Saturday, January 30, 2010  

Ooooh -- dry weather!

I took advantage of the break in the rain to go for a long trail-run. As part of my continuing, quixotic effort to make exercise appear entertaining, I took my camera with me, set it for a fast shutter speed, and kept snapping pictures as I ran along, so that I could present them here. Let me share my run with you!

To me, running outdoors, especially in a pretty area, is a hundred times easier than working out in a gym. I just feel happier and more relaxed getting my exercise that way.

Because using a camera while running is a bit of a trip-hazard, I chose to stay on "trails" that are really fire roads, so that I'd be running on a reasonably smooth surface and wouldn't have a lot of obstructions to stumble over (it worked -- I didn't take any falls).

The Mayacamas Mountains, visible off to the left of the trail, separate the Sonoma Valley (on the near side) from the Napa Valley (on the far side):

For reasons which scientists have not yet been able to explain, the mountains have the effect of making wine from the Napa side more expensive than wine from the Sonoma side.

My main frustration in photographing these trails is that the resulting images give absolutely now idea of how steep the hills really are. You'll have to take my word for it that, if you'd been there, the long climb would have had you begging for a break.

Taking pictures was a nice distraction from the difficulty of the climb.

On the plus side, doing a long climb usually rewards you in the end by giving you a better view of the landscape. 

With all the recent rain, Lake Ilsanjo has filled up nicely.

I'm not too comfortable sharing the trails with horses, but on the wider trails, where you can get around them safely, I can cope.

On the other hand, I'm quite used to sharing the trails with faster runners who pass me without difficulty. Look, someone has to be fast, and I'm just glad it isn't me.

A glimpse of Santa Rosa in the distance.

The weather became more beautiful as the miles went by. It would have been almost tragic not to have got outside today.

Some sections of the trail were impossible to get through without stepping into deep mud. My main concern was not slipping in it (and I managed not to).

Getting pack towards civilization -- that's the bridge that leads from the state park back to the city park.

And then -- climbing the final hill! (My car was parked on the other side of it.) I didn't even feel all that tired at the end; I seemed to have a lot of energy today.

I felt pretty high after the run. The endorphin release you get from a long run like that is extraordinary -- everything seems beautiful.

I suspect that, despite my best efforts, it really isn't possible for me to share, in a convincing way, the pleasure that I have learned to find in endurance exercise. I would miss it terribly if I had to give it up, but someone who hasn't experienced it may find it impossible to believe that running a long distance over hilly terrain could ever be enjoyable for them. That's the big problem with Type 2 diabetes: the most effective thing you can do about it is something which most people don't want to do.

Friday, January 29, 2010  

The rain came back. I did a gym workout instead of running. And it was a pretty light workout -- I wonder if that's why my diastolic blood pressure is up. I'll work out harder tomorrow, and see if that improves things.

There seems to be a new trend in the way people newly diagnosed with Type 2 diabetes are advised. Once upon a time, doctors gave these patients a chance to see what they could achieve with lifestyle changes (I, fortunately, was diagnosed under that regime).  In recent years, the new patients have usually been put on medications from the start (which means, of course, that they think no lifestyle change is necessary). But in recent months, I have been hearing more and more stories of newly-diagnosed patients being advised to have weight-loss surgery.

Yesterday a woman on the dLife forum reported that she was diagnosed this week, and the first thing the endocrinologist recommended was gastric bypass surgery, which (according to him) gets rid of diabetes in 90% of the patients who have it. She was uncomfortable with the idea. She mentioned that the endocrinologist in question also runs a spa that provides a variety of cosmetic medical procedures, which made her wonder if he was more interested in making money than in doing what was best for his patients. Well, it makes me wonder, too.

The widespread reports that weight loss surgery "gets rid of" diabetes need to be taken with a grain (or rather a sackful) of salt. These reports are based on what happens during a short period after the surgery -- and during that period, patients are only able to swallow tiny amounts of food (they throw up if they try to eat more). No doubt you can bring somebody's blood sugar down by putting him through a few months of starvation, but are you making him healthy in the long run?  

Little is known about the long-term results of weight-loss surgery, except that problems requiring further surgery are common. (Man, talk about a captive market! Once you've had radical stomach surgery, which tends to come undone and require follow-up operations, it's a little too late to decide that you want to get out of the game. You belong to the surgeon until the day you die!)

Now, the thing is, if some willful person with a lot of money to spend is determined to have gastric bypass surgery, and feels unable to succeed with any other approach, I would not stop them from having the surgery. We get to make our own choices in this life, and we get to define for ourselves what is an acceptable risk. I think people have a literal right to commit suicide if that's what they want to do, so I'm certainly not going to try to stop them from taking a risk just because it would make me uncomfortable. To each his own.

But in terms of ethics it is a very, very different thing for a doctor to counsel a newly diagnosed diabetes patient that a gastric bypass is the best option, and the first treatment that should be considered. I hear that some patients are actually being put under a lot of pressure to make this choice, as if it would be irresponsible for them to ask the medical profession to give them any help other than a radical quick-fix solution.

Although my main problem with gastric-bypass surgery is that it does too far, you could also argue that it doesn't go far enough. If the concept here is that we will make bad personal choices if we're free to behave however we wish, I think the surgery restricts us in too limited an area of life. Wouldn't it be better to emigrate to North Korea?

Thursday, January 28, 2010  

I should have mentioned that yesterday was the 2nd anniversary of this site. It still has, to put it mildy, a small following. Visits to this site went up only 40 percent in its second year. (That would be considered a lot of growth if I were an established business selling laptops or something, but in a non-commerical web site which started from nothing fairly recently, 40 percent growth is not exactly what you call "going viral".)

But, however small my readership may be, the people who read what I'm putting out there do give me feedback, and they seem to be finding this site helpful. Some of them even report significant improvement in their diabetic control, and their health in general, as a result of doing the things I'm advocating. I guess that means my approach can work for people other than me. So I'd better keep doing my bit to spread the word!

It was cold and foggy today, and I spent the first mile of my lunchtime run wishing I'd put on gloves. But it wasn't raining, and right now that seems like such a big advantage that putting up with the cold was a small price to pay for the privilege of running outdoors instead of on the treadmill at the gym. Toward the end of the run, the sun even started breaking through the fog.

Tomorrow it's expected to start raining again, but if it does I'll deal with it. I probably will go to the gym after work. Friday is the best time to do that -- it's never crowded!

Have you heard of Hara Hachi Bu? I have, and I almost wish I hadn't, but I have to face up to the implications.

Hara Hachi Bu is a phrase that comes from Okinawa, a place so famous for the health and longevity of its citizens that health researchers are always going there, trying to figure out exactly what people in Okinawa are doing that gives them such long lives and such low rates for age-related health problems (including heart disease, stroke, cancer, hip fractures, and dementia).

Here are some of the good health habits commonly practiced in Okinawa:

So now we get to the hard part, at least for me. Hara Hachi Bu can be roughly translated as "eat until you are 80 percent full". The idea is that, if you keep eating until you feel full, you will go too far, because the body does not detect fullness immediately. (Modern research supports this concept: if you eat enough to fill your stomach, you won't actually feel full until about 20 minutes later.) People in Okinawa eat rather slowly, and when they start to fill as if they're even getting close to being full, they stop.

Other research, outside Okinawa, confirms that people who eat fast tend to gain wait; people who take their time over a meal tend not to. I guess this explains why weight control has been such a problem for me. I'm a fast eater, no question about it. Put essentially the same plate of food in front of 8 people sitting around a restaurant table, and who finishes first? Me, that's who.

My standard excuse for this, if I feel I need to provide one, is that I hate it when a plate of hot food cools off before I'm done with it. I want to eat hot food while it's still hot. 

This is true, so far as it goes. The only trouble with this excuse is that it doesn't explain why I'm also the first to finish a salad or a cold sandwich.

The reality is that I eat everything fast, and for all intents and purposes I never get full. Maybe at Thanksgiving, but unless I'm participating in an over-the-top feast of that kind, I always feel as if I have room for more. And very likely the reason I feel that way is that I eat fast, and never give my stomach a chance to catch up with me and say "that's enough!".

One time a friend of mine, a good cook, scolded me for eating too many of the grapes he had put on the table before dinner, saying "You're going to spoil your appetite!". I looked at him in utter bafflement. What was he thinking? My appetite had never even been spoiled by prime rib, much less grapes!

So you can see what kind of challenge it is for someone like me to adopt a practice such as Hara Hachi Bu. It's pretty hard for me to feel even 80 percent full. To the extent that I have a weight loss system, it consists of forming the expectation that I'm going to go to bed hungry every night for the immediate future, and there's nothing that can be done about it. (Although maybe the hunger that I impose on myself is what an Okinawan would call "80 percent full"!)

Wednesday, January 27, 2010  

No rain today! We actually managed to do an outdoor run at lunchtime. Too bad we didn't get to do it a few hours later, after the fog broke up and the sun came out and it warmed up a bit. But at least we were able to stay dry! And after the first mile we warmed up internally anyway, so the fog and chill weren't a problem for us.

A lot of people still seem to believe that there are such things as "negative calorie" foods -- that is, foods which cause you to burn more calories digesting them than those foods provide. This idea is spread by diet-book authors and by web sites devoted to dietary issues, but they all seem to be circulating similar lists of vegetables (and even sugary fruits!), without ever explaining where the list came from or how it was determined that eating the foods on the list will subtract from your caloric intake instead of adding to it.

The idea has an obvious appeal ("maybe I can eat a piece of cheesecake, and then follow it up with a bunch of celery to burn off the calories!"), but it also gives off an unmistakable odor of too-good-to-be-true. How could anyone not be suspicious of a claim like that? I mean, come on: how likely do you suppose it is that nature gave us a digestive system which throws away the energy resources on which our survival depends? I would sooner believe that there's a casino in Las Vegas which consistently pays out more in winnings than it takes in. That is not how the world works, people!

I say the negative-calorie concept is an urban legend and nothing more. If someone wants to persuade me to change my mind, they'd better be prepared to tell me exactly how it was proved that the body burns more calories digesting these foods than it can obtain from them. Some of them are not even low calorie foods, let alone negative calorie foods!

Here's my theory of human interaction: any activity that involves large numbers of people is going to end up being utterly dominated by the most obnoxious individuals among them. And I'm not just talking about politics, business, or the arts. If there are a thousand people doing anything, then two or three people who are absolute swine will be exercising a hugely disproportionate influence on the whole enterprise (while every decent person is minding his own business).

Case in point: our beloved internet! ZDNet Tech News reported last week that less than 5 percent (let me repeat that, less than 5 percent) of e-mail messages sent every day are ever delivered to mailboxes. Why? Because 95 percent of e-mail messages sent every day are recognized as spam, and automatically deleted.

In fact, 80 percent of all SMTP connections are aborted because the senders are known spammers and are already on ISP blacklists for that reason. Of the 20 percent that aren't aborted, most are identified as spam by other means, and deleted or diverted. Only a pathetically small residue (less than 5 percent of what was sent out originally) ever makes it to a recipient's inbox -- and even that residue consists at least partly of spam that made it through the filters. Dealing with all this is a big expense for internet service providers, of course -- and of course they pass those expenses along to us.

Almost all users of the internet are only trying to inform or entertain themselves, but those people don't matter. The blameless individuals in a collective enterprise  never matter. It's the scumbags who matter. Almost all the resources of the internet are claimed, one way or another, by a few pieces of human garbage.

It would be enough to make me cynical, if I weren't such a Pollyanna by nature!

Tuesday, January 26, 2010  

I don't think treadmill running is ever going to be my cup of tea, but there was no avoiding it today. I certainly couldn't run at noon. Even if the weather had been dry (which it wasn't), I had to devote my lunch hour to a meeting. So, I went to the gym in the evening and did what had to be done.

But tomorrow it's supposed to stop raining, and I have high hopes that I will be able to get out there and run in dry weather.

On Sunday I missed a chance to photograph something interesting because I didn't have my camera with me when I needed it, so I'm trying to form the habit of carrying it around with me all the time. My camera's not large, after all, and I can slip it into a pocket easily enough. I had it at work with me today.

Late in the afternoon the light coming in from the windows on the west side of the building suddenly brightened. I looked out and noticed that, although the sun was breaking through the clouds, a fine rain was still falling. 

"I know what that means!", I said to myself, and raced over to the other side of the building with my camera.

If you are of a scientific frame of mind, you know what I expected to see over there, from the clues provided. Late afternoon in January: obviously the sun must have been pretty low over the southwestern horizon. And the sun was breaking through the clouds, but the air was still swarming with water droplets. No question at all about what had to be happening just above the horizion in the northeast, if I could get over to the other side of the building in time and get a look at it.

Which I did:

I have absolutely no patience with people who claim that knowing about science somehow undermines one's appreciation of the beauty of nature. Trust me, there is no such thing as a physicist who has stopped liking rainbows because he knows too much about what causes them, any more than there is a neurologist who learned too much about nerve stimulation and stopped thinking sex felt good.

If anything, knowing the details behind natural phenomena only helps you appreciate them more. For starters, I would never have seen today's rainbow at all if I had not known enough about rainbow formation to realize what I'd be missing if I didn't hurry over to the other side of the building and check out the northeastern sky. A nature-lover who refused to contaminate his brain with knowledge of optics, for fear that rainbows wouldn't be the same to him if he actually knew something about them, would miss a lot of rainbows by not knowing when to go over to the other side of the building.

Not only that, there are subtle details to the rainbow phenomenon which many people miss because they don't know to look for them. If the rainbow is bright enough, there is usually a wider, fainter, secondary rainbow outside the main one (a ghost of it is just barely visible in the picture above, but your monitor might not show it clearly enough for you to be able to spot it). I hope it won't spoil your appreciation of this too much to know it occurs because a little of the sunlight that hits a raindrop bounces around inside it before being reflected back, and (owing to that internal bounce) it comes back at a 52 degree angle instead of a 41 degree angle. Notice, also, that the sky looks darker outside the rainbow than inside it -- few people notice that at all.

A bright rainbow can also produce narrow "supernumerary" rainbows hugging the inside edge of the main one, but again my photographs today capture only the faintest suggestion of this effect (notice a hint of red and yellow repeated on the inside of the bow in the picture below). This phenomenon, I hope you won't be saddened to learn, is the result of interference between waves of light following slightly different paths through a raindrop.

Another detail which we wouldn't know if the physicists weren't there to explain it is that every rainbow is personal. That is, in a group of people staring at the same sky, each sees a different rainbow. The fact that one person is taller, or is standing four feet to the left, means that the light reaching his eyes is reflected from a different set of raindrops. A rainbow has no actual location in space; it is "located" relative to your eyes, and nobody but you can see exactly what you are seeing. So this one's mine, and you wouldn't have seen it even if you had been there:

To me it just seems stupid to go through life not knowing about, and not caring about, what scientists have learned about the basic rules of the natural world we live in. And if it's stupid for the average person to do that, it's even more stupid for people with diabetes to do that.

Managing diabetes is the most extreme, high-stakes example of a do-it-yourself project known to man. It will force you to choose among a lot of competing suggestions, most of which are going to be crazy. Having enough familiarity with science to be able to distinguish between a plausible suggestion and an implausible one seems like an absolute necessity to me. But then, I'm always chasing rainbows, so what do I know? 

Monday, January 25, 2010  

Another stormy day. Cold, rainy, windy. I wasn't even tempted to run outside, so I had to go to the gym after work. I'll have to do the same thing tomorrow, regardless of the weather, because I have a luncheon meeting scheduled.

Once we find a solution to a technical problem, we tend to get stuck on it. We take that solution as a fact of nature, not an artifact of human design, and we start to think that's not just a solution, it's the solution -- the only possible solution. Accordingly, our standard metaphor for a wasted effort is "reinventing the wheel".

Meet Guan Baihua, an engineer from Qingdao in the Shandong Province of China. Last year he created a bicyle with non-circular wheels, explaining "I just wanted to give people an alternative to normal, boring bikes":

It looks as if the bicycle would be unbearably jarring to ride, but those who have tried it say it's surprisingly smooth. The reason is that the wheels are Reuleaux polygons. A Reuleaux polygon has an unusual property: despite appearances to the contrary, it has the same diameter in all directions. The constant width of the shape, regardless of how you orient it, means that it can roll like a wheel. This animation illustrates how that works. Stare at it for the next twenty minutes and the concept will become increasingly clear.

Of course, one of the things that will become clear as you stare at the animation is that, although the distance between the high point of the wheel and the low point remains constant, the center of the wheel does not hold a fixed position. The axle oscillates. Probably this creates problems (inefficiency of motion, extra mechanical stress) which a circular wheel doesn't suffer from. So perhaps this kind of wheel really is inherently inferior to the circular kind, and "reinventing the wheel" remains valid as a symbol of all that is futile. On the other hand, maybe the oscillation of the axle is a solvable problem, or confers an advantage in some situations, in which case the wheel is worth reinventing. At least the bicycle meets its stated design goal: that of not being "normal and boring".

It seems to me that the science and/or art of diabetes care involves a strong reluctance to "reinvent the wheel", and even a reluctance to ask how well the current wheel is working. The studies which supposedly validate the "effectiveness" of the popular drug therapies only show that such therapies work better than doing nothing. That the drugs don't work as well as lifestyle changes (particularly exercise) is usually kept pretty quiet. That part of the data is not important. We must be realistic, after all! We've already decided that you can persuade patients to take drugs but you can't persuade them to exercise. Therefore, drug therapy is the wheel -- and we shouldn't waste time trying to reinvent it.

But are we sure?

Saturday, January 23, 2010  

When I saw that my fasting test was up a bit today, it initially struck me as surprising and even unfair, because yesterday I'd done a solid workout, and I hadn't taken in more carbs than usual. But then I cast my mind back over everything I'd eaten yesterday, and found that I was wrong -- I had taken in more carbs than usual, and hadn't allowed myself to notice it.

Man, no matter how long you work at this, you never lose the ability to fool yourself. That's why you can never give up glucose testing. If you don't get that kind of corrective feedback, you are sure to drift off course. I, at least, am sure to do that. Maybe there are supermen somewhere who don't have that problem, but I don't think it's what most of us are like.

Today was supposed to be our break from the storms. It was predicted to be sunny all day. Well, there certainly were episodes of brilliant sunshine, but there were also stormclouds about, and occasional rainshowers, and even a tornado warning in a location about 60 miles south of here. It looked as if almost anything might happen in terms of weather.

When I left the house to go to the park it was sunny, and when I arrived there I saw that plenty of people out walking around the lake (I even saw someone I knew from work there). But everybody was watching the skies a bit nervously.

When you do a long run like that, you're committed, and you have to accept whatever weather changes occur along the way, simply because there's no way to bail out of the thing. You still have to get back to your car, after all. There is no taxi service on the trails.

So anyway, I did get rained on, but whenever the sun came out it was beautiful. Sunshine never looks better than when it's interrupting a rainy day, and all the dripping-wet foliage is glistening. 

Friday, January 22, 2010  

More rain, and colder than yesterday -- we're even getting some snow in the higher hills around here. I couldn't face another run in the rain after yesterday, so I went to to the gym in the evening, and did my least favorite kind of running: on a treadmill. A hamster run, that's how I think of it.

It's supposed to be clear tomorrow -- maybe I can get in a nice long run in the park.

Thursday, January 21, 2010  

It was raining today, too, but this time I didn't have the option of going to the gym after work, because I had something else to do then. So, I had to go out at lunchtime and run in the rain. My running buddies were extremely uninterested in joining me. Nobody else was out exercising either. No problem with overcrowding in the locker room.

Running in the rain has one advantage: the hill-climbs aren't as hard on you, because you're so distracted by having a new reason to feel sorry for yourself that you barely notice the difficulty.

The biggest disadvantage of running in the rain is one you might not expect (and I, who should have known better, forgot to expect it): a rain-soaked shirt becomes rather abrasive to the most sensitive areas of your skin, especially when it's cold. Often you don't feel the chafing much during the run itself, but when you get back to the locker room you suddenly notice those two red patches on the front of your shirt, and you realize that you've abraded your nipples, and therefore the hot shower afterward is not going to be quite so rewarding as you had assumed it was going to be. That's when you feel it -- when the hot water first hits your chest. Ow! Ow! Ow!

I should have used some Body Glide (a waxy substance that runners apply to sensitive areas to prevent chafing), but I normally don't need that stuff unless the run is longer than 5 miles. I forgot that the rules are different in cold rainy weather. Oh well, some day I guess I'll learn.

A post on the dLife forum, titled "My secret of weight loss foods", caught my eye. Wow, someone has a secret of weight loss foods! And yet he's going to share it with everyone, so that it's no longer a secret! It's surprising that people still have secrets, considering how eagerly they share them on the internet.

The post begins promisingly: "I ever be a fat person, so i know how hard of the fat person." You see? We can trust him. He knows how hard of the fat person. So many people giving advice on weight loss have no clue how hard of the fat person!

The post coninues: "I want to share my weight loss secret to everyone. It worked for me, and I am sure it work for you too, all the people are unique in this world, so the key for this secret is you, the other person and I are need a unique combination of foods, exercise and nutrition."

You see, everyone is unique and needs to find a unique solution to the weight loss problem, but nevertheless the weight loss secret that worked for him is surely going to work for you. This seems a little contradictory. There's only one way I can make sense of it: his "secret" is that everyone is unique and needs to find a unique solution. Not that useful a secret, really.

So after that my interest began to wane. He provided multiple links to web sites where I could buy more information about his secret, but I decided not to follow up on it. Somewhere along the way he lost me. We've all become such cynics these days, we don't even trust someone who knows how hard of the fat person.

Wednesday, January 20, 2010  

The weather was stormy and unpredictable today -- with episodes of strong winds and very heavy rain, alternating with calm interludes. There were power failures, too (electricity was out when I got to the office in the morning, and it stayed out for about 40 minutes). I didn't dare go running outdoors, because the stormy episodes were intense to the point of being scary. I almost didn't go to the gym in the evening, either, because when I first went out my front door to do so, there was a gale-force wind breaking branches off the trees and flinging them around, and I wanted to hide. That only lasted about two minutes, though, and when it calmed down I decided to go. Not many people at the gym, I noticed -- I guess I wasn't the only one who thought it was a good night for staying home. If diabetes were not an issue for me, I certainly wouldn't have been there. Of course, if diabetes were not an issue for me, I would probably have never seen the inside of a gym in the first place.

You want to know what the difference is between diabetes and the mafia? The immediacy of the threat.

Try to imagine someone making the following speech: "They say If I don't pay them the money I owe them this week, I'm going to need a wheelchair, and then if I still don't pay them next week, I'm going to need a hearse. Yeah, okay, I get it, I get it. But still, somehow... I just can't seem to get motivated to get the money together. You know what I'm saying? I mean, I know I really ought to try to do something about this problem, but sometimes it's as if I just can't be bothered. Most of the time I don't even think about it. After a while it becomes such a bore, you know? Look, whatever happens, happens. I can't spend my life worrying about this kind of thing all the time."

People who are being threatened by gangsters do not talk that way, but people who are being threatened by diabetes talk exactly that way -- even though the threat is the same in both cases. The only difference is the time scale: we know that diabetes is not going to do anything to us this week, and probably not this year, either. That time difference is all it takes to make us behave as if we didn't believe the threat was for real. Sure, diabetes talks tough -- but maybe diabetes doesn't really mean it. Maybe diabetes is only kidding. Maybe diabetes makes a threat and then forgets to carry it out. Maybe diabetes will get whacked before we do. Who can say?

The flaw in this way of thinking is that diabetes has a considerable track record, and it points consistently to one thing: diabetes is not kidding. Diabetes does not make a threat and then forget to carry it out. Diabetes puts far more people in wheelchairs and hearses than the mafia does -- and yet, the mafia is very good at motivating people, and diabetes is lousy at it. The time factor makes that much difference.

We can always find ways to ignore a problem which won't affect us until much later. No matter how obvious it is that we're laying the groundwork for an environmental or financial disaster in the coming years, the prospect doesn't upset us very much because it isn't going to happen right away. When the disaster finally occurs, we conveniently forget that we were ever warned about it. Who could possibly have known that the levee system around New Orleans was weak and might fail catastrophically -- apart from everyone in the country, that is, since journalists had been warning us about that very problem years before it happened?

Because it seemingly isn't in human nature to give much attention to long-term concerns, it seems to me that the key to diabetes management is to focus on short-term goals rather than long-term goals. Who's going to pass up a plate of spaghetti because their goal is to avoid having a heart attack 15 years from now? Not many people, apparently. If your goal is to avoid going over 140 after dinner, though, that just might be enough to make you order the salmon instead.

Think short-term! Gangsters do, and it seems to work for them.

Monday, January 18, 2010  

87 isn't a bad fasting result for the day after a party. Also, yesterday was a rest day. But it was busy in a way. I went to a meditation workshop in the morning, and a Burns supper in the evening. Wait, I can explain.

The meditation workshop was the third or fourth such event that I've attended, and this time I was surprisingly successful in shutting off the inner monolog. During one of the exercises, I was sitting there with my eyes closed seeing a gray blank in my imagination, and for once I wasn't hearing any words flit through my mind. That's a real achievement for me; most of the time I wish my brain would just shut up and stop commenting on everything. However, I wasn't so successful at keeping my gray blank quite as blank as it had been at first. Some gray things started moving within it and clamoring for my attention. An elephant ran in, and collapsed as if his legs had suddenly broken under him. A gray car came skidding into view. So, I didn't turn in a perfect performance on the gray blank. But at least it was a silent gray blank -- no articulate thoughts about it came to me. I was sleepy yesterday morning (I would have slept late if I'd stayed home), so I think what happened was that, once I succeeded in shutting down the inner monolog, the mental quiet started putting me into a shallow state of sleep and giving me the beginnings of dreams. It felt like progress, all the same.

A large part of the reason that I have trouble getting to sleep at night is that I have never learned how to make my brain shut up; it always seems to be churning away on some issue or other, real or imaginary. I always used to assume that this is not a solvable problem, that we all have the kind of brains we have, and a brain can't be trained to behave any differently. But maybe it can.

The event I attended later that day was put on by the San Francisco Scottish Fiddlers. A Burns supper is a type of event that only Scots know about; it's a somewhat formalized annual party held to honor the memory of the poet Robert Burns, whose 251st birthday is coming up on Janurary 25 (we held ours a little early, partly because yesterday was when we could rent the hall we wanted). The standard script for a Burns supper includes a series of speeches, toasts, readings of Burns's poems and performances of his songs. Being a musical organization, we tend to emphasize the songs in our Burns suppers.

If we're going to get together for any purpose at all, we have to start off with a jam session; that's essential. I wonder how non-musicians get together and accomplish anything, if they can't warm up in that way first. It can't be easy. Liquor alone won't do it.

After the formal toasts and ceremonies, we had a ceilidh -- another custom not well known in the US. It's pronounced kaylee, and it's a social gathering in which the guests take turns entertaining one another (usually musically), followed by a dance. As befitted the occasion, must of the ceilidh acts were performances of Burns songs.

In Scotland or Ireland, everyone is expected to have a party piece -- something or other that they can contribute to an evening's entertainment. (And sometimes you might not be allowed to go home until you've done your bit.) There were too many of us last night for everyone to have a chance to do their party piece, but a lot of small ensembles had signed up to do something.

What makes this kind of approach to party-planning interesting is that, when the guests are all given a shot at the spotlight, a lot of them come out with stuff that you never knew was in them.

Because we had such a diverse group of musicians present, we were bound to have some surprising instrumental combinations. The percussionist on the left was taking a break from his more usual musical job, with the San Francisco Symphony.

There was even a bit of pantomime, in the form of a skit about the Loch Ness monster.

And then a bunch of us became a dance band for the remainder of the evening.

No matter how many electronic devices we invent and accumulate, do-it-yourself entertainment will always be the best kind.

I have a busy Tuesday planned, and probably won't be able to do a blog post. I'll set my sights on returning Wednesday night. I'll try to behave myself in the meantime.

Saturday, January 16, 2010  

The weather report said this morning that there was a big rainstorm over the Pacific, getting ready to crash into the coast sometime today or tonight. I figured I'd better get to the park and get my trail run finished before the rain started.

The skies started looking grim enough during the run to make me wonder if I was already too late. Then, rather dramatically, the sun came out, and it started to get warm. I suddenly remembered that I had no sunblock on. I switched my route to a different trail that went through the woods, so that I'd be in the shade most of the way. I decided I might as well make it long run, since the threat of rain had disappeared. And then, once I was committed to the longer trail through the woods, the dark clouds all came back and it started getting cold. It's hard to get these things right. But it didn't matter; there wasn't any rain at all until after I finished. I like being out in the woods, and the rapid weather changes just made it more interesting to be there. It was a good day, actually. The landscape was more beautiful than usual, and the horses less numerous; who could ask for more?

Nine miles is a pretty long run, especially when it's on steep and muddy trails, but I was pleased to find that I wasn't sore afterwards. It used to be that any run longer than five or six miles would pretty reliably make my hips and quad muscles sore enough that it would hurt me to climb into the car afterwards; today I didn't have that problem. I don't know whether that means I'm tougher than I used to be, or that I've improved my running technique enough that less toughness is required, but it's a good development either way.

If I was on the marathon training program I would have needed to run 16 miles today, and that would have made me sore, so I'm not feeling any regrets now about my decision not to do the race. It's nice to spend the wet winter months doing only as much running as I feel like doing.

2010 is going to be a mighty long year, if we are going to continue having arguments over whether we have started a new decade or not. The people who think of themselves as "strict" or "correct" or "sticklers for accuracy" say we haven't -- that the present decade doesn't end until December 31, 2010. They're full of it.

When people claim to be purists about anything (grammar, say) it almost always turns out that they are clinging neurotically to some notion that was discredited ages ago. People who have looked seriously at the history of the English language know that the so-called "rules" against splitting infinitives, ending sentences with prepositions, and using the adverb "hopefully" as a sentence modifier are bunk. But the people who perpetuate this sort of nonsense still think themselves superior to everyone who has enough common sense to reject it.

The idea that the 1900s didn't start untill 1901, and that the 1960s didn't start until 1961, is the kind of silliness that these people come up with. Their reasoning is that Dionysius Exiguus, the medieval monk who invented the "Anno Domini" system of numbering years by their distance in time from the birth of Christ, was unfamiliar with the "zero" concept, so all dates (BC and AD) refer to a starting point at +1 rather than at zero. I guess another way to put it is that Christ was already a year old on the day he was born.

Anyway, the concept is that every date is really off by one year from a common-sense understanding of what numbers mean. Even if that didn't give me a headache, I would still be inclined to point out that Dionysius Exiguus was an incompetent scholar who, according to modern historians, got the date of Christ's birth wrong not by one year but more likely by seven. And we're supposed to let this dingaling, who died 1466 years ago, continue to rule us from beyond the grave? No, thank you!

Since the starting point of the Anno Domini system has always been wrongly placed, it's not especially relevant now; we're free to use dates in a common-sense way. Even the dictionary sides with us there, as a "decade" is defined as any period of ten years, regardless of when you want to start it. As for terms like "the forties", the dictionary assures us that a man "in his forties" is not going to turn out to be 50 unless he lied about his age.

In short, there is nothing wrong whatsoever with saying that we started a decade in 2000 and it's now over (not a minute too soon, if you ask me). We never even settled on a name for it. Not that we have a name picked out for this new one, either, but it will be easier to find one for this decade, and I'd like to get on with it.

I wonder why it is that people only become obsessed with strict accuracy when they're discussing something that doesn't really matter anyway? When the issue is one which actually impacts people's lives, we're much more inclined to think it's okay to believe anything you feel like believing because you feel like believing it. We're that way about public policy, for sure!

Friday, January 15, 2010  

Today we acquired a new running-buddy at the office; Scott went running with the three of us for the first time. He started out fast, but to my great relief he wasn't able to keep up with Mike and Michele on the climbs. So, he fell back -- which meant that, instead of spending half the run struggling desperately to catch up with someone half way up the hill from me, I had someone to run with who was content to run at my pace. He's training for the Big Sur marathon in April, but he's only running part of the route, as one member of a relay team. We've convinced him that running at work with us is a good idea, because the hills here will toughen him up. Very few marathons, or even 10K races, feature hills as steep as the one we run on every day, so we can sign up for a race and not worry too much about hills. A lot of people who live in flat regions get a nasty shock when they sign up for a distance race, and then discover when they get there how much harder the climbs are than they had ever imagined.

I don't know why, but I got the impulse to check my blog entry from this date last year to see how things were for me twelve months ago. Not much different, it turns out. My fasting test result that day was exactly the same as today's. My blood pressure was a little lower; my weight was higher by 5 pounds.

The weight difference makes it sound as if I've made progress since then in weight control, but that simplifies the situation a bit. My weight was 184 that day, but it was coming down, and during the summer I was down to 175 for a long stretch. My two weeks of travel in Scotland in the fall, followed by the usual holiday sins, pushed me over 180. Now I'm climbing back down.

Although I'm now trying to get back to 175, or preferably below it, I didn't make a New Year's resolution of it. To the extent that I made any New Year's resolution this year, it was to work on reducing my carbohydrate intake. Because of the amount of exercise I do, I'm now able to get away with eating a lot more carbohydrate than I could before (and also a lot more carbohydrate than most people with Type 2 diabetes can get away with). However, the fact that I can get away with eating a lot of carbs doesn't mean I should.

One of the drawbacks of success in diabetes management is that it makes you cocky. This leads some people to stop testing once they start achieving good numbers (and, of course, by the time they start testing again they've lost control, irretrievably), but that isn't my problem -- I'm quite aware of that danger, so I'm determined to keep testing no matter how consistently my blood sugar is normal.

On the other hand, my seeming ability to get away with murder in this regard could be illusory. The fact that my endocrine system can (as of today) handle what I'm throwing at it doesn't mean it can continue to do that forever. Maybe I'm working my pancreas too hard, and wearing it out before its time. I don't actually know whether or not it is possible to do that, but if such a thing is possible, I shoudln't take a needless risk of bringing it about. So, I've been trying to bring my carb intake down. Not to extremely low levels, at this point -- just to lower levels than I'm used to.

Maybe this approach will help me lose weight. But whether it does that or not, it's probably time for me to learn how to be satisfied with a smaller carb intake, since I might not have a choice about it later on.

Tonight I came up with a good low-carb dinner. I went to an Asian market and bought a package of nori (the sheets of dried seaweed that are used in Japanese restaurants to wrap a roll of sushi):

Obviously it wouldn't be a low-carb dinner if I filled these wraps with a layer of sweetened rice, which is the usual practice. But I found that spreading tahini sauce on them, and using them to wrap fresh spinach and pieces of canned red salmon, made for a tasty low-carb dish. Not low-fat, of course, but that's not my concern at the moment.

I'm not ready to get ridiculous about this, however. I'm not on board with the people who would look at the BLT illustrated below (from This Is Why You're Fat ) and see no problem with it except for the bun. 

Thursday, January 14, 2010  

The sun came out today! Evidently it was looking for an opportunity to charge up my solar wristwatch and increase my vitamin D production.

I can remember as a child being at first confused, and then outraged, at being told that there was vitamin D in sunlight. How dumb did they think I was? Vitamin D is a chemical. Sunlight is radiation. How could one be in the other? Were they going to tell me next that the sound of the wind had tungsten in it?

And thus was I set on the path of my future development. To this day, it drives me absolutely crazy when things are dumbed down, especially when they are dumbed down needlessly and for no good reason. In the first place, it's insulting -- and as if that weren't bad enough, dumbing things down often prevents people from ever coming to a better understanding of the things that were misrepresented to them as children.

Not many kids are so stupid that they wouldn't understand you if you explained that sunlight causes your skin to produce vitamin D, and that, if you don't get enough sun exposure, your skin might not produce enough of the stuff. It's not that hard a concept.

And once they've got that concept, you can lead them on to slightly more difficult concepts. For example, does it really have to be sunlight and not artificial light, and if so, why? This question brings up the fruitful issue of the different wavelengths present in sunlight, some of which might be needed for vitamin D production, and might be missing from artificial light.

Another fruitful question: do people in less sunny parts of the world not get enough vitamin D? This brings up the issue of skin-color variations around the world -- and how nature balances the conflict between the need for vitamin D on the one hand, and the need for protection from skin cancer on the other. The average skin color in any country is the local compromise between those two problems. In Sweden vitamin D deficiency is a likelier threat than skin cancer, and in Zimbabwe it's the other way around, so people tend to be pale in Sweden and dark in Zimbabwe.

If we explained this kind of stuff to children, wouldn't it be more interesting to them than a bunch of nonsense about how sunlight has vitamin D in it? The biggest sin involved in dumbing things down is not that you get the finer details wrong, but that, in your quest to make the subject more accessible, you succeed only in making it uninteresting and implausible.

This problem certainly crops up often in connection with recommendations on diabetes management, and health management in general. Take, for example, the "5 grams of fiber" rule, according to which you can supposedly subtract the fiber grams in a serving of food from the carbohydrate grams in it, but only if the serving has at least 5 grams of fiber. Huh? Why does it have to be 5 grams? The whole concept is supposed to be that fiber is indigestible carbohydrate (cellulose, for example), which doesn't raise your blood sugar and therefore doesn't need to be counted. Are we to believe that celluslose is indigestible if there are 5 grams of it, but perfectly digestible if there are 4 grams of it? I mean, obviously that can't be how it works. I don't know what the actual (presumably complicated) reason for this recommendation is, but it is wildly implausible in the form in which it is usually presented, so I think it's time for proponents of this idea to either explain what they're thinking or shut up about the idea.

Another one that gets on my nerves is the line, always inserted in any article on the subject of diabetes, which explains that diabetes occurs when the patient either can't produce insulin or can't use insulin properly. Can't use it? Can't use it for what? It's hard to imagine what they could mean by that. Wouldn't it be a lot clearer to say that the patient has become "insensitive" to insulin than to say that he "can't use it"? We wouldn't say of a person who has become deaf that he can no longer use sounds, or of a person with numb fingers that he can no longer use texture. If you're afraid people won't be able to guess why being insensitive to insulin is imporant, you only need to mention that insulin is a hormone which stimulates body tissues to begin soaking up sugar from the blood, so that the blood sugar level comes down. If you're insensitive to insulin, this process fails and blood sugar stays high. There, was that so hard?

Making an interesting problem boring by leaving out crucial details does not seem to me like a good strategy for improving public awareness of medical and scientific issues. 

Wednesday, January 13, 2010  

I did the same run today as yesterday -- the same route, and even the same weather. But I was slower this time.

Yesterday I was trying to keep up with a faster runner the whole time, and I finished in 43:54, which is a pace of 9:37/mile. Today, my running buddies started out with me but split off half-way through the run, to do a longer route which I didn't have time for. So I did the second half of the run by myself, and once I was no longer trying to keep up with anybody, my mind wandered far from the subject of speed, and inevitably I slowed down. So, this time I finished in 45:46, which is a pace of 9:57/mile.

It's only a difference of 1 minute and 52 seconds -- except that a real runner wouldn't dream of saying "only" about a difference of that size. Runners are fixated on speed differences which most people would think are trivial. Such differences only seem trivial until you try to go faster by that "trivial" amount, and discover how much harder you have to work to do it. It's amazing how much effort runners have to put into an improvement in speed which to most people would seem trifling.

And if any real runners happen to read this, let me assure them that the route involved a lot of steep hills, so my pace isn't as lazy as it sounds.

The Centers for Disease Control and Prevention are reporting that, at long last, there is progress in the battle against obesity!

However, the progress isn't all that dramatic. Obesity rates aren't falling -- they've just stopped rising. According to the CDC's study of medical records over the years,  obesity rates have reached a plateau. They have been holding steady in recent years. That's the good news; the bad news is that they have been holding steady at very high levels. 17 percent of American children are obese. Two-thirds of U.S. adults are overweight or obese.

I'm now working with a bunch of transplanted Scots, who are brought up with a stereotyped view of Americans as (1) ignorant and (2) fat  -- and they see so many confirmations of these views every day, now that they're here, that I am powerless to defend us on either charge. Most of us are, indeed, uninformed about the world we live in, to a degree which must seem breathtaking to any visitor from the larger world we try so hard to ignore. And according to the CDC, most of us really are fat. The transplanted Scots are not.

Why aren't they? My studies aren't complete yet, but I've noticed that they are very active people. Several of them -- in fact, most of them -- come to work on bicyles, regardless of the weather and the forbidding hill they have to climb to get here. If they don't do that, they work out at lunch -- and they work out hard. Some of the Americans at work do that too, of course -- but most don't. The contrast between us and them is hard to miss.

I have come to feel that it's my duty, working among these recent arrivals, to save America's reputation to the extent that I can, by exhibiting wide-ranging interests and by working out. How much can one person do, though? Demonstrating that not every American is a dunce and a couch-potato does not go very far toward erasing the stereotype, if the ugly fact remains that huge numbers of us are exactly that.

One of the problems that results from ignoring the larger world is that it doesn't occur to you to question the way you're living. Isn't this how everybody on earth lives? Well, no, it isn't, actually. But if you're not confronted with other possibilities, it won't occur to you that those other possibilities exist.

It's not just a matter of ignoring what goes on outside the United States. Most of us choose to ignore a lot of what goes on within the United States. If we want to hang around only with people who have bad health habits, it's easy to do. There are rich subcultures here of people who live differently, but if we'd rather not know that, it's not hard to avoid being reminded of it. No matter how many people in your town show up to run the big United Way 10K race on Labor Day, you can bet that the people who wouldn't dream of doing such a thing will manage to remain unaware that the race even happened.

Tuesday, January 12, 2010  

I lucked out with the weather -- it rained hard last night, but there was only light rain this morning, and by the time we went running at noon there were only the tiniest droplets falling. It wasn't cold, either -- in the high 50s. We ran faster than usual today and I was still sweating after I got out of the shower. Certainly we're getting warmer weather than they are in Florida.

Apart from that it was a lousy day at work, and to be honest I'm surprised my blood pressure isn't elevated tonight. Well, here's hoping tomorrow will be a better day. It's not easy to believe that about a day which includes a dental visit after lunch, but I'll try to make it happen.

Scientists at the University of Bath (you know: that place in England) have developed a new testing method for distinguishing between normal proteins and "glycated" (sugar-modified) proteins.

They started with a process called gel electrophoresis, in which a sample substance is placed in a gel, and a current is run through the gel. The current gets the molecules in the sample moving, but the gel acts as a molecular sieve, sorting molecules of different sizes and shapes, and moving them different distances through the gel, so that they fan out into a kind of spectrum. However, the electrophoresis process barely distinguishes between normal and glycated versions of the same protein -- the two varieties hardly get separated at all.

The scientists in Bath developed  new electrophoresis process, in which they add boronic acid to the gel. This causes the glycated protein to separate entirely from the normal protein:

Unless the illustration above misleads, this is a non-quantitative measurement. The result is not a number but a picture, which shows you whether the glycated protein is present, and gives you a very rough idea of how much there is of it. But it seems to be a lot less precise than, say, a hemoglobin A1c test. If the picture above were a hemoglobin test, it would be mighty hard to squint at those little blue patches and say whether the result was 5.1%, 5.5%, or even 10%.

On the other hand, this test can apparently be applied to many different proteins, not just hemoglobin, and could be useful in diagnostic testing for all sorts of diseases (such as Alzheimer's) which tend to be age-related and are probably also glycation-related.

This is the second time this month (see my January 5th blog about glucose-detecting contact lenese) that a breakthrough in testing technology was announced which seems to give us a less precise picture of what is going on than the test we were using before. At least, that seems to be true in the case of hemoglobin. But apparently there is no blood test for detecting (or tracking the progression of) Alzheimer's disease, and perhaps this new method could be used for that purpose, and for similar purposes in connection with other diseases. However, if the test requires you to collect a bit of brain tissue, I don't want to see the lancet that they use to get the sample.

In terms of diabetes, the new method might give us information that a hemoglobin A1c test does not. The A1c test examines a protein with a very short lifestime, in order to track short-term fluctuations in the glycation rate (and consequently track short-term fluctuations in blood glucose). If longer-lasting proteins were examined, we might be able to track the progression of diabetic damage to the eyes, kidneys, and blood vessels. I'm not sure there is anything we could do about such problems if we were tracking their development, but maybe tracking their development could be a first step toward developing treatments.

I doubt that the new electrophoresis method is going to change the world very much in the coming years. As a practical matter, the main thing we need to know about glycation is already known (that it's injurious to human health and should be minimized). But it would be interesting, even if it's not terribly useful, to know more about how it progresses and what, exactly, it does to us.

Monday, January 11, 2010  

Today I went downtown to have lunch with a former coworker (who has become a coworker again, thanks to the vagaries of corporate breakups and mergers), so I wasn't able to use the time to run. I went to the gym after work instead. I had a hard time fitting it in between work and the yoga class, but I managed it. Finding time for exercise is a struggle sometimes, but not as big a struggle as it used to be, now that I've accepted that it must be done whether it's convenient or not. When you don't yet feel committed to daily exercise, a hundred things get in the way of it every time, but once you do feel committed, the obstacles are less numerous and much easier to move out of the way.

I plan to do a lunchtime run tomorrow. It may be a challenging run, as the weather forecasters say there is a chance of rain tomorrow. A 100% chance, to be exact. Well, there's nothing wrong with running in the rain, apart from the physical discomfort, the embarrassment of looking like a crazy person to anyone who sees you doing it, and the risk of taking  a deadly chill.

Today the company nurse announced that she scored some H1N1 flu vaccine somewhere (I won't ask how she managed that), and I signed up for a shot immediately. My appointment is for next Tuesday. I got the ordinary flu shot earlier, but I want the industrial-strength version. When I get the flu at all, I usually get it late in the flu season, after I think the danger is over. I think what happens is that my immune system is able to fight off the weaker viruses, and then I get slammed by the strongest one out there. I'd rather not get the one that's killing people, if there's anything I can do about it.

I did manage to do a trail run yesterday. It was 7.3 miles. That may sound long, but it's a good deal shorter than the 15-mile training run I would have had to do if hadn't decided against running the Napa Marathon. So, for me, it felt like a lazy weekend. I nearly always do a run of 7 miles or more on the weekend. Doing that much feels fine to me; I just don't feel like doubling it right now.

After the trail run and a nice hot shower, I drove down to Marin to play at an Irish music session. That session happens ever Sunday, but I hadn't been to it since November 29. Now, on that earlier occasion (as I see from my blog entry on the subject) I also drove down to the session right after finishing a long run. And the same thing happened to me this time that happened to me that time -- I sat down, played music for some hours, stood up to go to the men's room, started walking, and immediately felt a sudden pain in my hip. And this time, just like that time, the sensation was alarmingly intense at first, but faded gradually as I walked around, and didn't reappear the next day. The coincidence was striking enough to make me want to figure out what accounts for it.

As I said, I typically do a long trail-run on the weekend, and I don't typically experience a sudden burst of pain the first time I get up from a chair afterwards. But both times that I followed the trail-run with the music session in Marin, getting up to walk across the room hit me hard. So what was going on there?

In both cases, I had to sit in the car for a long time after the run -- it takes an hour to get to the session. Then I sat down while I was playing for a few hours. But maybe the crucial thing is that I was sitting down in an odd way. I was seated on bench-like seat behind a table, and because it's such a tight spot, I had to twist my body a bit to play. Playing a fiddle requires a lot of elbow room -- you need to be able to move the bow, and change the angle of the bow, quite a lot, and you need to be able to do it in such a way that you're not inflicting mayhem on any nearby furniture or personnel in the process. To get the space clear and the angles right, when you're in close quarters, you have to contort yourself a little, and hold whatever odd body position works. I suppose it's only natural that doing that for a few hours, when your body is still trying to recover from a long trail-run, is pretty likely to produce some uncomfortable results.

Well, next time I'll try to snag a space on the other side of the table, where there's more room, and I can sit on an individual chair rather than a bench, and see if I can give myself enough room to be able to play without contortion, so that I can walk (and run) afterwards without trouble.

I certainly don't want my exercise program to be in conflict with my music-making. The point of exercising, after all, is to live long enough to make more music, and I don't want to lose sight of my larger goals.

Saturday, January 9, 2010  

In recent months Friday has been my rest day, but I went running yesterday, so I took my rest today. Which is just as well, as the weather was rather dismal and I didn't feel energized by the gray skies. When I exercise on the weekend I want it to be in the great outdoors, and the great outdoors wasn't providing much inspiration today.

Well, the weather is supposed to improve tomorrow -- maybe I can fit in a good run in the morning.

There's a rule of logic known as "excluded middle", which means that, between two mutually contradictory propositions, one of them has to be right and one of them has to be wrong. Either Socrates is immortal or Socrates is not immortal; you can't take up a position half way between these alternatives, and say that Socrates is sort of immortal, or mostly immortal, or very nearly immortal, or that he's immortal on some days and mortal on others. There's no middle position. Either he's immortal or he's not.

Well, that rule works as long as the choices really are mutually exclusive, and no other possibilities exist. But most situations in life aren't that simple.

Suppose the proposition is that Socrates is talented. Well, very likely he's talented at some things and not at others.

Suppose the proposition is that Socrates is tall, or that Socrates is fat. Tall compared to whom? Fat by what definition? 

You can't apply the excluded-middle rule to cases like that. If you try to, you end up with a logical fallacy known as a false dichotomy. That is, you claim that either A is true or B is true, when in fact it's possible that both of them are partially true, or that neither of them is true at all. This sort of thinking is very popular in politics, of course. Either you agree with me about the alternative minimum tax, or you're on the side of the terrorists! So which is it, eh?

One might expect, and in fact most people assume, that the excluded-middle rule applies to a diabetes diagnosis. Either Socrates is diabetic or he's not. Right? Well, maybe it's not that simple.

Being diabetic, after all, simply means having too much sugar in your blood. But everybody's got some blood sugar, or else they'd be dead, so in order to define diabetes you have to decide how much is too much. You have to choose a cutoff point somewhere on the spectrum of blood sugar levels, and say "Everybody above this point is diabetic and everyone else is not." The trouble is, it's hard to know where that line should be drawn. It used to be drawn, for a fasting test, at 140 mg/dl. In more recent years, it has been moved down to 126. The question "is Socrates diabetic?" might have a different answer depending on whether the question was asked before or after the goalpost was moved. (And it may get moved again! No sensible person really thinks 125 is "normal".)

Let us suppose that Socrates is getting fasting test results above 200. Well, everyone agrees that you're diabetic if you're that high, so we can all answer firmly that, yes, Socrates is diabetic. But suppose that Socrates, alarmed for his health, goes on a diet, and joins the Athens track & field club, and looks after himself so well that after six months his fasting tests are consistently in the 90s. So we pose the question again -- is Socrates diabetic?

Well, if being diabetic means having chronically elevated blood sugar, then Socrates is not diabetic, because he doesn't have that symptom. But if you say that, everyone will insist quite loudly that Socrates is, too, diabetic! Diabetes is a permanent condition; it's incurable, it's progressive, it always gets worse over time. Everybody knows that. How could anyone even think of suggesting that Socrates is not diabetic?

Obviously, if people react this way, they are using a private, unspoken definition of "diabetic" that covers a lot more ground than the official one. For them, to be diabetic is to have a stain on one's permanent record which nothing can wash away. Just as you become a murderer after commiting one homicide, and remain a murderer forever even if you never commit a second one, you become diabetic once your blood sugar gets out of control, and you remain diabetic forever, even if you get your blood sugar back in control and keep it there.

I realize that the people who insist on the permanence of diabetes have a point (not the one they think they're making, but a point). It seems clear that something is different about you that made your blood sugar get out of control in the first place, and it also seems clear that this unspecified something-or-other is a health issue which will always be of concern to you, even if you have been able to defeat it for the present. In the absence of any other generally-accepted term for this mysterious something, we call it diabetes. And that's a problem. In effect, "diabetes" has two very different meanings (the symptom of chronic hyperglycemia, and whatever underlying health problem has the potential to give you the symptom of chronic hyperglycemia). The fact that people use the same word with these two meanings (often without the slightest awareness that the meanings are different) leads to a lot of communication problems. The biggest one is that we have no language with which to describe someone whose blood sugar used to be out of control, but no longer is. We are not allowed to say that such a person is "no longer diabetec", and in the absence of any other way to describe such a person, we are unable to discuss such cases with any clarity. This, of course, feeds into the conventional assumption that such cases don't exist ("everyone knows" that diabetes always gets worse, never better).

The other problem with diabetes and the excluded-middle rule is that plenty of people have blood sugar which is elevated, but not quite elevated all the way up to the diagnosis threshold. If Socrates has fasting tests in the range of 120 to 125, he is not diabetic by the current definition. Does that mean we can simply say that Socrates is "not diabetic", and let the matter drop? That would be a bit unfair to Socrates, wouldn't it? Any fool can see that Socrates is going to be diabetic, and had better do something about it now, while it's still easy to do something about it. But he's not going to do anything about it if we just tell him he's not diabetic and leave it at that. To cover these cases, doctors have started using the term "pre-diabetic", but it isn't working out very well. Patients tend to interpret the term as meaning "not nearly bad enough to be called diabetic", when it really means "well-advanced in the process of becoming diabetic".

So, the excluded-middle rule, as applied to diabetes, misleads everyone. If we insist on the idea that you're either diabetic or not diabetic, we lead people who are in serious trouble to think that they have nothing to worry about, and we also lead people who have achieved much into thinking they have achieved nothing. Neither seems like a good idea to me.

Friday, January 8, 2010  

Among the countless factors that can increase your odds of developing Type 2 diabetes is smoking, which increases the risk by about 30%, relative to people who never smoked.

But guess what? Quitting smoking increases your risk by 70% (according to a recent study, at least)! Seems like you can't win, doesn't it? It also seems like a logical impossibility. If a particular habit increases your diabetes risk, who can giving that habit up increase the risk even more?

There is probably less here than meets the eye. People who quit smoking typically gain weight, and of course weight gain tends to increase your diabetes risk, so the increased risk after quitting is not all that surprising.

The more puzzling question is how smoking increases your diabetes risk. However, I think it's a fairly safe bet that smokers, on average, are less careful about their health in general than non-smokers are, and are probably also less active. Smoking probably doesn't cause diabetes directly, any more than poverty does. It just so happens that neither smoking nor poverty are associated with good health habits.

I continue to be startled by the number of newly-diagnosed diabetes patients who report on diabetes forumns that their doctors have given them almost no information or guidance. I was sent to a class when I was diagnosed in 2001, but apparently a lot of patients are lucky if they get so much as a poorly-Xeroxed copy of a pamphlet on the subject. And I can imagine the kind of feeble advice that such pamphlets offer: eat whole-wheat bread instead of white bread, etc.

I realize that, as a practical matter, diabetes care has to be a do-it-yourself operation. No doctor can manage your blood sugar for you. Still, if doctors are going to throw everything back on the patient and say "this is your problem -- you deal with it!", then in all fairness they ought to give patients the information they need to be able to manage the problem themselves. Sure, it's complicated, and you can't explain it in a matter of minutes in the doctor's office, but what is to stop doctors from giving the patient a book, or at least recommending one?

I fear that patients are being given inadequate information simply because doctors think patients are too stupid to understand the basics of diabetes. I have never been of this opinion. If you treat people like idiots, and expect them to be idiots, of course they will behave like idiots, but if you assume they're intelligent and proceed accordingly, they will often rise to the occasion. You can't do a fool any harm by assuming he's smart, but you can do a smart person a great deal of harm by assuming he's a fool.

Diabetes is complicated, but only in the sense that weather is complicated. The mere fact that several fluctuating variables are involved does not mean that those variables are especially mysterious in and of themselves. It isn't hard to explain how insulin is supposed to work, or what happens when it doesn't, or what can be done about it -- and it isn't hard to understand the explanations, either. And people with diabetes have a pretty good motivation for understanding, unless they've already decided to pretend it doesn't matter (in which case they are lost souls and you can't do anything for them anyway). So why not concentrate on giving real help to the ones who aren't beyond help? Why not assume people are smart, so that the ones who actually are will be better off? The ones who aren't will certainly be no worse off. I mean, what problem do we think we're avoiding by treating adults as if they were children -- and not especially bright ones? I'd like to see the medical profession take a New Year's Resolution to stop dumbing this down!

Thursday, January 7, 2010  

Wow -- making the decision yesterday that I'm not going to do the Napa Marathon this year was a huge weight off my shoulders. I'm not necessarily saying I'll never run a marathon again, but after three years in a row of doing marathon training in the winter, it's a great relief not to be doing it this time, especially as this winter has been colder and wetter than average.

However, I'm not entirely letting myself off the hook in terms of exercise challenges. I definitely plan to do The Relay again this May. That's the event in which 12 runners on a team divide up the 200-mile distance from Calistoga to Santa Cruz. My share of it will be in the range fo 15 to 20 miles, but that will be divided into 3 separate segments with long rests in between

If my blood pressure is up slightly, it's because I just read an upsetting article from the Toronto Globe and Mail. Here's the gist: "Frequent self-monitoring of blood-glucose levels -- which is commonplace among diabetics -- actually provides little practical benefit to most patients who do not use insulin, a new study shows. Drugs plans could save hundreds of millions of dollars by reducing coverage for glucose test strips, a second research paper suggests."

Barb Shea, acting senior vice-president of science directorates at the Canadian Agency for Drugs and Technologies in Health, was quoted as follows: "From a practical point of view, most people with Type 2 diabetes don't need to test their blood as often as they do now. It's not something that is improving their health to any degree," she said. "From a systems point of view, there are a lot of resources being spent on these tests that could be better spent otherwise."

A study led by health economist Chris Cameron of the Canadian Optimal Medication Prescribing and Utilization Service of CADTH, found that patients who tested themselves frequently (more than seven times a week) reduced their hemoglobin A1c levels by a mere 0.25 per cent. Those who self-monitored had only marginally fewer complications than those who did not.  Cameron was quoted as follows: "There are very modest benefits in terms of glycemic control and complications and they come at a very high cost to the individual or health care system," Mr. Cameron said.

Muhammad Mamdani, director of the applied health research centre at St. Michael's Hospital in Toronto is quoted as follows: "We're not saying that monitoring of blood is a bad thing. On the contrary, it's essential. What we're asking is: What is the value of self-monitoring above and beyond what physicians already do?"

Let me get this straight -- blood monitoring is "essential", but it only needs to be done once or twice a year in the doctor's office? Isn't that a bit like trying to drive by flashes of lightning instead of turning on the headlights?

Of course the average diabetes patient doesn't benefit significantly from testing! The average diabetes patient tests his glucose and then, if the result is bad, does nothing about it beyond feeling sorry for himself. Well, we all know how well that approach usually works out. But the average patient isn't the only one who suffers for it! Now, because of the way the average patient behaves, insurers want to take the test strips away from those of us who are actually using them for a constructive purpose.

Test strips don't exist so that you can have a means of monitoring your decline (if all you wanted was to know was how unhealthy you are becoming, you could probably figure it out from other indications). Test strips exist to give you what is known in Washington as "actionable intelligence" -- the kind of information that can serve as a useful guide to decision-making. Glucose testing allows you to steer your course safely through the troubled seas of diabetes, instead of setting yourself adrift and hoping that everything comes out right in the end. The fact that most people choose to drift anyway, no matter what their test strips are telling them, doesn't mean that those of us who are willing to steer a safe course should be deprived of the means of doing so.

Well, I'm sure we will be deprived of it. The economists are in charge. I don't think it will affect me -- if I can't get any help in paying for the strips, I will still buy them, because they're too important to my health and my peace of mind. Flying blind is not an option I'm willing to consider.

But some people won't be able to afford the strips, if they're not getting any help in paying for them. I hope they will at least do some testing, even if they can't do it on a daily basis.

Wednesday, January 6, 2010  

I've been flirting with the idea of running the Napa Marathon again in this year, and I've even been doing the training for it. But today I decided, or at least I think I decided, that I don't want to do it this time.

Maybe it has something to do with the fact that, in the locker room as I was getting ready to go out to run today, I heard two co-workers talking about runners they knew who had wrecked their bodies so thoroughly with marathon-running that they were no longer able to exercise at all. I don't know how much that influenced my feelings. At any rate, I went out for what was supposed to be an extra-long run (the training schedule called for 7 miles). And within a mile after I started, I came to the realization that I really, really didn't want to go that far today. And I realized that I wanted even less to do the 15-miler that the schedule is calling for on Saturday. All of a sudden, the idea of doing the marathon this year seemed thoroughly unappealing to me, and I decided not to do the 7-mile route. 5 miles, okay, but not 7.

That's that, I guess, unless my running buddy Mike (who has been traveling and will probably be back at work tomorrow) is able to talk me into getting enthusiastic about the idea. I doubt he will be able to do it, even though he has talked me into remarkable things before. I'm not ruling out the possibility of running other marathons (perhaps one later in the year), but I just don't feel like putting myself through a fourth year in a row of winter marathon-training, in which every Saturday for three months consists of going out in the rain and cold to run ridiculously long distances.

I like distance-running, up to a point, but I think the half-marathon distance is about as far as I really want to run now. The amount of running I do routinely is enough to make me feel comfortable about running a half-marathon without special preparation for it, but a full marathon requires a great deal of special preparation -- so much special prerparation, in fact, that it entirely dominates your life for three months, and I'm just not feeling ready to make that commitment now.

I think exercise should be challenging, and it's always a good idea to push yourself a little bit outside your comfort zone, but if you get too far outside it you run the risk of injuring yourself, and I can't afford to do that. I want to exercise enough to make myself more healthy, not enough to make myself less healthy. It's hard to know where that balance point is sometimes!

A friend of mine has long been trying to persuade his wife to ready my blog, as she has developed Type 2 diabetes and he thought it would help her. But apparently she doesn't do the internet thing, and he couldn't talk her into reading it. Not being one to give up easily, he instead started giving her verbal summaries of what I've been saying. Remarkably, this worked. She got inspired, started exercising a lot, started dieting, lost a great deal of weight, and has now brought her fasting tests (which had been getting above 200) down to the point that they're consistently in the low 90s.

I guess this says more for his powers of persuasion and her dedication to the task than it does for my writings, seeing as she never actually read my writings. But it at least it confirms my view that it is often (not always, but often) possible to do something about this supposedly hopeless problem. People who are really determined can sometimes change the rules about what is possible and what isn't.  

Tuesday, January 5, 2010  

My running buddies were unavailable to run with me today, so I had to go it alone. I usually run much slower when I'm not struggling to keep with them, but today I somehow forced myself to maintain a pace of 9:37/mile, which sounds slow but is actually fast considering that I was running the same very hilly route that I described and photographed in my November 30 post. I think that's as fast as I've ever done it. A real runner would do it faster, but for me it was an impressive achievement.

Soon, Contact Lenses to Help Manage Diabetes reads the headline in a story on the ADA site. "Researchers at the University of Western Ontario have developed contact lenses that could help people with diabetes manage their blood-sugar levels."

How exactly would contact lenses do that, you ask? Well, the contact lenses are embedded with nanoparticles that react with glucose in your tears. The effect of the reaction is to change the color of the contact lenses. "Researchers say the contacts may someday eliminate the need for diabetes patients to test their blood-sugar levels by repeatedly drawing blood".

The ADA's article was so brief, and so lacking in detail, that I searched for other articles on the subject. I wanted to know whether the contact lens as a whole changes color. Is the patient supposed to notice that the world is looking awfully yellow all of a sudden, and reach for a syringe of insulin? And could casual bystanders see the color and realize what was going on?

Strangely, the other articles I found attributed the research to the University of Pittsburgh, not the University of Western Ontario. Either we're talking about separate inventions or sloppy journalism about the same one. Anyway, the Scientific American site provided a little more detail about how the lenses would work. You don't interpret your blood sugar by looking at the world through rose-colored glasses, as it were. Instead, you go to the bathroom, approach the mirror, pull down your eyelid and check out a tell-tale color patch below the iris:

The patch is green when your blood sugar is normal, red when it's low, and violet when it's high.

My reaction to this development is extremely negative. In fact I am astounded to see such sophisticated technology being used to bring about such a huge step backward. What the scientists involved seem to have done here is to reinvent the urine test-strip, which diabetes patients once had to use to get a vague (a very vague) idea of what was going on with their blood sugar. If green means "normal", that seemingly could mean anything between 70 and 120 mg/dl, and of course the top 40% of that range is only normal for a post-prandial test, not for a fasting test. The idea that this unbelievably crude system is seen as a replacement for blood testing is apalling.

I suppose there are diabetes patients out there who don't want anything more than a very rough notion of what's going on with their blood sugar, and who would be delighted to receive non-quantitive information on the subject (especially if it can be had without the terrible, terrible suffering of a momentary finger-prick). But patients who actually want to take diabetes seriously, and do something about it, are going to need specific, quantitative information, and they're not going to get that by peeking at color-patches under their eyelids.

If diabetes patients need better technology for glucose monitoring, the improvement needs to be in the area of measurement accuracy. An "improvement" that sacrifices accuracy for the sake of greater convenience is no improvement at all. People with diabetes who don't think staying alive is worth a moment's bother already have the option of not testing if they don't feel like it. People with diabetes who are more interested in protecting their health than in taking the easy way out need to have the option of collecting good data and making use of it.

And anyway, I have a hard enough time finding contact lenses that adequately correct my vision -- finding lenses that do that and also turn funny colors is probably never going to be a practical option for me.

Monday, January 4, 2010  

I guess we'll never get rid of these dopey nature-versus-nurture debates, in which one side claims that we are the product of our genes and nothing more, while the other side claims we are entirely the product of our environment and behavior. Both positions are absurd, of course, because both try to simplify things by ignoring half of the reality we must live with. It's nature and nurture, for heaven's sake, not one or the other! Why is that so hard to for people to accept?

Type 2 diabetes is one of the most popular battlegrounds for this kind of dispute. There are people who insist on its being a "lifestyle" disease, and others who insist on its being a "genetic" disease. Obviously it's both, but try telling that to someone who has staked out a political position on the issue. There are people who are eager to blame others for being diabetic, so that society can be excused from helping pay for their medical care. There are also diabetes patients who are eager to portray themselves as helpless victims of fate, so that they can be excused from making any changes in the way they live. Neither group is being sensible about this.

That Type 2 is associated with obesity and sedentary habits doesn't mean it isn't also associated with a certain set of genes (several of which have been identified). That these genes can put you at risk for becoming diabetic doesn't mean that the risk isn't greatly increased if you're obese and sedentary. It matters which genes you have, and it matters how you live. Because the latter of those two things is the only one you can do anything about, it gets a lot of emphasis in any discussion of how to live well with diabetes, but that doesn't mean it's the only thing that matters.

The genetic aspect of the disease is the wild card which makes it impossible to say that people who didn't become diabetic must have been living well, or that people who did become diabetic must have been living badly. Instead of trying to portray diabetes patients as angels or demons, we should be concentrating on what we can all do to prevent, delay, or mitigate the disease. Which means that we need to find out more about how nature and nurture interact.

And that's where these guys come in...

They are Tim and Paul Daly, who were profiled in a story by Allison Aubrey on National Public Radio this morning. They are identical twin brothers, sharing the same genes, but (as you can probably tell from the photo) not precisely the same lifestyle. Both gained weight in middle age, but Tim gained less, and exercised more (chiefly basketball). Paul, who gained more and exercised less, was diagnosed with diabetes in 1996.

So what did that mean for his identical twin Tim? Dr. David Nathan of Massachusetts General Hospital estimated that Tim's risk of also becoming diabetic was something like 95%. But 14 years later, Tim is still not diabetic.

Tim participated in a study which looked at more than 3000 people who were considered to be at high risk of developing diabetes. Tim was assigned to the lifestyle-intervention group of patients (who were coached on weight loss and exercise), while others were assigned to a group that was given metformin, the leading diabetes drug (or a placebo claiming to be metformin).

The study found that lifestyle intervention was twice as effective as metformin. It certainly was in Tim's case, as his blood sugar had risen to "pre-diabetic" levels at the time he started the study, but by losing 14 pounds and increasing his exercise level to 2.5 hours a week, he was able to work it back down to the normal range, and has been able to keep it there.

So what message do we take away from this story? What I take away from it is that your health is controlled by more than your genes, and that, even if your genetic makeup predisposes you to become diabetic, it is always worth trying to do something about the situation. Where nature lets you down, try nurture.

But there is something melancholy about the rather muted media reaction to the news that lifestyle intervention works twice as well as metformin. Can you imagine the hype that would have resulted if the researchers had found another drug that works twice as well as metformin?

Sunday, January 3, 2010  

Okay, I'm back from Camp Harmony, and it was a great way to spend the (for me) aimless and uneasy period between Christmas and New Year's. The location is only about 10 miles from my home, but it's high in the hills between Santa Rosa and Calistoga, and it seems very isolated (certainly it's isolated from my cell phone network).

When I arrived on Tuesday and started checking out the surroundings, I wondered whether the extremely uneven terrain was going to be a problem. The camp is located in a sort of canyon, and the buildings are all perched on shelf-like outcroppings at various altitudes. Going anywhere (from your cabin to the dining hall, for example) always involved climbing a series of steep paths and outdoor staircases. I had counted on being able to go running there for my daily exercise, but the setting didn't seem very runable. Everyone told me the road outside the camp was unsafe for running (fast traffic, not enough shoulder), and the trails within the camp boundaries seemed to be too steep, slippery, and strewn with hazards. Was I going to be able to get my exercise in while I was there?

It turned out to be a solvable problem. The place was big enough that simply running around on the paved roads within the camp gave me a certain amount of distance (and a huge amount of climbing) without my having to run multiple loops. Plus, it turned out that there was one hiking trail on the west side of the camp that was runable. Also, the uneven terrain of the camp, which at first seemed like an obstacle to exercise, actually had the effect of building exercise into everything I did all day. It was a music camp, after all, with workshops and jam sessions going on all over the place, and I was constantly walking from one building to another as I tried to exerpience as much of it as I could in the time available. With no two buildings at the same elevation, I was walking up and down hills and staircases all day and night -- so there was no way to be sedentary and still participate in the event.

I think all that climbing was helpful to me. My fasting test results on the five mornings I woke up at camp were 83, 77, 76, 89, and 85. Pretty good, I'd say -- even on the morning after the New Year's Eve party, I was under 90.

Despite the damp weather during much of the week, there were a few outdoor activities. One was a mushroom walk (two of the campers happened to be experts on the subject). We didn't collect anything to eat, it was just a learning opportunity.

Sometimes, when the sun came out, it got warm enough that a few jam sessions happened outdoors.

But even on a sunny winter day, it's hard to play outdoors very long before your fingers start to feel numb, so most of our playing was done indoors. The trick was to find enough indoor spaces for all the little groups of people that wanted to get together and play a particular kind of music. The owners of the place allowed us to use the living room of their house on the grounds as a playing space -- that was the most coveted location at camp. Very cozy and warm, and with good acoustics.

Being a fiddler, I spent most of my time on the fiddle-related events, such as Laurie Rivin's workshops on Quebecois dance tunes.

But of course a lot of other instruments were repesented -- plenty of banjos, squeeze-boxes, mandolins, guitars, and so on.

Also a lot of French bagpipes. They have a different sound from the Scottish variety, but they're not much quieter.

A lot of singing went on, of course. My favorite was the Friday afternoon singing session, which immediately followed a comparative beer-tasting event, and consisted of an hour of old "John Barleycorn" songs in praise of beer, followed by another hour devoted to sea-shanties. When you gather dozens of singers in one small room, give them enough beer to loosen them up, and then encourage them to sing sailor's work-songs as lustily as they can, you get some amazing sounds.

That's the thing about having a big group of people gathered in one location who are all musicians: when they're asked to sing "Happy Birthday" or "Auld Lang Syne", they can actually do an impressive job of it. At the New Year's Eve celebration on Thursday night, they might not have all agreed on what the dress code was, but they agreed on what the pitch was, and that's what counts.

Anyway, it was an excellent way to spend my days off, and I'm sure I'll want to do it again next year. I will hope for it to be a little less rainy next time, but if it's not I'll deal with it. 

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