Whether you love your body or hate it, you are going to have to live in it for the rest of your life. That being the case, do you suppose it might be a good idea to try to make your body a nice place to live?

The question ought to be an easy one to answer, but a lot of us have trouble grasping the principle involved. The principle, of course, is that if a situation is inescapable, you should do everything possible to make the best of it. This seems like such an obvious, common-sense rule that some people even think it applies in reverse: that you can make a situation better by making it inescapable -- thus forcing everyone in that situation to make the best of it. (The particular situation they have in mind is marriage, an institution which they think worked better in the days when you couldn't get out of it.)

The make-the-best-of-it principle may be common sense, but that doesn't mean it's the principle we actually live by. For whatever reason, it is human nature to look at an inescapable situation and decide that making the best of it would be way too much trouble.

We are especially likely to take this lazy attitude regarding the need to make the human body a more habitable and comfortable space. It's not that we are uninterested in comfortable living, of course. We simply prefer to define comfort in terms of external things. We would rather invest in home-improvement than in body-improvement. The phrase "comfortable living" does not remind us of how nice it would be to have a flexible spine; it reminds us of how nice it would be to have a big kitchen with a skylight and an "island" and marble counter-tops.

Far be it from me to deny the appeal of a well-appointed kitchen, but if you should ever find that your spine is so traumatized that you can no longer get out of a chair without being seized by agonizing spasms in your lower back, all the marble counter-tops in the world are not going to give you a satisfactory quality of life.

The gold standard of comfortable living is to have a strong, limber body which does what you ask of it without making you pay for it with pain and stiffness and cramping the next day. None of the other material comforts which you might be thinking of adding to your home will serve as an adequate substitute for this. The dream-house that can make you feel good when your body is feeling terrible has not yet been built.

And so, you can't just invest everything you've got in the comfortable house you would like to live in. You also need to invest in the body that you are required to live in. This is true for anyone, of course, but it is especially true for anyone with type 2 diabetes, because of the need to stay active in order to manage the disease effectively. Unfortunately, staying active throughout life can be a tricky assignment. It requires a lot of body-maintenance.

The non-youthful athlete

Leading an active life, particularly after age 40 or so, involves you in a circular dilemma: you have to keep exercising if you want to maintain your body in a healthy condition -- but you also have to maintain your body in a healthy condition if you want to be able to keep exercising.

I used to assume this was a problem which could solve itself. After all, the body does adapt itself to exercise, doesn't it? Running makes you faster. Weight training makes you stronger. As long as you keep exercising, you will keep your body in shape. Therefore, you will remain capable of exercising as long as you are willing to keep doing it. Right?

I thought I was seeing confirmation of this theory all around me: whenever I participated in a long-distance running or cycling event, there always seemed to be a number of elderly athletes taking part. Wasn't this proof that anyone could keep exercising into old age? To be sure, these elderly athletes were greatly outnumbered by younger ones. This didn't strike me as something which cried out for an explanation. If I had been challenged to explain it, I suppose I would have said that most athletes presumably lost interest in their sport once they were past their peak and no longer able to win medals, so at that point they just gave it up. Only a minority of athletes remained interested and involved in their sport over the years -- but those who did remain interested and involved also remained capable of participating, and those people were the older athletes that I saw at the footraces and bike rallies.

These assumptions of mine were not entirely wrong (like any oversimplified theory of how life works, my theory of the aging athlete had a grain of truth in it). But after a while it began to dawn on me that there had to be more to the story than that.

One of the consequences of getting involved in athletic activity is that, after a while, you find that you are socially acquainted with a rather large number of athletic people. Once you get to know athletic people, you start to realize that they are constantly dealing with (or at least worrying about) the issue that I had earlier overlooked: the issue of trauma. The human body is vulnerable to many injuries which cause pain, stiffness, and loss of mobility. I'm not talking about dramatic, visible injuries such as a broken leg. I'm talking about the cumulative-trauma injuries which build up within us, unnoticed, over a long period, and then suddenly manifest themselves as a stiff neck, a frozen shoulder, an aching back, a sore knee, numb fingers, muscle cramps, shin splints, and problems of that sort. As we get older, these flare-ups tend to occur more often, and also to persist longer, so that an increasing percentage of our time is spent in a compromised state. To say the least, such episodes aren't helpful to anyone who is trying to maintain a regular exercise schedule.

Being "in shape" for a sport, in the sense of having the strength and stamina required for it, counts for nothing if you are too stiff and sore to take part. Sad to say, many people give up their sport not because they have lost interest in it, but because they are hurting too much to keep going. I'm not just talking about Olympic gymnasts or professional football-players. We more or less take it for granted that people competing at that level will often have painful sports-injuries, and must work through the pain as best they can. But ordinary people who are merely exercising to stay healthy can end up in exactly the same situation. It simply isn't enough to have a body that is "in shape". You must also have a body that is reasonably flexible and free of pain. If you don't have that, you won't be able to keep exercising, and pretty soon you won't be in shape any longer.

Let me make a hasty course-correction here: I don't want to give the impression that exercise necessarily results in injury. I don't even want to give the impression that the injuries which afflict athletes are necessarily caused by the exercise they do. A lot of cummulative-trauma injuries are caused by subtleties of habitual behavior (such as standing or sitting with poor posture) rather than by working out too hard. You can certainly hurt yourself exercising if you don't do it right (and for some forms of exercise, "doing it right" is surprisingly difficult), but exercise probably gets a lot of undeserved blame for "sports injuries" that it didn't actually cause.

People who run, for example, have a lot of knee problems; there's no denying that they do. Neither is there any denying that people who don't run have a lot of knee problems. Human beings in general have a lot of knee problems; it's a vulnerable part of the body. The question is, do runners have more knee problems than other people? After all, the reason we blame lung cancer on smoking is that most of the people who get the disease are smokers. If running is especially harmful to the knees, knee problems should be a lot more common among runners than among people who have never been runners. But apparently this isn't the case; according to at least one sports-medicine study, the rate of knee injury is slightly lower among runners than among other people!

Why, then, are so many people convinced that running is injurious to the knees? Probably because non-runners usually have nothing obvious to blame for their knee problems; they just say "I've got a bad knee", and let it go at that. When runners develop knee problems, they do have something obvious to blame. They say "I've got a bad knee from running" -- which might be true, and might not.

Of course, a knee problem (regardless of what caused it) is going to have more impact on a runner than than it will on a sedentary person, who wasn't planning to get off the couch anyway, and is only too happy to have an excuse to stay there. Whether a supposed "sports injury" was or wasn't actually caused by the relevant sport, the fact remains that an injury of any kind can make it difficult or impossible to continue participating in that sport.

Even if you manage to exercise with such skill, grace, and safety-consciousness that you never, ever hurt yourself in the process, the human body can always find other, less dramatic ways to sustain an injury. Even people whose principle sport consists of slouching in a chair in front of a computer can manage to injure themselves as seriously as any enthusiast of extreme sports -- it just takes a little longer.

The sad fact is that the human body is extremely vulnerable to injury caused by habitual behavior. Day after day, our movements and postures tend to put just enough strain on the body to cause gradual deterioration in vulnerable parts of the body such as the neck, the wrists, the lower back, and the knees. However, the strain is usually not so great that we are conscious of it while it is happening. We don't think we're hurting ourselves, because we don't feel it. The damage accumulates, slowly and undetectably, perhaps for many years, and then suddenly we find that one day's normal dose of strain is the straw that breaks the camel's back. Now we have an injury, which seems to have come out of nowhere, and we can't understand what we could have done yesterday that made us wake up with so much pain, stiffness, or cramping. But it wasn't what we did yesterday that hurt us, except in the sense that yesterday we were probably making the same mistakes we've been making every other day during the last ten or twenty years.

Some athletes cope with these problems by switching from one form of exercise to another. For example, runners who have developed problems in the hips, knees, or ankles often take up cycling or swimming, so that they can still get an aerobic workout without a lot of hard pounding. But if they are unable to find a form of exercise that they can still do comfortably, they may give up on exercise entirely --  which is not a good option if you have type 2 diabetes. Exercise needs to be a lifetime commitment for you. You can't afford to think of it as a hobby which you will abandon the minute you start to feel that you're "getting too old for that sort of thing".

Therefore, the problem of maintaining a strong and limber body over the course of a lifetime is a very important matter for anyone with type 2 diabetes. You need to take this problem seriously, and you need to find a solution to it. Fortunately, a lot of work has been done in this area. It just hasn't been done by the medical profession. You will have to seek help elsewhere.


I'm sure to offend people by saying this, but the truth is that I don't take an especially admiring view of "alternative" or "traditional" medicine. I think folk healers (like all good showmen) have developed some pretty shrewd insights into audience psychology, but I don't think they have done nearly as well in the areas of biochemistry, genetics, endocrinology, or trauma care. I am not impressed by authoritarian insistence upon (or dopey sentimentality about) "ancient wisdom" either. Maybe the ancients did stumble upon some remedies that are actually useful, but if I wake up at 3 AM with crushing chest pains, the first phone-call I place is not going to be to an herbalist.

Despite all that, I also recognize that there are health problems which scientific medicine hasn't solved, and isn't particularly trying to solve. Scientific medicine is mainly interested in diseases: defining them, recognizing them, explaining them, preventing them, curing them if possible, and alleviating them if not. Because of its preoccupation with disease, scientific medicine gives very little attention to health itself.

Actually, scientific medicine doesn't even define health, except negatively, as an absence of disease. The presumption is that, if you get rid of all the patient's symptoms, whatever's left over must be "health". Medical researchers are not trained to think of health positively, as an identifiable state of existence in which people feel energetic, relaxed, well-balanced, comfortable, functional, and fully engaged with life. The assumption is that you will feel that way if you don't have any diseases. In fairness to the medical researchers, it's certainly a lot easier to feel that way if you don't have any diseases. I mean, whatever else is going on in your life, getting rid of your bladder infection is bound to be a mighty big step in the right direction. Still, being free of identifiable diseases is not enough by itself to make you truly healthy. Having a body that can comfortably do what you ask of it is an important part of the picture as well.

Unfortunately, the problem of maintaining a strong, flexible, pain-free body throughout adult life is exactly the sort of problem which scientific medicine is never going to attack directly. It is in this area that traditional practices can make a valuable contribution.

Traditional cultures might not be very good at investigating disease processes, but if such a culture maintains itself for centuries, and addresses itself patiently to the problem of body maintenance, it can develop some good, practical solutions. After all, if you train enough athletes, dancers, and warriors, sooner or later you are likely to hit on effective techniques for improving strength and flexibility. Your understanding of how these techniques actually work may be limited (or even wildly wrong) but finding things that work can be valuable even if you never find valid explanations for them.  

Several traditional cultures, mostly on the Asian continent, have developed useful methods of conditioning the body to keep it strong, flexible, and free of pain. I will refer to these practices collectively as "maintenance disciplines" (a phrase which, so far as I know, I invented; I din't know of any collective term for these practices). I don't know that the various maintenance disciplines all work equally well, but I know that a lot of people have been able to benefit from them, and in many cases there is clinical evidence to support at least some of the health claims that are made for them.

Differences & commonalities

There are many maintenance disciplines, and their numbers grow over time as variants develop, branch off, and attract independent followings in different regions. Some of these disciplines arose as adjuncts of the martial arts, others as medical or spiritual practices, but in the form we have them today they are primarily methods of getting the mind and body to work together to promote the health of both.

Two especially popular maintenance disciplines are tai chi (in which you perform various slow and fluid movements) and yoga (in which you hold various poses which look easy until you try them), but these are only the best-known examples.

There are countless regimens which use special movements, postures, breathing techniques, or massage in order to release tension, relieve pain, and promote strength and flexibility. Some of these practices (such as breema and shiatsu) come from traditions of long standing. Other practices, such as the increasingly popular methods of Joseph Pilates and Moshe Feldenkrais, are modern inventions (although they tend to incorporate elements of traditional practices, particularly yoga). These disciplines evolve over time, and differentiate into numerous distinct "schools". There are many variants of yoga, for example, including some (such as Iyengar yoga) that were developed by an identified modern teacher.

The bewildering variety of maintenance disciplines will make it difficult for you to know where to begin or what to try, but it will also improve your chances of finding something that works for you. I'm sure there are many maintenance disciplines (both ancient and modern) which I have never even heard of, because I don't happen to live in a location where they are popular. These techniques have been brought to America by immigrants, and because immigration is not evenly distributed across the country, the techniques are not evenly distributed either. Often a particular discipline will develop a following in one city, because a popular teacher has settled there, and then slowly spread to other regions. Breema bodywork, for example (a gentle massage technique from Afghanistan) is starting to gain some ground in the eastern U.S., but is still primarily a San Francisco Bay area phenomenon. Probably there are maintenance disciplines practiced where you live which are virtually unknown where I live. You will need to investigate to find out what's available in your neck of the woods, and there is no one right way to research the matter. (Doing a web search on "maintenance disciplines" won't do you much good, because I don't think anyone uses that term besides me.)

Although, at first glance, these techniques appear very different from one another, they have several things in common. They emphasize controlled breathing, relaxation, slow movements, and the gentle application of pressure or stretching to release tension from the body. Perhaps the most important thing they have in common is the assumption that the body has a great natural capacity to become healthy, relaxed, and strong -- a capacity which we regularly frustrate, with our stress-inducing thoughts and behaviors, and with our general tendency to devalue and disregard the body.

The maintenance disciplines all seek, in one way or another, to overcome a harmful division between body and mind, and to replace feelings of conflict and strain with feelings of unity and balance...

Wait a minute -- where are you going? Now, hold on! You come right back here!

I realize that this kind of talk can be extremely alienating to anyone who's not already a convert, but try to reserve judgement for a bit. The basic idea here (that good health requires the body and mind to be unified) is not mere mysticism. There is abundant evidence that the mind and the body influence one another profoundly, although we aren't anywhere near to having a scientific understanding of how that works. Even the commonest physical manifestations of the placebo effect, and of hypnosis, remain unexplained, but we know that that the body and mind are very much interdependent. Our thoughts and emotions have an impact on our bodies (just ask any stressed-out person who has had a heart attack). Although a scientific understanding of the mind/body interface is denied to us as yet, an intuitive or metaphorical understanding of it can nevertheless be extremely useful.

A lot of us have detached ourselves mentally from our bodies, and have learned to tune out the feedback that our bodies give us about our own behavior. (This is especially true of those of us with type 2 diabetes; most of us have become very good at ignoring the body when it is telling us we've had enough to eat.) If we get back in touch with our physical selves, if we become more aware of our habits, posture, breathing, and movements, if we allow our bodies to influence the way we think and act -- if we do all that, we will be in a much better position to take care of our bodies and our minds.

The theory problem

The theoretical underpinings of the various maintenance disciplines can be hard for a rationalist to take in with a straight face, and that's a bit of a problem. If buying the theory behind a maintenance discipline is crucial for you, you might have a hard time finding one that meets your needs.

I, at least, cannot listen to an explanation of the "chi" concept without being reminded of Obiwan Kenobi explaining "The Force" to a wide-eyed Luke Skywalker. To be fair, it may be that this is so only because "The Force" is a wholesale appropriation of the "chi" concept by Hollywood. All the same, I can't help pointing out that there is a difference between the level of plausibility required of a science fiction movie script and the level of plausibility required of a theory of health. It may be my loss, but I am unable to feel that The Force is with me, and this didn't help me in my earlier efforts as a student of tai chi (although the larger problem there, to be honest, was my inability to accept the forbidding personality of my teacher, who seemed to be dictatorship incarnate).

In terms of unpersuasive jargon, it can get a lot worse than tai chi. Practioners of shiatsu, for example, see the world as being composed of five elements (earth, metal, water, wood, and fire), each of which represents a special kind of energy which is associated with particular senses, tastes, colors, seasons, feelings, and vital organs (in the case of the "wood" element, that would be vision, sourness, blue,  spring, anger, and the liver). I could go on, but if it's okay with you I would much rather not.

I am not, by the way, trying to suggest that tai chi and shiatsu don't work. I am merely explaining that I would rather not hear very much about how they work, if that's as far as anyone has got towards developing a plausible explanation for them. I think I'm not alone in feeling this way. As a practical matter, teachers of these arts in the United States have learned to downplay the theoretical side.

You are probably not going to attend a yoga class and find yourself deeply immersed in South Asian mysticism; yoga teachers are aware that the fear of encountering that sort of thing can keep potential students away, and they know better than to push too far. They concentrate almost entirely on that branch of yoga known as hatha yoga (the only one of yoga's six branches that relates to body maintenance). The other five branches of yoga, which are unexplored territory to most American yoga students, concern themselves with meditation (raja yoga), devotion (bhakti yoga), service (karma yoga), ritual (tantra yoga), and intellect (jnana yoga). If I were marketing yoga in the U.S., and I looked at those options, I would be the first to agree that the branch that makes people's sore backs feel better is the one to run with.

No matter which one of the various maintenance disciplines you take up, there is going to be a theory behind it, and you are likely to find out what that theory is. Then you might just have to deal with the fact that you don't believe a word of it (and feel slightly insulted that someone expects you to). The good news is that you don't need to believe it -- at least not literally. You'll be fine so long as you can learn to accept the theory, whatever it may be, as a metaphor for processes not yet understood.

Metaphors are useful in training situations, even when their untruth is self-evident. For example, when you are learning to play the violin, it can be useful to imagine that the tone of the instrument is being produced by your breath, just as a singer's tone is, and to play sustained notes "from the diaphragm". Obviously this isn't true in any literal sense, but imagining that it's true is very useful: it helps you focus your attention on tone-production and phrasing, and also helps you feel more connected with the instrument (and therefore more relaxed). Musicians adopt all sorts of fanciful mental imagery when they play, not because they "believe in" these visions, but because they find them useful as a means of getting the mind and the body into a cooperative partnership (and not into an adversarial relationship, such as exists between body and mind when the musician is feeling too tense and frustrated to be able to play well).

It might be best not to mention to your tai chi instructor that you are treating the chi as a metaphor; that can be your own secret. Anyway, what matters about a maintenance discipline is not "how does it work?" (a question unlikely to be answered in your lifetime), but rather "does it help me?" (a question which you can probably answer for yourself, pretty quickly, through personal experimentation).

Anyway, the real selling point of these disciplines is never the theory behind them but rather the results that they get. Once you have met some of the older people who have been practicing yoga or tai chi for many years, and noticed how limber and strong they appear to be, you begin to believe that you can benefit by following their example. Once you have attended a few classes, and noticed that your body is feeling better and moving more smoothly than it has in a long time, you begin to believe that you might be on to something here. Much as I like to understand the theory behind anything affecting my health, I am not going to reject something that's helpful to me just because I don't know how it works. I don't know how aspirin works, either, but when I have a headache I know what to do.

Which one to choose?

Because there are so many of these disciplines, and they are so varied in their approach, there is almost bound to be one that is both right for you and available to you. Admittedly, the tai chi listings in the local phone book might not be as numerous in Cedar Rapids as they are in San Francisco, but if you do some web searching and some personal networking, my guess is that you will find something. The current popularity of yoga will probably make that your best bet, but in some areas Pilates is very popular as well. There is probably a teacher or practitioner in your area who can give you instruction in one of these disciplines. If you can't find anyone like that, you may be able to find a book or video on one of them which is sufficiently explicit to support self-instruction (however, in-person instruction is usually far better).

My own maintenance discipline of choice is yoga. Because yoga is so popular, your chances of finding a local teacher are pretty good. Because there are many forms of it, your chances of finding one that works for you are also pretty good. Because there are so many kinds of yoga poses to do, even within a given variety of yoga, you are likely to find solutions for whatever specific problems you are having.

My yoga class meets on Monday nights, and my teacher is very adept at sizing up the students, determining who is aching where as a result of their weekend activities, and putting together a program of yoga poses that relieves the stresses and strains that they are dealing with. Considering how hard I sometimes work out on the weekends (long hikes, long runs, long bike rides), it's good to know I'm going to have a yoga class on Monday, and will be getting some help in recovering from the event. Also, doing yoga before the event is helpful in preventing it from hurting me much in the first place.

I'm not particularly pushing yoga, though. If you find something else that helps you, go for it. But my advice is to find something. Track down a teacher of one of these disciplines, and see what you can do to cut down on the tension in your body. Trust me: alcohol alone won't do it.