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YOUR GUIDE TO LIVING WELL

HEALTH POST

TUESDAY, JANUARY 29, 2013

ASIA’S CHRONIC TIME BOMB >PAGE 5

FAT BURNER IN A BOTTLE >PAGE 9

Mouse trap How workplace technology plays havoc with your well-being >PAGE 6


2 NEWS HEART DISEASE

HEALTH BITES ......................................................

A potential cure on a plate ...................................................... Jeanette Wang jeanette.wang@scmp.com There is a rare inherited heart condition that affects athletes and has no treatment to stall its progression. But researchers are a step closer to developing therapies for the deadly condition, known as arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). In a paper published on Sunday in Nature, scientists at SanfordBurnham Medical Research Institute and Johns Hopkins University report how they used skin cells from ARVD/C patients to recreate the adult-onset disease in a laboratory dish – the first maturation-based “disease in a dish” model for the condition. Heart muscle cells were generated from ARVD/C patients’ own skin cells using new stem cell-based technology created by 2012 Nobel Prize winner Dr Shinya Yamanaka. However, most of these heart cells were immature, and so were no use for studying the disease or testing new therapeutic drugs. The researchers had to find a way to induce signs of the adult disease in the embryonic-like cells. After nearly a year of trial and error, the scientists finally figured it out: they made the cells’ metabolism more like that found in adult hearts. They applied several cocktails to the model to trigger the shift to adult metabolism, which uses fat rather than sugar for energy production. This led to the discovery that

Patients’ skin cells were used to create the “disease in a dish” model. metabolic malfunction is at the core of ARVD/C disease. The team also tracked down the final piece of the puzzle to make patient-specific heart muscle cells behave like sick ARVD/C hearts: the abnormal over-activation of a protein called PPARg. In the course of developing this “disease in a dish” model, the researchers also presented new potential targets for treating the heart condition. Previously, scientists had attributed ARVD/C to weakened connections between heart muscle cells, which occur only in half of the patients. Dr Vincent Chen Huei-sheng, associate professor at SanfordBurnham, was the senior author of the study. His team was recently awarded a grant from the California Institute for Regenerative Medicine to create additional ARVD/C models to determine whether all patients develop the disease via the same metabolic defects discovered in this study.

ASK THE DOCTORS CHARLES SIOW HUA CHIANG Q: I have read that fasting (or eating very lightly) a couple of days per week can do wonders for one’s health, and for the brain in particular. Is this true? A: There is some research out of the United States that intermittent fasting may be beneficial to brain functions. In particular, this may apply to Parkinson’s disease and Alzheimer’s. However, since the improvement in brain functions has been studied only in rats, one must be careful as it may not extrapolate to the same effect in humans. I believe more research is needed.

Jeanette Wang jeanette.wang@scmp.com

Slim chance of a problem Tall and thin may be desirable for a supermodel, but a new study shows that women with this type of physique are more likely to be infected by a type of bacteria that can cause fatal lung infections. Nontuberculous mycobacteria (NTM), related to the organism that causes tuberculosis, are widespread in water and soil. Evidence suggests that infections have been rising in recent decades. About five to six people per 100,000 develop NTM infections each year; the incidence is higher in people aged over 50. Elderly women accounted for 85 per cent of the patients seen during the study, averaging about 64 years of age. Compared to control subjects, the NTM patients were on average almost 5cm taller, had body mass indices almost two points lower and 2.6kg less fat on their bodies. They more frequently had concave chests, known as pectus excavatum, and scoliosis, or curvature of the spine. They also showed a weakened immune response associated with their fat cells.

Hearty response to Spanish smoking laws Partial smoke-free legislation has had a positive impact on the number of heart disease cases in Girona, a city in northeast Catalonia, Spain. In 2006, Spanish authorities passed a law that regulated the selling and advertising of tobacco. Smoking was also banned in the workplace, and hospitality establishments larger than 100 square metres had to provide a smoke-free area. A study on the law’s effects has found that between 2002 and 2008, the incidence of acute myocardial infarction in Girona dropped 11 per cent, especially among women, those aged between 65 and 74, and among non-smokers. In Spain, around 30 per cent of the adult population state they are smokers; passive exposure to tobacco smoke causes around 2,500 deaths due to coronary heart disease (7 per cent). Since 2011, smoking has been banned in all public places in Spain.

Cloudy with a chance of pain When lightning strikes, so may the migraine. University of Cincinnati researchers, in a study published in the journal Cephalalgia, have found that there was a 31 per cent increased risk of headache and 28 per cent increased risk of migraine for chronic headache sufferers on days lightning struck within 40 kilometres of the study participants’ homes. In addition, new-onset headache and migraine increased by 24 per cent and 23 per cent in participants. After accounting for other weather factors encountered with thunderstorms, the results still showed a 19 per cent increased risk for headaches on lightning days. Dr Vincent Martin, co-study author and a headache expert, says negatively charged lightning currents were particularly associated with a higher chance of headache. “Electromagnetic waves emitted from lightning could trigger headaches,” he says. “In addition, lightning produces increases in air pollutants like ozone and can cause release of fungal spores that might lead to migraine.”

Dr Charles Siow Hua Chiang is a consultant neurologist, headache and pain specialist with Siow Neurology, Headache and Pain Centre at Mount Elizabeth Novena Specialist Centre, Singapore

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

Hungry for a longer life People who eat less could be in better health and have a lower risk of cancer, according to a study by a team from the Spanish National Cancer Research Centre published in the journal PLoS ONE. The experts reduced the caloric intake of three-month-old mice by 40 per cent and observed them until their death. Mice with reduced caloric intake had longer telomeres – the end of chromosomes – as adults. This has a protective effect on DNA and genetic material. These beneficial effects translate to a lower incidence of cancer and other age-related illnesses. When the researchers carried out these same experiments with a variety of mice that produce more telomerase – a protein that lengthens telomeres and protects chromosomes – they observed that these mice not only enjoyed better health but also lived up to 20 per cent longer.


HEALTH 3 GASTRO-OESOPHAGEAL REFLUX DISEASE

Let’s not bring that up again ...................................................... Dr Yim Heng Boon healthpost@scmp.com With the Lunar New Year just around the corner comes another round of festive bingeing and drinking. If you experience indigestion, bloating, a burning sensation in the chest, an acid taste in the mouth, or vomiting, you could be suffering from gastrooesophageal reflux disease, or Gord. The condition affects about one in 10 Hongkongers. Gord develops when the reflux of stomach contents causes troublesome symptoms and/or complications. This happens when the normal anti-reflux mechanisms between the stomach and the oesophagus are not functioning properly or cannot cope with the increased backflow. The backflow of this acid from the stomach to the oesophagus is the cause of the symptoms described above. However, atypical symptoms can also occur, such as a chronic cough, sore throat and hoarseness. The classic reflux symptoms are usually bothersome and may also affect sleep. Studies have shown that Gord can result in a 10 per cent productivity loss at work. Prolonged exposure of the oesophagus to acid may even predispose one to the risk of oesophageal cancer. If you suspect you have Gord, you may want to adopt a healthy diet and lifestyle changes. You should avoid overeating, binge

Prolonged exposure of the oesophagus to acid may even predispose one to the risk of oesophageal cancer

drinking and irregular meal times. Certain foods that you may love, including chocolates, coffee, alcohol and other fatty foods, are known to precipitate reflux symptoms, too. You don’t necessarily have to avoid them entirely, just eat them in moderation. Maintaining a healthy weight is always beneficial and may even improve the reflux symptoms. If symptoms persist or recur

despite all these measures, then it is time to see a doctor. He may prescribe medication or recommend a gastroscopy. This involves inserting a long thin fibre optic tube through your mouth to the stomach. Your throat will be sprayed with a local anaesthetic or you may be lightly sedated for the simple five-minute procedure. The gastroscopy can tell whether your symptoms are due to reflux

disease or to other problems, including peptic ulcers or infection. If the diagnosis is still uncertain, further investigations to monitor and document acid reflux over 24 to 48 hours may be offered. There is no permanent cure for Gord (short of surgery in some cases) as many factors can precipitate or aggravate the reflux symptoms. But adopting a good diet and lifestyle, and avoiding

overeating or bingeing on alcohol will go a long way to preventing or reducing them. So think again before you reach for that extra portion or that next round of drinks. Dr Yim Heng Boon is a senior consultant gastroenterologist at Yim Gastroenterology Liver and Endoscopy Centre at Mount Elizabeth Novena Specialist Centre, Singapore

BOOK REVIEW

How to clean your way to a leaner life ...................................................... Jeanette Wang jeanette.wang@scmp.com If your excuse for inactivity is “I don’t have the time to work out”, Carolyn Barnes empathises. After having a second child and gaining 27 kilograms, she found it hard to juggle gym time, housework and looking after the kids. The turning point came one day about six years ago when her then two-month-old son Jack puked all over her in the kitchen. She threw a dish towel on the floor and used her foot to wipe up the mess while holding Jack in her arms. The swiping leg movements left her feeling a burn in her inner thighs – the same kind of burn she had felt in her legs training as a professional dancer for more than 20 years. She craved more, so she threw a couple

of damp rags on the kitchen floor with some water and soap, and began to use her feet as mops. Her heart raced, sweat flowed, and inspiration struck: she would call this marriage of exercise and housework Taskercise. Fast forward a few months: Barnes is 25kg lighter, has a blog (cleanmomma.com) and DVD based on her exercise routine, huge media interest in her “off-the-wall approach”, and lots of Facebook and YouTube fans. And now, this book: The cLEAN Momma Workout. Barnes, now a certified Pilates instructor and life coach, takes the “workout” to a deeper dimension in the 197-page paperback. She includes not only her exercise routine, but also advice for getting in order your home, diet and your overall life. Interspersed through the

book are “Down and Dirty Tips” – Barnes’ cleaning secrets – such as brightening white linens by adding lemon juice to the wash cycle. There’s a section dedicated to

healthy eating, including a 30-day eating plan with recipes mainly by nutritionist and dietitian Stephanie Lecovin (nutritionhousecalls.com). The good: the recipes are easy and fuss-free. The bad: no photos. Even when there are photos, they’re not in colour – not an attractive read. There are, however, step-by-step photos for each strength and conditioning move, of which Barnes offers 25 to incorporate into your daily schedule. The moves have been given fun names such as “cupboard calf raise”, “detergent bottle dumbbells” and “pillow plump and pump”. Barnes also offers exercise suggestions for cardio, and variations for seniors and children, and also for situations while you’re on the road: waiting in a car park, cruising the supermarket, waiting in line or sitting in a plane. In the final section, Barnes,

who went through a divorce and bankruptcy in 2010, offers advice for cleaning up your life. This involves letting go of clutter in the home and in life, calming your inner chaos and setting priorities. There is really nothing groundbreaking about The cLEAN Momma Workout. Incorporating exercise into daily life has been preached about at length, the healthy recipes she offers are the usual fare, and her motivational tips are self-help staples. But just as a new pair of running shoes can be the kick in the pants you need to get out the door, a new book could be the spark that you seek in your workout regimen. In her next book, Barnes should also consider another problem many Hongkongers face: “I don’t have the time to clean my home.”


4 MEDICAL CASE HISTORY

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It shows up as pain – pain in the lower abdomen before and during menstruation, pain during or following sexual intercourse, pain when moving your bowels, and pelvic or lower back pain during your menstrual cycle. The discomfort may be mild or intense, and it is one of the main symptoms of this condition affecting about 176 million women globally. But a woman can also suffer from this debilitating disorder and not know. Renee Wong (whose name has been changed for reasons of patient confidentiality), 39, only discovered she had endometriosis when she had trouble conceiving. Tests revealed that her fallopian tubes were damaged from an overgrowth of endometrial tissue implants, to such an extent that they had to be removed. “I was shocked to learn that I had endometriosis because I don’t suffer from painful periods or pelvic or lower back pain,” says Wong. “Without fallopian tubes, I cannot conceive naturally; so IVF is my only option if I want to start a family.” Endometriosis is a female medical disorder that occurs when cells from the womb lining grow in other areas of the body, says Dr Seng Shay Way, consultant obstetrician and gynaecologist at Raffles Women’s Centre in Singapore. Every month, a woman’s ovaries produce hormones that tell the cells lining the womb to grow and thicken. The body removes these extra cells from the womb lining (endometrium) when a woman gets her period. However, if these cells – called endometrial cells – implant and grow outside her uterus, endometriosis results. These growths are called endometrial tissue implants. Women with endometriosis typically have tissue implants on their ovaries, bowel, rectum, bladder, and on the lining of the pelvic area. The growths can occur in other areas of the body, too. Unlike the endometrial cells in the uterus, the implants outside the uterus stay in place when a woman gets her period. They sometimes bleed a little and grow during menstruation, causing the pain and other symptoms. But many women like Wong, who do not suffer from painful periods, only discover they have endometriosis when they have difficulty falling pregnant. The condition is typically diagnosed between the ages of 25 and 35. Dr Greg Cario, director of the Sydney Women’s Endosurgery

Illus trati on: A ngel a Ho

Sasha Gonzales healthpost@scmp.com

Troubling tissue Centre, says: “A physical examination may reveal signs of endometriosis. These include the palpation of scar tissue behind the uterus, in the vagina or in the rectum, and the presence of ovarian cysts full of blood. These cysts are formed from endometriosis tissue deep in the ovary and are called chocolate cysts.” He adds that while examination may reveal signs of endometriosis, the only way to tell for sure if you have the condition is by exploratory laparoscopy or keyhole surgery. If the pelvic pain does not respond to simple measures then this examination is mandatory. The cause of endometriosis is not known. One theory, says Seng, is that the endometrial

The rationale for endometriosis is hormonal [oestrogen] exposure DR SENG SHAY WAY, CONSULTANT OBSTETRICIAN AND GYNAECOLOGIST, RAFFLES WOMEN’S CENTRE

cells shed during menstruation travel backwards through the fallopian tubes into the pelvis, where they implant and grow. This is called retrograde menstruation. This backward menstrual flow occurs in many women, but researchers think the immune system may be different in women with endometriosis. Endometriosis is believed to begin around the time a woman has her first menstruation. Seng says a woman is more likely to develop endometriosis if her mother or sister also has it. Her risk is also higher if she has never had children, has frequent periods or periods that last seven or more days; or has a closed hymen, which blocks the flow of menstrual blood during her period.

Starting your period at a young age – for example, before nine – can increase the chances of developing the condition. “The rationale for endometriosis is hormonal [oestrogen] exposure, so if menses begins at a younger age, there is a longer period for hormonal exposure and thus a higher risk for endometriosis,” says Seng. According to Seng, the supposed idea that endometriosis causes infertility is controversial, but there is now more evidence to show that it can impact fertility. Besides the obvious distortion of the pelvic organs, which can impair ovulation, egg pickup and transport along the fallopian tubes, there are other biological and immunological effects that play a crucial role in fertility that have yet to be fully explained and understood. Fortunately, with appropriate treatment, women with endometriosis can still get pregnant. Young women with mild endometriosis can get pregnant with conservative management alone. So it is important to see your doctor early if you suspect you have endometriosis. Unfortunately, the condition is not something that goes away by itself. There is no cure, either, and treatment depends on age, severity of the symptoms and future fertility. Seng points out that hormonal (progesterone) treatments may be prescribed to relieve the symptoms. However, they do not prevent scarring or reverse the physical changes that have already occurred as a result of endometriosis. Hormonal treatments are not recommended for women who want to get pregnant. The best treatment is surgery done by laparoscopy to cut out the abnormal tissue permanently. “It should be done by a doctor who specialises in this type of keyhole surgery, and not a general gynaecologist, because the scar tissue can grow in tricky places,” says Cario. “Although a benign disease, this tissue should be treated like cancer and therefore removed carefully and completely in order to relieve the pain symptoms and improve fertility.” Seng adds that a hysterectomy can be done if the symptoms are severe and you do not want children in the future. One or both ovaries and the fallopian tubes may also be removed. If you have mild symptoms and are not looking to start a family or have more children, it’s a good idea to have examinations every six to 12 months to monitor the progress of the condition. Exercise, meditation techniques and pain medication can help ease the symptoms.


HEALTH 5 CHRONIC DISEASE ...................................................... Jeanette Wang jeanette.wang@scmp.com People are living longer and fewer are dying from infectious disease, but this progress in health is no guarantee of living happily and healthily. In fact, international experts warn to brace ourselves for the next pandemic: chronic diseases – and as a result, disabilities. Two in three deaths worldwide (34.5 million) were from chronic diseases in 2010 – an increase of about eight million between 1990 and 2010, according to the landmark Global Burden of Disease Study 2010 published in The Lancet last month, a collaborative project by nearly 500 scientists from more than 300 institutions in 50 countries. Comparing 2010 and 1990, eight million people died from cancer, a 38 per cent increase; one in four deaths (12.9 million) was from heart disease or stroke, versus one in five; and diabetes killed twice as many people, or 1.3 million. Conversely, one in four deaths was due to communicable diseases and maternal, neonatal, or nutritional causes – down 34 per cent. “The key message of the study is overwhelming: that there’s a huge shift [from infectious diseases] towards chronic disease and disabilities,” says Professor Peter Piot, director of the London School of Hygiene and Tropical Medicine, which released the report findings last month. “In a sense it’s actually good news: it’s the next stage, it’s societal success in a way.” But the advancement that’s led to this success has also brought about a new lifestyle: one of little exercise; a diet of processed food that’s high in bad fats, sugars and salt; and a growing smoking problem. These lifestyle factors are linked to high blood pressure, diabetes, and raised blood lipids – all direct causes and risk factors for chronic disease. In Asia, the trend is even more pronounced, says Piot. “Because of much faster economic growth and societal transition in Asia, I think you also find a much faster change in these patterns.” The study estimates that for the first time, shortly after the year 2015, there will be more people above age 65 than below age five globally. For every year of life expectancy that has been added to the average length of life since 1990, it is estimated that less than 10 months is healthy living and the rest is spent in some degree of disability. This isn’t exactly good news for Hongkongers, who are among the longest living people in the world. In 2011, life expectancy was 80.5 years for males and 86.7 years for females – up from 74.6 years and 80.3 years respectively in 1990. In 2041, life expectancy is projected to increase to 84.4 years for males and 90.8 years for females. “My ambition in life is to live long and die healthy,” says Piot, 63, a Belgian native who co-discovered the Ebola virus in 1976, and led research on HIV/Aids, women’s health and public health in Africa.

Peter Piot says improved standards of living in Asia are creating new health problems through changing lifestyles. Photo: Tom Whipps

Unhappily ever after “It’s not enough to add years to your life, but life to your years.” To do so requires a shift in mindset in society as a whole, he says. This includes reconfiguring and thinking of new ways of health management and dealing with chronic care in the community rather than in the hospital, which Piot says is too expensive. “Unfortunately, in all countries we are concentrating at the end of the problem: that is, when people have diabetes, or a triple bypass, or cancer. That requires enormous amounts of money,” he says. “We need to treat people, but we also need to think now how we can prevent this kind of unfolding disaster. What’s clear is that in every country in the world, health care expenditure is on a train wreck scenario. We can’t continue to increase health care expenditure indefinitely.” A key prevention method is by promoting a healthy lifestyle – healthier diets, tobacco control and a culture of exercise – and Piot says

societies need to be far more aggressive about this, starting from a young age. The food industry can help, too, by self-regulating, says Piot. “They’re bringing more and more healthy products on the market, but that still represents a tiny percentage of their sales. I think we need to convince the food and beverage industry that they need to produce healthy, inexpensive and tasty food – otherwise people won’t eat it.” The societal approach to battling chronic diseases that Piot advocates is based on lessons drawn from his experience dealing with HIV/Aids as the founding executive director of UNAids (the joint United Nations programme on HIV/Aids) and Under-Secretary-General of the UN from 1995 to 2008. “The solution [to HIV/Aids] was not only drugs,” he says, “but also a change in behaviour and societal norms.” Piot cites the introduction of “poignant laws and rules” in New York by Mayor Michael Bloomberg as a prime example.

It’s not enough to add years to your life, but life to your years PROFESSOR PETER PIOT, LONDON SCHOOL OF HYGIENE AND TROPICAL MEDICINE

By March, sugary soft drinks larger than 473ml will be banned from being sold in restaurants, cinemas and food carts in Manhattan. They’ll only be allowed for sale in stores that do not prepare food. In 2007, Bloomberg’s administration also initiated a five-year ban on restaurants using partially hydrogenated vegetable oils and spreads – the main source of trans-fat in the diet. At the end of the day, simply bombarding the public with health promotion messages isn’t going to bring about the

desired effect, says Piot. “I think it’s had very, very little impact,” he says. “It’s not just about messages, but how we deliver the messages. We need to learn from behavioural economics and marketing science.” How many times, for example, have you picked up some candy displayed by the cashier on a whim while checking out at the supermarket? “That’s smart marketing,” says Piot. “We’re often made to buy things we don’t need, or which may even be harmful.” So why not turn it around, perhaps by putting fruit at the checkout instead? In April, Piot will speak at the World Health Summit Regional Meeting in Singapore, and attempt to convince key policymakers in Asia on the urgent need for comprehensive efforts to stem the tide of chronic diseases. “This is not something only for the Minister of Health or for doctors to do,” says Piot. “We need a whole-of-society approach.”


6 COVER STORY

Snap out of it Injuries caused by poor posture and lazy habits while working on computers have become a widespread problem, writes Nadine Bateman

T

echnology: can’t live without it, can’t quite live pain-free with it. In this modern age, this seems to be the norm. According to Dr Grace Szeto, a professor in the department of rehabilitation sciences at Polytechnic University, work-related musculoskeletal symptoms are such a major health issue that extensive global research has been carried out on workers in many occupations, including office workers, bus drivers, cleaners, sewing machine operators and health care professionals. Two recent papers by Cornell University ergonomics professor Alan Hedge concluded that as US health care goes hi-tech, spurred by US$20 billion in federal stimulus incentives, the widespread adoption of electronic medical records and related digital technologies is predicted to reduce errors and lower costs – but it is also likely to significantly boost musculoskeletal injuries among doctors and nurses. The repetitive strain injuries, says Hedge, will stem from poor office layouts and improper use of computer devices. “Many hospitals are investing heavily in new technology with almost no consideration for principles of ergonomics design for computer workplaces. We saw a similar pattern starting in the 1980s when commercial workplaces computerised, and there was an explosion of

musculoskeletal injuries for more than a decade afterward.” In one paper, Hedge asked 179 physicians about the frequency and severity of their musculoskeletal discomfort, computer use in their clinic, knowledge of ergonomics and typing skills. The most commonly reported repetitive strain injuries were neck, shoulder and upper and lower back pain – with a majority of female doctors and more than 40 per cent of male doctors reporting such ailments on at least a weekly basis. About 40 per cent of women and 30 per cent of men reported right wrist injuries at a similar frequency. Szeto’s latest study reveals that Hong Kong surgeons have injuries “due to their static posture in the operating theatre, but part of it is due to their daily work on a computer, as well”. But it’s not only the medical profession that’s suffering, Szeto says. Those most at risk of ergonomic injuries are anybody who works in an office or uses computers. Ergonomics expert Justine Chim, whose company, Chim’s Ergonomics and Safety Limited, has advised employees of many large Hong Kong firms in the past decade, says her team completed 661 individual ergonomics workstation assessments in the past year and that many of those employees complained of musculoskeletal symptoms.

Says Chim: “More than 80 per cent of [those] office computer users reported musculoskeletal symptoms in at least one body region and more than half had received treatment in the past or are currently receiving treatment. Of those 661 office employees, about 75 per cent were required to use a computer for a prolonged period, cumulatively, for at least six hours a day for almost every day at work.” Common problems include neck pain from stiff joints and tight muscles, which can also cause pain down the arms – especially the right arm for those who are right-handed and use a mouse. Other problems faced by computer users are carpal tunnel syndrome, tendonitis and bursitis. The main cause is from maintaining a static posture with a bent neck – excessive neck flexion – for a long time. “You don’t even notice you’re doing it,” says Szeto, who has been studying this problem for more than 10 years and whose research includes the effects of cumulative exposure to IT in people using iPhones and iPads for leisure as well as using computers at work. She says: “The newest problem is the younger generation developing pain in the thumb. They may use a computer in the office, look at their phone on the MTR or bus, then go home and play games – for some people, especially the younger generation, it’s non-stop, almost all

The responsibility lies with employers to keep their employees safe and healthy during working hours JUSTINE CHIM, ERGONOMICS EXPERT


COVER STORY 7

Work this way If you sit behind a desk for hours at a time, you may start to develop niggling aches and pains. Proper office ergonomics can help you stay comfortable at work. Follow this advice from Dr Richard So, general secretary of the Hong Kong Ergonomics Society, to set up your work space. Remember also to take regular breaks from sitting. • Adjust the back of the chair so that you are leaning back only slightly while your upper and lower back are supported. Use inflatable cushions or small pillows if necessary

• Ideally the seat height should also be such that your feet are always touching the ground, and your knees level or slightly lower than the hips. If your feet are dangling, use a foot rest. If the seat is too low, use a cushion

• Centre the monitor directly in front of you above your keyboard. Keep the top of the screen at eye level. Sit at least an arm's length away from the screen

• If you use a fixed-height table, adjust the seat height and the keyboard position so that when you are typing your elbows are at a right angle and wrists are level

• Adjust the armrests so that your shoulders are relaxed. If your armrests are in the way, remove them

• Push your hips as far back as they can go in the chair

Illustration: SCMP

80%

Illustration: Kevin Wong

of office computer workers assessed by an ergonomics expert in HK reported having musculoskeletal symptoms

their waking hours are spent using technology.” There’s even a new term for people on the MTR or on the streets of Hong Kong who can be seen bent over their mobile phones or iPads: the “head down tribe”. “If you have a lot of static tension you can suffer muscle fatigue and [therefore] be prone to injury and pain,” Szeto says. “This kind of static tension is usually concentrated in just one or two muscles especially those which connect the neck to the shoulder. People will often have more tension on the right side. That muscle becomes overloaded and the muscle fibre changes, which contributes to the pain.” Frequent use of the mouse can make one vulnerable to forearm injury, says Szeto, because when a muscle is in a contracted position for a long time, it compresses the blood vessels, cutting off the flow of

SCMP

oxygen. This leads to inflammation of the muscles in the forearm, causing tendonitis or tenosynovitis. Szeto advises regular breaks of at least two to three minutes every hour to avoid injury and to cure or ease pain. Make time for exercise, to strengthen and stretch the muscles of the whole body, and to loosen the tension of static muscles that have stayed in the same position for prolonged periods of time. Dr Richard So, general secretary of the Hong Kong Ergonomics Society, says sitting continuously for hours on end causes numbness, discomfort and spine misalignment. “Studies show that lying down for half an hour, or doing some exercises on the gym ball, will pump the spinal fluid to keep the intervertebral discs even.” Chim says the responsibility lies with employers to keep their employees safe and healthy during working hours. She suggests that there are many employers who are not aware of the legislative requirements that have been put in place to protect prolonged computer users, “even though the regulation has been enacted for about 10 years”. This ignorance or oversight by employers is costing them money, she says, because they are “not calculating the cost of medical insurance, the time taken off work for treatment, lowering employee morale, productivity reduction, sick

leave and absenteeism, increased labour conflict and psychosocial issues which correlate to the prolonged use of computers”. Chim’s company has developed an office ergonomics programme with the objective of providing “a systematic solution to manage the potential risk of musculoskeletal disorders among computer users in an office setting”, which she says can eliminate or minimise the risk of musculoskeletal disorders among computer users but which must be based on an individual assessment by an experienced ergonomist. Szeto’s and So’s advice is to ensure your workstation is set up correctly and to try to relax your muscles when you’re working (see graphic above). “Some people tense their muscles when they are concentrating, they form the habit of using too much force – be aware of this and try to avoid it. Try a light touch,” says Szeto. If you have already developed symptoms of repetitive strain injuries, Szeto says your doctor may prescribe antiinflammation medication or physiotherapy, or you might want to see a chiropractor, osteopath or a Chinese bone setter. Acupuncture is also said to help. “Anything that helps to stretch or release the muscles can help relieve the pain,” she says. “But if you return to the same habits you will never solve the problem.” healthpost@scmp.com


8 DIET HEALTHY GOURMET

Parillero Jaime Blanco at Don Julio in Buenos Aires. Photo: Andrea Oschetti

...................................................... Andrea Oschetti healthpost@scmp.com

An important principle of health is to respect the cultural and emotional connections one has to different foods. Argentina is a meat-lover’s paradise. Argentineans consume an average of 60 kilograms of beef per year; it’s an important part of their identity. Pablo Rivero is the owner of Don Julio, one of the best parrillas, or steak houses, in Buenos Aires. I spent three days with him recently, learning his secrets. Rivero says meat is a family tradition: his grandfather owned a 25-hectare farmhouse along the Parana river with 500 cattle, all grass-fed. What the animals eat and how much space they have are vital for tasty beef. “If you don’t feed the cattle grass, you break the natural chain, which ultimately translates into the flavour and aroma of the meat. It’s like cold-pressing olive oil compared to using industrial methods,” says Rivero. Some cattle are fattened up in large grain feeding operations called feedlots, which decreases costs and allows farmers to produce meat more quickly. Grass-fed cattle are leaner than feedlot, with lower fat content and fewer calories. Meat from grass-fed cattle also has higher levels of conjugated linoleic acid, said to help with long-term weight management and health, and omega-3 fatty acids, which benefit the heart. “Meat is the best protein we have. It is a primal food,” says Rivero. Scientific studies are contradictory about whether eating meat is healthy or not. Those in favour say that meat reduces blood pressure, is high in calcium, vitamin D, protein and vitamin B12, and that the connection between animal protein consumption and cancer has not been established. Many agree that cooking methods have an impact on our health. For example, meat cooked at high temperatures, such as grilling and frying, tends to be linked with a higher risk of cancer. Here’s how to be a healthier carnivore. Choose grass-fed lean cuts. The meat should be brilliant red and fat should be white, not yellow. Look at the muscles: you want an animal that has been walking for 2½ years,

Upper cuts not standing still for eight months. Rivero says the best cut is rump steak, with its low fat and high omega-3 content. Tenderloin, sirloin and T-bone are also lean cuts. Skinless white breast meat is best for poultry. Eat pork sparingly. Store the meat properly. Before storing meat, pack it tightly with cling wrap to protect from bacteria and to avoid loss of water and vitamins. Make sure the temperature is between zero and four degrees Celsius; most domestic fridges are set to six degrees. Place the meat on the bottom shelf to avoid cross-contamination. Eat within three days of purchase; ground beef should be eaten within 24 hours.

Avoid cooking the meat for a long time at a high temperature. Heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) are chemicals – some of which can cause cancer – formed when meat is cooked at a high temperature. I use the sous-vide method: cooking in vacuum-sealed plastic pouches at controlled low temperatures. When I don’t have the sous-vide cooker, I pan-fry the meat in a very hot pan for two minutes per side. I then finish it in the oven at 250 degrees for two to three minutes. Grilling also reduces HCA and PAH exposure. When grilling more than one piece of meat, Rivero suggests cutting them the same size, otherwise they will need different cooking times. The grill must be

If you don’t feed the cattle grass, you break the natural chain, which translates into the flavour and aroma PABLO RIVERO, OWNER OF DON JULIO STEAK HOUSE, BUENOS AIRES

clean, or the flavour changes, and it must be very hot, with no fire underneath, only hot coals. Easy on the salt and sauces. Rivero says using too much salt is a major mistake. At his restaurant, no salt is added to the meat. The same goes for sauces; you need them only when the meat is tasteless. Wine. In moderation, wine is healthy. “God gave us meat and malbec to compensate for our politicians,” says Rivero. “Wine is amazing, meat is amazing, and together they are even more so.” Healthy Gourmet is a weekly column by private chef Andrea Oschetti. cuoreprivatechef.com


DIET 9 THE TASTE TEST DELI MEAT ...................................................... Jeanette Wang jeanette.wang@scmp.com

NUTRITION RASPBERRY KETONES

Berried treasure ...................................................... Gabriella Clarke healthpost@scmp.com

Jamon de Trevelez Ham HK$75 for 120 grams, City’super This all-natural, salt-cured ham is aged for 17 months in the traditional method by the community of Trevelez in southern Spain. Verdict: this is delicately flavoured and relatively lean with only a few streaks of fat.

Daniele Naturale Uncured Salame HK$46.90 for 84 grams, Jasons Minimally processed and made from antibiotic-free pork and all natural ingredients, this black pepper flavoured salami contains no artificial preservatives, artificial colours or flavours. Verdict: good, chewy texture and leaner than other salami, but nonetheless still leaves your mouth coated in a thin film of oil.

Rump steak with vegetables Serves 1 250 grams rump steak 1 tomato 100 grams salad of your choice 1 sprinkle of oregano 1 tsp extra virgin olive oil Salt • Take the meat out of the fridge one hour before cooking it. • Choose one of the three techniques described above; remember to pat dry the meat with a kitchen towel before cooking it. • If you want to pan fry the meat, turn it over every 30 seconds to avoid toxic chemicals from forming, until the meat is ready. • Cut the tomatoes into small cubes. • Mix them with the salad and season with the oregano, oil and salt.

Organic Prairie Roast Chicken Breast HK$53 for 170 grams, Jasons This thin-sliced roast chicken breast comes from birds that have been humanely raised on family farms without antibiotics. Verdict: moist and juicy, with a good meaty texture. Disclaimer: while all these products may be natural and/or organic, they are still forms of processed meat, which research has shown to modestly increase one’s risk of cancer and heart disease. Therefore, consume in moderation.

Could raspberry ketones be magic? Popular television doctor Mehmet Oz certainly thinks so: he proclaimed last year on The Dr Oz Show that the raspberry compound was “the miracle fat burner in a bottle”. Since then, the dietary supplement, which costs an average of US$20 a bottle, has been selling out in health food stores in the US and Britain. Search online and you’ll find many testimonials from happy customers – some even claiming to have seen results in as few as five days. But you’ll also find many doctors warning against putting your money and faith in this latest weight-loss short cut. There have been no major human studies to support the touted fat-burning feats of raspberry ketones. A few studies, however, have been done in vitro and on mice put on a high-fat diet. Japanese researchers reported in 2005 that the compound “prevents and improves obesity and fatty liver” by enhancing the break-up of fat cells. Korean researchers reported in 2010 that raspberry ketone increased fat cells’ secretion of a hormone called adiponectin that regulates the processing of sugars and fats in the blood. Raspberry ketone is the primary aromatic compound of red raspberries. It has been speculated that the compounds increase metabolism generally in a similar way to that of capsaicin found in chilli peppers. Weight management expert Caroline Cederquist, writing in a blog for The Huffington Post, says the chemical structure of the compound shares some similarities with synephrine, which is a stimulant, a quality being looked at continuously for weight loss. The recommended dose is 100mg per day. To get the same benefit from the whole fruit, you’d have to consume 40 kilograms of raspberries. According to the Food and Drug Administration, raspberry ketones are generally recognised as safe for the small quantities involved when used in food additives. There are no known interactions with medications. Although reported side effects are rare, there have been reports that it has caused palpitations and increased heart rate in some individuals. Safety of use during pregnancy and breastfeeding has not been established. “Additionally, raspberry ketones can have a negative interaction with the blood thinner Coumadin, which people take for heart or clotting conditions. Most importantly, however, no reliable clinical research has evaluated this

No reliable clinical research has evaluated this supplement for safety or adverse reactions CAROLINE CEDERQUIST, WEIGHT MANAGEMENT EXPERT

supplement for safety or adverse reactions,” says Cederquist. Raspberry ketones are also used in the cosmetics and perfume industries, and as a flavour additive in foods. It is one of the most expensive natural flavourings in the food industry, reportedly costing as much as US$20,000 per kilogram. There are claims that raspberry ketones may be useful in treating certain types of alopecia or hair loss. In a randomised controlled clinical study in the US, topical cream

containing raspberry ketones was applied to the skin and scalp in both mice and humans. Researchers found that the cream increased an insulin growth factor known as IGF-1 in the hair follicles and a promotion of hair growth in mice after four weeks of application. In human subjects, half experienced hair growth after five months. Studies carried out at Nagoya University in Japan indicated that topical use of raspberry ketones stimulated the release of dermal growth factors resulting in increased elasticity of the skin, helping the skin to remain youthful. Are raspberry ketones for you? If you trust Oz – a former cardiothoracic surgeon who found fame on The Oprah Winfrey Show – and the testimonials, then you may be compelled to give the supplement a shot. But remember: there is no miracle pill for maintaining weight loss; rather it is the combination of a healthy diet and exercise plan that brings results.


10 FITNESS MARATHON MANIA WEEK 9 ...................................................... Rachel Jacqueline healthpost@scmp.com You could eat as much as you wanted before a marathon, but for such a long race, it’s almost inevitable that you’ll still run out of energy – what runners call “hitting the wall” – if you only rely on the body’s natural stores. “You will manage a dawdle or slow jog at best,” says Dr Duncan MacFarlane, sports physiologist at University of Hong Kong’s Institute of Human Performance. This is because the body only stores enough energy for up to two hours of medium intensity exercise. Carbohydrates are the body’s main energy source. Carbs may be complex (such as legumes, grains and starchy vegetables) or simple (such as fruits and foods made with sugar). During digestion, the body converts carbs into sugars, which enter individual cells to provide energy. Sugar is stored in the liver and muscles as glycogen – your main energy source for a marathon. To stay energised, MacFarlane recommends refuelling on the run. “One decent bite of a sports bar every 30 minutes, several mouthfuls of a banana, or an energy gel pack every hour with water will help.” Research shows you can also guard against the mid-race bonk by carbo-loading in the days leading up to a marathon. A study by Liverpool John Moores University published in the International Journal of Sports Medicine in 2011 got 257 male and female runners at the 2009 London Marathon to keep a detailed food and training diary, which the researchers compared with the runners’ finishing times. Each runner’s pace was also tracked every five kilometres throughout the race. It was found that competitors who had consumed carbs the day before the race at a quantity of more than seven grams per kilogram of body mass had significantly faster overall race speeds and maintained their running speed during the race longer than those who consumed fewer carbs. The difference was especially striking beginning at about the 29-kilometre mark, just when many runners famously “hit the wall”. The key to race nutrition is finding out what works for you – and this can be done during training, says MacFarlane. Here are more tips on how to get the most out of your nutrition before, during, and after a marathon. Pre-race The target window for increasing your glycogen storage is two to three days before your race, says MacFarlane. During that time, increase your carbohydrate intake and decrease your training, or it will diminish your stores and counteract all that eating. As a guideline, dietitian Sylvia Lam from Pro Cardio recommends taking in between seven to 10 grams of carbohydrates per kg of body weight and making carbohydrates around 75 per cent of your diet. Vary your carbohydrate sources to

Banking on the carbs

morning of a race as it may lead to stomach issues as you run. MacFarlane says a bland carbohydrate breakfast, such as toast, is best at least 90 minutes before the start of the race. Finally, MacFarlane suggests a sugar hit just before the race, such as a handful of jellies combined with a sports drink. During the race What you choose on race day depends on your preference, but pick something easy to carry and easy to digest, such as energy gels. Aim to eat something every 30 minutes to one hour. During a marathon, favour sports drinks over water or soft drinks, MacFarlane says. “A high-quality commercial sports drink that has about 5 to 6 per cent carbs in it, with some electrolytes, which include sodium and potassium, is ideal, as this provides a small amount of carbs to keep your energy going, plus enough water to keep you hydrated.” While factors such as temperature, humidity, running speed and sweat rate will affect how often you should drink, as a guide, you should try to drink around 400ml to 800ml per hour. Post-race Once you cross the finish line, the recovery begins. “After a race, replenish with carbs for energy and protein for muscle repair,” says Lam. Thirty minutes after the race is crucial for repair. Your body is already producing enzymes enabling the body to repair itself, so additional protein helps to speed up the process.

include potato, rice and other grains to avoid bloating. MacFarlane suggests avoiding anything new or unusual during this time to keep things easy on the stomach. Steer clear of foods with high fibre content, such as broccoli, cauliflower or beans, as they tend to promote intestinal gas. “Avoid spicy foods, like curries, as they can irritate the gut,” he says. Lastly, go easy on meat the few days before a race. “Eating excessive protein before a race will not benefit your performance,” he says. “It will not be used for energy production during the race, so it’s better to focus on storing carbohydrates.” A 60kg person, for example, will need about 420 to 600 grams of carbohydrates per day leading up to the marathon, says Lam. Fifty grams of carbs is equal to about one bowl of rice, two slices of bread, one

Eating excessive protein before a race will not benefit your performance DR DUNCAN MACFARLANE, HKU SPORTS PHYSIOLOGIST

medium potato, 1.5 bowls of cooked pasta or 1.3 bowls of cereal. “So one might need to eat the equivalent of around eight to 10 bowls of rice,” she says. Try sports drinks and juices to supplement your carb intake. Race morning Resist the urge to pig out on the

A traditional remedy Traditional Chinese medicine (TCM) remedies may help to reinforce a runner’s physical well-being in preparation for a marathon, says registered TCM practitioner and chairwoman of the University of Hong Kong Bachelor of Chinese Medicine Alumni Association, Doris Mok Hang-yan. “It is important to keep a balance of yin-yang in the body,” she says. “Over-sweating may lead to a qi deficiency and yin deficiency.” Mok suggests making a tea with the following ingredients, which will help to tonify the qi and yin as well as quench thirst. • 500ml-1,000ml water • 6 grams sliced ginseng or American ginseng. This depends on your body type, so consult your TCM practitioner to determine what is right for you. • 6-20 grams Radix ophiopogonis (dwarf lilyturf root) • 6 grams Fructus schisandrae Chinensis (fruit of the Chinese magnolia vine) Bring water to boil. Add all the ingredients and boil for 20 minutes. Marathon Mania is a 12-week series leading up to the Hong Kong Marathon on February 24. For more preparation tips, go to facebook.com/hkmarathon or marathon.hku.hk


WELL-BEING 11 FIT & FAB

A better balanced life ...................................................... Rachel Jacqueline healthpost@scmp.com Towering above her peers, Allison Haworth West was a naturally gifted athlete who spent her childhood collecting medals in every sport imaginable. But a severe back injury cut short her dreams when she was told she would never play sport again. Two decades later, the 44-yearold from Australia is back skiing, and is taking up tennis lessons and contemplating golf. Her secret? Stand-up paddling (SUP). “SUP has done so much for me, physically, building up my core and putting a lot more structural integrity in my body,” she says. Her new sports passion almost didn’t happen – twice. She immediately dismissed it as a celebrity craze when discovering it in a “trashy gossip magazine” several years ago. “I thought it looked boring,” she says. When she finally decided to try the sport, she never made it to the water, as she injured her back picking up the oversized board. Thankfully, curiosity got the better of her and, after recovering, she tried again. Since those first reluctant strokes 18 months ago, she hasn’t stopped. She paddles several mornings a week in the south of Hong Kong Island. “Now, I love it,” she says. “Being a windsurfer, I really like that feeling of being out on the water; and being a skier, I like the sensation of gliding. Being a boating person, I understand the sea. So SUP brings together all those different things.” Haworth West’s working life is as varied as her sporting interests. She runs her family business, Captain Cook Cruises, in Fiji; has her own children’s clothing company, Kuki Kids; and is a Hong Kong representative for Canadian Mountain Holidays (CMH) Heli-skiing. Like most working mums, her biggest challenge is fitting it all in. “I try to have a good balance, but my kids are the most important thing and provide the pivot point around which everything else operates,” she says. Back in form and with a revived lust for sport, she says her latest struggle is moderating her aspirations. “It’s hard, as by nature I want to do as much as possible of everything.” What’s one thing people don’t know about you? I got in early before extreme skiing really got big; but I was the first ever New South Wales, Australia female extreme skiing champion in 1992 and the Telemark champion in the same year.

My nature is to want to do as much as possible of everything

What’s one sport you’ve still yet to master? Golf. I started playing as a child and then got back into it as an adult. Because I learned it at such a young age, the swing was very natural to me; but just when I decided to get into it, I did my back in. Now I’m stronger, it’s next on my list. You’ve had a successful professional career and a full sporting career. Do you think you’ve just been lucky or have you created your own path? I think it’s a bit of both. You could say I’ve been unlucky in some ways, as I’ve had so many injuries. I think it’s more about making your own life. When my back went and my life changed, I didn’t sit around and whinge about it. I said: “What’s the next thing I’m going to do?” And for me that was going to yoga every Saturday morning and barely being able to lift my head off the ground lying on my stomach. I didn’t get frustrated. It is what it is and I tried to make the most of it. What are your most memorable sporting moments? Jumping out of a helicopter at the top of the Canadian mountains and heli-skiing. Standing there as the chopper took off and being left in silence among all this snow in the mountains was incredible. And a ski run I did last year in Niseko, Japan, where there was so much snow I could barely see. That feeling of weightlessness as I bounced around through powder, snow-filled gullies. For someone who was told they would never be able to ski again, it was pretty amazing. With such a sporting pedigree, what’s your hope for your children? I grew up with my mother telling me to try and do my best at everything, but to not do anything to excess. She was very wise and seemed to know my temperament, and tried to protect me from hurting myself. It didn’t work, but it left a mark for sure. I feel the same way for my kids: I want them to try their best and enjoy sport. Whatever it is that they like, I want them to do it. My daughter is fanatical about karate right now, which is surprising, but I’m very happy for her.

Stand-up paddle boarder Allison Haworth West in Deep Water Bay. Photo: Paul Yeung

Do you think you could have achieved more sporting success as a child if you had been given the opportunity? As a girl I dreamed of winning a gold medal at track and field. I like doing things well and learning how things work. I’m a perfectionist. But there wasn’t any training. I’ve often reflected on what could have been, but at the end of the day I don’t think I had the body. Instead, I think I’ve led a richer life and had more experiences, with some sprinkling of sport along the way.


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JANUARY 29, 2013 SOUTH CHINA MORNING POST


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