20111220 health post

YOUR GUIDE TO LIVING WELL

HEALTH POST

How Hong Kong lags behind in the corporate wellness stakes >PAGE 4

Lift your game ’TIS THE SEASON TO BE STRESSED

THE BEST WINTER WORKOUT GEAR

>PAGE 6

>PAGE 8

TUESDAY, DECEMBER 20, 2011

2 NEWS APP OF THE WEEK

HEALTH BITES ......................................................

Not the ultimate heart helper, but it does come with Babs ......................................................

Katie McGregor healthpost@scmp.com HER Heart Health Free Rating 6/10 This might come across as a bit morbid, but thinking of Christmas stress and the phenomenon known as the “Merry Christmas coronary”, I thought it time to find the ultimate heart health app.

Such an app would combine stress relief techniques, a heart-rate monitor, a log to track blood pressure and cholesterol levels, and heart-healthy exercises and recipes.

I am still looking.

There are numerous apps performing the individual functions, and the Mayo Clinic Heart Health app looked a contender with a discussion on integrative medicine and sections on yoga, eating well and exercise. But it costs US$24.95.

Not within my budget, I thought.

Eventually, after much searching I found the HER Heart Health app by the Cedars-Sinai Women’s Heart Institute, which is free – and Barbra Streisand is one of the sponsors.

Without singing a single note, Streisand explains in a short introductory appeal video that although more women die of heart disease than men, and although the causes, symptoms and treatments are different for women, much heart research has focused on men.

“Please send money,” she adds.

An example of the difference between heart disease in men and women is found in the facts section: women suffer milder symptoms when having a heart attack and – without chest pain – a women may feel an unusual feeling or mild discomfort in the back, chest, arm,

neck or jaw, and may suffer a sudden onset of weaknesses, nausea or vomiting and fatigue. Something new to worry about for Christmas.

From the five question quiz I learned that taking a 30-minute nap three times a week reduces the chance of dying from heart disease by a third, cholesterol and heart disease levels are on the rise in women in the 20 to 39 age group, and a whopping 60 per cent of women at that age have at least one primary risk factor for heart disease.

That’s in the US at least.

The app comes with a simple exercise tracker, which seems to be set on a US time zone so gives you jet lag, and a nutrition section which provides tips such as: “don’t skip breakfast”, “substitute salt with lemon juice”, and “eat bananas to help regulate blood pressure”. There are six recipes.

On consideration, perhaps it would be worth paying US$24.95 for a bit more information.

Jeanette Wang jeanette.wang@scmp.com They drink, they shoot, they score If you play a team sport that involves endurance and skill – such as rugby, soccer or netball – consider hydrating with a beverage that blends carbs and caffeine for top performance. Research by Sheffield Hallam University on soccer players in match simulations shows that this combination not only allows participants to sustain higher intensity for sprints, but also improves shooting accuracy and dribbling.

Mayur Ranchordas, a senior lecturer and performance nutritionist at the English university, says: “There’s already plenty of research showing that caffeine and carbohydrates improve endurance, but this study shows that there is also a positive effect on skill and performance.”

Stress-free infants key to allergy research With the rise of allergies in children worldwide, experts from Sweden’s Karolinska Institute have uncovered a new finding that may be useful in future allergy prevention.

Their study, published in the Journal of Allergy and Clinical Immunology, has found that infants with low concentrations of the stress-related hormone cortisol in their saliva develop fewer allergies during the first two years of life compared to other children. A combination of environmental and lifestyle factors during pregnancy and early infancy are thought to be responsible for the sharp rise in allergies.

An apple a day keeps inflammation at bay Whatever you do, don’t skin that apple before you take a bite – the peel contains antioxidants that could suppress bowel inflammation, according to recent research findings by Montana State University published in the Journal of Leukocyte Biology. The study, done on mice, found that eating polyphenolrich peel counteracts inflammatory T cells (a type of blood cell that protects the body from infection) to enhance resistance against autoimmune disease, thereby protecting against colon inflammation. This finding could lead to new therapies and treatments for disorders related to bowel inflammation, such as ulcerative colitis, Crohn’s disease and colitisassociated colorectal cancer.

ASK THE DOCTORS DR CHAN KWOK-KI Q: What is the best way to treat undereye circles and puffiness?

A: For dark eye circles, since there are various causes, it is difficult to find a simple treatment, and the results may not be satisfactory.

Increased pigmentation of the skin around the eyebag area can be one of the causes of dark circles. Such surface skin pigmentation may be reduced by laser or by intense pulsed light (IPL). Unlike a laser, IPL produces a spectrum of light instead of a single wavelength.

Dark pigment is more sensitive to specific wavelengths of IPL or laser, which can lead to pigmented skin cells falling off.

If the symptoms are due to shadows at the edge of the eyebag, dark circles may be reduced by eyebag surgery or skin tightening, using radiofrequency

treatment, for instance. Sometimes, injection of hyaluronic acid in appropriate areas might also be effective to mask the edge of the eyebag.

There are two kinds of eyebag removal surgery: transconjunctival blepharoplasty and open blepharoplasty.

The former involves making a tiny incision on the inner, pink portion of the lower eyelid and removing excess fat, while the latter involves an incision just below the lower eyelid line, removal of excess fat and tightening of the lower eyelid skin.

Whether considering surgery or laser treatment, you should talk to your plastic surgeon about the potential risks involved and seek diagnosis of the root cause in eye circle cases. Their advice is always valuable before making any decision.

Dr Chan Kwok-ki is a specialist in plastic surgery

> 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

Self-cleaning cotton makes light work of laundry If you’re sick and tired of doing the washing, you’ll appreciate the latest breakthrough by mainland researchers: self-cleaning and deodourising cotton.

Chemical and environmental engineers Long Mingce of Shanghai Jiao Tong University and Wu Deyong of Hubei University for Nationalities developed the fabric by coating cotton with nanoparticles made from a compound that mixes nitrogen with titanium dioxide. The latter chemical breaks down dirt and kills microbes when exposed to certain types of light and is already found in a range of products such as self-cleaning windows and socks. But this new cotton is the first that does so in regular sunlight, according to a report in the journal ACS Applied Materials & Interfaces.

Carcinogenic fears over botanical ingredients Some plant-based food supplements contain compounds that in high doses could cause liver cancer, according to researchers collaborating on the European Union project PlantLIBRA. The compounds, known as alkenylbenzenes, were found at a relatively high level in products that contained a main ingredient of basil, fennel, nutmeg, sassafras, cinnamon or calamus, or their essential oils. However, there are also supplements in which the level of these compounds is negligible. It is also important to note that as the test animals were fed only high concentrations of pure alkenylbenzenes, the findings may overestimate the effects on humans.

More studies will be done, but in the meantime it is advisable to be cautious when it comes to supplements.

MEDICAL 3

CASE HISTORY

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Wynnie Chan healthpost@scmp.com Pushing oneself to the limit was something that Jason Wong, a 34year-old personal trainer, was used to. It was also a mantra that Wong (whose name has been changed for patient confidentiality reasons) often repeated to clients. So, even when he felt intermittent stabbing pains and cramp in his left calf, he worked through the discomfort.

But when he started getting severe pins and needles in his left leg, and had to rest after walking just a couple of blocks, he decided to get himself checked out at a local hospital.

Dr Graham Roche-Nagle, the attending physician, performed a routine physical examination on Wong and ran a blood cell count, liver and renal function tests, blood lipid levels and coagulation tests.

All of these tests came back within normal ranges.

The condition has the potential to create significant morbidity and can cause a devastating debility DR GRAHAM ROCHE-NAGLE

But given Wong’s age, occupation and leg pain, the doctor suspected his patient suffered from popliteal artery entrapment syndrome (PAES).

Roche-Nagle says the condition is an uncommon cause of lower limb claudication – aches, cramps, fatigue and sometimes burning pain in the legs that usually occur with walking and go away with rest.

The condition affects younger sports participants, athletes or soldiers who have no known cardiovascular risk factors. “These groups habitually undertake vigorous exercise, leading to calf hypertrophy [increase in the size of muscle cells], which unmasks the anatomical abnormality.”

The popliteal artery is situated behind the knee and supplies blood to the knee joint and muscles in the thigh and calf. PAES occurs when the popliteal artery gets compressed or trapped as a

result of an abnormal positioning of this blood vessel in relation to the increased size of the surrounding muscle. As a result, there is insufficient blood flow in the affected limb, commonly leading to exercised-induced pain in the leg.

The prevalence of PAES is unknown, but typically 60 per cent of patients are under 30 years old, usually male (15:1 ratio of males to females) and can affect both legs in 25 per cent of cases. Symptoms typically include temporary tingling or coldness in the foot, and later sporadic leg pain. Repeated compression of the popliteal artery can cause trauma to the wall of this artery. If this isn’t diagnosed early, there may be irreversible artery damage leading to localised atherosclerosis, which can potentially lead to the loss of the affected limb.

A Doppler ultrasound was conducted on Wong’s left leg. This test uses reflected sound waves to evaluate blood flow through the popliteal artery and vein. When Wong was asked to lift his ankles upwards and point his toes downwards (plantar flexion), the ultrasound showed a decrease in arterial blood flow to his left leg.

The same result was shown when Wong was asked to point his toes upwards towards his shins (dorsiflexion).

PAES was further confirmed using magnetic resonance angiography (MRA). This test uses a powerful magnetic field, radio waves and a computer to produce detailed images of the popliteal artery. During forced plantar flexion, MRA showed an absence of popliteal arterial blood flow.

Based on this diagnosis, Wong was admitted to hospital and underwent an operation to remove a small section of the surrounding muscle, which was constricting his left popliteal artery. No arterial damage was found and Wong made a full recovery.

“Although this diagnosis is infrequently reported in sports medicine publications, the condition has the potential to create significant morbidity and can cause a devastating debility,” writes Roche-Nagle in his case report published in the Hong Kong Medical Journal. Early and accurate diagnosis, along with the appropriate treatment, is necessary to reduce the risk of potential limb loss.

Illustration: Angela Ho

Over-training doesn’t go with the flow

4 COVER STORY

Nice workout – if you can get it Not many firms in Hong Kong have employee fitness programmes in place. But the situation is slowly improving, writes Monica Proctor

AIA workers take time for fitness (top); NBA Asia’s Chris Lee (left) shows the pedometer he uses; AIA assistant vice-president Ping Wu (right) gets coaching from Bob Ngai; AIA staff stretch their potential (below).

Photos: Edward Wong

83

Percentage of companies in Singapore that have employee health-care programmes in place, according to a survey

A

fter a stressful day at work glued to her computer or when a presentation calls for a clear head, Ping Wu heads to We Fitness, the corporate gym in her office building, for a run or dance class. “The fitness centre is a very convenient place to calm down, burn calories and feel good, so I am more energetic at work, in meetings and in my daily life,” says Wu, the assistant vice-president of Group Customer Value Management at AIA. The insurance company takes the health of its staff seriously. We Fitness is a state-of-the-art facility at the AIA Building on Stubbs Road, which occasionally introduces guest instructors to help employees develop an individualised fitness regimen. Health seminars on topics such as heart disease prevention, stress management and weight-loss strategies are also organised, and subsidised flu vaccinations are provided for staff and their family members.

“It’s easy to exercise at AIA. We have a great gym,” says Stella Chow, an executive secretary and single mother of two. “My supervisor is really supportive, as is the company.”

AIA, however, seems to be in the minority of Hong Kong companies.

According to results released in October of a poll of HR professionals by global professional services firm Towers Watson, fewer than one in three Hong Kong companies has a health-care strategy in place, while half of the respondents have no plans to adopt one.

This is in stark contrast to 83 per cent of companies in Singapore and 72 per cent in Shanghai that have health-care programmes in place, with the rest planning to launch one.

Hongkongers work among the longest hours in the world, largely because of a belief that more work hours means higher productivity.

But a recent study by researchers at Stockholm University and Karolinska Institutet found the opposite to be true: that it’s possible to use work time for exercise or

other health-promoting measures and still attain the same production levels or even higher. Two workplaces in dental care were asked to devote 21⁄2 hours per week to physical activity, distributed across two sessions. Another group had the same decrease in work hours but without obligatory exercise, and a third group maintained their usual 40-hour working week. All three groups were able to maintain or even increase their productivity levels, while those who exercised also reported improvements in self-assessed productivity.

“This increased productivity comes, on the one hand, from people getting more done during the hours they are at work, perhaps because of increased stamina and, on the other hand, from less absenteeism owing to sickness,” say Dr Ulrica von Thiele Schwarz and Dr Henna Hasson, the researchers behind the study, which was published in the Journal of Occupational and Environmental Medicine.

Marcel Daane, a fitness trainer and director of Singapore-based Body-Brain Performance Coaching, which specialises in maximising

COVER STORY 5

executive performance through health and wellness initiatives, agrees. He’s worked with the executive teams of large multinational companies such as SAP, Google and Accenture in Australia, Singapore and New Zealand.

“Other than obvious benefits such as a reduction in absenteeism rates and medical costs, and increased health, I believe increased performance, productivity and positive effect are key results of wellness programmes,” he says.

The good news is the corporate wellness trend is picking up in Hong Kong. This year, Community Business, a non-profit organisation aimed at advancing corporate social responsibility in the city, organised the first Work-Life Balance Week in October after three years of holding annual Work-Life Balance Days. According to the organisation, the list of participating companies has grown from 120 in 2008 to 178 this year.

During the week, companies simply have to roll out initiatives to help promote a better work-life balance for their employees.

Asset management firm

Workplace wellness is only going to work if companies are going to recognise that worklife balance is a serious and important consideration ROBIN BISHOP, COMMUNITY BUSINESS

Above: NBA Asia employees have a corporate wellness programme in place, including time off to play sports and to participate in the Just Walk 10,000 Steps a Day Programme. Photo: May Tse

BlackRock Asia Pacific offered 26 different activities to help staff take charge of their well-being in a fun and engaging way. “We invited health and fitness professionals to discuss good posture and eating intelligently in Hong Kong, and offered yoga classes in Australia and in-office massages in Singapore, to name a few of the activities,” says Catherine Barker, Southeast Asia director of iShares, which is under BlackRock.

Aside from this week, other companies have their own initiatives. Staff at NBA Asia, whose headquarters is in Causeway Bay, are encouraged to participate in the Just Walk 10,000 Steps a Day Programme. For eight weeks, they wear a pedometer and try to walk at least 10,000 steps a day, which is roughly equivalent to the recommended 30 minutes of daily exercise.

“The NBA has a strong commitment to the health and fitness of its employees,” says Scott Levy, senior vice-president and managing director of NBA Asia.

Swire Beverages, one of the largest Coca-Cola bottlers in the world, works with local governments to encourage

employees and families to walk and sponsor corporate sports events, as part of its Live Positively campaign.

Clive Saffery, CEO of Swire Beverages China and an ultramarathoner, is a keen advocate of keeping a balanced, healthy and active lifestyle. “All companies should do everything they can to get people away from their desks,” he says. “It’s not just about getting people to participate in sport; it’s about the simple things, like taking the stairs not the lift.”

Results of the annual work-life balance survey by Community Business, released in October, showed that 52.4 per cent of Hong Kong employees had felt overloaded at work in the past 12 months, but on a work-life balance scale of 0 to 10, where 10 was the best, workers rated themselves at 6.17, a slight improvement from the past five years (which had been consistently around 5.6 or 5.7).

So, there is progress being made, albeit slowly. “The long-term effects of this being overworked could be damaging both to workers’ health and to overall productivity, as workers drive themselves too hard and become disaffected, depressed or even physically ill,” says Hans

Leijten, regional vice-president of Regus, the international provider of flexible workplaces.

Employees are advised to find out if their companies offer wellness programmes, and if so, what kind of benefits, such as discounted gym memberships or financial incentives for staying healthy. They can make suggestions to their supervisor or human resources departments if there are no programmes in place. These can range from offering a yoga class in an empty conference room to sponsoring a dragon boat or basketball team to promote group wellness.

As for companies, the impact of wellness programmes can be assessed through the measurement of the company’s internal matrix, asking questions to employees at exit interviews, absenteeism rates, staff engagement surveys and effective measures on productivity, says Robin Bishop, chief operating officer at Community Business. “Workplace wellness is only going to work if companies recognise that a worklife balance is a serious and important consideration,” she says. healthpost@scmp.com

6 HEALTH FROM THE EXPERTS

PREVENTION FESTIVE STRESS

Enhancing mental health is the new train of thought

Why the ......................................................

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Dr Wong Chung-kwong healthpost@scmp.com Worldwide, mental health problems are increasingly prevalent. The US National Institute of Mental Health estimates that the one-year prevalence of all diagnosable mental disorders among adults in the average community is 26.2 per cent.

The World Health Organisation, in its 2003 publication Investing in Mental Health, estimated that one in four families had at least one member with a mental disorder.

Being mentally healthy involves not just the absence of mental illness. It must also include mental well-being and personal efficacy, effective functioning in the family and the workplace, and a good quality of life from the psychological perspective.

There are three states of mental health: 25 per cent of the population is mentally ill, 50 per cent is mentally unhealthy, and only 25 per cent is mentally healthy. The mentally unhealthy do not satisfy the criteria of mental illness, but have subclinical symptoms, compromised functioning, and/or

unsatisfactory quality of life. These figures explain why mental health is the core factor for corporations’ productivity and the quality of society.

The first, most traditional way of dealing with mental health problems is through therapy. While society should continue to do its best on this front, there can never be sufficient resources for the many with mental disorders.

The second approach is prevention; but even if it were successful, it is not the same as the promotion of mental health.

This is why we need a third, more innovative approach: enhancement.

For the mentally healthy, this will further equip them with knowledge and skills that can improve mental well-being and enable better functioning in their workplaces and families.

For the mentally unhealthy, it enhances their mental well-being and prevents deterioration of the mental illness.

For people with mental disorders, it improves mental wellbeing and indirectly improves the well-being of their significant others, thus enabling these others to be

Dr Susan Jamieson healthpost@scmp.com

better willing and able to accept and care for them.

The enhancement approach uses training as its main methodology.

Based on scientific knowledge, we are able to develop mental health enhancement curricula for adults and children. Through widespread training programmes, the entire population’s mental health can be enhanced.

The burden of mental health problems on the community is very heavy. The enhancement approach addresses the total mental health needs of everyone and is the most cost-effective approach.

Dr Wong Chung-kwong is a former professor and chairman of psychiatry at Chinese University. He is now chairman of the board of honorary advisers of the Whole Person Development Institute

Christmas is up there in the top 12 precipitants of stress and depression, according to the Holmes and Rahe stress scale. Although outranked by divorce, death of a spouse and moving house, it seems surprising that a holiday and time of celebration is on the scale at all.

As a Hong Kong family doctor for 23 years, I’ve seen the season’s toll on already stretched professionals.

Still working long hours, travelling for business and living in jet lag, they now have to cope with children’s expectations and increased social demands. Going out to more parties, with inevitable sugar and alcohol overload, what’s at first fun soon becomes tiring. There’s no opportunity to rest, recuperate and have a bit of “me” time.

This is when the depression begins to slide in, when we do something we don’t really want to because we’re simply tired – whether emotionally or physically.

There is a school of thought among therapists that in suppressing the real emotion (“I’m tired and bored of socialising”) and pretending to be

SUPPLEMENTS

When it comes to vitamin pills, some people just don’t know when to pop ......................................................

Sasha Gonzales healthpost@scmp.com Peek into Amanda Ho’s medicine cabinet and you’ll notice countless bottles of vitamin and mineral supplements. The 33-year-old special education teacher pops several of these pills a day, claiming that they do everything from prevent colds to improve her eyesight and give her more energy.

Ho says that because she follows a balanced diet, she probably doesn’t need half of these supplements, but she likes knowing that she has some kind of “backup” in case her diet falls short of her nutritional requirements.

According to a recent report by the Australian Trade Commission, the vitamin and dietary supplement industry in Hong Kong was worth HK$3.2 billion last year, with combination dietary supplements the top sellers. Ho says she spends just more than HK$6,000 a year on her non-prescription vitamins and minerals. “Having that peace of mind is worth every cent,” she says.

“I think of my supplements the same way I do health insurance.”

But are supplements necessary and are they for everyone? No, says dietitian Vivien Yu from

privatedietitian.com. “It really depends on your lifestyle needs, nutritional status, dietary habits, as well as physical health,” she says. “If you don’t eat a balanced diet, if you’re pregnant, or if you suffer from nutritional deficiencies or have certain conditions that require you to consume supplements, then you probably need them.” If you aren’t sure which supplements to take or if you should be taking any at all, it might be best to get advice from your health practitioner.

Daphne Wu, a freelance dietitian for Life Enrich Training & Consulting Centre, agrees.

“Supplements are meant to supplement your nutritional inadequacy,” she says, “so you do not need any extra vitamins and

3.2 • Value (HK$ billions) of supplement/vitamin market in Hong Kong in 2010

minerals if you already have a balanced diet.” She adds that nutrient requirements differ across age groups, physical activity levels and even gender – for example, women need more calcium than men. Vegans and people with food intolerances or allergies might also need an extra dose of nutrients.

For healthy bones and teeth, Yu says that the average adult needs two to three servings of dairy products a day. Unfortunately, most of us do not get this amount, and so a calcium supplement might be required. “Most adults need about 1,000 milligrams of calcium a day, but research has shown that we get just 400mg of this amount from food,” she says. “Taking a calcium supplement of 600mg a day should be adequate. However, you’ll need to increase this dosage if you are suffering from osteoporosis.”

If you’re at a childbearing age or are pregnant and in your first trimester, you are advised to take a folate supplement. Folate is a Bvitamin that occurs naturally in foods like leafy green vegetables, citrus fruits and dried beans. Yu says about 600 micrograms (mcg) a day is recommended to prevent neural tube defects in babies.

Antioxidants, like vitamins A, C and E, and minerals zinc, selenium

and manganese, help prevent cellular damage, which is believed to lead to cancer, ageing and a host of other diseases. Most people get enough antioxidants from food every day, says Yu, but if you smoke or do a lot of physical activities, you might need slightly more than the average person.

Smoking depletes your tissues and blood of vitamin C, so if you have yet to kick the habit, you should take a vitamin C supplement to counteract the damage that’s been caused to your body.

It’s a common belief that the more dietary supplements you consume, the more you get out of them. Unfortunately, there is such a thing as overdosing on vitamins and minerals. For example, long-term excessive intake (more than 1,000mg a day) of vitamin C, says Yu, may cause diarrhoea, lead to the formation of kidney stones, interfere with certain drugs, or cause iron overload in your system.

Over-consumption of vitamin D may lead to hypercalcemia, or excess calcium in the blood – the symptoms of which include constipation, nausea, frequent urination, pain in one side of the body between the abdomen and back, and even kidney damage.

And you might think you’re building healthier blood cells by taking iron supplements religiously, but over-consumption over a long period can cause liver damage, adds Yu. Research has also shown a link between high calcium intake and the risk of prostate cancer, and high beta-carotene intake and lung cancer, Wu points out. So don’t be tempted to take more than the recommended amount.

Another danger of an excess consumption of supplements is that specific nutrients can interact with others, hindering their absorption – animal studies show that high calcium intake appears to have a negative effect on iron absorption, says Wu. In addition, overdosing may mask the symptoms of other nutrients’ deficiency – for example, high folic acid intake can mask the symptoms of vitamin B12 deficiency.

When shopping around for supplements, you might consider quality, brand, price and popularity.

But, says Yu, what’s more important is to check the dosage on the label.

“The dose per tablet or capsule should be within the recommended daily allowance,” she advises. “You should only buy what your body needs, so avoid supplements that provide ‘mega doses’.”

HEALTH 7

e season can be anything but jolly someone we are not at that moment, we begin to sabotage ourselves. Put in a different way, there is an inner-outer mismatch, and something has to give.

Of course, there are other factors that may play a part in Christmasrelated depression, such as the loneliness of the recently divorced, the absence of one’s children or being single and surrounded by happily married friends.

So, I see the yearly pattern of stress building up and general health deteriorating after Thanksgiving. At a peak time for upper respiratory infections and flu, a depressed immune system due to stress is the last thing we want.

Often these minor illnesses are what drag a patient to my office, and the normally fit and healthy person can’t understand why he or she is picking up everything that’s “going around”.

I explain that, unfortunately, stress and minor depression have both been found to affect our immune response. Of course, it’s common sense that tiredness and exhaustion will also have an impact on the body’s defence systems. If we put all our energies into work and partying, there may not be much left

to fight off illness. Here’s what can be done: Carve out ‘me time’ I notice how hard people are on their bodies. Physically and mentally tired, they push themselves to the limit through over-exercising, working or socialising.

A step back is needed and a recognition of the fact that if there are extra things to do around Christmas, we must cut down on some other things. Yes, we all need to perform well at work; however we won’t do this when tired or sick, so recognise this and act on it.

Schedule time to really relax in whatever way that suits you. Try it for two weeks, and you’ll find you get twice as much done at work.

Prioritising is self-nurturing What is it in your life that you really like and value? Perhaps it’s spending time with your family, going to the gym or having tea with friends.

Whatever you find most nurturing must be given time in your life.

Seek professional help It’s amazing how much better patients will feel after just talking

Supplements are meant to supplement your nutritional inadequacy so you do not need any extra vitamins and minerals if you already have a balanced diet VIVIEN YU, DIETITIAN, PRIVATEDIETITIAN.COM

through their problems for an hour.

There’s very little chance to do this is our lives, as we don’t want to burden friends and family with our “stuff”.

Coaches and psychologists have a load of tools in their kit to share.

Personal development coach Angela Cummins, with Holistic Central, tells clients: “Firstly, spend just a moment, morning and night, being grateful for something in your life. By regularly focusing on these good things, you will attract even more of them.

“Secondly, be your own best friend instead of your worst enemy.

Imagine that a friend shared the same feeling as you are experiencing – of overwhelm, overburden and tiredness. What advice would you give them?”

Remember, your doctor is always there and has heard it all before, so he or she knows from experience what works. Increased suicide rates are a reality, so we take depression very seriously, often prescribing a brief course of anti-depressant drugs. Though the drugs take two weeks to start working, and sometimes with side effects, they do work.

In the US, anti-depressants are now the second most commonly

prescribed drug, second only to heart disease therapies. Does this mean we’re an increasingly miserable society or that we now have a good tool for a common problem? I don’t know. As a doctor, it’s not my place to judge but simply help people feel better in any way.

Nourish the nervous system The chances are that if we are this mentally depleted we will also be physically depleted.

Eating lots of green vegetables

and minimising sugar in all its forms will provide the body with more of the relaxing and happy hormones we want.

Vitamin B complex and magnesium will always work and should be taken daily.

Dr Susan Jamieson is a Scottish- and Harvard-educated family doctor with 23 years’ experience in Hong Kong.

Her speciality is the integration of science and indigenous healing wisdom. www.drsusanjamieson.com

8 FITNESS

Runners at the start of a 10-kilometre race in Warsaw.

Photo: AFP

GEAR WINTER WEAR

Kit up for cool running ......................................................

Thomas S. Altena healthpost@scmp.com There have been times when I have exercised in wintry conditions so extreme that I have questioned my sanity afterwards. Fortunately, hi-tech advances in fabrics have made running in cold weather an altogether safer and more comfortable experience.

Today, manufacturers produce clothes in a variety of natural and synthetic materials that draw away moisture, insulate the body and protect skin from cold temperatures, and these clothes often block both wind and water while remaining light, highly flexible and comfortable.

My experience with exercise in sub-zero temperatures, combined with deadly wind chills down to minus 40 degrees Celsius, comes from my time in the upper Midwest in the United States, where I spend the holiday season with family. If you are anything like me, exercise happens in any weather.

Before you challenge the elements, it is important to know the current weather conditions and if they may change as your exercise session progresses. Being underprepared or underestimating the elements is unwise, and there are days when the best option is finding an indoor alternative.

Keep in mind that definitions of winter weather will vary based on geographical location, personal experience and individual tolerance.

When you begin your exercise session, your body should feel cold, but you will warm up quickly and begin to feel more acclimatised to the winter weather. Your body will sweat; thus, skin exposure and moisture management are key to remaining warm, safe and comfortable.

Skin exposure can create dangerous – even deadly – circumstances if you are unprepared for cold temperatures and wind chill

factors. Keeping the outside “out” is important, and many materials made of both synthetic and natural fibres keep the elements away from your skin.

Winter weather materials A few manufacturers make materials that completely block the wind from penetrating the fabric, which is typically incorporated at the specific locations of jackets, pants, tights and gloves that face the wind. The downside of windproof material is that it does not allow sweat to escape, so plan to accumulate sweat under the shell.

A shell like Gore-Tex is great for winter because the material is waterproof yet allows sweat to escape. But Gore-Tex is not windproof. If your choice is to not

Even in the coldest of temperatures, the body will produce sweat and, if it is not removed from the skin, you will feel cold wear a synthetic material or windproof fabric, wool and wool blend (50 per cent wool) are amazing natural fibre alternatives that provide excellent breathability, mobility, wind prevention and insulation.

Unlike synthetic materials that do not accumulate moisture, natural wool-blended fabrics allow sweat and water to pass through and freeze on the outer part of the fabric (although Hong Kong isn’t cold enough for this). This freezing effect may seem detrimental, but the ice formed on the outside of the fabric creates a natural wind barrier effective for keeping a person warm.

Many hi-tech fabrics, including hats, socks and gloves, have special washing and drying instructions.

Washing these items on delicate or hand-wash cycle and drying them on low heat or line-drying will ensure the fabrics continue to be high performers over many winter seasons.

Moisture management Moisture management might be the single most important factor for keeping the body warm during winter exercise. Even in the coldest of temperatures, the body will produce sweat and, if that moisture is not removed from the skin, you will feel cold.

Avoid cotton and cotton blends because they absorb sweat. Instead of cotton, a better choice is base layer, a synthetic fabric that draws sweat away from the skin. Base layer is a blend of nylon, Lycra, elastane, polyester and acrylic. A good base layer fits snugly against the skin and moves as your body moves because it is skintight and elastic.

When selecting a base layer, make sure you explore different fabric thicknesses for different temperatures. Using two or three base layers can provide extra insulation for very cold conditions (about minus 12 degrees Celsius or lower) and will increase moisture management.

Running and cycling tights also come in a variety of material thicknesses, just like base-layer shirts. The Lycra-Spandex tights of old are still available, but now tights incorporate windproof front panels or a polyurethane coating that feels like thin neoprene in the front of the legs to prevent wind and water from reaching the skin.

Layering 101 The goal is to keep the core of your body warm, so upper body layering is more important than lower body layering. Layering tights in the most extreme combinations of cold temperatures and wind chills is

recommended, although it may compromise mobility. What you wear under your tights is a personal choice, but one of the best options I have found is tri-shorts (minimal chamois bicycle shorts).

Protecting your extremities Hands: Gloves with a Gore-Tex lining are a great choice for moisture management, but windproof gloves might be an advantage in a cold wind. I have discovered that these gloves fail after about 90 minutes of exercise, as sweat production exceeds the material’s ability to remove moisture. The thin, stretchy knit gloves are a low-cost option for moderately cold weather. These are easy to layer and losing one glove won’t cost very much.

Face: Some people might like wearing face masks, but they tend to capture humidity in breathing and impair vision by fogging up sunglasses or prescription lenses. Instead of a face mask, try using petroleum jelly on exposed skin in extreme cold. Petroleum jelly creates a thin barrier between your skin and the elements, but it will increase the risk of sunburn.

Feet: If you are exercising outside of Hong Kong in ice and packed snow, trail running shoes have an aggressive tread pattern. To improve grip even more, fit your running shoes with crampons.

As you consider exercising in the cold weather, I’d also recommend that you always carry a cellphone in case of emergency. However, remember that sweat ruins cellphones. You can protect your phone with simple a zipper-locked plastic bag.

Thomas Altena is an associate professor with Missouri State University’s department of health, physical education and recreation. Reprinted with permission of the American College of Sports Medicine, ACSM Fit Society Page, Winter 2011, p3-4.

WHAT TO WEAR Here are some suggestions for your running wardrobe this winter.

Outer layer For him: 2XU Active 360 Run Jacket, US$120.95 – wind and rain resistant, this hitech shell boasts 360degree reflectivity for safety.

For her: New Balance NBx Windblocker Jacket 2.0, HK$879 – windproof, waterproof, moisturewicking and reflective, it’s perfect for cold or poor conditions.

Base layer For him: adidas Porsche Design Sport Half Zip Top, HK$2,000 – made from quick drying fabric, this sleek and versatile top has built-in gloves and a zippered back pocket.

For her: Nike Pro Hyperwarm Crew, HK$349 – with a softbrushed interior, this is excellent at retaining heat, and is cut for a flattering fit.

Tights For him: Nike Gyakusou AS UC Swift Tights, HK$999 – the graphics are strategically placed to support key muscles while running.

For her: adidas by Stella McCartney Run Long Tights, HK$900 – sweatdrawing fabric and sharp design help to keep you warm, snug and stylish.

FITNESS 9 WALKING HOME

They’re men of few words ......................................................

Rob Lilwall healthpost@scmp.com Last year, while on a walking expedition across Israel and the West Bank, I stayed with a friend who was naturally gifted at languages. I asked him what was the secret to his linguistic ability. His answer was simple: “Vocab”.

“But what’s the secret to vocab?”

I asked.

“Repetition,” he said.

I admit I was never very motivated to learn languages at school, and always assumed I was simply not good at them. So my friend’s advice was encouraging six months ago, when I set about teaching myself some Putonghua before starting my 5,000 kilometre winter walk from Mongolia to Hong Kong. I was also encouraged to learn that research has shown that, for an English speaker, learning to speak Putonghua is only 20 per cent harder than French (although writing it is about 500 per cent harder).

My expedition partner, Leon McCarron, and I have completed our first month hiking south through the desert. As well as coping with some extreme cold on the Gobi trek, and enjoying some extraordinary hospitality from both Mongolian and Chinese desert dwellers, we have spent many, many hours just walking. The rather unglamorous side to expeditions is boredom with one’s own company. But I am determined not to take for granted that we have an abundance of thinking time – a rarity in the hustle and bustle of Hong Kong. I have also had time to practise my Putonghua by listening to lessons as I walk.

This past week, our steady schedule of 30 kilometres a day brought us out of the desert emptiness and into a wide valley of busy roads, a double rail track, and increasingly prevalent industrial factories and mines. To avoid the roads, we have sought out little snowy tracks through the fields, which are what I dreamed about when I decided to cross China in winter on foot.

Walking is quite a contrast to my previous expedition by bicycle – cycling is much easier and faster, but forces you to stick mostly to roads. It has been thrilling to walk through a world of vibrant farming communities with villagers bustling around and shouting questions at

us, while pigs lie sleeping and snorting beside huge haystacks, and flocks of tiny birds flit between the trees.

But the surprises of new China keep coming. Just beyond one village we came to a giant construction site of half-built compounds. A billboard showed what it would become: a huge new town, complete with parks and a power station.

As we encounter more and more people, there have been plenty of opportunities to use my Putonghua – and alongside the strategies of “vocab” and “repetition”, I have also added “being prepared to make lots of mistakes”. The Chinese are proving patient teachers, always working hard to figure out what I am saying; and, little by little, I am improving.

Last Tuesday evening, we crested a hill and before us was the incredible sight of the first proper Chinese city: Jining. As the hazy dusk sky turned from pink to purple behind it, we stared open mouthed at the vista of spewing chimneys, half-built apartment blocks, dazzling lights and fuming traffic.

Before us, China’s industrial revolution was in full swing. We took the next day off to explore the city.

We have now entered a new stage of the expedition, and the desert is behind us. More and more cities lie ahead, each one bigger and increasingly busy. But there will also be more off-road tracks and snowy villages, and impressive mountains.

This week, we are due to breach a Ming dynasty section of the Great Wall (although by all accounts, it is a small and rundown part, so we may have our work cut out to find it).

When we reach the Great Wall, we will take a week off in the nearby city of Datong for Christmas, and my wife is coming to meet me.

After that, we’re back on the road, and we’ll follow the Great Wall until we meet the Yellow River, then we’ll turn left and follow it south.

Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book, and a National Geographic television series. Every week in Health Post, he will write about the progress of his new expedition, Walking Home From Mongolia, which is in support of the children’s charity Viva. www.walkinghomefrommongolia.com

The warmth of locals never fails to surprise Rob Lilwall Photos: Rob Lilwall

10 DIET NUTRITION FESTIVE EATING

Lighten up for the long haul SENSIBLE SWAPS

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Jeanette Wang jeanette.wang@scmp.com Three low, one high: this is the eating principle that the Health Department’s Central Health Education Unit recommends for this holiday season. That means picking foods that are low in salt, fat and sugar, and high in fibre.

Such strict eating rules sound counter-intuitive at a time when the usual practice is to indulge and let loose, but research shows that the half a kilogram of weight most people gain during this season may never come off, according to the US National Institutes of Health. It may seem like a negligible amount of weight, but think of it as a 5kg weight gain over a 10-year period and it isn’t all that insignificant any more.

Healthy festive eating is easier than you would imagine: just passing on the skin of 100 grams

of butter-basted turkey, for example, can save you 42 calories and 2.9 grams of fat, says the website of Britain’s National Health Service.

Leaving that butter out of your Brussels sprouts can save you another 37 calories and 4.1 grams of fat.

Here are some other tips from the Health Department to enjoy the season healthily: Eat a regular amount at regular times. Don’t eat less or eat nothing during the day just to prepare for the big meal at night. When deprived of food, the body, instinctively fearing starvation, burns calories more slowly, hoards energy and builds up fat stores.

Think small. For party hosts, serve food in smaller or bite-sized portions, which can help guests better control their intake. Using smaller cutlery and smaller plates has also been shown to promote eating less.

The half a kilogram of weight most people gain during this season may never come off US NATIONAL INSTITUTES OF HEALTH

EAT SMART STEWED CHICKEN WITH PAPAYA

Enzyme helps digest meat before you chew it ......................................................

Jeanette Wang jeanette.wang@scmp.com If you want to eat papaya right away, pick one that’s mostly yellow and slightly soft to the touch. When cooking with the tropical fruit, however, green papayas – not yet ripe, and hence firm – are best.

Unripe papaya is rich in an enzyme called papain that helps digest proteins. In this recipe by the Chinese Cuisine Training Institute’s English-Speaking Dining Society, the fruit tenderises the chicken meat, making it soft and delicious.

Papaya also packs antioxidants such as carotenes, vitamin C and flavonoids; the B vitamins – folate and pantothenic acid; potassium, magnesium and fibre.

Stewed chicken with papaya Serves 4 For the chicken marinade ½ tsp fine salt 1 tsp starch ½ tsp ginger juice 1 tsp canola oil 160 grams sliced chicken (skin removed) 400 grams green papaya 16 seedless red dates 1 piece of black fungus, soaked 1 spring onion 1 piece of ginger, peeled and sliced 2 tsp canola oil 200ml chicken stock 1 tsp coarse white pepper

• Mix marinade ingredients together and rub all over chicken meat. Set aside.

• Peel the papaya and cut into wedges.

• Wash the dates, trim the fungus and cut spring onions into 4cm-long strips.

• Heat oil in a pan.

• Slightly brown the chicken pieces.

• Add ginger, dates and papaya and continue to stir fry for a couple of minutes.

• Add chicken stock, white pepper and fungus.

• Cover and simmer for five minutes.

• Add spring onions, season, serve.

This column features recipes provided by the Department of Health as part of its EatSmart@restaurant.hk campaign.

For more information, visit restaurant.eatsmart.gov.hk

Go natural. The less processing a food has, the better. Pick unrefined grains over whites, like a wholewheat dinner roll over a croissant. Avoid processed meat such as bacon, ham and sausage, which are often laden with salt and fat. Fill your plate with more fresh fruit and vegetables and less meat and carbohydrates. And have water as your main beverage: alcohol is very energy dense at seven calories per gram.

Celebrate differently. There are other ways to socialise than over food: playing indoor games or outdoor activities will also provide many memorable moments. On that note, don’t eat and play at the same time.

Paying attention to what and how much you eat can help you better sense satiety.

Enjoy. Eat slowly to allow time for your brain to get the message that your stomach is full and prevent overeating.

Portion size aside, some holiday favourites start off far worse for your waistline than others. “It’s not uncommon to gain nearly half a kilogram – or more – during the holiday season,” says Gloria Tsang, a registered dietitian and author of the new book Go UnDiet. Here’s some swaps to consider: • Crab cake appetisers typically are made with mayo and bread crumbs, and fried. Replace them – and puff pastries – with a shrimp cocktail.

• Candy canes are pure sugar and won’t fill you up. To satisfy a sweet tooth, choose small squares of dark chocolate, which have nutritionally valuable antioxidants.

• Eggnog is often packed with calories and sugar, as are pina coladas, daiquiris and cocktails with liqueurs such as Baileys Irish Cream or Kahlua.

Toast with champagne or hot chocolate made with low-fat milk.

• Spinach and artichoke dip sounds healthy, but the mayo, sour cream and cream cheese make it fat-heavy.

Serve a vegetable salsa instead.

• Croissants and biscuits seem light and fluffy, but that’s thanks to sugar and butter. Go with wholegrain dinner rolls.

• Shortbread cookies are crumbly because of their high fat content.

Ginger snaps are generally healthier.

• Cheesecake can pack lots of fat; while recipes vary, pumpkin pie tends to be a smarter choice and also offers fibre and antioxidants. Top it with fat-free whipped cream or whipped evaporated milk.

• Gravy tends to be high in fat, calories and salt. Make or buy low-fat versions; try diluting cream of chicken soup – look for a low-calorie, low-sodium product – with some skimmed milk.

• Mashed potatoes are high in carbs, but mashed cauliflower has a similar texture. Moisten it with canned chicken broth instead of butter.

McClatchy-Tribune

WELL-BEING 11 FIT & FAB

THE TASTE TEST SNACK CHEESE ......................................................

Ride of her life

Jeanette Wang jeanette.wang@scmp.com Parmareggio Snack Five 20-gram pieces for HK$61, City’super Parmigiano reggiano, also known as parmesan, is best known as a pasta or soup topper. But the aged hard cheese, especially in this waist-line friendly, 78-calorie portion, is just as delicious on its own.

Verdict: Good, strong, savoury flavour with a pleasant, slightly gritty texture.

Mini Babybel Swiss Five 20-gram pieces for HK$40, City’super A lunchbox favourite not just for its taste, but also its unique packaging – a piece of cheese encased in coloured wax – that makes for quick devouring of this satisfying snack.

Verdict: Pleasing, salty aftertaste that will appease that mid-afternoon attack of the munchies.

Pearl Tam says training for multisport events has sharpened her mind and her body, and helped make her more focused in the workplace. Photo: K.Y. Cheng

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P. Ramakrishnan rama.p@scmp.com It’s less than five years since Pearl Tam became a triathlete, but the 42-year-old is now one of the sport’s keenest advocates in Hong Kong.

The physical transformation aside (her waistline is notably slimmer, she says), this regime of swimming, cycling and running has had a host of health benefits, too.

“I used to have back problems, little health issues were creeping up as I grew older,” she says. These days, she no longer has those aches and pains, and is rarely ill.

Before her foray into multisport, she used to run just for fun in gyms or outdoors around Sha Tin. Then, in 2007, she joined Titan Triathlon Club and, for the first time, had a proper training programme to follow. “I grew more focused. I worked out harder,” she says. “I work harder in my office, too, as I’m more focused and goal-oriented.”

Tam, who lives in Tai Lam, enjoys working out on the trails and riding around the country park in that area. “In a gym, you can run and run, but you’re going nowhere. In the countryside, there’s a goal in sight, a beginning, middle and end.

You feel like you’ve accomplished something after every run or ride.”

Did triathlon seem overwhelming in the beginning, especially since you came to it so late?

Maybe, but I’m one of those people who want to meet a challenge head on. When I decided I was going to work out harder, stronger and better, I didn’t let anything stop me.

It’s both a mental and physical challenge, in equal measure. For some people, getting up early to work out is hard as they don’t want to get out of bed. I usually train at night because of my day job [at a toy factory] and busy mornings. So even when I’m tired after work, I say to myself: “It doesn’t matter; I must work out.” And then I take the 10-minute drive to the location, change and go for it.

What’s been the biggest challenge?

The hardest part for me was the swimming. I didn’t know how to swim front crawl before I joined the triathlon club. The coach gave me some exercises and taught me techniques to conquer the discipline. Now I’m a bit more relaxed about it. I always ran in the past, so that was no problem, and biking is always enjoyable. I used to bike for fun before; now it’s more strenuous, of course.

Can anyone do this?

Yes, I think anybody can do this. You

don’t need an expensive gym membership, huge personal trainer fees or designer workout wear – just the will to do it. The most expensive part of this is probably getting a good, light bike, but that’s a one-off expense. You can get a cheap bike, too, if you can’t commit to the sport and just want to try it first. When you’re sure, you’ll feel self-motivated to get the best equipment. For running and swimming, your body is the best equipment.

Did you ever hit the proverbial wall and think you can’t do this any more?

Sometimes I have that feeling, but I say to myself: “It’s all or nothing.”

When I work, I work harder when I feel I’m getting tired; I tell myself to.

When I feel bad during a swim, I say to myself: “Keep going.” The body won’t fail you first. It’s your mind playing tricks on you.

Do you have a role model?

Daniel Lee Chi-wo, the former Hong Kong triathlon champion who was one of Asia’s best. I don’t think he competes any more, but he remains in great shape. He has a bike shop, and when I went there to get my bike, I kept stealing glances at him.

Is there a particular goal in mind?

I want to do more competitions, like the Kam Sheung Road Duathlon

organised by Titan Triathlon two Sundays ago. In Hong Kong, I’m always looking for races I can compete in. The purpose isn’t to come first or second, but just to participate. I encourage my friends to just try it. That’s another goal, to get more people involved.

How would you encourage others to join the sport?

I’d tell them that it’s not just for health and fitness reasons, it’s a lifestyle choice. And somehow, being a triathlete also makes you do better at everything else, too. It clears your mind and keeps you physically fit. You’ll work better no matter what your job is. If you skateboard, do rowing or ride a bike, you’ll do those things better, too.

Is it an individualistic sport?

It can be. I train by myself and with friends. It’s up to the individual. I found it a great way to meet people.

It’s a very social sport. I have made a lot of new friends. When we see one another running, swimming or riding we always encourage each other. The competitive streak only comes out during races.While we’re training we want everyone to do better. We discuss future competitions, common goals and the many amusing things that have happened during races.

Sargento String Cheese Six 23-gram pieces for HK$36, City’super Traditional string cheese is eaten strip by strip. This American version, however, just means it’s low moisture, part-skimmed mozzarella cheese in a snack size (70 calories each).

Verdict: Ideal low-carb snack, but tastes over-processed and bland, and has a rubbery mouth feel.