YOUR GUIDE TO LIVING WELL
HEALTH POST
TUESDAY, DECEMBER 18, 2012
ASIA’S DIABETES PROBLEM >PAGE 5
HOME-MADE ENERGY BARS >PAGE 11
Eat, drink & be wary >PAGE 6
Illustration: Lau Ka-kuen
How to stay in the pink this Christmas
2 NEWS APP OF THE WEEK
HEALTH BITES
Slumbers never cease
......................................................
Snacking adds to woe Even if family history puts you at a high risk of cancer, research shows a healthy lifestyle could help. A new study has found that loading up on snack foods may increase cancer risk in individuals with Lynch syndrome, an inherited condition that increases one’s risk of developing colorectal, endometrial and other cancers at an early age. Researchers from Wageningen University in the Netherlands collected dietary information from 486 individuals with Lynch syndrome. During an average follow-up of 20 months, colorectal polyps (precancerous lesions) were detected in 58 participants. Patients who had higher consumption of snack foods – such as fast food snacks, chips, or fried snacks – were twice as likely to develop polyps as patients with lower intakes of snack foods. The study was published online in Cancer, a journal of the American Cancer Society. The team’s previous work revealed smoking and obesity may also increase the risk of developing colorectal polyps among individuals with Lynch syndrome.
...................................................... Katie McGregor healthpost@scmp.com Hypnosis Customizable Pack HK$8 Rating 8/10 This has been a particularly hard app to review. The first three times I tried to use it, I fell asleep within minutes of hitting the start button. I was once told by a hypnotist that the hardest people to hypnotise, besides those who didn’t want to be, are those who are exhausted. I was. The app is appealing in its flexibility. The first time you use it you can choose to listen to an introduction where the hypnotist, Benjamin DeFoor, puts aside several myths, explaining that you cannot be made to do anything against your own will and that you can always wake yourself up. It is recommended to listen to a session for at least three weeks to enjoy the maximum benefit. The first stage of a hypnosis session is the induction, where you are guided into the hypnotic state, which is midway between being asleep and awake. This app offers four levels of induction – choose one based on how much time you can spare and your receptiveness to being hypnotised. The next option in this app is the focus of the messaging you want to receive. There are 16 different goals, including assistance with weight
A: The “cover” is probably a crown placed over your tooth to strengthen it against further structural damage when you are biting. Thirty years ago, amalgam fillings containing mercury were the most common approach to restoring a decayed tooth, as no other materials were strong enough at that time. Recent advances in material science have improved the properties of tooth-coloured composites and glass ionomer
Floor power to you At your own pace, try to sit and then to rise from the floor, using the minimum support needed. Each of the two movements is scored out of five – subtract one point for each support used (hand or knee, for example). The total score, according to a new study in the European Journal of Cardiovascular Prevention, can predict how long you will live. Researchers in Brazil put more than 2,000 men and women aged between 51 and 80 years through this simple screening test. The subjects had a median follow-up of 6.3 years. Over the study period, 159 subjects died, mostly the people with low test scores. A one-point increment was related to a 21 per cent reduction in mortality. Lead researcher Dr Claudio Gil Araujo says the study shows that not only aerobic fitness, but also high levels of body flexibility, muscle strength, power-to-body weight ratio and co-ordination have a favourable influence on life expectancy.
loss, stopping smoking, attracting wealth and positive thinking. Then you choose whether you want to wake up refreshed or continue into sleep. Finally, you select a music type: binaural waves, transcendence, a pure embrace and bliss. At last, you get to start the session. To make sure I didn’t fall asleep, I chose to listen to my fourth session while walking to work. Hypnotised or not, taking time out in your busy day to listen to the messaging is probably beneficial. I have yet to be hypnotised by the app. Perhaps I need to get a good night’s sleep first.
ASK THE DOCTORS DR JOEL TAN Q: I have a filling that was done more than 30 years ago when I was a child. The “cover” of the filling recently came off, and I noticed the mercury is now exposed. I don’t feel any pain or discomfort, but the mercury is a concern. What should I do?
Jeanette Wang jeanette.wang@scmp.com
cements, and they do not contain any mercury. You may want to consider having your amalgam replaced with them. You will need to replace the crown after that. Depending on your needs, there are aesthetically pleasing ceramic crowns, or really tough crowns cast out of metal or gold for you to choose from. But before you embark on any treatment, I suggest that you have a periapical X-ray taken to ascertain whether the tooth is still healthy enough to be restored. Over the years, the tooth may die off due to leakage, cracks or decay underneath the crown/filling. Dr Joel Tan is a dental surgeon at White on Whites Dental in Singapore
> 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
Dogs know their business A new study has found that dogs can sniff out Clostridium difficile, the infective agent that is responsible for many of the dreaded “hospital acquired infections”. The findings, published on the British Medical Journal website bmj.com, support previous studies of dogs detecting various types of cancer. Diarrhoea due to C. difficile has a specific smell. A twoyear-old male beagle, Cliff, was trained for two months by a professional instructor to identify the bacteria in stool samples and in patients with the C. difficile infection. The dog’s detection abilities were formally tested on 100 C. difficile samples, half positive and half negative. He correctly identified all 50 positives and 47 negatives. The dog was then taken onto two hospital wards, where he correctly identified 25 out of 30 patients and 265 out of 270 negative controls. The researchers add that the dog was quick and efficient, screening a complete hospital ward in less than 10 minutes.
Old athletes never die Olympic medallists may live longer than laypeople, but researchers say everyone could enjoy this “survival advantage” by just meeting the recommended physical activity guidelines. Two studies were published on the British Medical Journal website last week: the first compared life expectancy among more than 15,000 Olympians who won medals between 1896 and 2010 with general population groups. All medallists lived an average of 2.8 years longer. The second study tracked nearly 10,000 athletes who took part in at least one Olympics between 1896 and 1936, and found that athletes from sports with higher cardiovascular intensity (like cycling, rowing, gymnastics and tennis) had similar mortality rates compared to athletes in lower intensity sports, like golf or cricket. In an editorial, two public health experts say those who do at least 150 minutes a week of moderate to vigorous intensity physical activity also have a survival advantage of up to several years.
NEWS 3 TECHNOLOGY
QUIZ ......................................................
“So while eating cruciferous vegetables is good for you,” says Lacorazza, “it will not have the same effect as what we saw in the lab.” Test your knowledge of cruciferous vegetables below.
Jeanette Wang jeanette.wang@scmp.com
The iTube detects allergens in food as accurately as if tested in a lab.
Portable lab puts allergens to the test ...................................................... Jeanette Wang jeanette.wang@scmp.com Finding out if the food you’re eating contains anything you’re allergic to could soon be as easy as turning on your mobile phone. A team of researchers from the University of California, Los Angeles (UCLA), Henry Samueli School of Engineering and Applied Science has developed a lightweight device called the iTube, which attaches to a common mobile phone to detect allergens in food samples – as accurately as if done in a lab. The iTube uses the phone’s builtin camera and an accompanying application that runs an allergen test.
[The data] would indeed be priceless for consumers, food manufacturers [and] policymakers AYDOGAN OZCAN, LEAD RESEARCHER
Food intolerances affect about one in 20 local schoolchildren – with shrimp being the main culprit – according to a study by Chinese University last year. Other studies show as many as 8 per cent of young children and 2 per cent of adults have some reaction to foods, which could cause severe and even lifethreatening reactions. While laws regulate the labelling of ingredients in pre-packaged foods, cross-contaminations can still occur during processing, manufacturing and transport. Devices to detect allergens in food are typically complex and
bulky, making them ill-suited for use in public settings. The iTube weighs less than 60 grams. The entire preparation of a test sample takes roughly 20 minutes. Food samples are initially ground up and mixed in a test tube with hot water and an extraction solvent; this mixture is allowed to set for several minutes. Then, the prepared sample is mixed with a series of other reactive testing liquids. The final sample is measured optically for allergen concentration using the iTube. The test identifies not only the presence of an allergen, but also how much of it there is. The research team successfully tested the iTube using commercially available cookies, analysing samples for peanuts. Other allergens that can be tested for include almonds, eggs, gluten and hazelnuts, says lead researcher Aydogan Ozcan. Ozcan says the platform could be valuable for parents and also public places such as schools and restaurants. “Once successfully deployed in these settings, the big amount of data – as a function of both location and time – that this platform will continuously generate would, indeed, be priceless for consumers, food manufacturers, policymakers and researchers, among others,” he says. Allergen-testing results of food products, tagged with a time and location stamp, can be uploaded from mobile phones to iTube servers to create a personalised testing archive, which could provide additional resources for allergic individuals around the world. A statistical allergy database, coupled with geographic information, could be useful for future food-related policies – for example in restaurants, food production and for consumer protection, the researchers say. The study was published online in the journal Lab on a Chip.
Cruciferous vegetables are known to have possible anti-cancer effects, and a new study published last week in PLOS ONE adds to the growing evidence. In broccoli, researchers at the Baylor College of Medicine in Texas found a concentrated form of a compound called sulforaphane, shown to reduce the number of acute lymphoblastic leukaemia cells in the lab. “Acute lymphoblastic leukaemia is a type of cancer of the white blood cells common in children,” says Dr Daniel Lacorazza, assistant professor of pathology and immunology. “There is about an 80 per cent cure rate, but some children don’t respond to treatment. For those cases, we are in need of alternative treatments.” Sulforaphane is also found naturally in other members of the cruciferous, or cabbage, family of vegetables. It’s believed to have both preventive and therapeutic properties in solid tumours. Studies have shown that people who eat a diet rich in cruciferous vegetables have a lower risk of some cancers. However, there have not been definitive studies showing how this compound interacts with blood
1. Which of the following is not a cruciferous vegetable? a. Wasabi b. Bak choy c. Asparagus
cancers, says Lacorazza. So researchers, led by Dr Koramit Suppipat, who performed the work while a clinical fellow in the Texas Children’s Cancer and Haematology Centres, incubated human-derived leukaemic cell lines and primary lymphoblasts from paediatric patients with the compound. The cancer cells died while the healthy cells from healthy donors were unaffected. Studies tested in pre-clinical mouse models showed similar results. Lacorazza says the compound works by entering the cells and reacting with certain proteins – but further research will determine which proteins and how. But lots of broccoli would be needed, as concentrated, purified sulforaphane was used in the study.
2. Sulphur-containing chemicals in cruciferous vegetables are responsible for their pungent aroma and bitter flavour. What are these chemicals called? a. Glucosinolates b. Geraniols c. Eucalyptol 3. Cruciferous vegetables are rich in other nutrients, including a. Carotenoids b. Vitamins C, E and K c. Folate 4. Which cruciferous vegetable has the most plant omega-3s (which are believed to protect against cardiovascular disease)? a. Broccoli b. Brussels sprouts c. Kale Answers: 1. c; 2. a; 3. all are correct; 4. b
4 MEDICAL
Illustration: Angela Ho
CASE HISTORY
...................................................... Eileen Aung-Thwin healthpost@scmp.com Madam Achara started having trouble with her vision in her early 60s. Her once-clear eyesight started misting and blurring. A consultation with an ophthalmologist showed that she had senile cataract in both eyes – in other words, age was causing the lenses in her eyes to become progressively thicker and more opaque. The lens focuses light on the retina and gives sight. Without a clear and healthy lens, light could not penetrate to the back of the eye. Cataracts are a common eye problem. In Hong Kong in 2009, there were more than 54,000 people waiting for cataract surgery at Hospital Authority hospitals alone, and more than 42,000 were over 71 years old. But cataracts are developing at a younger age: a 2007 survey by University of Hong Kong found that about 14 per cent of people between the ages 36 and 45 have cataracts. According to Prevent Blindness America, a volunteer eye health and safety organisation, an estimated 24 million Americans over the age of 40 suffer cataracts. Untreated, cataracts will rob sufferers completely of their vision. The remedy is fairly simple – a quick surgery to replace the cloudy lenses with artificial ones. However, Achara (whose name has been changed for reasons of patient confidentiality) was nervous about surgery. She agreed only to an operation on the right eye first. The most common form of cataract surgery is called phacoemulsification, where an ultrasound probe is used to emit ultrasonic vibrations to dissolve the clouded lens. The lens fragments are then removed and an artificial lens is inserted into the eye. This usually takes less than 30 minutes with local anaesthesia and minimal sedation. Hence, the patient is often conscious during the procedure and exposed to the
Hertz so good sounds in the operating room. Achara’s anxiety over the surgery was amplified by the experience of hearing the strange surgical noises and conversations. The surgery seemed to drag on endlessly. Despite the fact that her cataract surgery was a success, Achara was so traumatised by the experience that she refused to have surgery performed on her left eye. Five years later at age 67, Achara was finally persuaded. This time, however, she agreed to be part of a new study on reducing cataract
She happily reported that she felt very little anxiety during the surgery, which seemed to conclude in a flash
patients’ anxiety during surgery led by Dr Pornpattana Vichitvejpaisal of Chiang Mai University in Thailand. Pornpattana was studying if binaural beat audio therapy had an effect on patient anxiety. The therapy uses two tones that are pitched at a specific, slightly different frequency. Each tone is delivered to one ear via headphones. For example, 300 hertz may be played in one ear while 310 hertz is played in the other ear. The 10 hertz difference will give the effect of a pulsating sound.
At a frequency of 10 hertz, binaural beats stimulate alphafrequency brainwaves, linked to relaxation and reduced perception of fear and pain. In Pornpattana’s study, 141 patients were placed into three groups, matched for age, gender, cataract type and other health factors. The first group listened to binaural beats mixed with soothing music and nature sounds before, during and after the surgery. The second group was exposed only to the soothing music and nature sounds. The last group did not receive any sound therapy. All patients were assessed for anxiety, heart rate and blood pressure before and after surgery. Achara was randomly selected to be part of the group that received binaural beat audio therapy. When she arrived at the hospital, her systolic blood pressure was in the normal range of 130 millimetres of mercury (mmHg), with a heart rate of 68 beats per minute. While waiting for surgery, her systolic blood pressure shot up to 150mmHg – considered high – and her heart rate rose to 72 bpm. She scored 40 on the State-Trait Anxiety scale, a standard measurement of anxiety with scores ranging from 20 to 80. The higher the score, the greater the state of anxiety. Achara was given headphones that piped in the binaural beat and music mix. Five minutes into the procedure, her systolic blood pressure dropped to 136mmHg and her heart rate slowed to 69 bpm. Twenty minutes after the surgery, Achara’s systolic blood pressure was 128mmHg with a heart rate of 63 bpm. Her anxiety score also dropped to 25. She happily reported that she felt very little anxiety during the surgery, which seemed to conclude in a flash. Achara’s experience was not an isolated one. Pornpattana’s study found that the patients in the group that received binaural beat audio therapy reported less anxiety and had lower heart rates than those in the control group.
HEALTH 5 DIABETES
Struggle against the tide ...................................................... Elizabeth Snouffer healthpost@scmp.com More than 4,000 experts in diabetes research and medicine from all over Asia met last month at a conference in Kyoto, Japan, where a new mandate called the Kyoto Declaration on Diabetes was drawn up. The mission: to eliminate the disease in Asia. The fourth Asian Association for the Study of Diabetes (AASD) scientific meeting, jointly held with the ninth International Diabetes Federation Western Pacific Region (IDF-WPR) Congress, saw speakers emphasise the importance of research specific to the region and how gains in diabetes care must be made for the sake of Asia’s health. The AASD executive board made a strong appeal for prioritising science-navigated care and research in the region. “Diabetes in Asia today is as big and uncontrollable as a tsunami, and being from Japan – I know exactly what a tsunami wave feels like,” said Professor Nigishi Hotta, president of this year’s meeting and editor-in-chief of the Journal of Diabetes Investigation, in his opening address. It’s important to distinguish between diabetes care in Asia and the rest of the world. The highest prevalence of diabetes is in Asia, and because of diverse ethnicities and cultures, diabetes is manifested in different forms. According to last year’s Diabetes Atlas published by the IDF, 366 million people globally are living with diabetes, and the number is projected to rise to more than 565 million by 2030. East and Southeast Asia are the regions with the highest number of people with diabetes, where about 100 million people now have the disease. Type-2 diabetes, also called non-insulin-dependent diabetes, accounts for at least 90 per cent of all cases in Asia. This statistic is coupled with the perplexing fact that the number of diabetes patients in Asia is rising even more rapidly than in other parts of the world, and the prevalence of diabetes at younger ages is becoming more prominent. Undiagnosed or poorly cared for diabetes can lead to cardiovascular disease, blindness, kidney failure and lower limb amputation. But current clinical practice guidelines for diabetes are
Nurses hand out brochures for diabetes monitoring during a free clinic service in Yinchuan, Ningxia. Photo: Xinhua generated in the West – primarily from the American Diabetes Association and the European Association for the Study of Diabetes. Dr Yutaka Seino, chair of the IDF-WPR, has put in place a plan of action to tailor current guidelines to Asian patients. In the West, it is generally accepted that environmental factors such as food intake and lower levels of exercise play an important role in type-2 diabetes. Most white people with type-2 diabetes are either overweight or obese. In comparison, most Indian diabetics are of normal weight but are metabolically obese. They have higher body fat, visceral fat, a larger waist circumference and are profoundly insulin resistant. “In East Asia, 3 per cent of the population is obese, but this doesn’t mean diabetes doesn’t exist; it means that even if you’re not obese, you are still at risk,” says Seino.
There is no system set up to manage chronic illness, and new evidence is needed JULIANA CHAN (BELOW)
Many researchers believe most East Asians are challenged by low insulin secretion where obesity may not even play a role. Many patients are diagnosed with diabetes in their 20s and 30s, with a type called maturity onset of diabetes in the young (MODY). They are generally not overweight and don’t have other risk factors for type-2 diabetes like high blood pressure or abnormal blood fat levels. MODY is difficult to diagnose and can be confused with type-1 diabetes, which is an autoimmune disease that destroys the body’s ability to make insulin. Professor Juliana Chan Chungngor, director of the Institute of Diabetes and Obesity at Chinese University, describes this form of diabetes as “the result of swift economic development in a region where low birth weight due to poverty for centuries made an imprint on future generations”.
Called the thrifty phenotype hypothesis, this genetic anomaly may be seen in Hong Kong patients when blood sugar rises sharply after a meal, but is normal at non-meal hours or when fasting. This form of diabetes is difficult to detect, especially when the diagnostic test called HbA1c – the gold standard in the West – fails to diagnose Asian patients. “There are not so many studies in this area, so we need to do more research related to the Asian phenotype,” says Seino, who has led diabetes research and care in Asia for more than 40 years. What makes the modification of Western guidelines more complex is that within Asia there are population differences and cultural nuances that require even more specific guidelines tailored for each nation. Japan has driven diabetes research in the region, but Chan, who is also an AASD executive board member, believes all of Asia needs to work harder and invest in research “because successful outcomes for patients are not being achieved”. Chan doesn’t deny that diabetes is expensive for governments to tackle, but says diabetes patients are even more expensive to ignore. “There is no system set up to manage chronic illness, and new evidence is needed to provide better models for care,” says Chan, adding that Hong Kong is the perfect place to develop best-care prototypes for Asia. But the progress of care extends beyond science, says IDF president Dr Jean Claude Mbanya. “The world is conscious of diabetes, yes,” he says. “Governments are listening, but children are dying in the Pacific islands and Africa because they have no access to care, and in India if you are a woman and you have diabetes, you won’t find a husband.” Kyoto was also the city for the 1997 Third Conference of the Parties to the United Nations Framework Convention on Climate Change, at which the Kyoto Protocol – a template for global agreements committed to stabilising greenhouse gas emissions and climate change – was drawn up. Leaders backing the Kyoto Declaration on Diabetes want Asia to come to terms with the epidemic because, as one conference speaker said: “The risk of ignoring diabetes is as severe as ignoring the impact of climate change.”
6 COVER STORY
Perfectionist
Your holiday survival guide December
Illustrations: Lau Ka-kuen
The year-end festivities should be fun, so don’t let binge eating and family disputes turn them into a nightmare, says Charley Lanyon
F
or many, the holiday season is a time to gather with loved ones, feast on seasonal delicacies and celebrate. But for others, these activities are fraught with worry. A few days of feasting can ruin a year’s hard work of getting trim. Family tensions can rise and tempers can flare. For the lonely, feelings of depression can be exacerbated. Avoid a blue Christmas – or even a trip to the hospital – with Health Post’s survival guide to the season.
Do your revel best The year-end festivities are a good reason to indulge and give that diet a break, but many tend to overeat. While most people only put on 500 grams to 1kg of weight over the holidays, research shows that even this slight weight gain may never go away. “The problem is not working it off, even after a New Year’s resolution,” says Lona Sandon, assistant professor of clinical nutrition at the University of Texas Southwestern Medical Centre. “The gain stays on and adds up each year; in a decade that’s [five or 10 kilograms]. That can lead to obesity and related health problems such as hypertension, stroke, diabetes and other maladies.” Charmain Tan, a Hong Kong registered dietitian with Seventeen Nutrition Consultants, says the trick is to load your plate with a balanced assortment of foods. “Don’t skimp on the greens. Also, a lot of people think they are being healthy by avoiding carbohydrates, but then they just gorge on fatty meats and desserts,” Tan says. Instead of skipping meals to save up calories for the feast, Tan advises having a light snack before the party. This will get your metabolism going, and also ensure you’re not starving when you arrive. Tan also recommends throwing
parties at home instead of in restaurants, and encouraging people to contribute home-made dishes. Restaurant food is usually much higher in fat and salt than home-made fare, she says. But food is also wrapped up in emotion, says Lucy Aphramor, a researcher and dietitian with Atrium Health, a social enterprise of Britain’s Department of Health. The important thing is to listen to your body and not let food-related guilt ruin your holidays. “Imagine food was no longer something to fight. Let yourself eat when you are hungry,” she says, and don’t be hard on yourself if you eat for pleasure alone. Although that sounds risky, Aphramor insists research shows people who battle with food have a tough time regulating intake, are prone to weight gain, and experience eating as a source of stress. “People who move away from a focus on weight and eat to nourish and nurture themselves regain the pleasure of food, and are weight stable,” she says. Alcohol can be another potential holiday pitfall. Zachary Yu, a wine expert from the Langham Place hotel, says the secret is hydration. Dehydration is a major culprit in the most grievous hangover symptoms and drunken behaviour. “If you drink a glass of wine,
drink at least half a glass of water,” says Yu. Try not to mix your booze and avoid spirits altogether. Pace yourself – and perhaps stick to red wine. “[People tend to] drink red wine the most slowly, white wine a little more quickly because they want to drink it cold, and sparkling wine the fastest because it has a fantastic taste and goes down so easily,” says Yu. Splurge on the good stuff, not only because it’s a celebration, but also because cheap alcohol tends to contain more congeners or impurities from the distillation process that cause killer hangovers. If you are drinking and start to feel uncomfortable, tired or hot, you may want to try a folk remedy Yu picked up in his youth: have a glass of water with a pinch of salt and a pinch of sugar – and maybe a touch of vinegar or lemon juice. “That
COVER STORY 7
ought to wake you up,” he says. With all the eating and drinking, don’t forget to exercise. Tan suggests incorporating a physical activity into festivities, such as a short hike before a meal. “Wake up a bit earlier and do some exercise outdoors,” says Michal Bucek, a trainer with Hong Kong Bootcamp. “Use the stairs instead of lifts. Even a 20 to 30 minute walk helps.” Bucek recommends an easy exercise routine that works out the whole body, requires no equipment and takes only 30 minutes a day. “Stick to basic exercises such as push-ups, sit-ups, lunges, squats, and some core exercises like planks. Do five to 15 repetitions for each exercise, and three sets of the circuit,” says Bucek. Don’t sweat the season Perhaps the most serious traps of the season are emotional. A 2004 study published in Psychological Reports found that homicide rates in the US went up on Christmas Day,
If you’re alone, make plans that will get you out of the house doing things with other people DR CINDY CHIU, ASSISTANT PROFESSOR, HKU
and during Thanksgiving, New Year’s Eve and, in particular, on New Year’s Day. (The study also found suicide rates were generally lower on these days except on New Year’s Day.) Some experts have also coined the “Merry Christmas coronary” and “Happy New Year heart attack” to describe the phenomenon of increased cardiac deaths during the winter holiday season. University of California-San Diego scientists studied 53 million US death certificates from 1973 to 2001. They found a spike in daily mortality during the Christmas and New Year’s holiday period for both cardiac and non-cardiac diseases. The study, published in 2004 in Circulation, showed that the jump in holiday mortality was growing proportionately larger over time. In Hong Kong, Dr Duncan Ho Hung-kwong, a specialist in cardiology at the Hong Kong Sanatorium and Hospital, says he certainly sees more heart attacks around the holidays than any other time of the year. The exact mechanisms for this link are not determined, but experts believe it could be due to a combination of factors: changes in diet and alcohol consumption; weight gain and increased salt intake; emotional stress from family, finances and travelling; respiratory issues from burning wood in fireplaces; and holiday induced delays in seeking medical care. The biggest culprit by far, Ho says, is stress. “We are definitely busier, and if we have a lot of stress or a lot of work, the heart pumps faster. If there is stress, cholesterol plaque can rupture, causing a blood clot, and block the artery totally.” If you are at an increased risk of heart trouble, take special care. People with atrial fibrillation – a common and potentially dangerous form of heart palpitations – have almost a 4½ times greater chance of having an episode if they are consuming alcohol,
according to a study published in August in the American Journal of Cardiology. There are easy ways to manage your stress levels at home. Taking a 20-minute power nap is one, says Peter Yeung, an acupuncturist and Chinese medicine practitioner. “Even if you can’t sleep, just lie down. But make sure it’s for less than an hour or else you may ruin your sleep cycle.” Try also drinking tea, especially green tea or chrysanthemum tea, he says. It can help you relax, and aids digestion. Dr Cindy Chiu Pui-yu, clinical assistant professor at University of Hong Kong’s department of psychiatry, says managing expectations is key to a stress-free season.” We feel we’re supposed to be happy and have a good time when surrounded by family and friends, but that reality doesn’t really apply to everyone,” she says. “If you don’t have family, or you just went through a break-up, it’s not the end of the world.” Don’t get hung up on perfection. It doesn’t matter if things don’t work out flawlessly. If you’re alone, make plans that will get you out of the house doing things with other people. “Focus on the altruistic aspects of the holidays,” says Chiu. “Volunteer to help the less fortunate.” To avoid flaring family tensions, don’t bring up long-term chronic disputes or conflicts during this time, she says. Plan only a short exposure to each other. Have dinner, rather than stay together for several days. “Every family has its fair share of issues. You don’t have to be perfect. At the end of the day the most important thing is to be there together.” If you do get angry, take a deep breath and count to five. Also, try and get a good night’s sleep. When you are rested, you are less stressed, more active, happier, and less liable to binge and get drunk. Merry Christmas! charley.lanyon@scmp.com
8 HEALTH TRADITIONAL CHINESE MEDICINE ...................................................... Elizabeth Snouffer healthpost@scmp.com Diagnosed with stage-four liver cancer in 2009 and with surgery and chemotherapy no longer options, 79-year-old retiree Mr Xu was given six to nine months to live. Friends told him Chinese medicine might offer a lifeline, and Xu (whose full name has been withheld for reasons of patient confidentiality) immediately paid a visit to the Chinese Medicine Clinic of Hong Kong Baptist University’s (HKBU) School of Chinese Medicine. In early 2010, he began a Chinese medicine treatment programme, which included at least weekly follow-ups and daily herbal prescription medicine. Xu found himself digging deep into his pockets to pay fees for the monthly treatment, which cost up to HK$3,000. Fortunately, assistance soon arrived in the form of “privilege cards for the elderly”, a subsidy programme by the Lions and HKBU Chinese Medicine Charity Foundation. Xu has saved more than HK$300 on each visit. Since the programme’s inception in September 2007, more than 2,000 elderly chronically ill, financially challenged patients in Hong Kong have benefited. The foundation has issued more than 2,300 privilege cards and 13,489 coupons, each with a face value of HK$100, according to the director of the foundation, Paulman Tse Yim-pui. The foundation was jointly set up by HKBU and the Lions Clubs International of Hong Kong and Macau, and is funded through donations. Last month, the foundation received HK$200,000 from the Lions Club of Tuen Mun and HK$50,000 from Dr Lam Hoiham, former district governor of the Lions Club of Hong Kong and Macau – meaning more elderly patients can continue to benefit from the subsidy programme. The cards and coupons enable programme participants to enjoy subsidised or even free consultations, prescriptions, acupuncture, Chinese massage and other forms of therapy prescribed for well-being at eight HKBU Chinese Medicine Clinics. Eligibility for the programme requires Hong Kong permanent resident status for individuals over the age of 60. Participants must also meet the financial qualifications set by Hong Kong’s Comprehensive Social Security Assistance Scheme. Applicants need to have a monthly income of less than HK$8,740 or total assets of less than HK$406,000. Chronically ill patients under the age of 60 may also apply. Last month, Lam spoke of the challenges an ageing population poses to Hong Kong, where 70 per cent of about 1.5 million people over the age of 60 suffer from a chronic disease such as renal illness, cancer or diabetes. According to last year’s census, about 13.5 per cent of Hong Kong’s
Professor Bian Zhaoxiang (right), of Baptist University’s School of Chinese Medicine, helps the elderly cope with chronic illness. Photo: May Tse
Tea and sympathy population, or more than 941,000 people, are 65 or older. The median age rose from 36.7 in 2001 to 41.7 last year. “As a charitable organisation which focuses on improving social welfare, the Lions Club wanted to find a way to help the elderly who are living without any medical care,” says Lam. “Helping the elderly through this programme is one of the most important projects we are doing today.” Lions Clubs International, a secular service organisation with more than 45,500 clubs and more than 1.3 million members in 205 countries, was founded in 1917. It performs volunteer work for many different community projects, including caring for the environment, feeding the hungry and aiding the elderly and the disabled. The first Hong Kong Lions Club was established in 1955; today there are 68 active Lions Clubs in Hong Kong. When asked why the Lions Club chose traditional Chinese medicine over Western medicine, Lam says easy access and treatment costs are
important factors. “Firstly, Hong Kong’s elderly depend on Chinese medicine along with Western medicine to help manage side effects and symptoms,” he says. “Chinese medicine is affordable and we can see it offers benefits to the ageing population.” Chinese medicine has recently gained recognition for improving immunity and tolerability of chemotherapy for cancers in many hospital communities worldwide, which has prompted a newer understanding and acceptance of the traditional practice. Professor Rick Wong Wai-kwok, HKBU vice-president, also stresses how traditional Chinese medicine is a very popular option for disease management in the local community, especially among the elderly and for those who are chronically ill. Experts in the field believe that when the Hong Kong Chinese Medicine Ordinance took effect in 2000, ensuring all Hong Kong Chinese medicine practitioners are registered and licensed, patient confidence levels and demand increased.
Chinese medicine is affordable and we can see it offers benefits to the ageing population DR LAM HOI-HAM
Professor Bian Zhaoxiang, director of the clinical division, School of Chinese Medicine at HKBU, sees many elderly people who are coping with chronic illness. Fortunately, Chinese medicine has incorporated chronic disease management into a speciality system, making it more accessible and modern for these patients. Today, a patient suffering from renal disease can consult a kidney specialist, and those managing high blood sugar levels can see a diabetes specialist at one of HKBU’s clinics. “Based on the statistics, most elderly patients today suffer primarily from metabolic diseases, such as diabetes or cardiovascular disease,” says Bian. Xu has defied his death sentence. With the past two years of Chinese medicine treatment, his tumour has shrunk and his health has greatly improved. He continues to take herbal medicine every day and visits the clinic every two weeks. For more information or to donate, contact Ms Lee from Baptist University at 3411 2077
FITNESS 9 MARATHON MANIA WEEK 3 ...................................................... Rachel Jacqueline healthpost@scmp.com The standard formula for calculating one’s maximum heart rate is “220 minus your age”. But experts suggest the textbook is wrong: everyone’s maximums, from heart rate to output, are different. Understanding yours is the key to peak performance. To learn how to unlock my potential for next year’s Standard Chartered Hong Kong Marathon, I meet Dr Michael Tse from the Active Health Clinic and University of Hong Kong’s Institute of Human Performance. Tse is a former trainer and performance consultant to many of the territory’s elite athletes. A number of factors make a great runner, he says, including body composition, running mechanics and strength. “But when you’re starting out, what you really want to know to become a faster, more economical distance runner, is how to benchmark your fitness. Doing so allows you to see your inherent ability, as well as what sort of training will help you.” There are two measurements that are key, says Tse. First, VO2 max, or the maximum capacity of your body to transport and utilise oxygen to fuel muscle movement. (Think of it as the size of your “engine”.) Second, the lactate threshold, which is the point where pushing yourself harder becomes counterproductive during a long-distance race. Knowing your VO2 max gives you a good indicator of your condition and shows you where you can push the boundaries of your training to improve. Next, as running intensity increases, you produce lactate in the blood. Lactate (or more accurately, its negative by-product) is responsible for that burning sensation in your legs when running. While the good news is your body is pretty effective at processing lactate, there’s a point where its production exceeds its removal: the “lactate threshold”. It’s the point where fatigue sets in. Making sure you work up to, but not past, your threshold during a marathon race is essential for lasting the 42.195-kilometre distance. During training, working above and below your thresholds will help to boost your speed. There are many ways to calculate your VO2 max, from a simple formula that uses resting heart rate and age to the Rockport Fitness 1.6kilometre Walking Test. Just Google “calculate VO2 max” and you’ll find a range of online calculators. But the most accurate VO2 max measurement is done in the lab – and so I was tested by exercise physiologist Glen Joe at the Institute of Human Performance. Wearing a gas mask that vaguely looks like something from a Swat team, I ran on a treadmill at increasing speeds while Joe recorded the oxygen and carbon dioxide content of the air I breathe in and out. I’m pleased to find out that my
RACHEL’S DIARY While I mixed up the order of my runs this week, I still managed a speed session, threshold run, a few shorter runs and a long run. Two weeks in and feeling good. It was all about my running buddies this week: they pushed me hard along Bowen Road, stopping me from giving up on my sixth rep when I was spent, and kept me going on my long run when I wanted to opt for brunch. If any of you are struggling, enlist a friend. I have become slack with my running drills, but I bought some training cones for motivation. Let’s hope they work next week. Rachel Jacqueline undergoes a VO2 max measurement test at the Institute of Human Performance. Photo: Jonathan Wong
Push the red line VO2 max is 51.7 millilitres of oxygen consumed per kilogram of body weight per minute (ml/kg/min), putting me in an “elite” category for my age. In comparison, the late Norwegian marathon world champion Grete Waitz had a VO2 max of 73.5, the legendary Steve Prefontaine 84.4, and three-time Tour de France winner Greg LeMond 92.5. While my results reflect the training I have already put in, a good VO2 max also reflects genetics. My max heart rate is also high – recorded at 197 beats per minute – although both Joe and Tse believe I could have pushed it harder. For runners with a lower VO2
Knowing your VO2 max shows where you can push the boundaries of your training to improve
LIFT YOUR GAME Peak performance factors and how to improve them. • VO2 max: base level aerobic training and some running at VO2 max pace. • Lactate threshold: some running efforts at and around lactate threshold pace. • Body composition: reduce body fat within reason to carry less “useless” weight. • Running mechanics: proper mid-foot strike and higher running cadence; about 180 steps per minute. • Strength and injury prevention: running is weight-bearing exercise. Building strength can help you perform better, recover quicker and reduce injuries.
max, Tse recommends building a fitness foundation. “You need to go back to basics and build up a base at lower intensities,” he says. This means being disciplined with slow runs, and resisting temptation to go hard and fast every time you ride an endorphin high. Conversely, better-trained runners who want to improve need to do some high-intensity training. Tse’s advice reinforces the importance of the speed work coach Clinton Mackevicius has included in my training plan. The key to a faster marathon, says Tse, is to train the body to shift your lactate threshold to occur at higher speeds. During my treadmill test, Joe also checks my blood lactate at each stage with a small finger prick. Results show my lactate threshold occurs at 90 per cent of my VO2 max, meaning I can run up to 90 per cent of my capacity in an aerobic zone before relying on my anaerobic system. According to Tse, I am pretty efficient. To optimally change your lactate threshold requires a periodised training programme, similar to what Mackevicius has devised for me. It should include base aerobic work,
tempo runs below and around the lactate threshold, and interval running to train the body to tolerate lactate accumulation and facilitate its removal. I was also tested on the clinic’s DEXA scanner, the gold standard for measuring body composition and bone density. While my body fat percentage could go down (it is 27 per cent, which is in the healthy range of between 21 and 33 per cent by World Health Organisation guidelines), real improvements could be made in my muscle mass, which was slightly lower than average. “As a runner you want to reduce fat weight, which has little metabolic benefit compared to muscle,” says Tse. He recommended a variety of strength exercises to help stimulate and grow my muscles. “Whatever [fat] you can lose, without going overboard, and while remaining healthy, may be of benefit to running performance,” he says. Time to cut out the post-run indulgences, it seems. Marathon Mania is a 12-week series leading up to the Hong Kong Marathon on February 24. For more preparation tips, go to facebook.com/hkmarathon
10 WELL-BEING PERSONAL BEST
THE TASTE TEST TOAST ......................................................
Photo: Nora Tam
...................................................... Charley Lanyon charley.lanyon@scmp.com Health officials, educators and governments the world over are up in arms over what they see as an obesity epidemic. Changing diets, a growing dependence on processed foods, and modern conveniences have done away with the necessity for much physical exertion. This has resulted in rapidly expanding waistlines and a host of associated health complications: diabetes, heart disease, hypertension and joint damage, to name just a few. A recent article in Physicians News Digest referred to obesity as “a catastrophic public health issue that threatens to cripple and bankrupt the medical system”. You can hardly accuse governments of inaction: “fat taxes” are springing up in Europe, New York City recently banned large-sized sodas, and many cities have banned trans fats entirely. Aside from tax incentives and consumer restrictions, recognising being overweight as a preventable health problem is now a cultural consensus, taught in schools and driven home with anti-obesity public service announcements and education. Is this the kind of decisive action a dire health crisis demands? Dr Lucy Aphramor doesn’t think so. A researcher at Coventry University and a dietitian with Atrium Health, which is a social enterprise of Britain’s Department of Health, Aphramor thinks that in many ways, these measures are making the problem worse. She believes the measures are often based on outright falsehoods, namely that science is decisive on the link between health and weight. She fears the focus on weight as a preventable health issue has created a society-sanctioned environment of discrimination in which people struggling with their weight are openly ridiculed and treated as second-class citizens under the erroneous cover of moral obligation or public good. “It became apparent to me early on that the fixation on weight was harmful: patients weren’t improving their health, and would become preoccupied with weight and food, which affected their moods and social lives,” says Aphramor, who has worked with the National Health Service for more than 10 years. And these patients’ emotional health wasn’t the only thing being affected. “I read up about harmful effects of intentional weight loss on bone health, and the damage to heart health of yo-yo dieting.” She was at a loss. Like pretty much everybody else, she believed in the correlation between health and weight loss.
I’m worried about the huge emotional toll exacted by believing that you are not OK DR LUCY APHRAMOR, HAES UK
Weight ... there’s more “I’d been taught that you just help someone reduce calories and the weight comes off, but what I found was a whole heap of evidence showing it is not possible in the long term,” Aphramor says. “Even when people kept to a reduced-calorie diet for nearly eight years, they didn’t lose a significant amount of weight.” Then she discovered Health at Every Size (HAES), a belief system and trans-disciplinary global movement that sets out to change the fundamental ways society and individuals approach the issues of weight and weight loss. HAES emphasises intuitive eating: listening to your body and eating when hungry, and pleasurable physical activity in
conjunction with body acceptance and self-confidence building. In the abstract for a paper she wrote for the Nutrition Journal with Linda Bacon, a nutrition professor at the City College of San Francisco, Aphramor clearly set out the case for HAES. “Current guidelines recommend that ‘overweight’ and ‘obese’ individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behavioural change,” she wrote. “But the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality ... This weight focus is not only
Jeanette Wang jeanette.wang@scmp.com
ineffective at producing thinner, healthier bodies, but may also have unintended consequences ... reduced self-esteem, eating disorders, other reductions in health, and weight stigmatisation and discrimination.” Clinical trials showed a HAES approach resulted in greater improvement in both physical and psychological health, and healthier behaviour compared with traditional weight loss. Aphramor joined forces with Sharon Curtis, a computer scientist and self-described “fat activist”, to found HAES UK. Its aim is to improve people’s self-esteem and health, and push back against a perceived trend of weight-fixation in the health establishment, which HEAS considers dangerous. For Aphramor, the most important point to get across is perhaps the most radical: “Except at extremes of fatness and thinness, weight itself isn’t strongly correlated to health. We need to remember that weight loss and health are not the same thing.” Through HAES UK, she hopes to get the government to change its approach to weight loss and health. “There is no evidence these [public anti-obesity] campaigns are effective. Instead, we see an increase in food preoccupation, weight discrimination and eating distress. In Singapore, for example, antiobesity campaigns aimed at children did reduce their weight initially, but there was a huge surge in eating disorders in the children.” Aphramor brought the teachings of HAES to Hong Kong in the summer, giving an introductory HAES workshop at the Police Officers’ Club. She left convinced there was real demand for a new way of looking at weight in Hong Kong. She is planning to return in March to run another introductory class, and an intensive three-day version of Well Now, a course that she developed. Critics worry that HAES provides a justification for unhealthy choices. But Aphramor is unswayed. “I’m worried that conventional weight management gives cover for professionals to continue doing something that has mainstream support, even though it is harmful,” she says. “I’m worried people end up hating themselves and become so afraid of eating, they learn to distrust their bodies and are taught to ignore signals of hunger and fullness. “I’m worried about the huge emotional toll exacted by believing that you are not OK, and being told you’re a second-class citizen. And I’m worried about how food dread and body dissatisfaction get passed on to children.”
Van der Meulen Original Melba Toast HK$31 for 100 grams, City’super There are five handy 20-gram packs in this box, each with six slim slices a bit smaller than an Octopus card. Why “Melba”? Its creator – the same man behind peach melba – was a fan of Dame Nellie Melba, the early 20th century Australian opera singer. This version, however, is from the Netherlands. Verdict: sesame seeds, although few, add good flavour; the toast is dry on its own but great topped with everything from savoury to sweet.
Albert Menes Petites Biscottes Suisses Au Lait HK$54 for 165 grams, City’super This crisp, sweetened toast is also known as Zwieback, or “twice-baked” in German – so named for how it’s made. This version is made in Switzerland using a traditional recipe. Verdict: much thicker than melba toast and so can take on heftier toppings, though great on its own, or with tea or coffee.
Pelletier Toast Brioche Aux Raisins HK$39 for 175 grams, City’super When you rip open the packaging, you’ll notice this is made from a lone cylindrical-shaped raisin brioche because the end of the loaf is crust. The French-made brioche is sliced into 13 pieces of 55 calories each – an ideal snack-sized portion. Verdict: the lightest and crumbliest of the three due to a high egg and butter content – but it’s also the least appetising as it’s rather bland.
DIET 11 HEALTHY GOURMET
How to find a good bar ...................................................... Andrea Oschetti healthpost@scmp.com We like energy bars because they are convenient. Bars are great for lunch hours spent working out, for a posthike snack in a remote country park and for a bite on the bicycle when fuss-free energy is key. But as far as health is concerned, the bars we buy at the stores are not a substitute for a well-balanced meal made with real food. Even during prolonged exercise, there are better alternatives: home-baked bars, lowfat cakes, boiled rice patties, fresh and dried fruit, baked potatoes, and bread with Nutella. In some cases, the harm of prepackaged energy bars can outweigh the convenience they provide. Tooth decay, for example, is a serious problem for athletes because of the sugar content of bars. “Most bars in the market are the equivalent of candies,” says dentist Dr James Costello. “They are marketed differently, but the effect of the sugar on the teeth is the same.” Costello started his own organic whole food bar range under the Hong Kong-based food company Stephen James Luxury Organics name when his brother Steve couldn’t find an energy bar for his
Most bars are the equivalent of candies. The effect of the sugar on the teeth is the same DR JAMES COSTELLO, DENTIST
son that wasn’t unhealthy, or tasted terrible, or both. Costello’s advice is to look for energy bars with low sugar content, or those that use complex sugars. This way, you can avoid the acidifying effect that refined sugars have on the blood. He suggests you “stay away from chewy and sticky bars that get caught between the teeth, and stay in the mouth longer”. Besides putting your smile at risk, bars may end up on your hips. Bars are meant to replenish energy stores during exercise, rather than being eaten as snacks. But they are often unnecessary, even for an athlete who exercises regularly. Carbohydrates are the body’s key source of energy. What is not consumed right away is stored in the muscles and the liver in the form of glycogen. The body can store around 445 grams of glycogen, and any extra is stored as fat.
Timing is also important: it takes the body at least two hours to digest and convert carbs into energy. Eating during a hike that’s shorter than two hours will provide you with energy when you are back home. You shouldn’t eat proteins, fat, fibre and minerals such as zinc or iron just prior to, or during, prolonged exercise, as these ingredients are hard to digest. Look for bars that provide at least 70 per cent of calories as carbohydrates. During activities longer than two hours, consume bars that offer at least 25 grams of carbs, and avoid eating just before or after moments of intense effort. After exercise, replenish muscle glycogen. Bars containing high glycaemic-index carbs (meaning they are digested quicker), as well as some proteins, are recommended. No two brands are equal. Examining the nutritional label before you buy is critical. You should look for products that do not contain high-fructose corn syrup, which has been linked to obesity and other health problems. Differentiate between highquality protein such as egg, milk, soy, whey or casein, and low-quality sources such as collagen and gelatin. Stay away from bars with trans fats and chemical sugar substitutes. Costello showed me photographs of flax seeds taken with a so-called “energy camera” that is said to capture the life force energy in foods. He points out the considerable difference between regular and pre-sprouted seeds. “The Chinese people considered qi to be the vital energy that sustains life. They understood intuitively the importance of [pre-sprouting] – soaking nuts and seeds before eating them as a way of activating their life energy,” he says. Costello suggests soaking nuts and seed for 10 hours before eating them. “Any concept of health and healing, in order to work, must include enzymes. Foods without enzymes create a ‘drag’ on the body which impairs peak performance in athletes. Pre-sprouting activates the enzymes in the food, which is then easily digested and converted to energy for your body.” Costello sees my upcoming 40th birthday as the tipping point when my qi level starts to decrease: “Your ability to recover is slower, your injuries take longer to heal and you start to look older. While in our youth, qi reserves were endless, from now on is very important to actively nourish your qi by eating energetic and balanced food.” I searched the internet for advice on how to make healthy bars at home, and was surprised at the amount of butter and sugar most
Andrea Oschetti had difficulty finding a healthy energy bar in the shops, so he made his own. Photos: Dickson Lee
recipes included. Instead, I came up with a non-dairy, gluten-free, lowsugar alternative that is easy to make, and tasty. Andrea’s energy bars Makes six bars 80 grams walnuts 1 tbsp flax seeds One whole pumpkin 100 grams jumbo oats
30 grams dried cranberries 1 tbsp honey 1/2 tsp cinnamon • Pre-sprout the walnuts for 16 hours and the flax seeds for eight hours by soaking them in water. • Cook one whole pumpkin in an oven at 160 degrees Celsius for one hour or until soft. • Peel it and process the flesh into a purée – you need 135 grams of this purée.
• Roughly chop the cranberries and walnuts, and mix them with all the other ingredients in a bowl. • Place the mixture in a tray covered with baking paper. • Fill the tray with the mixture to about 1cm deep. Bake for 25 minutes at 180 degrees, or until brown. • Allow to cool and slice into blocks. Healthy Gourmet is a weekly column by private chef Andrea Oschetti
12
DECEMBER 18, 2012 SOUTH CHINA MORNING POST