20111018 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, OCTOBER 18, 2011

HEALTH POST NUT BUTTERS: SPREAD IT ON NICE AND THICK >PAGE 8

GPS WATCHES: KNOW YOUR PLACE AND TIME >PAGE 9

Animal attraction Furry friends can change our physical and mental well-being for the better >PAGE 4

2 NEWS HEALTH BITES

ASK THE DOCTORS DR YU BING-ON

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Jeanette wang jeanette.wang@scmp.com

Q: At about 3pm to 4pm on a work day, I often get a burning sensation behind my eyes and am unable to focus on the computer screen. Am I going blind?

Two eggs are better than one Having enough protein in your diet – 15 per cent of daily calorie intake – can help keep weight at bay, according to researchers from the University of Sydney, Australia. In their study published in the online journal PLoS ONE, lean and healthy volunteers fed a 10 per cent protein diet consumed 12 per cent more calories from other foods over four days than they did on a 10 per cent protein diet. Of the extra intake, 70 per cent was from snacking. But increasing the protein content to 25 per cent did not have any further observable behavioural changes. Include more protein in your diet through these healthy sources: white meat, lean beef, eggs, milk, yogurt, beans, nuts and soya products.

Dirty phone calls A University of London study has found that one in six mobile phones in Britain is contaminated with E. coli, a bacteria of faecal origin. It tested 390 samples across 12 cities and, although 95 per cent of people claimed they washed their hands with soap where possible, more than 90 per cent of phones and 80 per cent of hands had some form of bacteria on them. Faecal bacteria can survive on hands and surfaces for hours, especially in warmer temperatures away from sunlight. E. coli is a cause of diarrhoea and food poisoning.

It’s not all in the genes People say you can’t pick your family, but an international team of scientists has found that you can change the genes your parents passed on to you. Led by researchers at McMaster and McGill universities, their study published in PLoS Medicine showed that the 9p21 genetic variants – the strongest marker for heart disease – can be modified by eating lots of fruit and raw vegetables. More than 27,000 people from five ethnicities, including Chinese, were tracked, and high-risk individuals who ate such a diet had a similar risk of heart attack to those with low-risk genotypes.

Linguists linger longer It’s perhaps a good time to brush up on your Cantonese – speaking more than one language could delay the symptoms of Alzheimer’s disease. Researchers at St Michael’s Hospital in Toronto studied CT scans of patients diagnosed with probable Alzheimer’s who had similar levels of education and cognitive skills – apart from the fact one half could speak another language fluently. These bilingual patients performed as well when it came to cognitive function as single-language patients who were suffering half as much shrinkage of the brain. Lead researcher Dr Tom Schweizer says that the brains of bilingual people may be better prepared to compensate through enhanced brain networks or pathways when Alzheimer’s strikes.

What a drag it is to grow old Women who smoke may hit menopause about a year earlier than those who don’t light up, according to research by University of Hong Kong published in the journal Menopause. Early menopause is believed to be linked to a larger and higher risk of health problems, such as bone and heart disease, breast cancer, diabetes, obesity and Alzheimer’s. Experts analysed data from six studies of about 6,000 women in total and found that non-smokers hit menopause between the ages of 46 and 51 on average. Smokers were shown to reach menopause between the ages of 43 and 50. A look at five other studies involving more than 43,000 women found smokers were 43 per cent more likely to have early menopause.

A: The short answer is no, but it might be time to visit your ophthalmologist. Vision that appears normal in the morning, but gradually becomes blurred as you spend time in front of the computer, is not usually anything sinister.

To explain what is going on, one has to understand part of the normal workings of the eye, in particular “accommodation”. This is the automatic adjustment of the eye to see at different distances. If you have perfect eyesight, your eyes are in their most relaxed state when you are looking into the distance.

To look at something closer or close up, a muscle inside each eye called the ciliary muscle has to contract, allowing the lens to change shape, thereby focusing on the object of interest.

An analogy would be the autofocus function of a digital camera. This accommodation is normal and it happens in our eyes without our knowledge.

However, there are circumstances when this function becomes “overworked”. The first is if you were slightly long-sighted (hyperopic), but never had to wear spectacles. To compensate for this, your eyes have to rely on accommodation to see clearly, even at distance, so the ciliary muscles have to do “extra work” when looking at near objects.

A second scenario is if you were nearsighted (myopic) but your spectacle correction was overprescribed. This has the effect of artificially making you slightly long-sighted, and the end result is therefore the same as scenario one.

The last scenario is if you were becoming presbyopic, usually around 40 years of age. Our lenses have a tendency to harden with age, and so more ciliary muscle power is needed.

All three scenarios result in “overworked” ciliary muscles if you have been reading or using the computer for some time. The burning sensation is because the muscles are in spasm, and their failure to relax quickly results in blurred vision. The answer to all of these situations is appropriate eyewear.

Dr Christopher Yu Bing-on is a specialist in ophthalmology

APP OF THE WEEK

Tapping into a stress buster turns into a pointless distraction ......................................................

Katie McGregor healthpost@scmp.com Be Stress Free Fast US$0.99 Rating 1/10 Your “Stress Free” experience starts with a free app – the test – which comprises 25 multiple choice questions to calculate your stress level. I clicked through it, answering “usually true” to questions like “I feel good about my life”, and “seldom true” to questions like “I have physical pain”.

Despite my general joyousness, at the end of the quiz, I was informed that I was very stressed and could benefit from the Be Stress Free Fast full version, for 99 US cents. How unexpected.

I was still not convinced so

downloaded Be Stress Free Fast Lite for free. Expecting meditation techniques with sea sounds, I instead found a picture of a man with crosshairs on his face.

These target points turned out to be meridian points according to traditional Chinese medicine. After giving my stress level a score from zero to 10, I worked through a routine, tapping on these points with my index and middle fingers.

While tapping, I repeated the phrase “releasing this stress” out loud. At the end of the exercise, I reevaluated my stress level, but as it was low to start with, I couldn’t say the exercise had done much for me.

The instructions suggested that if I was unable to lower my stress by repeating the routine, I would benefit from the full version of Be Stress Free Fast. So I paid my money only to learn that the full version

offered little extra except that, in the last line of the Help section, I learned that the tapping was based on the emotional freedom technique, EFT. Some argue that EFT works because it is a distraction, much like counting to 10. Others argue that it is the most powerful tool for freeing yourself from limiting thoughts and emotions. For convenience consider the free version, but even at US$0.99, don’t bother with the full version, whatever they tell you.

> 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

Mystery bug proves tough to defeat ......................................................

Wynnie Chan healthpost@scmp.com Electrical technician Chan Manching had a history of good health, until a persistent two-week fever forced the Macau resident to check himself into a hospital in the former Portuguese enclave.

On examination, doctors found that Chan (name changed for patient confidentiality reasons), a 52-year-old father of two, had a swinging fever, an enlarged liver and inflammation of the iris – the coloured part of the eye – and the ciliary body, which comprises the muscles and tissues that make fluid in the eye. A succession of blood tests showed that he had progressive anaemia, a raised white blood cell count, abnormal liver function and his blood was slow to clot.

Chan was extensively examined to determine the underlying cause of his fever. Tumour marker levels were found to be normal, no bacterial or fungal growth was detected in the blood, urine, stool or cerebrospinal fluid cultures, and other investigations for viral infections all came back within normal ranges. However, a liver scan suggested hepatitis, since the liver was swollen, enlarged and inflamed. In the meantime, the fever persisted despite Chan being

The bacteria is extremely robust and is resistant to common disinfectants, heat or dehydration given two successive courses of intravenous antibiotics every eight hours for 13 days.

After his condition failed to improve despite being in the hospital for 17 days, Chan was transferred to Queen Mary Hospital in Hong Kong. A liver biopsy revealed multiple doughnut-shaped granulomas (small areas of inflammation due to tissue injury), and a cardiac ultrasound showed that some of the fibrous strings that control the movement of one of the heart valves had ruptured.

Further, an elevated level of antibodies due to bacteria called Coxiella burnetii was detected in two sets of blood samples taken two weeks apart.

With these findings, Chan was diagnosed with chronic Q fever.

The “Q” stands for “query: the name was coined when little was known about what caused the fever. It was first described in slaughterhouse workers in Brisbane, Australia. Q fever is common in parts of Australia, North America and Europe, but is seldom seen in Hong Kong.

Q fever can cause acute or chronic illness in humans, who usually pick up the condition after coming into contact with infected animals or being exposed to a contaminated environment.

Cattle, sheep and goats are commonly infected with C. burnetii, which gets excreted in the milk, urine and faeces of infected animals. The bacteria is extremely robust and is resistant to common disinfectants, heat or dehydration, which means it can survive for long periods in infected environments.

Humans are thought to be very susceptible to Q fever and only a small number of bacteria is needed to cause infection. It’s likely that Chan became infected with C. burnetii after cleaning up bird droppings while repairing outdoor electrical wires four to six months prior to his hospital admission.

Chan was treated with two different oral antibiotics: doxycycline twice a day and hydroxychloroquine three times a day. His condition improved over the next week, with the fever, liver malfunction, blood clotting response and iris inflammation all subsiding. Chan has to continue taking the antibiotics for at least 18 months, depending on how his blood serum responds, and must have regular follow-ups at an outpatient clinic.

University of Hong Kong researchers, in a report in the Hong Kong Medical Journal, believe that the incidence of Q fever, both in its acute and chronic forms, have been underestimated in Hong Kong. This is due to a number of reasons, including geographical uniqueness, clinical bias, diagnostic difficulty and suboptimal surveillance.

Dr Jasper Chan Fuk-woo, attending physician and honorary assistant professor of HKU’s department of microbiology, says: “The incidence of Q fever seems low in Hong Kong. It is often under-diagnosed because most patients with acute fever present with a self-limiting illness and are misdiagnosed as having influenza.

“Only 3 to 5 per cent of affected individuals [like Chan] progress to the chronic form. Diagnosis is often missed if an antibiotic like doxycycline is used [to treat] atypical bacterial infections.”

Illustration: Angela Ho

CASE HISTORY

4 COVER STORY

Creature Having regular contact with animals improves people’s outlook and physical and mental health.

Elaine Yau looks at the power of pets

COVER STORY 5

comforts B

ouncing a yellow ball, Kei runs around to catch the attention of Fat Fat the pug.

The bubbly 17-year-old giggles at the way the dog moves and it’s hard to picture him as a disgruntled youth who stayed at home all day and shut himself off from the world a year ago.

His self-imposed home confinement lasted a year. The school dropout, who now works at the Chinese Evangelical Zion Church, Youth Employment Training and Creativity Development Centre, says it’s still tempting to stay home playing video games. “But I know I have to go out. If I don’t go to work, no one will take Fat Fat out for strolls,” he says.

Fat Fat, the resident dog at the centre in Tsz Wan Shan, is a former stray rescued by the Hong Kong Animal Therapy Foundation in February and adopted by the centre in April to help withdrawn young people reintegrate into society.

Kei and his friend Kuen, 19, who locked himself away at home for a year before emerging back into the world in 2009, were given the task of caring for the four-year-old pug among their other chores at the centre. The change in both young men, from morose couch potatoes to responsible workers, shows the benefits of animal therapy, says psychiatrist William Fan Tak-wing, who started the foundation a year ago.

“The presence of animals gives withdrawn youths a sense of security,” he says. “Overwhelmed by exam pressures and family problems, such youths have low self-esteem. Unable to find a job, they don’t know how to face society.

Dogs are non-judgmental.

Regardless of your appearance and social status, they are always friendly and eager to please.”

The therapeutic effects of pet ownership manifest most obviously in the elderly, mentally disabled and psychologically unstable children that he treats, Fan says.

“I always advise my elderly patients who are living alone to adopt a cat, which is easier to keep than a dog,” he adds.

“Their stubborn and crabby traits lessen after living with the animal for a while. For families with mentally challenged people, owning a pet can help the disabled better control their emotions and learn to be co-operative by making them take care of the animals.”

The benefits of keeping pets, or companion animals as researchers call them, are well-documented in medical literature. Pet owners are

found to have better immunity and lower cholesterol and blood pressure than non-owners.

Research presented at the 10th International Conference on Human-Animal Interaction in October 2004 on 11,000 people in Australia, Germany and China, found that pet owners made 8 per cent fewer visits to doctors even after factors such as gender and income were taken into account.

A recent study by Miami and Saint Louis universities showed that pet owners were happier, healthier and better-adjusted than nonowners. The study, which was published online in the Journal of Personality and Social Psychology, delved into the well-being, personality and emotional attachments of 217 pet owners and non-owners. Pet owners are shown to have greater self-esteem and are more extroverted, conscientious and physically fit.

Stroking Bobby the dog or tickling Kitty the cat could also serve as chemical pick-me-ups, Fan says.

“Playing with a pet can boost levels of dopamine and serotonin, the

I always advise my elderly patients who live alone to adopt a cat … Their stubborn and crabby traits lessen after a while WILLIAM FAN, PSYCHIATRIST

neurotransmitters known to affect mood, and bring calming and pleasurable effects.”

A local study in 2007 found that in the presence of dogs, dementia patients displayed higher levels of activity, social interaction and frequency of pleasant emotional expressions. In the study, several dogs from Animals Asia, an antianimal cruelty charity, were sent to the Jockey Club Centre for Positive Ageing for a dozen weekly sessions with 25 elderly dementia patients.

But the centre’s director, Timothy Kwok Chi-yui, says the effects of dog companionship fizzled out a day after the dogs visited. “For animal therapy to have abiding effects, patients need prolonged exposure to animals.”

At Tuen Mun Public Riding School, Timothy Tsang Tin-chi, 16, who has a moderate form of cerebral palsy, is busy cleaning and brushing 11-year-old Opal, a chestnut pony. Having ridden the steed for a year, he credits it with strengthening his muscles and increasing the flexibility in his limbs. “I couldn’t crouch down before. Now I have no problem doing it when giving Opal a bath,” he says.

The school works with the Riding for the Disabled Association, which uses horses to treat those with physical or mental disabilities and autistic children. The association’s instructor, Sue Gazzi, says the horses’ docile personality makes them an ideal healer of human ailments.

“They are calm, co-operative and obedient,” she says. “They love interaction with humans and adore attention. They know they are

Fat Fat the pug has helped Kei (17) and Kuen (19) learn responsibility and reintegrate into society. Photos: Nora Tam, K. Y. Cheng

At Tuen Mun Public Riding School, horse riding has helped Timothy Tsang (16, left) and Natasha Tse (14) overcome their disabilities dealing with disabled people. They behave really well. They don’t move or push, as if they know they have to be careful with the disabled riding on them. They are much more unruly when others ride them. I have seen it so many times that it can’t be an accident.”

She says horse riding could help people with all kinds of disabilities.

An hour of riding is equivalent to 20 hours of physiotherapy because it works the whole body rather than just parts of it. “With the exception of people with uncontrolled epilepsy, a heart defect or brittle bones, anybody can gain much from riding horses as it improves circulation, breathing, posture and flexibility.

“Mentally, horse riding boosts the self-esteem of the disabled. With their siblings playing all kinds of sports like rugby, riding horses gives them certain status in the family as they also have their own activity.”

This sense of empowerment is the main element that attracts Natasha Tse Pui-ting, 14, to riding.

Born two months early, she suffers from a severe form of cerebral palsy and dyslexia. “I can only experience the sense of speed on horseback,” says the teenager, who can’t run or ride a bicycle due to weak leg muscles.

Her instructor, Yumi Toda, says Natasha’s health has improved greatly since she took up horse riding 10 years ago. “Her limbs are much stronger than before. She had to be supported by two people when walking in the past. Now she can put her foot in the stirrup to mount the horse by herself.”

Gazzi says the key to devising

horse therapy lessons is to match the patients with the right horses.

Those with cerebral palsy have very tight legs; a horse that has a relaxed, easy gait and does not trot is best for them. Those with Down’s syndrome have difficulty sitting up; a horse with a choppy gait will help tone their muscles.

Natasha’s mother, Gail Siah Aileng, says her daughter’s love for horses has become a driving force in her life. “She wants to work with horses when she grows up. She loves horses so much that she reads and watches videos about them all the time.”

Likewise, Kei’s love for Fat Fat and their daily routine of strolls, grooming sessions and visits to the vet has created a strong bond between them. “I talk to him whenever I am unhappy,” Kei says.

“He knows when you are scolding him. I want him to be healthy and happy. When he first came here, he was really heavy. I am so happy that my exercise with him has helped him lose 4.5 kilograms.”

The emotional bond between humans and animals has many psychological benefits, says Jane McNae, veterinary nursing lecturer at the University of London’s Royal Veterinary College “Keeping pets teaches children about empathy, compassion and responsibility,” she says.

“As animals have a shorter lifespan, pets prepare children for different stages of life, from birth to illness and death. For old people who have grown lonely after their kids grow up, animals provide very good company.” elaine.yau@scmp.com

6 HEALTH HOW TO PICK AN ORTHODONTIST

Here’s how to be braced for change ......................................................

Alison Johnson

A good night’s sleep helps modify cortisol levels in the body. Photo: Ocean/Corbis

FROM THE EXPERTS

Make it easy on yourself when nature takes over ......................................................

Katherine Dale healthpost@scmp.com Perimenopause is real. This is the time leading up to menopause, a stage that is not clearly defined by the medical profession and is thus often overlooked. From as early as the age of 38, women will begin to experience symptoms such as weight gain around the middle, hot sweats, restless sleep, memory loss and unexplained anxiety or mood changes.

But do not despair – these symptoms can be eased, naturally.

A naturopath will relate these symptoms to changing hormone levels, which can be measured with a salivary hormone panel.

Symptoms may be eased with the use of vitamins, herbal supplements and homeopathic remedies. Here is a naturopathic explanation for some of these uncomfortable symptoms: Weight gain Many readers have probably heard of cortisol. Cortisol is the hormone that gets us up and going in the morning. Stress also increases adrenal output of cortisol; and in turn a high cortisol level causes our bodies to use up muscle and bone reserves to feed the body quickly, resulting in high circulating fat and sugars. In addition, cortisol makes us hungry. Unfortunately, as we get older our bodies naturally produce more cortisol. We experience this as difficulty sleeping and weight gain around the middle. Thus, it is vital that in this stage of our lives we

I recommend more relaxation, more love-making and letting go of past resentments

force ourselves to slow down and relax. It is not fatigue or slowness that plagues us at perimenopause, but the opposite.

So, join a meditation group, take up Hatha Yoga and say your healing mantras every day. By using a variety of calming herbs and ensuring a good night’s sleep, you can modify these cortisol levels.

Speaking of yoga, did someone turn up the heat in here? Oh, it must be those horrid hot flushes.

Hot flushes It is not low levels of oestrogen causing the hot flushes; it’s fluctuating levels of oestrogen.

During perimenopause these fluctuations have an “addictionwithdrawal” effect on our bodies.

The body becomes addicted to the high levels of oestrogen and when the levels suddenly drop the hot flush is a reaction to the loss of oestrogen. Unfortunately, adding oestrogen to our bodies can be dangerous for our internal organs, and only delays the eventual withdrawal we must experience.

Mood changes Attitude and mood changes are some of the most obvious symptoms of perimenopause. When entering perimenopause, oxytocin levels begin to change. Oxytocin, also known as the “cuddle hormone”, is said to be the hormone that causes bonding between humans. Released during breastfeeding and love-making (when there is a strong emotional attachment between partners), oxytocin allows women to tolerate

family situations that are not always in her best interest. Oestrogen and oxytocin physiologically attach women to the role of caregiver.

However, at perimenopause, the levels decrease and the physiological attachment to others reduces; as a result, women begin to feel more independent and self-focused.

Unfortunately, there can also be a tendency to feel regret, disdain and resentment for past sacrifices that one may have made. In fact, any memories of the past that have not been dealt with may come back to haunt us. So it is best if a woman can deal with much of her anger before entering this time so as to protect herself and her loved ones.

Symptoms of perimenopause are all related to hormonal changes.

Although the changes are literally in our heads – in our pituitary gland and neurotransmitters – there are ways to ease the symptoms. One of my most popular recommendations to women in perimenopause is to be sure to engage in sexual activity (especially Taoist love-making) on a regular basis. This will increase oxytocin and assist with improving other symptoms of perimenopause, including dryness and stress levels.

So visiting a naturopath’s office doesn’t sound so bad. I recommend more relaxation, more love-making and letting go of past resentments.

Katherine Dale is a naturopathic doctor in Vermont, US, by the Vermont Secretary of State. She is also a member of the New York Association of Naturopathic Doctors

Getting braces or other orthodontic work can require frequent appointments and hefty payments, so choosing the right dentist is a must. “You are entering a relationship that could last years,” says Dr Alan Bagden, an orthodontist in Springfield, Virginia.

Here are some tips: • Ask for lots of recommendations.

Don’t just stick with your normal dentist. Ask for recommendations from friends, neighbours, colleagues and relatives. Visit the websites of potential practices.

• Request a no-obligation consultation. At these initial meetings – often free – discuss treatment goals, the doctor’s experience in correcting specific problems, payment options and insurance policies, and ask to see before-and-after patient photos. In large practices, it’s also smart to meet the office manager.

• Don’t be afraid to seek a second (or third) opinion. Getting braces is a major commitment, so compare treatment methods, prices and office atmosphere, including cleanliness and staff friendliness.

But note: if you love the first place you visit, that’s fine too.

• Be sure a doctor is board-certified in orthodontics. General dentists can take a few courses that allow them to perform orthodontic treatments, but they are not orthodontists. Rather, orthodontists are dentists who have undergone extra years of training, clinical experience and peer review.

Make sure you are comfortable with your orthodontist. Photo: AFP • Consider convenience. Ask about office hours, policies on changing appointments and how a practice handles emergency situations. If possible, select an office close to your home, work or your child’s school, because you might be heading there at least monthly for years.

• Be comfortable with your orthodontist as a person. You want to look forward to the visits, not dread them. Where the braces are for a child, take him or her to meet the potential doctor first.

McClatchy-Tribune

HEALTH 7 LIFESTYLE HANDLING THE NASTIES ......................................................

Alexia Elejalde-Ruiz They are your sneering co-workers, your prying neighbours, your insulting in-laws.

They are the nasty people who make environments toxic – and apparently their churlishness is quite lucrative, according to a new study that found that “less agreeable” employees earn higher salaries (18 per cent more among men, 5 per cent among women).

But you can beat them without joining them.

“They actually feel inferior to you, so they’ll slash you down to their level,” says psychologist Jay Carter, author of Nasty People: How to Stop Being Hurt by Them Without Stooping to Their Level.

The most important step is not to take what they say or do personally, Carter says. It’s not you, it’s them. OK, sometimes it is you.

About 1per cent of the population are deliberately malicious and antisocial, out to manipulate and control people for their own gain; 10 per cent were subjected to others’ antisocial behaviour and picked up bad habits; and then there are the rest of us, who can have moments of meanness when we’re stressed, insecure or succumbing to any number of our basic human emotions. Often we do so unconsciously, to our parents, children or best friends. Carter calls it engaging in “invalidating” behaviour.

“We’re all invalidators, even by silent invalidating,” Carter says, referring to when we demean people by ignoring them.

Being aware of your capacity to bite – and the destructive effects it can have on the well-being of others – goes a long way towards amending your own negativity.

Carter has a few suggestions for dealing with other difficult people.

See it for what it is Rather than internalise criticism or dwell on what you might have done to deserve the attack, recognise that the nasty person has personal issues. That’s not

They [nasty, hurtful people] actually feel inferior to you, so they’ll slash you down to their level JAY CARTER, PSYCHOLOGIST AND AUTHOR

to say a good friend can’t point out a flaw that needs fixing, but when someone piles on five or six things that are wrong with you, take a step back and see what’s really going on.

Get away Leave the room, the conversation, even town if necessary.

Do so calmly, efficiently and without saying anything you’d regret.

Get them on your side Invalidators respond well to three things: affinity, acknowledgment and admiration.

Repeat back what they have said to you so that they feel understood, and begin any argument with a compliment.

Diffuse with humour If your motherin-law becomes enraged about your skimpy outfit, agree with her to the point of exaggeration – “I know, I’m such a slut!” – and often everyone is laughing by the end.

Silent confrontation Rather than fire back or get into a row, you can confront without opening your

In an interpersonal tug of war, snapping is a bad option.

Photo: Corbis

Toxic avengers mouth. Just maintain eye contact and give a calm smile that indicates you know what your tormentor is doing; eventually they’ll feel so uncomfortable they’ll stop or leave.

Come again? Asking someone to repeat their nasty remark (“I’m sorry, what did you just call me?”) forces them to own up to what they said.

Many people, embarrassed, will water it down the second time.

State the obvious If, say, a co-worker berates you during a meeting, point out the facts – “You are yelling at me” or “You are embarrassing me in front of everyone” – and ask to talk about it later.

One on one If it’s not important, let it go. If it is important, get them alone and start by saying something like “Maybe you didn’t know...”. Some mean people deliver their biggest sting in front of an audience, and alone they might be apologetic.

Mirror If someone accuses you of stealing or cheating and they are way off base, ask them if they are guilty of the same.

Don’ts Don’t taunt, name-call or get physically violent. Also, never tell an invalidator he or she is wrong; it starts a war.

Tired of being the bigger person?

It may not be the most enlightened strategy, but sometimes all you want is to retaliate with a great comeback – which, inevitably, doesn’t come to mind until hours later.

Thankfully, we have Dear Asshole: 101Tear-Out Letters to the Morons Who Muck Up Your Life, by humour writers Jillian and Michelle Madison, creators of pop culture websites pophangover.com and damnyouautocorrect.com. The new book lets you eloquently vent your rage at life’s annoying cast of characters, such as the “asshole boss”, the “overly competitive asshole”, and the “asshole who left dirty dishes in the sink” (“P.S. It’s been two weeks. Exactly how much longer does that pot need to ‘soak’?”)

McClatchy-Tribune

8 DIET NUTRITION NUT BUTTERS

Spread a little nuttiness ......................................................

Elle Kwan healthpost@scmp.com Probably the most famous nut butter is peanut butter, which is actually not a “butter” in the traditional dairy sense, or made from nuts (peanuts are classed as legumes). Yet for many, especially those with children, peanut butter has long been a kitchen cupboard staple.

The creamy texture and sweet taste is a proven winner with young taste buds and one helping packs a beneficial punch of heart-healthy monounsaturated fats, fibre and protein. It also contains niacin, vitamin B and iron, so this spread isn’t just for kids. “Sometimes, it is useful for vegetarians who are taking note of their protein intake,” says Wendy Ma, dietitian and a programme director at HKU Space.

Peanut butter can make a good afternoon or pre-workout snack and is great sandwiched between crackers or spread on an apple.

While most supermarkets stock jars of the famous Skippy and Planters brands, more international supermarkets and health food stores are introducing all-natural varieties. The difference between them, says Ma, is in saturated fat levels and added sugar or salt.

Joseph’s Creamy Valencia Peanut Butter (HK$39.90, available at ThreeSixty) has just one gram of sugar and no salt – good for those watching their sodium intake – compared with three grams of sugar and 150 milligrams of sodium per two tablespoons of Skippy Creamy.

But these days there are a growing number of alternatives to peanut butter and, experts say, many are healthier. Almond and cashew nut butters are popular, but almost any nut can be made into a butter – from Brazil nuts and walnuts, to pistachios, hazelnuts and pecans. City’super IFC, for example, stocks the brand Artisana, which has cashew, walnut and pecan butters, and Meridian’s hazelnut and almond butters.

Dr Kenneth Chu, a naturopathic

People are eating a lot less red meat …

Alternative proteins like those found in nuts are being sought DR KENNETH CHU, NATUROPATHIC

doctor and director of the Redwood Natural Health Centre in Central, says that the arrival of more nut butters on the market has coincided with consumer concern about the quality of protein intake coming from meat. “People are eating a lot less red meat. Chemicals and drugs that are used in the meat industry, and whatever else they are doing in farming and agriculture to increase poundage, is a worry. Alternative proteins like those found in nuts, beans and seeds are being sought.”

For Chu, peanuts pale in comparison to some other nuts when it comes to nutritional value.

Brazil nuts contain the antioxidant selenium and walnuts have essential fatty acids. Pumpkin seeds are high enough in zinc to affect prostrate health. Almonds contain trace minerals good for brain development, vitamin E and more calcium than other nuts.

Nut butters can also be used as a dip with chunks of pear and banana, or red peppers and mushrooms. Apple sauce with almond butter is a good snack topper to try, Chu says.

Environmental concerns over the way peanuts are grown and harvested may sway others to avoid peanut butters altogether, says Hong Kong Boot Camp founder Nathan Solia. He says legumes are an acidic food, whereas nuts will keep the body alkaline. “Once your body is acidic it is open to the effects of stress. The more stressed your body is, the more open it is to a lowered immune system and infection,” he says. Solia is a fan of almond butter, which he spreads thickly on slabs of grainy bread in the morning.

You don’t have to rely on premade jars if you have an oven and 20 minutes to spare. Nut butters are surprisingly quick and simple to make. First, spread nuts thinly on a baking tray and toast on high heat for about 10 minutes until brown.

Once cooled, whizz them in a blender or food processor. For a few moments the blades might hack and choke over the nuts, but a wonderfully smooth paste should soon emerge. Transfer this to a jar and refrigerate. Because it’s allnatural, it’s common for the paste to separate slightly, leaving a layer of oil at the top, but simply stir to blend before each use.

In America, nut butters come in an exotic medley of flavours.

Illinois-based Futters Nut Butters, for example, makes an organic almond butter with orange oil and a chocolate pecan spread. Marilyn’s Nut Butters, made in Seattle, has hazelnut walnut spice with cardamom. You can spice up butters at home easily using inspiration from cookbooks or the internet – chef Mollie Katzen recently listed a walnut butter and cinnamon recipe on her Twitter page that would surely pep up a breakfast sandwich or a stick of celery come late afternoon.

RECIPE FOR HEALTH GRANOLA BARS

When it comes to the crunch, almonds get the chef’s vote .....................................................

Elle Kwan healthpost@scmp.com Chef Que Vinh Dang has a penchant for peanut butter, so it’s no surprise the peanut butter and jelly macaroons he serves up sometimes at his SoHo private kitchen TBLS have become the sweet stuff of legend.

For this recipe, native New Yorker Dang switches his allegiance to almonds to create this sumptuous take on the granola bar.

“Almonds are nice, nutritious and flavourful,” he says, “and this is a fairly easy recipe to make.”

Almond, chocolate and salted granola bars 4 cups oatmeal 1 cup flour ½ cup honey 400g soft butter 1 cup almond butter 1 tsp cinnamon ½ tsp baking soda 2 ⁄3 cup soft brown sugar 150g sliced almonds 250g raisins 250g bitter chocolate, melted Sea salt to finish • Mix all the ingredients except the chocolate and salt.

• Bake on a tray at 180 degrees Celsius for 12-15 minutes then allow to cool.

• Drizzle chocolate and sprinkle salt to taste.

Que Vinh Dang is the chef-owner of TBLS, 7/F, 31 Hollywood Road, Central, tel: 2544 3433

TBLS chef-owner Que Vinh Dang. a fan of nut butters, uses almond butter as a key ingredient in his granola bar recipe. Photo: May Tse

FITNESS 9 GADGETS RUNNING WATCHES

There’s no time like my present ......................................................

Jeanette Wang jeanette.wang@scmp.com There are many reasons why I love running, but most of all it’s because of its simplicity. Throw on a T-shirt and some shorts, lace up your shoes and your workout starts once you’re out the door. It’s not logistically challenging, unlike swimming or cycling, which I also do as a triathlete.

My runs used to be based on feel.

My legs and feet would set the pace and distance. If I was tired I would turn for home; on many occasions euphoria carried me farther than expected. How far or how fast I would go was unknown and arbitrary, the only thing that mattered was that I had been for a run.

Running is a primal act, and I liked keeping it that way, even shunning portable music players to have only my breath as a soundtrack.

But a couple of years ago this all changed when I got a Garmin Forerunner 405CX, a GPS-enabled running watch, as a birthday present.

To call it a watch is an understatement – it’s more like a mini-computer, and certainly felt like a brick on my previously bare wrist.

Like a ball and chain, the watch now holds me prisoner.

Firstly, I have to remember to charge it – the battery barely lasts a good long run of about four to five hours. (Since May, when a friend from Prague left his GPS watch behind, I have owned the Garmin 310XT, with a battery life of 20 hours.)

Then there’s the frustrating wait for the watch to locate satellites.

Outside my Causeway Bay apartment, overshadowed by towers, it’s difficult to give the gadget the clear view it needs to latch onto satellites. It can take 30 seconds, but rarely; at times I’ve waited 15 minutes.

When the watch is finally ready and the run begins, so does the obsessive-compulsive need to keep checking it for pace, distance covered, current elevation and elevation gained. (There used to be heart rate too, but the chest strap suffocated me so I ditched it. And there’s also a calorie count, but I’m not bothered.)

If you find plodding along lonely, there’s an option for you to pace – or compete with – a virtual partner, which shows up as a running stick man on the watch.

In a lot of ways, running with a GPS watch is no different from those tech addicts you see constantly checking their iPhones while walking down the street. Annoying.

Satellite signals and tracking can be iffy, especially among tall buildings or within a thickly forested trail. On a pancake-flat running track, the watch once claimed I’d gained a couple of hundred metres of elevation.

Nevertheless, according to Bruce Pye, managing director of Sports World, an official distributor of Garmin products in Hong Kong, the city has gone from being the smallest market for Garmin watches in Asia two years ago to the second-largest, just behind Japan. “Our aim is to be the largest market in Asia by the middle of next year,” Pye says.

Polar, Suunto and Timex are also popular makes, and the Nike+ SportWatch GPS debuted recently.

Arthur Tjandra, a cosmetic surgeon who runs for fitness, says that despite the frustrations (similar to my earlier rants), “I love my GPS, as I can keep track of my training.”

Roy Foo, a recreational runner, agrees: “I’m a techie and I thrive on seeing the detailed stats on Garmin Connect, which spurs me to find new ways to train and run faster.”

Likewise, this is where my adoration of the GPS watch comes in.

The Garmin synchronises wirelessly to my laptop in seconds, then transfers all the data to the Garmin Connect website, which displays all the beautiful post-run statistics.

There’s a map of the route run, graphs showing my speed against distance and the course profile, lap times and pace, and a whole lot of other performance metrics short of medals won. It also acts as a log of my progress as I train towards that big race.

“The market [for GPS watches] is huge, as anyone who is doing any kind of exercise wants to know how they’re performing,” Pye says. “Think of the Garmin watch as a training buddy, motivator and coach, giving you vital information and helping you work out at optimal levels.”

It’s becoming so ubiquitous that my friend Sandro says at the starting line of last year’s Ultra-Trail du MontBlanc, a 166-kilometre race through the Alps, his watch started to pick up everyone else’s heartbeat, and then indicated he was moving at 560km/h.

“I didn’t have time to reset it before the race started, so I just switched it off – not great,” he says.

“It’s a real love-hate relationship.”

Watch for these – the latest wrist gadgets for runners ......................................................

Jeanette Wang jeanette.wang@scmp.com Garmin Forerunner 910XT Set to launch later this year, the latest incarnation from arguably the world’s leading GPS watch brand is much sleeker than its predecessors. The all-in-one device not only tracks running and cycling, but also extensive swim metrics including distance, stroke identification, stroke count and pool length.

Nike+ SportWatch GPS Using GPS by TomTom, the Dutch navigation equipment maker, and the in-shoe Nike+ Sensor, this watch lets you get accurate speed and distance information indoors or out. The USB contacts are built into the watch strap – so it plugs directly into the computer to upload data and recharge.

Polar RCX5 Finnish brand Polar is the leader in heart rate monitoring watches, and ventured into the GPS arena by creating sensors as optional add-ons. While in the past the sensors were big and clunky, their latest, the G5 GPS sensor, is barely the size of a mobile phone battery. Pair with the watch and you’re in data heaven.

Suunto t6d Like Polar’s watches, this needs an add-on Pod to have GPS capabilities.

However, the circular Pod is considerably large, at about 7cm in diameter and weighing 72g.

Timex Ironman Global Trainer This is a huge watch, but it’s all-in-one. It’s boasted that it is “easy to use for those who want a simple speed and distance product, thanks to the thoughtful and intuitive interface that Timex is known for.”

With skyscrapers all around, finding a GPS signal on a running watch can take 15 minutes. Photo: Robert Ng

10 FITNESS

WALKING HOME

Wanders never cease ......................................................

Rob Lilwall healthpost@scmp.com

Clockwise from above: an icy Rob Lilwall pictured during his last adventure, “Cycling Home From Siberia”; stopping to watch the sunset in Siberia; a map at the ready for his forthcoming adventure; equipment for training walks near his Hong Kong home

The other evening at around 5pm I left home and set off from my village towards Sunset Peak.

I had loaded up my newly custom-moulded Osprey rucksack with five two-litre bottles of water and an old tent, bringing its weight to over 15kg. I carried my pink iPod in my left hand and a stick for the snakes in my right (I’m terrified of snakes).

Weaving through the village houses I reached the familiar path and began to climb. It was completely dark by the time I reached the top, so I used the light from the iPod to find my way down the other side. I finally got back to my village at around 9pm, where, drenched in sweat and looking like a swamp man, I stumbled through the door and into the arms of my incredibly patient wife. I’m trying to do this training hike at least three times a week.

He’s training for the Trailwalker, I hear you say. Well, not quite. Rather, all this hiking is for a less intense, but considerably longer journey – a six-month 5,000-kilometre walk with a friend, from Mongolia to my home in Hong Kong via a very wintry China. We are calling the expedition Walking Home From Mongolia.

To understand Walking Home From Mongolia, however, I need to explain my last major expedition: Cycling Home From Siberia.

In 2004, I quit my job as a geography teacher in Britain and bought a one-way plane ticket to the farthest away and bleakest place I could think of – northeastern Russia. I wanted to explore the world first hand, and I thought it would be fun to start a very long way away and try to get back again. What’s more, I would do this on a bicycle.

So I flew to Siberia with my bike in the hold and, when we landed, I set off to ride home. The subsequent journey of 56,000 kilometres took me three years, and along the way I passed through the wilds of Papua New Guinea, Tibet and Afghanistan – and also made a detour to Australia (to cross the sea I hitch-hiked on cargo ships and yachts).

There were tough times – I camped at minus 40 degrees Celsius, was robbed at gunpoint and caught malaria.

But there were lots of great times: the thrill of using pedal power to cross deserts, mountains and jungles; the countless kind people who looked after me, from Russian gold miners to Korean pastors, from Tibetan monks to Afghan NGO workers; and raising more than HK$300,000 for the children’s charity Viva.

I also enjoyed having such a clear purpose to my life – to know that I needed to cycle 100 kilometres or so, day after day, until I got home.

Best of all, a year into the trip I also met the Hong Kong girl who is now my wife.

It’s been almost four years since I

We will cross the Gobi as winter sets in, hike a deserted section of the Great Wall and kayak down a stretch of the Yellow River finished Cycling Home From Siberia.

Since then – and especially after I wrote a book and a television series was made about the journey – many people have been asking what my next adventure would be. I never knew what to say, partly because I had not found an adventure that captured my imagination.

But after relocating to Hong Kong with my wife a year ago and revisiting the mainland a few times, I was drawn to exploring China, of which I have only seen a fraction.

I liked the idea of starting the expedition somewhere tough and bleak again, and having to overcome many obstacles to return home. And this time, rather than cycling, I thought I would walk, as this would bring a new challenge and give me a chance to experience the land and its people at an even slower pace.

The expedition will again have its fair share of landmarks and difficulties. In the first two months we will cross the Gobi as winter sets in,

hike a deserted section of the Great Wall, and kayak down a stretch of the Yellow River (in portable kayaks we will carry in our backpack).

From there, back on dry land, we will walk through ancient Xian, before heading into a 1,900-kilometre stretch of snowy mountains and a long string of unknown towns and villages.

As spring arrives, around March, we will finally emerge from the mountains and reach Guilin, where we will unpack the kayaks again and paddle down the Pearl River, all the way to Guangzhou.

From there we will walk a mere hundred kilometres or so to Hong Kong. Home again, at last.

I am very excited about this new expedition, but also somewhat daunted. It will be a time to learn more about China, to push myself to the limit, to think hard about life and death again. To do something that makes me feel alive.

I will also again be raising money for Viva. But essentially, I will just be trying to get home.

Rob Lilwall is an adventurer, author and motivational speaker. In the coming months, he will write a weekly column about Walking Home From Mongolia (walkinghomefrommongolia.com) in Health Post. Meanwhile, join Rob this Friday at 7.30pm at his expedition send-off at the Vine Centre, Burrows Street, Wan Chai, where he’ll share his past and future adventures, complete with stunning photos and video footage.

Details at www.viva.org/hkevents.

WELL-BEING 11 PERSONAL BEST

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

Anthony Solimini healthpost@scmp.com The perfect antidote to frantic living in Hong Kong is arguably laughter.

The busier we get, the more we need humour. It may be overused, but there certainly is scientific truth behind the saying “laughter is the best medicine”. It doesn’t matter what makes you giggle. The act of laughing itself has healing properties.

A grin uses far fewer facial muscles than a frown. So unless you feel the need to exercise more of your facial muscles than necessary, a smile, a grin or a chuckle will make you feel much better than time spent worrying about bills and the future.

So why aren’t we all putting our sense of humour to work so that we can get the most out of every day?

The main reason is that people have become far too serious.

I worked in financial services for more than 17 years. During this time, I learned a lot about business, the world and, most importantly, people. I believe that much of my success was down to my ability to understand different types of people.

But my success was also a result of my love of laughter.

So, I started a training and consulting business focusing on presentation skills, public speaking and increasing the effectiveness of business professionals. I taught people to use psychology and human nature rather than PowerPoint slides and Excel spreadsheets.

This led me to my current passion: stand-up comedy. In 2007, I saw an advertisement in the South

China Morning Post for a comedy course offered by Jami Gong, a professional comedian from New York who opened The TakeOut Comedy Club on Elgin Street.

After that course, I knew comedy was for me. I did open mic nights for six months and now I’m a regular at the club. I have also performed in Singapore, the Philippines and Guangzhou. It has changed my life.

Making people laugh is a great thing because everyone loves to laugh. And laughter is the best medicine, after all. Laughter reduces pain by releasing pain-killing hormones called endorphins.

Laughter also significantly lowers the body’s level of cortisol, the hormone produced by stress.

By increasing the production of T-cells, interferon and proteins called globulins, a good laugh can strengthen our immune system.

Humour also has a positive impact on our intellectual and emotional functions.

It helps give us a healthy perspective on life’s trials and tribulations by making them seem smaller. It assists in overcoming fear, it triggers creativity and it allows us to take ourselves less seriously.

Of course, you don’t need standup comedy to get the full benefit of laughter. Here are a few ways to add some comedy to your life: • Smile – it’s the start of laughter and it’s contagious. Pioneers in laughter therapy have found it’s possible to laugh even when you don’t find something funny. The same is true for smiling. So when you see something even mildly pleasing, give it a go.

• Count your blessings – literally.

Go on, make a list. The simple act of

Illustration: Martin Megino

Funny side up

considering the good things in your life will distance you from the negative thoughts, which are a barrier to humour and laughter.

When in a state of sadness, we have farther to travel to get to humour and laughter.

• When you hear laughter, move towards it. Sometimes humour and laughter are private, a shared joke among a small group. But people are usually very happy to share something funny. It gives them an opportunity to laugh again. They can also feed off the humour the listener experiences. So when you hear laughter, seek it out and ask: “What’s funny?”

• Spend time with fun, playful people. These are people who laugh easily – both at themselves and at

The act of laughing itself has healing properties. It doesn’t always matter what you are laughing at

life’s absurdities. They routinely find humour in everyday events. Their playful point of view and laughter is contagious.

• Bring some humour into your conversations. Ask people, “What’s the funniest thing that happened to you today? This week? In your life?”

As a principal at Simitri Training and Consulting, I work with business professionals on the skills they need to succeed in the corporate world.

I focus on using humour. Why? Because it puts people at ease and makes them feel comfortable. If they feel comfortable, they are more open and honest about their feelings. If they are more open and honest, stress and conflict tend to disappear quickly.

So, keep laughing.

THE TASTE TEST BREAD STICKS ......................................................

Jeanette Wang jeanette.wang@scmp.com

La Rose Noire Cheese Sticks 165g for HK$23, Market Place

by Jasons The finely-grated cheese on one edge of these fat and angular sticks provided a pleasant savoury tinge, but it also had quite a few more grams of calories and fat.

Verdict: good with soup or salad, and also works well with slices of ham.

Moredough Kitchens Rosemary Grissini 200 grams for HK$98, Pacific Gourmet I had high hopes for this, given its price tag and the posh setting it’s sold in.

But while the rosemary added a fragrant touch, the skinny sticks had a dull crunch.

Verdict: something different, but could do with more bite.

Alis Grissini 120 grams for HK$20, Il Bel Paese Hand-coated with extra virgin olive oil, these traditional Italian sticks had a super crisp crust and were very light inside. They’re nothing special, but they are comfortingly familiar.

Verdict: a bit bland, so best to have this with your favourite dip.