YOUR GUIDE TO LIVING WELL
TUESDAY, MAY 8, 2012
HEALTH POST In a nutshell The humble coconut is back in favour with the health-conscious >PAGE 6
BUTEYKO – DON’T WASTE YOUR BREATH >PAGE 9
WHY YOU SHOULD PLEASE YOURSELF >PAGE 12
2 NEWS APP OF THE WEEK
HEALTH BITES
Let shine the rhythm of life
...................................................... Jeanette Wang jeanette.wang@scmp.com
...................................................... Katie McGregor healthpost@scmp.com
Better late than never It’s never too late to start exercising – even for heart failure patients – according to new research published in Circulation, an American Heart Association journal. The study found that heart failure patients who exercised had less muscle-wasting, increased strength and reduced inflammation. Sixty heart failure patients and 60 healthy volunteers, aged either 55 years and younger or 65 years and older, were randomly assigned to four weeks of supervised aerobic training or no exercise. In both age groups, exercise was linked with increased muscle force endurance and oxygen uptake. Heart failure patients 55 and under increased their peak oxygen uptake by 25 per cent, while those 65 and over increased it by 27 per cent. In both young and old patients, exercise also reduced muscle breakdown and inflammation, and increased leg muscle strength. Muscle size was unaffected.
Life Biorhythm Free Rating 2/10 Have you ever noticed how some days you have abundant energy and on other days you feel like a slug? On making this observation after a particularly – and unusually – energetic run, my running partner claimed it was down to biorhythms. Paying attention to one’s biorhythms, I was told, can ensure you exercise at the optimal time, and take it easy when your biorhythms are at the downward part of their cycle. The concept extends to your intellectual and emotional state. It sounded like nonsense to me, but my running partner is very no-nonsense, and we all know that jet lag – which apparently is a disruption of your biorhythm – is very real. So I downloaded Life Biorhythm to explore. This is one of the most basic apps reviewed; it simply comprises a daily chart, but the benefit is that the data is on your iPhone for convenient consultation. We are told that our emotional, mental and physical strength cycles between a negative and positive state, with a 23-day physical cycle, a 28-day emotional cycle, and a 33-day intellectual cycle. This means that on any particular day, your emotions are likely to be at odds with your mental acuity, or perhaps in harmony with your physical prowess. And that is why you need the chart. So for a week I tracked my physical, emotional and intellectual state, and compared it to the biorhythm chart. No match.
However, there was a good match to my diet, sleep schedule, alcohol consumption – and the weather. And that is probably closer to the truth. Many athletes swear by using biorhythm charts to decide when to train and rest, but research generally does not support such beliefs. In fact, the field of biorhythmics is considered a pseudoscience by conventional medicine. Much research has been done on circadian rhythms, which are the internal wake/sleep rhythm, and how disruption of this cycle is bad for us. Consider jet lag, shift workers, insomniacs and sufferers of seasonal affective disorder. We need the sun to keep our circadian rhythm on track – and without apps to guide us. All I know is that sunshine lifts my spirits, gives me energy and perhaps even makes me smarter.
ASK THE DOCTORS DR LIM LI LING Q: I often feel sleepy right after lunch. How can I combat this? A: Sleepiness in the mid-afternoon is physiological, which means it’s normal to have a dip in alertness because of the circadian clock in our brain, which
dictates when we feel sleepiest. Feeling sleepy after lunch can be normal, but if the sleepiness is so strong that you need to take a nap, this usually means that you are sleep deprived. The combined effect of the natural “mid-afternoon dip” in alertness together with lack of sleep leads to excessive daytime sleepiness. This can be combated by getting enough sleep on a regular basis. A shortterm fix is to drink a caffeinated beverage to boost alertness, though this is discouraged in the long term. Getting enough sleep on a regular basis is important for physical and emotional well-being. Dr Lim Li Ling is a neurologist with 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
Right pace at the right time It seems jogging has something in common with alcohol – regular and moderate amounts can reduce mortality compared to non-joggers or those who do extreme levels of exercise. The latest data from the Copenhagen City Heart Study shows that regular jogging increases life expectancy of men by 6.2 years and women by 5.6 years. A total of between one and 2½-hours a week, done over one to three sessions, delivers optimum benefits, especially when performed at a slow or average pace. “We can say with certainty that regular jogging increases longevity. The good news is that you don’t actually need to do that much to reap the benefits,” says Peter Schnohr, chief cardiologist of the study. The ideal pace, he says, is to feel a little, but not very, breathless.
The electrolyte cool-aid acid pest Sports and energy drinks could cause irreversible damage to your teeth. A recent study published in General Dentistry found that the acid in them erodes tooth enamel. Researchers examined the acidity levels of 13 sports drinks and nine energy drinks. Samples of tooth enamel were immersed in each for 15 minutes, followed by immersion in artificial saliva for two hours. This was repeated four times a day for five days. Damage to enamel was evident after five days of exposure to the drinks, with energy drinks found to cause twice as much damage. Damage to enamel is irreversible; without enamel, teeth become sensitive, prone to cavities, and more likely to decay. It’s advisable to chew sugar-free gum or rinse the mouth with water following consumption of these drinks.
Rethink on zinc A review of 17 trials concludes that the benefits of zinc are questionable. Published in the Canadian Medical Association Journal, the study covered 2,121 participants aged between one and 65. Compared with placebos, zinc significantly reduced the duration of cold symptoms, but the quality of evidence was moderate. Evidence was weak that people taking zinc were less likely to have symptoms after one week, and there was no difference in symptoms between the two groups at three days. While zinc appeared to reduce the duration of symptoms in adults, there was no apparent effect in children. Participants taking zinc were more likely to experience adverse effects including a bad taste in the mouth and nausea. “Until further evidence is available, there is only a weak rationale for physicians to recommend zinc for the treatment of the common cold,” writes coauthor Dr Michelle Science from The Hospital for Sick Children, Toronto.
NEWS 3 QUIZ ...................................................... Jeanette Wang jeanette.wang@scmp.com
The genetically altered juvenile zebrafish glow green when exposed to chemicals used in birth control pills, paints and plastics. Photo: Charles Mazel
POLLUTION
Fluorescent fish shed light on the impact of contaminants ...................................................... Russell McLendon What’s black and white but green all over? A genetically engineered zebrafish that’s helping scientists figure out how endocrine-disrupting pollutants damage the body. This zebrafish glows greenest in the parts of its body where the chemicals are most active. The pollutants in question are “oestrogenic compounds”, which chemically mimic the female hormone oestrogen. Previous studies have shown that these and other endocrine disruptors can wreak havoc on the reproductive system, whether they promote breast and testicular cancer in humans or cause male fish and frogs to switch genders. Described in the journal Environmental Health Perspectives, the green zebrafish were created by scientists at the University of Exeter and University College London. The results reveal that more organs and body parts react to environmental oestrogens than previously thought. “This is an exciting development in the international effort to understand the impact of oestrogenic chemicals on the environment and human health,” co-author Charles Tyler says. “This zebrafish gives us a more comprehensive view of the potential effects of these hormonedisrupting chemicals on the body.” The glowing fish are transgenic, meaning they have DNA from another organism artificially added to their genome. Such fluorescent zebrafish are not new – the company GloFish has sold them as pets for years, and scientists already use them to study health issues such as cell
disease and gene therapy. But the Exeter/UCL fish add a twist by glowing only in response to specific endocrine disruptors, which lets us see where the chemicals affect their bodies. The idea is that this will shed light on health effects in humans exposed to similar substances. The researchers tested their transgenic fish’s sensitivity to several chemicals that mimic oestrogen, including ethinyloestradiol (used in birth control and hormone replacement therapy), nonylphenol (used in paints and industrial detergents) and bisphenol-A, or BPA (used in many types of plastic). This eventually yielded a fish that was sensitive enough to give fluorescent green signals in the affected body parts. The fish were exposed to chemicals at levels found in local rivers, allowing researchers to watch in real time as specific organs and sections of tissue glowed green. These experiments unveiled both established and novel reactions to environmental oestrogens. Some affected the liver, for example, and BPA specifically showed signs of activity in the fish’s hearts. Other responses that weren’t previously known showed up in skeletal muscles, the eyes and even parts of the brain. “By being able to localise precisely where different environmental oestrogens act in the body, we will be able to more effectively target health effects analyses for these chemicals of concern,” Tyler says. “While it is still early days, we are confident that our zebrafish model can help us better understand the way the human body responds to these pollutants.” McClatchy-Tribune
BACTERIA
Clean and simple is best ...................................................... Menshealthmag.com We lead super-clean lives in which hand sanitisers and antibiotics are the answers to everything. But what if our war on germs was backfiring – and making us not only sicker but fatter? Follow these tips to stay on good terms with your germs. Skip antibacterial soaps The active ingredient, triclosan, has been linked to hormone disruption in animals and bacterial resistance to antibiotics. A University of Michigan study found that using plain soap prevented infectious illness just as effectively as using triclosan products did.
Nix antibiotic ointment for nicks Overuse of creams containing neomycin, a common antibiotic, may lead to resistant strains of MRSA, say researchers in Japan. Wash small wounds with soap and water, and use a bandage to prevent contamination by pathogens. Go with yogurt Yogurt with live Bifidobacterium promotes regularity and eases irritable bowel syndrome, studies suggest; other possible benefits are not proven. If yogurt makes you yak, pop a probiotic supplement: Align has the most effective strain, says a Northwestern University review. McClatchy-Tribune
There’s a tidal wave of myopia sweeping across Hong Kong and other East Asian countries, and the lack of time spent outdoors is thought to be a major cause. According to a new paper published in The Lancet, myopia, or short-sightedness, now affects between 80 and 90 per cent of school-leavers in major cities in East Asian countries such as China, Japan, Singapore and South Korea. Of these people, 10 to 20 per cent have “high” myopia, which can eventually lead to vision loss, visual impairment and even blindness. The paper’s main author, Professor Ian Morgan of the Australian Research Council Centre of Excellence in Vision Science at the Australian National University in Canberra, notes that while myopia had been thought to have a mainly
genetic basis, more recent evidence implicates environmental factors. For example, in Singapore, the three major ethnic groups (Chinese, Indian, Malay) have all seen sharp rises in myopia since 1996, suggesting similar sensitivity to the risk factors. Migrant studies have also been vital. Students of Chinese origin in Australia, for instance, show lower levels of myopia than those in urban centres in East and Southeast Asia. Epidemiological surveys have shown that increased amounts of time outdoors protect against the development of myopia. Trials are ongoing in Singapore and on the Chinese mainland to test the effect of increased outdoor exposure as a preventive measure. The authors say: “Even if successful prevention is possible, East Asia will still be faced, for the next 100 years, with adults at high risk of developing [high] myopia. More progress in our understanding of ... pathological myopia is thus essential,
and while there have been some promising developments in treatment, more effective treatments are still required.” How much do you know about myopia? Test yourself here. 1. A myopic person a. Can see distant objects clearly, but nearby objects appear blurred b. Can see nearby objects clearly, but distance objects appear blurred c. Cannot see either distant and nearby objects clearly 2. Which one of the following is not a complication of myopia? a. Retinal detachment b. Cataracts c. Glaucoma 3. Which of these is not a good habit when working on the computer? a. Keeping a working distance of about 50cm from the monitor b. Ensuring that all room lights are switched off c. Taking vision breaks of about three to five minutes after every 30 to 40 minutes of continuous close-up work 4. When should you go for an eye check-up? a. At least once a year if you are myopic b. When you want to buy a new pair of spectacles c. When images become blurred
Up to 90 per cent of young East Asian urban adults are myopic. Photo: Corbis
Answers:1. b; 2. None – all are complications of myopia; 3. b; 4. a & c
4 MEDICAL
Illustration: Angela Ho
CASE HISTORY
A lucky old puffer
...................................................... Eileen Aung-Thwin healthpost@scmp.com Every day for the past five decades, Jerry Wang, 71, would smoke 21⁄2 packs of cigarettes. Predictably, he racked up a host of health problems along the way: high blood pressure, gout, gastric reflux issues and other ailments. Despite these health concerns, Wang (whose name has been changed for patient confidentiality reasons) shrugged off pleas from loved ones over the years urging him to stub out. After all, he was still alive and kicking. What was the problem? The problem began as a crick in the neck. The pain plagued him for two months, and Wang finally consulted a doctor. The doctor ordered a chest X-ray. Although it shed no light on the cause of Wang’s neck pain, it did show up something unexpected: a 1cm lesion in the upper lobe of his right lung. Given Wang’s long history with cigarettes, the doctor was gravely concerned that the lesion was lung cancer, the No 1 cancer killer of men and women worldwide. Most cases of lung cancer are caused by smoking. According to Dr Lam Bing, director of the Respiratory Medicine Centre at Hong Kong Sanatorium and Hospital, about 4,000 new cases of lung cancer are diagnosed each year in Hong Kong, two-thirds of whom are men. There are about 3,500 deaths annually from lung cancer in the city. The cancer is so deadly because symptoms often don’t show in the early stages, when surgery can still cure it. By the time symptoms such as chest pains or prolonged cough surface, the cancer has already spread, making it inoperable and incurable. According to Lam, 80 per cent of lung cancer cases are diagnosed at a stage that is too late.
Wang’s example is typical of many cases in which the cancer is discovered incidentally as a result of a chest X-ray being taken for some other reason. Wang had a Computed Tomography (CT) scan, which offered a clearer look at the lesion, and a positron emission tomography (PET) scan, which highlights regions that have unusually high metabolic activity and helps doctors stage the disease. Cancer, infection and inflammation can all lead to metabolic “hot spots” in PET scans. The CT and PET scans confirmed the lesion in Wang’s right lung, but the PET scan showed something even more disturbing: a lymph node on the right side of his neck displayed mildly active metabolic activity. Wang’s doctor told him that the cancer had metastasised to the lymph node in his neck, meaning he had late-stage, terminal cancer. Wang was shocked. With death sentence and test results in hand, Wang sought out Lam for a second opinion. Reviewing Wang’s file, Lam was less certain of the terminal lung
A CT scan just tells you something is there but not what that something is. A PET scan tells you metabolic activity is raised, but not why it is raised DR LAM BING, RESPIRATORY MEDICINE CENTRE
cancer diagnosis. “A CT scan just tells you something is there but not what that something is,” says Lam. “A PET scan tells you metabolic activity is raised, but not why it is raised.” What’s more, Lam noted that the pattern of the suspected metastasis to the lymph node in the neck was inconsistent with the behaviour of the lymphatic system. If the cancer had spread to the lymphatic system, the lymph nodes closest to the site of the lesion should be affected first. “The lymphatic system is a bit like the MTR system,” says Lam. “It doesn’t make sense for the cancer to skip all the nearby stations and affect a lymph node so far away. The symptoms may not be related.” To investigate further, Lam proposed a bronchoscopy – a procedure in which a scope is passed down the airways to the site of the lesion to remove tissue for a biopsy. The tissue sample returned showing inflammation but not cancer. The result was inconclusive: they may have missed the lesion and instead obtained tissue around it.
Next, Lam needed to know more about the enlarged lymph node in Wang’s neck. He wanted to use ultrasound to investigate the lymph node and remove some fluid for analysis. But during the procedure, he could not find the enlarged lymph node – instead, he found a nodule on Wang’s thyroid. Nodules on the thyroid gland are common and require only monitoring. More importantly, it meant the issues in Wang’s neck and lung were unrelated. Therefore, the lesion in Wang’s lung was localised. Lam proposed removing the lesion to properly analyse it. To do so, he would need to remove the right upper lobe of Wang’s lung in a surgery called a lobectomy. If there was indeed cancer, this operation would effectively cure Wang in the process. Wang agreed. During surgery, the lesion was sent for frozen section, a procedure to rapidly analyse the tissue sample. It confirmed that Wang had non-small cell lung cancer, which makes up 80 per cent of all lung cancers. But it was only stage-one lung cancer, which has very high survival and cure rates once the lesion is removed. Three days later, Wang was discharged from hospital. Lam says: “The lesson to be learned here is that the tissue is the issue. Only pathologists can confirm a cancer diagnosis. Scan results alone are not conclusive.” After cheating death this time, Wang has wised up and quit the sticks. Lam often asks smokers to consider the price they want to pay for smoking. “Would you like to lose a lung, suffer a stroke or something else?” he asks. “It’s best to quit before you need to pay a heavy price.”
HEALTH 5 STOPPING SMOKING
At pains to make it plain ...................................................... Elaine Yau elaine.yau@scmp.com Smokers in Hong Kong might soon have trouble telling brands of cigarettes apart as the government toys with the idea of demanding plain packaging to combat tobacco consumption. Hong Kong is among about half a dozen jurisdictions that met recently to discuss the feasibility of such a move, says Judith Mackay, senior adviser with the World Lung Foundation. Mackay says she has been talking to the Hong Kong government about plain packaging for some time, although the government is “not quite ready to implement it”. “Many countries, including Hong Kong, are waiting to see what happens in Australia. We need a precedent before we go forward,” she says. On December 1, Australia will adopt the world’s first plain packaging legislation, which bans the use of the brand logo, symbols, other images or promotional text on tobacco products. The country is taking the lead in implementing Article 13 of the World Health Organisation (WHO) Framework Convention on Tobacco Control. This says “a comprehensive ban on
advertising, promotion and sponsorship would reduce the consumption of tobacco products”. Cigarettes will be sold in drab packages with graphic images of tobacco-related diseases and warnings that occupy 75 per cent of the area of the box. No trademark logos will be permitted on any packaging of tobacco products, although firms will be able to print their name and the brand in a small, prescribed font on the packets. “The smoking rate dropped from 30.5 per cent in 1998 to 15.1 per cent in 2010 in Australia, but we still expect 15,000 Australians to die from smoking every year,” says Jane Halton, secretary of Australia’s Department of Health and Ageing. Packaging, she says, is one of the last forms of tobacco advertising and must be removed. Her sentiments were echoed by authorities and experts at the 15th World Conference on Tobacco or Health in Singapore in March. The tobacco industry is fighting back. Australia has been sued by Hong Kong-based tobacco giant Philip Morris Asia, which alleges that plain packaging amounts to unlawful expropriation of the company’s investments and valuable intellectual property without compensation. Australia has also been sued in its
This indicates that big tobacco sees the writing on the wall. These are the death throes of the industry MARGARET CHAN, DIRECTOR GENERAL, W.H.O.
High Court by the tobacco industry. “The reaction from the industry is not surprising, but they are becoming more extreme and subversive,” says Halton. “We reject the claims filed by Philip Morris. Our arbitrators will hear the case.” Philip Morris moved its business from Australia to Hong Kong soon after the Australian government announced its decision on plain packaging in April 2010. Since the announcement, Halton says her department has received 53 “freedom of information requests” relating to plain packaging from the tobacco industry – a tactic aimed at slowing the bureaucracy down. “The requests are designed to ensure we are required to examine hundreds of files and tens of thousands of documents for
potential release. [The industry wants to] tie up funding and resources within my department to ensure we have less time to implement this law,” she says. “We will not be deterred by the threats and will fight this incredibly vigorously.” Uruguay, Norway and Turkey are also countering legal challenges from the tobacco industry regarding their tightened tobacco control measures. WHO director general Margaret Chan Fung Fu-chun says the chain of legal action taken by the tobacco industry shows its desperation. “I take it as an indication that big tobacco sees the writing on the wall,” she says. “These are the death throes of the industry.” Chan applauded Australia’s resolve in curbing tobacco consumption. “We must make plain packaging a big success so that it becomes the success of the world,” she says. Simon Chapman, professor in public health at the University of Sydney, says it’s ludicrous for the tobacco industry to take the Australian government to court – alleging the government is acquiring valuable intellectual property and using it to make money. A spokesman for the Hong Kong Health Department says it will
consider whether to adopt plain packaging legislation. In 1994, it became mandatory for cigarette packs sold in Hong Kong to carry written warnings. Graphic health warnings, which have to occupy half of a packet’s area, were introduced in 2007. Article 11 of WHO’s convention – which was enacted in 2005 and has 174 countries signed up so far – compels parties, within three years of joining the convention, to have tobacco product health warnings that cover at least 30 per cent (and preferably 50 per cent) of the visible area on a cigarette pack. Singapore, the first country in Asia to implement graphic health warnings on packets, will introduce a new set of health warnings that use gory and emotional images from next March. “What [the tobacco industry] wants to see is a domino effect,” says Chan. “When one country’s resolve falters under the pressure of costly, drawn-out litigation and threats of billion-dollar settlements, others with similar intentions are likely to topple as well.” Chan says no commercial interest should undermine public health measures to protect people. Article 5.3 of the WHO convention on tobacco control gives countries the space and legitimacy to take such actions.
6 COVER STORY
Nuts and
faults
Coconut water and oil are the new health food darlings. But with little research to back up their claimed benefits, consume with caution, writes Jeanette Wang
Clockwise from above: sorting dried coconuts in the Philippines; straining coconut milk in Tahiti; Vita Coco, a US drink that is becoming popular with sportsmen; coconut fat used in soap manufacture. Photos: Corbis, Koebe Ulrike
C
all it the Swiss Army knife of the plant kingdom. The coconut is a good source of calories and potable fluid, has fibre that can be spun into rope, and a hard shell that fuels fires. The whole nut can even act as a floatation device. A favourite among seafarers since ancient times, the fruit of the palm Cocos nucifera is being embraced by the health-conscious for two reasons: virgin coconut oil and coconut water. The former is said to do many things from boosting immunity to balancing hormones, while the latter is touted as a low-calorie beverage that hydrates better than sports drinks. In Hong Kong, these products are appearing on supermarket shelves along with foods that were previously perceived to be healthier, such as extra virgin olive oil and Gatorade. “We were the first to bring virgin coconut oil into the Hong Kong market in 2006,” says Denise Tam, product specialist at Jireh International Health, a health food importer in Aberdeen. “It was not only unknown, but frowned upon at that time. But with education, Hong Kong finally caught on to the wonder of the coconut. We have seen a great increase in demand and awareness of this oil, especially in the past two years.” Coconut oil had been demonised in the past by nutrition experts for its mega-dose of saturated fat, which raises blood cholesterol, clogs arteries and causes heart attacks. After a study in 1994, the Centre for Science in the Public Interest in the US warned consumers to avoid cinema popcorn – which, because it’s popped in coconut oil, contains as much saturated fat as six Big Macs. So, what has sparked the oil’s transformation from nutritional pariah to health food darling? Most studies involving coconut oil have been done with the partially hydrogenated version, according to Tom Brenna, a professor of nutritional sciences at Cornell University. Virgin coconut oil, which has not been chemically treated, is different. “Not all coconut oil is created
92 The percentage of saturated fat in virgin coconut oil compared with 64 per cent in butter
equal,” says Benita Perch, a naturopathic physician with the Integrated Medicine Institute in Central. The most prevalent coconut oil is produced from dried coconut meat, says Perch, who has a degree in nutrition. It’s refined, bleached and deodorised make it suitable for use. Sometimes, the coconut oil is hydrogenated, a process that keeps vegetable oil from rapidly going rancid, making it easier and more profitable to store and sell. But hydrogenation creates the trans fats that are linked with heart disease. It also destroys many good essential fatty acids and other positive components in the oil. “[Virgin coconut oil is produced] with the least amount of processing, so that the natural vitamin E, antioxidants and fresh coconut ‘essence’ are retained,” says Perch. “Fresh coconut meat is grated and expeller pressed to produce coconut milk. The coconut milk is then centrifuged using a proprietary process to separate the oil from the other components. This oil has a very light texture, and since no heat is applied, it retains all the flavour and scent of fresh coconut.” Virgin coconut oil still contains naturally saturated fats – about 92 per cent compared with 64 per cent in butter. But recent studies question whether these fats are as bad as previously thought. A series of articles published in the October 2010 issue of Lipids revealed recent advances in saturated fat and health research. “Although diets inordinately high in fat and saturated fat are associated with increased
COVER STORY 7
cardiovascular disease risk in some individuals, assuming that saturated fat at any intake level is harmful is an oversimplification and not supported by scientific evidence,” says researcher J. Bruce German, professor and chemist in the department of food science and technology, University of California at Davis. The main saturated fat in virgin coconut oil is lauric acid, a medium-chain fatty acid. According to Dr Melina Jampolis, a physician who specialises in nutrition, medium-chain fatty acids
I’ve been using virgin coconut oil for my cooking, baking, hair treatment, massage, and mosquito bite relief. It’s a miracle oil DENISE TAM, PRODUCT SPECIALIST
are quickly metabolised by the liver, so are less likely to be stored as body fat. Perch says virgin coconut oil can reduce the risk of heart disease, cancer and other ageing-related conditions. It helps prevent bacterial, viral and fungal infections due to its lauric and capric acid content; it boosts the immune system; helps with weight loss; and improves digestion and absorption of nutrients from food. Virgin coconut oil can replace butter and any type of vegetable oil in cooking. “There’s a distinct
coconut fragrance when you pour the oil into the pan, but the smell doesn’t stay on the food, so the food still tastes the way it should,” says Esther Tan, 30, a copywriter who cooks with the oil. “It’s a safer oil for high-temperature cooking.” Vegans, particularly, appreciate the oil as it’s a vegetable fat that solidifies at about 25 degrees Celsius – and so can create flaky or crumbly pastry and fluffy icing. It’s also ideal as a spread, mixing into rice, or simply eating straight off a spoon. Used topically, the oil is said to keep skin smooth and soft, help prevent acne, ageing and wrinkles, and treat damaged hair. “I’ve been using virgin coconut oil for my cooking, baking, hair treatment, massage, mosquito bite relief, and the list goes on,” says Jireh’s Tam. “It’s a miracle oil.” But while research is still scant, it’s perhaps prudent to stick to what dietitians recommend. Limit daily saturated fat intake to 10 per cent of total calories. In a 2,000 calorie diet, that’s 20 grams (each gram of fat has nine calories). The same goes for coconut water. Despite the marketing and hype, there is no evidence to support claims that it rehydrates better than sports drinks, says Dr Jason Lee Kaiwei, defence scientist at Singapore’s DSO National Laboratories and an adjunct assistant professor at the National University of Singapore’s School of Medicine. “Coconut water has a huge amount of potassium but lower sodium content than typical sports drinks. Evidence suggests its efficacy in rehydration is similar.” University of Memphis researchers put 12 exercise-trained men through 60 minutes of treadmill exercise on four occasions, each workout separated by at least five days. After each session, the men randomly received either bottled water, pure coconut water, coconut water from concentrate, or a sports drink. All tested beverages were found capable of promoting rehydration and supporting subsequent exercise. Little difference was noted between the four tested conditions with regard to markers of hydration or exercise performance in the men. Still, coconut water is a booming business. According to research
group New Nutrition Business, the market for the beverage grew 100 per cent last year, taking the combined retail sales value of the US and European markets to more than US$265 million. It is expected to grow about 50 per cent this year. The advantage of coconut water, according to the group’s research report, is that it connects to consumers’ desire for naturalness – the biggest trend in the food and beverage business worldwide. “It’s also been successful because it’s been marketed successfully,” says Jason Ing, co-founder of Hong Kong-based Jax Coco. Its coconut water will hit stores in a few months’ time – in special glass bottles. Morton Satin, who invented the coconut water bottling process that was patented in 2000 by the Food and Agriculture Organisation of the United Nations, calls the drink “the fluid of life”. Because coconut water contains the same five electrolytes found in human blood, it was used – siphoned directly from the nut – to give emergency plasma transfusions to wounded soldiers in the Pacific during the second world war. Two of the electrolytes, potassium and sodium, are the key ones lost through sweat during exercise, which is why coconut water is a hit with fitness buffs. Coconut water contains up to 15 times more potassium, but much less sodium, than the average sports drink. For example, a 250ml serving of Vita Coco coconut water – the brand used in the University of Memphis study – contains 515mg of potassium and 30mg of sodium; 250ml of Gatorade has 31mg of potassium and 115mg sodium. “It’s the perfect sports drink,” says former world champion triathlete Peter Robertson, 36, who’s been using coconut water for years. A 2009 study by Nanyang Technological University in Singapore found the water contains cytokinins, which have shown effects against ageing and cancer. So coconut water and virgin coconut oil do seem to have a lot going for them – but so did other health food trends that have come and gone. Consume in moderation and with caution. jeanette.wang@scmp.com
8 DIET Shrimp with coconut oil, ginger and coriander works better without using olive oil; sweet potatoes (below). Photos: NYT
NUTRITION COOKING WITH COCONUT OIL
Fragrant, with a gentle touch ...................................................... Melissa Clark My curiosity stirred with all the hype about coconut oil, I brought some home and experimented. I quickly learned that virgin coconut oil has a haunting, nutty, vanilla flavour. It’s even milder and richer tasting than butter, sweeter and lighter textured than lard, and without any of the bitterness you sometimes get in olive oil. Its natural sweetness shines in baked goods and sautés, and is particularly flavoursome paired with bitter greens, which soften and mellow under the oil’s gentle touch. And the saturated fat in coconut oil makes it a good choice in pastries, whether you avoid animal fats or simply want to pack a little more coconut flavour into that coconut cream pie. I found that virgin coconut oil has a deep coconut flavour that persists even after cooking. Refined coconut oil, which has a higher smoking temperature, lacks the same coconut depth, but supposedly works better for stir- and deep-frying. But in my recipe testing, the smoke point of
virgin coconut oil did not seem to be a problem. Melted and cooled, virgin coconut oil worked beautifully in my favourite olive oil pound cake. It yielded a loaf with a tight, golden crumb and gentle coconut fragrance that I enhanced with lime zest, almonds and fresh nutmeg. I also like coconut oil for sautéeing vegetables and aromatics, especially onions. They absorb the sweetness of the oil and pass that lovely nuance on to the whole dish. In one memorable meal, I sautéed scallions in coconut oil. That managed to gently perfume an entire pan of plump, juicy shrimp spiked with some garlic, ginger and a touch of coriander. I may never go back to olive oil for roasting sweet potatoes because coconut oil enhances their caramelised flavour and adds a coconut essence. But my favourite new way to use coconut oil is for popcorn. The oil brings out the nutty sweetness of the corn itself while adding a rich creamy sensation, without having to pour melted butter on the top. Here are two of the recipes that I tried out.
Sautéed shrimp with coconut oil, ginger and coriander Serves 2 to 3 Cooking time: 10 minutes 2½ tbsp refined coconut oil 6 spring onions, white parts thinly sliced; dark green parts sliced and reserved 1 tbsp finely chopped peeled ginger 2 garlic cloves, finely chopped ½ tsp ground coriander 450g large shrimp, shelled ½ tsp kosher salt 1 tsp fresh lemon juice ½ tsp ground black pepper lemon wedges, for serving • Heat a large skillet over a medium heat. • Melt the coconut oil in the pan. • Add the white spring onion slices, ginger and garlic. • Stir-fry until fragrant, about 30 seconds. • Add the coriander and cook for 30 seconds more. • Add the shrimp and salt, tossing occasionally, until shrimp are opaque, about two to three minutes. • Add the green spring onions and cook until wilted, 10 to 15 seconds. • Season with lemon juice and black pepper. • Serve with lemon wedges.
Coconut oil roasted sweet potatoes Serves 2 to 4 Cooking time: 75 minutes 1½ tbsp virgin coconut oil 800 grams sweet potatoes, peeled and cut into 1¼cm chunks 2 tsp light brown sugar, packed ¾ tsp kosher salt ¼ tsp ground black pepper ¼ tsp grated nutmeg
• Heat oven to 180 degrees Celsius. • Melt coconut oil in a small saucepan over low heat. • In a large bowl, toss together sweet potatoes, coconut oil, sugar, salt, pepper and nutmeg. • Spread potatoes in an even layer on a large baking sheet. • Roast, tossing occasionally, until soft and caramelised, about one hour. The New York Times
HEALTH 9 THERAPY
Easy does it: the shallow solution to a deep problem ...................................................... Nicole Chabot healthpost@scmp.com When you’re stressed, the usual advice is to stay calm and take deep breaths. But a breathing technique discovered half a century ago in Russia and now gaining popularity in Asia suggests otherwise. Shallow breathing is central to the Buteyko method, developed in 1952 by Dr Konstantin Pavlovich Buteyko. It’s mainly used as a drug-free alternative treatment for asthma, though anyone can benefit from it, says Jac Vidgen, a senior practitioner at Buteyko Breathing Asia, who has taught the method in the region for nearly two decades. In Hong Kong, he says, he’s worked with thousands of people over the past 14 years. “In the West, the idea is better known,” says Vidgen. “The BBC documentary Breathless and strong media coverage have helped.” The method is based on Buteyko’s concept that many chronic diseases – such as heart disease, diabetes and cancer – have their geneses in hyperventilation. Rapid, deep breaths are said to reduce the carbon dioxide content in the blood, affecting the cells and tissues of vital organs. Vidgen says sufferers of asthma, emphysema, sleep apnoea – conditions linked to a lack of carbon dioxide – can experience reduction of symptoms within a week of using the method of shallow and slow breathing through the nose. “Volumes of scientific work, along with some narrow trials done in the West for asthma, [are evidence of the method’s effectiveness],” he says. Though taught in Russian medical schools and covered by insurance in Australia, the method is not widely accepted in the medical community. Dr Adrian Wu Young-yuen, a specialist in allergy and immunology with the Centre for Allergy and Asthma Care in Central, is sceptical. “I do not have any personal experience of this method, nor do I recommend it to my patients. It is about as effective as conventional chest physiotherapy. As with a lot of
I sleep more restfully, am more alert during the day, and am in a better mood on a day-to-day basis RYAN HARPER, BUTEYKO EXPONENT
complementary medicine, its major effect is probably psychological. “Generally, if patients are motivated to spend the time and effort, I would encourage them to engage in aerobic activities, such as swimming. Aerobic exercises have unequivocally been shown to benefit asthmatics, and have many other benefits besides.” In a blog post in December 2009 on sciencebasedmedicine.org, paediatrics Professor Joseph Albietz of the University of Colorado in Denver observed that “Buteyko and his devotees have made some remarkable claims while providing almost no evidence”. Albietz searched for and reviewed published literature on the Buteyko method. He found 21studies discussing its use for asthma, of which eight were published clinical trials. He found no published studies evaluating the method for the other diseases Buteyko claimed to cure. Even so, patients say the method is effective. Elaine Morgan and her husband, Ryan Harper, participated in one of Vidgen’s workshops in Hong Kong and praised the results they experienced. “It’s been helpful. I feel calmer, more positive and lost six kilograms in five weeks,” says Morgan, who had been on long-term medication for asthma since age 10, including Symbicort for the past six years. Post-Buteyko, she was put on a single steroid, and the amount of her medications were reduced by almost half. “Asthmatics tend to panic and reach for medication, but I am much less reliant on it now,” she says. Harper, who suffered from general lethargy and fatigue, had been recommended the method several times over the past few years by his friends. “I have only been practising the Buteyko method for five weeks, but have already noticed that I sleep more restfully, am more alert during the day, and am in a better mood on a day-to-day basis. These are subtle but powerful changes,” he says. Vidgen says almost everyone can benefit from more optimal breathing, particularly those whose chronic ailments aren’t improving despite a dependence on medication. Vidgen, 63, had suffered from allergic rhinitis for more than 40 years and says he reversed the condition using the method. A member of the International Association of Buteyko Practitioners, he first encountered the method nearly 20 years ago in Sydney while doing administration and promotion work for Buteyko Australia. He then started assisting and training with Alexander Stalmatski, a
Jac Vidgen shows a group of Hong Kong youngsters how to inhale “correctly” using the Buteyko method leading protégé of Buteyko, at workshops. By 1994, he was teaching the method. “I have personally taught the method to about 40 medical doctors over the years – for their own health. For the past eight years, I have worked in conjunction with OT&P, a reputable medical group in Hong Kong.” People in this city might face more breathing problems than those elsewhere, not so much because of
air quality but because of the intense lifestyle here, says Vidgen. “It’s a crowded, noisy, environment where people work hard and life is fast.” Regarding air quality, he says those who hyperventilate will be more susceptible to pollution than those who don’t. Vidgen usually teaches the basic Buteyko method through five two-hour sessions held over a fortnight. The workshop costs HK$4,000 per person and is taught in small
groups of five to 15 people. Patients with more serious and complex health concerns usually require further sessions after the workshop, and Vidgen offers consultations by phone, online using Skype and by e-mail. Jac Vidgen will present a series of free introductory lectures on Buteyko therapy on May 22-28 in Central, Repulse Bay and Sai Kung. For details, go to buteykoasia.com
10 WELL-BEING Walking for a cause: Rob Lilwall’s expedition raises fund for Viva, a charity that benefits children at risk, such as these Nepali kids. Photo: Rob Lilwall
WALKING HOME
Changing lives, step by step ...................................................... Rob Lilwall healthpost@scmp.com I am now entering the final month of my 6½-month long Walking Home From Mongolia expedition. Along the way, my cameraman Leon McCarron and I have crossed the Gobi Desert and northern China in winter, and progressed into the beautiful springtime of the central and southern Chinese mountains. We have taken a dip in the Yellow River and the Yangtze. The Pearl awaits us this week. There have been many magical moments on the trip so far – sunrise in the frozen Gobi, being invited into a Chinese family’s home for Lunar New Year’s Eve, walking along the Great Wall and through unending mountains of terraced paddy fields. There have been dark times. Walking into the freezing night on dangerous, coal-truck filled roads; getting a painful foot injury that led to limping for weeks and thoughts of giving up; getting worn down by so many days and nights of not knowing where I would sleep or eat; and just missing my home and my wife. Sometimes, I wonder why I am doing it all. I suppose the adventure
is a big part, and I like doing things that test me to my limits. And I’m enjoying getting to know China better. But one of the other big motivations behind the expedition is to raise money for the children’s charity Viva. I think it’s a really good idea to help charities through doing sponsored events – whether it be running a marathon, going on a bicycle journey, or growing a moustache (Movember). You don’t have to do something big like walking the length of China, but you should choose a challenge that pushes you outside your comfort zone. Helping a charity in this way has several major benefits. Firstly, it gives you extra motivation not to give up, even when the going gets tough. When you are “hitting the wall” on your marathon and blisters are eating up your feet, knowing that you are raising money for a cause you believe in (perhaps to help people who are suffering far more than you are now) will help you keep going. Secondly, it encourages your friends to give more money to charity. Giving actually benefits both you and the recipient – studies from top psychologists at leading universities have shown that giving
I support Viva because I believe in it and have seen first-hand the work it does with children at risk
to others and being generous (whether it be with your time or your wallet) has definite benefits for your mental and physical health, increasing your life expectancy. Finally, of course, it also helps the charity itself, which will be benefiting those in a desperately needy situation. People can easily become cynical about giving to charities when they hear of cases that go wrong. But there are many wonderful charities around and standards of good practice are improving. When we support a charity, we need to be confident that it is transparent, accountable and effective in the work it claims to do. I support Viva because I believe in it and have seen first-hand the work it does with children at risk. If you spend a few days talking to people who work locally to help orphans, street children and children who have been abused, trafficked or exploited in other ways, it quickly becomes apparent that there are many projects that operate independently from one another. Because their efforts are not coordinated, they struggle to bring about lasting change. Also, sadly, many well-intentioned local projects are battling to survive, and collapse within a few years of
starting, owing to a lack of training, sustainable planning and funding. Viva equips and connects local charities, joining people up in citywide networks, so that workers can come together to brainstorm, share knowledge skills, receive training and find concrete ways to work together. This leverages the charities’ potential, and helps bring about long-term, sustainable transformation. Viva is 16 years old, and is changing the lives of more than 104,000 children through 22 citywide networks. In Asia, Viva works in Cambodia, Nepal, India and the Philippines. Find out more at www.viva.org. In three weeks’ time, a few days after Leon and I have finally walked 5,000 kilometres, we are going to celebrate our return at our Welcome Home Party for Viva on Wednesday, May 30. We’ll also give a short talk about the journey. Entry is free. Check our website for details. Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book, and a National Geographic TV series. Each week in Health Post, he will write about his new expedition, Walking Home From Mongolia. www.walkinghomefrommongolia.com
DIET 11 THE TASTE TEST COCONUT WATER
EAT SMART
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Thanks a bunch: a dish with a lasting bouquet
Jeanette Wang healthpost@scmp.com
...................................................... Jeanette Wang jeanette.wang@scmp.com The lily has been used in China as both a food and medicine for more than 2,000 years. The yellow-gold dried buds, in particular, feature in stir fries and soups. Good raw or cooked, the buds are said to be the sweetest part of the plant. This recipe, contributed by The Banqueting House at Tsim Sha Tsui, however, uses fresh blossoms, which add sweetness to the dish. Fancy tempura? Dip the blossoms in a light batter of flour and water and fry them in a wok. If you can’t get over consuming flowers, think of all the others you’ve eaten – including broccoli and artichokes. Delicious stuff, especially when cooked right.
O.N.E. Coconut Water HK$24 for 330ml, Nature’s Village Made with young, green coconuts from the Philippines, this drink packs 60 calories per packet and “super-hydrating electrolytes” – 670mg of potassium, 60mg of sodium and 25mg of magnesium. PepsiCo has a majority stake in O.N.E, a company started by two master’s degree students in Brazil. Verdict: weak coconut taste; drinking water would be just as satisfying.
Steamed meatballs with lilies and soya bean sheets Serves 6 2 eggs 110ml water 3 ⁄4 tsp salt 150 grams soya bean sheets 75 grams fresh lilies 1 ⁄2 tsp sugar 30 grams pork, minced
Chi Coconut Water HK$24 for 330ml, Just Green Produced in Thailand and packed in Germany for a London company, this drink seems to contain the least nutrition of the three: 25 calories per pack, 210mg of potassium, 17mg of sodium and 12mg of magnesium. Verdict: the strongest natural taste of the three, but still can’t beat fresh coconut water.
H2Coco Pure Coconut Water HK$16 for 330ml, City’super This is made with Australian coconuts – with added ascorbic acid (vitamin C). For some reason, it seems even 100 per cent natural coconut water varies in nutritional composition: this contains 85 calories per pack, 735mg of potassium, 66mg of sodium and 40mg of magnesium. Verdict: also lacks natural coconut flavour; slighty sappy taste.
20 grams prawn, minced 2 tbsp chicken broth 1 ⁄2 tbsp each of green, red and yellow bell pepper, finely chopped and blanched 1 stalk Chinese chives and 4 vegetable leaves, boiled, for garnish • Beat eggs with water and ¼ tsp salt. Steam egg until just done. Set aside. • Mould soya bean sheets into plum flower shape. Cut lily to similar shape and size. • Add ¼ tsp salt and sugar to pork and prawn. Mix well. Divide into small meatballs. • Set the meatballs on top of the
soya bean sheets. Adhere lily along the side of the meatballs. Steam for five minutes. • Place steamed meatballs on top of steamed egg. Bring chicken broth to the boil, add ¼ tsp each of salt and sugar. Add a few drops of broth over the steamed egg. • Sprinkle peppers on top of steamed egg. Garnish with Chinese chives and vegetable leaves. Recipe provided by the Health Department as part of its EatSmart@restaurant.hk campaign. For more information, visit restaurant.eatsmart.gov.hk
12 WELL-BEING PERSONAL BEST
Fed up trying to please everyone ......................................................
Imagine you are on a mission to get fit and lose weight. You find yourself in a social setting in which the host places a plateful of freshly baked, gooey fudge brownies on the table in front of you. The friend sitting beside you eats one lamenting her inability to say no to chocolate, then looks at you. What do you do? Do you pull a carrot out of your bag and declare your disgust at your friend’s lack of willpower? Or do you agree that the brownies do smell good and that it would be rude not to try at least one? If the second option sounds likelier, you may be a people pleaser. People pleasing characteristics, known clinically as sociotrophy, include the tendency to put others’ needs first, worrying about hurting others, and sensitivity to criticism. Dr Gerald Lui Chung-wing, clinical psychologist at Hub and Spokes International counselling centre, says: “A people pleaser can appear as a ‘sacrificial’ person, yet their ‘pleasing’ behaviour is to avoid negative reactions from others – real or imagined. This tendency is usually shaped from the people pleaser’s past experiences.” Professor Julie Exline of Case Western Reserve University in Cleveland, Ohio, was the lead author on a recent study that concluded that people pleasers were likely to eat more in certain situations. The study involved an experimenter handing a bowl of M&Ms to the actor, who took a small handful (about five pieces) before offering the bowl to the participant. After taking the sweets, participants reported how many they took and why. Researchers then assessed the number taken. The study was inspired by many years of research into situations in which people outperform others in areas such as income earning and academic achievement. These situations can often lead the high-performer to feel awkward and uncomfortable, and people pleasers are highly likely to feel guilty when they perform well. “So, in this study, we were trying to extend these ideas to a situation involving outperformance in the
Illustration: Sarene Chan
Jacinta Read healthpost@scmp.com
area of self-control: in this case, eating,” says Exline. Aisha Zaveri, 24, who was raised in Hong Kong, admits to eating to please: “Despite the fact that I am Indian and I love most things about India, I cannot stand the food. In fact, I hate it. But when I went to live there for a year, I would force myself to eat it. I didn’t want to insult the people I was with, and I suppose I was also trying to prove myself to them. I was saving face.”
A people pleaser can appear ‘sacrificial’, yet their behaviour is to avoid negative reactions from others – real or imagined DR GERALD LUI, CLINICAL PSYCHOLOGIST
Conformism is a mindset in which individuals defer their own values in favour of those shared by a group, or in this case, perhaps even just one more dominant personality. “It is human instinct to imitate one another. Of course, people are greatly influenced by each other in all areas of life, including food,” says Dr Lim Lit-sing, a freelance clinical nutritionist. A tendency closely related to conformism is “group think”, when individual members of a group seek
to minimise conflict by arriving at decisions with little critical analysis or personal evaluation. Fear of criticism or upsetting the group is the main motivator, along with the comfort and perceived security that comes with being part of a group. There is a significant downside to being a people pleaser. “People pleasers can harbour tremendous resentment, anger, disappointment and sadness,” says Lui. “As a result of their orientation in life, people pleasers have difficulties being aware of and expressing their own desires, needs and wants. This can cause them to struggle with feelings of being under-appreciated, emptiness and loneliness.” Exline adds: “Most people don’t feel good about caving in to social pressure … Sometimes, the best decision for you [in personal or even moral terms] might not please everyone else. Some people really need to learn how to tolerate situations in which they have different opinions or behaviour from others.” What steps do the experts recommend a people pleaser take towards change? “With eating, the big thing is to pay attention to whether you are actually hungry and whether you even want the food. Listen to yourself and your own body,” says Exline. “If you eat to please another person once in a while, it’s no big deal; but if you live or work with someone who is often pushing you to eat more, you might have to have a conversation with this person about the situation and how you are trying to make healthy eating choices.” Lui advises a people pleaser to: • Acknowledge that these unhealthy patterns of life are not good for oneself or others – come to this by self or feedback from trusted well meaningful friends or family. • Make a decision to change these patterns, keeping a better future in mind. • Begin to learn to realistically validate one’s needs and desires, and to meet these needs in a trusted supportive community, where one can learn to give and receive. This is best done with the guidance of a mentor, religious or professional help such as a counsellor or psychologist.