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YOUR GUIDE TO LIVING WELL

HEALTH POST

TUESDAY, OCTOBER 9, 2012

GUA SHA: OLD REMEDY STARTS FROM SCRATCH >PAGE 4

GREAT STRIDES: WIN A TRIP FOR TWO TO BEIJING >PAGE 10

Late bloomers How more seniors are giving themselves a sporting chance

>PAGE 6


2 NEWS HEALTH BITES ...................................................... Jeanette Wang jeanette.wang@scmp.com

Better to live life with a relish Here’s a good reason to have an extra squirt of ketchup on that hot dog: eating tomatoes and tomato-based foods is linked with a lower risk of stroke, according to a study published today in Neurology, the medical journal of the American Academy of Neurology. The active ingredient is the antioxidant lycopene, which is found mainly in tomatoes. Apricots, guava, watermelon, papaya and pink grapefruit are also significant sources. Researchers from the University of Eastern Finland in Kuopio tracked more than 1,000 men aged between 46 and 65 for an average of 12 years, during which 67 men had a stroke. The level of lycopene in their blood was tested at the start of the study, and those with the highest amounts of lycopene in their blood were 55 per cent less likely to have a stroke than people with the lowest amounts. Previous studies suggest that lycopene in cooked tomato products may be more readily absorbed by the body than lycopene in raw tomatoes.

How we burst our genes Like light switches, our genes get flicked on to initiate the basic biological process of protein synthesis, which takes place in every cell. Different proteins perform a variety of functions – from digesting fats to resisting viruses – and the timing and frequency of synthesis is crucial to maintaining cell health. Once thought to be a continuous process, recent studies suggest the opposite – that synthesis happens in rapid-fire “bursts”. New research by scientists at the Gladstone Institutes in San Francisco to be published this week online in the Proceedings of the National Academy of Sciences supports the latter theory. And they’ve taken it a step further, mapping the precise frequency by which human genes get turned on, thereby revealing new clues as to how disruptions of these “bursts” can be harmful. In certain cancers, for example, genes may be switched on at the wrong times, eventually leading to the formation of tumours.

Antidepressants make babies tune out Maternal depression and a common class of antidepressants can alter a crucial period of language development in babies, according to a new study in the Proceedings of the National Academy of Sciences. The study followed three groups of mothers – one being treated for depression with serotonin reuptake inhibitors (SRIs), one with depression not taking antidepressants, and one with no symptoms of depression. It found that treatment with SRIs can accelerate babies’ ability to attune to the sounds and sights of their native language, while offspring of mothers not treated with SRIs may have a prolonged period of tuning. The study’s senior author, Professor Janet Werker of the University of British Columbia, says: “At this point, we do not know if accelerating or delaying these milestones in development has lasting consequences on later language acquisition, or if alternate developmental pathways exist. We aim to explore these and other important questions in future studies.”

APP OF THE WEEK

ASK THE EXPERTS NANCY CLARK

When everything starts with an E ...................................................... Sasha Gonzales healthpost@scmp.com Foodditive – Food Additive Guide US$4.49 Rating 9/10 I’m pretty careful about what I eat and use on my skin. I spend more time in the supermarket than most people I know because I’m always stopping to read the labels. I might Google an ingredient if I’m not familiar with it, but if I come across something I can’t pronounce – or if it sounds plain nasty – I don’t bother checking it out and just place the product back on the shelf. When I found out about Foodditive, I was intrigued. Here was an app I could use on shopping trips, to get the scoop on all kinds of additives. No more need to Google in the supermarket aisle. I have the app ready whenever I go shopping. I can search an additive by classification or by its E number, and find out how it’s made and what it’s used in. Sometimes, I am amazed by what I find. For example, I used to think

Brace for a chain reaction Riding the wave of the growing popularity of cycling in the territory, Specialized, the renowned American bike brand behind multiple world champion cyclists and triathletes, will open its first concept store in Hong Kong at 831 Canton Road, Kowloon on Sunday. The premium services that will be offered include BodyGeometry Fit, a proprietary bicycle fit method that promises to help a rider be truly at one with the bike, therefore maximising comfort and power output while cycling. To commemorate the opening, a Specialized Cup XC mountain bike race will be held at Sheung Shui. Cyclists can register through its Facebook page (facebook.com/SpecializedHK).

that E307 – or alpha-Tocopherol – was toxic, simply because it had a fancy-sounding chemical name. But when I looked it up on Foodditive, I was surprised to discover that this synthetic form of vitamin E, used in cheese, soups and vitamin Eenriched foods, is generally safe for consumption and causes no adverse

reactions as long as it is used within approved guidelines. And who would have thought that the innocent-sounding carnauba wax (E903), which is sometimes used in cosmetic products, could trigger dermal eczema in people with super-sensitive skin, like me? And that carrageenan (E407), a naturalderived thickener and stabiliser that I always thought was pretty safe, is a suspected carcinogen? If you know or have a hunch that you’re allergic to a particular ingredient, you can mark it as such on Foodditive, making note of any adverse reactions you experience when you consume foods containing that ingredient. Then, the next time you’re out grocery shopping, you can refer to your list of ingredients to avoid. You can also check if each ingredient meets your dietary restrictions, including halal, vegan, vegetarian, kosher and gluten-free. Foodditive is user-friendly and written in straightforward language. It even includes links to reputable online sources in case you wish to research a particular ingredient further.

Q: I’m an athlete who takes protein supplements. I’d like to know whether all dietary protein sources are the same. What about supplements: whey versus soy versus casein? A: Different types of proteins are comprised of differing amounts of essential amino acids (EAA) and have different rates of digestion. For example, whey is more rapidly absorbed than casein. Soy protein contains fewer EAAs than whey or casein. The EAA leucine is a key “trigger” for building muscle, so leucine-rich foods with rapid digestive properties are best for recovery from resistance exercise. Animal proteins – including plain or chocolate milk, lean beef and tuna – are leucine-rich. Plant proteins contain leucine, but in lower amounts. Because casein is absorbed slowly, consuming casein-rich foods before bedtime (such as cottage cheese) can help support muscle-building processes

throughout the night. This may be particularly important for athletes seeking to maximise muscular growth during building seasons, such as during a pre-season training programme. Nancy Clark is a sports nutritionist and a Fellow of the Academy of Nutrition and Dietetics in Chicago. Reprinted with permission from the American College of Sports Medicine Fit Society® Page

> 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


MEDICAL 3 CASE HISTORY

...................................................... Eileen Aung Thwin healthpost@scmp.com Madam Thila’s health worsened dramatically after a fall at home. It left Thila (whose name has been changed for patient confidentiality reasons) with acute subdural haematoma, or bleeding in the brain, a potentially fatal condition where blood fills the skull cavity, pressing on the brain. Doctors in her home province of Punjab, India, battled for three months to save the 54-year-old’s life, and to stabilise her condition. She underwent repeated surgery, including craniotomies (where a piece of skull is temporarily removed to allow access to the brain) and a tracheotomy (where a hole is made in the windpipe to help get air into the lungs). Because of her many operations, she had to be given several courses of antibiotics to stave off infection. Unfortunately, Thila was allergic to penicillin and penicillin-like antibiotics, and hence was given a class of antibiotics called carbapenems. According to Dr Tsang Kay-yan, an infectious diseases specialist at the Hospital Authority Infectious Disease Centre at Princess Margaret Hospital, carbapenems are meant for serious infections that resist all other antibiotics and need to be used with great discretion. Overuse or inappropriate use of them can lead to the development of bacteria that are resistant to the superdrug. What doesn’t kill the bacteria makes them stronger. Part of the need for judicious use of carbapenem, says Tsang, is because no other antibiotics are being developed, and carbapenems are our last defence against severe bacterial infections. Thila’s condition was far from ideal and she remained bedridden. The bleeding had damaged part of her brain, and she was unable to speak or respond much. Her son lived and worked in Hong Kong, and decided to bring her here to be treated. A few days after she arrived in Hong Kong, Thila developed a fever, sudden shortness of breath and severe vomiting. She was admitted to Princess Margaret Hospital. Doctors found that her blood pressure had fallen, and there were low levels of oxygen in her blood – she had to be put on a ventilator and was placed in intensive care. Chest X-rays showed that Thila possibly had a chest infection (pneumonia) so they tested her sputum for bacteria. As she had some bedsores, doctors took a swab from a wound in her thigh for tests.

A vigilant nurse noted that Thila was recently admitted to hospital overseas – and regulations require such patients, as long as their admission was within the past six months, to be screened for carbapenem-resistant bacteria. This was in response to the growing worldwide threat of such pathogens. A rectal swab was taken, according to protocol. Three days later, the report from the sputum, leg wound and rectum specimens returned with alarming results. Different pathogens were found in all the three tests. But one chilling characteristic linked them all: every pathogen was carbapenem-resistant. Thila was transferred to the Infectious Disease Centre, where she was cared for in isolation. Tsang was called in to help manage her treatment. He needed to know more about the mechanism by which the pathogens were able to resist the drug, so further tests and gene sequencing of the pathogens were performed. The results filled Tsang with dread. Thila’s gut bacteria had the New Delhi metallobeta-lactamase 1 (NDM-1) gene. Pathogens with this DNA produce an enzyme called carbapenamase that inactivates the carbapenem antibiotic, rendering it ineffective. They were virtually unassailable. NDM-1 bacteria are the most feared, not only because they can destroy the super-antibiotic but because they can transfer the NDM-1 gene between strains of bacteria. If the NDM-1 gene is transferred to another antibiotic-resistant bacteria, it could lead to a potentially untreatable – and deadly – infection. That infection could easily spread from human to human. An epidemic of untreatable infections would be unthinkable. Thankfully, the strains of bacteria in Thila’s lungs and leg wound were not NDM-1 positive. Still, Tsang needed to find a way to address the infection that was ravaging her body. Moreover, bacteria had now infected her blood. Thila’s was Hong Kong’s first known symptomatic NDM-1 case. A previous discovery of NDM-1 was made from a patient’s urine sample but, by then, the patient had no symptoms and was not ill. Tsang and his team scoured medical journals and reports for other known NDM-1 cases. As of June 18 this year, there have been 306 reported cases of NDM-1 worldwide and 12 deaths. Surprisingly, colistin – an old antibiotic that has dropped out of favour in the medical community because of its potential to impair renal function – was one of the very

An epidemic of untreatable infections would be unthinkable

Illustration: Angela Ho

The bugs that resisted arrest few antibiotics known to be effective against NDM-1 pathogens. Thila was placed on a two-week course of colistin. That helped to bring down her fever and allowed her blood pressure to slowly return to normal. But colistin was unable to eradicate the NDM-1 bacteria. Thila continued to test positive for the bug for five months. Tsang says it is imperative that the medical community use antibiotics with great care – not all infections need antibiotic treatment. Viral infections do not respond to antibiotics. When symptoms persist, swabs should be taken to test for the type of pathogen is causing an infection, says Tsang. Simple bacterial infections can be treated using simple antibiotics. Using higher classes of antibiotics to treat simple infections could lead to creating superbugs that are too tough to kill.


4 HEALTH TRADITIONAL CHINESE MEDICINE GUA SHA

State of graze ...................................................... Elizabeth Snouffer healthpost@scmp.com There is mounting evidence that gua sha, an ancient form of Chinese medicine whereby the skin is scraped by a blunt instrument, can indeed be effective for pain relief. The 2,000-year-old treatment, used for generations by Chinese mothers as a home remedy for sick children, has migrated from East to West. Gua sha is now performed throughout Southeast Asia, and in Asian immigrant communities and by traditional Chinese medicine practitioners throughout the world. Since 2005, there have been more than 120 studies on gua sha, mostly investigating its effect on painful, musculoskeletal conditions, such as chronic back pain. In 2009, researchers at Harvard found that gua sha has potential for antiinflammatory and immunological properties and, in 2011, another Harvard study showed that gua sha reduced liver inflammation in chronic active hepatitis B. Last month, a study investigating the therapeutic benefits of gua sha on 40 patients with chronic neck and lower back pain was published in the American Journal of Chinese Medicine. The participants were randomly assigned to either a treatment group, which received only one gua sha treatment, or a waiting list control group. Seven days after the treatment, both groups were reviewed. Patients in the treatment group reported pain reduction and improved health status as compared to the control group. But, pain sensitivity improved in the chronic neck pain patients in the treatment group but not in those with lower back pain. The researchers suggest this was due to higher pressure sensitivity in the neck area. Romy Lauche, one of the researchers in the University of Duisburg-Essen team, recounted that many patients found sustained relief for more than seven days, and one participant, who had been anxious about the treatment, had unexpected results. “A woman with a back pain rate of seven on a 10point scale returned for evaluation without any pain. Having examined her before and after, I could see gua sha had eliminated all visible muscle

tension. The mountains of tight muscles had disappeared,” says Lauche in a phone interview. As with many complementary and alternative therapies, gua sha is not without controversy, mostly due to the distinctive and seemingly severe marks that are a result of the procedure. These marks are not bruises or rashes, but something called petechiae. It looks brutal enough to put off many patients seeking an alternative form of pill-free pain relief. Gua Sha Treatment, a 2001 film, did something to alleviate the misconception. Starring Hong Kong film star Tony Leung Ka-fai, it is a story about Chinese-American immigrants who come face to face with cultural misunderstanding when a doctor discovers the shocking gua sha marks on the school-aged son and calls the authorities. It’s a tale with a happy ending. But not all gua sha treatments are equal. Annie Tong, a Hong Kong resident, had the treatment a decade ago in a Kowloon clinic, and still remembers the pain. “It was uncomfortable, and my back was as red as a radish. It hurt for days, and there was little relief. I wouldn’t try it again,” she says. Dr Gladys Leung, a TCM practitioner and adviser to the Langham Place Hotel’s TCM-based Chuan Spa, believes gua sha needn’t be painful. It depends on the communication between patient and practitioner, and the skin sensitivity of the patient. “A practitioner may be doing it too strongly without asking for the patient’s feedback,” she says. Dr Wu Yue, a TCM practitioner in Singapore who specialises in acupuncture, says there are different degrees of firmness for different degrees of patient pain. “It depends on the qi and the state of congestion in blood flow. A firm stroke would be used for very blocked qi indicated by severely tight muscles.” Dr Arya Nielsen, director of acupuncture at Beth Israel Medical Centre’s Department of Integrative Medicine in New York, has spent a great deal of her career teaching gua sha to doctors throughout Europe and North America. She has written a textbook on fundamental gua sha, led research to prove evidence of gua sha efficacy for pain and


HEALTH 5

considers the treatment “a simple medical miracle”. Nielsen has submitted safety protocols for gua sha and cupping therapies to eliminate risks and raise the calibre of practice standards. Pain should not be part of a patient’s experience during the procedure, she says. The greatest misconception about gua sha is that the treatment causes bruises. “Gua sha does not cause bruising. Bruising represents traumatic bleeding and injury to the tissue,” says Nielsen. The red marks seen after a gua sha treatment represent the flight of red blood cells in the surface tissue. “When there is blood stasis [characterised as fixed, persistent or recurring pain], gua sha will cause the cells to go ‘outside’ the vessels, but they will immediately begin to be reabsorbed.” This process releases pain, enhances blood flow and improves function of the nervous system. During the treatment, special oil is applied for its protective, detoxifying or relaxing purposes depending on the requirements of the patient. The practitioner begins the procedure by scraping or press-stroking with a smooth-edged instrument traditionally made from jade, horn or metal. Practice guidelines today require

There is nothing scraped off with gua sha. If done by an adept provider, it should not be painful DR ARYA NIELSEN, DIRECTOR OF ACUPUNCTURE BETH ISRAEL MEDICAL CENTRE

Red marks appear during treatment, but they fade. Photos: Edmond So

that the tools be sterilised or disposable to eliminate infection. Press-stroking is unidirectional and repeated until the petechiae or red dots appear. From the colour of the petechiae, it is possible to see if the blood stasis is a recent (lighter red) or chronic (dark red or purple to black) stagnation. Normally, the red marks disappear completely within three to seven days. After the treatment, patients can feel a variety of symptoms. They notice, says Nielsen, “an immediate shift in pain, range of motion, fever, cough, nausea, vomiting, wheeze and so on”. Nielsen says the treatment is not advised for those with sunburn, rash, wounds, or over moles or pimples. Many doctors believe that pregnant women or those with diabetes and some cancers are also not suitable for gua sha. But Nielsen disagrees with this, saying that “it produces a protective immune response at the internal organs”. Researchers from the Korea Institute of Oriental Medicine did a systematic review of controlled clinical trials of gua sha and published their findings in 2010 in the journal BioMed Central. They searched 11 databases and found seven trials, three of which the researchers say showed favourable effects on pain reduction but were of

HERE’S THE RUB Gua sha is said to help: • All pain syndromes • Neck and shoulder complaints • Headaches and migraine • Backache • Repetitive strain injuries • Stress and burn out • Rheumatic complaints • Asthma • Digestive disturbances • Metabolic disturbances • High blood pressure • Chronic fatigue

Gladys Leung (right), TCM consultant at Chuan Spa, performs gua sha.

poor study quality. “Current evidence is insufficient to show that gua sha is effective in pain management,” they conclude. Another study published last year in the journal Pain Medicine by German researchers randomly assigned 48 patients with chronic neck pain to either one gua sha

treatment or local thermal heat pad treatment and followed up seven days later. The researchers concluded that gua sha has beneficial short-term effects on pain and functional status in chronic neck pain patients, but its value in the long-term remains to be seen.


6 COVER STORY

G

etting older was not an excuse to slow down for masters swimming champion Mabel Leung Yuen-ying. She took up competitive swimming in her 40s, learned how to ski in her 50s, and tried scuba diving and skydiving, during her 60s. Now 70, and fresh from competing at the World Masters Championships in Riccone, Italy, she has set her sights on completing the 1.5-kilometre crossharbour swim in Hong Kong. “When you reach a new milestone in your life, I think it’s really good to do something challenging,” says Leung, who trains for up to 90 minutes every day. “Being active makes you focused.” Keeping active is known to add years to a person’s life. A study by Sweden’s Karolinska Institutet, published in August in the British Medical Journal, tracked 1,800 people aged 75 years and older for more than 18 years. It found that those who maintained a healthy lifestyle – that is, those who didn’t smoke or drink, participated in a leisure activity and maintained a social network – lived, on average, five years longer for women and six

years longer for men. Of the leisure activities, physical activity was most strongly associated with survival. On average participants who swam, walked, or did gymnastics regularly lived two years longer than those who did not. Globally, life expectancy has risen in the past 30 years, according to World Health Organisation statistics. In 2009, global life expectancy at birth was 68 years, four years higher than in 1990. High-income countries tend to have higher life expectancy; in Hong Kong it’s now 86.7 years for women and 80.5 years for men, according to the latest government figures. So it’s not surprising that there are now more age-defying athletes such as Leung. Kor Hong Fatt, 80, began running at age 71 after a heart attack that served as a wake-up call. Losing his health so suddenly was a shock: “I could not accept that this could happen, since I was physically fit for a man my age and was not suffering from any chronic disease.” Running was a way to get fit, to avoid becoming a burden on his family.

“I wanted to prove that my body could take it,” says the Singaporean, who is a full-time carer for his wife, a stroke victim. Kor has run 16 marathons since. Last year he qualified for the prestigious Boston Marathon and was the race’s second oldest finisher in five hours, 13 minutes and three seconds. It’s never too late to start. Taking up sport later in life, even if a person has been sedentary in prior years, can reverse the effects of ageing and significantly modify risk factors for disease. Nearly 2,000 people born in 1920 and 1921 were assessed at ages 70, 78 and 85 in a study published in the September 2009 issue of the Archives of Internal Medicine. Compared to the sedentary, up to 17 per cent were less likely to die between the ages of 70 and 88, were more likely to remain independent and experienced fewer declines in their ability to perform daily tasks, and reported fewer new instances of loneliness and poor self-rated health. The benefits associated with physical activity were observed even in those who began exercising between ages 70 and 85.

Seniors the world over are learning that it’s never too late to take up a sport, writes Rachel Jacqueline

Get the wrinkles out

Another study, the Dallas Bed Rest and Training research by University of Texas Southwestern Medical School researchers, has tracked five healthy volunteers since they were 20-year-old college students in 1966. That year, their fitness was assessed after an eight-week training regimen following three weeks of bed rest. A 30-year follow up study, published in 2001, looked at the effect of age on the men’s fitness. While all five remained healthy and none required long-term medication, the men gained an average of 23kg and their average body fat doubled to 28 per cent. Their cardiac function suffered: resting heart rate and blood pressure rose, while maximum pumping capacity fell. The men were put on a six-month progressive endurance training programme that included walking, jogging and cycling. By the end of six months, they were exercising four or five times a week for a total of about 4½ hours. The men averaged weight loss of only 4.5kg, but their resting heart rate, blood pressure, and their heart’s maximum pumping abilities were back to their baseline level

from age 20. “We reversed 30 years of ageing with six months of training,” says one of the researchers, Dr Benjamin Levine. However, the men were unable to match their peak performance at age 20. It’s not surprising, however, because, from age 40, one’s maximal aerobic capacity begins a steady decline, dropping by as much as 10 per cent per decade. This is due mainly to the stiffening of the heart and loss of muscle mass with age. But performance doesn’t rely on only physical power. “While you can never again have the speed, strength or balance of youth, mentally you become a lot stronger with age,” says Robert Hutchinson, 70, who has done 28 ultramarathons since age 60. In March this year, he completed his third Gobi March, a 250-kilometre, self-supported, multi-day stage race across China’s Gobi Desert. Next up is the Hong Kong 100kilometre trail race in January, for which he trains up to 100 kilometres a week. The so-called golden years can be a time to get stronger through resistance exercise, say University of Michigan


COVER STORY 7

researchers. Normally, adults who are sedentary past age 50 can lose up to 180 grams of muscle a year. Resistance exercise – body weight exercises like squats and push ups or Pilates – can increase lean muscle tissue and strength even for those in their 80s and 90s, say the researchers. The American Journal of Medicine reported last year that after an average of 18 to 20 weeks of progressive resistance training, adults can add 1.1kg of lean muscle to their body mass and increase their overall strength by up to 30 per cent. It’s really a matter of use it or lose it. Consistency is key, says Klaus Köste, 69, the 1972 Olympic gymnastic champion in the vault. “You must move every day.” The German gymnast, who had heart

Every time I finish, I am simply euphoric. I will keep running as long as I am able to. I have never been this fit KOR HONG FATT, 80, MARATHON RUNNER

Ultramarathon enthusiast Robert Hutchinson (left), 70, ran across the Gobi desert. Clockwise from above: former Olympic champion Klaus Köste still does the parallel bars; Kor Hong Fatt ran his first marathon at 70; Hutchinson; Mabel Leung, 70, plans to swim the harbour. Photos: Warton Li, Sam Tsang

surgery in 2005, still trains on the parallel bars daily. “Doing a handstand, for me, is like my medicine.” It’s also about being conscientious in all aspects of good health. “You must continually eat good food, drink plenty of water and not too much alcohol,” adds Köste. Finding a good training partner helps. Köste and his wife, also a gymnast, train young equestrian vaulters (who do gymnastics and dance while on horseback) and share their passion for the sport. But there are challenges for senior athletes. Recovery is the biggest obstacle. “Rest becomes more important as you get older,” says Hutchinson. He often takes up to three complete days of rest after a long training session.

But he says he copes with aches and pains better now he is older: “I see them more as a sign of accomplishment.” Leung, who holds the Chinese national record for the 100-metre butterfly in the 60-64 age category, overcomes aches and pains with massage. “I get lots of massages and practise yoga regularly. It really helps with restoring your muscles,” she says. There are many ways to get healthy as you get older. But Kor notes that it’s important to listen to your body and stay within your limits. “Avoiding injuries is important, because it takes more time to heal the older you get,” he says. “Try to avoid running in the dark, and be constantly aware of potholes, kerbs and slippery surfaces. I usually run on

asphalt and flat surfaces, and try to avoid unfamiliar routes.” While Kor has had his share of struggles, crossing the finish line makes it all worth it. “There are no words that can adequately describe the joy it brings to my heart and soul,” he says. “Every time I finish, I am simply euphoric. I have never felt this fit.” Running gives Hutchison a newfound appreciation for the world around him – it’s almost a new lease on life, he says. For Chau, being in the best shape of her life brings a sense of self-worth. Competitions give her the opportunity to travel and make new friends. As George Bernard Shaw said: “We don’t stop playing because we grow old. We grow old because we stop playing.” So, what’s your excuse? healthpost@scmp.com


8 DIET THE TASTE TEST HEALTHY OILS

HEALTHY GOURMET

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

My pasta infatuation

Jeanette Wang jeanette.wang@scmp.com

Frantoia Extra Virgin Olive Oil Peperoncino HK$90.90 for 250ml, ThreeSixty Made up of two per cent natural chilli extract; the rest is extra virgin olive oil. Per 15 ml: 120 calories, 14 grams of fat, 10 grams of monounsaturated fat. Verdict: leaves very little oil in the mouth, but might be too spicy for some tastes.

Grove Avocado Oil Infused with Garlic HK$109.90 for 250ml, ThreeSixty Made from New Zealand avocados, this claims to be the “ultimate culinary oil”, for dressings and dips, high temperature cooking, and as a healthy alternative to butter. Per 5ml serving: 40 calories and 4.5 grams of fat, plus 24mg beta sitosterol, a plant sterol used for reducing cholesterol and treating an enlarged prostate. Verdict: has a thicker, creamier texture than typical oils and leaves an oily feel in the mouth.

Alfa One Rice Bran Oil Dressing Italian HK$38 for 250ml, ThreeSixty This oil from New Zealand is made with premium red wine vinegar and rice bran oil, which contains oryzanol, a plant sterol which is said to help reduce cholesterol absorption. Each 20 millilitre serving has 40 calories and three grams of fat, and a relatively high amount of sodium at 265 milligrams. Verdict: tangy and refreshing, good with salad, doesn’t leave an oily feel in the mouth.

...................................................... Andrea Oschetti healthpost@scmp.com “What you do is memorable, when you put your heart in it,” grandmother Elda used to tell me. As a young boy, I spent long afternoons amid the warmth of her stoves, waiting in anticipation for the week when she prepared the family’s tomato sauce supply for the whole year. Her home was full of tomato baskets, empty bottles that needed to be sterilised in boiling water, and the pots where the precious sauce was cooked for long hours. My help was much in demand and I was excused for having tomato all over my clothes. I grew up in the kitchen: the afternoons after school at my grandma’s; the evenings helping my mum, who despite a long day at work never failed to prepare a fresh dinner for the family; the Sundays with my dad, who after church prepared fresh pasta and his roast. These days I continue my love affair with food as a private chef, cooking clients a four-course Italian dinner. There are plenty of good Italian restaurants in Hong Kong, both trendy and classic, but I believe people come to me because I bring happiness to the table. Through my dishes, I guide my clients’ imaginations on a journey that revolves around Italy and its culture and traditions. It is an experience, and as such is eventful, surprising and joyful. This is, I believe, what ultimate dining is about. I believe everyone can cook a great meal. A bit of knowledge is needed, but just a little. What you really need are five virtues. 1. You must have a love affair with food and sharing it with friends. 2. Source the best ingredients. Hong Kong offers a great range of quality products from all over the world as well as local organic produce (I use House of Fine Foods, hoff.com.hk). 3. Take your time to cook; haste is not a friend of the kitchen. 4. Cut small and cook little. In general, this is the best way to both preserve the flavours and nutrients of food.

Cut small and cook little … this is the best way to preserve both the flavours and nutrients of food

There is no product on the market that can reproduce the taste of home-made fresh pasta, says Andrea Oschetti.

5. Be daring but humble: better a simple dish well done than a complex one that is not satisfying. Nothing is simpler to prepare than pasta, but so many people get it wrong. Here are the secrets to cooking it perfectly. With roughly 350 calories and 1.4 grams of fat per 100 gram serving, and barely any sodium and no cholesterol, pasta – eaten in moderation – is an ideal foundation for building healthy meals. Wholegrain and whole-wheat pasta offer more nutrition than traditional white pasta, but tend to be coarser and chewier. There are two main types of pasta: fresh and dried. The fresh one is made with egg and it should be made at home; there is no product in the market that is able to achieve the good taste of homemade fresh pasta. It is mainly used for filled pasta, like ravioli and

tortelli, or cut into long strips for tagliatelle and pappardelle. Spaghetti, linguine, maccheroni and penne are the dried pasta, made of durum wheat flour. You can’t make these at home. The point of each type of pasta is the marriage with its sauce. Spaghetti is best with oil and tomato-based sauces, which contain nothing too chunky, so that the sauce can cling to it. Penne is best for sauces with meat and vegetables, so that the ingredients are trapped inside the tubes, whereas with spaghetti it will get left on the plate. Buy quality Italian pasta. De Cecco, widely available in Hong Kong, is a very good one. Notice the cooking time is above 10 minutes: be suspicious of anything that cooks below six minutes. You need a high cylindrical pot, possibly made of stainless steel. The formula is straightforward: one litre of water for 100 grams of pasta, which is the amount of pasta for one person. This is the minimum amount of water; anything above is good too. To cook properly, the pasta needs enough space to swirl around easily. Don’t cook more than 500 grams of pasta together;

if you have more than five guests, use two pots. Once the pasta is at a rolling boil, add 10 grams of coarse salt for each litre of water, and after one minute add the pasta. While it cooks, don’t leave it alone but gently stir it from time to time. Everyone has their own preference for pasta texture, but generally you should make sure that the pasta stays firm, not too soft. Now, here’s the secret for pasta as it is done in restaurants: when taken out of the water, the pasta tends to soak up a lot of liquid. If you add your sauce at this point, it will absorb all the moisture of your sauce and you will end up with a dry dish. Instead, take the pasta out one minute before the time you would consider it ready. Mix it together with your sauce on a pan over the fire and add some broth or the water you used to cook the pasta, say around 40 millilitres per person. Don’t be afraid if it looks wet, in 30 seconds the pasta will absorb all the water and the flavours of your sauce. When most of the liquid is gone, take the pasta out of the pan and add parmesan cheese and herbs as needed. Buon appetito. Healthy Gourmet is a weekly column by private chef Andrea Oschetti. andrea@fioreblu.com


DIET 9 FAD DIETS INTERMITTENT FASTING

Gnaw of the jungle ...................................................... Richard Lord healthpost@scmp.com These days new diet fads come along roughly as often as MTR trains during rush hour, so it’s no surprise that the latest to grip the popular imagination is actually a reboot of a couple of existing ideas, a kind of a diet mash-up. Intermittent fasting, as the name suggests, combines elements of fasting – not eating for prolonged periods – with elements of the Paleolithic diet, which emphasises eating like our ancestors before the development of settled agriculture about 10,000 years ago, consuming foods such as meat, fish, fruits and vegetables. The Paleolithic diet is an attempt to eat the foods our digestive systems are best adapted to consume. Intermittent fasting has a similar aim: to mimic preagricultural eating patterns, when food was not so regularly available, by not eating on particular days or for a certain period each day. That runs contrary to a lot of recent nutritional wisdom, which tends to favour eating little and often. “We encourage small, frequent meals as some studies have showed that they might increase metabolic rate,” says Sylvia Lam See-way, chairwoman of the Hong Kong Dietitians Association. “[Frequent meals] can keep you satiated so that you can reduce the chance of overeating. And they can stabilise blood sugar, preventing big fluctuations in insulin secretion, which [could] reduce the risk of diabetes and obesity.” Intermittent fasting proponent Robb Wolf, in contrast, says that our eating patterns are those of herbivores, rather than the omnivores we’re designed to be. Wolf is a nutritional expert and author of The Paleo Solution: The Original Human Diet. He says that your diet is as much a matter of when you eat as what you eat. Wolf claims that “for almost every disease under the sun, systematic inflammation is a factor. And every time you eat, there is an inflammatory response. We’re constantly bombarding our digestive tract with food, and we need to give it a regular rest.” Fans of the diet claim it can do

everything from regulating blood glucose and controlling blood lipids to improving cardiovascular function and reducing blood pressure and the risk of cancer. But sceptics say there are risks. “Potential dangers from fasting include an increased chance of eating disorders, inadequate intake of micro- and macronutrients, and the possibility of overeating after a fast,” says Lam, who doesn’t recommend any form of fasting as a diet. “Some acute symptoms [also include] weakness, dizziness, low blood sugar and agitation.” Of course, the effects depend on what intermittent fasting regime you follow because this is an ill-defined diet with several manifestations. Sometimes it means not eating for 24 hours once or twice a week; sometimes it’s so-called alternate day fasting – eating for 24 hours and then not eating for 24 hours; sometimes it involves randomly skipping meals in an attempt to more accurately mimic the unpredictability of pre-agrarian revolution eating patterns. But probably most common is not to eat for a set number of hours per day – anything from 16 to 20 is common. Of course, all of us have a period of fasting each day: when we’re asleep, and usually for a while before and after, too, which can easily make up 12 hours out of 24. Wolf prefers this, among the milder of the various fasting regimes. “Going a full day without eating seems austere. Don’t eat your last meal of the day after 5pm or 6pm, and don’t eat the first before 9am or 10am, and that’s 16 hours. Doing that two or three days a week is fine at first. Eat proteins, fruits and vegetables. It’s the old wisdom: eat good food that’s not processed, and don’t eat too close to bedtime.” Karen Chong, dietitian at Matilda International Hospital, says that fasting for 16, 18 or even 20 hours a day “should be fine”. But for longer fasts, of say 30 hours, people might not get an adequate amount of nutrients or calories.” Weight restriction is the most common reason for taking up the diet, but weight loss is probably the result of consuming fewer calories. The element of calorie restriction makes it difficult to test the efficacy of intermittent fasting. “There are

Not eating for a certain length of time may help you reconnect with your caveman roots. Photo: Corbis not many human studies to support fasting as a good diet to reduce the risk of diseases,” says Lam. “Fasting has been shown to improve health and longevity only in animals such as dogs, fruits flies, rodents and nonhuman primates.” Other studies have focused on Ramadan, when more than a billion people undertake a form of an intermittent fasting regime. Results have been mixed, with some finding improvements in metabolic risk factors including cholesterol levels,

There are not many human studies to support fasting as a good diet to reduce the risk of diseases SYLVIA LAM, CHAIRWOMAN, HONG KONG DIETITIANS ASSOCIATION

triglycerides and blood sugar, but others finding no effect. Moderate intermittent fasting is unlikely to do you too much harm, but the more extreme versions might, plus at the moment there’s no proof that it does you any good. Among the people who definitely shouldn’t take up the diet, says Lam, are pregnant and lactating women, elderly people, children and people with chronic conditions such as diabetes and heart disease. For everyone else, the jury is still out.


10 FITNESS GREAT STRIDES

On the home stretch ...................................................... Troy de Haas healthpost@scmp.com Visitors to Hong Kong are usually familiar with the territory’s food, shopping, high-density living and pollution. But few tourists – and even residents – think of Hong Kong as a running paradise. The fact is, wherever you are in this great city, you are just around the corner from a park or traffic-free running trail. Hong Kong has been a very popular stopover city for athletes and teams passing by, in my experience as a sports travel manager for professional athletes. Erin Densham, Olympic bronze medallist in the women’s triathlon at this year’s London Games, has been among my clients. She uses Hong Kong as a training-camp base. The cycling and running opportunities here are much better than those in other Asian cities. The city’s subtropical climate means high humidity from May to September, and this can make running a very sticky pastime. But there are many running races held from October to April, when the weather is cool and dry. “If you are serious you will run all year round,” says Chris Wardlaw, 62, a former Australian Olympic runner and coach who lives in Hong Kong. There’s no shortage of such people in the running community in the city, so it’s easy to find running buddies. Among the popular groups are the Hong Kong Hash House Harriers (hkhash.com) – known as drinkers with a running problem – and Hong Kong Trail Runners (meetup.com/HKTrailRunners). Whether you are a tourist or resident, you are sure to enjoy the variety and accessibility of the running opportunities here. Best Running Spots Bowen Road: Hong Kong’s most famous running route, and the hip place to be seen out jogging by locals and expats alike. The route goes from Magazine Gap Road, near The Peak Tram railway, and ends at a roundabout on Stubbs Road near Hong Kong Adventist Hospital. It is actually not a road route at all, so is almost completely traffic-free. Winding along the forested mountainside, you feel like you can reach out and touch Hong Kong’s stunning skyline. Flat and shady, the out-and-back route is eight kilometres long. Happy Valley Racecourse: It’s not just for horses. This was the base for the Australian Beijing Olympic team’s pre-departure camp. Here you can choose between the one-kilometre inner tartan track or the longer 1.4kilometre inner cement road that

After running all over Asia for Great Strides, Troy de Haas is about to get on his bike.

runs inside the grass race track. Unless your name is Mo Farah or Usain Bolt, you are highly unlikely to get special permission to run on Hong Kong’s hallowed grass turf, so best to keep off. Shower and locker facilities are available in the middle of the field, as well as a small store with drinks and snacks.

See the Agriculture, Fisheries and Conservation Department’s “Enjoy Hiking” website (hkwalkers.net).

Tolo Harbour cycling track: This 10kilometre path in the New Territories runs from the town centre of Sha Tin to Tai Po Market. The route is via the Hong Kong Science Park, extending to the Tai Po Waterfront Park and Tai Mei Tuk. It’s popular with cyclists and joggers, as it is flat and traffic-free. The route hugs the coast, offering great views and a cooling sea breeze.

Victoria Park: Located in the centre of Hong Kong Island near the busy Causeway Bay shopping district, this 55-year-old park has a 625-metre jogging trail with six fitness stations for circuit training.

Dragon’s Back: Voted Asia’s best urban trail in Time magazine. The 8.5-kilometre trail takes you through bamboo and lush woodland, then along the rugged spinal ridge to Shek O called the Dragon’s Back. “If you only try one run in Hong Kong, make it the Dragon’s Back and Tai Tam Country Park,” says Rasmus Holm, head of sales at Puma AsiaPacific, and a regular runner. If trails are your thing, there are many routes through the northern New Territories, Sai Kung, Hong Kong Island, Lantau and Lamma Island.

Kowloon Tsai Park: A tartan track with distance markers winds its way through lush manicured gardens in the north of Kowloon. The nearest MTR stop is Lok Fu.

The main event: Standard Chartered Hong Kong Marathon The Hong Kong marathon is the territory’s biggest sporting event. In spite of a staggering 70,000 competitor quota, they still managed to completely sell out last year’s event within one month of registration opening. The marathon, half-marathon, and 10-kilometre events all end at Victoria Park. The routes have accurate kilometre markers, and there are sponges and drinks available along the course. The marathon and halfmarathon courses, which both begin on Nathan Road in Tsim Sha Tsui, have drawn much criticism for their rather lonely feel, as there are

very few spectators. For much of the race, you are running on the sometimes winding freeways. The many bridges and tunnels don’t allow for much rhythm, and there are relatively slow overall times. But running through the harbour tunnel and across the island’s many bridges gives a view of Hong Kong that very few get to experience. Après run • If you can’t run like an elite runner, at least you can look like one. Try Escapade Sports shop in Central or Causeway Bay, or Racing The Planet in Sheung Wan, for specialist running gear. • You will notice many massage shops in Hong Kong, but not all are equal. Invest in a quality foot or sports massage at Ten Feet Tall in Central (tenfeettall.com.hk). • Keep refuelled with a selection of healthy salads, wraps, juices and smoothies from MIX located in various areas across Hong Kong Island. I recommend the “Organic Breakfast” – a great recovery shake after a morning run. This is the final week of Great Strides, a series of city running guides by Troy de Haas, sports travel manager at Flight Centre and a former Australia representative in orienteering, mountain running and tower running

WIN! WIN! WIN! We have a travel package for two worth HK$8,000 to give away, courtesy of travel agency group Flight Centre (flightcentre.com.hk). The package includes return economy flights to Beijing and two nights at Mercure Wanshang Beijing with daily breakfast. The best answer to the following question wins. Where is your favourite place to run in the world, and why? (Hint: a nice photo of you running at that particular place will score you extra points.) Send your answer and photo to healthpost@scmp.com with “Great Strides competition” in the subject line. Please include your full name, age and contact number. The entry deadline is noon, Thursday October 11, 2012. The results will be announced in the next issue of Health Post.


WELL-BEING 11 PERSONAL BEST

Grit expectations ...................................................... Rachel Jacqueline healthpost@scmp.com I’m neither a serious nor gifted athlete. However, what I lack in natural ability I make up in unwavering drive and an insatiable appetite for getting the best of myself – what I’ve come to term as my “inner badass”. If you’re the competitive type, you know what I mean: it’s the voice in your head that doesn’t let you quit. It rips you out of bed in the morning and pushes you out the door for a run. It’s the one that calls it quits on a Saturday night in favour of an early morning adventure. But it is also responsible for exhausting extremes. It pushed me to train for six months to fight in a charity boxing match last year and it’s what drove me to run hundreds of kilometres training for ultramarathons. It also gave me the guts to quit my job as a corporate lawyer to pursue a writing career. So after a year of change and challenge, it was time to give myself – and my inner badass – a break. For two months I swapped my morning run for a yoga session, and let my hair down. Once the time passed, I eagerly

got back into training. Ten minutes into my first run I noticed something heartbreaking. Instead of the voice of irrationality egging me on, all I heard was: “Wow, this is hard work, can we stop now?” On my fifth day in a row of sleeping in, I woke in panic: where had my determination gone? To regain it, I knew I had to do something really challenging. Leadville, Colorado is the highest city in America at 3,094 metres, surrounded by snow-capped mountains all year round. It was once a bustling city known for mining gold and later silver; these days it’s best known for the Leadville Trail 100 Run, a gruelling highaltitude 160 kilometre race. While I wasn’t ready for such a challenge, I discovered its sister race: the Heavy Half Marathon, a 25-kilometre run starting in the town’s main street, making its way up to Mosquito Pass (altitude 4,019 metres) and back. It was just the shake-up I needed to recover my lost friend. I enlisted my two running buddies, Phil and Dom, and three weeks later I was in Leadville. A practice jog along the main street the night before the race resulted in an oxygen-deprived head spin. I realised that I was ever

Illustration: Lau Ka-kuen

A game of cat and mouse ensued: I nipped at her heels on the descents, but I lost ground on the uphills going to complete the race, I’d have to regain my competitive streak. The next morning, I waited anxiously at the start with my running companions. The gun fired and we were off. I started at a slow pace, eager to maintain it for as long as possible. But I slowed to a walk before the top of the first hill. I told myself it was just the altitude and I would push myself later. My inner badass – now more like my inner softie – agreed breathlessly. Off the road and into the trails, I was in my element – among the trees, dirt track and blue sky. I picked up my pace on the flatter sections and surged forward. But as soon as the gradient ramped up, I was once again walking at a snail’s pace. I berated myself while

my body fought for more oxygen. While my internal argument continued, a runner jogged past me. Dressed in a bright fluorescent orange top which flashed in the sunlight, she was like a warning beacon. I had to pick up the pace. A little voice within told me I was running a smart race. My skill is running the descents and I took comfort that this would allow me to finish strong. And so I continued a combination of walking and running to the top of Mosquito Pass, sighting fluorescent orange blazing on the horizon. At the summit, I took a quick happy snap, started my descent and began to fly. “You go girl!” shouted a fellow competitor as I overtook him. I could feel my determination stirring from the depths, locked on to the challenge of catching – and then passing – the fluorescent runner ahead. Pushing my limits, I strode over the loose rocky path, risking a broken ankle to chase my goal. Soon, I blazed past fluorescent orange, and also overtook a pink,

a purple and a few other colours of the sporting apparel rainbow. Then something happened. As the trail flattened, lethargy set in again and I slowed to a walk as I gasped for air. Fluorescent orange zoomed past. A game of cat and mouse ensued: I nipped at her heels on the descents, but I lost ground on the uphills. With only five kilometres to go, I could see her ahead. Tunnel vision set in. If my inner badass wasn’t going to return on its own, I was going to force it out. Letting my legs go, I propelled down the hill. I caught her and edged past. Victory! Or so I thought. In the last kilometre she gained on me. My reserves were empty. The combination of altitude, a mental fight and over three hours of running left me spent. Through sheer willpower and momentum, I tipped over the finish line, just ahead of my nemesis. After the race, I meekly walked up to fluorescent orange to congratulate her, hoping she hadn’t felt the mental lasso I had tied around her almost the entire race. She returned the compliment. “I kept thinking the whole race that I’ve got to keep up with the girl in the purple shorts,” she said. “You were badass out there.”


12 BEAUTY PROFILE DR DES FERNANDES

Words of wisdom from a day cream believer ...................................................... Catharine Nicol healthpost@scmp.com Dr Des Fernandes, a plastic surgeon from Cape Town, South Africa, has devoted more than 30 years to researching skin. Nearing 70, he shows no signs of slowing down. Fernandes was in Hong Kong recently to showcase his techniques – such as skin needling for collagen stimulation – and raised a few eyebrows with his dismissal of mainstream procedures. He criticises treatments such as microdermabrasion (a mechanical form of exfoliation using a vacuum) and laser resurfacing, which he says damage the skin, and certain peels, which can cause pigmentation, especially in Asian skin. He also says costly face creams are no better than their low-cost counterparts. “People buy expensive creams expecting a better result, but they’re probably getting the same as they’d get from a simple moisturiser.” Fernandes began his career as a surgeon at various hospitals,

Asian skin has higher SPF levels. including the famous heart transplant unit at Groote Schuur Hospital in Cape Town along with Christiaan Barnard, a cardiac surgeon who performed the world’s first human heart transplant in 1967. Fernandes was responsible for the illustrations of the “piggy-back” or “double” heart transplant. In 1975 he returned to plastic surgery and eventually became the

head of the Cleft Lip and Palate Division at the Red Cross War Memorial Children’s Hospital in Cape Town, a post he held until 2000. He entered private practice in 1979. Fernandes’ research into the skin and skin cancer was motivated by the loss of two young melanoma patients in the 1980s. This led to the creation of a skincare line crammed with higher doses of vitamin A than others, which he officially launched as the brand Environ in 1990. “[Vitamin A] is the crucial keystone in keeping up the health of the skin, controlling how cells grow,” he says. “However, it is destroyed by sunlight. In addition, every time a woman menstruates, her levels of vitamin A drop, which means she is more prone to getting skin problems. It is essential to keep up the skin’s vitamin A levels; they will determine how you age.” He explains that one of the biggest differences between Caucasian and Asian skin is their inherent natural sun protection factor (SPF) levels. Fair skin offers

only about SPF 1 protection. Asian skin falls between 2.5 and 4, and is far less susceptible to photo-ageing. But whatever race, he suggests that children from age four upwards should be using vitamin A on their skin, adding that most skin ageing happens before age 20. “If you start in your 40s, you’re about 30 years too late to make a big difference. You can improve but can never make as much collagen as in young skin.”

People get the same from an expensive cream as from a simple moisturiser DR DES FERNANDES

Fernandes’ new range of face creams are said to be more intense than the original formula to fight anti-ageing, and also skin problems such as couperose, rosacea and scarring. Peptides – active protein molecules that tell cells how to react and what to do – have been added to the combination of vitamin A, C and E, resveratrol and beta carotene. He has also developed an antiageing machine that uses iontophoresis (an electric charge) and sonophoresis (low-frequency ultrasound waves) to increase vitamin penetration, and the medical skin-needling tool to reduce scarring, lines and wrinkles. He has performed his needling technique on over 2,000 people, himself included. “Needling is good for every single type of skin,” he says. “We treat patients once a week for six weeks, and you get better for up to a year. We’ve set up a factory under the skin to make more collagen and elastin. It is the first treatment in the world to do that.” Fernandes self-tests all his products.


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