20120612 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, JUNE 12, 2012

Illustration: Tom Jellett

HEALTH POST BODY ODOUR: THE PITS OF DESPAIR >PAGE 5

SADDLE UP FOR THE CYCLE OF LIFE >PAGE 8

Doctors warn against sun exposure as skin cancer cases rise >PAGE 6

2 NEWS ASK THE EXPERTS BARBARA QUINN Q: I am confused. What’s the difference between inorganic and organic sources of nitrites?

A: “Inorganic” forms of nitrate and nitrite are found naturally in foods such as beets, celery and spinach.

Inorganic nitrates and nitrites are also used for food preservation.

These inorganic compounds have a lower risk for toxicity and help lower blood pressure and enhance athletic performance.

“Organic” nitrates and nitrites are more complex molecules and are the main ingredients in potent heart drugs such as nitroglycerine and amyl nitrite. An overdose of these could be fatal.

Sodium nitrate is an effective food preservative. It kills bacteria as it “cures” meats such as bacon.

According to the US Food and Drug Administration, sodium nitrate can be used to preserve foods if the amount does not exceed guidelines.

Hot dogs and other foods made with “no added nitrates” must be protected from bacteria in other ways. Celery is high in nitrate. So meat products preserved with celery salt contain sodium nitrate.

Remember that nitrate in food is converted in the body to nitrite and then to beneficial nitric oxide.

But bacon and hot dogs are not health foods. We should limit our intake of processed meats for other health reasons. As food safety expert Dr Carl Winter from the University of California, Davis, says, it’s a case of “the dose makes the poison”.

A recent study in the Journal of the Academy of Nutrition and Dietetics found a beneficial effect on

HEALTH BITES athletic performance from eating beets (which are high in nitrates).

“It is not known why dietary nitrate has been associated with healthful effects in some instances and harmful effects in others,” it states.

McClatchy-Tribune

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Jeanette Wang jeanette.wang@scmp.com

Barbara Quinn is a registered dietitian at the Community Hospital of the Monterey Peninsula in California

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Having babes at any old age It seems having children later in life has its positives – at least for men.

Northwestern University researchers have found that fathering children at an older age could help promote longevity of the offspring. This is because, unlike most cells, the telomeres in sperm lengthen, rather than shorten, with age. Telomeres are molecular caps at the ends of chromosomes (like plastic tips on shoelaces) thought to protect against ageing and disease. Elderly persons with shorter telomeres for their age are known to have reduced survival. The study, published in the Proceedings of the National Academy of Sciences, used information from multigenerational Filipinos. The authors measured telomere length of DNA from the blood of 1,779 young adults and their mothers, and determined the ages of the children’s fathers and grandfathers. It was found that an individual’s telomere length increased not only with their father’s age at their birth, but also further increased with their paternal grandfather’s age at their father’s birth.

Spot patch for cancer treatment Curing skin cancer without surgery or major radiation therapy? Yes, it can be done. Researchers at the All India Institute of Medical Sciences in New Delhi have developed a customised treatment called phosphorus-32 (P-32), a radiation spot-treatment skin patch that can safely and easily kill facial tumours Photo: Corbis with a few outpatient appointments.

The patch was tested on 10 patients aged between 32 and 74 with basal cell carcinoma, the most common type of skin cancer, which affects the skin’s surface layer. Biopsies were taken at three months and repeated within the three years that followed treatment, and eight out of 10 patients were found to be entirely cured and cancer free.

Further research will be needed before the patch can be provided for general clinical use, say the authors.

Light on their feet When it comes to basketball, what counts is speed, agility and how high you can jump.

Extra weight is a hindrance. So Adidas has developed what it claims is the world’s lightest basketball shoe, weighing just 269 grams – equivalent to about two iPhone 4s.

Launched in Hong Kong last week, the shoe is aptly named Adizero Crazy Light 2 and costs HK$1,199. “In the league, every game matters and you don’t want anything weighing you down on the court,” says Philadelphia 76ers point guard Jrue Holiday. “Putting on the Adizero Crazy Light 2 gives me that speed and confidence I need when it counts.”

> 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

NEWS 3 SLEEP DEPRIVATION

QUIZ

Too little shut-eye a time bomb for the heart

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Jeanette Wang jeanette.wang@scmp.com Deprive yourself of sleep and you may be more likely to eat junk food, have higher anxiety levels and raise your risk for stroke symptoms. So say findings from three separate studies presented over the weekend at the 26th annual meeting of the Associated Professional Sleep Societies in Boston.

In the first study, 25 men and women of normal weight were either restricted to four hours’ sleep or allowed to have up to nine hours’ sleep for five straight nights. After that, they looked at images of healthy and unhealthy foods while undergoing a brain scan.

The researchers, from St Luke’sRoosevelt Hospital Centre and Columbia University in New York, found that the sight of unhealthy food during a period of sleep restriction activated reward centres in the brain that were less active after adequate sleep.

“Indeed, food intake data from this same study showed that participants ate more overall and consumed more fat after a period of sleep restriction compared to regular sleep,” says Marie-Pierre St-Onge, the study’s principal investigator.

Brain scans were also used in the second study by the University of

The body requires adequate sleep to function. Photo: Jonathan Wong

Participants ate more overall and consumed more fat after a period of sleep restriction MARIE-PIERRE ST-ONGE, COLUMBIA UNIVERSITY RESEARCHER

APP OF THE WEEK

A handy tool for assessing your state of mind .................................................

Katie McGregor healthpost@scmp.com Mental Health Wellness Free Rating 7/10 The authors of this app, Dr Melvyn Zhang, National Healthcare Group, Singapore and Dr Mak Kwok-kei of the faculty of medicine at Chinese University of Hong Kong, say that mental health disorders are becoming increasingly prevalent.

These disorders are unique because there are no diagnostic tools to ascertain whether one has a particular disorder, they say.

This app serves as a diagnostic tool for frontline health workers such as doctors and nurses. There are detailed breakdowns of various mental illnesses and information on suitable medication for psychotic disorders.

I avoided this section and browsed through the basic mental health wellness questionnaires, which are available in English, Cantonese and Putonghua.

The purpose is to screen for the four main psychiatric disorders prevalent in Asia: depression, anxiety, obsessive

compulsive disorder and psychosis. The questionnaire functionality on the phone is very low-tech. You need a pencil or a very reliable memory to track your score, and the results are sent by e-mail. There is a long list of help centres if you feel that you might need support.

This app may be most useful for people who know someone who is in distress, and want to evaluate whether they should push them to seek help.

Available at mhwell.com

California, Berkeley, to analyse the effect of sleep deprivation on anticipatory activity in deep emotional brain centres.

The scans were done on 18 healthy adults in two separate sessions, one after a normal night’s sleep and a second after a night of sleep deprivation. During both sessions, participants were exposed to an emotional task that involved a period of anticipating a potentially negative experience (an unpleasant visual image) or a potentially benign experience (a neutral visual image).

Results showed that sleep loss exaggerated the degree to which participants anticipated impending emotional events, particularly among those who were highly anxious.

In the final study, researchers at the University of Alabama in Birmingham found that habitually sleeping fewer than six hours a night increases the risk of stroke symptoms among middle-aged to older adults, who are of normal weight and at low risk for obstructive sleep apnea.

The study tracked 5,666 people for up to three years. “We speculate that short sleep duration is a precursor to traditional stroke risk factors, and once these traditional stroke risk factors are present, then perhaps they become stronger risk factors than sleep duration alone,” says lead author Megan Ruiter.

Jeanette Wang jeanette.wang@scmp.com A young French father of two, who has been a Hong Kong resident for 20 years, has acute leukaemia and urgently requires a bone marrow transplant.

Unfortunately, none of his family members is a match.

A 31-year-old woman in Singapore, whose condition has reached a critical state, is also seeking a bone marrow donor. Her siblings are not matches.

The chance of siblings (from the same parents) having a match is one in four. Among two unrelated people, having identical tissue types is as low as one in 100,000, according to the Hong Kong Red Cross Blood Transfusion Service.

The pool of donors in the Hong Kong Bone Marrow Donor Registry is very small at 76,027. That’s just one per cent of the population, according to statistics from Bone Marrow Donors Worldwide, which coordinates an international registry.

Anyone healthy and between 18 and 60 years old can be a donor by registering at one of the seven blood donor centres in the city (no appointment required). It takes just 15 minutes and only five millilitres of blood is drawn. If you’re a match and you eventually donate bone marrow, your health or immune status will not be affected.

For details, go to ha.org.hk/rcbts.

A femur in cross section.

Photo: Science Picture Co Test your knowledge of bone marrow below.

1. What is bone marrow? a. Spongy tissue found in the centre of large bones, such as the hip and thigh bones b. Flexible connective tissue found in the joints between bones c. Fibrous tissue that connects bones to other bones 2. Bone marrow contains immature cells called stem cells that can develop into … a. Red blood cells that carry oxygen through the body b. White blood cells that fight infections c. Platelets that help with blood clotting 3. Leukaemia is a cancer in which bone marrow … a. Doesn’t make red blood cells b. Makes abnormal white blood cells c. Produces abnormal red blood cells 4. How much bone marrow is typically taken from donors? a. 500 to 1,000ml b. 1,000 to 1,500ml c. 1,500 to 2,000ml Answers: 1. a; 2. all are correct; 3. b; 4. a (about 2 per cent to 5 per cent of body’s total bone marrow)

4 MEDICAL CASE HISTORY

An enemy within ......................................................

Eileen Aung-Thwin healthpost@scmp.com Sophia Lau, 40, tried to ignore a little bump that was growing on her right upper eyelid, along her lash line. Lau (whose name has been changed for patient confidentiality reasons) thought it was a stye and hoped it would go away on its own.

Many styes, which are much like pimples, do disappear eventually. But Lau’s continued to grow in size and discomfort.

Eventually, she could not take the pain and discomfort any longer – the growth was now 5mm in diameter – and she turned to Dr Arthur Cheng Chak-kwan, a specialist in ophthalmology at the Hong Kong Sanatorium and Hospital, for help.

Cheng saw that the stye had become a chalazion, where the inflamed oil gland had become fully blocked and infected. The collection of pus inside the cyst was too much for antibiotics alone to resolve. He had to make an incision to drain the pus and deflate the chalazion. He then gave Lau antibiotic eye drops for day use and an antibiotic ointment for the nighttime.

By the end of the week’s course of antibiotics, Lau’s eyelid was good as new. But several weeks later, she noticed another little bump emerging on the lower lid.

Having learned her lesson with the first stye, Lau made a beeline for Cheng’s office.

Cheng was puzzled at the recurrence of the stye. It was evident that the medications were effective in clearing out the stye-causing bacteria.

But it was rather unusual for another stye to develop in a different location on the same eye. Nevertheless, Cheng prescribed another course of medication.

Lau was relieved when the bump shrivelled up and disappeared in days. But, again, another popped up a few weeks later, this time on the upper lid of her left eye.

This time, despite the antibiotics Cheng prescribed, the stye continued to grow. Cheng had to repeat the drainage procedure when the chalazion ballooned to 5mm.

Although there was nothing in Lau’s reported medical history or personal habits that could explain the persistent appearance of styes, Cheng knew something else was afoot. He mined the medical journals and papers for possible explanations for Lau’s condition.

He finally struck gold.

Cheng noticed that a parasitic mite called Demodex was sometimes associated with blepharitis, a condition in which eyelash follicles get inflamed.

People who have suffered

blepharitis are more prone to repeated styes and chalazia. Lau did not have the condition, but Cheng wondered if Demodex might also be involved in Lau’s unusual case.

While there are some 65 species of the eight-legged arthropod, only two species are found on humans: Demodex folliculorum and Demodex brevis.

They are commonly known as eyelash mites, and they feast on the natural oils, or sebum, produced by skin. These

Illustration: Angela Ho

microscopic parasites have a life cycle of 14 to 18 days.

Up to a quarter of the population, especially adults, might have some Demodex mites living harmlessly on their skin and eyelashes. Problems occur when there is an overgrowth of mites.

Cheng conferred with his colleague Dr Bone Tang Siu-fai, a specialist in clinical microbiology and infection. Tang helped with the testing and identification of this parasite, as there was no standard laboratory protocol in place.

Dr Cheng mined medical journals for possible explanations for Lau’s condition, and struck gold

Because the mites are nocturnal creatures, in the daytime they burrow into the eyelash follicles.

Sample eyelashes had to be plucked and immediately placed in saline to keep any mites present alive. Cheng took four eyelashes from each of Lau’s eyes.

Under a microscope, the doctors found live Demodex folliculorum mites wriggling away on the samples.

While the mites do not necessarily cause infections, they can plug the opening of glands that produce the protective oily substance in the eye, says Tang.

Their scaly surface traps infectioncausing bacteria, resulting in styes and chalazia, adds Cheng.

Demodex infestations can also cause red, itchy, dry and irritated eyes.

With the culprits pinned down, the next step was to eradicate them. Only two substances appeared effective: 100 per cent alcohol and tea tree oil solution. But alcohol was not an option because the high concentration of the solution could damage the eye.

Cheng did a skin test to ensure that Lau was not allergic to tea tree oil. Next, the doctor protected her cornea surfaces with contact lenses and applied local anaesthesia to her eyes.

He then applied a solution of 50 per cent tea tree oil and 50 per cent paraffin oil to her eyelashes.

Five to 10 minutes later, he cleaned the lashes again, and repeated the procedure.

Despite the protective measures taken, Lau still felt a stinging sensation in her eyes. Hence, it is imperative that such a treatment is done by a qualified doctor.

Lau needed to repeat the tea tree oil treatment another two times. Cheng said the first application of the tea tree oil would draw the mites out from their hiding places at the base of the eyelash follicles.

The second and third tea tree oil treatments would ensure that the mite population was largely exterminated.

When she returned home, Lau was advised to wash her face, eyebrows and hair with tea tree oil shampoo.

She also had to wash her pillow case, bed sheets and linen in boiling water to clear out any stragglers in the mite population.

After Lau’s case, Cheng saw an inexplicable and unusual spate of about 30 similar cases.

Subsequently, the doctors developed a protocol for patients presenting with styes and chalazia to be automatically tested for Demodex infestations.

Tang also taught the nurses and laboratory technicians how to retrieve and prepare the eyelash samples for investigation.

HEALTH 5

BODY ODOUR

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Sunory Dutt healthpost@scmp.com Ah, the smell of a hot, sweaty summer. Bromhidrosis, or body odour, can wreak havoc on your personal and social life if it’s not sniffed out at source. Amy Tan knows this well. The insurance agent, 24, has run the gamut of embarrassment, low self-esteem and isolation.

“Colleagues at work kept avoiding me, and I’d overhear them call me the ‘stink bomb’. It was so demeaning,” she says. “A visit to the dermatologist, some antibiotics and lifestyle changes helped me nip the problem in the bud.”

But that was two years ago, and the psychological scars are still healing, she says. “My boyfriend often asks me to work out with him at the gym. But I’d rather not do things that make me break into a sweat.”

There are two types of body odour: apocrine and eccrine bromhidrosis. The more common, apocrine bromhidrosis, is related to the apocrine glands in the underarms, genital skin and breasts.

They emit an odourless oily fluid that reaches the skin surface, where bacteria chemically alter it, causing its characteristic odour.

Colleagues at work avoided me, and I’d overhear them calling me the ‘stink bomb’ AMY TAN, BROMHIDROSIS SUFFERER

Body odour is generally worse if there are more bacteria, or if the level of apocrine sweat production is high.

It’s influenced by inadequate hygiene, family history, obesity, diabetes and localised skin infections related to an overgrowth of bacteria.

In eccrine bromhidrosis, the sweat from eccrine glands all over the body is altered by bacteria yielding an unpleasant smell. In this form of bromhidrosis, ingestion of foods including garlic, onion, curry, alcohol and certain drugs (such as penicillin) may contribute to body odour. In women, menstruation and stress can aggravate the condition.

The first line of treatment is to keep skin dry. Lifestyle changes and hygiene measures can also help curb body odour. Try showering and changing out of sweaty clothing after

exercise, washing underarms at least twice daily with a germicidal soap, and shaving underarm hair regularly to prevent accumulation of bacteria and sweat.

Medical tests at Imperial College, London, have shown that some people with body odour have imbalances in the “friendly bacteria” which live inside the digestive system. These can become unbalanced through medication (particularly antibiotics and steroids) or a high fat, high sugar, high redmeat, low fibre diet. The vital role these bacteria play in detoxification of the bowel and in manufacturing important nutrients is impaired, aggravating the body odour.

Dr Sheetal Chawla, from Secunderabad in India, recommends following a balanced diet and cutting down on junk food. “Avoid oily and spicy foods. Include a lot of fresh fruits, whole grains, sprouts, leafy vegetables, soya products and raw nuts in your diet.

“The high fibre content in fruits and whole cereals helps digestion and detoxifies the system. Stay clear of alcohol, cumin, caffeine, garlic and red meat. Sometimes, if body odour is caused by zinc deficiency, appropriate zinc or mineral supplements can be taken.”

Topical deodorants often help to mask odour and certain deodorants reduce the growth of bacteria. For individuals who have excessive sweating in the underarms, Dr Gavin Chan, a specialist in dermatology at Skincentral in Hong Kong, recommends the use of antiperspirants containing aluminium chloride. This blocks sweat production temporarily.

Topical antiseptic soaps and washes may reduce the accumulation of bacteria that contribute to body odour. If the soaps fail, Chan recommends topical antibiotics such as clindamycin and erythromycin. He also recommends Botulinum toxin type A (Botox) injections in the underarms for individuals who sweat excessively.

The injections reduce sweat production and body odour and its effects. It’s a safe procedure involving multiple injections into the skin of each underarm with minimal side effects. Effects last at least six months.

Surgical treatments may be helpful for long-term control in serious cases of bromhidrosis. But these can have side effects, or complications of scarring and risk of recurrence. Treatments involve surgically destroying or removing the apocrine glands within the skin of the underarm. Newer

Photo: Corbis

Reek season surgical techniques such as superficial liposuction curettage are generally less scarring than open surgery. But the problem is more likely to return.

According to Dr Henry Chan, from the Hong Kong Dermatology and Laser Centre, Botox injections to affect the innervation of the sweat glands can also be used to reduce hyperhidrosis (excessive sweating) and improve body odour. “More recently, a microwave device is being used to destroy the apocrine gland in the armpit.”

Sympathectomy, which involves cutting nerves that supply the sweat glands, is another option, says Dr Sunita Mishra from Seattle. “This is about 70 per cent effective at reducing sweat production. It’s most effective in people with excessive underarm and hand sweating.”

Mishra recalls the case of a patient who suffered from excessive sweat secretion: “The patient had to do a lot of public speaking and every time he got up to do this, his underarms would become drenched. We tried using over-the-counter and then

prescription strength antiperspirants without much success. The patient felt that his career was suffering.

“We referred him to a surgeon, who performed a thoracoscopic sympathectomy. The patient has regained his self-confidence. I try to leave surgical treatments to the very end. Once you cut your body, it’s never the same. But we felt that the benefits outweighed the risks.”

It takes effort to deal with body odour. But whatever the prognosis, you’ll be none the worse for putting those around you off the scent.

6 COVER STORY

Burned out Skin cancer is on the rise and while sunscreen offers protection, it is not infallible, writes Elaine Yau

C

oming from sundrenched Arizona in the United States, banker David Ratliff loved running and playing golf under the sun. At age 23, he found a big mole on his back and was diagnosed with melanoma. He had surgery to have the mole and a large piece of surrounding skin removed. Six months later, he felt swelling under both armpits and all his nymph nodes in that area had to be removed. He eventually emerged from the ordeal cancer-free and with the realisation of the importance of sun protection.

“I never wore any sunscreen back then,” says Ratliff, 43.

“Now, I take lots of precautions, and always wear sunscreen.

I was the first in my family to get [skin cancer]. My mum and sister also got it later, but they were treated.”

Skin cancer afflicts white people more than others, their inherently light skin colour and low amounts of melanin (the substance that gives skin colour) leave them vulnerable to the sun’s cancer-causing ultraviolet (UV) rays.

But the incidence of skin cancer among locals is rising.

The Hong Kong Cancer Registry’s figures show that there were 717 new cases of skin cancer in 2008, over 50 per cent more than in 1999; and Health Department figures show that 33 people died of skin cancer in 2007, compared to 27 in 2006.

Dermatologists blame a lack of awareness of skin protection

The WHO advises against the use of tanning beds for those under the age of 18, while some local doctors want them banned. Photos: Corbis, Oliver Tsang and the increasing popularity of tanning.

To promote awareness of sun protection, the Hong Kong Cancer Fund recently launched the SunSmart education campaign in collaboration with the Cancer Council Australia. The initiative includes a series of games and information packages aimed at clearing up public misconceptions about tanning and sunscreen.

“We absolutely advise against exposing oneself to the sun to get vitamin D,” says dermatologist Dr Louis Shih Tai-cho. “We get

vitamin D from daily food products like bread and soya bean milk. UV rays are a class-one carcinogen [along with arsenic and tobacco].”

Sun exposure, says Shih, is like smoking: the effects accumulate in the body. A balanced diet will provide enough vitamin D. A deficiency of the vitamin, he says, is rare and mostly found in the northern parts of Canada, where there’s little sunlight and where diets tend to lack dairy products.

Intense exposure to the sun causes basal cell carcinoma, squamous cell carcinoma and

melanoma, the three main types of skin cancer. Carcinoma makes up 95 per cent of all skin cancers and is highly curable if treated early.

Melanoma is highly dangerous and spreads easily to other parts of the body.

Government figures show that there were 62 new cases of melanoma in 2004 and 33 of them were fatal, compared to 23 fatalities among 594 new carcinoma cases.

Dermatologist Dr Ho Kai-keung says swimming should be avoided at around noon in summer.

According to the Hong Kong Observatory, on most days in July and August last year, the UV level at this time reached 11 or above, classified as “extreme”.

“People who head outdoors should bring hats and umbrellas and wear sunscreen,” says Ho. But sunscreen is not always reliable. With sunscreen classified as a non-pharmaceutical product, sale of such products is not regulated in the city, leading to misleading claims. For example, Ho says there’s no such thing as waterproof sunscreen, because it always washes off in water.

Last year, the US Food and Drug Administration outlawed the term “sunblock”. New US regulations require sunscreen products to shield consumers from both UVA and UVB rays.

Before the regulation went into effect, sunscreen labels were only required to carry a Sun Protection Factor (SPF) level to inform users how well the product protects against UVB light, the primary cause of sunburn. Under the new order, they will also have to

COVER STORY 7

insulate users from the more penetrating UVA rays associated with skin cancer.

Asian brands, particularly Japanese ones, use a “PA” (protection grade of UVA) ranking.

Under the new FDA regulations, sunscreens that don’t protect against both UVA and UVB rays but have an SPF of at least 15 will have to carry the warning label: “This product has been shown only to help prevent sunburn, not skin cancer or early skin ageing.”

Shih says sunscreen products labelled with SPF 100 levels can be found in Hong Kong. In the West, SPF 45 is the maximum level that can be printed on products.

“Allowing products with such exceedingly high SPF levels to be sold will give customers the wrong impression,” Shih says.

“They might think their sunscreen is invincible.”

The degree of protection offered is not in proportion with SPF levels.

According to the Skin Cancer Foundation in the US, SPF 15 filters out about 93 per cent of all UVB rays; SPF 30 keeps out 97 per cent and SPF 50 keeps out 98 per cent. If it takes 20 minutes for your unprotected skin to start turning red. Using an SPF 15 sunscreen theoretically prevents reddening 15 times longer – about five hours.

Sunscreens use active ingredients that either physically block absorption of harmful UV rays or chemically prevent the absorption of UV rays by the skin.

Physical sunscreens are effective immediately, whereas chemicalbased sunscreens take 20 to 30 minutes to be effective.

Shih says commonly used active ingredients in physical sunscreens include zinc oxide and titanium dioxide, which act like masks and umbrellas to block sunlight. He advises checking the combination of chemical and physical ingredients in the sunscreen before purchase.

“As there’s yet to be convincing scientific evidence to show sunscreens are harmful to the body, we still believe they afford good protection from the sun,” says Shih. “A mixed combination of the two with not too many chemical components should be safe.”

Recently, researchers at Missouri University of Science and Technology found that zinc oxide undergoes a chemical reaction when exposed to sunlight that may release free radicals. These are unstable molecules that cause damage to cells and DNA, leading to various diseases, such as cancer, Alzheimer’s and heart disease.

Kurunthachalam Kannan, professor of environmental health and toxicology at the State University of New York at Albany, studied the effects of benzophenone, which is highly effective in blocking the sun’s UV rays, on the human body. Small amounts of the chemical can pass through the skin and be absorbed into the blood, where it mimics the effects of the female hormone oestrogen, leading to a hormonal imbalance that may cause serious problems within the body.

He found that benzophenone might cause endometriosis, a painful condition in which uterine

We get vitamin D from daily food products like bread and soya bean milk. UV rays are a class-one carcinogen DR LOUIS SHIH TAI-CHO, DERMATOLOGIST

tissue grows outside the uterus.

“While we believe that sunscreen is useful, we suggest exercising caution and being aware of the fact that BPs are associated with endometriosis,” he says.

The Environmental Working Group, a non-profit American advocacy group, studied more than 800 sunscreens and its latest report shows that only a quarter of them met its standards for efficacy and safety.

Ken Cook, the president of the group, says the industry continues to load store shelves with sunscreens that make misleading claims.

“Their sky-high SPF ratings may protect against sunburncausing UVB rays, but they leave skin vulnerable to UVA,” he says.

“A quarter of this year’s products still contain vitamin A ingredients that accelerate the growth of skin tumours and lesions on sunexposed skin.”

While it is advisable to regulate

HOW TO PICK THE BEST SUNSCREEN Dermatologists suggest you choose: •Sunscreen with SPF30 and PA+++ for daily use •Sunscreen with SPF 50 and PA+++ for use during outdoor activities •Use water-resistant sunscreen when swimming, which gives approximately 40 minutes of protection •If you have sensitive skin, choose a sunscreen that contains only

titanium dioxide and/or zinc oxide as the active ingredient •Some of the chemicals used in sunscreens not only contribute to a hormonal imbalance, but also increase the risk of cancer. Read the labels on bottles of sunscreen to determine which are safe. Consumers can visit the Environmental Working Group’s 2012 Sunscreen Guide to check which chemicals are safe.

sunscreen, both Shih and Ho think tanning studios should be outlawed in Hong Kong. Tanning beds produce higher levels of UVA radiation than the sun.

UVA rays produce less sunburn but penetrate deeper into the skin than UVB rays, leading to melanoma.

“People are less likely to get burned while tanning [in sunbeds],” says Shih “But it will still speed up skin ageing and lead to cancer.”

Tanning lamps and beds were classified as class-one carcinogens by the UN in 2009.

International studies have showed that those who tan before age 30 have a 75 per cent higher risk of getting skin cancer.

The World Health Organisation advises against tanning beds for those under the age of 18. California became the first state in the US to ban the use of sunbeds for people under 18 last year. Australia is planning to outlaw tanning services within three years.

As tanning lamps are not classified as medical equipment, their use is not regulated in Hong Kong. Operators claim that a tanning session not exceeding nine minutes is safe.

“Some beauty parlours allow customers to use such lamps without any supervision by staff,” says Ho. “Young people who are susceptible to fashion trends but unaware of their risks are the most vulnerable. They should be made off-limits to people aged under 18.” elaine.yau@scmp.com

8 FITNESS SADDLE UP A FOUR-WEEK CYCLING SERIES

Chain gang ......................................................

Guy Haydon guy.haydon@scmp.com Official figures suggest that Hong Kong’s roads host about 12.3 million trips by vehicles every day. About 62,000 of them are by bicycle.

Cycling is thriving in the city, with more and more people taking it up, despite official efforts to dissuade cyclists from riding on the congested roads.

“Based on road safety considerations, the administration does not encourage the use of bicycles as a transport mode in urban areas,” the Legislative Council’s Panel on Transport report noted last year.

However, enthusiasts can be seen out on their bikes in all places (including city-centre roads), in all weather and at all times, but especially during weekends, early mornings or late evenings, when traffic is lighter.

Popular off-road areas include Sai Kung West Country Park, Lamma Island, Shek O, Chi Ma Wan Peninsula, Tai Mo Shan and Tai Lam Country Park. Gentle rides can be found along water catchments, coastal pathways and closed roads (family pathways) at Plover Cove, South Lantau, Sha Tin, Tai Po and Tsuen Wan. The city’s compact nature makes it ideally suited to cycling – for commuters

and those doing the activity as a hobby. “I love cycling for the freedom it offers,” says photographer Stanley Shin, 32, who has ridden a bike for the past 15 years. “It’s great to get from A to B in a more enjoyable, quick and interesting way than by bus. I often go training around Hong Kong Island; and Tung Chung town down to the airport or Disneyland are also good cycling routes.”

Another enthusiast, Don Fung, 25, spends much of his free time cycling around Sha Tin, Ma On Shan and Tai Wai. “I love being able to speed and exercise hard on my bike, and also to relax and hang out with friends when riding slowly,” he says.

Cycling is a sport that can be enjoyed by people of all ages and abilities. Once you start to ride a bike regularly you will notice a steady improvement in your overall fitness.

Over time, cycling increases the cardiovascular efficiency of the heart, lungs and circulation. It also reduces the risk of morbidity and mortality from coronary heart disease, stroke and obesity, and could help prevent Type 2 diabetes.

“Cycling is one of the most popular modes of exercise in Hong Kong,” says Lo Ka-kay, senior sports science officer at Hong Kong Sports Institute. “Bike riding places less stress on our joints, tendons and muscles than many other forms of exercise, such as running, and decreases the risk of injuries, tendonitis and muscle pain. These factors are very important for people

Albert Einstein’s theory of relativity came to him while he was riding a bike; cyclists on a 20-kilometre ride last December, to urge the government to approve a cycle path along the harbourfront (below)

Bike riding places less stress on our joints, tendons and muscles ... and decreases the risk of injuries LO KA-KAY, SENIOR SPORTS SCIENCE OFFICER, HONG KONG SPORTS INSTITUTE

who are overweight – they can lose weight [from the moment they start] cycling.”

Lo says cycling is safe for both young and old, including those with joint or mobility problems. “At the Institute we like to use cycling training for athletes with joint problems, or with injuries as a result of running, so that they maintain the training levels of their cardiovascular system.”

Two pieces of medical research published last year highlight cycling’s health benefits.

Last August, the British Medical Journal reported findings suggesting that the health benefits of cycling outweigh the risks by a ratio of 77 to 1. A survey of 181,982 people signing up to a public cycle-hire scheme in the Spanish city of Barcelona compared the risks to cyclists with those to car users in the same busy urban area. It found cycling to be very low risk, even after negative factors such as pollution and crashes were considered. When taking only the risks of injury into account (cyclists are also exposed to air pollution), the benefit ratio rises to 415 to 1.

In another study, 5,000 healthy people, aged 21 to 90, were tracked over 20 years by researchers at Copenhagen’s Bispebjerg Hospital in Denmark. They found that men who cycled quickly lived 5.3 years longer than those who cycled slowly. Men who cycled at an average pace lived 2.9 years longer. Among women, fast cyclists lived 3.9 years longer, and

FITNESS 9

average-speed cyclists 2.2 years longer, than those cycling slowly.

The American College of Sports Medicine recommends that adults should get at least 150 minutes of moderate-intensity exercise per week. This can be met through 30 to 60 minutes of moderate-intensity exercise five days per week, or 20 to 60 minutes of vigorous-intensity exercise three days per week.

Cycling is an ideal way to clock up those minutes, as it combines both low to moderate intensity (aerobic) and vigorous intensity (anaerobic) exercise.

For the most part, the activity is aerobic, meaning you’re working at 50 to 85 per cent of your maximum effort, which can be sustained for long periods. When sprinting over short distances or biking up steep hills, you dip into the anaerobic

zone, where you’re putting in at least 80 to 85 per cent effort sustained for only a few minutes.

Aerobic exercise helps strengthen the heart and lungs, improve stamina, increase circulation and burn calories to help meet weight loss goals. Anaerobic exercise forces muscles to work in a state of oxygen deprivation, and strengthens muscles and bones.

Besides improving overall cardiovascular fitness, cycling can also help people to relax and can ease stress, improving quality of life.

It raises endorphin levels in the brain, reducing feelings of pain and anxiety.

Saddle time can also help you think more clearly, as physicist and cycling fan Albert Einstein proved: “I thought of [the theory of relativity] while riding my bicycle.”

Actor George Clooney and actress Michelle Pfeiffer both love their bikes, while British naturalist David Attenborough cycles whenever he can. Writers Ernest Hemingway, Iris Murdoch, H.G. Wells and Arthur Conan Doyle were all enthusiasts.

“When the spirits are low, when the day appears dark, when work becomes monotonous, when hope hardly seems worth having, just mount a bicycle and go out for a spin down the road,” Doyle said.

Professional cyclists, unsurprisingly, cycle for more than money and prizes. Italian Mario

Cipollini, who ended his retirement in 2008 because he missed the sport, said: “The bicycle has a soul. If you succeed to love it, it will give you emotions that you will never forget.”

Seven-time Tour de France winner Lance Armstrong, who also made a comeback, said: “Chasing records doesn’t keep me on my bike.

Happiness does.”

Over the next four weeks, Health Post will run a series of articles aimed at getting you started in the sport. We’ll look at how to select a bike, picking the right gear, and tips on safety and avoiding injuries.

Lance Armstrong reacts as he crosses the finish line to win the 2005 Tour de France; Michelle Pfeiffer and George Clooney are keen cyclists.

Photos: AP, EPA

10 FITNESS/ DIET SMOKING ATHLETES

Light up the track

Advertisers used to try and associate smoking with sporting prowess and a healthy lifestyle, as this 1960s billboard from the US shows. Photo: Corbis

......................................................

Sasha Gonzales healthpost@scmp.com Talking to Petrina Wong, you would hardly guess that she was a smoker.

Fit and active, the 32-year-old journalist regularly takes part in triathlons and plays tennis and golf weekly. It is baffling why she would damage her body by smoking.

But for Wong (whose name has been changed for reasons of confidentiality), smoking seems to give her what nothing else can: a feeling of relaxation. “I’m usually very anxious, and smoking calms my nerves,” she says. “I know it’s not healthy, but I’m addicted and I’m lucky I have no breathing issues.

“I find that a stick just before a big race boosts me emotionally, and that

helps me perform better. Cigarettes are like a legal steroid,” she adds.

It is well known that smoking is detrimental to human health. But that has not stopped top athletes like footballer Wayne Rooney, basketball legend Michael Jordan and tennis star Anna Kournikova from lighting up. So why do competitive athletes smoke when they know the habit is bad for them?

Dr James Oliver from Island Health Family Practice says that, according to some reports, about 4 per cent of marathon runners smoke.

But it is unlikely that the reason is to relieve race anxiety.

“If it was, the smoker would suffer slower times and lower stamina levels due to the effects of smoking, as opposed to the negative effects of stress,” he says. “Stress induces

adrenalin, and this helps the body go into flight mode, which could be beneficial to running speed.”

Wong thinks that a cigarette before a race is calming. But it’s no more than a psychological security blanket. “Smoking decreases oxygen intake by up to 10 per cent during exercise training,” says Dr Winnie Mui from Dr Lauren Bramley and Partners in Central. “So it’s not true that smoking before a race can help improve one’s performance.”

Carbon monoxide is among the most poisonous of the chemicals in cigarettes. It binds to haemoglobin in the blood and interferes with oxygenation. According to Mui, “decreased oxygen to the brain, heart, lungs and muscles can increase mental and physical fatigue.

For athletes, this translates to

Decreased oxygen to the brain, heart, lungs and muscles can increase mental and physical fatigue WINNIE MUI, DOCTOR

decreased endurance, stamina, performance, strength, recovery and overall quality of training.”

Oliver adds that smoking also causes blood vessels to constrict, making it more difficult to get adequate blood flow to the muscles.

This, combined with decreased oxygenation throughout the body, can result in athletes experiencing fatigue faster, thereby affecting their endurance. Smoking also causes shortness of breath. In asthmatic athletes, this can be disastrous.

Nicotine puts pressure on the cardiovascular system as it increases heart rate and blood pressure.

Passive smokers, and even those who smoke occasionally, are also at risk, says Mui. In the short term, passive smokers may also experience headaches, eye irritation, wheezing, sore throat and/or dizziness, all of which can affect training and athletic performance.

“Although there are no conclusive studies on the effects, one can expect that the negative effects on [sporting] performance will be half or slightly less than that of an active smoker’s,” says Oliver.

Iggy Cheung, a 32-year-old dragon boat paddler, smokes “just a few cigarettes a week”. Cheung says that he makes up for his bad habit by exercising at the gym daily and eating a plant-rich diet.

But Oliver says exercise and diet will not counter the effects of smoking. The only solution is to quit.

The great thing about stubbing out is that you notice the benefits right away. Quitters experience significant increases in oxygen concentration and exercise duration.

Mui suggests medication such as Zyban or Chantix/Champix, psychotherapy, acupuncture, hypnotherapy or hypnosis, or traditional Chinese medicine. There are also programmes at Smoking Cessation Clinics run by the Hospital Authority, which is part of the Department of Health.

As for nicotine replacement therapy, Oliver says that these products do have their place in stopping smoking. But they are only useful if the dose is gradually reduced until cessation.

“The aim should always be the resolution of all cigarette and nicotine addiction,” he says.

EAT SMART

A tale of brown rice and dragon boats ......................................................

Jeanette Wang jeanette.wang@scmp.com With Tuen Ng, or the Dragon Boat Festival, approaching in a couple of weeks, glutinous rice dumplings are in season. Here’s a healthier take on the traditional treat contributed by QQ Rice, a Taiwanese fast food chain that sells rice balls.

This dish uses black glutinous rice and brown rice, and is more nutritious than the refined, white

version. A spoonful of black rice bran contains more health-promoting anthocyanin antioxidants – substances that can fight heart disease and cancer – than a spoonful of blueberries, according to Louisiana State University Agricultural Centre researchers.

Compared to white rice, the bran of brown rice contains higher levels of certain antioxidants that have shown to reduce blood levels of lowdensity lipoprotein cholesterol (LDL) and may help fight heart disease.

Sliced chicken with olive sauce rice roll Serves 6 90 grams red pepper, finely chopped 1 tsp each of sesame and finely chopped peanuts 150 grams skinless chicken breast A dash of olive oil Some dried lemon leaves 60 grams lean pork 300 grams cooked black glutinous rice 300 grams cooked brown rice A pinch of salt and sugar 18 strips of cucumber (each 5cm long), rinsed

• Roast red pepper, sesame and peanuts at 180 degrees Celsius until completely dry. Set aside.

• Cook chicken in boiling water until done.

Allow to cool, then shred.

• Add oil and dried lemon leaves, mix well.

• Cook pork in boiling water until done.

Allow to cool.

• Season with salt and sugar and roast at 190 degrees until dry. Shred.

• On a piece of cling wrap, place black

glutinous rice and brown rice side by side, flattened to make a rectangle.

• Place chicken, pork, cucumber, roasted red pepper, sesame and peanuts on top.

• Roll up and serve.

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

For more information, go to restaurant.eatsmart.gov.hk

WELL-BEING 11 WALKING HOME

Back in the arms of love ......................................................

Rob Lilwall healthpost@scmp.com It’s been about two weeks since we arrived home in Hong Kong after walking 5,000 kilometres back from Mongolia. In our final week, my cameraman Leon McCarron and I were in Guangzhou, walking through the heavily industrialised region of Dongguan.

Manufacturing towns were piled so thickly on top of one another that our route consisted of one seemingly unending muddle of twisted roads and sprawling factory complexes. Our smartphone map struggled to keep up with this rapidly changing layout.

It sometimes led us down roads that no longer existed or ended at the gates of a new development.

The days were hot, and we enjoyed the early morning and evening the most, although the evenings included the challenge of walking down streets full of young factory workers going home.

We finally staggered into

Some hardship is not a bad thing once in a while. It helps us appreciate our home comforts Shenzhen, and down our last mainland street to the Lo Wu border post. As I walked into Hong Kong, the immigration official narrowed her eyes at my thick beard, unsure whether I was the same person as in my passport photo. But I didn’t mind. I was just happy to be crossing the border.

The next day we started walking home through Tai Po, and then over the beautiful Wilson Trail, where monkeys lounged around in the middle of the path. We finally reached the end of Nathan Road.

It was a Friday night, and the street was thick with shoppers, couples out on dates, and people heading home from work.

We had to be careful not to knock anyone over with our heavy rucksacks, as the crowds ploughed past each other in a hurry.

After two hours, we reached the Star Ferry clock tower, and I climbed onto the viewing platform to see Hong Kong’s epic skyline towering around us.

I had arranged to meet my wife, Christine, here. I wandered around nervously in search of her for a few minutes before spotting her sitting on the waterfront. I was back in her arms again, at last.

The next day, our friend Tobi gave us a ride back to Lantau on his junk. At Discovery Bay, a group of 80 friends joined me for the final walk back to my home village of Mui Wo. Since being back, I have enjoyed simply being with Christine again. I also appreciate not having to get up at dawn and walk for 13 hours with a heavy rucksack.

Looking back on the journey, it all feels like a dream, as if it was not me who was doing it.

I ask the same question that I asked myself many times during the long walk home: was it a good use of six months of my life?

Walking across snowy deserts, through rugged mountains, down frozen river valleys, past subtropical hills and through hundreds of villages, towns and cities – what was the point?

This is partly the way I make a living. My job entails writing, motivational speaking and television shows. I suppose that justifies doing it.

Also, we have so far raised almost HK$400,000 for the children’s charity Viva, an organisation my wife and I are very passionate about.

But was it worth the risks? Well, it was not a particularly dangerous expedition. At least not compared to others I have undertaken in Papua New Guinea, the West Bank and in Afghanistan.

It was, however, a very hard slog that was full of discomfort.

But I think some hardship is not such a bad thing once in a while, as doing strenuous things helps us appreciate our home comforts.

It is good to treat life like an adventure. As my friend Todd says, life is not a dress rehearsal.

So I think we need to live as best we can, according to our deepest beliefs and values. Life is not about being as comfortable as possible.

The winner in life is not the person who dies with the biggest bank balance. As the writer Don

Leon McCarron (left) and Rob Lilwall with his wife Christine pose for the cameras on the Tsim Sha Tsui waterfront just hours after the two adventurers had arrived back in Hong Kong. Photo: Rob Lilwall Miller says, we should live and make our decisions as if we are characters in an epic story.

I was very pleased that my goal for the expedition was to walk home, rather than reach some unknown place on the map.

The thought of finally returning home was a deep source of motivation for me each day. I reflected on home as I walked,

passing by other people’s homes in China, where I was often welcomed and looked after.

I believe that “home” is not just the place where I can live safely and comfortably. It is more than simply the place where my belongings are.

More than anything, it is the place where I am with my wife. And it is the place where I am among a community of friends.

Rob Lilwall is a writer, motivational speaker, and TV adventurer based in Hong Kong. This is the final article of a six-month series in Health Post that followed the progress of his Walking Home From Mongolia expedition.

His journey was made in support of the children’s charity Viva. National Geographic is now producing a television series about the journey. Details are at walkinghomefrommongolia.com

12 WELL-BEING THE TASTE TEST SARDINES ......................................................

Jeanette Wang jeanette.wang@scmp.com

Marks & Spencer Portuguese Sardines in Olive Oil 120 grams for HK$23, Marks & Spencer These sardines were caught in the northeast Atlantic Ocean and are certified sustainable seafood.

Thick and chunky, there are three pieces in each tin, without skins.

Verdict: a tad overcooked, fishy, and too many bones and scales.

Dan Parr (left) and Rowley Aird, whose friendship has been forged by a shared passion for running, on the Wilson Trail in Tai Tam. Photo: May Tse

FIT & FAB TRAINING BUDDIES

These mates go the distance ......................................................

Rachel Jacqueline healthpost@scmp.com When Dan Parr and Rowley Aird banter, it is difficult to tell at times whether they like each other. But while each may enjoy a laugh at the other’s expense, it is clear the pair have a tight friendship.

It’s a bond forged by a shared passion for trail running.

Parr, 35, and Aird, 36, met at rugby training in 2005. But it was not until they began trail running a few years later that their friendship was properly cemented.

Despite a short time running together, they came fourth in their first team race in 2008. This good performance inspired them to continue working out together to see if they could do better.

The results have surprised them both. Parr has won two prestigious RacingThePlanet 250-kilometre seven-day self-supported desert races – the Gobi March in 2010 and the Sahara Race last year.

Aird was part of the team that broke the Oxfam Trailwalker 100kilometre mixed team record in 2010 (that record was broken by another team in 2011).

Last year, he finished sixth in the Vibram Hong Kong 100-kilometre race with a personal best of 13 hours, two minutes.

While the pair stick together on

training runs, it’s a different story during actual races.

“We start together, but we don’t always finish together,” says Aird, a sales director at an investment bank.

“I usually begin to hyperventilate mid-run, and Dan tells me to suck it up and grind it out.”

Last month, Parr and Aird took on their greatest challenge to date: the 156-kilometre Ultra-Trail Mt Fuji in Japan. It was Parr’s longest singleday race. For Aird, it was a chance to face his demons and complete a distance that had previously eluded him. Parr was 18th overall out of 900 competitors in 25 hours 31 minutes.

Aird was 83rd in 31 hours 52 minutes.

While Aird looks to Parr for inspiration, Parr relies on Aird for his knowledge, experience and sheer determination.

A mutual respect and the need for good company have kept them training together.

“I think there is a certain type of person who does these things,” says Parr, director of an international sports marketing agency. “You can get some pretty low moments.

“We have run enough together to know how to perk each other up, or when to keep quiet,” he adds.

Sometimes, they run for seven hours without talking.

But there is also a healthy competitive spirit. Says Parr: “We push each other to do better.

“It’s juvenile at times, but the net

result is that we run further, faster and are fitter than we were five years ago,” he says.

Off the trails, they are good family friends and Parr is the godfather to Aird’s third son.

Sum up each other in three words.

Parr: He’s sweaty, dogged and committed. (He sweats like no other man I know.)

Aird: Hates to lose.

What are his greatest strengths and weaknesses?

Parr: His commitment, energy and doggedness – he can just run and run and run. But that strength is also his weakness. Sometimes, he doesn’t

He doesn’t know when to call it quits. He’s put himself in hospital more than once DAN PARR ON HIS RUNNING MATE

know when to call it quits. He’s put himself in hospital more than once.

Aird: His ability to block out the suffering and not let anything get in the way of his goal. After a run, not only will he always insist on running home, regardless of how far we have run and the state of his condition, but he will also then refuse to take the elevator up to his 14th floor flat or use the bannister to help him up because “there are no lifts or banisters in the Sahara” (or wherever his next event is). His weakness, like us all, is alcohol and having too much fun in the months leading up to an event.

Connetable Sardines in Extra Virgin Olive Oil and Espelette Chillies 115 grams for HK$40, City’super Smaller in size than Marks & Spencer’s sardines, these fish from Brittany swim in a sea of red seedless Espelette peppers, which hail from the French commune of the same name.

Verdict: surprisingly fresh and non-fishy, and the chillies add a subtle kick.

Who would be the first person to quit?

Parr: Him, hands down.

Aird: I guess I would most likely be the first to quit as I have never known him to quit. Although, to be fair, the only time I did quit a race I had to be admitted to hospital.

Who looks the best in race gear?

Parr: Definitely Rowley – he has all the shiny, hi-tech, new stuff. I will wear the same gear until it wears out, then go out and buy the exact same kit again. Even my water pack has a hole in it, which has been sewn up.

Aird: He has been wearing the same visor and shorts for the last seven years. All I will say is that he looks terrible, so I am hoping by default I look better.

Les Belles de Camargue Sardines in Extra Virgin Olive Oil 115 grams for HK$68, Premiere Pression Provence Olives are an intrinsic part of everyday life in France’s Provence region, where these sardines – and the olive oil they’re covered in – are produced.

Verdict: the olive oil is delicate and doesn’t overpower the fresh and flaky meat, but too many scales get in the way.