20110816 health post

YOUR GUIDE TO LIVING WELL

EAT AND DRINK YOUR WAY TO A NATURAL GLOW >PAGE 9

IN THE SHORT RUN: 25-MINUTE WORKOUT >PAGE 10

A new test and treatment for hepatitis B offer hope for Hong Kong’s many sufferers and carriers >PAGE 4

TUESDAY, AUGUST 16, 2011

2 NEWS HEALTH BITES

Smoking deadlier for women than men Women who smoke have a 25 per cent higher risk of developing heart disease and twice the risk of dying from lung cancer than men. The study in The Lancet gathered data from 75 studies, involving almost four million people, which compared the risk of heart disease between smokers and nonsmokers. The risk rose by two per cent for every year women smoked, compared to men. Lead researcher Rachel Huxley, an associate professor of epidemiology at the University of Minnesota, suspects there are biological differences in how women’s bodies react to cigarette smoke. “Women may absorb more carcinogens and other toxic agents in cigarettes,” she says. In addition, women may have different smoking habits from men.

......................................................

Jeanette Wang jeanette.wang@scmp.com The spice of longer life A study by researchers in Pennsylvania has found that eating a diet rich in spices may reduce the effects of highfat meals, which raise triglyceride levels in the blood, and in turn increase heart disease risk. “We found that adding spices to a high-fat meal reduced triglyceride response by about 30 per cent, compared to a similar meal with no spices,” says Sheila West, an associate professor of biobehavioural health. The spices included rosemary, oregano, cinnamon, turmeric, black pepper, cloves, garlic powder and paprika, and had as many antioxidants as 150ml of red wine or 40 grams of dark chocolate.

Get over it already Are you laying blame for a recent failure on someone or something else? Constant bitterness can make you ill. When harboured for a long time, bitterness may forecast patterns of biological dysregulation – a physiological impairment that can affect metabolism, immune response or organ function – and disease, says Carsten Wrosch from the Concordia University Department of Psychology. Find other ways to fulfil the goals, says Wrosch and co-author Jesse Renaud.

Or try softening your heart. Wrosch says, “Something else may be required to overcome the negative emotion – that something is forgiveness.”

Dirty money rubs off on you Traces of bisphenol A (BPA), a potentially toxic substance, has been found in paper money from 21 countries. Hong Kong currency was not among the 156 BPA-positive notes in the study published in Environmental Science & Technology. The highest levels were in notes from Brazil, the Czech Republic and Australia, and the lowest from the Philippines, Thailand and Vietnam. BPA mimics oestrogen, and may affect the brain, behaviour, and prostate gland in fetuses, infants and children. Human exposure through skin absorption, however, seems minor.

Hang in there with colleagues you like A positive relationship with co-workers has long-term health benefits, according to a study by Tel Aviv University researchers published in Health Psychology.

Over 20 years, they tracked 820 adults aged between 25 and 65, who worked an average of 8.8 hours daily in finance, health care and manufacturing. Subjects who reported low social support at work were 2.4 times more likely to die within the time of the study. To make offices friendlier, lead researcher Dr Sharon Toker suggests coffee corners where people can chat; informal staff outings; a virtual social network similar to Facebook; or a peer-assistance programme where employees can confidentially discuss stress and personal problems.

APP OF THE WEEK

Elderly tai chi experts guide you through the first steps of a lifelong journey ......................................................

Katie McGregor healthpost@scmp.com Tai Chi Trainer US$1.99 Rating 8/10 I believe that as a general rule, you only see older people doing tai chi because it takes that long to learn how to do it. But as Dr Paul Lam, creator of the Tai Chi Trainer app, says: “A journey of 1,000 miles starts with the first step.”

After the introductory video, the first training video on this app describes a short set of qigong movements. This puzzled me until I discovered, through a quick web search, that tai chi is technically a form of qigong.

Qigong is the philosophy and practise of movements and

breathing techniques to stimulate inner energy. So the first step was a mental one – to start visualising my chi, or inner energy.

Guided by Lam, I squinted at my iPhone screen and imagined a force resisting, while I slowly “pushed” my opened palms towards each other and then “pulled” them away from each other. I began to understand the slow deliberate movements and focus associated with tai chi.

The main video of 38 minutes covers movements for beginners with evocative names such as “parting the white horse’s mane”.

While many lower-priced apps tend to be basic, this video isn’t. Lam and his class of elder citizens demonstrate each move very slowly.

They repeat the movement, giving you the chance to follow. Lam gives alternative stances if you don’t have enough strength or flexibility.

Lam is a good teacher but the app is sometimes confusing. I understand the value of a live tai chi group with real people to follow. The benefit of this app is that you arrive at your first live tai chi session with a few moves under your belt. Tai chi is truly a journey of 1,000 miles. > 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 Clarification Dr Chan Kwok-ki is a master of science in sport and exercise medicine at the University of Bath. In last week’s issue, Chan advised on a cycling ailment in the Ask the Doctors column.

MEDICAL 3 CASE HISTORY

Open-ended result to surgery ......................................................

Stephen Yau, 54, was an avid swimmer who covered 2,500 metres in the pool every day. But he was also a chain smoker with a history of high cholesterol and hypertension, which put him at high risk for coronary artery disease. This condition causes 68 per cent of heart-related deaths in Hong Kong.

Yau (name changed for reasons of patient confidentiality) was concerned about his health, and a close friend urged him to see Dr Albert Leung Wai-suen, a cardiologist, for a thorough check-up.

Given Yau’s age, sex, lifestyle and medical history, Leung recommended a non-invasive CT coronary angiogram to assess the health of Yau’s arteries. This allowed Leung to take a good look at the state of Yau’s arteries with minimal risk.

First Yau was intravenously given an iodine-containing contrast to make his blood vessels show up clearly under the scanners before images were taken of his coronary arteries.

According to the scan results, Yau’s right coronary artery, which supplies oxygen-rich blood to the heart, was severely narrowed in two places. A hard substance called plaque, caused by the cholesterol, had adhered to the internal artery surface and caused his artery to narrow by 80 per cent in one place and 50 per cent in another. He had atherosclerosis, and the narrowed artery walls were reducing blood flow to his heart.

Yau was also in grave danger of a fatal heart attack. Lack of sleep, an angry outburst or even a mild illness – anything that stressed his body – could cause the plaque in the artery to rupture. If it did so and entered the blood stream, his body would form a blood clot in an effort to repair the damage caused by the ruptures. But the clot could completely block the artery instead.

Given that the plaque-narrowed

Illustration: Angela Ho

Eileen Aung-Thwin healthpost@scmp.com

sites were so close to the root of the artery, any blockage would most certainly cut off blood supply to Yau’s heart, starving it of oxygen and causing the heart muscle to stop working, Leung says.

Next Leung needed to look inside the lesions to confirm the severity of Yau’s condition using a conventional coronary angiogram.

Leung inserted a catheter into Yau’s radial artery on his right wrist and

Coronary artery disease ... causes 68 per cent of heart-related deaths in Hong Kong

worked it up to the affected coronary artery. Using a tiny probe in the catheter, Leung took cross-sectional images of the narrowed areas in the artery. The angiogram results confirmed the findings.

Since Leung had already inserted a catheter into Yau’s body, he swept into action to conduct an intervention in which he could repair the artery without the need for open heart surgery. Leung

intended to use a balloon to open up the constricted artery and put a stent in place to keep it open.

A stent is an expandable mesh tube, usually made of metal. It can be collapsed into a smaller diameter so it can travel easily up a blood vessel via a catheter. When the stent is in place at a narrowed site, a balloon under the stent is inflated so that the mesh tube opens up into the required diameter and expands the blood vessel. Leung likens the stent to scaffolding that supports the surrounding structure.

Doctors now get to choose from three types of stent – a bare metal stent, a drug-eluting stent that minimises the thickening of the blood vessel wall, and a bioengineered stent that is coated with antibodies that help the body build cells around the stent and incorporate it into the blood vessel wall.

Leung says each type of stent has its own trade-offs in terms of the risk of a re-narrowing of the blood vessel, and the amount of antiplatelet medication the patient needs to prevent clotting around the stent. The selection of treatment options depends on the patient’s situation. For instance, doctors often recommend elderly patients and those who need to undergo other surgery within a short period of time to implant the traditional bare metal stent or the bio-engineered stent, which requires only four weeks of double anti-platelet medication.

Those without such considerations could use the drug-eluting stent that requires a year or more of medication.

As Yau belonged to the latter group, the drug-eluting stent was successfully implanted, and he will need to be on a single anti-platelet medication for the rest of his life.

Although he narrowly escaped a potentially fatal health crisis, he still has work to do to protect his health.

Leung urged Yau to stop smoking and to carefully manage his high cholesterol levels and hypertension.

ASK THE DOCTORS DR TINNY HO Q: My skin has acne and I go for facials regularly for extraction. Is it good for me?

A: Although the basic culprit behind acne is clogged pores, extraction is not a smart way to solve the problem. It only clears the clogged pores temporarily and they often become clogged again a few days later. Moreover, extraction, if done aggressively or improperly, can cause permanent scarring.

Clogged pores are caused by several factors: excessive sebum production,

excessive dead skin build-up around the pores and blocking of pores by skincare products.

A dermatologist’s approach to acne is to prevent clogged pores from happening in the first place, as opposed to extraction, or simply drying up an acne spot after it appears. Topical medications such as retinols, salicylic acid, glycolic acid and azelaic acid normalise the turnover of dead skin, helping to keep pores clear. Oral isotretinoin (often known as Roaccutane/Accuatane/

Oratane/ Nimegen) and certain oral contraceptive pills may be used in more severe cases to reduce sebum production. It is also important to make sure skincare and make-up products are non-comedogenic (non-pore-clogging).

Steaming and massage are often involved in facials and may aggravate rosacea – a very common condition that often mimics or co-exists with acne.

Rosacea is basically caused by overactive blood vessels. The individual may notice one or more of the following: facial

flushing, redness of face, skin sensitivity, dilated pores, acne-like spots and thickened skin/ bumps on nose and chin.

The worsening of the condition is hastened by repeated stimulation of the blood vessels by using hot water to wash the face, steaming, sun exposure, alcohol and facial massage. So if you are not sure whether you have a tendency towards rosacea, it is best to avoid having facials.

Dr Tinny Ho, a specialist in dermatology, is on the Health Post advisory panel

4 COVER STORY

Hepatitis B is a silent killer because many carriers are unaware they even have it.

But new drugs and tests at least offer sufferers of the disease the hope of leading a healthy life, says Elaine Yau

Liver of no

return H

epatitis B, with half a million carriers in this city, is a disease that haunts the medical and patient community. One in four sufferers dies from liver cancer, cirrhosis or other complications.

Spread through contact with the blood or body fluids of an infected person – such as from an infected mother to her baby at or after birth, and through unprotected sex with a carrier – the disease lacks symptoms.

Coupled with drug resistance in some patients, prompt and effective treatment is difficult.

Thanks to the introduction of DNA testing by local hospitals this year, a ray of hope has been cast on the quest to increase survival rates.

According to Nancy Leung Waiyee, chairwoman of AsiaHep Hong Kong, a non-profit organisation that aims to raise awareness of the disease, the introduction of the hepatitis B viral (HBV) DNA test by seven public hospital clusters could help reduce the number of lives lost to liver cancer. This is the second biggest cause of cancer deaths for men in Hong Kong.

The test measures the amount of hepatitis B virus present in a millilitre, or a drop, of blood. A high figure means the virus is active and the carrier has a high risk of having liver damage. Doctors can then switch to another medicine, or add a second drug if needed. A low amount means the virus is not present, or is present in such low numbers that it cannot be detected, which indicates the medicine is effective.

“It’s a promising development,” says Leung. The test, which costs about HK$400, is done once every three to six months on patients taking hepatitis B medicine. From this year onwards, the Hospital Authority will fund a quota of about 36,000 such tests each year.

Leung says the DNA test is a big improvement on the conventional liver enzyme tests that are done to check the effectiveness of anti-viral treatment. “Enzyme tests are cheap,

COVER STORY 5

costing less than a hundred dollars.

But their readings can be irrational,” she explains.

Checking enzyme levels alone to see whether the virus is active or not can delay treatment, says Dr Vincent Leung King-sun, a consultant at United Christian Hospital. “The levels of HBV DNA will rise before liver enzymes do in the presence of drug resistance,” he says. “For a patient who develops drug resistance, the virus will replicate itself for a period of time.

“By the time the virus replication spirals out of control, the immune system will begin to attack liver cells.

Damaged cells will release enzymes into the blood, pushing up readings.

Some sufferers develop drug resistance after taking medicine for only a short time. By the time the enzyme readings shoot up, liver cells are already damaged.”

Nancy Leung says patients must take both enzyme and DNA tests so doctors can better monitor their condition.

There are 350 million hepatitis B carriers globally, and 75 per cent of them are Asians. Hong Kong Hep B Free Foundation and AsiaHep Hong Kong launched a series of activities on World Hepatitis Day (July 28).

These included free medical tests to raise awareness.

According to the foundation, there are 500,000 hepatitis B carriers in the city. The infected can develop

Hep-B • There are 500,000 Hepatitis B carriers in Hong Kong • 75 per cent of the 350 million global carriers are Asians

complications such as chronic hepatitis, encephalopathy (liver disease that causes confusion and excessive sleepiness), liver cancer and liver failure. A common complication – cirrhosis – can induce vomiting of blood and accumulation of fluid in the abdomen. This can predispose patients to potentially fatal peritonitis, where the membranes of the abdominal wall and organs get inflamed.

The spread of the disease in the city has fallen dramatically since 1988, when the government made it compulsory for newborn babies to be vaccinated. This reduced the newborn infection rate from about 10 per cent to 0.78 per cent. There were 70 to 80 new patients in 2009, or only one third of 1988’s figure. Babies who are vaccinated against the virus enjoy protection for life. But those who were born before 1988 are still at risk of contracting the virus.

Nancy Leung says more than 10 per cent of people aged over 40 suffer from chronic hepatitis B infection.

Sin Chun-leung, 48, who has been battling the disease for 15 years, was forced to quit his job in horticulture six months ago due to his worsening condition.

In June, a PET scan showed two patches of white shadow on his liver – signs that could point to initialstage liver cancer.

“There was no medicine to take when I was diagnosed with chronic hepatitis B 15 years ago. I was just advised to get more rest,” he says.

Sin joined a free clinical trial in Alice Ho Miu Ling Nethersole Hospital in 2003, but withdrew from the scheme a year later because his condition did not improve. He began to suffer severe complications, including peritonitis, last year. “My stomach filled with water,” he says.

“It was so painful I couldn’t walk. I feel like I am carrying a ticking time bomb. I am afraid that I won’t be able to wake up after falling asleep.”

While there’s no known cure for the disease, drugs are used to stop the progression of liver ailments.

My stomach filled with water. It was so painful that I couldn’t walk... I feel like I am carrying a ticking time bomb SIN CHUN-LEUNG, HEPATITIS B SUFFERER

Lamivudine, which costs about HK$700 a month, was the standard treatment in the past. But 50 to 70 per cent of patients who use it for five years develop a resistance to it, says Nancy Leung.

A more potent drug, Entecavir, has been available since 2006, with only 1.2 per cent of patients developing drug resistance after using it for six years. Initially costing a hefty HK$3,000 a month, the cost is now down to HK$1,300. But the monthly medical expenses still put a heavy financial burden on patients.

Housewife Tsang Sui-sum, who was diagnosed with cirrhosis induced by hepatitis B virus in 1997, spent HK$50,000 for weekly injections of the anti-viral drug Pegylated interferon alpha 2a in 2005. “In spite of the cost, a medical test in 2006 showed an increase in virus amount,” she says. She switched to Entecavir soon afterwards, and her last test in June showed a normal enzyme reading.

The availability of drugs and tests has given Tsang more hope of leading a healthy life. “I felt very worried when I first got my diagnosis.

I was afraid that I would succumb to the disease and be unable to take care of my daughters,” she says.

“The fact that I could take the DNA test regularly to help pre-empt a worsening of the condition made me feel relieved.”

Another new drug, Telbivudine,

was approved by the US Food and Drug Administration in 2008. It was introduced in local hospitals this year. It is an efficient drug in the fight against the disease, says Nancy Leung. Although 11per cent to 25 per cent of patients develop drug resistance after using it for two years, it is half the price of Entecavir.

So it is a much more affordable option – especially for patients in the public hospital system, of whom half have to bear the full cost of the drugs.

For all the new medical advances, Nancy Leung says prevention through vaccinations, regular checkups, blood tests and follow-ups are key to fighting the disease.

A recent survey by the Hong Kong Hep B Free Foundation indicated a widespread lack of understanding of the disease. Of 2,000 people surveyed, 60 per cent had not been vaccinated, or did not know whether they had been vaccinated or not.

Only 70 per cent thought the disease was preventable. Forty per cent wrongly believed that the disease had obvious symptoms, and 30 per cent mistakenly thought that eating dinner together, using the same towel, sharing utensils and shaking hands with the virus carrier would infect them.

Clerical worker Chung Manhong, who has cirrhosis induced by the hepatitis B virus, has kept his condition a secret from friends and colleagues for fear of being stigmatised. But what frightens him most is the insidious way the disease struck his family.

“We got ourselves tested shortly after the death of my grandma, who died of liver cancer in 2001,” he says.

“It turned out my mum, older brother and I are also afflicted with the virus. There were no symptoms at all. My grandma felt her stomach was a bit swollen. One month later, she died of liver cancer. That’s why having medical check-ups is important.” elaine.yau@scmp.com

AVOID OR CONTAIN Lifestyle advice for hepatitis B carriers and non-carriers For non-carriers: • Get a vaccination that involves three shots • Practice safe sex and use condoms • Do not share needles or personal grooming items like toothbrushes, razors and nail clippers that might be contaminated with blood • Make sure that all equipment used for body piercing and tattooing is sterile For carriers: • Have a diet that is low in greasy foods, sugar and red meat • Get regular medical check-ups to monitor the state of your liver • Avoid alcohol if there is inflammation of the liver • Strengthen immunity against diseases through getting regular exercise and adequate sleep

6 HEALTH FROM THE EXPERTS PALLIATIVE CARE

Helping patients go gently into the night ......................................................

Dr Raymond Lo, told to Margaret Wee healthpost@scmp.com Marriage was on the cards for a young man when he found out he had a type of advanced cancer that was incurable. He entered palliative care, where he and his fiancée received emotional support to cope with his diagnosis. The couple held a sad but heart-warming wedding a few weeks before he died.

Another case: a terminally ill cancer patient was reluctant to be transferred to the palliative care unit. A divorcée, she worried that no one would take care of her three estranged teenage daughters after she was gone. With support and counselling, she overcame her anxieties, and her daughters even reconciled with one another.

A third case: a 17-year-old boy with liver cancer complained of constant pain despite large amounts of opiates. After exploration and counselling, the palliative care team discovered that the source of his pain was not purely physical and was linked to his parents’ divorce.

The boy was yearning to see his father before he died. After some persuasion, the boy’s mother allowed the father access to the boy.

The boy’s pain and need for opiates decreased dramatically with his father’s visits.

These stories are examples of how palliative care can improve a patient’s life. Palliative care is an umbrella term referring to specialised area of health care that focuses on relieving and preventing the suffering of patients. It takes in the area of hospice care towards the end of a terminal illness. The focus is

In the end, it’s not the years in your life that count; it’s the life in your years ABRAHAM LINCOLN

then on easing the pain and stress of a terminal illness, while improving the quality of life for both the patient and his or her family.

Conditions that may require palliative and hospice care include cancer, heart disease, kidney failure and Alzheimer’s disease. Doctors, nurses, clinical psychologists, physiotherapists, occupational therapists, spiritual workers and volunteer “friends” typically make up a palliative care or hospice team.

Aside from relieving pain and suffering in the final days, palliative care provides the terminally ill with psychological and spiritual support to address feelings such as fear and loneliness, and concern about the well-being of family and friends after they have gone. Such support has tangible benefits. A 2010 study published in the New England Journal of Medicine found that cancer patients who received early palliative care enjoyed both better quality and quantity of life. They were also more likely to get the chance to express their preferences for their end-of-life care.

Culture, however, influences attitudes toward death. In Chinese culture, death and end-of-life issues are traditionally considered taboo.

However, palliative care workers

have found that many terminally ill Chinese patients are not afraid of death or talking about it. What they worry about is the process of dying – whether they will suffer any pain, lose their dignity or be subjected to unnecessary medical interventions.

They also do not want to be a burden to their family.

These feelings of anxiety are compounded by the tendency of many Chinese families to withhold bad news from the patient, for fear of demoralising or depressing them.

While their intentions are good, patients must be made aware of their prognoses eventually. Family members may not know how to break the news delicately, or can inadvertently cause more distress by hiding the truth, which may erode the patient’s trust. A palliative care or hospice team can help gently break the news when requested by the patient, while realigning expectations and hope.

Palliative care marries medicine with compassion. It enhances communication so that there is no collusion, but truth and honesty.

This enables patients and their family members to be open about their emotions, opinions and preferences, helping to make the process of dying more peaceful, dignified and graceful.

In lending themselves to such a process, family members often experience personal growth even as their loved one passes away.

As Abraham Lincoln said: “In the end, it’s not the years in your life that count; it’s the life in your years.”

Dr Raymond S. K. Lo is a geriatrics and palliative medicine specialist, and president of the Federation of Medical Societies of Hong Kong

READING LIST

Myth as good as a mile for best-selling paediatricians ......................................................

Jane Glenn Haas A lot of what we think we know about health turns out to be myth, and yet we pass these “truths” on for generations. Like eggs. We all know we shouldn’t eat a lot of eggs because people who eat them get high cholesterol and are more likely to get heart disease. Right?

Wrong, say paediatricians Aaron Carroll and Rachel Vreeman, both associated with the Children’s Health Services Research Group at Indiana University School of Medicine. The paediatricians are authors of the best-seller Don’t Swallow Your Gum! Their new book is Don’t Cross Your Eyes ...

They’ll Get Stuck That Way (St Martin’s Griffin).

These myths “are widely believed by people of all ages and passed on to children. We even hear from medical doctors who accept these adages as true,” Vreeman says.

You discuss 75 quirky health claims in your new book. Can you describe some?

What about the concept you should uncover a wound at night to let it air and heal? Most people who believe in this time-honoured tradition do so for a number of reasons. Some believe that airing a wound reduces the likelihood of infection. Others believe that drying the wound allows it to scab and will make it heal faster.

This is completely backward.

When you cut yourself or sustain a wound, your skin heals itself by growing new cells from the edges towards each other. These cells actually need a moist environment in which to grow and spread.

Another myth is that you should stretch before you exercise because

it will help you perform better. There is good scientific evidence that stretching does not reduce your chances of being injured during sports and exercise.

What about the idea that soap is the best way to clean your hands?

Washing your hands is key to avoiding a slew of illnesses, especially a cold. Avoiding cold weather, dressing warmly and making sure you dry your hair before heading outside will not keep you healthy. Neither vitamin C, nor echinacea, nor zinc will prevent you from catching a cold. None of these things works except washing your hands. That does work.

Even so, soap can become contaminated with bacteria. There are a few types of bugs that cause infection through spores that seem to come off better by hand-washing with soap and water. But hand sanitisers – the alcohol-based hand rubs – win overall.

Why do we keep repeating these myths?

I think the internet and access to information makes myths stick around more. There is a tremendous amount of information, but it’s hard to know the quality. It circulates more quickly in the age of e-mail.

Are all of these sayings false?

There are a few that turn out to be true. Aloe does help heal burns.

Acupuncture does work for some conditions. There are benefits to chicken soup. But we really hope people will question these myths.

Sometimes they are not true, and we don’t need to encourage them.

Instead, we need to focus on information that’s important, especially data we tell our children.

McClatchy-Tribune

8 HEALTH

WELLNESS SUMMER SLUMBER WOES

Hot between the sheets ......................................................

Edward Eveld Summertime is so relaxing. The season brings a casual schedule, warm weather that draws people outdoors late into the evening, and the promise of holiday respite and fun. After that comes the promise of a restful night’s sleep.

Except that a lot of people can’t actually get to sleep. Or you crash, but you can’t stay asleep.

“Summer is really fraught with sleep hazards,” psychologist and author Michael Breus says.

Right about now, some people are realising that the season isn’t the restful reprieve they’d envisioned.

Few things are more frustrating than summer sleep problems.

“It’s the heat,” says Sue Sykes Berry of Kansas City, Missouri, who has trouble sleeping when her house won’t cool down at night.

“Then there’s the dog and cat that want to sleep with me, even if it’s 38 degrees Celsius.”

She’s right about the heat, and there’s some good science to back her up. Humans tend to sleep best when the ambient temperature is 18 degrees to 24 degrees.

Hot nights aren’t alone in disrupting sleep. You are far from alone if the summer months bring more tossing and turning than rejuvenation.

Breus says the numbers go up in his sleep lab during the summer months.

Knowing the causes of summer sleep problems can help point to corrections, sleep experts say.

“Almost any change of the environment has some degree of effect on sleep quality,” says Damien Stevens, a physician who specialises in sleep medicine at the University of Kansas Hospital.

You can be a victim of disrupted sleep – the bane of high-quality sleep – without even knowing it, Stevens says. Unless you’re awake for several minutes, you won’t recall the disruption.

Much shorter wakeful periods can occur – three seconds each, for instance – but those are enough to reduce sleep quality.

Leading the list of troublemakers is the heat. People fall asleep as their body temperature falls, and they wake up in the morning when body temperature rises.

But all during the night, as the body goes into “rapid eye movement” sleep, it periodically loses the ability to sweat and shiver, says Ann Romaker, medical director of St Luke’s Health System’s Sleep Disorders Centres.

Body temperature starts to match the surrounding air temperature. The result can be many waking episodes.

You should never go to bed hungry, but you should be careful how much you ingest late MICHAEL BREUS, PSYCHOLOGIST

There’s evidence that people native to very hot climates are acclimated to sleeping in higher temperatures, Stevens says.

The rest of us aren’t that lucky. If your air conditioner is struggling, adding a fan can help. A breeze on the skin increases evaporation, cooling the body.

Breus, whose books are Good Night and The Sleep Doctor’s Diet Plan, says to pay attention to the “microclimate” in the bed. Even weighty sheets can lead to an increase in temperature.

Some people seek assistance with speciality products such as the Chillow, which is made from “thermoregulating” material that stays cool and is placed on top of the pillow. Sykes Berry plans to try one. As it is, she resorts to sleeping pills when it’s very hot.

“That’s not optimal, I know, but at least I get some sleep,” she says.

Besides temperature issues, a host of lifestyle factors contribute to summer sleeplessness.

In general, exercise and increased activity improve sleep quality. But their summer timing – which typically involves starting later, when temperatures are cooler – can be a sleep killer.

Many people report they have “pent-up energy” after exercise, and that delays restfulness, Stevens says.

So it’s a good idea to end workouts two hours before going to bed. Some people need four or even six hours between exercise and bedtime.

Summertime means crowded bar patios late at night and evening runs for ice cream, even during the week. Experts say the effects of food and alcohol on sleep are often misunderstood.

Alcohol acts as a sedative at first, helping people fall asleep. But later during the night, the effect is reversed, causing episodes of wakefulness and low-quality sleep.

Romaker recommends no alcohol in the two hours before going to bed.

Late eating can be a minus for weight maintenance, and it also can disturb sleep, especially for those with acid reflux problems. A good guideline is to stop eating two hours before going to bed, Romaker says.

“You should never go to bed

hungry,” Breus says, “but you should be careful how much you ingest late. The body was not meant to digest food lying down.”

Iced tea and coffee lovers often underestimate their daily caffeine intake, experts say. Although some people report that caffeine doesn’t keep them awake, it’s a stimulant that, for many people, lingers in the body for hours.

Anyone with sleep problems should try cutting out caffeine at 2pm, or even noon, and limiting total consumption. The caffeine equivalent of 2½ cups of coffee a day is a good maximum for many people, Breus says.

A holiday’s effect on sleep quality can cut both ways. It might give a person a more relaxing night’s rest. But different time zones, mattresses, schedules and food might do the opposite.

What other ways are there to combat sleep issues? Try a nap.

Although working people can rarely find time for it, an afternoon rest of 15 to 30 minutes might help counter the effects of summer sleep problems, Stevens says.

So, how about some properly cooled workplace nap centres?

Sykes Berry likes the idea. “I lived in Spain for three years, and they really honoured the siesta,” she says.

“It’s a hot climate. It’s a great plan.”

McClatchy-Tribune

DIET 9 NUTRITION GO WITH THE GLOW

be merry ......................................................

Dr Benita Perch healthpost@scmp.com Most of us are overtired and overworked. But these dietary tips will give a healthy glow.

1. Drink mineralised water Water is essential for cells and organs to function optimally. Most people are chronically dehydrated and should drink at least 30 millilitres per kilogram of body weight daily. Drinking enough water gives you more energy, and can help with weight management, as hunger is often confused with thirst.

Additionally, when dehydrated, the body adapts by reabsorbing water from the colon, causing constipation, which could lead to poor health and skin.

Tap water is full of toxins and heavy metals that do not benefit the body, and distilled water lacks minerals, so I recommend mineralised water.

2. Eat a rainbow of colours and at least five vegetable servings a day The more colourful the fruit or

vegetable, the more nutrients it has.

The orange colour of butternut squash, for example, is due to its high level of beta-carotene. Eat a variety of colours to get full benefits.

For healthy skin and hair, try these specific compounds: • Vitamin C helps in the formation of connective tissue.

• Biotin, a B vitamin found in peanuts and some fruit and vegetables, may improve hair growth.

• Silica, found in horsetail, alfalfa and many other fruit and vegetables, is an important component of collagen, the substance that gives skin its bounce.

3. Load up on vitamin D Vitamin D deficiency has been linked to many cancers, high blood pressure, heart disease, diabetes, depression, fibromyalgia, chronic muscle pain, bone loss and autoimmune diseases such as multiple sclerosis. Most people are deficient because they stay indoors, use sunblock and don’t get enough D from the diet. Get a blood test for 25-hydroxy vitamin D and take supplements if necessary. It can

often take six to 10 months to get back to optimal levels.

4. Get checked for food intolerances The common ones are dairy, gluten, wheat, eggs and soya beans. Such intolerances can play a key role in many ailments. Discovering and treating intolerances can help with weight loss and boost energy levels, prevent headaches and irritable bowel syndrome. It can improve mood and autoimmune conditions.

5. Ensure daily bowel movements It’s essential for health. The ideal is a bowel movement after every meal.

With a lack of movement, the body reabsorbs toxins, leading to headaches, fatigue and poor skin.

Simply drink enough water, eat enough fibre – found in wholegrains and vegetables – and exercise.

Magnesium deficiency can also cause slow bowel movements.

6. Drink green tea daily Green tea has antioxidant compounds and is naturally detoxifying. Much research has shown the benefits of antioxidants, particularly in cancer prevention.

7. Take fish oils daily There is a vast amount of research that shows the benefits of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), compounds found in fish oil. EPA and DHA have been found to help with everything from preventing cardiovascular disease by lowering lipid levels to helping combat depression. They work by keeping cell walls healthy, which helps maintain healthy skin.

8. Choose organic Eating organic food is important to prevent a high intake of insecticides, hormones or antibiotics. Often the least contaminated fruit or vegetables are those with an outer layer that can be removed before eating, such as bananas or avocados.

Also try to frequent local organic markets or use food-box deliveries.

9. Get at least seven to nine hours sleep a night Most people are sleep deprived.

They wake up exhausted and use coffee to keep going. A study carried out over 14 days at the University of Pennsylvania showed that subjects

who had eight hours of sleep rarely suffered attention lapses and showed no cognitive decline over the study. Those in the four-hour and six-hour sleep group showed a steady decline in the same areas and, frighteningly, at the end of the study, felt that the lack of sleep was not affecting them.

Go to bed early. An hour’s sleep before midnight is worth two after.

10. Exercise Exercise is well known for its cardiovascular, osteoporotic and other health benefits. It is detoxifying and improves the functioning of the organ systems.

Regular exercise also helps prevent anxiety and depression, as it releases endorphins, also known as happy hormones. It even helps reduce the severity and frequency of hot flushes in menopausal women.

Even a simple exercise programme helps, such as a daily 30-minute walk.

Dr Benita Perch is a naturopathic physician with Dr Susan Jamieson & Holistic Central Medical Practice. www.drsusanjamieson.com

RECIPE FOR HEALTH BREAKFAST SMOOTHIE

A berried treasure for health and vitality ......................................................

Dr Benita Perch healthpost@scmp.com This is a power smoothie that will boost your energy and spirits, pick you up in the morning and keep you going long into the day.

Protein is important in the morning as it helps stabilise blood sugar, which in turn helps the hormone-producing adrenal glands. Protein provides the building blocks for tissues

and organs, and good mood neurotransmitters.

Berries are filled with powerful antioxidants called polyphenols.

Avocados contain healthy oils and spirulina detoxifies, alkalises and is a great source of nutrients.

Finally, flax seed in ground form is great for protecting the female reproductive organs and the male prostrate gland from disease. It also helps keep cholesterol in a safe range, supports liver and gall bladder function, improves large bowel health, reverses fibrocystic

breast disease, possibly supports bone density and improves the texture and smoothness of skin.

Everything combined makes a great smoothie.

You’ll need: 240ml-350ml soy, rice, almond or oat milk 2-4 tablespoons whey, rice or soy protein powder ¼ cup fresh or frozen berries ¼ avocado 1-2 teaspoon spirulina 1-2 tablespoon ground flax seeds

10 FITNESS

[Cardio] Butt kicks

[Cardio] Step-ups

[1] Shoulder raise

[2] Standing row

[Cardio] Mountain climbers [3] Side plank with leg raise

[4] Bicep squat

[5] Lunge with a twist

[6] Ski jump

[7] Tricep reach

SWEAT FAST FITNESS

Short circuit your workout ......................................................

Jeanette Wang jeanette.wang@scmp.com Whether you’re an advanced athlete or just starting out on a fitness regime, Davide Butson-Fiori says 25 seconds is just the right duration for each high-intensity strength or resistance interval of a circuit training programme.

“Everyone can handle it,” says the founder of Circuit25, a group fitness training company. “The advanced might do 20 repetitions, while the beginner might do five.

But everyone gets a workout, and no one gets left behind.”

The following circuit is based on the C25 Minute Travel Workout created by Butson-Fiori for travellers to stay fit on the road.

All you need is a resistance band and some space; a park or even your hotel room will do.

In just 25 minutes, you’ll work all the major muscles in your body through a series of strength and resistance exercises alternated with cardio.

• 0 minutes (workout time elapsed) Warm up: Begin by warming up with five minutes of jogging or skipping to get blood circulating to the muscles.

• Five minutes Cardio: (50 seconds with 10-second rest) butt kicks – bring heels to butt, one at a time, focusing on quick kicks, not racing forward.

Strength: (two sets of 25 seconds with five-second rest between sets)

Shoulder raise [1] – Place band under feet and grab top of band with hands close together. Keeping your arms straight, lift parallel to the ground, then return slowly to the start position.

Cardio: step-ups – step up on an elevated platform with left leg, drive right knee up towards chest, then bring right leg back on ground.

Alternate stepping up with right leg.

• Eight minutes Strength: standing row [2] – Place band around a fixed object, such as a tree, at about waist level. Keeping your back straight, pull elbows straight back to your side, then slowly extend forward.

Cardio: mountain climbers – in pushup position, do high-knee jogging on the spot.

• 10 minutes Strength: side plank with leg raise [3] – From push-up position, shift weight to the left, balancing on just the left arm and leg. Hold. Keep core tight.

Cardio: butt-kicks • 12 minutes Strength: bicep squat [4] – Place band under feet, shoulder width apart.

Lower into squat position while doing a biceps curl. Keep chest up and back straight. Stand up, lowering arms.

Cardio: step-ups • 14 minutes Strength: lunge with a twist [5] – Lunge forward with left leg, ensuring the left knee is directly over the ankle. Twist the body to the right, then return to standing position.

Alternate with right leg (twist to left).

Cardio: mountain climbers • 16 minutes Strength: ski jump [6] – Get into squat position, as though sitting on a chair.

Swing arms forward as you jump up and ahead. Land with knees bent to absorb shock. Repeat.

Cardio: butt kicks • 18 minutes Strength: tricep reach [7] – Step on band and grab ends with both hands behind your back. Extend hands above head, then slowly return down towards your back.

Cardio: step-ups • 20 minutes Cool down: Five minutes of jogging and stretching.

WELLBEING 11 FIT & FAB

Change the cycle of life ......................................................

Jeanette Wang jeanette.wang@scmp.com In August 2008, Andrea Oschetti was riding high in the corporate world, frequently living out of a suitcase and, at 99kg, had a host of health problems, including a bad spine and liver.

Three years on, the 38-year-old Italian is two weeks into a 3,200kilometre expedition along the Silk Road for charity, living out of bicycle panniers and as fit as a fiddle.

“I did sport when I was teenager, but the corporate world’s routine of sitting all day, client lunches and dinners, and living in planes and hotels led me to be overweight,” says Oschetti, who moved to Hong Kong nine years ago. “I was unhappy with myself but somehow managed to live with this health failure despite the success in other parts of my life.”

He finally plucked up the courage to leave his management consulting career that August to follow his passions – food, photography and sport. The following year, he ran the New York City Marathon in a personal-best two hours, 57 minutes, one second, and continues to race, he says, as an excuse to travel around the world.

A private chef (www.cuoreprivate chef.com), photographer (www.theworldinaphoto.com) and triathlete-explorer, and with a postgraduate degree in business administration and a master’s degree in anthropology, Oschetti is indeed a man of many talents.

How did the career change help you?

The first thing I wanted to do was to get my health back. It came in a surprisingly pleasurable and easy way with a detox holiday in Kamalaya, Koh Samui, which focused on body cleansing rather than calorie intake. At the end of it I lost five kilograms, felt energetic and had an appetite for exercise.

My taste for food changed, and I was eating plenty, healthily and

without feeling deprived of the food I like.

I started running. Three months later, I ran my first half marathon. I loved it and a passion for racing developed. Three years on, I am a competitive triathlete and runner.

I’ve never had a bad back since, my liver functions are perfect, and I’m fit and look young.

People say: “Never trust a skinny chef”. What do you think?

I would say the contrary: trust only a skinny chef. Cooking with tonnes of butter, eating all you can and neglecting your health are just not cool any more. Eating healthily and palate enjoyment go hand in hand. I do love wine and food, and I always spend long hours at the dining table with my wife and friends. But I do not diet. Eating per se does not make you fat.

I choose the freshest ingredients, which are cooked with techniques that preserve nutrients and condiments, supporting the main taste rather than masking it. The only nos are prepackaged food, deep-fried food and soft drinks. I choose menus that are balanced, and I pair my nutrition with exercise I enjoy.

What’s your typical breakfast, lunch and dinner?

I start the day with a mug of peppermint tea and muesli mixed with home-squeezed apple or pear juice. I snack on fruits in the mid-morning, and for lunch I’d go for a small dish of spaghetti, simply cooked with fresh tomatoes and seafood or pesto. In the evening, I’d have a juicy piece of meat or fish with a handful of vegetables. Oh, and ice cream; I have a sweet tooth for ice cream and I find it is always the right moment for one.

Has your healthy lifestyle influenced the dishes in your private kitchen?

Absolutely. Calories are not born equal, and when I compose menus, I favour the good ones and cut off the bad ones. For example, do you know

TASTE TEST HUMMUS

Get the skinny on chick pea dip

Andrea Oschetti, chef, photographer and triathlete, in his private kitchen in Wong Chuk Hang. Photo: Jonathan Wong that all low-fat products have more sugar content than their full-fat counterparts? Fat is needed by the body and should account for at least 20 per cent of our food intake, while sugar is the number one abused food in the modern diet.

My chocolate truffle cake, considered by many to be the best they have eaten, has 10 per cent of the sugar content of a normal recipe.

What’s your secret to looking good?

When I started doing the things I enjoyed most, people told me I

looked younger. I think it is about passion, about putting your heart into what you do. I do a lot of sport because I like it, not because I have to stay in shape. When I run, I feel the same joy as children who run for no apparent reason; I do not suffer through it for the sake of looking better.

When you love something, it’s easy to sustain it. You eventually fall off commitments that are sacrifices.

Do you know that 85 per cent of people who diet do not experience weight loss in the long term?

Eden Houmous HK$75.50 for 250g, City’super This caught my eye with its whole chickpeas and pine nuts under a layer of olive oil. Thick, creamy and smooth, it had the strongest beany flavour and was the most filling of the three. Pity about the pine nuts, though – they were tender when they needed more bite.

Perhaps tossing in a handful of toasted pine nuts would help.

Verdict: if you like your hummus unadulterated, this is as wholesome as it gets.

Follow Oschetti on his Silk Road expedition at www.fioreblu.com, and donate to his cause, the Sports for Hope Foundation.

Pilpel Baba Hummous HK$68.50 for 200g, City’super Not sure whether to go for baba ganoush or hummus?

Have both, with this dip that blends chargrilled eggplant and fresh chickpeas. The baba ganoush gives it a light texture and adds a tangy taste dimension, which I felt accompanied crackers and pita bread better than crudités.

Verdict: a fusion of two legendary Middle Eastern dips, it’s a unique alternative.

......................................................

Jeanette Wang jeanette.wang@scmp.com

If you could cook for any four people, who would they be?

Mum, dad, my wife, Sandy, and myself. Family cooking is at the centre of Italian cuisine: it is not an exercise in impressing others, but an effective way to love your nearest and dearest and be loved. There is always love at the base of any Italian meal.

Emerald Valley Smoked Jalapeno & Garlic Hummus HK$59 for 340g, City’super I had this as a dip for home-made pita chips and raw baby carrots, as a spread in a ham sandwich, and as dressing for a corn and tuna salad. It was fabulous in every way.

The jalapeno adds a subtle kick to the versatile dip, which will satisfy spicy food lovers, but won’t overwhelm those with milder palates.

Verdict: flavourful, smooth and light, this was by far my favourite of the three.