20120327 health post

YOUR GUIDE TO LIVING WELL

HEALTH POST Hong Kong suffers from an excess of illumination >PAGE 6

Unbearable lightness WHEN IT COMES TO THE BIG PUSH >PAGE 4

CEREALS THAT GO AGAINST THE GRAIN

Photo: Dickson Lee

>PAGE 9

TUESDAY, MARCH 27, 2012

2 NEWS APP OF THE WEEK

DIET

Alarm rouses employees from Chocoholics, grin as you thin workstations to action stations ......................................................

Jeanette Wang jeanette.wang@scmp.com

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Katie McGregor healthpost@scmp.com

Trying to kick your chocolate habit?

You may not need to. New evidence suggests that adults who eat chocolate frequently are thinner than those who don’t.

A study by a team of researchers from University of California, San Diego, was published yesterday in the Archives of Internal Medicine and funded by the US National Institutes of Health. It examined dietary, height, weight and other information provided by about 1,000 adult men and women from San Diego.

The researchers found that adults who ate chocolate on more days a week had a lower body mass index than those who ate it less often.

Office Fitness Free Rating 7/10 Apparently, there are app developers out there looking to make a fortune by releasing the next Angry Birds, so it is a puzzle that not one of them has thought to develop a decent – or even fun – app for the millions of office workers who could use an app to help them improve their desk health.

Hoping that something better might have come along since the last time we reviewed such an app for sedentary workers, I downloaded Free 10-minute Office Yoga. I should have read the reviews. Nine sets of yoga stretches – illustrated with very static photos and a peculiar voiceover, and it kept freezing.

The next free app – Cardinus HealthyWorking+ – had a lot more going for it, with several pages of advice plus short exercise videos with stretches for your arms, back, neck and eyes. But the app still didn’t take advantage of the functionality of the iPhone. After all, if I am sitting at my desk, I can just as easily find exercises and tips on the web, and they’ll be displayed on a bigger screen.

I then spent some cash – 99 US cents each on Lastics Office Stretch and Desk Yoga – and found more stretch videos but nothing I couldn’t get from my desktop.

Just as I was about to give up, I found a free app with an alarm that would randomly remind you to do a stretch or two. I could only guess this because of the alarm icon on the

iTunes description; everything else was in German. I downloaded the app anyway and was surprised to discover that the app itself was in English – sort of.

Office Fitness allows you to set your working hours, decide whether you want to exercise in your seat, or standing, and set the time period for each exercise. Then, through the day, you receive an alert with either a motivational message or instructions for an exercise.

The exercises are quirky. The “Wilhelm Tell”, as in the Swiss legend, involves balancing an apple on your head for 30 to 90 seconds; “All Ears” involves massaging your ears; and “Proud as Punch!” entails a quick, proud, punchy march across the office. The app isn’t bad, but I hope someone out there is working on something better.

There was another surprising finding. “People who ate chocolate more frequently ate more calories but did not exercise more; despite this, they weighed less,” says lead author Beatrice Golomb, associate professor in the university’s department of medicine. No differences in behaviour were identified that might explain the finding as a difference in calories taken in versus burned.

However, the study did not make clear exactly how much chocolate should be eaten on a regular basis.

Golomb says chocolate has been linked to lower heart disease and more favourable lipid profiles (hence, a lower risk of coronary heart disease). It also has other metabolic benefits to blood pressure and cholesterol, health indicators that also correlate with body mass index.

Golomb’s preference is for dark chocolate, which she says tends to be richer in phytonutrients – “plantbased nutrients that we think may underlie these metabolic benefits”.

“Our findings appear to add to a body of information suggesting that the composition of calories, not just the number of them, matters for determining their ultimate impact on weight,” she says. “In the case of chocolate, this is good news – both for those who have a regular chocolate habit, and those who may wish to start one.”

ASK THE DOCTORS DR ANTHONY LUKE ......................................................

Dr Anthony Luke healthpost@scmp.com Q: Can “brain exercises” help decrease the risk of Alzheimer’s disease?

A: Memory loss is a common problem that accompanies ageing. Many people think doing mental exercises can help reduce memory loss.

As I was looking into your query, I found interesting research that was conducted at my own institution, the University of California, San Francisco.

The study looked at two groups of 15 subjects (average age 72). One group performed a 40-minute training programme of pattern

recognition drills on a computer three to five times a week for three to five weeks. The other group did not.

When a memory test of recognition was administered to both groups, the group that completed the training programme scored better than the other group. Plus, the group that completed the programme showed less brain activity during the memory test, which suggests that their brains were more efficient during the testing.

Researchers suggest that regular perceptual training – in this case, it was vision – can lead to improvements in memory. For more information on this training, visit www.positscience.com.

Another interesting study,

published in 2009 by a group at the Mayo Clinic, found that computerbased hearing training (conducted for one hour per day, five days per week, for eight weeks) improved subjects’ memory and attention abilities.

Therefore, there does seem to be some evidence that regular brainchallenging tasks can help improve brain function such as memory. It seems my mother-in-law, who does sudoku every day to stay sharp, is really on to something.

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

Michael “Frosti” Zernow, a parkour athlete and instructor from California, demonstrates the tic-tac, a move to kick off a wall or any other solid object. Photo: McClatchy-Tribune

FITNESS

Muck up this high-impact exercise and you could end up with tic-tac toe ......................................................

Jeannine Stein Most of us traverse the environment by walking. Not Michael “Frosti” Zernow. He prefers to vault, flip and catapult his way from A to B. The Santa Monica, Californiabased professional parkour athlete and instructor has 10-plus years of experience, and it shows: the man defies gravity when in motion.

Parkour is a discipline developed

in France that involves smoothly navigating over and around obstacles such as walls, stairs and trees with jumps, climbs and acrobatic moves.

Zernow makes it look effortless, but it takes practice and discipline if you don’t want to smack a wall, graze your knees on asphalt or end up in A&E. Once you have the skills, you can practise parkour (or freerunning) almost anywhere.

Since some moves can be tricky and require a level of athleticism, you

may want professional instruction at the outset. But here’s an easy, explosive move – called a tic-tac – to get you started.

Why you should try this: because it’s fun. A tic-tac is usually done to jump over an obstacle and can help you climb higher. It instils body control, essential for parkour. The major muscles of the legs and core get a workout since they keep the body stable as it flies through the air.

What to do: pick a spot on a wall, sturdy tree or lamp post that is at a comfortable and achievable height.

Take a short running start and step onto the spot with the leg that’s closest, putting your weight into it.

Then push off with the same leg, like a billiard ball ricocheting off the side of a pool table.

Extend the other leg out for the landing, but don’t just settle for any random landing spot. Pick a specific place on the ground, and turn to face

it to help guide your body there.

Land on the balls of the feet, with your knees bent. This avoids injuring your joints.

How much to do: begin with one to two tic-tacs at a time, making sure you work both sides of the body. As you get stronger, add more.

McClatchy-Tribune Find out more at the Hong Kong Parkour Association www.parkour.hk

NEWS 3 HEALTH BITES

QUIZ

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Jeanette Wang jeanette.wang@scmp.com

Jeanette Wang jeanette.wang@scmp.com

Top of the pops You can feel a little less guilty for indulging in that bucket of popcorn. Scientists have revealed that the snack contains more of the healthful antioxidant substances called polyphenols than fruits and vegetables.

Speaking at a meeting of the American Chemical Society in California, lead researcher Joe Vinson said: “Popcorn may be the perfect snack food.”

Popcorn is only about 4 per cent water, compared with 90 per cent for many fruits and vegetables. The hulls (the part that everyone hates) have the highest concentration of polyphenols and fibre. A serving of

Your liver might be crying murder after the weekend’s revelry and beer guzzling at the Hong Kong Sevens.

Binge drinking certainly has negative effects on health, but recent research has shown that moderate and regular drinking of beer can actually match wine for its positive effects on cardiovascular health.

The study, published in the European Journal of Epidemiology, pooled scientific studies conducted worldwide involving more than 200,000 people.

Results confirmed what was already known about wine: a moderate consumption (about two glasses a day for men and one for women) can lower the risk of heart disease, up to 31 per cent lower compared with non-drinkers.

Beer was a surprise: drinking slightly more than a British pint a day (586ml) of a beer containing 5 per cent alcohol offers maximum protection against cardiovascular disease.

The study authors – from the John Paul II Foundation for Research and Treatment in Campobasso, Italy – warn that this finding cannot apply to everybody. For example, in young

popcorn – the only snack that’s 100 per cent unprocessed whole grain – provides more than 70 per cent of the daily intake of whole grain.

Vinson cautioned, however, that the way popcorn is prepared and served matters: air-popped without oil and naked is best.

One is the loneliest number The risk of depression is almost 80 per cent higher for people living alone than for those in a family or any other social group, new research in the journal BMC Public Health shows.

The study tracked 3,500 men and women of working age in Finland for seven years, but it could be relevant to Hong Kong, where government statistics show there were 382,300 one-person households in 2010. Researchers at the Finnish Institute of Occupational Health compared the living arrangements of subjects with various other risk factors leading to antidepressant use. For women, one-third of the risk was attributable to sociodemographic factors such as lack of education and low income. For men, the biggest contributing factors included a poor job climate, lack of support at the workplace or in their private lives and heavy drinking.

Flu-prone? It’s all in the genes During the recent swine flu pandemic, the virus provoked only mild symptoms in most people and rarely threatened the lives of others.

New research published in the journal Nature could help explain why: a human gene has been found to influence a person’s response to a flu infection.

IFITM3 is a protein that protects cells against viral infections. The study, led by the Wellcome Trust Sanger Institute in Cambridge, Britain, found in tests on mice and

humans that a rare version of the gene appears to make one more susceptible to severe forms of flu.

“Our research is important for people who have this variant, as we predict their immune defences could be weakened to some virus infections,” says Professor Paul Kellam, the study’s co-senior author.

“Ultimately, as we learn more about the genetics of susceptibility to viruses, then people can take informed precautions, such as vaccination to prevent infection.”

Become a sparty animal If you’re looking for a healthier alternative to boozing and bumping in Lan Kwai Fong, why not consider a sparty? In place of alcohol and loud music, sparties (spa parties) at the Hyatt Regency Hong Kong in Sha Tin offer spa treatments and refreshing snacks and drinks. Each two-hour sparty, held in a specially equipped relaxation suite called Melo Moments, can handle six to 12 revellers. The pampering begins on Sunday. There are three packages, starting from HK$588 per person. Call 3723 7684 or e-mail melospa@hyatt.com for reservations.

> 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

Department. That translates to 24.2 litres of beer – assuming beer has 5 per cent alcohol by volume – or 43 pints a year, fewer than one a week.

So, going by the study, it seems we can afford to indulge in beer a bit more to reap the health benefits. But before you do, test yourself on your knowledge of the drink.

1. About how many calories does a typical pint of beer have? a. 100 b. 140 c. 180 2. Beers with a higher alcohol content have the same number of calories as those with a lower alcohol content. a. True b. False 3. Brewer’s yeast used in beer is a great source of which nutrient? a. Niacin b. Folic acid c. Chromium women still of fertile age, alcohol can slightly raise the risk for some kinds of cancers, acting as a counterbalance to the positive effect on heart disease.

In Hong Kong, each person aged 15 and above drank on average 1.21 litres of alcohol from beer in 2010, according to statistics from the Health

4. What ingredient makes light beer lower in calories and carbohydrate content? a. Folic acid b. Ethanol c. Caffeine Answers: 1. c; 2. b (alcohol contains about seven calories per gram); 3. all are correct; 4. b.

4 HEALTH

Stand by me Birth companions are becoming more popular in Hong Kong, and the new mothers they’ve helped say it’s a useful service, writes Monica Proctor

H

istorically, women have been attended and supported by other women during labour.

Yet in many places throughout the world, including Hong Kong – and because more women give birth in hospital than at home – continuous support during labour has become the exception rather than routine. Experts say this may contribute to the dehumanisation of women’s birth experiences.

In a systematic review published in the Cochrane Library last year, a research team from the University of Toronto’s faculty of nursing analysed data from 21 trials from 15 countries involving more than 15,000 women in a wide range of settings and circumstances to assess the effects of continuous, one-to-one intrapartum support, compared with the usual care.

The researchers found that the best person to provide support is one who is present solely to provide support, is not a member of the woman’s social network, is experienced in providing labour support, and has at least a modest amount of training. Enter the doula.

Recently relocated expatriates Tiffany King, 35, and Lauren Ullman, 31, hired doulas – “women who serve” in ancient

10 The number of birth companions operating in Hong Kong at present

Greek – for their first babies. They were both hoping for natural births and wanted to create the necessary support by having a birth companion present.

King suffered from high blood pressure and was induced at 381⁄2 weeks; she had to undergo an emergency Caesarean section to prevent her baby from going into distress. “Even though I had a Caesarean section, I was still able to labour naturally 90 per cent of the time. Because of my doula’s coaching, I was able to get through the pain; it was totally worth it in the end,” she says.

Ullman, who was 21⁄2 weeks overdue, went into labour the day before she was to get induced and delivered a 4.2kg baby without drugs or stitches. “My doula’s massage during labour, suggestions on birthing positions

DOULA CONTACTS Annerley www.annerley.com.hk; Tel: 2983 1558 Jeanne Hauguel www.doulabirthstory.com; Tel: 6496 4318 Kathy Kitzis www.kathykitzis.com; Tel: 6340 4687 Mother’s Touch www.amotherstouch.com.hk; Tel: 9521 2347 Pascale Maitre pascalemaitre5@gmail.com; Tel: 6113 8491 A doula provides physical and emotional support to expectant mothers

and reflexology points and support for my husband were invaluable,” she says.

Doulas in Hong Kong are a relatively new phenomenon.

There are about 10 doulas mostly serving the expat and Westerneducated Chinese population.

But doulas have been present across history and cultures as experienced mothers assisting new ones.

These days, a doula is a birth companion who provides emotional and physical support and advice to the mother. Most of the doulas in this city, such as Eugenie Vallot-Perraud, a doula who moved to Hong Kong from Paris in 2009, also provide prenatal care and post-natal support. Each often works with a backup doula to ensure either she or the backup is present during the birth, and will often be on call from two weeks before the due date.

A birth doula supports the expectant mother before, during and after birth, while a postpartum doula supports the mother after. In contrast, midwives can undertake medical procedures such as checking dilation and the baby’s heart rate.

“We help the mother achieve the birth she wants,” says Kathy Kitzis, a Hong Kong-based doula and massage therapist.

Doulas are most common in countries where there has been a trend towards the medicalisation of childbirth, such as the US, says Hulda Thorey, midwife and director of Annerley, the maternity and early childhood group. “We are bound to have more doulas in Hong Kong as time passes.”

“First-time expectant parents and expatriates who are new to Hong Kong and have no family and friends nearby will find a doula helpful and supportive,” says Dr Patrick Chan, a specialist in obstetrics and gynaecology.

He says expectant parents should consult their doctor and hospital to ensure a mutual understanding is reached, and that the hospital has no restrictions on doula care.

Eugenie Vallot-Perraud is a doula at Annerley.

Photos: May Tse

“It’s important for the doctor, patient, midwife and doula to work as a team to optimise a good birthing experience, but also have an understanding that ultimately the safety of the fetus and mother takes priority. It’s important to support the mother during the natural birthing process – and in case the process deviates from expectation and intervention is required.”

Lizzie Purnell-Webb, a Hong Kong-based doula with a nursing background, says past birth experiences that have gone poorly are another reason couples tend to seek doula support. Doulas also give great support for dads. “It may be difficult to see the one you love in pain,” says Purnell-Webb.

“The doula is there to provide advice and suggestions to the couple during the birth planning process.”

In the University of Toronto study, the continuous support was provided either by hospital staff, such as nurses or midwives;

HEALTH 5

women who were not hospital employees and had no personal relationship with the labouring woman, such as doulas or women who were provided with a modest amount of guidance; or by companions of the woman’s choice, such as her husband, partner, mother or a friend.

The researchers found that women who received continuous labour support were more likely to give birth “spontaneously”, without Caesarean, vacuum or forceps. In addition, those women were less likely to use pain medication, were more likely to be satisfied, and had slightly shorter labour. Their babies were less likely to have low five-minute Apgar Scores, a measure of a newborn’s health. No adverse effects were identified.

A 1997 paper by the World Health Organisation’s Technical Working Group published in the journal Birth explains that doula support may include praise, reassurance, measures to improve

We help the mother achieve the birth she wants KATHY KITZIS (BELOW), DOULA AND MASSAGE THERAPIST

the comfort of the mother, physical contact such as rubbing the mother’s back and holding her hands, explanation of what is going on during labour and delivery, and a constant friendly presence.

These are tasks that could be fulfilled by a nurse or midwife, but they are often preoccupied with medical procedures. Given the short supply of hospital resources for delivering births, the doula could provide this continuous support, especially in a hospital setting where you do not know who is going to be on duty.

To select a doula, prospective parents can interview candidates to find one with a background, experience and personality that they feel most comfortable with.

Price is also a consideration. A birth doula can cost about HK$15,000, whereas a labour doula, who stays up until the birth (in the public hospital system only one companion is allowed to attend) costs HK$10,000.

This is three times higher than the cost of hiring an experienced doula in the United States, says King. In effect, the cost of having a doula is similar to that of an epidural and the services of the anaesthetist in a private hospital.

Doula fees are commonly not covered by medical insurance companies.

Apart from cost, the drawback of having a doula is that eagerness to ensure a natural birth can lead to them overstepping the line in the delivery room, where they may not appreciate the medical realities.

Since doulas are unregulated in Hong Kong, experience and training may also vary from one doula to another.

But both King and Ullman felt that their doulas were respectful, and say they would hire them again. Chan adds: “So far I have had very positive experiences when a doula is involved in a patient care.” healthpost@scmp.com

MOVING PICTURES In line with World Doula Week (2228), there will be a free film screening of Doula! The Ultimate Birth Companion 2010, a 50-minute documentary featuring three births, tonight, 7-9pm, at Kathy Kitzis, Room 202, Ivy House, 18-20 Wyndham Street, Central Contact: massage@kathykitzis.com

6 COVER STORY

COVER STORY 7

Never a dull moment Light pollution is taking its toll on the health of people living in the worst affected areas and may increase the risk of cancer, but little is being done to redress the problem, writes Jennifer Huang

T

o the residents of certain neighbourhoods in Hong Kong, it may seem as if the nights are just getting brighter and brighter, with eyepopping LED advertising panels, colour-saturated neon signs and floodlit billboards illuminating the streets, adjacent buildings and the night sky all around.

Although the bright lights promote the image of a modern and vibrant cosmopolitan city, they may be adversely affecting the daily lives and health of those living amid the glare in the city’s high density commercial-cum-residential areas.

“In the past couple of years, the light pollution issue has got more serious in the urban jungle,” says Edwin Lau Che-feng, a local director of environmental group Friends of the Earth.

“There are more and more advertising spotlights, panels and big screens being put up in different parts of the city. The government has received many complaints from the public about [external] lights shining through their windows and curtains.”

Last year, the Environmental Protection Department (EPD) received 361 complaints about external light installations that were the responsibility of private organisations – mostly about light nuisance caused by advertisements, decorative lighting, or spotlights directed on building facades. The number of complaints has increased dramatically over a five-year period; even in 2007, 40 had been a sevenyear high. And of course, many others suffer in silence.

“To be fair to the city, they have resolved a lot of the complaints,” says Carl Gardner, director of the London-based CSG Lighting Consultancy. Local authorities invited Gardner in October to conduct training seminars on practical lighting improvements based on British legislation.

Gardner says the local authorities have been going out to complainants and those responsible

for the lighting to reach an informal solution, “but they were starting to find it overwhelming because the number of complaints has increased exponentially”.

In response to the growing problem, the EPD established a task force of advisers from various professional bodies – environmental groups, advertisers, property developers, lighting designers and engineers – to set up technical guidelines to minimise light nuisance and energy waste. The six-page document, “Guidelines on Industry Best Practices for External Lighting Installations”, was released in January (available at the Environment Bureau’s website www.enb.gov.hk).

According to EPD information officer Chau Yau-fai, copies of the guidelines will be given to the offending parties when handling light nuisance complaints and compliance encouraged. “Among other things, [the EPD task force] will consider whether a voluntary or a mandatory approach should be taken to regulate external lighting installations,” he says.

The voluntary nature of the new guidelines has its limitations, says Gardner. “Hong Kong doesn’t want to go down the legislative route, but if you don’t have any sticks, then you need carrots to incentivise advertisers through subsidies on equipment or tax breaks. Otherwise, you won’t get any change.”

In 2007, Dr Jason Pun Chunshing, professor of observational astrophysics at the University of Hong Kong, began a light pollution survey in the city funded by the Environment and Conservation Fund. Having collected half a million data points, Pun found that the night sky in urban areas was many times brighter than in rural areas, even when measured on the same night with identical weather conditions.

“Unfortunately, in urban locations we don’t achieve a good night sky until very late in the evening,” says Pun. “City lights

The bright lights keep some people awake, but others say they help the city’s image. Photos: May Tse, Dickson Lee, Jonathan Wong, K.Y. Cheng, Samantha Sin

should be turned off around 11pm or so, but we still have a lot of lights around 1am, mostly unnecessary.”

Light pollution is defined as light seeping into the night sky, creating an aggregate halo effect over the city.

It is barely noticed by most urban dwellers, but may have manifold environmental effects from the waste of energy to changing the ecological lifestyle of nocturnal animals and plants.

Unlike many other cities, Hong Kong’s commercial and residential zones are not strictly separated. “In places like Causeway Bay, Mong Kok or Wan Chai, you might see 30 big spotlights shine on an advertising board and just above it would be

City lights should be turned off around 11pm or so, but we still have a lot of lights around 1am, mostly unnecessary JASON PUN, UNIVERSITY OF HONG KONG

residential flats,” says Friends of the Earth’s Lau. In several cases, tenants have complained that the lights actually penetrate through curtains and make it difficult for them to sleep.

Because no real studies have been conducted specifically on the health effects of this light trespass, it is difficult to prove any direct danger.

There are, however, serious consequences when light at night causes disruption of sleep.

David Blask, professor of structural cellular biology at Tulane University in New Orleans, is a leading expert on the link between cancer and light at night. In 1987, he read a paper published by Dr Richard Stevens, an epidemiologist, hypothesising that electrification in industrialised societies may account

for the elevated risk of breast cancer, which is roughly three to five times higher than in less developed countries.

At the time, Blask was conducting groundbreaking research on the hormone melatonin and its ability to combat cancer.

“The literature was quite solid showing that light at night would shut off melatonin production,” Blask says. “If you put animals on constant light, the tumours would grow faster. [Stevens] put the experimental work in a context never considered before. The possibility that light at night, which is so prevalent in a 24-7 society, could be a cause of breast cancer by suppressing melatonin is an intriguing and important idea.”

Melatonin is a powerful antioxidant that can prevent mutations by stimulating DNA repair. It also blocks tumours from taking up linoleic acid, which is “the king of pro-inflammatory fatty acids” and provides the fuel for tumour growth, Blask says.

The body is run by an internal clock that’s synchronised by light.

Darkness – usually around 9pm – triggers the production of melatonin via the pineal gland in the brain.

Light deactivates the pineal gland and stops production of melatonin.

Since 1993 Blask has teamed up with colleague Robert Dauchy, who pioneered a method to inject and grow human tumours in rats. In one experiment, some rats were kept in a facility with a light leak at night.

“We noticed that the tumours were growing much more rapidly in these animals than in the control animals,” says Dauchy.

They suffused human tumours in rats with blood from volunteers at three different times – daytime, at nighttime and after being exposed to 90 minutes of light at night. They found that tumour growth proliferated with the daytime and light-at-night blood whereas the melatonin-rich nighttime blood shut down the tumour.

They also conducted light box

experiments in which implanted female rats were kept under light of varying intensities. The brighter the light, the faster the tumours grew.

“Melatonin puts cancer cells to sleep at night,” says Blask. “Without melatonin, they are awake 24 hours a day.”

A 2005 study, by epidemiology Professor Scott Davis of the Fred Hutchinson Cancer Research Centre in Seattle, Washington, established the link between night-shift work and an elevated risk of breast cancer.

Lau suggests light nuisance could be minimised through mandatory curfews like noise control ordinances.

“There should be a time for advertisers to stop shining their spotlights. In different districts, lights may be turned on until 3am.

No one is doing any more shopping once they close at 10.30pm, so why do you need all that advertising?”

To Gardner, the solution is to regulate design principles. “I’ve seen signs where 50 per cent or more of the light is spilling across the street.

This is the wrong way to do it; with the right technique, you can position the light on the sign with no light spilling on the street,” he says.

He also suggests dimming the LED lights atop buildings so that the glare does not exceed a limit in square metres. “The city once had quite a good skyline,” says Gardner.

“But what you notice more and more are the really, really bright building signs – one overpowering the other, with just so many bright spots. It’s quite garish. There is no sense of balance over the city.”

But Pun disagrees: “In this city, brightness means prosperity.”

In a 2010 survey by the Advisory Council on the Environment, 70 per cent of 2,700 respondents felt that light pollution existed in Hong Kong, but 78 per cent said lights helped beautify the environment and promoted the city’s image.

In other words, most Hongkongers like the bright lights, so change may be a challenge. healthpost@scmp.com

Illustration: Angela Ho

8 MEDICAL

CASE HISTORY

How years of neglect take their toll ......................................................

Eileen Aung-Thwin healthpost@scmp.com Patrick Hung, 68, has suffered type-2 diabetes for about 20 years.

Despite knowing the health risks that diabetes presents, Hung stubbornly refused to change his diet and lifestyle. Over the years, his health deteriorated as diabetes and its associated complications ravaged his body.

Hung’s eyesight became progressively poorer, and he suffered numbness in his hands and feet as a result of nerve damage.

Like many diabetic patients, Hung (whose name has been changed for reasons of patient confidentiality) also suffered from hypertension and even had chest pains resulting from vascular disease where the small arteries in his heart had narrowed. So, besides seeing his family doctor to help manage his diabetes, Hung regularly consulted a cardiologist to keep tabs on his heart condition.

However, both experts had overlooked another potential complication arising from diabetes: kidney (renal) failure.

Diabetes is a rising cause of renal failure in Hong Kong. Thirty years ago, 20 per cent of patients on dialysis were diabetic; now, it’s 45 to

50 per cent. According to an international kidney disease registry in the United States, Hong Kong ranks seventh worldwide in renal failure as a result of diabetes.

Hung’s kidney problems came to light only because of another health crisis. He had developed acute cholecystitis, or infection of the gall bladder, and was taken to Hong Kong Sanatorium and Hospital for emergency treatment. While preparing Hung for an operation to remove his infected gall bladder, the surgical team ran some standard tests. One test showed he had very high levels of protein in his urine.

While a normal person might have about 0.2 grams of protein (albumin) per day in the urine, Hung had a whopping 4 grams. It was an indication of impaired kidney function. Dr Lai Kar-neng, director of health assessment and director of the HKSH Nephrology Centre, was called in.

Lai ordered a creatinine clearance test for Hung. Creatinine is a molecule constantly produced and released by muscles, and is almost exclusively excreted by the kidneys. By measuring how much creatinine was in Hung’s urine, Lai could assess his kidney function.

The results were grim. Hung had only 10 per cent of kidney function left and therefore had end-stage

A kidney disease registry ranks Hong Kong seventh worldwide in renal failure from diabetes kidney disease. Diabetes had caused the nephrons – or the fundamental blood filtrating units in the kidneys – to thicken and scar over time. As Hung’s kidneys grew more and more damaged, they could no longer function properly and started to leak protein into the urine instead of keeping the protein in the blood circulation where it normally belongs. His hypertension had probably contributed to the kidney damage, as well.

The condition was irreversible.

Lai could only hope to retard the deterioration by keeping Hung’s blood pressure under control to prevent further damage.

But there was another problem.

To reduce Hung’s blood pressure, his best bet was a class of drugs called angiotensin receptor blockers, or angiotensin converting enzyme inhibitors, which also help reduce the amount of protein lost in

the urine. But these drugs can raise potassium levels in the blood.

Potassium is normally removed by the kidneys; with failing kidneys, Hung’s potassium levels were already high. Any higher, and he could suffer abnormal heart rhythms.

Hence, Lai could not give Hung the appropriate dosage to obtain the desired results. He had to slowly increase the dosage instead.

Hung’s failing kidneys also exacerbated his diabetic control.

The drugs that he was taking to control the diabetes are designed to coax his body’s insulin from the pancreas, says Lai. Insulin helps move glucose from the bloodstream into muscle, fat and liver cells, and is normally metabolised by the kidneys.

Damaged kidneys results in a raised insulin level and can lead to low blood sugar.

Low blood sugar can cause a diabetic patient to feel faint and prompt him to eat more to compensate, resulting in a rollercoaster ride of glucose levels in the blood.

Many doctors would then assume that the patient is not observing a proper diet or not responding well to the drugs, and would therefore increase the medication dosages, says Lai.

Unfortunately, the real cause of the spikes and dips in blood sugar – deteriorating renal function – is often overlooked.

Hung failed to regularly take his medication, and that made his kidney condition worse. His family members were at their wits’ end, and his son even asked Lai to try to talk some sense into his stubborn father.

Lai told Hung to prepare for a lifetime of dialysis. Although treatment could delay the need for dialysis, Hung’s poor compliance to medications and lifestyle changes only hastened the inevitable.

In retrospect, Lai says that if Hung’s renal deterioration had been detected early, things need not have come to this stage. The American Diabetes Association recommends that every diabetic patient be given a micro-albumin urine test every year. When heavy protein levels are found, the prognosis would be poor, and kidney failure could occur within two years.

However, Lai says that studies show that if glucose levels are wellcontrolled, early kidney deterioration can be reversed.

Hence, he urges diabetic patients to be regularly tested for kidney function and to better manage their blood glucose levels.

DIET 9

NUTRITION CEREALS

Sweet deception ......................................................

Elle Kwan healthpost@scmp.com For those of us whose schedules are packed and whose mornings often start early, a quick bowl of cereal and milk or a sachet of wheat drink seems to offer a healthy, quick and convenient breakfast solution.

But we may be consuming sugar at levels far above what’s considered to be healthy.

Health experts say we should take more time selecting what we eat and more care in preparing it.

“Thanks to advertising, people think all breakfast cereals are healthy,” says Sally Poon, a registered dietitian and editor with the Hong Kong Nutrition Association. “In fact, they can have lots of hidden sugars.”

She cites a 2010 study by the Centre for Food Safety and the Consumer Council of nutrition labelling on breakfast cereals.

The research uncovered some alarming results. Among 21 coldprepared cereals, the total sugar content ranged from 4.4 grams to a whopping 43 grams.

For the sample highest in sugar, eating the serving of 28 grams recommended by the manufacturer would supply 12 grams of sugar, or about a quarter of the recommended daily intake.

For hot cereals, including oatmeal and wheat drinks, a 32gram sachet provided 16 grams of sugar, or about one-third of the recommended daily intake.

“The recommendation is that no more than 10 per cent of your daily total energy comes from sugar,” Poon says. “For instance, no more than 50 grams of sugar per day, based on a 2,000-kilocalorie diet.”

Excess sugar in the body increases the risk of obesity, diabetes and coronary heart disease, and it can also cause tooth decay.

Cereal manufacturers add sugar to improve taste and texture, so high-sugar varieties – those with more than 15 grams of sugar per 100 grams – may taste good but offer

very little beyond a sugar rush at the start of the day.

If sugar remains in the body, it can have a longer-term impact on health.

“Sugar provides empty calories, which means it doesn’t provide any nutrients apart from those calories,” says Nicole Wong, a nutritionist with NutraCare Consultancy. “Excess sugar will be converted and stored as fat in the body.”

Energy gained from sugar is not satisfying in the long term, resulting in hunger soon after consumption, which can lead to snacking.

Warning signs that sugar content is high can be found at the top of where the ingredients are listed.

“Ingredients are listed in order of weight,” Wong says. “Cereals contain a high sugar content if ‘added sugars’ appears near the top of the list.”

People think all breakfast cereals are healthy. In fact, they can have lots of hidden sugars SALLY POON, REGISTERED DIETITIAN

Sucrose, high-fructose syrup, molasses, honey and corn syrup are all sugar derivatives and are worth noting if they appear high on the list.

Aside from the listing per 100 grams found on boxes, many manufacturers also recommend a serving size. These can range from about 28 grams up to 50 grams.

Often, producers of cereals high in sugars will recommend a smaller serving of about 30 grams, so that sugar levels appear lower.

These unregulated serving suggestions can be misleading.

Spooning out 30 grams, for instance, will fill roughly two-thirds of a bowl – hardly enough to sustain most of us until lunch.

But do seek a good option and don’t be tempted to skip breakfast.

Avoiding food in the morning can lead to a sluggish system, shakiness and fatigue.

LOWER-SUGAR ALTERNATIVES

Five breakfast options that don’t slather it on ......................................................

Elle Kwan healthpost@scmp.com McCann’s Steel Cut Irish Oatmeal Made from 100 per cent wholegrain oats, this is a hearty, filling breakfast with zero sugar content. Hit it up with blueberries, low-fat milk and a dash of honey if you want to sweeten it naturally.

Multi Grain Cheerios Gives good crunch, good taste and comes with a wholegrain guarantee.

With just one gram of fat per serving, this is a winner with children and grown-ups alike.

Can-Best Blueberry, Cranberry and Milled Flax Seed Swiss-style Muesli Looks healthy, is healthy and has

only one gram of sugar per serving.

Canada proves its healthy, feel-good image with this product – and there’s no maple syrup in sight.

Weet-Bix Organic Aside from its low sugar content, this new take on an old favourite can now be found made from organiccertified wheat. It is 97 per cent wholegrain and high in fibre, too.

Rice Krispies “Snap, Crackle and Pop” still delivers entertainment value for kids, but this product also allows parents to offer a good low-sugar option at the breakfast table compared with many other cereals targeting the school-going set. And adults can always make the cereal more appealing with a sliced banana.

Carbohydrates in the system are good for regulating metabolism and give long-lasting energy.

Ardyce Yik, a registered naturopathic doctor, says many of her clients believe that skipping the first meal of the day means they’ll lose weight, a misconception that simply isn’t true.

“People who eat breakfast – a healthy one, I emphasise – are generally less likely to be overweight,” she says.

“Skipping a meal makes you hungry, which may lead to overeating at later meals.”

So what can we eat for a healthier option?

On days when there is time, an omelette prepared with omega-3 eggs and vegetables is one of Yik’s top picks. An alternative is wholegrain toast spread with almond butter and a sliced banana.

For quicker fixes, try wholegrains again, this time in cereals with simple ingredient lists that include oats, barley, spelt or quinoa.

Yik is particularly fond of “steelcut” oats. These are minimally processed, use the whole oat groat and have a nuttier taste and hardier texture different from the usual rolled-oat porridges and oatmeal.

Brands marketed to children with brightly coloured boxes and brightly coloured ingredients naturally arouse suspicion, but also pay attention to brands that appear healthy. Many cereals that promote natural or organic ingredients on the box fail to mention their high sugar levels until you look at the small print.

One imported muesli promoting all-natural ingredients and found in Hong Kong supermarkets was found to contain 41 grams of sugar per helping.

Lastly, don’t be your own worst enemy. Buying a low-sugar cereal and then lavishing it with sugar sprinkled from the bowl at home defeats the purpose.

Instead, sweeten more gently with antioxidant-rich red berries, a spoonful of raisins and maybe a dollop of yogurt.

10 WELL-BEING WALKING HOME

May the quest man win ......................................................

fashioned adventures – when my motive was simply to feel alive and learn about the world and about myself.

Charles Foster’s recent book about pilgrimage, The Sacred Journey, evokes an old memory about how good it is to be on the road as a mere pilgrim and enjoy the beauty of being on a journey that is raw, simple and close to the ground.

Pilgrims live one day at a time and take the rough, the smooth, the companionship, solitude, adventure and monotony in their stride, as they plod on steadily towards their destination.

So, how does one become a professional adventurer? First, make sure you are going on trips that make you come alive. You have to find it exciting for yourself.

Rob Lilwall healthpost@scmp.com From time to time, I get an e-mail from a young person asking me for advice on how to become a professional adventurer. Certainly, making a living from doing adventures seems pretty appealing.

But really, I ended up becoming a “professional” rather by accident.

When I was younger, I used to enjoy scraping together what spare cash I had to go on adventures – walking across Spain, hitch-hiking around America, cycling across Ethiopia or Pakistan or Peru. I always just did this on my holidays and never had in mind that I was going to make money through my experiences.

Then, I decided to go on a really giant adventure – Cycling Home From Siberia – which took me more than three years and through such wild places as Papua New Guinea, Tibet and Afghanistan. For the first time in my life, I wrote a blog about what happened and bought a video camera to film the adventures.

When I got home to London, I still didn’t have any thought about becoming a “pro adventurer”. But then a publisher read my blog and asked me to write a book. I started to be invited to give paid talks in schools. National Geographic heard that I’d filmed the journey – suddenly there was a six-part television series.

Things grew from there. I had a successful career – with corporate motivational speaking all over the world, translation deals for the book, and writing opportunities for papers and magazines. Right now I am in the middle of another madcap trip – Walking Home From Mongolia, a 5,000-kilometre expedition – and filming it for a new television series.

However, going pro has some less appealing sides. Now, when dreaming up new adventures, I have to focus and wrestle with the career side of it, too – speaking, writing, filming, sponsors and media partners.

I think back wistfully to the days when I used to embark on good, old-

You can just step out your door and go for an adventure for the weekend or even just the evening

Lilwall (right) and Leon McCarron at the Yungang grottoes. Photo: Rob Lilwall

Second, try to find something that will really capture other people’s imagination. Scotsman Mark Beaumont did very well on this front when, in 2007, he broke the speed record for cycling round the world, covering the 29,000 kilometres in 194 days and 17 hours (161 kilometres a day with a day off every fortnight). That journey kick-started a very successful career for Mark in Britain as a television adventurer.

Third, try not to make your exploits too long. Cycling Home From Siberia took me three years and yet I wrote only one book about it and I had to do some severe editing to stop the book from getting astronomically long. I probably could have gone on four or five decent adventures in that time – and

written a number of books. But I had never planned that expedition as a professional one, and it was an important rite of passage for me.

Fourth, factor in the extra strain on your time, energy and finances.

For example, if you are filming the journey, remember that this in itself will change the experience you are having, as filming is hard work. Getting television backing (and for that matter significant equipment sponsorship) is incredibly difficult.

But these are only hints and guesses, and perhaps in conclusion I should swing this article back to pure and simple amateur adventuring, and to the thought that you can just step out your door and go for an adventure for the weekend or even just the evening.

The best man at my wedding, Al Humphreys, who was one of 10 people named Adventurer of the Year by National Geographic this year, has been using his incredibly popular adventure blog in Britain (www.alastairhumphreys.com) to encourage people to get out and have what he calls “microadventures”. These are adventures that you can do with minimal cost, experience and time.

Al has showcased a number of these, including swimming down his local river, camping on top of a hill, and picking a random place on the map and walking to it. About two years ago, we spent a week together walking a lap of the M25 motorway in England in its adjacent fields and forests. It cost only about HK$600 each, but boy, did we have a great time.

In Hong Kong, we are spoilt for opportunities – scrambling up a stream bed (be careful of snakes), climbing a hill (or a tree) or finding a new, hard-to-access beach. These mini-adventures are the best place to prep for the big time.

Every week in Health Post, Rob Lilwall 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

EAT SMART

Don’t take the bait – there’s really nothing fishy about this dish ......................................................

Jeanette Wang jeanette.wang@scmp.com What fish? There is no fish in this dish – obviously, or it wouldn’t be called vegetarian.

You might be wondering, then, why does the word “fish” even feature in the recipe name? Well, perhaps you should take that up with the restaurant chain that provided this recipe – Kung Tak Lam Shanghai Vegetarian Cuisine.

Nevertheless, the dish is simple to whip up. It’s also delicious, says Kathleen Yau, an executive committee member of the Hong Kong Nutrition Association. “This

recipe uses a variety of vegetables, which are stir-fried with a little oil,” she adds. “It is very filling and can help you maintain a healthy weight as it is low in energy and contains lots of dietary fibre.”

Cloud ear, in particular, is a traditional Chinese remedy also known as black fungus that’s used for increasing the fluidity of blood and improving circulation.

2 tsp canola oil ⁄2 tsp salt 1 ⁄2 tsp sugar Mixture of starch and water 1

Sautéed vegetarian fish fillet Serves 2

• Trim the shiitake and rinse the cloud ears.

• Bring water to a boil in pot. Blanch all ingredients.

• Heat oil in a wok.

• Stir-fry all ingredients with salt and sugar until tender.

• Thicken with mixture of starch and water. Serve.

4 fresh shiitake mushrooms Handful of cloud ear fungus, soaked 1 ⁄3 loofah, sliced 1 stalk celery, sliced

Recipe provided by the Health Dept as part of its EatSmart@restaurant.hk campaign. For more information, visit restaurant. eatsmart.gov.hk

WELL-BEING 11 THE TASTE TEST CHESTNUTS ......................................................

Jeanette Wang jeanette.wang@scmp.com

Clement Faugier Chestnut Spread 500g for HK$69.90, Market Place by Jasons This classic crème de marrons has been sold since 1885 and is a supermarket staple in France. Made of sweet chestnuts from Ardeche, it’s spread on crêpes or toast, used in baking or added to whipped cream for pies and toppings.

Verdict: thick, creamy and nutty. Too sweet to be eaten alone, but great slathered on bread and pancakes.

Tiana Harilela credits her late grandfather, George, with introducing her to her first yoga pose and the cleansing yogic kriyas. Photo: Edmond So

FIT & FAB

Now that’s a stretch ......................................................

P. Ramakrishnan p.rama@scmp.com Many in the Hong Kong “in” crowd might remember Tiana Harilela, 36, from her spell working at a luxury champagne company and frequent appearances in social columns.

Dressed in her designer gear and blinged out, she was by no means unfit, but she’s now in the best shape of her life, and she attributes it to yoga.

Her first experience of physical or hatha yoga was with her late grandfather, businessman George N. Harilela. “He taught me my first ever yoga pose. He was also the first person to introduce me to the yogic kriyas [cleansing rituals] at a young age. But his biggest influence on me was his subtle teachings of the ‘true self’ and the inner aspects of yoga. He is still in my heart as my first teacher.”

While among the glitterati, she says she was far from a spiritual being. Up until her early 20s, she kept a distance from everything spiritual and Indian.

“I knew I needed a practice with a challenge, so I turned to Ashtanga Vinyasa as taught by the late Sri K Pattabhi Jois of Mysore, India. This was one of the most powerful yoga practices I had ever seen and tried. I was hooked.”

Frequent trips to Mysore have followed. She cites Paul Dallaghan,

who runs the beautiful Samahita Yoga Thailand retreat in Koh Samui, as one of her biggest influences.

Dallaghan’s master, Sri O.P. Tiwari, is the head of the Kaivalyadhama Yoga Institute in Lonavala, near Mumbai. Through their guidance, Harilela is now an Ashtanga yoga teacher teaching simple pranayama, a special form of breathing exercises.

“It is one of my favourite things to teach because it brings everything inwards and I have personally seen how it has transformed me,” she says.

What’s been the biggest effect of doing yoga?

The biggest surprise for me is how it has changed my body. Physically I am stronger and leaner. There is a lightness about my body now.

Because the asana practice I do is about two hours long, postures flowing one into the next, and practised six days a week, there is a wonderful effect on the respiratory system. You sweat out toxins and allow for your body to move back into balance. Ashtanga Vinyasa is a very cleansing practice.

What do you preach and teach?

I teach Ashtanga Mysore style, which is the best way to learn yoga.

It’s like having a private class with other people in the same room. You learn in the correct way pose by pose. You only move to the next pose once you have mastered the

It’s a different lifestyle altogether from what I was doing years ago. There’s less chaos and drama TIANA HARILELA, YOGA ADVOCATE

previous one. Everyone is doing the same sequence within a time frame at his or her own pace. Nowadays, there is a lot of rock ’n’ roll and music in yoga classes. In this class, the music is the breath, and it is one of the most beautiful things to witness and try. It also allows for independence in the student. The teacher is there to guide and to help.

How did yoga help your recovery from the motorcycle accident you had in India last year?

I smashed the right side of my body and face. I was unable to fly back to Hong Kong due to complications. I still suffer pain in my face from nerve damage, and I have problems with my right shoulder and hip from the crash. I never thought I would be back to my practice. It took a long time to be able to do some of the things I was doing before.

Meditation, yoga asana and pranayama brought me back. There was this inner sense of spirit that

kept me going. It’s a story I tell my students when they think they cannot do something. The human spirit is unbeatable when it shines.

Bonne Maman Marron Cream 225g for HK$28.50, Gourmet This Japanese version of the French classic contains only sugar, chestnuts and vanilla flavouring.

This spread is lighter than Clement Faugier’s, both in colour and on the palate, without the thin, oily sheen that tops the French variation.

Verdict: lacks a full earthy and nutty flavour and a bit too sweet, but a delectable alternative to typical jam.

Your Hong Kong friends may be surprised at how fit you are now.

What do you tell them?

It’s a combination of yoga and balance. While I am still working on balance in life, I feel my levels are better. I eat healthy as much as possible. I have a green and predominantly wheat-free diet. I sleep early. It’s a different lifestyle altogether from what I was doing years ago. It’s peaceful and there’s less chaos and drama, which I feel adds to looking and feeling good on the inside and out.

Have you changed your diet?

I have. I have a predominantly vegetarian diet, eating fish once in a while. I have also changed my thought process about food. I pay attention to the foods that have acidity in them and those that are alkaline. My husband is a great chef and mainly cooks healthy vegetarian cuisine. He is always showing me herbal substitutes to take. I think maintaining a good diet and having fun cooking is the best way. You cannot just exercise and not add the food part in. We aim to show it can be fun and delicious to be healthy.

What’s your indulgence?

Well, that’s easy: chocolate.

Four Seas Chestnut 100g for HK$8.50, Market Place by Jasons While this product can’t be spread, it’s the healthiest way to have chestnuts, and these are reputedly top-quality Hebei Yanshan chestnuts. Unlike other nuts and seeds, chestnuts are low in calories: this 100-gram pack has 186 calories, 1.5 grams of fat, 5.8 grams of protein and 35.6 grams of carbohydrates.

Verdict: firm, yet creamy and moist inside; thoroughly addictive.