- I also spent some time in the woods looking for mushrooms.

I don't gather and eat the mushrooms, I hasten to add -- I just admire their weirdness and photograph them.

I always try to get my macro lens down on the ground, to catch the details of the rib structure underneath the mushroom.

However, some of them look better from the top. The one below looked so gross underneath that I don't want to share the images I captured of it. 

And some of them looked fairly gross from any angle.

This one was growing straight out of a fallen log.

Of course, while I was crawling around on the ground I got to meet some other creatures that do that, including this newt.

It looks to me as if it's a pretty hard life, down there on the forest floor. Maybe we don't have it as bad as we think.

Thursday, December 17, 2009  

AAAAAARRRRGGGGHHH!!!!!!  I wrote a long blog post only to lose it to yet another computer crash!

I have had it with this PC, and I'm in the process of replacing it. I may have to go without updating this site for a few days while I'm getting all that sorted out.

Wednesday, December 16, 2009  

Don't people know there's a recession on? I swear that I have been invited to more holiday gatherings, and have been offered higher-quality goodies, than in any previous year. I seem to be surrounded by temptation nearly every day.

Yesterday one of my coworkers, an expert chocolatier, brought in a sampler plate of her latest creations (we're talking about the kind of chocolate truffles that make you wonder why anyone bothers taking drugs), and this afternoon I went to an employer-sponsored celebration at which waiters were strolling around holding out hors d'oeuvre trays to me and saying "Would you care for a hot crab cake, sir?". Yeah, maybe I would. Since you mention it.

The celebration today wasn't even a Christmas party. It was to celebrate a new product introduction which is going very well and is expected to bring in a lot of money to the company. I wasn't involved in working on that product, but they invited everyone in the division to the thing, which was at a very fancy place, and they were not only serving us good food, they were pouring us glasses of good wine (I had the Acacia Pinot Noir -- I really like that one, and you'd be surprised how seldom anyone pours me a glass of it for free.)

Tomorrow at work we have the actual Christmas party. This one will just be a humble potluck in the office, but I don't know if that's necessarily going to make it any less of a challenge to self-control.

I did manage to get out for a run before the party, and it was a pretty hard run. Not a hard enough run to make up for the party, but I did my best. There was an extremely light rain (or mist) -- enough to cool us without being enough to bother us. That's how rain should be. (I guess we need it to rain hard once in a while, but it should only do that while I'm asleep.) My running buddy Mike split off from the route before the end because he wanted to do an extra-long run (he ended up doing about 8 miles). He's the one who wants to do the Napa marathon again this year. The training schedule for the race doesn't call for 8 miles today, but he feels like he's out of training and needs to make up for lost time.

Hmmm.... if I'm going to run the marathon with him this year, that means I need to do a 12-mile run this Saturday. And it gets worse from there. Am I tough enough to face going through all that again? I guess we'll soon see.

Tuesday, December 15, 2009  

As I couldn't run at lunchtime, my original plan was to go to the gym after work. However, I had a big lunch, and I felt the need to work out a little harder than I would have done at the gym. It wasn't raining tonight, so I figured I should do an outdoor run. Because it was already dark when I started, I put on a reflective vest, hung a red flashing LED on the back of the vest, and put on a bright headlamp. The only flaw in these preparations was that I didn't realize the batteries in the headlamp were about ready to give up the ghost.

Midway through the run the headlamp faded away. I was still visible to drivers (thanks to the shiny vest and the red LED), so I wasn't in danger of being run over, but the pavement in my path was hard to see in places where there were no streetlights. The fact that I run that route all the time (usually in daylight) made me less worried about stumbling over something in the dark than I would have been on less familiar roads. But I'm certainly going to make sure I have fresh batteries in my headlamp the next time I do a night run!

Running at night can be a refreshingly different experience -- a bit of an adventure. And at this time of year there are some nice atmospheric touches to it -- displays of Christmas lights, and the smell of smoke from wood fires. Anyway, I liked it better than I ever like the gym.

This morning I woke up and found my back problem was entirely gone. In fact, I woke up and forgot about my back problem -- that's how gone it was. And when I got home from work, there on my front porch was a package waiting for me -- the TheraCane massage stick I ordered on Friday when my back was hurting like crazy. Well, I'm glad I have it, even though the emergency is over. I used it to work on my back after the run tonight, and I think that will be a good practice to adopt generally.

My blood pressure is down a lot tonight, probably from a combination of factors. One is that I did a hard run, and I did it less than 2 hours before I measured my blood pressure. The other is that (for the moment, at least) the stress level at work is down a bit. That won't continue, but I'll try to enjoy it while it lasts.

I sure am stuck in the cycle of holiday eating. I went to parties on Friday and Saturday, and I have two more planned for tomorrow and the next day. It's a tough time of year for weight management!

Monday, December 14, 2009  

I drink a lot of coffee, and I suppose I spend more money doing so than I ever want to see totaled up. It would be nice to think of it as a healthy habit, and not as a minor vice. So, of course I was pleased to read a report today which claims that coffee drinkers and tea drinkers have a lower risk of developing Type 2 diabetes -- and that, the more cups a day they have, the greater the reduction in risk. 

Being the sort of person I am, I couldn't dwell on that happy thought for very long before I started thinking of reasons to be skeptical of the claims as reported.

For one thing, the report, which comes from a team led by Dr. Rachel Huxley at the University of Sydney in Australia, is one of those "meta-analysis" studies. A meta-analysis (I think the term is Latin for "cherry-picking") is a study in which you assemble data from numerous other studies (18 other studies in this case). The trouble with this approach is that you have to make a judgment call about which studies are "good enough" to warrant inclusion. Human nature being what it is, studies which reinforce your own ideas on the subject are going to make the grade, and other studies are not. Meta-analysis studies are notorious for the predictability with which they support the known views of the people compiling them. (Announcements along the lines of "my meta-analysis shows clearly that I've been dead wrong on this issue for years" do not often appear in the scientific literature.)

Also, it's a bit hard to make sense of the numbers reported in the coffee study. The claim is that you get a 7% reduction in diabetes risk for each cup of coffee you drink per day (in other words, drink 3 to 4 cups a day and your risk goes down by 21 to 28%). But people who drank 3 to 4 cups of decaf coffee had a 36% reduction in risk. It is assumed that something other than caffeine is creating the reported benefit, but why would there be more of that something in coffee which has had the caffeine washed out of it? And why is it also present in tea, which yielded an 18% risk reduction for those who drank 3 to 4 cups a day?

No substance has been identified as the cause of the risk reduction, but there are some possibilities that are found in both coffee and tea: lignans, chlorogenic acids, and magnesium have been mentioned as potential research targets. But so far nobody knows if those things actually account for the reduction in diabetes rates. (And if there is a magic ingredient to be identified, there would seemingly need to be less of it in tea than coffee, but more of it in decaf coffee than in acceptable coffee.)

The most suspicious aspect of the research, for me, is that the reported risk reduction is modest. This could mean that coffee is only modestly protective -- but it could very easily mean that the association of coffee with risk reduction is a meaningless coincidence. Maybe what's actually protective is some factor other than coffee drinking -- and this factor just happens to be slightly more common among coffee drinkers. Maybe people who drink more coffee also tend (at least on average) to have something else in common which correlates with better health: they are more active, or more health-conscious, or they have more money, or something along those lines.

I was drinking plenty of coffee during the run-up to my diabetes diagnosis, so it certainly didn't prevent the disease in my case. Not that this is inconsistent with the Australian report. After all, reducing your risk 28% is not the same thing as eliminating it, and I was probably working a lot harder at becoming diabetic than Starbucks was at stopping me.

Whether coffee is or isn't helping me keep my blood sugar under control today is unclear. I'm not likely to give up coffee long enough to make the comparison. I do, however, have a basis for comparing the with-coffee and without-coffee versions of my phone conferences on Wednesdays at 6 AM. Guess which one I like better? 

The weather-guessers said it wouldn't rain again until Tuesday, but it was hard to have faith in that prediction when I went outside for my lunchtime run today, and saw thick dark clouds massing overhead. I figured my chances of completing the run without getting caught in a downpour were small, but once again my luck held. It stayed dry right through to the end.

Running at lunchtime is ruled out tomorrow by a training class I need to do which extends into the lunch hour. Another gym night for me, I guess.

On the bright side: the problem with my back is much improved. It already felt a lot better before the yoga class in the evening, and it felt even better afterwards. If don't have a relapse when I get up tomorrow morning, I'm probably over this. So, it looks as if my gamble of continuing to exercise while recovering from the problem payed off.

Sunday, December 13, 2009  

Sorry I haven't updated my blog since last Wednesday, but some practical problems got in my way. The biggest one was that I threw my back out, as the saying goes. 

Actually, I didn't throw my back anywhere -- it's still right here where it was. It just started hurting a lot, quite suddenly, as I was stepping out of the shower one morning. Is there a lesson here, apart from "Never Get Out Of The Shower!" (a rule I would live by if only I could)? It's hard to say. I don't think I "did" anything unusual recently that could have triggered this problem. More likely some bad habit of posture set me up for this, and on one random morning my back decided it had taken as much as it was going to.

Anyway, since that fateful exit from the shower I've felt okay while lying down or standing up straight, but getting into or out of chairs has been painful, and sitting has been pretty unpleasant. This made me very disinclined to sit at my computer for more hours of the day than my job required.

I used to have a lot of problems with lower back pain (I have a slightly herniated disk, which occasionally flares up and causes painful spasms in the back muscles). Since I was diagnosed with diabetes and started doing a lot of exercise (including yoga), these flareups have been less severe, and far less frequent. But they do still happen occasionally, and when they do I have to figure out what to do about them.

I know the basic things I can do: ibuprofen, icebags, stretching to the extent I can do it, and waiting as patiently as I can for the episode to be over. But then there's the big unanswered question: what about exercise? Will continuing my daily workouts make the situation better or worse? Will I heal faster if I run or if I rest?

My general rule, in any situation when I'm not feeling great and I don't know whether exercise will make me feel better or worse, is to go ahead and do the exercise. If my body doesn't want me to exercise, I figure it will find a way to stop me. Once in a while this habitual assumption of mine doesn't work out well (for example, when I ran a 10K race last June before I had quite finished recovering from a virus), but it works out well in the vast majority of cases. It's pretty rare for me to finish a workout not feeling better than I did before. And because I rely on exercise so much for glycemic control, I don't skip it without having a good reason.

So, I have been continuing my workouts through this recent lower-back crisis, and so far as I can tell that hasn't been a mistake. My back is gradually getting better, despite such challenges as the trail-run today. And I don't think there's anything I could have done that would have resulted in a rapid recovery; the slow one I'm experiencing as probably as good as it gets.

When a muscle is hurting, you want to be able to do something more direct about the problem than taking ibuprofen (or Vitamin I, as the runners call it). When I have a sore leg-muscle, I can use a massage stick to work on it. But working on a sore back-muscle is a lot more tricky -- maybe you can reach it, but can't press as hard into as you need to. One of the managers at work, who is a serious cyclist, has a device called a Theracane, which he can hook around to apply concentrated pressure to any point on his back:

No smart remarks, please. I know it looks weird, but it works. He let me try it out, and it seemed clear that it was exactly what I needed, so I ordered one from Amazon. By the time it gets here, my current back problem may already be over with, but it will be nice to have it ready the next time I need it. I probably should have ordered two of them so I could leave one at the office.

The body is such a complicated and vulnerable machine. If anyone sold me a car that needed this much maintenance, I'd sue. On the other hand, if I was going to have to live in that car for the rest of my days, keeping it in good repair might be worth the trouble. 

Wednesday, December 9, 2009  

Another mighty cold day, but I did manage to get out for a run, and this time I remembered the gloves, which made a big difference.

The day began early, with a 6 AM meeting. Not my idea of the right way to start the day, but I did get to see something I'd never see otherwise. After the meeting, I stood up and looked across the mostly-deserted (and mostly-unlit) office, and through the east-facing windows I had an unobstructed, dramatic view of the rising sun just as it was beginning to peak over the ridgeline. The darkened office was suddenly flooded with yellow-orange light. I wish I'd had a camera. But maybe I'll get another chance, as these Wednesday 6 AM meetings seem likely to continue for the next few months at least.

Why was my fasting test result down this morning? Probably because I got up at 5 AM. Why is my blood pressure up tonight? Perhaps because I'm playing music at a funeral tomorrow, and I know that's never an easy assignment. I can practice the music I'll be playing, but you can't practice for the real challenge of playing music at a funeral, which involves suppressing any emotional response to the service while it's happening (otherwise you can't concentrate well enough to play), and then having a delayed reaction once the ceremony is over. I can do it, but it's hard. And this funeral is for a woman who died young; her mother is the one making the funeral arrangements. I don't think this is going to be easy to get through calmly. And I'm working tomorrow -- only leaving the office long enough to go to the service and come back. It's not likely to be an easy day. So, a little rise in blood pressure seems unavoidable.

I sometimes think the reason people have such strong opinions about the subject of nutrition is that almost nothing is definitely known about the subject, and this leaves us free to believe whatever we're in the mood to believe. Almost anything you can say about nutrition might be true. So why hold back?

The only way we could ever really find out anything for sure about nutrition and human health would be to raise thousands of human beings in cages, control everything they eat, give them different diets, observe their daily behavior, and track what happens to their health for the rest of their lives. Then we'd know. Or at least we'd be pretty sure.

As it is, we rely on the ability (and willingness) of interview subjects to give accurate summaries of what they have been eating and drinking lately, and how much exercise they've been doing lately, and draw whatever conclusions we can from rather short-term observations of their health. Could you summarize your personal habits accurately for such a study? And would you if you could? There is way too much guesswork involved in this kind of research, and too few ideas about how to reduce it. All conclusions about nutrition must be tentative.

Of course, the antagonists in the diet wars are never tentative. The don't say "Here's my idea of what people should eat, and for various practical reasons this idea will probably never be disproved in my lifetime. I might be right, for all we know, so I'd really appreciate it if everyone would simply go along with me on this".

That's not how anyone talks about nutrition. What they typically say is, "Here's my idea of what people should eat, which is unquestionably correct, and has been tested and confirmed by every serious, intelligent, unbiased scientist who has ever looked into the matter -- although it has been dismissed by several careless, prejudiced, irresponsible people who call themselves scientists but are really little more than lobbyists for the industries which would lose money if the truth about nutrition were ever allowed to get out".

Most people engaging in these debates are thinking of diet primarily in terms of preventing obesity, or promoting general health. But even those who are specifically concerned with diet as a means of controlling diabetes disagree passionately about everything, including the simple question of whether or not carbohydrates should be limited, and if so, how severely.

One might expect the latter issue to be straightforward -- digestion turns dietary carbohydrate into glucose, so you'd think it would be obvious that anyone whose endocrine system has trouble controlling glucose levels should be on a low-carb diet. But nothing connected with nutrition is straightforward. Why does that person's endocrine system have trouble controlling glucose levels? What if some aspect of a low-carb diet might actually be causing that problem, or making it worse? What if the glucose-making potential of a particular food is less important in the long run than the hormone releases that that food tends to trigger? I'm not saying these questions are necessarily valid, I'm just illustrating how endlessly questionable all nutritional ideas are. We don't know anything about nutrition; we just know what we think about it. Of course, we can cite strong evidence to support what we think. And so can the people who disagree with us entirely.

The term "Type 2 Diabetes" probably describes a category of diseases rather than a single disease; at best, it describes one disease that varies considerably from patient to patient and may have many causes. As a result, what works for one person won't be what works for another, and there is bound to be at least some evidence in favor of almost any diabetes diet. Everybody can say "See, this proves I'm right about diet and diabetes", even though all these people who are right disagree with one another.

What my own experience suggests (for what it's worth to anybody else) is that the low-carb approach works for me in terms of glucose control but not in terms of weight control. If I want to lose weight, the only thing that has worked for me is to adopt a low-fat, vegetarian diet -- which almost inevitably is higher in carbs, and is therefore not as good in terms of glucose control. If I do enough exercise, I can make almost any kind of diet work for glucose control, but if I later find that I'm no longer able to exercise so much, I'll probably be forced to cut down quite a lot on carbs. This is only my own personal experience, and I don't think it's typical. So, like everyone else, I'm left with making a choice about what to believe, and sticking with it for as long as I can make it work. The trick is not to keep sticking with it after I can no longer make it work. And I think people who let themselves get too fiery in their advocacy of a particular set of nutritional ideas are in great danger of clinging to their ideas after they can no longer make those ideas work.

When we're guessing, we shouldn't act as if we're sure.

Tuesday, December 8, 2009  

Blood sugar under control, blood pressure under control, and weight still stubbornly refusing to go down. My fault, of course -- I haven't been trying hard enough to do anything about it. I certainly will want to start bringing my weight down if I'm going to do the Napa Marathon in March. Maybe that's the gimmick I need: sign up for the marathon, with the goal of getting my weight down to 170 by race day. In previous years, I always gained weight during marathon training (because all those long runs made me hungry enough to overcompensate for them), but I managed to lose eight pounds during the training for the 2009 Napa race. Now that I know it's possible to lose weight during marathon training (during the holiday season, yet!), I guess I have no excuse not to make it happen again.

It was cold today (temperatures in the 30s), so I wasn't sorry to be unable to get outside for a run at lunchtime. I was committed to a lunchtime rehearsal of Christmas music with some coworkers. I went to the gym in the evening and did 4 miles on the treadmill. At least it was warm in there, but to me 4 miles on the treadmill always feels a lot harder than 4 miles outdoors.

The Christmas-music rehearsal didn't exactly go brilliantly, but I guess it went as well as our first rehearsal for the season ever goes. We had a surprise newcomer join our group -- a trumpet player, who showed up in the vacant building we were planning to use for our rehearsal because he'd been planning to use it to get in some trumpet practice. Since a bunch of musicians were going to be using his practice space, he figured he might as well join them, and get involved in the Christmas music this year. But he agreed to bring a mute next time -- an un-muted trumpet is a pretty overpowering instrument for playing in close quarters. He just about blew me through the wall of the conference room. I guess there's a reason why no composer ever wrote duets for violin and trumpet.

Tomorrow I'm planning to run at lunchtime, but I'd better bring a lot of layers of clothing to wear, because it's forecast to be just as cold tomorrow. This is not the California I thought I knew. Note to self: don't forget the gloves this time!

Rain is expected on Thursday, so it's just as well that I will have a lunchtime musical committment on that day. This committment is not so lighthearted as the Christmas thing; I'll be playing at a funeral. As I have a piece of music to learn for the funeral, I think I'd better close now and go work on it. 

Monday, December 7, 2009  

Well, that was The Storm That Wasn't. The weather forecasters had really built up some excitement about the Alaskan storm which was rolling down the Pacific Coast towards us -- they had even suggested that people in this area should spend the weekend making sure their homes were well stocked with emergency supplies. But all that happened was a little light rain last night; the sun was back out today. Maybe the second Alaskan storm in the series, which should reach us Thursday, will be more impressive.

It was cold, though, at least by local standards. Ice on the windshields in the morning, that kind of thing. I managed to dress warmly enough for my lunchtime run, except that I should have worn gloves. My bandana came undone and my fingers felt so numb that I had a ridiculous amount of difficulty tying the thing back on.

It will probably be colder tomorrow. The stars are out, so there's no cloud layer to reflect back any of the heat that the earth is radiating away. I just checked my thermometer on the front porch: at 10:30 PM, it's already down to 33 degrees. I guess the weather won't be such an issue for me tomorrow, though. I plan to work out at the gym in the evening, rather than run at midday, because I need to use my lunch break to participate in a Chistmas-music rehearsal at the office.

Every year at my work site, on the last work day before Christmas, a small group my more musical coworkers strolls around from building to building, playing Christmas tunes in each of the main work areas. The ensemble this time will probably consist of a flute, a mandolin, two guitars, my fiddle, and possibly a French horn. It will be my 14th year of participating in this tradition. It's a mighty casual thing (most of us never play together the rest of the year), but we try to get together for at least a few rehearsals to work out what we're going to play and how we're going to arrange it. Also, the rehearsals are my opportunity to try to discourage the selection of tunes that I find intolerably embarrassing to play. Rudolph, Frosty, and the Little Drummer Boy can all go take a hike as far as I'm concerned, but there's always somebody who wants to play these songs and needs an intervention. I like some Christmas songs (usually the older ones, not the cheesy pop novelties), which I guess puts me in the middle of the spectrum of opinion on the subject. A clarinettist at work declined to play with us on the grounds that he hates all Christmas music. But there are plenty of people who like every kind of Christmas song (and seem to like the really dopey ones best of all). It's not easy to come up with a playlist that makes everyone happy. My bottom line is that I don't want to play a tune which, if someone else played it, would make me leave the room. I don't think that's too much to ask!

Why is my diastolic blood pressure down tonight? Because I worked out extra-hard today? (I didn't.) Because I went to a yoga class in the evening? (I do that every Monday.) Because my sodium intake was exceptionally low? (It wasn't.) Why, then?  I think it's just that the situation at work was less stressful today than it was last week. I doubt very much that there's any more to it than that. 

We hear a lot about things that can supposedly reduce blood pressure, but if you ask me "not being upset" is probably the one with the biggest impact. Now, if we can only figure out a way to get people to stop being upset, we can fight hypertension and achieve world peace in one move!

Sunday, December 6, 2009  

I knew that rainy weather was expected to start some time today, and I was planning to do a long trail-run, so I put on several layers (including a light jacket) and went to the park this morning to get a comparatively early start. It was colder than yesterday, and cloudy, and for a long time it looked as if I was sure to get caught in a downpour. Never happened, though. The first raindrops didn't fall until I was driving home from the park. Another lucky escape.

Although my running route was almost twice as long as yesterday's hike, it covered a lot of the same territory, so it would have been interesting to take a camera this time, too, and show how different the same landscpae can look after the weather changes.

The first five minutes of the run felt terrible -- which is usually the case; the question is always whether I will start feeling better once I get warmed up. I did -- much better. It often happens that way, but I wish I could not feel so bad during the first few minutes of a run. Maybe that reaction is just hard-wired into me and there's no overcoming it. I know that the body needs to convert over to a different energy-burning system when you start exercising, and the transition takes time, but I can't help suspecting that the symptoms I experience while waiting for that transition to happen (mainly nausea and despair) aren't universal. Maybe some people don't feel those things at all -- and those are the ones who become athletes.

I guess this is my last week to make a decision about whether or not to run in the Napa Marathon this year. Up to this week, the marathon training schedule I would be using for that race doesn't call for me to do anything more than (or even equal to) the amount of exercise I'm already doing anyway. But next week's schedule calls for a 6-miler on Wednesday, and a 12-miler on the weekend. If I'm going to do the race, I'm going to have to start doing that kind of serious training soon.

The training schedule is shown below. The numbers are running distances in miles. "Gym" means any kind of workout that isn't running. All Mondays are rest days, so there is no column included for them.

Week Tue Wed Thu Fri Sat Sun
Dec 7 - 13 3 5 3 Gym 7 Gym
Dec 14 - 20 3 6 3 Gym 12 Gym
Dec 21 - 27 3 6 3 Gym 13 Gym
Dec 28 - Jan 3 3 7 4 Gym 10 Gym
Jan 4 - 10  3 7 4 Gym 15 Gym
Jan 11 - 17 4 8 4 Gym 16 Gym
Jan 18 - 24 4 8 5 Gym 12 Gym
Jan 25- 31 4 9 5 Gym 18 Gym
Feb 1 - 7 5 9 5 Gym 14 Gym
Feb 8 - 14 5 10 5 Gym 20 Gym
Feb 15  - 21 5 8 4 Gym 12 Gym
Feb 22 - 28 4 6 3 Gym 8 Gym
Mar 1 - Mar 7 3 4 2 Rest Rest RACE

Of course, it's never possible to follow the training schedule to the letter. Some tinkering is always required. (For example, I doubt very much that I'm going to end up running 13 miles on Christmas, and I don't care who knows it.) But, however much I juggle dates and assignments on the schedule, I try to make sure I'm running as many miles in total as the schedule calls for.

The part that I'm still having a problem with is committing to do all that running in the winter, and probably in the rain a lot of the time. That's a hard thing to sign up for!

Saturday, December 5, 2009  

This was my rest day for the week, but all I mean by "rest" is that I'm not doing any kind of serious workout -- I don't mean that I'm spending the day on the couch. As the weather was sunny today, I thought I would go for a walk in the hills. The pace was slow, because I was stopping to take a lot of pictures --  it wasn't the kind of sweaty hike that, on a non-rest day, I might decide to count as my workout for the day.

A sunny cool day in December is usually a good day for a hike around here. The landscape looks better to me than it ever does in the summertime.

A couple of big storms are moving down from Alaska, and are expected to get here on Monday and Wednesday, so people were taking advantage of the current good weather while it lasts. There were a lot of runners, hikers, equestrians, and especially mountain-bikers on the trails.

Nice to see plenty of water in Lake Ilsanjo, which was drained last year due to careless dam management. (The reeds have come back to life, too, now that they're no longer high and dry.)

Because diabetes management requires doing more exercise than most people want to do (and about a hundred times more than I used to do before I was diagnosed), it's fortunate for me that I love the outdoors. That makes it possible for me to enjoy exercise, so long as it's happening in the open air. In the gym, it's still just work to me. Under the sky, there's always some pleasure in it. 

Friday, December 4,  2009  

Weather still cold, but not quite as cold as yesterday. We ran exactly the same route today as yesterday, but this time we were joined by a runner who used to work with us (we had huge layoffs this year). He lives in the neighborhood, and we just happened to cross paths with him while he was out running himself. So, he joined up with us. As we ran along, he asked about upcoming big races. Were we doing a marathon this year?

Funny, we'd been talking about that just before we ran into him. All three of us confessed to some degree of interest in the Napa Marathon in March, but only Mike seemed to feel sure he wanted to do it. Michele and I have mixed feelings. Because of the terrible weather and other problems that couldn't be helped last year, we do feel a desire to have another shot at it this year, and make a much more positive experience of it this time. When it doesn't rain, and it usually doesn't, the Napa race can be one of the prettiest marathons around. Still, running a race in early March means that we have to start training very soon, and do a lot of long-distance training runs during the coldest, wettest months of the year. I was trying to talk Mike into choosing a marathon that happens in the summer or fall, so that we don't have to go through winter training. But he's pretty firm in his choice: Napa, in March.

You may wonder why it matters to me which races anyone else is choosing to run -- why not run my race and let Mike run his? The explanation is that marathon training is not the kind of thing you want to do alone. The weekend training runs get longer and longer as you go along -- 12 miles, then 14, 16, 18, and 20. I don't want to do that kind of thing all by myself. Without training partners, it's just too lonely and boring. If I'm going to do a marathon at all, it's going to have to be one that that at least one of my running buddies is going to participate in. So, if Mike is going to do Napa in March, it's pretty likely that I'll do that too.

It's all part of my peer-pressure-based exercise system. I hang around with active people and more or less do what they tell me. It sounds undignified, but so far it's worked out pretty well for me.

Even though we were running the same route as yesterday, the presence of an extra runner (and he's a fast runner) inspired us to pick up the pace considerably. I was surprised by how much I was sweating afterwards, on a cold day like this. I guess that's another advantage of the peer-pressure-based system. My running buddies challenge me; I'd never run fast if I was always running alone. The harder workout today is probably part of the reason that my blood pressure is down tonight.

Surprising as it may seem, there is a website devoted entirely to haiku (Japanese 17-syllable poems) on the subject of Spam. That is, Spam the canned mystery-meat, not Spam the e-mail plague.

Some examples of Spam haiku (also known as Spamku):

Pink tender morsel,
Glistening with salty gel.
What the hell is it?

The color of Spam
Is natural as the sky:
A block of sunrise

Perfection uncanned
Like a beautiful redhead
Fresh from her trailer

Old man seeks doctor
"I eat Spam daily," he says

Made a SPAM puppet
To entertain my doggie
Need a new hand now

There's a book of this stuff, too.

Well, if the world has room in it for any such literary phenomenon as Spam-themed haiku, perhaps it also has room for some kind of comic verse form about diabetes. I don't think haiku is it, though. Maybe limericks would work.

I'm pretty good at writing limericks, and I find that limericks are often funniest when they address unexpected subjects -- even scientific subjects. My best was the one I came up with when I took a class in marine biology, and saw some startling diagrams illustrating the mating behavior of the male barnacle:

The barnacle's masculine portion
is built for long-distance contortion.
I could answer the door
as I lay on the floor,
if mine were of equal proportion!

But making comic poems about diabetes seems to be a little more of a challenge. I've been thinking about it for two hours now and not a single idea has occurred to me. Is it possible that diabetes is just not funny?

I'm reluctant to accept that any subject is inherently non-funny; maybe what's inhibiting me in this case is that I think the number of people who take diabetes too seriously is far smaller than the number of people who don't take it seriously enough -- and I don't want to encourage the latter.

When people on the dLife forum introduce themselves by sharing the most horrendous details about how out-of-control their diabetes is, and then try to make a joke of it, I get uncomfortable. Maybe treating the subject as a joke is the only way they can talk about such a serious problem, but I always wonder if their willingness to treat the subject as a joke explains how the problem get so serious in the first place.

Well, if I come up with any diabetes limericks, I'm going to have to be very careful about which ones I let loose into the world. But with zero ideas so far, maybe I don't need to worry about it.

Thursday, December 3, 2009  

Today I came to work fully armed with winter exercise clothes for the lunchtime run (including long pants, two shirts, and gloves). It was worth it, because it was foggy and 39 degrees -- definitely not the right weather for running around in shorts.

Looking on the bright side, it won't often get a lot colder than that this winter. Occasionally we get freezing weather here, but not often, and snowfall qualifies as a major news event. For people who live in places with a harsher winter climate, outdoor exercise isn't a very practical option during the winter. If they're going to run in December, it will probably have to be on a treadmill. I'm glad I don't have to face that. I found out what real winter running was like when I visited my sister in Idaho in 2007. I managed to do it, by wearing a lot of layers, but if I lived there I would find it hard to do that very often.

It's weird when you think about it: wood is made of sugar.

My coffee table is made of sugar. My front door is made of sugar. The fiddle I play is made of sugar, and the dancers I play for are doing their steps on a hardwood floor made of sugar. A forest is made of sugar, from the branches overhead to the bark on the trunks to the roots in the ground.

All this sounds very improbable, but it's true. Wood is made primarily of cellulose and hemicellulose, both of which consist of sugar molecules chained together. In the case of cellulose, the constituent sugar molecules are all glucose; hemicellulose is made from a mixture of different sugars. There's also some lignin in the wood, to bind all that sugar together, but when you pick up a baseball bat, more than 70% of the weight you're swinging is sugar.

We're used to thinking of sugar as a rather delicate substance -- something you dissolve in your tea, not something you pound nails into and build houses out of. Clearly, sugar has another side to it. Sugar is strong stuff.

To be more specific, sugar is sticky stuff. Sometimes very sticky, depending on how the sugar molecules are linked together. That strong adhesiveness can be an advantage, in that sugar can be used to make a material that has a lot of strength for its weight. That's why plants produce so much cellulose (the most abundant organic molecule in the world). Wood, grass, leaves, cotton -- it's all cellulose.

Although cellulose is made of sugar, it doesn't exactly melt in your mouth. In fact, even stomach acid doesn't break it down, so humans cannot digest it. Some animals are able to digest cellulose, and extract from it the constituent glucose molecules. It isn't easy, though. To be able to eat grass, cows need four stomachs, a lot of time, and a lot of help from symbiotic microbes in the gut. Even termites couldn't digest wood without microbial assistance. (Some cellulose is present in the human diet, but it's not the part we can digest -- we usually call it "fiber".) Cellulose makes great building material from a plant's point of view, but not exactly great dinner material from a herbivore's point of view.

So, the tendency of sugar compounds to form strong bonds can be seen a problem rather than an advantage. It's the main reason we don't want to have excesive amounts of sugar floating around in our blood. The human body is not going to benefit by having a lot of sugar dumped into it, any more than a machine is going to benefit by having a lot of epoxy dumped into it.

Sugar, with its natural tendency to bond itself to other substances, is very good at gumming up the works. One of the reasons the body constantly recycles its proteins is that, over time, proteins throughout the body tend to become encrusted with sugar, and this interferes with their functioning. In people who have too much sugar in their blood, proteins become encrusted with sugar faster than the body can recycle them. This results in health problems of every kind. Sugar is not to be messed with! 

Wednesday, December 2, 2009  

The reason my blood pressure is up is that I'm stressing out about a project at work -- but at least that project gave me some comic relief today.

I had to go in to the office at 6 AM (did I mention that I'm not a morning person?) for a phone/video conference with a bunch of people in Scotland and China. The guy leading the meeting (from Beijing) was taking notes on what we discussed; his notes were displayed on our computer screens for all to see, and sometimes the same note remained visible on the screen for a long time. He asked me about an issue raised earlier by someone named Ron who wasn't in the meeting. I said that the issue had to remain undecided at this time, but I would keep in touch with Ron about it. So he writes down this:

"Tom will keep touching with Ron."

Now, I can see why someone whose native language was not English would think that this was a sufficiently accurate paraphrase of what I'd said. Asking him to change it would embarrass him. It would also embarass me, as I would have to give him some idea what was wrong with it, and that would probably bring the house down. The only reason people weren't laughing already was that they weren't in the same room together -- they were sitting in their own offices watching their computer screens. Making faces, no doubt, but not laughing out loud.

So I let it go. But he didn't scroll past if for an eternity, so there it stayed on the screen. Tom will keep touching with Ron. Great. Now I know what will be put on my tombstone.

After the meeting, one of the Scots sent me an e-mail asking if "Tom will keep touching with Ron" is some kind of politically correct California euphemism which they ought to learn, now that they're working with me.

After the clear, sunny, comfortable weather of the last four days (with more of the same in the forecast), today's weather surprised us by turning out to be foggy and cold (very cold, by local standards). I wasn't able to run at noon. My running buddies did, and I think they suffered greatly for not having more suitable running clothes with them (they nad assumed the weather would be as forecast). I went running at 4 PM (repeating the same route I photographed on Monday), by which time it was a little warmer, but still awfully chilly for running in shorts. I guess it's time to break out the long running pants, and maybe even a light running jacket. (Of course, if I bring those things with me to work tomorrow, it will warm up again.)

One of the relocated Scots I work with, who moved here during the summer, asked me in some puzzlement why it was so cold today. I had to break it to him gently that, even in California, winter can happen. Not like winter happens in the midwest, or even in Scotland, but occasionally it does get cold here. Not much falls out of the sky, though, so things could be a lot worse! 

Tuesday, December 1, 2009  

I thought I ought to take a little break from running today. I'd run 18.5 miles over the past three days and my hips were feeling a little sore. So, I went to the gym after work and did a light workout on the stair-climber. I don't think that's enough of a workout for it to be my standard routine, but it's enough for the occasional light-exercise day.

I'll run tomorrow if I can fit it in. It won't be easy. My day will begin early (with a 6 AM meeting), so I'm certainly not going to exercise before work. And I won't be able to run at lunchtime tomorrow because of a meeting. However, since my workday is starting so early, I should be able to end it early, and go for a run before it gets dark.

When F. Scott Fitzgerald died in Hollywood in 1940, he left behind the unfinished manuscript of "The Last Tycoon", together with a lot of notes to himself which apparently were meant to help him complete that novel. Some of these notes have become famous (such as "ACTION IS CHARACTER" and "There are no second acts in American lives"), but the best of the lot in my opinion is one that nobody seems to quote today:

"The cleverly expressed opposite of any generally accepted idea is worth a fortune to somebody."

Talk about prophetic! If that isn't the unspoken motto of every modern writer, it is certainly the unspoken motto of every modern writer on the subject of health (and especially on the subject of healthy eating).

It seems that everything I read about how to stay healthy begins with an announcement that I must forget everything the "experts" have ever said on the subject. That is always the starting point: everything you've been told about this is a big fat lie.

Forget everything you learned in school, forget what the American Medical Association says, forget what the American Cancer Society says, forget what the surgeon general says, forget what your doctor says -- they're all wrong. Either they're in on the consipracy or they've been duped by it. Don't listen to them any more. Listen to me. Here's the real story.

What drives me crazy is that these people can almost always make a persuasive case, if you read them and you don't read anyone else. The low-carb enthusiasts can spin as convincing a tale as the low-fat enthusiasts. Same with the vegetarians and carnivores. Same with the pro-soy and anti-soy factions. They can all cite studies which bolster their case, and they are all very good at not mentioning studies which do not bolster their case.

What I've learned to hate about this style of argument is its appeal to paranoia. If you claim that there's a conspiracy to hide the truth, then this becomes a self-reinforcing concept (which, of course, is what all paranoid concepts are designed to be). The more vehemently the experts tell you you're wrong, the more they seem to validate your accusation of conspiracy.

I'm getting so weary of all this paranoid righteousness that I think I'm going to have to start subtracting credibility points from anyone who argues in that passionate, crusading manner, and start awarding extra credibility points to the next author who says "Here's my theory, here's why I think it's probably true, and here's why it might turn out not to be". If any author ever does!

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