YOUR GUIDE TO LIVING WELL
TUESDAY, OCTOBER 16, 2012
HEALTH POST MALE BREAST CANCER >PAGE 8
BAOBAB: THE TREE OF LIFE >PAGE 10
No time to lose Early intervention is essential for children with special needs, but where can they go? >PAGE 6
2 NEWS APP OF THE WEEK
HEALTH BITES ......................................................
Your personal push-up trainer
Advice for the long run The death of a 26-year-old man after completing this year’s Standard Chartered Hong Kong Half Marathon has prompted race organisers to improve participant safety for next year’s event. Last week, the Amateur Athletic Association unveiled a team of 12 experts, including doctors, nutritionists, trainers and top local athletes, who will share practical tips and answer runners’ questions over the next 20 weeks through Facebook (facebook.com/ hkmarathon). Next year’s race will be on Sunday, February 24. Registration opens online at hkmarathon.com on October 24. One of the experts, Dr Gary Mak, a specialist in cardiology and president of the Association of Sports Medicine and Sports Science, says: “We encourage everyone who wants to participate to consider undergoing a selfassessment before they register; and if they find themselves at high risk, they should go to their doctor for a thorough check-up before signing up.”
...................................................... Katie McGregor healthpost@scmp.com PushUps 0 to 100 HK$8 Rating 9/10 In a recent newsletter from Harvard Medical School I read that for a strong core we should forget sit-ups and try “planks” instead. Sit-ups are hard on your back, it says, and all that work on your hip flexors can cause them to become over tight and lead to back pain. This app is designed to help almost anyone achieve a goal of 100 push-ups within the 10-week programme. Even absolute beginners can do it; you lean against a table and push up against your body weight. The more competent can do knee or full push-ups and move ahead in the programme. The settings allow you to choose your push-up type, the gender of your coach’s voice and whether you want coaching with voice, beep or not at all. Then you start. Using the touch screen, you slide your finger up the programme “tree” to find a place that you would be comfortable to start at. An icon clearly indicates the programme for any day; for example on week seven, day three you see a little icon showing a push-up routine of 10:12:14:12:10. You rest between each set; but even so, I didn’t start there. I started at the beginning – 3:5:5:5. A lengthy five-minute stretch is recommended and the app directs
you to YouTube to view one of their favourite sites for stretches. Here I found an old friend, Jillian Michaels, whose weight loss and exercise app we have previously reviewed. I had yet to learn that you can fast forward your rest periods so after my first three push-ups, I spent a bored 90 seconds waiting for the go ahead for my next set. While I was originally disdainful of using an app to do something as simple as push-ups, this app does make the process fun, and having a plan that progresses towards a 100-push-up goal is motivational. You get badges for progressing through the programme, as well as the chance to bore your friends by sharing your achievements on social media.
ASK THE EXPERTS NANCY CLARK Q: How should athletes who are vegetarians – particularly vegans – meet their protein needs? A: Vegan athletes can successfully meet their protein needs by eating a variety of plant foods. Most grains contain all nine essential amino acids, just in lower amounts than an equivalent serving of animal foods. Hence, vegans need to consume generous portions of plant protein (grains, beans, legumes, nuts, soy) to compensate for both the lower density of the protein and the fact that plant proteins are less bioavailable (due to their fibre content). The wisest way for a vegetarian to optimise protein intake is to consume an adequate amount of food. If the vegan is
Jeanette Wang jeanette.wang@scmp.com
undereating, an energy deficit easily leads to muscle loss. Vegans who want to lose fat (not muscle) will want to focus their limited food intake on protein-rich plant foods. More tofu, anyone? Nancy Clark is a sports nutritionist and a Fellow of the Academy of Nutrition and Dietetics in Chicago. 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
Karma before the storm With the year-end revelries just round the corner, it’s perhaps a good time to be gentle and kind to your body, before the onslaught of boozing and buffets. A three-day juice detox and yoga programme could be an option for you. Pure Yoga is organising one starting on Friday, October 26 at its Tsim Sha Tsui branch, led by yoga instructors Margaret Chung and Samantha Chan. The programme is open to all and costs HK$3,750. Registration closes on Monday (pure-yoga.com).
Fumes and fortune Exposure to ambient air pollution is harmful, but more so for children under the age of one, finds a new study published in the American Journal of Respiratory and Critical Care Medicine. The study included more than 1,900 children who were followed from birth to eight years old with repeated questionnaires and lung function tests. Outdoor concentrations of particulate matter from road traffic were estimated for residential, daycare and school addresses using dispersion modelling, a mathematical simulation of how air pollutants disperse in the atmosphere. “Exposure to traffic-related air pollution during infancy was associated with decreases in lung function at age eight, with stronger effects indicated in boys, children with asthma and particularly in children sensitised to allergens,” says researcher Dr Goran Pershagen, professor at the Karolinska Institutet Institute of Environmental Medicine in Stockholm, Sweden. Even fat cells need their sleep Some people claim they can get by with little sleep. But while they may not have decreased alertness and cognitive ability, a lack of shut-eye has a harmful effect on the body’s energy metabolism and can lead to weight gain, diabetes and other health problems over time, say University of Chicago Medicine researchers. In the study, published in today’s issue of Annals of Internal Medicine, seven young, lean and healthy volunteers had four straight nights of 8½ hours of sleep, and at least four weeks later had four straight nights of 4½ hours of sleep. Food intake, strictly controlled, was identical during both stints. The four nights of short sleep negatively affected fat cells, reducing by 30 per cent their ability to respond to insulin, a hormone that regulates energy. This reduction is comparable to the difference between cells from obese versus lean participants, or from people with diabetes versus non-diabetic controls.
NEWS 3 QUIZ ...................................................... Jeanette Wang jeanette.wang@scmp.com More than 15 per cent of children suffer from eczema, an inflammatory skin disease that in some cases can interfere with daily life and be disfiguring. But a new form of relief could be on its way. A team of researchers, led by Dr Raif Geha of Boston Children’s Hospital, has discovered a new potential target for the condition that, if blocked, could slow the disease or even cure it completely. They report their findings in this month’s issue of Immunity. In eczema – also known as atopic dermatitis – white blood cells called immune T cells invade the skin and secrete factors that drive an allergic response, making the skin itch. Geha and his team have found that scratching the skin precipitates the condition by encouraging an influx of other immune cells called neutrophils. These neutrophils secrete a lipid called leukotriene B4 that calls in more neutrophils and, more importantly, recruits the potent immune T cells to the affected site. This aggravates the skin even further. Through tests in mice, the researchers showed that a drug that
GREAT STRIDES blocks the production of the lipid also blocks the development of allergic skin inflammation. Deleting the receptors on immune cells that bind to the lipid had a similar effect. Test your knowledge of eczema below. 1. The age of onset in most cases of atopic dermatitis is a. Before the age of one b. Before the age of two c. Before the age of four 2. Eczema can be triggered by a. Sweat b. Soap c. Clothing 3. Which of the following is not helpful in treating eczema? a. Infrequent showering b. Corticosteroid creams or ointments c. Antihistamines 4. Which of the following statements is correct? a. Eczema is contagious b. Most children will outgrow eczema by adolescence c. The exact cause of eczema is known Answers: 1. b; 2. all are correct; 3. a; 4. b
Grassland choice is a runaway success ...................................................... Jeanette Wang jeanette.wang@scmp.com The Arabian Desert in Jordan, Japan’s Lake Kawaguchi, Angkor Wat in Cambodia, and Hong Kong’s very own Ham Tin and Sai Wan beaches in Sai Kung – these are some of Health Post’s readers favourite running spots. Thank you to everyone who shared their answers and photos for the Great Strides contest last week, in which we asked: “Where in the world is your favourite place to run and why?” It was a tough decision to pick just one winner, but we were mesmerised by 39-year-old Chang Tshung-hui’s description of Mongolia. He wins a travel package for two to Beijing worth HK$8,000, including return economy flights and two nights at Mercure Wanshang Beijing with daily breakfast, courtesy of travel agency group Flight Centre. This is what he said: “My favourite place to run in the world is the grasslands of Inner Mongolia. I
Chang Tshung-hui pounds the grasslands of Inner Mongolia.
like this place so much that it is the only destination that I make the effort of travelling to each year. My annual pilgrimage started as a participant in the Genghis Khan Grassland Extreme Marathon. It has a unique setting on small packed sand and dirt trails across the grass plains around Xiwuzhumuqinqi. “I like the wilderness and tranquillity of the vast grasslands that were once traversed by the legendary Genghis Khan and his horsemen. It does not take long for one to feel the conquering spirit of Khan. I experienced a herd of horses galloping past during my maiden run. It was an amazing humanmeets-beast moment. There was no danger, as they have been galloping on these grasslands for years and run around creatures in their path. “After an exhausting day, one gets to experience the hospitality of the Mongolian people, who invite you for a hearty meal in their homes. “It is an extraordinary running experience for runners of all levels and one had better go there soon, as the number of participants seems to double each year.”
4 MEDICAL CASE HISTORY
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Madam Wang was navigating a pavement on a rainy day when she slipped and fell. Instinctively, her right hand shot out to break her fall, causing a sharp, intense pain in her wrist. At the Hong Kong Sanatorium and Hospital, Wang, 60, (whose name has been changed for patient confidentiality reasons) was attended to by Dr Tang Wai-man, a specialist in orthopaedics and traumatology. An X-ray showed that Wang’s wrist wasn’t just broken – the bones were shattered. Tang would need to piece the tiny bone fragments back together like a jigsaw puzzle and hold the mended wrist in place with a metal plate. But something else about Wang’s injury bothered Tang. He probed further into Wang’s medical history, and confirmed that she had experienced menopause about 10 years earlier. Menopause results in a dramatic fall in levels of oestrogen and progesterone, a woman’s hormones. Among other things, oestrogen plays an important role in stimulating bone formation. Bone is living tissue – it is constantly replaced by new tissue. When the action of oestrogen is reduced or removed, bone tissue may not form as quickly, or as well. This leads to a decrease in bone density, and results in brittle bones that could shatter in a fall. Given the extent of Wang’s injury, Tang suspected that she had osteoporosis, or “porous bone” disease. To confirm his suspicions, Tang had her undergo a dual-energy X-ray absorptiometry (Dexa) scan to measure her bone density. The painless and non-invasive procedure exposes the body to short bursts of X-ray beams of different energy levels. It then measures how many X-rays are absorbed by the bones, and can detect even early stages of mineral loss from the bones. The level of radiation the scan uses is less than a regular X-ray. The results are expressed as a T-score. Normal bone density yields a T-score greater than minus one. A T-score of less than minus 2.5 confirms osteoporosis. Wang had a T-score of minus three, which was considered very low.
Illustration: Angela Ho
Eileen Aung-Thwin healthpost@scmp.com
Too brittle too late
Like most people, a fracture was the first and only indication that Wang had osteoporosis, as the condition is usually symptom-free. But very low bone density can result in compression fractures or breaks in the bones of the spine that occur without any injury. It could also lead to a loss of up to 15cm of height over time and cause a stooped posture or a “dowager’s hump”. To try to halt, or hopefully reverse, the bone density loss, Tang put Wang on calcium and vitamin D supplements. Calcium is one of the important minerals that make up bone and vitamin D is needed for the body to absorb the calcium
When the action of oestrogen is reduced or removed, bone tissue may not form as quickly
effectively, says Tang. He also asked Wang to do gentle exercises and soak in some sunshine every day. The sun’s rays also provide vitamin D which helps the body absorb calcium. Exercise is important, because the strain exerted on bone when muscles contract helps stimulate bone formation and increase its density. Without sufficient movement, the body will assume that it no longer needs to maintain its calcium levels and starts to get rid of it, says Tang. Hence, people who have been bedridden for long periods of time are often at risk of developing
osteoporosis. Although it is often recommended that people undertake weight-bearing exercises like jogging to protect bone health, Tang says that even walking and gentle stretching exercises are good. But given Wang’s very low T-score, Tang wanted to support her bone health further with a diphosphonate, which can slow down further mineral loss in the bones. It does this by promoting the death of osteoclasts, whose job is to destroy bone, thereby helping to maintain bone density. Tang was mindful that recent studies had shown that prolonged use of diphosphonate can paradoxically increase the risk of fractures in rare cases. Hence, once Wang was on the drug, she would have to go for check-ups twice a year and be on the lookout for complications such as pain in the jaw, hip, or abdomen. Wang could only start the drug after the fractures in her wrist had healed, as diphosphonate can interfere with the healing process. Six to eight weeks after her wrist repair surgery, Wang started the drug therapy, which studies show will reduce the risk of another fracture in the first five years. Tang says that Wang’s lifestyle changes, supplement intake and medication will take some time to start showing results. She will undergo another Dexa scan in two years’ time. There is a chance that the T-score may show a slight dip as her body battles to rebuild bone density, says Tang. But the best-case scenario would be a slight improvement. Tang says that osteoporosis can affect both men and women when their hormone levels drop. He advises people to protect their bone health with regular exercise, some sunshine, and adequate intake of calcium and vitamin D. Women who have reached menopause should monitor their bone health by undergoing bone density tests. Osteoporosis is a silent disease, and if you discover it because of a fracture, the damage to your body’s supportive structure has already been done.
HEALTH 5 FROM THE EXPERTS LOVE & SEX
Lust but not least ...................................................... Dr Justin Grayer healthpost@scmp.com Are you getting enough sex? Perhaps not. Hong Kong men and women are satisfied with having sex an average 1.9 times and 1.6 times a week, respectively, according to a City University Community College 2011 survey of nearly 1,000 adults between 36 and 80 years old. By contrast, people in Greece prefer to have sex at least three times a week, according to a 2008 survey by British condom manufacturer Durex. Sex isn’t just intercourse, but any sexual activity that brings pleasure to the people involved. Research has demonstrated that safe, consensual sexual activity is related to good physical and mental health, and helps to keep a relationship alive. If both partners are satisfied with the levels of sexual activity in their relationship, there is no problem. But if one partner wants more sexual activity than the other, this is likely to affect the relationship.
Each of us is responsible for our own sexuality, and for getting ourselves turned on So, for those Hongkongers who want more good sex, why aren’t they getting it on, and how can they start? There are many reasons why people find themselves having less sex in their relationships. Social factors, such as long working hours or jet lag, can induce tiredness, and living in small apartments with inlaws, domestic helpers or children can reduce the feasibility of private, uninterrupted sex. Although most like the idea of spontaneous sex, waiting for this can be self-defeating. Try planning sex dates: pick a time when you are less likely to be interrupted, arrange for others to be out, or go to a hotel, even for an hour. (Let’s be honest, few people outside of Hollywood need that long.)
Where possible, make the environment fit with your fantasies of sexual and emotional intimacy, by using lighting, music and clothing. When planning dates, consider what might stop you from keeping them. With practical issues remedied, problems can still persist because sexual desire fluctuates. Sexual desire tends to increase when we believe we deserve, and anticipate, enjoyable sexual activity. Ultimately, each of us is responsible for our own sexuality, and for getting ourselves turned on. The key to good sex is to work as a team player, and communicating with your partner so they know what you like. Invite your partner to use their initiative, and focus your feedback on what you like, rather than what they are doing wrong. Relationship discord can be a big factor in reduced sexual desire. But this tends to be more pronounced for women than men. Men and women are wired differently with regards to how they are sexually turned on. In general, a woman’s sexual desire is more affected by the quality and safety of the relationship than by visual cues. It is important to talk about your relationship when you are calm, and can be clear. When we feel that our partner understands us and can meet our needs, we tend to solve problems more effectively, and are therefore able to remove some of the barriers to good sex. Boredom and excitement are mutually exclusive, so if you are having the same old sex every time, it may be time for you to mix it up by introducing new places, positions and pleasures. Share your fantasies with each other, but remember to let your partner know which fantasies are meant to stay as fantasies, and which you would like to become reality. Try creating a sexual “wish list”, too. Start to initiate sex if you normally leave it to your partner. In an ideal world, our physical appearance wouldn’t make any difference to our partner’s desire for us. But the reality is that our physical appearance impacts our own feelings of sexiness, and how attractive we are to others. It’s important to take care of our appearance, although this should be in the context of our overall health. Our thoughts and moods impact our sexual desire. If we are stressed or sad, we may not feel as sexy, or
Good communication and variety can forestall sexual problems. Photo: Corbis
may be keen for sex, but be worried about the outcome, and so avoid it. Believing that there is something wrong with you can impact how your body responds sexually, and can result in a self-fulfilling prophecy. There are strategies to help manage the impact of beliefs and emotions on sexual desire, and on performance. There may also be biological or physical factors, such as hormones, or ill health, that affect your desire for sex. Talk to your doctor, as there may be help available. Every couple has some sexual dissatisfaction. But the more varied your sexual repertoire, the less likely they will become problems. If you want more sex, and “good enough” sex, just remember that you’re the one responsible for creating it. Dr Justin Grayer is a clinical psychologist and sex therapist at thinktalkpsychology.com
6 COVER STORY
A
s Justin Huen Ho-yan’s parents look on, teacher Flora Chan encourages the baby to stretch his hand out and reach for the colourful toys near him. This action helps exercise Justin’s arm muscles, which are weak because the 16-month-old boy has Down’s syndrome. Justin has been getting muscle reinforcement training at the Hong Kong Down Syndrome Association in Wong Tai Sin since June. He is among the few toddlers with special needs who are lucky enough to receive special training before they start kindergarten. The association’s director, Anna Lee Mei-yin, says applying for a place at the government-run early education training centre for special needs children is like the interminable wait for a public housing flat. “In most cases, children get a place when they reach 20 months. But in districts like Yau Tsim Mong, where demand heavily outweighs supply, a child will not get a place until he is three years old. “For special needs children, the time right after their birth, when they undergo growth spurts, is a critical period where reinforcement must be given. Otherwise, it will be much harder for them to catch up as they grow older,” says Lee. The definition of “special needs” covers a range of developmental and health conditions. Down’s syndrome is just one example. Others include autism, epilepsy, cerebral palsy, and visual and speech disorders. Training services for preschoolers with special needs are provided by the Social Welfare Department. The aim is to “enhance the children’s physical, psychological and social development, thus improving their opportunities for attending ordinary schools”. As of August this year, there were 6,230 such places for special needs children aged six, says a department spokesman, and department figures show there are 6,711 children on the waiting list. Because of the acute shortage of special education services, parents have to search for training centres, put their children’s names on every waiting list, and dig deep into their pockets to pay for private therapists. The Down Syndrome Association’s muscle reinforcement training programme, launched in June, was the result of a funding injection of HK$160,000 by Eu Yan Sang, a company that specialises in traditional Chinese medicine. It’s one of six projects for special needs children supported by grants totalling HK$1.1 million from the company. At the Fu Hong Society Hin Dip Centre in Aberdeen, four-year-old Alex Kwok, who shows signs of attention deficit/hyperactivity disorder (ADHD) and spatial
Golden time It’s tough for parents of children with special needs to find the right support before kindergarten, writes Elaine Yau
relation problems – he can’t write within a grid nor differentiate between straight and sloping lines – has been undergoing three-hour sessions of multisensory training twice a week. In an activity room fitted with a spring bed, swings, ball pool and balance bar, Alex and two other children are given various challenges. Listening to classical music through headphones, the children scale a ladder, and then clamber onto a swing and throw sandbags into baskets. Stephen Chan Tsz-man, occupational therapist and manager of the Hin Dip Centre, says the soothing music can help children screen out peripheral din and help them concentrate on the tasks at hand. “In addition to their motor skills, their oral sense is also engaged by making them clench plastic in their mouths,” he says. “Their sense of touch is engaged, as they are given shaving cream and clay to play with. “The multisensory exercises give rise to a sense of novelty which, in
turn, induces the brain to release dopamine. Hyperactive children like Alex have lower than normal levels of dopamine, and this will diminish the inhibition capability of the brain’s prefrontal lobe.” Chan says that the programme will benefit 24 children. Those with autism, developmental delay and ADHD will be put into groups of four for the month-long training. The funds will also be used to organise
For special needs children, the time when they undergo infant growth spurts is a critical period where reinforcement must be given ANNA LEE, HONG KONG DOWN SYNDROME ASSOCIATION DIRECTOR
more workshops for parents on the benefits of multisensory therapy for special needs children, he says. “The therapy has existed since the 1970s, but it’s relatively new to Hong Kong. It’s only embraced by a handful of occupational therapists here.” Also pioneering a new therapy for special needs children is Woo Chi-wood, a social worker with the Tung Wah Group of Hospitals’ Centre for Family Wellness and Child Development, which provides support services to more than 50 dyslexic children. Helped by a HK$188,000 grant from Eu Yan Sang, Woo has designed a programme that uses music to help children master English vocabulary. Children with dyslexia have problems comprehending or memorising words, but they tend to have sharp audio sensitivity and so learn better through listening, says Woo. He commissioned a composer to write 32 songs in different genres. Each song, running for one to two minutes, is used to memorise an
English word of two to five letters. Woo says the rhythm of the songs is made to mimic the tempo of the heartbeat, which can help boost memory. “The CDs can be used by both therapists and parents in a home setting. The letters of an English word and its pronunciation are repeatedly sung by the singer. Some of the songs are soothing, while others are more upbeat. The genres can pique children’s interest in listening to the songs.” The six beneficiaries of the Eu Yan Sang grants were picked from 36 applicants by the Hong Kong Council of Social Service. The other three beneficiaries are Caritas Hong Kong’s “A Pioneer Project of Early Assessment and Intervention for Children with Developmental Delay”; Heep Hong Society’s “Positive Psychology Family Programme”; and Po Leung Kuk’s “Talk Wise: Children Development Project”. Mabel Chau Man-ki, chairwoman of Eu Yan Sang Charitable Foundation’s Donation and Community Activities Committee, says this is the first time the company has been involved with special needs children. “Our research shows that support services for young children with special needs are insufficient in the city. The long waiting period means many children fail to get prompt remedial support in their critical growth period.” It’s a gesture that Alice Lau, mother of the hyperactive Alex, appreciates. She has taken her son to the outpatient clinic at Queen Mary Hospital, where she says the doctor asks about Alex’s progress without prescribing any treatment, as the hospital only treats those above the age of six. So she has found private therapists who cost HK$1,000 per hour, “which is totally beyond our means,” says Lau. Without proper treatment, Alex’s hyperactivity has made him few friends at school. “As he is frisky all the time, his overenthusiastic contact with his classmates leaves bruises on them,” says Lau. “Teachers also complain that he’s too boisterous in class. He has been like that since he was a baby, running around all the time.” Lau is frustrated by the dearth of support places for preschoolers with special needs. “I have applied for a place with the early education and training centre. But no one can tell me when I’ll get a place. They say I can only switch to a faster queue when Alex is five.” Lau feels that may be a bit too late. “The golden time period for receiving remedial support will have passed by then.” elaine.yau@scmp.com
COVER STORY 7
Clockwise from above: four-year-old Alex Kwok plays at the Fu Hong Society; Joanne Fung Yuetmei and Joel Huen Chi-hung are helped with Down’s syndrome baby, Justin, by teacher Hora Chan; Woo Chi-wood developed a musical method to help dyslexic children memorise words. Photos: May Tse, David Wong, Dickson Lee
8 HEALTH CANCER AWARENESS
...................................................... Eileen Aung-Thwin healthpost@scmp.com Retired mechanic Mr Lo, 82, first found a small lump in his chest almost a decade ago. Then 73 and still working, he felt a small painless bump barely the size of a green bean near his left nipple while taking his nightly bath. When the nodule did not go away after 10 days or so, he felt uneasy and decided to see a doctor, who gave him some antiinflammatory medication. After a week of faithfully applying the medicine, the tiny bump remained. Lo returned to the doctor, who recommended that he see a specialist. Lo was eventually diagnosed with breast cancer. The condition is often thought of as a women’s disease but it can affect men, too, because men also have breast tissue concentrated behind the nipple. However, in men, this tissues does not produce milk. At puberty, a rise in female hormones in girls stimulates the breast tissue to grow and develop milk glands. Male hormones suppress that process. According to Dr Ava Kwong Hoiwai, chairwoman of the Hong Kong Hereditary Breast Cancer Family Registry (asiabreastregistry.com) and chief of breast surgery at University of Hong Kong, the incidence of breast cancer in local men is lower than in the West, and the disease remains rare worldwide. Hong Kong Cancer Registry statistics show that, in the past decade, an average of 16 men have been diagnosed with breast cancer
16 • The average number of men diagnosed annually with breast cancer in Hong Kong (compared to 2,351 women).
each year compared with an average of 2,351 women. The incidence rate among Hong Kong men is 0.3 to 0.5 per 100,000; in predominantly Caucasian populations it’s one per 100,000. Kwong analysed data from the past decade and found Hong Kong men tend to be older when diagnosed compared to women – 64.5 years for men versus 52.7 years for women – which is consistent with international trends. In the US, it’s 63 years for men and 54 for women, according to an Associated Press report. She says that although not proven, doctors theorise that men tend to be stricken with breast cancer later in life because as they get older their testosterone levels decrease and oestrogen levels become comparatively higher. Oestrogen exposure is linked to the development of breast cancer. Dr Polly Cheung Suk-yee, founder of the Hong Kong Breast Cancer Foundation (HKBCF), says there may also be many oestrogenising factors in the environment, such as chemicals in food, that might come into play. Kwong found that 7.6 per cent of sufferers in Hong Kong were likely to be diagnosed with breast cancer at a younger age (under 40) compared to 2.3 per cent of Caucasians. This parallels the trend among women, but no one yet knows why. All cases of breast cancer in men are self-detected, says Kwong. Four in five discover the disease because they notice a breast lump. The rest have more severe symptoms like bloody nipple discharge. About half of all Hong Kong men and women have tumours that are smaller than 2cm (stage I or IIa) at the point of discovery – a statistic Kwong is unhappy about because more women should be catching the disease early as most effort has been directed at them to get screened regularly. Men have little breast and fatty tissue in the chest area and so lumps are more easily spotted, which helps early detection. That said, 9 per cent of Hong Kong male breast cancer patients are diagnosed at the final
Illustration: Kaliz Lee
It can happen to him
stage 4, nearly double that among women. In general, however, a local study by Kwong showed that men survive breast cancer better – one in five male patients died within five years of diagnosis compared with three in five females. Male breast cancer patients face slightly different challenges. According to Doris Cheung Chunho, a counselling nurse and head of support services at the Hong Kong Breast Cancer Foundation, some men might have trouble accepting the diagnosis of what is commonly thought of as a women’s disease. As such, they may not seek help even when they have trouble coping with the disease. Polly Cheung estimates that only 5 per cent of male patients seek support services. She adds that the number of male breast cancer patients in Hong Kong is small and awareness about the disease is low. There is no critical mass to form support groups like in the US.
The number of male breast cancer patients in Hong Kong is small and awareness is low A patient once told Doris Cheung that it would have helped him to speak with other patients. But since breast cancer support groups were women-oriented, he did not feel comfortable joining them. She recalls another case of a man with a lump in his breast who chose to forego a follow-up test using the medical insurance provided by his employer because he did not want his colleagues to know about it. However, in Polly Cheung’s experience, many male patients
have tremendous support from their wives. A mastectomy, which removes the breast tissue, nipple and areola, leaves the form of the male chest somewhat intact – men are also less likely to have marital problems post-surgery. Men do not associate their sexuality with their breasts the way women do, so they cope better on some fronts, says Polly Cheung. However, the absence of the nipple and areola might make some men feel self-conscious. Kwong is studying the psychological impact of breast cancer on male patients. Lo considers himself lucky that the cancer was detected early. The fact that it developed in his breast did not concern him as much as the fact that he had cancer. Years previously, he lost his daughter to lung cancer. With support from his wife and two sons, Lo underwent treatment and beat the cancer. However, genetic testing revealed that he carried a mutation in the BRCA gene – 14.2 per cent of male breast cancer patients do, according to Kwong’s research – which markedly raises one’s risk for breast cancer. In men, the gene mutation also raises the risk for prostate cancer. Kwong says that while 3 per cent to 5 per cent of male breast cancer patients may have prostate cancer, the risk jumps to 14.2 per cent when one is a BRCA mutation carrier. One in seven BRCA carriers also develop multiple cancers. Lo was diagnosed with prostate cancer around the time the gene test results arrived. Four years later, the cancer spread to his bones. Given that BRCA mutations are hereditary, Lo’s two sons also underwent testing. Neither had the gene mutation. Despite his multiple health challenges, Lo remains sanguine. “When something like [cancer] happens, it has already happened,” he says. “Happy or sad, you still have to live, so you might as well be happy and positive. I know what it is like to watch a loved one go through this. Be happy, so you won’t affect your family.”
DIET 9 HEALTHY GOURMET
Gourd’s gift to cleansing your body the right way ...................................................... Andrea Oschetti healthpost@scmp.com When Hippocrates proffered the sage advice “let food be thy medicine”, we had not yet been confronted with preservative-laden pre-packaged meals and a microwave oven to cook them in. We are constantly exposed to environmental toxins, found in everything from plastic containers to dry-cleaned clothes to skin and hair care products. Toxins are also produced as a by-product of our digestive and metabolic processes. And we may even unknowingly be eating toxic food. I believe our bodies produce and take in more toxins than they can safely eliminate, and so we live in a state of chronic toxicity. Many natural health professionals believe this to be the underlying cause of many chronic diseases. Enhancing your body’s capability of detoxing helps to correct this imbalance. In my opinion a regular detox programme – one that targets the
There are two ways we can approach life ... eliminate things we don’t like, or focus on what we do like KARINA STEWART, TCM PRACTITIONER
liver – is an essential health practice. The problem is that detox has become fashionable and commercialised. There are a plethora of detox options, some of which may only mess up your metabolism more, weaken your immune system and leave you with the same toxins you started with. Water and juice don’t work. For the past two years I have been working with the nutritionists and chefs at the wellness sanctuary of Kamalaya in Koh Samui to infuse my dishes with well-being. I believe the key secret to being healthy is as simple as eating well. Kamalaya co-founder Karina Stewart, a traditional Chinese medicine practitioner, says research shows that certain key nutrients are needed for a detox programme to be effective. “These nutrients, which include antioxidants and amino acids, help your body to efficiently metabolise and clear out the waste,” she says. “Without them, the liver cannot deactivate the components of the detoxification process and what are left are very active, very toxic byproducts. Some supplementation is required, but many of the necessary
nutrients are found in food, which is why the diet is such an important part of our detox programmes.” This means that to detox, we should eat only low inflammatory, low glycaemic and low allergy foods – so no animal products, alcohol, soft drinks, sugar, bread, rice and most other grains. Peanuts, soy products, tomatoes, corn, potatoes, capsicum and eggplant are also off the menu, as they contain chemicals that can be inflammatory. You should also limit sweet fruits, like mango, and use only a minimal amount of healthy oils such as olive oil or coconut oil. A small amount of seeds may be included, but it is best to avoid all nuts. The liver loves certain foods, like green leafy vegetables, so eating a lot of these during a detox will support the process. It is not necessary to stick to a raw diet. In fact, it is beneficial to include some cooked food, such as soups, salads and steamed vegetables. You should avoid microwave cooking. The goal of a detox is never weight loss. I have been detoxing at Kamalaya for the past five years and what I found most helpful about going through a detox programme is the change in my daily habits. After completing my first detox, I started craving healthy food and lost interest in deep-fried food. I significantly reduced my alcohol intake by saying no to low quality wine and accepting only the good bottles: same budget, less quantity, more satisfaction. I found this transformation happening without effort, because eating is not just physical nourishment but also emotionally charged. When eating well is not uncomfortable or antisocial or boring, it also leads to inner balance. “As I see it, there are two ways in which we can approach life,” says Stewart. “One is to simply eliminate all the things we don’t like. The other is to focus on what we do like, using those things to nurture and nourish parts of ourselves that we want to develop. [With the latter], the unwanted aspects naturally atrophy because you’re not focusing on them and giving them energy.” This week’s recipe is from Kamalaya: a detox dish that’s both delicious and easy to make. Detox pumpkin curry Serves 2 For the curry paste 40 grams large dried red chilli, seeded 30 grams garlic 20 grams young galangal 50 grams lemon grass 4 grams kaffir lime leaves 200ml vegetable stock For the pumpkin curry 500 grams coconut milk
80 grams curry paste 4 kaffir lime leaves 140 grams sliced pumpkin 80 grams sliced kohlrabi or other white vegetable 30 grams sliced okra 3 sweet basil leaves 6 slices red chilli Sea salt • Combine all the ingredients of the curry paste and blend until fine. • Heat up the coconut milk in a pan until it starts to simmer. • Add the curry paste and kaffir lime leaves. Add the vegetables and simmer for two minutes more. • Before serving, add the sweet basil and garnish with three slices of chilli. Season with salt to taste. Serve with steamed rice or steamed rice noodles. • You can make more curry paste and store it in the fridge for up to one week. Healthy Gourmet is a weekly column by private chef Andrea Oschetti. andrea@fioreblu.com
10 DIET THE TASTE TEST APRICOTS
African baobabs are virtually indestructible life savers in the arid regions they inhabit.
...................................................... Jeanette Wang jeanette.wang@scmp.com
Maison Roucadil Abricots Moelleux HK$42 for 250 grams, Fusion by ParknShop These apricots come from Turkey but are processed by a small family company located in the heart of Aquitaine, in southwestern France, known for their prunes. Water and preservatives are the only two other ingredients in this low-fat product (0.8 grams of fat per 100 grams). Verdict: soft, very moist and almost creamy texture with an enjoyable natural sweetness.
NUTRITION BAOBAB
A feast from the tree of life ...................................................... Gabriella Clarke healthpost@scmp.com
Apicoltura Casentinese +Frutta Albicocche HK$63.80 for 295 grams, Fusion by ParknShop No sugar or thickening agents go into this jam, just apricots, and grape and lemon juice. Made in Arezzo in Tuscany, it’s unlike the jelly-like, overly sweet jams we’re used to. Verdict: very easily spreadable and light, with lots of apricot pulp and a natural tart flavour.
Golden Days Apricot Bites HK$35.40 for five 40 gram packets, Fusion by ParknShop Cubed, sugar-sprinkled and containing only 50 per cent fruit, this snack from Australia hardly resembles the original fruit. Each packet contains 148 calories, 1.3 grams of fat and 33 grams of carbs (of which 25 grams are sugar). Verdict: too sweet – and artificially so. Deceptively unhealthy, it’s full of calories and sugar.
Move over goji and acai, the fruit of the African baobab (or monkey bread) tree is the latest superfruit star. If you are looking to keep your weight in check and have radiant skin, this could be the one for you. Richer in antioxidants than both acai and goji berries, it is said to contain six times more vitamin C than oranges, twice as much calcium as milk, is richer in potassium than bananas and contains more magnesium than spinach. Baobab fruit is also rich in B vitamins and iron, and provides a good source of carbohydrates and dietary fibre. For thousands of years, people in Africa have used the versatile baobab tree for food, medicine, water and shelter. The fruit is sweet, tangy and has a pear-like flavour that’s enjoyed on its own or used as an ingredient, the leaves are eaten as a vegetable, and the seeds can be eaten raw, roasted, or ground to make an edible oil and thickener for soups and stews. Now, it is becoming a popular ingredient in smoothies and cereal bars, and is also available in powdered and capsule form. According to a 2008 report by the US National Research Council, the fruit of the baobab tree contains a sticky pulp that can be dried into a nutritious powder high in protein, vitamins, and minerals. The powder is stirred into warm water or milk to create a healthy drink, and also beaten and dried into thin pancakes
for use months or even years later, aiding food security. Baobabs have become known outside of Africa in recent years. In 2009, the US Food and Drug Administration approved the use of baobab in foods and drinks, and the dried fruit powder was assigned “generally regarded as safe” status.
Baobab pulp has been found to be 66 times higher in antioxidants than orange pulp
The pulp of the baobab fruit is dried into a nutritious powder. Photos: Corbis, AFP
Baobabs are thought to be some of the oldest trees on the planet – between several hundred and several thousand years old. But because they do not have tree rings (or growth rings) in their trunks, it’s hard to tell. Baobabs are virtually indestructible life savers in the desert regions they inhabit. They can reach 30 metres tall and are completely hollow inside. The trunks, which are up to 20 metres in circumference, can hold hundreds of litres of water to withstand the harsh drought conditions. During the rainy season, villagers often store up water in there for later use. Baobabs provide shelter and have been used as dwelling places. During the late 19th century in Derby, Western Australia, a baobab tree was used as a temporary prison. This tree still stands and is a popular tourist attraction. Although baobabs have a history of traditional use as a medicine, very little research has been carried out on their medicinal properties. However, the tree’s rich nutritional profile is likely be responsible for its health-giving properties. A study published in 2006 in the journal Food Chemistry by Italian researchers found that baobab pulp was 66 times higher in antioxidants than orange pulp. Other studies suggest that baobab pulp has anti-inflammatory and analgesic effects, due to the presence of triterpenes and sterols, both natural steroids that manage inflammation. Baobab has also shown to be useful in treating dysentery and
infant diarrhoea. Naturally occurring compounds in the plant called tannins are said to have an astringent effect on the bowel and reduce symptoms of diarrhoea. Because it is so rich in essential nutrients and very low in fat, baobab is often marketed as a weight loss aid. Its soluble fibres are said to have prebiotic properties, meaning it encourages the colonisation of healthy bacteria in the gut. This enhances the immune system and may help to treat digestive problems such as Candida albicans (an overgrowth of yeast in the gut). The fruits and leaves are traditionally used to treat asthma and allergic skin conditions because of the antihistamine properties. The leaves and bark are boiled and used to treat fevers and kidney problems. There have not been any reported side effects from using baobab, and it is not thought to interact with any medicines. Baobab oil, extracted from the seeds, is also gaining popularity in the cosmetics industry. It is easily absorbed into the skin and is rich in the antioxidant vitamins E and A, which may help to fight the signs of ageing. It has moisturising and soothing properties, and, being rich in omega 3, 6 and 9 fatty acids, may help treat skin problems such as eczema and psoriasis. It can also be used as a deep conditioning treatment for the hair and scalp. Some claim that it can help to regenerate skin cells, and recommend it for burns and other wounds to provide soothing relief and help reduce scarring.
WELL-BEING 11 Amateur boxer Adam Gazal trains at Jab studios. Photo: K.Y. Cheng
FIT & FAB
Role with the punches ...................................................... Rachel Jacqueline healthpost@scmp.com Adam Gazal expected changes when he signed up to the white-collar boxing match, the Hedge Fund Fight Nite, but he didn’t realise the impact would be felt all the way to the boardroom. “Boxing is all I’ve been thinking about,” says the managing partner of business banking at the National Australia Bank. Gazal, 35, has been found shadow boxing in the office kitchen and has sported a few new looks in the workplace. “The first time I sparred at lunch and had a client meeting right after, there was no hiding the bruise that was starting to show,” he says. “But everyone at the bank knows what I’m doing, and they are really supportive. It’s become a great talking point.” Gazal will join 13 other amateurs on October 25 as they swap their business suits for boxing gloves in support of local charities, Operation Smile and Operation Breakthrough. At 1.91 metres tall and weighing 85kg, Gazal has his work cut out as
he prepares to take on training buddy Grant Livingston from JPMorgan, who is 1.96 metres and weighs in at 95kg. But with a background in triathlons and competitive running, Gazal is always up for a challenge. He says this particular one has been transformational: “Running a marathon is great, but it’s more selfrewarding. There is something really special in that we are all in it together, and at the end of the day, it’s benefiting others.” Taking part in the boxing competition has also been a way for the Australian, who moved to Hong Kong 15 months ago,
There is nothing you can do to really prepare for that first blow. It still hurts, even now ADAM GAZAL, AMATEUR BOXER
to make new friends. He’s planning to fight another white-collar bout in November. “The camaraderie and the confidence that you build through the sport will definitely keep me going,” says Gazal. Though his last name sounds like “gazelle” – an animal known for its ability to outrun its predators – he says he won’t shy away from the challenge in the ring, and will provide a good show. “On the night, I know I won’t be thinking that I could have done more, because I’ve learned as much as I can. I’m just going to enjoy it and give it my best shot,” he says. Have your feelings towards boxing changed since you started training six months ago? Boxing is so much more technical than I first thought. I always had respect for boxing as a sport, but I would never have pictured myself in the ring. The level of fitness it requires, and the technical skills you need to be competitive, are mind-blowing. The first time I sparred in two by two minute rounds, I was absolutely spent.
How did you feel when you were first punched? I was just shocked. You try to condition yourself for it, but I remember the first time I copped a reasonably hard hit and it knocked me around. Try as hard as you like, there is nothing you can do to really prepare for that first blow. It still hurts, even now. What’s your secret weapon? A lot of hard work. I’ve been doing a lot of skill work, and luckily I’ve been picking that up just a little bit better, I think. I’ve been getting personal training once a week, training with a friend, and doing group boxing sessions twice a week. I’m training every day, and twice a day around three times a week. Where do you get your energy? There’s a lot of nervous excitement driving you. I’ve been watching a lot of past Fight Nite fights and visualising myself on the night. I don’t want to look back and think I could have done better. I don’t want any regrets. I’m putting everything into it that I can.
How are you going to prepare yourself on the night? I’ve picked an AC/DC song to get me pumped. I have a great corner man who’s more excited than I am – he’s been sending me motivational e-mails and YouTube videos every day. To manage the nerves, I’m keeping in mind that the other guy will be equally as fearful. In a white-collar event like this, you know exactly what the other guy has gone through. How will you celebrate afterwards? I’ll definitely have a beer with Grant, and a few drinks with friends, colleagues and my wife Liana, who has had to put up with my training regime for the past five months. How has the experience changed you? Boxing has broadened the scope of what I now think is possible. Training for this event has been the most difficult thing I’ve done, and stepping into that ring will be even harder. But I now feel I could do anything. I can tackle challenges with a different mindset. I’ve grown in confidence.
12 SPONSORED FEATURE
OCTOBER 16, 2012 SOUTH CHINA MORNING POST