Saturday, 28 November 2015

Run, Forest, Run

Getting my feet wet at the river jump
The River 'Jump', Run Forest Run, November 2015
It feels as though I've been building up to this for ever, because it has been a year since the idea of taking part in this event occurred to me. A year ago I was part of the support team, serving bacon butties and cake to around 40 runners who had run 5k from the village of Chiddingfold to a nearby bit of woodland, then gone round an obstacle course before running 5k back to the start. This event was named 'Run, Forest, Run' which is a reference to the classic movie Forrest Gump - you'll have to look it up if you haven't seen the film. At that time, as you can read in my contemporaneous report, I dismissed the idea almost immediately.

Run Director Bruce
and Timekeeper Freya
Back then I hadn't been running for very long, but as I continued to surprise myself by keeping up with the running program I decided it would be a challenging but achievable target to work up to. Also, because the organisers are my friends, it would be less daunting than a public event run by strangers. So at the weekend I packed a wide range of clothes to address as many types of weather as I could imagine, and took myself down to Surrey (stopping en route for a quick visit to mum and dad, who are remarkably well at the moment).

Lola II and Mr M were there too - naively I thought it was for the social aspect and as a public-spirited gesture to our organising friends. In fact, I found out it was only in order to support me, so I am very grateful. They were allocated marshalling duties in the forest obstacle course at the log pickup and deposit.

Log pickup marshal Lola II

Race Relations Officer Mr M
The weather this autumn has been unseasonably mild - until the weekend arrived and forecasts were for plummeting temperatures. Knowing how Lola II fares in the cold (hint - not very well) I was slightly concerned for her, and also for myself, not wanting to freeze during the running either. In the end we were both fine, and it was the mud rather than the cold that slowed me down. Although it didn't actually rain, the going was 'soft' underfoot. At the point where the mud came over the top of my shoes I decided that I would focus on remaining upright rather than clocking a fast time.

The Forest Marshalling Team
So now I've done a competitive 10k plus obstacle course race, and in fact my time was perfectly decent especially taking into account the sections where it was so slippery that I could barely walk let alone run. We had a good laugh about the obstacles afterwards - my short stature put me at a significant disadvantage when it came to climbing over bars and jumping across streams. I'm planning to carry on running, but I think I'll stick to 5k Parkruns for the time being.

Me and my log in the forest

Friday, 20 November 2015

Study Day

Round, ivy-clad decorative brick tower
Part of Rugby School, May 2015. I really like the slanty windows
I have mentioned carbohydrates on here so many times - they are the mainstay of the British diet in the form of cereal, bread, potatoes, pasta, rice, pastry and flour as well as all the sweet and sugary food and drink, fruit, milk and yogurt. Carbohydrate is also the dietary component that raises blood glucose in people who have diabetes, which can cause poor health in the long term. For this reason, we are coming round to the idea that it makes no sense to encourage people with diabetes to eat lots of carbohydrates.

A reduction in consumption of sugary food and drink has always been advocated, and not just for people with diabetes. This is why the 'traffic light' labelling system on the front of some food packets includes the amount of sugar. But starchy carbohydrate and natural sugars in fruit and dairy products were not restricted in the past, despite the fact that they are also converted to blood glucose when they are digested. Glucose from starchy food, fruit, milk and yogurt enters the bloodstream a bit more slowly than glucose from sweet things, that's all. But if you don't have diabetes, you only really need to care about sugar.

So when people with diabetes come to see me, they always know that they're not supposed to have sugary foods, and they commonly mention that they have been told that brown, wholemeal or granary bread is good for you, as well as lots of fruit. Sometimes they say they can't have bananas or grapes. They have usually picked up this information from non-specialist Dietitians or nurses in their GP practice, or from friends and relations with diabetes.

It now seems to be accepted among Dietitians that limiting all types of dietary carbohydrate (not just sugars) is a valid and beneficial approach for people with diabetes, and very recently Diabetes UK seems to have accepted this idea and at last - at last! - the dietary advice on its website has changed. It used to recommend that carbohydrate foods should make up a third of your diet, or up to 14 portions of starchy carbohydrate a day. Now the same web page suggests you should 'try' to have some wholegrain carbohydrate every day, but acknowledges that you may be advised to reduce the amount of carbs that you eat.

Carbohydrate intake is only half the story; the other factor that leads to raised blood glucose in Type 2 diabetes is insulin resistance, which is often caused by excess weight around the waistline. Most people with Type 2 diabetes are overweight or obese, so I try to recommend that my patients replace the carbs with vegetables that are lower in calories than carbs, which should result in a calorie deficit and very welcome weight loss. Reducing carbohydrate intake reduces blood glucose levels on a day-to-day basis, and losing weight lowers blood glucose in the long term by reducing insulin resistance,

There are some who are not particularly overweight, and therefore cutting the calories from carbohydrates needs to be balanced by an increase in calories beyond what vegetables can provide. For these people we have up to now suggested protein and healthy unsaturated fats: monounsaturated (from olive and rapeseed), polyunsaturated (from sunflowers and corn) and omega 3 (from oily fish, nuts and seeds).

Diabetes Specialist Dietitians are generally a mild-mannered lot (as are most Dietitians). However, there is a militant faction of Dietitians who declare that not only is there no evidence of harm from saturated fats (derived from animal sources), but that these fats are positively beneficial. They promote a low carb high fat (LCHF) diet, and not just any fat, but saturated fats.

The difficulty is that these LCHF people are either deluded or they are visionaries, and we have no certain evidence to tell us which. On Friday I attended a study day where one of the highlights was a debate between a leading proponent of LCHF and a respected academic research Dietitian. Both argued their case admirably, although unfortunately the advocate of the LCHF diet was a little less articulate and let herself down with a couple of poor examples that weakened her case for me. In the end, the consensus is still that we believe saturated fat promotes cardiovascular disease, but there's a chance that it doesn't. Unfortunately it is impossible to conduct human trials that are sufficiently long-term, randomised or blinded to give us the evidence we need, especially as people eat food not nutrients.

The study day also included discussions about the pros and cons of weight reduction through surgery or extreme calorie restriction, the 5:2 fasting diet, a protocol for adjusting diabetes medication in a weight loss programme, and the AGM of the Diabetes Dietitians' Specialist Group.

The session about the 5:2 diet was presented by the Dietitian who invented it within the setting of breast cancer management, and she made the point that there are now three times as many books about the diet than there were participants in the trials that supported it. The diet she invented involved two consecutive days of very low calorie intake separated by five days of 'normal' eating, whereas the common version now in the public domain has separated these two fasting days. Evidence is scanty, trial participants were all women (breast cancer, remember), and the end message was that we have no long term evidence about either benefit or harm. It's pretty unlikely to do any damage (unless there is blood glucose lowering medication or insulin in the mix) so if it works and people lose weight then we're fine with that.

The other diet discussed was the 'Diabetes Reversal' diet pioneered in Newcastle, which involves restriction to 800 calories a day. The rationale for this was because people who have bariatric surgery for weight loss and who have Type 2 diabetes often experience sudden remission in their diabetes and normal blood glucose levels immediately post-surgery. The researchers wanted to investigate whether this outcome was due to extreme caloric restriction alone, or something else to do with the surgery.

Their original study put people on the diet for 8 weeks and required a portion of vegetables every day alongside meal replacement products, and it showed impressive results. They have followed this up with a bigger study - the biggest research grant ever awarded by Diabetes UK - which is for 12 weeks' restriction with meal replacements only. All the information about the original diet is in the public domain on their website, so anyone can try it, and a number of our patients have done so. We are now considering how to support our patients if they were to choose this option for weight loss.

The other sessions I attended at the study were interesting but not remarkable. Back at work, this blog comprises the main reflection I have carried out on the day's experiences. My colleagues are working on a way to offer people a choice of weight loss pathways and I'm planning to use their approach in my service, once they have ironed out the wrinkles.

Saturday, 14 November 2015


A selection of obscure Indian vegetables
Southall, November 2015
Our new data projector has been installed at work!! All those months of nagging and chasing have paid off, and at last we are able to display Powerpoint in our education room, along with videos and other Internet content. It's only taken about 18 months to achieve, and I'm delighted. My joy is somewhat diminished by the others in the department commenting that now they'll be able to watch TV at lunchtime. I'm hoping that they're joking, but I'm not sure that they are...

Meanwhile, I have been to That London again, this time entirely avoiding the horror of M&M World and instead having a lovely time celebrating Diwali with food and fireworks. For a few years Lola II and Mr M have made an annual pilgrimage to Southall which puts on a fine show for the festival of lights, and I joined them in an absolutely delicious Indian meal followed by standing on the railway bridge playing with sparklers and watching all the many different fireworks displays that are visible from that standpoint. I ignored Guy Fawkes night this year but I do enjoy a firework display, and ten simultaneous displays is even better.

I got there slightly early, and being the kind of obsessive Dietitian that I am, I made a point of checking out some of the specialist produce on offer in the local emporia. While I know a fair amount about Indian produce, the fresh green veg is a bit of a mystery, so I took lots of photos and I will have to do a bit of research later.

Lola II with a sparkler

Friday, 6 November 2015

What I've been reading

Image of the book cover

The Valley of Fear
by Sir Arthur Conan Doyle

narrated by Simon Vance
"A brutal murder in an English country house leads Sherlock Holmes to unravel the grim and gruesome story of the Valley of Fear."
I imagine Conan Doyle still resisting the pressure to produce yet more of these dratted Sherlock Holmes stories, so in this book he created a mystery murder that is solved by the end of the first half of the book, and then spends the second half writing a story that he actually wants to write. Which is perfectly fine by me, even though the fact that it is set in America makes the narrator's job a bit more difficult.

Image of the book cover

by Stephenie Meyer
"When Isabella Swan moves to the gloomy town of Forks and meets the mysterious, alluring Edward Cullen, her life takes a thrilling and terrifying turn. With his porcelain skin, golden eyes, mesmerizing voice and supernatural gifts, Edward is both irresistible and impenetrable."

I picked this up on a whim from a big box of free books, because in its day it gained a reputation for being as good as Harry Potter and because the films made of the story are supposed to be excellent. Well, it is not as good as Harry Potter, nowhere near as good. It is actually quite boring for 80% of the way through, then there is one huge exciting action-packed event for about 20 pages, and then it gets boring again. I really won't be reading any more of the series and I will be putting it back into the box of free books where it came from.

Image of the book cover

Equal Rites
by Terry Pratchett

narrated by Celia Imrie
"Right before the wise old wizard Drum Billet died, he passed on his magical staff of power to the newborn eighth son of an eighth son. Unfortunately, Drum Billet never bothered to check the gender of the newborn baby, and it turns out it was a girl."
After all those years of attempting but failing to read his works, I've turned into someone who actually likes Terry Pratchett. However, Audible should be ashamed of the audio quality of this book, which sometimes sounds like it was recorded at the bottom of a well, and at other times includes strange pauses in the narration. Despite these issues I did enjoy the overt and the implied humour - at one point I got the distinct impression that he was describing Discworld magic in the same terms as particle physics.

Image of the book cover

The War of the Worlds
by H. G. Wells

narrated by B. J. Harrison
"Giant cylinders crash to Earth, disgorging huge, unearthly creatures armed with heat-rays and fighting machines. Amid the boundless destruction they cause, it looks as if the end of the world has come."
To be honest, it isn't really a very good book, even though it's well known enough to be called a Classic. The story is told in a rather pedestrian way, nothing much happens and there's virtually no change of pace from start to finish. I wouldn't have minded much if the Martians had won, I didn't care about the narrator's missing wife, and it wasn't even a War - certainly the native humans did nothing but get killed or run away. It highlighted a bit about life at a time when horses pulled buses and flying machines hadn't been invented, but that's all it has to commend it.

Image of the book cover

Reverse Your Diabetes
by David Cavan
"Based on the latest research and proven results, this clear and effective programme outlines the key steps you need to take to turn around your health, and tackles the myths and misinformation that surround type 2 diabetes."
Obviously this is a work book, but it recommends something that is causing some controversy in the world of diabetes and lifestyle - reducing or limiting dietary carbohydrate. [I think the subject might need its own blog post quite soon, maybe after a study day I'm attending this week.] Apart from the carbohydrate thing, it covers every relevant aspect of Type 2 diabetes in a readable and not over-long book, and encourages people with the disease to take control by learning what they can do to improve their own situation, and then planning and making sustainable changes where they can. This is the textbook for my approach to diabetes. If only change were as simple as reading a book.

Tuesday, 3 November 2015

Nothing interesting at all

Mr M took this photo somewhere, August 2014
I'm sitting here thinking about what to write, but I can't talk about the main things I'm involved with at work and at home, either because of professional confidentiality or just because they're not appropriate for a public blog. So I'm left with a few inconsequential happenings - the boiler's had its annual service, I've made lentil soup, I took some garden rubbish to the tip, I had a massage. I sewed a bit more of the dress I'm making for sister D. I met a friend in Birmingham and saw the remodelled station with its John Lewis (good) and new branch of Wasabi food outlet (better).

I've written enough about badminton and running, books get their own post, and the films I've watched have been OK but nothing special. So what's left? Honestly, I don't know. I haven't done anything particularly interesting recently. The new car is running fine. The garden is running wild. The house still needs loads of work doing. I haven't been on holiday. The clocks went back so it's dark really early.

Lola and Mr M and vertical tubes of coloured M&Ms
M&M World. Just Don't.
I did go down to That London for a family event, and Lola II and Mr M took the opportunity to expose me to M&M World, which is four enormous floors of M&M branded tat right next to Leicester Square in the heart of the West End. They justified this 'experience' by saying that they are educating me in the ways of London folk, but I would prefer to stay thoroughly provincial and never see M&M World ever again. But I've given you a nice picture of Lola II and Mr M in front of the rainbow of pick 'n mix M&Ms.

All of a sudden, out of the blue, something slightly interesting happened at work - the IT guy turned up with four large monitors for us to replace the tiny ones we've been using and which work perfectly well. We beg, plead and pray for a data projector, but without even asking we get replacement monitors; it's very peculiar. And not really that interesting after all. Sorry about that. If we're lucky, something properly interesting will happen next week.

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