20110920 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, SEPTEMBER 20, 2011

Photo illustration: Emilio Rivera III

HEALTH POST

COLLAGEN: CAN YOU EAT YOUR WAY TO YOUTH? >PAGE 6

LIFE’S A BEACH, HERE’S HOW TO WORK IT OUT >PAGE 8

How caregivers play a key role in enriching the lives of dementia sufferers >PAGE 4

Being there

2 NEWS APP OF THE WEEK

HEALTH BITES

Five minutes a day of sucking your thumb promises to be a veritable face saver

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Katie McGregor healthpost@scmp.com Five In 5 US$4.99 Rating 8/10 Years ago I reviewed a book of facial exercises by the queen of natural facelifts, Eva Fraser. It was hard work and my face was still in pretty good shape, so I quickly lost interest. But now I am interested. Remarkably, while Fraser is still in business (and looking younger than ever), her business has yet to come up with an app.

A little research gave me two contenders – Facial Fitness at US$1.99 and Five In 5 at US$4.99. Of course I downloaded Facial Fitness first, but quickly put it aside. The 12 exercises were not very well explained in the short training videos and the full fast-paced 4½minute video seemed too much for a beginner like myself.

The other app, by comparison, is to the point – five exercises plus a “bonus” exercise, clearly demonstrated through short training videos, to be done in a guided, daily five-minute routine. It

is better for a beginner. According to the app: “Depending on the age and condition of your skin, you may see results immediately after performing the exercises for the first time … You should definitely see results in the first five days.”

I did have reservations about the promise of instant results, so I took my own before photograph and set about the programme with enthusiasm and in privacy. You really do look strange as you tilt your head back, extending your neck and sucking hard on your thumb for 10 reps, which are counted out by the anonymous video instructor.

Strangely, this is incredibly intense and leaves the cheeks and jowl area throbbing with exhaustion.

According to the app instructions, regular practise yields the best results. The programme is something that you can do as part of your morning routine, or in a lift, or while waiting for the kettle to boil.

After a week I took another photograph, but there was no change. So I persevered for another week. Now, at the end of week two, I possibly see a slight lift in my jowls.

While this is not an instant result, I’ve spent my money so I’ll keep at it for a while. Watch this face.

Jeanette Wang jeanette.wang@scmp.com Green and serene If your child has hyperactivity problems, a dose of nature may help.

Researchers from the University of Illinois who studied more than 400 children diagnosed with attention deficit hyperactivity disorder (ADHD) have found that those who regularly play outdoors have milder symptoms than those who play indoors or in built-up outdoor environments.

Green and open areas, such as soccer fields, large parks and expansive lawned areas, are especially beneficial. The study was published in the journal Applied Psychology: Health and Well-Being.

Empty vessels There’s a reason why hunger and grumpiness go hand in hand. Research from the University of Cambridge has found that fluctuations of serotonin levels in the brain, which often happen on an empty stomach or during stressful periods, affect brain regions that enable people to regulate anger.

Under low levels of serotonin, communication between the emotional limbic system of the brain (a structure called the amygdala) and the frontal lobes weakens, which could make it more difficult for the prefrontal cortex to control emotional responses to anger that are generated within the amygdala. So, don’t ever provoke a hungry man.

A healthy partnership Broccoli’s cancer-fighting power can be boosted if you pair it with the right stuff. This includes spicy foods – such as broccoli sprouts, mustard, horseradish or wasabi – and other vegetables such as radishes, cabbage, arugula, watercress and Brussels sprouts. A University of Illinois study found such foods contain the enzyme myrosinase, which is necessary to form sulforaphane, broccoli’s cancer-preventive component. The right pairing will produce even more sulforaphane and hence provide greater anti-cancer benefits.

ASK THE DOCTORS DR LESLIE LO Q: I’m a pretty serious triathlete. I train six days a week, sometimes twice a day. My period comes about every six weeks, and the flow is light. Is this normal for my active lifestyle?

A: First of all, it would be useful to know what your period “pattern” was before you engaged in serious triathlon training.

Athletes with rigorous training tend to have delayed or even absent menses. This is due to the effect of rigorous exercise on the internal hormonal clock. Typically, long-distance runners and thin ballet dancers may experience absence of menses. Menarche (the first period) starts

at different ages. It has been observed that when the girl reaches a certain body mass, her internal hormonal clock will start to tick and her first period will come.

The reverse is also true; that is, if she lacks subcutaneous fat or is grossly underweight, her internal hormonal clock will stop.

So, you are perfectly fine with a sixweekly period and light flow. Don’t be surprised that if you increase your training schedule, your period may be further delayed or even stop.

Dr Leslie Lo is a specialist in obstetrics and gynaecology

> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@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

Few signs of inner turmoil ......................................................

Wynnie Chan healthpost@scmp.com Elizabeth Lee, 53, was constantly constipated and felt dizzy every time she stood up from her desk at work.

Lee (name changed for patient confidentiality reasons) put these changes down to menopause. But when her daughter, who is based in Australia, saw how pale and fatigued her mother had become since her last trip to Hong Kong, she quickly arranged a doctor’s appointment.

A blood test showed that Lee had low levels of both haemoglobin (red blood cells) and serum ferritin, which is a protein in the body that binds to iron. She was initially diagnosed with iron deficiency anaemia, but since her menstrual blood losses were infrequent, the doctor decided to further investigate the underlying cause of her anaemia.

Stool samples sent for faecal blood testing came back positive.

This warranted a colonoscopy to check the colon and rectum. Lee had to follow a liquid diet for a day before the procedure, drinking only clear soups, strained fruit juice, water, plain tea and coffee, sports drinks and gelatin. She had to steer clear of drinks with red or purple food colourings, which could be mistaken for blood in the colon. She also had to use a laxative the night before the colonoscopy to empty the gastrointestinal tract.

On average, the five-year survival rate of colon cancer is quoted as about 50 per cent JUDY HO, SURGEON, QUEEN MARY HOSPITAL

During a colonoscopy, a long flexible tube with a light and camera on the end – which is connected to a display monitor – is inserted into the anus under local anaesthesia and slowly guided through the rectum and into the colon.

A careful examination of the gastrointestinal tract is done by inflating the colon with carbon dioxide.

The colonoscopy showed the presence of an abnormal growth in Lee’s colon, from which a sample of tissue was removed and examined for cancer cells. This test confirmed that Lee had colorectal cancer, the second most common cancer in Hong Kong.

A CT scan of her abdomen, pelvis and chest found the cancer had grown through the outermost layers of her colon, but had not yet grown through the layers or spread into the

lymph nodes. Lee had stage IIA colorectal cancer.

The incidence of colorectal cancer is increasing here, says Dr Judy Ho Wai-chu, consultant colorectal surgeon at Queen Mary Hospital. “According to data from the Hong Kong Cancer Registry, the number of new cases of colorectal cancer in 2008 was 4,031. The registry predicts that the number of new cases in 2020 will be more than 6,100, which is a more than 50 per cent increase,” Ho says.

Symptoms of the condition vary depending on the location of the tumour and if it has spread to other body parts, says Ho. If the tumour is near the rectum, local symptoms may include blood and mucus in the stools; persistent changes in bowel habits, such as constipation or diarrhoea over a period of six to eight weeks; persistent abdominal pain over a number of weeks; and the presence of an abdominal mass, which is a localised swelling.

Ho says that cancers arising from the right side of the colon usually have minimal bowel symptoms.

Instead, the slow bleeding from the tumour usually gives rise to symptoms of anaemia, including postural dizziness and tiredness. In 10 per cent to 20 per cent of colorectal cancer cases, patients may have no initial bowel symptoms, but when they do have symptoms, these are due to the spread of the cancer to other organs.

Lee is now waiting for surgery to remove the tumour. In the meantime, she’s trying to remain positive and follow lifestyle recommendations from the World Cancer Research Fund. She has removed processed meats such as sausages and ham from her diet, cut down on red meat, limited herself to only one glass of wine a day, and is trying to eat more wholegrains, beans, fruit and vegetables. She has also started taking 30-minute walk each day.

“The most important predictor of survival for colon cancer is the stage of the cancer upon clinical presentation,” Ho says. “The earlier the stage, the better the prognosis.”

For stage I colon cancer, the fiveyear survival rate approaches 80-90 per cent; for Stage II, 60-70 per cent; Stage III 40-50 per cent; stage IV less than 10 per cent. “On average, the five-year survival rate of colon cancer is quoted as about 50 per cent,” Ho says It’s no surprise, then, that prevention is better than cure.

“For the general public – and people with personal or familial risk factors – I strongly recommend colon screening above the age of 50,” says Ho. The recommended screening methods include: annual faecal blood testing, a flexible sigmoidoscopy and barium enema (a special X-ray of the large intestine) every five years and a colonoscopy every 10 years.

Illustration: Angela Ho

4 COVER STORY

Forget me Tomorrow is World Alzheimer’s Day. Elaine Yau visited a care centre to review treatment options for dementia

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Chan Shui-nin and her daughter, Lam Sau-ying, have benefited from attending the Jockey Club Centre for Positive Ageing. Photo: May Tse

han Shui-nin, 86, used to be a bit of a handful. Often unable to sleep, the Alzheimer’s disease sufferer would noisily search through boxes in a storeroom at night, keeping her family awake.

Prone to emotional outbursts, she was reluctant to drink water. Her daughter, Lam Sau-ying, 60, and one of eight siblings, says: “My brother couldn’t put up with her and wanted her to leave after a twoday stay.”

But that’s changed a lot since she began attending day-care sessions at the Jockey Club Centre for Positive Ageing.

Ten years ago, Chan was diagnosed with Alzheimer’s, a degenerative disorder of the brain and the most common cause of dementia.

Sixty per cent of dementia cases are caused solely by Alzheimer’s, while other contributing factors include degeneration of blood supply to the brain, brain tumour, head injury, and excessive drug and alcohol use.

According to a 2006 study conducted by the Department of Health and Chinese University’s department of psychiatry, there are 63,000 elderly folk who have dementia in the city.

With about 9.3 per cent of people aged 70 or above suffering from the disease, the Census and Statistics Department has projected that there will be 77,000 such people in Hong Kong by 2019.

Alzheimer’s sufferers lives are generally shortened by the effects of the disease, but lifespans range from

three to 20 years after diagnosis.

There is no treatment to stop progression of the disease.

Therapy includes medication to slow down cognitive decline, drugs to lessen symptoms like aggression and sleeplessness, and care-giving by nursing homes and families.

Lam, a former owner of a textiles factory, took early retirement 10 years ago to care for her mother. She loved her mother, but it was an exhausting experience. “She lost the ability to organise her life. It took a lot of effort to make her do something as easy as drinking water,” says Lam. But then came Chan’s enrolment at the Centre for Positive Ageing.

Launched a decade ago, the centre, in Sha Tin, is the first integrated dementia care institution in the city. It provides day care and residential services to dementia patients and offers training to caregivers.

Tomorrow is World Alzheimer’s Day and the centre has rolled out a series of events to raise awareness of the condition, such as a symposium on the disease and its treatment.

Lam says the lessons in caregiving have helped her better communicate with her mother.

“I had no idea what dementia was about before,” she says. “There are actually many things that a carer can do. How I phrase my questions to her and respond to her words can have big effects on her behaviour.”

The importance of family caregiving in the treatment of dementia patients is supported by research and clinical trials.

A study by Johns Hopkins and

Utah State University published in the September 2009 issue of The Journals of Gerontology found that Alzheimer’s patients who share a close relationship with care-givers retain their brain function better over time than those without one.

Of the 167 pairs of patients and caregivers studied, the progression of the disease was the slowest in patients with close spouses.

The changes observed in these patients were similar to those in patients taking acetylcholinesterase inhibitors, an Alzheimer’s drug.

Professor Timothy Kwok Chi-yui, director of the Centre for Positive Ageing, says proper caregiving can delay institutionalisation of patients.

“Despite deterioration in their cognitive functions, [dementia patients] still have emotions,” he says. “From [their children’s] speech tones and expression in their eyes, they know whether they are being taken care of. Those who are hard of hearing and suffer from poor

COVER STORY 5

eyesight become isolated. They might engage in eccentric behaviour like yelling or hitting themselves.

They do this to confirm their existence. They want people to attend to them. Otherwise, [their whole existence] is blank.”

Given the high level of stress involved in dealing with Alzheimer’s patients, counselling and training can make lives easier for both caregivers and patients. A study by New York University School of Medicine, the University of South Florida and the University of Alabama at Birmingham spanning two decades found that counselling and weekly support groups delayed the placement of patients in nursing homes by an average of 557 days.

In the study, published in the November 2006 issue of Neurology, half of 406 caregivers were given advice, support and information by counsellors, and the other half had no contact with counsellors.

Professor June Andrews, director

of the Dementia Services Development Centre at the University of Stirling in Scotland, says caregivers should create a calm environment at home and avoid arguments with patients.

“They don’t remember things that happen five or 10 minutes ago,” she says. “If the patient says she hasn’t had her lunch and you correct her and say she has eaten already, arguments will occur. You can’t bring back their memory by reminding them like children.”

Andrews recommends nonverbal communication such as singing together, playing music to patients, and touch.

At the Centre for Positive Ageing, treatment includes engaging the patients’ senses, such as letting them hug dolls or dogs, and providing massage and aromatherapy, says Kwok.

Andrews says a relaxed atmosphere at home can also help.

This includes getting rid of unnecessary things so the home doesn’t feel cluttered; increasing light to aid ageing eyes; and putting up clear signs or pictures to show where things are. When moving into a new place, try to make everything as familiar as possible.

“Having difficulty in depth perception, [patients] can fall and stumble easily,” says Andrews.

“Having contrasting colours for walls and doors can help. If there’s a door you don’t want him to go through unaccompanied, paint it the same colour as the walls. For things you want to be noticed, make them obvious. For those you don’t, make them disappear.”

A show room at the Centre of Positive Ageing teaches caregivers how to decorate patients’ bedrooms. Motion detection sensors, bed rails, electronic pill boxes (with reminders to take medicine on time), a speed-dial

telephone with buttons bearing pictures of close relatives all make life easier for Ho Kwok-seung and her Alzheimer’s-afflicted mother, Kwok Lau Wai-yiu, 86.

“Technology helps a great deal. It makes me less worried,” says Ho, whose mother is cared for by a maid.

When designing games, case worker Wong Wai-ling, who oversees Kwok and Chan’s treatment at the centre, takes into account the history, personality and preferences of patients. Chan, for example, enjoys the personal grooming lessons and mock shopping sessions, where she makes mental calculations and counts spare change to exercise her mind.

Chan also enjoys talking about her days as a businesswoman running a boating business, says Wong.

Professor Kwok encourages caregivers to reminisce with patients who, while poor in shortterm memory, often can recall things that have happened when they were young.

“They can read photo albums together, organising them in a [chronological] sequence and singling out pictures and jotting down captions for events that mark milestones in each stage of life.

Sharing nostalgic moments together makes them happy,” he says.

While there’s no research on the relationship between caregiving and longevity, Andrews says those who are looked after well live much longer.

“With fuzzy concepts of time and place, patients don’t know where they are and what they are doing.

It’s like they have fallen into the sea, bobbing up and down and with no one around,” says Professor Kwok.

“If they are well taken care of, even people in a very advanced stage of Alzheimer’s can smile.” elaine.yau@scmp.com

Ho Kwok-seung with her mother, Kwok Lau Wai-yiu. Ho says technological aids have helped her manage her mother’s care. Photo: May Tse

6 HEALTH BEAUTY

Does eating collagen get under your skin? ......................................................

Margaret Wee healthpost@scmp.com Pig trotters in sweet vinegar is a traditional dish loved by many Chinese. Aside from its rich flavour, the dish is popular for another reason: the trotters contain very little meat and fat, but plenty of collagen.

Those obsessed with looking forever young have gone from having collagen injected and slathered on skin, to eating it to keep age at bay.

Collagen, a fibrous protein that connects and supports tissues in the body, is found naturally in trotters, shark’s fin, and chicken and fish skin.

But these days, thanks to a craze originating in Japan, it’s being added to all kinds of food – from marshmallows and jam to ramen and soft drinks.

Collagen makes up about one quarter of the body’s protein and occurs naturally in humans and animals. Derived from the Greek words “kolla” (glue) and “gennao”

(to produce), collagen is needed for healthy skin, bones, organs and connective tissue. Collagen production decreases naturally with age. It is also affected by free radicals formed through sun exposure, pollution, smoking, stress and alcohol use.

Its reduction is most obvious in the skin. “Healthy collagen fibres act as little springs inside the skin, giving it elasticity, suppleness and firmness,” says Dr Tinny Ho, a dermatologist at SkinCentral. “Loss of collagen causes wrinkles, sagging and a thin, crepey look to the skin.”

Secretary Paulina Chan, 30, swears by collagen supplements.

Chan downs a collagen drink once a day in a bid to keep her face wrinklefree. “I think it has made my skin more radiant, and I have fewer pimples. People tend to think I’m younger than I really am,” she says.

Eating collagen may help the overall formation of collagen in the body, according to a paper published in the Archives of Dermatological

Research in 2008. Research published a year later by Tokyo University suggested that eating collagen could reverse the effects of sun-related skin ageing.

Other experts, however, are not convinced. The British Skin Foundation asserts that there is no evidence to show that eating collagen is beneficial for the skin in any way.

“Very few oral supplements have good published studies to prove their

Collagen creams are not really useful for increasing collagen in the skin. They can be good moisturisers, at best DR TINNY HO, DERMATOLOGIST

effectiveness,” Ho says. “In general, dermatologists do not regard oral supplements as an effective way of boosting the collagen in the skin.”

There is actually no way for collagen to be transported directly to the skin when it is eaten, as it is broken down during digestion into amino acids just like any other protein. These amino acids are then used to produce different kinds of protein needed for muscle and cartilage growth, healthy hair and nails, haemoglobin production and other processes in the body.

“Any perceived improvement in skin condition is more likely to be because of a placebo feel-good effect and increased amount of water intake due to consumption of the product,” says Sally Poon, a registered dietitian.

The protective nature of skin also means that collagen creams don’t work, either. Although skin is porous to allow perspiration to take place, it also prevents microorganisms from invading the body. To be able to enter the epidermis – the outermost layer of skin – a substance must have a molecular weight of less than 3,000.

Most collagen molecules used in cosmetic creams and lotions have a molecular weight of 300,000.

“Collagen creams are not really useful for increasing collagen in the skin. They can be good moisturisers, at best,” Ho says. She adds that effective products should stimulate collagen production within the skin, rather than contain collagen per se.

“Many skincare ingredients such as retinols, glycolic acids and certain peptides have been proven to have this collagen-boosting effect,” she says. However, they can cause skin irritation and are found in higher, effective concentrations mainly in products that require a dermatologist’s prescription.

Prevention appears better than cure when it comes to collagen loss.

In particular, sun exposure can cause a lot of damage to the collagen structures within the skin. “UV, along with pollution and lifestyle habits such as smoking and stress, cause the formation of free radicals in the skin, which affects the skin’s ability to repair itself and produce new collagen,” Ho explains. “I would strongly suggest the proper use of a good sunscreen with UVA and UVB protection on a daily basis and the use of good antioxidant skincare products to counteract the damaging effects of free radicals.”

Poon suggests that those concerned with healthy skin should simply focus on eating healthily, instead of eating collagen. “In general, people in Hong Kong do not have a protein deficiency problem.

Adhering to a balanced diet is the best way to obtain suitable amounts and types of proteins and all other nutrients,” she says.

A 2001Swedish study found that eating more vegetables, olive oil, mono-unsaturated fat and legumes, and eating less milk and dairy products, butter, margarine and sugar resulted in less skin wrinkling, even with sun exposure.

Electron micrograph scan of collagen

HEALTH 7 PREVENTION

Grime is on our side ......................................................

Dennis Thompson

Good hygiene has saved millions of lives, protecting people from countless bacterial and viral infections, according to the US Centres for Disease Control and Prevention.

But there is growing concern that strict adherence to good hygiene, though a valuable means of protecting health, has left humans open to other forms of illness.

Proponents of the “hygiene hypothesis” believe that reduced exposure to bacteria, viruses and parasites has impaired the immune system’s ability to properly respond to environmental challenges.

Researchers have identified the hygiene hypothesis as a possible cause or exacerbating factor in a number of illnesses and medical problems, says Dr Graham Rook, a professor in the department of infection at the Centre for Clinical Microbiology at University College London. These include severe

If your kids come back from the garden with a little mud on their hands, it’s not a bad thing MITCHELL GRAYSON, PAEDIATRICS PROFESSOR

allergic reactions, gastrointestinal disorders such as inflammatory bowel disease and Crohn’s disease, and autoimmune disorders such as type-one diabetes and multiple sclerosis. “The evidence for all this is very powerful,” Rook says. “It’s easy to show: if you live on a farm or keep a dog, you’re less likely to have these disorders; if you are the youngest child in a big family, you’re less likely to have these disorders.”

The hygiene hypothesis has its roots in the theory of evolution, he says. “The bottom line is organisms that were present in mud, untreated water and faeces were with us right from the start of humanity,” Rook explains.

Proponents of the hypothesis believe that the human body adapted to these organisms and began using them as a means of training the immune system.

“What has happened over the course of evolution is, because these bugs had to be tolerated, they came to activate the tolerance of the

immune system,” Rook says. “They are the police force that keeps the immune system from becoming trigger-happy. Basically, the immune system is now attacking things it shouldn’t.”

Dr Mitchell Grayson, an associate professor of paediatrics at the Medical College of Wisconsin in Milwaukee, says that the hypothesis is most strongly linked to an increase in allergic diseases and asthma.

“It’s thought to have something to do with the way your immune system develops and is programmed,” Grayson says.

Bacteria in the environment teach an immune response to allergens that is more moderate and less severe.

“In the absence of these bacteria, the immune system is thought to become more prone to allergic disease,” he says.

Argentinian researchers have shown that the presence of intestinal parasites can moderate the progression of multiple sclerosis.

Follow-up studies indicated that, when people were treated for their parasitic infection, they had a relapse of MS. A research team at the University of Iowa found similar results related to Crohn’s disease, showing that intestinal parasites helped regulate the autoimmune reaction that causes the intestinal disorder.

On the flip side, such revelations carry risks. Doctors are concerned that some might use the hypothesis as an excuse to abandon good hygiene, causing a surge in diseases such as dysentery and cholera.

“Public health and sanitation has been the single greatest improvement in our life expectancy,” Grayson says. “I would not recommend living less cleanly.”

On the other hand, tolerance of a little dirt here and there won’t hurt.

“If your kids come back from the garden with a little mud on their hands, it’s not a bad thing,” Rook says. “They don’t necessarily have to wash their hands before picking up a sandwich.”

In general, though, it’s wise to maintain good overall hygiene, he says, and wait for the scientists to figure all this out. Larger studies are under way to determine the exact mechanism by which bacteria and parasites are causing the immune system to moderate its response, Rook says.

“We need to figure out how to replace what is good from the microbiological environment while maintaining the advances of good hygiene so we can get the best of both worlds,” he says. HealthDay

8 FITNESS SWEAT SAND CIRCUIT

Reach for the beach ......................................................

Jeanette Wang jeanette.wang@scmp.com Ah, the beach. With sun, sea and sand it makes for the perfect lazy weekend, but also a terrific – and free – fitness facility to get a great workout in.

Soft and unstable, sand is kinder on the joints compared to running on hard ground, and also makes any movement more challenging.

“Everything is harder to do on sand,” says Michal Bucek, a trainer and marketing director at Bootcamp Hong Kong, which holds group circuit training classes on Repulse Bay Beach. “You burn more calories exercising on sand.”

Here, he demonstrates a circuit, designed by Bootcamp managing

director Nathan Solia that will work your entire body. Start by warming up for five minutes with a light jog and some arm circles. Rest 60 seconds between each exercise (or less, to make it more challenging).

Perform the entire circuit one to three times, depending on your fitness level. You can wear shoes, but doing it barefoot will provide more stability, Bucek says.

Finish off by stretching all the major muscles groups, then plunge into the sea for a well-deserved dip to cool off.

1. Jumping squats With weight on the heels, stick your backside out as you lower it. Once the knees are almost at 90 degrees, jump, driving your body up explosively using the muscles of your backside and thigh. Land with bent knees and jump again without pausing to rest. Do 10 to 20 repetitions.

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2. Walking lunges Put your hands on your waist or out to the side for balance.

Take a large step forward (about twice the size of a normal step), lower your body until the back knee almost touches the ground.

Then push yourself forward and up, immediately taking a large step forward with the other leg. Do 20 to 30 reps.

To make it easier, bring both feet together after every lunge.

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3. Push-ups Place hands on ground just wider than shoulder-width apart, arms straight. Hold your body in a planked position. Bend elbows and lower chest until the chest almost touches the sand. Press up by straightening the arms. Do 10 to 15 reps. To make it easier, do the move on your knees.

4. Sandbag bent-over rows Fill two bags with sand. Lean forward slightly, knees bent at about 45 degrees, with arms dangling down and a sandbag in each hand.

Squeeze your shoulder blades together and bend the elbows until your wrists are almost touching your stomach. Slowly return arms to starting position. Do 10 to 20 reps.

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5. Bear crawls Start on all fours, with just the hands and balls of the feet touching the ground. Keep hands and feet quite far apart, to keep your backside down. Propel yourself forward by moving your opposite hand and leg at the same time. Do 10 to 40 reps.

6. Caterpillar Start in push-up position. Walk your feet towards your hands until they are as close as possible to each other (this depends on your flexibility), keeping the legs straight. Then keep your legs still and walk your hands forwards to return to the starting position.

Do 10 to 20 reps.

Fitness trainer Michal Bucek works out. Photos: Felix Wong

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DIET 9 RECIPE FOR HEALTH

Spears of influence ......................................................

Jeanette Wang jeanette.wang@scmp.com Canton Room at Gloucester Luk Kwok hotel has been participating in the Department of Health’s EatSmart@restaurant.hk campaign for a few years, offering increasingly health-conscious diners a range of dishes with more vegetables and less fat (or oil), salt and sugar.

Here, the Cantonese restaurant’s chef, Wilson Leung Wai-shun, shares an interesting way to enjoy your greens.

• Cut off the ends of the cucumber, slice into shorter segments, and make holes in them using a corer.

• With a peeler, slice the carrot and winter melon into thin, flat strips.

• Peel the skin off the asparagus, and slice into shorter segments.

• Layer the carrot, winter melon and Yunnan ham on top of each other. Wrap them around the asparagus and a couple of stalks of chives.

• Put the bundle through the hole in the cucumber to secure.

• Boil the rolls in the stock until tender.

Place on a dish.

• Add the chicken powder, salt, sugar and red cabbage to the stock and let boil.

• Add the Chinese wine and enough flour to make a relatively thick sauce.

• Pour onto the rolls and serve.

Velvet Greens in the Goldmine 400g cucumber 100g carrot 100g winter melon 160g white asparagus 20g Yunnan ham 60g Chinese chives 100ml stock 10g chicken powder 10g salt 5g sugar 60g red cabbage 10ml mei kuei lu (Chinese wine) Flour Chef Wilson Leung cooks with the healthy diner in mind. Photo: May Tse

THE TASTE TEST OAT BISCUITS ......................................................

Jeanette Wang jeanette.wang@scmp.com

Nairn’s Oat Biscuits Mixed Berries HK$31.20 for 200g, Great A pack (five pieces) of these wonderfully fruity biscuits kept me going as I missed lunch one busy workday. Full of dried cranberries and flavoured with raspberry, it has just the right sweetness and texture.

Verdict: A pack – or two – paired with tea makes a perfect snack.

Walkers Cracked Black Pepper Oatcakes HK$30.80 for 250g, Great A colleague commented that this traditional Scottish biscuit tasted like peppered cardboard. Another, a day and many biscuits after the initial tasting, said the taste grew on him. I think it’s not something you’ll eat on its own.

Verdict: Pair it with foie gras or gravlax, although that would make it less healthy.

Paterson’s Oat Bites Cheese & Chive HK$26.20 for 150g, Great Oats are good for you because the grain releases energy more slowly than sugar, and is also a source of soluble fibre which can help reduce blood cholesterol levels. These bitesized baked biscuits, however, need some work in the taste and texture department.

Verdict: So dry it got stuck at the back of my throat and I couldn’t eat much of it.

10 DIET

NUTRITION

Panacea for lunch, anyone? ......................................................

Jeanette Wang jeanette.wang@scmp.com It used to be that eating healthily meant restricting one’s diet to food low in fat, carbohydrates and sugar.

These days, good nutrition means incorporating functional foods with health-promoting ingredients.

With heart health, for example, a few decades ago it was about eating fat-free products. At the turn of the millennium, it was about avoiding certain types of fat. Now, says Katrina Diamonon, consumer markets analyst with Datamonitor, heart health is focused on the inclusion of certain fats that are good for you.

Two in three consumers in the Asia-Pacific region now make conscious attempts to eat healthily, 13 per cent more than in 2009, according to Datamonitor research.

The modern, hectic yet sedentary lifestyle fuelled by convenience foods has seen waistlines expand. Coupled with health issues experienced by an ageing population, Diamonon says consumers are taking a more holistic approach to health. “They want

longer, happier and healthier lives, and they’re using nutrition to try to achieve that,” says Diamonon, who addressed the Vitafoods Asia conference in Hong Kong this month.

According to New Hope Natural Media, organisers of the Natural Products Expo Asia, held last month in Hong Kong, the global nutrition industry had an estimated US$310 billion in sales last year, more than double that of 10 years ago.

Datamonitor research shows that on the mainland, 72 per cent of people say they are more interested in hearing about what to eat, rather than what not to eat. As lifestylerelated diseases continue to prevail, “consumers are becoming disillusioned and disappointed by [conventional] approaches to dieting”, says Diamonon. “They’re starting to think more positively.”

In Asia, consumers are predisposed to the idea that foods can have medicinal properties.

Functional foodstuffs include those that address the immune system, bone and joint health, energy, heart health, appearance, ability to concentrate or appetite control.

People want longer, happier and healthier lives, and are using nutrition to try to achieve that KATRINA DIAMONON, ANALYST, DATAMONITOR

The three-day Vitafoods Asia turned the AsiaWorld-Expo into a vast pantry of newfangled health ingredients and products. Here are some trends coming your way.

Probiotics If you’ve overdosed on yogurt because you read that probiotics were good for you, it seems not all probiotic strains are equal.

Manufacturers have now come up with various probiotic concoctions.

For example, British-based Protexin Healthcare’s Bio-Kult capsules are a “unique 14-strain probiotic expertly formulated to help the digestive and

immune systems”, and Taiwan’s GenMont Biotech has a patented ADR-1probiotic strain which it claims is proven to reduce blood glucose as well as cholesterol.

Blood management Keeping your heart healthy used to involve eating foods or taking supplements that could lower LDL (or “bad”) cholesterol and/or raise HDL (or “good”) cholesterol – think fish oil, flaxseed oil or garlic extracts.

Now, manufacturers have added blood management as an important aspect of heart health.

One of the highlights of Vitafoods was Fruitflow, an extract from the jelly around the seeds of the tomato that has shown to have antithrombotic ingredients – that is, the ability to prevent blood platelets to clump, which is a known cause of heart attacks, stroke and venous thrombosis.

Olive extracts Inspired by the heart-healthy Mediterranean diet, manufacturers have come up with a range of supplements made from the humble

olive plant. Hytolive, an olive fruit extract, claims to help in the prevention of brain deterioration and LDL cholesterol oxidation. Benolea tablets, meanwhile, contain oleuropein, a substance in the olive plant that has been shown to lower blood pressure. Opextan, an extract from the olive pulp of a specific Italian variety, has a phytonutrient called verbascoside and is said to be able to reduce UV-light induced damage to skin, as well as control blood sugar levels.

Relaxants With increasingly stressful lives, manufacturers know relaxants, especially natural ones, are in demand. Lactium, for instance, is derived from milk protein and claims to help regulate chronic stress symptoms (such as weight gain/loss and sleep disorders), help one face stressful periods and optimise general well-being by boosting immunity and energy. Neuravena, meanwhile, is a patented wild green oat extract that is said to help with one’s mental fitness and stresscoping abilities.

WELLBEING 11 PERSONAL BEST

FROM THE EXPERTS

The news in grief: there’s no right way to deal with it ......................................................

Illustration: Martin Megino

Tara Patricia healthpost@scmp.com

How to stay the best of defriends ......................................................

Irene S. Levine healthpost@scmp.com In an article entitled “It’s not u, It’s me” (in last month’s New York Times Magazine), Benoit DenizetLewis describes a one-day crash course, called “Healthy Breakups”, held in July in Boston.

Sponsored by the Boston Public Health Commission in collaboration with Northeastern University, the conference aimed to help teens learn how to end a relationship nicely – as opposed to nastily, angrily or unthinkingly – when it has run its course.

The writer quotes one organiser as saying: “No one talks to young people about this aspect of relationships.”

Why hold such an event now?

With the rapid growth of social media, many adults are concerned about how easy it has become for someone to “defriend”, or to be “defriended”, with the click of a key on a computer or smartphone – regardless of the lasting emotional pain it may cause for the person being dumped.

But the truth is that handling a break-up is exceedingly difficult for everyone, irrespective of age.

And if children are looking to their parents for advice, or as role models for how to defriend with grace, they may be disappointed.

After surveying more than 1,500 women from the ages of 17 to 70 for my book, Best Friends Forever: Surviving a Break-up with Your Best Friend, I realised why friendship break-ups are intrinsically so messy.

1. Break-ups carry a great deal of social stigma because our society often judges people, especially women, by their ability to make and keep friends.

So when a relationship ends, people tend to see it as a character flaw – someone betrayed or let the other person down. This is rarely the case. People change and no two lives follow the same trajectory, so why don’t we leave room for the possibility that many break-ups are no-fault occurrences and that some friendships simply have expiration dates?

There are no simple rules for breaking up – except to do so in a way that is graceful and kind 2. Sometimes a relationship works for one person and not the other.

If you’ve been blissfully engaged in a friendship with someone you thought would be your best friend forever, there’s no easy remedy for not feeling like you’ve been dumped when you’re suddenly cut loose, often without warning. Onesided break-ups are especially hard to execute, discuss and accept.

3. We all have a natural reluctance to let go of something we know (even if

it isn’t particularly good) rather than risk the uncertainty of something new.

Many women I surveyed were afraid to let go of toxic friendships because they felt that everyone else was already paired up, like the animals on Noah’s Ark. Whether young or older, they felt it was too late to meet new friends. This is a strong disincentive to healthy endings and healthy beginnings.

4. As compared to marriages, there are no social rituals to fall back on that are associated with breaking up with friends.

Not to trivialise the pain and complexities of divorce, but at least there are some rules. Close friends usually encircle the person who is going through a divorce, but when someone loses a friend, people are reluctant to talk about what happened. Both the dumped and the dumper suffer in silence, feeling either shame or blame.

5. Unfortunately, any break-up has consequences that extend beyond the two people directly involved.

Very often, the friendship involves connections with other family members and friends. In the case of workplace friends, the break-up spills over to colleagues and coworkers.

There are no simple rules for breaking up – except to do so in a way that is graceful and kind.

Dr Irene S. Levine is a clinical psychologist and professor of psychiatry at the New York University School of Medicine.

There are only two guarantees in life: you are born and one day you will die.

Death, by its very nature, gives meaning to life. In all cultures all over the world, death is the part of life that gives us reason to find purpose, fulfilment and faith.

But despite being a universal phenomenon, no two people respond the same, because no two people are the same. Many factors go into creating our different responses to death. To better understand this concept involves a look at the ideas of love, grief, mourning, belief systems and culture.

Grief is a direct result of love.

When you love someone, you feel connected to that person. It is this very connection that leaves you vulnerable to experiencing grief when they are gone. Mourning is how you work through and outwardly show your grief; how you do so depends greatly on your internal beliefs and external influences.

Many factors go into making your internal belief system. This system is formed at a very early age by those around you and then develops over time through your personal experiences. How you view life, death and the afterlife are greatly shaped by your own internal programming.

For example, if you were taught as a young child that life is hard but in heaven all is easy, you may view death as relief. This viewpoint of relief may allow you to reach peace quicker as you believe your loved one no longer needs to struggle. If you are raised with the concept that there is nothing after life, then you may have a more remorseful attitude towards death as you may believe your separation is final.

How you perceive the life your loved one had also affects the mourning process. If you feel they lived a full life (which judging life as full or not greatly reflects on your internal beliefs), you may experience acceptance more easily than if you feel they were ripped away too soon.

Perhaps you hold the internal belief that life comes and goes all in perfect timing no matter the age or circumstance. If this level of acceptance is at the core of your belief system, your mourning period may be shortened.

The age at which you experience loss is also important because your beliefs develop as you mature. At a younger age, you are much more impressionable to those around you.

External influences such as family, culture and society also shape how you mourn and

In Western cultures it is more accepted to seek therapy and support groups outside of family than in Eastern cultures eventually overcome grief. As with anything in life, you live and interact within the parameters of your cultural and societal norms.

Your society and culture will have appropriate ways for mourning, seeking support and expressing your feelings.

For example, in Western cultures it is more accepted to seek therapy and support groups outside of family than it is in Eastern cultures. In some cultures, to speak of the dead at all is considered taboo.

In some cultures, certain family members may have particular roles they must play out regardless of their feelings, while in other societies there may be no prescribed roles at all.

There is no right or wrong when it comes to death. As humans we are complex creatures that think, feel and interact differently within our environment. It is this diversity we find in each other, even within the same culture, which allows us to experience grief and mourn our loved ones in so many ways.

Tara Patricia is an author and speaker in the field of self-transformation. She holds a master’s in psychology with advanced postgraduate studies in clinical and neuropsychology.