The Public Health Collaboration Annual Conference

I spent last weekend at the annual conference of the Public HealthCollaboration, a charity I’ve been a patron of along with my wife Jane for the last 3 years. The conference was at the Royal College of General Practitioners in Euston Square and was attended by over 300 doctors, scientists, health professionals, journalists and professors. There was even at least one IT consultant, and I have to say that he was feeling somewhat out of place on Saturday morning surrounded by such eminent and dedicated people.

There was a packed schedule of 8 talks on each of the 2 days with subjects ranging from the history of fueling for endurance sports to curing epilepsy with a LCHF diet. 

The whole weekend was televised and will be available shortly on the PHC website. I’d like to highlight a small sample of the content that had the most impact on me.

Tom Williams and Simon Tobin gave a great talk on parkrun. Tom is the COO of parkrun which now has weekly 5k runs in over 530 locations worldwide. We had dinner with Tom on Friday night and it turns out that he is a low-carb advocate as well as a passionate believer in sport for all; there are even parkruns in prisons now and Tom likes to ensure that the focus of each event is not on the first finishers (we don’t call them winners!) but on the slower runners; the ones for whom 5k is a huge achievement. One of the things that Tom is most proud of is that the average parkrun time is getting slower!

Tom is pictured on the right here with Dr Ian Lake, a type 1 diabetic and marathon runner enjoying a very tasty LCHF dinner at Caffe Caldesi . 

Simon Tobin is a doctor from Southport and a previous correspondent of mine on this blog; he and the other doctors in his practice have been offering the LCHF diet as an intervention for patients with type 2 diabetes for several years now; the results are amazing with most patients managing to reduce or remove their dependence on drugs for managing the disease.  Remember that the best that a patient can hope for on drugs is that their condition might not get worse.

Simon often prescribes parkrun to his patients as a lifestyle intervention! This makes a lot of sense when you consider that over half of the diseases we suffer from are the result of lifestyle choices. Drugs are not the only answer and in many cases they are clearly the wrong answer.

Over the last 6 years Aseem Malhotra has become the poster-boy of the UK Real Food movement. He is regularly seen on TV debating with the likes of Susan Jebb the UK Government's advisor on obesity who is part if the team that advice the government on advice for healthy eating, or Professor Roy Collins who advises the NHS that just about everyone should be taking statins, although his own research suggests quite the opposite to anyone who doesn’t have a vested interest in the sales of Statins!  

When I first met Aseem 5 years ago he offered to share this slide with me but I forgot to follow up on his promise. 

One of his first major causes was to try to stop the sale of unhealthy and sugary foods in hospitals. When he had a heart attack patient wake up after an operation to be fed a burger and chips in bed he knew that something had to be done. His local hospital has now become the first in Britain to ban the sale of junk foods on site.

Aseem has published a number of contentious papers in the British Medical Journal, and he has developed a particularly tough skin having made a number of high profile enemies along the way. He is highly critical of the role of the food and drugs industry in influencing research and advice on matters of health; and equally critical of the eminent scientists who profit from this support whilst ignoring the latest scientific data on issues such as what causes heart disease.  

The best example of this is how the NHS still tells us that saturated fat and it's co-conspirator cholesterol are bad for us and will increase our risk of CVD despite the overwhelming evidence that they will not. There is so much at stake here in terms of NHS money and people’s lives, but it appears that what matters most is the imminence and incomes of those learned men and women who, by working so closely with the food and drugs lords have found themselves in the position of advising Her Majesty’s Government on what is best for her subjects. 

The phrase “eminence trumps evidence” is true at the highest level but it is good to see that increasingly, doctors are refusing to allow transparency and objectivity to be trumped by eminence and vested interests. A survey in Pulse, a publication for GPs, in October revealed that two-thirds of GPs were rejecting the Nice advice to offer statins to those at low risk.

Aseem received a well-deserved standing ovation at the end of his presentation. Interestingly this was attacked on twitter as evidence of cultist behaviour in the PHC movement. Anyone who was there would assure you that it was nothing of the kind. Just a spontaneous outpouring of gratitude for someone who has given so much. Exactly the same could be said of the next speaker.

Aseem and Tim

Tim Noakes – was just marvelous. He gave a self-deprecating account of his career, explaining how as a result of his research into nutrition for endurance sports he became the first producer of energy gels and the author of the bible of distance running (Lore of Running). He then tore this illustrious career apart by describing the faults in his methods and how they had been avoiding the importance of fat all along “because we didn’t understand the pathways by which the body uses fat for energy”.  Years later after reading the work of others he was not too proud or eminent to admit that his interpretation of his clinical data was wrong.

His favorite anecdote seems to be the one where back in the 80's the great Zimbabwean triathlete Paula Newby-Fraser accidentally miss-heard his advice and adopted a low-carb rather than a low-fat diet.  She then proceeded to win more Ironman races than anyone else in the history of the sport.

Tim has been involved in a high-profile court case for the last few years in which the Health Professionals Council of South Africa (HFCSA) have clearly tried to ruin his career because they take his recent research and publications on LCHF as a direct attack on their profession. Four years ago Tim gave some generic advice to a woman asking a simple question on Twitter and they have accused him of bringing their profession into disrepute.

You can find out all the details online if you wish but suffice it to say that I have never heard a sadder tale of the lengths that an eminent group of learned people will go to in order to protect their power and influence; ignoring simple evidence and attacking a kind and caring man in such a profound and prolonged manner. They are a disgrace to their profession and prove John Cleese (and more recently Assem Malhotra) correct when they said that 

“One should never forget the first principle of the old KGB. Always accuse your enemy of exactly what you are doing.”

The abuse that Tim has received as been awful, but the support he has gained is incredible and the whole fiasco has brought so much attention to the diet that he now feels that perhaps the human cost was worth paying.

And in many ways this story reflects the problem that we at the PHC were all gathered to discuss; the way that government advice is dictated by a small group of eminent men and women who seem intent on protecting their own dated research and opinions and incapable of changing their minds in the face of new evidence.

Professor Tim Noakes amazed the scientific world by tearing up the chapter on nutrition in his famous book and declaring that he got it wrong. Perhaps it’s now time for UK government health advisors like Professor Rory Collins and Doctor Susan Jebb to do the same thing.

Tim also mentioned the work of Virta Health, an American company providing structured programs for dietary intervention for the treatment of type 2 diabetes. There were not many plugs to commercial enterprises during the conference but this one deserved it’s airtime.

There is not much data on the longer-term impact of the diet on important health markers such as blood pressure, cholesterol and blood sugar, and this is what allows many of the diet’s detractors to state that the diet may work well in the short term but they have concerns about its longer-term efficacy and adherence. Well the data from Virta and Southport  (see below) is filling that void with overwhelmingly good news. Virta already have a very large study group and the papers that they are producing make fantastic reading. All of the important health markers being measured on their patients continue to improve in the two years that the data has been collected for. Comparing this data to the alternative of a life on Metformin and the likelihood of a painful early death I know what I would recommend to my loved ones.

When you consider that the huge majority of health issues relate to lifestyle choices it is a wonder that so little NHS time and investment is put into dietary interventions like this.

Which brings us on neatly to my final hero of the PHC conference Dr David Unwin. Four years ago a GP friend send me a link to a report written by Dr David Unwin and his wife Dr Jen Unwin from the Norwood surgery in Southport. The report described the early results of a trial that they had been performing with their diabetic patient in which they provided dietary advice as an option to patients. Patients who opted into the trial were given regular advice and assistance with adopting the LCHF diet. The results were very impressive and I wrote about them in this blog post 

David's talk provided a fascinating insight into the subject of fatty-liver disease, a precursor to diabetes and something that is entirely influenced by lifestyle factors such as diet and exercise.

For me the best bit of the talk was the way he dealt a huge blow to the detractors of the LCHF diet. If you research “LCHF diet” you will find lots of influential dietitians and health advisors whose principle criticism reads like this:

“The diet may have positive benefits in the short term but we have concerns about its long term use”.

These concerns arises from the lack of long term studies of the diet. This is despite the fact that of all the studies comparing the health effects of low-fat verses low carb diets there is an overwhelming majority in favour of low-carb. 

Much like the work by Virta Health but clearly in the impartial, public NHS domain, the Northwood trial has now been running for several years and they have been meticulously collecting data from all of the participants; they have now published data that shows the following:

And that’s not all that was achieved in the Northwood group. The risk of heart disease has dropped significantly according to the JBS3 score used to judge this risk

And so now we have the data. Of course it is open to scrutiny but I for one will be passing these last to graphics to anyone who continues to suggest that they have concerns about the long term use of the diet.

There were lots of other great talks at the conference; Peter Brukner (the Doctor on the Australia Ashes winning team) provided a very humorous introduction and update on the latest worldwide news. Zoe Harcombe was on fire as usual, destroying the ridiculous notion that “calories in = calories out” with a perfect explanation of the laws of thermodynamics and how they do not apply to weight or food. 

Zoe Williams (of Trust Me I’m A Doctor fame) gave an interesting talk about the importance of physical activity; her rather famous co-presenter Micheal Mosely was in the audience. Jen Unwin and Charlotte Summers made us think hard about whether we are addicted to sugar. Trudy Deakin, David Cavan and Professor Ian Broom gave us loads of fascinating insights into the practicalities of reversing type 2 diabetes for large patient groups. And Dr Scott Murray gave a great talk on factors influencing heart disease.   There were more talks but I had to take a few walks to stretch my limbs and give my brain time to digest everything!

Lastly, thanks to Sam Feltham the Director of the PHC charity. 

Jane and I have known Sam for several years and he is a great leader and motivator. He has the greatest respect of the many partners, patrons and members of the organization and he did a brilliant job of organizing a fascinating weekend. Sam puts his heart and soul (and his career) into everything he does.  Commitment like this is contagious, and the impact of the PHC is growing as a direct result of his work. 

 Well done Sam!

 

It's All In The Taper

I was fit and excited and the Brighton Marathon was only 3 weeks away. I’d done every training run but one. Almost everything had gone to plan. I hoped to run under 3:20 and get a good for age place in next year’s London Marathon.

But here’s the thing. I was in exactly this place last year; and the year before that. Both times at the last minute I picked up an injury and I’d had to pull out. It’s now been three years since I last ran a road race!

And right on cue disaster struck! The day before my last long training run, just walking down stairs at home something went wrong in my left calf. I’d say I strained it but I was only walking down the stairs. I call myself a marathon runner and here I was again on the sidelines. I put it down to my sedentary job; I sit at my desk all day and my legs and back stiffen up. This is not healthy!

Out of necessity I’ve learned to be more prudent with my planning and my running. If a run is going well I back off; if I am getting ahead of the plan I take a day off or do a Bulletproof  strength session instead. My weekly average milage is still in the 20s; but then I am getting older and things have to change.  The bulletproof sessions have made me feel stronger, and perhaps been the key to where I was 3 weeks ago, fit and ready to run long. There have been no Strava records this year, instead I have a new mantra – “Less is more, slow down!”.

I’d slowed down now, that’s for sure. On the Saturday I couldn’t run and I baled from my last long training run. On the Sunday I could walk comfortably but not run.  On the Monday I could walk comfortably but not run. But then I figured something out: the damage couldn’t be that bad as it was so innocuous. What if it’s just another nerve spasm? I have a 6-year history of compressed nerves kicking off referred pain in my legs.  There was a small knot in my calf sometimes but it went away in a hot bath. Why not try to warm it up some more and see how it behaves. So off I went to the gym and spent 10 minutes on a cross trainer which doesn’t apply any eccentric force on the calf but warmed it up nicely. That went well so I tried a light jog on the treadmill, and it worked! 30 minutes and 3 light jog sessions later it was still going. My mood went from miserable to very excited in those 30 minutes. There were nearly 3 weeks to go and I could still do it. No more speed work, just one long run, some light recuperation over the next 2 weeks and 1 target paced run 4 days out and I could still be in with a good chance.

So 5 days later I ran a last long run. 18 easy miles. And sure as eggs are eggs my right calf did the same thing just as I got home. Time to brew a cup of tea and think things through!

We then spent a week skiing. Luckily there was a gym at the sports center in Tignes and I visited twice. Each time I could feel the problem but with care and a long warm-up I was able to knock out a few miles. It started to become clear that the problem had to be with my back.

High altitude training camp

So after we got home I booked a session with my physio who found the problem right away, gave me some treatment, reminded me what to do to help it recover and sent me packing.

The next 3 days were horrible. 3 times a day I’d ice my back, do some spine twisting and then some "nerve flossing" and then some heat treatment. At first I could run well, then the problem got worse and included a light pain in my hamstring, and then last Friday I was able to run pain free again.  Just 2 days to go! 

Do I run, or not run? Is it too risky? How would I feel if I didn’t try? It was Jane asking that last question that tipped the balance.

I’d more-or-less given up on my target time. Normally it’s the last 2 weeks when I focus on running at marathon target pace for several runs to get used to it.  I decided to just focus on enjoying it as much as I could; not to worry if I had to pull out, after all I was fit and I’d be running again soon. There are lots of great events to aim for over the summer.

I had a target of 3:20. That’s exactly the time I got 3 years ago; I didn’t train very hard that year but I hadn’t been injured either. Back in December I’d I figured that if I could just train for four months and not get injured then my natural speed and experience should get me to the finish line on time. Now what? Do I abandon that plan, and with it my hopes of a "good for age" entry into next year’s London Marathon? Common sense said "yes; don’t risk it, just enjoy the run".  So that’s what I set out to do on Sunday morning.

Before the start my left hamstring was hurting a little. This is the site of the original referred pain injury that put me out of the Brighton Marathon 6 years ago. I was gunning for a sub-3 marathon after training very hard for six months; all the signs were positive and then it all feel apart. I was a complete mess for some time after that. 

If you saw me at the start on Sunday you would have seen a pretty despondent chap, moping about and ready to give up and walk home. My warm-up had no effect on my leg and I’d have rather been at home tucked up in bed. Not exactly “loving it”.

Then I bumped into an old running club mate and he cheered me up a bit; Mark is a 3-hour runner but said he was aiming for 3:30 and I thought I’ll try to keep him in sight. And I remembered that there were plenty of folks having a much rougher time than me that morning so it was time for me to man-up and get on with it.

For the first 3 miles the hamstring continued to ache, but it didn’t get worse. Then in the center of the city it started to fade away and soon it was gone; to be replaced by…. nothing! No pain anywhere. And that’s how things remained for the next 3 hours.  I couldn’t believe my luck after the problems I’ve had over the last year.  Brighton suddenly seemed full of happy people calling out my name (it was on my shirt for the first time) and the support I received from friends and strangers lifted my hugely.  

For the first time in over a year I remembered my great love of running. After a slowish start I felt great, I began to think about my target time and gradually increased my pace until I was about 10 seconds per mile under that target. By mile 7 I knew that I could keep that pace going and I stayed there for the next 13 miles.  Mile after mile of controlled running, passing runners steadily with very few people overtaking me. 

Those middle miles!

That’s just how I love to run.  So long as no injury came I knew I could do it.  There was no wall, just the likelihood of some pain in the last few miles as normal. My strength training did wonders and I could feel my form holding on for longer. Perhaps I could have pushed harder and gone a few minutes quicker, but perhaps not; I had planned to run at exactly this pace and there was no reason to go any faster, I just had to beat my target.

As for the LCHF diet, I was running high(ish) after training low. Just a few slices of bread and some potatoes the day before and energy drinks before and during the race. This strategy worked well for 15 hours back in October and I wanted to try it in a marathon. I probably only had about a quarter of  a liter of energy drink and a half of water during the race.  I was sure that this last minute glucose-fest would not interfere with my long-term adaptation to running on fat.   My energy levels were still high at the end although there were signs of oncoming cramps in the last 2 miles.

I was unnerved at 22 miles when the mile markers were not agreeing with the beeping of my watch; they came about 90 seconds later. That 90 seconds was my cushion and I thought I’d lost it. Should I speed up? That would be courting disaster, so I trusted the watch, it couldn’t be that far wrong.  

Hove seafront has seldom looked so long! I focused on form and looked out for obstacles; smooth running with no sudden changes to trigger a cramp that could set me back a few seconds. Then we hit the 40K timing mats and I had just over 10 minutes to go. Perfect.  I passed Jane and our friends and they were screaming; they knew I was close. “Just keep going” always sounds like such a stupid thing to say but that is all I needed to do now.

I enjoyed the last quarter-mile immensely. It takes 2 minutes to get to the finish from the Palace Pier and I had 3. Several folks from my running club were marshaling the finish straight and there were smiles and high-fives with no need to race for the line. I finished in 3:18:40, inside the London marathon V50 Good For Age target time of 3:20.  My pacing had gone perfectly and my times for both halves of the race were exactly the same.

Happy marshals from Arena 80 AC

Beating that time was a huge relief to me. Despite a taper of troubles I’d finished my first road race for 3 years and I’d achieved what I’d set out to achieve. I was a half-decent marathon runner again! Certainly not my fastest time but after a year of not racing I was back up where I belonged.

The next day they lowered the good for age entry time for the London Marathon down from 3:20 to 3:15.

At first I felt cheated. Gutted is a great description of how you feel when something you have worked so hard for is taken away. But after 24 hour’s reflection it doesn’t seem so bad now. I hit my target and that’s a big deal for me; the fact that the goalposts were moved while I was running is not something I can control. Far worse things have happened to people very close to me recently and I should be proud of what I have done, not upset about the future.

What I am Reading Now

 My current reading diet is mostly inspirational. This is what I need right now, tales of what humans can endure on their own two feet. I just completed the longest event of my life but I still consider myself to be in recovery from earlier injuries. Rest period; I need ideas, motivation.

I’ve been travelling for the last two weeks and on my birthday in Columbus Ohio I was given three books; one each from Jane, Cam and Molly; and they were all about running and mountains. Perhaps this was a signal that it’s OK to carry on where I left off in Cartmel 4 weeks ago. Or perhaps that’s just wishful thinking; we’ll see! 

I stayed on in the states after the family went home and I chose the two paperbacks to read on the planes, leaving the huge glossy hardback for when I got home.

Run or Die – Kilian Jornet

I have known about Kilian Jornet for some years now but this is the first time I have read anything that he has written (or at least read a very well translated version of it). Not only is he an amazing runner and mountaineer but he has an engaging narative style and paints a picture much wider than his incredible achievements.

I was surprised a few weeks back to learn that the husband of one of my wife’s clients has just appeared on Kilian Jornet’s Instagram page.

Dave is a bit of a running and BMF star locally and he knows how to grab attention. He was running at the recent Glencoe festival when Jornet, passing by, snapped a picture of him climbing in a pink tutu!

Jornet clearly loves a story and his book is a great tale of the life of a world class cross country skier and mountain runner.

He asks himself some powerful questions including "why do we run?", and "where do you go when you have surpassed the feats of your idols?" Where do you find inspiration now?  Clearly this will never happen to me but we all need to learn how to re-set our goals. As we grow older we grow slower and it is important to grow wiser, to sometimes look outside the box when setting our new goals. 

Jornet's goals have spread to cover the globe, and his prowess at ski mountaineering has enabled a world of high-altitude possibilities for racing and adventure. Jornet is still a young man and I worry that with his love of danger (just check out his Facebook page!) there may only be an all too familiar one ending to his story. How many of the authors of the mountain adventure books on my shelves are still around to tell their tales?

This book was written a few years back and Jornet is still at it, breaking records (including the fastest ascent of Everest this year) and seemingly smiling all the time. And the very fact that he was there in Glen Coe smiling and taking photos of pink Dave from Sussex and posting that on his page suggests to me that he is on a relatively sound path forwards.

  

Running Man – Charlie Engle

Charlie is an alcoholic, an addict; and he is a world class ultra runner. Right away this book got my attention. I often struggle to answer the question of why I run, why it is that I will happily go out and endure discomfort and pain for several hours at a time. Once or twice I have described it as an addiction, but never having been addicted to anything else I was not sure that the description was a fair one. Now I am.

A good book about running is often not really about running at all, it is about some other struggle, some other story. Running is just the medium through which the tale is told.  This is true for Running Man. Right from the start we know that Charlie is no ordinary athlete; he wanted to be great at everything he tried and he longed for recognition from those he admired; on failing to achieve this recognition he turned to alcohol and become a recognized champion at that instead.  

I have not read a better account of addiction to alcohol and drugs, of the way it affects the individual and all those around. Maybe it is the fact that Charlie consistently returns to running as a form of salvation that attracts me to him – surely many people would right him off as a looser from the start and perhaps only because I know where the story is going I force myself to listen to the depths of depravity and desperation that he seems incapable of escaping, despite its effects on family, career and friends and Charlie himself. I wanted Charlie’s escape to come sooner but he kept sinking lower, at times I almost wept for his mother, his kids and for him.

I have never really understood how Alcoholics Anonymous works. Now I do and I have learned an important lesson. Charlie has not drunk for 20 years but I understand that he is still an addict, and there are times when only another addict can understand the torments that he still encounters and help him to face up to them.

As a side note it was interesting to learn that Charlie was one of the very few people to be jailed as a result of the housing crisis that hit the US in the first few years of this century. Not for miss-selling mortgages (as so many bankers were happy to do and were not jailed for it) but because his accountant lied on a mortgage application form.  In spite of this awful injustice he used his time in prison well and when he couldn't run in the Badwater Marathon he ran the 136 miles with 540 laps of the prison track instead.

In the end escape did come, in  the form of an addiction to adventure running (a bit like ultra running but harder). Only something so incredible as running across the Sahara was enough to replace to hold that drugs had on an otherwise well loved and respected man.

Now I am looking forward to reading the glossy hardback Running Beyond by Ian Corless

Closing off a neat circle this book, with a foreword by Kilian Jornet is chock-full of great photos and descriptions of Ultra racing.

It was just such a book that last Christmas got me interested in running another big Ultra, and it was Ian’s photography, particularly of runners descending Halls Fell Ridge on Blencathra, that fired my enthusiasm for the Lakes In A Day race. He was there in the clouds taking pictures again 4 weeks ago but I was too busy watching my footing to smile for the camera!

Time to pour a glass of red wine, put my feet up and dream….

  

Train Low Race High - The Lakes In A Day Ultra

In all of the events that I have run since starting on the Low-Carb High-Fat diet I have set out to show what can be achieved when competing on very low carbs.  I have run my fastest off-road marathon on almost nothing but fat and I have successfully trained at very high intensity on a low-carb diet. But I am also aware that many proponents of the diet actually rely on carbohydrates to fuel the prolonged high intensity work that often comes when competing.

I hoped that with good pacing I could stay within my fat-burning zone (perhaps 80% of my VO2 max) for the time taken to run a fast marathon. And I think I have proved that I can. But some events place unavoidably high demands on your strength and endurance; mountain running is a good example.

When I entered a 50 mile Ultra across the Lake District National Park I was under no illusion that I could do it carb-free. The ascents would be long and grueling and would doubtless have me burning glycogen whether I liked it or not. So it was time to experiment with Train Low Race High.

You could be forgiven for thinking that this post's title was a reference to the fact that I live in Sussex where the hills rise to a mighty 250 meters above sea level, somewhat lower than the Lake District peaks I would be running over, but that's almost as far as I'll go with that metaphor, much as I like it!

So here is an account of the longest race of my life and my approach to nutrition.

Last Saturday morning at 8 a.m. I stood on the start line of the hardest event that I have ever entered. It had been a long road to get there and I had no idea if I was going to finish it, but I was determined to try my hardest.

Last Christmas Jane gave me a book entitled "50 Races to Run Before You Die", and brimming with confidence I entered The Lakes In A Day Ultra a 50 mile event that traverses the Lake District from north to south by way of nearly 4,000 meters of mountains.

I've always wanted to run a long one in The Lakes and being fighting fit at the time I laid down my plans in the depths of winter; perhaps I could finish inside 13 hours. That would be something special. Then in February I injured my knee and could not run properly for the next 7 months. If you are a regular reader of this blog you may have wondered why there have been so few posts this year, and the truth is that there has been almost nothing to write about!

I've spent a lot of time this year cycling and walking, and slowly building some jogging into my walks. I completed a 100 mile bike ride in 5.5 hours. I knew that I was fit but would I be able to run? 

Sometimes a little gentle jogging worked and sometimes the pain returned. The consultant looked at an MRI  scan and said rest, and so from May I rested from running completely for 3 months. The training plan changed and there was no room for any more injuries, but it still looked sort-of achievable, perhaps. 

All of my endurance walking was completed on a low-carb strategy. This included several 20-30-mile walks on just eggs & bacon for breakfast and a few bottles of water. 

The essence of Train Low Race High is to train your body to burn fat as effectively as possible and then add carbohydrates at the last minute to give you more power just when you need it. Adding carbs earlier or relying on them entirely would leave me susceptible to bonking into The Wall. I was sure that I could go all day on fat, I just needed a top-up for the hard bits.   Only in my last training walk/run did I experiment with an energy drink just to learn if my stomach could tolerate it. It's been a few years since I used an energy drink and I look back on Powerade and the like with some distaste. The Tailwind drink was not so bad as I'd feared so into the bag it went.

In France on holiday I learned more about how far I could push my injury on longer walks. After an hour or so my right knee would hurt a little, but after easing up the pain would subside and I'd be good for several more hours with no problems afterwards. I also figured that for a 50-mile mountain event "walk/run" was a pretty good strategy. There is no way that most entrants would be running more than half or even a third of the event and approaching it as a walk with a bit of running rather than a run with a lot of walking made good sense to me. I certainly put the miles in, the only thing missing was the altitude. As I mentioned before Sussex is not blessed with mountains and so my long walks had a lot of ups and Downs.

A typical training walk/run on the South Downs

I hit my reduced training targets in the nick of time without having run for more than 4 miles at a time since April. I was concerned by this of course but I drove up to Cumbria with Jane just hoping to finish the event at all. Above all else I was determined to enjoy it.

Jennings Ale - The fuel of champions!

In the two days before the event I started adding more carbs to my usual low-carb diet. Mostly in the form of bread and potatoes. The night before the race I enjoyed a couple of pints of Jennings in the pub at Caldbeck - it is a fell-run after all! Breakfast was an energy drink, a big bacon bap and a bowl of Alpen.  I carried 3 sachets of Tailwind energy powder and planned to scoff pizza, flapjacks and soup in the 3 feed stations along the way.  

Ready to roll

The first half was brutal. 27 miles, 2,500 meters of mountains, driving rain, a horrendous wind on the high tops and deep bogs on anything remotely flat. It had me cold and wet in the first two hours. I couldn't fault my Haglöfs jacket, OMM shorts or Salomons. But in order to keep warm I had to keep moving quickly.

I had planned not to take the direct route down from Blencathra as I feared for my knees, but the longer easier route was directly into the wind for the first mile; there was only one way down. There were queues of nervous runners inching their way down Hall's Fell ridge. 

Looking down Halls Fell Ridge to Threlkeld on a good day

It's not the steepest ridge but it's up there with them and a fall would have been serious. The wind was in our faces one moment and on our backs the next, not good on steep wet rock. We were all on all-fours on the steepest sections. Luckily I've done this sort of thing a few times before. I took a few risks to overtake the crowds and my knees held firm. 

Seeing Jane at the aid station at Threlkeld was a welcome sight. I refilled my drink, ate a quick ham&cheese roll and a flapjack and I was off. Only another 40 miles to go!

I then broke a walking pole crossing a slatted wooden bridge and had to manage the 17-mile Helvellyn range with one pole. All of my training has been with my lightweight Black Diamond carbon z-poles and so the ascent of Clough Head was all the harder with only one. I was working as hard as I could for 45 minutes. Taking turns with the remaining pole my arms were hurting badly; even so I was ascending faster than everyone around me.

Surprisingly when I got onto the long Dodds ridge I was able to run a good deal up there; it was bleak and I just wanted to get down! The wind picked up more with the altitude and being on a west-facing ridge - it was gusting well over 70 miles per hour and the horizontal rain was stinging our faces.  I ran with a group of about 10 others and we all seemed desperate not to get left behind; visibility was very poor and at times it was scary up there! Looking at the GPS tracker playback of the event I can see that several runners made some big mistakes on the ridge. Luckily I knew the route reasonably well and with just my compass I made a few good choices when the others were fetching their maps out. That kept me in touch. My running was slower but my climbing was faster. Then my left knee started hurting badly on the descents and I feared that I would have to stop. I got left behind on Helvellyn and I was very slow heading down to Grisedale tarn. I was hobbling, hurting and on my own. I felt low on energy but perhaps more from the cold than from the running.

Just beyond Fairfield I bumped into a lady who had fallen and was dazed. This was a section that I've never done before; she had but at first she didn't recognise anything. We soon got moving slowly but we were heading up when I hoped that we should be going down! Luckily she remembered the up, and I trusted the compass and I stayed with her until we both knew that we were not lost. As it happens we were both on the right route the whole time. By now I was shivering badly. Just checking the compass meant having to stop and get colder still. On the decent she passed me as I was hobbling and cursing. This section of the route took an hour longer than expected. I'd finished my energy drink and was  feeling very low. What made it worse was that there was no one else around. But I remembered that there was no one in sight either ahead or behind me as I had been ascending Fairfield.

I was about ready to give up at Ambleside when Jane appeared out of nowhere high up on the ridge above Sweden Crag with a fresh pair of  Z-Poles and a big smile. And just at this time the clouds parted to the south and we shared one of the classic Lake District views over Windermere. That did it for me, I was determined to go on.

First smile in 15 miles

The loss of 800 meters of altitude and a few slices of hot pizza at the food station in Ambleside warmed me up nicely. I soon felt strong again and I set out on the second half with a spring in my step. My knee was getting much better now that I was away from the rocky descents and I was soon able to run again.

The sun went down and it felt like I was on the home straight (albeit a 24 mile one). I knew the way alongside the lake and through the forests after walking this section on a family holiday at Easter. The sky was clear and a full moon rose over Windermere; a beautiful sight.

The lake was full too and at times I had to wade through it as the path skimmed the shore. Oddly this was a pleasure as it soothed my feet and I soon warmed up again from the constant effort. Jane met me three more times with encouragement and the miles flew by. 

Despite not having trained at night I was happy to be on my own in the dark. No one passed me in the second half and my energy levels were still high. I can't shake off my competitive spirit and it felt good to be steadily passing people. Even the incessant mud was not a big problem, with two poles I was able to stride confidently through it.  I think it’s fair to say that I ran (or at least jogged) everything that was runable in the last 20 miles of the race.

Two cups of soup and a sausage roll at the last aid station and I was off again into the moonlit mudfest; the bog was up to my knees in places.  When I finally hit the lanes I ran the last 2 miles down into Cartmel at 11 O’clock with a big grin on my face and half a bottle of energy drink left in my sack. 

It had been a wild adventure. I was down an hour and a half on my target time for the first half but the second half was as quick as I had expected (and nearly 2 miles longer!) and I finished in 15 hours; inside the top 20%. There was cheering from folks outside the pubs and I ran through the village like I was finishing a 5-miler. Such a great way to finish my first Lakeland Ultra after 8 months of pain and doubt.

Still smiling!

The organisation for the event was impeccable. The marshals were great, popping up in the most unexpected places; the aid stations were packed with good food and good cheer and the whole atmosphere was perfect.

On the day I estimate that I consumed between 2,000 and 3,000 calories (I'm not one for counting), mostly in the form of carbohydrates and mostly in the first half of the event. This compares to the 9,600 calories that Strava estimates that I used over 15 hours. I was able to deal with the mountainous first half with the aid of some glycogen and I was able to keep going strongly in the second half due to my long-term adaptation to fat-burning. This is not a proof of anything but the Train Low Race High strategy appears to have worked very well for me.

Thanks Jane, for putting me up to this challenge and seeing me through it!

Here is the Strava Route Profile