When I received the news that I had Type II Diabetes a few years back I should really not have been surprised. I could not have claimed that I had looked after my health and should have known that decades of sloth and excess would eventually take their toll. But, despite this, it still felt like a blow especially after re-reading the medical literature and realising that I was suddenly much closer to meeting my maker than I had ever previously thought.
For the first few months this was very dispiriting. I moped around feeling sad and rueful about my earlier nonchalance about my health. Occasionally I would feel angry thinking “I gave up smoking 60 fags a day to get this !!!“, as if one step I took to look after my health should have undone everything else that would befall me. I didn’t get depressed, but I did get sad and fearful, and imagined a future being blind, impotent and without my legs (having lost these to diabetic vasculopathy). But ‘every cloud has a silver lining‘, as they say, and this fearfulness prove to be very useful; it was the fillip I needed to change my behaviour.
Since then I have walked every day, at least twice a day, and made considerable changes to my diet and lifestyle. But it is the walking that has had the biggest impact on my life. This is not primarily because it helps me control my weight, although it does, it is because of the psychological effect it has. I am fortunate to live in a corner of Wales which is very scenic. Every morning and evening I walk the same 2km loop but every day it looks that little bit different.
In the mornings the walk is a great way to gather my thoughts for the day and plan what projects will take priority. It is a time to think over the news that the radio had delivered with the morning cup of tea. The weather is the major factor on the morning walk. This is the time of day that we can often have wonderful mists which reveal the hidden glens in the landscape. It is the first time of the day I venture out, so is the time I am introduced to the weather for the day. I now meet the rain, wind or frost having spent the last 8 hours warm in bed.
The evening walk is a different kettle of fish. This walk is a time for review; to look back over the day and consider how it went. This is a time to mull and compose correspondence in my head, as the dogs and I walk in the gathering darkness. The weather is less of an issue on this walk, as by know I have been outside much of the day and am well acquainted with what has been going on. On this walk it is usually the sky which is the focus. As the sun sets down behind Cader Idris we can have spectacular displays and hints at what tomorrow might bring.
Illness and death are inevitable. As we age and get closer to the latter we usually have to learn how to cope with the former. I have been fortunate not to have been tested too much. My first proper brush with poor health has forced me to think and caused me to lead a better life than I did before. I will not always be so lucky, but hopefully whatever happens in my life it will cause me to change and I may again find some way to salvage something good from whatever befalls me. (I think tonight’s sunset was making me feel particularly mellow.)
It is that time of the year when I get my HBA1c checked again. Now I know that is a measure of my glycosylated haemoglobin and it gives a weighted average of blood glucose levels over the life of red blood cells (117 days or so). But this is not really how I think of it. It is really a test of my abilities in self-deception. I test my blood daily and therefore should really know what my average blood glucose has been – but I cheat !
If I have had a bad day with my diet, a night out for a meal and a drink, I tend to forget to do my bloods just afterwards. If I have forgotten to do my exercises I tend also, quite conveniently, forget to check my sugar levels as well. I don’t want to see the results of my failings. Until that LED screen on the glucose meter frowns a high value at me I can pretend to myself that little has happened. When I check a little later, having been good and exercised properly, my sugars are not that bad. In essence, I manage to check myself at all the best times and give myself the feeling I am doing better than I am. This feeling of confidence all disappears when the HBA1c comes around and destroys my flimsy deceptions with its harsh reading of the true average reading over the last three months. Because it is a three month average it is not even possible to do a quick few days of good dieting and heavy exercise to bring the average down – the HBA1c doesn’t see this recent contrition, it just counts the pastries and sloth of the previous months.
I think we need similar tests of self-deception that we can use before we end up in the mess of being fat and diabetic. I would have loved to have an anti-deception mirror. This mirror would surreptitiously collect images of us and then present them back to us as an average image of how we looked over the last three months. It would not matter if you stood up straight, threw your shoulders back and sucked in your stomach and held the pose you managed, for the first 30 seconds, that you met a new attractive person. It would show you slouched, hunched and belly flopping. This might be a fillip to think about diet or exercise. These might meet the call Robert Burns put out in “To a Louse” :-
O wad some Pow’r the giftie gie us To see oursels as ithers see us! It wad frae mony a blunder free us, An’ foolish notion: What airs in dress an’ gait wad lea’e us, An’ ev’n devotion!
I can imagine another two ways to free us from possible blunders. Anti-deception headphones could also be valuable. These would monitor our conversations for words and phrases like “chubby”, “chunky”, “thick around the middle”, “buxom”, “full figured”, “hefty” or “portly”, when used to describe ourselves, and play the words “fat”, “overweight” or “obese” in their stead. But perhaps the most valuable tool, for men in any event, might be the anti-deception belt buckle.
After a certain age men often become aware of a paunch developing around their midriff. It gradually grows until it is quite a size. To the man this becomes recognizable when he can no longer look down and see his feet or genitals without either sucking in or using his hands. To the rest of the world this became apparent when the paunch had grown to cover his belt buckle. I noticed that I, like many men, dealt with this problem by a cunning strategy. By simply pulling my short out from under my waist band, while my paunch may be hiding my belt buckle, the short now covers the paunch and the buckle. I honestly believed that the rest of the world were fooled by this strategy. I thought that they thought “Hey, look at the thin guy over there whose shirt flaps outside his trousers. I wish I was slim like that“. I didn’t imagine they thought, “Heavens that bloke is too fat to do up his trousers properly and tuck in his shirt“. I believe women have similar cunning plans involving ponchos and similar outfits. I would never had pulled my shirt out while I was wearing a suit (It would have looked too wierd) but I was happy enough to deceive myself that this strategy worked when I wore jeans or chinos. A simple belt buckle with a light sensitive alarm could sound a siren, or ring a bell, when it was covered by a shirt to alert the wearer that they were being silly and making a fashion faux pas.
Anyway, I should know in a few days how much I have been deceiving myself when the HBA1c comes in. I am sure when I get this , temporarily at least, I will pull my sock ups, eat better and workout more. Although perhaps not tonight; as the next test will not be for over three months and tonight won’t figure in the next test !
Harvesting marrows this week lead me to think on the importance of anticipation and deferred gratification. The ability of humans to think ahead and store foodstuffs, to enable them to cross through the lean months of winter, is one of the vital skills we developed in our evolution and possibly, in the opinion of Jordan Peterson, the basis for our understanding of time itself.
“The discovery that gratification could be delayed was simultaneously the discovery of time and, with it, causality (at least the causal force of voluntary human action). “ Jordan Peterson. 12 Rules for Life.
The temptation would always be just to eat what we had at hand but our development as a species depended on learning that it was wiser to store foodstuffs for eating (or planting) later. Our overall happiness is much greater than the temporary happiness that we might get through a bout of gluttony. Even today this is an important skill. The Stanford Marshmallow Experiment has shown that children who are able to wait and defer their gratification (one marshmallow now against two marshmallows if you wait 15 minutes) generally do better in life on a variety of fairly robust measures. Deferred gratification is the basis of most planning, it is why we save, it is perhaps why we don’t mate with the first attractive person we meet (That may be also be because they don’t want to mate with us). If we are as individuals, and as a species, to maximise our happiness it is important, in many things, to forgo the immediate short-term fun for the future prolonged pleasure which is often more satisfying.
However, in addition to this utilitarian advantage of delayed gratification there is another reason we should consider waiting and anticipating. This is really quite simple, anticipation itself can be part of the pleasure, Waiting with the knowledge of future reward can often give as much pleasure as the reward itself. People often wish to know how to get ‘happiness‘ as if it were a thing that could be found. It is much more likely that happiness is the process of creating a good life for ourselves rather than any single thing which brings us temporary pleasure. When we know our striving has been successful, and when we can imagine future success, then we are likely to consider ourselves happy. While I have no doubt want and poverty are the scourge of happiness, I also doubt that a farmer in Africa who tends his fields, sees his herd healthy, and knows his family is cared for feels one iota less happy than I do, despite the massive disparity of material wealth between us. As Peterson again notes, happiness is to be found in the journey rather than being a destination.
“Perhaps happiness is always to be found in the journey uphill, and not in the fleeting sense of satisfaction awaiting at the next peak.”Jordan Peterson, ibid
A great deal of pleasure is the anticipation, Through March and April I watched for the Elderflower to bloom knowing that once it arrived we would make Elderflower cordial and champagne. The following month I looked forward to the new potatoes. Last month I waited for the beans and courgettes and this month my wait for the marrows ended. I am now starting my wait for soft fruits and honey. On the small holding our dietary pleasures are seasonal and we have to watch and wait but this adds to the taste of the produce when it finally arrives. New potatoes just pulled out of the patch boiled and served with a knob of butter are a sensational, if plain, meal. The wait I had, the work I put in, the anticipation I experienced, all magnify the taste meaning I will not find anything better in a restaurant no matter how good the chef.
Our supermarkets and farming systems have largely taken this pleasure away from us. There are really very few seasonal foods today. You want strawberries in winter ? no problem. Fresh tomatoes out of season ? likewise no problem. Not only can we have foods from all over the globe we can have them at any time. There is no need to wait or plan and, because of this, nothing is special. Industrial farming keeps our foodstuffs cheap but the hidden costs to our environment are not minor and nor are the costs to our dietary habits inconsequential. We, in the developed world, eat more and have diets Kings and Queens in the past would have envied, However, we can’t enjoy simple foods, as we did before, and we need our foods spiced, coloured and made in exotic combinations to pique our appetites. We are no longer happy with the novelty that used to follow seasonal foods. These changes in our diets have lead to us being unhealthier. The strategy of boosting foods’ sugar and fat ingredients and increasing portion sizes, to titillate our jaded palates, has lead to worrisome statistics; for example, in Wales more people are overweight and obese than are of normal weight.
I have found that by trying to live in accord with the local seasons I do get more pleasure from my food. This is why, difficult as it may be to believe, I found myself looking forward to the marrow crop. However, there is a possible downside to this. When the seasons decide that the time has come there is no arguing with them. It all comes at once and dealing with gluts of fruit or vegetables is a skill that has be acquired. Next month chutney making will be to the fore in dealing with the excess number of tomatoes I hope we have. This month it is marrows. Not just a lot of marrows but very large marrows as well. Faced with these huge tubers I don’t think the local populace has enough appetite for chutneys and jams to cope, so we needed to be more creative. Thankfully marrows are versatile and can be used for both sweat and savoury recipes. Today’s way of dealing with half a marrow used both recipes, I hope you enjoy them.
Marrow & Bean Soup
Cut 1kg of marrow into chunks and season with rosemary. Place in a baking tray and drizzle with olive oil. Roast for 30 – 40 minutes until the marrow is soft.
Boil runner, any other, bean in 2 pints of stock. Add a generous teaspoon of cumin,
Add the roast marrow to bean and stock mixture and simmer for 10 minutes
Blend with a mixer and thicken with cream
This recipe gives a very filling soup, it is easily a meal on its own with some crusty bread. It freezes well which is helpful, as it is a warm hearty soup better suited for autumn and winter.
Beat 3 large eggs and add 400g sugar, 250ml vegetable oil, and two teaspoons of vanilla
Gradually mix in 350g plain flour, 300g grated marrow, 3 teaspoons baking power, 2 teaspoons cinnamon and 2 teaspoons of nutmeg. Stir fully
Place the mixture in two greased loaf tins and bake in an oven at 170c for 45 minutes.
These are best buttered when still warm and are like a very moist banana loaf. If you slice these loaves they will also freeze, though to be honest they are so pleasant that they are unlikely to last long enough to see the inside of the freezer.
I have mentioned before that years of indolence and gluttony led me to develop Type II Diabetes a few years ago. It should really have been no surprise as my usual diet read like a nutritionists warning sheet – “Don’t eat these things!” – pies, sandwiches, cakes, sweets. The only vegetable I enjoyed was the potato and preferable after this had been deep-fried. Added to this I had a serious aversion to exercise. I tended to see my body as just the apparatus for moving my head from place to place, and anything that made me sweat or short of breath was clearly something to be avoided.
For the best part of a decade I had coasted thinking that because I had given up smoking (three packs a day) I had done all that was necessary for my health routine. It was while basking in the glory of my smoke-free life that I received the news of my diabetes and the reminder that I was going to die, and possibly my demise would not be a long time from now. After serious revision of my diet and serious weight loss (over three stones) my sugars were brought under control and I managed to get a bit fitter. I noticed for me, as the scientific research had said, a lower carbohydrate diet and regular exercise through walking brought my sugars close to the normal range.
I started walking every day, the dogs were delighted and they too became fitter. I started jogging and running. I saw my daily turns round the block as my “running away from death” exercises. Then I thought; if walking is good, and running is better, then surely getting a pair wheels will be able to put even more distance between me and the grim reaper with his scythe. I thus decided to buy a bike. Well, before this. I resurrected an old bike that I had kept in the garden for a decade under a tarpaulin with some holes in it. I freed the bike with two cans of WD40 and banged the chain into some form of flexibility with a mallet. The rear brakes worked, if you had plenty of notice to apply them, while the front brakes thankfully didn’t work ,as when they rarely did grip they did it with a grip sufficient to toss you over the handlebars. After a few weeks on old rusty I noted my sugars were better (probably the exercise of trying to combat the resistance of years of rust) and thus I decided to buy a new bike.
Now I am aware that I am prone to fads. I run at things with headlong enthusiasm for a month or so then loose interest so I was a little wary in buying a bike. I had quite a shock when I read reviews of bikes which suggest that this was an excellent buy at only £1000. There were also many warning in the magazines about buying BSO’s (bike shaped objects) as they suggested that these mass produced cheap and cheerful bikes were more trouble than they were worth and would not save you money in the long run. Fortunately my Scottish heritage came to the fore, my reluctance to spend money got the better of me, and I decided to buy at the lower and of the market.
After research I found out about B’Twin a French company with a long and established history of bicycle manufacture who now operate in the UK under the Decathlon name. They manufacture the high end bikes but also much more basic, and affordably priced, models. I plumped for the Riverside 120 hybrid bike and the affordable price included free delivery.
The bike came within 48 hours and was very easy to set up. Screwing on the handlebars and attaching the pedals were all that was necessary to be up and on the road. It also came with a basic set of lamps. There was a booklet which usefully described how to set the bike dependant on your size which was clearly written and helpful. The bike only has 8 gears rather than the 18 or 21 which are often offered. This had actually appealed to me as I found that the complicated gearing systems were too much for me, I would jump gear to gear trying to find a comfortable ratio to work in and there was far to much choice. I would either be standing on the pedals trying to use my weight to slowly turn them or my legs would be a blur, like an egg beater, as they whirled against little resistance and I made little, and wobbly,slow , headway. Eight gears are fine – gears 1 to 3 are for going up hills, 4 is pottering or into string winds, 5 to 8 are for going fast – it really is quite simple.
The simple gearing, correct position and absence of years of accumulated rust and resistance have made the bike a joy to ride. I have only had it week or so (so we are still in the possible ‘fad’ territory) but I have used it many times each day. By the end of the week I am faster and fitter that I was at the start and I have enjoyed my time on the bike. Hopefully, I am putting a little bit more distance between me and my funeral but in any event I am having fun. If you are in the market for a cheaper bike, something simple to use day-to-day then I’d recommend this. Even is this is a fad I haven’t bankrupted us and will still have a way to get to the village if the car breaks down.
I read today [OECD] that Britain has the highest rates of obesity, and fatness, in Europe and is the 6th most obese country in the world. There is also the terrifying statistic that the rate of obesity has doubled since the 1990’s and we face the serious prospect of this bankrupting the NHS. Obesity is a major risk factor, as we all know, for diabetes, cancer, hypertension, heart disease, stroke and dementia – this rate of change should alarm us – but it won’t.
For many years, most of my working life, I ignored a growing problem. This problem was the growing size of my belly and my increasing size. By the time I changed my lifestyle 6 years ago I had managed to create quite a respectable problem for myself. My waist was 35 inches, my weight was 14 stones and unfortunately not being a tall man my BMI was 31.6. I was quite clearly obese. This had crept up on me, I knew as I aged I was becoming less fit but I didn’t look that different to many other middle-aged men and nobody passed any adverse comments. As a doctor, I knew I was building up risks for myself but I was able to minimise these in my head. Nothing bad had happened, I don’t look that unusual, my blood pressure is OK, I still stay active – it really was easy to convince myself that this was no great deal.
Then came the rude awakening. Five years ago I was diagnosed with Type II diabetes mellitus with blood sugars so high I had the full range of symptoms and was started on metformin instantly, at a pretty high dose. I then went through the NHS’s education package. This told me to take my medicines, eat regularly and sensibly, and take a bit of exercise. With this, I was assured, the thing was manageable and I’d be fine. No-one took a blind bit of notice of the large, and obvious, wobbly bundle of fat I had around my middle even though this was the most conspicuous thing of my appearance. (If you want to imagine me then – not recommended – then imagine a potato with four cocktail sticks as limbs, that was me to a “T”). I sat on classes with other similarly shaped people and we all pretended that there was nothing amiss, nothing that eating a stick of celery couldn’t sort out. I went to the gym, where the rhythmical bouncing of my and my new friends’ bellies, while we tried to jog on the treadmills, was almost hypnotic to watch. Through it all no doctor, no nurse, no dietician, no-one said – for goodness sake get rid of that belly ! They were all too polite to mention it.
When I received the diagnosis a cold shiver went down my spine. I’d worked in an area where I’d seen the consequences of diabetes. I’d spoken to men about to have their feet amputated, I’d given rehab advise to folk after their stroke, I’d completed forms confirming that a diabetic man was now blind, and I’d consoled widows after their spouse’s fatal heart attack. I knew my mortality risk was now considerably increased and I knew some of the problems I might face. I also knew, from very cursory information gathering, that my poor diet and obesity were the main factor in this.
I decided to change, I was so scared and shocked, I knew I had to change. I went on a low carb diet and lost 3 stones, I kept on the diet and took regular exercise. I saw my waistline shrink, my belly disappear and my blood return to near normal. After a few months I came off medication and have remained medication free, and with relatively normal bloods, for the past years. A couple of my diabetic pals, who were equally shocked, did the same thing with similarly good results. But I meet my other pals, who were never troubled by the thought of their weight; still obese, still taking medication and now starting to experience the adverse consequences of this illness.
So I have a personal interest in this report of growing obesity in the UK even though I am a relative neophyte to the world of diets and healthy eating. What are we to do to try and stop this growing trend. It is clear that there are some things we can’t do.
We can’t reduce the availability of food. This is a non-starter, there is no way we can limit what people eat – they must do this themselves. If you don’t sell the double pack of Mars bars I’m smart enough to get around this by buying two packs as is everybody else. Attempt to limit things by smaller packaging could only work if we were happy to accept central rationing of our food, otherwise we just buy more of the smaller packets.
I don’t think that we will get around this by education. I don’t think that there is anyone left that thinks a Big Mac and fries becomes a healthy option because it has a gherkin in it. We all know that a salad is healthier than a bar of chocolate – education is the answer when ignorance is the problem. That is not the issue here.
I doubt we will have much success tackling our increasingly sedentary lifestyles. Anyone suggesting we get rid of the automobile, or suggesting we dig roads by hand or get rid of any other labour saving machinery, is unlikely to have a successful career in politics. We can suggest that people exercise and find ways to make it easier but, unless we are going to have forced marches then we need to find ways to make people want to do this.
The key in the affluent west is that we need people to want to be normal sized, to fear being obese. This is what we have lost. As I walked around I saw other people the same shape as me, it normalised my obesity. Chairs, cars, everything has been slightly adapted to suit the larger body, each step making it easier to be obese and, more importantly, making it easier to ignore your own obesity. I needed somebody to tell me – “Whoa ! You’ve got far too big there. That doesn’t look right” but even when I had fallen ill people were too afraid to mention it. They were happier to let me die earlier or loose my sight, or foot, than to be accused of “fat shaming”
We would prefer people to be comfortable in their obesity, than in any way upset – but this is precisely what we do not need. Discomfort might prompt thought and redirection and improvement to their health and life. I wish someone had spoken honestly to me, when I asked “How do I look ?” I wish they had said “you are getting fat” rather than lied with “Fine”. There is no need to be unpleasant about this we just need to be honest. We also need to be careful about attempts to actively normalise obesity. I noted, when in the supermarket today, this is not as strange and impossible idea as I had thought – three of the covers of magazines (directed to young women) were using obese models. It may be dangerous to promote anorexic stick insect ideals of beauty but it is equally dangerous to promote obesity as a good choice.
The problem of obesity has unfortunately got bound up in the gender issues of objectification of womenWe but obesity doesn’t affect only one gender. All of us are at risk when we treat our health and future in a cavalier way like this. There are many vested interests who would prefer us not to think about it; the food and pharmaceutical industries would be much happier we consumed more of their products and dealt with the consequences. The media and beauty industry can sell us their products either way, fat or thin models, it is of no concern to them simply which model sells more copy.
People are free to live as they wish, they are free to be fat or thin as they choose, but they must choose with adequate knowledge. We should not influence these decisions because of our political biases and we should net let people die early because we were too afraid to tell the truth.
A few years ago I was diagnosed as having Type II Diabetes. It was quite a shock as I hadn’t felt unwell and had not realised just how bad my diet was. In the first year I used a low carb/high fat diet to get my weight normal and to be able to stop taking medication. Since then I have paid better attention to my diet and started to exercise regularly, I have stayed off medication, my blood pressure and lipid levels are better than when I was a younger man and I am fitter. I also feel fitter and stronger.
When I look back to see what I had done wrong to end up in this state, it was clear that snack food had been my downfall. Looking back it was obvious quick, easy to eat, high carbohydrate treats had taken over my diet. Snacks had done it; a sandwich, a cake, a pie, a biscuit, a sausage roll .. there were many ways I could snack instead of eating regularly. I had developed a bad habit of eating easy food with a quick reward. There was no need for preparation, little need for thought, just eat and go.
Over the years this had done considerable damage to my body. I was three stones overweight, no amount of leaving my shirt outside my trousers could hide my belly, I could not run, and eventually my body started to fail. Fortunately I started to have to get up at night to pee and thinking I might have the other old man’s friend (prostate problems) I saw the doctor who, alarmed at the high levels of my blood sugar, started medication immediately.
I use the word “fortunately” as I am glad I found out the damage I was doing to myself before discovering it, too late, after a heart attack, an amputated foot or after going blind. I have turned some things around and hopefully reduced my risks somewhat. But I was clear that snacks had been my downfall, they had messed up my diet and consequently messed up me.
However, recently I have been trying to learn from my mistakes. If I did this much damage unwittingly, what other damage might I be doing ? Are there other dangerous snacks I have been overeating ?
I realised that in cultural terms I was wreaking similar damage in other areas by snacking. I decided to tackle these problems also before they started to cause problems or disability. I have started first with music. I was aware that over the years I have started to prefer small, easily digestible pieces of music; pieces of music that require little thought or attention and which catch you quickly and satisfy instantly. I prefered the snacks of the musicalworld.
I had been led to this by the mp3 and the download. Rather than listen to a concert or an LP I would listen to a single track. Instead of listening to the whole opera I’d listen to the popular aria made famous recently by its use in an advertisment. I noted that my musical tastes have been coarsened and are now much more reliant of rhythm and beat – the quick hit, the ‘carbs’ of the music world. I noticed also that often I was guided to music by the accompanying video which makes the emotional impact much more effective while, at the same time, taking away the need to think and consider. I think it is no surpise that the videos are becoming more important as it is not really the music that is being sold now. It is the quick snack, the fast food of the music world, rather than a balanced healthy diet.
I’m starting to see results. This morning was improved by listening to “A night on bald Mountain” and last night was spent in the company of the Dance Macabre of Camille Saint-Saens. This has been much better for my health and soul than my previous diet and hopefully, over time, I’ll see similar amounts of improvement. Certainly I feel better and I am also much more aware of what I consume musically and that, in itself, is not a bad thing.