Sunday, September 26, 2021

Eat More And Triumph

Picture from
I remember a fellow cross country runner who was on the stockier side, was really strong and fast (of course now I know he had what we call a mesomorph body type). The teacher in charge back then suggested that he '"needed to weigh a certain amount so he could run even faster".

This teacher had good intentions no doubt, but he was a Math teacher 'assigned' to be in charge of cross country running and not a 'real' running coach. Looking back, I'm not even sure if that teacher himself ran at all.

Anyway, my friend took his 'advice' and tried to lose weight mostly by not eating or eating a lot less. Not only did he lose weight, he lost a lot of his natural strength and his confidence to boot as he fared poorly in races thereafter. He quit running soon after. 

We now know that being a good athlete is all about finding what works for you. It's about finding YOUR 'strong'. We need to fuel our bodies adequately if we want long term growth and success.

For some runners, that means following that advice my cross country teacher gave to lose weight. For others, it means having a body that looks different (to the norm) and weighing more or less. All body types can work given our different and unique genes and backgrounds.

The problem with that advice is that it is often interpreted from elsewhere, an outlier perhaps, a person that won an Olympic medal. Interpreting data from outliers may be great if you're an exercise scientist writing up research to publish in a scientific journal. Definitely not great for giving advice to other athletes.

Athletes that go against their unique genes and background will not fare well with this training stimulus. They will be like a ticking time bomb and will almost always get slower with time, just like my former team mate.

Consider the *New Zealand rowing team, A survey they did found that all but one rower was at risk of having low energy because of their beliefs and eating habits. Coaches and Rowing NZ officials worked with their rowers to take up a challenge and eat more, thus changing their approach and culture to fueling. The rowers became faster, stronger and happier. Rowing was New Zealand's most successful sport at the Tokyo Olympics and four female boats won medals.

Here's what rower Brooke Donahue, who won a silver medal at the Tokyo Olympics recently said, "Now I understand being lean isn't a priority, being strong is," and "It doesn't matter what I sit on the scales. It's opened us up to understand it's not about a number but more about a good feeling, knowing we're fueling well." 

Eating well and eating enough can fuel your performance and recovery for long term growth and adaptation. Food can be your legal and natural performance enhancing 'drug'.


McFadden S (2021). Tokyo Olympics: How Our Female Rowers Ate More And Triumphed. Published on 17 Aug 2021. *Article on the New Zealand rowing team is taken from Stuff.

Sunday, September 19, 2021

Minimum Dose Of Training To Stay Fit

2 months after accident in 2013
I've written about how quickly you can lose your running fitness in the past. With my recent accident, I'm definitely losing fitness as the days pass. 

However, I'm probably not the only person who worries about losing fitness. Many people have lost their fitness during this Covid pandemic. I remember a few of my patients who are security officers for ministers/ VIP's whose ability to train while on duty is severely restricted. Similarly for military personnel on certain postings. Others with personal conflict, family commitments, caring for an ill family member and injury may face the same situation.

Since I'm in the same boat, I'm reading up to find out exactly how or what I need to do so I don't lose too much, or better still maintain whatever fitness I have left 2 weeks post accident.

Let me share what I found out from researchers from the US Army Research Institute of Environmental Medicine. They looked at three key training variables, frequency (how many days a week), volume (how long the session, how many sets or reps to lift) and intensity (how hard or how heavy the weight). 

Only studies on athletic performance (not weight loss or health) in which the training was reduced for at least 4 weeks were considered. This is to distinguish them from research on tapering before a big competition (usually a 3 week taper).

Most of the studies reviewed were based on work done by Robert Hickson in the early 1980's (Hickson and Rosenkoetter, 1981). Hickson's subjects were put through 10 weeks of brutal training. They involved 6 days of cycling or running for 40 minutes at 90-100 percent maximum heart rate (HR) at the end. Then for the next 15 weeks, they reduced the number of weekly sessions to twice or four times a week. Duration was reduced to 13 or 26 minutes and intensities of the sessions were reduced to 61-67 or 82-87 percent of max HR.

Picture from Med Sci Sp Ex article

In Hickson's original study , VO2 max is shown on the Y (or vertical axis) on the left of the picture above. You can see that after the 10 weeks (albeit brutal) training block on the X axis, VO2 max have improved by a impressive 20-25 percent. For the next 15 weeks, their VO2 max stayed at their improved values, despite training dropping down to 2-4 days a week. The subjects were recreationally active but untrained. 

Overall conclusion of this review is that you can get away with just 2 sessions a week as long as you maintain volume and intensity of your workouts. This is similar to what Hickson found with further confirmation in some areas. 

However, please bear in mind that maintaining your VO2 max is not the same as your ability to perform long duration activities (oops for me then since my Saturday bike rides go up to 3 hours). Similarly, don't expect to run your best marathon time after a few months of 2 times a week training. Your leg muscles will definitely not be able to handle it.

When duration of training was reduced by one (13 minutes) or two thirds (26 minutes), VO2 max gains were preserved for 15 weeks. The study included short (5 minutes) and long (2 hours) endurance. No prizes for guessing that short endurance was preserved when comparing the 13 and 26 minutes group, but those who reduced their training to 13 minutes fared worse in the 2 hour test.

When training intensities were dropped by a third (from 90-100 percent to 82-87 percent), VO2 max and long endurance declined. When training intensities were dropped by two-thirds (61-67 percent), most of the training gains were wiped out. Takeaway message is you can get away with training less often, or for a shorter duration but not with going easy.

A few other points to note. These conclusions were based on what I'll say is an "unsustainable training protocol" of hammering 6 days a week with one rest day! Most of us would surely have a more balanced training program of hard and easy days. 

The subjects used were not trained athletes nor military personnel. If you've been  training for years, you would have some structural changes like a bigger heart and a more extensive network of blood vessels that would hopefully take longer to take away (yay for yours truly).

Of course elite athletes would probably have a higher level of absolute fitness which may fade away quicker initially.

All you gym rats will be happy to know that the overall pattern is fairly similar when it comes to strength training too. Both frequency and volume of workouts can be reduced as long as intensity is maintained. Several studies found that even once a week training is enough to preserve maximum strength and muscle size for several months.

However, for adults above 60, evidence suggests that twice a week strength sessions are better at preserving muscle. Same for training volume, older people will need two sets while one set per exercise for young populations will suffice.

Now you (and I) definitely know what it takes. 


Hickson RC and Rosenkoetter MA (1981). Reduced Training Frequencies And Maintenance Of Increased Aerobic Power. Med Sci Sp Ex. 13(1): 13-16

Sperring BA, Mujika I, Sharp MA et al (2021). Maintaining Physical Performance: The Minimal Dose Of Exercise Needed To Preserve Endurance And Strength Over Time. J Strength Cond Research. 35(5): 1449-1458. DOI: 10.1519/JSC.0000000000003964

Sunday, September 12, 2021

Sugar Is Not Your Enemy

When can I drink Coke again?
Those of you who know me well know that I have a sweet tooth. I love eating chocolate and drinking Coca Cola. However, now that I'm not able to do much exercise over the next 6-8 weeks after my accident last week, I definitely won't be eating much sugar!

There is a huge difference between consuming too much added sugar when not exercising and fueling your exercise with sugar. This always confuses athletes, myself included previously. So let me try to explain this.

Too much sugar in our diet can definitely harm our health, but consuming carbohydrate, including simple sugars can be beneficial to your athletic performance. During intense exercise and in the latter stages of a long endurance session/ race, when our muscle glycogen gets low or depleted, bananas, Coca Cola, gels and other concentrated sources of simple sugars get into our bloodstream and muscle cells much quicker. Some of you must have experienced this while on the verge of bonking and getting a sugar boost when you consume an energy gel. 

This then presents a dilemma for some of you who want to fuel high performance and simultaneously reduce sugar intake.

Carbohydrates include whole grains, fruits, vegetables, processed grain, rice, noodles, pasta, table sugar (sucrose) and monosaccharides (fructose and glucose).

When a food contains extra or "added sugar", it means that sugar that was not naturally present in a food or ingredient but was added during preparation or cooking, then you have to be careful. These are mostly in packaged foods although it goes by names like high fructose corn syrup, cane juice crystals, muscovado, brown rice syrup etc.

So when doctors or dieticians warn about health risks associated with consuming large amounts of sugar, they are not referring to carbohydrates, but excessive added sugar.

Excessive consumption of added sugar, also known as 'free sugar' is the problem and it is associated with obesity, *insulin resistance, Type II diabetes, cardiovascular disease and **other health problems.

How is this different from consuming sugar while exercising? During prolonged exercise (greater than an hour at least), simple sugar is useful, effective and does not come with risks and problems mentioned above. This is also true (although to a lesser extent) immediately before and after exercise.

The problems associated with simple sugar are tied to consuming it when you are at rest (or not exercising). Since your body needs to do something with the energy in the sugar you are consuming when you're not active enough to burn it, your muscles are still full of glycogen and you cannot store it, your blood sugar levels stay elevated longer and the excess is stored as fat.

When we exercise, our bodies use carbohydrates differently. Our muscles use glucose to produce energy and the amount of glucose they transport from our bloodstream into our cells increases, without needing insulin. 

Kipchoge monitors his sugar levels

Since exercise reduces blood glucose levels, insulin secretion decreases and glucagon increases. Glucagon does the opposite of insulin, it helps free glucose from its storage form (glycogen) in muscle cells and the liver to increase blood glucose levels. All that in simple terms means that during exercise the sugar you ingest does not cause your insulin levels to spike.

After a hard, long exercise session (> 60 mins), both muscle and liver glycogen levels are low, there is an opportunity to quickly store sugar (this can be Coca Cola, banana or even prata) as glycogen. This is when you can consume simple sugar (until your glycogen stores are replenished) without the ill effects described above.

So now you know, you do not have to avoid added or simple sugar during exercise and perhaps immediately after a long intense session or race, but that does not mean you should ONLY consume added or simple sugar while exercising. Complex carbohydrates and other real food that contains fiber, fat and protein are all parts of a sound nutrition that our body needs.

So, when added sugar does not serve a useful function (like exercise), and this is usually more than hour before or after exercise, you definitely should be eating real food, without added sugar.


Burke LM (2004). The IOC Consensus On Sports Nutrition 2003: New Guidelines For Nutrition For Athletes. Int J Sp Nutr Ex Metabolism. 13(4): 549-552. DOI: 10.1123.ijsnem.13.4.549

*Since added sugar is absorbed quickly, our blood sugar levels spike up quickly which leads to insulin being release rapidly to remove sugar from our bloodstream. This can lead to insulin resistance over time where more insulin needs to be produced before sugar is being absorbed. Over time insulin resistance leads to Type II diabetes.

**Other health problems include affecting leptin levels, which affect perception of hunger. When there are lots of leptin in the bloodstream, we feel less hungry. When we have low leptin levels, our brain thinks we are running low on energy and increases our appetite. Consuming too much sugar leads to leptin resistance whereby high leptin levels in the blood does not signal satiety and we either eat more before feeling full or feel hungry soon after finishing a meal.

Sunday, September 5, 2021

Gino Was In A Cycling Accident.. Again!

ECG in progress
This was yesterday. Gino needed an echocardiogram done after his accident. Let's rewind to the start of 4th September 2021.

Gino went for his usual Saturday bike ride with the CycleWorx group. They had completed about 60km when they were cycling along Nicholl Highway towards the city. The roads were empty and they were cycling on the left most lane. So it came as a shock when a motorcyclist rear ended him. Gino recalls that it all happened so quickly. He flew backwards and landed on his back. He got up to see his bicycle on top of the motorcycle and the motorcycle on top of the motorcyclist. His friends called for the ambulance and police.

I received a call from Gino at about 8am. It was words I'm not fond of hearing, "I've been in an accident." I've since learnt from his last cycling accident in 2013 that Gino has a high pain threshold and always says he's ok. When I asked him where it hurt and he said his upper back, I thought, "Oh man! Not his spine again!" He had sustained a fracture in his skull and lower back in 2013.

My dad drove me to the scene of the accident and I was relieved that the ambulance was still there. Gino was on his right side, strapped onto the gurney. He was inhaling painkillers and complaining of upper back pain. He also asked for his muesli bar that was squashed from the impact of the accident in the pocket of his jersey, which was ripped to shreds by the accident. We had to be transported to Tan Tock Seng Hospital. 

It was not a good experience there. Most of the nurses were great but the doctor who received us at Accident & Emergency was less than impressive. To cut a long story short, even after we repeatedly told her that Gino's pain was between thoracic spinal levels 3 to 6, the X-rays were done for the lower thoracic and lumbar spine. We were elated when the doctor reported that there were no fractures, and took her word for it. In hindsight, I'm questioning myself why I did not check the films! We were discharged from A&E and told we could go home. Gino was feeling less pain as he had been given meds.

I am grateful that our friend who I had called after the accident, who's a spine surgeon, called us as we were waiting for our Grab ride home. He was appalled that we had been discharged so quickly after a road traffic accident. He asked to see the X-rays again and only then did we realize that the upper thoracic spine levels had not been captured. We changed our destination to Mount Elizabeth Medical Centre.

As the effects of the meds started wearing off and after the thorough assessment done by Prof Hee, Gino stood up and exclaimed," Oh no! This feels like the same pain I had when I fractured my low back." I know Gino knows his body really well so we proceeded to get him admitted to be assessed more thoroughly with MRI and to be monitored. 

His MRI films showed a wedge compression fracture at thoracic spine level 4. Since it was at that level,  he had to have his heart assessed with an ECG and blood tests plus a CT scan to ensure that all his organs and vessels were not injured and also check that his ribs are intact.

Arrow shows the location of the fracture
CT scans of his thorax turned out to be clear. Phew! There were some abnormalities with his ECG readings so we have to follow up with a cardiologist. We are hoping that it was just the stress from the accident and that it will settle, but we will get his heart checked. 

The fracture in his spine will be treated conservatively, meaning no surgery as that particular thoracic level is well supported by his ribs and connective tissue. We will let the body heal itself. Gino cannot work and cycle for a few months. His surgeon advised him to maybe to stick to the park connectors or the gym when he can start cycling again. I don't know about that!

His ripped jersey

Happy after being told he can go home