20130108 health post

YOUR GUIDE TO LIVING WELL

HEALTH POST

TUESDAY, JANUARY 8, 2013

A STEP CLOSER TO REVERSING OSTEOPOROSIS >PAGE 4

THE PAIN IS ALL IN YOUR BRAIN >PAGE 8

Cyclists are dropping gears in search of a quick “fixie” >PAGE 6

A single obsession

2 NEWS APP OF THE WEEK

BENZOIC ACID

Now sit up straight and pay attention

Hotpots across the border are out of order ......................................................

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Katie McGregor healthpost@scmp.com Ergo@work Free Rating 9/10 According to Dr Jason Queiros, a chiropractor at Stamford Sports and Spine in Connecticut, you add 9kg on your back and spinal column for every 2.5cm your head tilts towards your monitor. You don’t need a doctor to tell you that this isn’t good.

Ergo@Work, a product of Singapore’s Ministry of Manpower, is designed to help you analyse your posture. It provides a series of exercises and stretches, demonstrated by an animated character, to help you rebalance your body after a period at your desk.

The analysis is fun. Get a colleague to take a photo of you at your desk, aligning the app template with your seated figure as best as possible. Once the photo has been taken, you are presented with the analysis tool where you align key points on the stick figure with key points on your photo: eyes, shoulders, monitor, knees and so on. This is done by dragging the points on the screen with your finger. Hit next and the app asks for

Photo: Edward Wong

Jeanette Wang jeanette.wang@scmp.com

your profile details before giving you the results of the analysis.

If the points are red, you know you are doing something wrong.

Press on any of the points to learn more. The app tells you what you are doing wrong and makes suggestions on how to correct the situation. You are also recommended exercises to do.

I learned my head was tilted too far downwards, and that I should adjust my monitor height or tilt my screen. My recommended exercises included some neck rotations. The app lets you set a timer to remind you to take a break and stretch out.

This is a fun and free way to review the configuration of your seat, desk and monitor before you cause yourself any serious damage.

> 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.

A recent report on preservatives in hotpot meals may have you thinking twice about eating the traditional winter warmer this season, but how worried should you be?

Last week, a South China Morning Post cover story revealed that a report by the Market Supervision Administration of Shenzhen found unacceptable levels of preservatives in 38 of 200 samples collected from hotpot restaurants across our neighbouring city, a popular dining destination for Hongkongers.

The preservatives include benzoic acid, excessive levels of which could affect the central nervous system and liver, short-term studies in rats have shown, according to the World Health Organisation. Scientists also suggest that sodium benzoate – the sodium salt of benzoic acid – could cause DNA damage and neurodegenerative diseases such as Parkinson’s disease.

The preservatives were found in beef tendon balls, pork balls, beef balls and mushroom balls, which the restaurants had bought from various supermarkets in Shenzhen, Xinhua news agency reported.

Mainland authorities have zero tolerance for the use of benzoic acid in fresh foods, such as the meatballs.

In Hong Kong, benzoic acid – and its sodium, potassium and calcium salts – are permitted preservatives in specific food items, including beer, fruit juices and soy sauce, according to the Centre for Food Safety. The maximum permitted levels range from 70 to 10,000 milligrams per kilogram in different types of food.

Benzoic acid and sodium benzoate are on the US Food and Drug Administration’s list of substances that are generally

The preservatives were found in beef tendon balls, pork balls, beef balls and mushroom balls recognised as safe. Both may be used as antimicrobial agents, flavouring agents and as adjuvants with a current maximum level of 0.1 per cent in food.

The report provided no details about the level of preservatives found in the food samples. Also unknown was the source of the ingredients – and whether any of them had been exported to Hong Kong.

Benzoic acid was discovered in the 16th century and is used as a preservative in foods and found in cosmetics and drugs. In food, it is used as an antimicrobial additive

primarily against yeast and moulds.

It’s particularly effective for preserving foods with high acidity, such as soft drinks, fruit juices, salad cream, tomato sauce and yogurt.

Traces of benzoic acid are found in cranberries, prunes, greengage plums, cinnamon, cloves as well as milk products. Naturally occurring benzoic acid usually does not exceed 40 milligrams per kilogram.

Benzoic acid is also used in cosmetics, pharmaceuticals, herbicides, flavours and antiseptic ointments for fungal infections of the skin.

According to the WHO, information concerning long-term oral exposure of experimental animals to the preservative is very limited. Hong Kong’s Centre for Food Safety advises people to maintain a varied and balanced diet so as to avoid excessive exposure to benzoic acid and other food additives from a small range of food items.

So, don’t only have hotpots or meatballs this winter – there are many other ways to warm up.

ASK THE DOCTORS JULIAN LEE Q: I got in a fight and received a blow to the nose. There was no obvious break but now the swelling has gone down, I can’t breathe through my left nostril and have a throbbing pain on the bridge of my nose. Do you think there is a problem or will it ease off?

A: Due to its location, prominent and rather fragile structures, and sometimes provocative demeanour, the face is the subject of frequent mechanical trauma resulting in underlying bony injury.

Facial trauma commonly results from motor vehicle accidents, altercations, contact sports, domestic accidents, and workrelated injuries. The nasal bones are the bones most often fractured in facial injuries.

The common symptoms and signs of blunt nasal trauma include nosebleed or epistaxis, pain, swelling, deformity, tenderness and crepitus (cracking or popping sensations) over the dorsum (bridge) of the nose. In addition, one often has nasal congestion and obstruction due to the presence of blood clots, swelling, and possibly a deflection of the septum.

Blunt nasal trauma is evaluated through examination and selective radiological investigations. It is important to distinguish nasal contusion from simple fractures limited to the nasal bone and complicated fractures involving the nasal septum and other

facial bones. Nasal bone X-rays or CT scans will confirm the diagnosis.

Nasal septal fractures may be associated with a haematoma and require urgent treatment. An untreated haematoma may result in infection, tissue loss and collapse of the nasal dorsum.

Simple nasal bone fractures without cosmetic deformity may be allowed to heal spontaneously. This process may require up to two to four weeks. Symptomatic treatment and protection of the fracture may suffice. However, should cosmetic deformity or nasal obstruction exist, intervention

is required. Fractures in adults usually remain malleable for three to five days after injury and are amenable to closed reduction using a combination of topical and local anaesthesia, and immobilisation with intranasal packing and an external splint. A nasal septal haematoma will require drainage through an intranasal incision.

Significant nasal septal fractures may be similarly approached and repaired via an intranasal approach.

You should consult an ENT surgeon for an opinion.

Dr Julian Lee is an ear, nose and throat (ENT) surgeon and the medical director of The ENT Practice at Mount Elizabeth Novena Specialist Centre in Singapore.

NEWS 3 HEALTH BITES

Gap year for women The memory problems that many women experience as they approach and go through menopause not only exist, but appear to be most acute in the first year following a woman’s final menstrual period. A study by University of Rochester Medical Centre in New York state published last week in the journal Menopause assessed 117 women with a series of tests to evaluate cognitive skills. The women also reported on menopause-related symptoms, and took a blood test for levels of oestradiol (an indicator of oestrogen levels) and follicle-stimulating hormone. Women in early postmenopause performed worse on verbal learning, verbal memory and fine motor skill than women in the late reproductive and late transition stages.

However, lead author Miriam Weber, a neuropsychologist, says “these problems are normal and, in all likelihood, temporary”.

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Jeanette Wang jeanette.wang@scmp.com

Photo: Corbis

The crying game A new study suggests that most infants who wake up crying in the middle of the night are best left to self-soothe and fall back to sleep on their own. Researchers at Temple University in Philadelphia asked parents of more than 1,200 infants to report on their child’s awakenings at six, 15, 24 and 36 months. They found two groups: sleepers (66 per cent) and transitional sleepers. By six months of age, the “sleepers” woke up just one night per week. But the “transitional sleepers” woke up seven nights per week at six months, dropping to one night per week by 24 months. Most wakers were boys. These transitional sleepers also tended to score higher on an assessment which identified traits such as irritability and distractibility. These babies were more likely to be breastfed and their mothers more likely to be depressed and have greater maternal sensitivity.

Heart of the problem Stanford University School of Medicine researchers have identified the molecular basis for a heart condition that is the most common cause of sudden cardiac death among young athletes. The scientists bioengineered heart muscle cells using special stem cells extracted from the skin cells of 10 members of a family with a genetic mutation that causes hypertrophic cardiomyopathy (abnormally thick heart muscle). They then compared these heart muscle cells from the family members who have the mutation to those without it. They found that the cells with the mutation began to change after about 30 to 40 days in culture – displaying abnormal rhythms and elevated calcium levels. This is the first time calcium’s role in hypertrophic cardiomyopathy has been demonstrated conclusively in human cells. The researchers also used the bioengineered heart cells to quickly pinpoint the drugs most likely to be effective in human patients and to study their potential as preventive medications.

4 MEDICAL OSTEOPOROSIS

Fresh hope for old bones ......................................................

Elizabeth Snouffer healthpost@scmp.com Osteoporosis, the disease that weakens bones to the point of fragility and possible fracture, has long been known to be an irreversible condition. But a new study by researchers from institutes in China and Hong Kong provides hope that the debilitating disease could one day be remedied.

The multidisciplinary team of 30 scientists, including those from Hong Kong Baptist University (HKBU) and the China Astronaut Research and Training Centre in Beijing, has identified a type of generegulating molecule that acts as a key barrier to bone formation in skeletal disorders.

Further, this molecule could potentially be derived from herbal plants. Published in Nature Scientific Journal last month, the study suggests that therapeutic inhibition of the molecule, called miR-214, may

promote bone formation and therefore may reverse osteoporosis.

The molecule is a type of microRNA, a small molecule of ribonucleic acid (RNA), which is similar to deoxyribonucleic acid (DNA), the genetic material of a cell.

Scientists estimate that 500 to 1,000 microRNAs exist in the human genome. MicroRNAs play a crucial role in regulating genes, most typically by attaching to a piece of messenger RNA and blocking it from being translated into a protein.

The miR-214 molecule has previously been shown to play a role in cancer tumour progression and metastasis, but this study is the first to report its role in the regulation of bone formation.

Led by Dr Zhang Ge, an Associate Professor at the Institute for Advancing Translational Medicine in Bone & Joint Diseases at HKBU, the research team found that elevated miR-214 levels was linked with a lower degree of bone formation in bone specimens from

The best strategy for prevention is to develop a strong bone bank when you are young aged patients with fractures. The team also further defined the role of miR-214 by its capacity to mediate or alter an important protein in bone formation, called ATF4.

“Our observations give the first evidence from clinical bone specimens with low bone mass and osteoporotic fracture that miR-214 inhibits bone formation,” Zhang explains. “This study provides a novel target for [the research and development] of a new osteoporosis drug.” However, Zhang points out

that future studies are not yet ready for trials in humans.

His next step will be to determine the structure of miR-214 for designing new drugs or screening compounds from natural products in herbal plants.

Professor Lu Aiping, dean of the School of Chinese Medicine at HKBU, is optimistic about the team’s new finding: “I hope that Dr Zhang’s group can further determine the structure of miR-214 so as to design and screen the compounds from Chinese medicinal plants for the discovery of new anti-bone-loss drugs.”

Bone is living tissue, and continuously renews and changes through a process called remodelling. There are two distinct stages in the bone remodelling cycle: bone resorption (breakdown) and bone formation.

During resorption, special cells called osteoclasts on the surface of bones dissolve tissue and create small cavities. During formation,

CASE HISTORY

When fate plays a hand ......................................................

Eileen Aung-Thwin healthpost@scmp.com

Illustration: Angela Ho

Matteo Russo’s left thumb hurt every time he tried to move it. He assumed that, because he was 74, the problem might be age related.

He consulted a rheumatologist who diagnosed tendonitis, or inflammation of the tendon. He gave Russo (whose name has been changed for reasons of patient confidentiality) anti-inflammatory medication. Although the medication initially helped reduce the pain, the condition of his hand worsened over the next month to the point where Russo was in pain even when his hand was at rest.

Having lost confidence in the rheumatologist, Russo turned to the orthopaedic department at the University of Perugia, Italy. Radiographs showed that the bones in his hand were more porous than normal, with signs of cartilage wear and tear in his thumb joint. Russo was diagnosed with carpometacarpal osteoarthritis, and prescribed a hand splint to rest the joint, keep it in position and reduce pain.

Two months later, Russo lost his appetite. A heavy drinker and smoker, he had also been losing weight. His left hand was increasingly swollen and painful.

The pain was so excruciating that Russo could not even lift it without pain, much less use it.

Despite the agony and the obvious distortion of his hand, Russo endured the pain, refusing to seek medical help.

The following month, he was admitted to hospital with respiratory distress and severe weakness. The mass on his left hand was so large his hand looked like an inflated rubber glove. The slightest touch would inflict excruciating pain.

Dr Giuseppe Rinonapoli, associate professor of orthopaedics and traumatology at the University of Perugia’s orthopaedic department, was called in.

When he saw the condition of the hand, he suspected that a cancerous tumour had taken root but he needed to be sure.

An X-ray showed that the bones

at the thumb joint had nearly disappeared – they had been dissolved by the body. The rest of the hand was osteoporotic, meaning the bones had become porous.

Rinonapoli tried to have Russo undergo a magnetic resonance imaging (MRI) scan but severe pain meant he couldn’t keep his hand still long enough to complete the scan.

Given his respiratory symptoms, severe weakness and heavy smoking habit, internal medicine doctors gave him a chest X-ray. A lesion was found at the top of his left lung. A computed tomography (CT) scan showed a huge mass in his chest.

Further tests confirmed that Russo had large cell lung carcinoma, or lung cancer. This form of lung cancer makes up 9 per cent of lung cancers and metastasises to the brain in half of the cases.

Biopsy of his hand tissue showed that the cancer had metastasised to his hand, which is unusual. Other scans showed that it had only spread to the hand so far, making it the first location of metastases, which is an extremely rare occurrence.

Cancer cells break away from the tumour and travel in the bloodstream or lymphatic system to the bone marrow. Scientists think

protein molecules in the bone marrow called cytokines may attract cancer cells. But metastases usually take place in parts of bone that are rich in marrow, says Rinonapoli.

Metastases to the extremities are not common. Only 10 per cent to 15 per cent of bone metastases occur in the upper limbs, and only 4.1 per cent take place below the elbow or the knee.

The metastasis meant that Russo had stage IV lung cancer, with little hope of a cure. The goal was to extend and improve the quality of his life.

Given the extreme erosion of the bones in the hand, and to prevent the cancer from spreading further, Rinonapoli amputated Russo’s hand from above the wrist. Six months later, Rinonapoli examined Russo’s forearm, which was healing perfectly.

Unfortunately, Russo continued to deteriorate rapidly despite chemotherapy. The cancer eventually metastasised to his brain.

A few weeks after that discovery, Russo died.

Rinonapoli says that the rarity of the hand for bone metastasis might have delayed an accurate diagnosis.

MEDICAL 5 Dr Zhang Ge. Photo: David Wong osteoblasts fill these cavities with new tissue.

When healthy, bone resorption and formation take place in close sequence and remain balanced. An imbalance in the bone remodelling cycle normally occurs during menopause and with ageing in both genders. An imbalance can result in bone loss that leads to osteoporosis.

Osteoporosis is becoming more prevalent worldwide due to the ageing population. The condition is particularly a problem for postmenopausal women. According to Professor Suzanne Ho Sut-ying, research professor of community and family medicine and head of division of epidemiology of the Jockey Club School of Public Health, osteoporosis is an important public health concern.

There are two categories of osteoporosis medications: antiresorptive medications that slow bone loss and anabolic drugs that increase the rate of bone formation.

Osteoporosis medication use and effectiveness depends on the patient characteristics, medical history and preference, says Ho. She adds: “Further drug development is certainly required.

But treatment will still build on the basic requirement of adequate dietary intake, particularly calcium and lifestyle strategy like physical activity and vitamin D exposure.”

According to experts, the best strategy for osteoporosis prevention is to develop a strong bone bank when young. This is easily achieved with regular exercise, good nutrition and keeping a healthy lifestyle.

OSTEOPOROSIS RISK FACTORS Uncontrollable • Being over age 50 • Being female • Menopause • Family history • Low body weight • Broken bones or height loss

Controllable • Not getting enough calcium and vitamin D • Not eating enough fruits and vegetables • Getting too much protein, sodium and caffeine • Having an inactive lifestyle • Smoking • Drinking too much alcohol • Losing weight

From the US National Osteoporosis Foundation

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6 COVER STORY

Sprockets of resistance A small but growing group of cyclists are trading hi-tech wizardry for the simplicity of fixed-gear bicycles, writes Jeanette Wang

Eric Lee, co-founder of Rodafixa, says sales of fixed-gear bikes have been picking up. Photo: Nora Tam

COVER STORY 7

I

n this era of blinged-up, electronic-geared, ultralight carbon fibre bicycles that can cost as much as a car, it is ironic that the latest trend in the twowheeled world is actually a case of less is more. We’re talking a lot less: typically a metal frame, two wheels, one gear and, often, no brakes.

A fixed-gear bicycle, or “fixie”, is as basic as a bike gets. It is so named because, unlike a typical bicycle, it doesn’t have a freewheel – meaning you can’t just stop pedalling and coast along using forward momentum. On a fixie, the cog is directly bolted to the rear wheel’s hub, so if the wheel is moving, the pedals are, too. To stop – if the bike has no brakes – pedal backwards.

For Jason Dembski, 31, an architectural designer who took up fixed-gear riding in 2009 when he moved to Hong Kong, a fixie is the “purest form a bicycle can take”.

“Clean and simple – no brakes, no gears, no cables, just the bare essentials,” says the native of Columbus, Ohio, in the US. “Beautiful.”

There is a small but growing fixed-gear culture in Hong Kong, according to Brian Fu Hau-chun, 44, co-owner of Rodafixa Fixed Gear Boutique in Kwun Tong and the pioneer of fixed-gear bikes in Hong Kong. When he first opened shop – a tiny 300-square-foot space in Kau U Fong in Central – in January 2009, he was selling about one bike every two weeks. These days, he sells about 10 bikes a month.

At the same time, customers are now willing to shell out more for their prized steed: Fu first imported Taiwanese-made bikes costing about HK$3,000 each, but now he stocks a range of bikes that can cost up to HK$18,000.

“Fixed gear in Hong Kong is getting more popular. Sales have gone up about 20 per cent in the past year,” says Brian Kwan, 26, founder of Bicycle Pit, which has two shops, in Jordan and Tsuen Wan. Kwan first got into fixies seven years ago while living in London; he had been riding geared bikes for five years before that. “I feel more attached to the bike when I’m on a fixed gear, and the minimalist appearance looks amazing,” he says.

Indeed aesthetics – not only how the bike looks, but also what it says about its owner – are arguably what has made fixies popular, particularly among young urbanites. Adopted by a band of bicycle couriers in New York City and San Francisco in the 1970s, fixed-gear bikes, Fu says, are really just track bikes ridden on the street instead of in a velodrome.

Track cycling has been popular since 1870 and was included in the inaugural Olympic Games. Bicycles were all fixies until the late 1890s when the freewheel was invented.

But in the past few years, the marrying of the fixed-gear bike into pop culture and fashion has elevated the steed to hip status.

Actor Joseph Gordon-Levitt straddled one in the recent Hollywood blockbuster Premium Rush, where he portrayed a bicycle courier who gets mixed up in a criminal plot in New York City. Last month, fashion chain H&M announced a collaboration with East London’s Brick Lane Bikes, Britain’s first fixed-gear bike store,

Fixed-gear cyclists with their bikes on the West Kowloon Waterfront Promenade (above) before a ride; Viola Tso (below left) on her “fixie”. Photos: Nora Tam

Fixed-gear [riding] will never be mainstream, but it won’t go away. It will stay as a street culture, like skateboarding ERIC LEE, CO-FOUNDER, RODAFIXA

on a new men’s collection to launch in March worldwide.

Closer to home, Shanghai Tang worked with Dutch bicycle maker Colossi Cycling on a limited-edition fixed-gear bicycle. Fu’s local fixedgear collective, Flwrider, worked with Lee Jeans in 2011 to showcase a new city cycling clothing line. This weekend, fashion brand agnès b. presents the first Bicycle Film Festival (bicyclefilmfestival.com) in Hong Kong, starting on Friday at the Arts Centre in Wan Chai.

But beyond a fashion statement, riding a fixed-gear bike can be a great workout. Professional cycling coach Chris Carmichael, who has worked with Lance Armstrong, incorporates fixed-gear work in his training programmes.

Carmichael says riding a fixie provides much more aerobic benefit than geared-bike riding because the legs are constantly in motion. He says that 90 minutes to two hours of fixed-gear riding is equivalent to about four hours of regular riding.

Joe Friel, a renowned endurance sports coach and author, prescribes

fixed-gear riding to improve the efficiency and smoothness of the pedalling stroke. Most people waste energy at two dead spots of the pedal rotation, the six and 12 o’clock positions. The constant pedalling motion of fixed-gear riding can help overcome that.

Having only one gear also builds leg strength and power, because when you a hit a hill, you can’t shift down to an easier gear. You’ve just got to work harder. “Your gears are your legs,” says Eric Lee Chi-wai, 44, co-owner of Rodafixa.

Kwan, who cycles up to four times a week, says: “I have become stronger, both physically and mentally, since taking up fixed-gear riding.”

Dembski, who mainly commutes by bike, says cycling has helped him quit smoking. The experience of fixed-gear riding is also special. “You feel much more connected [to a fixed-gear bicycle] than you do to a normal bicycle,” he says.

“Depending on how you look at it, the bicycle becomes an extension of you, or you a part of it.”

The simplicity of a fixed-gear bike means it is usually more affordable and much easier to maintain than a regular bike. Lee recommends a budget of about HK$5,000 for a “reasonable bike”.

While it may be cool to have no brakes and pull off skid stops, it is illegal to ride without any brakes in Hong Kong, according to former pro cyclist Kenji Leung Chi-yin. “Riders must install a brake on the front to ensure their own safety and also of pedestrians,” says Leung, a cycling coach with ZERO1 training group.

“And always wear a helmet when you ride.”

Pick a gearing that suits your level of fitness and the terrain you’ll be riding on. It should be just heavy enough so that you’re not spinning like crazy, but also find it easy for starting off from a traffic light and maintaining control going downhill.

Having an unsuitable gearing could put pressure on the knees and cause injuries. The average rider will have a 17-tooth cog at the back and a 47tooth chain ring.

Try to get your first few rides in

an area with little traffic and flat terrain to allow yourself to get acquainted with the bike. If you do forget and coast, you’ll be immediately jolted from your seat.

“Riders should make sure their skill level is sufficient to handle the bike,” says Leung.

Is fixed gear just a fad? Lee doesn’t think so. “It’s never going to be mainstream, but it won’t go away. It’ll stay as a street culture, like skateboarding.”

“With the sport of cycling gaining more attention in Hong Kong,” Leung adds, “I believe there will be an increasing number of fixie riders as well.”

If the late French bicycle racer and Tour de France founder Henri Desgrange had his way, all cyclists aged 45 and under would be riding a fixie. As he once said: “I still feel that variable gears are only for people over 45. Isn’t it better to triumph by the strength of your muscles than by the artifice of a derailleur? We are getting soft ... As for me, give me a fixed gear!” jeanette.wang@scmp.com

8 HEALTH THE TASTE TEST SMOKED SALMON

HEADACHES

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It doesn’t hurt to know ...................................................... zigzag lines are seen just before the Balvinder Sandhu healthpost@scmp.com

A headache is a fairly common ailment, but when does it warrant more serious medical attention than a painkiller? There are several types of headaches, including “secondary headaches”, in which a pain in the head is a manifestation of a more serious medical condition.

“There is a need to get the right diagnosis to dismiss the more sinister secondary headaches and to distinguish whether it’s a chronic headache, a tension headache or a migraine. One reason is that each involves different medications,” says Dr Edward Wong, a specialist in neurology at Pacificare Medical Centre in Tsim Sha Tsui.

A tension headache is the most common, according to Dr N.V. Ramani, consultant neurologist at Raffles Neuroscience Centre in Singapore. “This headache lasts from some minutes to a few hours, typically affects both sides of the head, in the front and/or sides, often like a tight band. It usually occurs towards the end of the day, without nausea or visual disturbances.”

The second most common headache is migraine, says Ramani.

This lasts a few hours, or even days, and usually affects only one side of the head. It can be severe, and is usually associated with nausea and vomiting, and there is often increased sensitivity to light (photophobia) or sound (phonophobia). “There may be a warning where flashing lights or

headache starts,” he says.

Another frequent complaint is a cluster headache. These can occur daily or nightly as one-sided front headaches that are frequent, but short-lived, says Ramani. This headache typically disappears after a few days. It can recur up to a year later and may be associated with tears and a reddening of the eyes.

Ramani says these headaches are benign, or non-dangerous, headaches. Secondary headaches, however, are a symptom of some other more sinister health issue.

These include conditions such as meningitis, brain tumour, brain aneurysm, stroke or glaucoma.

“Warning signs of a more serious cause include: a headache that starts

for the first time above the age of 40; wakes you up from sleep, or is noticed on awakening; worsens after coughing, sneezing or straining; is associated with weakness or numbness or visual loss; occurs after a head injury; or does not respond to usual painkillers.

“Headaches with any of these features need medical attention as soon as possible,” explains Ramani.

Wong says patients who have headaches with fever are checked straight away for meningitis.

Headaches that occur after trivial injury also warrant a closer look.

If the cause of a headache is not known, at least the triggers should be. Says Wong: “It could be alcohol or even stress. Knowing what triggers them and how to deal with them is

very important. Sometimes, some of the triggers can be avoided.”

At other times, triggers such as work stress may not be easily avoidable so patients need to learn how to deal with them, Wong says.

Headaches from stressful situations, for example, can be eased with paracetamol or a relaxation technique, he says.

Age and gender also affect one’s tendency to get headaches. They tend to start at a young age, often in school or early adult working life, and may occur intermittently throughout adulthood, says Ramani.

“It would be unusual for anyone above the age of 40 to start developing benign headaches for the first time in their life,” he says.

Migraines are more common among women, and triggers can include menstruation and certain foods, such as cheese, coffee and red wine, says Ramani. Tension headaches are common in both genders, especially in young people and office workers, he says. The most common causes of such headaches are the tight muscles in the shoulders, neck, scalp and jaw.

Treatment plans for headaches include taking painkillers, or nonpharmacological treatments such as relaxation, biofeedback and cognitive behavioural therapy.

“Relaxation, meditation and lifestyle changes may be helpful to prevent headaches. If headaches occur, take the painkillers immediately at the recommended doses,” says Ramani. “But if any warning signs occur, seek medical attention as soon as possible.”

Take painkillers, but if warning signs occur, seek medical attention as soon as possible DR N.V. RAMANI

Jeanette Wang jeanette.wang@scmp.com Regal Smoked Salmon HK$140 for 200 grams, City’super Wood-roasted with mixed peppers and spices, this Marlborough salmon hails from the “pure crystal clear waters” of New Zealand’s Marlborough Sounds and is said to be one of the world’s finest. It contains no artificial flavours or additives.

Verdict: pale pink and mushy, it didn’t taste very fresh.

Le Borvo Semi-cooked Atlantic Salmon Steak with Spices HK$140 for 160 grams, City’super This Norwegian salmon is from Le Borvo, formerly the name of a Michelin-star restaurant in Paris until its founder turned fish expert and transferred it to his smoked salmon producing company. This steak is spiced up with pink peppercorn, dill, coriander, fennel, and green, black and white peppers.

Verdict: the spices and smoking don’t overpower the natural flavour of the fish, which is super fresh, moist and flakes finely with a fork.

Echo Falls Cracked Pepper Flavour Smoked Salmon HK$75 for 113 grams, City’super Unlike cold smoked salmon, this American hot smoked salmon is fully cooked and has a meatier texture and sweeter flavour due to sugar in the brine. Good in omelette or scrambled eggs, with pasta, or as a pizza topping.

Verdict: the fish is wonderfully firm yet flakey, and a bit drier than typical smoked salmon. Also has a bold woodsmoked and peppery flavour.

FITNESS 9 HEALTHY GOURMET

Running lean on greens and beans ......................................................

Andrea Oschetti healthpost@scmp.com I am making a commitment for the New Year. I want to run a marathon in under three hours, like I did in New York in October 2009. It’s relatively easy to adopt a running plan, but I find it difficult to drop down to race weight, a fundamental component of performance.

My body has a tendency to accumulate fat. For the last two months I have not raced, relaxed my eating habits and went home to Italy for the holidays, which meant eating too much of the Italian Christmas cake, Panettone. I need to lose body fat. Although I eat healthily, and it shows in my blood tests, it is not enough to achieve my goal. I know that diets don’t work: weight loss is regained because of the slower metabolic rate induced by eating less than the body needs.

A sustainable weight loss can come only from a metabolic change.

How to induce this change is difficult to know, not only because the science is still in its infancy, but because we are each unique and respond differently to food.

Scales can be misleading … I will use the mirror to track my changes towards a leaner and more toned body In the past four years, I spent a lot of time studying and researching nutrition, talking with athletes about their diet and experimenting with eating plans. Based on this I have devised a few guidelines.

1. I will not restrict my calories.

When I eat is as important as what I eat. The main signals for our metabolism are received in the morning; hence breakfast is significant. I will have dinner several hours before going to sleep, so that it does not interfere with my body clock, which wants to rest my stomach and intestines at night.

Cream of spinach with olives, raspberries and almond milk pudding Serves 4 400 grams spinach 50 grams Italian parsley Extra virgin olive oil Dried chillis Zest of 1 lemon Salt 400ml unsweetened almond milk 2 grams agar agar or other jellifying agent 1 sprig of rosemary 16 olives 16 raspberries

2. I will not look at the scales.

I want to lose fat and gain muscle.

Scales can be misleading; a bioimpedance analysis can differentiate fat from muscle. I will use the mirror to track my changes towards a leaner and more toned body.

3. I will eat quality food.

Refined sugar, deep-fried food, hydrogenated fat, sweeteners and preservatives are my enemies.

So no packaged foods and only home-made desserts where I can control the ingredients. I know that dairy makes me accumulate fat and grains make me feel bloated, so they’re out until I reach my goal. I will eat lots of fruits, preferably unadorned and never after a meal.

I will focus on a plant-based diet.

The most nutritious are green vegetables: leafy vegetables, peas, green beans, bok choi, sprouts, broccoli and cabbage. Then fruits, legumes and non-green and nonstarchy vegetables.

Lastly, I will keep my fibre intake high. Artichoke, green peas, broccoli, beans, raspberries, pears and apples have all more than five grams of fibre per serving.

4. I will eat enough protein.

For me, this is from one to 1.5 grams of protein per kilogram of bodyweight per day. I will favour fish over meat.

5. I will limit my yeast consumption.

I know I’m sensitive to it after I took a food allergy test. Inflammatory foods affect our metabolism and the body’s ability to lose or gain weight.

6. I will diversify what I eat and focus on making food interesting and appetising. Boiled spinach is boring but with some accompaniments, like those in this week’s recipe, you can make any food exciting.

7. I will favour high-intensity training.

This is the most effective way to stimulate the fat burn.

8. I will focus on achieving a psychological balance. I will do this mainly through adequate sleep and eating my meals slowly.

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

Andrea Oschetti has resolved to return to the shape he was in for the 2009 New York City Marathon

• Boil the spinach and the parsley in water for one minute.

• Cool in ice cold water.

• Reduce to a pulp, together with one tablespoon of oil and the dried chillis, using a food processor.

• To obtain a creamy consistency, add water as necessary.

• Add the lemon zest and the salt and set aside.

• Boil the almond milk, agar agar and rosemary for five minutes.

• Pour into moulds and let cool for a few hours in the fridge.

• Serve the creamed spinach warm in a plate with the pudding in the middle and the raspberries and olives scattered around it.

10 FITNESS MARATHON MANIA WEEK 6 Physiotherapist David Garrick says runners should take training breaks. Photo: Felix Wong

Make the best of the rest ......................................................

Rachel Jacqueline healthpost@scmp.com Rest replaces my usual schedule of drills, speed work and long runs on Tuesdays and Saturdays. Being the competitive type, the “R word” is generally not part of my vocabulary and I’m often tempted to do something extra.

But the experts advise that recovery, done right, is the key to getting in top condition.

“Recovery is about letting your body heal so you can be ready for your next session,” says David Garrick, a physiotherapist from Physio Central in Central. He strongly encourages runners to take recovery seriously when undergoing intense training, such as interval, tempo or long runs. “Without adequate recovery, you will not reach peak performance and may be more prone to injury.”

Building recovery into a training programme will help your body to adapt to training loads, get stronger and give you a mental break to keep up the zest for running.

Rest – otherwise known as “passive recovery” – is the most common recovery method allowing muscles to repair, rebuild and strengthen says Dr Lobo Louie, associate professor at the department of physical education at Baptist University.

“Active recovery refers to engaging in low-intensity exercise after workouts during both the cooldown phase immediately after a

hard effort as well as during the days following the workout,” he says. An example would be a short, easy “recovery run” in the 24 hours after a hard session.

It seems counterintuitive to exercise more when you’re sore, but active recovery helps clear lactic acid (responsible for that feeling of “soreness” after a strenuous session) from the blood faster than passive recovery, according to a study published in 2010 in the Journal of Sports Sciences.

To see improvement over the long term, athletes should take a strategic approach to recovery, says Louie. “Any training regimen should also include periods of recovery, including full rest periods and cross training, modification in workout types, and changes in intensity, time, distance and all the other training variables,” he says.

Without proper recovery, athletes may end up doing more harm than good, resulting in “overtraining”. This is when the body is exerted beyond its ability to recover, resulting in exhaustion.

The amount and type of recovery depends on the individual and one’s training programme, says Dr Michael Tse, director of the Active Health Clinic at University of Hong Kong’s Institute of Human Performance. “There is no hard and fast rule,” he says. “Rest too much and you will lose fitness; rest too little and you are on the slippery path to overtraining.”

Recovery becomes more important after a longer and harder

session, and when you are training more than four times a week. A general rule of thumb, says Tse, is to always follow a strenuous session with active recovery.

There are a number of other recovery techniques, such as ice baths and proper nutrition, which can benefit every athlete, says Garrick. Here, he and other experts share their strategies: Have an ice bath “When you’re exercising, you get a lot of waste products developing in your body,” says Garrick. Icing assists the body to eliminate these products. “An ice bath is going to change your blood flow, flushing out waste products that might have built up from training,” he says.

While having an ice bath after each training session may seem excessive, running cold and hot water alternately over the legs will also help. Other methods to help flush out lactic acid include wearing compression gear and self-massage.

Get enough sleep Louie says sleep helps the body repair itself. “Running causes physiological changes in the body, such as muscle tissue breakdown,” he says. “Eight hours of sleep is ideal.” Recent studies have shown that even more sleep – at least 10 hours a night – and napping where possible will also increase an athlete’s performance.

A 2011 study in Sleep Journal, found that collegiate basketball players on an increased sleep regime

Without adequate recovery, you will not reach peak performance and you may be more prone to injury DAVID GARRICK, PHYSIOTHERAPIST

over a period of five to seven weeks reported faster sprint times, reaction times and better moods.

Eat within 30 minutes of finishing a workout Proper refuelling after exercise is the most important aspect of a runner’s recovery, says Sylvia Lam, a dietitian at Pro Cardio. “Athletes need three things: carbohydrates to restore muscle glycogen, protein to repair muscles and fluids to rehydrate,” she says. “Our muscles store glycogen most efficiently within 30 minutes of completion of training, so it’s very important to have carbohydrates ready.”

Lam suggests easy-to-digest food such as smoothies, yogurt, fruit (such as bananas) or energy bars.

For fluids, marathon runners should replace 125 to 150 per cent of fluid loss. Fluid loss can be calculated by subtracting your post-run weight from your pre-run weight, and adding any fluids you may have drunk during the run.

“It’s best to use sports drinks to replenish both fluids and electrolytes together,” says Lam. Do a recovery run Fan Siu-ping, a Hong Kong national marathon runner, says recovery runs are an important part of her training regimen. “The cycle of intensive workouts followed by rest and recovery has helped me gradually push my maximum performance,” she says.

Recovery runs should be short, between 30 to 45 minutes, and at a low intensity, says Garrick.

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

RACHEL’S DIARY Here’s a one-word description of my second three-week training block by coach Clinton Mackevicius: “tough”.

Repetitions have stayed at the same speed but increased in time, and the 26-minute threshold session seems tougher than the 90-minute Sunday run. But it’s worth it. I’m running faster and for longer with less effort. I’m feeling on track for my five minute 20 seconds race pace.

The big test will be the longer road sessions in the weeks to come. My current greatest challenge is staying motivated on flat roads when my mind idles. More on that next week.

FITNESS 11 PERSONAL BEST

Wheeling on top of the world Cows graze on the grass verge of a hairpin bend as the riders push on uphill; setting off on one of the time trial stages of the Haute Route (top left); hot air balloons give a bird’s-eye view of the action (bottom left).

Photos: Pat Fitzpatrick

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

Pat Fitzpatrick healthpost@scmp.com On a warm summer morning last year, three riders from Hong Kong, me, and 600 other eager cyclists gathered on the shores of Lake Geneva in Switzerland. The riders, from 22 countries, were of varying age categories, genders, and cycling backgrounds.

In front of us lay the Haute Route, billed as “the toughest and highest ‘cyclosportive’ in the world”: seven days, 780 kilometres, 19 famous cols (mountain passes) and 21,000 metres of climbing in the Alps, with the finish line at Nice’s famous Promenade des Anglais on the Mediterranean coast of France.

The cyclosportive is to cycling what the marathon is to running. It’s a long-distance, mass participation event which, for most, is a personal battle against distance and the clock, rather than a race. Completion is an achievement in itself.

Spirits were high on that first morning. Competitors had obviously done their training: they looked fit, tanned, lean and ready for the challenge. The warm conditions were ideal for our pre-dawn ride out of Geneva. We paused momentarily when the starting gun fired, to admire the beauty of Lake Geneva for one last time.

The warmth of that first morning became a baking hot European

summer with the relentless, dehydrating heat. It was persistent, and only interrupted twice, by icycold Alpine storms that had us reaching for thermal clothing as the evening approached.

The Haute Route event was incredibly well organised. Water and feeding stations were plentiful and hundreds of volunteer road traffic marshals lined the route.

Official motorcycle escorts ushered us along a safe passage. Each town, village and city we whizzed through came out to clap, cheer and support us. The atmosphere was amazing, and we felt like riders in the real Tour de France.

We pushed our bodies to the limit as we rode up and down 19 of Europe’s highest, toughest and most famous cycling roads. Occasionally, the sound of an alpenhorn accompanied us as we pedalled silently up long mountain valleys.

We had a set programme for each day. We would rise early for breakfast, head to the race start and wait for the gun. Then eat, drink and pedal for hours until we reached the day’s finish line. We’d then retire our bikes in the secure parking area, collect our small daypack with fresh clothes, and get a massage to soothe our aching bodies.

We’d then eat a nice warm French-inspired meal, find our hotel, and attend the briefing for the next day’s ride. Bedtime was earlier than usual.

SADDLE UP FOR 2013 Gran Fondo Milan San Remo The 43rd edition of the event on June 9 will feature the same 290-kilometre route ridden by the pros during the annual spring classic in March. Riders face the famous slopes of the Turchino and the Cipressa. milano-sanremo.org La Marmotte Covering 174 kilometres and with 5,180 metres of climbing, this is thought to be the first cyclosportive.

Several famous Tour de France mountains feature: the Col du Glandon, Col du Telegraphe, Col du Galibier and the final ascent of the L’Alpe d’Huez. Set for July 6. sportcommunication.info L’Etape du Tour Established in 1993 to allow amateur cyclists to test their legs on the route of one of the mountain stages of the Tour de France. This year’s event will be held on July 7, in Annecy. letapedutour.com Tour de Bintan Held on Bintan Island, Indonesia, this three-day tour in November has categories for all abilities.

Participants cycle 300 kilometres. tourdebintan.com

The mood was very positive each night at the briefing. We’d congratulate each other on surviving another day. Camaraderie was building quickly on and off the road.

We were living the dream, the life of a pro rider. Although, with the demands placed on our minds and bodies, many riders would attest that we were living a nightmare.

We rode alongside former world champion Emma Pooley of Britain, Formula One legend Alain Prost and – one of my personal highlights – the inspirational young men from the Kenyan National Cycling Team.

Just how tough was each day? To put the ride into context, the 20kilometre out-and-back route to The Peak is popular with Hongkongers.

Imagine doing that seven times, which is the equivalent of what we did on day three. Starting at the ski resort town of Courchevel in France, we rode 140 kilometres through the Alps and climbed 4,700 metres over the Col de la Madeleine, Col du Glandon and finished atop the famous L’Alpe d’Huez ski station.

The Hong Kong trio – Duncan Morris, Glen Pendry and Nial Kelly, all 40-something and part of team South Island Riders – and I survived the day. Others didn’t: 20 per cent of the field was eliminated on that day for arriving after the cut-off time.

So what drives seemingly normal people to push themselves to extremes? The Hongkongers were all avid recreational cyclists from

We pushed our bodies to the limit as we rode 19 of Europe’s famous cycling roads varying sporting and professional backgrounds prior to the Haute Route. After cycling in Europe in 2011 for a week and covering 600 kilometres, they were bitten by the cycling bug. They wanted to ramp things up for 2012, and so they chose the Haute Route.

From November 2011 until the race start in August last year, they gradually increased the frequency and duration of their rides. They made weekly training plans and stuck to them. If Hong Kong’s weather stopped them riding outdoors, they rode for hours on a stationary bike trainer indoors.

Their social habits changed. The more they exercised, the less alcohol they consumed. Their eating and dietary habits improved to fuel their hungry, efficient bodies.

Each rider had a goal of finishing in the top half of the field, and in the end all three crossed the line within the top third.

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JANUARY 8, 2013 SOUTH CHINA MORNING POST