20120626 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, JUNE 26, 2012

COLORECTAL CANCER ON THE RISE Photo: Stanley Shin

>PAGE 5

HELPING KIDS SKIP TO A HEALTHY BEAT >PAGE 9

2 NEWS APP OF THE WEEK

HEALTH BITES

For this test, the eyes have it

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Household chemical triggers eczema Prenatal exposure to a ubiquitous household chemical increases risk for childhood eczema, according to a study by the Columbia Centre for Children’s Environmental Health in New York City.

Butylbenzyl phthalate (BBzP), used in vinyl flooring, artificial leather and other materials, can be slowly released into air in homes. Hereditary factors, allergens and exposure to tobacco smoke contribute to the condition. The study, which involved 407 non-smoking African-American and Dominican women and their children, found that onset of eczema by the age of two was 52 per cent more likely in children whose mothers had been exposed to higher concentrations of BBzP. The study was published online in the journal Environmental Health Perspectives.

Katie McGregor healthpost@scmp.com Vision Test Free Rating 9/10 One or more of my eyes failed the Visual Acuity Test, according to the Vision Test app. Not to be picky, but I think it should have been: “One or both of your eyes” to save app users from feeling as if they were a modern-day Cyclops or Argus Panoptes.

Seeking an iPhone app to test my eyes, I had read about the Near-Eye Tool for Refractive Assessment (Netra) app, developed by MIT Media Lab. The iPhone app required a simple adapter that would have cost about US$10 and, because of its relatively low cost and mobility, promised to bring accurate eye testing to millions in poorer parts of the world, which is very worthy.

However, Netra still hasn’t made it to the iTunes Store, so I initially settled for the free Eyes Test app.

Standing 1.5 metres away from your phone, the app runs you through an eye test using a traditional eyechart-like graphic, and then with iPhone in hand again, you test yourself for colour blindness using the familiar numbers and coloured dots test. This proved fun for all the family; my vision is the worst, my kids’ vision is apparently just fine, and my husband is very colour blind. All seemed acceptable until I tested the app on my iPad, and suddenly my vision was 20/20. The

app clearly doesn’t make any adjustment for the different screen sizes, and instantly lost credibility.

I then found Vision Test, which, according to the iTunes write-up, was the No 1 medical app of 2010.

This app tests for visual acuity, astigmatism, focusing ability and colour deficiency. The tests are run by holding your phone at arm’s length, and then covering one eye and then the other while tapping your answer as you proceed through the tests.

I was sceptical when I scored 100 per cent for visual acuity, as I know I am shortsighted. However, if you can sync to an iPad, the app offers a further test for shortsightedness.

I failed, so I was happy.

It’s not designed to replace a visit to the optometrist, but makes a good pre-test.

ASK THE DOCTORS DR LIM LAY CHENG Q: I seem to be having a lot of unexplained bruises, especially on my arms. My husband is worried that it could be a symptom of diabetes, which runs in my family. Is this possible?

A: Easy bruising is a non-specific symptom and may occur for a variety of reasons. Diabetic patients may sometimes experience easy bruising, but definitive diagnosis of diabetes requires testing the glucose levels in your blood.

As we age, we tend to bruise more easily, particularly women. Although bruises are generally harmless and go away spontaneously, easy bruising may be an indication of a more serious problem. If there is frequent and unexplained bruising or presence of other associated bleeding symptoms such as heavy menstrual bleeds, gum bleeds, nosebleeds or prolonged bleeding after surgery or dental work, it is important to investigate further for the presence of a bleeding disorder.

The term “bleeding disorder” comprises a condition in which the blood cannot clot properly. These may be broadly divided into three categories:

Jeanette Wang jeanette.wang@scmp.com

abnormalities of clotting factors (such as liver disease or vitamin K deficiency), related to platelets (insufficient numbers of them or abnormal function, such as autoimmune disease or kidney disease) or those related to blood vessels and supporting tissues (such as vasculitis or vitamin C deficiency).

Sometimes, easy bruising may occur as a side effect of medications or supplements. These include bloodthinning drugs such as aspirin, clopidogrel and non-steroidal antiinflammatory agents such as ibuprofen or warfarin.

Long-term usage of steroids (topical or oral) may cause the skin to become thin and thus bruise more easily.

Also, some dietary supplements such as ginkgo biloba or fish oil may predispose the body to easy bruising.

A detailed evaluation of your bleeding history, physical examination and, in some instances, laboratory investigations will help to determine the reason. Contact your doctor about your concerns.

Dr Lim Lay Cheng is a haemotologist at Gleneagles Hospital in Singapore

> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com Printed and published by South China Morning Post Publishers Ltd, Morning Post Centre, 22 Dai Fat Street, Tai Po Industrial Estate, Tai Po, Hong Kong. Tel: 2680 8888

Exercise versus cancer It’s known that exercise can reduce breast cancer risk, but University of North Carolina researchers have found that even mild physical activity can provide benefits. A study involved more than 3,000 women aged 20 to 98 years old, half with breast cancer and half without.

The women were part of the Long Island Breast Cancer Study Project, looking for possible environmental causes of breast cancer. Women who exercised 10 to 19 hours per week during their reproductive or postmenopausal years had about 30 per cent reduced risk of breast cancer.

Reductions were observed at all levels of intensity.

“A reduced risk of breast cancer for women who engaged in exercise after menopause is encouraging given the late age of onset for breast cancer,” says lead researcher Lauren McCullough.

Obesity and reward The common contemporary view is that obesity is linked with the increased drive of the reward circuitry in the brain.

But researchers at the Yale School of Medicine have turned this idea on its head: using transgenic mice in which hunger-promoting neurons had been altered or eliminated, the scientists showed that the reward aspect can be very high but subjects can still be very lean. In addition, some people who have no interest in food might be more prone to novelty-seeking behaviours and drugs such as cocaine. “These hunger-promoting neurons are critically important during development to establish the set point of higher brain functions, and their impaired function may be the underlying cause for altered motivated and cognitive behaviours,” says study co-lead author Tamas Horvath.

The study was published online in Nature Neuroscience.

Molecular gastronomy University of Michigan scientists have found that a molecule called Sfrp5 could help fight obesity. Studying the signals that fat-storing cells send to one another, the study showed that Sfrp5 influences a signalling pathway known as Wnt to stimulate fat cells to grow larger and suppress the rate at which fat is burned in the mitochondria inside them. By stopping cells from making Sfrp5, mice didn’t get fat as quickly because their fat cells didn’t grow even when fed a high-fat diet.

The study will be published in the Journal of Clinical Investigation. Researchers caution that the findings need to be explored further in both mice and humans.

NEWS 3 RESEARCH

QUIZ

Psoriasis linked to higher threat of type 2 diabetes

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Jeanette Wang jeanette.wang@scmp.com Here’s a new phrase to mark the end of the work week: TGIFF. From this week to August 31, the World Cancer Research Fund Hong Kong wants you to have Fruity Fridays by having “just one more” portion of fruit or vegetables. This annual campaign, now in its eighth year, aims to promote this simple step towards reducing cancer risk.

According to the Health Department, only one in five people in Hong Kong meets the recommendation of five portions of fruit and vegetables daily. This is one of the reasons close to 40 per cent of the city’s adults are overweight or even obese (body mass index of 30 or more); evidence shows a diet based on plant foods that includes fruits, vegetables, whole grains and pulses helps in weight management.

Along with regular exercise and maintaining a healthy weight, such a diet can reduce cancer risk by up to one-third.

Fruit and vegetables contain vitamins, minerals, fibre and phytochemicals that help to keep the body healthy and protect cells from damage that can lead to cancer. There is also evidence that they help to lower the risk of heart disease, protect against stroke and high blood pressure and help manage diabetes.

A good way to eat more healthily is to put fruits and vegetables within arm’s reach. A study published in the US journal Environment &

Behavior in April found that apples and carrots placed close to college students were likelier to be eaten than if placed at a table two metres away.

Interestingly, the researchers also found that making the food more visible to participants by placing them in clear bowls increased the intake of apples but not carrots.

The researchers said this might be because fruit is sweeter and may induce more motivation to eat than bitter-tasting vegetables.

How well do you know your fruit and vegetables? Test yourself here.

1. The World Health Organisation recommends a minimum of how many grams of fruit and vegetables daily? a. 200 grams b. 400 grams c. 600 grams 2. Which of the following constitutes one portion of fruit for an adult?

a. A medium-sized apple or orange b. Half a large banana c. A handful of blueberries 3. Why should you be wary of rotting apples? a. They generate patulin, a mycotoxin b. The acid may burn your mouth c. Flesh-eating maggots hide in the core 4. Which of the following is commonly known as a vegetable, but botanically classified as a fruit? a. Eggplant b. Artichoke c. Beetroot Answers: 1. b; 2. all are correct (each about 80 grams); 3. a; 4. a Support the campaign as an individual, family or corporation. Sign up at fruityfriday-hk.org, tel: 2529 5025, or e-mail fruityfriday-hk@wcrf.org

People with the chronic skin condition psoriasis may be more likely to develop type 2 diabetes, as well, according to an international study involving more than half a million people.

Researchers, whose results appeared in the Archives of Dermatology, found this was true especially in those with severe psoriasis, who were 46 per cent likelier to get a diabetes diagnosis than people without the condition, after weight and other health measures were taken into account.

Psoriasis is characterised by itchy, painful plaques on the skin.

Previous studies have suggested the condition is tied to a higher chance of having heart disease or suffering a heart attack or stroke. Other reports have hinted at a link between psoriasis and diabetes, as well.

“We already knew that some of the risk factors for psoriasis and diabetes are similar, like weight,” says Dr Rahat Azfar of the University of Pennsylvania, lead author of the study. “We do think that psoriasis itself makes people at higher risk.”

For the study, Azfar and her colleagues consulted five years’ worth of electronic medical records in Britain from about 108,000 adults with psoriasis, and about 400,000 without. None of them had diabetes at the outset.

They found that 3.7 per cent of those with psoriasis were diagnosed with diabetes over the course of the study, compared with 3.4 per cent of the comparison group. When patients’ age, weight and high blood pressure were accounted for, psoriasis was still tied to a higher chance of developing diabetes.

According to the study team, the body-wide inflammation that is seen both in people with psoriasis and type 2 diabetes may explain the link between the two conditions.

Azfar says psoriasis may induce that chronic inflammation through changes in the bloodstream, thus raising the risk of diabetes.

It could also be that people with psoriasis are more depressed or exercise less, helping to explain the difference in diabetes rates, says Robert Kirsner, a dermatologist from the University of Miami in Florida, who has studied psoriasis but was not involved in the study.

So far, the data cannot prove that psoriasis directly causes diabetes, nor have there been any studies to show whether the pills, ointments or injections used to treat psoriasis have any impact on the chance of getting diabetes, says Azfar.

Kirsner says patients with psoriasis should talk with their doctors about other ways to reduce their diabetes risks. Reuters

4 HEALTH

CASE HISTORY

Agents of change ......................................................

Eileen Aung-Thwin healthpost@scmp.com In 2005, Ellen Chen, then 63, was handed some unusually bad news.

Not only did she have breast cancer, she had it in both breasts. Incidents of bilateral breast cancer in Hong Kong occur in less than 5 per cent of sufferers.

Furthermore, both tumours tested positive for high levels of a protein called human epidermal growth factor receptor 2, or HER2, which meant that the cancer was fast-growing, more aggressive and spread through the body more quickly.

A gene mutation within the cancer cells had resulted in an excess of HER2, which requires additional treatment. This type of gene mutation is not hereditary and occurs in about 20 per cent of breast cancer patients.

As a former nurse, Chen had a wide network of friends in the medical community. Although she had both tumours successfully removed at a private hospital, a friend of hers recommended that she see Dr Kwan Wing-hong, who was working at a government hospital at the time, for follow-up treatment.

Kwan treated Chen with chemotherapy, radiation therapy to both breasts and a targeted HER2 therapy called Herceptin. Chen was given Herceptin once every three weeks for a year, and recovered uneventfully.

One year after she completed her treatment, Chen noticed that she had trouble signing her name: she could not control her right hand properly. Worried, she went back to Kwan.

Kwan noted the clumsiness in her right hand and ordered a magnetic resonance imaging (MRI) scan of her brain. He discovered a tiny lesion in her right parietal lobe within the motor cortex, the area responsible for motor control for the right side of the body. It explained the difficulties she experienced in using her hand.

Chen was referred to a neurosurgeon, but given the strategic location of the tumour, he was reluctant to operate on her.

Instead, a highly precise form of radiation called stereotactic radiosurgery (SRS) was used to target and kill the cancer cells in her brain.

By October 2007, Chen was cancer-free and back in full control of her hand. But this reprieve didn’t last.

Two years later, her hand control problems – and cancer – had returned. Given that she had received radiation only two years ago, the neurosurgeon could not risk damaging her surrounding brain tissue with another dose. Instead, he used surgery to remove the tumour.

Tests confirmed that the brain tumour had metastasised from the breast cancer and was also HER2 positive.

Chen was placed on another round of Herceptin with chemotherapy, but this time, her condition continued to deteriorate.

Slowly, she had increasing difficulty in eating and muscle control.

Doctors eventually gave her up as a terminal case, and she was moved to a hospice to await the end. The prognosis was so dire that Chen’s family had even prepared a burial plot for her.

But her son and daughter were unwilling to give up on their beloved mother without a fight.

They heard that Chen’s original doctor, Kwan, was now director of the Hong Kong Sanatorium & Hospital’s Department of Radiotherapy. They pleaded with him to take her case.

When Kwan saw Chen, she was in bad shape – unable to eat, speak or respond to questions. She also had weakness in her right arm and occasional convulsions.

An MRI scan showed that the tumour had returned in her left frontal cortex, but thankfully the rest of Chen’s body was clear of cancer.

Still, given her advanced age of 70, Kwan did not hold out too much hope.

Chemotherapy was not an

Ho la e g An n: o i at str Illu

option because of her poor general condition, and there were few other choices left.

Nevertheless, as Chen’s family was willing to try anything, Kwan opted for an unconventional route.

Herceptin was not the only targeted HER2 therapy. There was another called Tykerb.

Herceptin attaches itself to the HER2 receptors on the surface of the cancer cells and keeps out the growth stimulating agents.

Tykerb has smaller molecules that penetrate the cancer cells and block the HER2 receptors from within the cells, thereby preventing growth agents from reaching the nucleus of the cell.

Often one targeted therapy or other is used. But Kwan now tried using both. Perhaps this strategy could completely block the signals from the growth agents.

The tactic paid off handsomely.

The prognosis was so dire that Chen’s family had even prepared a burial plot for her

One month after starting therapy, Chen’s CA15-3 cancer marker fell significantly. An MRI scan showed that the cancer had shrunk from 3cm to half its original size. Starved of growth stimulants, the cancer was now dying.

Another month later, Chen’s feeding tube was removed and she could start eating normally. Two weeks later, she was able to speak and to regain muscle control in her right arm.

After three months of treatment, Chen’s cancer marker fell further to normal levels.

At the end of six months, Chen was up and about, and enjoying weekly jaunts to dim sum restaurants with her family.

Thanks to her children’s love and stubborn grip on hope, and to the brilliant treatment strategy of her doctor, Chen was able claw her way back from the grave.

HEALTH 5 CANCER

Spotlight on a silent killer ......................................................

Nadine Bateman healthpost@scmp.com It was just before Christmas last year when Patricia Chan had what she thought was the flu and took to bed for four days. Chan was relieved when she felt better and returned to work: she was too busy to be ill.

Then she got a stomach ache.

“It was in my upper abdomen and was really intense. It didn’t feel like indigestion or food poisoning,” says the 39-year-old architect.

Her doctor prescribed medication and the pain subsided but didn’t go away, so an ultrasound scan was scheduled.

Chan wasn’t concerned. She thought it was a routine procedure that would reveal she had gallstones or possible diverticulitis (a digestive disease). When the radiologist told her she could see a tumour, Chan, though shocked, didn’t consider the possibility of cancer.

The reason for her complacency she says, is that there’s no history of cancer in her family, her parents are in good health and her grandparents lived to a ripe old age – one is still alive at 99. However, she believes her lifestyle, which “wasn’t good” at that stage, may have been a contributory factor.

“I was always stressed and worked under a lot of pressure. But most importantly, I didn’t give much thought to what I was putting into my body. I used to smoke a lot and I didn’t really eat properly or do any exercise.”

Colorectal cancer is a disease of the large bowel (also known as the colon and rectum) and it is the second most common cancer in Hong Kong, affecting almost as many people as lung cancer.

Professor Yuen Siu-tsan of the Department of Pathology at the University of Hong Kong says the incidence of colorectal cancer has “increased dramatically” during the past 20 years in the city, averaging a three per cent rise each year, and is now the second greatest cause of cancer deaths.

Says Yuen: “Genetic and environmental factors play a role in causing or predisposing one to colorectal cancer. Studies have shown a relationship to food. In general, a diet that is rich in red meat, fat, processed food, and low in vegetables and fibre is associated with an increased risk. Drinking alcohol, smoking, obesity and lack of exercise are also associated with colorectal cancer.”

People with a family history of cancer may have an increased risk of developing it, and those who have a rare condition known as familial multiple polyposis, in which benign tumours called polyps are found in

the lining of the colon, are also at risk. So too are people with a long history of ulcerative colitis (a disease of the lining of the bowel).

Yuen says one other factor is increased age. But those with a strong family history of colorectal and related cancers are usually afflicted with the condition in their 30s or 40s, which has a strong impact on the family psychologically, socially and financially, as most of them are family breadwinners.

Symptoms can include blood in the stools, stomach ache, loss of appetite, anaemia or diarrhoea.

But there are often no symptoms in the early stages.

The recovery rate depends on the stage of the disease at diagnosis, says Yuen. It ranges from a cure rate of 90 per cent for stage I to just 10 per cent for stage IV. “More than 50 per cent of colorectal cancer patients are already in stage III or IV when diagnosed. Thus, overall, half of the patients in Hong Kong die of the disease. We know that colorectal cancer develops through stages, starting as small polyps, which grow to become big polyps and then transform into invasive cancers. This development takes more than 10 years and provides us with windows to prevent the cancer,” says Yuen.

Clearly, this makes early diagnosis crucial. The faecal occult blood test is one of the most common means of colorectal cancer screening, and people aged over 50 are advised to do it bi-annually.

For Chan, the next step was a blood test and CT scan followed by colonoscopy, which confirmed she had stage IV colon cancer that had spread to her liver. In January she had an operation to remove the tumour followed by a course of chemotherapy which she has half completed.

Chan’s reaction was to arm herself with information and talk to fellow sufferers. “The Hong Kong Cancer Fund was so supportive – they put me in touch with another patient and it has been very helpful to talk to her.”

She stopped smoking five months ago because she “felt disgusted” with herself. “Something like this makes you reevaluate your lifestyle and I thought ‘why am I being so stupid – I want to prolong my life as much as I can’.”

Chan befriended Kathy Thomas, 48, a school teacher from Canada who completed her chemotherapy last month. Thomas was diagnosed with stage III colon cancer last September after having diarrhoea for three weeks.

She had no other symptoms except fatigue when she went to the gym, which she attributed to ageing.

Her family history includes a father

Colorectal cancer affects almost as many people as lung cancer in Hong Kong. Photo: Edmund Ho who had oesophageal cancer and a grandfather who suffered from stomach cancer. She is also overweight, which she feels could be a contributing factor.

Thomas says there were “lots of issues” she couldn’t discuss with people because she didn’t want to be a burden, so she was grateful for the Hong Kong Cancer Fund which put her in touch with Chan.

She says a website and forum

More than 50 per cent of colorectal cancer patients are already in stage III or IV when diagnosed PROFESSOR YUEN SIU-TSAN

called the Colon Club (thecolonclub.com), was an excellent resource and muchneeded source of comfort.

“People are open about breast cancer but not colon cancer which is more common and more and more younger people are getting it,” says Thomas. “I think it’s important and helpful to talk about it because people often assume it’s something that only old people get.”

6 COVER STORY

Ab Chocolate can be beneficial, but before you reach for that bar there are a few conditions attached.

Richard Lord delivers the caveats

COVER STORY 7

bitter truth E

veryone loves chocolate.

And the more guilty the pleasure, the more we reach for studies which prove that – contrary to received wisdom – chocolate may actually be good for us. So good in fact, that its sales last year in Hong Kong increased 6 per cent to HK$1.3 billion, according to Euromonitor International.

While that’s a big figure, here’s an even bigger claim: chocolate is good for us, it’s just that it comes with a series of caveats. It’s only good in certain ways; only certain types are beneficial; and if we eat too much of it, the cons soon start to outweigh the pros.

Much of the research – and there’s been a deluge in recent months – on chocolate’s benefits reveals them to be cadiovascular. It can lower blood pressure, improve blood flow, lower blood glucose, and induce positive effects on both the good and bad forms of cholesterol.

It can allegedly also reduce stress and improve the mood through its effects on serotonin levels; it has anti-inflammatory properties in the small intestine; it may fight colon cancer by preventing undesirable changes in cell structure; and it may reduce migraines due to its effect on the brain’s trigeminal nerve.

It’s the multifunctional miracle of cocoa that produces the effects. The dried and fermented seed of a small evergreen tree native to tropical Latin America, cocoa (or cacao) has a distinguished history. First cultivated in Central America about 3,500 years ago, its value was transactional, as currency.

Spanish invaders introduced it to the world during the 17th century when it was only consumed as a drink. Then in the 19th century, an Englishman called John Cadbury developed an emulsification process to make chocolate solid. The rest is sweet history.

Today, cocoa is mostly grown in West Africa, with Ivory Coast the world’s largest producer, responsible for 35 per cent of the three million tonnes harvested annually, followed by Ghana and Indonesia.

Cocoa seeds contribute two properties to chocolate. First, cocoa solids – pure cocoa powder – and second, the fat, known as cocoa butter. Mix the two with sugar, and you have chocolate. The solids contain the chemicals most commonly identified as the source of health benefits: antioxidants called flavonoids and flavanols, in particular the epicatechin flavonoid.

But experts are still uncertain as to the exact effects.

“These substances do probably have effects in the body,” says Shelley McGuire, spokeswoman for the American Society for Nutrition and a professor of nutrition at Washington State University.

“But cocoa beans contain hundreds of other compounds that might act independently or interactively. For instance, levels of magnesium and zinc are also high in chocolate products. So the verdict is still out on this one.”

Eric Ding, an epidemiologist and nutritionist at Harvard Medical School, has conducted three meta-analyses (a statistical technique for combining the findings of independent studies) of randomised trials of cocoa flavonoids.

“There was a wide variety of benefits, and we didn’t see any inherent adverse effects,” he says.

“The meta-analysis we did on cardiovascular risks showed lower blood pressure, lower blood cholesterol, raised good cholesterol, lowered glucose, increased insulin sensitivity and improved blood flow.

It’s a confluence of beneficial factors that likely suggests long-term benefits for heart disease.”

The trials were shortterm, Ding says, and lacked hard end-points – measuring changes in the incidence of conditions such as heart attacks and strokes, for instance. The studies looked at a certain component of cocoa – not chocolate, with its extra fat and sugar. “The message should be that high-dose cocoa flavonoids are beneficial.”

Likewise, Josh Lambert, assistant professor of food science at Penn State University, used pure cocoa powder in his study on its potential antiinflammatory effects on the

People who eat the most chocolate, or cocoa, tend to suffer the least from cardiovascular disease SHELLEY MCGUIRE, SPOKESWOMAN FOR THE AMERICAN SOCIETY FOR NUTRITION

intestine. “I try to remind people that there’s some distance between cocoa and chocolate,” he says.

Lambert found that compounds in cocoa inhibit an enzyme called PLA2, which makes available fatty acids that are precursors to inflammation. He found that cocoa also inhibits pancreatic lipase, the main enzyme that breaks down fats in the digestive system, meaning less fat is absorbed by the body.

The result, he says, is that “if you eat chocolate, it has an effect. You absorb less fat from chocolate than from other fatty foods.” But, he adds, “in terms of looking at what the effect might be on the body overall, we’ve only looked at cocoa powder.”

As well as cocoa solids, cocoa fat can also be good for you, says Rhoda Lau, a dietitian at Hong Kong Baptist Hospital. “It contains high amounts of lipids. About one third is stearic acid, which is also found in olive oil, and can help to control blood cholesterol.” She says dark chocolate contains a similar amount of iron to pork or beef, and is therefore especially recommended during menstruation.

But the cardiovascular effects appear to be the most pronounced.

“The literature regarding chocolate is interesting and scientifically noteworthy, but at the same time not conclusive – especially in terms of the physiological basis for chocolate’s effects on the body,” McGuire says.

“But I believe … that the relatively consistent finding that people who eat the most chocolate – or cocoa – tend to suffer the least from cardiovascular disease should not be ignored, especially in folks at increased risk for inflammatory conditions, such as smokers.”

The best way to derive benefits from chocolate is to pick bars that have plenty of cocoa in them. Milk chocolate contains relatively small amounts of cocoa – the European Union specifies a minimum of 25 per cent solids, while in the United States it’s just 10 per cent.

White chocolate has virtually none – just cocoa butter. Dark chocolate generally has a minimum of 35 per cent cocoa solids, but proper bittersweet dark chocolate

starts at about 70 per cent. But cocoa levels alone might not be a reliable guide. “Certain processes used to produce chocolate can remove the flavanols from the final product,” says McGuire.

“So just knowing how much cocoa solids are in a chocolate bar doesn’t really tell you anything about how much of the flavanols remain. Some have suggested that manufacturers list the flavanol content of their products in addition to that of their cocoa solids for this exact reason.”

Then there’s the vexing issue of how much is too much: chocolate is loaded with sugar and fat. “There’s research showing that around six grams of dark chocolate – that’s about one square – will produce benefits, lowering blood pressure by about two per cent and cholesterol by about five per cent,” says Karen Chong, a dietitian at Matilda International Hospital.

“Some people say it’s OK to eat up to three ounces [about 85 grams] a day, but that can be about 450 calories and up to 30 grams to 40 grams of fat. I would say one ounce daily is OK, but not more than that – it’s too many calories,” says Chong.

She also warns of the potential knock-on effects of consuming the high-calorie food. “If you choose to have chocolate for the antioxidants, especially if you have weight issues, it’s important to reduce the amount of other foods you eat such as refined carbohydrates.

“It doesn’t mean you shouldn’t also take fruits and vegetables.

They’re full of antioxidants and they have much fewer calories and much less fat than chocolate.”

For a healthier way to eat chocolate, she says, combine it with nuts, in particular almonds, macadamias, pistachios, hazelnuts and walnuts. These are all full of vitamins, minerals, protein and good fats.

“People should keep in mind that eating less and exercising more are the real ways of countering conditions like obesity,” says Penn’s Lambert. “Adding chocolate to your diet is a good thing to do. But I’d hesitate to say to anyone that you can eat too much and not exercise and if you add chocolate it’ll make a difference.”

Like most foods for which health claims are frequently made, chocolate has its place in a balanced diet, but no more than that.

“At this point, I think we should simply be stressing that moderate chocolate consumption can likely be a component of a healthy diet,” says McGuire.

“Once again, it’s all about variety, moderation and balance. There’s no such thing as a magic bullet.” healthpost@scmp.com

8 COVER STORY CHOC-A-BLOC

Into the dark: not all bars are created equal ......................................................

Richard Lord healthpost@scmp.com If the health benefits of chocolate derive from the antioxidants in cocoa, as seems likely, then there’s no point eating a Snickers bar and expecting it to help your heart. You’re going to need something with a higher cocoa content. The problem is, cocoa is bitter, too much so for some. We sampled a selection of high-cocoa brands to work out which are good for dark-chocolate beginners, and which are purely for the cocoa-loving purist.

Marks & Spencer Organic Fairtrade Dark Chocolate – 72 per cent cocoa HK$28 for 100 grams, Marks & Spencer Quite sweet, fairly simple, almost milk chocolate-like flavour with minimal bitterness. Has a pleasant, creamy feel in the mouth.

Another good starting point for people who prefer their chocolate not too challenging.

Artisan du Chocolat Mole Chili Dark Chocolate – 70 per cent cocoa HK$55 for 45 grams, ThreeSixty Has a strong chilli flavour, but one that manifests itself more as poblano-style sweetness than an habanero-style heat attack. The chocolate starts off a little anaemic with little bitterness, but broadens and improves with time.

Alter Eco Dark Quinoa Organic Chocolate – 60 per cent cocoa HK$55 for 80 grams, City’super A simple sweetness with almost no bitter notes, it had the lowest cocoa percentage, so you’d expect it to be sweet, but not this sweet. The quinoa adds crunch but little else.

HK$55 seems a lot to pay for glorified Rice Krispie Squares.

Lindt Excellence 99 per cent cocoa HK$41.50 for 50 grams, Gourmet Fine Food A chocolate that takes itself seriously, this one comes with tasting advice. It has a very dry mouthfeel and an astringent bitterness with zero sweetness.

Strictly for those who love the taste of cocoa in all its full, ascerbic glory.

Les Tropiques du Chocolat François Pralus Le 100 per cent Criollo HK$65 for 100 grams, City’super Another sugar-free, cocoa-only offering, this one has a more pleasant feel in the mouth than the Lindt, but it’s still a bitter mouthful, albeit one that disappears quite smoothly. It’s lighter and mellower than expected, probably because of the rare, expensive Criollo beans.

Dolfin Noir 88 per cent de cacao HK$25.90 for 70 grams, City’super This has a surprising amount of sweetness for a chocolate with such a high cocoa content, but still not that much. It comes with a pleasant mouthfeel and a good, rich bitterness, but the latter becomes a little excessive on the aftertaste. Quirky tobaccopouch packaging.

Choco Late Organic Dark Chocolate 70 per cent cacao with Fleur de Sel of Ibiza HK$65 for 70 grams, ThreeSixty Initially has a simple, candyish, fruity flavour but works better as the well-integrated sea salt comes through. Again, not much bitterness.

Divided with a crazy-paving pattern that allows for irregular-size chunks to be broken off easily.

Green & Black’s Organic Dark Chocolate infused with Arabica Coffee – 70 per cent cocoa HK$42 for 100 grams, City’super Has an off-putting crumbly, dry mouthfeel. Very strong, startlingly authentic, highly bitter coffee flavour that totally overwhelms the cocoa. People who prefer very bitter coffee to chocolate will like it.

Vivani Cacao 70 per cent Feine Bitter Orange Organic Dark Noir Fondente Arancia HK$29 for 100 grams, Gourmet Fine Food A lot of bitterness and not much sweetness – the orange flavour is there, but it’s a Seville orange bitterness, and not well integrated.

So what we have here is a very bitter dark chocolate that has a passing acquaintance with an orange.

Photos: Stanley Shin

Endangered Species Chocolate With Hazelnut Toffee – 72 per cent cocoa HK$46 for 85 grams, ThreeSixty Rich, persistent bitter notes but with a balancing sweetness that comes mainly from the little bits of crunchy toffee. Approachable but still dark and complex, this is a good place to start if you prefer sweeter chocolate.

FITNESS/ DIET 9 SWEAT SKIPPING

Jump your way to a better you ......................................................

Jeanette Wang jeanette.wang@scmp.com Rachel Lai Yan-ki is frank about her feelings for exercise: “I don’t like sports at all.”

But under pressure from her mother to take up a physical activity, Rachel, a 13-year-old Form One student at CCC Mong Man Wai College in Kwun Tong, started skipping a couple of years ago. “I picked skipping because I don’t have to be really serious about it. It’s not as demanding as other sports, but it offers a lot of variety.”

A lot of children in Hong Kong seem to share Rachel’s distaste for physical activity. Government statistics from 2009 show that only 34.1 per cent of children

aged seven to 12 had at least 60 minutes of moderate or vigorous physical activity five days a week over a three-month period.

It doesn’t take a genius to know that a lack of exercise, along with ingesting excess calories, leads to weight gain and other negative effects on health and well-being.

But what exactly are Hong Kong children’s views towards physical activity? How do social support, physical environment and school policies influence their feelings towards exercise and their activity levels? And how does exercise impact children’s quality of life?

A groundbreaking study, led by Professor Amy Ha Sau-ching, chairwoman of the Chinese University’s department of sports science and physical education, aims to examine these questions through a skipping programme.

Skipping is a non-intimidating activity that has a low barrier to entry and is good for health.

“Skipping builds muscular strength and endurance,” says Ha, founder of the Hong Kong Rope Skipping Association. “It’s a full-body exercise that can be done individually or as a team.”

It’s also ideal for space- and timecrunched Hong Kong, where the air itself can be unhealthy. Skipping can be done indoors and burns about 150 calories in 15 minutes. “It’s cheap, portable, and you don’t need much space,” says Ha. Her study, titled Coca-Cola Rope Skipping Star Programme: Effect of Rope Skipping on Hong Kong Children, is funded by a HK$230,000

Students at CCC Mong Man Wai College (above and below left) join the skipping programme. Photos: K. Y. Cheng grant from the soft drink maker. It is part of a bigger programme that aims to promote the exercise to more than 13,000 teachers and students through skills courses, developing skipping corners in schools, and staging competitions.

Twenty primary and secondary schools, mainly from Kowloon and the New Territories, were selected to participate in the research study, which started last September and is ongoing. In each school, two classes, or 80 students in total, were randomly picked to go through a four-week skipping programme led by a trained skipping ambassador.

Each school received 100 skipping ropes, which are not only used during physical education lessons, but also placed in a public space to encourage students to skip – even if for only 10 minutes.

Various measurements were taken of the participants: height and weight, physical activity level (measured by an accelerometer worn by each student for five

EAT SMART

Make mine quick, easy and wholesome ......................................................

Jeanette Wang jeanette.wang@scmp.com Nabemono is a popular Japanese hot pot dish typically eaten during winter, but it is a perfect year-round meal for the health conscious, time-strapped or kitchen novice.

No oil is used in nabemono.

Bonito flakes, a dash of sake and a sprinkle of salt are employed to create a flavourful broth known as dashi, and this boiling liquid is used to cook whatever you fancy. This recipe, by Teppan Chiu Japanese Restaurant on Prince Edward Road West, suggests a mixture of seafood and mushrooms, but the variety and quantity of ingredients is really up to you.

The meal is quick and easy to prepare. And let’s be honest: dunking food in water is a cinch for even the most culinarily challenged.

Mixed seafood sake pot Serves 1 1 tbs bonito flakes 50ml water A small bunch of enoki mushrooms 1 piece fresh shiitake mushroom 3 slices carrot 1 piece Chinese cabbage 1 piece Shanghai cabbage 1 ⁄3 stalk leek 1 shrimp 1 Japanese scallop 1 piece salmon 1 piece squid

1 ⁄4 tsp salt 1 1⁄2 tsp sake

• Soak bonito flakes in water for 15 minutes. Strain and set aside.

• Rinse and drain all the ingredients.

• Trim the enoki and shiitake mushrooms. Slice cabbage and leek into strips.

• Blanch all ingredients and place in a small pot. Add bonito flakes, salt and sake.

• Cook over medium heat for 5-10 minutes until done and serve.

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

This is the final recipe in this series.

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

I picked skipping because I don’t have to be really serious about it. It’s not as demanding as other sports, but it offers a lot of variety RACHEL LAI, STUDENT

straight days during school hours), quality of life, and other healthrelated information (through an indepth qualitative interview).

Ha plans to produce a report of her findings by the end of August.

“It’s a great programme, the students really enjoy it,” says Fred Lai Chun-yin, 19, a first-year sports science student at the Chinese

University and rope skipping ambassador to CCC Mong Man Wai College. Fred himself went from 85kg to 68kg over three years just by skipping. “Everyone can skip. I’ve not met anyone who can’t.”

Bruce Lai Pok-man, physical education teacher at CCC Mong Man Wai College, says the programme has had a positive impact on his students.

Providing children with the right toys during playtime can indeed boost their intrinsic motivation to be physically active. A recent study by University of Buffalo researchers in New York found that when children were provided access to active toys – skipping ropes, mini hockey, bean bags and mini indoor basketball – physically active playtime rose by nearly 200 per cent for girls and 42 per cent for boys.

And, perhaps like Rachel, over time a dislike may turn into enjoyment. “I feel very satisfied when I learn new skipping skills,” she says.

10 WELL-BEING Watchmaker Adrien Choux is a fan of adventure racing.

Photo: Nora Tam

FIT & FAB

Time and motion ......................................................

Rachel Jacqueline healthpost@scmp.com Adrien Choux always has his eyes on the clock. As an adventure athlete, he races against time through challenges such as rock scrambling, kayaking, mountain biking and trail running.

Professionally, the Frenchman creates luxury watches under The Chinese Timekeeper, a brand he founded in 2008.

Choux, 31, regularly features on the podium in adventure races in Hong Kong. Among his greatest athletic accomplishments was coming third with teammate Damien Levy in the 2008 City Chase World Championships in Marrakech, Morocco, a race that’s part obstacle course, part scavenger hunt.

One of the challenges in the race involved eating cow’s head, the Moroccan delicacy. “We had to eat everything – the eyeballs, the tongue,” he says. “I still want to puke every time I think about it.”

It’s this bravery and willingness to venture in the unknown that has helped him in his career too. The Chinese Timekeeper was created at

a time when the world’s economy was in crisis and no one believed it could be done.

Choux came up with the idea after recognising an anomaly in the industry: although the world’s luxury watches were developed by Swiss companies, their components were sourced from China and manufactured there. “And 50 per cent of their customers were from Asia,” he adds. He was also inspired after spending several years living and working in China and Taiwan while studying Putonghua.

Further research revealed a rich history of Chinese timekeeping and an illustrious Chinese horologist from the 11th century, Su Song, whose awe-inspiring water driven

Races are a good excuse for me to get outdoors. I don’t just fit them in, they have become my weekend

astronomical clock tower became the brand’s muse.

After two years of design and development, he launched his first collection in Hong Kong in late 2010, proudly crafted in China and incorporating Chinese symbology.

“It was just me, my apartment and six watches,” says Choux.

To date, he has sold hundreds of his brand of watches, established a Wan Chai boutique and developed a second collection.

Success has not come without sacrifice. “I have not been to an expensive restaurant in over three-and-a-half years,” he says.

Gone also are the weekend jaunts around Asia and indulging in Hong Kong’s nightlife. But one thing has remained constant, and that’s his passion for sport.

How do you fit adventure racing into your schedule?

When you start your own business it is a 24-7 commitment and you can feel guilty if you’re not at work.

Races are a good excuse for me to get outdoors. I don’t just fit them in, they have become my weekend.

They allow me to have some balance, get an adrenaline kick and are a good way to release stress.

If you could change something about adventure racing, what would it be?

I would like to see more orienteering included. The races in Hong Kong are so predictable.

Orientation throws a spanner in the works; anybody can get lost. It makes more room for competition.

It’s not just 100 per cent physical, it also requires skill.

Your brand is very innovative; is this reflected in your approach to your sports and training?

I have no sense of direction, so you could say I am very innovative when it comes to orienteering and directions. If you give me a map and it shows that I should go to the left, 99 per cent of the time I will go to the right. I have got lost in every single Action Asia Sprint race I have run. I get distracted; I can never spot the red tags. So yes, I have to be innovative to get to the finish line.

You have a Chinese brand and you are French, what keeps you in Hong Kong?

What keeps everyone here: Hong Kong is probably the best city in the world. It is fast, convenient, simple to set up business and you pay little tax. Then you have the beaches,

mountain and forests. From Wan Chai to The Peak is only a 20-minute run, or in an hour you can be in Stanley or Big Wave Bay. There is no other place like it.

Will sport always be part of your life?

Yes, definitely. They say you can talk with someone for a lifetime and not know them. Or you can play sport them with them and get to know them instantly.

What inspires you more – having a successful business or building a Chinese brand?

Both, they are the same. Yes, I want my brand to be successful and have people queuing up in my store to buy my watches one day. The day that happens, my business will also be financially successful. The money is not the most important thing, but if you build a business and money is not one of your motivations, then forget it. More than anything, my motivation is to build a brand that people are really happy to buy. One of my friends is getting married and she bought my watch as a gift for her husband. This is what inspires me. I convinced one person of my story, and hopefully there will be many more.

WELL-BEING 11 SADDLE UP WEEK 3

Use your head, wear a helmet ......................................................

Guy Haydon guy.haydon@scmp.com Some say you’re not a real cyclist until you’ve fallen or crashed.

While that’s a standard I’d rather not have attained (and would happily still be a “fake” cyclist without the scars), the reality of cycling is you never know when you might hit the deck.

It doesn’t matter how skilled a rider you are. Children, adults and even experienced cyclists can – and do – fall off their bikes. That’s why it’s important to wear a helmet.

It’s a message that Wong Kam-po, top Hong Kong cyclist and 2007 scratch race world champion, hopes to spread through a new cycling road safety campaign by the UN children’s fund Unicef.

The government doesn’t regard cycling as public transportation – only a leisure activity CHAN CHI-KEUNG, HK CYCLING ASSOCIATION

Last month, in his role as Unicef ambassador, Wong stressed the importance of wearing helmets correctly and other road safety skills to 500 children, their relatives and friends in Sha Tin. His message: “Always wear a helmet when cycling: it could save your life.”

The campaign – part of Unicef’s global 2011-2020 Decade of Action for Road Safety – comes as government figures show 2,500 road accidents involved cyclists in Hong Kong last year – up 23 per cent on 2010 and 50 per cent on 2007 levels.

Road accidents last year killed 20 cyclists and injured more than 2,200 others. In the first two months of this year, one cyclist died and 243 cyclists were injured.

A new survey showed only 4.6 per cent of cyclists treated for traumatic brain injuries last year at the Prince of Wales Hospital in Sha

Tin, were wearing a helmet at the time of the accident.

“We are teaching children to protect themselves from being injured while cycling,” Wong says.

“Today in Hong Kong, many families love this sport, and go cycling together. But the chance of having an accident is also becoming higher, because many Hong Kong children still lack safe-cycling awareness.”

Falls and crashes can be due to the rider’s inexperience, lack of skill, or mechanical failure. But crashes can be caused by factors beyond the cyclist’s control, such as road hazards and unsafe motorists.

The Hong Kong government, mindful of road safety concerns, has officially said it “does not encourage cycling in urban areas” and wants cyclists to use New Town cycle ways and country park trails.

This stance has left cycling groups and enthusiasts frustrated.

“There’s a lack of any proper government policy on cycling,” says Chan Chi-keung, a spokesman for Hong Kong Cycling Association.

“The government doesn’t regard cycling as a type of public transportation – only a leisure activity. There are no standards or regulations for the departments to follow when building roads and park areas, so nothing is safe and suitable for cycling.”

Martin Turner is chairman of Hong Kong Cycling Alliance, which last year proposed a harbourfront Hong Kong Island cycle way as a convenient system to link locations from Kennedy Town to Heng Fa Chuen. He says the government should do more for cyclists.

“Hong Kong is fabulously suitable for cycling,” he says. “We live in such a compact city that all the locations you want to go to are close to one another – and easy to get to – by bicycle.’

Tom McGuinness, acting chairman of Hong Kong Mountain Bike Association, says: “The interest and participation in cycling in Hong Kong has exploded in the past few years. It would be great if the government would acknowledge this trend and bring together all the cycling groups and relevant government departments to draft a comprehensive plan and policy.”

Cyclists can ride on- or off-road in Hong Kong, but a helmet is essential. Photo: 2012 Hong Kong Committee for Unicef Many of Hong Kong’s weekend cyclists head to Sai Kung West Country Park, Lamma Island, Shek O, Sunny Bay, Hung Shui Kiu, Chi Ma Wan Peninsula, Tai Mo Shan, Tai Lam Country Park and Ma On Shan. There are rides along water catchments, coastal pathways and closed roads and family pathways at Plover Cove, South Lantau, Tai Po and Tsuen Wan. You can cycle on trails in 10 country park areas, but will need a permit, which is free. For application forms and trail details go to the Agriculture, Fisheries and Conservation Department’s website (afcd.gov.hk) or the Hong Kong Mountain Bike Association website (hkmba.org).

Many trails are challenging, but there are a few that are perfect for beginners, especially children, to

RULES OF THE ROAD Cyclists should always: Wear a helmet. It can save your life.

Check your bike before you go.

Carry a pump and spare inner tube.

Check the route, and ask an experienced cyclist if you’re unsure.

Carry lots of water, and a mobile phone for emergencies.

Ride with friends. Never go alone.

Obey road traffic rules.

Tell others where you’re going.

learn to cycle off-road. South Lantau’s water catchment’s maintenance road is open to bikers and offers 20 kilometres of largely flat, traffic-free riding.

Clear Water Peak Trail, starting at Ng Fai Tin in the New Territories, takes about an hour, and offers fine sea views. It is closed to bikers on Sundays and public holidays.

Tai Lam Country Park has Hong Kong’s most popular and biggest range of bike trails. The gentle 30-kilometre route around the edge of Tai Lam Chung reservoir, which takes about two hours, offers great views and is good for novices.

All of Wan Tsai Island, in Sai Kung, is designated as a mountain bike site. Its relaxing trail, through shaded woods, starts from Hoi Ha village and is perfect for beginners.

THE TASTE TEST RICE ......................................................

Jeanette Wang jeanette.wang@scmp.com

Lundberg Golden Rose Brown HK$49.90 for 907 grams, Gourmet Fine Food This premium medium grain rice, which hails from California’s Sacramento Valley, is certified US Department of Agriculture organic.

It takes about 50 minutes to cook on the stove, compared with just 10 minutes for the two other varieties.

Verdict: has a mild sweet flavour and is moist, yet with good bite; unlike typical brown rice varieties that can be tasteless, dry and hard.

SunRice Doongara Clever Rice White Long Grain HK$35.20 for 750 grams, Gourmet Fine Food Who knew rice had intellect? This variety claims to remain fluffy even if overcooked. It’s also has a lower glycemic index than most Australian rice, so it is digested more slowly, providing a sustained energy release.

Verdict: lacks fragrance and a tad sticky, but after my deliberate attempt to overcook it by a couple of minutes, it indeed remained plump and fluffy.

Waitrose Organic Basmati Aromatic Rice HK$36.90 for 500 grams, Gourmet Fine Food This long-grain variety is known as “the prince of rice”, which flourishes in “the Himalayan foothills, where fertile soil, snow-fed streams and the purest air combine to produce a splendid rice”. Basmati is said to have a medium glycemic index.

Verdict: aromatic, delicate flavour and fluffy. Firm and separate when cooked, not sticky.