20110927 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, SEPTEMBER 27, 2011

HEALTH POST Not just a sport for the old, tai chi is attracting the young ones, too

>PAGE 4

Smooth moves AN ANSWER TO PAIN: EAST-WEST PHYSIO >PAGE 6

WHEN A CRAVING IS MORE THAN JUST A CRAVING >PAGE 8

2 NEWS HEALTH BITES ......................................................

Jeanette Wang jeanette.wang@scmp.com

Skin Republic This annual health exhibition on skincare returns next month.

Organised by the Medical Society of the Hong Kong University Students’ Union, the exhibition will have free public lectures by doctors on various skin-related topics, such as acne and psoriasis, as well as basic health checks. It will take place from 10am to 7pm at different locations each weekend, starting at Tsuen Wan Town Hall this weekend, Metro City Plaza II (Tseung Kwan O) on October 8 and 9, and finally Tuen Mun Town Hall on October 22 and 23. For more details, see www.skinrepublic.net.

ASK THE DOCTORS DR PETER KO

Brain gain Think you can’t teach a post-adolescent dog new tricks?

Think again. Research from the University of Alberta’s faculty of medicine and dentistry has dispelled the longheld belief that the human brain stops developing in the teens. In an imaging study of brain wiring, the scientists found that in 103 subjects aged between five and 32, structural changes were still happening well into their 20s.

Young adult brains were continuing to develop wiring to the frontal lobe, tracts responsible for complex cognitive tasks such as inhibition, high-level functioning and attention. The researchers speculated that this may be due to the many life experiences young adults face, such as tertiary education, starting a career and independence.

Q: I ran an ultramarathon, and both my big toenails have fallen off. Will they grow back? Will they ever be normal nails again? I hope I don’t have to give up sandals because I’m afraid to show my ugly toes!

Sleep off diabetes risk?

Getting a good night’s sleep – 71⁄2 to 81⁄2 hours per night – may stave off type-2 diabetes in obese teenagers, say paediatric researchers from The Children’s Hospital of Philadelphia. In the study, published in the journal Diabetes Care, the experts worked with 62 obese children with an average age of 14, measuring total sleep time, stages of sleep and glucose levels. They found that getting optimal sleep helped keep insulin secretion and blood sugar (glucose) levels stable – findings that were consistent with research in adults showing an association between sleep deprivation and increased risk of type-2 diabetes.

A: For long-distance runners, losing big toenails is fairly common. Most of the time it is due to micro-trauma and pressure effect from the sport shoes. This results in the nail plate falling off, but the bed that grows the nail remains intact.

As long as the nail bed is intact and normal, the nail plate will certainly regrow. Unless there is prior injury to the nail bed, the nail plate should grow back normally.

Nevertheless, there is an interesting point here: “ugly toes” are more easily found in frequent and long-distance runners. It can be the result of the alteration of the foot biomechanics, which leads to forefoot or toe deformity, including bunions (hallux valgus), hammer toes, keratoses, etc.

If you find the “ugly toes” become symptomatic and troubling, or if it disturbs your daily life, you may want to consider consulting an orthopaedic surgeon.

The surgeon will also assess whether the forefoot and toe deformities are the underlying causes of the loss of toenails.

Dr Peter Ko Put-shui is a specialist in orthopaedics and traumatology

APP OF THE WEEK

Want to live longer? Sit up straight and pay attention ......................................................

Katie McGregor healthpost@scmp.com Computer Ergonomics 99 US cents (for iPhone and iPad) Rating 8/10 I sit more than six hours daily at my desk, which, according to a study by the American Cancer Society, makes me 37 per cent more likely to die prematurely than women who sit fewer than three hours a day. In an effort to dramatically reduce my risk of premature death by desk job, I downloaded this app and realised my desk lifestyle was wrong in so many ways.

The app has two parts: the first provides a diagram and guidelines for the optimal seated position; the second is an animated video series of 16 exercises or stretches that you can do at or beside your desk.

The ways in which my desk, seat, computer and keyboard are arranged wrongly in relation to each other and my body are too many to list. I realise that having a laptop is a big problem.

The app suggests that while I’m working, my elbows should be bent at a 90-degree angle, my head should not tilt forward more than 15 degrees, and my knees should be slightly lower than my hips.

In fact, my chair is too low and can’t be raised, so my knees are higher than my hips; my shoulders are hunched up around my ears, so I raise my forearms to reach the keyboard; the elbow angle is closer

to 15 degrees; and because the screen is at desktop level, my head tilts forward like a cow eating grass.

The app suggests some standard stretches, such as shoulder shrugs, but also some that were new to me, like desk marching, which involves raising one leg at a time and swinging the arms while seated.

The animations are quite clunky, but at 99 US cents I’m not complaining. After all, this is a matter of life and death. > 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

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Wynnie Chan healthpost@scmp.com One man’s meat is another’s poison. That’s no truer than with the stonefish. Found in the shallow waters of the Pacific region, it’s considered the most venomous fish, with 13 dorsal spines, each connected to a pair of glands that are capable of producing potent venom when pressure is applied along its back.

Yet in some parts of Asia, such as Japan and Hong Kong, the stonefish – specifically the edible species Inimicus japonicus, or okoze – is prized as a delicacy, eaten either sliced raw, boiled or deep-fried. Cutting the fish is an occupational hazard for seafood handlers, and chef Lee Kau-kee (name changed to protect patient confidentiality) knew that.

One day while Lee, 50, was preparing the stonefish for a diner in his restaurant, he injured his left ring finger. Within 10 minutes, he was rushed to an accident and emergency department in Kowloon, where his painful and swollen finger was immediately immersed in hot water. This quickly resolved the redness, pain and swelling.

Three hours after the injury, Lee was admitted to the orthopaedic department. His symptoms – minimal, localised pain – seemed to be subsiding and approaching normal. His vital signs were stable, and blood and liver function tests were satisfactory. He was given two antibiotics, augmentin and levofloxacin, intravenously.

However, 16 hours after the injury, Lee’s entire ring finger and the back of his left hand had swollen badly. This caused acute carpal tunnel syndrome, which created intense pain and numbness in his whole hand.

Because of the enormous pressure underneath the skin, blisters developed on the ring finger.

Lee was diagnosed with stonefish envenomation.

Given the rapid local progression of symptoms in his injured finger and hand, Dr Samuel Ling Ka-kin, the attending accident and emergency physician, gave Lee 2,000 units of stonefish anti-venom intravenously. At the same time, open carpal tunnel release surgery was performed to relieve the swelling and compression of the median nerve in Lee’s hand.

The median nerve runs from the forearm into the hand and controls sensations to the palm side of the

Illustration: Angela Ho

Risky, fishy, painful business thumb and fingers. This nerve also conducts electrical impulses to some of the small muscles in the hand that allow the fingers and thumb to move. The carpal tunnel, which is a narrow passageway lined by ligament and bones at the base of the hand, protects the median nerve and tendons.

Gross swelling of Lee’s hand caused the median nerve to be compressed within the carpal tunnel. To reduce pressure on the median nerve, open release surgery was performed by making an incision in Lee’s wrist and then cutting the carpal ligament (a band of tissue) to enlarge the carpal tunnel.

Examination of the muscles and nerves in the hand during surgery showed that they were all free of infection and bacterial growth. The surgery immediately relieved Lee’s hand of swelling and improved circulation in his fingers and hand.

One week later, having made a good recovery, Lee was discharged from hospital. Three months later during a follow-up, the wound had healed, and Lee had regained full range of motion in all his fingers and wrist. “There was complete resolution of the pain and numbness with no intrinsic muscle weakness or atrophy,” Ling says.

4 COVER STORY

On a youth Tai chi comes in several forms and can be a vigorous or gentle form of exercise for people of all ages, writes Ben Sin

I

n the wide spectrum of martial arts, tai chi has perhaps the unfairest reputation. The common impression is that it’s what old people do at the park.

Susan Gu and Edward Ho Man-kui, instructors at the two largest tai chi groups in Hong Kong, beg to disagree. Both aim to raise awareness for the art form and each teach a diverse group of students as young as 17. But because they teach different styles of tai chi, that’s about all they agree on.

The origin of tai chi – meaning “great extremes” in Chinese – has suffered from a convoluted history that’s become murkier through generations. The core concept, a theory that believes in yin and yang (two opposite but complementary extremes) and the creation of inner strength (chi), dates back to thirdcentury China.

But the actual martial art form, known specifically as “tai chi chuan” (“chuan” meaning “fist” in Chinese), started in the early 20th century. That bit of the lore is just as controversial, with both the Yang and Chen styles claiming to be the originators of the art.

What is known is that tai chi, in any form, is beneficial to people.

Scientific studies have long connected the sport’s combination of controlled breathing, meditation and physical movements with health benefits such as improved heart condition, lowered blood pressure and relief from arthritis.

The most recent study, by University of California Los Angeles, reports that tai chi effectively treats depression in the elderly because the exercise helps release endorphins.

But there we go again with the old-people bit. It’s a stereotype tai chi may never shake, at least not until the art form gets the same type of exposure that the 2008 movie Ip Man did for wing chun. The last notable film to represent tai chi was 1993’s Tai Chi Master, starring Jet Li. The small group of dedicated practitioners in the city, however, is proof that it’s not just for the old.

On a warm Tuesday night at Kowloon Park, Gu – president of the Hong Kong Tai Ji Study Society (HKTSS, with “tai ji” the pinyin spelling) – and her assistant, Leung Kinhung, are teaching a class of about 30. It’s a diverse group, including a local woman in her early 20s and a Japanese housewife in her 30s. At first glance, the group

and their Chen-style form don’t look much different from the slow, methodical movements often seen performed by the elderly in the park. at dawn.

Gu, a gaunt mainland native in her mid-30s, waves her arms in circular motions. With bent knees, she brings her right leg forward and, in one fluid motion, sweeps the leg towards the ground into a squat.

Then, she goes back to a standing position, right leg slightly bent, palms open at chest level – a stance that screams “I’m ready to strike”.

“That’s the ‘oblique stride and twisting step’,” Leung says. “There are 56 forms to the Chen-style tai chi, and this was one set.” Forgive the awkward English translation; the Chinese terms for the moves are actually poetic and sound like they could be titles for a Bruce Lee film.

Before I begin, Leung pulls me

Old people learn it, young people learn it; this is an art that is good for the body and soul WILLIAM NG CHIU-KIT, TAI CHI INSTRUCTOR

aside for stretching, which focuses on the pelvic area.

“It’s the most important part of the body for tai chi,” says Leung, as he swirls his hips as if he’s in a bad 1970s dance video. Leung, in his late 30s, started learning tai chi under Gu after experiencing constant back pain. He says his back doesn’t hurt any more.

Others at HKTSS echo similar sentiments. Ritsuko Yanagita, a Japanese expat housewife, says the graceful, dance-like progression of meditative poses has helped ease aches all over her body, especially during “that time of the month”.

She finds the low-impact nature of the exercise ideal.

Dr Chan Kwok-ki, an expert in sports science and a Health Post advisory panel member, backs these statements, adding that tai chi’s main benefits are

COVER STORY 5

kick MASTER THE MOVES Hong Kong Tai Chi Association www.hktaichi.com The association itself has several instructors, including Edward Ho, who teaches group classes several nights a week at his Yau Ma Tei studio and private lessons at students’ homes. Group lessons are HK$600 per month, with private lessons HK$800 per month. Other instructors charge similar prices.

Hong Kong Tai Ji Study Society taiji.thecorner.org Taught by Susan Gu, HKTSS’ classes are split into different categories, with the foundation course costing HK$500 for four sessions. Prices go up with levels, peaking at HK$900 for four advanced sessions. Classes take place at Kowloon Park, Happy Valley and Tuen Mun at either morning or evening.

Hong Kong Tourism Board Tai Chi Class www.discoverhongkong.com Free of charge, these classes take place for one hour on Mondays, Wednesdays and Fridays at 8am at Sculpture Court in Tsim Sha Tsui.

Ben Sin

Edward Ho (far left) teaches at the Tai Chi Association; Susan Gu gives Ben Sin (above, right) a lesson in tai chi basics; boys perform at the 4th East Asian Games’ opening ceremony in 2005 in Macau Stadium (main photo). Photos: Robert Ng, K. Y. Cheng

enhancements to cardiorespiratory functions and muscle strength.

“Those are areas that many Hongkongers need [to] work on – regardless of age,” he says.

After stretching, I jump into the class trying to mimic Gu’s movements. But I soon find that even the simplest movement requires a high level of balance – balance I do not have.

Seeing my struggle, Gu offers to take me back to the beginning. She guides me through the most fundamental moves, such as “Buddha’s warrior attendant pounds a mortar”, which, despite sounding complicated, involves just shifting both arms from left to right, repeatedly.

Aside from sore knees, I didn’t feel very different after the session.

“You’re not going to see a difference

immediately after the first session; tai chi works from the inside out,” Leung says.

Gu first learned tai chi at 14. After spending her teens and early 20s in London for school, she returned to Shenzhen, where she worked as a journalist. She says the stress of the job kept her sleepless many nights, until she picked up tai chi again.

She’s since become one of the top advocates of the sport, winning several wushu awards.

In 2003 she moved to Hong Kong, where her husband works as a schoolteacher. She felt the need to start HKTSS to promote Chen-style tai chi, which she believes to be the original form.

The Hong Kong Tai Chi Association’s Ho, 53, doesn’t really agree. “The purest form of tai chi is the Yang and Ng style,” he says.

“Chen style has been promoted so

heavily that we purists have given up trying to argue lately.”

Ho says Chen style is high on theatrics, is “louder and harder”, and contains Shaolin kung fu elements. “It’s a mishmash of many different types of martial arts,” he says. “If you think of tai chi, in the smoothest form, it’s Yang style.”

As a child, Ho learned kung fu from his father, a martial arts exponent specialising in hung kuen (a South Chinese art mostly associated with legendary folk hero Wong Fei-hung). At 14, he switched to tai chi because he felt it was more “artful”. In the 1970s, when the Hong Kong government promoted tai chi with a citywide campaign, Ho was one of several providing demonstrations around the city.

“At the time, so many people wanted to learn, [but] we didn’t have enough teachers,” he says.

He concedes that tai chi has fallen behind in the martial arts pecking order in the past couple of decades. “It doesn’t help that even the Hong Kong Tourism Board promotes it as a sport for the old,” he says. “Still, the [Hong Kong Tai Chi Association] has a dedicated, diverse group of pupils who believe in the art.”

For the Tourism Board, which initially promoted tai chi as traditional kung fu, with dojos and sifus (masters) during the ’70s, they decided to take a different approach in 1998, by making it more of a cultural sport.

“Tai chi, to [the Tourism Board], is a perfect promotional activity because it’s got a distinct Chinese heritage and it can be simplified enough for anyone to pick up,” says William Ng Chiu-kit, 73. He and his wife, Pandora Wu, 64, are

spokespeople for tai chi for the Tourism Board. They were approached by the board in 1998 to teach a thrice-weekly tai chi course outside the Hong Kong Museum of Art in Tsim Sha Tsui.

“The idea was this free programme for tourists to join, as a way to experience Hong Kong culture,” Ng says.

A tai chi instructor for decades, Ng says they were told to teach Yang style due to its slower nature, meaning it’s easier to pick up. He says the classes are usually made up of young foreigners, but local senior citizens join in regularly, as well.

When asked about tai chi’s reputation as an old person’s sport, Ng is blunt with his answer: “Who cares? Old people learn it, young people learn it; this is an art that is good for the body and soul.” ben.sin@scmp.com

6 HEALTH Jenny Chan Lai-nga uses acupuncture as a treatment option in hardto-access areas

TRADITIONAL CHINESE MEDICINE

In physiotherapy, the twain do seem to meet ......................................................

Andrew Dembina healthpost@scmp.com “Oh, East is East and West is West, and never the twain shall meet,” writes Rudyard Kipling in his 1889 poem The Ballad of East and West.

Never did he get it more wrong than in the case of 21st-century physiotherapy in Hong Kong.

For the past few years, a few therapists here have mixed elements of traditional Chinese medicine (TCM) with their Western repertoire. I recently discovered this when I hurt myself at the gym.

My symptoms: numbness in one arm and hand, and pain and swelling around a shoulder and shoulder blade. The cause: a prolapsed upper spinal disc putting pressure on a nerve, plus three torn tendons around the shoulder area. I was ordered off to physiotherapy.

The first physiotherapist I saw was at a private hospital. She used electropad therapy, ultrasound and shortwave diathermy (a heat-generating machine), as well as some

From left: Wong Che-loong, Judith Gould and Alex Leung Ka-ho all combine elements of Western and Chinese medicine. Photos: Nora Tam

manipulations. Some of the machinery prompted more numbness and discomfort.

The second physio I saw, at a private clinic and recommended by my doctor, dished out similar treatments.

But at a small clinic, Perfect Pointe, run by Jenny Chan Lai-nga, I was offered acupuncture, alongside manipulations of the hand and elbow – which served to avert a potential spine operation. Chan, a certified practitioner of Western-style physiotherapy, had done a course in acupuncture to enhance her capabilities.

“I believe that traditional Chinese medicine can add some benefits that help certain injuries,” says Chan, who also uses cupping and scraping in some treatments.

With injured ankles, for example, it’s difficult to reach some areas with fingers, especially when there is a lot of deep scar tissue, she says.

Acupuncture can treat such spots easily and help release tension.

Australian native Judith Gould, a 25-year physiotherapy veteran, says Western therapists are now using needles to treat similar localised ailments. Her clinic, Posture Plus, offers “dry needling”, which she says is a relatively new technique outside China. It involves introducing fine needles into the skin and deeper into the muscles, fascia (connective tissue) and occasionally joints, tendons and bone/tendon junctions.

“Unlike acupuncture, which taps into meridian lines, this technique seems to help relieve stress build-up in joints and spasmed muscle,” she says.

Gould believes that good Western physiotherapy, like TCM, should be holistic (take into account a patient’s overall state of health). She began incorporating this belief into her practice 14 years ago by treating clients with a curative form of Pilates.

“A good therapist will treat as much of a person as they can, setting them ‘homework’ between sessions, such as exercises and stretches,” she says.

Alex Leung Ka-ho, a registered Chinese medicine practitioner at Kerry Fung & Associates Physiotherapy Services, begins every consultation with a check of the client’s pulse. He asks about general lifestyle and examines meridian pathways to evaluate qi – the vital life force – and blood circulation. “Then I press relevant acupoints to probe for the pathway conditions,” he says.

“Are they congested or smooth?

Strong or weak? This information helps me estimate the severity of the injury.”

He says most injuries are due to the body being too “cool” or “hot”. A deficiency of qi, and cool syndrome

or “blood stasis” (the abnormally slow movement of blood), are believed to lead to joint and muscle pain. In these cases, Leung says moxibustion (burning of compressed medicinal herb sticks) and cupping therapies are given at various acupoints to boost qi.

Rubbing also generates heat and is believed to enhance qi and meridian blood movement. It is a technique of tui na, a distinct TCM massage that includes alignment manipulation.

But despite the effectiveness of some TCM techniques, many people fear them, according to Manual Care Rehabilitation Clinic’s Wong Cheelong, a registered Western-style physio who is trained in acupuncture.

For example, scraping, a harder form of “rubbing” that’s done with a wooden spatula, can be useful to make muscles more relaxed but can be quite painful. “A lot of people don’t want to have it done,” says Wong.

Chan adds: “Many won’t allow cupping, as it leaves marks on the skin.” She says that’s a pity, as the technique is an excellent way to relieve muscle tension and stimulate the fascia.

Treatments and tools of the trade Western • Many therapies involve therapeutic massage, manual therapy, stretch and traction manipulation, electrotherapy, electric heat pads, diathermy (short-wave frequency electromagnetic) waves and administering ultrasound waves – to topical or related areas.

• Dry needling is a recent addition.

• Active exercise and/or stretching are recommended.

Chinese • All therapy focuses on balancing qi – the flow of inner energy and the “coolness” or “heat” in a patient. A massage and manipulation system called tui na includes rubbing techniques to generate heat, when necessary.

• Meridians – qi pathways and acupressure or energy points – are also manipulated, sometimes for local benefit but often to conduct relief or benefit to another part of the body, linked by meridians.

• In providing local or corresponding benefits, these are often used: suction cups (for cupping), dried medicinal herb sticks (for moxibustion) and acupuncture needles. Andrew Dembina

HEALTH 7 WOMEN’S HEALTH Dizziness is the least of a drinker’s problems.

Photo: Dustin Shum

Beware the booze binge ......................................................

Sasha Gonzales healthpost@scmp.com Friday night drinks are a ritual for a 33-year-old ad executive we’ll call Melissa Chan. After work, she gets together with her colleagues at a bar near their office. They usually stay on well past happy hour, ordering round after round of wine and cocktails.

Some nights, she takes advantage of ladies’ night specials at a bar downtown. On Saturdays, it’s beer with her friends all afternoon, followed by more drinks with dinner.

Chan is not alone in her drinking habit. According to the Health Department, alcohol consumption in Hong Kong women has increased slightly over recent years. In a study of 1,095 women conducted in 2004, about 0.6 per cent reported that they drank alcohol daily, while in a study of 1,091women done last year, that figure was 0.9 per cent. More women also reported that they indulged in alcohol four to six times a week.

Excessive alcohol consumption puts women at a high risk of alcohol-related dementia BRITISH JOURNAL OF PSYCHIATRY, 2008 STUDY

Binge drinking levels, however, have more or less remained constant.

In both studies, 1.6 per cent of the women said they binge drank at least once during the previous month.

It’s a habit that’s certainly catching on. A review of 31studies by researchers from Washington University’s School of Medicine, published in the journal Alcoholism: Clinical & Experimental Research, showed that the binge-drinking gap between men and women is also shrinking. Experts say more women are hitting the bottle as a means to cope with life’s increasing pressures.

Also termed alcohol intoxication disorder, it can be described as excessive alcohol consumption in a short space of time. The Health Department defines it as consuming five or more glasses or cans of alcoholic drinks on one occasion.

Binge drinkers drink until they feel “buzzed”, or drunk. Social drinking

sometimes overlaps with binge drinking, as the latter tends to occur in social situations.

Easily available cheap alcoholic drinks aren’t helping. But Daphne Wu, a freelance dietitian for Life Enrich Training and Consulting Centre, says that the local study conducted last year suggests that the changing roles of Hong Kong women are likely to be associated with increased drinking levels.

For example, women are now urban-based and have a high disposable income. Wu adds that peer pressure, family drinking history and working in a male-dominated environment can also be considered contributing factors.

One thing is certain: we live in a society that not only condones drinking, but also possibly encourages it. Alcohol consumption is so much a part of our culture that we don’t stop to question its dangers.

We associate drinking with winding down after a hard day’s work or having fun with friends. Some see drinks as a reward, and think nothing of having a few drinks with dinner or during a business lunch.

Top chefs are seen knocking back a glass or two while they work over a stove. There are also more wine appreciation and whisky tasting events now than before. Ladies’ night and happy hour specials make it easier for women to indulge, too.

“On average, I’d say I consume about 20 standard drinks a week,” Chan says. “I know that’s a lot, but I don’t drink until I pass out. I know my limits. I can tell when I’m about to get intoxicated and stop drinking right then, because I hate the feeling of being blind drunk and I certainly don’t like hangovers.”

The Health Department recommends no more than two units of alcohol a day for women, or 14 units a week. One unit is equivalent to a glass of wine or a pint of beer.

Binge drinking can lead to alcohol abuse or dependence in the long term, Wu says. And of course, there are the well-known dangers such as poor decision making, acute alcohol poisoning, injuries, cardiovascular diseases, liver diseases and impaired brain function.

The results of a study published in the British Journal of Psychiatry in 2008 also showed that excessive alcohol consumption (28 units per week over five years) puts women at a high risk of developing alcoholrelated dementia.

Alcohol can affect your looks as

well. Wu says that red wine, beer and cocktails contain carbohydrates and empty calories. A glass of piña colada, for example, which is made with milk, rum, coconut and pineapple juice, can contain as many as 500 calories – equivalent to 21⁄2 cups of cooked rice.

Moisture is important to keep skin soft, supple and looking healthy, but alcohol has been proven to have a dehydrating effect on skin, making it more prone to lines and wrinkles. It

also causes blood capillaries under the skin to dilate, so the more you drink, the more dilated these capillaries become, and the greater their likelihood of bursting. Excessive drinking can also deplete skin of vitamins and nutrients.

Moderation is the key when it comes to consumption. Red wine has been shown to offer some cardiovascular benefits, but it is important to consume this in sensible

amounts. The next time you’re tempted to have a tipple, monitor the amount you drink and try not to exceed the standard two units a day.

If you find that drinking with friends relaxes you, it might be wise to start thinking of alternative activities to reduce stress.

And, if you sometimes use alcohol as a reward, you might want to consider other ways to make yourself feel good.

8 DIET

Cravings If you have to satisfy that taste for something, nutritionists say, it may be your body trying to tell you something more important, writes Alex Gazzola

T

hey can come out of nowhere, and we’ve all experienced them.

Cravings – be they healthy or unhealthy, food or drink, common or unusual – are natural responses.

But what does a particular craving mean? Here are eight common food urges along with what the experts say they could mean for you, your health and your body.

Salt “This is quite a common craving, and is partly due to people eating a lot of ready meals,” says Shona Wilkinson, nutritional therapist at The Nutri Centre in London.

“Processed meals can be high in salt, so it becomes a case of wanting more of what you’re used to.”

Salt cravings could indicate a problem with the adrenal glands – important glands located just above the kidney that release several hormones responsible for various functions in the body, including regulation of blood pressure, the immune system and stress response.

An increase in stress causes a rise in adrenal problems, according to Wilkinson. Under severe stress, the adrenal glands don’t produce hormones in the correct amount.

One of these hormones is aldosterone, and the wrong amount of it can disrupt the body’s sodium balance at a cellular level. This may increase your sodium needs, and therefore lead to a salt craving.

Says Wilkinson: “If your craving is more than just an everyday,

average craving, it may be worth talking to your GP about it.”

In the long term, the way to tackle ordinary salt cravings is to cook from scratch – and hold the salt. For flavouring, experiment with herbs and spices – although you’ll find that after eating unsalted or less-salted food for a while, your taste buds will “recover” greater sensitivity to ordinary, natural flavours in unprocessed foods.

Milk and dairy “This could be psychological,” says Dr Marilyn Glenville (www.marilynglenville.com), nutritionist and natural women’s health specialist. “Milk is the food we’re given as babies and is often perceived as comfort food.”

But it may also be a little more than that. Warm milk has high levels of tryptophan, which has an antidepressant and calming effect on the body (which is why some people drink it before bedtime).

“Although it’s tempting to think of a dairy craving as having something to do with a calcium deficiency, it’s more likely to be for emotional and mood-improving reasons,” Glenville says.

“In some cases, there could be psychological reasons you should try to get to the bottom of.”

Red meat “This is a very common craving, and is usually associated with an iron deficiency, although it can also occasionally indicate a need for other nutrients found in meat, such as vitamin B12, folic acid and magnesium,” Wilkinson says.

DIET 9

and the code “Women in their 20s and 30s who may be vegetarian – which is becoming more and more common – are increasingly at risk of being iron-depleted.”

If you aren’t vegetarian, indulging a meat craving with a good quality and organic piece of red meat is fine. But if you are, you may not be getting enough iron.

Vegetarian iron sources include dried fruit and pulses, but they are still less easily absorbed than others.

Wilkinson recommends boosting iron absorption by taking vitamin C with iron-rich food, such as a glass of orange juice with your bean salad.

If you are worried about iron levels due to meat cravings, see your doctor for a blood test.

Sugar “A drop in blood sugar – called reactive hypoglycaemia – triggers this craving, where the body asks for a quick fix of sugar to alleviate the problem,” Glenville says.

Women with hormonal changes

as they approach menstruation may have this craving, she says, although the link is not fully understood.

Curbing the cycle of sugar cravings is about changing your eating patterns. “You need to eat little and more often so that you don’t go so long without food that your blood sugar crashes and your body asks for that quick sugar fix,” Glenville says.

She also recommends having good quality food, and to include protein in meals to lower its glycaemic index (GI). A low GI is beneficial as the body has to work harder to break down such food, therefore releasing energy into the blood slowly. This, in turn, makes meals more sustaining and prevents the spike in blood sugar.

Spreading out your daily food intake across five small meals instead of three bigger ones can help, too, Glenville says.

Chocolate This could be a simple blood sugar

craving in disguise, but Wilkinson believes it could sometimes indicate a magnesium deficiency, as chocolate is a good source of the mineral.

“There’s a strong link between chocolate cravings and magnesium,” she says. “A majority of people are short of magnesium, which has over 300 functions in the body, including to help build strong bones, regulate body temperature and release energy from muscles.”

It’s difficult to know what causes the craving. Wilkinson advises to try some dried fruit or an apple, first, to take the edge off the craving. That can sometimes be enough in the case of a sweet craving, but if only the real panacea will do, then choose wisely.

Pick dark bitter chocolate, says Wilkinson. “You can’t eat too much – it’s not that sort of food – and just a little bit will relieve your craving without compromising your health too much. It’s richer in magnesium than milk chocolate, too.”

Yeast-containing/fermented foods If you’re craving bread, Marmite or alcohol, this could indicate a candida (yeast) problem.

“We all have candida in the gut,” Glenville says, “and this is controlled by beneficial bacteria. But if you’re under stress, have had to take antibiotics, or are on the pill, it can knock out those beneficial bacteria – allowing the yeasts to become more dominant.”

Over time, the yeast can change form and get into the bloodstream, and result in thrush or a fungal toe infection, she says, or a craving for anything fermented or yeasty.

“Although recurrent thrush could be a symptom of diabetes, it could just be a yeast overgrowth,” says Glenville. A diet low in sugar and yeast, and probiotic bacteria and prebiotic supplements, can help.

Water Wilkinson says a raging, constant thirst could be an indication of diabetes, because the excess sugar in

the blood resulting from the disease causes the body to draw water from the tissues, leaving them dehydrated and triggering a craving for water.

“You could be drinking your recommended two litres a day, and not consider it a problem,” she says, “but if you find you’re just not satisfied by the amount of water you’re having and you have to have more and more, it’s important you see a doctor.”

Spicy food “There is a school of thought that this could be a zinc deficiency,” says Glenville. “Zinc regulates our taste and smell, so if zinc levels are low, these will be working inefficiently.

Your body will tell you to go for stronger-tasting foods because it is unable to taste blander foods.”

Zinc is important to the function of the immune system, skin health, and major hormones such as insulin and the sex hormones. It’s found in eggs, fish, dairy and pumpkin seeds. healthpost@scmp.com

10 FITNESS PREVENTION POSTURE

Tips for an upright stance ......................................................

Julie Deardorff Poor posture can make you look almost 5kg heavier. It could sabotage a promotion. And slumped or hunched shoulders are a major reason back pain affects most Hongkongers at some point.

“Poor posture isn’t just disrespectful; it will ruin your spinal health and leads to a dreadful life,” says Gloria Starr, an international business coach who teaches posture at her North Carolina finishing and etiquette school.

When your frame is aligned – meaning your heels, knees, pelvis and neck are stacked on top of each other – it moves more efficiently, can carry heavier loads, tires less easily and is less susceptible to strain or injury.

But the minute you sit down to update your Facebook page or drive to the store, you’ll likely drop your chin, tilt your head forward and round or hunch your shoulders.

This pulls your muscles and ligaments out of balance – some muscles grow tight while others become weak – leading to back and neck pain, headaches, fatigue and other problems.

Still, it takes years to develop slouched shoulder syndrome and vulture neck, conditions that can’t be reversed overnight. Simply increasing physical activity doesn’t necessarily help; when a person with bad posture becomes more active, it’s “like driving around with a crooked axle and hoping that the driving will straighten it out,” says Esther Gokhale, founder of the Gokhale Method, which treats chronic pain through postural adjustments.

Therefore, what people need is a routine – moves that can help them stand up straight. If you’re having pain, get your posture assessed by a physical or occupational therapist who can test muscle strength and flexibility, and make adjustments to your work station if you have a sedentary job.

The following exercises can also help strengthen the muscles that grow overused and tight.

The OJ squeeze When shoulders hunch, the muscles that stabilise the shoulder – the rhomboids and mid-trapezius muscle – become weak.

Try it: Pretend you’re holding an orange between your shoulder blades and try to squeeze it to make juice by bringing the shoulder blades (scapula) down and together, says physical therapist Paul Drew, the author of the book Red Carpet Posture. Hold for 10 seconds. You’ll also stretch out the front of your shoulders, which may be tight from slouchy desk posture.

The shoulder roll Hunching the back forward compresses the front section of certain spinal discs and squeezes the contents backwards, similar to squeezing one side of an “s” more, says Gokhale, author of 8 Steps to a Pain-Free Back. “Over time, this action wears and tears the fibrous exterior at the back of the disc.”

Try it: Move one shoulder forwards, upwards and as far backwards as you comfortably can without significantly moving your body. Gently slide your shoulder blade down along your spine. Your shoulder may settle farther back than usual. Repeat on the other side.

The five-minute rest The eyes are often overlooked when it comes to posture. Once they’re overused or fatigued, the head moves forward, taking us out of alignment, says Donna Eshelman, a Los Angeles-based Feldenkrais practitioner who teaches posture improvement to desk workers.

Try it: Lie on your back for five minutes. “Cup” your eyes by interlacing your fingers and placing the heels of your hands on your cheekbones and outer eyes to block out the light. This will help “oxygenate your fatigued muscles, improve breathing and restore your alignment,” says Eshelman.

Repeat once an hour.

Towel chest stretch To stop the shoulders rounding forward, stretch out the chest muscles and strengthen the midupper back, says fitness expert Tracey Mallett, a Pilates instructor and personal trainer.

Try it: Stand tall with your legs shoulder-width apart, holding a rolled-up bath towel – one end in each hand, says Mallett. Keeping the bath towel taut, reach the arms forward at shoulder height.

Exhale and pull the arms up and as far back as you can; you should feel a stretch in the pectoral (chest) muscles. Hold for two breath cycles and then return the arms back to shoulder height. Repeat five more times.

Plank Strong transversus abdominis muscles, which are the deep back and abdominal muscles closest to your spine, protect your discs and nerves from impact, says Gokhale.

Try it: Begin in a push-up position, with your arms straight.

Imagine a straight line from your legs through your torso to your neck. Don’t sag or lift your butt. If your shoulders are tensed towards your neck, roll them open, Gokhale says. Hold for up to a minute. This will “strengthen the muscles that keep your spine happy and lengthened”, she says.

Do devices help?

“Ergonomic training”, or teaching people how to sit at their desks, is one of the most common ways to improve posture. But can gadgets such as posture braces, posture clothing and even posture necklaces also help?

In general, postural supports or harnesses “can be a helpful reminder to not slump the upper body forward”, says Gokhale. The iPosture device, a microchip that clips to your shirt or a necklace and vibrates when you slump, could be useful for this as well, but there’s no evidence to show that it actually works.

The problem with many of the devices is that “they don’t improve pelvic position, which is the key to sustainable, healthy posture”, Gokhale says. “Ultimately, there is no product that can substitute for knowing what to do with one’s own

The pelvic position ... is the key to sustainable, healthy posture ESTHER GOKHALE, FOUNDER, GOKHALE METHOD

body. Devices can only be useful in conjunction with an education in healthy posture.”

One promising device, however, is a webcam that provides desk workers with pictures of how they currently look alongside a photo of their own correct posture. A study in the current issue of Applied Ergonomics found that use of the webcam, in conjunction with conventional training, resulted in sustained improvement. An effective intervention should be “a continuous process that provides frequent feedback”, say the Israeli researchers. McClatchy-Tribune

WELL-BEING 11 THE TASTE TEST LOW-SUGAR JAMS

Lam Nguyen surfing in Lombok, Indonesia, and Phuket, Thailand (below).

Photos: Anahi Frauenfelder

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Jeanette Wang jeanette.wang@scmp.com Enjoy Blueberry HK$35.90 for 310 grams, Great This jam has 70 per cent fruit and a good sweetness. But to taste it, you’ll need a spoon rather than a spread knife; it has a watery consistency that made my toast soggy.

Verdict: Too light – mixing it with some peanut butter will help.

Smucker’s Low Sugar Strawberry Preserves HK$26.90 for 291 grams, Great On paper this is a winner, with half the sugar and calories of regular preserves. But despite the morsels of mushy strawberry pieces, it has an artificial taste about it that’s more like drinking strawberry soda than eating the fruit.

Verdict: Decent taste, but I doubt I’ll buy this again.

FIT & FAB

A swell time on the water ......................................................

Jeanette Wang jeanette.wang@scmp.com

St Dalfour Deluxe Royal Fig Spread HK$31.50 for 284 grams, Great This is what all jams should be like – with a thick and spreadable consistency, natural sweetness and slivers of real fruit. This old French recipe has figs sweetened only with grape juice concentrate.

Verdict: Pass me another slice of toast; this is delicious.

If there’s anyone who gets upbeat when the weather is forecast to turn really foul, it’s Lam Nguyen.

As rain battered the city two weekends ago, the Vietnamese-born Swiss national surfed the swells at Tai Long Wan. “Lucky to be alive, free and in these beautiful surroundings,” he wrote on his Facebook wall.

“Generous skies, clear water and a slow sunset.”

Monsoon and typhoon seasons are happy times for Lam, 33, his wife and a group of friends. On weekends, they regularly haul their boards and hike 90 minutes to the secluded beach on Sai Kung’s east coast, surf all day, have a barbecue on the beach, camp overnight, wake up with the sunrise and surf again.

In the afternoon, they make their way back to town for an evening of opera, theatre or movie, followed by a nice dinner to cap off what Lam calls “a perfect weekend”.

Don’t believe you can surf in Hong Kong? Neither did I until I saw Lam’s self-shot YouTube video of himself riding crashing waves under threatening skies in Tai Long Wan. It will either make you shudder at the danger of it all or make you want to get out there yourself.

How did you get started in surfing?

I always saw surfers in Big Wave Bay, so I simply rented a board and tried by myself. Hong Kong is one of the rare cities where you can have a cultural life, dynamic business environment and surf spots.

What do you enjoy about it?

It’s a mix. It’s about being in nature: this sport doesn’t require any machine nor sport court, it’s just you

and your friends on surfboards, rocked by the sea with birds flying and fishes jumping around you. Then I like having to observe and to understand elements such as wind, tide, swell, etc. But what is very specific to surfing is this unique feeling when riding a wave: adrenaline and Zen at the same time.

Ultimately, surfing is nothing more than riding the earth’s energy.

Where do you ache most after a day out on the water?

The upper back. I soothe it with a good massage, at best right on the beach.

How else do you keep fit?

Basically I try to do at least an hour of sport every weekday, be it swimming, running or going to the gym. I prefer to do a little bit regularly rather than a lot but rarely. I mostly build my training around surfing – for example, standing on a bosu ball while lifting light weights to improve my balance and stability.

I also try to eat healthily. If I have a huge unhealthy dinner, I’ll eat less the next day. My philosophy is to keep a healthy balance. The body is not meant to sit 12 hours a day behind a desk, so I use every opportunity for physical activity.

There’s a stereotype that surfers are beach bums escaping capitalist culture. Is that true in Hong Kong?

Actually it’s a very wrong stereotype.

Surfing is technically difficult and physically very demanding. It’s also an early morning sport: surfers wake up at 5am to go surfing. So a surfer has to be disciplined, persevering and hard working. Beach bums don’t surf.

My surfer friends here are entrepreneurs, bankers, engineers, CFOs, designers and professors.

The swells here in Hong Kong don’t seem big enough to surf.

That’s because you’ve never been in Hong Kong waters during a typhoon!

Actually the swell is very consistent in the winter thanks to the northeast

monsoon. In summer we have to rely on swell generated by tropical storms and typhoons.

Do you ever approach a swell with fear?

I’d say it varies between respect and terror. Some spots can be really scary, with powerful waves smashing on shallow water with a razor-sharp reef underneath, not to mention strong currents and rocks nearby. But that’s why surfing is exciting: either you get eaten alive by this pure energy vortex or you ride it.

Interestingly, I have never been injured at such spots, only on “easy” ones when I wasn’t concentrating and took it too easy. I remember once after having proudly mastered a big session, I went straight into a reef which was hidden by the high tide. I ended up with broken fins, a dinged board and deep leg cuts.

Any thoughts of becoming a pro surfer?

I wish, but I should have started 20 years ago. Maybe my child will be.