YOUR GUIDE TO LIVING WELL
TUESDAY, MARCH 13, 2012
HEALTH POST ONLINE DRUGSTORE COWBOYS
ACTRESS HEADS FOR THE HILLS
>PAGE 4
>PAGE 11
Hepatitis sufferers need to make their voices heard >PAGE 6
Illustration: Stephen Case
Going viral
2 NEWS APP OF THE WEEK
HEALTH BITES
Synchronise your sleep pattern to get up and glow
......................................................
...................................................... Katie McGregor healthpost@scmp.com Sleep Cycle alarm clock 99 US cents Rating 9/10 How did I sleep last night? As it turns out, checking my sleep pattern for the previous night is so fascinating that it gets me up in the morning like nothing else. But this is not the advertised purpose of the app. Sleep Cycle is designed to provide a gentle wakeup by triggering the alarm at what Sleep Cycle – using the iPhone’s accelerometer to track your movements during the night – calculates to be a light sleep phase falling within a wake-up window set by you. The app recommends a halfhour wake-up window, so if you must rise at 6.30am, your window will be 6am to 6.30am. You might resist the idea of waking a minute sooner than you need to, but the app write-up explains that you will feel better being awakened during a lighter sleep phase, albeit earlier, than being dragged from a deep sleep by your alarm set at a later time. To use the app, first use the test function to check that it can monitor your movements in bed. Then, when night comes, set the alarm wake-up window and place your iPhone face down near your pillow. During the first night of testing, I woke up about an hour earlier, and tossed and turned waiting for the alarm to go off, which it eventually did, at the end of my wake-up window. I wasn’t sure it had worked.
However, over the next few nights, when I was in a deep sleep, the alarm “waited” and only woke me at the end of my sleep window, but would trigger earlier on mornings when, according to the movement charts, I was emerging from sleep sooner. At first I did not feel significantly more refreshed. But then, by looking at the sleep charts, I realised that I simply wasn’t getting enough sleep. Typically, I would be in a deeper sleep phase at waking-up time. The usual sleep pattern is made up of 90-minute cycles, and as the night progresses, each cycle comprises a larger proportion of light, dreaming sleep and a reduced portion of deep sleep. By tracking my sleep pattern and by going to bed a little earlier, I was able to wake up refreshed at a light sleep phase. Highly recommended.
A: athletes are commonly low in vitamins and minerals such as calcium, vitamin D, B vitamins, iron, magnesium, zinc and some antioxidants, such as vitamins C, E, A-carotene and selenium. Calcium, vitamin D and iron are
Red alert for meat eaters Pass on red meat and load up on healthier protein sources such as fish, poultry, nuts and legumes instead – you’ll likely live longer. Eating red meat has been linked with a higher risk of total, cardiovascular, and cancer mortality, in a study by the Harvard School of Public Health researchers published yesterday in the American Medical Association’s Archives of Internal Medicine. The researchers prospectively observed 37,698 men from the Health Professionals Follow-up Study for up to 22 years, and 83,644 women in the Nurses’ Health Study for up to 28 years. These subjects were free of heart disease and cancer at the start. Diets were assessed through questionnaires every four years. There were a combined 23,926 deaths, of which 5,910 were from heart disease and 9,464 from cancer. One daily serving of unprocessed red meat (about the size of a deck of cards) was linked with a 13 per cent increased risk of death, and one daily serving of processed red meat (one hot dog, or two slices of bacon) was linked with a 20 per cent increased risk. The researchers estimated that 9.3 per cent of deaths in men and 7.6 per cent in women could have been prevented at the end of the follow-up, if all subjects had eaten less than 0.5 servings per day of red meat.
Discovery could reduce chemo’s side effects A team of researchers at Duke University in North Carolina has determined the structure of a key molecule that can carry chemotherapy and anti-viral drugs into cells, which could lead to more effective drugs with fewer effects to healthy tissue. In the study, published last Sunday in Nature, senior author and assistant professor Lee Seokyong says they found that this transporter molecule has three forms, which recognise different drugs and reside in different tissues. The transporter moves nucleosides – the building blocks of DNA and RNA – and nucleosidelike chemo drugs into cells. Once inside, the drugs are modified and incorporated into DNA, preventing tumour cells from dividing and functioning. Lee believes it is possible to improve the drugs to be better recognised by the transporter, so fewer drugs will be needed to infiltrate the tumour cells efficiently. Because the drugs enter both healthy and tumour cells, a lower drug dose would help protect the patient, too.
ASK THE DOCTORS DR ANTHONY LUKE Q: I’m a female runner in my 30s, and I run regularly. What do I need to consider for vitamin and mineral supplements? Do I really need them?
Jeanette Wang jeanette.wang@scmp.com
particularly important for women. The American College of Sports Medicine’s updated Position Stand on Nutrition and Athletic Performance recommends: “Vitamins and mineral supplements are not felt to be needed if an athlete has adequate dietary intake from a variety of foods to supply energy and maintain body weight. However, athletes who are at risk for nutritional issues, including those who restrict energy intake, use severe weightloss practices, eliminate one or more food groups from their diets, or consume unbalanced diets with low micronutrient density, may require supplements.” In the end, a healthy diet is still the best solution for making sure your body gets the nutrients it needs. Dr Anthony Luke is an associate professor of clinical orthopaedic surgery at the University of California, San Francisco. Reprinted with permission of the American College of Sports Medicine’s ACSM Fit Society Page
> 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
Play out of your skin Circumcision before a male’s first sexual intercourse may help protect against prostate cancer, according to researchers at the Fred Hutchinson Cancer Research Centre in Seattle. Published yesterday in Cancer, a journal of the American Cancer Society, the study suggests that circumcision can hinder infection and inflammation that may lead to the condition. Information from 3,399 men (1,754 with prostate cancer and 1,645 without) was analysed. Men who had been circumcised before their first sexual intercourse were 15 per cent less likely to develop prostate cancer than uncircumcised men. Sexually transmitted infection is one of the mechanisms that may lead to the cancer, by causing chronic inflammation that creates a hospitable environment for cancer cells. Circumcision may protect against these infections by toughening the inner foreskin and by getting rid of the moist space under the foreskin that may help pathogens survive.
Pull yourself together Criminologists and sociologists have long believed that people commit violent crimes when an opportunity arises and they’re low on self-control. A recent study finds that it is possible to deplete self-control – or to strengthen it by practice. The review article, published in Current Directions in Psychological Science, looked at research in the past decade by psychologists worldwide that manipulated self-control in subjects in experiments. Studies showed that after people have had to control themselves for a period – such as not taking cookies from a jar placed in front of them – they behave more aggressively.
On the other hand, it’s also possible to practise self-control the same way you would practise the piano. One experiment asked people to try to use their non-dominant hand for two weeks for most tasks, like using the mouse and opening doors. After two weeks, people who have practised self-control manage their aggression better. “I think, for me, the most interesting finding that has come out of this is that if you give aggressive people the opportunity to improve their self-control, they’re less aggressive,” says Thomas Denson, a psychologist at the University of New South Wales in Australia.
NEWS 3 QUIZ ...................................................... Jeanette Wang jeanette.wang@scmp.com A food safety group asked the US Food and Drug Administration (FDA) last week to ban caramel colouring agents used in several popular soft drinks which have been found to contain high levels of a chemical linked to cancer in animals. The US Centre for Science in the Public Interest said it had found unsafe levels of the chemical, known as 4-methylimidazole or 4-MI, in cans of Coca-Cola, Pepsi, Dr Pepper, and Whole Foods’ 365 Cola. The FDA is reviewing the petition, but said the beverages pose no health risk. You would have to drink well over 1,000 cans of soda a day to reach the doses administered in the studies that have shown links to cancer in rodents, an FDA spokesman said. But shouldn’t this food safety group focus instead on trying to reduce the consumption of soft drinks? After all, there’s nothing safer than avoiding these high-sugar, empty calorie-filled drinks altogether. Not only are soft drinks bad for the waistline, the more you consume, the higher your chance of having asthma and/or chronic obstructive pulmonary disease (COPD), according to a study published last month in the journal Respirology. University of Adelaide researchers interviewed 16,907 participants aged 16 years and older in South Australia between March 2008 and June 2010. They asked about the consumption of soft drinks, including cola, lemonade, flavoured mineral water and sports drinks. They found that those who drank more than 500ml of soft drinks per day were 1.26 times more likely to have asthma and 1.79 times more likely to have COPD than those who did not consume them.
SUPPLEMENTS Test yourself on your knowledge of the aforementioned drinks. 1. How long does a 70kg man have to walk for to burn off a can of cola? a. 14 minutes b. 26 minutes c. 38 minutes 2. Approximately how many teaspoons of sugar does a can of Pepsi contain? a. 5 b. 10 c. 15 3. According to the Centre for Health Protection, a 2008 study involving more than 9,000 Primary Four and Five pupils in Hong Kong found that the percentage of students who consumed drinks with added sugar at least once a day in the week before the survey was a. 24 per cent b. 37 per cent c. 51per cent 4. In a recent study published in the Journal of General Internal Medicine, participants who drank diet soft drinks daily were how much more likely to have suffered a vascular event than those who drank none? a. 43 per cent b. 52 per cent c. 64 per cent Answers: 1. c (about 139 calories per 330ml can); 2. b (about 39g of sugar per 330ml can); 3. c; 4. a
PET HEALTH
Six steps to help your dog shed its winter weight gain We’re all guilty of packing on pounds during the winter season, and our dogs are no exception. While a little extra weight on a human may not look like much, just a couple of additional pounds on your dog can really affect its health. Exercise not only keeps your dog physically fit, but mentally, as well. With spring rapidly approaching, the American Kennel Club offers the following tips for safely helping your dog drop its winter weight gain.
• Check with your dog’s veterinarian before starting any new exercise routine. Have your dog “weigh in” at the vet to determine how much weight they need to lose. You need to consider your dog’s age, health and activity level, and a check-up by the vet will start your dog on the right track. • Simply letting your dog out in the backyard doesn’t qualify as proper exercise. Try playing a good game of fetch with them. • Start your exercise regimen slowly to build up your dog’s endurance. As with humans, exercising too much too quickly can result in injury for your dog. • When you are out exercising with your dog, try to stay on grass or an earthy surface. Surfaces with sharp gravel can be hard on your dog’s paws. • Always take clean water and a portable bowl with you to offer your dog a drink when they need it. • Dogs can suffer from heat stroke, so if your dog begins to pant rapidly, stop exercising. McClatchy-Tribune
It’s D-day for girls with stress fractures ...................................................... Genevra Pittman Girls and young women who took large doses of vitamin D are half as likely to suffer a stress fracture as those who don’t get much of the vitamin, according to a US study. Stress fractures are small cracks in the bones that typically affect people who do lots of high-impact exercise, such as running or gymnastics. They’re especially a concern for teenage girls because bone strength at that age is tied to the risk of osteoporosis and more serious injuries later on. “This study can add to the existing thought that adolescent girls and young women should be particularly cognisant of getting their vitamin D,” says Kendrin Sonneville, a clinical nutrition specialist from Children’s Hospital Boston, who worked on the study. Vitamin D is naturally present in fatty fish, but is also added to dairy products such as milk and yogurt. As it’s not always easy to get enough through food, the Institute of Medicine in the US recommends that children and adults get 600 international units (IU) of vitamin D daily. Doctors recommend taking supplements. For the study, published in the Archives of Pediatrics &
We were surprised to find that vitamin D was only found to be protective KENDRIN SONNEVILLE, NUTRITION SPECIALIST
Adolescent Medicine, the researchers followed about 7,000 girls who were the daughters of women participating in the long-term Nurses’ Health Study. Starting when the girls were aged between nine and 15, they were surveyed every year or so between 1996 and 2001 about their typical eating habits and use of vitamin supplements. From that information, the researchers calculated how much vitamin D each girl got in a typical day. Then, in 2004, the girls’ mothers were asked whether their daughters had been diagnosed with a stress fracture from 1997. Just under 4 per cent of the girls had suffered a stress fracture, with a much higher risk seen among those who did high-impact exercise for at least an hour a day. There was no link between how much calcium they received from their diets and their chance of sustaining injuries. But those with the greatest daily vitamin D intake were half as likely to have a stress fracture as those who got the least. “We know that calcium is important for bone health, so we were surprised to find that vitamin D was only found to be protective,” says Sonneville, adding that the vitamin is necessary for calcium absorption. Reuters
4 MEDICAL
Shopping for online drugs can save money, but purchasers should check with their doctor first. Not all online pharmacies are registered, and some sell controlled or tainted drugs. Photo: Corbis
ONLINE PHARMACIES
It’s not what the doctor ordered ...................................................... Sasha Gonzales healthpost@scmp.com Shopping online is one of Anita Lim’s favourite pastimes. Her regular purchases include pharmaceuticals, such as appetite suppressants, painkillers and tablets that claim to do everything from boost energy to improve memory. Lim buys them without a doctor’s prescription and doesn’t see anything wrong with it. “They aren’t ‘hard-core’ medicines, so I don’t think it’s necessary to get my doctor’s advice before buying them,” says the 36-year-old graphic designer. “Plus, if I can access them easily online, why bother with a prescription?” Lim, who spends HK$300 a month on various medications, isn’t the only one clicking her way to what she believes is better health. The global online pharmaceuticals trade is a multibillion-dollar industry – and is still growing. It isn’t just the convenience of online shopping that attracts customers. In many cases, drugs bought online are cheaper – particularly generic brands – plus, there’s no need for a prescription. There are also drugs available online that are not on sale in Hong Kong. Dr Winnie Mui, a general practitioner at Dr Lauren Bramley and Partners in Central, says: “Many shoppers also don’t consult their doctors before buying because they want to save time, especially if they have only a minor ailment.
There are also no doctor’s fees or insurance coverage when purchasing medicine online.” Self-medication is nothing new. But the proliferation of online pharmacies means that more people are taking medical treatment into their own hands, through self-diagnosis and then searching online for drugs that might help. But Mui points out that with self-medication comes the danger of overdosing, allergic reactions, interference with other drugs, and side effects from the drug itself. She adds that under the influence of certain medications, some people might experience drowsiness, amnesia, hallucinations or erratic behaviour. Not experiencing side effects immediately does not mean the drugs are safe, either. Sometimes the consequences don’t show up until years later if patients take the drugs for long enough. Dr William Wong Chi-wai, clinical associate professor with the department of family medicine and primary care at the University of Hong Kong’s Li Ka Shing Faculty of Medicine, says that self-medication when appropriate is encouraged. But many don’t turn to their doctors when they should. “If you don’t seek medical help for a particular condition, there is a real danger of that condition developing into an irreversible disease,” he says. There is also the issue of the quality of drugs sold online, since it’s difficult to guarantee their authenticity and safety.
One of my patients ordered codeine … His parcel was intercepted by customs, and he received a summons to appear in court DR JAMES OLIVER, GENERAL PRACTITIONER, ISLAND HEALTH FAMILY PRACTICE
Allergy warnings, list of active ingredients and expiry dates can be altered or even omitted. Some online pharmacies might even be outlets for unregistered or illegal drugs. “As the pharmaceuticals market is lucrative, dubious online pharmacies abound,” says Mui. “Online drug dealers need not be licensed. With low overheads and cheap labour from developing countries, anyone with chemical or pharmaceutical knowledge, the inclination, and the start-up capital can open an online drugstore. The profit margin is potentially staggering, and making money tends to override safety.” In the case of drugstores that do not comply with local health regulations, the internet is like a no-man’s land, so there is no jurisdiction over orders and deliveries, and certainly no accountability if anything goes wrong. That said, Mui adds that there are numerous legitimate online pharmacies that are a blessing for people who are homebound, busy or far from a conventional pharmacy. Dr James Oliver, a general practitioner at Island Health Family Practice, says that another issue with ordering medication online is that, unlike your doctor, the company has no interest in your well-being, and there is no on-going relationship. He urges buyers to keep this in mind when purchasing drugs from an online pharmacy and to do some research before placing an order, because online purchases may get
you sent to court. “One of my patients ordered codeine, which in Hong Kong is a tightly controlled substance,” says Oliver. “His parcel was intercepted by customs, and he received a summons to appear in court to explain his actions.” It’s important to let your doctor know if you’re intending to purchase drugs online, even if it’s just simple vitamins or something you can buy over the counter. There can be a danger of drug interference. Choose the larger, more reputable pharmaceutical companies, and check that your medication is registered with the Health Department’s Drug Office (www.drugoffice.gov.hk), says Mui. Oliver also advises to be aware of the effects and side effects of the medication, and the appropriate dosage. Drugs that you should never purchase online without first seeking your doctor’s advice include injectable ones such as insulin, cancer medicines, sedatives and amphetamines. Also check on anything that might be considered exotic, including herbal drugs. Intravenous blood products are dangerous because you risk contracting blood-borne infections such as hepatitis and HIV. Even topical medicines aren’t always safe, says Mui. That’s because the ingredients can be absorbed into the skin. Oliver adds that some topical creams, such as the stronger steroids, can cause serious problems if not monitored.
MEDICAL 5 CASE HISTORY
...................................................... Eileen Aung-Thwin healthpost@scmp.com Kitty Wu, 42, has worn glasses for most of her life. By the age of five or six, her myopia was already at minus six dioptres, meaning she needed lenses with a corrective power of 600 degrees. The young Wu (name changed for patient confidentiality reasons) wore thick glasses that were heavy on her face, and she couldn’t play as freely as her friends. By the time she hit her teens, her nearsightedness had reached 2,400 degrees, and she suffered 300 degrees of astigmatism. She was unable to see things a short distance away, and the astigmatism blurred all the fine details up close or far away. Her glasses severely restricted her field of vision, and she could see clearly only when looking straight ahead. When Wu started work, she had to wear both contact lenses and glasses to correct her vision. She longed to play sports and travel, but her severe myopia made it difficult. She had to rush home after work each day to switch from contact lenses to goggle-like glasses, because her eyes were getting too dry. Last year, she had to stop using contact lenses, as they made her eyes unbearably dry. Several of her friends had raved about the liberating results of Lasik eye surgery and implantable contact lenses (ICL), and Wu decided to explore those options. She sought the help of Dr John Chang So-min, a specialist in ophthalmology and director of the Guy Hugh Chan Refractive Surgery Centre at the Hong Kong Sanatorium and Hospital. After assessing Wu’s condition, Chang said neither Lasik nor ICL was a good option for her. With Lasik, the cornea of the eye is reshaped to correct up to 1,200 degrees of myopia. In ICL, a special type of contact lens is inserted into the eye in front of its natural lens to correct up to 1,800 degrees of myopia and 600 degrees of astigmatism. Another option was a procedure called bioptics, which combines the two techniques. But Chang considered that Wu was 42, the age at which presbyopia (longsightedness) usually kicks in. Once it does, it will climb slowly to a maximum of 300 degrees. In some patients who already had presbyopia, Chang had fully corrected the vision in one eye and under-corrected it in the other to enable monovision. That’s where one eye is used for distance vision and the other for things up close. But Wu did not yet have reading problems, so monovision was not an option. The difference in vision between the two eyes would leave her dizzy. If he fully corrected both
eyes now, her options for correcting the eventual presbyopia would be limited and unsatisfactory. Chang offered a third option – a lens exchange surgery known as clear lens extraction. “The lens of the eye is like a grape,” Chang says. “We make an opening in the front of the grape skin, suck out the pulp and put in an artificial lens.” A new artificial lens, called a multifocal toric lens, had arrived in Hong Kong a few months earlier. It can correct up to 3,000 degrees of myopia, 1,200 degrees of astigmatism and all 300 degrees of presbyopia, making it an ideal solution for Wu’s condition. The genius of the lens lies in its multiple rings, which bend light into two zones, near and far. This creates two images in the eye. When the patient wishes to see something in the distance, the images in the “far zone” will dominate, and the brain will not notice that the “near zone” images are present. When the patient looks at something close, the reverse will happen. The brain adroitly adapts to this process, which is transparent to the patient. But in low light, the patient will notice the double images in the form of halos around light sources. Chang says 60 per cent of patients will see halos at night. But in Wu’s case, halos and glare were already a permanent part of her world, so she would barely notice the post-surgical side effects. The results are not perfect. About 20 per cent of patients might need to wear glasses of 125 degrees for reading or when using a computer, Chang says. Also, the surgery is not without risks. There is a one-in-10,000 chance of developing a bacterial infection in the eye, which risks permanent loss of vision from 10 per cent to more. There is also a one-in-500,000 chance of being blinded. Patients under the age of 50 risk a ninein-500 chance of retinal detachment, in which the lightsensitive membrane at the back of the eye tears away from its supporting layers, causing vision problems. But Chang says with advances in micro-incision surgical techniques, the success rate for retinal detachment surgery is high. There is also a slight chance of needing Lasik surgery to touch up the vision after the clear lens extraction procedure. Wu mulled over her options and risks for three months. Finally, she decided to go ahead with the surgery. Chang operated on one eye at a time, at an interval of two weeks. The procedures were a resounding success: Wu was left with only 75 degrees myopia. Breaking free from the frames that had cramped her existence, Wu promptly quit her job and set out to travel the world.
The genius of the lens lies in multiple rings, which are able to bend light into two zones, near and far
Illustration: Angela Ho
So clear and yet so far
6 COVER STORY
Break the si Hepatitis is a far more serious problem than most people realise, and sufferers need to join forces to get that message across, writes Jeanette Wang
Illustration: Henry Wong
COVER STORY 7
lence W
ill hepatitis carriers please stand up? Leaders from the global health community made this request at a recent symposium organised by the Coalition to Eradicate Viral Hepatitis in Asia Pacific (Cevhap) in Taipei. Patients must drive the campaign for better care because despite its devastating impact, viral hepatitis does not receive the same level of attention and awareness as diseases of a similar social impact, such as HIV/Aids, tuberculosis and malaria, according to World Hepatitis Alliance president Charles Gore. Hepatitis B and C affect one in 12 people worldwide and claim approximately one million lives each year. While fewer than 0.5 per cent of Hong Kong’s adult population has hepatitis C, according to the Health Department, up to 8 per cent has chronic hepatitis B despite various vaccination schemes. The universal hepatitis B immunisation programme for newborns introduced in Hong Kong in 1988 reduced the chronic infection rate among five-year-old children from about 10 per cent to 0.78 per cent. The circulating pool of hepatitis B virus (HBV) has also “likely” dissipated in the city, according to a Centre for Health Protection surveillance report published last year, due to the increased vaccination coverage in adults, practise of universal precautions in health care settings, pre-donation blood screening and safe-sex promotion. Dr Nancy Leung Wai-yee, chair of AsiaHep Hong Kong and a specialist in gastroenterology and hepatology, says about a quarter of those with HBV will develop serious liver conditions such as cirrhosis or cancer. Treatments are getting more effective and affordable, but are still relatively costly, and, hence, few are treated privately. “Based on our calculations, 80,000 to 100,000 people need treatment,” says Leung. “Government hospitals are treating only 30,000 to 35,000 people.” Leung says the Health Department focuses purely on prevention, while the Hospital Authority only looks after those with acute liver failure, cirrhosis or other complications. Despite studies that show it’s more cost-effective to treat patients early, Leung says “[the government] doesn’t listen because they don’t look beyond one year, so that’s the frustration we’re facing”. In Hong Kong, there’s only one known patient advocacy group – six people that are part of AsiaHep HK, a non-profit organisation
set up in 1996 to raise awareness and education of the disease. Anthony Wong Tsz-ching, 30, a member of the group who contracted HBV through birth, says they focus mainly on promoting World Hepatitis Day annually on July 28. Apart from that, six people “can’t do much”. “Compared with other developed countries such as the US, Canada or Europe, their patient groups are more structured and more people are willing to join the group,” says Wong, a ship terminal supervisor. Patient advocacy can drive much-needed change in public health policies, says Professor David Thomas, a keynote speaker at last month’s 22nd Conference of the Asian Pacific Association for the Study of the Liver held in Taipei. Chief of infectious diseases at the Johns Hopkins School of Medicine in Baltimore, Maryland, Thomas says surveillance and diagnosis of viral hepatitis remain “woefully under-resourced”, and many countries have yet to realise that the “broader public health benefits of treatment often outweigh the cost”. Doctors aren’t as effective as patients in advocacy because they’re often seen as employees and therefore find it difficult to be taken seriously, Gore adds. “Aids has shown that those living with the condition must be at the centre of advocacy because they are ‘the people’ and the government’s legitimacy depends on them,” says Gore, who was diagnosed with hepatitis C in 1995 and cirrhosis in 1998. “Ultimately, you cannot suppress the people if they’re determined to change the government.” Patient group advocacy in fact was a main driving force behind the World Health Assembly’s resolution on viral hepatitis in May 2010, which for the first time recognised the full scale of the challenge and put viral hepatitis on the global health agenda alongside Aids, tuberculosis and malaria. Gore says 80 patient
groups in Brazil had persuaded their government to lead the push for a resolution; Brazil, co-sponsored by Colombia and Indonesia, did submit the eventually approved proposal to the assembly. The trouble is, patients and people in general don’t like talking about hepatitis. Silence, which has a chicken-and-egg relationship with low awareness – 42 per cent don’t know if they’re HBV carriers or not, according to a poll of 1,900 citizens last year by the Hong Kong Hep B Free Foundation – means the disease will continue to circulate. HBV was discovered in 1965. But Aids, which was first recognised in 1981, has achieved much greater success in terms of the global response to prevent and control the disease over the past 30 years. Why the hush over hepatitis? Professor Lai Ching-lung, chair of medicine and hepatology at the University of Hong Kong, thinks the main problem is education. He says, for example, many of his patients don’t know about their family history, or that hepatitis is infectious rather than hereditary. The second problem Lai cites is that few celebrities “dare to stand up” – a reflection of the stigma that patients face. Singer-actor Andy Lau Tak-wah, for example, a HBV carrier
[Hepatitis B] is not really a shameful disease. You acquire it through your own family members PROFESSOR LAI CHING-LUNG, UNIVERSITY OF HONG KONG
Dr Nancy Leung is chair of AsiaHep Hong Kong. Photo: Edward Wong
since childhood, was a hepatitis ambassador with the Chinese Foundation for Hepatitis Prevention and Control a few years ago. News media hailed his move, but Lau got flak from fans for doing kissing scenes in his films. “[Hepatitis B] is not really a shameful disease,” says Lai. “You acquire it through your own family members. It’s infectious, but if you transmit it to your sex partner as an adult, they’d only develop acute hepatitis B [lasting fewer than six months], not become chronic carriers, so I think the stigma should not be so bad.” In mainland China, where there are about 130 million people with HBV, carriers frequently encounter discrimination, say doctors Yang Tian and Wu Mengchao from Eastern Hepatobiliary Surgery Hospital at the Second Military Medical University in Shanghai. Many employers and universities, and some kindergartens, refuse to accept anyone with a positive HBV test. In their commentary, published in The Lancet in September, the doctors say public education is key to eliminating this fear and prejudice that stems from ignorance and misunderstanding about HBV. It doesn’t help that, globally, hepatitis hasn’t really been a priority. Gore says that when he first approached the World Health Organisation in 2007, he was “amazed” to find that none of its 8,000 staff had “hepatitis” in their job titles. “They said, ‘We have a vaccination for hepatitis B, so we’ve sort of sorted it.’ I said, ‘Well, what about the million people who are dying every year? I don’t really think that’s sorted.’ ” Strategies for better education, surveillance, prevention, screening and treatment programmes are needed. There is now a team of four – the smallest WHO unit – co-ordinating national strategies on hepatitis to ensure a comprehensive response, says Gore. But hepatitis still does not feature as one of the United Nations’ eight Millennium Development Goals, nor in the Global Fund (which benefits Aids, TB and malaria). Professor Stephen Locarnini, head of the WHO Regional Reference Laboratory for Hepatitis B and Cevhap joint secretary, thinks governments have been so successful with immunisation programmes that they fail to see the greater burden of hepatitis. “There are messages to take up to the government to reset the awareness standpoint.” This is where patient advocacy can help. Unfortunately, compared with the often militant Aids activists, Locarnini says “in hepatitis land, we’re so well behaved”. “With Aids, there was an abundance of vigorous activists whose work was complemented
KNOW YOUR B & C • While there’s a vaccine that protects against hepatitis B infection, there’s none for hep C. • Both viruses can be contracted though blood-to-blood contact. Hepatitis B is more infectious than C and can also be spread through saliva, semen and vaginal fluid. • Hepatitis B infection can occur through having unprotected sex with an infected person. This is much rarer for C. While unlikely, it’s possible to contract hepatitis B – but not C – through kissing. • Neither virus is easily spread through everyday contact. You cannot be infected by shaking hands, coughing or sneezing, or by using the same toilet. • There are different treatments for the two viruses. While treatment can control chronic hepatitis B, it can often cure hepatitis C. • A healthy lifestyle is important. Alcohol, smoking, eating fatty foods, being overweight or extreme dieting may worsen liver disease. Try to avoid alcohol, do not smoke, eat a low-fat diet with enough fruit and vegetables, and lose weight if needed. Information provided by the World Hepatitis Alliance. For more details, go to www.worldhepatitisalliance.org, or www.asiahep.org.hk by celebrities who would come out and recognise their condition,” says Thomas. “That was a perfect storm for public health impact and recognition.” Hongkongers, says Leung, have the mentality that they’re not empowered enough. “They’re so used to being guided. So, if the government and doctors don’t take the lead, they feel a little helpless.” Thomas says the silence that surrounds hepatitis mirrors how the virus operates. When the virus enters a body, it becomes subverted, because the immune system will attack and kill it if it’s recognised. Hepatitis B and C are therefore silent diseases; often people don’t have symptoms and aren’t diagnosed, and because of the length of time from infection to real problems developing, it doesn’t seem so urgent. It seems far from the desperation and intensity of Aids. “[The viruses] have managed to survive by also not drawing attention to themselves at the population level; they’re very tricky and clever in that way,” says Thomas. “Humans need to become just as smart as those viruses so that we can get rid of them.” jeanette.wang@scmp.com Be a hepatitis advocate; e-mail info@asiahep.org.hk
8 HEALTH Experts say there is still much work to be done in the global fight against hepatitis. Photo: AFP
FROM THE EXPERTS
Lessons from an earlier battle ...................................................... Jeanette Wang jeanette.wang@scmp.com Viral hepatitis B and C affect as many as 500 million people globally. Of those, about 340 million are from the Asia-Pacific region – 10 times the number of people living with HIV worldwide. Yet despite this devastating reach and the knowledge of the impact of these types of hepatitis for many decades, the global response to the disease lags far behind that of HIV. In the 30 years since the first reported Aids cases in 1981, advocacy and activism have been very successful in bringing about significant progress in prevention, control and treatment of HIV/Aids. Leaders from the global hepatitis community recognise there are lessons to be learned from the Aids experience, and discussed this at a meeting in Taipei last month organised by the Coalition to Eradicate Viral Hepatitis in Asia-Pacific (Cevhap) and held at the 22nd Conference for the Asian Pacific Association for the Study of the Liver. HIV expert, Professor David Thomas, director of the division of infectious diseases at the Johns Hopkins University School of Medicine in Baltimore, Maryland, delivered the keynote speech at the meeting, highlighting the following five lessons for the hepatitis community. 1. Treatment saves lives In 1996, an effective combination of antiretroviral therapy (ART) drugs that delays the onset of Aids became available to those living with HIV in developed countries, cutting death rates of people with HIV/Aids in these countries by 84 per cent. But it wasn’t until 2001, when the price of the drugs per patient fell from US$15,000 a year to US$295 – thanks to an Indian
generic drug maker that sparked a price war – that developing countries had access to them. The most widely used drug combination now costs US$64 per year. Between 2003 and 2010, figures from the World Health Organisation showed a 16-fold increase in the number of people receiving ART, with an estimated 6.6 million people in low- and middle-income countries at the end of 2010. “With viral hepatitis, we have proved in principle that treatment saves lives as well. The question is: can we push those treatments into a broad enough proportion of the population to actually have efficacy, as has occurred with HIV?” says Thomas. “We certainly need to improve the safety and efficacy of the treatments that we have right now. For hepatitis C, that means getting rid of Interferon – a cure which costs about US$90,000 – and replacing it with a cheaper, simpler pill that you take once a day for 12 to 24 weeks. For hepatitis B, it means extending the treatments that we have now to the people who need them.” 2. Improved treatment efficacy means improved urgency In 2010, 119 countries reported a total of 95 million HIV tests that year alone, up from 67 million tests in 100 countries in 2009. Expanded testing and detection of infection was driven by developments in treatment efficacy, says Thomas. “In the beginning, when many were dying from HIV, some people said, ‘Look, don’t bother testing people because you’re just going to ruin their lives when they find out they have HIV; let them live in peace until they die.’ But when treatments were effective and could save lives, everything changed. “Once ART was discovered, in the United States, we changed our
recommendations so that everyone from age 13 to 64 was to have an HIV test. Throughout Sub-Saharan Africa there was a paradigm shift: instead of occasionally offering testing, testing was actually the expectation – you had to opt out of it.” With hepatitis C, advances in treatment have been made and celebrated, with drugs offering up to a 70 per cent cure. But Thomas says only a small fraction of the estimated 170 million individuals with chronic hepatitis C infection know they are infected; far fewer ever start
We need different models for hepatitis control, and programmes to make care more affordable PROFESSOR DAVID THOMAS, DIRECTOR, DIVISION OF INFECTIOUS DISEASES, JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE
treatment. In the US, from 2002 to 2007, only about 663,000 of the four to five million people with chronic hepatitis C were treated. “When we take this kind of perspective, we haven’t done anything yet. There’s no reason to stop just because we can cure an individual when the population is not benefitting. We certainly need different models for hepatitis control, to expand testing and treatment access, and we need programmes to make care more affordable.” 3. You reap what you sow “There’s a dose-response relationship between the amount of effort and funding, and the outcome. Prior to 2002, there’d been approximately 65 million persons infected with HIV worldwide, and 25 million deaths and 14 million orphans because of its devastating effects. The treatments were effective, but they weren’t working where most of the infections were. “So the Global Fund devoted some money to treatment, and the US put in US$15 billion over five years to fight HIV, malaria and TB. About
San Francisco’s provocative Hep B Free ad campaign aims to force the city’s Asian population into confronting the public health hazard of the disease
half of it went into HIV testing and treatment. In the following years, there was a 16-fold increase in ART use in Africa. So we’ve taken an effective treatment, put resources behind it, pushed it into an area where it’s needed, and it has reduced mortality. “Hepatitis C has surpassed HIV in deaths in the US, but the resources put into it are hardly anything compared to what’s put into HIV. So it’s not surprising that we haven’t had the same impact, because what you reap is what you sow, and we’re not sowing in chronic hepatitis.” 4. There’s more to disease than just the virus “With HIV, even after viral suppression was achieved, an HIV infected person still has a diminished lifespan because there’s more to it than just the virus. In Denmark, for example, HIV infected persons taking ART still have lower life expectancies than the general population. In the same way, we’ll cure hepatitis C, but still have to worry about liver cancer and some of the end organ effects. It’s true for hepatitis B as well, and persons with cirrhosis.” 5. Prevention is better than treatment Thomas cites the success of Taiwan’s universal hepatitis B vaccination programme for newborns started in 1984, which reduced infection rates in children aged below 15 from 9.8 per cent in 1984 to 0.7 per cent in 1999. “This lesson needs to be taken to HIV in this instance. In recognising the potential value of the hepatitis B vaccine, Taiwan was essentially able to reduce incidence of liver cancer even in children, by a campaign that was extraordinarily effective at the population level. I think this is one of the most spectacular achievements that I know of, right up there with the saving of millions of lives with ART use in Sub-Saharan Africa.”
FITNESS 9 BRIDAL BOOTCAMP WEEK 6
Fitness worth the weight ...................................................... Jeanette Wang jeanette.wang@scmp.com First, the bad news: Chalothorn Vashirakovit, who had hoped to lose 5kg for his wedding this week, has actually increased his weight from 74.3kg to 76kg over the past six weeks. The good news: he can now slip into an old pair of trousers that didn’t fit at the start of his Pure Fitness exercise programme under personal trainer Matthew Ha and boxing coach Jimmy Leung. “It was an amazing moment,” 30-year-old Chalothorn says of his wardrobe triumph. So it seems the scales can lie. Despite failing to reach his target weight, Chalothorn, an investment associate with a global investment firm, does look thinner and leaner. His body fat percentage is down from 18.2 per cent to 14.7 per cent, and his muscle mass is up from 60.8kg to 64.9kg.
Ha says Chalothorn’s body fat reduction has been faster than expected. “He’s great to work with,” says Ha. “He endures and takes challenges with a delightfully positive attitude.” Last week, the challenge was a innovative exercise tool called ViPR (pronounced “viper”), a metre long virtually indestructible rubber tube that looks like a big pipe. An acronym for vitality, performance, reconditioning, the ViPR comes in seven weights from 4kg to 20kg, and is so versatile that it’s said over 9,000 exercises can be performed with it. Chalothorn flipped, lifted, carried, dragged, threw and rolled the ViPR through a circuit of strength and movement exercises that worked his cardio, strength, power, agility, balance and core. Ha says the tool fosters stronger and faster co-ordination between the upper and lower body. “The exercises left my muscles burning and it certainly improved
SWEAT
Exercise for every body ...................................................... Jeanette Wang jeanette.wang@scmp.com Just how much do we need to do to stay in shape? And what type of exercise is best? According to the Central Health Education Unit of Hong Kong’s Health Department, the specific type and amount of activity required to prevent weight gain have not yet been established by studies. It differs between individuals, but in general more activity increases the probability of successful weight maintenance or loss. The Health Department offers the following weight loss tips. For weight maintenance International guidelines recommend that adults do 45 to 60 minutes of moderate-intensity physical activity each day, while controlling energy intake to prevent becoming overweight or obese. A review of randomised, controlled trials in early-postmenopausal women, published in 2004 in the journal Sports Medicine, suggested that walking at least 30 minutes per day plus twice-weekly resistance exercise sessions was likely to be effective in preserving normal body weight. If you’ve been sedentary, build up progressively to your goal, starting with 10 to 20 minutes every other day during the first week or two, to minimise potential muscle soreness and fatigue. For weight loss Overweight or obese adults are encouraged to do at least 30 minutes
of moderate-intensity physical activity five or more days a week. It can be done in one session or over a few sessions lasting 10 minutes or more. Loss of 450 grams of body fat requires, in general, about 3,500 calories of energy expenditure. Even if no weight is shed, the overweight are encouraged to increase physical activity, as it brings other health benefits, such as reduced risk of type 2 diabetes and cardiovascular disease. Walking is excellent for overweight people – brisk walking counts as moderate-intensity physical activity for both the sedentary and overweight. Weightbearing physical activity may be difficult for some people with a body mass index over 35, particularly those with joint problems. Try nonweight-bearing moderate-intensity physical activities, such as cycling, swimming and water aerobics. Including muscle strengthening exercises is also suggested for a balanced exercise programme. For maintaining weight loss Several studies have been conducted on the role of physical activity in preventing weight regain after an initial sizeable weight loss. Although these had different designs and methodologies, all the studies focused on people who had lost 13.6 to 22.7kg and had not regained the weight after several years. The studies using self-reported physical activity and energy expenditure generally support the notion that 60 to 90 minutes of moderate-intensity physical activity each day might be necessary for weight maintenance after such large weight loss.
Burning rubber: Chalothorn Vashirakovit trains with the ViPR exercise tool. Photo: Nora Tam my endurance and my body’s ability to handle the build-up of lactic acid,” says Chalothorn. It’s hard to imagine that just six weeks ago, Chalothorn, a former road cyclist who turned completely sedentary for four years, was floored by a 30-minute workout. Now, he’s a glutton for punishment. In this final straight to the
wedding, he has stepped up his training from four to six days a week, doing at least 30 to 45 minutes of running or cycling before or after each workout with Ha. “It’s very rewarding to see Chalothorn being able to pick up regular exercise and enjoy it,” says Ha. He suggests that his client’s weight hasn’t dropped partly
because of diet and excessive water intake (muscles can hold and store water). Chalothorn is doing all he can to change that – cutting carbs from dinner, having salad for lunch and fruit for tea. “I don’t mind the hard work,” says Chalothorn. “Pain is temporary, but a good wedding picture is forever.”
10 WELL-BEING WALKING HOME
Because you asked for it ......................................................
4. Any advice about buying equipment? I still think of my father’s advice to me that when I buy an item of equipment, the first one I buy should be a cheap one, so I could learn how to use it and about what I really need. When I have worn out the first one, the second one I buy should be the very best I can afford, and it will last me a long time. So, for example, aged 18, I bought my first adult bicycle from a police auction in London for about HK$720. It carried me about 2,800 kilometres before falling apart. The next one I bought, a few years later, was about HK$4,800 – which was the best I could afford then. I ended up riding it over 55,000 kilometres across dozens of countries, and it still works today.
Rob Lilwall healthpost@scmp.com People who learn that I’m walking 5,000 kilometres from Mongolia to Hong Kong always have plenty to ask me. Here are the five most common questions. 1. Why go on these madcap adventures? This is a huge question. In summary, I go on adventures for the same reasons as everyone else – because adventures are fun, they are a place of learning, and also a way of testing ourselves to the limit. In addition, I go on adventures to pay the bills. 2. Aren’t you afraid? Indeed, yes, I am regularly afraid when on adventures, but that’s half the point of an adventure, isn’t it? There are a couple of things I think about to deal with this fear. First, I take only calculated risks. I work out what the main dangers are, sense-check that they are reasonable, and think hard about how to minimise them. I am also prepared to compromise if necessary. For example, while walking south through China this winter, I recently made the decision not to kayak down the semi-frozen Yellow River as originally planned, but instead to walk along it, as the risks of our kayaks being sunk or shredded by a sharp block of ice were just too great. Second, I remind myself that often the fears may be in my head, and actually statistically very unlikely to happen. An example would be camping in the wild, which, to people unfamiliar with it, might seem scary or dangerous. When I first started wild camping in Europe, I was worried that I was accidentally pitching my tent in the field of an axe-murderer. Gradually, the more I camped, the less afraid I became of such dangers,
Rob had to learn how to conquer his fears when camping in the wild Photo: Rob Lilwall as I realised that they are, in fact, completely negligible. Nonetheless, I do regularly get afraid, and sometimes wimp out of taking risks. But just because we are afraid or bail sometimes is not a good reason not to go on an adventure. In fact, it is probably a good reason to go on one. It feels great to take on a fear and come out the other side intact, and the future suddenly feels full of possibility again. As Eleanor Roosevelt said: “Do one thing every day that scares you.” 3. What does your family think? My family have been amazingly supportive. They had taken me on camping holidays since I was
young, and I did not go suddenly from there into completely crazy adventures. Rather, I started with small trips (a bike trip with a friend around Wales and Ireland), and then gradually grew to bigger trips (riding across Ethiopia), and then the even bigger adventures of cycling Siberia, walking Israel and the West Bank, and the latest: walking China. At times I have had to ask my family to trust my judgment about the places I am going – as I have more experience and also done more research than they. And to their credit, they have accepted my decisions, while on my part I have been prepared to make compromises and take fewer risks because of them.
Adventures are fun, they are a place of learning, and also a way of testing ourselves to the limit ROB LILWALL
EAT SMART
Try a little tenderness: adopt the stir-fry method ......................................................
To preserve their tenderness, meat and seafood are typically deep fried, says Ivy Ng, president of the Hong Kong Nutrition Association. However, the same effect can be achieved by blanching seafood coated in egg white, she says. This cooking method is used in the following recipe from Hong Kong cafe chain Daniel’s Restaurant. “The amount of oil used is greatly reduced,” says Ng. “Mushrooms, rich in dietary fibre, further enhance the flavour of the dish.”
50 grams fish fillet 2 pieces baby cuttlefish 3 pieces shrimp 2-3 pieces clam meat 1 egg white 1 ⁄4 tsp salt 1 tsp starch 1 ⁄2 tsp white wine 9 florets broccoli, cut into smaller pieces 3 fresh shiitake mushrooms, sliced 1 ⁄2 abalone mushroom, sliced 6 oyster mushrooms, sliced 2 tsp canola oil 3 cloves garlic, minced 4 slices ginger 6 slices carrot 5 strips spring onion
Japanese-style stir-fried broccoli with mushrooms and seafood Serves 8-10
For the sauce 1 ⁄2 cup broth (pork or chicken) 1 tbsp sake
Jeanette Wang jeanette.wang@scmp.com
1 tbsp light soy sauce 1 ⁄3 tsp sugar • Marinate the fish, cuttlefish, shrimp and clam meat with egg white, salt, starch and white wine for 10 minutes. • To make the sauce, combine all ingredients and mix well. Set aside. • Blanch broccoli and seafood. Set aside. • Heat oil in a frying pan. Stir-fry garlic and ginger until aromatic. • Sauté mushrooms, seafood and broccoli. • Add carrots, spring onions and Japanese sauce. Mix well. Serve. Provided by the Health Department as part of its EatSmart@restaurant.hk campaign. For more information, visit restaurant.eatsmart.gov.hk
5. How do you afford it? Depending on the type of adventure you are on, it need not cost a fortune. Once you are on the road – and especially if you are prepared to camp and eat simply – you can live very cheaply. In most countries you can live for less than HK$80 a day if you try. Of course, it does start to get more expensive and complex if you are keen to document your trip with photos and video. On this expedition, my expedition partner, Leon McCarron, and I have an expensive camera, a laptop for backing up, and regularly have to replace little things that break. We are now on our third tripod and our ninth pair of sunglasses. However, if you are going on an adventure for its own sake, it can be economical as well as fun. Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book, and a National Geographic TV series. Every week in Health Post, he will write about the progress of his latest expedition, Walking Home From Mongolia, which is in support of the children’s charity Viva. www.walkinghomefrommongolia.com
WELL-BEING 11 THE TASTE TEST FROZEN BERRIES ...................................................... Jeanette Wang jeanette.wang@scmp.com Stahlbush Island Farms Marion Blackberries 283 grams for HK$49, City’super Named after a county in Oregon, the deep-hued Marion blackberries are typically harvested in July and August. This variety is flash frozen straight from the field and said to be just as nutritious as fresh berries so you can enjoy them year-round. Verdict: convenient, but when thawed, they lose the firmness, sweetness and juiciness of the fresh variety.
Vanessa Haywood, in the hills around Hout Bay near Cape Town, has been trail running for two years ago. Photo: Craig Kolesky
FIT & FAB Cascadian Farm Organic Red Raspberries 284 grams for HK$55, City’super One of the advantages of frozen berries is that they can be blitzed into a cool smoothie. The packaging for this brand, which hails from a home farm in Rockport, Washington state, has a recipe for sparkling raspberry-lemonade slush. Verdict: similar to the blackberries, these are limp and tart – and not very appetising – when thawed.
Actress scales fresh heights for the role of a lifetime ...................................................... Rachel Jacqueline healthpost@scmp.com
Creative Gourmet Fresh Frozen Pitted Cherries 300 grams for HK$68, City’super After the disappointment of the first two brands, I didn’t have high hopes for these. Surprisingly, they turned out to be fantastic. Like eating a frozen fruit sorbet, only guilt-free. Verdict: delicious eaten frozen straight from the box, they are meaty, sweet and refreshing.
There is only one race that Vanessa Haywood hasn’t finished in her life. She was mountain biking when her front wheel hit a rock, and she fell off – face first – while racing downhill at 50km/h. “And I didn’t finish only because I knocked myself out and had to be rushed off to hospital,” she says. While the South African actress, TV personality and model-turnedfitness fanatic is better known for her role in the Peter Jackson produced film District 9 and her stint on Survivor South Africa Maldives – Celebs vs Plebs, many would be surprised to know that she is also a competitive trail runner and mountain biker. A “DNF” (did not finish) is the last thing Haywood wants next to her name. She was in Hong Kong last month with her professional athlete boyfriend and champion ultra marathoner, Ryan Sandes, who took out the Vibram Hong Kong 100-kilometre trail race in 9 hours, 54 minutes, smashing last year’s record by two hours. While Sandes may beat her on the trails, Haywood would probably take him on a downhill technical mountain bike ride. She’s training for the ABSA Cape Epic, a gruelling eight-day, 800-kilometre race in South Africa’s outback, with around 15,000 metres of climbing – the equivalent of about two Mount Everests.
Haywood attributes her drive and adventurous spirit to growing up on a farm, riding horses and running barefoot through wheat fields covered in mud. She is now in training for the 250-kilometre trail race, Racing the Planet: Iceland 2013.
Did you enjoy your trail running experience in Hong Kong? I absolutely loved it. One minute you are surrounded by jungle and the next you look to your side and there are skyscrapers right there. It’s crazy. You really feel as if you’re in an urban jungle.
I was finishing in the middle of the pack in races and it just wasn’t sitting with my competitive nature. Second, I had been single for a few years and wanted to meet someone with the same love of the outdoors. I am very lucky, as I have managed to do both.
How long have you been a trail runner? I was on the athletics team growing up, but I only started trail running two years ago, about the time I met Ryan. Before that, I didn’t know what trail running was. I thought it was just glorified hiking. It was Ryan who really got me into it – we first met at a 15-kilometre trail race. I was amazed at him running uphill effortlessly while I was panting and wheezing behind. But he stayed with me the whole way.
What advice do you have for someone wanting to get into trail running or mountain biking? Enter a race. It’s a great motivator, as you have a goal to work towards. It doesn’t have to be something crazy – it can be something as simple as a short run. Once you’ve paid your money and made a commitment, that’s all the motivation you need. You don’t want to not complete it because you didn’t train. Plus, every bit of training you do beforehand makes the challenge so much more enjoyable and rewarding.
What’s your diet like usually? I usually eat very healthily – lots of fresh salads and free-range meats, such as venison and ostrich. When racing, I find it’s best to race on real food such as salted nuts, biltong (a type of South African dried meat), a few Jelly Babies, bananas, baby potatoes and Hammer Nutrition products. And I try to avoid the junk.
What do you enjoy about it? It’s my release and a great way to de-stress. It’s also technical. You are constantly thinking about where your foot is going next. If it’s a flatter trail, then you are just enjoying the environment.
It’s about having a balanced lifestyle: work hard, play hard, rest hard
Do you have a favourite motivational quote? Carpe diem [“seize the day”]. I remember watching the film Dead Poets Society as a 16-year-old and hearing that Latin phrase, and it really resonated with me. You have to seize every day, as you never know if you’re going to get hit by a bus, or, in my case, fall flat on your face off a bike. What inspired the change to become a more serious athlete? It was a very conscious decision. First, I wanted to up my game.
What’s your training regime like? At the moment I’m training six days a week with a day off – about 15 to 18 hours a week. That’s not all the time, only when I’m racing. Ryan is always training … but then, I’m not a professional athlete. What tips have you got for looking good both on and off the trails? Stay out of the sun. It’s difficult when I do so much sport, but I never tan. It’s about having a balanced lifestyle: work hard, play hard, rest hard. And most importantly, be around people who bring out the best in you. Follow Haywood on Twitter @VanHaywood and Facebook www.facebook.com/ VanessaHaywoodOfficial