20121204 health post

YOUR GUIDE TO LIVING WELL

TUESDAY, DECEMBER 4, 2012

HEALTH POST

CAN TCM WORK ON INTERNET ADDICTS? >PAGE 5

PREPARING FOR THE MARATHON >PAGE 8

ng Wa n ia Br n: o i at str Illu

Rise and dine How a good breakfast will make your day

>PAGE 6

2 NEWS APP OF THE WEEK

HEALTH BITES ......................................................

Jeanette Wang jeanette.wang@scmp.com

A seven-minute method to get your chakras in tune ......................................................

Katie McGregor healthpost@scmp.com Chakra Tuner HK$23 Rating 8/10 According to Hindu and Buddhist teachings, your body contains many thousands of chakras, or energy centres, but your seven main chakras are aligned from the base of your spine to the crown of your head. Each chakra corresponds to the health of a set of organs or glands. If your chakras are out of balance, it is said that this will affect your health, or vice versa.

There are a number of apps to help you tune your chakras, many free, but I chose Jonathan Goldman’s Chakra Tuner. On his website, Goldman explains that he is author of Healing Sounds, creator of album Chakra Chants, president of music label Spirit Music and director of the Sound Healers Association, which suggests he knows what he is doing in this field.

If this is a new field to you, the app gives you a rundown on each chakra. Besides being associated with a set of organs, each chakra has its own colour, associated gemstone, related musical note and

vowel sound. Om, the sound we most often associate with Eastern spirituality, is associated with your seventh chakra, the crown chakra.

This, in turn, is said to be the foundation of your spiritual, or better, self. If you’re feeling a bit egotistical, it is probable that your crown chakra is out of kilter.

If you are a beginner there is an option for a seven-minute chakra tuner session that automatically runs through the chakras. Choose the guided option where Goldman introduces each chakra, and leads with the sound and tone. You follow, breathing out, intoning the sound and allowing it to resonate through your body. It is peaceful and relaxing. Once you are familiar with the routine, you can turn Goldman off.

If you are tuned in enough to know which chakra is out of tune, the app allows you to select a chakra on which to focus, and then set a timer. You can set this for 23 hours, 59 minutes if you desire.

Whether you believe in the concept or not, most will agree that a few moments of quiet meditation is always beneficial. This app will help you focus, and tune out busy thoughts, and may perhaps be working at another level as a bonus.

Correction Last week’s Health Post story Decoding the Disease incorrectly stated that “the number of Singapore residents aged above 40 with diabetes is projected to increase to 600,000 by 2013”. The year should have been 2030. The error was introduced by the writer.

> 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

Down in the mouth Poor oral hygiene could put more than just your teeth and gums at risk. Men who have inflamed gums caused by severe periodontal disease are three times more likely to suffer from erection problems, according to a study published in The Journal of Sexual Medicine. Researchers from Inonu University in Turkey compared 80 men aged 30 to 40 with erectile dysfunction with a control group of 82 men without erection problems. Slightly more than half the men with erectile dysfunction had inflamed gums, compared with 23 per cent in the control group.

“Erectile dysfunction is a major public health problem that affects the quality of life of some 150 million men, and their partners, worldwide,” says lead author Dr Faith Oguz. “Many studies have reported that chronic periodontitis may induce systemic vascular diseases, such as coronary heart disease, which have been linked with erection problems.”

A hearty appetite The combination of a heart-healthy diet and medication could help protect patients from recurrent heart attacks and strokes better than drugs alone. Researchers at McMaster University in Hamilton, Ontario, Canada surveyed 31,546 adults (of an average age of 66.5) in 40 countries with cardiovascular disease or end organ damage. The subjects were asked about their dietary habits and lifestyle choices in the past 12 months. Nearly five years later, participants had experienced 5,190 cardiovascular events. Those who ate a hearthealthy diet had a: 35 per cent reduction in risk for cardiovascular death; 14 per cent reduction in risk for new heart attacks; 28 per cent reduction in risk for congestive heart failure; and 19 per cent reduction in risk for stroke.

Focus groups If you and your partner often have differing views, a new study from University of Bristol published in PLoS One offers a scientific reason for this: men and women literally see things differently. Researchers examined where men and women looked while viewing still images from films and works of art. They found that while women made fewer eye movements than men, those they did make were longer and to more varied locations. These differences were largest when viewing images of people. With photos of heterosexual couples, both men and women preferred looking at the female figure. However, this preference was even stronger for women. While men were only interested in the faces of the two figures, women’s eyes were also drawn to the rest of the bodies – in particular that of the female figure.

Scientists stem the flow University of Cambridge scientists have found a way to make stem cells from a routine blood sample, offering an efficient alternative to making stem cells from skin and other tissues.

The scientists hope these stem cells could one day treat cardiovascular disease. “Tissue biopsies are undesirable – particularly for children and the elderly – whereas taking blood samples is routine for all patients,” says Dr Amer Rana. “Researchers can freeze and store the blood cells, and then turn them into induced pluripotent stem cells at a later stage, rather than having to transform them as soon as they are sourced, as is the case for other cell types used previously. This will have tremendous practical value – prolonging the “use by date” of patient samples.”

NEWS 3 MOVEMBER DIARY

QUIZ

Hairs looking at you

......................................................

......................................................

Chester Grucza healthpost@scmp.com It was a mega month with some serious moustache action. And as I sit twizzling the end of mine – it has become a bit of habit – I can’t help feeling proud of what we have achieved.

To sum up the results of the city’s campaign, who better to chat to than Greg Rafferty, head of Movember Asia?

Growing a moustache is a big deal for guys in Hong Kong, so when I asked Greg about the registration figures he was understandably thrilled. With almost 2,000 signing up and raising awareness across the territory, we finished the month in 11th place on the global leader board with HK$3.6 million raised – a great achievement in our maiden year.

Throughout Movember, the campaign picked up impressive momentum with activities taking place across the city.

From the Mustachio Megashow festival and Movember-themed pub quizzes, to a Mo Against the Machine dodgeball event, the commitment to raising awareness and vital funds has been outstanding.

Hitting the HK$3 million mark before the campaign even ended was something Greg never anticipated. The great news is that this year all funds raised in Hong Kong will benefit local prostate

cancer initiatives and support research into a cure for the disease.

Despite these outstanding figures, there is still time to donate to our Hong Kong mo bros to reward them for their efforts throughout the month. Simply go to hk.movember.com to make your contribution.

From our rugby community to corporate businesses, school teachers and restaurateurs, the campaign has reached all corners of the city. We’ve raised the stakes, we’ve flown the flag, and we can now look forward to doing it all again next year. Until then, stay on top of your game and look after your health, mo bros.

Chester Grucza manages Fly nightclub in Central. This is his final Movember Diary entry

ASK THE DOCTORS DR SURESH NAIR Q: I’m a 26-year-old female. I started my period yesterday and the pain I am feeling is much worse than normal, especially in my back. It’s also causing me to vomit heavily and I have no appetite either. The pain comes in waves and is unbearable.

What could be causing this?

A: There is a chance that you might have endometriosis. This is a condition where there is a backward flow of menstrual blood into the body that can irritate the pelvic area and cause pain, especially during menses (periods).

The other reason you could be experiencing this pain is that after you ovulated – that is, after your eggs were released from the ovary – a blood clot formed in the ovary. The clot may have been released around the time of menses, leading to pain.

My advice is to see your gynaecologist to get an ultrasound scan. This will ensure that you do not have an ovarian cyst or uterine fibroids (growth in the uterus).

You are most likely experiencing severe period pain, or

dysmenorrhea. This is common in young women, and is usually treatable with painkillers such as Arcoxia tablets or Voltaren suppositories. It can normally be controlled without any major procedures.

Dr Suresh Nair is a senior obstetrician & gynaecologist with Gynaecology Consultants Clinic & Surgery at Mount Elizabeth Novena Hospital in Singapore

1. Why is HFCS in so many foods? a. It’s more nutritious than sugar b. It’s cheaper to make than sugar c. It has fewer calories than sugar

Jeanette Wang jeanette.wang@scmp.com Is it or isn’t it any worse for you than other sweeteners? The controversy over high fructose corn syrup (HFCS) continues – with a new study that implicates HFCS in the rising global epidemic of type-2 diabetes and resulting higher health care costs.

University of Southern California and University of Oxford researchers found that among 42 countries analysed, those that use HFCS in their food supply had a 20 per cent higher prevalence of diabetes than countries that didn’t. This was independent of total sugar intake and obesity levels, suggesting – and adding to a growing body of research – that the negative health consequences of HFCS are distinct and more dangerous than natural sugar.

The US has the highest per capita consumption of HFCS at a rate of 25kg per year. China, along with countries such as Australia, France, India and Britain, has a per capita consumption of less than 0.5kg per year. Countries with a higher use of HFCS had an average prevalence of type-2 diabetes of 8 per cent compared to 6.7 per cent in countries not using HFCS.

2. Earlier this year, an association that represents the US corn refinery industry failed to gain permission from the Food and Drug Administration to change the name of HFCS. What did they want to call it? a. Corn sugar b. Sweet syrup c. Corn crystals 3. If you’re trying to avoid added sugars, which ingredient should you watch for on food labels? a. Molasses b. HFCS c. Raw sugar The study, published in the journal Global Public Health, proposes that this link is probably driven by higher amounts of fructose in foods made with HFCS. Growing evidence reveals that the body metabolises fructose differently from glucose. Among other things, fructose metabolism occurs independently of insulin, primarily in the liver where it may be readily converted to fat, which probably contributes to nonalcoholic fatty liver disease.

Now test your knowledge of HFCS.

4. With the jury on HFCS still out, the American Heart Association recommends that the maximum calories a day from added sugar from any source should be 100 for women and 150 for men. That is equivalent to a. Four teaspoons for women and six teaspoons for men b. Six teaspoons for women and nine teaspoons for men c. Eight teaspoons for women and 12 teaspoons for men Answers: 1. b; 2. a; 3. all are correct; 4. b

4 MEDICAL CASE HISTORY

Some scars go deeper Eileen Aung-Thwin healthpost@scmp.com Gary Lai first noticed the red spots dotting his abdomen some 15 years ago. Then 25, he had recently graduated and was looking forward to building his life and his career. A little skin irritation hardly seemed significant.

But the little red spots spread to his back and legs, eventually covering 80 per cent of his body in a sheath of thick, reddened and scaly skin, taking his life down an unexpected and difficult path.

Lai’s condition was familiar to his loved ones. His mother and her grandfather had suffered from similar patches of red, itchy skin. His family persuaded him to visit a doctor, who diagnosed him with psoriasis, a chronic, inflammatory skin condition.

According to Dr Yeung Chikeung, honorary clinical associate professor at the University of Hong Kong, psoriasis affects 0.3 per cent of the Hong Kong population, compared to a worldwide rate of 1 to 2 per cent.

The incurable and poorly understood condition is thought to be related to a malfunction in the immune system, in which the body mistakes skin cells as a threat and attacks them. The immune system also causes the skin cells to divide

much faster than the normal rate, and dead cells start to pile up on the skin surface as the body is unable to clear the excess skin cells quickly enough.

While there is a strong genetic component – as in Lai’s case – psoriasis is not contagious.

Doctors also believe certain triggers must be present in combination with the genetic disposition before psoriasis flares.

Psoriasis can take a number of forms, from mild to severe, appearing as small drop-like spots, to plaque-like patches with silvery scales and pus-filled blisters.

Lai had the most common type – the plaque-like patches called psoriasis vulgaris. But his condition became severe, covering most of his body. Finding relief was a frustrating and winding journey for Lai. Because psoriasis is incurable, the goal of treatment is often to control symptoms and prevent complications.

Topically, steroid creams are often used as a first line treatment to reduce the inflammation and redness caused by psoriasis.

However, given the extensive coverage of psoriasis on Lai’s body, it was not a viable solution. Other common topical treatments include skin lotions, creams, ointments and shampoos that contain coal tar, salicylic acid and vitamin D- or vitamin A-derived products.

Psoriasis has a strong psychological impact on sufferers because it is a disfiguring disease Lai then tried oral medications that aim to suppress the body’s faulty immune response. One of them, methotrexate, affected his liver, leading to raised liver enzyme levels, so he was forced to stop taking the medicine.

Doctors told him to use light therapy where ultraviolet B light (UVB) is used to slow down the inflammation of the skin.

Unfortunately, for the phototherapy to have been effective, Lai would have needed to visit a doctor’s office for the therapy twice a week during office hours. He could not do this without creating problems at work and had to forego this option.

Retinoids eventually helped to control his condition by up to 50 per cent by slowing the growth and shedding of skin cells. But Lai continued to see it flare and recede, often according to the seasons.

Winter is a particularly aggravating time for psoriasis sufferers.

Lai then started to participate in clinical trials that tested therapies and new drugs on psoriasis patients.

The most effective treatment to date is a type of medicine called biologics – bioengineered protein-based drugs that target specific parts of the immune system.

During the biologics drug trials, Lai saw a 75 per cent improvement in his condition, much to his delight.

Unfortunately, the drug can be prohibitively expensive at nearly HK$10,000 a month, and is not covered by government aid. Lai returned to using retinoids after the biologics trials ended.

The effects of psoriasis are not limited to physical and financial aspects. Yeung says that psoriasis has a strong psychological impact on sufferers because it is a disfiguring disease. A patient’s self-image and self-confidence can take a heavy beating.

In the early years, after the initial onset of psoriasis, Lai sank into depression and hid himself from the world. He was afraid to meet his friends for fear of their reactions to his condition.

Although Lai continued to work, psoriasis cast a heavy cloud over his career. The maddening itch that he suffered robbed him of his sleep at night and his concentration during the day.

Sometimes, Lai was driven to scratch vigorously, so much so

that his already vulnerable skin would rip and bleed. The blood would soak through and stain his clothes, drawing looks of suspicion and alarm from bystanders and colleagues.

Well-meaning colleagues would enthusiastically ply him with suggestions to seek alternative treatments such as traditional Chinese medicine or acupuncture. But all the unwanted attention only added to the pressure he felt. Other colleagues shunned him.

Reactions from people on the streets were less kind. Fellow travellers on the MTR would give him a wide berth for fear that they might “catch” the disease.

Swimmers at public swimming pools would urge the lifeguards to stop Lai from entering the water because they did not want him to “contaminate” it.

Yeung emphasises that psoriasis is not a contagious disease but an autoimmune one, and hopes that the general public will become more accepting and understanding of psoriasis patients.

Lai now makes it his life’s mission to help other patients and to educate the public about psoriasis.

He is a member of support groups and acts as an advocate for psoriasis sufferers. He encourages psoriasis patients to receive proper treatment and group support.

Illustration: Angela Ho

......................................................

HEALTH 5 TRADITIONAL CHINESE MEDICINE

Reduced to virtual prisoners Research in China claims that 24 million people in the country are addicted to the internet. Photo: NYT

......................................................

Elizabeth Snouffer healthpost@scmp.com Last month, Sun Xinying and six other researchers from various academic centres in Beijing interviewed almost 11,000 Chinese teenagers using a number of diagnostic evaluations and found evidence linking internet addiction and decreased well-being. Students who showed signs of internet addiction had lower self-esteem, decreased satisfaction with life and signs of depression.

The American Psychiatric Association and other psychiatry experts agree that internet addiction disorder (IAD), also called internet use disorder, is a growing social issue causing psychological and neurobiological disturbances.

Last year , Professor Tian Jie from the Institute of Automation at the Chinese Academy of Sciences conducted a study into the effects of internet addiction on the micro structural integrity of neuronal fibre pathways. Study results suggest that long-term internet addiction results in structural alterations to the brain, and the team concluded that IAD contributed to chronic dysfunction.

Although IAD is controversial, the American Psychiatric Association is including it in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) – used as the standardised classification system by mental health practitioners in the US. Next year IAD will qualify as a legitimate mental illness, “requiring further study”.

How can families and health professionals assess and treat a disorder that is not yet included in practice guidelines?

In March, Professor Zhang Qinyuan, a researcher at Shandong University in China, led a study to evaluate and observe the efficacy of traditional Chinese medicine on patients suffering from internet addiction. After assessing 4,000 students for IAD, 114 cases were randomly selected for study.

Symptoms included depression, insomnia, restlessness, and decreased appetite.

Treatment strategies for each case included Chinese herbal prescriptions for depression and acupuncture treatment in combination with regular psychological counselling. A 20 per cent reduction in symptoms was reported.

According to the Chinese Internet Network Information Centre (Cinic), as of September this year there were 538 million internet users on the mainland. More than 26 per cent of net users are between the ages of 10 and 19.

In 2010, the China Youth Association for Network Development claimed that more than 24 million young mainlanders were addicted to the internet and/ or online gaming.

In Hong Kong, where there are a total of 5.3 million internet users, a 2010 University of Hong Kong study found that about one in 15 local teenagers displayed five or more symptoms of internet addiction.

Zhang says internet addiction is a very common problem in China, but he believes the addiction is more common for one demographic in particular. “Most patients are between the ages of 18 and 24, and male.”

Zhang’s research revealed a number of causes: weak family relationships, heavy academic

pressure and a need to escape reality. Zhang believes in the efficacy of traditional Chinese medicine to help internet addiction, although he has little evidence to back this up.

Dr Kimberly Young, founder and director of the Centre for Internet Addiction Recovery in the US, hopes that future studies will look into the efficacy of acupuncture and alternative medicine for the recovery of internet addiction, and confirms there is little evidence supporting a wide variety of therapies for a very modern disorder.

“No research has studied alternative medicine with internet addiction. I think it does help; I am a firm believer in acupuncture and alternative therapies,” says Young.

She believes that cognitive behavioural therapy offers the most

No research has studied alternative medicine with internet addiction.

I think it does help DR KIMBERLY YOUNG

promise, but confirms current opinion: “There just aren’t enough treatment programmes to tell what practices work best.”

This month, Current Psychiatry Reviews published a summary of research and practice on internet addiction treatment. Hilarie Cash, lead author of the summary and executive director of reSTART:

CAUGHT IN THE NET? Symptoms for internet addiction disorder (Three or four yes answers suggest abuse; five or more suggest addiction) • Increasing amounts of time spent on computer and internet activities • Failed attempts to control behaviour • Heightened sense of euphoria while involved in computer and internet activities • Craving more time on the computer and internet • Neglecting friends and family • Feeling restless when not engaged in the activity • Being dishonest with others • Computer use interfering with job/school performance • Feeling guilty, ashamed, anxious, or depressed as a result of behaviour • Changes in sleep patterns • Physical changes such as weight gain or loss, backache, headaches, carpal tunnel syndrome • Withdrawing from other activities Developed by Dr Hilarie Cash, executive director of reSTART: Internet Addiction Recovery Programme in Washington state

Internet Addiction Recovery Programme in Washington state, believes combination treatments such as “psychotherapy, psychoeducation, getting the client away from digital technology for a minimum of 45 days, physical fitness training, meditation and 12-step programmes” work well.

Surveys in the US and Europe indicate prevalence rates between 1.5 and 8.2 per cent.

There is a surprising lack of study to support guidelines for IAD recovery, with most evidence for pharmacological, psychological or alternative medicine stemming from small population studies with “low-methodological quality”.

Even so, treatment for internet addiction is advancing rapidly without formal practice guidelines, because medical experts are making inroads on their own, and reporting their results.

Pharmacological intervention using antidepressants, and antianxiety medication, is often utilised, although there is little evidence of its efficacy.

Psychological approaches, including family intervention, counselling and training, as well as cognitive behavioural therapy have given the most promising results.

For some experts, being “addicted” to the internet is more likely a compulsive behaviour, while other psychiatrists argue that IAD shares features that characterise drug or substance addictions, including excessive use and withdrawal symptoms.

Others believe that “addiction is addiction” whether related to overeating, gambling, alcoholism or obsession with Angry Birds.

6 COVER STORY

Breakfast club

Six Hong Kong health and fitness experts tell Nadine Bateman how to make more of the most important meal of the day

Linds Russell (above), personal trainer and endurance athlete Russell works with group fitness training company Circuit 25 and was part of an all-women team that finished second at the recent Oxfam Trailwalker 100-kilometre race.

She’s up at 5.30am most days and that’s when she has the first of two breakfasts. “I do a lot of training and I don’t want to be starving by lunchtime and end up eating too much,” she says.

Her first breakfast is a cocktail of nutrient-dense ingredients: coconut water, because it’s “full of electrolytes and is a natural sweetener”; something green, such as fresh or frozen kale or spinach; berries or banana; wholegrain oats, soaked overnight so they are easier to digest; a raw plant-based protein such as bean sprouts or brown rice.

Half a teaspoon of coconut oil is also added, which she says helps weight loss by boosting the metabolism, fortifies the immune system and has antibacterial properties to help improve her skin, which can be affected by being outdoors a lot in the pollution and dirt.

Sometimes she adds cocoa

powder or maca powder, derived from a Peruvian root said to be a superfood with a high vitamin and mineral content that benefits the endocrine system.

“This super smoothie sets me up for a morning of working with clients,” says Russell. Her second breakfast is eaten around 7am and may comprise eggs on rye bread with spinach.

Linds Russell has two breakfasts a day so that she doesn’t eat too much at lunchtime. Photo: May Tse

Dr Simon Yeung, expert in physiotherapy and ergonomics Yeung is an associate professor in the department of rehabilitation sciences at Hong Kong Polytechnic University. A keen athlete, he is senior vice-chairman of the Amateur Athletics Association and sits on other sports committees.

His breakfast often includes oatmeal or cereal, toast and sometimes macaroni with ham in soup, which he says is “a typical Chinese breakfast”. He also has milk – usually 95 per cent fat-free cow’s milk or sometimes soya milk.

He believes carbohydrates are the main energy source for the body, especially if you exercise a lot. He recommends that most people should consume five to seven grams of carbs per kilogram of bodyweight per day.

Protein intake for the average person should be 0.8 grams per kilogram of bodyweight, and 1.2 to 1.7 grams per kilogram of bodyweight for athletes. Protein should be consumed after exercise to help repair muscles and growth tissue, preferably in the form of milk, yogurt or beans. If you like eggs, Yeung says to eat the whites only as the yolk “has too much fat”.

Carbohydrates are the main energy source for the body, especially if you exercise a lot

Dr Simon Yeung usually has 95 per cent fat-free cow’s milk or soya milk

COVER STORY 7

Miles Price says the way eggs are prepared is crucial, and recommends poaching them. Photo: Nora Tam

Miles Price, holistic nutritionist Price has a master’s degree in clinical nutrition from Hawthorn University in the US and works at Life Clinic in Central.

He says an individual’s nutritional needs depend on factors such as circadian rhythms and the body’s level of cortisol, the hormone that is affected by physical or emotional stress. But generally, he believes the healthiest breakfast should be protein-rich.

“Protein is an activator of your metabolism – it takes energy to digest but also creates energy. Eggs are a good source of protein for breakfast because they contain the all-important amino acids and are a source of several nutrients – including zinc, copper, choline and cholesterol – which promote brain function and seratonin [or ‘feel-good’ hormone] production.”

The way in which the eggs are prepared is crucial: they are best poached.

“When the yolk is overcooked it can become oxidised and convert to bad cholesterol,” says Price. “The yolk is the most nutrient-dense part of the egg.”

Other cooking suggestions include “sunny side up”, cooked in coconut oil or scrambled, but definitely not hard boiled.

Price also recommends asparagus because it contains compounds including the antioxidant glutathione, that boost the body’s ability to detox.

Asparagus also contains vitamins B6, A, C and E and calcium. He says blanching the asparagus and adding butter helps to convert the carotenes it contains into vitamin A. He also recommends adding spinach which has been wilted for around 20 to 30 seconds to neutralise the phytates, which bind with minerals and prevent their absorption, but also have antiinflammatory effects and are believed to help normalise cell growth. Spinach also contains vitamins A, C and K, manganese and phosphorous.

Sylvia Lam, dietitian Lam is the chairwoman of the Hong Kong Dietitians Association. She says breakfast is the most important meal of the day for many reasons: it replenishes nutrients needed for the day after a night’s rest; it boosts metabolism; it provides a third of nutrients for the day; it can provide sugar that the brain needs to function; and it prevents you from eating excessively at lunchtime.

“One should have a complete nutritionally wholesome breakfast by having some carbohydrates, protein, fibre and good fats,” says Lam. The ratio should be 50 to 55 per cent carbohydrates, 30 per cent fat and 15 to 20 per cent protein.

Examples include high-fibre cereal with skimmed milk or low-fat milk and fruit; wholewheat Sylvia Lam says breakfast provides key bread with peanut nutrients and boosts the metabolism. butter or olive oil spread and yogurt with fresh fruit; oatmeal made with soya milk or skimmed milk with nuts and dried fruits such as raisin or cranberries.

Chinese breakfasts can also be healthy, she says, such as 10-grain congee or buckwheat noodles in soup, both with lean meat and chopped vegetables.

Lam believes many Hongkongers choose unhealthy breakfasts and advises alternatives such as rice noodles or macaroni instead of instant noodles; ham instead of luncheon meat or sausages; boiled egg instead of fried egg; and wholegrain bread instead of buns.

Lam says she “can’t live without breakfast” and will typically have a wholegrain bagel with low-fat cream cheese and jam, or oatmeal with soya milk.

Triathlete Anne Knecht-Boyer says good nutrition is key to keeping energy levels up. Photo: K.Y. Cheng

Anne Knecht-Boyer, triathlete Knecht-Boyer, 54, is a top age group triathlete who has competed at the Ironman World Championships in Hawaii.

By January, Knecht-Boyer will have increased her weekly training from the current eight to 10 hours a week to 16 to 18 hours. It’s a gruelling schedule in which nutrition plays a huge part. “I have to maintain a healthy weight to keep my energy levels up,” she says.

Before her morning run at 6.30am she has a banana and an energy gel, washed down with a cup of chamomile tea. After her run, she has a large bowl of organic oatmeal cereal mixed with berries, honey and full-fat Swiss yogurt, followed by a glass of fresh fruit juice.

Before a long bike ride (up to five hours), she eats half a toasted bagel spread with butter, peanut butter and Nutella, plus a banana.

On the day of a race, she eats a bowl of oatmeal muesli with hot milk about two hours before. Then she munches on energy bars that contain granola.

A nutritionally wholesome breakfast should have carbohydrates, protein, fibre and good fats

Moosa Al-Issa says breakfasts should be balanced and visually appealing. Photo: May Tse Moosa Al-Issa, chef and cafe owner Al-Issa is a chef and the owner of organic vegan restaurant Life Cafe in Central. He’s not a vegetarian himself and strives to create breakfasts that are satisfying, nutritionally balanced and visually appealing. “You eat with your eyes first,” he says.

His dishes include ones that are “close to the traditional fry-up”, which include vegetarian sausages and bacon. He believes a good breakfast needs to include a balance of all the food groups – and that’s the reason why “traditional” breakfasts work so well.

Life Cafe’s generous breakfasts appeal to non-vegetarians, too, says Al-Issa. A disclaimer: his dishes aren’t low fat. “Who wants a low-fat breakfast? I like to produce food that everybody likes, not just preach to the converted,” he says.

8 FITNESS MARATHON MANIA WEEK 1

Distance learning

......................................................

Rachel Jacqueline healthpost@scmp.com I’ve never run more than 14 kilometres on the road, but in 12 weeks, one of the toughest running tests awaits me: a marathon.

I do run, but mostly on trails.

Last month, for instance, I completed the 100-kilometre Oxfam Trailwalker. I enjoyed dawdling on a scenic path for hours, as the kilometres flew by and I tackled varied terrain. By comparison, the monotony of tarmac – particularly a 42.195kilometre stretch of it – has simply not seemed that interesting to me.

Until now, that is.

That’s because I signed up for the Standard Chartered Hong Kong Marathon in late October, along with 13,500 other marathoners (and more than 58,000 others in the 10-kilometre and half-marathon events). I knew a road marathon was something I definitely wanted to accomplish, because crossing the finish line elevates you to the ranks of “seasoned runner”.

This ultimate test of human endurance has sombre beginnings.

Legend has it that in 490BC, the ancient Greek hero Pheidippides, after running from Marathon to announce the victory of the Athenian army over the Persians, died from exhaustion.

Preparing for a marathon will put the body under considerable stress. Hours of training deplete the body, and extra demands are placed on the heart and the respiratory system. Add cramps, chafing, dizziness, and dehydration, and the marathon mission can push the body to its limit.

With this in mind, the Hong Kong Marathon race organisers brought together a team of experts – appropriately called Team Marathon Experts – to share health information and training tips with runners of all distances in the lead up to next year’s race, which takes place on February 24.

Staying safe and healthy means runners should check whether they are physically prepared for the challenge before training, say the experts. Runners should also make sure they do enough training.

To make sure I am “race ready”,

I met with three Team Marathon Experts last week. Here’s some of the advice that they gave me.

How’s your heart?

Studies show that men aged over 45 are most at risk of a heart attack during a marathon. But a 29-year-old healthy female like myself may still have health problems on the run, says Dr Gary Mak Yiu-kwong, president of the Hong Kong Association of Sports Medicine and Sports Science.

“Underlying congenital or structural defects of the heart have been known to cause death among younger athletes during longdistance running,” says Mak. He says that although the incidence of sudden cardiac death among young athletes is not high (one in 100,000 people aged 35 and under, according to US race

Preparing for a marathon puts the body under stress.

Hours of training deplete the body statistics), it cannot be prevented, making early detection crucial.

Team Marathon Experts have made a pre-race checklist available for participants to better understand their fitness, and check whether they have a healthy heart. For any concerns, Mak recommends a resting electrocardiogram (ECG) and an echocardiogram for someone of my age.

“An ECG will reveal any rhythmic-prone problems and whether there is any underlying disease of the heart,” says Mak, “while an echocardiogram will help to identify any major causes of sudden cardiac death.” For those over 35, treadmill stress testing is recommended and a scan of the heart is also an option.

Apart from a low resting heart rate (which is not uncommon for regular endurance runners) I have no underlying heart issues, and am ready to run, says Mak.

How’s your body?

Every time your foot hits the pavement during a run, a force of nearly three times your body weight is transferred to your lower limbs.

Constant pounding may lead to injury or overuse strains.

A free Hong Kong marathon training clinic is run each year by Dr Simon Yeung, associate professor in the department of rehabilitation services at Polytechnic University.

He assesses the flexibility, foot arch and running gait of hundreds of runners to help prevent running related injuries during their training.

1. Flexibility: having tight leg muscles may lead to injury and shorten the stride of a runner, affecting performance, says Yeung. If you are unable to stretch your hamstring past 70 degrees (when lying on your back), or have less than 40 degrees of calf flexibility (angle between flexed foot and calf), your inflexibility may be holding you back, he says.

My own tests revealed some muscle tightness, which can be helped by a regular stretching regime. Yeung recommends holding a static stretch in the major muscle groups for at least 10 seconds and repeating three times to help loosen the muscles. The best time to stretch is outside of training periods.

2. Foot arch: knowing the arch of your foot is the first step towards finding the right shoe, says Yeung: “The arch is very important to the resilience of the foot, and knowing how it absorbs shock.”

Tests show I have a high arch, so I need a shoe with shock absorbance and cushioning.

While neutral-arched runners have more choice in running shoes, flat-footed runners also need to be careful about shoe selection. “If the arch collapses inward too much, it may cause the foot to move around and increase injury,” says Yeung.

3. Running gait: a runner’s gait is their own unique running formula, determining efficiency and speed. It is made up of the “stance” (how the foot hits the ground) and the “swing” (the rotation of your legs and body).

Reviewing your running gait may determine whether you have any habits contributing to injury, such as

excessive heel strike or pronation, and whether your shoes are supportive for your gait.

Yeung observed me running on a treadmill and confirmed I am more of a midfoot to forefoot striker, and my gait does not show any sign of over-pronation, which indicates I am not at high risk of injury.

My stride length (the length of my step) and stride frequency (how quickly my legs turn over) are also within an efficient range, as the former is around 65 per cent of my height. (Recreational runners can be between 50 per cent to 60 per cent.)

My frequency is 165 strides per minute (elite runners aim for 180 strides per minute). To become a faster runner, I can try to improve these factors.

How’s your diet?

According to dietitian Sylvia Lam at Pro-Cardio, intense marathon training requires runners to increase their caloric (particularly carbohydrate) intake for energy, increase the protein in their diet to maximise muscle strength, and make sure they take on sufficient fluids to maintain hydration.

Based on one hour of exercise a day, a person within a normal weight range should make sure their diet is made up of the following each day, per kilogram of body weight: • 30 to 35 calories • five to seven grams of carbohydrate (seven to 12 grams for training periods of 10 to 15 hours per week) • 1.2 to 1.8 grams of protein “Someone who weighs 60 kilograms needs about 1,800 to 2,100 calories per day, of which 50 to 55 per cent of energy intake should come from carbohydrates (preferably complex carbohydrates) and 15 to 20 per cent should come from protein,” says Lam. Being female and an irregular meat eater, Lam suggests I take a vitamin C-rich fruit a day, like and orange, to absorb iron in my diet and maintain immunity. Dark green vegetables will help. I tend to avoid dairy, so Lam suggests a calcium-fortified soya beverage.

Marathon Mania is a 12-week series leading up to next year’s Hong Kong Marathon on Feb 24. For more tips on preparing for the event, go to facebook.com/hkmarathon

Rachel Jacqueline undergoes rigorous physical t

FITNESS 9 Sample marathon training diet by dietitian Sylvia Lam This diet was prepared for the author, based on the following statistics: Age: 29 Weight: 58kg Height: 164cm 1,500 kcal (non-training day)

2,000 (training days)

Breakfast

2 slices of bread + honey and vegemite or peanut butter + 1 cup calcium-fortified soya milk (or soya latte)

1.5 cups of high-fibre cereal (such as shredded wheat, Cheerios, bran flakes) + 1 cup calcium-fortified soya milk

Morning snack

2 scoops of whey protein powder with water

1 fruit + 2 scoops of whey protein powder with water

Lunch

1 cup brown rice + 115 grams chicken/fish or 300 1.5 cups brown rice + 115 grams chicken/fish or 300 grams tofu or 1 cup dried beans + green vegetables grams tofu or 1 cup dried beans + green vegetables

Afternoon snack 1 fruit

1 fruit + low-fat yogurt or soya latte

Dinner

1 cup of brown rice + 115 grams chicken/fish or 300 1.5 cups brown rice + 115 grams chicken/fish or 300 grams tofu or 1 cup dried beans + green vegetables grams tofu or 1 cup dried beans + green vegetables

Supper

1 fruit

30 grams of unsalted nuts

Supplements

1 multivitamin tablet 1 vitamin C tablet (500mg)

1 multivitamin tablet 1 vitamin C tablet (500mg) SCMP

testing with Maurice Hon (above right), and Dr Simon Yeung (below) before embarking on her training regimen. Photos: K.Y. Cheng

YOUR PRE-RACE CHECKLIST 1. Do you experience any chest pain or discomfort during exercise?

2. Do you experience unexplained fainting or near fainting during exercise?

3. Do you experience any excessive breathlessness or fatigue associated with exercise?

4. Have you had any prior recognition of a heart murmur?

5. Do you have any family history of premature death (before 50 years) due to heart disease or family history of inheritable heart disease?

6. Do you have a personal history of heart disease, stroke or peripheral artery disease?

7. Do you have any other major coronary risk factors, such as diabetes, hypertension, and high lipid levels, or do you smoke?

8. Are you a man aged over 45 or a woman over 55?

If you answered yes to any of these, you should consult your family doctor before attempting the race.

For more information, go to hkmarathon.com

10 DIET THE TASTE TEST GOJI BERRY SNACKS .....................................................

Jeanette Wang jeanette.wang@scmp.com

HEALTHY GOURMET

Back to the garden ......................................................

Andrea Oschetti healthpost@scmp.com Vegetables have an unfair reputation for being boring and bland. Foie gras, tenderloin, salmon and caviar are often seen as the stars that make great dinners. Carrots, fennel, rocket and pumpkin only play supporting roles.

Not any more. The most exciting contemporary chefs in the world are bringing vegetables into the spotlight of gourmet cuisine. Today, heavy cookery is not what gourmet is about. Instead, light dishes with delicate but decisive and unique flavours are the best.

Chef Luca Fantin of Il Ristorante at the Bulgari Ginza Tower in Tokyo is well known for his creativity with vegetables. Fantin, who was awarded his first Michelin star this year, focuses on contemporary interpretations of traditional Italian cuisine using healthy foundations.

His dishes change seasonally.

He does not like to overcook food, preferring techniques that do not alter the integrity of flavours. He does not sauté, thereby avoiding the production of burned oils.

“People want to feel physically good when they eat,” says Fantin. “If you feel bloated, or not able to sleep well at night, you had a poor dining experience.

“To feel good, vegetables are key, especially for those long festive dinners. Veggies will help your digestion and balance your nutrient intake.

“Flavours in the mouth are important, but only as

Luca Fantin can turn the most mundane vegetable into an exotic dish.

much as physical sensations in the rest of your body.”

The challenge that chefs and home cooks face is to make vegetables interesting. Fantin’s secrets are simple: 1. Use the freshest vegetables.

Even one day after they have been harvested, vegetables start losing their taste.

2. Use the oven to capture flavours.

If your veggies don’t come from your garden, use the oven to get their flavours back. Fantin is able to surprise his guests with a simple carrot: “I boil my carrots in water for two minutes, wrap them in foil and cook them in the oven with rosemary or thyme. The result is exciting because you do not expect so much taste in a carrot.”

3. Don’t buy ready-made stocks and vinaigrette. Avoid nasty chemicals and make your own. A good stock is a chef’s best friend. It adds depth to dishes. Prepare broths with the same ingredients as your main dish: use the skin and seeds of the pumpkin to make the stock for your pumpkin soup. For salads, Fantin suggests mixing whole nuts, sun-dried tomatoes, balsamic and extra virgin olive oil.

4. Replace some ingredients with veggies.

“All of my creations have a vegetable element in them,” says Fantin.

“I replace ingredients with veggies of similar consistency. For example, eggplants have a similar texture

to fish, so use them instead of a fish tartar.”

5. Variety makes it interesting.

“One of my signature dishes is the autumn vegetable salad (above) with Parmesan cheese cream. It has 40 different elements between veggies and herbs. To make it more interesting, I use different cooking methods and consistencies,” says Fantin.

While it is difficult to prepare such a long dish at home, my suggestion is to use this week’s recipe as a guide, because it shows how to best cook an array of veggies.

Break down Fantin’s recipe for different occasions. For example, pick two or three veggies that you like most and add the Parmesan cream on top.

Autumn vegetable salad with Parmesan cheese cream Parmesan cheese sauce 150ml milk 250ml cream 250 grams Parmesan cheese 50ml vegetable stock Mix milk, cream and stock. Bring to a boil and stir in Parmesan cheese.

Pass through a strainer.

Jerusalem artichoke purée One Jerusalem artichoke Salt Olive oil Bathe the artichoke in water and remove all traces of soil. Cut lengthwise and bake at 100 degrees Celsius for 50 to 60 minutes. Purée in a blender with salt and olive oil.

Seasonal vegetables Red turnip, kohlrabi, black turnip, yellow carrot, beetroot, celery, purple potato, puntarella, fennel, leek Red turnip and kohlrabi: slice thinly and add salt.

Black turnip: cut into bite-sized pieces and bake at 100 degrees for 10 minutes.

Yellow carrot: bake at 180 degrees for 60 minutes. Cut into bite-size pieces.

Beetroot: cut into bite-size pieces and bake at 100 degrees for 15 minutes. Marinate with strawberry vinegar and salt.

Celery: bake at 180 degrees for 1½ hours. Cut into bite-size pieces.

Purple potato: bake at 180 degrees for 1½ hours. Cut into bite-size pieces and marinate with olive oil and rosemary.

Puntarella and fennel: cut into bite-size pieces and boil for one minute.

Leek: grill until tender.

Crispy vegetables 1 onion 1 Jerusalem artichoke, peeled Slice vegetables thinly and boil for several minutes with salt. Cool and dry in an 80 degree oven for few hours. Heat oil in a pan and fry the vegetables for several seconds.

Pat dry.

Navitas Naturals Cacao Goji Superfood HK$128 for 227 grams, Just Green These tasty, chewy little blocks are packed with the goodness of date paste, cacao powder, raisins, seeds (chia, sesame, sunflower), superfood powders (goji, maca, lacuma, camucamu) and natural chocolate flavour. They’re high in fibre and vitamin C, with no refined sugar.

Verdict: the perfect antidote for the attack of the mid-afternoon nibbles.

Nature’s Sensations Crispy Gogi Berries HK$41 for 84 grams, Taste This Thai product is all antioxidantrich fat-free goji berries, and nothing else – no preservatives or artificial stuff. The berries are believed to support the immune system and improve blood function.

Verdict: a versatile snack – great on its own or a tasty accompaniment to cereal, yogurt or salad.

Brown butter Butter Cook butter in a pan until almost no liquid remains and pass through a strainer.

Herbs 30 grams corn salad 15 grams mizuna picante 15 grams amaranth 30 grams wild rocket 15 grams red basil 15 grams carrot 15 grams mustard leaf 15 grams nasturtium 15 grams red salad 180 grams endive Put the leaves and herbs into a bowl.

Wash with water and drain off.

Presentation Arrange all the elements above on a plate. Drizzle with Parmesan cream.

Healthy Gourmet is a weekly column by private chef Andrea Oschetti. cuoreprivatechef.com

Seapoint Farms Dry Roasted Edamame Goji Blend HK$32 for 99 grams, Just Green This snack combines goji with another nutritious Asian food, edamame. Each 30-gram serving (120 calories, 3 grams of fat) provides 11 grams of soya protein – the packaging claims that 25 grams of soya protein a day as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.

Verdict: the sweet, soft goji goes well the crunchy, savoury edamame.

WELL-BEING 11

Illustration: Lau Ka-kuen

PERSONAL BEST

The ode less travelled ......................................................

Chad Lykins healthpost@scmp.com On December 14, I will run all four of the territory’s long trails – Lantau, Hong Kong, Wilson and MacLehose, a total of 300 kilometres – in under 72 hours. That’s about seven marathons in three days, along with 14,400 metres of elevation gain.

Mount Everest, in comparison, is a mere 8,848 metres high.

This is not an official race. There will be no souvenir T-shirt, no checkpoints, no prizes for completing. At the end I will go home, shower, nap and take my three children to the park.

Friends have asked me how I’m training for it. The answer is actually quite boring.

I run a few times during the week and then run longer distances at the weekends, all the while fuelling my body with a healthy, but not overly restrictive, vegetarian diet.

The real question is why. I can start my answer by referring back to Typhoon Vicente, which struck Hong Kong on the eve of my daughter’s birth in late July this year.

As Hongkongers battened down, I laced up. I ran with two friends to the top of High West, a 494-metrehigh hill adjacent to The Peak.

Running through the wind and rain, we could have been mistaken for the runners described in Charles Hamilton Sorley’s The Song of the Ungirt Runners: The rain is on our lips, We do not run for prize.

But the storm the water whips And the wave howls to the skies.

The winds arise and strike it And scatter it like sand, And we run because we like it, Through the broad bright land.

My family and colleagues thought what I was doing was dangerous and maybe even irresponsible. But they were also a little envious. Asked why I did it, I said, “It was fun.”

I am not an elite runner. I have no sponsors and I will never threaten a course record (although because the Four Trails course is made up, I suppose I will have a record of sorts). Only once have I placed highly enough to earn a trophy. I run simply because I like it.

Of course, one can say I’ve evaded the question. What the nonrunner wants to know is why I, and so many people similar to me, like to run – and why I’m undertaking an absurd adventure like running 300 kilometres over difficult terrain.

I think I have an answer. If you look at photographs of runners taken after a long race, the overwhelming majority show smiling, proud, grateful people celebrating not just a result, but the long process of which the result is a part. Yet, as W.H. Auden knew, the photos leave much unsaid: The camera’s eye Does not lie, But it cannot show The life within, The life of a runner The unsaid truth in these photos is that the best and surest happiness in life is found in overcoming limitations. If you can find an unhappy photograph, it will be of a runner frustrated by not overcoming limitation on that particular day.

Ralph Waldo Emerson went so far as to say that the only sin is limitation. The reason I run – the reason we all run – is to discover and go beyond our limits. Emerson called this the act of transcendence.

The children chasing each other on the playground and the adults running along rutted trails are driven by the same primal human compulsion – to reach beyond their former selves and to become something greater. I do not finish a

The camera’s eye Does not lie, But it cannot show The life within, The life of a runner W.H. AUDEN

run the same as I start it, physically or mentally.

Long-distance runners speak of hitting a wall – the acute and urgent pain that attends the discovery of one’s limits. This often happens around the 30-kilometre mark of a marathon. In ultra races, it can happen several times, each wall thicker than the last.

Breaking through these walls helps convince us that most pain can be overcome.

Running is a microcosm of what it means to live well. As a father, I hope my children will learn that all happiness and meaning is found not in ease, but in the “strenuous life” described

by William James and more recently by the late runner-sage George Sheehan. I want them to

know the meaning, if not the words, of the verse from Rudyard Kipling’s If: If you can fill the unforgiving minute With sixty seconds’ worth of distance run, Yours is the earth and everything that’s in it, And – which is more – you’ll be a man, my son.

It is strain, not ease, that leads to happiness. If my children can fill their time with honest effort, I have no doubt they will live happy lives.

I am running Four Trails to discover what my mind and body are capable of – and then going beyond that. I am also running because I am grateful to be able to run. I know how fragile our bodies can be. My body won’t always be able to take me from dawn to dusk.

At some point, hopefully long from now, I will no longer be able to reach the peaks of mountains or the remotest parts of the wilderness. I am aware of finitude and mortality, and because of that, I feel gratitude and urgency. I run because I like it.

Chad Lykins is a father of three and assistant professor at HKU’s faculty of education. fourtrails.com

12

DECEMBER 4, 2012 SOUTH CHINA MORNING POST