YOUR GUIDE TO LIVING WELL
TUESDAY, AUGUST 23, 2011
HEALTH POST The rising trend of elective Caesarean section surgery is putting women at risk >PAGE 4
>PAGE 8
HILL RUNNING: HOW TO MAKE THE GRADIENT >PAGE 10
Illustration: Oliver Raw
HOUR OF KNEAD: BENEFITS OF DEEP TISSUE MASSAGE
Exit strategy
2 NEWS HEALTH BITES ...................................................... Jeanette Wang jeanette.wang@scmp.com
15 minutes means an extra three years Only about 20 per cent of adults on the mainland, in Japan and Taiwan do the recommended 30 minutes of daily exercise. But 15 minutes daily is enough to have significant health benefits, according to a study published in The Lancet. Taiwanese who did so extended their expected lifespan by three years compared to inactive people. Researchers at the National Health Research Institutes in Taiwan, who followed 416,175 Taiwanese over an average of eight years, also found that the risk of death from any cause decreased by 4 per cent for every additional 15 minutes of exercise up to 100 minutes a day. These findings were regardless of age, gender, health status, tobacco use, alcohol consumption or cardiovascular disease risk.
Smartphone addiction is not so smart Do you pick up your smartphone repeatedly to check your menu screen, news, e-mail, contacts and social applications? You may have what researchers, who collected data from Finland and the US, call a “checking habit”. “What concerns us here is that if your habitual response to, say, boredom, is that you pick up the phone to find interesting stimuli, you will be systematically distracted from the more important things happening around you,” says Antti Oulasvirta, senior researcher at the Helsinki Institute for Information Technology. “Habits … compromise the more conscious control that some situations require and studies are already starting to associate smartphone use to dire consequences like driving accidents and poor work-life balance.” This week, try giving your fingers and phone a break – it will do you good.
South Asians say they glow with good health Nearly eight in 10 South Asian residents in Hong Kong have good self-rated health with no or few physical illnesses, according to research by Professor Yan Yuk-yee of Baptist University’s geography department. In her pilot study of 125 Nepali, Pakistani and Indian adults – the first of its kind here – just 16 per cent rated their health as “fair” and 7.2 per cent as “poor” or “very poor”. Studies show that a lower self-health rating was associated with a higher mortality and morbidity risk, she says. Further, 72 per cent owned or were the sole tenant in private housing, which was linked with greater odds of having good self-rated health. More awareness of and attention to the health of South Asians, who make up about 0.7 per cent of Hong Kong’s population, is crucial, Yan says.
Healthy milk, healthy body Milk rehydrates active children better than sports drink or water, especially during the summer. This is because milk is a source of highquality protein, carbohydrates, calcium and electrolytes, says Brian Timmons, research director of the Child Health and Exercise Medicine Programme at Canada’s McMaster University. His study of eight to 10year-olds involved exercising in a climate chamber, then receiving a drink and being measured for hydration. Timmons says milk rehydrates effectively because it replaces sodium lost in sweat and helps the body retain fluid better, and its protein is essential for muscle development and growth.
Sniffing out disease Sniffer dogs could be used for the early detection of lung cancer, the most common cause of death from cancer worldwide. Research by experts from Germany’s Schillerhoehe Hospital published in the European Respiratory Journal found that trained dogs could sniff out cancer-linked volatile organic compounds in breath. Of 220 volunteers, including lung cancer patients, chronic obstructive pulmonary disease patients and healthy volunteers, the dogs successfully identified 71 of 100 samples with lung cancer. They also correctly detected 372 of 400 samples that did not have lung cancer. Study author Thorsten Walles says: “Our results confirm the presence of a stable marker for lung cancer … but we still need to precisely identify the compounds observed in the exhaled breath of patients.”
APP OF THE WEEK
It takes a plan to be fit, and this one includes videos for a full body workout ...................................................... Katie McGregor healthpost@scmp.com Men’s Health Training Pro Rating 8/10 Free If you like to have a plan – and never more so than when you are in the dog-eat-dog world of a gym – this app lets you enter any gym with a determined stride and work out looking like a professional. The routines are designed by fitness experts from Men’s Health, Britain’s best-selling men’s magazine. It’s easy to get started: the app comes pre-loaded with a sample workout with exercises for the whole body. The abs exercise is a rather smart routine with a medicine ball, which is described as being more effective than crunches. For the
arms, parallel-bar dips and standing barbell curls; for the back, nasty back raises using the gym’s back extension station; for the chest, lat pull-downs, recommended for those lacking the strength for a bodyweight pull-up, followed by a set or two of barbell bench presses and dumbbell inclined flyes. To finish, work the legs with barbell squats. If this order of exercises isn’t to your liking, the app allows you to customise your own workout. Each routine comes with a video and written instructions. Strangely, the app lacks guidance on how many sets or repetitions you should attempt, but you can estimate and set this up before you the start, adjusting it after each workout as your fitness improves. The target time is just half an hour for the sample workout; the app’s built-in timer ensures you won’t lose track. A
basic exercise history log helps you keep tabs on your progress by routine and also by the five key body parts. According to the iTunes description, this app comes with 16 exercise routines and two sample workouts – but it doesn’t. Apparently, you can also download more exercise routines for a price, but I couldn’t find these online. These inconsistencies are annoying, but, other than that, this is an excellent free app. > 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
...................................................... Wynnie Chan healthpost@scmp.com Seventeen-year-old Yin-ling had been withdrawn and sleeping at strange hours for six months, something her parents initially put down to exam stress. But when she accused her mother of poisoning her food, her mother realised something was wrong. “I just wanted to be by myself,” says Yin-ling (whose real name has been withheld for reasons of patient confidentiality). “My friends used to text me, but I couldn’t be bothered to reply. I could hear voices coming from the TV talking about me, even though it wasn’t on. I tried telling the voices to shut up, but they just got louder.” Initially, Yin-ling’s mother had been reluctant to discuss her daughter’s symptoms with anyone. She thought Yin-ling might just get better on her own. But on a drive home from work one evening, she listened to a radio programme where a doctor spoke about early psychosis. She was struck by the similarity of Yin-ling’s symptoms, and decided to seek medical help for her daughter’s condition. “Often, the first sign of psychosis is withdrawal from normal social activities and deterioration of function, such as a worsening of selfcare and exam results,” says Professor Sham Pak-chung of the University of Hong Kong’s psychiatry department. Every year in Hong Kong, about 700 people between the ages of 15 and 25 develop symptoms of early psychosis, which include disorganised thinking with jumbled up ideas, irrational and often bizarre beliefs (delusions), and hearing voices when nobody is around (auditory hallucinations). The symptoms can be quite difficult for others to comprehend. “Some sufferers become convinced that they are under the persecution or surveillance of others. Such ideas are sometimes elaborated into a complex system of beliefs. Equally difficult to understand is the sense that their thoughts are somehow
Illustration: Angela Ho
Long road to peace of mind being broadcast to others, or conversely that others’ thoughts are being inserted into their minds,” Sham says. Those with psychosis can also suffer from a wide range of altered mood states, including depression, elation, the inability to feel emotions and having inappropriate emotional responses, such as laughing in a grave situation. This pattern of mental symptoms can result from many brain diseases and conditions. “What these conditions have in common is that they increase the reactivity of the brain chemical dopamine, which is important for controlling alertness and evaluating the significance of situations,” Sham says. “Hyperreactivity to dopamine causes a person to be overly anxious and to misinterpret trivial situations as having undue significance.” This hyper-reactivity could be caused by the use of drugs such as amphetamine and ketamine, or
There is widespread ignorance, fear and prejudice in society against psychosis PROFESSOR ERIC CHEN
brain damage due to long-term overuse of alcohol or cannabis. Most cases, however, do not have a clearcut cause, but result from a combination of biological and psycho-sociological factors. Biological factors include genetic predisposition and maternal illnesses during pregnancy such as infections and malnutrition. Another high-risk group is immigrants who grow up in an alien culture that they find difficult to understand.
One of biggest obstacles in identifying and treating psychosis sufferers is that they are often deeply immersed in their vivid mental experiences, and ignorant that these experiences are a result of mental illness. Consequently, few sufferers seek medical help, and many are reluctant to accept treatment. “The symptoms of psychosis often come on very gradually over a number of months or even years, and can be very difficult for family
This is not post-natal depression but part of a response or adjustment to the stresses in life. In general, with the support of the husband, family members and close friends, the wife is able to share her feelings and fears. Once help is available, she is more able to cope with the situation and recover from the negative mood. However, if the situation has not improved, special help from the medical or para-medical profession is warranted. There are certain medical conditions worth excluding. For instance, transient hypothyroidism is common in the early
post-partum weeks. It is thought to be a common cause of “post-partum blues”. Anaemia can occur after delivery, especially in cases of Caesarean section or difficult vaginal delivery with significant blood loss. A doctor can do a clinical examination and simple blood tests to identify these conditions and give appropriate treatment. Infant feeding problems including breast engorgement and frequent crying with infant colic can be frustrating and demoralising for the mother. An experienced midwife, lactation consultant, paediatrician or even a close
members or friends to pick up [on] at first,” says Professor Eric Chen Yuhai, also from HKU’s psychiatry department, who is a pioneer of the early psychosis clinical service in Hong Kong. “To make matters worse, there is widespread ignorance, fear and prejudice in society against psychosis. This means that sufferers and their families are often reluctant to accept or even consider the possibility of psychotic illness.”
The sad consequence is that there is often a long delay between onset and treatment. According to Chen, a study of patients in Hong Kong who developed psychosis for the first time found that half of the patients did not seek help until six months after their symptoms had surfaced, and as many as one-third did not do so for up to a year. Studies from other countries also found an average delay of one to two years before treatment was received. This is unfortunate because early detection and intensive treatment through a multidisciplinary approach involving doctors, nurses, social workers and psychologists are usually effective in alleviating symptoms and improving function. “If psychosis isn’t tackled early, it can easily develop into more serious mental illnesses. Studies have shown that psychosis can lead to a several-fold increase in suicide risk,” Chen says. An intervention programme called Early Assessment Service for Young people with Psychosis (Easy) was set up by the Hospital Authority in 2001. The public can ring the hotline at 2928 3283 to refer cases to the Easy team, which conducts an initial assessment on the phone and, if necessary, schedules an appointment with a doctor within seven days. Yin-ling was diagnosed with an early stage of psychosis, and her symptoms have been controlled by a low-dose anti-psychosis drug and cognitive therapy. A year on, she is still on medication and attends regular follow-ups at a hospital outpatient clinic. “I go to a support group now, and I get to meet other people who are like me,” says Yin-ling. “The sharing is really useful; it shows that I am not alone and that I can keep the symptoms under control and get on with my life.” Yin-ling thinks she no longer needs medication, but the results of a study led by Chen, published in the British Medical Journal last year, showed that patients who discontinued medication were 30 per cent more likely to relapse than those who did not.
ASK THE DOCTORS DR LESLIE LO Q: It has been three weeks since I gave birth, and today I started to feel sad and cried a bit about missing being pregnant. I miss my belly and the feelings of my baby being inside of me. Is this post-natal depression or just something normal? A: Feeling down, exhausted, inadequate or teary is a common occurrence in the early post-partum period. The job of looking after a newborn baby and the commitment to breastfeed on demand is very taxing. When the mother becomes exhausted, physically and mentally, negative moods and feelings can set in.
friend who is experienced in child rearing and breastfeeding can be of great help in such situations. A family doctor or clinical psychologist can be called upon to counsel, reassure and give psychological support to the mother. Only when depressive symptoms (namely loss of appetite, insomnia, suicidal thoughts, etc) occur would postnatal depression be suspected and warrant psychiatric referral. Dr Leslie Lo, a specialist in obstetrics and gynaecology, is on the Health Post advisory panel.
4 COVER STORY
More women are choosing to give birth by Caesarean section, dramatically increasing their risk of severe complications or even death, writes Monica Proctor
Knife’s edge
COVER STORY 5
T
o avoid damage to her pelvic floor muscles and the risk of incontinence, Panda Chu decided to have her first child delivered by Caesarean section. “I was more interested in the product than the process,” the physiotherapist says. “But I can understand other women’s sense of achievement in wanting to go through labour.” These days, both mother and doctor are able to propose elective Caesarean sections, even without medical indications. “At the time, my obstetrician asked if I wanted more than two children and whether the second one would be within a year of the first,” Chu says. “Since my answer was no to both, she was fine with my decision.” A “yes” would have increased the risks and complications associated with Caesarean sections. As it stands, the risk of maternal death or severe complications increases by up to 14 times when Caesarean sections are done without medical reason, according to a World Health Organisation (WHO) study last year. For every 10 women in Hong Kong who give birth, four have Caesarean sections, a rate nearly double that of other developed countries. In private hospitals, the rate rises to six in 10, the study says. Caesarean section delivery accounted for 16.6 per cent of all Hong Kong births in 1987, but 27.4 per cent in 1999. This rising trend is a global one that is causing concern. Suthit Khunpradit, a researcher from the department of obstetrics and gynaecology at Lamphun Hospital in Thailand, points out that while reported rates vary, studies have shown that, in England, Scotland, Norway, Finland, Sweden and Denmark, Caesarean section rates rose from between 4 per cent and 5 per cent in 1970 to between 20 per cent and 22 per cent in 2001. Some medical experts are critical of patients and their doctors opting for the procedure without medical reason. In a recent HealthDay report, Dr Alan Fleischman, medical director of the March of Dimes, a US non-profit body aimed at improving the health of mothers and babies, said: “Caesarean sections should be done at the right time and for the right reason … convenience for the woman or her doctor isn’t the right reason.” According to the United States National Library of Medicine, the operation has existed since ancient
times and originated from attempts to save the soul, if not the life, of a fetus whose mother was dead or dying. Efforts to save the mother bore fruit in the 19th century when systematic improvement of Caesarean section techniques eventually led to lower mortality for women and their babies. Planned, or elective, Caesarean sections may be due to medical reasons, such as small birth canal, abnormal position of the baby, placenta previa (placenta too close to the cervix), medical conditions (such as heart problems or diabetes), or small or premature babies. Women over the age of 35 are more likely to need the surgery as they are at a greater risk of certain complications during pregnancy. In a study published in July in Obstetrics & Gynecology, Yale School of Medicine researchers analysed indications for Caesarean delivery on prospectively collected data from more than 30,000 births at Yale-New Haven Hospital from 2003 to 2009. “We found that more objective reasons, such as the baby being in a breech position and placenta previa, remained stable over time, while less objective reasons, such as slow progress in labour and concerns about fetal heart tracings, contributed large proportions – greater than 50 per cent – to the increasing primary Caesarean delivery rate,” says lead researcher Dr Jessica Illuzzi of the department of obstetrics, gynaecology and reproductive sciences. In Hong Kong, one news report cited a doctor saying that at least a quarter of pregnant women request the operation for non-medical reasons, of which about 70 to 80 per cent are due to fung shui. Actress Michelle Reis, for example, scheduled the birth of her first son on February 8 this year, which was said to be an auspicious date on the Chinese lunar calendar. A 2007 study by Dr Selina Pang
The delivery mode should be a free choice for the mother, as long as the doctor explains the pros and cons DR LESLIE LO, OBSTETRICIAN
Man-wah and her team from Chinese University’s department of obstetrics and gynaecology, Prince of Wales Hospital, found that women reported “safety of the baby”, “fear of vaginal birth”, and “pain associated with vaginal birth” as important reasons for choosing an elective Caesarean section. “Because of the increasing emphasis on patients’ participation in medical decisions in recent years, women’s demands for Caesarean sections have become a main reason for the abdominal route of delivery,” says the study published in the Hong Kong Medical Journal. The increasing strain on obstetric services, in large part due to mainland mothers wanting to give birth in this city, is not helping either. Births are tightly packed to deal with the demand, with the Caesarean section the route of choice since it guarantees deliveries run on schedule, and controls the time and cost of the mother’s stay. Some operations are booked for as early as 36 weeks for convenience. “Some of my patients rather go with an elective Caesarean section to avoid the risk of an emergency Caesarean section and be hit with even higher fees,” says Dr William So, a local obstetrician who specialises in fertility treatments. While going under the knife can save the life of both the mother and the unborn child, a Caesarean section is still major abdominal surgery and, like any operation, carries risks. These include maternal infections, haemorrhage, other organ injury, anaesthetic complications and psychological complications. “In some settings, maternal mortality associated with Caesarean section has been reported to be two to four times greater than that associated with
Birth choices
70-80
per cent of requests in Hong Kong for Caesarean section deliveries are motivated by fung shui considerations
vaginal birth,” says Suthit, whose study, “Non-clinical interventions for reducing unnecessary Caesarean section”, was published in the Cochrane Database of Systematic Reviews last month. In addition, babies born before term can also experience problems, such as “wet lungs” syndrome (fluid retained in the lungs), and are four to seven times more at risk of respiratory problems as babies born naturally. Death is also possible. Fleischman points out in the HealthDay report that women need to understand the importance of going full term. “Fetuses are not just getting fatter in the last month,” he says. “Their lungs and brains and kidneys are developing.” In her 2007 report, Pang says that changing attitudes towards Caesarean sections among staff and patients could be adding to the trend. “It has been shown that a significant number of obstetricians would agree to perform an elective Caesarean section without an obstetrical indication upon maternal request,” she writes. Clearly, there needs to be more scrutiny of women planning to have a Caesarean section, and doctors and hospitals.
Six in every 10 babies born in Hong Kong’s private hospitals are delivered by Caesarean section, according to a WHO study last year
In Britain, for example, the National Collaborating Centre for Women’s and Children’s Health has created clear clinical guidelines for Caesarean sections. Firstly, when considering the operation, its benefits and risks compared with vaginal birth, specific to the woman, should be discussed. Secondly, maternal request is not on its own an indication for the operation and specific reasons for the request should be explored, discussed and recorded. When an identifiable reason is absent, the overall benefits and risks of a Caesarean section should be discussed and recorded. According to Suthit’s findings, the use of Caesarean sections can be reduced by requiring not one, but two doctors to agree on the best way to deliver a baby; providing internal feedback to doctors on the number of operations performed; and seeking support from local opinion leaders. A previous Caesarean section delivery convinced Hong Kong resident Grace Southergill to have her second child by Caesarean section – although she admits convenience, a fear of pain and an auspicious date also played a role. “The first time round, my doctor advised a Caesarean section at 37 weeks because the baby was too big and I had gestational diabetes,” says the stay-at-home mum. Looking back, Southergill, who had wanted a natural delivery, wishes she had better researched her doctor and waited longer before having the first Caesarean section. “I am still in pain from my second delivery. The surgery took really long, largely in part because of the scarring from my first Caesarean section.” Dr Leslie Lo Siu-fai, a local obstetrician, believes that mothers seeking to have a natural birth often pick an obstetrician by word of mouth. He notes that doctors performing more than 20 to 30 births a month may have less time for vaginal births, and that doctors’ fees for either mode of delivery should be the same so that there is no financial incentive to push for medical intervention. Getting a doctor’s delivery statistics could help – a useful indicator would be the success rate of patients wanting a natural delivery. “The delivery mode should be a free choice for the mother, as long as the doctor explains the pros and cons in either situation,” says Lo. healthpost@scmp.com
6 HEALTH TRADITIONAL CHINESE MEDICINE
Yin, yang and why hot food can cool ...................................................... Eileen Aung-Thwin healthpost@scmp.com Suffering from indigestion? Instead of popping a pill, chewing on a chalky tablet or chugging a viscous liquid, wouldn’t you rather tuck into a dish of delicious sliced radish fried with garlic paste or sip a steaming hot cup of fragrant ginger tea? In traditional Chinese medicine, all foods can have therapeutic benefits for the body, and the lines between an edible item’s nutritional and medicinal properties are often blurred. Knowing how to harness food’s medicinal powers can yield significant health dividends. Professor Lin Zhixiu of Chinese University’s School of Chinese Medicine gives credit for Hongkongers’ relative longevity and good health in part to a general understanding among the Chinese population of how to use food therapeutically. “Hongkongers really pay attention to the foods they eat and often incorporate Chinese herbs into their diet,” he says. “This practice helps strengthen their immune system, ward off minor infections and strengthen their qi and digestive system.” Michele Ong, 37, is a believer in the therapeutic power of food. “My grandmother and mother often made nourishing soups for me when I was feeling tired and prepared cooling teas when the weather was too hot,” she says. “They also told me what food to avoid when I had a bit of a sore throat or if I had to stay up late to study or work. “As a result, I rarely fell sick, even as a child.” Food therapy is a particularly useful approach for the very young, very old, and pregnant or lactating women who may not tolerate medicine or other therapies as well as others, says Dr Dang Yi, associate director of the master’s programme in personal health management (Chinese medicine) at Baptist University’s School of Chinese Medicine. She adds that those who are recovering from an illness, suffer from chronic conditions or have subclinical health problems – that is, are not diagnosed with an illness but do not feel well – benefit greatly from a diet tailored
according to the therapeutic properties of food. The medicinal function of food was documented at least two millennia ago in Chinese medical classics such as the Yellow Emperor’s Internal Classic and the Divine Farmer’s Materia Medica, Lin says. Instead of focusing on the nutritional value of food, Chinese medicine characterises food as having four natures (hot, warm, cool and cold) and five flavours (sweet, salty, sour, bitter and pungent). The hot or cool nature of food does not refer to the temperature of the food but to the type of energy that it generates within the body after consumption. For instance, green tea may be drunk hot, but the body feels cool afterwards, so it is considered a cool beverage. Mutton generates a great deal of heat energy within the body after consumption and hence is considered a hot food.
After drinking the tea, their lips return to a normal colour, and they feel more comfortable STEPHANIE LAU
Each of the five flavours of food is thought to have a specific effect on the body. They correspond with the five organ systems (liver/ gallbladder, heart/small intestine, spleen/stomach, lung/large intestine and kidney/bladder), and help each system to function better. The application of food’s medicinal properties is then guided by foundational theories in Chinese medicine such as yin/yang and the five element theory, all with the aim of achieving balance and, therefore, health. Perhaps the easiest of these theories to grasp is that of yin and yang, where yin embodies qualities such as passivity, cold, dark and the feminine while activity, heat, light and masculine qualities characterise yang. Yin and yang exist in relation to, and mutually counteract, each other to achieve a dynamic balance. They are present in and characterise all things, including the inherent nature of food, the weather and the human body. So health and balance
can be achieved by eating the right types of foods at the right times of the year, according to the condition of one’s body. Lin explains that yin foods are those that generate cold or cool energy in the body, such as watermelon, bitter gourd, crab and most green vegetables. Yang foods, such as red meat, ginger, pepper and garlic, generate warm or hot energy. If you’re experiencing a heat syndrome (excessive yang in the body) and have symptoms such as a rapid pulse, a red tongue with yellow coating, flushed face, thirst, irritability, fever, yellow phlegm and constipation, and excrete scanty, yellow urine, take yin foods that generate cool or cold energy in the body to counteract the excessive heat, says Lin. Chow Yuen-pin, a Chinese medicine practitioner, says to avoid foods like mutton or chicken. Conversely, Lin says, if you have a cold syndrome (excessive yin in the body) you may experience diarrhoea or loose stools, stomach pains that are relieved by warmth or pressure to the abdomen, a pale complexion, a pale tongue with white coating, an aversion to cold or feeling cold, white or clear phlegm and copious amounts of lightcoloured urine. Treat this by consuming yang foods. Dang suggests avoiding cold drinks and green tea, which have a very cooling effect. Eat foods appropriate to the weather. During winter, eat more warming foods to build up the yang energy in the body. During summer, eat more yin foods to maintain balance internally. When Stephanie Lau’s children start to show signs of being too hot, or yang, she will boil tea made from dried chrysanthemum flowers, barley or water chestnut, which have a cooling effect. “After drinking the tea, their lips will quickly return to a normal colour, and they start feeling more comfortable again,” says Lau, 39. When her children have a cough, she avoids giving them chicken, which is supposed to make a cough worse. Although observing general guidelines for eating correctly is helpful, it is also important to consider one’s personal body type or constitution. Chinese medicine has identified nine types of constitution, including yang type, yin type, heat-deficient or blooddeficient, and diet can be used to correct imbalances in each type. Dang advises consulting an experienced Chinese medicine practitioner to have a proper assessment of your body type and condition in order to obtain the right advice on the appropriate foods and food combinations to consume for optimal health. “Soups and tonics are all very good, but you must take the right ones for your body type, or you could inadvertently create more problems for yourself,” Dang says.
8 HEALTH ALTERNATIVE THERAPY
They aim to squeeze ...................................................... Katie McGregor healthpost@scmp.com
Steven Bremner, a Rolfing (structural integration) therapist at Holistic Central, demonstrates the technique. Photos: Edward Wong
With only two of the world’s 1,850 Rolfing practitioners working in Hong Kong, chances are you have not heard of this system of intense, deep-tissue massage. Named after its architect, Dr Ida Pauline Rolf, the therapy method has developed a following in the United States, and in Colorado in particular, where the Rolf Institute of Structural Integration is based. The Phoenix Suns National Basketball Association (NBA) team was an early adopter in 1994, and the list of Olympic medal winners who endorse Rolfing is long. In Hong Kong, recreational athlete Alexander van Praag has also been a beneficiary. Arriving from London, Van Praag spent some time looking for a Rolfer. “I have always been heavily involved in sports and athletic activities, particularly martial arts, but I also accumulated many injuries. As I entered my mid-30s, I started to feel the mileage,” he says. Van Praag got more than he expected when he went to see Rolf therapist Steven Bremner to treat his long-term neck, knee and back pains. “The aches and pains have gone, but I’ve also noticed a very marked improvement in performance at the gym. It feels like I have been driving with my parking brake on for years, and now it’s released,” he says. Another patient in her late 40s, whose name has been withheld for patient confidentiality reasons, describes how treatment for a persistent and nagging shoulder pain helped her whole body feel more fluid, lighter and released. She says: “Not only has the pain gone, but I also saw my marathon speed shift noticeably. I am looking forward to my next marathon to see how I perform.” Rolf, who died in 1979, aged 83, was an innovator. She was awarded her PhD in biochemistry in 1920, virtually the dark ages for women’s education. Then, driven by family health problems and influenced by her interest in osteopathy, chiropractic, homeopathy and yoga, she came to the belief that if the body’s components were free to move optimally with gravity, the body would heal itself. Rather than working on bone (like a chiropractor) or muscle (like a massage therapist), she discovered that she could achieve remarkable changes in posture and structure by manipulating and freeing the body’s myofascial system, made up of connective tissue (fascia) that surrounds and supports our muscles, tendons, bones and organs in an intricate 3-D network. With repetitive use, abuse and trauma, these tissues can become scarred and inflexible, causing distortion and rigidity where there should be balance and fluidity. This in turn can lead to chronic pain. Rolf called her system of freeing the body “structural integration”. Other practitioners may do deep tissue massage or even some form of structural integration, but Rolf set her system apart by establishing the Ten Series. Over 10 hour-long
sessions, the whole body gets worked on – important from a Rolfing perspective because everything is interconnected. Patients get gouged with knuckles and kneaded with fists, limbs contorted, and tendons and ligaments loosened with elbows. They often get treated for one complaint but find that at the end of the series, other niggling pains have also been dealt with. “Take the knee as an example,” says Ea Holm, a Hong Kong-based Rolf therapist. “Too many knee injuries are ‘cured’ with surgery. A doctor looks at the knee as a body part, whereas a Rolfer will look for the cause above and below the point of pain. The causal problem may be as far away as the jaw.” While some patients accept the concept of a structured, thorough approach with an end in sight, others don’t, says Holm. In such cases, Holm will fall back on her massage therapy background and introduce some Rolfing techniques, explaining to the patient how the process works. “It’s very difficult not to use Rolfing techniques when you can feel the problem and know that the solution is only through Rolfing. Without a doubt, the Ten Series is the best approach,” she says. Patients are persuaded when
A doctor looks at just the knee, whereas a Rolfer will look for the cause above and below the pain EA HOLM, ROLF THERAPIST
they feel an immediate benefit. “In the first session, we work to free the ribcage so that people can use the full capacity of their lungs as and when needed. I might work to release one side of the ribcage and the patient will immediately feel the difference in their breathing in just that side of their body,” says Holm. When asked about the therapy’s reputation for being painful, Holm said that Rolfing had evolved since Rolf first established her series. “Pain only causes the body to seize up in response to the perceived violation. The aim is pain free treatment. The therapist reaches the deeper tissue with slow manipulation, allowing the body time to relax into it.” Van Praag describes his treatment as an “education for the body”, saying his body learned and adapted to new ways of movement and alignment. “Each lesson was delivered through Steve’s hands, elbows, and even feet, directly to the tissue of the body, and also through movements that he taught me to take home to use.” While popular amongst athletes, Bremner says that he has never met anyone whose body wouldn’t benefit from Rolfing. While the name might not be appealing, the thought of a structurally integrated body is. As I hunch over my laptop, I couldn’t agree more.
DIET 9 NUTRITION BLACK FOODS
Black
reveals its true colours ...................................................... Sasha Gonzales healthpost@scmp.com For years, nutritionists have urged us to load up on dark-green leafy veggies, deeply pigmented berries and red and orange foods such as carrots, salmon, beets and sweet potatoes to boost our immune system and prevent ill health. If you’ve followed their advice, give yourself a pat on the back. Charmain Tan, a registered dietitian at Seventeen Nutrition Consultants (www.my17.com), says these foods are rich in potent antioxidants called phytochemicals (or plant chemicals), which help the body neutralise oxidative stress and fight disease. Phytochemicals are what give foods their colour. Yellow or orange foods contain a phytochemical called beta-carotene and related carotenoids, while blue and purple foods are rich in anthocyanins, a class of flavonoids. Some red foods also contain these phytochemicals. If a food’s colour is a sign of its antioxidant content, then black
fruits, fungi, legumes and grains are nutritional powerhouses. “Black foods contain high amounts of anthocyanin, which has been shown to reduce the risk of heart disease and cancer. Anthocyanin also has antiviral, antiallergic, antiplatelet, antiinflammatory, anti-tumour and antioxidant properties,” Tan says. Apart from antioxidants, these foods are also rich in important vitamins, minerals and fibre. If you’d like to reap the benefits of anthocyanins, there is no shortage of black foods to choose from. Brown rice is good, but black is better, Tan says, because it is high in fibre, which is necessary for a healthy digestive system. Plus, it contains iron and other crucial minerals. The bran hull also has significantly higher amounts of vitamin E than that of brown rice – vitamin E is essential as it protects cells from damage by free radicals. In ancient China, black rice was highly regarded for its nutritional benefits. It was known as “forbidden rice” because the nobles kept it to
themselves and forbade the common people to eat it. A South Korean study found that protein-rich black soya beans are better than yellow or green soya beans, as they lower one’s risk of thrombosis, Tan says. And black lentils, sometimes called beluga lentils, contain high levels of vitamin B and soluble fibre. Another legume, black beans, aren’t just high in fibre and iron; their dark skins also contain high levels of bioflavonoids. These are powerful antioxidants that may protect against cancer and heart disease. Bioflavonoids have a natural antibiotic effect on the body, as well. Black fungus reduces the risk of cardiovascular disease, as it lowers blood viscosity, softens the blood vessels, reduces blood fat and gets the blood flowing smoothly, Tan says. And don’t forget black tea, which is high in theaflavins. These are antioxidants that combat inflammation and support a healthy immune system. Some studies also suggest that regular consumption of
black tea can reduce the risk of stroke and coronary heart disease. The next time you’re planning a meal, try to introduce as many black ingredients as you can to create a dish that is well balanced and tasty. For example, if you like tri-colour rice (made up of brown, red and white grains), add black to the mix for four-colour rice. Soaked dried black fungus is not only great with meat or vegetable stir-frys but also gives fresh salads a lovely crunch. Black sesame seeds are an excellent addition to home-made bread, muffins or cookies and impart a delicious earthy flavour to steamed vegetables, salads and noodles. Tan suggests cooking a vegetarian meal once or twice a week using black lentils or beans. Think stews or casseroles, or a Mexicanstyle bean burrito. For a vitamin-rich snack or dessert, you can’t beat blackberries – have them fresh, frozen or dried, or add them to your cake or muffin batter. While black foods are packed with the good stuff, that’s not to say they are superior to other foods.
“Each food is unique and carries a different amount of calories, macronutrients and micronutrients,” Tan says. So while they provide a host of nutritional benefits, you can have too much of these black superfoods. Since they provide energy, overconsumption can lead to weight gain, although you’ll find that, because of their high fibre content (in the case of black beans and lentils), you only need a small portion to feel satisfied. If you have kidney problems, you should monitor your intake of beans and lentils, too, as they’re rich in protein. And black tea contains a lot of caffeine, about 50mg per cup. (Green tea has only 8mg to 30mg a cup, while coffee contains anywhere between 100mg and 350mg.) Tan suggests using the Food Pyramid as a guide when preparing your meals. “Remember that moderation, balance and variety are the keys to sound nutrition,” she says. So choose a rainbow of colours, but be sure to add some black.
RECIPE FOR HEALTH GREEK SALAD
When it comes to the crunch, this dish is hard to beat ...................................................... Sidney Schutte healthpost@scmp.com Based on the Cretan diet, this Greek salad – a favourite at The Landmark Mandarin Oriental’s MO Bar – is the perfect healthy dish to have on a hot summer day. The people of Crete have one of the highest life expectancies in the world, around 80 years, and one of the lowest incidences of heart and other chronic diseases. The Cretan diet uses only organic, minimally processed, and in-season ingredients with an abundance of raw or boiled vegetables. This low-calorie salad is full of flavour and contains many seasonal ingredients which provide different nutrients essential for good health. Cucumber is rich in vitamins A and
C, and folic acid. Bell peppers are high in fibre and vitamin C, and are a good source of antioxidants. Olives are full of antioxidants and contain mono-unsaturated fats, which can help lower cholesterol levels. Feta cheese is low in fat, full of calcium and rich in conjugated linoleic acid, a fatty acid and antioxidant that can help lower the risk of diabetes and heart disease. MO Bar’s Greek salad Serves four as a starter or two as a main course 70g cucumber 100g red bell peppers 100g yellow bell peppers 100g green bell peppers 90g organic red mini tomatoes 80g organic yellow mini tomatoes
100g pitted black olives 100g pitted green olives 40g feta cheese 20g lemon juice 60g extra virgin olive oil Sea salt flakes and black pepper ½ small red onion A few sprigs of parsley or oregano Peel the cucumber and bell peppers, taking the seeds out. Slice into thin, 3cm strips. Cut tomatoes and olives lengthwise into quarters. Cut the feta cheese into 1cm cubes. Mix ingredients. Dress with extra virgin olive oil, lemon juice, and salt and pepper. Garnish with fresh thinly cut onion rings and chopped parsley or small oregano leaves, and freshly ground black pepper from the mill. Serve with warm, crispy pita bread. Sidney Schutte is the executive sous chef at The Landmark Mandarin Oriental
In-season produce makes this salad a winner. Photo: Jonathan Wong
10 FITNESS WORKOUT
Lifting weights eases burden of quitting ...................................................... Jeannine Stein
Uphill training helps in the Sai Kung Mountain Marathon and half marathon, part of the King of the Hills Mountain Marathon Series. Photo: Dominic Nahr
SWEAT HILL RUNNING
The only way is up ...................................................... Roy Stevenson healthpost@scmp.com Do you approach hills with a sense of dread when you run? Most people do, and it’s not surprising because it can feel as exhausting as racing. Research done at the Nike research lab found that running up an incline as small as one degree, increases energy expenditure by 12 per cent, enough to slow you down by about six seconds per kilometre. Yet, hill training has many physiological benefits to the runner – increased stride length and frequency, stronger upper body musculature and improved lactate tolerance, to name a few. Hong Kong, blessed with a variety of climbs, offers the perfect setting for such training. Renowned New Zealand coach Arthur Lydiard integrated hill springing and bounding into his training programme more than 40 years ago. Today, there few coaches who don’t give their charges some form of hill training at some stage of their yearly development plan. Here are the benefits of hill training, and what research says about them: Neuromuscular benefit – stride length Biomechanists and exercise scientists will tell you the two ways a runner can increase speed is by increasing stride length and stride frequency (or both). Uphill running helps increase stride length by increasing knee lift. The quadriceps and hip flexor muscle groups become stronger
from lifting the knees higher. This effect carries over to running on flat land, because high knee lift translates into a slightly longer stride length. So, if you run with longer strides using the same effort, it’s logical that you’ll cover a given distance in a shorter time. Here’s an example using the 10-kilometre distance for a runner going at an eight-minutesper-mile pace, covering about one metre per stride: simply lengthening the length of the stride by 2.5 centimetres (multiplied by the 9,090 strides to cover 10 kilometres) shaves about 230 metres, or about one minute. Neuromuscular benefit – stride frequency The faster and more powerful your foot-strike, the faster you’ll run and the more steps you’ll take per minute. Hill sprinting improves the tensile strength of your leg muscles, and thus enhances the recoil or return of energy from each foot compression. One study examined the joint kinematics and stride dynamics involved in high-speed running on an inclined treadmill compared with running on flat surfaces. The uphill-trained runners performed
As aerobic capacity is improved by uphill training, less energy and oxygen are needed
better than the flat-trained runners in all parameters. Another, similar study looked at uphill sprinting on high-speed treadmills – it, too, found that highspeed treadmill training on gradients up to 25 per cent is an effective tool for speed training, as part of a conditioning programme. There’s also another way hill running can increase stride frequency – downhill running. If done with short, quick strides, your neuromuscular system adapts to a faster leg turnover, thus increasing stride frequency. Metabolic benefit – anaerobic At the metabolic level, hill-trained runners experience an increase in lactate threshold and anaerobic threshold. Lactate threshold is the point when lactic acid starts to accumulate in the bloodstream because production exceeds removal, which spells the beginning of the end of high-intensity exercise. Anaerobic threshold is just a way to measure this for comparative purposes, where blood lactate reaches a level of four millimoles per litre. Hill running improves the strength and endurance of the quadriceps, hip flexor and hip extensor muscle groups – so the increased ability of these muscle groups to resist fatigue (lactic acid) shows through in the latter stages of races. You’ll slow down less and improve your race times. Metabolic benefit – aerobic Studies show that VO2 max – or maximum oxygen uptake – contributes significantly more to uphill running compared with
running on flat land. This high VO2 max level incurred during uphill running is partly due to the increased demands of the lower extremity muscles, the largest muscle mass in the body. Boost running economy As aerobic capacity is improved by uphill training, less energy and oxygen are needed at a given speed, or over longer distances, so running economy improves. This derives from better co-ordination of your neuromuscular system. A study in 1992 is mentioned in the International Olympic Committee’s book Endurance and Sport, where runners who did 12 weeks of regular training, plus hill training with bounce running. Their running economy improved by 3 per cent. Psychological benefits Hill-trained runners don’t fear steep gradients in races because they have improved confidence from training on them. They mentally withstand the extra demands of hills in races and training to the point of eagerly anticipating hilly courses. Better performance at hilly races The principle of specificity dictates that you’ll improve at whatever you practise in training. If you train hard on hills, you’ll run the uphill sections of your races faster. One research paper in the 1977 European Journal of Applied Physiology illustrates this benefit. It concluded that runners doing an intense six-week uphill running programme improve their training distances, anaerobic capacity and strength.
Smokers may have another tool to use in the battle to stop puffing: resistance training. A pilot study found that men and women who did several weeks of strength training had better quit rates than those who watched health and wellness videos. Researchers tracked the progress of 25 male and female smokers, all of whom received nicotine patches and a counselling session on how to stop smoking. They were then randomly split into two groups – one did three months of resistance training and the other watched twice-weekly videos on healthrelated topics. The latter served as a control group. The strength training group worked out twice a week for an hour, doing a full-body routine. Sets and weights increased as the participants got stronger. After 12 weeks, 16 per cent of people in the resistance training group had quit, compared with 8 per cent in the control group. The exercise paid off in other ways – those who worked out also lost about half a kilogram on average, while the controls gained about the same amount of weight. The workout group also decreased body fat on average by 0.5 per cent, while those in the control group increased their body fat by an average 0.6 per cent. The authors noted that these results show that a resistance training programme could not only aid efforts to quit cigarettes, but also halt weight gain and help maintain muscle mass. The results seemed to last. Three months after the study ended, 15 per
cent of participants in the resistance training group and 8 per cent in the control group were still on the quit list. Although the authors concede this was a small study, lead author Joseph Ciccolo calls the results promising. Also noted was that other similar studies have focused on aerobic training and involved mostly women participants. “While the large majority of smokers want to quit, less than 5 per cent are able to do it without help,” says Ciccolo, an exercise psychologist, researcher and physiologist with the Miriam Hospital’s Centres for Behavioural and Preventive Medicine in Providence, Rhode Island. “We need any new tools that can help smokers successfully quit and it appears resistance training could potentially be an effective strategy.” The study appeared in this month’s issue of the journal Nicotine & Tobacco Research. McClatchy-Tribune
WELL-BEING 11 PERSONAL BEST
Let your belly do the talking ......................................................
life. It simply knows what’s best for us. “The body relays feelings, reactions and sensations for us to listen to,” says Fung. “If we choose to ignore these messages, we’ll remain stuck where we are.” It’s not called a “gut feeling” for nothing, either. Hunches or vibes originate in your belly or solar plexus. In Japan, intuition is called “stomach art”. Since we’re all blessed with the gift of clairsentience, Fung believes that every one of us has the solutions to our problems. We all know which direction to take because our gut tells us every day.
Sasha Gonzales healthpost@scmp.com I once made the decision to rent a flat in all of two seconds. As I walked through the front door, something inside me told me I’d found the right place. Making my way around the rooms, I got a really good vibe – safe, comfortable and settled. I just knew I’d be happy living there. Rationally speaking, my decision made no sense. The condo was miles away from work, and the rent wasn’t what I’d expected to pay. But all that didn’t matter because, in my heart, I knew I’d made the right choice. I ended up renting that flat for a few years and enjoyed some of the best moments of my life there. My instincts have never failed me. Every time I made a decision based on my feelings – even if my head was signalling something else – that hunch usually turned out to be the right one. We all receive intuitive messages every day. They show up as “gut feelings” when we have to make a decision or are looking for answers to a problem. Our instincts are also the “warning bells” we hear when we’re about to enter a dangerous situation, and they’re the good or bad vibrations that radiate within us when we meet someone for the first time. Cimone-Louise Fung, a Sydneybased clairvoyant and intuitive mentor, believes our bodies are our truth monitors because they offer immediate feedback and allow us to respond in certain situations. This, she says, is clairsentience – a gift we’re all born with. We feel the way we do for a good reason. Our intuition is like an inner compass, keeping us on the right path as we journey through
The body relays feelings, reactions and sensations for us to listen to
Illustration: Brian Wang
CIMONE-LOUISE FUNG, CLAIRVOYANT AND INTUITIVE MENTOR
However, most of us do not take the time to listen to what our inner voice tells us. To communicate with our intuitive side, it’s also vital to first quieten the conscious mind. “You may be surprised to learn just how much your intuitive mind is suppressed by the constant bombardment of media and information,” says Fung. Letting go of this mental clutter, therefore, must be done before we can begin to tune in to that inner voice and develop our clairsentience further. Meditation can certainly help with this process of letting go. According to Fung, meditation “strengthens the ties to the spiritual self, which provides intuitive information”. Another good way is simply to
make time for yourself regularly. “Any form of self-expression is useful,” Fung says. “Let yourself go in ways that feel good to you, whether it’s writing, swimming, running or some other activity. It’s only through letting go that you can become aware, awake and alive.” She adds never to compare yourself to others – realise that you are unique and amazing. And finally, be creative; it’s how your soul expresses itself. You’ll sometimes find your head overriding what your gut is telling you. This is your ego – the part of yourself that is concerned with image and the physical, and not necessarily concerned with your higher good. The messages you receive from your ego, therefore, may not always be in your best interests. The best answers come from the gut. The next time you find yourself stuck or in need of clarity, activate your inner compass: sit, relax and be still, allowing your thoughts to come and go. Focus on your breathing and stay in the present. Now, notice what happens in your solar plexus. Place your hand on this area and allow it to “speak” to you, says Fung. Remember, she says, “If it’s light, it’s right. If it’s heavy, it’s a lie.” So, if your body feels light and you experience a soft, pleasant feeling in your gut, this is your inner voice saying yes. If you experience a tightening sensation that makes you feel heavy or burdened, your intuition is saying no. If you don’t get an answer right away, repeat the process the next morning. “Anyone can tap into the subtle vibrations, which often have hidden powerful messages,” Fung says. “If you tap into this psychic potential often and continue to develop this inner resource, it will be with you for life.”
THE TASTE TEST FRENCH FRIES
Call them chips, fries or frites – these three are blue-chip .............................................. Jeanette Wang jeanette.wang@scmp.com Alexia Yukon Gold Julienne Fries with Sea Salt HK$45 for 425g, City’super With the skin on and a sprinkle of sea salt, these have a good, earthy and buttery taste and just the right amount of saltiness. But because they’re nearly shoestring size, make sure you don’t overbake them or they will get very dry inside. Verdict: the most distinct and tastiest of the three. Yummy.
Ore Ida Steak Fries HK$48 for 793g, City’super
Lutosa Organic Chips HK$32 for 750g, City’super
This is how I like my chips – thick and chunky, best for soaking up ketchup, vinegar or gravy. Because of their size and shape, they have fantastically fluffy insides and a good potato flavour. They take longer to crisp – but it’s well worth the wait. Verdict: I’m definitely having seconds, maybe with some aioli.
You can’t really taste the difference, but it’s assuring to know that these fries are made with potatoes grown without pesticides or chemical fertilisers, and pre-cooked in sunflower oil, which is low in saturated fat. Verdict: delish. They crisp well outside and stay moist inside.
Note: all fries were baked for 20 minutes in an oven at 220 degrees Celsius – the healthiest cooking method. (If you like them really crisp, they should be fried.)