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HEALTH POST Hong Kong’s women ultramarathon runners are in it for the long haul >PAGE 6

Blister sisters





Keep on running, or riding

...................................................... Jeanette Wang

...................................................... Katie McGregor RunCycleSwim HK$8 Rating 7/10 Shoedometer Free Rating 7/10 Emergency Bike Repair HK$23 Rating 9/10 This week, I’m reviewing not one but three apps that would be useful to triathletes. These are apps that keep gear in check. As much as you may love a pair of running shoes, they have a limited lifespan, and once that has been exceeded, you risk discomfort and injury. RunCycleSwim is a simple app that allows you to track the kilometres covered in your running shoes. Take a photo and name each pair of shoes, and you can keep individual shoe running diaries. The Shoedometer app tracks only your shoes’ distances, but if you use distance-measuring devices such as Garmin Connect or Nike+, you can upload your distances to it. You can customise your shoes’ profile, either by taking a photo or

choosing a photo from the library. Shoedometer also allows you to set a distance at which you will receive a “retire your shoes” warning. The big question is, what distance should you set? At this point, you realise that the apps are redundant because the recommended retirement distance for any pair of shoes depends on your weight, running style, the terrain on which you run and the shoe brand, and can vary from 500 to 1,000 kilometres. Because of this, most sites and experts recommend that the best way to decide whether to retire your shoes is a visual check. My purchase of the Emergency Bike Repair app is like “closing the barn door after the horse has bolted”. But now, if I have a problem while out cycling, I have a repair kit, as advised, with Allen keys and a chain tool. For the emergency repairs section, there are photographs and text to guide you through repairing chains, tyres, derailleurs and more.

ASK THE DOCTORS DR MICHAEL SOON Q: What are long-term effects of wearing high-heeled shoes to work? A: Wearing high heels changes your centre of balance and alters your gait. There is an increased risk of ankle sprains and fractures, but these are traumatic and not a consequence of chronic high-heel use. When you wear a high-heeled shoe, the toe box (the area where your toes go) is narrow and squeezes your toes. The higher the heel, the greater the force. This can lead to bunions, hammer toes and toes crossing each other. A stiletto has minimal medial arch support. Over time, this can lead to strain or injury of the plantar fascia (connective tissue on the sole of the foot) – leading to pain over the heel, arch and toes.

Reducing the heel height reduces force on the toes. A wider toe box also helps. To prevent strain, alternate heels with highheeled platforms. If your ankle and foot are always in a flexed position, the Achilles’ tendon will gradually shorten. You can end up with an almost tip-toe gait, even when you remove your heels. A shortened Achilles’ tendon suffers extra strain when you wear flats, which leads to pain at the back of the calf. I have a patient who is so used to three-inch heels she cannot wear flats. To combat this wear sneakers and change shoes at the office. Remove the heels when possible to stretch the tendon. Dr Michael Soon is a consultant orthopaedic surgeon at the Centre for Orthopaedics in Singapore

Correction In last week’s cover story Cold Comfort, the photo caption stated incorrectly that umbilical cord blood is stored at minus 135 degrees Celsius at the CordLife facility. CordLife stores the umbilical cord blood at minus 190 degrees Celsius. > CONTACT US Deputy Culture Editor: Choong Tet Sieu Health Post Editor: Jeanette Wang General inquiries: Advertising: tel: 2565 2435; e-mail Printed and published by South China Morning Post Publishers Ltd, Morning Post Centre, 22 Dai Fat Street, Tai Po Industrial Estate, Tai Po, Hong Kong. Tel: 2680 8888

Get a wriggle on Scientists at Cardiff University in Wales are a step closer to treating male infertility with their latest discovery: adding a missing protein to infertile sperm can “kick-start” its ability to fertilise an egg and significantly increase the chances of a successful pregnancy. The team found that the sperm protein, called PLC-zeta, is transferred to the egg upon fertilisation and activates all the biological processes necessary for development of an embryo. Some forms of male infertility are due to defective PLCzeta. In the lab, the scientists prepared active human PLC-zeta and injected it into an unfertilised egg. The egg responded exactly as it should at fertilisation, says lead researcher Professor Tony Lai, adding: “In the future, we could produce the human PLC-zeta protein and use it to stimulate egg activation in a completely natural way.” The study was published last week in the journal Fertility and Sterility.

A choc to the system The roots of chocolate temptation lies in an unexpected part of the brain previously linked with movement, according to new findings by researchers at the University of Michigan. In a study published last week in Current Biology, rats were injected with an opiate-like drug called enkephalin, which was delivered straight to a brain region called the neostriatum. The rats then gorged themselves on more than twice the number of M&M chocolates than they would otherwise have eaten. As they ate, enkephalin – produced naturally in the same brain region – surged, too. “The same brain area we tested here is active when obese people see foods and when drug addicts see drug scenes,” says lead researcher Alexandra DiFeliceantonio. “It seems likely that our enkephalin findings in rats mean that this neurotransmitter may drive some forms of overconsumption and addiction in people.” Not-so-sweet 16 What’s the best way to keep your weight in check? Cut sugarsweetened beverages out of your diet, says a new study published in the New England Journal of Medicine. Teens who did so for a year as part of the study by the New Balance Foundation Obesity Prevention Centre of Boston Children’s Hospital maintained their body mass index and gained an average of 1.8 fewer kilograms than their peers in a control group who continued to consume sugary drinks. The teens in the intervention group received deliveries of non-caloric beverages for one year, as well as check-in visits and reminder messages from the researchers. However, in the second year of the study, in which there was no intervention, both groups of teens showed similar weight gain. These findings suggest that teens are likelier to make healthier choices (drinking non-caloric beverages) when they are more easily available to them. This probably applies to adults, too.

Safety in numbness If you’ve got major surgery lined up, take heart: survival after a general anaesthetic and within 48 hours of surgery has greatly improved worldwide over the past 50 years, according to a report in The Lancet. The paper analysed data from 87 studies spanning more than six decades and involving more than 21.4 million anaesthetics given worldwide. The estimates suggest that although more operations are carried out on patients who are considered high-risk or who need more complicated surgeries now than in the past, the likelihood of dying after a general anaesthetic has dropped by roughly 90 per cent to 34 per million people. The risk of dying from any cause within 48 hours of surgery has also decreased by about 88 per cent to 1,176 per million. However, the researchers note that the greatest and most progressive decline has been in developed countries, and more must be done to reduce anaesthetic mortality rates in developing countries.




Quiz yourself on cadmium below.

Jeanette Wang Cadmium, a heavy metal that occurs naturally in the earth’s crust, ranks high on the list of environmental toxins that pose considerable health threats. According to the Hong Kong Centre for Food Safety, cadmium is ingested mainly through food. Plants, animals, fish and shellfish will absorb cadmium when grown in a contaminated environment. Human activities may also release cadmium into the environment. For smokers, tobacco smoke is a key source of cadmium exposure. Cadmium exposure may lead to kidney dysfunction, osteoporosis, cancer, cardiovascular disease and other serious conditions. “Cadmium is virtually everywhere, and it is taken up into the human body and bio-accumulates for decades in the kidney,” says Dr Stephan Clemens of the University of Bayreuth in Germany. Clemens is the lead author of a study published earlier this month in the journal Trends in Plant Science that examined how cadmium accumulates in certain plants. He suggests using breeding techniques

1. Last year, cadmium made the headlines in China after being found in which crop? a. rice b. choi sum c. corn 2. Eating food contaminated with high levels of cadmium can cause shortterm effects such as a. abdominal cramps b. flu-like symptoms c. tingling hands

to develop crops that transport less of the heavy metal to the grain. The Joint Food and Agriculture Organisation/World Health Organisation Expert Committee on Food Additives has established a provisional tolerable monthly intake of 25 micrograms per kilogram of body weight. In Hong Kong, the Food and Environmental Hygiene Department has been conducting routine surveillance for cadmium and other heavy metals in foods collected from import, wholesale and retail levels.

3. According to the WHO, each cigarette contains how much cadmium? a. 0.1 to 0.2 microgram b. 0.5 to 1 microgram c. 1 to 2 micrograms 4. How can one test the levels of cadmium in the body? a. X-ray b. blood test c. urine test Answers: 1. a (it was reported that 10 per cent of Chinese rice contained excess cadmium); 2. all are correct; 3. c (and about 10 per cent is inhaled when cigarette is smoked); 4. b or c

Bus passes keep elderly active ...................................................... Jeanette Wang Free bus passes for the elderly could be the way to go in Hong Kong to boost public health. Not only do they benefit the pocket, they also encourage older people to be more physically active, according to a new study published in the American Journal of Public Health. Imperial College London researchers reached this conclusion after analysing data from the National Travel Survey from 2005 to 2008. In April 2006, a bus pass scheme for people aged 60 and older began, entitling holders to free travel anywhere in England from 9.30am to 11pm on weekdays and all day on weekends and public holidays. In a poll of 16,911 people 60 and older, the researchers found that those – both wealthier and poorer – with a bus pass are more likely to walk frequently and take more journeys by “active travel”, which is defined as walking, cycling or using public transport. Previous research has shown that

15 minutes of moderate daily exercise, or even just walking to and from bus stops, is associated with a 12 per cent lower risk of earlier death in people over the age of 60. In Hong Kong, the elderly (defined as being 65 and older) don’t travel for free but pay a concessionary rate of HK$2 per trip for most public transport services. This scheme, which also applies to eligible people with disabilities, was launched on June 28 and is being rolled out in three phases until the first quarter of next year. Each phase adds more transport options. But the English scheme is facing pressure to be scrapped, as it costs £1.1 billion (HK$13.8 billion) a year.

“Active travel” benefiting the elderly includes buses. Photo: Dickson Lee


...................................................... Eileen Aung-Thwin Larry Chung was on his annual skiing holiday in Vancouver, carving his way down powdered slopes when he heard a “pop” followed by the feeling that his left heel was on fire. The 45-year-old banker knew that his Achilles’ tendon had ruptured – again. Ten years earlier, Chung (whose name has been changed for patient confidentiality reasons) had suffered the same injury to his right foot while playing soccer. So he was familiar with the symptoms and sensations of the injury, and also acquainted with the long, drawn-out – and somewhat hazardous – road to recovery. He mentally braced himself for the process as he gingerly made his way to the ski resort’s medical centre. The Achilles’ tendon is a band of connective tissue holding the calf muscles to the heel bone. It enables a person to push up on their toes and to push off when walking, running or jumping. According to Dr Tang Wai-man, a specialist in orthopaedics and traumatology at the Hong Kong Sanatorium and Hospital, the Achilles tendon is the most troublesome part of the human anatomy. The tendon earns its name from an ancient Greek myth about the warrior Achilles, whose mother dipped him into the Styx river to try to make him invincible. However, because she held his heel while immersing him in the magical waters, a small vulnerable spot was created. Achilles was later killed by a shot in the heel from a poisoned arrow. Doctors know that the Achilles’ tendon is vulnerable, not only because it has to bear up to 12 times a person’s weight when they are running or jumping, but also – and more importantly – because blood flow to the heel area is poor. Sub-optimal blood flow to any area impedes healing and creates problems. The last time Chung had to recover from an Achilles’ tendon rupture, he spent three months hobbling around with his foot in a cast and developed deep vein thrombosis (DVT). Hence, he knew

he needed his loved ones near during recovery to make the uncomfortable road ahead more bearable. So Chung, who divides his time between Canada and Hong Kong for work, chose to return to the city to stay with his family during the treatment. The medical staff at the Vancouver resort bandaged his ankle tightly to immobilise it, thereby minimising movement and pain for his long trip home. Back in Hong Kong, he consulted Tang. Tang was a little surprised that Chung experienced the tendon rupture while skiing because the sport does not require the typical strains and jerky movements that usually precede a tear. When examining Chung’s heel area, Tang found a gap where the tendon should have been. Upon squeezing Chung’s calf muscle, there was no movement in his left foot when there should have been a slight flexing of the foot if the Achilles’ tendon was intact. The connection between foot and calf had indeed been severed. The ruptured tendon needed to be repaired. Ten years earlier, the surgery to repair Chung’s tendon in his right foot left a 6cm wound in his ankle. The extra trouble with a long wound in this area was not simply the slow rate of healing caused by poor blood flow. Poor blood circulation to this area meant the injured skin might not get the nutrients and oxygen it needed to heal, leading to death of the skin tissues in a condition called skin necrosis. However, minimally invasive tools and techniques now enabled the torn ends of the tendon to be reattached with only a 2cm-long incision, minimising healing time, risk of infection and skin necrosis. The reattachment process was a delicate one as Tang had to ensure the two ends of the tendon were stitched so they just touched. An over-tight repair could result in another rupture. Because the newly repaired tendon was fragile and prone to rupture, the whole foot and ankle area needed to be immobilised to enable the tendon to strengthen and heal. The improved tendon-repair techniques also meant that the healing time would be shortened

Illustration: Angela Ho

Tendon loving care

The reattachment process was a delicate one as Tang had to ensure the two ends of the tendon just touched

from the three months of a decade ago to four weeks. Immobilising the foot for an extended period also presented its dangers, as Chung found out previously when he developed DVT. In normal situations, contractions of the calf muscle help pump blood through the veins in the lower legs. This mechanism is especially important in promoting blood flow because the lower legs are so far away from the pumping action of the heart. When the calf muscles are immobilised, the pumping action of the muscle is stilled. This results in slow blood flow to the lower legs and increases the risk of blood thickening and clumping together to form a blood clot, Tang says. This blood clot can break away and travel in the bloodstream. If it reaches an artery in the lung, it can cause a blockage or pulmonary embolism, which can damage the lungs and other organs, and even cause death.

DVT can also cause symptoms such as leg pain, redness and swelling. Hence, patients recovering from Achilles’ tendon reattachment surgery need to take anticoagulants or blood thinners. In the past, Chung had to stay in the hospital for a number of days while the anticoagulants were delivered through an intravenous drip. This time, he could continue taking anticoagulants orally at home, thereby reducing his hospital stay. Four weeks later, his foot was freed from the cast. He had to undergo six weeks of physiotherapy to rehabilitate his leg muscles and help him to walk normally again. Chung was delighted with the improved treatment for the tendon rupture. Tang advised him to ease back into light exercise after four months’ rest. He also advises people to build up their muscle strength and exercise routines gradually, and avoid sudden and vigorous exercise that their bodies are not used to.


A little spot of bother ...................................................... Sasha Gonzales If you travel often, you might want to check that you and your family have been immunised against measles. The disease might be under control in Hong Kong but, since 2009, outbreaks have been reported in many other parts of the world. In Hong Kong, children are vaccinated against the disease when they are a year old. They then receive a booster when they are in Primary One or aged about six years old (a booster is recommended because 2 per cent to 5 per cent of people do not respond to the first dose of the vaccine). The vaccine is also called MMR as it combines vaccines for measles, mumps and rubella. According to the Centre for Health Protection, there were 12 reported cases of the measles in Hong Kong last year and five cases this year to May 31.Unfortunately, in some countries the numbers are not as low. The risk of contracting measles is high in developing areas in Asia and Africa, where there is overcrowding, and where poverty is rife and health infrastructure is weak. According to Brian Ward, professor of infectious diseases and microbiology at McGill University in Montreal, Canada, measles is a disease caused by a virus with the same name that is a member of the paramyxovirus family. Highly infectious, it remains active and contagious for up to two hours in the air or on surfaces, and is easily spread via the respiratory system – through contaminated droplets from coughing and sneezing. Measles is commonly believed to be a childhood disease, but unless you have had it before or have been adequately vaccinated, you are susceptible to the virus at any age. Protection provided by vaccination is sometimes incomplete, and a modified and usually milder form of the disease can occur in people who have received one or even two doses of the vaccine, says Ward, who is also associate director of the J.D. MacLean Tropical Diseases Centre at McGill. It is presumed that a newborn child is protected in

380 Average number of measles deaths reported per day in 2010, according to the World Health Organisation

The measles virus has an incubation period of up to 12 days. Photo: CDC the first six to nine months of life by maternal antibodies, if the mother is protected. The disease shows up as flu-like symptoms accompanied by a reddish-brown rash. It tends to be more severe in the very young, says Dr Diane Griffin, chairwoman of the department of molecular microbiology and immunology at Baltimore’s Johns Hopkins University Bloomberg School of Public Health. After exposure to the virus, there is an incubation period of about eight to 12 days before the symptoms appear. “Unless you have partial protection, you would initially experience a runny nose, red, watery eyes and a fever for a couple of days, followed by a blotchy rash on your entire body,” Ward says. “The fever can be very high – 40 degrees Celsius or higher – and acute infection can be accompanied by diarrhoea and maybe coughing.”

The disease can lead to serious health complications and even death. The most common complications are secondary bacterial pneumonia and diarrhoea, but encephalomyelitis – an inflammation in the brain triggered by measles – can also occur, Griffin points out. Encephalomyelitis, however, is rare, occurring in about one in 1,000 measles sufferers. “It is an autoimmune reaction and can lead to seizures or mental retardation,” she says. Certain people are at greater risk of developing these complications, such as children under the age of three, malnourished children (especially those with insufficient vitamin A and who have lowered immunity), and patients over 65 who have contracted the disease for the first time. Unfortunately, there is no treatment for the disease. Most patients recover within two or three

Travelling families should ensure that everyone’s vaccinations are appropriate, and not just those for the kids PROFESSOR BRIAN WARD, McGILL UNIVERSITY

weeks, but in areas where measles mortality remains high (more than 1 per cent), a high dose of vitamin A is recommended, says Ward. Up to 30 per cent of adults who become infected are admitted to hospital, and the rate is even higher in young children, he adds. Several developed countries have reported measles outbreaks in recent months, including France, Britain, Italy, Germany and Spain. And the Centres for Disease Control and Prevention in Atlanta reports that 222 people in the US caught the disease last year – more than three times the national average of 60 per year. According to the World Health Organisation, 139,300 people died of the disease globally in 2010 – nearly 380 deaths every day, or almost 16 every hour. This figure, however, represents about a 74 per cent drop from the 535,300 measles deaths reported in 2000. The last measles outbreak in Hong Kong was in 2007. Between January and April, 17 cases were reported. In most of these cases, the patients either did not have appropriate vaccination or were not yet due for a vaccination, according to the Health Department’s Centre for Health Protection. To prevent another outbreak, Hong Kong residents are advised to get their measles vaccination before travelling. “Appropriate vaccination is the best and really the only protection,” says Ward. “Travelling families should ensure that everyone’s vaccinations are appropriate, and not just [those for] the kids.” If your child is aged between six and 11 months and has not yet been vaccinated, speak to a doctor about getting the first measles shot before you travel overseas. The vaccine is safe and very effective. Dr Winnie Mui of Dr Lauren Bramley & Partners in Central advises you to maximise your immunity with sufficient rest, a balanced diet, hydration and exercise. And minimise contact with individuals who are ill or have a fever or a rash. Although some doctors will tell you to avoid travelling to destinations where there are outbreaks, Griffin says that as long as you have been appropriately immunised, you are protected for life. To be on the safe side and to allay any fears, is it important to maintain good personal and environmental hygiene. So, cover your nose and mouth when sneezing or coughing, keep your hands clean at all times, dispose of nasal discharge and sputum carefully and avoid sharing eating utensils – habits that should be practised daily, no matter which part of the world you are in.


The ascent of women Three Hong Kong runners earned the right to compete in one of the toughest foot races on the planet, writes Rachel Jacqueline


marathon is usually the summit of a runner’s achievements, but three Hong Kong women nearly quadrupled that distance on an unseasonably cold and wet day in June. Claire Price, Kami Semick and Ida Lee Bik-sai ran through the remote California wilderness, which included a vertical ascent of more than 5,500 metres and 7,000 metres of accumulated downhill running in the Western States 100Mile Endurance Run (WS100), one of the world’s toughest foot races. Ultramarathons, races longer than the marathon distance of 42.195 kilometres, have surged in popularity with women being the fastestgrowing segment. There will be at least nine ultras in Hong Kong in the next year – including three new events – but none as challenging or historic as the WS100. Semick, 46, in her fourth attempt at the race, was among the favourites after she came a close second last year to Ellie Greenwood of Scotland. USA Track and Field’s Ultrarunner of the Year in 2008 and 2009, Semick moved to Hong Kong in August last year from Oregon, after her husband was transferred to the city. Compared with Semick,

Ida Lee. Photo: Rachel Jacqueline Price, 43, a property agent, and Lee, 42, a civil servant, are less accomplished, nonetheless they are consistent top finishers in local races. Both started running only 10 years ago, and this was their WS100 debut. All three are driven by a passion for long-distance running – often mistaken for a mild form of insanity. Also providing motivation is the WS100’s quirky finishing medal: a belt buckle, in silver for a sub 24hour finish and bronze for sub-30.

But just earning the right to be at the WS100’s 5am start in Squaw Valley, California, deserves an award. You cannot simply sign up for the race. First you have to prove yourself at a qualifying event – run 50 miles (80 kilometres) in under 11 hours, 100 kilometres in under 15 hours, or 100 miles within the particular event’s official cut-off time. That puts you into a lottery, where you then need a tonne of luck to win one of the 369 race slots. It’s so hard to get in that even being admitted to hospital with sudden unexplained hearing loss a week before the race would not stop Lee. “This was my second attempt at getting into the race, and I was so lucky to be selected,” she says. “It was an opportunity I couldn’t afford to miss.” The WS100 began as a horseback challenge and, as the race guide warns, “presents numerous medical risks, many of which can be extremely serious or fatal”. So it may seem odd that anyone in their right mind would be keen to do it. What has possessed Semick, Price and Lee? All three say it’s the freedom that running in the mountains gives and the deep sense of the appreciation for the world it invokes. “I always discover small things that we overlook or take for granted,” says Lee. “I think I am more grateful for life since I started running.” Price says: “It’s inspiring in so many ways. There’s the beauty of the natural landscapes, the camaraderie, the feeling of freedom and the exhilaration to push yourself to run further and faster.” The College of Western Idaho published a study last year in the Journal of Strength and Conditioning Research which surveyed 344 female ultramarathon runners. It found that these women were task-oriented, internally motivated, health- and financially conscious individuals. They trained an average of about 12.5 hours a week and spent 64 per cent of their time training alone. A 2009 study on the WS100, published in the journal Medicine and Science in Sports and Exercise, found that since the race’s inception, in 1974, participation had increased among women. Finish times have been improving for the top women, unlike those for the men.

Claire Price (front) and Kami Semick tackle the W Christopher McDougall, in his bestselling book Born to Run, notes that the female world record for the mile (four minutes, 12 seconds), was achieved a century ago by men and rather routinely now by high school boys. Yet at the Leadville Trail 100 milelong race in the Colorado Rockies, nearly all the women finish the race and fewer than half the men do. “Every year, more than 90 per cent of the female runners come home with a buckle, while 50 per cent of the men come up with an excuse,” writes McDougall. Dr Duncan MacFarlane, sports physiologist at University of Hong Kong’s Institute of Human Performance, links it to a female’s ability to metabolise a higher percentage of fat than males. Fat is the body’s main fuel source for ultramarathons. Women are also usually smaller and lighter, says MacFarlane, so long distances take less of a toll on their


Wilson Trail in Tai Tam; (below left) Price on the climb in Squaw Valley, California during the Western States 100-Mile Endurance Run in June. Photos: May Tse, WS100 bodies. They’re also better at preserving themselves for the long haul. A 1997 study by University of Cape Town sports scientists in South Africa found that women ultramarathon runners have greater fatigue resistance than do equally trained men whose performances are superior up to the marathon distance. This ability to resist exhaustion is believed to be due to not only physical factors, but also mental strength. “Put it this way, I think there’d be far fewer children if men had to give birth,” says sports psychotherapist Dr Bruce Gottlieb in a Runner’s World article. Price loves a challenge as much as a good chat. To her, running is a social activity, a way to make new friendships and cement existing ones. “It’s about the people who share the journey with me,” she says. For Semick, ultramarathons are a sprint compared with her past life as a mountaineer: she can race and be

I always discover small things that we overlook or take for granted … I am more grateful for life since I started running IDA LEE

back in time for dinner that night or breakfast the next day with her husband and daughter. “It’s easier on the family than mountaineering,” she says. “And there are as many or more peaks and valleys during one day than there are in three weeks of big mountain climbing.” By the 47-kilometre mark of the WS100, the runners had battled two long climbs totalling almost 2,000 metres in ascent and a steep run down into a valley. For the past six hours, they had endured sleet and hypothermic conditions in high winds. The high spirits that marked the race start gave way to a more sombre mood. Yet Price was still smiling, joking that she felt “gypped” by the weather after coming from Hong Kong’s hot summer. She knew the race almost didn’t happen for her: a month earlier, she had fallen during a run and badly bruised her knee, forcing her to stop training.

Semick’s day wasn’t as good, as she dropped out around this point following a severe asthma attack. It was truly unfortunate, especially since she had been running strongly among the race leaders, men included. In 2010, Semick finished third overall in the Vermont 100 Mile Endurance Run, beating all but two men. In the world of ultrarunning, women outperforming men isn’t surprising. As race distances get longer, the gap between men and women gets smaller. A few hours behind Price, Lee trudged on determinedly despite her ear troubles and ill preparation. “I just kept thinking: ‘Keep it up; you can make it,’” says Lee. “Just one more step and you will be closer to the finish line.” It’s this unbreakable spirit that got Lee to the finish at last year’s Ultra Trail Mont Blanc in Chamonix, France. After 94 kilometres and with the 2,490-metre-high Grand Col

Ferret ahead of her, she pulled out from exhaustion. But she became impatient waiting to be picked up by race officials, so she decided to rejoin the race. She finished the 166 kilometre race in 44 hours, 22 minutes and 38 seconds. The same mental tenacity got Lee through the last 50 kilometres of the WS100. She finished in 28 hours, 29 minutes and 55 seconds despite crippling knee problems and stiffness. “I am not a talented or gifted athlete,” she says. “I am just a normal person.” Price blazed the final 34 kilometres, picking off fellow competitors who had lost steam. She eventually finished in 18th place among women and 87th overall in 22 hours, 32 minutes and 52 seconds. To outsiders, it’s an extraordinary feat. To Price, it’s just another day. “You can train yourself to overcome many things you thought were impossible. You just have to put your mind to it.”

8 DIET THE TASTE TEST PORTION-CONTROLLED SNACKS ...................................................... Jeanette Wang

M&S Cheese & Onion Popped Potato Chips HK$48 for five 23-gram bags, Marks & Spencer Unlike typical chips, these are neither fried nor baked, and hence have a rather unusual shape and texture – a bit like crunchy styrofoam. Each bag has 95 calories and 3.2 grams of fat. Verdict: the cheese and onion flavour – described as all-natural – is overpowering. And the crunch lacks the oomph of normal chips.


Yin and tonics ......................................................

Omega Slims Cranberry Orange Crackers HK$15 for 24 grams, Just Salad These are super-hard and dry crackers. Each three-cracker pack has 100 calories and 3.5 grams of fat. Verdict: smear something on them to make them more palatable.

Glico Everyday Fruit Biscuit – Apple HK$42.50 for five 22.5 gram packs, City’super Better known for the biscuit sticks called Pocky and Pretz, the Japanese biscuit company Glico has tapped into the health-conscious market with these generously fruit-filled delights. Each threebiscuit pack contains 80 calories and 0.6 grams of fat. Verdict: slightly chewy, slightly crunchy, moist and very moreish.

Wynnie Chan As the backlash against processed food grows, interest in holistic approaches to health has hit new heights. Increasingly, people are looking to superfoods, natural products, plants and herbs as a way to ward off illnesses and maintain optimal health. In response to this interest, the Chinese Cuisine Training Institute (CCTI) recently organised a course on Chinese tonic foods. It brought together health-conscious individuals from all walks of life – from professional chefs to housewives and students – all wanting to learn about the principles of food therapy and theories of Chinese dietetics. “I’ve been eating tonic foods from a young age, so learning about the theoretical basis has helped to enlighten me,” says Anita Chan, who was one of 19 course participants. “I am here to learn more about the maintenance of health and prevention of diseases so that I can apply this knowledge when cooking meals for my family.” The course, led by Tung Shuang, assistant professor at the Chinese medicine division of the University of Hong Kong’s School of

Professional and Continuing Education, also taught participants how to put theories into practice in the kitchen. She highlights the importance of eating according to the seasons. During summer, for example, “summer heat evil” – one of the six climatic evils in TCM – causes deficiency of the life energy, qi, and body fluids. This is characterised by heat diseases in the summer, and damp diseases in the late summer and early autumn. “Heat can lead to a disturbance of the mind, which manifests as irritability, dizziness and headache, while loss of qi and disturbance of harmony results in fatigue, dry mouth, constipation, dry throat, sore throat, oral ulcers, toothache, acne and nosebleeds,” says Tung. “Dampness tends to block the natural upward flow of qi from the spleen, which results in excessive intestinal fluids, exhibited as diarrhoea and loose stools. Dampness also blocks the natural downward flow of qi from the stomach, resulting in poor appetite, oral ulcers, acne, toothache, nausea and vomiting.” To clear summer heat, Tung recommends foods of a cold (yin) nature such as tomato, winter melon, silk melon, bitter gourd, aubergine, watermelon, water

The Chinese Cuisine Training Institute’s tonic foods course puts theory into practice with cooking sessions in the kitchen. Photos: Jonathan Wong

My grandparents were in the TCM business, so foods and dishes were always prepared according to our state of health JOHN K.C. WAN (BELOW), ANTHROPOLOGY STUDENT

chestnut, plum and pear. These are suitable for relieving dry mouth, a sore throat and nosebleeds. Teenagers with summer acne can benefit from drinking a special concoction, made by boiling mung beans, lotus leaf, wild chrysanthemum and smilax glabra root (sarsaparilla) in water. Tonic foods like barley, lentils, red bean, melon and tangerine peel are useful for reducing dampness. To aid digestion, relieve dampness and increase appetite, Tung suggests drinking barley and winter melon soup. This can be made by placing 30 grams of pearl barley, a large slice of winter melon with skin on, a piece of lean meat, six grams of dried tangerine peel, and two slices of fresh ginger in a pot, covering everything in water and boiling for 30 to 45 minutes. John K.C. Wan, an anthropology student, found the course useful. He says: “My grandparents were in the TCM business, so foods and dishes were always prepared according to our state of health. But I never really understood the theory behind them. Attending this course has helped me link theory to practice.” For more information on Chinese tonic food courses, contact CCTI on 2538 2200 or e-mail


Beat those triathlon blues with a timely carb fix ...................................................... Andrea Oschetti Last month, the Shangri-La’s Mactan Resort and Spa in Cebu, the Philippines, was taken over by a rather different crowd from the usual holidaymakers: 1,340 athletes (myself included) and their families. The resort was the heart of the course for the Ironman 70.3 Philippines triathlon, which comprised 1.9 kilometres of swimming, 90 kilometres of cycling and 21.1 kilometres of running in heat and humidity. Training for such a long race involves a massive investment of time, money, and physical and emotional energy. So it was shocking to see that most athletes were sabotaging their own performance through poor nutrition. It’s not difficult to get nutrition right: there are no secrets, just a few simple guidelines coupled with an understanding of what works best for you as an individual.

Lots of wholegrain and fat one to two hours before a race makes for a nutritional disaster. Learning to listen to your body is essential I took the opportunity of this gathering of professional and amateur athletes to find out what people ate. With the help of the resort’s executive chef, Joris Rycken, we monitored the athletes’ food consumption to see if it was any healthier than that of standard hotel guests. On race morning, 1,850 breakfasts were served: 95kg of bananas, 80kg of bacon, 60kg of hash browns, 260kg of mango (eaten fresh and juiced), 90 litres of orange juice, 110 litres of milk, 40kg of bread (of which 30kg was wholegrain). Compared with the usual hotel guests, Rycken says the athletes ate significantly more wholegrain bread, muesli, peanut butter and pancakes, fewer croissants and the same amount of eggs, bacon and sausage. But ingesting lots of wholegrain bread or cereal and fat one to two hours before a race makes for a nutritional disaster. Here are some guidelines for pre-race and preexercise nutrition. Limit fibre as much as possible While wholegrain is preferable to white carbohydrates in a normal diet, it is not good for you before a race. Dietary fibre is an indigestible type of carbohydrate which will stimulate your bowels – and cause

unwanted visits to the Portaloo during a race. Switch to white bread the day before a race and avoid fruits with high fibre content such as apples. On race mornings I eat white toast with honey, apple sauce (cooked fruits have lower fibre content), a low glycaemic index energy bar and a carbohydratebased sports drink. Three days before a race, increase your intake of carbohydrates moderately – commonly known as carbo-loading – while reducing your intake of fat and protein Fat and protein slow digestion; by minimising their intake you will offset the increased carbohydrate consumption before a race. During these three days you are likely to be resting more and training less in preparation for the race. With the reduced calorie expenditure and increased calorie intake, you may feel bloated, have sleeping difficulties and gain some weight. Some athletes compound the problem by overeating, flooding the digestive system with more than it can process. Eat a higher proportion of carbohydrates, not more food, before a race. Do not feast the day before a race. Contrary to typical carbo-loading behaviour, on the night before a race dine early and eat only a small amount of pasta. Stop eating three hours before the race starts The biggest mistake athletes make is to eat one or two hours before a race. This increases the depletion of glycogen (the body’s energy store) and inhibits the use of fat as energy. With the two main sources of fuel disrupted, race performance is wrecked. I wake up earlier than most athletes to have breakfast; this ensures my hormonal balance is restored on the starting line. I spend the extra hours relaxing, mentally preparing for the race, stretching or sleeping a bit more. After the race in Cebu, I spoke with several athletes about their race experience. Most said they felt significant gastrointestinal issues that inhibited their performance, which wasn’t surprising given what was consumed that morning. In search of good eating practices, I spoke to the race winners, professional athletes Caroline Steffen and Pete Jacobs. “I am very careful about what I eat since I take so much out of my body,” said Steffen. “I stay away from industrial products and white sugar. Everything I eat is fresh: fish, vegetables, fruit, all kind of meat, except pork. I love bread, but I try to only eat a little of it. I don’t eat pasta, but I eat brown rice.” Her favourite dish is grilled salmon with cherry tomatoes and basil, and spinach on the side. Steffen is sceptical about energy bars: “They are full of chemicals; I see too many people at races with stomach problems. I prefer to eat bananas and chocolate.”

Pete Jacobs’ roasted vegetable frittata Serves 4 Your favourite vegetables Your favourite spices 6 eggs 4 tbsp of milk 3 tbsp of parmesan cheese Salt and pepper Extra virgin olive oil, salt, pepper

Jacobs says he eats almost everything in moderation. “I tried to go gluten- and dairy-free, but I felt the same, so I reintroduced them into my diet.” Learning to listen to your body is essential for the serious athlete. My final nutrition tip is to try different things and see what works and what does not work for you.

Jacobs found food that works well for him and made it part of his routine. “When I am off that routine, coincidentally or not, my performance is not so good.” His favourite food is a frittata with roasted vegetables – pumpkins, potatoes, onion and capsicum – and lots of paprika.

• Preheat your oven to 180 degrees Celsius • Roast the vegetables with your favourite spices at 180 degree Celsius for 30 minutes or until soft and golden. • Beat the eggs with a fork, and add milk, cheese, salt and pepper. • Heat a pan with a little extra virgin olive oil, add the egg mixture and the vegetables and stir rapidly. • Lower the heat after a few seconds. • When the bottom of the frittata is cooked, but the top is still creamy, turn over and cook for a further two minutes. • You can avoid turning it over by covering with a lid. Healthy Gourmet is a weekly column by private chef Andrea Oschetti. He can be reached at


Runners now list Bali high ...................................................... Troy de Haas Welcome – or as the Indonesians say, selamat datang – to Bali. The moment you step off the plane, you will notice something special about the island. Not only is it spectacularly beautiful, it also has a wonderful spirit and amazingly warm people. Many visitors return time and again to experience this; 2.8 million tourists from all over the world visited the island last year. It’s no surprise that Bali is one of Hong Kong’s premier holiday destinations. Although it’s just a four-hour flight away, it feels a world apart. Hong Kong’s affection for Bali has a long history. The Kuta bombing in 2002 marred its image as the perfect paradise escape and, for a time, the island fell into decline because of its heavy dependence on tourism for survival. Today, the Indonesian government and Tourism Bali are working hard to rebuild the island’s attraction with a number of new cultural and sports tourism events, including the new BII Maybank Bali Marathon every April and the Biznet Bali International Triathlon in June at Jimbaran Bay. Bali is back and better than ever – from the mountains to the beach, it has something for all budgets. Best running spots Kuta Beach: Bali’s most popular beach, covering more than 20 kilometres from Tuban (near the airport) in the south to Tanah Lot in the northwest. A wide and flat beach, it offers the only traffic-free running for those staying in the Kuta, Legian and Seminyak areas. Best early in the morning before the beach crowds arrive, it can be a bit of a monotonous run, as you can see for kilometres, so it’s best to bring your mp3 player along. Tanjung Benoa in Nusa Dua: this area offers the best running in Bali. The tree-lined boulevards and vast open golf courses make Nusa Dua a joy to run around, and both the Bali half marathon and triathlon courses go through this area. Cut off from the hectic residential areas, the Tanjung Benoa peninsula has its own beaches and the main road, Jalan Pratma, has minimal traffic throughout the day, making it ideal for running. Tjampuhan Ridge in Ubud: The charming mountain village of Ubud is a world away from the Bali beaches, set among rice paddies and rainforest valleys. Avoid running in the Ubud streets, as there are stray dogs that enjoy harassing runners.

Tanjung Benoa near Nusa Dua offers some of the best running opportunities, and the half marathon and triathlon organisers know it. Photo: Troy de Haas

Instead, hit the trails to one of the valley and ridge lines such as Tjampuhan Ridge. Starting at Pura Gunung Lebah, the Tjampuhan Ridge trail is a step back in time as you pass streaming rivers, ancient temples and the odd curious monkey that you will need to bribe with a banana before they will let you pass. The main event: BII Maybank Bali International Marathon The BII Maybank Bali International Marathon took place for the first time this year. It offers full marathon, half marathon, 10kilometre and five-kilometre events. The race starts and finishes near the Bali Safari and Marine Park and features a combination of flat road and rolling hills. The first 10 kilometres take place on a highway, after which the course weaves through the small villages, rice fields and farms of Gianyar province. The race organisers scouted out this

route after years of conducting a half marathon in Nusa Dua. The organisers are looking to build the race’s international status and have injected big prize money to attract many world-class runners. This year’s winner, Lilan Kennedy Kiproo, took home a US$20,000 cheque with a time of two hours, 16 minutes and 54 seconds. About 2,500 people took part this year, and attendance is expected to grow as the race has been officially recognised by the Association of International Marathons for its organisational standards. Next year’s race is scheduled for Sunday, April 24. Après run Bali today has an array of activities for those wanting to do more than just sunbathe or shop: • Get in touch with your wild side at the Bali Safari and Marine Park, a conservation park where you can get up close and personal with orang-

Cut off from the hectic residential areas, Tanjung Benoa has its own beaches, and the main road, Jalan Pratma, has minimal traffic

utans, Sumatran tigers and leopards. You can take an elephant safari ride or even share your lunch with a pride of lions. • Kick off your running shoes and jump in a tube as you slide down one of the island’s river canyons, stopping only to replenish your thirst at one of the riverside bars. • Bali’s delicious cuisine is divine yet very affordable and fresh: just look for a place that is busy. You can’t go home without trying a nasi goreng (I had seven in four days on my last visit); it’s an ideal pre- or post-run meal of rice with an egg on top. • Still got plenty of energy? Hit one of the many beachfront club lounges, such as the hip Ku-De-Ta or La Plancha in Seminyak. Great Strides is part of a series of city running guides by Troy de Haas, a sports travel manager with Flight Centre who represented Australia in orienteering, mountain running and tower running

WELL-BEING 11 PERSONAL BEST ......................................................

Pay more attention to what you’re doing A study published this month in the Journal of Consumer Research made subjects eat either a healthy or an unhealthy snack. Some of the participants were asked to count how many times they swallowed while eating the snack. Those who did so were more satisfied more quickly, even if they otherwise reported poor self-control.

Jeanette Wang

Surround yourself with the right people Self-control – or the lack of it – is contagious, according to a 2010 study by the University of Georgia published in the journal Personality and Social Psychology Bulletin. The researchers found that watching or even thinking about someone with good self-control made others more likely to exert self-control. The opposite holds true, too.

Illustration: Adolfo Arranz

I will not eat fudge cake. I will not eat fudge cake. I will not eat fudge cake. I will eat fudge cake. Why is it that some people can resist temptation while others can’t? Experts zero in on one factor – self-control – and many believe that this trait is a limited resource. Self-control enables us to maintain healthy habits, save for a rainy day and get important things done. But according to the model originally proposed by social psychologist Roy Baumeister of Florida State University in the 1990s, if we exercise a lot of self-control by resisting an impulse handbag purchase, we may not have enough self-control later in the day to refuse that slice of fudge cake. More than 100 research papers have produced findings that support this model. A recent study by the University of Iowa, to be published in next January’s Journal of Consumer Psychology, used MRI brain scans to show the limits of selfcontrol. Study participants were placed in an MRI scanner and made to perform two self-control tasks – first, ignoring words that flashed on a computer screen, and then choosing preferred options. Subjects had a harder time exerting self-control on the second task, a phenomenon called “regulatory depletion”. The brain scans showed that the anterior cingulate cortex – the brain area that recognises a situation in which selfcontrol is needed – fired with equal intensity throughout the two tasks. This suggests the subjects had no problem recognising temptation. But the dorsolateral prefrontal cortex – the brain area that manages self-control – fired with less intensity after prior exertion of self-control. This suggests it got harder and harder not to give in to temptation. But can self-control really become depleted? Researchers Michael Inzlicht of the University of Toronto and Brandon Schmeichel of Texas A&M University don’t think so. In an article published in this month’s issue of Perspectives on Psychological Science, they argue that a newer crop of studies show that self-control may actually be more like a motivation- and attention-driven process. “Engaging in self-control, by definition, is hard work; it involves deliberation, attention and vigilance,” the authors write. They suggest the inability to resist that slice of fudge cake is not necessarily because we’re “out” of self-control, but rather because we choose not to control ourselves any longer. At the same time, our attention shifts so that we’re less likely to notice cues that signal the need for self-control and pay more attention to reward cues. Fudge cake, as we all know,

Waiting for gateaux contains empty calories, but it’s also a delectable treat. Some studies suggest that selfcontrol is linked to genes. A study of more than 800 sets of twins published in May in the Journal of Personality found that identical twins – whose DNA is exactly the same – were twice as likely to share character traits such as self-control, decision making or sociability, compared with non-identical twins. But whether it is nature or nurture, exhibiting self-control at a young age is linked with having a lower body mass index as an adult. The study, which tracked subjects for 30 years, was published last month in the Journal of Pediatrics. Between 1968 and 1974, 653

four-year-olds completed a delayof-gratification test, in which they were given one treat, such as a biscuit or marshmallow, and told they would be given a second treat if they could wait to eat the first treat for an unspecified length of time (it ended up being about 15 minutes). Follow-up studies found that each minute a child delayed gratification predicted a 0.2 decrease in adult body mass index. The preschoolers who could delay gratification for longer also showed adolescent academic strength, social competence, ability to handle stress and higher exam scores. Research on self-control is important in understanding behaviour related to a wide range

of problems, including obesity, impulsive spending, gambling and drug abuse. If you struggle with self-control, here are some tips to restore your willpower.

Whether nature or nurture, self-control at a young age is linked with having a lower body mass index as an adult

Postpone consumption Many people find the more they resist unhealthy food, the more they crave it. Nicole Mead, of Catolica-Lisbon School of Business and Economics, suggests postponing consumption to an unspecified future time can reduce the desire for that unhealthy snack. In her study, 105 high school students in the Netherlands were given a bag of potato chips. Participants were given different instructions: they were told to either freely eat the chips, postpone eating the chips, or were instructed not to eat them at all. The others could choose one of the three eating strategies. Over the course of one week, students who initially postponed eating the chips – whether by instruction or not – ate the fewest chips. Watch your favourite television reruns Two studies in this month’s Social Psychological and Personal Science journal found that watching a favourite rerun may help restore the drive to get things done in people who have used up their reserves of willpower. Watching reruns does not use up mental energy, explains researcher Jaye Derrick, of the University of Buffalo’s Research Institute on Addictions. “At the same time, you are enjoying your interaction with the TV show’s characters, and this activity restores your energy,” she says. Refuel Willpower, according to Baumeister’s research, can be beefed up like an unused muscle. In one study, subjects given a sugarsweetened drink had improved selfcontrol. Apparently, the sugar provided fuel for the brain to get back to work and restore the person’s willpower. Seek divine intervention In an article in the journal Psychological Science, psychologist Kevin Rounding of Queen’s University, Ontario, ran experiments in which he primed volunteers to think about religious matters. They had more discipline than the control group, and more ability to delay gratification.

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