20120501 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, MAY 1, 2012

HEALTH POST THE SWEET TRUTH ABOUT STEVIA

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Illustration: Henry Wong

MEET THE MASTER OF BRAIN GAMES

How men are cleaning up their act to become fathers >PAGE 6

Fertility rights

2 NEWS APP OF THE WEEK

HEALTH BITES

Exercise in peer pressure adds competitive edge to fitness

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Katie McGregor healthpost@scmp.com Endomondo Sports Tracker Free Rating 8/10 I’m guilty of doing Endomondo a disservice. I took a quick look a while back and decided it was basic and the icon and name irritated me for some reason. A bad day at the office perhaps. But it meant I missed out on Endomondo’s strength: it fires up your inner competitiveness, motivating you to exercise ... and then exercise some more.

Like many exercise apps, Endomondo uses the smartphone’s global positioning system to track your workout, from mountain biking to walking. Some of the options – such as yoga – seem a bit nonsensical, so I didn’t try them out.

As you exercise, you can track your statistics – duration, distance, calorie burn, heart rate (if using a monitor) – either by taking a quick peek at the workout screen, or by choosing to receive updates from a mechanical Endomondo voice. You can challenge yourself with a distance goal, and the app will note your best and worst times. Your route is tracked and can be viewed on a satellite or graphic map.

At the end of your workout, you get a breakdown of more data including average speed, maximum speed, and split times for laps (usually a kilometre long). The app also provides your elevation change during the workout, but this seems unreliable.

Where Endomondo truly shines is through its online features and community function. When you set up the app, you are asked to create

an account. Doing so gives you access to the world of Endomondo, where you can challenge friends or follow a route set by someone else and see how you compare.

I set up a challenge to run 100 kilometres within seven weeks and invited friends and colleagues to do the same. By making the challenge public, my friends were able to invite their friends, so now 10 of us are involved.

Now every time I run with Endomondo, my kilometres are automatically added to that challenge, and any other challenge I may have joined. We are a fired-up group; so much so that even though it is “my” challenge, I’m currently in fifth place. I’m itching to get out and change that, and that is why it works so well.

The “pro” version of Endomondo (US$3.99) has a little more functionality and allows you to set more personal challenges on the phone itself.

ASK THE DOCTORS DR RALPH STANLEY Q: After exercise, when I have pushed myself hard, I often find that one or both of my ears are blocked. Why is this so?

A: The symptoms could be due to one, or a combination, of two reasons.

During exercise, the blood vessels in the body generally dilate (or enlarge).

Hence, more blood flows to the muscles and the skin, resulting in facial flushing.

This leads to vascular congestion for all the muscles, including those in and around the facial skeleton.

The muscles that surround the Eustachian tube (which is the tube that connects the back of the throat with the middle ear cavity) are also affected by this vascular congestion.

Eustachian tube dysfunction occurs,

leading to blockage of the ears, as transmission of sound in the middle ear is impaired.

After exercise, when the blood vessels return to normal, the congestion is reduced, enabling the Eustachian tube to function properly, and hence the ears get unblocked at rest, restoring normal hearing.

The other possible explanation is that during excessive exercise, many people clench their jaws. The muscular spasm around the Eustachian tube also leads to Eustachian tube dysfunction and ear blockage.

Dr Ralph Stanley is an ear, nose and throat surgeon at Gleneagles Hospital in Singapore

> 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

Printed and published by South China Morning Post Publishers Ltd, Morning Post Centre, 22 Dai Fat Street, Tai Po Industrial Estate, Tai Po, Hong Kong. Tel: 2680 8888

Jeanette Wang jeanette.wang@scmp.com

Make light work of it Conventional gym wisdom states the way to bigger muscles is lifting heavy weights. But scientists at McMaster University in the Canadian province of Ontario, in a study published last week in Applied Physiology, Nutrition and Metabolism, say lighter weights but with more repetitions may be just as effective. The researchers ran experiments that manipulated various resistance exercise variables (such as intensity, volume, and muscle time under tension). They found that in young men, a workout of lower intensity and more repetitions of resistance exercise, performed until muscular failure, was equally effective in stimulating muscle proteins as the conventional method. “These findings have important implications from a public health standpoint because skeletal muscle mass is a large contributor to daily energy expenditure and it assists in weight management,” says lead author Nicholas Burd. “Additionally, skeletal muscle mass, because of its size, is the primary site of blood sugar disposal and thus will likely play a role in reducing the risk for development of type 2 diabetes.”

Herbal powerhouse Oregano, the common pizza and pasta seasoning herb, has long been known to possess a variety of beneficial health effects, but preliminary data from a recent study by Long Island University researchers in New York has revealed its potential as an anti-cancer agent. Carvacrol, a constituent of oregano, has been shown to induce “cell suicide” in prostate cancer cells. The researchers are now trying to determine the signalling pathways that the compound uses to cause this suicide.

“We know oregano has anti-bacterial as well as anti-inflammatory properties, but its effects on cancer cells really elevate the spice to the level of a super-spice like turmeric,” says Dr Supriya Bavadekar of the pharmacology department.

Hit the spot So it seems it’s not a myth: the G-spot really does exist, and a study published last week in The Journal of Sexual Medicine details the location and shape of this elusive structure. Dr Adam Ostrzenski of the Institute of Gynaecology in St Petersburg, Florida, found the G-spot, a “well-delineated sac structure”, after conducting a layer-by-layer front vaginal wall dissection on an 83-year-old cadaver. He’s even listed the exact co-ordinates of the spot – 16.5mm from the upper part of the urethral opening, creating a 35 degree angle with the side border of the urethra (the tube that carries urine out of the body). “This study confirmed the anatomic existence of the G-spot, which may lead to a better understanding and improvement of female sexual function,” Ostrzenski concludes. But before you get too excited, Ostrzenski admits the G-spot may not be the same in every woman.

Suck it and see Giving pacifiers to newborns is believed to interfere with breastfeeding, but a recent study shows that limiting its use in nurseries may actually increase infants’ consumption of formula during the first few days in hospital. Researchers at Oregon Health & Science University analysed feeding data on 2,249 infants born in its hospital for about a year. Results showed that the rate of exclusive breastfeeding at the mother-baby unit decreased from 79 to 68 per cent after pacifiers were restricted, and the proportion of breastfed infants receiving supplemental formula increased from 18 to 28 per cent. The World Health Organisation recommends exclusive breastfeeding for the first six months of life. Medical centres that follow the WHO’s “10 Steps to Successful Breastfeeding” can be recognised as “baby-friendly hospitals” – and one step states that artificial teats or pacifiers should not be given to breastfeeding babies. The researchers say they hope their findings will stimulate discussion and scientific inquiry about whether there is sufficient evidence to support this universal recommendation.

NEWS 3 QUIZ

FOOD COLOURING

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Unhappy meals: how additives trick the body

Jeanette Wang jeanette.wang@scmp.com Potatoes, just like white bread and sugar, have gained a bad reputation for causing high insulin levels that can lead to obesity and diabetes. But a recent study shows that you can still enjoy your spuds.

University of Washington researchers have found that habitual consumption of white potatoes (baked, boiled and mashed) is not associated with obesity, type 2 diabetes, or levels of C-reactive protein, a marker of systemic inflammation.

Unlike previous studies examining the association between potato consumption and disease, this one considered demographic factors that could potentially confound the relationship, such as age, gender, race/ethnicity and education.

“One of the purposes of this study was that we hypothesised that demographic factors – particularly socioeconomic status – might be associated with both potato consumption and the prevalence of obesity and diabetes. Therefore, we controlled for these factors,” says lead researcher Adam Drewnowski, professor of epidemiology and director of the nutritional sciences programme at the University of Washington.

The researchers had examined dietary intake and health data in a representative sample of 5,800 adults in the US using two cycles (2003-04 and 2005-06) of a national health and nutrition survey. The study, presented last

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Lisa Leake

week at the Federation of American Societies for Experimental Biology Conference in San Diego, California, was funded by the US Potato Board.

Are you a spud stud? Test your knowledge here.

1. How many calories does a medium potato (150 grams) contain? a. 80 b. 110 c. 150 2. What percentage of your daily vitamin C requirement (60mg) does a medium potato with skin offer? a. 15 b. 30 c. 45 3. Which of these is not an attribute of the potato? a. Gluten-free b. Fat-free c. High potassium content 4. Potatoes contain an assortment of phytochemicals with antioxidant potential. Which of the following contains higher antioxidant capacity? a. artichoke b. broccoli c. tomato Answers: 1. b; 2. c (a medium potato contains 27mg of vitamin C); 3. none, all are true of potatoes; 4. a

NEURAL SCIENCE

Bilingualism helps boost brain power and hearing ......................................................

Jeanette Wang jeanette.wang@scmp.com Nei ho, bonjour, konnichiwa, shalom, annyong, hello. Speaking more than one language not only breaks down communication barriers, but a new study has found biological evidence that bilingualism also improves hearing and enhances attention and working memory.

Published yesterday in the Proceedings of the National Academy of Sciences, the Northwestern University study zoomed in on the auditory regions beneath the brain’s cortex that are bathed with input from cognitive brain areas. It was found that the experience of bilingualism changes how the nervous system responds to sound.

“People do crossword puzzles and other activities to keep their minds sharp,” says Viorica Marian, professor of communication sciences in Northwestern’s School of Communication. “But the advantages we’ve discovered in dual language speakers come automatically simply from knowing and using two languages. It seems that the benefits of bilingualism are particularly powerful and broad,

and include attention, inhibition and encoding of sound.”

Nina Kraus, an auditory neuroscientist, adds: “Bilingualism serves as enrichment for the brain and has real consequences when it comes to executive function, specifically attention and working memory.”

The researchers recorded the brainstem responses to complex sounds in 23 bilingual Englishand Spanish-speaking teenagers and 25 English-only-speaking teens as they heard speech sounds in two conditions.

Under a quiet condition, the groups responded similarly. But against a backdrop of background noise, the bilingual brains were significantly better at processing sound and paying greater attention to relevant versus irrelevant sounds.

“Bilinguals are natural jugglers,” says Marian. “Rather than promoting linguistic confusion, bilingualism promotes improved ‘inhibitory control’, or the ability to pick out relevant speech sounds and ignore others.”

In future studies, the researchers will investigate whether these results can be achieved by learning a language later in life.

Artificial food dye, synthetic food dye, food colouring, FD&C Red No 40 or tartrazine (aka Yellow No 5, or E102) ... whatever name they’re given on food ingredient labels, they’re all pretty much the same thing. And by that we mean that they are all chemicals derived from petroleum products.

No typos there, that’s what these artificial food dyes are made from, and unfortunately the 6.8 million kilograms of food dye used in the US last year (five times more than in 1955) is in much more than just colourful icing these days.

These brightly coloured dyes are added to a host of packaged foods, including Kraft Macaroni & Cheese, Minute Maid Lemonade, Lunchables, Fruit Roll-Ups, Cheetos and even Yoplait “Light and Fit” Yogurt. And the crazy thing is, these companies tell us right there on the package that artificial colour – and sometimes “artificial flavouring” – have been added, but most consumers aren’t even fazed by it.

Consider the following facts about artificial food dyes.

• They are made in a lab with chemicals derived from petroleum.

• They’ve been linked to long-term health problems.

These products confound the senses we rely on to assess new foods MICHAEL POLLAN, FROM IN DEFENCE OF FOOD

• Food products containing artificial dyes are required to have a warning label in Britain. The label states that the food “may have an adverse effect on activity and attention in children”.

• Synthetic food dyes have been shown to cause an increase in hyperactivity in children.

• They are odourless and tasteless, and therefore add absolutely no value to the foods we are eating, but they do, in fact, pose quite a few risks.

• They trick your senses like other additives, including sweeteners.

• They contribute to the obesity epidemic by

attracting children (and adults) to colourful, highly processed food, which in many cases is being eaten instead of fresh whole foods.

In closing, here’s a quote from Michael Pollan’s book In Defence of Food: “One of the problems with the products of food science is that they lie to your body; their artificial colours and flavours and synthetic sweeteners and novel fats confound the senses we rely on to assess new foods and prepare our bodies to deal with them. Foods that lie leave us with little choice but to eat by the number, consulting labels rather than our senses.”

McClatchy-Tribune

4 MEDICAL

CASE HISTORY

Illustration: Angela Ho

Going with the grain

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Wynnie Chan healthpost@scmp.com William Chan, 75, had been in good health, though he did have a few episodes of prostatitis, a condition where the prostate swells.

The annual physical that Chan (name changed for patient confidentiality reasons) had in 2007 showed his prostate-specific antigen (PSA) levels had risen to 5.2 nanograms per millilitre of blood, from an initial value of 3.1 nanograms per millilitre.

PSA is produced by the cells of the prostate – a walnut-sized gland located directly below the bladder in men – and can be used as a biological marker for disease detection. According to the US National Cancer Institute, the higher a man’s PSA level, the likelier it is that cancer is present, but there are other possible reasons for an elevated PSA level. Benign conditions, such as prostatitis, can also raise it.

In the past, most doctors considered a PSA level below four nanograms per millilitre normal, but recent studies have concluded that there is no specific normal or abnormal PSA level. Consequently, one abnormal PSA test result does not necessarily indicate the need for a prostate biopsy. However, if the PSA level continues to rise over time, other tests may be needed.

Unfortunately for Chan, biopsies taken from both lobes of his prostate tested positive for malignancy. He was diagnosed with stage T2a cancer.

His Gleason score – which grades prostate cancer on a scale of two to 10 – was five. High-grade tumours generally grow more quickly and are likelier to spread. Chan’s relatively low score suggested a low-grade cancer that would grow slowly.

Based on these results, his urologist outlined several treatment options – radiation therapy, radical prostatectomy (removal

of prostate and some of its surrounding tissue) or expectant management (watchful waiting).

Chan researched the various options extensively and concluded that the side effects and negative impacts on his social functioning and quality of life far outweighed the benefits of active treatment. So he decided to wait and watch.

Dr Yiu Ming-kwong, consultant and chief of urology at the department of surgery, Queen Mary Hospital, says: “Prostate cancer differs from most other cancers in the body, because some small areas of cancer within the prostate are common in elderly males, and some may remain unchanged for some time before they get really malignant and begin to grow.

Active surveillance is a viable treatment option for selected cases of low-risk prostate cancer among patients DR YIU MING-KWONG, QUEEN MARY HOSPITAL

“In a group of low-risk cancer cases, these cancers could grow very slowly, and so may not cause an immediate problem, particularly in elderly men. As such, active surveillance is a viable treatment option for selected cases of low-risk prostate cancer among patients, say, over the age of 70 to 75.”

For the next five years, Chan had regular PSA tests every three months and digital rectal examinations every six months. However, during this period, Chan and his family constantly worried about his health, and any pain, ache or malaise would be scrutinised for fear of cancer.

Earlier this year Chan’s PSA level rose to 9.2 nanograms per millilitre. Chan had an emotional discussion with his family and

reviewed the options again with his urologist. He decided to go for permanent internal radiotherapy called brachytherapy.

Yiu says: “Low-dose-rate brachytherapy involves placing radioactive seeds in the prostate gland permanently, where they slowly release radiation. The idea is to place the seeds close to the cancer cells, where the radiation can kill the cancer cells without causing too much damage to healthy tissue.

However, it still carries side effects of impotence, painful urination, urinary frequency, rectal pain and problems of bowel motions due to an inflamed rectum.”

Before the procedure, Chan was asked to follow a clear liquid diet the day before and fast from midnight onwards. For the procedure, Chan was given a general anaesthetic.

During the brachytherapy process, a fluoroscope and an ultrasound procedure were used to visualise his prostate and guide the long needles containing the radioactive seeds, the size of rice grains, into his prostate.

A CT scan was performed later that day to check the positioning of the radioactive seeds before Chan was allowed to go home. Although Chan was assured that the low levels of radiation in the seeds weren’t harmful to his family, as a precaution he was told to avoid close contact with his grandchildren for a couple of weeks.

After the procedure, Chan reported expected side effects including mild pain, painful urination, and increased urinary frequency. His urologist recommended Chan maintained a high fluid intake and prescribed a week’s course of antibiotics.

Ten months after treatment, Chan is now continent and able to sustain erectile function. His latest follow-up PSA level was two nanograms per millilitre. Looking back, he says he has no regrets about delaying treatment.

HEALTH 5

MENTAL HEALTH

Train the

brain ......................................................

Nicole Chabot healthpost@scmp.com

37 Number, in millions, of seniors with dementia projected in the world by 2050, according to a Shanghai-based study on mental activity

Cognitive training, including puzzles, handicrafts and life skills, are known to reduce the risk and help slow down the progress of dementia among the elderly.

But healthy, older adults can benefit from such mental activity too – improved reasoning, memory, language, and hand-eye co-ordination – according to a Shanghai-based study by Chinese researchers published in the journal BMC Medicine in March.

By 2050, it’s estimated that the number of people over 65 years old will have increased to 1.1 billion worldwide, and that 37 million of them will suffer from dementia. So it’s no wonder that in recent years, brain training has evolved into a multibillion-dollar industry.

But cognitive gymnastics needn’t cost much. In fact, if you’re looking for a daily challenge for the mind, the South China Morning Post has a new one – Shikaku. If the puzzle sounds uncannily like the ubiquitous logic-based game of numbers Sudoku, that’s because it’s by the same creator, Maki Kaji.

Launched yesterday in the City section, Shikaku – also known as “rectangles” – involves dividing a grid-like board into small rectangular or square boxes. Each box must contain a number that indicates the area of the box (detailed instructions at promotions.scmp.com/shikaku).

Beginners to this puzzle may start with a guess, but soon realise that the fun lies in searching for rectangles using logic.

Just like its more popular sibling, Shikaku uses only numbers,

rather than letters, like a crossword.

Anyone can solve and enjoy it.

“These puzzles speak the same language, because numbers are universal and can be understood by everyone no matter where they live,” says 61-year-old Kaji.

“My policy is that puzzles are entertainment. They should be relaxing rather than challenging or educational as such. Laughing and humour are important.”

Puzzles, he says, are a spa for the mind. “I don’t see the point of making such a difficult puzzle that nobody can solve or enjoy it. I have always desired to create a puzzle that can be enjoyed by many people around the world, so that they can have a break from daily stress.

This has been my company’s goal [from the outset].”

Nikoli, the company he founded in 1980, has about 30 employees and has churned out about 300 puzzles since Sudoku began in Japan in 1984. Though known as the Godfather of Sudoku, Kaji, a college dropout, acknowledges that he got the idea from a game called “Number Place” in a US puzzle magazine.

Ironically it’s not these brain games that the low-key Kaji credits for his good health; instead, he says his secret is smoking, drinking, and betting on racehorses. (Nikoli is named after the winner of the Irish 2,000 Guineas in 1980.)

But Kaji’s puzzles are undoubtedly helping many preserve their mental sharpness. Sudoku alone appears in more than 600 newspapers, on thousands of

I have always desired to create a puzzle so that people can have a break from daily stress MAKI KAJI (BELOW), CREATOR OF SUDOKU AND SHIKAKU

Photo: Nora Tam

websites and in dozens of books in more than 70 countries, played by people aged five to 90.

Many studies have shown the link between such mentally stimulating activities and halting the advancement of dementia.

One study, published in Neurology in August 2009, tracked nearly 500 people aged 75 to 85 who did not have dementia at the start of the study for an average of five years.

It was found that for every brain activity a person participated in – reading, writing, doing crosswords, playing board or card games, having group discussions, or playing music – the onset of rapid memory loss was delayed by 0.18 years.

Another study published last November in BMC Medicine observed dementia patients from five nursing homes in Germany.

Half acted as a control group, while the other half were put through a regime of mental and behavioural exercises that included games (bowling, croquet, balancing exercise), puzzles, “daily living” activities (preparing snacks, gardening, crafts) and a “spiritual element”.

After 12 months of therapy, the group maintained their level on the Alzheimer’s Disease Assessment Scale and their ability to carry out activities of daily living, while the control group all showed a decrease in cognitive and functional ability.

Dementia is a degenerative condition that can progress fast or slowly, and has a variety of causes.

Symptoms include confusion, loss of memory, and problems with speech and understanding. The condition can be unpleasant for both the sufferers and their families.

With the brain, it’s use it or lose it.

And it’s never too late to start.

6 COVER STORY

Potent advice It’s just as important for men as it is for women to keep healthy when trying to conceive, writes Angela Baura

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Yoad Reiter with his wife, Karin, and their second child, Rio

een to father a second child, Stewart Hinds hung up his dancing shoes and turned his back on Hong Kong’s partying scene. Hinds reduced his consumption of alcohol, and his wife quit smoking. “The idea was to give the potential embryo and fetus the best possible environment for starting out,” says Hinds, 34. The couple are expecting their second child in September.

Hinds (whose name has been changed for reasons of patient confidentiality) is one of a growing number of men who recognise their role in creating a healthy baby requires more than the simple act of sexual intercourse. As women meticulously calculate their ovulation dates and clean up their diets, men are embarking on detox diets and fitness regimes to get their sperm in good working order.

“Previously, men did not appreciate their role in conceiving children; however, attitudes are now changing,” says Dr Patrick Chan, specialist in obstetrics and gynaecology at Matilda International Hospital. “A man needs to be able to produce healthy sperm and the sperm must be able to reach and fertilise the egg.”

Male factors alone contribute to 30 per cent of all “subfertility” cases, says the Family Planning Association of Hong Kong, which served more than 2,500 clients in 2010. Female factors contribute another 30 per cent, and the remaining is a result of either joint or unknown problems.

A number of factors can affect the production and transport of sperm. Medical conditions include undescended testes, varicose vein in the scrotum, damage of the genital tract from previous infection or operation,

history of prostate infection, erectile or ejaculatory problems, and mumps orchitis in childhood.

Lifestyle choices such as smoking, drinking or exposure to chemicals can also make a difference. Daily exposure to bisphenol A (BPA) – sources include epoxy resin-lined food cans and hard polycarbonate plastics – caused lower sperm counts and testosterone levels in mice, a study last year from Banaras Hindu University in Varanasi, India, showed. Researchers from Queen’s University in Kingston, Canada, also

found that frequent cellphone use among men was associated with lower levels of luteinising hormone, an important reproductive hormone secreted by the pituitary gland.

Chan advises men to avoid excessive alcohol intake and smoking months before trying for a baby. “For each ejaculation, the sperm is in production for the previous one to two months,” he says. He also suggests men steer clear of hot tubs, saunas and prolonged bike rides to avoid raising the temperature around the scrotum and impairing sperm as a result.

COVER STORY 7

30

Illustration: Henry Wong

• The percentage that male factors contribute to “sub-fertility” cases, according to the Family Planning Association of Hong Kong

A poor diet can also lead to the destruction of healthy sperm. Chan says obesity or being underweight impair sperm quality. A diet high in saturated fats has also been linked with reduced semen quality, in a recent study by the European Society of Human Reproduction and Embryology. In the study of 99 men in the US, those in the third with the highest fat intake had a 43 per cent lower total sperm count and 38 per cent lower sperm concentration than men in the third with the lowest fat intake.

Consuming marine fish such as

Previously, men did not appreciate their role in conceiving children, however attitudes are now changing DR PATRICK CHAN, OBSTETRICS AND GYNAECOLOGY SPECIALIST, MATILDA INTERNATIONAL HOSPITAL

salmon and tuna – excellent sources of a certain omega-3 fatty acid called docosahexaenoic acid (DHA) – might help. University of Illinois researchers, in a study published recently in Biology of Reproduction, found that DHA is essential in constructing the arch that turns a round, immature sperm cell into a pointy-headed super swimmer with an extra-long tail. This arch, called the acrosome, houses, organises, and concentrates a variety of enzymes that sperms use to penetrate an egg, says study author Manabu Nakamura.

While Yoad Reiter, 35, has always maintained a healthy lifestyle, he appreciates that life as an investment banker can take its toll on his body.

“With extremely long hours, plenty of travelling, a highly stressed environment, topped up with wining and dining, keeping fit and healthy becomes tough,” he says.

Prior to the conception of his second child, now two months old, he engaged in more sporting activities, embarked on a detox diet refraining from alcohol, coffee and meat, and took multivitamin supplements. “I was confident that this contributed to having strong healthy sperm.”

He had plenty of encouragement from his wife, Karin Graubard Reiter, a medical nutritionist and founder of Nutritious N’ Delicious. Having previously worked in an IVF clinic in Sydney, she is an advocate of healthy eating when a couple is trying to conceive. “A man’s sperm is as fit as he is. As he becomes fitter they perk up and become more businesslike. The better his nutritional status, the healthier his sperm is and the more easily a woman can conceive,” she says.

Karin advises couples to opt for fresh, local, seasonal and organic produce, eliminate processed and junk foods, review medical drugs, and take supplements of zinc, folic acid, calcium, selenium, vitamin C, D, and E, with the advice of a doctor.

Parental age affects a couple’s ability to bear children. Research findings suggest men have a biological clock that starts ticking at the age of 35. Recent studies show an increased likelihood of autism, schizophrenia, bipolarity, epilepsy, prostate cancer and breast cancer, as well as a reduced level of intelligence, in children born to men approaching 40.

Research published in the journal Nature Genetics found that Apert syndrome, a disorder

characterised by malformations of the skull, face, hands and feet, is caused exclusively by advanced paternal age.

While Chan says that there is no conclusive evidence to link paternal age to specific problems in children, he adds that “we do know that sperm quality is affected, and chromosome abnormalities are increased with age. This could lead to reduced fertility, abnormal embryos, miscarriages, and abnormal fetuses.”

Although one would assume that non-stop sex would be the key to conception, it seems that too much sex also needs to be added to the long list of what not to do when trying for a baby. The Family Planning Association warns: “Too frequent sexual intercourse, say, once every night, may result in a decrease in the number of sperm in semen. Too infrequent sexual intercourse, say, less than once per week, may lower the motility of sperm.”

Chan says: “As sperm live inside a woman’s body for two days, sexual intercourse every second day around the time that a woman is ovulating would suffice.”

Trying to conceive can lead to an inordinate amount of stress on a couple – and stress can also result in reduced sperm count, according to Charlotte Douglas, a yoga instructor and homeopath who advocates yoga and meditation to maintain a healthy mind. “We live in an increasingly toxic and stressful world and so doing everything possible to keep this to a minimum will ultimately aid healthy fertility,” she says.

Chan says that “while the definition of infertility or sub-fertility is the inability to conceive after 12 months of regular intercourse, a couple can consult a doctor after six months to make sure that they are doing the right thing.” healthpost@scmp.com

8 HEALTH

TRADITIONAL CHINESE MEDICINE

Breathing room ......................................................

Elizabeth Snouffer healthpost@scmp.com

Dr Yuen Lai-ping, who spent a few years in a Taoist monastery as a young girl, leads a class in Happy Valley. Photo: Thomas Yau

A nine-month study of qigong announced recently may give Hong Kong cancer patients, their families and oncologists a new way to improve their quality of life.

The study, “Walking Hand-in-Hand – a Qigong Efficacy Study for Cancer Patients and Caregivers”, is a collaboration between the University of Hong Kong’s Centre on Behavioural Health, the International Association for Health and Yangsheng, and the Hong Kong Anti-cancer Society (HKACS). It will help practitioners of traditional Chinese medicine and Western physicians better understand how qigong might effect recovery for the chronically or terminally ill.

Study participants come from HKACS’ Walking Hand-in-Hand Jessie and Thomas Tam Cancer Family Support Programme, which aims to help cancer patients and their families cope with difficulties such as treatment side effects and emotional stress.

In one of the Centre on Behavioural Health’s more recent studies, researchers found that qigong improved the physical and

Before, I was alone and isolated; now people in my qigong class call me to make sure I’m OK YANN CHEUNG, QIGONG STUDENT

mental fatigue levels of patients suffering from chronic fatigue syndrome and depression, and have used the results of that study as the basis for the new study.

Qigong involves rhythmic breathing co-ordinated with slow repetitive movement, a calm state of mind, and visualisation of guiding the qi through the body. Combined with healthy diet and habits, qigong can help patients achieve an improved state of well-being.

Professor Jonathan Sham Shun-tong, honorary clinical professor at HKU’s clinical oncology department and one of the experts in the “Walking Hand in Hand” study, suggests the use of qigong to about one-third of his patients.

Some 80 per cent to 90 per cent of his patients use TCM, as many are troubled by the side effects of Western medicines.

Sham is reluctant to make any grand claims, however. “It is not possible to discern with 100 per cent certainty the effect of qigong from the effects of various treatment combinations, but the general feeling is that these patients have better quality of life and more confidence in their own health and tumour control.”

Dr Yuen Lai-ping, chairwoman of the International Association for Health and Yangsheng, will lead the qigong classes for the study. She has designed Wuxing pinghenggong, a sequence of 10 movements that is said to suit the needs of modern life.

Yuen was separated from her family as a young girl and sent to a Taoist monastery in Shaanxi to live for a few years. While there, she learned from the priests who practised qigong every day.

“I would wake up at 5am and walk with the priests to find herbs and then meditate.”

After she graduated from school, she attended the Beijing University of Chinese Medicine and has been practising Chinese medicine in Hong Kong for more than 15 years. She believes that the internal nourishment of qigong helps people who suffer from chronic conditions such as

cancer, stroke, depression and immunological disorders.

Last year, Yuen oversaw qigong treatment of 72 women, aged 23 to 52, who reported symptoms of chronic fatigue in a study facilitated by the Centre on Behavioural Health. Professor Cecilia Chan, associate dean of HKU’s faculty of social sciences, led the research and found that, compared with the control group, “qigong learners experienced a reduction in physical and mental fatigue, and the effect may have lasted for three months after the class”.

Ng Lai-ling, a nurse in her 40s, suffered from chronic fatigue for five years until she begin taking qigong with Yuen. “It was the only way to save myself because I tried everything. I was in a severe state.

I was exhausted all the time.”

After a month of qigong study classes three to four times a week, Ng felt more energetic and was sleeping better. “Now, I can manage the shifts, and I feel in a state of well-being. I even taught my 80-year-old mother qigong so we can do it together,” she says.

For Yann Cheung, 39, who suffers from chronic pain and depression, matters were more desperate. “I couldn’t leave the house or even go to the bathroom alone. The chronic pain and fatigue were so bad, I wanted to kill myself.”

After nearly one year of qigong with Yuen, Cheung has stopped nearly all her pain medication and is sleeping through the night. “I feel great, and even though I still have some pain, I have made many friends. Before, I was alone and isolated; now people in my qigong class call me to make sure I’m OK.” According to Professor Richard Fielding, clinical psychologist at HKU’s School of Public Health, chronic fatigue syndrome is a rather ill-defined condition, which is probably “conflated with depression, as chronic fatigue is also a presenting symptom of depression”. Fielding has also observed that, while chronic fatigue is common, it may have many causes: overwork and poor sleep quality are the most likely cause in Hong Kong.

The term “qigong” is sometimes confused with “tai chi” or “neigong”.

Christel Wilk, founder of the Tian Yan Nei Gong Centre in Central, says choosing one over another should be based on what “a person feels drawn to for their healing”, as all three closely related art forms have physical components that cultivate balance or qi, yin and yang and the five elements – all cornerstones of traditional Chinese medicine’s 5,000-year history.

DIET 9

NUTRITION STEVIA

Sweetness and lite ......................................................

Audrey Lo healthpost@scmp.com Sugar has been called the sweet poison because of its negative effects on the body and the fact that it is hard to resist. To satisfy one’s sweet tooth while reducing the amount of sugar in foods, there’s been a relentless search for sugar substitutes that are natural, non-caloric and healthier.

The sweetener of the moment seems to be stevia.

According to the latest report by Zenith International, a world leading food and drink consultancy, the worldwide stevia market will reach nearly US$1 billion by 2014. This is up 31 per cent from the estimated US$763 million in 2010. The World Health Organisation (WHO) estimates stevia intake could eventually replace 20 to 30 per cent of all dietary sweeteners.

The market is being driven by such major corporations as CocaCola and PepsiCo, as consumers worldwide are demanding that zero-calorie products be all natural.

In the past four years, more than 600 products sweetened with stevia have been launched. With the European Union’s approval for its use as a sweetener in December, a flood of products is anticipated.

Formerly banned in Hong Kong, steviol glycosides (commonly known as stevia) gained official approval in 2010

It is stable, noncalorific and it maintains good dental health by reducing sugar intake PROFESSOR JAN GEUNS, UNIVERSITY OF LEUVEN, BELGIUM

after the Joint Food and Agriculture Organisation/WHO Expert Committee on Food Additives evaluated and determined its safety in June 2008. An acceptable daily intake has been set of up to 4mg per kilogram of body weight.

According to the Centre for Food Safety, steviol glycosides are natural constituents of the Stevia rebaudiana (Bertoni) plant, a native to South America but now also grown in several Asian countries. Leaves of this plant contain at least 10 different steviol glycosides (a mixture of compounds in which steviol is bound to different types of sugar), with major ones being stevioside and rebaudioside A. Stevia is about 200 to 300 times sweeter than sucrose (table sugar) and contains no calories. As a sweetener or dietary supplement (daily intake estimated to be below 200mg), there are many advantages of stevia, according

to Professor Jan Geuns of the University of Leuven in Belgium, who has researched the plant since 1993.

“It is stable, non-calorific and it maintains good dental health by reducing the intake of sugar. It opens the possibility for use by diabetic and phenylketonuria patients, Candida patients and obese persons,” says Geuns.

“These low doses possess only sweetening properties without pharmacological effects.”

For about four centuries, the leaves of the stevia plant have been used by indigenous Guarani Indians in Paraguay to sweeten food, drinks and medicine. Japan started using stevia as a substitute for cane sugar in 1970, but the sweetener was viewed unfavourably elsewhere in the world because it lacked critical scientific research and had discrepancies in studies with respect to possible toxicological effects.

Since 1995, powdered stevia leaves and refined extracts from the leaves have been used as a dietary supplement in the US. But it wasn’t until 2008 that the US Food and Drug Administration recognised the safety of rebaudioside A, a steviol glycoside, for use in food and drinks.

Consuming sugar substitutes, such as stevia or aspartame, instead of sugar has been shown to reduce caloric intake and prevent overeating. The study, published in

the August 2010 journal Appetite, gave both healthy and overweight adult participants a pre-meal (before lunch or dinner) containing either sucrose, aspartame or stevia.

Those who received the stevia or aspartame consumed fewer calories overall, did not overeat at those meals, and did not report increased feelings of hunger.

“Although the totality of the scientific evidence demonstrates that low-calorie sweeteners and the products that contain them are not related to weight gain, increased hunger or overeating, there have been recent reports questioning the benefits of low-calorie sweeteners,” says Beth Hubrich, a dietitian with the Calorie Control Council, an international trade association. “When used as part of an overall healthy diet, low-calorie sweeteners and light products can be beneficial tools in helping people control caloric intake and weight.”

Not only a potent weapon against obesity, stevia is also believed to be helpful in the management of type 2 diabetes.

Research has demonstrated that oral intake of stevioside, a steviol glycoside, causes a clear-cut reduction of the blood glucose level after a test meal.

Still other studies have shown stevia’s potential in reducing cholesterol levels, and lowering blood pressure of hypertensive patients with normal blood glucose levels. However, the safety

of the herb is not yet completely determined. It’s believed that stevia is safe for mild to moderate use, but the pharmacological effects of increased or long-term use have not been studied.

The Centre for Food Safety advises to maintain a balanced diet to avoid excessive exposure to certain food additives, including sweeteners. Always seek advice from medical professionals over the use of sweeteners if you have a personal or medical concern.

SUGAR ALTERNATIVES Permitted sweeteners in HK 1. Acesulfame potassium 2. Alitame 3. Aspartame 4. Aspartame – acesulfame salt 5. Cyclamic acid (and sodium, potassium, calcium salts) 6. Saccharin (and sodium, potassium, calcium salts) 7. Sucralose 8. Thaumatin 9. Neotame 10. Steviol glycosides There are no maximum permissible levels set for these permitted sweeteners. According to the Centre for Food Safety, the quantity of the permitted sweeteners to be used in foods is to be in accordance with good manufacturing practices.

(Source: Centre for Food Safety)

Stevia seems a good natural sweetener, but the effects of long-term use are unknown

10 WELL-BEING

FIT AND FAB

Tough to get toned ....................................................... “grumpy” when she hasn’t P. Ramakrishnan rama.p@scmp.com

Alexa Towersey, wearing a tracksuit and ponytail at the crossroads of Hollywood Road and Lyndhurst Terrace in Central, looks like any one of the tourists ambling about.

That is, until her track top is lifted.

There doesn’t seem to be an ounce of fat on her well-defined abs. Surely this body was built after a lifetime in the gym.

“No, I was teased for being too skinny through intermediate and high school. My nickname was Alexa Anorexa,” says the fitness expert. “So, in contrast to a lot of people, I started going to the gym to get bigger and put on some muscle.”

She was a runner at school. “I was far too polite to win, though. My mum told me I said ‘excuse me’ when I had to pass the other children on the track.”

Then she tried soccer, netball and skiing, but her true passion was riding horses. On most weekends, she was up at dawn, competing in various events around New Zealand.

These days, however, weight training has become a love affair.

Like most gym-goers, she gets really

I was sick and even injured. Recovery is just as important to getting results as training.

trained for a while. But she swears her body is the result of smart, not long, hours at the gym.

“Doing crazy hours in the gym is how you get injuries, not results.”

Is there a weakness anywhere in your regimen?

Swimming is not really my forte, and has been a humbling experience for me. I have progressed from hating it, to disliking it, to enjoying it on the odd occasion – “odd” being the operative word there.

What are you doing differently?

Honestly, it’s something as simple as having a goal. I started triathlons 15 months ago, and set myself a huge goal of getting to a World Championships of some sort. I’ve managed to qualify for this year’s Ironman World Championship 70.3 in Las Vegas [a triathlon race consisting of a 1.9-kilometre swim, 90-kilometre bicycle ride and a 21-kilometre run].

That’s my goal.

Are you determined every day to reach that goal?

Don’t get me wrong, I don’t wake up every day excited about having to train. There are days when the worklife balance is overwhelming and I’m tired and irritable, and it’s hard to find the motivation. But I do it. It’s just a choice I make. That said, the most important thing I have learned in the past six months is to listen to my body. I used to train through thick and thin, on no sleep, when

What’s the secret to rock-hard abs?

I don’t do traditional sit-ups – never have, never will. It’s just not my thing.

My core strength comes from a background in heavy weights, and when I’m eating well, you can see the definition, which is always a bonus.

To see abs, you need to have low body fat. To lose fat, you need to gain lean muscle, and you can only do that when you train and eat for your body type.

Alexa Towersey. “I didn’t walk into a gym and transform overnight.”

Photo: Sabrina Sikora

How much weight training do you do?

I enjoy lifting heavy weights, and my body responds really well to this type of training. One of my pet peeves is that there is a huge stigma attached to women and weights.

Girls shouldn’t be afraid to do weights. I know I’m not everyone’s

ideal body type, and a lot of girls are intimidated by how much muscle mass I have, but you have to put this into perspective. I have spent a good proportion of my life doing this. I didn’t walk into a gym and transform overnight. Most women don’t have the hormonal profile to be able to develop this much. And it takes time and dedication on so many levels.

What’s your diet like?

I think people really underestimate how important good nutrition is.

You can train as much as you like, but unless you’re a genetic freak, if you don’t eat right, you won’t get the results you want. I’m definitely not into deprivation, I like clean, green and lean. Clean and organic fruit and vegetables where I can, Brussels sprouts, lean white meats, and fish. I tend to avoid gluten and dairy – that cuts out a lot of processed foods – and I don’t drink any more.

What do you indulge in?

My one weakness is Cadbury’s Creme Eggs. I once ate 18 in a row, then had to give the last six away, not because I felt sick, but because I felt guilty.

EAT SMART

Wrapped in fusion for a nourishing snack ......................................................

Jeanette Wang jeanette.wang@scmp.com What do you get when you cross a chicken burrito with a Vietnamese rice paper roll? This recipe for fragrant wild rice, crisp veggies and poached chicken in a translucent wrapper. Contributed by New Life Restaurant in Shek Kip Mei, it’s another example of Hongkongers’ penchant for fusion dishes.

But unlike most local favourites, this dish is actually healthy.

Each serving (11⁄2 rolls) has approximately 281 calories, 12 grams of fat, 34 grams of carbohydrates and 13 grams of protein. The vegetables and wild rice are also rich in dietary fibre, says Ivy Ng,

president of the Hong Kong Nutrition Association.

Chicken roll with assorted wild rice Serves 2 50 grams assorted wild rice ⁄2 carrot, shredded 1 ⁄6 cucumber, shredded 1 shallot, sliced 2 tbsp peanuts 1 stalk spring onion 2 tsp canola oil 50 grams skinless chicken 3 sheets Vietnamese spring roll sheet 3 tsp water 6 pieces Chinese lettuce 20 grams mung bean sprouts 9 basil leaves A few sprigs of mint and flowering Chinese chives for garnish (optional) 1

• Cook rice according to instructions on package.

• Roast peanuts and sliced shallots until aromatic.

• Crush peanuts.

• Dice spring onion, then pour heated canola oil over it.

• Set everything aside.

• Cook chicken in boiling water.

• Cut into strips and set aside.

• Soften spring roll sheets with water.

• Place 2 pieces of lettuce on the sheet, then evenly place rice and the rest of the ingredients on top.

• Roll up and trim the ends.

• Cut the roll in half.

• Make two more rolls.

• Serve with sour and spicy sauce.

Garnish with mint and flowering Chinese chives if desired.

For the sour and spicy sauce 1 clove garlic, minced 1 chilli, minced Juice of 2 limes 1 tsp rice vinegar 1 tsp sugar 1 ⁄5 tsp salt 3 tsp boiled water

• Combine all the ingredients and mix thoroughly.

Recipe provided by the Health Department as part of its EatSmart@restaurant.hk campaign.

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

WELL-BEING 11 THE TASTE TEST PEANUT BUTTER BARS ......................................................

Jeanette Wang jeanette.wang@scmp.com Gnu Foods Flavor & Fiber Peanut Butter Bar HK$24 for 45 grams, Just Green This does contain a lot of fibre – a whopping 12 grams, or nearly half your daily need – per bar, but the flavour is sadly lacking. However, if you can get past the taste, it’s a nutritious 140-calorie snack made with six whole grains and sweetened by 100 per cent fruit juice.

Verdict: neither “chewy” nor “delicious” as claimed.

Rob Lilwall faces fresh challenges as he and his expedition partner temporarily go their separate ways. Photo: Rob Lilwall

WALKING HOME

Divide and concur ......................................................

Rob Lilwall healthpost@scmp.com Is it better to go on an adventurous journey alone, or in a team? There are pros and cons to both.

On my current 5,000 kilometre Walking Home From Mongolia expedition, I have been with my cameraman and friend, Leon McCarron, the entire way – until very recently. Besides the obvious advantage of Leon being able to film our adventures professionally, we have also had the peace of mind of knowing we are not alone and have had a companion to talk to in English.

However, after five months of walking all day together, sleeping in the same room, sitting at the same table (or the same bank of roadside grass) to eat, we recently decided to split up for a short, 600 kilometre section of the expedition. This was not because we had become deadly enemies – though, understandably, we have plenty of mutual petty annoyances (we get through these by trying to be man enough to apologise as quickly as possible after annoying each other).

Rather, we decided to split up mainly because we were feeling so claustrophobic from this huge amount of time together, and we were also jaded from so much time on the road. We felt that splitting up

would be the best way to inject some new life into things.

So how has it been, walking alone? I have to admit I have felt a renewed buzz about the adventure, and have a new spring in my step.

Suddenly, I am not able to rely on Leon for map reading and he has taken the expedition’s only smartphone, so I am having to use inaccurate Chinese maps.

This means I not only have to ask for directions far more often, but – because of my propensity to take non-existent paths on shortcuts through the mountains – I am also far more likely to get lost. However, it is nice to know that if I do get lost, while I may have to flounder around (and perhaps feel scared) for hours on a misty, muddy mountain track, I will not have to feel guilty about making Leon walk those extra miles.

On the days when I am on a nice easy road, the hours pass quite differently to when I am with Leon. No longer do they go by quickly in conversation in English.

For much of the time, I am left to myself to just think (I really appreciate such thinking time – there is so little of it in normal life), or pray, or listen to my iPod (I try to alternate between music, ChinesePod, and audiobooks).

As a solo walker, my experience of other people has also been different. I am more likely to be invited into village homes – perhaps

We felt that splitting up would be the best way to inject some new life into the expedition because as a single traveller I am less like a tourist, and more like a solitary, nomadic dude.

On the downside, I have to do all the talking, which can be exhausting. For example, when I pass through villages, or a passing farmer stops for a chat, I will often have an extremely similar conversation with them. They will ask where I am from, what I am doing and why, why I don’t take a car or bus, how old I am, and so on.

The Hong Kong-based hiker and travel writer Bill Purves, on his own walk through China some 14 years ago, described this almost identical round of questions and answers as “reciting his catechism”, which I think captures the experience pretty well. When I was with Leon, we would take turns reciting our catechism, but now I have to answer everyone myself.

On a practical level, my pack is heavier now, because Leon and I

both have to carry full camera and production gear (on top of clothes, sleeping bag, and so on). And selffilming is decidedly more tricky.

The other day, after I had been kindly hosted for the night by a little village community buried in the mountains, I set up my tripod and filmed myself saying goodbye to them. Then I turned the tripod to show myself waving to them and walking away on the muddy track.

As I set off walking, the whole household started pointing at the camera and shouting at me that I had forgotten it.

So, such self-filming challenges add to the workload, but also to the interest and challenge of being alone.

Leon and I plan to meet up again in Guilin later this week.

Then we will have just four weeks of walking as a team, until I return to the bustle of Hong Kong, whereupon the routine of my life as a walker will suddenly seem very distant.

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

Think Thin Creamy Peanut Butter HK$24 for 60 grams, Nature’s Village Take the claim that “managing your weight never tasted so good” with a pinch of salt – this high-protein bar is pure function over flavour. It has the texture of a dense cake and an artificial, processed taste.

Verdict: good if you’re a protein junkie (each bar has 20 grams) – but why not a juicy, tender piece of chicken instead?

Probar Sweet & Savory Cocoa Pistachio HK$35 for 85 grams, Just Green This is pricey because it’s a meal in itself: each bar packs 390 calories, 22 grams of fat, 42 grams of carbs and 11 grams of protein. Organic oats and peanut butter form the base of the bar, which also contains dates, raisins and a mixture of seeds, nuts and chunks of rich, dark chocolate for an indulgent treat.

Verdict: tastes far better than it looks – dense, moist and a good blend of flavours.