YOUR GUIDE TO LIVING WELL
TUESDAY, JULY 26, 2011
HEALTH POST How to kee as summ p your cool er sizzle s > PA G E 4
In for the chil l HAZY BUT NOT LAZY > PAG ? E3
THE MOST EFFECTIVE EXERCISE > PAG E 1 1
2 NEWS HEALTH BITES ...................................................... Jeanette Wang Jeanette.wang@scmp.com
Short and sweet It seems being petite isn’t such a bad thing, after all. University of Oxford researchers have found that tall folk may be more likely to develop cancer. Their report, published last week in The Lancet Oncology, said that among women, the risk of breast, ovarian, uterine and bowel cancer, leukaemia, or melanoma appears to go up about 16 per cent for every 10.2cm bump in stature – though a cause-and-effect was not proven. Nearly 1.3 million middleaged women were tracked for more than nine years on average between 1996 and 2001. An exception: smoking played a more pivotal role than height in influencing cancer risk. A review of the findings of 10 prior studies also found a similar association between height and cancer – in both men and women – across continents.
Flip out So...you’ve always wanted to jump on the toning shoe bandwagon, but could never find one that matched your summer outfits. Well, the FitFlop Lolla (HK$750) wedge cleverly conceals its muscle-activating foam midsole in raffia for a more fashionable touch. The midsole uses technology that is said to activate leg and buttock muscles more while you walk, and can help realign posture and reduce back/joint stress. Available at GigaSports and Marathon Sports.
Mean and not lean The impulsive, cynical, competitive or aggressive are more likely to be overweight, finds a new study by the US National Institute on Ageing. And the highly neurotic and less conscientious are likely to see their weight yo-yo. “Individuals with this constellation of traits tend to give in to temptation and lack the discipline to stay on track amid difficulties or frustration,” the researchers said. Data compiled over 50 years on nearly 2,000 generally healthy and higheducated people was examined to determine how personality traits might affect weight. People who scored in the top 10 per cent on impulsivity weighed an average of 10kg more than those in the bottom 10 per cent.
Too close for comfort You’re likely to be holding this paper about 40cm away from your eyes. If you were reading this on a webpage on your smartphone, however, you’ll probably only be 32cm away from the screen – a distance that could force your eyes to work harder than usual, according to new research published in Optometry and Vision Science. For texting, the study found that people on average held their phones about 36cm away. This can result in dry eye, discomfort and blurred vision after prolonged use, the study authors say.
Don’t worry, be happy Being optimistic can lower your risk of having a stroke, according to new research from the University of Michigan. More than 6,000 men and women aged over 50 did an optimism test and were tracked for two years; after adjusting for age, gender, lifestyle and cultural factors, the connection between positivity and reduced stroke risk was robust. Other studies have found that more optimistic people have a healthier immune system, faster wound healing and lower risk of heart disease, among other benefits. Researcher Eric Kim speculated that those who expect the best things in life take steps to promote their health.
APP OF THE WEEK
A great way to teach your children – but not your iPhone – how to swim ...................................................... Katie McGregor healthpost@scmp.com uSwim Free – to a point Rating 8/10 First things first – iPhones do not like water, so you need to do a bit of juggling to get the most out of this app without destroying your phone. That settled, this app does give you the chance to not only spend some quality time with your child, but also help teach him or her a lifesaving skill, along with improving long-term fitness and building selfesteem. It’s also a great social activity. Once your child can swim, you don’t need to be on Bondirescue alert mode when “relaxing” by the pool or at the beach. Developed by Aquatic Achievers, an Australian swim school near Brisbane that teaches more than 400,000 lessons – in person – a year, the app contains videos, lesson
plans and certificates to award your children when they complete a level. Level 1 is for babies as young as four months; level 2 covers safety fundamentals for children over the age of three, and level 3 focuses on stroke development for those the same age. At 11, my son is considerably older, but I knew his skill level was not what it should be. I had also forgotten how to teach the skills he needed – breathing smoothly during front crawl and kicking with extended legs. Skipping ahead to these lessons, we worked through the techniques and tips provided, and we have made good progress. The trickiest part is keeping your phone dry. Tightly sealed plastic “sandwich” bags work well, although you’ll have trouble hearing the lesson. If you can find one, an Overboard waterproof iPhone case would also work. However, I simply brushed up on the class just before hitting the water, and we managed just fine. You can also visit
www.uswim.com to print lesson plans, which can be laminated. The frustration with the app is that once you go past the free introductory modules, you start paying. For example, in Level 3 you get two free modules but need to pay 99 US cents for each of the remaining five modules. At US$4.95, this really is nothing to complain about, but it’s annoying that the app is advertised as “free” in the iTunes shop, and that the same lessons are provided free on the website. But for the convenience of taking the app along – especially on holiday – it’s easier to go with the flow.
> CONTACT US Culture Editor: Janelle Carrigan janelle.carrigan@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
MEDICAL 3 CASE HISTORY
Muddle hints at deeper trouble ......................................................
As a tailor, Marcus Ho, 56, spent 20 years deftly drafting and cutting paper patterns. Ho (name changed for patient confidentiality reasons) would take measurements and do quick calculations in his head. But then he started to make repeated mistakes at work. His boss started to get annoyed with him, and he became dismayed at his errors. Things got worse outside of work, too. Ho kept misplacing his possessions and had trouble differentiating between right and left. One day, he found that he could not navigate his way to his close friend’s house, which he had been visiting every month. Then he lost his way at a familiar MTR station. The situation took a turn for the worse when his boss – fed up with his deteriorating performance – fired him. Ho’s wife was furious at her husband for losing his job over what she saw as laziness. But Ho knew by now that his condition was no common muddle-headedness. Anxious, confused and feeling helpless, he turned to his family doctor for answers. The general practitioner then referred Ho to Dr K. W. Liu at the Prince of Wales Hospital’s department of medicine and therapeutics, who has a special interest in cognitive impairment. Liu and his team of experts saw that Ho had some signs of dementia but the symptoms were not typical of Alzheimer’s disease, which accounts for 34 per cent of young-onset dementia cases (those that start before 65 years of age). Ho was a non-drinker, so alcoholrelated causes were unlikely. To find the cause, Ho ran a battery of tests. First, Liu had Ho do cognitive assessment tests including the mini-mental state examination to determine the degree of cognitive impairment. Ho appeared to have lower than normal cognitive abilities for his age and educational background. He also had difficulty drawing a clock showing 10 minutes past 10 and drawing a cube, which was very unusual given his job as a
Illustration: Angela Ho
Eileen Aung-Thwin healthpost@scmp.com
tailor. It revealed Ho’s poor visualspatial ability in determining and navigating space. Liu investigated possible physical causes such as sleep apnoea, thyroid disorders, nutritional deficiencies, HIV/Aids and even venereal diseases such as syphilis, which could cause cognitive impairment. Ho did not suffer any of these conditions. Liu’s team used a CT scan to check for brain lesions but only found that the back part of Ho’s right brain had shrunk a little. It was not enough to explain the dementia.
Ho had always worked as a tailor, but he started to make mistakes while making calculations. This lost him his job
developing them. Males aged 40 and older are at risk, as are those with a family history of kidney stones and those who have had them before. You are also at a greater risk of developing another if you are prone to dehydration: if you live in a warm climate or if you sweat a lot and do not drink enough water. Certain foods that are high in calcium, uric acid, phosphate or oxalate may increase the risk of developing certain types of kidney stones. There are also different types of diseases and gastrointestinal operations that can alter the level of the minerals and salt levels in your blood and urine to make stone formation easier.
It could be useful to have a sample of excreted kidney stones analysed. This could help to identify the underlying cause of the stone formation. There are also other useful tests, such as a blood sample and 24-hour urine collection. These analyse the levels of different stoneforming minerals. Imaging tests can also be useful to identify different types of kidney stones. Treatment for small stones with minimal symptoms will not be invasive. Drinking water and taking pain relievers are usually adequate treatments. Large stones can cause bleeding, infection, obstruction and kidney damage. The larger stones usually
Next, an MRI scan and angiogram were used to check for any additional structural or vascular lesions, as 18 per cent of young-onset dementia cases are caused by a stroke. This can cause part of the brain to die. Ho’s scans came back clean. Next up was the single photon emission computed tomography (Spect) scan, which shows the amount of blood flow in the right and left sides of the brain. If there is a difference in the amount of blood flow in any part of the brain, it could help pinpoint the problem area.
Finally, Liu made some headway in the investigations. Ho’s Spect scan showed that his occipital lobe in the rear part of the brain had abnormally low blood flow, and there was a marked decrease in metabolic activity in that area. This part of the brain – the parietooccipital lobe – houses one’s visualspatial abilities and a problem in that area was consistent with the type of cognitive impairment that Ho suffered. But Liu had another important scan to conduct. In patients with Alzheimer’s disease, deposits of an abnormal protein called a beta-amyloid are often found in the brain. Scientists think that these deposits likely coincide with the areas that suffer impairment. Liu conducted a positron emission tomography (PET) scan, which showed that Ho had the deposits in the part of the brain that interprets what we see. Liu could finally put a name to Ho’s troubles – posterior cortical atrophy, a neurodegenerative disease that is considered an atypical form of Alzheimer’s disease. There is no cure, but drugs called cholinesterase inhibitors may slow the rate at which the body naturally destroys neurotransmitters that carry messages between his brain cells. They would hopefully retard the progress of the disease. When Liu broke the news to Ho, the patient heaved a sigh of relief. He had a diagnosis and a name to his suffering. He was also vindicated, as his inability to work lay in a physiological cause, and not a failing in his character or personal ethos. Ho was given the cholinesteraseinhibitor therapy, and it has helped improve his cognitive abilities for now. While Ho no longer works, Liu reports that he seems to have found a new lease on life and is pursuing new interests and taking exercise. He has gained muscles, and his wife reports that he seems much happier than before. With the knowledge that dementia will eventually exact a terrible toll as it slowly robs Ho of his cognitive and even physical abilities, he and his wife have chosen to seize the day and enjoy the lucid years while they last.
ASK THE DOCTORS DR KELVIN HO Q: I have had 12 kidney stones in the past five years. Every time I pass a stone, the doctor tells me to follow a special diet. But when I follow the diet, I still get kidney stones. Do you have any suggestions? A: Kidney stones are deposits that form inside kidneys. They are made of different minerals and salts such as calcium, oxalate, uric acid and phosphate. There are a number of causes of kidney stones. One common cause is that concentrated urine allows minerals to crystallise and stick together. It is possible to have recurrent kidney stones. There are many risk factors predisposing some people to
require surgical removal or use of ultrasound waves to break up the stone. A correct diagnosis of the underlying cause(s) and an attempt to minimise the predisposing
factors for the formation of kidney stones is important to prevent recurrence of stone formation. Dr Kelvin Ho, a specialist in nephrology, is a member of the Health Post advisory panel.
4 COVER STORY
Have an With the summer heat at its fiercest, finding relief away from your air-conditioned office is not always an easy task. Jeanette Wang provides her top tips for softening that sizzle
IT’S NOT THE HEAT... Heatstroke 101 At temperatures lower than 35 degrees Celsius, heatstroke is less likely. But high humidity, even with lower temperatures, can cause the condition, as well, says Dr Kenneth Tsang, a specialist in respiratory medicine. Watch for symptoms of heatstroke, such as headache, dizziness, disorientation, agitation or confusion, fatigue and hot, dry skin. There may also be a fast heartbeat and, sometimes, fainting.
1. Boost your qi Summer heat consumes this vital energy, but proper diet can help the body adapt to climatic changes, says Dr John Fung of Integrated Chinese Medicine Holding’s Herbal Medicine Clinic. For outdoor types, he suggests soups made with winter melon, mung bean, American ginseng, and lotus leaf, to clear body heat and promote body fluid and qi production. Those who mostly stay indoors may have difficulty sleeping, fatigue and poor appetite. Fung suggests drinking herbal tea to clear body heat and promote urination. Pungent foods like ginger and onion can help invigorate the lungs and facilitate sweating; lotus seed, common rush and bamboo leaf can clear heart fire and promote sleep; coix seed, hyacinth bean and euryale seed can invigorate the spleen and relieve fatigue. 2. Leave the lap clear With the weather outside frightful, it’s best to make conditions at home delightful. One way is to avoid using a laptop on your lap, as the heat from the machine transfers to your body. Research published in Fertility and Sterility found that laptops on laps can raise men’s testicle temperatures by up to 2.5 degrees Celcius within 10 to 15 minutes, which could affect sperm production and quality, and harm reproductive health. Place the laptop on a desk instead. 3. Laugh about it If you find yourself in a heated discussion, slow down. Think through your responses, and try using humour to defuse rage, relax a tense situation, and get a more balanced perspective, says Dr Jenny Tsang, a specialist in psychiatry and
Health Post advisory panel member. “Use humour to help face [the problems] more constructively,” she says. “But avoid using harsh, sarcastic humour – that’s just another form of unhealthy anger expression.” 4. Think mint Using minty products leaves a nice cooling sensation. Try Origins Peace of Mind on-the-spot relief with a stress-busting blend of basil, peppermint and eucalyptus, and Murad Shampoo for Fine Hair, which leaves a pleasant tingly sensation on the scalp. 5. Stay fit In a warm and humid endurance race, a well-trained person who is native to a cold climate may do better than a less-trained but well heat-acclimatised native to the tropics, says Dr Jason Lee, an adjunct assistant professor at the National University of Singapore and research scientist at DSO National Laboratories. For healthy adults aged under 65, the American College of Sports Medicine recommends doing moderately intense cardio 30 minutes a day, five days a week, and eight to 10 strength-training exercises (eight to 12 reps each exercise) twice a week. 6. Vent Run a fan and air conditioner (on low) simultaneously. “A running fan increases ventilation and creates a wind chill effect,” says Angus Wong, senior campaign officer for climate with WWF Hong Kong. The fan also helps evaporate sweat and moves heat away from the body. 7. Bluetify yourself Wear a blue top that’s made using natural materials like cotton, linen and silk, says June McLeod, founder
of colour therapy consultancy Colours of the Soul (www.coloursofthesoul.com) and author of a book of the same name. The ancient Greeks and Egyptians had used the colour to lower blood pressure. In the early 1950s, researchers had test subjects look at the colour blue – typically associated with calm and serenity – and produced the same result. “Indigo blue was used for many years to lower blood pressure and cool the body, yet over time we found the whole of the blue spectrum being just as effective,” says McLeod. 8. Breathe through your nose “This is something I learnt from performing yoga and the Buteyko Breathing Technique,” says Nathan Solia, director of Elite Personal Training Hong Kong, and Bootcamp. The technique emphasises nasal breathing, which restricts the amount of water expelled through an open mouth and allows one to stay hydrated for longer. 9. Freeze and spritz Dr Barbara Lam, a specialist in paediatrics
and Health Post advisory panel member, says: “When heading out, always take a bottle of water which has been semi-frozen in the refrigerator, so that it can remain cool for a longer time. Drink plenty of water and regularly spray the face, neck and shoulder with water after being outdoors.” 10. Schedule your workouts Try to exercise in the early morning – before the sun and humidity have taken effect – or in the evening, after sundown, advises Clinton Mackevicius, a fitness consultant and former Australian 1,500 metre champion. That said, if you’re
COVER STORY 5
ice day looking for an extra edge, he says “it has been scientifically proven that training in high humidity and heat is akin to altitude training”, which may lead to a faster performance in cooler climates. When training in the heat, keep training consistently, but modify the intensity by about 5 per cent to 10 per cent. 11. Relax Hot and bothered? Don’t sweat the small stuff. “Simple relaxation techniques, such as deep breathing and relaxing imagery, can help one to stay cool and calm during summer,” says Dr Jenny Tsang. Breathe deeply from the diaphragm
and not the chest, while slowly repeating a calm word or phrase such as “relax” or “take it easy”. Or try non-strenuous, slow yoga-like exercises to relax your muscles. 12. Green your roof According to the Architectural Services Department’s 2007 Study on Green Roof Application in Hong Kong, local studies have found that roof surface temperatures can be dramatically reduced by about 18 degrees Celsius to 26 degrees during August and by 10 to 15 degrees during sunny days in November and December. Researchers in Singapore have found that this can translate to cooler room temperatures, and a net annual energy saving of around 15 per cent for a five-storey commercial building. 13. Stick to the pure stuff Dr Donald Li, a specialist in family medicine and Health Post advisory panel member, says: “Mineral water and balanced electrolyte drinks are good. Strong teas and coffees which make the heart beat
and work harder are not advisable. Likewise, alcohol should be taken in moderate amounts. The ice cold beer chills and feels good, but the alcohol does not stop dehydration.” 14. Eat light and liquid Oily and heavy foods can make body temperature rise, so keep cool with light meals such as sandwiches, vegetables and fruit. Load up on hydrating foods such as cucumber (300ml fluids per piece), or a cup of mixed greens (265ml), tomato sauce (205ml), or diced watermelon or cantaloupe (150ml). 15. Fight mites House dust mites thrive in hot and humid conditions, and this can cause misery for allergy sufferers. Dr Adrian Wu, an allergy specialist and Health Post advisory panel member, recommends encasing mattresses, pillows, and duvets with mite-impermeable covers to reduce allergen exposure. Try installing HEPA filters in air conditioners to combat fine mite particles, and pack winter clothing in vacuum bags.
16. Shut the lights or change bulbs Only 10 per cent of the energy used by an incandescent bulb produces light. The rest is given off as heat, according to the World Wildlife Fund. Compact fluorescent light bulbs are an energy-saving alternative. Up to four times as efficient as regular bulbs, they produce about 70 per cent less heat and last up to 10 times as long. 17. Stand up to problems Not being able to find solutions to problems can be very frustrating and make your blood boil. But Dr Jenny Tsang says the best attitude is not to focus on finding solutions, but on how you can handle and face the problems. “Make a plan and monitor the progress along the way. Try your best, but don’t punish yourself if an answer doesn’t come right away,” she says. “If you can approach it with your best intentions and efforts, you will be less likely to lose patience and fall into all-or-nothing thinking, even if the problem does not get solved right away.”
18. Give the skinnies a break Tight and sleek may be fashion forward, but in the summer, it’s best to go for loose, billowy clothing, and those made of sweatwicking material to keep you cool and dry. Dr Donald Li says clothing should be permeable to allow ventilation, and offer some UV protection. Smooth cotton wear is preferred. Don’t forget to wear a wide-brimmed hat when you’re under the sun, says Dr Tinny Ho, a specialist in dermatology and Health Post advisory panel member. It not only reflects the sun’s rays, but also reduces your risk of skin cancer and minimises skin ageing. 19. Have a Slurpee The slushy drink has been proven through scientific tests to be a more effective cooling aid than iced water. Preliminary research by Dr Jason Lee and his team have shown that it may boost exercise performance significantly, by improving the body’s core temperature capacity.
Those who need to take care when it’s hot Heart disease patients The hot environment can put extra stress on the heart. This can lead to a worsening of underlying heart disease, such as increasing angina for coronary artery disease patients and a shortness of breath in heart failure patients, says Dr Adam Leung, a specialist in cardiology and Health Post advisory panel member. Those with heart failure cannot pump blood effectively to lower body temperature. Heart drugs don’t help, either: diuretics can cause worsening
dehydration, and beta-blockers can prevent the heart from beating fast enough to allow body cooling.
“Always listen to your body, and never push beyond what you’re capable of,” says Lee.
Very fit or unfit people Besides being poorer at thermoregulation, unfit people may also be less experienced at pacing, which is a recipe for disaster, says Dr Jason Lee, an adjunct assistant professor in physiology at the National University of Singapore. Conversely, the very fit might ignore internal cues to stop or slow down.
The young or elderly Dr Chua Siew Eng, a psychiatrist and Health Post advisory panel member, says: “Kids have larger surface area to volume, so they tend to absorb more heat. They also have a higher metabolic rate, so they generate more heat. The elderly are also more prone to less efficient thermoregulation.” Jeanette Wang
6 HEALTH
Shame about the face More adults are facing acne problems, and its usually caused by stress, writes Margaret Wee
L
et’s face it: while beauty is only skin deep, it’s undeniable that first impressions count. So it’s not surprising the Asia Pacific Digital Health Index earlier this year revealed that skin health was the top online discussion topic among 13- to 30-year-olds in Hong Kong, ahead of conditions such as cardiovascular disease and cancer. Acne is a leading concern. Though widely regarded as a teenage problem, it can happen at any age – half of all women and one in four men will suffer from it at some point in their adult lives. Administrative executive Rowena Cheung, 33, never had persistent acne as a teen. “I had the occasional breakout, but I could usually clear them with pimple creams. It was never so bad that I thought I would have to seek medical help,” she recalls. But after moving to a highly stressful job two years ago, she began developing full-blown adult acne. Stress triggers changes in hormones such as androgen and oestrogen, which are known respectively as male and female hormones but are found in both sexes. This hormonal imbalance leads to an over-secretion of sebum by the sebaceous, or oil glands, and clogs the skin’s pores. The build-up of dead skin material (keratin), the use of overly rich skincare products, or taking or discontinuing certain medications such as corticosteroids can also exacerbate the problem. Clogged pores attract bacteria, resulting in inflammation that manifests as blackheads, whiteheads, pimples or scaly red skin, typically on the face, upper chest and back. Serious bouts of inflammation may result in scarring. “For some adults, breakouts are a result of hypersensitivity or overproduction of androgens,” says Dr Kingsley Chan, dermatologist at the Quality HealthCare Dermatology and Laser Centre. “But an imbalance in both male and female hormones can also cause breakouts. For women, this can happen during pregnancy, perimenopause and menopause.” Diet is also often linked with acne – with dairy, nuts, chocolate and fried food the commonly named culprits – though dermatologists say the evidence is not strong. “I don’t find that there are universal triggers,” says Dr Tinny Ho, a dermatologist at Skincentral. “When topical and oral medications work pretty well for acne, I don’t like to place restrictions on diet, which may or may not help.” She adds: “Too much focus on diet will lead to the patient wasting time trying out different diets ... [They may] delay proper treatment, which
then leads to more scarring.” Persistent acne should be treated medically, says Chan, if over-thecounter products do not alleviate the problem, or if the patient is psychologically disturbed by it. “[You should also see a doctor if] the acne is painful, pus-filled, red and inflamed or if scarring occurs after the acne has gone,” he says. The first line of defence is topical comedolytics such as retinols, benzoyl peroxide, glycolic acid and salicyclic acid. These prevent pore clogging by drying sebum or making secretion less sticky. Dermatologists may also prescribe oral medication such as antibiotics (doxycycline or tetracycline) or oral contraceptive pills. The most severe cases are prescribed oral isotretinoin (known commercially as Roaccutane), a powerful form of vitamin A that reduces sebum production, prevents skin cell build-up and infection, and kills bacteria. “In my opinion, oral antibiotics should always be used in conjunction with topical comedolytics for acne. The oral antibiotics will provide rapid control while waiting for the topicals to work, which may take weeks. Ideally, topicals should provide long-term control. But taking oral antibiotics alone often ends up in relapses upon stopping,” says Ho. Microdermabrasion may also be used to remove the outer layer of dead skin cells using gentle friction, and treatments such as glycolic peels can help to unclog pores. Newer treatments include light therapies such as blue light and diode lasers, which penetrate deep into the skin to target bacteria, while improving skin texture and reducing the appearance of scars. “Blue light and laser have been scientifically shown to be effective treatments for acne. However, these treatments can be expensive and are often painful. Compared with the traditional oral and topical treatments, these therapies are usually less effective and visible results require repeated administration,” says Chan. As a result, doctors usually start with conventional medications and reserve newer therapies for patients who do not respond to or are not suitable for conventional treatment, such as pregnant women. Cheung tried countless pharmacy products and went for frequent facials to clear her skin. Nothing worked. Finally, she turned to a dermatologist, who prescribed antibiotics and, later, isotretinoin for several months. Although her skin is now smooth, it has come at a price. “My skin and eyes have become very dry since I started taking Roaccutane. I have to moisturise my face religiously and carry eye drops. But otherwise, it’s worth it,” she says. “No woman my age wants to go around with pimples all over her face.” healthpost@scmp.com
8 HEALTH FROM THE EXPERTS MIND MATTERS
Help comes with meeting of minds ......................................................
symptoms and deal with stressful situations or interpersonal conflict.
Eileen Aung-Thwin healthpost@scmp.com The differences between psychiatry and psychology can seem as inscrutable to the average person as the mysteries of the mind. When someone is mentally ill, is in emotional distress or has trouble coping with life, who is in the better position to help? Who are they? The Oxford English dictionary defines the suffix “-iatry” as “healing” whereas “-logy” means “subject of study”. So while both fields deal with the mind, psychiatry focuses on the medical treatment, while psychology deals with the science. Psychiatrists are medical doctors who can prescribe medication, and psychologists are not. According to Peter W. H. Lee, honorary professor in the psychiatry department at University of Hong Kong, psychiatry is a medical speciality concerned with the diagnosis and treatment of mental illnesses, similar to the way a cardiologist treats disorders of the heart. Psychologists are concerned with the human mind, behaviour and thought processes, such as how perception, memory, behaviour and habits are formed. What is their training? As medical doctors, psychiatrists must first obtain a medical degree or MBBS (bachelor of medicine, bachelor of surgery) before they undergo another six years of advanced training in the field of psychiatry. According to Dr Chan Kai-tai of the Hong Kong College of Psychiatrists, practising psychologists here must be a registered medical doctor as well as a registered specialist with the Medical Council, and must have obtained the Fellowship of the Hong Kong College of Psychiatrists as well as the Fellowship of the Hong Kong Academy of Medicine. Psychologists begin their training with an undergraduate degree in psychology followed by a
A broad goal of psychological treatment is to increase the well-being of the patient by teaching them skills and strategies to manage their symptoms and deal with stressful situations. Photo: Sam Tsang postgraduate master’s or a doctoral degree. A psychologist with an interest in clinical work (seeing patients) is likely to pursue a doctor of psychology degree, while those inclined towards research may obtain a doctor of philosophy degree. According to the Hong Kong Psychological Society’s website, while there is “no legal requirement for a person to register in order to practise as a psychologist in Hong Kong”, the society does maintain its own register of qualified practitioners. Its vice-chairwoman of external relations, Samantha Yung, says they are working with the government to explore statutory registration for the field. Tools of the trade According to Dr Roger Ho Chunman, a Hong Kong native who is an assistant professor in the department of psychological medicine at the National University
Mental disorders are best treated with pharmaceutical and psychological intervention PROFESSOR PETER LEE, HKU
of Singapore, psychiatrists usually make their diagnoses based on interviews with patients. They might order medical tests to check blood count, and kidney, liver or thyroid function tests to help with diagnosis. Psychiatrists primarily treat patients with psychotropic medication – drugs that affect mental activity, behaviour or perception – and psychotherapy. Sometimes, psychiatrists might also use electroconvulsive therapy in
severely ill patients as well as hypnosis or abreaction (a procedure that results in unrestrained expression of emotion). Psychologists, on the other hand, may use standardised assessments such as IQ tests or detailed memory assessments to help them understand the patient’s problems, says Winnie Yuen Wai-nei, clinical psychologist at the Whole Person Development Institute. Psychologists would primarily use different types of psychotherapy to help patients. Lee says they would try to get to the psychological root – say, the perception or belief system – of a disorder to help patients change their attitudes, to try changing their behaviour and to better cope with their problems. Yuen says a broad goal of psychological treatment is to increase the well-being of the patient by teaching them skills and strategies to manage their
Which one to see It appears that the answer depends on a variety of factors, including the severity of the condition and even patient preferences. A very severe mental disorder such as a psychosis would require treatment from a psychiatrist, because such illnesses respond best to medication, says Lee. Ho says that chronic mental illnesses such as schizophrenia, bipolar disorder, Alzheimer’s disease and chronic depression require long-term medication, which requires the care of a psychiatrist. The principle is similar to that of managing other chronic diseases such as diabetes. Even with less severe conditions, Ho says that psychiatrists often take the lead in diagnosing illnesses and managing patient care. Although psychiatrists may also be trained in a variety of psychotherapies, heavy caseloads in public hospitals often mean that psychiatrists do not have the time to do psychotherapy with patients as it is very labour- and time-intensive. Therefore, psychiatrists, especially those in the public sector, would refer patients to psychologists for psychotherapy. Psychiatrists and psychologists would then work in partnership. Some patients might choose to forgo psychotherapy and rely only on medication for financial or other reasons, in which case, they would consult only a psychiatrist, says Ho. Other patients might seek to manage their conditions without medication and, therefore, may work exclusively with a psychologist for psychotherapy. However, both Ho and Lee say many patients would benefit from a combination of psychiatric and psychological treatment. “Nowadays, our understanding is that a whole range of mental disorders are best treated with pharmaceutical and psychological intervention,” Lee says. “First, gain immediate relief from symptoms with medication, then find out how the condition came about and how to deal with it.”
HOW TO LONG-RUN RECOVERY
Go the distance? Wind down the right way ...................................................... Alison Johnson healthpost@scmp.com To help your body bounce back from distance running, listen to Dave McGillivray – race director for the Boston Marathon and a marathon runner himself – and his frequent running partner, Josh Nemzer. “Recovery from a long run begins immediately after you finish it,” McGillivray says. Keep moving After a run, “cool down” by trying to walk for at least five minutes instead of immediately coming to a full stop, which can
cause cramping, nausea or dizziness. Once you stop, do some light stretching to boost circulation to muscles.
healthy snacks and meals throughout the day.
Replenish fluids No matter how much you’ve had to drink on a run, you’ll need water or sports drinks as soon as possible after the finish to prevent dehydration. Stay away from soda, alcohol and caffeine.
Soak your legs in cold water The temperature will promote circulation to your leg muscles, helping the healing process (heat, on the other hand, can increase swelling and soreness). Take a bath or shower, douse your legs with water from a hose or use an ice pack.
Have a snack Fresh fruit, yogurt, pretzels or bagels are good choices for giving you the calories you need without being too heavy on the stomach. Eat as soon as you can after a run and have plenty of
Scale back on workouts Don’t push your pace or distance for a few days after a long run. Try some crosstraining – walk, swim or bike, for example – or short runs until your legs feel fresh again. McClatchy-Tribune
Good hydration matters as much after the race as during it. Photo: Felix Wong
DIET 9 Could the nutritional content of chia turn it into a replacement for dairy and eggs? Photo: Stanley Shin
Powerhouse ingredients punch up a sago dessert
NUTRITION CHIA
Super-seeds have what it takes to go the distance ...................................................... Monica Proctor healthpost@scmp.com Popularised by The New York Times best-seller Born to Run by Christopher McDougall, chia is the fuel of choice of the mysterious Tarahumara running tribe in Mexico. In the book, the world’s greatest distance runners call it “chia fresca” or what the author describes as “home-brewed Red Bull”, made from chia seeds mixed in water with sugar and lime. You may also fondly remember chia from the 1980s, when the sprouted seed was used in Chia Pets. So, the seed is making a comeback. Yolanda Che, store manager for Health Gate, an organic food store in Central, says: “The first batch of people started coming last year, mainly young professionals wanting to try something new. They said they had read about it and had heard it was great for an active lifestyle.” According to Che, sales have grown 43 per cent in the first half of this year compared with last year. “This year, customers are coming mainly for the nutritional content of chia and its functionality as an egg and dairy replacer,” she says. Carmen Lo, a certified dietitian, suggests that chia seeds can help protect against heart disease and be beneficial to the skin, hair and brain. They contain heart-healthy omega-3
and 6, some antioxidants such as myricetin, quercitin, eight essential amino acids, many minerals such as boron, calcium, copper, phosphorus, and vitamins such as A, B, C, D, E and K. Grovin Wong, store manager for Just Green, an organic convenience chain, says his clients include runners, kayakers, yoga teachers, vegetarians, people with diabetes or high cholesterol, and the elderly. Chia has a low glycaemic index, high fibre and good fat (or linolenic acid) content, which makes it suitable for diabetics, people wanting to control their cholesterol levels and certain digestive disorders. Wong says that the meal form of chia is also quite popular. Unlike flax – another super-seed high in omega-3, fibre and antioxidants – chia doesn’t really need grinding. “It can be used for making puddings,” he says. “Because of its neutral taste, it helps flavours stand out.” It’s also a baker’s dream and can be used in breads, muffins and biscuits, especially for those with restrictive diets such as the gluten-sensitive. Triathlete Chris Parry each morning eats chia seeds soaked overnight. “It’s good for endurance athletes because it holds water well,” he says. Historically, Aztec warriors in Mexico would use small amounts of chia seeds for sustained energy during conquests. “Today the craze
over superfoods from remote areas of the world has helped the chia seed trend,” says gourmet raw food chef Dr Wendy Yang. Chia seeds, native to Mexico and Guatemala, were cultivated by the Indians for centuries as a staple food also known as “running food”. Yang says they’re a good alternative to flax seeds, and she likes their gelatinous binding nature. The best way to take chia is raw, which preserves the high omega oil content, as it is sensitive to heat. “I also like to soak them in coconut water, which contains electrolytes, for 20 to 30 minutes in the morning or overnight,” says Yang. “Of course, they can also be used in salads, cereals and smoothies.” Chia, after about 30 minutes in water, will appear to be almost solid gelatin. This gel-forming reaction is due to the soluble fibre in chia. Research shows that this same gel-
forming phenomenon takes place in the stomach when food containing these gummy fibres, known as mucilage, are eaten. The gel that is formed in the stomach creates a physical barrier between carbohydrates and the digestive enzymes that break them down, thus slowing the conversion of carbohydrates into sugar. Some suggest that this “filling up effect” helps in weight loss. But more research is needed. Lo notes that chia seeds, like other herbs and spices, have not been evaluated by the US Food and Drug Administration, and there’s no evidence to show they can treat, heal or prevent any diseases. “Chia seeds are something good we can implement in our diet, but it is not a must,” she says. “It is important to eat a balanced diet to obtain good fats, high fibre, antioxidants, vitamins and minerals.”
...................................................... Monica Proctor healthpost@scmp.com Chia seeds are a type of ancient Central American “strength” food. They are said to have twice the protein of any other seed or grain, five times the calcium of milk, three times the antioxidant strength of blueberries, three times more iron than spinach, and an abundance of omega-3 and omega-6, which are important for heart and brain health. This sago recipe is a real natural treat. It boasts the superfoods chia and coconut, and can be enjoyed throughout the day. It is packed with protein, omega oils, calcium, iron, antioxidants and electrolytes. which rejuvenate and stimulate the immune and digestive systems. “This is an Asian-inspired dessert,” says Dr Wendy Yang, a gourmet raw food chef. “It is simple, requiring few ingredients, and healthy, especially if one uses a fresh coconut to make the cream.” To make fresh coconut cream: scoop out the flesh of a young fresh coconut. Place in a blender with coconut water. Process until smooth. Voilà! Each coconut will yield about ½ cup of coconut cream. Coconut chia sago Serves 2 4 tbsp chia seeds 1½ cup coconut water 1 cup fresh coconut cream Optional: ¼ tsp vanilla extract A pinch evaporated cane juice ½ cup ripe mango, finely chopped Soak the chia seeds in the coconut water for four hours in the fridge. Stir, making sure the seeds do not clump together. Divide the seeds into three parts and pour fresh coconut cream on top. Serve immediately. You may wish to use one of the options above for added flavour.
10 FITNESS SWEAT BURN BOOSTERS
Put a fire in your belly ...................................................... Melvin Hoe healthpost@scmp.com You want to shed some kilos, and you’ve spent a small fortune on gym memberships and diet products. But you’re still stuck with belly fat and your fitness levels aren’t improving. If this sounds familiar, you’re too preoccupied with zapping calories during a workout when you should be thinking about how to boost the afterburn. Bumping up your basal metabolic rate (BMR) can help the body scorch fat all day – even when relaxing in front of the television. BMR is essentially the “minimum rate at which your body uses energy at rest,” says Carmen Lo, a registered dietitian. It’s the bare amount of calories needed to keep you alive. It enables processes such as blood circulation, lung function, tissue repair and so on. Although it’s largely genetic, there are some components that can be altered. First, it’s directly proportional to lean body mass, says Kendy Tam, a registered dietitian and a Hong Kong Nutrition Association committee member. The more muscle you have, the higher your body’s fatburning ability. We lose muscle mass at a rate of about 0.5 per cent a year past the age of 25, so it pays to build and maintain that storehouse. The second component of metabolism – albeit a small percentage of it – is the thermic effect of food. When you eat, you not only consume calories, but also burn them, says Lo. This is because the body uses energy to digest, absorb and store the nutrients in food. The third, most easily influenced and largest element of metabolism, is physical activity. The more you do, the more calories you burn – even in hours following exercise. This year, researchers from the University of North Carolina and Appalachian State published results from their first study using a metabolic chamber – a US$1 million 2.4-metre by 3.3-metre space that volunteers stay in overnight. It found 10 men who exercised vigorously for 45 minutes in the morning continued to burn calories over the next 14 hours. It was proof that “afterburn” exists. Sadly, most of us don’t get enough activity and work in sedentary jobs. While it’s unlikely you can change your job (or your genes), simple tweaks to the way you eat and exercise can stoke your body’s natural fat-burning furnace. Eat frequently This isn’t a licence to pig out. Dr John Berardi, author of The Metabolism Advantage, recommends eating small meals at two to three hour intervals to boost your metabolic rate. This means splitting larger meals into smaller meals. In effect, you eat five to six meals a day. In addition, eating small meals serves to regulate your appetite, so you’ll be less likely to overeat. It may even help decrease LDL (that is, bad) cholesterol and stabilise blood sugar levels in healthy individuals, says Tam. Eat protein Include some form of protein – eggs, nuts, lean meat or cheese, for
Give fat the knock-out instance – in all your meals. “Fat requires the least energy to be broken down before it can be used by the body, whereas protein requires the most,” says Lo. That’s because protein contains nitrogen, which must be removed before the body can use it. This extra step requires more energy. In addition, protein builds fat-burning muscle, so it’s win-win. Do short, intense workouts For weight loss, that 10 kilometre run may actually be less effective than a few sets of 100 metre sprints, according to Ed Haynes, head of fitness and performance at New Territories-based Coastal Fitness. “Steady-state training tends to burn more calories during the session, but
interval training burns almost twice the amount of calories after the workout,” he says. While you shouldn’t rule out endurance sessions, interval training is timeefficient and adds variety, says Haynes. Justin Lee, a strength and conditioning specialist and fitness coach from Kitchee Sports Club in Tseung Kwan O, notes that an anaerobic workout releases more human growth hormone – a response to the micro-tears in muscle tissue after intense exercise – that burns fat and builds muscle. High-intensity exercise also increases the body’s post-exercise oxygen consumption (EPOC, or afterburn) boosting metabolism and fat burn even after the workout.
Try this workout recommended by Haynes. Head to a running track, sprint for 50 metres then walk for 10 metres. That’s one set. Aim for anything between five to 20 sets, depending on your goals and ability. Alternatively, you can try a pool workout by doing a freestyle sprint for one lap and immediately going for a recovery lap with the breaststroke. Rest 20 seconds before going for your next set. “Use your creativity to design and plan your own interval workout,” he says. Tweak your gym session The hard-and-fast principle of interval training applies to the gym as well. Forget about isolation exercises like bicep curls, tricep kickbacks and leg extensions.
Instead, focus on compound exercises like the bench press, deadlift, squat, pull-up or push-up, says Haynes. “If fat loss is your goal, you should do exercises that recruit more muscles,” he says. Keep your sets per exercise in the range of three to four, Lee recommends, as that is sufficient for muscle gain. A Greek study found that doing more sets didn’t provide a substantial increase in fat loss. Aim for around eight to 12 repetitions with a weight that is heavy enough to make it difficult for you to complete your last rep, says Lee. Limit your rest periods to about two to three minutes. This is the optimal level for the balance between recovery and intensity.
WELLBEING 11 PERSONAL BEST
Pardon me – what’s that exercise? ......................................................
What is the single most effective exercise? This question was put to me recently and, after thinking about it, I came to this conclusion: it depends. I say this because if you are looking for one exercise to do exclusively, you will get a different answer depending on who you ask. But if you want to know the single most effective exercise to do within a regular fitness regime of running or other activity-based exercises, then the answer is clear and resounding: the burpee. Before I explain why, let me first describe how to do the exercise. It should move smoothly from one position to the next, until the entire burpee is completed. From a standing position, get into the pressup position, bring your legs into your chest and then explode back, extending your legs back into the press-up position. Jump up, exploding into the air with arms reaching for the sky, before landing in the standing position. To make this exercise more effective, add a press-up before or after your squat thrust. This exercise should be done in sets with a rest between each set. That allows you to do a lot of them. I suggest doing 25 to start with, rest, then a set of 24, then 23, and so on, until you reach zero. Take your time. If done correctly, you should do 325 burpees in total. If done with progressively longer rests between each set, you can finish your total workout within 25 minutes. The reason I believe this to be the single best exercise is that it hits almost every major muscle group: the chest, biceps, lower back, core, quadriceps, glutes, calves and back. If performed as described above, you will get a workout for your heart, helping your endurance and cardiovascular system.
Illustration: Bay Leung
Davide Butson-Fiori healthpost@scmp.com
But this exercise could get boring if it is all you do. Perhaps you should try walking instead. A brisk walk for 30 minutes a day will keep you fit and help to reduce your risk of heart disease, hypertension and obesity, and reduce signs of depression. Walking has also been shown to help with weight control. A 15-year study found that middle-aged
You will get a workout for your heart, helping your endurance
women who walked for at least an hour a day maintained their weight over the decade. There have been studies on groups of people who live very long lives. The one thing they have in common is that they walk about 10,000 steps a day. So if you want to live longer and be healthier, take a walk to the shops, walk the dog
yourself and take the stairs instead of the lift or the escalator. Throw in some burpees to hit those muscles for toning, and there you have it: the single best exercise. Davide Butson-Fiori is the founder of Circuit25 (www.thecircuit25.com), which specialises in boot camp/outdoor group personal training
THE TASTE TEST GLUTEN-FREE COOKIES
Only if you’re a gluten for punishment ...................................................... Jeanette Wang jeanette.wang@scmp.com Glutino Gluten Free Dream Cookies HK$46 for 300g, Nature’s Village (Lyndhurst Terrace) At first bite, these tasted like Oreos – overpoweringly sweet, and seemingly naughty with a rich vanilla creme filling. But a few moments later the truth was revealed: the cookie was dry and powdery. I couldn’t take another bite. Verdict: A good compromise for the real stuff if you’re gluten-sensitive, but why not have a chocolate bar – which is naturally gluten-free – instead?
Pamela’s Pecan Shortbread HK$42 for 206g, Nature’s Village Pamela wasn’t joking when she said on the package that this is “mixed with lots of butter”. Eating this was like taking a bite right out of a butter slab. But it was a little too crumbly, and the pecans were really hard and unpalatable. Verdict: Not bad, but watch your teeth and its nutrition content – 130 calories and 8g fat per cookie.
Mi-Del Chocolate Chip Cookies HK$39 for 227g, Nature’s Village “No additives, no fancy packaging, just simple old-fashioned delicious,” the blurb on the wrapper claims. I disagree on all fronts except for the packaging. Apart from having too few chocolate chips, these bite-size cookies also had an artificial taste and texture. Verdict: If they were the last ones on earth, I’d give up eating chocolate chip cookies.