(I've written an explanation elsewhere of why disclaimers of this sort may be necessary.) 

Wednesday, July 29, 2009  

I didn't take my usual rest day last Friday, and I thought I was just going to skip it altogether, and keep exercising until the Friday the 31st. But today I had schedule problems when I wanted to go running, and ultimately I decided that if I was having this much trouble finding time to fit in a workout today, I might as well take a rest day after all.

Maybe it doesn't speak well for me, but I think hardly anything is funnier than foreign prose ineptly translated into English. Often, what the translation loses in clarity, it gains in expressiveness. For example, this warning notice on a Chinese video game:

Relevant crazy warning


When takea look at in the usualenvironment inside usually a certain flashlight that appear or a certainpattern,minimum amount the part of people will or crazy disease go into actionis take placed to temporary lose the consciousness. This part of people at takea look at a certain television diagram to resemble or operate a certain TV game hour may cause the crazy to go into action The person of the operation game is sometimes although can' t superficially take place above crazy go into action .may still be placed in and did not realize the crazy appearance.

If youor the member of your family appeared with the crazy and relevant condition of illess (for example go into action or lose the consciousness), then at any TV game of operation before. Should in advance consult the doctor.

When child operation TV game ,we suggest the parent to should attention,be you or your child emergence below condition of illness,for example faint,sense of vision variety,eye or muscle crispation.not sport that aware of self ,lose the consciousness, lose bearing or spasm,should immediately stop usage ,and please go on a long journey the treatment.

I don't like video games, so you wouldn't think there would be much danger that careless use of one will "cause the crazy to go into action" in my case, or that I will have to "go on a long journey the treatment" as a result. However, I have been known, in my time, to experience "sense of vision variety", and I'm no stranger to "muscle crispation", either. And on a few occasions I have been told, after the fact, that apparently I did not "realize the crazy appearance". So, I may well be at risk here, and I guess I'd better be extra careful to steer clear of that game.

In this case, the translator obviously has little familiarity with English, and therefore has a good excuse for whatever the warning lacks in coherence or clarity. I am a little less ready to excuse people who are writing in their native language and still can't communicate.

An example is ready to hand, from the EosHealth web site. Under their "Ask an Expert" column, this is the answer that the Expert (who is is identified as 'Adam Adminis' -- a pseudonym that makes 'Click and Clack' sound genuine) provides to the question "What is the difference between Type 1 and 2 diabetes?":

Type 1 diabetes, in which insulin is not secreted by the pancreas, is directly treatable only with injected insulin, although dietary and other lifestyle adjustments are part of management. Type 2 may be managed with a combination of dietary treatment, tablets and injections and, frequently, insulin supplementation.

Now, I ask you: on what planet would that qualify as an answer to the question? At least the Expert does say something about what Type 1 is ("insulin is not secreted by the pancreas"). He doesn't mention why the pancreas might not be secreting insulin, but it's a start. He doesn't even drop any hints about what Type 2 is, however. The only distinction he draws between Type 1 and Type 2 concerns the differences in how they are treated -- but in his description, it hardly sounds as if there are any differences, except that Type 2 patients apparently require "tablets" which Type 1 patients can get along without.

Why flood the internet with this kind of shallowness? Is diabetes not a sufficiently serious issue for people to want to make an effort to say something intelligible about it?

For what it's worth, here's how I would have answered the question...

Type 1 diabetes is an auto-immune disease -- that is, a disease in which the immune system goes haywire and attacks one of the body's own tissues as if it were an invading micro-organism. The tissue attacked in this case is the the pancreas, specifically the beta cells in the pancreas -- the cells which produce your insulin supply. Because of this auto-immune reaction, people with Type 1 diabetes can no longer produce insulin, and must inject it. Because this reaction usually happens early in life, Type 1 used to be called juvenile diabetes.

Type 2 diabetes (which usually develops later in life, and used to be called adult-onset diabetes) is more mysterious as to its cause. It usually involves "insulin resistance" in cells (that is, a loss of sensitivity to insulin, so that whatever insulin the body produces is not as effective as it ought to be). Many people with Type 2 also suffer a decline in their ability to produce insulin, which of course makes the situation worse. The risk of developing Type 2 depends largely on genetic factors, but lifestyle also plays an important role; most Type 2 patients are overweight, and can improve their blood sugar control by losing weight and exercising. Where that approach is not sufficient, Type 2 patients may also need to take oral drugs and/or insulin injections.

There. Was that so hard?

Tuesday, July 28, 2009  

How did we get here? How did things manage to go so far?

The dessert pictured below is the "Gotta Have It Founder's Favorite" from Cold Stone Creamery.

What's remarkable about this particular dessert is not the calorie count (1600), nor the grams of sugar (84), nor the grams of fat (52). No, what's remarkable about the Founder's Favorite is that it is not the most excessively caloric dessert currently being sold by an American chain restaurant.

That honor (and the additional honor, at least according to Men's Health, of being the worst food item in the world) goes to Baskin Robbin's "Large Chocolate Oreo Shake":

Described by critics as "Diabetes In A Cup", this shake outdoes the Founder's Favorite by a hefty margin: 2600 calories, 135 grams of fat, and 263 grams of sugar.

What I'm curious about is how our perceptions or expectations of food were slowly ratcheted up over the years, to the point that a major chain restaurant thinks nothing of serving (and their customers think nothing of consuming) a dessert which combines the saturated-fat content of 59 strips of bacon with the sugar content of 20 bowls of Froot Loops cereal. That shake contains more than half a pound of sugar, for heaven's sake! I repeat, how did we get here? How did this kind of thing start to seem normal to us?

I guess you can get used to almost any kind of change, if it happens gradually enough, and if the people around you are accepting it as normal. It is particularly easy to get used to change if it involves eating more and more stuff that tastes good. We seem to be hard-wired to react that way, in fact.

If you can step out of that fast-food world for a while, and get used to eating less, it is possible to restore your perceptions to normal, and start recognizing ridiculously excessive foods as ridiculously excessive. But if you're not extremely careful, the process of acclimation just starts over again.

A nice day for running -- sunny but only 70 degrees. My running buddies were unavailable, and when I run by myself I'm never as fast as when somebody is challenging me to keep up, but I think I did fairly well despite the handicap of setting my own pace.

I ran into more wild turkeys during the run. No mountain lions, and that's the way I like it. No cars managed to hit me, either, even though one woman barreling down the hill saw no reason why she should hit the brakes hard enough to stop short of the crosswalk. It didn't matter, I had my eye on her all along and was able to keep clear of her. It's amazing how easy it is to look at an approaching car and know, from one quick glance, that the driver is a moron. You don't even have to see the cell phone, you just know, somehow. Although I did get surprised at that same intersection once, by a guy who got a sudden impulse to make a right turn from the left lane. The guy seemed to be looking around to see if any cops were there to object to his illegal turn; at any rate he looked in every direction but the one in which is car was traveling. I was able to jump back onto the curb in time.

Exercising outside the gym can be a dangerous thing, but I have such a strong preference for outdoor exercise that I almost have to take that risk, if I'm going to have any kind of serious exercise program at all. When you're depending on exercise for your long-term diabetes management, the risk of getting bored with exercise is perhaps the greatest risk of all. Probably more people succumb to that risk than to the risk of being hit by a car.

Monday, July 27, 2009  

I did some hilly cycling on Saturday, and felt okay with it. (Pedaling seemed to help, rather than hurt, the sore calf muscle in my left leg that I was having trouble with last week.) So, I went down to San Francisco yesterday and cycled some more. It was a good day for it -- sunny but not hot. In the photo below, the small island that looks like a battleship is Alcatraz.

As usual, riding over the Golden Gate Bridge meant entering a different weather system: windy, cold, and foggy. But it was sunny and comfortable on either end of the bridge. From all directions you could get a nice clear view of the bridge roadway, even if the towers above it were invisible.

The bridge weather system puzzles me. No part of San Francisco is far from the ocean or the bay, so the climate should be more or less the same everywhere. And yet, even at the water's edge, the weather on dry land is nearly always calmer, warmer, and clearer than the weather on the bridge itself. How does that work? The roadway is 220 feet above the water, and apparently something about that location promotes the formation of clouds at just that altitude. The result is that the bridge is constantly appearing and disappearing as the clouds condense and dissipate.

Earlier in the morning (much earlier in the morning), the runners in the San Francisco Marathon had run over that bridge and back. I did that race once (in 2006), and I was glad to have done it, but so far I haven't felt tempted to do it again. I'm not sure whether or not I am going to do any more marathons at all, and if I do, there are certainly easier marathons than San Francisco's. Every marathon is hard, I hasten to add. That doesn't mean they are all created equal.

Lately I've been doing so much running and so little cycling that I had almost fogotten the advantages of cycling as a form of exercise: it's more fun, more adventurous (in that you can get farther from your starting point), and in most ways less traumatic. The "good tired" feeling you get after a long bike ride is better than the equivalent feeling after a big run, because you don't feel so beat-up by the experience.

However, there is one area in which cycling (at least for men) is more traumatic than running. I want to know, once and for all, who decided that this is the best shape for a bicycle seat for male riders?

Allow me to draw your attention to that narrow slot down the middle of it. What the hell do they think we've got down there -- a shark fin?

Some of what we have, in fact, got down there ends up being crushed down along those winglike structures to the left and right, and chafed mercilessly throughout the ride (particularly during strenuous uphill pedaling). The fact that I haven't been cycling lately added to my difficulties with the bike seat, no doubt, but even when I was doing long rides frequently, this was often an issue for me. There has to be a better way to design a bicycle seat -- there just has to be!

Friday, July 24 , 2009  

Lately Friday has been my rest day, but I thought I should do at least a short run today because my workout yesterday was such a light one. However, I was worried about whether I would be able to handle running today. My left leg is still feeling sore from the bad muscle-cramp I had on Wednesday. It turned out that running felt better than walking -- my leg felt better and better as the run went on. But after the run was over, it gradually went back to feeling stiff and sore when I walked on it.  Not as bad as it felt yesterday, but not a lot better either.

I'm always having this dilemma in one form or another -- if I keep exercising while I recover from a minor illness or injury, does that speed or delay the healing process? I think sometimes exercise helps my recovery and sometimes it hurts; the trouble is that there's no way to know which it is in any given case! Because I rely on exercise so much for diabetes management, I'm very reluctant to rest up. I tend to assume that, if I'm well enough to get out of bed and walk out my front door, that means I have no excuse not to exercise. No doubt I sometimes prevent an injury from healing as fast as it could by not resting. Maybe it was a mistake to run today, but I went with my instinct, and my instinct said that my leg muscle would never loosen up if I didn't use it. I hope my instinct was right.

I didn't ride my new bike at all today, but I figure I'll try it out tomorrow afternoon. I'll try not to overdo it, as I've made a commitment to go riding in San Francisco on the following day, and that's pretty sure to be a hilly ride.

Thursday, July 23, 2009  

I couldn't run at lunch today, because I had a dental appointment that screwed up my schedule -- but probably I couldn't have done it anyway. As a result of the ferocious muscle-cramp that I suffered in my left leg yesterday, I was sore and even limping a bit today. Sometimes, when I have a really bad cramp, the muscle continues hurting afterward for a day or so. I figured I was better off using the elliptical trainer at the gym to work out. I figured that would stretch the muscle, but more gently than running would. The sore muscle did seem to feel better and better as the workout went along. However, when I got off the machine and walked to the locker room, the muscle still hurt me a bit with each step. I just worked it over with a massage stick; maybe that will help. But sometimes only time helps.

Perhaps, all things considered, this was not the ideal day to purchase a bicycle. But my bike was stolen a few months ago, and it was beginning to look as if the bike was not going to find its own way back home. It was time replace it, because I'm going to need and it on a vacation I'm taking soon. I went to the shop where I bought the bike I lost, figuring that I might as well buy another one just like it, as I'd been happy with it. They didn't carry that type any more, of course. But I found one that I did like, and in fact I think it's going to be better than the one I'm replacing. And it even cost me a little less than the one I'm replacing, partly because they surprised me by giving me a pity discount at the register, on account of the theft. The employees shared with me some vivid details regarding what ought to be done to bike thieves.

I did test-drive the bike around the block, and surprisingly enough my sore leg didn't bother me while I was pedaling. However, riding around the block (downtown, where it's flat), would not be at all the same thing as climbing up the steep hill I live on. So I didn't attempt to ride the thing home. I hauled it home, strapped to the back of my car. That is, the bike was strapped to the back of my car; I was steering from the usual place.  

"What a book a devil's chaplain might write on the clumsy, wasteful, blundering, low, and horribly cruel work of nature!"
Charles Darwin

Darwin's famous complaint about the unlovely way nature operates, if you examine it closely enough, comes to my mind whenever "natural" is used to mean "ideal". It is often assumed that the key to healthy living is to get into better harmony with nature's ways. I'm not sure that is as safe an assumption as a lot of people imagine.

As Darwin noticed, to his distress, the natural world is not necessarily designed to give living things the longest, happiest, most comfortable life possible. Living things actually tend to suffer rather a lot. They have brief lives, painful injuries and diseases, terrifying deaths. To cite one particularly ugly fact of nature: an actual majority of animal species are parasites. When biologists go out to do their fieldwork, the natural world that they must confront is, to put it mildly, not the Disney version.

Nature's definition of a successful life is pretty narrow: you've lived long enough to (1) reproduce, and (2) protect your offspring so that they can live long enough to reproduce. And once you have reached that pinnacle of success, nature is done with you. Nature doesn't care what happens to you after that. As far as nature is concerned, if you have somehow reached the age of 40, you are already old and in the way.

Therefore, whenever you are tempted to pin your hopes for a healthy life on Nature's Plan, you need to bear in mind is that living past 40 is not part of that plan. (Being free of tapeworms at 20 is, unfortunately, not part of that plan either.)

The reason I bring all this up is that a lot of people look to the lives of pre-historic human populations (or primitive populations today) for proof of what is or isn't a healthy lifestyle. Sometimes they look at the lives of apes, too. The assumption is that natural selective pressure must have adapted humans and apes for the lives they were living, and therefore we'll be working against the grain if we don't live the way these creatures did, particularly in regard to diet.

This kind of thinking isn't totally crazy, but it has to be viewed with caution. Even if you eat a caveman's diet, you still won't be living a caveman's life. And even if you can manage to live a caveman's life (eating only meat that you hunted using a spear you made yourself), you shouldn't count on this to give you more than a caveman's lifespan.

This kind of thinking inspires a lot of rather silly controversies. For example, the vegetarian-gorilla controversy. Anti-vegetarians claim that avoiding meat makes you a weakling. Vegetarians counter that mountain gorillas are not weaklings, and they only eat plants. Anti-vegetarians counter that this isn't true, gorillas aren't really vegetarians; they eat animals too. Vegetarians point out that the "animals" the gorillas eat are termites, and these tiny insects only account for very small fraction of their food intake anyway. And so on, and on, and on. But I ask you: what difference does it make how strict gorillas are about their vegetarianism, when it doesn't prove anything about what kind of diet will be likelier to help a human being achieve a long and healthy life (which presumably is what we want to know)?

Anyway, I've learned to be cautious about accepting the idea that "natural" equals "good for you". A lot of things are natural that aren't good for you. Cobra venom is natural. Botulinum toxin is natural. Infant mortality is more or less nature's way.

I think we need to adopt a human standard rather than a natural one for determining what is desirable. Sometimes (maybe most of the time) living in harmony with nature will be just the ticket. But often we will want something better than what nature offers us. We just need to get good at distinguishing between those two cases.

Wednesday, July 22, 2009  

Hmmm, a fasting test result of 88. That's not high, but very recently my fasting average was 80, and I've come to see that as normal for me, or at least possible for me, so I'm going to try working it back down there.

Exercise alone won't do it; I'd better make a reduction in simple carbs. It occurs to me that I've been eating a lot of fruit this week. Part of the reason is that on Sunday I happened to make a stop at Dry Creek Peach & Produce (the best source of organic fruit I know of), and bought some truly excellent peaches and nectarines. They're very ripe, and I hate to let anything that good go to waste. Well, I had the last of them this afternoon after running -- the juiciest peach I ever remember eating (I should have worn a raincoat or something). Well, they're gone now. I still have some raspberries that I'm planning to eat at breakfast tomorrow, but after that I should probably minimize fruit for a while, and see if it makes a difference.

My running buddies weren't in the mood for a short run today. One of them wanted to run 8 miles, as a matter of fact, but we didn't feel like joining him on that one; we let him split off from us after a few miles and take a longer route. The 5.5-mile route we stayed with was plenty long enough for me today. Anyway, I felt good, my pace was good, and the weather was mild; I guess there's not much else I could ask for in a run.

Well, there's one thing I could ask for: not to get a leg cramp after the run was over. That happened to me, very suddenly, while I was putting on my pants after showering. It was a really bad calf-cramp, extremely painful, and my gasping and howling alarmed the other guy who was in the locker room at the time -- I could hardly even speak to explain what was wrong with me. When I finally managed to say it, he sympathized. He said he had the same problem, and he'd had success with a non-prescription medication for it containing quinine. I guess I'll have to see if I can find some. In the meantime, I took an electrolyte supplement tonight, in case I'm low on potassium or magnesium or something. Maybe it will prevent me from getting another cramp while I'm trying to sleep tonight. 

Ah, the office refrigerator! The very arena where people first learned the standards of behavior which they now practice in their dealings with strangers in on-line discussion boards:

Actually, this note did not appear on my office refrigerator; I swiped it from FOUND Magazine. But it wouldn't surprise me to see a note of this sort.

That reminds me: once somebody brought in a bunch of dietary supplements to the office (somehow they got stuck with such a large supply of them that they decided to give them away free to anyone who wanted them, so they left them on the coffee stand in the main hallway). I've forgotten the names of most of these naturapathic cure-alls, but one of them got my attention at the time: it was called "SOY MENOPAUSE". I remember seing that, and asking if menopause was also available in chicken and beef. And what would this stuff do if a guy took it, I wondered? Would my periods stop? (Or start?) Hard to know. I never did put it to the test. Maybe I should have been bolder.

"Wines & Sunsets in Paradise", they call it. That's a little overstated, perhaps, but if you're in Santa Rosa, California on a Wednesday evening in the summertime, you could do worse than to drop in at the Paradise Ridge winery.

One Wednesday evenings they open up the winery to the public (which is not usual, for any winery, after 5 PM), and they serve wine by the glass. You can bring a picnic dinner and sit on their balcony, sipping wine as the sun goes down.

If it isn't actually "paradise", it will do. I had a glass of their 2003 Garrod Ranch Syrah, and watched the world turn golden. The winery is about a mile from where I work, so it's almost as if they planned this event for my convenience. I think I'm going to take some coworkers there next Wednesday -- unfortunately, for a farewell party. Some of our layed-off employees have departure dates next week.

Tuesday, July 21, 2009  

90 isn't a "high" fasting result, but it's up a bit from where I've been lately. The slight increase could be bogus (a meter fluctuation of the kind which is normal and expected), but if it's for real, the likely explanation is that I had rather high-carb dinner last night, and a late dinner at that. We'll see what tomorrow's test shows. If I see a persistent upward trend developing, I'll do something about it. I really haven't changed my diet that much -- I'm crawling in the direction of a low-fat vegetarian diet, but I'm not really in Dr. McDougall territory yet. I've been avoiding animal foods, all right, but the fat reduction has been more modest so far. Still, I'm pretty sure carbs are a bigger share of my total calorie intake lately, and if I can't have that without having a rise in blood sugar, something will have to change.

Blood pressure is down; I don't know why. Well, I had a good solid run today, and nothing upsetting happened since then. Maybe that's all it takes.

Can it really be that the only thing wrong with this dish is the bun?

That's what the ultra-low-carb people say. I can't quite believe that this is true. Perhaps I should say that I can't quite feel that this is true. Even if nutritional research yielded much more reliable data than it in fact does, it would be very hard to overcome our instinctive feelings about which foods are good for us and which foods are not. I'm pretty sure that, even if no one had ever suggested that a heavy intake of saturated fat promotes arterial disease, I would still have an instinctive certainty that a big greasy cheesebuger is not what I need to be eating.

I don't mean that everyone else feels that way, or should feel that way. I'm merely saying that I feel that way, and that the feeling is not one I can easily argue away on the basis of anyone's research findings. So, as a practical matter, I'm not a good candidate for an Atkins-style low-carb diet, and I'm better off trying to find a diet that I'm more comfortable with -- provided, of course, that I can make it work for me.

A few years back, there was a low-carb diet craze big enough to force fast-food chains to offer their cheesburgers wrapped in cabbage leaves rather than buns. That the craze didn't last does not prove that it's the wrong approach, or that some people don't do well on it. What it proves, more likely, is that it's not for everybody. A lot of people just didn't like the bunless-cheeseburger life, or grew tired of it and moved on.

Some people can take grains or leave them, but can't imagine giving up meat. I'm the other way around. These things aren't irrelevant. Nobody's going to be happy dedicating his life to eating foods he doesn't like (and giving up foods he does like), which is why I don't think there's any point in recommending a vegetarian diet to someone whose heart sinks at the merest mention of the word "broccoli". 

My heart just happens to sink for different reasons.

Monday, July 20, 2009  

A pretty good day, really. I got into the office and found out that a coworker who was at risk of being layed off while I was away last Friday (and whose departure would have royally screwed-up the project I'm working on) was spared the ax.

More good news, or at least so it seems to me: my boss's boss, who has just relocated here (he spent last week moving his family here from Washington), turns out to be seriously into exercise. Well, anybody could have guessed that upon meeting him (he just plain looks like an athlete), but while I was in the locker room today getting ready for my lunchtime run, he was in there getting ready for his lunchtime bike ride (and to judge from who he was planning to go with, it wasn't going to be an easy ride). He asked me if I ran daily, and when I told him yes, he said "Great!". We talked a bit about good places for trail-running and mountain-biking in the area.

This sort of thing is important to me. The convenient setup for exercise at work (locker rooms, showers, flexible schedules) has made it a lot easier for me to make exercise a daily habit -- but these advantages would be useless if the company's managers took a discouraging attitude toward employees who work out regularly. For this reason, I'm always pleased to see managers working out at lunchtime themselves. (One of my two regular running buddies at work used to be my boss, and during that time we trained for a marathon together.) My immediate supervisor these days is also very much in shape, and I've heard that he has won competitions as a waterskier.

I think the company is aware that they gain from having healthier employees -- and not just in the obvious area of health-care costs. Fit people seem (and probably are) more energetic, more confident, more dependable. I continue to get the impression that, in terms of promotion, my company favors the fit. I'm not sure that this is a conscious element of the decision-making process. Maybe what it comes down to is that, between two candidates for a management position, the one who doesn't walk into a room looking exhausted by the effort of getting there is the one who inspires confidence.

The heat that we experienced over the weekend was gone today (it was in the low 70s), so the lunchtime run was comfortable. I did an exceptionally good job of keeping up with my running buddies today, at least until the final hill-climb, where they lost me. From studying some video of myself running, I've concluded that I don't move my hips enough, and that this has been making my running less efficient. I focused on overcoming that fault today, and the result was a noticeable increase in speed. My running buddies noticed it too. And even though they pulled ahead of me on the final climb, one of them confessed that he was working so hard on that climb that he was pretty sure he had died half-way up the hill and was having an out-of-body experience. Well, if that's how it would have felt to keep up with him, I'm just as glad I didn't.

I even did better than usual in yoga class tonight (apart from a foot cramp that interfered a bit near the end of the class). A good day all around.

My apparent loss of three pounds over the last 24 hours is surely bogus, however. I certainly didn't burn 3 pounds of fat on that trail-run yesterday. It's water-weight that I lost. I had a long run in the morning, and it was very hot in the afternoon. Today my run was less than half as long, and the weather was much cooler, so I expect to see a higher number when I get on the scale tomorrow morning.

Sunday, July 19, 2009  

Ah, that's better. I knew as soon as I woke up that I was recovered from whatever made me sick on Friday. It's remarkable how fast things changed: on Friday I barely got out of bed all day, on Saturday I felt able (by late in the day) to do an easy workout at the gym, and on Sunday morning I felt able to do a difficult, steep trail-run more than 7 miles long.

After the run I didn't collapse into bed, either. I had a cup of coffee at Starbucks, went home and showered, and drove to Sebastopol to attend an early-afternoon house-concert by a bluegrass band (I knew some of the people involved in it, but the musicians were so good that it wasn't a duty call -- it was a terrific performance).

Then I went straight from there to a Healdsburg to attend a meeting of the San Francisco Scottish Fiddlers. It was at the home of one of our members, in West Dry Creek Valley; he's a vineyard manager for the local wineries, and we gathered on the deck behind his house, surrounded by the oddly comforting presence of grape vines. Our music director, Alasdair Fraser, was there, and we had a jam session with him on the deck as the heat faded in the evening. We played a lot of tunes that he's written over the years, most of which have some kind of sentimental association or other for us or for him. His wife and sons were there too, and we learned a new tune that his older son had written.

Now, to me, civilized pleasure doesn't get a lot better than sitting outdoors on a summer evening in the middle of a vineyard and playing music with old friends. So my weekend ended on a high point, you might say, especially considering that 48 hours earlier I was pretty close to deciding that life was pointless and the human race was a failed experiment. I guess the lesson of my weekend is that it's really important not to be sick. Whatever other priorities you're juggling, health has to come first, because without it everything else is worthless.

Saturday, July 18, 2009  

I felt better today -- not fully recovered from whatever bug it was that knocked me flat yesterday, but much improved. Although I didn't feel up to running, I thought some light exercise was doable, so I went to the gym and did 30 minutes on the elliptical trainer. Later I went for a walk at the park, and as so often happens when I'm merely walking, I felt a little envious of the runners and cyclists there. Probably I'll be able to run tomorrow. (I'd better go early though -- it's forecast to be hot.)

I spent a lot of yesterday thinking about how depressing it is to be sick. Not that I had anything serious, but the frustration of being unable to get up and do anything on a summer day, and the impossibility of ignoring the exhaustion and nausea I was feeling, made me wonder how some people manage to keep their spirits up while coping with more serious conditions. I knew it was just a passing unpleasantness, and still I couldn't have been gloomier.

And today I read about some research which seemingly proves that I was right -- apparently it is depressing to be sick. At least, that's my reading of the research report; the researchers themselves make their point so obliquely that it's a little hard to be sure what they're saying. The researchers (Patrick J. O'Connor and five co-authors, from the HealthPartners Research Foundation in Minnesota) reported their study in the current issue of Annals of Family Medicine, under the title "Does Diabetes Double the Risk of Depression?".

Several studies in the past have suggested that diabetes does, indeed, double the risk of depression, but not every study has confirmed this. The new study arrived at a somewhat different conclusion, by controlling for a factor which previous studies had not considered: frequency of contacts with the medical system. If you compare diabetes patients with people who don't have any chronic health problem, the diabetes patients have a higher rate of depression. However, if you compare diabetes patients with people who go to the doctor just as often as diabetes patients do (but because of some other problem), then you find that those two groups have the same rate of depression.

In other words, earlier studies which seemed to show that diabetes leads to depression really just showed that having any chronic disease serious enough to require frequent doctor visits leads to depression.

Let me reiterate that this is my reading of a murky presentation, and I might not be reading it right. Still, it makes sense. In fact, it seems like an elaborate statement of the obvious. Why wouldn't it be depressing to have a disease requiring frequent doctor visits? (Especially as this would involve frequent dealings with those lovable folks in the health-insurance industry, which could very well be a major factor in all this.)

At this point my contacts with the medical system are limited to an annual physical, which is pretty unusual for a diabetes patient. It won't be that way forever (time waits for no man, or so they tell me), but I might as well make it last as long as I can, if only to avoid depression. 

Friday, July 17, 2009  

I woke up feeling very ill today -- my stomach felt awful, and I was sure I would throw up if I ate anything, or even moved around much, so I spent most the day lying in bed. Now my back hurts like crazy. There's nothing less therapeutic than rest, for me anyway, but this was one of those rare occasions when lying down is about all I'm good for. It wasn't until late afternoon that I dared to take in any calories (a glass of milk), and it wasn't until 8 PM that I dared to eat anything solid (pumpkin bread).

Yesterday I was at a family picnic in Joaquin Miller Park (in the Oakland hills), and I was hoping that this wasn't some kind of food poisoning and the rest of the family was sick too -- apparently that didn't happen. I'd done some of the cooking at the picnic, and I didn't want to think that I'd poisoned Dad.

It's a long-established tradition in our family to go to that park to attend the open-air musicals that are put on in the Woodminster Theater there during the summer. Here's a view of the stage, at sunset, as we're waiting for the show to start.

We always manage to enjoy it whether the show is a good one or not. Last night's show, we realized going in, was going to need more charity from the audience than most: "Peter Pan", Broadway's 1954 musical version of James Barrie's 1904 creepfest. The recent death of Michael Jackson had, unfortunately, reminded us all a little too vividly of the disturbing implications of the Neverland story. In particular, the ending (where Peter comes back, not to visit Wendy, but to take Wendy's young daughter to Neverland and begin the cycle anew) pushed things a bit too far for the comfort of the audience. We heard enough remarks from the rows behind us to be sure we weren't the only ones bothered. Still, it was a fun evening despite everything. I you open a nice bottle of wine before the show, and the weather is beautiful, even a musical that places a sentimental veneer of innocence over child-stalking can be a pleasant enough way to spend a summer evening. (But we're counting on "Singin' In The Rain" to be more palatable.)

Lying in bed fighting nausea all day is not a very pleasant way to spend a summer day, but I did the best I could with the experience. I know that, as a child, I rather enjoyed being home sick, reading all day. I couldn't quite enjoy this one. I was reading a biography of the physicist Richard Feynman, which involved some pretty bleak details (the death of his young wife from tuberculosis, the beginning of nuclear warfare, Feynman's repeated bouts of cancer). I had the radio on, and every bit of news that I heard was sad one way or the other. Walter Cronkite died today, for example. What's worse, several celebrities who need to die very soon are still here.

I finally checked my e-mail in the evening, and found out that someone I know a little better died today: the great fiddler Jerrry Holland, from Cape Breton (Nova Scotia).

Jerry had been struggling with cancer in recent years. I'm glad I went to see him when he came out to California last September and played at a local house-concert. I'm also glad that I'd met him before he had cancer, because it let me know that his habit of becoming tearful whenever certain subjects were mentioned (his father, say) was a lifelong weakness of his, not a consequence of his illness. Here he is playing his tune "Lonesome Eyes" -- be prepared to get a little tearful yourself:

If I were a more mature person, hearing about people dying all day would have thrown my little sickday into perspective, and made me stop feeling sorry for myself. Well, I guessI'll have to work on it.

I sure hope I'm feeling better tomorrow...

Wednesday, July 15, 2009  

Here's a word for you -- "iatrogenic". An iatrogenic health problem is one that his caused by the doctor.

Michael Jackson's doctor, for example. The police in Los Angeles are apparently taking a lively interest in him. He is suspected of administering the general-anaesthesia drug Propofol to Jackson, causing his death. Propofol is normally not used outside a hospital setting, partly because some patients are far more sensitive to it than others, and the drug can cause a sudden drop in blood pressure and respiration, leading to cardiac arrest. Why any doctor would give it to a patient who is at home, and is not undergoing any surgical procedure, is a question of some, ah, legal interest.

Iatrogenic harm is usually a much less dramatic problem than this, and not just because celebrities usually aren't involved. The risk that medical treatment is going to do more harm than good is usually low. Unfortunately, it's never zero.

Most of us don't read the fine print on the leaflet that comes with a prescription drug. If we do, and we find that it says this drug once in a while causes someone to become color-blind, grow nipples on his legs, and eat clay, we figure that those things won't happen to us. And probably they won't. But if you want to be sure they won't, you can't take the drug.

Not many people with Type 2 diabetes have the option of not taking any medications at all.  Right now I'm not taking any (apart from the low-dose aspirin thing), and I'm trying to keep that going as long as I can, but I'm not counting on this happy state of affairs to be permanent. Sooner or later I'm probably going to have to take some drug or other. But I still think there's a world of difference between taking one or two drugs and taking six.

People with Type 2 diabetes typically end up taking one or two or three oral diabetes drugs, plus some kind of ACE inhibitor or other drug to control hypertension, plus some kind of statin or other drug to control cholesterol, plus additional drugs to ameliorate various diabetic complications. And on top of all that, they may have to take Prozac or something to deal with how anxious or depressed they are about being dependent on so many drugs. What are the odds that they're going to be able to take all those medications and not experience any serious side-effects? The risk of a problem grows by leaps and bounds with each drug they add to the list.

What we know about the side effects of any drug usually concerns what that drug does by itself. Who knows how it might interact with whatever combination of other drugs your'e getting? Maybe we know something about how most people react to Metformin, but do we know how they react to Metformin combined with Lipitor and Monopril? More to the point, do we know how you will react to Metformin combined with Lipitor and Monopril, in the particular doses you're taking them? 

Also, there is the problem of paying for all that suff. It's very common for patients who have been given multiple prescriptions to get only some of them filled, because they can't afford to fill all of them. So then they experience both the problem of drug-dependence and the problem of not getting their drugs.

I think there's a lot to be said for minimizing (if not eliminating) your dependence on drugs. It's preferable to be unmedicated, if you can pull it off. But if that isn't an option, I'd still prefer to be minimally-medicated, not heavily-medicated. Cutting down on the risk of iatrogenic harm, not to mention the risk of iatrogenic poverty, is (or should be) an important goal for anyone who is obliged to live with a chronic disease.

Tuesday, July 14, 2009  

It was hot again today -- hotter, in fact: 95 degrees. But I was in the mood for a run, and my hips weren't feeling sore at all, so I thought I might as well go for it. It was a tough run, very hilly. I took a water bottle with me, and drank most of it. The heat didn't bother me as much as you'd think, during the run, but the heat did make it hard to stop sweating after the shower. In that sense it's an advantage that the people I work with are mostly in remote locations. I don't often have to meet with anybody in person, right after my luncthime run, and explain why my shirt is so wet. Usually I can just sit in my cubicle, over by the windows, hardly noticed by anyone, and dry off.  

Blood pressure is down today, compared to yesterday, and I don't think it's because my emotional state is any different; I think it just indicates that I did a hard workout today and an easy one yesterday. My blood pressure was also down after the long trail-run on Sunday. My blood pressure can always surprise me, but the most reliable predictor of how high or low it's going to be is how hard I worked out.

The current New Yorker has an article by Elizabeth Kolbert discussing a bunch of recent books about the obesity epidemic and the possible reasons for it. Among the more interesting findings:

Other possible causes of the obesity epidemic have been proposed (increasingly sedentary lifestyles; heavy use of high-fructose corn syrup in processed foods; overconsumption of simple carbohydrates by people who assumed that anything low in fat was good for them). But maybe the fact that we're eating more food than we used to is a sufficient explanation. When a serving which would once have been considered huge is redefined as the standard serving (and people feel cheated if you offer them less), how could widespread weight gain not be the result?

To take one striking example -- if you ate a bagel every morning, the recent increase in the size of bagels would be enough (even if you changed absolutely nothing else about your diet) to make you gain 12 pounds a year.

Monday, July 13, 2009  

Wow -- Monday the 13th. I've always wondered why people make such a big deal of Friday the 13th, when seemingly it should be a day at the beach compared to the Monday version.

Not that today was so bad. It was hot, though -- 93 degrees, which was hotter than predicted. At lunchtime I decided that, after yesterday's 9-mile run, I felt like having an easier workout than a hilly run in the heat. My hips were feeling a little sore from yesterday, too. So, I went to the air-conditioned gym and did 30 minutes on the elliptical trainer.  In the evening I went to yoga class, and my teacher announced that we were going to work on hips tonight. (This happens a lot -- I show up at class on Monday night with some part of me feeling sore from whatever I did on the weekend, and her yoga program for the evening ends up being focused on loosening up that specific part of the body, even if I haven't mentioned the problem to her. I think she can read my mind -- or at least my hips.)

So anyway, we worked on hips tonight, and now my hips feel better. I expect I will run tomorrow, even if it's hot. I think it's an important (but seldom mentioned) part of staying healthy to do some kind of body-maintenance discipline -- yoga, Tai Chi, Pilates, or any other kind of systematic stretching or massage. Whatever it takes to keep you flexible. You can't stay healthy if you don't exercise, and you can't exercise if you can't move. I put some pretty hard demands on my body, with activities such as that long trail-run yesterday, and if I didn't do something to make up for it I would become too stiff and sore to continue. When I started my exercise program I was rather prone to sports injuries (especially shin splints), and I've put a lot of effort into avoiding injury and increasing flexibility. So far it's working pretty well. We'll see how long I can keep it going. But I'm sure my odds of prolonged success are a lot better if I keep doing yoga, or something roughly equivalent, than if I try to get by on exercise alone.

I made another low-fat vegetable stew, in my continuing quest to find a way to give up vegetable oil without giving up on flavor. Once again I "sauteed" the onions and peppers in vegetable broth rather than olive oil. I added nutritional yeast flakes, spices, and one of a package of flavor tablets from Italy (similar to flattened bouillon cubes) that a friend of mine had given to me. Then I tossed in a a mixture of vegetables. The resulting stew was very good, and I wondered what was in the flavor tablet; I knew from the label that it was Porcini mushroom flavor ("AI FUNGHI PORCINI"), but the remaining description on the box was hard to piece together from a shallow knowledge of operatic Italian. So, I went to the Babel Fish web site for a translation. Here's what I got: "Magic Aromas is a mixture of aromatic grass already mashed and dosed in practical tablets, which brings to your plates all the scent and the flavor of the grass in every period of the year and without some waste." I eventually found an ingredient list in very small print, but Babel Fish did not recognize most of the ingredients, so I'm still in the dark. Probably there was some fat in it, but there couldn't have been much, simply because the thing was so small, and most of its volume must have been taken up by all that aromatic grass from every period of the year.

I'm not exactly going cold-turkey on dietary fat. I'm pretty hooked on hummus, and so far I haven't adopted a low fat version of it (I've acquired a good recipe for making it myself, and I haven't experimented yet with reducing the olive oil or tahini in it). But I've cut some fat from my diet -- it's a start!

Sunday, July 12, 2009  

The 9-miler today was the longest run I've done in a long time (and a tough one -- very hilly). My slow recovery from bronchitis in June, and the setback I suffered when I ran a 10K race too early in that recovery process, made me very skittish about doing long-distance runs lately. I was beginning to miss them. And because I felt so good on the shorter run I did yesterday, I thought I was ready to do something more challenging. 

I like doing a long run on the weekend. It gives me a feeling of accomplishment, and to the extent it tires me out it's a "good tired" feeling. I'm not a wreck afterwards -- I'm just relaxed and enjoying the endorphins. After the run this afternoon I went to play Irish music with friends, and I'm sure nobody there could have guessed what I'd been doing earlier in the day. I didn't mention it. I used to brag about these things more; now I am likelier to brag about them on this site, and not mention them socially. At this point my social acquaintances are divided into two groups: people who wouldn't want to hear that I ran 9 miles today, because they couldn't do it and live to tell the tale, and people who wouldn't be impressed that I ran 9 miles today, because they can do it faster than I can. Either way, there's not much point in mentioning it.

At the state park today, the signs were no longer posted about a mountain lion being in the area. That didn't mean I wouldn't run into one, and I did tend to react nervously to the sounds made by small animals scurrying in the dead leaves beside the trail. Also, the occasional growl did tend to get my attention, even though it was coming from my stomach. I found it comforting that a lot of other people were out there on the trails. Even if a mountain lion did eat somebody today, the chances of its being me seemed lower because there were so many other people on the menu.

Once again, during today's run I encountered a swarm, herd, flock, gaggle, or whatever it is of wild turkeys, including several juveniles. I usually see only the fully-grown turkeys, but this is the second time in a week or so that I got to see them escorting their babies around, which is cool. Considering how closely the turkeys allowed me to approach, I find it hard to understand why people who hunt wild turkeys have to go in for such elaborate camouflage outfits. But maybe the turkeys who live where turkey hunting is allowed are a lot more shy than the ones that live in my neighborhood.

It's forecast to be warmer this week -- highs in the range of 88 to 90. I'm laundering some running clothes for the week, and I'm making sure that they're as light-weight as possible. I think I'll be carrying a water bottle with me during my lunchtime runs this week. I usually don't carry a water bottle unless the distance is more than 5 miles, but when it's hot I like to play it safe.

Saturday, July 11, 2009  

I didn't post anything yesterday because I was busy with the concert, which went very well. The place was packed (it wasn't a big place, but we more than filled it), and the audience was responsive from the get-go. Usually, in a concert, the audience needs to get warmed up just as much as the musicians do, but this audience was with us from the start. There were a couple of moments in the first part half of the concert that I wish I could do over again, and get them right this time, but I was a lot more relaxed in the second half, and enjoyed it a lot more. Strangely enough, I felt most relaxed and happy during the encore, playing a fast and furious Irish jig which was a last-minute addition to the program -- but there I was in my comfort zone, playing the kind of thing I usually play. For the rest of the concert I was in an unaccustomed role, playing harmony lines to accompany singers (to hear it you would have thought it was much easier music than what I normally play, but nothing is simple if you're not used to doing it).

There was an excellent dinner provided to the musicians (a vegetarian dinner, catered by the Annapurna restaurant in Santa Rosa), and after the concert the father of our bass player brought us some fantastic desserts he'd baked himself. Not a low-calorie day for me (and it was a non-exercise day to boot), so I was relieved to get a fasting test of only 81 this morning.

I went to the farmer's market today and picked up some vegetables to help me ease into Dr. Neal Barnard's recommended diabetes diet, which takes a little getting used to. I like making vegetable stews for dinner -- so far soo good -- but I'm accustomed to start off by sauteeing onions in a rather generous splash of olive oil, and he's against that. He thinks fat plays a big role in diabetes, and even a "healthy" fat such as olive oil has to be used very sparingly. So, I started tonight's vegetable stew by just cooking the onions and peppers in vegetable broth. I was afraid it would be too bland, so I added a lot of seasonings, including nutritional yeast flakes and shoyu. It ended up being pretty good. Nothing intensifies flavor like fat, so I was conscious that this wasn't as savory as it would have been if I'd started with olive oil, but I did like it, and I ate the entire (generous) bowl that I'd served myself. Probably high-fat cooking is something that you miss less and less as you migrate away from it. Your palate adjusts to the lower fat content, and low-fat dishes start to taste "normal" to you. At least, that's what I'm told will happen, and I'm hoping it's true.

It was warm and slightly muggy today. I put off running until the early evening, but when I finally got started I was surprised to discover that I was feeling very energetic, and felt like running fast. I wasn't wearing my Garmin GPS device, and now I wish I had. I don't know the exact distance of the route I chose (it's a little over 4 miles, I'm pretty sure), so I don't know what my exact pace was, but I wish I did know, because I felt great and I think my pace must have been pretty good.

But that's the mysterious thing about running: every once in a while you surprise yourself by discovering that you've got a lot more energy than you thought you did. The reason I didn't have my GPS with me today was that I didn't think I was feeling at all frisky, and I assumed I would just be doing a slow jog around the lake -- certainly nothing worth recording for posterity. Then I got there, started running, and thought "Hey, this feels good today -- but why?". And I don't know why!

I never know, in the hours leading up to a run, how well I'm going to feel during it, or how much energy I will turn out to have. Typically it turns out that I've got more in the gas tank than I thought I did; occasionally it turns out that I have less than I thought I did.

Some athletes claim to get more energy when they reduce the amount of fat in their diets -- I'll continue experimenting with that and see what happens. 

Thursday, July 9, 2009  

A little warmer today -- about 85 degrees. I did a very hilly run at lunchtime with one of my fastest running buddies, and I kept up with him fairly well. Not my fastest-ever pace on that route, but a lot faster than Tuesday, when I ran the same route alone.

Tomorrow I'm taking a day off work, so I can relax and get focused on the concert tomorrow evening. It's hard to spend a day at the office and then rush from there to a concert venue. Under those circumstances, you tend to bring the office with you, and it becomes very difficult to relax and get into the music. When you're making music you're creating an alternative reality (which is one of the reasons people get hooked on doing it), but to create that alternative reality you first have to let go of the standard-issue reality of the workaday world. It takes a little time.

At least, it takes a little time in my case. Maybe some people can spend the day talking about whether LTE networks or femtocells are going to be the next big thing in mobile-phone technology, then hop in the car and hurry to the concert venue and immediately come up with the proper moody accompaniment to an old Celtic ballad about a boatman who is never coming back. If there are people who can do that, I'm not one of them. So, I'd better just take the day off. (I've got plenty of vacation time to use up -- which tends to happen to you if you're not very fond of travel, and I'm not.) I'll practice the music in the afternoon, arrive at the concert venue in plenty of time, and stay focused on what I'm there to do.

You might think you don't have this issue to deal with if you're not a musician, but in a way I think it's a dilemma we all face in one form or another. Modern life involves spending a great deal of our time concentrating on things that don't really touch us personally. (Not just work-related issues: the amount of information I have been taking in about Sarah Palin lately is wildly out of proportion to her importance in my life.) All this preoccupation with things that don't really matter to us is an enormous distraction from things which do, one way or another, matter to us. We have time for everything except what counts. For example, we all like to clain that we'd cultivate more healthy habits of living if only we had the time, but it's pretty embarrassing to take a hard look at all the things we do spend time on, and consider what that says about our priorities.

I haven't had a day off exercise since last Friday, so I might take tomorrow as a rest day, but I might also work out. Working out would be an advantage, especially if I do it in the afternoon and I play the concert before the endorphins wear off. I'll defer the decision until tomorrow. I'll be practicing the music, and if I feel as if I need to keep at it, I'll put off the workout until Saturday.

I had been thinking of doing a trail-run at Annadel State park, but a recent mountain-lion sighting there is making me nervous about going there. You can't play a concert in the evening if you're eaten in the afternoon, can you? It stands to reason.

Wednesday, July 8, 2009  

Once again, schedule problems arose, and I had to run without my running buddies today. Instead of concentrating on my pace, I decided to look at something else: my heart rate.

I have a heart-rate monitor that I haven't used in a long time, and I thought I'd run with it on to see what it would tell me. At first, what it seemed to be telling me is that it wasn't working. It would show me numbers that were impossibly high or low (188 while having an easy jog downhill, 48 while huffing my way uphill -- and sometimes the number, even if it was believable, would stay the same for an implausibly long period). I think the chest-strap sensor wasn't adjusted properly on me, and the signal was unreliable. I kept fussing with the strap, and eventually I started to get plausible numbers that went up promptly when I started climbing and went down promptly when I started descending.

Assuming that the plausible-sounding numbers which I eventually obtained were accurate, I've made progress: even on the steepest climbs I only went up to about 150. I used to have trouble keeping it under 170 on the same hills.

Of course, the fact that I was running alone this time, and not trying to keep up with anyone else, could have played a role in the lower heart rate. But I used to get higher numbers even when I ran alone, so I think the lower numbers today are significant.

Of course, the message isn't entirely consistent: how come my blood pressure is up tonight, instead of down? Probably because of my immediate circumstances. I got home late from a concert rehearsal, and I'm rushing to get something posted here. Also, I'm fretting a little bit about an early-morning phone conference with a project manager in Israel tomorrow.

I'm not fretting about the concert on Friday, though. Tonight was our last rehearsal, and I finished it feeling good about the whole thing. I really didn't feel that way at last night's rehearsal -- nobody was really in the mood yesterday, we couldn't focus, we never quite came together. But everything seemed to come together tonight. I think we rehearsed just exactly enough: to the point where we feel that we can simply relax and play the concert and not worry about it.

Even the concert opening, which seemed too elaborate and stagey last night, seemed to flow perfectly naturally tonight. We start out with only Kate on stage, singing a long ballad with many verses, and the rest of us standing in the wings. On the second verse Riggy walks on stage, sits down beside her, and starts playing concertina. On the third verse, Chris enters and plays an octave mandolin. Next, Roxanne enters and plays harp. Then I enter and play my fiddle. Then Jon enters and plays his fiddle (a higher part, above the harmony part I'm playing). Jeff enters and plays guitar. Vic enters and plays drums. And we're all in!

It's technically a "house concert", but it's in Studio E, a big house set up as a concert venue, and we have room for a sizeable crowd. If you're interested, and you're going to be in Sebastopol, California on Friday, contact Jeff Martin at jeffm5@sonic.net and ask for directions to the July 10 concert at Studio E.

Well, what do you know: I just checked my blood pressure again, and this time it was down to 118/74 with a pulse of 49. Why did it drop? Probably because I know I'm finished writing this!

Tuesday, July 7, 2009  

We're not really having a summer this year, it seems. We had one hot weekend, in June, but that's pretty much it so far. It's been sunny (in the afternoons, anyway, after the coastal fog finally burns off), but it doesn't warm up very much even after the sun comes out. That's good weather for running, of course. The temperature just barely made it to 70 degrees at lunchtime, so after I ran I didn't have to go back to my desk sweating like Nixon. Still, in July it feels weird to me to be putting on a jacket in the morning as I'm leaving for work. I don't especially enjoy heat waves, and I didn't think I'd miss them if they didn't happen, but it seems almost unnatural for the afternoon temperature to be peaking at 70 rather than 95 at this time of year. The forecast isn't calling for anything hotter than 83 for the next five days.

My running buddies were not available to run with me today, due to some unfortunately-scheduled meetings, so I had to run by myself, and my pace ended up being slow because they weren't there for me to try to keep up with. Without them, I lost my motivation! I made the mistake of mentioning this fact later in the day, so tomorrow I think they're going to provide me with more motivation than I can stand.

Lately it seems as if every day somebody on the dLife forum is posting yet another message saying "I'm so frustrated because I've been going to the gym and working out and I'm still not losing weight!". Well, of course they're frustrated: they're waiting for something to happen which is not going to happen.

It drives me crazy that exercise, which everyone needs (and everyone with diabetes desperately needs) is so often promoted in terms of the one benefit it can't deliver. To be sure, it is not theoretically impossible to lose weight through exercise alone, any more than it is theoretically impossible to become a movie star. But what are the odds?

To lose a pound of fat, you have to burn 3500 calories. That is, you have to burn 3500 extra calories -- 3500 calories that you wouldn't have burned otherwise. To lose that pound of fat over the course of one week, you have to burn 500 extra calories, every day, with no days off. 

For most people that would equate to at least an hour of aerobic exericse, seven days a week. (Keep in mind that if you're told a particular kind of workout burns 600 calories an hour, that's not 600 extra calories, because you'd probably burn somewhere between 50 and 100 of them anyway, just by being alive and having a functioning brain and liver.) So, there are some obvious problems with trying to lose a pound of fat per week through exercise alone:

It may happen, once in a while, that somebody loses weight by exercising more without eating less, but I would guess that it's a rare phenomenon. For the most part, people lose weight because they ate less food, not because they started going to the gym.

The reason this drives me crazy is that, if you tell people the pounds will fall off them once they start exercising, they try it, and very soon realize that it isn't true. Then they conclude that exercise "doesn't work", and give up on it. Usually the heart attack doesn't come until long after this decision, so they don't see the connection.

Exercise "works" -- the benefits it provides are real. It's just that it doesn't provide the one benefit that everyone thinks is the most important one.

Monday, July 6, 2009  

I had a busy Fourth of July: the 10K race in Kenwood in the morning, and the fiddling contest at the county fair in Marin at noon. I didn't win either of them, but I was happier with the way the race went than I was with the way the fiddling contest went.

It was a surprisingly cool weekend -- foggy and damp during the race. Of course, that's a good thing when you're running, especially on steep hills. I felt good during the race, and my pace was better than it had been last year. It wasn't my best-ever performance at Kenwood, but it was pretty good considering how difficult the route is. This was my sixth time participating. Here are my finish times, by year:

Not a very big difference from year to year, you might think. This year I was only 2 minutes and 23 seconds faster than last year (when I was very unhappy with my finishing time). But you'd be amazed how much harder you have to work to cut more than 2 minutes off your finishing time in a 10K race, especially when it's on a hilly course.

I knew a lot of the other runners. Some finished after me, but the ones that I would describe as serious athletes finished well ahead of me. One guy who works in my department finished in 51:07. Two other coworkers, who were on my team in The Relay in May, finished in 53:13 and 49:43. So, my time of 59:31 isn't much to brag about. But I certainly wasn't in last place. 

60% of the runners finished ahead of me, and 40% after me. That's about where I usually fit into the results of any big race. I don't know if that will ever change. It doesn't really need to -- I'm getting a big health benefit from the exercise even if I'm not getting much in the way of bragging rights. It would be nice, though, to put on a more respectable performance when I'm involved in community athletic event such as this, especially when I know a lot of the competitors.

The fiddling contest served only to remind me why I don't usually participate in that kind of thing. The pressure involved in walking out on a stage under bright lights and playing to an audience of judges who are sitting there at a table noting down your faults is simply unbelievable. It makes your hands shake, which doesn't help in playing any instrument but is devastating when you're playing a fiddle (if you don't have a relaxed bowing arm, you're lost). I was hoping that either the fatigue or the endorphins produced by the 10K race a few hours earlier would have quieted my nerves, but that only worked up until the point it was time to go backstage and wait my turn to play -- that's when I got the shakes, and I suddenly remembered why I hadn't tried my hand at contest playing in years.

I don't know how the people who are good at coping with the pressure of a musical competition manage to do it, but there are always a few people who can. I couldn't. I wasn't happy with the way I played, and it didn't strike me as unfair that I didn't make the finals. The people who did make the finals were clearly better than me, and the woman who won first prize was clearly better than any of us. There's no reasonable complaint I can make, and in theory I shouldn't be any more bothered by not doing well in the fiddling contest than I was bothered by finishing the race behind 60% of the runners participating. All the same, I was satisfied with the way the race turned out, and very embarassed and unhappy with the way the contest turned out. At least, in the race, it wasn't personal: I didn't have to run, by myself, by a bunch of judges so that they could observe the faults in my running style.

I dressed very lightly for the Kenwood race, despite the cool morning weather, partly because that's what the fast runners do, and partly because the weather for this race nearly always turns hot before the race is over, no matter how cold it is at the start. I guess I miscalculated in this case. It never did get warm (all weekend long), and I think I got chilled from running the race underdressed (and standing around underdressed for a long time afterwards). It seemed to take something out of me. For the rest of the weekend I didn't really feel like doing anything except taking naps. I did do some other things, I hasten to add, but I was no fountain of energy. My workout on Sunday was just a very light gym workout, and I didn't even feel like doing that; I sort of had to drag myself there.

I felt better today, though. I didn't maintain a very fast pace in my lunchtime run, but I wasn't very slow either, and the run felt better as I went along.

More about Dr. Neal Barnard's book on reversing Type 2 diabetes...

I'm not finished reading it, but it's clear that he's already made the points he intends to make in it. So, I know what his position is, and I just have to decide to what extent I buy it.

His recommendations are neither complex nor original -- the same kind of vegan, low-fat diet (with fiber maximized and simple carbs minimized) that is recommended by Drs. Ornish, McDougall, & company.  His rationiale may be more original, as I hadn't heard it before: that what causes Type 2 diabetes is a failure of signalling inside muscle cells (thus preventing a cell from responding properly to insulin on the outside of it), that this failure of signalling is caused by excessive fat inside the muscle cells (which can occur whether you are obese or not), and that this buildup of fat within cells is caused by excessive fat (particularly animal fat) in the diet.

What's appealing about this view of Type 2 diabetes is that it explains an aspect of the disease which is otherwise baffling: Type 2 is usually associated with obesity, but some people develop it without ever having been overweight. In Barnard's view, the explanation is that diabetes develops when there is too much fat inside your muscle cells, which can occur even if you don't have a bulging waistline, but is more likely to occur if you do. Although genes make some people more suceptible than others to developing these fat deposits inside the muscle cells, it's best (whether you are highly suceptible to the problem or not) to avoid setting yourself up for the problem by including foods in your diet which are likely to contribute to it. Animal foods tend to contain a lot of saturated fat, so he's down on animal foods, but he's not keen on "healthy" vegetable oils either. He points out that olive oil merely contains less saturated fat than animal foods do -- not none. So he advocates cooking with little or no added oil. (This makes certain kinds of cooking tricky, but he says there are solutions to the problem.)

Barnard doesn't really have the kind of evidence he needs to prove that his view of what causes diabetes is correct; as usual with health studies of nutrition, we are left with suggestive statistical correlations which might, or might not, mean what they appear to mean. It's possible that he started from a basic prejudice against animal foods and dreamed up a theory to justify it. My reading of the available data makes me inclined to think that he's probably on the right track, but I'm not sure. And even my doubts are suspect: I don't mind giving up beef, chicken, or pork, because I don't especially crave them, but sometimes I do crave fish and cheese. Probably that is what has kept me for so long in my half-assed flirtation with vegetarianism, eating mostly plants but granting myself to the right to indulge in sushi or a cheese omelet whenever I'm in the mood.

I can't deny that I've been eating a fairly high-fat diet, and surely that is why it's been hard for me to lose weight. Giving up animal foods entirely and cutting way back on oils would probably take care of that problem. Certainly most  of the vegans I know are able to stay slender without half trying.

Anyway, I think I'm going to try to reduce my fat intake and eliminate or at least greatly reduce my intake of animal foods, and see what happens. Dr. Barnard has been achieving big improvements in glycemic control in diabetes patients who take up his approach. However, he's mostly dealing with people whose diabetes is desperately out of control to start with. Mine is in good control, so if his approach makes it a little worse instead of a little better, I don't think I'll stay interested much longer than it takes me to lose a few pounds.

Oh, so this is what it's so complicated:

That's the shape of an insulin molecule. Tricky things, those proteins! If insulin is the "key" that has to open the "lock" of a muscle cell's insulin receptor, I'm not surprised it so often fails to fit properly. Of course, that's a finicky view that shows all the atoms in the molecule. If you're only interested in the overall ribbon structure of the protein, you can simplify the shape down to this:

Plain as the nose on your face, isn't it?

Friday, July 3, 2009  

It dawned on my belatedly that I might as well rest up entirely today, rather than doing a gym workout as I had planned, because tomorrow is supposed to be my rest day and instead I'm running a 10-kilometer footrace in the morning. Why this didn't occur to me earlier I cannot tell you.

I did go for a walk after dinner, but it was too short and relaxed a walk to count as any kind of workout. As usual when I'm outdoors but not exercising, the joggers and cyclists that went by made me feel left out.

I've been reading Dr. Neal Barnard's book on reversing Type 2 diabetes; in essence he is recommending a dietary program very similar to that of Drs. Ornish and McDougall, and like them has been successful in demonstrating the effectiveness of the approach. In side-by-side comparison studies, Barnard's diet worked better than the ADA's diet in reducing blood sugar and insulin resistance. Less attention has been paid to this than you would expect, for the same reason that less attention has been paid to Dr. Ornish's success with heart patients than you would expect: most doctors assume their patients would never adopt the recommended diet, so there's no point in discussing it even if it works.

Barnard's diet is easily summarized: plant foods only (primarily those that have a low glycemic index index), and very little fat. Inevitably, his diet is high in carbohydrates, which sounds paradoxical for a diabetes diet, but Barnard argues that carbs are not the real enemy in Type 2 (and especially not whole-food carbs, unrefined carbs with a low glycemic index). He says the real enemy is fat; he points out that recent research has found that insulin resistant people have more fat inside their muscle cells (even if they are not overweight), and that this fat in the cells blocks the intra-cellular signaling which is supposed to cause the cell to absorb glucose after it has been stimulated by insulin. He argues that too much fat in the diet (especially animal fat) causes this buildup of fat in the muscle cells where it doesn't belong, which in turn causes insulin resistance and diabetes. There may be many ways to improve the situation, but adopting a low-fat, plant-based diet seems to be the most effective of them.

I'll say more about this later -- must get to bed, if I'm going to get up early for the race tomorrow.

Thursday, July 2, 2009  

I might be having a busy morning on the 4th of July. At 7:30 AM I'm running in the Kenwood Footrace, and at 11:30 AM I might possibly be competing in the fiddle contest at the Marin County fair.

I'm not sure that I'll do the second event, and I hadn't even considered it until someone suggested it to me yesterday. It's been years since I've participated in that contest, and at the time it seemed that I wasn't cut out for competition playing (the tension that comes with performing for judges sort of unhinged me, and my playing was pretty bad). But maybe I've become more relaxed about it since, and I'll do better this time if I try again.

The timing is just barely feasible. It takes about an hour to run the race, and I'll probably hang around afterwards talking to people for about half an hour (I usually know several of the participants). That plus the driving distance will probably get me home and in the shower around 9:30. After I get cleaned up and dressed I will need to drive down to Marin; I figure I'd be able to get there before the contest starts, but without a lot of time left to practice and get warmed up. Should I do it? I'ts a pretty stupid idea, actually. I probably will.

At a superficial level there isn't much point in my participating in either the race or the fiddle contest. I'm unlikely to win either of them (particularly the race), and there wouldn't be a lot of prize money or fame involved if I did. So why bother? I guess because I've found it useful, over the years, to develop the habit of taking on challenges regularly. Sometimes I do something that doesn't come easily to me for the very reason that it doesn't come easily. I just don't think I gain anything by doing what's easy. It's when you're doing what's not easy that growth and learning happen. Not that I throw myself challenges every day, but I do it from time to time. I think it's a good habit.

We'll see how I feel after the race is over, but it's only a 10K, so even if I push myself hard in the race I'm probably not going to be too tired to go do something else a few hours later. And who knows? Maybe the endorphins released during the run will relax me and help me play better in the contest than I otherwise would.

We're back to very mild summer weather. When I ran at lunchtime it was only about 70 degrees. I ran at a pretty good pace, though not as good as yesterday's. Tomorrow, to go easy on myself before the race, I'll skip running and do a light workout at the gym.

See you at the county fair...


Wednesday, July 1, 2009  

Got home late from a rehearsal again, so time is limited...

On today's hilly run my pace was 9:35/mile, which is probably the best I've done on that particular route (two weeks ago I got it down to 9:54, and last week 9:44). The run felt good, even though I was working hard. I hope this is a sign that I'll be able to do well in the Kenwood race on Saturday.  I'll run tomorrow, and I'll probably run hard, but I don't want to run the day before the race. On Friday I'll go to the gym or something, for a light workout.

It's a tricky thing getting ready for a race. You don't want to wear yourself out before the event, but on the other hand you don't wan't to go too easy on yourself, and not be in shape for the event. We're having the same issue with the music rehearsals we're doing -- you want to be get the details nailed down, but you don't want to over-rehearse the music and drain the life out of it. Finding the golden mean is tricky, though!

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