YOUR GUIDE TO LIVING WELL
TUESDAY, NOVEMBER 27, 2012
Illustration: Stephen Case
HEALTH POST
GENETIC CLUES TO TYPE 2 DIABETES >PAGE 8
TAKE THE DREAD OUT OF THE TREADMILL >PAGE 9
Power at a price Just how dangerous are energy drinks? >PAGE 6
2 NEWS APP OF THE WEEK
MOVEMBER DIARY WEEK 4
A big thank you for your growing ...................................................... Chester Grucza healthpost@scmp.com
Lose weight fast with five simple rules
As Movember draws to a close, it’s time to reflect on what a month it has been. I gave up my almostthree-year-old whiskers four weeks ago and – despite feeling slightly reluctant about shaving at first – I have no regrets at all; it’s been worth every second and cent. I think we can all admit that our knowledge of prostate cancer and its symptoms is pretty low in Hong Kong. But I believe this month has really made the gents sit up and think about getting that check-up.
QUIZ ......................................................
...................................................... Katie McGregor healthpost@scmp.com Slow Carb Diet Tools HK$23 Rating 8/10 If you like Mexican food, you will love the “slow carb” diet, which comprises beans of any sort, vegetables and meat. The diet was promoted in a book, The 4-Hour Body: An Uncommon Guide to Rapid Fat Loss, Incredible Sex and Becoming Superhuman, by Timothy Ferriss, an apparently hyperactive blogger, entrepreneur and the holder of the Guinness World Records title for the most tango spins in one minute. In his book, Ferriss suggests that you could lose 14kg of fat in 30 days without exercise, and on his blog there are many astounding success stories. Slow Carb Diet Tools is one of several unofficial support apps. The diet’s success lies in its simplicity. There are only five rules: no white starchy carbs; eat the same few meals repeatedly; don’t drink calories; don’t eat fruit, and for one day each week, forget the rules. Otherwise, eat whatever you want. The app opens to an overview page that allows you to track your water consumption by tapping off the recommended eight glasses. In the food diary, you can snap a photo of your meal. This keeps the facts straight as the camera doesn’t lie. You may also track your weight and measurements over time. There’s also a list of allowed foods and a meal ideas generator. It recommends that you eat a mix of protein, vegetables and a non-carb filler, together with a seasoning. Shake your iPhone and the app provides you with a random mix. Right now it recommends I eat turkey, kimchi, lima beans, and salt for seasoning. I’d rather plan my own menu.
This month has made me reflect on my own health and reminded me that regular health checks can be life-saving. As my “magic carpet” reasserts itself, it’s definitely cause for celebration. Despite all the economic woes, this month the Hong Kong community has really come together to show generosity and commitment to the cause. A big thank you to those who have put their money where their mouth is to raise these vital funds for cancer initiatives. This campaign really does sort the men from the boys, so I want to take this opportunity to salute every
Jeanette Wang jeanette.wang@scmp.com As with most things, moderation is key when it comes to physical activity. There’s an optimal amount that’s good for your knees, but both too much and too little exercise can accelerate the degeneration of knee cartilage in middle-aged adults, according to a new study presented at the annual meeting of the Radiological Society of North America. Researchers at the University of California in San Francisco looked at changes in knee cartilage among a group of middle-aged adults over a four-year period. They used magnetic resonance imaging to measure T2 relaxation times, which is associated with the biochemical and molecular composition of cartilage. Increased relaxation times indicate increased water mobility in damaged cartilage. The researchers analysed 205 osteoarthritis patients, age 45 to 60, measuring the T2 values of their cartilage at the patella (knee cap), femur (thigh bone) and tibia (shin bone) of the right knee joint at the start and at two- and four-year visits. Participants used a questionnaire to record their physical activity.
generosity
one of my fellow mo bros for dedicating their upper lip to Hong Kong’s 2012 Movember campaign. You can proudly say you were one in a million and you won’t be getting coal at the bottom of your stocking. If you haven’t already dug deep and shown your support for your favourite mo bro, there’s still time. Check out the hk.movember.com website and you’ll see just how easy it is to donate.
This Friday, many participants will be parting with their moustaches (apart from the ones who have grown attached to theirs). If you’d like to celebrate the success of this momentous campaign, the Official Movember Gala Party will be held at Bisous in Central on the same day. Hong Kong’s rugby community is holding its own event at the Hong Kong Football Club on Saturday. Until next week, remember: good deeds brighten a hairy world. Chester Grucza manages Fly nightclub in Central. Follow his mo-growing exploits this month in Health Post
ASK THE DOCTORS DR CHANG HAW CHONG The study found that those participants who often took part in high-impact activities, such as running, were associated with more degenerated cartilage and higher risk for osteoarthritis. But so, too, were those with very low levels of physical activity. Dr Thomas M. Link, professor of radiology and chief of musculoskeletal imaging at UCSF, notes that people who have a higher risk for osteoarthritis – such as those with a family history of total joint replacement, obesity, history of knee injury or surgery – can reduce their risk of cartilage degeneration by maintaining a healthy weight and avoiding risky activities and strenuous, high-impact exercise. “Lower impact sports, such as walking or swimming, are likely to be more beneficial than higher impact sports, such as running or tennis, in individuals at risk of osteoarthritis,” he says. Test your knowledge with this quiz from the Yale Medical Group. 1. Which of these is a factor in developing osteoarthritis? a. Young age b. Excess body weight c. Too little body weight 2. How can an X-ray help a doctor diagnose osteoarthritis? a. It can show cartilage loss b. It can show bone damage c. It can show bone spurs 3. Which of these is a treatment for osteoarthritis? a. Exercise b. Bed rest c. Cast 4. Which of these medications is a treatment for osteoarthritis? a. Aspirin b. Acetaminophen c. Hyaluronic acid Answers: 1. b; 2. all correct; 3. a; 4. all are correct
Q: I think I have a slight tear in my Achilles tendon. I’ve followed doctor’s orders of no running, hiking or cycling for four months, but I’m still sore and stiff. I don’t want surgery. What are my options? A: The Achilles tendon is the large tendon at the back of the ankle that connects your calf muscles to the bone in the heel of your foot. Large forces go through the tendon when running and jumping. Often, when a partial Achilles tendon tear occurs, the tendon’s central fibres are broken while the surrounding ones remain connected. This is particularly common in running, jumping, throwing and racket sports. It can be caused by: • wearing unsuitable shoes; • a change in your training; • failure to warm up your calf muscles properly before exercising. Initial treatments include: • rest, ice, compression and elevation (RICE); • use of oral anti-inflammatory medication and painkillers; • a brace to keep the Achilles tendon straight so it can heal; • a heel raise to shorten the Achilles tendon to help in healing; • massage to soften the scar tissue; • strengthening exercises. If your pain symptoms persist, the most important step now is to obtain an accurate diagnosis. An MRI scan of your Achilles will tell us whether you have a partially torn tendon or if you are suffering from other conditions, such as Achilles tendinopathy. The scan can also quantify the degree of the tear. Persistent pain in the Achilles is often caused by partial ruptures leading to a hypoxic state in the tissues, insufficient healing and an immature, painful scar. It is notoriously slow to heal because of its poor blood supply. If the partial tear involves less than 25 per cent of the tendon’s
cross section and the diagnosis is made acutely, casting the ankle for a short period followed by physiotherapy to strengthen the muscle-tendon unit may be helpful. Minor partial tears can heal without surgery, but may take months. As your condition has persisted for more than three months, you should be referred for a course of physiotherapy without the need for casting. There are preliminary reports of a non-operative biological treatment approach for partial Achilles tendon lesion using autologous platelet growth factors through multiple platelet-rich plasma (PRP) injections. It is believed these injections with processed blood taken from one’s body can promote tendon healing. But significant partial ruptures involving more than 25 per cent of the tendon’s cross section seem to respond poorly to conservative measures and do not improve with time. Surgical treatment to excise the degenerated tissue is usually the preferred option for such cases. This is because it fully restores function and gives complete relief from pain in most cases. Dr Chang Haw Chong is an orthopaedic surgeon with an interest in orthopaedic sports medicine. He works with Synergy Orthopaedic Group at the Mount Elizabeth Novena Specialist Centre in Singapore
NEWS 3 HEALTH BITES ............................................... Jeanette Wang jeanette.wang@scmp.com
A lethal cocktail If you’re taking medication, it’s best to avoid grapefruit juice. A new article published in the Canadian Medical Association Journal says the number of prescription drugs that can have serious adverse effects from interactions with the fruit are markedly increasing, yet many physicians may be unaware of these effects. The article, published by the researchers who discovered the interactions more than 20 years ago, notes that this is a result of the introduction of new chemical entities and formulations. There are more than 85 drugs that may interact with grapefruit, and 43 can have serious side effects. Other citrus fruits such as Seville oranges, often used in marmalade, limes, and pomelos, also contain the active ingredients (furanocoumarins). Adverse effects include sudden death, acute kidney failure, respiratory failure, gastrointestinal bleeding, renal toxicity and other serious side effects. The interaction can still occur even if the grapefruit is consumed many hours before taking the medication.
Live and let dry Respiratory conditions that restrict breathing such as asthma and chronic obstructive pulmonary disease are common killers. No effective treatments have existed to address the major cause of death in these conditions – excessive mucus production. But Washington University School of Medicine scientists have found the molecular pathway responsible for this in airway cells – and have designed a series of new drugs to inhibit that pathway. In their study, which appears in the Journal of Clinical Investigation, some of the drugs reduced mucus production in cultures of human airway cells by 100 times. The researchers also see a possible role for the drugs in cystic fibrosis and even the common cold. Why the mind boggles For more than two decades, the term “chemo brain” has been used to describe the mental fog experienced by patients on chemotherapy. The cause had been unclear, but a new study shows that chemo brain is more than just a feeling – it’s a change in brain function. West Virginia University School of Medicine researchers found that the areas in the brain responsible for planning and prioritising used less energy after chemotherapy. Lead researcher Rachel Lagos cites another study where patients complained of inability to prepare meals after chemotherapy. “But when provided with written, planned menus for each meal, the women could … prepare and enjoy them with their families,” she says. Correction In last week’s Health Post cover story, Bad to the Bone, we incorrectly stated that there is a 20 per cent increased risk of mortality from one serving per week of processed red meat and a 13 per cent increased risk from one serving per week of unprocessed meat. It should have read “one daily serving” instead of “one weekly serving”. The error was introduced during the editing process. > 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
All roads lead to autism Your baby’s brain may be affected by polluted air, say scientists at the University of Southern California and Children’s Hospital Los Angeles. The study, published in the Archives of General Psychiatry, shows that exposure to traffic-related air pollution during pregnancy and the first year of life is associated with a more than two-fold risk of autism. In addition, exposure to regional pollution consisting of nitrogen dioxide and small particles is also associated with autism even if the mother did not live near a busy road. The study involved data on 279 autism cases and 245 control subjects. Mothers’ addresses from birth certificates and addresses reported from a residential history were used to estimate exposure during pregnancy and the first year of life.
4 HEALTH FROM THE EXPERTS WORLD AIDS DAY ...................................................... Dr Justin Grayer healthpost@scmp.com Since 1988, World Aids Day has been held on December 1 to promote awareness of HIV/Aids around the globe. UNAids, the United Nations organisation for HIV/Aids, sums up its focus as “Zero new HIV infections. Zero discrimination. Zero Aids-related deaths”. According to UNAids, in 2009, 21 years after the first World Aids Day, there were an estimated 4.9 million people living with HIV across Asia. This number is almost equivalent to the population of Singapore. An estimated 300,000 in the region died of Aids-related illnesses. HIV, which stands for human immunodeficiency virus, can lead to acquired immune deficiency syndrome, or Aids. At present, people can live much longer – even decades – with HIV before they develop Aids, because of “highly active” combinations of medications introduced in the mid-1990s. The prevalence of HIV in Hong Kong is much lower than in most other parts of Asia. Nonetheless, according to Hong Kong government data, there has been a general upward trend in the number of those newly diagnosed with HIV each year, from 28 in 1988 to 438 last year. The increase in new diagnoses may reflect a real rise in the incidence of the virus, or an increase in the number of people being tested, or both. The number of new Aids diagnoses each year in Hong Kong has also increased, from seven in 1988 to 82 last year. But as a proportion of new HIV diagnoses each year, new Aids diagnoses have fallen from 25 per cent in 1988 to 19 per cent last year. As Hong Kong residents have access to affordable HIV medical care, the decline may represent improved health care and HIV management. The Hong Kong Aids Foundation’s message this World Aids Day is that HIV is a chronic, not terminal, disease. The shift from terminal to chronic illness is mainly due to the development of highly active anti-retroviral therapy (HAART) medication regimens. But if patients miss more than one of their twice-daily doses of medication a month, the virus may become resistant to the medication. Thus, HIV requires active management to remain chronic, and to prevent its transition into a potentially terminal illness. While Hong Kong has yet to achieve zero new HIV infections, it seems to be headed in the right direction. Effective HIV treatment requires psychological and social support on top of medication, as patients are more at risk of psychological distress than those without HIV. In 2006, a small-scale Chinese study found high rates of major depression and suicidal feelings in people with HIV compared to those without. But despite their distress, few sought or were provided with
Students come together to show off a handmade red ribbon to mark this year’s World Aids Day at a school in Hanshan, Anhui province. Photo: AFP
The difference a day makes mental health assistance. This suggests a need to increase awareness of psychiatric comorbidity and to facilitate access to mental health services. Anecdotal reports suggest there is limited psychosocial care provided directly by the Hong Kong government. But non-governmental organisations can help fill the gap for Cantonesespeaking clients. There are many reasons people with HIV may experience psychological distress. A person’s beliefs about the disease will influence how they cope with the diagnosis. For example, someone who mistakenly believes that HIV is an infection that does not have many symptoms and is curable will cope differently from someone who correctly understands that HIV is incurable and life-threatening if not medically managed. HIV patients have to make changes to their lifestyles, such as taking medication and dealing with any side effects, managing possible
Those with HIV may be identified by their HIV status rather than the illness being seen as just an aspect of their identity symptoms as well as the hospital environment and health care staff relationships. They also have to decide whether to disclose their HIV status to others. In general, the terms HIV and Aids are associated with negative ideas – just ask a handful of people what they think and feel about these terms. Those living with HIV may be labelled, or identified by their HIV status, rather than the illness being seen as just one aspect of their identity. Consequently, they are
more likely to be stereotyped and discriminated against. In 2008, a US study found that employers across five different industries in Chicago, Hong Kong and the mainland were generally concerned about hiring people who reveal their HIV-positive status. This was more prominent in Hong Kong and the mainland. Furthermore, Hong Kong and mainland Chinese participants reported more discriminatory behaviour than those in Chicago. The study’s authors suggested that the increase in discrimination was influenced by a lack of social contact with people with HIV; a belief that hiring those with HIV would result in a spread of morality in the workplace and consequently a possible loss of face to the employer and company; and less knowledge, practice and enforcement of discrimination protection laws. The Hong Kong Disability Discrimination Ordinance exists to protect people living with HIV/Aids
against discrimination in the same way that it protects those with disabilities and other chronic illnesses. This is in stark contrast to Singapore where, according to UNAids, non-citizens with HIV are denied visas and deported if their HIV-positive status is made known. Thus, it seems that Hong Kong is doing better than some other Asian countries, but still has some way to go to achieve the goal of “zero discrimination”. To mark this year’s World Aids Day, the Hong Kong Aids Foundation is selling red ribbons and cupcakes in different community locations. It is also holding a candlelight vigil in remembrance of people who have died from Aids. The vigil will be held at 6.30pm on Saturday at the Star Ferry pier in Tsim Sha Tsui. Dr Justin Grayer is a clinical psychologist and sex therapist at thinktalkpsychology.com
MEDICAL 5 CASE HISTORY
...................................................... Elaine Yau elaine.yau@scmp.com Miss Ho’s nightmare began two years ago when she was suddenly struck by intense headaches. The pain, sometimes lasting all day, was so severe that she vomited and felt dizzy. A brain scan found that she was suffering from glioblastoma multiforme (GBM), the most aggressive and malignant form of primary brain tumour. “The tumour, the size of an orange, traversed my left and right brain,” says Ho, who is in her 30s. “I underwent surgery, which removed half of it. The other half, located too close to the nerves, had to be dealt with using chemotherapy and radiation therapies, which lasted six months.” But just as Ho was about to finish her chemotherapy, she lapsed into a coma. She was then diagnosed with hydrocephalus – brain swelling caused by fluid build-up inside the skull – triggered by the resurgent brain tumour. The relapse rate for GBM patients is 100 per cent, says Ho’s doctor and specialist in neurosurgery, Dr Tony Chan Kamtong. “It’s the most malignant form of brain tumour,” he says. In Hong Kong, there are 200 new cases of brain cancer every year, of which 70 are GBM cases. Nearly all GBM patients suffer from a relapse about nine months to a year after treatment. “The tumour came with straggly whiskers that got entwined with blood vessels. Doctors could not remove all of it, so traces are always left after surgery. That’s why all the patients suffer from a relapse,” Chan says. The response rate of chemotherapy for the relapse is less than 10 per cent. Less than 30 per cent of GBM sufferers remain alive for more than a year. But patients got a glimmer of hope in 2009 after the US Food and Drug Administration approved a targeted therapy drug called bevacizumab for treatment of relapsed GBM. A synthetic antibody used alongside chemotherapy to treat metastatic cancer, bevacizumab was first approved in 2004 in cases of colon cancer. It has since also been approved for use in certain lung cancers, renal cancers and GBM of the brain. Chan says the drug enhances
survival time by up to eight months. “A decade ago, GBM sufferers could live for only 10 months. Five to six years ago, chemotherapy extended that to a year and two months,” he says. “But after getting the targeted therapy drug, patients can now live for a year and a half to two years.” International research shows that response rate for the drug, taken in combination with chemotherapy, was about 37 per cent. After taking the drug alongside chemotherapy, 50 per cent of patients can survive for six months if the tumour does not worsen. Only 10 to 20 per cent of patients who receive traditional treatment can survive that long. Chan says bevacizumab has also improved patients’ quality of life. “The tumour cells are surrounded by blood vessels, which provide nutrients to the growing cells. The drug stops the vessels from growing. After some time, the vessels will wilt and the tumour shrinks,” he says. “The tumour usually weighs on the regions of the brain for vision, language, motor movement and cognition. The patient would not be able to move without support and their thoughts would be muddled. But the drug, which shrinks the tumour, gives patients a better quality of life.” Because it is not subsidised by the government, bevacizumab treatment costs HK$40,000 a month, putting it beyond the means of many Hongkongers. However, Ho was luckier: as a beneficiary of a special subsidy programme, her treatment cost was sponsored by a pharmaceuticals company. She has received 28 injections of the drug so far – once a fortnight – and says she feels much better. “Before, even when I walked with support, I couldn’t walk in a straight line. But now I can walk and I can go to the living room to watch television,” she says. “I can also speak fluently now, and I don’t feel many side effects either. I was glad when my latest check in September showed that the tumour had shrunk a lot in size.” Chan says it’s a miracle Ho is still alive, but has dim hopes she will survive the tumour in the long run. “Causes of GBM are still unknown. The death rate remains at 100 per cent,” he says. “But patients usually die peacefully and quite painlessly. Most spend much of their time sleeping and eventually die in a state of semi-coma.”
Illustration: Angela Ho
Clinging to hope
After getting the targeted therapy drug, patients can now live for up to two years DR TONY CHAN KAM-TONG
6 COVER STORY
A jolt to the system
35 en ph te :S ion at str Illu se Ca
• Coca-Cola has this many mg of caffeine per 330 ml can • Coffee has 80mg to 150mg of caffeine per 180ml cup • Energy drinks have from 50mg to 500mg
COVER STORY 7
Energy drinks are among the most popular on the market, but there is growing concern about their potentially harmful effects, says Charley Lanyon
W
hen does a stimulating drink become dangerous, even fatal? That’s what the US Food and Drug Administration is trying to find out as it investigates a possible link between so-called energy drinks and at least 18 deaths in the United States in recent years. Energy drinks contain a number of stimulants that claim to increase one’s attention span and stamina, and even improve sporting performance. But there is growing concern about their harmful effects even as their popularity rises worldwide. The FDA’s investigation is focused, in particular, on two energy drinks: 5-Hour Energy, which may be linked to the deaths of 13 people in the past four years; and Monster, which may have contributed to five other deaths. Global energy drink consumption rose 14 per cent year on year in 2011 to 4.8 billion litres – more than 1.5 billion litres higher than in 2007, according to a report from leading food and drink consultancy Zenith International, released in February. Consumption has grown by an average of 10 per cent a year over the past five years. China ranked third for consumption among the 57 countries covered by the report. North America is still the leading consumer, with 36 per cent of global volume in 2011, followed by the AsiaPacific region at 22 per cent. By 2016, Zenith estimates, global market consumption volumes will have risen 35 per cent to 6.5 billion litres. This rise in consumption of drinks that may not be safe is a worrying trend. In recent years, the Hong Kong Centre for Food Safety notes, several countries have reported possible links between the consumption of energy drinks and cases of cardiac dysrhythmia, seizures, kidney failure and fatalities. Such incidents generally involved improper intake of the beverages, such as drinking them with alcohol, or in greater quantities than recommended. Energy drinks are meant to enhance energy by stimulating the nervous system with ingredients such as caffeine, a selection of B vitamins, taurine (an amino acid) and glucuronolactone (a carbohydrate). Caffeine and taurine have been singled out in research studies as the potential culprits. Though ingredients such as caffeine are not inherently dangerous, problems could arise when these substances are taken in excessive amounts, in combination
INSIDE STORY
with other substances, or by the wrong people. “Both caffeine and taurine have been shown to have a direct impact on cardiac function,” says Dr James Kalus from the Henry Ford Hospital in Detroit. Kalus was the lead author of a 2009 study which found that healthy adults who drank two cans a day of a popular energy drink experienced an insignificant increase in their blood pressure and heart rate. This could prove harmful to people with a heart condition. Kalus notes that energy drinks should not be confused with sports drinks, which aim to replenish the carbohydrates and electrolytes that a body needs. “If you have high blood pressure, heart problems, or high blood-sugar levels, you shouldn’t drink [energy drinks] because they all have high doses of stimulants and sugar,” says Mimi Li Shuk-ping, a Hong Kongregistered dietitian. “The caffeine will increase your heart rate and
Red Bull: The king of energy drinks and the best-selling energy drink worldwide. A 250 millilitre can contains 80 milligrams of caffeine, 27.5 grams of sugar and 1,000mg of taurine.
If you have high blood pressure, heart problems, or high blood sugar-levels, you shouldn’t drink energy drinks
Lucozade Energy: From Britain, this straddles the line between energy and sports drink. In Hong Kong it comes in a 300ml bottle and contains 27.3 grams of sugar and 40mg of caffeine, with no taurine.
MIMI LI, DIETITIAN
blood pressure, and, in the end, may increase the chance of having a heart attack.” The caffeine content of energy drinks varies over a 10-fold range, with some containing the equivalent of 14 cans of Coca-Cola, according to scientists at Johns Hopkins University, who have spent decades researching the effects of caffeine. A regular 330 millilitre can of cola has about 35 milligrams of caffeine, and a 180ml cup of brewed coffee has 80mg to 150mg. Energy drinks can contain from 50mg to more than 500mg of caffeine. In an article published in 2008 in the journal Drug and Alcohol Dependence, the scientists highlight the potential health risks of excessive caffeine – and the need for warning labels on energy drink cans. Caffeine intoxication, a clinical syndrome included in the World Health Organisation’s International Classification of Diseases, is marked by nervousness, restlessness, anxiety, insomnia, gastrointestinal upset, tremors, rapid heartbeat
Monster: The second most popular energy drink worldwide comes in a 473ml can, which contains 160mg of caffeine, 54 grams of sugar and 2,000mg of taurine, as well as some ginseng, guarana and L-carnitine. Shark: This is a Thai energy drink commonly found in Hong Kong. It comes in a similar can to Red Bull and contains 80mg of caffeine, 35 grams of sugar and no taurine.
Relentless: One of Coca-Cola’s most popular energy drinks, it comes in a whopping 500ml can and contains 160mg of caffeine and 50 grams of sugar. Like Monster, it also contains some guarana, and has 2,000mg of taurine.
(tachycardia), psychomotor agitation (restlessness and pacing) and, rarely, death. By contrast, little is known about the effects of heavy or long-term taurine use. Taurine, a non-essential amino acid derivative often found in meat and fish, plays a range of roles in musculoskeletal and nervoussystem development. Dietitian Katherine Zeratsky, writing on the Mayo Clinic website, notes: “Some studies suggest that taurine supplementation may improve athletic performance,
which may explain why taurine is used in many energy drinks. Other studies suggest that taurine combined with caffeine improves mental performance, although this remains controversial.” Up to 3,000mg a day of supplemental taurine is considered safe, says Zeratsky. Any excess is excreted by the kidneys. A single Red Bull contains 1,000mg of taurine. Guarana is another common ingredient in energy drinks. It is a plant found in the Amazon, the seeds of which contain about twice
the caffeine level of a coffee bean. The possible adverse effects of these stimulants are compounded when energy drinks are mixed with alcohol, such as in Red Bull vodkas, or Jagerbombs. A study published last year in the journal Alcoholism: Clinical & Experimental Research found that an energy drink alters the reaction to alcohol a drinker experiences when compared to drinking alcohol alone. The latter leads to impulsive behaviour, but energy drinks provide an enhanced feeling of stimulation, leading to possibly risky scenarios. “Energy drinks have become enmeshed in the subculture of partying,” researchers said in a commentary published last year in the Journal of the American Medical Association. “The practice of mixing energy drinks with alcohol has been linked consistently to drinking high volumes of alcohol per drinking session and subsequent serious alcohol-related consequences such as sexual assault and driving while intoxicated,” the journal said. There’s another common ingredient present in high doses in energy drinks that has proven time and again to be disastrous for health: sugar. Energy drinks, for the most part, have as much, or more, sugar than soft drinks, and excessive sugar has been irrefutably linked to chronic diseases such as obesity, heart disease and cancer. These drinks are also bad for your teeth. A study published recently in General Dentistry, the clinical journal of the Academy of General Dentistry, found that the high acidity levels in energy drinks caused twice as much damage as sports drinks to tooth enamel, the glossy outer layer of the tooth. The recent incidents in the US have led to renewed concern over energy drinks, and rising calls for tighter regulation of the beverages. In the US, energy drinks fall in the category of dietary supplements, meaning they are exempt from FDA approval and rules requiring nutritional labelling information. In Europe, drinks with more than 150mg of caffeine per litre have to be labelled “high caffeine content”. France had imposed a ban on Red Bull for 12 years before backing down in 2008 after European regulators said they found no evidence of danger. There is no specific legislation governing the standard of energy drinks in Hong Kong. With the recent incidents in the US, perhaps it is time to review the regulations of such drinks here. Even if that energy drink probably won’t kill you, there are healthier ways to get a boost. “Have some coffee, go outside and take a few minutes’ walk to get some fresh air and increase your oxygen level. Take a shower or a 20-minute nap,” says Li. “All of these methods are preferable to energy drinks.” charley.lanyon@scmp.com
8 HEALTH DIABETES
...................................................... Elizabeth Snouffer healthpost@scmp.com According to the updated fifth edition of the International Diabetes Federation’s Diabetes Atlas 2012, released on World Diabetes Day earlier this month, there are 371 million people in the world with diabetes. If urgent action is not taken, that figure will grow to 552 million by 2030. China leads the figures with 92.3 million people with diabetes, 57 per cent of whom are undiagnosed. Dr Jenny Leung, president of Diabetes HK, says Hong Kong is experiencing a diabetes calamity, too. “We estimate that 10 per cent of the population, or 700,000 people, have diabetes in Hong Kong, but only 350,000 know it.” In Singapore, diabetes statistics are similar. Singapore’s health minister Gan Kim Yong, speaking on World Diabetes Day, said: “Today, more than 400,000 Singaporeans over 40 live with diabetes, and by 2013 it is estimated to increase to 600,000.” With a population of just over five million, Singapore would cross the 10 per cent population threshold next year.
Half of all people who are blind have diabetes, and the same is true for kidney disease
Decoding the disease
DR RONALD MA
Are East Asians more at risk for type-2 diabetes than are other ethnic groups? To find out, a team of 75 scientists from 27 universities and institutions worldwide are conducting a genetic study involving five major ancestry groups. The study involves 10,000 participants of East Asian, South Asian, European, Hispanic and African-American descent, half of whom have diabetes. The sequencing of 18,000 of each participants’ protein-coding genes will be completed this year. By comparing the DNA of individuals with type-2 diabetes and controls, the scientists hope to isolate genes or variants that increase or reduce an individual’s predisposition for developing the disease, says T. M. Teslovich, research fellow in statistical genetics at the University of Michigan. “If different variants are associated with different populations, that has implications
Dr Ronald Ma, lead investigator in research on the genetics of diabetes. Photo: Nora Tam
FITNESS 9
for risk prediction and [eventually] treatment,” he says. “Knowing which variants are causal can lead to the development of new drug therapies. But it takes time to go from variant to treatment.” The study is a project sponsored by the US National Institutes of Health called T2D-Genes, or type-2 diabetes genetic exploration by next-generation sequencing in multi-ethnic samples. Chinese University is part of the T2D-Genes consortium, with Dr Ronald Ma, professor at the department of medicine and therapeutics, as lead investigator. Ma, who is also an honorary consultant at the Prince of Wales Hospital, says that while Hong Kong samples were not included in T2DGenes, he and his team are replicating the study. He believes this is one of the most significant studies to date because so little is known about the genetics of diabetes. “We have found only 10 per cent of the genes that are linked to diabetes,” he says. “There are still many unexplained risks and the T2D study will provide some answers.” Diabetes can strike an individual at any age. Type-1, type-2 and gestational diabetes are the three main kinds of the illness. Type-1 diabetes, also known as juvenile diabetes or insulindependent diabetes, is usually first diagnosed in children, teenagers or young adults. Type-2 diabetes, also known as adult-onset diabetes or non-insulin-dependent diabetes, is the most common form of the illness. One can develop type-2 diabetes at any age. Some women develop gestational diabetes during the late stages of pregnancy. Although this usually goes away after the baby is born, a woman who has had it is more likely to develop type-2 diabetes later in life. Type-2 diabetes is nearly at crisis level in Hong Kong because, while incidence is growing steadily, funding for the condition is not. “A doctor typically has no more than 10 minutes with each patient, and that’s not a lot of time to discuss prevention, risks and the importance of adherence to
250 Estimated number of new type-2 diabetes cases among Hong Kong children each year, according to the Asia Diabetes Foundation
treatment,” Diabetes HK president Dr Jenny Leung says. According to Ma, awareness of diabetes symptoms is also low and patients ignore the risks. “Diagnosed cases don’t take their condition seriously because they think it will always be silent,” he says. “But half of all people who are blind have diabetes, and the same is true for kidney disease.” Both Ma and Leung believe that campaigns like World Diabetes Day help generate greater public awareness by emphasising the seriousness of the illness. This year’s campaign focuses on the urgency for action to protect the health of our future generations, reflecting the rising incidence of type-2 diabetes in children and adolescents globally. According to the Asia Diabetes Foundation, there are an estimated 60 to 70 new cases of type-1 and about 250 new cases of type-2 diabetes among Hong Kong children each year. In Hong Kong, childhood obesity increased from 9.3 per cent overweight and 2.6 per cent obese children in 1993 to 13 per cent and 3.7 per cent respectively in 2006. IDF practice guidelines state that metabolic syndrome can be diagnosed in children over age 10 with abdominal obesity and the presence of two or more other clinical features, such as elevated triglycerides, low HDL cholesterol, high blood pressure and increased plasma glucose. But not only overweight and obese people get diabetes, and misconceptions may lead to adverse outcomes, says Dr Yao Ho-chung, resident specialist with the department of paediatrics at Prince of Wales Hospital. “Non-obese children with type-2 diabetes will probably be missed,” he says Joanna Hotung, co-founder and chairwoman of the Hong Kong Juvenile Diabetes Association, thinks it may be time for her organisation to cater to the rising incidence of type-2 diabetes among children. Most of its members who receive general and emotional support have type-1 diabetes. The EatSmart@school.hk campaign, launched jointly by the Education Bureau, the Health Department and Diabetes HK in 2009, is still going strong. The campaign, which promotes healthy eating practices among students, has been successfully conducted in 54 primary schools. New estimates predict that this year 4.8 million people will die from diabetes and that half of them will be under the age of 60. The IDF says that if we don’t change our behaviour, our kids may be “the first generation where children may die before their parents”.
SWEAT
An end to run-of-the-mill workouts ...................................................... Danielle Braff healthpost@scmp.com Running indoors doesn’t have to be boring. Mix up your treadmill time with this fun routine, offered by Patricia Friberg, a Los Angeles-based trainer and fitness instructor. 1. Warm up Do a light jog or fast walk for five minutes without an incline. 2. Super slow motion Treadmill set-up: 1 km/h with an incline of 10 With your hands at your sides, palms facing back, take a very slow step with your right foot. As your right heel strikes the treadmill, your left arm should move slowly upward on the diagonal. Pause for a second as you extend your left leg behind you before it moves in front, firming your glutes. Repeat. Duration: two minutes 3. Low squat sideways step Treadmill set-up: 1.5 to 2.5km/h with an incline of 10 Pause the treadmill while you set up for this exercise. Standing sideways, lower yourself into a deep squat, being careful to keep your knees in line above your ankles. As the treadmill moves, stay low in your squat and side-step. You will feel your gluteus medius (the side of your butt) working hard. Before you switch sides, pause the treadmill. Duration: alternate sides twice with one minute per set 4. Low backward walking Treadmill set-up: 1.5 to 3km/h with an incline of 10
Facing away from the treadmill, hold onto the handrails carefully and keep your knees bent in a squat position. Walk slowly, paying attention to articulating your toe-to-heel movement. Duration: two minutes 5. Cardio blast Treadmill set-up: 9.5 to 14.5km/h without an incline Begin your sprint facing forward for one minute, then hit the pause button and carefully step off the treadmill. Standing next to the treadmill, get low into a squat position, pressing down into the floor before you use your legs to jump high into the air, reaching your arms up. Catch your landing in a squat position before exploding up in the air again. Duration: one-minute sprint and two or three sets of 15 squat jumps 6. Hill and abs training Treadmill set-up: 5.5 to 9.5km/h with an incline of 15 Walk or run for two minutes, then hit the pause button and step off the machine. Place your hands on the treadmill and your feet on the floor so you are in an inclined position (resembling the top of a push-up, but with your hands on the machine). Your hands should be directly under your shoulders, and your feet firmly positioned on the floor. Since your heart rate should already be up, it’s important to lift your chest slightly forward, keeping your head in line with your spine so you don’t get dizzy. Remain in the plank position as you bring your right knee in towards your chest without rotating your hips,
and hold for 30 seconds. Switch legs. Duration: a two-minute walk or run, followed by a one-minute plank. Do the sequence two or three times 7. Row lunge Treadmill set-up: a comfortable walking or running place without an incline After a three-minute walk or jog, pause the machine and step off. Hook a resistance tube around a secure pole or rail on the treadmill, making sure there isn’t an opening where the band could slide off. Loop it over the rail, and thread one handle through the other so that you have one handle to hold a long tube. To make this more difficult, step farther from your anchor point. Hold the handle with your right hand, palms facing each other. Place your right leg backwards in a lunge position. As you pull your right elbow back, rotate your torso toward your right and extend your left arm. Bend your left elbow and rotate toward your left side as your right arm reaches forward. Switch hands and repeat on the other side. Duration: a three-minute walk or run followed by 15 reps on each side 8. Rolling hills Treadmill set-up: walk or jog at a comfortable pace without an incline Start by walking or jogging without an incline for 30 seconds. Then walk or jog the following: 30 seconds each at an incline of five, 10, five, 0, five, 10, 15, 10, five, 0. Duration: 10 minutes, walking or jogging 9. Cool down A five-minute walk at a comfortable pace without an incline. McClatchy-Tribune
10 DIET THE TASTE TEST CHOCOLATE COOKIES
HEALTHY GOURMET
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Jeanette Wang jeanette.wang@scmp.com
Jeanette Wang jeanette.wang@scmp.com
Hail Merry Macaroons HK$52 for 100 grams, Just Green At first glance, these may look like dog treats, but they’re macaroons, made with maple syrup, shredded coconut, dark cocoa, extra virgin coconut oil, pure Madagascar bourbon vanilla and sea salt. The coconut is said to contain medium chain fatty acids that burn quickly and contain zero cholesterol. Verdict: melt-in-your-mouth, moist, slightly chewy, rich chocolate taste... I’m addicted.
Go Raw Chocolate Super Cookies HK$64 for 85 grams, Just Green These dollar coin-sized, super thin cookies are made with coconut, sesame seeds, dates and cacao. All ingredients are raw, meaning they’re dried below 40 degrees Celsius and are thus “live”, containing enzymes that make them easier to digest. Verdict: great natural chocolate flavour, but devouring them is a real workout for the jaw.
Is there any way to have your festive feast and eat it? According to the American Council on Exercise, the average Thanksgiving dinner packs 3,000 calories and 229 grams of fat. The average Joe – weighing about 73kg – would have to run at a moderate pace for four hours, swim for five hours or walk 48 kilometres just to burn off the meal. But private chef Andrea Oschetti doesn’t think a Thanksgiving dinner – or any festive feast for that matter – need necessarily be a calorie-laden affair. “It’s unhealthy because people stuff themselves to death,” says the Italian, whom my friends and I had hired to cook up a Thanksgiving meal for a party of 23 last Thursday. Let’s face it: pumpkin tortelli with cream, turkey with gravy, stuffing and cranberry sauce, and chocolate truffle cake – this was our Thanksgiving menu – is high in fat, calories, sodium and everything else your doctor would advise you against indulging in. But this annual, predominantly North American celebration is rooted in religious tradition, and Oschetti suggests not to fight it. “You should eat the food that’s given to you, whatever the calorie count,” he says. “Just keep the portion size minimal, and when you’re full, stop eating. Don’t stuff yourself.” He offers five other strategies for healthy feasting that will come in handy for the year-end revelries. 1. Don’t stay seated at the table With food placed right in front of you, you’ll keep eating. Move around and chat with people. Help to clear the plates or wash dishes. 2. Don’t starve yourself for the meal Most people do so in anticipation of a big feast and then get so ravenous that by the time dinner comes, they eat quickly and stuff themselves silly. Have healthy snacks during the day, such as carrot sticks, so that you don’t overindulge later on. 3. Stay hydrated Remember to keep drinking a lot of water while enjoying alcohol.
Andrea Oschetti with Thanksgiving birds. Altering the cooking method can make turkey healthier. Photos: Dickson Lee
Stay on full alert For our dinner, Oschetti used pumpkin, a traditional Thanksgiving ingredient (called zucca in Italian), in an unusual way. Rather than turn the squash into soup or a pie, he made pumpkin tortelli, a typical autumn dish in northern Italy. “It’s a traditional Italian recipe that puts together the sweetness of pumpkin, the saltiness of parmesan and the bitterness of amaretti,” he says. “It’s also a common Christmas Eve dish, as according to tradition, no meat is eaten on that day.” It is said that in Italy, you can make good pumpkin tortelli only if you know how to pick the best pumpkins. But this skill, says Oschetti, is a well guarded secret. So, naturally, I try to get the chef to share his secret with me.
Tortelli de zucca Serves 6
You should eat the food that’s given to you, whatever the calories. Keep the portion size minimal ANDREA OSCHETTI
“I can’t tell you,” he says. “But I think the Hong Kong pumpkins are good – I get mine from an organic farm in the New Territories.” While Oschetti didn’t share the secret, fortunately he agreed to share his recipe.
4. Incorporate some exercise Take a 20-minute walk with a friend after dinner to help with digestion. Plan a workout for the morning after, or – if you’re lucky like Oschetti – go for a run while the turkey is in the oven and put your partner on basting duty. Jovial Crispy Cocoa Einkorn Cookies HK$58 for 250 grams, Just Green There’s wheat, and then there’s einkorn – which is the original variety of wheat from the birth of agriculture more than 10,000 years ago. It’s said to be more nutritious than other wheats, so in theory, these should be extra good for you. Verdict: delicate chocolate flavour, slightly buttery and a tad crumbly – tasty, but nothing special.
5. Don’t have second servings If you’re preparing a home-cooked feast, alter the cooking methods or menu to make it healthier. “Try cutting up the turkey and cooking it in parts – this will allow you to control the amount of butter you put in it. Or cook it sous vide and you won’t need much butter at all,” says Oschetti. “For the stuffing, try using chestnuts instead of sausage.”
Pumpkin tortelli with cream is a typical autumn dish in northern Italy.
2kg pumpkin 100 grams dry amaretti (macaroons) 12 tbsp grated parmesan cheese Pinch of salt Pinch of ground nutmeg 4 eggs 400 grams flour 100ml cream Some butter Pinch of ground sage Pistachio nuts or almonds, coarsely ground • Cut the pumpkin into pieces and bake at 180 degrees Celsius until tender. • Purée the pulp until smooth in a food processor or blender. • Crumble the amaretti and add to the purée with eight tablespoons of parmesan and a pinch of salt and nutmeg. • Prepare the pasta dough by mixing the eggs with the flour. • Knead the dough until smooth, cover with cling film and allow to rest for an hour. • Roll out the dough into a thin sheet. • Cut out 10cm by 10cm squares. • Spoon the pumpkin filling into the centre of the square and fold it in half to make the tortelli. (Or put two squares together for a bigger tortelli.) • Prepare the parmesan fondue by melting four tablespoons of parmesan with cream. • Cook the tortelli in salted boiling water. • Transfer them to a skillet with melted butter and sage. • Put the tortelli on a plate, spoon parmesan fondue over and sprinkle with ground nuts.
WELL-BEING 11 FIT & FAB
Matthias Weiskopf trains at Impakt gym in Central. Photo: Warton Li
Hooked on a feeling ...................................................... Ben Sin healthpost@scmp.com When management consultant Matthias Weiskopf arrived at work one morning with a black eye, no one in the office batted theirs. That’s because the 40-year-old German has been taking boxing lessons at Impakt gym – a fact that his colleagues at the Volkswagen Hong Kong office are aware of. Considering that Weiskopf’s trainer and sparring partner is the huge, four-time muay Thai world champion Alain Ngalani, his colleagues likely expected far worse than just a swollen, discoloured eye. The lifestyle of a globetrotting, senior executive can be stressful. Weiskopf – who has in the past decade worked in more than 20 European countries, plus Singapore, China and the Middle East – relaxes by exercising. It’s the one constant in his ever-changing life. “One of the first things I do when I arrive at my new location is look for a gym and a running trail,” he says. Living in Central, a running trail wasn’t “immediately accessible”, but he found a gym with ease, and randomly took up boxing. He had
never tried the sport before, nor was he a particularly big fan of it (although he does love the Rocky movies), but he had heard that it involves intense cardio. Four months on, Weiskopf has fallen in love with the sport. He goes at least twice a week and almost never misses a session. The sport has been good to him too. He says he’s lost a bit of fat and gained muscle all around since starting the sessions. “I used to think running was great; that I was in shape,” he says. “But really, boxing is another level – I was so sore and tired after the first few sessions.” What’s a typical session like? I come in straight from work, change, and then jump right in. I usually warm up with a jog on the treadmill, then I hit the punching bags with Alain watching and guiding me, making sure that I vary my punches and combinations. Then we spar in the weightlifting and abs training. Alain is massive. Were you intimidated by him at first? Yes, I was. Alain and I are the same height, but he has 30kg on me and it’s all muscle. I actually signed up
without knowing his background – that he’s a four-time world champion. I was just looking for someone to push and motivate me. He’s a very disciplined and strict trainer, which is good – it’s exactly what I was looking for. How do you stay motivated to work out when you lead such a busy lifestyle in a bustling city? It’s easy – boxing actually relieves stress for me. So in a way, I need to come after work to unwind. I missed a session once and I didn’t like it; I didn’t feel good. What’s your diet like? Chinese food tends to be heavy on the carbs. Do you stay away from that? No, I eat local Hong Kong food. I love dim sum. But yes, I do try to limit myself to eating Chinese food only in the day and not too late at night. I eat a wide variety of food, both Western and Chinese cuisines. What’s the hardest part about boxing? Mastering the footwork is tricky, but the hardest part is how much cardio it is. I used to watch boxing and wonder why a round lasts only three minutes – it just seems so short, you
Now that I’ve tried boxing, I realise that … three minutes of it is already draining enough MATTHIAS WEISKOPF
know. But now that I’ve tried it myself, I realise that boxing is the most intense cardio sport around and, really, three minutes of it is already draining enough. Boxing is the hardest cardio I’ve ever done and, remember, I used to be a runner. Would you consider participating in the Hedge Fund Fight Night event that’s been taking place in Hong Kong? I haven’t really thought about it. I don’t plan on doing it right now, but at the same time, if it comes around and someone asks, I may not say no. Impakt gym has recently become known for its mixed martial arts training sessions. Would you consider trying that next? Yes, I plan on trying it next year. But I want to work on boxing more, to get my foundation right first. You’ll still be here next year? I’m only here until this month on my current contract, then I’m going elsewhere for a bit. I’m pretty sure I’ll be back in Hong Kong some time next year. But even when I’m not here, I’m going to continue boxing. I love it.
12 WELL-BEING PERSONAL BEST
Less attitude, more gratitude is key to a happier life ...................................................... Mary MacVean healthpost@scmp.com Before we eat Thanksgiving dinner at my house, along with saying grace, each of the 20 or so people at the table lights a candle and expresses gratitude. This expression is not an empty exercise. If we all developed the discipline to be consciously grateful on a regular basis, research shows we’d be happier and less stressed. We’d sleep better, avoid depression and be better able to face our problems.
Susan Swan says gratitude has a part to play in yoga. Photos: MCT
Long embraced by religion as a “manifestation of virtue”, gratitude is one of the few things that “can measurably change people’s lives”, says Robert Emmons, a University of California, Davis, professor who has been studying it since 1998 and is the author of the book Thanks! How the New Science of Gratitude Can Make You Happier. “Gratitude implies humility – recognition that we could not be who we are or where we are in life without the contributions of others,” he writes. Jeffrey Froh, a professor at Hofstra University in New York state, has researched more than 1,000 high school students and found that grateful teenagers were also less likely to be depressed, more likely to want to give back to their communities and more likely to have higher grade-point averages, among other traits. “We know there’s a negative relationship between materialism and gratitude. That’s pretty powerful, right there,” says Froh. But despite the benefits, Emmons says, gratitude is in trouble. “Outside of happiness,
gratitude’s benefits are rarely discussed these days. Indeed, in American society, we’ve come to overlook, dismiss or even disparage the significance of gratitude as a virtue. We have become entitled, resentful, ungrateful and forgetful.” Not all of us. Gratitude, says Susan Swan, is an important component of yoga – something she’s taught since 1991. Almost three years ago, she had a stroke during a class. But when she tells the story, she focuses on her good fortune. Her students called 911, help came quickly and she was given an experimental drug that worked wonders. She has children, grandchildren and friends. She’s gone back to teaching yoga, which she credits for her ability to feel gratitude rather than anger. At age 68, Swan, who has also survived breast and colon cancer, says: “If you have something that life serves up, you have a choice to say ‘Hey, there is a blessing in here. How is it going to serve me and not impede me?’” Gratitude could save the planet, says filmmaker Louie Schwartzberg.
Louie Schwartzberg made a film about being grateful.
We know there’s a negative relationship between materialism and gratitude JEFFREY FROH, HOFSTRA UNIVERSITY
“If you can really absorb the beauty of a flower or a landscape, can you really bear to see it destroyed?” he asks. “Gratitude touches your heart. And we need the heart to create a shift in consciousness.” Schwartzberg, who has been shooting time-lapse photography of flowers for more than 30 years, showed his Gratitude film at a TEDx (Technology, Entertainment and Design) talk. In it, author, lecturer and Benedictine brother David Steindl-Rast says: “You think this is just another day in your life. It’s not just another day. It’s the one day that is given to you, today. “It’s the only gift that you have right now, and the only appropriate response is gratefulness. If you learn to respond as if it were the first day in your life, and the very last day, you will have spent this day very well.” Schwartzberg urges: “Look, really look, at a cloud, a stream, a strawberry. Instead of gobbling it while you’re reading the paper, say: ‘Oh, my God’, and take the time to be in awe of it.” McClatchy-Tribune