What I Think about When I Think about Running

I’ve been listening to Haruki Murakami’s book, What I Talk about When I Talk about Running. Murakami is a far more serious runner than I am, logging 30 or more miles a week, compared with my average of, say, 15. He talks about the rhythms of running and how the discipline involved in running regularly mirrors the kind of discipline you need as a writer. He loves the simplicity and freedom of running, and the fascination of watching your body change shape as your running speed and style evolve. Today, as I ran in the 36th Tufts Health Plan 10K for Women, I thought about a few things myself.

Tufts 10K finish area
Should I try the kids’ race next year?

The Tufts 10K, a Boston institution, takes place every Columbus Day. The course runs through downtown, and loops over the Charles River. Thousands of women run/walk/wheel the USTAF-sanctioned course. Today, Joan Benoit Samuelson came in second in my age group, with a pace of 6:11/mile. Let’s just say I’m a tad slower.

So, what did I think about today?

Mile 1: Way too crowded. Lots of elbowing. I can’t get any speed going. Still, fun to be in the pack. Legs a bit tired. Sciatica. Quads.

Mile 2: Yep, I’m tired! Heart rate and pace decent but not up to what they were my last 10K—the Lone Gull in Gloucester. Running over the Mass Ave bridge is less intimidating than rowing under it. Sciatic pain goes away at about Mile 2.5. Yay. On to quads…

Mile 3: I’m warmed up now. Should be hitting my stride but not quite there. How can people actually be carrying on conversations at this point? About party dresses? Aieeee! The cut-through on the Mem Drive median strip looks very tempting. Did not do it! Did I have the optimal breakfast? Too long ago? Not long enough ago?

Mile 4: Am I really going to toss my cookies? Why did I have that beer last night? Will I ever write a book? A decent blog post? A good shopping list? More than one woman is wearing a tutu. Pink, as if there were another color.

Mile 5: OK. How is this woman, looking about my age, just sailing on past me like I’m standing still? Did she start at Mile 4? Trying to sprint a bit as I notice the heart rate going down. Little kids extending hands for high fives. Too zoned out to play.

Mile 6: Almost there! I am not going to break 1 hour. Recording of a girl-group singing “We Are the Champions”! Whoa…

Post race: Lost my bearings looking for the Park St. station. Why not walk around an extra half hour?

I guess what I have in common with Murakami is a real appreciation of running, and how it can build a structure, a foundation. When I run on my everyday solo runs, I solve problems without meaning to, remember things I said I’d do but haven’t, think of people I need to see or talk to, imagine what I’d like to do when I have time/money/opportunity. As Murakami said in his memoir, he doesn’t really think about anything in particular when he runs, but somehow the rhythm, the habit, and the love of it gives him something to put in his pocket for later. You don’t remember it, but you remember it.

Prevent Alzheimer’s? You sure?

“Keep your brain healthy for the rest of your life,” reads the book jacket. If you’ve watched a family member or friend fade into dementia, this is one promise you wish with all your heart to believe even as doubt simmers on that back burner. Dr. Gary Small is on the book tour to promote The Alzheimer’s Prevention Program, and as accessible, positive, and reasonable as the program is, I still balk. Not that I think Dr. Small is selling snake oil or is otherwise untrustworthy. He’s a well-regarded neurologist who is recommending, based on evidence from research, a program of nothing more than regular exercise, good nutrition, stress management, and memory exercises to maintain brain health. Nothing harmful here, and nothing we haven’t heard before. And even if it doesn’t keep your brain sharp, his program might just help you avoid or delay heart disease or diabetes. So why not? And why don’t I feel a sense of unease when the talk is about preventing heart disease using similar methods?

Maybe my attitude is emblematic of the Baby Boomer zeitgeist–we’re living longer, we’re fighting aging, and we’re scared to death we’ll exit this vale by staring off into space uncomprehendingly or “wandering off,” as some of our parents have already. I saw my mother gradually lose her engagement with daily life, her capacity to speak, her ability to eat, and, finally, her self, as she slipped steadily away from us. It just might be her shade that pulls me up short when I’m about to fully believe in prevention. I’m sure she’d want me to believe, much as she wanted me to believe in the Holy Trinity or transubstantiation, but it’s just not in me yet. I’ll gladly eat my fruits and veg, exercise to the point of injury, and OM with the best of them to keep heart disease, cancer, or diabetes at bay, but dementia? It can’t be that easy to save a soul, can it?

Brain Food: One Doctor’s Prescription for Preventing Alzheimer’s

Alzheimer’s disease, the bane of Margaret Thatcher and now Glenn Campbell, may be preventable, said Dr. Gary Small to a crowd of about 100 people at a church in Cambridge, MA, last night. Speaking about his new book, The Alzheimer’s Prevention Program, Small, director of the UCLA Longevity Center, challenged the notion that Alzheimer’s, the most common form of dementia, cannot be prevented. Small’s plan combines physical activity, nutrition, stress reduction and memory training to defend against Alzheimer’s.

Dr. Gary Small in Cambridge, Mass., February 2012

Paying attention to these four factors, Small believes, will help you delay or prevent the brain changes that may lead to Alzheimer’s. The same problems that are believed to contribute to heart disease—chronic inflammation and oxidation—may lead to the buildup of the plaques and tangles seen in the brains of people with the disease.

Despite the promise implicit in his book’s title, Small said he agreed with the substance of the National Institutes of Health 2010 Consensus Statement that there is not now enough evidence to associate the modifiable risk factors of his program with delaying or preventing the disease. The NIH statement also said that there is reason to continue research to discover ways to delay the onset of Alzheimer’s, if not prevent it.

Small’s book is accessible and energetic, and the program’s components boil down to behavior changes that many people find extremely difficult to make—exercise more, eat better and reduce stress. The audience, most of whom appeared over age 50, was animated and involved in the topic. Asked for a show of hands to gauge the level of personal connection to Alzheimer’s, about 95% responded. During the question-and-answer period, about 15 audience members approached the microphone with thoughtful and well-informed questions.

For example, one query asked whether people may be more motivated to follow his program to prevent Alzheimer’s over a similar one to prevent heart disease. Small’s response was that there is a fear factor, especially if one has watched a family member descend into dementia. The second is age. “As we get older we notice changes in ourselves,” he said.  “But there is something about Alzheimer’s that strikes at the core. Our identity—who we are, memories, cognition, define who we are.”

Small’s language in selling his program—“slam dunk” techniques to improve memory, for instance, and a bright, can-do style—could be interpreted as manipulative or overpromising. However, Small’s scientific credentials are solid, and he does cite evidence and acknowledges the limitations of his approach. Preventing or delaying onset of Alzheimer’s, or reducing the risk of contracting it, is a growing area of research, and is far from the fringe.

After Small’s remarks, the event moderator, Dr. Margaret O’Connor, director of Neuropsychology at Beth Israel Deaconess Medical Center, introduced the question-and-answer period with a question of her own. When should a person be worried about changes they notice in themselves? she asked. Small answered that people with mild cognitive impairment (MCI), a transitional stage from normal age-related changes to dementia, should get medical advice.

MCI is a stage of early dementia, when people are beginning to have some cognitive difficulties, but can still live independently. This is a stage where drug therapies may be most effective. However, once cognitive changes are observed, it is likely too late to do much to delay progression. For this reason, any attempts at prevention or delay should begin early—in one’s 30s or 40s.

So, can people with MCI manage a program such as Dr. Small’s? O’Connor, in a telephone conversation the next day, said that MCI and dementia are heterogeneous, meaning they affect people in different ways. Some are more affected in their multitasking skills, others in language. If an individual is not too memory-impaired, then he or she could probably manage such a program. Otherwise, O’Connor said, a caregiver would have to be very involved.

Gary Small, MD, spoke about his new book, The Alzheimer’s Prevention Program, as part of the “How We Live Today” series presented by the Cambridge Forum. For further information on Alzheimer’s disease, visit the Alzheimer’s Association.