When the Spring-Back Slows

When the Spring-Back Slows

People say their body is not what it was as they get older. Stiff for a good while on waking, tight when bending at the waist or turning the neck. Yet at the hospital they are usually told there is nothing much wrong. Blood sugar normal, inflammatory markers normal. "I am not even diabetic — why am I stiffening like this?" they ask.

At such times I start with the kitchen.

It Is the Same As a Crust Browning and Hardening

Bake bread and the outside turns brown and hardens. Sear meat and the surface firms and gives off an aroma. This is the reaction in which sugar and protein meet heat and stick to one another. It is called the Maillard reaction, after the chemist who set the phenomenon out more than a century ago. So far this is cooking.

But the same thing happens inside our bodies. Using time instead of heat, very slowly.

Sugar Sticks a Little at a Time Even Without High Blood Sugar

Glucose in the blood travels around the body and attaches bit by bit to proteins. It is a reaction that happens of itself, with no enzyme directing it. With very high blood sugar it sticks quickly; at normal levels it still sticks, slowly. After repeated attaching and detaching, with more time it hardens into a bond that does not come apart.

The question is where these bonds accumulate. What turns over most slowly in our bodies is collagen and elastin — the connective tissue that makes up skin, tendon, ligament, vessel wall and joint. Once made, these stay in place for months or years. So the hardened marks of sugar sticking to them remain just as long.

Collagen fibres normally slide against one another as they stretch and return. That sliding is the tissue's elasticity. But when fibre and fibre are joined by sugar like a bridge and set hard, they cannot slide and become stiff. The force that stretches and returns is lost.

Up to here these are well-established facts.

Tests Measure Now; Stiffness Speaks of Accumulated Time

So why does it not show up on tests?

A blood sugar test measures the value at this moment. Even HbA1c looks at the last two or three months at most. But these hardened marks in tissue are an accumulation over years. They are the result of how long sugar dwelt in the tissue across past seasons, and the blood sugar measured this morning does not hold those years.

So the test comes back normal. The test is not wrong. It measured accurately what it set out to measure — today's blood sugar. It is only that the stiffness the body speaks of is not today's value but the circumstance of accumulated time. The two are looking at different things.

So Working It Loose Physically Loosens It Less

From here is the picture I see in the consulting room.

Press and stretch stiffened tissue by hand and it becomes considerably softer. That is the work of reviving the force that returns after pressure — elasticity. But a place already "welded" chemically does not come back as it used to, however it is worked physically. There is a limit to what hands can do.

So with such a person I look at softening the body and at keeping sugar from dwelling long together. Marks already set are hard to reverse, but the speed at which new ones set can be slowed. This part is a view I have formed in practice, and a place I still have to fill in further.

If you are on medication, continuing it with your doctor comes first. And if a single joint suddenly swells, reddens and grows hot, or fever comes with it, that is a different matter from this story and you must be examined first.

We commonly put a stiffening body down to age alone. But that stiffness is also the body reporting, belatedly, how long sugar dwelt in its tissue. That today's blood sugar is normal, and that my body has been setting hard, can be true side by side like that.