YOUR GUIDE TO LIVING WELL
TUESDAY, AUGUST 14, 2012
HEALTH POST
Every aching hour A LOOK AT THE AIR THAT WE BREATHE
VITAMIN B12: POWER TO THE PEOPLE
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>PAGE 9
Illustration: Brian Wang
Chronic pain affects thousands in Hong Kong, but help is at hand >PAGE 6
2 NEWS APP OF THE WEEK
HEALTH BITES ......................................................
Stick with it and train the brain ......................................................
Dr Reichel’s IQ Test US$15 Rating 8/10
doing it, I made use of the option to have background music “especially designed to increase concentration”. Within touching distance of the end, on question 58, I lost my concentration for a moment and hit a wrong key, causing the app to close. Trying to not panic, I reopened the app and was relieved that the app recognised the test was incomplete, and allowed me to continue. At the end, you receive your score and the opportunity to review the questions you missed. The app allows you, or someone else, to redo the test, and the final score is kept on a leader board. I got my 16-year-old daughter to have a go, but halfway through she tossed it aside with disdain and returned to Facebook.
Photo: Corbis
Red alert for bowel cancer A study published last week in Cell Reports could explain why red meat is linked to an increased risk of bowel cancer. Scientists at Cancer Research UK have found that high levels of iron – red meat being an excellent source – could raise the risk of bowel cancer by switching on a key pathway in people with faults in a critical anti-cancer gene. Mice with faulty APC genes that were fed high amounts of iron were two to three times likelier to develop the cancer than mice who still had working APC genes. In contrast, mice with faulty genes fed low-iron diets didn’t develop the cancer at all. Study author Professor Owen Sansom of the charity, based in Scotland, says: “The APC gene is faulty in around eight out of 10 bowel cancers, but until now we didn’t know how it causes the disease.” The researchers plan to develop treatments that reduce the amount of iron in the bowel.
Katie McGregor healthpost@scmp.com
They say that repeatedly doing IQ tests will improve your IQ score and make you look like a genius in test-based job applications. They also say that online or app-based tests are tipped to flatter your ego by awarding you a generous result; after all, the developers have nothing to lose. My Dr Reichel’s IQ Test score did not especially flatter my ego, and doing the test is so turgid you have to believe that it is at least close to the real thing. If it improves your IQ, then this is a useful way to spend 45 minutes. Dr Wolfgang Reichel, the introductory text explains, is one of the most renowned IQ experts in Europe and the author of several books about aptitude and IQ tests. This app has 13 sections that test a range of mental abilities from spotting the odd word out, through completing visual and numeric series to memory testing. The questions on the whole, seemed fair, but a section on technical reasoning required that you know some laws of physics – such as levers, gears and magnetism – which is not particularly fair. To do the test, you simply type in your name and age, and then work through the 70 questions, tap in the correction option and keep an eye on the timer. While
Jeanette Wang jeanette.wang@scmp.com
Snore point for behaviour Loud and persistent snoring in preschoolage children has been linked with a higher rate of behavioural problems including hyperactivity, depression and inattention, according to a new study published in Pediatrics. Researchers at the Cincinnati Children’s Hospital Medical Centre surveyed the mothers of 249 children about their kids’ sleep habits and behaviour. Children who snored loudly at least twice a week at the age of two and three had more behavioural problems than children who either don’t snore or who snored at two or three but not at both ages. “The strongest predictors of persistent snoring were lower socioeconomic status and the absence or shorter duration of breastfeeding,” says lead study author Dr Dean Beebe. He suggests doctors routinely screen for and track snoring, and avoid taking a wait-and-see approach.
Q: My uncle has schizophrenia, and I am worried I may have it. Is schizophrenia a hereditary condition?
Photo: Corbis
A: Schizophrenia is a mental disorder characterised by the patients’ inability to tell the difference between what is real and what is not. Those diagnosed may
suffer from auditory hallucinations, paranoia or abnormal emotional responses. No one knows the exact cause of schizophrenia, but there is definitely a genetic factor in many cases. The risk of developing schizophrenia during one’s lifetime is about one per cent for the general population. Having a family history of this illness increases the risk, but this risk is correlated to the closeness of the relationship to the affected person. First-degree relatives (parents and siblings) have the highest risk, but for more distant relatives, such as a cousin or an uncle, the risk is relatively low. You should not worry too much about developing schizophrenia just because an uncle has this illness. Your chances of not getting this illness are significantly higher than getting it. Adrian Wang is a consultant psychiatrist at Dr Adrian Wang Psychiatric and Counselling Care, Gleneagles Medical Centre 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
Rethink on brain dots A common condition in the elderly thought to be a harmless part of the ageing process has been shown by Mayo Clinic researchers to be a disease that alters brain function. Leukoaraiosis is a condition in which diseased blood vessels lead to small areas of damage in the brain’s white matter. The lesions, which show up as bright white dots on brain scans, are common in the brains of people aged over 60, though its extent varies among individuals. Apart from ageing, it is believed high blood pressure may also be a risk factor. Participants in the Mayo Clinic study with moderate leukoaraiosis, though able to perform cognitive tests as well as the control group, showed atypical brain activation patterns, in brain areas involved in language processing and visual-spatial perception. “Our results add to a growing body of evidence that this is a disease we need to pay attention to,” says researcher Dr Kirk Welker.
Photo: Corbis
ASK THE DOCTORS DR ADRIAN WANG
Happy trails for runners If you’re looking for a head start into the world of trail running, or just a seasoned runner seeking a fun weekend, consider the Raidlight Trail Running Festival. To be held on September 22 and 23, this novel training camp on Lantau will consist of three team races, four running clinics, and a beach barbecue and party. Friendly race distances (about four kilometres each) will make even newbies feel at home. So grab a partner, form a team and register at hktrailfest.com. Early bird fees (until tomorrow) are HK$1,080 per team of two and exclude lunch and accommodation; participation is capped at 150 teams.
NEWS 3 FOOD
QUIZ
Berried benefits come to light
Genetics unlocks the fruit fly in all of us
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Jeanette Wang jeanette.wang@scmp.com
Jeanette Wang jeanette.wang@scmp.com
This summer, why not slather on some strawberries instead? A new study shows that the fruit could protect skin cells against the harmful effects of ultraviolet (UV) radiation. This opens the door to the creation of photoprotective cream made from strawberries, say the team of Italian and Spanish researchers behind the study published in the Journal of Agricultural and Food Chemistry. The protective powers are thought to come from anthocyanins, the pigment that gives the fruit its red colour. “These compounds have anti-inflammatory, antioxidant and anti-tumour properties and are capable of modulating enzymatic processes,” says one of the study authors, Dr Sara Tulipani of the University of Barcelona. Scientists added strawberry extract to human skin cell cultures (fibroblasts), which were then exposed to UV light – a dose “equivalent to 90 minutes of midday summer sun on the French Riviera”, says lead author Maurizio Battino. Strawberry extract displayed photoprotective properties in the fibroblasts, increased cell survival and viability, and decreased damage
Fruit flies and humans have more in common than you think – and we’re not talking about being annoying. About 30 per cent of our genes are the same, and our brains are essentially wired the same way, according to Erik Johnson, an associate professor of biology at Wake Forest University in North Carolina. Studies have shown that about 75 per cent of known human disease genes have a recognisable match in the genome of fruit flies. For decades, fruit flies have been workhorses in thousands of studies worldwide. Just this year alone, they have played a role in research into genetic mechanisms and mutations that cause cancer, restless leg syndrome, neurodegenerative disease, kidney stones and addiction. In a paper in Genetics, Wake Forest neurobiologists, led by Johnson, examined how fruit flies (Drosophila) react when confronted with a decreased diet. The research team found that by manipulating a group of hormone-producing cells in the brain called AMP-activated kinase, the blood sugar levels could be controlled. This finding offers potential for research into weightloss drugs and diabetes treatment.
Photo: Bill and Brigitte Clough in the DNA when compared with control cells that had no added strawberry extract. But these are not the only benefits of strawberries. Other recent research has revealed that: • extracts from strawberries positively activate a protein in the body that works to decrease blood lipids and cholesterol, thus reducing the risk of cardiovascular diseases. • eating strawberries reduces the harm that alcohol can cause to the stomach mucous membrane, reducing gastric illnesses and formation of stomach ulcers. • freeze-dried strawberries may slow the progression of precancerous lesions in the oesophagus; it may be an alternative or work together with other chemoprotective drugs for the prevention of oesophageal cancer.
INTELLIGENCE
Brain’s connections matter, too Melissa Healy Measuring human intelligence may be controversial and tricky to do. But like obscenity, we think we know it when we see it. However, a recent study demonstrates a more rigorous way to see and measure differences in intelligence. Connectedness among the brain’s disparate regions is a key factor that separates the plodding from the penetrating. As many researchers have long suspected, intelligence does have a “seat” in the human brain: an area just behind each of the temples called the lateral prefrontal cortex. But researchers writing in the journal Neuroscience found that human behaviour that is very flexible, responsive and capable of navigating complexity requires something beyond a strong and active prefrontal cortex: strong and agile runners must link that seat to areas involved in perception, memory, language and mobility. The researchers estimate that the strength of those connections, as measured when subjects rested between mental tasks, explains about 10 per cent of differences in intelligence among individuals. This measure is a better predictor of intelligence than brain size – a measure that scientists believe may explain about 7 per cent of the variation in intelligence. The study compared functional magnetic resonance imaging (fMRI) brain scans of 78 men and women between 18 and 40 years old with their performance on tests of
cognitive performance that required “fluid intelligence” and “cognitive control”. Tests involved counting backwards from nine, and watching a series of visual images and then indicating whether a single image shown had been among them. The resulting picture is a remarkably simple one: from a single hub in the prefrontal lobes radiates a plethora of brightly lit connections to all corners of the brain. This suggests that when we
Illustration : Corbis
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engage in goal-directed behaviour that requires judgment, sustained attention and flexibility, the two sides of the prefrontal lobe coordinate incoming information, send out commands and keep us on task, says lead author, Dr Michael Cole of the cognitive neuroscience department at Washington University in St Louis, Missouri. McClatchy-Tribune
“The basic biophysical, biochemical make-up is the same [for fruit flies and humans],” says Johnson. “The difference in complexity is in the number of cells. Why flies are so simple is that they have about 100,000 neurons versus the 11 billion in humans.” Scientists at the A*STAR Institute of Molecular and Cell Biology in Singapore have devised a fast and cost-saving way to uncover genetic changes that have a higher potential to cause cancer. Published last month in the journal Genes & Development, the research paves the way for more targeted treatment against cancers, based on specific cancer-linked mutations present. The whole fly genome was genetically screened for genes that could co-operate with a particular mutation associated with aggressive breast and lung cancers in humans.
Several new “co-operating” genes were identified; most have yet to be identified as cancer genes in human or mouse models. How much do you know about fruit flies? Test yourself here. 1. What does the scientific name of the fruit fly, Drosophila, mean? a. Dew-loving b. Fruit-eater c. Honey-tongued 2. Which scientist first used fruit flies in studies of heredity at Columbia University in 1910 and realised its potential importance in genetic research? a. Albert Einstein b. Lazzaro Spallanzani c. Thomas Hunt Morgan 3. Humans taste food using their tongue and sense of smell; the fruit fly not only uses its tongue-equivalent (labial palps), but also what? a. Head and abdomen b. Legs and wings c. Feet and antennae 4. Fruit flies have long-term memory largely based on which sense? a. Smell b. Sight c. Taste
We’re not so different. Photo: Corbis
Answers: 1. a; 2. c; 3. b; 4. a
Illustration: Angela Ho
4 MEDICAL
CASE HISTORY
A diet made to measure ...................................................... Eileen Aung-Thwin healthpost@scmp.com At 33, Mark Teng was riding high. He had a successful business, a loving and supportive family, a romantic relationship and many friends. Teng (whose name has been changed for patient confidentiality reasons) had an appetite for life that was mirrored in his appetite for food. Weighing in at 127kg, he would eat four to five large meals a day. It was no surprise that his childhood nickname was fei jai (fat boy). But Teng received some sobering news when his family doctor told him he had a fatty liver, marginal blood glucose and hypertension that required medication to control. Other than a brief dalliance with a weight-loss drug with temporary results, Teng had never tried to slim down. But now his health was on the line, he knew he had to shape up. His doctor referred him to Flavia U, senior dietitian at the Hong Kong Sanatorium and Hospital. Teng hated the idea of seeing a dietitian because he thought he would be told only about the things he could not eat. In the two weeks before his appointment, wanting to get a head start, he went on a crash diet and ate only fruit and vegetables. He shed 4.5kg. When he finally saw U and proudly reported his success, he was surprised when U expressed concern. “I was worried that he was not getting enough nutrition, and that would affect his metabolism in the long run,” she says.
She explained that a diet that was too low in calories could result in fatigue, headaches and mood swings. Teng admitted that in those two weeks, he had suffered extra thirst, fatigue and headaches. Aside from the immediate discomfort, a very low-calorie diet could also train the body to get used to the reduced intake and start to conserve energy as best it can. When the person eventually starts to eat more or eat normally, the body will absorb more nutrition and hoard the calories so that it will be even harder to lose weight in the future. Furthermore, an unbalanced diet will result in a lack of coenzymes, organic substances that usually contain a mineral or a vitamin that helps balance the metabolism. Teng weighed 119.3kg and was 1.76 metres tall. This gave him a body mass index of 38.5, well over the ideal Asian BMI of 23. (Many Asian countries adopt a lower ideal BMI than the American standard of 25 because studies show that Asian physiques tend to carry more fat.) He was classified as being severely obese. More importantly, his body fat was 38.9 per cent, almost double the ideal of 20 per cent or less for males. U took a careful account of what Teng’s typical food intake had been before the drastic two-week diet. In a typical day, Teng would start with breakfast at a cha chaan teng where he would eat rice noodles and pork chop macaroni. Lunch was a plate of rice with pork chop and sauce but
no vegetables. Afternoon tea was a must, and sweet confections were favoured. Dinner often consisted of two bowls of rice and at least 11⁄2 bowls of meat. The day wasn’t done until he had had instant noodles or some other pre-packed frozen meal for supper. U estimated that Teng ate an average of 3,000 calories a day and sorely lacked fruit and vegetables. She asked about his lifestyle, preferences and food aversions, and found that, in addition to his recently discovered health woes, he frequently had diarrhoea, especially after meals. He also often suffered from colds and flu. U devised a 1,900-calorie plan that enabled Teng to feel sated as well as give him healthy choices that he could easily access. He could still eat meat but in smaller portions, such as eight slices of roast pork. He could still eat at the cha chaan teng, but he had to pick healthier non-fried options such as ham instead of pork chop or luncheon meat. He had to eat plenty of fruit and steamed vegetables, which he eventually grew to enjoy. Two or three times a week, he could indulge in a dessert. Teng had to be vigilant about the amount of sauce he used, however, as gravy contains a lot of fat and salt. U encouraged him to enjoy one “free” day a week where he could eat as he pleased – this helped him to stay motivated and kept him from feeling deprived. She says that controlling a diet too strictly
U devised a 1,900calorie plan that enabled Teng to feel sated as well as give him healthy choices he could easily access
frequently leads to cravings and a failure to sustain weight loss. It can even result in eating disorders such as anorexia and bulimia. Teng was astonished by the “generous” diet plan, but more astounding was the weight loss that followed. The tweaks in his diet led to an unexpectedly rapid weight loss of about 6kg a month. His chronic diarrhoea disappeared, as did the frequent flus and colds. His blood glucose normalised, and the fatty liver and hypertension abated. He no longer needed medication. At the end of six months, he reached his target weight loss of 36kg and his body fat dropped to a healthy 19 per cent. Buoyed by his remarkable – and relatively painless – success, Teng became a poster boy and enthusiastic advocate of a dietitianguided weight-loss plan. He started recommending everyone in his family and circle of friends to see U. In all, he sent about 60 people to her. His girlfriend lost 13kg. His campaign for healthy eating did not end there. Teng influenced his business associates to eat healthier during business lunches. He also created a healthier work environment for his staff by stocking his office pantry with low-fat options such as non-fried noodles, soda crackers and sugarfree drinks. U says that healthy, sustained weight loss is possible if people have a realistic and workable plan and learn to make gradual changes.
HEALTH 5
The choke's on us
Population Figures refer to urban area of each city only Scale
Hong Kong’s air pollution problem
PM10 pollution Annual mean particulate matter in micrograms per cubic metre of air. World Health Organisation guidelines advise a value of no more than 20 µg/m3
Population 10 million 5m
Roadside air pollution set a new record on August 2 with the air pollution index hitting 212 in Central, its highest level ever in Hong Kong with the exception of a sandstorm in 2010. Although local pollution still ranks favourably compared with that of major mainland cities, statistics on the cost of dirty air, both to our health and economy, make for sobering reading.
1m 100,000
Lanzhou
150 ug/m3
What we breathe Particle pollution comprises various components, including acids, organic compounds, metals and dust. Particles of 10 microns (0.01 millimetres) or less in diameter are small enough to pass through the throat and nose and enter the lungs, potentially causing serious negative health affects. 10 microns PM10
Human hair
2.5 microns PM2.5
Urumqi
PM10 particles Respirable coarse particles that are found near roads and dusty industries. Between 2.5 and 10 microns in diameter. PM2.5 particles Fine respirable particles with a diameter less than 2.5 microns. Often seen as smog or haze in the atmosphere.
Beijing
70 microns
Chongqing Wuhan
Tianjin
Xian Chengdu
Particulate pollution in China
100
The smoke clouds represent PM10 pollution levels in select Chinese cities. The size of the cloud shows the relative size of each city’s population. The cloud’s height illustrates that city’s PM10 level.
Nanjing
Natural pollution
Man-made pollution
Carbon monoxide
Lead
Copper
Shanghai
Nausea
Nitrogen oxide Particulate matter
Cardiovascular illness
Ozone
Sulphur dioxide
Skin irritation
Hydrogen fluoride
Carbon dioxide
Cadmium Nitrogen dioxide
Guangzhou
Health impact
Cancer risk Respiratory illness
PM10 this year in Hong Kong WHO guideline (short term)
WHO guideline (annual)
150
Lhasa Nanning
Hong Kong
100 50
50
Jan 1, 2012
Haikou
Aug 1, 2012
Avoidable harm The University of Hong Kong School of Public Health has devised a formula to calculate the number of Hong Kong deaths, hospital stays and doctor visits that could have been avoided in a given period with proper pollution-control measures. Premature deaths (July)
154
150 (Weekly totals)
7,118
8,000 (Weekly totals) 6,000
100
Doctor visits (July)
Hospital bed-days (July)
324,690 300,000 (Weekly totals) 200,000
4,000 50
100,000
2,000
Jul 12 to 18
Jul 19 Jul 26 Aug 2 to 25 to Aug 1 to 8
Sources: National Bureau of Statistics, WHO, HKU, USEPA, Demographia, Hedley Environmental Index, MIT, Reuters
Jul 12 to 18
Jul 19 Jul 26 Aug 2 to 25 to Aug 1 to 8
Jul 12 to 18
Jul 19 Jul 26 Aug 2 to 25 to Aug 1 to 8
0 SCMP
6 COVER STORY
Discomfort Thousands of Hongkongers suffer some form of chronic pain. But medical specialists are offering new treatments to help sufferers rebuild their shattered lives, writes Elaine Yau
Meet the pain busters: Tsui Siu-lun (left) and Chan Chi-wing (right) from the department of anaesthesiology at Queen Mary Hospital with Professor Cheung Chi-wai from HKU’s Laboratory and Clinical Research Institute for Pain. Photo: Dickson Lee
W
hen retiree Fong Yickhung first felt a mild tingling sensation in the right side of his face 20 years ago, he had no idea that it would become a searing ache that would rack him day and night. The pain struck at all hours, and sometimes left the right side of his face immobile. “I couldn’t even speak as the slightest movement induced excruciating pain,” he says. Fong, 72, underwent all kinds of treatment including acupuncture and physiotherapy, but to no avail. His respite came only in 2009 when a public hospital doctor transferred him to pain management specialists at Queen Mary Hospital. In 2010, he underwent minimally-invasive surgery, where high-frequency radio waves were used to cauterise the trigeminal nerve, the largest cranial nerve that conducts sensations from the upper, middle and lower portions of the face and oral cavity to the brain. “I only feel numbness on the right side of my face now, which is way better than the pain,” says Fong. “But, so far, no one can tell me what initiated the pain.” Pain management specialists say an insufficient understanding of the physiology of pain means many people suffer from chronic pain without obvious causes. To increase knowledge of pain treatments, the University of Hong Kong Li Ka Shing Faculty of Medicine recently set up the city’s first Laboratory and Clinical Research Institute for Pain with HK$1.5 million in funding from the faculty and government. Hong Kong got another boost in pain management last year when the Hong Kong College of Anaesthesiologists, which is part of the Hong Kong Academy of Medicine, set up the first fellowship programme to train medical practitioners to become pain specialists. The two-year fellowship, which puts Hong Kong on par with Western counterparts in the training of pain management specialists, will begin next year. These initiatives are undoubtedly a filip for chronic pain sufferers in a city that doesn’t seem to have paid much attention to the problem. The most recent statistics, for example, date back to 2002 – a University of Hong Kong department of anaesthesiology study polled some 1,000 people and found that more than 10 per cent suffered from continuous chronic pain and had sought medical treatment in the previous three months. Queen Mary Hospital says it had 3,236 new acute pain cases last year, while more than 10 per cent of the 4,402 referrals for chronic pain to the hospital were new cases. “Some pain is a symptom, like the manifestation of damaged
cancerous tissues in the form of intense pain,” says Tsui Siu-lun, consultant and head of pain medicine with Queen Mary Hospital’s department of anaesthesiology. “But for some patients who have already received successful treatment for whatever disease they have, the pain that still afflicts them renders them immobile, severely affecting their life and their family. In such cases, the pain itself has become a disease. Some live with the pain for decades.” Housewife So Chui-ha, 48, suffered intense pain in her waist for more than a decade. She believes it was caused by a work accident when she was a teenager. “I hurt my back carrying boxes. The pain returned when I got older.” She needed to maintain a rigid posture so as not to aggravate the pain. She didn’t sleep or eat well, making her easily irritable. Disabled by the pain, she stopped cooking and her family was forced to eat out every day. She says this led to depression and the need to see a psychiatrist. In 2010, So was treated with radio frequency surgery. A day after the operation, she was pain-free for the first time in years. She repeats the procedure every three to four months now, but each time the pain crops up again. “But I have my life back,” she says. “And I cook for my family again.” “We have yet to know why a person feels pain,” says Cheung Chi-wai, clinical assistant professor with HKU’s anaesthesiology department. “On the surface, the sensation of pain is easy to understand. You cut your finger and the nerves send the messages to the brain and you feel pain. But how the pain pathways transmit messages is affected by factors like neurology and genetics. We should study each of the factors and pathway levels to see which parts [of the brain] are involved. Only through this can we devise new effective pain treatments.” Some brain studies show that chronic pain is the inability to turn off the memory of the pain. A study by Northwestern University published last month in the journal Nature Neuroscience found that chronic pain develops the more two sections of the brain – related to emotional and motivational behaviour – communicate with each other. The more emotionally the brain reacts to the initial injury, the more likely the pain will persist after the injury has healed. “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 culmination of 10 years of research,” says senior study author Apkar Vania Apkarian.
Local hospitals such as Queen Elizabeth and United Christian Hospital offer comprehensive pain management programmes with experts including occupational therapists, physiologists, clinical psychologists, anaesthetists and rehabilitation specialists. “The psychologist can help determine whether psychological factors are involved. An occupational therapist can teach the patient to move in a way that can lessen the pain. Physiotherapists can teach stretching exercises that can relieve the pain,” says Chui Tak-yi, a
rehabilitation specialist who is head of the chronic pain rehabilitation programme and chief executive at the Haven of Hope Hospital. “While we might not make the pain go away, patients can learn ways to live with it and still have a normal life.” Although there have been advances in pain treatment over the years, high costs have kept them out of reach of most patients, according to Cheung. One example is spinal cord stimulation, which is a small pulse generator that works like a cardiac pacemaker. Implanted in the back, it sends electrical pulses to the spinal cord. These pulses
COVER STORY 7
t zone Asians prefer to tough it out than resort to painkillers ...................................................... Abigail Collier abigail.collier@scmp.com Are Asians gluttons for punishment? Experts who spoke at a Hong Kong Pain Society workshop last month seem to think so. They say a passive attitude towards seeking treatment among Hongkongers and a reluctance to resort to pain relief medication are two reasons why so few are being treated for chronic pain in the city. Opioids are a case in point. Those such as morphine have long been used in Western medicine to manage severe pain following surgery or to ease the suffering of advanced cancer patients. But despite strong evidence supporting their pain-relieving benefits and 25 years of responsible use globally, opioids remain little used in Asia. A survey by the International Narcotics Control Board published last year that looked at opioid use for medical and scientific purposes found that more than 80 per cent of East and Southeast Asian countries reported consumption levels of below 200 daily doses of opioids per million inhabitants per day. Hong Kong ranked 62nd in the world at 208 doses, well below top-ranked United States at 39,487 daily doses. “Chinese people say, ‘I don’t need to take pain medication; I’m a strong person,’” says Dr Cheung Chi-wai, president of the Society of Anaesthetists. “Even post-surgery patients are refusing pain medication because they think that is the way to act.” He adds that sensitive historical memories of the opium wars could also be a factor. The media also play a large role in public feelings towards drugs,
While we might not make the pain go away, patients can learn ways to live with it and still have a normal life CHUI TAK-YI, HAVEN OF HOPE HOSPITAL
interfere with the nerve impulses that register pain that are sent to the brain via the spinal cord. It costs more than HK$100,000 to install the stimulator, says Cheung. He had applied for funding to install it for patients, but was rejected as the benefit to so few people did not justify the high cost. “Only one patient will get it installed [at the public hospital] every few years. But in the US where being free of pain is a basic human right, such installation is standard treatment.” Another high-cost treatment option is intrathecal drug delivery.
The system uses a small pump that is surgically placed under the skin of the abdomen and delivers medication through a catheter to the area around the spinal cord. It’s similar to the epidural that women may have during childbirth. “Many local patients with chronic pain are 30 or 40 years old only,” says Cheung. “The pain keeps them indoors and forces them to rely on handouts. If they can get the treatment from the government, they can get their life back and work again, lessening the financial burden on society.” elaine.yau@scmp.com
There is little or no evidence to show use of these drugs for treating pain causes addiction DR ALEX YEO, WORLD INSTITUTE OF PAIN
according to Dr Steven Stanos, medical director of the Rehabilitation Institute of Chicago’s Centre for Pain Management. While anti-recreational drug advertisements can lower illicit use of opioids, they can also stigmatise prescription drug use. Stanos says some people assume all painkillers will cause addiction and damaging side effects like hallucinations, insomnia, delirium, paranoia and impotence. Dr Alex Yeo, president of the World Institute of Pain, Southeast Asia Chapter, says education and awareness can help dispel myths. “There is little or no evidence to show that the use of these drugs for the treatment of pain causes any increase in addiction among the general population.” Cheung says governments would rather devote resources to cancer research and bone marrow transplants than pain management and research. “Cancer is sexier,” says Stanos. But he adds that this reluctance comes with a heavy price, as chronic pain costs more – in terms of unemployment, social benefits and health care costs – than cancer and diabetes combined.
Pain treatments brought relief to Fong Yick-hung (left) and So Chui-ha
8 DIET HEALTHY GOURMET
Embrace the art of eating for pleasure ...................................................... Andrea Oschetti healthpost@scmp.com A few weeks ago, I wrote about how healthy food can and should be tasty. This is contrary to a common perception that healthy food is unexciting and antisocial. Fresh, quality ingredients, cooked well, balanced in flavour and combined with herbs are far better than dishes that try to be tasty by using sauces and fats, which mask the real flavour of the main ingredients. This week, continuing on our tour of Italy, I share with you some principles for constructing the flavour of dishes, so you can create tasty gourmet recipes that are good for your well-being. On the island of Ortigia, the historic centre of Siracusa, Sicily, and a Unesco World Heritage site, there is a special restaurant called Oinos (oinosrestaurant.it), where I recently spent several happy lunches and dinners. The owner, Ivo Vatti, is passionate about the ingredients he uses. He tells me that his
restaurant operates on the “micro-grocery” principle. He spends the morning finding the best ingredients, which will be used only on that day. “Because I spend so much effort finding ingredients, I make sure that they are respected when they’re cooked so that their superior natural flavours are preserved.” This means he’s against deepfrying and in favour of applying gentle heat, cooking food as little as possible by steaming and boiling. He also minimises the use of fats and sauces, using extra virgin olive oil instead.
You must think about the dishes that you make; you cannot just let them happen by chance IVO VATTI, SICILIAN RESTAURATEUR
His dishes are works of art, rooted in the tradition of Sicily but lighter and healthier, using the knowledge of nutrition that has become available to all. “My clients come to eat here for pleasure, not for need. They come to try new tastes,” Vatti says. The human tongue can taste five flavours – sour, salty, sweet, bitter and umami – but our noses can detect more than 10,000 smells. This is why we are not able to enjoy flavours when we have a cold. When you cook, take note of the five basic flavours and balance two or more of them in a single dish. When you taste a dish, ask yourself: which is the first flavour you notice? What comes after it? Do the two flavours work well together? “You must think about the dishes that you make; you cannot just let them happen by chance,” Vatti insists. For me, this is the fun part of cooking. Free yourself from slavishly following recipes; rather, understand how they are constructed so you can add your own creativity to them by making use of what you have in your fridge or at the store. A chef’s best friends are herbs and spices, which add depth and aroma to dishes. Basil, oregano, thyme, mint, parsley ... use plenty of them. To complete the sensory experience, take note of the texture of foods when you bite into them and give pleasure to the eye by manipulating colours and presentation. Complicated? Hardly. The recipe for Vatti’s carpaccio di gamberi rossi di Sicilia – or Sicilian red prawn carpaccio – shows how easy whipping up a healthy dish can be. The prawns are extremely sweet, the wild greens are bitter, the orangeflavoured vinaigrette is acidic, and the whole nuts add texture.
Sicilian red prawn carpaccio Serves 4 200g Sicilian red prawns, shelled 2 oranges Extra virgin olive oil Some wild greens A handful of walnuts • Clean the prawns of their intestines. Place them between two sheets of cling film and flatten them using a weight. Mould the flattened prawns into the shape of a square. • Make the vinaigrette by mixing one part orange juice (one orange) and two parts oil. • Cut the other orange into small pieces. Arrange the prawns, oranges pieces, greens and walnuts on a plate. Drizzle with the vinaigrette and serve. Healthy Gourmet is a weekly recipe column by private chef Andrea Oschetti. He can be reached at andrea@fioreblu.com
NUTRITION GRAPEFRUIT JUICE ...................................................... Jeanette Wang jeanette.wang@scmp.com
Cheers to a lower dose
It’s widely known that taking grapefruit juice with certain medications can make the drugs more potent, causing dangerous side effects. But what if it could be used in a controlled fashion to increase the efficacy of a drug? A clinical trial by researchers at the University of Chicago Medicine has shown that a glass of grapefruit juice daily lets patients get the same benefits from an anticancer drug with a much lower dose. This could not only help patients avoid the side effects associated with high drug doses, but also lower medication costs. In the study, published this month in Clinical Cancer Research, patients who drank a glass (235 millilitres) of grapefruit juice a day slowed the body’s metabolism of the drug called sirolimus, increasing the drug levels in the patients by 350 per cent. A drug called ketoconazole that also slows
drug metabolism increased sirolimus levels by 500 per cent. The study was supported by the US National Institutes of Health and not by a pharmaceutical company. Sirolimus was the first of a series of drugs developed to prevent rejection of transplanted organs but that also have anticancer effects. Grapefruit juice has the ability to inhibit enzymes in the intestines that break down sirolimus and several other drugs. The effect begins within a few hours of consuming the juice and wears off over a few days. Previous studies have shown that the active ingredients in grapefruit juice that are responsible for the drug interactions are chemicals called furanocoumarins, which attach themselves to enzymes and destroy their ability to interfere with drug absorption. The 138 patients enrolled in the clinical trial, all with incurable cancer and no known effective therapy, were divided into three
groups. One received only sirolimus; one, sirolimus plus ketoconazole; and the third, sirolimus plus grapefruit juice. The optimal cancer-fighting dose for those taking only sirolimus was about 90 milligrams per week. At doses above 45mg, however, the drug caused serious gastrointestinal problems, such as nausea and diarrhoea, so patients switched to 45mg twice a week. The optimal doses for the other groups were much lower. Patients taking the drug plus ketoconazole needed only 16mg per week to maintain the same levels of drug in the blood, and the sirolimus plus grapefruit juice group needed between 25 and 35mg per week. Although ketoconazole proved slightly stronger in drug retention, grapefruit juice is non-toxic, with no risk of overdose. The effect of grapefruit juice can vary among individuals, but tests of enzyme levels in patients may be able to predict one’s response.
DIET 9
SUPPLEMENTS VITAMIN B12
Powerhouse to the stars ....................................................
Image: Corbis
Sunory Dutt healthpost@scmp.com Cobalamin, which is a powerhouse micronutrient more commonly known as B12, is a water-soluble vitamin that is naturally present in some foods, added to others, and available as a dietary supplement and a prescription medication. According to British tabloid the Daily Star, dozens of A-listers now have vitamin B12 injections to banish exhaustion, with party animal Rihanna, 24, recently tweeting a photo of a drip in her arm. Other fans include Simon Cowell, 52; Madonna, 53; and Katy Perry, 27. Stars have discovered that the benefits include weight loss, clear skin and thick hair. But the body needs this essential vitamin for many vital functions, not merely cosmetic superficialities. These include keeping nerve and blood cells healthy, and aiding in the production of DNA, the genetic material in all cells. The nutrient also helps prevent a type of anaemia called megaloblastic anaemia that makes people tired and weak. Other functions include: • proper metabolism of nutrients; • maintaining the central nervous system: B12 helps produce a material called myelin, which covers and protects nerve fibres; • healthy growth and development: boosts the immune system, supports female reproductive health and pregnancy; • mental well-being: regulates mood, and aids mental clarity, concentration and memory function. It’s just as well the nutrient seems to be in vogue now, because experts have identified vitamin B12 deficiency as a growing public health problem worldwide. According to the book, Could It Be B12? An Epidemic of Misdiagnoses, by registered nurse Sally Pacholok and Dr Jeffrey Stuart, the real issue is that doctors are not testing for B12 deficiency, so patients are being diagnosed with other ailments, given medicine they don’t need and continuing to be ill. A B12 deficiency can cause fatigue, clinical depression and memory loss, as well as more detrimental and irreversible effects to the brain and nervous system. The overall prevalence of B12 deficiency is unknown, but according to the British Medical Journal’s Evidence Centre, the condition is likely to be higher in developing countries. Globally, several studies have found prevalence to range from 25 to 70 per cent of the studied population. Foods that come from animals, including fish, meat, especially liver, milk, eggs and poultry, are typical sources of B12. With the rising popularity of a vegan and vegetarian lifestyle, B12 deficiency might become even more common. Two steps are required for the body to absorb the nutrient from food. Hydrochloric acid in the stomach first separates B12 from the protein to which it’s attached in food. Once released, B12 combines with a substance called intrinsic factor and is then absorbed by the body. Certain people with a condition called pernicious anaemia cannot make intrinsic factor and, therefore,
have trouble absorbing B12 from all foods and dietary supplements. A study published last September in the journal Neurology found that older people with low levels of B12 in their blood may be more likely to lose brain cells and develop problems with their ability to think. The body stores several years’ worth of vitamin B12 in the liver, kidneys and other tissues. Other vitamins such as riboflavin and thiamine are quickly passed in the urine. As a result, a deficiency may not show itself for a number of years, depending on a person’s diet and the body’s ability to efficiently absorb B12. The US National Institute of Health’s recommended dietary allowance for vitamin B12 is 2.4 micrograms per day for people aged above 14. A serving of fortified breakfast cereal provides between 1.5 and 6mcg; 85 grams of cooked cow’s liver provides about 70mcg. Vegans might need to consider a daily supplement. So too nursing mothers and their babies, who are at a higher risk of deficiency. B12 is frequently used in combination with other B vitamins in a formulation. Since B12 needs stomach acid for absorption, the body’s ability to
The human body stores several years’ worth of vitamin B12 in the liver, kidneys and other tissues break it down decreases with age. The Harvard Health Letter reports that up to 30 per cent of people aged 50 and over suffer from atrophic gastritis, a thinning of the stomach lining. This condition reduces the amount of B12 absorbed by the small intestine. Those who take lots of antacids might also need to up their intake to make sure they’re getting enough. How do you know if you’re getting sufficient amounts of vitamin B12? A simple blood test can indicate the body’s B12 levels. It’s usually measured at the same time as a folic acid test since a deficiency of both can lead to anaemia. The very first indications of B12 deficiency would be a sense of exhaustion, paler or even yellow
complexion, short breath and a quicker heart beat. In extreme cases, when anaemia has set in, the sufferer is a lot more at risk of bacterial infections and also other ailments like frequent diarrhoea and weight loss. Ultimately, when the scenario carries on without treatment, nerve failures surface, like a general feeling of weakness, prickling, and feeling numb in the hand and foot. There are mood swings plus a diminishing of mental abilities. For starters, a B12 deficiency can usually be treated simply by enriching your everyday diet. It is available as a supplement in oral liquid or intranasal forms, soft gels, lozenges and hydroxocobalamin shots. B12 sprays are available too – apparently spraying the fine-mist formula into your mouth causes the essential nutrients to become absorbed rapidly. As a result, it delivers more of this product’s nutrients to your circulatory system, tissues and cells quickly. There’s even a vitamin B12 toothpaste. But if you are considering taking a B12 supplement, ask your health care provider to help you determine the right dose for you.
10 WELL-BEING PERSONAL BEST
Into thin air Walter Cheung holds Hong Kong’s flag near the starting line. Cheung is the first Hongkonger to compete in the Tenzing-Hillary Everest Marathon. Photos: Walter Cheung
...................................................... Walter Cheung healthpost@scmp.com The Tenzing-Hillary Everest Marathon is held annually on May 29 to commemorate the first successful ascent of the world’s highest mountain by New Zealand explorer Edmund Hillary and Nepalese Sherpa Tenzing Norgay in 1953. It’s the world’s highest marathon, starting from Everest Base Camp at about 5,400 metres above sea level. Extreme elevations put the body under tremendous physical exertion. Reduced air pressure and lower oxygen levels at altitudes higher than 2,500 metres can lead to altitude sickness. Symptoms include headaches, fatigue, nausea, dizziness, lack of appetite and poor sleep. In some cases, further complications can develop, and the condition can become lifethreatening. Apprehensive about what lay ahead, I tried to persuade a couple of running and trekking buddies to join the race with me. One said it was too serious, the other said he would die if he tried it – this from two guys who had conquered Kilimanjaro (Africa’s highest mountain at 5,900 metres) and finished the 100-kilometre Oxfam Trailwalker in Hong Kong in a respectable 16 hours. So in May, I found myself as Hong Kong’s first and sole representative among 150 international runners who set off on the slow journey to the marathon starting line. Over the next 11 days, and under medical supervision, we trudged about 80 kilometres with a net ascent of 2,500 metres, and altitudes close to 5,550 metres. A number of athletes were hit by altitude sickness on the way up and had to rest. One seasoned runner who had completed marathons on all seven continents had to be evacuated. Other participants battled with severe coughs and bronchitis. I experienced shortness of breath and a tight chest. In keeping with my surroundings, I moved at a glacial pace and frequently stopped to rest. Two nights before the race, I woke up with a splitting headache. Given the tough conditions, I had moments of doubt as to whether I was being foolish undergoing such
In keeping with my surroundings, I moved at a glacial pace and frequently stopped to rest
suffering for a race. I resolved these by telling myself it would be a lifeenhancing experience just to reach the start line at Base Camp and enjoy the majesty of the mountains. Prayer and a family photo in my rucksack provided further strength. High-altitude running is more demanding than normal road racing, as “your heart rate, breathing rate and exertion level will be higher”, says Dr Raymond So, sports science and medicine co-ordinator at the Hong Kong Sports Institute. He says it is much more difficult to run at the Everest Base Camp level because the atmospheric pressure and inspired oxygen
pressure are only about half that at sea level. This means a runner who is not acclimatised to the altitude will lose 30 to 35 per cent of his or her VO2max ability [or maximal oxygen uptake] at 5,400 metres. “Endurance athletes are no less likely to experience attitude sickness than sedentary individuals,” he says, adding that given the challenges, completing the Everest Marathon should be considered a “marvellous achievement”. Kenyan Paul Tergat, holder of the world’s fastest marathon time from 2003 to 2007, recalls his highaltitude training at Kaptagat near the
Two nights at Everest Base Camp helped runners get used to altitude
WELL-BEING 11 TRADITIONAL CHINESE MEDICINE
Survival is in the balance ...................................................... Elizabeth Snouffer healthpost@scmp.com
Great Rift Valley in Kenya: “My body was not used to an altitude of 2,300 metres … The training was exhausting. Every evening I was very, very tired.” The Everest Marathon is certainly not an event for anyone hoping to set a new personal best. The arduous conditions of the race are reflected in the clock, with most runners doubling or even tripling their usual 42.195-kilometre time. The top finishers over the past 10 years have all been Nepalese; this year’s winner was Phurba Tamang in three hours, 41 minutes and 31 seconds. I clocked 13 hours, 15 minutes and two seconds. Bikram Pandey, president of the race organising committee, says that when they started the marathon 10 years ago to commemorate the golden jubilee of the first successful ascent of Everest, they made it known it would be “very special in many ways”. While the number of participants in this extreme event remains relatively small, participation is growing. There were only 29 runners in the first year, but more than 150 runners – including 90 from 15 countries – took part this year. Pandey says the Everest Marathon is steadily gaining in popularity as it is “a unique tourism product”. Retired British auditor David Vaughan, who has completed 280 marathons worldwide, rated it the most exciting run of his life. Race event manager Shikhar Pandey says: “We want to promote Nepal as one of the best destinations for adventure sports.” Leveraging the growing interest in extreme sporting experiences, the Everest Marathon team launched the Annapurna Marathon (which starts at 4,395 metres) this year. Next year, they will hold the first Winter Everest Marathon in December. High-altitude running appears to be on the rise. An online search shows that in Nepal and India alone, there are at least eight races held at higher than 3,000 metres elevation. Having completed 22 marathons on five continents, I believe that more runners in Hong Kong are looking overseas for challenging race experiences. Whether in Nepal or elsewhere, I hope to see more athletes run out of their comfort zones. Expect the unexpected and you’ll have the experience of a lifetime.
For more than 50 years, the treatment and cure of cancer has relied predominantly on Western surgery, cytotoxic therapy or chemotherapy and radiation resulting in longer survival periods. Sadly, cancer continues to be one of the world’s main causes of death. What has become key to survival are supportive measures that can improve the quality of life related to side effects, containing further cancer growth, and even preventing the disease altogether. Yu Rencun, honorary director and professor at the Beijing Hospital of Traditional Chinese Medicine, and Hong Hai, professorial fellow at the Nanyang Technological University in Singapore, are authors of Cancer Management With Chinese Medicine, which has been credited as the first English guide explaining how TCM and Western medicines can be integrated for better outcomes. The authors, with jointly more than 50 years of research and care for cancer patients integrating both types of treatments, have written the book for both Western medical professionals and a general Englishspeaking readership, who may benefit from understanding the basic principles of TCM. These are outlined in the first three chapters. In the last three chapters, the authors present how specific TCM principles relate to cancer treatment and care. There is also a section dedicated to various decoctions and how these herbal remedies can help sustain a functional life with cancer, perhaps helping to eliminate the disease altogether. Crediting oncology and Western medicine for discovering the various origins and therapies for cancer, the authors believe TCM has a role to play. Admitting that it may not eliminate cancerous tumours, Yu wants patients and a “Westerneducated audience” to understand how TCM can strengthen and rebalance the body’s yin and yang to increase the odds of success. The imbalance of yin and yang is considered the root of all illness. In this way, TCM restores the internal balance of a cancer patient by
strengthening chi against harmful pathogens, and preventing the development of excess and deficiency syndromes. According to the US National Cancer Institute the most prevalent side effect of chemotherapy is fatigue, although nausea, vomiting, low blood-cell count and pain are also frequently encountered. It is here that the authors believe TCM offers the most promise. The book guides the reader through the varying elements of cancer treatment and which herbal remedies should be used in preparation for chemotherapy, radiation and surgery. Yu illustrates the use of TCM in 11 patient case studies covering the major cancers – lung, breast, liver and stomach. In one case history, a 63-year-old female patient with lymph and bone metastasis after breast cancer surgery is presented. After undergoing three to four years of TCM herbal remedies with radiotherapy and chemotherapy, she experienced increased control of metastasis. In plain language, managing the terrible side
The book [advises] which herbal remedies should be used in preparation for chemotherapy, radiation and surgery
THE TASTE TEST HEALTHY SAUSAGES ...................................................... Jeanette Wang jeanette.wang@scmp.com Yves Tofu Dog HK$58 for nine (342 grams), City’super Made with tofu and vegetable protein, this is low-fat and vegan, and contains no cholesterol or nitrites. With just 45 calories, 1 gram of fat and 8 grams of protein per wiener, it’s a healthy meat alternative for vegetarians. Verdict: looks and smells like a real sausage, but it tastes bland, has a rubbery texture and a tough skin casing. Better to stick to tofu in its original form.
Field Roast Vegetarian Grain Meat Sausage, Mexican Chipotle HK$78 for four (368 grams), City’super This smells hot and spicy even through the packaging, thanks to a smoked chipotle and chile de arbol peppers. “Grain meat”, a blend of wheat gluten, vegetables, herbs and spices, forms the basis of this vegan sausage. Each link has 250 calories, 12 grams of fat and 23 grams of protein. Verdict: this looks and tastes so much like real sausages that a chef friend was fooled – until a few bites later when the unusually grainy texture, he said, gave it away. Beware of highsodium content (520mg per piece).
effects with TCM herbal remedies allowed the patient to take on a more aggressive treatment plan and increased her chances for survival. According to the Hong Kong Cancer Fund, 24,000 new cases of cancer are diagnosed each year. The three most commonly diagnosed are lung, colorectal and breast cancers (in order). It is universally accepted that eating a healthy diet, avoiding smoking and wearing sun protection all help lower the chances of developing cancer. But according to the book’s authors, incorporating the principles of TCM not only increases the quality of life for patients, but can also be used as preventive strategies. Many of the strategies outlined in the final pages reinforce what the general reader may already know: eating a high-fibre diet (whole grains and green vegetables) rich in anticancer properties and low in fat and sugar; avoiding alcohol, smoking and too much sun exposure; committing to daily exercise; and striving for emotional equilibrium, which includes decreasing work and life stress, anger and anxiety. Other preventive strategies specific to TCM include focusing nutritional efforts towards syndrome differentiation. For example, if a patient is suffering from hot syndrome, it is best to avoid foods that are warm in nature such as ginseng, lamb or prawns. In TCM, foods are classified by the five flavours: pungent, sweet, sour, bitter and salty. Foods that strengthen chi or have high anticancer properties include Chinese barley, bitter gourd, water chestnut, walnut, seaweed and mushroom. The practice of qigong is highlighted and credited as a positive step for prevention. Quoting from the first comprehensive manual of Chinese medical history, the Neijing, the authors reinforce the significance of living life in balance as the key to good health: “The ancients knew the Tao and the way of yin and yang, and how to exercise; moderation in food and drink, regularity in living habits, avoidance of overexertion, maintaining harmony between body and spirit.” Cancer Management With Chinese Medicine, World Scientific Publishing Company; 1st edition, 224 pages
Chef Bruce Aidells Mango Smoked Chicken Sausage HK$85 for 340 grams, City’super This is a real meat sausage but claims to be healthier as it’s all natural, minimally processed, and contains no MSG, nitrites or added hormones. Nutrition-wise, however, it’s something you want to have only occasionally: each sausage packs 170 calories, 12 grams of fat, 13 grams of protein and a whopping 650mg of sodium. Verdict: too salty, although mango morsels give a delicious subtle caramel sweetness that complements the meaty and juicy sausage well.