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Efficacy vs. Effectiveness for Diet and Exercise.

25 October 2016

There was recently a big hubbub about flossing. It turns out that flossing is efficacious (i.e., it can work) but not effective (i.e., it doesn’t benefit people as it is ordinarily practiced). That is, there is evidence that when a person flosses as directed for a long period of time, that person will usually have healthier teeth than a person who doesn’t. But at the population level, flossing isn’t effective because almost no one actually does it like that. And so there’s no evidence, when you compare two groups, one of which says they floss, and another that doesn’t, that the flossing group has healthier teeth on average.

I suspect diet and exercise for weightloss is similar. We have all these studies that show the various metabolic and physical responses to various interventions. Some say diet is better. Some say exercise is. But what almost everyone agrees on is that over time people gain weight back and most people don’t achieve lifelong weightloss. Once a person is obese, they may be able to make short term impacts, but long term BMI reduction is very rare. This has led many people to conclude that there’s no hope for weightloss, and we should focus on other aspects of metabolic health.

Now, it is certainly true that people’s metabolisms slow as they age, and getting the same bang for one’s buck, diet and exercise-wise, gets more difficult as we get older. Also, as time goes by, people are at risk of injury and disease which may impact their ability to maintain a diet and exercise regimen. But those strike me as rarer than the most common issue people face. Dieting is hard, and sucks. Exercise is hard, and sucks. So we quit.

We often create diet and exercise goals, like losing a specific number of pounds, or accomplishing an exercise challenge like a race. Then, when we’ve achieved it, we stop doing the things that got us there. We reward ourselves with treats and rest, which disrupt our routine, and eventually end our investments. We treat these goals as if, once achieved, our bodies never change again, so we can stop doing the things it took to get us there.

We know that diet and exercise are efficacious. The laws of thermodynamics require them to be. If you limit the input of energy, and increase the expenditure of energy, eventually, your body will be forced to decrease mass to compensate for the flux. There will be issues, like metabolic changes that conserve energy, etc., but there is only so much conservation one’s body can do.

But diet and exercise are not, by and large, effective. Because people don’t do them well, or sufficiently, or for a long enough time. The caloric deficit one has to maintain for a weightloss of 50 pounds, like I did, is enormous and challenging. I have spent time and effort for years, and it’s been difficult and painful. I’ve had injuries, I’ve had setbacks, I’ve had to commit to an entirely different way of life from the one I used to have, and it’s had to be permanent.

Diet and exercise are at least somewhat similar to abstinence as a treatment for addiction. We know good and well that if you don’t drink, if you don’t take drugs, you don’t get drunk and you don’t get high. But telling an alcoholic, “just don’t drink,” or an addict, “just don’t use,” is not an effective treatment, no matter how efficacious it would be if they followed the advice. Most addicts will never stop using. Most addicts will die in active addiction. We don’t know how to make efficacious treatments more effective, mostly.

The same is true, I think, for diet and exercise. Changing lifestyle is hard. It’s not a matter of will, I know that from my own experience being sober now for more than 8 years. It takes a sea-change of behavior that I’m not certain how to describe. It takes seeing one’s self and one’s life in a new way. It takes effort and determination, yes, but it takes something else as well. Not something more, maybe not internal at all. Certainly, I could not stop drinking alone.

I don’t know why I’ve been able to make life changes and other people who want to just as badly can’t. I know it’s not about money or time, because I know people with less of both who’ve succeeded better than I have – though I admit money and time have made my path easier. It’s not will. It’s not intelligence.

Maybe it’s just luck. Maybe I’m just lucky that making wholesale lifestyle changes agrees with me. That I am enriched and satisfied, internally, by the kinds of things I have to do to achieve these things. I don’t know. I don’t know how to pass it on. I wish I did. Because the things I have accomplished in sobriety and in fitness have brought me joy and pride and capability. I wish I knew better how to share them.

Three Elements of the Great Long Run.

24 October 2016

Well, things appear to be wrapping up in positive directions on several fronts. The title company issues with my house are settled, now I just need to sign things and get them mailed off. The sale should close on Tuesday. After that, I am thinking of spending some of the proceeds on a Subaru Crosstrek, a cute compact crossover-SUV that would allow BB and I to expand our radius and learn more about the areas we live in. And take our bikes out to more distant areas and ride them in the countryside. And go to IKEA more*.

My marathon training is finally sort of on track. This past week was warmer, and I had a couple of hard slogs worth about 10 miles which felt awful. But the weather was back up over 80 degrees again. I’m never going to be good in the heat. I just don’t have the constitution for it. But I should be better than I am and I’m going to work harder this coming summer than I did this past one. But despite the heat and misery, I got in a 7 mile run in the afternoon, puddled in sweat.

Then it cooled off over the weekend, and BB and I did our 15 miler. It was a pullback from last week’s 20. Pullback weeks are crucial to allow the body to rest and recover. So I had about a 26 mile week and that’s good. This coming week is the big one. The longest of the training season. My training schedule says it’s 39 miles, but my plan is to do at least 42. Possibly 44. With the cooler weather (it’s going to be in the high 50s when I run today) I should be able to run faster and harder, and get in some good distance.

I felt really nervous the past few months about not getting into shape. So, I did something about it. I did longer, faster, harder runs to build fitness faster than I otherwise might have. And it’s paid off. I had a good 15 miler this weekend, and a great 20 miler last weekend. This weekend is going to be 21, and I know what to do and how to do it. I know how to fuel now. I know how to pace. I know how to prep. I’ve learned a few things about running long. Here’s what I’ve discovered in two and a half years of doing long-distance runs:

There are three aspects to a good long run: Musculoskeletal, Cardiovascular, and Metabolic. All three have to be at least decent to have a good long run. But really, only one is under direct control on the day of the run. In order:

  1. Musculoskeletal. Gotta have bones and muscles that can do the job. A little pain, a few tweaky injuries that shake out as the run progresses? No problem. That’s just being a distance runner. Fatigue and injury are part of the game. But if you have sharp, ice-pick pains, or swelling, ease off and let yourself heal. No need to die a hero at mile 4. Take regular rests and pullbacks to keep yourself healthy. And for me, I need short, slow runs regularly.
  2. Cardiovascular. For this, nothing works but putting the time in. You need to be able to get your heart rate up, and sustain it up for a long time. Interval training is really good for this. Jumping rope (boooo!). And running. As BB’s trainer says: if it doesn’t challenge you, it doesn’t change you. Get that sweat pouring, get that heart rate up. Work like hell. Then, you’ll have what you need on the long run day.
  3. Metabolic. This is the one we can control on game day. The big deal for me starts the night before. I need to hydrate aggressively, and eat a lot of lean protein and carbohydrates of middling complexity, like potatoes or white rice. Pasta doesn’t work for me. Then, in the morning before the run I need granola and yogurt or milk. And I’ve discovered a shot of honey, agave nectar, or maple syrup right before I run helps immeasurably. During the run I need 200 calories an hour, starting with food-like substances (date and nut bars), shifting to performance fuel (powerbars), and finally to pure sugar (gels, GU, Bloks, etc.) for the final few miles. And extra electrolytes regularly.

If I hit these three things, I can do any long run. My muscles and bones are fit, even though I have several minor injuries and pains to fight through (foot, knee, high hamstring, shoulder). My cardiovascular fitness is good as long as the temperature stays below 65 degrees. And I’ve figured out how to fuel and drink on the run.

I’m not counting any chickens yet, but these eggs look healthy.


*This might be the whitest thing I’ve ever written.

What it Takes to Learn.

18 October 2016

This weekend was a promising step forward. We had our first 20 mile run of the training season (of two – three if you count race day). This one was exactly 20 miles, and it went off without a hitch. I figured out my fueling (powerbars, almond butter and maple syrup, extra salt, and gels for late in the run), and have a plan for race day. The 20 miles took us 3:45, plus a couple of bathroom stops. So we were right exactly at about race pace last year. And the key was that it really felt great. I can’t believe I’m saying that. A 20 mile run that felt great.

But we may not be faster this year. We may slog along and miss five hours and not set a personal record. I don’t know. I’d love to beat last year’s time, but if I don’t, I don’t. But it is interesting how I really only learn things deeply by failing at them. It took last week’s 18 miler and hitting a wall to pay attention to my fueling seriously this week. And then yesterday, I completely bonked on a 5 mile run because I was dehydrated. 42,175 steps froward, 6,435 steps back, I guess.

Today I need to do about 8-9 miles, and it’s going to be warm and unpleasant. At least not humid. But I will be well hydrated and fed, and bring fuel and water. My two ten mile runs last week were quite satisfying, but the weather has turned back warm. I’m sick of it. I hate heat. Which sucks because it’s only getting hotter for the rest of my life.

The house situation looks good. Everything is going to be in place for the sale to go through on the 27th. The title company is switched, the required work is being done, and the stars are aligning toward the sale being completed. I have a great real estate agent in St. Louis, if anyone needs one.

Up next is a discussion with a health policy expert about potentially collaborating and doing some more interesting work for MECMC by leveraging my computer skills for public health work. I’d like to expand my sphere, and do some things that influence policy and strategy, not just day-to-day operations. And I’d like less management on my plate and more intellectual contributions. I really do need to have a deep conversation with my boss about my plans moving forward in my career. But that’s another post.

Updates on Homes and Things.

14 October 2016

It looks like a different title company is going to be willing to offer the title insurance, and that’s good. As long as I have a reputable title company willing to do it, the contract is in force, and we’re going to be able to move forward almost certainly. So that’s a relief. The other title company, recommended by my agent, doesn’t care about the statement from the person I used to owe money to, more than six years ago. Which is, in my opinion, as it should be.

I went to the dentist and I have no cavities! Very happy. I have had some toothachy sensations which they say are likely caused by calculus below the gumline. I’ll have to have an anesthetic-supported cleaning to remove it, which means two trips because they only do one side of the mouth at a time. Luckily it’s 100% covered by my insurance and I’ll be able to get it done and then not worry about the dentist again for several years.

The dentist also told me I needed a night time mouth guard and I said no. He said I’m playing with fire. I wish I’d said, “Flame on.” But I’m doing good, I didn’t need any root canals or fillings or caps or bridges or anything. That’s a massive relief. Being pre-diabetic and also an alcoholic, and a former smoker, all can cause terrible dental damage. Add to that a history of poor dental health in my family, and I should do better than I do.

This week has had a couple of good runs in it. Two ten milers. Yesterday afternoon I did my 10 miles at about a 10 minute pace. Monday it was at a 9 minute pace. So if Monday was a hard tempo, Thursday was a mezzo-tempo. Both faster than my goal race-pace of somewhere around 10:45-11:00. An 11 minute average is a 4:48 marathon. I’d be happy with that. I’ll be happy with finishing but I’m hopeful that I’ll go faster than the last one. We’ll see.

I have a number of minor nagging injuries: sore quad, sore hamstring, balky knee, and a new one. The outside of my left foot is aching and tender. Not swollen though. I think it’s just pain. Pain is not real. I can manage pain. You don’t run marathons and not endure pain. It’s part of the deal when you sign up. The pain is what makes it an accomplishment. If there wasn’t any hard work, if there wasn’t any pain, then crossing the finish line wouldn’t mean anything.

So things are moving forward and I’m getting everything set up. It’s going to be ok. I think.

Housing Troubles and the Dentist.

12 October 2016

I may have trouble selling my house after all. There is a weird issue with the buyer’s title company that seems to me to be wildly, unreasonably risk-averse. Basically it is saying, “There’s a person out there that Dr24 once owed money to. Even though it was paid years ago, and that person has no legal claim to the house and never did, they need to sign an affidavit that they have been paid.” The problem is, I have no way of contacting this person, they have no reason to do me the favor of signing such an affidavit, and I don’t think either of us wants to reopen such a chapter in our lives.

So I don’t know what to do. Maybe I can’t sell it. Maybe another title company will insure it. We’ll just have to see. Maybe I put it back on the rental market. We’ll see what can be done. It’s frustrating, but there’s nothing I can do to force a title company to take on risk, even though I see it as ridiculous. So it’s an exercise in acceptance. I can’t make other people do what I want.

My other big news is that I’ve been having a couple minor toothachey type things going on and so I made an appointment with the dentist. I haven’t been to the dentist since 2009. So I’m worried that I’ll have cavities and need root canals and caps and crowns and ugh. If I do, I do. I have dental insurance and it’ll be ok. No one likes the dentist, but my father has lived half his life with no teeth and it’s not something I want to emulate.

I’ve been sore for days now with two hard runs and two hard workouts in the last four. Today may be an unscheduled off day because I don’t have time for the dentist, a run, and my AA meeting. Tomorrow I have 7 scheduled, but I’ll probably do 10 again, but at a nice slow pace. That way I’ll have gotten 20 weekday miles in to prepare for my 20 on Saturday. Which should be nice and cool. I’m “looking forward” to it. I want to be able to do it.

So I’m in maintenance mode. Maintenance of self and soul and body. That’s the best I can do.

Improving. I Hope.

11 October 2016

Saturday we did 18 miles, at an 11:04 pace. That’s not promising for breaking our time from last year. The last couple miles were really hard and I even walked about a tenth of a mile at mile 16.8. I hit a hard wall. But I gathered up and ran the last mile and we finished our 18 at 3:19 and change. While that’s faster than our overall pace last year, if we’d done 8 more miles at a 12 minute pace, about what we were running at the end, we’d end up with the same time as last year: about five hours.

So I really need to improve my fitness and I don’t have a lot of time left to do it. This is hard work and I need to push extra to get where I want to be. This has led to me deciding on a drastic course. I am taking a Nitzschean approach for the remainder of my training: whatever doesn’t kill me makes me stronger.

Now of course, this is manifestly untrue. It risks overtraining injury, acute injury, burnout, etc. But right now, I don’t have a choice. I have to do better, and fast. I have less than six weeks until race day, and I need to make some major upgrades to my abilities between now and then. So yesterday I laid down a really hard run, especially for mid-week.

After work, I went out for a tempo run. I had 7 miles on my schedule. I did 10. I had no pace on my schedule, just get the miles in. I pushed hard. I wasn’t close to my race-pace 10 mile PR, of about 84 minutes. And I did pause my GPS watch to pee and fill up my hand held water bottle a couple times. But those totaled probably 5 minutes. The rest of the time I ran at or above my half-marathon PR pace. 10 miles, 1:31:15. 9:04 pace.

My hamstrings and quads are sore, my knees hurt (especially the right one), and my abs have been cramping nonstop for four days now. But if I’m going to upcycle this jelly-sack I call a body into something that can run 26.2 miles in 40 days, I need to accept that there’s gonna be some pain. Pain is ok. As BB always says: if it doesn’t challenge you, it doesn’t change you.

We have 20 miles on Saturday morning. I need to fuel better (350ish calories during the 18 mile run was not enough), but I’m finding it hard to power stuff down. I feel like I need to work on food early in the race, and then more sugar-based fuels toward the end. A quick calculation shows that I ought to be getting around 250 calories an hour while I run, based on what my technology thinks I burn. So I’m going to shift it up and see what I can do.

I think I’ll be ready, especially if I really do kick up my speed and distance to compensate for my lack of fitness coming into the training season. I can do this. I know I can because I have before. Now that the weather has broken, and I’m running in temperatures ranging from the high 40s to mid 60s, I’m feeling better and turning in faster times. My fitness is way up over two months ago. But I have a long way to go, both literally and figuratively.

The Responsibilities of a Third Millennium Man.

30 September 2016

It is becoming more complex to be a man in the world. That’s not a complaint. For centuries, being a man has been very straightforward (which is not the same as saying it’s easy). Fundamentally, men were expected to be leaders of the household, to provide the primary income, to be physically imposing, and as a gender to be willing collectively to do the dangerous, difficult work that provided for the prosperity and security of nations. In exchange, we were generally unquestioned as the decision-makers and entitled to rights and privileges that women were not, whether explicitly codified in the law or implicit and ubiquitously enforced by the culture.

The 20th century saw a gradual erosion and shift in male supremacy in a variety of places. The transition is ongoing, and will take some time before it is complete. I think that we are slowly moving toward a society based on equality of the sexes, but that it will require a lot of time and effort still to get there. But certain facts and processes draw us inevitably towards it: high-status professions once male-exclusive like law and medicine are much closer to parity than once they were, and women are now more than 50% of college graduates. The law is less unequal than it used to be. Our political processes (the current Trump tantrum is a symptom, I think) are showing that we are more and more accepting of women with power.

All of this has many men adrift. Yes, there’s a tangible frustration with the loss of unquestioned and exclusive political and economic authority, but I think there’s more than that. Rage at perceived marginalization is understandable, even if men are not actually being marginalized. But it can feel like marginalization to move from supremacy to equality. The remedy for that is, perhaps, simply to let men rage it out and have their little tantrum. The world is changing, and some will be left behind when it does. That’s the way the world works.

I know it’s satisfying for some people to watch that tantrum. It’s a kind of cultural revenge. “Male tears” are mocked when men act out with anger or defensiveness at the loss of some previously exclusive privilege. I get that. But I wonder if there isn’t a more inclusive way to address this. The world is changing, and yes, some will be left behind. But shouldn’t we aspire to help everyone who might do so move along with it, rather than gleefully abandoning some who have the capacity for change, if only they had some mooring and instruction?

This is where I see the men of my generation and persuasion failing. Those of us who have at least nominally worked out how to get along in the world as it changes, and to embrace the direction and destination we think represents equality and justice. The third millennium man. What is our role? What part can we play that diminishes the inherent cultural violence that is being done by so many other men?

I think it starts with representing masculinity in a new way. One thing that many – especially young – men seem to believe is that masculinity has become despised and derided. This is simply not true. What is true is that the imagos of masculinity which we were once told represented the ideal (but which never did) are now being revealed as what they always were: toxic and hateful. I promise you, men, women have not suddenly and collectively decided that they hate masculinity.

What has happened though, is that women are showing us the kind of masculinity they prefer (at large – generalizations aplenty here), and it had never been the fake, flat characters that are so straightforward for us to process. It’s not the hulking action hero who seethes at the precipice of rape because he’s entitled by dint of gladiatorial triumph to whatever flesh he can reach. But that that flesh will swoon and melt for him. We men were taught that. But it was never true.

The responsibility of the third millennium man is to demonstrate that masculinity does not mean entitlement. It does not mean supremacy. And that crucially, masculinity is – in itself – a “how” and not a “what”.

Being male no longer means doing things, or having privileges, that women can not or do not. Unless you’re an elite athlete, there is nothing you can do by virtue of being male that women cannot do. And so expressing your masculinity by asserting superiority over women? That is going to leave you lonely and isolated among the enraged and hateful men the rest of the world is leaving behind.

Describing what positive masculinity is not is easier than describing what it is. Because all of the things that a positively masculine man does are perfectly within the rights and capabilities of a woman as well. So masculinity should not be seen as a bas relief, or mirror, or contrast to femininity. We were taught that these are opposites. They are not. If we men want to understand how to express (rather than assert) our masculinity in a world that doesn’t reward simian dominance rituals, we need to compare ourselves not to women, but to our own ideal and shortcomings.

Masculinity in the new world is about becoming better than we are. You do not have to apologize for being male. You simply have to work toward being a good man. All the stereotypes of masculinity presented so egregiously inflated in the culture have their grains in truth. It is ok to be physically strong and to work on your body. Master a trade or skill. Do these things confidently. But there’s no need to teeter from confidence to arrogance. In the new world, masculinity will have to be thoughtful.

So many men look at the changing world and think that women have come to dominate it, and that being unapologetically male is a liability. That men are being consigned to low-status misery and economic nonviability. It’s just not true. But the world is changing, and if men want to flourish in the new age, in the culture we’re building that will be based on universal justice and equality, we have to change with it. Our understanding of masculinity needs to change.

Because our understanding of masculinity has always been deficient. Now, finally, women are getting to have a true place in the conversation about what makes men masculine. Just as men have been part of the conversation about what makes women feminine forever (that’s changing too but I have nothing to say about it). It is time we started listening instead of just dictating. The strategies by which men are going to be successful in the new world are different from the old ones. But men are still men.

And expressing my own masculinity through self-betterment and challenging myself has been among the most satisfying aspect of my life. I do it for me. And my masculinity is appealing to the people for whom that matters. And those who look at me and see something less than a man because I believe that my female colleagues and compatriots are my equals? Well, I have little doubt who will be more content in the Third Millennium.