Thursday, August 21, 2014

How to Maintain: FAQ

I'm fasting for my annual checkup blood tests, which includes HbA1C, cholesterol & triglycerides, all indicators of my cardiac risk and of how well, on the whole, I've been controlling my blood glucose levels. I had my physical exam last week and all was well. It's been 7 years now that this has been the case.

Seven years of controlling my Type II and CVD risk factors with nutrition and exercise. Seven years with numbers in the "normal" range or better. And yes, seven years at my target weight.

Sometimes folks ask if it is "as they say" harder to maintain this weight (and really, I guess, that means healthy habits too) than it is to lose the weight or make the needed changes in the first place. I have a clear answer: no. It's way easier. But that's just one of the questions I get asked about weight loss. I usually try to change the subject to the broader category of healthy behaviors. Because I really never set a goal of losing weight, it was just a means to the other end of getting healthy and getting to a place where I didn't need to take medication to control my risk factors.

But I know folks want to know about losing weight and maintaining weight loss. So...here are some other questions folks sometimes ask, presented with short answers. If you have others, feel free to ask and I'll answer them too.

About Me & Losing Weight

Q: So how much weight did you lose, anyway?
A: About 70lbs. I was 230 at my heaviest. For the last 7 years I've been within a few lbs of 160 with zero exceptions.

Q: How long did that take?
A: About 9 months. Apart from the first week with some water weight loss, I didn't drop more than about 1-2 lbs per week.

Q: Did you hit a "plateau?"
A: I didn't graph it, but I do recall weeks with losses less than 1lb. But otherwise it was pretty steady.

Q: So, how did you do it? Diet? Exercise?
A: Both. I did 45 minutes of vigorous exercise 6 days a week. I counted carbohydrates and calibrated my intake to achieve a normal steady-state blood glucose level between 100-140 mg/dl, with the high number being less than two hours after eating.

Q: Yeah, but what was your diet?
A: No restrictive diet. Just counting everything, watching what the food did, then adjusting portions, timing, and choices to get the BG results I wanted. I still ate (and still eat) everything.

Q: So you still eat sweets and stuff.
A: Oh yes.

Q: Wait, so did you count calories?
A: Nope. Because all calories aren't the same. (try getting fat eating celery; pandas can do it, but you can't).

Q: So did how did you set a goal weight?
A: I didn't really. I eventually got to a place where my other numbers - the ones I was really monitoring like BG, A1c, etc. were normal, and that determined it. Now, somewhere between 160 & 165 is what I try to stay at, but only as a shorthand for the other things.

Q: Ok, so then how do you figure out how many carbs equals the right amount?
A:  That took a while. But you can only do it by monitoring your BG.

Q: So about this *exercise*...what did you do to lose the weight?
A: I've written a lot about this, so I'll keep it simple. I rode my $300 7-speed comfort bike on an $150 indoor trainer. I did structured workouts consisting of short, intense intervals and varied these each day. I did it all while watching inane sports talk shows.

About Me and Maintaining Weight
Q: So what do you do now? is it the same?
A: No. I eat a little more and exercise a little more, on average, than before.

Q: How much more do you eat?
A: Not much. Roughly 1 more carb unit per meal per day than when I was trying to lose weight. That amounts to 2-3 units for breakfast, 3-4 for lunch and 3-4 for dinner and usually one 2 unit snack somewhere during the day too, depending on how active I am that day.

Q: How much more exercise?
A: About 6-12 hours per week. On the high end of that range in warmer weather. At least half and sometimes more than that is vigorous exercise (heart rate above 75% of max.)

Q: So why more exercise?
A: Just for fun.

Q: Oh, so that's not all for keeping weight off?
A: No...for that I'd need only about 75 minutes of vigorous exercise per week, or 150 minutes of moderate (less than 60% of max hr).

Q: So this HR thing...is this important?
A: Only as a measure of intensity. Your body will only adapt to exercise that is a challenge. If you do the same thing over and over and never challenge yourself, you won't cause change. Bodies are amazing at adapting to things. The cool thing, though, is that intensity is better than duration for causing adaptation. So a little hard exercise can be as good for you as lots and lots of moderate exercise. (so stop reading on the treadmill).

Q:  But you are some kind of cycling freak now, right?
A: Kind of, yeah, but that's not required. It's just fun for me. (although when you burn 9,000 calories in a day you *can* pretty much eat whatever you want)

Q: So you are now, like, normal? I mean no diabetes or anything?
A: Clinically yes. Normal numbers. I'll find out if that's true still next week when my latest tests come back. But I've had an A1c near 5 for the last 7 years. So far, so good. And much better.

Sunday, July 20, 2014

Buying a New Bike: Do, Don't Do, and FAQ

So you are thinking of getting a new bike...
One of the things that my friends and colleagues often ask me about is buying a new bike. Usually, they haven't been on a bike since they were young. They might never have set foot in a bike shop. Given the way the bike market has diversified - with lots of different models and brands available - it can all be quite intimidating.

I can't tell you in words just how much I LOVE giving this kind of advice! See, I can only buy so many bikes for myself before a) my sanity is questioned, b) my marriage begins to crumble (though since Leslie rides too, we are delightfully co-dependent). So helping others select a new bike is a great way for me to get the vicarious thrill. Also, it fills me with joy to think about the feeling my friends have when rediscovering the bike.

If you are thinking of getting a new bike, here are some things to do, things to not do (or not worry too much about, and then answers to some common questions!

Buying a Bike (for the first time in a long time): DO...

...go to a local bike shop (LBS). Bike shops sell bikes that are better quality than those offered in retail stores. The frames, the components, and perhaps most importantly the assembly/setup is worth the extra cost.

...visit several shops in your area. Bike shops have personalities, and they carry different brands and models to serve different kinds of riding. They do this to be competitive with one another, but also because the people that run these shops usually do so out of love (it's a VERY low-margin business and a tough way to make money) and out of dedication to a vision of one sort or another to provide something needed in the community (e.g. a woman-friendly shop, or a shop that caters to recumbent riders).

...build a relationship with the LBS that fits you. Your bike will need service and you'll need a reliable place to get supplies like tubes, tools, etc. As your riding changes, you may also need other gear like a bike rack or bib shorts. Buying these from your LBS will help them out (the margin on these items is often better than on bikes, which is super low).

 ...think ahead about the kind of riding you want to do. This should be the first question you are asked when you are looking at bikes. How often do you plan to ride? How long will your typical ride be? Where will it be? On bike paths? on dirt trails? on the road, perhaps to work or to the farmer's market? maybe a little of all of these? Why are you interested in a bike? for exercise? for a source of green transportation? for long-distance bike tours? Answers to these questions will help narrow down what bike *categories* are best suited for you.

...think about your budget. Entry level bikes at bike shops will run from about $400 to $1000 depending on the category. You may also need a few accessories right away which can add some cost, namely a helmet, water bottles, bike shorts or other clothing, pedals and shoes (for road bikes, especially), etc.

...ride several different models that fit your riding needs and your price point. The good news about bike shop bikes is that they are very, very similar in overall quality and - because competition is very tight - all the major manufacturers (Specialized, Trek, and Giant are the big three) offer similar models at similar price points. You may need to go to more than one shop to try all of the ones that appeal to you. But riding them - outside - is essential.

...buy a bike that fits you. You can only do this by riding them. So go do it. You'll feel the difference.  How can they differ so much if the quality is all similar? The simple answer is that they have different frame geometry (the shapes/sizes of the main triangles that form the bike) and even small differences in geometry can make a surprising difference in how the bike feels depending on your own body. A good shop will help dial a bike in to your comfort zone, but even after all the adjustments are made to the seat, bars, etc., the fit will be better on some bikes than others. Just like a pair of pants.

...buy a bike that you LOVE. I mean it. Buy the one that is so gorgeous it quickens your pulse. The one you can't take your eyes off of. The one that makes you want to get on and go! I hereby grant you permission to care about the colors, the leather seat, the lug details where the seat tube joins the bottom bracket, the sparkly streamers that come out of the bar ends... A bike you love is a bike you will ride. And for all the expense, there is no bike more expensive than one that you do not ride.

Buying a Bike (for the first time in a long time): DO NOT...

...settle for shabby treatment by an LBS. If you can't get your questions answered when you are actively interested in a bike, or if you get attitude because you are looking at one kind of bike that the salesperson doesn't happen to like, this is not OK. I recommend that you  wrap up your visit and walk out. Go to another shop. The experience in the shop matters.

...buy a bike without riding it. It's like buying pants off the rack without trying them on. They might look good and they might be the right waist and inseam numbers. But they could be tight through the hips. Or they could pinch when you sit down. And they will just hang in the closet unworn, mocking you.

...worry about the brand of bike. If you are buying from a reputable shop, all the brands will be good. In fact, if you are buying one of the major brands, odds are they are made in the same handful of factories overseas anyway. If you are buying from a more boutique maker, you'll be paying a little more but you may or may not get a better fit (unless you are going full custom, bespoke, crafted just for you...but that's another post). Buy the bike that fits you, suits your riding needs, and that you Love. Brand be damned!

...be afraid to ask for an extended test or demo. Bike shops will usually let you take a bike you like for a weekend to see if it will work for you. Go for it.

...spend more than you are comfortable spending. Bike prices scale up mostly as a function of the components on the bike - the wheels, the drive train (e.g. crank, derailleurs, gears, shifters...collective known as "the group" or gruppo) and your all-important touch points: the saddle, the bars, and the pedals. Frame materials contribute to cost too, but not as much as you might think. So...don't feel bad about sticking to a lower price point at first if you need to. Why? you can always upgrade the components later as your riding changes.

...leave the shop without everything you need to actually ride the bike. Got a helmet? pedals? If you don't, you'll kick yourself.

...discount the health impact a bike can have, and factor that into your thinking about costs. I haven't spent a dime on health care costs apart from my health insurance contributions (out of my paycheck from work) in four years. A lot of that is due to my bike. Well worth it!

Buying a Bike (for the first time in a long time): FAQ

1. Should I wait for a sale? Probably not. Because bikes are already sold by shops at a very low profit margin, sales are not frequent and when they happen, they are usually only offered on models that shops need to clear out of the shop. If the model doesn't happen to fit you (either in terms of style, size, or look) you'll be out of luck anyway.

2. What about used bikes? Like on CraigsList.
I know this can be tempting. I've bought a bike on CL myself. But only after watching it for 2 YEARS until the bike I wanted came around... The main reason I don't recommend buying a used bike is the LOVE thing. It's hard to find a bike that you'll feel passionate about that way. And depending on the condition, etc., it may not even be a bargain.

3. Can I buy a bike online?
It is possible, though most brands sell only through authorized dealers/shops. There are business reasons for this, of course, but also a customer-service reason. See above all that stuff about riding a bike first and fitting, etc. Hard to do that online. So...I don't recommend online purchases for a first (or first in a long time) bike purchase. It's just too hard to get everything right.

...got another one? fire away!  use the comments or tweet @billhd



Thursday, July 17, 2014

Riding a Bike: Why It Doesn't Get Old

Unlike my "it's complicated" relationship with running, I love cycling. And while I'm mostly a road cyclist, I enjoy all forms of riding a bike. Commuting to work, cruising on fat tires on a bike path, plowing along a gravel road or trail. I don't have much experience on singletrack or trails, generally, but I'm pretty sure I'd like that too.

Now, compared to running, there is really no contest. Riding is way better. And I don't want to make this all too complicated. So here's my simple test: is it enjoyable while I am actually doing it? Bike: yes! Run: not really.

But just in case you need a nudge, here's a list of things that, for me, never get old about riding a bike:
  1. Speed. It is fun to go fast. Feeling the wind in your face. You can go fast on a bike. Even if you aren't some kind of hard core racer, you can  still go fast downhill. It makes grownups smile just like kids every time.
  2. Getting to know the land. You really learn a lot about the roads and the terrain, the sights and the natural features, and yes the traffic and the people who live near you when you ride a lot. Every bump and pothole, every stretch of silky new tarmac, every wooded glade with a country lane winding through it become part of your consciousness, on a bike, in ways that they never do in a car. It's possible to get to know places this way on foot too, but you just can't cover anything like the same amount of area that way.
  3. People who ride bikes are pretty great people. The bike tends to create experiences that challenge riders, and for those that have shared the challenges, there is a bond. This bond makes us want to help each other - we've been there or, maybe, we'll one day be there - and, beyond the karma of paying one forward, we likely have a reason to pay one back. 
  4.  Riding is an activity where you can actually talk - we aren't hammering all the time - and get to know each other. 
  5. Riding with others builds trust. When you are riding close together in a group, it benefits everyone to get to know the others nearby. Not just names (or sometimes not even names) but habits, strengths, experience. It helps keep everybody safer when we are all able to trust the wheel ahead, especially when we are zipping along at 25mph.
  6. Recovery from a bike ride is easier. Easier than running, easier than most other hard workouts. I can almost always ride again the following day even after a long or hard ride. This means I can ride more often too. And get more out of each ride if I have some kind of health or fitness goals that I am working on.
  7. The bike will take whatever you give it. Some days, you can give it all and the bike will happily oblige, letting you empty the tank only to wobble home cross-eyed in desperate need of rest and calories. But the bike is also happy to spin along at 10 miles an hour while you laugh with your kids. 
  8. Bikes fix what is wrong with you. Emotionally and physically, there are few problems that a bike can't help with at least a little bit. Only if you ride them, though. I've seen them transform lives - mine included - and make a bad day into a good one countless times.
The other day, I was talking with a friend of mine bitten by the bike bug last year. He's in deep now. I was mentioning that I don't try to evangelize bikes, nor do I think of my own affinity as something like a religious conversion. But he convinced me that despite that, I did manage to spread the good word whether I meant to or not. By example, sometimes. And by recommendation (if not admonition) at others. I concede the point. But you needn't convert or do what I do or what he does. There are lots of ways to ride a bike and to experience all the things I listed here. Nobody even has to know.

Monday, July 7, 2014

Running, at 44: Why?

Last week I turned forty four. Today I ran five miles. And as one does when on a training run, I did some thinking about running. So here's my version of the listicle genre, all about why I'm still running thirty years after I first started.

1. I like to be able to run. And I like to have run. 
Even though I don't like running much anymore, really. Two out of three are enough to keep me going. The first sentiment is about being in good health and feeling like I can still do something that I used to do when I was young. The second thing is about feeling accomplished and feeling tired in a good way - something that solves another problem lots of people have but which I am blissfully free of: sleep issues. Plus, you never know...


2. I am an athlete. And running is a core ability for athletes.
There is an identity thing going on with me and running, even though I'm not a straightforward "runner." I once was that. Today I ride bicycles more than I run, but I still like to think of and conduct myself as an athlete. I like to train and prepare for things, even if I don't compete all that often. And running is important to lots of other sports, of course, so it's useful on the rare occasions where I do one of those.

3. When I do compete, I like to do well.
I still enter a race every now and then. At least two a year for the last several years, and sometimes a few more. And while I haven't gotten faster as I've gotten older, I have gotten relatively faster compared to the others my age. Most of that is due to the fact that fewer people my age run at all, and those that do enter races likely don't train. I do not do much running-specific training, but I ride a lot and that has been enough to keep me competitive in my age group.

4. I like to suffer.
Yeah, I know, it sounds sick to say it. But the truth is you can get to a place where you enjoy going to a place that most people avoid when it comes to engaging in intense physical activity. A lot of that is the thrill of exploring your own limits, mentally and physically. And some of it is being out of your head and in your body in a truly physical way. The ability to push hard and then a little harder is something you strive for, and the discomfort (not really pain) is feedback. How hard can I go? Can I do a little more? It is hard to beat running for a pure physical test of your ability to go and keep going. It is so simple that it takes very little skill to get to your limit. And with no mechanical advantage, just you and the road, it's go or no go.

5. A good workout doesn't take long, is portable, and is really effective. 
If I have the shoes and proper clothes, a run is something I can do just about anywhere I go. And unlike a bike ride, I can squeeze one into a half hour and feel like I've got a thorough workout in for the day. 

So there are five reasons I'm still running after all these years. I go a little slower than I used to, but I don't really miss the speed relative to the clock like you might guess. I don't suffer any less for going slower, and as I said in #3 above, I actually do a little better in races these days so I don't care about the time so much. I do miss being able to recover from running fast - like the next day - as I used to when I was young. And I miss the ability to thermoregulate so effectively so that it isn't quite so tough on a hot day. But I imagine that despite these things, I'll still be running in another thirty years if I'm able to. The age groups are really thinned out in the 70+ category!

Thursday, May 29, 2014

Chronic Illness: How Riding (and Giving) in Public Might Help

It is almost June, and that means that we are close to the 2014 Tour de Cure, a fundraising 100 mile bike ride that benefits the American Diabetes Association. As of today, I've raised $400. You can help out by making a donation too. If you do, it just might make you healthier.

That might sound like a stretch, I know. But stay with me on this one.

Diabetes - both types - is a chronic illness. There is no cure (yet), and so people with a diagnosis have to learn to live with and manage the effect of chronic illness. In the general sense, those of us who manage diabetes and its impact on our lives are far from alone. In fact, the CDC reports that up to half of all U.S. adults deal with chronic illnesses at any given time.

Chronic illnesses, including cancer, heart disease, hypertension, asthma, COPD, arthritis, and diabetes,  rather than infectious disease, constitute the major health challenges of our generation in the United States and, increasingly, the world.

Chronic illnesses present different, and very difficult, challenges for treatment and prevention too. Not just on a population scale, but on an individual one. First, the big ones on the list above - heart disease, cancer, diabetes - effect critical systems in our bodies and do so in a systemic way and on a molecular level. This means the problems are pervasive throughout the body, they get more severe over time, but they do so in very very tiny ways. Often we don't even know what is going on until a disease is fairly far along. And then, once we do know, we may or may not be able to do something about reversing or slowing the effects a disease has.

When I got my diagnosis of Type II Pre-Diabetes, I was lucky. I had time and I had options to respond. About that same time in my life, I'd recently lost loved ones - family members and friends my own age - to chronic illnesses where there were few, if any options, for treatment beyond palliative care. Knowing that, I wasn't about to sit by and ignore the chance I had to improve my health.

Sometimes we call it "fighting back." We want our loved ones with chronic illnesses like cancer to have strong resolve, to muster the will to "battle." But managing chronic illness isn't really about battling. Or, at least, it's not about going on the offensive. It's more about playing great defense and shifting your priorities to make your body function as well as it possibly can given the circumstances.

TdC 2007 at the Start
And that's where, for me, riding a bike came in. I rode a bike because I could do that to address nearly all of the risk factors I had been diagnosed as having. Amazing, right? One change with lots of potential good outcomes. And for me, it worked.

But you know what also worked? Saying, out loud, in places like this blog and on Facebook and to my friends and family in person that I was riding my bike. That I was going to do an event like the Tour de Cure and ride 66 miles (the distance of the first couple I rode).

And I am not alone. I'll spare you the long version, but suffice to say that there is a lot of research in a lot of different exercise and health behavior areas done by a lot of different people for the last 30 years that show basically the same thing: if you express your intent to change your behavior to be more healthy in social settings, including social media, you'll be likely to make those changes.

So...why not try it? Announce it here (in the comments) or on Facebook. Donate to my campaign as a way to keep both of us going (heh, no really, that works too!). And then let me know how it works for you.

One last point about chronic illnesses: nobody asks for them. In many cases, they are genetically linked and so we inherit all or some chance to have them affect us. But it is also true that what makes them tough to treat and prevent is the fact that how much they shorten or otherwise impact our lives is usually the product of not just one thing (like a bite from an infected mosquito) but maybe thousands of little decisions we make every single day. But that also means that if you start today making little decisions that go the OTHER way...towards a healthy, longer life...you are helping to solve one of the most challenging problems of our time. So, make some good choices today. And a few more tomorrow. And change your life, or some one else's, for the better.

Tuesday, August 6, 2013

The Quantified Self, Qualified

I've said on a few occasions here that the single biggest change I made when I began to get healthy was paying more attention. By that, I mean to my physical self as a whole. I started behaving as if I actually *am* a body made of flesh and bone and neurotransmitters. In my line of work, as an academic, it is surprisingly easy to go through days, weeks, months, and years doing otherwise. I call this "brain in a jar" syndrome. Over time, though, I found ways to pay attention to specific things about my physical self, specifically what I was eating, what activity I was doing, and how those things influenced my overall health and well-being in measurable ways.

I've talked about mindful eating, for instance, and how important the simple act of keeping track of what you eat each day can be. Tracking what you eat allows you to reconcile inputs with outcomes that you are trying to manage, like your blood glucose if you are controlling diabetes symptoms, or your blood pressure if you are managing cardiac risk. It can also, of course, help you adjust eating habits to meet goals related to body weight (losing, maintaining, or gaining).

Paying attention is, in itself, something that seems to have positive effects on goals many people share such as weight loss. My view is that paying attention is necessary, but not sufficient to be healthy. Others who posit a more direct relationship between paying attention and achieving healthy outcomes might say that the problem is one of a lack of knowledge due to insufficient information. My view is just a little different. My view is that it is a lack of *feedback* needed to determine if actions taken in the present are actually getting you somewhere. It's a subtle, but important difference.

Let's take weight gain/loss as one example. It doesn't happen quickly. That is a good thing and a bad thing when it comes to what you are eating on a given day. On the plus side, it means you can have birthday cake on your birthday. That piece of cake won't make you unhealthy, it likely won't contribute in a measurable way to your weight one way or another. If you have a piece of cake every day, well, that's another story. Unless you compensate for that in other ways, you might well see this new pattern start to produce new outcomes as time wears on.

Making changes that improve your health, especially lifestyle changes known to improve chronic disease symptoms such as high blood pressure, also may not have obvious effects very quickly. Even when you are on the straight & narrow, it is hard to know you are on the right path if there aren't any road signs. What paying attention lets you do, though, is keep track of the path. Even if you aren't seeing the destination (because it is yet over the horizon). The pattern of new behavior, itself, can begins to take shape on paper or, increasingly, on a computer screen.

Flying By Instruments
In the last several years, a range of new devices have been introduced designed to track activity, sleep, and other things. All of these can sync with computers and/or mobile phones, too, so that the data collected can be visualized and tracked with relative ease. Medical devices, too, can provide data streams. And because much of the logging work is passive, the act of paying attention to each little detail (such as how many steps one has taken) becomes easy enough to do routinely.

I've written about how I charted my eating & blood glucose levels like a mad scientist when I was first diagnosed with T2DM. That tells you how much I enjoy this sort of thing. So I've been looking forward to getting one of these tracking systems - I say system because we are really talking about one or more sensors + the log/visualization application - and seeing what it could do. I've been using one of these, a fitbit flex, for a few weeks now. And last week, I undertook to save some reports so I could reflect and share them a bit here. I had some initial trouble with the first flex I received, which was frustrating. It simply wouldn't wake up and track anything. But after a couple of weeks, the company sent me a new one and it has worked fine ever since. I really like it, in fact. But this is not a product review. My aim is to show you how the information allows me to pay attention to things and, importantly, what I try *not* to obsess over amidst all the data available to me now.

Broadly speaking, my goal in using the fitbit is to monitor how well my day-to-day, often subconscious choices about what to eat, drink, and how to move through the world might influence my health-related goals. Do they bring me closer to them? Do they take me further away? Or, more subtle, do my choices take me on a garden path rather than a beeline for my most important goals? That is, are there adjustments or course corrections I can make that could add up to something better? Since the course I'm navigating is long (in this case, there is no true destination or end state other than "being healthy"), I can't see where I'm going. In some cases, the outcome itself is invisible anyway because the indicator is an internal bodily state (e.g. blood pressure in a healthy range). No visual flight rules, in other words. Before, I was flying mostly by feel. Now, I'm flying with instruments.

My Week with Fitbit
The graphs I'm sharing here are not the day-to-day visualizations from the fitbit dashboard. Those are cool, and they give you a sense of what you are doing on a given day. Those displays have altered my behavior already. I'm motivated to hit my step goal (don't ask me why...it's hard wired for some reason), so I'll work out ways to get an extra walk in. I'm also motivated to keep my calories in/out balance acceptable, even though I'm not terribly concerned about calories as a measure of what I eat. That balance is a pretty good indicator of my more general goal of "moderation." But when it comes to nutrition and its role in my overall health, I care more about the type of food those calories come from. In that regard, the chart below is very helpful for me.

Food

Where did my calories come from?
With a weeks' worth of meals as input, this chart shows me that I'm achieving the balance I hope to with regard to carbohydrates, fat, and protein as components of my diet. I also see that I generally use more calories than I take in on a given day, but that this difference is not so extreme that I would see changes in my weight beyond a pound or so. My numbers for carbs and fats are low and high, respectively, the report notes. That's ok for me, though, since I'm doing diabetes. My fats tend to be the healthier ones too (Omega 6 & 3, which this report doesn't show).

The data to build the chart above comes from self-reporting via the fitbit dashboard food log, not the sensor I wear on my wrist. Maybe one day soon, I'll have an implant that allows for passive collection of nutrition data, but not yet (hey, a geek can dream, no?). So let's have a look at how I used up calories last week using data the sensor does collect.

Activity

Overall Activity Compared to My Gender/Age Group (U.S.)
I know that some of my friends and family think I'm some sort of crazed exercise freak. Probably due to all those 100 mile bike rides. But really, in an average, week, I'm not spending hours and hours exercising. Last week was pretty typical. And it puts me on the high side of the curve for my age and gender demographic...but not way, way out there in terms of overall activity (measured by calories burned). What is more interesting is how I achieve that. I don't have a job that has me moving very much. In fact, my line of work may well pose the single biggest threat to my health these days given that I manage everything else pretty carefully.

My point is that I have to get to an "active" lifestyle by being very conscious about moving during a given day. I have to make time for it and make it a deliberate part of my routine. Sometimes this involves making small changes in my habits like parking farther away from a building rather than closer. It also means I need to plan for some "very active minutes" to offset my hours of butt-in-seat time at work. And fitbit helps me track those very active minutes too.
My Very Active Minutes Compared w. U.S. Population
Ah...now we see a big difference. I averaged 78 very active minutes per day during my week, which puts me way out on the long tail (so far, you can't see my little green line very well in the graph on the right). A couple of things are also worth noting. This reflects not only my walking, but also my planned exercise, which included two runs and two bike rides. This is a pretty normal number of exercise sessions per week (four) but is a slightly higher amount of overall minutes because it is summertime. I am not training or preparing for any events, though, so this is about as baseline as we can get. A good overall picture of how I try to stay active in a job that doesn't involve much movement.

Sleep
Something new to pay attention to, for me, is sleep. The Flex tracks sleep patterns, including how long it takes me to fall asleep and how many times I am awake and/or restless overnight. It uses those to compute a sleep efficiency score, which I really had no reference for prior to seeing the results on my dashboard. I have always been - knock wood here - a good sleeper. I can fall asleep easily and wake up easily. I sleep soundly, rarely get up during the night, and can sleep in all kinds of different conditions (hot, cold, noisy, bright, etc.). No complaints. And I don't take this for granted. Sleep is awesome. Thank you, sleep.

With the data I can see, I am somewhat validated in my sleep identity. I'll spare you the charts, as they are kind of boring, but I'll say that I sleep about as much as others my age and gender (about 7hrs per night last week, on average) and that's in the recommended range. I sleep a little more soundly than most (with 96% efficiency, meaning that I don't wake up often once I nod off) and I go to sleep quickly compared to most (within 7 minutes, on average).

Result: Steady as (s)He Goes
So what's the point of all of this? It's a happy and relatively straightforward one for me, at this point: my actions are in line with my goals. I'm doing what I hope to be doing, for the most part. And I'm doing it consistently. I'm not trying to lose or gain weight in significant quantities, and I'm not likely to based on my activity last week. I'm looking to stay active through the day even when I'm spending lots of hours sitting. My active minutes are good, but my overall activity shows that I have to remain vigilant given that my workday makes it all too easy to be sedentary.

All of this gives me confidence, via the feedback loop established here, that my choices are good ones. If I keep making similar choices, I'll likely see the results I want to see. This, to me, is the real benefit of the "quantified self" technology craze. It is not something to be found in the volume of information itself. It is the confidence that comes from seeing evidence that your actions are aligned with your goals. That's a qualitative thing from all this quantitative data.



Saturday, June 22, 2013

Ride Report: 2013 Tour de Cure Michigan

It only took me a week to find the upside of riding for 12.5 hours, on a soggy trail, in the rain, uphill on the Great Allegheny Passage. Doing so makes riding 100 miles on perfectly lovely paved roads, in perfectly dry and reasonably cool weather, seem downright easy. That was my day on Saturday 6/15 at the Brighton, MI Tour de Cure Ride.

I rolled out with a lead group of about 20 and we would mostly stay together through most of the first 50 miles, with a little leapfrogging due to folks choosing to stop, or not, at the various rest stops. The TdC folks do a great job supporting this ride, and there are stops every 15 miles or so. I hit stops 2, 4, 6, and 7, and cruised through the others on the route which loops through parts of two MI state recreation areas: Pinckney & Waterloo.

The stats: I finished the ride in 5 hours, 40 minutes including all the stops. Rolling time was about 5:20 or so. I rode with my HRM and generally tried to go no higher than my zone 3 threshold of about 167 BPM until the last 21 miles when I gave myself permission to go as hard as I wanted to on the climbs back up from Hell to Brighton. I've done this course enough to know that this is the time when all the weekend warriors not used to going long would be loaded up with lactate and struggling home. I had been there in years past, because it is so easy to overcook the first 40 since it is mostly downhill.

Bill at Hell's Handbasket
All day, I rode well within myself in a Leipheimer-like effort. Then, after the last fuel & water stop at mile 79 in Hell's Handbasket where I got a fellow rider to snap a quick photo, I took off up the climb like a bat out of Hell.

I passed most of the folks I'd been riding with all day and soloed home for the most part. I offered my wheel a few times but everybody was waving me on. I felt like my energy-saving plan worked well. I had done a 5:20 century and enjoyed every turn of the pedals. Even what I like to call the "tough 20" between miles 60-80 that tends to be the most mentally taxing part of a 100 mile exploit seemed to fly by. I wasn't racing, and I could have likely gone a little faster (I'm sure I could do a sub-5 century alone now and, if I had a group to work with in an organized way, could likely do a lot better than that). But it was a great day on the bike all in all. And I was back in Brighton by lunchtime.

Most importantly, though, this ride is all about raising funds for the American Diabetes Association. I beat the drum on social media, and my wonderful, generous, and dedicated friends, family, and colleagues respond every year! This year, we once again produced a top-ten effort in terms of individual fundraising campaigns for the Michigan TdC. Thank you, thank you, thank you!!

I continue to be inspired and energized by all of your support. Thanks to you all! We'll see you next year for this event, for sure.

And...stay tuned, because the June of Centuries continues with one more amazing ride coming up: the Allegrina 100!

Wednesday, June 12, 2013

Ride Report: 2013 Ride2CW on the Great Allegheny Passage

On Thursday, June 6, I spent twelve and a half hours in the saddle riding the Great Allegheny Passage from Pittsburgh, PA to Frostburg, MD. Twelve. And a half. Hours. It was 125 miles. It was hard. It was wet. It was rainy and windy.  And it was, uh, uphill.

Here's what I'm talking about:
http://www.atatrail.org/tmi/elevation.cfm
See Pittsburgh there on the left? and see Frostburg 119 miles from there, near the peak of that big pointy bit? The tippy top of that pointy bit is the Eastern Continental Divide, marking the point where rivers West of the divide drain into the Gulf of Mexico via the Mississippi River and various tributaries, while rivers East of the divide drain into the Atlantic Ocean.

That was a great moment, riding through that tunnel. After spending all day riding uphill, it meant I could go downhill for the first time. I nearly shed a tear. Shortly after that, I crossed the Mason-Dixon line into Maryland.

I did not imagine this ride would take me quite this long.  But the wet conditions made this a much tougher ride in the second 2/3 or so of the trip. The trail itself is crushed stone and is quite well-maintained. Apart from a stretch in Homestead, PA and a few small sections here and there, there's not much pavement. And when stone dust gets saturated, well, its' slow going.

I made great time in the first 40 miles or so to Connelsville, averaging a little over 18mph. But as the track got slower, I also got a bit more tired. The elevation was not epic - there are no steep sections at all except for a bridge or two - but combined with a mushy trail it means that there is no end to the pedaling. Ever. Must pedal.

As with all epic rides (you can't plan an epic ride, they just have to happen to you), I learned a lot. Here are a few things I'd pass along:

1. Everybody else I saw was riding the GAP trail the *other* way. See elevation chart for details. Getting the climb out of Cumberland, MD out of the way early in the ride, I can imagine it would be a pretty nice trip down to Pittsburgh. If you can arrange that, give it a thought.

2. Ohiopyle State Park in PA is amazing. Hands down, the most scenic part of the trip. If you want a picture for your mind's eye, this is the area where Frank Lloyd Wright's famous house Fallingwater is located. The bike trail goes through the cliffs all along the Yough river(s), Upper and Lower. Fantastic.

Photo by Mike Mcleod @mcleodm3
3. Trail miles are not the same as road miles. I knew this in the abstract, of course, which is why I brought my 'cross bike. But this trip brought it home. In dry conditions, I think this ride is feasible in 8-9 hours counting stops to fill bottles, etc. It would help to have someone to ride with too. I did it alone. Though I had a friend up the road who I was hoping to meet up with (he did an out and back from Frostburg) we never quite made the connection.

4. The Homestead trailhead area is a fine place to overnight. It is suburban, near a big mall complex, with several hotels nearby. I got dropped off here and rode to the trailhead the next morning to start. After a long day in the saddle, I was very much looking forward to a shower and a bed. In Frostburg, mine were waiting for me in a dorm at Frostburg State University. Not quite the Holiday Inn Express. But the rooms there are available to riders who need a place to stay.

5. A few of the towns really cater nicely to riders on the trail. West Newton, Connellsville, Ohiopyle (the town), and Meyersdale all have nice stopping places where you can fill bottles, grab food, and rest near the trail. Because this is a converted rail trail, these town had stations that are now converted to trail visitors centers and most seemed to be staffed during working hours (9-4).

6. When you ride with an extra 20ish pounds of gear on your back in a backpack, a corresponding pressure is applied to the sit bones, altering ever so slightly but in a manner that is culumulatively consequential the otherwise well-seasoned touch points on one's saddle area. For the first time in years, my backside was sore during a ride. That started about halfway in. No lasting damage, but man was I glad to get out of that backpack. I don't have panniers, but I'd recommend them to anyone doing this trip.

All in all, it was a ride I'm happy to have done. It was for a great cause...we raised over $3000 for the Ride2CW supporting graduate students and fixed-term faculty grants. Apart from the weather, it was fantastic. The route was great. Kudos and thanks to the folks in Pennsylvania and Maryland (the GAP trail goes to Cumberland, but picks up another and continues all the way to D.C.) for this fantastic resource!






Monday, June 3, 2013

100 Miles of Nowhere: On a trainer in front of a bike shop with a big finale edition!

It would all end with me throwing up over and over and over again...



















...but, you know, not in the bad kinda way. (that's what we call a "flash-forward"). My 2013 Fat Cyclist 100 Miles of Nowhere ride was a true nowhere affair this year. I did it on a staionary trainer in front of my local bike shop: Denny's Central Park Bicycles in Okemos, MI. We are fortunate to have several really great bike shops in Mid-Michigan, and I truly have nothing bad to say about any of them. But the folks at Denny's have always been helpful to me and the staff is geeked about bikes. All bikes and every bike. They love 'em, and they love that we love 'em. And all of that shows.

I was really happy when Dave, the store manager, gave me the green light to take up some sidewalk in front of the store this year. I set up before the shop opened.

Dave had me come in during the morning meeting where I told the techs and the sales folks what I'd be doing. They loved it right away, and one even said he'd rather set up another trainer alongside and do the ride with me than work...and, he was quick to add, "I love working here!" This goes to show you just how crazy bike people are. The Denny's crew ran bottles for me all day and were frequently coming out to get the race radio update.

The Ride
It was overcast and breezy in the morning, with some chance of rain. I quickly made a show of displaying my rain jacket on the nearby bike rack in plain view of the cycling gods to temper any hubris. This worked, because it stayed relatively cool, breezy and at least partly sunny all day. I rode non-stop, sans dismount, for 5 hours & 26 minutes to achieve the 100 mile goal. That's about 18.5 mph, a pace that allowed me to talk with folks as they passed by and to generally be something other than a suffery, sweaty man in front of store.

And that turned out to be the best part of the whole ride: talking to folks about what would possess me (and hundreds of others in divisions all their own) to do such a thing as ride on a trainer on a perfectly lovely day in June. "It's Fatty," I said to one person who asked me precisely that question. "He's a really persuasive dude." Which is true of course. I mean, I've never met the guy and here I am with his name on my jersey pedaling along to no avail right there in public.

But of course the bigger reason is what Fatty is up to. And it is, I suspect, what a lot of us are up to, too, who do the 100 Miles of Nowhere. We are out to ride in a way that not only makes our own lives a little better, but makes others' lives a little better too. Fatty has found a bunch of ways to do that. He raises money for great causes that matter to him and that have touched the lives of people he loves.

Why I Ride to Nowhere
I wrote all about that already in an earlier message, so I won't re-hash it all here. But I ride to nowhere because riding to nowhere gave me my health back. I don't hate the trainer like some do. I am deeply grateful for it. Don't get me wrong, I love to ride on the road and go fast. But riding on the trainer is what got me to the place where I could do that.

I dedicated my 100MoN to a fundraiser of my own - my American Diabetes Association 2013 Tour de Cure campaign.  We raised $601 dollars in a single day on Saturday, bringing my total so far for this year over the $2100 mark with a couple of weeks left to go. Truly awesome. My #100MoN entry fighting cancer, and the ensuing spectacle inspiring others to fight diabetes.

Thanks to all who helped!

Friday, May 31, 2013

Why I ask for your support and your money (it may surprise you)

Why Do I Ask You For Money?
For the last six years, I've been asking you for money. And giving my own away too, in support of the American Diabetes Association, mostly. And you've responded with enthusiasm! Over that time span, together, we've raised over $10,000!

This year - 2013 - is no different from the past few years. I'm asking you for money in support of my Tour de Cure campaign. I ride, you give. 100 miles, every one of them backed by your dollars. And they matter. But maybe not just the way you think they do.

Tomorrow I'll be once again asking for your support. One final big crazy event before this year's TdC on June 15th. Before that 100 mile ride, I'm going to ride 100 miles, going nowhere, on a stationary trainer in front of Denny's Central Park Bikes in Okemos, MI.

Inevitably, folks ask me: why? why do such long rides? why be so public about it? Here are a few good reasons:

1. I *feel* your support, every bit of it, with every pedal stroke. It sustains me and keeps me pedaling when I think about all the people out there who've chosen to lend a little confidence in me by giving away some of their hard-earned cash. It is the way I maintain my behavior changes.

To put it another way, I create a public account of this journey to get and stay healthy. And by creating that account, I am account-able. You see it. I know it. And hopefully you create accounts of your own. Maybe lighthearted, but I hope also inspiring. These accounts could change your life. Or someone else's. For the better.

2. Clinically, since May of 2007, I don't *have* diabetes anymore. My risk factors are in check and my blood glucose values are in the normal range. So are my cardiac risk factors.

But this doesn't mean I am back to the way I was. I don't *have* diabetes because I *do* diabetes. That includes being mindful about eating and exercising. It includes, for me, riding a bike. Those things make me healthy. They have made a big, big difference in my life. One that I can prove with evidence from my medical chart, from my health care expenditures, and from my overall quality of life.
3. I *do diabetes* publicly to inspire others. And it really has done that. I know because people tell me. They write with questions about how to start riding a bike. They write to ask what to do differently when they have a new diagnosis. Or to ask how to help a loved one who has one.

I am happy and proud to show to the world what, to some, might be embarrassing. Before and After.
I do this because for me, the change was real. And I believe it can be real for many others too.

So why do I ask you for money? It is a symbol of your commitment. An invitation to join the team. To help me and others - especially those you love - *do diabetes* so fewer of us *have* it.

Your dollar is a beginning. I'd rather have you beside me on a bike going down the road, or better yet, I'd like to have your own account to keep the account-ability going. There is real research to show that this sort of group dynamic really works to keep people healthy. I won't bore you with it here. But let me ask one more time:

Support my campaign here: http://main.diabetes.org/goto/billhdTdC2013

Then make a further investment in a change. For you or someone you love.

Thank you!

Friday, May 24, 2013

And I would ride 100 miles, and I would ride 100 more...

June is going to be a busy month on the bike! I've got four - count 'em - four centuries on the calendar. And I'm looking forward to every one of them. Here's the list, just so we can keep it all straight.

June 1st - 2013 100 Miles of Nowhere Ride

The first big ride is coming up on June 1st and is my second consecutive 100 Miles of Nowhere. This year, I'll be on a stationary trainer in front of a local bike shop. My registration fee for that ride supports a Cancer charity fundraiser sponsored by Elden Nelson, aka, Fat Cyclist.





June 6th - 2013 Ride2CW (Ride to Computers & Writing)
 
This is an annual fundraising ride supporting the Computers & Writing Graduate Research Network Travel Scholarship fund. The fund pays travel stipends for grad students and fixed-term faculty to attend the annual pre-C&W network forum and the conference. It is a great cause! Click the link above to donate! My ride this year will take me from just outside Pittsburgh, PA to Frostburg, MD which is the site of this year's C&W conference, at just over 100 miles along the Great Allegheny Passage.



June 15th - 2013 Tour de Cure Michigan

My main fundraising event each year, this will be my 7th consecutive ride in support of the American Diabetes Association. My 2013 campaign is going along well - we've raised nearly $1500 so far and have about three weeks left as of this writing. The ride is a lovely 100 mile route. That takes me through Hell, MI, among other truly beautiful places. Watch this space for more about that ride. And run, walk, or ride over to my donation page to support the campaign!




June 23rd - 2013 5th Annual Allegrina 100 

Last, but by no means least, is the best little century around! The Allegrina 100 benefits the John Allegrina scholarship foundation and is, without question, a wonderful event organized and ridden with fabulous people! I strongly encourage all riders of all levels to check this event out. It is organized as a series of successive loops, which makes it ideal for riders doing their first event or doing the event with family members. Folks can do one or all of the loops, start early, start late, etc. There will be great food and fine, fine beverages at the start/finish area, the historic Felt mansion in Holland, MI. Best of all...you can still register! 


I'm also sneaking in at least one road race on foot, the Dexter-Ann Arbor Run 5k, on June 2.It's going to be a great June! Hope to see many of you out on the roads and trails!



Friday, May 17, 2013

Hack Your Metabolism, Part III: Sending the Right Messages

Note: this post is part three of a three part series. If you like it, consider contributing to a fundraiser called the Tour de Cure. If this helps you or someone you love, please consider clicking here to see more and donate to support my campaign on behalf of the American Diabetes Association. Thank you!

In the first part of my "Hack Your Metabolism" series, I talked about mindful eating and in the second installment I talked about what role exercise plays in regulating blood glucose and, ultimately, in losing or maintaining body weight.

In this final segment of the Hack Your Metabolism series, I want to talk about something that the two other discussion have in common. In my experience it is not obvious to most people, nor even to experts. And so it is the closet thing to "a secret" if not the secret behind making metabolic changes that improve your health in a measurable way. Including controlling body weight.

Here it is: mindful eating and the kind of exercise "dosing" I discussed both trigger long-term changes to the messages your body sends to regulate your metabolism. Insulin signaling is one of these types of messages, and an important one, for regulating the way your body uses energy.  What's counterintuitive about this is that we don't often think about changing eating habits or doing exercise as anything but direct interventions. That is, we think: eat less, gain less weight! Exercise more, burn more calories!

But our bodies are more complicated than that. And they are really, really good at adapting to external conditions that effect the most fundamental functions: eating, drinking, breathing, etc. It's that homeostasis thing again.

What I'm arguing here is that we should think of changes in our eating habits as a way to re-wire the circuits and change the messaging patterns that resulted in an increase in health risk. And we should adjust our expectations to how (and how long it takes for) the changes to take effect accordingly. This is a bit tough to get, I know. It took me a long while. So let's think through the example that most people care about a lot: losing weight.

Losing Weight: The Secret Is, There Is No Secret...Right?
On the surface it is simple. To lose weight you have to use more energy than you take in over some period of time. Right? Well...yes. Kind of. Not always, and not exactly.

Dieting - as an intervention in eating habits - is the most common way people pursue weight loss. But as my mindful eating post hopefully made clear, not all food is treated the same way in the body and the processes that signal your body to break down fat to use for energy may not happen if you eat too little of something (like carbs) or only something else (like proteins). So the first thing to ask when you are considering whether a new way of eating is appropriate as an intervention for you is to ask: what kinds of messages am I trying to re-program by eating in this new way?

Let's talk Paleo for a second. It may be the current hot diet. As with others, it is shrouded in controversy. And as with others, it has some elements that have been shown to work. In particular, it has been shown in at least one small-N study to improve insulin tolerance (though not a rate much different than doing those short, quick bursts of exercise I wrote about in part II). That same study showed that, over 12 weeks, it had no effect on weight loss or waist size, however.

All of this makes perfect sense to me. Why? Because the change in eating habits implied by the Paleo diet would have the most immediate impact on messaging related to blood sugar. Why? Less dietary carbohydrates means that the body would need to get better at using the blood glucose available and would initiate some changes to do this. This may or may not include a metabolic state called "ketosis," a condition that is sometimes portrayed as a desirable end goal for folks on the Paleo diet. But ketosis is not best understood as an end state. It is, rather, an indication of both the metabolic functions and messaging going on in the body. Specifically, it refers to the presence of elevated levels of ketone bodies in the bloodstream, something that happens when liver glycogen stores (remember those? the bodies' mid-term storage medium for blood glucose) are depleted.

Endurance athletes are familiar with ketosis, even if they don't know it by name. We have to train our bodies to switch to a different form of fuel during long efforts (lasting more than 45 minutes). And the better trained we are, the smoother this transition goes so that it is easier to maintain a given level of intensity even after our more immediate sources of fuel - carbohydrates - are depleted.

I bring up endurance athletes because this is a group that explicitly understands their exercise and eating habits to be in the service of causing specific kinds of metabolic changes: those that increase athletic performance in their sport. They (ok, we) can get a bit obsessive about it, in fact. And so in this group we have some interesting examples of what happens over time when we induce something like ketosis. I'll give you the short answer: the body can adapt. Even in extreme conditions, human bodies can learn to use other forms of fuel - in the case of Paleo, fat and proteins - to get what it needs. And, just as importantly, our bodies will continue to adapt to make these new processes more efficient. Eventually, we'll see a new set of metabolic rules in place that keep the body in a homeostatic state...all regulated by a new set of messaging pathways.

Habits Are What matter
The paleo diet isn't magic. And its efficacy in any one human body likely has little or nothing to do with the fact that some strain of ancient humans that you may or may not share ancestral DNA with ate in particular ways. If it works for you it is because it rewires your metabolism in a certain way, for a certain amount of time, to cause changes that reverse negative outcomes.

Your body adapts and changes constantly. It's trying to keep you alive and healthy, but it is rigorously biased to attend to immediate, basic needs. It will fulfill those needs in the short term to keep you alive at the expense of longer term health risks. So it is up to your conscious self to keep those longer term risks in check while complying with your greedy brain's need for fat.

The good news is that almost any sustained change in eating habits can cause signaling changes. So can almost any level of exercise. For how long? well that depends. And what changes does it cause? well that depends too. But what this all means is that there are no perfect diets and no perfect exercise routines. There are only habits that cause changes - harmful or helpful. And that word - habits - is important. One time doing anything is not likely to cause *any* signaling changes at all! So eat a piece of cake. Once. It's fine. Run once, if you feel like it, but it won't magically make you healthy.

What we are aiming for when we hack our metabolism are durable adaptations. These happen when we apply a new level of adaptive stress, which is a fancy way to say "habits."

Like what you read? Feel free to share, make comments or ask questions below. Also check out my Tour de Cure fundraiser here and consider a donation! Thanks!

Monday, May 13, 2013

2013 100 Miles of Nowhere Preview: Now with 100% more juggling!

So last year, I did this crazy thing where I rode around my circle driveway (almost) 3000 times...

It was all for not one, but two really great causes. First, it was part of Fat Cyclist's fundraiser that he does each year, which is a thumb in the eye of cancer. And second, I posted and tweeted about my exploits and raised some money for *my* campaign for the American Diabetes Association Tour de Cure. My 2013 Campaign is underway. You can support it here!

This year, I'm doing it again. I'm registered for Fatty's 2013 event, which will raise money for Camp Kessem, a place where kids who've lost loved ones to cancer can meet others and do a little healing. I'm planning an equally absurd day in the saddle this year for 2013, and with similar hopes of a good day of raising awareness and raising funds.

Here's how it will go down. On Saturday June 1, I'll ride 100 simulated miles on a stationary trainer in front of my local bike shop: Denny's Central Park Bicycles. They've agreed to lend me a chunk of their front sidewalk so I can pedal my way to, well, nowhere. How did I come to this plan you ask? Well, I asked you! (or at least some of you...). I posted a poll. People voted. And the winner was a true 100 Miles of Nowhere. On one of these:
Here's an action shot:

I also took some suggestions. One of which was that I spend some of my time riding to nowhere while also juggling. This seems like a fine idea to me. And I am happy to consider others as well. Because you see the whole point is to make a spectacle of myself so that we might have more people paying attention to the ways that riding a bike can make you healthy! And we all know I'm not above making a spectacle of myself...

So feel free to make some additional suggestions in the comments section below about what I might do while riding my bike on Saturday June 1st. If you are in the area, drop by and ring a cowbell and support Denny's shop. I'll invite you all to support my Tour de Cure Campaign for 2013 too, of course, where we've already raised over $1000!


Thanks!

Tuesday, May 7, 2013

Hack Your Metabolism, Part II: What is Exercise For?

Note: this post is part two of a three part series. If you like what you've read, consider contributing to  a fundraiser called the Tour de Cure. If this helps you or someone you love, please consider clicking here to see more donate to support my campaign on behalf of the American Diabetes Association. Thank you!

In the first part of my "Hack Your Metabolism" series, I talked about eating and how to pay attention to what you eat and what that does to your blood glucose (BG). I made the case that even if you weren't watching your blood glucose due to risks associated with diabetes, it is worthwhile to pay attention to it anyway. Why? because it helps you to monitor the amount of energy you take on board. Too much energy coming in means that the body has to deal with a "rich mix" in the bloodstream: high blood glucose. Over time if this rich mix condition persists, metabolic changes start to happen. One that concerns most people is that you accumulate fat. Why? Because that is one way the body stores excess fuel it hasn't an immediate need for.

What Exercise is NOT For
This second installment of "Hack Your Metabolism" isn't precisely about fat, though. I bring up the subject because I want to address a misconception that many people have about the role of exercise in staying healthy, losing weight, and controlling BG. That misconception is that exercise is for using up the energy you took on board from eating a recent meal. Like earlier that day. Or even earlier that week. You hear this kind of thing all the time: "I have to work out later because I ate like a pig yesterday!" Or this: "I ran today, so I'm going to treat myself to a Triple Venti Frappucino with Whip..."

Yeah, no. That's not what exercise is for.

For one thing, it is difficult for most people to exercise long enough and with enough intensity necessary to make up for any "extra" eating they do measured in calories alone. That Frappucino? 510 calories. I'd have to run more than 20 miles at 10 min/mile pace to burn that many calories! But recall our little discussion about mindful eating. Did we talk about calories there? No. We talked about carb units. That little post-workout treat at Starbucks would be worth almost six of them (84g). And a big spike in your BG levels to go with it. Even if you worked out really hard and for a really long time - with a few little exceptions limited to the first 30-45 minutes after exercise - your body reacts the same way to that big cup o' carbs no matter what!

So What *is* Exercise For?
Adaptive stress.

Engaging in exercise presents a challenge to your metabolism causing adaptation. Ideally. Where there is no challenge, there is no change. This idea is consistent with our discussion of mindful eating. Recall that the body is amazing at mobilizing regulatory systems to achieve and maintain a sense of "business as usual." You might recall the scientific name for this: homeostasis. New stress on the system - whether it comes from lifting weights, pedaling a bicycle, or doing yoga - may present new energy needs to muscle groups as they are challenged. The body responds to these challenges not only in the short term (burning calories during a workout), but also by preparing for the next similar challenge. These longer-term changes are signaled and initiated during exercise, but take place long after the workout is done while the body is recovering from the effort.

So the point of a workout is the change that results when your body is at rest afterward. This includes an array of changes to your metabolic systems that regulate energy, its storage and its use. Your body is constantly adapting to the conditions it finds itself in, in fact, whether you are working out or not. It is always trying to achieve homeostasis. This is a moving target. When you are more sedentary, for instance, the body adapts to that too. Adaptations to chronic high BG, a condition that can happen when your intake of carbs keeps that "rich mix" flowing, put stress on the mechanisms associated with insulin response. The body usually adapts to these stresses in ways that maintain homeostasis, until it cannot anymore. This is a condition related to Type II diabetes (T2DM), but it is life-threatening on its own even when some of the T2DM symptoms are in check. It goes by another name: Syndrome X or Metaboblic Syndrome. I wrote about that in a post titled Rx:Bike. Some of the thoughts in that piece helped shape this one. Check it out. And then go ride a bike. But first, I have just a few more things to say about exercise and adaptive stress.

What Kinds of Exercise Produce Good Metabolic Changes?
I have great news in response to the question that I get asked a lot: "what kind of exercise should I do?" Answer: any kind! All kinds! Whatever feels fun to you. Whatever makes you smile and lifts your mood. Me, I like bikes the best. And running, well, it's complicated. But I do it. I've learned to like yoga. I hate push ups, but I like the core workout stuff ok. I love to play sports like basketball, softball. I even juggle. It's all good. No really.

It *is* all good because, depending on my fitness level and the kind of activity I choose, it can all apply a "dose" of adaptive stress that will produce positive metabolic changes (among others). The more sedentary you are, the more likely it is that any amount or any level of physical activity will kick off some positive adaptations. As you get more fit - that is, as your body re-models itself internally and externally to better handle the heightened needs for energy, strength, and endurance that your new activity level requires - the "dose" of adaptive stress will have to change in order to produce positive results. So you run a bit longer or a bit faster, lift a heavier weight, or maybe add some Zumba classes to your your twice-a-week water aerobics schedule.

It's all good. Potentially. But it is not all good for the same thing. Different kinds of workouts produce different kinds of changes, of course. But let's keep things simple and talk just about varying two factors of exercise that apply to almost every activity you can think of: duration or length of the workout and intensity or how much effort the workout requires.

Two Categories of Adaptations that Enhance Metabolism (And How to Cause Them)
As with my advice in Part I, the information I am presenting here is a mix of things that are well known if not always well followed and relatively new knowledge produced, in some cases, by some recent science. Some of it is quite surprising. I won't explain all of that here. But if you want a very engaging overview, check out The Truth About Exercise with Michael Mosely. What I will do instead is break down two kinds of changes to metabolism that seem to be related to different kinds of exercise. This, in turn, may help you exercise a bit more mindfully.

1. How to Enhance Your Insulin Response to Regulate BG More Efficiently

This one is easy and fast, if not painless: short, maximum-intensity intervals of exercise. This is sometimes called HIIT, or high intensity interval training. An interval is a timed unit. And an intense interval, in this case, means that you should be working at your full potential for a very short burst of time. A work interval is done at max effort for 15, 20, maybe eventually 30 seconds at a time. This is followed by a recovery interval that is at least as long if not longer. Just a few of those intervals - 3 or 4 to start and then maybe 5 or 6 later on - twice a week is all most of us need to see a measurable improvement in insulin response. The reason is not quite yet well known, but it is thought to be related to building and strengthening the neural pathways associated with insulin signaling. This effects the way the body uses insulin, and so this adaptation is not tied exclusively (or perhaps very strongly at all) to the way the body makes insulin (the science here is early days, but really interesting). So even if you get your insulin from somewhere other than your body, these kinds of exercises may help. And for those whose bodies make insulin, including those with T2DM, HIIT works.

As with all exercise, the adaptations we see from HIIT will begin to fade if the length and intensity of "the dose" is too consistent. So as you get more fit, you might throw some intervals into the middle of another, longer workout rather than just doing three 15 second bursts. Or you might vary the length, or the recovery period between. But the essential idea - quick, high energy bursts - remains the same.

How you achieve these matters very little in terms of the end result at the metabolic level, except that you have to put your whole body to work including your cardiovascular system. And so how you do them *does* matter in the real, macro world of your whole body and your life. Running is one way to do HIIT. But running even in short bursts at maximum effort is hard or impossible for some folks. It is a little easier on a hill. But with running, the biomechanics of the activity put limits on getting to that "maximum effort" level. I find it hard to do with swimming too, because my stroke is so sloppy I simply can't keep a short intense interval going (maybe I should swim with sharks?). I think a bike - and especially a stationary bike - is best for these exercises. A regular bike works too, though you need a spot where you can go all out with little risk. Up a hill is good for this because all out doesn't necessarily mean high speed. Weight lifting usually doesn't do it, but "circuit training" routines where you quickly move from one exercise to another with no breaks can certainly get you there. 

2. How to Get Your Body Using Stored Energy from Fat All Day, Every Day


Do long, steady, exercise that builds lean muscle and endurance. The opposite of HIIT in many ways, exercise that gets your body in a rhythm of converting glycogen stored in the liver to blood glucose and converting fat into glycogen to replenish those stores is slow, steady, and long. Like walking. More walking, more often, will apply a kind of stress that asks your body to use its energy system in a consistent way. I think of it as calibrating the "thermostat." Instead of lighting a fire to heat the house and then putting it out or opening the window when it gets too hot, we set a thermostat to cycle the furnace or boiler on in our house to keep the temperature steady and comfortable.

To work well - by which I mean to produce the effective adaptation - this type of exercise should not be too intense. Why? because that shifts the body to a different energy use method. Intense exercise produces a different, though no less desirable adaptation that we talked about above with HIIT.

For athletes and others training for reasons related to performance - i.e. racing or other forms of competition - it can be a tremendous challenge to slow down enough to let this kind of adaptation happen. It is also challenging for normal people like you and me for a different reason: time. Slow is slow. And if we only have so much time to spend working out, then we tend to want to "get the most out of it" and so we amp up the intensity. And that can be beneficial. But that might not be all we need.

The secret to doing this kind of exercise, then, is not to think about it as exercise at all. But rather to make small adjustments in everyday life to increase the amount (time spent) doing low-intensity activity. Instead of parking close to the mall entrance, park far away and walk. Take the stairs instead of the elevator. Get a fitbit or another pedometer and count your steps. Have standing meetings or walking meetings when you can. Walk to work. Ride your bike to pick up a few groceries at the store.

Putting It All Together: Applying the Minimal Effective Dose
I know not everyone enjoys exercising. I happen to. I like to find where my limits are and see if I can extend them. But testing your limits in a race or a crazy-long endurance event like a marathon is not necessary in order to hack your metabolism and get healthier. All you need to do at any given moment is apply the minimal, effective dose of adaptive stress. (I know this guy uses that term, and on this he's right.)

Exercise smarter, and yes sometimes that means *harder* and sometimes it means *longer*, but it doesn't mean go out and run a marathon or, maybe not even a mile. It means do what will challenge your body to adapt, today, in the way that will produce a better "normal" state tomorrow. That might mean doubling your steps per day and doing two HIIT sessions a week several days apart. It might mean a two hour walk on Sunday and run around the yard with the dog on Tuesday and Friday. You get the idea. What it means for you will change as your body changes. You'll be able to do more, do it faster, and do it for a longer time. As you change, your minimal effective dose will change. But if you apply it consistently, you'll not only change. You'll get better.

Like what you read? Feel free to share, make comments or ask questions below. Also check out my Tour de Cure fundraiser here and consider a donation! Thanks!


Sunday, April 21, 2013

Hack Your Metabolism, Part I: Mindful Eating

Note: this post is part of a three part series I wrote. If you like these, consider contributing to fundraiser called the Tour de Cure. If this helps you or someone you love, please consider clicking here to see more donate to support my campaign on behalf of the American Diabetes Association. Thank you!

How to Eat?
This is some information, and some advice, about mindful eating. I briefly considered calling this post "How to Eat" because when I left my doctor's office on December 15th, 2006 an hour before lunch time with a diagnosis of Type II Diabetes (T2DM), it occurred to me that I needed to re-learn what to do about eating.

I did not think that I'd eaten my way into the disease - and I have some things to say about that, but not in this post - but I did know that eating differently would be part of managing the risk factors that the doctor had ticked off for me that accompanied T2DM: high blood pressure, good cholesterol low, bad cholesterol high, and of course chronic high blood glucose (BG) levels. These are chronic symptoms with deadly impact if left untreated. In the immediate term, I knew I had to eat in such a way as to control my BG levels. That was the key to preventing immediate vascular damage and, managing those levels over the longer term would bring my cardiac risk factors in line as well.

But how in the heck do you eat to manage blood glucose? Even as a well-educated person, I didn't know. Now I do know some things about it, and I think I can offer others some advice. I'll tell you how I learned and what I learned. And I'll share with you a theory or two about how you can use this information to get to or maintain a healthy weight, which is also a very effective way to manage cardiac and BG-related risk factors.

A disclaimer: this is not medical advice. It is just plain ol' advice. I am not a medical doctor. I'm a bio-hacker. I am a Ph.D. who has studied the research literature carefully and I actively manage risk factors related to T2DM in my daily life. You should always talk about your health and any plans to improve it with your primary care doctor. If you find that hard to do for any reason, seek out a new doctor. For those confronting a new diagnosis of T2DM, you may also find it helpful to see a certified diabetes educator. The American Diabetes Association has a finding tool that may help. If you are covered by insurance, your doctor may be able to prescribe an education program that your insurance will cover. These programs are clinically proven to improve outcomes in patients. They are good medicine.

Step 1: Pay Attention
By far, the most important thing you can do to make a change in your health related to eating is to pay more attention to what you eat and drink. And by this I mean that you should be able to account for everything that goes in on a given day. Every. Thing.

This is a challenge at first, so I recommend writing it all down: items, amounts, and time of day. You might have heard of a food diary? This is what we are talking about. The U.S. National Institutes of Health has a good format you can get for free. So does diabetes.co.uk. And there are lots of smartphone apps, etc. you can find too.

Eventually, you'll want to track carbohydrates as well if you are managing BG. To do that carefully, you'll need to read some nutrition labels. Those of us doing diabetes (rather than "having diabetes") count carbs 15 grams at a time, and we call each 15g one unit. This lets you figure out a "budget" for your meals and snacks that keeps your BG levels where they should be. More on that below, but first a bit about carbohydrates.

Q: What Raises Your Blood Sugar? (and what doesn't)
A: Carbohydrates are the only thing that directly raise your blood sugar.  Almost everything else you eat does not. (Fat is a bit more complicated, because it has a systemic effect that can mess with the signals your liver gets about the need for more glucose in the blood. And so eating a high-fat meal may well contribute to longer-term rises in blood glucose levels. But it is not a direct cause.)

Step 2: Get Data (You can't hack code you can't read)
Blood glucose meters
Used by permission of Flickr user DeathbyBokeh
Before my T2DM days, I had no idea how BG levels worked - what is normal? what foods raise them? does exercise lower them? And, like a growing number of adults in the U.S., I was walking around with dangerously high levels of BG without being aware of it. That began to change when I got a glucometer. A glucometer is a device that measures the amount of glucose in your blood at any given time and gives you a simple number back: N milligrams of glucose per 100 milliliters of blood.

Now the reading you get from a glucometer doesn't tell you how well you are doing over the long term at managing your BG or those nasty risk factors I mentioned. It can only tell you what's going on in the moment. And the levels it reads are subject to all of the metabolic things going on right then and immediately before you test. So if you just ate a high-carb meal, your BG will be elevated no matter who you are. After a couple of hours, the body should adjust BG levels provided that that person's insulin response is normal. For those with DM (of any sort), it may take more time and more direct intervention to make that adjustment.

Get a glucometer and learn to use it. Test yourself a lot and write down the results. Chart them too if you know how to do that (see example below). When you first start, test more often. This will be expensive because the test strips are a huge racket. That's yet another post... But your doctor may be able to up your Rx for these as you first learn to manage your symptoms - ask for more - ask for lots of free samples too. The more data you can get the better in the early going.

Q: What is "Normal" BG?
A: Not to be evasive, but that's a difficult question if you read the stuff above. Why? Because it depends on when you test and what happened before that. Did you eat? Did you run a mile at a brisk pace? Your body dynamically and rapidly adjusts levels of BG to respond to the need for energy (or the lack of it). This "insulin response" is complex and involves multiple systems: nervous, digestive, endocrine, circulatory, musculo-skeletal. So normal is different for different people. What doctors agree on, though, is that after an 8 hour fast, normal adult BG should be below 125 g/ml.

Step 3:  Work the Trends
Once you can account for what you eat and test your BG, you can start to see trends. These trends can tell you how what you are eating affects your BG. Over the long term, they can also tell you if you are doing what you need to do to manage risk factors. There is another very important test for that called an HbA1C that is the gold standard for diagnosing DM, including T2DM. These are done every three months and they give you an extremely accurate measure of your blood glucose levels over that period of time. If you haven't had an A1C and your doctor is prescribing diabetes-related medications, go ask for one. It is essential information for managing your risk-factors.

But back to those trends...you should be able to produce a picture that looks something like the one below. Have a look and then we'll talk about why this picture is valuable for losing weight (yep, I said it)...


First, let me say that these are made up numbers. But they are reasonable and not uncommon for me today. They track BG every waking hour of two fictional days. The red line represents a day when I eat in a way that manages BG well. I stay in a zone between 90 and 130 BG. This level, by the way, corresponds with an HbA1C in the normal range over three months (below 6).

Here's another fascinating fact...the red line also stays inside the green zone, which is a "sweet spot" in my own metabolism when I lose weight (if I am trying to do that) or maintain a healthy weight (if I am trying to do that). To maintain weight, I need about 75 minutes of moderate exercise per week with one or two short intervals (15 minutes) of intense activity thrown in now that I am very fit. To lose weight, I would double that to 150 & 30 minutes. Do that, and the lbs. come off at a rate of about 1.5/wk unless I eat differently or exercise less.

So what is the blue line? That's a strategy I see lots of people trying when they are "on a diet." Follow along...it goes like this: wake up a bit low, but not overly so, and have only coffee for breakfast maybe with a touch of cream. BG stays below 90. Stomach grumbling, you eat one little thing from the candy bowl at work at 10 (17g carbs, one unit). Ridden with guilt, you eat only a salad and an unsweetened ice tea for lunch. BG continues to slide through the afternoon until you are starving at dinner. You've been "good" all day though, so you eat a low-fat meal of pasta primavera with garlic & olive oil only, some garlic bread, and a glass of wine. You also have two thin mint cookies for dessert. BG goes up after dinner and as you watch TV you can't resist a couple more cookies before you turn in. All in all, it's been a successful diet day. Or has it...

How much time do you spend in the zone on that kind of day? Not much. Compare that to the red line which goes something like this: Breakfast 2-3 carb units. Lunch 4 carb units. Dinner 4-5 carb units. After dinner snack 2 carb units. With that "carb budget," I'm in the zone all day.

I'll offer some more thoughts about what this zone is and why being at that level is likely good not just for folks with T2DM but for anyone trying to lose or maintain their weight in Part II when we talk about exercise.

Like what you read? Feel free to share, make comments or ask questions below. Also check out my Tour de Cure fundraiser here and consider a donation! Thanks!