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YOUR GUIDE TO LIVING WELL

TUESDAY, MAY 29, 2012

HEALTH POST

SUPPLEMENT OF HYPE OR HOPE? >PAGE 8

THE FABULOUS FLYING THERAPIST >PAGE 11

Last gasp Why fresh air days may soon be over in south Lantau >PAGE 6


2 NEWS APP OF THE WEEK

HEALTH BITES

Soothing voice helps to lower stress levels

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...................................................... Katie McGregor healthpost@scmp.com Relax with Andrew Johnson – Deep Relaxation – Sleep Rating 10/10 US$2.99 My guess is that in Hong Kong most people, whether they know it or not, could use a good app to help them deal with stress. Stress is bad, and according to the Mayo Clinic in Minnesota, people frequently attribute the symptoms of stress to illnesses, rather than laying the blame where it belongs. The Stress Check app by Azumio agrees with professional advice on this matter: taking time to chill out brings my stress levels – in the form of heartrate variability – right down. With his gentle Scottish tones, Andrew Johnson gives you what could be considered the James Bond of relaxation inductions (and I am thinking Sean Connery, of course). A clinical hynotherapist, Johnson provides more than just a pretty voice to accompany the typical, deep resonating relaxation sounds. Like other meditation, relaxation or hypnotherapy apps, this one will talk you into a deep state of relaxation. This almost-asleep state is when you are most receptive to a hypnotherapist’s suggestions. Johnson suggests: “You will feel more energised, more focused, nerves stronger and steadier, and with practice your body remains more and more relaxed; in fact, you become more relaxed yourself, about the world around you ... life seems happier, healthier, more satisfying.” How can a positive suggestion like this be bad?

Tellingly, researchers in the University College of London’s psychology department say the hypnotic procedure produces a modest increase in suggestibility when it is called “relaxation”, but a significant increase if it is labelled “hypnosis”. So, if you acknowledge you are being hypnotised, you will get more out of it. I first downloaded the free Relax with Andrew Johnson Lite which comprises a 12-minute relaxation and hypnosis session. It assumes you are seated and want to “awaken” refreshed at the end. This is perfect for a midday pickup, but I still chose to download the full version, which gives you the option of two lengths of induction (the relaxation part), a choice of number of repetitions of the hypnosis part, and whether to continue to sleep or wake up afterwards. Given my happiness and satisfaction with life, I recommend both versions.

ASK THE DOCTORS DR CHUANG HSUAN HUNG Q: My father had a heart attack when he was pretty young. Should I be worried about having one? A: Coronary heart disease (CHD) and heart attacks are caused by blockages in the coronary arteries that compromise the blood supply to the heart muscle, leading to damages. It is caused by a complex interaction of environment, genes and lifestyle. If any immediate family member developed heart disease at a young age – under 65 for a woman or under 55 for a man – the risk is higher. Epidemiology studies have shown that having a parent with a history of heart disease almost doubles the risk of also getting heart disease regardless of ethnicity. There is also a clustering of susceptibility to CHD in families that have risk factors (such as abnormalities of lipid metabolism, hypertension, diabetes or obesity), indicating a genetic basis for these conditions and risk factors.

While certain risk factors cannot be changed, it is important to realise that you do have control over many others. Regardless of your age, background, or health status, you can lower your risk of heart disease – and it doesn’t have to be complicated. Protecting your heart can be as simple as taking a brisk walk, whipping up a good vegetable soup, or getting the support you need to maintain a healthy weight. You should also start screening your risk factors (blood pressure, cholesterol, sugar levels) early and regularly. For example, the recommendation is that adults start screening for cholesterol at the age of 20, and at least once every five years afterwards. If the cholesterol level is abnormal on that initial measurement, then the screenings should be done more frequently, even annually. Dr Chuang Hsuan Hung is a cardiologist at Gleneagles Hospital in Singapore

> CONTACT US Deputy Culture Editor: Choong Tet Sieu tetsieu.choong@scmp.com Health Post Editor: Jeanette Wang jeanette.wang@scmp.com General inquiries: healthpost@scmp.com Advertising: tel: 2565 2435; e-mail advertising@scmp.com Printed and published by South China Morning Post Publishers Ltd, Morning Post Centre, 22 Dai Fat Street, Tai Po Industrial Estate, Tai Po, Hong Kong. Tel: 2680 8888

Jeanette Wang jeanette.wang@scmp.com

It pays to be studious A study published today in Neurology suggests that improving the quality and quantity of education early in life could help protect one’s cognitive abilities down the road. Harvard University researchers analysed the effects of solvent exposure at work on thinking skills later in life. Studying 4,134 employees at the French national gas and electric company, the researchers found that the thinking of those who had less than a high school education was affected, while those with more education were not, even if they had the same amount of exposure. “People with more education may have a greater cognitive reserve that acts like a buffer allowing the brain to maintain its ability to function in spite of damage,” says study author Professor Lisa Berkman. “This may be because education helps build up a dense network of connections among brain cells.”

Heart of the matter A study led by researchers from McGill University in Montreal has revealed fresh insights into the structure and function of the muscle fibres in the heart – a discovery that could help engineer artificial tissue and contribute to the study of heart diseases. Using a combination of diffusion magnetic resonance imaging (dMRI) and computer modelling, the researchers examined images of the heart tissue of rats, humans and dogs. They found that the muscle fibre bundles had the same pattern – a special “minimal surface” with the general shape of a flattened coil or spiral. This knowledge could be used, for example, to provide a scaffold to guide the repair of heart wall damage caused by heart attacks, say the researchers. The study appears in the Proceedings of the National Academy of Sciences.

For the love of dog If you had a dog, what breed would it be? In a study by the University of Leicester in Britain published recently in the journal Anthrozoos, participants were asked to indicate their preference for different types of dogs and do personality tests. The dogs were independently rated according to how aggressive people perceived them to be. Bull terriers were rated as most aggressive, followed by boxers; retrievers and cocker spaniels were seen as least aggressive. The researchers found that younger people who are disagreeable are more likely to prefer aggressive dogs. Individuals low in agreeableness are typically less concerned with others’ well-being and may be suspicious, unfriendly and competitive. However, there was no link found between liking an aggressive dog and delinquent behaviour.

These shoes were made for walking Soak up summer in style with FitFlop’s latest range of sandals. Just like the brand’s first design sold in 2007, this season’s shoes feature the “microwobbleboard” midsole that was designed by biomechanists at London South Bank University and said to diffuse underfoot pressure, absorb shock and activate leg muscles. The Walkstar Slide (HK$690), with padded leather straps and bright colours, exudes casual cool that’s perfect for a sizzling hot day. Available at Sogo, city’super, Rush, Marathon and Giga Sports.


NEWS 3 QUIZ

RESEARCH

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Painkillers may guard against skin cancer

Jeanette Wang jeanette.wang@scmp.com Thursday is World No-Tobacco Day, and the theme this year is “tobacco industry interference”. The World Health Organisation (WHO) aims to use this day, and continue throughout the next year, to educate policymakers and the general public about the tobacco industry’s nefarious and harmful tactics. According to the WHO, the tobacco industry has had “brazen and increasingly aggressive attempts to undermine the WHO Framework Convention on Tobacco Control [FCTC] because of the serious danger they pose to public health”. For example, in an attempt to halt the adoption of pictorial health warnings on packages of tobacco, the industry recently adopted the novel tactic of suing countries under bilateral investment treaties, claiming that the warnings impinge the companies’ attempts to use their legally registered brands. As more and more countries move to fully meet their obligations under the WHO FCTC, the tobacco industry’s efforts to undermine the treaty are said to be becoming more and more energetic. Tobacco use is one of the leading preventable causes of death. It kills nearly six million people globally each year, more than 600,000 of whom are those exposed to secondhand smoke. Unless action is taken, it will kill up to eight million people by 2030, more than 80 per cent of whom will live in less developed countries. Don’t be a statistic; act now to kick the habit. Find out your nicotine dependence using the following questionnaire developed by Dr Karl Fagerstrom, an international expert in the fields of behavioural medicine, tobacco and nicotine. Write your score, a number ranging from 0 to 3, after each question. Add up your total score; it will be on a scale of 10. A low dependence means you’ll benefit from professional counselling, though pharmacotherapy is not

...................................................... Jeanette Wang jeanette.wang@scmp.com

needed. But if you have a medium to high dependence, professional counselling is advised, as well as pharmacotherapy. 1. How soon after you wake up do you smoke your first cigarette? 0. After 60 minutes 1. 31-60 minutes 2. 6-30 minutes 3. Within 5 minutes 2. Do you find it hard not to smoke in places where smoking is prohibited? 0. No 1. Yes 3. Of the cigarettes you smoke daily, which will be the hardest to give up? 0. Any, other than the first cigarette in the morning 1. The first cigarette of the day 4. How many cigarettes do you smoke a day? 0. 1 to 10 1. 11 to 20 2. 21 to 30 3. 31 or more 5. Do you smoke more in the first hours after you wake up than during the rest of the day? 0. No 1. Yes 6. Do you smoke even if sickness keeps you in bed most of the day? 0. No 1. Yes Tobacco dependence: 0-3 points = low; 4-6 points = medium; 7-10 points = high

GENETICS & DISEASE

DNA knowledge of limited use ...................................................... Jeanette Wang jeanette.wang@scmp.com Does knowing your genetic make-up increase your chances of avoiding disease? As scientists try to reduce the cost of doing a high-quality analysis of a person’s total DNA structure from US$10 million in 2004 to US$1,000 or less, Harvard School of Public Health researchers have found that detailed knowledge about your genetic make-up may change your estimated disease prediction risk for three common diseases by only a few percentage points. That’s typically not enough to make a difference in prevention or treatment plans, they say. Knowing one’s genetic make-up means understanding the interplay with other genetic variants, or with environmental risk factors. Scientists have long hoped this

information could improve disease risk prediction enough to help in prevention and treatment. But the Harvard study, published online last week in The American Journal of Human Genetics, found that “the benefit of such a discovery for risk prediction purposes might be very limited”, according to lead author Hugues Aschard, research fellow in the epidemiology department. The team examined whether disease risk prediction would improve for breast cancer, type 2 diabetes and rheumatoid arthritis if they included the effect of synergy in their statistical models. But for each of these disease models, researchers calculated that the increase in risk prediction sensitivity – when considering the potential interplay between various genetic and environmental factors – would only be between 1 per cent and 3 per cent at best.

Aspirin and other similar painkillers may help protect against skin cancer, according to a study published online today in Cancer, a journal of the American Cancer Society. This finding follows up on studies that have suggested a link between taking commonly used medications – including nonsteroidal anti-inflammatory drugs (Nsaids) such as aspirin, ibuprofen and naproxen – and a lower risk of developing some types of cancer. In a study published in Britain’s Journal of the National Cancer Institute in 2010, for example, a widely used arthritis drug called celecoxib (a prescription-strength Nsaid) was found to reduce non-melanoma skin cancers, which includes basal cell carcinomas and squamous cell carcinomas, by 62 per cent in adults. The researchers, from the University of Rochester in New York state, noted that the decrease in these cancers is much greater than that achieved through the use of sunscreen, which provides only moderate protection against non-melanoma skin cancers. In the study published today,

Aspirin has the potential to inhibit cancer cells. Photo: Bloomberg researchers from Aarhus University Hospital in Denmark analysed whether the medications might decrease the risk of those two types of skin cancer, as well as malignant melanoma. The researchers analysed records from northern Denmark from 1991 through 2009 and found 1,974 diagnoses of squamous cell carcinoma, 13,316 diagnoses of basal cell carcinoma, and 3,242 diagnoses of malignant melanoma. These patients’ information, including prescription data, was compared with that from nearly 180,000 people without skin cancer. It was found that those who filled more than two prescriptions for Nsaids had a 15 per cent lower risk

for developing squamous cell carcinoma and a 13 per cent decreased risk for developing malignant melanoma than those who filled two or fewer prescriptions for the medications, especially when the drugs were taken for seven or more years or taken at high intensity. However, those who took Nsaids didn’t seem to benefit from a reduced risk of developing basal cell carcinoma – even though people who took them long term were 15 per cent less likely to develop this type of cancer on less-exposed sites (body areas other than the head and neck), and those who took them at high intensity were 21 per cent less likely. “We hope that the potential cancer-protective effect of Nsaids will inspire more research on skin cancer prevention,” says lead researcher Dr Sigrun Alba Johannesdottir. “Also, this potential cancer-protective effect should be taken into account when discussing benefits and harms of Nsaid use.” Caffeine is another possible ally in the fight against skin cancer. When applied directly to the skin, it might help prevent damaging ultraviolet light from causing certain skin cancers, according to a study on mice published last year by Rutgers University. Caffeine inhibits a protein enzyme in the skin, reducing the risk of cells becoming cancerous.


Illustration: Angela Ho

4 MEDICAL

...................................................... Eileen Aung-Thwin healthpost@scmp.com Eleven-year-old Andy Ho’s mother was anxious about his upcoming admission to secondary school. But Ho (names changed for patient confidentiality reasons) had more reason than usual to worry about her son. Andy’s eyes were not the same as most other children. As an infant, he could not seem to open his eyes properly. It turned out that his eye muscles were too weak to fully open, so at age two, he underwent an operation to strengthen those weak eyelid muscles. But it made only a slight improvement to his right eye, keeping it slightly more open than the left. The young boy was well aware of the differences in his appearance; he often avoided looking directly at others and was terribly shy. As he grew older, the condition took a toll on his social and emotional development. While looking different may be difficult for a primary school pupil, secondary school presents its own heady and potentially crushing mixture of escalating peer pressure, increased need for social acceptance and belonging, as well as a growing awareness of the opposite sex. Andy’s self-esteem could suffer even deeper trauma. Ptosis, or drooping eyelid, is caused by weakness of the muscle responsible for raising the eyelid, damage to the nerves that control those muscles, or looseness of the skin of the upper eyelids. Ho thought that the earlier failed attempt to correct the condition doomed Andy to suffer the rest of his life until her friends persuaded her to seek a second opinion, especially with the important milestone of secondary school looming. SheJ took the boy to see Dr Dorothy Fan Shu-ping and Dr Alvin

CASE HISTORY

Lifting the lid on a delicate problem Kwok Kwan-ho, consultant ophthalmologists with the Hong Kong Sanatorium and Hospital. Fan explained that ptosis not only presented a cosmetic and emotional concern. In children younger than eight years old, the drooping eyelids could also result in vision problems and scramble the development of vision in their brains. It could cause astigmatism, and even amblyopia (also known as “lazy eye”) where the eyes are unable to see details properly. But treatment was available. Kwok and Fan found that Andy’s right eyelid muscle was stronger

Secondary school [means] … escalating peer pressure ... and a growing awareness of the opposite sex

than the left. Hence, they could simply shorten and tighten the muscle in Andy’s right eyelid to give it more “spring” as the muscle is quite like a rubber band. Andy’s left eyelid muscle was much weaker, and a simple muscle strengthening procedure would not do the job. The doctors proposed using a sling operation or brow suspension, which would borrow the strength of the forehead muscle in keeping the eyelid open. The forehead muscle would be connected to the eyelid by using either the body’s own tissue or a synthetic material. Some patients have an extra

tendon in the arm that can also be used for the brow suspension, but Andy didn’t. The alternative was to take a tendon from his thigh. While using his own body tissue would reduce the chances of rejection, this option would create a second wound, increasing the patient’s pain and risk of infection. His parents opted for him to use a synthetic material. Synthetic material such as silicon carried a slightly higher risk of the body rejecting the material. But as the risk was not significant, the family was more comfortable with this option. The trick in both procedures was to ensure that both eyes were able to close properly after the operation, failing which the eyes could suffer from dryness or be exposed to debris or contaminants, especially during sleep. Andy’s operation was successful. Although his eyes could not fully close in the days immediately after the operation, the function of his eyes grew more and more natural with time. Six months after the operation, Ho reported that Andy was more sociable and confident. In Andy’s case, ptosis was a congenital abnormality. But Fan says the condition can affect adults, too, and can be a consequence of the ageing process, excess skin sagging over the eye or as a result of an injury or disease such as a stroke. Defects in the nerves that tell the eyelids to open, the muscle junctions that receive the nerve signals or the muscles in the eyelids can all prevent the eyelids from opening fully. Some ptosis patients actually suffer from an autoimmune condition called myasthenia gravis. Such patients also suffer weakness in their voluntary muscles, which worsens when the patient is tired. Ptosis becomes more obvious then, as well.


MEDICAL 5

HEALTH WORLD THYROID DAY

Life in your gland ...................................................... Nadine Bateman healthpost@scmp.com For more than a decade, Maria Santos suffered symptoms of a thyroid disorder that left her struggling at work and unable to enjoy life. “I felt tired all the time and found it really hard to get out of bed in the mornings,” says Santos (name changed for patient confidentiality reasons), 44, a project manager at a bank. She moved to Hong Kong four years ago from the United States, where she was diagnosed with hypothyroidism (an underactive thyroid). “I couldn’t concentrate properly; my brain felt ‘foggy’ and slow. I was moody and irritable. My skin, hair and nails were terrible – really dry and dull – and I gained weight easily … My husband used to say ‘Come on, let’s go to the gym, you can get out of this lethargy’, but I just couldn’t.” Hongkonger Milia Chan, 40, has experienced the other extreme of

1 in 5 • The estimated number of people worldwide with thyroid disorders

thyroid disorder – hyperthyroidism, or an overactive thyroid – since being diagnosed in 1995. The service business manager with an information technology company has symptoms that include “an extremely fast heartbeat, shaking hands, shortness of breath and bad temper”. Both forms of thyroid disorder are surprisingly common (an underactive thyroid being more common) but they often go undiagnosed because many of the symptoms are similar to those of other conditions. The symptoms can also be attributed to “lifestyle factors”, such as stress, poor nutrition, and a lack of exercise or sleep. The thyroid, a butterfly-shaped gland in the neck, controls metabolism. It produces hormones called T3 and T4, which tell cells how much energy to use. Hyperthyroidism occurs when the thyroid overproduces the hormones and the body uses energy faster than it should. Hypothyroidism is the opposite: the thyroid doesn’t produce enough hormones and the body uses energy slower. People of all ages can get the disease, but women have it more often than men. It is estimated that one in five people worldwide have a thyroid disorder. Hence World Thyroid Day, last Friday, to promote understanding of the condition. Dr Lauren Bramley, a family doctor who has a clinic in Central, suspects the figure is higher because many cases go undiagnosed. She recently completed a master’s in endocrinology, diabetes and

metabolism at the Chinese University and is treating a number of patients with thyroid conditions. “Hypothyroidism is now rampant,” says Bramley. “Hyperthyroidism, although increasing in prevalence, is not nearly as common as hypothyroidism. Furthermore, many hyperthyroid patients can become hypothyroid.” She says the list of hypothyroid symptoms is exhaustive, which is why it can be difficult for doctors to diagnose. “For example, fatigue – a major symptom of hypothyroidism – is also present in many other conditions or the result of lifestyle factors. But thyroid disorder has more symptoms than any other disorder in the body. This is because the thyroid gland is important in so many functions of every organ.” Other key symptoms of hypothyroidism include low body temperature, sensitivity to heat or cold, difficulty waking up in the mornings, severe fatigue at around 3pm, difficulty concentrating, low mood, enlargement of the thyroid gland in the neck and thinning of the outer areas of the eyebrows. Weight gain and hair loss are common complaints but are not always present. Bramley also believes pollution may negatively impact the function of the thyroid gland. Hypothyroidism can be caused by many factors, such as autoimmune thyroid disease, hereditary conditions, inflammation (thyroiditis) and tumours. Worldwide, the most common cause is believed to be iodine deficiency.

Thyroid disorders have more symptoms than any other disorder in the body DR LAUREN BRAMLEY, FAMILY DOCTOR

Dr Teofilo San Luis of the Asia & Oceania Thyroid Association says: “Iodine is available through eating marine foods such as fish, shrimps, squid, oysters, crabs and seaweeds; processed foods which have been iodised; milk; and iodised salt.” He says people affected with thyroid disorders will have goitre (thyroid enlargement) as evidence of poor iodine nutrition. However, he says that goitre is “only the tip of the iceberg” as there are “more insidious manifestations” of iodine deficiency not commonly recognised, such as reproductive failures. “Women are very vulnerable because of increased demands for iodine during pregnancy and lactation, and if their iodine nutrition is overlooked this could result in their babies having significantly lower IQ levels.” Patients are typically diagnosed through a physical examination, analysis of medical history and laboratory tests such as blood tests. Bramley notes lab test results can sometimes be unreliable. If the condition is hypothyroidism due to iodine

deficiency, San Luis says the treatment is to increase intake of iodine through iodised salt or, in extreme cases, iodised oil capsules. (Bramley, however, suggests refined, iodised salt is “not the ideal source”. She advises taking unrefined sea salt which is not iodised, and supplements such as Iodoral tablets or Lugol’s Solution.) In general, Bramley advises first correcting underlying deficiencies of iron, vitamin D3, selenium and iodine, and suggests a review of heavy metal toxicity such as mercury, arsenic and fluoride. Medications such as oral contraceptives and psychiatric drugs should also be considered. Identifying and balancing other hormones such as cortisol, progesterone and DHEA are important, says Bramley. Chan had an operation to remove her thyroid gland last April. Her doctor, Laurence Shek, prescribed thyroxine, which she will take every day for the rest of her life. “It took my body a while to adjust, but my heart is better now and I can do more exercise,” Chan says. Last September, Santos was prescribed T3, vitamin D, DHEA and iodine supplements – she had previously taken T4 medication for years without benefit. “I’m so much happier. I’ve more energy – I go to the gym three times a week. I feel good when I wake up in the mornings; I’m enjoying socialising again; and I’m losing weight.” For years, Santos, a book lover, could not concentrate enough to finish one book. Last month, she read four.


6 COVER STORY

Burning issue

Mui Wo resident Rosa Ma and her asthmatic daughter, Sun-yi


COVER STORY 7

South Lantau families are worried about the potential impact an incinerator to be built on Shek Kwu Chau will have on their children’s already fragile health, writes Charley Lanyon

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ast year, Rosa Ma and her eight-year-old daughter boarded the ferry in Mui Wo and headed into town for a ballet lesson. As soon as they disembarked at the Central ferry terminal, Ma’s daughter, Sun-yi, became uncomfortable. “She said she felt attacked by the dust on her face,” says Ma. By the end of the lesson, Sun-yi was having trouble breathing. Racing against a full-blown asthma attack, they boarded the ferry home, where, in south Lantau’s clean air, the little girl was finally able to regain her breath. Sun-yi, who suffers from asthma and eczema, has been diagnosed with an elevated immunoglobulin level that makes her 17 times more sensitive to the environment than other children her age. Ma monitors the air quality index every morning to ensure it’s safe for her daughter to venture outdoors. Yumi Yeung, another Mui Wo resident, moved to the area from Aberdeen with her family seven years ago to seek relief for her youngest son, who suffered serious asthma attacks every two to three months that required being admitted to hospital. Doctors seemed powerless to help and medication offered no relief. After the move, however, the boy’s condition improved rapidly. The

Dioxins, depending on wind flow, can cause worsening cases of asthma in children DR KENNETH TSANG, RESPIRATORY SPECIALIST

asthma attacks stopped and within six months he was off medication. For families such as these, south Lantau offers more than a pretty beach: it represents a chance for normality and a childhood free of debilitating health problems. But with the government’s plan to build a mass burn incinerator just six kilometres away on Shek Kwu Chau island, parents such as Ma and Yeung feel their children’s health is under attack. For now, the plan is on hold. Last month, the Environment Bureau was forced to abandon its HK$23 billion funding request for the incinerator, leaving the decision of whether to move ahead with construction up to the next government. But it seems inevitable it will be built because the city’s three major landfills are forecast to be exhausted by 2014, 2016 and 2018.

The effects of the new incinerator have been debated since 2008, when a shortlist of sites was announced. But such controversy is not limited to Hong Kong; incineration has been a hot topic worldwide for decades. There’s even a Global AntiIncinerator Alliance (GAIA), founded in 2010 and with a membership of more than 650 grass-roots groups, NGOs, and individuals in 90 countries. Dr Kenneth Tsang Wah-tak, a respiratory medicine specialist in Hong Kong, says incinerators pose two main dangers: dioxins and airborne particulate matter. “Dioxins are basically fumes that, depending on wind flow, can cause worsening cases of asthma in children,” says Tsang. Dioxins are also known carcinogens. “[Although] we don’t know of a direct relationship between instances of cancer and incinerators, it would be easy to extrapolate that dioxins could expose kids to a risk of the development of cancer later on.” According to the World Health Organisation, experiments have shown that dioxins affect a number of organs and systems. Dioxins that enter the body – typically through food – endure a long time because of their chemical stability and their ability to be absorbed and stored by fat tissue. Dioxins have a half-life of an estimated seven to 11 years. Meanwhile, particulate matter, Tsang says, goes directly into the lungs and is associated with the deterioration of lung function. A 2008 report, “The health effects of waste incinerators” by the British Society for Ecological Medicine, says two large cohort studies in the United States have shown that fine particulate air pollution causes increases in death from cardiovascular disease and lung cancer, among others. It also says that higher levels of fine particulates have been associated with an increased prevalence of asthma. Nitrogen dioxide, another pollutant produced by incinerators, has been shown to inflame the lining of the lungs, increase the susceptibility to lung infection, and increase the likelihood of respiratory problems. Tsang says there are many other chemicals from incinerators whose dangers we are as yet unaware of. Elvis Au, an assistant director at the Environmental Protection Department who is spearheading the Shek Kwu Chau incinerator project, says the plant will “showcase the best technology in the world” and be “totally different” to the old incinerator that closed down 20 years ago. This new generation of incinerator ensures a cleaner burn by burning waste in a highly turbulent environment at 850

A protest against the government’s plan to build an incinerator on Shek Kwu Chau (top); a representative from an environmental group points out the location of the proposed incinerator on a map. Photos: Dickson Lee, Nora Tam

2018 • The date by which all three of Hong Kong’s major landfills are projected to be exhausted

degrees Celsius for more than two seconds. This should ensure the complete combustion of all waste and organic material, including the toxic dioxin compounds. Toxic fly ash, a by-product of this process, will be collected, mixed with cement and disposed of in landfills. To clean the chimney emissions, the facility will also use a combination of filtering technology, including selective catalytic reduction (to remove nitrogen oxides) and activated carbon (to remove dioxins). The incinerator will be kept up to European Union standards, the most stringent in the world. “That’s why even a distance away, say, in Cheung Chau, about 3.5 kilometres away … it is pretty safe. There is no significant impact at all,” says Au. An EPD report in December last year notes that with the new incinerator, levels of nitrogen dioxide in Cheung Chau and south Lantau are projected to rise to 17 and 26 micrograms per cubic metre

respectively. This is still below the stated government air quality objective of 80 micrograms per cubic metre – and WHO’s recommended healthy level of 40 micrograms per cubic metre. For the most part, the real impact of modern incinerators on health is still unknown. Most published epidemiological studies relate to older incineration plants. Epidemiology, by its nature, after all, involves retrospective studies. “Proponents of new facilities tend to dismiss the older research as irrelevant,” writes Professor Vyvyan Howard, a toxico-pathologist with the University of Ulster, in a 2009 statement to the Ringaskiddy Incinerator inquiry in Ireland. “Opponents take a contrary view, arguing, not unreasonably, that similar claims of safety were made in relation to those older facilities when they were operating.” Howard adds: “The modern incinerators tend to be much larger than those operated historically, so that although the emissions concentrations have reduced, the total mass of pollutant emissions may even increase.” There’s no doubt that something must be done about Hong Kong’s looming waste crisis. We produce 13,800 tonnes of waste per day – among the world’s most prolific trash producers. But nobody wants anything potentially unpleasant in their neighbourhood and the “not in my backyard” phenomenon can stall vital public works projects indefinitely. Yeung says something as small as recent local roadworks were enough to put her son in hospital with an asthma attack. “I moved into a rural area to avoid the pollution of cities – where my son could have a healthier environment to grow up in,” she says. “There are so few truly ‘rural’ areas in Hong Kong; it is wrong of the government not to protect them.” Au says the site was chosen only after a “very objective, vigorous, systematic site search process starting with 21 sites all over Hong Kong”. Shek Kwu Chau was chosen over Tuen Mun mainly in an attempt to more fairly distribute unwanted facilities across Hong Kong. Tuen Mun is already home to a landfill and a proposed sludge incinerator. Au says he has been tirelessly meeting with community members to reassure them. Since 2008, he’s had 120 different consultation engagement activities. But his work does not seem to have had the desired effect. Says Ma: “[Au] says we’ve been consulted, but is he listening?” charley.lanyon@scmp.com


8 DIET NUTRITION

The hyped or the helpful?

...................................................... Sasha Gonzales healthpost@scmp.com Thomas Chan started taking L-arginine supplements after learning that it could help his high blood pressure problem. Six months on, Chan (name changed for patient confidentiality), 59, says his blood pressure has improved to below 120/80. He also no longer feels tired when he exercises. “After doing my own research on the benefits of L-arginine, I decided to purchase it online,” says Chan. “I take the full dose daily, and so far I haven’t experienced any negative side effects. I also take prescription drugs to control my blood pressure and cholesterol.” In recent years, L-arginine supplements have become popular with people wanting to maintain their cardiovascular health. Dr Benita Perch, a naturopathic physician with the Integrated Medicine Institute in Central, says she has noticed the trend among athletes. Arginine is a semi-essential amino acid, which is a kind of protein. It is found naturally in protein-rich foods such as beef, pork, chicken, lamb, fish, nuts, legumes, seeds, brown rice and dairy products. According to Charmain Tan, a registered dietitian at Seventeen

Nutrition Consultants in Hong Kong, as long as your diet contains sufficient protein, your body is normally able to make enough arginine. However, in some cases, supplementation might be needed. Scott Forbes, a doctoral student in exercise physiology at the University of Alberta in Canada, says the supplement is popular among athletes for two reasons: “First, L-arginine is a precursor for nitric oxide, which is known to improve blood flow, which in turn may aid the delivery of important nutrients to working muscles and assist with metabolic waste product removal. Second, L-arginine has been shown to increase growth hormone levels in the blood.” L-arginine is used to increase lean body mass in bodybuilders and boost muscle strength in athletes, says Perch. Outside of sport, L-arginine is used for a variety of heart and blood vessel conditions including congestive heart failure, chest pain, high blood pressure, and coronary artery disease. It is also claimed to be effective on cramps and pain in the legs due to blocked arteries, senile dementia, bladder inflammation, erectile dysfunction and male infertility. Sally Poon, a sports dietitian for Private Dietitian in Hong Kong, says some people also use L-arginine in combination with

over-the-counter or prescription medication to treat other conditions such as migraine; breast cancer; to speed up wound healing and minimise infection; shorten recovery time after surgery; and increase blood flow to hands and feet. With so many benefits associated with the supplement, it is little wonder that L-arginine is so popular. Since starting on the supplement a year ago, Marcus Ho, 37, a recreational runner, says he can run for longer periods without cramping or feeling tired. “I’ll take anything to improve my endurance, as long as it’s safe, of course. L-arginine seems to do the trick,” he says. Some experts, however, disagree that L-arginine actually enhances athletic performance.

There is evidence that the supplement helps patients with coronary artery disease, angina or atherosclerosis CHARMAIN TAN, DIETITIAN

Forbes’ study, published in the journal Applied Physiology, Nutrition and Metabolism last November, tested the supplement on 14 active, physically fit men who were free of nutritional supplements. He found that neither a low nor high dose of L-arginine showed any advantage; there were no significant increases in nitric oxide and growth hormones. Forbes suggests the impact of L-arginine depends on one’s health status: the more healthy and athletic the person, the less they’ll benefit from it. Tan says a study published last year in the Journal of Strength and Conditioning Research found there was little to support L-arginine as a strength-training aid. However, a 2006 trial of L-arginine for muscle building published in Nutrition did show that resistance-trained men could increase their bench presses significantly by taking the L-arginine supplement. “It’s just marketing hype,” says Poon. “There is insufficient evidence to prove L-arginine is an ergogenic aid in sports.” Another study published last year in the British Journal of Sports Medicine found that in competitive male cyclists, L-arginine improved their performance in 20-kilometre time trials. Perch says the supplement does

benefit athletes to some extent, although she adds more research is needed to work out the optimum doses and exact mechanism. Studies on L-arginine’s cardiovascular benefits have produced more favourable results. Tan says there is evidence that the supplement helps patients with coronary artery disease, angina or atherosclerosis, because it causes blood vessels to dilate. She adds a small number of studies have also shown its effectiveness on patients with peripheral vascular disease, in which the blood vessels in the legs and feet narrow due to fatty plaque deposits, leading to leg pain and tiredness. Before you go on an L-arginine binge, consider its side effects. Perch says more than 40 grams a day can cause diarrhoea. Other side effects include bloating, gout, blood abnormalities, allergies, airway inflammation, worsening of asthma and low blood pressure, Poon and Tan note. If you are pregnant or nursing, it’s best to avoid it as a safety precaution, as not enough is known about the long-term use of the supplement during motherhood. And if you have a herpes outbreak or the herpes virus, Perch says arginine promotes herpetic lesions, as it is an integral amino acid for the growth and reproduction of the virus.


FITNESS 9 GET FIT FOR GOLF FINAL WEEK

Do your game a power of good ...................................................... Nicole Chabot healthpost@scmp.com Rory McIlroy’s secret to success is not so secret: he openly credits his new body, honed over the past 18 months through strength training, as the foundation for his rise to the top of the golfing world. With his new posture, physique and strength, McIlroy, who works with British trainer Steve McGregor, is able to swing more powerfully yet stay balanced, and uses less effort in making his signature long drives. Hong Kong former No 1 James Stewart also credits strength training for improving his shot distance.

“When I have been training consistently, I really notice the increases that I can achieve,” says Stewart, a touring professional and executive director at the J&J Golf Academy at Discovery Bay Golf Club. Stewart works out with golf biomechanics coach Ross Eathorne at Optimum Performance Studio in Central. “Three times per week for a month will produce significant results,” says Eathorne. “And training for a progressive flexibilitybalance-strength programme of three to nine months will change your game.” Try this series of exercises demonstrated by Stewart and watch your game improve.

Deadlift What it works: teaches correct way to bend and ground body into the earth. Vital in building a stable base for a powerful coil. Method: with knees bent and arms straight, bend from the hips. Keep chin up and abdominals engaged. Lift dumb-bell over three counts, emphasising lower back arch. Return to start position over three counts. Eight to 12 repetitions per set; do two or three sets with a one-minute rest in between.

Standing cable woodchop What it works: provides the strength foundation for developing power for driving and middledistance shots. Method: stand with feet apart, knees bent, both hands on cable, arms straight. Pull cable in front of chest over two counts, keeping abdominals engaged and arms straight. Return to start position over three counts. A set consists of eight to 12 repetitions on each side; do two or three sets with a one-minute rest in between.

Medicine ball power swing What it works: conditions and develops power for long distance. Emphasises core engagement, balance and shoulder and pelvis rotation. Method: holding the medicine ball, get into the golfer’s stance, emphasising top of backswing arm position. Mimic the golf swing all the way to follow through, keeping as fast a tempo as you can to maintain fluidity. Six to eight repetitions per set; do four to six sets with two to three minutes’ rest in between.

Standing cable chest press What it works: integrates arms, torso and legs; helps downswing movement. Method: with weight on right foot and left heel raised, push cable forward over two counts. Keep left arm straight. Ensure spine is aligned and back knee is bent. Return to start position over two counts. Eight to 12 repetitions on each side per set; do two or three sets with one minute rest in between.

Standing cable row What it works: encourages rotational forces through the middle back and maintains proper function in spinal joints. Method: with weight on left foot and right arm straight, hold the cable. Place left arm on hip and engage abdominals. Pull right elbow back and straighten left arm, like shooting an arrow, over two counts. Return to start position over two counts. Eight to 12 repetitions on each side per set; do two or three sets with a one-minute rest in between.

Rip Trainer pelvic rotation What it works: helps the drive from hips and legs. Trains abdominal muscles and improves hip rotation. Method: hold rip trainer in front of body, keeping chest open. Rotate pelvis while keeping the bar horizontal. Return to start position. A set consists of as many moderate tempo repetitions you can do in 30 seconds; do two or three sets with a one-minute rest in between.


10 WELL-BEING WALKING HOME

Shave the best for last

Rob Lilwall (left) and Leon McCarron at the American Chamber of Commerce annual spring ball in Guangzhou. Photo: Rob Lilwall

...................................................... Rob Lilwall healthpost@scmp.com We’re home. Finally. In the past six months, myself and my cameraman Leon McCarron have walked 5,000 kilometres from Mongolia to Hong Kong. Last Saturday, we arrived at my home in Mui Wo, joined by my wife Christine and friends who walked the last seven kilometres with us. With all the talk of foreign investment in China, I had expected that we would see quite a few Westerners during the adventure. However, aside from the tourist hot spots of Xian, home of the terracotta warriors, and Guilin/Yangshuo, we have

seen a mere three: two in Datong city (Shanxi) and one in Enshi city (Hubei). There must have also been a few intrepid entrepreneurs and English teachers kicking around, but we never saw them in the mountains, valleys, towns and cities we passed. And so it seems the interior regions of China are still quite sheltered from the outside world. But this changed two weekends ago when we finally arrived in Guangzhou, a city I had never visited before. I was pleased to discover it had a heart and soul, criss-crossed as it was by the Pearl River Delta. Our first stop in town was the American International School, where we had been invited to give a talk. The children were happy to see

us arriving drenched in rain and carrying huge rucksacks, and with heavy beards. As a former geography teacher, I enjoy giving talks to schools when in the middle of a giant expedition. It’s a fun chance to introduce children to the lands, places and people of the world, and to encourage them to take life by the horns. I’m not a fan of the cliche that if you follow your dreams they’ll come true. But I do believe we are capable of more than we think, and a lack of confidence stops many youngsters from striving for an interesting and fulfilling life, and makes them settle for something “safe”. The following day, the American Chamber of Commerce arranged for us to film at a member’s production

The interior regions of China are still quite sheltered from the outside world

facilities – the Fortunique factories, where we saw at first-hand the mass production of “medical draping solutions” (sterilised covers and containers for hospitals). Hundreds of workers were busy sewing, sticking, stamping or folding the products along the whole production line. They worked in good conditions, and because they were paid per item, worked incredibly hard and fast. The finished products were placed in boxes, which were then put in containers leaving for the four corners of the world. It was a fascinating learning experience, because I know so little about the source of the thousands of products I use, except that they are mostly made in China. That same afternoon, we also went shopping for some smart and clean clothes, because we were invited to be the guests of honour at the AmCham annual spring ball that evening. We scrubbed ourselves up (but did not shave off our beards) and headed out for a night of eating, drinking and dancing in a ballroom full of millionaires. It certainly made quite a contrast to our previous six months of sleeping in deserts and fields, and eating instant noodles. But then it was time to walk onwards again – so we set off on our final 200-kilometre walk to Shenzhen, and then Hong Kong. If you have been reading this column in the past six months, please join us for our welcome home party tomorrow in Wan Chai. The details are on our website. We hope to see you there. Rob Lilwall’s previous expedition, Cycling Home From Siberia, became the subject of an acclaimed motivational talk, a book, and a National Geographic TV series. For the past six months in Health Post he has written about the progress of his new expedition, Walking Home From Mongolia, which is in support of the children’s charity Viva. walkinghomefrommongolia.com

EAT SMART

The thighs have it: why dark meat is flavour of the month ...................................................... Jeanette Wang jeanette.wang@scmp.com When it comes to chicken, chefs agree it’s better on the dark side. Dark meat – the chicken thigh and drumstick – is lower in price and higher in flavour. Because it’s a tad fattier than chicken breasts, it’s more forgiving of overcooking and doesn’t dry out as easily. “I’m going to be the one to say what nearly every person in the culinary world thinks: we all hate chicken breasts ... It might as well be a McNugget,” wrote American food writer Josh Ozersky in Time magazine last year. “We love the flavour of the dark meat, its

succulence, its complexity, its wealth of delicious, tasty skin, the way the meat is proportional to the bone, keeping it moist and sapid during cooking.” Dark meat is the most used muscle in chickens, and hence gets its colour from the protein myoglobin, which plays a key role in oxygen uptake during sustained activity like walking. Moist and tender, ground chicken thigh meat works well shaped into patties – as demonstrated in this recipe contributed by Golden Fortune Restaurant in Tai Wai. Steaming the thighs is a great way to seal in the natural flavours while keeping the dish’s fat content to a minimum.

Steamed chicken with mushrooms and asparagus Serves 4 150 grams skinless chicken thigh meat, diced 25 grams lotus root 110 grams baby asparagus 15 grams each king oyster, oyster and fresh shiitake mushrooms 1 ⁄2 tsp salt 1 ⁄2 tsp sugar 100ml chicken or pork broth Starch water (3 tsp starch, 2 tbsp water) 20 grams each red and yellow capsicum, diced

• Boil the lotus root and asparagus until tender. Set aside. • Steam the mushrooms. Season with 1 ⁄4 tsp salt and 1⁄4 tsp sugar. • Blend half of the mushrooms into a purée and set aside. • Finely chop the other half. • Combine chopped mushrooms, chicken, 1⁄4 tsp salt and 1⁄4 tsp sugar. Make small patties. • Steam the patties until done. Place on

top of the cooked asparagus. • Add the mushroom purée to the broth. • Thicken the purée with starch water. Pour over patties. • Garnish with capsicum. Serve. Recipe provided by the Health Department as part of its EatSmart@restaurant.hk campaign. For more information, go to restaurant.eatsmart.gov.hk


WELL-BEING 11 THE TASTE TEST ORGANIC CONFECTIONERY ...................................................... Jeanette Wang jeanette.wang@scmp.com Vermints Peppermint 40 grams for HK$39, Just Green Typical mints contain chemicals, meat by-products or artificial sweeteners, but not this all-natural variety made in Vermont from US-grown organic ingredients. You can actually see little shreds of mint leaves in each white pastille. Verdict: they’re great for refreshing your breath and to give you that mid-afternoon lift at work.

Adrian Yahvah, an athletic therapist at The Body Group in Central, says skateboarding helps him steer clear of Hong Kong’s many vices. Photo: Felix Wong

Tasty Organic Smoothie Fruit Snacks 78 grams for HK$31, Gourmet Fine Food These so-called gummies do not contain high fructose corn syrup, genetically modified organisms, gluten, or anything artificial. Made with real fruit juice, each serving (about half a pack, or 19 pieces) provides 102mg of vitamin C – slightly more than 100 per cent of the daily recommended intake. Verdict: lack chew, but make up for it with delectable fruit flavours.

FIT AND FAB

You’ve got to roll with it ...................................................... Rachel Jacqueline healthpost@scmp.com When Adrian Yahvah moved to Hong Kong four years ago, he thought it was time to hang up his skateboard once and for all. But a chance trip to Morrison Hill skate park in Wan Chai within weeks of arriving reignited his lifelong passion that began at age nine. “Being back on my board made me realise I needed skateboarding more than ever to manage stress, release some energy and stay away from Hong Kong’s many vices,” says the 33-year-old American. Skateboarding is not just a favourite pastime; it is an important part of Yahvah’s identity. As a child, he was “that skinny kid that never got picked on a sports team”. But after talking his dad into buying him a skateboard, he found his niche. Yahvah is also grateful to the sport for adding an extra dimension to his personality and teaching him not to judge a book by its cover. While he may be a fearless skateboarder who’s had his fair share of injuries, paradoxically, his other passion is sports injury prevention and management. He is a certified athletic therapist at The Body Group in Central. The art of healing is in Yahvah’s blood; his mother and grandmother are both masseurs. Growing up in a small town in Montana in the western United States,

he would assist in his family’s massage clinic. He later went on to refine his skills with a master’s in exercise science. An opportunity to move to Hong Kong – 350 times smaller but with six times as many people as his home state – pushed Yahvah out of a comfort zone beyond even the challenges of skateboarding. “Although the move was daunting, I didn’t want to miss the opportunity to see the world,” he says. What is it that you like about skateboarding? The fact that I can look at architecture, stairs or a pavement that has been altered by a tree and dream up ways I can skate it; there are endless possibilities. I can see beauty in the concrete of the world and have a lot of fun in it. There is also the thrill factor of doing something that you probably shouldn’t be doing, and hiding from security guards. What are the cons of skateboarding? Skateboarding is injurious and also quite expensive. If you’re skating a lot, you’re going through a board every other week ( about HK$550) – and that’s just the deck. You’re always wearing your gear out as you’re doing tricks. You’re tearing things up, including yourself. But that’s all part of the fun. How does your career affect your approach to such a high-risk sport?

It has taught me to appreciate the body and how long it takes to heal, but also how well it heals It has taught me to appreciate the body and how long it takes to heal, but also how well it heals. Sometimes when I look at a jump I think, “If I break a collarbone I’m going to be out for six weeks,” which would affect my clients and my income. But sometimes I feel like pushing the envelope and I have racked up a few injuries over the years. In retrospect, I’ve probably been a bit more cautious but I think I’ve also been lucky to avoid any big injuries. Has getting older made you a better skateboarder? I think I’m as good, if not better, than I ever was. I’ve been lifting a lot of weights and am a lot stronger. Even if it’s just a simple kickflip, I can make it look pretty good because I’ve been doing it for 24 years. I can still take a good slam and walk away from it, which is just as important as landing tricks in skateboarding; it’s important to be comfortable with busting yourself.

If you could choose, would go back and be a jock instead of a skateboarder? I can’t say I’d go back and change anything. Skateboarding has broadened my horizons much more than any other sports could have done. What’s your best trick and what’s a trick you’re still trying to nail? My best trick is a fakie kickflip. It’s where you’re rolling backwards, flicking the board, catching it mid-air and then landing while continuing to roll backwards. It sounds a lot more impressive than it probably is, but it’s not about complexity, it’s about how smooth you can make it look. A backside tailslide, on the other hand, I’ve never landed clean. It’s where you approach an obstacle (like a pole, or a ledge), turn your back towards it, slap the tail of the board on the obstacle, and slide down it. This trick has always eluded me; it’s quite frustrating. If I ever manage that, I think I’ll go out and buy myself a big steak. Will you ever stop skateboarding? All good things must come to an end. There may be a day that I walk away. Hopefully, it will be to something that is equally fulfilling, but I haven’t found that yet. Maybe when I nail that backside tailslide I’ll feel good and can walk away from it. Or a handplant – that would be pretty sweet.

Go Organic Hard Candies (Apple) 100 grams for HK$31, City’super These handmade treats are naturally sweetened without high fructose corn syrup, a type of processed sugar that’s been linked with metabolic problems, heart disease and other health problems. That said, any type of sugar, when consumed in excess, will lead to those problems, too. Verdict: plump, wholesome apple flavour; delicious, but fight the urge and consume in moderation.

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