dawn effect and fasted exercise

I have always eaten something before exercising, even 5:30 am masters swimming.  I have a cast iron stomach--the only time it ever bothers me is if I catch the stomach flu.  When I first started training for triathlons, I ate a little carbohydrate and protein before morning training, something like an orange and a couple of pieces of cheese.  Even after I went low carb, I was prone to feel out of energy and irritable if I went too long without eating (though my blood glucose was not problematically low).

I also had read that for some people with type 2 diabetes, morning high blood glucose (the dawn effect) would just go higher and higher until the person ate something to stimulate the body to produce insulin.  The liver would release glucose, but the body wouldn't be able to use it until it got that insulin.  I never tested that myself; it matched all my assumptions about eating before exercise.  And when I was training for racing, the approach I took worked well for me, as it fit into my fueling strategy for racing.

Now that I am following the primal way of eating, I have been paying attention to the arguments for not snacking and realizing that I'm not hungry.  I am less and less prone to that running out of fuel feeling.  So I decided I would do a test and see if my blood glucose went high if I exercised without eating first.  My test was swim practice-- 1 1/2 hours of swimming starting at 5:30 am.  I tested after my warmup and an hour or so in after some hard swimming.  I first tested the way I had been doing it, and then five days later I tested without eating first:

July 5
5:00  120 waking
5:25  115 before exercise, just after eating melon
6:05    93 after 1/2 hour of warmup
6:45  105 after swimming hard
7:30  125 1/2 hour after finishing workout
8:30  137 just finished slowly drinking my breakfast smoothie
9:40  119 to see if it came down

July 10
5:15  116 waking
5:50  100 after 1/2 hour warmup, no food
6:30  106 after swimming hard
7:40  120 after showering and driving home
8:20  130 after slowly drinking my breakfast smoothie

So there certainly doesn't seem to be any harm in fasting exercise for me.  I felt a little less energy, and a little strange when the food hit me afterwards.  But my body will adapt.

Two years

It is about two years now since we realized John had Parkinson's disease. He was diagnosed as soon as we saw his family practitioner and sent to a neurologist and then to the Movement Disorder Specialist who said Lewy Body Dementia.

John is doing better than I had expected. Our son, who isn't very observant, said he thought John hadn't changed significantly in those two years. The changes I see are that John is slower and gets confused more easily. But he is still taking care of himself except for wanting help putting on his socks and he still doesn't have hallucinations. He did a driving evaluation with the occupational therapist at the rehab hospital and passed. I think our new renovated house has improved our lives--he can deal with his sleep issues by watching tv or listening to books on tape in bed or sleep on his back and snore. We have a caregiver/cleaning person twice a week who does her best to keep his chaos under control. I'm happier anyway now that I have my own peaceful space.

He is in somewhat more denial about the cognitive issues, but he admitted recently he can't handle financial matters and the like when he asked for my help with a situation where he has been dropping the ball for years--serving as executor of the estate for some people who were important to him when he was young. I thought he had withdrawn a year or so ago but it turns out he didn't. I will play the illness card on that one--tell them he has early dementia and doesn't like to admit it. We also have arranged for an accountant to help aunt Florence with her finances so she doesn't keep asking John for help.

John and I talked a little about how he is doing better than I expected after two years. He wondered how much of it is due to his taking coconut oil and MCT oil? No way of knowing. He does have impaired glucose tolerance, so if some dementia is a kind of diabetes in the brain he is likely to be in that group. And that is what the oils are supposed to address by providing ketones as an alternative fuel for the brain.

We saw John's neurologist yesterday and the doctor was pleased with John's muscle tone. John is working with a better physical therapist and she has even motivated him to do some exercising on his own. He has even gone out for a walk a couple of times in the last few weeks. I just wish he didn't have such a tendency to decide to go for a walk or to go see his aunt Florence at dinner time.

fairly stable

We are now pretty well settled in the renovated house. We have a woman who comes twice a week and cleans, does John's laundry, and straightens up his area. He doesn't like it when she tries to organize his things but he doesn't get around to doing it himself. I tried to suggest that when he can't do things himself he needs to accept someone else doing it not exactly his way, but he doesn't buy that.

He will let her help him with some things like putting on his socks. I tried to push him that he needs to shower more than once a week but his answer was that putting on his socks was too difficult. Sigh.

Today he went out for a walk for the first time in months and called me to come get him because he had been too ambitious (he went nearly two miles). It would be good new if he would get back to exercising. He has a physical therapist he likes and now goes there twice a week. Maybe she has finally found the trick to get him to make the effort to exercise.

He did a driving evaluation with an occupational therapist at the rehab hospital and he passed. It worries me that he came home exhausted by the effort because he had to change his usual habits for the evaluation (for example staying under the speed limit). But so long as he has no hallucinations and does this three hour driving evaluation once a year I won't fight it. Despite how slow he has become his reaction time tested as good.

doctor's visit

John had a neurologist's visit Thursday. John reported that his balance is worse and we both reported that he is moving slower. He asked about increasing the Sinemet but the doctor said no because the doctor found his muscles not stiff. The doctor seems most worried about falls.

We asked about when the doctor thinks Namenda should be started. He said when the Aricept stops working. What I wonder is whether the Namenda would be any better than the Aricept, which John takes only a half dose of because it causes him balance problems.

John reported that he doesn't get enough air through his nose and needs to breathe through his mouth. The doctor asked about allergy symptoms, but John said it is true even when his nose is not running. The doctor suggested more exercise to strengthen his chest and diaphram muscles. John said he would go back to using our exercise bike. He does take a 1/2 hour walk several times a week, but I don't know how aerobic that is.

After we got back from Massachusetts it was several days before I got John to go visit the other house, and then he didn't say much. The renovations are in the stage where everything is torn out and some of the changes are framed in. I did get him to make a decision about whether he wanted a larger closet or more built in bookshelves. But it feels like he isn't interested, which is hard on me. It is mostly just one more thing than he can deal with--he has trouble getting the necessary things done in a day.

I'm having a tough time because the main part of the budget for the program I run at work just got eliminated. My job is safe but it is discouraging and hard to know what to do. We also got a lowball offer on our current house and they haven't responded to our counteroffer.

motivation

I drove our daughter to a summer class at Duke today--left at 9:30 am, got back at 8:30 pm. It didn't seem like as long a day of driving as it was; she and I talked to whole way up and I had downloaded several new albums to listen to on the way back. I tried to explain the whole family financial situation to her and she seemed reassured to know. My father gave the kids college funds when they were born which have done very well, so I'm not worried about our new situation limiting them.

I called John from the road to tell him when I would get home, and I asked him if he had gone to church. I didn't particularly expect it--it is something which has always been more my thing than his--but he likes the Sunday evening service we have been going to recently. He said he hadn't been able to motivate himself. I thought that was interesting, that he saw it as not being able to motivate himself. That applies, I think, to doing more exercise--he knows it is a good thing but needs structure to motivate him. He says he does want to try Silver Sneakers, so maybe he and I will go sign up at the Recreation Center tomorrow after his urologist appointment. I wish so much for him to have motivation to do as much as he can, but the disease is taking that away.

exercise class

John went today to an introduction to a Silver Sneakers exercise program at our local community recreation center. He seems more interested in the question of whether his insurance would pay for it than in what the courses were like--he doesn't seem to have come to any conclusion about whether a group exercise class would work for him. They were supposed to do a demonstration class but unfortunately they didn't. They have a stretch and strength class twice a week, which sounds like what he needs. I wouldn't have thought he would have considered a group exercise class, but he seems willing to try it out.

When we went to a conference on Parkinson's disease one of the doctors said that the thing that will help most is exercise. I don't know what structure will work to get John to do exercises (in addition to his walking) when he finishes his month of physical therapy, but I think he needs some structure. I've done a little bit of looking into finding him a personal trainer, but maybe a class would be better.