YOUR GUIDE TO LIVING WELL
HEALTH POST Salt therapy comes to town >PAGE 4
Rock your world WALK THIS WAY: THE LATEST HIKING APPS >PAGE 8
AT A PINCH: THE BENEFITS OF CINNAMON >PAGE 10
TUESDAY, DECEMBER 13, 2011
2 NEWS HEALTH BITES ...................................................... Jeanette Wang firstname.lastname@example.org
APP OF THE WEEK
A few missteps but a lot of fun ...................................................... Katie McGregor email@example.com Latino Aerobics Lite Free (Full version is US$5.99) Rating 7/10 They say that young people are slim because of a high metabolism that just burns away the calories they consume in crisps, chocolate bars and doughnuts. I believe it’s down to the many hours spent on the dance floor. With this in mind, and because it is the festive season, I thought to kill three birds with one stone: keep fit, have fun and learn a few Latino dance moves – by reviewing a dance fitness app. Unfortunately, the free “lite” version of the app and I immediately started off on the wrong foot. In her brief presentation, the firm-bodied Latina instructor told me that the 45-minute course comprised an aerobic workout using steps from salsa, merengue and cha-cha, but they then wanted to charge US$5.99 to show more than a cursory glimpse of the video. I was not happy, but then I realised that it still cost less than a bowl of
salad around town, so I stumped up the cash. Then, I was off, tapping my left heel, then the right – that’s a paso step – and on to a rhumba. I was enjoying myself; the music is good, and because I was doing it in private, I didn’t mind if I missed a step or two. After the warm-up, the instructor introduces new steps such as the mambo, cha-cha, and a side-kicking “suzuki” – a little-known Latin dance step. You don’t get much step-by-step guidance, but the repetitive nature of the dance means that you do pick it up. Just as I remembered, I can dance for a lot longer than I can run. But my fun ended when I had to stop the app, and on restarting found that I had to go through the whole purchase routine again, except that I wasn’t charged this time. After a few download routines, I decided there had to be an easier way so I downloaded the full version directly from the iTunes App Store – and was charged US$5.99 again. Feeling put out, I did try another app – Salsa Dance Cardio Workout – at US$4.99, but this seemed more clinical. Despite the issues, my vote goes to Latino Aerobics, but buy the full app at the outset.
ASK THE DOCTORS DR ANTHONY LUKE Q: I have been very obese for a long time, and I’ve decided to undergo weight reduction surgery. Although I haven’t been physically active for a long time, will I be able to exercise after the surgery? A: Lap band procedures reduce the amount of food that you can eat by surgically placing a band around the opening of the stomach. Gastric bypass surgery is a more intensive procedure where the stomach is made smaller and attached to the small intestine. Gastric bypass surgery helps you lose weight by reducing the amount of food you can eat (since the stomach is smaller) and reducing the calories absorbed (since there is a bypass of part of the intestine). Both of these surgeries have shown positive results with weight reduction of about half the extra weight or more after surgery. A recent study by researchers at the University of Texas showed that about half of individuals who performed a highvolume exercise programme (equal to 2,000 calories per week) after the surgery had enhanced physical fitness. All patients reported better quality of life. Therefore, exercise is still a necessary portion of the post-operative plan.
Weighing less should also make it much easier for you to move around and do your everyday activities. Bypass surgery alone is not a solution for weight loss. It can train you to eat less, but you still have to do the work to lose weight and keep it off. To avoid complications from the procedure, you must follow the exercise and nutrition guidelines that your doctor and dietitian give you. Exercise is key to achieving the body you want after weight loss bariatric surgery. Getting started on a gradual exercise and physical activity plan is a very important part of bariatric surgery. An exercise plan should begin before and resume as soon as your doctor allows bariatric surgery. A doctor should closely supervise your exercise or activity plan. Try to get at least 30 minutes of physical activity each day above and beyond what you typically do in a day. Dr Anthony Luke is an associate professor of clinical orthopaedic surgery at the University of California, San Francisco. Reprinted with permission of the American College of Sports Medicine, ACSM Fit Society Page, Fall 2011, p2.
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Curbing carbs lowers breast cancer risk Carbohydrates provide essential nutrients and energy, but eat them wisely. Eating more carb-rich foods, especially starchier ones such as white bread and pasta, may boost the risk of breast cancer recurrence, according to research from the University of California, San Diego. About 2,650 women reported their carb intake at the start of the study and a year later. The average intake was about 233 grams daily at the start of the study. Those whose cancer did not return decreased starch intake by 8.7 grams a day, while those with a recurrence reduced intake by only 4.1 grams a day. According to the US Department of Agriculture, a slice of bread has 12.5 grams of carbs, of which 10 grams are starch. A cup of pasta has 43 grams of carbs, 36 of which are starch. Starchy foods elevate insulin levels, which has been linked with higher breast cancer risk.
Boys will be girls A stressful early pregnancy could lower a woman’s odds of having a boy and increase her risk of premature delivery. Published last week in the journal Human Reproduction, the study looked at how the stress of a major 2005 earthquake affected pregnant women in Chile by analysing the birth certificates of all babies born there between 2004 and 2006. Exposure to the 7.9-magnitude quake during the third month of pregnancy reduced the ratio of male births from 51 per cent to 45 per cent. More than 9 per cent of women exposed to the quake in the third month of pregnancy had a premature baby, up from the normal rate of about 6 per cent.
Craving chocolate? Just walk away Just taking a 15-minute stroll can cut snacking on chocolate at work by half, a study published in the journal Appetite has found. University of Exeter researchers in Britain put 78 regular chocolate-eaters in a simulated work environment after two days’ abstinence from the treat. Participants were split into two groups: people in one group took a brisk 15minute treadmill walk and were then given work to complete at a desk, and the other rested before completing the same tasks. These groups were further split into two: one was given an easy, low-stress task, and the other a more demanding job. Chocolate was placed on the desk for all participants as they worked. Those who had exercised before working consumed 15 grams of chocolate on average, compared with the resting groups’ 28 grams. Task difficulty made no different to snacking amount, suggesting stress did not contribute to sweet cravings.
Seeing into the future New research from Tufts University’s School of Arts and Sciences puts a new spin on having “eyes in the back of the head”, and opens doors for the development of novel approaches to detecting and repairing birth defects, and organ transplantation and regeneration.
Biologists have managed to grow eyes on a tadpole’s back by altering the natural bioelectrical communication among cells in frog embryos. “The hypothesis is that for every structure in the body there is a specific membrane voltage range that drives organogenesis,” says Vaibhav Pai,
the paper’s main author. “These were cells in regions that were never thought to be able to form eyes. This suggests that cells from anywhere in the body can be driven to form an eye.” The researchers will be pursuing further research, additionally targeting the brain, spinal cord and limbs.
Baffling condition enough to make your toes curl ...................................................... Eileen Aung-Thwin firstname.lastname@example.org The Richardsons (whose real name has been withheld for patient confidentiality reasons) had been awaiting their beach holiday in Thailand for weeks. With powder-white beaches and azure seas, the family of three looked forward to a week of fun and relaxation with friends. But days before their scheduled departure from Hong Kong, eight-year-old Ben came down with flu-like symptoms. With a 39-degree Celsius fever, cough, runny nose, body aches and fatigue, he was in no condition to travel. The Richardsons told their friends they would meet them at the resort after Ben’s symptoms cleared up in a few days. Their friends, including Dr Julie Chen, an assistant professor with the department of family medicine and primary care at the University of
Ben found a new way of moving around ... he curled his toes under his feet and walked on his toe ‘knuckles’ Hong Kong, went ahead to Thailand. Ben’s symptoms faded after a few days, and the family caught the first flight there. After arriving, however, the boy’s parents noticed a mild fever had returned. Ben also complained that his calves ached. Thinking that it was probably the strain of travelling so soon after a flu, Ben’s parents figured he just needed a quiet evening and a good night’s rest. But when Ben woke up the next morning, he couldn’t get out of bed because it hurt to walk. To go to the bathroom, Ben crawled to avoid putting any weight on his legs. In their consternation at their son’s physical complaints and behaviour, the Richardsons called Chen for help. Although Chen was not currently in medical practice, she had been trained as a family doctor in Canada. When the Richardsons first described Ben’s symptoms, Chen had a flash of concern that Ben might have rhabdomyolysis, a condition in which the muscle fibres
break down, generating muscle weakness and pain. Another possibility was Guillain-Barre syndrome, a post-flu complication in which the immune system mistakenly attacks the nervous system, resulting in muscle weakness that ascends from the legs to the upper body, eventually leading to paralysis. In these situations, she realised that Ben would need immediate hospitalisation, but the nearest hospital was three hours away. She hurried to the Richardsons’ room. She was greeted enthusiastically by Ben, who was sitting up in bed and playing computer games with great gusto. She examined him and found he was perfectly healthy with no fever, rash or swelling or other unusual signs, except for tenderness in his calves when touched. More importantly, he reported that his urine was pale yellow, thereby reducing the likelihood of rhabdomylysis, which often is accompanied by dark red or cocoacoloured urine. He also had no other symptoms that might hint at Guillain-Barre syndrome. With mischievous delight, Ben showed Chen that he had found a new way of moving around with minimal pain to his calves – he curled his toes under his feet and walked on his toe “knuckles”. Ben suffered acute calf pain only when he tried to stand or walk normally. Ben’s sprightly behaviour and unusual condition was baffling. Although concerned about the calf pain, his parents took comfort in his otherwise normal, peppy behaviour. Hence, they were reluctant to make the three-hour trip to the hospital. In the hopes of finding out more about the cause of Ben’s pain, Chen searched the internet for conditions with his symptoms. To her surprise, several case studies showed up that were close matches. They described a rare condition called Benign Acute Childhood Myositis (BACM). With BACM, which tends to affect male school-age children, an upper respiratory tract infection with flu-like symptoms are followed by a sudden onset of calf pain and an inability to walk. While its causes are unknown, it appears more often associated with the influenza B strain. Despite its dramatic presentation, BACM is not serious and will suddenly vanish. Chen shared this information with Ben’s parents. In light of Ben’s classic presentation and otherwise good health, his parents decided to keep him under close observation, with the expectation that the BACM would disappear quickly.
Ben borrowed a wheelchair from the hotel and showed no signs of worsening physical distress. About 36 hours after the calf pain began, Ben astonished everyone by suddenly jumping up and running off to play. The BACM had run its course. Looking back, Chen says that had medical assistance been more easily accessible, she would have sent Ben for tests to rule out other causes. At it was, the Richardsons had a memorable holiday story to tell.
Illustration: Angela Ho
4 COVER STORY
Taken with Salt therapy is taking off as an alternative remedy for everything from allergies to asthma. But not everyone is convinced of its healing properties, writes Richard Lord
s I lie back on a lounger in a slightly weird but very comfortable salt-lined grotto, a magazine perched on my lap and soothing nature documentaries on the giant television in front of me, it strikes me that this is the least unpleasant medical treatment I’ve ever had. The experience is marred only by the deeply unattractive blue plastic shoe-covering booties on my feet, to protect the salt that covers the floor. The slight tang of salt in the air gives away what the treatment is: salt therapy. Also known as halotherapy and speleotherapy, it involves breathing in the tiny particles of salt that are being pumped into the air around me. There are various supposed benefits, most of them lung related. The therapy has its roots in naturally occurring salt caves in eastern Europe. But I’m a bit nearer home, in Central, at the newly opened Inhalo, which houses Hong Kong’s first so-called salt caves.
The simplicity of the treatment – there really is nothing to it except lying back in a room and breathing – along with a shortage of credible clinical studies, can make it hard to swallow (or indeed, to inhale) some of the claims. Like most people, I’m accustomed to thinking of salt as essentially bad for me, but according to the halotherapists, it’s the method of ingestion that counts. If salt is inhaled rather than eaten, proponents of the therapy claim that it is effective against a range of conditions. These include asthma, cystic fibrosis, emphysema, psoriasis, ear infections, allergies, bronchitis, colds and even snoring. Salt therapy emerged in the 19th century when doctors in Poland noticed that salt miners didn’t seem to suffer from respiratory conditions. But it took off in the past decade, with spas like Inhalo that recreate salt cave conditions mushrooming around the world. It has spread, in particular, to western Europe, North America,
Australia and, thanks to the many people with eastern European heritage there, Israel. It was there that Inhalo CEO Omri Shamir, an asthmatic, became convinced of its benefits. “After a few sessions, I felt better. Not completely better – you never get completely better with asthma – but I only had to use my inhaler occasionally, when I’d been using it every day before.” He and his wife, marketing director Caroline GoldsmithShamir, gave up their jobs in academia and marketing and moved to Hong Kong to set up the spa. “We think Hong Kong is perfect for this,” explains Caroline, saying that because of the city’s wealth, there is an openness to alternative therapies. There are also a host of respiratory problems, most caused by cramped living conditions and air pollution. Sessions at Inhalo last for 50 minutes – 30 minutes for children – and a minimum of 10 to 15 sessions are recommended,
This is definitely non-evidence-based, and would not be approved by any sensible, normal person PROFESSOR KENNETH TSANG
COVER STORY 5
The rock salt decorating the floor and walls of the “salt caves” at Inhalo (left, above) is purely cosmetic. The therapy actually involves grinding up medicinal grade salt into minute particles and pumping it into the air for inhalation; children are also catered for (below). Photos: May Tse
a grain two to three times a week. That can add up to more than HK$7,000 – and, unlike a lot of medical treatments, the raw materials aren’t exactly expensive. About four to five tablespoons of medical salt imported from Europe are used in an adult session, with about five milligrams of it actually absorbed by the body. The only moving part is the generator that grinds up the salt to microscopic quantities and distributes it into the air. The rock salt decorating the floor and walls of the salt caves is purely cosmetic. It took a couple of months to dry out properly between the couple taking over the premises and being able to declare Inhalo open. It’s also possible to undergo a form of salt therapy that doesn’t involve sitting in Santa’s grotto. This is courtesy of a salt pipe, which is a specially designed pipe filled with salt crystals. Inevitably, having only sat through a single session, I didn’t
notice any improvement in my respiratory functions. But it was at the very least a nice experience. Potential side effects are mild – my own seemed to be fairly typical, including a faint prickly sensation on my arms and around my eyes that persisted until washed away with a shower, and a vague taste of salt in the back of my throat that persisted until washed away with a beer. Of course, what goes in must come out, so expect a certain amount of mucus. The big problem for salt therapy, as with so many alternative treatments, is a lack of robust scientific evidence. There are certainly plenty of people convinced of its benefits. But the medical profession is still largely sceptical. “Some doctors are receptive,” says Caroline, optimistically. But, clearly, many are not. “This is definitely non-evidence-based, and not approved by any sensible, normal person,” says Professor Kenneth Tsang of the department
of medicine’s division of respiratory and critical care at the University of Hong Kong. Most of the existing papers on the subject, he adds, “are obscure or unreferenced sources. Superficially, there seem to be some European Respiratory Journal papers which are good scientifically if you look at the standing. “But if you look at the actual papers, they were not fully published projects but rather abstracts in meetings, which carry next to nothing in terms of standing. “Overall, I am afraid there is not enough evidence to justify any use of salt therapy treatment in a straight scientific sense.” There are, for example, Russian studies from 2004 and 2006 that claim a reduction in a range of symptoms, including coughing, and an improvement in lung flow/volume among people at risk of chronic obstructive pulmonary disease, and smokers, who used a salt-based inhaler. But cast around for medical
evidence of salt therapy’s effectiveness and you’ll find plenty of quotes from the author of those studies, Dr Alina Chervinskaya of the Federal Medical and Biological Agency in St Petersburg, who herself had a hand in the development of salt-based aerosols. Dr Amos Lo, a specialist in otorhinolaryngology at Matilda International Hospital, adds that the therapy may be helpful in the treatment of asthma and cystic fibrosis. But he says that the evidence isn’t there. “There haven’t been any good-quality studies to show that it works,” he says. “There are some studies that show a slight benefit, and lots of claims. “There was a paper written in 2006 in Allergy which found out that halotherapy would decrease bronchial hypersensitivity in asthmatics,” he says, but adds that there was no evidence that the treatment increased airflow to the lungs. “At most we can only say that halotherapy may possibly be an
add-on therapy in asthmatics, but the usual inhaled steroid should be continued as definitive treatment.” Salt therapy’s claimed benefits in the treatment of skin conditions such as psoriasis, acne, dermatitis and eczema, are likewise unproven, says Dr Tinny Ho of dermatology clinic Skincentral. “I have never heard of halotherapy as a proven treatment option for skin problems,” she says. “I also don’t believe in the proposed mechanisms of ‘normalising pH’, and ‘improvement of local microcirculation’. The only part that I agree on is that it may give positive psycho-emotional and antidepressant effects. So it’s basically a placebo effect. “A placebo is fine as long as the treatment doesn’t over-claim its beneficial effects or market itself as a proven medical treatment option,” adds Ho. “That can delay people from getting proper medical attention. A placebo must also not be harmful.” email@example.com
6 HEALTH PREVENTION MYOPIA
Outdoor ...................................................... Margaret Wee firstname.lastname@example.org
About 90 per cent of Hong Kong university students have myopia, mostly because, as children, they rarely get outdoors, studies suggest
Twelve-year-old Megan Lim does not have much time to play outdoors. The bespectacled girl used to go cycling or rollerblading at least once a week when she was eight, but she stopped after her homework increased dramatically. With the reduction in outdoor playtime came a corresponding increase in her myopia from 150 degrees to 400 degrees in both eyes today. “It’s too late to do anything about it now, because she’s reached puberty and her vision has stabilised,” says her mother, Tang Meng Choo. It’s been known for some time that outdoor play can keep myopia at bay. A Cambridge University study has found that for every hour children spend outdoors each week beyond the norm, their risk of developing myopia falls by 2 per cent. The study, involving 10,000 children and adolescents, found those with myopia spend 3.7 fewer hours outdoors a week on average than children with normal vision.
TRADITIONAL CHINESE MEDICINE
Ancient remedies ﬁnd a fresh role: integration with m ...................................................... Elizabeth Snouffer email@example.com Conventional treatments for many cancers – lung, colorectal, breast and liver, for example – don’t offer much success, especially if diagnosed in later stages, according to Professor Bian Zhaoxiang, acting dean of the school of Chinese medicine at Baptist University. That is why his team of traditional Chinese medicine (TCM) oncology specialists and the Hong Kong Anti-Cancer Society have been collaborating on an integrative clinical approach. For two years, the team has been conducting an outpatient pilot study to assess patient response to combined approach of conventional chemotherapy treatments integrated with TCM. “The integrative approach is the new direction for oncology, and because it’s safe, it’s working,” says Bian. Although stronger data and more evidence are needed, Bian says this approach has shown to improve the quality of life for cancer patients during and after highly toxic courses of chemotherapy treatment. There are more than 50 different cytotoxic chemotherapy drugs, with side effects such as fatigue, nausea, diarrhoea, constipation, visceral pain, insomnia, loss of appetite, weakened immune system and vulnerability to
bacterial or viral infections. In the pilot study led by Bian, patients experienced a significant reduction in side effects such as nausea and were able to sleep better and function at a relatively high level. “After taking the Chinese herbs, many patients were able to increase the potency of their chemotherapy treatment, which, in turn, increased their overall chance for improved survival rates,” says Bian. “Patients also indicated they felt happier, which is significant, as most of these patients might be living longer, but aren’t living well.” He believes the future is bright for an integrative medical approach, especially where cure rates are low. Based on these and other protocols, Baptist University’s school of Chinese medicine will now begin clinical trials for further study. In Hong Kong, the number of new cancer patients rose from 8,900 in the mid-1970s to about 26,000 in 2009. Lung, colorectal, breast, liver, prostate, stomach, nasopharynx, non-melanoma skin, non-Hodgkin’s lymphoma and corpus uteri cancers account for 75 per cent of all new cancer cases and will continue to rise at a steady rate, according to the Hong Kong Cancer Registry website. The top two leading cancers – in both incidence and mortality rate – are lung, first, and colorectal. Dr Joshua Ko Ka-shun, associate professor at Baptist University’s Centre for Cancer and
Inflammation Research, has been studying the effects of Chinese herbs on colorectal cancer patients. He has witnessed the reversal of low white blood cell count, or leucopenia; the restoration of depleted platelets; and a reduction of pain, such as neuropathy, in patients. “Western drugs retain their potency, but Chinese medicine minimises side effects and strengthens immunity, giving people a fighting chance,” Ko says. Worldwide, particularly in the
Patients said they felt happier, which is significant, as they might be living longer, but not well PROFESSOR BIAN ZHAOXIANG, BAPTIST UNIVERSITY
Many cancer patients in Hong Kong use at least one form of Chinese medicine without ever informing their oncologists. Photo: Liu Yang
US and Europe, medical schools are also beginning to take notice. Tommy Cheng Yung-chi, professor of pharmacology at the Yale University School of Medicine and honorary professor at SCM, has made some profound discoveries about the therapeutic effects of Chinese medicine on chemotherapy cancer treatments. Named as one of Yale’s most prolific inventors, Cheng created a botanical drug called PHY906 to reduce the toxic effects of chemotherapy based on a 1,800year-old ancient herbal remedy. Cheng, in conjunction with the US National Cancer Institute, is exploring PHY906’s mechanism of action and what the future might hold for its therapeutic promise. According to a survey conducted last year at Baptist University, more than half of the 786 cancer patients interviewed in outpatient clinics in Hong Kong were using at least one form of Chinese medicine along with Western treatments, and more than two-thirds of those in this group were not telling their oncologists. This is a dangerous practice because the risk of contraindications is high without monitoring, and certain Chinese compounds may interfere with conventional treatment. The key reason for keeping quiet is physicians’ attitudes toward TCM, which are sceptical at best. Baptist University researchers found most oncologists and
r play helps kids see the point In an earlier study announced in June, researchers at the University of Sydney hypothesised that lack of exposure to sunlight may be the main factor in myopia. Exposure to sunlight releases retinal dopamine, which inhibits eye growth. This prevents myopia, which develops when the eyeball is too long so that light entering the eye falls in front of the retina instead of directly on it. When this happens, close objects are seen clearly, and objects farther away appear blurred. The study suggested that children should spend two to three hours a day outdoors, as there is 10 times more light outdoors than indoors. These studies may explain why so many young people in Hong Kong are myopic. The city has one of the highest rates of myopia in the world – three times that of the United States and more than 10 times that of the Middle East. Five per cent of kindergarten-age children and 36 per cent of primary school students need glasses. Sixty per cent of secondary school students have myopia. Among university-age students, the figure rises to 90 per cent.
Parents should encourage more outdoor activities for all preschool children at the age of three to four years, especially if they themselves have myopia DR CHNG NAI-WEE, OPHTHALMOLOGIST
modern treatments general physicians have too many theoretical concerns about Chinese medicine, so they forbid it. Curiously, when patients have finished a six-week course of chemotherapy treatment, they are often told that the hospital can no longer do anything for them, whereas patients in the final stages of cancer are advised to use alternative therapies for relief. According to Ko, while cannabis and morphine are generally perceived to be drugs which can effectively reduce pain, neither of these offers long-term, sustainable relief. Cannabis acts on the central nervous system, he says, “so a patient’s increased tolerance makes it ineffective after a month or two. Morphine can be used only short term or in the final stages of cancer as it adversely affects the heart and brain.” Professor Tony Mok Shu-kam of Chinese University’s department of clinical oncology, named the leading light in Hong Kong oncology by medical journal The Lancet last year, believes that Chinese medicine has merits; but until there is evidence to support its efficacy, he won’t depend on it. “There is a reasonable amount of evidence for the use of acupuncture for pain control or to reduce the state of nausea,” says Mok, but he adds that Chinese medicine will be used only by a few patients, such as those who refuse pain medication or wish to supplement conventional treatments.
Mok is focusing on investigating drugs that target the molecular characteristics of a tumour, and has had a 70 per cent success rate in non-small-cell lung cancer patients. “One of my patients told me: ‘Your pill worked really well with my Chinese medicine’, and I understand what she means,” he says. “However, I use science rather than pure belief to cure my patients.” In the past, toxic herbs were used to treat the highly potent properties of carcinomas, but are no longer used today for fear of fatalities. Instead, many anticarcinogenic herbs are familiar and often mild in nature. TCM uses decoctions that are generally prescribed following a patient examination. “Most cancer patients display a heat deficiency as all the Western treatments are cold,” explains Bian. So, to offset the imbalance, different combinations of herbs are used: • Group 1 targets the origin and development of the cancer – for example, barbat skullcap, giant knotweed rhizome, iris rhizome root. • Group 2 tonifies the qi, blood, yin and yang. Examples are ginseng, Chinese desert-thorn, rehmannia root. • Group 3 – such as coix seed, fleece flower root, chuling – modulate the immune system. • Group 4 – such as germinated barley and prepared liquorice root – integrates with other ingredients.
Although myopic parents are likelier to have myopic children, environmental factors play a bigger role. Hong Kong’s dense population, poor air quality, relative lack of play areas and stressful education system combine to keep children indoors for extended periods. As a result, many of them engage in activities such as reading, doing homework, watching television or playing computer games. “Children tend to hold books too close to their eyes when they read. They also write with their heads too close to the desk. In addition, many spend a lot of time playing video games and tend to hold the consoles too close to their eyes,” says Dr Chng Nai-wee, consultant ophthalmologist with Eagle Eye Centre in Singapore. Such habits – called “near work” – cause myopia because they force the eye to focus on close objects within half a metre for extended periods. This causes the eye to lengthen gradually, affecting distance vision. “Although the majority of children in Hong Kong have low to
moderate myopia of between -3 to -6 diopters, some have severe myopia of greater than -6 diopters. I have seen patients with more than -20 diopters,” says Dr Dorothy Fan Shu-ping, consultant ophthalmologist at Hong Kong Sanatorium & Hospital. A diopter, expressed in negative numbers for myopia, is the power of the lens needed to correct vision. The higher the number, the stronger the lens. One diopter corresponds to 100 degrees. Several therapies have been developed to try to correct myopia. These include eye exercise programmes, as well as products such as pinhole glasses, which purport to cure myopia by exercising the eye’s muscles. The latter claim has been decried as a myth by the American Optometric Association. “So far, only the use of atropine eye drops is clinically proven to control or slow myopia progression,” Chng says. Atropine, a naturally occurring substance found in certain plants, relaxes the eye’s focal muscles when the person works. A study
by the Singapore Eye Research Institute published in 2006 found that a nightly dose of 1 per cent atropine eye drops slowed the progression of low and moderate childhood myopia compared with a placebo treatment. Ultimately, the best way to keep myopia at bay seems to be simply sending children outdoors to play more often. “Parents should encourage more outdoor activities for all preschool children at the age of three to four years, especially if they themselves have myopia,” Chng advises. This has the added benefit of encouraging physical fitness, which children in highly urbanised environments such as Hong Kong typically lack. If going outdoors is not possible, good posture while engaging in near work will also help. “As we know that near work makes myopia worse, we should encourage children to read and write at a proper distance,” Fan says. The ideal focal distance for reading and writing is 38 to 63cm, and at arm’s length for computer viewing.
Hot on the trails Clockwise from above left: the MotionX-GPS, Enjoy Hiking and EveryTrail apps
APPS AND DOWNS Enjoy Hiking is free. MotionX-GPS is US$1.99. iMapMyHike+ Lite version is free; US$1.99 for the full ad-free version that allows you to geo-tag photos to your saved routes and provides voice feedback throughout the session. EveryTrail has a free lite version; US$3.99 for the Pro version, which allows you to sync all your trips online, record, share and map videos, and saves maps for offline use when you are using it without an internet phone connection. All from iTunes.
...................................................... Ly-ann Tan firstname.lastname@example.org One of the things that makes Hong Kong such an appealing destination is the possibility of keeping fit in the great outdoors. Now that the weather has cooled dramatically, I have spent the past couple of weekends hiking paths that overlook the vistas from the heights of Dragon’s Back, Lantau Peak and Victoria Peak. The territory has a maze of trails to please the seasoned hiker. But where does a newcomer to the city begin to explore these trails? I looked to iTunes to download the apps that would point me in the right direction. The Agriculture, Fisheries and Conservation Department’s (AFCD) Enjoy Hiking app is the most immediately useful, listing all
the walks and trails by types and regions. The app provides trail information such as starting point, expected sights en route, difficulty level and a map of the route. So, now I had places to go. But there were so many routes that I needed to get feedback from people who had walked the trails. I found it in the EveryTrail Pro app. It has guides and tips from experts, as well as members of the public, who have recorded their routes in detail and included photos. Many hikers use this app to share information. I had read good things about Jardine’s Lookout, so I took some visiting friends to conquer stage five of the Hong Kong Trail. But when we got to Hong Kong Parkview, the condominium on Tai Tam Reservoir Road where the stage began, I realised that there were trails leading in all directions.
The territory has a maze of trails to please the seasoned hiker. But where does a newcomer to the city begin to explore these trails
It was a case of the blind leading the blind. The Enjoy Hiking app indicated the route would head towards Quarry Bay, so I led the group in a northeasterly direction only to find we were heading towards the Tai Tam Family Walk, a much easier trail that wouldn’t give us the workout we wanted. I backtracked to the starting point and switched to EveryTrail Pro, which allowed me to track and record my signal directly on the topological trail map, and check with waypoints and pictures that we were on the right track. It would have been far less frustrating if I could have checked my bearings against the trail map on the Enjoy Hiking app with the phone’s GPS signal, or had the ability to view my location in terrain rather than satellite mode on EveryTrail Pro, which would show much more than just a canopy of green. To track my fitness goals, I pulled up the iMapMyHike+ app, which marked out my path and recorded the essentials: duration, distance, pace, speed, elevation and, most importantly, calories burned. Once we reached Taikoo Shing for lunch, I saved the path and pictures taken on the phone to the route recorded on EveryTrail Pro and iMapMyHike+. This automatically uploaded the data to EveryTrail.com and MapMyHike.com, where I was able to review my hike once I got home. My second hike on Lantau Island along the Olympic Trail turned out to be a little more complicated. I was not going to be able to track my route clearly on Enjoy Hiking and I could not find any shared maps on EveryTrail Pro; so I scoured the web for a gpx (an open GPS data exchange format)
map that I could follow on MotionX-GPS. Again, there were many possible trails from Mui Wo, but this time I felt confident knowing I was navigating towards a specific set of co-ordinates on the topographical map while seeing my location on MotionX-GPS. The app also recorded and uploaded all the key data, but didn’t translate them into useful workout information. After a hearty meal at the hike’s end point in Tung Chung, I posted the data on Facebook and Twitter directly from the app. Enjoy Hiking is a handy application to source for information about the official AFCD gazetted trails, but not very helpful for tracking. It’s a pity that although the department has done a good job of marking the trails and listing them online, the app is unable to use the trail markers to establish waypoints for hikers to navigate to. It would be much more useful if hikers could track their signal on the route map against the distance posts. Use iMapMyHike+ if you want to track route and fitness data, but if you have a specific gpx file you want to follow, you will need MotionX-GPS. And until there is some way to merge Enjoy Hiking with EveryTrail’s waypoint checks and social functionality, this might be more useful if you’re planning to go off the beaten path. EveryTrail Pro has plenty of walks, guides and trips, and even shows trail routes on topological maps so you may find some “unofficial’ hikes. It is now my go-to app for hiking in Hong Kong. It won’t be a case of the blind leading the blind any more.
FITNESS/ DIET 9 WALKING HOME
Miles not smiles in the Gobi ................................... Rob Lilwall email@example.com We prepare to leave at 8am, and outside dawn has just risen over Inner Mongolia. We have been sleeping in a little truckers’ roadhouse hotel which we stumbled upon last night, after three hours of marching through the Gobi darkness. It’s Friday, December 9, and seriously cold outside – about minus 20 – although this is made much worse as the Siberian winds are whipping down from the north, biting through our clothes, stinging our faces, and, when we remove our gloves for simple tasks such as tying a shoelace, making our hands go numb in less than 20 seconds. So we were relieved to find this place to sleep in the warm, and be spared another night in our icy tents. As we stumbled through the door last night, our huge rucksacks sticking in the doorframe, a gaggle of truck drivers looked up from their dinner, understandably surprised to see the arrival of two absurd foreigners in puffa jackets and giant fur Chinese army hats. I tried to break the ice by explaining in my faltering Putonghua that we were English people, to which a quick-tongued driver smiled and replied “and we are Chinese people”, to much laughter. We ate a bowl of noodles and collapsed into bed. Today, we repack our bags, brace ourselves and walk back out into another mid-winter’s morning. We are heading south along the road again, which is good for fast progress, but also not much fun, especially because the trucks which periodically go past often sweep an icy cloud of snow and fumes into our faces. I call this kind of day a “miles not smiles” day. For other days this week, we have managed to find much smaller paths and tracks through the
hills or alongside the railway. These days are slower but more fun and more interesting – “smiles not miles”. Despite our progress being so slow, with us covering only about 30 kilometres of hard-fought ground daily, the landscape has been gradually changing. The flat desert plains of Outer Mongolia and the Chinese border lands have given way to a world of rounded hills, with increasing tufts of shrubs poking through the snow, and even groves of what look to be recently planted trees. Sign of human habitation are becoming more regular, too. Little farmhouses with sheep pens are visible every few kilometers, and there are plenty of ramshackle, half-abandoned villages, consisting of small brick houses, insulated with mud on the outside. We wander through them in the middle of the day, dogs barking at us and old men staring at us. I wonder to myself what these elderly folk must have seen in their lifetime, in this remarkable and unpredictable country – a world war, a revolution, the extraordinary to-ing and fro-ing of government policy. And I imagine we are among the first Westerners they have seen walking through here: what do they think of us? Our progress is also giving us more glimpses of the new China – from the crest of small hills we spot huge chimneys spewing fumes into the cold clear sky. Beside the road, there are petrol stations, newly built towns, and walled compounds of neat, production-line factories. As we plod on southwards, the weight on our backs feels heavier and heavier. I have a slightly strained shoulder, and the top of my spine and soles of my feet are aching before day’s end. My cameraman and expedition partner, Leon McCarron,
It may be bitterly cold outside, but there have been plenty of warm receptions along the way. Photo: Rob Lilwall has a sore left foot and a slightly pulled chest muscle. The cold wind allows us to take only very short breaks, and so we have only just enough time to eat a handful of crumbled biscuits and drink some lukewarm water from our broken thermos flask. And then we haul on the packs and start walking to warm up again. Today we have a morale booster – we see a kilometre marker indicating that we have now walked 500 kilometres, which is 10 per cent of our walk home to Hong Kong. And as evening approaches and the temperatures start to dive, we are relieved to see another little settlement come into view, where the local restaurant owner gives us a cheery welcome, and
Our progress is giving us more glimpses of the new China – we spot huge chimneys spewing fumes into the sky
again has some rooms in which we can sleep. So it has been a good day of miles, and it even ends with a smile. When the expedition gets tough, and the pain and exhaustion tests me to my limits, thinking of Viva, the children’s charity for which this expedition is raising funds, keeps me going. Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book, and a National Geographic television series. Every week in Health Post, he will write about the progress of his latest adventure, Walking Home From Mongolia, which is in support of the children’s charity Viva. www.walkinghomefrommongolia.com
EAT SMART PORK BALLS
Dining high on the hog: a leaner indulgence ...................................................... Jeanette Wang firstname.lastname@example.org It’s hard to think of a pig as lean, but according to the US Department of Agriculture, pork tenderloin contains only 2.98 grams of fat per 85 gram cooked serving – the same fat content as an equal serving of skinless chicken breast. In fact, the “other white meat” is healthier than ever, through breeding methods that produce leaner hogs. That serving of pork tenderloin is an excellent source of protein, thiamin, vitamin B6, phosphorus and niacin. It’s also a good source of riboflavin, potassium and zinc. If you need to eat pork, skip the char siu and get your fix by cooking this quick and easy dish. The recipe is provided by the English-Speaking Dining Society of the Chinese Cuisine Training Institute.
Simmered pork balls with water chestnuts Serves 4 ½ piece white bread 300 grams green vegetables 4 silver fungi, soaked 8 water chestnuts, peeled 2 Chinese black mushrooms, soaked 1 tbsp American ginseng 60 ml boiling water 200 grams minced lean pork 1 tsp fine salt ½ tsp sugar 1 tbsp starch Ground white pepper to taste 2 tsp canola oil 1 litre chicken stock For the thickening 150 ml chicken stock ½ tsp fine salt ½ tsp sugar 2 tsp starch 1 tbsp water • Soak white bread in water. Drain and set aside.
• Wash vegetables and fungi. • Finely dice the water chestnuts and mushrooms. • Soak ginseng in 60ml boiling water, strain and reserve water for later usage. • Mix the pork and salt. Add sugar, starch, white pepper, oil, diced chestnuts and mushrooms, and soaked bread. • Mix well, divide into four equal portions and shape into balls. • Bring chicken stock to a boil. Add meat balls. Lower heat and simmer for 10 minutes. Use the same stock to cook vegetables and fungi. Place meat balls, vegetables and fungi in a deep dish. • Bring 150ml of chicken stock and ginseng water to a boil. Season with salt and sugar, thicken with starch and water, and pour over the dish. The recipes for this column are provided by the Department of Health as part of its EatSmart@restaurant.hk campaign. For more information, visit restaurant.eatsmart.gov.hk
Using leaner pork means you can eat these meat balls without feeling guilty
Spice up the medicine cabinet ...................................................... Elle Kwan email@example.com These days cinnamon isn’t only a staple of the spice rack. More and more health practitioners are prescribing it for medicinal use, as research into the effects of the age-old spice shows it can aid in many conditions from ulcers to gas control. It’s also been widely touted as a diabetes remedy, although studies on its efficacy have been mixed. One of the most cited studies is that done by Dr Shah Alam Khan from NWFP Agricultural University in Peshawar, Pakistan, and published in December 2003 in Diabetes Care. In the study, 60 men and women with type 2 diabetes were given between one and six grams of cinnamon (one gram of ground cinnamon is about half a teaspoon) or a wheat flour placebo each day for 20 days, followed by a 20-day wash-out period. After 40 days, those who took cinnamon had lower blood sugar and cholesterol levels, with the highest dosage group showing the best levels. In 2009, a study headed by the US Department of Agriculture evaluated 22 obese people who were considered by doctors to be “pre-diabetic”. Half were given a placebo, and the other half took 250 milligrams of dried, watersoluble cinnamon extract twice a day for 12 weeks. The cinnamon group showed up to 23 per cent higher antioxidant levels, indicating the spice could help maintain healthy blood glucose levels and prevent diabetes.
We wouldn’t classify cinnamon as a drug, [although] results from animal studies do look promising CONNIE LEE, CHINESE UNIVERSITY DIETITIAN
In other tests, however, cinnamon had no effect on blood sugar or cholesterol levels. “At this point we wouldn’t classify cinnamon as a drug,” says Connie Lee Pui-wai, a registered dietitian with Chinese University, who researches diabetes and cardiovascular health. “Results from animal studies do look promising.” There are clear indicators to show why cinnamon may be beneficial. Compounds found in the spice are antioxidant and antiinflammatory. This is encouraging for diabetes sufferers whose inflammatory markers are higher than normal, says Lee. The compounds could also aid capillary function and help protect blood vessels, she says. Alternative medicine practitioners are even more enthusiastic. Dr Kenneth Chu, a naturopath at Redwood Natural Health Centre, says: “Most naturopaths would prescribe cinnamon straight off the bat.” Cinnamon can enhance insulin usage in the body, he says, making it suited to treating metabolic
issues, but he stresses that he recommends cinnamon only on an individual basis after full assessment. “We tend to prescribe to the person, not the disease,” he says. Cinnamon is available as capsules, in powder form and as a tincture. Cinnamon can also be helpful with other conditions. Its astringent effects can be beneficial for those with ulcers, and its tendency to create tautness helps avoid bleeding, says Chu. Other studies show that chewing or even sniffing cinnamon helps refresh the mind, and improve attention span and memory. Benita Perch, a naturopathic doctor with Holistic Central Medical Practice, says that cinnamon’s anti-spasmodic, muscle relaxant qualities help calm the intestinal tract, making it helpful in managing dyspepsia, indigestion, nausea and gas. There is also evidence to support the spice’s ability in treating postpartum haemorrhaging, again due to its astringent nature. Some studies have suggested that using cinnamon in a highcarbohydrate meal could lessen effects on blood sugar levels. However, Perch warns the spice should not be used as a shortcut. “Recent studies have found that compounds in cinnamon can stimulate our cells’ insulin receptors, increasing the cells’ ability to absorb and use glucose,” she says. “Sprinkling it on foods can help to lower the glycaemic index of a meal. However, it’s best used together with a diet low in carbohydrates in those with insulin resistance and diabetes.”
MOROCCAN TAGINE Cinnamon has been used to boost health for centuries in many cultures. It’s prominent in Indian and Middle Eastern foods. In Egypt, Bedouin tribes make kerfa, an infusion of ground cinnamon, cloves, milk and honey to warm the body during cold desert nights, says Dody Adel Wakim, an Egyptian who runs Sahara and Le Souk restaurants in Central. He also suggests boiling cinnamon sticks in soya bean milk. In Middle Eastern and Moroccan cuisine, cinnamon is commonly found in couscous and tagine dishes, adding depth and lifting flavour, such as in this recipe. Le Souk’s Moroccan tagine Serves 4 1kg lamb shoulder 2 tsp ginger powder 2 tsp cinnamon powder ½ tsp turmeric 2 onions, finely sliced 3 garlic cloves, finely chopped A few shallots, finely chopped 5 carrots, sliced 133 grams butter or 2 tsp olive oil 750ml water or vegetable stock Salt and black pepper to taste 1-2 cinnamon sticks A handful each of green and black olives 240 grams dried apricots, halved 60 grams dried prunes, halved A handful of almond flakes • Remove any fat from the lamb and cut into cubes. Set a pan on medium heat and add half the butter or oil.
(Butter is traditionally used). Brown the meat in batches and set aside. Cover with the ground spices. • Add onion, garlic and shallots to the pan. Fry gently with butter or oil until tender. Add carrots and cook for another three minutes. • Add meat and spices to the pan and cover with water or stock. Bring to a boil. Add salt, pepper and cinnamon sticks. • Continue cooking over a low heat, stirring and adding water or stock as needed until mixture is stew-like (about two hours). • Transfer mixture to a tagine or heavy-bottomed casserole dish. Add olives and dried fruit. Cook in oven on medium-high heat for about 10 minutes. • If you don’t have an oven, add olives and dried fruit to the pot of stew and simmer for a further 20 to 30 minutes. Add water as needed. • Sprinkle on almonds before serving with bread, couscous or rice. Elle Kwan
WELL-BEING 11 PERSONAL BEST
It’s all smoke and mirrors
...................................................... Jeanette Wang firstname.lastname@example.org Kallo Organic Dark Chocolate Rice Cake Thins 90 grams for HK$29.90, ThreeSixty Sheets of crisp, wholegrain brown rice are smothered in top-quality Belgian chocolate to produce this heavenly snack, which packs just 53 calories per slice. Verdict: Perfect with a hot drink. It’s hard to stop at just one.
Illustration: Henry Wong
Sasha Gonzales email@example.com I used to smoke so much that a friend actually came up with a joke about my habit. “If you’re trying to find Sasha in a crowded room,” she said, “just look for a cloud of cigarette smoke, and there she’ll be, standing right under it.” A cloud sounds like an exaggeration, but that’s how heavy a smoker I was. I picked up smoking when I was 18, to fit in with a new group of friends, all of whom were smokers. The first time I inhaled, I hated it but convinced myself that I could learn to love it. The next day, I managed to smoke three cigarettes and felt accomplished. Two days later, I bought my first pack. In just a few months, I was smoking 20 sticks a day. My addiction ruled my life. I got antsy whenever I couldn’t get my fix. It was definitely an emotional crutch – smoking cheered me up and calmed me down. I couldn’t get through difficult situations or confront problems unless I’d smoked a cigarette or two first. It didn’t bother me that it was an antisocial habit. My attitude towards non-smokers was if you didn’t want to inhale second-hand smoke, then just don’t come near me. The fact that I was slowly killing myself didn’t worry me either. I was still young and had plenty of time to quit. I believed that I was in control of my habit, and could stop whenever I wanted. I figured I had an addictive personality, and that’s how I justified my habit to myself and everybody else. It wasn’t until my mid-20s that I considered quitting. I was on a mission to live more healthily, and felt a little disgusted by my habit. I threw all my cigarettes away and started on nicotine gum and patches. But the withdrawal symptoms were overwhelming, and after a couple of days, I relapsed. Over the next few years, I made several more attempts to stop, all unsuccessful. I would manage to quit for a few days or weeks, but eventually caved in to the cravings. After I turned 30, I began experiencing breathing problems and heart palpitations. These were symptoms of my generalised anxiety disorder, according to my doctor, and smoking only made them worse. I’d sometimes wake up breathless in the middle of the night, not sure if it was due to my anxiety or my smoking, or both. In times of severe work stress, I smoked more than a pack a day. My lungs felt perpetually congested, I was coughing all the time and was always short of breath. Then I read an article about emphysema – the thought of being hooked up to an oxygen machine scared the hell out of me. I didn’t want to suffer that way in the prime of my life. I didn’t want to struggle to talk or walk. I became more desperate than ever to kick the habit, but I didn’t know how to do it without feeling deprived. Five years prior, a colleague had lent me a book, Allen Carr’s The Easy Way to Stop Smoking. I’d read it and it made sense to me, but I didn’t understand how to apply it to my situation. Carr had been a chain
THE TASTE TEST LUNCHBOX SNACKS
smoker for more than three decades. Then, one day, he quit, just like that, and never experienced another craving again. He wrote his bestselling book, and went on to start smoking cessation clinics all over the world. Carr’s method is simple: understand the psychological reasons behind your smoking and you will be able to stop. Smokers believe that they “need” to smoke, but Carr explains that this is not true. He describes how the tobacco industry keeps smokers hooked by making them believe that cigarettes relieve boredom and stress. He also describes how smokers brainwash themselves into thinking that they can’t break their addiction. Carr uses no scare tactics in his book – smokers know what diseases they’re signing up for when they take up the habit – and he explains why willpower has nothing to do with quitting. For a long time, I’d kept Carr’s ideas in mind, but the penny didn’t drop until October 2007. I’d just finished a cigarette when I had trouble taking a full breath. I panicked and began to feel lightheaded. A colleague had to send me home, and on the way in the taxi, I felt like I was going to die. Right there and then, I knew that I’d be doing myself a great disservice by continuing to smoke. I reached into my bag, threw my cigarettes and lighter away, and made the decision to be smoke-free. Once it clicked in my mind that I was hurting myself and no longer wanted to be a slave to cigarettes, I was able to quit. The truth really did
Once it clicked in my mind that I was hurting myself and no longer wanted to be a slave to cigarettes, I was able to quit
set me free. Since then, I’ve had no desire to light up. Smoking was such a big part of my life for 14 years that it pretty much defined who I was. Going from a hard-core smoker to a nonsmoker overnight sounds farfetched, but if I can do it, anybody can. I can’t believe how easy it was too, compared to my previous attempts. In the end, quitting smoking is about wanting to quit in the first place, and knowing why you’ve not been able to stop all this while. It’s also about understanding how you use cigarettes as a crutch and coming to the realisation that you will be perfectly fine without them.
Nana’s Cookie Bars Box of five 35-gram bars for HK$49, ThreeSixty These bars – baked with real bananas – are described as “a smooth fruit explosion” on the website. However they were dry, powdery and tasted like cardboard. Verdict: I can’t be forgiving about these; they’re really, really bad.
Revolution Foods Organic Jammy Sammy Box of five 29-gram bars for HK$47, ThreeSixty This organic, wholegrain, peanut butter and grape jelly square is small (think Honey-I-shrunk-the-PB&Jsandwich) but huge on flavour. Verdict: The kids will love these.