20120605 health post

YOUR GUIDE TO LIVING WELL

HEALTH POST Go the distance A look at the best nutrition for exercise >PAGE 6

FUND HELPS PAY FOR CANCER DRUGS >PAGE 5

MIND POWER A MATTER OF PERCEPTION >PAGE 9

TUESDAY, JUNE 5, 2012

2 NEWS APP OF THE WEEK

HEALTH BITES

Dodging death, on the run

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Katie McGregor healthpost@scmp.com Zombies, Run! US$7.99 Rating 10/10 Zombies, Run! trumps WiiFit!, bringing a new level of gaming to your fitness, or perhaps a new level of fitness to your gaming.

The audio adventure of runner 5, that’s you, is fed to you through your headphones as you take your regular run, and while listening to your regular playlist. The story was created by Naomi Alderman, a British award-winning novelist – and game writer. It is set in a time when the world has been taken over by zombie hordes. As a fan of The Walking Dead television series, I could picture the setting clearly.

Your first run takes place when your helicopter is shot out of the sky, and you must evade the zombie hordes as you run for safety in the nearby township. Sam, the lead communications operator from the township, is in touch with you by some sort of radio, and guides you to the camp, warning you of any lurking zombies.

My initial concern was that I might need to suddenly start zig-zagging or make myself look ludicrous by dropping down on my belly, but your dignity is maintained at all times. As you run, you passively collect “supplies” and are notified of this by a robotic voice. When the zombies do start chasing you, you hear a repeating beep that intensifies as they get closer, and Sam urges you on.

On my first zombie encounter I ran and ran, and at the point I thought I could run no longer, I was told that I had evaded the zombie

hordes. What a relief. On my second encounter I allowed myself to get caught to see what would happen. I lost all my supplies and this was bad because I had been told that everyone must earn their keep at the township, and if I didn’t show up with supplies, I might not be let in.

The story develops with additional characters joining in, and hints being dropped about various mysteries that remain to be revealed about the township and its population. Each run/mission is about half an hour, but you can run for as long as you want and pause the programme when you stop, and resume next time. While you run, you can check your time and distance, although this doesn’t seem to get logged anywhere so I suggest using another running app in the background to track your statistics.

While cooling down, swipe the map of the town to distribute your supplies to the hospital or wherever you consider appropriate. You can also read the Codex to learn more about the characters, supplies and township.

The app comes with 22 story missions, and seven supply missions, which should keep you running for about 14 hours. While relatively expensive compared to other apps, this new kind of enterfitness app is good value and fun.

Jeanette Wang jeanette.wang@scmp.com Metal fatigue A clinical trial published in the Canadian Medical Association Journal has found that menstruating women low in iron (but not anaemic) who were given iron supplementation for 12 weeks saw their fatigue levels decrease by 50 per cent from baseline. In the study, 198 women aged between 18 and 50 years were given either daily oral supplements of 80mg of prolongedrelease ferrous sulfate or a placebo.

Study co-author Dr Bernard Favrat from the University of Lausanne in Switzerland says the reduction of fatigue through iron supplements was “a significant difference of 19 per cent compared with placebo”.

The authors note that iron did not affect anxiety or depression scores or quality-of-life indicators such as physical and psychological performance. Women are three times more likely than men to report fatigue.

A light chain with a dark secret People whose immune systems produce too much of a certain antibody are four times more likely to die from lifethreatening illness such as cancer, diabetes and cardiac and respiratory disease. Mayo Clinic researchers in Minnesota, the US, identified this immune system glitch after studying blood samples from nearly 16,000 people aged 50 and above in Olmsted County, Minnesota. The finding suggests high levels of the antibody molecule – called a free light chain – are markers of increased immune system response to infection, inflammation or other serious disorders, says lead researcher Dr Vincent Rajkumar. However, he cautions against testing with the intent of gauging one’s risk of death because “it will only cause alarm”. “We do not know why this marker is associated with higher rates of death,” he says. “We do not have a way of turning things around. Therefore, I would urge caution in using this test until we figure out what to do about it and what these results mean.”

ASK THE DOCTORS DR CHRISTOPHER CHONG Q: I often bleed between periods.

Should I be worried?

A: Bleeding in between periods, called intermenstrual bleeding, is not normal until proven otherwise. Some premenstrual women have spotting for one day during ovulation, and this is a normal part of the menstrual cycle called the “Mittel Schmertz” (German for “middle pain”) phenomenon. It is important to see a gynaecologist for assessment should one have IMB. A physical examination is done to check for any abnormality in the genital area, including the cervix and the vagina.

An ultrasound of the pelvis will also be ordered to look for growths in the womb, fallopian tubes and ovaries, and especially to assess the lining of the womb. The lining of the womb is where menses and staining come from.

In a pre-menopausal woman, the lining of the womb should not be more than 10mm in thickness. Thickened lining of the womb could be due to menses coming soon, polyps (piece of flesh – usually benign) in the lining, cell

enlargement called hyperplasia (which can lead to cancerous change), and growths including cancer. Infection in the lining of the womb is another possible cause.

In some patients, treating the cause, such as infection, and using hormonal medication will stop the IMB. Often, diagnosis is needed. This is done by taking the lining cells out for microscopic examination. Hysteroscopy (putting a scope/micro-camera through the cervix into the womb) to visualise the lining of the womb, and dilatation of the cervix with curettage (scraping out the lining cells) is done at the same time, under general anaesthesia and as a day procedure. This is with minimal pain and down time. Polyps in the lining can be removed at the same time during the minor surgery. Dilatation and curettage is done for diagnosis and sometimes is therapeutic, as well.

Dr Christopher Chong is an obstetrician and gynaecologist at Gleneagles Hospital in Singapore

> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com 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

Bed bugs: no killers in the mist “Bug bombs” or “foggers” have been sold for decades for use against many common household insects, but a recent study published in the Journal of Economic Entomology shows these products to be ineffective against bed bugs. Researchers from The Ohio State University conducted experiments on five different bed bug populations using three different fogger brands. Little, if any, adverse effects on the bed bugs were found. Because most bed bugs frequently hide in protected sites (under sheets, in cracks), Susan Jones a co-researcher, says it’s very unlikely they will be exposed to the insecticide mist from foggers. Many bed bug populations also have varying degrees of resistance to the insecticides, so they will most likely survive anyway. It typically takes a professional to do it right,” Jones says. “Also, the ineffective use of these products can lead to further resistance in insects.”

In your face A Facebook profile photo speaks a thousand cultural words, according to recent research published in the International Journal of Psychology.

The study found that the Facebook profile pictures of Westerners are more likely to zoom in and focus on the individual’s face than those of East Asian users. People from this region, on the other hand, tend to have profile pictures that pull out to include more background features.

These findings echo previous research on cultural factors influencing cognitive preferences: East Asians are more sensitive to contextual information than Westerners, who tend to process focal and discrete attributes of the environment. The research also found that these cultural influences over self-presentation can change over time and from place to place. East Asian students at American universities, for example, will be more likely to have close-ups of their own face in their profile pictures.

NEWS 3 QUIZ ......................................................

Jeanette Wang jeanette.wang@scmp.com You may be trying to hide it, but a new study shows that people can actually sniff out your age. Research from the Monell Chemical Senses Centre in Philadelphia, the US, reveals that humans can identify another human’s age based on differences in body odour.

“Similar to other animals, humans can extract signals from body odours that allow us to identify biological age, avoid sick individuals, pick a suitable partner and distinguish kin from non-kin,” says senior author Johan Lundstrom, a sensory neuroscientist.

Humans, like animals, emit body odours that contain a rich array of chemical components that can transmit various types of social information. The perceptual characteristics of these odours are reported to change across the lifespan, as are concentrations of the underlying chemicals.

The elderly are known to emit a unique smell – what Japanese call kareishu. But contrary to popular belief, this “old personal smell” was found in the Monell study to be rated as less intense and less unpleasant than body odours of middle-aged and young individuals.

In the study, published in the journal PLoS ONE, body odours were collected from three groups of 12 to 16 individuals each: young (2030 years old), middle-aged (45-55) and elderly (75-95). Each donor slept for five nights in unscented T-shirts containing underarm pads, which were then cut into quadrants and placed in glass jars.

Odours were assessed by 41 young (20-30 years old) evaluators, who were given two body odour glass jars in nine combinations and

NUTRITION SOYA asked to identify which came from the older donors. The evaluators also rated the intensity and pleasantness of each odour, and were asked to estimate the donor’s age for each sample.

Evaluators were able to discriminate the three donor age categories based on odour cues.

Statistical analyses revealed that odours from the old-age group were driving the ability to differentiate age.

Future studies will both attempt to identify the underlying biomarkers that evaluators use to identify age-related odours and also determine how the brain is able to identify and evaluate this information.

Test yourself here on your knowledge of the sense of smell.

1. The nerve cells associated with the process of olfaction are different from most nerve cells because they a. Have the ability to reproduce b. Are larger than other nerve cells c. Have more branches than other nerve cells 2. What percentage of what we taste relies on smell? a. 30 b. 60 c. 90 3. When people are unable to smell, they’re said to have a. anaemia b. anosmia c. ataxia 4. A dog has more than 220 million olfactory receptors in its nose, whereas humans have a. Five million b. 25 million c. 50 million Answers: 1. a; 2. c; 3. b; 4. a

OLYMPICS

Working on gut instinct ......................................................

Kate Kelland If someone’s stomach is cramping after eating a burger from a pop-up vendor at the London Olympics, Brian McCloskey plans to be among the first to hear about it.

As the man in charge of disease surveillance during the event, he says the greatest risk will be food poisoning from people eating street snacks in warm weather, failing to wash their hands, and using the same toilets as millions of others.

McCloskey’s Health Protection Agency Olympic Co-ordination Centre will gather data daily – not only on confirmed cases of diseases such as meningitis and flu, but also on the stomach cramps, coughs, headaches and fevers.

“It’s called syndromic surveillance, and it’s kind of a speciality of the UK,” he says.

The idea is that while waiting for doctors to diagnose and report a specific illness, which may take days, McCloskey’s team will assess symptoms early.

The Olympic and Paralympic Games will be one of the largest mass gatherings ever in Britain, with 10 million tickets sold worldwide.

More than 10,000 athletes from more than 200 countries will take part in events across 34 venues.

Mass gatherings can be hotbeds of disease. They have even inspired a new academic scientific discipline called “mass gathering medicine”. A series of papers published recently in The Lancet Infectious Diseases warned that conventional concepts of disease spread and crowd control were often inadequate.

Prior Olympics experiences, however, suggests major infections do not happen often.

“We’re fairly confident we have the right systems in place to know if anything is happening, and the right resources to respond,” says McCloskey. “But the most likely thing to happen is nothing at all.”

Reuters

Beans’ benefits brought back down to earth ......................................................

Jeanette Wang jeanette.wang@scmp.com Two new studies on soya shed light on the cognitive and cardiovascular benefits of the ancient Asian dietary staple for older women. The first study, published today in Neurology, the medical journal of the American Academy of Neurology, suggests that soya protein may not preserve overall thinking abilities in postmenopausal women, contrary to earlier reports. However, a high soya protein diet did not appear to harm thinking skills either.

“Our study found long-term use of soya protein neither improved nor impaired overall cognition,” says study author Dr Victor W. Henderson, with Stanford University in Palo Alto, California.

More than 300 healthy women between the ages of 45 and 92 were given 25 grams of soya protein daily – a dose comparable to that of traditional Asian diets – or a milk protein-matched placebo.

Participants were also given tests that measured memory and other thinking abilities at the start of the study and 2½ years later.

The study found no significant change in test scores in both groups.

There was, however, a small improvement in visual memory, or

facial recognition, in the soya protein group compared to the milk protein group, by about 13 per cent.

In the other study, published last week in The American Journal of Clinical Nutrition, researchers from Baylor College of Medicine in Houston examined whether soya isoflavone supplements provided cardiovascular benefits, such as cutting blood pressure or cholesterol levels.

Previous research had shown that Asian populations with soyarich diets have lower rates of heart disease than people who eat Western diets. But the researchers found that soya supplements alone

may not do anything for older women’s blood pressure.

Twenty-four menopausal women, all with moderately elevated blood pressure, were randomly assigned to take either 80mg of soya isoflavones or placebo tablets daily for six weeks. Those taking the soya supplement were found to fare no better than those on the placebo (that is, on the upper threshold of “normal”).

Special blood tests were also done to see whether the soya supplement affected the production of nitric oxide, a chemical that dilates blood vessels.

No effect was found.

4 MEDICAL Illustration: Angela Ho

CASE HISTORY

Seven-year itch for a cure ......................................................

Eileen Aung-Thwin healthpost@scmp.com Businesswoman Fenny Kwong was on one of her frequent trips abroad when she caught the flu in Paris.

Like most people, she shrugged it off as a passing inconvenience, but her sniffles and stuffy nose eventually turned into asthma.

Not long after the flu, Kwong (whose name has been changed for patient confidentiality reasons) suffered debilitating attacks that left her short of breath and struggling to sleep. The 43-year-old would feel so winded and weakened that she had trouble getting around.

Her doctor tested her and found that she was allergic to cat dander and house dust, and concluded that her asthma was triggered by these allergens. He gave her the standard arsenal of asthma control and relief drugs. But Kwong’s asthma attacks persisted.

Over the next seven years she scoured three continents for relief, seeking treatment from doctors in the United States, Britain and Hong Kong to no avail. When she was 50 years old Kwong visited Dr Lee Tak-hong, director of Hong Kong Sanatorium and Hospital’s Allergy Centre.

By this time, lung function tests showed that Kwong’s organs were only functioning at 60 per cent capacity. Every breath seemed a Herculean effort, draining her of strength and energy.

Lee says the onset of asthma after a viral infection is quite common, although why this happens is unknown. But the late age at which Kwong experienced her first asthma attack was unusual. Lee was not convinced that she suffered from typical asthma.

He dug deeper into Kwong’s medical history and asked her to list all her ailments, even if she thought they were unrelated to the asthma.

Several of her reported ailments were of particular interest. Firstly, Kwong had suffered rhinitis and sinusitis for the past 15 years.

Secondly, she would get flushed and suffer a horrible itch all over her body if she drank alcohol. And lastly, occasionally she would suddenly break out in hives.

Combined with Kwong’s unusually late onset of asthma, these conditions pointed Lee to a very different disorder than true allergic asthma. He suspected the source of her torment was a pseudo-allergy.

The condition, Samter’s triad, presents with a specific combination of symptoms: asthma, nasal problems and a hypersensitivity to

salicylates (the active ingredient in aspirin).

Salicylates block an enzyme called cyclooxegenase-1 (COX-1), resulting in an overproduction of leukotrienes, substances that trigger contractions in the airway muscles.

An overproduction of these fatty molecules results in severe inflammation, causing asthma and allergic rhinitis symptoms.

(Childhood onset asthma, on the other hand, is caused by the swelling and constricting of airways due to the antibody immunoglobulin E, which the body produces in reaction to allergens.)

Further clues that supported Lee’s theory were Kwong’s symptoms of itchiness and hives, which are also known symptoms of salicylate intolerance.

Salicylates are found in plants, fruits and vegetables as a kind of natural protection against insects and disease. Examples of such fruits

and vegetables include apples, avocados, peaches, dates, kiwi fruit, grapes, strawberries, cherries, cauliflowers, cucumbers, mushrooms, radishes and broccoli.

Many dry spices, tomato sauce and soy sauce also contain the chemical, as do beverages such as tea and alcoholic drinks. Salicylates are also found in everyday health and beauty products.

So even if Kwong did not take aspirin, the substance could enter her system through eating and product use.

Lee says it is likely that the levels of salicylates built up in her system, initially causing the nasal problems, itchiness and hives, before the levels finally broke her body’s threshold and resulted in the asthmatic symptoms.

He advised Kwong to cut

Kwong’s symptoms of itchiness and hives are known symptoms of salicylate intolerance

salicylates from her diet and to closely monitor the ingredient lists of the personal products she used.

Meanwhile, he briefly increased the dosages of the asthma control medications she had been taking.

Although the extensive list of foods and products to avoid was daunting, the idea of spending the rest of her life trying to catch her breath was much worse.

In three short weeks, Kwong’s seven-year battle for breath was over. Her symptoms vanished and a test showed that her lungs were functioning at 100 per cent. With the right diagnosis and treatment plan under Lee, Kwong was able to discard her asthma medication.

MEDICAL 5

TREATMENT CANCER DRUG RELIEF FUND

Help the medicine go down ......................................................

Jeanette Wang jeanette.wang@scmp.com Needing urgent treatment for recurrent advanced breast cancer, and with her savings running dry, Ms Ng was in a quandary. Her doctor had suggested chemotherapy and targeted therapy, a treatment combination that would cost HK$100,000 over six months.

Ng (whose real name has been withheld for patient confidentiality reasons) tried applying for treatment subsidies, but being in the middleincome bracket, or sandwich class, and living with her husband in their own flat, she failed to qualify. Ng, who is in her early 60s, feared her medical costs would become a huge burden on her two married daughters once her savings ran out.

Last week, help arrived in the form of the Cancer Drug Relief Fund, a collaboration between the Hong Kong Cancer Fund (HKCF) and drug maker GlaxoSmithKline (GSK). Instead of paying HK$126.25 for each tablet of the targeted therapy drug Lapatinib, she now has to shoulder only 20 per cent – or HK$25.25 – of the cost. With a daily dose of five or six tablets, that’s a saving of more than HK$15,000 each month.

Over the next three years, the HKCF aims to support 600 lowincome and sandwich-class cancer patients like Ng – a quota of 200 cases per year – with free or subsidised drugs through the HK$42 million fund.

“Families in these groups are financially stretched at the best of times, so when they are faced with cancer and the additional costs of treatment, their financial situations often become dire,” says Sally Lo, HKCF founder and chief executive.

“The Cancer Drug Relief Fund came about due to a much needed gap in our cancer support services.

With more and more families coming to us for help, it is my hope that this fund will help us lessen the financial burden of cancer.”

The pilot project includes only two drugs – Lapatinib for breast cancer and Topotecan for cervical, ovarian and small-cell lung cancer – but Lo hopes the list will expand to include more drugs and reach more people in the future. “We’re open to co-operation with other drug companies,” says HKCF head of service Tammy Leung.

GSK’s contribution to this pilot project is valued at HK$25 million, according to GSK Hong Kong general manager Jose Alberto Pena.

HKCF will raise the fund’s remaining HK$17 million in the same way it raises money for all its other operations: through public donations. The organisation, founded in 1987, receives no money from the government or Community Chest.

“We are asking the public to support us to build this special fund,” says Lo. “This is the last resort [for these patients].”

Lapatinib and Topotecan are self-financed drugs on the Hospital Authority’s Drug Formulary, and

both are used primarily as secondline treatment in advanced cancer patients when first-line treatment has failed. They were selected by HKCF’s panel of doctors from a list of five or six GSK drugs, says Lo. “[The panel of doctors] chose the ones they thought would be most appropriate for patients to prolong life and to give them quality of life.”

Professor Anthony Chan Takcheung, head of the clinical oncology department at Chinese University, says: “Clinically, these two drugs are more efficient in controlling tumour growth, delaying disease progression, relieving symptoms and reducing complications in patients who have failed to respond well to traditional chemotherapy... There are potential side effects, but on the whole, these are well-tolerated drugs.”

Lapatinib is used to treat a certain type of advanced breast cancer in patients who have already been treated with other chemotherapy medications. The

We are asking the public to support this special fund.

This is the last resort [for these patients] SALLY LO, FOUNDER, HKCF

drug works by blocking the action of the abnormal protein that signals cancer cells to multiply. This helps stop or slow the spread of cancer cells, therefore prolonging the progression-free survival in patients.

Pena says Lapatinib was introduced in 2008 to Hong Kong, where about 200 to 300 people have been treated with the drug since then.

The fund will subsidise 80 per cent of the cost of Lapatinib for 300 breast cancer patients over the project’s three years – and only for sandwich class patients. This is because the drug is also supported by the Community Care Fund Medical Assistance Programme administered by the Hospital Authority for lowincome patients.

Topotecan, on the other hand, will be free under the fund for the low-income group and 80 per cent subsidised for the sandwich class.

Three hundred patients over three years will benefit – 90 with ovarian cancer, 90 with cervical cancer and 120 with small-cell lung cancer.

The chemotherapy drug, given via infusion or an oral capsule, was launched here in 2000 and has been given to a “few hundred” people, according to Pena. Chan says it’s taken for a few days in a row every three to four weeks, for an average of three to four months. Depending on various patient factors, this works out to between HK$4,000 and HK$10,000 per cycle.

Asked how many patients in Hong Kong would potentially need

Topotecan, Chan says: “Unfortunately, for small-cell lung cancer, most of them at some point will reach this stage [of advanced cancer that has failed first-line treatment] because it’s a devastating disease. For cervical cancer, only about 20 to 30 per cent would get to this stage. For ovarian cancer, it’s probably a little less, about 20 per cent.”

Dr Daniel Chua Tsin-tien, clinical oncologist and associate director of the Comprehensive Oncology Centre at the Hong Kong Sanatorium and Hospital, says the fund is a “good step” because the middle class usually “have difficulty getting support from the government and other channels”.

But he adds: “Topotecan is actually a very old drug. Its use is more limited as we’re seeing fewer and fewer small-cell lung cancer and cervical cancer cases. Lapatinib is more promising as it can reach out to a lot of breast cancer patients.”

Statistics from the Cancer Registry show that lung cancer is the most common cancer and biggest cancer killer in Hong Kong – although only 10 to 15 per cent are cases of small-cell lung cancer.

Breast cancer is the third most common, while ovarian and cervical cancers are not in the top 10 (though ranked sixth and seventh respectively in incidence among women).

For more information on the Cancer Drug Relief Fund visit the HKCF website www.cancer-fund.org

6 COVER STORY

Fire in the bel Fuelling your body during exercise can affect your performance dramatically. Rachel Jacqueline offers some food for thought

“A

lmost every athlete has a nutrition mistake,” says cyclist Simon Chau, recalling his experience at the Tour of Hualien in Taiwan. Halfway through the 160 kilometre road race in 2005, Chau, 26, ran out of food.

He also hadn’t eaten or drunk sufficient fluids during the previous day’s travel from Hong Kong. With little in the way of stored energy, he barely made it to the finish line before collapsing – dehydrated, hungry and far from winning a prize.

Keeping body fuel topped up during exercise, whether it’s a race or just a training session, has a huge impact on performance – particularly for an activity that lasts 90 minutes or longer. US-based sports dietitian Andrea HackerThompson likens an athlete’s body to a car. Beyond 90 minutes, a nutritional plan is needed to prevent the low-fuel light from turning on.

We’re spoiled for choice when it comes to sports nutrition. In recent years, many new products come onto the market. This supply is in response to a demand fuelled by rising participation in endurance sports like marathons, triathlons and cycling, and a growing interest in general well-being.

According to the Nutrition Business Journal, the sports nutrition industry – which includes supplements, nutrition bars and gels, and sports and energy drinks and shots – has enjoyed a compound annual growth rate of more than 10 per cent over the past decade. Last year, global retail sales of sports nutrition products reached US$21.4 billion.

Of this, nutrition bars and gels contributed US$2.8 billion (a 13 per cent increase from 2010) and sports and energy drinks and shots US$15 billion (a 15 per cent increase).

But do we really need these shiny and expensive packets of gels, bars, chews and fluids? Not always. If you’re trying to meet the recommended 30 minutes of moderate exercise a day, or running on the treadmill for only 60 minutes at a time, sports drinks or food are not needed during the workout.

“You are only taking on excess sugars,” says Dr Duncan Macfarlane, sports physiologist and professor at the Institute of Human Performance at University of Hong

Kong. “You are better off saving money and drinking water.”

But for anyone competing in high-intensity endurance activity, supplementing the body with the right nutrition during exercise not only ensures you will finish the event, it can also boost performance.

Hacker-Thompson, writing on the American College of Sports Medicine (ACSM) website (www.acsm.org), explains that the body of an endurance athlete is like a racing car with two fuel tanks.

In one tank are the body’s fat stores, which contain about 70,000 calories of fat that are available during lower-intensity aerobic exercise. The other tank contains carbohydrates – stored as glycogen in the muscles and liver, and up to 2,000 calories at a time. As workout intensity increases, the body’s ability to use fat as fuel decreases, and it becomes more dependent on carbohydrates for fuel.

“When your body runs out of glycogen, your race is over,” says Macfarlane. Known as “hitting the wall” or “bonking”, glycogen depletion can turn any athlete, even a world champion, into a crawling mess in a matter of minutes.

A body depleted of glycogen can still function by tapping into fat stores for energy. But Macfarlane says these stores “will only allow you to dawdle along”.

The ACSM recommends having a fuelling “pit-stop” every 45 to 60 minutes during a long workout or race. This consists of 30 to 60 grams of carbohydrates (120 to 240 calories), as well as 180 to 355 ml of sports drink or water, every hour.

Recommended mid-exercise foods, apart from sports energy products, include natural items such as honey, bananas and oranges.

But which is better, speciality sports nutrition or “real” food?

Carbohydrate-rich food – such as a muesli bar, bread, banana or cookie – can provide energy for endurance exercise, says Stephen Wong Heung-sang, a registered nutritionist and professor of sports science and physical education at City University. But foods like this are less transportable and not as easy to eat on the go.

Sports nutrition products are typically more carbohydrate dense, easily digestible and come in convenient forms. The composition

Cyclist Simon Chau makes sure that he eats well during a race. Photos: Jonathan Wong ensures you’re not loading up your body with things that it can’t process during exercise, like too much fibre.

That said, many athletes still swear by “real” food such as bananas, nuts, dried fruit and baby potatoes, particularly as the duration of activity gets longer.

Some just don’t like the taste or texture of gels or bars, while others get stomach trouble due to the lack of solid food.

Jeremy Ritcey, one of the top trail runners in Hong Kong, says mixed bags of dried mango, apricot and almonds have worked “fairly well” for him in training.

But he adds: “I think the nutrition manufacturers have it down, though. Nothing packs a punch like some liquid gooey stuff.”

As for hydration, water alone is not enough, says Wong: “When we sweat, we lose salts from our bodies

as well as water.” Sports drinks are packed with the electrolytes sodium and potassium to replace what is lost through perspiration.

During moderate-to-hard exercise, the body is most efficient at processing fluids that have a carbohydrate concentration of six to eight per cent of its total volume. A good sports drink offers carbohydrates in this ratio, while sugary soft drinks may contain a higher ratio of up to 12 per cent carbohydrates.

Nutrition during prolonged exercise is important. But what you eat before the activity is equally crucial. That’s because reliance on nutritional supplementation during an endurance sport can be decreased – and performance increased – with the right preparation, says Wong.

He recommends increasing

I think the nutrition manufacturers have it down, though.

Nothing packs a punch like some liquid gooey stuff does JEREMY RITCEY, TRAIL RUNNER

COVER STORY 7

lly

What’s best in the long run ......................................................

Rachel Jacqueline After trying a range of sports nutrition products, here are my favourites: Gel: Gu Roctane Gel in Blueberry Pomegranate, HK$20, Escapade Sports (www.escapade.com.hk) This quite thick gel stands out for its yummy flavours and added amino acids, allowing you to go harder for longer.

Although a bit more expensive than a regular gel, it’s worth it.

Chew: Powerbar Energy Gel Blasts (Raspberry), US$2.95, Racing the Planet (racingtheplanet.com) These gummies with a liquid gel centre taste so good you forget you’re eating a sports specific product. The good thing about chews is they can be taken in one hit or rationed throughout a race.

Athletes pick their favourites: Nora Senn, 35, trail runner Hammer Sustained Energy. I mix the powder into the water in my hydration pack and sip it continuously during long runs. It gives me a constant flow of energy and is light on my stomach.

Simon Chau, 26, cyclist Gu energy gels. They are convenient and are very tasty with lots of different flavours to choose from. They help me to make sure I am taking in enough carbohydrates on my long rides.

Michal Bucek, 31, triathlete Hammer Perpetuem. It has really increased my endurance and speed, as well as my recovery. I can push harder than I used to with less pain. healthpost@scmp.com

Gu Roctane Ultra Endurance Energy Gel

Honey Stinger Rocket Chocolate

Electrolyte: High5 Zero, Citrus, HK$85, Escapade Sports This low-calorie drink allows you to load up on electrolytes the day before a race while avoiding unnecessary sugars.

Energy bars: Honey Stinger Bar in Rocket Chocolate, HK$20, SportsWorld (sportsworld.hk) This tasty bar has a hint of honey mixed with chocolate. It’s very light, easy to eat and digest. For longer events I go for the Stephen James Luxury Organics Beauty Bar, US$5, Racing the Planet. It’s full of raspberries, cherries and figs, and is very light and full of calories, which is perfect for multiday endurance events.

Recovery food: Hammer Recoverite in Chocolate, HK$32.50 per single serve sachet, Escapade Sports Full of glutamine, carbohydrates to restore glycogen, proteins to rebuild muscles and electrolytes to replenish stores, this drink packs a serious punch.

Mixed with water, the chocolate flavour goes down like cold chocolate milk and helps avoid soreness the next day.

carbohydrate intake to up to 75 per cent of total daily calories in the week leading up to race day to build up glycogen stores.

This could be in the form of sports nutrition products, though pasta, potatoes, bread and rice will work well, too.

Trail runner Nora Senn, 35, makes sure she eats a lot of healthy and nutritious food in the days leading up to a big race to strengthen her immune system.

She starts with the same ritual the morning of every race: two pieces of toast with butter and honey. Add a glass of juice, says Wong, and this combination is the perfect start for any endurance athlete’s day.

Once your workout and race are finished, it’s not all over.

For 30 minutes after exercise, enzymes enabling the

body to rebuild its glycogen stores run rampant.

“If you deprive your body of carbohydrates at this time it will extend the time that it takes for your body to rebuild itself in preparation for your next race,” says Wong.

While it usually takes between 24 hours and three days to restore glycogen levels, a combination of amino acids and protein will expedite the recovery process.

With so many sports nutrition choices on the market, which is the best? “It’s very personal,” says Senn, who swears by Hammer Nutrition products. “It’s about taking the time to know the conditions and the environment you will be racing in.

With experience, you can understand your body and know what the best combination is, so you can really go for it.” healthpost@scmp.com

PowerBar Energy Gel Blasts

Stephen James Luxury Organics Mini Beauty Bars

High5 Zero electrolyte

Hammer Recoverite, Chocolate

Trail runner Nora Senn eats food to strengthen her immune system in the days before a race

8 HEALTH

TRADITIONAL CHINESE MEDICINE

When truth is in the balance ......................................................

Elizabeth Snouffer healthpost@scmp.com In the Dr and Mrs Hung Hin Shiu Museum of Chinese Medicine at Baptist University, there is a wall displaying the faces and quotations of famous scholars of Chinese medicine.

The words of Zhang Xichun (1860-1933) are particularly apropos today: “Learn from the past, but not to be confined to it; learn from the West not to abandon it.” Zhang was a modern scholar who led an early movement to integrate Chinese and Western medicine but believed that it was essential to keep the holistic principles of Chinese philosophy, such as yin and yang, in the heart of China and Chinese medicine.

The fundamental mission of the museum is to “foster a comprehensive and correct understanding of traditional Chinese medicine.”

As part of the annual International Museum Day last month, the museum, in Kowloon Tong, offered two days of free public workshops, covering a wide range of topics, such as acupuncture basics and history of Chinese medicine.

There was a tour showcasing real versus fake Chinese herbs, and interactive games for people to experience the practice of Chinese medicine.

About 200 people, ranging from primary school children to adults, attended the workshops. One participant, Candy Chan Wai-chan, says she went because she never had the opportunity to learn about Chinese medicine.

“I’m here because I am Chinese.

There is thousands of years worth of knowledge that I know little about,” Chan says. “Today, many of my friends are turning to traditional Chinese medicine for alternative therapies for cancer to complement Western medicine. I want to learn about the remedies and the history behind them.”

Edna Chan Yi-yi, the museum’s registered Chinese medicine practitioner in the workshops and a practising doctor, says most of the visitors to the museum have only a basic knowledge of Chinese medicine and its history.

“We have found that the Hong Kong public has a very rough idea of basic principles, such as yin and yang,” she says. “It’s not our goal to discuss theory or to overwhelm the public with academic principles but

to give the workshop participants a better understanding of meaning and practical guidelines.

“People see Chinese herbs listed in bottled drinks in the supermarket, and many Hong Kong kitchens use herbs in recipes routinely, but often the public don’t fully understand the benefits of Chinese medicine.”

Selina Ming, executive officer with the secretariat of Baptist University’s School of Chinese Medicine, remembers feeling curious as a small child watching her grandparents use cupping treatments or drink decoctions.

“I think as people age, they want to learn about the medicines because it is a part of their own personal Chinese history and everyday life,” Ming says.

One of the greatest issues for Chinese medicine practitioners today is the public’s misconception about its powers and healing properties. Movies, both Western and Chinese, tend to exaggerate the effects of acupuncture.

In Kiss of the Dragon (2001) martial arts star Jet Li Lianjie kills a villain by sticking an acupuncture needle in a forbidden location on the neck of the man, known as the “kiss of the dragon”, causing a painful death. Other films portray

I’m here because I am Chinese. There is thousands of years worth of knowledge I know little about CANDY CHAN, WORKSHOP PARTICIPANT

Florence Tsui Ho-fun weighs herbs (top); the Chinese medicine workshop. Photos: Edward Wong

miracle cures with just one acupuncture session.

“In reality this is not the case,” Edna Chan says, “so we try to dispel the myths that people have come to believe.” In the workshop, she explained the nature of the meridians. Participants then practised their knowledge of the meridians by identifying pressure points on a balloon model. Most participants believed the meridians are associated with the health of the blood vessels or nerves, but in reality it is neither. Jing luo, Chinese for meridian, provide a channel for the fundamental substances of qi, blood and body fluids.

Jane Cheung Wai-hung and her son, Henry Pak Wan-hang, eight, patients at the School of Chinese Medicine, attended the workshop.

“Henry has been watching me and my husband use acupuncture for a few years. He wants to be a Chinese medicine doctor when he grows up,” Cheung said. “He was really keen to be here, and it’s very exciting for me to watch him learn.”

Aside from International Museum Day, the museum holds 50 workshops annually for primary and secondary schools and the public.

See cmmuseum.hkbu.edu.hk for details.

HEALTH 9 MENTAL HEALTH

Who do you think you are? ...................................................

Katie McGregor healthpost@scmp.com There is no doubt that the 2004 Indian Ocean tsunami was a catastrophe for hundreds of thousands of people. But for Linda Fancy, it gave her the impetus to bring together the strands of her experience as a counsellor, crisis management consultant and neuro-linguistic programming (NLP) practitioner to create a programme to help relief workers cope with the emotional maelstrom of helping others in that time of crisis.

Today, Fancy, who has lived in Hong Kong since 1998, runs a more refined version of this early programme, a one-day workshop called Personal Power, to help city dwellers deal with their own personal turmoil.

“I was in Sri Lanka just after the tsunami and, like so many others, I wondered what I could do to help,” says Fancy. Although she had experience helping others in Hong Kong, she felt ill equipped to deal with a disaster of this kind.

However, an unexpected interaction with a distressed man who had survived the tsunami by climbing a tree gave her the confidence to step forward.

“I was hired by the UN and the Sri Lanka Ministry of Health to support medical graduates doing psychosocial field work. I saw there

was a problem with burnout, as these freshly graduated doctors and nurses had not been taught any self-management techniques, and all too easily identified with and became ‘damaged’ by the emotions of the very people they were trying to help.”

And so the MeManagement self-awareness programme was born, scribbled out on a flip chart and offered as a self-help programme to the graduates along with relief workers at other NGOs. Fancy herself had a traumatic childhood with the loss of four close family members. This, she says, gave rise to deep-seated feelings of abandonment, and through her early life would make her overly sensitive to rejection, real or imagined.

“I attended workshop after workshop, seeing many truths, but with minimal change,” she says.

“One of the turning points came when I was introduced to the more results-oriented NLP techniques, and undertook certification so that I could better understand my mind. I had dabbled in self-hypnosis with astounding results, so the different mind awareness techniques came easily to me.”

NLP processes can help participants make peace with selfsabotaging inner voices, through the use of techniques to moderate or reframe thoughts. The technique is popular, especially where quick results are required, such as in an

environment of crisis, because it doesn’t dwell on the causes of behaviour but seeks to allow patients to “move on”.

The techniques stand at odds with classical psychoanalysis – or the “talking cure” – where the focus is on understanding the cause of emotional reactions. The conflict between the methods is illustrated in the recent film, A Dangerous Method, about the relationship between Sigmund Freud and Carl Jung. In the end the friendship cools as they diverge in their beliefs; Jung believing that while psychoanalysis can reveal the cause of unwanted behaviour, it cannot cure the patient.

Fancy has found what she believes to be the middle ground: “While the initial programme focused more on reframing and disassociation techniques, it quickly became apparent that you do need to see the roots of your behaviour in order to manage your mindset. It’s all very well doing a workshop and leaving full of good spirits and intention, but it is easy to fall back into old habits when you are involved in an emotional situation.”

With her painful childhood, Fancy realises more than most that our early years do have an impact on the way we think and react. “We are born without a sense of self but as we grow we create a conditioned identity of ‘me’, and with our absorption of language and

influences come a whole range of ‘me’ – the doubter, the selfrighteous, the neglected, the needy, the independent.

“Science has shown that 95 per cent of the time we are automated in our responses to life, operating on the premise of our conditioned thoughts, which more often than not are unreliable; they are just our childhood perception of affairs, which can be very distorted.

“I provide people with models to help them see the roots of their conditioning, and then stand back as if witnessing their inner ‘me’.

From that place, which I call the MetaMind, you are able to act like a movie director – you can call the cut on destructive thoughts, and then move to the next scene.

Where you put your thoughts is where you put, and potentially lose, your power.”

But rather than spend weeks in counselling, the Personal Power workshop attendees run through a series of exercises in a day, learn

Where you put your thoughts is where you put, and potentially lose, your power

disassociation techniques, develop a better awareness of “me” with drawing and charting exercises, and pick up tools and techniques to help regain and maintain balance.

“The best thing about Fancy’s course is that you walk away with real tools that you can use on your own,” says workshop attendee Jane. “You’re taught simple meditation and visualisation techniques, and creative methods for drawing and mapping your life, thoughts, emotions and perceptions.”

Another attendee, Nathan, an airline pilot, says: “From the start of the workshop I saw immediately why I act and think the way I do.

The programme gave a good insight into who I am and how to adjust my thoughts. It also helped me gain energy by letting needless thoughts go.”

While Fancy runs a regular public workshop, she also offers corporate and one-on-one sessions. “It’s amazing how these simple exercises can allow people to step back and see how their the mindset drives their reactions, and this then frees them to choose how they want to respond to life in every moment,” she says.

This is personal power.

For more information on Fancy’s workshops, visit her website: www.me-management.net

Linda Fancy runs workshops to help you understand yourself.

Photo: David Wong

10 WELL-BEING WALKING HOME

Leon McCarron dances to keep warm in a Gobi blizzard.

Photo: Leon McCarron

Making up for frost time ......................................................

Leon McCarron healthpost@scmp.com For 195 days, I lived the life of a wandering nomad, my existence condensed into the contents of a rucksack. Having agreed to join adventurer and friend Rob Lilwall on his latest expedition, I found myself arriving during the Mongolian winter at the wild frontier town of Sainshand, located in the eastern Gobi Desert steppe.

Our rules for onward travel from there were simple: we must only move forward by foot, we must eventually reach Hong Kong, and we must have some good adventures along the way. Writing this, after more than six months on the road, it seems almost unbelievable that we actually did it. What’s more, that we are still both in one piece.

And so now, from the comfort of a coffee shop, with no more 40-kilometre days of walking on the horizon, how do we feel? Did we learn a lot? Was it worth it?

I cannot answer all of those questions yet, as the experience is still so fresh, but certain aspects have become immediately clear. I have

no qualms in saying that this was the single biggest challenge of my life to date. It was a journey that stretched me physically and mentally, personally and professionally.

For me, the hardest section was undoubtedly the harsh and unforgiving winter Rob and I experienced in Mongolia and northern China. To wake up each morning to a day of walking and filming in temperatures which would not exceed minus 10 degrees Celsius was a morale-breaking prospect. Even worse was the knowledge that it would stay that way for months. Surviving was one thing; we became quite good at that and learned that prevention was far superior to cure when it comes to the cold.

But holding the camera and making a television show – that was where it got difficult. For minutes on end, I would stand with camera in hand, trying not to shake it. The biting wind and freezing air would attack through my clothing, causing fingers to throb in agony and eventually go numb. The camera had the conductive properties of a block of ice, and I would have to visit that “happy place” inside my head

The journey was hard and made us suffer.

But it also broadened our horizons and enriched our lives to escape from the pain. And just when I thought I could hold on no longer, I had to hold on a bit longer.

When, finally, the scene ended, I would be clenching my fingers tightly and running around madly to regain circulation and feeling, which often took up to an hour.

It is thus perhaps not surprising that my most enjoyable moments were in the sun, as spring descended. Plants pushed upwards through the melting snow and birds arrived to sit on the still-bare trees.

Aside from the temperatures, I encountered a variety of other challenges being the cameraman on this expedition. My adventurecamerawork experience came primarily from a year-long solo

EAT SMART

Healthy dining goes back to its roots ......................................................

Jeanette Wang jeanette.wang@scmp.com Burdock, native to Europe and Northern Asia, has eye-catching purple flowers when in bloom, but the plant’s main attraction lies underground.

Its deep, slender roots have been used for centuries to treat a host of ailments. The University of Maryland Medical Centre says it’s traditionally used as a blood purifier to clear the bloodstream of toxins, as a diuretic, and as a topical remedy for such skin problems as eczema, acne and psoriasis.

In traditional Chinese medicine,

burdock is often used with other herbs for sore throats and colds.

The root’s sweet flavour works well in stews and stir-fries – as in this recipe contributed by Bodhisattva Vegetarian Restaurant in Kowloon City Plaza.

Lettuce wrap with burdock root Serves 2 A few lettuce leaves ⁄3 piece burdock root (about 10cm) 300 grams soya bean sprouts 200 grams Chinese long beans 3 pieces shiitake mushrooms ½ tsp peanut oil ½ tsp salt ½ tsp sugar ½ tsp light soy sauce

1

• Cut out eight palm-sized discs from the lettuce leaves.

• Mince and roast burdock root until dry.

• Cook sprouts, long beans, mushrooms and lettuce in boiling water.

• Heat oil in a wok. Stir-fry soya bean sprouts, long beans and mushrooms until tender.

• Season with salt, sugar and light soy sauce.

• Serve a spoonful of the mixture on each lettuce disc.

Recipe provided by the Health Department as part of its EatSmart@restaurant.hk campaign.

For more information, go to restaurant.eatsmart.gov.hk

bicycle adventure, travelling from New York to Hong Kong. I can say now, unreservedly, that filming a bicycle journey is a dream compared with walking. Rob and I had to work out routines for everything – carrying the camera and the tripod so they were easily accessible, looking after footage and charging batteries.

But, as in most times of need, we channelled that amazing human ability to make do with what we had, coming up with workable solutions.

I kept the camera in a pouch on the back of my rucksack, and the tripod strapped on the side. To avoid wasting time and energy taking off my pack, Rob would unclip and pass the filming equipment to me. I would adjust the settings, Rob would step in front, and within 30 seconds we were ready to film. We would send footage on hard drives back to Hong Kong every month or so to avoid carrying too much precious material, and found that charging electronics was never a problem.

The population density on the mainland is such that even in the most remote areas we’d never be more than a couple of days’ walk from a settlement.

Overcoming these obstacles is what I will take away as my most rewarding experience of this journey. I am forever in awe of the human brain and body, and constantly guilty of underestimating them. Over 5,000 kilometres, my body held up with only minor injuries, and over countless navigational and expedition-related challenges, my mind always came through to keep us safe and moving forwards with our journey and show.

Seeing China by foot is something I will never forget: the vast expanse of the Gobi, the Great Wall snaking its way over ridges and valleys, the frozen Yellow River carving a deep grove into the Loess Plateau – all of these things are etched indelibly into my memory.

The journey was hard and made us suffer. But it was also beautiful, and has broadened our horizons and enriched our lives. Pushed out of our comfort zones, we learned the value of home, loved ones, community and comforts.

We return to Hong Kong with a greater appreciation of many things, and a life experience to cherish. At the very least, we have grown some mighty beards. healthpost@scmp.com

WELL-BEING 11 THE TASTE TEST DATES

Kings and queens of the oasis ......................................................

Jeanette Wang jeanette.wang@scmp.com

Bard Valley Natural Delights Medjool Dates 226 grams for HK$42.90, Gourmet Known as the “king” or “diamond” of dates, medjool dates are prized for their large size, natural sweetness and chewy texture. These come from California’s Bard Valley, the microclimate of which is said to produce superior dates.

Verdict: amazingly brown-sugary sweet with hints of caramel, but lacks the famed chewiness.

Illustration: Martin Megino

PERSONAL BEST

Never run out of options ......................................................

Natural Selection Organic Deglet Nour Dates 250 grams for HK$48, Just Green Smaller than the medjool, the deglet nour is the “queen” of dates. These are grown in the Djerid oasis, deep in the heart of the Tunisian Sahara.

Pitted, they’re great for stuffing with fillings such as almonds or peanut butter, and taste good chopped up and added to dishes.

Verdict: seedless and convenient to eat, but a tad stiff and dry.

USA Organic Dates 100 grams for HK$28.50, City’super The origin of these dates wasn’t on the package, but judging by their size, I reckon they’re medjools too.

They’re quite a bit pricier than the Bard Valley dates (which were about HK$19 per 100 grams), probably because of the organic label.

Verdict: creamy and chewy, these are truly satisfying. They’re also not as sweet as the Bard Valley dates – which I think is a good thing.

Mark Graham healthpost@scmp.com Recently, while out for a long training run in the fields, bridleways and woods near the village where I grew up, it struck me how much I had hated running cross-country at school. Yet here I was, more than 40 years later, volunteering to stride across muddy terrain in brutally cold weather.

What changed my mind? It was a posting overseas, to one of the most sports-mad places on the planet, that initially prompted me to invest in a pair of trainers, tackle a race or two, and gain a new perspective on a sport I once loathed.

Bermuda is the kind of place where virtually everyone is involved in some kind of outdoor leisure activity, be it tennis, scuba-diving, sailing, fishing, squash, golf or lawn bowls. I played the odd game of tennis and became a moderately proficient windsurfer, but it was running that really hooked me.

Jogging on roads flanked by palm trees and the turquoise ocean or along pink-sand beaches was a new experience. The scent of tropical flowers in summer and cedar wood fires in winter were also novelties for someone who grew up in England.

The camaraderie and fun were also new to me. At school, physical education meant enduring crosscountry runs that were presided over by cruel, and sometimes violent, teachers. They would mock the fat, panting boy who finished

last, and try to humiliate everyone else without natural athletic talent.

In Bermuda, nobody forced me to run. But I was entering 10kilometre races and half-marathons within a year of living there, delighting in the chance to become fit and make friends. There was a weekly fun run at the Botanical Gardens, a fiercely competitive blast around a three-kilometre circuit.

Beating a friend in that race gave you bragging rights for a week.

I was so hooked that I even ran the New York City Marathon, marvelling at the fervent support that came from ordinary people.

Encouragement came from jazz bands, brass bands, rock bands, cheerleaders and excited children.

The race goes through all the five boroughs, giving a real flavour of the city’s diversity and the residents’ love of a good spectacle.

Running, as I have discovered over the years, is by far the best way to explore a city. An early morning jog through the streets and parks allows the runner to observe the sights and soak up the atmosphere.

When I tell visitors Hong Kong is a superb city for running, they look at me quizzically, suspecting a wind-up is in progress. But I manage to convince people that Bowen Road, with its bird’s-eye view of the bustling harbour and soaring hills, is one of the world’s most magnificent urban running routes.

My personal Hong Kong favourite is the trail from the Sai Kung Country Park entrance at Pak Tam Chung, up and over the hill to

the first reservoir causeway. In years of running that route, I have seen giant snakes slither across the pathway, heard wild boar rooting through the undergrowth, been mesmerised by yellow and blue butterflies dancing in front of my eyes and been temporarily blinded when I ran into hanging cobwebs.

After a fierce rainstorm, it is thrilling to cross raging streams and squish through thick mud.

Almost all places have some merits for the adventurous runner. I have ventured gingerly out into the Gobi Desert in China and the Wahiba Sands in Oman, followed tribal paths in Papua New Guinea to the amusement of face-painted locals, gasped for breath in the high air of the Andes and the Himalayas, and dodged cows, monkeys, and Ambassador cars in New Delhi.

I have been lucky enough to be able to pound along the paths of Tokyo parks at cherry blossom time, a magical experience that feels like a dance across a pink-hued carpet.

Only a handful of destinations have defeated my efforts to run.

Shanghai, where I lived for a time, is

Running, as I have discovered over the years, is by far the best way to explore a city

a dreadful city for running, with impossibly crowded and potholed pavements and precious little greenery. The only serious options are a suburban park built by the British colonials and Century Park, a depressingly unimaginative contemporary construction.

But even the most beautiful cities have unforeseen drawbacks.

Recently, while in Paris, with the intent of watching the sun’s rays gently light up the Eiffel Tower, I attempted an early morning run along the River Seine. Instead, I found myself sharing the riverside cobblestones with giant rats eagerly devouring leftover food from dinner-cruise boats, glass underfoot from late-night revellers, and (friendly) vagrants.

I was in the city to run the halfmarathon, an event that involved 30,000 people. The course starts near a 12th-century suburban chateau and winds its way towards the Seine, past the Bastille and back to a park. I was very pleased with my time, which put me in the top third of all finishers and respectably high in my age category. It was fun and friendly, precisely the opposite of my school experience with mean-spirited teachers.

Sadly, that breed of educator still exists, as I discovered on a Bowen Road run not so long ago. An expat PE teacher was supervising an out-and-back run (yes, the fat boy was last), shouting at her charges and forcing them to squeeze past large construction trucks. It was a far more dangerous variation of my childhood runs.