20130122 health post

YOUR GUIDE TO LIVING WELL

HEALTH POST

TUESDAY, JANUARY 22, 2013

GINSENG: THE RIGHTEOUS ROOT >PAGE 5

PERSONAL INTELLIGENCE >PAGE 11

Up and running Going the distance in the shadow of Everest >PAGE 6

2 NEWS HEART DISEASE

HEALTH BITES

Cholesterol: the good, the bad and the ugly

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Jeanette Wang jeanette.wang@scmp.com We know that high cholesterol is life threatening, but do you know which type is the most frequent killer?

Well, there’s the good, the bad, and the plain ugly – the latter raising the risk of ischaemic heart disease by three times.

This is the finding of a new study of 73,000 Danes published in the Journal of the American College of Cardiology.

Cholesterol is divided into “good” HDL (high-density lipoprotein) cholesterol, “bad” LDL (low-density lipoprotein) cholesterol and “ugly” cholesterol – also called “remnant-like particle cholesterol”, the really bad guy.

The study reveals that ugly cholesterol is the direct cause of arteriosclerosis (hardening of the arteries), says Professor Borge Nordestgaard, chief physician at Herlev Hospital and clinical professor at the faculty of health sciences at University of Copenhagen in Denmark.

“High ugly cholesterol is the result of high blood levels of normal fat [triglycerides]. The most important cause of high ugly cholesterol is obesity,” says Nordestgaard.

Most ischaemic heart disease is caused by arteriosclerosis. The coronary arteries supply blood to the heart muscle and no alternative blood supply exists, so a blockage in the coronary arteries reduces the supply of blood, and hence oxygen, to heart muscles.

In 2009, about a quarter of the Hong Kong population suffered from high cholesterol. Heart

ASK THE DOCTORS LEE YEOW HIAN

Jeanette Wang jeanette.wang@scmp.com

Don’t make app judgments Smartphone apps can do a lot of things these days, but it’s best not to trust them with diagnosing skin cancer. University of Pittsburgh School of Medicine researchers tested four apps that claim to evaluate a user’s photographs of skin lesions for the likelihood of cancer, uploading 188 images of skin lesions to each app. They found that three apps incorrectly diagnosed 30 per cent or more melanomas as “unconcerning”. Only the app that utilised dermatologists for a personal review of user images, essentially functioning as a tool to facilitate teledermatology, provided a high degree of sensitivity in diagnosis – just one of the 53 melanomas was diagnosed as “benign” by the experts reading the images. This app also was the most expensive, costing users US$5 per image evaluation. The study is published in JAMA Dermatology.

Net benefit to doctors The ease of access to online medical information has had a positive overall impact on the relationship between patients and doctors in Hong Kong, finds a survey of more than 100 physicians in the city.

Two-thirds of respondents shared this view, in the poll by Ipsos Healthcare and Ruder Finn Asia Health and Wellness released last week. A further 1,000 patients were polled and it was found that only 48 per cent of Hongkongers seek medical information online and 42 per cent self-diagnose – indicating that patients may be sceptical about such information.

Three in four doctors say they use the internet to check health information and medications, stay current on industry news and connect with their peers. Eighty-six per cent think online tools help to improve their diagnosis or treatment practice, and 60 per cent say they have changed a diagnosis based on information accessed online.

The most important cause of high ugly cholesterol is obesity PROFESSOR BORGE NORDESTGAARD, UNIVERSITY OF COPENHAGEN

diseases were the second most common cause of death in the city in 2010, accounting for 15.5 per cent of all deaths. According to World Health Organisation estimates, 17 million people fall victim to cardiovascular disease – the most common cause of death worldwide.

You can lower your blood cholesterol level by eating a low-fat diet and keeping your weight in the healthy range.

Nordestgaard says people with high ugly cholesterol should be advised to lose weight, but drugs such as statins and fibrates may also lower levels of ugly cholesterol in the blood.

Travellers evade Ebola virus If you’re travelling to the tropics, in particular Western Africa and India, seek pre-travel advice on vaccinations and medications, and while at the destination drink bottled water and take precautions to prevent insect bites. This is the recommendation of an international team of researchers that studied more than 80,000 returned travellers from the tropics who sought medical care for illnesses at GeoSentinalassociated clinics worldwide between June 1996 and August 2011. About 4 per cent of travellers were affected by malaria, typhoid fever and other potentially life-threatening tropical diseases – though not a single traveller contracted the highly contagious and lethal Ebola virus. There were a total of 13 deaths, 10 of which occurred in patients with malaria.

Travellers who become ill with fever or flu-like illness while travelling or soon after returning home from high-risk areas should seek immediate medical attention and share their travel history with their physician, cautions one of the researchers, Dr Mogens Jensenius of the University of Oslo.

Q: How can I stop a persistent cough so I can get some sleep?

A: The way to treat a persistent cough is to treat the underlying cause. It would be prudent to get one’s lungs X-rayed, especially in this region where the prevalence of tuberculosis is high.

Cigarette smoke is a common cause of irritation to the airways and, if at all possible, one should try to avoid the noxious and carcinogenic substances contained within. In those with a normal chest X-ray, common causes of chronic cough are asthma, gastrooesophageal reflux disease and postnasal drip due to rhinitis.

Dr Lee Yeow Hian is a consultant respiratory physician and intensivist with Lee Respiratory and Sleep Clinic at Mount Elizabeth Novena Specialist Centre

DNA helps predict cancer return Medical researchers at the University of Alberta tested the DNA of more than 300 women in Alberta and discovered a “genetic marker” method to help accurately profile which women are more likely to have their breast cancer return years later. Using a simple blood test, a research team led by Professor Sambasivarao Damaraju scanned the entire human genome of 369 women who had been diagnosed with breast cancer. Of those, 155 had their cancer come back and 214 did not. Treatment options for breast cancer patients are based on what doctors know about the tumour itself – its size, grade and the absence or presence of certain markers within the tumour. Damaraju thinks the accuracy of prognosis could be improved by complementing tumour-based markers with the DNA marker. “Treatment strategies could be tailor-made for these women based on their genetic make-up and how susceptible it makes them to breast cancer recurrence,” he says. The study was published in PLoS One. A larger study is planned to reconfirm these findings.

MEDICAL 3 TREATMENT CHRONIC MYELOGENOUS LEUKAEMIA

More drug choices improve prognosis ......................................................

Jeanette Wang jeanette.wang@scmp.com There are more chronic myelogenous leukaemia (CML) sufferers in Hong Kong than ever. But that’s a good thing because it means patients are living longer, according to experts.

Once an almost inevitable death sentence, the blood cell cancer has transformed into a nearly always treatable condition in the past decade or so, thanks to targeted drugs known as tyrosine kinase inhibitors (TKIs).

“The prognosis [for CML patients] is now very good,” says Dr Herman Liu Sung-yu, a specialist in haematology and haematological oncology. “So we’ve seen a cumulative increase in patients.”

The incidence of CML in Hong Kong is about 0.8 to 1 per 100,000 people, says Liu. About 50 to 70 new cases are diagnosed each year.

CML – one of five types of leukaemia – can occur at any age, but it most commonly affects middle-aged and older people.

Tyrosine kinases are proteins on leukaemia cells that act as on-off switches. TKIs shut down these proteins, in particular a mutant gene known as BCR-ABL, which causes the disease to flourish.

BCR-ABL occurs when two chromosomes swap portions of their genetic material from the BCR and ABL genes during cell division.

This abnormal gene is called the Philadelphia chromosome. The resultant fusion protein drives the

Imatinib is a terrific drug; but 30 to 40 per cent of CML patients become resistant to it DR JORGE CORTES

overproduction of white blood cells and immature stem cells, called blasts, which crowd out red blood cells and platelets.

Before 2000, fewer than half of CML patients survived seven years after diagnosis; now nearly 90 per cent do so. Imatinib was the targeted drug that turned things around: it received approval from the US Food and Drug Administration (FDA) in 2001, and in the same month made the cover of Time magazine as the “magic bullet” to cure cancer.

However, patients eventually become resistant to imatinib, and this has prompted the development of newer generation inhibitors.

Last month, the FDA approved the drug ponatinib, which will “drastically improve the outcome of most patients” who are resistant or intolerant to prior inhibitors, says Dr Jorge Cortes, professor and deputy chair at the University of Texas MD Anderson Cancer Centre Department of Leukaemia.

Ponatinib is the third drug approved by the FDA for CML in the past four months.

“It’s important to have as many therapies against cancer as we can, because rarely does one drug or combination succeed for all patients,” says Cortes.

Dr Raymond Wong Siu-ming, honorary clinical associate professor at the department of medicine and therapeutics at Chinese University, says a phase III clinical trial for ponatinib, involving patients worldwide, including a number in Hong Kong, will begin in a couple of months.

For now, patients in the territory have three treatment options approved by the Hospital Authority: dasatinib, imatinib and nilotinib. All three have been included in the Samaritan Fund as self-financed drugs with a safety net – meaning the government subsidises the drugs for patients who need them but have financial difficulties.

“Imatinib is a terrific drug; but 30 to 40 per cent of CML patients become resistant to it,” says Cortes.

“Nilotinib and dasatinib work for 40

> 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

to 50 per cent of these patients.”

Dasatinib, the newest drug on the list, was approved in Hong Kong as a first-line therapy for newly diagnosed CML in the chronic phase (about 85 per cent are diagnosed at this phase) in July last year.

A landmark study, published last year in the American Society of Haematology journal Blood, compared the effectiveness of dasatinib with imatinib. It showed that dasatinib has superior efficacy, as well as faster and deeper responses. The drug also gave patients better control of the disease and a higher overall survival rate.

Furthermore, dasatinib is unique in its simple treatment schedule – once daily, either in the morning or

evening, with or without a meal. Liu says this improves compliance among patients. “Continuous, effective dosing is important for optimal outcomes,” he says.

Madam Ho, 51, was prescribed dasatinib daily in July last year. After five months, her BCR-ABL reached undetectable levels. However, Ho has to take the drug continuously, which costs about HK$17,000 to HK$18,000 a month, says Liu. If she stops, the disease is likely to relapse.

“TKIs don’t eliminate leukaemia stem cells, which remain a potential source of cancer recurrence,” says Dr Ravi Bhatia from the City of Hope National Medical Centre in Duarte, California.

For now, patients have to take

TKIs indefinitely, which Bhatia says carries “a significant risk of toxicity, lack of compliance, drug resistance, relapse and associated expense”.

Fortunately, in Hong Kong, despite the growing pool of CML patients, Wong says the government has been very supportive. Hospital Authority figures show that in the past two financial years, all who applied to the Samaritan Fund for imatinib or dasatinib were successful. That’s 441 applications, or about HK$67 million in subsidies, for imatinib, and 40 applications, or HK$9.4 million, for dasatinib.

“We haven’t encountered any problems in getting support for these patients,” says Wong. “And we’re thankful for that.”

4 MEDICAL CASE HISTORY

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Cody Lehe had a great life and a bright future. A tall, handsome, strapping young man, the 17-year-old was a high school senior and captain of the football team. Lehe was also a smart student with his sights set on college. Buoyed by the support of a loving, well-to-do family, he had everything going for him.

Tragically, Lehe’s life was to take a sharp turn that not only derailed his potential, but also was very nearly fatal.

It began on the football field.

American football is a game that demands teamwork, strategy, skill and a tougher-than-nails attitude. If you want to play the game, pain is to be expected – and ignored.

During a Friday night game, Lehe received a helmet-to-helmet hit from an opponent during a tackle.

Although he was able to get back up, he told a teammate that it was the hardest hit he had ever received.

The impact left Lehe dizzy and unable to see clearly. But true to the macho code of football, he gritted his teeth, shook off the discomfort, and finished the game.

The next night, Lehe went to watch a college football game. But the following day, he complained of a severe headache and felt extremely tired. On Monday morning, he told his mother he wanted to see a doctor.

A computerised tomography (CT) scan showed that all appeared normal in Lehe’s head.

Nevertheless, the doctor told him to stop playing football until all his symptoms subsided.

But an important game was coming up. As team captain, Lehe was determined to set an example and get back on the field of play.

Moreover, his CT scans were completely normal, meaning there was no evidence that anything was seriously wrong.

The teenager did not tell his coach that he was still suffering the effects of Friday night’s hit to the head.

Despite searing headaches and finding it difficult to concentrate, Lehe attended practice and participated in hitting drills – exercises where players run at each other at full speed with the intention of knocking the other player down.

After taking a few hits, Lehe stepped to the side and told a friend: “My head is killing me, and I can’t feel my legs.” He then collapsed in a seizure before falling into a deep coma.

Illustration: Angela Ho

Eileen Aung-Thwin healthpost@scmp.com

Double trouble Lehe was rushed to a local hospital where CT scans showed small subdural haematomas, the pooling of blood on the surface of the brain. He was airlifted to the Goodman Campbell Brain and Spine Centre at Indiana University Health Methodist Hospital in Indianapolis.

Doctors there, including neurosurgeon Dr Michael Turner, found that the pressure inside his head was dangerously high. Normal levels should be between 5 and 15mmHg (millimetres of mercury).

Lehe’s brain was under a whopping 25 to 30mmHg of pressure.

His brain suffered another trauma before it had fully recovered from injuries caused by a first impact

Magnetic resonance imagining (MRI) scans showed that there were small blood clots, but they were not the cause of Lehe’s problems. The real problem was cerebral swelling.

Lehe was a victim of second impact syndrome (SIS) whereby his brain suffered another trauma before it had fully recovered from injuries caused by a first impact, leading to catastrophic – and often fatal – swelling of the brain.

SIS is a relatively rare condition, with only 30 or so reported cases in the United States to date. But the mortality rate is extremely high at 90 per cent, says Turner.

The condition has only ever been reported in young athletes. Turner hypothesises that teenage brains are susceptible to SIS because they are still developing, and the immature brain responds differently than the mature one to trauma.

The initial impact probably affects the brain’s ability to regulate the amount of blood reaching the organ, says Turner. When this cerebral autoregulation is impaired and a second jolt to the brain is delivered, the brain overreacts, causing the cerebral arteries to widen, enabling more blood to flood the brain, and therefore leading to massive cerebral swelling.

The swollen brain creates intense pressure inside the fixed confines of the skull. This pressure was so great in Lehe’s case that it pushed his brain and upper spinal cord downwards, and damaged parts of his brain.

Turner and his team battled for the next 55 days to save Lehe’s life.

They used everything in their medical arsenal to bring down the cerebral swelling and intracranial pressure, while trying to balance his blood flow, volume and pressure; respiratory rate; oxygenation levels; and other vital functions.

During this critical time, Lehe’s body suffered hypotension (low blood pressure), renal failure, sepsis, pneumonia and even temporary cardiac arrest.

When Lehe was finally stable enough to leave the intensive care unit, he faced disabling changes and a long road to recovery. Lehe was no longer able to walk or talk. He spent the next 43 days in rehabilitation before he could finally go home.

Six years later, Lehe still cannot walk without support.

He has regained much of his speech, but struggles with his short-term memory.

Given the rarity of this condition and the resulting dearth of data, SIS is not well understood.

Medical experts had long thought that SIS was brought about by blood clots that form after the first impact, thereby causing headaches. However, Lehe’s case was a particularly instructive one for medical researchers because the CT scan after his first hit was clean, which debunked this longstanding theory.

More importantly, says Turner, it shows that a clean CT scan does not prevent one from a devastating syndrome, and does not clear a player to return to the game.

Instead, severe and persistent headaches, such as those suffered by Lehe, might be a better predictor of the dangers of SIS.

HEALTH 5 TRADITIONAL CHINESE MEDICINE

The rise of ginseng ......................................................

Elizabeth Snouffer healthpost@scmp.com Ginseng has long been used in traditional Chinese medicine to boost immunity and lower blood sugar, but recent research suggests a new reason to consume the plant: to perk up, quite literally, a man’s sex life.

In a study published last month in the International Journal of Impotence Research, scientists from the Yonsei University College of Medicine in Seoul, South Korea, found that men who suffered from erectile dysfunction and took tablets of ginseng berry extract daily for eight weeks saw improved sexual function.

The research team concluded that ginseng should be considered as an alternative medicine to improve all domains of sexual dysfunction.

A wealth of studies provide evidence that more than half of the world’s male population has some degree of erectile dysfunction. Two main symptoms of sexual dysfunction are erectile dysfunction and premature ejaculation. Erectile dysfunction occurs when a man is not able to achieve or keep an erection for sexual intercourse.

Prevalence of erectile dysfunction in the Hong Kong population has been reported by University of Hong Kong’s Urology Division as 61 per cent of men aged 51 to 60, 47 per cent of men aged 41 to 50, and 38 per cent of men aged 31 to 40.

To treat erectile dysfunction, drugs such as Viagra and selective serotonin reuptake inhibitors are commonly used.

However, these drugs may produce negative side effects such as headaches, gastrointestinal disorders or muscle pain, and are often contraindicated with other drugs and illnesses.

Furthermore, these drugs are not well tolerated by the larger proportion of men who are most likely to suffer from the condition – those living with heart disease, stroke, hypotension, hypertension or diabetes.

Researchers working on the Yonsei University study hypothesised that ginseng berry extract could be as effective and safe as synthetic drugs, which work in much the same way.

The pharmacological properties of ginseng have been studied and used for more than 2,000 years.

In traditional Chinese medicine, Asian ginseng, particularly Panax ginseng, is used to increase strength, increase blood volume, promote life and appetite, and it has been prescribed for

weakness, deficient qi patterns, anaemia and impotence.

Each part of the ginseng plant has distinct properties and research has provided evidence to show that the berry contains a greater amount of a ginsenoside (the active compound in ginseng), which enhances nitric oxide – a chemical important for relaxing muscles and improving blood flow for sexual function.

In the Yonsei University study, 119 married men between the ages of 20 and 70 were administered either four 350mg tablets of ginseng berry extract or a placebo daily for eight weeks. Efficacy of the tablets

The [ginseng] tablets we used are … a kind of complementary medicine or dietary supplement CHUNG WOO-SIK

was assessed by a questionnaire known as the International Index of Erectile Function, which consists of 15 questions related to erectile function and sexual satisfaction.

The ginseng group scored significantly better in premature ejaculation. Other areas tested included intercourse satisfaction and sexual desire, which improved only slightly.

One member of the study team, Chung Woo-sik, a professor of urology at Ewha Womans University in Seoul, acknowledges that the extract is less efficacious than typical erectile dysfunction drugs.

“The tablets we used are not a drug, but a kind of complementary medicine or dietary supplement,” he says.

A scientific review of natural aphrodisiacs published in the journal Food Research International in 2011 found that ginseng, along with saffron and a chemical from the African yohimbe tree, were proven sexual performance boosters. The researchers from the University of Guelph in Canada examined hundreds of studies on commonly used aphrodisiacs to investigate claims of sexual enhancement, both psychological and physiological.

According to the Hong Kong Urology Clinic, the cause of erectile dysfunction includes poorly controlled diabetes, atherosclerosis and depression. Erectile dysfunction can also develop because of stress, anxiety or bad lifestyle choices such as smoking or a poor diet, which can lead to weight gain.

Certain surgical procedures or medical treatments, such as prostate surgery or radiation treatment for cancer, can also cause erectile dysfunction, as well as many drugs including hypertensive drugs, antidepressants, alcohol and tranquilisers.

There is some concern that the Yonsei University study, and others like it, suggest natural remedies might exacerbate sexual problems as patients shun more conventional medication.

Dr Yiu Ming-kwong, consultant and division chief of the University of Hong Kong’s Urology Division, believes that most patients in Hong Kong who are diagnosed by registered doctors feel positive about taking prescription medication.

“Most of them expect drug treatment from their GP or urologist during the consultation.”

Yiu also believes that many sufferers are never treated.

“The important point is that a lot of men suffering from erectile dysfunction are too embarrassed to reveal their problem to their doctor.

Instead, they will purchase overthe-counter drugs of various kinds, including drugs or tablets which claim to have ginseng.”

In October last year, researcher Mario Liong Chan-ching surveyed approximately 1,000 Hong Kong women and men aged 36 to 80 with stable partners to determine attitudes towards sex and erectile dysfunction prescription drugs.

Study results showed Hong Kong women had a lower level of support for erectile dysfunction drugs for their partners than their counterparts in Europe, North America and Australia.

6 COVER STORY

Peak condition N

estled into the foothills of the Himalayas, Nepal is a magnet for trekkers and a launch pad to scale the world’s highest mountains.

But as the ultra-running fad gains momentum, Nepal has become a proving ground for thrill seekers drawn to its striking scenery, extensive trail network and diverse terrain. Strong competition from local running talent is an extra drawcard for the destination.

In the past three years, the number of single and multi-day running races in Nepal has almost tripled. These are not your average 10-kilometre fun runs, but real tests of endurance. New to the racing calendar last year was the Annapurna 100-kilometre Ultra Mountain, descending from Annapurna Base Camp at 4,130 metres to Pokhara at 820 metres, and the Manaslu Mountain Trail Race, a 212-kilometre race over seven days, topping out at more than 5,100 metres.

Runners say the experience in Nepal allows them to be among the mountains and get a glimpse of nature at its best. Athletes from novices to elites are taking on such challenges, says Nepalese ultra-running pioneer Ramesh Bhattachan, “some for the sake of participation, some for enjoyment, and some for pre-training for their main trail races in their countries”.

Bhattachan, 58, was early to spot Nepal’s potential as a running destination and breeding ground for elite runners. He helped to establish Nepal’s first 100-kilometre high altitude ultramarathon in 1995, the Annapurna 100. As the proposed route took a strong hiker four days to walk, the run was deemed impossible and attracted only 25 daring Nepali runners, he says.

“The first runner finished in a mind-boggling time of 11 hours 51 minutes,” says Bhattachan.

“Nobody could believe it.”

In its sixth edition in 2012, the Annapurna 100 (which now offers 50, 75 and 100-kilometre distance options) attracted 100 foreign runners from 26 countries, and 75 Nepali runners.

For accomplished British trail runner Rob James, competing in the Annapurna 100 last year was an enjoyable opportunity to get back to basics. “It was an uncomplicated

Nepal’s mountainous terrain offers stunning and challenging race options for runners, writes Rachel Jacqueline

100 The number of foreign runners, from 26 different countries, at the 2012 sixth edition of the Annapurna 100 high-altitude race

trail race in an amazing country. No expensive entry fee, no large brand as a sponsor, no hi-tech gear prizes; just a group of runners organising a running race for anyone wanting to run in one of the world’s very special places,” says James, 47.

But the running destination presents its own risks.

“When things go wrong, they go terribly wrong,” says Michael Maddess, event director of Hong Kong-based Action Asia Events, who has organised a three-day running event in Nepal since 2011.

“In 2011, only four days before the event, one section of the course was wiped out due to the worst landslides in years, forcing us to completely reroute the course at the last minute.”

During last year’s event, keeping competitors on the correct trail was made difficult by curious local villagers taking the ribbons and signs that marked the course.

Samantha Fanshawe, vicepresident and event organiser of Hong Kong-based Racing The Planet, which held a roving race in Nepal in 2011, also says the country is a challenging racing destination.

“Logistics were very complicated,” says Fanshawe. “We got many confused looks from locals when we started asking for specifics like ‘When was this bridge built?’ and ‘What is the load capacity?’”

Despite the possible hiccups runners may face along the way, the beauty and diversity of the country, as well as the opportunity to test one’s limits, continues to attract runners each year, says Richard Bull, local race organiser and founder of the Trail Running Nepal website (trailrunningnepal.org).

Apart from races, self-guided running tours in the country are easy to organise, says Bull. “Nepal’s established network of trekking tea houses, that provide bed and board, means you can run for days, even weeks, carrying very little.”

The joy of the Nepalese trails can also be had not far from Kathmandu, only a four-hour flight from Hong Kong, says British expatriate and former Hong Kong resident Thomas Bellamy.

“Once you’re over the first big hills on the edge of the valley you wouldn’t know that Kathmandu was just a few kilometres away,” says Bellamy, 25. “There are some fantastic climbs all around the

UP FOR A CHALLENGE March 9: Annapurna 100 Ultra Trail – 50km/70km/100km, annapurna100.com March 12: Kanchenjunga Ultramarathon – 49km, himalayanguides.com March 29: Trail of the Three Valleys – 353km, trailrunningnepal.org March 30: Everest Ultra – 65km, everestultra.com April 19: Annapurna Mandala Trail by Raidlight – 250km, leschevaliersduvent.fr April 27: Mustang Trail Race – 277km, mustangtrailrace.com May 29: Everest Marathon – 42km, everestmarathon.com October 6: Himal Race – 900km, leschevaliersduvent.fr October 18: Everest Sky Race – 360km, leschevaliersduvent.fr November 9: Manaslu Mountain Trail Race – 212km, manaslutrailrace.org

valley: Shivapuri National Park, Nagarjun and Chobhar, to name just a few.”

The races also give a unique insight into the Nepalis, who are naturally powerful and impressive runners after years of trekking through rural mountain areas. Their talent has been felt in Hong Kong, as Aite Tamang, Bed Sunuwar and Sudip Kulung finished second, third and eighth respectively at the Vibram Hong Kong 100 ultramarathon. Together with Bhim Bahadur Gurung, the runners were sixth in the Oxfam Trailwalker in November, while Ram Khatri and Samir Tamang were on the team that came second.

Aite Tamang, a soldier, believes it is the hardy Nepalese life among challenging and beautiful terrain that makes them great runners. “It makes us want to go out and do our best, for Nepal and for the opportunity of a lifetime,” he says.

“If we are good runners, we may travel overseas,” adds Sunuwar.

Steve Brammar, HK100 race director, says the Nepalis’ performance is just a start. Big things are expected of them this year.

Beyond the country’s impressive landscape and the natural running ability of its people, it is the beauty of the Nepalis that Maddess believes makes the journey worthwhile.

“Nepalis always seem to have smiles on their faces no matter how poor they are,” he says. “It’s very different from the materialistic society ... in Hong Kong.”

Bull adds: “You’ll meet many different ethnic groups as you traverse the mountains, from Gurungs to Sherpas to Tibetans, and very different ways of living. It gives a different perspective on life.”

It is these unique elements that make Nepal the best place in the world for trail running, says Bhattachan. The ex-Gurkha, who also organises the Everest Ultra and manages the top runners, is on a mission to show the world just how good running – and runners – in Nepal can get.

And he has no plans to stop any time soon. “I’ve run more than 45,000 kilometres in the past 40 years,” he says. “I like running adventures in order to keep physically fit and I wish to live more than 100 years.” healthpost@scmp.com

COVER STORY 7

You’ll meet many different ethnic groups as you traverse the mountains, from Gurungs to Sherpas to Tibetans RICHARD BULL, FOUNDER, TRAILRUNNINGNEPAL.ORG

Foreigners and locals alike take on the Annapurna Marathon (top), and the Tenzing-Hillary Everest Marathon (right). The country boasts some superb local runners (left).

Photos: Jonathan Wong/Corbis/AFP

8 FITNESS SWEAT LAGREE FITNESS

Sebastien Lagree puts reporter Ben Sin through the workout the Frenchman developed at H-Kore, in Central. Photo: Warton Li

Rage against the machines ......................................................

Ben Sin healthpost@scmp.com Remember the 2008 film Tropic Thunder, and how ripped Ben Stiller, playing a narcissistic Hollywood action star, looked in it?

The comedian, then 43, achieved that physique by training with Los Angeles-based celebrity fitness trainer Sebastien Lagree, doing a type of workout that involves continuous resistance movements while standing, sitting or lying on a machine designed by Lagree.

The workout is officially named the Lagree Fitness method, but it’s known in Hollywood circles as “Pilates on crack”. That was how Courtney Cox, one of the stars of the hit sitcom Friends, described it during an interview a few years back. “I thought it was going to be this easy Pilates class, but it’s work-your-ass-off tough,” she said.

Developed in 2003 by Lagree, the workout has become so popular that the 38-year-old Frenchman is now an international exercise entrepreneur, licensing his routine, and his machines, to more than 60 cities, including New York,

Toronto, Seoul and London. Now, it’s in Hong Kong, at H-Kore, a new exercise studio in Central opened by British expats Vivienne Fitzpatrick and Vanessa Valenzuela. The Lagree method, which boasts “a shortcut to fitness” in just 40 minutes per session, is perhaps especially appealing in this city, where time is at a premium.

The two women had been doing the Lagree method regularly at a gym in London. After moving to Hong Kong in 2011 they soon found themselves out of shape and missing the workout. They tried various gyms and workouts, but came away unimpressed with the results each time. Eventually, they decided to bring the Lagree method here.

So Fitzpatrick quit her job and the two set to work scouring potential gym locations, contacting Lagree and hiring staff. The process took more than six months.

Lagree, like he does with every new gym that uses his machines, travelled here last month to train the H-Kore’s staff … and me.

I’ve led an active lifestyle most of my life: for more than two decades, I’ve either played basketball or jogged at least four nights a week.

But lately, especially after basketball, I’ve experienced knee discomfort. So when the ladies at H-Kore invited me for a trial workout, claiming the Lagree method would give me an intense workout without stressing my joints, I jumped at the chance.

Lagree’s machine is called the Megaformer. It looks like a Pilates Reformer on steroids: it’s got the similar sliding platform, pulleys and adjustable resistance springs as the Reformer, but it’s longer and has different handles.

Lagree was inspired to develop his method when, as a Pilates instructor in California, he noticed that his clients would always do cardio and weight training after a Pilates session. He began creating a series of machines that would reinvent the Pilates workout, offering something quicker and more efficient, thereby eliminating the need to go to the gym.

To start with, I was given a pair of special socks with skid-proof soles.

Lagree said they would keep me from “slipping off the machine and falling on [my] ass”.

Once you get on the Megaformer, there’s no stopping.

For 40 minutes, I was on the

That each session only takes 40 minutes should appeal to many in a hectic city like Hong Kong VANESSA VALENZUELA, CO-FOUNDER, H-KORE

machine, transitioning from one exercise to the other. Each routine involved placing either my feet, knees or back on the machine, hands gripped to the handles, using various muscles to move the slider.

It’s done at a slow and steady pace; but it’s tough, requiring strength, balance, control and endurance.

Lagree has devised more than 1,000 exercises for the Megaformer.

For example, the “Mega Plank to Pike” had me place my hands on the floor, back angled with my bum in the air, moving the slider back and forth with my feet. It’s like the ultimate ab roller, and works the shoulders and legs as well as core.

It’s a killer. The continuous nature of

the exercise keeps the heart rate up, while Lagree says the deliberate pace ensures you activate your “slow twitch muscle fibres” – the muscles engaged during low-intensity, highendurance movements such as distance running. “It places pressure on your muscle at all times,” he says.

Somewhere between trying to catch my breath and seeing my legs wobble and shake with each movement, I noticed that my knees didn’t feel a thing. It’s one of the most strenuous workouts I’ve ever done, yet it had nearly no impact on my grumpy knees. Lagree says his machines are designed for everyone – of all ages and fitness levels – and for everything: building strength and endurance, or for fat-burn and muscle toning. His diverse clientele, including professional athletes as well as film stars, support the claim.

The H-Kore founders expect a similarly diverse experience in Hong Kong. Says Valenzuela: “That each session only takes 40 minutes should appeal to many in a hectic city like Hong Kong.”

For more information, go to h-kore.com.

Classes are sold in packages, starting from HK$300 per session

DIET 9 HEALTHY GOURMET

Way of the vegan ......................................................

Andrea Oschetti healthpost@scmp.com Although we know some things are bad for us – like hydrogenated fat or too much sugar – there is no scientific agreement that one kind of diet is better than another.

Whatever you like to eat, knowing how to cook it properly makes a big difference to your health. For the next three weeks this column will look at the worlds of vegans, carnivores and piscivores, and provide some tips on how to cook in the healthiest way.

My cousin Simona Ferrante has been a vegan since she discovered a few years ago that she has diabetes.

On top of this our family has a history of kidney failure. She did not want to become dependent on medicines, so she started looking for solutions on how to eat healthier.

She was drawn to veganism after reading studies that found that cholesterol from animal-derived products can stay in the body, affecting the liver, intestines and kidneys. As a result Simona has managed to keep her diabetes under control. Her two children, Gabriele, six, and Federico, three, have been on vegan diets since they were born.

They have never been vaccinated, nor have they ever had antibiotics.

They have never fallen ill.

Simona says you can eat with satisfaction, even with the restrictions of a vegan diet – and you can convince your children to do so too. This is how she does it.

1. Take time to explain to your children why one diet is healthier than another “They do respond and also get used

to what they are given: it becomes a habit to eat legumes and dried fruits every day. Federico’s favourite food is zucchini, says Simona. “They don’t even reach the table because he eats them before they are served.”

Simona Ferrante bakes a focaccia roll (bottom); her Italian salad (below left).

2. Look for variety and try new things “At the start, I knew what I wanted to eat but not how to cook it. So I bought books, searched the net and experimented. Little by little, I learned how to make better choices.

Last week I made a chocolate cake with boiled beetroot. The beetroot made the cake moist and soft and provided additional nutrients.”

Focaccia roll with olives, onions and capers For the dough 300 grams flour 170ml lukewarm water 12 grams yeast Pinch of salt

3. Make your dishes interesting “My children love olives, so I make them focaccia with olives and onions. I use olives instead of cheese when making pizza.”

For the filling 1 onion 1 tomato A handful of capers 100 grams olives Some thyme Olive oil

4. Everything can be done at home “Make stock cubes by processing vegetables with oil and spices. Cook over low heat until it has reduced.

Freeze them in an ice-cube tray.”

5. Use only fresh ingredients “Don’t even walk down the supermarket aisle where processed and ready-made products are kept.

Make mayonnaise at home without eggs by using soya milk, oil, lemon and salt. The biscuits I make contain hazelnuts, flour, oil and fructose, rather than refined sugar.”

Italian salad

Create flavours and depth in vegetarian dishes by roasting seeds and nuts, adding the acidity of lemon or vinegar and using fresh chopped herbs and spices. Keep the nutrients by using a pressure cooker and avoid overcooking them. Always beware of dressings.

• Soak the chickpeas in cold water overnight, then boil and purée them. Let cool.

• Boil the carrots, potatoes and green peas until tender.

Let them cool.

• Prepare the mayo by whipping the soya milk, lemon and salt for about one minute. Add the olive oil gradually until it’s a suitably creamy consistency.

• Mix everything together.

200 grams dried chickpeas 2 carrots, diced 2 potatoes, diced 200 grams green peas 400ml soya milk Extra virgin olive oil, salt, juice of one lemon A handful of capers

• Mix all the dough ingredients together with a fork, then knead the dough. Cover the dough and leave it for one hour to rise.

• While waiting, prepare the filling. Slice the onions and sweat them in a pan over low heat until translucent.

Dice the tomato and olives, and add them to the onions with the capers and thyme. Cook for two minutes.

• Gently spread the dough over parchment paper with the tip of your fingers. Spread the filling on top and roll the dough.

• Bake at 200 degrees Celsius for 30 minutes.

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

THE TASTE TEST CRACKERS ......................................................

Jeanette Wang jeanette.wang@scmp.com

Grate Britain All-British Smoked Cheese Crackers HK$25 for 45 grams, City’super Freshly grated Dorset Red, made from the milk of cows on Britain’s Dorset coast, give these bite-sized, handmade crackers their natural, mellow flavour.

Verdict: Rich, full and lingering taste.

Not too salty and very moreish.

Tucker’s Natural Multifibre Snacks Caramelised Onion and Cheddar HK$39.90 for 100 grams, Jasons Food & Living These cheesy triangles are made with insoluble and soluble natural plant-based fibres which aid digestion. Among the wheat grains used is Greenwheat Freekeh, an Australian variety that has up to four times the fibre of brown rice, is low in carbohydrates, has a low glycemic index, digests slowly and is rich in prebiotic properties.

Verdict: Like cheese and onion crisps, but better – with visible grain specks and a more natural flavour.

Mondovino Porcini Mushroom Crackers HK$45 for 125 grams, Jasons Food & Living Wheat flour, extra virgin olive oil and dried mushrooms make up the bulk of these intensely flavoured gourmet crackers. Dried porcini bits and coarse sea salt speckle each brown square.

Verdict: The packaging suggests you serve with champagne, but they do deliciously well on their own. They’d be great with soup or pasta.

10 FITNESS MARATHON MANIA WEEK 8

What’s best in the long run? ......................................................

Rachel Jacqueline healthpost@scmp.com Logically, if running is good for your health, then more must be better.

But experts have discovered a point where the benefits are outweighed by the wear and tear on your heart – and research suggests it’s about half of what training for a marathon requires.

The threshold is 32 kilometres a week. Running more than that does not improve your chance of living any longer than someone who doesn’t run at all, say American researchers who analysed the data of more than 50,000 people who were tracked for up to 30 years.

The take-home message for most is to limit one’s vigorous exercise to 30 to 50 minutes per day DR JAMES O’KEEFE, CARDIOLOGIST

Presenting their findings at the American College of Sports Medicine (ACSM) annual meeting in June last year, the researchers revealed that the 14,000 runners in the study were linked with a 19 per cent lower risk of death compared to non-runners. A U-shaped relationship between running and mortality was observed. The largest benefit was observed in those who ran 16 to 24 kilometres weekly.

Similarly, the researchers found an optimal pace and frequency.

Running at between 9.7 kilometres and 11.3 kilometres per hour was linked with up to 27 per cent lower risk of death; a pace faster than 12.8 kilometres per hour had only a 7 per cent lower risk of death. Running two to five days per week produced the most benefit.

The Copenhagen City Heart Study, published last year in the European Heart Journal, showed similar results. Researchers who followed 20,000 Danes since 1976 found that the runners lived about

six years longer than the nonrunners, with a 44 per cent lower risk of death during the study. The optimum: jogging at a slow to average pace, for a total of one to 2½-hours per week over two or three sessions.

Marathon training, however, requires running on most days, with a weekly mileage of 60 kilometres or more, says Michael Tse, director of the Active Health Clinic at University of Hong Kong’s Institute of Human Performance. Putting your body under periods of stress and running at high speeds is vital to improving performance, he says.

Cardiologist Dr James O’Keefe of Saint Luke’s Hospital in Kansas City, Missouri, led a study published last year in Mayo Clinic Proceedings that suggests constant training for and competing in extreme endurance exercise such as marathons, ironman-distance triathlons, and very long distance bicycle races may cause structural changes to the heart and large arteries, leading to myocardial injury.

At rest, the heart pumps about five litres of blood per minute, increasing to up to 35 litres during strenuous exercise. While the heart is designed to handle increased volumes in short bursts, doing so for more than an hour overloads its thin-walled chambers, causing micro tears.

The good news is these abnormalities tend to return to normal within one week, according to O’Keefe’s study. But in some people, over months and years of repetitive injury, this process can lead to the development of patchy myocardial fibrosis (scarring of the heart muscle).

“The take-home message for most is to limit one’s vigorous exercise to 30 to 50 minutes per day,” wrote O’Keefe in an editorial published recently in the journal Heart. “If one really wants to do a marathon or full-distance triathlon, and so on, it may be best to do just one or a few and then proceed to safer and healthier exercise patterns.”

But not all scientists agree.

Concerns over the effect of endurance exercise are overblown, according to cardiologist Dr Benjamin Levine of the University of

New runners are advised to train for 12 months before competing in a marathon. Photo: Dickson Lee

Marathon training: week 8 to 10 The writer moves into the third block of the 12-week training plan designed by running coach Clinton Mackevicius. It’s the final push before a two-week taper for the race.

Drills consist of two sets of 60 high-knees / 60 bum-kicks / 20-metre knee-drives / 2 x 10-metre strides PE = perceived exertion, on a scale of 1 to 10, with 10 being the hardest

MON

TUE

WED

THU

Strength and speed

Rest

Medium pace

Threshold session

70 minutes

60-70 mins + drills

120-160 minutes

Run at PE 6.

Warm-up at PE 5 for 15 mins.

Drills.

Run repetitions at PE 7.5-8 for duration below.

Week 8: 15 mins, 15 mins, 5 mins Week 9: 15 mins, 15 mins, 10 mins Week 10: 15 mins, 15 mins, 15 mins Rest 3-5 mins between each repetition.

Cool down at PE 5 for 10 mins.

Week 8: 1 hour at PE 5-6 + 20 mins at PE 7 + 1 hour at PE 5-6.

Week 9: 1 hour at PE 5-6 + 40 mins at PE 7 + 1 hour at PE 5-6.

Week 10: 2 hours at PE 5-6.

Focus

Active recovery

Duration

50-60 mins + drills 61 mins + drills

Description Run at PE 5.

Drills.

Get a massage if you can.

Warm-up at PE 5 for 15 mins.

Eight repetitions of 4 mins at PE 8.5.

Rest for 2 mins between each repetition.

Drills.

SAT

FRI

Rest

SUN Long run

Have an energy gel every 7km.

SCMP

Texas Southwestern Medical Centre in Dallas. Levine’s studies of both young and old elite endurance athletes have suggested a physiological adaptation to exercise.

He has found no evidence of fibrosis in these athletes.

Dr Carl Lavie, a researcher involved in the ACSM study, acknowledged that other factors may have led to a reduction in the mortality of the endurance runners in the study, such as poor diet.

“There is always a danger with too much of anything, even ‘good’ stuff,” says Tse. Taking on too much too early may do more harm than good. Beginners should only run every other day before working up to a daily regime. Tse also recommends mixing in some cross training and alternating between high intensity training days and days of easier running with less volume.

Apart from hurting the heart, there’s also the possibility of other

60 The number of kilometres of running per week required when training for a marathon, according to a health and fitness expert

musculoskeletal injuries. David Garrick, a physiotherapist from Physio Central, suggests at least three months’ preparation for a marathon – and that’s if you’re already a runner. “A beginner would need probably closer to 12 months to build up to such a level without injury risk,” he says. “The best rule is the 10 per cent rule: increase total mileage from the week before by only 10 per cent.”

These days, distance running is becoming the norm. Hippocrates, the father of medicine, said: “The right amount of nourishment and exercise, not too much, not too little, is the safest way to health.” While I’d prefer to live out my days running, I don’t want to run too fast to an early finish line.

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

WELL-BEING 11 PERSONAL BEST

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

Step aside, emotional intelligence.

There’s a new way to measure success: personal intelligence.

Motivational coaches refer to it as PI, and for some time now, it has been regarded as an important foundation for nearly every aspect of life, from work to relationships.

American developmental psychologist Howard Gardner defined two types of personal intelligence. The first, intrapersonal intelligence, has to do with the relationship with the self. It is about understanding one’s own complex feelings and thoughts, and knowing how to make sense of them as a precursor to one’s behaviour. The second, interpersonal intelligence, has to do with one’s relationship with others, and the ability to know and communicate with others appropriately in accordance with their moods, temperaments, motivation and intentions.

Winnie Chiu, a registered counsellor and life coach, says that having a high PI not only helps you live a more successful life, it also enables more harmonious connections with others. The higher your PI level, the fewer problems you are likely to have in all your relationships and the less difficulty you will have connecting with others and communicating effectively.

“When you are aware of your feelings, motivations, strengths and weaknesses, it is also likely that you would be committed to personal growth and be interested in fulfilling your purpose in life,” Chiu explains.

“And if you know how to relate to others and can detect their emotions, intentions and desires, it shows that you are good at verbal and non-verbal communication as well as conflict resolution.”

Hong Kong-based career and executive coach Angela Spaxman specialises in the area of leadership development. She says that it is well known and true that, as people rise to higher levels of leadership, their interpersonal skills become more important to their success, while the importance of their technical skills declines. This means that if people wish to be promoted and succeed as managers and leaders, they should learn how to develop their PI. “Very high levels of PI are

Illustration: Wilson Tsang

Sasha Gonzales healthpost@scmp.com

Life of more PI essential for the highest levels of leadership success. It is only now that we are learning the connection between very deep intrapersonal abilities and excellence in leadership,” Spaxman says.

Like our temperament, PI is something we are all born with.

According to Gardner, PI is affected by several factors – culture, the influences of our caregivers, and our experiences during our formative years.

“Your upbringing must have been healthy for your PI to reach its full potential,” Chiu adds. “You [are] able to empathise and understand others on the condition that you were exposed to these qualities

Very high levels of personal intelligence are essential for the highest levels of leadership success ANGELA SPAXMAN, CAREER COACH

in your developmental years.”

However, adds Spaxman, PI is more developed in some people than others. Autistic children, for example, are known to be especially unable to connect with and understand others. Likewise, some people have a natural predilection for understanding themselves and others, and their enjoyment of that exploration can lead them to develop very advanced PI abilities.

Certain occupations might require a higher level of PI than others, such as in Spaxman’s job as a career coach. “We have to be very self-aware in order to be able to act as a clean slate for reflecting our clients, and because it helps us to

gain expertise in self-improvement so that we can assist our clients to do the same,” she says. In contrast, many technical jobs do not require high levels of PI. Self-examination is a great way to learn and cultivate PI. This task requires a certain level of honesty.

Glynis Ferguson, a Hong Kongbased life coach at Freedom Coaching, suggests asking yourself questions relating to your work and management style, the health of your relationships, and your own personal growth and fulfilment.

For example, when you communicate, are you frank, diplomatic or evasive? When you enforce rules, are you compassionate, authoritative or collaborative? When you have to make decisions, are you analytical or intuitive, or do you avoid making them altogether? How good a listener are you? Do you feel like you are living in line with your values?

Do you feel dragged down or uplifted by the decisions you make for yourself?

Self-reflective practices such as meditation, yoga and journaling can also help you understand what triggers or causes your responses, as can getting feedback from those close to you.

And when it comes to developing your interpersonal intelligence, observing, socialising and talking with others can help you understand what makes them tick and give you better insight into how they see the world.

In defining the path to workplace, family and personal success, PI is often overlooked.

But it is a crucial skill if you want to work and live with others effectively and happily.

“Human beings are social and emotional creatures, after all,” says Chiu. “We need to have a connection with others in order to feel love and contentment. And building good relationships with others can contribute to this contentment. But before developing our relationships with others, we need to first connect with ourselves in every sense. Otherwise, it will be difficult to reach out to others.”

The Tao sums it up best in this popular saying: “Knowing others is intelligence, knowing yourself is true wisdom. Mastering others is strength, mastering yourself is true power.”

12

JANUARY 22, 2013 SOUTH CHINA MORNING POST