Thursday, January 29, 2009  

Change of plans -- the birthday dinner that was supposed to happen tonight is happening tomorrow instead. And tomorrow I'm having a going-away lunch (because I'm leaving the division I have been working in). So, I'm going to have not one but two restaurant meals tomorrow -- and it's a non-running day. I may have time to squeeze in a light gym workout in the morning, but I'm certainly not going to be doing any heavy-duty exercise.

So, I'm going to face the dangerous combination of rich food and little exercise tomorrow. I'd better try pretty hard not to overdo it at lunch or dinner. It's very hard for me to be careful in that way. I'm pretty good at not going to the store and buying foods that I shouldn't have, but when I'm a restaurant and the foods are right there for the taking, and everyone else is indulging in them -- that's when my self-discipline tends to dissolve. I just can't handle peer pressure, I guess. It's one of the reasons I shouldn't hang around with drug addicts.

Another beautiful day for running, sunny and in the 50s (the high 50s this time -- I think it hit 60 during the run). My running buddy who was tied up in meetings yesterday, and couldn't run the 9-miler, was running it today instead. I certainly wasn't going to do a 9-miler twice in a row just to be sociable, so I ran with him for a few miles, and then we went onto separate routes. The route I chose covers a distance of about 5.5 miles, if memory serves. I forgot to recharge the battery on my GPS last night, so I couldn't measure the distance exactly, but I know that route is more than 5 miles long, and 5 miles was what the marathon training schedule called for today. (The GPS is charging at this very moment, so that it will be ready for the weekend.)

What the marathon training schedule actually calls for tomorrow is rest, but I prefer to do only one rest day a week, and Friday is not it. During marathon training I do an easy workout in the gym on Fridays, and it wouldn't be a great idea to skip it on a day when I'm going to be having two restaurant meals. My numbers were all pretty good today, and it would be a shame to spoil it all with too much eating tomorrow.

The catch is that I need to get up early enough in the morning to hit the gym on the way to work. Getting up early is not usually one of my talents. I'll try, that's all I can say.

Wednesday, January 28, 2009  

I liked my glucose reading and my weight, but my blood pressure's been climbing the last few days. Certainly not for lack of exercise; more likely it's because I'm allowing myself to worry about things. American corporations laying off more than 55,000 employees on a single day -- that sort of thing. Worrying about these things doesn't change them, but telling yourself that it's useless to worry about these things doesn't make you stop worrying.

Returning to the subject of things I can control: I managed to find room in an eventful day to squeeze in the entire 9-mile run that the marathon training schedule called for. Unfortunately I had to do it alone; one of my running buddies is healing from an injury, and the other got tied up in meetings and couldn't get free.

At least it was a beautiful day for running, sunny and clear and in the mid-50s. The route I chose included a lot of steep climbing, but I favored that route because I knew from experience that it would work out to just over 9 miles, and I was unable to think of a flatter route that would be the right distance. I don't mind the hills quite so much when I'm running alone; I'm not trying to keep up with anyone else, so I don't have to deal with the frustration of falling behind.

My meals today were a bit high in carbohydrate, but not really excessive when you consider that I did a 9-mile run today. I'll have to be more careful tomorrow, not only because my run will be shorter, but because I will be going to a birthday dinner at an Italian restaurant which doesn't exactly specialize in low-carb meals. I'd better make breakfast and lunch pretty light tomorrow, to make up for it.

"Sleep apnea independently linked to insulin resistance" said the headline from Reuters Health yesterday:

"Independent of obesity, sleep apnea appears to be a risk factor for the development of insulin resistance, according to a report in the first February issue of the American Journal of Respiratory and Critical Care Medicine. Dr. Naresh M. Punjabi and Dr. Brock A. Beamer, from Johns Hopkins University School of Medicine, Baltimore, performed polysomnography, frequent glucose tolerance tests, and body composition measurements in 118 nondiabetic subjects. Seventy-nine of the subjects had sleep-disordered breathing, while 39 who did not served as controls. Relative to controls, those with sleep-disordered breathing had reductions in insulin sensitivity, ranging from 26.7% to 43.7%, which were directly related to the severity of the disordered breathing. This finding was independent of gender, age, race, and percent body fat. The study findings also showed that sleep-disordered breathing was associated with reductions in beta-cell function and glucose effectiveness."

Well, now. If the range of reduction in insulin sensitivity was from 26.7% to 43.7% in people with sleep apnea, then none of them lost less than 26.7% of their sensitivity to insulin. Isn't it understating the case a bit to say that sleep apnea appears to be "a risk factor for" insulin resistance? We're not talking about "risk" here, seemingly. If everybody taking a new drug lost at least 26.7% of their hair, would we say that the drug appeared to be "a risk factor for" hair loss, or would we simply say that it caused hair loss?

Anyway, we seem to have direct evidence here that sleep-disordered breathing causes insulin resistance and other physiological defects that are associated with (or, rather, that define) diabetes. And yet, the huge problem of sleep apnea and the role it plays in promoting diabetes gets remarkably little attention. If eating asparagus (or not eating it) played as big a role in diabetes as sleep disorders do, people with diabetes would talk about the asparagus issue constantly. But the sleep issue? We don't talk about it. I'd be willing to bet that the majority of people who have both Type 2 diabetes and sleep apnea are completely unaware of there being any connection at all between the two.

I've been trying to get the word out, but there's only so much I can do. Why is this subject not getting more attention?

Tuesday, January 27, 2009  

Today this website passed two milestones: it is exactly one year old, and its hit-counter reached 2000. I guess it's time for me to reflect on my year of running this site, and the effort that went into it, and whether or not it was worth the trouble.

First of all, I should admit that running a web site which includes a frequently-updated blog turns out to be less easy than you would expect. The biggest problem is that you have to have something to say every day -- including those days when you do not, in fact, have anything to say. I thought I always had something to say, or if I didn't, I could surely improvise a bit of wisdom or observational humor to fill the gap. I thought I would always be able to note some ordinary occurrence of the day, and use it as a springboard to launch into an insightful analysis of some diabetes-related issue or other. It turns out to be harder to do this on a daily basis than I had imagined. There's nothing like writing a blog to make you aware that your imagination is not quite so fertile as you had thought.

On the other hand, if you aren't willing to make room in your life for a challenging, time-consuming daily task, maybe diabetes is not for you. I've made room in my daily schedule for other tasks which are more difficult than blogging is (including long-distance running, these days). Over the course of the year I have gradually become better at fitting the website work into my life; most of the time it's not that big a burden.

Is it worth it? It is if it helps people. 2000 hits per year is a laughably small number for a website. However, the first thousand took a lot longer than the second thousand did, so maybe the pace will pick up. Anyway, I have heard from people with Type 2 who felt that the site was very useful to them in getting control of their diabetes. So, I have been able to help people, which was the whole point of putting up the site in the first place. I would like it to help more people than it's helping now, though, so one of my goals this year is to make the site better known.

Of course, if the site becomes much better known, I will become more an more self-conscious about the facts I'm revealing -- test results, meals, weight. So far this doesn't bother me too much, because I can always console myself with the knowledge that almost nobody is reading what I'm writing anyway. Sure, anyone could read it, but what are the odds? And who would bother reading it if they didn't have a legitimate interest in the subject?

I do feel conflicted about reporting undesirable results -- such as my struggles with weight, and the occasional blood-sugar test that isn't within my target range (<95 mg/dl, fasting). On the one hand, I'm trying to set a good example, so it's embarassing when my results are nothing to brag about. On the other hand, this blog would become pretty pointless if I never reported any disappointing results, and explained why I think I got that result and how I expect to get a better result next time. (Today, for example, my fasting test of 100 is not hard to explain: yesterday was a rest day from exercise, unfortunately combined with party food. I expect to get a better result tomorrow because I did a hard 5-mile run today, and had less to eat. If my result isn't better tomorrow, I'll find something else to change.)

I guess my biggest concern about the site is that, apart from my daily blog entries, I change it very little from day to day. I ought to be adding new features to it, to encourage return visitors. Unfortunately, the time I would need to develop new features is difficult to find. One of my other goals for the year is to find a way to add more to the non-blog areas of the site, but it's going to be a tough requirement to meet. Well, I'm not entirely unused to meeting tough requirements.

My two faster running buddies both commented today that I was improving my speed. They still get ahead of me on the hill-climbs, but not as far ahead of me as they used to, and I'm getting better at catching up to them after they get ahead. The reason may simply be that I lost a few pounds. But it was a very few pounds, and you wouldn't think it would make much difference. Whatever it is that's made me able to run little faster lately, I hope it lasts! 

Monday, January 26, 2009  

My day was almost entirely given over to the funeral -- which turned out to be a beautiful event, pretty much the ideal funeral, the funeral that most people would hope their own might be like when the time comes. (Most of us won't earn it, of course. There's always a catch, isn't there?) There was a huge turnout, for one thing. Not only did Noreen have a big family (she left behind 35 descendants!), she was also extremely active in her church, in music, and in some Irish cultural organizations she belonged to, so the church was crowded with people who were connected to her in a variety of ways. During the service itself, there were musical performances by various members of the family (songs, duets for flute and harp, a fiddle solo, and two bagpipe solos). I was not playing in the service itself, but at the family gathering afterwards, some of us re-created the kind of casual Irish-music session that we were used to sharing with Noreen. We tried to make sure we played all of her favorite tunes, and at various points some of the family members joined us in playing them. I think we managed to create the kind of atmosphere that Noreen would have liked, and her family seemed to feel the same way.

I was glad this was a rest day on my exercise schedule, because I felt absolutely wiped out when I came home. (More exhausted, honestly, than I was after the 18-mile run on Saturday.) I came home, sat down, fell asleep, and almost missed my yoga class tonight. Funeral services do that to me, I guess because I have a fear of being around strong emotion -- I tense up, and later become exhausted with the effort of keeping my own emotions under control. You could argue that this indicates my attitude toward strong emotion is unhealthy and wrong. Maybe so, but we have to be who we are.

At least I have the advantage of being able to communicate through music. It's a wonderful thing, really, to sit down with a bunch of musicians, half of whom you're never seen before, some of them just off a plane from Ireland, and immediately start making music with them, finding common ground, getting in sync, creating something together, communicating better than you ever could with anything as clumsy and inadequate as the spoken word. Sometimes I wonder how non-musicians stand it. (I certainly couldn't stand it when I was one; that's why I signed up for lessons in the first place.)

When I'm at a party, I pretty much throw my half-assed vegetarianism out the window, and eat what's there. It was high-fat food, certainly, but I'm hoping I at least kept the carbs under reasonable control. I guess my fasting test tomorrow morning will tell me something about that. But my weight will surely be up a bit, with lots of calories today, and no exercise to wring any of the water out of me. At least my blood pressure was good today; the rest I'll have to work on tomorrow.

Sunday, January 25, 2009  

After I completed the 18-mile marathon-training run yesterday, I felt pretty good, but I was still a little worried that I might wake up this morning (or even in the middle of the night) with some part of me hurting a lot. You never can be sure about that sort of thing. Fortunately, nothing like that happened. I feel fine today. I can certainly tell by the way my joints and muscles feel that they were heavily used yesterday, and I'm walking just a little stiffly, but really, nothing hurts. I feel better than I did after the 16-miler, and even the 15-miler. My body seems to be settling into this training a little more willingly than it has during previous marathons. At any rate, it's complaining less than it used to.

The most obvious after-effect of the run, this morning, was that I woke up feeling extremely hungry. I had breakfast at a cafe, and ordered a Mexican breakfast dish which, if it wasn't exactly low-carb, was at least lower in carbs than most of the other things on the menu. But it wasn't too long after breakfast that I was hungry again. Sometimes I think the hardest part of marathon training is finding a way to cope with the hugely increased appetite that comes with very long workouts. Gaining weight is no way to get yourself ready for race day, after all. In the past I've usually gained four or five pounds during marathon training, but I've been trying hard to avoid that this time. So far, so good; I'm actually a couple of pounds down.

I'm going to take tomorrow off work to attend a funeral service for a local musician (Noreen, an 86-year old fiddler from Cork, Ireland). For years she has been playing with us at a monthly Irish music session in Sonoma. Her family asked me (and some of the other regulars at the session) to play at the funeral tomorrow. Actually, we'll be playing at the family home after the service; during the funeral itself, the music will be played by some of her children, one of whom will be using Noreen's own fiddle for the occasion.

Saturday, January 24, 2009  

Based on the weather forecast, we were expecting to do the whole 18-mile run in the rain. Not so, fortunately! It was foggy and misty at the start, but there was never any precipitation solid enough to be called "rain", and toward the end of the run there were patches of sun. The hills and vineyards of Dry Creek Valley looked beautiful as the moments of sunlight came and went.

It was a good run for me. Nothing hurt. It's early for me to say that, of course -- who knows what might be hurting when I wake up in the morning? But so far I feel pretty good, and I felt pretty good during the run. As I was finishing it, I thought that if this were the 20-miler instead of the 18-miler, I could have done the extra 2 miles. Not that I wanted to (I definitely did not), but I could have. That's how you want to feel after one of the longer training runs: you want to feel that you could have gone farther if you needed to. In the past I usually haven't felt that way at the end of marathon training runs, so I was glad to be able to feel that way today.

After the run I may have looked a tiny bit fatigued, however:

Maybe "fatigued" isn't the word I'm looking for. Would "drunk" be closer to it? Well, at that point I wasn't high on anything but the endorphins that a good long run tends to produce. Maybe that look on my face is nothing more than the the special, smug complacency that comes over people who have just taken on a ridiculously difficult athletic challenge, and have succeeded at it.

I was actually less sober (but looked more sober) when this photograph was taken later in the day at the Woodenhead Winery near Forestville:

Well, if you can't reward yourself for extreme athletic training, what's the point of it?

Friday, January 23, 2009  

There was light rain all day, so I was satisfied to be working out in the gym today instead of outdoors.

I didn't want anything too demanding, because we're doing one of the longer marathon-training runs in the morning: 18 miles. It's a long way to run, any way you look at it. And it will probably be wet tomorrow too, which has a way of making any run seem longer. At least it will be cool enough to help me avoid getting dehydrated. I'll be carrying a "Camelback" water bag, but the amount of water you can comfortably carry while running is not always enough to last you 18 miles.

The weight-training I did was all lower-body stuff -- nothing north of the abdominal muscles. I did that a couple of weeks ago, the day before the 16-mile run, and the run seemed to go well, so maybe it will help me be ready for the 18-miler.

I have become increasingly unhappy about the way the earliest easily-detected stage of Type 2 is referred to as "pre-diabetes", as if it were something wholly unrelated to real diabetes, and nothing to get alarmed about. A diabetes patient wrote to me recently, saying it had never registered on her that her earlier diagnosis of "pre-diabetes" had meant that she was in the process of becoming diabetic and needed to take action to prevent it. "Pre-diabetes" didn't even sound to her like a disease. She is surely not alone. Plenty of people with fasting tests in the 120s are entirely unaware that this means they have a serious problem. They think it means they might develop a serious problem, some day in the distant future -- but who knows, so why worry about it in the meantime? And, of course, if you're not worrying about it, you're not doing anything about it. If doctors are trying to clarify the situation, they're not trying hard enough. Or maybe there's nothing they can do to overcome the false impression created by the horribly misleading term "pre-diabetes". Sometimes, words kill.

Depend on it: allow a technical expert to name anything, and he will choose the wrong word for it, a word which suggests a different meaning from the real one. When doctors came up with the term "pre-diabetes", they royally screwed the general public. Nearly every patient who hears the term "pre-diabetes" think it means "you don't have diabetes yet, so there's no big problem here, nothing to get worried about". Almost nobody understands that it means "you've got metabolic syndrome, and your system can no longer compensate for it, so you're becoming diabetic, and before long you're blood sugar will be high enough that the health-insurance industry will allow us to call a spade a spade, and level with you about what you've got". And so, a lot of people who could do something about their diabetes at an early stage, when it's more easily corrected, instead wait until it's totally out of control.

The thing is that, before you even reach the point of being "pre-diabetic" (that is, before your problem is easy to spot), you have already been suffering for who knows how long from metabolic syndrome. And metabolic syndrome (insulin resistance, plus some other problems commonly linked to it) is already a serious health threat, in and of itself. Before metabolic syndrome makes you diabetic, or even "pre-diabetic", it can do serious harm.

A recent study at the Pennsylvania State University College of Medicine found that people with metabolic syndrome have a heightened risk of ischemic strokes (that is, strokes caused by blood clots). And we're not talking about 10% more risk, or 20% more. The risk is more than doubled in people with metabolic syndrome. (Elevated blood sugar, or elevated blood pressure, magnify the risk even further!)

But people who have metabolic syndrome, and have had it long enough for their blood sugar to start creeping up above the normal range, are still being handed this fake, comforting nonsense about having "pre-diabetes" -- a non-disease, a "potential" problem, rather than a serious disorder which puts them at risk of having a stroke (or a heart attack, according to other research).

Not that we patients aren't responsible for a large part of the communication breakdown. A lot of it is caused by our unwillingness to hear what we'd rather not hear. It isn't until the diabetes diagnosis is finally made that we start to look back and say, "Oh, so that's what he was getting at!". For some people, it takes even longer than that. Some people who undeniably have diabetes, by anyone's definition of the disease, spend months or years trying to convince themselves that the diagnosis was some kind of terrible mistake. For some patients, getting rid of the term "pre-diabetes" would not be enough. But it would be a start!

Thursday, January 22, 2009  

It was raining a bit this morning, and we weren't sure if we were going to get out for a lunchtime run. However, by late morning we decided to take our chances with the weather. It was densely foggy, but not raining, and it wasn't especially cold (low 50s). Pretty good running weather, really. So we ended up having a nice run.

I felt good, which was almost surprising because this week I've actually run 3 miles more than the training schedule called for. Of the four of us who are training for the Napa marathon together, I think I'm the only one who isn't behind on the training miles at this point. It takes both perserverance and luck to complete all the miles on the schedule. You can't get an injury, for example, and you can't get sick, either (which is a hard trick to pull off at this time of year). So far I've been able to keep running, and I've found ways to fit it all into my schedule. But in less than two weeks I'm starting a new job, and who knows what will happen to my flexible schedule then. Well, I'll do my best. I think it's probably uncommon for marathoners to get in every bit of the training they're supposed to do. If you make a serious effort to do as much of it as you can, that's probably good enough.

My blood pressure is still good, especially for someone who is having recurrent nightmares about layoffs (but that's most of us, at this point). It isn't the first time that I've been training for a marathon during hard times, and it's helping me now in the same way it did then. But the marathon is going to be over and done with on March 1, and the recession won't be, so I may have to think of another exercise challenge to take on then, to hold my stress level down. Maybe it's time to get back into distance cycling, and do another "century" ride.

Here's what drives me crazy about scientists and the journalists who cover them: they announce a research finding that involves something very puzzling, some detail which doesn't make sense, so that the only thing you can think about is how much you want them to clear up that one detail -- and then they say nothing further about it! Not even "yes, we realize this one aspect of the study is very unexpected and strange, and we can't explain it yet, but we're working on it". Not even that. They just keep quiet, as if nobody's going to notice the puzzling detail so long as they're careful not to emphasize it themselves. How they expect to be accorded any credibility after pulling something like that, I cannot understand.

The particular research news that irritated me in this way most recently comes from HealthDay News (November 4, 2008):

"A hormone produced by fat tissues holds promise for people with insulin resistance or type 2 diabetes, a new report suggests. The hormone, called apelin, significantly lowered blood sugar levels when injected intravenously into normal and obese mice, according to a study published in the November issue of the journal Cell Metabolism. Apelin also appeared to restore glucose tolerance and improve glucose uptake in mice that are obese and insulin resistant. According to the finding, apelin seems to stimulate muscle and fat tissue so it better absorbs glucose from the bloodstream. It does this by activating a pathway for AMP-activated protein kinase (AMPK), an enzyme that's key to control of skeletal muscle glucose and the metabolism of fatty acids, the researchers said."

The researchers went on to say that "The involvement of AMPK in apelin-mediated glucose uptake represents an attractive pathway that could conceivably lead to a new drug target for the treatment of metabolic disorders."

Okay, fine, a potential new wonder drug -- that's what I would say, too, if I wanted to get more research grants. But what about the elephant in the room?

They say that apelin is an insulin-like hormone produced by fat tissue, that it lowers blood glucose, and that it restores glucose tolerance. In other words, fat tissue produces a hormone which has precisely the opposite effect that fat tissue is known to have on human and animal physiology! Having excess body fat degrades glucose tolerance, yet fat tissue produces a hormone which improves glucose tolerance? How can that make sense?

I'm not claiming it's impossible for there to be any sensible explanation of this seeming contradiction. But to refuse to provide that explanation, or even to admit that an explanation is called for -- that's just plain bad manners. Do they really think nobody is going to notice that what they're reporting doesn't make any sense? Do they think no one has heard that body fat is regarded as a cause of Type 2 diabetes?

As usual in these situations, I don't know who's the guilty party here -- the scientists themselves, or the publications that report what the scientists have said. I do know that one or the other, or both, decided that the most startling aspect of the research under discussion didn't need to be discussed. That seems to indicate a disrespect for the public they are addressing which is very hard to excuse. Both scientists and science-writers like to complain about how badly misunderstood they are by the public. But whose fault do they suppose that might be? And who might be in a position to do something about it?

Wednesday, January 21, 2009  

It was cloudy this morning, bringing to an end a 13-day streak of ridiculously un-wintry weather. It was still overcast during the run, and threatening rain. A very few raindrops fell on us, but the real rain didn't start until after we were finished and back indoors. Which was fine with me.

The marathon training schedule called for 9 miles, and because I doubted I would have time for that long a run today I did it on Monday instead. Today's 6.5-miler was challenging enough. It was extremely hilly -- with one long climb in the middle of it that was heartbreakingly steep. The actual marathon route won't have a hill half that steep in it (if it did, no one would sign up for it!) but it does have some hills, and it's a good idea to include at least a few really difficult climbs in your training. The hills on the marathon route are comparatively shallow, but one of them occurs around mile 20, just at the point where you're starting to run out of steam, so it seems steep. It helps to be able to say that you've climbed much worse hills than that -- otherwise it's too easy to get discouraged when the going gets tough.

Researchers in Finland claim to have found that the age of onset of Type 1 diabetes varies depending on whether or not the patient's parents had Type 2. The average age of onset is later (17 instead of 16) in patients with a family history of Type 2. This result is considered surprising and a puzzle to explain.

But wait a minute. 17 instead of 16? Is that worth making a fuss over? Is it at all likely that a difference so small is anything more than garden-variety statistical variability, probably amplified by some error in the way test subjects were selected?

While the Finnish doctors are busy wondering what this discovery means, I'm wondering whether it's even true in the first place. I'll be very surprised if subsequent studies find the same result, and that Type 2 turns out to make your children develop Type 1 (if they develop it at all) a year later than they otherwise would.

I hope the researchers were looking for something more significant than this! 

Tuesday, January 20, 2009  

The auditorium at work had a giant TV screen showing the inauguration, and quite a crowd of employees gathered there to watch it. I don't remember there being such intense interest in an inauguration before. I was a little surprised by the grimly-serious tone of Obama's speech, but it wasn't hard to think of reasons why it needed to be that way.

Today is certainly a grim milestone for me personally: for the first time in my life, I am older than the president! (But I suppose it's not mature of me to think in those terms.)

Ho-hum, another gorgeous day, sunny and clear and in the 60s. By my count it has been like this for 13 days now. Visitors to California from places with more tumultuous weather are inclined to argue that this kind of extended pleasantness is bad for us, and that they wouldn't be able to stand it themselves. That doesn't seem to discourage them from coming here, though.

I did a short run today, 4 miles. That was all that the training schedule called for. Tomorrow the schedule calls for 9 miles, which I did yesterday because I was afraid I wouldn't have time to do it tomorrow. But I'll do a longish one tomorrow, too, if I have time. Not 9, but maybe 6 or 7. I've got extra miles to my credit going into this week, so I have room to negotiate. I should probably do more miles than I need to tomorrow, because I'm expecting to go to a brew-pub for dinner with two friends who have both just lost their jobs. Yes, these are scary times in America, all right.

Yesterday I mentioned the Burns supper that I attended on Sunday, but not the other event I attended on Sunday: a meditation workshop, given by the son of my yoga teacher. He's been studying meditation in a serious way, and is interested in teaching it himself. This may have been his first experience of teaching it. It was plain that his biggest challenge was figuring out what to omit, in presenting so complicated and abstruse a subject in three hours.

I have always had a certain interest in meditation, combined with utter confusion about what meditation is, or what it's for. The workshop was focused on a particular school of meditation (of Indian buddhist origin) known as vipassana. The word "vipassana" is, of course, untranslatable, but is sometimes said to mean "insight into the nature of reality". Another attempt: "seeing deeply", with an emphasis on seeing as a direct perception, not as a rational understanding of how the world supposedly works. It's about learning to perceive clearly. It's also about learning to be less reactive -- learning not only to perceive what's going on but also to accept it without denial and resistance, and therefore not suffering unduly.

There was much discussion, much question-and-answer -- but also some meditation exercises. The first was simply to sit with our spines straight and our eyes closed, and think specifically about each breath we were taking. The work was learning to quiet the inner monolog we all suffer from. You can't help having your mind wander in all sorts of directions under the circumstances; the work was to gently bring our thoughts back to all the sensations of breathing each time we started thinking of something else.

I had a lot of trouble with that one. But I was more successful with the second exercise, a variant of the first in which we were to count our own breaths -- but only up to a count of three, at which point we started over at 1. If our minds wandered, so that we forgot what number we were on, we simply started over at 1. My mind, at least, wandered a lot less during this one.

The third exercise was the best. We were to think successively about sensory perceptions all over the body -- the slight soreness of a mucle or joint, a faint itch on the forehead, the strain of holding the spine straight, whatever we were feeling. For each sensation we were to think about it briefly, give it a mental label ("that's a touch sensation"), accept the sensation rather than resisting it, breathe for a few seconds (with the idea that we were somehow breathing into that location), and then move on to some other sensation elsewhere in the body. I was surprised at how well this one worked for me. Several of my sensory perceptions were at least a little uncomfortable (particularly the difficulty I have in sitting with my spine straight), and I found that these sensations would fade (partially or even entirely) as I catalogued them, and above all as I accepted them instead of straining against them. Maybe there's something to this.

I'm not sure I gained much expertise on meditation during that one workshop, but at least it made me think about the issues involved. Also, I felt rather relaxed for the rest of the day, so maybe this is something I can apply towards stress reduction. Not that I need it, of course, being an utterly stress-free person who never worries about anything. But you never know. These are troubled times, I hear.

Monday, January 19, 2009  

I don't always get Martin Luther King day off, but I did this year, and I decided to use the day off to bank some extra miles toward the marathon training. Monday is supposed to be a rest day, but I was so busy yesterday that I didn't have time to work out, so I took Sunday as my rest day and worked out today instead. Also, the training schedule calls for a 9-miler on Wednesday and I'm not sure I'll have time for it, so I figured there was no time like the present. I went to Annadel State Park to do a trail run.

I guess a lot of other people had the day off, and wanted to take advantage of the opportunity; there were plenty of walkers, runners, and cyclists in the park.

Even after a long string of fair-weather days, this one was a bit stunning.

It continues to be hard to believe that this is January. I know it's actually a sign of serious trouble that the weather is like this in January, and I supposed it's a litte irresponsible to enjoy it under the circumstances. But what's the alternative? Staying indoors and moping about it?

Most of the mountain-bikers showed up dressed for summer riding, and I doubt that they had any regrets.

I certainly didn't have any regrets about doing a long run today. In a sense I cheated, because I had a camera with me and stopped several times to take pictures. Normally I don't stop during a training run. Okay, so I cheated. I don't do it often!

I was trying to eat light today because I went to a party last night and ate more than I usually do. It was a Burns supper, which takes some explaining if you're not Scottish. It's a theme party devoted to "the immortal memory" of the 18th century Scottish poet and song-writer, Robert Burns. These things are held all over the world in January, on or near Burns's birthday (January 25th). This year happens to be his 250th birthday, so the celebrations are a little bigger than usual. But people and organizations put on these events every year.

The one I attended last night was put on by the San Francisco Scottish Fiddlers. Every group has its own idea of how to do a Burns supper, but some elements of it are pretty much universal. In addition to readings of the Burns poems, and performances of the Burns songs (such as "Ae Fond Kiss" and "Auld Lang Syne"), there are such things as the Toast to the Lassies (given my one of the men) and Toast to the Laddies (given by one of the women), a little procession led by a bagpiper to bring in the haggis (an extremely humble Scottish dish, honored by Burns in a poem which is read before dinner -- and which contrasts the feebleness of those who eat fancy continental cuisine with the awesome strength of the Scottish peasant), and most importantly the Toast to the Immortal Memory of Robert Burns. The latter is usually a somewhat lengthy speech, discussing Burns's life and art. I did it at last year's supper, in the form of a poem rather than a straight lecture. This year, someone else took on the Immportal Memory toast, to my great relief. I was able to relax and be  a spectator this year, except that I was one of the fiddlers for the dancing after dinner -- but that's easy by comparison.

My poem last year was written in imititation of the poetic form used by Burns in several of his more famous works (including "To a Mouse", the source of that famous phrase about the "best-laid schemes o' mice an' men"). It turns out to be an extremely difficult form to write in, because it calls for a series of quadruple rhymes, and if you don't think that's a hellishly difficult requirement, you haven't tried it. For what it's worth, I'll reproduce it here...

Toast to the Immortal Memory of Robert Burns

by Tom Ross, January 2008
The whole world oe'r this winter night
the Scots assemble where they might,
in banquet rooms, by candle-light.
This tartan'd mass
will gather while the moon is bright
to raise a glass.
Acknowledging an ancient debt,
they'll drink a cup o' kindness yet,
to toast a friend they've never met:
the greatest Scot,
an old acquaintance they won't let
to be forgot.
What king or hero earns this toast?
What famous name would dare to boast,
from pole to pole and coast to coast,
all nations know it?
No king at all: our absent host,
a farmer-poet.
It very seldom is the case,
in any country, tribe, or race,
a poet takes the leading place,
but all the same,
for many, Scotland has one face,
and has one name.
That name is Robert Burrrrrrns, and here
I beg indulgence, for I fear
I'll never learn to say it clear.
I trill those R's
and sound (at least to my own ear)
like I'm from Mars.
The way my Yankee palate churns,
it's best if I pretend that Burns
rhymes perfectly with "earns" or "turns";
his name's too hard
(that's why, as ev'ry schoolboy learns,
he's called "the Bard").
But call the poet what you will,
his memory is honored still.
Although he's long put down his quill,
all 'round the earth
tonight we eat and drink our fill
to mark his birth.
Now, surely, this is unexpected!
Since when are bards so well-connected?
Have other nations genuflected
to a poet?
If such a case has been detected,
I don't know it.
Italians, I have been assured,
revere good Dante's every word.
But though their souls are deeply stirred
by flame-broiled sinners,
they don't, so far as I have heard,
hold Dante Dinners.
Unless I greatly miss my hunch
the Spaniards have no Lorca Lunch,
the Japanese no Basho Brunch.
And ain't it winsome
that Germans never grab a bunch
of Goethe Dim Sum?
Our T. S. Eliot, some swear,
wrote brilliant verse. But do they share
their supper hour with his despair,
and give applause
to his "I should have been pair
of ragged claws"?
No, Burns's case appears unique;
however far afield you seek
for poets Russian, French, or Greek,
you won't find one
who offers half the Burns mystique
or half the fun.
And fun is relevant, I think.
Let other poets make hearts sink,
with Burns, a kind of verbal wink
a champagne fizz,
invites us in and bids us link
our hands with his.
That's not to say Burns always wrote
on cheerful themes of little note,
or ever tried to sugar-coat
life's grief or shame,
but seizing readers by the throat
was not his aim.
For even when he wrote about
injustice, sorrow, pain, and doubt
from him no ugliness leaked out 
-- and none leaked in.
Where other poets seem to shout,
he seems to grin.
A gently smiling, friendly tone,
as cozy as a fresh-baked scone.
Who else has that, but Burns alone,
the ploughman poet?
A voice familiar as our own,
so well we know it.
I find his works comparable
to one gigantic parable
which says life can be terrible,
for want of money --
but here is why it's bearable:
it's also funny.
In grasping Burns, it seems to me
his sense of humor is the key.
It's not as if he couldn't see
that life is tragic,
but Burns knew it could also be
comedic magic.
So Burns the satirist could feast
on haughty lord or parish priest.
Hypocrisy he never ceased
to find amusing.
His wit is best when he seems least
to be accusing.
We well might ask, does Burns's charm 
sometimes regrettably disarm
those verses which should most alarm?
When we annoint
him patron saint of heaven's farm,
we miss the point.
I think we often do betray
the poet's memory today;
sometimes what Burns has got to say
we miss completely,
if all we notice is the way
he says it sweetly.
In this, and so much else, his case
resembles Mozart's. If we place
an artist on a Dresden vase
and not a tower,
then people will perceive his grace
and not his power.
Take "To A Mouse": at first glance, merely
sentimental. With each yearly
reading it becomes more dearly
true to life.
No Hallmark greeting, this! Burns clearly
drew a knife.
But how did Rabbie reach this height?
A farmer scribbling when he might
by tallow-candles in the night?
It's hard to say.
Perhaps his life will shed some light
-- at least one ray!
In seventeen and fifty-nine
the poet in whose name we dine
was born, the eldest in a line
of seven -- which,
though generous, might have been fine
if they'd been rich.
His family name was spelled Burness;
he later used two letters less.
I don't know why, but I can guess
at where they went:
he had to sell the E and S
to pay the rent.
As family records sadly tell,
the Burns's farm did not do well.
At one point Rabbie planned to sell
himself in bond
and sail to who knows what new hell
across the pond.
Although this scheme was soon forsaken,
imagine if he'd really taken
his planned trip, and gone Jamaican.
There's a mystery!
Who knows how Rabbie might have shaken
Reggae history?
Each Burns biographer portrays
the hardship of his early days
as Rabbie tries so many ways
to earn his bread;
a youthful life seen through a haze
of toil and dread.
This picture cannot be quite right;
the youthful artist's wretched plight,
biographers have made too trite.
It's more complex.
His life did not lack warmth or light
-- for sure not sex.
To mention Burns loved life I dread,
because that's what is always said
of everybody who is dead.
But this cliche
is truer of the life he led
than most can say.
That Burns the poet often sings
of earthly pleasures sometimes brings
on Burns the man the moral stings
of prudes; what mainly
galls them is he liked these things
and said so plainly.
He sang in praise of food, and drink,
and love, and sex -- without a blink.
No hints that this was poet's ink
and nothing real.
He left good evidence, I think,
to prove his zeal.
His tastes in women were diverse;
he loved each lass, milkmaid or nurse
and often gained, through lyric verse,
a warm reception.
Alas, no man was ever worse
at contraception.
In this romantic to and fro
at least five women that we know
bore children to him -- eight or so
these women carried.
That's leaving out five more he'd grow
when he got married.
His knowledge of love's arts was wide,
if offspring count as any guide.
Indeed I sometimes cannot hide
a gentle smirk
whenever someone claims he died
from overwork.
Where other bards of love seemed limp,
to neighbors, Burns was more a pimp.
To pious Scots it seemed this imp
defied the church.
At least we know he didn't skimp
on his research.
And maybe now it's clear to me
how Burns could think he'd ever see
that man to man would brothers be.
The logic runs:
we're brothers in the sense that we
might be his sons.
But by this point I'm sure that you
must I think it's shameful I'd pursue
such disrepectful jibes. That's true --
I did provoke.
But Burns, like all the great ones do,
can take a joke.
So let us each now, lad or lass,
stand up and drink a toast en masse,
to one whose verses can surpass
all vain ephemery.
Join in the toast and raise your glass:
"Immortal Memory"!

Saturday, January 17, 2009  

Some days you have it and some days you don't. I have found most of the other long runs in this training series to be a lot more pleasant than today's 12-miler. I think I just wasn't in the mood for it, really. I was cold and couldn't warm up. My energy level was low and my mind was unfocused. I was watching the clock (or rather the mileage count on my GPS gadget) too much, eager to get the run over with. I didn't feel bad, really, but I actually felt good during the 16-miler the previous weekend, and I didn't come very close to achieving that today, even though the run was shorter.

This is all part of the training program, of course. The primary goal of training is to get your body adapted to prolonged running, but there's another goal, a psychological one: to get your personality adapted to running when you don't feel like it. This is one of the reasons why I think training for a marathon (or any other big physical challenge) is valuable to anyone who is trying to manage diabetes. The marathon is like diabetes, in that it demands that you do certain things which you may find difficult, uncomfortable, and inconvenient. The marathon, like diabetes, doesn't care what you're in the mood to do, and doesn't feel bad about disrupting your life.

If marathon training gets you into the habit of simply doing what needs to be done, even when you would much rather not do it, then marathon training will have been worth the trouble. Many people with Type 2 diabetes are perfectly aware of the things which they are supposed to be doing, but can't quite persuade themselves to get up and do them. Marathon training can be very helpful in overcoming that kind of inertia; it teaches you to ignore the voice in your head that keeps saying "but I don't feel like it!".

At least I felt pretty good after the run, when I'd had a shower and a meal. By then the weather had warmed up, and it was time for a champagne toast on the balcony at my father's place. You can see I wasn't suffering by that point.

My meal after the run was pretty high in carbs, but I figured it was acceptable after a 12-mile run. We went to an Italian restaurant for dinner, and I tried to be a little more careful there -- I did have some bread, but the meal itself didn't include pasta or anything like that. With luck my fasting test in the morning won't be too high. Probably higher than this morning, but hopefully not over the top.

My blood pressure tonight was remarkably low. In fact, I think it's a record for me. Maybe it wasn't such a bad day really, all things considered.

Friday, January 16, 2009  

Another nice sunny warm day, but I wasn't outside to enjoy it much; my workout was in the gym.  I have been doing non-running workouts on Fridays because, on the marathon training schedule, the longest run of the week is on Saturdays, and I don't want to overwork my running muscles the day before doing that one.

Tommorow's training run is a 12-miler. I will be doing it out of town, and I will have to get up well before sunrise to get there on time. I hope I don't oversleep.

Footraces and organized cycling events usually involve getting up very early in the morning, and I have conflicting feelings about that. On the one hand, I have a very hard time getting up before dawn, and I have a well-justified fear of oversleeping -- and either missing the event entirely or causing an embarrassing amount of trouble for other people involved in it. On the other hand, there is something exciting about almost any kind of activity that you have to set an early alarm for, and the world can be a very beautiful place when you see it at sunrise (which I usually do not). I guess the clearest way to sum up my feelings about this is that there's nothing I like less than getting up early, and there's nothing I like more than being up early. So, if I can just manage to get up early and get on the road on time, life will be good from that point on.

I'm glad I like spicy foods. Grabbing some vegetables out of the fridge, chopping them up, and making a stew out of them could, if you do it too cautiously, result in a pretty boring dinner. But if your'e willing to cook those vegetables in a red pepper sauce with hot green chiles, even the blandest ingredients can turn into something exciting. 

Thursday, January 15, 2009  

This is the seventh day in a row of sunny clear beautiful weather. There's been a gradual cooling trend since the 82-degree weather on Monday, but it still got up to about 60 this afternoon, which is still mighty warm for January.

I didn't feel nearly as energetic during today's 4.5-mile run as I did during yesterday's 7.5-mile run. It's a mysterious thing, running; you never know how it's going to make you feel from day to day. But I didn't feel bad, I just was disappointed not to feel as good as I did yesterday. Well, if I was going to feel energetic during only one of those two runs, I'm glad it happened during the longer one!

Tomorrow I'll take a break from running, but not from exercise; I'll work out at the gym. On Saturday, the marathon-training schedule calls for a 12-mile run. It's an "easy" run, in other words, at least compared to the 16-miler last Saturday, and the 18-miler coming up a week from Saturday.

I'm sure that marathon training sounds nightmarish to anyone who hasn't done it and can't imagine doing it, but it has some real benefits -- the physical benefit of getting huge amounts of exercise, the confidence-boost that comes with mastering any really difficult challenge, and above all the stress-relief and the distraction from the current economic crisis. I wouldn't want to be in marathon-training mode all the time, but I've found it very helpful despite the difficulty. Marathon training has seen me through some pretty hard times before, and it's doing so again!

I'm finding that a lot of vegetables which can seem pretty uninspring when they're boiled can have a much more appealing character when they're baked. Tonight I put some small potatoes and Brussels sprouts in a small clay pot and left it in the oven for an hour. Everyone knows potatoes are good baked, but have you tried Brussels sprouts that way? Much, much better than the boiled variety. To me, the boiled sprouts usually taste bitter; the baked  ones taste downright sweet. The trouble with boiling vegetables is that too much of the flavor (and nutritional value) gets soaked right out of them. Baking seems like the better bet to me, even though it takes longer.

Wednesday, January 14, 2009  

Another beautiful day, sunny and about 65 degrees. My running-partner and I both had odd schedules today, but we managed to fit in a long run in the early afternoon. Not quite the 8 miles that the marathon-training schedule called for, but we did an extra mile yesterday, so we're still running a half-mile surplus on the week. 

Our route involved a big hill-climb (up to a ridge-line road with great views), and although it certainly wasn't easy, I felt great. Part of it was simply the fine weather -- it felt like the beginning of September rather than the middle of January. But I also seemed to have a lot of energy today, more than I expected to. It's an odd thing about running -- you can never tell, until you actually do the run, what you're in shape for this time. Occasionally I start out feeling strong and then run out of steam, but more often (far more often, actually) I start out feeling weak and apprehensive, and then discover that I start to feel better and stronger as I run. Today I felt downright ecstatic. I don't know why, and I don't know if I can repeat the same experience tomorrow, but every once in while a run (even a difficult run like today's) is pure pleasure. Well, you might as well relish it when it happens.

I'm still feeling good physically -- no pain in the hips, knees, or feet, and the sore spot on my thigh that I developed after the long weekend run has healed up nicely.

Americans Spending More on Health Care says the headline from Health Affairs. Out-of-pocket expenses for health care among U.S. citizens have apparently increased about 40% over the last decade. The main cause of the increase has been the increased incidence of chronic diseases (especially diabetes and hypertension) and the increased cost of prescription medications for those chronic diseases.

Or, as the cartoonist Pat Oliphant put it more bluntly:

I have to admit that one of the reasons I am so committed to treating my diabetes with lifestyle adjustments rather than prescription medications is that I can't accept the idea of putting myself entirely at the mercy of an industry whose unspoken motto is "Pay Or Die". One of the likely consequences of America's current economic meltdown is surely going to be that a lot of us will have to find a way to get by without health insurance. Right now my own routine medical expenses amount to little more than the cost of test strips. I'm glad that I don't have to add to that the cost of the five meds my doctor says I would be on by now if I hadn't changed the way I was living!

Tuesday, January 13, 2009  

Not quite as warm as yesterday, but still very warm for January: around 65 degrees during my run. To my great relief, I had no trouble running at all -- the sore spot on the outside of my left thigh was feeling much better, and I didn't notice it at all while I was running. I think the only thing I was thinking about throughout the run was trying to keep up with my running buddies. They're always faster on the uphills than I am, so I fall behind them, and then have to speed up ridiculously on the downhills to catch up with them again.

Anyway, the 16-mile run on the weekend did me no harm. I'm feeling good. I've been through the marathon training process repeatedly, and this has been my best experience of it to date.

My biggest concern about it is that a virus is currently cutting a swath through my workplace, and several people are out sick with it now. People are warning me that I'll get it next, and I won't like it. Well, that's not acceptable, I'm afraid. I can't deal with getting sick in the middle of marathon training, and that's that. I don't have time for this. The virus will have to find someone else to infect. I refuse even to discuss the matter any further.

After a non-exercise day, I'm never surprised if my fasting glucose goes up a bit, but 97 is higher than I like to see it even then. I try to keep it below 95. The vagaries of the meter might have exaggerated the uptick, of course. If it goes down tomorrow, I'll relax about it; if not, I'll see what I can change.

The standard English translation of frijoles refritos is "refried beans", but it's not at all an accurate translation, and it confuses people (why do you need to fry them twice?). You don't fry them twice, actually. The word refritos doesn't mean "re-fried", it means "well-fried". Translating a foreign word based on what you think it sounds as if it would mean is never a safe bet, but people cannot be stopped from doing it, seemingly.

I love refried beans, but it's surprising how much this simple dish can vary in style and quality. I tried making them from scratch at home once, and was shocked to learn how much trouble it was; since then I have bought them canned, but I've learned to be choosy. My favorite brand is Amy's Vegetarian Organic Refried Beans. The nutrient breakdown (per half-cup serving) is:

Not carb-free, obviously, but with 6 grams of fiber included, a serving is effectively the carb equivalent of just one slice of bread (only with more protein than you'll get from a slice of bread). I think it's a great side-dish, and very satisfying in cold weather. Not that I'm experiencing any cold weather lately, but the principle still applies. When I've been doing a long run or bike ride, especially in cold weather, no dish is more warming and satisfying to me. 

Monday, January 12, 2009  

Absolutely spectacular weather, almost unreal. Here it is mid-January, and the temperature got slightly over 80 degrees this afternoon.  I took my camera to work with me and took some photos around the site, just to illustrate what the day was like.

It was so beautiful outside that it was a shame this is my rest day from running. On the other hand, I would have had trouble coping with the sudden rise in temperature, when I've been running in 50-degree weather for a while now. People were walking around in shorts and T-shirts.

At sunset, the air was still quite warm (the atmosphere was more Indian-summer than mid-winter) and the hilltops glowing orange in the late-afternoon light seemed anything but wintry.

The sore spot on my left thigh was making me walk a bit stiffly today, especially on stairs, so I was glad not to have a run scheduled. But I could tell that it was healing gradually over the course of the day. I went to yoga in the evening, and I was worried about not being able to do various poses that I knew would put a strain on that sore spot, but I was able to do them all, and I think it was therapeutic. I ought to be able to run tomorrow without too much difficulty. Supposedly it won't be quite as warm tomorrow, but I should lay out some running clothes for tomorrow that aren't designed for more normal January weather.

Sunday, January 11, 2009  

After the 16-mile run yesterday I went to bed with nothing hurting, and hoped that nothing would be hurting when I woke up. Not much did, I'm glad to say; my feet, knees, hips, and even quad-muscles were feeling pretty good (just a little worn-out from the run). However, I do have one sore muscle, on the outer side of my left thigh.

 Why I should have this one sore spot, on only one side of the body, I don't know, but there's no soreness at all on the right side. (That kind of asymmetry always makes me worry that there must be something about my running form that's out of balance, and it's straining one side more than the other.) The sore spot on the left doesn't actually bother me when I'm sitting or standing still, but I feel it when I walk, and I feel it more painfully when I raise my left leg, or pull it back (to get in and out of my car, for example). Also, the sore spot is senstive to touch (or rather pressure). It feels as if there is something traumatized deep within the muscle. I've been stretching it and working on it with a massage stick. I also gave it a little icing treatment after dinner. I'm hoping it will be feeling better before long. My yoga class tomorrw will probably help. I need to it to feel better before my next training run, which is on Tuesday.

My gym workout actually made me feel better rather than worse, even that one sort spot. Surprisingly, I felt no lack of energy.

I am still feeling a residual high from all the endorphins I must have generated during the run. It's a very nice sensation -- a warm glow, a feeling of satisfaction and calm. I went to a music session in the afternoon, and felt so relaxed that I played better than I usually do.

One of the biggest challenges of marathon training, for me, is coping with the ferocious appetite I develop when the training runs start to get really long. I usually gain weight during marathon training, and I'm trying very hard not to do it this time. I thought I had been doing pretty well up to now, but I had a big, high-carb lunch after the run yesterday, and this morning I was still feeling very hungry -- I had a big, high-carb breakfast at a cafe. I can't keep doing that, clearly. I'll have to be especially careful tomorrow, as it's a non-exercise day.

Saturday, January 10, 2009  

The weather couldn't have been better for our 16-mile training run...

It was sunny, crystal-clear, calm, and just cool enough for comfortable running. The hills and vineyards were gorgeous. We saw few runners, but we were on a road that's very popular with cyclists, and we saw many groups of them go by -- and often they were calling out polite encouragement to us.  Active people constitute an informal fraternity; when we encounter one another in the great outdoors, we exchange greetings even if there isn't time to stop and exchange the secret handshake. It's like: "Oh look! There's another couple of people who get it! Well good for them!".

Under conditions like this, running (even long-distance running)almost seems more like entertainment than hard work. Actually, the work didn't seem all that hard to me; I was ready for this one. So far, I'm not as sore after the 16-miler as I was after the 15, or even the 13. See, look how not-miserable I was after finishing the run:

But the real test will be tomorrow morning -- that's when you find out how well you really handled a long run. We'll see what hurts then!

Obviously, I altered my eating habits considerably today, given that I was doing a 16-mile run. Whether I overdid it or not remains to be seen. I don't normally eat French fries, but if your'e going to eat them at all, the first meal after a 16-mile run is your best opportunity. The soup I had for dinner is was actually pretty low-carb (it's the soup for which I gave the recipe on Wednesday, and it's a good one), but having bread with it doesn't help in that regard.

Well, if I'm going to do marathon-training runs, I'm going to want to reward myself for it with some higher-carb dishes than I normally go in for. I assume that the training run depleted my muscle glycogen and I needed to replace it anyway. I expect that my fasting glucose in the morning will be signficantly higher than the 82 reading I got today, but I'm not going to worry about that right now. And my blood pressure was good -- I certainly credit that to the run.

Friday, January 9, 2009  

It was such a beautiful day (sunny, very clear air, temperatures climbing above 60 in the afternoon) that it felt almost decadent for me to be exercising indoors, in the gym, instead of running outside. However, I wanted a softer workout before tomorrow's 16-mile training run; the last thing I wanted was to be out there pounding the pavement the day before an assignment like that.

Today, while I was exercising on the stair-climber, I realized that my quadriceps muscles felt good for the first time since the 15-miler last weekend. I guess that means I'm ready for further punishment! But my hope is that my quads will be less sore after this challenge than after the last one. Sometimes, in marathon training, you start to feel stronger and better (not weaker and worse) as the challenges get tougher. No guarantees on that, of course, but it's at least possible that I will feel better after the 16-miler than I did after the 15-miler. Or at least no worse.

My fasting average over the past 7 days has been 87. Quite an improvement on the 100+ readings I was getting right after Christmas. Something like that always happens to me at the holidays, and it always scares me: did I get too cocky, and go too far this time? Can I pull it back now, or is it too late?

And then I pull it back.

Thursday, January 8, 2009  

I started the day with an early dental appointment -- which, I guess, is the ideal way to start the day, because it can only get better from there. It was just a cleaning appointment, but I'm such a nervous dental patient that even that is a trial for me. Surprisingly, the cleaning was done by my dentist himself and not a hygienist. I don't know why; maybe the hygienist was sick. So anyway, the close examining and prodding and scraping was done by the master himself and not an assistant. I kept waiting for him to give me some kind of thumbs-up or thumbs-down judgment on the condition of my gums, but he never really said anything about it, which is probably a good sign. He wanted to talk to me about my marathon-training instead. I did my best to tell him about it, at least when my mouth was free for the purpose.

He gestured toward the ugly gray weather out the window and said that, if it was going to be this damp and foggy and depressing, he wished it would just go ahead and rain, so that we at least got some drought-relief out of it. That was certainly what the forecast called for, and I thought it likely that out lunchtime run would be canceled in favor of a gym workout.

But no! Shortly before noon, a weather miracle occurred. The fog burned off, the clouds vanished, the sun shone brilliantly. The temperature went high enough into the 50s that I decided to wear shorts instead of long running pants. The marathon training schedule only called for 4 miles, and the route we chose was only a little longer than that. It was a very nice run, and I felt good during it, except that my quadriceps muscles (the big ones above the knee) were still feeling a little sore from the 15-miler on Saturday. As I have a 16-miler coming up in two days, I'm glad that my workout tomorrow is going to be a gentler gym workout, not a run.

Despite the difficulty of the training schedule I'm feeling better now than I did during the earlier (and easier) phase of it. The foot and hip problems that I feared would get worse as the miles built up have gotten better instead. The trick will be to keep it that way between now and the marathon (which is on March 1).

The software release process at work is going better than I thought it would -- I was expecting this week to be far more stressful than it has turned out to be. Maybe that's why my blood pressure has been coming down.

Wednesday, January 7, 2009  

It was a cold and foggy day, and it seemed so damp that we assumed it might start raining at any time, but it never did. When we went running at midday, it was in the 40s. I might have been better off with gloves on; apart from that I had enough layers on me to be comfortable.

The marathon-training schedule called for an 8-miler, and we came pretty close to it. Our long route ended up being 7.4 miles. We had two reasons (besides being out of time) to call that good enough: our training run the day before had been a mile longer than the schedule called for, and the run we did today involved climbing a hill so ferociously steep that we surely were entitled to give ourselves a little mileage credit in exchange for the extreme difficulty level.

This is the point in the marathon training process at which it becomes a little difficult to remember exactly why you signed up to do this in the first place, and why you're working so incredibly hard on a project which isn't going to put a single dime in your pocket. Even the most ordinary daily activities are being rescheduled (or canceled altogether) so that you can make time to run, and run, and run some more. And it's cold and wet outside. And your calves and hips are sore. And other people aren't doing this, so why should you?  

On the other hand, your best memories in life are never about the times when you were taking it easy. The things that you did despite their being difficult or scary are what matter to you in the end. I take on difficult exercise challenges once in a while, and I do it mainly because I think my health benefits from the training I have to do to get ready for these things. But I also do it because the difficulty itself is a kind of reward; it adds a touch of drama to life, an element of suspense, a sense of consequence -- and somehow all this makes everything else in life better. People who have never done a long run in cold wet weather have no idea how luxurious the experience of a hot shower can be.

More unsurprising research, from the December 2008 issue of Nutrition and Metabolism. Dr. Eric C. Westman, of Duke University Medical Center, Durham, North Carolina, did a study of low-carb dieting in patients obese individuals with Type 2 diabetes, and found that carbohydrate restriction greatly improved glycemic control. Most of the patients were able to reduce or eliminate their need for medication, and the more severely they restricted their carbohydrate intake, the better their result were.

"Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes," the researchers conclude.

Speaking of low-carb eating, one of my running buddies passed on to me a recipe which got from Sunset magazine. She said it's great; it tastes creamy without actually containing any cream. It qualifies as low-carb by my standards, although maybe not by the more radical standards of Dr. Atkins.

Creamy Cauliflower Soup

Time: 1 hour.
Serves 4 or 5 (makes 7 1/2 cups).

  1. Heat vegetable oil in a large pot over medium-high heat. Add onions and salt, cover, reduce heat to medium, and cook, stirring occasionally, until onions are very soft, 5 to 8 minutes. Add garlic and wine. Cook, stirring, until liquid is almost completely evaporated, 3 to 5 minutes.
  2. Stir in cauliflower and broth and bring to a boil. Reduce heat to a simmer, cover, and cook until cauliflower is very soft, 20 to 25 minutes.
  3. In 3 batches, whirl soup in a blender until very smooth, at least 3 minutes per batch (or, if you'd like a few florets in your soup, blend 2 batches and leave the last chunky). Stir together and season to taste with white pepper and salt.
  4. In a small bowl, combine olive oil, chives, and parsley. Ladle soup into bowls and decoratively drizzle herb oil on top.

Note: Nutritional analysis is per 1 1/2-cup serving.

Calories:    131 (59% from fat)
Protein:    4.8g
Fat:    8.5g (sat 1.2)
Carbohydrate:    11g
Fiber:    2.9g
Sodium:    702mg
Cholesterol:    0.0mg

Tuesday, January 6, 2009  

The day started out cold and gray, and it kept looking as if it was about to rain. However, by the time we got outside and started our run it had got up to the mid-50s, and over the course of the run the clouds disappeared; we ended up running in the sunshine. That happens to us a lot, simply because we run at about the time of day when the fog layer burns off, but it always feels as if nature is rewarding us for running. Just because we had the gumption to get into our running clothes and go outside, mother nature decides that we're entitled to a little kindness. I probably shouldn't say this, though. Maybe tomorrow we'll go outside for a run and mother nature will decide that we're about due to be caught in a hailstorm. Mother nature can be kind, but she doesn't believe in encouraging anyone to take her kindness for granted.

The marathon training schedule called for only 4 miles today, but my running buddies wanted to do 5, and I went along with the idea. Peer-pressure is what it's all about. Also, I sometimes make my shorter training runs a little longer, in case I can't make the longer ones as long as they're supposed to be. I'm a little worried that I won't have time for the scheduled 8-miler tomorrow. I might have to a shorter run than that at noon, and make up for it at the gym afterwards, or something. Of course, the point of doing an 8-mile training run is to run 8 miles continuously, and it's cheating to break it up into separate workouts, but finding time for a really long run in the daytime can be tough. I'm thinking of doing some of these at night, with lights on for safety. If I were training in the summertime, it wouldn't be a problem -- there would be plenty of daylight in the evening for a long run after work. In fact, in the summertime I make it a practice to do a trail-run after work once a week. In the winter, it's a bit harder. Running at night, even if you feel that you can do it safely, is bound to seem a little creepy, almost self-punishing. On the other hand, it tends to be a dramatic, memorable experience. And the recovery phase -- the hot shower, the robe and slippers, the wee dram of Highland single-malt -- can be pretty rewarding on a winter's night.

From Reuters Health: more proof (if proof were needed) that sleep deprivation promotes insulin-resistance.

"Continuous positive airway pressure (CPAP) therapy, primarily used as a treatment for obstructive sleep apnea, improves glycemic (blood sugar) control during sleep in patients who also have type 2 diabetics, according to a report in the Journal of Clinical Sleep Medicine".

Nobody knows exactly how, but going without sleep somehow promotes insulin resistance and Type 2 diabetes. It happened to me: I developed a serious case of obstructive sleep apnea (OSA), and developed Type 2 shortly afterward. I used a CPAP machine myself, at least until I had lost enough weight to be able to sleep without it.

The average decrease in nocturnal glucose level in diabetic patients was about 20 mg/dL. "The decrease was small in those with good glycemic control and much greater in those whose control was poor," Dr. Arthur Dawson from Scripps Clinic, La Jolla, California, told Reuters Health. This finding "suggests that treating obstructive sleep apnea could have a major impact on the management of those type 2 diabetics who, for whatever reason, cannot get their glucose levels down to the optimal range."

In my opinion, any doctor diagnosing a patient with Type 2 diabetes should investigate the possibility that the patient also has OSA or some other sleep disorder. It's not necessarily an easy issue to investigate, however. OSA is characterized by loud snoring, which progresses to episodes of complete airway blockage. These blockage episodes force the patient to wake up just enough for breathing to resume (but usually not enough for the patient to be aware of what's happeing). The patient becomes increasingly sleepy and exhausted during the daytime, however, without knowing why. Establishing a diagnosis of OSA requires a sleep study (that is, trying to sleep overnight in a clinic when you're attached to a bunch of diagnostic equipment). The CPAP machine is an effective treatment, and weight loss is often an effective cure. In any case, getting OSA under control is often a necessary step toward getting diabetes under control.

I wish all of this were common knowledge, but it isn't. Many people with diabetes who suffer from chronic exhaustion assume that diabetes is causing the problem, when the reality may be that the problem is causing diabetes. 

Monday, January 5, 2009  

Monday is my rest day from exercise, but I go to a yoga class on Monday nights, partly to help undo whatever harm I've done to myself with my intense weekend activities. This weekend the activities were very intense indeed, but the only conspicuous problem I had today was sore quadriceps muscles. Still, I was in need of loosening up generally, and I felt better after the yoga session. And some parts of it which I was expecting would hurt turned out not to be as hard as I expected, which is always nice when it happens.

In recent years I have become terribly conscious of body maintenance -- the challenge of figuring out how to make your body fitter and stronger without, in the process, injuring it and making it ultimately less fit and strong. My exercise program (which was originally centered around cycling) has become very much centered around distance-running, a sport which certainly carries a higher risk of overuse injury. Therefore, I have to focus a lot of my attention on injury-prevention. I'm always monitoring myself for signs of problems developing, looking into different types of shoes and shoe-inserts, and trying to make adjustments to my running style. So far, it's working for me. Earlier in the training schedule for the upcoming marathon, I was having problems with my left foot and my right hip. Right now (despite having run 15 miles on Saturday), both are feeling better than they have in over a month. I hope I can keep it that way!

When it comes to cooking vegetables, I'm not much inclined to follow recipes. Throw in whatever looks like it might be good, is my principle. Tonight the ingredients were shallots, broccoli, bok choi, carrots, a Serrano chile, oyster mushrooms, seitan, vegetable broth, spices, and red curry sauce. It was pretty spicy stuff, but supposedly that's good for blood sugar control. As I happen to like spicy food, I'm happy to seize on the idea that it's therapeutic, whether or not it really is. My experiment on the subject last month didn't seem to show that hot chiles helped me any, but perhaps they only held those who need help, and I didn't.

Sunday, January 4, 2009  

After yesterday's long training run, I wasn't exactly bursting with energy today (reading and napping occupied more of the dalylight hours than I would like to admit), but on the other hand I wasn't feeling bad. My quadriceps muscles were a bit sore (which is perfectly normal at this point in the marathon-training program), but only when I was using them. Nothing else hurt. To my relief, I found that my left foot and right hip (both of which hurt during or after some previous long runs) were both okay this time. There is also a lingering narcotic effect from the endorphins I generated during the run. The runner's high doesn't last terribly long, but after a really long run there can still be an afterglow the next day.

According to the training schedule this isn't a rest day, just a non-running day, so I needed to work out in some other way. I went to the gym this afternoon. Damn those New Year's resolutions! The place was overcrowded with people trying to make a change in their lives -- which I approve of except when it means that my preferred exercise machines are all occupied. I had to settle for the stair-climber, which is not the kind of exercise machine I would normally choose when I have sore quadriceps muscles. Using that machine really worked the muscles that were least ready to be worked. However, it was probably just as well; if you rest sore muscles entirely, they stiffen up and stay that way a long time. If you work them, but a little more gently than you worked them when you were making them sore in the first place, you stand a chance of loosening them up. I think the workout helped me.

The run yesterday depleted me enough to make me extremely hungry all day, and if I yielded to the impulse I probably would have eaten twice as much as I did. I'm trying not to do that, because so far I have found that marathon training has always caused me to gain weight instead of losing it. I burn a tremendous number of calories, but I get so hungry that I eat enough to make up for it and then some. This time I'm trying to see if I can lose some pounds, or at least not gain any, during the training period. I've got a little less than two months to go, but I'm in the most dangerous phase now because the miles are really piling up, and it's very hard not to feel that you're entitled to eat absolutely anything under these circumstances. Your natural impulse is to say "Hey, I just ran 15 miles -- I can eat whatever I want, and as much of it as I want, and it won't count!". But of course it does count, and it's pretty easy to eat enough to make up for whatever calories you're burning, even when you're doing heroic amounts of exercise. At least, it's easy for me; it is my tragedy that I have an almost limitless appetite, and that almost every kind of food tastes good to me. In the evening I went to play at an Irish music session at Murphy's Pub in Sonoma. I had dinner there, and the urge to order a big greasy plate of fish and chips was hard to suppress, but I went for a more modest chowder and salad instead. Maybe a few modifications like this will do the trick.

When I was initially diagnosed with Type 2, in early 2001, I reduced my weight from 250 pounds to 200 pretty rapidly, inspired as I was by panic and desperation. However, dropping to 185 was much harder and took much longer, because the pressure was off (my blood sugar was under control by then) and I wasn't focused on weight in the same way. I've been hovering around 185 ever since, and often rising above 190 before dragging myself back down. One of the things that has pushed me above 190 in the past has been marathon training, or rather the excessive appetite that comes with marathon training. If I can conquer that effect, maybe I can also bring myself down to 170, which is apparently where I really ought to be.

Saturday, January 3, 2009  

Well, if you're going to do a marathon-training run in San Francisco, it certainly helps a lot to have weather like this...

Today the marathon-training schedule called for a 15-miler, which turns out to be a long way to run. In fact, it's long enough that finding a safe and suitable route of that length in San Francisco can be a challenge. We decided to run back and forth across the bridge a couple of times to rack up some miles; then we ran along the shore to Ghirardelli Square and back, which brought us right up to 15. It was cold at first, but not windy (even on the bridge), and it stayed sunny all day. Spectacular views in all directions.

The bridge has a fairly wide pedestrian path along the east side, and runners must mix with hundreds of walkers there. Sadly, most of the tourists walking on the bridge are utterly oblivious of the need to keep on their side of the path, to give others room to get around them, and to avoid moving backwards suddenly (without looking) in order to frame a snapshot better. None of these requirements should be terribly hard to figure out, but time after time these herds of randomly-wandering people blocked the path ahead of us. When we yelled "Excuse us!" to try to get around them, or had near-collisions with them when they suddenly lurched in front of us, they would freeze and stare at us like deer, with a look of astonishment at discovering that someone besides themselves was on the bridge.

The amusing part of this was that, as we were running south from the Marin end of the bridge, we encountered a large group of blind people who were walking with their white canes in front of us -- and we got around them without the slightest difficulty! They were keeping to their side of the path, they were keeping together in close formation, and they were walking forward in a predictable straight line. They were almost the only pedestrians on the bridge who weren't presenting a safety hazard to themselves or anyone else. I wish those blind people could have given lessons to the other pedestrians on how to walk across the bridge. Think of it: the blind leading the dumb!

As the milage ratchets up during marathon training, there comes a point at which you have to start getting concerned about hypoglycemia. For really long runs, I carry glucose gels or other concentrated sources of sugar. It's not really a diabetes issue; on a long-distance run, anybody's blood sugar can drop, and most distance-runners carry something of that type, or put a sugared sports-drink in their water bottles. I used to get low around the 10-mile point. More recently, I have been able to go longer without taking in any sugar, but 15 miles is pushing it. During the last few miles today I felt a drop in my energy level, and I figured I was going to get hypoglycemic soon, but I didn't want to take a glucose gel until I had to. When I get hungry and shaky, I go ahead and have some sugar, but in this case I thought I had enough fuel in the tank to complete the run, so I waited. I knew I could get a muffin at the Warming Hut where we finished the run. I think it was a close thing. I felt a little shaky after the run, but after I ate the muffin I rebounded pretty quickly. I was able to look fairly serene while posing for a post-run shapshot.

After the run I ate an early dinner at a Mexican restaurant. That's my favorite kind of meal to have while recovering from a very long run or bike ride -- partly because it's a satisfying kind of food when you're tired, cold, and hungry, and partly because that's the only time I can justify eating a meal that's as carb-heavy as Mexican restaurant food tends to be.

When the running distance gets as high as 15 miles, you're bound to be a little stiff and sore after a run, but considering the circumstances I actually feel pretty good. Nothing is really hurting. I hope I feel good in the morning as well. 

Friday, January 2, 2009  

I overslept a bit today, and took my fasting test later than usual; that usually gives me a higher result, so maybe I would have done better than 92 if I had got up on time. But 92 isn't bad, especially compared to the results I was getting just after Christmas.

The day started out rainy, but around 2 PM, as I was leaving the gym, the skies suddenly cleared, and it was all brilliant sunshine from then on. I hope the clear weather lasts, because tomorrow is the 15-mile training run for the marathon, and I'd rather not do that in the rain. 

There were a lot of mushrooms poking up from under the pine needles all around my house, a red-topped species which I haven't yet been able to identify, although it's very common in my neighborhood, whatever it is.

I would like to learn how to identify mushrooms, although not with any intention of collecting and eating them. I just would like to become more familiar with them. They're just such strange organisms, like something from another planet. There's a local mycological society which I could join, but I met a couple of their members once, and they seemed a little like something from another planet, too. Maybe I just happened to meet their two weirdest members, and the rest of the gang is a lot of fun to hang out with, but it's held me back from making further contact with their organization. They have a special weekend event coming up in which you hike around with experts and collect mushrooms; maybe I can get up enough nerve to sign up for it. My only anxiety about the thing is social in nature; there's no doubt in my mind that I would enjoy tramping around in a damp forest looking for grotesque fungal organisms. It wouldn't be everyone's idea of a fun weekend, I realize, but it's just the kind of thing I like. (Somebody has to be that way, or no science would happen at all.)

Thursday, January 1, 2009  

One of my own New Year's resolutions is to say more in this blog about what I'm eating. So far I have given a lot of detail, almost every day, about the exercise I do, while commenting only rarely on meals. Others have noticed this imbalance, and have asked me to be more forthcoming on the subject. My excuse for not doing it so far was that I food gets too much attention in regard to diabetes management, and exercise gets too little attention, so I was trying to compensate. But the real reason, of course, is that it's embarrassing to have to give an accounting of your eating habits to virtually anyone in the world who wants to know. I'm not sure I have the nerve to continue with this idea, but I'll try it for a while and see how it goes. Maybe it will force me to make more careful food choices, just because I won't want to eat anything that will look bad in the report.  

Another beautiful day here...

Of course it was New Year's Day, which meant that everyone who had made a resolution to get more exercise in 2009 was outdoors giving it a whirl. The pedestrian path around Spring Lake had so many walkers, joggers, and cyclists on it that it seemed as if someone ought to be directing traffic. Certainly someone should have been cleaning up after the dogs...

I had gone there to do a 4-mile training run, but when I arrived I was not feeling up to it. I had no energy at all. Was I coming down with a cold? Hypoglycemic? Just in a bad mood? I was afraid to start the run for fear that I wouldn't be able to complete it. I killed time for a while, taking pictures in the park. Finally I started feeling a little bit better, or convinced myself that I was feeling better because I was tired of waiting to feel better. So, I started the run, and as usual I started feeling better as soon as I got going.

I still feel a little below par, so maybe I do have a mild virus or something, despite the absence of any cold symptoms. If so, I'm hoping that my immune system is fighting it off successfully, and I'm not going to feel any worse tomorrow. I usually have this kind of feeling several times during the winter -- I think I'm coming down with a fever, and then the feeling goes away. I tend to think of these episodes as personal victories against the virus team. I had a cold (not a very bad one) in September, before the virus season really got started, but nothing since. Maybe I'm overdue to catch something, but I think that the amount of exercise I do strengthens my immune system, and allows me to experience nothing more than a day or two of fatigue, when the same virus would have incapacitated me for a week in the days before I started exercising.

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