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YOUR GUIDE TO LIVING WELL

TUESDAY, AUGUST 21, 2012

HEALTH POST End of the road How sudden cardiac arrest strikes the young, old and fit alike >PAGE 6

A DIM VIEW OF DIABETES >PAGE 4

FITNESS ROUTINE GOES POSTAL >PAGE 10


2 NEWS APP OF THE WEEK

HEALTH BITES

Basic facts about what you eat

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

...................................................... Katie McGregor healthpost@scmp.com

Vocal support Vocal cords lose flexibility with age and disease, leading to voice loss, but a new lab-made material could help people speak and sing again. At an American Chemical Society meeting in Philadelphia recently, lead scientist Robert Langer, a Massachusetts Institute of Technology professor, revealed that the artificial vocal cord material was made using a gel that is a starting material for polymers currently used in personal care creams, medical devices and drugs. The gel is “just like the real thing”, says Langer, with flexibility and pliability. It would be injected into a patient’s vocal cords. Formulations are individualised: a singer, for example, would probably get a formulation that is more loosely stitched together, which is more flexible, to allow them to hit high notes. The gel degrades over time, so two to five injections per year are needed. Tests in animals suggest that the material is safe, and human trials will hopefully begin next year.

Joy Bauer Food Cures Free Rating 6/10 Before the new food labelling laws were introduced in Hong Kong, you could wander the aisles and believe you could gain a svelte body and live forever if you only ate certain branded foods. Now health claims are banned unless backed up with proper nutritional labels, and perhaps more safely, shoppers are left to educate themselves. Joy Bauer is a well-qualified nutritionist, the health editor on MSN’s Today show, and the author of cookbooks and diet books including The New York Times bestseller Joy Bauer’s Food Cures. The first thing you get with the app is a tip of the day – today’s tip is about the benefits of low-fat (1 per cent fat) milk. The app also comes with a list of food groups and their benefits. Under “Sweeteners” I learn that blackstrap molasses is a concentrated source of iron, calcium, magnesium and other minerals – but heavy on calories. I also learn that aspartame is often reported as a trigger for migraines. This is not groundbreaking information so I checked under “Herbs and Spices”, hoping for revelations of the healing qualities of, say, basil, or cumin; but instead I was told that many herbs possess antioxidants and anti-inflammatory

properties that may help contribute to heart health, beautiful skin and hair. A bit disappointing for a best-selling author. The health section covers seven conditions: arthritis, high blood pressure, high cholesterol, IBS, migraines, osteoporosis and type-2 diabetes. The information is more specific: under the section on migraines there are five essays including migraine basics, four nutrients for fighting migraines and nine common migraine triggers. The app does lead you to the Joy Bauer Food Cures website, which is perhaps the intention all along. The website covers many more conditions, has a lot more information and is much more interactive, with quizzes and “prescriptions” for your condition.

They haven’t quite cracked it Athletes who engage in strenuous exercise should consume the much-hyped coconut water with a pinch of salt – literally – says a research team that yesterday revealed a new scientific analysis of the natural beverage. Indiana University Southeast scientists say coconut water fails as a good sports drink for heavy sweaters because it has a lower sodium content than traditional ones – about 40 milligrams per litre compared to 600 for Gatorade and Powerade. However coconut water does have 1,500mg per litre of potassium, five times more than traditional sports drinks, which helps to rid muscle cramps. It’s also high in healthful antioxidants. “[Coconut water] is a healthy drink that replenishes the nutrients that your body has lost during a moderate workout,” says lead researcher Chhandashri Bhattacharya.

ASK THE DOCTORS DR KENNETH NG Q: How common is it to have eyes that change colour? I have noticed lately that my green eyes are turning brown. A: Iris colour is very much a function of the density and distribution of the iris pigment (melanin) in the iris pigment epithelium. This is genetically determined. For lighter-coloured eyes, the hue may vary according to the ambient lighting condition. The colour of the eyes could change during puberty, early childhood, in certain eye diseases and after major ocular trauma. Studies on Caucasian twins, both fraternal and identical, have shown that eye colour over time can change, and major loss of melanin in the iris may also be genetically determined. Most eyecolour changes have been observed or reported in white people with hazel eyes.

Current favourites Looking for a way to increase your intake of antioxidants? Try electrocuting sweet potatoes. Researchers from the University of the Ryukyus in Okinawa, Japan, have found that running an electric current through them increases the content of beneficial polyphenols, or antioxidants, by 60 per cent. Polyphenols are a family of chemical compounds found naturally in fruits and vegetables that may help protect people from diseases and the effects of ageing. The research team had previously put white potatoes through the same process – dunking them into a salt solution that conducts electricity, and then passing various amounts of electric current through the water and the potatoes for five minutes. Untreated sweet potatoes, however, already have seven times more polyphenols than other potatoes. The researchers note that the electrical zapping seems to have no effect on the flavour, and that steaming is the best method of cooking to retain the most antioxidants.

If you have any visual symptoms associated with the colour change, you may want to have your eyes properly examined. Dr Kenneth Ng is a specialist in Ophthalmology at the Eye Institute of Hong Kong

> 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

Fake three times a day It could take just 10 minutes to find out if the medicine you bought is counterfeit. Researchers from Saint Mary’s College in Notre Dame, Indiana, have developed a simple and inexpensive paper-test strip that can be used by consumers, medical practitioners and authorities. To check for counterfeit ingredients, a person simply swipes the pill over the business card-sized paper and dips the paper in water. Colour changes on the paper indicate suspicious ingredients. The test was validated on 570 Panadol pills, including many with fake ingredients added by researchers. The World Health Organisation estimates that at least 10 per cent of the drug supply in developing countries consists of counterfeit medicines, causing thousands of deaths every year.


NEWS 3 FITNESS

QUIZ

The secret science of running

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...................................................... Dorene Internicola Are modern men and women born to run, or must our 21st-century bodies be carefully cross-trained to stay fit and healthy? When it comes to care and training of today’s distance runner, expert opinions are mixed. Jay Dicharry, author of the new book Anatomy for Runners, believes that to be a better runner, running is not enough. “Running is typically a onedimensional sport,” says Dicharry, a physical therapist. “You’re basically just moving forward; you’re not really developing as a true athlete.” Studies have shown that onethird of runners are hurt every year. His book focuses on identifying weaknesses, with detailed tools for gait analysis, tips for injury prevention and corrective exercises that range from yoga-like toe strengtheners to stability work. Comparing the body to a car, Dicharry says that while many books focus on the runner’s cardiovascular system, or engine, he zeroes in on the biomechanical body, or chassis.

“The more stable the chassis, the more efficient you can be.” Robert Forster, who has practised sports therapy for 30 years, says the most common running mistake involves stride length, or the distance of the foot on the ground. “Everyone is over-striding,” says Forster, who worked with the American Olympic track-and-field team. “You want to land under your centre of gravity, or as close to it as possible. We tend to take too few steps per minute.” Dr Lewis Maharam, a former medical director of the New York City Marathon author of Running Doc’s Guide to Healthy Running, says the beauty of running is that you do not need to do complex exercises to be efficient. “Cross-training isn’t really necessary. Professional athletes do it because it makes you faster, but the best people will tell you that a nice warm-up and a good flexibility programme for your lower extremities are all you need.” The most important thing is the preparation. “Without training, you’re going to get hurt,” he says. Reuters

Jeanette Wang jeanette.wang@scmp.com Older folks who enjoy a tipple could prevent a topple, according to a study that looks at the effects of red wine in mice. Resveratrol, the natural compound found in the drink, might help improve mobility and prevent life-threatening falls among the ageing population. The catch, says lead researcher Jane Cavanaugh of US-based Duquesne University, is that because resveratrol is poorly absorbed by the body, you’d have to drink a lot benefit. We’re talking almost 700 120ml glasses of red wine a day for a 68kg person. Nonetheless, this finding is believed to be groundbreaking and could lead to the development of natural products to help older people live healthier lives. Previous studies on resveratrol have shown the antioxidant might help reduce inflammation, lower cholesterol, slash the risk of heart disease and certain cancers and, perhaps, have some anti-ageing effects in the body. Some experts call it the “miracle molecule”. To determine its effects on balance and mobility, Cavanaugh

and her team fed both young and old laboratory mice a diet containing resveratrol for eight weeks. They periodically tested the rodents’ ability to navigate a steel mesh balance beam, counting the number of times each mouse had a misstep. Initially, the older mice had more difficulty manoeuvring on the obstacle. But by week four, the older mice made far fewer missteps and were on par with the young mice. Lab experiments reveal some clues about how resveratrol works in the body. Natural cells were exposed to dopamine, a neurotransmitter that in large amounts can induce cell death. However, neurons treated with resveratrol before being exposed to dopamine survived. It was found that the compound mitigated the damage done by oxygen-based free radicals – generated by the breakdown of the dopamine – and activated protein-

signalling pathways that appeared to promote cell survival. Cavanaugh’s team is now investigating similar man-made compounds that mimic the effects of resveratrol. Test your knowledge of the natural compound here. 1. Where does resveratrol come from? a. skin of red grapes b. grape seeds c. pulp of green grapes 2. Most supplements contain 250 to 500 milligrams of resveratrol, but some animal studies show the beneficial daily dose is a. 1,000 milligrams b. 2,000 milligrams c. 3,000 milligrams 3. In comparison, a 120ml glass of red wine contains about how many milligrams of resveratrol? a. 0.6 b. 6 c. 60 4. Apart from grapes and berries, resveratrol can also be found in a. potatoes b. broccoli c. peanuts Answers: 1. a; 2. b; 3. a; 4. c


Illustration: Angela Ho

4 MEDICAL

CASE HISTORY

Get out of my sight ...................................................... Eileen Aung-Thwin healthpost@scmp.com As a truck driver who drove eight hours a day transporting goods between Hong Kong and the mainland, Larry Ho, 46, was used to long hours on the road. One day while driving, however, Ho (whose name has been changed for patient confidentiality reasons) noticed something strange floating to the right side of his visual field. The image started to blur and within an hour he could no longer see with his right eye. Terrified, he pulled over, flagged down a taxi and headed straight for a mainland clinic. As his family’s sole breadwinner, his sight was more than his window on the world – it was his means of providing for his wife and four-year-old son. While his right eye looked normal on the outside, peering in, the doctor saw that he was bleeding inside his eyeball, behind the lens. The bleeding was so severe that the vitreous humour (the normally clear, gel-like substance that fills the cavity of the eyeball) was badly clouded with blood. The doctor examined Ho’s left eye, and saw abnormalities that might be caused by diabetic changes. However, the patient was

in no immediate danger of losing the sight in his left eye. Ho, a Hong Kong resident, decided to seek treatment back home. He consulted Dr Chan Waiman, a specialist in ophthalmology at the Hong Kong Sanatorium and Hospital. Chan’s investigations confirmed that the vitreous humour in Ho’s right eye was completely occluded by blood. He found that the surface of Ho’s left retina was covered with tiny dots of clotted blood. These tiny blood clots – or dot-blot haemorrhage – indicated that abnormal, brittle blood vessels had started to grow. The left eye also showed signs of macular edema, or retina swelling. Chan strongly suspected that there was a proliferation of abnormal blood vessels in Ho’s right eye, and that one or more of those blood vessels had ruptured. The profuse growth of abnormal blood vessels in the eye is often caused by diabetes. Because abnormally high blood sugar levels can affect microcirculation, organs with a profusion of tiny blood vessels such as the eyes and kidneys are more susceptible to damage. As the tiny blood vessels become damaged from sluggish blood circulation, the organ suffers from ischaemia – a deprivation of blood

These tiny blood clots indicated that abnormal, brittle blood vessels had started to grow and oxygen. To compensate, the body releases growth factors to spur the growth of new blood vessels to carry more oxygen to the organ. However, these new blood vessels are fragile and can cause complications, including the vitreal haemorrhage that Ho experienced. A blood test confirmed that Ho, indeed, did have diabetes. Healthy fasting blood sugar levels should be less than 6.1 mmol/L (millimoles per litre) and anything higher than 7 mmol/L is indicative of diabetes. Ho’s readings were 10.2 mmol/L. The findings surprised Ho, who had always considered himself to be in good health despite being obese and lacking exercise. In hindsight, he realised that he had been more thirsty than normal in the past few months, and had needed to urinate more frequently. But he missed these early signs of

diabetes because he shrugged off the symptoms and was too busy to have a health check. Chan starting treating Ho with a vitrectomy of the right eye. He made a tiny hole in the eyeball and painstakingly removed the blood clot one piece at a time. Once the occluded vitreous humour was removed, Chan saw that Ho’s retina was covered in abnormal blood vessels, which he then trimmed and cauterised with a laser, effectively sealing them off and preventing future haemorrhaging. However, the procedure, called photocoagulation by laser, also leads to some vision loss, as it damages the retinal receptors. Chan says Ho’s circulation was so poor that it could not support all the receptors on the retina. Hence, peripheral vision receptors had to be sacrificed so that central vision could be maintained. The two-hour-long procedure enabled Ho to retain 20/20 central vision in his right eye but he lost 50 per cent of his peripheral vision. After Ho’s right eye stabilised, Chan began treating the left eye. Because its diabetic changes, namely macular edema, were at an earlier stage, and thanks to medical advancements, a more benign treatment could be used.

Until five or six years ago, the only was to treat this stage of the condition was laser photocoagulation. However, a new outpatient treatment now enables antibodies to be injected into the eye to neutralise the growth factors that stimulate abnormal blood vessel growth (so Ho’s left eye vision was able to be preserved). Less than a month after the injection, Ho’s retinal thickness returned to normal. Separately, he also sought treatment for his diabetes and learned how to eat and live more healthily. In less than two months, Ho was back on the road. According to Chan, diabetes is the leading cause of blindness for middle-aged people. Many cases of macular edema and retinal angiopathy (disease of the blood vessels in the eye) go unnoticed in the early stages. Untreated, the scarring left by the ruptured blood vessels can pull on the retina, which lines the inside of the eye cavity, resulting in retinal detachment. If things progress to this stage, blindness will be permanent. Although the events leading to the discovery of Ho’s conditions were dramatic and terrifying, the experience was a blessing in disguise as it alerted him to his health condition early enough for a successful intervention.


MEDICAL 5 FROM THE EXPERTS

How doctors can kill with kindness ...................................................... David Shaw healthpost@scmp.com The British Medical Association has recently suggested that patients should be kept alive using elective ventilation, or life support, to facilitate the harvesting of their organs for donation. But this is useless if the patient’s family vetoes his or her wish to donate. In fact, this problem is the main hindrance to organ donation, with at least 10 per cent of families in Britain refusing permission. There is of course a much simpler way to solve this problem: getting doctors to do their jobs. Doctors who heed the family’s veto deny the patient’s last wish to help the world. The family has no legal grounds to override the deceased’s wishes if that person clearly wanted to donate, such as by carrying an organ donor card. It is true that the situation causes families emotional distress, and doctors may be willing to respect a

veto to avoid upsetting them further. One solution is so-called advance commitment, where donors designate a family member in advance to confirm their decision when the right time comes. The failure to overrule the veto and to respect the wishes of the deceased is a classic case of doctors giving in to psychological pressure without considering the wider effects on others. The doctor causes deaths by omission and greater distress to other families whose relatives will

Doctors who heed the family’s veto [against their loved one’s organ donation] deny the patient’s last wish to help the world

die because they failed to get an organ transplant. When a doctor encounters resistance from a patient’s family, he can either leave them alone or persist in ensuring the organ donation. Persistence will cause the family short-term distress, but they usually see within a week that the doctor was right. And of course they have no legal grounds to complain. If the doctor does not persist, the family will be relatively happy in the short term but will probably regret their decision. Further, the patient’s eyes, heart, kidneys and other organs will have gone to waste, with grave consequences for other patients in need. Giving in to the family is unprofessional. Although we should treat the family compassionately, doctors have a duty to dying patients and organ beneficiaries. Kenyon Mason and Graeme Laurie, authors of the 2006 book Law and Medical Ethics, state that “while this may be laudable sympathetic medicine,

About 10 per cent of families in Britain oppose organ donation. Photo: Corbis it is paradoxically doubtful medical ethics”. Many family members who oppose their loved one’s organ donation even come to regret their decision days or weeks later. Moving towards elective ventilation might alienate would-be donors and will not be necessary if doctors remember that respecting a

veto of organ donation is unethical, unprofessional and against the spirit of the law. David Shaw is a lecturer in ethics at the University of Glasgow’s faculty of medicine. He can be reached at davidmartinshaw@gmail.com. This column was first published in this month’s British Medical Journal


6 COVER STORY

Stopped in their t Sudden deaths from cardiac arrest are on the rise, even among athletes, and doctors are struggling to work out why, writes Elaine Yau

From top: Hong Kong policeman Andy Naylor died in New York recently while competing in the Ironman triathlon; Cameroonian midfielder Marc-Vivien Foe is honoured by teammates after he collapsed on the pitch in 2003; Livorno midfielder Piermario Morosini’s heart attack causes panic on the field during a game in April. Photos: SCMP Pictures, AP, AFP

2.2m The number of cardiac arrests treated by emergency medical services personnel worldwide each year, according to a Cambridge study

T

he unfortunate demise of Hong Kong resident Andy Naylor at a triathlon race two weekends ago has brought attention to sudden death, cases of which are rising in this city, figures indicate. The 43-year-old, a top local runner and Hong Kong police superintendent, “experienced distress” near the end of the 3.8kilometre swim leg in the Hudson River during the Ironman US Championship in New York, according to race organisers. The results of an autopsy are pending. Naylor’s death comes a year after two athletes died of sudden cardiac arrest in the 1.5-kilometre swimming portion of the New York City Triathlon, also in the Hudson River. Minneapolis Heart Institute cardiologist Kevin Harris published a study in 2010 in The Journal of the American Medical Association analysing the results of 2,971 USA Triathlon-sanctioned events held between January 2006 and September 2008, involving nearly 960,000 participants. During that period, 14 participants died. Thirteen of them, aged between 28 and 65, died while swimming and another while cycling. Autopsies identified cardiovascular abnormalities as factors behind seven of nine swimming deaths. Harris’ study found a suddendeath rate of 1.5 per 100,000 competitors in triathlons, while the rate in marathons over a 30-year period was 0.8 per 100,000. Evidence suggests that exercise seems to trigger or cause sudden cardiac death in athletes with underlying heart disease, says Dr Timothy Noakes, a sports science professor at the University of Cape Town in South Africa. A consultant cardiologist with Yan Chai Hospital in Tsuen Wan, Dr Stephen Tam Kin-ming, says about 20 per cent of sudden-death cases are caused by heart conditions that have existed since birth, such as coronary artery anomalies and hypertrophic cardiomyopathy, where a portion of the heart muscle becomes thicker without any obvious cause. These are widely believed to be the leading causes of death, particularly in young athletes.

Other victims have structurally normal hearts, but die of heart rhythm disorders. Ventricular tachycardia (fast heart rhythm) and ventricular fibrillation (irregular heart rhythm) can trigger acute coronary syndrome, where blood supply to the heart is suddenly blocked, causing sudden death. “[These victims] haven’t had any ultrasound tests and the heart problem remains hidden. Sports veterans who are susceptible to sudden cardiac death usually suffer from hidden heart disease,” says Tam, who is also the chairman of the Hong Kong Public Hospitals Cardiologist Association. Recent studies shed light on the role of genetics in underlying heart conditions. An American Journal of Cardiology study published online last month confirmed the link between the sickle-cell trait – a genetic condition behind a blood disorder – and cardiac death among young African-American male athletes, especially football players. The sickle-cell trait affects about 8 per cent of the American population. A large and comprehensive investigation by an international team of researchers, published last year in PLoS Genetics, discovered a variation in the human DNA sequence that was linked to a significant increase in the risk of sudden cardiac death. “Our analysis suggests if you have one copy of this variant, your increased risk is double that of someone who doesn’t,” wrote lead author Dan Arking of Johns Hopkins University. “If you have two copies, having inherited one from each parent, you have almost a fourfold increased risk of sudden cardiac death.” Not all cardiac arrests are caused by underlying or genetic heart disease. In Hong Kong, cardiologists say, lifestyle factors, such as fastfood diets and the lack of physical activity are greater culprits. Because sudden cardiac arrest is so often linked to coronary artery disease, the risk factors are similar. The rising number of sudden deaths in Hong Kong is mirrored in the spike in deaths caused by coronary heart disease – the narrowing of small blood vessels –


COVER STORY 7

d tracks Sports veterans who are susceptible to sudden cardiac death usually suffer from hidden heart disease STEPHEN TAM KIN-MING, CHAIRMAN OF HONG KONG PUBLIC HOSPITALS CARDIOLOGIST ASSOCIATION

which has gone up by some 50 per cent from a decade ago. Department of Health figures show that 6,400 people died of heart disease in 2009, accounting for 15.6 per cent of all deaths in Hong Kong. One-third of these fatalities were sudden. And cardiologist Tam says the victims are getting younger and younger. “While people aged 50 got it in the past, sufferers are just 30 or 40 [years old] now. The rising incidence among young people has to do with poor lifestyle.” A recent report by the cardiologist association cited taxi and commercial drivers as among those in high-risk occupations where workers are predisposed to die suddenly. Figures retrieved from local newspaper reports showed that a total of 24 local drivers aged between 29 and 81 – half of whom were cabbies – died abruptly in the 12 months to May this year. “Many drivers are living high-risk lifestyles with irregular mealtimes, a diet heavy in salt, sugar and fat, and a sedentary lifestyle,” Tam says. “Eighty per cent of sudden-death cases [are caused by] coronary heart disease, [which in turn is] caused by smoking, stress, poor diet, obesity and lack of exercise … Besides, [heart attacks] may occur in coronary-heart-disease sufferers during strenuous exercise such as a marathon,” he adds. Professor Yu Cheuk-man, head of Prince of Wales Hospital’s cardiology unit, says the symptoms are unnoticed in most sudden-death cases. “Those with [irregular heartbeats] will feel heart palpitations and pass out gradually. Some die on the first attack.”

Heart attack symptoms include intense chest pain, heart palpitations, cold sweat, dizziness and shortness of breath. But Duncan Ho Hung-kwong, a cardiology specialist with the Hong Kong Sanatorium and Hospital, says victims rarely show these signs. “The symptom of chest pain extending to the upper jaw and arms – always mentioned by people and the media – is only seen in very few people. Any kind of [discomfort] can be a sign of heart attack, like shoulder pain and back pain. “It’s likely that sufferers misinterpret it as only muscle pain. The symptoms can be mild, like those for a cold,” Ho warns. One of his recent patients felt nauseous while walking, after eating breakfast. The patient went home, vomited and felt better. Still, he went to hospital as a precaution. “We did an electrocardiogram [which records the heart’s electrical signals] and it turned out he had just suffered a heart attack,” says Ho. He says everyone should get at a check-up as a precaution, especially those who have a family history of heart disease. The tests include an ultrasound for the heart-thickening condition, a scan of the coronary arteries’ size as well as a stress test where patients run on a treadmill while connected to an electrocardiogram, which tracks how the heart responds to stress and exercise. Chinese University researchers have been studying Hongkongers who have suffered sudden heart attacks since 2007, with more than 2,000 people having been analysed so far. Yu, from Prince of Wales, says the study aims to explore the effects of high-risk factors on coronary heart disease. To their surprise, the researchers found that half of the Hongkongers had only one or zero high-risk factors before they were stricken. In contrast, it takes two or three highrisk factors for a foreigner to have a heart attack. “We do not know the reason for the discrepancy … Maybe it has to do with our rice-based diet which is heavy in carbohydrates,” Yu says. “We are still recruiting patients for the study and will study what predisposes them to heart attacks.” elaine.yau@scmp.com

Cardiologist Yu Cheuk-man says the symptoms often go unnoticed in most sudden-death cases. Photo: Felix Wong

HOW TO HELP SOMEONE SURVIVE Professor Yu Cheuk-man, head of Prince of Wales Hospital’s Division of Cardiology, says the first three minutes after the heart stops beating is the critical period. Most people who die of sudden death fail to get prompt medical support. “If resuscitation and electrical shock are administered to

the patient in a timely manner, there’s a 70 per cent survival rate. The survival rate drops by 10 per cent for every minute that passes,” says Yu. What to do if someone goes into shock or a coma when exercising • Stay calm. Loosen any tight clothing

on neck, chest or waist and call for medical help. • If the victim has lost consciousness but is still breathing and has a pulse, let him stay lying on his back. • If the victim is not breathing or doesn’t have a pulse, start cardiopulmonary resuscitation.


8 DIET NUTRITION DETOX

Time to squeeze the day ...................................................... Catharine Nicol healthpost@scmp.com Hong Kong’s fine-dining and drinking lifestyle is an integral part of Claire Blackshaw’s life, as the director of public relations for a fivestar hotel. “It’s a wonderful position to be in, but equally agonising for the waistline,” she says. Eager to make amends for her health, she signed up for a juice detox after chancing upon a Twitter post by local company Genie. For three days she replaced her three meals with six fresh-pressed juices delivered to her door. The detox worked, she says. “No alcohol, cigarettes or caffeine, no processed food; I felt lighter and less sluggish, even though I was tired, and I didn’t have to make food decisions either.” The juice detox is not a new phenomenon and two local companies have recently given the concept a 21st-century facelift. As a result, there’s something of a juice renaissance in Hong Kong. Punch Detox (punchdetox.com) and Genie (thegenieconcept.com) deliver juices to your home or office in little coolers with mini bibles of information. Both claim to have consulted nutritionists in devising their six-juices-a-day diet. Both say their juices are produced by a stateof-the-art hydraulic cold press to retain the maximum concentration of vitamins, minerals, antioxidants and enzymes from the produce. There is value in a juice detox, says registered dietitian Gabrielle Tuscher – if positive aspects of the detox can be carried forward into everyday life once the programme is over. But she has reservations when it comes to their general efficacy and benefits, especially if followed for more than three days. Juicing is an easy way to flood your body with concentrated amounts of vegetables and fruits, vitamins and antioxidants, she says, while lowering the things you want to avoid such as toxins, fat, salt and sugar. But following a programme for more than a few days “come at a price, as most commercial plans leave gaping nutritional holes in your diet”. Detoxers ingest most of their

calories from carbs, with high levels of natural sugars from the fruit and sweet vegetables such as carrots and beetroot, while missing out on vital proteins and fibre that is lost as pulp, Tuscher says. “The high carb, low protein, low fibre diet can cause dramatic spikes in blood sugar levels, resulting in headaches and mood swings. A commercial juice cleanse can include up to 45 teaspoons of sugar in a day. That’s a lot, even though it’s natural.” Angela Cheng Matsuzawa and Ann Cha at Punch became obsessed with detoxes after they had their children. They started juicing for themselves and their friends, and by the end of 2009 were incorporating a three-day detox with 10-day Pilates and yoga programmes. They launched Punch in January, and recently started working with Pure Yoga on “Yoga Juicing weekends”. “Our juice detox is really a kickstart,” says Cheng Matsuzawa. “Other programmes seem scary, full of things our clients don’t understand. But fruit, vegetables and nuts for three days, they understand that.” Genie’s Cara Grogan and Melanie White, who launched in April with a store in Sheung Wan, estimate they juice an average of 50 kilograms to 60 kilograms of fruit and vegetables a day. “A lot goes into our green juices – up to 1.3kg of produce per bottle,” says Grogan. Roger Chan, founder of local chocolate brand Vero, is a Punch regular. His health-conscious wife introduced him to the concept and they have racked up seven three-day courses (HK$1,680 each) over two years. “It is eye-opening,” says Chan. “I drink a lot [of coffee] every day, and it shows me how reliant I am on coffee and sugar, too. After doing the detox I think twice about having that extra cup, and ask myself if I’m really hungry or if I’m eating for the sake of eating. Basically, I listen more to my body.” Tuscher says your body is fully equipped to detox on its own if you nix the junk and focus on clean eating. “If you want to try juicing, skip the full-on liquid diet and focus on green juices. Drink these with or in place of one of your meals and continue to fill your day with

Photo: Corbis powerful proteins found in beans, lentils, nuts and lean meats.” Tuscher recently started consulting with Genie, and as a result Grogan and White have made some changes, adding chia seeds (pure protein) and psyllium husks (soluble fibre) to the daily juices. “These two new additions will add two key nutrients for a truly balanced juice fast,” says Grogan. Chan Cudennec, founder of SOL Wellness, orders vegetable-only juices from Genie for clients with serious health issues, such as cancer. These green alkalising juices, she says, helps cleanse them of toxins, high acidity, chemicals, stress and pollution. Punch and Genie list symptoms that can be aided by a juice detox, including low energy levels; digestive, skin and weight issues; an addiction to sweet foods; foggy brains and headaches; and low quality of sleep. While Miles Price, a nutritionist at Life Clinic in Central, appreciates that Punch’s founders have

Detoxes can have a place [in your diet] if you are basically medically sound MILES PRICE, NUTRITIONIST

nutrition certificates and have clearly been reading into the subject, he worries that both companies are trying to provide a catch-all solution to something that might be much more metabolically complex. “Detoxes can have a place if you are basically medically sound, and it is always good to stop the build-up of excessive cooked proteins, bad fats and alcohol, giving the liver a break and increasing the bile flow of toxins coming out into the gut. But if you’re dumping toxins into the gut are you getting enough fibre to take them away?” he says. “During juice cleanses there are a lot of carbs and fructose going into the body which can make the sugar levels spike. This is not a problem if you can manage insulin. Basically, is the detox suiting the individual, or is the individual suiting the detox?” What the experts say, however, is unlikely to rattle the detox trend. The recent Punch/Pure Yoga “Juicing Yoga weekend” attracted 25 participants, and another event is set for October.


DIET 9 HEALTHY GOURMET

Food for thought from a land where tradition is cherished ...................................................... Andrea Oschetti healthpost@scmp.com Altomonte is a beautiful village in the Calabria region of southern Italy, and while its people may be poor they are also wise. “We make good food out of necessity, not by will; we cannot but follow the principles of simplicity and seasonality,” says Vincenzo Barbieri, owner of Barbieri (barbierigroup.it), a restaurant and hotel perched on a hill with amazing views of the countryside. “We don’t give industrial food to our animals, but our leftovers. We do not have the money to invest in technologies for intensive farming, so we trim our olives by hand. We don’t bleach our flours, and we dry and salt our vegetables for the cold months.” His hotel pioneers a style called albergo diffuso, or “widespread hotel”, where there’s not just one block of rooms – it is spread over various historic buildings. My room is in a traditional house next to the convent where, in the 16th century, Tommaso Campanella developed his heterodox philosophy. In the village’s small main square some

We don’t use any chemicals … Organic was the way our grandfathers ate, it is not something new VINCENZO BARBIERI, RESTAURATEUR

men are playing cards and drinking wine outside a bar, behind them a 360-degree view of the countryside, the source of food for these people. Barbieri takes me on a tour of his 14-hectare garden, where he grows whole nuts such as hazelnuts and almonds, chillies, lettuces, onions, mulberries, strawberries, apples, figs and olives. He is proud of his land and of Calabria’s families who, generation after generation, dedicate themselves to excellence in their produce. “If we abandon our traditions and our land, we don’t have any hope of making it into the century,” he says. Keeping its farming and culinary heritage alive is the only viable economic opportunity for Calabria, Barbieri says, and a source of healthy and gourmet food for us. When you go grocery shopping, ask where the products come from,

who made them, and what stories lie behind them. In Europe, the “Designation of Origin” law protects the name of quality agricultural products and foodstuffs. It guarantees the product you buy comes from where it belongs: tomatoes from Pachino, parmesan cheese from Parma, and more. As we continue our tour of his garden, Barbieri expands on his story: “We don’t use any chemicals to grow our plants, only manure and patient work to eradicate weeds. Organic was the way our grandfathers ate, it is not something new. Industrial production with pesticides is new, and the biggest challenge to our health.” It is beautiful walking through his garden, picking mulberries from the tree and strawberries from the ground; they taste special. I remember as a child my dad would pick an egg from my aunt’s small henhouse and we’d drink the egg raw. This connection between us and the land is being broken, and with it the quality of what we eat, and ultimately our health. Have you ever seen the plant of the food you eat? Have you ever been to a vegetable patch? Do you know when asparagus is in season? British cook and food writer Nigel Slater has written a cookbook about vegetables, Tender, in which he explores the essence of a large variety of vegetables and offers recipes to make the best of them. Vegetables are the foundation of healthy eating. I’ve learned to love them and they are a key part of my diet. How? First by understanding them – and Slater’s book is an important resource. Then by trying new vegetables and recipes to avoid a veggie rot. Finally, by keeping them in sight, which increases the likelihood of eating them – and they make your refrigerator and kitchen look amazingly colourful. Barbieri’s restaurant is now run by his son, Michele. Family-owned eateries are often an indication of good food compared to those corporate places run by managers and chefs unhappy with their work. Michele has the same passion for the land as his father. Healthy gourmet eating, the younger man says, is about using local produce and cooking them with simple regional techniques. I am presented with the famous Barbieri vegetable appetiser tray – pumpkin flowers, chillies, dry strips of zucchini, porcini mushrooms, wild artichokes, aubergine, potatoes – and a porcini mushroom and chickpea soup, so delicious and simple to make that I must share the recipe with you.

Porcini mushroom and chickpea soup Serves 4 500g dried chickpeas 1 tsp baking soda 500g fresh porcini mushrooms 3 garlic cloves Extra virgin olive oil Bay leaves, rosemary, oregano Dried red chillies • Leave chickpeas overnight in water with a teaspoon of baking soda. • The next day, rinse and cook them in salted water. Drain but keep the water. • Clean the mushrooms and chop them. • In a frying pan, add one tablespoon of water and one of olive oil, the herbs and garlic. Stir-fry on low heat, until the garlic starts to gain a golden colour. • Add the mushrooms, bring the fire to medium heat and cook for a few minutes. • Add the chickpeas together with

a little of the water used to boil them. • Allow the flavours and aromas to mingle for another minute, then serve topped with olive oil and a sprinkle of dried red chillies.

Healthy Gourmet is a weekly column by private chef Andrea Oschetti. He can be reached at andrea@fioreblu.com


10 FITNESS THE PEAK CONDITION PROJECT

Poster boy for fitness ...................................................... Rachel Jacqueline healthpost@scmp.com The website of the Peak Condition Project (PCP), a 90-day online health and fitness programme, stands out from the swarm of others of its type. There are no white smiles flaunting sculpted abs, money back guarantees or flashing buttons urging you to “sign up here”. Instead, there are only links to the blogs of ordinary people detailing the transformation of their bodies – and minds. The differences don’t end there. PCP’s founder, Patrick Reynolds, 33, is not a fitness guru; he’s a yoga teacher, Zen practitioner and accidental wellness revolutionary. “I never intended for this to be a business,” he says of his blossoming wellness empire. “I just did this project for myself.” It started four years ago as Reynolds faced his 30s with trepidation. “I always had that layer of fat around my gut that I couldn’t get rid of,” and he felt it was only getting worse. An American expat in Japan, he searched for a way to combat the effects of a slowing metabolism, demanding work schedule and overindulgence. His solution was to enlist the help of his martial arts trainer and fulfil a childhood dream of looking like Bruce Lee: lean, flexible and strong. He radically overhauled his eating habits, completed a basic training regimen daily and detailed his journey on a blog. Over 90 days, Reynolds lost 8 per cent of his body weight, changed his views on food and finally found that elusive Bruce Lee washboard stomach. (He also had the hairstyle to match.) His breakthrough earned him thousands of dedicated blog readers eager to emulate his success. Four years later, more than 600 people around the world (including Hong Kong’s Sean Macfarlane and Cecilia Aiello featured on the facing page) have followed in Reynolds’ footsteps. Reynolds is not the only one riding the wave of the booming global US$600 billion health and

fitness market as it takes to the internet. There are a number of similar websites on offer, such as DailyBurn.com, iBodyFit.com and 12wbt.com. Local Hong Kong business, Circuit25, has started offering online fitness programmes, and the personal training studio, Fitness Compass, also offers “how to” YouTube videos on its website. Interactive, personalised websites can help people not only lose weight but keep weight off, according to a 2010 study funded by the US National Institutes of Health and published in the Journal of Medical Internet Research. Among the 348 obese or overweight participants, consistent website users who logged on and recorded their weight at least once a month for 2½ years maintained the most weight loss. “Consistency and accountability are essential in any weight maintenance programme. The unique part of [the 2010 study] was that it was available on the internet, whenever and wherever people wanted to use it,” says the study’s lead author Kristine L. Funk, a researcher at the Kaiser Permanente Centre for Health Research in Portland, Oregon. For Reynolds, PCP is more than a health and fitness programme. “It’s about recrafting yourself and making a lifestyle change.” The programme aims to equip participants with the knowledge and skills required to continue to lead a healthy life. “Our goal is that on day 90 you fire us, because we’ve taught you how to take care of yourself,” explains Reynolds on his website. It may seem like an uncharacteristically noble goal for the fitness industry, but it is a genuine one. The programme reflects Reynolds’ life passions: writing and helping people. After getting a degree in creative writing, he joined the Peace Corps and travelled to Turkmenistan and Morocco as a volunteer nurse. He then moved to Japan to teach English and later opened a yoga studio. “PCP is my way to help people in the coolest way I’ve found.”

Patrick Reynolds, founder of the project, was inspired by Bruce Lee. Photos: Patrick Reynolds

Our goal is that on Day 90 you fire us, because we’ve taught you how to take care of yourself PATRICK REYNOLDS, FOUNDER, PEAK CONDITION PROJECT

The programme has a 90 per cent completion rate and participants lose between 5 and 15 per cent of their body weight on average. Its philosophy is brutally simple: “Weight loss occurs when you expend more energy in the day than you consumed,” says Reynolds. “The body, when its dietary needs aren’t met externally, will turn to its stored fat reserves.” This doesn’t require cutting out carbohydrates, juice detoxes or drinking only protein shakes. “We just eat natural food in the correct portions.” In practice, this results in eating about 200 fewer calories than their daily output. The training regimen is also simple: for six days a week, 1,000 jump rope exercises each day for cardio and a strength training combination of sit-ups, resistance

band work on his legs and arms. No two days are the same. The programme is designed to be completed anywhere with minimal equipment, so travel or not getting to the gym are not valid excuses. Every 25 days, participants are allowed to enjoy any food or beverage of their choice, provided they celebrate it and learn how it makes them feel physically. “The word ‘treat’ actually means this unexpected, happy thing, but these days they’ve become habits,” says Reynolds. The key ingredient of the programme’s success is daily – and public – accountability. Participants receive daily messages tailored to each stage of the programme, explaining the intentions and educating them on their body. They are required to blog daily and

upload pictures of themselves weekly. “And if you don’t write on your blog for 10 days, you get kicked off the programme,” says Reynolds. The programme costs US$599, but the greater investment is time: at least two hours a day to the regimen, and eight hours sleep each night. “The result is participants walk away with more than having just lost a few kilograms; for some, it has changed their life,” he says. Ultimately, Reynolds dreams of a world one day where there is no need for a programme like PCP as healthiness becomes the norm rather than exception. He admits that “peak condition” is not achieved through expensive equipment or by following fads; it’s a decision to invest in one’s health. And that can be done at anytime, anywhere.


FITNESS 11 FIT & FAB

THE TASTE TEST FRUIT & VEGGIE CHIPS

Try a little slenderness ...................................................... Rachel Jacqueline healthpost@scmp.com Sean Macfarlane, a magician, recently pulled off one of his greatest tricks yet: losing 12kg and 10cm off his waist in 90 days. But it wasn’t magic behind the 42-year-old’s transformation; it was all sweat and a few tears through an online health and fitness programme called the Peak Condition Project (PCP). His girlfriend, Cecilia Aiello, who did the programme with him, lost 7kg. The duo took on the challenge together after their romance – fostered through a mutual love of Din Tai Fung dumplings – caused them to gain weight. Aiello, 30, a law firm office manager, was captivated by the astounding “before and after” photos on the website (thepeakconditionproject.com). “I was also hooked by the philosophy that I was missing the motivation needed to sustain such a lifestyle change,” she says. Macfarlane, on the other hand, was less enthused: “I didn’t want to join,” he admits. “I only did it to keep her happy.” But once signed up, he embraced the experience and its effects have astonished them. “I didn’t know that Sean was such a slender guy underneath,” says Aiello. He was surprised that Aiello finished the programme at all. “I thought she was going to wimp out.” His doubts – which she herself had – were understandable given she had “zero fitness history, a lifetime of inactivity, and a deep love of sitting on my ass”. But 90 days later, through tenacious adherence to the regimen, she emerged lighter, more toned and with better posture. “I even feel taller walking down the street.” Even though they were on the programme together, they saw less of each other due to its daily mandates: blogging, one-hour-plus workouts, nightly food preparation and eight hours of sleep. But they made up for it through emotional support and working out together in a playground in Macfarlane’s building, where he would help Aiello with her form. “I’d push myself that little bit harder when I was training with him,” says Aiello. “I would show off a little bit.” What’s the training buddies’ next project? “It’s my dream to ride a bike through the rice paddies in Vietnam,” says Aiello. Macfarlane agrees; he doesn’t need convincing this time around. What has been your training buddy’s best improvement? Sean: Cecilia’s improved in so many areas: her posture is great and her

...................................................... Jeanette Wang jeanette.wang@scmp.com Banana Chips HK$16.50 for 120 grams, City’super They can be deep-fried, dehydrated or baked, but the cooking method and nutrition box aren’t listed on the packaging of this Japanese product. I hope the healthier option was used. Verdict: intense banana flavour with a hint of coconut. Delicious, though a little bit dry.

Good Health Natural Foods Crispy Cinnamon Apple Chips HK$31 for 70 grams, City’super Made with Washington State red apples dusted with cinnamon, the snack has 30 per cent less fat than potato chips. Each 28 gram serving has 140 calories and 7 grams of fat. Verdict: great texture that is crisp but also chewy in parts. But too much cinnamon means the overpowering sweetness mars the natural apple flavour.

Cecilia Aiello and boyfriend Sean Macfarlane joined the 90-day PCP programme together. Photo: Edward Wong skin is always glowing. Her commitment to exercise and eating well really took hold and now she rarely deviates from the PCP principles – it was very motivating for me and helped me finish strong. Cecilia: Confidence. After proving to himself that he has the mental and physical strength to complete something as challenging as PCP, Sean is confident that he can achieve his other goals in life. What’s your favourite song to work out to? Sean: I like the 1980s stuff. Van Halen’s Jump got me revved up during my skipping training. Cecilia: We Didn’t Start the Fire by Billy Joel. I would listen to it on repeat and sing the chorus out loud. What’s the one food you missed the most while on the PCP? Sean: For a long while I was craving

chocolate. However, I got my fix on my birthday when a friend gave me a huge box of chocolates – I demolished it in a day and a half. Ice cream comes in a close second. Cecilia: I mostly missed processed sugar and desserts. I never thought I had a sweet tooth until I cut processed sugar out of my diet and realised just how much I craved it. I was totally oblivious to how habitual indulging in these treats had become. What is one thing you’ve taken away from the programme? Sean: Eating well is 80 per cent of the programme. I felt better instantly after taking control of how I fed myself. It makes a huge difference to how I feel physically and emotionally. Cecilia: That I can be fit and healthy. I never thought it was possible for me to get there.

What would be the first “rule” of the programme that you would let go of? Sean: Early morning skips. I am not a morning person and was barely able to implement it. Cecilia: All the “rules” of PCP make so much sense in maintaining a fit and healthy body, like eating lots of fruit and veggies, using less oil, avoiding salt and getting plenty of rest. But avoiding desserts is hard when eating out, so I think I’d let that go. What did it mean to you to have a training buddy? Sean: It made it fun and more meaningful to give and receive support when it was needed. Cecilia: He was my rock, my cheerleader and my fellow traveller on the PCP journey. It would have been lonely without him. And the shared experience has brought us so much closer together. I see the man he is when the going gets tough.

Cassava Republic & Roots Chips (Lime Chilli Gourmet) HK$14.90 for 120 grams, ThreeSixty Made with produce grown in Java, this Singaporean product is 30 per cent lower in fat than regular potato chips. Each 28-gram serving has 148 calories and 8 grams of fat. Verdict: addictive – lots of crunch and not too salty (90mg of sodium per serving), unlike typical chips.


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