YOUR GUIDE TO LIVING WELL
TUESDAY, NOVEMBER 20, 2012
HEALTH POST
FACTS ABOUT MISCARRIAGE >PAGE 5
NO END TO INDIA’S PAIN >PAGE 8
n Ma ee ai-y :W tion stra Illu
Sins of the flesh The dangers of eating red meat
>PAGE 6
2 NEWS APP OF THE WEEK
HEALTH BITES
Workout blasts maximum fat in four minutes flat
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...................................................... Katie McGregor healthpost@scmp.com Tabata Trainer HK$15 Rating 9/10 It did not surprise me to discover that a Japanese scientist had invented a way to fit an hour’s exercise into four minutes and achieve better results. But Professor Izumi Tabata admits he was only following instructions from the head coach of the Japanese national speed ice skating team when he came up with the Tabata Protocol. Based on the concept of interval training, the protocol includes 20 seconds of high-intensity activity followed by 10 seconds rest, repeated seven times for four minutes of exercise. This is all the more appealing when you hear that – according to research and numerous YouTube testimonials – the method gets you better aerobic and anaerobic results than an hour-long moderate-intensity exercise session. Many videos also promise that you will “incinerate” fat too. Although a simple routine, a timer is a must and as basic as the requirements are, it did take six downloads before finding the best Tabata timer for me. Many of the timers flashed a numeric countdown and had a single claxon horn to tell you when to change. In my state of exhaustion, I found the numbers soon became meaningless, and the claxons would catch me unawares with the result that I missed a count between exercise and that all-important rest.
The Tabata Trainer has a pleasing grid that gives a graphic representation of your progress. Three tones count you into the rest phase, and then out again. A quick start option means you can get going without much thought, but if you do want to think about it, use the preset routines or build your own. Suitable high-intensity exercises include burpees, squats, lunges, jumping jacks and high knees; all easily done at home. Go online for routines with barbells, kettlebells and resistance bands. The Tabata Timer automatically stores a history of your workouts, and posts them online if you choose. The only thing missing is the option to select music from within the app. But the superior display more than makes up for this minor inconvenience.
ASK THE DOCTORS DR TEO CHENG PENG Q: I am a 52-year-old man. At a recent medical exam, my haemoglobin level was 12.4. Is it normal? Do I need treatment? I am otherwise perfectly healthy. A: A haemoglobin (Hb) level of 12.4 grams per decilitre (g/dL) is below the normal range of 13.5 to 18 g/dL. This is called anaemia. While it is not severe or at a critical level, the fact that it is not in the normal range (especially in a male) calls for further action. This will involve a clinical examination and further investigation to determine the cause before treatment can be offered. There are many causes of anaemia. It is not possible to determine the cause or to give an exact diagnosis based on the Hb alone. Further investigations such as
an endoscopy, bone marrow examination and further blood tests may be required. An initial clinical examination may be helpful to determine which of the above are needed. Causes which must be excluded include blood loss from the gastrointestinal tract (such as peptic ulcer disease, tumours in the stomach/ intestines etc), bone marrow disorders (from cancers to druginduced problems), autoimmune problems, kidney problems, liver problems, chronic infective and inflammatory conditions. Dr Teo Cheng Peng is a senior consultant in haematology with Parkway Cancer Centre at Mount Elizabeth Novena Specialist Centre in Singapore
Jeanette Wang jeanette.wang@scmp.com Rhyme and reason Isn’t it neat if you’re given a beat and you can straight away compose something sweet? That’s my lame attempt at “freestyling”, but a new study reveals that this form of vocal improvisation is associated with a unique functional reallocation of brain activity. US National Institutes of Health researchers say this suggests a novel neural network that appears to be involved in improvisatory and creative endeavours, such as poetry and story telling. The scientists used functional magnetic resonance imaging to study the brain activity of 12 experienced rappers while they performed both freestyle and rehearsed lyrics. During freestyle rapping, increases in brain activity were seen in the medial prefrontal cortex, a brain region responsible for motivation of thought and action, but decreased activity in dorsolateral prefrontal regions that normally play a supervisory or monitoring role. Freestyling also increased brain activity in the perisylvian system (involved in language production), the amygdala (an area of the brain linked to emotion), and cingulate motor areas, suggesting that improvisation engages a brain network that links motivation, language, mood, and action.
Photos: AP, AFP. Illustration: Emilio Rivera III
Water on the brain Your kidneys could signal trouble ahead for your brain. A new study led by Temple University in Pennsylvania, US, has found that decreased kidney function is associated with decreased cognitive functioning in areas such as global cognitive ability, abstract reasoning and verbal memory. “The brain and kidney are both organs that are affected by the cardiovascular system,” says the study’s lead author, Adam Davey, associate professor of public health at Temple. “They are both affected by things like blood pressure and hypertension, so it is natural to expect that changes in one organ are going to be linked with changes in another.” The researchers established the link by examining data, five years apart, from 590 people. Kidney function tends to decrease naturally with age, and so if there’s an extra issue involved in renal function, such as chronic kidney disease, it needs to be managed immediately, says Davey.
Foggy recollections Living in areas of high air pollution can lead to decreased cognitive function in older adults, according to new research presented at the annual meeting of The Gerontological Society of America. The study, by Jennifer Ailshire of the University of Southern California, analysed data from nearly 15,000 men and women aged 50 and older. Individual data were linked with data on the annual average levels of fine air particulate matter, which are thought to be sufficiently small that if inhaled they can deposit deep in the lungs and possibly the brain. Ailshire discovered that those living in areas with high levels of these particles scored poorer on the cognitive function tests assessing word recall, knowledge, language, and orientation. Fine air particulate matter exposures ranged from 4.1 to 20.7 micrograms per cubic metre, and every 10-point increase was linked with a drop in cognitive function roughly equal to that of ageing three years. Foam away from home In the comforts of home lurks a hidden danger in the form of flame retardant chemicals widely found in foam furniture, electronics, carpets, upholstery and other consumer products. Researchers at the University of California, Berkeley, have found that prenatal and childhood exposure to these compounds are linked to poorer attention, fine motor co-ordination and IQ in school-aged children. PBDEs, or polybrominated diphenyl ethers, are a class of endocrine-disrupting compounds that easily leach out into the environment and are inhaled or ingested through dust, then accumulate in human fat cells. Evidence of adverse human health effects from PBDE exposure has been steadily building over the past decade. These include links between flame retardant concentrations in mothers’ blood and decreased fertility, lower birth weight babies and changes in thyroid hormone levels. Things that people can do at home include: seal any tears in couches and upholstered furniture; damp mop and vacuum frequently; and wash hands frequently.
> 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
NEWS 3 MOVEMBER DIARY
QUIZ
Way to grow, Hong Kong
...................................................... Jeanette Wang jeanette.wang@scmp.com
...................................................... Chester Grucza healthpost@scmp.com It’s been a big week for Movember. Not only did we cross the halfway point, the campaign has surpassed the one million mark for registered Mo Bros and Sistas worldwide. From a group of 30 Australian guys in 2003 to a massive global effort in 2012, the growth just goes to show how powerful the moustache has become. In Hong Kong, our Movember campaign is growing nicely. As I write this, we’re sitting ninth on the global leaderboard (out of 21 countries), and have raised more than HK$1.6 million to date. Well done, Hong Kong. As a heavily involved Mo Bro, I’ve been privileged to learn of some moving stories about why people and businesses here have felt compelled to back the campaign. Whether people have had a family member, friend or colleague experience cancer in one of its many forms, or they have been a victim of the disease themselves, I find it incredibly moving and inspiring to learn why individuals are motivated to make Movember a success in this part of the world. By shining a light
Chester Grucza on men’s health issues, encouraging discussion and raising awareness of early detection, Movember truly does work to save lives. On a lighter note, if you’re in need of a local moustache fix, have a look at the entries for Hong Kong’s Next Top Mo-del – a competition currently being run on the Movember Hong Kong Facebook page. This will silence anyone who has ever doubted Hong Kong’s moustache-growing ability. If you or someone you know has a Mo worth showcasing, submit a photo before the end of the month. Now that my facial hair is back on track, I’ll be entering (and I’m quietly confident I can take the title). It’s still not too late to register for Movember. To do so – or to make a donation – visit hk.movember.com. Until next week, stand tall; the moustache is the mark of a man. Chester Grucza manages Fly nightclub in Central. Follow his Mo-growing efforts all this month in Health Post
NEWS
Hanging around gets them down ..................................................... Jeanette Wang jeanette.wang@scmp.com Canadian psychoanalyst Elliott Jacques coined the term “midlife crisis” in 1965 to describe the period when adults are known to take stock of their lives and sink into depression. But a new study finds that this phenomenon is not unique to humans – and might be a result of evolution rather than modern life. An international team of researchers studied 508 great apes in zoos and sanctuaries in the US, Japan, Canada, Australia and Singapore, and found chimpanzees
Leaf me alone: orang-utans suffer severe midlife lows. Photo: Xinhua
and orang-utans can experience a midlife crisis, too. The apes’ happiness was high in youth, fell in middle age and rose again in old age. “We hoped to understand a famous scientific puzzle: why does human happiness follow a U shape through life?” says economist Professor Andrew Oswald from the University of Warwick, who was part of the research team. “We ended up showing that it cannot be because of mortgages, marital break-up, mobile phones, or any of the other paraphernalia of modern life. Apes also have a pronounced midlife low.” The study, in the Proceedings of the National Academy of Sciences, is the first of its kind. The apes were assessed by keepers, volunteers, researchers and caretakers who knew them well. Their happiness was scored with a series of measures adapted from human subjective well-being measures. The researchers point out that their findings do not rule out the possibility that economic events or social and cultural forces contribute part of the reason for the pattern in humans.
Pregnant women who have higher levels of vitamin D in their blood may have a lower risk of developing multiple sclerosis (MS) – an autoimmune disease that affects the brain and spinal cord – than women with lower levels, a study finds. But their babies may not be protected. “A mother’s levels of vitamin D during early pregnancy did not have an effect on MS risk for her baby,” says study author Dr Jonatan Salzer with Umea University Hospital in Sweden. The study is published today in the online issue of Neurology. Scientists reviewed information about 291,500 blood samples collected from 164,000 people since 1975 in the northern half of Sweden. Of those, 192 people developed MS an average of nine years after their blood sample was drawn, and there were 37 blood samples drawn during pregnancy from mothers whose children went on to develop MS later in life. Women who had high levels of vitamin D in their blood had a 61 per cent lower risk of developing MS, compared to those who had lower levels of vitamin D in their blood.
Overall, few people had high levels of vitamin D. “Another interesting finding in our study was that the vitamin D levels became gradually lower with time from 1975 and onward,” says Salzer. “It is possible that this decline in vitamin D status is linked to the increasing numbers of MS cases seen worldwide.” MS is a relatively rare disease in China. The World Health Organisation estimates that the median prevalence of MS in the Western Pacific region, which includes China, was five cases per 100,000 people between 2005 and 2007. In Europe, it was 80 cases per 100,000 people over the same period. Since 2000, discrepancies have arisen regarding the benefits of
vitamin D and how much is sufficient. The recommended daily allowance, as set in 2010 by the US Institute of Medicine, is based on age: 600 IU for those aged one to 70 years, including pregnant and lactating women and 800 IU for those 71 years and older. Now test your knowledge of vitamin D levels below. 1. What is the best source of vitamin D? a. Diet b. Supplements c. Sun 2. What percentage of vitamin D comes from sunlight? a. 20 per cent b. 45 per cent c. 90 per cent 3. Which mineral does vitamin D help the body to absorb? a. Calcium b. Iron c. Zinc 4. Which types of fish are rich in vitamin D? a. Oily fish b. White fish c. Freshwater fish
Photo: Dickson Lee
Answers: 1. c; 2. c; 3. a; 4. a
4 MEDICAL
Illustration: Angela Ho
CASE HISTORY
...................................................... Eileen Aung-Thwin healthpost@scmp.com Anson Wong, 40, noticed a small, painless lump on the right side of his neck but paid it little attention as it did not bother him. He ignored the lump, which was 2cm to 3cm in diameter, for about six months. Wong (whose name has been changed for reasons of patient confidentiality) noticed that the lump sometimes shrank and at other times increased in size. When it remained enlarged, he decided to seek medical attention. His doctor did not like the look of it. Enlarged lymph glands on relatively young men can indicate a number of medical concerns, including tuberculosis and some cancers. Nasopharyngeal cancer is a particular concern as it is 25 per cent more prevalent among southern Chinese than it is among people in other parts of the world. Wong was given a blood test and had a biopsy using a procedure called fine needle aspiration. Unfortunately, the test results were inconclusive. However, Wong was referred to Dr Raymond Liang Hin-suen, director of the Comprehensive Oncology Centre at Hong Kong Sanatorium and Hospital, for further investigation. Liang decided to remove the affected lymph gland for
Two-pronged attack gets results
a biopsy. It showed that a type of immune cell – B cells – in Wong’s body had gone awry and were multiplying uncontrollably. He had lymphoma, or cancer of the lymphatic system. There are as many as 35 types of lymphoma. Although some of them may appear similar, they function differently and respond to different therapies. Liang found Wong was suffering from follicular lymphoma, where cells group together to form follicles, or spherical structures with a cavity within. Follicular lymphoma is a slowgrowing or indolent cancer. It exhibits subtle warning signs, including enlarged lymph nodes, fever, weight loss, sweating and fatigue. Although it is slow-moving and responds well to treatment, low-grade lymphomas like this are hard to eradicate. What was unusual was that follicular lymphoma typically affects people over the age of 55, and Wong was only 40. Liang needed to know how widespread the disease was. A Positron Emission TomographyComputed Tomography (PET-CT) scan was used to detect areas of unusually high metabolic activity in Wong’s body. Such activity is indicative of cancer. The scan results were alarming.
Although it is a slow-moving disease and it does respond well to treatment, low-grade lymphomas are hard to eradicate
The cancer had travelled extensively through the lymphatic system and many lymph glands in Wong’s chest and abdomen were affected. One of the glands was so swollen that it was obstructing his ureters, causing his kidneys to balloon. A bone marrow biopsy showed that cancer had penetrated his bone marrow. Wong had stage four follicular lymphoma as the disease had spread outside his lymphatic system. Despite the alarming findings, Liang assured Wong that even with advanced follicular lymphoma, there was no immediate threat to his life, and the disease tends to respond well to treatment. This would include chemotherapy and monoclonal antibody therapy. Monoclonal antibodies are made by identical immune cells cloned from a parent cell. They bind to a specific type of cell (in this case the B cells at the root of the lymphoma) and stimulate the immune system to attack and destroy those cells. But Wong had reservations. He and his wife had been hoping to start a family and he was worried that chemotherapy would affect his fertility. Chemotherapy has been shown to reduce the number and quality of sperm. So, Wong’s sperm was collected and stored before chemotherapy began.
Wong was also found to be a hepatitis B carrier, like 10 per cent of Hong Kong’s population. There was concern the combined cancer treatment could reactivate the virus. So Liang gave Wong an antiviral medication concurrently with the cancer treatment to protect his liver. Liang put Wong on a monoclonal antibody drug and a new chemotherapy drug, which is more effective at controlling the lymphoma than other regimens. After the first dose of the drug, Wong suffered an allergic reaction in the form of a fever. But this was readily controlled with the use of steroids. Three months of treatment yielded encouraging results – a repeat PET-CT scan showed the cancer was gone from his lymphatic system and bone marrow. Wong continued with another three months of treatment, after which he was put on the antibody therapy every two months for the next two years. However, follicular lymphoma has a nasty habit of resurfacing after years in remission. Wong will need to be screened and monitored regularly to guard against a relapse. In the meantime, Wong is enjoying his restored health and making plans to extend his family.
HEALTH 5 PREGNANCY
Take the myth out of miscarriage ...................................................... Sunory Dutt healthpost@scmp.com For many Asians, it’s inauspicious to announce the news of a pregnancy before the end of the first trimester. There might be something in this: studies reveal that between 10 and 25 per cent of all pregnancies end in miscarriages during the first 13 weeks of pregnancy. Sandra Ng had a miscarriage in the fifth week of her second pregnancy. “It was extremely traumatic for me, more emotionally than physically. I still wonder, had I not told everyone prematurely, could it have been averted,” she says. “I know it was still embryonic, but to me it was still my baby.” Ng’s miscarriage had less to do with superstition than science. Sporadic miscarriages occur in 15 per cent of pregnancies due to a chromosomal abnormality that prevents normal development. A small group of women have recurrent losses. “There are a number of reasons why women have multiple miscarriages,” says Dr Sangeeta Senapati, who is an obstetrician gynaecologist with the Department of Obstetrics and Gynaecology at NorthShore University HealthSystem in Chicago. “Anatomical issues like uterine malformations or a weak cervix can cause repeated losses, says Senapati. “Chromosomal or immunological disorders, a propensity for blood clots (thrombophilia), chronic hormonal variations, and prolonged exposure to toxins such as drugs, alcohol and smoking can all cause repeated losses.”
Women who’ve had miscarriages should allow time to heal before attempting another pregnancy Age is another factor. With women marrying and conceiving later in life, the chromosome abnormality rates of the egg and hence the baby increase, making it more difficult to conceive and carry to full term. By the age of 40, 60 per cent of the eggs are chromosomally abnormal. It increases by about 10 per cent each year. Paternal age also plays a role. Some studies indicate that the chance of miscarriage is higher if the father is 35 years or older. This increases with age. Genetic diseases such as thalassaemia, endocrine disorders such as thyroid disease
and diabetes mellitus, and an overactive immune system with elevation in natural killer cells are other causes. Can miscarriages be prevented? Depending on the cause, many things could help, according to Dr Mahesh Choolani, an obstetrician gynaecologist with The Choolani Clinic at Mount Elizabeth Novena Hospital in Singapore. “Some [miscarriages] have a proven ‘evidence-base’, whereas others are more anecdotal and experiential,” she says. “I find lifestyle and dietary changes including an antiinflammatory diet significantly enhance the well-being of the environment for the embryo.” There are medical options says Choolani. These include progesterone, aspirin, low molecular weight heparin (used to treat and prevent blood clots), higher doses of folate supplement, and intravenous immunoglobulin. There are also procedures that could help, such as removal of the uterine septum, a thin wall of tissue inside the uterus of some women that separates the uterus into two parts, or cervical cerclage, putting stitches in the cervix to hold it closed in the case of cervical impotence. Choolani adds: “Of course, we often have to look after patients with miscarriages with other specialists: endocrinologists for diabetes and thyroid disease, rheumatologists for autoimmune conditions such as APS [antiphospholipid antibody syndrome], SLE [systemic lupus erythematosus], Protein C/Protein S deficiency and elevated natural killer cells.” According to the American Pregnancy Association, when a miscarriage occurs during the first 13 weeks of a pregnancy, the main goal of treatment is to prevent haemorrhaging and/or infection. The earlier in the pregnancy, the more likely that the body will expel all the fetal tissue by itself and will not require further procedures. It was previously thought that if the body doesn’t expel all the tissue, an operation would be needed. But Dr Alexander K. Doo, a specialist in obstetrics and gynaecology with The Women’s Clinic in Hong Kong, says there is now “very good evidence” that the infection rate is the same whether an operation is done or not. “In 85 per cent of cases in early pregnancy, it can be passed out naturally within three weeks of diagnosis. This avoids the (albeit small) risk of the operation.” Most women have a healthy pregnancy after miscarriage, as in the case of Ng, who conceived and delivered a healthy baby girl. Doo explains: “In general, if there is a complete cycle between the miscarriage and conception, there is no increase in risk of a further
A human embryo at 40 days. Photo: Carolina Biological
miscarriage, and within the first six months of a miscarriage, there is evidence that the chances of conception actually improve. “Having had one miscarriage, the chance of a second is not much higher. Having had two only marginally increases the risk.” Women who’ve had miscarriages should allow sufficient time to heal physically and emotionally before attempting another pregnancy. Mayo Clinic recommends healthy choices before conception and during pregnancy. Take a daily prenatal vitamin or folic acid supplement, ideally a few months before conception. Maintain a healthy weight, include physical activity in your routine, and limit caffeine. Manage stress and avoid alcohol and smoking. If you’ve had multiple miscarriages, pregnancies need to be carefully planned and monitored with consultations with your health care provider.
6 COVER STORY
Bad to the bone Eating red meat could put you on the fast track to an early grave, writes Balvinder Sandhu
20% Illustration: Wai-yee Man
The increased risk of mortality from eating a serving of processed red meat a week. One serving per week of unprocessed red meat increases the risk by 13 per cent
COVER STORY 7
I
t’s said that one man’s meat is another’s poison, but these days it seems increasingly that meat is every man’s poison. Stacks of research studies suggest eating red – especially processed – meat increases one’s risk of dying from heart disease or cancer. But is it as bad as it’s made out to be? Earlier this year, a study by the Harvard School of Public Health that tracked more than 121,000 people for up to 28 years found that red meat consumption is associated with an increased overall risk of mortality, including from cancer and cardiovascular complications. One daily serving of unprocessed red meat (about the size of a deck of cards) was associated with a 13 per cent increased risk of mortality, and one daily serving of processed red meat (one hot dog or two slices of bacon) was associated with a 20 per cent increased risk. “This study provides clear evidence that regular consumption of red meat, especially processed meat, contributes substantially to premature death,” says the study’s senior author, Frank Hu, a professor of nutrition and epidemiology. The World Cancer Research Fund (WCRF) defines red meat as beef, pork, lamb and goat, says Charmain Tan, a registered dietitian with Seventeen Nutrition Consultants. “Processed meat is meat preserved by smoking, curing or salting, or by the addition of preservatives. Examples include ham, bacon, pastrami and salami, hot dogs and some sausages.” The main problem with red meat is its very high fat content. Dr Kathy Lee Lai-fun, consultant cardiologist at Cardiac Health Heart Centre in Central, says red meat usually has more fat than white meat – particularly saturated fats, which increase bad cholesterol (or LDL) and is no good for the heart. “So, indirectly, it may increase coronary heart disease, meaning blockage in the heart vessels,” says Lee. “It could also block off the artery going to the brain, which could cause a stroke. It’s not healthy
for the vessels or the heart because of its fat content.” Lee notes there has been a lot of data to suggest red meat may increase the risk of cancer, especially cancer of the duct, such as colorectal and stomach. Other studies suggest a link – albeit weaker – between red meat consumption and cancer in other organs such as the lungs. Research presented last month at an American Association for Cancer Research conference found that two components of red meat – dietary protein and dietary iron – may combine to form powerful carcinogens called N-nitroso compounds, which increase the risk of bladder cancer. Further, some people with a reduced ability to reverse the effects of these compounds because of a genetic variation were found to be at a particularly high risk. Dietary protein is made up of amino acids, which can be naturally metabolised into biogenic amines, explains the study’s lead researcher, Chelsea Catsburg, from the University of Southern California’s Keck School of Medicine. The processing and storage of meat increases amine concentrations. These amines, in the presence of nitrites, generate nitrosamines, which have carcinogenic properties. In addition, heme iron found in red meat has been shown to increase the formation of nitrosamines from amines. Catsburg’s findings further support recommendations by the WCRF to limit red meat intake and avoid processed meats to reduce risk of stomach and bowel cancer. “There is no amount of processed meat that can be confidently shown not to increase the risk,” says Tan. “It is suggested that the heme iron in red meat damages gut wall membrane, and preservatives which are widely used in processed meats such as bacon, ham, sausages, smoked and preserved meats are found to be cancer-inducing.” How meat is prepared, seasoned and cooked also contribute to its detrimental effects. “Red meats cooked with an open flame and high cooking temperature – such as
This study provides clear evidence that red meat, especially processed meat, contributes to premature death FRANK HU, NUTRITION PROFESSOR
frying, grilling and barbecuing – generates carcinogens called heterocyclic amines and polycyclic aromatic hydrocarbons on the surface,” explains Janice Chong, a dietitian with Raffles Hospital in Singapore. “These chemicals can damage DNA and promote cancer.” Another study from the Keck School of Medicine, published online in August in the journal Carcinogenesis, provided important new evidence on how red meat and its cooking practices may increase prostate cancer risk. Examining data from nearly 2,000 men, researchers found that those who ate more than 1½ servings of pan-fried red meat a week increased their risk of advanced prostate cancer by 30 per cent. Men who ate more than 2½ servings of red meat cooked at high temperatures were 40 per cent more likely to develop advanced prostate cancer. Hamburgers – but not steak – were linked to an increased risk of prostate cancer. “We speculate that these findings are a result of different levels of carcinogen accumulation found in hamburgers, given that they can attain higher internal and external temperatures faster than steak,” says lead researcher Mariana Stern. It’s not all bad news with red meat though; it does have some benefits. “Red meat is a good source of protein, vitamins and minerals, such as iron, zinc and B vitamins,” says Tan. “Iron is essential to our immune function and red blood cell production. Zinc is needed for hair growth and sperm production.”
There have even been a few studies in support of eating red meat – albeit in controlled and lean portions. Research published last year in the American Journal of Clinical Nutrition showed that as long as saturated fat levels in one’s diet are controlled and lean beef portions kept in check – about 28 grams a day (uncooked) – beef can be part of a heart-healthy diet. Such a diet can lead to equal reductions in cholesterol and risk of heart disease as found with white meat and fish, the researchers say. The WCRF advises people to have no more than 500 grams (cooked) red meat per week and avoid processed meats, says Tan. “Slow down the cooking time with a low flame. Techniques such as braising, steaming, poaching, stewing and microwaving meats produce fewer carcinogenic chemicals,” says Chong. “Cut off any charred portions of the meat and avoid processed meat, if possible.” Executive chef Gan Swee Lai, of Gordon Grill at Goodwood Park Hotel in Singapore, says the healthiest way to cook red meat would be sous vide – “a fillet or striploin is vacuum packed and then cooked in water at between 55 and 58 degrees Celsius. Lightly season with good sea salt and ground pepper before serving. “Or you can blanch thin slices of meat in home-made vegetable broth – like a Japanese shabu shabu,” adds Gan. “You can make a good broth with celery, carrots and onions.” To satiate your protein cravings, dietitians advise trying other sources. In the Harvard study, replacing one serving of total red meat with one serving of a healthy protein source was associated with a lower mortality risk: 7 per cent for fish, 14 per cent for poultry, 19 per cent for nuts, 10 per cent for legumes, 10 per cent for low-fat dairy products and 14 per cent for whole grains. Says Lee: “There’s really no need to take [red meat] and there’s nothing in it that you can’t absorb from other healthier sources. There are also fewer health problems for people who abstain from red meat.” healthpost@scmp.com
8 HEALTH PALLIATIVE CARE
At the end of their tether ...................................................... Amrit Dhillon healthpost@scmp.com The worst day in Dhyaneshwar Raghunath’s life was when his 85-year-old father, in the advanced stages of mouth cancer, pleaded with him at their Pune home: “Just throw me over the balcony. Do anything, I don’t care, I want this pain to go.” Friends told Raghunath, a truck loader, about a free cancer hospital in Pune, near Mumbai, called the Cipla Palliative Care and Training Centre. They arrived in late September, and Raghunath has been learning how to look after his father while staying there. The free hospital offers accommodation and meals to patients’ relatives. In the men’s ward, Raghunath changes the dressing on his father’s cheek where the lining has been eaten away. His father is on morphine. “I was terrified when he was at home because I didn’t know what to do. Here, his pain is under control,” he says. The 52-bed hospital is one of a handful of palliative care centres in India and has cared for more than 8,000 patients over the past 15 years. It’s unique in two ways: first, there is an adequate supply of morphine provided by Cipla, a generic drugs giant. Second, the staff are trained in palliative care, which focuses on relieving and soothing the systems of a life-threatening disease. These two factors are generally missing in India. About 70 per cent of cancer patients in India require palliative care because
0.4% The percentage of cancer sufferers in India who have access to palliative care, representing about 100,000 people
Government rules make it almost impossible for a hospital to get morphine DR NAGESH SIMHA (ABOVE)
most cases are diagnosed in the advanced stages. “It’s been estimated that only 0.4 per cent of the 2.5 million cancer patients in the country at any given moment have access to palliative care,” says Dr Priyadarshini Kulkarni, head of the hospital. In September, a World Health Organisation report upbraided India for the red tape around morphine, saying it was responsible for the “sub-optimal” use of morphine. Ironically, India is one of the biggest producers of opium in the world. It exports most of it to Western countries, but Indians inside the country are denied it. “Hospitals don’t store it, pharmacists won’t give it without a specific dosage, and doctors are not trained in dosage so they dare not prescribe it,” says Dr Nagesh Simha, president of Indian Association of Palliative Care in Bangalore. “Government rules make it almost impossible for a hospital to get morphine. You need six licences, which can take years to get.”
The culprit is the 1985 Narcotic Drugs and Psychotropic Substances Act aimed at curbing the trafficking of drugs such as morphine – without any exception being made for its use for the terminally ill. Any doctor prescribing it without the relevant licences can end up in jail and be ineligible for bail. Most hospitals and pharmacies, afraid of ending up on the wrong side of the law, abandoned the use of morphine. Because it was almost impossible to procure, doctors abandoned its use for palliative care. Soon after the 1985 law came into effect, experts say the use of morphine as a painkiller plunged by 97 per cent. Families have to watch their loved ones writhe in torment. Some terminal patients prefer suicide to the pain. At that stage, it is hell for their relatives. In the women’s ward at the Cipla hospital, Prashant Dhingre recalls how his wife, Ruchira, suffered at home from breast cancer. Their family doctor in Pune was unable to relieve her pain. The government hospital had no cancer ward, never mind pain management experts. When they arrived at the Cipla hospital in late September, they walked through the gates into the dappled sunshine of the courtyard with its two majestic palms. Dhingre instantly felt a surge of relief. “When the nurses took over and the doctor told me he would ease her pain, I felt as though a great weight had been lifted from me,” he says. Ruchira, a magazine journalist, can manage a smile. Her prognosis is not good, but at least she will be able to go home and her husband will help collect morphine from the hospital when she needs it. Palliative care is new to India and gaining ground only very slowly. But people like Simha are trying to change things and the southern state of Kerala has pioneered a voluntary scheme. The Pain and Palliative Care Society, set up by the Institute of Palliative Medicine in Kozhikode, Kerala, has thousands of volunteers helping some 2,500 patients in pain management and psychological counselling. The volunteers include retired bankers, bus drivers, policemen and auto rickshaw
A serious disease is the final cruelty. They also need to die with dignity but it doesn’t happen DR PRADEEP KULKARNI
Ruchira Dhingre has breast cancer.
drivers who all pitch in by visiting the homes of the terminally ill for a few hours a week. Kerala had a special mention in the WHO report for having simplified the maze of regulations around morphine. In 1998, when New Delhi allowed state governments to ease the rules if they wished, Kerala was among the 14 out of India’s 28 states which acted on the opportunity. Morphine is much more easily available in Kerala now. Realising that easier access to morphine did not necessarily lead to misuse, the Health Ministry is considering a revision to its law on morphine. It was also galvanised into action by a ruling from the Supreme Court in August, ordering top civil servants to make morphine available for terminally ill patients. The ruling was in response to a petition filed by the Institute of Palliative Medicine which, along with patient advocacy groups, has been lobbying tirelessly for the law to be changed. An amended law is
HEALTH 9 TRADITIONAL CHINESE MEDICINE
Ancient therapy sets them straight ...................................................... Wynnie Chan healthpost@scmp.com
A nurse attends to a patient in the ICU ward at a hospital in Ahmedabad, India. Photo: AFP
likely to be passed in the winter session of parliament. “It will be a great blessing. Access to painkillers should be a basic human right,” says Dr Pradeep Kulkarni from the Cipla hospital. In another step forward, the Indian Medical Council recognised palliative medicine as a distinct speciality six months ago. A batch of students has started training at Tata Memorial Hospital in Mumbai. Simha is a surgeon who turned to practising palliative medicine after three kidney transplants. His doctor advised him to avoid surgery because of the risk of catching infections from his patients. As luck would have it, he had trained in palliative medicine at Cardiff University in Wales, and he took it up full time on the advice of his doctor. He sees progress happening in Asia gradually. “In Thailand, Bangladesh, Malaysia, Sri Lanka, there is work happening in palliative care, even if it is just short courses to
make the medical fraternity more aware,” he says. Experts say that Asian culture can be an impediment to palliative care. “There is a taboo against talking about imminent death from a terminal disease. People want to keep the patient optimistic,” says Dr Nitin Patel in New Delhi. But the problem is not confined to Asia. A 2011 report by the Human Rights Watch organisation said that 60 per cent of people who die each year in low income countries need palliative care. Morphine is a drug of the rich. Nearly 90 per cent of morphine consumption is in North America and Europe. Developing countries consume only 6 per cent even though they have a far higher number of people suffering from cancer and Aids. “It’s sad that the poor don’t get morphine. After a lifetime of poverty, a serious disease is the final cruelty. They also need to die with dignity, but it doesn’t happen,” says Dr Pradeep Kulkarni.
Tui na, which translates as push and grasp, is a branch of traditional Chinese medicine that is used to help remove blockages and harmonise the beneficial flow of qi throughout the body. This therapy treats patients with a combination of massage, acupressure and body manipulations. It’s often used to heal disturbances in muscle and bone alignments such as scoliosis. Scoliosis is an abnormal curvature of the backbone or spine. A normal, healthy spine should be straight. In scoliosis, the spine is curved either in one direction (C-shaped curvature) or in both directions (S-shaped curvature). This condition can be congenital (present at birth), idiopathic (unknown cause) or neuromuscular (caused by injuries or other factors). According to Lau Yee-ching, a Chinese medicine practitioner with Hong Kong Baptist University’s School of Chinese Medicine, most spinal deformity cases are idiopathic, particularly in children and adolescents. “Those who seldom exercise or have incorrect posture are more prone to the problem,” says Lau. Adolescent idiopathic scoliosis (AIS) affects 2 per cent to 3 per cent of children between the ages of 10 and 16 worldwide. A 2007/08 Health Department survey that screened more than 800,000 Hong Kong students as part of the Student Health Service Programme found that AIS affected up to 4.5 per cent. Scoliosis is about two times more common in girls than boys. Depending on the severity of the curve, scoliosis is conventionally treated by observation, bracing or surgery. However, based on past clinical treatments using tui na, the clinical division of the School of Chinese Medicine formulated a course for 15 patients. They were aged between eight and 23 years old and had scoliosis confirmed by measuring the lateral curvature of the spine on X-rays. The Cobb angle, used to measure the curvature of the spine in degrees, helps to quantify the magnitude of spinal deformity in scoliosis, diagnosed when the Cobb angle measures at least 10 degrees. Patients recruited had Cobb angles ranging from 13 to 54 degrees. Between March and August 2012, the 15 patients received an average of 14 treatments. They were also instructed to hold a yoga position called the locust for a couple of seconds at a time, repeated 20 times, twice a day.
A patient undergoes therapy for scoliosis. Photos: Connie Ko
It helps to relax muscles, stimulate blood circulation, and relieve aches and pains LAU YEE-CHING, BAPTIST UNIVERSITY
After the treatment period, a significant improvement was recorded in 12 patients – Cobb angle decreases of 6 to 11 degrees. A drop of 0 to 4 degrees was noted in the remaining three cases. Since treatment, the efficacy rate has been up to 80 per cent with no reported cases of worsening. Early medical treatment is effective for young patients whose bones are still growing. “The younger [the patients] affected by scoliosis, the more serious the deformity will be,” says Lau. “In addition to the negative impact on the patients’ appearance, scoliosis poses other health problems, such as back pain and back muscle tension. In serious conditions, the heart and lung
functions of the patients can also be affected. “Tui na treatment helps to relax the muscles and joints, stimulate blood circulation, and relieve aches and pains. [Repeating the locust stretch] at home supplements the clinical treatment by strengthening patients’ back muscles.” To prevent scoliosis, Lau suggests adopting a good posture, avoid carrying heavy schoolbags and toting bags on one shoulder. One should exercise more frequently. Weight-bearing exercises such as walking, jogging, running and playing soccer help. HKBU Chinese Medicine Speciality Clinic offers private consultations for the treatment of scoliosis. Tel: 3411 2968 or 3411 2988
10 DIET THE TASTE TEST LOZENGES
HEALTHY GOURMET Grilled angel food cake. Photos: K.Y. Cheng
..................................................... Jeanette Wang jeanette.wang@scmp.com
Zand Orange C Herbalozenge HK$29 for 15 pieces, Just Green Each contains a proprietary herbal blend plus 60mg of vitamin C. Unlike typical lozenges sweetened with corn syrup, sucrose or cane sugar, this uses only brown rice syrup, which is said to produce a less dramatic rise in blood glucose. Verdict: tastes like orange candy – effects not immediately apparent.
Lighten up a bit ...................................................... Andrea Oschetti healthpost@scmp.com
Wedderspoon Organic Manuka Honey Lozenges HK$90 for 21 pieces, Just Green Made in New Zealand, these all-natural lozenges contain active 15+ manuka honey, said to be extremely rare – less than 1 per cent of all manuka honey – and is proven to have immune-supporting and protective properties. Verdict: pleasantly sweet and soothing, and coats the throat well.
Strepsils Ginger HK$21.90 for 16 pieces, Taste Ginger tea has long been used in traditional Chinese medicine to soothe the lungs and stop coughing, so it’s no wonder the popular brand recently introduced this new flavour. The active ingredients, however, seem to be a combination of two antiseptics. Verdict: the ginger flavour is familiar and comforting, while not overpowering. A nice departure from herbal or minty lozenges.
Occasional indulgences such as desserts are important to our well-being. But how can desserts be made healthier? To find out, I met Gregoire Michaud, pastry chef at the Four Seasons Hong Kong Hotel, who creates breads and desserts for three-star Michelin restaurant Caprice and Lung King Heen. He’s also an avid food blogger (gregoiremichaud.com) and an advocate for healthy eating. “If there is a secret to eating well, it is to cook and bake with real ingredients,” says Michaud. Processed food loaded with preservatives has become ubiquitous. “With these engineered flavours, our palates have become numb to authentic taste and I have often witnessed people liking a chemically-flavoured pastry more than one made with real ingredients. We forget what real food is supposed to taste like.” Michaud shares three ways to make desserts healthier and tastier. 1. Look at the glycaemic index (GI) GI is a measure of how quickly the level of glucose in your blood rises after eating a particular food. Many nutritionists suggest looking for low GI food to eat healthier. Michaud thinks this also applies to desserts. He believes that keeping GI low is a question of balancing the ingredients. “You can have something fat and sweet but it needs to be offset by something else: for example, if you have a chocolate pudding you can combine it with a sorbet which will lower the overall GI content,” he says. Another strategy is to use
natural sugars, which have lower GI. Michaud has researched widely and found that agave nectar has a lower GI than a fresh apple. He adds: “Palm sugar has a low GI of 30, and has a rounder taste than brown sugar with pleasant caramel notes.” 2. Find a substitute for table sugar (sucrose) “It is not fat that makes you fat,” says Michaud, “it is sugar, which also kills flavours. In a vanilla cream, less sugar means more vanilla taste.” When you follow a recipe you cannot simply halve the sugar. It’s not just a sweetener, it also binds the ingredients together, gives texture, moisture and colour. Hence the need to substitute table sugar with another sweetener. “For example, I use glucose and inverted sugar, which is half as sweet as sucrose and better for people with diabetes,” he says.
Gregory Michaud
When you look for alternative sweeteners, use natural ingredients and avoid chemically engineered ones like aspartame. In my private kitchen, I use Stephen James Luxury Organics’ Carazuc made from the coconut flower, which has a very low GI and can be found easily in Hong Kong. “There are no golden rules for substituting sugar,” Michaud says. “You need to experiment by replacing 10 per cent of sugar at a time with something less sweet. We made a meringue with 80 per cent sucrose and 20 per cent glucose, coupled with fruit purée and egg white powder – it was yummy and healthy.” You can also reduce the sugar content overall. Michaud suggests that to keep a cake’s texture soft, include ingredients like carob and xanthan gum. A useful book that can acquaint you with those unusual beans and gums is Modernist Cuisine at Home by Nathan Myhrvold and Maxime Bilet (available at Amazon.com). 3. Use more fruits “Use fruits, raw is best, and never cook them so long that they are completely puréed – it transforms the starch and increases the GI level,” says Michaud. “Cook fruits in their own juices; don’t add sugar.” I notice that Michaud’s creations for the night are relatively small. “Portion size is very important – people tend to eat too big desserts. We put quality before size; everything is small and it makes a difference.” In addition to moderation, I believe that our bodies metabolise food differently depending on how we approach the experience of indulgence. A sense of guiltiness
as opposed to a sense of celebration over what you indulge in, will generate a different assimilation process in your body. Michaud has written four recipe books, including two winners of the prestigious World Gourmand Cookbook Awards. One of his favourite recipes to make at home is grilled angel food cake. Grilled angel food cake with lemon yogurt dip and steamed apricots For the cake 6 egg whites A pinch of salt 100 grams inverted sugar (trimoline) 50 grams cake flour 1 vanilla pod, cut lengthwise 1 piece lemon zest • Whip egg whites with salt to form soft peaks. • Add the inverted sugar and mix. • Carefully mix in the flour, vanilla seeds and the lemon zest. • Spread the mixture 3cm thick on a tray. • Bake at 200 degrees Celsius for 15 to 20 minutes until golden brown. For the accompaniments 50 grams dried apricots 1 vanilla pod, cut lengthwise 15ml water A tub of yogurt Zest of one lemon Some nuts • Place apricot and vanilla bean on a metal tray with the water. Cover with plastic film and steam for 30 minutes. • Mix the lemon zest into the yogurt. • Cut the cake into fingers and grill them. • Serve with apricots, lemon yogurt, nuts. Healthy Gourmet is a weekly column written by private chef Andrea Oschetti. cuoreprivatechef.com
WELL-BEING 11 PERSONAL BEST
...................................................... Rob Lilwall healthpost@scmp.com Ice cream doesn’t stand a chance against me – I have been known to polish off entire two-litre tubs in one sitting. In my resolve to eat less of the sweet treat, I find the battle is usually won or lost long before I dip my spoon in the tub. It takes place in the supermarket, when I decide whether to put the tub in my trolley. I find it quite easy to resist buying the ice cream, really. But once in my freezer, it’s hard to overcome the temptation to have a nice big bowl of it after dinner almost every night. I think this holds true for many healthy and life-giving decisions in my life – the key battle is often fought before the final decision. Take drinking. If I want to drink a little less alcohol at home, I must make sure that I don’t buy or put any bottles of beer or white wine in my fridge.
For many healthy and life-giving decisions in my life – the key battle is often fought before the final decision With exercise, I find the best way to make sure I keep fit is not to make lots of resolutions about running, but to make a deliberate strategic early decision – that is, to sign up for a race. Once I’ve done so, I suddenly have plenty of motivation to go running much more often. What about work? As a writer, my main problems are distractions that take me away from my core task of working on a book or an article. And my greatest distraction is checking my e-mail, both on the computer and on my mobile phone. I know full well from experience that if I try to resist on my own willpower, I often fail. Just as I am about to start doing some serious writing, I decide to have a “quick check”, and this often turns into an epic e-mailing marathon.
So I’ve thought hard about how to defeat this bane. My first strategy in my war against e-mail distraction is to use a free Mac application called SelfControl (selfcontrolapp.com), which blocks any website for up to 24 hours. There is no way to undo it once you activate it – not even by restarting your computer. I activate it to block all e-mail, social media, search engine and blog websites, before I start work on any concentrated task. It is quite effective. The smartphone is a more difficult enemy to defeat. My solution is to leave it in another room or ask my wife to hide it. This may sound radical, but this is war, and I need to be honest with myself about how much time I will waste otherwise. A final area that I’ve been working on for greater selfdiscipline is in my marriage. We have been married only three years and have no children, but I’ve noticed that, especially in Hong Kong, it’s easy to fill up our time with being busy and to have little quality time left over for each other. Nicky and Sila Lee, creators of the Marriage Course (themarriagecourse.org), say that the single most important piece of advice they give to married couples is to schedule one quality “date night” every week – and note it down in your diary. This is when you go on a good old-fashioned date, and actually get time and space to talk to your spouse for an unhurried amount of time. The cinema doesn’t count. My wife and I have tried this strategy, and we have found it to be true on two counts: first, unless we write the date night into our calendars, we often do not go on a date for weeks. Second, having this quality evening together each week has been really good for our marriage. So in these areas of life – eating, drinking, exercise, work and relationships – I think it’s wise to fight the battles early. Merely making a resolution in my head does not really work, but thinking strategically about an earlier decision I can make gives me a far greater chance of success. That is the theory anyway. Now, where’s my iPhone? I want to check my e-mail.
Illustration: Sarene Chan
How to harness your willpower
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NOVEMBER 20, 2012 SOUTH CHINA MORNING POST