What I've been reading

This Is How It Ends
by Kathleen MacMahon

"Bruno is a middle-aged American banker who has come to Ireland to escape the financial meltdown in his own country. Addie is an out-of-work Irish architect. Addie and Bruno’s story is one of nationality and identity, of the power of optimism to defeat despair and the unstoppable march of time."

The very last of my 12 Books of Christmas, all finished in only 14 months or so. I chose the order to read them at random, so it's been interesting that I seemed to pick the worst ones to read first - this one was pretty good, even though lots of loose ends were left hanging, but I didn't much care in the end because I wasn't particularly interested in the story or the characters. It's been quite an experience, reading all sorts of books that weren't chosen by me, and finding out what sort of stuff can get published. Maybe when I retire I'll have a go myself.

The Blind Assassin
by Margaret Atwood

narrated by Lorelei King

"Laura Chase's older sister Iris, married at eighteen to a politically prominent industrialist but now poor and eighty-two, is living in Port Ticonderoga, a town dominated by their once-prosperous family before the First War. While coping with her unreliable body, Iris reflects on her far from exemplary life, in particular the events surrounding her sister's tragic death."

Here we are, a satisfyingly complex book by a skilful author, but I am in such a quandary about the story. It's more than 18 hours of (outstandingly good) narration, and for about 17 hours I wasn't sure why I was listening, or what the point of it all was - there seemed to be no arc to the story, no change in the pace or emotional quality. The characters behaved as people do, went about their business, sometimes life was eventful, sometimes not. I couldn't see how it had earned its reputation (and its Booker Prize). Then it all changed. The last hour and a half has set me to wondering whether I misunderstood the whole thing, and for the first time ever with an audio book I wished it were a print book instead so I could flick back and check what really happened throughout, whether the clues were there and I just didn't notice. I'm going to have to get a print or e-book version, because most online reviews are so cagey about giving away key aspects of the plot that they don't go into the aspects that I want to clarify.

Memento Mori
by Muriel Spark

"In late 1950s London, something uncanny besets a group of elderly friends: an insinuating voice on the telephone informs each, "Remember you must die." Their geriatric feathers are soon thoroughly ruffled by these seemingly supernatural phone calls, and in the resulting flurry many old secrets are dusted off."

When I started reading this, it felt like literature, with proper characters, long words and what seemed to be heading towards a proper story. But it never seemed to go anywhere. As a characterisation of old age maybe it has some merit, but the mystery of the voices on the telephone is never explained and the crimes and misdemeanours of the participants are uninteresting and almost embarrassing. So, a disappointment in the end.

The Innocence of Father Brown
by G. K. Chesterton

narrated by Frederick Davidson

"With his round face, pipe and umbrella, the shambling, bespectacled priest Father Brown is an unlikely detective - yet his innocent air hides a razor-sharp understanding of the criminal mind. The wise, worldly, clerical sleuth has an uncanny ability to bring even the most elusive wrongdoer to justice."

I have read these stories on and off since I was very young, and thought I liked them. In fact, they don't really stand the test of time, and I now think Father Brown is a rather sanctimonious prig. The solution to each mystery is often impossibly complicated and far-fetched, and to cap it all, the narrator gave Flambeau a very French accent, which I also found annoying.

Forty Stories
edited by Cal Morgan

This was a free download onto our new Nexus tablet, which now is not so new, showing just how long it has taken me to get through the book. I don't know whether I'm not appreciative of the short story format, or whether they're just not very good stories. I suspect the latter.

Mostly walking and a bit of running

Canterbury pub

As usual, quite a lot going on, but little inclination to document everything. I remember when I used to write a lot about social stuff and holidays, but for some reason I'm not doing this so much. I suppose I feel a little exposed because anybody at all can read this blog, and while my family and friends may like to know more personal stuff, those who are more interested in the professional stuff may be put off. I need to spend some time thinking about who my target audience is, and who I'd like it to be, and how comfortable people I know might be if I feature them here. But I don't think I use anyone's real name any more, so perhaps it doesn't matter.

Last week, on the spur of the moment, Mr A and I contacted our old friends Landrover Man and Bee Lady, whom we see approximately once a year (if you go by the number of mentions they get on this blog). It was a beautiful day and we had a nice long walk and a lovely pub lunch and it was brilliant. We're going to try and get them over here a bit sooner than in a year's time, but it may still be a month or two away. We're working on it.

My 'Couch to 5k' plan is still going quite well, and I'm on target to be able to run 5 kilometres by the end of May, all being well. It's an interesting programme, with just 60 seconds running at a time at the beginning, and I've now managed to run very slowly for 20 minutes in one go without ill effect. I'm starting to see how I will be able to run 5 km by the end of the series, which I always believed but didn't quite comprehend how it might be achieved.

On the other hand, badminton is going through a difficult period, with my Club C in abeyance due to hall refurbishment, and lots of end-of-season administration with Club A because I am Secretary. Club C doesn't play over the summer, but Club B (where I used to play a year ago) does - but I took a break from Club B because of a few annoying members. I shall be going back to Club B over the summer to see if I can put up with said annoying members, and then decide which of them to join for next season along with Club A. It's complicated.

Mr A and I have just returned from a few days camping in Kent. We went on Saturday, arriving quite late, and then it rained all day Sunday so we went for as much indoor activity as possible, starting in Rochester with their local museum. The highlight for Mr A was a camera mounted on top of the building which you could control from inside - eventually he had to relinquish control to a visiting child. Because it was still raining we spent the afternoon watching a film, then it was still raining and getting dark and we couldn't read any more in the tent and it was getting cold too, so obviously we went to a pub to get warm, which happened to have friendly locals and live music.

On Monday the sun came out, so we went to Whitstable for our traditional Guinness, oysters and crab sandwiches on the beach. We walked along the beach all the way to Seasalter, then went back to the campsite to take advantage of the better weather in order to sit and read. Unfortunately, it started to rain again on Monday night, and didn't stop all night. For some reason Mr A woke up very early this morning and decided to make tea without looking at the time. When he told me my tea was ready I asked him if he realised it was only 6.40 a.m? We packed everything up in the rain, loaded it into the car in the rain and drove back in the rain - there's going to be a fair bit of drying out needed when it's a bit less damp outside.

Carbohydrate

Groombridge Place, June 2013

After much deliberation, I decided to call the talk I gave at the weekend 'Carbohydrate'. It was part of a scheduled day of talks from healthcare professionals at a public awareness day organised by the local Diabetes UK voluntary group. Other speakers included doctors, podiatrists, eye specialists and a paediatric dietitian who was planning to talk about exercise (unfortunately I missed most of her talk because I was talking to someone about injection sites).

A colleague had sent me a presentation that she had recently delivered, so I based mine on hers and stole her case study. I started by reminding people that all types of Diabetes are characterised by blood glucose that is higher than it should be, and that the source of glucose in the blood is carbohydrate from the food we eat. As a Dietitian specialising in Diabetes, carbohydrate in food is my bread and butter (not so much butter, actually), and then posed the question: how do I decide what advice to give to patients about what they should eat?

This brought us on to the evidence-based nutritional guidelines published by Diabetes UK in 2011, and the changes that this document brought to the accepted picture of healthy eating for Diabetes. The trouble with the scientific method is that as more evidence is accumulated and new guidelines are researched and published, our total knowledge increases and conclusions can change from one day to the next.

The new guidelines advise that the primary nutritional strategy in Type 2 Diabetes should be weight loss above all else, and what's more, that there is no evidence to favour any one approach to weight loss over any other. Limiting energy intake overall is more important than where the calories come from. The document also says that low carbohydrate diets can be particularly effective at producing improved blood glucose control, especially when weight loss is achieved.

This is a drastic U-turn. Previously, guidelines suggested that a significant proportion of food eaten should be starchy carbohydrate - 50% or more of the total dietary intake. The potential consequences of restricting carbohydrate were perceived as deficiency of B vitamins, and increased fat intake leading to weight gain, higher blood cholesterol and an increased risk of cardiovascular disease. From one day to the next, our advice based on the best evidence goes from recommending fairly high carbohydrate portions to weight loss at all costs with a definite option of low carb. No wonder people are frustrated by reporting in the popular press, where advice seems to change every time a journalist sneezes.

One of my colleagues has thoroughly researched the low carb approach, and even converted her own diet to exclude carbs. She has converted the other Diabetes staff to the new low carb religion, and pioneered this method with her patients. We have two treatment groups increasing in numbers every month - a 'reducing carbs' cohort, and a 'very low carb' group.

'Reducing carbs' means limiting carbohydrate intake to 120g or less a day - 30g per meal and 30g for snacks. As an example, a slice of bread from a medium sliced loaf is 15g carbohydrate, as is a diet yogurt, or a portion of fruit. 30g carbohydrate equates to three tablespoons of cooked rice or pasta, or three egg-sized potatoes. Admittedly it usually involves a change in diet, but not necessarily a drastic change, and most people would find it manageable with a bit of forward planning.

'Very low carb' or VLC is a different kettle of fish, and this plan limits carbohydrate to just 40g or less per day. This means giving up all starchy carbohydrate - no bread, pasta, rice, cereal, potatoes or other starchy vegetables, with allowed carbs limited to a small amount of milk, berries and pulses and natural yogurt. Animal and vegetable protein features heavily, including nuts and seeds, along with less carb-heavy vegetables and salads. Saturated fats should be replaced with unsaturated as much as possible, and caffeine and artificial sweeteners should also be avoided.

The idea of both these diets is that the less carbohydrate you eat, the less glucose ends up in the blood. Consumption of lower calorie foods also increases, including vegetables and salad, so a very welcome by-product is weight loss. The VLC diet is also intended to change the body's metabolism from using carbohydrate to using fat as the main fuel for energy, which was once assumed to be a bad idea. It has now been shown not to have the undesirable effects that were once thought likely in the short term, although we still don't know the long-term consequences. Another very positive aspect of the change to fat metabolism is that it seems to have an appetite-suppressing effect.

For people with Type 2 Diabetes who are overweight, a VLC plan can bring about a miraculous transformation. High blood glucose levels start to drop straight away; medication can be reduced, appetite is reduced and weight starts to decrease. This allows medication to be reduced further, success reinforces motivation, and some people have even stopped taking the majority of their Diabetes medication, including insulin.

This is not to say it works for everyone. There are some who can't manage to construct an acceptable daily meal plan without carbohydrate, and others unable to tolerate the change to fat metabolism, which can result in headaches, constipation and fatigue over a transition period. Increasing emphasis on protein and vegetables can prove too expensive, although it is to be hoped that the reduction in total amount of food needed can offset the expense up to a point. Family circumstances are often the biggest barrier - it is not a suitable plan for children, other adults may not want to join in, and making separate meals can be impractical. I've thought about it for a while, and I'm not sure that I would be able to deal with the practicalities of this VLC option.

In between talking about the nutrition guidelines and explaining our low carb diets, I managed to include some audience participation, in the form of 'Find the Carbs'. I showed a selection of pictures of meals, and got people to tell me which components contained carbs, to illustrate how an acceptable diet might contain less carbohydrate than the traditional choices of toast, jam, cereal, fruit, yogurt and juice.

My talk seemed to go down well, and the whole event was very well attended. I met some more local Dietitians, which is always good to do, and the Diabetes UK local group committee and members actually talked to me a bit for a change. I still think I might not go to any more of their weird meetings, though.

At last

Les Deux Alpes, March 2014

I hope it's worth the wait, but just imagine my situation, each day knowing that there is no blog post waiting to be published. I have sinned, it's been a long month since my last confession. There has been a lot going on. I don't think there's ever been such a long gap between posts.

The last time I wrote was the week before my holiday. I went to the Snowdome to practise (what a good idea that was), dad went into hospital for his back operation, I went to work, badminton, the usual. Then it was off to France skiing for a week, home again and a lot of important admin stuff to catch up with, dad out of hospital, back to work, a Diabetes UK meeting. Last weekend was even more hectic: a friend over from Germany for a brief stay in order to sign paperwork so he could sell his house, and... The Hen Weekend.

Holiday

The holiday was great. It was a good group, almost everyone was congenial, and my biggest problems were a) the people who didn't look like their names, and b) breaking away to spend time on my own without appearing anti-social. In the end, I had to explain and apologise to the people who didn't look like their names because I kept calling them by the different names that I had conjured out of nowhere. I just resigned myself to appearing anti-social.

A vast amount of snow fell on our arrival day/night, which is heaven for experienced and skilful skiers. Since the instructor was an experienced and skilful skier, she took the group up where the snow was deep on our very first morning, when everyone was just getting the hang of skiing again after a long break. We were not experienced or skilful, and it was carnage. But nobody was hurt, and the rest of the week was fabulous. I am in two minds about repeating this type of holiday; I think on the whole I would prefer a less organised group and private lessons instead.

Work

The Structured Education sessions have been interesting. I missed week 2 because of skiing, which was a shame because it was the big one from the Dietetic point of view - focus on carb counting, weighing and measuring food. Week 3 involved talking about alcohol and eating out, and the nurses covered exercise. I am looking forward to when I start to lead sessions, which looks as though it won't be until June. Otherwise, consultations remain much the same, and I still find it fascinating to listen to people's stories about their lives, whether positive or negative. And the Diabetes department has already arranged its Christmas party.

Diabetes UK is dominating my thoughts at the moment, as I'm preparing my 30-minute talk for the weekend and attending another of their weird local meetings. My name is on the programme for Saturday's Diabetes Awareness Day, and at the meeting still nobody greets me with any glimmer of recognition. I did gain some understanding of the physiology of weight gain due to injecting insulin peripherally rather than having it released by the pancreas, so that was good. I left before the raffle. I really think I might not go to any more meetings.

Hens

Lola II decided to have a relatively low key hen weekend with just two of her friends and me. I was in charge of entertainments, although we agreed the basic agenda between us. Lola II put in some specific requests: Yorkshire puddings; a steamed chocolate and apricot pudding; sleeping in a tent; no veils, strippers or other tacky accoutrements of the vile and tasteless hen parties. With no time for blogging, I spent my weekday evenings making stew and puddings and cooking veg as well as preparing a guided tour of the delights of Leamington Spa based on the Discovering Britain website. Mr A put up the tent, which was christened the Hen House.

It went very well - we walked the walk, talked the talk, placed a bet on the Grand National, watched one of the worst movies I have ever seen (this was a mistake - it was well reviewed and featured quality actors like Terence Stamp and Vanessa Redgrave), ate stew and Yorkshire puddings and chocolate and apricot pudding, Lola II slept in the Hen House, and we went kayaking on the river. The highlight for me was none of these things - it was the revelation that Lola II needs reading glasses! After more than forty years, at last she can experience the interminable nuisance of not being able to see properly. I'm not gloating - I will definitely need bifocals at my next visit to the optician, and I'm thinking of getting reading glasses myself for when I wear contact lenses.

In other news...

The 'Couch to 5k' running programme continues to go well, despite interruption from skiing. I've completed Week 4 and am about to start Week 5 of 9; I have progressed from 60 seconds to 90 seconds to 3 minutes and now to 5 minutes 'running' at a time. I run on the circular path around the park, and this week there were a couple of women chatting and walking in front of me - as an indication of the speed I have achieved, I completely failed to catch up with them. I am concentrating on stamina and technique, I tell myself, I can work on speed later.

Lastly, you should know that the only reason I'm managing to produce this post is because I went to badminton (club #2) and the hall was locked up with nobody there. My loss is your gain on this occasion. I have a journal article to write after the weekend, so there may be another lengthy pause after this...