20121002 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, OCTOBER 2, 2012

HEALTH POST

POWER OF PINK: HELP FOR BREAST CANCER PATIENTS >PAGE 8

WOMEN’S RUGBY STAR SIDESTEPS THE DOUBTERS >PAGE 11

Milky way A galaxy of alternatives for the lactose intolerant >PAGE 6

2 NEWS APP OF THE WEEK

HEALTH BITES

This will have you seeing red

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Jeanette Wang jeanette.wang@scmp.com

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Katie McGregor healthpost@scmp.com

There’s safety in slumbers Adolescents who sleep poorly may be at risk of cardiovascular disease in later life, according to a study in the Canadian Medical Association Journal. Researchers from The Hospital for Sick Children in Toronto analysed data from more than 4,000 children in Ontario. Subjects slept an average of 7.9 hours on week nights and 9.4 hours on weekends. Almost one in five reported poor quality sleep during the week, and one in 10 on weekends. Those who consumed more junk food, exercised less and had more screen time had more sleep disturbance. This in turn was linked with a higher cholesterol level and blood pressure, higher body mass index, larger waist size and higher risk of hypertension.

How to protect your eyesight Free Rating 3/10 The blurb describes the app as a solution to reduce your visual fatigue and protect your eyesight because “myopia results from aesthenopia”. I should have heeded my inner alarms that go off when apps unnecessarily use big words to describe perfectly simple things.

Aesthenopia means eye strain.

The app is a series of eye exercises. You are instructed to hold your head still while following a red dot around a series of mazes on the screen. On an iPhone screen, this is not a challenge as your eyes need to move only a little to keep up.

You are supposed to do this for 10 minutes every two hours. Before realising the red dot’s speed could be increased by tapping the “+” sign, I thought the greatest benefit of this app would be to put you to sleep within that time. The default speed is slow, and I found myself trying to push the red dot along faster with my eyes – a sort of telekinetic exercise. At high speed, your eyes begin to flicker in a way that would be alarming to an onlooker.

Useless, I thought, until I clicked the information button and found a section with tips for eyesight care.

The information here is what I had always understood to be good advice. That is: take a break, and

move your eyeballs up, down, left and right, clockwise and anticlockwise; do a few reps of focusing your eyes on a distant object and study its detail for 25 seconds, then focus on your palm for five seconds; then close your eyes and softly massage the acupuncture points for a few minutes. Unfortunately, it doesn’t identify where those points are.

I was beginning to have a little respect for the written instructions until I read the healthy foods section. Sensible suggestions such as foods rich in vitamin A, vitamin C, calcium and zinc were listed – but pearls? Wouldn’t egg shells do?

I do owe my eyes a little more care. The solution is an alarm on my iPhone to remind me to take a break from my screen, look at a distant object, then back at my palm. No red dots for me.

ASK THE EXPERTS NANCY CLARK Q: Do some athletes need more protein than others?

A: Just as children have high protein needs during growth periods (1.3 grams of protein per kilogram), athletes also have requirements higher than the recommended daily allowance (0.8 grams per kg) when building muscles: 1.2 grams per kg for endurance athletes and 1.7 grams per kg for strength athletes.

These protein recommendations assume the athlete is consuming adequate energy from carbohydrates and fat. Athletes who restrict their food intake end up using some protein for fuel, thus they need a higher protein intake.

Most athletes consume about 1.6 grams of protein per kg per day,

so they easily meet the recommendations – without the addition of supplements.

The biggest way to stimulate muscular growth is to lift weights or do other forms of resistance exercise. To support muscular development after hard lifting, all athletes need to consume highquality protein (with all the essential amino acids) in close proximity to their training. High-quality proteins include whole milk products, poultry, eggs, fish, lean beef, all meats and soy protein.

Nancy Clark is a sports nutritionist and a Fellow of the Academy of Nutrition and Dietetics in the US. Reprinted with permission from the American College of Sports Medicine Fit Society Page

> 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

Allergies bite the dust quickly A new study suggests relief for children with dust mite induced allergies and asthma may come sooner rather than later. While three to five years of allergy shots are recommended for long-term effectiveness, three years is enough and the additional two years has no clinical benefit, says lead study author Dr Iwona Stelmach, from the Medical University of Lodz, Poland. The study found that after three years of immunotherapy, 50 per cent of children with asthma due to dust mites experienced remission with greatly reduced or no medications need at that point. This reduces total health care costs by 33 per cent to 41 per cent, says allergist Dr James Sublett. Children allergic to dust mites react to proteins within the bodies and faeces of the mites. These particles are found mostly in pillows, mattresses, carpeting, stuffed animals and upholstered furniture. There may be as many as 19,000 dust mites in one gram of dust. The study is published in this month’s Annals of Allergy, Asthma & Immunology.

Cafeteria diet a recipe for disaster Just two months on a “cafeteria diet” can lead to a lifetime of health problems, dramatically increasing the risk of stroke or death at a younger age, according to a study presented yesterday at the Canadian Stroke Congress. This type of diet is high in calories, sugar and sodium. In the study, sedentary rats were given unlimited access to both nutritional food pellets and junk food – such as sausages, cupcakes and sugary drinks. The rats preferred the treats, and after only two months had most symptoms of metabolic syndrome: high levels of cholesterol, blood sugar, blood pressure and obesity. The animals were roughly equivalent to 16 to 22 years in humans at the time of disease onset, says lead researcher Dr Dale Corbett, scientific director of the Heart and Stroke Foundation Centre for Stroke Recovery. He predicts people in their 30s or 40s will soon start having strokes and dementia because of this diet.

How cherries can rout the gout Having up to three servings of cherries or cherry extract over two days can lower the risk of gout attacks on those susceptible by 35 per cent, compared to those who don’t eat the fruit, finds a study in Arthritis & Rheumatism. When combined with a uric-acid reducing drug, the risk of gout flares is 75 per cent lower than in periods without exposure to cherries or treatment. Gout is an inflammatory arthritis triggered by a crystallisation of uric acid within the joints that causes excruciating pain and swelling. Patients have recurrent gout attacks in spite of many treatment options available. The study, led by Dr Zhang Yuqing, professor of Medicine at Boston University, recruited 633 gout patients with a mean age of 54 years who were followed online for one year. A serving was qualified as 10 to 12 cherries. The researchers say further clinical trials are needed to confirm the findings.

NEWS 3 PROFILE SALLY GARDNER

QUIZ ......................................................

The research team plans to isolate the active protein from the P. acnes virus and test whether it is as effective as the whole virus in killing acne bacteria. In the meantime, test your knowledge of acne with this quiz from the Yale Medical Group at the Yale University School of Medicine.

Jeanette Wang jeanette.wang@scmp.com

Dyslexic author fights public misconceptions about disorder ......................................................

Sunory Dutt healthpost@scmp.com As a child, Sally Gardner was likened more to a sieve than a sponge. More information was lost than retained, and she was called a problem child, unteachable and lazy.

But there was a reason: Gardner had severe dyslexia, a lifelong learning disorder that typically manifests in reading, writing and spelling difficulties.

According to the Health Department’s Child Assessment Service, the prevalence of dyslexia among children is between 9.7 per cent and 12.6 per cent. The condition in about 70 per cent of these is considered to be mild, 20 per cent to be moderate and 10 per cent severe.

Gardner’s condition was considered severe. She was actually named Sarah, but she couldn’t figure out whether the R or H came first, so her name was changed to Sally: S is like a snake, followed by a little A and two long lines, and a Y to catch it all.

That, she could remember.

She was bumped from school to school, had few friends and eventually ended up in a school for “maladjusted” children. Her parents, both lawyers, were

My parents had given up on me and, without the pressure, I could finally read SALLY GARDNER

mystified. At age 11, she was finally diagnosed with dyslexia.

Miraculously, at 14, her condition took a U-turn. “I think that ... they’d given up on me and, without the pressure, I could finally read.”

Gardner, now in her late 50s, is an award-winning novelist living in London. Her books have been translated into 22 languages, and she’s sold more than 1.5 million copies in Britain. She’ll be in town this weekend for the Hong Kong International Literary Festival (festival.org.hk), where she will conduct a special Come Read With Sally Gardner event for children and parents on Sunday.

Gardner studied art at Central Saint Martins College of Art and Design, graduated with first class honours and joined Newcastle University Theatre Society, where she first worked as a theatre designer, then moved to costume design and illustration. She took to writing after having children.

Her first full-length novel, I, Coriander, won the Nestle Children’s Book Prize Gold Award in 2005. Silver Blade, her sequel to 2007’s The Red Necklace, was shortlisted for the Guardian Children’s Fiction Prize in 2009.

The Sunday Times called her an “idiosyncratic genius”.

Just because you can’t spell, it doesn’t mean you can’t write, Gardner says. Dyslexic people have very visual memories and make visual associations. She lists other famous accomplished dyslexics such as Albert Einstein, Pablo Picasso and Agatha Christie.

“I think of writing like singing: everyone has a voice, and then there’s Adele. If you have a voice that soars above the rest, then it will soar, whether or not you have dyslexia,” Gardner says. “I do think that dyslexic people have a heightened perception of their environment, and it contributes to my creativity.”

The downside is the common misconception. “Other people’s misinterpretation and impatience with dyslexia has been the hardest to handle, their underestimation of my abilities, assuming that I’m stupid when I’m not,” she says.

To Gardner, what needs to change are the attitudes towards the condition and the education system.

“Non-dyslexic children could benefit from education that doesn’t give one answer to one question but explores many answers to it,” she says. “Education should be empowering, not disabling.”

Hasta la vista, pimples. Scientists at the University of California, Los Angeles and the University of Pittsburgh have discovered a virus family that naturally preys on pimple-causing bacteria.

Harnessing this virus could offer a safe and effective weapon against the physical and emotional scars of severe acne, say the researchers.

The family of viruses, called Propionibacterium acnes phages, live on human skin but are harmless to humans. They infect and kill the Propionibacterium acnes bacteria, which thrive in pores. When the bacteria aggravate the immune system, they cause swollen, red bumps associated with acne.

Using over-the-counter pore cleansing strips from the chemist, the researchers lifted the acne bacteria and the P. acnes viruses from the noses of both pimply and clear-skinned volunteers.

Sequencing the microbes’ genomes, the scientists discovered the viruses possess multiple features – such as small size, limited diversity and the broad ability to kill their hosts.

“The lack of genetic diversity among the phages that attack the acne bacterium implies that viral-

1. Acne is a disease that affects which of these? a. epidermis b. endodermis c. hair follicles based strategies may help control this distressing skin disorder,” says co-author Graham Hatfull, biological sciences professor at the University of Pittsburgh. The findings were published last week in the American Society for Microbiology’s journal mBio. Most effective treatments work by reducing the number of P. acnes bacteria on the skin. But the arsenal of anti-acne weapons has not expanded in decades, say the scientists. “Antibiotics such as tetracycline are so widely used that many acne strains have developed resistance, and drugs like Accutane, while effective, can produce risky side effects, limiting their use,” says study co-author Dr Jenny Kim, director of the UCLA Clinic for Acne, Rosacea and Aesthetics.

2. Which of these factors causes acne? a. poor hygiene b. poor diet c. dirty skin 3. Some cosmetics and toiletries aggravate acne. What kind of cosmetic is least likely to do so? a. non-comedogenic (or oil-free) b. lip products with moisturisers c. hair gel products 4. What percentage of adults suffers from acne? a. 20 per cent b. 30 per cent c. 40 per cent Answers: 1. c; 2. none (likely due to genes, hormones or medication); 3. a; 4. a

RUNNING

Be quick off the mark ......................................................

Dec 2: Mizuno Reservoir Race Series 2, Tai Lam Chung, 15 kilometres Jan 13: China Coast Marathon, Pak Tam Chung, Sai Kung, full marathon and half marathon Feb 7: Mizuno Reservoir Race Series 3, Tai Tam Reservoir, 11 kilometres

Jeanette Wang jeanette.wang@scmp.com The cooler weather marks the return of the running season. Here are some of the events scheduled for the next few months. Make sure to register early, as races fill up fast.

The North Face King of the Hills mountain marathon series is a four-race series that takes participants on routes you won’t find on a map (seyonasia.com).

Dec 16: Tai Po, 36 kilometres and 14.75 kilometres Jan 6: Sham Tseng, 37 kilometres and 2.5 kilometres Feb 3: Lantau, 29.8 kilometres and 14 kilometres Mar 3: HK Island, 30.5 kilometres and 18.6 kilometres Action Asia Events is the city’s main organiser of off-road races and has some new events this season, including the MSIG HK50 series (actionasiaevents.com).

Oct 7: Suunto Lantau 2 Peaks, Tung Chung, 21 kilometres and 15 kilometres Oct 27: MSIG HK50, HK Island, 50 kilometres and 23 kilometres Nov 25: Patagonia Nature Run, Tai Lam Country Park, 22 kilometres and 14.5 kilometres

Dec 8: MSIG HK50, Lantau, 50 kilometres, 27 kilometres and 14 kilometres Mar 3: MSIG HK50, Sai Kung, 50 kilometres, 26 kilometres and 13 kilometres Athletic Veterans of Hong Kong is a 30-year-old club that organises a number of races each year, including the popular China Coast Marathon (avohk.org).

Oct 7: Mizuno Reservoir Race Series 1, Aberdeen Reservoir, 12 kilometres

And the rest.

Nov 4: Asics Hong Kong 10 kilometre Challenge, Tin Shui Wai (hkaaa.com) Nov 4: Rotary 10 kilometre race, Sha Tin (rotary3450.org) Nov 18: GigaSports 10 kilometres, Science Park (gigasports.sportsoho.com) Nov 25: Unicef Charity Run, Disneyland, 21 kilometres, 10 kilometres and three kilometres (run.unicef.org.hk) Dec 9: Mizuno Shek Mun 10 kilometres (hkmarathonpro@yahoo.com.hk) Dec 9: Habitat Challenge Day, Tung Chung, 14km (sportsoho.com) Dec 16: Feet of Fire 10 kilometres, HK International Airport (my10km.nows.org.hk) Dec 16: Riverside Winwin Run, Ma On Shan, 21 kilometres, 10 kilometres and three kilometres (winwinrun.com) Feb 24: Standard Chartered HK Marathon, full marathon, 21 kilometres and 10 kilometres (hkmarathon.com)

4 MEDICAL CASE HISTORY

Poisoned ......................................................

Eileen Aung-Thwin healthpost@scmp.com Teddy Mak’s family noticed that he was behaving a little oddly. The 49-year-old did not appear to fully understand them when they spoke, and seemed a little confused. He was also increasingly unsteady when he walked and appeared to be losing his muscle strength.

Mak (whose name has been changed for patient confidentiality reasons) had two pre-existing conditions: cardiomyopathy, or disease of the heart muscle, for which he was regularly taking medication, and bipolar affective disorder, which causes extreme mood swings.

Mak had been taking lithium to control the mood swings, and had successfully managed the condition for more than a decade.

There had been no recent adjustments to his dosage.

But the unusual symptoms he was displaying did not fit any of his known conditions. After a few months of deterioration, his family decided to take him to hospital.

At Queen Elizabeth Hospital, the doctors noted he had a mild fever and was slightly confused when speaking. His ability to follow simple instructions, like “open your mouth”, was mildly impaired.

Given his long history of taking lithium, which can cause serious side effects, or even death in the case of overdose, his blood was tested for lithium levels. They found 3.2 millimoles per litre. This was well above normal levels of between 0.5mmol/L and one mmol/L. Based on the blood test results, Mak was suffering from acute lithium toxicity. Although he did not have classic symptoms such as nausea, vomiting and cramps, doctors knew that they needed to flush the excess lithium from his bloodstream.

Mak was admitted and put through saline diuresis, a process in which his body was infused with saline solution to stimulate the kidneys and accelerate the excretion of lithium via urine. This treatment succeeded in reducing the lithium levels in his blood to 1.6mmol/L by the fourth day.

In light of Mak’s slight fever and mental confusion, doctors also performed a lumbar puncture to obtain cerebrospinal fluid to test for

infection of the central nervous system. Results were negative for infection and other tests, such as a Computed Tomography (CT) scan of his brain, did not indicate any other problems.

However, on the fourth day, despite decreasing lithium levels in his blood, Mak collapsed and fell unconscious.

His body exhibited none of the basic reflexes such as the knee-jerk reflex, indicating a problem with the nervous system.

He was taken to the ICU where Dr Stanley Chan Choi-hung, a specialist in intensive care medicine, was called in.

Chan examined Mak and found that he had reduced muscle tone in all four limbs and that the muscles controlling his eye movements were paralysed. A repeat CT scan of his brain showed no significant change from the first scan.

As Mak was in a deep coma, Chan inserted a tube into Mak’s windpipe to ensure he continued to receive air in his lungs.

To speed up the flushing of lithium from Mak’s system, Chan put him on Continuous VenoVenous Haemofiltration (CVVH), where Mak’s blood was fed into a dialysis machine to be cleaned before being returned to his body.

After eight hours of CVVH, lithium levels in Mak’s blood dropped to a normal 0.8mmol/L, and he was taken off the CVVH machine. But Mak remained in a deep coma. Chan conducted further tests in an attempt to uncover the cause but found no clues.

He then performed nerve conduction tests to check how well electrical signals were travelling along Mak’s nerve pathways.

Chan found that Mak’s peripheral nervous system was impaired, a condition called peripheral neuropathy. The peripheral nerves carry signals between the spinal cord and the rest of the body.

Although the most likely explanation for Mak’s condition was lithium poisoning, lithium toxicity usually affects the central nervous system such as the brain and the spinal cord.

This would normally give rise to symptoms such as odd eye movements, involuntary muscle contractions, involuntary repetitive muscle movements or even convulsions. The peripheral nervous

Illustration: Angela Ho

minds

system is seldom involved: the last documented case in medical literature was in the 1980s.

Chan tested Mak for other possible causes of peripheral neuropathy, such as heavy metal poisoning and immune disorders.

All tests were negative.

On the third day in ICU, Mak suddenly woke up, to the relief of his family and the doctors. He gradually improved and was increasingly able to follow simple instructions and regain muscle control.

The next day, Chan removed his breathing tube. By day five, Mak had improved so much that he regained eye movement and could eat without choking. By day eight, Mak was moved from ICU to the general ward and made an uneventful recovery thereafter.

Chan theorised that while the lithium levels in Mak’s blood were decreasing, lithium had accumulated within the cells of his body. The lithium had breached the

Lithium was once banned by the US Food and Drug Administration, but the ban was lifted

body’s threshold and caused it to shut down before it was flushed out.

Mak was lucky that the lithium had not caused permanent damage to his brain. Despite the severe effects of peripheral neuropathy caused by the lithium toxicity, it is reversible with support and care.

The prognosis is good, says Chan.

Lithium was once banned by the US Food and Drug Administration for its toxic side effects, but the ban was lifted and the drug continued to be used in bipolar treatment.

But given its toxicity, patients on lithium need to have their blood tested regularly to guard against overdose or poisoning. Some 10,000 cases of lithium toxicity occur in the US each year, according to medical website, Medscape (medscape.com).

Other bipolar medication has emerged, and these have generally overtaken lithium in popularity of use, says Chan. Mak, too, has now been put on different medication.

MEDICAL 5 VACCINES PNEUMONIA

Photo: Corbis

Now adults can breathe a little easier ......................................................

Elaine Yau elaine.yau@scmp.com The fight against pneumonia has received a boost with the first pneumococcal vaccine for adults approved by the World Health Organisation.

This is significant because, along with children under the age of five, the elderly are especially vulnerable to Streptococcus pneumoniae, the bacteria that are responsible for causing diseases such as pneumonia, blood poisoning, meningitis, endocarditis and sinusitis.

“Anybody can be struck by the bacteria, but the very old and the young will react badly to it,” explains Professor John Simon, a specialist in infectious and tropical diseases, and the chairman of Hong Kong’s Scientific Committee on Vector-borne Diseases.

Certain people are predisposed to pneumococcal infection and should also get the vaccine, he adds.

Anybody can be struck by the bacteria, but the very old and the young will react badly to it JOHN SIMON, TROPICAL DISEASES EXPERT

These include HIV patients and other immuno-suppressed people, or those who have had their spleen removed. (The spleen mops up bacteria and decreases the number of bacteria circulating in blood.)

The vaccine, called Prevenar 13, was approved by Hong Kong’s Health Department in April this year, following successful clinical trials in older people conducted by the vaccine’s makers Pfizer. The US Food and Drug Administration also gave its seal of approval in February.

Launched in 2010, the vaccine has been provided free of charge to eligible children in Hong Kong since December last year under the government’s Childhood

Immunisation Programme. Health Department figures show there were 6,131 deaths in Hong Kong caused by pneumonia last year.

According to the World Health Organisation, up to 1.6 million people die each year globally – mainly children under the age of five in developing countries – as a result of pneumococcal diseases. This makes it the leading cause of vaccine-preventable deaths.

Vaccines contain extracts or inactivated forms of bacteria or viruses that cause disease. These altered forms of the organisms stimulate the immune system to produce antibodies against them, but don’t actually cause disease themselves. The antibodies produced remain in the body, so that if the organism is encountered naturally, the immune system can recognise it and attack it, thus preventing it from causing disease.

Streptococcus pneumoniae has 90 bacterial strains. The first vaccine for the bacteria was developed in 1979. Prevenar 13, as the name suggests, protects against 13 of the most common strains, which account for 80 per cent of all pneumococcal diseases. It expands the protection coverage offered by Pfizer’s previous versions, Prevenar 10 and Prevenar 7.

Simon explains that the new shot – a conjugate vaccine – is a big improvement on the previous pneumococcal polysaccharide vaccines. Polysaccharide vaccines have a short-lived impact on the carriage of bacteria (people can carry the bacteria for years without symptoms, but still spread it) and causes decreased immune response after repeated doses.

“It’s a milestone,” says Simon, adding that polysaccharide vaccines will gradually be phased out.

While the new vaccine offers longer-lasting protection, Simon is unsure if the immunity imparted is permanent. “It might or might not last forever. We don’t know how often people should have booster shots. There’s the possibility that if you get one shot, the immunity might last forever. But studies have yet to be published and we don’t have the answers yet.”

Simon is certain that there’s a real need for a good vaccine against the common, possibly fatal disease

6,131 • The number of people who died from pneumonia in HK last year.

• 1.6 million people die from the disease globally each year.

that people “don’t seem to make a big fuss about”.

“It’s not something like H5N1 or Sars that is newsworthy. But every day doctors see people with pneumococcal disease. Curiously enough, it’s the common disease that we can have the most impact on. We can decrease the death rate by careful attention to good vaccinations,” he explains.

Healthy people aged between five and 50 years tend to have better immunity, and most can deal with the bacteria, Simon says. So should they be vaccinated, too?

“I don’t know whether they should get the shot,” says Simon.

“Maybe in five years’ time, the opinion will be that it should be given to everybody.”

But whether the new vaccine can eradicate pneumococcal bacteria is a moot point, as the history of the development of vaccines is fraught

with setbacks. Researchers working on the world’s first vaccine against dengue fever were recently dealt a blow, as the first large clinical trial of the vaccine proved it to be only 30 per cent effective. It was well short of the study’s goal of 70 per cent. The results of the trial involving 4,000 children in Thailand were reported in a paper published in the medical journal The Lancet in September.

The battle to eliminate polio, which had been nearly 100 per cent successful, also suffered recent setbacks when outbreaks of new cases were reported in Nigeria and Afghanistan. The victims have been paralysed by a polio virus derived from the oral vaccine.

Prevenar 13 is not without side effects. As indicated on Pfizer’s official website for the vaccine: • A temporary pause of breathing following vaccination has

been observed in some infants born prematurely.

• The most commonly reported serious adverse events in children were bronchiolitis (an infection of the lungs, 0.9 per cent), gastroenteritis (inflammation of the stomach and small intestine, 0.9 per cent), and pneumonia (0.9 per cent).

• In infants and toddlers, the most common side effects were tenderness, redness or swelling at the injection site, irritability, decreased appetite, decreased or increased sleep, and fever.

• In adults, immune responses to the vaccine were reduced when given with a shot of a seasonal flu vaccine.

• In adults, the common side effects were pain, redness, or swelling at the injection site, limitation of arm movement, fatigue, headache, muscle pain, joint pain, decreased appetite, chills, or rash.

6 COVER STORY

Awa with t dairi

The lactose intolerant hav more choice, writes Jean

S

upermarkets have come a long way since a South China Morning Post reader complained to the editor 11 years ago about the lack of options for the lactose intolerant.

Today, there are so many milk alternatives available that the biggest problem is deciding which one to buy.

Walk into a supermarket and you’re likely to find a range of milk substitutes derived from soy, rice, almond and oats. If you’re in one of the posher grocery stores, you might even find hemp and flax milk.

Bart Cheng, key account manager with Hutchison Hain Organic (HHO), a Hong Kong-based distributor of natural and organic products, says demand for its range of milk alternatives has been growing since they were introduced in the city in 2010.

The company distributes Almond Dream, Soy Dream, Rice Dream and Westsoy. Sales of its two main products, the latter two, have grown 35 per cent in the past year at ParknShop supermarkets.

Faced with so many alternatives, Shane Early, a teacher at a local girls’ college, wonders: “Soy milk, rice milk, almond milk – what’s the real difference? I can’t do dairy milk; my stomach gets very angry.”

Reactions in the stomach to dairy

products are symptoms of lactose intolerance and may include flatulence, diarrhoea, a bloated feeling, pains and cramps, stomach rumbling and a general ill feeling, according to Britain’s National Health Service.

“Asians are more prone to lactose intolerance,” says Karen Chong Kam-leng, a registered dietitian at Matilda International Hospital.

“Some studies say it is hereditary.

Northern Europeans have the lowest percentage of lactose intolerance in their populations.”

In a study published in 2009 in the journal PLoS Computational Biology, researchers at University College London found that the drinking of cow’s milk started about 7,500 years ago in central Europe.

Continued exposure to milk caused the genetic change in Europeans that enabled them to digest the milk sugar lactose.

Today, more than 90 per cent of the population of northern Europe is lactose tolerant. So are some African and Middle Eastern populations. But that’s not true of most of the global adult population.

According to a Cornell University study published in 2005 in Evolution and Human Behaviour, about 60 per cent of the global population, and primarily those of Asian and African

Asians are more prone to lactose intolerance.

Some studies say it’s hereditary. Northern Europeans have the lowest percentage of lactose intolerance KAREN CHONG, DIETITIAN

descent, stop producing lactase, the enzyme required to digest milk, as they mature.

Mimi Li Shuk-ping, consultant dietitian at Children 818, says many Hongkongers are lactose intolerant because mothers tend to cut milk from their child’s diet after they become a year old.

But this intolerance tends to be mild. “Most people can actually consume a small amount of dairy products,” she says.

Intolerance can be overcome, says Chong, by introducing lactose slowly into the diet.

“For example, start with half a glass of milk first – try to have it warm, and have something with it.

Do it gradually, day after day, and you can get used to it.”

Some dairy products that don’t have a lot of lactose, such as hard cheese and yogurt, are also good ways to start reintroducing lactose into the diet, adds Chong.

But not all adverse reactions to dairy are caused by lactose intolerance. Some people are allergic to the milk proteins, casein and whey, says Li. Allergic reactions include runny nose, itchy eyes, dry throat, rashes, hives, nausea and diarrhoea.

There are potentially more serious complications, such as difficulty breathing and anaphylactic shock.

Hence the appeal of milk alternatives. But these products have an even wider reach. HHO’s Cheng says they also attract people who have other food sensitivities, or want cheaper organic alternatives.

Rice and almond milk, for example, retails for about HK$22 to HK$23 per litre, and soy milk about HK$12 to HK$14 per litre.

Organic milk can cost more than double that.

Milk alternatives, especially from plant sources, seem more appealing in the wake of tainted milk scandals that have plagued the Chinese dairy industry.

Furthermore, plant-based milk is

cholesterol free, since cholesterol is found only in animal products (though there is a minimal amount in fat-free milk).

Li says advertising has boosted the popularity of milk alternatives.

“Some soy milk marketing claims milk protein is not well absorbed. A lot of my clients ask me if this is true.

But there are no guidelines or research that recommends patients switch to other sources, unless you’re lactose intolerant or have a milk protein allergy.”

Still, more people are avoiding cow’s mile. But can milk alternatives match the real deal, providing essential vitamins, minerals and other nutrients?

Milk is seen as a “complete” food. After all, it is what all babies thrive on in their first few months of life.

Cow’s milk is high in protein, calcium, phosphorus, and vitamin A, D and B12. The recommended daily intake for adults is two servings (each 240ml) of low-fat or skimmed milk, says Chong.

“Calcium is the most important thing – if you want to replace dairy products, look for something that is high in calcium,” she adds. “Make sure the milk alternative is fortified with or naturally high in calcium.”

Li notes that milk alternatives are often fortified with vitamins and

COVER STORY 7

Milk it for all it’s worth: no end of alternatives ......................................................

Jeanette Wang jeanette.wang@scmp.com

ay the ies

The supermarket chain Fusion by ParknShop stocks an extensive range of milk alternatives. We picked five at random for review.

Vitasoy Organic Soya Drink (HK$20.50/litre) Soya is said to be one of the top genetically modified (GM) crops to resist herbicides, and hamsters fed with GM soya were unable to have offspring and suffered a high mortality rate. No GM ingredients were used in this soya milk from Hong Kong.

It is creamy and smooth, and has a raw, beany flavour. It isn’t as sweet as typical soya milk. Each 250ml serving has 130 calories, 2.4 grams of fat, 10.5 grams of carbs (of which only two grams are sugars) and 8.7 grams of protein.

minerals. So their nutrition formulae are similar to milk.

These added nutrients are comparable to naturally occurring ones, she says.

“The body is still able to absorb the nutrients. Adding them to food is better than taking supplements alone because food has naturally existing enzymes that help with the absorption of the nutrients.”

You can also supplement your calcium intake through other food sources, says Chong. These include sardines or dried small fish with edible bones; dark green leafy vegetables like choi sum and kai lan; Brazil nuts and almonds; sesame, tahini and hummus; and fortified orange juice and cereal.

If you want to try a milk alternative, here are some common options, and their pros and cons.

Soya milk A study published last year in the European Journal of Clinical Nutrition showed that soya protein compared to dairy milk protein supplementation improves the lipid profile in healthy individuals, supporting heart health. “[Soya milk] is the first recommended alternative, but look for those fortified with calcium as soya by itself is not very high in

Photo: Corbis

ve never had nette Wang

calcium,” says Chong. Soya milk contains isoflavones, a phytoestrogen thought to protect against some cancers, although it’s recommended that women with oestrogen-dependent breast cancers limit soya foods. Some people with milk protein allergy might not tolerate soya milk, too.

Rice milk Most rice milk has calcium levels fortified to match dairy milk. It’s also low in fat and saturated fat. Rice milk is usually unsweetened but naturally high in sugars – it’s twice as sugary as soya milk on average.

Chong says the protein in rice milk is not as good as that in soya milk, which is not as viscous as the other options, although some manufacturers add oils to thicken it.

Almond milk Chong says almond milk is high in calcium. It’s also naturally low in calories and saturated fat. “Because it’s from a nut, it also has monounsaturated fat, which is a heart-protecting oil,” says Chong.

But she adds that, like rice milk, the protein in almond milk is incomplete. You’ll need complimentary foods with protein to ensure you get all the essential amino acids.

Also, most products have added

sugar or syrups made from agave, cane or rice. Li adds that almond milk may not be suitable for those with nut allergies.

Oat milk Oat milk is relatively low in fat and saturated fat, and offers a moderate amount of protein. It also contains cholesterol-lowering beta glucan. Li says people with wheat allergies will not be able to stomach oat milk.

Goat’s milk Goat’s milk is a “natural functional food”, according to a study released last year by researchers at the University of Granada in Spain. It has many nutrients that make it similar to human milk.

These include oligosaccharides, which are compounds that reach the large intestine undigested and keep the gut healthy. Goat’s milk contains less of the milk protein that’s responsible for most milk allergies, and a lower proportion of lactose. It also has more essential omega-6 fatty acids (linoleic and arachidonic), which have heart benefits.

Goat’s milk is rich in calcium and phosphorus, and also has more zinc and selenium, which are essential micronutrients that prevent neurodegenerative diseases. jeanette.wang@scmp.com

So Natural Rice Milk (HK$20.90/litre) Slightly milky and pleasantly sweet, this Australian rice milk is refreshing served ice-cold. Amazingly, the sweetness comes only from brown rice flour. Compared to the other milk alternatives, this has a high-carb, low-protein content. It also has added canola oil.

Per 250ml serving: 128 calories, 2.5 grams of fat, 26 grams of carbs and 0.9 grams of protein. It also contains 300mg of calcium, or 38 per cent of the recommended daily intake (RDI), comparable to a glass of skimmed milk.

Almond Dream Unsweetened Original (HK$24.90/946ml) This all-natural almond milk from the United States has a thin consistency similar to skimmed milk and a neutral flavour. So even almond-haters might like it. Each 240ml serving has 50 calories, 3.5 grams of fat, three grams of carbs and one gram of protein. As for vitamins and minerals, it has: vitamin A (30 per cent of RDI), D (25 per cent), E (30 per cent), B12 (50 per cent), calcium (30 per cent), phosphorus (20 per cent) and iron (four per cent).

Pure Harvest Organic Oat Milk (HK$36/litre) According to the carton, oat milk contains a variety of phytochemicals (naturally occurring nutrients found in plants) that boost the body’s natural detoxification systems and also have anti-inflammatory effects due to their antioxidant properties. This drink from Australia is made of whole organic oats, water and a touch of sunflower oil. It has a strong oat flavour, but the watery blend is not very palatable. Per 250ml serving: 145 calories, five grams of fat, 19.3 grams of carbs, 5.8 grams of protein and only 6.8mg of calcium.

Marusan Malted Soymilk Coffee (HK$27.90/litre) This coffee-flavoured soya milk is more like an iced latte and has about half the calories of regular soya milk. It’s a great alternative to the typical sugar-laden canned milk coffee. Per 250ml, it has 60 calories, 3.3 grams of fat, 3.3 grams of carbs, 4.5 grams of protein, and 52.5mg of calcium.

8 HEALTH PINK REVOLUTION

A little help from her friends ......................................................

Jeanette Wang jeanette.wang@scmp.com

PINK POSITIVE

When Flora Law Shuk-ting was first diagnosed with stage IIb breast cancer in February, she reacted the same way that any 45-year-old who has lived a largely healthy lifestyle would: with shock and tears.

But she wasn’t crying because of the diagnosis – “I immediately focused on what I had to do next,” she says – but because she was touched by the concern that so many friends showed her.

“My mailbox was full,” says Law, a general manager with a logistics company. “Relatives, colleagues, friends, even friends of friends, e-mailed me information and advice they had seen on the internet, on television and in books. I had so much information, I was very confused.”

Fortunately, her doctor told her to phone the Hong Kong Cancer Fund (HKCF) CancerLink helpline to clear the air, alleviate worry and set her on the right treatment path.

“The social worker talked to me and filtered the right information from the wrong. She helped me think logically,” she says.

Although Law initially didn’t know anyone directly affected by breast cancer, through the HKCF she found many other sufferers.

A few survivors rallied around her during her treatment, providing support and sharing their experience. Surgery to remove Law’s right breast was followed by four months of chemotherapy.

“I was quite optimistic [about the treatment],” she says, “but after speaking to the survivors, I was so optimistic. Throughout the chemotherapy, I was so positive and relaxed mentally.”

Psychosocial support can make a huge difference for breast cancer patients, many of whom are devastated by the news. A report by the Hong Kong Breast Cancer Registry this year found that among 5,399 patients surveyed, one in four reacted to their diagnosis with acceptance and a positive attitude to fight. But one in three patients felt depressed, and 18 per cent of patients were in disbelief.

Figures from the registry show that breast cancer has been the most common cancer affecting women in Hong Kong since 1993. Cases diagnosed annually have more than doubled, rising from 1,152 in 1993 to 2,945 in 2009. On average, about eight women are diagnosed with breast cancer every day in the city.

A recent HKCF-funded study by the University of Hong Kong of 246 breast cancer patients who had completed primary treatment showed that one in seven patients experienced chronic psychological

This year marks the Hong Kong Cancer Fund’s (HKCF) 11th Pink Revolution, a month-long campaign in October to increase awareness of breast cancer.

Singer and actress Coco Lee is this year’s Pink Ambassador. She will appear in print and television ads, and attend events throughout the month. Lee, 36, who is married to businessman Bruce Rockowitz, says she and her husband have supported HKCF for many years. But this year she wanted to do more than donate money. “You need people to do things. I’m ready; let’s help, let’s do something,” she says.

Rockowitz’s mother had breast cancer about 15 years ago, and Lee understands how tough the journey for patients can be. “A lot of women in Hong Kong have no idea about breast cancer,” she says. “I want to spread the word. We want to send the message that breast cancer is not a death sentence. The earlier you detect it, the more chance you have of surviving.”

Through Pink Revolution, the HKCF aims to raise HK$4 million to support its free breast cancer services that benefit more than 7,000 women a year. Here’s how you can get involved. For details, go to cancer-fund.org/pink.

Coco Lee (centre), Pink Ambassador for the Hong Kong Cancer Fund, with survivors of the disease. Photo: HKCF

instability. More than 40 per cent reported having symptoms of distress – lack of energy, itching and acute anxiety.

Dr Wendy Lam Wing-tak, psycho-oncologist and assistant professor at HKU’s School of Public Health, says that younger patients have more difficulty dealing with the symptoms and the impact of the treatment. “The impact on their lives is perhaps more apparent and imminent than it is for older women,” she says.

Effective symptom management can help prevent chronic psychological instability, says Lam. With these findings, the HKCF plans to enhance its post-treatment rehabilitation to focus on managing these symptoms.

“The study found out more than we could observe during daily interaction with the patients,” says Tammy Leung Yuk-chun, HKCF’s head of service. “We can now plan treatment programmes in a more professional and precise way.”

Earlier this year, a study published in the journal Biological Psychiatry showed that psychological intervention through a stress management programme could alter tumour-promoting processes at the molecular level in breast cancer patients. The 10-week group-based programme developed at the University of Miami in Florida combined relaxation, imagery and deep breathing, along with cognitive

Some patients thank the disease for giving them new meaning in life, but others get stuck in the trauma TAMMY LEUNG, HEAD OF SERVICE, HONG KONG CANCER FUND

Friends aided Flora Law’s recovery from cancer. Photo: HKCF

behaviour therapy, which is designed to help patients reduce bodily tension, change the way they deal with intrusive stressful thoughts, decrease negative moods and improve their interpersonal communication skills.

The patients who went through the 10-week programme adapted better psychologically to the whole treatment process for breast cancer.

There were also physiological changes that indicated the women were recovering better than the control group who didn’t go through the programme.

Psycho-therapeutic support offered by the HKCF includes art and dance therapy, yoga and meditation, peer support and life coaching, as well as a “look good, feel good” class.

“Some patients thank the disease for giving them new meaning in life, but others get stuck in the trauma,” says Leung. “We [the HKCF] want to teach them how to carry on with their lives.”

Last week, Law completed six weeks of radiation therapy. This month, she plans to go back to work.

But she will continue as a volunteer with HKCF, counselling other patients. “In the beginning, it’s especially important to know you’re not alone,” she says.

CancerLink hotlines: 3656 0800 (Kowloon), 3667 3000 (HK Island), 3919 7000 (New Territories)

Dress Pink Day, Friday, Oct 26 Whether it’s the full blush or just a tinge of rose, pink your outfit on this date. Organisations are encouraged to host their own Pink Party and make a donation to support breast cancer patients. For as little as HK$100, you can sponsor a Pink Recovery Pack, which contains a temporary breast prosthesis, information booklet and other important items that help postsurgery patients with their healing and rehabilitation.

Shop for Pink HKCF has collaborated with a number of fashion, beauty and lifestyle brands – such as The Body Shop, Zojirushi, Pizza Express and Shanghai Tang – to sell special pink products and services. Part of the proceeds will go to supporting HKCF’s free breast cancer services.

Check out the website for a list of items on sale.

Plan your own activity If you’re feeling creative and want to show your support for Pink Revolution in your own unique style, organise a stand-alone Pink event.

For more information, contact Sue Lo on 3667 6389 (suelo@hkcf.org), or Zoe Lam on 3667 6384 (zoelam@hkcf.org)

DIET 9 HEALTHY GOURMET

THE TASTE TEST FLAVOURED WATER ......................................................

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Captain Mauro uses sardines marinated in vinegar and onions to make his nautical dish.

Photo: Andrea Oschetti

Andrea Oschetti healthpost@scmp.com French poet Charles Baudelaire liked to walk by Honfleur harbour in France. What he saw there inspired him. He noted in his diary: “Those large and beautiful ships, invisibly balanced on tranquil waters, those hardy ships that look dreamy and idle, don’t they seem to whisper to us in silent tongues: ‘When shall we set sail for happiness?’ ’’ Today, if travels are to be a way to act out our dreams, my advice is that you get off the beaten track. Put away the guide books and do away with tour guides. Enter the world of bespoke travel, tailored to your interests, not for the masses.

Travelling has become more of a spectator’s sport than an exciting voyage of discovery.

Tourists are stripped of experiences and presented with an orgy of landmarks: a Gothic cathedral, a Renaissance painting, a postmodern bridge, a glimpse of a sunset and a dinner at a busy restaurant, all in one day.

I am passionate about cooking and I make my travels meaningful with it: not as a spectator, but by immersing myself in food experiences and connecting with people who open new culinary landscapes for me.

This is bespoke travel. It changes travel from ticking boxes to life-enhancing opportunities.

Simone Sturla is my travel guru (simone.sturla@italybao.com). He has been tailoring travel experiences for his clients for more than 20 years, and can arrange a private visit to the Sistine Chapel, a dinner in the home of a celebrity chef, a night at the Palladian Villa of a local duke, or a private tour round a Formula One circuit with a professional driver.

On a recent trip, I wanted to experience Italian food. It’s not just about what you eat at restaurants, it’s a culture with rich culinary traditions rooted in local people and their territory.

Its authenticity is to be found in a private setting – a home, a boat, a picnic in the vineyards – where your host passionately tells the exciting stories behind what you eat.

Sturla took me on a short journey to discover two of what he calls “Italian food excellences”.

In Venice, he exposed me to a different way of travelling: sailing on Eolo, one of the few remaining flatbottomed bragozzo boats that allow you to escape the usual canals and get to know Venice and its lagoon from a new perspective.

Mauro is Eolo’s captain and the chef who took us on an overnight sailing trip to celebrate the full moon that covers the lagoon “with a silver kiss”. He took us to the local market to buy the food for dinner.

The boat starts sailing towards the treasures of the lagoon. Mauro gets busy in the kitchen. Everything he is cooking for us is rooted in the lagoon: the ingredients, the recipes and Mauro’s cooking skills, learned from his mum and grandmother.

Fish fulfilment We open a bottle of wine and he invites us to help him in the kitchen.

The dishes he is preparing are not just local, but linked to our sailing experience. The rice is made richer with the black ink of squid, which were caught en route.

The sardines are marinated in vinegar and onions, which preserve them for a long journey at sea. The lagoon’s crabs are served with the local radicchio, a chicory with the distinctive white-veined red leaf that’s mildly bitter and has been known since antiquity.

The full moon finally rises. We are sitting around the table in the Eolo’s stern, travelling around Venice, eating local delicacies and sipping wine, listening to Mauro’s storytelling. I feel in harmony with the local environment: I am living in

Mauro, the captain of the Eolo, says the full moon in Venice covers the lagoon ‘with a silver kiss’

Venice, not watching a touristic rendition of it.

From Venice, we travel south.

Near Orvieto, we turn on to an unpaved road, lined with trees, which climbs up over the mountain near the medieval town of Monteleone, perched on a hill.

We arrive at an isolated cottage, which in the 19th century was the resting place for travellers on a pilgrimage to Rome. The air is clean, the silence broken only by the singing of crickets.

A local family is waiting for us, and they are all busy cooking.

Francesca is rolling the pasta, her daughter Anna is stirring the sauce, her son Stefano is preparing the lamb, and the father Antonio opening the wine.

Italians are at their best at home – even our global fashion businesses are family-run. In this cottage, all is home-made: preserved vegetables, jams, cheeses, hams and wine. The vegetables come from the garden and the meat from a neighbour.

Home cooking is a must for any gourmet travelling to Italy. The three-star restaurants are not enough to experience Italian cuisine. You need to find a way to be welcomed into a local home.

For the next four hours, we sit in the big open kitchen beside the

marble fireplace. The rustic taste of home food brings back memories of my childhood, lulled by the chatting of Antonio, and Francesca’s invitation to eat and drink more.

They are proud of their food and, once again, we have all found happiness together.

Jeanette Wang jeanette.wang@scmp.com

Perfectly Clear Divine Summer Fruits HK$8.90 for 500ml, Marketplace by Jasons A “Very English” still spring water from the county of Kent, the “Garden of England”, contains blackcurrant and raspberry flavouring and artificial sweetener sucralose. The result is six calories per bottle that may change water-haters’ minds.

Verdict: much too sweet and artificial tasting; all that sweetener can’t be good for you.

Asahi Mitsuya Water Lemon HK$18 for 485ml, City’super Only 1 per cent of this is actual lemon juice.

Most of it (22 grams) is glucose, fructose syrup and sugar.

That’s why each bottle has such a surprisingly high calorie count (87).

Verdict: pleasantly sweet, but not worth the calories. Go for a simple slice of lemon in water instead.

Mauro’s appetiser of sardines Serves 4 9 fresh sardines Vinegar Extra virgin olive oil A bunch of parsley A clove of garlic Some breadcrumbs One country loaf of bread, sliced • Clean the sardines and pass the fillets through a bath of vinegar. Then let them rest in olive oil.

• Finely chop the garlic clove and the parsley and add them to the breadcrumbs with some more olive oil.

• Coat the sardines in the breadcrumb mixture. Fry them on medium heat for about two minutes each • When ready to serve, lay each sardine fillet on a small slice of grilled or toasted bread. Top with parsley sauce.

Healthy Gourmet is a weekly series by private chef Andrea Oschetti, andrea@fioreblu.com

Meko Vitamin Water Zero HK$12.90 for 500ml, 7-Eleven This zero-calorie citron flavoured drink has no preservatives or artificial colours. But it has seemingly copious amounts of flavouring and artificial sweetener because the taste is simply cloying.

Verdict: overpowering – much like drinking detergent diluted in water.

10 FITNESS GREAT STRIDES THE PHILIPPINES

Treasure islands

The Intramuros area of Manila is a good place for a jog.

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Troy de Haas healthpost@scmp.com Less than two hours from Hong Kong and comprising 7,107 tropical islands, the Philippines makes for an ideal weekend getaway. But surprisingly few Hongkongers visit the archipelago compared to more popular spots in the region such as Bali or Phuket.

So if you are looking to escape the tourist hordes, then the Philippines could be right up your street.

Metro Manila has a reputation for traffic jams, pollution and crime. But in recent years, the city has cleaned up its act, and the level of crime has dropped to the point where you can feel safe running around town.

“Just run this side of town,” reassures my hotel’s gym manager, Juan Buenavista, who leads a daily 6am run starting from the InterContinental Manila.

Makati, where the hotel is located, is where you are most likely to find yourself staying in Manila.

This is apparently the “right” side of town to keep out of trouble.

Running in the Philippines is largely a university sport. You will

notice that many runners you see around town proudly wear their college tracksuits.

Despite Manila having so few open areas to offer the distance runner, a dedicated and motivated group called the Pinoy Runners (pinoyrunners.org) promote running culture with regular group runs. They also provide up-to-date information for those wanting to run in and around Manila.

For the country’s best running, you must head further afield to the island of Boracay, or just outside the capital to places such as Tagaytay, where you’ll run against a backdrop of volcanoes.

Best running spots Mall of Asia (Bay Walk) One of Asia’s largest malls with more than 2,500 shops, it is also home to the city’s most popular running spot. The eight-kilometre loop is free from traffic and follows Manila Bay’s esplanade. It continues along a boardwalk into the parkland of Intramuros, the Spanish walled city.

The Fort An upscale suburb where residents live in private estates known as “villages”. Forbes Park and

Dasmarinas Village are ideal for running as they have numerous tree-lined boulevards and parks. As it is a gated community, you won’t run into too much traffic.

The main event: Milo Manila Marathon Over the years, the Milo Manila Marathon (milo.com.ph) has built a reputation as one of the country’s major sporting events.

The aim is to help popularise running, make it accessible and encourage a healthy lifestyle for all Filipinos.

It is a star-studded event with local television and movie celebrities taking part, and a Milo campaign that brings the Milo Manila Marathon to everyone in a Tour de France-like showcase across the country.

The event is one of a series of 18 races across the country held between July and December, with each attracting up to 20,000 competitors. The race distances vary from five kilometres to 21 kilometres, and it all ends with the full marathon in Metro Manila on December 9.

However, the event’s focus is more on participation and entertainment than the race itself.

With poorly marked kilometre signs and unopened bottles of energy drink at stations, it is hard to expect any world-class fields or times at this event. But generous prize money is still on offer for those expecting to complete the race in about 21⁄2 hours.

In a country with so much poverty, it’s great that everyone gets the chance to experience the simple joys of a big running event.

Boracay To experience the true spirit of the Philippines, you must journey to the islands of Cebu, Palawan or Boracay. With their white sandy beaches and crystal clear water, it is no surprise that they are often voted among the top 10 beaches of the world. The tiny island of Boracay is one of the Philippines’ premier tourist destinations, and running there is an unforgettable experience.

It’s also an ideal way to see more of the island.

The best spots for a run on Boracay are: • White Beach: an immaculate four-kilometre stretch dotted with resorts, bars, restaurants and shops.

At the northern end, a path is cut into the cliffs which takes you to

hidden beaches. A popular training spot for foreign triathletes.

• Mount Luho: the island’s only mountain, it has rewarding views of the entire island once you reach the summit. Numerous roads and tracks wind through the lush jungles.

Après run • The Philippines turn on excellent Spanish-inspired buffets, which are ideal for refuelling after a run.

• Manila is peppered with shopping malls. Many leading brands of running shoe are made in the Philippines, and these malls sell them at half the price of most stores in Hong Kong.

• Most of the islands offer action sports such as banana boat riding, quad biking, diving, caving and water shooting (a type of white water rafting).

• If you visit the island of Bohol be sure to look out for the tiny tarsier, one of the world’s smallest and rarest primates, which is endemic to the Philippines.

Great Strides is a series of city running guides by Troy de Haas, sports travel manager at Flight Centre and a former Australia representative in orienteering, mountain running and tower running

WELL-BEING 11 FIT & FAB ......................................................

Rachel Jacqueline healthpost@scmp.com Amelie Seure went from being a complete rookie at women’s rugby to a Hong Kong team member in five years. She puts this quick rise down to her competitive streak.

She achieved parallel success in her professional career. After finishing a master’s degree in industrial engineering in Hong Kong, she began working as the sole employee of apparel manufacturer Full Connexion. Seven years later, the 29-year-old Frenchwoman is the company’s general manager, overseeing a team of seven across Hong Kong and the mainland.

“I don’t hesitate much,” she says.

“But I don’t do crazy stuff. My brother will go bungee jumping in Macau, but that’s not something I would do. Not that I’m scared; it’s just not my thing.”

Seure’s thing is sport. In France, she played handball at a national

level, but was unable to find the same level of competition when she moved to Hong Kong. She searched for a new sporting fix and discovered women’s rugby.

“In France, hockey and netball are not popular. I’m not a big fan of soccer, and volleyball wasn’t intense enough,” she says.

“I was familiar with rugby and my boss, who used to play, pushed me towards the game.

I loved it instantly.”

She has represented Hong Kong in the sevens and 15s teams since 2008. She was named the 2011 coach’s player of the year.

The people around her have been an important part of her journey, she says: “I have been very lucky to meet a lot of experienced people and learn from all of them, including my club and national coaches, teammates and other players.”

To continue to achieve good results, Seure believes in constant improvement. “I’ve reached a good

Scrum girls do

Amelie Seure represented Hong Kong in the sevens. Photo: K.Y. Cheng

standard, but I always want to develop my game,” she says. “I’m always trying to get better.”

How much of your success at rugby do you attribute to natural ability? Or is it more about working hard?

It’s definitely been a combination of both. After a game, I only remember everything that I did wrong, and then work hard to fix it. On the other hand, I am lucky that my handball experience has helped with ball handling and the technical aspects of rugby, too. Unfortunately, my speed is pretty average. So I compensate by anticipation and aggression – I try to think faster than my opponent.

Do you ever worry about getting hurt?

No, I don’t. Maybe that’s because I’m lucky and I haven’t been injured – apart from two broken noses. But those really weren’t that bad. If you’re scared about getting hurt, you are at greater risk of being injured.

Your rugby journey has been fast and successful. Is there anything that you would change if you could?

I wish I could have started earlier.

I’m trying to make up for my late start on the very specific and technical parts of the game – like ball handling skills and tackling. That kind of stuff just comes naturally if you start playing at age five.

What does your work experience bring to your rugby game?

I’m always running late to training and rushing as I come straight from work. So in some ways, maybe the extra training keeps me fitter. But in the game, my work experience definitely helps me to deal with disappointments and stay motivated, and I can also help others with that. Obviously, knowing how to work well in a team is a big part of that, too.

What goes through your head when you’re being tackled?

I’m concentrating on the game; I’m

not really thinking about anything else. Some of the guys can talk about a game three years later in every detail – what happened where – but I find that when I’m out there I’m just in the moment, in the zone.

Would you encourage other women to try rugby?

Of course. It is a great sport that everyone can play, no matter what your body shape. All you need is the right mental approach. The social side is also very enjoyable.

Do you think women make better rugby players?

While I’d like to say that women are smarter and better players, at the end of the day, rugby is a combat sport and strength and power help the men. But I think women are more humble and willing to learn.

That allows them to tap into their strengths and become good players.

Women who come to rugby are prepared to work hard, which makes a difference.

I’m lucky, I haven’t been injured, apart from two broken noses. But those weren’t that bad AMELIE SEURE, RUGBY PLAYER

12 SPONSORED FEATURE

OCTOBER 2, 2012 SOUTH CHINA MORNING POST