20120703 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, JULY 3, 2012

Illustration: Man Wai-Yee

Male order babies

Would-be parents go abroad to choose gender of child

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COMMON CYCLING INJURIES

CONNECTIONS: BRAINS AND BONES

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2 NEWS APP OF THE WEEK

HEALTH BITES

Making sure you’re never ‘out’

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Five million ART reproductions Assisted reproduction technologies (ART), which have been giving infertile couples the chance to have children for 34 years, have reached a milestone: five million births achieved through in-vitro fertilisation and intracytoplasmic sperm injection. The figure, from the International Committee for Monitoring Assisted Reproductive Technologies, was announced at a meeting in Istanbul, Turkey. The number of ART cycles performed is rising: it’s now about 1.5 million annually, producing 350,000 babies. The two most active countries are the US and Japan, but the most active region by far is Europe with 537,287 treatment cycles in 2009. The pregnancy rate from a single “fresh” treatment cycle is said to have stabilised at about 32 per cent. “This technology has been highly successful in treating infertile patients. Millions of families with children have been created, thereby reducing the burden of infertility,” says Dr David Adamson, the committee’s chairman. Britain’s Louise Brown was the world’s first ART baby, born on July 25, 1978.

Katie McGregor healthpost@scmp.com The Tennis App Free Rating 8/10 Wimbledon is regarded by many as the most prestigious of the four Grand Slam tournaments. As it enters its second week and the finals approach, you can be sure that fans the world over are developing a renewed interest in the sport, and even in getting onto the courts to play a little tennis themselves.

The Tennis App was devised by the Bryan brothers to be “the” tennis app. The twins, Bob and Mike, have won 11 Grand Slam doubles titles and are seeded number two for Wimbledon. They lost out at the recent French Open in their bid to claim a record 12th title.

With all that fame behind the American siblings it is a pleasant surprise that this app is free.

When you first use the app, besides the buttons for news, rankings, scores and shopping, you will see a section to download training videos.

Cynical me immediately thought: “Oh yes, free until you have to pay to download content.” But it’s all free, and the concept is to save space on your iPhone; you only download what you need.

The videos are broken down to cover specific shots, and within each lesson, for example “Forehand Top”, you’ll find further videos that break the shot down by viewing angle, and then go into the components of the shot.

A sliding bar allows you to slow the video speed so you can try to better understand the action.

Descriptive captions provide even more information.

Left-handed players have also

been considered and by adjusting the settings, videos are flipped so they are shown from a left-handed perspective.

There are 12 lessons available for download plus a further four sessions with other world-class players such as Jelena Jankovic. You are encouraged to check back often for new training videos.

The news section promises headlines, tweets, and messages, but seems to comprise stories from sources such as ESPN and BBC Sport, and tends to be a day or two behind. Similarly, the “live” matches can be several days old.

To get news hot off the press, I download event-specific apps, such as the Wimbledon app. Finally, for those obsessed with their game, ProTracker Tennis (free) allows you, or your coach, to track a live game by tapping the visual of the tennis court on your iPhone or iPad. This indicates the outcome of each stroke, so that afterwards you can analyse your opponent’s strengths and weaknesses. For most, that will be a stroke too far.

ASK THE DOCTORS DR DESMOND WAI Q: I eat a diet rich in fruits, vegetables and whole grains, but I suffer from frequent gas and bloating, and can’t help wondering if I’m overdosing on fibre. Is this possible?

A: Fibre offers a lot of health benefits. It increases bulk of the faeces and helps move the bowels. It slows down digestion and absorption of glucose, thus reducing the spike of the insulin level in the blood and can help reduce the risk of developing diabetes mellitus.

Some studies even suggest that a diet high in fibre can help reduce the risk of colon cancer. A high-fibre diet can also make a person feel full sooner, helping to reduce total calorie intake.

In fact, many health professional bodies, such as the American Diabetic Association and the American Heart

Jeanette Wang jeanette.wang@scmp.com

Association, recommend a daily intake of 25-30 grams of fibre.

However, too much fibre can lead to excessive bloating and constipation. For patients with excessive bloating after eating fibre, it is advisable for them to reduce the amount of beans or legumes.

Fibre should be accompanied by an adequate oral intake of fluid. A diet rich in fibre but without adequate fluid intake may cause constipation.

Last but not least, abdominal bloating and flatulence may be symptoms of digestive disorders such as irritable bowel syndrome, inflammatory bowel disease, etc. Do consult a specialist to get properly diagnosed and treated.

Dr Desmond Wai is a gastroenterologist 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.

Cancer drug on trial A Hong Kong biotechnology company has achieved a breakthrough with a drug it has been developing since 2001 for the treatment of liver cancer. The drug, BCT-100, has obtained approval from the US Food and Drug Administration to commence human clinical studies in the US – a first for a home-grown drug. Using recombinant DNA technology, the research team produced an enzyme that could deplete an amino acid called arginine, which is necessary for the growth of liver tumours. A phase I clinical study in 2008, which was conducted at Queen Mary Hospital and published in the Journal of Investigational New Drugs, indicates that BCT-100 is well tolerated and safe. With the FDA approval, a new phase I clinical trial will be initiated at Loma Linda University in California at year’s end to evaluate its efficacy against a variety of cancer types.

Painless pins Tired legs? You could get a massage, but for a portable solution, Algotherm’s Tonic Spray (HK$360) promises to tone and relieve your pins and provide a longlasting cooling sensation. The active ingredient is palmaria palmata, a seaweed that’s said to be rich in vitamins A and B12, which regulate blood flow and encourage elimination of water and toxins that cause tired legs. Other ingredients include menthol and rosemary essential oil. Get it at The Strand Hair and Beauty Salon in Cochrane Street, Central. www.thestrandhk.com

Secrets of a longer life Restricting your diet is not enough to help you live longer; physical activity counts, too. Researchers at Buck Institute in California studied fruit flies and found that those on dietary restriction shifted their metabolisms towards increasing fatty acid synthesis and breakdown, specifically in muscle tissue. “Our work argues that simply restricting nutrients without physical activity may not be beneficial in humans,” says Professor Pankaj Kapahi, a researcher on the study, published today in Cell Metabolism. Another finding: a potential target that could yield a drug that mimics the effects of dietary restriction. Lead author Dr Subhash Katewa of the institute says flies genetically engineered to overexpress a circulating peptide showed increased fat metabolism, spontaneous activity and extended lifespan even though their diet was unrestricted. The peptide plays a critical role in glucose and lipid metabolism. “These results suggest that enhanced fat metabolism could help slow ageing and age-related disease,” says Katewa.

NEWS 3 NUTRITION

QUIZ

Two studies on drinking coffee indicate actual health benefits

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Jeanette Wang jeanette.wang@scmp.com Good news, coffee addicts: two recent published studies give you more excuses to have a java jolt more than once a day. Coffee consumption has been found to not only lower one’s risk of developing the most common form of skin cancer, basal cell carcinoma, but also reduce one’s risk of heart failure.

But just how much should you drink? The first study, published in Cancer Research in Britain, does not set a limit. “Our results indicate that the more caffeinated coffee you consume, the lower your risk of developing basal cell carcinoma,” says Han Jiali, the study’s lead researcher and associate professor at Harvard Medical School.

The study analysed data of nearly 113,000 people tracked over more than 20 years. An inverse association was seen between coffee consumption and intake of caffeine (from coffee, tea, cola and chocolate) and risk of basal cell carcinoma. But consumption of decaffeinated coffee didn’t produce the same link.

Han says other conditions that have an inverse relationship with increasing coffee consumption include Parkinson’s disease and type 2 diabetes. But, he adds, “I would not recommend increasing your coffee intake based on these data alone.”

The second study advises moderate coffee consumption – four Northern European servings per day, or about two typical 237ml American servings – may significantly lower risk of heart

failure by as much as 11 per cent.

Indulging, however, may be linked with an increased chance of developing serious heart problems.

Researchers from Beth Israel Deaconess Medical Centre in Boston analysed previous studies on the link between coffee intake and heart failure in this study, published in Circulation Heart Failure.

Combined, the studies included 6,522 heart failure events among 140,220 men and women. There was, however, no indication on brew strength and differentiation between caffeinated and decaffeinated coffee.

“There are many factors that play into a person’s risk of heart failure, but moderate coffee consumption doesn’t appear to be one of them,” says Elizabeth Mostofsky, lead study author. “This is good news for coffee drinkers, of course, but it also may warrant changes to the current heart failure prevention guidelines, which suggest coffee drinking may be risky for heart patients. It now appears that a couple of cups of coffee per day may actually help protect against heart failure.”

CHRONIC PAIN

‘Talking’ brain creates the pain ......................................................

Jeanette Wang jeanette.wang@scmp.com Pain, it seems, is really all in the mind. A new study by Northwestern University’s Feinberg School of Medicine shows for the first time that chronic pain develops when two sections of the brain – related to emotional and motivational behaviour – talk to each other. The more communication between the frontal cortex and nucleus accumbens, the greater the chance a patient will develop chronic pain.

“For the first time we can explain why people who may have the exact same initial pain either go on to recover or develop chronic pain,” says A. Vania Apkarian, professor of physiology at Northwestern and senior author of the paper published in the journal Nature Neuroscience.

“The injury by itself is not enough to explain the ongoing pain. It has to do with the injury combined with the state of the brain. This finding is the result of 10 years of research.”

The study involved 40 participants who had an episode of back pain, diagnosed by a clinician, that lasted four to 16 weeks – but with no prior history of back pain.

Brain scans were conducted on each participant at the beginning of the study and for three additional visits during one year.

The researchers were able to predict, with 85 per cent accuracy at the start of the study, which participants would go on to develop chronic pain based on the level of interaction between the frontal cortex and nucleus accumbens.

The latter is an important centre for teaching the rest of the brain how to evaluate and react to the outside world, Apkarian says, and it may use the pain signal to teach the rest of the brain to develop chronic pain.

The more emotionally the brain reacts to the initial injury, the more likely the pain will persist after the injury has healed.

Based on this work, researchers hope to develop new therapies for chronic pain treatment.

Jeanette Wang jeanette.wang@scmp.com A new hi-tech approach to cataract surgery introduced to Hong Kong about three months ago is said to be safer and more efficient than the traditional manual method.

Femtosecond laser technology uses a near infrared light to create precise subsurface cuts on the cornea. It has been used to successfully treat 120 cataract patients in the city so far, according to Dr Jean Paul Yih, an ophthalmologist at the Hong Kong Eye Day Surgery Centre, one of two centres that offer the surgery in Hong Kong.

Dr Vincent Lee Wing-hong, an ophthalmologist at Hong Kong Laser Eye Centre – the other centre that does the surgery – says the use of the laser “diminishes the risk of complications and trauma after operation, and wounds recover faster than before.”

Traditional cataract surgery is typically an outpatient procedure that involves the surgeon making cuts in the patient’s eye, aided by a microscope. Though complications are rare, when mishaps happen they are usually during the incision or slicing process, says Lee. Femtosecond laser surgery replaces the key steps in traditional cataract surgery. “It is a very good way to increase the predictability

and safety of the procedure – other than hiring a very good surgeon.”

The laser cuts the eye’s lens into small pieces, so that less energy is needed to make the fragments tiny enough to be removed with suction. Less ultrasound energy means less trauma to the eye.

Cheng Kam-sik, 74, had his left eye fixed with traditional cataract surgery two years ago. Recently, his right eye was treated using the new surgery, and Cheng says he felt safer and more comfortable during the procedure.

Each year, 10 million cataract surgeries are performed around the world. In Hong Kong, an ageing population means the number of cases is on the rise.

Most patients will be able to undergo the surgery, says Lee, except in certain rare cases due to anatomical issues such as having small pupils.

1. What causes cataracts? a. diabetes b. ageing c. medications (such as steroids) 2. A common symptom of cataract is a. cloudy or blurry vision b. poor night vision c. double vision 3. As the clear lens slowly colours with age, your vision gradually may acquire what type of shade? a. green b. red c. brown 4. If you have advanced lens discolouration, you may not be able to identify which two colours? a. blue and purple b. orange and red c. grey and black Answers: 1. all are correct; 2. a; 3. c; 4. a.

4 MEDICAL CASE HISTORY

Feel it in your bones Scooping up an armful of exercise books and sitting at his desk for long hours was all in a day’s work for 35year-old Jason Wang, a secondary school language teacher.

Day after day, he would pick up or hand out assignments while balancing a heavy load in his other arm. When he was not teaching, Wang (name changed for patient confidentiality reasons) would be hunched at his desk for hours on end, grading stacks of assignments and tests.

While the hardworking Wang gave little thought to these habits, they were creating undue stress on his neck muscles, cartilage and bone. After more than a decade of repeated neck strain, Wang developed a persistent neck pain.

To relieve the discomfort, he turned to massage, physiotherapy, acupuncture, moxibustion and other forms of therapy. However, not only did the pain not go away despite his efforts, it spread to his left shoulder and shot down his arm to his fingertips.

After two years searching for a remedy, the pain suddenly intensified. It was so severe Wang could not sleep. He also experienced weakness in his left arm.

Wang bore the severe pain for two months before he finally sought medical attention from Dr Mak Kanhing, a specialist in orthopaedics and traumatology at the Hong Kong Sanatorium and Hospital.

Magnetic resonance imaging and X-ray scans showed that the bones in Wang’s neck (collectively known as the cervical spine) were degenerating in a condition called cervical spondylosis or arthritis of the neck.

Wang’s decade-long poor posture and bad work habits strained his neck muscles. As these muscles grew fatigued from the prolonged stress, the pressure then transferred to the bones, says Mak. The cervical spine is made of seven pieces of bone called vertebrae that are stacked on top of one another. In between the vertebrae are shock-absorbing cushions called the intervertebral discs. These discs also give some elasticity and flexibility between the vertebrae. The spinal cord, which is composed of millions of nerve fibres, runs through a hollow within the vertebrae.

In Wang’s case, the pressure that transferred to the vertebrae affected the proper circulation of nutrients

People who work at jobs that keep their necks in a fixed and strained position are most at risk for cervical spondylosis

around the intervertebral discs. This essentially starved some of the discs to the point that they started to degenerate early and desiccate.

As the discs dry out, they lose height and the space between the vertebrae starts to narrow, resulting in extra stress and friction between the bones. This also causes the cartilage that protects the bones to wear out.

The excessive stress causes pulling on the “skin” or surface of the bone, says Mak. In response to the excessive movement, the vertebrae start to grow new bone called osteophytes, or bone spurs.

The additional bone formation encroach on the space occupied by the nerves and can impinge on the nerves themselves.

In Wang’s case, the discs between his fifth and sixth vertebrae, and between his sixth and seventh vertebrae, were badly degenerated.

Mak proposed surgery to remove what was left of the two desiccated intervertebral discs and fuse the fifth and sixth bones, and the sixth and seventh cervical bones. This way, there would be no movement between those two pairs of vertebrae, thereby removing the cause of osteophyte growth.

The offending bone spurs that were now impinging on Wang’s nerves and causing him such distress could also be removed.

The surgery only involved a small incision to the left side of Wang’s neck.

As Wang had tried every other form of conservative therapy and failed to find relief, he agreed to the surgery.

The surgery proceeded smoothly and six months later, a follow-up X-ray showed that Wang’s fifth and sixth bones, as well as the sixth and seventh vertebrae, had fused beautifully. Most of Wang’s range of neck movements had been retained, while the pain that had plagued him for years was finally gone. In comparison to the debilitating pain of the past, the little numbness that now remains in Wang’s finger barely registers in his consciousness.

Mak says that people who work at jobs that keep their necks in a fixed and strained position are most at risk for cervical spondylosis.

Taxi drivers and office workers in particular should give themselves short breaks every hour to relax and stretch their neck muscles.

Ho

Eileen Aung-Thwin healthpost@scmp.com

Illu str ati on :A ng ela

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MEDICAL 5 TRADITIONAL CHINESE MEDICINE

Answer on the tip of your tongue ......................................................

Elizabeth Snouffer healthpost@scmp.com The eyes are the windows to the soul, says the adage. In traditional Chinese medicine, though, it’s the tongue that gives insight into the overall physical status of the body, otherwise known as zheng.

Now, in a modern update to the ancient practice, University of Missouri researchers, working in collaboration with Beijing’s Tsinghua University, have developed computer software that does tongue analysis to warn of disease.

Based on this software, the researchers aim to create an application for smartphones within the next year that will allow anyone to take a photo of their tongue and learn the status of their zheng. This could help both practitioners and patients better predict or prevent disorders and chronic conditions.

“Zheng is an overall description of health, similar to how Westerners look at body temperature and blood pressure to gauge physical status.

Zheng is of a similar spirit,” says Professor Xu Dong, chairman of Missouri’s computer science department in the college of engineering and study co-author.

“In a healthy state, your zheng is balanced, and if you exhibit abnormal features, such as a discoloured tongue, your zheng is unbalanced.

“Knowing your zheng classification can serve as a prescreening tool and help with

preventive medicine. Our software helps bridge Eastern and Western medicine, since an imbalance in zheng could serve as a warning to go see a doctor.”

Chinese medicine practitioners believe the colour and texture of the tongue is a mirror of internal organ health. The software analyses images based on the tongue’s colour and coating to distinguish between tongues showing signs of “hot” or “cold” zheng.

Shades of red and yellow are associated with hot zheng, whereas a white coating on the tongue is a sign of cold zheng. Hot and cold zheng don’t refer directly to body temperature; they point to a combination of symptoms associated with the state of the body as a whole, says Xu. A person with cold zheng, for example, may feel chills and coolness in the limbs and have a pale face. Their voice may be highpitched. Other symptoms of cold zheng are clear urine and loose stool.

They may also prefer hot food and drinks, and desire warm environments.

Both hot and cold zheng can be symptoms of gastritis, an inflammation of the stomach lining often caused by bacterial infection.

In the study, published in the journal Evidence Based Complementary and Alternative Medicine in May, the researchers analysed the tongues of 268 gastritis patients and 48 healthy patients using their new software.

The gastritis patients were classified by whether they showed

Software would analyse the zheng on this girl’s tongue, dealing with texture, coating, colour and shape. Photo: Corbis infection by a certain bacteria, known as Helicobacter pylori, as well as the intensity of their gastritis symptoms. In addition, most of the gastritis patients had been previously classified with either hot or cold zheng. This allowed the researchers to verify the accuracy of the software’s analysis.

“The study results had the software classifying patients with an accuracy rate of about 80 per cent, which is an excellent performance,” says Xu. The software was able to discern healthy from unhealthy patients as well as discriminate between hot and cold zheng.

Xu and his team believe the tool could be a useful predictor of one’s physical status and as a prescreening tool for many conditions.

“Unlike today, the image will provide a permanent and objective record for the doctor and the patient to access and evaluate,” says Xu. The first market launch for the application will be in the US within a

PROFESSOR XU DONG, UNIVERSITY OF MISSOURI

year. “Initially the software application will be used for entertainment with a disclaimer stating the predictive nature of the software is for consumer knowledge and fun only,” Xu says.

The smartphone app will be a pilot with the goal of a launch for the professional Chinese medicine market once the software is finetuned to 100 per cent accuracy.

“We want to build a threedimensional image of the tongue that can evaluate the texture or coating, colour and shape,” Xu says.

“So far we have collected hundreds of tongue images.”

The research team believe their software will not only determine overall health related to digestive disorders, but also indicate risks for diabetes, heart disease and other chronic conditions. In this way, the application could be an early step in standardising tongue analysis, which may also help to advance TCM theory scientifically.

Early targets of the treatment are melanoma and squamous cell carcinoma (two of the most common types of skin cancer), the common inflammatory skin disorder psoriasis, diabetic wound healing, and epidermolytic ichthyosis, a rare genetic skin disorder that has no effective treatment. Other targets could even include the wrinkles that come with ageing skin.

Professor Chad Mirkin, co-senior author of the paper and director of Northwestern’s International Institute for Nanotechnology, first developed the nanostructure platform used in this study in 1996.

The technology is now the basis of powerful commercialised medical diagnostic tools, but this is the first sign that the nanostructures

naturally enter the skin. In the study, the nanostructures were combined with a commercial moisturiser and then applied to the skin of mice and humans.

They were designed to target the epidermal growth factor receptor (EGFR), a biomarker associated with a number of cancers.

In both cases, the drug penetrated the skin very deeply, with cells taking up 100 per cent of the nanostructures. They selectively knocked down the EGFR gene, decreasing the production of the problem proteins.

After a month of continued application, there was no evidence of side effects, inappropriate triggering of the immune system or accumulation of the particles in organs.

In a healthy state, your zheng is balanced, and if you exhibit abnormal features, your zheng is unbalanced

MEDICAL TECHNOLOGY

I’ve got you under my skin ......................................................

Jeanette Wang jeanette.wang@scmp.com Treating skin cancer and skin conditions could soon be as simple as slathering on moisturiser. In a ground-breaking study published online yesterday in the Proceedings of the National Academy of Sciences, researchers at Northwestern University in Illinois show the use of commercial moisturisers to deliver gene regulation technology.

Topical delivery of such technology to cells deep in the skin is extremely difficult because of the skin’s formidable defences. But the researchers have found a way to take advantage of drugs consisting of nucleic acids – spherical structures each about 1,000 times smaller than

Cross section of human skin.

Photo: David Phillips

the diameter of a human hair. These acids are able to bind to natural proteins that allow them to traverse the skin and enter cells.

Applied directly to the skin, the drug penetrates all of the its layers and can selectively target diseasecausing genes while sparing normal genes. Once in cells, the drug simply flips the switch of the troublesome genes to “off”.

“This allows us to treat a skin problem where it is manifesting – on the skin,” says co-senior author Dr Amy Paller, chief of dermatology at Northwestern’s Feinberg School of Medicine and director of Northwestern’s Skin Disease Research Centre. “We can target our therapy to the drivers of disease, at a level so minute it can distinguish mutant genes from normal genes.”

6 COVER STORY

Family

planning

Gender selection is illegal in Hong Kong, so couples travel abroad to choose the sex of their child, writes Elaine Yau

Alfred Siu Wing-fung and his wife Tina Fong run a company which arranges for clients to go abroad to choose the sex of their children. Photo: Nora Tam

M

iss Chan, who has a daughter, did not want to leave anything to chance when she decided to have another child a year ago. For a foolproof way to conceive a boy, she turned to a local consultancy which arranges for couples to undergo gender-specific artificial insemination in Thailand and US. After spending HK$180,000 and 10 days in Bangkok, the 26-yearold’s wish came true six months ago.

“I had a test after returning from Thailand, and it confirmed that I’m carrying a boy. All the money and procedures are worth it as my mother-in-law wants a grandson very much,”she says.

Chan’s treatment consisted of invitro fertilisation and preimplantation genetic diagnosis (PGD) – also known as embryo screening – which tests embryos for genetic diseases and gender.

Gender selection is illegal in Hong Kong, so couples must travel to have the treatment in the US, Thailand, South Africa and the Middle East, the handful of countries where the process is legal.

Consultancies serving as middlemen between local couples and hospitals overseas say more people are turning to them to get a baby of their preferred sex.

One such consultancy, Eden Marriage Registry, offers celebrant services and fertility treatments like egg freezing for career-oriented young women and gender selection services. Its managing director Alfred Siu Wing-fung says it has served over 100 people since it started offering the gender selection services three years ago.

“Many people came to us last year as they wanted to give birth to a baby in the year of the Dragon.

Traditional Chinese culture prefers boys to girls. As the process is outlawed on the mainland, we get many clients from there.

“We have also served overseas couples. While they might not prefer male offspring like the Chinese, they want gender selection services for family balance.”

Siu’s consultancy acts as the overseas representative of hospitals in the US and Thailand which have years of experience offering gender selection services. He says most locals and mainlanders tend to favour Thailand over America because of the ease of travel. “The more stress-free the experience, the higher the chance for conception.”

Success depends on the woman’s age. Siu says 75 per cent of those aged under 35 succeed on the first attempt, while only 50 per cent of those aged over 35 do. “While PGD using DNA analysis can deliver 100 per cent success rate for gender selection, we cannot guarantee that women can conceive successfully on first attempt, especially those more advanced in age.”

The procedure starts with a series of daily injections for about 10 days to stimulate the ovaries into producing a number of egg follicles.

This is to ensure the availability of multiple eggs for fertilisation prior to gender selection. Next, patients are put under general anaesthesia for egg collection.

The harvested eggs are fertilised with semen to form embryos in the laboratory. The hospital’s embryologists will differentiate the gender of individual embryos using PGD. The embryos can also be tested for genetic defects. Finally, the gender-specific embryos are transferred from the laboratory to the uterus using a small catheter.

Of the gender selection treatments available, only PGD is close to 100 per cent accurate. The sex of a baby is determined at the moment of conception by the sex chromosomes X and Y present in the egg and sperm. In PGD, a single cell from an embryo that is three-tofive days old is removed to allow its genes and chromosomes to be analysed. Only embryos carrying the gender-specific chromosomes are implanted into the uterus.

Siu says the treatment costs HK$220,000, which includes lodging and accommodation in Thailand.

But most patients will pay an extra HK$50,000 to get a 100 per cent

success guarantee. “The more fertilised eggs are implanted into the uterus, the higher the success rate [for conception].

“But it’s illegal to implant more than three embryos. For those who pay the total HK$270,000, we will try until they get the baby of their preferred sex.”

In Hong Kong, the Human Reproductive Technology Ordinance, in effect since August 1, 2007, states that no person shall, by means of a reproductive technology procedure, cause the sex of an embryo to be selected, whether directly or indirectly.

Gender selection can be conducted only to avoid a sexlinked genetic disease. At least two registered medical practitioners must state in writing that the selection is for that purpose and the disease would be sufficiently severe to justify such selection.

The Council of Human Reproductive Technology did not respond to queries on whether middlemen in Hong Kong offering such services are covered by the law,

COVER STORY 7

but a spokesman with the council says any person who contravenes the law is liable, on first conviction, to a fine of HK$25,000 and six months in prison.

Siu says their services are not in breach of the law as “all transactions involving payment are conducted outside Hong Kong”.

Several exclusive clinics in Hong Kong also offer similar services, referring clients to overseas hospitals, he adds.

Solicitor Wong Kwok-tung says it’s difficult to prosecute such middlemen as there’s no precedent for charging them. “The wording of the ordinance is controversial.

The ordinance does not state clearly what parties are covered and in what places it will be applied,” he says.

Overseas fertility treatments sought by locals who want to circumvent the reproductive ordinance have stirred up much controversy recently following the police investigation of Henderson Land Development vice-chairman Peter Lee Ka-kit who reportedly

Overseas couples might not prefer male offspring like the Chinese. They want gender selection for family balance ALFRED SIU, EDEN MARRIAGE REGISTRY

used a commercial surrogate to deliver triplet sons in the US. Siu says the fact that the investigation was eventually dropped meant that their services are legal. Although such services might not constitute a legal transgression, gynaecologist Loong Ping-leung says there are health risks involved in such procedures.

“Women who get injections to induce ovulation are more likely to give birth to twins or triplets. The likelihood of women suffering from complications from carrying multiple foetuses is higher than those who conceive naturally,” Loong says.

“The injections may make the women produce too many eggs which can lead to enlarged ovaries and ovarian bleeding. In serious cases, a patient’s life can be at risk.”

Ovarian hyperstimulation syndrome is particularly associated with injection of a hormone called human chorionic gonadotropin (hCG) which is used to trigger ovulation and increase the chances of pregnancy.

Tina Fong, 31, Siu’s wife who co-runs the registry, says there are no risks involved in the treatment so long as patients are properly monitored by professionals. The treatment helped Fong conceive her daughter, now 18 months old. (Siu has three sons with his ex-wife.)

“Every medical process comes with risks,” says Fong. “There’s a case in 2011 when a woman fell ill after receiving treatment at the Union Hospital. She was given too many injections for ovulation and suffered from ovarian overstimulation. She eventually had to get one of her ovaries removed. It was a medical blunder. However, if the process is monitored well, there are no risks involved.”

Loong, who helped draw up the Human Reproductive Technology Ordinance as a former member of the Council of Human Reproductive Technology, says the act of gender selection is unethical.

“A baby’s gender should be designed by nature,” Loong says.

PGD has aroused much controversy since it became

available at the start of the 1990s. A 2006 survey carried out by Johns Hopkins University’s Genetics & Public Policy Centre in Washington, DC found that almost half of US fertility clinics that offered PGD had done so for non-medically related sex selection.

Nearly half of those clinics said they would only offer sex selection for a second or subsequent child.

But ethicists worry that use of PGD for gender selection will open the way for designer babies.

Loong say it is unethical to make “designer babies” which are not only free of medical defects but also possess certain desirable traits.

“Artificial tinkering is allowed only for medical reasons. The ordinance lists [around 70] genetic diseases that are exempted.

“Nearly all of the diseases, like muscular dystrophy, are only hidden in the male Y chromosome, which means that they will only pass down to males. If selection is allowed under such circumstances, they can only opt for a female baby.” elaine.yau@scmp.com

8 HEALTH CHRONIC DISEASE

True measure of diabetes ......................................................

Elizabeth Snouffer healthpost@scmp.com A recent survey of 500 Type 2 diabetes patients revealed startling findings: only 9 per cent were able to correctly identify the term HbA1c – the single most important metric for identifying good blood glucose control.

The results of the survey, conducted in April by Hong Kong University’s Public Opinion Programme and commissioned by the Hong Kong Specialist Medical Association (HKSMA), suggest that many patients in the territory may not be receiving optimal care for their diabetes. Hence, patients are at greater risk for microvascular (eye and kidney disease) and macrovascular complications (coronary, peripheral vascular disease).

In response to the survey, the HKSMA and 100 local doctors are supporting the launch of a new patient education initiative called the Target 7 Alliance, which aims to raise patient awareness about achieving good blood glucose control by meeting the target HbA1c level of 7 per cent. This target is linked with as much as a 35 per cent risk reduction for diabetes complications.

The HbA1c test, usually administered in the doctor’s office or diagnostic laboratory every three months, reflects the average of a person’s blood glucose levels over the past quarter and is based on the attachment of glucose to haemoglobin, the protein in red blood cells that carries oxygen. The higher the percentage, the higher the blood glucose level.

Other notable survey findings: only 55 per cent believed their diabetes was in good control, and 35 per cent admitted they were not well informed or knowledgeable about diabetes. More than 20 per cent could not name the types of complications most closely associated with poorly controlled diabetes – blindness, amputations, kidney failure, cardiovascular disease and early death. Over 90 per

Diabetes patient Ada Chan Sum Man-wah never checks her glucose level at home.

Photo: David Wong

10 • The percentage of the population in Hong Kong with diabetes • Of these cases, 97 per cent are Type 2 diabetes

cent of the respondents receive their medical care from public doctors.

Diabetes is a chronic condition where the body is unable to convert sugar into energy for tissue and organ cells, which leads to excessive sugar in the blood. Type 2 diabetes is a reversible metabolic disorder responsible for about 90 per cent of all diabetes cases worldwide, affecting both children and adults.

Type 1 is an incurable autoimmune disease that strikes children, teens, and adults up to age 40. Both types of diabetes are on the rise.

According to the International Diabetes Federation (IDF), 366 million people worldwide have the condition and by 2030 this will rise to 552 million. The Western Pacific region, which includes Hong Kong and China, has the greatest number of patients, totalling 132 million.

Roughly 10 per cent of Hong Kong’s population has diabetes, of which 97 per cent are Type 2.

The Hospital Authority recently introduced six outpatient diabetes clinics in hospitals throughout the city, each manned by a nurse consultant who specialises in diabetes education and care.

“When patients arrive at our clinic, about 70 per cent don’t know their targets for good blood glucose control,” says Maisy Mok, diabetes nurse consultant at the United Christian Hospital.

To help patients become better informed, the Target 7 Alliance will disseminate information through educational posters, leaflets, and a broadcast advertising campaign.

“The HbA1c really tells the big story on how well a patient is doing, while a blood glucose reading on a home glucose meter is a snapshot.

Patients don’t even know the difference and they need to. HbA1c is an important term for patients to know,” says Dr Lo Kwokwing, HKSMA chairman.

According to the American Diabetes Association, diabetes patients require a multidisciplinary team of health professionals, including diabetes educators, nutritionists, and a variety of other physician specialists in order to achieve good blood glucose control.

Further, it is recommended that guidelines and treatment plans are shared with the diabetes patient who must take an active role in managing their diabetes, including modifying diet, initiating an exercise plan, adhering to medication treatment and utilising home blood testing devices as required.

“Diabetes is neglected by a lot of Hong Kong practitioners,” says Lo. “The symptoms resulting from high

HbA1c tells the big story on how a patient is doing; home glucose readings are snapshots DR LO KWOK-WING, CHAIRMAN, HONG KONG SPECIALIST MEDICAL ASSOCIATION

blood sugars are silent and the patients are not given all the information or guidance they need.

Target 7 will help patients become more empowered to demand better treatment.”

Dr Annie Kung, a private physician in Central, believes the HbA1c term isn’t imperative for patient understanding and argues that patients already know the general meaning.

“I think doctors usually explain the HbA1c term as the average sugar index rather than the proper Chinese medical term of HbA1c,” she says. “Indeed, if you ask my patients whether they have heard of Hba1c, they would say no; but if you ask about the average three-monthly sugar index, they will tell you the value. This has been the practice in the past 10-plus years,” says Kung.

Ada Chan, 56, was diagnosed eight years ago. While she never tests her blood sugar at home, she has a test every six months from her

DIET 9

private doctor. “I trust him because he tells me if my control is good or not. I don’t know the name but my sugar was 6.4 [recommended range is between four and seven] last time he checked.”

“I have never heard of a target or an average,” says another patient, Ian Kwan, diagnosed two years ago.

However, Kwan does check his blood sugar twice a week or two hours after he eats a large meal with his home blood glucose meter.

Professor Ronald Ma Ching-wan, president of Diabetes Hongkong, believes the main problem for Type 2 diabetics in the city is the misconception that diabetes is not a serious condition. “Diabetes can lead to blindness or leg amputation if not well controlled, and is also associated with around 30 per cent increase in risk of different cancers.”

However, Ma also knows the challenge doctors face managing patients who are resistant to treatment. “Diabetes requires motivation, and also ongoing support.”

Sarah Dyer Dana, whose 10-yearold son was diagnosed with Type 1 diabetes in 2010, represents the gold standard for managing and living with diabetes. “We’re steadily working toward achieving [the target HbA1c level], but our real focus is on the day-to-day effort to eat well, exercise, count carbohydrates and dose insulin. It’s a constant effort to achieve stable levels and the HbA1c is a periodic insight on how well we’re doing.”

The Health Department says it has given high priority to prevention and control of diabetes primarily through promoting healthy lifestyles. A booklet and patient record have been developed to empower patients to prevent and manage their conditions, says Janet Lam, a Health Department spokesperson.

But Lo doesn’t believe the Health Department is doing enough, with patient wait-times for diabetics up to one year.

Colostrum strengthens the gut lining in mammals. This helps newborns and athletes with heavy training schedules. Photos: AFP, Richard Hamilton Smith/Corbis

SPORTS NUTRITION

More than just gut healing ......................................................

Joanna Moorhead When Team GB member Zoe Smith was described by a newspaper as being “on a special diet of colostrum”, the weightlifter was outraged. “I assure you it’s not true,” she tweeted. “I’m a normal person who eats normal food and the occasional protein shake. Stop making me sound like a colostrum drinking freak!”

Perhaps Smith’s reaction reflects a misplaced distaste for ingesting milk created straight after a cow gives birth, but while she isn’t taking bovine colostrum, plenty of other British Olympic athletes will be – and with good reason.

“It’s not a wonder food,”says Dr Glen Davison, a sports scientist at the University of Kent, southeast England, “but it can be very useful in boosting the immune system, especially during periods of intense physical training and when someone is under a lot of stress.”

Colostrum is produced by all mammals in the first few days after giving birth. This first milk is packed with a huge amount of goodies, including immunoglobulins, antimicrobial peptides and other bioactive molecules including growth factors – a nutritional armoury designed to get a newborn through the critical first few days of life. Its properties have been revered for thousands of years across many cultures: in ancient Chinese medicine it was regarded as a vital health-giving potion, and for the Maasai people of East Africa it has long been regarded as an important part of a healthy diet. In Britain, dairy farmers refer to it as beestings: traditionally, mother cows would be milked after feeding their newborn calves and any surplus colostrum was used to make an extra-creamy, and very healthy, pudding.

Over the past five years it has become an increasingly popular

dietary supplement for many athletes. It is converted into a powder, and added to other drinks and shakes. “Most of the commercially available bovine colostrum here comes from organic cows in New Zealand,” says Davison. “It’s not clear yet what the optimum amount to take per day is, but some studies show benefits from as little as two grams.”

Gastroenterologist Professor Raymond Playford of Plymouth University in southwest England has researched the benefits for athletes of taking colostrum.

“When they are in intense periods of training, many athletes develop gut problems – ‘runners’ trots’ – which can have a serious effect on their performance,” he says. “They’re caused by a combination of stress and by the raising of their body’s core temperature by about two degrees, which seems to increase the permeability of the gut wall and that in turn allows toxins into the bloodstream that wouldn’t usually be there.

“My studies show that this tendency to leakiness increases two- to three-fold during intense exercise, such as the training athletes are undergoing now to get ready for the Olympics. But if they take bovine colostrum for two weeks prior to exercise, the change

in gut leakiness is almost completely prevented.”

Colostrum works because it contains growth factors designed to strengthen the gut lining. That is an important part of its value for a newborn mammal, who will have a very permeable gut and needs it to toughen up fast.

For athletes who fear gastrointestinal problems such as cramps, diarrhoea and nausea, says Playford, pharmacological options to reduce the problems are limited – so there is a lot of interest in a natural product such as colostrum.

However, it’s not just gut problems.

Some of Davison’s studies show that athletes who take it are as much as 20 per cent less likely to get infections of the upper respiratory tract. “Last-minute illness is a real fear for athletes, and colostrum seems to give the immune system a boost to reduce the risk,” he says.

Away from the Olympic stadium, other people could benefit from taking colostrum too. “It could be really useful to people who have to do physical exercise in hot conditions, such as soldiers in Afghanistan,” says Playford. “They are susceptible to heatstroke because of all the gear they have to wear and carry, and taking colostrum could reduce that very serious risk.

Another group who could

benefit are older people with arthritis who develop serious gut problems because of the strong painkillers they use, and those with ulcerative colitis. “These patients are at risk of damage to their gut lining and the colostrum helps it to heal and reduces its permeability.”

Colostrum is sometimes referred to as a “nutriceutical”– partnutrition, part-pharmaceutical.

Crucial for Olympic hopefuls is the fact that – as far as scientists can tell – it doesn’t introduce substances into the body that will give positive results in drugs tests. The International Olympic Committee is monitoring its use.

Jeni Pearce, a nutritionist for Team GB who is currently at the training camp at Loughborough University, central England, says she is aware that some athletes will have used or are using the substance. “Athletes are often on a nutrition programme that has been worked out uniquely for them,” she says. “And within that, colostrum could be useful – especially for those at risk of leaky gut conditions.”

“It seems clear that there are no performance benefits. Colostrum isn’t going to make a competitor go faster or stronger or longer. And it isn’t something they would take as a one-off – it would be part of their diet for a while.”

Guardian News & Media Athletes like weightlifter Zoe Smith (left) could benefit from colostrum

It could be useful to those who exercise in hot conditions, such as soldiers in Afghanistan PROFESSOR RAYMOND PLAYFORD

10 FITNESS SADDLE UP FINAL WEEK

How to break the pain cycle ......................................................

Jeanette Wang and Guy Haydon healthpost@scmp.com Luxembourg’s Andy Schleck was a favourite to win this year’s Tour de France until a fractured pelvis, suffered during a crash at a race last month, forced him out of the threeweek bicycle race.

Of course, injuries are possible even if you’re not a professional cyclist like Schleck. You don't have

to ride fast to get them either. Most injuries tend to be chronic rather than acute, says Adrian Yahvah, a sports and manual therapist with The Body Group in Central.

“Cyclists don’t get a lot of acute injuries because it’s not a contact sport, but repetitive strain injuries do occur because you’re sitting in a crouched position and doing a repetitive motion, usually for long periods of time,” says Yahvah.

In 2005, the journal South

African Family Practice published a report by Martin Schwellnus, a professor of sports medicine and exercise from the University of Cape Town. In it, he cited a survey of more than 500 male and female recreational cyclists in which 85 per cent of respondents reported one or more injuries caused by overuse.

About one-third of these reported injuries were severe enough to warrant medical attention.

The most common sites for

NECK Staying in one riding position for too long usually causes neck pain, especially for those who ride racing bikes that force you to lean forward, says Rufina Lau Wing-lum, clinical associate and registered physiotherapist in Polytechnic University’s department of rehabilitation sciences. Handlebars that are too low or tight hamstrings and/or hip flexor muscles may also cause a rounded back, which puts strain on the neck, says Dr Brian Sennett, expert consultant with the American Orthopaedic Society for Sports Medicine. Weak back muscles or a saddle that’s too high are other culprits.

Prevent it: do shoulder shrugs and neck stretches during and after a ride.

Change your grip on the handlebars to redistribute pressure to different nerves. Get fitted on the bike properly.

LOWER BACK This is usually linked to neck pain and caused by improper bicycle set-up, although chronic lower back pain should be evaluated for other causes (such as intervertebral disc compression) through clinical examination.

Prevent it: adjusting the saddle angle appears to be particularly effective, says Schwellnus. Adjustments to saddle height, and handlebar height, position and length, may also be required. Strengthening the lower abdominals and core muscles, as well as improving flexibility, will help.

overuse injuries: neck (48.8 per cent), knee (41.7 per cent), groin/buttock area (36.1 per cent), hands (31.1 per cent) and lower back (30.3 per cent).

Acute injuries, says Schwellnus, are usually caused by accidents – from a collision with a vehicle, road surface or an obstacle, to mechanical problems with the bike.

Up to 25 per cent can be severe: fractures, dislocations, head and internal injuries.

Head and neck trauma can be fatal, so it’s important to always wear a helmet when cycling.

Compared with acute injuries, chronic problems are much more preventable as they are usually related to improper bike fit, equipment or riding style. Here’s a look at some common repetitive injuries and what you can do to avoid them.

If pain persists, seek advice from a doctor without delay.

WRIST/HAND Cyclists who ride for days in a row are more likely to feel pain, tingling and numbness in the hand – particularly in the ring and little fingers – due to the compression of a nerve caused by the constant pressure and vibration of holding the handlebars, says Yahvah.

Prevent it: ride with your elbows slightly bent so that they act as shock absorbers, and change hand positions during the ride, says Sennett. Be sure that the wrists don’t drop below the handlebars. Use padded gloves and stretch the hands and wrists before riding.

KNEE Two of the most common types of chronic knee pain in cyclists are patellofemoral syndrome (cyclist’s knee) and iliotibial band (ITB) friction syndrome, both characterised by pain around the kneecap. Lau says knee pain can be caused by repeated movement, wear and tear, or riding position.

Prevent it: ride using a lighter gear but pedal faster (as opposed to a heavier gear and lower cadence) to reduce pedal resistance. Yahvah advises increasing strength and flexibility in the hip stabiliser muscles. Shoe implants, wedges beneath the shoes and cleat positions may also help, says Sennett.

GROIN/BUTTOCKS The pressure of the saddle during prolonged sitting can cause the compression of blood supply to the genital region, leading to numbness and pain in the genital or rectal area.

Prevent it: select a saddle of appropriate size and shape for your body, adjust its tilt, and use a good pair of padded bike shorts. “Some people with wide pelvis should sit on a wider saddle so it supports the whole body,” says Lau.

FOOT Shoes that are too tight or narrow are the main cause of numbness and tingling in the foot.

Prevent it: slight adjustments to the shoes, straps or cleats will help. Remove any irregular seams, straps or buckles that may be pressing against your foot.

WELL-BEING 11 THE TASTE TEST MANUKA HONEY PRODUCTS ......................................................

Jeanette Wang jeanette.wang@scmp.com

Illustration: Brian Wang

PERSONAL BEST

Free your mind, see a lumbarjack ......................................................

Noch Noch Li healthpost@scmp.com Most people associate mental health with happiness, balance, stress, and absence of mental or mood disorders. Some resort to medication to lift moods, others to psychological counselling. Few would think of seeing a chiropractor.

Like many people, I associated chiropractors with solving back pain by bone manipulation. I was surprised, therefore, to learn that chiropractors heal not only on the bone level, but by doing so, strengthen the functioning of our nervous system. Given that the nervous system controls just about everything in our bodies – physical, mental and emotional – it doesn’t sound so far-fetched to find a correlation between chiropractic healing and mental health.

The American Chiropractic Association (ACA) explains the practice as “a health care profession that focuses on disorders of the musculoskeletal system and nervous system, and the effects of these disorders on general health”.

There is no medicine involved.

Chiropractors focus on the biomechanics, structure and function of the spine through adjusting the bones with their hands or a mallet-like instrument.

Wrought with depression and anxiety amid other physical problems such as severe migraines and vertigo for the past three years, I

decided to see a chiropractor in Beijing, where I live, to see if we could come up with any new insight into my sufferings.

The consultation started with some scans. The surface electromyography scan checked the amount of electrical activity in my muscles, and the thermal scan measured skin temperature along the spine. An inclinometer measured the range of motions in my neck and back, and a pulsewave profiler recorded the rate of my pulse. A roller down my spine tested my tolerance of pain, and tender spots along the spine. A few X-rays of the spine were taken, from the neck down to the sacrum.

I was shocked to learn my spine was S-shaped, and the vertebrae near my lower waist were almost crushed together. Under normal conditions, there should be space between each vertebra and the spine should be more or less straight viewed from the front, with curves in the neck and waist areas when seen from the side. The thermal scan showed red along the spine, meaning there were subluxations.

According to the ACA, a subluxation is “one or more bones of the spine moving out of position and creating pressure on, or irritating, spinal nerves”. The result is a malfunction and interference with signals travelling from those nerves to other organs and parts of the body. This causes a vacuum of instructions on how to operate, or in some cases, a disruption in daily activities.

New Zealand Honey Co Lemon & Honey Cordial with Manuka Honey HK$86 for 375ml, ThreeSixty Pure honey (62 per cent), pure manuka honey (10 per cent), lemon juice (25 per cent), and apple cider combine for a drink that has vitamin C and antioxidants. Each bottle makes 2.5 litres of drink.

Verdict: served hot, it soothes; cold, it quenches and refreshes.

Autumn Valley Manuka Honey Nuglets HK$39.90 for 100 grams, ThreeSixty These sweets are made with raw sugar cane, glucose, “active” manuka honey (said to have antibacterial properties) from New Zealand, and a touch of natural lemon flavour.

Verdict: throat-soothing, with a smooth, refreshing taste that’s not sickeningly sweet.

Chiropractors believe the body can heal itself given the right conditions. Realigning the spine would not only heal me of physical pain, but also improve my mental and emotional state.

Related scientific research and chiropractic journals claim that subluxations at different parts of the spine are associated with different symptoms, including mental conditions. I was surprised to see that the lower back and the sacrum, where I had a lot of pain, were associated with depression and anxiety, both of which I suffer from.

I had always thought it was muscle soreness from being a couch potato.

Also, my neck and mid-back areas were extremely tense, which could be the reason for my migraines, insomnia and other sleep problems. Chiropractors have worked in mental institutions beside psychiatrists for many years and helped treat patients with attention deficit hyperactivity disorder, depression, schizophrenia and other mood disorders.

Adjustments even when patients don’t feel pain create optimal conditions for the body to regulate itself

Chiropractic healing doesn’t just fix sick people. Adjustments even when patients don’t feel pain create optimal conditions for the body to regulate itself, to reach a balance that is right for each person.

Some people can cope with more stress, others less. It is up to the body to transmit messages through the nervous system in order to process the challenges people face mentally and emotionally.

Chiropractic healing promotes and maximises patients’ mental health before they even experience mental illnesses by allowing the appropriate signals to go through the nervous system without disruptions.

Whether chiropractic healing can cure me of my depression and anxiety remains to be seen. I also see a psychologist who helps guide my thoughts and stop my selfdestructive intentions. I have also been exercising a little more, and I’m finally starting to eat breakfast instead of starving myself until lunch.

With so many factors in play, it is impossible to isolate and identify the direct causes between my occasional uplifts in moods and chiropractic healing.

One must also exercise judgment in trusting a chiropractor, as with any medical practitioner. It is your right to terminate any form of therapy or treatment at any time.

So why not give chiropractic healing a try next time you feel down, stressed and burnt out, especially if you have exhausted traditional remedies?

Nature’s Harvest Organic Apricot & Manuka Honey Good Health Bar HK$8 for 50 grams, ThreeSixty On closer inspection of the ingredients list, I discover that manuka honey makes up only 1 per cent of the entire bar. Most of the bar has a soft, biscuit-like texture, plus a bit of apricot filling.

Verdict: subtly sweet and pretty tasty, but a tad dry.