20111011 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, OCTOBER 11, 2011

HEALTH POST CAN CHINESE MEDICINE HELP NOSEBLEEDS? >PAGE 8

THE TRUTH ABOUT TONING SHOES

Photo: Stanley Shih

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For a lifetime of well-being, follow the right diet in your prime years

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Eat your age

2 NEWS HEALTH BITES

ASK THE DOCTORS DR MICHAEL CHENG

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Jeanette Wang jeanette.wang@scmp.com

Q: I have a bad habit of peeling the skin around my fingernails until the skin is raw and painful. I try to make a conscious effort to stop but somehow I keep doing it without thinking. What can I do to about it?

From iPhone to cell phone Here’s a new use for the iPhone to add to its already long list: a medical-quality imaging and chemical-detection device.

Using materials that cost about the same as a typical app, researchers at the University of California, Davis, have decked out the phone’s camera to turn it into a microscope capable of identifying different types of blood cells, and a simple spectrometer that could help diagnose chemical markers of future disease. The enhanced iPhone could help doctors and nurses diagnose blood diseases in developing nations where lab equipment may be limited or unavailable. It could also allow real-time data to be transmitted for further analysis and diagnosis.

A: Your problem is essentially a form of obsessive-compulsive behaviour.

These are actions that you do repeatedly and cannot seem to control yourself – even when they may cause harm.

Typically they are worse when you are under stress. Treatment is often difficult otherwise you would have stopped doing it by yourself.

Usually, I recommend seeing a clinical psychologist for advice. If the problem continues and the self-harm gets worse you will need to see a psychiatrist for help.

Dr Michael Cheng is a family doctor

APP OF THE WEEK The way to a spotless mind Some soap and water could be good for your psyche, according to a literature review by University of Michigan researchers published in the journal Current Directions in Psychological Science. By cleansing or just thinking of the act, researcher Spike W.S. Lee says, “people can rid themselves of a sense of immorality, lucky or unlucky feelings, or doubt about a decision. The bodily experience of removing physical residues can provide the basis of removing more abstract mental residues.” For example, in one study reviewed, participants who washed their hands after a bad streak in gambling started to bet higher stakes, suggesting they thought they had “washed away” their bad luck.

Relish your fitness If lean and ripped is your thing, try eating more mustard. The plant contains homobrassinolide, which, when fed to rats, triggered a response similar to anabolic steroids, with minimal side effects. The study,

by North Carolina State University scientists, also found that the stimulatory effect of the substance on protein synthesis in muscle cells led to increases in lean body mass, muscle mass and physical performance. In their report in The FASEB Journal, the researchers say they hope the substance may one day provide an “effective, natural and safe alternative for ageand disease-associated muscle loss”.

Leaner living down to a tea Having green tea with that fast-food lunch may be the saving grace for the meal. In a study published online in the journal Obesity, researchers at Penn State found that obese mice fed EGCG, a compound found in most green teas, along with a high-fat diet gained weight 45 per cent more slowly than mice eating the same diet without EGCG. The findings also suggest that the compound reduces the ability to absorb fat and enhances the ability to use fat. The mice in the study had the equivalent of 10 cups of green tea daily, but the researchers say just a few cups could help control weight.

How to make running a walkover ......................................................

Katie McGregor healthpost@scmp.com Jeff Galloway’s Ultimate 10k US$2.99 Rating 10/10 Entering the 10-kilometre Unicef Charity Run 2011 seemed a fine thing to do after a glass or two of wine with friends. After all, thanks to the C25k and Runmeter apps, I am now capable of running a reasonable five kilometres when the wind is in the right direction.

I chose Jeff Galloway’s Ultimate 10k to help me with this new challenge. I was intrigued by the app’s beat-sync technology, which promised to adjust the tempo of my music to get the best results out of me. As a bonus, it turns out that Jeff Galloway is a running legend and renowned trainer, and he favours a run-walk-run training method similar to the one I followed in the C25k app.

The programme appears well constructed, with three runs a week over a 13-week plan. The pattern is two shorter runs followed by a longer run so that, surprisingly, Galloway has you run-walking 9.1 kilometres by the end of week three.

But you are always in control. You can adjust the tempo as you run, and alter your run-walk ratio: a relaxed 10-second run to 50-second walk goes up to a 20-second walk to sixminute run. At the worst, I know I can manage a 9.1-kilometre walk.

I was intrigued by the app’s beat-sync technology .... As a bonus, it turns out Jeff Galloway is a running legend

On my first run, I found it hard not to laugh out loud when the beatsync technology slowed my favourite running songs into ballads in the walk sections, and gave my slower music a ’70s disco beat on runs.

But it worked. Even though I selected a ratio of one-minute walk to three-minute run, I outpaced my usual plodding pace. My body also felt thoroughly exercised, and that was a good feeling.

Galloway makes an excellent coach as he assures you that walking doesn’t mean you’re quitting. “Is it better to be strong in the first mile, or the last mile? … Take your walk breaks early and often,” he advises.

He explains that this method has helped thousands of beginners train for and complete distance runs faster and without injury.

Notes: the app can also be used by 10k runners to improve their speed; there are free downloadable power songs and motivational audio from Jeff; the dashboard shows you all kinds of information including time elapsed, time to go, distance elapsed, distance to go and so on.

You can delete songs from your playlist that don’t work with the beat-sync.

> 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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Eileen Aung-Thwin healthpost@scmp.com Retirement can be the start of a whole new relaxing phase of life or a chance to pursue dreams sacrificed for a lifetime of toil. For others it casts a pall over their sense of worth as a productive member of society and can lead to depression.

Hence, when newly retired Ng (whose full name has been withheld for patient confidentiality reasons) attended a private doctor at the age of 60 because of increasing forgetfulness, he was cast in the latter group.

The doctor dismissed Ng’s slight memory loss as a symptom of emotional issues related to retirement after more than 30 years in government service. Adding to Ng’s possible emotional strain, his

Ng could not recognise his family … previously loving and cheerful, he was now sullen and would spit indiscriminately mother had recently passed away.

Just to be sure, though, the doctor had blood tests carried out and found that Ng had a vitamin B12 deficiency, which can contribute to memory loss.

He gave Ng oral B12 supplements and referred him to a public hospital for a follow-up.

By the time of Ng’s appointment four weeks later, his condition had deteriorated drastically.

His anxious wife and children had brought him in for his appointment and the doctor knew that information loved ones could provide about a cognitively impaired patient could be key to an accurate diagnosis. So he listened carefully as the family told of the alarming changes in Ng. For one, his memory loss was now so severe that he could not recognise his wife and children or remember their names.

Ng’s personality had also undergone a stark change – previously loving and cheerful, he was now sullen and irritable. He would even spit indiscriminately.

He could no longer control his

bladder or bowels, nor could he feed or bathe himself. Ng had also started walking clumsily and needed the aid of a walking stick.

Although Ng’s wife was worried that he had dementia, the doctor noted that the combined symptoms – memory loss, personality change and physical impairment – within a period of just two months were danger signs that something else could be wrong with Ng’s brain.

Ng was suspected to have a brain tumour and was referred to the Accident and Emergency Department of the Prince of Wales Hospital in Sha Tin for urgent investigation.

A computed tomography (CT) brain scan confirmed that a tumour some 5cm in diameter had grown in Ng’s left frontal lobe.

The frontal lobe houses a person’s personality, explaining the drastic changes in Ng. A tumour of this size would likely have been growing inside Ng’s brain for some years. However, his symptoms did not appear until the tumour was large enough to exert pressure on the brain tissue.

Luckily, the tumour was in a fairly accessible part of the brain and was operable.

Eight days after Ng’s admission, doctors performed a craniotomy to completely remove the growth.

After the surgery, doctors confirmed that Ng had an atypical meningioma, which accounts for 7 per cent of tumours that originate from the meninges, or membranes covering the brain and spinal cord.

Although most meningiomas are benign or non-cancerous, atypical meningiomas can be malignant.

They grow slowly like benign tumours and can recur.

Meningiomas in general account for 15 per cent of brain tumours.

Because they often have welldefined edges, it is often possible to remove them completely.

Although not every brain tumour needs to be removed immediately, the growth in Ng’s brain was creating debilitating symptoms and required excision. Ng has now fully recovered from his operation.

A long-term relationship with a family physician can often be helpful in early detection of illnesses, especially cognitive-related ones.

Knowing a patient’s history and disposition could help doctors assess whether one is prone to depression or other mental health conditions, or if personality changes may be caused by physiological problems.

Illustration: Angela Ho

Changed man had something on his mind

4 COVER STORY

Nature takes

As you grow older, your body acquires an appetite for different nutrients.

Michelle Tchea guides you on a dietary journey through the ages

A

s our biological clock counts down, it’s difficult for even the most fearless junk food eater to ignore how his or her body reacts with time.

The process of ageing can demand more than just changing your wardrobe and investing in expensive creams to hide inevitable wrinkles.

What you put in your mouth can effect your health.

Ruth Chan, research associate from the department of medicine and therapeutics at Chinese University, suggests that apart from adopting a balanced lifestyle and maintaining high activity levels, regular meal times, eating at home and following a diet low in fat, sugar and salt can also help make for a smoother transition with age.

“Almost 85 per cent of all diseases are caused by lifestyle choices,” she says.

Candy Wong Sze-man, an accredited practising dietitian and executive committee member of the Hong Kong Dietitians Association, adds: “Only 5 per cent to 10 per cent of cancer cases are inherited; eight out of 10 cancers are closely linked to diet, smoking and lifestyle. A study headed by the World Cancer

Research Fund shows that about one-third of cancers can be prevented by maintaining a healthy weight, eating healthily and staying physically active.”

Doris Lau, an accredited dietitian with the United Christian Nethersole Community Health Service, recommends feeding the body with good nutrients and vitamins as early as during adolescence. “Ageing is a natural process, yet, with good nutrition, ageing can be delayed,” she says.

Different stages in life, however, require specific nutrients as the body changes. Here’s what you should be focusing on, depending on your age.

In your 20s Key nutrients: calcium and vitamin D With the body’s metabolism at its peak, this decade is the best time to eat what you want, when you want – but it’s easy to become slightly complacent and forget about the dangers of a poor diet. The importance of eating healthily is often overlooked in the busy transition from carefree adolescence to the rigours of adult life – work,

Only 5 per cent to 10 per cent of cancer cases are inherited; eight out of 10 are linked to diet, smoking and lifestyle CANDY WONG SZE-MAN, DIETITIAN

socialising, dating, getting married, or even starting a family. For the busy and stressed, takeaway food becomes an easy and efficient option, though not the most nutritious one.

Carmen Lo, a registered dietitian and Health Post advisory panel member, stresses the importance of a well-balanced diet from early on. “I have seen children with early diabetes and those in their 20s with heart failure because of their unhealthy and sedentary lifestyle,” she says.

A healthy diet at this stage will ensure minimal problems for the later phases of life, where diseases are more prevalent. Lo says dietary supplements are not necessary; balanced meals, maintaining healthy weight and limiting alcohol consumption are good enough.

In particular, it’s an important time to build stronger bones and muscle by consuming more calcium. “In our 30s, bone loss begins, which can be slowed down if calcium supplies are met,” Lo says.

Have more leafy greens and dairy products, such as milk and cheese.

According to the International Osteoporosis Foundation, many

COVER STORY 5

its courses Hongkongers take only 450mg of calcium daily, far lower than the recommended 1,000mg. The foundation notes that a lack of calcium, coupled with inadequate levels of vitamin D (which helps with calcium absorption), is associated with low bone mass, whereas consuming fruit and vegetables with high calcium has been shown to help with good bone health.

“If sufficient calcium levels are not met, the body pulls nutrients from the bones, which diminishes bone mass more greatly,” says Dr Edith Lau, Asia-Pacific director of the Centre for Clinical and Basic Research. She stresses that calcium alone is not enough to prevent disease. “The body requires vitamin D and protein combined with weight bearing exercise.”

With men, especially, muscle building hormones such as testosterone are at their highest in their 20s. The foundation states that trying to replenish these lost calcium sources in your 30s will be too late.

It’s not difficult to get your fill: just two 240ml glasses of vitamin Dfortified low-fat milk daily will give you 581mg of calcium and five micrograms (mcg) of vitamin D.

Then top it up by including tofu, broccoli or salmon in your meals, and snacking on almonds, yogurt or dried figs.

In your 30s Key nutrients: folate, iron and phytonutrients Trying to juggle the demands of a career and children can make this decade of life extremely overwhelming.

For those planning to have children, every nutrient is important, but folate is vital during early pregnancy, Chan says.

“Malformations during childbirth can be minimised with enough folate in the diet,” she says. The nutrient supports a healthy pregnancy, prevents neural tube defects and helps the body make new cells. Those who don’t want children should still invest in folaterich foods – high intake of the nutrient may reduce colorectal cancer risk, according to a recent study published in Gastroenterology.

To get your 400mcg daily need, try fortified breakfast cereals, baked beans (60 mcg per cup) or asparagus (85mcg per four spears).

The effects of daily stress are probably starting to show up through fine lines on the face and a suppressed immune system.

Loading up on antioxidant-rich phytonutrients can help slow the ageing process and ward off heart disease. Chan adds: “There’s a wealth of evidence that shows a diet rich in phytonutrients, can prevent, or at least delay, the onset of cancers and other diseases.

Your diet should have a variety of coloured vegetables, since each vegetable and fruit offers a different phytonutrient to fight specific diseases.” Chocolate is another option – recent research published in the Chemistry Central Journal found that the sweet treat is a rich source of antioxidants and contains more polyphenols and flavanols than fruit juice.

Lastly, if you’re feeling physically and mentally drained, try topping up your intake of omega-3s – excellent sources include salmon, flax seeds and walnuts. A recent study on healthy young people found that consuming more fish oil, which is rich in omega-3, can reduce both anxiety and inflammation.

In your 40s (and beyond) Key nutrients: fibre and protein In this decade, the average person loses 250g of muscle mass and gains 500g of fat each year. Every kilogram of muscle uses about 12 calories a day just to sustain itself, while each kilogram of fat burns only four calories daily, metabolism goes down and weight typically goes up.

“As we age, muscle mass decreases and so does our motivation to exercise. Despite this, we keep eating the same amount of food we consumed [in our younger years],” says Bernice Cheung Ho-ki, registered dietitian of the Centre for Nutritional Studies at the Chinese University’s faculty of medicine. The best way to beat this trend, says Cheung, is to start healthy habits from a young age. But if you didn’t, there’s still hope.

Fill up on protein, fruit and vegetables; and fibre can help, according to Leslie Bonci, a registered dietitian and author of the new book The Active Calorie Diet.

She writes that protein (one quarter of your plate) can boost post-meal calorie burn by 25 to 30 per cent; fruit and vegetables (one half of your

plate) by 20 per cent; and fibre (one quarter of your plate) by 10 per cent.

Protein also helps in building muscle, while fibre makes you feel fuller for longer and also helps decrease cholesterol and risk of heart disease.

Try eating “energising” foods.

According to Bonci, green tea contains caffeine (a known metabolism booster) and catechins, an antioxidant that raises resting metabolism by 4 per cent. Dark chocolate contains both substances, but stick to a small serving each day to limit your fat and calories.

Remember to keep getting your daily need of calcium and vitamin D, especially women. With the onset of menopause and declining oestrogen levels, the body absorbs less calcium from the diet and loses more bone mass, which could lead to osteoporosis-related fractures.

Overall, the World Cancer Research Fund suggests a lower intake of salty, fatty and sugary foods to stay healthy well into your 50s.

Says Chan: “The most important thing is to adopt a healthy lifestyle and not get obese, since this is an underpinning factor to all diseases.” healthpost@scmp.com

6 HEALTH BEAUTY HAIR

Heading for a fall Treatments and a balanced diet can help people reduce hair loss.

Photo: Corbis

Taking measurements

1.3

The average growth rate, in centimetres per month, of hair

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Sasha Gonzales healthpost@scmp.com Stress can have devastating effects on your physical and emotional health, from weight fluctuations and mood swings, to insomnia, anxiety disorders and an increased susceptibility to colds. If you’re under severe stress, you may also experience significant hair loss, also known as telogen effluvium.

The average scalp contains about 100,000 hairs; it is normal to lose about 50 to 120 a day.

Extreme stress, however, can interrupt the hair’s growth cycle – your hair stops growing and “rests” for a while, only to fall out a couple of months later and typically in clumps.

Apart from stress, your hair may fall out as a result of hormonal changes from pregnancy, major surgery, certain medical treatments like chemotherapy, medication (such as vitamin A, antidepressants, birth control pills, or drugs for high blood pressure), fungal infections (such as those of the scalp), or underlying illnesses such as diabetes or lupus. Hair loss in these cases is temporary; normal hair growth usually resumes once these interruptions to the growth cycle are minimised or stopped.

Hair loss as a result of ageing or genetic factors, on the other hand, is permanent. According to Gary Chow, managing director of Nu/ Hart Hair Solutions, both male pattern baldness (also called androgenetic alopecia) and female pattern baldness are genetic and, therefore, inevitable.

More men than women suffer from

this form of hair loss, which is related to the production of certain hormones and their effect on the hair follicles.

Jonathan Tang, managing director of HIS Hair Clinic, agrees that nothing can bring your hair back once the follicles are dead.

“Unless you have alopecia, which might be due to stress or a medical condition, your hair isn’t going to grow back. Lotions and potions generally don’t work and are a waste of money, although there are a couple of brands on the market that do slow down hair loss,” he says. Tonics, herbs and pills are also ineffective at making hair grow again.

If you’re lucky enough to have a full head of hair, you can keep it looking lustrous with a balanced diet. Charmain Tan, registered dietitian at Seventeen Nutrition Consultants, says hair needs protein, iron, omega-3 fatty acids, zinc and a very small amount of vitamin A to stay healthy and strong. “Very low-calorie diets are often lacking in essential nutrients and can stunt hair growth or leave hair dull and limp,” she says. “If the nutritional deficiency is significant enough, such as in the case of someone with an eating disorder, hair can fall out.”

Iron helps red blood cells carry oxygen to the hair follicles, and the best sources of this mineral include lean meat, spinach, tomatoes, beans, lentils and bran. “It’s been well-established that women suffering from hair loss or baldness have low levels of iron in their blood,” Tan says.

Zinc deficiency not only causes hair loss, but also a dry and flaky

scalp, so it’s important to consume zinc-rich foods, such as oysters, red meat, seafood, whole grains, beans, nuts and dairy products.

Foods such as salmon, sardines and other oily fish, and walnuts, have high amounts of omega-3 fatty acids, which help to keep your strands shiny. “Foods that are good for your hair are also good for your heart, so you get extra benefits from consuming them,” adds Tan. If you’ve been diagnosed with male or female pattern baldness,

Foods that are good for your hair are also good for your heart, so you get extra benefits CHARMAIN TAN, DIETITIAN

no amount of good food can cause your hair to grow back again; however, there is hope in the form of a hair transplant. This treatment, which is performed at Chow’s Nu/Hart clinic, involves removing follicular units from the donor area, such as the back or sides of the head, and placing them in the thinning or balding area.

According to Chow, the donor areas are not susceptible to hair loss, which means that, once their follicular units have been transplanted to the thinning or balding area, your hair will grow back naturally, and continue to grow back for the rest of your life.

“Most of our male clients are in their mid-30s, while our female clients are in their late 30s to 50s,” Chow says. “We’ve also had a few clients in their early 20s with extreme hair loss.”

At HIS Hair Clinic, a special MHT (Micro-Hair Technique) scalp pigmentation treatment is performed to give men the appearance of a short, cropped hairstyle. Think the “close-shaved, stubbly head” look. This innovative procedure uses a combination of cosmetic pigmentation and artistic techniques, and does not involve surgery or hairpieces. There is no scarring, either. The treatment is ideal for thinning hair, a balding crown, complete hair loss or hair loss due to alopecia, and lost hairlines or sideburns.

“This treatment is performed just once,” Tang says. “It lasts a few years and then you have the option of topping up the pigment to refresh the look. You can even alter the appearance of your ‘scalp stubble’ several years down the road. We can remove some of the pigment on your crown using a modern sonic laser.”

Stem cell technology might be the next big thing in hair restoration procedures. This involves producing hundreds of hair follicles from just one donor follicle. In tests, bald mice grew hair after being implanted with these cloned hair follicles.

However, “there’ve only been trials on mice so far, none on humans,” Tang says. “If the human trials go well, it’ll be another five-plus years before the procedure is available commercially, but it’ll definitely be very expensive.”

8 HEALTH In TCM, overheated blood can cause nosebleeds

NUTRITION

That’s a lot

TRADITIONAL CHINESE MEDICINE

If you can’t walk away from a bloody nose, it’s time to cool down ......................................................

Rose Tse healthpost@scmp.com Occasional nosebleeds are common. The nasal lining is rich in tiny blood vessels, which are fragile and sensitive. When the air is too dry or if you blow your nose vigorously, nosebleeds can easily result.

Even though they are a nuisance, they are usually not a sign of any serious medical condition.

Most nosebleeds can be handled at home. First, sit upright, lean forward and breathe through your mouth. Then blow your nose to clear out any blood. Next, pack your nose with cotton or gauze and squeeze the soft part of the nose shut for 10 minutes. If the bleeding does not stop, apply fresh packing and pressure for another 10 minutes.

Remember that the ruptured blood vessel needs seven to 10 days to heal completely. Do not pick your nose or knock the scab off during this period.

If you have frequent nosebleeds, or if the bleeding is heavy and hard to stop, you should call your doctor. Medical conditions that may cause nosebleeds include allergic rhinitis, sinusitis, infectious diseases, hypertension and bleeding disorders that need clinical tests to differentiate.

If clinical examination rules out any physical cause for your nosebleeds, try traditional Chinese medicine for relief.

In TCM, nosebleeds are attributed to overheated blood, and they are usually treated with cooling herbs such as couch grass rhizome (bai mao gen), hairy vein agrimonia (xian he cao), common bletilla tuber (bai ji) and oriental arborvitae leafy twig (ce bai ye).

Persistent or recurrent nosebleeds may indicate internal disharmony. Physicians will consider the characteristics of the bleeding and the overall condition of the patient when identifying a disharmony pattern.

For example, bright red nasal bleeding, extreme dryness and a burning sensation in the nasal

passages are associated with lung heat disharmony that often occurs during the dry season or with a common cold.

Profuse nasal bleeding with bright or dark red blood may indicate stomach heat that tends to occur in those who consume too much greasy and spicy foods, or alcohol.

Hypertensive individuals may bleed a deep red colour, along with having a headache, blurred vision, a bitter taste in the mouth, a red face, bloodshot eyes and irritability. These symptoms indicate a liver heat disharmony. If bleeding is persistent but mild and accompanied by bleeding gums or purpura (purple spots or patches on the skin), a spleen deficiency may be present.

For some females, nosebleeds follow the hormonal fluctuations of the body. In TCM, this is mainly because of over-heated blood or a qi (vital energy) disturbance in the pelvic region that forces the blood flow to the upper body and out of abnormal pathways. Individuals with this problem may experience decreased menstrual flow or missed periods.

If the underlying cause of a nosebleed is not due to a bloodclotting problem, acupuncture can be effective. Because nosebleeds are thought to be nature’s way of draining excessive heat from the body, acupuncture can help eliminate the heat by working on appropriate body points.

For those who have a tendency to get nosebleeds, a healthy lifestyle should be maintained.

Staying up all night, alcohol consumption, cigarettes and mental stress can easily trigger nosebleeds. It is recommended to avoid hot spicy foods and eat more cooling foods, such as Chinese cabbage, lotus root, tomatoes, loquat fruit, water chestnuts, Chinese radish, pears and aubergines. It goes without saying that staying calm and getting enough rest also make a difference.

Rose Tse is editor of shen-nong.com, a subsidiary of Integrated Chinese Medicine Holdings.

Watch what you eat 1 Serving size

1

This is determined by the product’s manufacturer, but as registered dietitian Sally Poon (www.personaldietitian.com.hk) notes, “that may not be the exact amount that you consume”. For example, a serving of biscuits (supposedly five) may be 100 calories, but if you are someone who eats 15 in one go, that’s 300 calories.

2 Calories from fat

2

3 % Daily value

Each gram of fat gives 9 kilocalories of energy, while one gram of protein or carbohydrate gives 4 kcal. Don’t be fooled by low fat claims made on such products as frozen yogurt. Poon says sugar (and hence calories) is added to make up the taste.

3 4 5 6

4 Total fat

7 8 9 10

Although some trans fat occurs naturally in animal-based foods, most is created during food processing (e.g. in fried food and bakery products) through the partial hydrogenation of unsaturated fats. Eating too much of it increases the risk of heart disease, says Poon.

8 Carbohydrate Carbs are the body’s main energy source.

They may be complex – found in starchy foods like potatoes – or simple, such as sugars. The Australian Institute of Sport recommends a person who does minimal physical activity eat 2-3 grams of carbs per kilogram of body mass daily.

5 Saturated fat

The body needs some fat to help it absorb essential vitamins, maintain the structure of cell membranes and keep the immune system working. Aim for a maximum of 60 grams of total fat intake daily. Of this, cap saturated fat at 20 grams and trans fat at 2.2 grams.

6 Trans fat

9 Sugar This may be natural, such as that in fruits, vegetables, milk and some grains, or processed, such as in jams, cakes and drinks. Aim for no more than 50 grams of sugar daily.

This shows how much of the recommended amount of a vital nutrient is contained in one serving of the food. Eat no more than 100 per cent of each nutrient daily.

This is found in animal products, such as red meat, poultry and whole milk products, and foods made with tropical oils like coconut or palm. Saturated fat may increase your risk of heart disease and type-2 diabetes.

7 Sodium Sodium maintains fluid balance in the body, transmits nerve impulses and affects muscle contraction and relaxation. An excess, however, raises blood pressure and the risk of heart disease and stroke. Poon advises limiting intake to no more than 2,000 milligrams a day, or one level teaspoon of salt.

10 Protein A basic building block of the human body, protein consists of amino acids, most of which cannot be made by the body so must come from other sources. Individual needs depend on age, size and activity level. An average person needs about 60 grams of protein daily. SCMP Text: Margaret Wee

DIET 9 RECIPE FOR HEALTH BELL PEPPERS

to digest

A rainbow of colours stuffed with goodness ......................................................

Anna Last Bell peppers are part of the chilli family but, unlike their spicier counterparts, such as jalapenos and habaneros, they don’t contain capsaicin, the compound that gives other chillies their heat. All bell peppers start off green and can turn red, orange or yellow as they ripen and their flesh becomes sweeter. At their peak, in late summer and early autumn, bell peppers are available in a rainbow of colours.

Choose peppers that feel heavy for their size and have glossy, smooth skins. Wash well and buy organic whenever possible – bell peppers are among the vegetables grown with the most pesticides.

When shopping for peppers to stuff, pick ones that are uniform in size and shape for even cooking.

Refrigerate them in a ventilated bag in the crisper, for up to five days.

Bell peppers’ mild flavour and satisfying crunch make serving them raw a popular choice, but roasting, grilling, baking or stir-frying brings out a deeper, sweeter taste. To swiftly stem and seed a pepper, stand it upright, then slice off the sides, cutting from top to bottom, leaving the core, ribs and seeds behind.

For this recipe, the rice and sausage mixture can be made up to three days ahead and refrigerated in an airtight container until needed.

For a lighter dinner, use crumbled turkey or chicken sausage in place of, say, pork sausage.

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Margaret Wee healthpost@scmp.com Stroll down any supermarket aisle and you will inevitably be drawn to the foods with the snazziest packaging. But before you put that colourful box of biscuits into your shopping cart, take a look at the most important thing on it – the nutrition label.

Under the food labelling law, nutrition labels in Hong Kong must show the energy content of the food as well as seven types of ingredients: carbohydrate, protein, saturated fat, total fat, trans-fatty acids, sodium and sugar. Both the energy and core nutrients must be presented as “per 100ml or grams” or “per serving size” on the nutrition panel.

The law, which came into force in July last year, is part of the government’s efforts to encourage healthier eating in the face of rising rates of chronic disease and related health conditions.

“Pay more attention to certain nutrients according to your health condition. For instance, those with high blood pressure should consume less sodium, saturated fat and trans fat. Heart disease patients should keep to a low fat, low sodium, low sugar diet with less saturated fat and trans fat, while obese or overweight individuals should consume a diet with lower energy, low fat and low sugar levels,” says Sally Poon, a registered dietitian in private practice.

How do you interpret all the nutritional information on a package of food? We take the mystery out of nutrition labels.

Nutrient content claims Hong Kong has specific guidelines for claims such as “low-calorie”, “trans-fat free”, and “high protein”.

To maintain a healthy diet low in fat, sugar and salt, and high in fibre, look for the following claims: • Low fat or fat-free: this means not more than three grams of fat per 100 grams of solid food and not more than 1.5 grams of fat per 100ml of drink. Fat-free food and drink should contain not more than half a gram of fat per 100 grams or 100ml.

Sausage and rice stuffed peppers Forget fancy packaging, it’s the information that counts. Photo: Bloomberg

One should pay more attention to certain nutrients according to their health conditions SALLY POON, DIETITIAN

• Low sugar or sugar-free: food and drink should have no more than

How many calories do you need daily?

Recommended daily energy intake depends on a person’s age and activity level.

Here is what the Chinese Nutrition Society recommends.

Age/activity level 18 to 49 50 to 59 60 to 69 70 to 79 80 and above

Male (kcal per day) Low Medium High 2,400 2,700 3,200 2,300 2,600 3,100 na 1,900 2,200 na 1,900 2,100 1,900

Female (kcal per day) Low Medium High 2,100 2,300 2,700 1,900 2,000 3,200 na 1,800 2,000 na 1,700 1,900 1,700

Note: women who are pregnant should add 200 kcal a day to their diet, while those who are breastfeeding should add 500 kcal

SCMP

five grams of sugar per 100 grams or 100ml to be considered low in sugar. To be considered sugar-free, a food or drink must contain less than half a gram of sugar per 100 grams or 100ml.

• Low sodium (salt) or sodium-free: a low-sodium food must contain no more than 0.12 of a gram of sodium per 100 grams or 100ml.

A sodium-free food has no more than 0.005 of a gram of sodium per 100 grams or 100ml.

Serves eight Ready in 55 minutes 3 1⁄2 teaspoons extra virgin olive oil, plus more for baking sheet 225g sweet Italian sausage with the casings removed 1 zucchini, diced small 1 medium yellow onion, diced small 1 garlic clove, minced Coarse salt and ground pepper 1 ⁄4 cup Parmesan, grated 4 cups cooked long-grain white rice 1 ⁄2 cup fresh breadcrumbs 4 large bell peppers (any colour), halved lengthwise, seeds and ribs removed

• Preheat oven to 205 degrees Celsius • In a large skillet, heat one teaspoon of oil on a medium-high heat. Add the sausage and cook, breaking up the meat with a wooden spoon, until browned, (about five minutes). With a slotted spoon, transfer the sausage to a mediumsized bowl • Add one teaspoon of oil to skillet along with zucchini, onion and garlic. Season with salt and pepper and cook until vegetables are tender, about eight minutes • Add zucchini mixture to bowl with sausage, along with Parmesan, rice and one teaspoon oil; stir to combine and season with salt and pepper • In a small bowl, combine breadcrumbs and half a teaspoon of oil, and season with salt and pepper • Brush a rimmed baking sheet with oil and arrange bell peppers, cut side up, on the sheet • Divide the rice mixture among the peppers and top with breadcrumbs • Bake until the breadcrumbs are browned and peppers are tender (about 30 minutes). Serve warm Nutritional information per serving: 462 calories; seven grams fat (two grams saturated fat); 14 grams protein; 85 grams carbohydrates; three grams fibre.

Good Things from Martha Stewart

• Dietary fibre: is found in fruits, vegetables, whole grains and legumes. It prevents constipation while reducing your risk of diabetes and heart disease.

For a food or drink to claim that it is a “source of dietary fibre”, it must contain no less than three grams of dietary fibre per 100 grams of food; or no less than 1.5 grams per 100ml of drink. A “high in dietary fibre” food must have at least six grams of dietary fibre per 100 grams of food, while a drink must have at least three grams per 100ml.

Ingredients in packaged foods are usually listed in order of weight, so the main ingredients come first. If the first few ingredients listed are high-fat ingredients, such as cream, butter or oil, then you can safely assume that the food in question is high in fat.

Sausage and rice turn bell peppers into a filling meal. Photo: NYT

10 FITNESS Reebok’s EasyTone technology has been under fire recently.

Photo: Bloomberg

Get a grip – it’s mostly hype ......................................................

Sasha Gonzales healthpost@scmp.com Maya Calica, a journalist in her 40s, is passionate about her sequinned FitFlop sandals, and not just because they look good. She claims they help her move more quickly and are so comfortable that she prefers them to sneakers for her daily walk. “I can’t tell if it’s the sandals doing it, as I run and do yoga as well, but I definitely move faster and more energetically in them,” she says.

Calica isn’t alone in her devotion to the FitFlop and its “Microwobbleboard” midsole.

When it launched in 2007, sales of the brand’s “toning” sandals, boots and shoes soared. Since then, other firms have released their own version of toning footwear, which claim to create instability that makes your muscles work harder.

Today, you can find a plethora of fashion-forward styles from Reebok, New Balance, MBT, Skechers and Crocs. Dr Yeung Yeung, a specialist in orthopaedics and traumatology from Asia Medical Specialists, says that the idea behind toning shoes originated from the rocker-bottom shoe designed for orthopaedic use, which came out in the 1990s. The thick but rounded base assists patients whose normal heel-to-toe gait, or walking pattern, is affected by degenerative foot or ankle problems. The design helps the

patient walk normally without stressing the afflicted joint.

This rocker-bottom technology is also behind the success of toning shoes. Podiatrist Douglas Horne, from Douglas Horne Podiatry Services, says: “The claims of these types of shoes is that, through utilisation of components in the shoes that make them a little unstable, your muscle function increases, which in turn tones your buttocks and thighs.”

But is there truth in the claims?

Two weeks ago, Reebok agreed to pay US$25 million in customer refunds for their deceptively advertised toning shoes, as part of a settlement agreement with the Federal Trade Commission, the US competition watchdog and consumer protection agency.

(Hongkongers may be able to get the refund – the request form on www.reeboksettlement.com/ftc allows customers from more than 100 countries to apply for it.)

According to the FTC complaint, Reebok made unsupported claims in ads that walking in its EasyTone shoes and running in its RunTone shoes strengthened and toned key leg and buttock muscles more than regular shoes.

But Reebok is sticking to its guns.

“Settling does not mean we agreed with the FTC’s allegations; we do not,” says a statement on the company’s website. “We fully stand behind our EasyTone technology – the first shoe in the toning category inspired by balance-ball training.”

In recent months, Skechers and New Balance have had lawsuits filed against them in the US claiming false advertising. Sales of toning shoes have also fallen dramatically – sales of Skechers shoes have dropped 14 per cent in the last year.

Horne, who specialises in lower limb biomechanics, says most scientific evidence is produced by the shoe companies themselves.

“While there may be a kernel of

While there may be a kernel of truth in this science, I believe the effect is minimal and the rest is advertising DOUGLAS HORNE, PODIATRIST

truth in this science, I believe the effect is minimal and the rest is advertising,” he says.

Both Yeung and Horne believe that the problems associated with toning shoes far outweigh the benefits. This is especially true if you have weak ankle muscles or suffer from recurrent ankle sprain.

“The thick round-bottomed soles may actually precipitate another ankle injury,” Yeung warns, “although this hasn’t been fully investigated”.

Horne says: “I see patients

whose foot pain or ankle issues stem from muscle imbalance and particularly tight calf muscles. If you wear unstable shoes that make your muscles work harder, the problems can be exacerbated.”

Personal trainer Li Si Yang, of Journey To Fitness, agrees. “It can cause injuries because most people are not used to the instability of toning shoes. Also, if you have poor posture or any misalignments, the shoes will only reinforce these issues, not improve them,” she says.

A study conducted last year by exercise physiologists at the University of Wisconsin-La Crosse found that it did not matter whether you wore regular sports shoes or three different models of toning shoes; you still burned the same number of calories, and muscle activation remained unchanged.

John Mercer, a professor of biomechanics at the University of Nevada, Las Vegas, also ran a study on toning shoes and concluded that his subjects’ muscle activation and oxygen consumption were no different from when they wore regular walking shoes. In fact, the rocker-bottom design did not even make a difference in how they moved.

Toning shoes may be helpful in that they get you off the couch and walking, but it’s no substitute for good old-fashioned cardio. “Sure, everybody wants a quick fix, but a 10-minute uphill walk or climbing a few flights of stairs every day will not

only tone your buttocks and thighs, it also burns calories,” Horne says.

Yang points out that the only reason you would lose weight wearing toning shoes is because you are walking and burning calories. “You can get the same results from any type of shoe,” she says.

According to Yeung and Horne, the best walking or running shoes should have a firm, supportive base for a stable landing; heel padding or air cushioning for shock absorbance on heel landing; adequate forefoot width so your toes have room to move; mild medial arch support so you can adjust the mid-foot loading and springing; a good gripping sole to prevent slipping; and firm side support to prevent sideways strain and ankle sprain.

That said, Horne says he does advise his clients to try the FitFlop sandal as an alternative to the classic flip-flop. “The heel is slightly raised and the heel contour is slightly cupped, which offers more stability than regular flip-flops. Plus, flip-flops offer zero cushioning,” he says.

But before you buy into the toning shoe trend, Yeung says it might help to check in with your podiatrist. “I suggest a proper analysis of your ankle and foot condition first. If you have weak ankles, speak to your podiatrist about strengthening this part of your leg before wearing toning shoes.”

WELLBEING 11 THE TASTE TEST ALMONDS ......................................................

Jeanette Wang jeanette.wang@scmp.com Nuttz Vienna Almond HK$35.90 for 100g, Great Said to be made according to a generations-old Viennese family recipe, these caramelised vanilla-coated almonds are so sweet that there’s not much nut taste.

The amount of sugar also negates the heart-healthy benefits of the nuts.

Verdict: A few paired with a sugar-free latte might be fine – but that’s it.

Real Good Food Organic Tamari Roasted Almonds HK$75.90 for 200g, Great These are a bit too salty because they’re coated in tamari, a wheatfree soy sauce made from soya beans, sea salt and water. They also lack crunch, which is unforgivable.

Verdict: Not to my liking, although it seemed to grow on my colleague, who finished the bag in two days.

Blue Diamond Almonds Honey Roasted HK$31.20 for 150g, Great Its packaging claims that eating this constitutes “smart snacking”. This may be true if you’re having a serving of raw almonds (about 23) daily, but coated with honey, sugar, salt and oil? Not quite.

Verdict: Addictive – self-control a must to keep the snacking healthy.

FIT & FAB

Different spokes ......................................................

Jeanette Wang jeanette.wang@scmp.com Many people complain, but few do anything to make things right. Mark Collins is in that minority. Fed up with the poor service and advice dished out by bicycle and triathlon shops in the city, the avid age-group triathlete decided to ditch his job in venture capital and set up his own.

Collins found a business partner in his coach and national triathlete Andrew Wright, and Tribal was born. The cosy shop at the base of Broadwood Road in Happy Valley prides itself on “solid advice backed by professional services”, such as bike fitting and running-style analysis.

“Retail is a tough industry,” says Collins, 35, who has lived in Hong Kong since the age of two. Apart from balancing cash flow, there is another challenge – long hours.

Tribal, which celebrated its first anniversary two weeks ago, is open seven days a week, nine hours a day.

Despite this, Collins still finds the time to train, doing a couple of early morning bike rides and evening runs during the week. He can’t remember the last time he did laps in a pool, though. “At the moment, [my training schedule] is very broken,” he says. “[That’s] another myth about owning a bike shop busted – you don’t have more time to train and you cannot absorb fitness by being surrounded by fit customers.”

Sure, it’s not as rosy as people make it out to be. But Collins is living his passion and dream – and how many of us can say the same?

How did you get started in triathlons?

My first love in sport is sailing, in which I compete at a high level. I started triathlon as a way to keep fit and help counter the very active après-sail. I initially started with just cycling and then the challenge of throwing in a swim and a run really appealed to me. It may be a little odd, but I have no interest in running a marathon, but add one onto the end of a swim and bike and suddenly it’s appealing to me.

What are your proudest achievements to date?

I am really proud of what we have managed to achieve with Tribal. Our

Mark Collins ditched a finance job to open a bike shop.

Photo: Edward Wong

goal was to provide great service and proper advice, and the feedback we have so far is that we are on track.

My ultimate goal is to get some balance back in my life and get back out on the water – oh, and to add that marathon onto the end of a swim and bike and complete an Ironman.

Ever had a close call on the road that made you think twice about cycling?

I have had a few close calls and spills on the roads in Hong Kong. Luckily, there has been nothing to make me think twice, but plenty to make me realise how non-cycle aware Hong Kong motorists are.

There are bikes that cost as much, or even more, than a car. Are bikes worth investing all that money in?

The sky is the limit when you look at high-end bikes. There is a true difference in the way the bikes ride, but there are certainly areas that are worth spending money on and others that are a complete waste of cash. If you are looking to make an

I have no interest in running a marathon, but add one onto the end of a swim and bike and suddenly it’s appealing to me MARK COLLINS, TRIATHLETE AND CO-FOUNDER OF TRIBAL

upgrade to your bike, then a good wheel set should be your first on your wish list. Save the money for the titanium bolts and carbon bling for another day.

Lance Armstrong said it wasn’t about the bike. What do you reckon?

Lance had the advantage of being supplied with very high-spec bikes. I certainly agree that nothing will make a bike go fast if the engine is suboptimal, but unfortunately with bikes you can buy speed. If you put the same engine on a low-end bike and a high-end bike, throw in some hills and there will only be one result.

However, the amount you spend and the speed you go are not proportional, and working on the engine is free.

Where do you see yourself in 10 years?

Probably still on my feet with grease and oil under my fingernails, but still smiling.

Can you ever wear too much lycra?

Yes – end of story.