San Francisco

I've just returned from a 10-day trip half-way around the world to Puerto Rico and San Francisco and back. 

Me racing under the Golden Gate Bridge in San Francisco at the ADA 5k.
Photo credit: Novo Nordisk

The study center visit to Puerto Rico provided a great opportunity to catch-up with the PEARLS clinical trial team at the University Hospital in Rio Piedras (see blog entry below). Albeit a relatively short visit of just four days, we crammed in many meetings to discuss progress and future plans, including phone meetings with our National Institutes of Health program officers up in Washington D.C.. Whilst the study is very challenging, the importance of undertaking health interventions in this underserved and overburdened community remains clear to us all I think, which keeps the team motivated. 

I left Puerto Rico late Thursday afternoon and flew via Houston to San Francisco, arriving at my hotel about 12 hrs later, in the early hours of the morning local time. The nine hour time difference meant everyone back home in Sweden was up and about, so I had a quick call with my wife to catch-up on life back home, before putting my head down for a few hours. 

For the past few years I've traveled extensively with work, clocking-up a couple hundred thousand miles of air travel. These trips often involve traveling to distant time zones, which can really mess with one's sleeping and eating routines, both of which are important determinants of metabolic health. So far as I can, I try to keep fairly aligned with European time, so I don't fall too far behind with work back home or suffer major jet-lag in either direction. Whilst getting up at 2 or 3am local time on the US east coast (8-9am back home) is doable for a few days, getting up at an equivalent time when I'm on the west coast (midnight local time) is completely impracticable, so a bit of jet-lag is inevitable! The early mornings allow time for a run or swim (usually in the dark!) and as well as conference calls with members of my team back in Sweden. E-mail responses are done by 5am, and an hour later I'll have located a cafe and be tucking into breakfast. By 8am, the first meeting of the day will have begun, with almost a full European working day behind me! The down-side to this topsy-tervy world is that nights are short, as dinner engagements often make getting to bed early impossible, but for a few days this is manageable.

My trip to San Francisco was for the ADA (American Diabetes Association Scientific Sessions), the annual Mecca for diabetologists in the US and beyond. The meeting attracts well over 10,000 clinician/scientists and includes hundreds of presentations on the state-of-the-science in diabetes research. These meetings are important events in my calendar, not only because they facilitate the exchange of new knowledge and ideas through formal presentations, but also (perhaps most importantly) because of the social networking opportunities. So I had many discussions on the sidelines of the congress, with almost every breakfast, lunch and dinner shared with past, present or prospective collaborators. 
   
The ADA, like many meetings for health scientists and health professionals, also includes a 5km run race for delegates and members of the local community. The race at this year’s ADA saw more than 1,000 people cross the finish line, with the fastest guys coming from Novo Nordisk’s team of professional runners, all with type 1 diabetes (see: www.teamnovonordisk.com/elite/).  

The start of the ADA 5km, with the Novo pros center and me far left.
Photo credit: Novo Nordisk

It’s half a lifetime ago that I last toed the line for a 5km race. With such a strong and deep field at this year’s ADA 5k, I knew the race would be fast. My hotel was a few kilometers from the start line, down by Pier 32 on the San Fran bay, right next to the Golden Gate Bridge. So I rented a bike from one of the many roadside bike stations around the city, and headed down to the start. The cold windy morning didn’t seem to have put anyone off, and the music and PA announcements blared out from a distance as I approached the start. After ditching my gear at the bag-drop, checking the course map, and catching-up with a couple of friends, we were corralled into the start area and moments later the gun went and we were off. Wow!! I’d forgotten how fast these things are. The three Novo Nordisk team pros went off like greyhounds out of the trap, with a thousand others in tow. I had no idea how to pace my race, as I haven’t come close to running this fast for at least a decade (perhaps two), so I just tried to hang with the front group as long as I could. I hit the first mile mark (1.6 km) in about five and a half minutes, with a bunch of guys ahead - all felt good. Living in a Sweden, where everything is expressed in metric units, I was trying desperately to recalculate my pace in mins/km, which felt analogous to the cognitive tests climbers do at high altitudes and divers do at the bottom of oceans to check their brains are working properly. Hypoxia was apparently getting the better of me though, and after a few rough guesses, I gave up and focused on running. At two miles the pace held and we hit a switch-back, which allowed a view of the runners coming up behind. The night before I’d had dinner with a great pediatrician friend and collaborator at Harvard, Marie-France Hivert MD, and her Canadian coworker Dr. John McGravy. Both are keen runners, and I knew John would be fast, having run competitively for many years through college and after. As I hit the switch-back I saw John was 10 meters down. Another half mile and we hit a second turn and headed back on ourselves, at which point John was hot on my heels, and with 400 m to go he passed me. My lungs were bursting as I tried to respond, but as we sprinted the last 100 meters to the line, I knew it was over, and I trailed in a second behind John at 18.07, to finish 9^th. What a great way to start the day!

Back in the Caribbean

The Kullamannen ultra now seems like a distant memory, albeit only a little over a week ago! My lungs, muscles and brain recovered quickly, with almost everything feeling back to normal within 3 days of the event... almost everything except an inflamed ITB (iliotibial band) that is!! The ITB is the long band that inserts into the hip and at its base into the outside of the knee (to the head of the tibia). About halfway through the Kullamannen it was starting to feel quite sore, but my stubbornly competitive nature convinced me to complete the event, perhaps unwisely!! 

The four runs I’ve done in the past week have all ended with more pain and inflammation in my knee, a clear sign that this is shifting from an acute to a chronic injury – the classic ‘runner’s knee’!! Fortunately, it’s happened at a good time, the point in my preparation where I’d planned to switch from just running to full on IronMan training, and it turns out that my knee feels just fine when I swim and bike, so I’ll put my running shoes on the shelf for a couple of weeks and focus on the other two events!!!!

Looking out from the apartment in Ocean Park, Puerto Rico

My wife Camilla is also 'IronMan training'. Her event is little over 2 weeks away in the south of France, so last week she and I swam and biked together. Cam’s an awesome athlete, so good that she made the Swedish women’s team last year, finishing 9^th at the world championships and top 10 in several other IronMan and half IronMan events in her age-group. Her next race is on a particularly challenging course that includes more than 2,000 m elevation on the bike, climbing up through the foothills of the southern French Alpes. She raced this event 2 years ago, and I myself raced it twice about 20 years ago, so it’s something of a favorite. Despite her achievements, Cam’s pretty new to triathlon. The IronMan in France, exactly 2 years ago, was her first ever triathlon (of any distance!!!), and five months prior to the race she couldn’t swim! But Cam’s an incredibly driven and athletically gifted woman, and so she learned to swim, trained hard on the bike and running for 5 months, and went out and hammered the IronMan, finishing high enough to qualify for the world championships the following year. Truly amazing!!

Late last night I arrived in San Juan, Puerto Rico for a four-day visit to the University Hospital in Rio Piedras, where our clinical trial is based (see post below). It’s my first visit since January and much has happened on the trial since then. The US Government sponsors the trial and took some major decisions in March concerning how we should proceed, which have required considerable reorganization. The team here in Puerto Rico has been doing a stellar job coping with these new challenges, led by my co-Principal Investigator Prof. Kaumudi Joshipura. Today I’ll met with the team to hear how they’re fairing, and to receive updates on progress with data collection and participant interactions.  This is very much a real-world trial, with participants recruited from a population in desperate need of health intervention. The trial is focused on helping these pregnant women manage weight gain during their pregnancies and to teach them about healthy diet and other lifestyle habits, which we’ll help them sustain during the first 12 months of their babies’ lives. Behavior change is always a major challenge, especially in tightknit communities where social pressures to eat lots of unhealthy foods and refrain from being physically active prevail. But as much as these factors make this trail hugely challenging, they also make it extremely important. So the work we’re doing here, will, I hope, have numerous positive knock-on effects, which in some shape or form will help improve the lives of these women and their children.

           

Post-race: Kullamannen ultra

The morning after the Kullamannen and I feel surprisingly fresh in my legs, so hopefully I'll be back in training tomorrow. My only real niggle is an inflamed ITB in my right knee, but ice and strapping seem to be doing the trick! 

The early stages of the ultra - Photo credit: Kullamannen

The Kullamannen was quite an eye opener, as the event traversed all sorts of terrain, covering forest trails, sandy beaches, and near-vertical rocky sections, with a constant sequence of steep climbs and descents in the latter half of the race. I don't think I've ever done an event like this before!! Whilst I know the idea of running so far must seem crazy to most, for me it's a great opportunity to be alone with my thoughts, sorting through ideas and plans, as well as finding ways to push myself harder and further than before. All very character building... for me at least :-)


Aside from the obvious value of preparatory races for the IronMan later this summer, I'm also using these to build publicity for the fund-raising campaign. The short promotional film we shot last week is now live: www.youtube.com/watch?v=gveDhOIKycg and a press release has been distributed to some of the local media outlets. In the coming weeks we'll also make contact with potential industry donors, who we're hoping will see the merits of the campaign and feel it's a worthy thing to support. Never having done something like this before, I have no idea how this process will unfold, so I'm faithfully following the advice of the media people at Lund University!

56 km later - at the finish with two of my biggest supporters :-)

More travel coming up this week, with a quick trip to the north of Sweden to discuss progress on one of our largest population genetics projects based out of Umeå University, where I hold a part-time appointment. 
 

Pre-race: Kullamannen Ultra

It's a little after 7am and I've been awake for a couple of hours. Two hours from now I'll be standing on the start-line for the Kullamannen Ultra-marathon, which takes in the beautiful Kullan peninsula, a spit of land that juts out into the North Sea and marks the start of the Øresund shipping lane between Sweden and Denmark. The 56 km (34 mile) trail run starts with 27 km on the flat, but then soaks up 1250 m elevation during the last 29 km. My last ultra-marathon was almost a decade ago, when I ran rim-to-rim-to-rim at the Grand Canyon in Arizona (~80 km, with 3,000 m elevation). Whilst today's event is in relative terms a 'short-ultra', I must admit I'm feeling a wee bit nervous. Back in a few hours with my 'post-race' report!

And now on the start line

!

Chain-ganging

105 km!! That's how far my ride to work was this morning. I woke-up at 4.45 am with the sun streaming through the cracks in the curtains whilst the birds outside were proclaiming the wonders of another beautiful spring day in Skåne.  Unlike the birds, I didn't feel the least bit chirpy, having stayed up way too late last night!! Ignoring my desire to crawl back under the covers, I stumbled downstairs, crammed a bowl of oatmeal and a cup of tea down my throat and was out on the road 20 minutes later, still feeling zombified. 

Uncharacteristically for this part of the world, there was no wind this morning; and as I headed out of the village the sun was beaming through patches of fog rising up from the damp farmland and the air went from warm to cool and back again as the road dipped up and down. I'd arranged to meet a cycling buddy 10 km away, so I put my head down and cranked hard. It felt great to be out on my competition bike - an obscenely expensive, but very beautiful work of art made by Cervelo, which feels like a Ferrari on PEDs to ride!!

As with all the 'first rides of the season' I've ever done, I felt a little trepidation as I set out, not knowing how well the next 100 km would go, but luckily for me my legs and lungs were on great form today. So after picking up my buddy Ferenc in town, we chain-ganged (a biker's word describing the technique where two or more riders take their turn on the front of the group, rotating every few hundred meters, whilst the other rider sits in the slipstream behind) the next 60 km until we parted company north of Lund, with Ferenc heading off to his office and me carrying on to Malmö. The final 30 km went quickly and I arrived at work a little less than 3 hrs after leaving home, and 2 minutes late for my first meeting of the day (which I attended in my sweaty bike gear!). 

I run one of the largest research Units at Lund University Diabetes Center in Malmö, with 20 or so members. Monday's are usually the day when we meet to discuss the tasks for the week ahead. We have what we call the "board meeting" on Monday mornings, during which everyone present takes a few minutes to update the rest of the team on progress with projects, what's going well, what's not, and sharing ideas and solutions. The team's comprised of a remarkably multi-ethnic bunch, with 13 nationalities represented, and with roughly equal numbers of men and women. I have no hesitation in saying that my team is excellent. I'm an incredibly lucky person to have such talented, motivated and well-intentioned people working alongside me, which underlies the team's ability to produce a large volume of high-caliber diabetes research. 

Like almost all other academic research enterprises, my Unit's supported primarily by funds from either government-backed agencies such as the Swedish Research Council or the European Union, or charities such as the Swedish Diabetes Association. Some of our funding also comes directly or indirectly from pharmaceutical companies such as Novo Nordisk, which is probably the biggest fiscal donor for diabetes research in the region and has supported much of my research since I moved to Sweden in 2006. Because so much of our funding is derived from charities and from public taxes, spending our funding responsibly and ensuring that the research we do is of the highest standards is always front and center in our minds. So aside from the personal satisfaction of working with a great team, having very competent and hard working people working with me helps me ensure we do the best we can with the funding we're given.

Mid-afternoon I had a meeting scheduled with the media people from my Institute who're helping me with this fund raising campaign. Sara and Tord showed up with a film camera and microphone in hand, just as I was wrapping up a meeting with one of my doctoral students Dmitry. Never one to let an opportunity to crack a joke at my expense pass, Dmitry pounced on the opportunity to poke fun at the idea I'd be the star of a short promotional film about the campaign, highlighting that the camera was far too small to do my ego justice... how I love these guys... grrr!! If only we'd done this a few weeks earlier I thought, I would have been the talk of Cannes ;-) More to follow.

Back in the saddle

The sore throat I had during the marathon deteriorated into a full blown cold last week. It's 6 months now since I took more than 3 days off running and I'd planned to have just one day off after the marathon last weekend (it was only ever meant to be a training race), but after running 9km on Tuesday, I realized I needed a few days to recover. Taking time off is always difficult for competitive athletes, but if there's one thing I've learned with age, it's that a few days rest can save being knocked out for a few weeks. So rest I did until yesterday, when I headed out for a 'steady' 22km run. 

At the turnaround point during yesterday's run.
The 254m high Kullen peninsular just visible in the background

The past week had two key work objectives; the first was to finalize and submit a funding application to the Heart Lung Foundation. The Foundation is one of the largest Swedish funders of cardiovascular and cerebovascular research. Together, these diseases kill roughly two thirds of men and women in Sweden and abroad; although the diseases are being treated better than ever before, because most Western societies are living longer, more and more people develop cardiovascular disease and eventually die from it. The Heart Lung Foundation works hard and plays an incredibly important role in Sweden to help fight these devistating diseases. They also provide patient education and advocacy. I've been lucky enough to be funded over successive years by the Foundation, which has supported all of my key research on the genetics of cardiovascular disease. So as each grant cycle draws to an end, I make a big effort to ensure my next funding application is highly competitive. 

Our application this year focuses on studying genetic and lifestyle determinants of long term deteriorations in blood pressure and blood lipid concentrations. Fortunately we've just had a major paper accepted for publication outlining our most recent research on lipid genetics in one of he top genetics journals (PLOS Genetics), and we've had several other major papers published in the past few months, which all help support the new application for funding. 

The second key task last week was to attend the Swedish Research Council's information day for grant reviewers. For the past two years I've been invited to sit on one of the panels that evaluate research funding applications for government money from Swedish medical scientists. So on Thursday I headed up to Stockholm to meet with other members of the evaluation panels to discuss how the process would be run this year. It's a ton of work reviewing grant applications (something that will take most of the summer), but it's also an important aspect of my work, as any well structured research funding mechanism requires rigorous peer review.

So back to the run yesterday. Having felt rough all week, I needed to test my legs and lungs to see if I'd been able to shake the bug. It was great running weather so I headed out on my seafront trail route into a slight head wind. I usually hold a 3hr marathon pace on my long runs (4.15 mins/km), but because I've been sick I focused more on settling into a comfortable pace, regardless of how fast or slow it might be, and not coughing and spluttering too much. At 11 km I got to the turn around point on 4.16 min/km pace, and with the wind behind me on my way back I cruised through half marathon distance bang on 1hr 28 mins (4.11 min/km pace), without feeling too worse for wear. A relief, given that it's now just over 5 days until my next event, the 54 km ultra marathon on Kullen!! I also got back in the water today after nearly 4 months off swimming. We live close to the sea and it's now just about warm enough to train. So I knocked out 1500 m before dinner. Tomorrow I'll get up early for one of my first bike sessions this spring, a 96 km ride from home down to the diabetes center at Skåne University Hosptial in Malmö, where I work.

Copenhagen marathon - Sunday 18th May

I've been laying down a lot of running miles since returning to Sweden in January, clocking up 80-110km each week, with one long run each weekend of 30-40km. May was a busy work month with trips to Cambridge (UK), Reykjavik (Iceland), Washington D.C., and Frankfurt (Germany), so I've had to fit training in around travel, which means doing a lot of running in the dark! 

Out running along the bay in Reykjavik (May 2014)

It's more than 10 years since I raced a marathon (one that wasn't part of an Ironman or just for training that is), so I decided to enter the Copenhagen marathon last Sunday. The race covers much the same route as the IronMan event later this year and the Danes have a great reputation for organizing great events and supporting them with thousands of supporters. True to form, the Copenhagen marathon was a fantastic event!!!

I arrived home from Germany last Thursday to a house full of sick kids, so I did may best to help Camilla take care of them without picking up a bug myself! My plan had been to stay in Copenhagen the night before the race, but instead I decided to sleep at home Saturday night and drive down early Sunday morning. At 5am I hopped out of bed with a bit of a sore throat (which I ignored), ate breakfast and jumped in the car, arriving in Copenhagen at 8am. 

The Copenhagen marathon is a medium-sized event as big-city marathons go, with about 12,000 entrants. It starts on the waterfront close to the city center and winds around the city for 42.2km, with crowds lining most of the streets in their thousands. We stood bunched tightly together 50m from the start line, with the smell of Deep Heat muscle rub hanging in the air, and athletes jostling from one foot to the other in nervous anticipation of what was about to come. Then the gun fired and we were off. 

I raced the London Marathon back in 1997 and set my best time ever of 3hrs 02mins. 17 years later, and my goal was to better this and dip under the illusive 3hr barrier - call it an age-neutral attitude if you will ;-). My race started well and I soon slotted into a comfortable pace, on track for a 2hr 55min marathon. My throat was still sore, but kept my fingers crossed it wouldn't affect my performance. At half-way I was well inside 3hr marathon pace, but things were getting tougher. I focused on staying on pace until 32km with the hope I could hang in their for the last 10km. At 32km, I was still running just under 3hr marathon pace, but the writing was on the wall; my legs were tiring and the last 10km proved a struggle. With 5km to go I knew it wasn't going to be my day, so I decided to save my legs and cruise in for a 3hr 07mins marathon. Not exactly what I'd hoped for, but good preparation for my next event on May 31st, the Kullamannen Ultra marathon, a 54km hilly trail race on the Kullen peninsula!!